With the standardization and promotion of laparoscopic technology,totally laparoscopic radical gastrectomy(TLRG) has been applied widely.The main difficult points of TLRG focus on digestive tract reconstruction.The common methods of digestive tract reconstruction in TLRG include circular stapler,linear stapler and manual suture.Compared with the circular stapler method and manual suture method,the linear stapler has the advantages of simple operation,better field of vision and larger caliber of anastomotic stoma.This article introduces and evaluates the common anastomotic methods of digestive tract reconstruction with linear stapler in TLRG.

Objective To observe the effect of gastric bypass (GBS) on intestinal flora and some serum indexes in spontaneous type 2 diabetic rats (GK rats),and to explore the mechanism of improving insulin resistance.Methods 30 Goto-Kakizaki rats,aged 8 weeks,were randomly divided into GBS operation group,sham operation group and diet matching group (n=10).Another 10 8-week-old male SD rats served as blank control group (free eating and drinking).The levels of fasting blood glucose(FPG) and fasting insulin(FINS) were measured and compared before and 4 weeks after operation.The insulin resistance index(HOMA-IR) was calculated before and 4 weeks after operation.Fresh feces of rats were collected 4 weeks after operation and DNA was extracted.The intestinal flora composition of each group was detected by real-time polymerase chain reaction (RT-PCR) at 4 weeks after operation.Results Four weeks after operation,FPG level in GBS group decreased from (13.83±0.35) mmol/L to (5.73±0.21) mmol/L(P＜0.05),HOMA-IR in GBS group decreased from(5.71±0.27) to (2.15±0.17) (P＜0.05).The DNA content of Firmicutes(22.71±12.81)(P=0.020),Enterobacterium spp.(3.11±4.17) (P=0.043) decreased significantly,and the DNA content of Bacteroides (30.74± 17.33) (P=0.013)increased significantly.Conclusion GBS can down-regulate the intestinal thick-walled bacterium,Enterobacteriaceae and upregulate the content of mimetic bacterium in type 2 diabetic rats,improve insulin resistance and insulin sensitivity.

Objective To investigate the risk factors for multiple organ dysfunction syndrome (MODS) in patients with type 2 diabetes mellitus (T2DM) complicated with infection.Methods The clinical data of 115 patients with T2DM complicated with infection in our hospital from Jan.2016 to Jan.2018 were retrospectively reviewed,including 60 patients with MODS(study group) and 55 patients without MODS(the control group).The related risk factors were analyzed by single factor and multi-factor logistic regression analysis.Results Single factor analysis showed that HbAlc[(5.47±0.86) vs (8.67±1.34)],hs-CRP[(8.31±2.18) vs (19.03±2.13)],PCT [(4.59±1.46) vs (13.42±2.67)],lac[(3.69±0.99) vs (6.58±1.18)],APACHE Ⅱ [(14.94±1.83) vs (24.98±3.19)],MBG[(9.81±0.62) vs (8.72±0.44)],SDBG[(3.43±0.20) vs (2.65±0.22)],MACE [(4.31±0.36) vs (2.93±0.19)],LAGE[(10.55±0.89) vs (6.49±0.19)],and MODD [(3.28±0.34) vs (2.05±0.25)] had statistical difference between the control group and the study group (P＜0.05).There was no significantly difference of blood glucose between the study group and the control group.Multi-factor logistic regression analysis showed that HbAlc,CRP,PCT,lac,APACHE Ⅱ],SDBG,LAGE,course of the disease were the main risk factors for MODS in patients with T2DM complicated with infection (P＜0.05).Conclusion HbAlc,CRP,PCT,lac,APACHE Ⅱ,SDBG,LAGE,and course of the disease were the main risk factors for MODS in patients with T2DM complicated with infection.

Objective To observe the improvement of weight rebound in obese type 2 diabetes mellitus patients who underwent metabolic surgery after low-carbohydrate diet intervention.Methods 38 patients with obese type 2 diabetes mellitus who had underwent metabolic surgery in Changhai Hospital from Jan.2010 to Nov.2015,were randomly divided into two groups and intervened by low carbohydrate (LC) diet or diabetes mellitus (DM) diet.The blood glucose and body weight of the two groups were compared and analyzed.Results There was no statistical difference in fasting blood glucose,HbA1c,fasting C-peptide,body weight,waistline and BMI value(t=0.34,S=1.00-32.5,P＞0.05)in diabetes mellitus diet intervention group;while there was significant statistical difference in fasting blood glucose,body weight,waistline and BMI (t=2.38,S=17-24.5,P＜0.05)in low-carbo hydrate diet intervention group.There was significant differences in body weight difference (Z=2.31,P＜0.05),BMI difference(Z=2.36,P＜0.05),and weight rebound rate(P＜0.05) between the two groups,with the low carbohydrate diet intervention group displaying advantages.Conclusions Low carbohydrate diet intervention can improve fasting blood glucose,obesity indexes in obese type 2 diabetes mellitus patients who underwent metabolic surgery.Compared with diabetes mellitus diet intervention,low carbohydrate diet intervention can more greatly improve weight,weight rebound rate,rebound scale and have more advantages for maintaining the operation effects.

