Volume 101 ·  Issue 34 ·  2021

Gastric cancer (GC) is one of the malignant tumors with both high morbidity and mortality in China. Immunotherapy is expected to improve its prognosis. Molecular classification of GC based on multiple levels of assessment such as genes and tumor immune microenvironment (TiME), which can precisely screen the population with potential benefit from immunotherapy. It is helpful to make the treatment decision-making, and to further improve the efficacy of immunotherapy.

Cervical cancer can be eliminated through primary, secondary, and tertiary prevention. Yet it remains one of the gravest threats to women′s lives worldwide. In November 2020, the World Health Organization (WHO) officially launched the global strategy to accelerate the elimination of cervical cancer, and underlined that screening and treatment for cervical pre-cancer lesions are two of three key measures for the elimination. In July 2021, WHO issued the second edition of"WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention"to provide important guidance to countries to support them in achieving the target of cervical cancer elimination in all women. This article will interpret the methods for the guideline development, the recommendations/good practice statements on screening and treatment to prevent cervical cancer (including the age to start/stop screening, screening methods, screening interval, the management of screen-positive women and treatment of the precancerous lesions, etc.) and its impact globally, providing reference for the updates of guideline and policy making on cervical cancer prevention and control in China.

A clinical research paper which could be published should be based on a qualified clinical research, which includes a reasonable topic from clinical settings, concentrating resources to answer a question, having new findings and drawing concrete conclusions. The author should prepare a scientific story, which originates from clinical scenarios, with working hypothesis and research design, standardized organization and implementation, reasonable analysis and evaluation. The conclusion should be based on the research results, and go back to the problems and needs to form a closed loop. The key point of writing a clinical research paper is to provide complete information and show a complete research process according to the writing format and specification of the paper. Finally, the key points of the current paper help avoid detours and improve the probability of paper publication.

Primary aldosteronism (PA) patients diagnosed with aldosterone-producing adenoma and unilateral adrenal hyperplasia are preferred for surgical treatment.The aim of the operation is to remove the hypersecretory aldosterone tissue of adrenal and to improve the prognosis.Current studies have shown that both partial adrenalectomy and total adrenalectomy can achieve clinical cure for PA, but the choice of surgical methods is still controversial. This paper discusses the efficacy and safety, postoperative changes in cortisol level, postoperative recurrence and surgical techniques of different surgical methods in the treatment of different PA subtypes, so as to find the best surgical methods for different PA subtypes and to maximize the benefits for patients.

To explore related factors associated with unilateral aldosterone secretion of patients with primary aldosteronism (PA) and construct a predictive model.

The clinical data of patients who were diagnosed as PA in West China Hospital from April 2016 to September 2020 was analyzed retrospectively. According to the results of the adrenal enhancement CT, patients were divided into 3 groups, namely non-nodular group with no bilateral adrenal glands lesions, only with unilateral adrenal hyperplasia or bilateral adrenal hyperplasia, unilateral nodule group with unilateral adrenal nodules and the contralateral adrenal glands with hyperplasia or not, and bilateral nodules group with nodules in both adrenal glands. Regarding the related factors of dominant side of aldosterone secretion, univariate analysis and binary logistic regression were used. Receiver operating characteristic curve and nomogram were used to evaluate the diagnostic performance of regression models.

A total of 237 patients with PA were included, of which, 118 males and 119 females, the median age was 39 years, and the body mass index (BMI) was (25.2±3.5) kg/m². There were 157 (66.2%) of 237 patients with typical imaging findings. There were 32 cases in no-nodular group, 183 cases in unilateral nodule group, and 22 cases in bilateral nodules group. Multivariate analysis showed that age (OR=0.876, P<0.001), blood potassium concentration (OR=0.430, P=0.004), and typical imaging findings (OR=2.202, P=0.035) were associated with unilateral aldosterone secretion. As for unilateral nodule group, multivariate analysis showed that age (OR=0.900, P<0.001), plasma aldosteronism concentration (PAC) (OR=1.050, P=0.018), and typical imaging findings (OR=2.637, P=0.025) were associated with unilateral aldosterone secretion. The agreement rate between the dominant side of the adrenal CT and AVS was only 50.2%. Multivariate analysis showed that age (OR=0.954, P=0.001), BMI (OR=0.893, P=0.024) and PAC (OR=1.043, P=0.011) were independently associated with concordance between AVS and CT. The cut-off value of the ROC curve was 0.43; the model sensitivity was 56.3%; the specificity was 86.7% and the area under the ROC curve was 0.742.

