Objective To evaluate the protective effect on lung by using continuous pulmonary artery perfusion with oxygenated blood and L-arginine during cardiopulmonary bypass(CPB).Methods Forty five cases received mitral valve replacement were randomly divided into 3 groups and each group involved 15 cases. Group I(control group), patients received routine procedure of CPB. Proup Ⅱ, patients received rcontinuous pulmonary artery perfusion with oxygenated blood. Group Ⅲ,continuous pulmonary artery perfusion with oxygenated blood containing L-arginine (200 mg/kg) (n=15). All cases received routine procedure of CPB and continuously infused from the root of pulmonary artery until releasing aortaoaic clamp. Blood samples were collected from the radial artery respectively at the following time points:after the induction of anaesthesia, 1 hour after opening of aorta, 0, 6, 12, 24 hours after patients being taken back to ICU. ELISA test was used to detected the expression of tmmor necrosis factor-α(TNF-α), interleukin-6 (IL-6) and interleukin-10 (IL-10). Lung tissue samples (1.0 cm ×1.0 cm×1.0 cm) were obtained from right lower lobe. The pathologicl changes of lung tissues were observed under light mi-croscope by using HE staining. Results at each time points, the expression of TNF-α, IL-6 in group Ⅱ and group Ⅲ weresignificantly lower than that in group Ⅰ (P<0.05). The level of TNF-α, IL-6 in group Ⅲ were lower than in group Ⅱ(P<0.05). However, the expression of IL-10 in group Ⅱ and group Ⅲ were higher than in group Ⅰ, and the level of IL-10 in group Ⅲ were higher than that in group Ⅱ(P<0.05). In the group Ⅰ: HE staining showed marked pulmonary interstitial edema, intra-alveolus neutrophilic granulocyte exudation with karyorrhexis. In the group Ⅱ, light capillary vessel hyperaemia and pulmonary interstitial lymphocyte exudation were detected. Nearly normal lung tissue were observed in group Ⅲ. Conclusion Continuous pulmonary artery perfusion with oxygenated blood and L-arginine could inhibit the synthesis of inflammatory factors significantly and increase the releasing of anti-inflammatory factors during CPB. Therefore, it may reduces pulmonary inflammatory reaction and have protective effects on lung tissue.

Objective To evaluate the value of captopril challenge test (CCT) in the diagnosis of primary aldosteronism (PA).Methods A total of 674 patients [(45.0±13.7) years, men 341, women 333] admitted to Peking Union Medical College Hospital from 2000 to 2015 were analyzed.Among them, 222 subjects were with essential hypertension (EH), 28 were with pheochromocytoma (PHEO), 246 were with idiopathic hyperaldosteronism (IHA) and 178 were with aldosterone producing adenoma (APA).All patients received CCT.24 h urine sodium was measured in partial patients.Plasma renin activity (PRA), aldosterone (ALD) were detected.Results Compared with EH [PRA: before 0.5(0.2,0.9) μg·L-1·h-1, after 0.8(0.4,1.5) μg·L-1·h-1;ALD: before (393±122) pmol/L, after (360±97) pmol/L] and PHEO [PRA: before 0.3(0.1,0.9) μg·L-1·h-1, after 0.4(0.1,1.6) μg·L-1·h-1;ALD: before (396±108) pmol/L, after (374±114) pmol/L], lower levels of PRA and higher levels of ALD before and after CCT were observed in PA patients [PRA: before 0.1 (0.1,0.2) μg·L-1·h-1, after 0.1 (0.1,0.2) μg·L-1·h-1;ALD: before (468±216) pmol/L;after (457±199) pmol/L].After CCT, the suppression rate of ALD [2.8% (-8.8%,15.4%) vs 6.6% (-4.3%, 17.6%)] and increasing rate of PRA [0(0,50%) vs 50%(0, 200%)] in PA patients were lower than those in EH patients.The ALD/PRA ratio (ARR) were higher in PA than that in EH or PHEO patients.In the EH subjects, ALD levels of seated posture were higher than those of recumbent posture both before and after receiving captopril, but with no changes in ARR after CCT.No significant differences in ALD and ARR (before and after receiving captopril) were observed between seated and recumbent position in the PA group.The ARR after CCT tended to decrease in EH subjects with elevated urine-sodium compared with those with normal urine-sodium.No changes could be viewed in ALD and PRA levels between normal urine-sodium and elevated urine-sodium groups among APA, IHA and EH patients either before or after CCT.Among patients with APA, the ALD levels before CCT and the ARR after CCT were lower in the patients with AngiotensionⅡ(AngⅡ) reactive than those without.A ROC curve analysis suggested that the optimal cutoff value was 46.2 (ALD unit:ng/dl;PRA unit:μg·L-1·h-1) for ARR after challenge in diagnosing PA, with the sensitivity of 88.7% and specificity of 84.8%.Conclusions ARR after 25 mg captopril had high sensitivity and specificity in diagnosis of PA with the cutoff of 46.2.Seated CCT could replace recumbent CCT as a more confirmatory test.The PRA increasing rate should be taken into consideration when diagnosis of PA.

