Volume 96  ·  Issue 31  ·  2016

With the improvement of China's social and economic development level, people's quality of life has also been greatly improved. For middle-aged and elderly people, they all hope to be happy and healthy and live with dignity in their later years. Faced with the intensifying process of population aging, the consequences of the national family planning policy in the late 20th century and the continuous increase in the number of chronic diseases such as cancer patients and cardiovascular and cerebrovascular diseases, the importance of palliative care is further highlighted at present, which has also become an important direction that needs to be grasped in the reform of China's medical and health system. The core connotation of palliative care lies in attaching importance to the dignity of patients, and trying to relieve the pain of patients and meet the needs of patients' longevity through effective means.

In August 2015, the Journal of Clinical Endocrinology and Metabolism (JCEM) published a new version of the treatment guidelines for Cushing's syndrome (CS) in the United States^[1]。 Compared with the 2008 edition of the guidelines, the new edition focuses on clinical treatment. In order to help clinical work, this article mainly interprets this version of the guide from the perspective of clinicians.

To summarize the characteristics of the etiology distribution of Cushing syndrome (CS) patients in Chinese PLA general hospital during the past 20 years.

All data of CS patients admitted to Chinese PLA General Hospital between 1995 and 2014 were collected. The sex ratio of patients, visiting age, final diagnosis were retrospectively analyzed.

From January 1995 to December 2014, 522 patients with CS were admitted, of which, 134 (25.67%) were males and 388(74.33%) were females. The overall mean age was (42±13) years old. 46.36% of the cases were adrenocorticotropic hormone (ACTH) dependent, and ACTH independent CS accounted for 53.64%. At the 41-60 age group, the proportion of ACTH independent CS was higher than that of ACTH independent CS.The proportions of ACTH-independent macronodular adrenal hyperplasia (AIMAH), ectopic ACTH syndrome and adrenal cortical carcinoma were higher in male group than in female group. The number of CS patients was gradually increased during the past 20 years. The proportion of ACTH independent CS was increased (from 32.8% to 60.4%). The proportion of ACTH dependent CS was declined (from 67.2% to 39.6%).

The etiology spectrum of CS has changed. There was significant gender-related, age-related difference of etiology distribution in patients with CS.

To predict the therapeutic effect of Cushing′s disease after transsphenoidal surgery by using morning serum cortisol level.

The clinical data of 275 cases that had transsphenoidal surgery in Peking Union Medical College Hospital from 2010 to 2014 were analyzed retrospectively.Early morning serum cortisol level less than 140 nmol/L 3 days postoperation was usedto predict endocrinological remission. And long-term efficacy was evaluated by follow-up.

Of the 275 patients, there were 49 males and 226 females; average age was 36.5 years old.Remission wasconfirmed in 201 cases, the remission rate was 73.1%, and 8 cases recurrent duringfollow-up.There were 17 macroadenomas, theremission rate was 47.1%; 258 microadenomas and MRI negative adenomas, the remission rate was 74.8%.And 43 recurrent cases had reoperations; the remission rate was 46.5%.

Early morningserum cortisol 3 days post operation can evaluate the effectof transsphenoidal surgery, but even if the level of cortisol is less than 140 nmol/L, there is still tumor recurrence.Patients should be follow-up for a lifetime.

To Verify the value of the ratio of sensory nerves conductive velocity along palm-median finger /wrist-palm minus 1 for diagnosis of the mild-moderate carpal tunnel syndrome(CTS).

The different value between 1 and the ratio of sensory nerves conductive velocity along palm-median finger/wrist-palm was defined as index-CTS which was used to assess the severity of CTS.The index-CTS of 100 palms from healthy controls and 58 palms from mild-moderate CTS patients were calculated and compared.Multiple regression was used to identify the relative factors of index-CTS.The ROC curve was used to evaluate the sensitivity and specificity of index-CTS at different values.

