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25 October 2020, Volume 19 Issue 05 Previous Issue    Next Issue

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Diagnostic value of measuring the plasma renin and aldosterone by chemiluminescence immunoassay in the primary aldosteronism CHENG Yibang, LI Mingxuan, CHEN Bo, CAO Sheng, JIANG Gonghao, XU Jianzhong, LI Yan, WANG Jiguang 2020, 19 (05):  474-480.  DOI: 10.16150/j.1671-2870.2020.05.006 Abstract ( 357 )   HTML ( 4 )   PDF (799KB) ( 227 )   Objectives: To verify the accuracy of measuring the plasma renin and aldosterone by chemiluminescence immunoassay (CLIA) and assess its diagnostic efficacy in primary aldosteronism (PA). Methods: The plasma renin and aldosterone level were detected in out-and in-patients using CLIA, enzyme-linked immunosorbent assay(ELISA) and radioimmunoassay, and the intravenous saline infusion test was conducted as confirmatory test. The consistence among three tests was assessed with Pearson correlation analysis and Bland-Altman analysis. The aldosterone and renin level detected by CLIA were used to calculate aldosterone to renin ratio (ARR). The receiver operator characteristic curve （ROC curve） was performed to determine the optimized ARR cut-off value and the area under ROC curve (AUC) for diagnosing PA. Results: The aldosterone and renin concentration detected by CLIA were significantly correlated with the results tested by ELISA(rennin and aldosterone concentration) and radioimmunoassay (renin activity and aldosterone concentration) respectively（r≥0.67, P<0.01; r≥0.79, P<0.01）. Compared with that by CLIA using blood collection tube with the enzyme inhibitor, rennin concentration by CLIA using blood collection tube without enzyme inhibitor had a better correlation with renin activity by radioimmunoassay (correlation coefficient: 0.80 vs. 0.67, P<0.01). In 45 hypertension patients, the AUC of ARR acquired by CLIA for diagnosing PA was 0.91 and the optimized ARR cut-off value was 18.26 [(pg/mL)/(pg/mL)], and both sensitivity and specificity were 86.7%. Conclusions: CLIA could be used for clinical PA screening as a reliable detective method since it has high accuracy of measuring plasma renin and aldosterone. Figures and Tables | References | Related Articles | Metrics

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Clinical manifestation and gene mutation of multiple endocrine neoplasia 2A: analysis of a pedigree data LIN Xiaoyun, QI Luyue, ZHANG Zhenlin, YUE Hua 2020, 19 (05):  481-486.  DOI: 10.16150/j.1671-2870.2020.05.007 Abstract ( 246 )   HTML ( 0 )   PDF (724KB) ( 52 )   Objective: To analyze the clinical characteristics, gene mutation of a pedigree diagnosed with multiple endocrine neoplasia 2A (MEN2A) and comprehensively review the related literature. Methods: The proband was a 33-year-old female,and the clinical data of the pedigree was collected. The genomic DNA was extracted from peripheral blood withdrawn from the proband and family members, and coding region of RET gene was analyzed by Sanger sequencing.Three hundred unrelated healthy volunteers were enrolled as controls. Pathogenicity and conservativeness analysis were carried on the detected mutant gene. Results: The blood biochemical examination of the proband showed the increased calcium (3.25 mmol/L), parathyroid hormone(1 252 ng/L) and calcitonin (37.24 ng/L) in serum. The presence of unilateral parathyroid adenoma and medullary thyroid carcinoma(MTC) were confirmed by postoperative pathology. Sanger sequen-cing identified that a heterozygous missense mutation in exon 11 of RET gene c.1901G>A in proband led to p.Cys634Tyr. The pathogenic gene came from the mother, while the healthy sister or the controls did not show the same mutation. Conclusions: The proband with MEN2A is caused by a missense mutation in exon 11 of RET gene (c. 1901G> A). The diagnosis of MEN2A depends on the detection of RET gene mutation. Early surgical intervention is the best treatment choice for MEN2A patients. Postoperative follow-up of the recurrence of MTC is the key to assessing the prognosis in MEN2A patients. Screening RET gene mutation in the fetus of proband with RET mutation is necessary, and intervention as early as possible may decrease the incidence and mortality of MEN2A. Figures and Tables | References | Related Articles | Metrics

