Objective:To investigate the distribution of pathological types of unilateral primary aldosteronism, and to explore the clinical characteristics and prognosis of patients with different pathological types.Methods:A total of 241 patients with unilateral primary aldosteronism who underwent adrenal surgery were included in this study. The clinical data and postoperative follow-up data were collected, and the postoperative tissue sections were stained with HE and aldosterone synthase. According to the staining results, pathological types of 241 patients were classified, and the clinical characteristics and surgical prognosis of patients with unilateral primary aldosteronism were compared.Results:According to the international histopathology consensus for unilateral primary aldosteronism, among 241 patients with unilateral primary aldosteronism, 223 were classical(92.5%), 17 were non-classical(7.1%), and 1 was aldosterone producing carcinoma(0.4%). Among classical cases, 189 were aldosterone producing adenoma and 34 were aldosterone producing nodule. In the non-classical cases, 8 cases were multiple aldosterone producing nodule and 9 cases were multiple aldosterone producing nodule. Compared with the classical group, the non-classical group had a longer duration of hypertension(9.0 vs 5.0 years, P=0.062) and a lower baseline plasma aldosterone concentration(273 vs 305 pg/mL, P=0.147), but the difference was not significant. There was no significant difference between the two groups in the proportion of patients who achieved a complete biochemical response after surgery(98% vs 92.3%, P=0.281), but the proportion of patients who achieved a complete clinical response was significantly lower in the non-classical group(23.1% vs 52.9%, P=0.046). Conclusion:The pathological types of unilateral primary aldosteronism are predominantly classical, with aldosterone-producing adenoma being the most common. There were no significant differences in the clinical characteristics and postoperative biochemical remission rates between classical and non-classical patients, but the clinical prognosis of the latter was inferior to the former.

Objective: To explore the correlation between different nutritional status and depressive symptoms among adolescents, so as to provide a theoretical basis for targeted improvement of nutritional status and depressive symptoms in adolescents. Methods: A total of 8 102 adolescents aged 12-17 years in Shanghai, Urumqi, Changsha and Kunming were selected by random cluster sampling. Depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale(CES-D). Height and weight were measured. Kruskal Wallis H test, Chi square test and ordinal Logistic regression were used to analyze the relationship between nutritional status and depressive symptoms in adolescents. Results: The overall detection rate of depressive symptoms in adolescents was 25.6%, with girls (30.1%) higher than that of boys (21.1%) ( χ 2=87.60, P <0.01). There were statistically significant differences in the scores of depressive symptoms among girls with different nutritional status ( Z =8.34, P <0.05). The detectable rate of depressive symptoms increased with BMI among girls( χ 2 trend =6.04, P <0.05). After controlling for confounding factors, ordinal Logistic regression showed that the obese girls had higher risks in depressive symptoms detection compared with normal weight girls ( OR=1.45, 95%CI=1.10-1.91, P <0.05). Conclusion The nutritional status of girls is better than boys, but the prevalence of depressive symptoms is higher than boys. The risk of depressive symptoms in girls increases with BMI.

Objective: To explore the correlation between non suicidal self injury(NSSI) behaviors and depressive symptoms in adolescents and to provide a theoretical basis for improvement of adolescent physical and mental health. Methods: A total of 8 102 adolescents aged 12-17 years were selected by random cluster sampling method in Shanghai, Urumqi, Changsha and Kunming, using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Adolescent Non Suicidal Self Injurious Behavior Assessment Questionnaire. Depressive symptoms and the occurrence of NSSI behaviors were assessed. The relationship between NSSI behaviors and depressive symptoms was analyzed using Chi square test, one way analysis and Logistic regression analysis. Results: The overall detection rate of NSSI in adolescents, 24.6%, with a significantly lower detection rate in boys (23.1%) than in girls (26.2%) ( χ 2=10.97, P <0.05), and 24.7%, 24.6% in the middle school and high school segments, respectively, but the difference was not statistically significant ( χ 2=0.01, P >0.05). The overall detection rate of adolescent depressive symptoms was 49.7 % in the group with NSSI and 17.7% in the group without NSSI, with statistically significant differences ( χ 2=808.80, P < 0.01 ). The detection rates of adolescent depressive symptoms in the group with NSSI (male:44.0%, female:54.7%, middle school:49.6%, high school:49.8%) and the group without NSSI (male:14.2%, female:21.4%, middle school:14.3%, high school: 21.0 %) were statistically significant by sex and age groups ( χ 2=385.58, 412.44, 520.60, 313.78, P ＜0.01). Logistic regression models, after adjusting for gender and age, the risk for depressive symptoms was 2.65 times (95% CI =2.27-3.09) and 7.28 times (95% CI = 6.34- 8.37) more frequently in adolescents with episodic self injurious behavior and frequent self injurious behavior, respectively, compared to those without self injurious behavior. The association between NSSI status and depressive symptoms did not show sex differences ( P >0.05). Conclusion Adolescent NSSI behavior is positively associated with depressive symptoms, the attention should be paid to adolescent physical and mental health to reduce the occurrence of NSSI.

