Objective To investigate advantages and disadvantages of endoscopic thyroidectomy.Methods A total of 61 consecutive patients with thyroid diseases from December 2003 to August 2004 in this hospital were freely divided into two groups: the Endoscopic Group(30 patients) and the Open Group(31 patients).The operating time,blood loss,hospital stay,postoperative pain assessment,jugular sensation 3 months after operation, swallowing function,and cosmetic outcomes between the two groups were compared.Results The operating time in the Open Group was significantly shorter than that in the Endoscopic Group(78?34 min vs 126?53 min;t=4.125,P=0.000).The intraoperative blood loss was less in the Endoscopic Group(20?13 ml) than in the Open Group(34?19 ml)(t=-3.313,P=0.002).The postoperative pain in the Endoscopic Group was slighter than that in the Open Group 24 and 48 hours after operation(t=3.255,P=0.002;t=-2.598,P=0.012).Three months after operation,jugular hypesthesia and discomfort at swallowing occurred in 1 and 2 patients in the Endoscopic Group,respectively,whereas jugular hypesthesia or paresthesia occurred in 11 patients(?~2=10.594,P=0.001) and discomfort at swallowing happened in 9 patients((?~2=5.773),P=0.016) in the Open Group.All patients in the Endoscopic Group were satisfied with the cosmetic results,but 19 patients in the Open Group complained of unsatisfactory cosmetic outcomes(?~2=52.141,P=0.000).Conclusions Endoscopic thyroidectomy gives little blood loss,mild postoperative pain,and good cosmetic results,being a feasible and safe procedure.

Objective To study the sub chronic toxicity of silver nanoparticles on medaka.Methods Adult fish were divided into silve nenopartides and control group.Animals were collected on 14 days after exposure, and some toxicological endpoints such as death rate, tissue distributed of silver irons, oxidative stress and histopathological damage were measured.Results There were significant difference in death rate of medaka treated with silver nanoparticles and control group.Compared with the control group, the content of silver in gill, intestine and liver of medaka treated with silver nanoparticles were increased significantly.Compared with control group, the activity of LDH in liver and SOD in liver and gill were significantly decreased(P<0.01).The content of MDA in liver of medaka treated with silver nanoparticles was significantly increased(P<0.01).The liver and gill of mekada treated with silver nanoparticles were damaged, compared with control group.Conclusion Nano silver has a certain subchronic toxicity to aquatic life.

Objective To evaluate sleeve gastrectomy with ileal interposition and duodenojejunal bypass for the treatment of nonobese Type 2 diabetes mellitus.Methods Forty one patients of nonobese Type 2 diabetes mellitus underwent sleeve gastrectomy with ileal interposition and duodenojejunal bypass.Fasting glucose ( FPG ),glycosylated hemoglobin ( HbAlc ),fasting insulin and C-peptide,triglycerides (TG),high density lipoprotein(HDL),low density lipeprotein(LDL) were measured preoperatively and on postoperative first,3rd,6th month.Results Mean postoperative follow-up was 9.6 months (range 6-21 months).95％ patients achieved adequate glycemic control (HbAlc ＜ 7％ ) without antidiabetic medication.Fasting glycemia decreased from ( 9.7 ± 0.4 ) mmol/L to ( 6.2 ± 0.3 ) mmol/L ( P ＜ 0.01 ).Glycosylated hemoglobin decreased from 8.1％ ± 1.4％ to 5.8％ ± 0.6％ ( P ＜ 0.01 ).2-hour postprandial blood glucose decreased from ( 13.6 ± 0.7 ) mmol/L to ( 10.6 ± 0.2 ) mmol/L ( P ＜ 0.01 ).Insulin resistance (Homa-R) decreased from 4.8 ± 1.3 to 1.2 ±0.4 (P ＜0.01 ).Fasting C-peptide increased from ( 3.3 ± 1.7 ) ng/ml to (4.9 ± 0.2 ) ng/ml ( P ＜ 0.01 ).Fasting insulin increased from ( 10.2 + 1.4 ) mlu/L to (15.6±0.7) mlu/L(P＜0.01 ).Triglycerides (TG) decreased from (3.1 ±0.5) mmol/L to (1.9 ±0.4) mmol/L ( P ＜ 0.01 ).High density lipoprotein (HDL) increased from ( 1.2 ±± 0.2 ) mmol/L to ( 1.9 ±0.8 ) mmol/L( P ＜ 0.01 ).Low density lipoprotein (LDL) decreased from (3.5 ± 0.3 ) mmol/L to (2.4 ±0.6) mmol/L (P ＜0.01 ).Hypertension was controlled in 3/7 cases.Microalbuminuria resolved in 78％ patients.Retinopathy was improved in 53％ cases.Conclusions Sleeve gastrectomy with ileal interposition duodenojejunal bypass is effective for treatment of nonobese type 2 diabetes mellitus as showed by 6 month's follow-up.