Objective To study on the difference of plasma renin activity ( PRA),angiotensin Ⅱ (Ang Ⅱ ),and aldosterone levels in patients with essential hypertension (EH) or primary aldosteronism (PA) or pheochromocytoma (PHEO),and to analyze the sensitivity and specificity on the diagnosis of PA among patients with hypertension with aldosterone/PRA ratio (ARR).Methods The plasma aldosterone,Ang Ⅱ and PRA concentrations in supine and upright positions were measured by radioimmunoassay from 413 patients including idiopathic hyperaldosteronism (IHA,n =111 ),aldosterone-producing adenoma (APA,n=l18),PHEO (n=98) and EH (n=86).ARR was calculated.Results Plasma aldosterone concentrations in both of supine and upright positions in PHEO group [ 374 (294,465 ) pmol/L and 629 (449,997) pmol/L] and PA group [471 (346,632) pmol/L and 673(499,825) pmol/L] were higher than those in EH group [ 277 (224,332) pmol/L and 427 (341,501 ) pmol/L ] (P ＜ 0.01 ).They were also higher in APA group [576 (416,731 ) pmol/L and 726 (554,906 )pmol/L ] than those in IHA group [399(313,504) pmol/L and 609(485,776)pmol/L ] (P ＜0.01).Ang Ⅱ levels in both positions were lower in PA group [43.2(26.4,74.4) ng/L and 60.1(38.5,103.6) ng/L] than in EH group [56.7 (43.3,78.9) ng/L and 84.3(61.3,108.4) ng/L] or PHEO group [54.3(29.9,101.5) ng/L and 102.8 (49.9,167.0) ng/L] (all P values ＜ 0.01 ),and there was no difference between IHA and APA group (P ＞ 0.05 ).The PRA level in both positions of each group were PHEO group [ 0.3 (0.2,1.0) μg ·L-1 · h-1 and 1.4(0.6,3.4) μg · L-1 · h-1] ＞EH group [0.2(0.1,0.4)μg · L-1 · h-1 and 0.6(0.4,1.0)μg· L-1 ·h-1] (P＜0.01) ＞PAgroup [0.1(0.1,0.1)μg· L-1 · h-1 and 0.2(0.1,0.3)μg·L-1 · h-1] (P＜0.01),and APA group [0.1(0.1,0.1)μg · L-1 · h-1 and0.1(0.1,0.3)μg · L-1 ·h - 1 ] ＜ IHA group [ 0.1 ( 0.1,0.2 ) μg · L - 1 · h - 1 and 0.2 (0.1,0.3 ) μg · L-1 · h - 1 ] ( supine P ＜0.01 ; upright P ＜ 0.05 ).APA was divided into 2 types with renin-Ang Ⅱ -responsive APA ( n =26) and unresponsive APA (n =92).The plasma aldosterone concentration was lower in supine position but higher in upright position in renin-Ang Ⅱ-responsive APA than in unresponsive APA patients.ARR in upright was higher in PA group ( P ＜ 0.01 ) but lower in PHEO group ( P ＜ 0.05 ) compared with EH.ARR was higher in APA than in IHA (P ＜0.01 ).The sensitivity and specificity of ARR as 40 (aldosterone unit:ng/dl;PRA unit:μg · L-1 · h-1; its value should multiply 27.7 when transferred to pmol/L,simili) were 93％ and 76％,respectively.Conclusion The levels of PRA,Ang Ⅱ and aldosterone from patients with EH,PA and PHEO are significant different.ARR as 40 in upright position could be used for PA screening cutoff point.

