Association of 5-HTR1A gene C- 1019G polymorphism with antidepressant efficacy ：a meta-analysis / 中国药房

OBJECTIVE To evaluate the correlation between 5-HTR1A gene C- 1019G polymorphism and the efficacy of antidepressants. METHODS PubMed，Embase，Cochrane Library ，CNKI，Wanfang database ，CBM and VIP database were searched for domestic and foreign literatures on the correlation between 5-HTR1A gene C- 1019G polymorphism and antidepressant efficacy. The retrieval time limit was from the inception to February 2022. According to different outcome measures of drug response，Stata 14.0 and RevMan 5.4 software were used for meta-analysis of efficacy group and remission group ，respectively. RESULTS A total of 18 literature were included. The combined results showed that among recessive gene model in valid group ， the correlation of 5-HTR1A gene C- 1019G polymorphism with the efficacy of antidepressants had statistically significance in Asian population（GG vs. CG+CC ，OR＝0.751，95％CI＝0.585-0.964，P＝0.024）. There was statistical significance in the correlation of 5-HTR1A gene C- 1019G polymorphism and the efficacy of antidepressants in China （GG vs. CG+CC ，OR＝0.677，95％CI＝ 0.508-0.901，P＝0.007）. There was no statistical significance in the correlation of 5-HTR1A gene C- 1019G polymorphism and the efficacy of antidepressants in remission group （P＞0.05）. CONCLUSIONS In the effective group ，5-HTR1A gene C- 1019G polymorphism is correlated with the efficacy of antidepressants in the Asian population and the Chinese population ；while in the remission group ，it is not proved that this polymorphism is correlated with the efficacy of antidepressants.

Expert consensus on early prediction and diagnosis of diabetic kidney disease / 中华内科杂志

Diabetic kidney disease (DKD) is a type of chronic kidney disease (CKD) caused by diabetes. The clinical diagnosis of DKD is usually based on the presence of increased albuminuria and/or decreased estimated glomerular filtration rate (eGFR), and exclusion of other causes of CKD. The clinical features of DKD are proteinuria, gradual decline in renal function, and severe renal failure in the later stages, which is one of the main causes of death in patients with diabetes. Any single biomarker might be insufficient to evaluate renal injury; thus, multiple methods and markers are needed. In addition, diabetic patients should be paid more attention to the kidney, and kidney damage should be evaluated with standardized assessment aimed at strengthening the early prediction and diagnosis of DKD.

Herb-drug interaction in the protective effect of Alpinia officinarum against gastric injury induced by indomethacin based on pharmacokinetic,tissue distribution and excretion studies in rats / 药物分析学报

Alpinia officinarum Hance of the Chinese traditional herb for the treatment of emesis,abdominal pain and diarrhea has been used to counteract gastric disease induced by indomethacin in rats without obvious side effects.However,the role of herb-drug interaction between indomethacin and A.officinarum based on pharmacokinetic,tissue distribution and excretion still remains unknown.In this study,an ultra-fast liquid-tandem mass spectrometry(UFLC-MS/MS)method was developed for simultaneous determina-tion of indomethacin and its three metabolites,O-desmethylindomethacin(ODI),deschlor-obenzoylindomethacin(NDI)and indomethacin acyl-β-D-glucuronide(IDAβG)by oral administration of indomethacin solution with and without the ethanolic extract of A.officinarum and applied to comparative pharmacokinetic,tissue distribution and excretion studies.Our results clarified that oral administration of A.officinarum produced significant alterations in the pharmacokinetic parameters of indomethacin.And the pharmacokinetic interaction between indomethacin and A.officinarum reduced the systemic exposure of indomethacin and increased its elimination.Tissue distribution results demonstrated that co-administration of A.Officinarum could not reduce the accumulation of indo-methacin in the target tissue of the stomach,but could accelerate the excretions of indomethacin and its three metabolites including ODI,NDI and IDAβG in the bile and feces of rats in the excretion study.Therefore,A.Officinarum might have a gastrointestinal protective effect through the interaction role with indomethacin based on the pharmacokinetics and excretion in rats.

