Objective To study the mechanism of gastric bypass operation on treatment of type 2 diabetes mellitus,recognize the etiology and pathogenesy of the disease and frame therapy strategy for type 2 diabetes mellitus.Methods The literatures about gastric bypass operation on treatment of type 2 diabetes mellitus,including clinical cases reports and evidence-based studies were reviewed.Results Gastrointestinal bypass operation was regarded as an effective treatment for type 2 diabetes mellitus.There were three hypotheses of therapy mechanism: early delivery of nutrients to the distal intestine,exclusion of the proximal intestine and incretin/anti-incretin.Conclusion Gastrointestinal bypass operation is now considering as an effective treatment,there is still a lack of basic experimental studies to clarify the mechanism.

Hyperlipidemic pancreatitis (HLP) has an increasing incidence.Primary HLP is common in patients with familial difficiency of lipoprotion lipase or apo-C Ⅱ.While for secondary HLP,the common reasons are excessive drinking,diabetes,obesity,fat-rich diet and special medications.Lipidlowering drugs,plasma exchange (PE) or continuous veno-venous hemofiltration (CVVH),low molecular heparin as well as insulin,have been widely used for the treatment of HLP.Changing of diet and lifestyle,in addition to controlling risk factors are the keys to preventing HLP.This article summarizes the latest perspectives and research progress of HLP.

Gallbladder cancer is a highly malignant tumor of the digestive tract with a poor prognosis. Currently, only radical surgical resection can achieve good results. As an important part of tumor adjuvant treatment and palliative treatment, radiotherapy has been widely used in the treatment of various malignant tumors and achieved certain effect. This article mainly reviews advances of radiotherapy in gallbladder cancer from four aspects: postoperative radiotherapy, preoperative neoadjuvant radiotherapy, intraoperative radiotherapy and palliative radiotherapy for gallbladder cancer.

Objective: To compare the selective splenic artery embolization (SSAE) with non-operative therapy of traumatic splenic rupture (TSR). Methods: The clinical data of 23 patients with TSR receiving SSAE and 32 undergoing non-operative therapy between 1992 and 2006 in our hospital were retrospectively analyzed. Results: There was no blood transfusion in SSAE group, and one patient was received it in the non-operative therapy group. Two patients in SSAE group had complications with left pleural effusion, and one had left pulmonary infection. One patient with non-operative therapy complicated with spleen abscess (P=0.298). The ratio of successful management in SSAE and non-operative group were 100% (23/23) and 81.3% (26/32) respectively(P=0.035). All the patients in both groups were survival. The mean hospital days in non-operative group(11.9?4.6) were significantly longer than that in SSAE group(7.9?2.1, P=0.045). Conclusions: Splenic injuries with grade Ⅰor Ⅱ are suitable for preserving spleen management. SSAE may be more safe and effective than non-operative therapy.

Objective To investigate the expression of integrin α6 mRNA in skin lesions of patients with condyloma acuminata. Methods Sixty outpatients with condyloma acuminate, including 30 primary cases and 30 recurrent cases were enrolled in the study;30 non-condyloma acuminate patients undergoing circumcision were used as normal controls. The expression of integrin α6 mRNA in condyloma acuminata lesions of primary and recurrent cases, as well as in skin samples of normal controls were determined by RTPCR. ANOVA was used to compare the differences among the groups, and Student-Newman-Keuls test(q test)was used for pairwise comparisons. Results Relative contents of integrin α6 mRNA(integrin α6/GAPDH)in normal controls, primary and recurrent condyloma acuminata lesions were 0.25±0.10, 0.79±0.16 and 1.07±0.29, respectively, and the difference was of statistical significance(F=127.687, P=0.001). Conclusion Integrin α6 may be associated with the pathogenesis and recurrence of condyloma acuminate, which may provide a new target for prevention and treatment of the disease.

Objective To summarize the experience of reconstruction of Ⅴ and Ⅷ hepatic veins in right lobe (without middle hepatic vein) living donor liver transplantation. Methods The clinical data of 55 cases of living donor liver transplantation of right lobe without middle hepatic vein were analyzed, and Ⅴ and Ⅷ hepatic veins were reconstructed. All donors underwent evaluation on the basis of vascular anatomy, GRWR and graft volume/ESLV. Fifty-one grafts underwent reconstruction of Ⅴ and Ⅷ hepatic veins with cold-storage cadaveric iliac veins. Great saphenous vein, varicose umbilical veins, recipient intrahepatic portal veins and recipient intrahepatic veins were used respectively in the remaining 4 cases. Results One recipient died of obstruction of out-flow on the postoperative day 43. One recipient was converted to cadaver donor liver transplantation at the 7th day after operation, because of acute liver function failure. The remaining 53 cases recovered successfully. Conclusion Reconstruction of Ⅴ and Ⅷ hepatic veins with proper materials in right lobe (without middle hepatic vein) living donor liver transplantation is feasible, and the effect is satisfactory.

