Volume 91  ·   Issue 30  ·  2011

The Qinghai-Tibet Plateau is known as the "roof of the world" and the "third pole of the earth", with an average altitude of 4000 m, accounting for 26% of China's total land area. It is cold, hypoxic, dry, strong ultraviolet rays, and the living environment is harsh. More than 10 million people suffer from various acute and chronic diseases caused by hypoxic injury. The harsh hypoxic environment makes people fear to enter the plateau, which has become one of the main factors hindering the development of productive forces in the plateau area, and seriously hinders the economic and social development and national defense construction in the plateau area [1-2].

Objective To evaluate whether combined oral oxycodone hydrochloride controlled-release tablets plus paracetamol and tramadol hydrochloride tablets is better than epidural analgesia with respect to uterine cramping pain control and side effects after cesarean section.Methods Sixty consecutive patients scheduled for cesarean section from April to May, 2010 were randomized to either patient-controlled epidural analgesia with 0.1% ropivacaine, 0.1 μg/ml sufentanil (for postoperative 48 h) plus injected pethidine on demand (EDA group) or controlled-release oxycodone (2×15 mg for 1st postoperative 24 h;2×10 mg for 2nd postoperative 24 h), paracetamol & tramadol hydrochloride tablets (8×1 tablet for postoperative 48 h) orally plus pethidine injection on demand (OXY group). Two groups were compared with respects to uterine cramping pain control when the oxytocin infusion (20 U plus 500 ml 5% glucose solution, iv. gtt within 2 h) once per day for postoperative 3 days as determined by the means of a visual analogue scale (VAS), pethidine consumption, side effects and costs.Results The EDA group experienced significant more pain than the OXY group when the oxytocin infusion was administered (mm)[50.0(15.0,72.5) vs 25.0(0,40.0),60.0(47.5, 72.5) vs 20.0 (0,30.0), 35.0 (20.0, 50.0) vs 0(0,20.0)].all P<0.05). Pethidine was used for pain control in 2 patients (150 mg total) of EDA group during the oxytocin infusion whereas none of the OXY group received an injection of pethidine. There was a higher level of maternal satisfaction with a lower analgesic dose in the EDA group (80.9±9.3 vs 90.0±9.8, P<0.01). The median duration of hospital stay was around 5 days in both groups.ConclusionPostoperative pain control after cesarean section with the above combined regimen is superior to EDA in terms of a lower cost and a higher level of maternal satisfaction.

Objective To study the STAT5 phosphorylation levels of erythropoietin receptor (EPOR) and thrombopoietin receptor (TPOR) in CD34+CD59- and CD34+CD59+ bone marrow cells of the patients with paroxysmal nocturnal hemoglobinuria (PNH).Methods The bone marrow mononuclear cells (BMMNC) were extracted from 23 PNH patients treated at our department from April 2010 to February 2011 and 11 normal controls. The mean fluorescence intensity (MFI) of phosphorylated STAT5 (P-STAT5) in CD34+CD59+cells and CD34+CD59-cells with or without the stimulation of 10 U/ml EPO and 50 U/ml TPO were examined by flow cytometry.Results (1)Without stimulation, the P-STAT5 MFI in CD34+CD59- cells of PNH patients was significantly lower than that of CD34+CD59+cells (31±15 vs 74±47, P<0.01). And it was 59±23 in normal control CD34+CD59+cells (P<0.05). No statistic difference existed between the CD34+CD59+cells of PNH patients and the normal control CD34+CD59+cells. (2)Under the stimulations of EPO and TPO, the P-STAT5 MFI was significantly lower in CD34+CD59-cells of PNH patients than that of CD34+CD59+cells (49±24 and 51±41 vs 120±82 and 124±87, both P<0.01). For the normal control CD34+CD59+cells, they were 79±47 and 98±53 respectively (P<0.05).No statistic difference existed between the CD34+CD59+cells of PNH patients and the normal control CD34+CD59+cells. P-STAT5 MFI was elevated after the stimulations of EPO and TPO. The increments of CD34+CD59+cells in PNH patients were significantly higher than those of CD34+CD59-cells (49±11 and 54±43 vs 17±4 and 16±6, both P<0.01).Conclusion Under the in vitro stimulations of EPO and TPO, the STAT5 phosphorylation levels of EPO and TPO receptors in normally cloned hematopoietic stem cells in PNH patients are obviously superior to those in abnormally cloned counterparts.

