An international symposium on the standard surgical treatment of morbid obesity and type 2 diabetes mellitus was held in Florida, USA in March 2011. An expert panel from all over the world attended the meeting. The expert panelists discussed and established International Sleeve Gastroectomy Expert Panel Consensus Statement : best practice guidelines based on experience of more than 12,000 cases, which made a very commendable attempt in standardized surgical pathway of sleeve gastroectomy. Based on clinical experience over 10 years and the understanding of the consensus , this paper discusses the learning curve, preoperative preparation, indications/contraindications, surgical technique, management and prevention of complications, and post operative management.
Consensus Development Conferences as Topic ; Gastrectomy ; methods ; Humans ; Obesity, Morbid ; surgery ; Practice Guidelines as Topic

Objective To evaluate the differential diagnostic values of combined detection of adenosine de aminase (ADA),carcinoembryonic antigen (CEA),carbohydrate antigen 153 (CA153),neuron-specific enolase (NSE) and carbohydrate antigen 199 (CA199) in patients with pleural effusion.Methods Serum and hydrothorax fluid of CEA,CA153,NSE and CA199 in patients with plearal effusion were measured by electrochemiluminescence assay(ECLA),ADA from pleural effusions were measured by enzyme rate assay,and the clinical value of combined detection in the differential diagnosis of pleural effusion was evaluated.Results The levels of ADA(65.89±19.81 U/L) in hydrothorax fluid group with tuberculous pleural effusion were beth higher than those in the groups with inflammatory pleural effusion (17.33±16.58) U/L and malignant pleural effusion(27.44±22.64) U/L (q=12.19 and 10.72,P＜0.01).The positive rate of A DA was 82.88% (29/135) in hydrothorax fluid group with tuberculous pleural effusion,13.41% (11/135) in malignant pleural effusion and 11.11% (2/135) in inflammatory pleural effusion (X~2=59.07,P＜0.01).The levels and positive rate of CEA,CA153,NSE,and CA199 in serum and hydrothorax fluid group with malignant pleural effusion were both higher than those in the group with tuberculous pleural effusion (P＜0.05).Compared with the group with malignant pleural effusion,the levels of CA153 and CA199 in serum and the levels and the positive rate of NSE in serum and hydrothorax fluid were not statistically different in inflammatory pleural effusion group.In the 82 cases with malignant pleural effusion,the positive rate of the four kinds of serum tumor markers including CEA,CA153,NSE and CA199 was 74.39% (61/82) and the positive rate of those hydrothorax fluid tumor markers was 82.93% (68/82).Conclusions Combined detection of ADA,CEA,CA153,NSE and CA199 is of some significance to the differential diagnosis of pleural effusion.

Objective To retrospectively investigate the endoscopic characteristics and pathological features of colorectal polyps in over-aged patients (≥80 years). Methods The 1617 colonoscopies performed between January 2006 and December 2010 were enrolled in our retrospective analysis. The detection rate, size, location, form and pathological feature of polyps in 150 over-aged patients were investigated, and they were compared with those in 832 young patients (＜60 years) and 635 old patients (60-79 years) with colorectal polyps. Results The detection rate of polyps was 62.0% in over-aged group, and was significantly higher than in young group and old group (30.2% and 48.7%, respectively, χ2=56.58 and 8.64,both P＜0.001). The malignant transformation rate of ascending colon polyp was 5.4% in over-aged group, and was significantly higher than in young group (1.2%, χ2=4.90, P＜0.05), but there was no significant difference between over-aged group and old group (3.9%, χ2=0.36, P＞0.05). There were no statistical differences in canceration rate, polyp diameter, morphology and adenomatous polyp rate among the three groups. The malignant transformation rate was significantly increased in adenomatous polyps with diameter over 2 cm, but didn't reach statistical significance. Conclusions The polyp detection rate is noticeably higher in the over-aged than in the old and the middle-aged, and the malignant transformation probability is also increased. The colonoscopy indications in the high risk age groups should appropriately be broadened, they should receive regular intervals follow-up, and undergo polypectomy in time if necessary.