Objective To investigate the clinical features,diagnosis and treatment of infantile diabetes.Methods The clinical data of 27 infants with type 1 diabetes (T1DM) admitted to our hospital from Apr.2014 to Jun.2016 were retrospectively analyzed.SPSS16.0 statistical software was used to carry out t test and chisquare test on relevant data.Results The onset age of diabetes in infants and young children was 1 year to 3 years and 7 months.There were 15 males and 12 females.The onset season was mainly in winter and spring.The fasting blood glucose in cesarean section was significantly higher than that in natural production group (P＜0.05).12 cases(44.44％) were complicated with respiratory infections before the onset of the disease,including 6 cases of pathogenic detection of viruses,mainly Coxsackie virus.Among them,14 cases were admitted to hospital with polydipsia and polyuria,6 cases had fever,cough and mental retardation,7 cases had elevated blood glucose,16 cases (62.50％) and 6 cases of women with diabetic ketoacidosis (37.50％).The incidence of diabetic ketoacidosis in male diabetic patients was higher than that in females (62.50％ vs 37.50％,x2=6.49,P＜0.05).With abnormal liver function and dyslipidemia in 2 cases;myocardial enzyme abnormality in 7 cases;abnormal thyroid function in 10 cases;26 cases of electrolyte abnormality,mainly hyponatremia;2 cases of positive anti-insulin antibody and 5 cases of positive glutamic acid decarboxylase antibody.Before admission,13 (35.14％) cases were misdiagnosed,6 cases were misdiagnosed as bronchopneumonia,3 cases were misdiagnosed as central nervous system infection,3 cases were sepsis and 1 case was myocarditis.All patients were treated with insulin.After 7 to 10 days of treatment,the patient's condition improved and continued to be treated at home.Conclusions The clinical manifestations of infantile T1DM onset are not typical,and it is easy to be associated with ketoacidosis.Infection may be one of the important causes of diabetic ketoacidosis.When the child has an infection and the blood sugar level is high,attention should be paid to the occurrence of diabetic ketoacidosis,to avoid misdiagnosis.

Objective To investigate the expression of peroxisome proliferator-activated receptor γ (PPARγ) and uncoupling protein-1 (UCP-1) after sleeve gastrectomy in Zucker rats and to discuss the weight loss mechanisms.Metbods 30 male Zucker rats aged 10 weeks were randomly divided into 3 groups:the operation group (10 rats),the sham operation group(10 rats) and the diet-pairing group (10 rats).The rats were decapitated to retrieve the retroperitoneal adipose.mRNA and protein expressions of PPARγ and UCP-1 were detected by RT-PCR and Western blot.Results As for the operation group,the weight decreased significantly after the operation compared to the other two groups((250±5.8) g,(370±10.0) g,(310±9.6) g,respectively,P＜0.05).The expressions of PPARγ and UCP-1 gene of mRNA and protein were all significantly higher in the operation group (P＜0.05).Conclusions SG can up-regulate the expressions of thermogenic gene PPARγand UCP-1 in adipose in Zucker rats,browning the white adipose tissue,which was one of the important mechanisms of weight loss.