The value of index-CTS from healthy controls and patients both fitted Gaussian distribution.The mean value were -0.053±0.042 vs 0.055±0.074 in the controls and the patients respectively.The difference was statistically significant between the two groups by T-test(P<0.001). Multiple regression analysis showed that Tinel sign, Phalen sign, laterality, clinical grade, electrical grade were identifiable factors related to index-CTS.When index-CTS was over 0.001 and Ⅳ-DL over 0.395 ms , specificity of diagnosis by both can get 92%, but index-CTS showed more higher sensitivity(98.3% vs 89.7%).

Rising index-CTS could be the most significant electrophysiological feature in CTS.It can be used as a sensitive marker to assess the extent of conduction block of median nerve in carpal tunnel.

To compare the clinical efficacy between calcar replacement arthroplasty and InterTan nail in treatment of intertrochanteric fractures in the aged.

From January 2008 to July 2013, a total of 58 elderly patients with intertrochanterie fracture , had been treated in Department of Orthopaedics, Tianjin Occupational Diseases Control and Treatment Hospital, were retrospectively compared.Half of them were treated with calcar replacement arthroplasty and half with InterTan nails.In the calcar replacement arthroplasty group, there were 8 men and 21 women, with an average age of (85.3±4.9) years, there were 8 A1, 16 A2 and 5 A3 fractures according to the AO classification.In the InterTan nail group, there were 10 men and 19 women, with an average age of (86.1±5.6) years, there were 11 A1, 15 A2 and 3 A3 fractures according to the AO classification.The 2 groups were compared in terms of the duration of the operation, intraoperative blood loss, hospitalization time, time of off-bed activity, complications, mortality rate, Harris hip score, short form 36 questionnaire score and ADL score.

Twenty-seven patients in the calcar replacement arthroplasty group and twenty-six patients in the patients in each group were followed up InterTan nail group were follow-up for a period of 24 months.There were no significant differences between the 2 groups regarding hospitalization time, complications, mortality rate, Harris hip score, short form 36 questionnaire score and ADL score(P>0.05). However, the operative time, intraoperative blood loss, and the time of off-bed activity for the calcar replacement arthroplasty and InterTan nail groups was respectively (78±29) minutes vs (59±32) minutes, (316±185) ml vs (108±97) ml, and (15±5.8) days vs (32±12.7) days, all of them with a significant difierence(P<0.05).

The patients in the calcar replacement arthroplasty group suffered longer operative time and more blood loss, but they can obtain early off-bed activity.The hospitalization time, complications, mortality rate, hip function and quality of Life between the two were the same.

To invstigate the mechanism of new mechanically-activated cation channel protein (Piezo1) can cause the apoptosis of the human chondrocytes under compressive loading, using a Flexercell unit by activating classical Mitogen-activated protein kinase (MAPK) signal pathyway(ERK1/2).

Primary human chondrocytes were isolated, cultured, and then subjected to the static compressive loading for 0, 2, 12, 24, 48 h, respectively.The expressions of Piezo1 and the ERK1/2 were assessed by reverse transcription-polymerase chain reaction(PT-PCR), as well as the apoptosis gene B cell lymphoma/leukemia-2(Bcl-2) Bel-associated X protein(Bax). In addition, Piezo1inhibitor, Grammostola spatulata mechanotoxin 4(GsMTx4), was used to block Piezo1, served as a positive control.The immunofluorescence was used to locate the expression of Piezo1 protein and ERK1/2.AnnexinV-PI was used to detect the apoptosis of chondrocytes.

The expression of the Piezo1 in chondrocytesis was weak, the 12 h group was significant increased(0.198 1 vs 0.021 4, P<0.05), the 24 h group was the highest expression while the expression of the 48 h group was lower than the 24 h group, as well as the ERK1/2, Bcl-2 and caspase3.The result of AV-PI had shown that the 2 h group had increased early stage of apoptosis.The 12 h group had increased late stage of apoptosis, and the 24 h group′s apoptotic rate was the highest, while the apoptotic rate of the 48 h group was lower than the 24 h group(0.497 1 vs 0.743 1,q=0.035 9). The GsMTx4 could inhibit the late stage of apoptosis, and the location of the Piezo1 was expressed in the nucleus and cytoplasm of the chondrocytes.

