We report on two cases of type C insulin resistance syndrome(TCIRS) admitted to the Department of Endocrinology, Peking Union Medical College Hospital from January 2000 to December 2020. Both patients presented with persistent hyperglycemia, low immunoreactive insulin, extreme insulin resistance, high insulin autoantibodies, high total insulin, and large insulin antibody pool. TCIRS is marked by extreme insulin resistance with ketoacidosis and respond to medium to high doses glucocorticoids rather than plasmapheresis.

Objective:To analyze KCNJ5 mutation of adenomas in patients with aldosterone-producing adenoma (APA) companying with hypokalemia, and to compare the clinical characteristics of patients with and without KCNJ 5 mutations.Methods:Clinical data of 144 APA patients were retrospectively analyzed. DNA were extracted from adenoma tissues, and amplified and sequenced for KCNJ5 gene. The serum potassium level and cardiac complications in patients with and without KCNJ5 gene mutation were compared.Results:Among 144 tumors, 131 tumors (91%) had KCNJ5 mutation, including 68 tumors with G151R, 56 tumors with L168R, 5 tumors with E145Q, and two tumors with novel mutations, V156_K160delITE and G151delinsVR. Compared with patients without KCNJ5 mutation, patients with KCNJ5 mutation had lower preoperative serum potassium levels, more cardiac complications, lower postoperative systolic blood pressure, and better postoperative hypertension relief. There were no statistical differences in age, gender, blood pressure, serum potassium level, plasma renin activity or plasma aldosterone concertration.Conclusion:91% adenomas in patients with APA and hypokalemia had KCNJ5 mutation, suggesting that KCNJ5 mutation is the main cause in these patients.

Objective:To explore the research hotspots in home care for the aged at home and abroad, so as to provide a reference for the research on the home care for the aged in China.Methods:Literature on home care for the aged at home and abroad was retrieved in China National Knowledge Infrastructure (CNKI) and Web of Science Core Collection from January 1, 2010 to July 8, 2020. SPSS, COOC and other softwares were used to visually analyze the retrieval results.Results:In the past ten years, the common research hotspots in home care for the aged at home and abroad focused on health education, family caregivers, quality of life, senile dementia, community care, and long-term care. Domestic and foreign scholars had different emphases on dementia and long-term care research. In the past ten years, the differences in the research hotspots of home care for the aged at home and abroad were reflected in the nursing model, family function, and physical and mental health management of the aged. Domestic scholars paid more attention to the management of elderly physical diseases, while foreign scholars paid more attention to the high-dimensional needs of elderly health management and dignity in the management of elderly diseases at home.Conclusions:In the past ten years, the differences in the research hotspots of home care for the aged at home and abroad are mainly concentrated on the nursing level. Domestic scholars paid more attention to disease care, while foreign scholars pay more attention to high-dimensional psychological needs and health level management. It prompts Chinese scholars to carry out research on the status of the high-dimensional needs of the aged, as well as related research on satisfaction strategies.

Monoamine oxidase A (MAOA) can catalyze the degradation of a variety of amine neurotransmitter,including serotonin.The abnormalities of these neurotransmitter are closely associated with many psychiatric disorders.Studies have found that MAOA is polymorphic,with a low activity variant (MAOA-L),and a high activity variant (MAOA-H).In this review,through the studies of early stress on human and animal models,the effects of early stress and MAOA polymorphism on the behavior and emotional loop of individuals are analyzed.Analysis shows that,MAOA-L,versus MAOA-H,is more plastic.In early adverse environment,MAOA-L will increase the risk of adult violence,and in the early of energetically favorable environment will reduce the incidence of violence.Abnormality is more likely to occur in the emotional processing and cognitive function in the neural affective loop of individuals with MAOA-L,which makes them more environmentally susceptible than those with MAOA-H.

With the social development, the importance of medical records has become increasingly prominent.This paper analyzes the methods and shortcomings of the current medical record quality control and proposes a new mode under two-level randomized blind method combining with the experience of our own hospital.This new mode, through reconstructing the work team, adjusting work pattern and task allocation, supervising problems rectification, combining with experts′ supervising terminal record, inspecting link record randomly, handling dissent, evaluating connotation quality and assessing performance, effectively reduced the defect rate of medical records, improved the archiving rate and promoted the quality of medical records, which is worth promoting.

