Objective To study the clinical characteristic of the central hyperthyroidism due to thyrotropin-secreting pituitary adenoma. Methods 5 patients with TSH-secreting pituitary adenoma (4 male and 1 female) among 1500 pituitary adenomas were summarize between 1992 and 2006, and clinical characteristics of the 5 patients were analyzed retrospectively. Results 5 patients represented 0.33% of all pituitary adenoma patients were seen during the same period. The mean age of the patients was 39.8 years old, and mean duration 5.84 years. All patients were presented with thyrotoxicosis. 3 patients were previously considered as suffering from primary hyperthyroidism and were treated with anti-thyroid drug for 6 to 16 years, and one of them subsequently underwent hypothyroid operation twice. None of them had visual field defect. Hyperthyroidism was determined in all patients by means of elevated total or free thyroid hormone levels while serum TSH levels varied between 3.94?54.7mU/L. TRH provoked an increase in serum TSH concentration greater than 30 mU/L from the baseline level in one patient, whereas no response was observed in two patients. MRI showed pituitary macroadenomas in four patients, while microadenomas in remaining patient. Four patients underwent transsphenoidal adenomectomy and followed by radio therapy in three patients. This resulted in normalization of all hormone parameters in all patients 1-2 weeks after operation. Conclusion Central hyperthyroidism due to thyrotropin-secreting pituitary adenoma should be considered in patients with elevated thyroid hormone and non-suppressed serum TSH level. Combined treatment (transsphenoidal adenomectomy and radiotherapy) is the choice for thyrotropin-secreting pituitary adenoma.

To investigate the clinical characteristics of hypertension in patients with primary aldosteronism (PA), 112 cases of PA confirmed by pathological examination after operation were studied retrospectively. These included 111 cases of PA with unilateral adrenal adenoma and 1 case of bilateral adrenal adenoma. Incidence of hypertension in patients with PA was 100%. 14 3%, 37 5% and 48 2% of patients were at stage 1, 2 and 3 of hypertension, respectively. No relationship between hypertension and the age or duration of hypertension and the size of tumor. Complications of hypertension were found in 31 3% of patients with PA. Stroke was found in 4 5% patients, 3 6% patients with cerebral hemorrhage and 0 9% patients with cerebral infarction. Coronary artery disease as myocardial infarction was found in 1 8% of patients. Proteinuria and renal insufficiency were found in 22 3% of patients and 2 7% of patients, respectively. Complications of hypertension were independent of the age, duration of hypertension, the size of tumor, or preoperative highest systolic pressure and diastolic pressure. 83 9% of patients had taken antihypertensive drugs before operation, and 46 5% of patients still had persistent hypertension after operation. The results suggested that the incidence of hypertension in patients with PA was extremely high, and the majority of patients were suffering from moderate and severe hypertension. Complications of hypertension were common in patients with PA. Hypertension was difficult to control by using antihypertensive drugs before operation, and still persisted after operation in some of the patients with PA.

Objective To evaluate the clinical feature of the aldosterone-producing adenoma(APA) and idiopathic hyperaldosteronism(IHA)in primary hyperaldosteronism.Methods Retrospectively analyzed clinical feaures of 76 patients with APA and 17 patients with IHA.Results (1)Compared with the patients with IHA,the patients with APA had higher plasma and urinary aldosterone,lower serum potassium.(2)Furosemide provocation test(FPT)in 48 patients with APA and 14 patients with IHA were carried out.It was found that the plasma aldosterone after FPT was increased or no changed in 27 patients with adenoma,and increased in the others.It was increased in all IHA patients.(3)The diagnostic accuracy rate of CT was 84.2% in 88 patients with computed tomography imaging(CT).Conclusion The anomalies of laboratory in patients with APA are more evidence than those of IHA.The results of FPT are overlapped in a considerable amount of APA and IHA.Now those with elevation of serum aldosterone after the FPT can not exclude the adenoma.The diagnostic accuracy rate can be improved according to FPT and CT.

Objective To analyze the clinical characteristics of familial adrenocorticotropin-independent macronodular adrenal hyperplasia (AIMAH). Methods The clinical and laboratory data of 3 patients with familial AIMAH were retrospectively analyzed. Results Case 1 was the proband. The mean age of onset of familial AIMAH was 59.3 years, and mean duration of disease was 6.7 years. The plasma ACTH levels of case 1 and case 2 were below 2.2pmol/L, and the secretion rhythm of serum cortisol in them was disorderly. Low or high dose of dexamethasone failed to suppress cortisol secretion in case 1, while only low dose of dexamethasone failed to suppress cortisol secretion in case 2. In case 3, all the plasma cortisol, ACTH level and their secretion rhythm were normal, and either low or high dose of dexamethasone suppressed cortisol secretion successfully. Ultrasound examination revealed multiple hypoechoic nodules in both adrenal glands, and CT scanning showed bilateral macronodular adrenal hyperplasia in all 3 cases. Pituitary MR imaging was normal in all 3 cases. Conclusions The pathogenesis of sporadic and familial AIMAH remains unclear. Familial AIMAH provides an evidence that genetic transmission of the disease may happen. The clinical characteristics of familial AIMAH are similar to those of sporadic AIMAH. It is possible that some subclinical cases among familial AIMAH ascape the diagnosis.

