Objective:To investigate the value of 24 h urinary aldosterone(24 h-UAC) measurement by liquid chromatography-tandem mass spectrometry(LC-MS/MS) in the subtype classification of primary aldosteronism(PA).Methods:A total of 86 patients with PA, including 51 with unilateral primary aldosteronism(UPA) and 35 with bilateral primary aldosteronism(BPA), were enrolled in the Department of Endocrinology and Metabolism at West China Hospital between January 2018 and December 2022. Plasma aldosterone concentration(PAC), plasma renin concentration(PRC) and 24 h-UAC were measured by LC-MS/MS. 24-hour urinary electrolytes and 24-hour urinary creatinine(24 h-UCR) were also measured. The diagnostic value of 24 h-UAC in PA subtype classification was evaluated using receiver operating characteristic(ROC) curve analysis. Multivariate logistic regression analysis was conducted with PA subtypes as the dependent variable(UPA=1, BPA=0) to establish a diagnostic model for differentiating unilateral from bilateral lesions, and its performance was compared with published Chinese classification models. Results:There were no statistical differences between the UPA and BPA groups in terms of age, gender, BMI, systolic and diastolic blood pressure, 24 h urinary potassium, sodium, chloride, 24 h-UCR and PRC( P<0.05). The lowest plasma potassium level was significantly lower in the UPA group than in the BPA group, while PAC, 24 h-UAC, aldosterone-renin ratio(ARR), and 24 h-UAC/UCR were significantly higher( P<0.05). The detection rate of typical adenomas on imaging also showed a significant difference between the two groups( P<0.05). The area under the ROC curve(AUC) of 24 h-UAC for differentiating UPA from BPA was 0.829(95% CI 0.733-0.902), with an optimal cut-off value of 15.4 μg/24 h, yielding a sensitivity of 68.63% and a specificity of 88.57%( P<0.001). At a cut-off value of 24.5 μg/24 h, specificity reached 100%, with a sensitivity of 27.45%. Multivariate analysis indicated that a combined model incorporating 24 h-UAC, the lowest plasma potassium level, and imaging findings of typical adenomas significantly improved diagnostic accuracy for PA subtyping, achieving a specificity of 91.43%. Compared with the existing Chinese modified Küpers scoring model and CONPASS prediction model, this model demonstrated higher diagnostic efficiency, a lower missed diagnosis rate, and a misdiagnosis rate intermediate between the two. Conclusion:The 24 h-UAC in UPA patients is significantly higher than in BPA patients, making it a valuable marker for PA subtype classification. A predictive model combining 24 h-UAC, the lowest plasma potassium level, and imaging evidence of typical adenomas demonstrated high diagnostic accuracy for PA subtype classification and may provide valuable guidance for clinical decision-making.

Objective:To analyze the characteristics of cardiovascular and cerebrovascular diseases in patients with primary aldosteronism (PA) and compare them with age-, sex-, and blood pressure-matched patients with essential hypertension (EH).Methods:This cross-sectional study was conducted at the West China Hospital of Sichuan University. Patients with PA and EH between December 2018 and December 2021 were included. Demographic characteristics, stroke events, coronary artery diseases, peripheral vascular diseases, and cardiac structure and function indicators were analyzed. Propensity score matching (PSM) was used to balance non-study data. The t-test, chi-square test, and Wilcoxon signed-rank test were used for data comparison. The cardiovascular and cerebrovascular damage in the patients with unilateral and bilateral PA were also compared. Results:A total of 336 and 369 patients with PA and EH, respectively, were enrolled in this study. One hundred and ninety-eight patients from each group were included after PSM; no significant differences were found in terms of age, gender, and blood pressure. The prevalence of stroke in the PA group was considerably higher than that in the EH group [12.6% (25/198) vs. 5.6% (11/198), P=0.014], due to the significantly greater risk of ischemic stroke [10.0% (20/198) vs. 4.5% (9/198), P=0.029]. The prevalence of hemorrhagic stroke, coronary artery disease, peripheral arterial stenosis, aorta atherosclerosis, and aneurysm in the PA group were also higher than those in the EH group, but there was no statistical significance (all P>0.05). More patients with PA had concurrent left ventricular hypertrophy [22.2% (44/198) vs. 9.1% (18/198)], left atrial enlargement [40.4% (80/198) vs. 30.3% (60/198)], ventricular septal thickening [50.0% (99/198) vs. 36.9% (73/198)], and aortic widening [21.7% (43/198) vs. 13.1% (26/198)] than those with EH (all P<0.05). Compared with the bilateral PA group, the unilateral PA group had higher prevalence of left ventricular hypertrophy [28.3% (51/180) vs. 13.4% (11/82), P=0.013]. Conclusions:Compared with well-matched patients with EH, patients with PA have significantly higher risks of cardiovascular and cerebrovascular diseases, which are mainly manifested in increased prevalence of stroke and severe damage to the cardiac structure. Patients with unilateral PA may suffer more severe cardiac damage than those with bilateral PA.