Objective To observe the effects of sevoflurane and propofol on cerebral oxygen metabolism and postoperative cognitive function during cardiopulmonary bypass (CPB). Methods Fifty ASA Ⅱ or Ⅲ patients aged 40-65 years old scheduled for cardiac valve replacement surgery with CPB were randomly assigned into two groups,sevoflurane group (group S) and propofol group (group P),25 in each group.Two groups of patients used the same method of anesthesia induction:midazolam 0.1 mg?kg-1,sufentanil 0.7 μg?kg-1,vecuronium 0.1 mg?kg-1,and etomidate 0.2 mg?kg-1 were intravenously injected successively,and then tracheal intubation was performed.For maintenance of anesthesia,patients of group S continuously inhaled 3%-4% sevoflurane, and patients of group P were intravenous pumped with propofol 4-6 mg?kg-1?h-1 via vein;midazolam,sufentanil and vecuronium bromide were intermittently injected in both groups.At the time points of pre-bypass (t1), nasopharynx temperature dropping to constant temperature regularly ( t2 ) ,nasopharynx temperature rising to constant temperature regularly ( t3 ) ,1 h after the end of CPB ( t4 ) ,and 6 h after the end of CPB ( t5 ) ,blood from radial artery and right jugular bulb was harvested for blood gas analysis,and mini-mental state examination( MMSE) score were evaluated before and 24 and 48 h after the surgery. Results The jugular venous bulb oxygen saturation( SjvO2 ) in the two groups were both increased during T2 period and then decreased during t3 period, but arteriovenous oxygen content difference ( AVDO2 ) and oxygen extraction rate (O2ER) were both decreased during t2 period and then increased during t3 period.There was no significant difference between the two groups during t2 and t3 period (P>0.05).MMSE scores of the two groups after operation were all less than those before operation,but that was significantly higher in the sevoflurane group than in the propofol group 24 h after the surgery ( t=4.34,P<0.05) . Conclusion The two anesthesia methods can meet the need of valve replacement surgery and maintain the cerebral oxygen balance during CPB period, but sevoflurane anesthesia has fewer influences in post-operation mental nerve functional changes.

Objective To survey the thyroid-hormone changes in gravidas,and to establish the reference intervals for thyroid-hormones in each trimester of normal pregnancy in Pingdingshan.Methods 2 645 gravidas who established documents in our hospi-tal were enrolled,The gravidas were divided to different groups by age (≤30 and >30 years old)and 425 cases of early pregnancy women,1 657 cases of middle pregnancy women and 563 cases of late pregnancy women were collected as research group.4 kinds of thyroid functions in the six groups were detected by electrochemical luminescence.Results FT3 and FT4 gradually reduced as the growth of the pregnancy period,but TSH and TPOAb increased.There is statistical difference in all thyroid-hormones between all trimesters of pregnancy and different age groups.Conclusion There is significant difference in thyroid-hormones for different sta-ges of pregnancy and different age groups.Therefore,establishing reference intervals of thyroid-hormones during different stages of pregnancy may be important for clinical practice.

Objective To investigate the changes of T lymphocyte subsets of severe acute respiratory syndrome(SARS) patients during acute phase and recovery stage and study its clinical significance in early diagnosis of SARS.Methods T lymphocyte subsets of 40 patients of SARS and 22 cases of SARS recovery stage were detected by flow cytometry.Results Compared with normal group, T lymphocyte, Th and Ts cell counts of SARS patients decreased obviously( P =0.013, P 0.05). Conclusion The cellular immunity of SARS patients were badly damaged during acute phase. Their T lymphocyte, Th and Ts cell counts decreased obviously. This could be a guideline of early diagnosis of SARS. The counts of T lymphocyte subsets of SARS patients can return to normal after they were cured.

