A survey of current perioperative fasting management in patients with orthopaedic trauma in China / 中华创伤骨科杂志

Objective:To investigate the current situation of perioperative fasting management in patients with orthopaedic trauma waiting for elective surgery (those combined with diabetes mellitus included) and the surgeons' awareness in China.Methods:From November 1st to December 31st, 2021, the questionnaire forms were distributed through WeChat in the exchange group of National Enhanced Recovery Surgery (ERAS) and the exchange group of national training orthopaedists in Beijing Jishuitan Hospital. The survey contents included: time for preoperative water deprivation and for postoperative recovery of drinking in patients without diabetes mellitus, the rationales for orthopaedists to choose perioperative dietary management, the orthopaedists＇understanding of the existing guidelines, time for preoperative water deprivation and postoperative recovery of drinking and diabetes-related issues in patients with diabetes mellitus, and the time for postoperative recovery in all the patients (For the postoperative recovery of eating, there is no difference between patients with and without diabetes mellitus). The relationships were analyzed between some professional data of the orthopaedists and their rationales for choice of management strategies and their understanding of the guidelines.Results:A total of 565 valid questionnaires were collected. 12.92% (73/565) of orthopaedists required their patients without diabetes mellitus not to drink for at least 2 hours. In fact, the proportion of water prohibition from 0 o'clock on the day of operation was still the highest [24.07% (136/565)]. Respectively, 22.83% (129/565) and 42.12% (238/565) of the orthopaedists chose "water intake is allowed once awakened" and "water intake after at least 6 hours after operation" for their patients without diabetes mellitus. 33.98% (192/565) of the orthopaedists required all the patients fasted for at least 6 hours before surgery, and 44.25% (250/565) of the orthopaedists chose "eating can be resumed if there is no discomfort for 2 hours after water intake" .21.06% (119/565) of the orthopaedists demonstrated that they were quite familiar with the guidelines and carried out perioperative dietary management according to the guidelines. The management of water deprivation was more inconsistent for patients with diabetes mellitus, and more hospitals followed the traditional principles for water deprivation. The proportions of water deprivation starting at 0 o'clock on the day of operation, 8 hours before operation, 6 hours before operation and 4 hours before operation accounted respectively for 22.83% (129/565), 19.12% (108/565), 21.95% (124/565), and 18.94%% (107/565). The level of an orthopaedist's hospital and the professional rank of an orthopaedist were the factors related to the orthopaedist's understanding of the guidelines ( P<0.05). Conclusions:The current perioperative dietary management guidelines are not widely implemented or well known in Chinese faculties of orthopaedic trauma. The process of perioperative dietary management needs to be optimized for the patients combined with diabetes mellitus.

Clinical efficacy of perioperative fasting abbreviation in patients with orthopaedic trauma and diabetes mellitus / 中华创伤骨科杂志

Objective:To evaluate the effectiveness of perioperative fasting abbreviation in traumatic patients with orthopaedic trauma and diabetes mellitus undergoing selective surgery.Methods:The patients were selected for this prospective nonrandomized controlled study who had undergone selective surgery from June 2019 to June 2021 at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. They were divided into an intervention group and a control group according to the wards where they stayed. The intervention group was fasted for solids from 0 o'clock on the surgery day and received oral solution with 6.25% maltodextrin which had been prepared by the nutritional department 3 hours prior to surgery. The control group was fasted for either liquids or solids from the midnight before surgery. All patients were evaluated according to the wake-up score and defensive reflex score after surgery. Once they were awakened, they were allowed slag-free drinks. Normal food was allowed if there was no discomfort after 2 hours. The 2 groups were compared in terms of basic information, actual preoperative fasting time, total amount of preoperative drinking, and postoperative time for initial drinking and eating. The perioperative subjective feelings (anxiety, thirst, hunger, nausea, fatigue, dizziness, sweating, stomach discomfort, etc.), grip strength and blood glucose were observed and compared between the 2 groups. Adverse reactions in the 2 groups were also observed.Results:A total of 135 patients were included, including 52 in the intervention group and 83 in the control group. The intervention group consisted of 22 males and 30 females aged from 30 to 84 years; the control group consisted of 39 males and 44 females aged from 29 to 81 years. There was no significant difference in the basic information between the 2 groups, showing comparability ( P>0.05). The intervention group had significantly shorter preoperative fasting time [3.5 (2.5, 6.3) h versus 12.0 (9.0, 16.0) h], significantly higher water intake before surgery [300 (200, 300) mL versus 100 (100, 200) mL], significantly shorter postoperative fasting time [0.08 (0, 1.25) h versus 2.00(0, 6.00) h], and significantly reduced time to return to normal diet [2.0 (2.0, 2.3) h versus 3.0(2.0, 6.0) h] than the control group (all P<0.05). The symptoms of anxiety, fatigue, sweating, and stomach discomfort in the intervention group were significantly fewer than those in the control group throughout the evaluation period. The thirst in the intervention group was significantly alleviated than that in the control group immediately after returning to the ward after surgery, and the dizziness and hunger were significantly alleviated than those in the control group when the patients left the ward to the operation room before surgery and immediately after returning to the ward. The symptom of nausea after returning to normal diet in the intervention group was significantly relieved compared with the control group. All the comparisons above showed statistically significant differences ( P<0.05). The blood glucose in the intervention group 2 hours after taking slag-free drinks was significantly higher than that in the control group ( Z=-2.108, P=0.035). There was no significant difference in the blood glucose between the 2 groups during other measurement periods ( P>0.05). There were no serious adverse reactions in either of the 2 groups. Conclusion:The protocol of perioperative fasting abbreviation may be safe and feasible for the patients with orthopaedic trauma and diabetes mellitus undergoing selective surgery, because it shows benefits of improving the patients' subjective feelings and stabilizing the blood glucose perioperatively.

