Objective To investigate the efficacy of gastric bypass surgery for the treatment of nonobese type 2 diabetes mellitus. Methods From November 2008 to August 2009, 40 patients with gastric diseases and nonobese type 2 diabetes mellitus were admitted to the Changhai Hospital, and their clinical data were prospectively studied. All patients were randomly divided into 4 groups; 10 patients received Billroth I distal gastrectomy +gastroduodenal anastomosis (BⅠ group) , 10 received proximal gastrectomy + remanant gastric esophageal anastomosis ( PG group), 10 received total gastrectomy + esophagoduodenal Y-anastomosis ( RY group) and 10received subtotal gastrectomy Billroth Ⅱ gastro-jejunostomy (BⅡ group). The length of hospital stay, pre- and postoperative body mass indexes (BMIs) , waist circumferences, levels of fasting blood glucose (FBG) , glycated hemoglobin ( GHbA1) , fasting serum insulin (FSI) and fasting C-peptide (FCP) of patients in the 4 groups were compared. All data were analyzed using analysis of variance, LSD-t test, paired t test or chi-square test. Results The clinical effects of the 4 different operative procedures on the gastric diseases were similar. The levels of FBG were (8.0 ±2.9)mmol/L before operation and (5.9 ±0.7)mmol/L after operation in the RY group, with a significant difference (t = 2. 342, P < 0. 05). The preoperative level of GHbA1 in the RY group was 7.7% ± 1.1%, which was significantly higher than 6. 9% ± 0. 6% at 2 months after the operation and 6. 1 % ± 0. 4% at 6 months after the operation (t = 4. 920, 3.012, P < 0.05). The preoperative level of FCP in the RY group was (1.30 ±0.54) μg/L, which was significantly lower than (1.95 ± 0.86) μg/L at 2 months after the operation and (2.18 ± 0.63)μg/L at 6 months after the operation (t =6. 063, 4. 651, P < 0.05). The levels of FSI in the RY group at postoperative month 1, 2 and 6 were (18 ±5) , (19 ±3) , (21 ±3) mU/L, which were significantly higher than the level of FSI [(11 ±4) mU/L]before operation (t =3. 158, 4. 502, 7. 517, P <0. 05). Preoperative levels of FBG, GHbA1, FSI and FCP in the B Ⅱ group were (8. 3 ± 1. 3) mmol/L, 7. 7% ±0. 9% , (13±4)mU/L and (1.34±0.48) μg/L, which were ignificantly different from (6.7 ± 1.2)mmol/L, 6.8%± 0.8%, (18±4)mU/L and ( 1.68 ±0.46) μg/L at postoperative month 1, (6.4 ± 1.3)mmol/L, 6.3% ±0.6% ,(18±4)mU/L and (1. 96 ± 0. 67) μg/L at postoperative month 2, and (5. 6 ±0. 7) mmol/L, 6.0%±0.3%, (19 ± 4) mU/L and (2.27 ± 0. 59) |μg/L at postoperative month 6 (t = 2. 468, 2. 598, 6. 028; 3. 055, 4. 586,4.572; 3.618, 5.860, 8.577; 2.300, 3.511, 3.943, P<0.05). The levels of FBG,GHbA1 and FCP in the 4 groups at 2 months after surgery were significantly different from those at 6 months after surgery (F = 4. 699,14. 378; 7.411, 29. 192; 3. 335, 9. 334, P < 0.05). The levels of FSI in the 4 groups at different time points were significantly different (F =2. 896, 7. 012, 11. 998, P < 0.05). Conclusion The efficacy of gastric bypass surgery for the treatment of nonobese type 2 diabetes mellitus is satisfactory.

