Prolactinoma is the most common adenoma of pituitary gland, which causes hyperprolactinemia. Differential diagnosis for hyperprolactinemia may sometimes become difficult. The stimulating test with metoclopramide or thyrotropin-releasing hormone helps. Bromocriptine is the first choice to treat prolactinoma. Other medicaments, surgery and radiation are also of choice under certain particular conditions.

Objective To study the value of adrenal venous sampling (AVS) in the differential diagnosis of primary aldosteronism (PA).Methods Fourteen patients (11 adenoma and 3 adrenal hyperplasia) clinically diagnosed as PA were examined with AVS for measurement of plasma aldosterone and cortisol levels.Selectivity of AVS was assessed by the aldosterone level in each adrenal vein and in the infrarenal inferior vena cava plasma.The data were compared with CT and postoperative pathologic result.Results The diagnosis of adenoma by AVS in 9 (9/11) cases was in accordance with the postoperative pathologic findings.The diagnosis of hyperplasia by AVS in all 3 cases was in accordance with CT scanning result.Conclusion AVS should be selected to distinguish the PA without overt occupational lesion in CT scanning.

Objective To observe the role of the mild changes in hepatic nuclear factor (HNF)-1? gene in the pathogenesis of type 2 diabetes mellitus. Methods With PCR, denatured gradient gel electrophoresis and DNA sequencing,the genomic DNAs from the blood of type 2 diabetic patients and normal control were analyzed to find the changes in HNF-1? gene. These changes were added up in-groups and compared with plasma insulin concentration. Results Code 459 CTG changed to TTC,codes 489 AGC changed to AAC in the 7th exon;no 7G changed to A in the 7th intron. The 3 point changes were of one kind of polymorphism. Its frequency to normal genotype was 61: 39 in normal control, 56: 44 in type 2 diabetes mellitus. Homozygotes of the polymorphism in the group of type 2 diabetes mellitus had slightly lower plasma insulin concentration, but t-test result was P

Objective To evaluate the tests in differential diagnosis of subtypes in patients with primary aldosteronism. Methods Fifty-seven patients in the past 7 years chnically diagnosed as primary aldosteronism [22cases of aldosterone-producing adenoma (APA), 26 idiopathic hyperaldosteronism (IHA) and 9 primary adrenal hyperplasia (PAH)] were selected. The plasma potassium, basic and upright plasma renin activity, plasma and urinary aldosterone were determined. 19 patients with essential hypertension served as control. All patients with primary aldosteronism underwent adrenal CT, postural stimuhtion test (PST) and adrenal venous sampling (AVS) to differentiate the subtypes. The clinical and laboratory data were followed up during survey. Results (1) The patients with APA had higher blood pressure and aldosterone level in plasma or urine, but lower plasma potassium and plasma renin activity than those with IHA. In PAH group, these parameters were in the ranges between APA group and IHA group. For the diagnosis of APA, IHA and PAH, the coincidences were 86.4%, 73.1% and 22.2% by adrenal CT, 86.4%, 80.8% and 77.8% by the ratio of aldosterone in both sides of AVS and 95.5%,92.3% and 100.0% by the ratio of aldosterone to cortisol in beth sides, respectively. (2) The plasmaaldosterone, systohc and diastolic blood pressure were decreased after operation in the patients of APA and PAH,and no significant changes were found in patients with IHA. Conclusion The abnormal laboratory findings in patients with APA axe more evident than those in IHA. The result of PST is overlapping considerably in cases ofAPA and IHA. Adrenal venous samphng yields a high coincidence, which should be done in patients with negative CT scanning. The ratio of aldosterone to eortisol in AVS is more reliable. The clinical and laboratory data,especially plasma potassium will be improved after operation in patients with APA and PAH. But there is no change in patients with IHA during the follow-up period.

