Effectiveness of Thermal Ablation for Aldosterone-Producing Adrenal Adenoma: A Systematic Review and Meta-Analysis of Clinical and Biochemical Parameters

PurposeTo assess the effectiveness of thermal ablation for aldosterone-producing adrenal adenoma.Materials and MethodsA systematic search of the PubMed and CINAHL databases was performed to identify studies of thermal ablation for adrenal adenomas. Random effects meta-analysis models were used to compare pre- and post-treatment values of the following outcomes: systolic blood pressure (SBP), diastolic blood pressure (DBP), use of antihypertensive medications, and biochemical parameters (plasma aldosterone levels, aldosterone-to-renin ratio, and potassium levels). The rate of hypertension (HTN) resolution and improvement were also evaluated.ResultsA total of 89 patients from 7 studies were included in the analysis. The mean postablation follow-up duration was 45.8 months. Pooled data analysis revealed a statistically significant decrease in SBP (−29.06 mm Hg; 95% confidence interval [CI], −33.93 to −24.19), DBP (−16.03 mm Hg; 95% CI, −18.33 to −13.73), and the number of antihypertensive medications used (−1.43; 95% CI, −1.97 to −0.89) after ablation. Biochemical parameters had returned to normal ranges after ablation in all studies. The cumulative rate of resolution or improvement in HTN status was 75.3%. On metaregression analysis, there was no statistically significant association between postablation blood pressure changes or serum aldosterone levels and study follow-up duration.ConclusionsThermal ablation for aldosterone-producing adrenal adenoma can be effective in controlling blood pressure, reducing the need for antihypertensive medications, and normalizing hormone secretion. Further higher-quality evidence is needed to confirm these results.     

多相胃肠道造影和腹部CT扫描在诊断及评估小肠恶性肿瘤可切除的价值

目的：探讨多相胃肠道造影和CT扫描在小肠恶性肿瘤诊断和可切除性中的应用价值。资料与方法：小肠恶性肿瘤50例，包括腺癌16例，非霍奇金淋巴瘤14例，平滑肌肉瘤5例，转移癌15例，先后行多相胃肠造影和腹部CT扫描检查，所得图像分别由3位放射科医师进行评价。结果：50例小肠恶性肿瘤多相胃肠检查敏感性100％，准确性88％。CT扫描检查敏感性94％，准确性90％。两种方法相结合准确性100％。CT扫描评估手术可切除敏感性86％，不可切除敏感性85％。结论：多相胃肠道造影检查和腹部CT扫描结合应用可作为小肠恶性肿瘤诊断和评估可切除性必要的检查方法。     

假性甲状旁腺机能减退综合征5例报道及文献复习

目的 探讨假性甲状旁腺机能减退综合征的X线表现和诊断方法。资料与方法 回顾分析5例经临床和实验室证实的典型病例的手、足、颅骨X线表现并文献复习。结果 掌（跖）指（趾）骨对称性不成比例短缩畸形5例，颅内基底节和脑实质钙化3例，骨质疏松，颅板增厚、板障变窄，下颌角变浅各2例。结论 掌（跖）指（趾）骨对称性不成比例短缩畸形，尤其是第415掌骨和拇指末节指骨变短是该病特征性X线表现，结合临床表现和实验室检查发现低血钙、高血磷，甲状旁腺激素（PTH）含量正常或升高，且应用PTH治疗无效可确诊。     

Secretin-stimulated magnetic resonance imaging/magnetic resonance cholangiopancreatography for the detection of chronic pancreatitis: A meta-analysis

