Identification of Long Noncoding RNAs Associated With the Clinicopathological Features of Papillary Thyroid Carcinoma Complicated With Hashimoto’s Thyroiditis

Long noncoding RNAs (lncRNAs) play a significant role in cancer biology. This study aimed to determine the roles of lncRNAs in establishing the differences in clinical features between patients with papillary thyroid carcinoma (PTC) without Hashimoto’s thyroiditis (HT) and patients with PTC and HT. In the present study, we detected the differentially expressed lncRNAs between tumor tissues of patients with PTC with or without HT through lncRNA microarrays. The data were verified and analyzed through qRT-PCR, cell viability, cell cycle and bioinformatics analyses. We found that 1031 lncRNAs and 1338 mRNAs were abnormally expressed in 5 tissue samples of PTC complicated with HT [PTC/HT (+)] compared with 5 samples of PTC without HT [PTC/HT (-)]. Gene Ontology and pathway analyses of the mRNAs suggested that several biological processes and pathways, particularly immune system processes, were induced in the PTC/HT (+) tissues. Twenty lncRNAs were verified in 31 PTC/HT (+) and 64 PTC/HT (-) specimens by qRT-PCR, and the results were consistent with the microarray data. Specifically, ENST00000452578, a downregulated lncRNA in PTC/HT(+), was negatively correlated with the tumor size. Cell viability assays revealed that ENST00000452578 could inhibit cell proliferation. Our results indicate that lncRNAs and mRNAs play an important role in establishing the different clinical characteristics between patients with PTC/HT(+) and patients with PTC/HT(-), and might provide new insights from the perspective of RNA for obtaining a further understanding of the clinical features related to PTC with HT.

Pathological analysis and surgical modalities selection of cT1N0M0 solitary papillary thyroid carcinoma in the isthmus

Background

prognosis, identify clinicopathological characteristics, and determine optimal modalities for cT1N0M0 solitary papillary thyroid carcinoma in the isthmus (PTCI).

Methods

The clinical data of 124 patients with cT1N0M0 solitary PTCI from 3 medical centers were analyzed retrospectively. Of these, 32 participants had undergone total thyroidectomy plus unilateral central neck dissection, 36 had received total thyroidectomy plus bilateral central neck dissection, 24 had less-than-total thyroidectomy plus unilateral central neck dissection, and 32 had less-than-total thyroidectomy plus bilateral central neck dissection. We compared the effects of different surgical modalities and clinicopathological characteristics on the prognosis of cT1N0M0 solitary PTCI.

Results

There was no significant difference in postoperative recurrence-free survival between participants who received different extents of central region lymph node dissection and thyroidectomies (P>0.05). Temporary hypocalcemia occurred in participants who underwent total thyroidectomy plus bilateral central neck dissection [chi-square (χ²) =7.87, P=0.005]. Tumors with primary lesions ≥0.55 cm were prone to have central lymph node metastasis [95% confidence interval (CI): 0.51 to 0.71, P=0.047]. Multiple logistic analysis suggested that age over 55 years [odds ratio (OR) =11.90, 95% CI: 1.36 to 104.03, P=0.025], tumor size greater than 0.55 cm (OR =4.16, 95% CI: 1.28 to 13.52, P=0.018), and absence of nodular goiter (OR =2.57, 95% CI: 1.05 to 6.32, P=0.04) were risk factors for central lymph node metastasis of patients with cT1N0M0 solitary PTCI.

Conclusions

Less-than-total thyroidectomy is recommended for patients with cT1N0M0 solitary PTCI. Central lymph node dissection is recommended for patients who are prone to have central occult lymph node metastases with tumor size ≥55 cm, older than 55 years, and without nodular goiter.

The Anatomical and Clinical Significance of the Superior Laryngeal Nerve

OBJECTIVE

This study summarizes the anatomical features of the superior laryngeal nerve in Chinese to enable the rapid location of the superior laryngeal nerve during an operation.

STUDY DESIGN

Retrospective analysis of anatomical data.

SETTING

Hangzhou First People's Hospital Affiliated to Nanjing Medical University.

