Objective To discuss the clinical value of transluminal endoscopic surgery (TUES), and to find a simple and safe no-scar surgical approach. Methods A total of 13 cases of TUES, including 1 case of hepatic abscess fenestration, 1 abdominal exploration, 5 appendicectomy, and 6 cholecystectomy, were carried out in our hospital. Among the cases, 3 were accomplished using upper-digestive endoscopy, and 10 were performed using triple-channel catheter technique by modified instruments.Results All the operations were completed successfully without conversion to routine laparoscopic surgery or open surgery. The operation time was 90-150 min in the 6 cases of cholecystectomy, 15-40 min in the 5 cases of appendectomy, 90 min in the hepatic abscess fenestration, and 50 min in the abdominal exploration. The abdominal exploration showed peritoneal abrasion around the bladder, and the hemorrhage was controlled by electric coagulation. No complications including hemorrhage and biliary fistula occurred in this series. No abdominal scar was found after the operation except in the skinfolds around the hilum. Conclusions The TUES is a simple, safe, and feasible technique. Since the TUES for cholecystectomy is difficult, the patients should be selected carefully.

Objective The aim of this study is to verify the feasibility of transumbilical endoscopic cholecystectomy by using the tri-channel trocar technique.Methods Eight domestic pigs were submitted to transumbilical endoscopic cholecystectomy using the tri-channel trocar technique.After establishment of pneumoperitoneum,a tri-channel trocar was placed through an infra-umbilical incision.A fine grasper of 2 mm in diameter was inserted through a small skin incision on the right upper abdomen into abdominal cavity to grasp the fundus of the gallbladder.Then the cystic duct was dissected with a flexible hook.Once the cystic duct and artery were free,they were clipped by a clip fixing device,and the gallbladder was separated from the liver bed using flexible hook dissection.The specimen was then extracted through the umbilical trocar.Results All the gallbladders were removed successfully in the eight pigs without severe bleeding during dissection,or intraoperative and postoperative complications.The operation time was from 1.5 to 2.5 hours and decreased with experience.Postmortem examination revealed that the gallbladder fossa was clean,and the clips on the cystic duct and artery were secure.Neither bile leakage nor hemorrhage was found at the operative field.Conclusions Transumbilical endoscopic cholecystectomy is feasible and safe without leaving obvious abdominal scars.

Objective To investigate the feasibility of "non-scar" total laparoscopic cholecystectomy trough the transumbilical approach by using modified instruments.Methods Trocars(5 and 3 mm in diameter respectively)without the proximal seal system on the sleeves were designed for this procedure.The maximum diameters of the trocars were reduced to 8 and 5 mm respectively.The instruments used in this study were 5 cm longer than commercially available instruments.10 cases of total laparoscopic cholecystectomy were performed by using the tools.Results All the gallbladders were removed successfully without massive bleeding during dissection.A mini port was placed on the right upper abdomen to assist retraction in one case because of technical difficulty.The mean operation time was(62?25)minutes(range,45 to 110 minutes)in this series.No intra-and postoperative complications occurred.All the patients were satisfied with the abdominal cosmetic results.They were discharged in 48 hours after the operation,and then back to work in a week.Follow-up was available in the patients for 1 to 5 months.None of them showed complication or recurrence during the period.Conclusions The interference between trocars and surgical instruments can be partially avoided by using the modified tools."Non-scar" total laparoscopic cholecystectomy is feasible by using the technique.

Objective The major barrier to transumbilical endoscopic surgery is from external interference between the instruments handles around the umbilicus. We describe the technique of totally transumbilical endoscopic cholecystectomy by using improved instruments. Methods 54 cases of transumbilical laparoscopic cholecystectomy were performed with improved instruments in patients with gallbladder polyps (13 cases) and gallstones (41 cases). The new trocars without the proximal seal system on the sleeves were designed for this procedure. The instruments used in this study were 5 cm longer than commercially available ones. Results All the gallbladders were removed successfully without severe intraoperative bleeding during and postoperative complications. Mean operating time was 25-56 min (average 34±28 min). All the patients were satisfied with the abdominal cosmetic results, discharged 48 h after the operations, and returned to work within seven postoperative days.Conclusions The external interference between trocars and instruments can be partially avoided by using the improved instruments. Totally transumbilical laparoscopic cholecystectomy becomes feasible by this technique.

