Objective To observe the effects of Roux-en-Y gastrointestinal reconstruction(RYGR) on carbohydrate and lipid metabolism in non-obese patients with type 2 diabetes and gastric carcinoma.Methods Fifty seven gastric cancer cases who underwent radical distal gastrectomy were studied and among them 35 patients had Roux-en-Y gastrointestinal reconstruction (RYGR group) and 22 had Billroth-Ⅰ gastrointestinal reconstruction (B-I GR group).Both groups were subjected to the measuring of preoperative and postoperative third,sixth months values of body mass index (BMI),glycosylated hemoglobin (GHbA1c),fasting glucose (FPG),fasting insulin (Flns) and C-peptide (FC-P),oral glucose tolerance (OGTT) including 2 hour insulin (2hIns) and C-peptide (2hC-P),plasma levels of total cholesterol (TC),triglycerides (TG),high density lipoprutein (HDL-c) and low density lipoprotein (LDL-c).Result There was no significant difference between the two groups in preoperative values (P＞0.05).There was no statistically significant difference in BMI values measured postoperatively (P ＞ 0.05).In RYGR group,preoperative FPG and that of third and sixth month postoperatively was (9.3±0.9) mmol/L vs.(7.2±2.1) mmol/L vs.(7.1±0.8) mmol/L,P=0.000,GHbAlc was (9.2±1.2)% vs.(7.3±1.2)% vs.(7.2±1.1)%,P=0.000,TG was (3.21±0.88) mmol/L vs.(2.12±0.97) mmol/L vs.(2.02±0.09) mmol/L,P =0.000,TC was (6.4±1.9) mmol/L vs.(4.3±1.0) mmol/L vs.(4.1±1.0) mmol/L,P =0.000 and LDL-c was (3.61±1.05) mmol/L vs.(2.77±0.68) mmol/L vs.(2.71±0.18)mmool/L,P=0.000,2 hour glucose after OGTT(2hPG) was (17.6±2.5) mmol/L vs.(12.1±1.9) mmol/L vs.(11.6±2.3) mmol/L,P = 0.000.Levels of FIns was (98±11) pmol/L vs.(120±9)pmol/L vs.(122±8) pmol/L,P =0.000,FC-P was (0.21±0.08) mmol/L vs.(0.30±0.01) mmol/L vs.(0.30±0.01) mmol/L,P=0.000,HDL-c was (1.08±0.10) mmol/L vs.(1.61±0.34) mmol/L vs.(1.62±0.09) mmol/L,P = 0.000,2 h Ins was (410±19) pmol/L vs.(446±19) pmol/L vs.(459±18) pmol/L,P = 0.000 and 2 h C-P was (0.87±0.17) mmol/L vs.(1.22±0.14) mmol/L vs.(1.19±0.15) mmol/L,P =0.000.In B-I GR group,preoperative and third and sixth postoperative month values of GHbA1c were (9.2±1.2)% vs.(8.4±1.6)% vs.(8.3±1.1)%,P =0.046.Conclusion Roux-en-Y gastric bypass can significantly improve the metabolism of carbohydrate and lipid in non-obese patients with type 2 diabetes and gastric carcinoma,and the effects are not related with postoperative weight loss.

