Objective To investigate the treatment of combined subclavian artery and brachial plexus injury. Methods Since 1994, we have treated 5 cases of combined subclavian artery and brachial plexus injury. 2 of them were cut wound, 1 gun shot wound, and 2 blunt trauma. 2 cases had combined aneurysm and 1 had combined aneurysm plus A V fistula. According to the sites of subclavian artery injury, vein graft( 1 case) , suture repair( 1 cases) and ligation (1 case) were performed. The 2 cases of blunt trauma underwent only neurolysis because of masses of hematoma and tissue adhesion. Results The 3 cases of open injury who had underwent early repair of artery and nerve had various degrees of recovery of nerve functions and experienced no pain in the injured extremities. As for the 2 cases of blunt trauma, 1 got only pain relief and 1 had no recovery. Conclusion Dysfunction due to hematoma or progressive pseudoaneurysm compression on the brachial plexus can be relieved and patients can get maximal rehabilitation if hematoma or aneurysm is managed in time and the brachial plexus nerve is decompressed early.

Objective This study aimed to investigate the effects of angiotensin Ⅱ and Losartan pretreatment on regulating insulin secretion in human islet ? cells.Methods We measured changes in intracellular calcium by confocal laser scanning microscopy using Flou3-AM-loaded human islet cells.RT-PCR was used to measure changes in intracellular CaM.Dynamic insulin secretory responses were determined by chemiluminescence following perfusion of human islets.Results Exposure of the isolated islets to angiotensin Ⅱ induced glucose-stimulated insulin release coupled with intracellular calcium ascending in first phase and descending in second phase.Intracellular CaM concentration could not be affected by angiotensin Ⅱ.Conclusion The change of free Ca2+is induced by the combination of AngⅡ with ATI receptors of islet B cells,which results in the damage to islet B cells.Losartan pretreatment protects the islet B-cell function by inhibiting calcium overload.

Objective To examine the effects of mixed infusion of mesenchymal stem cells(MSCs) and bone marrow cells(BMCs) in the induction of chimerism and islet allograft tolerance.Methods BALB/C mouse was used as the recipient and C57BL/6 mouse was as the donor.BALB/C mice were rendered diabetic via injection of streptozotocin.The islet cells of donor mice were transplanted into the recipient mice under the capsule of kidney.Rat anti-mouse CD154 mAb was intraperitoneally injected to the recipient mice.All of recipient mice(n=25) were then randomly divided into five groups: A group(received nothing),B group(donor MSCs),C group(donor BMCs),D group(donor BMCs and MSCs) and E group(donor BMCs and the third strain-derived MSCs).The chimerism level of donor cells and the survival time of islet grafts were compared among these five groups on 7,30d and 60d after transplantation.Results On 30d and 60d after islet transplantation,the chimerism levels of donor cells in D and E groups,in which the recipient mice received the mixed infusion of MSCs and BMCs,were significantly higher than that in C group,in which the recipient mice received BMCs infusion only,and the survival time of islet graft prolonged from 53.0?16.4d to 77.0?7.7d and 61.0?2.2d,respectively(P

Objective To evaluate the influence of glutamine(Gln)-enriched total parenteral nutrition on nutritional status,suppression of excessive systematic inflammatory responses and immunological competence on critical patients in ICU.Methods Sixty critical patients were included in a randomized controlled clinical trial and divided into Gln group and control group,with 30 case for each group.Both groups received isocaloric and isonitrogenous nutritional formulas on everyday.In addition,Gln was added to Gln group from day 1 to day 8.On day 1 and 8 after treatment,serum albumin,proalbumin,transferin,IgA,IgG and IgM were determined respectively.The plasma level of CPR,IL-6,TNF-?,blood suger,liver function were also monitored.Results (1)The level of serum albumin,proalbumin,transferin,IgA,IgG,and IgM decreased in all patients.Albumin,proalbumin,transferin,IgA,IgG,and IgM were significantly improved in Gln group on day 8 compared with control group and before treatment(P

Objective To upgrade the current X-ray vehicle.Methods Modern digital X-ray radiography was analyzed and 3 kinds of X-ray detectors were compared.Canon CXDI digital X-ray detector was used to update field X-ray vehicle into a field digital X-ray radiography vehicle.Results Real-time X-ray signal synchronization was realized.Digital images could be edited and labeled with detection information.Conclusion The working efficiency is enhanced and the support ability is improved.