Age is an important predictor in the diagnosis of PA subtypes. It is recommended to refer to subgroup based on imaging results for clinical decision. For patients with no obvious lesions or bilateral lesions on CT, AVS should be performed as far as possible to confirm the subtypes in diagnosis of PA.

To explore the value of serum parathyroid hormone (PTH) in the diagnosis of primary aldosteronism (PA) and to investigate an optimal cut-off of serum PTH to distinguish PA from nonfunctional adrenal tumor (NFA).

The clinical data of patients with adrenal incidentaloma in Chinese PLA General Hospital from January 1, 2017 to December 31, 2019 were collected. The data of PA and NFA by clinical characteristics and evaluation on endocrine function were retrospectively analyzed. The logistic regression model was used to find the potential risk factors of elevated PTH. The receiver operating characteristic(ROC) curve was used to evaluate the efficacy of PTH in diagnosis of PA and to explore the best cut-off value.

A total of 773 patients were included. There were 356 PA patients (203 males, 57.0%), aged (50±11) years and 417 NFA patients (219 males, 52.5%), aged (51±12) years. The serum PTH level in patients with PA was significantly higher than that in patients with NFA [63.1 (48.4, 80.3) ng/L vs 41.7 (34.1, 51.7) ng/L, P<0.05], as well as the proportion of patients with elevated PTH level (47.8% vs 7.2%,P<0.05). Logistic regression analysis showed that having PA and deficiency of Vitamin D were risk factors for PTH elevation (bothP<0.05). The ROC curve showed that the best cut-off value of PTH for the diagnosis of PA in patients with vitamin D deficiency was 56.44 ng/L, with a sensitivity of 66.5% and a specificity of 83.0%, and that in patients with normal vitamin D was 48.81 ng/L, with a sensitivity of 70.5% and a specificity of 72.6%.

Patients with PA tend to show increased levels of serum PTH compared with NFA patients. The level of serum PTH can be used as one of the valuable indexes in screening of PA.

To explore the potential application of a three-dimensional visualization technique in adrenal vein sampling (AVS).

The clinical data were retrospectively analyzed, which included 76 patients with primary aldosteronism (PA) who have undergone AVS in Guizhou Provincial People′s Hospital from December 2017 to May 2020. All cases were examined by adrenal thin-section enhanced CT and blood was drawn by bilateral AVS. Among them, the adrenal vein blood of 46 cases was sampled with the help of three-dimensional (3D) visualization processing of CT data, while that of 30 cases was without 3D visualization processing. The rate of the catheter in place, the successful rate of AVS, the time of blood collection, the dosage of the contrast agent, and surgical complications were compared between the two groups.

There were 76 cases included, while 38 were male and 38 were female. The average age was 45 (25-57) years. Compared with the patients without the aid of 3D visualization, the success rate of right AVS of the patients with the aid of 3D visualization technology increased from 43% to 78% (P<0.05). The success rate of adrenal vein blood collection increased from 53% to 83%. The dose of contrast agent decreased [theM(Q₁,Q₃) were78 (59, 89) ml vs 28 (16, 51) ml, P<0.05], and the time of blood sampling from the right adrenal vein approximately decreased [theM（Q₁，Q₃） were 70 (66, 88) min vs 44 (22, 61) min, P<0.05]. Compared with the case without the aid of 3D visualization, the left adrenal vein catheterization rate of patients in the 3D visualization group increased from 97% to 98%, the success rate of adrenal vein blood collection increased from 97% to 98%, and the differences of the time of blood sampling and the dosage of the contrast were not statistically significant between the two groups. Among all the cases experienced bilateral AVS, only one patient without 3D reconstruction had contrast extravasation, and the others had no obvious complications.