BACKGROUND: Up to now, no universally successful therapy to treat substantial articular cartilage defects has been available. Numerous therapeutic approaches can only improve clinical symptoms of joint lesions, but not stimulate the regenerative and reactive capacity of the biological tissue in the defect, and not restore an articular surface capable of functional load bearing.OBJECTIVE: To investigate the curative effects of homograft of mesenchymal stem cells (MSCs) seeded onto cancellous demineralized bone matrix (DBM) on articular cartilage defects.DESIGN, TIME AND SETTING: A randomized controlled study which conducted in Orthopaedics Institute, the Second Hospital of Lanzhou University from January to March 2005 and Central Laboratory of Guilin Medical Collage from May to August 2008.MATERIALS: Bone metaphysis and vertebral cancellous bone were derived from rabbits to prepare DBM materials. MSCs were seed on DBM stent and cultured in vitro. All 36 rabbits were randomly divided into combination group (DBM/MSCs), DBM alone group, and blank control group, with 12 rabbits per group.METHODS: Full-thickness cartilage defect model of knee joint was frilled using a cylinder of 4 mm diameter and 3 mm thickness on intercondylar fossa. The cartilage defects in the intercondylar fossa were filled with MSCs/DBM in combination group A, with only DBM in the DBM group, and nothing was treated in the blank control group.MAIN OUTCOME MEASURES: Four rabbits were killed at three time points, which were 4, 8 and 12 weeks after the operation in each group, and the reparative tissue samples were evaluated grossly, histologically, immunohistochemically and graded according to gross and histological scale.RESULTS: Tirty-six rabbits were included in the final analysis. The defects of MSCs/DBM transplantation were repaired by byline-like tissue, and the other defects were repaired by fibrous tissue. Gross and histological grading scale was made on 12 weeks postoperatively. Gross and histological scores in the MSCs/DBM group were significantly lower than DBM group and control group (P<0.05); while, the scores in the DBM group was significantly lower than control group (P<0.05).CONCLUSION: The full-thickness cartilage defects of rabbits were repaired with homograft of mesenchymal stem cells seeded onto cancellous demineralized bone matrix, which is a promising way for the treatment of cartilage defects.

Objective To investigate the level of plasma GDF-15 in patients with COPD and its clinical value in the diagnosis of COPD in the stable stage and in acute exacerbation stage. Methods From 2015 to 2016, 58 cases of patients with COPD were enrolled ,including COPD patients in the stable stage and in acute exacerba-tion stage. 29 cases of COPD patients diagnosed in our hospital were enrolled in the experimental group ,and 29 cases of age-,gender and body mass index-matched healthy people were enrolled in the control group. Compared and analyzed the blood cell count ,determination of plasma GDF-15 and C-reactive protein were performed and ana-lyzed. Spearman correlation analysis was conducted to compare levels of GDF-15 and C-reactive protein between pa-tients with the stable stage of COPD and those with acute exacerbation stage of COPD. The diagnostic efficacy was compared between GDF-15 and C-reactive protein in differentiatingthe COPD in acute exacerbation period and in the stable period. Results Level of GDF-15 in the stable COPD patients was significantly increased compared with that in the control group. The plasma GDF-15 level was significantly increased in acute exacerbation COPD patients compared to patient with the stable COPD(P<0.001). For the stable COPD patients,GDF-15 level and C-reactive protein level was positively correlated(r = 0.776,P < 0.001). In acute exacerbation COPD patients, GDF-15 level and C-reactive protein level was positively correlated (r = 0.877,P < 0.001). The ROC curves showed that the GDF-15 level on the diagnosis of acute exacerbation COPD patients with an AUC was 0.783(95%CI,0.666~0.900,P<0.001)and with the diagnostic accuracy was 69%. C-reactive protein in the acute exacer-bation of AUC diagnosis of COPD was 0.686(95%CI:0.549~0.823,P<0.01)and the diagnostic accuracy rate was 59%. Conclusion The plasma level of GDF-15 was significantly increased in COPD patients compared with people in the healthy control group. Plasma GDF-15 and C- reactive protein were highly correlated in the stable stage of COPD patients and in acute exacerbation stage of COPD patients. The diagnostic accuracy of GDF in patients with the stable stage of COPD and with acute exacerbation stage of COPD was higher than C-reactive pro tein.

Objective To investigate the association of serum C peptide concentration with the severity and the outcome of diabetic foot ulcer (DFU). Methods The clinical data of 257 inpatients with DFU were collected, including fasting and postprandial 2h C peptide levels and C peptide area under curve (AUCCP ). The patients were followed up on the outcomes of ulcers and death. The associations of serum C peptide concentration with the Wagner degree, infection severity, and healing rate were analyzed. Results The medians of fasting and 2h postprandial serum C peptide as well as AUCCP were 1. 37(0. 02 ~ 9. 00) nmol/ L, 3. 22(0. 02 ~ 29. 61) nmol/ L, and 511. 65 (3. 60 ~ 2 691. 30)nmol·min-1 ·L-1 respectively, which were lower than general levels. The time of follow-up in our study was 2. 8 (1. 0 ~ 5. 1) years. By the end of study, the wound of 75. 88% patients was healed, 3. 5%undergone major amputation, and 23. 74% died. After adjusting for relative factors, there were no significant associations of serum fasting and postprandial C peptide levels and AUCCP with Wagner degree and infection severity (P>0. 05). Cox regression analysis showed that the fasting plasma C peptide and hemoglobin were the independent protective factors for the healing of ulcers; old age, male, higher infection degree, and diabetes family history were their independent risk factors ( all P < 0. 05). Conclusions The lower plasma fasting C peptide concentration in patients with DFU is not correlated with Wagner degree and infection severity, but closely related with healing rate.

