Objective To study the diagnosis and treatment of primary aldosteronism. Method 507 cases of primary aldosteronism were reviewed. Result Serum potassium was lower in aldosterone producing adenoma (APA) as compared to idiopathic hypersteronism (IHA) (2.35?0.53) mmol/L vs ( 2.94 ? 0.55 ) mmol/L.Aldosterone in serum and 24h urine were higher in APA than in IHA ( 1 027.67 ? 531.84 )pmol/L and (69.25?43.77) mmol/L vs (781.14?310.24)pmol/L and (37.12?9.99) mmol/L.The diagnosis rate on B ultrasonography was 83.9% and on CT 93.1%.The postural stimulation test was more sensitive in IHA and on imaging procedures both the adenals were increased in size or with small nodule.In aldosterone producing adrenocortical carcinoma (APC),there were pronounce increase of cortisol and dehydroisoandrosterone and the tumor size was usually greater than 5cm.APA and APC should be treated surgically but the prognosis was only favorable for APA not for APC.IHA should be treated medically. Conclusion Serum and urine aldosterone were significantly higher in APA and serum potassium lower than in IHA.Postural stimulation test,B ultrasonography and CT were helpful to the diagnosis of APA.In patients with a single APA especially complicated by adrenal atrophy,partial adnalectomy of the affectd side is indicated whereas total adrenalectomy of the affected side is mandatory if the APA is multiple or there is adrenal hyperplasia.

ObjectiveTo observe whether if intravenous infusion of dexmedetomidine in advance can prevent irritation and cough causing by sufentanil.MethodsNinety patients who performed excision of intracranial tumor were divided into observation group and control group by random digits table with 45 cases each.Patients in observation group were intravenously infused 0.5 μg/kg dexmedetomidine for 10 minutes before induction.Patients in control group were intravenously infused 0.9％ sodium chloride for 10 minutes before induction.All the patients were intravenously infused 0.3 μg/kg sufentanil after taking drugs of load dosage in 3 seconds,and the incidence of irritation and cough in 1 minute was observed.The mean arterial pressure and heart rate were recorded before infusing dexmedetomidine or sodium chloride(T0),at the end of infusing dexmedetomidine or sodium chloride (T1),before intubation (T2),1 minute after intubation (T3).ResultsThe incidence of irritation and cough,moderate-severe irritation and cough in observation group [ 24.4％ ( 11/45 ),11.1％ (5/45) ] were lower than those in control group [ 48.9％ (22/45),22.2％ ( 10/45 ) ]with significant differences(P＜ 0.01 ).The mean arterial pressure in control group at T2 was lower than that in observation group [ (71.2 ± 3.5) mm Hg( 1 mm Hg =0.133 kPa) vs.(84.7 ± 4.1 ) mm Hg] with significant difference (P ＜ 0.05 ).The mean arterial pressure in control group at T3 was higher than that in observation group [(96.7 ± 6.4) mm Hg vs.(83.1 ± 5.2) mm Hg] with significant difference(P＜ 0.05).The heart rate at T1,T2,T3 in observation group was lower than that in control group [ (53.2 ± 4.7 ) beats/min vs.(70.4 ± 6.2 )beats/min,(56.3 ± 3.1 ) beats/min vs. (64.7 ± 3.7) beats/min,(59.1 ± 4.8) beats/min vs. (81.5 ± 6.1 )beats/min],and there were significant differences(P ＜0.05).Conclusions Intravenous infusion of dexmedetomidine (0.5 μg/kg) in advance can effectively prevent irritation and cough causing by sufentanil,and can enhance the stability of circulation during intubation.