Before AVS, 3D visualization processing of adrenal vein from CT data is capable of increasing the success rate of blood sampling from the right adrenal vein, as well as reducing the dosage of contrast agent and the time of adrenal vein blood sampling. Therefore, it has a potential clinical value of the application.

To observe the expression of potassium voltage-gated channel subfamily C member 3 (KCNC3) in gastric cancer and analyze its clinical significance with related signal pathways involved.

The high-throughput sequencing data of gastric cancer in the Cancer Genome Atlas (TCGA) database was analyzed by bioinformatics methods to reveal the relationship between KCNC3 mRNA expression and patient prognosis as well as related signal pathways. Western blotting was used to detect differences in KCNC3 protein expression in gastric cancer cell lines. Tissue microarray (218 cases of gastric cancer (165 males and 53 females, aged (62.8±11.2) years) and 119 cases of non-cancer gastric mucosal tissues) was used to detect the relationship between KCNC3 protein expression and clinical characteristics together with patient prognosis statistics analysis followed by immunohistochemical staining.

KCNC3 mRNA expression was higher in benign gastric tissues, and its expression level was positively correlated with gastric cancer stage. High KCNC3 expression in cancerous tissue indicated poor prognosis (HR=1.69,95%CI:1.39-2.05,P<0.001). KCNC4 and MAZ genes and Notch signaling pathway, oxidative phosphorylation, γ-aminobutyric acid transport and electron transport chain related signaling pathway were predicted to involved in promoting cancer progression. KCNC3 protein expression was in consistent with its mRNA expression level, and high-expressed KCNC3 (χ²=9.512,P=0.023) was related to lymph node metastasis and late TNM stage (χ²=12.927,P=0.024). Multivariate analysis showed that high KCNC3 expression (HR=1.911,95%CI:1.198-3.050), late TNM stage (HR=1.962,95%CI:1.497-2.572), and high preoperative blood CEA levels (HR=2.007,95%CI:1.268~3.404) were independent prognosis factors of gastric cancer patients (P<0.05).

In the development of gastric cancer, high-expressed KCNC3 can be an independent factor for poor patient prognosis and a potential marker for targeted therapy.

To elucidate the biological role and potential mechanism of integrin α5 (ITGA5) in gastric cancer (GC).

From January 2019 to December 2020, 35 pairs of GC tissue [21 males and 14 females, aged (53.8±5.4) years] and matched adjacent tissue samples were collected from GC patients who underwent surgical resection in Zhejiang Provincial People′s Hospital. GC and normal gastric mucosa cells were purchased from Beijing Biobw Biotech Company. Quantitative real-time PCR (qRT-PCR), immunohistochemistry, Western blotting were performed to detect the mRNA and protein expression levels of ITGA5, cell adhesion-related genes (pFAK, pSrc, aRac1) in GC cells. Cell Counting Kit-8 (CCK-8), Transwell invasion, wound healing and cell adhesion assays were conducted for GC cell phenotype detection.

ITGA5 was highly expressed in GC compared with normal gastric mucosa cells (relative expression increased from 1.00±0.26 to 1.23±0.27,P<0.05). In addition, ITGA5 overexpression promoted the cell proliferation [from (1.14±0.14) OD to (1.61±0.14) OD], migration ability [from (20.3±2.3)% to (56.4±6.1)%], invasion ability (from 144.0±4.6 to 216.7±6.6), and adhesion ability of matrix protein (from 99.0±8.5 to 152.0±12.3) through FAK/Src/Rac1 signaling pathway in GC.(allP<0.05)

ITGA5 acts as a cancer-promoting factor in GC. The current study provides theoretical evidence for probing the novel molecular targets for the treatment of GC.

To investigate the clinical effect of the radical resection with a proximal incisal edge length of 20-25 mm and 30-35 mm in Siewert type Ⅱ advanced esophagogastric junction adenocarcinoma, to shorten the minimum safe distance of the proximal incisal edge to 20-25 mm.

A retrospective cohort study method was used. The clinical data of 166 patients with Siewert type Ⅱ advanced esophagogastric junction adenocarcinoma who underwent total gastrectomy from January 2017 to August 2020 in the Department of Gastrointestinal Surgery, Heji Hospital Affiliated to Changzhi Medical College were retrospectively collected. According to the proximal incisal edge length, the patients were divided into two groups: the proximal incisal edge length of 20-25 mm group (69 cases) and 30-35 mm group (97 cases). The perioperative conditions and the 6-month follow-up after the operation were compared between the two groups.

