BACKGROUND:The use of donor rat of cardiac death inevitably experiences warm ischemia injury, so the length of warm ischemia time plays a significant role on the number and function of pancreatic islet obtained. OBJECTIVE:To investigate the effect of Exendin-4 on pancreatic islet function of donor rats with cardiac death at different heat ischemia time. METHODS:Islet cells from Wistar rats were cultured in vitro and randomly divided into three groups according to the experimental conditions:0, 30, 45 min heat ischemia groups. Each group was further assigned into two subgroups, control group was cultured for 24 hours while experimental group wad cultured with 10 nmol/L Exendin-4 for 24 hours. The number of isolated pancreatic islets was calculated with diphenylthiocarbazone staining, and the purity of the extracted islets was adjusted. The viability of the islets was examined by AO/EB staining, and insulin secretion index assay was used to detect the function of the islets. RESULTS AND CONCLUSION:With the time of heat ischemia increasing, the number, purity, viability and function of islet cells obtained were decreased. After the cells in heat ischemia 0, 30, 45 min groups were cultured with 10 nmol/L Exendin-4 for 24 hours, the number, purity and viability of isolated and purified islets were increased compared to the group without added Exendin-4. There was significant difference between experimental group and control group in 30-minute and 45-minute ischemia groups (P<0.05). Exendin-4 can protect pancreatic islet cells in donor rats with cardiac death at different heat ischemia times, reduce the apoptosis, and improve islet survival and functions. The use of Exendin-4 can be an effective pretreatment method at early ischemia phase of islet transplantation.

Objective To discuss the application of Chaperon guiding catheter system in endovascular treatment of intracranial aneurysms. Methods A total of 20 patients with intracranial aneurysms were enrolled in this study. The patients hadⅡorⅢtype of aortic arch (n=11) or sclerotic plague at the orifice of internal carotid or vertebral artery (n = 9). Endovascular embolization of the intracranial aneurysm was carried out in all patients. By using Cordis guiding catheter system the catheter was placed into the target artery. Chaperon guiding catheter system was used during the procedure in order to determine whether the Chaperon guiding catheter could be smoothly placed into the target artery or not. Results When the Chaperon guiding catheter system was employed in the endovascular procedure, the difficulties of catheterization caused by the distortion of the aorta or by the plagues on the walls of arteries could be basically overcome. The Guiding catheter could be smoothly placed into the target arteries. Conclusion The Chaperon guiding catheter system can be successfully used in the endovascular treatment for the intracranial aneurysms, especially when the patient has tortuous aorta or there is sclerotic plague on the artery wall. (J Intervent Radiol, 2014, 23:281-283).

Objective To explore the incidence,clinical features,causes,treatment method and risk factors of 30-day readmission after bariatric and metabolic surgery.Methods The retrospective case-control study was conducted.The clinical data of 631 obese patients who underwent bariatric and metabolic surgery in the First Affiliated Hospital of Nanjing Medical University from May 2010 to May 2016 were collected.All the 631 patients underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB).Patients were followed up by outpatient examination and telephone interview for 1 month to detect readmission of patients up to June 2016.Observation indicators:(1) 30-day readmission situations after bariatric and metabolic surgery:cases with readmission,readmission time,clinical features,causes and treatment of readmission;(2) risk factors analysis affecting 30-day readmission after bariatric and metabolic surgery.Measurement data with skewed distribution were described as M (range).The univariate analysis and multivariate analysis were respectively done using the chi-square test and Logistic regression model.Results (1) Thirty-day readmission situations after bariatric and metabolic surgery:among 631 patients receiving postoperative 1-months follow-up,21 had 30-day readmission,with an incidence of 3.33％ (21/631),including 13 males and 8 females;10 received LSG and 11 received LRYGB.The median readmission time of 21 patients was 12 days (range,4-30 days).Of 21 patients,nausea,vomiting and dehydration of the main manifestations were detected in 11 patients,gastrointestinal bleeding in 6 patients,high fever in 2 patients,bowel obstruction in 1 patient and abdominal pain in 1 patient.The causes of the readmission of 21 patients:8 had improper food intake including 5 with premature solid food intake,1 with premature semi-fluid food intake,1 with irritating food intake and 1 with swallowing whole tablets;3 had postoperative over-anxiety;1 had Petersen hiatal hernia;1 had anastomotic ulcer;1 had anastomotic edema;1 had abdominal abscess.Of 6 patients with uncertain causes,4 had gastrointestinal bleeding and didn't receive endoscopy;1 had postoperative unexplained abdominal pain and underwent laboratory and imaging examinations and gastroscopy,showing no trouble finding;1 had high fever,and no abnormality was detected by imaging examination.Of 21 patients,19 underwent conservative treatment (rehydration and acid suppression) and then discharged from hospital after improvement,without readmission;1 with abdominal abscess was cured after emergency debridement and drainage;1 with Petersen hiatal hernia was cured by emergency surgery.The median duration of hospital stay in 21 patients with readmission was 7 days (range,3-40 days).(2) Risk factors analysis affecting 30-day readmission after bariatric and metabolic surgery:the results of univariate analysis showed that gender,preoperative adephagia habit and duration of postoperative hospital stay were related factors affecting 30-day readmission after bariatric and metabolic surgery (x2 =5.330,6.498,4.574,P＜0.05).The results of multivariate analysis showed that male and preoperative adephagia habit were independent risk factors affecting 30-day readmission after bariatric and metabolic surgery (OR=2.489,2.912,95％ confidence interval:1.006-6.161,1.196-7.088,P＜0.05).Conclusions Nausea,vomiting and dehydration are common manifestations of patients with 30-day readmission after bariatric and metabolic surgery,and it might be associated with improper food intake.Male and preoperative adephagia habit are independent risk factors affecting 30-day readmission after bariatric and metabolic surgery.

