Syndrome of resistance to thyroid hormone and thyrotropin-secreting pituitary adenoma: Case series study / 中华内分泌代谢杂志

Objective:To outline clinical features in syndrome of resistance to thyroid hormone(RTH) and thyrotropin-secreting pituitary adenoma(TSH adenoma) based on a case series, and to assess the value of octreotide suppression test and high-dose dexamethasone suppression test(HDDST) in differentiating the two diseases.Methods:A total of 22 cases with RTH and TSH adenoma clinically diagnosed in Xiangya Hospital of Central South University from October 2010 to December 2021 were retrieved. The clinical characteristics of the two diseases and results to different tests were analyzed and summarized.Results:(1) The tumors in TSH adenoma patients were larger than those with RTH complicated with pituitary mass, which presented chiasmatic compression on images( P<0.05). (2) In octreotide suppression test, thyrotropin(TSH) inhibition rate in RTH patients was lower than that in TSH adenoma patients( P<0.05). In HDDST, TSH inhibition rate was higher in patients with RTH than in patients with TSH adenoma( P<0.05). (3) The TSH inhibition rate was calculated by receiver operating characteristic(ROC) curve. The sensitivity and specificity of octreotide suppression test were 91.9% and 55.6%, respectively, and the threshold value of TSH inhibition rate was 64.24%. The sensitivity and specificity of HDDST were 54.4% and 89.0%, respectively, and the threshold value of TSH inhibition rate was 65.73%.The combined sensitivity and specificity of the two tests were 77.8% and 90.9%, indicating better diagnostic value( P<0.05). Conclusions:The combination of octreotide suppression test and HDDST is of clinical value in differentiating RTH from TSH adenoma. TSH adenoma is more aggressive than that of pituitary adenoma with RTH.

Ulnar-Mammary syndrome with TBX3 gene mutation in a Chinese family: A case report and literature review / 中南大学学报(医学版)

Ulnar-Mammary syndrome (UMS) is a rare monogenic disorder caused by mutations of the TBX3 gene. This paper reported a family of UMS. The proband, a 15-year old man, was presented with mammary gland dysplasia, ulnar limb defect, short stature, and delayed growth. Whole exome sequencing revealed a 1294_1301dup mutation in exon 6 of the TBX3 gene. Sanger sequencing was used to verify other members of the family, which suggested his mother also carried the same mutation, but merely resulting in the dysplasia of her left little finger. Notably, unilateral finger involvement without any systemic organ involvement was unusual in UMS patients. The proband then was treated with recombinant human growth hormone (rhGH) and human chorionic gonadotropin (hCG). After a year and a half, his height and secondary sexual characteristics were significantly improved. The clinical manifestations of the disease are highly heterogeneous, which is easy to be misdiagnosed and missed. When the diagnosis is unclear, genetic testing is helpful for auxiliary diagnosis.

Investigating Relationship Between Renal Damage and Endoplasmic Reticulum Stress in Diabetic Kidney Disease Rats with Blood Stasis Syndrome Based on Combination of Disease and Syndrome / 中国实验方剂学杂志

