Research progress in thyroid cancer: dedifferentiation mechanisms and differentiation therapies / 中华核医学与分子影像杂志

Iodine accumulation represents a differentiation marker of thyroid cancer (TC) and a cornerstone of benefits from 131I therapy. However, dedifferentiation phenotypes occur in nearly 70% of recurrent or metastatic TCs driven by oncogenic mutations such as B-Raf proto-oncogene, serine/threonine kinase (BRAF), telomerase reverse transcriptase (TERT) promoters, and tumor proten p53 (TP53). Beyond genetic alterations, epigenetics, autophagy, tumor microenvironment and other pathways are also involved in the dedifferentiation of TC and the tolerance to 131I therapy. Targeting the above-mentioned pathways has potential to improve the malignant phenotype of TC and restore sensitivity to 131I therapy, which is of great clinical significance. Based on the relevant mechanisms of dedifferentiation, this paper elaborates on the progress of preclinical experiments and clinical studies related to differentiation therapies of TC.

Ectopic adrenocorticotropic hormone syndrome originating from retroperitoneal paraganglioma: one case report and literature review / 中国医师杂志

Objective:To present the clinical characteristics and treatment on patients with ectopic adrenocorticotropic hormone(ACTH) syndrome (EAS) caused by the retroperitoneal paraganglioma.Methods:The clinical data of a case of EAS caused by retroperitoneal paraganglioma were analyzed retrospectively, and the related literature at home and abroad was reviewed.Results:The 53-year-old female patient was admitted to endocrinology department due to a fifteen-year history of hypertension, accompanied by fatigue for three months, headache and dizziness for one month. The laboratory data demonstrated severe hypokalemia, high level of serum and urinary cortisol, while the ACTH level remained unsuppressed. The 24 h urinary vanillyl mandelic acid (VMA) and serum free methoxyepinephrine (MNs) level were elevated. The abdominal computed tomographic scan suggested a retroperitoneal mass next to the abdominal aorta. After the retroperitoneal tumor resection was performed, immunohistochemical staining of the tumor revealed Syn (+ ), CgA (+ ), ACTH (focal + ). By the retrospective analysis of 22 similar cases from 16 papers and the case summarized above, we found that most patients with EAS caused by the paraganglioma could demonstrate the typical clinical features of Cushing′s syndrome, while lack of the manifestation of paraganglioma. Therefore, preoperative preparations for paraganglioma were usually neglected.Conclusions:Ectopic ACTH syndrome (EAS) originating from paraganglioma is very rare. To improve the diagnosis rate, examination for catecholamine, MNs and 24 h urinary VMA before surgery in patients with EAS is suggested. Considering surgical resection as the optimal treatment, comprehensive preoperative preparations for both paraganglioma and Cushing′s syndrome are significant. A genetic test for pheochromocytoma/ paraganglioma and lifelong postoperative follow-up are also recommend.

Serum thyroglobulin in evaluating the response to 131I treatment in patients with distant metastatic differentiated thyroid cancer / 中华核医学与分子影像杂志

