Objective To analyze the glucose and metabolism and perinatal outcome in pregnant women with different extent gestational diabetes mellitus (GDM) of IADPSG diagnostic criteria,and to investigate the necessity to manage mild GDM.Methods Total 368 pregnant women at 24-28 gestational weeks were given 75 g glucose oral glucose tolerance test (OGTT).They were divided into three groups according OGTI result,single abnormal group (GDM1 group,148 cases),combination abnormal group (GDM2 group,120 cases) and normal group (100 cases).The three groups were given determinations of glycosylated hemoglobin,fasting C peptide (FCP),fasting insulin (FINS),total cholesterol (TC),triglyceride (TG),high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C),apolipoprotein (Apo) A1 and ApoB,calculated homeostasis model of assessment for insulin resistance index (HOMA-IR) and homeostasis beta cell index (HBCI).Results From normal group,GDM1 group to GDM2 group,the fasting plasma glucose,glycosylated hemoglobin,FCP,HOMA-IR,TG were gradually increased [(4.39 ± 0.38),(4.98 ± 0.49),(5.25 ± 0.59) mmol/L; (5.10 ± 0.29)％,(5.27 ± 0.36)％,(5.46 ± 0.46)％ ;(1.37 ±0.67),(1.73 ±0.73),(1.99 ±0.96) μ g/L;1.07 ±0.42,1.26 ±0.54,1.37 ±0.43; (2.77 ±0.67),(3.05 ± 0.78),(3.34 ± 0.92) mmol/L,P ＜ 0.01],while HBCI was gradually decreased (5.93 ± 0.48,5.42 ±0.45,5.29 ± 0.44,P ＜ 0.01).ApoA1 in GDM1 group and GDM2 group were significantly lower than that in normal group [(2.21 ±0.39),(2.15 ±0.35) g/L vs.(2.42 ±0.37) g/L,P ＜0.01],but there was no significant difference between GDM1 group and GDM2 group (P＞ 0.05).ApoB/ApoA1 in GDM2 group was significantly higher than that in normal group and GDM1 group (0.49 ±0.14 vs.0.42 ±0.14 and 0.45 ±0.12,P ＜ 0.01),but there was no significant difference between normal group and GDM 1 group (P ＞ 0.05).There was no significant difference in FINS,TC,HDL-C,LDL-C,ApoB,neonatal weight and the incidence rate of premature delivery among the three groups (P ＞ 0.05).The incidence rates of eclampsism,large for date infant and cesarean section in GDM1 group and GDM2 group were significantly higher than those in normal group [8.1％(12/148) and 14.2％(17/120) vs.2.0％(2/100),14.9％(22/148) and 16.7％(20/120)vs.6.0％(6/100),52.0％(77/148) and 54.2％(65/120) vs.30.0％(30/100),P＜ 0.01].Conclusions Different extent GDM of IADPSG diagnostic criteria has different extent abnormal glucose and lipid metabolism and abnormal perinatal outcome,so it is necessary to diagnose and manage GDM pregnant women even mild GDM.

As a non-pungency inhaled agent with less respiratory irritation,sevoflurane has been widely used in various surgeries for induction and maintenance of general anesthesia.However,the incidence of pediatric emergence delirium has been significantly increased with sevoflurane general anesthesia which severely disturbs the surgical effect and increases the requirement of medical staff in post anesthesia care unit.This article systematically reviews the research advance in emergence delirium in children with sevoflurane general anesthesia and introduces the reasonable intervention for the improvement of anesthesia quality.

Objective To evaluate the value of ultrasound-guided channel establishment in minimally invasive percutaneous nephrolithotomy(MPCNL).MethodsBetween May 2006 and December 2007,85 patients received MPCNL in our hospital.Puncture points were selected and then channels were established under the guidance of ultrasonography according to the distributions of calculi during MPCNL.ResultsUnder the guidance of ultrasonography the puncture was completed at one session in all of our 85 cases.No massive hemorrhage or other severe complications occurred.In the cases,57 cases were cured after the first operation,and 27 cases received a second surgery.One of the cases was diagnosed as having calcification of the renal papillae without kidney calculi during the operation.Residual calculi(

Objective To investigate the efficiency of the modified posterolateral curved incision with double intermuscular approach in the treatment of posterolateral tibial plateau fractures.Methods From August 2009 to March 2013,15 men and 17 women aged 28 to 77 (mean,46.25) years with posterolateral spitting or collapse tibial plateau fractures were treated to undergo a modified posterolateral approach.All types of fractures were closed,without nerve or artery injury.The duration from injury to fixation was 3-18 (mean,7.13) days.The modified posterolateral approach was preformed to expose tibial anterolateral condyle and posterolateral condyle through intermuscular space of anterior tibial muscle,popliteus muscle and soleus muscle.After open reduction,anterolateral fractures and posterolateral fractures were fixed by the T-shaped plate and Golf shaped plate respectively.Results All of the 32 patients were followed up from 6 months to 36 months (in average of 15.3 months).Postoperative X-ray showed satisfied fractures without obvious collapse of the articular surface.At the last follow-up,the Rasmussen scores were range from 6 to 18 (in average of 14.06),namely 14 cases excellent,15 cases good,3 cases fair.The knee joint functions were evaluated according to HSS.The HSS results showed that there were 12 cases excellent,16 cases good,3 cases fair and 1 case bad.None of the cases suffered from injuries of crucial blood vessel or nerves.No incision necrosis,wound infection or fixation failure occurred during follow-up.Conclusion Open reduction and internal fixation via modified posterolateral approach can expose posterolateral and anterolateral tibial plateau fracture in one incision.Fibular head osteotomy can be avoided.The present approach could also reduce surgical injury,minimize the possibilities of incision necrosis or plate exposure.The modified posterolateral approach can be recommended in clinical practice.

