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Objective To retrospectively analyze the clinical characteristics of patients with Cushing's syndrome (CS) complicated with perioperative pulmonary embolism (PE). Methods Depending on Chinese Pituitary Disease Registry Network (CPDRN) and Pituitary Tumor Database in Peking Union Medical College Hospital, 20 patients with CS complicated perioperative PE were collected from January 1, 2013 to September 30, 2020, and the clinical manifestations and laboratory examination data of the patients were investigated. The clinical characteristics were compared between ectopic adrenocorticotropic hormone syndrome (EAS) and CS with PE during the perioperative period. In addition, clinical characteristics were also studied in these patients before and after the operation. Results According to etiology, they were divided into CS (7 cases), EAS (9 cases) and adrenal adenoma (4 cases). The course of CS was longer than EAS (t = ⁃ 2.938, P = 0.011). According to the occurrence time of PE, the patients were divided into preoperative PE (13 cases) and postoperative PE (7 cases). The patients with postoperative PE had a lower body mass index (t = 2.427, P = 0.026) and a higher fibrinogen (t = ⁃ 2.162, P = 0.047). The patients with PE before surgery included 5 cases of CS, 5 cases of EAS, and 3 cases of adrenal adenomas, while those who with PE after surgery included 2 cases of CS, 4 cases of EAS, and one case of adrenal adenoma. Among the 7 patients with PE after surgery, 5 cases did not get remission. Compared with preoperative examination, the erythrocyte count (t = ⁃ 2.032, P = 0.042) and hemoglobin (t = 9.807, P = 0.001) were decreased after operation, the prothrombin time (t = ⁃ 2.847, P = 0.047) and international normalized ratio (t = ⁃ 3.059, P = 0.038) were increased after operation. Conclusions Longer course of disease and no remission hypercortisolemia after surgery may be the risk factors for perioperative PE in CS patients. Patients with elevated fibrinogen before surgery and reduced red blood cell count and hemoglobin after surgery should be alert to the risk of PE. doi：10.3969/j.issn.1672⁃6731.2021.03.009

Objective To summarize the clinical features of adrenocorticotropic hormone (ACTH)⁃dependent Cushing's syndrome (CS) with multiple endocrine neoplasia (MEN). Methods Based on the pituitary tumor database of Peking Union Medical College Hospital of China Pituitary Disease Register Network (CPDRN), 18 patients with ACTH ⁃ dependent CS complicated with MEN from January 1984 to September 2020 were collected. The clinical manifestations, involved other endocrine glands, laboratorial and imageological examinations were analyzed. Results Among 18 patients, 13 cases were Cushing's disease and 5 cases were ectopic ACTH syndrome (EAS); 15 cases were MEN1 type, 2 cases were MEN2 type and one case was MEN4 type. The clinical manifestations were subclinical CS in 6 cases and overt CS in 12 cases. All cases had osteopenia or osteoporosis. Urolithiasis accounted for 11/18 cases. Regarding the involved endocrine glands, pituitary ACTH adenoma accounted for 13/18 cases, prolactinoma accounted for 4/18 cases, hyperparathyroidism accounted for 15/18 cases, pancreatic neuroendocrine tumors accounted for 13/18 cases and adrenal adenomas and hyperplasia accounted for 10/18 cases. Laboratorial examinations showed the average morning serum cortisol was (652.90 ± 254.90) nmol/L, the morning ACTH was (13.38 ± 8.73) pmol/L and the 24 h urinary free cortisol was 446.35 (233.08, 531.10) µg. Serum prolactin was elevated in 2 cases, parathyroid hormone was elevated in 13 cases and serum calcium was elevated in 11 cases. In imageological examinations, there were pituitary microadenoma in 12 cases, pituitary macroadenoma in 3 cases, adrenal adenoma in 8 cases, thickened adrenal in 4 cases, adrenal pheochromocytoma in 2 cases, and paraganglioma in one case. Genetic test showed 3 cases had MEN1 gene mutation including c.1183C ＞ T, c.1579C ＞ T and c.1174G ＞ T. Conclusions ACTH⁃dependent CS with MEN is a rare disease with complex manifestations. The most common symptom is osteopenia/osteoporosis. The most common cause of CS is pituitary microadenoma. MEN1 is the most common MEN type, and primary hyperparathyroidism is the most common type of affected endocrine glands, followed by pancreatic neuroendocrine tumors. doi：10.3969/j.issn.1672⁃6731.2021.03.008

