Preliminary results of low-dose computed tomography screening for lung cancer in asymptomatic participants / 中南大学学报(医学版)

OBJECTIVES@#Low dose computed tomography (LDCT) is the best method for early diagnosis of lung cancer. Even though it has been widely used in clinic, the selection of screening objects and the management scheme of pulmonary nodules are still not unified among research institutions. This study aims to evaluate the effect of LDCT in detection effect and follow-up process for pulmonary nodules in asymptomatic participants.@*METHODS@#A total of 1 600 asymptomatic participants (37 to 82 years old), who came from Yantian District People's Hospital, Southern University of Science and Technology, received LDCT. The lung nodules were categorized into positive nodules and semi-positive nodules, and according to the density of positive nodules they were categorized into 4 types: solid nodules (SN), partial solid nodules (pSN), pure ground glass nodules (pGGN), and pleural nodules (PN). The number, detection rate, imaging findings, follow-up change of lung nodules, and the postoperative pathological results of positive nodules were recorded and analyzed.@*RESULTS@#Lung nodules were found in 221 cases by LDCT. The total detection rate of lung nodule was 13.8% (221/1 600), and the detection rate in positive nodules was 4.9% (79/1 600). The detected nodules were mainly single (173 cases), solid (133 cases) and semi-positive nodules (142 cases). Most of nodules (177 cases) had no change in the follow-up process. The enlargement and/or increased density of nodules (5 cases) were lung cancer. Pathological results were obtained in 10 cases, 8 cases were malignant (1 small cell lung cancer and 7 adenocarcinomas), 2 cases were benign (cryptococcal infection and alveolar epithelial dysplasia). The detection rate of lung cancer was 0.5% (8/1 600), and the proportion of early lung cancer was 75% (6/8).@*CONCLUSIONS@#LDCT screening can identify and increase the detection rate in the early lung cancer, which is an effective screening method. It is safe and feasible to take regular follow-up and re-examination for nodules with diameter less than 5 mm. When the size and or density of nodule increases, it indicates the malignant prognosis of the nodule and timely clinical intervention is needed.

New knowledge reserve for medical graduates: Phenotypes and functions of tissue-resident regulatory T cells / 医学研究生学报

Regulatory T cells (Tregs) play important roles in immune homeostasis and tolerance.Recently, several characteristic studies on tissue-resident Tregs have been drawing wide attention.Some tissue-resident Tregs express some special molecules and are involved in the regulation of local tissue functions apart from immune regulation.This article focuses on the functions of some tissue-resident Tregs, such as fat-resident Tregs participating in the regulation of insulin resistance, muscle-resident Tregs in the regeneration and repair of damaged skeletal muscle, and thyroid-resident Tregs in the regulation of thyroid function, aiming to help medical graduates further understand the phenotypes and functions of tissue-resident Tregs.

Effects of N-acetylcysteine, glutathione, and dexamethasone on oxidative stress of human thyrocyte / 中华内分泌代谢杂志

[Summary] The human thyroid epithelium cells were obtained from normal para-adenoma tissues of patients with thyroid adenoma or nodule.Cells were treated with 1 000 IU/ml interferon-γ (IFN-γ) + 10 ng/ml tumor necrosis factor-α (TNF-α),1 mmol/L N-acetylcysteine (NAC),1 mmol/L glutathione (GSH),and 10 μmol/L dexamethasone (DEX) respectively.Malondialdehyde(MDA),glutathioneperoxidase(GSH-Px),and superoxidedismutase(SOD) levels in the cell supernatant were measured.The results showed that IFN-γ+TNF-α significantly increased MDA level (P＜0.05) while decreased GSH-Px and SOD levels (P＜0.05).After NAC,GSH,and DEX intervention,MDA levels all were significantly lowered (all P＜0.05) while GSH-Px and SOD levels were significantly increased compared with IFN-γ+TNF-α stimulation(all P＜0.05).These results suggest that IFN-γ and TNF-α can induce oxidative stress in the human thyrocyte,and this effect is antagonized by NAC,GSH,and DEX via increasing GSH-Px,SOD activity and decreasing MDA content.