Effect of glucose pretreatment on the effect of rapid rehabilitation surgery in patients undergoing hip replacement / 中国骨伤

OBJECTIVE@#To explore the effect of glucose pretreatment in the rapid rehabilitation surgery of hip replacement patients, and to provide reference for the future clinical treatment.@*METHODS@#From June 2016 to June 2018, 168 patients (100 males, 68 females) were treated with hip replacement. The patients were divided into control group and observation group, 84 cases in each group, aged 25 to 90 (52.05±5.73) years old. Both groups were treated with the concept of rapid rehabilitation surgery, the control group was given traditional fasting water deprivation before operation, and the observation group was given glucose pretreatment before operation. The levels of fasting blood glucose(FBG), C-peptide, fasting insulin(FINS), IgG, IgM, IgA and total lymphocyte count (TLC) were compared before and after operation, and the sensitivity of thirst, nausea, fatigue, sweating, stomach discomfort, anxiety, hunger and dizziness were compared.@*RESULTS@#All the 168 patients were followed up. There was no significant difference in FBG, C-peptide and fins levels between the observation group and the control group (>0.05). The levels of FBG, C-peptide and fins in the observation group were higher than those in the control group (0.05);the serum IgG, IgM, IgA and TLC levels after operation were higher than those before operation, and the observation group was higher than the control group(0.05);the degree of anxiety, hunger and dizziness in the observation group was less than that in the control group (<0.05).@*CONCLUSION@#Glucose pretreatment before hip replacement can relieve insulin resistance, improve immunity and change energy storage under fasting, which can be widely used in clinic.

Effect of preoperative carbohydrate treatment on patients in Enhanced Recovery After Surgery / 中华创伤骨科杂志

Objective To evaluate the safety of preoperative oral carbohydrate treatment for the patients in Enhanced Recovery After Surgery (ERAS) and the treatment effect on the perioperative state of the patients.Methods A prospective controlled research was conducted in the patients who had received selective operation for fractures at Department of Orthopaedic Trauma,Beijing Jishuitan Hospital from August 2016 to August 2017.They were divided into 2 groups according to the floor where they stayed.In the traditional fasting group (group TF),fasting was performed one day before operation at 12:00 p.m.;in the preoperative carbohydrate treatment group (group PCT),12.6％ mahodextrin fructose beverage was indicated one day before operation and on the day of operation.The patients in both groups were managed according to ERAS requirements perioperatively.The fasting blood glucose values were measured at admission,just before operation,immediately after operation,and on the next day after operation.The subjective feelings,grip strength and adverse reactions in the 2 groups were observed and recorded.Results A total of 171 patients,112 in group TF and 59 in group PCT,participated in the whole observation.The blood gluco.se value just before operation in group PTC(5.9 ± 1.0 mmol/L) was significantly higher than that (5.2 ±0.6 mmol/L) in group TF (P ＜ 0.05).In group TF,the blood glucose values immediately before operation,immediately and on the next day after operation (5.2 ± 0.6 mmol/L,5.4 ± 1.1 mmol/L and 5.4 ± 1.0 mmol/L) were significantly lower than that at admission (5.7 ± 1.1 mmol/L) (P ＜ 0.05);in group PTC,the blood glucose values immediately and on the next day after operation (5.4 ±0.7 mmol/L and 5.2 ±0.7 mmol/L) were significantly lower than those immediately before operation and at admission (5.9 ± 1.0 mmol/L and 5.9 ± 1.0 mmol/L) (P ＜0.05).Patients in group PTC reported milder uneasy subjective feelings than those in group TF.The grip strength values immediately and on the next day after operation in group PTC (34.3 ± 10.4 kg and 34.5 ± 10.9 kg) were higher than those in group TF (29.1 ± 13.1 kg and 30.1 ± 12.0 kg).Patients in group PCT showed higher satisfaction with perioperative fasting management than those in group TF [9 (9,9) versus 8 (7,9)].All the above differences were significant (P ＜ 0.05).Conclusion Preoperative carbohydrate treatment by oral intake of maltose and fructose drinks may be safe and feasible in fracture patients,benefiting their energy storage during fasting and improving their perioperative subjective feelings.