Objective To investigate the application value of combined detection of antikeratin (AKA) antibody,anti-cyclic citrullinated peptide(anti-CCP) antibody,anti-RA33 antibody,RF and ESR in the diagnosis of rheumatoid arthritis(RA).Methods One hundred cases of RA and 60 cases of suspected RA in our hospital from June 2014 to May 2015 were collected.One hundred and twenty cases of non-RA other autoimmune diseases served as the control group.The indirect immunofluorescence assay (IFA) was used to detect anti-KA antibody,anti-CCP antibody and anti-RA33 antibody were detected by using ELISA.The rate scatter turbid assay was used to detect RF.The Westergren method was used to detect ESR.The diagnostic performance of each diagnostic indicator was evaluated.Results The detection rates of anti-KA antibody,anti-CCP antibody,anti-RA33 antibody,RF and ESR in the RA group were in turn 64%,75%,44%,84% and 51% respectively,the detection rate(sensitivity) of 5-indicator parallel detection were 97%, the specificity of 5-indicator series detection was 89.2%;in the suspected RA group,the detection rates of 5-indicator were in turn 16.7%, 31.7%,13.3%,20%,15% respectively,which in the control group were in turn 0.8%,2.5%,1.7%,0.8% and 5.8% respectively.The detection rates of 5-indicator in the RA group was significantly higher than that in the suspected RA group,showing extremely significant difference (P<0.001),the detection rate of 5-indicator had extremely significant difference between the suspected RA group and control group (P<0.001),the sensitivity of five-indicator parallel detection was 97%,which was significantly higher than that of single indicator detection (P<0.05),the detection specificity of 5-indicator series detection was up to 100%,which was also significantly higher than that of single indicator detection (P<0.05),the missed diagnosis rate of parallel detection was minimal,while the negative predictive value was highest,the misdiagnosis rate of series detection was lowest,the positive predictive value was highest,the Youden index of parallel detection was largest.Conclusion The single detection of anti-CCP antibody and RF have good sensitivity and specificity, but 5-indicator combined detection has higher sensitivity and specificity,which can better reduce the missed diagnosis rate and misdiagnosis rate,can greatly improve the efficiency of diagnosis,and has an important clinical significance for the early diagnosis of RA.

Objective To determine the expression of Notch pathway receptors (Notch1 and Notch4) and ligands (Jagged1 and Dll4) in cutaneous malignant melanoma (CMM) tissues,and to preliminarily explore the role of the Notch signaling pathway in the pathogenesis of CMM.Methods Immunohistochemical study was performed to determine the expression pattern and intensity of Notch1,Notch4,Jagged1 and Dll4 in 40 paraffin-embedded CMM specimens and 15 paraffin-embedded pigmented nevus specimens.Statistical analysis was carried out by chi-square test and Spearman rank correlation analysis with the SPSS 21.0 software.Results Notchl was detected in 31 (77.5％) of 40 CMM specimens,as well as in 3 of 15 pigmented nevus specimens,and the positive rates significantly differed between the two groups (x2 =15.281,P ＜ 0.001).However,no significant difference in the expression intensity of Notch1 was observed between 18 in situ melanoma tissues and 22 invasive melanoma tissues (x2 =0.631,P =0.427).In addition,the positive rates of Notch4,Jagged1 and Dll4 were also significantly higher in the CMM group than those in the pigmented nevus group (all P ＜ 0.05),and the expression intensity of Notch4,Jagged1 and Dll4 significantly differed between in situ and invasive melanoma tissues (all P ＜ 0.05).In CMM tissues,the expression of Notch1 was positively correlated with that of Jagged1 (rs =0.350,P =0.027) and Dll4 (rs =0.562,P ＜ 0.001),while the expression of Jaggedl was negatively correlated with that of Dl14 (rs =-0.734,P ＜ 0.001).Conclusion Abnormality of the Notch signaling pathway may be involved in the pathogenesis of melanoma,but further researches are still needed to elucidate the detailed mechanism.

Considering the present condition of nuclear medicine experiment teaching and management model,this paper proposes some reform measures:reforming teaching model,adjusting teaching content,enhancing lab management.

Objective To compare the biomechanical properties between the two-level fixation by im- plantation of pedicle-screws into the adjacent upper and lower vertebrae of the fractured vertebra and the three-level fixation by implantation of pedicle screws into the fractured vertebra and its adjacent upper and lower vertebrae in the treatment of thoracolumbar burst fractures.Methods Eight fresh frozen calf spines were used in this study.Each specimen was tested in four models:intact model as the control,L1 burst fracture model,two-level fixation model, and three-level fixation model.The L1 burst fracture model was created on a biaxial material testing machine (MTS858 Bionix test system,America).During the experiment,the flexion,extension,bilateral bending and axial rotation loadings were applied to the specimens and the range of motion(ROM)was measured with a three-dimensional laser analysis apparatus and the stiffness was calculated subsequently.One-way statistical analysis was used.Results The ROMs under six different loadings in the fracture model became larger obviously(P＜0.05)and the stiffness decreased(P＜0.05).The ROMs in both fixation models were smaller than those in the other models(P＜0.01)and the stiffness increased distinctly(P＜0.05).There were no significant differences in ROMs and stiffness between the two-level fixation and three-level fixation models(P＞0.05).Conclusion Two-level fixation provides similar biomechanical stability as three-level fixation does in the reconstruction of unstable thoracolumbar fractures.

