To summarize the clinical data of two cases with severe hyponatremia diagnosed as adrenal insuffiency combined with syndrome of inappropriate secret on of antidiuretic hormone(SIADH),and to review related literatures.Case 1 diagnosed as Addison's disease for 27 years and developed severe hyponatremia again but did not response well to sufficient glucocorticoid.Further examination showed SIADH caused by lung cancer and tolvaptan worked well.Case 2 was diagnosed as SIADH caused by lung cancer and responsed well to tolvaptan.However,hyponatremia reoccurred with the decreasing level of ACTH and cortisol during the chemotherapy.It was thought that hyponatremia was caused by drug-related adrenal insuffiency and glucocorticoid replacement therapy achieved good response.Both primary/secondary adrenal insuffiency and SIADH can lead to severe hyponatremia,but it is rare that the two situations exist in one patient and occur in different time.We should consider the possibility of the situations when we make differential diagnosis of refractory hyponatremia,monitoring the curative effects carefully,then correct the diagnosis timely,and reduce missed diagnosis and misdiagnosis.

Adrenal hemangioma is a rare neoplasm.The clinical data of a case of adrenal cavernous hemangioma and review of related literatures are herewith presented.Adrenal cavernous hemangioma is often nonfunctioning and benign.CT and MRI show the features of hemangioma.The treatment depends on the size of the mass,and the diagnosis is based on pathology.

Objective To analyze the clinical risk factors of hemorrhagic transformation (HT) of cardiogenic cerebral embolism and the influence of HT on outcome. Methods The clinical data of 115 inpatients were reviewed from May, 2012 to December, 2015. They were di-vided into HT group (n=58) and non-HT group (n=57). The age, anticoagulant therapy, thrombolytic therapy, infarction diameter, diabetes, coronary heart disease, hyperlipidemia, the National Institutes of Health Stroke Scale (NIHSS) score and HAS-BLED score were compared. The risk factors for HT was screened with the multivariate Logistic regression. NIHSS score and Modified Rankin Scale (mRS) score as hos-pitalization, and one month and three months after stroke were compared. Results There were significant difference in NIHSS score (t=-2.991, P=0.003) and HAS-BLED score (t=-2.499, P=0.014), as well as infarction diameter (χ2=8.355, P=0.004) between HT group and non-HT group. NIHSS score (OR=1.127, P=0.027), HAS-BLED score (OR=1.783, P=0.03) and infarction diameter (OR=4.390, P=0.035) were the risk factors for HT. The incidence of HT was less in low-risk group (HAS-BLED score=0-2) than in high-risk group (HAS-BLED score≥3) (χ2=4.643, P=0.031). The NIHSS score as hospitalization, and one month and three months after stroke were all more in HT group than in non-HT group (t>2.387, P<0.05). The mRS score was more in HT group as hospitalization (t=-2.262, P=0.026), but not significant one and three months later (t<1.468, P>0.05). Conclusion HT tends to happen in the patients of cerebral embolism patients after atrial fibril-lation with severe neural function defect, large infarction diameter and high HAS-BLED score. The neural function is poor in those with HT.

Stigma is common in patients with head and neck cancer, which greatly affects their physical and mental health and the quality of life. This article summarizes the research progress of stigma in patients with head and neck cancer from the aspects of research status, measurement tools, influencing factors and intervention strategies, in order to provide a reference for carrying out the research on stigma in patients with head and neck cancer in China.