BACKGROUND:Theoreticaly, lumbar semi-rigid fixation can slow down the degeneration of adjacent segments, but there is stil a lack of biomechanical support. OBJECTIVE:To explore the biomechanical effect of semi-rigid fixation system, taking Isobar TTL for instance, on adjacent segment disc by means of finite element analysis. METHODS: The finite element models of USS and Isobar TTL were constructed by putting respective parameters into a validated L2-S5 lumbar model. The angular displacement and von Mises stress of adjacent segments were recorded when the models were subjected to 400 N preload and 7.5 N?m moment of forces under different conditions: flexion, extension, lateral bending and axial rotation. RESULTS AND CONCLUSION:The angular displacement and inter-vertebral disc stress of adjacent segments in the USS and Isobar TTL models were higher than those of an intact state in every condition. But the values in Isobar TTL model were lower than the USS model in varying degrees. Compared with the USS model, the decrease rates of angular displacement in Isobar TTL model for flexion, extension, left bending, right bending, left axial rotation and right axial rotation were 19.2%, 15.1%, 11.1%, 12.2%, 18.4% and 22.1%, respectively. The decrease rates of von Mises stress were 33.0%, 20.2%, 23.9%, 18.6%, 28.8% and 28.0%, respectively. The results suggested that the Isobar TTL, when compared with the USS, partialy reduced the angular displacement and inter-vertebral disc stress of adjacent segments.

Objective:To prepare the immunoglobulin Y(IgY) against Avain Influenza Virus (H5N1) and to investgate its inhibitory activity to Influenza virus A (FM1).Methods:Iimmunized by Avain Influenza vaccine,IgY against Avain Influenza Virus was purified from the yolk and then the antibody was enriched by the means:caprylate acid-two-step salt precipitation-gel chromatograph.TD0 of IgY and the inhibory effectiveness were showed by nhibiting cytopathic effect (CPE) thst in MDCK infected with Influenza virus A(FM1).Results:IgY against Avain Influenza Virus was obtained.The TD0 value of IgY against Avain Influenza to MDCK cell line was 1.764 mg/ml,while at the dosage as low as 0.082 8 mg/ml the lnfluenza virus A(FM1) was still inhibited in vitro.Connchusion:Caprylate acid-two-step salt precipitation-gel chromatograph can prepare IgY successfully and the inhibitory effectiveness of IgY is good for inhibition of Influenza virus A(FM1).

Objective To discuss the diagnostic paradigm of non-Hodgkin lymphoma with bilateral adrenal gland and pituitary involvement.Methods Clinical features of one patient with non-Hodgkin lymphoma with bilateral adrenal gland and pituitary involvement,manifesting fever of undetermined origin and refractory hyponatremia,were analyzed retrospectively.The related literature was reviewed,and experience in diagnosis of non-Hodgkin lymphoma with bilateral adrenal gland and pituitary involvement was summarized.Results Clinical manifestations of the patient was nonspecific,and there was definite evidence to support the diagnosis of infectious and autoimmune diseases.However,the abnormal elevation of serum lactate dehydrogenase(LDH)and ?2 microglobulin,which were suggestive of the diagnosis of lymphoma.The diagnosis of non-Hodgkin lymphoma with bilateral adrenal gland involvement was finally established by adrenal gland biopsy under CT.On the other hand,the endocrine evaluation indicated there was pituitarism even though the lesion was not obvious on the MRI image.However,18F fluorodeoxyglucose-positron emission tomography-computed tomography(18F-FDG PET-CT)clearly showed lesions in pituitary,liver and lymph node of neck.With supplementation of hydrocortisone,sodium the serum level gradually elevated to above the normal range,and the lesions in pituitary and adrenal glands disappeared after three courses of CHOP chemotherapy.The functions of pituitary and adrenal gland recovered 3 months later.Conclusions Non-Hodgkin lymphoma with bilateral adrenal gland and pituitary involvement is a rare disease.Early diagnosis relies on the logical clinical evaluation and 18F-FDG PET-CT image.

