The value of X-ray guided desmopressin stimulated bilateral inferior petrosal sinus sampling in diagnosing the recurrence of ACTH dependent Cushing disease or ineffectiveness of surgery or radiotherapy / 中华放射学杂志

Objective To investigate the value of X-ray guided desmopressin (DDAVP) stimulated bilateral inferior petrosal sinus sampling (IPSS) in diagnosing the recurrence of ACTH dependent Cushing disease or ineffectiveness after surgery or radiotherapy. Methods Retrospective analyses of patients with recurrent ACTH dependent Cushing disease (31 cases) or ineffective (3 cases) treatment after surgery or radiotherapy from January 2013 to October 2014 in our hospital was conducted. Bilateral inferior petrosal sinus angiography showed the same side of the cavernous sinus to prove successful intubation. The cases with discontinuous of the inferior petrosal sinus and cavernous sinus were excluded by this study. Finally, there were 34 cases of the patients in this study. Diagnosis was based on the ratio of ACTH level in IPS to peripheral vein after desmopressin test.The gradient≥2 at baseline or gradient≥3 after desmopressin test suggested the sources were in the pituitary. Diagnosis was confirmed by gold standard to investigate the value of X-ray guided desmopressin (DDAVP) stimulated bilateral IPSS. Results The IPS gradient≥2 at baseline or gradient≥3 after desmopressin test suggested the sources were in the pituitary in 30 patients. A total of 22 (22/30) patients underwent surgery with a final diagnosis of ACTH adenoma. The symptoms were obviously relieved in 8 (8/30) cases after sellar area gamma knife treatment and lesions were confirmed in the pituitary. IPS gradient<2 at baseline or gradient<3 after desmopressin test was found in 4 cases. One case (1/4) was found to have for ACTH adenoma after pituitary surgery. The other 3 cases (3/4) were confirmed to have lung carcinoid and clinical symptom alleviated after surgery. The sensitivity of desmopressin stimulated IPSS was 96.8%, the specificity was 100%, and the accuracy was 97.1%. Conclusion Desmopressin stimulated IPSS is an effective diagnostic procedure in diagnosing ACTH dependent Cushing disease recurrence or ineffectiveness after surgery or radiotherapy.

Academic features exploring and analysis on Ding-Ganren’s medical records / 国际中医中药杂志

To discuss the academic features of Ding-Ganren’s medical records and to provide the references for learning and applying the theories in the book. With bibliography research method, the academic features of Ding-Ganren’s medical records were investigated in academic thoughts, medication characteristic and clinic experience, etc. The academic features of Ding-Ganren’s medical records were summarized into 4 pointes, which are ①good at classical prescription and determination of treatment based in pathogenesis obtained through differentiation of symptoms and signs of typhus and complicated diseases. ②Focusing on six meridians and proposing the combination of cold and warm treatment. ③Mild treatment and claiming gentle application of the medicine. ④Determination of treatment based in pathogenesis obtained through differentiation of symptoms and signs of scarlet fever and emphasizing to distinguish Qi from Ying. Ding-Ganren YiAn has high academic value in research and clinic application and worth further study.

Key academic features of Waizheng-YiAn-Huibian / 国际中医中药杂志

To investigate the academic features of Waizheng-YiAn-Huibian and provide references for research and application of it. With research approach in bibliography, the academic features of the book were studied from source of medical cases, writing characteristic, academic thought, etc. The academic features of Waizheng-YiAn-Huibian were summarized into the following 5 points, including multiple chosen medical cases but all with unique individual features, precious discussion after each case, named external symptoms, but covered internal symptoms, encouraging mild treatment and against being broad and complicated, emphasis on veins and arteries, positioning and nature determination. Waizheng-YiAn-Huibian is a wonderful masterpiece in medical cases research and worth learning and studying.