Objective: To investigate the prevalence of depression and anxiety and its relationship with bullying and violent behaviors among middle school students in Beijing, so as to provide a scientific basis for promoting the mental health of middle school students. Methods: A total of 18 379 junior high school, general high school, and vocational high school students from 16 districts of Beijing were selected by stratified cluster random sampling from September to November, 2023. The χ2 test was used to analyze the depression or anxiety symptom and injuryrelated behaviors such as bullying among middle school students. Logistics regression was used to analyze the correlation between depression or anxiety symptom and injury correlation behaviors among middle school students. Results: The detection rates of depression symptoms and anxiety symptoms were 18.2% and 8.6% among middle school students in Beijing, and the comorbidity was 7.6%. The reporting rate of school bullying was 3.3%. The results of Logistic regression showed that girls (OR=1.23), high school students (OR=1.85) and vocational high school students (OR=1.91), school bullying (OR=3.83), being scolded and beaten by parents (OR=3.32) and being exposed to cyber violence (OR=4.43) were positive factors related to depression symptoms; and nonresidential students (OR=0.87) was a negative factor related to depression symptoms (P<0.05).Girls (OR=1.32), high school students (OR=1.77) and vocational high school students (OR=1.50), school bullying(OR=3.63), being scolded and beaten by parents (OR=3.41) and being exposed to cyber violence (OR=3.33) were positive factore related to anxiety symptoms (P<0.05). Conclusions The depression and anxiety symptoms among middle school students in Beijing are closely related to the behaviors of school bullying and experiencing violence from parents or the Internet. Various measures should be taken to reduce the situation of school bullying, being scolded and beaten by parents and cyber violence among middle school students to promote their mental health.

Objective To analyze the correlation between vitamin D levels and vascular endothelial function and plasma renin activity (PRA) in hypertensive patients.Methods 415 patients with essential hypertension admitted to our hospital from January 1 to December 2017 were selected as the experimental group.142 healthy subjects who received physical examination and met the included indicators were selected as the control group.The blood biochemical indexes and the 25 (OH) D contents in the blood of two groups were detected and analyzed.The experimental group was divided into vitamin D mild deficiency group (15-30 mmol/L),severe deficiency group [25 (OH) D ＜ 15 mmol/L] and normal group [25 (OH)D ＞ 30 mmol/L] according to vitamin D content.The endothelial function (RHI value) and renin were compared in the three groups,and multiple linear regression analysis was performed on endothelial function and orthotopic renin activity and related factors.Results The diastolic blood pressure,vitamin D content and blood lipid biochemical indexes of the experimental group and the control group were significantly different (P ＞ 0.05).The higher the vitamin D content,the lower the plasma renin activity PRA;the RHI value of the vitamin D severe deficiency group was lower than the vitamin D normal group [(1.4 ±0.15)mmol/L vs (1.6 ± 0.20) mmol/L] (P ＜ 0.05).Vitamin D was negatively correlated with 24 hours systolic blood pressure (24 h SSD),the standard deviation of 24 hours diastolic blood pressure (24 h DSD),the Standard deviation of daytime systolic blood pressure (dSSD),the Standard deviation of daytime diastolic blood pressure (dDSD),the Standard deviation of nighttime systolic blood pressure (nSSD),the Standard deviation of nighttime diastolic blood pressure (nDSD) (P ＜ 0.05),and positively correlated with the decrease of night systolic blood pressure and night diastolic blood pressure.Vitamin D and total cholesterol were independent influencing factors of endothelial function (P ＜ 0.01).Vitamin D and 24 h mean heart rate were independent influencing factors of orthostatic renin activity (P ＜ 0.01).Conclusions The low vitamin D content in patients with essential hypertension affects endothelial function and plasma renin activity,which should be paid more attention in clinical practice.

