Patients with type 2 diabetes mellitus experience a complete and comfirm diabetic remission after bariatric surgery. Although weight-loss, reduction of food intake and other factors may play important roles in diabetic resolution after bariatric surgery, the major mechanism is the change in gastrointestinal hormones. Further research is essential to better understand these mechanisms and bariatric surgery may ultimately become a major tool in the treatment of type 2 diabetes mellitus.
Bariatric Surgery ; Diabetes Mellitus, Type 2 ; physiopathology ; surgery ; Humans

OBJECTIVETo assess the possibility of hydroxyapatite (HAT) nanoparticles as a gene vector for inner ear gene transfection.

METHODSThe HAT nanoparticles were prepared by the precipitation hydrothermal technique. DNA binding test under series of pH values and HAT concentrations were carried out by means of DNA electrophoresis to show the DNA binding and protective effect of the HAT nanoparticles. The cytotoxicity of HAT was evaluated via methyl thiazolyl tetrazolium assay (MTT) test with cultured Hela cells. The in vitro green fluorescent protein (GFP) reported transfection test and neurotrophin 3 (NT3) Western blot were completed with both Hela cells and primarily cultured mice cochlear neurons, so as to observe HAT mediated in vitro gene transfection efficiency and consequent NT3 gene expression. The complex consisting of HAT nanoparticles and recombinant plasmid with enhanced GFP and NT3 (HAT-pEGFPC2-NT3) was perfused perilymphatically into the cochlea of the guinea pigs with experimental excitotoxic inner ear damage. Inner ear NT3 gene expression was immunohistochemically demonstrated (DAB method) to evaluate the capability of HAT nanoparticles in mediating NT3 gene transfection in living animals and the possibility of future clinical application.

RESULTSWhen applied at the lowest concentration of 250 microg/ml and the pH values of 3-7, the 40-50 nm stick-shaped nanoparticles fully loaded the recombinant plasmid pEGFPC2-NT3, and well protected the genes from being destroyed by DNase I. Well biocompatibility between HAT nanoparticles and the cultured Hela cells had been confirmed by methyl thiazolyl tetrazolium assay (MTT) method when the concentration of HAT nanoparticles ranged from 62.5 microg/ml to 500 microg/ml. Immunofluorescence test of the report gene GFP revealed that the transfection efficiency of HAT nanoparticle vector in Hela cells was 15.7% +/- 2.6% (x +/- s). EGFP was immunofluorescently expressed by transfection of HAT-pEGFPC2-NT3 in the primarily cultured cochlear neurons of mice. NT3 immunohistochemical test showed many marked ganglion cells in the cochlea when perilymphatically transfected HAT-pEGFPC2-NT3 complex into the cochlea of guinea pigs with experimental excitotoxic inner ear damage in vivo.

CONCLUSIONSHAT nanoparticles can mediate NT3 gene transfection both in vitro and in the living animal's cochlea. As a non-viral gene vector without the risk of biological disaster, HAT nanoparticle vector is worthy of further fully researches although its transfection efficiency needs to be improved.

Animals ; Cochlea ; drug effects ; metabolism ; Drug Carriers ; Durapatite ; administration & dosage ; Ear, Inner ; drug effects ; metabolism ; Genetic Therapy ; Genetic Vectors ; Guinea Pigs ; HeLa Cells ; Humans ; Labyrinth Diseases ; therapy ; Mice ; Mice, Inbred Strains ; Nanoparticles ; Plasmids ; Transfection

