Objective: To investigate the clinical significance of dynamic contrast-enhanced computed tomography (CT) combined with magnetic resonance imaging (MRI) in differential diagnosis of adrenal adenoma and metastasis. Methods: 120 patients with adrenal adenoma who were examined by enhanced MRI and enhanced CT before operation were collected. According to the pathological examination after operation, they were divided into adrenal adenoma group (86 cases) and adrenal metastasis group (34 cases). The difference of time-density curve between the two groups was compared, and the diagnostic criteria were evaluated by using receiver operating characteristic (ROC) curve. Results: Dynamic CT and dynamic MRI were mainly type A, followed by type C, B, D and E. Dynamic CT and dynamic MRI were mainly type B, followed by type D/E, type A and type C. There were significant differences in type A, B, C, E dynamic CT and dynamic MRI between the two groups (P<0.05); there was no significant difference in type D dynamic CT and dynamic MRI between the two groups (P>0.05). The AZ value of adrenal adenomas ranged from 0.714 to 0.825 and that of adrenal metastasis ranged from 0.872 to 0.965 at 3-30 minutes delay. Conclusions Dynamic contrast-enhanced CT combined with MRI in patients with adrenal adenoma and metastasis has a time-density difference, 5min has high discriminant value in time lapse.

Objective: To investigate the clinical characteristics during the perioperative period of pheochromocytoma in patients aged 60 years and over. Methods: Data of age, sex, tumor size, anesthesia time, intraoperative bleeding volume, intraoperative blood pressure, complications and hospitalization time from patients with pheochromocytoma in our hospital treated by the retroperitoneal laparoscopic adrenalectomy from January 2008 to October 2018 were retrospectively analyzed.The relationships of age with the intraoperative hemodynamic instability and postoperative complications were analyzed. Results: A total of 203 patients with pheochromocytoma met the inclusion criteria were enrolled.Age over 60 years(OR1.771, 95%CI=1.015-3.089, P=0.044)was an independent risk factor for intraoperative hemodynamic instability. Conclusions Laparoscopic retroperitoneal adrenalectomy is a safe surgical method for pheochromocytoma patients aged 60 years and over.For elderly patients with pheochromocytoma, especially those with a tumor diameter of more than 5 cm, special attention should be paid to the prevention of intraoperative hypertension crisis.

A 26-year-old female patient was admitted to the hospital with recurrent infection of the incision after resection of a back sebaceous cyst,and the pus culture showed Mycobacterium abscessus.Clinical pharmacists reviewed relevant guidelines and literature,analyzed and summarized drug selection,drug resistance,adverse drug reactions and coping strategies,sequential treatment plans and treatment courses,and assist physicians in formulating individualised anti-infective treatment plans.Initially imipenem,amikacin and azithromycin were given according to bacterial culture results.Secondly,according to the results of drug sensitivity,they were changed to tigecycline,amikacin and clarithromycin.Finally,due to the adverse drug reaction of tigecycline and the recurrence of sinus in the patient,and considering the possibility of imipenem and clarithromycin resistance,the anti-infection regimen was adjusted in time to cefoxitin,amikacin and azithromycin.During treatment,the clinical pharmacist monitors drug effectiveness and adverse reactions,combining pharmacy expertise with clinical practice.After the treatment,the patient improved and was discharged.After discharge,azithromycin and omacycline were successively given to continue anti-infection treatment,and the incision on the patient's back basically healed through follow-up.Clinical pharmacist involvement in Mycobacterium abscessus anti-infective drug selection can provide individualised drug regimens for patients,ensure the safety and effectiveness of medication for patients,and provide references for the treatment and management of similar patients.

Objective: This study explored the relationships among psychological stress, achievement motivation and psychological capital in college students to provide a reference for improving the level of psychological capital in college students. Methods: A multi stage stratified cluster sampling method was used to select 9 940 college students from ten universities in Anhui Province. The achievement motivation scale (AMS), psychological stress scale (SRQ-20) and psychological capital scale (PPQ) were applied. The moderating effect of the questionnaire was analyzed with χ 2 tests, Spearman rank correlation and stratified regression. Results: Statistical differences were found in psychological stress according to major, whether students leader, family economic status and whether students had left behind experience ( χ 2=15.50, 10.25, 28.61, 25.55, P <0.05). The rank correlation results indicated that psychological stress was negatively correlated with the pursuit of success ( r =-0.27) and four dimensions of self efficacy,optimism,hope and resilence in psychological capital ( r =-0.43, -0.41,-0.36,-0.45)( P <0.05), and was positively correlated with the avoidance of failure ( r =0.25, P <0.05). The stratified regression model indicated that psychological stress in the dimensions of college students achievement motivation (pursuit of success: β =0.02, Δ R 2=0.01, P <0.01; failure avoidance: β = 0.03 , Δ R 2=0.01, P <0.01) played a moderating role in the relationship between psychological capital and psychological capital. Conclusion Being female, senior students, low household economic status, and left behind experience are associated with more psychological stress among college students. Psychological stress is correlated with achievement motivation and psychological capital, and has a moderating effect on the relationship between achievement motivation and psychological capital.