Perioperative fasting management by traumatic surgeons in China / 中华创伤骨科杂志

Objective To investigate the current perioperative fasting management by Chinese traumatic surgeons for elective patients and the related awareness in Chinese traumatic surgeons.Methods Traumatic surgeons were interviewed through questionnaires which addressed the current pre-and post-operative fasting time for liquid and solid food in their hospitals,the postoperative practice to keep the patients in recumbent position without pillow,their reasons to choose perioperative fasting management and their knowledge of the current related guidelines.The associations between surgeons' information and their reasons to choose fasting management and their knowledge of the related guidelines were analyzed.Results A total of 187 valid questionnaires were collected.The percentages of the surgeons who indicated perioperative fasting time for liquid for at least 2 hours and for solid food for at least 6 hours were only 3.74％ and 27.27％,respectively.Nil by mouth from midnight for liquid or for solid food was actually indicated by 29.95％ and 31.55％ of the surgeons,respectively.64.71％ of the surgeons still required their patients to fast for liquid for at least 6 hours postoperatively,even longer for solid food.Only 1.6％ of the surgeons did not ask their patients to keep in recumbent position without pillow postoperatively whatever the anesthesia types were.Only 6.95％ of the surgeons chose a perioperative fasting protocol based on the related guidelines.Only 9.09％ of the surgeons knew the related guidelines very well.The reasons of the surgeons to choose a perioperative fasting protocol and the knowledge of the surgeons about the related guidelines were not associated with the professional ranks of the surgeons,hospital ranking or hospital location (P ＞ 0.05).Conclusions The current management of perioperative fasting is backward in the Chinese communities of traumatic orthopedics,and the related guidelines are not well implemented due to the poor awareness of them.

A prospective cohort study on reducing perioperative fasting in traumatic patients following Enhanced Recovery After Surgery protocol / 中华创伤骨科杂志

Objective To evaluate the effectiveness of perioperative fasting abbreviation in traumatic patients undergoing selective surgeries.Methods The traumatic patients undergoing selective surgeries from November 2016 to January 2017 at our department were selected for this prospective cohort study.They were divided into an intervention group (69 patients) and a control group (121 patients) according to the wards where they stayed.The intervention group was fasted for solids 6 hours prior to surgery and received oral solution with maltodextrin 2 hours prior to surgery.After surgery,they were allowed to drink liquids as soon as they were awakened.Normal food was allowed 2 hours later.The control group was fasted for either liquids or solids the night before surgery.After surgery,the patients who had received brachial plexus block only were allowed liquids with no limitation while the other patients were allowed liquids 6 hours after surgery and then were free for solids and liquids if no discomfort was observed.The time periods for preoperative liquids and solids fasting and for postoperative intake of liquids and solids were recorded and compared between the 2 groups.The perioperative well-beings (including anxiety,thirst,hunger,nausea,fatigue,dizziness,sweating and stomach discomfort) and serum glucose levels were compared between the 2 groups.Adverse reactions were observed.Results The preoperative fasting time for liquids for the intervention group (4.5 ± 2.9 hours) was significantly shorter than that for the control group (14.3 ±3.9 hours) (P ＜ 0.05).The preoperative fasting time for solids for the intervention group (17.6 ± 3.0 hours) were significantly longer than that for the control group (16.1 ±3.8 hours) (P ＜ 0.05).The postoperative fasting time periods for both liquids [1 (0,3) h] and solids [2 (1,4) h] for the intervention group were significantly shorter than those for the control group [6(6,6) h] hours and [6(6,6) h] (P ＜ 0.05).Compared with the control group,the perioperative anxiety,thirst,hunger,nausea,fatigue,dizziness and stomach discomfort were significantly improved in the intervention group (P ＜ 0.05).The average serum glucose level was similar in both groups upon admission (P ＜ 0.05);it was significantly higher in the intervention group immediately before surgery (P ＜ 0.05) but was gradually decreased after surgery until there was no significant difference between the 2 groups (P ＞ 0.05).No major adverse reaction was observed in either group.Conclusion The protocol of perioperative fasting abbreviation may be safe and feasible in traumatic patients for selective surgeries,showing benefits of decreased anxiety,thirst,hunger,nausea,fatigue,dizziness and stomach discomfort.