To compare the blood lipid profile among post-operative craniopharyngioma children and adolescents with that among healthy controls and to reveal the effects of rhGH replacement.Methods: Data of 79 post-operative craniopharyngioma children and adolescents in our center were retrospectively collected. Sixty patients underwent rhGH replacement during the follow-ups. We selected 36 patients who received rhGH replacement therapy, while 20 patients received rhGH replacement for at least 1 year and had complete lipid data before and after treatment and compared them with 19 patients who did not receive rhGH replacement therapy.Results: Craniopharyngioma patients had higher total cholesterol (TC) (5.17 vs 3.77 mmol/L), triglyceride (TG) (1.51 vs 0.73 mmol/L), and low-density lipoprotein cholesterol (LDL-C) (3.14 vs 2.10 mmol/L), and lower high-density lipoprotein cholesterol (HDL-C) (1.06 vs 1.39 mmol/L) than controls (all p < 0.001). The lipid profile of obese and non-obese patients was not significantly different. After rhGH replacement, TC was 0.90 mmol/L lower (p = 0.002) and LDL-C was 0.73 mmol/L lower (p = 0.010) than baseline. Although the baseline LDL-C was higher, patients with rhGH replacement had lower LDL-C (− 0.73 mmol/L adjusted for age and sex, p = 0.045) after the initiation of replacement compared with patients without rhGH replacement.Conclusion: The lipid profile of obese and non-obese children and adolescents with craniopharyngioma was unfavorable, and rhGH replacement could improve their lipid profile. [ABSTRACT FROM AUTHOR]

Android is a growing target for malicious software (malware) because of its popularity and functionality. Malware poses a serious threat to users’ privacy, money, equipment and file integrity. A series of data-driven malware detection methods were proposed. However, there exist two key challenges for these methods: (1) how to learn effective feature representation from raw data; (2) how to reduce the dependence on the prior knowledge or human labors in feature learning. Inspired by the success of deep learning methods in the feature representation learning community, we propose a malware detection framework which starts with learning rich-features by a novel unsupervised feature learning algorithm Merged Sparse Auto-Encoder (MSAE). In order to extract more compact and discriminative feature from the rich-features to further boost the malware detection capability, a hybrid deep network learning algorithm Stacked Hybrid Learning MSAE and SDAE (SHLMD) is established by further incorporating a classical deep learning method Stacked Denoising Auto-encoders (SDAE). After that, we feed the feature learned by MSAE and SHLMD respectively to classification algorithms, e.g., Support Vector Machine (SVM) or K-NearestNeighbor (KNN), to train a malware detection model. Evaluation results on two real-world datasets demonstrate that SHLMD achieves 94.46 and 90.57 percent accuracy respectively, which outperforms the classical unsupervised feature representation learning Sparse Auto-encoder (SAE). MSAE performs similarly to SAE. SHLMD can further improve the performance of MSAE and the supervised fine-tuned method SDAE. Besides, we compare the performance of our methods with that of state-of-the-art detection approaches, including classical deep-learning-based methods. Extensive experiments show that our proposed methods are effective enough to detect Android malware. [ABSTRACT FROM AUTHOR]

Objectives. To analyze and summarize the effect of SSA treatment on EAS due to p-NETs (EAS-p-NETs). Methods. Thirteen patients with EAS-p-NETs treated with SSAs at our center or described in the literature were included in this study. Clinical characteristics, laboratory data, imaging studies, histopathologic results, the effect of SSA treatment, and the prognosis of these EAS-p-NET patients were evaluated. Results. Four males and 9 females with an average age of 42.9 years were included in the study. The mean duration of follow-up was 38.8 ± 28.2 months. As one of the combined treatment measures, SSAs controlled the levels of ACTH and cortisol in 9 of the 13 patients (69.2%). Partial response was observed in 3 patients (23.1%), stable disease in 2 patients (15.4%), and progressive disease in 6 patients (46.2%). The median time to tumor progression was 24 months, and the median overall survival was 61 months. The side effects of SSA treatment included temporary mild abdominal pain, diarrhea, gallstones, and cholecystitis. Conclusions. As a supplemental therapy, SSA treatment led to clinical and biochemical improvement with a good safety profile in patients exhibiting EAS-p-NET with metastasis. However, tumor progression was inhibited by SSA treatment in only a few patients. Combined with other treatments, SSAs may improve the prognosis of patients with EAS-p-NETs. [ABSTRACT FROM AUTHOR]

