Objective: to observe the effect of Roux-en-Y Gastric Bypass (RYGB)on STZ induced type 2 diabetic rat model, and to clarify its initial mechanism. Methods: 42 type 2 diabeticrats were randomly allocated into operation group(group O 12 rats); sham group(group S 10 rats); diet control group(group F 10 rats); control group(group C 10 rats). Fasting glucose, Insulin Growth Factor-1 ( IGF1), fasting plasma insulin levels, weight and food intake were measured before and 1st , 2nd, 3 rd ,4th, 8th and 16 th week after operation. Results: 16 weeks after operation in the Group O, fasting glucose fell to (8.8?4.9)mmol/L, IGF1 increase to (148.6?7.3)ng/L ,fasting plasma increase to (74.7?9.2)mIU/L and weight decline to (212.6?15.1)g ,there was statistical significance compared with the levels of preoperation (P

Objective To clarify mechanism of Roux-en-Y gastric bypass (RYGB) and gastric banding on diabetes induced by STZ injection. Methods 40 rats with STZ induced diabetes were randomly allocated into Roux-en-Y gastric bypass (RYGB) group (group RYGB, n=10), gastric banding group (group GB, n=10 ), diet control group (group F, n=10), control group (group C,n= 10). The fasting blood glucose, the fasting insulin IGF-1, the fasting Plasma leptin, the fasting plasma insulin level, the weight and the food-intake, the operation time, the death rate were measured and recored before and after operation on 1st , 2nd, 3 rd ,4th, 8th and 16 th week postoperatively. Results The fasting blood glucose of the group of gastric banding(GB) descended to (12.6±3.7) mmol/L, the fasting plasma insulin rose to (58.7±9.2) mIU/L, the fasting plasma leptin descended to (14.6±3.3) pg/ml, the weight was (212.6±15.1) g.There were significant differences between before and after operation on 16 th week(P<0.01). The fasting blood glucose of the group of Roux-en-Y (RYBG) descended to 8.8±4.9 mmol/L in the sixteenth week, the fasting insulin IGF-1 rose to (148.6±7.3) ng/L, the fasting plasma insulin rose to (14.1±3.5) pg/ml, the fasting plasma leptin descended to 14.1±3.5 pg/ml, the weight was (200±15.1) g. There were significant differences between before and after operation 16 th week (P<0.01). There were significant differences of the fasting plasma insulin and the the fasting plasma leptin between group F and group C during the 3 rd to 4th week after operation (P<0.05). Compared the weight of the group F and the group C on the third week of operation, there were significant differences (P<0.05), and there were no significant differences in other time. The fasting blood glucose of the group F and the group C had no sig-nificant differences between before and after operation.(P<0.05). Conclusions The fasting blood glucose and the fasting insulin level of the group F improve more than of the group GB at the same time. The plasma insulin and the plasma leptin of the two groups all work in glucose control. The diet control and the modification of the plasma insulin and the plasma leptin all play a major role in the gastric banding mechanism, and the IGF-1 may work in the descending the blood glucose after the operation of Roux-en-Y. In the operation time and die rate, the group of F surpass the group of GB.

0.05).On the day 3,7 postoperatively,IL-6 and CRP significantly increased as compared to those preoperatively in two groups(P

Objective: To investigate the feasibility of chitin as bone substitute material and carrier of rhBMP2.Methods: Porous chitin and chitin/rhBMP2/collagen complex were implanted into calvarial defects in 8 rabbits. Bone repairing ability was assessed by radiographic and histological observation. 2 rabbits without implantation were served as controls. Results: Chitin had certain bone conductive ability. When combined with rhBMP2,a complex possessing both bone conductive activity and bone inductive activity was produced. The complex had greater bone repairing ability than chitin alone. Conclusion: Chitin may be used as a bone substitute material and carrier of BMP. But its mechanical strength and surface activity should be improved.

Objective To evaluate the feasibility of reconstruction of artificial bladder tissue using the expanded bladder cells seeded onto both sides of a synthetic PLGA polymer and cultured in the nude mice by tissue engineering technique. Methods The urothelial cells and smooth muscle cells were obtained from young rabbits by mechanical isolation and enzyme digestion method. In vitro cultured and expanded smooth muscle cells and urothelial cells were seeded onto the outer and inner surfaces of each polymer. Then, the constructs were implanted into the subcutaneous pockets of athymic mice. At 4 and 8 weeks after implantation, the specimens were harvested and examined macroscopically, histologically, and immunohistochemically. Results The polymer was covered with urothelial cells inside and smooth muscle cells outside. As polymer degradation was in progress, the urothelial cells and the smooth muscle cells kept proliferation and converged. Conclusion Artificial bladder tissue reconstructed by tissue engineering technique has the similar properties to those of the normal bladder wall. This study has laid solid foundation for further studies of tissue engineering bladder.