Objective To elucidate gene mutation and promoter methylation changes of p16 gene in pheochromocytomas (PHEO) and paragangliomas (PGL) and to assess its relation with tumor clinical characters. Methods A total of 34 tumors (20 PHEO, 14 PG L, 15 benign, 19 malignant) were collected.Direct sequencing of p16 gene after PCR was performed to analyze genetic alterations. Hypermethylation of p16 gene promoter CpG island was analyzed by methylation specific PCR(MSP). In addition, mRNA expression was detected by RT-PCR. Results Homozygous deletion and gene mutation were not observed in 34 PHEO and PGL. Aberrant methylation of p16 gene promoter CpG island was found in 35.3% (12 of 34 tumors, 3 PHEO, 9 PGL). The p16 promoter hypermethylation in PGL was significantly higher than PHEO (P=0. 005). The higher p16 promoter hypermethylation was associated with malignant behavior, tumor number, and younger age at presentation, but no statistical significance, due to the limited number of cases. The p16 mRNA expression in malignant cases was lower than in benign tumors(0.83±0.65 vs 1.12±0.81 ,P=0.278). Conclusion p16 gene homozygous deletion and mutation were not frequent in PHEO and PGL. The promoter hypermethylation is mainly attributed to inactivation of the p16 gene.

Objective: To analyze the effect of breakfast nutrition quality on the satiety among young white-collar workers. Methods: A total of 278 subjects were recruited from two cities, Shenyang and Chongqing, in June 2015. The inclusion criteria: white-collar workers aged 25-45 years involved mainly in office work, who did not experience major changes, and individuals who should follow the study protocol and sign the informed consent form. The study employed a three-phase crossover design trial. Each participant received nutritional-adequate breakfast, nutritional-inadequate breakfast, and no breakfast treatment on the basis of assignment to one of three sequences. The breakfast time was once a week and then changed, all participants underwent the tests for three successive weeks. At last, we compared the effect of participants to consume different nutritional quality on satiety sense and hunger sense. Results: A total of 232 participants completed three successive breakfast intervention studies, the age of participants was (35.2 ± 7.9) years, comprised of 48.7% male (n=113). The numbers of participants of aged 25-35 year-old and aged 36-45 were 118 and 114, respectively. Satiety scores of nutrition-adequate breakfast group, nutrition-inadequate breakfast group and no breakfast group were 63.5±14.7, 53.1±10.2 and 36.4±7.2, respectively (P<0.05). In nutrition-inadequate breakfast group and no breakfast group, male subjects scored significantly higher than female subjects (50.9±10.5 vs 46.6±9.4, 35.2±8.3 vs 31.8±5.4) (P<0.05). And, participants aged 25-35 year-old. got satiety score significantly higher than aged 36-45 (51.3±11.0 vs 45.6±12.1, 34.1±6.8 vs 32.5±7.9), the difference was statistically significant (P<0.05). The scores of hunger in the group of nutrition-adequate breakfast, nutrition-inadequate breakfast and no breakfast were 26.3 ± 8.0, 35.1 ± 11.2 and 57.3 ± 17.0, respectively (P<0.05). Conclusion The nutrition quality of breakfast affects the satiety of young white-collar workers. The better the nutrition quality of breakfast is, the higher the satiety score and the lower the hunger score become. Compared with women and participants aged 36-45 year-old, men and those aged 25-35 year-old get satiety sense more easily.