Objective:To analyze the characteristics of cardiovascular and cerebrovascular diseases in patients with primary aldosteronism (PA) and compare them with age-, sex-, and blood pressure-matched patients with essential hypertension (EH).Methods:This cross-sectional study was conducted at the West China Hospital of Sichuan University. Patients with PA and EH between December 2018 and December 2021 were included. Demographic characteristics, stroke events, coronary artery diseases, peripheral vascular diseases, and cardiac structure and function indicators were analyzed. Propensity score matching (PSM) was used to balance non-study data. The t-test, chi-square test, and Wilcoxon signed-rank test were used for data comparison. The cardiovascular and cerebrovascular damage in the patients with unilateral and bilateral PA were also compared. Results:A total of 336 and 369 patients with PA and EH, respectively, were enrolled in this study. One hundred and ninety-eight patients from each group were included after PSM; no significant differences were found in terms of age, gender, and blood pressure. The prevalence of stroke in the PA group was considerably higher than that in the EH group [12.6% (25/198) vs. 5.6% (11/198), P=0.014], due to the significantly greater risk of ischemic stroke [10.0% (20/198) vs. 4.5% (9/198), P=0.029]. The prevalence of hemorrhagic stroke, coronary artery disease, peripheral arterial stenosis, aorta atherosclerosis, and aneurysm in the PA group were also higher than those in the EH group, but there was no statistical significance (all P>0.05). More patients with PA had concurrent left ventricular hypertrophy [22.2% (44/198) vs. 9.1% (18/198)], left atrial enlargement [40.4% (80/198) vs. 30.3% (60/198)], ventricular septal thickening [50.0% (99/198) vs. 36.9% (73/198)], and aortic widening [21.7% (43/198) vs. 13.1% (26/198)] than those with EH (all P<0.05). Compared with the bilateral PA group, the unilateral PA group had higher prevalence of left ventricular hypertrophy [28.3% (51/180) vs. 13.4% (11/82), P=0.013]. Conclusions:Compared with well-matched patients with EH, patients with PA have significantly higher risks of cardiovascular and cerebrovascular diseases, which are mainly manifested in increased prevalence of stroke and severe damage to the cardiac structure. Patients with unilateral PA may suffer more severe cardiac damage than those with bilateral PA.

Alzheimer's disease(AD)is mainly characterised by irreversible progressive cognitive dysfunction,which is complex in its pathogenesis and difficult to cure,and seriously affects the quality of life of patients.MicroRNA(miRNA)is a type of small non-coding RNA with high targeting specificity and potential for multi-pathway regulation.This paper takes miRNA as the entry point to systematically elaborate the mechanism of action of traditional Chinese medicine intervening in AD by regulating miRNA.The results revealed that the active ingredients of traditional Chinese medicine(e.g.notoginsenoside R1,salidroside,catalpol,madecassoside,baicalin,dihydromyricetin,osthole,berberine,ursolic acid,parthenolide,thymoquinone,plumbagin),the extracts of traditional Chinese medicine(e.g.,Ganoderma extract and Ginkgo biloba leaf extract),and the compound formulas of traditional Chinese medicine(e.g.,Dihuang yinzi decoction,modified Shuyu pill,and Anshen dingzhi formula)can regulate miRNA to reduce the production and deposition of β-amyloid protein,inhibit the over-phosphorylation of τ protein,and inhibit the neuroinflammatory response and programmed neuronal death by regulating miRNA,thus playing a role in intervening in AD.

