Research advances in the clinical diagnosis and treatment of pheochromocytoma and paranganglioma / 现代泌尿外科杂志

Pheochromocytoma and paranganglioma (PPGL) is a rare neuroendocrine tumor. In recent years, the continuous development of multimodal imaging, pathonomics, genomics, transcriptomics, epigenomics, metabolism and proteomics have provided us with ideas to better understand the complex transfer mechanism of PPGL. This paper will review the precise typing system of PPGL, current research advances in the diagnosis and clinical prognosis.

The efficacy and safety comparison of transperitoneal laparoscopic adrenalectomy and retroperitoneal laparoscopic adrenalectomy for adrenocortical carcinoma / 中华泌尿外科杂志

Objective:To compare the efficacy and safety of retroperitoneal laparoscopic adrenalectomy (RLA) and transperitoneal laparoscopic adrenalectomy (TLA) in the treatment of localized adrenocortical carcinoma (ACC).Methods:The data of 22 patients with stage Ⅰ/Ⅱ ACC underwent laparoscopic adrenalectomy in our institution from January 2009 to December 2018 were retrospectively analyzed. According to the different surgical approaches, these patients were divided into RLA and TLA groups. Eleven patients underwent RLA and 11 patients underwent TLA. There were no significant differences between the RLA group and the TLA group in terms of age at first diagnosis[44 (35, 54) vs. 46(41, 55) years, P= 0.793], sex (male/female: 3/8 vs. 4/7, P = 1.00), secreting tumor ratio (3/11 vs. 4/11, P = 1.00), tumor location (left/right: 6/6 vs. 7/4, P = 1.00), with hypertension or diabetes mellitus (4/11 vs. 3/11, P = 1.00). However, RLA has significantly smaller tumor size [3.0(2.5, 8.4) cm vs. 7.7(5.2, 8.4)cm, P= 0.001], and more stage Ⅰ patients [90.9%(10/11) vs. 18.2%(2/11), P=0.002], compared with those in TLA group. The perioperative indicators and oncology prognosis outcomes were collected and compared between the two groups. The Kaplan-Meier method was performed to calculate the overall survival (OS) and disease-free survival (DFS). Results:Compared with TLA, RLA had shorter operation time[90(70, 100) vs. 110 (90, 120) min, P = 0.005] and postoperative drainage tube removal time [2 (2, 3) vs. 3 (2, 6) day, P = 0.002), and the difference was statistically significant. In the TLA group, one patient was converted to open operation due to intraoperative tumor capsule rupture. For postoperative complications, one patient in the TLA group suffered with wound infection. There were no perioperative deaths in either group. All postoperative pathological examinations confirmed ACC, and there was no significant difference in Ki-67 index between the two groups [10%(3%, 35%) vs. 10%(9%, 25%), P = 0.484]. The median follow-up was similar in the two groups [48(26, 98) vs. 31(18, 49) months, P=0.237]. The local recurrence and metastasis rates were 36.4% for RLA group and 63.6% for TLA group ( P = 0.395). Survival analysis showed no statistically significant difference in DFS [5-year DFS rate: 33.6% vs. 73.2%, P = 0.118] between the two groups. The 5-year OS rates for RLA group versus TLA group were 58.3% vs. 45.5% ( P=0.485). Conclusions:For localized (stage Ⅰ/Ⅱ) ACC, both RLA and TLA seem safe and feasible, based on the similar long-term oncological prognosis. However, compared with TLA, RLA has the advantage of shorter operation time and postoperative drainage tube removal time. Due to the small number of cases included in this study, further multi-center, large-sample studies are required to demonstrate clear benefit of one surgical approach in the future.

