Objective To evaluate gastric bypass on relieving type 2 diabetes mellitus. Methods From September 2009 to September 2010,Thirty two cases of type 2 diabetes mellitus patients underwent gastric bypass operation in Xijing Hospital.Preoperative FBG,2hPG,HbAlc,weight,blood pressure and fatty liver were compared with that on 1 month,6 months,12 months after operation. Result There was no significant postoperative complications.FBG on 1 month,6 months,12 months postop and preoperative level was respectively 7.8 ± 2.2,7.7 ± 2.2,7.2 ± 1.8 and 11.1 ± 2.7 ( mmol/L),P ＜ 0.05.2hPG was 10.2 ± 2.6,10.5±2.8,10.5 ±3.1 and 14.0 ±3.5 (mmoL/L),P＜0.05.HbAlc was 7.6％ ±1.4％,7.5％ ± 1.7％,7.1％ ±1.9％ and9.0％±2.3％,P＜0.05.FBG[(6.9±1.5) mmol/L],2hPG[(10.0±3.2) mmol/L] and HbAlc[ (6.9％ ± 1.9％ ) ] on 12 months after operation were lower than preoperative[ FBG ( 10.7 ± 2.9 ) mmol/L,2hPG ( 14.3 ± 4.1 ) mmol/L,HbAlc ( 8.8％ ± 2.0％ ) ] in patients with BMI ＜25 kg/m2 (P ＜ 0.05 ).In patients with preoperative BMI ≥ 25 kg/m2,FBG ( 7.5 ± 2.3 ) mmol/L,2hPG ( 11.3 ±2.9) mmol/L HbAlc (7.3％ ± 1.9％ ),12 mos pest were lower than that of preoperative levels of [FBG(11.7 ±2.3) mmol/L,2hPG(13.5 ±2.4) mmol/L,HbAlc(9.2％ ±2.7％)] (P ＜0.05).Postoperative blood pressure became normal in 5 out of 6 patients complicating preoperative high blood pressure as evaluated on 12 months after operation. Fatty liver ameliorated in 8 out of 17 patients.Conclusions Gastric bypass significantly improves glycometabolism and comorbidity in type 2 diabetes patients.

Objective To investigate the effect of immediately lymphatic reconstruction (LR) after heterotopic small bowel transplantation on pharmacokinetics (absorption and transportation) of FK506. Methods Male Brown-Norway (BN) and Lewis (LEW) rats were divided to two groups. Group A: BN→LEW+LR+FK506 ( n =12); Group B: BN→LEW+FK506 ( n =12). FK506 at a dose of 5?mg/kg per day was taken through stoma. At 1, 4, 7 and 14 postoperative day (POD), venous blood 0.5?ml was obtained on the 1.2 , 2 and 3?h after administration of FK506. Whole blood concentration of FK506 was analyzed by microparticle enzyme immunoassay and a kit of monoclone antibody. Results At the every phase of early period after transplantation (1, 4, 7 POD), the levels of FK506 in plasma were significantly higher in group A than in group B ( P