Objective To explore the pathological changes of lung,pancreas and kidney in abdominal compartment syndrome by making an animal model of abdominal hypertension.Methods 20 New Zealand rabbits were divided into 3 groups,4 in the control group,8 in the experiment group 1,and 8 in group 2.The control group were not injected with pressure water capsule,the pressure was 0 mmHg(0 Kpa),and the time limit was 48 hours.The pressure and increased volume of abdominal pressure was recorded each time of injection of 50 ml saline in group 1 and group 2.The abdominal pressure-volume curve was plotted.Then the pressure of the experimental group was adjusted to 22 mmHg(2.96 Kpa),and the time limit of experimental group 1 was 24 hours,the group 2 was 48 hours.The experimental animals were killed at the time of observation,the whole lung,pancreas and kidney were completed and fixed with 10％ Formaldehyde solution for 24 hours,and the routine paraffin was embedded,sliced,stained with HE,and observed under the biological optical microscope.Results During the experiment,4 of the control group survived,1 died in the experimental group 1,and 2 died in group 2.There was a positive correlation between abdominal pressure and increasing volume of abdominal cavity in the experimental group of abdominal high pressure liquid animal model.The function equation:Y=0.1486X-119.0000 (R2=0.827 4,P=0.004 5).Pathological changes of lungs in three groups of experimental animals:control group:terminal bronchioles and a large number of alveoli in normal lungs,interstitial small vessel dilatation.The group 1:alveolar epithelial hyperplasia,alveolar septum size,alveolar lumen fusion,alveolar interstitial bleeding,dark brown matter deposition,intravascular thrombus,and computerized recanalization.In the group 2,the alveoli were dilated obviously,some alveolar cavities were fused,the alveolar septum was not one,and a large number of red cells and cellulosic exudates were found in the terminal fine bronchioles,including dark brown matter deposition.Pathological changes of pancreas in the three groups:control group:acinus:acinar cell consists of a layer of vertebral acinar cells,the nucleus was round,close to the base of the cell,and the nucleolus was obvious;the basal cytoplasm was basophilic because of the rich in rough endoplasmic reticulum and ribosome.The group 1:pancreatic acinar degeneration,large number of inflammatory cells infiltrating in the pancreatic tissue,lymphatic sinus dilation,lymph nodes filled with lymph,lymphatic edema,paranantral lymph nodes,lymphatic sinus dilatation,sinus endothelial cell proliferation and lymphoid hyperplasia.In the group 2,the pancreatic acini were markedly degenerated,blood vessels were dilated and congested in the interstitium,and the lymphatic vessels in the pancreatic tissue expanded and contained large amounts of lymph.Pathological changes of kidney in three groups of experimental animals:control group:glomeruli and blood vessels were basically normal,and renal tubules were slightly dilated.The group 1:mild segmental hyperplasia of glomerular mesangial cells,mild enlargement of mesangial matrix,dilatation of renal tubules,internal protein tube type,granulosa like degeneration of renal tubular epithelial cells and dilatation and congestion of endoplasmic blood vessels.Experimental group 2:glomerular segmental hyperplasia,renal tubular epithelial cell edema,renal tubule dilatation,canalicular type in the lumen,small vessels of the renal interstitium dilated and hyperemia.Conclusion Lung,pancreas and kidney have obvious secondary damage at the development of abdominal compartment syndrome and aggravates with the extension of time.

Objective To investigate the relationship between the expression of ASPP2 mRNA and the methylation of ASPP2 gene in gastric cancer cells,to observe the inhibitory effect of 5-Aza-CdR on the growth of gastric cancer cells,to observe the effect of demethylation on the expression of ASPP2 mRNA and the methylation of ASPP2 gene in gastric cancer cells,and to explore the molecular mechanism of gastric cancer.Methods Real-time PCR was used to detect the expression of ASPP2 mRNA in two gastric cancer cells and normal gastric epithelial cells.BSP was used to detect the methylation of ASPP2 gene in two gastric cancer cells and normal gastric epithelial cells.CCK-8 was used to detect the growth inhibition rate of gastric cancer cells treated with 5-Aza-CdR of different concentrations,then they were used to detect expression of ASPP2 mRNA and the methylation of ASPP2 gene in gastric cancer cells again after the demethylation.Results ① The expression of ASPP2 mRNA in MKN-45 cells was significantly lower than that in GES-1 cells(P＜0.01).The expression of ASPP2 mRNA in MGC-803 cells was significantly lower than that in GES-1 cells (P＜0.01).There was no significant difference in MGC-803 cells and MKN-45 cells(P＞0.05).② The methylation rate of ASPP2 in MKN-45 cells was significantly higher than that in GES-1 cells (P＜0.01).The methylation rate of ASPP2 in MGC-803 cells was not significantly different from that in GES-1 cells (P＞0.05).The methylation rate of ASPP2 in MKN-45 cells was significantly higher than that in MGC-803 cells (P＜0.01).③ At the same time,the growth inhibition rate of each 5-Aza-CdR concentration group increased as the drug concentration depended.4.The expression of ASPP2 mRNA in MKN-45 cells was significantly higher than that before treatment (P＜0.01),the expression of ASPP2 mRNA in MGC-803 cells was not significantly different from that before treatment(P＞0.05).The methylation rate of ASPP2 in MKN-45 cells was significantly lower than that before treatment (P＜0.01).The methylation rate of ASPP2 in MGC-803 cells was not significantly different from that before treatment (P＞0.05).Conclusion ① Abnormal hypermethylation of ASPP2 gene in MKN-45 cells may be a molecular mechanism of decreased ASPP2 mRNA expression.② 5-Aza-CdR can inhibit the growth of MKN-45 and MGC-803 cells,and it can enhance the expression of ASPP2 mRNA in MKN-45 cells.Reversal of methylation in the promoter region of ASPP2 gene is the possible mechanism.③ Abnormal hypermethylation of the promoter region of ASPP2 gene may lead to silencing of mRNA expression that may be associated with gastric cancer.

