1.Activation of the Gamma-Aminobutyric Acid (GABA)ergic Neural Circuit in Salicylate-Induced Tinnitus: the Inferior Colliculus to the Medial Geniculate Body
Xu-Yuan PENG ; Jiang WANG ; Ming-Yue GONG ; Li-Yuan ZHANG ; Min ZHANG ; Zhi-Bin CHEN ; Zheng-Quan TANG ; Lei CHENG
Clinical and Experimental Otorhinolaryngology 2026;19(1):55-69
Objectives:
. This study aimed to investigate the regulatory functions of gamma-aminobutyric acid (GABA)ergic neural circuits from the inferior colliculus (IC) to the medial geniculate body (MGB) in salicylate-induced tinnitus.
Methods:
. Mice were treated with salicylate to induce tinnitus, and tinnitus-like behaviors were evaluated via gap prepulse inhibition of acoustic startle. Using combined viral tracing methodologies, we identified and mapped the pathways and connections from the IC to the MGB. Furthermore, we employed Gq-coupled human M3 designer receptors exclusively activated by designer drugs (DREADDs) and Gi-coupled human M4 DREADDs to achieve targeted excitation or suppression of GABAergic neurons in the IC and MGB. Following the administration of clozapine N-oxide, which binds to these receptors, we modulated these neural circuits to assess their impact on tinnitus severity in a mouse model.
Results:
. Our findings demonstrated that mice exposed to salicylate exhibited tinnitus-like behaviors. GABAergic neurons projecting retrogradely from the MGB to the IC were primarily concentrated in the external nucleus of the IC. After clozapine N-oxide administration, chemogenetic activation of IC-MGB GABAergic neurons aggravated salicylate-induced tinnitus. Additionally, activation of GABAergic neurons between the IC and MGB induced the perception of tinnitus even without salicylate. However, chemogenetic inhibition of the IC-MGB GABAergic circuit did not reverse salicylate-induced tinnitus.
Conclusion
. These findings suggest that activation of the IC-MGB GABAergic neural circuit may contribute to tinnitus generation through a mechanism distinct from that of salicylate-induced tinnitus. This study provides novel insights into the mechanisms underlying tinnitus.
2.Mediating effect of coping styles in the relationship between psychological resilience and somatic symptoms among Chinese medical team members
Jiayong CHEN ; Yu CHENG ; Guanyang ZOU ; Ming LI
China Occupational Medicine 2026;53(2):150-154
Objective To analyze the mediating role of coping styles on the relationship between psychological resilience and somatic symptoms in Chinese medical team members. Methods A total of 267 members from 24 Chinese medical teams were recruited as the study subjects using a convenience sampling method. The 10-item Connor Davidson Resilience Scale, the Simplified Coping Style Questionnaire, and the modified Somatic Symptom Scale developed by the research team were used to assess their psychological resilience, coping styles, and somatic symptoms. Structural equation modeling was applied to analyze the relationships among the variables and their mediating effects. Results The average scores for psychological resilience, positive coping, and negative coping among the study subjects were (30.4±5.9), (28.6±5.6), and (12.3±4.7) points, respectively. The median and the 25th and 75th percentiles of somatic symptom score were 4.0 (1.0-8.0) points. Somatic symptom scores were negatively correlated with psychological resilience and positive coping scores [Spearman correlation coefficients (rS) were -0.396 and -0.367, respectively, both P<0.01], and positively correlated with negative coping scores (rS=0.260, P<0.01). Structural equation modeling analysis revealed that the psychological resilience did not directly affect somatic symptoms [95% confidence interval (CI): -0.359 to 0.000]. Psychological resilience indirectly affected somatic symptoms through positive and negative coping, with a total indirect effect with 95% CI of -0.381 to -0.114. Positive coping and negative coping accounted for 83.7% and 16.3%, respectively, of the total indirect effect. Conclusion The coping styles play multiple parallel mediating roles between psychological resilience and somatic symptoms of Chinese medical team members. Improving psychological resilience and coping ability can help alleviate somatic symptoms and promote the mental health of Chinese medical team members.