Contactin 5 (CNTN5) belongs to a subgroup of the immunoglobulin superfamily.It is highly expressed in the amygdala and occipital lobe of the human brain as well as in the presynaptic terminal of glutamatergic neurons in the auditory system.In recent years,researchers have used animal experiments to identify the biological functions of CNTN5.They have also investigated the relationship between CNTN5 and menial disorders including autism,Alzheimer's disease,and anorexia nervosa among others.Furthermore,immunofluorescence assays have shown that CNTN5 is expressed in glutamatergic neurons in the hypothalamus.A reduction in the number of glutamatergic neurons can cause the long-term potentiation of synapses.Long-term potentiation is an important mechanism in post-traumatic stress disorder (PTSD).It suggests that mutation of CNTN5 may be one of the mechanisms underlying PTSD.We reviewed the research concerning CNTN5 to identify future research directions.

Objective To summarize the clinical phenotype profiles and mitochondrial DNA mutation in maternally inherited diabetes and deafness ( MIDD ) , and to improve the diagnosis and treatment of this disease in clinical practice. Methods Sixteen patients with MIDD in six families from Peking Union Medical College from 2007 to Dec 2014 were confirmed as carrying the mitochondrial ( mt) DNA 3243 A to G mutation. Sanger sequencing was used to detect the mt DNA 3243 A to G mutation. The peak height G/A ratio was used to determine mutation heteroplasmy levels. Results The patients with early onset of diabetes (35. 0 ± 14. 6 years), deafness, normal or lower body mass index ( BMI) , and maternal hereditary tendency suggested the diagnosis of MIDD. The peak height G/A ratio was significantly different according to the onset age of MIDD [≤25 years (61. 6 ± 20. 17)%;25-45 years (16.59±8.64)%;>45 years(6.37±0.59)%;P<0.01]. The peak height G/A ratio was negatively correlated with the onset age of MIDD(r=-0. 785,P=0. 001). Conclusion Early onset of diabetes with deafness, normal/lower BMI, and maternal hereditary tendency strongly suggests the diagnosis of MIDD. The peak height G/A ratio might provide a simple prediction regarding the onset age and severity of MIDD.

According to the infection characteristics of batches of patients with extensive burns in dust explosion, the article focused on the concept and mode of whole-range fine management.Based on the characteristics and rules of infection prevention in bat-ches of patients with extensive burns, the measurement and examination of infection management were refined, the infection monitoring indexes were designed scientifically, the infection prevention scheme and monitoring table were formulated.By early and whole-range intervention of infection prevention, quantitative evaluation, fine management and precise control at different times, all levels of infec-tion management teams could fully serve their purposes in order to realize effective infection prevention.

Objective To observe changes of apoptosis and Caspase-12 expression in hippocampus of the rat model of posttraumatic stress disorder ( PTSD ) .Methods Single prolonged stress ( SPS ) was used to duplicate a rat model of PTSD.Male Wistar rats were randomly divided into 1, 4, 7 days groups after exposure to SPS and a normal control group.Transmission electron microscopy was used to observe morphologic changes of the hippocampus neurons .The expression of Caspase-12 was detected by immunohistochemistry , Western blotting and RT-PCR.Results After SPS, the hippocampus neurons had characteristic morphologic changes of apoptosis , and the expression of Caspase-12 reached the peak at SPS 4d.Conclusion PTSD activates the ERS-mediated apoptosis in hippocampus via Caspase-12, which may be a pathophysiology base of the atrophy of the hippocampus in PTSD .

Objective: To compare the efifcacy and safety of circumferential pulmonary vein antecourt isolation (CPVAI) ablation and stepwise linear (SL) ablation in treating the patients with atrial ifbrillation (AF) Methods: A total of 136 AF patients with catheter ablation under EnSite 3000 guidance in our hospital were retrospectively summarized. The patients included 93 paroxysmal AF and 43 persistent AF and divided into 4 groups. Paroxysmal AF with CPVAI ablation,n=45, Paroxysmal AF with SL ablation,n=48 and persistent AF with CPVAI ablation, n=18, persistent AF with SL ablation,n=25. The differences of left atrium diameter, ablation time, X-ray exposure time, the success rate and complication were compared among different groups. Results: For 12 months follow-up study, the success rate and complication were similar between 2 ablation methods for treating both Paroxysmal AF and persistent AF patients. For Paroxysmal AF patients, both ablation methods could effectively reduce left atrium diameter,P<0.01. The SL ablation had less procedural time than CPVAI ablation,P<0.01, while the X-ray exposure time was similar between 2 ablation methods. Conclusion: Both CPVAI and SL ablation methods were effective and safe for treating AF patients.