Clinical analysis of 8 cases of primary pigmented nodular adrenocortical disease / 基础医学与临床

Objective To summarize the clinical characteristics of primary pigmented nodular adrenocortical disease (PPNAD).Methods Eight patients with PPNAD from 2001 to 2009 in PUMC Hospital were reviewed,their clinical data were collected.Results PPNAD often occurred in adolescents.62.5% of patients with PPNAD were complicated with Carney complex(CNC).In addition to general features of Cushing's syndrome,amenorrhea and growth retardation in stature were very frequent in clinical manifestations of PPNAD.Plasma ACTH was undetectable,circadian rhythm of plasma cortisol was disappeared,glucocorticoid excretion was increased paradoxically during the dexamethasone suppression test in 50% patients with PPNAD.Adrenal imaging from 75% patients revealed normal-sized adrenal glands or suspectable micronodular changes.Adrenal pathologic analysis revealed numerous brown cortical nodules containing lipofuscin pigmentation.Unilateral adrenalectomy may relieve symptoms of Cushing's syndrome,but plasma ACTH and circadian rhythm of plasma cortisol were difficult to recovere.Hypercorticoidism might re-occure after unilateral adrenalectomy.Conclusion PPNAD should be bewared in ACTH independent Cushing's syndrome patients without apparent adrenal mass,and CNC should be screened and followed up.

The relationship between hyperlipidemia and lower limb arterial disease in elderly diabetes patients / 中华内科杂志

Objective To evaluate the correlation between hyperlipidemia and lower limb arterial disease in eldedy diabetic patients with color Doppler uhrasonography.Methods Two hundred and sixty elderly diabetic patients and 206 normal subjects were enrolled in the study.Doppler uhrasonographic manifestations of lower limb arterial disease,blood pressure and blood biochemistry parameters including fasting plasma glucose(FPG),postprandial plasma glucose(PPG),TC,TG,HLD-C,LDL-C,apoprotein B (apoB),very low density lipoprotein cholesterol(VLDL-C),apoprotein Al(apoA1)and fibrinogen(Fb)were compared between the 2 groups.Results (1)The blood biochemistry parameters,including the levels of FPG,PPG,TC,TG,VLDL-C,LDL-C,apoB and Fb were higher in diabetic patients t11an in normal subiects.while HDL-C was lower(all P＜0.05).(2)The thickness of intima-media(IMT)in the lower limb arterial disease group was significantly increased and the presence of arterial stenosis and wall plaques more in diabetic patients[IMT in 205 cases(78.85%),atherosclerotic plaque in 241 cases(92.69%),muhivessel disease(more than 2 vessels)in 60 cases(23.08%)and arterial stenosis in 89 cases (34.23%)]than in normal subjects[IMT in 37 cases(17.96%),atherosclerotic plaque in 51 cases (24.76%),muhivessel disease in 27 cases(13.11%)and arterial stenosis in 3 cases(0.01%)],all P＜0.01.(3)Regression analysis showed that lower limb arterial disease was correlated with high level of LDLC and low level of HDL-C.Conclusions Arteriosclerotic plaque is one of the early manifestations in elderly diabetic patients and hyperlipidemia may provide the basis of its formation.Doppler uhrasonographic examination of lower limbarterial discloses the early arteriosclerotic changes of lower limb arterial disease in elderly patients and offers the basic data of indication for clinical treatment.

Insulin resistance and adrenal androgen excess in adolescents with polycystic ovary syndrome / 中国糖尿病杂志