Objective To employ the technology of interfering RNA (RNAi) to identify the role of Foxp3 in the in vitro suppressive effect of human regulatory T cell (Treg) on effector T cells. MethodsExpanded human Treg were transfected with siRNA targeting Foxp3 genes. The transfection efficiency, the level of corresponding gene and its protein expression were measured by fluorescent microscopy, fluorescence-activated cell sorting (FACS), real-time PCR and Western blot respectively. The phenotypes of Treg were analyzed by FACS. The siRNA transfected Treg was then co-cultured with porcine PBMC or human PBMC-stimulated autologous CD4+CD25- T cells. Their proliferations were examined by WST-1. Treg and autologous CD4+CD25- T cell-related suppressive cytokines were assessed by ELISA. ResultsA 68% transfection efficiency in expanded Treg was achieved for Foxp3 siRNA. Real-time PCR revealed a 61.4% mRNA knockdown induced by siRNA targeting Foxp3 genes in Treg versus the control (P<0.01). Some Treg-associated surface markers were significantly altered versus the control. And the production of suppressive cytokines was lowered. These changes were correlated with the diminished Treg activity in suppressing the proliferation of effector CD4+CD25-T cells. There was 83% suppression by non-transfected Treg vs 48% suppression by Foxp3 siRNA transfected Treg in xeno-immune response (P<0.05);and 65% suppression by non-transfected Treg vs 48% suppression by Foxp3 siRNA transfected Treg in allo-immune response (P<0.01). Conclusion Foxp3 is a key intracellular marker for maintaining the phenotypes and functions of Treg.

Objective To explore the relationship between serum α1-acid glycoprotein (AGP), disease progression, imatinib plasma trough concentration and efficacy in the patients with chronic myeloid leukemia (CML).Methods A total of 112 CML patients were recruited from August 2008 to February 2010 in our hospital. There were 72 males and 40 females with a median age of 39 years old (range: 6-76 years old). Among them, 102 patients were in chronic phase, 4 in accelerated phase and 6 in blastic phase. Ninety-nine patients were treated with imatinib while 13 patients received hydroxyurea. Twenty healthy blood donors were designated as the control group. The serum AGP levels of all patients were detected by immuno-turbidimetric assay. And the concentrations of AGP and imatinib were detected in 12 patients before and after 3 months of imatinib therapy respectively.For 84 CML patients, their plasma trough concentrations of imatinib were detected by high performance liquid chromatography-tandem mass spectrometry simultaneously.All patients were divided into 5 groups by efficacy to evaluate the significance of serum AGP and its relationship with imatinib concentration.Results Serum AGP of no response (NR) group [(1.18±0.26)g/L] was significant higher than that of complete cytogenetic response (CCR), complete hematologic response (CHR) and control group[ (0.60±0.21), ( 0.71±0.17),(0.52±0.15) g/L,all P<0.05]. Serum AGP of accelerated/blastic phase group [ (1.28±0.50) g/L]was significant higher than CCR or control group (P<0.05). Serum AGP of CHR group was higher than that of control group (P<0.05). No significant difference existed between CCR, CHR or control group (P>0.05). There were no significant differences between NR, relapse or accelerated/blastic phase group (P>0.05). The serum AGP of 12 patients on a 3-month therapy of imatinib were lower than that of patients at pre-treatment [(0.54±0.17)g/L vs(0.83±0.31)g/L,P<0.01]. The plasma trough concentration of imatinib was (1307± 586) μg/L (range: 109-3400 μg/L) in 84 patients. And it was positively correlated with the serum level of AGP (r=0.443, P<0.01).Conclusion The serum level of AGP can reflect the in vivo loads of leukemic cells for CML patients. There is a positive correlation between the serum level of AGP and the plasma trough concentration of imatinib. Serum AGP can be used as a monitoring index of efficacy for CML patients.

Objective To compare the distant disease-free survival between breast cancer patients with nodal pathological complete response (pCR) and those with nodal residual disease (RD) after neoadjuvant chemotherapy.Methods The clinical and pathological data of 376 needle biopsy proved node positive breast cancer patients undergoing neoadjuvant chemotherapy were retrospectively analyzed. ResultsThe median follow-up time was 24 months(range: 5-100). The pCR rate of axillary lymph node was 30.9%. And the three-year distant disease-free survival (DDFS) rates were 91.7% and 78.8% in the patients with axillary lymph node pCR and RD respectively. According to the Log-rank test, there were significant differences in survival curves (P=0.016). Multivariate analysis showed that the relative risk of DDFS for patients with RD was 2.14 folds of than that of the pCR group (P=0.047). No significant difference existed between the disease-free survival (DFS) curve in two groups. DDFS had significant differences between the patients with the number of lymph node metastasis ≤ 3 and ≥ 4 in the RD group (P=0.001).Conclusion The distant disease-free survival of node positive breast cancer is associated with the status of axillary lymph node after neoadjuvant chemotherapy.

