Objective To explore the standardized procedures of laparoscopic sleeve gastrectomy (LSG).Methods The clinical data of 153 patients with obesity who underwent LSG at the First Affiliated Hospital of Nanjing Medical University from December 2010 to December 2014 were retrospectively analyzed.All the 153 patients were divided into 3 groups:22 patients in the first stage group were admitted to the hospital from December 2010 to September 2011,57 patients in the second stage group were admitted to the hospital from October 2011 to December 2013 and 74 patients in the third stage group were admitted to the hospital from January 2014 to December 2014.In the first stage group,1.1 cm gastroscope in diameter was introduced into the pylorus as a support,great curve of stomach with 5 cm distances from the pylorus was cut using a green cartridge,and then blue cartridges were used at the body and fundus of stomach.The 3-0 vicryl continuous and whole-layer suture was performed.The routine abdominal drainage was ended at postoperative hour 24 without the gastric tube placement.In the second stage group,36 Fr bougie tube was placed at the gastric antrum,cutting at the proximal 5 cm from pylorus was performed using a green cartridge,and then blue cartridges were used.The 3-0 Vicryl interrupted and wholelayer suture was performed at the reinforcement of staple lines,and no drainage tube was placed.In the third stage group,36 Fr bougie tube was placed at the gastric antrum,cutting at the proximal 3 cm from pylorus was performed using two green cartridges,and then blue cartridges were used.The 3-0 vicryl continuous and whole-layer suture was performed at the reinforcement of staple lines,and no drainage tube was placed.Other common perioperative management included as follows:free greater omentum was done by the supersonic knife.Patients had outof-bed activity after waking up and intake of water and fluid diet at postoperative hour 6-8,including oral liquid diet of 300-500 mL at postoperative hour 24 and 500-1 000 mL at postoperative hour 48.Patients were followed up till May 2015,and return visit at postoperative month 1,3,6,9 and 12 within 1 year and once every 6 months after postoperative year 2.The operation time,volume of intraoperative blood loss,duration of hospital stay and excess weight loss (EWL) percentage were analyzed.Comparison of count data was analyzed by the chi-square test.Measurement data with normal distribution were presented as-x± s.Comparisons among groups were evaluated with the one-way ANOVA and chi-square test.Results All the patients received successfully LSG without conversion to open surgery,perioperative reoperation and death.Four patients were complicated with intraoperative injury,including 3 patients with liver injury and 1 patient with hepatic round ligament injury.No intraoperative and postoperative hemorrhea,postoperative gastric leakage and obstruction were detected.The operation time,volume of intraoperative blood loss,duration of hospital stay and 1-year EWL were (91 ± 31) minutes,(51 ± 33) mL,(4.1 ± 3.4) days,67％ ± 12％ in the first stage group,(56 ± 27) minutes,(24 ± 20) mL,(3.1 ± 2.7) days,65 ％ ± 14％ in the second stage group and (54 ± 18) minutes,(21 ± 20) mL,(3.0 ± 2.1) days,68％ ± 24％ in the third stage group,respectively.There were significant differences in the operation time and intraoperative volume of blood loss among the 3 groups (F =7.471,6.037,P ＜0.05).There was no significant difference in the duration of hospital stay and 1-year EWL among the 3 groups (F =1.439,2.296,P ＞ 0.05).All the patients were followed up.Nineteen patients with sleep apnea had complete remission of symptoms at postoperative month 3.Twenty-one patients with polycystic ovary syndrome had remission of symptoms after operations.Of 27 patients with type 2 diabetes mellitus,25 patients had remission of symptoms at postoperative year 1 and 2 patients had improvement of symptoms.Fifty-seven of 79 patients with lipid metabolism disorders returned to normal at postopera tive year 1.One hundred and twelve patients with fatty liver were improved after operation.Conclusions LSG is safe and feasible with a standardized operative procedure.Whole-layer suture may be prevent the leakage and no placement of gastric tube and drainage tube after operation can reduce the incidence of complications.

