Objective To explore the clinical efficacy of three dimensional (3D) laparoscopic sleeve gastrectomy (LSG) in the treatment of obesity combined with type 2 diabetes mellitus.Methods The retrospective cross-sectional study was conducted.The clinical data of 28 patients with obesity combined with type 2 diabetes mellitus who were admitted to the Qinghai Red Cross Hospital between January 2013 and April 2016 were collected.All the patients underwent 3D LSG.Observation indicators:(1) surgical and postoperative recovery situations;(2) follow-up and metabolic indexes changes.Follow-up using outpatient examination and telephone interview was performed to detect complications of patients after discharge and usages of antidiabetic drugs or insulin up to February 2017.Body mass,body mass index (BMI),hemoglobin (Hb),albumin (Alb),fasting serum C-peptide,fasting blood sugar,2-hours postprandial blood glucose (2HPBG) and glycosylated hemoglobin (GHb) were detected at month 1,3,6 and 12 postoperatively.Measurement data with normal distribution were represented as (x)±s.Repeated measurement data were analyzed by the repeated measures ANOVA.Count data were evaluated by the proportion.Results (1) Surgical and postoperative recovery situations:28 patients underwent successful 3D LSG,without conversion to open surgery.Operation time,volume of intraoperative blood loss,time of postoperative gastrointestinal function recovery and time of postoperative drainage tube removal were (133 ± 20) minutes,(45 ± 22) mL,(2.5 ± 1.2) days and (3.4 ± 0.9) days,respectively.There were no postoperative complications and perioperative death.Duration of hospital stay was (7.1 ± 1.5) days.(2) Follow-up and metabolic indexes changes:28 patients were followed up for 6-12 months,with a median time of 8 months.During the follow-up,there was no death or severe complications.Body mass,BMI,Hb,Alb,fasting serum C-peptide,fasting blood sugar,2HPBG and GHb from pre-operation to month 1,3,6 and 12 post-operatively were decreased from (113±26) kg to (78± 14) kg,from (44±6) kg/m2 to (35±5) kg/m2,from (157±19) g/L to (140±13) g/L,from (43±5)g/L to (40±4)g/L,from (2.50±0.37) μg/L to (1.20±0.33) μg/L,from (10.5±2.0)mmol/L to (5.6±0.5)mmol/L,from (16.3±3.1)mmol/L to (7.9±0.9) mmol/L,from 9.2％± 0.9％ to 6.8％ ±0.6％ with statistically significant differences between preoperative and postoperative indicators (F=396.47,328.20,111.10,21.28,161.06,127.80,243.40,234.64,P＜0.05),and showing a downward trend.Of 28 patients,25 had complete remission of type 2 diabetes mellitus at 12 months postoperatively and 3 had partial remission,with an effective rate of 100.0％ (28/28).The excess weight loss was 63％± 16％.Conclusion 3D LSG is safe and effective in the treatment of obesity combined with type 2 diabetes mellitus,with a good shortterm outcome.

Cardiovascular Diseases ; Cell Proliferation ; Humans ; MicroRNAs ; Muscle, Smooth, Vascular

Objective To discuss the feasibility, safety and validity of the use of ViabahnTM self-expanding covered stent in endovascular repair of peripheral traumatic pseudoaneurysm (TPA). Methods During the period from June 2012 to April 2014, a total of 8 patients with peripheral TPA were admitted to the Department of Vascular and Endovascular Surgery of Shanghai Changzheng Hospital . The clinical data were retrospective analyzed. The lesions were located at the common carotid artery (n=4), vertebral artery (n=1), subclavian artery (n=1) and superficial femoral artery (n=2). On the basis of acute and chronic TPA classification and different therapeutic principles, endovascular repair with ViabahnTM self-expanding covered stent was employed in 8 patients. Intraoperative angiographic findings, the size and number of the implanted stent, and the immediate angiographic results after stent implantation were recorded. All the patients were followed up to evaluate the improvement of the symptoms, the effectiveness of the repair of TPA cavity, and the occurrence of endoleak or restenosis. Results Successful implantation of ViabahnTM self-expanding covered stent was accomplished in all 8 patients, with a technical success rate of 100%. Angiography performed immediately after stent implantation showed that complete repair of TPA cavity was obtained in all patients, the distal segment of the parent artery was patent, and no endoleak was observed. The sizes of the stent used in the patients were 8×50 mm (n=2) and 9×50 mm (n=2) in common carotid artery, 6×50 mm (n=1) in vertebral artery, 11×100 mm (n=1) in subclavian artery, and 8×100 mm (n=2) in superficial femoral artery. The patients were followed up for 6-30 months (mean of 14.3 months), and the clinical symptoms disappeared in all patients. CT angiography indicated that there was no endoleak or restenosis. Conclusion Based on the different therapeutic principles, the use of ViabahnTM self-expanding covered stent in endovascular repair of peripheral TPA is technically simple and micro-invasive, and clinically feasible with reliable effect and safety. Therefore, this technique can be employed as a first-line therapy option for peripheral TPA.

Objective To explore the feasibility and safety of carotid artery stenting (CAS) via right transradial approach (TRA).Methods A retrospective analysis was made on 46 cases undergoing the CAS via right TRA.Patients were divided into the right carotid artery group (RCA),bovine left carotid artery group (B-LCA),nonbovine carotid artery group (NB-LCA) according to the lesion location.Low TRA or high TRA were selected to overcome the difficulties of insufficient supporting power,using techniques such as catheter looping and retrograde engagement technique(CLRET).Results CAS were successful in all cases (100％),the differences of the operation time and fluoroscopy time among RCA group,B-LCA group and NB-LCA group were not significant.In NB-LCA group,CLRET were applied in 10 cases (55.56％,10/18),includeing 8 cases with type Ⅲ aortic arch(100％,8/8)and 2 cases with type Ⅱ aortic arch (33.33％,2/6).The CLRET prolonged the operation time and fluoroscopy time [(39.45 ±7.27) min vs.(30.80±4.66) min;(11.84 ± 2.05) min vs.(9.91 ± 1.45) min,P ＜0.05).There was no cerebrovascular events and puncture point complications in perioperative period.Conclusion Right transradial approach for carotid artery stenting is safe and technically feasible,especially in RCA stenosis and LCA stenosis with type Ⅰ or Ⅱ aortic arch.