3.Pathogenesis and Syndrome-Differentiated Treatment of Viral Pneumonia in the Lancang-Mekong River Basin from the Perspective of Filthy Dampness as the Affliction and Yang Failing to Be Stored in the You (酉) Position
Shiwen LUO ; Ming CHENG ; Kun LI ; Maorong FAN ; Zijun ZHANG ; Ying LIU ; Yuyang YANG
Journal of Traditional Chinese Medicine 2026;67(21):2354-2358
Viral pneumonia in the Lancang-Mekong River Basin exhibits distinct regional epidemiological characteristics and pathogenic mechanisms. Filthy dampness constitutes the core pathogenic factor of the disease here, and the core pathogenesis lies in the yang failing to be stored in the you (酉) position. Clinically, the fundamental therapeutic principle is established as boosting qi to expel filth and guiding yang qi to descend and converge into the you position. In the early stage, the pathogenesis is characterized by the pervasive diffusion of filthy dampness, yang qi floating externally and failing to be stored, and the lung failing to diffuse qi. The treatment focuses on invigorating yang qi to dispel filth and dredging the you pathways, primarily using modified Ganlu Xiaodu Decoction (甘露消毒丹). In the progressive stage, the pathogenesis involves the tenacious stagnation of filthy dampness, yang constraint transforming into heat, and the rampant spread of heat-toxins. The therapeutic approach shifts to acrid medicinals for opening and bitter medicinals for promoting descent, rectifying healthy qi to expel filth, utilizing modified Dayuan Beverage (达原饮). In the recovery stage, filthy dampness gradually recedes, accompanied by the depletion of qi and yin, and insufficient kidney yang. The treatment emphasizes supplementing qi and nourishing yin, accompanied by warming yang, with modified Yunv Decoction (玉女煎).
4.Effect of Qihuang Jianpi Zishen Granules for Treat-to-target on Renal Podocyte Injury Markers in Patients with Systemic Lupus Erythematosus
Junjie CHEN ; Chuanbing HUANG ; Tianshu WANG ; Ming LI ; Lili CHENG ; Zhongfu TANG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(23):169-177
ObjectiveTo investigate the clinical efficacy of Qihuang Jianpi Zishen granules in the treatment of systemic lupus erythematosus (SLE),observe their effects on renal podocyte injury,and decipher related mechanisms. MethodsSixty-two SLE patients with renal damage who met the inclusion criteria and treated in the First Affiliated Hospital of Anhui University of Chinese Medicine between November 2022 and July 2024 were selected. They were randomly allocated into a control group and an observation group (31 patients in each group). The control group was treated with oral hydroxychloroquine sulfate,prednisone acetate,and mycophenolate mofetil. The observation group received Qihuang Jianpi Zishen granules orally in addition to the regimen in the control group. After 12 weeks of continuous treatment,the SLE Responder Index-4 (SRI-4) response rate was evaluated for both groups. Comparisons were made between the two groups before and after treatment regarding disease activity scores,traditional Chinese medicine (TCM) symptom scores,kidney-related indicators [serum creatinine (SCr),cystatin C (Cys C),24-hour urine protein quantitation (24 h Pro),urine protein/creatinine ratio (UPCR),and urine albumin/creatinine ratio (UACR)],immune and inflammatory markers [anti-double-stranded DNA antibody,interferon-γ (IFN-γ),and monocyte chemoattractant protein-1 (MCP-1)],urinary podocyte injury markers (Nephrin,Podocin,and WT-1),and mRNA levels of apoptosis-related factors (Bax,Bcl-2,and Caspase-3) in peripheral blood mononuclear cells. Adverse reactions were recorded. ResultsAfter 12 weeks of treatment,the SRI-4 response rate in the observation group was 48.38%(15/31),which was higher than that in the control group 36.66%(11/30). Within-group comparisons showed that after treatment,both groups exhibited decreases in TCM symptom scores,kidney-related indicators (UACR,UPCR,24 h Pro,SCr,and CysC),inflammatory markers (IFN-γ and MCP-1),podocyte injury markers (Nephrin,Podocin,and WT-1),and the mRNA levels of Bax and Caspase-3 (P<0.05,P<0.01) and an increase in the mRNA level of Bcl-2 (P<0.01). After treatment,the observation group showed lower disease activity score,TCM symptom scores,levels of UACR,UPCR,24 h Pro,SCr,IFN-γ,MCP-1,and podocyte injury markers (Nephrin,Podocin,WT-1),and mRNA level of Bax (P<0.05,P<0.01) and higher mRNA level of Bcl-2 (P<0.05) than the control group. No serious adverse reactions occurred during the treatment period. ConclusionQihuang Jianpi Zishen granules can effectively reduce the disease activity,TCM symptoms,proteinuria,podocyte injury,and renal damage in patients with SLE by regulating the immune-inflammatory state,mitigating podocyte injury,and inhibiting cell apoptosis.