Objective: To evaluate the radiological tumor response patterns and compare the response assessments based on immunebased therapeutics Response Evaluation Criteria in Solid Tumors (iRECIST) and RECIST 1.1 in metastatic clear-cell renal cell carcinoma (mccRCC) patients treated with programmed cell death-1 (PD-1) inhibitors. Materials and Methods: All mccRCC patients treated with PD-1 inhibitors at Henan Cancer Hospital, China, between January 2018 and April 2019, were retrospectively studied. A total of 30 mccRCC patients (20 males and 10 females; mean age, 55.6 years; age range, 37–79 years) were analyzed. The target lesions were quantified on consecutive CT scans during therapy using iRECIST and RECIST 1.1. The tumor growth rate was calculated before and after therapy initiation. The response patterns were analyzed, and the differences in tumor response assessments of the two criteria were compared. The intra- and inter-observer variabilities of iRECIST and RECIST 1.1 were also analyzed. Results: The objective response rate throughout therapy was 50% (95% confidence interval [CI]: 32.1–67.9) based on iRECIST and 30% (95% CI: 13.6–46.4) based on RECIST 1.1. The time-to-progression (TTP) based on iRECIST was longer than that based on RECIST 1.1 (median TTP: not reached vs. 170 days, p = 0.04). iRECIST and RECIST 1.1 were discordant in 8 cases, which were evaluated as immune-unconfirmed PD based on iRECIST and PD based on RECIST 1.1. Six patients (20%, 6/30) had pseudoprogression based on iRECIST, of which four demonstrated early pseudoprogression and two had delayed pseudoprogression.Significant differences in the tumor response assessments based on the two criteria were observed (p < 0.001). No patients demonstrated hyperprogression during the study period. Conclusion Our study confirmed that the iRECIST criteria are more capable of capturing immune-related atypical responses during immunotherapy, whereas conventional RECIST 1.1 may underestimate the benefit of PD-1 inhibitors. Pseudoprogression is not rare in mccRCC patients during PD-1 inhibitor therapy, and it may last for more than the recommended maximum of 8 weeks, indicating a limitation of the current strategy for immune response monitoring.

Objective: The study was aimed at exploring the latent classes and factors influencing middle school students health risk behaviors in Beijing, so as to provide a scientific basis for determining key intervention targets and formulating relevant intervention measures. Methods: A questionnaire survey was conducted among 17 730 junior middle school, senior high school and vocational high school students in 16 districts of Beijing from October to December 2022. Six types of health risk behaviors were assessed with latent class analysis, including unhealthy diet, lack of exercise, unintentional harm, intentional harm, substance abuse and Internet addiction behavior. Results: The latent classes of health risk behavior among middle school students in Beijing were divided into three classes:high risk behavior (961 participants, 5.42%), low lack of exercise/high intentional injury (1 099 participants, 6.20%), and low risk behavior (15 670 participants, 88.38%). Disordered multiple Logistic regression analysis indicated that middle school students who were male ( OR =1.45), in high school ( OR =2.00), had other family types ( OR =1.90), possibly had depressed feelings ( OR =2.27), had depressed feelings ( OR =6.18), or were absent from school because of illness in the past year ( OR =1.79) were more likely to be in the high risk than the low risk behavior group. Moreover, middle school students who were male ( OR =2.30), had an extended family ( OR =1.18), had a reorganized family ( OR =1.70), had other family types ( OR =1.94), possibly had depressed feelings ( OR =3.10), had depressed feelings ( OR =4.91), had taken sick leave in the prior 2 weeks ( OR =1.54), or had absence from school because of illness in the past year ( OR =1.71) were relatively more likely to be in the low lack of exercise or high intentional injury group ( P <0.05). Conclusion Clear latent classes of health risk behaviors among middle school students are found to be present in differing proportions in Beijing. Relevant departments should take targeted intervention measures in a timely manner to reduce the occurrence of health risk behaviors among middle school students.

