Objective To study the diagnosis and treatment of adrenocorticotrophic hormone (ACTH) independent Cushing syndrome. Methods A retrospective review was done on 89 patients with ACTH independent Cushing syndrome, including 85 cases of adrenal tumors with hypercorticism, 2 cases of adrenocortical adenocarcinoma and 2 cases with ACTH independent macronodular adrenal hyperplasia. Results Favorable results were observed from the surgery for 85 cases of adrenal tumors combined with hypercorticism.Two cases with ACTH independent macronodular adrenal hyperplasia were cured by bilateral adrenolectomy. Adrenal cortical adenocarcinoma was unresectable for both the patients who survived 7 and 9 months respectively. Plasma ACTH,dexamethasone suppression test,B ultrasonography and CT scan were useful for the diagnosis and differentiated diagnosis of ACTH independent Cushing syndrome. Conclusions Prognosis of adrenal tumors with hypercorticism and ACTH independent macronodular adrenal hyperplasia is favorable after surgery,whereas the prognosis of adrenal cortical adenocarcinoma is poor.

Objective To investigate the effects of preoperative jaundice relieving on hemihepatectomy of hilar cholangiocarcinoma.Methods The clinical data of 18 patients who received preoperative percutaneous transhepatic cholangiography and drainage (PTCD) or endoscopic nasobiliary drainage (ENBD) before hemihepatectomy at the Tongji Hospital of Huazhong University of Science and Technology from January 2007 to January 2012 were retrospectively analyzed.The condition of the 18 patients (jaundice relieving group) was compared with that of 24 patients (non-jaundice relieving group) who did not receive PTCD or ENBD before hemihepatectomy.The differences in the pre-and postoperative blood loss,blood transfusion,operation time and postoperative incidence of complications between the 2 groups were analyzed.All data were analyzed using the t test or chi-square test.Results After PTCD or ENBD,the levels of total bilirubin (TBil),direct bilirubin (DBil),alanine aminotransferase (ALT) were (27 ± 5) μmol/L,(22 ± 6) μmol/L and (52 ± 42) U/L,which were significantly lower than (287 ± 120)μmol/L,(212 ± 86)μmol/L,and (267 ± 180)U/L before PTCD or ENBD in the jaundice relieving group (t =4.33,6.61,4.19,P ＜0.05).In the jaundice relieving group,left hemihepatectomy was performed on 14 patients,and right hemihepatectomy on 4 patients,and the radical resection rate was 16/18.In the nonjaundice relieving group,left hemihepatectomy was performed on 11 patients,and right hemihepatectomy on 13 patients,and the radical resection rate was 83.3％ (20/24).There was no significant difference in the radical resection rate between the 2 groups (x2 =1.09,P ＞ 0.05).The operation time,volume of intraoperative blood loss,volume of blood transfusion were (5.0 ± 0.8) hours,(562 ± 207) ml and (430 ± 317) ml in the jaundice relieving group,and (6.3 ± 1.5)hours,(815 ± 463)ml and (750 ± 146)ml in the non-jaundice relieving group,with significant differences between the 2 groups (t =4.77,7.80,4.65,P ＜ 0.05).The incidences of postoperative complications,bleeding and postoperative hepatic failure were 3/18,1/18 and 1/18 in the jaundice relieving group,and 75.0％ (18/24),33.3％ (8/24) and 33.3％ (8/24) in the non-jaundice relieving group,with significant differences between the 2 groups (x2=5.14,7.58,7.58,P ＜ 0.05).Conclusion Preoperative jaundice relieving could shorten the operation time and reduce the volume of intraoperative blood loss and the incidence of postoperative complications.

