ObjectiveTo discuss the clinical diagnosis and treatment of multiple endocrine neoplasia ( MEN ) 2A, and report the mutation of the RET proto-oncogene in a pedigree of three patients with MEN 2A.MethodsBilateral adrenalectomy was performed on two of the three patients with hypertension and bilateral adrenal-conserving adrenal pheochromocytoma resection was performed on the other patient. All three patients were treated by total thyroidectomy and neck lymphadenectomy. Twelve family members were recruited to the study. Peripheral blood was collected and total genomic DNA was prepared for polymerase chain reaction (PCR). PCR products of exon 10 and exon 11 of the RET proto-oncogene were purified and a direct DNA sequence analysis was performed.ResultsThe pathological diagnosis of the specimens was bilateral adrenal pheochromocytoma and medullary thyroid carcinoma in all the three patients. There was no tumor recurrence or distant metastasis after 1.5 - 5 years of follow-up. A missense mutation of TGC (Cys)to CGC (Arg) at codon 634 in exon 11 of the RET proto-oncogene was detected in all three patients. Genetic screening identified two mutation carriers in the other members of this pedigree.ConclusionGenetic mutation screening and surgical intervention may be helpful to the members of high-risk families.

ObjectiveTo evaluate the laparoscopic procedure and therapeutic efficacy of retroperitoneal laparoscopic surgery for the treatment of adrenal ganglioneuroma.Methods6 patients [4 male and 2 female,32 to 59 (mean 41.3) years old],underwent retroperitoneal laparoscopic resection of adrenal ganglioneuroma. In this group, 2 patients with left adrenal ganglioneuroma, 4 patients with right adrenal ganglioneuroma. ResultsAll of the 6 cases was successfully performed uneventfully with retroperitoneal laparoscopic adrenalectomy. Pathologic studies confirmed there were 6 cases of adrenal ganglioneuroma. No case was transferred to open operation.The blood pressure remained stable during operation.Mean tumor size was (5.9±2.1) cm (tumor diameter 3.6-11.2 cm) Mean operative time was 120(90-210) min.Mean estimated blood loss was 160 (50-700) ml.Postoperative hospital stay ranged from 7 to 9 days.All the patients were cured without relapse during 4-32 month, follow-up. ConclusionsRetroperitoneal laparoscopic procedures for adrenal ganglioneuroma causes less traumatic;less operative blood loss;distinct image during operation;less postoperative discomfort;faster postoperative recovery and earlier return to daily activities and diet.Retroperitoneal laparoscopic procedure should be considered as the first choice for adrenal ganglioneuroma.

Objective To investigate the diagnositc value of high frequency ultrasound guided fine needle aspirates (FNA) and thyroglobulin (Tg) in fine-needle aspirate fluid (FNA-Tg) measurement for detecting metastatic lymph nodes in patients underwent thyroidectomy for papillary thyroid carcinoma (PTC).Methods Sixty-five patients with 79 suspected metastatic lymph nodes were retrospective analysis in this study.FNA for suspected lymph nodes was performed guided by high frequency ultrasound and FNATg was measured.The histopathologic diagnosis for all of the suspected lymph nodes was obtained after lymphadenectomy.Results By histopathologic diagnosis,62 lymph nodes were positive metastasis,while 17 were negative metastasis.Fifty-four lymph nodes were diagnosed as positive metastasis and 25 as negative metastasis by FNA.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of FNA for assessing cervical metastatic lymph nodes from PTC were 89.87％ (71/79),87.10％ (54/62),100％ (17/17),100％ (54/54) and 68.00％ (17/25),respectively.Sixty-five lymph nodes were diagnosed as positive metastasis and 14 as negative metastasis by FNA-Tg.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of FNA-Tg were 96.20％ (76/79),100％ (62/62),82.35％ (14/17),95.38％ (62/65) and 100％ (14/14),respectively.There was no significant difference between FNA and FNA-Tg for evaluating cervical metastatic lymph nodes from PTC (x2 =1.454,P =0.228).Eight positive metastatic lymph nodes which were missed by FNA were corrected diagnosed by FNA-Tg measurement.Conclusions Both FNA and FNA-Tg are effective methods for assessing cervical metastatic lymph nodes from PTC postoperatively,and these two methods could be combined for early and accurate evaluating the lymph nodes state.

