Bariatric and metabolic surgery has been in China for more than 30 years, which has developed rapidly. However, it can be predicted that there will be many opportunities and challenges in the future development of bariatric and metabolic surgery, including the replacement of classic surgical methods, the guarantee of surgical safety, the brave exploration of new surgical methods, the decisive abandonment of bad surgical methods, the implementation of surgical standardization, and the breakthrough of basic and clinical research all mean more efforts. With the continuous rise of the incidence rate of metabolic syndrome and the continuous improvement of people′s health needs, these opportunities and challenges are particularly significant. Bariatric and metabolic surgery will also play a crucial role in overcoming obesity and metabolic diseases.

Objective To investigate the relationship between Livin and Ki-67 proteins, and the expres-sion and clinical significance of Livin and Ki-67 proteins in cholangiocarcinoma. Methods Fifty-five samples of cholangiocarcinoma tissue were collected in Shengjing Hospital from January 2002 to December 2003. The expres-sion of Livin and Ki-67 proteins in the 55 samples of cholangiocarcinoma tissue and 12 samples of chronic cholan-gitis tissue were detected by immunohistochemical assay. The relationship between the expression of Livin and Ki-67 proteins and the clinicopathological parameters of cholangiocarcinoma was analyzed. The results were analyzed by Spearman rank correlation coefficient, chi-square test and t test. Results The positive expression rate of Livin protein in cholangiocarcinoma was 71% (39/55), which was significantly higher than 0 (0/12)in chronic cholan-girls tissue (χ2=20.361, P<0.01). The expression of Livin protein was influenced by the differentiation of cholangiocarcinoma and the lymph node metastasis (χ2=4.193, 4.245, P <0.05). The positive expression rate of Ki-67 protein was 96% (53/55) in cholangiocarcinoma. The label index of Ki-67 in patients in clinical stage Ⅰ,Ⅱ,Ⅲ,Ⅳ,were 22%±16%, 33%±12%, 43%±15%, and 49%±10%, respectively. There was signifi-cant difference in the label index of Ki-67 between patients in clinical stage Ⅰ and those in clinical stages Ⅱ, Ⅲ,Ⅳ(t=2.307, 2.871, 3.957, P<0.05). The label index of Ki-67 was 43%±13 % in patients with local lymph node metastasis, and 34%±16% in patients without local lymph node metastasis, with statistical difference between the 2 groups (t=2.334, P<0.05). The expression of Livin protein in cholangiocarcinoma was positively correlated with the label index of Ki-67 (r=0.502, P<0.01). Conclusions Livin protein plays an important role in the pathogenesis and development of eholangiocarcinoma, and it also has correlation with the proliferating activity of cholangiocarcinoma cells. Combined detection of the expression of Livin and Ki-67 proteins may be helpful in judging the malignancy of cholangiocarcinoma and determining the prognosis of patients.

OBJECTIVEThe aim of this study was to investigate the value of free anterolateral thigh myocutaneous flap (ALTMF) and computed tomography angiography (CTA) for the reconstruction of mouth-floor defects after the resection of middle-late stage carcinoma of the mouth floor.

METHODSSixteen cases of middle-late stage carcinomas of the mouth floor underwent radical resection, and mouth-floor and tongue defects were reconstructed with ALTMF. CTA was applied to plan the lateral circumflex femoral artery (LCFA) and its perforating vessel, which was verified during the operation.

RESULTSThe position of the perforating vessel in the operation was fully consistent with that designed by the preoperative CTA. All 16 flaps completely survived. The appearance and function of all cases were both satisfactory. All donor sites were primarily closed and healed without functional morbidity. During the follow-up period of 6-36 months, 15 cases survived with acceptable aesthetic and functional results in mouth floor and tongue reconstruction, except for 1 case (T4N2M0) that died of metastasis carcinoma 10 months after operation.

