Type 2 diabetes mellitus (T2DM) usually becomes complicated and unmanageable when combing with metabolic syndromes of obesity,hypertension and hyperlipidemia.Medical treatment generally adopts non-surgical management,such as diet control,exercise and oral medications; surgical treatment can improve the condition of patients with T2DM and the metabolic syndromes.In this article,the multi-disciplinary treatment of a patient with T2DM and obesity in the Third Xiangya Hospital of Central South University was analyzed,so as to provide a new way for the treatment of this disease.

The incidence of obesity increases worldwide every year,positioned as an important disease by WHO,and it has become an important public health problem.National survey shows that overweight and obesity rates were 22.8％ and 7.1％ respectively in Chinese adults in 2002,affecting 270 million people.At present,bariatric surgery is a safe and effective treatment for severe obese patients.In July 2011,a patient with Ⅲ degree obesity (weight 148 kg and BMI 51 kg/m2) complicated with type 2 diabetes mellitus was admitted to the Third Xiangya Hospital of Central South University.The treatment plan was made after diagnosis and treatment of muhidisciplinary team and the patient underwent laparoscopic sleeve gastrectomy.The patient was followed up to September 2012 and recovered well without severe surgical complications,and the weight and BMI were decreased to 75 kg and 25 kg/m2 respectively.

The incidence of obesity is increasing in the world yearly, obesity and its complications pose a serious threat to the health of people at the same time. In recent years with the progress of economy, the development of science and technology and the change of concept, surgical robots are increasingly used in metabolic and bariatric surgery. In this review, the application and development trend of minimally invasive surgical robot in metabolic and bariatric surgery are reviewed, the advantages of surgical robot in metabolic and bariatric surgery are discussed, and the future development are prospected.

Objective To observe the therapeutic efficacy of ultrastructural dense acupotomy treatment in treating lumbar intervertebral disc herniation (LIDH). Methods Seventy-two LIDH patients were randomized into a treatment group and a control group, 36 in each group. The treatment group was intervened by ultrastructural dense acupotomy treatment, while the control group was by conventional acupuncture. The therapeutic efficacy was evaluated after a course of treatment. The visual analogue scale (VAS) was adopted for assessing pain, and the Japanese Orthopaedic Association (JOA) score for estimating the symptoms, signs, and functional activities. Results The VAS and JOA scores were significantly changed in both groups after intervention (P＜0.01). There were significant differences in comparing the changes of VAS and JOA scores between the two groups (P＜0.01, P＜0.05). The total effective rate was 97.2% in the treatment group versus 80.6% in the control group, and the difference was statistically significant (P＜0.05). Conclusion Ultrastructural dense acupotomy treatment is an effective approach in treating LIDH.

The interaction between medical instrument and target tissue during the surgery occurs in instrument-tissue interface. The reliability research on the interface is directly related to the safety and effectiveness of medical instrument in the clinical application. This paper illustrates the necessity of reliability research on instrument-tissue interface. Two main contents are synthetically reviewed the present paper: (1) reliability research on medical instruments; (2) biological tissue properties and its mechanical response.
Humans ; Reproducibility of Results ; Surgical Instruments ; Surgical Procedures, Operative

Vitamin D plays an important role in cellular differentiation and Calcium phosphate metabolism.At the same time,the role of Vitamin D in glycolipid metabolism had attracted a lot of attention.Bariatric surgery is an effective treatment to achieve therapeutic endpoints for comorbidities associated with obesity,but vitamin D status is always insufficient before and after surgery.In this review,the author aim to (1) discuss the deficiency of vitamin D in bariatric patients,(2) to summarize the impact of vitamin D on glycolipid metabolism and the outcome of bariatric surgery,(3) to discuss the supplementation for the deficiency of vitamin D.

