Objective To study the characteristics of clinical and laboratory findings in patients with adrenocorticotropic hormone(ACTH)independent macronodular adrenocortical hyperplasia(AIMAH).Methods The clinical and laboratory findings of 7 cases of AIMAH admitted between 1997 and 2005 were reviewed retrospectively.Results 5 of the 7 patients showed typical clinical features of Cushing's syndrome,including moon face,central obesity,hypertension,etc.A part of patients had hypokalemia(43%)and secondary diabetes mellitus(71%).There was lowering of plasma ACTH levels,and an increased cortisol secretion or disturbance in or circadian rhythm.In 6 patients,a low dose or high dose of dexamethasone suppression tests failed to suppress cortisol secretion.CT scan showed bilateral macronodular adrenal hyperplasia.Pituitary MR imaging for pituitary was negative in 6 patients.Unilateral total adrenalectomy was performed in 2 cases.4 cases were treated by bilateral adrenalectomy.One patient died of stroke before operation.5 cases received glucocorticoid replacement therapy after operation.Pathologic examination showed diffuse yellow or brown nodules measuring 0.3 cm～7.0 cm in diameter in all the specimems of 6 patients who undement operation.There was no recurrence in all the patients ofter surgery during the follow-up period.No Nelson syndrome occurred in these 6 patients postoperatively.Conclusion AIMAH is a rare cause of Cushing's syndrome with unique clinical,CT image and pathological findings.Bilateral adrenalectomy in one stage or in stages,or unlateral adremectomy is indicated on the basis of clinical and CT findings.

Objective To explore the association between vitamin D deficiency and nonalcoholic fatty liver disease (NAFLD).Methods From April to June 2013,104 outpatients met NAFLD diagnostic criteria were enrolled.At the same period,98 age and gender matched healthy individuals were enrolled as control.The clinical data were collected through questionnaire,physical examination and lab tests.The severity of hepatic steatosis was dertermined with upper abdominal ultrasound examination.The serum concentration of 25 (OH )D was detected by radio-immunology.The association between vitamin D deficiency and NAFLD was analyzed with two independent sampling t analysis,chi-square test,analysis of variance (ANOVA)and Logistic regression analysis.Results The clinical indexes including body mass index (BMI ), abdominal circumference, blood pressure, aspartate aminotransferase, alanine aminotransferase,glutamyl ranspeptidase,lactate dehydrogenase,uric acid,triglyceride,overall cholesterol, lower density lipoprotein cholesterol and fasting blood glucose of NAFLD group were higher than those of the healthy control group,and the differences were statistically significant (all P < 0.05).But the level of higher density lipoprotein cholesterol of NAFLD group was lower than that of the healthy control group, and the difference was statistically significant (t=-2.941 ,P =0.004).However there was no significant difference in serum 25 (OH)D concentration,the level of calcium and phosphorus (all P >0.05).The results of stratification analysis in age and BMI indicated that the rate of 25 (OH )D deficiency (<37.5 nmol/L)in NAFLD patients aged less than 30 was higher than that of healthy control group (χ2 =6.679, OR = 13.71,P = 0.025 );the rate of 25 (OH)D deficiency in NAFLD patients with BMI≤25 kg/m2 was higher than that of healthy control group (χ2 = 3.734,OR = 4.97,P < 0.01).Among BMI≤25 kg/m2 group,after the adjustment of age,gender and metabolic syndrome,the results of multiple group Logistic regression analysis indicated that serum 25(OH)D concentration was negatively correlated to NAFLD (OR= 1 .16,95 % CI :1 .03 to 1 .30,P = 0.032).Conclusion Vitamin D deficiency might be a risk factor in pathogenesis of NAFLD patients with age less than 30 year old and BMI ≤25 kg/m2 .

Objectlve To investigate the value of basic and contrast-enhanced ultrasound in the diagnosis of superficial cervical lymph nodes.Methods Five hundred and forty-five cases of superficial cervical lymph nodes were sacned by basic ultrasound,in which 52 cases were also scaned by contrast-enhanced ultrasound.All cases were performed ultrasound-guided biopsy.Lymph nodes were divided into benign group and malignant group according to pathology reports.The differences of the two groups were analysed,and statistical analysis was performed.Results Two hundred and thirty cases were benign,315 cases were malignant.S/L(P＜0.01),RI(P＜0.01),vascular pattern(P＜0.01)and contrast enhancement pattern(P＜0.01)between benign and malignant group showed statistical significant differences,while no statistical difference in coefficient correlation of the time-intensity curve between the two groups was found.Conclusions A combination of basic and contrastenhanced ultrasound can significantly enhance the ability to identify malignant lymph nodes from benign lymph nodes.