Objective To evaluate Roux-en-Y gastric bypass operation on carbohydrate and lipid metabolism in type 2 diabetes mellitus patients with BMI range of 24 -29. Methods Thirty seven cases of type 2 diabetes mellitus patients undergoing Roux-en-Y gastric bypass operation were studied. Body mass index (BMI), glycosylated hemoglobin ( GHbAlc), fasting glucose ( FPG), fasting insulin (FIns) and C-peptide( FC-p), HOMA-IR, oral glucose tolerance (OGTT) including 2 hour insulin (2hIns) and C-peptide (2hC-p) , plasma levels of total cholesterol (TC), triglycerides(TG), high density lipoprotein( HDL-c)and low density lipoprotein ( LDL-c) were measured preoperatively and on 3 months, 6 months, later postoperatively. Result There was no statistically significant difference between BMI values measured preoperatively and postoperatively (P>0. 05 ). Serum levels measured in pre-operative and third and sixth post-operative months were: FPG (8. 8 ± 0. 9, 7. 0 ± 2. 0, 6. 3 ± 0. 6, P<0. 01) ( mmol/L) , GHbAlc (8.2±1.2, 7.0±0.8, 6.2±0.7, P<0.01)(%), FIns(10. 6 ±1. 2, 9.0±0.9, 9.0±0.8, P<0.05)(mU/L), FC-p(1.9±0.5, 1.2 ±0.6, 1.2 ±0.4, P<0. 01) (nmol/L), TG(3.3 ±0.8, 2.7 ±0.9,2.6±0.7, P<0.05)(mmol/L), TC(6.5±1.8, 4.6±0.9, 4.2 + 1.0, P<0. 05) (mmol/L)and LDL-c (3. 6 ±1.2, 2. 8 ±0.8, 2. 7 ±0.2, P<0.01) (mmol/L), 2 hour glucose after OGTT(2hPG) (18. 6 ±3.0, 12.7 ±2.3, 11.4±2.0, P<0. 01) (mmol/L), HOMA-IR(3. 2 ± 1. 7, 2.6±1.6, 2. 5 ±1.3, P<0. 05). Postoperative levels of HDL-c (1. 2 ± 0. 1, 1. 4 ± 0. 4, 1. 4 ± 0. 2, P<0. 01) ( mmol/L) , 2hIns (17. 2 ±3.4, 26. 3 ±4.7, 28. 6 ±4.1, P<0. 01) (mU/L)and 2hC-p(4. 2 ± 1. 0, 6. 3 ± 1. 5, 6. 2 ± 1.4,P<0. 01 ) ( nmol/L) were significantly higher than that of the pre-operative values ( P<0. 01 ).Conclusions Roux-en-Y gastric bypass significantly improves the metabolism of carbohydrate and lipid in type 2 diabetes patients with BMI 24-29, and the effects are not associated with weight loss.

Objective ToexplorethevalueofCTtargetreconstructionforpureground-glassnodules(pGGN)onidentifyingthe invasivenessofthelungadenocarcinoma.Methods ThepGGNs weredividedintopre-invasivegroup[atypicaladenomatoushyperplasia (AAH),andadenocarcinomainsitu(AIS)]andinvasivegroup[minimallyinvasiveadenocarcinoma(MIA),andinvasiveadenocarcinomas(IA)] accordingtothepathologicresults.ThemorphologicfeaturesofpGGNonCTincludedthelargestdiameters,CTvalue,pleuralindentation,air bronchogram,bubblelucency,vesselconvergence,vesseldilatation,lobulationandspeculation.Twodiagnosticiansevaluatedthemorphologic featuresofpGGNonCT.Binary L o g istic regressionwasusedtoassesstheassociationbetweenCTfindingsandhistopathological classification.ROCcurveanalysiswasusedindiameterandCTvalue.Results Betweenpre-invasiveandinvasivegroup,therewere significantdifferencesindiameter,CTvalue,spiculationandvesseldilatation(P<0.05).Nodifferencewasfoundinlobulated-margin,bubble lucency,airbronchogram,vascularconvergenceorpleuralindentationbetweenthetwogroups(P>0.05).Thediagnosticthresholds forpredictingpGGOinfiltrationwere8.75mminmaximumdiameterand-605HUinCTvaluerespectively.Conclusion ThepGGNwitha diametermorethan87.5mm,theCTvaluemorethan-605HU,andpresencesofspiculationandvesseldilatationsuggeststhatpGGOisinvasive.

Objective To explore the feasibility of reduction by using cone beam computed tomography (CBCT) before intensity modulated radiation therapy(IMRT) in the patients with nasopharyngeal carcinoma.Methods Twenty-three patients with nasopharyngeal carcinoma (NPC) undergoing IMRT were included in this study.The reverse IMRT plan with CBCT verification was prepared with location center coordinates origin as the planned central point.Before therapy,the CBCT reduction was adopted,the CBCT scanning was performed before the second and third radiotherapies.The registering data in 3 times were analyzed and summarized.Results In CBCT reduction,the absolute value at any direction≤3 mm accounted for 89.9％ (62/69),＜5 mm accounted for 98.6 ％ (68/69),and the deviation value at every direction was (0.6 ± 2.1)mm;in the second and third CBCT,the absolute value at any direction ≤3 mm accounted for 92.8％ (128 q38),＜5 mm accounted for 99.3％ (137/138),and the deviation value at every direction was (0.4 ± 2.0) mm:the difference between the two sets of data had no statistically significant difference (P＞ 0.05).Conclusion In formulating the nasopharyngeal carcinoma IMRT plan withthe location center coordinates origin as the planned central point,adopting the CBCT reduction is intuitional,convenient,practicable and feasible.