Objective:To explore the significance of serum thyroglobulin (Tg) in the decision-making of response to 131I therapy and subsequent treatment for distant metastatic differentiated thyroid cancer (DM-DTC). Methods:Between January 2018 and December 2019, a total of 62 papillary thyroid cancer (PTC) patients (20 males and 42 females, age: (38.1±15.9) years) with pulmonary metastasis from Peking Union Medical College Hospital were retrospectively analyzed. Patients were divided into two groups (non-radioactive iodine (RAI)-avid group and RAI-avid group) according to the post-treatment whole body scan (Rx-WBS). The serum Tg response to 131I therapy including Tg change and Tg change speed was compared between two groups, and the relationship between serum Tg change speed and structural progression was explored by binary logistic regression analysis. The Tg response to different treatment schemes ( 131I treatment or follow-up) was compared in non-RAI-avid group. χ2 test and Mann-Whitney U test were used to compare data between different groups. Receiver operating characteristic (ROC) curve analysis was used to find the best threshold of Tg change speed to predict the structural progress. Results:After 131I treatment, increased Tg level was found in 60.0% (15/25) patients in non-RAI-avid group ( n=25), while only 21.6%(8/37) patients in RAI-avid group ( n=37; χ2=9.417, P=0.002). Non-RAI-avid group showed an overall increased Tg trend, with a speed of 0.05(-0.16, 0.15) μg·L -1·month -1, while RAI-avid group showed a general decreased Tg trend, with a speed of -0.18(-1.95, 0.01) μg·L -1·month -1 ( U=265.000, P=0.005). A significant correlation between Tg change speed and structural response (odds ratio ( OR)=53.005, P<0.001) was found. When Tg change speed was more than 0.135 μg·L -1·month -1, structural progression could be well predicted with the sensitivity of 87.5% and specificity of 97.1%. In comparison to non-RAI-avid patients with merely follow-up, further 131I treatment for such patients did not yield significant benefit in terms of Tg change and Tg change speed ( χ2=0.071, U=394.000; both P>0.05). Conclusions:The serum Tg monitoring can be more sensitive in evaluating the therapeutic response to 131I for DM-DTC patients in whom response evaluation criteria in solid tumors (RECIST) might not be sensitive enough to reflect the minor change. For patients with non-RAI-avidity, Tg evaluation will offer more sensitive evidence to tailor the necessity of further 131I treatment.

Safety and feasibility of the combined medial and caudal approach in laparoscopic D3 lymphadenectomy plus complete mesocolic excision for right hemicolectomy in the treatment of right hemicolon cancer complicated with incomplete ileus / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the safety and feasibility of the combined medial and caudal approach in laparoscopic D3 lymphadenectomy plus complete mesocolic excision(CME) for right hemicolectomy in the treatment of right hemicolon cancer complicated with incomplete ileus.</p><p><b>METHODS</b>Clinical data of 65 patients with incomplete obstructive right-sided colon cancer (T1 to 4M0) diagnosed by abdominal CT enhanced scan or MRI and/or electric colonscope undergoing laparoscopic right hemicolectomy (D3 lymphadenectomy + CME) at Department of Emergency Medicine and Department of Gastrointestinal Surgery from June 2014 to June 2017 were retrospectively analyzed. Among them, 33 patients received the combined medial and caudal approach (combined medial and caudal approach group) and the other 32 patients received the cephalo medial-to-lateral approach (cephalo medial-to-lateral approach group). The operation highlights of the combined medial and caudal approach group were as follows: (1) The superior mesenteric vein (SMV) was first identified and exposed using the combined medial and caudal approach, and lymph node dissection along the anterior and right of SMV was performed. (2) With horizontal part of duodenum as landmarks, the dorsal mesenteric membrane of terminal ileum was opened by caudal-to-cranial approach, and right retroperitoneal space along the Toldt's space was separated. The anterior of pancreatic head and the right Toldt's space were then exposed. (3) Finally using medial-to-lateral approach, the roots of ileocolic vessels, middle colic vessel and right colic vessel were disconnected and ligated along the left border of SMV. The right branch of gastrocolic trunk of Henle was ligated and lymph node dissection along SMV was performed again. Patients in cephalo medial-to-lateral approach group underwent conventional operation. Baseline information, intraoperative blood loss, operation time, number of harvested lymph nodes, proportion of no less than 12 harvested lymph nodes per case, postoperative hospital stay and postoperative morbidity in both groups were analyzed and compared.</p><p><b>RESULTS</b>Thirty-eight males and 27 females with age of 31 to 72 (56.8±11.7) years were enrolled in this study. There was no significant difference in baseline information between combined medial and caudal approach group and cephalo medial-to-lateral approach group(all P>0.05). Intraoperative blood loss [(106.5±24.5) ml vs. (308.4±27.1) ml, t=-31.501, P=0.000] was significantly less, and operative time [(176.3 ± 18.0) minutes vs. (208.4 ± 47.3) minutes, t=-3.602, P=0.001] was significantly shorter in the combined medial and caudal approach group. The proportion of no less than 2 harvested lymph nodes per case [87.9%(29/33) vs. 84.4%(27/32)], the number of harvested lymph nodes (22.5±8.9 vs. 21.5± 7.6), postoperative morbidity of complication [6.1%(2/33) vs. 12.5%(4/32)] and postoperative hospital stay [(11.9±1.5) days vs. (13.4±4.4) days] were not significantly different between the two groups(all P>0.05).</p><p><b>CONCLUSION</b>The combined medial and caudal approach in laparoscopic right hemicolectomy (D3+CME) in the treatment of incomplete obstructive right-sided colon cancer is safe and feasible, and has advantages of less intraoperative blood loss and shorter operation time compared to the cephalo medial-to-lateral approach.</p>