METHODS

A total of 71 embalmed human cadavers (132 heminecks) were examined over 3 months. The length and diameter of the internal and external branches of the superior laryngeal nerve and their relationships with different landmarks were recorded.

RESULTS

The total length of the internal branch of the superior laryngeal nerve was 23.4 ± 6.9 mm. The length of the external branch of the superior laryngeal nerve was 47.7 ± 11.0 mm. Considering the midpoint of the lower edge of the thyroid cartilage as the starting point and using that edge as a horizontal line, when the entry point is above that line, the external branch of the superior laryngeal nerve can be found within 41.1 mm and at an angle of 57.2°. When the entry point is below the lower edge of the thyroid cartilage, the external branch of the superior laryngeal nerve can be found within 34.0 mm and at an angle of 36.5°.

CONCLUSION

The superior laryngeal nerve in Chinese people has distinct anatomical characteristics. This article provides a new method of quickly locating the external branch of the superior laryngeal nerve during the operation, which can reduce the probability of damaging the external branch of the superior laryngeal nerve.

A Novel Scoring System for Predicting the Metastases of Posterior Right Recurrent Laryngeal Nerve Lymph Node Involvement in Patients With Papillary Thyroid Carcinoma by Preoperative Ultrasound

OBJECTIVE

Our goal was to investigate the correlation between papillary thyroid carcinoma (PTC) characteristics on ultrasonography and metastases of lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN). There is still no good method for clinicians to judge whether a patient needs LN-prRLN resection before surgery, and we also wanted to establish a new scoring system to determine whether patients with papillary thyroid carcinoma require LN-prRLN resection before surgery.

PATIENTS AND METHODS

There were 482 patients with right or bilateral PTC who underwent thyroid gland resection from December 2015 to December 2017 recruited as study subjects. The relationship between the PTC characteristics on ultrasonography and the metastases of LN-prRLN was analyzed by univariate and logistic regression analyses. Based on the risk factors identified in univariate and logistic regression analysis, a nomogram-based LN-prRLN prediction model was established.

RESULT

LN-prRLN were removed from all patients, of which 79 had LN-prRLN metastasis, with a metastasis rate of 16.39%. Multivariate logistic regression analysis revealed that LN-prRLN metastasis was closely related to sex, age, blood supply, larger tumors (> 1 cm) and capsular invasion. A risk prediction model has been established and fully verified. The calibration curve used to evaluate the nomogram shows that the consistency index was 0.75 ± 0.065.

CONCLUSION

Preoperative clinical data, such as sex, age, abundant blood supply, larger tumor (> 1 cm) and capsular invasion, are positively correlated with LN-prRLN metastasis. Our scoring system can help surgeons non-invasively determine which patients should undergo LN-prRLN resection before surgery. We recommend that LN-prRLN resection should be performed when the score is above 103.1.

The Prediction of Metastases of Lateral Cervical Lymph Node in Medullary Thyroid Carcinoma

PURPOSE

Development and validation of a nomogram for the prediction of lateral lymph node metastasis (LLNM) in medullary thyroid carcinoma (MTC).

METHODS

We retrospectively reviewed the clinical features of patients with MTC in the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2017 and in our Department of Surgical Oncology, Hangzhou First People's Hospital between 2009 and 2019. The log-rank test was used to compare the difference in the Kaplan-Meier (K-M) curves in recurrence and survival. The nomogram was developed to predict the risk of LLNM in MTC patients. The prediction efficiency of the predictive model was assessed by area under the curve (AUC) and concordance index (C-index) and calibration curves. Decision curve analysis (DCA) was performed to determine the clinic value of the predictive model.

RESULT

A total of 714 patients in the SEER database and 35 patients in our department were enrolled in our study. Patients with LLNM had worse recurrence rate and cancer-specific survival (CSS) compared with patients without LLNM. Five clinical characteristics including sex, tumor size, multifocality, extrathyroidal extension, and distant metastasis were identified to be associated with LLNM in MTC patients, which were used to develop a nomogram. Our prediction model had satisfied discrimination with a C-index of 0.825, supported by both training set and internal testing set with a C-index of 0.825, and 0.816, respectively. DCA was further made to evaluate the clinical utility of this nomogram for predicting LLNM.

