Objective To investigate the clinical characteristics of patients with clinical and subclinical Cushing's syndrome caused by primary bilateral macronodular adrenal hyperplasia(PBMAH).Methods A retrospective analysis was performed on the clinical data of 198 patients with Cushing's syndrome caused by PBMAH diagnosed in the First Medical Center of Chinese PLA General Hospital from January 2004 to October 2024.According to clinical manifestations,the patients were classified into clinical type Cushing's syndrome(n=61)and subclinical type Cushing's syndrome(n=137),and the clinical characteristics of the two types were compared.Results The mean age at diagnosis of patients with PBMAH-induced Cushing's syndrome was(53.5±10.4)years,including 118 males and 80 females,with a male-to-female ratio of 1.475:1.Compared with the subclinical type,the clinical type had a higher proportion of females,higher levels of serum cortisol,24-hour urine free cortisol(24 h UFC),and inhibited serum cortisol after low-dose dexamethasone suppression.Additionally,the clinical type had lower plasma ACTH,larger adrenal nodules and a higher risk of surgery(P<0.05)compared with those in subclinical type.The incidences of hypertension,dyslipidemia,obesity,diabetes mellitus,hypokalemia,vitamin D deficiency,osteoporosis,coronary heart disease,and cerebrovascular disease in patients with Cushing's syndrome caused by PBMAH were 87.9%,50.5%,37.1%,36.9%,27.8%,25.9%,18.7%,18.7%and 12.1%,respectively.Among them,compared with subclinical type patients,clinical type patients had higher incidence of hypokalaemia,vitamin D deficiency and osteoporosis(P<0.05),while there were no statistically significant differences in the incidences of other comorbidities between the two types(P>0.05).The results of postoperative follow-up for PBMAH patients showed that the short-term biochemical remission rate of unilateral total adrenalectomy was 41.5%(22/53)and the long-term biochemical remission rate was 32.0%(8/25).The short-term biochemical remission rate of unilateral partial(or nodular)adrenalectomy was 52.9%(9/17),and the long-term biochemical remission rate was 14.3%(1/7).All patients who underwent unilateral total adrenalectomy plus contralateral partial resection developed adrenal insufficiency(3/3),and 1 patient(1/3)relapsed 3.4 years after surgery.Conclusion Clinical and subclinical types of Cushing's syndrome caused by PBMAH have their distinct clinical characteristics.Surgery is an effective treatment for PBMAH,but a certain proportion of patients fail to achieve biochemical remission after non-bilateral total adrenalectomy.

OBJECTIVE To observe the effect of a short course of oral glucocorticoids(GCs)on the expression level of tight junctions(TJs)in the epithelium of nasal polyps.METHODS Patients with chronic rhinosinusitis with nasal polyps(CRSwNP)who were hospitalized for nasal endoscopic surgery were recruited and given oral GCs for 7 consecutive days before surgery.Nasal polyp tissues were harvested before and after GCs treatment respectively.Adult patients who were to undergo nasal endoscopic surgery due to non-inflammatory diseases were selected,and the mucosa of the middle turbinates,inferior turbinates,or uncinate process obtained during surgery was retained as normal controls.Real-time PCR and immunofluorescence confocal microscopy were used to detect the expression of TJs.RESULTS Before oral GCs therapy,the mRNA expression levels of claudin-3,claudin-4,and occludin in nasal polyp specimens were significantly lower than that of normal nasal mucosa.After a short course of oral GCs therapy,the mRNA expression levels of claudin-3 and claudin-4 in nasal polyp specimens were significantly higher than those before treatment.After oral GCs treatment,the protein expression levels of claudin-1 and claudin-4 in nasal polyp tissues were significantly higher than those before treatment.CONCLUSION Compared with normal nasal mucosa,the expression of multiple tight junction proteins in the epithelium of nasal polyps decreases.Short-term oral GCs therapy can significantly up-regulate the expression of tight junction proteins.

OBJECTIVE To analyze the differences in clinical and imaging characteristics of patients with respiratory epithelial adenomatoid hamatoma(REAH)and nasal polyps(NP)whose lesions are located in bilateral olfactory cleft regions,so as to provide evidence for clinicians in the preoperative differential diagnosis of REAH and NP.METHODS Patients with bilateral olfactory cleft REAH,who underwent nasal endoscopic surgery from June 2006 to August 2023 in Beijing Tongren Hospital,were retrospectively analyzed as the REAH group.Patients with bilateral olfactory cleft NP who underwent nasal endoscopic surgery from January 2023 to October 2023 in Beijing Tongren Hospital were included and set as the NP group.The demographic and clinical characteristics,as well as the sinus CT data were analyzed to explore the intergroup differences.RESULTS Both the REAH group and the NP group included 155 patients.The REAH group was dominated by older men,and the prevalence of comorbid asthma was lower than that in the NP group(P<0.05).In the REAH group,the middle turbinate width,the superior turbinate width,the ratio of middle turbinate width/orbital board width,the ratio of superior turbinate width/middle orbital board width,and the maximum angle between the middle turbinate and nasal septum were significantly higher than those in the NP group(P<0.05).CONCLUSION Sinus CT examination can help clinicians identify REAH lesions before surgery,which is conducive to the formulation and implementation of treatment plans.