Objective To observe the influence of warm ischemia time on acquisition of rat pancreatic islets and islet function.Method Male Wistar rats were used.After heart beats stopped,the pancreases in four groups of rats were harvested,and warm ischemia time was 0,15,30 and 45 min separately.The pancrease was preserved in UW at 4℃C for 8 h,and subjected to injection of collagenase solutions.After islets were acquired,the purity,survival rate and islet activity were tested,and statistical analysis was performed.Result The number of islets obtained in 0 min group,15 min group,30 min group and 45 min group was (433 ± 41),(396 ± 38),(350 ± 31) and (66 ± 17)IEQ/one,islet viability was 94％,88％,77％ and 25％,and purity was 88％,78％,60％ and 32％,and insulin release index was 2.38 ± 0.23,2.25 ± 0.18,2.19-± 0.18 and 1.25 ± 0.12,respectively.There was no significant difference in islet number,purity,survival rate and activity 15 min group and 30 min group between 15 min group or 30 min group and 0 min group (P＞0.05).There was significant difference between 45 min group and 0 min group in islet number,purity,survival rate and activity (P＜0.05).The survival rate and purity in 45 min group were lower than the clinical standards for islet transplantation (survival rate ＞ 75％,and purity ＞ 50％).Conclusion Warm ischemia time of 15 min in non-heart-beating brain death(NHBD) rats had no effect on islet isolation and purification.Warm ischemia time within 30 min showed no significant influence on islets of NHBD rats,which can be used in islet transplantation.Warm ischemia time at 45 min showed significant influence on islets of NHBD rats,which can't be used in islet transplantation.

Purpose To explore the diagnostic value of double exponential model for pelvic lesions using 3.0T MRI for the diagnosis of pelvic lesion. Materials and Methods Fifty patients with pelvic lesions (30 benign cases and 20 malignant cases) underwent MR750-diffusion weighted imaging (DWI) scans, with b values of 0, 50, 300, 600, 800 and 1200 s/mm2, Functool-MADC software was used on AW 451 workstations for data processing, Slow ADC value, Fast ADC value, Standard ADC value, Fraction of fast ADC value were recorded and compared between benign and malignant lesions, and Standard ADC images were fused with axial T2 fat-suppressed images. Results Slow ADC values [(1.83±0.86)×10-3 mm2/s] and Standard ADC values [(1.79±0.78)×10-3 mm2/s] of benign lesions were larger than those of the malignant lesions [Slow ADC values:(1.05±0.31)×10-3 mm2/s;Standard ADC values:(1.13±0.39)×10-3 mm2/s] (t=3.90, 3.51;P<0.01), and the difference of Slow ADC value was largest between benign and malignant lesions. Slow ADC values of both benign and malignant lesions were significantly less than the Fast ADC values [benign:Slow ADC value=(1.83±0.86)×10-3 mm2/s, Fast ADC value=(16.95±8.63)×10-3 mm2/s; malignant: Slow ADC value=(1.05±0.31)×10-3 mm2/s, Fast ADC value=(15.12±9.90)×10-3 mm2/s] (t=-10.40,-6.29;P<0.01). Conclusion Double exponential decay model is capable of differentiating benign and malignant pelvic tumors, thus is of great significance for clinical preoperative diagnosis.

