Objective To explore the causes of congenital hypothyroidism by single photon emission computed tomography(SPECT) thyroid imaging.Methods Nineteen cases with congenital hypothyroidism were collected,and SPECT thyroid imaging was performed 15 minutes late after injected 99m TcO_ 4- 18.5-37.0 MBq.Results Five cases were found with normal glands,1 case with enlarged thyroid, 2 cases with enlarged thyroid and increased radiation,4 cases with ectopic thyroid,4 with a hypogenetic thyroid,and the last 3 cases showed no thyroid imaging.Conclusions The causes of congenital hypothyroidism can be found by SPECT thyroid imaging,which is important to the diagnosis of congenital hypothyroidism combined with detection of T_3,T_4,TSH.

Objective To evaluate the effects of prostaglandin E1 (PGE1) and low-dose dopamine on renal function during orthotopic liver transplantation (OLT) .Methods Eighteen ASA Ⅲ-Ⅳ patients with end-stage liver diseases undergoing OLT were randomly divided into two groups of 9 patients each : PGE1 group (group P) and low-dose dopamine group (group D). Anesthesia was induced with midazolam 0.1-0.2 mg?kg-1 , fentanyl 5 ?g?kg-1 and pipecuronium 0.1 mg?kg1 and maintained with isoflurane inhalation and intermittent i.v. boluses of fentanyi and pipecuronium. The patients were mechanically ventilated after tracheal intubation. PGE1 was infused at 0.4-0.8?g? kg-1 ? h-1 in group P and dopamine at 1 -3 ?g ? kg-1? min in group D after induction until the end of operation. Swan-Ganz catheter was inserted via right internal jugular vein or subclavian vein and radial artery was cannulated. MAP, ECG, CVP, SvO2 , cardiac output ( CO), SpO2 , PET CO2 and core temperature were continuously monitored during operation. Venous blood samples were taken and urine was collected before induction of anesthesia (T1 .baseline), during preanhepatic (T2) anhepatic (T3) and neohepatic phases (T4) and at the end of operation (T5) for determination of serum creatinine (Cr) concentration and serum and urine concentration of ?2 -microglobulin (?2-MG). Creatinine clearance ratio (CCr) was calculated. Total urine output during operation and urine output and the amount of furosemide given during anhepatic phase were recorded. Core body temperature was maintained above 35.5℃ during operation. Veno-venous bypass (VVB) was performed during anhepatic phase.Results In group P, compared to baseline there were no significant changes in MAP, Cr and CCr duringoperation, while serum ?2-MG decreased significantly at T5 and urine ?2-MG increased significantly at T3-5 . In group D serum ?2-MG was significantly decreased while urine ?2 -MG significantly increased at T2.5 compared to baseline. There was significantly more urine output during anhepatic phase and the whole operation and less furosemide was given in group D than in group P. Conclusion Low dose dopamine is more effective in protecting renal function during OLT than PGE1 .

Objective To evaluate the effects of ulinastatin on proinflamatory cytokines and oxygen free radical during orthotopic liver transplantation (OLT). Methods Eighteen ASA Ⅲ-Ⅳ patients with end-stage liverⅣ diseases, undergoing OLT were randomly divided into two groups: (1) ulinastatin group received intravenous infusion of ulinastatin 2? 105 IU in 100 normal saline after skin incision and every 4 hours thereafter (group U n = 9); control group received same amount of normal saline instead of ulinastatin (group C n = 9). Anesthesia was induced with midazolam 0.1-0.2 mg?kg-1 , fentanyl 5 ?g?kg-1 and pipecuronium 0.1 mg?kg-1 and maintained with isoflurane inhalation and intermittent iv boluses of fentanyl and pipecuronium combined with epidural anesthesia(T8.9). The patients were mechanically ventilated with 100% O2 and PETCO2 was maintained at 35-40 mm Hg during operation. Swan-ganz catheter was inserted via right internal jugular or subclavian vein after induction of anesthesia. Cardiac output, mixed venous oxygen saturation and central venous temperature were continuously monitored with continuous cardiac output monitor (Baxter, Vigilance). ECG,CVP,SpO2 and PETCO2 were also continuously monitored during operation. Radial artery was cannulated for continuous direct blood pressure monitoring. Blood samples were taken before skin incision (T0), 120 min after skin incision (T1), 30 min after liver was removed ( anhepatic phase) (T2) , 5 min and 60 min after reperfusion of the graft (T3 , T4) and at the end of operation (T5 ) for determination of plasma IL-6, IL-8, TNF-? and MDA concentration. Body temperature was maintained above 35.5℃ during operation. Venovenous bypass was performed during anhepatic phase. Results (1) In group C plasma IL-6 and Ⅱ-8 concentrations were significantly increased from T1-5 during operation as compared with the baseline values (T0), whereas plasma levels of TNF-? and MDA did not change significantly before and during anhepatic phase (T1 , 2) but were significantly increased during neohepatic phase and at the end of surgery (T3 ,45) as compared with the baseline values (T0).(2) In group U plasma IL-6, IL-8, TNF-? and MDA concentrations were not significantly increased during operation, except that plasma IL-6 and IL-8 concentrations were significantly higher at T3 (5 min after reperfusion of the graft) than the baseline values. Conclusion Ulinastatin inhibits release of proinflammatory cytokines and reduces production of oxygen free radicals during OLT.

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.

Decontamination ; methods ; Gastric Lavage ; methods ; Humans ; Poisoning ; therapy

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 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 .

Objective To explore the clinical characteristics,diagnosis and therapeutic strategies of acute appendicitis in pregnancy.Methods The clinical data of 45 cases with acute appendicitis in pregnancy,which had been diagnosed by surgeries in our hospital since Jan 2010 to Jun 2016,were retrospectively analysed.Results All patients had exhibited abdominal pain.Among them,15 patients(33.3％)had exhibited shifting pain in right lower quadrant,and 44 patients(97.8％)had abdominal tenderness.4 cases with appendiceal gangrene and 1 case with necrosis of the great omentum had been found during the surgeries.There were 5 patients had occurred complications after the surgeries,including 2 cases with poor wound healing,1 case with septic shock,1 case with inflammatory ileus and 1 case with incompletely adhesive ileus.Threatened abortion and threatened premature delivery were found in 11 patients(during 22+3 to 36+2 weeks gestation)after the surgeries.Finally,1 patient occurred abortion(25+3 weeks gestation)and 3 patients occurred premature delivery(during 28+4 to 30+4 weeks gestation).Conclusion Abdominal pain as the main clinical manifestations of the pregnancy with acute appendicitis,prone to severe complications.

Rotavirus capsid protein Vp4 plays an important role in the virus adhering and entering the cells. In this study, a Vp4 gene cloned from a rotavirus strain TB-Chen was highly expressed in E.coli BL21 (DE3). The results of the Western blot showed that the protein possesses specific immuno-reactivities and can be specifically recognized by guinea pig antibodies against rotavirus strain SA11 or Wa. Some Vp4 dimers were formed during renaturation. These data obtained from this study provide a strong basis for further study on the structure and function of the Vp4.