Objective To evaluate the efficacy of Coopdech bronchial blocker combined with a strengthened single-lumen tube for airway management in patients undergoing upper mediastinal tumor resection. Methods Twenty-two ASA Ⅱ or Ⅲ patients, aged 24-66 yr, weighing 48-78 kg, scheduled for elective resection of upper mediastinal tumor, were randomly divided into 2 groups (n=11 each):double-lumen tube group(groupⅠ) and Coopdech bronchial blocker combined with a strengthened single-lumen tube group(group Ⅱ).One-lung ventilation was achieved with a double-lumen tube in groupⅠ. The Coopdech bronchial blocker combined with a strengthened single-lumen tube was used for airway management and the Coopdech bronchial blocker was used for lung isolation when one-lung ventilation was required in group Ⅱ. The fiberoptic bronchoscope was used to assist endotracheal tube positioning in both groups. The intubation time, positioning time, the number of patients required for tube displacement, the number of fiberoptic bronchoscopy, increase in airway peak pressure, degree of lung collapse, postoperative sore throat and hoarseness, and the number of patients needing ventilator-assisted ventilation were recorded. Results The intubation time was significantly shorter, the number of patients required for tube displacement was significantly smaller,and the rate of increase in airway peak pressure and incidences ofpostoperative sore throat and hoarseness were significantly lower in group Ⅱ than in group Ⅰ (P＜0.05 or0.01). Conclusion The efficacy of the Coopdech bronchial blocker combined with a strengthened single-lumen tube for airway management is better in patients undergoing upper mediastinal tumor resection than the double-lumen tube.

BACKGROUND: Islet transplantation is an effective method for the treatment of type 1 diabetes mellitus and parts of type 2 diabetes mellitus. However, its application is hindered by insufficient sources and immunologic rejection. Though transdifferentiation of pancreatic stem cells is at the starting step, it is thought to be the hopeful source for islet cell transplantation.OBJECTIVE: To look for a suitable cells-transplantation source for the treatment of diabetes mellitus. METHODS: The pancreatic ductal epithelial cells were separated from Kunming mice and cultured in DMEM/F12 medium supplemented with keratinocyte growth factor, hepatocyte growth factor and nicotinamide, etc. Samples were taken at different time points for light microscopy and electron microscope. The changes of CK-19 and PDX-1 were detected by immunocytochemistry at 1 and 16 days. The expressions of insulin and glucagon gene were detected by RT-PCR at 1 and 16 days. The physiologic function of these islet-like clusters was determined by dithizone staining and glucose stimulation at 21 days. RESULTS AND CONCLUSION: A large number of epitheliod cells were CK-19 immunoreactive positive and few of them were PDX-1 positive at 1 day after isolation, then CK-19 positive cells proliferated quickly and formed substantial plaques of epithelial cells in cobblestone pattern. At 16 days later, these cells begin to form islet-like clusters gradually, while most of them were PDX-1 immunoreactive positive. The analysis of mRNA by RT-PCR showed very low levels of insulin and glucagon mRNA in the starting materials but increase was found as the process of transdifferentiation. At 21 day differentiated islet-like clusters were stained red by dithizone. In those samples exposed to a stimulatory 15 mmol/L glucose, there was a 1.6-fold increase in insulin compared with to 5.6 mmol/L glucose (P < 0.05). Pancreatic ductal cells of adult Kunming mice could proliferate quickly and have the potency of transdifferentiation into islet-like clusters when cultured in vitro under appropriate conditions.

Objective To observe the clinical effect of compound danshen dropping pills on the early diabetic kidney disease.Methods A total of 850 type 2 diabetes mellitus (T2DM) patients with diabetic nephropathy (DN) at stage Ⅲ who met the criteria for DN from January 2012 to July 2012,aged 60 to 75 years [mean age (66.6±4.8) years],were retrospectively analyzed and randomized into the treatment group (n=601) and the control group (n=249).All patients received rational hypoglycemic,antihypertensive,lipids-adjusting treatment and the treatment group received compound danshen drop pill (15 pills,tid),additionally.Laboratory indexes such as urine albumin (UA) and urine creatinine (UCR) were examined 24 weeks after treatment.Results The levels of UA and UCR,and the UA/UCR ratio (ACR) in the treatment group were decreased after versus before treatment.The decreases of UA and UCR had significant differences between the treatment and control group [(39.1±78.7) mg/L vs.(14.7±77.1) mg/L,(1.1±4.5) mmol/L vs.(-0.3± 3.6) mmol/L,t=4.15 and 4.86,both P＜0.01].Conclusions The comprehensive treatment combined with compound danshen dropping pills for 24 weeks can more effectively reduce UA and ACR,thereby it has effects in treating DN and delaying the progression of DN.

