Objective To understand the application of dietary supplements among adult patients with type 2 diabetes mellitus (T2MD) in two areas of China. Methods A total of 615 T2MD patients were recruited from three hospitals in Beijing and Shenyang, with convenience sampling for the study using self-reported questionnaires. Data were statistically analyzed. Results Overall 34. 8% of the participants (22.5% in Beijing and 45.5% in Shenyang, respectively) reported ever use of at least one dietary supplement in the past 12 months. The most commonly used supplement was royal jelly ( 16. 1% ), followed by vitamins ( 10. 1% ), calcium (8. 8% ),fish oil (7. 3% ), spirulina (3.9%), and lecithin (2. 3% ). Except that royal jelly was used for complementary treatment for T2MD, most of the other supplements were used for improving their body defense. In addition, more than 20 other health dietary supplements were also used for diabetes-related conditions in 8. 5% of the participants surveyed. The participants' main sources of information about dietary supplements were from mass media or recommendations by relatives and friends. About half of supplements users perceived that the dietary supplements were effective. The application of dietary supplements was associated with gender, educational background, living area,perceived burden of medical cost, stage of diabetes, comorbidity, and body mass index (BMI) of the patients ( all P ＜0. 05). Conclusions Dietary supplements are widely used among T2MD patients in Beijing and Shenyang.The types of these dietary supplements are diverse and lack professional instructions. It is recommended that information on dietary supplements should be included in diabetes education.

Objective To assess the feasibility and advantage of systematic transperineal ultrasound guided template prostate biopsy. Methods In a prospective study, a total of 1270 patients(26 -90 year old,mean age 70. 4) who met the inclusion criteria underwent 11 regions systematic transperineal ultrasound guided template prostate biopsy. The median PSA level was 12. 96 ng/ml(range 0. 25000. 0 ng/ml) and the mean prostate volume was 53. 6 ml(range 7-200 ml). Results Prostate cancer was detected in 486 of 1270(38. 3%). The prostate cancer detection rate in group with PSA 0-4.0, 4. 1-10. 0, 10. 1-20. 0, 20. 1-40.0, 40. 1-60.0, 60. 1-100.0、and> 100. 0 ng/ml groups was 21.9%(16/73 )、16.6%(67/ 403)、30.7% (122/397)、46. 7%(77/165)、68. 3%(41/60)、86.2% (46/54) 、99.2% (117/118), respectively . While cancer detection rate in group with prostate volumes less than 20, 21-40, 41-60, 61-80 and great than 80 ml was 72. 1%(49/68 )、55. 6%(234/421) 、32.5%(136/418)、23.3%(48/206)、12. 1%、(19/157). The mean positives for the cancer of regions 1- 10 and region 11 (the apical region) were 35.3% vs. 44.8% in patients whose PSA＜20ng/ml(P＜0. 05). The positives for cancer within the right lobe and left lobe were 70. 8% vs. 74.2%(P>0.05)and the positives for cancer within the anterior and posterior parts were 79. 4% vs. 86. 8%(P>0. 05). No serious complication occurred during the procedure. Conclusions Systematic transperineal ultrasound guided template prostate biopsy could be accurate and safe. Prostate carcinoma foci are more frequently localized in the apical region in patients with PSA ＜20 ng/ml. Special attention should be paid to the apical region during the process of biopsy.