Efficacy and safety of Changsulin ? compared with Lantus ? in type 2 diabetes: a phase Ⅲ multicenter, randomized, open-label, parallel, controlled clinical trial / 中华内科杂志

Objective:To compare the efficacy and safety of Changsulin ? with Lantus ? in treating patients with type 2 diabetes mellitus (T2DM). Methods:This was a phase Ⅲ, multicenter, randomized, open-label, parallel-group, active-controlled clinical trial. A total of 578 participants with T2DM inadequately controlled on oral hypoglycemic agents were randomized 3∶1 to Changsulin ? or Lantus ? treatment for 24 weeks. The efficacy measures included changes in glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2h postprandial plasma glucose (2hPG), 8-point self-monitoring of blood glucose (SMBG) profiles from baseline, and proportions of subjects achieving targets of HbA1c and FPG. The safety outcomes included rates of hypoglycemia, adverse events (AEs) and anti-insulin glargine antibody. Results:After 24 weeks of treatment, mean HbAlc decreased 1.16% and 1.25%, FPG decreased 3.05 mmol/L and 2.90 mmol/L, 2hPG decreased 2.49 mmol/L and 2.38 mmol/L in Changsulin ? and in Lantus ?, respectively. No significant differences could be viewed in above parameters between the two groups (all P>0.05). There were also no significant differences between Changsulin ? and Lantus ? in 8-point SMBG profiles from baseline and proportions of subjects achieving the targets of HbA1c and FPG (all P>0.05). The rates of total hypoglycemia (38.00% and 39.01% for Changsulin ? and Lantus ?, respectively) and nocturnal hypoglycemia (17.25% and 16.31% for Changsulin ? and Lantus ?, respectively) were similar between the two groups (all P>0.05). Most of the hypoglycemia events were asymptomatic, and no severe hypoglycemia were found in both groups. No differences were observed in rates of AEs (61.77% vs.52.48%) and anti-insulin glargine antibody (after 24 weeks of treatment, 6.91% vs.3.65%) between the two groups (all P>0.05). Conclusions:Changsulin ? shows similar efficacy and safety profiles compared with Lantus ? and Changsulin ? treatment was well tolerated in patients with T2DM.

Study on the Active Ingredients and Mechanism of Alpinia officinarum in the Treatment of Gastric Ulcer Based on Network Pharmacology / 中国药房

OBJECTIVE：To explore the potential active ingredients and mechanism of Alpinia officinarum in the treatment of gastric ulcer. METHODS ：By network pharmacology method ，the active ingredients and action targets of A. officinarum were screened through TCMSP and TCMID database retrieval [oral bioavailability （OB）≥30％ and drug like （DL）≥0.18] and literature mining. Targets of gastric ulcer were obtained in the TTD ，CTD，OMIM，PubMed，DrugBank and DisGeNet databases. Venny 2.1 software was used to screen common targets for the active ingredients of A. officinarum and gastric ulcer. Then ，the protein-protein interaction（PPI）of the common targets was obtained by STRING database ，and the PPI network was constructed and analysed by using Cytoscape 3.7.1 software. GO function and KEGG pathway enrichment analysis of the common targets were performed by using ClusterProfiler R package. Finally ，Cytoscape 3.7.1 software was used to construct and analyze the network diagram of “active ingredients-targets-pathways ”. RESULTS ：Totally 19 active ingredients of A. officinarum ，209 active ingredients targets and 195 gastric ulcer related targets ，involving 35 common targets ，were screened out. The average node degree of PPI network of common targets was 18，and the average intermediate number was 16.9. There were 11 key targets ，i.e. PTGS2，VEGFA，IL6， IL1B，CCL2，MYC，MMP9，EGFR，HIF1A，ESR1，BCL2L1. The common targets were mainly concentrated in the cell constituents such as the platelet α granule lumen and mitochondria outer membrane ，involved in the biological processes as oxidative stress ，inflammatory response regulation ，and molecular functions as protein phosphatase binding ，growth factor receptor binding. They were also enriched in the signal pathways such as PI3K/Akt，HIF-1. The network of“active ingredients- targets-pathways”showed the active ingredients such as quer- cetin，apigenin，kaempferol and galangin in A. officinarum played an anti-gastric ulcer effect by acting on PTGS2，NOS2， BCL2， IL6， VEGFA， IL1B， MMP9， BCL2L1 and other targets to jointly regulate PI 3K-Akt，HIF-1，TNF，IL-17， NF-κB and other cell proliferation，angiogenesis，and infla- 163.com mmation related pathways. CONCLUSIONS ：A. officinarum shows anti-gastric ulcer effect with the characteristics of multi-ingredient ，multi-target and multi-path.