5.Transzonal Projections and Follicular Development Abnormalities in Polycystic Ovary Syndrome
Di CHENG ; Yu-Hua CHEN ; Xia-Ping JIANG ; Lan-Yu LI ; Yi TAN ; Ming LI ; Zhong-Cheng MO
Progress in Biochemistry and Biophysics 2025;52(10):2499-2511
Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder affecting a substantial proportion of women of reproductive age. It is frequently associated with ovulatory dysfunction, infertility, and an increased risk of chronic metabolic diseases. A hallmark pathological feature of PCOS is the arrest of follicular development, closely linked to impaired intercellular communication between the oocyte and surrounding granulosa cells. Transzonal projections (TZPs) are specialized cytoplasmic extensions derived from granulosa cells that penetrate the zona pellucida to establish direct contact with the oocyte. These structures serve as essential conduits for the transfer of metabolites, signaling molecules (e.g., cAMP, cGMP), and regulatory factors (e.g., microRNAs, growth differentiation factors), thereby maintaining meiotic arrest, facilitating metabolic cooperation, and supporting gene expression regulation in the oocyte. The proper formation and maintenance of TZPs depend on the cytoskeletal integrity of granulosa cells and the regulated expression of key connexins, particularly CX37 and CX43. Recent studies have revealed that in PCOS, TZPs exhibit significant structural and functional abnormalities. Contributing factors—such as hyperandrogenism, insulin resistance, oxidative stress, chronic inflammation, and dysregulation of critical signaling pathways (including PI3K/Akt, Wnt/β‑catenin, and MAPK/ERK)—collectively impair TZP integrity and reduce their formation. This disruption in granulosa-oocyte communication compromises oocyte quality and contributes to follicular arrest and anovulation. This review provides a comprehensive overview of TZP biology, including their formation mechanisms, molecular composition, and stage-specific dynamics during folliculogenesis. We highlight the pathological alterations in TZPs observed in PCOS and elucidate how endocrine and metabolic disturbances—particularly androgen excess and hyperinsulinemia—downregulate CX43 expression and impair gap junction function, thereby exacerbating ovarian microenvironmental dysfunction. Furthermore, we explore emerging therapeutic strategies aimed at preserving or restoring TZP integrity. Anti-androgen therapies (e.g., spironolactone, flutamide), insulin sensitizers (e.g., metformin), and GLP-1 receptor agonists (e.g., liraglutide) have shown potential in modulating connexin expression and enhancing granulosa-oocyte communication. In addition, agents such as melatonin, AMPK activators, and GDF9/BMP15 analogs may promote TZP formation and improve oocyte competence. Advanced technologies, including ovarian organoid models and CRISPR-based gene editing, offer promising platforms for studying TZP regulation and developing targeted interventions. In summary, TZPs are indispensable for maintaining follicular homeostasis, and their disruption plays a pivotal role in the pathogenesis of PCOS-related folliculogenesis failure. Targeting TZP integrity represents a promising therapeutic avenue in PCOS management and warrants further mechanistic and translational investigation.
6.Network pharmacology and animal experiments reveal molecular mechanisms of Cordyceps sinensis in ameliorating heart aging and injury in mice by regulating Nrf2/HO-1/NF-κB pathway.