To design teaching course of problem-based learning (PBL) combined with case-based learning (CBL) for standardized training of clinicians based on clinical decision thinking mode (CDTM) of diagnosis and treatment process for primary liver cancer. The CDTM of treatment choice for primary liver cancer is multi-scheme selection model. The general decision rule includes decision condition, action plan and decision tree. For the theoretical study of clinical decision rules, it is suitable to design PBL teaching, but it is suitable to design CBL teaching course for clinical decision-making practice. The teaching course of PBL combined with CBL is conducive to improving the ability of clinicians' clinical decision thinking step by step.

Objective To evaluate the indications and results of liver transplantation ior benign liver tumors.Methods From Jan 2001 to Dec 2014,16 patients of inoperable severely symptomatic benign liver tumors underwent liver transplantation in our department.There were 10 cases of polycystic liver disease,2 cases of hepatic epithelioid hemangioendothelioma,1 case of hepatic cavernous hemangioma,1case of liver mesenchymal hamartoma,1 case of hilar bile duct mucinous cystadenoma,1 case of hepatic adenoma.Results 3 cases were dead in the perioperative period.The remaining patients were alive and discharged with normal perioperative liver and kidney function.One case of polycystic liver lost to follow-up,the remaining 12 patients were all alive at the end of a follow-up of 17 to 161 months,with fully active life style.Conclusions Liver transplantation is an effective and sometimes the only treatment option for unresectable and symptomatic benign liver lesion.

Objective To explore the expression and change of ski-interacting protein (SKIP) in rats after spinal cord injury. Methods A total of 60 adult female Sprague-Dawley rats were randomly divided into sham group (n=30) and spinal cord injury (SCI) group (n=30), each group was further divided into five time points including one day, three days, five days, seven days, and 14 days with six rats in each time points. The model was established at T10 with modified Allen's technique, and the sham group only bit the lamina of rats. The hindlimbs behavior was assessed with Basso-Beattie-Bresnahan (BBB) score at each time point. The pathological changes of spinal cord neurons were detected with Nissl staining. The expression of SKIP were observed with immunofluorescence staining. Results The BBB scores were signif-icantly lower in each time point in SCI group than in the sham group (t>48.267, P<0.001). Compared with the sham group, Nissl bodies in the cytoplasm of spinal cord neurons began to disintegrate, coalesce and irregularly distribute, the neurons began to degenerate and die on the fifth day, and the damage deteriorated on the 14th day. Immunofluorescence staining showed that SKIP expression was mainly expressed in the gray matter of the spinal cord and little expressed in the white matter. The expression of SKIP gradually increased after SCI, and reached a peak on the fifth day (t=-17.035, P<0.001) and decreased significantly on the 14th day (t=3.853, P<0.05). Conclusion SKIP may be a new signaling molecule, which play an important role in neuronal apoptosis after SCI.

Objective To compare the clinical efficacy of primary closure versus T-tube drainage after laparoscopic common bile duct exploration in acute cholangitis cases.Methods The clinical data of 100 patients with acute cholangitis undergoing laparoscopic common bile duct exploration from January 2012 to December 2014 were reviewed.54patients received primary closure of the common bile duct and 46 patients were subjected to T-tube drainage after choledochotomy.Results One hundred patients underwent the surgery successfully.Compared with the T-tube group,the operation time(96.72 min vs 123.00 min,P =0.001),intraoperative blood loss(27.13 ml vs 38.48 ml,P =0.009),postoperative gastrointestinal function recovery time(1.57 d vs 2.33 d,P=0.003) and postoperative hospital stay(6.19 d vs 9.20 d,P=0.000) were significantly less in the primary closure group.There were no statistical differences in the incidence of postoperative drainage (309.22 ml vs 212.46 ml,P =0.070),drainage time (3.96 d vs 4.02 d,P =0.875),incidence of bile leakage(9.3％ vs 0,P =0.060) and postoperative bleeding rate(5.1％ vs 2.2％,P =0.622) between these two groups.Conclusion Laparoscopic common bile duct exploration with primary closure of the common bile duct is an effective and safe procedure in acute cholangitis cases compared with T-tube drainage.