Objective To investigate clinical and pathologic features of hypertension patients with adre -noeorticotropic hormone ( ACTH)-independent adrenal hyperplasia , and to analyze the relationship between them . Methods The data of patients with ACTH-independent adrenal hyperplasia and hypertension was collected in Department of Urology , the First Affiliated Hospital of Zhengzhou University from Jan .2012 to Dec.2012.The clinical manifestations , endocrine examination results , imaging findings and the pathological changes of adrenal gland were retrospectively analyzed .Results 75 cases were followed-up.Among them, 39 cases were male and 36 were female.Their ages ranged from 20 to 74 years(with 47 as the average).Pathological results showed that diffusive hyperplasia was observed in 42 cases, tubercle hyperplasia in 26 cases, mixed corticomedullary patho-logical changes in 6 cases, and medullary hyperplasia in 1 case.No significant difference was found among diffu-sive, tubercle and mixed corticomedullary hyperplasia in clinical manifestations except for headache , endocrine examination results, or imaging findings(P>0.05).Conclusion There is no relation between clinical manifes-tations, endocrine examination results , imaging findings and pathological changes in adrenal gland for patients with ACTH-independent adrenal hyperplasia and hypertension .

【Objective】 To explore the effects and mechanism of p38 mitogen activated protein kinase (MAPK) pathway on the formation of calcium oxalate (CaOx) kidney stones in rats,so as to provide new ideas for the treatment of kidney stones. 【Methods】 A total of 40 rats were divided into control, SB203580, CaOx and SB203580+CaOx groups, with 10 rats in each group.Intragastric administration of a mixture of 1% ethylene glycol and 1% ammonium chloride was given to the CaOx and SB203580+CaOx groups to construct CaOx models, while intragastric administration of drinking water was given to the control and SB203580 groups.After molding, SB203580 and SB203580+CaOx groups were injected with 5 mg/kg SB203580 peritoneally once a day for 14 days, while the control and CaOx groups were injected with equal volume of normal saline.The renal mass of rats was measured and the renal coefficient was calculated; the serum levels of blood urea nitrogen (BUN) and serum creatinine (SCr) were measured with an automated biochemical analyzer; the urinary levels of neutrophil gelatinase-associated lipid carrier protein (NGAL) and kidney injury molecule-1 (KIM-1) were determined with enzyme-linked immunosorbent assay (ELISA); the crystal deposition and tissue damage in renal tissues were observed with Von Kossa staining; the apoptosis of renal tubule cells was observed with TUNEL; the expressions of autophagy markers in kidney tissues were detected with immunohistochemical staining; the molecular expressions of autophagy-endoplasmic reticulum stress related pathways in renal tissues were determined with RT-qPCR and Western blot. 【Results】 Compared with the CaOx group, the SB203580+CaOx group had increased body mass after molding (P<0.05); decreased kidney mass, kidney coefficient, BUN, SCr, NGAL and KIM-1 levels (P<0.05); alleviated pathological damage of kidney tissues; significantly reduced black crystal; down-regulated proportion of positive TUNEL cells, positive expression area of LC3B and Beclin-1, mRNA expressions of LC3B, Beclin-1, CHOP and GRP78, protein ratio of LC3-Ⅱ/LC3-Ⅰ, and protein expressions of Beclin-1, CHOP and GRP78 (P<0.05); but up-regulated mRNA and protein expressions of p62 (P<0.05). 【Conclusion】 The p38 MAPK pathway is involved in the formation of CaOx kidney stones in rats.Inhibition of this pathway can reduce the formation of kidney stones, which may be related to the regulation of autophagy and endoplasmic reticulum stress.

Objective:To investigate the influence factors of poor efficacy after flap repair operation in patients with pressure ulcers.Methods:The retrospective case series study was conducted. From January 2011 to June 2021, 125 patients with stage Ⅲ and Ⅳ pressure ulcers treated in Hainan General Hospital met the inclusion criteria. There were 82 males and 43 females, aged 15-90 (57±20) years. According to the postoperative effects, the patients were divided into poor efficacy group (47 cases) and good efficacy group (78 cases). The clinical data of patients in the two groups were collected, including the age, gender, location, stage, size, and bone exposure of pressure ulcers, preoperative microorganism culture results of wound exudate sample, whether combined with osteomyelitis, diabetes, lower limb paroxysmal myospasm, and gatism or not, the number of surgical debridement combined with negative-pressure wound therapy, type of surgical flap, postoperative position, and preoperative albumin, leukocyte, C-reactive protein (CRP), and hemoglobin. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, and chi-square test. The binary multivariate logistic regression analysis was conducted to screen the independent risk factors influencing the poor efficacy after flap repair operation in 125 patients with stage Ⅲ and Ⅳ pressure ulcers. Results:The ratio of patients with lower limb paroxysmal myospasm in poor efficacy group was 22/47, which was significantly higher than 3/78 in good efficacy group ( χ2=33.83, P<0.01). The preoperative hemoglobin level of patients in poor efficacy group was (102±17) g/L, which was significantly lower than (113±20) g/L in good efficacy group ( t=-3.24, P<0.01). The preoperative CRP level of patients was 39.1 (14.1, 91.6) mg/L in poor efficacy group, which was significantly higher than 15.3 (6.6, 42.0) mg/L in good efficacy group ( Z=-3.04, P<0.01). There were no statistically significant differences in other indexes between patients in the two groups ( P>0.05). Multivariate logistic regression analysis showed that age, lower limb paroxysmal myospasm, and preoperative hemoglobin level were the independent risk factors for poor efficacy after flap repair operation in patients with pressure ulcers (with odds ratios of 1.03, 40.69, and 0.97, 95% confidence intervals of 1.00-1.06, 9.18-180.39, and 0.95-1.00, respectively, P<0.05 or P<0.01). Conclusions:Poor efficacy after flap repair operation in patients with pressure ulcers is affected by many factors, among which the age, lower limb paroxysmal myospasm, and preoperative hemoglobin level are the independent risk factors.