Clinical analysis of patients with adult isolated ACTH deficiency / 医学研究生学报

Objective Adult isolated ACTH deficiency ( IAD) is an uncommon and underestimated disorder with high rate of misdiagnosis.This paper aimed to analyze and summarize the clinical features of 6 patients with IAD to have deeper understanding of the disease. Methods Retrospective analysis was made on the data of 6 IAD cases enrolled in Nanjing Hospital of Nanjing Medical University from 2007 to 2015.Statistical analysis was made on the clinical manifestations, therapeutic schemes, laboratory and imaging results, along with outpatient follow-up(ranging from 0.5-10 years), in order to analyze clinical efficacy and prognosis result. Results Of 6 IAD patients, 4 patients showed main symptoms of long-term fatigue, anorexia, weight loss;5 patients were with differ-ent degrees of hypoglycemia (fasting blood glucose2.70 [1.2-3.0]mmol/L), among which 3 had hypoglycemic coma (fasting blood glucose <1.8mmol/L), 1 had chronic hypoglycemia and 1 had asymptomatic hypoglycemia( asymptomatic hypoglycemia by continu-ous glucose monitor system).4 of them had refractory hyponatremia (Serum Na+117 [110-120]mmol/L).ACTH values of all the patients were less than 0.01ng/L.After glucocorticoid replacement therapy, all the patients were followed up for six months after treat-ment and cortisol rhythm, plasma cortisol, urine cortisol, fasting blood glucose, serum sodium of the patients were in normal range, but still at a low level of ACTH. Conclusion The clinical manifestation of IAD is characterized as hypoglycemia, hyponatremia, low ACTH with other normal pituitary hormones.Long-term glucocor-ticosteroid therapy has favorable prognosis for patients with adult isola-ted ACTH deficiency.

Risk factors and etiological characteristics of urinary tract infection in type 2 diabetes mellitus / 中国糖尿病杂志

Objective To explore the risk factors for urinary tract infections in type 2 diabetes mellitus(T2DM )by analyzing the pathogens distribution characteristics and drug sensitivity. Methods A total of 3 ,065 T2DM patients were retrospectively analyzed for the clinical and etiological characteristics of urinary tract infections in T2DM. All patients enrolled in the study were divided into two groups :T2DM with urinary tract infection group (n= 210) and simple T2DM group (n= 132). Data harvested were analyzed by SPSS 19.0. Results Of 3 ,065 patients with T2DM the incidence of urinary tract infection was 6.85%. Compared with T2DM group ,patients in T2DM+ urinary tract infection group were older , with longer duration of diabetes ,higher levels of FPG ,urea nitrogen ,creatinine and 24 hUAlb ,and lower levels of serum albumin ( P< 0.05 ). Logistic regression analysis showed that age ,gender ,duration of diabetes and 24 hUAlb were risk factors and albumin was protective factor for urinary tract infection in T2DM. 84.2% was gram-negative bacteria among the 210 isolated strains of pathogenic bacteria. The top three pathogens were Escherichia coli (65.2% ) ,Enterococcus faecalis (6.2% ) and Klebsiella pneumoniae (5.2% ). Gram-negative bacteria had high sensitivity to Imipenem (100% ) ,Cefoperazone sulbactam (99.2% ) and Amikacin (99.2% ) but low sensitivity to cephalothin (38.1% ) ,piperacillin (35.7% ) and amoxicillin (28.2% ). Conclusion T2DM patients who have the factors including female ,advanced age , long course of diabetes and renal insufficiency are prone to suffer from urinary tract infection. Gram-negative bacteria are the most common pathogens in T 2DM patients with urinary tract infection but bacteria spectrum has changed with percentage of multiple resistant bacteria rising dramatically.

The research progress of immune disorders in type 2 diabetes mellitus / 中国糖尿病杂志

[Summary] The incidence of diabetes mellitus is increasing year by year ,which attracts more and more attention. Scientific researches have demonstrated the role of chronic systemic inflammation and immune dysregulation in the development of type 2 diabetes mellitus (T2DM ). Moreover ,the evidence of islet autoimmunity has also been identified in some patients with T 2DM. These discoveries highlight the potential of immune‐modulatory therapies for T 2DM.

Progress in research on oxidative stress in Graves disease / 医学研究生学报

Graves′disease ( GD) is an organ-specific、autoimmune and hyperthyroid thyroid disease closely related to the TSH receptor antibody ( TRAb) .Oxygen free radicals and the oxidative damage caused by these are closely related to the development and progression for GD .Researches on oxidative stress are providing novel therapeutic targets of GD .

