Age-related macular degeneration (AMD) has become a leading cause of irreversible visual loss in senior population with serious influence to their ability of living independently.Epidemiological researches have revealed various risk factors of AMD,some of which are not controllable such as age,heredity and race ;while others are modifiable such as lifestyle,eye conditions and other systemic diseases.However,the awareness of AMD risk factors is alarmingly low in public.Meanwhile,the understanding of AMD risk factors among ophthalmologists is also unsatisfactory.Therefore,the risk factors of AMD are reviewed here in order to improve the understanding of the ophthalmologists and better guide the clinical management of AMD.

Objective To describe a case of female sexual abnormality with 46, XX caused by an androgen-producing adrenocortical tumor and to explore the mechanism of abnormal androgen secretion from the tumor. Methods The tumor tissues as the experimental group were compared with the normal adrenal tissue. The LH/human chorionic gonadotropin ( hCG) receptor was determined by immunohistochemisty, the activity of 3β-hydroxysteroid dehydrogenase ( 3β-HSD ) , 17α-hydroxylase ( CYP17 ) , and 17β-hydroxysteroid oxidoreductase ( 17β-HSD ) by enzyme linked immunosorbent assay(ELISA) and the expression of mRNA of 3β-HSD2, 17β-HSDB3, CYP17, and LH/hCG receptor by real-quantitative polymerase chain reaction ( RQ-PCR ) . Results The immunohistochemisty results showed that the LH/hCG receptor was negative in the experiment group, but positive in control. The activity of 3β-HSD and CYP17 of the experiment group was higher than that in the control (P<0. 01), while the activity of 17β-HSD was lower(2 638. 798±70. 551 vs 9 148. 174±382. 836, P<0. 01) according to ELISA results. The relative contentof3β-HSD2mRNAoftheexperimentgroupwashigherthanthatinthecontrol(P<0.05),andtherelative content CYP17 mRNA of the experiment group was much higher than that in the control (P<0. 01). However, the relative content of 17β-HSDB3 mRNA and LH/hCG receptor mRNA were much lower than those in the control ( P<0. 01) by RQ-PCR. Conclusion Sexual abnormality and virilization could be caused by the excessive androgen secreted by androgen-producing adrenocortical tumor, which is an extremely rare disease. The mechanism of the secretion of androgen from the tumor remains unknown so far. It may be related to the increased activity of 3β-HSD and CYP17, but has no relationship with the expression of LH/hCG receptor.

Objective To study the clinical features of patients with ACTH-independent bilateral macronodular adrenal hyperplasia(AIMAH).Methods Eighteen cases with AIMAH diagnosed in Chinese PLA General Hospital from 1998 to 2010 were analyzed retrospectively.Results ( 1 ) AIMAH was equally distributed between genders,mean age at diagnosis was ( 51.4 ± 10.7 ) years,and average course was ( 9.9:t:2.7 ) years.( 2 )Most patients visited hospital because of adrenal incidentaloma; hypertension and impaired glucose tolerance/diabetes mellitius were the most common clinical presentations; typical signs of Cushing′s syndrome (CS) such as moon face and central obesity were less frequent.( 3 ) All cases′ laboratory findings met the diagnostic criteria of ACTH-independent CS,some cases with the features of subclinical CS.24 h dynamic plasma ACTH and cortisol monitoring had the advantage of revealing the features of subclinical CS for some AIMAH cases; there was remarkable elevation of plasma cortisol after exogenous ACTH stimulation in AIMAH patients.(4) Bilateral adrenal macronodular changes could be visualized on CT scan.( 5 ) Pathology identified bilateral macronodular adrenal hyperplasia.( 6 ) Bilateral adrenalectomy was the most useful treatment.Conclusions AIMAH is an infrequent cause of CS,and some patients present subclinical CS.Its marked clinical feature is ACTH-independent bilateral macronodular adrenal hyperplasia.

In order to explore the treatment of Her-2 positive breast cancer patients who failed in multi-line treatments, we retrospectively analyzed the clinical data of a patient with refractory Her-2 positive breast cancer.The patient was initially diagnosed as Her-2 positive advanced breast cancer.After six line treatment in the outer hospital, the patient′s condition was basically in a progressive state.The breast tumor was broken and purulent, the lung metastasis increased, and the patient′s quality of life was poor.The patient was admitted to Department of Breast Surgery of Affiliated Suqian Hospital of Xuzhou Medical University, after MDT discussion, we gave pyrrolotinib combined with capecitabine treatment, the chest wound healed gradually, the lung metastasis gradually reduced, and the quality of life was better.A retrospective analysis of this case showed that pyrrolidine combined with capecitabine may bring hope to Her-2 positive breast cancer patients who failed to receive multi-line therapies, especially those who failed to target therapy.