Objective To discuss the clinical characteristics and management principles of com-posite pheochromoeytoma of adrenal gland (pheochromocytoma-ganglioneuroma). Methods Four cases of composite tumor of adrenal gland diagnosed pathologically were reviewed. All the cases were male, aged 37 to 62 years;three of them had the history of hypertension, one of them accompanied with paroxysmal palpitation, while one case was asymptomatic. Computerized tomography and ultra-sonography showed single tumor in adrenal, the diameter was about 2.5、3.8、6.3、15cm respectively. Two cases showed positive results in 131Ⅰ-metaiodobenzylguanidine (MIBG) scintigraphy. One case showed positive result in 99Tcm-hydrazinonicotinamide-3trysinoctreotide (HTOC) scintigraphy. Twenty-four hours urinary catecholamine examination revealed the average of norepinephrine, epi-nephrine and dopamine were (196.1±92.2)nmol/24 h, (26.6±8.9)nmol/24 h, (1957.9±913.5) nmol/24 h respectively. Two cases were at a little elevated level and the others with normal. All cases were managed with α-adrenergic receptor blocker preoperatively for 2-4 weeks. Results Tumor re-section was performed in all 4 cases, and 3 cases by retroperitoneal laparoscopy, one by open surgery. All 4 cases were diagnosed as composite pheochromocytoma of adrenal (Pheochromocytoma-gangli-oneuroma) by pathology. All patients had no evidence of recurrence or metastasis during follow-up from 15 to 38 months. Two of three cases with hypertension reverted to normotensive. Conclusions Composite pheochromocytoma of adrenal is rare, difficult to be diagnosed preoperatively. Except mild in eatecholamine secretion, which clinical manifestations are similar to pheochromocytoma. Pheochro-mocytoma-ganglioneuroma is no apparent tendency for aggressive behaviors, the results of surgical management are favorable.

Objective To evaluate the safety and efficacy of adrenal autotransplantation for the treatment of persistent Cushing's disease after transsphenoidal pituitary tumor resection. Methods Four patients were treated by adrenal autotransplantation with attached blood vessels after bilateral adrenalectomy for persistent Cushing's disease from April 1991 to March 2008 in our institute. The four patients were 3 females and 1 male. Their ages ranged from 14 to 36 years, with an average of 30 years. Right adrenalectomy was performed 1 to 3 months before the left adrenalectomy. 30 % ?50 % of the left hyperplastic adrenal was placed in the left inguinal region with the anastomosis of the inferior epigastric artery and the central adrenal vein, and between the left saphenous vein and the incised adrenal envelope with the adrenal middle artery inside. The hormone replacement dosage decreased gradually after operation. They were followed up for 1.0, 1. 5, 8. 0 and 10. 0 years. The patient's symptoms, adrenal hormone (serum cortisol, urinary free cortisol and adrenocorticotroph) levels and the steroid replacement dosages were recorded and analyzed. Results The symptom of the Cushing's disease disappeared completely after operation and there was no Nelson's syndrome except one patient with slight darken skin. Through 4 ways of imaging examination, operation, clinical presentation and endocrine examination, the 4 transplanted adrenals functioned well with less steroid replacement dosage needed after operation. The 4 transplanted adrenal glands functioned steadily 1 year after the auto-transplantation, and no hyperplasia was detected in the transplanted adrenals with the stimulus of high dosage adrenocorticotroph. Conclusions The long-term effects of adrenal autotransplantation with attached blood vessels after bilateral adrenalectomy is effective and safe. Adrenal autotransplantation can be a feasible option for the treatment of persistent Cushing's disease.

Objective To evaluate the clinical application of a muhiprobe FISH (multicolor fluorescence in situ hy-bridization,M-FISH) assay in voided urine specimens for detection of bladder cancer and compare the results with those afforded by urinary cytology.Methods Voided urine specimens from 100 cancer patients with or without surgery and 10 patients with prostate hyperplasia were obtained for urinary cytology and FISH.FISH was performed using a mixture of fluorescent labeler DNA probes for the centromeric regions of chromosomes 3,7,and 17 and 9p21 region.Cystoscopy with biopsy or tumor resection was performed in all patients and compared the pathological results with the cytological and FISH findings.Results The sensitivity of M-FISH were 75.6% for low grade tumors,100% for high grade tumors,with overall sensitivity of 85.5%.Urinary cytology affords an overall sensitivity of 62.9% (33.3% for low grade tumors,96.0% for high grade tumors).Significant difference in overall sensitivity was observed between M-FISH and urinary cytology (P＜0.05).The specificity of M-FISH and urinary cytology was 84.6% and 87.8% respectively.No significant difference in specificity was observed between M-FISH and urinary cytology.Conclusion M-FISH improves the sensitivity obtained with urinary cytology for bladder cancer detection with similar specificity,so can detect all high grade infiltrating tumors patients.