Objective To study the role of CFZ in the amelioration of hepatic function in cancer cachexia and its associated mechanism.Methods Forty BALB/c mice were selected.BALB/c mice were divided into 4 groups randomly,including a healthy control group (HC),a CFZ prevention group (CP),a CFZ treatment group (CT) and a cancer cachexia group (CC).Cancer cachexia model was induced by injecting murine colon 26 adencarcinoma cells into male BALB/c mice intraperitoneally.Following administration of CFZ intraperitoneally twice a week to CP and CT groups on the days 5 and 12 after tumor cells injection,respectively,all mice were acrificed on day 19.hepatic function was detected by automatic biochemistry analyzer,The concentration of inflammatory cytokines and CRP were detected by ELISA.The mRNA and protein expression of IκBα and p65 were detected by real-time PCR and western blotting.Results Compared with HC group,CP group and CT group,the albumin in CC group was significantly decreased,and the concentration of glutamate transaminase,total bilirubin,direct bilirubin and triglyceride were significantly increased,(221.67±12.38)U/L、(315.53±13.60)U/L、(1.65±0.32)mmol/L、(0.88±0.21) mmol/L、(4.98±0.32)mmol/L respectively.Liver biochemical test of CP group [(108.27±16.55)U/L、(180.45±15.28)U/L、(1.15±0.27) mmol/L、(0.58±0.12) mmol/L、(2.93±0.18) mml/L) and CT group [(148.56± 18.16)U/L、(247.18±21.64)U/L、(1.34±0.19) mmol/L、(0.69±0.16) mml/L、(3.75±0.28) mmol/L] was improved after CFZ treatment,and CP group was better than that of CT group.The concentrations of TNFa,IL-1,IL-6 and CRP in CC group [(156±9.56)ng/L、(762±9.46)ng/L、(962±9.12) ng/L、(772±10.04 ng/L)] were significantly higher than those in HC group[(16.42±5.63ng/L、174±9.61 ng/L、206±8.27 ng/L、397±10.2 ng/L)],CP group[(71.25± 4.41 ng/L、398±9.72 ng/L、398±9.72 ng/L、483±9.71 ng/L)] and CT group [(113±8.01 ng/L、506±8.74 ng/L、703± 7.76ng/L、651±11.31 ng/L)].The expression of IκBα in HC group,CP group and CT group were higher than that in CC group,and the difference was statistically significant.The expression of IκBαwas was more obvious in CP group than that in CT group.Compared with HC group,the expression of p65 in CP group,CT group and CC group was significantly increased,respectively,and the difference was statistically significant.The expression of p65 in CP group was lower than that in CT group(P=0.000).Conclusion CFZ ameliorates hepatic function in cancer cachexia mice,which may be related to the inhibition of NF-κB resulting in liver function improvement,the inhibition of tumor growth and the consumption of skeletal muscle.

Objective To investigate the efficacy and safety of indocyanine green fluorescence imaging in the lymph node dissection of radical thyroidectomy.Methods Radical thyroidectomy was performed using indocyanine green fluorescence imaging technology for two patients at the Department of General Surgery of Chinese People's Liberation Army (PLA) General Hospital in July 2018.Indocyanine green was injected into the thyroid glands after bilateral thyroid glands were exposed during operation.Bilateral total thyroidectomy plus central lymph node dissection was performed in case 1,and bilateral total thyroidectomy plus central area and left lateral area(area Ⅱ a,Ⅲ,Ⅳ) lymph node dissection was performed in case 2.Both operations were performed under the guidance of real-time fluorescence imaging system.The total number of lymph nodes detected,the number of small lymph nodes (diameter less than 3 mm),the level of parathyroid hormone(PTH),the incidence of complications such as hypocalcemia,hoarseness and short-term recurrence were observed.Results After excitation by the near-infrared light of the fluorescence detector probe,the display showed that the parathyroid gland and surrounding tissues were not visualized,and the thyroid glands and lymph nodes were brightly illuminated.The number of lymph nodes dissected in the central region of the two patients was 20 (13 with diameter less than 3 mm) and 10(6 with diameter less than 3 mm),respectively.For case 2,13 lymph nodes were dissected in the left lateral area (area Ⅱ a,Ⅲ,Ⅳ),and 8 lymph nodes with diameter less than 3 mm were dissected.There were no complications such as hypocalcemia and hoarseness after operation.The levels of parathyroid hormone and serum calcium were normal on the first day and 3 months after operation.There was no recurrence or metastasis of the tumors by ultrasonography 3 months after operation.Conclusion Indocyanine green fluorescence real-time imaging technology can help to identify lymph nodes specifically during radical thyroidectomy,and can achieve real-time dynamic imaging,which can make lymph node dissection more thorough and can be used as a new method for lymph node tracing in thyroid cancer surgery.