OBJECTIVETo compare the efficacy differences among acupotomy, electroacupuncture and acupuncture for treatment of simple obesity.

METHODSOne hundred and five cases were randomly divided into an acupotomy group, an electroacupuncture group and an acupuncture group, 35 cases in each group, and Zhongwan (CV 12), Tianshu (ST 25), Shangjuxu (ST 37), Sanyinjiao (SP 6), etc, were selected in three groups and also with selection of acupoints according to symptoms. The acupotomy group was treated with acupotomy 40 mm in length and 0.6 mm in diameter, the electroacupuncture group with the Han's LH402A electroacupuncture stimulator and the acupuncture group with simple acupuncture treatment. The clinical therapeutic effects of three groups were compared. The obesity signs such as body weight, body mass index (BMI), obesity degree, etc., and blood lipid and fasting blood sugar (FBS) were observed.

RESULTSThe markedly effective rate of 91.4% (32/35) in the acupotomy group was higher than that of 71.5% (25/35) in the electroacupuncture group and that of 42.9% (15/35) in the hand acupuncture group (both P<0.05). There were significant differences in the obesity signs and blood fat and FBS of the three groups before and after treatment (P<0.05, P<0.01). The differences rates of body weight, BMI, obesity degree, chest circumference, waistline, thighline, waist-hip ratio, total cholesterol before and after treatment in the acupotomy group were all better than those in the electroacupuncture group and in the acupuncture group (all P<0.05), and the differences rates of hipline, FBS in the acupotomy group were better than those in the acupuncture group (both P<0.001).

CONCLUSIONAcupotomy treatment can obviously reduce fat, FBS and blood lipid and has obvious therapeutic effects on simple obesity.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Body Mass Index ; Body Weight ; Electroacupuncture ; Female ; Humans ; Lipids ; blood ; Male ; Middle Aged ; Obesity ; metabolism ; therapy ; Young Adult

BACKGROUNDGastric cancer ranks high among the most common causes of cancer-related death worldwide. This study was designed to explore key genes involved in the progression of normal gastric epithelial cells to moderate gastric epithelial dysplasia (mGED) and to gastric cancer.

METHODSTwelve pairs of mGED tissues, gastric cancer tissues, and normal gastric tissues were collected by gastroscopy. Total RNA was then extracted and purified. After the addition of fluorescent tags, hybridization was carried out on a Gene chip microarray slide. Significance analysis of microarrays was performed to determine significant differences in gene expression between the different tissue types.

RESULTSMicroarray data analysis revealed totally 34 genes that were expressed differently: 18 highly expressed (fold change > 2; P < 0.01) and 16 down-regulated (fold change > 2; P < 0.01). Of the 34 genes, 24 belonged to several different functional categories such as structural molecule activity, extracellular regions, structural formation, cell death, biological adhesion, developmental processes, locomotion, and biological regulation that were associated with cancer. The remaining 10 genes were not involved in cancer research. Of these genes, the expression levels of Matrix metalloproteinase-12 (MMP12), Caspase-associated recruitment domain 14 (CARD14), and Chitinase 3-like 1 (CHI3L1) were confirmed by semi-quantitative RT-PCR. A two-way clustering algorithm divided the 36 samples into three categories and the overall correct classification efficiency was 80.6% (29/36). Almost all of these genes (31/34) showed constant changes in the process of normal gastric epithelial cells to mGED to gastric cancer.

CONCLUSIONSThe results of this study provided global gene expression profiles during the development and progression from normal gastric epithelial cells to mGED to gastric cancer. These data may provide new insights into the molecular pathology of gastric cancer which may be useful for the detection, diagnosis, and treatment.

Adult ; Aged ; Epithelial Cells ; metabolism ; Gastric Mucosa ; metabolism ; pathology ; Humans ; Middle Aged ; Reverse Transcriptase Polymerase Chain Reaction ; Stomach ; metabolism ; pathology ; Stomach Neoplasms ; genetics ; Transcriptome ; genetics

BACKGROUNDIncomplete right bundle branch block (ICRBBB) is commonly associated with atrial septal defect (ASD), but lacks sufficient diagnostic test characteristics. An abnormal T wave is also often observed in ASD, with horizontal or inverted displacement of the proximal T wave limb in the right precordial leads, termed "defective T wave" (DTW).

METHODSWe examined the diagnostic test characteristics of combining ICRBBB with DTW as a new index to diagnose ASD. A total of 132 consecutive patients with ASD and 132 cases of age/gender-matched controls without ASD were enrolled.

RESULTSSensitivities of DTW, ICRBBB, and both were 87.1% - 87.9%. Specificities were 97.0%, 96.2%, and 100%, respectively. Positive predictive values were 1.3%, 1.1%, and 100.0% respectively, while negative predictive values were 99.9% for each.

