Objective To investigate the effects of different modes of one-lung ventilation (OLV) on hemodynamies in the patients undergoing thoracic operation.Methods Forty-five adult patients undergoing thoracic surgery,were randomly allocated into 3 groups based on the modes of OLV used ( n =15 each):intermittent positive pressure ventilation ( IPPV,VT 6-8 ml/kg,RR 10-14 bpm,I:E 1:2) group,IPPV + positive end-expiratory pressure (PEEP) group and IPPV + continuous positive airway pressure (CPAP) group.Double-lumen tube was inserted.Conrrect positioning was verified by fiberoptic bronchoscopy.The patients were mechanically ventilated.PETCO2 was maintained at 35-45 mm Hg.In group IPPV + PEEP,OLV was performed for 30 min with PEEP of 5 cm H2O and then for another 30 min with PEEP of 10 cm H2O.In group IPPV + CPAP,OLV was performed with IPPV in the lung on the ventilated side and with CPAP of 5 cm H2O in the lung on the operated side (for 1 h).MAP,HR,cardiac output (CO),cardiac index ( CI),stroke volume (SV),and stnoke volume index (SVI) were recorded before induction of anesthesia,at 10 min after intubation,at 30 min of two-lung ventilation,at 30 min and 1 h of OLV,and at the end of operation ( T1-6 ).Arterial blood samples were taken at T1,2,4-6 for blood gas analysis.The levels of blood glucose and lactate were measured.Oxygen delivery ( DO2 ) and DO2 index ( DO2I) were calculated.Results Compared with IPPV group,SV,SVI,CO,CI,DO2 and DO2I were significantly decreased at T4,5 ( P ＜ 0.05),and no significant change was found in the levels of blood glucose and lactate in group IPPV + PEEP,and no significant change was found in the parameters mentioned above in group IPPV + CPAP ( P ＞ 0.05).Compared with IPPV + PEEP group,SV,SVI,CO,CI,DO2 and DO2I were significantly increased at T4,5 ( P ＜ 0.05),and no significant change was found in the levels of blood glucose and lactate in group IPPV + CPAP ( P ＞ 0.05).Conclusion It exerts no influence on hemodynamics using OLV with IPPV in the lung on the ventilated side and with CPAP of 5 cm H2O in the lung on the operated side,however,OLV with IPPV + PEEP can result in hemodynamic fluctuation,but the degree of fluctuation is lesser and DO2 can be maintained in the patients undergoing thoracic operation.

Objective To investigate the effect of glucocortieoids on tenasein C(TNC) expression in nasal polyp tissues and airway epithelia,and explore the possible mechanism of glucocorticoids inhibiting remodeling of nasal polyp tissue.Methods The enzyme linked immunosorbent assay(ELISA) was used to detect the protein levels of tenascin C and transforming growth factor-β1(TGF-β1) in nasal polyp tissues from intranasal glucocorticoids (Budesonide,BUD) treated group and untreated group.The cell culture,real-time RT-PCR and in situ ELISA were employed to investigate the regulatory effects of budesonide on the TNC mRNA and protein expression in BEAS-2B immortalized human bronchial epithelial cells.Results The protein levels of TNC and TGF-β1 were decreased in nasal polyp tissues from intranasal BUD-treated group as compared with untreated group(P<0.01).There was a significantly positive correlation between TNC and TGF-β1 protein levels in nasal polyp tissues (r =0.68,P<0.01).After preincubation with BUD,TNC mRNA and protein expression induced by TGF-β1 in BEAS-2B cells was significantly decreased(P<0.01).Conclusion Glucocorticoids might participate in the regulation of tissue remodeling in nasal polyp by inhibiting the TGF-β1 expression in nasal polyp tissue and suppressing the induction of TGF-β1 to up-regulatie the TNC expression in airway epithelia.

BACKGROUNDIncretin-based therapies provide additional options for treating type 2 diabetes. We aimed to evaluate the efficacy and tolerability of exenatide monotherapy in obese patients with type 2 diabetes.

METHODSA 26-week, metformin controlled, parallel-group study was conducted among antidiabetic drug-naive obese patients aged > 18 years, and with type 2 diabetes. Participating patients were randomly assigned to receive exenatide or metformin treatments.