BACKGROUND:Ischemia/reperfusion (IR)injury during the pancreas transplantation can cause numerous postoperative complications, among which,secondary pancreatitis can cause small intestinal mucosal injury and result in severe Consepuence.OBJECTIVE:To observe the protective effect of ischemic preconditioning (IPC) on small intestinal mucosal barrier after pancreas transplantation in rats.DESIGN:Randomized controlled animal trial.SETTING:Department of Gastrointestinal Surgery,Xijing Hospital,Fourth Military Medical University of Chinese PLA.MATERIALS:This trial was done in the Laboratory of Gastrointestinal Surgery,Xijing Hospital,Fourth Military Medical University of Chinese PLA between September 2001 and April 2004.Eighty-three male SD rats were involved in this trial.METHODS: Forty-seven rats were randomly chosen to prepare diabetic rat models by penile-intravenous injection of 65 mg/kg streptozotocin.Thirty-six successful model rats were randomized into 3 groups,with 12 in each group:IR group,donor IPC(DIPC)group and recipient with two hindlims IPC(RIPC)group.Twelve of the remaining 36 normal rats served as control group,and the other 24 rats were used as donors.Laparotomy was conducted only in control group,and pancreas transplantation was conducted in the other 3 groups In DIPC group,the splenic vessels of donors were blocked for 5 minutes and reperfused for 5 minutes twice before obtaining pancreas from donor;In the RIPC group, blood flow of two hindlimbs of recipients was blocked for 5 minutes and reperfused for 5 minutes before reperfusing the pancreas of donor,and this procedure was repeated 3 times.IR group was untouched.MAIN OUTCOME MEASURES:① On the 5th day after operation,6 rats were randomly chosen from each group to detect small intestinal permeability[expressed with plasm fluorescent-isothiocyanate-dextran(FITC-dextran)concentration]and absorption function(expressed with plasm xylose concentration).② On the 5th day after operation.blood was taken from the left 6 rats in each group to detect serum tumor necrosis factor-α(TNF-α) and nitric oxide(NO)level as well as superoxide dismutase(SOD)and amylase activity.Ileal mucosal tissue was taken to detect wet weight of small intestinal mucosa,the height and width of microvilli,malonaldehyde(MDA)level and myeloperoxidase(MPO)activity.At the same time,mesenteric lymph node,liver and splenic tissue were taken to perform bacterial culture.Bacterial translocation was observed.RESULTS:After supplement,72 rats were involved in the result analysis.①Plasm FITC-dextran concentration of IR group were higher than that in control group,DIPC group and RIPC group,respectively(P＜0.01).②Plasm xylose concentration in the IR group was lower than that in the control group,DIPC group and RIPC group,respectively(P＜0.01).③Bacterial translocation rate in the IR group was higher than that in the control group,DIPC group and RIPC group,respectively(P＜0.01).④Small intestinal mucosal injury degree in the IR group was lower than that in the other 3 groups(P＜0.01).⑤Small intestinal MPO activity and MDA level in IR group were significantly higher than those in the other 3 groups(P＜0.01). Serum SOD activity and NO level were lower but amylase activity and TNF-α 1evel were higher in the IR group as compared with the other 3 groups(P＜0.01).CONCLUSION:IPC of two hindlimbs in both donor and recipient can protect small intestinal mucosal barrier and reduce bacterial translocation rate after pancreas transplantation in rats.

BACKGROUND: A latest research indicates that γ~δ T cells following touching with microbe products show characteristics as dendritic cells and antigen-presenting cells (APC) and induce intensive immune response of CD4~+ CD8~+ γ~δ T cells.OBJECTIVE: To verify APC-like functions of γ~δ T cells during transplantation rejection, investigate a simple and effective method to amplify γ~δ T cells in vitro, and to infect γ~δ T cells with FasL retrovirus system.DESIGN, TIME AND SETTING: An animal experiment was performed at Central Laboratory of the First Affiliated Hospital of the Fourth Military Medical University of Chinese PLA from August 2007 to August 2008. MATERIALS: A total of 60 healthy adult Wistar rats of clean grade and weighing 200-320 g were used to establish donor and receptor models with segmental heterotopic small intestine transplantation.METHODS: Models of segmental heterotopic small intestine transplantation were established using three sleevelet vascular anastomosis. γ~δ T cells were obtained using flow cytometry and its function was demonstrated. Mononuclear cells were routinely separated and amplified with Mtb-Ag. MAIN OUTCOME MEASURES: Cell proliferation was observed; percentage of γ~δ T cells for lymphocytes was detected using TCRγ~δ magnetic beads kit; γ~δ T cells following transfection were detected using pLXSN FasL retrovirus system. RESULTS: Activated γ~δ T cells showed dendritic cell-like adhesion function and APC-like functions during transplantation rejection. γ~δ T cells accounted 4.5% for mononuclear cells, the purification of γ~δ T cells was up to 72.2% on the 10~(th) day after activated by Mtb-Ag, and the purification of γ~δ T cells was up to 99.1% through positive magnetic sorting. 285 bp FasL fragment demonstrated that the gene integration was observed in PA317 cells. The ration of FasL+ cells was 97.3% after infected by pLXSN FasL retrovirus system.CONCLUSION: This study demonstrated APC-like functions of γ~δ T cells during transplantation rejection. γ~δ T cells were successfully amplified in vitro. PA317/ pLXSN2FasL+ retrovirus system was successfully constructed and γ~δ T cells were modified by FasL retrovirus system.