Objective To study the ultrastructure of human oocytes cultured in vitro.Methods Ultrastructure of oocytes at different stages and of different quality were observed under transmission electron microscope(TEM).Immature oocytes at germinal vesicle(GV) stage and at MI stage after germinal vesicle break-down before and after being cultured in vitro,as well as mature oocytes at MⅡ stage after being cultured were evaluated according to their morphology under light microscope,and then studied by TEM. Results At GV stage the microvilli on oocyte surface were rare and shorter.Nucleus with a dense nucleolus was located in the periphery of oocyte.After culture the oocyte microvilli became denser and increased in number.There were rich ooplasm with organelles,such as large numbers of secretion vesicles,mitochondria and lipid droplets in the GV oocyte.The end of cumulus cell expanded and penetrated into the oocyte zone,forming gap junctions with oocyte microvilli.Functional connection of the adjacent cumulus cells was by desmosomes. In mature oocytes the rough endoplasmic reticulum and Golgi apparatus decreased while the smooth endoplasmic reticulum increased in number.Mitochondria degenerated and lipid droplets fused to form bigger ones.Cortical granules were distributed beneath the cytoplasm membrane in a line manner.The cell junctions between oocytes and cumulus cells were interrupted.There were various organelles in the first polar body.The mature oocytes with lower quality appeared to have lots of swollen mitochondria with blurred cristae and membrane.Some of these oocytes had fractured first polar bodies and deformed zona pellucida.Their surrounding cumulus cells showed higher frequency of cell apoptosis.Conclusion The ultrastructure of human oocytes at different stages and of different quality cultured in vitro was revealed.

Objective To observe the effects and mechanism of Ganoderma Lucidum Polysaccharides (GLP) on the activity of superoxide dismutase(SOD), the content of malondialdehyde(MDA) of hippocampus tissue and the learning and memory ability. Methods AD rats induced by A? 25-35 were treated with GLP for 7 days and then observing the Morris water maze to study the learning and memory ability, the content of MDA, and the activity of SOD was measured in the hippocampus tissue with spectrophotometer. Ultrastructural changes of neuron were viewed under transmission electron microscope. Results GLP can distinctly improve the learning and memory ability of A?-injected rats(P

Objective To evaluate the reliability of ultrasonography used to guide the selection of uncuffed endotracheal tube (ETT) size for pediatric patients.Methods Eighty pediatric patients requiring endotracheal intubation for elective surgery under general anesthesia,aged 2-6 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,were randomized into 2 groups (n=40 each) using a random number table:control group and ultrasonography group.In control group,the internal diameter of an uncuffed ETT was determined according to age-based formulas.In ultrasonography group,the outer diameter of an uncuffed ETT was determined according to the transverse diameter of the subglottic airway at the level of the cricoids cartilage measured by ultrasonography.The air leak test was performed after intubation,and either a larger or a smaller size of ETT selected was considered as a failure of intubation.The failure of intubation and postoperative complications related to intubation were recorded.Results Compared with control group,the total failure rate of intubation and failure rate due to the smaller size of ETT selected were significantly decreased in ultrasonography group (P＜0.01).There was no significant difference in the incidence of intubation-related complications between the two groups (P＞0.05).Conclusion Ultrasonogra-phy can be used to guide the selection of ETT size for pediatric patients.

Objective To evaluate the early effects on insulin resistance following sleeve gastrectomy with ileal interposition duodenojejunal bypass operation.Methods From Jun.2010 to Sep.2011,37 cases of type 2 diabetes mellitus patients [23 male,14 female; mean age (45.2 ± 2.4) years,mean BMI (21.7 ± 1.8) kg/m2] underwent sleeve gastrectomy with ileal interposition duodenojejunal bypass operation.Fasting plasma glucose(FPG),fasting insulin(FIns),body mass index(BMI),and homeostatic model assessment for insulin resistance (HOMAIR) were detected before surgery and on the 10th,20th,30th,and 60th day after surgery.Results The level of FPG was (6.8 ± 0.7) mmol/L,(7.2 ± 0.6) mmol/L,(6.9 ± 0.3) mmol/L respectively on the 10th,20th,and 30th day after surgery,significantly lower than that before surgery[(10.2 ±0.4)mmol/L].The difference had statistical significance (P ＜ 0.05).The level of Fins was (6.3 ± 1.1) mIu/L,(7.1 ± 1.3) mIu/L,and (7.3 ± 1.6) mIu/L respectively on the 10th,20th,and 30th day after surgery,significantly lower than that before surgery[(12.6 ± 1.4)mIu/L].The difference had statistical significance (P ＜ 0.05).The level of lnHOMA-IR was 0.7 ± 0.2,0.9 ± 0.5,and 0.8 ±0.4 respectively on the 10th,20th,and 30th day after surgery,significantly lower than that before surgery (1.8 ±0.6).The differenc had statistical significance(P ＜0.05).However,the change of BMI was not obvious between before surgery and on the 10th,20th,and 30th day after surgery.The difference had no statistical significance (P ＞ 0.05).on the 60th day after surgery,the level of FPG,Fins,lnHOMA-IR and BMI was significantly reduced compared with that before surgery.The difference had statistical significantce(P ＜0.05).Conclusion After sleeve gastrectomy with ileal interposition duodenojejunal bypass operation,the early improvement of insulin resistance occurs rapidly and it is iadependent of the loss of BMI.