AIM: To evaluate the efficacy and safety of orbital decompression in the treatment of Graves ophthalmopathy. ·METHODS: Totally 55 patients 77 eyes with Graves eye disease were selected in our hospital from February 2011 to February 2016. All eyes underwent orbital decompression, the visual acuity, exophthalmos and complications of the patients were followed up for 6mo. · RESULTS: Postoperatively 6mo, the best corrected visual acuity were 0. 23±0. 09, which were better than that of preoperative 0. 46±0. 07(P<0. 05). Postoperatively 6mo, the degree of exophthalmos of the patients were 16. 20 ± 1. 99mm, which was significantly lower than that preoperative 20. 13±1. 87mm (P<0. 05). Postoperative CAS score was ≤3 points in 56 eyes ( 73%) , significantly increased compared with preoperative 15 eyes (19%), the difference was statistically significant (P<0. 05). There were 50 eyes ( 65%) with color vision disorder before operation;after operation, 42 eyes (55%) had significant improvement in visual impairment, and there was no change in the eye in 8 eyes (10%). Postoperatively 6mo, the average decreased degree of exophthalmos were 3. 87±1. 03mm;5 cases were found postoperative diplopia, new diplopia rate was 10%;followed up for 3mo, diplopia disappeared. ·CONCLUSION:Orbital decompression is an effective method for the treatment of Graves ophthalmopathy, but attention should be paid to postoperative complications such as diplopia.

Background Sclera remodeling process in axial elongation is one of the main pathological mechanisms of axial myopia progression.Studies confirmed that transforming growth factor-β1(TGF-β1) participates in the sclera remodeling process,and Smad3 is one of TGF-β1 downstream signal gene transcriptive factors,so to explore its role in sclera remodeling process of myopic eyes is of great significance for pathogenesis and prevention research of myopia.Objective This study was to investigate the expressions of type Ⅰ collagen and Smad3,a TGF-31 downstream target,in sclera of form deprivation myopic (FDM) eyes and explore the impact of TGF-β1-Smad3-type Ⅰ collagen signaling pathway on collagen remodeling in myopic sclera.Methods Seventy-five 1-week-old guinea pigs were randomly divided into normal control group (25 guinea pigs) and FDM group (50 guinea pigs).Monocular FDM was induced by occluding the left eyes of guinea pigs in FDM group with translucent latex balloons for 2,4,6 weeks,respectively,and consecutive occluding for 4 weeks followed by uncovering for 1 week (4/-1 weeks).The refractive power was detected by retinoscopy and axial length was measured with A-type ultrasound.Immunohistochemistry and reverse transcription-PCR were employed to detect the dynamic expressions of type Ⅰ collagen and Smad3 protein ad mRNA in the sclera of guinea pigs with emmetropia and experimental myopia,ard the relationship between collagen Ⅰ and Smad3 levels was analyzed.Results The refraction was hypermetropic in both normal control group and FDM group before occluding of eyes (P＞0.05),and the hypermetropic power was gradually reduced over time in the normal control group.In the FDM group,the refractive power was gradually changed from (+2.09 ± 0.31)D before occluding to (-1.23±0.69),(-4.17±0.59),(-7.07±0.56) and (-4.30±0.58)D,and the axial length was increased from (5.93-±0.39)mm to (6.62±0.36),(7.30±0.34),(7.99--0.32),and (7.21 ±0.36) mm at weeks 2,4,6,and 4/-1 after occluding,respectively,indicating significant differences in refractive power and axial length over time in the FDM group from normal control group and self-control group (all at P＜0.05).The expressions of Smad3 and type Ⅰ collagen protein and mRNA in the sclera of the FDM group was significantly lower than those of the control group and self-control group in various time points (all at P＜0.05).The positive correlation were found in the expression of Smad3 on the myopic sclera with that of type Ⅰ collagen in both protein and mRNA levels (protein:r=0.993,P＜0.05;mRNA:r=0.954,P＜0.05).Conclusions The myopic power and ocular axis increase dependent upon occluding time,and the expressions of Smad3 and type Ⅰ collagen in the sclera are correspondingly weakened in FDM eyes.A consistent expression trend is found between Smad3 and type Ⅰ collage,suggesting Smad3 and type Ⅰ collagen participate in the regulation of sclera remodeling in myopia by TGF-β1-Smad3-Collagen Ⅰ signaling pathway.

