Type 2 diabetes(T2DM) is the collective result of insulin resistance in both muscle and liver andβ cell function failure. Traditional pharmaceutical therapy fails in ceasing progressive decline in β cell function. Bariatric surgery has been widely accepted as an efficient measure to treat diabetes. However, the prevalent standards mainly based on body mass index can not meet the demand for promoting remission rate. Related factors should be included in prediction of post-operative remission, like end-point setting, T2DM status, biochemical index, and operative method etc. The combination of these factors can be used to benefit more patients with diabetes.

OBJECTIVE:To establish a diazotize solution-spectrophotometry for the determination of bilirubin in zhenhuang oral liquid.METHODS:The solution to be determined was added with diazotize solution and the absorbability was detected at a detective wavelength of533nm.RESULTS:The calibration curve was linear for bilirubin at the range of1.07～8.56?g/ml(r=0.9999).The average recovery of loading sample was100.2%(RSD=0.73%).CONCLUSION:The method is simple,reproducible,cost-effective and suitable for the determination and quality control of bilirubin in zhenhuang oral liquid.

Objective To explore the effects of TMPRSS2 promoted suicide gene CD-5-FC combined with phytochemicals on the proliferation and apoptosis of prostate cancer (PCa) specific cell-line 22RV1.Methods From March 2016 to October 2016 TMPRSS2-VISA-CD/UPRT'vector was used to deliver pro-drug 5-FC (5-Fluorocytosine) in to PCa specific cell-line 22RV1.Transfection effect was verified by Western-blotting.5-FC,5-FU (5-Fluorouracil) and four phytochemicals epigallocatechin gallate (ECGC),Genistein,Daidzein,and Equol were selected in this study.MTS assay was performed to select dosages,which can kill 10％-40％ of 22RV1 cells,from their pre-set drug concentrations,respectively.According to their select concentrations,either 5-FC plasmid or 5-FU in combination with one of four phytochemicals were added in 22RV1 cells in orders,and then cultured them together.Besides,these four phytochemicals were added in 22RV1 cells individually regarding their selecting concentrations and cultured at the same time.Cell viability was detected by MTS assay on 24hrs,48hrs and 72hrs.Comparing the cell killing rates between the combination groups and each single drug groups on cell-line 22RV1.Results TMPRSS2-VISA-CD/UPRT'plasmid with 5-FC was transfected on PCa specific cell-line 22RV1 successfully.The most obvious transfection occurred on 48hrs.The selected concentration of the pro-drug 5-FC were 83.32 μmol/L and 833.20 μmol/L,5-FU were 76.87 mol/L and 768.70 μmol/L.The concentrations of four phytochemical agents were 2.00 μmol/L,10.00 μmol/L and 20.00 μmol/L.In term of the cell killing numbers,results showed that the combination treatment of 83.32 μmol/L 5-FC/ 76.87μmol/L 5-FU and 10.00 μmol/L/20.00 μmol/L four phytochemicals compared with 10.00 μmol/L/20.00 μmol/L single treatment of four phytochemicals,respectively,there was no significant difference (P ＞0.05),while the combination treatment of 833.20 μmol/L 5-FC/768.70 μ mol/L 5-FU and 2.00 μmol/L/10.00 μmol/L four phytochemicals compared with 2.00 μ mol/L/10.00 μmol/L single treatment of four phytochemicals,respectively,there was a significant difference (P ＜ 0.05).In addition,this study proved that 83.32 μmol/L 5-FC and 76.87 μmol/L 5-FU,833.20 μmol/L 5-FC and 768.70 μmol/L 5-FU reached the same cell killing effect,and there was no statistical difference (P ＞ 0.05).Thus the suicide gene transfection was successful,and its function was the same as the effect of cytotoxic drugs.Conclusions This study has proved that this plasmid with 5-FC suicide gene system can be successfully and efficiently transfected into PCa cells 22RV1.As the pro-drug of 5-FU,5-FC got similar treatment effect with 5-FU,and inhibited cell proliferation.There was no synergistic reaction of enhancing cell apoptosis after combined phytochemical drugs EGCG,Genistein,Daidzen,Equol with suicide gene therapy on 22RV1 cell-line.