Analysis of risk factors for intraoperative hemodynamic instability in adrenal incident pheochromocytoma / 中华泌尿外科杂志

Objective To evaluate the risk factors for intraoperative hemodynamic instability (HI) in patients with adrenal incident pheochromocytoma.Methods Perioperative clinical parameters of patients undergoing surgery for adrenal incident pheochromocytoma at the First Hospital of Peking University from January 2001 to July 2018 were analyzed.There were 39 males and 41 females,with mean age of 45.1 years (13-76 years old).The median tumor length was 5.1 cm (1.5-14.0 cm),with 25 cases (31.3％) on the left side,55 cases (68.8％) on the right side.There were 37 cases combined with coronary heart disease or diabetes or BMI≥24 kg/m2.Patients were divided into hemodynamic instability (HI group) and hemodynamic stability group (HS group) by whether intraoperative hemodynamic instability occurred.The differences of demographic characteristics and clinical parameters between the two groups were compared.Logistic regression analysis was done for seeking the risk factors for hemodynamic instability during surgery.Results There were 54 cases (67.5％) in the HS group and 26 cases (32.5％) in the HI group.Univariate analysis showed that there was no significant difference in age [(44.06 ± 13.58) years old vs.(47.35 ± 16.11) years old],combined with coronary heart disease or diabetes or BMI≥24 kg/m2 [50.0％(27/54) vs.38.5％ (10/26)],tumor long diameter [median 5.0 cm(1.5-14.0 cm) vs.6.0cm(1.5-13.5 cm)],tumor location [left:29.6％ (16/54) vs.34.6％ (9/26)],preoperative catecholamine test positive [44.4％ (20/45) vs.50.0％ (10/20)],open surgery [27.8％ (15/54) vs.34.6％ (9/26)]and preoperative non-alpha blockers[13.0％ (7/54) vs.30.8％ (8/26)] between HS group and HI group (P ＞ 0.05).Further logistic regression analysis was used to analyze the risk factors of intraoperative hemodynamic instability.Multivariate analysis found that patients who preoperative non-alpha blockers before surgery were independent risk factor for HI (OR =4.574,95 ％ CI 1.273-16.432,P =0.020).Conclusions Preoperative non-alpha blocker in patients with adrenal incidental pheochromocytoma could be independent risk factor for intraoperative hemodynamic instability.Therefore,it is recommended that patients with adrenal incidental tumors,especially those who fail to rule out pheochromocytoma,take preoperative alpha blockers.

The metabolic comorbidity of obesity and its association with body mass index in an obese clinic population in Beijing China / 中华内分泌代谢杂志

Objective The prevalence of obesity is constantly increasing. Multiple metabolic complications are related to obesity, including type 2 diabetes mellitus and non-alcholic fatty liver disease(NAFLD). Our study aimed to investigate the prevalence of obesity comorbidities and its association with BMI. Methods 765 individuals who visited the multidisciplinary clinic for obesity in Peking University First Hospital from 2015, Jun. to 2018, Sept. were enrolled in this study. The height, body weight, waist circumference, hip circumference were measured during the first visit. Body adipose percentage and basal metabolic rate were recorded. Questionnaires for daily food intake, comorbidity, and lifestyle were recorded. Fasting insulin, C peptide, glucose, HbA1C , uric acid, liver enzymes and lipid profile were measured. Statistical analysis was performed using SPSS 16. 0, and P<0. 05 was considered as statistical significant. Results Daily energy intake was higher in obesity group [ obese vs non-obese, (2136.6±739.4vs1905.7±468.4)kcal/d,P=0.046].Hypertension,NAFLDandgoutriskincreasedsignificantly in obesity group (obese vs non-obese, 36.0％vs 24.5％, P=0.02;76.5％ vs 60.6％, P<0.01;6.9％ vs 1.8％, P=0.04, respectively) . Family history of obesity and diabetes increased in obesity group ( obese vs non-obese, 64.5％vs 53.6％, P=0.03;47.4％vs 37.3％, P=0.048). Fasting insulin and C-peptide levels were higher in obesity group [obese vs non-obese, (24.8 ± 15.3 vs 13.6 ± 9.5)μIU/ml, P<0.01;(3.72 ± 1.40 vs 2.70 ± 1.16)μIU/ml, P<0.01). Liver enzymes increased significantly in obesity group [obese vs non-obese, (47.2±45.4 vs 23.3±21.4)U/L, P<0.01; ( 30. 4 ± 24. 0 vs 19. 9 ± 8. 5 ) U/L, P=0. 001 ] . Conclusions Obesity population had higher risk of hypertension, NAFLD and gout. Fasting insulin, C-peptide, liver enzymes, and UA also increased significantly in these patients. It is critically important to those obese individuals for regular screening of NAFLD and diabetes mellitus.

