ObjectiveTo evaluate treatment of type 2 diabetes mellitus (T2DM) by laparoscopic Roux-en-Y gastric bypass (LRYGB) using different amastomoses. MethodsTwenty one T2DM patients were divided into two groups:transoral EEA (OrVil) and Endo-GIA according to ways of gastrointestinal anatomosis andunderwentLRYGB. Clinicaldataincluding outcomeof operation, complications,preoperative and postoperative oral glucose tolerance test (OGTT),Homa-IR,Homa-β,blood lipid and nutrition status were analyzed.ResultsLRYGB procedures were successfully performed in all the 21 patients with no conversion to open surgery.The difference of intraoperative blood loss,postoperative recovery time between two groups was not significant.The mean operation time in OrVil group ( 126 ± 29 )mins was shorter than that in Endo-GIA group ( 156 ± 28 ) mins ( P ＜ 0.05 ),but at the same time,the mean expenditure was higher. Evaluated on three months after operation,the T2DM cure rate was 78％,and effective rate was 100％ in OrVil goup and those were 83％,100％ respectively in Endo-GIA group.No postoperative malnutrition, anemia or severe complication occurred.ConclusionsThe efficiency of laparoscopic Roux-en-Y gastric bypass using different amastomoses was same in the treatment of type 2 diabetes mellitus.The operation time was shorter in OrVil group but the expenditure was higher.

Objective To investigate the technical difficulties and the avoidance of complications in delayed laparoscopic cholecystectomy (LC) for acute cholecystitis (AC).MethodsThe results of LC carried out on 133 consecutive patients with AC between February 2004 and August 2008 were retrospectively studied.The outcomes were compared between patients who received LC for AC within 72 hours (the early group) and those after 72 hours (the delayed group).There were 34 patients in the early group and 99 in the delayed group.During LC,Calot's triangle was carefully dissected,and the relationship of the cystic duct to the CBD and common hepatic duct was clearly identified.Retrograde cholecystectomy in 2 patients was used when the Calot's triangle was poorly identified.Laparoscopic subtotal cholecystectomy was carried out in 4 patients whose inflammation or fibrosis precluded dissection of the Calot's triangle.ResultsThere was no conversion to open cholecystectomy,biliary tract injury,biliary leak,or any other intraoperative or postoperative complications.There was no 30day readmission in the 2 groups.Patients who received delayed LC had a significantly longer operation time [(44.1±5.32) vs (66.4±3.05)rnin,P＜0.01].There was no significant difference in wound infection rates in the 2 groups (1/34 2.94 ％ vs 2/99 2.02 ％,P＞0.05).ConclusionsDelayed LC was as feasible and safe as early LC in the treatment of AC.Delayed LC was technically more demanding than early LC.

Objective To explore the application of different approaches in single lateral endoscopic thyroidectomy.Methods Ninety one patients with single lateral thyroid nodule who underwent endoscopic thyroidectomy were divided randomly into bilateral axillo-breast approach group (n =45) and transaxillary approach group (n =46).The clinical data and cosmetic outcomes were compared.Results Procedures were successfully performed in 86 patients with no conversion to open surgery,5 patients in transaxillary group were excluded because of the malignant frozen pathology.The total operation time of transaxillary approach group was (61.6 ± 4.9) min,significantly shorter than that of the bilateral axillo-breast approach approach (90.0 ± 6.5) min,P ＜ 0.05.There was no significant difference in time of subcutaneous tunnel construction,muscles disposal,lateral dissection,lower pole resection,parathyroid identification,thyroid lobe resection and bleeding volume between two groups (P ＞ 0.05),while the time of work space creation,upper pole resection in transaxillary approach was significantly shorter than that in the bilateral axillo-breast approach (P ＜ 0.05).All patients of both groups were satisfied with cosmetic results.Conclusions The operation time in transaxillary approach group was shorter than that in bilateral axillo-breast approach group for the single lateral thyroid nodule,but the operation was more difficuh.

OBJECTIVETo investigate the feasibility and efficacy of transanal specimen extraction in laparoscopic colorectal resection.

METHODSFrom January 2009 to December 2010, transanal specimen extraction technique was performed in 12 patients undergoing laparoscopic colorectal resection. The clinical data were retrospectively analyzed.