Objective: Ectopic adrenocorticotropic hormone (ACTH) syndrome (EAS) is a condition of hypercortisolism caused by non-pituitary tumors secreting ACTH. Appendiceal neuroendocrine tumor as a rare cause of ectopic ACTH syndrome was reported scarcely. We aimed to report a patient diagnosed with EAS caused by an appendiceal neuroendocrine tumor and summarized characteristics of these similar cases reported before. Case Report and Literature Review: We reported a case with Cushing's syndrome who was misdiagnosed as pituitary ACTH adenoma at first and accepted sella exploration. Serum and urinary cortisol decreased, and symptoms were relieved in the following 4 months after surgery but recurred 6 months after surgery. The abnormal rhythm of plasma cortisol and ACTH presented periodic secretion and seemingly rose significantly after food intake. EAS was diagnosed according to inferior petrosal sinus sampling (IPSS). Appendiceal mass was identified by 68Ga-DOTA-Tyr3-octreotate (DOTATATE)-PET-CT and removed. The pathological result was consistent with appendiceal neuroendocrine tumor with ACTH (+). The literature review demonstrated 7 cases diagnosed with EAS caused by appendiceal neuroendocrine tumor with similarities and differences. Conclusion: The diagnosis of an ectopic ACTH-producing tumor caused by the appendiceal neuroendocrine tumor can be a challenging procedure. Periodic ACTH and cortisol secretion may lead to missed diagnosis and misdiagnosis. IPSS is crucial in the diagnosis of EAS and 68Ga-DOTATATE-PET-CT plays an important role in the identification of lesions. [ABSTRACT FROM AUTHOR]

Background and Aims: Neurotensin (NT) is a gut hormone with broad effects on the cardiovascular system. Recent data suggested that circulating proneurotensin (pro-NT)-the stable precursor fragment of NT-could independently predict cardiovascular artery disease (CAD) development. However, serum pro-NT levels in patients with premature cardiovascular artery disease (PCAD) are still unknown. This study aims to determine serum pro-NT levels in patients with PCAD and investigate its relationship with PCAD risk.Methods and Results: A total of 490 subjects, including 364 with PCAD and 126 without PCAD (NPCAD), and 182 controls were enrolled in the study. Data of baseline clinical parameters and biochemical variables were collected. Serum pro-NT levels were measured by ELISA. Serum pro-NT levels were higher in patients with PCAD than in controls (59.42 ± 66.66 vs. 38.07 ± 48.48 pg/mL, P < 0.05), especially in patients with BMI<25 kg/m2. Serum pro-NT levels were independently related to PCAD (β = 0.349, P < 0.001), and the association revealed a U-shaped curve characteristic between pro-NT tertiles and CAD risk in patients with premature CAD and controls. Subjects with low and high tertiles of pro-NT levels had 1.79-fold and 2.23-fold higher risks of PCAD, respectively, than subjects with median pro-NT levels (P < 0.05). After adjusting for age, gender, and BMI in Model 1 and other confounders in Model 2 and Model 3, the U-shaped relationship remained significant.Conclusion: Serum pro-NT levels were significantly increased in patients with PCAD. The association between pro-NT levels and PCAD risk presents a U-shaped curve characteristic, which demonstrated that subjects with lower and higher pro-NT levels both were more likely to have PCAD. [ABSTRACT FROM AUTHOR]

Background and Aims. Owing to its unique anatomical structure and metabolism, epicardial adipose tissue (EAT) has attracted amount of attention in coronary artery disease (CAD) research. Here, we analyzed differences in proteome composition in epicardial (EAT) and subcutaneous adipose tissues (SAT) from patients with or without CAD. Methods. EAT and SAT samples were collected from 6 CAD patients and 6 non-CAD patients. Isobaric Tagging for Relative and Absolute Quantitation (iTRAQ) analysis combined with liquid chromatography tandem-mass spectrometry (LC-MS/MS) was performed to identify the differentially expressed proteins. Results. In total, 2348 proteins expressed in EAT and 2347 proteins expressed in SAT were separately identified. 385 differentially expressed proteins were found in EAT and 210 proteins were found in SAT in CAD patients compared to non-CAD patients. Many proteins differentially expressed in EAT of CAD patients were involved in biological functions associated with CAD development such as cell-to-cell signaling and interaction, inflammatory response, and lipid metabolism. Differential expressions of proteins (MMP9, S100A9, and clusterin) in EAT or SAT were involved in several signaling pathways such as mitochondrial dysfunction, acute phase inflammation, and LXR/RXR activation, which was confirmed by western blotting, and similar results were obtained. Conclusions. The largest profiles of differentially expressed proteins in EAT and SAT between CAD patients and non-CAD patients were identified. The significant signal pathways, mitochondrial dysfunction, and LXR/RXR activation, which differential proteins were involved in, were firstly found to play roles in EAT of CAD patients, and clusterin was firstly found to be upregulated in EAT of CAD patients. [ABSTRACT FROM AUTHOR]