ObjectiveTo evaluate the diagnostic accuracy of secretin-stimulated magnetic resonance imaging/magnetic resonance cholangiopancreatography (S-MRI/MRCP) as noninvasive modalities in detecting chronic pancreatitis (CP).MethodsA systematic literature search in the PubMed, EMBASE, Web of Science, Cochrane, and Chinese Biomedical Literature Databases to identify relevant original studies. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (version 2). Study data were independently extracted to calculate sensitivity and specificity, as well as areas under summary receiver operating characteristic curves (AUCs), and to test for heterogeneity and the threshold effect.ResultsThe sample comprised 11 studies including 180 patients with CP and 340 patients without CP. Pooled sensitivity and specificity were 0.72 (95% confidence interval [CI] 0.65–0.78) and 0.87 (95% CI 0.83–0.90), respectively. Pooled positive and negative likelihood ratios were 4.99 (95% CI 2.59–9.61) and 0.32 (95% CI 0.19–0.54), respectively. The diagnostic odds ratio was 23.31 (95% CI 7.50–72.44). The AUC and Q¹ index were 0.8631 and 0.7937, respectively. Publication bias was absent (P = 0.64).ConclusionsS-MRI/MRCP had low sensitivity and moderately high specificity for the detection of CP. Large-scale, quality-controlled, prospective studies are needed to verify the diagnostic accuracy of these modalities.     

Systemic sclerosis: Genetics and epigenetics

Systemic sclerosis (SSc) is an autoimmune disease characterized by immune abnormalities, vascular obliteration, excessive extracellular matrix deposition, and fibrosis of the skin and/or internal organs. To date, the exact etiology of this complicated disease remains unknown. Over the past few years, however, the role of genetic susceptibility and epigenetic modifications caused by environmental factors have been intensively studied in relation to the pathogenesis of this disease, and important advances have been made. This review focuses on the recent progress in the field of SSc research, including HLA and non-HLA susceptibility genes identified in genome-wide association studies (GWAS), and aberrant epigenetic modifications of gene loci associated with SSc. HLA genes most closely linked with SSc susceptibility include HLA-A, -B, -C, -DR, -DP and -DQ. A large number of non-HLA genes were also reported. It has also been noted that different genetic variants can be linked to specific clinical patterns. Finally, DNA demethylation of regulatory genes (eNOS, CD40L and CD70), therapeutic effects associated with Trichostatin A (TSA) treatment, and abnormal expression of a large spectrum of microRNAs (miR-21, -31, -146, -503, -145, -29b, etc.) are all observed in SSc.Overall, the findings presented in this review illustrate how both genetic and epigenetic aberrations play important roles in the development of SSc; however, several unanswered questions continue to impede our understanding of this complex disease. Future research should focus on the identification of new biomarkers for early diagnosis and prognosis, which will help improve the clinical outcome of patients with SSc.     

The relationship between impulsivity and Internet addiction in a sample of Chinese adolescents.

OBJECTIVE: Previous studies regarding Internet addiction have investigated associated psychological variables such as shyness, loneliness, self-consciousness, anxiety, depression and interpersonal relations. Few studies about the relationship between Internet Addiction and impulsivity have been done. This study aimed to assess whether Internet addiction is related to impulsivity among Chinese adolescents. METHOD: This study was performed in two stages. We screened for the presence of Internet Addiction among 2620 high school students(age ranging from 12years to 18years) from four high schools of Changsha City using Diagnostic Questionnaire for Internet Addiction (YDQ). According to the modified YDQ criteria by Beard, 64 students were diagnosed as Internet addiction. Excluding current psychiatric comorbidity, 50 students who were diagnosed as Internet Addiction (mean age, 14.8+/-1.4years) and 50 normal students in Internet usage(mean age, 14.5+/-1.8years) were included in a case control study. The two groups were assessed using Barratt Impulsiveness Scale 11 (BIS-11) and behavioral measure of impulsivity (GoStop Impulsivity Paradigm). RESULTS: Sixty-four students met the modified YDQ criteria by Beard, of whom 14 students suffered from comorbid psychiatric disorders, especially comorbid ADHD. The Internet Addiction group had significantly higher scores on the BIS-11 subscales of Attentional key, Motor key, and Total scores than the control group (P<0.05). The Internet Addiction group scored higher than the control group on the failure to inhibit responses of GoStop Impulsivity Paradigm (P<0.05). There was a significant positive correlation between YDQ scores and BIS-11subscales and the number of failure to inhibit responses of GoStop Impulsivity Paradigm. CONCLUSION: This study suggests that adolescents with Internet addiction exhibit more impulsivity than controls and have various comorbid psychiatric disorders, which could be associated with the psychopathology of Internet addiction.     