Objective To evaluate the diagnostic values of osteoporosis self-assessment tool for Asians (OSTA) in aged men.Methods Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry (DXA) in 382 male outpatients. Their data were collected. After excluding such influencing factors of BMD as diseases or drugs, they were divided into 3 groups according to the WHO osteoporosis diagnosis value or age. The correlation between OSTA index and BMD was analyzed by Spearman correlation. The concordance of OSTA and BMD were calculated and analyzed by a four-fold table.ResultsThe prevalence of osteoporosis was 9.42% and osteopenia 42.67%. Age increased gradually in the osteoporosis, osteopenia and normal bone mass groups. But OSTA index, BMD (including lumbar vertebrae L1-4, femoral neck, trochanter and hip) and weight decreased gradually in those groups. The percent of normal bone mass decreased with advancing age. And the percentages were 60.68%, 51.97% and 33.33% respectively. Osteoporosis increased in the older group (>80 years old) and the percentage was 24.64% accounting for 94.44% of all osteoporotic subjects. Judging by the OSTA index, the rate of low osteoporotic risk decreased with advancing age. But the rates of mid-risk and high-risk increased. The correlation coefficients of OSTA index and BMD in femoral neck, trochanter, hip and L1-4 was 0.33, 0.28, 0.29 and 0.06 respectively. And the correlation between OSTA index and BMD had statistical significance except for L1-4. The sensitivity, specificity, coincidence and Youden index of OSTA index with a T score cutoff of -1 of BMD were 56.28%, 64.48%, 60.21% and 0.21 respectively versus 86.11%, 57.80%, 60.47% and 0.44 with a T score cutoff of -2.5.Conclusion Correlation exists between OSTA index and BMD. The sensitivity, specificity and coincidence of OSTA index are excellent based upon the standard of BMD by DXA. It is a useful and simple diagnostic tool of osteoporosis.

Objective To decipher the association of visceral adiposity (VA) with 24-hour urinary albumin excretion (24 h-UAE) in type 2 diabetics.Methods We collected the clinical data, VA, subcutaneous adiposity (SA), 24 h-UAE, blood lipids, fasting blood glucose, glycosylated hemoglobin, insulin and tumor necrosis factor (TNF)-α of type 2 diabetic inpatients at our hospital. According to the quartile of VA, the subjects were divided into 4 groups. And their profiles were compared with regards to the level of 24 h-UAE and the incidence of heavy proteinuria. And their relative intensities and the linear relationship of VA and lg (24 h-UAE) were analyzed.Results lg (24 h-UAE) of groups C and D was larger than that of groups A and B. With the rising level of VA, the prevalence of heavy proteinuria increased. A moderate correlation existed between VA and lg (24 h-UAE)(r=0.51).lg (24 h-UAE) increased 0.26 units as VA expanded 100 cm2, i.e. 0.15 units after relative factor adjusting. After gender and triglyceride adjusting, the odds ratio of heavy albuminuria in group C was 2.75 versus that in group A. And the OR was 3.87 in group D.Conclusion Expansion of VA is a risk factor for an elevated risk of 24 h-UAE. With the expansion of VA, the prevalence of heavy albuminuria increases.