A secretive expression vector of Pichia pastoris system which can be used for the direct cloning of PCR products was constructed,and was verified through the expression of recombinant cellobiohydrolase II in Pichia pastoris.A randomly selected fragment was amplified with properly designed primers by PCR.The XhoI and Eam1105Ⅰ restriction sites were included in the 5'end of the fragment,and the Eam1105Ⅰ and XbaI restriction sites were included in its 3'end.The PCR amplified product was inserted into the P.pastoris expression plasmid pPICZ?A through XhoI and XbaI restriction sites and the resultant plasmid was digested with Eam1105Ⅰ,and lastly the big fragment was recovered,generating the P.pastoris expressive Tvector pPICZ?T.Then the cellobiohydrolase II of T.reesei was successfully expressed in P.pastoris with this expressive Tvector.Such results indicated that the constructed expression Tvector was convenient for PCR product cloning,and was effective for heterologous protein expression in P.pastoris.On the other hand,the application of the expression Tvector avoided the introduction of additional amino acids at the Nterminus of the expressed protein,which generally occurred when normal expression vectors were used in secretive expression system.

AIM　To investigated the effect and mechanism of Houttuynium (HOU) on splenectomy animals. METHODS　The models of splenectomy mice and splenectomy rats were made and delayed type hypersensitivity (DTH) reaction, ANAE (+) cell percentage of peripheral blood lymphocytes, Con A-induced thymus and groin lymph node lymphocyte proliferation, the amount of lymphocytes of groin lymph node,and T cell subpopulation in peripheral blood were measured. RESULTS　HOU ig (60 mg*kg-1, 120 mg*kg-1) can strikingly enhanced delayed type hypersensitivity (DTH) reaction, ANAE(+) cell percentage of peripheral blood lymphocytes. strengthened Con A-induced groin lymph node lymphocyte proliferation, raised the amount of lymphocytes of groin lymph node in splenectomy mice. But the effects of them on Con A-induced thymus lymphocyte proliferation were not apparent. HOU ig (40 mg*kg-1, 80 mg*kg-1) improved Th subset, reduced Ts subset, and then modulated the rate of Th/Ts in splenectomy rats. CONCLUSION　HOU strengthened the cellar immune function of splenectomy animals by promoting the compensating capability of lymph node and regulating T cell subpopulation.

Objective To evaluate the efficacy of three-dimensional conformal radiotherapy (3DCRT) combined with concurrent chemotherapy for loco-regionally recurrent or mastastatie rectal cancer. Methods Between June 2004 and January 2007,47 patients with loco-regionally recurrent or nmatastatic rectal cancer were treated by 3DCRT of 55-65 Gy in 1.8-2.0 Gy fractions. Chemotherapy was given concurrenfly using oxaliplatin(100 mg/m2 ,iv drop,d1 ) and capecitabine(1500 mg/m2,orally,dl-14,21 days per cycle). Results After the follow-up of 12-35 months, the total response rate, complete response rate and partial response rate were 79% (37/47) ,19% (9/47) and 60% (28/47) ,respectively. The pain-alleviation rate and the mean pain-alleviation time were 85% and 6 months. The 1- and 2-year survival rates were 83% and 51%. Quality of life was improved without any treatment related death. Conclusions 3DCRT combined with concurrent chemotherapy is effective and well-tolerated in patients with post-operatively locoregionally recurrent or mastastatic rectal cancer.

Objective To identify the optimal surgical approaches for the resection of adrenal tumors. Methods The choices and effects of surgical approaches in 1 077 patients with adrenal tumors of varying sizes and types were analyzed. Results An 11th or 10th intercostal incision was used for 567 cases of aldosterone producing adrenocortical tumors (APA) and Cushing syndrome (CUS).An 11th or 10th incision was used in 173 cases of pheochromocytomas and 136 cases of incidental tumors.Transabdominal approach was performed in 136 cases of pheochromocytomas and 22 cases of incidental tumors.Twenty five patients receiving thoracoabdominal approach were all those with pheochromocytomas or incidental tumors.Nine patients with adrenal tomors less than 4 cm in diameter received laparoscopic surgery.Surgeries included 1 060 cases of tumor resection and 17 cases of biopsies,and splenectomy was procedured in 9 patients simultaneously. The main complication of 11th or 10th intercostal incision approach was pleural injury,and transabdominal approach had its main complication of spleen injury. Conclusions An 11th or 10th intercostal incision is the best choice for patients with APA,CUS and pheochromocytoma or incidental tumor less than 7 cm in diameter.For tumors greater than 7 cm,transabdominal or thoracoabdominal approach is indicated.Transabdominal approach is also indicated for extra adrenal or multiple pheochromocytomas and bilateral adrenal tumors.The 11th or 10th intercostal incisions or thoracoabdominal incisions provide more chances of renal vessel repair and renal sparing compared with transabdominal approach for pheochromocytomas adjacent to the renal vascular pedicle.Laparoscopic surgery is suitable for patients with adrenal tumors less than 6 cm in diameter.