Comparative analysis of blood glucose changes of different strains of mice under food and/or water deprivation / 军事医学

Objective To provide reference on the difference in blood glucose metabolism between different mouse strains by comparing blood glucose changes under food and /or water deprivation.Methods C57BL/6J mice, BALB/c mice,and ICR mice used in this study were divided into four groups:control group, food deprivation group, water depriva-tion group and food &water deprivation group .Their blood glucose was measured within 12 hours under various stresses . Results and Conclusion There are different blood glucose regulation patterns in different mice strains .The blood glucose level of C57BL/6J mice is usually higher than that of the BALB/c and ICR mice, while the of blood glucose level BALB/c mice stays relatively stable , and the ICR mice have the widest range of blood glucose levels upon these stresses .Accord-ing to our data, the difference in blood glucose metabolism between different mouse strains should be taken into considera -tion in blood glucose related studies for proper interpretation and design of experiments .

Maternal water deprivation affects the spermatogenesis of the offspring rats / La privación del agua en la etapa materna de ratas afecta la espermatogénesis de sus crías

Prenatal stresses such as water deprivation affect developmental process of embryo. This study evaluated the effects of water deprivation in pregnant mother on histological parameters of testis of offspring. Pregnant rats were divided into two groups (control and experimental). In experimental animals, water was removed from the ewes for 48h at the end of third trimester of gestation (19-21th days). Histopathology and histomorphic analysis and also TUNEL assay on offspring's testes were performed at pubertal age (60 days). The sperm motility either compared between two groups. The results showed that prenatal water deprivation induced histopathological alteration such as epithelium vacuolization, sloughing and detachments (P<0.01). Morphometrical data showed that prenatal water deprivation decreased tubular diameter and reduce epithelium height (P<0.01). Johnsen's score showed poor spermatogenesis in experimental group (P=0.001). The percent of germ cell apoptosis was increased in offspring's testes of rats born to mothers exposed to stress during pregnancy (P=0.000). The increased number of Multinucleated cells in the seminiferous lumen (P=0.000) in parallel with decreased number of sertoli cells (P=0.03) showed adverse effect of prenatal water deprivation on blood testis barrier. Present study revealed that prenatal water deprivation had injurious effect on developmental process of testes that affects on both germ cells and sertoli cells and had noxious effect on sperm parameters. These data confirm that prenatal stress disrupts normal spermatogenesis of offspring.

El estrés prenatal, como la privación del agua, afecta el proceso de desarrollo embrionario. Este estudio evaluó los efectos de la falta de agua en la rata preñada sobre los parámetros histológicos del testículo de las crías. Las ratas preñadas fueron divididas en dos grupos (control y experimental). En los animales de experimentación, se eliminó el agua durante 48 h al final del término de la gestación (19-21 días). Junto al análisis histopatológico e histomorfométrico se realizó el ensayo TUNEL en los testículos de las crías en la edad puberal (60 días). La motilidad de los espermatozoides se comparó entre los dos grupos. Los resultados mostraron que la privación de agua prenatal induce alteraciones histopatológicas tales como vacuolización del epitelio, descamación y desunión (P<0,01). Los datos morfométricos mostraron que con la privación de agua prenatal hubo disminución del diámetro tubular y se redujo la altura del epitelio (P<0,01). El score de Johnsen mostró una espermatogénesis deficiente en el grupo experimental (p = 0,001). El porcentaje de apoptosis de las células germinales se incrementó en los testículos de las crías de las ratas nacidas de madres expuestas a estrés durante el embarazo (p = 0,000). Un aumento del número de células multinucleadas en el lumen seminífero (P = 0,000) junto a la disminución del número de células de Sustento (P = 0,03) demostró el efecto adverso de la privación de agua prenatal en la barrera hemato-testicular. El presente estudio reveló que la falta de agua prenatal tuvo un efecto perjudicial en el proceso de desarrollo de los testículos, lo que afecta a las células germinales y los sustentocitos, y tuvo un efecto nocivo sobre los parámetros seminales. Estos datos confirman que el estrés prenatal altera la espermatogénesis normal de la descendencia.