Objective: To analyze the correlation between physical activity and depressive symptoms in adolescents, so as to provide a reference for the early prevention of depression among adolescents. Methods: Using a random cluster sampling method, 8 102 adolescents from Shanghai, Urumqi, Changsha and Kunming were investigated via the Physical Activity Assessment Questionnaire of Chinese Children and Adolescents aged 7 to 18 and the Center for Epidemiologic Studies Depression Scale (CES-D) for physical activity and depressive symptoms. Multivariate Logistic regression analysis was used to analyze the correlation between physical activity and depressive symptoms in adolescents. Results: The proportion of adolescents who met moderate to vigorous physical activity (MVPA) standard was 37.0%, and the detection rate of depressive symptoms was 25.6%. The detection rate of depressive symptomsin compliant with MVPA standard group was significantly lower than that in non compliant group among different age and gender( χ 2=7.62-34.54, P <0.05). Adolescents with severe depressive symptoms had high light intensity physical activity(LPA) duration and low vigorous intensity physical activity(VPA) duration, while adolescents with mild depressive symptoms or asymptomatic adolescents had higher MVPA duration. There were differences in LPA and VPA among adolescents with different levels of depressive symptoms in the overall sample, and the differences were still significant among girls, middle school and statistically significant differences in LPA, moderate intensity physical activity(MPA), MVPA were also found among the high school subgroup. However, differences only in LPA were observed among boys with different levels of depression( H=46.48, 10.31, 25.02, 29.54, 30.25, 19.80, 22.20, 9.54, 8.62, 18.06, P <0.05). Multivariate Logistic regression model showed that gender and duration of MVPA were significantly related to risk of depressive symptoms( OR=1.56, 1.42, P <0.05). Conclusion Physical activity among adolescents is significantly related to depressive symptoms. MVPA may be an effective measure to reduce the degree of depressive symptoms.To improve the physical health and prevent depression among adolescents, it is important to choose appropriate physical activity types and effectively increase the duration of MVPA.

Primary aldosteronism(PA) is one of the most common secondary hypertension, the pathogenesis is still not fully understood. Aldosterone synthase(CYP11B2) was thought to be continuously expressed in the zona glomerulosa of the adrenal cortex. In recent years, it is found that there were discontinuous CYP11B2 positive cell clusters in adrenal cortex via immunohistochemical staining, and proposed the concept of aldosterone-producing cell clusters(APCC). Thenceforwarding a growing body of studies suggest that there may be a potential causal link between APCC and PA. This article summarizes the latest studies on APCC and provide an update on the potential role of APCC in the pathogenesis of PA.