Objective To evaluate the prognosis value of the expression of galectin 3 in patients with acute ischemic stroke. Methods 165 Patients with acute ischemic stroke had been observated for 12 months and their occurrence of recurrent stroke e-vents were recorded.The concentration of galectin-3 was detected.Results 65 patients had recurrence stroke events with a rate of 39.39% within 12 months.It was also found that the serum concentration of galectin-3 in acute ischemic stroke recurrence patients were significantly higher than those of patients without recurrence,the difference was statistically significant(P <0.05).The rate of acute ischemic stroke recurrence in patients with high concentrations of galectin-3 was higher than that in patients with low concen-trations of galectin-3,the difference was statistically significant(P <0.05).Conclusion Galectin-3 is a good indicator to predict the prognosis of patients with acute ischemic stroke,and it could be used to evaluate the risk of recurrence in patients.

Objective To analyze the clinical data of patients with Cushing's syndrome(CS)and to un-derstand the relationship between glucose metabolism and CS .Methods Oral glucose tolerance test (OGTT), the level of insulin, body mass index(BMI), 24-hour urinary free cortisol(24h UFC), family history of diabetes in patients with CS were retrospectively analyzed .Results The course of disease in patients of CS complicated with diabetes mellitus ( CS/DM) group was longer than CS complicated with impaired glucose tolerance ( CS/IGT) and CS complicated with normal glucose tolerance (CS/NGT)group.66.67%of patients with CS/NGT have insu-lin resistance .Logistic regression analysis indicated that age , course of disease , midnight plasma cortisol were risk factors of CS induced diabetes mellitus .CS/DM group had higher proportion of family history of diabetes . 24h UFC and BMI had no significant differences among the three groups (P>0.05).Conclusions Age, course of disease , midnight plasma cortisol are risk factors of CS induced diabetes mellitus .OGTT and insulin level de-termination are necessary for diagnosis and intervention treatment at the early stage .

Objective:To investigate the renal injury of portal hypertensive rat after one hour of occlusion of portal vein and inferior vena cava.Methods:Healthy male Wistar rats were taken randomly as normal control、portal hypertensive control and trial group.The recoverable portal hypertensive model was induced firstly.Three weeks later ,15 model rats were taken randomly as portal hypertensive control group,others had another operation and were divided randomly into 0,6h,12h,24h,48h,72h,7d group according to different reperfusion time after 1 hour of occlusion of portal vein and inferior vena cava.At the corresponding time points after reperfusion,the examinations below were done:serum ALT,TBIL,BUN,Cr concentrations;mor-phological changes of liver and kidney,the ultrastructure of renal tissue.Results:Serum and Cr in trail group reached their peak value 12~24 hours after reperfusion,then decreased gradually,and returned to normal 72 hours after reperfusion.The main injury of kidney was located in proximal tubular epithelial cell ,it peaked at 12 hours and 24 hours after reperfusion,the sporadic karyopyknosis and karyorrhexis could be seen,but the basement membrane preserved well.48 hours later,the restoration could be seen.7 days later it restored obviously.Conclusion:There are obvious injury in tubular epithelial cell in the portal hypertensive rat after 1 hour of occlusion of portal vein and inferior vena cava.But the injury of kidney is reversible.

Objective The study was designed to compare the ultrasound-guided technique for the cannulation of subclavian vein with the traditional technique using anatomic landmarks.Methods One hundred and twenty ASA Ⅱ or Ⅲ patients undergoing cannulation of subclavian vein before gastrp-intestinal tumor resection were randomly divided into 2 groups (n=60 each) according to the technique used for cannulation:ultrasound-guided group (group US) and anatomic landmark group (group AL).The puncture time,successful puncture and complications were recorded.Resulls The success rate was 100% in group US;while the cannulation failed in one patient in group AL.The rate of successful puncture at 1st attempt was 100% in group US but ouly 90% in group AL.The cannulation time was significantly shorter in group US than in group AL.The incidence of accidental puncture of subclavian artery,hematoma and pneumothorax was significantly higher in group AL than in group US.Conclusion The ultrasound-guided catheterization of the subclavian vein is superior to the landmark technique.