?AIM:To investigate the correlation between dry eye and different degrees of diabetic retinopathy ( DR ) in type 2 diabetic patients.?METHODS: In the cross-sectional study, 340 patients (340 eyes) with type 2 diabetes were enrolled. Tear film function tests including tear meniscus height, tear film breakup time ( BUT ) , fluorescein staining, Schirmer Ⅰtest were performed followed by surveying questionnaires about dry eye. Retinal status was evaluated by retinal color photography and indirect ophthalmoscopy exam with dilated pupils to evaluate DR and whether companied by macular edema.?RESULTS:The prevalence of dry eye was 49. 41%. The mean duration of diabetes in patients with dry eye was 11.15±7.07a, while 6.92±5.45a without dry eye(P<0.01). Dry eye had the positive correlation to the development of DR. The incidence of dry eye in people with mild nonproliferative diabetic retinopathy ( NPDR ) , moderate NPDR, severe NPDR and proliferative diabetic retinopathy (PDR) was 1. 097 times, 1. 724 times, 2. 86 times and 5. 43 times respectively, compared with people without DR. The occurrence of dry eye in people with macular edema increased by 3. 697 times compared with people without macular edema.?CONCLUSION: Dry eye was more prevalent in people with type 2 diabetes. The incidence of dry eye increased gradually with the occurrence and development of diabetic retinopathy.

Objective To observe the effect of daidzein on extracellular matrix of uremic rats and to discuss its mechanism.Methods Uremic rat model were established by 5/6 nephrectomized. Model rats were devided into daidzein group, control group. Rats with sham-operation were regarded as the normal control. At time of baseline, 4th and 8th week after operation, urinary protein and biochemical detection were measured. The pathologic changes, fibronectin (FN) and typeⅣcollagen (ColⅣ) were investigated at 8th week. The Western-Blot and RT-PCR were used to measure protein expression and mRNA transcription of TGF-β1. Results At 8th week after operation, the urinary protein (12.35 ± 2.13 mg/24 hvs. 19.93 ± 3.19 mg/24 h), serum urea (10.11 ± 0.65 mmol/Lvs.12.09 ± 0.78 mmol/L) and creatinine (68.10 ± 2.51μmol/Lvs.77.63 ± 3.20μmol/L) in the daidzein group decreased significantly than those in the control group (P<0.01). The deposition of ColⅣ (16.33% ± 2.14%vs. 24.68% ± 3.97%) and FN (19.17 ± 2.68 vs. 29.35 ± 4.15) in the daidzein group decreased significantly than those in the control group (P<0.01). Compared with control group, the pathological lesion in the daidzein group was less serious. The mRNA transcription (0.37 ± 0.06vs. 0.64 ± 0.08) and protein expression of TGF-β1 (0.28 ± 0.09vs. 1.40 ± 0.13) in the daidzein group were attenuated significantly than those in the control group (P<0.05). ConclusionsDaidzein had a beneficial effect on uremic rats. It may be associated with a decrease of extracellular matrix accumulation.

Objective To investigate the effect of genistein on deposition of extracellular matrix(ECM) in uremic rats and its mechanism.Methods The uremic rat model was established by 5/6 nephrectomy.The model rats were divided into the genistein group(G) and control group (C).The sham-operation group served as the normal control(S).Urinary protein and biochemical indexes before operation,at postoperative 4,8 weeks were measured in various groups.The pathologic changes of renal tissue were observed.The glomerular sclerosis index(GSI) was evaluated by the semi-quantitative method.fibronectin(FN) and type Ⅳ collagen (ColⅣ) deposition situation were detected by using the immunohistochemical method.Western blot and RT-PCR were used to measure the protein expression and mRNA transcription of TGF-β1.Results Comparing postoperative 4 weeks with the group C,the urinary protein excretion amount was decreased[(11.63 ± 2.07) mg/d vs.(19.93 ± 3.19) mg/d,all P＜ 0.01],serum urea nitrogen and creatinine levels of the group G were decreased[(9.39±0.59)mmol/L vs.(12.09±0.78)mmol/L,(65.11±3.79)mmol/L vs.(77.63±3.20)μmol/L,all P＜0.01].Until postoperative 8 weeks,the urinary protein excretion amount was decreased and the decrease of serum urea nitrogen and creatinine levels was more obvious.The deposition of ColⅣ and FN in renal glomerulus was lower than that of the control group[(17.30±1.96)％ vs.(24.68±3.97)％;(18.26±2.31)％ vs.(29.35±4.15)％,all P＜ 0.01].Glomerular sclerosis was significantly alleviated.The TGF-β1mRNA and protein expression were attenuated (P＜0.05).Conclusion Genistein can reduce the deposition of ECM in uremic rats and has a protective effect on kidney.