An analytical method based on high performance liquid chromatography tandem mass spectrometry has been developed for the simultaneous determination of 20 anti-obesity drugs ( fenfluramine, phenylpropanolamine, sibutramine, sertraline, rimonabant, bupropion, citalopram, fluoxetine, benfluorex, topiramate, zonisamide, caffeine, phenolphthalein, emodin, indapamide, bumetanide, torasemide, triamterene, orlistat, phenformin). that were extracted from various weight-loss functional foods by ethanol-acetone(7:3, V/V)and purified by primary secondary amine (PSA) and octadecyltrimethoxysilane(ODS) under ultrasonication. The analysis was carried out on HPLC-MS /MS by electrospray ionization using multiple reaction monitoring after the chromatographic separation on Waters Atlantis T3 (3 μm, 150 mm × 2. 1 mm) column. Identification was achieved by the retention time and the ion ratio, quantification was done by the external standard method. The limits of detection for the appetite suppressants were 0. 05-3. 0 mg/kg. The mean recoveries at the three spiked levels were 67 . 1%-101 . 4%, with the intra-day precision less than 10%and the inter-day precision less than 15%. The method is reliable, accurate, reproducible and suitable for the determination of the anti-obesity drugs in different weight-loss functional foods.

A comprehensive analytical method based on ultra performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) was developed for the simultaneous determination of active components and anti-diabetic) drugs in propolis health foods. The samples were extracted by ultrasound extraction with methanol). The insoluble residue of extract was removed by freeze-centrifuging. The analysis was performed on an ACQUITY UPLC C_(18)) column(50 mm ×1 mm, i.d., 1.7 μm) utilizing a gradient elution profile and a mobile phase of 0.3% formic acid in water and acetonitrile. The analytes were detected using an electro spray ionization tandem mass spectrometry with multiple reaction monitoring. Qualitative and quantitative analysis was based on the peak area of the parent ion and two fragment ions. The LOD and LOQ level for 14 active components ranged from 0.7 mg/kg to 42.0 mg/kg and 2.2 mg/kg to 140 mg/kg respectively, and recoveries were 77.8%-113.6%, with the intra- and inter-day precision less than 15%. The LOD and LOQ level for 9 anti-diabetics) ranged from 0.1 mg/kg to 0.9 mg/kg and 0.3 mg/kg to 2.5 mg/kg respectively, and recoveries) were 79.3%-108.5%, with the intra- and inter-day precision less than 15%. The method is simple) and sensitive, and can be used for quality control of propolis.