Objective To understand the correlation between insulin resistance(IR) and adrenal androgen excess in adolescents with polycystic ovary syndrome (PCOS). Methods According to BMI, 90 adolescents with PCOS were divided to groups of normal weight PCOS(NW-PCOS,33 cases,BMI<25.0 kg/m2) and obesity PCOS(OB-PCOS,57 cases, BMI≥ 25.0 kg/m2),and 15 normal weight healthy girls matched for age as controls.All patients had normal OGTT.Acute ACTH stimulating test was performed on patients, and cortisol (F), 17-hydroxyprogesterone(17-OHP), dehydroepiandrosterone(DHEA) during ACTH testing at 0 and 60 minute (steroid0 and steroid60) were determined. Results Compared with controls, NW-and OB-PCOS patients showed significantly greater levels of total testosterone (T), Luteotropic hormone(LH), FIns, 2 hIns, and HOMA-IR(P<0.01).The freqnencies of hirsuties and acne, and serum level of FIns, 2 hIns, and HOMA-IR were significantly higher and LH levels were much lower in the group of OB-PCOS than those in NW-PCOS(P<0.05 and P<0.01).ACTH stimulating test showed that PCOS patients had significantly higher levels of basal 17-OHP0, DHEA0, as well as 60-minute ACTH-stimulated levels (Steroid60) of 17-OHP60、DHEA60, and net increase of 17-OHP(Δ17-OHP)as compared with normal controls(P<0.05 and P<0.01).The 60-minute ACTH-stimulated levels of 17-OHP60, DHEA60,Δ17-OHP, and ΔDHEA were also higher in group of OB-PCOS than those in group of NW-PCOS(P<0.05 and P<0.01), and there were no obvious discrepancies in basal 17-OHP0, DHEA0 between OB-PCOS and NW-PCOS groups.Spearman correlation analysis showed that in group of OB-PCOS, HOMA-IR value was significantly associated with BMI, 17-OHP60, Δ17-OHP, DHEA60, ΔDHEA(P<0.05 and P<0.01); whereas in group of NW-PCOS, HOMA-IR was associated only with BMI(P<0.01). Conclusions The significantly higher basal and ACTH-stimulated levels of 17-OHP and DHEA indicates adrenal hyperresponsiveness in adolescents with PCOS.Adrenal androgen excess appears to be closely associated with insulin resistance in obese adolescents with PCOS

A neglected master on integrative medicine: Wei-Ju ZHU / 中西医结合学报

Through analyzing the academic ideas in Shanghan Zhinan written by Wei-Ju ZHU, a modern famous physician, it is pointed out that ZHU's achievement on integrative medicine has been overlooked. Taking the theory of syndrome differentiation of six channels from Shanghan Lun as an example, ZHU presumed that the essence of therapeutic theory of traditional Chinese medicine was to conform to or strengthen human body's self-healing and self-regulating abilities. Since Yangqi is the major force in the body to help heal disease when it occurred, ZHU often took measures to strengthen Yang first in treating disease and also was good at using hot-natured herbs, such as Radix aconiti lateralis preparata. ZHU's thoughts on integrative medicine were concerned with etiology, pathology and therapeutics. In addition, ZHU generalized the syndrome differentiation into the theory of five phases and eight principles, and made important contributions to the history of integrative medicine. His thinking will provide valuable revelation for clinical practice and modern research on traditional Chinese medicine.

Screening 21-hydroxylase deficiency carriers in androgen excess women of Chinese Han nationality / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To gain a primary understanding of the prevalence of 21-hydroxylase deficiency(21-OHD) heterozygote (carrier) among androgen excess women of Chinese Han nationality, compare the molecular genetic changes therein revealed with the results of adrenocorticotropic hormone (ACTH) stimulating test, and assess the carriers' phenotype-genotype correlation.</p><p><b>METHODS</b>Eighty-two androgen excess cases and 14 healthy women underwent ACTH stimulating test during the follicular phase. Molecular genetic analysis of CYP21 for 9 common mutations was performed with the method of amplification-created restriction sites.</p><p><b>RESULTS</b>In androgen excess group, the basal level of F0 (P<0.01), as well as basal 17-OHP0 and the ACTH stimulated concentrations of 17-OHP60 were much higher than controls (P<0.01), and there was no obvious discrepancy in F60 (P>0.05). The net increase of 17-OHP and the ratio of net increase of 17-OHP to net increase of F were also higher than controls (P<0.01). No CYP21 gene mutations were found in control group. Four patients of the androgen excess group were identified as heterozygous carriers of CYP21 mutations. The ACTH stimulating test results from gene normal patients and from carriers overlapped to a certain extent.</p><p><b>CONCLUSION</b>Among 82 patients of Chinese Han nationality androgen excess women, 4.9% were 21-OHD heterozygous. The response of serum 17-OHP is not useful for predicting CYP21 gene mutation carrier status. Genotyping is the most reliable method to detect carrier.</p>