Objective To compare the effects of different medications of fentanyl during anesthesia induction on fentanyl-induced cough.Methods Four hundred and twenty ASA Ⅰ or Ⅱ patients aged 18-60 yr undergoing selective operations under general anesthesia,were randomly divided into 4 groups ( n =105 each):group Ⅰ (control group) received successive intravenous injection of midazolam 0.05 mg/kg,fentanyl 2 μg/kg,propofol 2 mg/kg,and rocuronium 1 mg/kg,group Ⅱ (pre-injection group) received successive intravenous injection of midazolam0.05 mg/kg,fentanyl 0.5 μg/kg,propofol 2 mg/kg,rocuronium 1 mg/kg,and fentanyl 1.5 μg/kg,group Ⅲ (dilution group) received successive intravenous injection of midazolam 0.05 mg/kg,fentanyl 2 μg/kg (20 μg/ml),propofol 2 mg/kg,and rocuronium 1 mg/kg,and group Ⅳ (last injection group) received successive intravenous injection of midazolam 0.05 mg/kg,propofol 2 mg/kg,rocuronium 1 mg/kg,and fentanyl 2 μg/kg.Fentanyl concentration was 50 μg/ml in each group except group Ⅲ.Endotracheal intubation was performed 2 min after anesthesia induction.The incidence and severity of fentanyl-induced cough before intubation were recorded and the incidence of propofol-induced pain was recorded.Invasive arterial blood pressure (ABP) and heart rate (HR) were observed before induction (T1 ),immediately after induction (T2 ),at time of coughing (T3 ),and at time of endotracheal intubation (T4).Results ABP and HR had no significant differences at T1,T2,T3,and T4between the four groups (P ＞ 0.05).The incidence of propofol-induced pain had no significant differences between the four groups (P ＞ 0.05).The incidences of cough was 7.6％ in group Ⅱ,9.5％ in group Ⅲ,and 1.9％ in group Ⅳ,which were significantly lower than 35.2％ in group Ⅰ ( P ＜ 0.01).The incidence of cough in group Ⅳ was significantly lower than that in groups [ and Ⅲ (P ＜ 0.05).In the four groups,ABP and HR were significantly higher at T3 than that at T1 and T2 ( P ＜ 0.01 ).Conclusion Different medications of fentanyl including last injection,pre-injection,and dilution of fentanyl can significantly reduce the incidence of fentanyl-induced cough during anesthesia induction,and injection has the best effect.

Objective:To report the diagnosis, treatment, and follow-up of a 21-hydroxylase deficiency boy with central precocious puberty caused by complex heterozygous mutation of CYP21A2 gene.Methods:The child was symptomatic of rapid growth and secondary sexual characteristics at the age of 6. The diagnosis of central precocious puberty was confirmed by serum testosterone, gonadotropin levels, and gonadotropin-releasing hormone (GnRH) stimulation test. 21-hydroxylase deficiency was diagnosed clinically based on the serum adrenocorticotropic hormone (ACTH), 17-hydroxyprogesterone levels, and images on the computed comography (CT) of the adrenal glands.Results:The CYP21A2 gene was detected to have a compound heterozygous mutation by Sanger sequencing and multiplex ligation-dependent probe amplification. During the 3 years follow-up, the effects of glucocorticoids, GnRH analogs, and recombinant human growth hormone were regularly monitored and evaluated.Conclusions:Glucocorticoid replacement followed the principle of the lowest effective dose. GnRH analogs showed an effective inhibition of the hypothalamus-pituitary-gonadal axis, while recombinant human growth hormone had no such growth-promoting effect.

Three cases of Langerhans cell histiocytosis (LCH)with central diabetes insipidus as the first manifestation were reported, with the summary of their clinical manifestations, laboratory examinations, imaging examinations, pathological results, diagnosis process, and treatment response. All three patients presented with central diabetes insipidus in the early stage. The pituitary magnetic resonance imaging (MRI)showed thickened pituitary stalks, and all lost the normal high signal of the posterior pituitary. Two patients showed isolated hypothalamic-pituitary lesions, while one case showed pituitary and thyroid systems involvement. Pathological findings showed typical Langerhans cells, immunohistochemistry showed positive for S-100, CD1a, Langerin. The clinical manifestations of LCH manifested distinct heterogeneity, which is easy to be misdiagnosed and left out. The diagnosis should be confirmed by pathological examination. The biopsy of isolated hypothalamic-pituitary lesions is difficult. It is recommended to actively screen other organs to increase the probability of biopsy. LCH-induced neurohypophysis requires life-long hormone replacement therapy.