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.

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.

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

Objective:To analyze the expression of MUC15 and PI3K/Akt in gastric carcinoma and its association with clinicopathologi-cal characteristics and prognosis. Methods:The expression of MUC15 and Akt was detected in 144 cases of gastric carcinoma tissues and corresponding para-carcinoma tissues by tissue microarray and immunohistochemistry. Results:The positive expression rate of MUC15 in gastric carcinoma was 79.8%, higher than that of para-carcinoma tissues (22.2%, P<0.01). The positive expression rate of Akt protein in gastric carcinoma was 80.6%, higher than that of para-carcinoma tissues (16.7%, P<0.01). The expression of MUC15 and Akt was statistically associated with the grades of differentiation, invasion depth, lymphatic metastasis, TNM stage of tumor tissues (P<0.05), and the positive correlation between the two protein expression that appear in the gastric tumor tissue (P=0.001). Univariate survival analysis showed that the over-expression of either MUC15 or Akt was inversely correlated with the survival time (P<0.05 and P<0.01, respectively). Cox multiple regression analysis indicated that patients with over-expression of both MUC15 and Akt had the worst prognoses (HR=3.115, P<0.05). Conclusion:MUC15 may be involved in the occurrence, development, invasion, and metastasis of gastric cancer through the PI3K/Akt cell signaling pathway, and the expression of MUC15 combined with Akt is a powerful predictor for the prognosis of gastric cancer.

Objective: To identify small molecule peptides specifically binding to RhE antigen via phage display technology, providing a theoretical basis to prevent RhE alloimmunization. Methods: A peptide (FLWMFWPSVNSPLLRSPIQRKNA) with RhE antigen-specific amino acids was artificially synthesized as the target peptide. A random phage display 12-mer peptide library was screened in vitro against the artificially synthesized peptide via phage display technology. After two rounds screening in vitro and ELISA identification of the monoclonal phage, amplification and purification were carried out. Sequencing of the positive phage clones derived exogenous peptide amino acid sequences that specifically bind to RhE antigen, with target-binding specificity confirmed by competitive antibody inhibition assays. Results: Two rounds screening of the target peptides results showed a significant enrichment of phages that specifically bind to the target peptides. 96 phage clones were randomly selected for ELISA identification after two rounds screening, and the results showed 23 positive clones with good affinity for the target peptide. After further verification by ELISA, 13 phage clone results were consistent with the initial ELISA identification results, which indicated that these 13 clones have good affinity for the target peptide. DNA sequencing of these clones yielded five amino acid sequences: THDRNNTPVWRF, TPYETIFDPRTS, TFWQMSADTQAL, AASSTLSIYPPR and SHDTRSPFTWGR. Competitive inhibition assays revealed all five peptides have competitive inhibitory effects with anti-E antibodies. Conclusion: Based on phage display technology, 5 small molecule peptides that specifically bind to RhE antigen have been successfully identified, which may provide a research basis for the prevention of HDFN by small molecule peptides and also provide new ideas for preventing RhE antigen alloimmunization.

With the further research on the pathogenic factors of ankylosing spondylitis (AS), though the mechanism of its pathogenesis is not fully understood, many treatment methods of traditional Chinese medicine (TCM) have achieved good results in the treatment.Therefore, TCM has certain advantages in the treatment of AS, and shows a good application prospect.Retrieval CNKI, Wanfang database and VIP Chinese database, retrieval of domestic clinical research literature on AS in recent years, with the latest advances in the understanding of TCM in the treatment of AS.

