Objective To observe the influence of pulse pressure on renal injury in patients with essential hypertension (EH).Methods Two hundred and twenty-nine patients with mild-to-moderate EH completed 24 h ambulatory blood pressure monitoring.The patients were divided into 2 groups according to 24 h mean pulse pressure (MPP):EH 1 (24 h MPP ≥ 60 mmHg,1 mmHg =0.133 kPa) group (128 cases) and EH2 (24 h MPP ＜ 60 mmHg) group (101 cases).According to 24 h urine microalbumin and biochemical determination of renal function,the influence of pulse pressure on kidney function was observed and compared.Results The 24 h mean systolic blood pressure (MSBP) and 24 h MPP in EH1 group were significantly higher than those in EH2 group [(156.20 ±6.11) mmHg vs.(143.67 ±5.46) mmHg,(69.09 ±5.87) mmHg vs.(51.15 ±7.15) mmHg] (P ＜0.01),the 24 h mean diastolic blood pressure (MDBP) in EH2 group was significantly higher than that in EH1 group [(92.52 ±5.93) mmHg vs.(87.11 ± 5.52) mmHg](P＜ 0.01).The 24 h urine microalbumin in EH1 group was significantly higher than that in EH2 group [(104.80 ± 24.25) mg vs.(91.29 ± 24.03) mg] (P ＜ 0.01).There was positive correlation between 24 h MPP,24 h MSBP and 24 h urine microalbumin (r =0.259,0.201,P ＜ 0.01),and there was negative correlation between 24 h MDBP and 24 h urine microalbumin (r =-0.180,P＜ 0.01).Conclusion The 24 h MPP is closely related with the renal injury which is caused by high blood pressure in patients with EH.

Objective:To have an experimental investigation on teaching reform of Orthopedics of TCM based on network resources.Method:Two comparison groups were set and observed when we were teaching the orthopedics students of 2003 grade.One was taught by traditional problem-based learning(PBL) method,the other was taught by PBL method based on network resources.Results:The creative thought and research ability of the students who had been taught by PBL method based on network resources were greatly improved.Conclusion:The teaching method based on network resources has so many advantages such as students being able to self-learn and research without time and space limit that it can be used more in medical students teaching.

Two recombinant plasmids pVAX/Sj23 and pVAX/mIL-18 containing Schistosoma japonicum 23 000 membrane protein (Sj23) and murine IL-18 were evaluated for their ability to induce immune responses and to protect against S. japonicum challenge in mice. All animals vaccinated with pVAX/Sj23 alone or plus pVAX/mIL-18 developed specific anti-SWAP (soluble worm antigen preparation) ELISA antibody and splenocyte proliferation response,and co-injection of pVAX/mIL-18 significantly increased the production of IFN-γ and IL-2 compared with pVAX/Sj23 alone, indicating that IL-18 enhances the Th1-dominant immune response. The challenge experiment showed that worm reduction rates in pVAX/Sj23 group compared with control group (pVAX1) was 26.5% and in the pVAX/Sj23 plus pVAX/mIL-18 group was 41.9% ,and the hepatic egg reduction rates were 42.7 and 49.6%,respectively. These results indicated that co-injection of an IL-18 plasmid with Sj23 DNA vaccine efficiently improves the protective effect against S. japonicum infection.

Objective To analyze the clinical characteristics of the patients with pituitary stalk interruption syndrome (PSIS) in our hospital in the past seven years, and to achieve better comprehension of this kind of disease. Methods Five patients with PSIS (4 males, 1 female) in our hospital were retrospectively analyzed, regarding clinical manifestation, laboratory and imaging data. Results The clinical features of 5 cases of PSIS were as follows: (1) growth retardation; (2) high incidence of breech delivery; (3) 159-165 cm in body height; (4) retarded bone age; (5) average intelligence; (6) adenohypophyseal dysfunction in clinical and laboratory examinations; (7) normal posterior pituitary function; (8) MRI with gadolinium contrast revealed no pituitary stalk and anterior pituitary hypoplasia with ectopic posterior pituitary. The pathogenesis of PSIS is not clear. Appropriate hormonal replacement therapy is the only effective way. Conclusion PSIS is rarely seen and its clinical feature is different from pituitary dwarfism and hypogonadotropic hypogonadism. The realization for this syndrome should be emphasized and early therapy is essential.