Objective To analyze the relationship between daytime sleepiness and oxygen desaturation in the male eldcrly with obstructive sleep apnea /hyponea syndrome (OSAHS).Methods 147 male elderly (aged 60-80 years) with OSAHS in our sleep laboratory from March 2008 to February 2011 were divided into daytime sleepiness and daytime non-sleepiness groups. Epworth sleeping scale (ESS) and polysomnography (PSG) were employed to detect the degree of sleepiness.Oxygen desaturation were evaluated by oxygen desaturation index (ODI),average and minimum blood oxygen,time percentage of 90％ oxygen desaturation (CT90). Resulls There were significant differences between the two groups in body mass index (BMI) (t=4.157),ODI (t=-10.063),average (t=5.800) and minimum (U=916) blood oxygen,CT90(U=887)and apnca/hypopneaindex (AHI) (t =-11.361) (all P＜0.001).ESS scores were related with desaturation parameters of ODI,average and minimum blood oxygen and CT90 (r=0.683,-0.450,-0.583,0.507,all P＜0.001).ODI was correlated with average and minimum blood oxygen and CT00 (r=-0.628,-0.763,0.689,all P＜0.001).Among parameters of oxygen desaturation,only ODI had influence on ESS scores (odds ratio=1.11,95％CI:1.07 1.15),The sensitivity and specificity predicting daytime sleepiness at ODI ≥23 times/h were about 79.2％ and 84.3％,respectively.Conclusions Daytime sleepiness is associated with oxygen desaturaion and may be predicted by ODI through which average and minimum blood oxygen and CT00 are related with daytime sleepiness in the male elderly with OSAHS.

Objective To investigate the effect of angiotenisn ⅡI (Ang Ⅱ) on RIN-m β-cell,and to explore the mechanism of β-cell function impairment caused by Ang Ⅱ.Methods RIN-m cells were cultured with various concentrations of AngⅡ (0.1,1,10,100 nmol/L).After incubation for 24 hours,the basal(3.3 mmol/L) and glucose-stimulated(16.7 mmol/L) insulin secretion(GSIS)were detected by radioimmunoassay,mRNA and protein expressions of uncoupling protein 2(UCP2)were determined by RT-PCR and Western blot,respectively.The intracellular ATP content was measured by luciferase bioluminescence.The mitochondrial membrane potential and cellular Ca~(2+) concentration were detected by flow cytometry.Results (1) Various concentrations of Ang Ⅱ had no significant influence on the basal insulin secrection of RIN-m cell(F=0.644,P = 0.634).Except for 0.1 nmol/L AngⅡ,the other concentrations of Ang Ⅱ markedly reduced GSIS of RIN-m cells(F= 118.528,P = 0.000).(2) Compared with the control group,Ang Ⅱ significantly increased mRNA and protein expression of UCP2(F= 1 370,P = 0.000;F=675.175,P = 0.000).(3)Except for 0.1 nmol/L Ang Ⅱ,the other concentrations of Ang Ⅱ significantly decreased the mitochondrial membrane potential,cellular ATP content,and cellular Ca2+ concentration of RIN-m cell(F=4.035,P=0.008;F=3.353,P = 0.013;F=5.867,P = 0.001).Conclusion Ang Ⅱ impairs GSIS of p-cell,the mechanism of impairment may be interpreted that Ang Ⅱ can increase the expression of UCP2,furthermore,it can reduce mitochondrial membrane potential,decrease the content of cellular ATP and the concentration of cellular Ca~(2+),can finally impair the function of β-cell.

The teacher training of medical colleges has become a pressing task force.Young doctors should systematically study the educational theory,make positive observation,conduct teaching rounds and share experience,use the Internet,read the literature and pay attention to academic practice to improve clinical teaching ability.