RESULTSThere were 8 males and 4 females. The age ranged from 41 to 67 (mean, 58) years old. The mean operative time was (240±45) min, mean blood loss was (70±40) ml. There was no anastomotic leakage or stenosis. One patient with constipation suffered from intractable right lower abdominal pain and was managed with antispasmodic agents. The frequency of bowel movements was 3-7/d in the 5 patients with constipation and 1-2/d in patients with colorectal carcinoma at six months postoperatively. No local recurrence and metastasis in patients with colorectal cancer after follow-up of 1-20 months.

CONCLUSIONTransanal specimen extraction in laparoscopic colorectal resection is feasible, safe, and reliable.

Adult ; Aged ; Anal Canal ; surgery ; Colectomy ; methods ; Colorectal Neoplasms ; surgery ; Female ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Diabetic kidney disease (DKD) is a serious long-term complication and major death cause of patients who have suffered from diabetes mellitus (DM),which is a serious threat to the health of human being.Professor Zhao Zongjiang first came up with the of DKD "consumptive kidney disease" scientific theory,and led the scientific research team for DKD research.Our team had achieved some results,which were mainly focused on the animal experiments and cell culture experiment.And the research fields covered pharmacodynamics,oxidative stress levels and signal transduction pathways.Focusing on the reduction of extracellular matrix in the glomerular mesangial area and tubulointerstitial deposition,inhibition of podocyte injury,inhibition of podocyte apoptosis,inhibition and reversal of podocyte transdifferentiation,inhibition of renal tubular epithelial cell transdifferentiation and other scientific issues,this paper systematically explored the biological mechanism of DKD "consumptive kidney disease" scientific theory.This paper explained how "consumptive kidney disease" scientific theory was proposed and summarized related research results of our research team and developed traditional Chinese medicine (TCM) theory by supplying the TCM "consumptive organ disease" theory.

This study was aimed to explore the renoprotective effects of Tang-Shen-Ping (TSP) on RhoA/ROCK signaling pathway in KKAy mice with diabetic kidney disease (DKD).A total of 60 female 10-week SPF degree KKAy mice,which were fed with KK special food for 10 weeks,were made into DKD model.Mice were randomly divided in the model group,irbesartan group,low-,medium-and high-dose TSP group (0.525 g· kg-1,1.05 g· kg-1,and 2.1 g· kg-1).Ten female C57BL/6J mice were used as the normal control group.Mice of each group were intragastrically administered with corresponding medicine,respectively,while mice of the control group and the model group were given deionized water of the equal volume.The body weight was measured and the 24-hour urine protein quantification was detected every 4 weeks.At the end of the 26th week,all mice were sacrificed and the biochemical indicators,such as fasting blood glucose (FBG),serum blood urea nitrogen (BUN),serum creatinine (Scr),and triglyceride (TG) were measured.HE staining,Mallory staining and PAS staining were used to observe the pathological morphology of kidney tissues.Immunohistochemistry (IHC) and in situ hybridization (ISH) were used in the detection of transforming growth factor-β1 (TGF-β1),Ras homolog gene family member A (RhoA),Rho-associated coiled-coil-containing protein kinase 1 (ROCK1),α-smooth muscle actin (α-SMA),E-Cadherin (E-Cad) mRNA and protein expression.The results showed that compared with the model group,there were significant differences on body weight,the ratio of kidney weight to body weight,and urinary protein in the middle-and high-dose TSP group (P ＜ 0.01);the renal pathological damage was obviously decreased;contents of FBG,BUN,Scr and TG decreased (P ＜ 0.01);mRNA and protein expression of E-Cadherin increased;mRNA and protein expression of TGF-β1,RhoA,ROCK1 and α-SMA decreased with significant difference in the middle-and high-dosc TSP group (P ＜ 0.01).It was concluded that the renoprotective effects and epithelial-mesenchymal transdifferentiation (EMT) of renal tubular epithelial cells of TSP on DKD KKAy mice may be related to the regulation of RhoA/ROCK signaling pathway.

OBJECTIVETo explore the treatment outcomes of obese type 2 diabetes mellitus (T2DM) after laparoscopic gastric bypass.

METHODSThe clinical data of 18 patients with obese T2DM who underwent laparoscopic Roux-en-Y gastric bypass in Beijing Shijitan Hospital between March 2009 and February 2011 were retrospectively analyzed. The clinical parameters included preoperative and postoperative blood glucose, blood lipid, nutrition status and weight lose.

