Objective To discuss adrenalectomy effects on biochemical and metabolic impairment for patients with subclinical Cushing syndrome (SCS) due to an adrenal incidentaloma (AI) compared with conservative management.Methods Data from 87 patients with SCS due to AI in Peking Union Medical College Hospital between September 2011 and January 2016 were reviewed.Forty-eight patients underwent laparoscopic adrenalectomy (operative group), whereas 39 were managed conservatively (control group).No significant differences were found at baseline between the two groups concerning all the examined parameters, including age [(51.8 ± 10.2) years vs.(53.2 ± 12.1)years], male/female ratio (18/30 vs.20/19), size of adrenal mass [(3.01 ± 0.84) cm vs.(2.99 ± 1.01) cm], body mass index [(27.34 ±3.84) kg/m2 vs.(26.98 ± 3.99) kg/m2], adrenocorticotropic hormone (ACTH) [(2.01 ± 0.40) pmol/L vs.(1.96 ±0.42) pmol/L] and daily urinary free cortisol levels[(75.80 ± 39.71) mg vs.(71.06 ±31.35) mg], responsiveness to 1 mg of dexamethasone, arterial blood pressure, hypertensive patients (77.08％ vs.79.49％), glucometabolic control parameters, diabetic or impaired glucose tolerance patients (35.42％ vs.33.33％), lipid profile, dyslipidemia patients (70.83％ vs.71.79％).Results The duration of follow-up was 9-54 months in operative group, and 5-57 months in control group,respectively.In the operative group, laboratory corticosteroid parameters normalized in all patients but not in the control group.In the operative group, blood pressure of hypertensive patients improved or normalized (22 of 48).On the contrary, in the control group, cure or improvement was not achieved among the patients with hypertension, whereas worse condition was observed in 5 patients (P =0.004).No significant difference was found in glycemic control and blood lipid change between the two groups.However, a decrease in triglyceridaemia and HbA1c was found in operative group compared with the control group (P =0.011 and P =0.017, respectively).Substitutive corticosteroid treatment was administered in 3 patients due to postoperative adrenal insufficiency during hospital stay, and the duration of treatment was 9 weeks, 10 weeks and 12 weeks, respectively.Conclusion Laparoscopic adrenalectomy could be performed for patients with SCS due to AI.

Objective To evaluate the biocompatibility of nano-hydroxyapatite/polyvinyl alcohol (n-HA/PVA ) hydrogel com-posite for keratoprosthesis .Methods There were four materials to be evaluated ,big-porous and small-porous n-HA/PVA hydrogel composite ,big-porous and small-porous PVA hydrogel .Every kind of materials was digested in F12 nutrient culture for 24 h to get the materials impregnant .Corneal fibroblasts were cultivated in materials impregnant and through methyl thiazolyl tetrazolium col-orimetry to assay the cytotoxicity .Rabbit corneal fibroblasts were seeded onto the four materials in vitro .Three days later the growth of fibroblasts were observed by inverted microscope and scanning electron microscope (SEM ) .Results The cytotoxicity scores of the materials with big-porous were both grade one .The mean corneal fibroblasts counts on culture were no obvious differ-ence between big-porous materials groups and control group under plate inverted microscope 72 hours later(P=0 .608) .Through scanning electron microscope 72 hours later ,corneal fibroblasts grew well on n-HA/PVA hydrogel composite ,and migrated into the porous of composite materials .The corneal fibroblasts on big-porous n-HA/PVA hydrogel composite were more obviously found than the other three materials(F=95 .245 ,P=0 .000) .Conclusion The porous n-HA/PVA hydrogel composite is a kind of good biocompatible material which has no cytotoxicity .The n-HA/PVA hydrogel composite with big porous would be an ideal pe-ripheral skirt of keratoprosthesis .