Objective To explore the effectiveness of dietary treatment in reducing macrosomia risks for pregnancies with borderline gestational glucose intolerance (BGGI).Methods From July 2009 to June 2011,a total of 1046 pregnant women with BGGI were randomized into group A (intervention,n =525) and group B (non-intervention,n =521).Another 521 pregnancies with normal glucose screening were assigned into group C (normal control).Randomization was applied following stratification according to age,body mass index (BMI),prior Cesarean section (C-section) and multiparity,etc.Women in group A underwent the examinations of fasting plasma glucose (FPG),2 h-post prandial glucose and HbA1c once every 2 weeks.Their newborn outcomes were collected for analysis.Results Women of three groups were similar in age,parity,initial BMI and initial FPG.Dietary treatment for group A improved glucose-related indices and women's pregnancy weight gain (P ＜0.0l).Also,in comparison with group B,the intervention of group A reduced risk of macrosomia (9.14％ vs.13.82％,P =0.02),prior C-section rate (43.87％ vs.56.07％,P ＜ 0.01) and postpartum hemorrhage (3.81％ vs.7.10％,P =0.02).However these indices were no better than group C.Dietary treatment did not increase the risk of fetal growth restriction,neonatal hypoglycemia and hyperbilirubinemia.Conclusion As a simple noninvasive therapeutic measure for improved glucose tolerance,BGGI may reduce the risk of risk of macrosomia and prior C-section rate.

Objective To explore the efficacy of liver retransplantation for hepatocellular carcinoma (HCC) patients with or without HCC recurrence.Method 131 cases of retransplantation performed between 2003 and 2012 were analyzed retrospectively.Their first and second liver transplantations were both performed in our hospital.Diagnoses of their primary diseases before transplantations were confirmed pathologically after the first transplantation.Patients were divided into two groups in terms of benign causes and HCC.Results Sixty cases were fallen into benign disease group and 65 cases into HCC group.The proportions of main causes of retransplantation were similar between two groups.The graft survival rate of early retransplantation (retransplantation performed within 30 days after the first transplantation) and late retransplantation (retransplantation performed beyond 30 days after the first transplantation) was calculated and compared respectively due a great difference in survival rate between the two phrases.The deaths of HCC patients with HCC recurrence before retransplantation were more than those without HCC recurrence (P＜0.01) and benign disease group.The 5-year cumulated survival rate was close between HCC patients without recurrence before retransplantation (51.0％) and benign disease group (51.8％).Conclusion The retransplantation after HCC recurrence has an unacceptable prognosis.The survival rate was similar between patients without HCC recurrence and patients with benign diseases.HCC patients without recurrence should not be restrained from retransplantation just for the HCC history.

Objective To investigate the effects of castration treatment by luteinizing hormonereleasing hormone(LHRH)analog(goserelin)on bone loss and bone resorption in men with prostate cancer.Methods Serum sex hormones,bone mineral density(BMD),serum and urine concentrations of bone turnover markers were determined in men with prostate cancer(n=36) and in age-matched controls(n=13).BMD in the lumbar spine(L2-4),femoral neck,trochanter,Ward's triangle and total femoral was determined by dual energy X-ray absorptiometry(DEXA).Results After 12 months of LHTH analog therapy,the BMD of the femoral neck,total femoral and Ward's triangle decreased significantly in men with prostate cancer compared with the controls,all P＜0.05. No significant bone loss was observed in the control subjects.The concentrations of the serum markers of bone formation,i.e.bone alkaline phosphatase(BALP),and urine markers of bone resorption,i. e.DPD,Cros,Ca/Cr were significantly increased in patients treated with LHRH analog compared with control subjects,all P＜0.05,respectively.Conclusions These findings demonstrate that a significant increase of bone turnover and loss of bone mass in men with prostate cancer after receiving LHRH analog therapy were correlated with the decreased levels of serum androgen and estrogen,and suggest that measuring BMD by DEXA and assesing the bone turnover markers can early detect the bone loss and osteoporosit induced by goserelin castration treatment.

