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 assess the nutritional risk of patients with inflammatory bowel disease (IBD).Methods The nutritional status of 112 IBD patients from PUMC Hospital were evaluated by Nutritional Risk Screening 2002 (NRS 2002).Using Chinese standard,a body mass index (BMI) that was lowered than 18.5 kg/m~2 according to clinical material was regarded as malnutrition,and the score was recorded as 3.The se-verity of ulcerative colitis (UC) was evaluated using True-Love criteria as mild,moderate,and severe.Crohn's disease (CD) was evaluated using Harvey-Bradshaw Index as in remission stage (≤4),moderately active stage (4-8),and severely actively stage (≥9).Results All these 112 patients,including 70 UC cases and 42 CD cases,were evaluated by NRS2002.Forty-five patients (40.2%) were judged as at the risk of malnutrition.The incidence of malnutrition was significantly higher in CD patients than in UC patients (52.4% vs.32.9%,P<0.05).It was also significantly correlated with the severity of disease.In patients with severe IBD,the rate of mal-nutrition evaluated by BMI according to clinical material was significantly lower than the rate of nutritional risk.Con-clusions The risk of malnutrition is high in IBD patients.NRS 2002 can be used for nutritional risk screening.

Objective To investigate the methods and results of lengthened proximal femoral nail antirotation (PFNA) in the treatment of femoral shaft fractures combined with ipsilateral femoral neck fractures. Methods Of the 21 patients with femoral shaft combined with ipsilateral femoral neck fractures treated by lengthened PFNA from 2006 to 2009,16 patients with complete follow-up were retrospectively studied.There were 15 males and 1 female,at mean age of 35 years (range,21-51 years).Injury causes were all high-energy trauma including traffic injuries in 11 patients and fall injuries in five.According to Garden classification,there were seven patients with type Ⅰ femoral neck fractures,six with type Ⅱ and three with type Ⅲ.Femoral shift fractures contained six superior part fractures and nine medial part fractures and one inferior part fracture.According to Winquist classification,there were two patients with type Ⅰ femoral shaft fractures,four with type Ⅱ,six with type Ⅲ and four with type Ⅳ.Two patients had open fractures belonging to type Ⅰ Gustilo-Anderson.Harris hip score was used to evaluate functional outcomes at the last follow-up postoperatively. Result The mean follow-up time was 2.4years (range,1-4 years ).The mean period for healing of femoral neck and shaft fractures was 4.2months ( range,3-6 months) and 5.1 months ( range,3-8 months) respectively.Four patients showed delayed diagnoses of femoral neck fractures ; two patients had delayed union of femoral shaft fractures ; one suffered from avascular necrosis of the femoral head ; one patient presented 3 cm of extension of the affected limb and was accompanied by active pain of the knee joint for over four months.According to Harris score,function of hip joints was excellent in seven patients,good in six and fair in three,with excellence rate of 82％. Conclusions It is relatively few that the femoral shaft fracture is combined with ipsilateral femoral neck fracture.The rate of missed diagnosis of femoral neck fractures is high and the patients with high energy trauma hould be highly paid attention to.Lengthened PFNA conforms to characteristics of biomechanical fixation and presents short operation time and solid fixation. Lengthened PFNA achieves affirmatory effects for treatment of femoral shaft fractures combined with ipsilateral femoral neck fractures.

Objective To evaluate chest CT features of microscopic polyangiitis(MPA).Methods Clinical data and chest CT images of 66 patients diagnosed as MAP had been collected.Depending on clinical manifestations.the 66 cases were divided into the active group and the stable group.The data of two groups were analyzed by x2 test.Results Forty-three of 66(65.2%)CT images were abnormal including 32 of them in active group and 11 in stable group. In these patients,CT images showed ground glass opacities(53.5%),lung consolidations(23.2%),scattered patchy opacities(44.2%),ground glass opacities and/or lung consolidations(76.7%),reticular opacities(65.1%),honeycomb(14.0%),pleural effusions(48.8%),emphysema(18.6%),and mediastinal adenopathies(58.1%).Lung consolidations,ground glass opacities,scattered patchy opacities,mediastinal adenopathies,and pleural effusion in the active group are more common than that in the stable group(X2=4.479,4.083,4.053,9.697,9.345 respectively,P<0.05).Conclusion Chest CT features of in patients with MPA have difference between active and stable periods.The chest CT scan is a useful tool to diagnose MAP in different periods and guide the treatment.

Objective To reclassify the patients with former diagnosis of vulvar intraepithelial neoplasia (VIN)Ⅱ, VIN Ⅱ - Ⅲ, VIN Ⅲ, Bowen disease and Bowenoid papulosis according to the 2004 modified terminology of International Society for the Study of Vulvar Disease (ISSVD) and evaluate the effects of surgical treatment. Methods According to the 2004 modified terminology of ISSVD, a retrospective review of the histological slides of 19 cases, who diagnosed as VIN Ⅱ , VIN Ⅱ - Ⅲ, VIN Ⅲ,Bowen disease and Bowenoid papulosis treated in Peking Union Medical College Hospital from 1999 to 2006,were performed to reclassify by pathologist and the clinicopathologic data were also analyze& Results According to the 2004 modified terminology of ISSVD, all 19 cases were reclassified as usual type VIN and were belonged to the subtype of warty type except one, the only Bowen disease patient whose one of focuses belonged to the subtype of basaloid type and the other focus belonged to the subtype of warty type. The primary cure rate of extended local excision was 89% (17/19). There were two cases recurred during follow-up period, and were cured by second surgical treatment and the focuses of recurrence site were still diagnosed as warty type VIN. Conclusions The patients with former diagnosis of VIN Ⅱ , VIN Ⅱ-Ⅲ, VINⅢ, Bowen disease and Bowenoid papulosis are basically reclassified as usual type VIN (warty type) according to the 2004 modified terminology of ISSVD. The results showed that the diagnosis of VIN could be simplified by new terminology. The surgical excision is the good choice and combined cytologic and human papillomavims (HPV) test during follow up is also important for patients of VIN.

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 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.

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 .