Polyuria with the Concurrent manifestation of Central Diabetes Insipidus (CDI) & Type 2 Diabetes Mellitus (DM)

We report a rare case of the concurrent manifestation of central diabetes insipidus (CDI) and type 2 diabetes mellitus (DM). A 56 year-old man was diagnosed as a type 2 DM on the basis of hyperglycemia with polyuria and polydipsia at a local clinic two months ago and started an oral hypoglycemic medication, but resulted in no symptomatic improvement at all. Upon admission to the university hospital, the patient's initial fasting blood sugar level was 140 mg/dL, and he showed polydipsic and polyuric conditions more than 8 L urine/day. Despite the hyperglycemia controlled with metformin and diet, his symptoms persisted. Further investigations including water deprivation test confirmed the coexisting CDI of unknown origin, and the patient's symptoms including an intense thirst were markedly improved by desmopressin nasal spray (10 microg/day). The possibility of a common origin of CDI and type 2 DM is raised in a review of the few relevant adult cases in the literature.

A Case of Syndrome of Inappropriate Scretion of Anti-Diuretic Hormone Associated with Sodium Valproate

We report a rare case of the concurrent manifestation of central diabetes insipidus (CDI) and type 2 diabetes mellitus (DM). A 56 year-old man was diagnosed as a type 2 DM on the basis of hyperglycemia with polyuria and polydipsia at a local clinic two months ago and started an oral hypoglycemic medication, but resulted in no symptomatic improvement at all. Upon admission to the university hospital, the patient's initial fasting blood sugar level was 140 mg/dL, and he showed polydipsic and polyuric conditions more than 8 L urine/day. Despite the hyperglycemia controlled with metformin and diet, his symptoms persisted. Further investigations including water deprivation test confirmed the coexisting CDI of unknown origin, and the patient's symptoms including an intense thirst were markedly improved by desmopressin nasal spray (10 microg/day). The possibility of a common origin of CDI and type 2 DM is raised in a review of the few relevant adult cases in the literature.

Sheehan's syndrome with central diabetes insipidus / Síndrome de Sheehan e diabetes insípido central

Sheehan's syndrome refers to the occurrence of hypopituitarism after delivery, usually preceded by postpartum hemorrhage. The condition still continues to be a common cause of hypopituitarism in developing countries like India. The disorder usually presents with anterior pituitary failure with preservation of posterior pituitary functions. Posterior pituitary dysfunction in the form of central diabetes insipidus is rare in patients with Sheehan's syndrome. We describe the clinical course of a young lady who after her sixth childbirth developed severe postpartum hemorrhage followed by development of panhypopituitarism which was confirmed by hormonal investigation and demonstration of empty sella on imaging. In addition, she developed Polyuria. The water deprivation test and response to vasopressin test results indicated central diabetes insipidus. She needed oral desmopressin on a continuous basis to control polyuria.

A síndrome de Sheehan está relacionada à ocorrência de hipopituitarismo pós-parto, geralmente precedido por hemorragia pós-parto. Essa condição clínica ainda constitui causa comum do hipopituitarismo observado em países em desenvolvimento como a Índia. Essa síndrome se caracteriza pela insuficiência da glândula hipofisária anterior, porém com a conservação das funções da glândula hipofisária posterior. A disfunção da hipófise posterior, sob a forma de diabetes insipidus central, é algo raramente observado em pacientes que apresentam a síndrome de Sheehan. Neste artigo, descrevemos o caso de uma jovem que, após o sexto parto, apresentou hemorragia pós-parto grave, seguida pela evolução de pan-hipopituitarismo que foi confirmado por pesquisa hormonal e exames de imagem que evidenciaram sela vazia. A jovem também apresentou poliúria. Os resultados do teste de privação de água e exame de resposta à vasopressina indicaram diabetes insípido central. A paciente fazia uso contínuo de desmopressina para controlar a poliúria.