Objective To evaluate the efficacy of using dual laser system in off clamp nephronsparing surgery.Methods We used dual laser system in the patients who underwent off-clamp NSS between Jan 2016 and Apr 2016 in our institution.There were 16 males and 8 females with average age of 49 years.Mean tumor size was 1.9 cm (range 0.8-3.2 cm).The mean R.E.N.A.L.score was 3.8 (range 3-6).The mean Zhongshan score was 3.5(range 3-5).The mean ZⅡ(zero ischemia index)was 1.6(range 1-4).The Evolve Dual (980 nm/1 470 nm) laser system set at 60 W in continuous mode was used.Results Offclamp NSS was successfully performed in 22 patients except for renal artery occlusion in 2 case.Mean operative time was 74 min(range 50-100 min);The average estimated blood loss was 52.9 ml(range 10-200 ml);Mean postoperative drainage was 65.4 ml(range 20-150ml);Mean postoperative hospital stay was 5.2 days (range:4-7days).No severe post-operative complication was found.The mean pre-and postoperative serum creatinine levels were 76.2 μmol/L(range:48-112μ mol/L) and 81.5μ mol/L(range:54-122 μ mol/L) with no significant difference(P ＞0.05).The postoperative pathology indicated that 20 cases of clear cell carcinomas,3 cases of chromophobe renal cell carcinomas,one case of papillary carcinoma.Conclusions Dual laser system can be used in off clamp nephron-sparing surgery safely and effectively.

Objective To investigate the clinical efficacy of selenium-enriched garlic on patients with oligoasthenospermia.Methods From October 2012 to August 2013,160 patients with oligoasthenospermia were randomly divided into two groups.Treatment measurements for 80 patients in the control group included oral treatment of Shengjing capsules 1.6 g/time Tid,Vit-E soft capsules 100 mg/time Tid,and took Vit-B 0.2 g/time Tid,for three months.Treatment measurements for 80 patients in the treatment group included oral treatment of selenium-enriched garlic in addition to all the above,for three months.We observed the changes of the semen quality indexes (including semen volume,sperm density,motility,survival rate,etc.) of two groups before and after treatment.Results Sperm quality was improved after treatment in both groups.All indices in the treatment group were significantly higher than those in the control group (P ＜ 0.05).Conclusions For patients with male infertility caused by oligoasthenospermia,The use of combination of selenium-enriched garlic and Shengjing capsules can improve the quality of sperm.

Objective To evaluate the quality of examination papers of otolaryngology among students of grade 2007 in the first clinical college of Chongqing Medical University.Methods Totally 202 copies of examination papers of otolaryngology from grade 2007 students in our college were taken as research references.SASS 15.0 software was used to statistically analyze total score of every student and score of each question.Mean score,standard deviation,difficulty coefficient and discrimination coefficient of each question were counted and normality test was conducted.Results Scores were in negative skewness distribution,with mean score of 80.9,standard deviation of 10.9,the lowest score of 56.5,the highest score of 98.0,difficulty coefficient of 0.781,and discrimination coefficient of 0.308.Conclusions Examination papers are well designed and discriminated and can objectively reflect students' command of the course.However,distribution of sores is unreasonable and examination paper is relatively easy to complete,indicating the weakness in the teaching process.

Objective To evaluate the efficacy of double-lumen central venous catheter (DLCVC) for airway management in children undergoing resection of laryngeal papilloma under inhalation anesthesia with sevoflurane-spontaneous breathing.Methods Twenty-nine ASA physical status Ⅰ or Ⅱ podiatric patients,aged 1-9 yr,weighing 10-35 kg,scheduled for elective resection of laryngeal papilloma under self-retaining laryngoscope,were included in this study.Anesthesia was induced with inhalation of 8 ％ sevoflurane and the children kept spontaneous breathing.The larynx was sprayed with 2％ lidocaine for topical anesthesia.A self-retaining laryngoscope was inserted and a 7F DLCVC was placed below the glottis via the self-retaining laryngoscope.4％-6％ sevoflurance was insufflated via the main lumen of DLCVC (14G) to maintain anesthesia.PETCO2 was monitored through the branch lumen of DLCVC (18G).Before surgery (T1),at 20 min after the beginning of surgery (T2),and at the end of surgery (T3),arterial blood samples was obtained for blood gas analysis,and body movement,hypoxemia (SpO2 ＜ 95 ％ during oxygen inhalation),and airway management failure (SpO2 ＜ 90％ during oxygen inhalation) were also recorded.Results Compared with the baseline value at T1,although there were significant changes in PaCO2,base excess,pH value and PaO2 at T2 and T3 (P ＜ 0.05),they were all within the clinical reference ranges.There were no significant differences between PaCO2 and PETCO2 at T1,T2 and T3 (P ＞ 0.05).The incidence of body movement and hypoxemia was 10％,and the rate of airway management failure was 3％ (due to degree Ⅲ laryngeal obstruction).Conclusion DLCVC can be safely and effectively used for airway management in children with degree Ⅰ or Ⅱ laryngeal obstruction undergoing resection of laryngeal papilloma under inhalation anesthesia with sevoflurane-spontaneous breathing.