Batch Inspection of Sildenafil and its Analogues in Anti-fatigue Health Foods by HPLC-MS/MS / 中国药师

Objective:To detect 11 kinds of illegally added chemicals in anti-fatigue health foods including sildenafil ,tadalafil, vardenafil , acetildenafil , homosildenafil , hydorxyhomosildenafil , norneosildenafil , aminotadalafil , pseudovardenafil , thioaildenafil and noracetildenafil.Methods:An HPLC-MS/MS method was used with LUNA C18(250 mm ×4.6 mm, 5μm)as the analysis column and triethylamine phosphate , acetonitrile and methanol as the mobile phase with gradient elution at the flow rate of 1ml.min-1 .An ESI+scan and an MS/MS mode were applied .The qualitative and quantitative analysis were carried out by HPLC-MS/MS.Results:Through the detection of 100 batches of samples , 85 batches were only found illegally added chemical substance sildenafil mainly at the concentration of 5-15 mg per granule .Conclusion:The method of HPLC-MS/MS can be used as a powerful screening tool for the rapid drug screening in basic level drug control laboratories to reduce chemical substances illegally added in anti -fatigue health foods .

Anterior approach for right hepatectomy using liver hanging maneuver in severe blunt liver trauma / 中华普通外科杂志

Objective To evaluate the application value of anterior approach right hepatectomy using the liver hanging maneuver for severe blunt liver trauma.Methods Clinical data of 63 patients with severe blunt liver trauma undergoing right hepatectomy in our hospital from January 2011 to January 2017 were retrospectively analyzed.Among them,31 patients received anterior approach right hepatectomy (anterior approach group,31 cases) while the others did conventional right hepatectomy (conventional approach group,32 cases).Clinical data,intraoperative blood loss,postoperative alanine transaminase (ALT) at POD3,postoperative morbidity and mortality in both groups were analyzed and compared.Results There were eight surgical deaths,one in the anterior approach group and seven in the conventional approach group.All the 31 cases underwent anterior approach right hepatectomy successfully using the liver hanging maneuver.The mean intraoperative blood loss (768 ± 231) ml vs.(1 264 ± 1 248) ml (P ＜ 0.05),postoperative hepatic function ALT value at POD3 (155 ± 89) U/L vs.(689 ± 67) U/L (P ＜ 0.05),postoperative morbidity and mortality of the anterior approach group were markedly superior to conventional approach group (12.9％ vs.34.4％,3.2％ vs.21.9％,all P ＜ 0.05).Conclusions Anterior approach right hepateetomy using the liver hanging maneuver has advantages of decreased intraoperative blood loss,less hepatic function compromise,reduced postoperative morbidity and mortality compared to conventional approach right hepatectomy in cases of severe right liver blunt trauma.

18F-FDG PET/CT imaging in the monitoring of response to sorafenib in patients with radioiodine- refractory differentiated thyroid cancer / 中国癌症杂志

