Primary hyperparathyroidism (PHPT) in children is a rare condition,co-existing with vitamin D deficiency can lead to more diagnostic uncertainty.Here we report a case of a boy with PHPT complicated with vitamin D deficient rickets.The diagnosis and treatment of this patient was analyzed against literature review to summarize evidence-based clinical features of PHPT in children.We found that compared with adult PHPT,PHPT in children is associated with severer symptoms,higher serum calcium level,lower parathyroid hormone,preponderance of single adenoma in pathology,and higher cure rate of surgery.Co-existence of osteomalacia may induce reduction of the serum calcium level to the normal range,but cause more severe bone lesions.

Colon cancer may invade the adjacent organ in the absence of distant metastasis, which is called stage T4bM0 colon cancer according to the 7th edition of TNM staging system. It is not rare in clinical setting, and usually recognized intraoperatively. How to deal with this situation is a big challenge for the surgeons. It is difficult to distinguish between dense adhesion and cancerous invasion. Intraoperative biopsy should be avoided because of the risk of tumor cell dissemination and frozen often gives false-negative results. After evaluating the resectability of the tumor sufficiently, the surgeon should make every effort to do an en bloc multivisceral resection and to achieve a margin-free (R0) resection if there is no absolute contraindication. This effort will bring long-term prognosis benefit for the patients with stage cT4bM0 colon cancer.
Colonic Neoplasms ; surgery ; Humans ; Neoplasm Staging

0.05).On 1,3 and 5 days after the operation,the PHS and PVAS of Group B decreased significantly than those of Group A(P

Objective To explore the relationship between the membranous tissue(MT)and organized thrombus(OT)in membranous obstruction of the inferior vena cava(MOVC),we investigated the related cytokines expression in the membranous tissues in MOVC as well as venous organized thrombi. Methods Using immunohistochemical method the expression of TGFβR,PDGFR,ET-1,FⅧ-rAg, ferritin and α1-antitrypsin were observed in the membranous tissues in 11 cases with MOVC and organized thrombi in 8 cases with deep venous thrombosis(DVT). Results Expression rates of TGFβR,PDGFR,ET-1,FⅧ-rAg, and ferritin in membranous tissues in 11 cases with MOVC and organized thrombi in 8 cases with DVT were as follows: TGFβR:MT 72.3%,OT 50%(P＞0.05);PDGFR:MT 45.5%,OT 100%(P＜0.05＝;ET-1:MT 100%,OT 0(P＜0.05＝;FⅧ-rAg: MT 90.9%,OT 12.5%(P＜0.05＝;ferritin: MT 72.3%,OT 100%(P＞0.05).α1-antitrypasin was not detected in either membranous tissues of MOVC or organized thrombi of DVT. Conclusions ThrovIgh the investigation of the related cytokines expression, it is possible that membranous tissue formation in MOVC is related to the organized thrombus.

In this paper, based on the special influence of supramolecular chemistry on the basic theory of Chinese medicines ( CM) , the authors further analyzed the history of meridian tropism and natural origins of CM organisms and explained CM ingredients and the universal regularity of the automatic action of the supramolecular "imprinting templates" hole channel structure. After entering human bodies, CMs, as the aggregation of supramolecular "imprinting templates" , automatically seek supramolecular subjects that are matched with their "imprinting templates" in human meridians and organs for the purpose of self-recognition, self-organization, self-assembly and self-replication, so as to generate specific efficacy in meridians and organs, which is reflected as the meridian tropism phenomena at macro level. This regularity can be studied by in vitro and in vivo experimental studies. In vitro methods are mostly supra molecular structure analysis and kinetic and thermodynamic parameter calculation; Whereas in vivo methods are dominated by the analysis on object component distribution, chromatopharmacodynamic parameters and network chromatopharmacodynamic parameters; Particularly, the acupoint-medicine method can simplify to study the supramolecular subject-object relations. Consequently, CM's'meridian tropism reveals the universal regularity for interactions of macromolecular and micromolecular "imprinting templates" of subjects and objects in natural organisms. As the first barrier for the material base of the CM theory and breakthrough in the modernization of the basic CM theory, meridian tropism plays an important role in studies on basic theories of the basic CM theory.
Acupuncture Points ; Drug Therapy ; Drugs, Chinese Herbal ; chemistry ; Humans ; Medicine, Chinese Traditional ; Meridians

