Re-evaluation of the diagnostic value and optimal cutoff point of captopril challenge test in diagnosis of primary aldosteronism / 中华内科杂志

Objective:The aim of the present study was to re-evaluate the diagnostic value and optimal cutoff point of captopril challenge test (CCT) in diagnosis of primary aldosteronism (PA).Methods:This is a retrospective study. All patients with a high risk for PA underwent screening test, and then proceeded to CCT and fludrocortisone suppression test (FST) on different days. The FST was used as a reference standard for PA. The plasma renin concentration (PRC) and plasma aldosterone concentration (PAC) were measured with an automated chemiluminescence immunoassay. Random number method was performed in the patients with unilateral primary aldosteronism (UPA), in order to make the proportion of the analyzed UPA in PA was 35%. Receiver operating characteristic (ROC) analyses were performed to compare diagnostic accuracy.Results:A total of 543 patients with 400 PA patients and 143 essential hypertension (EH) patients were enrolled. The diagnostic value of post-CCT PAC was significantly higher than that of the post-CCT plasma aldosterone-renin ratio (ARR), and that of the PAC suppression percentage, respectively. The area under the ROC curve (AUC ROC) was 0.86 (0.83, 0.89) for PAC, 0.78 (0.74, 0.82) for ARR, and 0.62 (0.56, 0.67) for the PAC suppression percentage (all P<0.01), respectively. The optimal cutoff point of post-CCT PAC for PA was 110 ng/L, in which the sensitivity and specificity were 73.25% and 79.02%, respectively. The diagnostic efficiency of post-CCT PAC was not improved either in combination with PAC suppression percentage or in combination with post-CCT ARR. Conclusions:CCT is a useful test for the confirmation of PA. PAC level of 110 ng/L at 2 h after 50 mg of captopril is recommended as an optimal cutoff point for the diagnosis of PA.

Effect of adrenocorticotropic hormone stimulation during adrenal vein sampling / 中华内分泌代谢杂志

Objective:Aimed to investigate the value of adrenocorticotropic hormone (ACTH) stimulation in adrenal venous blood sampling (AVS).Methods:Patients who diagnosed as primary aldosteronism (PA) and completed successful bilateral cannulation judged by selection index (SI) for routine and(or) ACTH stimulation AVS were enrolled. The lateralization index(LI) was calculated to compare the effect of ACTH stimulation on AVS cannulation success rate and lateralization judgment.Results:A total of 73 patients with PA were enrolled in the study, of whom 28 were confirmed as aldosterone producing adenoma (APA) after unilateral adrenalectomy. Cortisol and aldosterone in peripheral and adrenal veins were significantly increased after ACTH stimulation. The left SI was increased from 6.5(3.0-13.6) to 26.8 (16.9-40.3) ( P<0.01) and the right SI from 20.8(4.8-34.8) to 57.6(35.7-80.9) ( P<0.01) after ACTH stimulation. There was no significant difference on LI before and after ACTH stimulation [7.7(2.3-19.6) vs 5.6(1.9-14.6), P=0.14]. The success rates of left and right adrenal cannulation were increased by 15% and 10% respectively after ACTH stimulation. For 57 patients who were determined in successful cannulation by both routine and ACTH stimulation AVS, 27 patients were determined to have lateralization by both AVS methods, 21 patients were determined to have bilateralization, and the consistency of lateralization by both AVS methods was 84%(48/57). Among the 28 patients who were confirmed to be APA after unilateral adrenalectomy, the correct rate of lateralization by both AVS methods was 89% (25/28). Conclusion:ACTH stimulation is able to improve the success rate of bilateral adrenal vein cannulation, and is helpful to judge AVS results. For patients with successful cannulation, there is no significant difference in lateralization judgment for routine and ACTH stimulation AVS.

Spermatic venous sampling in assisting the diagnosis of reninoma: One case report and literature review / 中华内分泌代谢杂志

To investigate the renal venous and spermatic venous sampling in assisting the diagnosis of reninoma. The case of reninoma was retrospectively reviewed together with the literature review of reninoma diagnosed with renal venous and spermatic venous sampling. A young patient with hypertension and headache was admitted to our hospital. Laboratory test showed high plasma renin concentration (>500 mIU/L), and enhanced computed tomography(CT) in the upper abdomen showed a mass in left inferior renal pole. The concentration of renin in the left spermatic vein was significantly higher than that in renal veins and branches, and peripheral vein, which was considered the left reninoma possibility. The left renal mass was resected surgically and pathologic exam revealed reninoma. The renin level and the blood pressure recoveried normal after operation.The literature reported that the positive rate of renal vein segmental blood collection for locating renin tumor was only 8.3%-64%. The possible reason was that reninoma usually located in the renal cortex, and the tumor blood might be collected by renal capsule vein instead of renal vein. In fact, the renal capsule vein intersects with the lateral division of the spermatic vein, but there have been no reports about the localization of reninoma by spermatic vein sampling. Since renin secreted by reninoma may go into the spermatic vein through renal capsule vein, it should be noted that spermatic venous blood should be collected simultaneously in renal vein sampling when locating reninoma.