Objective To investigate the mechanism of gastric bypass surgery in the treatment of type 2 diabetes mellitus in a rat model. Methods Seventy-two 8-week-old GK rats were randomly divided into operation group, sham operation group, diet control group and control group (18 rats in each group) according to the random number table. Rats in the operation group and the sham operation group received gastric bypass surgery and transection and reanastomosis of the gastrointestinal tract, respectively. The food intake was set as 15 g/d for each rat in the diet control group, while rats in the control group were fed ad libitum. The levels of fasting blood glucose ( FBG), postprandial blood glucose (PPBG) and glucagon-like peptide-1 (GLP-1) were detected before operation and at postoperative week 2, 4 and 8. The levels of PPBG and GLP-1 were detected at postoperative week 2, 4 and 8, then 6 rats of each group were sacrificed to detect the apoptosis of islet B cells using the TUNEL method. All data were analyzed using the t test. Results In the operation group, the preoperative levels of FBG and PPBG were (16.2±0.8)mmol/L and (31.1 ± 1. L)mmol/L, respectively, which were significantly higher than (9.2± 0.6) mmol/L and (13.1 ±0.7) mmol/L at 4 weeks after the operation, and (9. 7 ± 0. 7) mmol/L and (12. 3 ± 0.7) mmol/L at 8 weeks after the operation (t = 20. 7, 49. 7; 18. 8, 39. 0, P < 0.05 ). The levels of FBG and PPBG before the operation and at 4 and 8 weeks after the operation in the operation group were significantly lower than those in the sham operation group, diet control group and control group at corresponding time points (t = 27.7, -57.8; 11.3, -59.9; -27.4, -48.2; -13.2, -52.7; -7.0, -24.9; -18.2, -56.4, P<0.05). In the operation group, the levels of fasting GLP-1 and postprandial GLP-1 were ( 10. 7 ± 1. 0) pmol/L and (42.5 ±1.2)pmol/L, respectively, which were significantly lower than (26. 1 ±0.9)pmol/L and (90.7 ± 1.7)pmol/L at4 weeks after the operation, and (25.3 ± 1.2)pmol/L and (90.4 ±2.0)pmol/L at 8 weeks after the operation (t=42.1, -92.4; -29.1, -72.7, P <0.05). The levels of fasting GLP-1 and postprandial GLP-1 before the operation and at 4 and 8 weeks after the peration in the operation group were significantly higher than those in the sham operation group, diet control group and control group at corresponding time points (t = 48.0, 61.9; 38.0, 62.2; 50.9, 65.2; 37.0, 48. 1; 27.5, 51.6; 17.5, 52.9, P<0.05). The number of the apoptotic islet β cells in the operation group was decreased with time. The apoptosis rates in the operation group, sham operation group, diet control group and control group were 5.9%±0.7% , 47.2%± 1.0% , 21. 1%± 1. 2% , 46.5%±1.4% at 4 weeks after the operation, and 6.3%±1. 1% , 47.2%±1.0% , 21.2%±1.2% and 46.0% ± 1.4% at 8 weeks after the operation. The apoptosis rates in the operation group were significantly lower than those in the sham operation group, diet control group and control group at corresponding time points (t = -82. 2, - 67. 0; - 27. 1, - 22. 4; - 55. 2, - 54. 6, P < 0.05). Conclusion After gastric bypass surgery, the level of blood glucose reduces and the level of GLP-1 increases which significantly inhibit the apoptosis of islet B cells in rats with type 2 diabetes mellitus.

Objective To investigate the impact of laparoscopic gastrointestinal surgery on serum protein expression in patients with type 2 diabetes mellitus(T2DM).Methods Twelve patients with T2DM received gastrointestinal surgery at Changhai Hospital of the Second Medical University from June 2008 to September 2010.Their serum samples were collected at different time points(before surgery,1 week and 1 month after surgery).Total proteins were seperated by two-dimensional(2D)gel electrophoresis.The differentially expressed proteins were analyzed by mass spectrometry and bioinformatics.Results Protein extracts of the serum samples were separated on 2D gels successfully.Twenty differentially expressed proteins in the serum after surgery were screened out.Eight proteins were successfully identified,in which the expression of 5 proteins(Rho GDP-dissociation inhibitor 1,Prohibitin,Alpha-1-anfitrypsin precursor,Serotransferrin precursor and Fibrinogen gamma chain precursor)was increased after operation,and the expression of 3 proteins(MAP3K12-binding inhibitory protein 1,Coronin-1A and Isovalery1-COA dehydrogenase) was decreased.Conclusions The expression of 20 proteins have been changed significantly in serum samples after laparoscopic gastrointestinal surgery in patients with T2DM,and 8 proteins were successfully identified.

Objective To evaluate the feasibility of getting retroperitoneal lymph node biopsy via technique of natural orifice transluminal endoscopic surgery(NOTES)in human being with current available devices.Methods We performed trans-gastric endoscopic biopsy of retroperitoneal lymph node with the aid of laparoscopy in a 50-year-old man,who presented with abdominal pain and enlarged retroperitoneal lymph nodes and signed a written informed consent before the procedure.After routine anesthesia and abdominal skin sterilization,a pneumoperitoneum was induced with a Veress needle placed in the umbilical area,followed by the introduction of a 5-mm trocar.Gastral cavity Was sterilized with antibiotics and povidone iodine.Under laparoscopie optical control,we made a styliform incision in the anterior wall of gastric corpus with a needle knife,and enlarged the incision by a dilatation balloon and then entered the peritoneal cavity with a sterile endoscope.We got two biopsies from the enlarged lymph node with a heat forceps assisted by laparoscopy.The specimen was taken out by retrieval basket through the stomach.The gastric incision Was closed with metal clips.Results The biopsy by means of NOTES was successfully performed without intra-or postoperative complications.The diagnosis was confirmed as lymphoma pathologically.The patient received chemotherapy and was discharged on the sixth postoperative day.There was no short or long-term complication.Conclusion Transgastric access for laparoscopy-assisted biopsy of retroperitoneal lymph node is feasible and safe in human being.