Objective to investigate the emotional state and childhood trauma among users of amphetaminetype-stimulants under compulsory seclusion rehabilitation in Shaoxing.Methods A cross-sectional design was conducted on 140 users of ATS in Shaoxing compulsory isolation drug rehabilitation center,collecting general information using homemade questionnaires.Using the Patient Health Questionnaire (PHQ-9),Generalized Anxiety Disorder Scale (GAD-7) and Mood Disorder Questionnaire(MDQ) to investigate the emotional state of users of ATS.The Childhood Trauma Questionnaire (CTQ) was applied to explore the childhood trauma experiences of users of ATS.Results Among the 140 users of ATS,84 (60％) users had emotional problems,24 users (17.14％) of anxiety disorder,22 users (15.72％) of depression,27 users (19.28％) of depression and anxiety disorder.66 users (47.1％)experienced at least one childhood trauma.The most common childhood trauma is the physical neglect,60 users (42.9％),followed by emotional neglect in 23 users(16.4％),again sexual abuse in 18 users (12.9％),emotional abuse and physical abuse is relatively fewer.Conclusion Among users of ATS under compulsory seclusion rehabilitation,emotional problems is prevalent.Proper emotional intervention and treatment in users of ATS would promote their mental health,thereby reducing the re-use of ATS,better return to society life.

Choroidal thickness and its relevance with retinal disease has been widely studied in recent years,as choroid is an important source of retina blood supply.Diabetic retinopathy (DR) studies have been focused on retinal vascular injury and related circulatory disorders for a long time,however recent studies have found that choroidal blood vessels are also affected by diabetes,including the thickness changes.The choroidal thickness of diabetic patients is thinner than normal.There is no conclusive conclusion about choroidal thickness and the severity of DR lesions,as the choroid thickness results are determined by multiple factors,including diseases,ocular conditions (choroidal vascular status,ocular axial length,refractory errors and other eye parameters),systemic factors (age and sex) and measurement methods.Therefore,it is necessary to calibrate the ocular and extra-ocular factors affecting choroidal thickness when trying to further clarify the relationship between the choroidal thickness and DR.

