This is to study the clinical features of thyrotoxic periodic paralysis (TPP) caused by Graves′ disease. Fifty-nine patients, accounting for 25.4% of 232 patients with Graves′ disease, were found to be suffering from TPP. Among them, 58 were male and one was female. 54 patients were young men (age 19～45) (91.5%). Hypokalemia was found in 53 cases (89.8%) during episodes of paralysis. The results indicate that the rate of TPP caused by Graves′ disease is 25.4%, and it occurs mainly in young men(98.3%). Hypokalemic periodic paralysis was the most common type of TPP.

Objective To study the related factors of leukoaraiosis (LA). Methods 480 elderly patients examined with cranial CT or MRI were investigated retrospectively. A single-factor and multi-Logistic regression analysis were performed. A rank correlation analysis was performed between the severity of LA and age as well as the course of hypertension. Results The prevalence of LA was 35%. The age (t=3.243，P=0.0013) and the incidence of hypertension (χ2=9.8941，P=0.0017) were higher in LA group than in non-LA group, the incidence of diabetic were lower (χ2=4.4193，P=0.0355). The age (OR=1.06，95%CI：1.027～1.103，P=0.0006), hypertension (OR=1.15，95% CI：1.065～1.236，P=0.0003), and diabetes (OR=0.85，95% CI：0.726～0.994，P=0.0421) were correlated with LA. Neither age (r=0.1553，χ2=4.9701，P=0.5477) nor the course of hypertension (r=-0.0758，χ2=1.9076，P=0.7527） were correlated with the severity of LA. Conclusion The age and hypertension was independent risk factors for LA, but the severity of LA was not correlated with age or course of hypertension.

Objective To evaluate the effects of drotaverine hydrochloride versus scopolamine in re-ducing duodenal motility and in facilitating cannulation during endoscopic retrograde cholangiopancreatogra-phy (ERCP). Methods Randomized controlled trial of 650 participants from 4 endoscopic centers assigned to receive scopolamine 20 mg or drotaverine hydrochloride 40 mg intravenously 15 minutes before ERCP. Pa-rameters including duodenal motility grades, success rates of deep cannulation, ERCP-related complications and adverse effects were recorded. Results The data of 638 patients (319 in each group) were valid. There were no significant differences in duodenal motility grades (1.17 ±0. 82 vs. 1.13 ± 0.89, P =0. 705), success rate of deep cannulation (90. 9% vs. 91.8%, P =0. 672) and incidence of ERCP-related complications (11.3% vs. 11.0%, P =0. 900) between 2 groups. However, the incidence of tachycardia (heart rate > 120 bpm) during ERCP was lower in drotaverine group than in scopolamine group (2. 2% vs. 6. 9%, P = 0. 004). There was no significant difference in other adverse effects (nausea, vomiting) between 2 groups. Conclusion Drotaverine hydrochloride may provide a reasonable alternative as antimotility agent before ERCP.

Ascites ; therapy ; Humans ; Treatment Outcome ; Ultrafiltration ; instrumentation

Objective To investigate the clinical treatment strategy of large and giant pituitary adenomas invading the cavernous sinus.Methods One hundred and nine patients with large and giant pituitary adenomas invading the cavernous sinus,admitted to our hospital from January 2010 to December 2018,were chosen in our study.Four patients with prolactin-type pituitary adenomas received oral treatment with bromocriptine;the remaining 105 patients received surgical treatment,and choices of surgical approach were based on classification of pituitary adenomas.The clinical data and efficacies of these patients accepted different treatment approach were retrospectively analyzed.Results Of the 105 patients with pituitary adenomas,63 (60％) were of type Ⅰ,15 (14.3％) were of type Ⅱ,18 (17.1％)were of type Ⅲ,and 9 (8.6％) were of type Ⅳ.Single extended transsphenoidal approach was used in 75 patients,transcranial approach was used in 26 patients,and combined extended transsphenoidal and transcranial approach was used in 4 patients.Gross total tumor resection was achieved in 86 patients,subtotal resection in 17 patients,and partial resection in two patients.Ten patients had new cranial nerve palsy after surgery,including 7 with oculomotor nerve palsy and three with abductor nerve palsy;two patients with preoperative neurological paralysis were aggravated,and both of them were oculomotor nerves;transient insipidus was noted in 19 patients and electrolyte disorder was noted in 23 patients;no permanent insipidus,cerebrospinal fluid leakage or intracranial infection,and no new or aggravated visual field vision disorder were noted.Conclusion Reasonable clinical treatment strategies and appropriate microsurgical approaches can achieve good therapeutic effect in patients with large and giant pituitary adenomas invading the cavernous sinus.

Bartter syndrome (BS, OMIM #601678) is a rare inherited salt-losing tubulopathy characterized by hypokalemia metabolic alkalosis with secondary renin-angiotensin-aldosterone system activation. As reported, BS type 1 is generally presented prenatal and neonatal period, and symptoms usually appear before and after birth or in infancy, accompanied by severe salt loss, whilst kidney function remains mostly normal. In this study, we report a case of BS type 1 with childhood onset and proteinuria and renal impairment. The child was born preterm due to hyperamniotic fluid, but there were no apparent symptoms after birth until the age of 3 when the child began to present with polydipsia, polyuria and increased nocturnal uria. At the age of 5, she had elevated serum creatinine level and proteinuria. After admission, she was diagnosed with chronic tubulointerstitial disease and stage 2 chronic kidney disease(CKD). According to the chloride clearance test, the abnormal function of medullary thick ascending limb Henle′s loop, was confirmed and BS type 1 was diagnosed by gene sequencing. After active management of complications, kidney function of the child improved. In the long-term follow-up, the urinary protein amount of the child still increased, eGFR slowly decreased, and the child was currently in the CKD2 stage. Children with prenatal BS may not present typical clinical manifestations immediately after birth until the onset of relevant clinical symptoms in childhood. BS type 1 patients may have renal impairment, which needs to be identified in time. Clinical differentiation diagnosis between BS and Gitelman syndrome can be made by chloride clearance tests. Early diagnosis and treatment are critical to improve prognosis.

Objective:To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice.Methods:Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate′s parents used the JCard to measure jaundice at the neonate′s cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson′s correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis.Results:Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation ( r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2?μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0?μmol/L. The TcB value of 205.2?μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions:JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).