Objective To analyze the changing rules of schistosomiasis endemic situation before and after reaching the crite-ria of schistosomiasis transmission controlled or transmission interrupted in Zhejiang Province,so as to provide scientific evi-dence for schistosomiasis contro1. Methods Xiuzhou District and Zhuji City were selected and investigated retrospectively to collect schistosomiasis epidemiological information 10 years before they reached the criteria of transmission controlled and the subsequent years until 2008. The database of retrospective investigation was established for analyzing the trends and rules of changes of Oncomelania hupensis snail status and schistosome infection status of cattle and human. Results The snail status and schistosome infection kept a steady declining before reaching the criteria of transmission controlled ,and there were positive correlations between the area of living snails and the infection rates of human and animal in two places(rhuman=0.764,P<0.01, rcatl e=0.709,P<0.01;rhuma=0.775,P<0.01,rcatl e=0.676,P<0.01);No local infection person and animal except residual snails, and found 7 cases of imported infection source were found after reaching the transmission interruption. Conclusion The epi-demic status of schistosomiasis in zhejiang is stable after reaching the criteria of transmission interruption ,and residual snail are easy to re-found and spread under some certain conditions,and some imported cases were found sometimes,which may in-crease the risks for re - emergence of schistosomiasis. The integrated solidification strategy with emphasis on control of residu-al snails and imported cases should be taken in the areas of transmission interruption in the future.

Objective To investigate the clinical featurcs of hepatic perivascular epithelioid cell carcinoma (PEComa) and the experiments in the surgical treatment of PEComa.Methods The clinical data of 16 patients with hepatic PEComa who received surgical treatment at the First Affiliated Hospital of Nanjing Medical University from January 2008 to January 2012 were retrospectively analyzed.The incidence,clinical manifestations,imagiong characteristics,surgical outcomes and pathological manifestations of this disease were analyzed.B sonography,hepatic function test,tumor markers test and epigastric computed tomography (CT) were applied to detect tumor recurrence and metastasis.The follow-up was ended in December 2012.Result Middle aged and female patients took large part of the patients.Of the 16 patients,8 had no subjective symptoms,and other patients had discomfort in the right upper quadrant,pain or tenderness of the liver.All the tumors were solitary,and most of them located at the right liver (11 tumors were in the right liver,4 in the left liver,1 in the caudate lobe).No specific features were detected by preoperative B sonography,while inhomogeneous low density in the tumor region was detected on by CT.All the patients received partial liver resection without morbidity and morality.The results of immunohistochemistry showed that thc expressions of HMB-45,Melan-A and vascular smooth muscle actin were positive.The mean time of follow-up was 27.9 months (range,9.0-46.0 months),no tumor recurrence and death was observed during the follow-up.Conclusions Middle aged females are susceptive to hepatic PEComa,and patients have no specific clinical presentations.Preoperative CT examination is helpful for differential diagnosis of PEComa,and partical hepatectomy can achieve satisfactory short-term clinical outcomes.

Objective To survey on the prevalence of schistosomiasis among floating population in Zhejiang province. Methods A survey on prevalence of schistosomiasis among floating population was conducted from September to November 2008, and the stratified cluster sampling method was adopted in the survey. Totally 129 villages of 19 counties or districts were selected as survey sites, and 100 samples of migrants aged 6 to 65 from schistosomiasis-endemic areas were taken in each selected village. All selected individuals were surveyed by questionnaire and underwent serum indirect hemagglutination (IHA) test. For individuals with positive serum IHA testing the fecal examination was carried out to detect the eggs by nylon sedimentation method. SPSS 13.0 software was used for data processing. Results The number of migrants in survey sites was 3 357 420, among whom 303 219 were from schistosomiasis-endemic areas (9.03%).The positive rate in serum IHA test was 2.06% (286/13 898), 276 IHA-positives individuals received fecal examination, and 7 cases were positive (2.52%). Based on above data it was estimated that there would be potentially about 33 500 serum IHA-positive cases and 845 egg-positive cases among floating population in Zhejiang province. Conclusion The risk of schistosomiasis transmission still exists in Zhejiang province due to the infected migrants from endemic areas, and a surveillance system and quick response are required for prevention of re-emergence of the disease.