OBJECTIVE: To analyze the main pathogens of infection after the liver transplantation and their antibiotic resistant patterns. METHODS: The main pathogens of infection after the liver transplantation were retrospectively analyzed. Using 3-dimensional tests, ESBLs (extended-spectrum beta-lactamase), and AmpC were detected among the Gram negative bacilli. beta-Lactamase and Van gene in Enterococcus were determined by the standard agar dilution susceptibility tests and Nitrocefin respectively. RESULTS: The main infected strains were Enterococcus faecalis (15.0%), Enterobacter cloacae (13.9%), fungus (13.3%), and Escherichia coli (10.7%) after the liver transplantation. Among them, 32.4% of Enterobacter cloacae and 36.8% of Escherichia coli produced ESBLs; 33.8% of Enterobacter cloacae and 10.5% of Escherichia coli. produced AmpC beta-lactamases. The detectable rate of VanA gene in Enterococcusfaecalis and Enterococcus faecium was 7.5% and 11.1%; VanB was 3.8% and 7.4%; VanC was 1.3% and 0, respectively. CONCLUSION The infection mainly occurs in the intestinal tract after the liver transplantation. The production of ESBLs and AmpC beta-lactamases is the main mechanism of antibiotic resistance. The increased detectable rate of vancomycin-resistant Enterococcus should be paid attention to.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Drug Resistance, Bacterial ; genetics ; Enterobacteriaceae ; drug effects ; enzymology ; isolation & purification ; Enterobacteriaceae Infections ; microbiology ; Female ; Humans ; Infant ; Liver Cirrhosis ; surgery ; Liver Neoplasms ; surgery ; Liver Transplantation ; adverse effects ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Postoperative Complications ; microbiology ; Retrospective Studies ; Vancomycin Resistance ; genetics

OBJECTIVE: To investigate the toxicology and biodynamics of silica nanoparticle. METHODS: The silica nanoparticles were injected into mice through tail vein, and the mice were amphimixised, the urine was collected in different time, variations of pathology in organs and tissues of the mice were detected. At the same time, the silica nanoparticles' distribution in the tissues was observed through electron microscope. RESULTS: The silica nanoparticles were detected in all tissues and urine of the mice. The injected mice can reproduce as normal. CONCLUSION The silica nanoparticles do not have toxicity and can be used in vivo.
Animals ; Female ; Male ; Materials Testing ; Mice ; Nanostructures ; toxicity ; Rats ; Silicon Dioxide ; pharmacokinetics ; toxicity ; Tissue Distribution ; Transfection

OBJECTIVE: To evaluate the effect of anti-inducible costimulator monoclonal antibody (anti-ICOS-Ab) combined with low-dose cyclosporine (CsA) on the survival quality and chronic rejection of heart allografts in rats. METHODS: The rats' heterotopic cardiac transplantation model was established by Ono's method. The recipient rats were randomly divided into an isotransplantation control group and an allotransplantation experiment group. The experiment group was re-classified into a placebo group, a normal-dose CsA group, an anti-ICOS-Ab group, a low-dose CsA group, and an anti-ICOS-Ab combined with low-dose CsA group. The survival time of grafts was monitored. The cardiac grafts were harvested for histological analysis. Flow cytometric analysis was employed to detect the population of CD25+CD4+ in peripheral lymphocytes from recipients with a long-term surviving graft. RESULTS: The survival time of the cardiac allografts in CsA-treated groups was significantly longer than that in placebo group (P<0.05). The survival time of the cardiac allografts in anti-ICOS-Ab combined with low-dose CsA group was significantly longer than that in low dose CsA-treated group (P<0.05). There was no significant difference in the survival time of the cardiac grafts between the anti-ICOS-Ab group and the placebo group (P>0.05). Compared with the normal-dose CsA group, the chronic rejection lesions of the anti-ICOS-Ab combined with low-dose CsA treatment group significantly were alleviated in the long-term survival grafts, and the proportion of CD4+CD25+ regulatory T cell increased in peripheral blood. CONCLUSION The anti-ICOS-Ab combined with low-dose CsA can prolong the survival of cardiac allografts and alleviate the chronic rejection significantly. The high expression level of CD4+CD25+ regulatory T cell is beneficial to the long-term survival of grafts.
Animals ; Antibodies, Monoclonal ; therapeutic use ; Antigens, Differentiation, T-Lymphocyte ; immunology ; Chronic Disease ; Cyclosporine ; administration & dosage ; therapeutic use ; Drug Therapy, Combination ; Graft Rejection ; drug therapy ; Graft Survival ; drug effects ; Heart Transplantation ; adverse effects ; Inducible T-Cell Co-Stimulator Protein ; Random Allocation ; Rats ; T-Lymphocytes, Regulatory ; immunology

