Combined transplantation of fetal pancreas and thymus was performed in 10 patients suffering from severe diabetes I. They were closely followed for over one year, and it was found that among them 7 showed spectacular clinical improvement, including 2 with total discontinuation of insulin, and 5 with average reduction of insulin by 82%. In 3 patients, the dosage of insulin was reduced by an average of 56.9%. The average reduction of insulin for the 10 patients in 2 months, 6 months and one year after the transplantation was 68.3%, 74.5%, and 78.4%, respectively. The effect of warm ischemia of different durations on the donor tissues was studied with electron microscopy. The significance of combined transplantation and the relationship of the techniques of procuring the donor tissues and transplantation is discussed.

OBJECTIVETo observe the morphological changes during development of the ventricular zone (VZ) and subventricular zone (SVZ) of human fetus and the distribution pattern of neural stem cells in the VA and SVZ.

METHODSHuman fetuses at the gestational ages of 9-11 weeks, 14-16 weeks, 22-24 weeks and 32-36 weeks were collected, and the brain sections of the VZ/SVZ under the frontal lobe were examined for cytoarchitecture and distribution of nestin-positive cells with HE staining, immunohistochemistry or immunofluorescence.

RESULTSThe thickness of VZ underwent no significant changes at the gestational ages of 9-24 weeks (P>0.05) and became obviously thinner at 32 weeks (P<0.05), while the thickness of SVZ increased during 9-24 weeks (P<0.05) without obvious thinning at 32 weeks (P>0.05). VZ was thicker than SVZ at 9-11 weeks but became markedly thinner than SVZ after 14 weeks (P<0.05). The VZ contained denser cells than SVZ and showed a distinct boundary between the VZ and SVZ. Large numbers of nestin-positive cells were detected in the VZ and SVZ, and nestin immunoreactivity was found primarily in the cell processes and occasionally in the soma. Some nestin-positive cells in the SVZ had 1-3 processes. Nestin immunoreactivity in the VZ and SVZ gradually grew weak with development. The cells positive for both nestin and Ki67 were located mainly in the inner zone of the VZ and throughout the SVZ, where some nestin-positive but Ki67-negative cells were also found.

CONCLUSIONThe SVZ fully extends and the neural stem cells in the VZ/SVZ can be morphologically heterogeneous during the development of fetal human brain.

Fetus ; Frontal Lobe ; cytology ; embryology ; metabolism ; Humans ; Nestin ; metabolism ; Neural Stem Cells ; metabolism ; Neurons ; metabolism

OBJECTIVETo investigate the expression of metabotropic glutamate receptor 5 (mGluR5) and its cellular distribution in the frontal cortex, ventricular zone (VZ) and subventricular zone (SVZ) in human fetuses.

METHODSAccording to the gestational age, the collected fetuses were divided into 4 groups, namely 9-11 weeks, 14-16 weeks, 22-24 weeks and 32-36 weeks. Brain tissue blocks including the frontal lobe or VZ/SVZ were prepared into slices, and the expression pattern and cellular distribution of mGluR5 in the frontal cortex and VZ/SVZ were observed by immunohistochemistry or immunofluorescence.

RESULTSmGluR5 immunoreactivity was present in the cell membrane in the frontal cortex, VZ and SVZ from the 9th to 36th weeks and the immunoreactivity in the marginal zone (MZ) and cortical plate (CP) was markedly stronger than that in VZ and SVZ. The cells expressing mGluR5 included neural stem/progenitor cells in the VZ and SVZ, immature neurons in the VZ and MZ, and numerous mature neurons in the CP.

CONCLUSIONmGluR5 is expressed by a variety of cells such as neural stem cells in the frontal cortex, VZ and SVZ in human fetus, suggesting a role of mGluR5 in the development of human cerebral cortex.