Objective To review the experience in the management of gastric cancer with liver cirrhosis and portal hypertension.Method A retrospective analysis was made in 35 gastric cancer cases with liver cirrhosis and portal hypertension admitted into our hospital from January 2000 through June 2009.Result There were no intraoperative death in this group.Postoperative ascites occurred in 19 patients,anastomotic leakage in one case,anastomotic bleeding in 2 cases,wound bleeding in 2 cases,intraabdominal infection in 17 cases (of which combined fungal infection in 4 patients),incision infection in one patient and chylous leakage in one case.The morbidity rate was 71%.Four patients died during hospitalization including multiple organ dysfunction syndrome in 2 cases,with mortality rate of 11%. Conclusion In order to reduce the incidence of mortality and complications,we should complete preoperative evaluation,correct perioperative management,guide surgery with damage control concept,follow individualized principles and emphasize on preventive devascularization.

Objective To evaluate gastrobiliary duct drainage in the treatment for iatrogenic distal common bile duct injury found during the operation.Methods We analyzed clinical data of 17 cases with application of gastrobiliary duct drainage in immediate treatment for the injury of distal common bile duct found during the operation from June 2010 to June 2016.Postoperative bile drainage,postoperative gastrointestinal function recovery,time for removal of the gastrobiliary duct and hospitalization time were recorded.Postoperative bile leakage,intestinal fistula and pancreatic leakage were observed.Patients were followed up until June 2016.Results The mean volume of bile drainage on the third postoperative day were (310 ± 112)ml,the mean time of postoperative gastrointestinal function recovery were (3.0 ± 1.5) days,time for removal of the gastrobiliary stent were (7.5 ± 1.0) days and hospitalization time were (9.5 ± 1.5) days.There was no postoperative bile leakage,intestinal fistula and pancreatic leakage.All patients were followed up for a median time of 12 months (range,1-45 months).Meanwhile,we found no significant biliary strictures and cholangitis patients.Conclusion Gastrobiliary duct drainage is a simple,rational and effective treatment for iatrogenic injury of distal common bile duct during common bile duct exploration.

Objective To study the effectiveness of different treatment modalities for iatrogenic injury of distal common bile duct during operation.Methods We browsed Chinese Medical Full-text Data-base with the term of “distal common bile duct injury”.All the clinical studies associated with perioperative latrogenic injury of distal common bile duct and adjacent tissue published after 1990 were enrolled,and we collected the clinical data,mortality and reoperation rate with different treatments for analysis.Results Thirty-four case series and case reports with 233 patients were included.14 patients with isolated duodenal injury were excluded.The overall mortality of the remaining 219 patients was 9.6％,and the reoperation rate was 17.4％.A total of 145 patients who were diagnosed with distal common bile duct injury during and after operation from 21 articles were compared.The mortality and reoperation rate were both 1.9％ among 106 patients who were diagnosed during operation.The figures were 43.6％,and 84.6％ among 39 patients who were diagnosed after operation,respectively.In 9 articles with 46 patients,the clinical outcomes of 21 patients who were treated by intraoperative suture was compared with 25 patients who underwent enhanced biliary and retroperitoneal drainage.The mortality and reoperation rates were 0 in both groups.Conclusions Early detection and management are crucial to perioperative common bile duct injury.Furthermore,no significant difference of clinical outcomes observed between bile drainage and perforation suture groups.

Objective:To study the feasibility and efficacy of the modified posterolateral laparoscopic approach for resection of massive splenomegaly.Methods:The data of 48 patients who underwent laparoscopic splenectomy for massive splenomegaly at the Affiliated Hospital of Jiangnan University (Wuxi 4th People's Hospital) from January 2016 to July 2019 were retrospectively analyzed. There were 29 males and 19 females, with an average age of 55.8 years. These 48 patients were divided into two groups according to the operative approach, the study group ( n=26) using the modified posterolateral approach which treated the splenic pedicle as the last step; and the control group ( n=22) which used the posterior tunnel of splenic pedicle established by anterior approach to treat the splenic pedicle first. The operation time, gastrointestinal function, recovery time, intraoperative blood loss, rates of conversion to laparotomy and postoperative complications were compared between two groups. The follow-up data were also analyzed. Results:There were no significant differences in operation gastrointestinal function recovery and hospitalization time between the two groups (all P>0.05). The intraoperative blood loss, numbers of patients with convention to open surgery and intraoperative blood transfusion, were (50.2±15.1) ml vs (160.1±40.3) ml, 2 patients (7.7%) vs 7 patients (31.8%), and 1 patients (3.8%) vs 5 patients (22.7%), in study group and control group respectively. The differences between groups were significant (all P<0.05). The complications of the study group and control group were 9 patients (34.6%) vs 13 patients (59.1%), which were significantly in the two groups ( P<0.05). On follow-up which ranged from 1 to 15 months, the numbers of patients with thrombocytosis and portal vein thrombosis in the study group and the control group were 20 patients (76.9%) vs 17 patients (77.3%), and 7 patients (26.9%) vs 6 patients (27.3%), respectively. Conclusion:The modified posterolateral laparoscopic approach for resection of massive splenomegaly was safe and feasible. It should be promoted to treat massive splenomegaly.