Si-Yi LIU ; Yue TU ; Wei-Ming HE ; Wen-Jie LIU ; Kai-Zhi WEN ; Cheng-Juan LI ; Chao HAN ; Xin-Yu LIANG
China Journal of Chinese Materia Medica 2025;50(4):1063-1074
This study aims to explore the effects and mechanisms of the traditional Chinese medicine Cordyceps sinensis(CS) in ameliorating heart aging and injury in mice based on animal experiments and network pharmacology. A mouse model of heart aging was established by continuously subcutaneous injection of D-galactose(D-gal). Thirty mice were randomly assigned into a normal group, a model group, a low-dose CS(CS-L) group, a high-dose CS(CS-H) group, and a vitamin E(VE) group. Mice in these groups were administrated with normal saline, different doses of CS suspension, or VE suspension via gavage daily. After 60 days of treatment with D-gal and various drugs, all mice were euthanized, and blood and heart tissue samples were collected for determination of the indicators related to heart aging and injury in mice. Experimental results showed that both high and low doses of CS and VE ameliorated the aging phenotype, improved the heart index and myocardial enzyme spectrum, restored the expression levels of proteins associated with cell cycle arrest and senescence-associated secretory phenotypes(SASP), and alleviated the fibrosis and histopathological changes of the heart tissue in model mice. From the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP),259 active ingredients of CS were retrieved. From Gene Cards and OMIM, 2 568 targets related to heart aging were identified, and 133common targets shared by CS and heart aging were obtained. The Gene Ontology(GO) functional annotation and Kyoto Encyclopedia of Genes and Genomes( KEGG) pathway enrichment revealed that the pathways related to heart aging involved oxidative stress,apoptosis, inflammation-related signaling pathways, etc. The animal experiment results showed that both high and low doses of CS and VE ameliorated oxidative stress and apoptosis in the heart tissue to varying degrees in model mice. Additionally, CS-H and VE activated the nuclear factor E2-related factor 2(Nrf2)/heme oxygenase-1(HO-1) pathway and inhibited the expression of key proteins in the nuclear factor-κB(NF-κB) pathway in the heart tissue of model mice. In conclusion, this study demonstrated based on network pharmacology and animal experiments that CS may alleviate heart aging and injury in aging mice by reducing oxidative stress,apoptosis, and inflammation in the heart via the Nrf2/HO-1/NF-κB pathway.
Animals
;
Cordyceps/chemistry*
;
Mice
;
NF-E2-Related Factor 2/genetics*
;
NF-kappa B/genetics*
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Aging/genetics*
;
Male
;
Signal Transduction/drug effects*
;
Network Pharmacology
;
Drugs, Chinese Herbal/pharmacology*
;
Heme Oxygenase-1/genetics*
;
Heart/drug effects*
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Humans
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Myocardium/metabolism*
;
Membrane Proteins/genetics*
7.Digital identification of Cervi Cornu Pantotrichum based on HPLC-QTOF-MS~E and Adaboost.
Xiao-Han GUO ; Xian-Rui WANG ; Yu ZHANG ; Ming-Hua LI ; Wen-Guang JING ; Xian-Long CHENG ; Feng WEI
China Journal of Chinese Materia Medica 2025;50(5):1172-1178
Cervi Cornu Pantotrichum is a precious animal-derived Chinese medicinal material, while there are often adulterants derived from animals not specified in the Chinese Pharmacopeia in the market, which disturbs the safety of medication. This study was conducted with the aim of strengthening the quality control of Cervi Cornu Pantotrichum and standardizing the medication. To achieve digital identification of Cervi Cornu Pantotrichum from different sources, a digital identification model was constructed based on ultra-high performance liquid chromatography tandem quadrupole time-of-flight mass spectrometry(UHPLC-QTOF-MS~E) combined with an adaptive boosting algorithm(Adaboost). The young furred antlers of sika deer, red deer, elk, and reindeer were processed and then subjected to polypeptide analysis by UHPLC-QTOF-MS~E. Then, the mass spectral data reflecting the polypeptide information were obtained by digital quantification. Next, the key data were obtained by feature screening based on Gini index, and the digital identification model was constructed by Adaboost. The model was evaluated based on the recall rate, F_1 composite score, and accuracy. Finally, the results of identification based on the constructed digital identification model were validated. The results showed that when the Gini index was used to screen the data of top 100 characteristic polypeptides, the digital identification model based on Adaboost had the best performance, with the recall rate, F_1 composite score, and accuracy not less than 0.953. The validation analysis showed that the accuracy of the identification of the 10 batches of samples was as high as 100.0%. Therefore, based on UHPLC-QTOF-MS~E and Adaboost algorithm, the digital identification of Cervi Cornu Pantotrichum can be realized efficiently and accurately, which can provide reference for the quality control and original animal identification of Cervi Cornu Pantotrichum.