Glucose-dependent insulinotropic peptide (GIP), the incretins, is synthesized and released from the duodenum and proximal jejunum. Continual high-fat diet powerfully stimulated GIP secretion, leading to obesity and harmful lipid deposition in islet cells and peripheral tissues, and giving rise to insulin resistance and major disturbances in the secretion of insulin. We can improve Type 2 diabetes by compromising GIP action. The exclusion of proximal small intestine and reduction of GIP secretion may be the important reasons for Type 2 diabetes after gastric bypass surgery.
Animals ; Diabetes Mellitus, Type 2 ; complications ; surgery ; Diet, High-Fat ; adverse effects ; Gastric Bypass ; Gastric Inhibitory Polypeptide ; metabolism ; Humans ; Insulin ; metabolism ; Insulin Secretion ; Obesity ; surgery

Objective To explore the correlations of intracranial pressure (ICP) with changes of neuron specific enolase (NSE),D-Dimer (D-D) and C-reactive protein (CRP) levels in patients with severe traumatic brain injury.Methods A serial of 35 patients with severe traumatic brain injury,admitted to our hospital from January 2012 to January 2014,were chosen as experimental group,and 20 healthy subjects performed physical examination in our Physical Examination Center at the same period were as controls.ICP monitoring was performed in these 35 patients.The patents were divided into two groups according to ICP:severely elevated ICP group (＞40 mmHg) and moderately elevated ICP group (20-40 mmHg).The NSE,D-D and CRP levels were measured,and these data were compared with those from the control group.The correlations of ICP with changes of NSE,D-D and CRP levels were analyzed.Results The levels of NSE,D-D and CRP in the severely elevated ICP group and moderately elevated ICP group were obviously higher than those in the control group ([12.11 ±2.35] lg/L,[0.39±0.61] mg/L,[3.72±0.69] mg/L) (P＜0.05).The levels ofNSE,D-D and CRP in the severely elevated ICP group ([104.08±7.90] μg/L,[1.55±0.26] mg/L,[47.66±8.60] mg/L) were also obviously higher than those in the moderately elevated ICP group ([61.89±30.35] μg/L,[0.93±0.32] mg/L,[30.87±9.84] mg/L)(P＜0.05).Significant positive correlations were noted between ICP and changes ofNSE,D-D and CRP levels in the patient group (regression equation:ICP=18.598+0.256 NSE [t=7.200,P=0.000],ICP=10.779+23.955D-D [t=10.29,P=0.000],ICP=9.932+0.771 CRP [t=8.423,P=0.000]).Multivariant stepwise regression analysis indicated the closest correlation between ICP and D-D (multiple correlation coefficient=0.873,coefficient of determination=0.762,F=105.917,P=0.000).Conclusions Significant positive correlations can be noted between ICP and changes of NSE,D-D and CRP levels,and the closest correlation is between ICP and D-D in patients with severe traumatic brain injury.The combined application of ICP and NSE,D-D and CRP levels can promote the diagnosis and treatment of severe traumatic brain injury patients.

Objective To investigate the effect of laparoscopic Roux-en-Y gastric bypass(LYGB) on body fat distribution,and relationship between the changes of body fat distribution and improvement of insulin resistance.Methods A total of 65 patients with type 2 diabetes who underwent LYGB were selected for a retrospective analysis.Metabolic parameters,anthropometric measurements,body composition and fat distribution measured by dual-energy X-ray absorptiometry (DEXA) were collected separately before and 6 months post LYGB.All data of pre-and postoperation were compared with pair t test,Pearson correlation analysis was used to evaluate correlation of two variables.Results Weight,body mass index,waist circumference,waist-to-hip ratio,triglyceride,fasting plasma glucose,fasting insulin and homeostatic model assessment for insulin resistance (HOMA-IR) were significantly decreased in 6 months after surgery (P ＜ 0.05).Total fat mass,body fat mass of trunk,upper and lower limbs decreased significantly (P ＜0.05).Percent fat mass at the whole body,Android region,upper and lower limbs decreased significantly (P ＜0.05).After 6 months postoperatively,abdominal obesity indices waist circumfernce decreased from (98.10±13.03) cm to (91.60±7.68) cm (P＜0.01) and percent fat mass at the Android region decreased from (35.71 ±10.24)％ to (29.44 ± 12.11) ％ (P＜0.05),HOMA-IR decreased from 3.62 ± 5.18 to 1.79 ± 1.52 (P ＜ 0.05).The improvement of postoperative insulin resistance is positively correlated with the changes in waist circumference (P ＜0.01) and percent fat mass of Android region (P ＜0.05).Conclusions The body fat distribution changes after LYGB,change of abdominal fat distribution is positively correlated to the improvement of insulin resistance.