Search

The aim was to assess the short- and long-term outcomes of unilateral adrenalectomy (UA) in patients with primary bilateral macronodular adrenal hyperplasia (PBMAH).We conducted a retrospective study of 124 patients with PBMAH who underwent UA.One hundred sixteen patients were available for follow-up (median, 28.5 months). Cushingoid features remitted in 43 of 65 patients (70.8%) with overt Cushing syndrome (CS). Hypertension and diabetes mellitus improved in 79 of 96 (82.3%) and 29 of 42 patients (69.0%), respectively. Glucocorticoid insufficiency developed in 7 of 116 patients (6.0%) after the surgery, and it resolved in all the patients during follow-up. The mean 24-hour urinary free cortisol level decreased gradually from 456.02 ± 422.33 mg/24 h at baseline to 84.47 ± 70.06 mg/24 h within 3 months and then increased progressively in some patients. Sixty-four of the 116 patients (55.2%) had biochemical recurrence and 43 patients (67.2%) underwent contralateral adrenalectomy. The median time interval between the second operation and the first UA was 24 months. Patients with overt CS had a larger surgical-side or contralateral adrenal volume than patients without overt CS. Patients with a contralateral adrenal volume of33.54 mL or with a preoperative urinary free cortisol level of216.08 mg/24 h were more likely to have recurrence.The efficiency of UA is transient for the majority of patients, and the indications should be strictly limited to those with subclinical or milder CS. Patients who undergo successful UA still require close life-time follow-up for the recurrence of hypercortisolism.

Backgroud: Bladder cancer (BLCA) is one of the most fatal types of cancer worldwide. However, there are limited methods for us to provide a prognostic prediction of BLCA patients. Therefore, we aimed at developing a lncRNA signature to improve the prognosis prediction of BLCA. Results An eight-lncRNA signature was significantly associated with recurrence free survival in BLCA patients from both discovery and validation groups. Furthermore, genes involved in the signature were enriched in extracellular matrix organization pathway. Finally, functional experiments demonstrated that six out of the eight lncRNAs significantly regulated the invasion of BLCA cells. Method A total of 343 BLCA patients from The Cancer Genome Atlas (TCGA) were employed and randomly divided into training (n=172) and validating (n=171) groups. The lncRNA expression profiles of BLCA patients were screened and a risk-score formula were created and validated according to the Cox regression analysis. Next, WGCNA method was employed to cluster genes that highly correlated with the risk scores based on the profiling data of TCGA dataset and transwell assay was also performed to further investigate the role of these lncRNAs. Conclusions Our results suggested that the eight-lncRNA signature was a candidate prognostic biomarker for predicting tumor recurrence of patients with BLCA.

Incidence of intraoperative vaginal perforation is generally considered to be low but varies among different procedures. Vaginal perforation could not only prolong the surgeries and aggravate surgical trauma but also result in postoperative discomfort or even a second surgery.Vaginal perforation, vaginal epithelial perforation, vaginal wall perforation, vaginal penetration, urinary incontinence were searched in PubMed, Cochrane, Embase database to identify the qualified clinical trial and relevant literature sources were also searched.A total of 9223 cases of from 33 trials from literatures and 387 cases from our own trail were analyzed, which provided detailed data on intraoperative vaginal perforation. Incidence of intraoperative vaginal perforation during mid-urethral sling surgery treating stress urinary incontinence was generally low, which was 1.56%. Incidence of intraoperative vaginal perforation during transobturator (TOR) procedure was higher than that during retropubic (RPR) procedure, which were 2.11% and 0.89% respectively. Incidence of intraoperative vaginal perforation during outside-to-inside TOR procedure like TOT and MONARC was higher than that during inside-to-outside TOR procedure like TVT-O, which were 2.74% and 1.52%, respectively. Incidence of intraoperative vaginal perforation during single-incision surgery like H-type TVT-SECUR reached 1.97%, while no report on U-type TVT-SECUR surgeries.The incidence of intraoperative vaginal during mid-urethral sling procedures for female stress urinary incontinence is fairly high. Vaginal perforation was more common in trans-obturator route (TOR) than retropubic route (RPR). In TOR route, it was less frequent in inside-to-outside procedure than outside-to-inside procedure. Surgery proficiency could also have an impact on this complication.

To explore the effects of different forms of glucocorticoid excess on cortisol/cortisone ratio and to reveal the mechanisms of hypokalemia in Cushing's syndrome patients.The levels of urinary free cortisol (UFF) and urinary free cortisone (UFE) were determined in 6 adult patients with ectopia adrenocorticotropic hormone (ACTH) syndrome, 6 normal serum level of potassium adults with hypercortisolism due to adrenal tumor, 5 hypokalemic adults with hypercortisolism due to adrenal tumor and 6 healthy volunteers using high-performance liquid chromatography plus tandem mass spectrometry (LC-MS/MS).For 4 groups, the results of UFF+UFE were (2 787 ± 820), (689 ± 163), (697 ± 120) and (70 ± 27)µg/L and UFF/UFE ratio 2.98 ± 0.35, 1.03 ± 0.42, 2.24 ± 0.37 and 0.42 ± 0.20 respectively. The values of UFF+UFE had no statistical difference between normal and low levels of serum potassium adults with hypercortisolism. And the ratio of UFF/UFE of hypokalemic adults with hypercortisolism was significantly higher than that of normal serum level of potassium adults with hypercortisolism. It suggested that the deficiency of 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD 2) was present in hypokalemic adults with hypercortisolism.Due to a deficiency of 11β-HSD2, active cortisol can not be transformed into inactive cortisone in some patients with ACTH-independent Cushing's syndrome.

Background Academic burnout refers to students who have low interest, lack of motivation, and tiredness in studying. Studies concerning how to prevent academic burnout are rare. Objective The present study aimed to investigate the impact of core self-evaluations on the academic burnout of university students, and mainly focused on the confirmation of the mediator role of life satisfaction. Methods A total of 470 university students accomplished the core self-evaluation scale, Satisfaction with Life, and academic burnout scale. Results Both core self-evaluations and life satisfaction were significantly correlated with academic burnout. Structural equation modeling indicated that life satisfaction partially mediated the relationship between core self-evaluations and academic burnout. Conclusions Core self-evaluations significantly influence academic burnout and are partially mediated by life satisfaction.