Cerebral Cortex ; cytology ; Cerebral Ventricles ; cytology ; metabolism ; Fetus ; cytology ; metabolism ; Frontal Lobe ; cytology ; metabolism ; Humans ; Neural Stem Cells ; cytology ; metabolism ; Receptor, Metabotropic Glutamate 5 ; Receptors, Metabotropic Glutamate ; metabolism

In order to improve the cure rate of critically ill patients in Wuhan epidemic area and reduce the fatality rate, the state have dispatched medical staffs from the whole country to support Wuhan and treat critically ill patients in dedicated facilities. A medical team from the First Affiliated Hospital of Xi’an Jiaotong University, consisting of 133 medical staffs major in critical care medicine, respiralogy, infection, cardiology, and general surgery, entirely took over the critical care unit of the East Hospital of the Renmin Hospital of Wuhan University, and formed a multidisciplinary collaboration team with local medical staffs to treat patients together. Up to March 13th in 2020, the author′s medical team has admitted a total of 109 patients, of which 48 had been discharged up on recovery. Critically ill patients with Corona Virus Disease 2019 mainly have elder age, comorbidities, complicated conditions, and difficult diagnosis and treatment. The author and the author′s team combined with clinical practice, share experience and strategies of general surgery related issues in the treatment of critically ill patients, providing reference for collegues in general surgery.

Objective To analyze and discuss the medication rule of professor Ruan Yan in the treatment of children with allergic rhinitis by using data mining method,and to provide reference for the clinical research and patented drugs development for the treatment of children with allergic rhinitis.Methods The outpatient medical records of professor Ruan Yan for the treatment of children with allergic rhinitis were collected.Microsoft Excel 2010 software was used for frequency statistics.SPSS Clementine 12.0 software was used for association rule analysis,cluster analysis and factor analysis to obtain the data.The frequency of use of various drugs and the association rules between drugs were obtained.Then the medication rules in professor Ruan Yan's prescription were analyzed.Results A total of 308 Chinese medicine compounds were included,involving 80 kinds of Chinese medicines,among which relieving drugs and qi-invigorating herbs were high-frequently used.The distribution of traditional Chinese medicine syndrome types was mainly characterized by lung-qi deficiency-cold syndrome and lung-spleen qi deficiency syndrome.The medicinal properties were mainly spicy,warm and sweet,and most of them belonged to the lung,spleen and stomach meridians.Five core prescriptions were extracted by factor analysis.Four drug combinations were obtained by systematic cluster analysis.Conclusion Ventilating lung and opening the orifices,expelling wind and removing cold,strengthening the spleen and replenishing qi are basic therapeutic principles for professor Ruan Yan in the treatment of children with allergic rhinitis.The treatment mainly focused on dispelling evil,ventilating lung and opening the orifices,expelling wind and removing cold during the acute stage of allergic rhinitis.In the remission period,according to the principle of"treating disease must be based on its origin",the treatment should enhance children's physical fitness,tonify lung and strengthen spleen,thereby reducing recurrence.

ObjectiveTo investigate the therapeutic effect of Xiao Qinglongtang （XQLT） on ovalbumin （OVA）-induced allergic rhinitis （AR） in mice and its effect on the interleukin-33 （IL-33）/suppression of tumorigenicity 2 （ST2） signaling pathway. MethodSeventy-two female BALB/c mice of SPF grade were randomly divided into a control group， a model group， a positive control group （loratadine， 2.05 mg·kg^-1）， and low-， medium-， and high-dose （5.005，10.01，20.02 g·kg^-1） XQLT groups. All mice except for those in the control group were sensitized by intraperitoneal injection of OVA solution， and the AR model was induced by intranasal drops of OVA solution. Thirty minutes before local intranasal drops， drugs were administered once， and mice in the control group and the model group received phosphate buffered saline （PBS） at 20 mL·kg^-1 for 7 days. After the last intranasal drop of OVA solution， the times of sneezing and nasal rubbing of mice within 10 min was recorded. After drug administration for 7 days， blood samples were collected， and nasal bones of mice were decalcified for the preparation of pathological sections. The content of OVA-specific immunoglobulin E （OVA-sIgE）， interleukin-4 （IL-4）， interleukin-5 （IL-5）， and interleukin-13 （IL-13） was detected by enzyme-linked immunosorbent assay （ELISA） kits. Hematoxylin-eosin （HE） staining， periodic acid-Schiff （PAS） staining， and Giemsa staining were used to observe the pathological changes， goblet cell hyperplasia， and eosinophil infiltration of nasal mucosa， respectively. Western blot was used to detect the expression levels of IL-33， ST2， and IL-1 receptor accessory protein （IL-1RAP） in nasal mucosa. ResultCompared with the control group， the model group showed increased times of sneezing and nasal rubbing （P<0.01）， edema and thickening of nasal mucosa， goblet cell hyperplasia and eosinophil infiltration， increased serum levels of OVA-sIgE， IL-4， IL-5 and IL-13 （P<0.01）， and increased protein expression of IL-33， ST2， and IL-1RAP in nasal mucosa （P<0.05，P<0.01）. After drug administration， compared with the model group， the high-dose XQLT group showed reduced times of sneezing and nasal rubbing （P<0.01）， improved pathological conditions of nasal mucosa， reduced serum levels of OVA-sIgE， IL-4， IL-5， and IL-13 （P<0.01）， and declining protein expression of IL-33， ST2， and IL-1RAP in nasal mucosa （P<0.05，P<0.01）. ConclusionXQLT has a therapeutic effect on OVA-sensitized AR mice， and the mechanism may be related to the regulation of the IL-33/ST2 signaling pathway and Th2 inflammatory cytokine to reduce Th2 inflammatory response and alleviate nasal mucosal injury.