Predictive value of transvaginal ultrasound measurement of cervical length in first and second trimester on spontaneous preterm birth in singleton pregnancies / 中华围产医学杂志

Objective:To explore the predictive value of transvaginal ultrasound measurement of cervical length (CL) in the first and second trimester on spontaneous preterm birth in singleton pregnant women.Methods:This study retrospectively recruited 2 254 singleton pregnancies without severe comorbidities at Peking University First Hospital from January 2019 to June 2019. CL was measured for all subjects using transvaginal ultrasound in the first (11-13 +6 weeks) and second trimester (21-23 +6 weeks). Differences in CL between women with preterm (preterm group) and full-term delivery (full-term group) as well as the CL during the first and second trimester were compared. The independent risk factors for preterm birth and the predictive value of CL in the first and second trimester for spontaneous preterm birth were also explored. Fisher's exact test, t-test, χ2 test, and logistic regression analysis, etc, were adopted for statistical analysis. Results:(1) For the 2 254 subjects, CL measured in the first trimester and second trimester were (36.1±4.2) mm (22.4-52.6 mm) and (36.9±5.3) mm (2.9-59.7 mm), respectively. The incidence of short cervix in the first trimester and second trimester were 0.31% (7/2 254) and 1.46% (33/2 254), respectively. When CL was ≤25.0 mm ( OR=43.92, 95% CI:6.83-282.49) or >25.0-≤30.3 mm ( OR=6.59, 95% CI:1.97-22.0) in the first trimester, the risk of short cervix increased in the second trimester (both P<0.05). (2) The total incidence of preterm delivery was 3.06% (69/2 254). CL and the incidence of short cervix did not differ significantly in the first trimester between the preterm and full-term group [(35.2±4.5) and (36.1±4.1) mm, t=－1.78, P=0.076; 1.5% (1/69) and 0.3% (6/2 185), χ 2=2.98, P=0.084]. Compared with the full-term group, CL was shorter and the incidence of short cervix was higher in the second trimester in the preterm group [(33.6±6.7) vs (37.0±5.2) mm, t=－5.12;8.7% (6/69) vs 1.2% (27/2 185), χ 2=25.80, P<0.001]. (3) Multivariate regression analysis showed that age ≥35 years ( OR=2.05, 95% CI:1.22-3.46), history of spontaneous preterm birth ( OR=25.25, 95% CI:5.01-127.28), conception assisted by reproductive technology ( OR=10.39, 95% CI:2.39-50.33), and short cervix during the second trimester were independent risk factors for premature delivery. (4) There was no significant difference in the risk of preterm delivery when comparing to those with CL≤25.0 mm, >25.0-≤30.3 mm, >30.3-≤33.0 mm, >33.0-≤35.7 mm, >35.7-≤38.7 mm women with CL>38.7 mm during the first trimester (all P>0.05). The risk of premature delivery was relatively increased for those with CL≤25.0 mm,>25.0-≤29.5 mm, >29.5-≤33.6 mm, >33.6~≤36.8 mm, >36.8~≤40.1 mm during the second trimester compared to those with CL>40.1 mm [ OR (95% CI):17.64 (4.99-62.32), 6.89 (2.11-22.55), 3.58 (1.34-9.59), 4.04 (1.58-10.32), 3.34 (1.28-8.67), respectively , all P<0.05]. (5) When CL≤25.0 mm and ≤29.5 mm in the second trimester were used as the cut-off value, the prediction of preterm delivery was with a sensitivity of 8.70% and 17.39%, specificity of 98.80% and 95.29%, positive predictive value of 18.20% and 10.43%, negative predictive value of 97.16% and 97.34%, and the accuracy rate of 96.01% and 92.90%, respectively. Conclusions:There were no significant differences in CL and the incidence of short cervix during the first trimester among women with preterm or full-term delivery. CL in the first trimester is not an independent risk factor for preterm birth, but the risk of short cervix in the second trimester is increased when CL≤30.3 mm in the first trimester. The shorter the cervix during the second trimester, the greater the risk of preterm birth.