OBJECTIVE:To explore the role of clinical pharmacists in cancer pain management. METHODS:The cases were presented to investigate the content and method of clinical pharmacists participating in cancer pain management. RESULTS:The clinical pharmacists could provide professional analgesic recommendations and participated in the formulation of individual analge-sic plan. By carrying out pharmaceutical care and patient education,clinical pharmacists could find potential medication risk,cor-rected medication errors and improved patient compliance. By carrying out patient family members training,clinical pharmacists could help to strengthen patient support system and improve cancer pain management effectiveness. CONCLUSIONS:Clinical phar-macists participating in cancer pain management can promote rational use of analgesics,guarantee the safety of drug use,and im-prove cancer pain management.

Objective:To investigate the use of proton pump inhibitors ( PPIs) in the patients with cirrhosis or hepatitis in one hospital and evaluate the use rationality .Methods:A retrospective study was carried out on 211 patients with the diagnosis of hepatitis or cirrhosis in the infectious disease ward between 2013 and 2014 , and the use rationality of PPIs was evaluated .Results: A total of 211 cases were inspected, and among them, 192 ones were treated with PPIs (91%) with 62 ones treated with PPIs irrationally, which accounted for 29.3%of the total cases.The main irrational use of PPIs was long treatment course (24.5%), inadequate prophylaxis indications (5.7%) and purposeless use (2.6%).Conclusion: Irrational use of PPI is common in hepatitis or cirrhosis patients . Clinical pharmacists should strengthen pharmaceutical care to improve the rational drug use .

Objective:To compare expression levels of matrix Gla protein (MGP) and bone morphogenetic protein 2 (BMP-2) in Randall's plaque of renal papillary tissues in patients with calcium oxalate kidney stones and the underlying mechanism for stone formation.Methods:A total of 30 samples of Randall's plaque in renal papillary tissues from patients with calcium oxalate kidney stones were collected from the Department of Urology of Xiangya Hospital of Central South University from April,2015 to December,2015 and served as an experimental group.Ten samples of renal papillary tissues in patients undergone renal tumor nephrectomy were collected from the same hospital and served as a control group.The expressions of MGP and BMP-2 mRNA and protein were detected by quantitative real-time PCR and Western blot.Meanwhile,immunohistochemical technique was used to observe the expressions of MGP and BMP-2 in different parts of renal papillary tissues in the 2 groups.Results:1) The mRNA expression levels of MGP in the experimental group and the control group were 0.760±0.804 and 1.365±0.348,respectively,with significant difference between them (P＜0.05).Them RNA levels of BMP-2 in the experimental group and the control group were 2.500±0.725 and 1.485±0.870,respectively,with significant difference between them (P＜0.05).The expression levels of MGP protein in the experimental group and the control group were 0.130±0.424 and 0.202±0.704,respectively,with no significant difference between them (P＞0.05).The expression levels of BMP-2 protein in the experimental group and the control group were 0.885±0.220 and 0.682±0.272,respectively,with significant difference between them (P＜0.05).T-he immunohistochemistry showed that the protein expression of MGP in the experimental group was lower than that in the control group,while the protein expression of BMP-2 in the experimental group was higher than that in the control group (both P＜0.05).Conclusion:The BMP-2 expression is increased while MGP expression is decreased in renal papillary tissues in patients with calcium oxalate kidney stones,and the formation of calcium oxalate kidney stone might be a kind ofosteogenetic reaction or ectopic calcification.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Humans ; Immunophenotyping ; Leukemia ; diagnosis ; immunology ; therapy ; Male ; Middle Aged ; Neoplastic Stem Cells ; immunology ; Prognosis ; Treatment Outcome ; Young Adult

Objective To understand the incidence.mortality and risk factors of ventilator -associated pneu-monia(VAP)in surgical intensive care unit among elderly patient,in order to direct the clinical prevention and treat-ment of VAP.Methods Retrospective analysis was used on 65 cases of mechanical ventilation elderly patients in our hospital nearly 3 years.Results The incidence of VAP was 66.2%.The mortality of VAP was 67.4%.The factors of long-term mechanical ventilation,high APACHE Ⅱ score,low Glasgow score and inappropriate initial antimicrobial therapy were influenced the prognosis of VAP.Conclusion The incidence of VAP can be decreased and the cure rate can be increased by some effective measures in SICU.