Objective To evaluate the role of adrenolectomy in ectopic ACTH syndrome. Methods Clinical data of 23 cases of ectopic ACTH syndrome were analysed.Of them,14 were males and 9 were female,the average age was 38.All of the 23 cases had clinical and biochemical and imaging evidences for the diagnosis of Cushing's syndrome.16 of the 23 cases were treated with total adrenalectomy and the other 7 were treated without surgical intervention. Results Sixteen cases,having no identifiable source of ectopic hormone production, treated with bilateral or unilateral total adrenalectomy,had resolution of their presenting signs and symptoms,1-year survival was 67%,2-year survival was 44% and 5-year survival was 19%.Seven of the patients who were managed without surgical intervention,1-year survival was 0%. Conclusions To most patients with no identifiable source of ectopic hormone production, bilateral adrenolectomy with hormonal replacement is effective.

Objective To investigate the efficacy and safety of 3D-laparoscopic surgery in adrenalpheochromocytomas /paragangliomas.Methods From December 2012 to July 2014,23 cases of adrenal pheochromocytomas/paragangliomas were treated by 3D-laparoscopic surgery.Among them,7 cases were male and 16 cases were female,whose mean age are 47 (32-68) years old.Their clinical symptoms including sustained hypertension in 11 cases,intermittent hypertension in 8 cases,sustained hypertension with intermittent progression in 2 cases and asymptom in 2 cases.All tumors were diagnosed by endocrine examination,image test and nuclear medicine.Mean diameter of tumors are 8 cm,ranged from 3-14cm.In order to adjust the blood pressure,patients took α-receptor blocker for 2-4 weeks preoperatively.Under the general anesthesia,19 patients received the 3D-laparoscopic surgery via retroperitoneal approach and 4 cases received the procedure via peritoneal approach.Results All operations were completed successfully.There were no major intraoperative complications.Mean operating time was (78 ± 21) min and mean estimated blood loss was (54.8 ± 36.3) ml.Mean hospital stay after operation was (3.8 ± 1.4) days.The pathological diagnosis included pheochromocytomas in 15 cases and paragangliomas in 8 cases.During the 3 to 18 months following up,no recurrence or metastasis was found in this study.Conclusions 3D-laparoscopic surgery has obvious advantage in spatial location and the sense of depth for adrenal pheochromocytomas /paragangliomas,which shortens the operation time and increase the safety obviously.

Objective To study the classification and treatment of juxtaglomerular cell tumor of the kidney. Methods Five cases of juxtaglomerular cell tumors of the kidney were diagnosed and treated surgically in our hospital during the last 4 years. Seven large series of cases report of juxtaglomerular cell tumors have been published in the Pubmed. These series of cases report plus 1 case report of static juxtaglomerular cell tumor were incorporated into a review of 71 cases previously published in English literature. The clinical presentation, laboratory examination and imaging study were summarized. The clinical presentation including blood pressure, the laboratory examinations including kalium, plasma renin activity and aldosterone, and renal venous sampling for renin assay, and the imaging study including ultrasonography, CT, excretory urography, and selective renal angiography were studied retrospectively. Results The 71 cases juxtaglomerular cell tumors could be classified into 3 types, that is, typical type, atypical type and static type. The 57 typical cases had the typical characteristics of hypertension, hyperaldosteronism, and hypokalemia secondary to tumor renin secretion.The 12 atypical cases had hypertension with normal kalium, and the 2 static cases had normal blood pressure and kalium. Typical juxtaglomerular cell tumor of the kidney should be considered in hypertensive patients with secondary aldosteronism. Atypical juxtaglomerular cell tumor of the kidney should be considered in patients with hypertension and renal tumor. Static juxtaglomerular cell tumor of the kidney should be considered in patients with benign renal tumor. Conclusions The classification of typical, atypical and static juxtaglomerular cell tumors depends on blood pressure and serum kalium. As a surgically corrected disease, juxtaglomerular cell tumor of the kidney should be considered in patients with benign renal tumor, and nephron-sparing surgery is the first choice.