Objective To investigate the prevalence and possible factors influencing metabolic syndrome in people from Guizhou Province and to explore the predictive value of the fat-to-muscle ratio in diagnosing metabolic syndrome. Methods A multistage stratified sampling method was used in this cross-sectional study of 20–80 years old Han and Bouyei populations from Guizhou Province, southwestern China, from October-December 2012. The study included 4,553 cases of metabolic syndrome, that was defined according to 2005 International Diabetes Federation criteria. The receiver operating characteristic curve was used for determining the sensitivity, specificity, and predictive ability of the fat-to-muscle ratio for the diagnosis of metabolic syndrome. Results The age-standardized prevalence of metabolic syndrome was 11.38% (men: 9.76%; women: 12.72%) for Han and 4.78% (men: 4.43%; women: 5.30%) for Bouyei populations. In Guizhou Province, the cut-off value for the men fat-to-muscle ratio was 0.34, the area under the curve was 0.95, and the sensitivity and specificity were 0.94 and 0.85, respectively. The cut-off value for the women fat-to-muscle ratio was 0.55, the area under the curve was 0.91, and the sensitivity and specificity were 0.93 and 0.79, respectively. Conclusion The fat-to-muscle ratio is highly predictive of metabolic syndrome in Guizhou Province, and a useful reference indicator. [ABSTRACT FROM AUTHOR]

In data integration, entity resolution is an important technique to improve data quality. Existing researches typically assume that the target dataset only contain string-type data and use single similarity metric. For larger high-dimensional dataset, redundant information needs to be verified using traditional blocking or windowing techniques. In this work, we propose a novel ER-resolving method using a hybrid approach, including type-based multiblocks, varying window size, and more flexible similarity metrics. In our new ER workflow, we reduce the searching space for entity pairs by the constraint of redundant attributes and matching likelihood. We develop a reference implementation of our proposed approach and validate its performance using real-life dataset from one Internet of Things project. We evaluate the data processing system using five standard metrics including effectiveness, efficiency, accuracy, recall, and precision. Experimental results indicate that the proposed approach could be a promising alternative for entity resolution and could be feasibly applied in real-world data cleaning for large datasets. [ABSTRACT FROM AUTHOR]

The Android platform is becoming increasingly popular and various organizations have developed a variety of applications (App) to cater to market trends. Due to the characteristics of the Android platform, such as supporting the unofficial App stores, open source policy and the great tolerance for App verification, it is inevitable that it faces serious problems of malicious software intrusion. In order to protect the users from the serious damages caused by Android malware, we propose a low-cost and high-efficient method to extract permissions, sensitive APIs, monitoring system events and permission-rate as key features, and employ the ensemble Rotation Forest (RF) to construct a model to detect whether an Android App is malicious or not. Specifically, a dataset containing 2,130 samples is used to verify the performance of the proposed method. The experimental results show that the proposed method achieves an high accuracy of 88.26% with 88.40% sensitivity at the precision of 88.16%. To further evaluate the performance of the proposed model, we also compare it with the state-of-the-art Support Vector Machine (SVM) model under the same experimental conditions, and the comparison results demonstrate that the proposed method improves the accuracy by 3.33% compared to SVM. The experimental results show that the proposed model is extremely promising and could provide a cost-effective alternative for Android malware detection. [ABSTRACT FROM AUTHOR]

The aim of the study is to investigate the changes of serum leptin and kisspeptin levels in children and adolescents with different pubertal stages and nutritional states. A total of 647 Chinese children and adolescents were recruited, and serum estradiol, testosterone, pituitary gonadotropins, leptin, and kisspeptin levels were measured. The results showed that serum leptin levels of boys in T2 stage were the highest among the five stages, while they showed a gradual increase from T1 to T5 stage in girls and reached the highest in T5 stage (P<0.05). Conversely, serum kisspeptin levels of boys were higher in T4 and T5 stages than those in T1 stage, while its levels of girls were the highest in T2 stage, 21.4% higher than those in T1 stage (P<0.05). Both leptin and kisspeptin levels were positively correlated with BMI, WC, and weight in all boys and girls (all P<0.05). In conclusion, kisspeptin levels were firstly found to be notably changed in pubertal stages and nutritional status in Chinese children and adolescents with a significant sexual dimorphism. Obese/overweight girls had higher kisspeptin levels, and there was a positive correlation between kisspeptin and FSH and LH and obesity-related parameters in all boys and girls. [ABSTRACT FROM AUTHOR]