CONCLUSIONS

Male sex, tumor size >38mm, multifocality, extrathyroidal extension, and distant metastasis in MTC patients were significant risk factors for predicting LLNM.

The Diagnostic Role of Computed Tomography for ACR TI-RADS 4-5 Thyroid Nodules With Coarse Calcifications

Objectives: Coarse calcifications are prone to cause echo attenuation during ultrasonography (US) and hence affect the classification of benign and malignant nodules. This study aimed to investigate the diagnostic role of computed tomography (CT) for differentiating the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) 4–5 nodules with coarse calcifications.

Methods: CT data of 216 ACR TI-RADS 4–5 nodules with coarse calcifications confirmed by surgery and pathology in 207 patients were analyzed retrospectively. Halo sign, artifacts, and CT values (i.e., Hounsfield unit) of the nodules were determined by two radiologists. Univariate analysis and binary logistic regression were used to determine the relationship of halo sign, artifact, and CT value with benign nodules. A predictive model for benign nodules with coarse calcifications was then constructed. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of halo sign, artifact, CT value, and logistic regression model.

Results: Of the 216 ACR TI-RADS 4–5 nodules with coarse calcifications, 170 were benign and 46 were malignant. There were 92 benign and 7 malignant nodules with halo sign (χ² = 22.067, P < 0.001), and 79 benign and 10 malignant nodules with artifacts (χ² = 9.140, P < 0.001). The CT values of benign and malignant nodules were 791 (543–1,025) Hu and 486 (406–670) Hu, respectively (Z = −5.394, P < 0.001). Binary logistic regression demonstrated that the halo sign, artifact, and CT value were independent predictors for benign nodules with coarse calcifications. The area under the ROC curve (AUC) of halo sign, artifact, CT value and regression model for predicting benign nodules with coarse calcifications were 0.776, 0.711, 0.784, and 0.850, respectively, and the optimal threshold of CT value was 627.5 Hu.

Conclusion: Halo sign, artifact, and CT value > 627.5 Hu were helpful for identifying ACR TI-RADS 4–5 thyroid benign nodules with coarse calcifications. The diagnostic performance of the logistic regression model was higher than that of any single indicator. Accurate identification of these indicators could identify benign nodules and reduce unnecessary surgical trauma.

Hounsfield Unit Values in ACR TI-RADS 4-5 Thyroid Nodules with Coarse Calcifications: An Important Imaging Feature Helpful for Diagnosis

Purpose

The purpose of this study is to investigate the diagnostic role of Hounsfield unit (HU) values on noncontrast computed tomography (CT) for differentiating benignity from malignancy in the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) 4-5 nodules with coarse calcifications.

Patients and Methods

CT images of 216 ACR TI-RADS 4-5 nodules with coarse calcifications from 207 patients who underwent surgery in our hospital between 2017 and 2019 were retrospectively reviewed. The average HU values (AHUVs) and maximum HU values (MHUVs) of the nodules were measured on noncontrast CT. The distribution of AHUVs and MHUVs in benign and malignant nodules with coarse calcifications was analyzed using the Mann-Whitney test. Receiver operating characteristic (ROC) curves were used to identify the best cut-off values. Diagnostic performances were assessed according to the area under the ROC curve (AUC), sensitivity and specificity.

Results

Of the 216 ACR TI-RADS 4-5 nodules with coarse calcifications, 170 were benign and 46 were malignant. The AHUVs of benign and malignant nodules were 791 HU [interquartile range (IQR), 543-1025 HU] and 486 HU (IQR, 406-670 HU), respectively (P < 0.001). The MHUVs of benign and malignant nodules were 1084 HU (IQR, 717-1477 HU) and 677 HU (IQR, 441-986 HU), respectively (P < 0.001). The AUCs for AHUVs and MHUVs for predicting benign nodules with coarse calcifications were 0.759 and 0.732, and the cut-off values were 627.5 HU and 806.0 HU, with sensitivities of 67.6% and 68.8% and specificities of 73.9% and 67.4%, respectively. The sensitivity and specificity of the combination were 68.8% and 76.1%.