Objective:To establish the biology reference interval (RI) of peripheral blood procalcitonin (PCT) for children between 3 days and 6 years old in China.Methods:Totally 3 353 reference individuals with apparent health or no specific diseases were recruited in 18 hospitals throughout the country during October 2020 to May 2021. Reference individuals were divided into four groups: 3-28 days, 29 days - 1 year, 1-3 years and 4-6 years. Vein blood or capillary blood were collected by percutaneous puncture from every reference individual. The PCT level in serum and the capillary whole blood were assayed by Roche Cobas e601 and Norman NRM411-S7 immunoanalyzer. Outliers were deleted and 95th percentiles of every group were provided as RIs. Man-Whitney U test or Kruskal-Wallis test were used performed to assess the difference among different gender, age or method groups. Results:The difference of PCT distribution between male and female is not statistically significant, but the difference between serum and capillary whole blood is statistically significant. The differences between age groups are significant too. For Roche e601, serum PCT RI of 3-28 days group is <0.23 μg/L, 29 days - 6 years are <0.11 μg/L. For NRM411, Serum PCT RI of 3-28 days group is <0.21 μg/L, 29 days - 1 year: <0.09 μg/L, 1 - 6 years: <0.10 μg/L. For whole blood PCT, RI of 3-28 days group is <0.26 μg/L, 29 days - 6 years is <0.15 μg/L.Conclusions:Serum and capillary whole blood PCT have different RIs, however, capillary whole blood PCT testing is valuable in pediatric application. Children in 3-28 days show higher PCT levels than other age group. To establish the RIs and understand the differences among different groups are essential for the interpretation and clinical application of peripheral blood PCT testing results.

Objective    To explore whether surgery combined with adjuvant chemotherapy can bring survival benefits to patients with cervical and upper thoracic esophageal squamous cell carcinoma (ESCC). Methods    The clinical data of patients with cervical and upper thoracic ESCC who underwent R0 resection and neck anastomosis in our department from 2006 to 2010 were retrospectively analyzed. Patients received neoadjuvant therapy or adjuvant radiotherapy were excluded. The adjuvant chemotherapy group was given a combination of taxanes and platinum based chemotherapy after surgery; the surgery alone group did not receive adjuvant chemotherapy. The Kaplan-Meier method was used to analyze the survival difference between the adjuvant chemotherapy group and the surgery alone group. Results    A total of 181 patients were enrolled, including 141 (77.9%) males and 40 (22.1%) females, with an average age of 61.0±8.2 years (80 patients aged≤61 years, 101 patients aged>61 years). There were 70 (38.7%) patients of cervical ESCC, and 111 (61.3%) patients of upper thoracic ESCC. Eighty-seven (48.1%) patients underwent postoperative adjuvant chemotherapy, and 94 (51.9%) patients underwent surgery alone, and the basic clinical characteristics were well balanced between the two groups (P>0.05). The median survival time of patients in the adjuvant chemotherapy group and the surgery alone group was 31.93 months and 26.07 months, and the 5-year survival rate was 35.0% and 32.0%, respectively (P=0.227). There was no statistical difference in median survival time between the cervical ESCC and upper thoracic ESCC group (31.83 months vs. 29.76 months, P=0.763). For cervical ESCC patients, the median survival time was 45.07 months in the adjuvant chemotherapy group and 14.70 months in the surgery alone group (P=0.074). Further analysis showed that the median survival time of lymph node negative group was 32.53 months, and the lymph node positive group was 24.57 months (P=0.356). The median survival time was 30.43 months in the lymph-node positive group with adjuvant chemotherapy and 17.77 months in the lymph-node positive group with surgery alone. The survival curve showed a trend of difference, but the difference was not statistically significant (P=0.557). Conclusion    There is no statistical difference in the long-term survival of cervical and upper thoracic ESCC patients after R0 resection. Postoperative adjuvant chemotherapy may have survival benefits for patients with cervical ESCC and upper ESCC with postoperative positive lymph nodes, but the differences are not statistically significant in this setting.

