Although weight loss is beneficial for obese patients with diabetes, current medical treatment for obesity is difficult. Bariatric surgery leads to substantial and durable weight reduction.Nearly 30% of patients who undergo bariatric surgery have type 2 diabetes.For many of them, diabetes resolves following bariatric surgery (83% to 93% for bypass procedures and 55% to 84% for restrictive procedures).This review discusses the effects of various bariatric procedures on type 2 diabetes mellitus and their possible mechanisms.

Objective To observe the basic rhythm of myoelectrie activities of sphcter of Oddi (SO)and explore its biological significance.Methods Healthy adult rabbits(n=32)were randomized into 4 groups with 8 in each.The first group was for recording of myoelectric activities of SO after keeping fast for 18 hours.The second group was manipulated to observe the myoelectric activities of SO after food infusion through the stoma in stomach.The myoelectric activities of SO in the third group were monitored after the classical Nardi test was performed on these rabbits.The fourth group was used to observe the myoelectric activities of SO after the cholinergic receptors had been blocked.Using the double claw metal electrodes which were put into SO and duodenum through the plasma membrance,the myoelectric signal were recorded with RM6240 multi-channel physiologic recording and signal processing system and non-stop recording was conducted for 120-150 mins.Results 1)Spike Potentials of SO with the frequency was observed in rabbits that had been fasting.2)Myoelectronic activity of SO was observed in rabbits infused with 50 ml milk through stoma.3)After the administration of 1 mg morphine and 1 mg neostigmine i.v,the myoelectric activities of SO were noted as long-lasting persistent MASO.4)Administration of anisodamine 1 mg(i.v.)in the empty abdomen group dismissed SPSO and MASO.This state lasted for 120 min before SPSO gradually reconverted to the state of empty abdomen.Conclusion There are four patterns of myoelectric activities of SO,i.e,tensional waves under empty abdomen indicating a state in which the SO kept a basic tension level.Peristaltic waves under intake of food.Spastic waves under the stimulation of drugs and relaxant waves under the post-ganglionic block of cholinergic receptors were observed in the present study.Correspondingly,their mechanic locomotion is inferred as the basic tensional state to faciliate the deposition and condensation of bile,the peristalsis for the entry of bile into duodenum,the spasmus so that the bile can not be released into duodenum under pathological situation or the effect of drugs.the long lasting relaxant state after effective inhibition of post-ganglionic cholinergic receptors,respectively.The above results indicate that there are more than two states that is ON or OFF in SO and the concepts of contract and peristalsis of SO should be distinguished.

@@

Objective: To investigate the expression of LL37 in oral lichen planus (OLP) lesions. Methods: 25 OLP and 7 health controls were included in this study. IHC and RT-PCR methods were used to detect the LL37 expression on protein level and mRNA level. T-test was used for data analysis. Results: Positive staining of LL37 was found in all the samples in cytoplasm of epithelium cells using IHC method, and mostly in prickle and basal layers. But the reaction intensity in health control was weak, compared to the strong signal in OLP group(P<0.05). The expressions of LL37 mRNA in OLP were significantly higher than those in health controls(P<0.05). Conclusion: The expression of LL37 on normal oral mucosa suggests that it may play a role in maintaining the health of oral mucosa as a part of innate immunity. The up-regulation of LL37 under inflammation status might participate in the immunopathological development of OLP.

Objective To explore the roles of B lymphocyte and plasma cell in liver allograft re-jection to find the evidences of humoral factor participating in the rejection. Methods Immunohisto-chemical inspection of C4d, CD20+ B lymphocytes and CD138+ plasma cells were performed in 34 liver biopsy specimens from 25 patients with hepatic injury and their preoperative specimens. Then we ob-served the variances of the above parameters in the liver biopsy specimens and the differences of them with different hepatic injuries. We further observed the relation of the presence of CD20+ B lympho-cytes and CD138+ plasma cells to C4d positivity. Meanwhile, we compared the difficulties of clinical therapy with different presences of CD20+ B lymphocytes and CD138+ plasma cells in the liver biopsy specimens. Results The positive ratios of CD20+B lymphocytes and CD138+ plasma cells were signif-icantly higher in the acute rejection group than in the non-rejection group(P<0. 05 and P<0. 01).The positive ratios of CD20+ B lymphocytes were markedly higher in the chronic rejection group than in the non-rejection group(P<0. 05). There was no difference in CD138+ plasma cells between the 2 groups. The degrees of hepatic injury could not influence the positive ratioes of CD138+ plasma, but the positive ratioes of CD20+ B lymphocytes in the heavy hepatic injury groups was higher than in the slight hepatic injury groups(P<0. 05). CD20+ B lymphocytes and CD138+ plasma cells presented fol-lowing C4d(P<0. 01 and P<0. 05). The effective power of steroid in the all-positive group was obvi-ously lower than in the all-negative group(P<0. 05). Conclusion Humoral immune may participate in some liver allograft rejection. It would be more favorable for observing and prewarning the humoral re-jection by finding CD20, CD138 and C4d by immunohistochemical staining in liver biopsy specimens with hepatic injury after liver transplantation. It would be helpful for choosing the therapeutic regi-mens of liver allograft rejection.