There was no statistically significant difference in baseline information between the patients in the two groups (P>0.05). The operations of both groups were completed. The intraoperative operation time of the proximal incisal edge length of 20-25 mm group was shorter than that in the proximal incisal edge length of 30-35 mm group ((172±24)and(206±27)min,P<0.001). There were no significant differences in the amount of intraoperative blood loss, the treatment of the diaphragm during the operation and the positive rate of intraoperative freezing of the upper incisal edge between the patients in the two groups (allP>0.05). And there was no significant differences in the first exhaust time, gastric tube removal time, first feeding time and hospital stay after the operation of the two groups (allP>0.05). There was no significant differences in the incidence of anastomotic leakage, anastomotic stenosis, reflux esophagitis and intestinal obstruction after the operation between the patients in the two groups (allP>0.05). And there was no anastomotic leakage case among the 69 cases in the proximal incisal edge length of 20-25 mm group. Postoperative pathological treatment showed no significant differences in the vascular tumor thrombus and nerve infiltration between the two groups (bothP>0.05). During the 6-month follow-up, there was no death or tumor recurrence in the two groups, and there was no significant difference in body weight loss at 6 months after the operation between the two groups (P=0.178).

When radical resection of Siewert type Ⅱ advanced esophagogastric junction adenocarcinoma is performed, it is feasible to shorten the minimum safe distance of the proximal incisal edge to 20-25 mm under the premise of ensuring R0 resection. The operation time is shortened. Due to the shortening the incisal edge distance, the anastomotic tension is decreased, and the incidence of postoperative anastomotic leakage is also reduced.

To investigate the value of spleen density in predicting the prognosis of patients with gastric cancer after radical gastrectomy.

A total of 415 patients with gastric cancer who underwent radical resection in the Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University from January 2012 to December 2015 were retrospectively analyzed. Of the patients, there were 295 males and 120 femles with a median age of 59 years (range 28-83 years). The patients were divided into diffuse decreased spleen density group (DROSD) (spleen density≤43.0 HU, n=118) and non-diffuse decreased spleen density group (N-DROSD) (spleen density>43.0 HU,n=297) according to the density of spleen detected by computed tomography (CT). The receiver operating characteristic (ROC) curve was used to identify the checkpoint of spleen density in predicting the recurrence of the gastric cancer in those patients. The relationship with clinicopathological factors and prognosis in the two groups were further analyzed.

The optimal critical value of spleen density for predicting postoperative recurrence of gastric cancer was 43.0 HU, the area under the curve of ROC was 0.608, and the sensitivity and specificity was 84.9% and 40.4%, respectively. Spleen density was related to albumin, hemoglobin, neutrophil lymphocyte ratio (NLR) and tumor diameter in patients with gastric cancer (all P<0.05). The 5-year disease-free survival rate and 5-year disease-specific survival rate of all the patients was 45.5% and 50.1%, respectively. Univariate survival analysis showed that age, NLR, PLR, tumor location, tumor diameter, Lauren classification, TNM stage, nerve invasion, vascular invasion, DROSD and adjuvant chemotherapy were all related to the 5-year disease-free survival rate (allP<0.05); Age, NLR, tumor location, tumor diameter, Lauren classification, TNM stage, nerve invasion, vascular invasion, DROSD and adjuvant chemotherapy were all related to the 5-year disease-specific survival rate (allP<0.05). Multivariate survival analysis showed that high NLR level (HR=1.501, 95%CI: 1.136-1.984), late TNM stage (HR=2.559, 95%CI: 1.850-3.539), DROSD (HR=2.093, 95%CI: 1.571-2.788) and no adjuvant chemotherapy (HR=1.583, 95%CI: 1.204-2.083) were independent risk factor for the 5-year disease-free survival rate (all P<0.05). Late TNM stage (HR=1.938, 95%CI: 1.395-2.692), DROSD (HR=1.566, 95%CI: 1.180-2.078) and no adjuvant chemotherapy (HR=1.336, 95%CI: 1.016-1.758) were independent risk factors for the 5-year disease-free survival rate (all P<0.05). For stage Ⅰ patients, the 5-year disease-free survival rates of DROSD group and N-DROSD group was 78.6% and 83.7%, respectively; and the 5-year disease-specific survival rates was 85.7% and 89.8%, respectively (bothP>0.05). For stage Ⅱ and Ⅲ patients, the 5-year disease-free survival rates of DROSD group and N-DROSD group was 15.4% and 48.8%, respectively, and the 5-year disease-specific survival rates was 17.3% and 54.0%, respectively (allP<0.001).