Objective To review the clinical diagnosis and treatment of acute focal renal infarction. Methods Three cases of focal renal infarction were reported and the literature was reviewed.The patients aged from 45 to 63 years with mean age of 54. Two cases had low back pain, 1 case with abdominal pain. Based on clinical history, B-ultrasonography and CT scan, focal renal infarction was diagnosed in 3 patients. There were 2 cases on left kidney and 1 case right. All cases were applied digital subtraction angiography (DSA) and thrombolytic anticoagulant therapy. Results Two cases received DSA and thrombolytic therapy. The other one case received pethidine 50 mg, progesterone 20 mg treatment, the salvia infusion and low molecular heparin 6000 U anticoagulant therapy. All patients had symtoms relieved after 1 d. A week later CT scan, 3 cases of renal infarction were apparently disappeared. Serum creatinine and urea nitrogen were normal. Three patients were followed, mean follow-up time was 1. 5 (0. 5-2) years. Conclusions The diagnosis of acute focal renal infarction mainly depends on B-ultrasound and CT. Early diagnosis and treatment is important for achieving recovery of the compromised renal function. Renal infarction should be suspected in the presence of abdominal pain of sudden onset.

Bronchopulmonary dysplasia (BPD) is a common neonatal respiratory disease.The mortality rate of premature infants has reduced with the development of medical technology,while the incidence of various complications after birth,such as BPD-associated acute kidney injury (AKI),has gradually increased.Patients with BPD-associated AKI usually have poor prognosis due to exposure to hyperoxia.This review describes the occurrence,mechanism and intervention development of BPD-associated AKI.

Objective:To analyze the effect on the expressions of nuclear factor-erythroid 2-related factor 2(Nrf2) and NAD(P)H quinone oxidoreductase 1 enzyme (NQO1) in A549 cells exposed to hyperoxia and interfered by small interfering RNA, and to investigate the role of Nrf2 and NQO1 in hyperoxia-induced lung injury as well as their relationship with apoptosis.Methods:A549 cells were gained by serial sub cultivation in vitro and then randomly divided into 4 groups: the air group without interference ( group Ⅰ), the hyperoxia group without interference (group Ⅱ), the air group transfected with Nrf2 siRNA (group Ⅲ), and the hyperoxia group transfected with Nrf2 siRNA (group Ⅳ). The hyperoxia groups (Ⅱ, Ⅳ group) were continuously exposed to an atmosphere containing a high concentration of oxygen (950 mL/L O 2, 50 mL/L CO 2), while the air groups (group Ⅰ, Ⅲ) were still placed in the incubator with 50 mL/L CO 2. In the pre-experiment, cells were transduced with a mixture of siRNA-1, siRNA-2, and siRNA-3. Then the siRNA with the highest efficiency for repressing Nrf2 expression was used for subsequent experiments. The mRNA and protein expression levels of Nrf2 and NQO1 in the 4 groups were detected by quantitative real-time polymerase chain reaction (qPCR) and Western blot.The distribution of Nrf2, Kelch-like ECH-associated protein 1(Keap1) and antioxidant response element(ARE) proteins in A549 cells after interference with Nrf2 was analyzed by immunofluorescence and confocal laser scanning microscope, and the cell apoptosis of the 4 groups were observed. Results:(1) Nrf2 siRNA significantly down-regulated the mRNA expression of Nrf2 in the groups siRNA-1, siRNA-2 and siRNA-3, and the inhibition efficiency of group siRNA-1 was the highest (80.57%). (2) The re-lative mRNA expression levels of Nrf2 and NQO1 in the group Ⅱ were 4.553±0.498 and 5.866±0.582, respectively.The mRNA and protein expression of Nrf2 and NQO1 and the cell apoptosis rate [(21.67±0.75)%]in the hype-roxia group were significantly higher than those in the group Ⅰ (all P<0.01). (3) The relative mRNA expression levels of Nrf2 and NQO1 in the group Ⅳ were 0.937±0.057 and 0.789±0.058, respectively.Compared with the group Ⅱ, the mRNA and protein expression of Nrf2 and NQO1 in the group Ⅳ were significantly decreased, while the cell apoptosis rate [(35.83±0.42)%]was significantly increased (all P<0.01). Conclusions:The abnormal expression of Nrf2 and NQO1 in A549 cells induced by hyperoxia and siRNA interference suggests that Nrf2 and NQO1 are involved in the pathogenesis of hyperoxia induced lung injury.Nrf2 and NQO1 are possibly protective factors in the hyperoxia induced lung injury and apoptosis.

Bronchopulmonary dysplasia(BPD), a common respiratory disease in premature infants, leads to poor long-term prognosis.The crosstalk between the gut and lung which can be mediated by microbiota is known as the gut-lung axis.Recently, an increasing amount of evidence has indicated that the gut microbiota is closely related to the pathogenesis of many respiratory diseases.The gut-lung axis affects the occurrence and development of BPD through microbiota translocation and regulation of immune pathways.At present, the relationship between the gut-lung axis and BPD is still in the research stage and exploring the potential association may help to search early markers and new therapies for BPD.In order to provide insights into preventing and treating BPD, this review describes the relationship between the gut-lung axis and BPD.