Rural students’ perception and satisfaction on Nutrition Improvement Program for Rural Compulsory Education Students across different implementation areas / 中国学校卫生

Objective@#To understand rural students’ perception and satisfaction of the Nutrition Improvement Program for Rural Compulsory Education Students (NIPRCES), and to provide basis for promoting students’ participation in the school feeding program and improving the acceptability of school feeding.@*Methods@#In 3 national pilot counties and 2 local pilot counties of NIPRCES, 1 middle school and 1 primary school were randomly selected. Two classes of 2 364 students from grade 4 to grade 9 were randomly selected and investigated with questionnaires.@*Results@#Students were aware of the policy, with 78.9% of the students reported to be familiar with NIPRCES. The awareness rate of students at the national pilot areas was higher than that in local pilot areas(P<0.05). Students showed positive attitude towards NIPRCES. The median score of students’ understandings of the influence of NIPRCES was 20.0 (18.0, 20.0) points. Students in national pilot areas showed a more positive attitude toward the program than those in local pilot areas(P<0.05). Moderate satisfaction was reported in school feeding, 78.7% of students thought that school provided adequate amount of food, and 60.9% of the students enjoyed the food very much. The main reasons for leftovers were too much in amount(27.4%), repetition of food types (22.8%) and food aversions(9.2%).@*Conclusion@#Students are quite aware of NIPRCES and show moderate satisfaction in school feeding. The awareness and satisfaction are relatively higher among students in national pilot areas than those in local pilot areas. Health promoting schools should be established and students and parents should be advocated to take part in the program, health education need to be promoted in schools. Experiences sharing between different places could help improve the quality and acceptability of school feeding program.

Relationship between placental thickness,MRI signs and postpartum hemorrhage in patients with placenta accreta / 实用放射学杂志

Objective To explore the relationship between placental thickness,MRI signs and postpartum hemorrhage in placenta accreta(PA)patients.Methods 28 PA patients with postpartum hemorrhage and 3 9 PA patients without postpartum hemorrhage were analyzed retrospectively.We compared the clinical features and MRI signs between the two groups,and analyzed the correlation between placental thickness and PA related postpartum hemorrhage.Results The mean placental thickness was significantly higher in the hemorrhage patients (62.04±13.826)mm than that in the patients without hemorrhage (39.72±11.362)mm.Among the clinical features, there were no correlations between age,previous intrauterine operation history,previous cesarean section history and occurrence of the PA related postpartum hemorrhage.The following MRI signs were related to the occurrence of the PA related postpartum hemorrhage,including placenta previa,local bulging of the uterine,heterogeneous signal intensity in the placenta,intraplacental hypointensity bands,intraplacental abnormal vascularity,scar covered by placenta,abnormal signal intensity around the cervix,thinning of myometrium.Conclusion Measurement of placental thickness by MRI combined with placenta previa,local bulging of the uterine,heterogeneous signal intensity in the placenta,intraplacental hypointensity bands,intraplacental abnormal vascularity,scar covered by placenta,heterogeneous signal intensity around the cervix, thinning of myometrium are valuable in predicting PA related postpartum hemorrhage.

Developmentand application of maker education in orthodontics course for undergraduate / 中华医学教育探索杂志

In order to stimulate students' interest in orthodontics and develop their competency in self-directed learning,innovation and practice,we introduced "maker education" into the orthodontics course for undergraduate.In the early stage,the teaching materials were organized based on fragmentation of learning,and the "maker group" is the basic unit.In class,the topics were discussed in the form of flipped classroom.Finally,a series of orthodontic experiments were carried out.This article can provide new ways to improve the quality of orthodontics education.