Objective To explore the effects of Kangshuaiyizhi capsule on ChAT/AchE and NE, DA and 5-HT levels in the brain tissue of aging model rats, and explore its effect of protecting cerebral function. Methods Totally 72 rats were randomly divided into normal group and model group. The subacutely aging model rats were made by injecting D-gal (0.125 g/kg) into abdominal cavity continually, then aging rats were divided by random number table into model group, Naofukang group and Kangshuaiyizhi high-, low-dose group. After intervented with correspongding drugs for 60 days, activity of ChAT and AchE, cerebral cortex NE, DA, and 5-HT levels were detected. Results Activity of AchE was much higher (P<0.05), but level of ChAT, NE, DA and 5-HT in model group were significantly downregulated compared with normal group (P<0.05). After treated with Kangshuaiyizhi capsule, activity of AchE was downregulated, ChAT, NE, DA and 5-HT levels were significantly upregulated (P <0.01, P <0.05). Conclusion Kangshuaiyizhi capsule can regulate cholinergic and monoamine neurotransmitter levels in the brain tissue of aging model rats, and play a very important role in protecting cerebral function.

Background and purpose:It has a signiifcant effect for erlotinib on treatment of patients with epidermal growth factor receptor mutation in advanced non-small cell lung cancer (NSCLC). But almost all patients will eventually progress for the resistance of drug. This study was to evaluate the efifcacy and safety of retreatment of erlotinib in patients with advanced NSCLC. Methods:It was a retrospective analysis of the 46 advanced NSCLC patients who previously treated with erlotinib and had clinical beneift. The patients were given erlotinib 150 mg orally once daily after failure to other medications until disease progression or the occurrence of intolerable toxicity. The clinical features, therapeutic effect and survival were analyzed. Results: The objective response rate of retreatment with erlotinib was 28.3%. The disease control rate was 60.9%. The rate of symptom relief was 45.7%. The median progression-free survival was 3.6 months. The median overall survival was 7.3 months. One-year survival rate was 8.7%. The median progression-free survival was signiifcant longer in the patients who stopped taking erlotinib more than 6 months than those less than 6 months (P=0.002). The median overall survival was signiifcant longer in the patients whose ECOG ≤2 than those ECOG >2 (P=0.038). The most common drug-related adverse events were rash and diarrhea. Conclusion:The retreatment of erlotinib could possibly prolong the survival time of patients who previously treated with erlotinib and had clinical beneift.

Child, Preschool ; Coronary Aneurysm ; etiology ; pathology ; Coronary Vessels ; pathology ; Female ; Humans ; Infant ; Male ; Mucocutaneous Lymph Node Syndrome ; complications ; pathology

Objective To develop a rapid, sensitive and specific assay based on multiplex real-time PCR for detecting and identifying Escherichia coli O157: H7. Methods The lipopolysaccharide gene (rJbE) and H7 flagellar antigen gene(fliC) of Escherichia coli O157:H7 was chosen as targets, and then the primers and TaqMan-MGB probe were designed. The 5'end of probes was labeled with FAM and HEX fluo-resceins respectively; the 3'end of probes was labeled with MGB. The PCR reaction was optimized systemati-cally. Then the specificity, sensitivity and reproducibility of multiplex real-time PCR were estimated. Final-ly, multiplex real-time PCR was applied to detected clinical specimens. Results Escherichia coil O157:H7 were detected by multiplex real-time PCR accurately and quickly, which could distinguish Escherichia coli O157:H7 from O157: non-H7. Meanwhile, none of other bacteria could be identified. The sensitivity was 10 CFU/ml in pure culture. The coefficient of variation of intra-assay and inter-assay was less than 5%. When this assay was applied directly to identify 66 clinical specimens, the results showed that t5 were positive to Escherichia coil O157:H7 and 2 were positive to Escherichia coil O157: non-H7, in which 16 was the same to the results obtained from the conventional assays. The coincidence was 98.49%. Conclusion It is showed that multiplex real-time PCR is a reliable, accurate and feasible assay for detecting and identifying Escherich-ia coli Oi57: H7, The assay reported here provided a tool for analysis and diagnosis in the field of detecting clinical pathogens, epidemiologic survey and food safety monitoring.