Objective To investigate the efficacies of conventional and modified laparoscopic gastric bypass in the treatment of type 2 diabetes mellitus.Methods The clinical data of 30 patients with type 2 diabetes mellitus who were admitted to the Xijing Hospital of the Fourth Military Medical University from January 2012 to October 2012 were prospectively analyzed.All the 30 patients were randomly divided into the conventional group (15 patients) and the modified group (15 patients) according to the random number table.Patients in the 2 groups received conventional and modified laparoscopic gastric bypass,respectively.The operation time,blood loss,anal exhaust time,duration of postoperative hospital stay,incidence of severe complications,postoperative 3-month body mass index (BMI),fasting plasma glucose (FPG),fasting serum insulin (Fins),fasting serum C-peptide (FC-P) and glycosylated hemoglobin (HbAlc) of the 2 groups were compared.The measurement data were analyzed using the t test,and the count data were analyzed using the Fisher exact probability.Results The operation time of the conventional group and the modified group were (141 ± 22)minutes and (113 ± 26)minutes,with significant difference between the 2 groups (t =3.184,P ＜ 0.05).The volume of intraoperative blood loss,anal exhaust time,duration of postoperative hospital stay,postoperative 3-month BMI,FPG,Fins,FC-P and HbAlc were (65 ±29)ml,(2.5 ±1.2)days,(7.5 ±2.1)days,(27 ±4)kg/m2,(6.7 ±1.5)mmol/L,(18 ± 8) mU/L,(2.0 ± 0.6) μg/L and 5.8％ ± 1.5 ％ in the conventional group,and (57 ± 25) ml,(2.1 ± 1.0) days,(7.1 ± 1.9) days,(28 ± 4) kg/m2,(6.4 ± 2.0) mmol/L,(17 ± 6) mU/L,(1.9 ± 0.6) μg/L and 6.1％ ± 1.4％ in the modified group,with no significant difference between the 2 groups (t =0.809,0.992,0.545,0.485,0.463,0.523,0.130,0.572,P ＞ 0.05).The levels of preoperative BMI,FPG,Fins,FC-P and HbAle of the conventional group were (31 ± 4) kg/m2,(11.3 ± 2.3) mmol/L,(13 ± 4) mU/L,(1.4 ± 0.5) μg/L and 8.6％ ± 1.0％,which were significantly different from those at 3 months after operation (t =2.304,6.615,3.109,2.920,5.997,P ＜ 0.05).The levels of preoperative BMI,FPG,Fins,FC-P and HbAlc of the modified group were (31 ±4)kg/m2,(11.9±2.4)mmol/L,(12±5)mU/L,(1.4 ±0.6) μg/L and 8.9％±0.9％,which were significant different from those at 3 months after operation (t =2.165,6.711,2.616,2.478,6.571,P ＜0.05).Conclusion The safety and short-term efficacy of modified laparoscopic gastric bypass are comparable to those of the conventional laparoscopic gastric bypass,but the operation time of the modified method is significantly shorter.

Objective To investigate the association of serum adiponectin and tumor necrosis factor alpha (TNF-α) with endothelial damages in metabolic syndrome (MS) patients. Methods One-hundred and five patients diagnosed as MS were recruited as cases and 37 subjects without characteristics of MS were recruited as controls. The cases were divided into two groups according to the level of serum von Willebrand factor (vWF) :normal endo-thelial functional MS group (57 patients) and abnormal endothelial functional MS group (48 patients). Serum adi-ponectin concentration was measured by enzyme-linked immanosorbont assay (ELISA). Serum TNF-α concentration was measured by radioimmunoassay (RIA). Results The concentration of serum adiponectin in normal subjects (10.5 mg/L [SD:3.2]) was significantly higher than both that of normal endothelial functional MS group (7.9 mg/L [SD :2.2]) and abnormal endothelial functional MS group (6.5 μg/L [SD :2.5]) (P < 0.05). The concen-tration of serum TNF-α in normal subjects(0.17 μg/L [SD :0.04]) were significantly lower than that of normal en-dothelial functional MS group (0.19 μg/L [SD:0.05]) and abnormal endothelial functional MS group (0.23 ng/mi [SD: 0.06]) (P< 0.05). The level of serum adiponectin were negatively correlated with TNF-α(r=- 0.555, P < 0.01). Logistic regression analysis results showed that high level of TNF-α was a risk factor of endo-thelial damages (OR = 20.649, P = 0.035), whereas high level of serum adiponectin protected against endothelial damages (OR = 0.340,P=0.006). Conclusions Low level of serum adiponectin and high level of serum TNF-α may correlate with endothelial damages in MS patients.