Objective To evaluate the efficacy and safety of photodynamic therapy(PDT)combined with intravitreaIinjection of bevacizumab for choroidal neovascularization(CNV)caused by agerelated macular degeneration(AMD). Methods A total of 21 eyes of 21 patients with AMD,which was diagnosed by examination of visual acuity,intraocular pressure,ocular fundus,fundus color photography,fundus fluoreseein angiography(FFA),indocyanine green angiography(ICGA)and optic coherence tomography(OCT),were underwent PDT combined with intravitreal injection of Bevacizumab.The patients,15 males(15 eyes)and 6 females(6 eyes),aged from 56 to 78 years,with the average of 68.6years.The best corrected visual acuity:counting fingers/10cm-0.9,logMAR was 1.04±0.41.CNV located in below or side central fovea of macula.There was obvious leakage of fluorescein which examined by FFA and ICGA.The average of retinal thickness of macular foveal was(258.91±78.66)μm.The treatment method of PDT has to according to the way of PDT for TAP and Verteporfin PDT for VIP.Intravitreal infeetion with 1.5mg bevacizumab was performed after three days under surface anesthesia.Follow-up time was 1,3,6,12 months after the treatment. Resuits At last visit,the best corrected visual acuity:counting fingers/10 cm-1.5,logMAR was 1.04±0.41,and the differences are statistically significant compared with before.The BCVA improved four or more lines in 6 eyes(28.57%),improved two to four lines in 9 eyes(42.86%),stabilized(±1 line or no change)in 6 eyes(28.57%)and decreased in none.The average intraocular pressure was(15.20±2.41)mmHg after surgery,and the differences was not statistically significant compared with before(P＞0.05).FFA and lCGA showed CNV complete closure in 13 eyes(61.90%).partial closure in 8 eyes(38.10%).The average of retinal thickness of macular foveal was(127.38±20.14)μm(P＜0.01). Conclusion Combining treatment with PDT and intravitreal injection of Bevacizumab is safe and effective for CNV which caused by AMD.It has significant improvement in BCVA.1eakage of CNV and retinal edema.

Bariatric and metabolic surgery has become the clinical hot topic of the treatment of metabolic syndromes including obesity and diabetes mellitus, but how to choose the appropriate surgical procedure remains the difficult problem in clinical practice. Clinical guidelines of American Society for Metabolic and Bariatric Surgery(ASMBS)(version 2013) introduced the procedures of bariatric and metabolic surgery mainly including biliopancreatic diversion with duodenal switch(BPD-DS), laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy(LSG). To choose the appropriate bariatric and metabolic procedure, the surgeons should firstly understand the indications and the contraindications of each procedure. Procedure choice should also consider personal condition (body mass index, comorbidities and severity of diabetes), family and socioeconomic status (postoperative follow-up attendance, understanding of potential surgical risk of gastrectomy and patient's will), family and disease history (patients with high risk of gastric cancer should avoid LRYGB; patients with gastroesophageal reflux disease should avoid LSG) and associated personal factors of surgeons. With the practice of bariatric and metabolic surgery, the defects, especially long-term complications, of different procedures were found. For example, LRYGB resulted in higher incidence of postoperative anemia and marginal ulcer, high risk of gastric cancer as well as the requirement of vitamin supplementation and regular follow-up. Though LSG has lower surgical risk, its efficacy of diabetes mellitus remission and long-term weight loss are inferior to the LRYGB. These results pose challenges to the surgeons to balance the benefits and risks of the bariatric procedures. A lot of factors can affect the choice of bariatric and metabolic procedure. Surgeons should choose the procedure according to patient's condition with the consideration of the choice of patients. The bariatric and metabolic surgery not only manages the diabetes mellitus and weight loss, but also results in the reconstruction of gastrointestinal tract and side effect. Postoperative surgical complications and nutritional deficiency should also be considered. Thereby, individualized bariatric procedure with the full consideration of each related factors is the ultimate objective of bariatric and metabolic surgery.
Anemia ; epidemiology ; Bariatric Surgery ; adverse effects ; methods ; statistics & numerical data ; Biliopancreatic Diversion ; adverse effects ; methods ; statistics & numerical data ; Body Mass Index ; Comorbidity ; Contraindications ; Diabetes Mellitus ; surgery ; Disease Management ; Gastrectomy ; adverse effects ; methods ; statistics & numerical data ; Gastric Bypass ; adverse effects ; methods ; statistics & numerical data ; Gastroesophageal Reflux ; Gastroplasty ; methods ; mortality ; statistics & numerical data ; Humans ; Informed Consent ; Laparoscopy ; adverse effects ; methods ; statistics & numerical data ; Long Term Adverse Effects ; epidemiology ; Malnutrition ; epidemiology ; Obesity ; surgery ; Patient Acuity ; Patient Care Planning ; Patient Compliance ; Postgastrectomy Syndromes ; epidemiology ; Postoperative Complications ; epidemiology ; Risk Assessment ; methods ; Risk Factors ; Stomach Neoplasms ; epidemiology ; Treatment Outcome ; Weight Loss