Conclusion

AHUVs and MHUVs were helpful in differentiating benignity from malignancy in ACR TI-RADS 4-5 nodules with coarse calcifications. This may provide an important basis for reducing misdiagnosis and unnecessary aspiration or surgical trauma.

The clinical significance of ultrasound grayscale ratio in differentiating markedly hypoechoic and anechoic minimal thyroid nodules

Purpose

This study explored ultrasound grayscale ratios (USGRs) for differentiating markedly hypoechoic and anechoic minimal thyroid nodules.

Materials and Methods

Longitudinal scan images of 193 markedly hypoechoic papillary thyroid microcarcinoma (PTMC) lesions from 184 patients were retrospectively reviewed using RADinfo and compared with 123 anechoic micronodular goiters (MNGs) from 110 patients. Final diagnosis was validated by pathological examination; MNGs predominantly manifested with cyst formation. Grayscale values of PTMC, MNG, and normal surrounding tissues were obtained from grayscale histograms; USGRs (grayscale ratios of pathologic tissue to surrounding normal tissue) of PTMC and MNG were calculated. Optimal USGRs for differentiating PTMC and MNG were determined with receiver operating characteristic (ROC) curves.

Results

Among 193 PTMC and 123 MNG lesions, USGRs were 0.24-0.51 (mean ± standard deviation [SD]: 0.41 ± 0.07) and 0.01-0.38 (mean ± SD: 0.12 ± 0.08), respectively. The area under the ROC curve for distinguishing markedly hypoechoic PTMC and anechoic MNG was 0.992. As USGRs decreased, sensitivity decreased and specificity increased for MNG diagnosis. At a USGR of 0.26, the Youden index was high (0.933), corresponding to 94.3% sensitivity and 99% specificity for predicting anechoic MNG. At a USGR of 0.23, sensitivity and specificity for diagnosing anechoic MNG were 92.7% and 100%, respectively. In contrast, as USGR increased, sensitivity decreased and specificity increased for predicting PTMC. At a USGR of 0.38, sensitivity and specificity for diagnosing markedly hypoechoic PTMC were 68.4% and 100%, respectively.

Conclusions

USGRs could objectively quantize grayscale values of markedly hypoechoic and anechoic lesions, enabling accurate and quantitative determination of nodular properties.

Twin pregnancy with triple parathyroid adenoma: A case report and review of literature

Primary hyperparathyroidism (PHPT) is rare during pregnancy. A case of twin pregnancy with three simultaneous parathyroid adenomas at the same time has not been reported. Multiple parathyroid lesions are difficult to diagnose, as pregnant women who insist upon continuing a pregnancy are not able to undergo 99mTc-sestamibi scintigraphy, so cases of PHPT are easily unobserved and often can have serious consequences for the patient and the fetus. Therefore, we reported a case of a 28-year-old woman mid-pregnancy with twins, who had hypercalcemia and was eventually diagnosed with twin pregnancy with PHPT due to a triple parathyroid adenoma, had good pregnancy outcomes after undergoing surgery in mid-pregnancy. Twin pregnancy with PHPT due to a triple parathyroid adenoma, as presented in this case, is very rare and surgery in mid-pregnancy is demonstrated here as safe. Intraoperative parathormone monitoring was and remains key to a successful operation.

