Adrenal tuberculosis is still the main cause of primary adrenal insufficiency (Addison Disease) in China. A case of bilateral adrenal tuberculosis without PAI symptoms was admitted to Department of Urology, Shanxi Provincial People’s Hospital. Pathological report showed adrenal tuberculosis. We present an overview and discuss how to diagnose early adrenal tuberculosis and reduce misdiagnosis rate so as to preserve residual adrenal function to the greatest extent.

BACKGROUND:Simple pedicle screw fixation for thoracolumbar fractures has better outcomes, but there are some deficiencies, such as poor applicability for severe compression or burst fractures, strong vertebral pain, easy to cause vertebral wound denervation and paraspinal muscle injury, and slow recovery. OBJECTIVE:To investigate the clinical effects of pedicle screw fixation combined with artificial bone graft for the treatment of thoracolumbar fractures. METHODS:A total of 126 patients with thoracolumbar vertebral compression fractures, who had undergone pedicle screw fixation without bone graft (control group,n=62) and with bone graft (test group,n=64) were enroled. The fracture healing, anterior vertebral height ratio, sagittal Cobb angle, and loss rate of vertebral height after 6 months were observed by X-ray in the two groups. RESULTS AND CONCLUSION:Al patients were folowed up, and had complete fracture healing after 12-16 months. The anterior vertebral height and Cobb angle were both improved in the two groups at 1 week after operation (P < 0.01), but there was no difference between the two groups (P > 0.05). New bone formation was observed in the test group at 6 months after operation, and patients were pain-free; but the speed of bone formation was slower in the control group, and patients stil suffered from painful thoracolumbar fractures. There was no difference in the loss of anterior vertebral height and Cobb angle between the two groups (P> 0.05). These findings indicate that pedicle screw fixation combined with artificial bone graft lead to a better recovery in thoracolumbar fractures.

ObjectiveTo explore the clinical features and factors inlfuencing the prognosis of childhood non-Hodgkin's lymphoma (NHL).MethodsPathologically diagnosed 78 pediatric patients with NHL and treated in the Afifliated Hospital of Qingdao University from January 2004 to August 2013 were collected and analyzed. Patients were grouped according to age, sex, tumor size, immunologic classiifcation, B-symptoms, LDH, hemoglobin and clinical staging. The 5-years event-free survival rate (EFS) were calculated and analyzed by Kaplan-Meier method, and the difference of the survival rate between groups were com-pared. Using Cox proportional hazards model, we analyzed the possible factors that might inlfuence 5-years event-free survival rate EFS , such as age and clinical staging. TheOR value and the 95%CI were calculated.ResultsAmong the 78 cases, median age of onset is 7 years old, male to female ratio is 2.90:1, there are 25 cases of T-cell type and 53 cases of B-cell type. According to pathological types,Burkitt lymphoma is the most common (34.6%), followed by T-lymphoblastic lymphoma (20.5%), diffuse large B-cell lymphoma (11.5%). According to the St. Jude malignant lymphoma staging system, there are 2 cases in stage I, 9 in stageⅡ, 35 in stageⅢ and 32 in stageⅣ. Swelling of periphery lymph node (80.7%) was observed as initial symptom in 26 cases of lymphoblastic lymphoma. Among 45 cases of mature B-cell tumor, the main clinical feature including abdominal cavity and gingival were observed in 27 cases of Burkitt lymphoma. Among the 73 cases received treatments, 66 cases (90.5%) attained CR (complete remission) and 4 cases (5.5%) attained PR (partial remission) by cytology and radiographic assessment after two course of combined chemotherapy, 2 cases (2.7%) rapidly relapsed after the remisson of one course treatment, 1 case (1.3%) appeared the central nervous system inifltration in the chemotherapy. With median follow-up time of 42 months, the 5-year EFS of the 73 cases was (67.0+5.5)%. Single factor analysis showed that B-symptom, LDH, and clinical staging were signiifcantly correlated with prognosis (P<0.05), while age, sex, tumor size, hemoglobin and immune classiifcation was independent of prog-nosis (P>0.05). Multiple factor analysis showed that LDH and clinical staging inlfuenced the prognosis (OR=3.34,95%CI 2.275?10.683,P<0.01;OR=4.354,95%CI 1.519?12.475,P<0.01) .Conclusionclinical features of childhood NHL are variable. LDH and clinical staging at primary diagnosis are important factors affecting the prognosis.