Objective To explore the clinical effects of metabolic surgery on obese adolescents.Methods The clinical data of 28 obese adolescents who were admitted to the First Affiliated Hospital of Nanjing Medical University from June 2010 to January 2014 were retrospectively analyzed.Patients underwent gastric bypass and sleeve gastrectomy according to their own intention and were followed up regularly at 1,3,6,9 months after surgery till October 2014.The perioperative conditions and postoperative effecacies of patients were observed.The measurement data with normal distribution were presented as-x ± s,the comparisons of weight-loss trends among different surgeries were analyzed by the repeated measures ANOVA.Results All surgeries were performed under laparoscope without severe complications or deaths,including 16 cases of gastric bypass and 12 cases of sleeve gastrectomy.The median operation time and duration of postoperative stay were 136.5 minutes (range,60.0-320.0 minutes) and 4 days (range,2-8 days),respectively.Three patients had perioperative complications.All patients received postoperative follow-ups.The median body mass index(BMI) at postoperative month 1,3,6,9 were 36.1 kg/m2,33.2 kg/m2,30.2 kg/m2 and 28.4 kg/m2,and mean excess weight loss (EWL) rate were 24.6％,40.4％,55.1％ and 63.9％.The BMIs before operation and at postoperative month 1,3,6,9 were (43 ± 6) kg/m2,(37 ± 5) kg/m2,(34 ± 4) kg/m2,(30 ± 4) kg/m2 and (29 ± 4) kg/m2 in patients undergoing gastric bypass,and (39±4)kg/m2,(35±4)kg/m2,(32 ±5)kg/m2,(31 ±4)kg/m2 and (28 ±4)kg/m2 in patients undergoing sleeve gastrectomy,respectively.The EWL at postoperative month 1,3,6,9 were 24％ ± 9％,40％±9％,59％ ± 12％ and 65％ ± 12％ in patients undergoing gastric bypass,and 25％ ±9％,41％ ± 15％,49％ ± 16％ and 63％ ± 17％ in patients undergoing sleeve gastrectomy,respectively.There was no difference in the change of BMI and EWL between gastric bypass and sleeve gastrectomy (F =0.777,0.332,P ＞ 0.05).Four patients undergoing gastric bypass were found to have nutritional complications in follow-up and recovered after symptomatic treatment.Concltsion Bariatric surgery is safe and feasible for obese adolescents with a significant weight loss.However relevant nutrition complications may occur,it is significant to sustain a long-term followup and nutrition intervention,and the choice of surgical procedures should follow the principle of individuation.

Objective To investigate the efficacies of laparoscopic sleeve gastrectomy + duodenojejunal bypass (DJB) and laparoscopic gastric bypass in the treatment of patients with non-obese type 2 diabetes mellitus (T2DM).Methods The clinical data of 42 patients with type 2 diabetes mellitus and body mass index (BMI) ＜ 30 kg/m2 received surgical treatment at the First Affiliated Hospital of Nanjing Medical University from January 2012 to June 2013 were retrospectively analyzed.Fifteen patients received laparoscopic sleeve gastrectomy + DJB (Sleeve + DJB group),and 27 received Roux-en-Y gastric bypass (RYGB group).The follow-up time for all the patients was more than 6 months.The decrease of BMI,complete remission of T2DM,decrease of fasting glycemia and glycosylated hemoglobin (HbAlc),postoperative nutritional condition and the incidence of complications of the 2 groups were compared.The measurement data were analyzed using the t test and the repeated measurement chi-square test.Results The operation time of the Sleeve + DJB group and the RYGB group were (137 ± 61)minutes and (89 ± 43) minutes,with significant difference between the 2 groups (t =6.158,P ＜ 0.05).No mortality and hemorrhage,bowel obstruction and anastomotic stenosis were detected.One patient was complicated with bile leakage in the Sleeve + DJB group,and was cured by conservative treatment 5 days later.The levels of fasting glucose before operation and at postoperative month 1,3,6 were (8.9 ± 0.7) mmol/L,(5.8 ± 1.3) mmoL/L,(5.6 ±1.8) mmol/L and (5.7 ± 0.3) mmol/L in the Sleeve + DJB group,and (9.9 ± 1.2) mmol/L,(6.9 ± 0.8) mmol/L,(6.6 ± 2.2) mmol/L and (5.6 ± 0.8) mmol/L,with no significant difference between the 2 groups (F =1.670,2.932,0.444,0.158,P ＞ 0.05).The levels of HbAle before operation and at postoperative months 1,3,6 were 7.4％± 1.4％,6.5％ ±0.6％,5.7％±0.5％,5.9％ ±0.6％ in the Sleeve + DJB group,and 7.7％± 2.0％,6.8％ ± 1.3％,5.7％±0.8％,5.6％ ± 1.1％ in the RYGB group,with no significant difference between the 2 groups (F =0.055,0.125,0.005,0.286,P ＞ 0.05).The remission rates of T2DM of the Sleeve + DJB group and the RYGB group were 14/15 and 74.1％ (20/27) at postoperative month 6,with no significant difference between the 2 groups (x2 =2.320,P ＞ 0.05).The decrease rate of BMI of the Sleeve + DJB group and the RYGB group were 18.2％±9.5％ and 21.2％ ± 4.9％,with no significant difference between the 2 groups (t =0.982,P ＞0.05).The numbers of patients with postoperative anaemia,avitaminosis and diarrhea were 0,0,2 in the Sleeve + DJB group and 3,2,6 in the RYGB group,with no significant difference between the 2 groups (x2=1.795,1.167,0.908,P ＞0.05).The BMIs of all the patients were above 19 kg/m2.Conclusion The effects and incidence of postoperative complications of Sleeve + DJB for the treatment of T2DM are comparable to those of RYGB.Sleeve + DJB has less interference on the nutritional condition of patients compared with RYGB.