Discussion of ShangHanLun's emergency medical principles / 中华中医药杂志

'Man-Langzhong'is a description for the general impression people have for traditional Chinese medicine.Chinese medicine does in fact emphasize the maintenance of one's health,and promotes taking precautions in order to prevent sickness.But through observations found in Shanghanlun's philosophies,taking into consideration the linguistic views and the world views of the East and the West,we have discovered that this general concept people have for Chinese medicine is inaccurate.This essay raised the notion that'Chinese medicine practices its philosophies and medical procedures based on emergency support and preventative medical science'.

Study of acupuncture treatment for ischemic cerebrovascular disease by random,control and blind methods with clinical literature / 中华中医药杂志

Objective:It was a part of an overall study of the clinical research literature about ischemic cerebrovascular disease treated by various acupuncture techniques,namely "restoring consciousness and inducing resuscitation technique","needling Baihui(DU20) through Qubin(GB7)","Jiao’s three-needle technique" and "temporal three-needle technique".The papers collection for analysis were designed on the random,control and blind methods.Methods: A data bank was set up with Access 2003.A statistical analysis was made for the method of employing ratio and constituent ratio about the research literature mamaged with the ramdom,control and blind methods.Results: The ratio of those that were designed randomly is as follows: the "restoring consciousness and inducing resuscitation technique"(50%),"needling Baihui(DU20) through Qubin(GB7)"(100%)(Only two articles meet the request and futher exploration is needed),and the "temporal three-needle technique"(50%).And the "Jiao’s three-needle technique"(40%).The ratio of those that were designed with the control method is as follows: the "restoring consciousness and inducing resuscitation technique"(60%),"needling Baihui(DU20) through Qubin(GB7)"(100%)(Only two articles meet the request and further exploration is needed,the "temporal three-needle technique"(75%),and "Jiao’s three-needle technique"(70%).The blind method was not used.Conclusion: It is suggested that the three methods should be stressed in the study of acupuncture in the treatment of ischemic cerebrocvascular disease.Only in this way,can there be a maximum comparability and the sampling error is decreased.The bias due to subjective factors of the researchers and subjects can be overcome.

Evaluation of correlations between hyperlipidemia and carotid arthrosclerosis manifestations in elderly diabetes patients / 中华老年医学杂志

Objective To evaluate the correlation of hyperlipidemia and carotid arthrosclerosis manifestations on color Doppler ultrasonography and dynamics of elderly diabetes patients. Methods One hundred and fifty elderly diabetes patients and 106 normal subjects were enrolled in the study. The carotid color Doppler ultrasonography and blood sugar, TC, TG, HDL-C, apoB,VLDL, apoA I, apoB were examined and compared between the two group. Results The blood sugar, TC, TG, HDL-C, apoB, VLDL, apoA I, apoB were increased in diabetes patients which were higher than in normal subjects (P

THE NEGATIVE FEEDBACK REGULATION OF PITUITARY N-POMC SECRETION BY GLUCO CORTICOIDS WAS BLUNTED IN CUSHING'S DISEASE / 中华内分泌代谢杂志

The effect of hydrocortisone (135 nag i.v. as a bolus) on the levels of serum N-POMC was studied in the patients with Cushing's disease [including three groups: untreated (CD, n=8), post-adrenolectomy without Nelson's syndrome (CDA, n=5), and Nelson's syndrome (NS, n=4)]; Addison's disease (AD, n = 13) and congenital adrenal hyperplasia (CAH, n=4). The results showed that the levels of serum N-POMC were decreased after the administration of hydrocortisone in all three groups of Cushing's disease, however the suppression rate of N-POMC was much lower in these groups than that in AD and CAH (P