Objective To assess the effects of VVI (ventricular demand) and DDD (dual-chamber) pacing models on cardiac remodeling and the long-term clinical outcome of patients with symptomatic bradycardia.Methods All patients with DDD and VVI pacing models at our hospital from January 1991 to January 2003 were retrospectively analyzed.Results After a follow-up period of over 8 years in DDD and VVI groups (97±27, 107±44 months), left atrial diameter [(45±12) mm vs (39±12) mm, P<0.01] and left ventricular end-diastolic diameter[ (53±11) mm vs (50±9)mm, P=0.01] in 57 patients with VVI pacing model were markedly enlarged than those at pre-implantation. And tricuspid regurgitation increased (42.4% vs 16.9%, P<0.05). But in 59 patients with DDD pacing model, except for increased tricuspid regurgitation(42.1% vs 10.5%, P<0.01), left atrial diameter [(37±5) mm vs. (35±5)mm, P=0.07] and left ventricular end-diastolic diameter[(47±7)mm vs (47±5)mm, P=0.32] were not significantly different. Mitral regurgitation significantly increased only in the VVI group (P<0.01). The increases of left ventricular end-diastolic diameter (P=0.04), mitral valve (P=0.02) and tricuspid regurgitation (P<0.01) were much more pronounced in the VVI group than those in the DDD group. Left ventricular ejection fraction (LVEF) showed no difference with that at pre-implantation (P=0.11 in DDD group, P=0.05 in VVI group). But the LVEF value was lower (P=0.04) while the incidence of thrombolism was higher (P=0.03) in the VVI group than those in the DDD group at post-implantation. However, the incidence of atrial fibrillation (P=0.14), hospitalization (P=0.08) and survival (P=0.77) showed no significant difference between two groups.Conclusion DDD pacing offers more benefits over VVI pacing through improving cardiac functions and arresting left ventricular remodeling. However, neither groups showed any difference in decreasing mortality rate and hospitalization.Moreover, both pacing modes fail to reverse cardiac electrical and anatomical remodeling. It is imperative to explore more physiological pacing site and rational atrioventricular (AV) interval to improve the prognosis of patients.

Objective To describe the anatomic variations of total anomalous pulmonary venous connection (TAPVC) and its corresponding surgical techniques.Methods A total of 143 TAPVC subjects were hospitalized from April 1981 to July 2010. Those patients with other complex congenital heart diseases, such as transposition of great artery and single ventricle, were excluded. A pathological diagnosis was made by echocardiography, magnetic resonance imaging, computed tomography, catheterization and intra-operative findings.The specific types of TAPVC were as follows:supra-cardiac (49.7%, 71/143), cardiac (40.6%, 58/143), infra-cardiac (4.2%, 6/143) and mixed (5.6%, 8/143). The subtypes were classified by the pathway of common confluence, distribution of pulmonary vein and their orifice site.The techniques of surgical repairs included modified Warden procedure and pulmonary vein transplantation.Results The patients with supra-cardiac type were further divided into 4 subtypes according to the course of vertical veins and their orifice site:right and left veins forming a common confluence, then draining into vertical and innominate veins (n=65);common confluence of pulmonary vein drainage into superior vena cava through a short vertical vein at the right pulmonary hilus (n=3);right and left pulmonary veins separately draining into superior vena cava (n=2);common confluence draining into innominate vein through a right path beside trachea (n=1). Cardiac types were further divided into 3 subtypes:coronary sinus (n=20), right atrium (n=37) and right atrium & sinus (n=1). Infra-cardiac type had no subtype. Mixed type was more complex and it was further divided into 3 subtypes:bilateral & symmetrical connection (right 2 + left 2, n=5);bilateral & asymmetrical connection (3+1, n=3). Surgical repairs were performed on 135 patients. The surgical mortality of TAPVC was 5.9% (8/135). And there was no late death. The major causes of death were pulmonary infection and low cardiac output syndrome.Conclusion A detailed classification of TAPVC is of great importance for surgical approaches and methodological designs. And an individualized surgical plan yields excellent patient outcomes.

Objective To assess the tone recognition of cochlear-implant subjects by a REZ-1 device.Methods Speech recognition experiments were conducted to measure the tone recognition with standard assessment table and standard testing program. A total of 34 postlingual hearing-impaired adults who were native speakers of Mandarin undergoing operations from June to October, 2009 were tested and scored both preoperatively and postoperatively (1, 2, 3, 6, 12 months post-implantation)for speech recognition. Results All patient scores of speech recognition (initials, finals, monosyllabic words & tones) decreased gradually during the postoperative follow-up period. Preoperative speech recognition scores were all 0. And after a 12-month training, their average scores were increased significantly [(70±8)%±(82±8)%]. Significant statistical differences existed between pre- and post-implantation in each test (P<0.01). Conclusion REZ-1 cochlear implantation may improve the tone recognition of adults with severe-to-profound postlingual hearing loss in a quiet environment.