Diagnostic value of computed tomography (CT) histogram analysis in thyroid benign solitary coarse calcification nodules

This study was to investigate the diagnostic value of the computed tomography (CT) histogram in thyroid benign solitary coarse calcification nodules (BSCNs). A total of 89 thyroid solitary coarse calcification nodules (coarse calcification ≥5 mm, no definite soft tissue around calcification) confirmed either by surgery or histopathological examination in 86 cases enrolled from January 2009 to December 2015 were evaluated. These included 56 BSCNs and 33 malignant solitary coarse calcification nodules (MSCNs). Overall, 27 cut-off values were calculated by N (4≤N≤30) times of 50 Hounsfield units (HU) in the range of 200 to 1500 HU, and each cut-off value and the differences in the corresponding area percentages in the CT histogram were recorded for BSCN and MSCN. The optimal cut-off value and the corresponding area percentage were established by receiver operating characteristic (ROC) curve analysis. In the 19 groups with an ROC area under curve (AUC) of more than 0.7, at a cut-off value of 800 HU and at an area percentage of no more than 93.8%, the ROC AUC reached the maximum of 0.79, and the accuracy, sensitivity, and specificity were 75.3%, 80.4%, and 66.7%, respectively. At a cut-off value of 1050 HU and at an area percentage of no more than 93.6%, the accuracy, sensitivity, and specificity were 71.9%, 60.7%, and 90.9%, respectively. At a cut-off of 1150 HU and area of no more than 98.4%, the accuracy, sensitivity, and specificity were 70.8%, 57.1%, and 93.9%, respectively. At a cut-off of 600 HU and area of no more than 12.1%, the accuracy, sensitivity, and specificity were 61.8%, 39.3%, and 100.0%, respectively. Compared with the cut-off value of 800 HU and an area percentage of no more than 93.8%, the sensitivity of cut-off values and minimum areas of 1050 HU and 93.6%, of 1150 HU and 98.4%, and of 600 HU and 12.1%, was gradually decreasing; however, their specificity was gradually increasing. This can provide an important basis for reducing the misdiagnosis and unnecessary surgical trauma.

Model of lymph node metastasis posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma

Background

Cervical lymph node metastasis (LNM) is a prognostic factor of papillary thyroid carcinoma (PTC). The way to deal with lymph node posterior to the right recurrent laryngeal nerve (LN-prRLN) is controversial. Nevertheless, if metastatic lymph nodes are not removed during the first operation, the subsequent salvage surgery of recurrent tumor in this area would entail high risk and complication. The purpose of this study was to develop a preoperative prediction model for LN-prRLN metastasis in PTC patients using clinicopathological characteristics.

Patients and methods

We performed a prospective study of 595 patients with PTC who underwent LN-prRLN dissection from March 2014 to June 2017. The clinicopathological data were randomly divided into derivation (n=476) and validation sets (n=119). A predictive model was initially established based upon the data of the derivation set via multivariate analyses, and the accuracy of the model was then examined with data of the validation set. The discriminative power of this model was assessed in both sets.

Results

Metastases of the LN-prRLN were identified in 102 (17.14%) of 595 patients. Age (odds ratio [OR] 0.971, 95% CI, 0.949–0.994, p=0.013), tumor size (OR 2.163, 95% CI, 1.431–3.270, p<0.001), capsular invasion (OR 1.934, 95% CI, 1.062–3.522, p=0.031), and right LNM (OR 3.786, 95% CI, 2.012–7.123, p<0.001) were significantly associated with LN-prRLN metastasis. The areas under the curves were 0.790 for the derivation set (sensitivity 71.95%, specificity 78.68%) and 0.878 for the validation set (sensitivity 85.00%, specificity 78.79%).

Conclusion

We developed and validated the first model to predict LN-prRLN metastases in patients with PTC based on clinicopathological parameters.

Expression profile and clinical significance of microRNAs in papillary thyroid carcinoma