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Accuracy of home versus ambulatory blood pressure monitoring in the diagnosis of white-coat and masked hypertension LI Zhoutong, ZHANG Wei, WANG Jiguang 2020, 19 (05):  487-493.  DOI: 10.16150/j.1671-2870.2020.05.008 Abstract ( 249 )   HTML ( 5 )   PDF (647KB) ( 106 )   Objective: To investigate accuracy of home blood pressure (BP) monitoring in the diagnosis of white-coat and masked hypertension in comparison with ambulatory BP monitoring. Methods: Participants were patients enrolled in the China Ambulatory and Home BP Registry, and underwent clinic, home, and 24 h ambulatory BP measurements. White-coat hypertension was defined as an elevated clinic systolic/diastolic BP (≥140/90 mmHg) and a normal 24 h ambulatory (<130/80 mmHg) or home systolic/diastolic BP (<135/85 mmHg), while masked hypertension as a normal clinic systolic/diastolic BP (<140/90 mmHg) and an elevated 24 h ambulatory (≥130/80 mmHg) or home systolic/diastolic BP (≥135/85 mmHg). Results: In untreated patients (n=200), the prevalence of white-coat hypertension (10.0% vs 17.0%), masked hypertension (26.5% vs 14.5%) significantly (P=0.04) differed between 24 h ambulatory and home BP monitoring. Regardless of the treatment status, compared with 24 h ambulatory BP, home BP measurement had low sensitivity (range 43%-86%) but high specificity (91%-99%), and accordingly low positive predictive values (46%-91%) but high negative predictive values (84%-100%). These two modalities had moderate diagnostic agreement (81%-90%) and Kappa statistic (0.43-0.78). Conclusion: Home BP monitoring has high specificitybut low sensitivity in the diagnosis of white-coat and masked hypertension. It may behave as a complementary to, albeit not a replacement of ambulatory BP monitoring. Figures and Tables | References | Related Articles | Metrics

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Feasibility study on the portal vein imaging using non-contrast-enhanced magnetic resonance angiography with flow inversion recovery sequence in the cirrhotic portal hypertension WANG Lijuan, PAN Zilai, SU Wenting, XU Jingci, RAO Min, LIU Xiao 2020, 19 (05):  494-498.  DOI: 10.16150/j.1671-2870.2020.05.009 Abstract ( 171 )   HTML ( 1 )   PDF (686KB) ( 62 )   Objective: To compare the efficacy of the non-contrast-enhanced magnetic resonance angiography (NC-MRA) with flow inversion recovery (FIR) sequence and contrast enhancement MRA(CE-MRA) on portal vein imaging in the cirrhotic portal hypertension. Methods: Twenty patients diagnosed as the cirrhotic portal hypertension by the clinical criteria or radiology were enrolled, and CE-MRA with fast field echo 3D coronal imaging and NC-MRA with FIR were performed to display the portal vein system, respectively. The imaging quality of the portal vein, splenic vein and superior mesenteric vein in the portal vein system on NC-MRA was compared with CE-MRA, and the signal-to-noise ratios of images the were calculated. Results: The width of the main portal vein and splenic vein measured by NC-MRA was not different from CE-MRA(P value was 0.330 and 0.090, respectively), and the scores of the imaging quality in splenic vein and proximal superior mesenteric vein had no difference either(P=0.677, P=0.077）. The imaging quality showed the clarity and the smooth degree in the portal vein and the branches of grade 1-2 on NC-MRA was superior to CE-MRA. However, the cases with image quality score ≥3 detected by NC-MRA were less than CE-MRA (9 vs 17, P=0.008), indicating CE-MRA had advantage in displaying distal veins over NC-MRA. The signal intensity and signal-to-noise ratios on NC-MRA were higher than CE-MRA(P=0.040, P<0.01). Conclusions: The NC-MRA with FIR sequence could clearly display the main blood vessels of the portal vein system in patients with the portal hypertension and shows similar efficacy as CE-MRA. NC-MRA with FIR sequence could be used as a safe and invasive method for displaying the portal vein system in spite of the lower efficacy on displaying distal veins. Figures and Tables | References | Related Articles | Metrics

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Five cases of the malignant melanoma with serosal effusion: the clinical and pathological analysis YANG Qiao, WEN Yuting, YANG Changwei 2020, 19 (05):  499-503.  DOI: 10.16150/j.1671-2870.2020.05.010 Abstract ( 140 )   HTML ( 0 )   PDF (773KB) ( 72 )   Objective: To study the clinical manifestations, cytopathological diagnosis and differential diagnosis of the malignant melanoma with serosal effusion. Methods: Five cases of malignant melanoma diagnosed by the cytology of serosal effusion in XijingHospital were enrolled. The cytology of serosal smear and the immunocytochemical staining of the paraffin-embedded section prepared from centrifugation of the serous effusion were studied, and the clinical feature and prognosis of the patients were analyzed. Results: Five cases included 2 males and 3 females, the age of onset ranged from 30 to 71 years and the average age was 48.6 years. Three cases had pleural effusion and 2 cases had intraperitoneal effusion. Five cases were diagnosed as malignant melanoma by morphological observation in the serosal smear and immunocytochemistry examination(all case was positive for HMB45, S-100, Pan-mel, SOX10 and vimentin). All patients were followed up until April 2020, with a follow-up period of 2 to 11 months. In 5 cases, three died, one survived and one was lost during follow-up. Conclusions: The serous cavity effusion caused by malignant melanoma is very rare, and the diagnosis is not difficult since most cases have clear history. The malignant melanoma diagnosed by the cytology of serosal effusion need to be differentiated with the poorly differentiated adenocarcinoma, lymphoma, and malignant mesothelioma. Centrifugation of the serosal effusion and immunocytochemical staining is helpful to make diagnosis. It is important to confirm the diagnosis by performing cytological examination of serous effusion accurately and timely because of the low survival rate of metastatic malignant melanoma. Figures and Tables | References | Related Articles | Metrics