Objective To investigate the related risk factors of hair loss in obese patients after laparoscopic sleeve gastrectomy (LSG).Methods The retrospective case-control study was conducted.The clinical data of 54 obese patients who underwent LSG in the East Hospital of Tongji University between November 2013 and June 2015 were collected.All the patients received LSG,and postoperative hair loss of patients was observed.Factors affecting postoperative severe hair loss were analyzed,including gender,age,preoperative body mass index (BMI),postoperative excess weight loss (EWL),total bilirubin (TBil),albumin (Alb),hemoglobin (Hb),iron,zinc,copper,folic acid,vitamin B12 and vitamin D.Observation indicators:(1) follow-up and postoperative hair loss situations:cases with follow-up,follow-up time,cases with hair loss,severity of hair loss,time of hair loss,treatment of hair loss;(2) univariate analysis affecting severity of hair loss after LSG;(3) multivariate analysis affecting severity of hair loss after LSG.Follow-up using outpatient examination and Wechat was performed to detect the changes of BMI and hair loss up to September 2016.Measurement data with normal distribution were represented as (x)±s and comparison between groups was done by the t test.Comparison of count data was analyzed by the chi-square test.Multivariate analysis was done using the Logistic regression model.Results (1) Follow-up and postoperative hair loss situations:all the 54 patients were followed up for 15 months.Forty-two patients had hair loss,including 21 with slight hair loss,10 with moderate hair loss and 11 with severe hair loss.A proportion of hair loss was 6/11 in male and 36/43 in female.The onset time and end time of hair loss were (3.4± 1.4) months and (9.0± 3.6) months,respectively.Of 42 patients,15 took oral medication (6 with ferrous sulfate,5 with decavitamin and 4 with zinc gluconate oral solution) against hair loss,with no obvious improvement.During the follow-up,42 patients stopped hair loss and gradually grow new hair.(2) Univariate analysis affecting severity of hair loss after LSG:gender,postoperative EWL and folic acid were factors affecting severity of hair loss after LSG (x2 =5.161,t =-5.114,4.266,P＜0.05).(3) Multivariate analysis of affecting severity of hair loss after LSG:postoperative EWL and folic acid were independent factors affecting severity of hair loss after LSG (OR=1.039,0.499,95％ confidence interval:1.011-1.068,0.300-0.802,P＜0.05).A prediction accuracy of severity of hair loss after LSG was 85.2％.Conclusion Postoperative EWL and folic acid are independent factors affecting severity of hair loss after LSG.

Objective To assess the influence of laparoscopic sleeve gastrectomy (LSG) on the nutritional status in patients with obesity.Methods From August 2014 to July 2015, 24 obese patients underwent LSG in Dongfang Hospital Affiliated to Tongji University.Weight and nutritional status of these patients were measured pre-operatively and 3, 6, and 12 months after surgery.Results The mean body weight of the 24 obesity patients was (81.94±21.39) kg, (78.83±24.49) kg, (62.67±10.79) kg 3, 6, and 12 months after surgery, respectively, which were significantly lower than the preoperative body weight [(99.02±23.92)kg] (P=0.004).The serum levels of albumin, hemoglobin, and trace elements (including calcium, iron, zinc, magnesium, and copper) showed no significant change after surgery (all P>0.05).Plasma vitamin D[25(OH)D] increased significantly from (13.1±4.1)μg/L preoperatively to (19.8±5.3)μg/L 12 months after surgery (P=0.031).Folic acid was (6.2±3.9)μg/L before LSG and significantly increased to (14.2±9.2) μg/L 3 months later surgery (P=0.009);the folic acid level gradually decreased 6 and 12 months after LSG but was still higher than the preoperative level.Conclusion Vitamin D deficiency is present in obese patients before LSG.After surgery, while the serum albumin and trace elements have no obvious change, the vitamin D and folic acid levels remarkably increase.

An analytical method based on high performance liquid chromatography tandem mass spectrometry has been developed for the determination of 11 appetite suppressants (fenfluramine,phenylpropanolamine,sibutramine,sertraline,rimonabant,bupropion,citalopram,fluoxetine,benfluorex,topiramate,zoni-samide). Various weight-loss functional foods were extracted under accelerated solvent extraction and separated on Waters Atlantis T3( 150 mm×2.1 mm,3μm) column. The analysis was carried out on HPLC-MS/MS by electrospray ionization using multiple reaction monitoring. Identification was achieved by ihe retention time and the ion ratio,quantification was done by the external standard curves. The limits of detection for the appetite suppressants were 0.05-4.0 mg/kg. The mean recoveries at the three spiked levels(low,middle,high) were 78.3% - 103. 6% ,with the intra-day precision less than 12% and the inter-day precision less than 15%. The method is reliable,sensitive,reproducible,and adapts to the determination of the appetite suppressants in different weight-loss functional foods.