Bariatric and metabolic surgery is an effective treatment for obesity and metabolic syndrome with definite results. In recent years, bariatric and metabolic surgery has developed rapidly, and the surgical indications and procedures have gradually matured. At the same time, the complications have also been widely discussed, including those specific to bariatric metabolic surgery and the risks common to gastrointestinal surgery, of which gastrointestinal leak is one of the most important and serious complications, which can be life-threatening in severe cases. This paper will review the mechanisms, clinical manifestations, diagnostic strategies, prevention, and treatment advances related to gastrointestinal leak after bariatric metabolic surgery based on the two major procedures that cause gastrointestinal leak, namely, staple line leak after laparoscopic sleeve gastrectomy and gastrojejunostomy leak after laparoscopic Roux-en-Y gastric bypass.

Objective; To explore mechanism of Zhongjiling tablet treats experimental autoimmune myasthenia gravis on rats. Methods:Normal mice, immunosuppressive mice and EAMG rats were used to investigate the mechanism. Results:Zhongjiling tablet enhanced T and B cells proliferation of normal mice and immunosuppressive mice induced by ConA or LPS, and increased the production of IL-2. T cell proliferation of EAMG rats was improvement stimulated by AChR and decline by ConA. Zhongjiling tablet inhibited the improvement by AChR and enhanced the decline by ConA, and reduced the expression of IFN-? and IL-4 mRNA. Zhongjiling tablet also induced the apoptosis of CD4 + T lymphocyte stimulated by AChR. Conclusion: Zhongjiling tablet increased immunity of normal mice, immunosuppressive mice and EAMG rats. But it suppressed specific T lymphocyte proliferation induced by AChR and reduced the expression of IFN-? and IL-4 mRNA. It was probably one of mechanisms Zhongjiling tablet induced the apoptosis AChR specific CD4+T lymphocyte.

Objective　To investigate the effect of congenital human cytomegalovirus（HCMV） infection on the growth of embryo and cerebral cortex. Methods　HCMV (6.0 log TCID50 in 1.0 ml/mice) was separately injected into the intraperitoneum of 10-week-old female mice on pre-mating, 3, 7, 15 gestation days. Cerebral cortices of fetuses were collected by laparotomy on 19th gestation-day just before delivery. The specimens were fixed with 4% buffered solution of paraformal dehyde. And then sectioned and stained with HE. Meanwhile, part of the specimens was used for viral isolation and HCMV DNA test by PCR. Results　In the cerebral cortex of fetal mice, it was found that the capillary was dilated and congested, and the parenchyma was infiltrated with neutrophils, monocyte for experimental group and not for control group. The degeneration, necrosis and apoptosis of neurons co-existed. The rates of virus isolation for the fetal cerebral cortex among pre-mating, 3-, 7-, 15-gestation-day groups were 60%、62%、67%、25%,respectively （χ2=13.475，P＜0.05) and the rate for 15 gestation-day group was significantly lower than others. Average weight of experimental mice for 15-gestation-day was significantly lower than control group and those for other gestation groups were not significantly different on group t-test. Conclusion　HCMV can replicate in the cerebral cortex of ICR mice, infect fetal and initiate congenital infection of cerebral cortex of fetus. In addition, embryo of different gestation stages can be infected by HCMV on experiment. HCMV delays embryo growth and causes the cerebral cortex damage.

Objective To analyze laboratory turnaround time (TAT) and find effective ways to shorten TAT.Methods Data associated with cardiac panel (CK,cTnI and Mb) were collected in 2011 including 19 906 outpatient data and 22 973 inpatient data.The medians and the average medians of the quality indicators on TAT were calculated and the results were transformed to the Six Sigma scale to estimate the degree of control over related process.Processes were considered well controlled when σ ≥4.Based on the results of data analysis,an improvement plan was decided by laboratory quality management meeting and clinical communication meeting.The effect of the improvement plan was evaluated through 2011-2012 satisfaction surveys of outpatients and clinicians.Results The average median of overtime reports for outpatient from specimen collection to reception was 2.78％ (3.5σ),and 17.82％ (2.5σ) for inpatients.The average median of overtime reports for outpatient from specimen reception to result reporting was 3.39％ (3.4σ),and 2.96％ (3.4σ) for inpatients.The average median of overtime reports for outpatient from specimen collection to result reporting was 3.93％ (3.3σ),and 12.18％ (2.7σ) for inpatient.The results of TAT satisfaction surveys for outpatients from 2011 to 2012 were similar,which were 78％ in 2011 and 79％ in 2012; the results for clinicians showed an increase from 80％ in 2011 to 90％ in 2012,including an increase from 75％ to 79％ for very satisfaction choice.Conclusions Outside the laboratory TAT is a key step in sickroom patients delay TAT.The implementation for ten improvement suggestions enabled to shorten TAT effectively.