Objective To investigate the short-term outcome of laparoscopic adjustable gastric banding (LAGB) for morbid obesity complicated with type 2 diabetes. Methods Eight morbidly obese patients with type 2 diabetes underwent LAGB from October 2006 to August 2007. The weight parameters, fasting (FBG) and 2-hour blood glucose (2hBG), medication for diabetes were assessed 1,3, 6 and 9 months after surgery. Results All of the patients lost weight, with a mean body mass index decreased from (38.7±7.5) kg/m2 before LAGB to (30.5±4.3) kg/m2 9 months after LAGB. The FBG and 2hBG were decreased significantly at month 6 and 9 after LAGB, with normal FBG and 2hBG in 4 patients. At month 9 after LAGB, 3 of 5 patients with insulin treatment before LAGB were changed to oral hypoglycemics, 1 was continuously administered with a reduced dose of insulin, and 4 patients stopped any medication. Conclusion LAGB is an effective procedure in the treatment of morbid obesity complicated with type 2 diabetes with a favorable short-term outcome.

Objective To evaluate the effect of laparoscopic adjustable gastric banding(LAGB) in patients with obesity and obesity-related comorbidities.Methods From Oct.2006 to Dec.2007,50 morbidly obese patients including 11 cases with type 2 diabetes,3 with hypertension,15 with hyperlipidemia,28 with fatty liver,1 with obstructive sleep-apnea syndrome and 2 cases with gallstones underwent LAGB.The mean follow-up period for these patients was 11.2 months.ranging from 6 to 18 months.The weight loss,obesity-related comorbidities,outcomes and complications were evaluated.Results Mean BMI decreased significantly from preoperative(39±6)kg/m2 to postoperative(31±4)kg/m2,(28±7)kg/m2 and(27±7)kg/m2 respectively at 9,12 and 18 months(P＜0.05).The mean excess weight loss at 9,12 and 18 months postoperatively was 30%±11%、42%±13%and 45%±13% respectively.At 12 and 18 months,respectively,20%and 44%of patients had＞50%excess weight loss.The obesity-related comorbidities resolved or improved in 66%～100%of the patients at 12 and 18 months postoperatively.Complications occurred in 4 cases,among them 3 cases were cured conservatively and in 1 case reoperation was performed. Conclusions Based on short-term follow-up results,LAGB is a safe,effective and feasible technique in the treatment of patients with morbid obesity and obesity-related comorbidities.

The diagnosis and treatment characteristics of head-wind sha in She medicine were analyzed and summarized. By visiting She-nationality villages and towns in Zhejiang province and Fujian province and interviewing hundreds of doctors of She medicine, the sha diagnosis, sha differentiation, experience and theory of treatment were arranged, and a comprehensive summary on theory and application of head-wind sha in She medicine such as pathogeny, name of disease, mechanism, diagnosis, differential diagnosis and treatment was made. It is believed that the methods of diagnosis and treatment in She medicine for head-wind sha could effectively enhance curative effect, safety and patients' quality of life, and the further research should be carried out.
Acupuncture Therapy ; China ; ethnology ; Combined Modality Therapy ; Drugs, Chinese Herbal ; administration & dosage ; Headache Disorders ; diagnosis ; drug therapy ; ethnology ; therapy ; Humans