Objective To comparatively analyze the clinical characteristics of thyrotropin-secreting pituitary adenomas (TSH-omas).Methods The clinical features, laboratory variables, imaging and pathological Results were retrospectively compared and analyzed of 26 cases with TSH-omas admitted in Chinese PLA General Hospital from Feb. 2006 to Oct. 2016 and 20 cases with TSH-omas admitted in Shanghai Huashan Hospital from Apr. 2006 to Apr. 2013.Results The female ratio was slightly higher in patients of Chinese PLA General Hospital than in Huashan Hospital [(57.7%(15/26)vs. 45.0%(9/20)], while the mean age was similar [39.5±14.1(18-67 years)vs. 40.0±14.5(17-74 years)]. The most common chief complaint was thyrotoxicosis [73.1%(19/26)vs. 55.0%(11/20)], and mild-to-moderate goiter was the most common symptom. The mean serum TSH levels in Chinese PLA General Hospital and in Huashan Hospital were 5.06(2.97-6.27)mU/L and 6.16(3.76-10.91)mU/L respectively, and patients with normal serum TSH levels were more common in Chinese PLA General Hospital than in Huashan Hospital [57.7%(15/26)vs. 40.0%(8/20)]. Microadenoma was more common in Chinese PLA General Hospital than in Huashan Hospital [34.62%(9/26)vs. 20.0%(4/20)], while macroadenoma was more common in Huashan Hospital than in Chinese PLA General Hospital [20.0%(4/20)vs. 7.7%(2/26)]. Microadenoma was more common in female patients of the both groups [66.7%(6/9)vs. 75.0%(3/4)], while macroadenoma was all found in male patients. Tumor invasion of surrounding tissue and structure was often found in macroadenoma. In terms of octreotide inhibition test, the range of 24h TSH inhibition rate was roughly the same in the two groups (37.4%-91.8% and 46.5%-94.1%, respectively). Mixed adenoma was rare among all the pathologically confirmed cases. In Chinese PLA General Hospitals, TSH immunoreactive negative neoplastic cells were found in 3 of 8 cases, and octreotide scanning showed negative in 2 of 12 cases.Conclusions Patients with TSH-omas in the two hospitals show similarities but also some significant differences in the clinical features. Overall, the domestic patients with TSH-omas are diagnosed without gender difference according to the reports in China. The mean age at diagnosis is significantly younger than that in foreign data. Microadenoma is more common in females, while macroadenoma is more common in males. Serum TSH levels can be normal in patients with TSH-omas. Immunostaining and/or octreotide scanning for TSH can be negative.

Objective To explore the potential influence of gender on screening value of aldosterone-renin ratio (ARR) for primary aldosteronism (PA).Methods The biochemical parameters were collected of 451 PA patients and 300 essential hypertension (EH) patients who were diagnosed in the General Hospital of PLA from 1992 to 2014. Each group was then divided into two groups by gender. The clinical characteristics were compared and then the receiver operating characteristic curve (ROC) was conducted to evaluate the best cut-off value.Results The plasma aldosterone concentration (PAC), serum sodium and ARR were much higher, but the plasma rennin activity (PRA), serum potassium and BMI were much lower in PA patients than in EH patients (P<0.01), and no significant difference existed between the two groups in age, duration of hypertension and blood pressure. The PRA was obviously lower in males than in females either in PA or in EH patients, but no signicantcant difference existed between males and females in PAC (P>0.05). The best cut-off value of ARR in male PA patients was 19.11, the relevant area under the curve (AUC) was 0.968, the sensitivity and specicantcity was 92.44% and 93.08%, and the Youden index (YI) was 0.86. The best cut-off value of ARR in female PA patients was 27.26, with AUC 0.956, sensitivity 92.07%, specicantcity 90.00% and YI 0.82, respectively. If the cut-off value was set at 27.26 in males, the specicantcity would rise a little, but the sensitivity and YI would sharply decrease. Similarly, the sensitivity would increase a little but the specicantcity and YI would fall substantially if the cut-off value in females was set at 19.11. The best cut-off value of ARR in men was smaller than the ocantcial value recommended by guidelines.Conclusion Gender is an important factor should be considered while ARR is used in PA screening, and the cut-off value of ARR in screening female PA patients should be setting higher.

Objective To analyze the relationship between the brain functional alterations of patients with Cushing's disease (CD) and patients' mental symptom by applying the Evaluating Emotional Scales and task functional magnetic resonance imaging (Task fMRI).Methods Task fMRI was performed on 8 patients with diagnosed CD admitted in the Department of Endocrinology of Chinese PLA General Hospital from Nov. 2015 to Nov. 2016 and 21 healthy people with matched age, gender and education level as control. Meanwhile, Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), Positive and Negative Affective Scale (PANAS) and Cushing Quality of Life Scale (Cushing QOL) were obtained to assess the brain functions.Results Significant depression and anxiety were observed in patients with CD, and their positive affective score was substantially lower while the negative affective score was relatively higher compared with that in the controls. Task fMRI revealed that, when watching the positive pictures, the activation degree of left cerebellum and right postcentral gyrus weakened in CD patients than in the controls, and the positive correlations existed between the activation degree of left cerebellum and the 16 o'clock adrenocorticotrophic hormone (ACTH) level, and between the activation degree of right postcentral gyrus and the urinary free cortisol (UFC) level in CD patients. In contrast, when watching the negative pictures, the activation degree of left cerebellum, bilateral parahippocampal gyrus and left inferior frontal gyrus was weakened in CD patients than in the controls, and the activation degree of left cerebellum was negatively correlated to the 0 o'clock cortisol level and SAS score, but is positively correlated to the UFC level. When watching the neutral pictures, the activation degree of left cerebellum and left parahippocampal gyrus was weakened in CD patients than in the controls.Conclusions CD patients may have impaired brain function with depression and anxiety mental symptoms. By Task fMRI, it can be found that the weakened activation degree of left inferior frontal gyrus, right postcentral gyrus, bilateral parahippocampal gyrus and left cerebellum may be related to CD patients' mental symptoms.