Piezo1 plays an important role in the apoptosis of the human chondrocyte through the classic MAPK/ERK1/2 signal pathway.

To investigate the imaging features of Erdheim-Chester.

A total of 7 patients with ECD confirmed by pathology were analyzed retrospectively.And the DR(n=5), CT(n=6, 3 patients underwent enhanced scan), MR(n=4, 2 patients underwent enhanced scan) and SPECT (n=3) features were observed.

Among 7 cases of ECD, four cases of DR images showed luffa cystic changes.Five cases of CT images showed bone dissolved, four showed peripheral localized sclerosis, one showed symmetric sclerosis, No enhancement was found on CT scan.Four cases of MR images, three occurred as long T₁ and long T₂ signal, one occurred as short T₁ and long T₂ signal, and inhomogeneous enhancement.One case in soft tissue occurred as long T₁ and long T₂ signal, and inhomogeneous enhancement.Three cases of SPECT images were characterized by radioactive nuclide concentration of diseased region.

When ECD lesions located in capitulum and metaphysis, most images of DR and CT show bone dissolved and peripheral localized sclerosis; MRI findings are complicated, the reason might be different proportion of mature and immature lipid components.SPECT would be a kind of effective measure of finding hidden lesion and monitoring curative effect.

To summarize ultrasound features associated with medullary thyroid carcinoma (MTC) and investigate the predictive value of ultrasonography in preoperative diagnosis of MTC.

The sonographic and clinical data were studied in a series of nodules histologically proven as MTC collected from January 1993 to January 2013.

A total of 86 patients (92 nodules proven as MTC) were enrolled in the study with an average age of (47±12) years.Among the MTCs, 21.7%(20/92) were excluded because of missing data and the remained 78.3%(72/92) had complete data with the average diameter of (2.1±1.3) cm.The common US findings for MTC were solid, hypoechogenicity, regular sharp, well-defined margin, AP/ TR<1 and calcification (mostly microcalcification). Calcification and vascularization were more common in MTC nodules(48.6% vs 5.6%,P=0.001). Nodules with enlargement of cervical lymph node tended to be undergone FNAB(76.0% vs 55.3%, P=0.084), and ill-defined margin was more common in MTC nodules with cervical lymph node metastasis(36.4% vs 12.8%, P=0.009).

Despite having a few US features closely linked to the malignant nodules such as solid, hypoechogenicity and with microcalcification, the MTC nodules also have specific US imaging characteristics as regular sharp, well-defined margin and AP/ TR<1.

To investigate the characterizations of genetic recombination hotspots and linkage disequilibrium (LD) patterns in peroxisome proliferative activated receptor gamma (PPARG) gene in Kirgiz and Uyghur ethnic groups.

Blood samples were collected from 100 Kirgiz (50 healthy controls and 50 patients with type 2 diabetes mellitus) residents in Halajun County, Artux City, Kizilsu Kirgiz Autonomous Prefecture, Xinjiang in August 2013, and 50 healthy Uyghur residents in Hotan Prefecture of Xinjiang Uygur Autonomous Region in May 2012.Thirty-one tagSNPs in PPARG gene were genotyped using Matrix-Assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry (MALDI-TOF-MS) method.The recombination hotspots and LD patterns within the PPARG gene were estimated by analyzing the SNP genotying data using the Hotspot Fisher program and Haploview software, respectively.