Background::High body mass index (BMI) results in decreased fecundity, and women with high BMI have reduced rates of clinical pregnancy and live birth in in vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI). Meanwhile, ovarian responses show great heterogeneity in patients with a high BMI. This study aimed to analyze the effects of a high BMI on IVF/ICSI outcomes in the Chinese female with normal ovarian response. Methods::We performed a retrospective cohort study comprising 15,124 patients from the medical record system of the Reproductive Center of Peking University Third Hospital, with 3530 (23.3%) in the overweight group and 1380 (9.1%) in the obese group, who had a normal ovarian response (5-15 oocytes retrieved) and underwent fresh embryo transfer (ET) cycles from January 2017 to December 2018, followed by linked frozen-thawed embryo transfer (FET) cycles from January 2017 to December 2020. Cumulative live birth rate (CLBR) was used as the primary outcome. Furthermore, a generalized additive model was applied to visually illustrate the curvilinear relationship between BMI and the outcomes. We used a decision tree to identify the specific population where high BMI had the greatest effect on IVF/ICSI outcomes.Results::High BMI was associated with poor IVF/ICSI outcomes, both in cumulative cycles and in separate fresh ET or FET cycles. In cumulative cycles, compared with the normal weight group, obesity was correlated with a lower positive pregnancy test rate (adjusted odds ratio [aOR]: 0.809, 95% confidence interval [CI]: 0.682-0.960), lower clinical pregnancy rate (aOR: 0.766, 95% CI: 0.646-0.907), lower live birth rate (aOR: 0.706, 95% CI: 0.595-0.838), higher cesarean section rate (aOR: 2.066, 95% CI: 1.533-2.785), and higher rate of large for gestational age (aOR: 2.273, 95% CI: 1.547-3.341). In the generalized additive model, we found that CLBR declined with increasing BMI, with 24 kg/m 2 as an inflection point. In the decision tree, BMI only made a difference in the population aged ≤34.5 years, with anti-Mullerian hormone >1.395 ng/mL, and the first time for IVF. Conclusions::High BMI was related to poor IVF/ICSI outcomes in women with a normal ovarian response, and CLBR declined with increasing BMI, partly due to suppressed endometrial receptivity. A high BMI had the most negative effect on young women with anticipated positive prognoses.

The hemodynamics of children with congenital heart disease (CHD) often changes during the perioperative period. Unfortunately, the evaluation of cardiac function in children with CHD is mainly focused on the left ventricle. With the further understanding of cardiac hemodynamics, the monitoring of RV function has gradually become an important part of cardiac intensive care department. We totally searched five databases including Pubmed, Embase, Cochrane, Wanfang Med, as well as China National Knowledge Infrastructure (CNKI) and reviewed the clinical research progress of the application of TAPSE in the evaluation of RV systolic function in children with CHD to provide a theoretical basic for the monitoring of RV function before and after operation in children with CHD.

Objective:To investigate the prognostic significance of high sensitivity-C reactive protein (Hs-CRP) in patients with peripher-al T-cell lymphoma (PTCL). Methods:A total of 234 newly diagnosed PTCL patients with a median age of 48 years were analyzed retro-spectively. Serum Hs-CRP levels and other factors, including tumor stage and international prognostic index (IPI), were determined. Af-ter a median follow-up of 23 months, the relationship between Hs-CRP and overall survival (OS) was observed. Results:Serum Hs-CRP level positively correlated with IPI score (r=0.132, P<0.001), tumor stage (r=0.183, P=0.005), B symptoms (r=0.225, P=0.001), and lactic dehydrogenase (r=0.169, P=0.009), but negatively correlated with plasma albumin levels (r=?0.343, P<0.001), hemoglobin concentra-tion (r=?0.239, P<0.001), and platelet count (r=0.131, P=0.045), and is uncorrelated with age (P>0.05), gender (P>0.05), fitness score (P>0.05), and leukocyte count (P>0.05). Patients with serum Hs-CRP levels≤10 mg/L had better OS than patients with serum Hs-CRP levels>10 mg/L. Univariate and multivariate Cox regression models showed that platelet count, Hs-CRP, albumin levels, and IPI score were independent adverse prognostic factors. Conclusion:The baseline Hs-CRP level can serve as a major indicator of prognosis in PT-CL patients.