CONCLUSIONCTA can accurately locate the LCFA and artery perforator. Preoperative perforator planning using CTA in ALTMF transplantation is a reliable and useful method thatresults in safe operation with optimal outcome. The ALTMF is an ideal choice for the reconstruction of soft tissue defects after the resection of middle-late staie carcinoma of the mouth floor

Angiography ; Carcinoma ; Free Tissue Flaps ; Humans ; Mouth Floor ; Myocutaneous Flap ; Patient Care Planning ; Reconstructive Surgical Procedures ; Thigh ; Tomography ; Tongue

OBJECTIVEThis study aims to evaluate the effect of customized titanium mesh, which was designed by mirror imaging and rapid prototyping technique, with Medpor applied for orbital fracture with enophthalmos.

METHODSOrbital axial, coronal, and sagittal CT scan, and three-dimension CT examination were performed routinely in. 18 cases of orbital fracture with enophthalmos preoperatively. Based on the CT data, prosthesis model was designed by reverse engineering and rapid prototyping technique. The customized titanium mesh and Medpor were applied for orbital reconstruction and enophthalmos correction. Orbital reduction and globe projection were evaluated by postoperative CT scan and clinical follow-up visits.

RESULTSCT scans revealed that the customized titanium mesh with Medpor had great accuracy to reconstruct the orbital fracture and correct the enophthalmos in all patients without serious complications. The eye and facial appearance and function recovered significantly. No serious complication occurred in the operation and after operation.

CONCLUSIONThe customized titanium mesh, based on mirror imaging and rapid prototyping technique, can accurately reconstruct the orbital fractures with enophthalmos. The application of Medpor can effectively correct enophthalmos and eyeball mobility malformation.

Enophthalmos ; therapy ; Facial Bones ; Humans ; Orbit ; Orbital Fractures ; surgery ; Polyethylenes ; Postoperative Period ; Prostheses and Implants ; Reconstructive Surgical Procedures ; Surgical Mesh ; Titanium ; Tomography, X-Ray Computed

Objective To investigate the effects of three laparoscopic bariatric operations on relieving type 2 diabetes in morbid obese patients. Methods From 2005 to 2009, 15 morbid obese patients with type 2 diabetes received bariatric operations in Shengjing Hospital including lapband operation (7 cases) , sleeve gastrectomy (7 cases) and gastric bypass(4 cases). All patients were followed up for more than 1 year. Results All patients recovered without major complications. Body weight decreased and BMI was respectively (27. 6 ± 2. 0) kg/m2, ( 26. 9 ± 1. 4) kg/m2 and (27. 5 ± 3. 0) kg/m21 year after operation. The excess BMI loss in three groups were (76. 4% ± 6. 8% ) , (83. 7% ± 4. 6% ), (85. 7% ±9. 5% ) 1 year after operation. On the other side, the fasting glucose levels and glycohemoglobin in gastric bypass group were much lower than that in other two groups. Conclusion All these operations were effective in controling the weights and fasting glucose levels, while the gastric bypass method is better than other two methods in weight and serum glucose control. Sleeve gastrectomy was better in weight and glucose control than lap band operation.

Objective To observe the characteristics of different level of normal abdominal aorta’s time-flow,time-velocity curve and to investigate the hemodynamic factors in role of the occurrence and development of abdominal aorta’s disease.Methods PC-MRI scanning was performed on 60 normal volunteers T12/L1-L4/5 disc at the level of abdominal aorta,time-flow and time-veloci-ty curve were generated respectively.The characteristics of blood flow curves at different levels of abdominal aorta were observed. Results The time-flow,time-velocity curve of the normal abdominal aorta in different levels have 2nd phase (no diastolic reflux) and 3rd phase (diastolic reflux).Conclusion The characteristics of blood flow curves of different levels of abdominal aorta are dif-ferent.