Objective To study on the changes of the IL-6、IL-8、TNF-? in the type 2 diabetes with insulin resistance and the relation of plasma glucose or insulin resistance and cytokines. Methods (1) To assay the serum level of cytokines in 90 cases with type 2 diabetes mellitus (T2DM) and 30 normal controls. (2)To measure the level of fasting plasma glucose (FPG),hemoglohin A_1c (HBA_1c),fasting insulin(FINS),fasting C-peptide (FCP).(3) To analysis the relation of the level of FPG,HBA_1c,FINS,FCP and cytokines. Results (1) The serum levels of cytokines in T2DM group were significantly increase than in control groups,IL-6 and TNF-? in T2DM group with insulin resistance were significantly increase than in T2DM group without insulin resistance (2) There was significantly positively correlated between insulin resistance and the increasing of cytokine levels. Conclusion There is an excess activation of cytokines in T2DM,which is significantly correlated with insulin resistance. Cytokines play the important role in the occurrence and development of T2DM and insulin resistance.

Objective:To explore a new way of nursing teaching round-making compatible with the nursing students at junior college,and to establish and improve the standards for its assessment.Methods:We performed a new mode of nursing teaching ward round jointly organized by nursing teachers of the school and clinical supervisors of the hospital among student nurses of Grade 2006 on four different subjects respectively,by going through the following four steps: establishing the subject,working out the plan,making the ward round and assessing the quality.Results:The average score on the quality assessment of the four subjects by teachers and students was 93.78.Conclusion:The new mode of nursing teaching ward round jointly organized by the school and hospital can make the best of nursing faculty resources,give full play to nursing students'potential and optimize this activity and facilitate the teaching of clinical nursing.

Objective: To explore an integral training mode for student nurses in large modern general hospitals.Methods: Integral nursing training was conducted in our hospital among 610 student nurses from universities and postsecondary specialized colleges.Results: All the student nurses considered the integral training to be helpful for the promotion of their professional nursing competence.Conclusion: The professional competence-oriented integral nursing training can optimize the teaching quality of clinical nursing and help enhance the professional competence and comprehensive qualities of student nurses.

Objective To summarize the experience on treatment of esophageal leiomyoma and mesenchymoma with video-assisted thoracoscope under the assistance of a fiber gastroscope.Methods The clinical data of 14 cases of esophageal leiomyoma and 2 cases of esophageal mesenchymoma treated with video-assisted thoracoscope under the assistance of fiber gastroscope from October 2004 to December 2009 was retrospectively analyzed.Selected different surgical path and operation hole position according to the lesion site.Fiber gastroscope was conductive to accurately find lesion positions,and detected esophageal mucosa was breaked or not.Extra-mucosal excision was conducted in 16 cases.Results Ihere was no death and severe complications during perioperative period.Patients were diagnosed by pathological examination.Thirteen cases were followed up for 6-48(18.5 ±9.5)months,all patients ate unobstructed,and without relapse.Conclusion Treatment of esophageal leiomyoma and mesenchymoma with video-assisted thoracoscope under the assistance of fiber gastroscope has the advantages of intraoperative accurate positioning,minimally invasive,thoroughly,fewer complications,and it is the first choice of esophageal benign tumor treatment.

Noninvasive early diagnosis of colorectal cancer is conducive for patients to reduce the mortality rate and their suffering from diagnosis procedures.One of the most significant methods to proceed noninvasive early diagnosis of colorectal cancer is analysis of stool DNA.Extracting high quality and great quantity of human genomic DNA from stools guarantees diagnosis accuracy.However,the complexity of stool component hinders DNA extraction.Hence,it is crucial to develop highly efficient extraction methods of human genomic DNA from stools for the DNA analysis-based early diagnosis of colorectal cancer.Currently,two kinds of extraction strategies are employed:one is to directly extract total DNA from stools,the other is to enrich exfoliated colonocytes in stools before DNA extraction.This article reviews the advances on these two kinds of extraction techniques and summarizes their applications.