【Objective】 To investigate the clinical characteristics， treatment and outcome of elderly patients with COVID-19. 【Methods】 We made a retrospective analysis of the clinical data of elderly patients with COVID-19 admitted by the National Anti-epidemic Medical Team of The First Affiliated Hospital of Xi’an Jiaotong University in Department of the seventh ward of Renmin Hospital of Wuhan University between February 9 and March 15， 2020. We fully extracted the patients’ demographics， epidemiological characteristics， clinical manifestations， laboratory examination， imaging performance， treatment and outcomes. 【Results】 In this study we included a total of 30 patients（18 males and 12 females）， with an average age of（71.1±14.4） years. Their underlying diseases included cardiovascular and cerebrovascular diseases（23 patients）， chronic pulmonary disease（3 patients）， digestive disease（2 patients）， diabetes mellitus（3 patients）， and chronic kidney disease（1 patients）. Before admission， 22 patients received oral medication. The initial symptoms were fever and cough. The peak body temperature averaged（38.4±0.6）℃ The mean time from symptom onset to hospitalization was 15.0±7.7 days. The clinical classification was mainly severe type in 26 patients（87%）. Laboratory examination revealed lower lymphocyte count（0.7±0.2）×10⁹/L， and higher blood D-D dimer lever（6.9±13）μg/L. Serum lactate dehydrogenase（LDH） significantly increased（310±136）U/L. Serum C-reactive protein（61±52）mg/L and erythrocyte sedimentation rate（ESR）（66±38）mmol/L slightly increased. Imaging performance revealed that diffuse lesions were located in bilateral pulmonary parenchyma（22 patients） and in single pulmonary parenchyma（7 patients）. Ground-glass opacity was found in all the patients， and the average number of CT examination during hospitalization was 3.5±1.3. Viral load revealed that nucleic acid in nasopharyngeal swabs of 30 patients was all positive， nucleic acid in the feces of 6 patients was positive， and nucleic acid in nasopharyngeal swab of 1 patient was positive， whose nucleic acid in alveolar lavage fluid was negative. Serum IgG antibody level was（157.5±29.2）AU/mL and IgM antibody level was（69.0±148.7）AU/mL. Complications included ARDS in 5 patients， AKI in 5 patients， cardiac injury in 3 patients， shock in 2 patients， nosocomial infection in 3 patients， coagulation disorder in 3 patients， and gastrointestinal bleeding in 3 patients. Finally， 5 patients received non-invasive mechanical ventilation and 2 patients received invasive mechanical ventilation. Another 2 patients underwent CRRT and 1 patient received CRRT plus ECMO. Of the 3 patients with critical type， 2 died and 1 survived. There were 25 patients who turned from severe type into normal type/light type， and 1 patient finally died（turned from severe type into critical type）. In the end， 15 patients were cured and discharged. The average time of viral nucleic acid from positive to negative was 12.4±5.6 and the average time of lesion absorption in computer tomography was 16.9±5.8 days. The total hospital stay was 22.9±8.1 days， and the 28-day mortality rate was 6.7%. 【Conclusion】 COVID-19 in elderly patients is mostly severe and its initial symptoms are still fever and cough. Patients should be immediately hospitalized when symptoms develop. The time of viral nucleic acid transformation and imaging improvement is longer than that of others. The mortality in critically ill patients is higher than that of others. Clinicians should pay more attention to the elderly people.