Objective To observe the clinical efficacy of HE’s needling method (three ways for unblocking) in treating mild simple obesity due to dampness from spleen deficiency.Method Forty eligible subjects with mild simple obesity due to dampness from spleen deficiency were randomized into group A and group B, 20 cases in each group. Group A was intervened by mild unblocking method plus intensive unblocking method from HE’s needling method, and group B was by mild unblocking method plus warm unblocking method. The obesity-related indexes were observed before and after treatment, and the clinical efficacies were compared.Result The body weight and Body Mass Index (BMI) were significantly changed after intervention in the treatment group (P<0.05). The body weight was significantly changed after treatment in the control group (P<0.05). After treatment, there were no significant differences in comparing the obesity-related indexes (body weight, BMI, waist circumference, hip circumference, and waist-hip ratio) between the two groups (P>0.05). The total effective rate was 55.0% in the treatment group versus 10.0% in the control group, and the difference was statistically significant (P<0.01).Conclusion HE’s needling method is effective in treating mild simple obesity due to dampness from spleen deficiency, and mild unblocking method plus intensive unblocking method can produce a more significant efficacy compared to mild unblocking method plus warm unblocking method.

Fibro-optic bronchoscopy (FB) examinations were undertaken in 42 cases with lung cancer and 25 cases with benign lung disease; methylation-specific PCR was performed in plasma, sputum and bronchoalveolar lavage fluid (BALF) specimen for detection of p16 gene promoter methylation in all patients.Of the 42 cases of lung cancer, the positive rates of p16 gene promoter methylation were 59.5% in BALF, 52.4% in plasma and 47.6% in sputum, respectively; while p16 gene promoter methylation was detected only in one plasma sample from 25 cases with benign lung disease ( P ＜ 0.05 ).The sensitivity,specificity and overall accuracy of FB were 59.5%, 100.0% and 74.6%, respectively.The sensitivity,specificity and overall accuracy of FB combined with aberrant p16 gene methylation in diagnosis of lung cancer were 92.9%, 96.2% and 94.0%, respectively.The FB examinations combined with detection of aberrant p16 gene methylation can further improve the accuracy to diagnosis of lung cancer.

Objective To investigate the effect of ischemic preconditioning (IPC) on the expression of a disintegrin and metalloprotease with thrombospondin type 1 motifs (ADAMTS-1), and to study whether the application of small interfering (si)RNA specifically targeting ADAMTS-1 would help to recover IPC protection in the aged heart. Methods The 32 young (4 months) and 32 aged(24 months) male Sprague-Dawley (SD) rats were assigned randomly to IPC group (n=20) and sham operated group (n= 12) respectively. Myocardial samples from the ischemic-reperfused region were harvested for detecting the ADAMTS-1 expression. In addition, the 110 aged SD rats were assignedrandomly to ADAMTS-1 siRNA group and control group (n=55, each). The effects of ADAMTS-1siRNA transfcction on the expression of ADAMTS-1 protein, myocardial infarction survival rate,heart function and myocardial infarction size after IPC were observed.Results Twenty-four hours after IPC, the ADAMTS-1 protein expression increased significantly in iscbemic-reperfused region both in young and aged rats (P＜0. 05), and the protein expression was higher in aged rats than in young rats (P＜0.05). In young-IPC group, the absorbency showed ADAMTS-1 protein expression at 0 hrs and 24 hrs after IPC were 0. 05±0.01 and 0.12±0.03 by immunohistochemical staining, and were 0.68±0. 16 and 1. 17±0.21 by Western blots respectively. In aged-IPC group, the absorbency showed ADAMTS-1 protein expression at 0 hrs and 24 hrs after IPC were 0.07±0. 03 and 0.21 ±0.04 by immunohistochemical staining, and were 0. 76±0. 21 and 1. 48±0. 17 by Western blots. In the aged rats, ADAMTS-1 siRNA transfection inhibited ADAMTS-1 protein expression (0. 66±0. 19and 0.78±0.21, by Western blots at 0 hrs and 24 hrs after IPC, P＞0.05), but didn't improve myocardial infarction survival rates [ADAMTS-1 siRNA group and sham operated group: 14.3% (5/35) vs. 17.1 %(6/35), P＞0.05], left ventricular fractional shortening [(14.0±3.2)% vs. (13.0±2.9)%, P＞0.05] and myocardial infarction size[(39.0±4.1)% vs. (38.0±5.3)%, P＞0.05].Conclusions ADAMTS-1 expression induced by IPC increases significantly in aged versus in young rats. ADAMTS-1 knockdown by siRNA inhibits ADAMTS-1 protein expression but cannot recover the age-associated loss of IPC protection.