Type 2 diabetes is a high-profile global public health problem, particularly in Asia. The young age of onset, low body mass index, and early appearance of pancreatic islet dysfunction are characteristics of Asian patients with T2DM. Metabolic surgery has become the standard treatment for T2DM patients and can significantly improve T2DM through a variety of mechanisms including modulation of energy homeostasis and reduction of body fat mass. Indeed, restoration of islet function also plays an integral role in the remission of T2DM. After metabolic surgery, islet function in Asian T2DM patients has improved significantly, with proven short-term and long-term effects. In addition, islet function is an important criterion and reference for patient selection prior to metabolic surgery. The mechanism of islet function improvement after metabolic surgery is not clear, but postoperative anatomical changes in the gastrointestinal tract leading to a number of hormonal changes seem to be the potential cause, including glucagon-like peptide-1, gastric inhibitory polypeptide, peptide YY, ghrelin, and cholecystokinin. The authors analyzed the current retrospective and prospective studies on the effect of metabolic surgery on the islet function of Asian T2DM patients with a low BMI and its mechanism, summarized the clinical evidence that metabolic surgery improved islet function in Asian T2DM patients with a low BMI, and discussed its underlying mechanism. It is of great significance for realizing personalized and precise treatment of metabolic surgery and further improving its clinical benefits.
Bariatric Surgery ; Body Mass Index ; Cholecystokinin/therapeutic use* ; Diabetes Mellitus, Type 2/surgery* ; Gastric Inhibitory Polypeptide/therapeutic use* ; Ghrelin/therapeutic use* ; Glucagon-Like Peptide 1/therapeutic use* ; Humans ; Peptide YY/therapeutic use* ; Prospective Studies ; Retrospective Studies ; Treatment Outcome

OBJECTIVESOrthotopic liver transplantation (OLT) is an accepted therapy for selected patients with advanced liver diseases. However, the early mortality rate after OLT remains relatively high due to the poor selection of candidates with various serious conditions. The aim of this study is to assess the value of pretransplantation artificial liver support treatment in reducing the pre-operation risk factors relating to early mortality after OLT.

METHODS50 adult patients in various stages of different etiologies who underwent OLT procedures had been treated with molecular adsorbent recycling system (MARS) preoperatively. The study was designed in two parts: the first one was to evaluate the effectiveness of a single MARS therapy by using some clinical and laboratory parameters which were supposed to be therapeutical pretransplantation risk factors. The second part was to study the patients undergoing OLT by using the regression analysis on preoperation risk factors relating to early (within 30 d after OLT) mortality rate.

RESULTSAmong the 50 patients, a statistically significant improvement of the biochemical parameters was observed (pretreatment vs posttreatment). 8 patients cancelled their scheduled LTXs due to significant improvements in their clinical conditions or recovery of their failing liver functions. 8 patients died and 34 patients successfully underwent LTX. The immediate outcome (within 30 postoperative days) of these 34 patients was that 28 were kept alive and 6 died.

CONCLUSIONSPreoperation sequential organ failure assessment (SOFA), level of creatinine, INR, TNFalpha, and IL-10 are the main preoperative risk factors relating to early death after an operation. MARS treatment before a transplant operation can relieve these factors significantly, hence improve survival rate of liver transplantation or even make the transplantation unnecessary.

Aged ; Factor Analysis, Statistical ; Female ; Humans ; Interleukin-10 ; blood ; Liver Cirrhosis ; surgery ; Liver Neoplasms ; surgery ; Liver Transplantation ; methods ; Liver, Artificial ; Male ; Middle Aged ; Preoperative Care ; Risk Factors ; Treatment Outcome ; Tumor Necrosis Factor-alpha ; blood

OBJECTIVE: To evaluate the safety and feasibility of the domestic surgical robot in clinical applications.METHODS: From March 2014 to January 2019, 103 domestic robot-assisted laparoscopic surgeries were performed in Department of General Surgery, Third Xiangya Hospital of Central South University. The clinical features, operation and postoperative results were collected and analyzed. The patients were followed up for 1 month. RESULTS: Among 103 cases, 2 cases(2%) trasfered to open surgery. Two patients(2%) required intraoperative blood transfusion and no postoperative blood transfusion. Intraoperative complications occurred in 2 cases(2%) which were bladder injury and ureteral injury respectively. Postoperative complications occurred in 2 cases(2%) which were anastomotic leakage and pelvic infection. There was no reoperation during hospitalization. All patients were discharged smoothly. There were no re-admissions and deaths within 30 days after surgery. CONCLUSION: Domestic surgical robots are safe and feasible in clinical applications,which needs further verified by multicenter, randomized controlled trials.