Objectives: To investigate the effects of immediate reconstruction of lymphatic drainage of the graft after small bowel transplantation (SBT) and early enteral nutrition (EN) support on plasma level of free fatty acids (FFAs) using a model of lymphatic reconstruction (LR) after SBT. Methods: The level of FFAs in two groups (depend on LR or non LR), including C 14 , C 16 , C 18∶1 , C 18∶2 and C 20∶4 in plasma were measured by gas chromatography before and day 1, 4, 7, 10 and 14 after the operation. Results: The plasma concentrations of FFAs in LR group were higher than in non LR group. Conclusions: Immediate reconstruction of lymphatic drainage of the intestinal graft after SBT and early EN support will not only provide sufficient energy for host, but also correct the lower concentration of FFAs in plasma effectively.

Objective:To investigate appropriate accommodation of nutrition after living-related small bowel transplantation.Methods: According to the function of allograft and general body state,TPN was used and gradually transferred to PN+EN,finally to TEN.The clinical and laboratory nutrition markers in 4 recipients were observed.Results: 2 recipients survived over 4 years,various kinds of nutrition markers were normal,and the health status was good.One recipient died of acute pulmonary infarction at 19 days.Another recipient died of multiple system organ infection at 5 months.Conclusion: EN cand promote restoration of allograft function.

Objective:To investigate the impact of alanyl-glutamine(Ala-Gln) on outcome in radiation enteritis rats.Methods: Male SD rats(n=70)were separated randomly into four groups: control group(n=10),AR+pseudosurgery group(n=20),AR+TPN group(n=20) and AR+TPN+Ala-Gln group(n=20).Rats were observed for mortality,changs of body weight,villous hight and area,the bcteriral translocation(BT)in mesenteric lymph nodes(MLNs),liver,spleen and peritoneal cavity.Serum TNF-? and sIL-2R level were determined by sandwich ELISA.Results: When Ala-Gln was administered in radiation enteritis rat,the mortality,body weight loss and bacterial translocation were decreaded,the villous hight and area was increased and the TNF-? and sIL-2R levels were reduced.Conclusion: Parenteral Ala-Gln nutrition can improves the results of radiation enteritis rats.

Objective To investigate the expression of ligands of DNAM-1 and NKG2D in the colonic cancer.Methods The colonic cancer tissue and adjacent normal colonic tissues were collected from 42 colonic cancer patients who were admitted to the Tangdu Hospital of Fourth Military Medical University from June 2010 to January 2011 were retrospectively analyzed.The expressions of CD155,CD112 and MICA/B in the colonic cancer tissues and the normal colonic tissues were detected by immunohistochemistry.The expressions of CD155,CD112 and MICA/B in the colonic cell line SWll6,SW480,SW620 and Colo205 in the Duke's A,B,C and D phases were detected by cell cytometry.The relationship of the expressions of the 3 ligands and the clinicopathological parameters was analyzed using the Mann-Whitney U test,chi-square test and Fisher exact probobility.Results Week expression of CD155 was found in the normal colonic tissues,while the expressions of CD112 and MICA/B were not found.In the colonic cancer tissues,the expressions of CD155,CD112 and MICA/B were 81.0％,52.4％ and 47.6％,which were significantly increased.The expressions of CD155,CD112 and MICA/B were not correlated with the gender,tumor differentiation,lymph node metastasis and Duke's staging (P ＞ 0.05).The overall expression rates of CD155,CD112 and MICA/B in the colonic cancer cell line SWll6,SW480,SW620 and Colo205 were 88.9％,67.4％ and 42.3％,respectively.The overall expression of CD155 was significantly higher than CD112 and MICA/B (F =23.17,P ＜ 0.05).Conclusion CD155,CD112 and MICA/B express in the colonic cancer tissues and colonic cancer cell line SW116,SW480,SW620 and Colo205,and the expression of CD155 is the highest.