Clinical characteristics of rare adrenal angiomyolipoma / 中华泌尿外科杂志

Objective:To analyze the clinical characteristics of rare adrenal angiomyolipoma.Methods:Clinical data of 5 patients with adrenal angiomyolipoma admitted to West China Hospital of Sichuan University from April 2009 to April 2019 were retrospectively analyzed. There were 2 males and 3 females. Age ranged from 40 to 57 years old, with an average of 46.7(40-57) years old. Clinical manifestations included right upper abdominal mass in 1 case, pain in the lower back in 1 case, and no significant symptoms were found in the rest. One patient was complicated with hypertension, one patient was complicated with decreased activities of epinephrine, norepinephrine and renin activity (orthosis), and the other patients had no abnormal hormones. 2 patients underwent abdominal ultrasound with " strong echo mass in adrenal area" , and all underwent enhanced abdominal CT with " space occupying lesion in adrenal area" , which was specifically manifested as tumors with mixed density in fat, blood vessels, muscle and so on. The average tumor diameter was 5.8(2.3-9.1) cm, including 2 cases on the left, 3 cases on the right, and 1 case with renal angiomyolipoma. All patients underwent laparoscopic adrenal tumor resection.Results:All the 5 patients underwent surgical resection successfully and were diagnosed as adrenal angiomyolipoma by pathological examination of tumor specimens after surgery. There was no significant change in blood pressure level of patients with hypertension after surgery. Follow-up time was 2-7 years and no recurrence.Conclusions:Adrenal angiomyolipoma is an extremely rare benign nonfunctional disease, which is more common in middle age. Most of the patients had no clinical history and signs. The tumor has no hormone secretion function and can be basically diagnosed with CT and other imaging examinations. The final diagnosis depends on pathological examination. After operation, the prognosis of adrenal angiomyolipoma is good.

Analysis of thyroid iodine uptake rate and 99Tc m imaging in the treatment of Graves hyperthyroidism with 131I / 中国医师杂志

Objective:To investigate the relationship between thyroid iodine uptake rate, 99Tc m imaging and treatment of Graves' hyperthyroidism with 131I. Methods:132 patients with Graves' hyperthyroidism were analyzed retrospectively. According to the difference of thyroid 24-hour iodine uptake rate, they were divided into group A (≤50%), group B (50%-80%) and group C (≥80%). According to the trend of iodine uptake rate curve, they were divided into peak advance group (6 h/24 h iodine uptake rate ratio >1) and non-peak advance group (6 h/24 h iodine uptake rate ratio≤1). Thyroid 99Tc m imaging was divided into three groups according to quality, including group 1 (≤30 g), group 2 (30-60 g) and group 3 (≥60 g). The therapeutic effects of 131I in different types of patients were compared. Results:132 patients were followed up for 6 months after the first 131I treatment. The total effective rate, total cure rate and uncured rate were 88.6%(117/132), 78.0%(103/132), 22.0%(29/132), respectively. The serum thyroxine levels of patients with different 24-h iodine uptake rates in the three groups after treatment were significantly lower than those before treatment ( P<0.05). The lower the 24-h iodine uptake rate of thyroid, the more significantly the serum total triiodothyronine (TT3), total triiodothyronine (TT4), free triiodothyronine (FT3) and free thyroxine (FT4) levels decreased after treatment, the more obvious the increase of thyroid stimulating hormone (TSH), and the more obvious the treatment effect ( P<0.05). The cure rate (13/29, 44.8%) in the peak advance group was significantly lower than that in the non peak advance group (90/103, 87.4%), with statistically significant difference (χ 2=23.899, P<0.001). There was significant difference in the cure rate among the three groups with different thyroid 99Tc m imaging quality (χ 2=15.502, P<0.001). Conclusions:With the increase of thyroid mass, the higher the 24-h iodine intake rate, the more obvious the peak shift, the lower the cure rate, the higher the non-healing rate, and the lower the incidence of hypothyroidism.

Pre-operative 8 am plasma total cortisol level predicts survival for adrenal cortical carcinoma after surgery / 中华泌尿外科杂志