As an imaging evaluation method, spleen density is a new tool, which can be used as a prognostic indicator for gastric cancer patients.

To analyze the clinical characteristics of chronic total coronary occlusion (CTO) combined with bifurcation lesions and the features of coronary intervention and perioperative complications.

This study adopted retrospective cross-sectional research methods and included 673 patients who underwent interventional therapy for chronic total occlusion in Beijing Anzhen Hospital. According to whether there were side branches (diameter ≥2 mm) within 5 mm before and after the CTO occlusion segment, patients were divided into bifurcation group (337 cases) and non-bifurcation group (336 cases). The measurement data did not conform to the normal distribution and were represented as M (Q₁, Q₃). The clinical risk factors, coronary angiography characteristics, interventional treatment strategies and perioperative complications were compared between the two groups.

The patients in the bifurcation group were 60 (51, 65) years old, and 86.6% (292 cases) were male; the patients in the non-bifurcation group were 60 (52, 66) years old, and 83.0% (279 cases) were male.Coronary artery disease in all patients was mainly multivessel disease, of which three-vessel disease accounted for 59.9% (403 cases) and double-vessel disease accounted for 25.4% (171 cases).The target vessel in the bifurcation group was predominantly left anterior descending artery (62.3%, 210 cases), and the target vessel in the non-bifurcation group was more common in the right coronary artery (56%, 188 cases). The target vessel diameter was larger in the bifurcation group (2.91(2.71, 3.24) mm vs 2.80(2.55, 3.13) mm, P<0.001). Most patients used the antegrade technique (88%, 592 cases), and the use of antegrade technique in the bifurcation group (91.9%, 307 cases) was higher than that in the non-bifurcation group (84.8%, 285 cases) (P=0.012). After CTO-PCI, 72.8% (490 cases) of patients achieved successful angiography. A total of 73 patients (10.8%) had perioperative complications, and there was no statistical difference between the two groups. However, the incidence of perioperative myocardial infarction was higher in the bifurcation group (5.9%, 20 cases) than non-bifurcation group (2.7%, 9 cases) (P=0.038).

CTO complicated with bifurcation lesions are very common in clinical practice. Most patients with CTO have multiple coronary artery disease at the same time. The target vessel is more common in the left anterior descending artery, and the diameter of the vessel is larger. It is more common to use antergrade technique, accompanied by more perioperative myocardial infarctions.

To evaluate the diagnostic efficacy of combined diagnostic model based on extreme gradient boosting (XGBoost) algorithm to determine the pathological grading of gastric neuroendocrine neoplasms (NENs).

A total of 81 gastric NENs patients in the First Affiliated Hospital of Zhengzhou University confirmed by definite pathological grading from August 2012 to December 2019 were enrolled. The data of clinical and CT findings were collected. The number of lesions, tumor location, shape, lymph node metastasis, thickness, longitude of tumor and CT values in arterial and venous phase were analyzed. ITK-SNAP software and Python 2.1.0 PyRadiomics software were used to perform the image preprocessing and radiomics features extraction from segmented images. XGBoost algorithm was used to build the CT findings model, radiomics model in arterial phase, radiomics model in venous phase and combined diagnostic model. The diagnostic efficacy of CT imaging model, radiomics model in arterial phase, radiomics model in venous phase and combined diagnostic model were evaluated by accuracy, mean squared error (MSE) and mean absolute error (MAE).