Eighteen tagSNPs (rs1151999, rs1175540, rs1875796, rs1899951, rs2292101, rs2921190, rs2938397, rs2959272, rs2959273, rs2972162, rs3856806, rs4135247, rs4135275, rs709151, rs4135354, rs6805419, rs17036700 and rs4135304) were same with relatively higher recombination rates between the patients with type 2 diabetes mellitus (T2DM) and healthy controls of Kirgiz ethnic group, and healthy controls of Uyghur ethnic group.Five haplotype blocks with LD coefficient D′ value of 1, indicating no genetic recombination occurred within the region, were observed in the healthy controls of Kirgiz ethnic groups, whereas five haplotype blocks with LD coefficient D′ value less than 1 were observed in the Kirgiz patients with T2DM, indicating historical recombination events occurred within the region.Four haplotype blocks with LD coefficient D′ value of 1 were observed in the Uyghur healthy controls, indicating no genetic recombination occurred within the region.There were significantly different recombination hotspot profiles between the Kirgiz, Uyghur, Utah residents with Northern and Western European ancestry (CEU), Yoruban in Ibadan, Nigeria (YRI) and Han Chinese in Beijing (CHB) and Japanese in Tokyo (JPT) samples.There are six recombination hotspots in the HapMap profile of genetic recombination.The last 5 SNPs within the PPARG gene were shown with lower recombination rates in the Kirgiz, whereas no recombination hotspot was found in the Uyghur.

Variable recombination rates may be present in certain chromosome region between patients and healthy controls within the same or between the different ethnic groups.There may be presence of recombination hotspots of ethnic specificity and with variable recombination rates.

To observe the expression of uncoupling protein (UCP2) and its effect on modulation of mitochondrial function and apoptosis of cardiomyocytes exposed to high-glucose.

AC16 cardiomyoctyes were randomly divided into normal-glucose group (NG), high-glucose group (HG), HG+ UCP2 siRNA group and HG+ negative control siRNA group.The expression of UCP2, succinodehydrogenase(SDH) activity, ATP content, reactive oxygen species (ROS) generation, cell apoptotic rate, caspase-3 activity and cell viability were detected.

Compared with the cardiomyocytes in NG group, the ROS production, apoptotic rate and caspase-3 activity were significantly increased in HG group, accompanying with the decreases in SDH activity, ATP content and cell viability.The expression of UCP2 was increased in HG group. Furthermore, UCP2 siRNA inhibited the expression of UCP2 and aggravated high-glucose induced the ROS production (37.96±1.08 vs 27.68±0.60, P<0.05), cell apoptosis ((25.68±0.78)% vs (17.80±0.99)%,P<0.05), caspase-3 activity ((2.71±0.13)% vs (2.14±0.28)%,P<0.05) and cell inactivation (0.74±0.04 vs 0.62±0.03,P<0.05), but had no impact on SDH activity and ATP content in cardiomyocytes.

The up-regulation of UCP2 expression in cardiomyocytes, induced by high-glucose, maybe a protective mechanism for the mitochondrial damage, and UCP2 may inhibit high-glucose induced cardiomyocytes apoptosis.

To analyze the role of oxycodone in acute lung injury(ALI) induced by lipopolysaccharide (LPS) in rats.

Male SD rats were randomly allocated into 4 groups: control group, oxycodone group, LPS group, LPS+ oxycodone group. The effects of oxycodone on LPS-induced neutrophils influx, inflammatory cytokines release, pulmonary edema, apoptotic cell were examined. In addition, the toll-like receptor 4 (TLR4) in lung tissues was detected by Western blotting.

Oxycodone significantly attenuated LPS-induced pulmonary histopathologic changes, alveolar hemorrhage, and neutrophil infiltration. The lung wet-to-dry weight ratio, was markedly decreased by oxycodone(5.60±0.24 vs 6.80±0.27, P<0.05 ). Moreover, oxycodone decreased the productions of the inflammatory cytokines including IL-1β, TNF-α, HMGB-1((1 208±18)pg/ml, (1 660±14) pg/ml, (61±4) pg/ml , allP<0.05). Oxycodone treatment also reduced the concentration of apoptosis in lung tissues(18.6%±0.5%,P<0.05). Furthermore, the expression of TLR4 was significantly suppressed by oxycodone treatment in lung tissues(1.20±0.15,P<0.05).