Objective To evaluate the effects of insulin gene transcription regulators PDX-1, NeuroD1 and MafA on the differentiation of bone marrow mesenchymal stem cells (mMSCs) into insulin-producing cells.Methods Murine mMSCs were isolated, cultured and expanded.The base sequences of transcription factors PDX-1, NeuroD1 and MafA were obtained by total gene synthesis and the recombinant adenovirus vectors harboring target genes constructed and transfected into packaging cell line 293A. mMSCs were infected with adenovirus separately or together, and then differentiated in vitro into insulin-producing cells. Reverse transcription-polymerase chain reaction (RT-PCR) was utilized to detect insulin gene expression, immunofluorescence for identifying the presence of insulin protein and insulin enzyme-linked immunosorbent assay (ELISA) for evaluating the secretory volume of insulin.Results The differentiation extent of mMSCs into β-cell was analyzed. The β-cell-specific transcriptional regulators and insulin gene were expressed in mMSCs after transfection. Immunofluorescent analyses revealed the activated expression of insulin in the cytoplasm of differentiated cells.A significant content of insulin was released in these cells in response to a certain concentrations of glucose stimulation.The insulin content of mMSCs infected with a combination of three transcription factors was significantly higher than that of the control group [(112.84±9.67)mU/L vs (1.60±0.22)mU/L, P<0.05].Conclusion After modification by transcriptional factors PDX-1, NeuroD1 and MafA, mMSCs can secrete insulin through starting endogenous insulin gene transcription.

Objective To explore the effects of granulocyte-macrophage colony-stimulating factor (GMCSF) on hyperoxia exposure lung injury in newborn rats and elucidate its protective mechanism of operating via the signaling pathway of advanced glycation end products (RAGE)-NF-κB.Methods Twenty-four 3-day-old SD rats from 3 litters were randomly divided into 3 groups. They were hyperoxia exposure plus GMCSF group (group A), hyperoxia exposure group (group B) and air exposure group (group C). The rats from groups A and B were placed in a sealed Plexiglas chamber with a minimal in-and-outflow, providing 6-7 exchanges per hour of chamber volume and maintaining O2 levels above 95%.While the rats in group C only were exposed to air simultaneously.The rats in group A received subcutaneous injections of recombinant murine GMCSF (9 μg/kg) during hyperoxia exposure at 24 h, 72 h and 120 h respectively. And the rats in groups B and C received subcutaneous injections of saline vehicle alone at the same time point. Seven days later, all were sacrificed and immunohistochemistry was employed to assess the expression of RAGE in lung tissue. The levels of tumor necrosis factor-α in bronchoalveolar lavage fluid (BALF) and serum samples were detected by ELISA (enzyme-linked immunosorbent assay). The RAGE mRNA and NF-κB mRNA in tissue homogenates were detected by RT-PCR while RAGE and NF-κB by Western blot. Also the values of lung damage score were calculated with microscopic histology.Results The value of lung damage score in group C, B and A was 0.46±0.20, 3.06±0.33 and 2.31±0.56 respectively, there was significantly difference among three groups (P=0.000). The expression of RAGE mRNA and protein in three groups were 0.14±0.02, 0.34±0.06, 0.28±0.04 and 0.30±0.04, 0.76±0.11, 0.55±0.08 respectively. There were both significantly differences among three groups (P=0.000, P=0.000). The expression of NF-κB mRNA and protein in three groups were 0.41±0.21, 0.90±0.36, 0.69±0.30 and 0.41±0.26, 0.96±0.43, 0.77±0.33 respectively, there were both significantly difference among three groups (P=0.000, P=0.017). The level of TNF-α in BALF was 76±10, 224±42 and 143±24 respectively, there was significantly difference among three groups (P=0.000). All indicators above in group B and group A were significantly more than those in group C (all P<0.05), while these indicators in group A were lower than those in group B. But there was no difference in the level of TNF-α of serum among three groups (P>0.05).Conclusion GMCSF may protect hyperoxia-induced lung injury via down-regulating the signaling pathway of RAGE-NF-κB.