Effect of interpersonal and social rhythm therapy combined drugs on sleep quality and quality of life in patients with insomnia / 中华行为医学与脑科学杂志

Objective To explore the effect of interpersonal and social rhythm therapy combined drugs on sleep quality and quality of life in patients with insomnia.Methods A total of 100 patients with insomnia treated in hospital from January 2016 to October 2017 were selected as subjects.The patients were divided into experimental group (n=50) and control group (n=50) according to the random number table.The control group was given conventional drug only,and the experimental group was combined with interpersonal and social rhythm therapy on the basis of the drugs treatment.The clinical efficacy was compared between the two groups.Pittsburgh Sleep Quality Index (PSQI) and Sleeping Personal Beliefs and Attitudes (DBAS) were used to assess the recent sleep quality of the two groups.The WHO Quality of Life Measurement Profile (WHOQOL-BREF) was used to compare of the quality of life between two groups.Results The clinical effective rate was 94.0％ in the experimental group and 80.0％ in the control group.There was significant difference between the two groups (x2=4.332,P＜0.05).Before treatment,there was no significant difference in PSQI ((13.61±2.09) vs (13.60±2.08),t=0.03,P＞0.05) and DBAS((80.96±10.11) vs (80.87±11.03),t =0.02,P＞ 0.05) scores between experimental group and control group.After treatment,D BAS score ((125.74 ±21.53) vs (104.22±20.97),t=4.93,P＜0.05) of both groups increased significantly,and PSQI score decreased significantly((7.51±2.35) vs (10.02±2.40),t=16.73,P＜0.05).The PSQI score in experimental group was significantly lower than that of the control group(t=7.97,P＜0.05),and the DBAS score was significantly higher than that of the control group (t =13.72,P＜0.05).Before treatment,scores in the psychological,physiological,environmental and social relations fields of the two groups were not statistically different (P ＞0.05).After the treatment,all the scores in the four fields of the two groups were significantly increased (P ＜0.05),and the scores in the experimental group were significantly higher than those in the control group (P ＜0.05).Conclusion Interpersonal and social rhythm therapy combined with drugs can effectively improve sleep quality and the quality of life.

Research progress in skin advanced glycation end-products and diabetic kidney disease / 中国糖尿病杂志

Diabetic kidney disease(DKD) is one of the major complications of diabetes mellitus.The formation of advanced glycationend-products (Advanced Glycation End-products,AGEs) has been widely accepted to play a crucial role in the pathogenesis of diabetic nephropathy.It has been reported that the skin autofluorescence test of AGEs can better reflect the AGEs accumulation in vivo,thus providing stronger evidence in predicting diabetic nephropathy.As a noninvasive,convenient and steady measure,skin autofluorescence will be widely applied in the assessment and monitoring the progress of diabetic nephropathy in the future.Here,we reviewed the research progress in skin AGEs and diabetic nephropathy.