Objective To investigate the effects of preoperative 8 am plasma total cortisol level (PTC) on the prognosis of adrenocortical carcinoma (ACC).Methods A total of 44 patients from January 2009 to October 2017 with ACC were included,PTC level within one week before surgery,clinical and pathological data were collected.The mean age of the patients was (45.2 ± 15.2) years.There were 27 females and 17 males.The mean tumor diameter was (63.6 ± 20.7) mm.There were 20 cases with functional ACC,in which 18 patients presented symptoms associated with Cushing syndrome.According to ENSAT stage,9 patients were staged as stage Ⅰ,and 35 were staged as stage Ⅱ.The median pre-operative 8 am PTC was 572.6 nmol/L,range from 89.3 to 1 118.7 nmol/L.Open adrenalectomy was employed in 23 patients and laparoscopic approach in 21 patients.The optimal cut-off value of pre-operative PTC was determined by receiver operating characteristic curve (ROC) and patients were divided into two groups with high PTC and low PTC values.Kaplan-Meier method was used to draw the survival curve,univariate and multivariate Cox regression were used to explore factors influencing the prognosis of ACC patients.Results The median follow-up duration was 42 months,range from 3-104 months.The optimal cut-off value was determined as 476.2 nmol/L,baseline and clinic-pathologic characteristics differences between two groups were not statistical significant (P ＞ 0.05).The overall survival (OS) in the high PTC group was shorter than that in the low PTC group [median 18months (20-104 months) vs.40 months (5-98 months),P =0.014],and the recurrence free survival (RFS) of patients in the high PTC group was also shorter than that in the low PTC [median 26 months (0-104 months) vs.50 months (5-98 months),P =0.028).In univariate analysis,age,gender,tumor stage,preoperative PTC,and symptoms were correlated with postoperative OS and RFS (P ＜ 0.05).After adjusting for age,gender,tumor stage,symptoms,multivariate Cox regression showed that pre-operative high PTC was an independent prognostic factor associated with a decreased OS (HR =2.086,95 ％ CI 1.495-2.287,P =0.014) and decreased RFS (HR =2.234,95％ CI 1.546-2.334,P =0.045).Conclusion The preoperative morning PTC is an independent risk factor for the prognosis of ACC.

Standardized diagnosis and treatment of primary aldosteronism from a surgeon's perspective / 中华泌尿外科杂志

Primary aldosteronism (PA) is a subtype of adrenal diseases in urological department,which is the most common cause of secondary hypertension.In recent years,great improvements and achievements have been made in the field of diagnosis and treatment of adrenal hypertension in China,however,there are some insufficiencies in the process of screening,diagnosis,function diagnosis and treatment.Because of the disease complexity and different levels of health care among China,it's necessary for urological doctors to learn about the standarization of diagnosis and treatment of PA.This review gives emphasize on the common problems during the process of diagnosis and treatment of PA.We highlight the principle in standarization of diagnosis and treatment of PA by discussing epidemiology,screening,multidisciplinary team building,adrenal venous sampling and treatment strategy,hoping to improve clinical practice of adrenal hypertension in China.

Clinical value of 99Tcm-MIBI SPECT/CT in the diagnosis of hyperparathyroidism / 中国医师杂志

Objective To evaluate the clinical value of 99Tcm-sestamibi (MIBI) single photon emission computed tomography/computerized tomography (99Tcm-MIBI SPECT/CT) imaging in hyperparathyroidism (HPT),and to investigate the diagnostic significance of different phase tomographic imaging and compare with 99Tcm-MIBI dual phase plane imaging.Methods All 54 patients underwent 99Tcm-MIBI dual-phase planar imaging,99Tcm-MIBI SPECT/CT early tomographic fusion imaging,delayed tomographic fusion imaging.According to the clinical diagnostic criteria,the sensitivity of three imaging methods in the diagnosis of hyperparathyroidism and the lesions was analyzed.Results (1) The diagnostic sensitivity of the 99Tcm-MIBI dual-phase planar imaging was 75.9％ (41/54).The diagnostic sensitivity of the 99Tcm-MIBI SPECT/CT early tomographic fusion imaging was 88.9％ (48/54).The diagnostic sensitivity of 99Tcm-MIBI SPECT/CT delayed tomographic fusion imaging was 77.8％ (42/54).(2) There were 74 lesions diagnosed by 99Tcm-MIBI dual phase planar imaging,95 lesions diagnosed by 99Tcm-MIBI SPECT/CT early stage fusion imaging,and 78 lesions diagnosed by 99Tcm-MIBI SPECT/CT delayed fusion imaging.The detection rate of positive lesions in early stage tomography was the highest.(3) There were 4 cases of ectopic parathyroid lesions diagnosed by early CT fusion imaging,3 cases by dual phase planar imaging and delayed CT fusion imaging.Conclusions 99Tcm-MIBI SPECT/CT is an effective method to locate the focus of HPT,especially early tomographic fusion imaging combined with serum parathyroid hormone (PTH) value can improve the diagnostic efficiency.