Seven adult albino rats were used for this study. The 50％ HRP solution was injected into the cervical enlargment unilaterally. Labelled neurons were mainly found in the nucleus paraventricularis, nucleus lateralis, nucleus paraventricularis, nucleus lateralis, nucleus perifornicalis, nucleus hypothalamicus anterior, nucleus hypothalamus posterior, nucleus suprachiasmaticus, nucleus supraopticus and nucleus periventricularis ipsilaterally. Most of the labelled neurons were found in nucleus paraventricularis hypothalamicus, less in the nucleus lateralis and only a few in other nuclei.The authors suggest that the efferent projections from the hypothalamus to the spinal cord in the rat may play a role in the integrative function of the spinal cord. which may be involved in the process of acupuncture analgesia.

Attempts were made to determine the cells of origin from the thalamus to the spinal cord by using the retrograde tracer technique with horseradish peroxidase (HRP). The solution of HRP was injected into the intumescentia cervicalis unilaterally in eight albino rats. The results indicated that the HRP-labeled cells were located in the parafascicular nucleus, subparafascicular nucleus and the ventromedial nucleus of the thalamus. The function of spinal projection from these neuclei were discussed.

The efferent projections to the spinal cord from the brain stem were studied with HRP. Fifty per cent solution of HRP was slowly injected into the intumescentia cervicalis at six points on its right side in 10 albino rats and the HRP-labelled cells were found in the following nuclei:1. Of the midbrain: the nucleus linearis, nucleus raphe dorsalis, substantia nigra, nucleus ruber, nucleus cuneiformis, nucleus colliculus superior, nucleus Edinger-Westphal, nucleus Darkschewitsch, nucleus interstitialis (Cajal), nucleus ventralis tegmenti and nucleus dorsalis tegmentalis;2. Of the ports: the nucleus raphe magnus, nucleus medianus raphe, nucleus trigemini principalis, nucleus lemnisci lateralis, nucleus reticularis pontis oralis, nucleus reticularis pontis caudalis, locus ceruleus, nucleus subceruleus, nucleus vestibularis lateralis, nucleus vestibularis medialis, nucleus parabrachialis and nucleus olivaris su- perior;3. Of the medulla oblongata: the nucleus raphe obscurus, nucleus raphe pallidus, nucleus gracilis, nucleus cuneatus, nucleus tractus spinalis nervi trigemini, nucleus tractus solitarius, nucleus commissuralis (Cajal), nucleus reticularis lateralis, nucleus reticularis paramedianus, nucleus reticularis gigantocellularis and nucleus olivaris inferior;4. Of the cerebellum: the nucleus medialis and lateralis.The functions of spinal projection from the nuclei raphe, reticularis, locus ceruleus, substantia nigra and the nucleus dorsalis tegmentalis have been discussed.