Odontogenic maxillary sinusitis(OMS)is a subtype of maxillary sinusitis(MS).It is actually inflammation of the maxillary sinus that secondary to adjacent infectious maxillary dental lesion.Due to the lack of unique clinical features,OMS is difficult to distinguish from other types of rhinosinusitis.Besides,the characteristic infectious pathogeny of OMS makes it is resistant to conventional therapies of rhinosinusitis.Its current diagnosis and treatment are thus facing great difficulties.The multi-disciplinary cooperation between otolaryngologists and dentists is absolutely urgent to settle these questions and to acquire standardized diagnostic and treatment regimen for OMS.However,this disease has actually received little attention and has been underrepresented by relatively low publication volume and quality.Based on systematically reviewed literature and practical experiences of expert members,our consensus focuses on characteristics,symptoms,classification and diagnosis of OMS,and further put forward multi-disciplinary treatment decisions for OMS,as well as the common treatment complications and relative managements.This consensus aims to increase attention to OMS,and optimize the clinical diagnosis and decision-making of OMS,which finally provides evidence-based options for OMS clinical management.

Objective To retrieve,evaluate and summarize the best evidence of physical activity in patients with venous leg ulcer(VLU),and to provide the evidence for clinical practice of physical activity intervention for patients with VLU.Methods We systematically searched all relevant literature on the physical activity of patients with VLU,including clinical practice guidelines,clinical decision-making,systematic reviews,evidence summaries,expert consensuses,and original studies,from the guideline websites,databases,and professional association websites,with the search period from the database establishment to May 19,2023.2 researchers independently evaluated the quality of the literature,and included and extracted and integrated evidence based on the judgment of professionals.Results A total of 18 articles were included,consisting of 6 guidelines,2 clinical decisions,6 systematic reviews,3 expert consensuses and 1 original study.Finally,26 pieces of best evidence were summarized,categorizing into 8 aspects which include timing of physical activity,patient assessment before physical activity,mode of physical activity,time and frequency of physical activity,intensity of physical activity,effect evaluation of physical activity,quality control and tips.Conclusion This study summarizes the best evidence of physical activity in patients with VLU.It is recommended that health care professionals should formulate individualized physical activity programs based on the practical conditions and clinical situation,and fully consider the evaluation results of patients.

Bone marrow biopsy is one of the important means of hematopathological diagnosis, which has decisive diagnostic significance for various benign and malignant lymphohematopoietic system diseases. Its diagnostic value includes morphological observation, immunohistochemistry, genetics, and molecular biology testing. Owing to the unique nature of bone marrow biopsy, decalcification is an essential step in the pre-treatment process. Its purpose is to remove calcium from bone tissue, preserve intact collagen fiber components, facilitate tissue sectioning, and prevent tissue detachment during staining. If bone marrow biopsy lacks sufficient decalcification, preparing a section is difficult. Conversely, if decalcification is excessive, it can seriously disrupt tissue antigen activity. Therefore, a decalcification method with high decalcification efficiency and mild antigen damage is essential for bone marrow biopsy. This article introduces a bone marrow biopsy tissue decalcification method with high efficiency and less antigen loss: decalcification is performed at room temperature with 12% formic acid and 8% hydrochloric acid decalcification solution on a shaker.

