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Objective To study the surgical treatment of adrenocorticotropic hormone independent macronodular adrenal hyperplasia (AIMAH).Methods The clinical data of 12 AIMAH patients were analyzed retrospectively.There were 3 males and 9 females, with an average age of 55 years (range, 39-67 years).10 cases had typical clinical features of Cushing syndrome.Endogenous hypercortisolism was confirmed on the basis of loss of circadian rhythm of serum cortisol, high late-night serum cortisol level and inadequate cortisol suppression after overnight low-dose dexamethasone suppression test.ACTH independence was established on the basis of suppressed serum ACTH levels and inadequate cortisol suppression after overnight high-dose dexamethasone suppression test.CT scan showed bilateral enlargement of the adrenal glands with multiple macronodules.Steroid supplement was given after operation.Results Surgical intervention was performed in all the patients.Seven patients underwent bilateral adrenalectomy,and unilateral adrenalectomy was performed in 5 patients, one of whom had the history of contralateral adrenalectomy.Pathological examination confirmed multinodular hyperplastic adrenal enlargement.The average duration of postoperative follow-up was 50 months (range, 1-105 months).One patient undergoing bilateral adrenalectomy died from respiratory failure and pulmonary infection one month after operation.Remission of Cushing syndrome symptoms was obtained after surgery in other 11 patients.For these 11 cases,the serum cortisol declined into normal ranges, but suppressed serum ACTH levels and inadequate cortisol suppression after overnight low-dose dexamethasone suppression test were still present.Two patients received contralateral adrenalectomy due to recurrent overt Cushing syndrome after one year and 5 years, respectively.Conclusions Unilateral adrenalectomy might be an effective and safe treatment modality for AIMAH, but subclinical hypercortisolism would be present postoperatively.Contralateral adrenalectomy may be performed in case of the recurrence of overt Cushing syndrome.
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Objective To examine the galectin-3 expression in bladder cancer and explore the relationship between the galectin-3 expres-sion and the clinicalpathological characteristics of bladder cancer.Methods Immunohistochemical streptavidin-peroxidase（S-P）method was employed to examine the expression of galectin-3 in 45 bladder cancer tissues and 6 normal bladder tissues.The relationship between galectin-3 expression and the clinicopathological parameters was analyzed in bladder cancers.Results The positive rate of galectin-3 ex-pression in bladder cancer was 62.2%,significantly higher than that in 6 normal bladder tissues（P 〈 0.05）.The positive rates of galectin-3 expression in primary cases and recurrent cases were 60% and 70% respectively without significant difference（P 〉 0.05）.The up-regulated expression of galectin-3 was positively correlated with the pathological degree and clinical stage of bladder cancer（P 〈 0.05）.Conclusion Galectin-3 expression is up-regulated in bladder cancer and its increased expression is useful for diagnosis of bladder cancer.Additionally,it could be used as an important index to evaluate the pathological degree and clinical stage of bladder cancer.
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Objective To study the immunoreactivity of fascin and Ki-67 proteins in bladder carcinoma and the correlation between their expression and the pathological features.Methods The immunohistochemistry of fascin and Ki-67 proteins were detected in 111 cases of bladder carcinoma and 42 cases of normal bladder tissues.The correlation between their expression and the pathological features were analyzed statistically.Results There was no expression of fascin and Ki-67 in normal bladder tissues.The immunoreactivities of fascin and Ki67 were detected respectively in 94 and 92 of 111 bladder carcinomas.The immunoreactivity of fascin was correlated with TNM staging and the size of the tumor(P0.05).The expression of fascin was positively correlated with the expression of Ki-67 in bladder carcinoma(P<0.01).Conclusion Fasicn and Ki-67 were expressed in bladder carcinoma.The combined detection of fascin and Ki-67 expression might be helpful to assess the prognosis of bladder carcinoma.Targeting the fascin and Ki-67 pathway could be a novel therapeutic strategy of bladder carcinoma.
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Hepsin is a type Ⅱ transmembrane serine protease and it' s over expressed in the majority of human prostate cancers. It has a close association with the invasion and metastasis of prostate cancer. In this paper, we review the research of Hepsin in prostate cancer.
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OBJECTIVE: To investigate the information acquired through the four diagnostic methods of traditional Chinese medicine in patients with bronchial asthma, and to classify the syndrome types. METHODS: Four hundred and thirty patients with bronchial asthma were randomly investigated. The information acquired through the four diagnostic methods was recorded and the database was established by Amos software, and then the data were analyzed by confirmatory factor analysis (CFA). RESULTS: After analyzing the data with 4 factors, 5 factors and 6 factors, we found that the results of CFA with 6 factors were in accordance with clinical practical experience. CONCLUSION: According to the results of CFA with 6 factors and with the standard regression coefficient 0.4 as primary and secondary critical points, the syndromes in patients with bronchial asthma can be classified into 5 types, which are syndromes of cold fluid retained in lung, phlegm-heat obstructing lung, wind-phlegm blocking lung, qi deficiency of lung and kidney and qi deficiency of spleen.
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Some non treatment variables that affect the outcome of a disease are often called covariates. These covariables should be considered in the design and analysis of clinical trials to obtain unbias conclusion. To ensure that any observed treatment effect is not influenced by an imbalances in baseline characteristics, both preadjustment and postadjustment are provided in the design stage and analysis stage of the trials respectively. They can improve the credibility of the trial results and increase the statistical efficiency. Based on a few papers published about adjustment for covariates and some documentations of the International Conference on Harmonization (ICH), we review the concepts, methods and procedures for adjustment of treatment effects for the influence of covariates. The statistical issues on the application of adjustment are especially discussed in great depth.