Objective To detect the mechanism of serum uric acid (UA) in different types of coronary heart disease (CHD).Methods 88 patients were divided into three groups：the control group，stable angina (SA) group and acute coronary syndrom (ACS) group.The levels of UA，alpha-granule membrane protein 140 (GMP-140)，von Willebrand factor(vWF)，plasminogen activator inhabitor typed (PAI-1)，Thromboxane B_2 (TXB_2) and C-reacting protein(CRP) were measured.Results ①UA and CRP in ACS group were higher than that in SA group and control group [(392.1±68.57) μmol/L and (42.2±39.4) mg/L vs (370.50±58.80) μmol/L and (18.9±17.1) mg/L vs (286.00±65.31) μmol/L and (2.5±0.7) mg/L，P＜0.05)].For UA，there was no difference between ACS and SA group(P＞0.05)；CRP was higher in ACS group than in SA group (P＜0.05).②vWF and TXB_2 were higher in ACS[(1.65±0.48)%，(19.73±18.66)ng/L]and SA group[(1.35±0.49)%，(11.18±10.71) ng/L]than in control group[(1.07±0.26)%，(6.46±5.41) ng/L，P＜0.05]，and those were higher in ACS group than in SA group (P＜0.05).③GMP-140 and PAI-1 were higher in ACS [(13.04±0.99) μg/L and (65.65±14.76) μg/L]and SA group[(12.55±0.74) μg/L and (62.69±12.24) μg/L]than in control group [(12.32±0.29) μg/L，(50.78±13.88) μg/L，P＜0.05].There were no differences between ACS and SA group (P＞0.05).④Comparing hyperuricemia group and non-hyperuricemia group in CHD patients：the CRP(71.3±18.9) mg/L，vWF(1.08±0.52) %，GMP-140(13.57±1.11) μg/L，TXB_2 (57.26±47.84)ng/L，PAI-1 (72.12±9.23) μg/L in ACS group possessing hyperuricemia were higher than non-hyperuricemia group [CRP (20.7±17.9) mg/L，vWF (0.84±0.54) %，GMP-140 (13.23±1.07) μg/L，TXB_2 (26.70 + 23.83) ng/L，PAI-1 (61.30±12.07) μg/L](t=7.394，0.008，0.227，7.605，0.421，P＜0.05)；CRP(31.1±18.9)mg/L and TXB2 (21.54±3.90) ng/L in SA group possessing hyperuricemia group were higher than non-hyperuricemia group[(10.9±10.1)mg/L and (5.02±4.93) ng/L，t=0.494，8.669，P＜0.05].Logistic stepwise regression analysis indicated that the related factors with ACS were UA(OR=1.046)，CRP(OR=7.615)，PAI-1(OR=1.301)，PT(OR=0.300)and TG(OR=2.243) (P＜0.05).Conclusions UA is an important risk factor in CHD patients.UA can induce different types of CHD by damaging blood vessel endothelium function，activating platelet，changing coagulation and causing inflammatory.

Objective To explore the volume size of mastoid pneumatization in normal adults and the relation‐ship with a history of recurrent otitis media in childhood .Methods A total of in 40 adults (80 ears) ,based on with or without otitis media in childhood ,were divided into the study group (n= 20) and the control group (n=20) . The volume sizes of mastoid pneumatization were measured by temporal bone CT scanning of three-dimensional re‐construction ,and the relationship with the history of childhood ear infections was studied .Results The average vol‐ume of pneumatization in all 80 temporal bones was 10 .4 ± 1 .8 ml .The average volume of pneumatization in sub‐jects without otitis media history (48 ears) and subjects with a history of otitis media (32 ears) were 9 .7 ± 2 .2 ml and 6 .3 ± 1 .7 ml ,respectively .The difference was statistically significant (P<0 .05) .For the subjects with single ear disease in the study group ,the average volume of pneumatization in subjects without otitis media history(8 ears) and subjects with a history of otitis media(8 ears) were 9 .2 ± 1 .3 ml and 5 .8 ± 3 .6 ml ,respectively ,and there were statistically significant differences(P<0 .05) .The average volume of pneumatization in the control group (40 ears) was 10 .1 ± 4 .4 ml .Comparing with the subjects with out otitis media history(8 ears) in the study group ,there was no statistically significant difference (P>0 .05) .Conclusion The volumes of mastoid pneumatization in normal ears have a wide range .The subjects with a history of recurrent otitis media in childhood may be the cause of the volume decrease of mastoid pneumatization in adulthood .