Currently, studies on the association between per-/polyfluoroalkyl substances (PFAS) concentrations and the renal function of residents, especially teenagers, living near fluorochemical industrial plants, are relatively rare, and not all these studies suggested associations. In this cross-sectional study, 775 local teenagers (11–15 years old) were included, and serum concentrations of 18 PFAS were measured. Perfluorooctanoic acid (PFOA) was found to be the dominant PFAS with a concentration of 22.3–3310 ng/mL (mean = 191 ng/mL), accounting for 71.5–99.1% of ΣPFAS. Statistical analyses demonstrated that internal exposure of perfluoroalkyl carboxylic acids (PFCA, C8–C10) was related to the plant. In addition, the prevalence rate of chronic kidney disease (CKD) (35.0%) in the participants was relatively high. A significantly positive association was observed between the increase in PFOA concentration and increasing risk of CKD (OR = 1.741; 95% CI: 1.004, 3.088; p = 0.048) by adjusting for gender, age, body mass index (BMI), and household income. Similar positive correlation was also observed in PFHpA with CKD (OR = 1.628, 95% CI: 1.031, 2.572; p = 0.037). However, no significant correlation was observed for concentrations of other PFAS and CKD (p > 0.05). Furthermore, linear regression analyses demonstrated that none of the PFAS concentrations were significantly correlated with estimated glomerular filtration rate (eGFR) or urine albumin/urine creatinine ratio (ACR) (p > 0.05). However, a significantly negative correlation was observed between PFOA concentration and abnormal ACR (β = −0.141, 95% CI: −0.283, 0.001; p = 0.048) after stratifying by CKD. Sensitivity analyses further confirmed these results. This cross-sectional study is the first, to our knowledge, to investigate the association between PFAS concentrations and renal function in teenagers living near a Chinese industrial plant. Further prospective and metabonomic studies are needed to interpret the results and clarify the biological mechanisms underlying this association. [Display omitted] • Extremely high PFOA exposure in local teenagers was related to an industrial plant. • The prevalence rate of CKD (35.0%) in the participants was relatively high. • A significantly negative correlation was observed between PFOA and abnormal ACR. • Serum PFOA concentrations were significantly associated with a higher risk of CKD. [ABSTRACT FROM AUTHOR]

Abstract: Background: Safflor yellow A (SY) has been demonstrated to be beneficial to cardiovascular system. Our previous study showed that hydroxysafflor yellow A (HSYA), a main component of SY, could increase peroxisome proliferator-activated receptor γ mRNA expression. In this study, we investigate the effect of HSYA on the proliferation and adipogenesis of mouse 3T3-L1 preadipocytes. Methods: The proliferation and adipogenesis of 3T3-L1 cells treated with HSYA was studied by 3-(4,5-dimethylthiazol-2-yl) 2,5-diphenyl tetrazolium bromide (MTT) spectrophotometry, Oil Red O staining and intracellular triglyceride assay methods. HSL mRNA expression and promoter activity were studied by real-time quantitative RT-PCR, transient transfection and dual luciferase reporter gene methods. Results: HSYA (0.1mg/L) significantly inhibited the proliferation of 3T3-L1 cells when compared with control cells in 8h. This effect was further enhanced with the extension time (24 to 96h) and an increase of concentration of HSYA (1–10mg/L). The maximal inhibitory action was observed at 0.1mg/L HSYA in 72h (86±11.8% vs. 100±4.1%, p<0.01). HSYA notably reduced the amount of intracellular lipid and triglyceride content in adipocytes to 85% (1mg/L) and 75% (100mg/L) on Day 4 following the differentiation, respectively, while increased HSL mRNA expression and promoter activities to 2.7 fold and 1.55 fold, respectively (p<0.01), in differentiated 3T3-L1 adipocytes. Conclusions: HSYA inhibits the proliferation and adipogenesis of 3T3-L1 preadipocytes. The inhibitory action of HYSA on adipogenesis may be due to the promotion of lipolytic-specific enzyme HSL expression by increasing HSL promoter activity. [Copyright &y& Elsevier]