Effect of dexamethasone on inflammatory response of thyrocytes / 中华内分泌代谢杂志

Objective To explore the impact of dexamethasone on inflammatory response of thyrocytes.Methods Primary thyrocytes were extracted from thyroid tissue of patients with Graves' disease.The cells were stimulated with interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α),and cultured in dexamethasone.Thyrocytes were divided into 4 groups:control group,dexamethasone group,TNF-α + IFN-γ group,and dexamethasone+TNF-α+IFN-γ group.Interferon-γ-induced protein 10 (CXCL10) and CCL2 in supernatant of cell cultured in 4 groups were detected by enzyme-linked immunosorbent assay.Cell protein in 4 groups was extracted and GSK-3β,P50,and P100 protein were detected by Western blotting.Results MTT assay demonstrated that 10-5 mmol/L concentration of dexamethasone was optimal for cell culture.The CXCL10 level in TNF-α+IFN-γ group was higher than that in the control group and dexamethasone group (P＜0.01),but no difference was found between dexamethasone+TNF-α+IFN-γgroup and TNF-α+IFN-γgroup(P＞0.05).The CCL2 level in TNF-α+IFN-γ group was higher than that in control group and dexamethasone group(P＜0.01).There was a significant lowering of CCL2 level in dexamethasone + TNF-α + IFN-γgroup compared with TNF-α + IFN-γ group (P ＜ 0.05).The expression of GSK-3β and P100 protein was increased in TNF-α + IFN-γgroup compared with control group.The expression of GSK-3β and P100 protein was lower in dexamethasone+TNF-α + IFN-γ group than that in TNF-α + IFN-γ group.Conclusion TNF-α + IFN-γ could stimulate the secretion of CXCL10 and CCL2 in thyrocytes and thus activate the inflammatory response.Dexamethasone could reduce CCL2 secretion.Dexamethasone had little effect on CXCL10.Dexamethasone could reduce GSK-3β and P100 expressions,and inhibit the activation of NF-κB signaling pathway and thus the inflammatory response.

Study on the realationship between the high density lipoprotein and atherosclerosis / 中国基层医药

Objective To investigate the presence of type 2 diabetes dyslipidemia,and the association with HDL levels and vascular complications in diabetes.Methods Of 524 cases of type 2 diabetes,fasting blood lipids,blood glucose,glycated hemoglobin results,blood basic data,the level of lipid controlling and based data of the patients were observed.The relevance between abnormal blood lipids and vascular atherosclerosis was analyzed.Results Type 2 diabetic patients have lipid metabolism,in 524 type 2 diabetes patients,58.4％ had lipid disorder;The serum level of HDL in atherosclerosis group[(0.8 ±0.26)mmol/L]was significantly lower than that in non-atherosclerotic group[(0.95 ± 0.43)mmol/L](t =1.648,P ＜ 0.05).Conclusion The decreasing of HDL had relationship to vascular atherosclerosis in patients with type 2 diabetes.

Determination of zofenopril and its active metabolite zofenoprilat by a new derivative LC-MS method and their pharmacokinetics in healthy Chinese volunteers / 中国药科大学学报

Aim: A new derivative LC-MS method was developed for the simultaneous determination of zofenopril and its active metabolite zofenoprilat to investigate the pharmacokinetic characteristics of zofenopril and zofenopri-lat in healthy Chinese volunteers after single and multiple oral doses of zofenopril calcium tablets. Methods: Ten Chinese healthy volunteers were given three single oral doses of 15,30, and 60 mg, respectively, and consecutively the multiple doses of 30 mg. The concentration and pharmacokinetic parameters of both the parent drug and the active metabolite were simultaneously determined by derivative LC-MS method using p-bromophenacyl bromide (p-BPB) as the derivative reagent. Results: After the single oral administrations of 15, 30, and 60 mg of zofeno-pril calcium, there was no significant difference in the t_(1/2) of both zofenopril and zofenoprilat among the three do-ses. The values of AUC_(0-24h) and c_(max) for both zofenopril and zofenoprilat showed the good linearities to the dosage over the dose range from 15 mg to 60 mg. There were no significant differences in AUC_(0-24h) and c_(max) for both com-pounds between female and male volunteers. After multiple oral administration( 30 mg once daily for 6 days ), the average steady state plasma concentration( c_(av)) for zofenopril was (5. 07 ±1. 06) ng/mL with the degree of fluctu-ation (DF) of 14. 26 ± 2. 94. The c_(av) for zofenoprilat was (6. 28 ± 1. 87) ng/mL with the DF of 11. 61 ±4. 68. The accumulation index values for zofenopril and zofenoprilat were 0. 94 ± 0. 31 and 0. 83±0. 13, respec-tively. Conclusion: Both zofenopril and zofenoprilat were demonstrated of linear kinetics after single administra-tion and showed no accumulation after multiple administration of the test zofenopril calcium tablets. There was significant difference in the pharmacokinetic characteristics for zofenopril calcium between healthy Chinese and European volunteers.