The subjects were 28.0 to 78.0 (58.6+10.7) years old, including 56 males (69.1%). The number of lesions, tumor location, shape, lymph node metastasis, thickness and longitude of tumor between G1/G2 and G3 patients showed statistic significances (all P values<0.05), while there were no differences in CT values in arterial and venous phase (bothP values>0.05). Six most important features in the combined diagnostic model were A_logarithm_glcm_Imc1, P_squareroot_glcm_Maximum Probability, thickness, longitude, A_wavelet-HHL_glrlm_GrayLevelNonUniformity and P_wavelet-LLL_ngtdm_Contrast, respectively. The accuracy of CT findings model, radiomics model in arterial phase, radiomics model in venous phase and combined diagnostic model were 81.8%, 86.0%, 87.8% and 91.0%, respectively; with MSE were 539.41, 490.08, 429.99 and 371.92, respectively; and MAE were 16.72, 15.25, 14.23 and 12.33, respectively. The MAE value of the combined diagnostic model was lower than those of CT findings model and radiomics model in arterial phase (P<0.001 and 0.004, respectively), while no statistically difference was detected compared to radiomics model in venous phase (P=0.111).

The combined diagnostic model based on XGBoost algorithm have a good diagnostic efficiency for the pathological grading of gastric NENs.

On the basis of existing laparoscopic transabdominal adrenalectomy, this article described a safe and reliable surgical method for the treatment of small adrenal lesions-laparoscopic anatomical adrenalectomy (LAA), and retrospectively analyzed the clinical data of 74 patients who had undergone LAA. All patients had no signs of recurrence on imaging. LAA has high safety and feasibility, clear intraoperative anatomical layers, good spatial operability, and low postoperative complications. LAA provides a more reliable option for the treatment of small adrenal diseases.

The data of 56 patients with mitral valve prolapse undergoing thoracoscopy-assisted mitral valvuloplasty in the Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University from May 2019 to December 2020 were retrospectively analyzed. Among them, 31 cases were male and 25 cases were female, with a mean age of (45±14) years. There was no death during perioperative period. No patient was converted to median sternotomy. The duration of cardiopulmonary bypass (CPB), aortic cross-clamp and operation was (207±58) min, (134±59) min, and (374±90) min, respectively. The intraoperative blood loss was (690±268) ml, and 5 (8.9%) patients required blood transfusion. Postoperative mechanical ventilation duration was (19±9) h, and 24-hour pleural fluid drainage volume was (460±247) ml. The length of intensive care unit (ICU) and hospital stay was (25±6) h and (13±4) d, respectively. Therefore, thoracoscopy-assisted mitral valvuloplasty has the advantages of reliable curative effect, less trauma, less complications, fast recovery and satisfactory perioperative outcomes.

This paper reports a case of clear cell papillary renal cell carcinoma with contrast-enhanced ultrasonography. The ultrasonography showed fast advancement and slow recession, with annular high enhancement in the periphery and non-uniform high enhancement in the interior. Its angiographic findings are obviously different from the typical sonographic findings of common papillary renal cell carcinoma and renal chromophobe cell carcinoma, but it lacks specificity in differentiation from renal clear cell carcinoma. The potential differences between the two need to accumulate more cases.

In recent years, the incidence of chronic kidney disease (CKD) has been increasing year by year. CKD patients have impaired renal function, decreased glomerular filtration rate (GFR), blocked potassium ion excretion, and are prone to hyperkalemia. Severe hyperkalemia can be malignant, arrhythmic and even life-threatening. Therefore, the standardized management of CKD patients with hyperkalemia is particularly important for clinicians. Long-term management of hyperkalemia includes dietary control, avoiding drugs that induce hyperkalemia, correcting metabolic acidosis and the use of related potassium-lowering drugs, etc. This article expounds the etiology, diagnosis, harm, treatment and comprehensive management of hyperkalemia.

Primary hyperaldosteronism (PA) is a disease with hypertension and hypokalemia as the main clinical manifestations. A large number of PA patients fail to be correctly diagnosed and hide in the huge hypertensive population and fail to receive correct treatment. This paper will systematically expound the progress of accurate imaging diagnosis of PA, analyze its advantages and disadvantages, and put forward the thoughts and suggestions of accurate imaging diagnosis of PA.