BACKGROUND: During pancreas transplantation, ischemia/reperfusion (I/R) injury can lead to many complications, which directly threaten the survival of the donor pancreas and the receptor itself, and the serious ones may result in the failure of transplantation. Ischemic preconditioning can protect the target organs in the following ischemia, which has become one of the hot spots in investigating organ transplantation.OBJECTIVE: To observe the early protective effect of ischemic preconditioning on the I/R injury of the grafted pancreas in the rat, and analyze its correlation with apoptosis.DESIGN: A randomized control animal experiment.SETTINGS: Department of Gastrointestinal Surgery, Department of Anesthesiology, Xijing Hospital of the Fourth Military Medical University of Chinese PLA.MATERIALS: Seventy male SD rats of 3-6 months, weighing 250-320 g, were used.METHODS: The experiments were conducted in the laboratory of Department of Gastrointestinal Surgery between September 2001 and April 2004.Six normal rats were taken as the control group, and 24 successful diabetic models were divided into I/R group and 1, 2 and 3-time ischemic preconditioning groups (n=18) according to the method of random number table,with 6 rats in each. The rats in the latter three groups were treated with 5-minute ischemia and 5-minute reperfusion for once, twice and three times respectively, all the rats underwent the pancreas transplantation. Twentyfour SD rats served as donors.MAIN OUTCOME MEASURES: ① Blood glucose before and after reperfusion in each group; Serum contents of tumor necrosis factor alpha (TNF-α) and nitric oxide; Activities of superoxide dismutase (SOD) and myeloperoxidase (MPD) and content of malondialdehyde (MDA) in the grafted pancreatic tissue; ② Apoptosis in the grafted pancreatic tissue observed by means of in situ end-labeling; Expressions of Bax and Bcl-2 proteins in the grafted pancreatic tissue with the method of Western blotting.RESULTS: ① Changes of blood glucose before and after reperfusion: The levels of blood glucose were decreased as compared with those before reperfusion in the I/R group and ischemic preconditioning groups. It was significantly lower in the 2-time ischemic preconditioning group than in the I/R group, 1 and 3-time ischemic preconditioning groups (P ＜ 0.05). ②Serum content of TNF-α at 2 hours after reperfusion: It was lower in the ischemic preconditioning groups than in the I/R group; It was lower in the 2-time ischemic preconditioning group than in the 1 and 3-time ischemic preconditioning groups (P ＜ 0.05). ③ Serum content of nitric oxide after reperfusion: It was higher in the ischemic preconditioning groups than in the I/R group; It was higher in the 2-time ischemic preconditioning group than in the 1 and 3-time ischemic preconditioning groups (P ＜ 0.05). ④SOD activity in the grafted pancreatic tissue after perfusion: It was higher in the ischemic preconditioning groups than in the I/R group; It was higher in the 2-time ischemic preconditioning group than in the 1 and 3-time ischemic preconditioning groups (P ＜ 0.05). ⑤ MAD content and MPD activity in the grafted pancreatic tissue after perfusion: Those were lower in the ischemic preconditioning groups than in the I/R group, also lower in the 2-time ischemic preconditioning group than in the 1 and 3-time ischemic preconditioning groups. ⑥ Apoptosis in the grafted pancreatic tissue: The apoptosis index after perfusion was lower in the ischemic preconditioning groups than in the I/R group; It was significantly lower in the 2-time ischemic preconditioning group than in the 1 and 3-time ischemic preconditioning groups (P ＜ 0.05). ⑦ Expressions of Bax and Bcl-2proteins in the grafted pancreatic tissue: There was high expression of Bax protein and low expression of Bcl-2 protein in the grafted pancreatic tissue after perfusion in the I/R group; Low expression of Bax protein and high expression of Bcl-2 protein in the grafted pancreatic tissue after perfusion were observed in the ischemic preconditioning groups; In the 2-time ischemic preconditioning group, the expression of Bcl-2 protein was the highest but that of Bax protein was the lowest.CONCLUSION: Ischemic preconditioning can protect the grafted pancreas from I/R injury at early pancreas transplantation, which maybe correlated with the elevation of SOD activity, increase of the synthesis of endogenous nitric oxide, down-regulation of TNF-α and the alleviations of the adhesion and aggregation of polymorphonuclear leukocytes. Ischemic preconditioning can reduce the apoptosis of the grafted pancreas, and the the possible mechanism may be correlated with the alleviations of the adhesion and aggregation of polymorphonuclear leukocytes, reduce of oxygen-derived free radicals, up-regulation of Bcl-2 protein and the down-regulation of Bax protein. 5-mintue ischemia and 5-minute reperfusion for twice is the best way to induce ischemic preconditioning in rat pancreas transplantation.