Objective:Analysis of the clinical characteristics and genetic mutations of ten tuberous sclerosis complex(TSC) families to provide support for clinical diagnosis of TSC.Methods:Retrospective analysis of ten TSC family probands and their members were performed with detailed medical history collection and physical examination. The study consisted of 26 patients in 10 TSC families, including 12 males and 14 females, with male to female ratio of 1∶1.17, and aged 7-65 years. In terms of skin lesions, there were 24 cases of facial angiofibromas, 20 cases of hypomelanotic macules, 16 cases of ungual fibromas, and 9 cases of shagreen patch. There were 12 cases of renal angiomyolipoma, 4 cases of subependymal nodules based on craniocerebral CT, and 1 case of lymphangioleiomyomatosis. Four cases had a history of seizures. Peripheral blood was extracted for next generation DNA sequencing.Results:A total of 23 TSC patients were genetically tested, and a total of 14 patients in 6 families were TSC2 mutations(5 frameshift mutations, 5 heterozygous deletions, and 4 nonsense mutations), a total of 4 patients in 2 families were TSC1 nonsense mutations, and no mutations were seen in the 2 families.Conclusions:A total of 10 TSC families were summarized, and the patients mainly had skin manifestations and kidney lesions.There were 18/23 patients having TSC1/2 mutations, of which TSC2 mutations accounting for 14/18. In the two non-mutant families, patients mainly had facial angiofibroma and/or hypomelanotic macules.

Objective To evaluate subclinical Cushing syndrome cases and to improve the diagnosis.Methods A retrospective analysis was done on the data of 24 subclinical Cushing syndrome cases.Clinical data included clinical manifestations,endocrinal tests,imaging,treatments,light microscopic and electron microscopic results.Results No typical sign of Cushing syndrome was found in these 24 cases.Endocrine tests showed that 24-hour urine free cortisol increased in 18 cases (75%),cortisol rhythm disappeared in 12 cases(50%),high-dose dexamethasone suppression test was not inhibited in 11 cases (46%),and low-dose dexamethasone suppression test (LDDST) was not suppressed in all 24 cases (100%).CT scan showed the average tumor diameter was 3.1(1.8-4.5)cm.Laparoscopic resections of adrenal tumors were performed for all 24 patients.The light microscopic examination of the tumor specimens showed adrenocortical adenoma,and the electron microscopic examination found a greater number of cytoplasmic secretory granules.After 3 months' followup,patient's blood pressure was normal and the normal cortisol rhythm was detected.Conclusions Endocrine tests,especially LDDST,are important for the diagnosis of subclinical Cushing syndrome.Once a clear diagnosis of subclinical Cushing syndrome is established,the patient should be treated with surgery and will have a satisfactory result in both blood pressure control and endocrinal rhythm.

Objective Improve understanding the clinical features of bladder varices with portal hypertension. Methods A 63-year-old male manifested seven episodes of painless gross hematuria and had a 9-year history of liver cirrhosis. Physical examination was unremarkable. There was thrombocytopenia of 56 × 109/L. Ultrasound showed splenomegaly. Cystoscopy revealed a 3. 0 cm × 5.0 cm sized hemangiomatous on the left lateral and anterior wall of the bladder. Computed tomography angiography revealed the vesical varicose veins flowing into the inferior mesenteric vein and then to the splenic vein. Results The patient was diagnosed vesical varices, liver cirrhosis and portal hypertension. Performed perivesical devascularization and in ultrasound one month after the operation the variees disappears. Conclusion Vesical varices can occur in liver cirrhosis and portal hypertension patients without history of abdominal and pelvic operation, and can be treated by perivesical devascularization.

Objective: To study the effect of Juglans Mandshuria on tumor cells. Methods : The apoptotic effect on the Hela、PC-3 of tumor cells was observed by agarose gel electrophoresis of DNA fragments. Results : It has directly cytotoxicity on tumor cells, LC 50 is about 9～15?g?mL -1 . Based on this, the inoculating trial on entity tumor in vivo administrated by hypodermic injection on mouse had the same effect as in vitro, the high-dose group (12mg?kg -1 ) can decrease the weight of tumor to 42.21%. Conclusion : Juglans Mandsshurica has the inhibition of tumor.