新型冠状病毒感染者脊柱外科急诊手术的围手术期管理专家共识

自2019年12月以来,已有200余个国家和地区相继报道了新型冠状病毒感染病例,世界卫生组织（WHO）于2020年3月12日宣布新型冠状病毒全球大流行,截至6月18日,全球已累计有824万余人感染,44万余人死亡,对全世界医疗、政治和经济领域影响巨大^［1-2］。WHO将其命名为“2019冠状病毒感染性疾病”（COVID-19）,病原体被命名为重症急性呼吸综合征冠状病毒2（SARS-CoV-2）^［3-6］。按照《中华人民共和国传染病防治法》,COVID-19被纳入乙类传染病,采取甲类传染病的预防控制措施^［7］。     

Telencephalin protects PAJU cells from amyloid beta protein-induced apoptosis by activating the ezrin/radixin/moesin protein family/phosphatidylinositol-3-kinase/protein kinase B pathway

Telencephalin is a neural glycoprotein that reduces apoptosis induced by amyloid beta protein in the human neural tumor cell line PAJU. In this study, we examined the role of the ezrin/radixin/moesin protein family/phosphatidylinositol-3-kinase/protein kinase B pathway in this process. Western blot analysis demonstrated that telencephalin, phosphorylated ezrin/radixin/moesin and phosphatidy-linositol-3-kinase/protein kinase B were not expressed in PAJU cells transfected with empty plasmid,while they were expressed in PAJU cells transfected with a telencephalin expression plasmid. After treatment with 1.0 nM amyloid beta protein 42, expression of telencephalin and phosphorylated phosphatidylinositol-3-kinase/protein kinase B in the transfected cells gradually diminished, while levels of phosphorylated ezrin/radixin/moesin increased. In addition, the high levels of telencephalin,phosphorylated ezrin/radixin/moesin and phosphatidylinositol-3-kinase/protein kinase B expression in PAJU cells transfected with a telencephalin expression plasmid could be suppressed by the phosphatidylinositol-3-kinase inhibitor LY294002. These findings indicate that telencephalin activates the ezrin/radixin/moesin family/phosphatidylinositol-3-kinase/protein kinase B pathway and protects PAJU cells from amyloid beta protein-induced apoptosis.     

集中隔离医学观察场所感染防控专家共识

 为科学指导新型冠状病毒肺炎(以下简称新冠肺炎, COVID-19)疫情期间集中隔离医学观察场所内感染防控工作, 在早期有效识别感染者的同时, 有效避免集中隔离医学观察场所内的交叉感染, 中华预防医学会医院感染控制分会、中国医院协会医院感染管理专业委员会、中国感染控制杂志编辑部组织有关专家共同制定本共识。本共识适用于确诊病例、疑似病例、无症状感染者的密切接触者、密切接触者的密切接触者, 以及入境人员或其他根据防控工作需要"应隔尽隔"人员开展集中隔离医学观察时所设置的集中隔离医学观察场所, 指导其工作人员正确做好个人防护及防止感染传播工作, 避免发生场所内感染及传播。本共识借鉴医疗机构内新型冠状病毒感染防控的基本原则、文件规范, 结合集中隔离医学观察场所的特点与实际工作情况, 对不同区域工作人员、工作环节开展新型冠状病毒传播的风险评估, 并据此对集中隔离医学观察场所的感染防控组织架构、选址布局、人员防护、人员闭环管理、清洁消毒、环境核酸监测、人员健康监测、职业暴露处理及交叉感染判定原则等感控相关工作给予指导。