AIM: To investigate the comparison of different types of catheter treatment of anastomotic ring canalicular effect.
METHODS:Retrospective analysis. A total of 114 cases 114 eyes were randomly selected between May 2013 to May 2015 jointly admitted to Huizhou Huizhou City People's Hospital and the Central People's Hospital of canalicular patients in accordance with the agreement of the annular catheterization divided into three groups, group A of annular nasal lacrimal duct catheterization in 36 eyes, group B for the whole nasal lacrimal annular catheterization in 33 eyes, group C between the upper annular tears point catheterization 45 eyes. Through the A, B, C three groups after 1, 3wk, 1, 3mo and 1y follow-up were analyzed to compare.
RESULTS:Group A of 31 eyes were cured, improved in 2 eyes, 3 eyes, the effective rate was 91. 7%;group B, 27 cases were cured, improved in 3 eyes, 3 eyes, the effective rate was 90. 9%;group C, 40 cases were cured, improved in 2 eyes, 3 eyes, the effective rate was 93. 3%. A, B, C three groups efficiency pointless difference (P=0. 124). Eye Effect: A, B, C meaningful difference among the three groups(F=36. 578; P=0.002), Group A scored the highest score of a minimum group C, respectively( 3. 5±0. 8 ) and ( 2. 3±0. 7 ); comparison meaningless difference between group a and group B( t=0. 086, P>0. 05 ); Group A and C and comparison of differences between group C and group B have the significance ( t = 15. 241, t = 17. 472; P<0. 05 ). Nasal influence: A, B, C meaningful difference among the three groups(F=778. 581;P=0. 001), the highest score in group B, group C minimum scores were(6. 6±0.8) and ( 0. 9 ± 0. 7 ); A, B, C three groups comparison of differences twenty-two have significance(t=17. 262; t=18.247; t = 16. 647; P<0. 05). Shape Effect: A, B, C difference among the three groups of meaningful ( F=481. 113;P=0. 002), Group A scored the highest score of a minimum group C, respectively(5. 8±0. 9) and(1. 2±0.6);Compare the difference between Groups B and C meaningless ( t = 0. 087, P > 0. 05 ); comparing the differences between the Groups A and B and between Group A and C were significance(t=26. 362, t=27. 532; P<0. 05 ). Unplug risk: A, B, C meaningful difference among the three groups(F=751. 121;P=0. 003), Group A scored the highest score of a minimum group C, respectively(6. 5±0. 7 ) and ( 1. 5±0. 7 ); A, B, C three groups comparison of differences twenty - two have significance(t=19. 642; t=20. 153; t=18. 345; P<0. 05). Group A had 8 patients had lower eyelid eversion, 5 cases of inferior lacrimal point expansion, 13 cases of sneezing, itchy nose, runny nose syndrome. Group B had 20 cases of varying degrees of now sneezing, itchy nose, runny nose syndrome. Group C had no serious complications.
CONCLUSION: Similar to A, B, C three groups of treatment efficacy, patient lacrimal functional recovery is safe and effective, which the group C treatment, during treatment and less material and fewer postoperative complications in patients, it is worth promotion.

Objective To explore the influence of type 2 diabetes mellitus combined with subclinical hypothyroidism on diabetic vascular complications.Methods One hundred and two patients with type 2 diabetes mellitus were selected.The serum free triiodothyronine (FT3),free thyroxine (FT4),thyroid stimulating hormone (TSH),anti-thyroid peroxidase antibody (TPO-Ab),thyroglobulin antibody (TG-Ab) levels were measured by chemiluminescence method.The patients were divided into type 2 diabctes mellitus combined with subclinical hypothyroidism group (47 cases) and type 2 diabetes mellitus with normal thyroid function group (55 cases) according to the thyroid function.The glycated hemoglobin (HbA1c),total cholesterol (TC),low-density lipoprotein cholesterol (LDL-C),triacylglycerol (TG),high-density lipoprotein cholesterol (HDL-C),urea nitrogen,creatinine and albumin levels were measured.The estimated glomerular filtration rate (eGFR) was calculated according to the formula of modification of diet in renal disease (MDRD).The presence of diabetic retinopathy was examined by fundus examination,and the presence of lower limb artery lesions was measured by vascular ultrasound.All indicators were compared between 2 groups.Results There were no statistical differences in age,disease course,HbA1c,body mass index (BMI),TC,TG,HDL-C,LDL-C,incidence of lower limb artery lesions and incidence of diabetic retinopathy between 2 groups (P＞ 0.05).TheeGRF in type 2 diabetes mellitus combined with subclinical hypothyroidism group was significantly lower than that in type 2 diabetes mellitus with normal thyroid function group:(83.74 ± 21.55) ml/(min· 1.73 m2) vs.(115.02 ± 12.29) ml/(min· 1.73 m2),and there was statistical difference (t =4.274,P ＜ 0.01).The incidence of diabetic nephropathy in type 2 diabetes mellitus combined with subclinical hypothyroidism group was significanlty higher than that in type 2 diabetes mellitus with normal thyroid function group:48.9％ (23/47) vs.23.6％(13/55),and there was statistical difference (x2 =7.103,P＜ 0.01).Logistic regression analysis showed that subclinical hypothyroidism was a risk factor for diabetic nephropathy (OR =0.524,95％ CI 0.12-0.93,P ＜ 0.05),but it was not the risk factor for diabetic retinopathy (OR =0.618,95％ CI0.19-2.16,P =0.475) and lower limb artery lesions (OR =0.485,95％ CI 0.32-2.13,P =0.689).Conclusion Subclinical hypothyroidism in patients with type 2 diabetes mellitus has no obvious effect on lower limb arterial complications and diabetic retinopathy,but may increase the risk of diabetic nephropathy.