Objective:To investigate the expression of DARS2 and its clinical significance in colorectal cancer.Methods:In this study, bioinformatics tools, especially gene expression profile interactive analysis 2 (GEPIA2), were used to conduct an in-depth analysis of DARS2 expression in colorectal cancer tissues. Immunohistochemical staining was carried out in 108 colorectal cancer specimens and 30 normal colorectal tissues obtained from the First Affiliated Hospital of Nanchang University, Nanchang, China. Colorectal cancer cell lines (HCT116 and SW480) were transfected with small interfering RNA (siRNA) and DARS2 overexpression plasmid to examine the effects of DARS2 knockdown and overexpression on cell function. To assess the effects on cell function, CCK8 and transwell migration assays were used to assess proliferation and cell motility, respectively. Additionally, protein immunoblotting was employed to scrutinize the expression of proteins associated with the epithelial-mesenchymal transition of colorectal cancer cells.Results:DARS2 exhibited a pronounced upregulation in expression within colorectal cancer tissues compared to their normal epithelial counterparts. Furthermore, DARS2 expression was higher in colorectal cancer of stage Ⅲ-Ⅳ than those of stage Ⅰ-Ⅱ, exhibiting a significant correlation with N staging, M staging, and pathological staging ( P<0.05). Kaplan-Meier analyses showed a decreased overall survival rate in colorectal cancer with DARS2 expression compared to those without DARS2 expression ( P<0.05). In the siRNA transfection group, there was a significant reduction in cell proliferation and migration ( P<0.01 and P<0.05, respectively). Conversely, the transfection of DARS2 overexpression plasmids substantially increased both cell proliferation and migration ( P<0.05). Additionally, immunoblotting revealed that DARS2 knockdown led to an upregulation of E-cadherin expression and a downregulation of N-cadherin and vimentin expression. In contrast, DARS2 overexpression resulted in increased N-cadherin and vimentin expression, coupled with reduction in E-cadherin expression. Conclusions:There is a strong association between DARS2 expression and colorectal cancer progression. Silencing DARS2 inhibits cell proliferation and migration, exerting a discernible influence on the epithelial-mesenchymal transition process.

Objective To approach the spine MRI features and its possibility of etiology for refractory lower urinary tract symptoms(LUTS) in female patients.Methods We conducted prospectively a cross sectional description study of female patients with refractory LUTS during January 16 through March 27 in 2017 based on a urologist's outpatient work.The including criteria were adult female patients with refractory LUTS which defined as having LUTS more than three months and having poor response to behavior therapy and medication treatment.The excluding criteria were patients having evidence of infection,tumor,stone in urinary tract,any central nerve system diseases,or any other diseases may potentially producing LUTS.Data collected included patients demographic information,main complains,present disease features,disease history,physical examination,urine routine,urodynamic study and spine MRI.The characteristics of clinical manifestation,urodynamic study and spine MRI were analyzed.Results During the time span of study,totally 70 cases had been diagnosed as having refractory LUTS and had qualified data of clinical recordings,urodynamic study and spine MRI.Among these 70 cases,63 (90.9％) had storage phase symptoms,11 (15.7％) had voiding phase symptoms,8 (11.4％) had postmicturition symptoms,12 (17.1％) also had disorders in defecating,45 (64.3％) had pain in lower abdomen or pelvic region.69 cases (98.6％) had urodynamic disorders,33 (47.1％) had oversensitivity of bladder,12 (17.1％) had smaller bladder volume,16(22.9％) had detrusor overactivity,15 (21.4％) had bladder outlet obstruction,39(55.7％) had detrusor underactivity.69 cases(98.6％)had spine MRI abnormalities,54(77.1％) had sacral nerve lesions,49 (70.0％) had cervical lesions,48 (68.6％) had lumbar lesions,4 had thorathic lesions.Conclusions The present study revealed extraordinary high prevalence of abnormality in urodynamic parameters and spine MRI in female patients with refractory LUTS,which implies possibility that the refractory LUTS are caused by lesions in spinal nerve system.