Objective:To observe the effect of blood stasis syndrome on renal damage and endoplasmic reticulum stress (ERS) in diabetic kidney disease (DKD) rats, and to explore the relationship between renal syndrome of blood stasis damage and ERS in DKD rats. Method:The 50 Male SD rats of SPF level were selected to establish DKD rat model by high fat and high sugar diet combined with intra-abdominal injection of streptozotocin(STZ). They were randomly divided into normal group, diabetes mellitus group and diabetes mellitus and blood stasis syndrome group（0.05 mg·kg-1）, among which diabetes mellitus and blood stasis syndrome group was prepared by dextran method. The general conditions, hemorheology indexes, 24 h urine protein, serum creatinine and renal pathology of the rats in each group were observed. Immunohistochemical analysis, Western blot and Real-time fluorescent quantitative polymerase chain reaction(Real-time PCR)were used to detect mRNA and protein expressions of endoplasmic reticulum stress-related proteins glucose regulated protein 78(GRP78), activating transcription factor-6(ATF6) and renal fibrosis index fibronectin(FN), and alpha smooth muscle actin(α-SMA). Result:Compared with normal group, the rats in diabetes mellitus group showed polyphagia, polyuria and weight loss, increased hemorheology index of whole blood viscosity and plasma viscosity(P<0.05，P<0.01), increased 24 h urine protein, serum creatinine and urea nitrogen(P<0.01), and increased renal pathology, and increased mRNA and protein expression of GRP78, ATF6, FN and α-SMA(P<0.05，P<0.01). After dextran preparation of blood stasis model. Diabetes mellitus and blood stasis syndrome group increased mortality, signs of change is more obvious in the diabetic group, whole blood viscosity, plasma viscosity, 24 h urine protein ration, serum creatinine and urea nitrogen were significantly higher than those in diabetic rats(P<0.01), pathological changes aggravated in the diabetes group. At the same time， mRNA and protein expressions of GRP78, ATF6, FN, and α-SMA in renal tissue were significantly higher than those in diabetic mellitus group(P<0.05，P<0.01). Conclusion:Under the combined disease and syndrome model, the blood stasis syndrome may further aggravate the pathological damage of the kidney of DKD rats, and is related to the enhancement of ERS in the kidney of DKD rats.

Artificial ascites assisted ultrasound guided fusion virtual MRI navigation radiofrequency ablation for hepatocellular carcinoma adjoining hollow viscera / 中华普通外科杂志

Objective To evaluate ultrasound assisted virtual MRI guided radiofrequency ablation (RFA) in the treatment of hepatocellular carcinoma (HCC) adjacent to gastrointestinal tract with artificial ascites.Methods A total of 33 HCC lesions in 32 patients adjacent to gastrointestinal tract in our hospital were collected.After the establishment of artificial ascites,they were treated with radiofrequency ablation guided by ultrasound-guiding fusion and virtual MRI navigation.The curative effect and complication rate were compared with the control group (non-hollow GI tract abutting HCC lesions).Results All 33 lesions were completely ablated without residual.After 1 month and 3 months follow-up,the reexamination of contrast-enhanced ultrasound and MRI showed no activity and no new lesions.All cases had no serious complications such as gastrointestinal injury.There were no statistically significant differences in tumor complete inactivation rate,complication rate and recurrence rate between the two groups.Conclusion Ultrasound-guiding fusion and virtual MRI guided radiofrequency ablation with artificial ascites is safe and effective in the treatment of liver cancer adjacent to gastrointestinal tract.

Percentile normal values of BMI for children and adolescents in Shanghai / 预防医学

Objective To fit children and adolescents' normal values and curves of BMI with coefficient of skewness-median-coefficient of variation (LMS) method, so as to provide a reference for the monitoring of obesity in children and adolescents. Methods 15259 children and adolescents aged 7 to 18 years old were selected in Shanghai, and the height and weight of the subjects were measured . The LMS Chartmaker software was used to fit the percentile curves of BMI of boys and girls with age. With P3, P5, P10, P15, P25, P50, P75, P85, P90, P95, P97 as the reference curve. Results The percentile of students showed an increasing trend with the age increases, and the boys are higher than girls. The P50 of all age groups of boys and girls in Shanghai was higher than that of the national level. The P85 and P95 of BMI were basically equal to the national level in the early stage, and was higher than the national level in the later period. The curve of boys has entered the peak of BMI growth since 9 years old, after 12 years old, the growth rate is slow, the curve is still rising at 18 years old. The curve of girls has entered the peak since 10 years old, after 14 years old, the growth rate is slow, after 16 years old, the curve tends to be stable. Conclusion The BMI percentile curve constructed by LMS method can correctly reflect the growing development of children and adolescents, and the BMI of children and adolescents in Shanghai is higher than the national level.

