Objective To investigate the efficacies of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery in the treatment of patients with different body mass indexes (BMI) and type 2 diabetes mellitus.Methods The clinical data of 40 patients with type 2 diabetes mellitus who underwent LRYGB surgery at the Shengjing Hospital of China Medical University from January 2013 to December 2013 were retrospectively analyzed.According to different BMI,8 patients with BMI ＜ 27.5 kg/m2 were allocated into group 1,14 patients with BMI≥27.5 kg/m2 and ＜32.5 kg/m2 in group 2 and 18 patients with BMI≥32.5 kg/m2 in group 3.Forty patients were followed up via telephone interview and food habits questionnaire by weight loss file managers of Shengjing Hospital and the fourth Affiliated Hospital of China Medical University.All the patients received the reexamination of blood test and data collection at postoperative year 1.The preoperative and postoperative 1-year fasting plasma glucose,glycosylated hemoglobin (HbA1 c),BMI and C-peptide were collected and detected.The fasting plasma glucose ＜ 7.00 mmol/L and HbA1 c ＜ 7.00％ were used as a standard of complete remission.Count data and comparison of rates were analyzed using the chi-square test.Measurement data with normal distribution were presented as x ± s and analyzed by the t test.Skew distribution data were described as M (range) and analyzed by the Wilcoxon rank sum test.Repeated measurement data were analyzed by the repeated measures ANOVA.Results Forty patients received successful LRYGB surgery without perioperative complications,and were followed up for 1 year at the Shengjing Hospital (23 patients),the fourth Affiliated Hospital (8 patients) and other hospitals (9 patients).Of the 40 patients,85.0％ (34/40) of patients had no postoperative long-term obvious malnutrition,anastomotic stenosis,ion disorders and digestive tract dynamic obstacles,15.0％ (6/40) of patients were not adapted to the change of life habits such as frequent nausea and vomiting.Five patients with different degrees of frequent vomiting,abdominal pain and night heartburn within postoperative 1 month had the remission of synptoms after symptomatic treatment.One patient in group 2 had a symptom of hypertonic coma due to intake of oral high-sugar drinks at postoperative 1 week and then was cured by hospitalization.The fasting plasma glucose,HbA1c and BMI in group 1 from preoperation to postoperation were decreased from 11.07 mmol/L (range,6.00-17.00 mmol/L) to 7.18 mmol/L (range,6.00-15.00 mmol/L),from 8.85％ (range,6.00％-11.00％) to 6.35％ (range,6.00％-9.00％) and from 26.0 kg/m2 (range,22.0-27.0 kg/m2) to 22.2 kg/m2 (range,20.0-25.0 kg/m2),with significant differences (F =2.413,3.256,6.750,P ＜ 0.05).C-peptide from preoperation to postoperation was decreased from 1.20 nmol/L (range,1.00-3.00 nmol/L) to 1.07 nmol/L (range,1.00-2.00 nmol/L),with no significant difference (F =1.678,P ＞ 0.05).The remission rate of diabetes in group 1 was 3/8.The fasting plasma glucose and HbA1c in group 2 from preoperation to postoperation were decreased respectively from 10.73 mmol/L (range,7.00-19.00 mmol/L) to 5.89 mmol/L (range,5.00-9.00 mmol/L) and from 8.00％ (range,6.00％-15.00％) to 5.85％ (range,5.00％-8.00％).The BMI from preoperation to postoperation was decreased from 31.0 kg/m2 (range,29.0-32.0 kg/m2) to 25.5 kg/m2 (range,21.0-29.0 kg/m2),with significant differences in the above 3 indexes (F =5.449,4.008,-3.296,P ＜ 0.05).C-peptide from preoperation to postoperation was decreased from 1.53 nmol/L (range,1.00-5.00 nmol/L) to 1.52 nmol/L (range,1.00-6.00 nmol/L),with no significant difference (F =-0.251,P ＞ 0.05).The remission rate of diabetes in group 2 was 10/14.The fasting plasma glucose,HbA1c and BMI in group 3 from preoperation to postoperation were decreased from 9.44 mmol/L (range,5.00-16.00 mmol/L) to 6.65 mmol/L (range,4.00-15.00 mmol/L),from 7.90％ (range,6.00％-11.00％) to 6.45％ (range,5.00％-9.00％) and from 36.9 kg/m2 (range,33.0-47.0 kg/m2) to 27.7 kg/m2 (range,23.0-34.0 kg/m2),with significant differences (F =-3.027,-3.410,-3.724,P ＜ 0.05).C-peptide from preoperation to postoperation was decreased from 2.91 nmol/L (range,0.00-9.00 nmol/L) to 2.13 nmol/L (range,0.00-6.00 nmol/L),with no significant difference (F =-3.724,P ＞ 0.05).The remission rate of diabetes in group 3 was 14/18.There was no significant difference in the remission rate of diabetes of 3 groups (x2 =4.460,P ＞ 0.05).There were significant differences in the changing trends of fasting plasma glucose and BMI among the 3 groups (F =3.200,22.500,P ＜ 0.05).There were no significant differences in the changing trends of HbA1c and C-peptide among the 3 groups (F =0.720,1.640,P ＞ 0.05).Conclusion LRYGB surgery is feasible for the treatment of type 2 diabetes mellitus with effectively decreasing fasting glucose,and should be performed on patients with BMI ≥ 27.5 kg/m2 instead of patients with BMI ＜ 27.5 kg/m2 according to a correlation of blood glucose control and preoperative BMI.