BACKGROUND: Ginkgo biloba extract (GBE) has the pharmacological actions of antioxidation, eliminating free radicals and anti-platelet activating factors, it also can relieve the ischemia/reperfusion injury of various organs.OBJECTIVE: Toobserve whether GBE can relieve the ischemia/reperfusion injury of transplanted pancreas in diabetic rats or not.DESIGN: A complete randomized grouping design, controlled study.SETTINGS: Department of Gastrointestinal Surgery and Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University of Chinese PLA Hospital.MATERIALS: Totally 128 male SD rats of clean grade, aged 3-6 months,weighing 250-320 g, were used. GBE was produced by Dr. Willmar Schwabe Pharmaceuti - cals (Ginaton parenteral solution, 5 mL/piece, containing 17.5 mg GBE, including 4.2 mg ginkgo flavone glycosides, batch number: 1511102).METHODS: The experiments were carried out in the laboratory of Department of Gastrointestinal Surgery from September 2001 to April 2004.① Eighty rats were injected with STZ (65 mg/kg) via penile vein, and 60 of them with fasting blood glucose exceeding 17.4 mmol/L for 2weeks were taken as the diabetic rats, and the other 48 normal rats were taken as donors. ② The 60 diabetic rats were randomly divided into two groups: ischemia/reperfusion group (n=30) and GBE group (n=30), and pancreas transplantation was performed in both groups. In the ischemia/reperfusion group, the rats were douched with 4 ℃ iced balanced salt solution containing heparin (1.5×105 U/L) for 20 minutes. In the GBE group, the recipients were given intravenous injection of GBE (1.5 mL/kg) at 1 day and 30 minutes before transplantation, and those in the ischemia/reperfusion group were intravenously injected with saline of the same volume. The donor pancreases were all reserved in 4 ℃ iced balanced salt solution containing heparin (1.5×105 U/L), the cold and hot ischemia times were kept for 180 and 15 minutes in each group to induce ischemia/reperfusion injury of transplanted pancreas. ③ Six randomly selected rats were killed at 2 days before transplantation and at 3 and 7days after transplantation respectively to detect fasting blood glucose; The activity of amylase was determined with corresponding kit provided by Nanjing Jiancheng Bioengineering Institute; Pancreas tissues were removed for hematoxylin and eosin (HE) staining; Six rats were used to observe the metabolic indexes; The other 6 rats were used to observe the survival rate within 1 month. ④ The differences of the measurement data were compared with the paired t test.MAIN OUTCOME MEASURES: ① Changes of fasting blood glucose level, metabolic indexes and activity of amylase before and after pancreas transplantation in the rat recipients of both groups; ② Pathological changes at 3 and 7 days after transplantation in the rat recipients of both groups.RESULTS: All the 60 rat as recipients finished the detections of blood glucose, food intake, water intake, urinary output and blood amylase. ①The survival rate within 1 month after transplantation was obviously higher in the GBE group than in the ischemia/reperfusion group (83%, 33%, P＜ 0.01). ② The blood glucose, water intake, food intake and the urinary output at 3 and 7 days after transplantation were obviously decreased as compared with those at 2 days before transplantation in both theischemia/reperfusion group and GBE group (P ＜ 0.05-0.01), and those at 3 and 7days after transplantation were obviously lower in the GBE group than in the ischemia/reperfusion group (P ＜ 0.05-0.01). ③ The activity of blood amylase at 3 days after transplantation was obviously increased as compared with that before transplantation in both the ischemia/reperfusion group and the GBE group (P ＜ 0.01, 0.05), it was still obviously higher at 7 days after transplantation than at 2 days before transplantation in the ischemia/reperfusion group (P ＜ 0.01), and it had almost recovered to normal in the GBE group. The activities of blood amylase at 3 and 7 days after transplantation were obviously lower in the GBE group than in the ischemia/reperfusion group (P ＜ 0.01). ④ The results of the pathological observation showed that the damaged severity of the transplanted pancreas was greater in the ischemia/reperfusion group than in the GEB group.CONCLUSION: GBE pretreatment can improve the survival rate of pancreas transplantation in rats, reduce the activity of blood amylase, ameliorate the metabolism, relieve the severity of reperfusion injury of pancreas,and plays a protective role in the pancreas transplantation.