Abstract: Objective: Zinc-α2-glycoprotein (ZAG) has been identified recently as a novel adipokine due to its close link with lipid and glucose metabolism, as well as regulation of body weight. The aim of our present study is to investigate the ZAG genetic polymorphism association with obesity in Chinese north Han population. Design and methods: Five SNPs of ZAG gene including rs2247607 (A>T), rs4727442 (G>T), rs4215 (A>G), rs2527923 (C>T) and rs2527882 (C>T) were genotyped in 648 overweight/obese patients and 313 healthy controls by TaqMan-PCR methods. Crosstabs statistical analysis method with subjects stratifying by age (≦30y, 31–45y, ≧46y) and gender was used. Results: The results showed the constitution of three genotype frequencies in rs4215 (A>G) site significantly differs in male subgroup (aged 31–45y) between overweight/obese and healthy control group (χ 2 =6.401, P=0.041). GG genotype frequency in overweight/obese group is 19.3% which is much higher than 6.1% in healthy control group. Further statistical analysis under a recessive inheritance model demonstrated odd ratio (OR) for GG vs. AA+AG in overweight/obese group was 3.674 (95% CI 1.049–12.866; P=0.035). Among three genotypes of rs4215, the subjects with GG genotype have much more higher body weight, BMI, waist circumference and SBP. Conclusion: Our data, for the first time, suggest the genotypes of rs4215 in ZAG gene are significantly associated with obesity in Chinese north Han population. GG genotype subjects in rs4215 site have an increased susceptibility to obesity when compared with the AA+AG genotype subjects. [Copyright &y& Elsevier]

Abstract: Context: Myostatin (MSTN) is a member of the TGF-β superfamily of signal transduction proteins, which plays an important role in muscular growth and lipid metabolism. Objective: To study the association of myostatin gene polymorphisms with obesity in Chinese north Han human subjects. Design: 297 healthy and 606 over-weight/obesity Chinese north Han subjects were selected as healthy control group and overweight/obesity group, respectively. The methods of DNA Sequencing, Restriction Fragment Length Polymorphism (RFLP) and TaqMan® probe were used to screen myostatin gene SNPs and clarify genotype in every individual. Results: Total 11 SNPs in MSTN gene were identified by DNA sequencing and three SNPs including rs35781413 (G/A), rs3791783 (A/G) and rs3791782 (A/G) were selected for further study in total 903 samples. The results showed that the frequency of AA genotype of rs3791783 A/G SNP was significantly higher (56.4% vs. 50.8%) and the frequency GG genotype was significantly lower (3.2% vs. 6.7%) in overweight/obese patients than in normal weight subjects. A logistic regression analysis under a recessive inheritance model (AA+AG vs.GG) demonstrated that the Odd ratio for AA+AG vs.GG were 1.985 (95% CI 1.078–3.643; P=0.029). Among three genotypes of rs3791783, the subjects with AA genotype have much more higher body weight, BMI, waist circumference, TC, TG and LDL-C than those with GG genotype. Conclusions: Our data firstly suggest that genetic variant rs3791783 A/G in myostatin gene are associated with obesity. The A allele carriers in rs3791783 SNP have an increased susceptibility to obesity compared with the G allele carriers. Participants with AA genotype in rs3791783 SNP site will have higher risk suffered from overweight or obesity than those with GG genotype. [Copyright &y& Elsevier]

• Serum PFCAs (C8-C10) declined with the increasing distance from the fluorochemical industrial plant. • The source of PFCAs in soil (C5-C9) and serum (C8-C10) was the fluorochemical industrial plant. • There is a potential health risk for some teenagers with high serum concentrations of PFOA. Discharges released from fluorochemical industrial plants lead to severe contamination of the environment with per- and polyfluoroalkyl substances (PFASs), which may pose risks to human health. In this study, 187 serum samples from teenagers (age = 14 years), 22 tap water samples and 40 soil samples were collected in areas within 0–11 km of a fluorochemical industrial plant in Huantai County, Shandong Province, and concentrations of 18 PFASs were quantified by UPLC-MS/MS. Perfluorooctanoic acid (PFOA) was found to be predominant, concentrations of which ranged from 40.4 to 845 ng/mL in serum, from 2.88 to 19.3 ng/L in tap water, from 4.40 to 189 ng/g in soil, and accounting for 84.1–98.6%, 15.9–79.8%, and 73.8–96.7% of the total PFASs, respectively. Statistical analysis demonstrated that concentrations of perfluorinated carboxylic acids (PFCAs) in soil (C5-C9) and serum (C8-C10) were associated with the industrial plant. And PFOA concentrations in tap water were not relevant to the industrial plant, which were comparable with the non-contaminated area and lower than the threshold value recommended by U.S. EPA (70 ng/mL), indicating that the contribution to the high concentration of serum PFOA of local teenagers by drinking water was limited. Moreover, PFCAs in soil only made a limited contribution to the serum PFCAs of local residents by direct inhalation and dermal exposure, but the potential health risk by the soil via food chain should be paid attention to. Furthermore, health risk assessment demonstrated that high concentrations of PFOA in serum could pose potential health risk to local teenagers. Therefore, effective measures should be taken to attenuate the health risks caused by the industrial plant to local residents, and further epidemiological studies should be carried out in the future. [ABSTRACT FROM AUTHOR]