This study screened microRNAs (miRNAs) that are abnormally expressed in papillary thyroid carcinoma (PTC) tissues to identify PTC and nodular goiter and the degree of PTC malignancy. A total of 51 thyroid tumor tissue specimens paired with adjacent normal thyroid tissues were obtained from the Department of Surgical Oncology of Hangzhou First People’s Hospital from June-December 2011. miRNA expression profiles were examined by microarrays and validated by quantitative real-time PCR (qRT-PCR). Expression levels of the miRNAs were analyzed to assess if they were associated with selected clinicopathological features. Eleven miRNAs were significantly differentially expressed between nodular goiter and PTC and between highly invasive and low invasive PTC. miR-199b-5p and miR-30a-3p were significantly differentially expressed among the three groups. miR-30a-3p, miR-122-5p, miR-136-5p, miR-146b-5p and miR-199b-5p were selected for further study by qRT-PCR and miR-146b-5p, miR-199b-5p and miR-30a-3p were different between the PTC and nodular goiter groups. miR-199b-5p was over-expressed in PTC patients with extrathyroidal invasion and cervical lymph node metastasis. In conclusion miR-146b-5p, miR-30a-3p, and miR-199b-5p may serve as biomarkers for the diagnosis of PTC and miR-199b-5p is associated with PTC invasiveness.

Clinicopathological and molecular genetic analysis of HNPCC in China

AIM: To explore the clinicopathological and molecular genetic features of hereditary nonpolyposis colorectal cancer (HNPCC) in Chinese population.

METHODS: We collected 16 Chinese HNPCC families from Wenzhou, Zhejiang Province, China. Tumor tissues and peripheral white blood cells were studied using microdissection, microsatellite analysis, immunostaining of hMSH2 and hMLH1 proteins and direct DNA sequencing of hMSH2 and hMLH1 genes.

RESULTS: (1) A total of 50 patients had CRC. Average age at diagnosis of the first CRC was 45.7 years; 40.9% and 28.7% of the CRCs were located proximal to the splenic flexure and in the rectum, respectively. Thirty-eight percent of the colorectal cancer patients had synchronous and metachronous CRC. 34.4% and 25% of the CRCs were poor differentiation cancer and mucinous adenocarcinoma, respectively. Fourteen extracoloni tumors were found, and the hepatic cancer was the most common tumor type. Twenty-one patients whose median survival time was 5.7 years died during 1-23 years. Twenty-nine patients have survived for 1-28 years, 58.6%, 41.4% and 24.1% patients have survived for more than 5, 10 and 15 years, respectively; (2) All nine tumor-tissues showed microsatellite instability (MSI) at more than two loci. Four tumor-tissues lost hMSH2 protein expression and one lost hMLH1 protein expression. Three pathological germline mutations were identified from five genetically analyzed families; two of three mutations had not been reported previously as they were a transition from C to A in exon 14 (codon 743) of hMSH2 and a TTC deletion in exon 14 (codon 530) of hMLH1.

CONCLUSION: Chinese HNPCC have specific clinicopathological features, such as early onset, propensity to involve the proximal colon, and high frequency of multiple CRCs, liver cancer more frequent than endometrial cancer. Chinese HNPCC showed relatively frequent germline mutation of mismatch repair (MMR) genes that correlated closely with high-level MSI and loss of expression of MMR genes protein.

[Changes of angiotensin II autocrine by cultured pulmonary artery smooth muscle cells exposed to anoxia]

Alterations of autocrine function of pulmonary arterial smooth muscle cells (PASMCs) might play an important role in development of hypoxic pulmonary hypertension (HPH). To test this hypothesis, the effects of hypoxia on angiotensin II (AT II) secretion by cultured new born bovine PASMCs were investigated. AT II secretion decreased significantly when PASMCs were incubated under 2.5% O2 hypoxic condition for 3 to 48 h (P < 0.01 vs control), but decreased further under anoxic condition (P < 0.01 vs control and 2.5% O2 group). Nitric oxide (NO) donor SIN-1 inhibited AT II secretion significantly under normoxic condition, but NO synthase inhibitor L-nitro-arginine (LNA) eliminated the inhibitory effect of anoxia on AT II autocrine and promoted AT II release. It was also found that the concentration of cGMP in PASMCs increased significantly (P < 0.01) at 24 h incubation in 0% O2, an effect that can be attenuated by LNA. Hypoxia stimulated 3H-TdR incorporation of PASMCs significantly (P < 0.001), while captopril exerts an inhibition in normoxic condition (P < 0.001), but without effect under hypoxic condition. The above results suggest that hypoxia can inhibit AT II secretion by inducing endogenous NO production in PASMCs. AT II autocrine is not involved in hypoxic proliferation of PASMCs, but a decrease of AT II may contribute to prevention of the development of HPH.