Clinical analysis of two different incisions of coaxial phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To compare the clinical effects of 2.2mm coaxial micro-incision and 3.0mm standard incision in cataract phacoemulsification surgery. ·METHODS: A total of 67 patients (80 eyes) were randomly divided into two groups. Cataract phacoemulsification and artificial lens implantation surgery was carried out with 2. 2mm coaxial micro -incision (Group A, 40 eyes) and 3. 0 mm standard incision(Group B, 40 eyes), respectively. The effective phacoemulsification time and average ultrasound energy, corneal endothelial cell count, corneal edema, corneal astigmatism, postoperative visual acuity and postoperative complications were compared between the two groups. ·RESULTS: Effective phacoemulsification time of Group A and Group B was 8. 18 ± 11. 22s and 7. 82 ± 2. 12s, respectively, and the difference had no statistical significance(P> 0. 05); average ultrasonic energy was (17.25 ± 4.22)% and (17.64 ± 4.27)%, respectively, and the difference was not statistical significance(P>0.05). There was no significant difference in endothelial cells between the two groups of corneal endothelial cells at 1wk after surgery compared with that before operation (P>0.05). On the first day after surgery, corneal edema was observed in some patients. There were 9 eyes in Group A,6 eyes in Group B,corneal edema relief or subsidence after 3d to 5d. There was significant difference in corneal astigmatism change between the two groups at 1wk (P<0.05), but there was no significant difference at 1 and 3mo after operation (P>0.05). The changes of corneal astigmatism before and after operation in Group A were insignificant (P>0. 05), while the changes of corneal astigmatism before and after operation in Group B were significantly different (P< 0. 05). At 1 and 3mo after operation, the astigmatism of each group tended to be stable, and the corneal astigmatism in the two groups after 1 and 3mo had no statistical significant difference (P> 0. 05). The uncorrected visual acuity (UCVA) differences of the two groups was statistically significant at 1d,1wk and 1mo after operation (P<0.05), but there was no significant difference between the two groups in UCVA after 3mo (P>0.05). ·CONCLUSION: For soft or medium - hard nucleus cataract, compared with the traditional 3. 0mm small-incision coaxial phacoemulsification, the 2.2mm micro-incision coaxial phacoemulsification can effectively reduce the surgically induced astigmatism, and the astigmatism state is relatively stable, and conducive to early recovery of visual acuity.

Diversity analysis of biofilm bacteria on tracheal tubes removed from intubated neonates / 中华儿科杂志