Animals
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Algorithms
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Antlers/chemistry*
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Boosting Machine Learning Algorithms
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Chromatography, High Pressure Liquid/methods*
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Deer
;
Drugs, Chinese Herbal/chemistry*
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Mass Spectrometry/methods*
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Quality Control
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Reindeer
;
Tandem Mass Spectrometry/methods*
;
Tissue Extracts/analysis*
8.Dahuang Zhechong Pills delay heart aging by reducing cardiomyocyte apoptosis via PI3K/AKT/HIF-1α signaling pathway.
Wen-Jie LIU ; Yue TU ; Wei-Ming HE ; Si-Yi LIU ; Liu-Yun-Xin PAN ; Kai-Zhi WEN ; Cheng-Juan LI ; Chao HAN
China Journal of Chinese Materia Medica 2025;50(5):1276-1285
This study aimed to investigate the effect of Dahuang Zhechong Pills(DHZCP) in delaying heart aging(HA) and explore the potential mechanism. Network pharmacology and molecular docking were employed to explore the targets and potential mechanisms of DHZCP in delaying HA. Furthermore, in vitro experiments were conducted with the DHZCP-containing serum to verify key targets and pathways in D-galactose(D-gal)-induced aging of cardiomyocytes. Active components of DHZCP were searched against the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCSMP), and relevant targets were predicted. HA-related targets were screened from the GeneCards, Online Mendelian Inheritance in Man(OMIM), and DisGeNET. The common targets shared by the active components of DHZCP and HA were used to construct a protein-protein interaction network in STRING 12.0, and core targets were screened based on degree in Cytoscape 3.9.1. Metaspace was used for Gene Ontology(GO) and Kyoto Encyclopedia of Genes and Genomes(KEGG) enrichment analyses of the core targets to predict the mechanisms. Molecular docking was performed in AutoDock Vina. The results indicated that a total of 774 targets of the active components of DHZCP and 4 520 targets related to HA were screened out, including 510 common targets. Core targets included B-cell lymphoma 2(BCL-2), serine/threonine kinase 1(AKT1), and hypoxia-inducible factor 1 subunit A(HIF1A). The GO and KEGG enrichment analyses suggested that DHZCP mainly exerted its effects via the phosphatidylinositol 3-kinase(PI3K)/AKT signaling pathway, HIF-1α signaling pathway, longevity signaling pathway, and apoptosis signaling pathway. Among the pathways predicted by GO and KEGG enrichment analyses, the PI3K/AKT/HIF-1α signaling pathway was selected for verification. The cell-counting kit 8(CCK-8) assay showed that D-gal significantly inhibited the proliferation of H9c2 cells, while DHZCP-containing serum increased the viability of H9c2 cells. SA-β-gal staining revealed a significant increase in the number of blue-green positive cells in the D-gal group, which was reduced by DHZCP-containing serum. TUNEL staining showed that DHZCP-containing serum decreased the number of apoptotic cells. After treatment with DHZCP-containing serum, the protein levels of Klotho, BCL-2, p-PI3K/PI3K, p-AKT1/AKT1, and HIF-1α were up-regulated, while those of P21, P16, BCL-2 associated X protein(Bax), and cleaved caspase-3 were down-regulated. The results indicated that DHZCP delayed HA via multiple components, targets, and pathways. Specifically, DHZCP may delay HA by reducing apoptosis via activating the PI3K/AKT/HIF-1α signaling pathway.
Proto-Oncogene Proteins c-akt/genetics*
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Drugs, Chinese Herbal/pharmacology*
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Signal Transduction/drug effects*
;
Apoptosis/drug effects*
;
Myocytes, Cardiac/cytology*
;
Hypoxia-Inducible Factor 1, alpha Subunit/genetics*
;
Phosphatidylinositol 3-Kinases/genetics*
;
Animals
;
Rats
;
Humans
;
Molecular Docking Simulation
;
Aging/metabolism*
;
Protein Interaction Maps/drug effects*
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Heart/drug effects*
;
Network Pharmacology
9.Occupational Hazard Factors and the Trajectory of Fasting Blood Glucose Changes in Chinese Male Steelworkers Based on Environmental Risk Scores: A Prospective Cohort Study.
Ming Xia ZOU ; Wei DU ; Qin KANG ; Yu Hao XIA ; Nuo Yun ZHANG ; Liu FENG ; Fei Yue LI ; Tian Cheng MA ; Ya Jing BAO ; Hong Min FAN
Biomedical and Environmental Sciences 2025;38(6):666-677
OBJECTIVE:
We aimed to investigate the patterns of fasting blood glucose (FBG) trajectories and analyze the relationship between various occupational hazard factors and FBG trajectories in male steelworkers.