Clinical observation of intrapleural hyperthermic perfusion chemotherapy for patients with malignant pleural effusion caused by lung cancer / 国际肿瘤学杂志

Objective To observe the efficacy and adverse reaction of intrapleural hyperthermic perfusion and intrapleural chemotherapy for patients with malignant pleural effusion (MPE) caused by lung cancer.Methods A total of 103 patients with MPE caused by lung cancer were assigned into one of two groups:intrapleural hyperthermic perfusion group (n =65) and intrapleural chemotherapy group (n =38).The disease control rate,MPE progress free survival,the relationship between vascular endothelial growth factor (VEGF) concentration in pleural effusion and curative effect and adverse reactions were observed.Results The overall disease control rate in intrapleural hyperthermic perfusion group and intrapleural chemotherapy group was 81.5％ and 52.6％ respectively,with a significant difference (x2 =9.834,P =0.002).The median MPE progress free survival of the two groups was 3.10 and 2.15 months respectively,with a significant difference (x2 =10.512,P =0.001).A significant difference of the median MPE progress free survival was observed in low VEGF concentration subgroup between intrapleural hyperthermic perfusion and intrapleural chemotherapy (3.34 months vs.2.20 months;x2 =9.409,P =0.002),but no difference was observed in high VEGF expression subgroup (2.85 months vs.2.10 months;x2 =2.429,P =0.119).The main adverse reactions included gastrointestinal adverse reaction,fatigue and hematotoxicity.Fatigue occurred in intrapleural hyperthermic perfusion group more commonly compared with intrapleural chemotherapy group (67.7％ vs.13.2％;x2 =28.595,P ＜ 0.001).Conclusion Compared with intrapleural chemotherapy,intrapleural hyperthermic perfusion can better improve disease control rate and MPE progress free survival in MPE patients caused by lung cancer,and it's adverse reactions are tolerated easily.The MPE progress free survival prolonging is observed especially in VEGF low expression subgroup.VEGF level in pleural effusions maybe could predict efficacy of intrapleural hyperthermic perfusion.

Clinical observation of intrapleural hyperthermic perfusion chemotherapy for patients with malignant pleural effusion caused by lung cancer / 国际肿瘤学杂志

Objective To observe the efficacy and adverse reaction of intrapleural hyperthermic perfusion and intrapleural chemotherapy for patients with malignant pleural effusion (MPE) caused by lung cancer.Methods A total of 103 patients with MPE caused by lung cancer were assigned into one of two groups:intrapleural hyperthermic perfusion group (n =65) and intrapleural chemotherapy group (n =38).The disease control rate,MPE progress free survival,the relationship between vascular endothelial growth factor (VEGF) concentration in pleural effusion and curative effect and adverse reactions were observed.Results The overall disease control rate in intrapleural hyperthermic perfusion group and intrapleural chemotherapy group was 81.5％ and 52.6％ respectively,with a significant difference (x2 =9.834,P =0.002).The median MPE progress free survival of the two groups was 3.10 and 2.15 months respectively,with a significant difference (x2 =10.512,P =0.001).A significant difference of the median MPE progress free survival was observed in low VEGF concentration subgroup between intrapleural hyperthermic perfusion and intrapleural chemotherapy (3.34 months vs.2.20 months;x2 =9.409,P =0.002),but no difference was observed in high VEGF expression subgroup (2.85 months vs.2.10 months;x2 =2.429,P =0.119).The main adverse reactions included gastrointestinal adverse reaction,fatigue and hematotoxicity.Fatigue occurred in intrapleural hyperthermic perfusion group more commonly compared with intrapleural chemotherapy group (67.7％ vs.13.2％;x2 =28.595,P ＜ 0.001).Conclusion Compared with intrapleural chemotherapy,intrapleural hyperthermic perfusion can better improve disease control rate and MPE progress free survival in MPE patients caused by lung cancer,and it's adverse reactions are tolerated easily.The MPE progress free survival prolonging is observed especially in VEGF low expression subgroup.VEGF level in pleural effusions maybe could predict efficacy of intrapleural hyperthermic perfusion.