Objective To evaluate the application value of hyperinsulinemic euglycemic clamp in the diagnosis and treatment of newly-onset diabetic patients. Methods Totally 11 newly-onset diabetic inpatients (10 patients with type 2 diabetes mellitus and 1 patient with latent autoimmune diabetes of adulthood) who were diagnosed in the Department of Endocrinology of Peking Union Medical College Hospital from January 2009 to August 2009 were included in this study. Hyperinsulinemic euglycemic clamp was applied to measure the glucose disposal rate (M value). Afterwards insulin pump therapy was applied and the total insulin dosage per day to get to the target of the fasting and postprandial blood glucose was calculated. Final]y the relationships between insulin dosage per day and the M value, body mass index (BMI) , fasting blood glucose, fasting insulin level were separately analyzed. Results The insulin dosage was only negatively correlated with M value (r = - 0. 83, P = 0. 003), and was not significantly correlated with BMI (r = 0.54, P = 0.106), fasting blood glucose (r = - 0. 16, P =0. 657) , and fasting insulin (r = 0. 16, P = 0. 659). The formula of insulin dosage and M value according to the mathematic model as follows: insulin dosage per day = - 3. 327 M + 49. 849. Conclusion Hyperinsulinemic euglycemic clamp can effectively evaluate the insulin sensitivity in the newly-onset type 2 diabetic patients, and thus can be a useful tool in deciding the clinical insulin dosage.

We reported a case of hypophysitis caused by a programmed death-1 ( PD-1) inhibitor. The patient was a 59-year-old female with metastatic malignant melanoma who participated in the phaseⅡclinical trial of a PD-1 inhibitor toripalimab. More than five months after the administration of toripalimab,she experienced fatigue, depression, nausea, and anorexia. Laboratory examinations showed mild hyponatremia, secondary adrenal insufficiency, and secondary hypothyroidism. MRI revealed the enlargement of her pituitary with obvious enhancement. The patient was diagnosed as hypophysitis caused by the PD-1 inhibitor and was given replacement therapy with physiological doses of corticosteroid and levothyroxine sodium. Her symptoms were then improved. MRI revealed that her pituitary size returned to normal after 8 weeks of treatment and remained stable during every 3-month follow-up. This case reminds us of the possibility of hypophysitis when patients suffere from fatigue and anorexia during the process of PD-1 inhibitor treatment. Correct diagnosis, proper therapy, and regular follow-up are important to ensure the patients' safety, and to improve their prognosis.

Objective To investigate the effect of Ulinastatin on the delivery of cytokines in patients with septic shock.Methods It was a prospective and controlled clinical study.Seventy-eight patients with septic shock were randomly divided into control group and treatment group and thirty-nine in every group.Patients in treatment group received Ulinastatin 200 000 units intravenous everyday for 3 days,while those in control group received equal volume of normal saline as placebo.At different time points (at 24 th,48 th,72 th hour after start of treatment),the levels of tumor necrosis factor-alpha (TNF-?),interleukin-1 (IL-1),interleukin-6 (IL-6 ),interleukin-8 (IL-8) and superoxide dismutase (SOD) in serum were assayed.Results In comparison with control group,the levels of TNF-?,IL-1,IL-6,IL- 8 of treatment group decreased markedly (P＜0.05,P＜0.01) at different time points,whereas the level of SOD was higher markedly (P＜0.05,P＜0.01) at various time points.Conclusion Ulinastatin has protective effect on patients with septic shock through decreasing the levels of TNF-?,IL-1,IL-6,IL-8 and increasing in the level of SOD.

OBJECTIVETo investigate the effects of pH0 on the electrophysiological properties of vascular smooth muscle cells (VSMCs) in brain artery of spontaneously hypertension rats (SHR).

METHODSWe studied the effects and the ion mechanism of pH0 on whole-cell membrane current of VSMCs in brain artery of 200 - 250 g SHR by whole-cell patch clamp recordings.