Objective To investigate the efficacies of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery in the treatment of patients with different body mass indexes (BMI) and type 2 diabetes mellitus.Methods The clinical data of 40 patients with type 2 diabetes mellitus who underwent LRYGB surgery at the Shengjing Hospital of China Medical University from January 2013 to December 2013 were retrospectively analyzed.According to different BMI,8 patients with BMI ＜ 27.5 kg/m2 were allocated into group 1,14 patients with BMI≥27.5 kg/m2 and ＜32.5 kg/m2 in group 2 and 18 patients with BMI≥32.5 kg/m2 in group 3.Forty patients were followed up via telephone interview and food habits questionnaire by weight loss file managers of Shengjing Hospital and the fourth Affiliated Hospital of China Medical University.All the patients received the reexamination of blood test and data collection at postoperative year 1.The preoperative and postoperative 1-year fasting plasma glucose,glycosylated hemoglobin (HbA1 c),BMI and C-peptide were collected and detected.The fasting plasma glucose ＜ 7.00 mmol/L and HbA1 c ＜ 7.00％ were used as a standard of complete remission.Count data and comparison of rates were analyzed using the chi-square test.Measurement data with normal distribution were presented as x ± s and analyzed by the t test.Skew distribution data were described as M (range) and analyzed by the Wilcoxon rank sum test.Repeated measurement data were analyzed by the repeated measures ANOVA.Results Forty patients received successful LRYGB surgery without perioperative complications,and were followed up for 1 year at the Shengjing Hospital (23 patients),the fourth Affiliated Hospital (8 patients) and other hospitals (9 patients).Of the 40 patients,85.0％ (34/40) of patients had no postoperative long-term obvious malnutrition,anastomotic stenosis,ion disorders and digestive tract dynamic obstacles,15.0％ (6/40) of patients were not adapted to the change of life habits such as frequent nausea and vomiting.Five patients with different degrees of frequent vomiting,abdominal pain and night heartburn within postoperative 1 month had the remission of synptoms after symptomatic treatment.One patient in group 2 had a symptom of hypertonic coma due to intake of oral high-sugar drinks at postoperative 1 week and then was cured by hospitalization.The fasting plasma glucose,HbA1c and BMI in group 1 from preoperation to postoperation were decreased from 11.07 mmol/L (range,6.00-17.00 mmol/L) to 7.18 mmol/L (range,6.00-15.00 mmol/L),from 8.85％ (range,6.00％-11.00％) to 6.35％ (range,6.00％-9.00％) and from 26.0 kg/m2 (range,22.0-27.0 kg/m2) to 22.2 kg/m2 (range,20.0-25.0 kg/m2),with significant differences (F =2.413,3.256,6.750,P ＜ 0.05).C-peptide from preoperation to postoperation was decreased from 1.20 nmol/L (range,1.00-3.00 nmol/L) to 1.07 nmol/L (range,1.00-2.00 nmol/L),with no significant difference (F =1.678,P ＞ 0.05).The remission rate of diabetes in group 1 was 3/8.The fasting plasma glucose and HbA1c in group 2 from preoperation to postoperation were decreased respectively from 10.73 mmol/L (range,7.00-19.00 mmol/L) to 5.89 mmol/L (range,5.00-9.00 mmol/L) and from 8.00％ (range,6.00％-15.00％) to 5.85％ (range,5.00％-8.00％).The BMI from preoperation to postoperation was decreased from 31.0 kg/m2 (range,29.0-32.0 kg/m2) to 25.5 kg/m2 (range,21.0-29.0 kg/m2),with significant differences in the above 3 indexes (F =5.449,4.008,-3.296,P ＜ 0.05).C-peptide from preoperation to postoperation was decreased from 1.53 nmol/L (range,1.00-5.00 nmol/L) to 1.52 nmol/L (range,1.00-6.00 nmol/L),with no significant difference (F =-0.251,P ＞ 0.05).The remission rate of diabetes in group 2 was 10/14.The fasting plasma glucose,HbA1c and BMI in group 3 from preoperation to postoperation were decreased from 9.44 mmol/L (range,5.00-16.00 mmol/L) to 6.65 mmol/L (range,4.00-15.00 mmol/L),from 7.90％ (range,6.00％-11.00％) to 6.45％ (range,5.00％-9.00％) and from 36.9 kg/m2 (range,33.0-47.0 kg/m2) to 27.7 kg/m2 (range,23.0-34.0 kg/m2),with significant differences (F =-3.027,-3.410,-3.724,P ＜ 0.05).C-peptide from preoperation to postoperation was decreased from 2.91 nmol/L (range,0.00-9.00 nmol/L) to 2.13 nmol/L (range,0.00-6.00 nmol/L),with no significant difference (F =-3.724,P ＞ 0.05).The remission rate of diabetes in group 3 was 14/18.There was no significant difference in the remission rate of diabetes of 3 groups (x2 =4.460,P ＞ 0.05).There were significant differences in the changing trends of fasting plasma glucose and BMI among the 3 groups (F =3.200,22.500,P ＜ 0.05).There were no significant differences in the changing trends of HbA1c and C-peptide among the 3 groups (F =0.720,1.640,P ＞ 0.05).Conclusion LRYGB surgery is feasible for the treatment of type 2 diabetes mellitus with effectively decreasing fasting glucose,and should be performed on patients with BMI ≥ 27.5 kg/m2 instead of patients with BMI ＜ 27.5 kg/m2 according to a correlation of blood glucose control and preoperative BMI.