<p><b>OBJECTIVE</b>The catheter-related infections caused by mechanical ventilation have become a intractable clinical problem, and it is related to the formation of bacterial biofilm (BF) on the surface of the implanted material. The majority of natural biofilms are formed by multiple bacterial species. However, there always only one or limited species were detected on tracheal tubes removed from intubated neonates by using traditional methods including bacterium culture and antigen detection. The aims of this study were to observe the bacterial communities diversity of BF on endotracheal tube (ETT), and discuss the difference between traditional bacterium culture methods and the use of molecular biology techniques on the basis of denatured gradient gel electrophoresis (DGGE), to provide new ideas for clinical prevention, diagnosis and treatment of bacterial infections.</p><p><b>METHOD</b>Thirty-five ETTs were obtained from 26 neonates on mechanical ventilator (from October 2012 to March 2013) in Department of Neonatology of Children's Hospital. Among the patients, 18 were boys and 8 girls, and 19 patients were < 37 weeks gestational age and 7 patients ≥ 37 weeks. DGGE profiling of 16S rDNA gene amplicons was used to assess the diversity of the bacterial population by using the software of quantity one. TA Cloning Kit and sequencing were used to investigate the distribution of bacteria and common dominant bacteria in ETT-BF.</p><p><b>RESULT</b>The mean bands of 35 ETTs cases were 13.8 ± 5.4 from 16S rDNA PCR-DGGE, and the mean Shanon-Wiener indexes was 2.42 ± 0.38. The 16 ETTs were collected in different stages of diseases from the 7 patients. The indwelling days of 6/7 patients' ETTs increased, the Shanon-siener indexes were decreased. Among the 6 cases from different basic illnesses, and there were different Shanon-siener indexes. The result of molecular cloning and sequencing for 24 dominant bands showed that 35 cases (100%) contained Klebsiella SP·, 28 cases (80%) had Pseudomonas SP·, 27 cases (77%) had Streptococcus SP·, and 32 cases (91%) had Uncultured bacterium, while more than 2 bacterial species were found in 34 cases (97%). 28/35 (80%) Klebsiella SP· and 22/27(82%) Streptococcus SP· were accompanied by Pseudomonas SP·. There were 22 positive results of sputum culture from 26 newborns, including 10 strains (45%) of Klebsiella pneumoniae, 2 strains (9%) of Acinetobacter baumannii, Enterobacter cloacae and non-cultured bacterium in each patient (5%), but only one bacterium isolated from every sputum. Eight sputum samples had normal flora only, corresponding to the ETTs on which Klebsiella and other bacterial genuses were found.</p><p><b>CONCLUSION</b>The diversity of microbiota in BF on ETT was confirmed. 16S rDNA PCR-DGGE could produce a more complete picture of bacterial community than traditional bacterium culture method. Klebsiella, Pseudomonas and Streptococcus were common dominant bacteria in ETT-BF, and there might be interactions among them in the formation of BF.</p>

Developing Geriatric Services in Taiwan

Taiwan is aging fast, and so are neighborhood countries in eastern Asia. The rapid demographic transition triggers the need of developing elder-friendly health care system. However, developing geriatric services in eastern Asia was not as successful as western countries due to various reasons. In Taiwan, the development of geriatric services has been highly supported by the Veteran Affairs Commission in the past few years. Outpatient and inpatient geriatric services, as well as the post-acute care services have been successfully developed. The success of developing geriatric services in Taiwan was related to the development of geriatric specialty training program, which provided well-trained geriatricians for institutes to start new services. The success of specialty training programs also extended into clinical geriatric researches, especially the health service researches that proved the clinical benefits of outpatient, inpatient, post-acute and long-term care services with active participation of geriatricians. This review summarized the development of geriatric services and clinical geriatric researches in Taiwan in recent years.

Study on canceration law of gastric mucosal dysplasia based on syndromes of Chinese medicine / 中国结合医学杂志

<p><b>OBJECTIVE</b>To study the syndrome evolution law of Chinese medicine (CM) in the patients with gastric mucosal dysplasia.</p><p><b>METHODS</b>Three hundred and twenty four gastric mucosal dysplasia patients with deficiency and excess correlation syndromes were enrolled by a multi-center collaboration for two years' clinical follow-up to detect the levels of tumor supplied group of factors (TSGF) and carcino-embryonic antigen (CEA).</p><p><b>RESULTS</b>Among the 324 cases, 29 cases turned cancer in the two years, and the canceration rate was 9.0%. The three syndromes with higher canceration rate were the damp-heat accumulating Wei syndrome concurring or combining with asthenia-cold in Pi and Wei syndrome for 16.7%; stagnation in Wei collaterals syndrome concurring or combining with asthenia of both qi and yin syndrome for 13.2%; stagnation of Gan and Wei qi syndrome concurring or combining with asthenia-cold in Pi and Wei syndrome for 8.0%, respectively. Among the three syndromes, the highest level of TSGF occurred in the former two syndromes. In the half year before carcinogenesis, the syndromes of the patients took on deficiency and excess concurrent syndromes, and the deficiency syndromes involving the qi and blood deficiency syndrome and the Shen deficiency syndrome accounting for 48.0%.</p><p><b>CONCLUSIONS</b>Gastric mucosal dyspalsia canceration syndromes took on the polymorphism of excess and deficiency concurrent syndromes and had the characteristics of deficiency syndromes involving qi and blood deficiency syndrome and Shen-yin-yang deficiency syndrome.</p>