Clinical value of 99Tcm-MIBI SPECT/CT in the diagnosis of hyperparathyroidism / 中国医师杂志

Objective@#To evaluate the clinical value of 99Tcm- sestamibi (MIBI) single photon emission computed tomography/computerized tomography (99Tcm-MIBI SPECT/CT) imaging in hyperparathyroidism (HPT), and to investigate the diagnostic significance of different phase tomographic imaging and compare with 99Tcm-MIBI dual phase plane imaging.@*Methods@#All 54 patients underwent 99Tcm-MIBI dual-phase planar imaging, 99Tcm-MIBI SPECT/CT early tomographic fusion imaging, delayed tomographic fusion imaging. According to the clinical diagnostic criteria, the sensitivity of three imaging methods in the diagnosis of hyperparathyroidism and the lesions was analyzed.@*Results@#⑴ The diagnostic sensitivity of the 99Tcm-MIBI dual-phase planar imaging was 75.9%(41/54). The diagnostic sensitivity of the 99Tcm-MIBI SPECT/CT early tomographic fusion imaging was 88.9%(48/54). The diagnostic sensitivity of 99Tcm-MIBI SPECT/CT delayed tomographic fusion imaging was 77.8%(42/54). ⑵ There were 74 lesions diagnosed by 99Tcm-MIBI dual phase planar imaging, 95 lesions diagnosed by 99Tcm-MIBI SPECT/CT early stage fusion imaging, and 78 lesions diagnosed by 99Tcm-MIBI SPECT/CT delayed fusion imaging. The detection rate of positive lesions in early stage tomography was the highest. ⑶ There were 4 cases of ectopic parathyroid lesions diagnosed by early CT fusion imaging, 3 cases by dual phase planar imaging and delayed CT fusion imaging.@*Conclusions@#99Tcm-MIBI SPECT/CT is an effective method to locate the focus of HPT, especially early tomographic fusion imaging combined with serum parathyroid hormone (PTH) value can improve the diagnostic efficiency.

Value of three-dimensional multi-slice spiral computed tomography imaging in the diagnosis and activity evaluation of Crohn's disease / 中国医师杂志

Objective@#To evaluate the diagnostic value of three-dimensional multi-slice spiral computed tomography (CT) imaging in Crohn's disease(CD) of small intestine and its active and remission stages.@*Methods@#The clinical and CT data of 34 patients with Crohn's disease confirmed by digestive endoscopy were retrospectively analyzed. According to whether the lesions were active, the patients were divided into active group (25 cases) and remission group (9 cases). The difference of CT signs between the two groups was compared. Chi square test was used to evaluate the diagnostic efficiency of CT three-dimensional imaging for polyps and their activity evaluation of Crohn's disease.@*Results@#The incidences of intestinal wall stratification, moderate enhancement, severe enhancement, ulcer, cellulitis, lymph node enlargement and wood comb sign in active group were higher than those in remission group (χ2=20.193, 9.018, 4.986, 3.947, 9.551, 4.986, 6.766, 4.986 respectively, P<0.05). The incidence of intestinal wall monolayer thickening, non-enhancement, mild enhancement and abdominal abscess in remission group was higher than that in active group, with significant difference (χ2=15.092, 13.768, 25.336, 16.996, P<0.05). while there were no significant difference between the two groups in the incidence of pneumoperitoneum, intestinal stenosis and enlargement (P>0.05).@*Conclusions@#Spiral CT three-dimensional reconstruction imaging can show the intestinal wall thickening, intestinal lesions and parenteral complications of Crohn's disease comprehensively, carefully and intuitively, and play an important role in guiding clinical treatment by evaluating the active and remission stages of CD.