Intestinal flora is an important part of the body, and its quantity and composition have a certain balanced relationship with the development and maturation of immune system. In recent years, many studies have found that intestinal microecological disturbance is closely related to abnormal immune function in patients with chronic kidney disease (CKD), and it is a potential trigger for the persistence of immunodeficiency and systemic inflammation in patients with CKD. This review mainly expounds the relationship between intestinal flora and immune function of patients with CKD, aiming to explore the progression mechanism of CKD, and provide new theories and new targets for intervention therapy.

Primary hyperaldosteronism (PA) is due to the increase in aldosterone caused by aldosterone-secreting adenoma (APA) or bilateral adrenal hyperplasia (IHA), which leads to hypertension and hypokalemia. PA-related hypertension can cause serious damage to cardiovascular, kidney and other target organs. The standard treatment for APA patients is adrenalectomy, with surgical outcomes differentiated into clinical and biochemical outcomes, with clinical cure referring to complete elimination of postoperative hypertension without the need for additional antihypertensive drugs, and biochemical cure referring to normalization of serum potassium, aldosterone, and plasma renin activity levels. Although hypokalemia and hypertension will return to normal in most patients after adrenalectomy, 40% to 70% of patients still need antihypertensive drugs to control their blood pressure. To explore preoperative factors associated with biochemical and clinical outcomes after laparoscopic adrenalectomy in patients with PA, the study retrospectively included 202 patients who underwent adrenalectomy (37 of whom met the diagnosis of PA) for analysis. Patients had a confirmed age of (50 ± 10) years, most were female (59%), had hypertension for 10 (3, 20) years, and had taken at least 2 (1, 3) types of antihypertensive drugs. All 37 patients with PA achieved biochemical cure after adrenalectomy, and 41% achieved complete clinical cure. Types of blood pressure medications taken (OR=2.30，95%CI：1.07~4.93，P<0.05), time to hypertension (OR=1.11，95%CI：1.03~1.25，P<0.05) and BMI (OR=1.13，95%CI：1.01~1.29，P<0.05) was an associated factor for postoperative clinical cure. Age, sex, ethnicity, preoperative aldosterone or renin levels, and tumor volume were not associated factors to predict clinical cure.

Both type 2 diabetes and dementia are the most common diseases in later life. Patients with type 2 diabetes have an increased risk of cognitive impairment, which may lead to difficulties in self-management and increase the risk of diabetes-related complications. It has been reported that low-grade inflammation may lead to cognitive dysfunction, while vitamin D [25-hydroxyvitamin D,25 (OH) D] deficiency is associated with various neuropsychiatric symptoms and also plays an important role in the development of dementia. Recent evidence suggests that low 25 (OH) D levels are associated with elevated levels of inflammatory markers. Previous studies have described the relationship between inflammation [expressed by high-sensitivity C-reactive protein (hs-CRP)] or 25 (OH) D levels and mild cognitive impairment (MCI) in diabetic patients, but in elderly patients with type 2 diabetes with MCI, there is still a lack of data to explore the relationship between mild inflammatory status and serum 25 (OH) D levels and MCI. In order to find factors associated with MCI in elderly patients with type 2 diabetes, including 25 (OH) D and hs-CRP levels, the study included 194 elderly patients with type 2 diabetes who attended the diabetes outpatient clinic of the Hospital affiliated to the Medical University of Lodz, Poland, from November 2013 to February 2014, and were divided into MCI group (62 cases) and control group (132 cases) by cognitive assessment. The MCI group had lower levels of 25 (OH) D and higher levels of hsCRP compared to the control group (bothP<0.01）； 25 (OH) D levels were inversely correlated with hsCRP levels (r=-0.28，P=0.028), positively associated with the Montreal Cognitive Assessment (MoCA) score (r=0.31，P=0.016）； hsCRP levels were inversely correlated with MoCA scores (r=-0.59，P<0.01), positively correlated with glycosylated hemoglobin (HbA1c) levels (r=0.55，P<0.01）。 Multivariate analysis showed that short years of formal education, previous cardiovascular disease and hypertension, increased number of comorbidities, high hsCRP levels, and low 25 (OH) D levels increased the risk of developing MCI in older patients with type 2 diabetes.