Oxycodone exerts protective effects on LPS-induced ALI in rats. The potential mechanism of this action may attribute partly to the inhibition of TLR4 activation.

To investigate the effect and possible mechanisms of olmesartan medoxomil on atherosclerosis of apolipoprotein E knockout (ApoE^-/-) mice.

Sixteen 6-week-old male ApoE^-/- mice were randomly divided into atherosclerosis model group fed with high fat diet, and olmesartan medoxomil intervention group fed with high fat diet and olmesartan medoxomil (10 mg·kg^-1·day^-1, per gavage). Eight C57BL/6 mice were fed with normal diet, and treated for 12 weeks.The blood pressure and the serum level of lipid were detected; the aorta were removed, oil red staining for plaque area, Hematoxylin and eosin (HE) staining for plaque morphology, Elastica van Gieson (EVG) staining for elastin, and picrosirius red (PSR) for collagen respectively; and the expression of cathepsin S (Cat S), smooth action protein (ASMA) and macrophage surface molecule-3 (Mac-3) were detected by immunohistochemisty analysis.

Serum cholesterol and low density lipoprotein levels were significantly higher in atherosclerosis model group than in control group[(15.08±1.64) vs (2.06±0.15) mmol/L, (15.60±1.05) vs (0.00±0.00) mmol/L] (all P<0.01), while triglyceride level was similar between the two group.In contrast to model group, the mice in intervention group showed no statistical difference in blood pressure and plasma lipid levels, while the plaque areas in the aorta were significantly decreased (P<0.05) as well as the expression of Cat S and Mac-3[(2.4±1.2) vs (8.8±3.2)%, (2.2±1.2) vs (7.2±2.8)%] (allP<0.01). In addition, the elastin levels, collagen contents, and the expression of ASMA remained significantly higher compared with model group (P<0.05).

Olmesartan medoxomil could slow down the atherosclerosis process, the possible mechanism was implicated with the suppression of Cat S and decreased inflammatory responses alongside the increased elastin and collagen contents.

fibromatosis, also known as desmoid fibroma, invasive fibromatosis, and desmoid fibroma, is a rare tumor of unknown etiology that originates from mesenchymal tissue. Intermediate tumor originating from soft tissue fascia and aponeurosis, which grows invasively and is prone to recurrence, is a benign tumor with malignant biological behavior. Foreign literature reports that the incidence rate accounts for about 3% of all soft tissue tumors and 0.03% of all tumors^[1]。 According to its onset site, it is divided into external abdominal type, abdominal wall type and intra-abdominal type. Abdominal wall fibromatosis belongs to abdominal wall type. Because this disease is easy to be misdiagnosed and the coincidence rate of preoperative diagnosis is very low, in order to improve the diagnostic accuracy, this study reviewed the ultrasound graphic data of 7 cases of abdominal wall fibromatosis confirmed by surgery and pathology in Sino-Japanese Friendship Hospital of Jilin University from 2014 to 2016, aiming to improve the diagnostic value of ultrasound for this disease.

Pilocytic astrocytoma (PA) is a rare and slow-growing glial tumor of the central nervous system. In 2007, the World Health Organization (WHO) classified it as Grade I astrocytoma, accounting for 2.3% of primary central nervous system tumors^[1], accounting for about 8.0% to 23.5% of children's central nervous system tumors^[2]。 PA is usually an astrocytoma with benign localized growth, rarely infiltrates the surrounding brain tissue, and rarely has malignant manifestations, such as anaplasia, meningeal dissemination, and local tumor recurrence is very rare. PA often occurs in children and adolescents, generally single, most occurs in or near the midline in the axis, the cerebellum is the most common, followed by optic pathway, hypothalamic area, diencephalon, brainstem, and adults are more common in supratentorial^[3,4]In this study, the imaging, pathology and clinical manifestations of 13 patients with intraventricular PA confirmed by surgery and pathology were retrospectively analyzed in order to improve the understanding of the disease and the accuracy of diagnosis.