0.05).According to the HSS system,the mean score was 92.1(ranged from 76-97) one year after operation.No complication occurred,such as deep infection,necrosis of skin incision or loosening and breakage of internal fixators.[Conclusion]This modified posteromedial and posterolateral approaches could reduce the complications in incision successfully for the direct reduction and buttress fixation of articular fragments,as well as and soft tissue.

The abnormal activation of phosphatidylinositol-3-kinase (PI3K)-proiein kinase B (Akt) pathway has already been confirmed to be closely related to the origin and development of various tumors.PI3KAkt pathway plays an important role in development of colon cancer,it can regulate cell survival,proliferation,anti-apoptosis,cell cycle progression,etc.Furthermore,inhibition of this pathway may play a potential roll in oncotherapy.

Objective To evaluate the efficacy and clinical value of percutaneous transluminal angioplasty(PTA)with stenting for the treatment of superior vana cava syndrome(SVCS)with malignant causes.Methods A total of 13 patients with SVCS with malignant causes were enrolled in this study.Among the patients,2 had mediastinal cancer,and 11 had metastatic mediastinal tumor.The malignancy of the primary tumors of the 11 patients,including pulmonary cancer in 8,esophageal cancer in 2,and breast cancer in 1,were all confirmed by pathological examination.Via the right femoral vein,a pigtail catheter was introduced percutaneously into the proximate or remote end of the stenotic segment for the visualization of the SVC.After the location,length,and gravity of the stenosis were determined,Wallstent(Boston Scientific,USA)was placed into the SCV,if the patients had no local thrombosis in the stenotic segment.In one patient,a Z-shape stent(COOK,USA)was inserted simultaneously.For the cases complicated with thrombosis,the Wallstent was inserted after local thrombolysis.Results The procedure was completed in all the 13 patients with a success rate of 100%.The average length of the stenotic segment was 4.3 cm(3-6 cm).In one patient,two stents were used,while in the others only one stent was inserted.Thrombolysis was carried out before stenting in 6 patients.The intravenous pressure at the proximate end of the stenotic segment was determined with the patients supine before and after stenting.The pressure decreased from(26.2?1.6)cm H2O to(4.3?0.8)cm H2O after the operation.Postoperative angiography showed no collateral vein in the patients.The SCVS disappeared 0 to 3 days after the surgery.The patients were followed up for 8-26 months with a median of 13.During this period,8 patients died of multiple organ failure caused by multiple metastasis of the primary tumor in 4 to 10 months;the other 5 patients survived(3 of them received further therapies)without recurrence of SCVS.Conclusion PTA with stenting combined with local thrombosis is an effective and invasive treatment for patients with SCVS with malignant causes.

Objective To evaluate the effectiveness and method of intraarterial embolization in treatment of hepatic cavernous hemangioma. Methods 17 patients,8males and 9 females, were treated by super selective hepatic artery embolization with iodized oil, gelfoam pieces, and embolization coils. Results All patients had been embolized successfully. The rate of success was 100%. 11 cases were followed up by CT/USG for 1～12 months. The size of tumor was decreased more than 50% in 8 cases, more than 30% in 2 cases, and the effect was uncertain in 1 case. Symptoms of 11 patients were disappeared and relief was obvious in 5 cases.Total effective rate was 94% with no significant complications. Conclusions HAE is a safe and effective method. It may be considered as the first method of choice in treatment of hepatic cavernous hemangioma.