Background and Purpose: This study aimed to investigate the association of metabolic syndrome (MetS) with both intracranial atherosclerotic stenosis (ICAS) and imaging markers of cerebral small vessel disease (CSVD) in a community-based sample., Methods: This study included 943 participants (aged 55.6±9.2 years, 36.1% male) from the community-based Shunyi cohort study. MetS was defined according to the joint interim criteria and quantified by the MetS severity Z-score. ICAS was evaluated by brain magnetic resonance angiography. The MRI markers of CSVD, including white matter hyperintensities (WMHs), lacunes, cerebral microbleeds (CMBs) and enlarged perivascular spaces (EPVS), were assessed. Multiple regression models were used to investigate the association of MetS severity Z-score with ICAS and these CSVD markers., Results: We found that risk of ICAS (OR=1.75, 95% CI 1.39 to 2.21, p<0.001) increased consistently with MetS severity. MetS severity was significantly associated with higher risks of WMH volume (β=0.11, 95% CI 0.01 to 0.20, p=0.02) and lacunes (OR=1.28, 95% CI 1.03 to 1.59, p=0.03) but not the presence of CMBs (OR=0.93, 95% CI 0.74 to 1.16, p=0.51) and PVS severity (EPVS in basal ganglia: OR=0.96, 95% CI 0.84 to 1.09, p=0.51 and EPVS in white matter: OR=1.09, 95% CI 0.96 to 1.23, p=0.21)., Conclusions: Our findings suggest that WMH and lacunes share risk factors with atherosclerosis of the cerebral artery, whereas the impact of glucose and lipid metabolic disorder to CMB or EPVS might be weak., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Perioperative adjuvant treatment has become an increasingly important aspect of the management of patients with non-small cell lung cancer (NSCLC). In particular, the success of immune checkpoint inhibitors, such as antibodies against PD-1 and PD-L1, in patients with lung cancer has increased our expectations for the success of these therapeutics as neoadjuvant immunotherapy. Neoadjuvant therapy is widely used in patients with resectable stage IIIA NSCLC and can reduce primary tumor and lymph node stage, improve the complete resection rate, and eliminate microsatellite foci; however, complete pathological response is rare. Moreover, because the clinical benefit of neoadjuvant therapy is not obvious and may complicate surgery, it has not yet entered the mainstream of clinical treatment. Small-scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancellation of surgery, additional illness, and even death, and have therefore attracted much attention. In this article, we draw on several sources of information, including (i) guidelines on adverse reactions related to immune checkpoint inhibitors, (ii) published data from large-scale clinical studies in thoracic surgery, and (iii) practical experience and published cases, to provide clinical recommendations on adverse events in NSCLC patients induced by perioperative immunotherapy., (© 2021 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.)