Clinical application of continuous subcutaneous insulin infusion in elderly type 2 diabetic patients / 中华老年医学杂志

Objective To explore the application of continuous subcutaneous insulin infusion (CSII) in elderly type 2 diabetic patients. Methods Elderly group(n = 415) and control group (n= 461) received the transient CSII intensive treatment. The different regiments and the incidence of hypoglycemia were observed between the two groups. Results The average duration reaching the target blood glucose and the insulin dosage at the target time were similar between the two groups (P>0.05). The insulin basal rate in the elderly patients was lower than that in control group. The incidence of hypoglycemia, especially at night, was significantly higher in the elderly patients.Conclusions CSII could control blood glucose effectively in elderly type 2 diabetic patients, but the basal insulin dosage should be decreased to reduce the risk of hypoglycemia.

Reasonable application of continuous subcutaneous insulin infusion in type 2 diabetic in-patients / 中华内分泌代谢杂志

Objective To study the regiments of continuous subcutaneous insulin infusion (CSII) in admitted type 2 diabetic patients, and to analyse the factors related to its effectiveness and insulin dosage. Methods A total of 1 276 type 2 diabetic patients were treated by CSII. The total efficacy of CSII was evaluted. The use of CSII was also analysed in the newly diagnosed patients, elderly patients, and patients with obese or infectious disease. Results The excellent control of blood glucose were achieved in (5.7±2.6)days in the dosage more early and quickly in the newly diagnosed group than that in the previously diagnosed group after the blood glucose levels achieved good control. The percentage of the patients reached the clinical relieve was also higher in the newly diagnosed group. The incidence of hypoglycemia was significantly higher in the elderly patients with lower basal insulin dosage at night. The bolus insulin dosage in the obese patients was higher than that in the non-obese patients. The patients with infectious disease usually have a higher basal insulin dosage than those without infectious disease. The days needed for achieving good control of blood glucose and the insulin dosage were related to infectious factors, the basal blood glucose and obesity. Conclusion The application of CSII among the patients is varied with different conditions. Blood glucose level, body mass index and infection factors are important to determine the initial insulin dosage.

The levels of intraeythrocytic glutathion and its related factors in IGT and newly diagnosed type 2 diabetes patients / 医学研究生学报

Objective:To evaluate the antioxidant status in IGT and newly diagnosed type 2 diabetes patients, we detected the levels of serum Vitamin E(Vit E), vitamin C(Vit C) and intraerythrocytic glutathion(GSH).Methods:The levels of serum Vit E, Vit C and intraerythrocytic GSH were measured in 32 IGT and 41 newly diagnosed type 2 diabetes patients, and the associated factors with GSH/GSSG (oxidized glutathione) were evaluated.Results:Significant decrease of serum Vit C intraerythrocytic GSH and GSH/GSSG were noted in IGT and newly diagnosed type 2 diabetes patients. There were negative correlation between GSH/GSSG and blood glucose, triglyceride, HbA_(1c) in IGT and newly diagnosed type 2 diabetes patients.Conclusion:The results showed that antioxidant defenses are decreased in IGT and newly diagnosed type 2 diabetes patients. To improve the metabolism of blood glucose and triglyceride may have some beneficial effects on antioxidant defenses in IGT and newly diagnosed type 2 diabetes patients.

MRI Manifestations of the Dural Sinus Thrombosis / 实用放射学杂志

Objective To sum up MRI and MR venography features of the dural sinus thrombosis (DST).Methods The findings of MRI and MR venography in 20 patients with DST were retrospectively analysed.Results MRI showed the normal flowing void of the dural sinus disappeared,instead of the abnormal high signal intensities.The easily involved positions respectively were transversal - sigmoid, superior sagittal and straight sinuses. Some cortical drainage and large internal cerebral veins were also involved . MR venography demonstrated that there were no blood flowing in these involved dural sinuses or veins . The locations of these lesions in MRI were same as that in MRV.Conclusion Because the DST can be directly displayed in MRI and MR venography,they are the most reliable methods of non- invasive diagnosis of DST.