RESULTS1. Acidic pH0 could inhibit the outward current of VSMCs of brain artery in SHR in a voltage-dependent manner. It induced a more pronounced inhibition of the outward current from 0 to + 60mV; 2. In the presence of 1 mmol/L TEA, the inhibition of acidic pH0 on the outward current of VSMCs of brain artery was inhibited.

CONCLUSIONThe changes of outward current of VSMCs of brain artery in SHR induced by pH0 may be connected with BKCa channel.

Animals ; Cerebral Arteries ; cytology ; Electrophysiological Phenomena ; Extracellular Fluid ; physiology ; Hydrogen-Ion Concentration ; Muscle, Smooth, Vascular ; physiology ; Rats ; Rats, Inbred SHR

OBJECTIVEThis study was designed to examine the impact of the antioxidant metallothionein (MT) on cardiac contractile, intracellular Ca(2+) function and oxidative stress in lipopolysaccharide (LPS)-treated mice.

METHODSWeight and age matched adult male FVB and cardiac-specific MT-overexpressing transgenic mice were injected intraperitoneally with 4 mg/kg Escherichia Coli LPS dissolved in sterile saline or an equivalent volume of pathogen-free saline (control groups). Six hours following LPS or saline injection, cardiac geometry and function were evaluated in anesthetized mice using the 2-D guided M-mode echocardiography. Mechanical and intracellular Ca(2+) properties were examined in hearts. Cell shortening and relengthening were assessed using the following indices: peak shortening (PS)-indicative of the amplitude a cell can shorten during contraction; maximal velocities of cell shortening and relengthening (± dl/dt)-indicative of peak ventricular contractility; time-to-PS (TPS)-indicative of systolic duration; time-to-90% relengthening (TR(90))-indicative of diastolic duration (90% rather 100% relengthening was used to avoid noisy signal at baseline concentration). The 360 nm excitation scan was repeated at the end of the protocol and qualitative changes in intracellular Ca(2+) concentration were inferred from the ratio of fura-2 fluorescence intensity (FFI) at two wavelengths (360/380). Fluorescence decay time was measured as an indicator of the intracellular Ca(2+) clearing rate. Glutathione/glutathione disulfide ratio and ROS generation were detected as the markers of oxidative stress.

RESULTSHeart rate was increased while EF was reduced in LPS-FVB mice and heart rate was reduced and EF increased in MT-LPS transgenic mice [(528 ± 72) beats/min vs (557 ± 69) beats/min, (66 ± 14)% vs (42 ± 10)%, P < 0.05]. Cardiomyocytes from the LPS treated FVB mice displayed significantly reduced peak shortening (PS) and maximal velocity of shortening/relengthening (±dl/dt) associated with prolonged time-to-90% relengthening (TR(90)), these effects were attenuated in cardiomyocytes from the MT-LPS mice [PS(5 ± 1.1)% vs (7.2 ± 0.8)%, dl/dt(160 ± 15) µm/s vs (212 ± 36) µm/s, -dl/dt (175 ± 32) µm/s vs (208 ± 29) µm/s, TR(90) (0.24 ± 0.03)s vs (0.19 ± 0.02)s, P < 0.05]. LPS treated mice showed significantly reduced peak intracellular Ca(2+) and electrically-stimulated rise in intracellular Ca(2+) as well as prolonged intracellular Ca(2+) decay rate without affecting the basal intracellular Ca(2+) levels, again, these effects were significantly attenuated in MT-LPS transgenic mice. Metallothionein overexpression also ablated oxidative stress [reduced ROS generation and increased glutathione/glutathione disulfide ratio, ROS (0.35 ± 0.08) A/µg protein vs (0.24 ± 0.03) A/µg protein]. GSH/GSSG 2.1 ± 0.2 vs 2.6 ± 0.4, P < 0.05.

CONCLUSIONMT overexpression improved cardiac function and ablated oxidative stress in LPS treated mice.

Animals ; Calcium ; metabolism ; Lipopolysaccharides ; Male ; Metallothionein ; genetics ; metabolism ; Mice ; Mice, Inbred Strains ; Mice, Transgenic ; Myocardial Contraction ; Myocytes, Cardiac ; metabolism ; physiology ; Oxidative Stress ; Reactive Oxygen Species ; metabolism ; Sepsis ; metabolism ; physiopathology