Objectives To study the correlations between stroke-preventive knowledge,health belief and health behaviors in community hypertensive patients.Methods The questionnaire of SPKQ,CHBMS and HPLPⅡwere used to take the investigation among 94 hypertensive patients from a community hospital in Guangzhou.Results The total score on SPKQ was 62.70±18.39 and the average scores on CHBMS and HPLPⅡwere 3.51±0.24 and 2.48±0.37,respectively.The stroke-preventive knowledge was positively correlated with health belief,health motivation and self-efficacy(r=0.289,P<0.01;r=0.246,P<0.05;r=0.350 (P<0.01,respectively).The health motivation was positively correlated with health behaviors(r=0.304,P<0.01)and the seriousness negatively correlated with health behaviors(r=-0.279,P<0.01).Conclusion Medical staff should provide much more stroke education with community hypertensive patients and promote patients’health motivation and self-efficacy of health belief in stroke prevention,help patients understand stroke seriousness,establish and sustain healthy lifestyles.

Objective To estimate heart function among patients with diabetic foot ulcer,and to investigate the characteristics of heart failure(HF) before and after treatment of ulcer. Methods Items associated with diabetes and some physiological and biochemical indicators were observed in patients with diabetic foot ulcer(162 cases) and with high risk factors of ulcer(75 cases). Heart function was evaluated at patients′ admission, during ulcer related treatment, and prior to discharge. Left ventricular ejection fraction and other cardiac assessment were measured with ultrasonic scan.Results During hospitalization, 23.6%(56/237) patients underwent HF with normal left ventricular ejection fraction, and it was 27.2%(44/162) in patients with foot ulcers. The prevalence of HF was 8.9%(21/237) in all patients studied on admission, and that was 10.5%(17/162) in patients with foot ulcer, more than that without foot ulcer(P＜0.01). More patients with HF were found, being 14.8%(35/237) during 2-7 days after ulcer related treatment initiated, and peak was on the 4th day. There was statistical difference among different Wagner grades(P＜0.05) about the morbidity rate of HF. All patients with HF were improved and tolerant to ulcer related treatment. Conclusion The prevalence of HF with normal left ventricular ejection fraction was relatively high in patients with diabetic foot ulcer, especially after ulcer treatment.

Objective To evaluate the sensitivity and specificity of various assays in diagnosing Cushing′s syndrome. Methods The plasma cortisol, urinary free cortisol (UFC), circadian rhythm in cortisol secretion and dexamethasone suppression test were assessed in 173 patients clinically diagnosed Cushing′s syndrome. The data were compared with the postoperative pathologic diagnosis. Results The normal diurnal rhythm of cortisol secretion was lost in 92.9% patients with Cushing′s syndrome. The loss of normal diurnal rhythm of cortisol secretion of 2 time points occurred in 85.1% (8:00, 16:00) and 91.8% (8:00, 24:00), and that of 3 time points (8:00, 16:00, 24:00) in 94.7% of the cases. The excretion of UFC was increased in 91.7% of patients with Cushing′s syndrome. Low-dosedexamethasonedidnotsuppressthe excessive secretion of glucocorticoid in 79.7% (1 mg) and 84.3% (2 mg) patients with Cushing′s syndrome. The basal level of plasma cortisol was raised in 75.6% patients. The sensitivity of 8 mg dexamethasone suppression test was 50%-70% as the standard was set at 50% suppression, and specificity was more than 95%. Conclusion The most sensitive tests for Cushing′s syndrome are the loss of normal circadian rhythm of cortisol secretion and increased UFC. The method of 3 time points is more sensitive than that of 2 time points in the assessment of circadian rhythm. The 8 mg dexamethasone suppression test is the most useful method in differentiating Cushing′s disease from adrenal adenoma.