Objective To explore the effects of acteoside on dysfunction of learning and memory and the protective effect of oxidative stress in rats with vascular dementia.Methods 30 SD rats were randomly divided into sham group,model group,nicergoline group,low-dose acteoside group and high-dose acteoside group,with 6 rats in each group.Preparation of vascular dementia model by 2-vessed occlusion.The ability of exploring and learning and memory in rats were detected by step down test and avoid dark test.Determination of malondialdehyde (MDA),reactive oxygen species (ROS) and glutathione peroxidase (GSH-PX) activity in serum and brain tissue was conducted by Elisa.Results Autonomic activity test showed that the frequency and activity of autonomous activity in the model group were significantly lower than those in the sham group(P＜0.01),the frequency of autonomous activity in each administration group was significantly higher than that in the model group (P＜0.01),and the central activity time in the high-dose group was significantly higher than that in the model group (P＜0.01).Step down test and avoid dark test showed that the latency of the model group was significantly lower than that of the sham group.(Model group of step down test:(25.33 ± 3.01) s,Sham group of step down test:(56.83 ± 15.90)) (P＜ 0.01).(Model group of avoid dark test:(15.67 ± 3.61) s,Sham group of avoid dark test:(135.82±44.00) s) (P＜0.01).The latency of low dose group was significantly higher than that of model group.(Low dose group of step down test:(46.40±14.32) s) (P＜0.01).(Low dose group of avoid dark test (44.20± 8.26)s) (P＜0.05).Step down test and avoid dark test showed that the number of mistakes in the model group was significantly higher than that in the sham operation group(P＜0.01).The number of errors in nicergoline group and the low dose group was significantly lower than that in the model group (P＜0.01,P＜0.05).In serum,the content of MDA and ROS in model group was significantly higher than that in sham group (P＜0.01) while the activity of GSH-PX in model group was significantly lower than that of sham group.The content of MDA in the other groups was significantly lower than that in the model group (P＜0.01).The content of ROS in the nicergoline group and low dose group was significantly lower than that in the model group (P＜0.05,P＜0.0l).The activity of GSH-PX in high dose group was significantly higher than that in model group (P＜0.01).In brain tissue,the content of MDA and Ros in model group was significantly higher than that in sham group (P＜0.01).The content of MDA and ROS in low dose group and high dose group were significantly lower than that in model group (P＜0.05,P＜0.01).Conclusion Acteoside can improve the dysfunction of learning and memory and depressive mood disorder caused by vascular dementia and reduce oxidative stress injury by decreasing the content of MDA-ROS and increasing the activity of GSH-PX enzyme.

OBJECTIVE: To analyze the pathogenic variant of preaxial polydactyly in a Chinese Han pedigree and identify the cause of polydactyly. METHODS: The peripheral blood DNA of the proband and her parents was extracted. The polydactyly-related genes were detected by trio whole exome sequencing, and the suspected pathogenic gene was screened out. Sanger sequencing was applied to other members of the pedigree. RESULTS: The results of gene sequencing showed that the LMBR1 gene had a heterozygous variant of c.423+4909(IVS5)C>T in 6 patients of the pedigree. The same variant was not detected in family members with normal phenotype. Based on the ACMG guidelines, c.423+4909(IVS5)C>T of the LMBR1 gene was predicted to be pathogenic (PM1+PM2+PP1-S(PS)+PP4+PP5). CONCLUSION The heterozygous C>T variant at position 4909 of intron 5 of the LMBR1 gene probably underlies the disease in this pedigree.
China ; Female ; Humans ; Mutation ; Pedigree ; Polydactyly/genetics* ; Thumb ; Whole Exome Sequencing

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.