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Detection rate of colorectal adenoma in the asymptomatic population of 40 to 59 years and its relationship with the detected gastric polyps in Shanghai XU Chenying, XU Qingling, TANG Chenyue, YU Lifen 2020, 19 (05):  504-509.  DOI: 10.16150/j.1671-2870.2020.05.011 Abstract ( 214 )   HTML ( 1 )   PDF (549KB) ( 148 )   Objective: To investigate the detection rate of colorectal adenoma and gastric polyps in the asymptomatic population with the age of 40 to 59 years and to explore whether the patients with gastric polyps were the new target population for the colorectal cancer (CRC) screening. Methods: A total of 11 918 subjects of 40 to 59 years (5 616 males and 6 302 females) with the average risk of CRC were included during January 2015 to December 2018 at the endoscopy center of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. All the subjects underwent colonoscopy and volunteered to undergo esophagogastroduodenoscopy (EGD), and were grouped by the age interval of 5 years and gender. The patients with gastric polyp (GP group) and with EGD negative results (EGD negative group) were enrolled based on the pathological biopsy results, and the clinical characteristics and detection rate of colorectal polyp, adenoma and advanced adenoma were compared between two groups. Results: The overall detection rate of colorectal poly,adenoma,and advanced adenoma were 10.7%, 15.4%, and 3.6%, respectively. For the male subjects, the detection rates of colorectal polys, adenoma, and advanced adenoma were 14.0%, 19.8% and 4.7%, respectively,while for the female subjects, the corresponding rates were 7.6%, 11.4% and 2.7%. The detection rate of colorectal adenoma was significantly higher in the GP group than in the EGD negative group (16.7% vs 11.7%) (P<0.001). In the GP group, the detection rate of colorectal adenoma in the males of 45 to 49 years was significantly higher than the males of 40 to 44 years (26.7%, 28/105 vs. 14.6%, 15/103) (P=0.031), but was similar to the rates in the males of 50 to 54 years (18.8%, 29/154) and 55 to 59 years (26.3%, 41/156). However, the colorectal adenomas were less common in women of 40 to 44 years(7.6%, 10/132) and 45 to 49 years (11.2%, 21/187). Conclusions: The detection rate of asymptomatic colorectal adenoma in the population of 40 to 59 years was 3.6%. Male patients of 45 to 49 years having gastric polys with the average risk of CRC are a new target population for colonoscopy screening. Figures and Tables | References | Related Articles | Metrics

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Expression of microRNA-337-3p in oral squamous cell carcinoma and its clinical significance ZHANG Xingming, GU Wenli 2020, 19 (05):  510-515.  DOI: 10.16150/j.1671-2870.2020.05.012 Abstract ( 140 )   HTML ( 0 )   PDF (729KB) ( 44 )   Objective: To investigate the expression of microRNA (miRNA)-337-3p in oral squamous cell carcinoma (OSCC) and its clinical significance. Methods: The expression of miRNA-337-3p in OSCC cancer and paracancerous tissue of 20 OSCC patients was determined, and the correlation of miRNA-337-3p expression with clinical-pathological parameter was analyzed. Scratch test was performed to detect the effect of miRNA-337-3p on migration ability of OSCC cell line HN30 cells, and the possible molecular mechanism was explored. Results: Expression of miRNA-337-3p in OSCC was significantly lower than that in paracancerous tissue(P<0.000 1), and was correlated significantly with the status of lymph node metastasis (P<0.05). Patients with lymph node metastasis (N1+N2) had a lower expression level of miRNA-337-3p than those without lymph node metastasis (N0). Overexpression of miRNA-337-3p in HN30 cells inhibited cell migration, whereas suppression of miRNA-337-3p led to increase of cell migration. miRNA-337-3p could inhibit the expression of matrix metalloproteinase-14 (MMP-14). Conclusions: miRNA-337-3p plays a suppressive role in OSCC, inhibitingthe invasion and metastasis of OSCC cells, and is expected to be used as a biomarker for assessing the invasion and metastasis of OSCC and helping the monitoring of prognosis. Figures and Tables | References | Related Articles | Metrics