Value of three-dimensional multi-slice spiral computed tomography imaging in the diagnosis and activity evaluation of Crohn's disease / 中国医师杂志

Objective To evaluate the diagnostic value of three-dimensional multi-slice spiral computed tomography (CT) imaging in Crohn's disease(CD) of small intestine and its active and remission stages.Methods The clinical and CT data of 34 patients with Crohn's disease confirmed by digestive endoscopy were retrospectively analyzed.According to whether the lesions were active,the patients were divided into active group (25 cases) and remission group (9 cases).The difference of CT signs between the two groups was compared.Chi square test was used to evaluate the diagnostic efficiency of CT three-dimensional imaging for polyps and their activity evaluation of Crohn's disease.Results The incidences of intestinal wall stratification,moderate enhancement,severe enhancement,ulcer,cellulitis,lymph node enlargement and wood comb sign in active group were higher than those in remission group (x2 =20.193,9.018,4.986,3.947,9.551,4.986,6.766,4.986 respectively,P ＜ 0.05).The incidence of intestinal wall monolayer thickening,non-enhancement,mild enhancement and abdominal abscess in remission group was higher than that in active group,with significant difference (x2 =15.092,13.768,25.336,16.996,P ＜0.05).while there were no significant difference between the two groups in the incidence of pneumoperitoneum,intestinal stenosis and enlargement (P ＞ 0.05).Conclusions Spiral CT three-dimensional reconstruction imaging can show the intestinal wall thickening,intestinal lesions and parenteral complications of Crohn's disease comprehensively,carefully and intuitively,and play an important role in guiding clinical treatment by evaluating the active and remission stages of CD.

Gold standard for primary aldosteronism subtype diagnosis: adrenal vein sampling / 中华内分泌外科杂志

Adrenal vein sampling (AVS),as the gold standard of subtype diagnosis for primary aldosteronism,can directly detect the hormone concentration in adrenal vein by adrenal vein cannulation.Adrenal tumor can be categorized into no function adenoma,adrenal carcinoma,aldosterone producing adenoma (APA),cortisol producing adenoma (CPA) and pheochromocytoma.Traditionally,peripheral blood hormone testing and image examination were performed to make functional diagnosis of adrenal tumor,which exhibits low specificity and sensitivity.On the contrary,AVS can help make a distinct lateralization diagnosis according the aldosterone concentration of each gland,even in the condition of bilateral adrenal tumor and early stage tumor,which is difficult to make functional lateralization diagnosis by traditional methods.AVS can be categorized into simultaneous sampiing and sequencing sampling,according to the order of sampling.According to using adrenocorticotropic hormone (ACTH) or not,AVS can be categorized into no stimulus sampling and post-stimulus sampling.

Effect of regulating peroxisome proliferator-activated receptor γ on soluble endoglin expression in first-trimester trophoblasts / 中华围产医学杂志

Objective To investigate the effect of regulating peroxisome proliferator-activated receptor γγ (PPAR γ) on soluble endoglin (sEng) expression in first-trimester trophoblasts via an in vitro study.Methods Chorionic villus were collected from 20 samples of first-trimester artificial abortion in Peking University First Hospital from July 1 st to 31 st,2016.Primary culture of trophoblast cells was performed.Trophoblast cells from each sample were divided into three groups,which were PPAR γ antagonist group,PPAR γ antagonist and PPAR γ agonist group,and control group.Supematant sEng level was detected in each group by enzyme linked immunosorbent assay (ELISA).Paired-sample t test was used for statistical analysis.Results Compared with the control group,trophoblast cells in the PPAR γ antagonist group grew slower and were reduced in number.No significant difference in growth or morphology of trophoblast cells was observed between the PPAR γγ antagonist and PPAR γγ agonist group and the control group.Supernatant sEng level was elevated in the PPAR γ antagonist group,but was not significantly changed in the PPAR γ antagonist and PPAR γ agonist group as compared with that in the control group [(124.1 23.8) vs (94.0± 12.7) pg/ml,t=-4.31,P＜0.05;(87.1 ± 10.6) vs (94.0± 12.7) pg/ml,t=1.62,P=0.12).Conclusions Suppression of PPAR γ promotes sEng expression in trophoblast cells and that can be reversed by PPAR γ agonist.