Tryptophan metabolism change in patients with chronic hepatitis B and hepatitis B cirrhosis and its correlation analysis / 重庆医学

Objective To investigate the tryptophan (Trp) metabolism change in the patients with chronic hepatitis B (CHB) and hepatitis B cirrhosis (HBC) and to analyze the related risk .Methods Eighty-one cases of CHB and 40 cases of HBC hospitalized in the First Affiliated Hospital of Chongqing Medical University from October 2015 to January 2016 served as the stud-y subjects ,and 40 healthy persons as the controls .High performance liquid chromatography -fluorescence detection (HPLC-FD) were adopted to detect the levels of plasma Trp ,kynurenine (Kyp) and its metabolite 5-hydroxy tryptamine (5-HT) .HBV-DNA vi-ral replication number was detected by real-time quantitative PCR .The serological indicators differences among 3 groups were ana-lyzed .The risk factors were analyzed and screened by the Logistic regression analysis and Pearson correlation analysis .Results Compared with the control group ,plasma 5-HT and Trp levels in the CHB group and HBC group were significantly decreased (P<0 .01);plasma Kyn/Trp in the HBC group was significantly higher than that in the other two groups (P<0 .01) .Kyn/Trp in the HBC group was negatively correlated with A/G (r= -0 .686 ,P<0 .01) ,and Kyn/Trp in the CHB group was positively correlated with Log DNA (r= 0 .784 ,P<0 .01) .The Logistic regression analysis indicated that Kyn/Trp was the risk factor of CHB and HBC .Conclusion Detecting plasma Trp and its metabolite can serve as the adjuvant indicators for assessing the progression of hep-atitis B .

Fine-needle aspiration biopsy for thyroid nodules: a clinical and pathological study of 782 patients / 中华全科医师杂志

Objective To evaluate clinical application of thyroid fine-needle aspiration biopsy (FNAB) and its diagnostic value.Methods FNAB was performed for 782 cases during 2005-2009 at China-Japan Friendship Hospital,Beijing and their clinical pathological data were retrospectively analyzed.Cytopathological diagnoses by FNAB were classified as unsatisfactory,benign,atypical cellular lesions,follicular neoplasm,suspicious malignancy and definite malignancy.Results of thyroid cytological and histological examinations of 76 patients with subsequent thyroidectomies were compared to those with FNAB to evaluate its diagnostic accuracy.Results Of 782 FNAB specimens,74.4 % (582/782) were classified as benign,2.6 % (20/782) as malignant,5.6 % (44/782) as follicular neoplasm,3.2 % (25/782) as atypical cellular lesion,2.9% (23/782) as suspicious malignancy and 11.3 % (88/782) as unsatisfactory.Among 76 patients with thyroidectomies,65.8 % of them (50/76) were histologically diagnosed as benign lesion,28.9 % (22/76) as definite malignancy and only 5.3 % (4/76) as benign follicular adenoma.Agreement between FNAB cytological diagnoses and histologically confirmed diagnoses for benign lesion and malignancy was 16/16 and 16/17,respectively.Conclusion FNAB is a reliable diagnostic method for evaluation of thyroid nodules.

Primary thyroid lymphoma:report of 7 cases and review of literature / 中国实用内科杂志

Objective To investigate the clinical characteristics of primary thyroid lymphoma(PTL) and its prognostic factors.Methods Clinical and pathological data of 7 cases diagnosed as primary thyroid lymphoma were retrospectively analyzed.Results All of the 7 patients were diagnosed on thyroidectomy and presented with thyroid nodules,of whom 6 cases were middle-aged to elderly women and some had locally oppressive symptoms.Four cases were diagnosed as diffuse large B non-Hodgkin's lymphoma (DLBCL) and 3 were mucosa-associated lymphoid tissue B-cell lymphoma (MALT).Pathological subtype of mucosa-associated lymphoid tissue B-cell lymphomas and younger patients had better prognosis.Conclusion The possibility of PTL must be kept in mind in the differential diagnosis of thyroid nodules in middle-aged to elderly women.Age and pathological subtype are important prognostic factors.

Fine-needle aspiration for thyroid nodules:a comparative study of cytology and histology in 74 cases / 西安交通大学学报(医学版)

Objective To investigate the diagnostic value of fine-needle aspiration(FNA) for thyroid nodules.Methods The cytological and histological results of 74 patients who had undergone FNAs for thyroid nodules,followed by thyroidectomy,were compared to evaluate the accuracy of cytological diagnosis of thyroid FNA and analyze the common causes of missed diagnosis and misdiagnosis in thyroid cytopathology.Results Benign lesions were histologically diagnosed in 48 patients(65%),malignant tumors in 22 cases(30%) and benign tumors in 4 cases(5%).Cytological diagnosis of benign and malignancy was confirmed histolopathologically in 96% and 94%,respectively.Fifteen discrepant cases came mainly from the group of FNA diagnosis of follicular neoplasm,and the discrepancies resulted mainly from cytodiagnostic errors and overlapping cytological features between adenomatoid nodule and follicular neoplasm.Conclusion Despite some limitations,thyroid fine-needle aspiration is a reliable diagnostic method of assessing thyroid nodular disease,especially in differentiation of benign lesion and malignant lesion.