Objective To assess the lipid profiles of obese patients undergoing laparoscopic gastric by-pass surgery.Methods A retrospective observational study was performed , involving 25 patients(BMI>28 kg/m2 ) who consecutively underwent gastric bypass surgery in the First Affiliated Hospital of Nanjing Medical Univer -sity from Oct.2010 to Dec.2012.For the surgery, a small gastric pouch about 30 ml was performed with 100 cm biliopancreatic limb and 100-200 cm alimentary limb.Total cholesterol(TC),triglycerides(TG),high density lip-oprotein( HDL) and low density lipoprotein ( LDL) at baseline and 1, 3, 6, 9 and 12 months after surgery were measured.Related complications were recorded .Results All surgeries were performed laparoscopically and no serious complications occurred .TC, TG, and LDL significantly reduced after the surgery (P<0.05 for all).In-versely, HDL disclosed a significant rise(P<0.05).Of the lipid profiles at baseline, only HDL concentration displayed a correlation with BMI .Percentage of excess weight loss ( PEWL ) displayed significant correlation with the variety of TG、LDL、HDL after surgery(P<0.05 for all).Conclusions Laparoscopic gastric bypass is a safe operation which improves the lipid metabolism of obese patients .The operation can decrease the concentration of TC, TG, LDL and increase HDL level .

This paper describes the design of the printing output function for a multi-parameter patient monitor by using the graphic plot function of a Laser Printer. The ECG data are preprocessed with a notch filter and interpolation algorithm. A logical page is constructed in the extended memory for virtual page printing. This monitor is able to output a satisfied printing with ECG waveforms of high quality.
Automatic Data Processing ; methods ; Computer Graphics ; Diagnostic Equipment ; Electrocardiography, Ambulatory ; instrumentation ; methods ; Equipment Design ; Humans ; Lasers ; Printing ; instrumentation ; methods ; Quality Control

Novozym 435 was selected from four lipases and two proteinase because of its high catalytic activity and enantiosectivity.For the ammonolysis of (?)-?-methylbenzyl acetate,The effect of ammonia sources,the concentration of enzyme and substrates on the reaction were further explored .under the optimum conditions of this study,after 6h reaction,with the enantiomeric excess of the remaining (-)-?-methylbenzyl acetate was found to be higher than 99%.

The effects of reaction media, water activity, temperature and pH on Novozym 435-catalyzed enantiose-lective ammonolysis of (?) -?-methylbenzyl acetate have been systematically explored. Novozym 435 showed high catalytic activity and enantioselectivity in hexane; the optimum temperature and the initial water activity were 25℃ and 0.33 respectively; The suitable reaction pH was in the range of 6.0 - 7.0.