Objective To investigate the clinical efficacy of surgical treatment for stage Ⅳ gastric cancer after conversion therapy.Methods The retrospective cohort study was conducted.The clinicopathological data of 50 stage Ⅳ gastric cancer patients who were admitted to the First Affiliated Hospital of Dalian Medical University between January 2012 and June 2016 were collected.All the 50 patients who were diagnosed with single distal metastasis underwent chemotherapy.After chemotherapy,21 patients with operation indication receiving gastrectomy (R0 or R1 resection) were allocated into the conversion surgery group and 29 without operation indication continuing to chemotherapy were allocated into the chenotherapy group.Patients received S-1 + oxaliplatin or S-1 + docetaxel regimen.Patients underwent open distal or total gastrectomy.Observation indicators:(1) response assessment of chemotherapy (complete remission,partial remission,stable disease and progressive disease),grading of of adverse reactions;(2) intra-and post-operative situations of conversion surgery group:operation procedures,intraoperative situations (operation time,volume of blood loss,number of lymph node dissected and surgical margin) and postoperative situations (complications and duration of hospital stay);(3)comparison of follow-up and survival between the 2 groups;(4) prognostic factors analysis affecting stage Ⅳ gastric cancer patients.Follow-up using outpatient examination,correspondence and telephone interview was performed to detect postoperative survival of patients up to September 2016.Survival time was from operation to the last follow-up or death.Measurement data with normal distribution were represented as x±s.Comparison of count data and univariate analysis were done using the chi-square test.Ordinal data were analyzed by the nonparametric test.The survival rate was calculated by the Kaplan-Meier method,and the Log-rank test was used for survival analysis.Multivariate analysis was done using the COX regression model.Results (1) Response assessment of chemotherapy:of 50 patients,24 received S-1 + oxaliplatin regimen and 26 received S-1 + docetaxel regimen.Twenty-one patients in the conversion surgery group underwent chemotherapy,with negative peritoneal metastasis,N2 and below of lymph node metastasis (No.16 lymph node disappeared or reduced),invasive depth ＜T4b and narrowing or disappeared hepatic metastasis.A median preoperative chemotherapy cycle was 4.2 cycles (range,2.0-9.0 cycles).Chemotherapy reaction of 21 patients:15 had partial remission and 6 had stable disease.Twenty-nine patients without operation indication in the chemotherapy group didn't receive surgery.The median cycle of first-line chemotherapy was 5.5 cycles (range,2.0-10.0 cycles).Chemotherapy reaction of 29 patients:13 had partial remission,11 had stable disease and 5 patient had progressive disease.Chemotherapy adverse reactions of 50 patients:26 had reduced white blood cells (WBCs),including 6 with grade Ⅲ-Ⅳ of adverse reactions;29 had reduced neutrophils,including 12 with grade Ⅲ-Ⅳ of adverse reactions;18 had anemia,including 6 with grade Ⅲ-Ⅳ of adverse reactions;12 had reduced platelets,including 2 with grade Ⅲ-Ⅳ of adverse reactions;27 had apositia,including 5 with grade Ⅲ-Ⅳ of adverse reactions;7 had stomatitis;9 had diarrhea;3 had elevated serum creatinin;4 had hand-foot syndrome;3 had abnormal sensory nerve.There was no chemotherapy-related death.(2) Intra-and post-operative situations of conversion surgery group:of 21 patients in the conversion surgery group,8 underwent radical total gastrectomy + D3 lymph node dissection,6 underwent radical distal gastrectomy + D3 lymph node dissection and 7 underwent radical distal gastrectomy + D2 lymph node dissection (including 4 combined with resection of hepatic metastatic tumors and 1 combined with radiofrequency ablation of hepatic metastatic tumor).Operation time,volume of blood loss,number of lymph node dissected and recovery time of gastrointestinal function of 21 patients were (216±31)minutes,(128±52)mL,31±8 and (3.0± 0.7)days,respectively.There were 17 patients receiving R0 resection and 4 receiving R1 resection (3 with positive gastric margin and 1 with positive hepatic margin).There was no death.Seven of 21 patients with complications were cured by conservative treatment,including 2 with pancreatic fistula,1 with intra-abdominal hemorrhage,1 with intestinal obstruction,1 with pneumonia,1 with intra-abdominal infection and 1 with wound infection.Duration of hospital stay of 21 patients was (13.0±3.0) days.(3) Comparison of follow-up and survival between the 2 groups:50 patients were followed up for 6-46 months,with a median time of 24 months.The 3-year cumulative survival rates in the conversion surgery and chemotherapy groups were respectively 33.3％ and 6.9％,with a statistically significant difference between the 2 groups (x2 =7.678,P＜0.05).Results of further analysis showed that R0 resection of 17 patients and R1 resection of 4 patients in the conversion surgery group were respecgtively (25.3±2.8)months and (8.3±0.9)months,with a statistically significant difference between the 2 groups (X2=16.242,P＜0.05).(4) Prognostic factors analysis affecting stage Ⅳ gastric cancer patients:results of univariate analysis showed that T stage,N stage,response assessment of chemotherapy,surgery after chemotherapy and degree of tumor radical resection were related factors affecting prognosis of stage Ⅳ gastric cancer patients (X2 =5.288,12.645,25.581,8.372,12.001,P＜0.05).Results of multivariate analysis showed that R1 resection after conversion therapy was an independent risk factor affecting prognosis of stage Ⅳ gastric cancer patients (HR=14.021,95％ confidence interval:1.928-10.938,P＜0.05).Conclusion Radical resection after conversion therapy can increase survival rate of stage Ⅳ gastric cancer patients,and R1 resection after conversion therapy is an independent risk factor affecting poor prognosis of stage Ⅳ gastric cancer patients.

Objective To explore clinical effect of surgical treatment of displaced intra-articular calcaneal fractures via modified lateral L-shaped incision.Methods From January 2005 to October 2011,133patients (143 feet) with displaced intra-articular calcaneal fractures,including 125 males and 8 females,aged from 19 years to 65 years (average,43.2 years),underwent open reduction and internal fixation via modified lateral L-shaped incision.There were 56 cases of left calcaneal fractures,67 cases of right calcaneal fractures,and 10 cases of bilateral calcaneal fractures,and all of them were closed fracture.According to Sanders classification,15 feet were classified as type Ⅱ,107 type Ⅲ,and 21 type Ⅳ.The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale were used to access outcomes.Results One hundred and twenty five patients (135 feet) were followed up for 12 to 28 months (average,18.5months).All fractures healed after an average of 13 weeks (range,8-16 weeks).There were on nerve injury or osteomyelitis.Incision dehiscence occurred in 4 feet,which healed after removing the plate.Subtalar joint traumatic arthritis occurred in 17 feet,with walking pain.Collapse of articular surface occurred in 5 feet after weight-bearing.According to AOFAS ankle-hindfoot scale,excellent result was got in 94 cases,good in 29 cases,fair in 14 cases,poor in 6 cases; and the excellent and good rate was 92.9％.Conclusion Open reduction and internal fixation via modified lateral L-shaped incision for treating displaced intra-articular calcaneal fractures can obtain satisfactory results,but the skilled surgical techniques are needed.