Objective: Tuberous sclerosis complex (TSC) is a multisystem genetic disorder caused by mutations in the TSC1 and TSC2 genes, but the molecular events contributing to TSC are not well understood.However, little is known about the role of microRNAs in TSC.To explore the microRNA differential expression profile between tuberous sclerosis complex cell line TSC2-/-MEFs and normal type cell line TSC2+/+ MEFs, and to provide new clues to study the mechanism of microRNA function in tuberous sclerosis complex.Methods: TSC2-/-MEFs and TSC2+/+ MEFs cell lines were cultured in vitro, each with three samples chosen as the experimental group and the control group respectively.Total RNA was isolated using TRizol and purified with RNeasy mini kit according to manufacturer''s instructions.RNA quality and quantity were measured by using nanodrop spectrophotometer and RNA integrity was determined by gel electrophoresis.Total RNAs were extracted by TRizol, followed by RNA quantification and quality control.MicroRNA profiles were analyzed by microarray and the threshold value used to screen up-regulated more than 2-fold change or down-regulated less than 0.5-fold change compared with controls.Real-time PCR was used to validate the reliability of microarray.Cell counting kit-8 (CCK-8) assay was performed to evaluate the proliferation.Results: Fourteen microRNAs, including miR-18a-5p, miR-376c-3p, miR-136-5p, miR-467c-5p, miR-467b-5p, miR-5104, miR-3098-3p, miR-30a-3p, miR-302b-3p, miR-18a-3p, miR-19b-1-5p, miR-19a-5p, miR-20a-5p, miR-155-5p, were up-regulated, while twenty-six microRNAs, including miR-200b-3p, miR-450a-1-3p, miR-542-5p, miR-199b-5p, miR-10a-5p, miR-466c-5p, miR-450a-5p, miR-450b-5p, miR-542-3p, miR-351-5p, miR-322-3p, miR-199a-3p, miR-335-5p, miR-10b-5p, miR-351-3p, miR-155-3p, miR-497a-5p, miR-503-5p, miR-148a-3p, miR-1843a-5p, miR-199a-5p, miR-490-5p, miR-450a-2-3p, miR-322-5p, miR-214-3p, miR-450b-3p, were down-regulated in tuberous sclerosis complex cell line TSC2-/-MEFs compared with normal type cell line TSC2+/+ MEFs (P<0.05).Real-time PCR confirmed the expressions of miR-136-5p, miR-30a-3p, miR-302b-3p, miR-10b-5p, miR-148a-3p, miR-199a-5p consistent with the microarray data (P<0.05).Furthermore, the overexpression of miR-199a-5p significantly inhibited cell proli-feration (P<0.05).Conclusion: There are differences in the expression of miRNA between the tube-rous sclerosis complex cell line TSC2-/-MEFs and normal cell line TSC2+/+ MEFs.MiRNA-199a-5p plays an important role in tuberous sclerosis complex, which may be developed as an important molecular target for the treatment of tuberous sclerosis complex.

Objective To discuss the value of preoperative transcatheter arterial embolization (TAE) in surgery for giant pheochromocytoma. Methods During the period of Jan 2000 to July 2010,six patients with giant pheochromocytoma underwent preoperative TAE in Peking Union Medical College Hospital.The medical records were reviewed retrospectively. Results The lesions were all solitary giant pheochromocytoma.In four casesthe pheochromocytoma was located in the aderenal gland the remaining two cases were paraganglioma.The tumor size ranged from 7 cm to 16 cm.And CTA showed the masses were well vascularized and fed by diverse arteries.All six patients underwent preoperative TAE successfully and surgical removal was successfully performed within 24 hours after embolization.No major complications occurred.After surgery no patient suffered recurrence and clinical symptoms were significantly improved. Conclusions Preoperative TAE is safe and effective for giant pheochromocytoma.Preoperative pharmacological management,gastrointestinal preparation and surgical remoral performed within 24 hours after embolization markedly reduced the complications related to embolization.TAE can help achieve hemodynamic stability during operation and is very helpful to a complete resection of giant pheochromocytomas.