Analysis of the Application of Second Class of Psychotropic Drugs in Outpatient Department of Our Hospi-tal during 2012-2015 / 中国药房

OBJECTIVE:To provide reference for rational use of second class of psychotropic drugs in the clinic. METHODS:The second class of psychotropic drugs in outpatient department of our hospital during 2012-2015 were analyzed retrospectively in respects of the number of common drugs prescription,distribution of gender/age/disease diagnosis,DDDs and DUI,etc. RE-SULTS:During 2012-2015,second class of psychotropic drugs in outpatient department of our hospital accounted for 25.09%of to-tal prescription amout. The drugs with high use frequency were alprazolam,clonazepam,lorazepam and estazolam,accounting for 93.10% of total prescription amount of second class of psychotropic drugs. The proportion of male to female was 1∶1.50;the pa-tients aged 19-35 years old took up the biggest proportion,accounting for 34.62%. The proportion of schizophrenia prescription was the highest,accounting for 45.17%. DDDs of alprazolam was the highest,being 742 141.67;its DUI was 1.075;DUI of oth-er drugs was lower than 1.0. CONCLUSIONS:The use of second class of psychotropic drugs is basically reasonable in our hospi-tal. Guiding principles of Clinical Application of Psychotropic Drugs should be implemented strictly and continously to avoid abuse of second class of psychotropic drugs.

Clinical features of diabetes insipidus with urinary tract dilatation / 中华内分泌代谢杂志

Diabetes insipidus ( DI) could lead to urinary tract dilatation, even renal dysfunction. This study compared clinical features of DI with or without urinary tract dilatation. The results showed that the former had earlier onset age, more male patients, longer duration, and higher serum creatinine, as well as lower urine osmotic pressure and urine specific gravity after injection of vasopressin. But only disease duration was the independent risk factor (OR=1. 248). More nephrogenic DI and more hereditary DI were with urinary tract dilatation compared with central DI or acquired DI.

The role of peroxisome proliferator-activated receptor-γ coactivator-1 in glucose metabolism in the liver of OLETF rat / 实用医学杂志

Objective To investigate the effect of PGC-1 on hepatic glucose metabolism of type 2 diabetes by observing its changes in the liver of OLETF rats. Methods OLETF rats were observed,even-aged LETO rats were controled. Oral glucose tolerance test, Fasting Insulin, triglyceride and total cholesterol were measured and then the protein level of PGC-1 , phosphoenolpyruvate earboxykinase and uncoupling protein 2 of liver tissue were detected by Western blot respectively in 8,18 and 28 weeks. Results (1)OLETF rats had significantly higher levels than LETO rats, in body weight, OGTT2h blood glucose and TG at 18th, 28th week. The levels of Fasting Insulin of OLETF rats were higher while insulin sensitive index were lower than that of LETO rats at 28th week. (2)Protein expressions in the livers: PGC-1 of OLETF rats was lower than that of LETO rats at 18th and 28th week. PEPCK of OLETF rats was more while UCP2 was lower than that of LETO rats at 28th week. Conclusions OLETF rats showed pathological phenotypes of type 2 diabetes. The changes of PGC-1 , PEPCK and UCP2 in 28-weeks OLETF rat suggested that PGC-1 plays an important role in the liver glycometabolism in type 2 diabetes.

Expression of IL-12 family subunit genes in mice C6 glioma cells / 中国免疫学杂志

Objective:To observe the expression of IL-12 family subunit genes by real-time quantitative PCR in mice C6 glioma cells,construct the basis of the brain glioma research on IL-12 family in the future.Methods:Mice C6 glioma RNA was abstracted and reversed transcription cDNA.The mice C6 glioma cells mRNA expression influence of IL-12 family subunit genes was compared and analyzed by real-time quantitative PCR.Results: In mice C6 glioma cells, high expression abundances in IL-23a, IL-12a, midlde expression abundances in EBI3, IL-27, low expression abundance in IL-12b.Conclusion: IL-12 families are closely related to the occurrence and development of glioma,IL-12,IL-23 are regarded as the most potential anti-glioma cytokines among them,research de-velopments will bring a new way of brain glioma immune therapy.