[Effects of serotonin on the proliferation of pulmonary arterial smooth muscle cell under hypoxia]

The effects of hypoxia on the bovine pulmonary arterial smooth muscle cell (PASM) proliferation and serotonin transporter gene expression were investigated using 3H-Thymidine incorporation, immunocytochemical staining and mRNA dot blot hybridyzation, the results were as follows, PASM 3H-Thymidine incorporation increased in response to anoxia for 24 h (P < 0.05). The anoxia-induced increased in DNA synthesis of PASM was significantly stimulated by 5-HT (100, 10 and 1 mumol/L) (P < 0.001), but 5-HT did not increase 3H-TdR incorporation under normoxic condition. Immunocytochemical reaction of serotonin in PASM under normoxic condition was markedly stronger than that of anoxic PASM (P < 0.001). Dot blot analysis showed hypoxia increased serotonin transporter mRNA expression of PASM (P < 0.01). These results indicate that stimulation of PASM proliferation with enhanced serotonin transporter gene expression and high consumption of 5-HT in hypoxia or/and anoxia may take part in the development of hypoxic pulmonany hypertention.

[Clinical significance of changes in plasma renin-angiotensin aldosterone system in patients with high altitude pulmonary edema]

Plasma levels of renin activity, angiotensin II and aldosterone were determined in 16 patients with high altitude pulmonary edema (HAPE) with radioimmunoassay and compared with those in the controls including 9 patients with high altitude acute response (HAAR) and 14 health subjects. All of them arrived recently in Lhasa, a place with an altitude of 3,658 m. The results showed that the concentration of plasma renin activity, angiotensin II, and aldosterone was significantly increased (P < 0.05-0.001) in patients with HAPE and higher than that in the controls. It is suggested that the increase plays a role in the development of pulmonary edema in patients with HAPE.

[Effects of nicardipine on left ventricular function in patients with hypertrophic cardiomyopathy]

Calcium channel blockers have emerged as important adjuncts to pharmacotherapy of hypertrophic cardiomyopathy. Nicardipine, a new hydropyridine calcium channel blocker, was evaluated for its short-term effects (14 days, 20 mg tid) on left ventricular function in 16 patients with hypertrophic cardiomyopathy (HCM) with UCG. Results indicated that heart rate, blood pressure and systolic function changed very little after nicardipine (P greater than 0.05). However, the following changes were noted after administration: IVRT decreased (132.4 +/- 21.2----120.7 +/- 27.0, P less than 0.02); left ventricular posterior wall rapid filling amplitude and mean velocity increased (8.86 +/- 2.23----9.68 +/- 2.41, P less than 0.01; 54.96 +/- 13.6----59.66 +/- 18.36, P less than 0.05); EF slope increased (3.52 +/- 1.33----3.88 +/- 1.37, P less than 0.01); left ventricular end diastolic pressure and pulmonary capillary wedge pressure decreased (11.79 +/- 3.32----9.72 +/- 2.46, P less than 0.01; 11.11 +/- 2.97----9.19 +/- 2.42, P less than 0.01). The conclusion is that nicardipine may improve left ventricular diastolic function of patients with HCM without serious side effects. It is valuable to conduct further study.

Vasectomy and health: cardiovascular and other diseases following vasectomy in Sichuan province, People's Republic of China

The long-term sequelae of vasectomy were studied in a retrospective cohort study of 4596 vasectomized and 4340 nonvasectomized farmers from eight rural communes in Sichuan, People's Republic of China. The mean duration since the operation was 14.5 years with a range of 10 to 25 years. At the time of evaluation the vasectomized men were generally healthier than the non-vasectomized for a wide range of health indicators including clinical signs of cardiovascular disease, resting ECG changes, positive ECG changes following a maximal stress test, or fundus abnormalities. The lack of association between vasectomy and cardiovascular disease noted in Europe and the USA is supported by the present study conducted in a population with a low prevalence of cardiovascular disease and risk factors.