Objective:To investigate the value of 24 h urinary aldosterone(24 h-UAC) measurement by liquid chromatography-tandem mass spectrometry(LC-MS/MS) in the subtype classification of primary aldosteronism(PA).Methods:A total of 86 patients with PA, including 51 with unilateral primary aldosteronism(UPA) and 35 with bilateral primary aldosteronism(BPA), were enrolled in the Department of Endocrinology and Metabolism at West China Hospital between January 2018 and December 2022. Plasma aldosterone concentration(PAC), plasma renin concentration(PRC) and 24 h-UAC were measured by LC-MS/MS. 24-hour urinary electrolytes and 24-hour urinary creatinine(24 h-UCR) were also measured. The diagnostic value of 24 h-UAC in PA subtype classification was evaluated using receiver operating characteristic(ROC) curve analysis. Multivariate logistic regression analysis was conducted with PA subtypes as the dependent variable(UPA=1, BPA=0) to establish a diagnostic model for differentiating unilateral from bilateral lesions, and its performance was compared with published Chinese classification models. Results:There were no statistical differences between the UPA and BPA groups in terms of age, gender, BMI, systolic and diastolic blood pressure, 24 h urinary potassium, sodium, chloride, 24 h-UCR and PRC( P<0.05). The lowest plasma potassium level was significantly lower in the UPA group than in the BPA group, while PAC, 24 h-UAC, aldosterone-renin ratio(ARR), and 24 h-UAC/UCR were significantly higher( P<0.05). The detection rate of typical adenomas on imaging also showed a significant difference between the two groups( P<0.05). The area under the ROC curve(AUC) of 24 h-UAC for differentiating UPA from BPA was 0.829(95% CI 0.733-0.902), with an optimal cut-off value of 15.4 μg/24 h, yielding a sensitivity of 68.63% and a specificity of 88.57%( P<0.001). At a cut-off value of 24.5 μg/24 h, specificity reached 100%, with a sensitivity of 27.45%. Multivariate analysis indicated that a combined model incorporating 24 h-UAC, the lowest plasma potassium level, and imaging findings of typical adenomas significantly improved diagnostic accuracy for PA subtyping, achieving a specificity of 91.43%. Compared with the existing Chinese modified Küpers scoring model and CONPASS prediction model, this model demonstrated higher diagnostic efficiency, a lower missed diagnosis rate, and a misdiagnosis rate intermediate between the two. Conclusion:The 24 h-UAC in UPA patients is significantly higher than in BPA patients, making it a valuable marker for PA subtype classification. A predictive model combining 24 h-UAC, the lowest plasma potassium level, and imaging evidence of typical adenomas demonstrated high diagnostic accuracy for PA subtype classification and may provide valuable guidance for clinical decision-making.

Objective:To analyze the clinical characteristics, etiological composition, imaging features, and prognosis of adrenal metastases.Methods:This study is a retrospective case series that included 96 patients with pathologically confirmed adrenal metastases who were treated at West China Hospital, Sichuan University, from 2007 to 2017. Clinical features such as sex, age, tumor size, biochemical tests, imaging characteristics, postoperative pathology, treatment methods, and prognosis were collected and analyzed. The prognosis of patients and its influencing factors were analyzed by Kaplan-Meier survival curve and single-factor Cox risk proportional model.Results:Among the 96 included patients, 64 were male and 32 were female, with a median age of 60 years. There were 89 cases of unilateral adrenal metastases, five cases of bilateral metastases, and two cases with unspecified laterality. The median diameter of the metastases was 3.5 cm×2.9 cm, with an average CT value of 31 HU. Thirty-four cases of adrenal hormones were evaluated, and no abnormality was found.The primary tumor sites were as follows: lung ( n=36), kidney ( n=19), liver ( n=12), pancreas ( n=7), rectum ( n=3), stomach ( n=2), and one case each of tumor in the esophagus, skin, thyroid, left maxillary muscle, breast, bladder, cervix, chest wall, and gastrointestinal tract. There were three cases with unknown primary tumors. The most common pathological type was lung adenocarcinoma (20.8%, 20/96), followed by hepatocellular carcinoma (9.4%, 9/96) and high-grade invasive urothelial carcinoma of the kidney (8.3%, 8/96). Thirty-nine cases were diagnosed concurrently with the primary tumor, while 37 cases were diagnosed after the primary tumor, with a median interval of 15 months (range: 2-144 months). There was no significant correlation between the death risk of adrenal metastatic tumor patients and gender, age, and the size of the metastatic tumor (all P>0.05). There were 4 patients with radiotherapy and chemotherapy alone, 19 patients with surgery alone, and 6 patients with combined radiotherapy and chemotherapy. The median overall survival was 1, 3, and 7 years, respectively. Conclusions:Adrenal metastases were mostly diagnosed at the same time as the primary tumor or within 15 months after the diagnosis of the primary tumor. Unilateral metastasis is common. The lungs are the most common primary lesion, followed by the kidney and liver. CT is the preferred method for the diagnosis of adrenal metastases, and the plain CT value is more than 30 HU. The overall prognosis of adrenal metastases is poor. The prognosis was better for patients who underwent surgery combined with radiotherapy and chemotherapy than those who received only surgery or radiotherapy and chemotherapy alone.