A clinical analysis of 21 cases of adrenal non-Hodgkin's lymphoma / 中华内科杂志

Objective To elaborate the clinical characteristics of adrenal non-Hodgkin's lymphoma and to expand the clinical thinking of adrenal tumors.Methods Subjects with adrenal tumors and nonHodgkin's lymphomas between January.1994 and December.2012 in Peking University First Hospital retrospectively were included and these with adrenal lymphoma patients were analyzed in the present study.Results Among 1100 adrenal tumors and 1 002 non-hodgkin's lymphomas,21 patients (aged 35 to 80 years,mean 56 years) were diagnosed as having adrenal non-Hodgkin's lymphoma with 14 males and 7 females.Among the 21 patients,15 were with pain on the waist and the back,3 with fever,1 had weight loss.Two patients were diagnosed by regular health examination.Only 2 subjects accompanied by superficial lymph node enlargement,while 10 by abdominal cavity lymph node enlargement.Eleven subjects were with extranodal involvement.Bilateral adrenal were involved in 8 patients with 9 on the left and 4 the right.The average diameter of the masses was 7.2 cm.There were no specific features in conventional imaging such as CT and MRI scan.All of the 21 cases were found normal adrenal function by endocrinological examinations.Pathology reviewed that 18 of 21 were diffuse large B cell non-Hodgkin's lymphoma,2 were T cell lymphoma,1 were anaplastic large cell lymphoma.Only 7 of 21 cases were diagnosed with adrenal lymphoma pre-operation.Seventeen patients were followed up by telephone in September 2014,in which 14 died and the average survival time was 5.5 months,2 were tumor-free survival for 4 and 10 months respectively,1 were currently undergoing chemotherapy.Conclusions Adrenal lymphoma is rare with less superficial lymph node,more bilateral adrenal involved with high malignant degree.It progressed quickly with poor prognosis.Clinical and imaging features were not specific,so misdiagnosis was very common.Pathology is the diagnostic gold standard.The most common type was diffuse large B cell type.

The clinical analysis of adrenal tumor combined with renal carcinoma in 42 patients / 中华内分泌代谢杂志

Objective To summarize the clinical characteristics of adrenal tumors combined with renal carcinoma and to extend the clinical understanding of the situation.Methods To analyze the data of 1 100 patients with adrenal tumors hospitalized in Peking University First Hospital from Jan.1994 to Mar.2012 retrospectively,in the series there were 42 combined with renal carcinoma.Results There were 27 males,15 females,aged 29 to 83 years,mean 60.5 years old.In 42 renal carcinomas,there were 29 (69.0％) clear cell carcinomas,5 (11.9 ％) cystic renal carcinomas,2 (4.8％)clear cell with granulosa cell hybrid carcinomas,1 renal lymphoma,1 (2.4％) spindle cell tumor,1 acidophilic cell adenoma,and 1 undifferentiated type of renal cell carcinoma and pathologically not clear in 2 cases (4.8％).Clinical manifestations were not specific.In 42 adrenal tumors,20 situated in the left,and 17 right,and 5 were bilateral.35 cases were considered primary adrenal tumors,in which 3 were diagnosed primary hyperaldosteronism,32 were non-functional tumors.Other 7 were non-functional matastatic carcinomas.25 patients underwent resection of adrenal tumors,and pathology revealed 22 (88.0％) were primary,in which 12 (54.6％) were cortical adenomas,7 (31.9％) hyperplasia,1 (4.5 ％) pheochromocytoma,1 (4.5 ％) ganglioneuroma,1 (4.5 ％)adenoma with hyperplasia;2 (8.0％)metastatic tumors,and 1 (4.0％) non-Hodgkin' s lymphoma.The mean diameter of primary adrenal tumors was 1.9 cm,while that of metastatic carcinoma was 3.84 cm.25 underwent abdominal ultrasonography,40 underwent computed tomography (CT) scan,6 underwent magnetic resonance imaging (MRI) scan,positive rate was 72.0％,97.5％,and 100.0％ respectively.25 patients who underwent surgery were followed up,17 survived for 8 months-6 years,4 died,in which 1 metastatic carcinoma died of intraoperative bleeding,1 died of adrenal lymphoma,2 died because of other disease,4 were lost to follow-up.Conclusions The most common type of renal carcinoma combined with adrenal tumors was clear cell carcinoma,while majority of the adrenal tumors were primary with non-specific clinical manifestations and function.The adrenal tumors might be located in the same or the opposite side of renal carcinoma,also might be bilateral which were more common in metastatic carcinomas and always bigger than primary ones.CT/MRI scans were important in judging the nature of the tumors and pathology was the gold standard.The non-functioning primary adrenal tumors could be safely followed up,and the isolated metastatic carcinoma should be resected.Prognosis depends mainly on that of renal carcinoma.