Objective To explore the status quo and potential profile of self-management in elderly patients with venous leg ulcers,analyse the differences and influencing factors in different profiles,and provide references for clinical nursing.Methods Convenient sampling method was used to select patients who were followed up in the department of vascular surgery and vascular department of 3 tertiary A hospitals in Shanghai from October 2022 to May 2023 as the study subjects.General data questionnaire,Chronic Wound Patient Self-management Behavior Questionnaire,Health Literacy Management Scale,Brief Illness Perception Questionnaire,Social Support Rating Scale,Chronic Disease Self-Efficacy Scale and Geriatric Depression Scale-15 were used for investigation.Mplus 8.3 was used for potential profile analysis,and SPSS 25.0 was used for univariate analysis and multiple Logistic regression analysis.Results A total of 316 valid questionnaires were collected,and the patients were divided into 3 potential profiles according to their self-management level:low management-inefficient wound response,middle management-highly effective compliance and high management-efficient wound response,accounting for 25.63％,46.84％and 27.53％respectively.Multiple Logistic regression analysis showed that duration of illness,depression,health literacy,self-efficacy and illness perception were factors influencing the potential profile of self-management in elderly patients with venous leg ulcers.Conclusion The self-management level of elderly patients with venous leg ulcers is at a medium level and has obvious classification characteristics.Clinical nurses can take targeted nursing measures according to different characteristics of patients to improve their self-management ability.

AIM To evaluate the pharmacokinetic properties and bioequivalency of Yexiazhu Formula Granules and Decoction.METHODS Twelve rats were randomly assigned into two groups and given intragastric administration of the solutions of Yexiazhu Formula Granules and Decoction(0.428 2,2.000 g/kg),respectively,after which blood collection was made at 0.083,0.167,0.25,0.5,0.75,1,2,3,4,8,12,24,36 h,UPLC-MS/MS was adopted in the plasma concentration determination of gallic acid,corilagin and ellagic acid,and main pharmacokinetic parameters were calculated.Subsequently,the bioequivalency of these two preparations was investigated.RESULTS No significant differences in AUC0-∞,AUC0-t,MRT0-∞,MRT0-t,t1/2,Tmax,CL and Cmax were observable between the two preparations(P＞0.05),whose Cmax,AUC0-∞ ratios or logarithmic mean differences accorded with bioequivalence standard at the 90%confidence level.CONCLUSION Yexiazhu Formula Granules and Decoction demonstrate approximate pharmacokinetic properties and display bioequivalency.

Gastric cancer (GC) is one of the most common malignant tumors worldwide, and most of the patients are diagnosed at the advanced stage. Most of the treating options are comprehensive treatment, in which immunotherapy plays more and more important role. Melanoma antigen-associated gene-A (MAGE-A) family is a kind of cancer testis antigens. Except in germ cells of testis and trophoblast cells of placenta, MAGE-A family is highly expressed in cancerous tissues and participates in a variety of biological processes, such as cancer cell proliferation, differentiation and metastasis. In addition, cancer testis antigen also possesses good immunogenicity, which can induce humoral and cellular immune responses, is a good target for immunotherapy, and has good application value in the diagnosis, treatment and prognosis of GC. A variety of targeted therapeutic drugs based on MAGE-A are in phase I or II clinical trials, it has good safety and potential clinical application value. With the continuous progress of clinical trials and basic research on MAGE-A targets in GC, it is expected to provide a theoretical basis for clinical transformation and immunotherapy of MAGE-A in the future.
Male ; Humans ; Stomach Neoplasms/therapy* ; Antigens, Neoplasm/genetics* ; Melanoma ; Immunotherapy ; Prognosis

AIM: To investigate the differences of myopia and ocular biological parameters of primary and middle school students in Urumqi.METHODS: A cross-sectional survey. A total of 2 495 primary and middle school students aged 7 to 18 from 4 schools in Urumqi were selected by judgemental sampling from September 2021 to November 2021 for relevant eye examination. The differences of ocular biological parameters and refractive status of students of different ages, genders and nationalities were compared, and the correlation between spherical equivalent(SE)and ocular biological parameters was analyzed.RESULTS: The detection rate of poor vision among the students was 80.36%, the detection rate of myopia was 55.91%, and the detection rate of astigmatism was 42.96%, among which the detection rate of low myopia was 63.80%, the detection rate of moderate myopia was 27.60%, and the detection rate of high myopia was 8.60%. There were significant differences in the detection rate of poor vision, myopia, astigmatism, SE and some ocular biological parameters among students of different ages and nationalities(all P<0.05). Among them, the detection rate of myopia, astigmatism and poor vision among Uygur and Kazakh ethnic groups was significantly lower than that of Han. The detection rate of poor vision and myopia among boys was lower than that among girls, while the detection rate of astigmatism was higher than that of girls. Spearman correlation analysis showed that axis length of eye, axial length to axial ratio, anterior chamber depth, and pupil diameter were negatively correlated with SE(rs=-0.664, -0.724, -0.320, -0.086, all P<0.001), and lens thickness was positively correlated with SE(rs=0.147, P<0.001).CONCLUSION: The prevalence of myopia among primary and secondary school students in Urumqi is high, and there are differences in the distribution of ocular biological parameters among children and adolescents of different ages and ethnicities.