Objective To explore the reliability of Chinese simplified diagnostic method for acute drug‐induced liver injury (DILI) in diagnosis of acute DILI .Methods From 2008 to 2013 ,a total of 320 patients diagnosed with acute DILI were enrolled .The clinical data of them were collected .International recognized Roussel Uclaf causality assessment method (RUCAM ) was taken as control and then simplified diagnostic method for DILI in China was evaluated . Variance analysis was performed for statistical analysis .Gamma value of two diagnostic methods was calculated and the correlation was analyzed .Results Among the 320 patients with acute DILI ,according to RUCAM ,there were 39 cases (12 .19% ) with quite high probability ,193 with high probability (60 .31% ) ,74 with possibility (23 .12% ) ,11 with less possibility (3 .44% ) and three with no probability (0 .94% ) .According to simplified diagnostic method for acute DILI ,194 cases were diagnosed (60 .62% ) ,103 were suspicious (32 .19% ) and 23 were excluded (7 .19% ) .The RUCAM score of diagnosed group (7 .5 ± 1 .2) was higher than that of suspicious group (5 .3 ± 1 .3) and excluded group (2 .1 ± 1 .1) ,and the difference was statistically significant (F =239 .545 ,P< 0 .01) .The correlation analysis between these two diagnostic methods indicated that Gamma value was 0 .955 (P < 0 .01) .Conclusions The simplified diagnostic method for acute DILI in China is simple ,practical and consistent with RUCAM .It can be used as one of the clinical methods for screening acute DILI .

Objective:To observe the clinical efficacy of combining neuromuscular joint facilitation (NJF) with floating needle treatment in treating stroke survivors with painful shoulder subluxation.Methods:Thirty-nine stroke survivors with painful shoulder subluxation were randomly divided into an NJF group, a floating needle group and a combination group, each of 13. In addition to the basic treatment for shoulder subluxation and pain (including positioning, physiotherapy, active and passive motor function training, progressive training of the upper limbs, and using shoulder pads to protect the affected shoulders when standing or walking), the 3 groups were also given NJF, floating needle therapy or both as their group names imply six days per week for 4 weeks. Shoulder subluxation was evaluated using ultrasonography to measure the acromion-greater tuberosity distance (AGT). Pain was self-reported using a visual analogue scale. And the Fugl-Meyer assessment (FMA) was applied to quantify the treatments′ efficacy.Results:Before the treatment, no significant differences were found among the 3 groups in terms of their average AGTs, pain ratings or FMA scores. Afterward, significant improvement was observed in all of the measurements in all 3 groups, with the combination group′s average results significantly better than those of the other two. The combination group′s overall effectiveness was 85%, significantly better than that of NJF group (54%) and the floating needle group (62%).Conclusions:Floating needle treatment combined with NJF and routine rehabilitation can significantly improve motor functioning and relieve the pain of shoulder subluxation after a stroke.

Objective To discuss the outcome of repair of limbs bone defect by using mineralized collagen graft.Methods The clinical data of 35 cases who diagnosed the existence of bone defect from January 2013 to December 2013 in our department were retrospectively analyzed.After operation,Lane Sandhu X-ray score standard was evaluated.Results All patients were followed up for 12 months.Postoperative 1 month,Lane Sandhu X-ray score was 3 points in 20 cases and 15 cases with 2 pointss;postoperative 6 months,Lane Sandhu X-ray score was 9 points in 21 cases,10 cases with 8 points and 4 cases with 7 points.Postoperative 12 months,Lane Sandhu X-ray score was 12 points in 28 cases,7 cases with 11 points.The scores of postoperative 6 months were better than the scores of postoperative 1 month [(2.60±0.49)points vs.(8.49±0.12)points,t=107.860,P=0.000].There was significant difference between the scores of postoperative 12 months and scores of postoperative 6 months [(8.49±0.12)points vs.(11.8±0.06)points,t=41.630,P=0.000].Conclusion MC is used as an effective bone substitute material,and its clinical effect is good.