METHODS:
The study cohort included 3,728 workers who met the selection criteria for the Tanggang Occupational Cohort (TGOC) between 2017 and 2022. A group-based trajectory model was used to identify the FBG trajectories. Environmental risk scores (ERS) were constructed using regression coefficients from the occupational hazard model as weights. Univariate and multivariate logistic regression analyses were performed to explore the effects of occupational hazard factors using the ERS on FBG trajectories.
RESULTS:
FBG trajectories were categorized into three groups. An association was observed between high temperature, noise exposure, and FBG trajectory ( P < 0.05). Using the first quartile group of ERS1 as a reference, the fourth quartile group of ERS1 had an increased risk of medium and high FBG by 1.90 and 2.21 times, respectively (odds ratio [ OR] = 1.90, 95% confidence interval [ CI]: 1.17-3.10; OR = 2.21, 95% CI: 1.09-4.45).
CONCLUSION
An association was observed between occupational hazards based on ERS and FBG trajectories. The risk of FBG trajectory levels increase with an increase in ERS.
Humans
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Male
;
Adult
;
Blood Glucose/analysis*
;
China
;
Prospective Studies
;
Occupational Exposure/adverse effects*
;
Risk Factors
;
Middle Aged
;
Steel
;
Fasting/blood*
;
Metal Workers
;
East Asian People
10.Comparison of clinical characteristics between primary bilateral macronodular adrenal hyperplasia and adrenal cortisol-producing adenoma
Bing LI ; Ming-Xiu YANG ; Huai-Jin XU ; Jing-Xuan WANG ; Qing-Zheng WU ; Ya-Jing WANG ; Yi-Jun LI ; Kang CHEN ; Yu CHENG ; Qi NI ; Ya-Qi YIN ; Li ZANG ; Qing-Hua GUO ; Jian-Ming BA ; Wei-Jun GU ; Jing-Tao DOU ; Zhao-Hui LYU ; Yi-Ming MU
Medical Journal of Chinese People's Liberation Army 2025;50(7):779-785
Objective To comparatively analyze the clinical characteristics of primary bilateral macronodular adrenal hyperplasia(PBMAH)and adrenal cortisol-producing Adenoma(CPA),and enhance the understanding of two diseases.Methods The clinical data of 85 PBMAH patients(PBMAH group)and 195 CPA patients(CPA group)diagnosed at Department of Endocrinology,the First Medical Center of Chinese PLA General Hospital,from September 2014 to August 2024 were retrospectively analyzed.The demographic characteristics,comorbidities,biochemical indicators,adrenocorticotropic hormone-cortisol(ACTH-F)levels,and adrenal imaging features and treatment conditions were compared between the two groups.Results(1)General characteristics:Compared with CPA group,PBMAH group had older age at diagnosis and a higher proportion of male patients.(2)Clinical characteristics:Compared with CPA group,PBMAH group had a longer disease duration,a higher proportion of subclinical Cushing's syndrome(CS),and a higher proportion of hypertension,impaired glucose tolerance/diabetes,bone mass reduction or osteoporosis,with higher serum potassium levels,and the differences were statistically significant(P<0.01).(3)Hormone levels:Both PBMAH and CPA groups showed ACTH-F rhythm disorder,significantly increased cortisol levels and suppressed ACTH.Compared with PBMAH group,CPA group had stronger autonomous cortisol secretion ability,manifested by increased midnight serum cortisol(F0:00),16:00 serum cortisol(F16:00),24-hour urinary free cortisol(24 h UFC)levels and lower 8:00 serum ACTH(ACTH8:00)and 16:00 serum ACTH(ACTH16:00)(P<0.01).After low-dose dexamethasone suppression test(LDDST),CPA group showed lower suppression rates of ACTH and cortisol,and higher proportions of paradoxical elevation in serum cortisol and 24 h UFC compared with PBMAH(P<0.01).Conclusions PBMAH has a longer disease course and higher proportions of comorbid metabolic disorders than CPA,mostly manifested as subclinical Cushing's syndrome.CPA has stronger autonomous cortisol secretion ability,with cortisol less likely to be suppressed after LDDST and more obvious paradoxical elevation of cortisol and 24 h UFC.

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