Meta-analysis on the relationship between leptin receptor Gln223Arg and Prol019Pro gene polymorphism and obesity in the Chinese population / 中华流行病学杂志

Objective To evaluate the associations between polymorphisms of LEPR Gln223Arg,LEPR Pro 1019Pro and the risk on obesity.Methods A computerized search on literature was carried out in Wanfang,CNKI,VIP databases and CBM,PubMed,EMBASE databases to collect articles published between 1979 and 2010 concerning the associations between polymorphisms of LEPR Gln223Arg and/or LEPR Pro 1019Pro and risk of obesity in the Chinese population.Odds ratios (ORs) were used to assess the strength of the association,and 95％ confidence intervals (CIs) to present the precision of the estimates.Meta-analysis was performed using the STATA statistical software.Results Fifteen literature were collected for Meta-analysis by the uniform inclusion and exclusion criteria.There were 1096 obese patients and 949 controls for polymorphisms of LEPR Gln223Arg in 9 papers,together with 961 obese patients and 818 controls for polymorphisms of LEPR Prol019Pro in 8 papers.Overall,there were significant associations between decreased risk of obesity and LEPR Gln223Arg polymorphisms (-668 A→G) (G versus A,OR=0.66,95％CI:0.49-0.89; AG and GG versus AA,OR=0.50,95％CI:0.32-0.77; respectively).There were significant associations between increased risk of obesity and LEPR Prol019Pro polymorphisms (-3057 G→A) (A versus G,OR=1.61,95％CI:1.15-2.26; AG and AA versus GG,OR=1.50,95％CI:1.08-2.08; respectively).Conclusion Variant alleles at both LEPR-668 and LEPR-3057 were associated with obesity in the Chinese Han-dominated population.

Case-control studies on complex tibial plateau and posterior condylar fractures treated through combined anterior-posterior (small incision or micro-incision) approach / 中国骨伤

<p><b>OBJECTIVE</b>To study the therapeutic effects of combined anterior-posterior (small incision or micro-incision) approach for complex tibial plateau and posterior condylar fractures.</p><p><b>METHODS</b>From 2000 to 2008, 79 patients (81 limbs) with complex tibial plateau and posterior condylar fractures were reviewed. There were 45 males and 34 females, ranging in age from 19 to 66 years, with an average of 40.6 years. Thirty-nine limbs were treated using small incision through combined anterior-posterior approach, in which 13 limbs were Schatzker type IV, 15 limbs were type V ,and 11 limbs were type VI. Other 42 limbs were treated using micro-incision through combined anterior-posterior approach, in which 18 limbs were Schatzker type IV, 16 limbs were type V, and 8 limbs were type VI. The Rasmussen scores for knee joint and radio scores were used to evaluate therapeutic effects after the treatment. The complications such as cutaneous necrosis and incision infection were observed.</p><p><b>RESULTS</b>All the patients were followed up. According to Rasmussen criterion, in small incision group, 16 limbs got an excellent result, 13 good, 7 fair and 3 bad; in micro-incision group,above data were 19, 11, 8 and 4 respectively. Comparison between the two groups, P = 0.924. Comparison of complications such as cutaneous necrosis and incision infection: in small incision group,10 limbs had the complications, and in micro-incision group were 4 limbs; the occurrence rate of small incision group were higher than that of micro-incision group (P = 0.047).</p><p><b>CONCLUSION</b>There are no significant differences between the two groups in the knee joint function rehabilitation; however, there is smaller rate for cutaneous necrosis and incision infection in micro-incision group.</p>