Background and purpose:The evaluation of treatment response is one of the most important building blocks in determining the best strategy for the management of malignant tumors. In lymphoma and several solid cancer types, PET/CT-based response evaluation has been shown to be valuable, especially in visualizing the effect of the targeted treatment, which induces tumor activity changes not necessarily followed by tumor shrinkage. This study aimed to evaluate the role of18F-FDG PET/CT in the monitoring of response to sorafenib treatment in radioiodine-refractory differentiated thyroid cancer (RR-DTC) patients; and to compare the Response Evaluation Criteria in Solid Tumors (RECIST 1.1) with the European Organization for Research and Treatment of Cancer (EORTC) criteria.Methods:This was a single-center retrospective analysis of 14 patients with RR-DTC treated with sorafenib in the period from Dec. 2011 to Dec. 2014. A Wilcoxon signed-rank sum test was used to assess the differences in percentage changes between the sum of diameter and ∑SUVmax. These values of responses were statistically compared using the chi-square test (Fisher’s exact test). The differences in PFS between response categories according to either RECIST 1.1 or the EORTC criteria were evaluated using the Wilcoxon signed-rank sum test. The Spearman rank correlation coefficient was estimated between PFS and either morphologic (RECIST 1.1) or metabolic response (EORTC criteria) categories.Results:There was an agreement between the RECIST 1.1 and EORTC criteria in 10 of the 14 patients (χ2=2.345,P=0.424). The remaining 4 patients with SD in-cluded 2 patients with PMR and 2 patients with PMD. Differences in PFS among different response categories according to either RECIST 1.1 (χ2=8.571,P=0.003) or EORTC criteria (χ2=8.781,P=0.003) were statistically significant. Correlations were found between PFS and either morphologic (r=0.741,P=0.002) or metabolic (r=0.816,P=0.0004) response criteria. Conclusion:18F-FDG PET/CT imaging is of value in the monitoring of response to sorafenib in patients with RR-DTC. Although RECIST 1.1 and EORTC criteria agree in 71.4% patients, PET-based metabolic response criteria seems to be more accurate in predicting therapeutic outcome and may be more suitable than morphologic response criteria for the eval-uation of response to targeted therapy.

Re-differentiating therapy of radioiodine-refractory differentiated thyroid cancer / 中国癌症杂志

Clinical management of radioiodine-refractory differentiated thyroid cancer (RR-DTC) is extremely diffcult. Re-differentiation compounds, such as retinoids, peroxisome proliferator-activated receptor (PPAR) agonists, DNA methyltransferase inhibitors and histone deacetylase inhibitors, have been used in trials to increase iodine uptake in RR-DTC. However, data on these drugs failed to meet the initial high expectations. In recent years, targeted agents have been increasingly used in pre-clinical and clinical studies to induce re-differentiation and mediate131I therapy, and the outcomes are encouraging.

Emergency one-stage intestinal resection and tension-free hernioplasty for acutely strangulated inguinal hernia complicating intestinal necrosis in 58 cases / 中华普通外科杂志

Objective To evaluate the validity and surgical outcome of emergency one-stage intestinal resection and tension-free hernioplasty for acutely strangulated inguinal hernia complicated with intestinal necrosis.Methods Clinical data of 58 patients diagnosed strangulated inguinal hernia and intestinal necrosis in our hospital from July 2011 to April 2014 were retrospectively analyzed.Of the 58 patients,33 were males and 25 were females,mean age of (64 ± 18) years (range 52-86).There were 28 strangulated inguinal and 30 femoral hernias undergoing emergency small bowel resection and tension-free mesh hernioplasty.Patients with intestinal perforations,preoperative peritonitis,inflammatory hernia and those who required colon resections were excluded from the study.Results The mean operative time was (92 ± 22) min (range,80-120 min).Average length of hospital stay was (8.6 ± 2.5) d (range,6-21 d).There were three postoperative c omplications (5.2％):one of subcutaneous hematoma,one of superficial surgical site infection and one of scrotal fluid collection,which were all cured by wound dressing,removal of infected prosthetic mesh,vacuum sealing drainage (VSD) and continuous irrigation,intravenous antibiotics and scrotal puncture.During a follow-up period of 6 to 32 months (mean 12 ± 6 months),there was no hernia recurrence.Conclusions Emergency one-stage intestinal resection and tension-free mesh hernioplasty for strangulated inguinal hernia complicated by intestinal necrosis is safe,feasible with a favourable outcome and low rate of postoperative complications.