A Case of Langerhans Cell Histiocytosis Presented with Central Diabetes Insipidus / 대한내분비학회지

Langerhans cell histiocytosis can cause central diabetes insipidus. Here, a case of Langerhans cell histiocytosis invading the pituitary stalk was experienced. The patient was 15 years old boy, with complaint of polydipsia and polyuria. A water deprivation test was carried out, and the urine osmolarity was increased from 165 to 469 mosm/kg following an injection of AVP to confirm the diagnosis of central diabetes insipidus. A pituitary function stimulation test gave a normal response. A sellar MRI was performed, which showed a thickened pituitary stalk mass (about 5.7mm), with an increased size, 6.9 mm, on a second MRI 2 month later. A tissue biopsy was performed, which showed aggregates of histiocytes and inflammatory cells, with prominent eosinophils (H&E), and also revealed strong reactivity to anti-CD1a antibody on the immunohistochemistry. After confirmative tissue diagnosis, the patient received radiotherapy (900 cGy). The thickened mass of the pituitary stalk disappeared on the MRI following the radiotherapy. The patient was managed with DDAVP nasal spray, after which the polyuric symptoms were completely relieved.

The study of dopaminergic immunoreactive cell change in mesencephalon and pons of mongolian gerbil by water deprived day / 대한해부학회지

Mongolian gerbil (Meriones unguiculatus) has been as an model animal for studing the neurologic disease because of the long-term survival in the condition of water-deprived desert condition. In order to accomplish the this research, first of all another divided the laboratory animals 10groups. In this study of the long term water deprived condition investigated catecholamine synthetic enzymes, tyrosine hydroxylase(TH), dopamine-beta-hydroxylase (DBH), and phenylethanolamine-N- methyltransferase(PNMT) in the brain by using immunohistochemical stain. The results obtained in this study were summarized as following. 1. It were observed TH-IR cells in substantia nigra pars compacta, ventral tegmental area and substantia nigra pars reticular of Midbrian. Most of them were presented in pars compacta and ventral tegmental area, but a few in pars reticular. TH-IR cell decreased until the 5th water-deprived day, increased from the 10th water-deprived day to the 15th water-deprived day and redecreased in the 20th water-deprived day 2. In locus ceruleus and rubrospinal tract were observed TH-IR cells and a few DBH-IR cell. Therefore there was composed of dopaminergic neuron and noradrenergic neuron. 3. The quantity of dopamin in serum were decreased until the 4th water-deprived day, increased from the 5th water-deprived day, redecreased on the 15th water-deprived day and reincreased from the 20th water-deprived day.

Effect of brain angiotensin II receptor antagonists and antisense oligonucleotide on drinking and renal renin in rats

The physiological roles of brain angiotensin II in mediating water deprivation-induced drinking and in regulating renal renin release were assessed in male Sprague-Dawley rats. Specific AT1 receptor antagonists, losartan and SK 1080, and antisense oligonucleotide (AS-ODN) directed to AT1 receptor mRNA were intracerebroventricularly (i.c.v.) administered in conscious unrestrained rats. When water was given 20 min after i.c.v. injection of AT1 receptor antagonists in 48-h water-deprived rats, losartan and SK 1080 produced approximatly 20% and 50% decrease in 1-h water intake, respectively. In contrast, i.c.v. treatment of the AS-ODN to AT1 receptor mRNA for 24-h did not alter 1-h water intake in 24-h water-deprived rats, but prevented the increase in overnight water intake after 24-h water-deprivation. Six-day i.c.v. treatment of AS-ODN did not alter either the basal plasma renin concentration or renal cortical levels of renin and renin mRNA. The present results suggest that endogenous brain Ang II plays an important role in thirst and water intake through AT1 receptors, but further studies are required to elucidate its regulatory role in renal renin synthesis.

INVESTIGATION OF HYPOTHALAMIC-POSTERIOR PITUITARY FUNCTION OF GROWTH RETARDED CHILDREN / 中华内分泌代谢杂志

Responses to water deprivation test of 27 children with growth retardation were obseived in an attempt to investigate their hypothalamic-posterior pituitary function, and as control, 13 cases of diabetes insipidus and 10 normal children were tested in the meantime. The results showed: 1) All GH deficient children presenting with polyuria and polydipsia had severe ADH deficiency; 2) In 11 GH deficient children without polyuria and polydipsia, 7 were found endogenous ADH insufficient; 3) The children with short stature, polyuria and polydipsia but a normal GH secretion were partial ADH deficient; 4) Hypothalamic-posterior pituitary function of the children with short stature but normal GH secretion and without polyuria and polydipsia %vas normal.We conclude that growth retarded children were proved more or less insufficient of ADH, thus the posterior pituitary function of growth retarded children should be investigated as well, that water deprivation test is an accurate and simple test for this purpose.