RESULTSFifty-nine patients (age (50.5 ± 8.6) years, body mass index (BMI) (30.2 ± 1.6) kg/m(2), and hemoglobin A1C (HbA(1C) (8.2 ± 1.2)%) were enrolled in the study. Glucose control and weight reduction improved in both groups receiving treatment. HbA(1C) and oral glucose tolerance test (OGTT) 2 hour glycemia reduction with exenatide was superior to that obtained with metformin ((-2.10 ± 1.79)% vs. (-1.66 ± 1.38)%, (-5.11 ± 2.68) mmol/L vs. (-2.80 ± 2.70) mmol/L, P < 0.05). Fast plasma glucose (FPG) reduction was not significantly different between the two groups ((-1.8 ± 2.0) mmol/L vs. (-1.6 ± 1.7) mmol/L, P > 0.05). Patients treated with exenatide achieved HbA(1C) of < 7% (97% of patients) and < 6.5% (79%) at end-point, vs. 93% and 73% with metformin (P > 0.05). Greater weight reduction was also achieved with exenatide ((-5.80 ± 3.66) kg) than with metformin ((-3.81 ± 1.38) kg, P < 0.01). Homeostasis model assessment of beta-cell function (HOMA-B) was not significantly increased, but the insulinogenic index and HOMA for insulin sensitivity (HOMA-S) were greatly improved in the exenatide group (P < 0.05). Nausea was the most common adverse effect in exenatide treatment (30% vs. 8%; P < 0.05), but most cases were of mild to moderate intensity. One case in the exenatide group was withdrawn early because of severe nausea. Hypoglycemia events were often observed during the first 4 weeks, with 12% of patients in the exenatide and 3.2% in metformin groups, respectively (P < 0.05). No incidents of severe hypoglycemia were reported.

CONCLUSIONSExenatide demonstrated more beneficial effects on HbA(1C), weight reduction and insulin resistance during 26 weeks of treatment, but there were more hypoglycemic events and mild-to-moderate nausea compared with metformin. These results suggested that exenatide monotherapy may provide a viable treatment option in newly developed type 2 diabetes.

Adult ; Diabetes Mellitus, Type 2 ; blood ; drug therapy ; Female ; Glycated Hemoglobin A ; metabolism ; Humans ; Hypoglycemia ; chemically induced ; Hypoglycemic Agents ; adverse effects ; therapeutic use ; Insulin Resistance ; Male ; Metformin ; adverse effects ; therapeutic use ; Middle Aged ; Nausea ; chemically induced ; Obesity ; blood ; drug therapy ; Peptides ; adverse effects ; therapeutic use ; Venoms ; adverse effects ; therapeutic use ; Weight Loss ; drug effects

OBJECTIVETo evaluate the efficacy and safety of trigonella foenum-graecum L. total saponins (TFGs) in combination with sulfonylureas (SU) in the treatment of patients with type 2 diabetes mellitus (T2DM) not well controlled by SU alone.

METHODSSixty-nine T2DM patients whose blood glucose levels were not well controlled by oral sulfonylureas hypoglycemic drug were randomly assigned to the treated group (46 cases) and the control group (23 cases), and were given TFGs or placebo three times per day, 6 pills each time for 12 weeks, respectively. Meanwhile, the patients continued taking their original hypoglycemic drugs. The following indexes, including effects on traditional Chinese medicine (TCM) symptoms, fast blood glucose (FBG), 2-h post-prandial blood glucose (2h PBG), glycosylated hemoglobin (HbA1c), clinical symptomatic quantitative scores (CSQS), body mass index (BMI), as well as hepatic and renal functions, were observed and compared before and after treatment.

RESULTSThe efficacy on TCM symptoms was obviously better in the treated group than that in the control group (P<0.01), and there were statistically remarkable decreases in aspect of FBG, 2h PBG, HbA1c and CSQS in the treated group as compared to those in the control group (P<0.05 or P<0.01), while no significant difference was found in BMI, hepatic and renal functions between the two groups (P>0.05).

CONCLUSIONThe combined therapy of TFGs with sulfonylureas hypoglycemic drug could lower the blood glucose level and ameliorate clinical symptoms in the treatment of T2DM, and the therapy was relatively safe.

Adult ; Aged ; Diabetes Mellitus, Type 2 ; drug therapy ; Drug Therapy, Combination ; Female ; Humans ; Male ; Middle Aged ; Saponins ; administration & dosage ; adverse effects ; Sulfonylurea Compounds ; administration & dosage ; Trigonella

OBJECTIVETo summarize the surgical effect and clinical application value of esophagectomy with extended 2-field lymph node dissection for patients with esophageal carcinoma.

METHODSFrom June 1987 to December 2008, 1690 patients with esophageal cancer underwent esophagectomy with extended 2-field (thoracic and abdominal) dissection of lymph nodes. Patients with the middle and lower thoracic esophageal cancer underwent Ivor-Lewis esophagectomy, and patients with upper thoracic esophageal cancer underwent Akiyama esophagectomy. 2-field (thoracic and abdominal) lymph node metastases information and the 1, 3, 5, 10-year survival rates were analyzed retrospectively.