Early rapid diagnosis and rational choice of the first-line agents for acute aortic dissection in the emergency department: ses / 中华急诊医学杂志

Objective To explore the rapid diagnosis and the rational chice of the first-line agents for acute aortic dissection (AAD) in the emergency department.Methods The clinical data of 360 patients with AAD treated at our hospital from March 2007 to March 2013 were retrospectively analyzed.Of them,338 patients with suspected AAD were examined by chest radiography,trans-thoracic echocardiography (TTE),and computed tomography angiography (CTA) successively.The reliabilities of results from each diagnostic method were verified by the gold standard of intra-operative findings and the comparisons of their diagnostic potential were carried out.Results The preoperative diagnostic sensitivity of chest radiography,TTE and CTA in the assessment of AAD were 64％,77％ and 100％,respectively;the specificity is 86％,90％ and 100％,respectively;the accuracy rats were 70％,78％ and 100％,respectively;the positive predictive values were 93％,99％ and 100％,respectively;the negative predictive values were 46％,27％ and 100％,respectively.In the work-up of any patient with suspected AAD,the emergency bedside non-invasive TTE or computed tomography was the first-line initial diagnostic screening,and the best method for the accurate diagnosis of AAD was CTA.Medical management included pain control and deliberate hypotension therapy by using rapidly short-acting vasodilator and beta blockers to lower heart rate,and the hibernation therapy in small dose of specific agents might serve as a useful adjuvant method,and the early combination of vasodilatation medicines was better than the single one.Of them,242 patients fortunately survived on treatment,and 42 died of hypovolemic shock after rupture of AAD and multiorgan failure.Conclusions Acute aortic dissection is the most potentially life-threatening cardiovascular disease,though it is extremely rare in the hypertensive patients,attending doctors should pay more attention.Early rapid diagnosis is the key to AAD treatment.The best method for correctly diagnosing AAD is complementary use of TTE,CTA and magnetic resonance angiography (MRA).Correct and timely diagnosis and strictly deliberate hypotension treatment are the essential determinant of decreasing mortality and improving prognosis of AAD.

Effect of CpG ODN on pancreatic cancer cell line PANC1 sensitivity to gemcitabine / 中华胰腺病杂志

Objective To investigate the effects of toll-like receptor 9 (TLR9) agonist CpG ODN2216 on the sensitivity of pancreatic cancer cell line PANC1's to gemcitabine.Methods The immunofluorescence staining method and Western blot method were used to examine the expression of TLR9 protein in PANC1 cells.The changes of sensitivity to gemcitabine after CpG ODN2216 treatment were examined by MTT assay.Results The TLR9 protein was highly expressed in PANC1 cells and the median inhibition concentration of gemcitabine against PANC1 cells was reduced from (1.23 ± 0.14) mg/L to (0.28 ± 0.13) mg/L after CpG ODN2216 treatment,and the difference between the two groups was statistically significant (P ＜0.01).After 0.01,0.10,1.00,10.00 mg/L gemcitabine treatment with CpG 0DN2216,the inhibition rates of PANC1 were (34.4 ±1.3)％,(43.5 ± 2.7)％,(76.3 ± 2.5)％,(95.3 ± 2.2)％ ; and without CpG ODN2216,the inhibition rates of PANC1 were (14.5 ± 0.9) ％,(23.5 ± 1.1) ％,(44.8 ± 1.4) ％,(63.6 ± 1.8) ％,and the difference between the two groups was statistically significant (P ＜ 0.01).Conclusions The sensitivity of PANC1 cells to gemcitabine can be enhanced by CpG ODN2216.

Blood flow image technique for evaluating the effect of hypertension on carotid atherosclerosis / 重庆医学

Objective To investigate the effect of hypertension on carotid atherosclerosis ,and the clinical significance of BFI technique in the diagnosis of carotid atherosclerosis .Methods Using BFI technique and CDFI technique to detect 198 cases of pa-tients with hypertension(hypertension groups) and 200 cases with normal blood pressure(control group) of carotid internal-media thickness(IMT) and the number of atherosclerotic plaque .To explore the relationship between hypertension and carotid atheroscle-rosis .Results IMT and the detection rate of plaque of hypertension groups was significantly higher than which of control group (P<0 .01) .In hypertension groups ,the higher of blood pressure levels ,the higher carotid IMT and the detection rate of plaque(P<0 .01 or P<0 .05) .The detection rate of plaque in BFI technique was higher than which in CDFI technique (P<0 .01) .Conclusion hypertension can aggravate carotid atherosclerosis ,and the higher blood pressure levels ,the more obvious of carotid atherosclerosis . BFI technique is useful for the detection of carotid atherosclerosis .