Objective To investigate the feasibility of differentiating lymph node metastases of four types of primary tumors (lymphoma, lung adenocarcinoma, lung squamous cell carcinoma and cholangiocarcinoma) using gemstone spectral imaging (GSI) . Methods Three cases with lymphoma (28 lymph node), five cases with lung adenocarcinoma(30 lymph node), four cases with lung squamous cell carcinoma(24 lymph node) and two cases with cholangiocarcinoma( 10 lymph node) were evaluated by germstona spectra imaging CT scans. Imaging protocol included unenhanced conventional CT scan (120 kVp) ,enhanced GSI (80/140 kVp) on arterial phase and conventional CT scan (120 kVp) on portal phase. CT attenuation values of lymph nodes in the monochromatic images at 11 sets of keV levels (40-140 keV, 10 keV step) and the iodine and water contents of these lymph nodes were measured. All results were analyzed with ANOVA and t test. Results The optimal monochromatic level was 70 keV for the optimal contrast-noise ratio (CNR) of metastatic lymphadenopathy. The CT attenuation values of metastatic lymphadenopathy were (81.36 ±9. 81 ), (58.33 ± 21.55 ), (56. 47 ± 10.62) and (73. 57 ±4. 43 ) HU,respectively, at 70 keV( F = 17.29, P ＜0. 01 ). There were significant differences in CT attenuation values between lymphoma and lung adenocarcinoma, between lymphoma and lung squamous cell carcinoma and between lung squamous cell carcinoma and cholangiocarcinoma (P ＜ 0. 05 ). The differences in CT attenuation values were significant between cholangiocarcinoma and lung squamous cell carcinoma, between cholangiocarcinoma and lymphoma ( P ＜ 0. 05 ). There was no difference in CT attenuation values at all 11 sets of keV levels between lung squamous cell carcinoma and lung adenocarcinoma ( P ＞ 0. 05 ). The iodine contents of lymphoma, lung adenocarcinoma, lung squamous cell carcinoma and cholangiocarcinoma were ( 1. 93 ± 0. 04 ), ( 1.16 ± 0. 15 ), ( 1.25 ± 0. 21 ) and ( 1.44 ± 0. 04 ) g/L, respectively. The water contents of lymphoma, lung adenocarcinoma, lung squamous cell carcinoma and cholangiocarcinoma were (1029.40 ± 20. 85), (1024.98 ± 11.19), (1022.12 ± 12. 94) and (1030.87 ± 10.10) g/L,respectively. Except between lung squamous cell carcinoma and lung adenocarcinoma, the differences in the iodine contents of metastatic lymphadenopathy were significant among tumors ( P ＜ 0. 05 ). There was no difference in the water contents of metastatic lymphadenopathy among tumors ( P ＞ 0. 05 ). Conclusions Although CT spectral imaging fails to differentiate metastatic lymphadenopathy of lung adenocarcinoma and lung squamous cell carcinoma, it is also a promising method of distinguishing metastatic lymphadenopathy of malignant tumors by CT attenuation values in monochromatic images and iodine contents in material density images. The optimal monochromatic level was determined to be at 70 keV for providing the optimal CNR of metastatic lymphadenopathy.