Objective: To evaluate the predictive value for baseline levels of high sensitivity C-reactive protein (hs-CRP) in morbidity of pulmonary embolism (PE). Methods: We conducted a prospective cohort study of 101510 subjects in Kailuan Group by regular physical examination from 2006-07 to 2007-10, and 94314 subjects were enrolled by relevant criteria including 75252 male and 19062 female. The baseline levels of hs-CRP were divided by quartile levels as①hs-CRP<0.3l mg/L,n=25592,②hs-CRP (0.3l-0.77) mg/L,n=21746,③hs-CRP (0.78-1.9) mg/L,n=23504 and④hs-CRP≥2.0 mg/L,n=23472. The subjects were followed-up for (81.5 ± 4.76) months, the morbidity of PE was collected and the predictive value of baseline levels of hs-CRP for PE occurrence was evaluate by multivariable Cox proportional hazard regression analysis. Results: The total PE morbidity was 0.15%, the female subjects were similar with male subjects,P>0.05. As the increased baseline level of hs-CRP, PE occurrence was elevated accordingly,P<0.05. Multivariable Cox proportional hazard regression analysis presented that with adjusted age, gender, smoking, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG), fasting blood glucose (FBG), neutrophile granulocyte (NEU), white blood cells (WBC) and heart rate (HR), the subjects in the highest quartile group had 2.84 times higher risk for PE occurrence than the subjects in the lowest quartile group. With the elevated baseline level of hs-CRP, the subjects’ mean age, BMI, SBP, FBG and NEU levels increased accordingly, allP<0.05; while DBP, TG and HR were similar between quartile③ and quartile④ groups, allP>0.05. WBC counts had the increasing trend in quartile①,②,③ groups and had the decreasing trend in quartile④ group, while it was similar between quartile③ and quartile④ groups,P>0.05. Conclusion: Baseline hs-CRP level may predict the risk of PE morbidity; the increased hs-CRP level could be used as one of the predictors for PE occurrence.

Objective To evaluate the correlation of Omentin-1, the high sensitivity C-reactive protein (hsCRP) and coronary heart disease (CHD). Methods Sixty-eight patients with CHD were divided into the unstable angina pectoris (UAP) group (n=36), stable angina pectoris (SAP) group (n=32). And 30 normal subjects without CHD diagnosed by coronary arteriography (CAG) were served as the control group. The serum level of Omentin-1 was measured by enzyme linked immu-nosorbent assay (ELISA) and the serum level of hsCRP was measured by turbidmetric immunoassay. Results The serum level of Omentin-1 was significantly lower, but the serum level of hsCRP was significantly higher in CHD group than that of control group (P<0.05). The serum level of hsCRP was significantly lower in SAP group than that of UAP group (P<0.05). There was no significant difference in serum level of Omentin-1 between groups (P>0.05). The serum level of Omentin-1 was significantly lower in patients with single, double and three-vessel lesion group than that of control group, but the serum level of hsCRP was significantly higher in CHD group than that of control group (P<0.05). There were no significant differ-ence in serum levels of Omentin-1 and hs-CRP between single, double and three-vessel lesion groups (P>0.05). The se-rum level of Omentin-1 was negatively correlated with serum level of hsCRP (P<0.01). Conclusion The serum level of Omentin-1 and hsCRP may correlate with CHD, but which may not reflect the severity of artery stenosis.

Objective To study the clinical features and CT findings of pulmonary fungal infection(PFI) secondary to malignant tumor.Methods The clinical features and CT findings of PFI secondary to malignant tumor proved clinically and pathologically were analyzed retrospectively.Results In pulmonary fungal infection,pulmonary candidiasis was most common seen,which were found in 34 (68%) of 50 cases.CT findings of PFI usually consist of a mixture of patterns,ground-glass attenuation(n=31,62%)and air-space consolidation (n=29,58%) were most common CT findings. Other CT findings included nodule(n=20,40%), air cresceut sign (n=2,4%), thickening of bronchovascular bundles (n=7,14%), mass (n=1,2%),tree-in-bud appearance(n=5,10%),cavity(n=3,6%).Conclusion CT findings of PFI secondary to malignant tumor were nonspecific,which can’t distinguish from other pneumonia,to pay more attentions on it is necessary.