The clinical significance of IMT and PWV in type 2 diabetic patients / 中国基层医药

Objective To investigate the relationship between intima-media thickness(IMT)and pulse wave velocity(PWV)in patients with type 2 diabetes mellitus.Methods 100 cases with type 2 diabetes were randomly divided into:hydrochlorothiazide group of 35 cases,valsartan group of 35 cases,valsartan and hydrochlorothiazide combined treatment group(combined group)30 cases.All the patients were treated for 16 weeks,systolic blood pressure (SBP),diastolic blood pressure(DBP),24h urinary albumin,blood urea nitrogen(BUN),carotid IMT,PWV,fasting plasma glucose(FPG)were measured before and after treatment in each group.Results The SBP,DBP,24h urinary albumin before treatment compared with after treatment was significant differences in three groups(t =2.7875,2.755,2.733,2.645,all P ＜ 0.05); IMT associated with SBP(r =0.669,P =0.013),pulse pressure(r =0.581,P =0.015),FPG(r =0.337,P =0.018);PWV associated with SBP(r =0.759,P =0.001),pulse pressure(r =0.707,P=0.002),FPG(r =0.679,P =0.016).Conclusion The non-invasive indicators of PWV can be used as aortic compliance.The PWV measurement of its vascular complications has important clinical value.

Multidisciplinary approach to acute massive gastrointestinal bleeding caused by Dieulafoy's lesion / 中华普通外科杂志

Objective To explore the multidisciplinary treatment for acute massive gastrointestinal (GI) bleeding caused by Dieulafoy's lesion.Methods The clinical data of 48 patients with Dieulafoy's lesions treated at our hospital from April 2007 to April 2012 were retrospectively analyzed.Of the 48 patients,40 were males and 8 were females,with a mean age of 46.7 years (range 21 -52 years).Accurate diagnosis was established by emergency upper gastrointestinal endoscopy, angiography and emergency laparotomy.Results The most common location of the bleeding Dieulafoy's lesion was at the body of stomach (40 cases),followed by the cardia (4 cases),the duodenum (2 cases) and the jejunum (2 cases ),with most lesions being located in the upper part of the stomach within 6 cm of the gastroesophageal junction.Correct diagnosis was made by endoscopy in 46 patients and by emergency laparotomy in 2 cases.Of the 18 patients initially treated endoscopically epinephrine injection and endoscopic hemoclips,2 cases needed angiography to identify the source of bleeding and were cured by transcatheter arterial embolization.23 patients underwent surgical therapy.In this series,47 cases were cured,1 patient died of hypovolaemic shock and multi-organ failure during the hospital stay.Average length hospital stay was (10.8 ± 2.5 ) d.Conclusions Dieulafoy' s lesion is less common cause of gastrointestinal bleeding.Endoscopy plays a key role in the diagnosis and treatment.Topical epinephrine injection and haemoclipping may cure the patients,if it fails angiography and embolization provides a therapy.Most patients may need a laparotomy and surgery as a decisive measure.