Background: Patients with hypothalamic-pituitary disease have the feature of central obesity, insulin resistance, and dyslipidemia, and there is increased prevalence of liver dysfunction consistent with non-alcoholic fatty liver disease (NAFLD) in this population. The causes of hypopituitarism in the reported studies varied and combined pituitary hormone deficiency including central diabetes insipidus is much common in this population. This retrospective cross-sectional study was performed to analyze the clinical characteristics and related factors with NAFLD and cirrhosis in Chinese adult hypopituitary/panhypopituitary patients., Aim: To analyze the clinical characteristics of and related risk factors for NAFLD in Chinese adult hypopituitary patients., Methods: Adult Chinese patients with hypopituitarism and/or panhypopituitarism were enrolled at the Pituitary Center of Peking Union Medical College Hospital between August 2012 and April 2018. According to abdominal ultrasonography, these patients were divided into an NAFLD (-) group and an NAFLD (+) group, and the latter was further divided into an NAFLD group and a cirrhotic group. The data, such as patient characteristics, diagnosis, and treatment, were extracted from medical records, and statistical analysis was performed., Results: A total of 36 male and 14 female adult Chinese patients with hypopituitarism were included in this retrospective study; 43 (87.0%) of these patients exhibited growth hormone (GH) deficiency, and 39 (78.3%) had diabetes insipidus. A total of 27 (54.0%) patients were diagnosed with NAFLD, while seven patients were cirrhotic. No significant differences were noted in serum GH or insulin-like growth factor 1 among patients with cirrhosis, subjects with NAFLD, and those without NAFLD. However, plasma osmolality and serum sodium concentration of the cirrhotic patients were 314.9 mOsm/kgH 2 O and 151.0 mmol/L, respectively, which were significantly higher than those of the NAFLD patients ( P = 0.036 and 0.042, respectively). Overweight/obesity and insulin resistance were common metabolic disorders in this population. The body mass index (BMI) and homeostasis model assessment of insulin resistance parameters of the cirrhotic patients were 27.7 kg/m 2 and 9.57, respectively, which were significantly higher than those of the patients without NAFLD ( P = 0.011 and 0.044, respectively). A correlation analysis was performed, and fasting insulin concentration was positively associated with plasma osmolality in patients with NAFLD, after adjusting for gender, age, and BMI ( r = 0.540, P = 0.046), but no correlation was noted in patients without NAFLD., Conclusion: NAFLD is common in patients with hypopituitarism. Plasma osmolality and serum sodium levels of hypopituitary patients with cirrhosis are higher than those of subjects with NAFLD, and fasting insulin concentration is positively associated with plasma osmolality in patients with NAFLD, which suggests that hyperosmolality might be a contributor to the worsening of NAFLD in hypopituitary patients., Competing Interests: Conflict-of-interest statement: There is no conflict of interest regarding the work presented in this manuscript.

Cushing's disease (CD) is a relatively rare disease,characterized by pathological hypercortisolism secondary to excessive adrenocorticotrophic hormone that is secreted by pituitary adrenocorticotrophic hormone adenoma or hyperplasia. In addition to the typical clinical symptoms such as moon face,buffalo hump,and central obesity,the CD patients may also experience mental disorders and cognitive dysfunction. This review mainly focuses on the cognitive state of CD patients,the mechanisms of cognitive impairment caused by high cortisol levels,and the imaging findings (especially magnetic resonance imaging) for the evaluation of cognitive functions.

Purpose: To assess the efficacy of neoadjuvant chemotherapy (NCT) plus targeted agents versus NCT alone for the treatment of colorectal liver metastases (CRLM) patients., Methods: Trials published between 1994 and 2015 were identified by an electronic search of public databases (MEDLINE, EMBASE, Cochrane library). All clinical studies were independently identified by two authors for inclusion. Demographic data, treatment regimens, objective response rate (ORR), hepatic resection and R0 hepatic resection rate were extracted and analyzed using Comprehensive MetaAnalysis software (Version 2.0)., Results: A total of 40 cohorts with 2099 CRLM patients were included: 962 patients were treated with NCT alone, 602 with NCT plus anti-epidermal growth-factor receptor (EGFR)-monoclonal antibodies (MoAbs) and 535 with NCT plus bevacizumab. Pooled ORR was significantly higher for NCT plus bevacizumab or anti-EGFR-MoAbs than NCT alone [relative risk (RR) 1.53, 95% CI 1.30-1.80; p < 0.001; RR 1.53, 95% CI: 1.27-1.83, p < 0.001; respectively]. NCT plus bevacizumab significantly improved R0 hepatic resection rate (RR 1.61, 95% CI: 1.27-2.04, p < 0.001), but not for overall hepatic resection rate (RR 1.26, 95% CI: 0.81-1.94, p = 0.30). While hepatic resection and R0 hepatic resection rate was comparable between NCT plus anti-EGFR-MoAbs and NCT alone (p = 0.42 and p = 0.37, respectively)., Conclusions: In comparison with NCT alone, NCT plus bevacizumab significantly improve ORR and R0 hepatic resection rate but not for hepatic resection rate. Our findings support the need to compare NCT plus bevacizumab with NCT alone in the neoadjuvant setting in large prospective trials due to its higher hepatic resection rate and R0 hepatic resection rate in CRLM patients.

Coronary artery disease (CAD) is one of the major life-threatening diseases. In addition to traditional risk factors including age, sex, smoking, hypertension,and diabetes, genomic studies have shown that CAD has obvious genetic predisposition. In recent years, the rapid advances in genomics shed new light on early diagnosis, risk stratification and new treatment targets.