Objective To explore the effects of oncogene protein v-akt-siRNA on the sensitivity of human lung cancer cell line NCI-H446 to cisplatin and drug resistance proteins in human lung cancer cells.Methods The small interfering siRNA expression vector targeting Akt2 gene (siAkt2) was constructed. And the NCI-H446 cells were transfected with negative control vector or siRNA vector. The expressions of Akt2-mRNA and lung resistance-related protein (LRP) and P-glycoprotein (P-gp) were detected by reverse transcription-polymerase chain reaction and immunocytochemistry respectively. NCI-H446 and transfected cells were treated by cisplatin for 24 h. The cell proliferation was measured by 3- (4,5-cimethylthiazol-2-yl)-2,5-diphenyl tetrazolium (MTT) assay and cell apoptotic rate detected by flow cytometry.Results Akt2-mRNA decreased significantly in the transfected NCI-H446 cells versus the non-transfection group. And the expressions of LRP and P-gp proteins decreased significantly in the transfection group versus the control group (P<0.01). The cell proliferation rate decreased from (60.2±2.8)% to (34.7±2.6)% (P<0.01). The cell apoptotic rate increased from (19.3±1.6)% to (38.8±1.2)% after a therapy of cisplatin (P<0.01).Conclusion The siRNA targeting Akt2 can decrease the Akt2 expression, increase the chemotherapeutic sensitivity to cisplatin and partially reverse the cisplatin resistance of NCI-H446. The mechanism may be through the lowered expressions of LRP and P-gp.

Objective To investigate the effects of transplanted endothelial progenitor cells (EPCs) on the spermatogenic functions in testicular detorsion. Methods Bone-marrow-derived EPCs were obtained from rats and transfected by enhanced green fluorescent protein adenovirus (Ad-eGFP). The rats were divided into 3 groups (n=6 each). In the sham group, left testis was not twisted. In the ischemia reperfusion injury (IRI) group, 1 ml saline was injected into the femoral vein of each rat after testicular detorsion. In the EPCs group, 1 ml EPCs suspension (1.0×106 EPCs) was injected into each rat after testicular detorsion. The Ad-eGFP transfected EPCs were injected into the 3 additional rats of testicular torsion-detorsion. At Day 5 post-transplantation, the characteristics of transplanted EPCs homing were detected. And the pathological changes and apoptotic cells/seminiferous tubules in left testis were examined. ResultsWhen the value of multiplication of infection (MOI) was at 50, the transfection rate of EPCs by Ad-eGFP exceeded 73.7%. At Day 5 post-treatment, the cells exhibiting green fluorescence were detected in left testis. The germ cells in rats of the sham group were normal. And the ratio of apoptotic cells to seminiferous tubules was 0.09±0.02. The germ cells in rats of the IRI group were much fewer. And the ratio of apoptotic cells to seminiferous tubules was 2.82±0.81. As compared with the IRI group, seminiferous epithelium was thicker in the EPCs group. And the ratio of apoptotic cells to seminiferous tubules was 0.32±0.09 in the EPCs group. It was much smaller than that in the IRI group. There was significant difference (P<0.01). Conclusion The transplantation of EPCs is effective for treating the spermatogenic dysfunctions caused by testicular torsion so as to greatly enhance the spermatogenic functions.

For community-acquired pneumonia (CAP), reducing systemic inflammatory response without affecting local anti-infection is an ideal intervention.Corticosteroids can turn off the genes encoding proinflammatory factors,open the genes encoding anti-inflammatory factors,and regulate the balance of inflammatory cytokines. Low-dose corticosteroids can down-regulate the transcription of proinflammatory factors,prevent cytokine overresponse,and their early use in CAP may accelerate the resolution of local and systemic inflammation in the lungs.

Type 1 diabetes is a kind of autoimmune disease with absolute lack of insulin secretion due to the destruction of β cells, which requires lifelong application of exogenous insulin replacement therapy. Therefore, diabeticians have been trying to explore a way to recover patients to non-diabetic state.

encephalopathy associated with autoimmune thyroid disease (EAATD) is a recurrent or progressive encephalopathy associated with autoimmune thyroid disease, characterized by positive thyroid autoantibodies in serum and/or cerebrospinal fluid and good response to glucocorticoids.

Kallmann syndrome is the most common type of idiopathic hypogonadotropic hypogonadism (IHH), and it is a rare congenital disease. The prevalence rate is reported to be 1/8000 in men and 1/40,000 in women. The prevalence rate in men is much higher than that in women, about 5~6 times that in women [1]. In gonadal agenesis, its prevalence is second only to Kilinefilter syndrome.

A 56-year-old female was admitted to hospital on October 19, 2009 due to right waist pain for more than 1 year and epigastric pain for 10 days. The patient developed right waist pain 1 year ago, which worsened after exertion, without frequent urination, urgency, painful urination, pyometria, hematuria and dysuria. Physical examination at admission: blood pressure 150/86 mm Hg (1 mm Hg =0.133 kPa), heart rate 83 beats/min, breathing 20 beats/min, body temperature 36.1℃, no percussion pain in the right kidney area, and no obvious abnormalities were found in laboratory examination.