Early changes of TSH and thyroid hormones after131I ablation treatment in patients with papillary thyroid cancer / 中华内分泌代谢杂志

Objective To investigate the patterns of change in thyroid functional parameters ( serum TSH,FT3, and FT4 ) in patients with papillary thyroid cancer (PTC) before and after the initial 131I treatment for thyroidal remnant ablation. Methods Seventy-four PTC patients, treated with 3.7 GBq 131 I therapy, were divided into two groups, group A with serum TSH＜30 mIU/L and group B with serum TSH ≥30 mIU/L the day before 131I treatment. Five days after the treatment, the patients were re-examined for serum FT3, FT4, and TSH levels.Results In group A (22 cases), 5 days after the 131I ablation treatment, FT4significantly increased by 88% and FT3 by 87%, while TSH decreased by 87% (all P＜0. 05 ), and 45% (10/22)cases manifested the signs of transient thyrotoxicosis. In group B (52 cases)after treatment, individual variance of FT3 and FT4 was obvious,with FT4 decreased by 13% and FT3 decreased by 14% ( both P＜0. 05 ), while TSH slightly increased by an average of 6% ( P＞0.05 ). Conclusion After the initial 131 I ablation therapy for thyroidal remnant, the thyroid hormone levels in some PTC patients significantly increase while in others may slightly decrease in the early stage. The supplementary and suppressive therapy after 131I ablation for PTC patients might be individualized depending on the thyroid hormone determination.

The effect of smoking on resting energy expenditure in patients with early diabetic kidney disease / 中华内科杂志

Objective To study the effect of smoking on resting energy expenditure ( REE ) and the relationships among REE, smoking , inflammation and oxidative stress in patients with diabetic kidney disease. Methods A case control study of 31 smokers and 40 non-smokers with early stage of diabetic kidney disease( stage Ⅲ ) were performed to evaluate the chronic effect of smoking on REE. REE/fat free mass( FFM ), biomarkers of oxidative stress malondialdehyde ( MDA ), superoxide dismutase ( SOD ) and inflammation high-sensitivity C-reactive protein (hs-CRP), adiponectin, TNFα were also measured in these subjects. Data were analyzed by Pearson correlation analysis. Results Compared with non-smokers, REE/FFM in smokers group was significantly increased by 15.96% ( P =0.001 ). Pearson analysis showed that smoking was significantly correlated with REE/FFM ( t = 0.395, P = 0.001 ). There were significantly different between smokers and non-smokers in MDA, SOD and hs-CRP ( P＜0.05 ). But no difference between two groups in adiponectin and TNFα ( P ＞ 0.05 ). No significant relationships between REE/FFM and MDA, SOD, hs-CRP, adiponectin, TNFα was found ( P ＞ 0.05 ). Conclusion Chronic smoking can lead to increased REE, arouse oxidative stress and inflammatory in patients with early stage of diabetic kidney disease. However, there is no relationship between increased REE due to smoking and oxidative stress and inflammatory.

Diagnostic value of free plasma metanephrines for pheochromocytoma / 中华检验医学杂志

Objective To investigate the application value of free plasma metanephrines metanephrine(MN) and normetanephrine (NM) measured with enzyme immunoassay (EIA), NM in diagnosis of pheochromocytoma. Methods Histologically confirmed pheochromocytomas (n=30) and control patients with hypertension (n=51) were enrolled in the study. Blood tests for free plasma metanephrines(MN and NM) were performed with a commercially available EIA kit and the results were compared with [3] I-metaiedobenzyl guanidine (MIBG) whole body scan findings. Results The whole body scan was positive in all pheochromocytoma patients and negative in 15 control patients with 100% accuracy. The median values in the 2 groups were 59.3 ng/L and 33.7 ng/L (Z=-2. 440, P<0.05) for MN, 652.0 ng/L and 36. 3 ng/L (Z=-6.699, P<0.001) for NM, with 96. 7% (29/30) sensitivity, 86. 3% (44/51)specificity and 90.1% (73/81) accuracy for their combination ( either or both positive). There was no significantly statistical difference when compared with 13I-MIBG whole body scan findings (100. 0% ,P >0. 05). Conclusion The results show that the EIA method may be eligible as an alternative to HPLC for plasma metanephrines determination in the identification of pheochromocytoma.