RESULTSLymph node metastases were found in 713 patients. The lymph node metastases rate was 42.2% (713/1690).Thoracic lymph node metastasis rate was 39.3% (665/1690), among which in the right pleural apical para-tracheal triangle was 20.7% (349/1690), in the posterior upper mediastinum was 26.3% (444/1690), in the lower mediastinum was 18.2% (307/1690). Abdominal lymph node metastasis rate was 20.1% (339/1690). THE Postoperative complication rate was 16.4% (278/1690), among which the pulmonary complication rate ranking the first, was 43.6% (136/312). The operative mortality rate was 0.2%. The 1-year, 3-year, 5-year and 10-year survival rates were 88.2% (1388/1574), 63.5% (868/1367), 54.8% (705/1287) and 30.8% (232/754), respectively. The 5-year survival rate in patients without lymph node metastasis was 76.2% (448/588), but that in patients with lymph node metastases was 36.8% (257/669).

CONCLUSIONThe results of this study demonstrated that Ivor-Lewis and Akiyama esophagectomy with two-field lymph node dissection exposes the operation fields clearly and make radical lymphadenectomy thoroughly, especially the lymph nodes in the posterior upper mediastinum around the recurrent laryngeal nerve and in the right pleural apical para-tracheal triangle. It is essential that patients with esophageal carcinoma with lymph node metastases should undergo esophagectomy with extended 2-field dissection of lymph nodes. This can elevate the postoperative 5-year survival rate remarkably.

Adenocarcinoma ; mortality ; pathology ; surgery ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; mortality ; pathology ; surgery ; Esophageal Neoplasms ; mortality ; pathology ; surgery ; Esophagectomy ; adverse effects ; methods ; Female ; Humans ; Lymph Node Excision ; adverse effects ; methods ; Lymphatic Metastasis ; Male ; Middle Aged ; Respiratory Insufficiency ; etiology ; Retrospective Studies ; Survival Rate

OBJECTIVE: To investigate the expression of Clara cell 10-KDa protein (CC010) in sinonasal mucosa of murine bacterial chronic rhinosinusitis (BCRS) model. METHOD: A murine BCRS model was established by Streptococcus pneumoniae inoculation plus Merocel ostiomeatal obstruction. After 12 week's intervention, histological changes of sinonasal mucosa in BCRS model were examined by hematoxylin and eosin stain, periodic acid-schiff stain, and Masson-Trichrome stain. The mRNA and protein expression of CC10 in sinonasal mucosa were determined by reverse transcription polymerase chain reaction and immunohistochemistry methods. The number of CC10 positive cells in sinonasal epithelium was also counted. RESULT: In BCRS model group, polymorphonuclear neutrophils (PMN), subepithelial collagen deposition, goblet cells, and epithelial thickness were significantly increased, compared with control group (P<0.01). However, CC10 positive cells, CC10 mRNA and protein expression in sinonasal mucosa of BCRS model group were significantly decreased, compared with control group (P<0.01). Moreover, the number of CC10 positive cells was significantly negatively correlated with PMN (r=-0.734, P<0.01), subepithelial collagen deposition (r=-0.776, P<0.01), epithelial goblet cells (r=-0.841, P<0.01), and epithelial thickness (r=-0.805, P<0.01), respectively. CC10 average grayscale value was significantly positively correlated with PMN (r=0.771, P<0.01), subepithelial collagen deposition (r=0.802, P<0.01), epithelial goblet cells (r=0.887, P<0.01), and epithelial thickness (r=0.855, P<0.01), respectively. CONCLUSION The expression of CC10 is downregulated in sinonasal mucosa in BCRS model. As an important endogenous modulin, CC10 might play a crucial role in the pathogenesis of chronic rhinosinusitis.
Animals ; Chronic Disease ; Disease Models, Animal ; Male ; Mice ; Mice, Inbred C57BL ; Pneumococcal Infections ; metabolism ; Sinusitis ; metabolism ; microbiology ; Uteroglobin ; metabolism