Hypercortisolism and psychosis / 中华内分泌代谢杂志

Objective To studytherelationshipbetweenhypercortisolismand psychosis. Methods According to pathologic diagnosis, 133 cases of hypercortisolism were dividedinto adrenal lesion group, pituitary adenoma group and ectopic ACTH tumor group, and the relationship between hypercortisolism and psychosis was analyzed. Results (1) There were significant differences between groups regarding cortisol levels and the amplitude of fluctuation. (2) Depression and mania were the main manifestations of psychosis in the patients, and 79.7% of the patients showed symptoms of depression. (3) In ectopic ACTH tumor group, the level and the increased amplitude of 24 h urinary free cortisol were significantly higher than those in the other two groups, all the patients had severe depression, and the rate of suicide tendence (58.3%) was significantly higher than the other two groups. Conclusions (1) Psychosis has a close relationship with hypercortisolism,especially with the marked fluctuation in cortisol level. (2) Sufficient attention should be paid to this relationship, which will improve the diagnosisand treatment of hypercortisolism.

Gitelman′s syndrome (report of 2 cases) / 中华内分泌代谢杂志

Objective To study the clinical characteristics of Gitelman′s syndrome, and the differentiation of Gitelman′s syndrome from Bartter′s syndrome. Methods Clinical data of 2 patients diagnosed as Gitelman′s syndrome were retrospectively analysed. Results The symptoms of both patients appeared at adult age, their main manifestation included hypokalaemic alkalosis, hyperreninemia and juxtaglomerular apparatus hyperplasia with normal blood pressure, hypocalciuria and hypomagnesemia, then the diagnosis of Gitelman′s syndrome was established. Potassium and magnesium supplementation ameliorated one patient′s symptom. Another patient treated with indomethacin, serum potassium was recovered to normal level. Conclusion Gitelman′s syndrome and Bartter′s syndrome appear to be similar in the pathogenesis, clinical manifestation and prognosis, but still show some differences, Gitelman′s syndrome should be carefully differentiated from Bartter′s syndrome.

Study on clinical characteristics of hypertension in patients with Cushing′s syndrome / 中华内分泌代谢杂志

25 years group. Among 129 cases who had taken antihypertensive drugs before operation, only 43 cases continued to use drugs after operation, therefore, rate of antihypertensive drugs administration decreased significantly after operation (P

AN ANALYSIS OF THE EFFECT OF TRANSSPHENOIDAL PITUITARY MICROSURGERY FOR CUSHING DISEASE / 中华内分泌代谢杂志

From the beginning of 1980 to the end of 1992, 125 patients with Cushing disease were undergone transsphenoidal microsurgery. 41 patients were operated by selective adenoma resection and 62 patients by radical surgery. 103 cases were available to be analyzed. The results of a long-term follow-up showed: (1) The cure rates were 63. 1% and 48.1% with positive and negative pathological study, respectively. (2) The cure rates were 72.6% and 41. 5% with radical and selective surgery respectively. In cured patients the plasma cortisol level dropped to normal or subnormal within 48 hours after the surgery. However, in uncured patients, it was still above the normal. After operation, 1. 6% of cases (1/60) had secondary hypothyroidism and 62.5 % of cases (30/48) who had abnormal menstruation preoperatively restored normal menstrual cycle. The recurrent rate was 11.4%. Conclusion: (1) The outcome of radical surgery is better than the selective adenoma resection; (2) The pathological study and the analysis of the plasma cortisol level within 48 hours after the surgery may have predictive value for efficacy of the surgery.

SERUM LEVELS OF N-TERMINAL PEPTIDE OF PRO-OPIOMELA-NOCORTIN (N-POMC) IN PATIENTS WITH PITUITARY-ADRENAL DISORDERS AND IN NORMAL SUBJECTS / 中华内分泌代谢杂志

Serum N-POMC levels were measured by a specific, sensitive and homogeneous radioimmunoassay (RIA). The morning (8AM) serum N-POMC levels in patients with pituitary-dependent Cushing's disease (624.4 ? 196.2 pg/ml, n = 25) were significantly higher than that of normal (182.9?78.2 pg/ml,n = 67) and of obese subjects (164.5 ? 86.4 pg/ml, n = 20) (p