Objective To explore the diagnostic value of sympathetic skin response ( SSR) and P300 event-related potentials (ERP) in depression patients. Methods The SSRs and ERPs of 46 depressed patients and 42 normal healthy people were measured. Results Abnormal rates of SSR were observed in 84. 8% of the depressed group (39/46) and 78.3% (36/46) of the controls. Compared with those in the control group, the latency and amplitude of the SSRs were significantly longer and lower in the depressed group. Abnormal ERPs were observed in 89. 1% of the depressed group(41/46) compared with 78. 3% of the controls (36/46). The latency of N2 and P3 and the amplitude of P3 in the ERPs of the depressed patients were longer and lower in comparison with those in the control group. Hence there was a significant difference between two groups. There was a high positive correlation between N2 and P3 latency in the ERPs and the SSR readings in the depressed group, and between amplitude of P3 and SSR, while there was a significant negative correlation between latency and amplitude in the two indexes of P300 and SSR in the depressed group. Conclusion SSR and ERP have remarkable clinical value as diagnostic indexes for depres-

Objective To compare the effects of different doses of FTY720 on inhibiting expression of Caspase-3 and neural apoptosisin rats with acute spinal cord injury (SCI), and find out the suitable dose. Methods 200 female SD rats were randomly divided into 5 groupswith 40 in each group. Group A (laminectomy but not contusion) were administered 0.3 ml normal saline by gavage. SCI model was establishedby Allen's WD method at the T9 level of spinal cord in other groups. Group B were administered 0.3 ml normal saline after modeling.Groups C, D and E were administered 0.3 ml FTY720- saline solution of 1, 3 and 5 mg/kg respectively. All the groups were sacrificed at 6 h,12 h, 24 h, 48 h, 72 h (n=8, per each time-point). Caspase-3 expression was detected with streptavidin-peroxidase immunohistochemistry,and neural apoptosis was detected with the TUNEL method. Results Positive Caspase-3 expression and neural apoptosis were not observedin Group A at 6 h. In Groups B、C、D and E, the number of apoptotic cells increased with increased time of acute SCI, peaked at 24 h afterinjury, and then gradually reduced. Caspase-3 expression was at equal pace with neural apoptosis. The difference of the number of apoptoticand Caspase-3 expression cells among all groups were significant, with the order Group B>Group C>Group D>Group A (P<0.05). However,there was no significant difference between Group D and Group E (P>0.05). The number of apoptotic and Caspase-3 expression cells negativelycorrelated with the dose of FTY720 when the dose was less than 3 mg/kg (P<0.05), and there was no relationship when the dose wasmore than 3 mg/kg (P>0.05). Conclusion FTY720 significantly reduces Caspase-3 expression and neural apoptosis in rats with acute SCI.There is a dose-effect relationship between the dose of FTY720 and the Caspase-3 expression and neural apoptosis. It's indicated that 3 mg/kg is the most appropriate dosage.

Objective Adipsic hypernatremia is very rare in clinical practice and only a few cases have been reported so far. Since the pathogenesis of adipsic hypernatremia is unclear, therapeutic method is very limited and uncertain. We previously found the existence of partial central diabetes insipidus in the patient with adipsic hypernatremia according to a series of clinical studies. In this clinical study, we observed the response of vasopressin in the treatment of adipsic hypernatremia as a routinely used agent in treating central diabetes insipidus.Methods Five patients with chronic sustained hypernatremia and hypodipsia were diagnosed as adipsic hypernatremia according to the criteria by Halter. After testing plasma electrolytes, urinary osmolality, plasma osmolality, and free water clearance (CH2O);with evaluating thirsty grade and anterior pituitary function, patients were forced to drink water 2 000-2 500 ml each day combined with prednisone and/or levethyroxin supplementation therapy if hypopituitarsm was revealed. One week later, since the hypernatremia was unrelieved, desmopressin acetate (0.05-0.2 mg/d)was administered to those 5 patients. About 5-7 days later, plasma electrolytes, urinary and plasma osmolality, and free water clearance ( CH2O ) were reevaluated. Osmolality was detected by the method of freezing point depression and thirst grade by the method of visual analogue scales. Results The plasma sodium was 160-190 mmol/L and plasma osmolality was 330-370 mmoL/L without thirsty perception during the hospitalization. Four of the five patients were revealed to be suffering from hypopituitarism, but the hypernatremia could not be corrected by intentional water intake combined with prednisone treatment. After administering vasopressin 0.05-0.2 mg/d to these patients, that hypernatremia was relieved, and hyperosmolality and hypodypsia were improved effectively. During this period of time, no side effects were detected in these patients. Conclusion We testified the existence of central partial diabetes insipidus in the patients with adipsic hypernatremia. Desmopressin acetate in the treatment of adipsic hypernatremia is proved to be effective, simple, and safe.