Objective: To analyze the status of health risk behaviors among middle school students in Beijing City from 2018 to 2022, in order to provide reference for scientific and effective intervention. Methods: Using multi stage stratified cluster random sampling method,data of student health and associated factors monitoring among 84 712 middle school students from 16 districts of Beijing during 2018 to 2022 were compared regarding the differences of health risk behaviors among students in different groups by Chi quare test. And their change trends were evaluated by annual percentage change (APC). Results: In the five surveys during 2018 to 2022,reporting rates of unhealthy diet, unintentional injury, intentional injury, substance abuse and Internet addiction (only in 2018 and 2020) behaviors were higher in boys than in girls ( χ 2=4.91-297.52, P ＜0.05).Reporting rate of physical inactivity behavior in girls was higher than that in boys ( χ 2=56.49-160.88, P ＜0.05). Reporting rates of unhealthy diet, physical inactivity, unintentional injury (except 2021), substance abuse and Internet addiction (only in 2018 and 2019) behaviors were the highest in vocational high school, followed by general high school, and the lowest in junior middle school ( χ 2=23.30-1 285.98, P ＜0.01). Intentional injury behavior was highest in junior high school, followed by vocational high school, and lowest in general high school ( χ 2=96.18-378.32, P ＜0.01).Reporting rate of Internet addiction (2020-2022) behavior was highest in general high school, followed by vocational high school, and lowest in junior high school ( χ 2=16.93-60.11, P＜0.01). Reporting rates of unhealthy diet, intentional injury (2020 and 2022) and substance abuse (except 2018) behaviors were higher in suburban areas than in urban areas (χ 2=6.70-117.56, P＜0.05). Reporting rates of physical inactivity, unintentional injury, intentional injury (2018 and 2019) and Internet addiction behaviors were higher in urban areas than in suburban areas (χ2=3.90-130.80, P＜0.05). Standardized rates of unintentional injury, intentional injury, substance abuse and Internet addiction behaviors showed a statistically significant downward trend from 2018 to 2022 (APC=-14.16, -13.43, -16.03, -8.48, t =-6.94, -4.46, -11.98, -4.36, P ＜0.05). Conclusions During 2018-2022, unintentional injury, intentional injury, substance abuse and Internet addiction behaviors of middle school students in Beijing City have improved, and the reporting rates of unhealthy diet and physical inactivity behaviors are high and don t show a downward trend. Efforts should be made to strengthen intervention in unhealthy diet and physical inactivity behaviors among middle school students, in order to reduce the occurrence of health risk behaviors.

Objective: To study the correlation between short sleep duration and screening myopia among primary and middle school students in Beijing, so as to provide a scientific basis for the comprehensive prevention and control of myopia among students. Methods: Using a stratified cluster random sampling, 25 593 primary and middle school students from 16 districts of Beijing were selected from September to November 2023. The National Common Diseases and Health Influencing Factors Monitoring Survey Questionnaire was used to conduct a questionnaire survey, and visual acuity was tested according to the Specification for the Screening of Refractive Error in Primary and Middle School Students. The reporting rates of short sleep duration and detection rates of screening myopia among primary and middle school students were compared using the Chi square test. Binary Logistic regression was used to analyze the correlation between short sleep duration and screening myopia. Results: About 68.63% of students reported short sleep duration. There was a statistically significant difference in the reporting rate of short sleep duration among students in different school stages ( χ 2=981.18, P <0.01), with the lowest reporting rate of vocational high school students (47.07%) and the highest reporting rate of ordinary high school students (76.17%). The detection rates of screening myopia among primary school students ( 57.09% ) and middle school students (76.53%) who reported short sleep duration were higher than those who reported enough sleep duration (52.65%, 71.94%), with satistically significant differences ( χ 2=14.83, 17.96, P <0.01). The results of binary Logistic regression analysis showed that primary and middle school students with short sleep duration had a higher risk of developing screening myopia, compared to students with enough sleep duration ( OR =1.25); after adjusting for confounding factors such as educational stage, gender, region, boarding situation, primary and secondary school students with short sleep duration still had a higher risk of screening myopia ( OR =1.26) ( P <0.01). The analysis results stratified by educational stage showed that primary school students from grades 4-6 and middle school students with short sleep duration had a higher risk of screening myopia ( OR=1.18, 1.20, P <0.01). Conclusions Primary and secondary school students in Beijing with short sleep duration sleep have a higher risk of developing screening myopia. Families, schools, and society should ensure enough sleep duration to reduce the occurrence of myopia among students.