The 42-year-old female was admitted to the First Affiliated Hospital of the People's Liberation Army General Hospital for more than 1 year due to intermittent fatigue for 6 years. The patient has been feeling weak since 2009. Because of the positive antinuclear antibody (ANA) test, the patient was given low-dose prednisone and hydroxychloroquine sulfate (HCQ) treatment according to "connective tissue disease". Since May 2014, he has voluntarily reduced urine output, positive urine protein test, ANA and anti-DS-DNA antibody, and was diagnosed as "systemic lupus erythematosus (SLE), lupus nephritis". When prednisone was increased to 20 mg once a day, the above symptoms were improved, and urinary protein did not turn negative. Several months later, the hormone was self-reduced to 10 mg once a day, and at a follow-up in August 2015, the alanine aminotransferase (GPT) was elevated (88.2 U/L) and the serum creatinine was elevated (167.6 μ mol/L). Both eyelid edema and concave edema on the back of both feet with shortness of breath after activity were found 2 weeks before admission. He was admitted to hospital at 10:00 on September 26, 2015 for further diagnosis and treatment. During the course of the disease, the patient had no fever, butterfly erythema, joint swelling and pain, dry mouth, dry eyes and acral Raynaud's phenomenon, and denied the history of repeated abortion. Increased blood pressure was found untreated 4 years ago; Six months ago, MRI of the brain revealed multiple old and subacute cerebral infarctions, which were not treated because there was no discomfort. Physical examination after admission: blood pressure 160/100 mmHg (1 mmHg =0.133 kPa), pulse 88 beats/min, breathing 19 beats/min. There was no yellowing stain in the skin and mucosa of the whole body, slight edema in both eyelids, and no abnormalities in the palpebral conjunctiva and cornea. The thorax was symmetrical without deformity, the breathing sounds of the right middle and lower lungs were weakened, and dry and wet rales were not heard. There was no lifting beat in the precordial area, the rhythm was uniform, the heart rate was 88 beats/min, and no murmur was heard in each valve area. Abdominal examination showed no abnormalities. There was concave edema below both knees, and the pulsation of the dorsal pedis artery was normal. Present tendon reflex, negative Babinsky sign. Hemoglobin was 95 g/L and platelets were 60×10 in out-of-hospital tests in the past week¹²/L. Preliminary diagnosis: SLE, lupus nephritis, chronic renal insufficiency, lupus blood system involvement, hypertension.

Aging is widespread in organisms and is a process of time-dependent functional degradation of organism tissues and organs^[1]。 Recent studies have found that hypothalamus, as a key structure in neuroendocrine regulation, plays a leading role in the aging process, and gonadotropin-releasing hormone (GnRH) also occupies a place in this process^[2]。

Rapid eye movement sleep behavior disorder (RBD) is abnormal sleep that occurs during REM sleep, with skeletal muscle achalasia and recurrent dream play behavior (DEB), and may be accompanied by increased tonic and/or temporal electromyographic activity during REM^[1]。 REM sleep behavior disorder is divided into idiopathic and secondary types. Multiple observational studies have shown that idiopathic REM sleep behavior disorder (iRBD) is closely related to neurodegenerative diseases associated with α-synucleinopathy, such as Parkinson's disease (PD), multiple system atrophy (MSA) and Lewy body dementia (DLB), while RBD is also superimposed with early symptoms of neurodegenerative diseases^[2]。 Therefore, early intervention and neuroprotective treatment for RBD patients are of great significance for screening, monitoring and delaying the occurrence and development of neurodegenerative diseases.

Bone marrow mesenchymal stem cells (BMSCs) are a kind of stem cells that exist in bone marrow with multidirectional differentiation potential and self-replication and renewal ability. In recent years, with the development of immunology and transplantation, BMSCs have become a research hotspot because of their immunological properties.