In this study,RNA interference technique was employed to silence the expression of DNMT1 and/or DNMT3b in human bladder cancer T24 cells.The expression levels of their mRNA and protein were greatly decreased by up to 75% and 65% respectively after T24 cells were transfected with lipofectamine2000 for 72 h,indicating RNA interference is an effective tool in gene knockdown.Proliferation and apoptosis of T24 cells were detected by MTT,and annexin-V-FITC and propidium iodide staining flow cytometry,respectively.It was found that loss of the DNMT1 or DNMT3b expression could inhibit the cell growth and promote the cell apoptosis to some extent.However,combined treatment with shRNA targeting both DNMT1 and DNMT3b mRNA could ob-viously enhance the above effects.It was concluded that simultaneously silencing both genes could result in strong suppressing effect on tumor proliferation and promoting ceil apoptosis than separate use,suggesting combined use of DNMT1 and DNMT3b can achieve a synergistic effect in the CpG island methylation in human bladder tumorigenesis.

Objective To summarize the clinical experience and application value of two-incision laparoscopic sleeve gastrectomy for the treatment of simple obesity.Methods From January 2016 to February 2017,the clinical data and follow-up results of 11 patients with simple obesity who underwent twoincision laparoscopic sleeve gastrectomy in the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed.Data were expressed by mean standard deviation.The learning curve was analyzed based on the cumulative sum method.At the 1st,3rd,6th,9th and 12th months after surgery,the postoperative complications,weight loss and satisfaction of abdominal cosmetic effect were also collected and analyzed through the follow-up of outpatient service or telephone.Results All the patients were successfully completed the two-incision laparoscopic sleeve gastrectomy,with the mean operation time of (83.2 ± 10.7) minutes,mean intraoperative blood loss of (15.3 ± 8.2) ml and mean postoperative hospital stay of (3.8 ± 1.3) days.Learning curve analysis indicated that the expierenced bariatric surgeon could master the two-incision laparoscopic sleeve gastrectomy after five cases of practice.During the follow-up ranged from 1 to 12 months through outpatient and telephone,none of the patients was sufferred from the postoperative complications including leakage of the gastric sleeve,abdominal abscess,incision infection,incision liquefaction,delayed wound healing and umbilical hernia.The excess weight loss was (26.3 ± 3.2) ％,(47.4±5.3)％,(65.7±7.3)％,(70.5±7.9)％ and (80.2±10.7)％ at the 1st,3rd,6th,9th and 12th months follow-up after surgery.All the patients were satisfied with cosmetic outcomes of the reduced abdominal trocar incisions.Conclusions Two-incision laparoscopic sleeve gastrectomy is safe and effecive.Moreover,it is asscosicated with convinient operational management,short learning curve,and increased abdominal cosmetic effect compared with conventional five-incision laparoscopic sleeve gastrectomy.