Objective To investigate the effects of ghrelin on colonic motility in mice.Methods The eflfects of ghrelin on colonic propulsive movement were detected by charcoal suspension pushing test after injection of normal saline and different doses of ghrelin(20,50,100,200 ng/g).The effects of atropine,NG-nitro-L-arginine methylester hydrochloride(L-NAME)or D-Lys3-GHRP-6 on the changes of colonic propulsive movement caused by ghrelin(100 ng/g)were also investigated.In vitro,the effects of different doses of ghrelin(0.01,0.1,1,10μmol/L)on the spontaneous contraction amplitude of proximal colonic circular muscle strips were studied.Results Ghrelin significantly accelerated the colonic propulsive movement in dose-dependent manner,but the efiect was significantly inhibited in the presence of atropine,L-NAME or D-Lys3-GHRP-6(t=10.230,12.560,11.590,P＜0.05).Administration of ghrelin significantly increased the contraction amplitude of colonic circular muscle strips.but this effect was inhibited when the colonic circular muscle strips were pretreated by tetrodotoxin.ConclusionsGhrelin can accelerate colonic propulsive movement by activating growth hormone secretagogue receptor of cholinergic excitatory pathways and nitrergic nervous pathways in the enteric nervous system of colon.

Objective To study a modified method of laparoscopic partial nephrectomy with hypothermic renal artery perfusion in situ.Methods Laparoscopic partial nephrectomy with hypothermic renal artery perfusion in situ was performed in 5 patients from March 2009 to May 2009.There were 3 males and 2 females,with an average age of 49 years (39 to 63 years).There were 3 tumors in the left kidney and 2 in the right kidney,with an average diameter of 5.6 cm (range,3.8 to 7.0 cm).There were 2 cases of chronic renal insufficiency,1 case of solitary kidney,1 case of contralateral renal atrophy and 1 case of larger benign tumor.The procedure of laparoscopic partial nephrectomy with hypothermic renal artery perfusion in situ was as follows:A catheter with balloon was placed in the renal artery with percutaneous approach through the femoral artery preoperatively.During the operation the balloon of the catheter was inflated with water in order to block the renal artery,and renal artery perfusion of about 200ml saline of 4 ℃ was conducted through the catheter under high pressure in order to achieve low temperature in situ kidney.The water of the balloon was extracted after the accomplishment of the laparoscopic partial nephrectomy.Results Laparoscopic partial nephrectomies with hypothermic renal artery perfusion in situ were carried out successfully in 5 cases.The average operative time was 102 min (80 to 120 min),the average renal artery occlusion time was 35 min (range,29 to 39 min),and the average amount of bleeding was 190 ml(50 to 300 ml).The temperature of skin,kidneys,and tumor after hypothermic perfusion dropped by an average of 0.6℃,10.0 ℃,and 9.8℃,respectively.The endogenous creatinine clearance rate was(84.7±16.9),(48.9±14.5),(52.1±12.4),(54.5±13.8),and(54.6±11.7)ml/min before and 1 day,3 days,5 days and 10 days after operation.There was significant difference among the 5 groups in endogenous creatinine clearance rate(P=0.001).There was significant difference between each 2 groups except that between the group at 5 days and 10 days after operaton,The endogenous creatinine clearance rate kept steady in 5 days after operation.Conclusions Laparoscopic partial nephrectomy with hypothermic renal artery perfusion in situ is feasible and safe in favor of the extension of renal ischemic time and the protection of renal function.And it has resolved 2 problems in laparoscopic partial nephrectomy,that is,the laparoscopic artery occlusion and the hypothermic perfusion.