Placental endoglin expression in women with severe preeclampsia / 中华围产医学杂志

Objective To investigate the relationship between placental endoglin expression and the pathogenesis of severe preeclampsia (SPE). Methods Forty nine pregnant women with SPE and 40 normal pregnant controls were collected in Peking University First Hospital from January 2006 to January 2008,among which,nine SPE patients complicated with fetal growth restriction (FGR),six with hemolysis,elevated liver enzymes and low platelets syndrome (HELLP syndrome) and 12 with heavy proteinuria. The expression of placental endoglin was detected and semi-quantified by immunohistochemistry.Data were analyzed by independent sample t test. Results Endoglin was presented on cell membranes of placental syncytiotrophoblasts and vascular endothelial cells. The endoglin density of SPE group was higher than that of control group (0.1621± 0.0029 vs 0.1576 ± 0.0038,t=- 6.367,P＜0.05).No significant difference in endoglin density was found between FGR group and non-FGR group (0.1611±0.0026 vs 0.1623±0.0029,t=1.107,P＞0.05) ; neither did the heavy proteinuria group and non-heavy proteinuria group (0.1611±0.0032 vs 0.1624±0.0027,t=1.350,P＞0.05).The endoglin density of HELLP group was lower than that of non-HELLP group (0.1595±0.0032 vs 0.1625±0.0027,t=2.495,P=0.016). Conclusions The elevated placental endoglin expression might contribute to the pathogenesis of SPE.

The value of helical computed tomography in differential diagnosis of xanthogranulomatous cholecystitis and wall-thicked gallbladder cancer / 中华消化杂志

Objective To explore the value of helical computed tomography (CT) in differential diagnosis of xanthogranulomatous cholecystitis (XGC) and wall-thicked gallbladder cancer (GBC).Methods The CT signs of 18 XGCs and 20 wall-thicked GBCs were retrospectively analyzed.The maximum thickness of gallbladder wall, intramural hypoattenuated nodules, mucosal line of gallbladder inner wall,patterns of enhancement of thickened wall,whether combined with stones,the pericholecystic adjacent liver tissue involvement and biliary tract obstruction were observed.Measurement data were analyzed by independent sample t test and count date were analyzed by Fisher precisely the probability method.Results The mean maximum thickness of the gallbladder wall of XGC and wall-thicked GBC was (22.11±10.19) mm and (20.55±7.94) mm respectively,and there was no statistical significance (t=0.530,P=0.600).Eighteen cases of XGC and five cases of wall- thicked GBC patients were with intramural hypoattenuated nodules (Fisher precisely the probability method,P＜0.01 ),14 cases of XGC and six cases of GBC were with integrated mucosal line (Fisher precisely the probability method,P =0.004 ),three cases of XGC and 12 cases of GBC were with biliary tract obstruction (Fisher precisely the probability method,P=0.009).There was no statistical significance in the CT signs of the range of wall thickness,patterns of enhancement and enhanced degree of thickened wall,adjacent liver tissue involvement, lymphadenopathy, combined with gallbladder or bile duct stone between XGC and wall-thicked GBC patients (Fisher precisely the probability method,all P ＞ 0.05).Conclusions The thickened gallbladder wall with intramural hypoattenuated nodules and integrated gallbladder inner wall mucosal line were characteristic signs for diagnosing XGC.Helical CT scanning can provide evidence for differential diagnosis in XGC and wall- thicked GBC.

Efficacy and safety of sunitinib in the treatment of metastatic renal cell carcinoma / 中华泌尿外科杂志

Objective To investigate the efficacy and side effects of the molecular targeted drug sunitinib in the treatment of metastatic renal cell carcinoma(mRCC). Methods Fifteen patients with histopathological confirmed mRCC,including 10 males and 5 females,were enrolled in the study.The median age was 56(range from 37 to 73 years).Fourteen cases of clear-cell RCC and 1 papillary RCC were diagnosed.Thirteen patients had prior nephrectomy,and 6 patients were treated with cytokines previously.All of the patients were given sunitinib at a dosage of either 50 mg daily(4 weeks on/2 weeks off)or 37.5 mg daily continuously.Objective response rate(ORR),progressive-free survival(PFS)and overall survival(OS)were evaluated,and adverse events were also observed. Results The median follow-up was 13 months(2-24 months).According to RECIST,partial response could be evaluated in 8 patients and stable was found in another 5 patients.Only 2 patients were confirmed disease progression.The ORR was 53% with the disease control rate of 87%,However,the median PFS and OS were not yet available due to the short-term follow-up.During the treatment,the most common adverse events experienced by patients were hand-foot syndrome 11/15(73%),changes in hair color 10/15(67%),mucositis 9/15(60%),alopecie 9/15(60%),diarrhea 8/15(53%)and neutropenia 8/15 (53%). All of adverse events were manageable and reversible. Conclusions Sunitinib as a single agent in the treatment for Chinese mRCC patient is efficient and the side effects are reversible. Further long-term follow-up and expanded samples should be expected to confirm the efficacy and safety of sunitinib.