Objective To investigate use of magnetic resonance diffusion tensor imaging (MR-DTI) for quantitatively evaluating the efficacy of Mailuoning Injection on non-compressive lumbar radiculitis.Methods Nine Bama mini pigs were selected and divided into group A,B and C,3 cases in each group.The non-compressive lumbar radiculitis model was established under CT-guiding.The corresponding therapeutic drugs (group A:10 mL Mailuoning;group B:10 mL normal saline;group C:10 mL diminishing inflammation fluid) were given by epidural injection on 14 d after constructing model.MR-DTI was performed before model construction,14 d after model construction and before treatment.One experimental pig in each group was taken on 3,7,14 d after treatment,performed MR-DTI and killed for taking the nerve root sample to conduct the immunohistochemical detection.The fractional anisotropy (FA) values of nerve root in MR-DTI imaging were measured.The FA values and immunohistochemical detection results were statistically analyzed.Results MR-DTI:the FA values after model construction in each group was decreased (P<0.05);the FA values on 14 d after treatment in the group A was increased,which showed statistically significant difference compared with before treatment (P<0.05);the FA values after 3,7 d treatment in the group A had no obvious increase,the difference between the group A and B was not statistically significant (P>0.05),but the FA values increase in the group C was earlier and more rapid than other two groups (P<0.05);the FA values after 14 d treatment in the group A was risen again,the FA values of bilateral nerve roots had no statistical difference between the group A with the group B and C (P>0.05),while the FA values had statistical difference between the group B and C (P<0.05).The immunohistochemical results:TNF-α integral absorbency value(IA value) on 7 d after treatment in the group A began to decline;the TNF-α IA value on 14 d after treatment in the group A and C was significantly decreased compared to group B,the difference was statistically significant (P<0.05).Conclusion Mailuoning Injection has a certain effect on non-compressive lumbar radiculitis,which can be evaluated by using DTI.

Objective To develop a traditional Chinese medicine (TCM) syndrome score scale for acute gastrointestinal injury (AGI) in sepsis, and to carry out its reliability and validity analyses and its clinical preliminary application. Methods ① According to the characteristics of intensive care unit (ICU) patients, combined with the understanding of etiology, pathogenesis and physical signs of TCM and literature search, a preliminary framework of scoring system for TCM syndromes of AGI in sepsis was constructed to carry out the scoring by this scale. ② After the scale and data were obtained, the analyses of split-half reliability (indicated by Guttman's split-half reliability of the a and b groups), test-retest reliability and the internal consistency reliability (expressed by the Cronbach's coefficient α) were carried out, and the structural validity and criterion validity were also analyzed. ③ The AGI patients were divided into two groups according to the 28-day survival and death conditions, and the AGI TCM syndrome score, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, and multiple organ dysfunction syndrome (MODS) score were compared between the two groups to determine the best cut-off point for survival analysis. Results ① The first draft of the septic AGI TCM syndrome rating scale was prepared, The TCM syndrome indicators include: abdominal distension, constipation/diarrhea, diet situation, vomiting/stomach retention, tongue proper, tongue coating, pulse manifestation, belching, body temperature, and accompanied syndrome, there were 6 points for scoring, 0 - 6 points, and they were divided into normal (0 points), mild (2 points), moderate (4 points), and severe (6 points) in severity. ② Eighty-eight patients with septic AGI were included in the final statistics. The retest of correlation coefficient of this scale was R = 0.974 (> 0.85), Guttman's split-half reliability was 0.793 (> 0.7) and the Cronbach's coefficient α was > 0.7. This scale was suitable for factor analysis. After rotation, 3 factors were determined, which were named as TCM syndrome differentiation, related physical signs, and gastrointestinal tolerance. After modeling, the confirmatory factor analysis showed that the model approximate error root mean square (RMSEA) was 0.07 (< 0.08), and the goodness of fit index (CFI) = 0.90; the Pearson correlation analyses between the criteria validity of APACHE Ⅱ, SOFA, MODS scores and TCM 1 score and TCM 2 score of this scale showed that the r values were 0.802 and 0.752, 0.524 and 0.519, 0.619 and 0.590, respectively, all P < 0.01. ③ Compared with the survival group, TCM score (33.73±5.95 vs. 37.28±5.26, t = 2.945, P = 0.004), the APACHE Ⅱ score (19.90±4.47 vs. 22.28±5.79, t = 2.069, P = 0.043), SOFA score (8.73±1.11 vs. 9.64±1.38, t = 3.329, P = 0.020) in the death group were significantly decreased; MODS score in the death group showed a decreasing trend (6.65±1.22 vs. 7.28±1.60, t = 2.078, P = 0.050). Cox regression analysis showed that when the survival analysis was performed with a cut-off point of 35, the 28-day survival rate of patients with TCM syndrome score ≥ 35 was significantly lower than that of patients with < 35 score, χ2= 6.362, P = 0.012. Conclusions The TCM syndrome rating scale for AGI in sepsis was successfully prepared. The statistical reliability and validity of this scale are good. Preliminary clinical application shows that this scale can predict the prognosis and severity of patients with septic AGI. Trial registration China Clinical Trial Registry Center, ChiCTR-IOR-15007625.