CONCLUSIONCombining ICRBBB with DTW in electrocardiogram (ECG) as a new index significantly increased the specificity and positive predictive values while maintaining a high sensitivity in diagnosing ASD.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bundle-Branch Block ; diagnosis ; physiopathology ; Child ; Child, Preschool ; Electrocardiography ; Female ; Heart Septal Defects, Atrial ; diagnosis ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Sensitivity and Specificity

BACKGROUNDThe precise molecular mechanisms underlying the gallbladder carcinoma (GBC) metastasis has not been fully elucidated.

METHODSIn the present study, metastasis-associated proteins were identified by comparative proteomic analysis. The functional study of the candidate protein vimentin was further investigated. First, a pair of higher and lower metastatic sublines (termed GBC-SD/M3 and GBC-SD, respectively), originated from the same parental cell line, was screened by spontaneous tumorigenicity and metastasis in vivo in animal study and further characterized by metastatic phenotypes analysis in vitro. Subsequently, a proteomic approach comprised two-dimensional gel electrophoresis analysis and mass spectroscopy was used to identify and compare the protein expression patterns between higher metastatic GBC-SD/M3 and lower metastatic GBC-SD cell lines. Then twenty-six proteins were identified.

RESULTSAmong the 26 proteins identified, fourteen proteins were up-regulated and 12 proteins were down-regulated in GBC-SD/M3. Vimentin was identified and found to be overexpressed in GBC-SD/M3 as compared with GBC-SD. This result was further confirmed by quantitative PCR and Western blotting analysis. Furthermore, the cell migration and invasion potency of GBC-SD/M3 in vitro was remarkably suppressed after small interference RNA-mediated knockdown of vimentin. Moreover, immunoblot and immunohistochemical analysis on 12 human GBC specimens showed consistently increased vimentin expression in metastases compared with primary tumors.

CONCLUSIONTumor vimentin level may reflect the pathological progression in some GBC and may be a useful marker for predicting tumor metastasis and a therapeutic target for the treatment of GBC patients with metastases.

Animals ; Blotting, Western ; Cell Line, Tumor ; Cell Movement ; genetics ; physiology ; Electrophoresis, Gel, Two-Dimensional ; Gallbladder Neoplasms ; genetics ; metabolism ; pathology ; Humans ; Immunohistochemistry ; Mice ; Mice, Nude ; Neoplasm Metastasis ; genetics ; pathology ; RNA Interference ; Reverse Transcriptase Polymerase Chain Reaction ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ; Vimentin ; genetics ; metabolism

Objective To summarize the positive signs on multi-detector CT angiography (CTA) for active severe gastrointestinal bleeding (GIB).Methods We retrospectively evaluated the clinical records and CT images of 93 patients with active severe GIB confirmed by digital subtraction angiography (DSA),endoscopy or surgery. The positive CT signs indicating the locations and causes of the bleeding were recorded. Results Intraluminal extravasation of contrast material was identified in 44 cases (47.3%),vascular malformation was found in 22 cases (23.7%),gastrointestinal tumor was detected in 18 cases (19.4%),focal or segmental abnormal bowel mucosal enhancement was present in 7 cases (7.5%),and diverticulum with abnormal enhancement was found in 2 cases (2.2%). Conclusion Positive signs for active severe GIB on CT are diverse and thus should be carefully interpreted in clinical setting.
Angiography, Digital Subtraction ; Contrast Media ; Gastrointestinal Hemorrhage ; diagnostic imaging ; Humans ; Retrospective Studies ; Tomography, X-Ray Computed

Objective To evaluate the clinical characteristics and etiologies of central diabetes insipidus (CDI).Methods The clinical data of 230 patients with CDI in the Department of Endocrinology of Chinese PLA General Hospital from 2008 June to 2014 December were collected and analyzed retrospectively.Results The three most common causes of CDI were idiopathic CDI,lymphocytic hypophysitis and intracranial germ cell tumors.Among all the CDI,the idiopathic CDI accounted for 37.48％.There were significant differences in age onset and gender distribution among the different causes of CDI.The patients with intracranial germ cell tumors [age of onset(19.2± 10.2) years] were younger than the other types of CDI.Germ cell tumors patients were more common in male,and lymphocytic hypophysitis patients were more common in female.The most frequent abnormality of anterior pituitary in patients with CDI was growth hormone deficiency,followed by hypogonadism,adrenal insufficiency and hypothyroidism.The dysfunction of thyroid axis and adrenal axis in patients with germ cell tumor was more common than those in patients with idiopathic and lymphocytic hypophysitis.Conclusions The most common causes of central diabetes insipidus were idiopathic CDI,lymphocytic hypophysitis and intracranial germ cell tumors.There were differences in age of onset,gender distribution and abnormal production of anterior pituitary hormones among all causes of CDI patients.