Profile of serum soluble endoglin in pregnant women with severe pre-eclampsia and eclampsia / 中华妇产科杂志

Objective To discuss the serum endoglin expression in severe pre-eclampsia and eclampsia women and their relationships. Methods Forty-two severe pre-eclamptic patients and 4 eclamptic patients in Peking University First Hospital from Dec. 2005 to Dec. 2007 were enrolled in the study group, with the mean gestational week of 35 ± 4, the mean age of 29.3 ± 5.7 and the mean BMI (30.1 ± 4.1 ) kg/ m2. This group included 25 cases of early onset pre-eclampsia, 21 cases of late onset pre-eclampsia, 8 cases of fetal growth restriction and 5 cases of HELLP syndrome. The control group included 29 cases of normal pregnant women during the same period, with the mean gestational week of 33±4, the mean age of 30.7± 3.4 and the mean BMI(27.2±2. 2) kg/m2. Peripheral serum endoglin was determined by ELISA in these two groups. Results (1)There is positive correlation between serum soluble endoglin level and the gestational weeks during 27 to 37 gestational weeks in the control group (r=0.79, P<0.05), but there is no distinct relationship in the study group (r=0.31, P>0.05). (2) Serum endoglin level of severe pre-eclampsia group was higher than the normal group [(14.2±5.6)μg/L vs. ( 10.9 ± 4.2 ) μg/L, P<0.05]. (3) Serum endoglin level of early onset group did not differ from late onset group [(14.3±5.7)μg/L vs. (13.6±5.0)μg/L, P >0.05]. (4) No difference of serum endoglin between HELLP group and non-HELLP group was found [(10.1±2.9) μg/L vs. ( 14.4±5.4) μg/L, P>0.05 ]. (5) Serum endoglin level of FGR sub group was higher than non-FGR sub group [(17.3±6.1) μg/L vs. (13.0±4.8) μg/L, P < 0.05] in the stady group. Conclusion The elevated peripheral serum endoglin level may contributes to the pathogenesis of severe pre-eclampsia and FGR, but not the week of the onset of the disease.

Cesarean scar pregnancy analysis of 42 cases / 中华妇产科杂志

usions CSP is not common and can be easily misdiagnosed and color ultrasound scan is important in its early diagnosis. UAE combined with MTX followed by curettage is an effective treatment of CSP.

Pregnancy in renal transplant recipient: A case report and review / 北京大学学报(医学版)

SUMMARY In recent years, successful pregnancies in renal transplant women have been reported worldwide. However, pregnancy in renal trasplant recipient is relatively rare in China. This paper reported a case of pregnancy 2 years post renal transplant. At the end of 28 weeks' gestation she had abnormal liver and renal function complicated with severe preeclampsia. Literatures were reviewed on considerations about pregnancy in renal transplant women. Maternal and neonatal outcomes can be improved by intensive care during pregnancy, proper immunosupression and timely termination of pregnancy.

Effect of topical application with warm and wet carthamus tinctorius alcohol and anisodaminum on phlebitis caused by mannitol injection / 中国实用护理杂志

Objective To observe the effect of topical application with warm and wet carthamus tinctorius alcohol and anisodaminum on phlebitis caused by mannitol injection. Methods 100 patients with fractured bones suffered from phlebitis caused by mannitol injection were randomized into the observation group and the control group with 50 cases in each group. The observation group adopted topical application with warm and wet carthamus tinctorius alcohol and anisodaminum while the control received external application of 50% magnesium sulfate. The dosage was 3 hours per time,2 times a day, one time in the morning and afternoon respectively. The treatment continued till the phlebitis disappeared and the effect at the 24th,48th and 72th post treatment was compared between the two groups. Results The effect at the above mentioned time points in the obsevation group was superior to that of the control group(P＜0.05).Conclusion Topical application with warm and wet carthamus tinctorius alcohol and anisodaminum on phlebitis caused by mannitol injection proved to be safe and had no adverse effect.