Objective To evaluate the effect of simpler and chemotherapeutic renal artery embolizations in the treatment of renal carcinoma preoperatively Methods 19 patients including simpler renal artery embolizaiton group( n =8) and chemotherapeutic renal artery embolization group( n =11) were retrospectively studied. The surgical procedures were recorded and pathology sections were observed for all the patients. Results All the preoperative embolization were achieved successfully. We found vessels obliteration of the renal carcinoma in the operation. In pathology, the tumor had clear border with the necrosis. Conclusions Preoperative renal artery embolization could decrease the risk in operation, and had positive effects on the prognosis of these patients.

Objective: To investigate changes of plasma glucagon level in patients with heart failure (HF) caused by coronary heart disease (CHD) and its clinical significance. Methods: A total of 30 HF patients caused by CHD were selected as HF group, another 30 healthy subjects with corresponding age and gender were regard as normal control group. HF patients received comprehensive therapy of enhancing myocardial contractility, diuretic and vasodilator of 7~10d according to Chinese diagnostic and treatment guideline of chronic heart failure. Changes of glucagon level before and after treatment were observed. Results: Before treatment, plasma level of glucagon in HF group was significantly higher than that of normal control group [(205.67±120.22) ng/L vs. (90.53±20.5) ng/L, P<0.05]. After treatment, plasma level of glucagon [(120.42±30.33) ng/L] significantly decreased than before treatment (P<0.05) in HF group. Conclusion: Plasma glucagon significantly increases in patients with heart failure and gradually decreases to near normal level after treatment. Glucagon level may be regard as one of indexes judging patients’ condition.

Objective To evaluate the effectiveness of pulmonary embolectomy by cathether for the treatment of acute pulmonary embolism. Methods 38 cases were diagnosed pulmonary embolism by pulmonary angiography, treated by thrombus fragmentation and suction by cathethers, and local fibrinolysis. The symptoms, PaO 2, PAPM and pulmonary arteries were observed after the procedure. Results 36 patients survived and showed clinical improvement with significant decrease in PaPm and increase in PaO 2( P

Objective To explore the correlation between acute infarctions in different parts of the brain and the risk of vascular cognitive impairment (VCI). Methods 212 patients with acute cerebral infarction were tested using Mini Mental State Examination(MMSE)and Montreal cognitive assessment(MoCA),and were divid-ed into normal cognition group,VCI group,vascular dementia group,and mixed dementia group. We analyzed the gender,age,past medical history,personal history,MMSE and MoCA scores,and imaging data. Results Of the 212 patients,61(28.77%)had normal cognition level,74(34.91%)had VCI,56(26.42%)had vascular demen-tia,and 21(9.91%)had mixed dementia. Multiple regression analysis showed that frontal lobe infarct increased the risk of VCI(OR,41.72)and vascular dementia(OR,48.49);cerebellar infarction also increased the risk of vascular dementia(OR,4.70)and mixed dementia(OR,12.38);and temporal lobe infarction increased the risk of mixed dementia significantly(OR,56.98). Conclusions Approximately 71.3%of the patients with acute cere-bral infarction develop vascular cognitive impairment. The infarcts occurring in the frontal lobe ,temporal lobe and cerebellum increase the risk of VCI significantly ,which should be given interventional therapies.

Objective To investigate the therapeutic effects and adverse reaction of Gastrodin Injection combined with Fluoxitine (Prozac) in the treatment of post-stroke depression (PSD).Methods One hundred and two patients with PSD were randomly allocated into two groups:51 cases in the Gastrodin Injection and Fluoxitine combination group (treatment group),51 cases in Fluoxitine Group (control group).The treatment group was treated by intravenous injection of 600 mg/d Gastrodin (14 days) plus oral administration of 20 mg/d Fluoxitine (30 days).The control group was only treated by oral administration of 20 mg/d Fluoxitine (30 days).The therapeutic effects were evaluated by the observations of the changes of symptoms and signs and Hamilton Depression Scale (HAMD) respectively in the two groups.Results The cured,effective,improved and invalid rates were 9.8％ (5/51),52.9％ (27/51),27.5％ (14/51) and 9.8％ (5/51) respectively in the treatment group and 2.0％ (2/51),11.7％ (6/51),66.7％ (34/51) and 19.6％ (10/51) in the control Group.The total effective rate in the treatment and the control groups were 90.2％ (46/51) and 80.4％ (41/51) respectively.The therapeutic effect was better in the treatment group than in the control group,and there was significant difference observed between the two groups (x2 =13.03,P ＜ 0.05).The rate of adverse reaction was significantly lower in the treatment group than in the control group (3.92％ (2/51) vs.25.5％ (13/51),x2 =9.64,P ＜ 0.01).Conclusion Gastrodin Injection in combination of Fluoxitine,with low adverse reation rate,is an effective therapeutic method for the treatment of PSD.