Application of 131I-MIBG scintigraphy in diagnosis of pheochromocytoma / 中国医学影像技术

Objective To assess the clinical value of 131I-metaiodobenzylguanidine (MIBG) scintigraphy in pheochromocytoma. Methods A total of 430 patients with clinically suspected pheochromocytoma underwent 131I-MIBG whole body scintigraphy, 326 among them underwent B-ultrasound, 400 for CT and 77 for MR examination respectively. While 178 among them were diagnosed with pathology and the others were diagnosed clinically. Results Of all the patients, 108 were diagnosed pheochromocytoma, including 89 131I-MIBG scan positive and 19 negative. The sensitivity, specificity and accuracy of 131I-MIBG were 82.41%, 100% and 95.70%, respectively. 131I-MIBG scan detected 90.00% of unilateral adrenal, 45.45% of bilateral adrenal, 85.71% of ectopic and 66.67% of malignant lesions, respectively. The proportion of patients with positive 131I-MIBG scan increased from 20.69% in all patients to 35.15% in patients with clinical symptoms and positive conventional imaging (at least one of B-ultrasonography, CT or MR was positive) and 64.58% in those with clinical symptoms, positive conventional imaging, and elevated 24 h urinary catacholamines. In 59 patients with adrenal incidentaloma, 8 were scan-positive and all had confirmed pheochromocytoma, while 2 of scan-negative patients also had confirmed pheochromocytoma. Conclusion 131I-MIBG scintigraphy is the first choice for the diagnosis of both adrenal and extra-adrenal pheochromocytoma. However, it is inappropriate to take this method as the initial screening approach.

Correlation of hyperuricemia with cardiovascular and cerebrovascular diseases in type 2 diabetes mellitus / 中国基层医药

Objective To investigate the effect of hyperurieemia on cardiovascular and cerebrovaseular complications in type 2 diabetes mellitus(T2DM). Methods According to the level of blood uric acid,430 patients with T2DM were divided into hyperuricemia group and non-hyperurieemia group, the differences of uric acid(UA) ,creatine(Cr) ,total cholesterol(TC) ,triglyeride(TG) ,fasting blood glucose(FBG) ,glycosylated hemoglobin(HbA1c) and body mass index(BMI) were compared,and the occurrences of coronary heart disease, hypertension and acute cerebrovascular accidence were observed. Results The FBG and HbAIc were not significantly different between the two groups(P＞0.05). The BMI ,TG,TC and Cr in the hyperurieemia group were significantly higher than those in the non-hyperuricemia group(P＜0.05 ). The incidence rates of coronary heart disease, hypertension and acute cerebrovascular diseases in the hyperuricemia group were also significantly higher than those in the non-hyperuricemia group (P＜0.05 ). Conclusion Hyperuricemia is obviously correlated with obesity and blood lipid abnormalities. Hyperurieemia can aggravate the metabolic disturbances,and can accelerate the occurrence and development of cardiovascular and eerebrovascular diseases in the patients with T2DM.

Clinical effects of gliclazide sustained-release tablets on type 2 diabetes mellitus / 中国基层医药

Objective To investigate the clinical effects of gliclazide sustained-release tablet for recently diag-nosed type 2 diabetes mellitus. Methods 118 subjects with recently diagnosed type 2 diabetes and normal figure were divided into three groups. The three group subjects used gliclazide sustained-release tablet, repaglinide(import-ed) ,novolin 30R for 12 weeks,respectively. For all pretherapy and post-treatment cases, blood glucose and glycosy-lated hemoglobin were tested before meal. After two hours of meal, blood glucose was tested again. Meanwhile, hypo-glycaemia event was inspected. The test results were analyzed by "mean ± standard deviation" method. Results There are no significant difference(P>0.05) in fasting blood sugar and postprandial blood sugar(2h) level between the group using gliclazide sustained-release tablet and the group using novolin 30R. The clinical effects of both gli-clazide sustained-release tablet and novolin 30R to fasting blood sugar are all better than that of repaglinide(import-ed) (P < 0.01). But there are no significant difference in postprandial blood sugar(2h) level between the group of us-ing gliclazide sustained-release tablet and the following two group: repaglinide(imported) and novolin 30R. Conclu-sion The investigation results show that gliclazide sustained-release tablet is better than repaglinide(imported) in fasting blood sugar. But for the effects of postprandial blood sugar(2h), there is no significant difference between gli-clazide sustained-release tablet, repaglinide(imported) and novolin 30R.