OBJECTIVE: To explore the difference in some subjective symptoms, objective examination results, and pathological characteristics between chronic sinusitis patients with and without nasal polyps (CRSwNP and CRSsNP). METHOD: Prospective data of 42 CRSsNP patients and 33 CRSwNP patients scheduled for surgery were collected and analyzed retrospectively. A visual analog scale (VAS) symptom score was completed. The preoperative computed tomography (CT) scans were graded according to Lund and Mackay. The preoperative nasal endoscopy was graded by assigning an endoscopy score according to Lanza and Kennedy. Blood was drawn to determine the number of peripheral eosinophils (EOS) by means of automated analysis. Surgical specimen was examined pathologically for the number of EOS per high-powered field. Interleukin (IL)-5 was determined by means of quantitative enzyme-linked immunosorbent assay. RESULT: (1) As to the single VAS symptom score relating to overall symptom severity and the VAS score based on the sum of five sinonasal symptoms, there was no difference between CRSsNP and CRSwNP patients (P > 0.05). However, compared with CRSwNP patients, CRSsNP patients had higher VAS score of nasal discharge (P < 0.05) and lower score of hyposmia (P < 0.01); (2) Compared with CRSsNP patients, CRSwNP patients had higher CT and endoscopy scores, peripheral and mucosal EOS counts, and mucosal IL-5 level (P < 0.05); (3) The preoperative CT and endoscopy scores were positively correlated with peripheral and mucosal EOS counts and mucosal IL-5 level (P < 0.01). CONCLUSION There is no significant difference in overall symptom between CRSsNP and CRSwNP patients. However, CRSwNP patients have more severe inflammation in nasal and sinus cavity, which is related to eosinophilic inflammation in local mucosa.
Adolescent ; Adult ; Aged ; Child ; Chronic Disease ; Endoscopy ; Eosinophils ; pathology ; Female ; Humans ; Inflammation ; Male ; Middle Aged ; Nasal Polyps ; complications ; pathology ; Retrospective Studies ; Sinusitis ; complications ; pathology ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVE: To explore the relationship between rhinosinusitis symptoms and objective sinus examinations. METHOD: Prospective data of 75 patients with CRS scheduled for surgery were collected and analyzed retrospectively. The preoperative computed tomography (CT) scans were graded according to Lund and Mackay. The preoperative nasal endoscopy was graded by assigning an endoscopy score according to Lanza and Kennedy. A visual analog scale (VAS) symptom score was completed. RESULT: (1) There was a significant correlation between preoperative CT and endoscopy scores (r = 0.88, P < 0.01); (2) The severity of smell function disturbance correlated with severity of disease on CT scan and endoscopy (r value was 0.57 and 0.53 respectively, P < 0.01). However, other symptoms and overall sinonasal symptom severity had no correlation (P > 0.05). Furthermore, a statistically significant but weak correlation was found between the VAS score based on the sum of five sinonasal symptoms and the Lund-Mackay CT scan score (r = 0.26, P < 0.05), while no correlation between VAS score based on the sum of five sinonasal symptoms and endoscopy score was found ( P > 0.05). CONCLUSION There is no good correlation between CRS symptoms and objective examinations. In order to evaluate CRS patients' severity and select treatment properly, both symptoms and objective examinations must be considered.
Adolescent ; Adult ; Aged ; Child ; Chronic Disease ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Severity of Illness Index ; Sinusitis ; diagnosis ; diagnostic imaging ; Tomography, X-Ray Computed ; Young Adult

Objective To explore whether there are gene mutations of Tolloid-like 1 ( TLL-1 ) gene in Chinese patients with sporadic congenital heart disease (CHD).Methods One hundred and fifteen patients with sporadic CHD were selected as CHD group.One hundred and two age and gender-matched healthy people were recruited as control group.After amplifying the exon 10 of the TLL-1 gene by polymerase chain reaction,the polymerase chain reaction products were purified,sequenced and analyzed in order to investigate the TLL-1 gene mutation.Results An insertion mutation of base A in the exon 10 of TLL-1 gene was identified in 7 out of 115 CHD patients,including 3 patients with atrial septal defect,2 patients with ventricular septal defect,1 patients with patent ductus arteriosus and 1 patients with complex CHD,the total mutation rate was 6.1％ in CHD group and 0 in control group ( P ＜ 0.01 ).Conclusions TLL-1 gene mutation with an insertion mutation of base A in exon 10 is often in Chinese patients with various CHD.The underlying pathogenesis between TLL-1 gene mutation and occurrence of congenital heart disease in Chinese people remains unclear and warrants further investigations.

Objective To explore the feasibility and nursing strategy of active-fixation lead in patients with right ventricular outflow tract high septum ( RVOTHS)pacing. Methods Forty patients were divided into two groups randomly and use VVI pacing mode. One group underwent the right ventricular outflow tract high septum(RVOTHS) with the active fixation lead. The other group underwent the right ventricular apex (RVA)pacing with the passive-fixation lead. The parameters and complication after operation of two groups were recorded and compared accordingly. Results Operations went smoothly with few complications in two groups.The active-fixation lead group had one wire dislocation. while the passive-fixation lead group also had one. There was no serious complication during all operations. The exposure time during operation for RVOTHS prolonged obviously (t=4.036,P＜0.01). The comparative difference of ventricular spacing threshold , feeling threshold and electrode impedance between the two groups during operation had no statistic meaning (P＞0.05), the pacing electrocardiogram QRS wave width of RVOTHS team was more narrow than that of RVA team, but the difference has no statistical meaning (t = 1. 613, P ＞ 0. 05 ). Conclusions It is safe and feasible to pace in RVOTHS with active electrode. The complication after operation can be well decreased by nursing care and individual nursing.