Objective    To evaluate the clinical outcomes of larynx-preserving limited resection with total thoracic esophagectomy and gastric pull-up reconstruction for the treatment of cervical esophageal squamous cell carcinoma (ESCC) without tumor involvement of the larynx and hypopharynx compared with the upper thoracic ESCC. Methods    Retrospective and comparative analysis of consecutive patients with cervical and upper thoracic ESCC who underwent R0 surgical resection from 2006 to 2011 in our center was performed. Kaplan-Meier method was used to calculate the patients’ survival. Results    In total, 44 pairs of patients, including 71 males and 17 females with an average age of 60.66±8.49 years were enrolled in the study after propensity score matching. The baseline characteristics of the two groups of patients were well balanced. There was no statistical difference in the operation time (P=0.100), blood loss (P=0.685), mortality rate in 30 days (P=1.000), total complication rate (P=0.829), cervical anastomosis leakage (P=0.816), mechanical ventilation (P=1.000), normal oral diet within 15 days (P=0.822) and anastomosis recurrence rate (P=0.676) between the two groups. Survival analysis showed that there was no statistical difference in survival time between the cervical group [31.83 (95%CI 8.65-55.02) months] and upper thoracic group [37.73 (95%CI 25.29-50.18) months, P=0.533]. The 5-year survival rates were 32.6% and 42.1%, respectively. Conclusion    Larynx-preserving limited resection  with total thoracic esophagectomy and gastric pull-up reconstruction for the treatment of cervical ESCC without involvement of the larynx and hypopharynx may result in a similar clinical outcome to upper thoracic ESCC.

Mitochondrial fission regulator 2 (MTFR2) is associated with mitochondrial fission, while few studies have assessed the associations between MTFR2 expression and clinical characteristics or prognosis of esophageal squamous cell carcinoma (ESCC). In this study, we compared the expression of MTFR2 in 6 ESCC tumors and relative normal tissues by immunohistochemistry (IHC). To assess the effect of MTFR2 expression on clinicopathologic characteristics and survival, 115 paraffin embedded ESCC tissue samples were assessed by IHC staining. Furthermore, the association between clinicopathological properties and MTFR2 expression in patients with ESCC was examined. The survival analysis was performed using the Cox regression models. We found that MTFR2 expression was significantly increased in ESCC tumors compared with normal esophageal epithelial cells. IHC analysis of 115 paraffin embedded ESCC tumor specimens of the patients showed that the expression of MTFR2 was significantly associated with clinical stage (P < 0.001), tumor classification (P < 0.001), histological grade (P < 0.001), and other clinicopathological characteristics. Both univariate and multivariate analyses showed that MTFR2 expression was inversely correlated with the survival of ESCC patients. In conclusion, the expression of MTFR2 is significantly associated with clinicopathologic characteristics and prognosis of ESCC. Thus, MTFR2 expression could serve as a potentially important prognostic biomarker and clinical target for patients with ESCC.

Objective To investigate dermoscopic,reflectance confocal microscopic (RCM) and histopathological features of trichoepithelioma.Methods A total of 23 outpatients with histopathologically confirmed trichoepithelioma were enrolled from Department of Dermatology,Wuhan No.1 Hospital between January 2017 and December 2018.Dermoscopic and RCM images were collected,and the consistency was analyzed between dermoscopic or RCM features and histopathological features.Results Among the 23 patients,5 were male,and 18 were female.Their age was 39.5 ± 22.1 years.Histopathological examination showed that the tumor was well-circumscribed and surrounded by abundant fiber matrices,consisted of many basaloid cells forming clusters or interlacing cords with surrounding cells arranged in a fence-like pattern.Tumor cells differentiated into dermal papilla cells to different extents,and varying amounts of keratinous cysts were observed.RCM showed bud-like downward extension of cord-like cells at the dermoepidermal junction in 8 patients,which tended to be arranged in a fence-like pattern;seemingly lobulating nodular tumor masses were scattered in the dermis in 18 patients,which appeared as extended hypoechoic structures,with no constriction gap between tumor masses and surrounding tissues;tumor masses were surrounded by moderately to highly refractive amorphous substance in 16 patients;characteristic hair papilla structures suspected to be derived from primary differentiation were observed in 16 patients;keratinous cysts were clearly observed in 20 patients.Dermoscopy clearly showed that homogeneous pearlwhite structures in 20 patients,and linear telangiectasia in 10 patients.Conclusion RCM features of trichoepithelioma are highly consistent with its histopathological features,so reflectance confocal microscopy can serve as an efficient method for auxiliary and differential diagnosis.