Common variants in PERK, JNK, BIP and XBP1 genes are associated with the risk of prediabetes or diabetes-related phenotypes in a Chinese population / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Prediabetes is an early stage of β-cell dysfunction presenting as insulin resistance. Evidences suggest that endoplasmic reticulum (ER) stress is involved in the pathogenesis of type 2 diabetes mellitus and prediabetes. In a Chinese population with prediabetes, we investigated single nucleotide polymorphisms (SNPs) in the genes of PERK, JNK, XBP1, BIP and CHOP which encode molecular proteins involved in ER stress pathways.</p><p><b>METHODS</b>Nine SNPs at the PERK, JNK, XBP1, BIP and CHOP loci were genotyped by mass spectrometry in 1 448 unrelated individuals. By using a 75 g oral glucose tolerance test (OGTT), 828 subjects were diagnosed as prediabetes and 620 subjects aged 55 years and over as normal controls based on WHO diagnostic criteria (1999) for diabetes mellitus.</p><p><b>RESULTS</b>The allele C of SNP rs867529 at PERK locus was a risk factor for prediabetes, with the carriers of C allele genotype at a higher risk of prediabetes compared to non-carriers (OR = 1.279, 95% CI: 1.013-1.614, P = 0.039, after adjustment for age, sex and body mass index (BMI). The SNPs rs6750998 at PERK locus was associated with homeostasis model assessments of insulin resistance (HOMA-IR) (P = 0.019), and rs17037621 with BMI (P = 0.044). The allele G of SNP rs10986663 in BIP gene was associated with a decreased risk of prediabetes (OR = 0.699, 95% CI: 0.539-0.907, P = 0.007). The SNP rs2076431 in JNK gene was associated with fasting plasma glucose levels (P = 0.006) and waist-hip ratios (P = 0.019). The SNP rs2239815 in XBP1 gene was associated with 2-hour plasma glucose levels after 75 g oral glucose load (P = 0.048) in the observed population.</p><p><b>CONCLUSION</b>Common variants at PERK and BIP loci contributed to the risk of prediabetes, and the genetic variations in JNK and XBP1 genes are associated with diabetes-related clinical parameters in this Chinese population.</p>

Approach to the patients with adrenocortical insufficiency combined with the syndrome of inappropriate secretion of antidiuretic hormone / 中华内分泌代谢杂志

To summarize the clinical data of two cases with severe hyponatremia diagnosed as adrenal insuffiency combined with syndrome of inappropriate secret on of antidiuretic hormone(SIADH),and to review related literatures.Case 1 diagnosed as Addison's disease for 27 years and developed severe hyponatremia again but did not response well to sufficient glucocorticoid.Further examination showed SIADH caused by lung cancer and tolvaptan worked well.Case 2 was diagnosed as SIADH caused by lung cancer and responsed well to tolvaptan.However,hyponatremia reoccurred with the decreasing level of ACTH and cortisol during the chemotherapy.It was thought that hyponatremia was caused by drug-related adrenal insuffiency and glucocorticoid replacement therapy achieved good response.Both primary/secondary adrenal insuffiency and SIADH can lead to severe hyponatremia,but it is rare that the two situations exist in one patient and occur in different time.We should consider the possibility of the situations when we make differential diagnosis of refractory hyponatremia,monitoring the curative effects carefully,then correct the diagnosis timely,and reduce missed diagnosis and misdiagnosis.

Approach to the patient with adrenal cavernous hemangioma / 中华内分泌代谢杂志

Adrenal hemangioma is a rare neoplasm.The clinical data of a case of adrenal cavernous hemangioma and review of related literatures are herewith presented.Adrenal cavernous hemangioma is often nonfunctioning and benign.CT and MRI show the features of hemangioma.The treatment depends on the size of the mass,and the diagnosis is based on pathology.