Objective To investigate the metabolic outcomes of primary aldosteronism(PA)patients receiving adrenalectomy(ADX)or spironolactone treatment and the contributing factors to the metabolic outcomes.Methods The clinical data of 70 patients with aldosterone-producing adenoma(APA)and 86 patients with idiopathic hyperaldosteronism(IHA)were retrospectively analyzed.All subjects received confirmatory diagnosis of APA or IHA at the Department of Endocrinology and Metabolism,West China Hospital between March 2018 and October 2020.APA patients underwent ADX,while IHA patients were given spironolactone,a mineralocorticoid receptor antagonist(MRA).After ADX or spironolactone treatment,the outcomes of the metabolic indicators and the inter-group differences between the APA patients and IHA patients were studied.Results There was no significant difference between the baseline data of the APA group and those of the IHA group in terms of age,sex,duration of hypertension,maximum systolic blood pressure(SBP-max),maximum diastolic blood pressure(DBP-max),body mass index(BMI),fasting blood glucose(FBG),lipid parameters,and renal function.IHA patients had higher waist circumference,serum potassium,and plasma renin activity(PRA)than those of the APA patients(all P＜0.05).All patients showed significant improvement in blood pressure,blood potassium,and plasma aldosterone at follow-up.However,they also showed increased triglycerides(TG)accompanied by deterioration in renal function(P≤0.001).Multiple regression showed that TG levels were associated with spironolactone treatment for IHA patients and post-treatment BMI and creatinine levels.Furthermore,APA patients showed improvement in their FBG after ADX(P=0.041),while IHA patients showed elevated levels of FBG after spironolactone treatment(P=0.037).Conclusion After treatment,PA patients still may experience abnormal lipid metabolism and deteriorating renal function.Spironolactone therapy may give rise to worse glucolipid metabolism than ADX therapy does.

Radiomics and radiogenomics are used to provide comprehensive tumor biological characte-ristics and further clinical information by extracting,screening and analyzing the most valuable quantitative ra-diomics features. In recent years,numerous studies have shown that radiomics plays a role in the diagnosis, treatment and predicting efficacy and prognosis of lung cancer. Radiogenomics shows a great value in the pre-diction of lung cancer gene phenotype and individualized precision treatment by combining radiomics features with genomics,proteomics and so on. Radiomics and radiogenomics are non-invasive,quantitative,and repro-ducible,and they can provide multidirectional tumor biological characteristics,which are expected to be widely used in the precise medical treatment of lung cancer in the future.

Objective The purpose of this study was to provide efficient evidence to the treatment and nursing for patients with colorectal cancer after colostomy surgery by conducting a quality of life survey on the patients. Methods The WHOQOL-BREF scale was distributed to 103 patients after colostomy surgery in the Tumor Hospital of Yunnan Province. Results The average score of these patients was 23.45±9.92,with the highest score of 29, the lowest score of 13. In terms of quality of life in the physiological field and psychological field, there was a significant difference between the high self-efficacy ability and low self-efficacy ability ( <0.05) .In terms of quality of life in the social field and environment field, there was no significant difference between the high self-efficacy ability and low self-efficacy ability (>0.05). Conclusion The patients’familiarity with stomas was closely related to the quality of life, which indicated that the quality of life could be improved by improving the patient's familiarity with stoma care.It is necessary to know the condition of colostomy care in different postoperative stages and provide efficient support and help for the patients.

Objective A multicenter, randomized, controlled and open-labled clinical trial was performed to compare the efficacy and safety of recombinant human insulin injection ( Yousilin R) and treated with Yousilin R versus Novolin R for 12 weeks respectively. Results Compared with baseline,the levels of glycosylated hemoglobin A1c ( HbA1c ) at the end of 12 weeks treatment decreased from 10. 77% to 7. 72% ( P ＜0. 05 ) in Yousilin R group and from 10. 33% to 7. 62% ( P ＜0. 05 ) in Novolin R group,2-hour postprandial plasma glucose ( 2hPG ) decreased from 15.49 mmol/L to 9. 72 mmol/L ( P ＜ 0. 05 ) in Yousilin R group and from 15.33 mmol/L to 10. 07 mmol/L( P ＜ 0. 05 ) in Novolin R group, and fasting plasma glucose (FPG) decreased from 10. 90 mmol/L to 7. 31 mmol/L( P ＜0. 05 ) in Yousilin R group and from 10. 22 mmol/L to 7.21 mmol/L (P ＜0. 05) in Novolin R group. The changes of HbA1c, 2hPG and FPG from baseline to endpoint in Yousilin R group was similar to those in Novolin R group ( P ＞ 0. 05 ).Furthermore, hypoglycemic events(26. 42% vs 30. 48% ), other adverse events( 13.21%vs 16. 19% ) ,and serious adverse events( 1.89%vs 1.90% )were comparable between Yousilin R and Novolin R groups(P ＞0. 05 ). Conclusions Yousilin R has similar efficacy, safety and compliance profiles to Novolin R group in the treatment of diabetic patients.