Objective:To investigate the correlation between the distribution of traditional Chinese Medicine (TCM) constitution and the syndrome of TCM and the performance under gastroscope in patients with hiatal hernia(HH).Methods:A total of 300 HH patients diagnosed in the Department of Gastroenterology, the Second Affiliated Hospital of Shandong University of TCM from January 2016 to December 2018 were enrolled in this study.The clinical information was collected to complete TCM constitution, TCM syndrome type and gastroscopic performance classification.Results:The composition ratio of TCM constitution in 300 patients with HH was not exactly the same(χ 2=88.140, P<0.05). From high to low, the order was: Qi stagnation(58 cases), Qi deficiency(56 cases), damp heat(51 cases), phlegm dampness(45 cases), Yang deficiency(27 cases), Yin deficiency(21 cases), peace(17 cases), blood quality(17 cases), special quality(8 cases). There was a significant attribute association between TCM syndrome type and TCM constitution classification(χ 2=129.753, P<0.05), among which: the syndrome of liver and stomach stagnation heat corresponded to damp heat and Yin deficiency; the syndrome of spleen and stomach dampness heat corresponded to phlegm dampness syndrome; the syndrome of spleen and stomach deficiency cold corresponded to Yang deficiency and Qi deficiency; the syndrome of Qi stagnation and phlegm corresponded to blood sputum and Qi stagnation; Qi deficiency and blood stasis syndrome corresponded to Qi deficiency.There was significant attribute association between gastroscopic performance and TCM constitution(χ 2=123.189, P<0.05), among which: no esophagitis corresponded to Yang deficiency, Qi deficiency, peace and phlegm dampness; the grade A reflux esophagitis corresponded to the dampness heat and the Qi stagnation; the grade B corresponded to the dampness heat and the Qi stagnation, the grade C had no obvious correspondence, the grade D corresponded to the Yin deficiency. Conclusion:The TCM constitution of HH patients is mainly characterized by Qi stagnation, Qi deficiency, damp heat and phlegm dampness, and there is a significant correlation between constitution classification and TCM syndromes type and gastroscopic performance.

Objective To analys hyperinsulinemia in Bartter syndrome. Methods Twenty-three cases of Bartter syndrome [age (27 ±9) years;fasting serum potassium(2. 8 ±0. 5)mmol/L], 20 patients of aldosterone-producing adenoma [APA, age (45 ± 11 ) years, fasting serum potassium ( 3.0 ± 0. 4 ) mmol/L], 20 patients of idiopathic hyperaldosteronism [IHA, age (51 ± 11 ) years, fasting serum potassium (3.4 ±0. 2)mmol/L] were diagnosed in Peking Union Medical College Hospital from September 2003 to May 2008. All patients underwent 3-hours oral glucose tolerance test(3hOGTT), postural stimulation test and calculated HOMA-insulin resistance ( HOMA-IR ) and HOMA-insulin sensitivity ( HOMA-IS ) by Homeostasis model.Results The insulin area under curve-(229.0±162.4)mIU·L-1·h] was singnificantly higher than APA group [(227.7±158.6)mIU·-1·h].But HOMA-IR in Bartter group were similar to APA group( 1.96 ± 1.14 vs 1.41 ± 0. 91 ), and HOMA-IR in APA group was lower than IHA group ( 1.96 ± 1.14 vs 2.40 ± 1.60, P ＜ 0. 05 ). There was no deference in HOMA-IS among three groups,but APA group had lower level. In all three groups, the peak of insulin secretion was delayed. Conclusion Bartter syndrome patients commonly present with hyperinsulinemia.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread worldwide and threatened human's health. With the passing of time, the epidemiology of coronavirus disease 2019 evolves and the knowledge of SARS-CoV-2 infection accumu-lates. To further improve the scientific and standardized diagnosis and treatment of maternal SARS-CoV-2 infection in China, the Chinese Society of Perinatal Medicine of Chinese Medical Association commissioned leading experts to develop the Recommendations for the Diagnosis and Treatment of Maternal SARS-CoV-2 Infection under the guidance of the Maternal and Child Health Department of the National Health Commission. This recommendations includes the epidemiology, diagnosis, management, maternal care, medication treatment, care of birth and newborns, and psychological support associated with maternal SARS-CoV-2 infection. It is hoped that the recommendations will effectively help the clinical management of maternal SARS-CoV-2 infection.