Objective To evaluate the effect of low dose fentanyl on target plasma concentration (CP) of propofol (P) given by target controlled infusion (TCI) required to prevent response to proseal laryngeal mask insertion in 50% of patients (EC50). Methods Forty-six ASA Ⅰor Ⅱ patients aged 20-50 yr with body mass index ≤ 30 kg/m2 undergoing elective gynecological laparoscopy were randomly divided into 2 groups (n=23each):propofol group (P) and propofol-fentanyl group (PF). Anesthesia was induced with TCI of propofol. The initial Cp of propofol TCI was set at 2.5 μg/ml in group PF and 4 μg/ml in group P. Following equilibration between plasma and effect site concentration of propofol, fentanyl 1 μg/kg (in group PF) or normal saline (in group P) was injected iv. Laryngeal mask airway (LMA) was inserted at 3.5 min after fentanyl administration. EC50 was determined by up-and-down sequential trial. The ratio of Cp between the two consecutive patients was 1.2 in group P and 1.1 in group PF. LMA insertion response was defined as nausea, bucking and/or body movement during insertion. "Probit method was used to calculate the Echo and 95 % confidence interval required to prevent LMA insertion response. Results The EC50 and 95 % confidence interval of propofol given by TCI required to prevent LMA insertion response was 4.68 (4.20-5.21)μg/ml in group P and 2.63 (2.45-2.83) μg/ml in group PF. There was significant difference between the 2 groups. Conclusion Fentanyl 1 μg/kg iv can significantly reduce the Cp of propofol TCI required to prevent LMA insertion response.

Objective To clarify the risk factors of postoperative recurrence of early gastric cancer (EGC)patients who underwent radical gastrectomy.Methods We investigated follow-up records of 336 EGC patients on whom curative operations were performed at the First Affiliated Hospital of Dalian Medical University between January 1994 and January 2008 with special reference to 12 cases of cancer recurrence.Results The 5-year survival rate of D1 was 89.0％,D1 + t was 91.4％,D1 + β was 91.8％,D2 was 92.5％,D3 was 90.0％(P =0.981).The recurrence rate was 3.6％(12/336).The recurrence time was 17-58 months,the survival time was 33-68 months.Six cases suffered from hematogenous recurrences,four cases from lymph node recurrences,two cases from remnant stomach recurrences.The recurrence rate of SM was higher than M(P =0.015),lymph node positive was high than negative(P =0.011),D1 was higher than D2(P =0.025).Conclusions The recurrence rate of EGC correlated with depth of invasion,lymph node metastasis and lymph node dissection.

Objective To explore the characteristics of lymph node metastasis in gastric stump cancer and the efficacy of surgical treatment. Methods The clinical data of 42 patients with gastric stump cancer (test group) and 56 patients with primary cancer in the upper stomach (control group) who were admitted to The First Affiliated Hospital of Dalian Medical University from January 1994 to January 2008 were retrospectively analyzed. All data were analyzed by t test and chi-square test. The survival of the patients and lymph node metastasis rate were analyzed using the Kaplan-Meier method and Log-rank test, respectively. Results The metastasis rates of lymph nodes 1-3 of the test group and control group were similar (43%-61%), with no significant difference between the 2 groups (χ2 = 0.752, 0. 833, 0. 678, P > 0. 05). The metastasis rates of lymph nodes 7-9 of the test group and control group were 22% , 18% , 25% and 46% , 25% , 30% , respectively, and this was signifi-cantly different between the 2 groups (χ2 = 2. 168, 3. 263, 5. 761, P < 0. 05). The metastasis rates of lymph nodes 10-14 were 47% , 36% , 31% , 20% and 25% in the test group, which were significantly higher than 33% , 34% , 19% , 6% and zero in the control group, respectively (χ2 =3.225, 1.883, 3.945, 4.137, 6.823, P <0.05). The metastasis rate of lymph node no. 16 was zero in the test group and 23% in the control group. The metastasis rate of jejunal mesenteric lymph nodes was 27% in the test group and zero in the control group. The accumulative 5-year survival rate of patients was 38% in the test group and 48% in the control group, and this was significantly different (χ2 =4. 165, P<0.05). The overall 5-year survival rate of patients with radical resection was not significantly different between degree A (54%) and B (57%) (χ2 = 0. 622, P > 0. 05). Conclusions Gastric stump cancer has a unique pattern in lymph node metastasis. Surgical resection is effective in improving the prognosis of patients with gastric stump cancer.