Objective To assess the incidence,risk factors and mortality of acute kidney injury(AKI)in patients with chronic myelogeneous leukemia(CML)after myeloablative allogenetic hematopoietic stem cell transplantation(HSCT). Methods Renal function in 93 CML patients undergone myeloablative allo-HSCT was retrospectively analyzed by the RIFLE criteria. Results Thirty-nine patients (41.9%) developed AKI at a median of 40 days after allo-HSCT, including 24 AKI-R patients(25.8%), 10 AKI-I patients(10.8%) and 5 AKI-F patients (5.4%). The morbidity of AKI in patients with ≥Ⅲ acute graft-versus-host disease (aGVHD) and without ＜Ⅲ GVHD was (81.82±11.63)% and (36.59±5.32)% (P=0.0037)rospectively. The morbidity of AKI in patients with increased total bilirubin and without increased total bilirubin was (72.73±13.43)% and (37.04±5.37)%(P=0.0192) respectively. ≥Ⅲ aGVHD was peor-prognostic factor of AKI and RR was 2.773 [95%CI (1.073-7.167), P=0.035]. RR of AKI-I and AKI-F in patients with ≥Ⅲ aGVHD was 6.320195%CI (1.464-27.291), P=0.013]. The mortality within 100 days after allo-HSCT of patients with AKI was significantly different as compared to patients without AKI (P=0.001). Six-mouth survival rates of different class AKI patients after myeloablative allo-HSCT were (86.96±7.02)% (AKI-R), (70.00±14.49)% (AKI-I), 0 (AKI-F) (P=0.000)respectively. Conclusions AKI is one of the main complications in CML patients after myeloablative allo-HSCT. ≥Ⅲ aGVHD and increased total bilimbin are poor-prognostic factors of AKI, and higher morbidity of AKI-I and AKI-F can be found in patients with ≥Ⅲ aGVHD. With the deteriorated AKI, 6-month survival is decreased. RIFLE criteria is sensitive to the early diagnosis of renal function. Moreover RIFLE can monitor the progression of AKI and predict the clinical outcome.

Objective To analyze morbidity and prognosis of acute kidney injury (AKI) in patients with acute leukemia after myeloablative allogenetic hematopoietic stem cell transplantation (HSCT).Methods Renal function and related clinical data in 66 patients receiving myeloablative alloHSCT were retrospectively analyzed.Renal function was evaluated by RIFLE criteria,which defines AKI as three grades of severity-risk (AKI-R),injury (AKI-I) and failure (AKI-F).Results Thirtyseven recipients (56.1%) developed AKI at a median of 29 days after allo-HSCT,including AKI-R(19 recipients,28.8 %),AKI-I (11 recipients,16.7 %),AKI-F (7 recipients,10.6 %).Compared with baseline value,serum creatinine level in the recipients was significantly increased at the 21st day after transplantation (P＜0.05).During 100 days after HSCT,the morbidity of AKI-F in recipients with HVOD and without HVOD were respectively (55.56 ± 22.22)% and (9.01 ± 4.75)% (P＜0.01).The morbidity of AKI in recipients with or without increased total bilirubin was respectively (68.75 ± 24.54)% and (8.38 ± 4.17)% (P＜0.01).The morbidity of AKI in recipients with or without increased CsA concentration was respectively (66.67 ± 10.29) % and (44.44 ± 8.28) % (P＜0.05).100-day survival rate in recipients after myeloablative allo-HSCT without AKI,with AKI-R,AKI-I and AKI-F was respectively (89.66 ± 5.66) %,(83.88 ± 8.54) %,(81.82 ± 11.63) % and (42.86 ± 18.7) % (P＜0.05).Conclusion AKI is one of the main complications in patients with acute leukemia after myeloablative allo-HSCT.The influence of different class AKI on the mortality was different.The earlier diagnosis,prophylaxis and treatment of AKI by the RIFLF criteria might increase the survival rate in recipients with HSCT.