Background: Twenty-four-hour urinary free cortisol (UFC) measurement is the initial diagnostic test for Cushing’s syndrome (CS). We compared UFC determination by both direct and extraction immunoassays using Abbott Architect, Siemens Atellica Solution, and Beckman DxI800 with liquid chromatography-tandem mass spectrometry (LC-MS/MS). In addition, we evaluated the value of 24-hr UFC measured by six methods for diagnosing CS. Methods: Residual 24-hr urine samples of 94 CS and 246 non-CS patients were collected.A laboratory-developed LC-MS/MS method was used as reference. UFC was measured by direct assays (D) using Abbott, Siemens, and Beckman platforms and by extraction assays (E) using Siemens and Beckman platforms. Method was compared using Passing–Bablok regression and Bland–Altman plot analyses. Cut-off values for the six assays and corresponding sensitivities and specificities were calculated by ROC analysis. Results: Abbott-D, Beckman-E, Siemens-E, and Siemens-D showed strong correlations with LC-MS/MS (Spearman coefficient r = 0.965, 0.922, 0.922, and 0.897, respectively), while Beckman-D showed weaker correlation (r = 0.755). All immunoassays showed proportionally positive bias. The areas under the curve were 0.975 for Abbott-D, 0.972 for LCMS/MS, 0.966 for Siemens-E, 0.948 for Siemens-D, 0.955 for Beckman-E, and 0.877 for Beckman-D. The cut-off values varied significantly (154.8–1,321.5 nmol/24 hrs). Assay sensitivity and specificity ranged from 76.1% to 93.2% and from 93.0% to 97.1%, respectively. Conclusions Commercially available immunoassays for measuring UFC show different levels of analytical consistency compared to LC-MS/MS. Abbott-D, Siemens-E, and Beckman-E have high diagnostic accuracy for CS.

ObjectiveTo analyze the epidemiological distribution and temporal trends of liver cancer incidence among Luzhou residents from 2016‒2022， and to provide a theoretical basis for improving liver cancer prevention and treatment strategies in Luzhou. MethodsData on liver cancer incidence among Luzhou residents from 2016 to 2022 were collected， and the incidence rate， age-specific incidence rate， and annual percentage change （APC） were calculated. A Joinpoint regression model was used to fit a time series segment to the monthly number of new cases in each district and county of Luzhou to explore the trend of liver cancer incidence rate. ResultsThe incidence rate of liver cancer in Luzhou increased from 22.96/10⁵ in 2016 to 32.31/10⁵ in 2022. The incidence rate of liver cancer in men was higher than that in women in both 2016 and 2022， and the incidence rate of liver cancer in men increased from 34.83/10⁵ in 2016 to 47.95/10⁵ in 2022， with an APC of 3.3%； the incidence rate of liver cancer in women increased from 10.50/10⁵ in 2016 to 15.95/10⁵ in 2022， with an APC of 3.0%， and the differences in the change trends were not statistically significant （P>0.05）.The incidence of liver cancer was low in the age group of 0‒<40 years from 2016 to 2022 and increased with age； the incidence of liver cancer in the age group of 55 years and above was increasing at an average annual rate of 16.4%. ConclusionThe overall incidence of liver cancer in Luzhou is on the rise， and the incidence of liver cancer in men is higher than that in women. Middle-aged and elderly men are the key population for liver cancer prevention and treatment， and liver cancer prevention and treatment should be carried out in a targeted manner， taking into account regional development differences.