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The quantitative measurement of morning voided urinary gonadotropin in diagnosis of rapidly progressive central precocious puberty in prepubertal girls MA Xiaoyu, YANG Yuanyan, LU Wenli, NI Jihong, WANG Junqi, CHEN Ye, QIN Xueyan, DONG Zhiya, WANG Wei 2020, 19 (05):  516-520.  DOI: 10.16150/j.1671-2870.2020.05.013 Abstract ( 181 )   HTML ( 1 )   PDF (529KB) ( 95 )   Objective: To explore a approach of differentiating rapidly progressive central precocious puberty (RP-CPP) from slowly progressive central precocious puberty(SP-CPP) in girls. Methods: Girls showing breast development before 8-year-old were enrolled. On the first visit, the lutropin hormone（LH） and follicle-stimulating hormone（FSH） in serum were quantitatively detected by lutropin hormone releasing hormone（LHRH） stimulating test, LH and FSH in urine were tested by quantitative determination Kits. Among enrolled girls, fifty-three were diagnosed as central precocious puberty (CPP). The patients were divided into SP-CPP (30 girls) and RP-CPP (23 girls) groups after 6 month-follow-up for pubertal advancement, height acceleration, and bone age maturation. The levels of LH and FSH in serum and urine as well as related parameters were compared between RP-CPP and SP-CPP groups. Results: Serum LH peak, the ratio of LH peak/FSH peak (the ratio of LH/FSH peak) and urinary FSH(UFSH) level showed reference value in differentiating RP-CPP from SP-CPP, While morning urinary LH (ULH) and urinary FH/FSH ratio were not different between RP-CPP and SP-CPP girls. Compared with SP-CPP subjects, RP-PP ones had significantly increased serum LH peak [（18.06±3.68） IU/L vs. (7.58±2.50） IU/L, P<0.001] and serum LH/FSH peak ratio（1.67±1.08 vs. 0.97±0.43, P=0.014） and decreased UFSH[（4.34±1.52） IU/L vs. 7.60±1.20）IU/L, P=0.007]. The diagnostic efficacy of indices mentioned above were assessed with receiver operator characteristic （ROC） curve. It showed that the sensitivity and specificity of serum LH peak (cutoff 9.68 IU/L) for differentiating RP-CPP from SP-CPP were 76.9% and 87.0% respectively, and serum LH/FSH peak ratio (cutoff value 1.24) were 69.2% and 73.9%. Morning UFSH （cutoff value 5.91 IU/L）for prospectively diagnosing RP-CPP had a sensitivity of 76.9% and a specificity of 78.3%, which had similar efficacy as serum LH peak and serum LH/FSH peak ratio. Conclusions: Quantitative measurement of morning voided urinary gonadotropin is a noninvasive and reliable approach to diagnose RP-CPP prospectively, and UFSH measurement on the first visit has reference value in prospective diagnosis. Figures and Tables | References | Related Articles | Metrics

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Application value of noninvasive ocular surface analyzer in diagnosis of dry eye CHEN Yan, WU Yanlin, ZHANG Qiong 2020, 19 (05):  521-524.  DOI: 10.16150/j.1671-2870.2020.05.014 Abstract ( 277 )   HTML ( 6 )   PDF (477KB) ( 138 )   Objective: To analyze the application value of noninvasive ocular surface analyzer in the diagnosis of dry eye. Methods: A total of 150 patients suspected of dry eye from December 2017 to December 2018 were enrolled. All the patients were examined with noninvasive ocular surface analyzer(non-invasive method), and traditional invasive examination was then performed. The detection rate of tear film abnormality was compared between the two methods. Pearson and Spearman analysis was used to analyze the relationship between results of noninvasive method and indice of dry eye. Results: The detection rate of tear film abnormality by non-invasive method (90.67%) was significantly higher than that by traditional invasive examination(74.67%)(P<0.05). Tear break-up time (TBUT) by traditional invasive examination was positively correlated with the noninvasive tear break-up time (NITBUT) (r=0.88, P<0.01）. Schirmer I test (SIT ) by traditional invasive examination was positively correlated with NITBUT（r=0.54, P<0.01）. Tear meniscus height (TMH) by non-invasivemethod was positively correlated with TBUT and SIT（r=0.53, P<0.01; r=0.76, P<0.01）. Scores of lipid layer ana-lysis and meibomian gland loss were negatively correlated with TBUT（r=-0.61, P<0.01）, but had no relationship with SIT（r=0.25, P=0.15）. Conclusions: Detection rate of tear film abnormality by non-invasive ocular surface analyzer is higher than that by traditional invasive examination, and can assist the classification and formulating of treatment of dry eye. Figures and Tables | References | Related Articles | Metrics