Kidney injury and decreased chemosensitivity of tumor cells are obstacles with cisplatin (CDDP) chemotherapy. Down-regulation of the organic cation transporter 2 (OCT2) and multidrug resistance-associated protein 2 (MRP2) is a key means to alleviate CDDP-induced kidney injury and increase chemosensitivity. Astragaloside IV (AS IV) is obtained from the well-known traditional Chinese herb Astragalus membranaceus. This study explored the role of AS IV in preventing kidney injury and enhancing the antitumor effect of CDDP by suppressing OCT2 expression in kidney and MRP2 in tumors. This project was reviewed and approved by the Animal Ethics Committee of the First Hospital of Jilin University. The effects of AS IV on CDDP inhibition of tumor growth and promotion of apoptosis were assessed in Lewis lung tumor (LLC)-bearing mice by H&E and TUNEL staining. Kidney injury was assessed by serum biochemical parameters and H&E staining. We used Western blotting and immunohistochemistry assays to detect OCT2 and MRP2 expression in kidney and tumor. The concentration of CDDP in kidney and tumor was measured by HPLC-MS/MS. AS IV enhanced CDDP chemosensitivity by increasing tumor cell apoptosis and slowing tumor growth, and decreased kidney injury as evidenced by lower blood creatinine (Cr) and blood urea nitrogen (BUN). Co-administration of AS IV suppressed MRP2 overexpression induced by CDDP in tumor tissues and may be an important mechanism for enhancing CDDP chemosensitivity. Moreover, AS IV reduced CDDP-induced kidney injury in mice along with suppression of OCT2 expression in kidney. The concentration of CDDP was increased in tumor but decreased in kidney. In total, AS IV not only enhanced the antitumor effect of CDDP by suppressing MRP2 expression in tumor cells, but also decreased kidney injury induced by CDDP. The results provide new insight into the combined use of a chemotherapy drug and natural ingredients to treat cancer.

The herbs used as the material for traditional Chinese medicine are mostly planted at mountain areas where there is appropriate weather condition. Due to the complex terrain condition in mountain area, the planting at such places is always associated with a scattered pattern, which inevitably bring difficulty to the work of accurate measurement for the planting area. Advanced research about monitoring the planting area for medicine-herb under complex environmental condition is so critical and meaningful for developing the medicine-herb planting to a large scale and an industry. Therefore, this research, taking the planting of Herpetospermum pedunculosum in Luding county as an example, utilizes RS&GIS: using the image data from TM and ETM datum as the remote sensing information source, integrating GPS data from quadrat survey on the spots, and analyzing on a GIS platform, to extract the planting area of H. pedunculosum in Luding county. The results indicate that: (1) the method and technology used to estimate the planting area of H. pedunculosum are feasible and can be applied to monitoring the planting area of medicine-herb at mountain area under complex environmental conditions: (2) the planting area of H. pedunculosum in Luding county is estimated to be 857. 246 acres by the methods utilized in this research, which is closed to the value from local statistical data with an error range less than 5%; (3) in consideration of those inevitable errorrs generating from the procedures such as remote sensing data acquisition, data preprocessing, data interpretation, and so on, and the fact that the classification of remote sensing data, which must be implemented by those above procedures, was used directly to extract the herb type, the accuracy of area estimation for the herb is significantly influenced by the accuracy of classification for herb type, and the estimated area is inevitably associated with some error.
China ; Cucurbitaceae ; chemistry ; growth & development ; Geographic Information Systems ; Medicine, Tibetan Traditional ; Remote Sensing Technology ; methods

BACKGROUND: Few studies have reported the effects of early tracheotomy in acute severe asthmatic patients. We report two patients with acute severe asthma who were successfully treated with early tracheotomy. METHODS: The two patients with acute severe asthma were retrospectively reviewed. They had been treated at the Department of Emergency and Critical Care, Renji Hospital, Shanghai Jiaotong University School of Medicine. RESULTS: They developed progressively hypercapnia and severe acidosis, and were not improved after conventional therapies. Early tracheotomy after mechanical ventilation decreased airway resistance and work of breathing, and corrected hypercapnia and acidosis. Adequate gas exchange was maintained after tracheotomy. The two patients were subsequently weaned from mechanical ventilation and discharged. CONCLUSION: Early tracheotomy could be a valuable approach in certain patients with severe asthma.