Epigallocatechin gallate protects dopaminergic neurons against 1-methyl-4- phenyl-1,2,3,6-tetrahydropyridine-induced neurotoxicity by inhibiting microglial cell activation / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe whether the dopaminergic neuroprotective effect of (-)-epigallocatechin gallate (EGCG) is associated with its inhibition of microglial cell activation in vivo.</p><p><b>METHODS</b>The effects of EGCG at different doses on dopaminergic neuronal survival were tested in a methyl-4-phenyl-pyridinium (MPP+)-induced dopaminergic neuronal injury model in the primary mesencephalic cell cultures. With unbiased stereological method, tyrosine hydroxylase-immunoreactive (TH-ir) cells were counted in the A8, A9 and A10 regions of the substantia nigra (SN) in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated C57BL/6 mice. The effect of EGCG on microglial activation in the SN was also investigated.</p><p><b>RESULTS</b>Pretreatment with EGCG (1 to 100 micromol/L) significantly attenuated MPP+-induced TH-ir cell loss by 22.2% to 80.5% in the mesencephalic cell cultures. In MPTP-treated C57BL/6 mice, EGCG at a low concentration (1 mg/kg) provided significant protection against MPTP-induced TH-ir cell loss by 50.9% in the whole nigral area and by 71.7% in the A9 region. EGCG at 5 mg/kg showed more prominent protective effect than at 1 or 10 mg/kg. EGCG pretreatment significantly inhibited microglial activation and CD11b expression induced by MPTP.</p><p><b>CONCLUSION</b>EGCG exerts potent dopaminergic neuroprotective activity by means of microglial inhibition, which shed light on the potential use of EGCG in treatment of Parkinson's disease.</p>

Common mistakes and nonstandard expressions in English abstracts of medical literatures / 中南大学学报(医学版)

The mistakes in English abstracts of medical literatures influence the international communication of medical information. The misuse of words, grammar mistakes, and improper expressions are common problems. Moreover, nonstandard expressions also include the names of Chinese herbal medicines, numbers, punctuations, and so on.

Development of the quality of life scale specific for patients with benign prostatic hyperplasia / 中南大学学报(医学版)

OBJECTIVE@#To develop a specific quality of life (QOL) scale for Chinese patients with benign prostatic hyperplasia (BPH).@*METHODS@#The scale was developed with the programmed decision methods. The item pool was certified by experts. Five methods were used in item selection after a pilot study for which 256 BPH patients had been recruited. The scale was evaluated by its reliability and validity.@*RESULTS@#We formed a 27-item quality of life scale specific for patients with benign prostatic hyperplasia prior test version (BPHSQL). The test-retest correlation coefficient and Cronbach's alpha coefficient of BPHSQL were 0. 774 and 0. 945. The structure of the scale was similar to the theory construction. The scale's correlation coefficients with criteria ranged from 0.531 to 0.700. BPHSQL could well discriminate the quality of life between BPH and non-BPH patients as well as patients with different degrees of symptoms, different sources and patients with or without urethral catheters.@*CONCLUSION@#BPHSQL is reliable, valid and sensitive, and will be a convenient tool in clinical research to provide advice on different treatments for different patients.

Seeking the common end of both doctors' and patients' value orientation / 中华医院管理杂志

How to handle the relationship between doctors and patients is currently a hot spot of society. The author first expounds the fundamental propositions in the theories of the science of value. Then, using the theories of the science of value, he first describes the relationship between the object and subject of value, viz. who comes first, the patients or the staff, arguing that in the mind of the hospital director there should always be an unbiased balance of value benefiting both sides. Then he describes the realistic form in which value exists, viz. which is more important, the value of utility or the value of effectiveness, arguing that the hospital director should lay equal emphasis on the staffs value of utility and the patients value of utility, thus satisfying both sides. Thirdly, the author describes value accounting and the cost of value, viz. the dual unity of the values of effects and effectiveness, arguing that creating value while paying cost indicates the dual nature of the practice of hospital administration. Hence the need to lower cost as much as possible and create greater value.