OBJECTIVE: To evaluate the value of fundus autofluorescence (FAF) imaging combined with spectral domain optical coherence tomography (SD-OCT) in diagnosis, prognostic assessment and follow-up observation of acute Vogt-KoyanagiHarada (VKH) disease. METHODS: Clinical data were collected from 12 patients (23 eyes) with acute VKH disease treated in our hospital from May, 2018 to November, 2019, including detailed medical history, best corrected visual acuity (BCVA), and results of slit lamp biomicroscopy, fundus photography, SD-OCT, fundus fluorescein angiography (FFA) and FAF imaging.SDOCT and FAF imaging were repeated after a course of treatment and in follow-up examination, and the results were compared with those at the time of admission. RESULTS: VKH disease involved both eyes in 11 patients (91.7%).Fundus photography showed optic disc edema in 16 eyes (69.6%), and multiple retinal neuroepithelial detachment was detected by SD-OCT in all the involved eyes (100%).IN all the eyes, FFA revealed small and dense fluorescein leakage in the early stage and fluorescein accumulation in advanced stages of VHK disease to form multiple dye pooling in the areas of serous detachment.Hyperauto fluorescence was a common finding in FAF imaging (100%), and the area involved was consistent with that of fluorescein accumulation shown by FAF imaging.Ten eyes (43.5%) showed patches of relative hypoautofluorescence in the hyperauto fl uorescence areas, and granular hyperauto fl uorescence was found in the lesions in 4 eyes (17.4%).During the remission period of VKH disease, FAF imaging showed normal finding in 8 eyes (34.8%) and reduced areas (by 55.2%) and intensity (by 46.5%) of hyperautofluorescence in 9 eyes (39.1%).In 6 eyes (26.1%), only a few hyperautofluorescent spots scattered in the macula were observed.SD-OCT demonstrated significantly reduced (by 69.5% on average) or even disappearance of subretinal fluid in the eyes.The fluorescence intensity in FAF imaging showed a significant positive correlation with the volume of subretinal fluid detected by SD-OCT ( CONCLUSIONS The combination of fluorescein angiography, FAF imaging and SD-OCT can significantly improve the diagnostic accuracy of VKH disease.FAF imaging combined with SD-OCT provides an effective and noninvasive modality for evaluation of remission and monitoring the changes in VKH disease.
Acute Disease ; Fluorescein Angiography ; Follow-Up Studies ; Humans ; Retinal Detachment/diagnostic imaging* ; Tomography, Optical Coherence ; Uveomeningoencephalitic Syndrome/diagnostic imaging*

Objective: To investigate the role and mechanism of Krüppel-like factor 4 (KLF4) in regulating epithelial-mesenchymal transition (EMT) and migration of bladder cancer cells. Methods: Bladder cancer 5637 and T24 cell lines that stably over-expressing KLF4 (LV-KLF4, experiment group) were constructed, and the negative control group (LV-NC) was also established; the mRNA and protein expressions of KLF4 were verified by qPCR and WB, respectively. Transwell chamber assay was used to detect the migration ability of cells in LV-KLF4 and LV-NC groups. WB was performed to detect the expression levels of EMT-related markers (E-cadherin, N-cadherin, Vimentin) and Wnt signaling pathway-related proteins. Immunofluorescence technique was used to detect the distribution of β-catenin in cells after over-expression of KLF4. Results: The 5637 and T24 cell lines over-expressing KLF4 gene were successfully constructed. Compared with the LV-NC group, the mRNA and protein expressions of KLF4 increased in LV-KLF4 groups (all P<0.01); the expression of E-cadherin increased (P<0.01), while the expressions of N-cadherin, vimentin, and the expression levels of total β -catenin, nuclear β -catenin, MMP 9 and c-Myc decreased (all P<0.01); moreover, the migration ability of cells decreased significantly (P<0.01); the fluorescence expression of β-catenin in cells also decreased significantly in LV-KLF4 group as compared to LV-NC group. Conclusion: Over-expression of KLF4 gene in bladder cancer cells may inhibit EMT process by regulating Wnt/β-catenin signaling pathway, and further inhibit the migration of bladder cancer 5637 and T24 cells.