Objective To evaluate the clinical and radiological results of Phlios plate and Multiloc nail in treatment of proximal humerus fractures.Methods From February 2013 to December 2015,data of 37 cases of proximal humerus fractures who were treated by reduction and fixation using Phlios plate or Multiloc nail were retrospectively analyzed.In group one (Phlios plate),there were 10 males and 8 females,with an average age of 56.3±5.8 years,including 7 cases of Neer 2-part surgical neck fracture,6 cases of Neer 3-part fracture,4 cases of Neer 4-part fracture,and 1 case of fracture-dislocation.In group two (Multiloc nail),there were 8 males and 11 females,with an average age of 57.2±7.4 years,including 8 cases of Neer 2-part surgical neck fracture,9 cases of Neer 3-part fracture,1 case of Neer 4-part fracture,and 1 case of fracture-dislocation.Operation time,range of motion of shoulder joint,visual analogue scale (VAS) pain score,American Shoulder & Elbow Surgeon (ASES) score and ConstantMurley score were collected.Results All 37 patients were followed up for an average period of 15.5 months (range,12-36 months).The average bone healing time were 2.5±0.5 months (range,2-3 months)and 2.2±0.5 months (range,1.5-3 months) in the plate and nail group respectively.At the latest follow-up,average VAS score was 0.4±0.6 (range,0-2),the ASES score aver aged 85.4±6.8 points (range,73-96),Constant-Murley score averaged 83.4±7.3 points (range,71-94),and external rotation averaged 30.8°±10.0° (range,10°-50°) in plate group,while average VAS score was 0.2±0.4 (range,0-1),ASES score averaged 89.7± 5.6 points (range,80-98),Constant-Murley score averaged 88.5±6.8 points (range,76-98),and external rotation averaged 40.3°± 7.9° (range,20°-50°) in the intramedullary nailing group.One case had partial necrosis of humeral head in the plate group,while 1 case suffered absorption of the greater tuberosity in the nail group,with the complication rate of 5.6％ (1/18) and 5.3％ (1/19) respectively,without significant difference.The internal and external rotation degrees,ASES and Constant-Murley scores were better in nail group than those in plate group for 2-part fractures,while the forward elevation and abduction degrees were similar.Conclusion Similar results were achieved for the treatment of proximal humeral fractures by Phlios plate and Multiloc nail.The Multiloc nailing group had achieved superior outcomes in Neer-2-part proximal humeral fractures.

OBJECTIVETo investigate the serum levels of Th1/Th2 cytokines in children with non-systemic juvenile onset idiopathic arthritis (non-SOJIA).

METHODSClinical data of 41 children with non-SOJIA, including 11 cases of polyarthritis, 10 cases of oligoarthritis and 20 cases of enthesitis related JIA (ERA), admitted in Children's Hospital of Zhejiang University School of Medicine during November 2012 and May 2015 were retrospectively analyzed. Serum levels of Th1/Th2 cytokines including IL-2, IL-4, IL-6, IL-10, TNF-α and IFN-γ were measured by flow cytometry in patients with non-SOJIA, and compared with those in patients with SOJIA (SOJIA group, n=85) and healthy children (control group, n=202); their correlations with erythrocyte sedimentation rate and C reactive protein and CRP were analyzed.

RESULTSCompared with the healthy control group, serum levels of IL-2, IL-6 and IFN-γ were significantly increased in patients with non-SOJIA (2.9 vs. 2.6 pg/mL, 9.9 vs. 6.4 pg/mL, 6.3 vs. 5.1 pg/mL, allP<0.05),while levels of TNF-α and IL-10 were significantly decreased (2.7 vs. 3.9 pg/mL, 2.9 vs. 7.1 pg/mL, both P<0.01). Compared with the SOJIA group, serum levels of IL-6 and IL-10 were significantly decreased in patients with non-SOJIA (9.9 vs. 33.5 pg/mL, 2.9 vs. 4.1 pg/mL, both P<0.01), while levels of IL-4 and IL-10 were significantly increased (3.1 vs. 2.3 pg/mL, 6.3 vs. 4.4 pg/mL, both P<0.05). Serum levels of IL-6 in patients with polyarthritis or ERA were higher than that in patients with oligoarthritis (12.7 and 11.0 vs. 4.2 pg/mL, both P<0.05). A positive correlation of IL-6 or TNF-α level with C reactive protein was observed in patients with ERA.

CONCLUSIONSThe results indicate that Th1/Th2 imbalance and Th1 predominance may exist in children with non-SOJIA; and IL-6 may be involved in the pathogenesis of non-SOJIA children with polyarthritis.