Objective To compare the differences in the long-term survival rate and the tumor shrinkage rate of inoperable hepatocellular carcinoma (HCC) between transcatheter arterial chemoembolization (TACE) combined with percutaneous ablation therapy and simple TACE therapy in order to provide the basis for the clinical treatment of HCC.Methods Randomized controlled trials (RCT) for comparing the difference in survival rates between TACE plus PA and simple TACE for inoperable HCC were searched from medical literature database,from which the relevant data were extracted.According to Cochrane manual standard,the quality of inclusion literature was evaluated.Results A total of 15 RCT papers were included in this study,including 859 HCC patients.The results of meta-analysis showed that all the 1-year,2-year and 3-year survival rates in TACE plus PA group were better than those in simple TACE group (RR=1.454,95％CI=1.333and 1.586,Z=8.56,P＜0.001;RR=1.781,95％CI=1.511 and 2.099,Z=6.88,P＜0.001;RR=2.351,95％CI=1.808 and 3.059,Z=6.37,P＜0.001,respectively).The tumor shrinkage rate in TACE plus PA group was also better than that in simple TACE group (RR=1.314,95％CI=1.190 and 1.452,Z=5.38,P＜0.001).The sensitivity analysis indicated that the results of the differences in survival rate and tumor shrinkage rate between the two groups were reliable.Conclusion The 1-year,2-year and 3-year survival rates as well as the tumor shrinkage rate of TACE plus PA group are higher than those of simple TACE group.

Objective To determine the correlation between papillary thyroid cancer( PTC) malignancy with thyroid antibody expression level. Methods In this retrospective study, 4046 goiter patients with complete clinical data who have undergone thyroidectomy were separated into the benign nodule ( n=1357) and PTC groups ( n=2689), and their preoperative thyroglobulin antibody ( TgAb) and thyroid peroxidase antibody ( TPOAb) were assessed through antibody analysis. HT was determined based on the postoperative histopathology. The collected data were then evaluated for the correlation with PTC malignancy through statistical tests. Results In general, patients in the PTC group showed a significantly higher TgAb positivity ( 10. 9％) than those in the benign group ( 5. 6％, P<0.01) . Among female patients, a higher TgAb positivity was observed for those in the PTC group than those in the benign group (14.0％ vs 7.0％, P<0.01), while no significant difference between groups was observed in male patients. The high odds ratio of 2.18 supports the significant correlation between TgAb-positive status and higher risk of developing PTC in women (P<0.05). However, the risk of developing PTC was not correlated with higher TgAb titre. TgAb was not significantly correlated with the mass size, multifocality, lymph node metastasis or the TNM classification of malignant tumor stage Ⅲ/Ⅳ. Conclusion The increasing risk of PTC is related to TgAb among female patients, but it will not increase as TgAb titer rises. It is not associated with PTC aggressiveness.

Objective:To investigate the influence of hemoglobin glycation index (HGI) on the risk of incident chronic kidney disease (CDK) among nondiabetic patients.Methods:Prospective cohort study. At baseline, a total of 7 407 nondiabetic patients without a history of CKD from Pingguoyuan Community of the Shijingshan District in Beijing were included from December 2011 to August 2012, who were then divided into three groups according to the tertiles of their baseline HGI levels. The CKD incidence rate was compared among the different HGI groups at last follow-up. Cox multivariable regression was applied to evaluate whether HGI measures predicted CKD risk. Test for trend across tertiles were examined using ordinal values in separate models.Results:The mean age of the subjects was (56.4±7.5) years, and 4 933 (66.6%) were female. At mean follow-up of 3.23 years, 107 (1.4%) individuals developed CKD. The incidence of CKD was gradually increasing from the low to high HGI groups [1.1% (28/2 473) vs. 1.2% (31/2 564) vs. 2.0% (48/2 370), P=0.016]. In the multivariate Cox regression analysis, after adjustment for potential confounders, the high HGI group had a 68.5% increased risk of CKD compared with the low HGI group ( HR=1.685, 95% CI 1.023 to 2.774). CKD risk increased with increasing HGI tertiles ( P for trend=0.028). Conclusion:High HGI is associated with an increased risk for CKD in the nondiabetic population, indicating that HGI may help identify individuals at high risk for CKD.