RESULTSEighteen patients included 8 men and 10 women. The range of age was 27-62 years (mean, 42.4±10.7 years). The range of BMI was 28.7-57.4 kg/m(2)(mean, 34.9±6.9 kg/m(2)). All the patients underwent laparoscopic Roux-en-Y gastric bypass, and no mortality, complication or conversion to open operation occurred. At 3 months after operation, there were significant changes in OGTT, BMI, HbA1c, Homa-IR and Homa-β(all P<0.05). Fourteen patients(77.8%) showed clinical complete remission, and the overall effective rate was 100%(18/18). The level of blood lipid decreased significantly (P<0.05), and the change of nutritional status was not statistically significant(P>0.05).

CONCLUSIONGastric bypass is an effective treatment for obese type 2 diabetes mellitus.

Adult ; Diabetes Mellitus, Type 2 ; complications ; surgery ; Female ; Gastric Bypass ; methods ; Humans ; Laparoscopy ; Male ; Middle Aged ; Obesity ; complications ; surgery ; Retrospective Studies ; Treatment Outcome

Objective:To evaluate the application of Moorehead-Ardelt Ⅱ questionnaire (MA Ⅱ) in assessment of the quality of life (QOL) among obese patients after bariatric surgery.Methods:One hundred and five patients with obesity were enrolled, the weight, body mass index (BMI), comorbidities and MA Ⅱ scores before and after operation were counted. The difference between the QOL of pre- and post-operation was analyzed.Results:All the patients completed the questionnaire. The Cronbach α coefficient of the questionnaire was higher than 0.7. The post-operational scores of 6 items were significantly higher than that of pre-operation. ( P<0.001). The proportion of "poor" and "very poor" QOL in the pre-operational patients was 43.8%, compared with 0 in the post-operative patients;the proportion of "good" and "very good" QOL in the pre-operatve patients was 4.7%, compared to 86.7% in the post-operative patients ( χ2=146.863, P<0.001). Conclusions:MA Ⅱ questionnaire is a professional, easy oprated tool for assessment of QOL associated with obesity.

Objective:To investigate the predictive value of preoperative peripheral blood lymphocyte to monocyte ratio (LMR) for lymph node metastasis in gastric cancer.Methods:Data of 177 gastric cancer patients who underwent surgical treatment in Beijing Shijitan Hospital from Jan 2014 to May 2017 were retrospectively analyzed. According to the ROC curve, the optimal critical value is determined to be 3.79. By this value, patients were divided into high LMR group (LMR≥3.79) and low LMR group (LMR<3.79). Patients′ clinicopathological characteristics were collected to analyze the relationship between LMR and lymph node metastasis and lymph node N staging.Results:A comparison of LMR and N1 and N2 stage between the two groups showed no significant difference, but both N1 and N2 had statistical defference with N3 ( P<0.05), suggesting a positive correlation between low LMR and high N stage. Logistic regression analysis proves that low LMR is significantly correlated with metastatic lymph node when the number was more than 6. Conclusion:Low LMR is positively correlated with lymph node metastasis in gastric cancer patients.

[Abstract] Objective: To prepare GNS (gold nanostars) loading photosensitizer chlorin e6 (Ce6) and to investigate its photodynamic effects on lung cancerA549 cells. Methods: GNS was firstly modified by SH-PEG-NH2 and then mixed with Ce6 and shaken overnight to prepare GNS-PEG@Ce6, which had photodynamic therapy effects. The characterization, morphology and encapsulation rate were detected. The difference between the phagocytosis of Ce6 and GNS-PEG@Ce6 by A549 cells were observed with a Leical TCS SP8 confocal laser scanning microscope. MTT assay was used to examine the inhibitory effect of GNS-PEG@Ce6 on the proliferation of A549 cells while FCM was used to detect the effect of probe GNS-PEG@Ce6 on the apoptosis ofA549 cells. Results: The particle size of the GNS-PEG@Ce6 was about 100 nm. The prepared GNS-PEG@Ce6 nanoparticles exhibited good dispersion and stability and the encapsulation rate of Ce6 was about 50%. GNS-PEG@Ce6 entered the cells by endocytosis and mainly distributed in the cytoplasm; compared with Ce6, GNS-PEG@Ce6 could enter the cells more effectively. The proliferation-suppression effect of GNS-PEG@Ce6 on A549 cells was significantly stronger than that of Ce6 (P<0.05). The results of flow cytometry showed that the probe exhibited strong apoptotic effect on A549 cells. Conclusion: GNS, as the drug carrier, could effectively increase the Ce6 uptake efficacy in A549 cells, thus further enhancing the killing effects of Ce6 on lung cancerA549 cells.