BACKGROUND:Bone marrow derived mesenchymal stem cells (BMMSCs) have multi-differentiation potentials, possessing a repairing capability for the sectional bone defects if combined with degradable porous β-tricalcium phosphate china. This provides a new idea in clinical repair of various bone defects.OBJECTIVE: To explore in radiology the curative effect of implanting porous β-tricalcium phosphate and autogenous BMMSCs compound to treat bone defects.DESIGN: A randomized controlled study with callus growth at various healing periods as subjects for observation. SETTING: Department of Orthopaedics, Renmin Hospital, Wuhan University; Tissue Engineering Center, Research Institute of Basic Medicine,Academy of Military Medical Sciences of Chinese PLAMATERIALS: This experiment was carried out at the Tissue Engineering Center, Research Institute of Basic Medicine, Academy of Military Medical Sciences of Chinese PLA between March and September 2002. Twenty China healthy adult sheep were randomized into the groups of blank control group (4 sheep), simple implantation group (8 sheep) and complex implantation group (8 sheep).METHODS: Under general anesthesia and aseptic condition, 10-15 mL of sheep marrow was extracted; MSCs were separated and cultured before combined with porous β-tricalcium phosphate china for tissue engineering bone construction. Rats in each group were cut off 21mm long metatarsus in the middle section of metatarsus bonestem. Β-tricalcium phosphate china and autogenous MSC compound was implanted into the sheep of the complex implantation group; β-tricalcium phosphate china was implanted into the simple implantation group; and the bone defects in the blank control group remained untouched. Then the incision was sutured.X-ray filming was carried out right after the operation, as well as 1, 3,and 6 months after the operation for radiological appraisal (scored for1 if bone union formed in one surface of bone defect, but scored 0 if no boneunion formed in any surface of bone defect, and scored 4 if bone union formed in front, back, lateral surfaces and the center of bone defect), Xray radiation-resisting density was analyzed to compare the results of bone defect repair.MAIN OUTCOME MEASURES: The postoperative general condition and general observation, as well as the results of the radiological analysis of the bone defects of all sheep.RESULTS: Totally 20 sheep were brought into this xperiment and all entered the stage of result analysis. ① The postoperative general condition:Sheep regained consciousness 2-6 hours after the operation without incision infection and loosing of internal fixation. Their spirit gradually was back to normal 1 week after the operation, at which time the injured legs could touch ground but were incapable of bearing load, and the affected legs could bear load 2 weeks after the operation, walked slightly lamely 3 weeks after the operation, and even moved freely without limp 4 weeks after the operation. ②The general condition 6 months after the operation: In pure implantation group, the surface white hyaline cartilage-like tissues were gradually calcified, with both ends connected with the host bone by bone bridge, but china granules could still be easily observed; while no implantation substance could be observed in compound implantation group,with the boundary between implantation substance and host bone vanished,and bone defect became basically the same as host bone. However there was no bone tissue formed in bone defect at various postoperative time points in the blank control group. ③ Radiological analysis of the bone defects at various postoperative time points: The radiological rating score was obviously higher in complex implantation group at the time poin ts of 3, 6 months after the operation compared with the pure implantation group [(2.3±0.3), (1.8±0.5); (3.3±0.5), (2.6±0.6), P ＜ 0.05]. ④ Radiological analysis of bone callus thickness and the relative value of radiation-resisting density at various postoperative time points: The bone callus thickness in the complex implantation group was obviously lower than that of the pure implantation group at the postoperative time point of 6 months (4.62 vs 7.64, P ＜ 0.05), with relative value of radiation-resisting density obviously higher than that of the pure implantation group (70.4±1.5 vs 61.18±1.2, P ＜ 0.05).CONCLUSION: Radiological appraisal and bone defect density measurement can well reflect the dynamical repairing process of bone defects; the implantation of porous β-tricalcium phosphate china and autogenous BMMSCs compound into sheep can enhance the repair of large sectional bone defect.