0.05).In the elderly group,every complication rates of LR were lower than those of OR(P

Objective To compare the difficult degree,differences in gastric pouch volume,the complications,and postoperative weight loss effect of two gastric pouch practices in laparoscopic gastric bypass for bariatrics.Methods We retrospectively analyzed laparoscopic gastric bypass surgery in 76 bariatrics cases from May 2010 to May 2012.Two methods were used to create gastric pouch,among which 39 cases were operated with the dissection landmark method (called dissection),and 37 cases with bougie airbags 30 ml (called the bougie).Parameters were compared between the 2 groups including operation time for gastric pouch,the amount of staple cartridges,intraoperative complications,blood loss,and postoperative excess weight loss percentage (EWL ％),the postoperative bleeding,obstruction,fistula and other complications.Results All patients were followed up for more than one month.The dissection group used longer time in creating gastric pouch than that in the bougie group [(58 ± 27) min,(42 ±21) min,P ＜ 0.01].The number of staple cartridges used were significantly different between the two groups [(6.2 ±3.0),(4.3 ± 2.0),P ＜ 0.01].There were 10 cases of complications in the dissection group (26％),and 3 cases in the bougie group (8％) (P ＜0.05).One month after the surgery,one each patient had transient hematochezia.There was no gastric pouch-related complications in the two groups postoperation.There was no difference in excess weight loss (P ＞ 0.05).Conclusions The two methods can achieve the same effect on excess weight loss.The bougie method used less time in creating the gastric pouch,less consumable materials,and less complications occurred in creating gastric pouch.

Objective To investigate the clinical significance of CD28 expression on peripheral blood T lymphocytes in children with juvenile idiopathic arthritis (JIA).Methods Flow cytometry and tri-color direct immunofluorescence were used to examine CD3 + T lymphocyte subsets and CD28 expression in whole blood (using the no-wash method) from 36 children with JIA.Results During the active phase of disease,the frequency of CD28 + expression on both CD4 + and CD8 + T cells in the peripheral blood of children with JIA was significantly lower than in normal controls (P ＜ 0.01).The frequency of CD4 + CD28-T cells in the peripheral blood of children with JIA was significantly higher than in normal controls (P ＜ 0.01).CD4 + T cell counts in the peripheral blood of children with JIA,which were mostly of the CD4 + CD28-T cell subtype,were significantly higher than in normal controls (P ＜ 0.01),whereas the CD8 + T cell count was significantly reduced (P ＜0.01).During the resting phase,CD4 +/CD8 + T cell counts and CD28 expression in the peripheral blood of children with JIA were significantly different from normal controls (P ＞ 0.05).Conclusions The frequency of CD4 + CD28-T cells can be used as an indicator of the active phase of JIA.CD4 + T cell and CD4+ CD28-T cell apoptosis was inhibited in JIA patients.These immune-active T lymphocytes with continued survival can promote the occurrence and development of JIA.

Objective To study the identification of rare Nocardiaotitidiscaviarum and its drug sensitivity .Methods Morpho-logical ,physiological and biochemical phenotype identification methods combined with 16S rRNA sequence analysis were employed to identified the bacteria strains .Broth method was used to detect their drug sensitivity .Results The clinically isolated Nocardia strain was identified as Nocardiaotitidiscaviarum which was resistant to piperacillin ,erythromycin ,ceftazidime ,cefoperazone ,gen-tamicin ,cefoxitin ,piperacillin/tazobactam ,and was sensitive to vancomycin ,levofloxacin ,imipenem ,etimicin ,ciprofloxacin ,amika-cin ,sulfamethoxazole .Conclusion 16S rRNA gene sequence analysis can be used to identify Nocardia otitidiscaviarum ,and sulfa drugs shows good therapeutic effect .

Objective To explore the incidence,clinical features,causes,treatment method and risk factors of 30-day readmission after bariatric and metabolic surgery.Methods The retrospective case-control study was conducted.The clinical data of 631 obese patients who underwent bariatric and metabolic surgery in the First Affiliated Hospital of Nanjing Medical University from May 2010 to May 2016 were collected.All the 631 patients underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB).Patients were followed up by outpatient examination and telephone interview for 1 month to detect readmission of patients up to June 2016.Observation indicators:(1) 30-day readmission situations after bariatric and metabolic surgery:cases with readmission,readmission time,clinical features,causes and treatment of readmission;(2) risk factors analysis affecting 30-day readmission after bariatric and metabolic surgery.Measurement data with skewed distribution were described as M (range).The univariate analysis and multivariate analysis were respectively done using the chi-square test and Logistic regression model.Results (1) Thirty-day readmission situations after bariatric and metabolic surgery:among 631 patients receiving postoperative 1-months follow-up,21 had 30-day readmission,with an incidence of 3.33％ (21/631),including 13 males and 8 females;10 received LSG and 11 received LRYGB.The median readmission time of 21 patients was 12 days (range,4-30 days).Of 21 patients,nausea,vomiting and dehydration of the main manifestations were detected in 11 patients,gastrointestinal bleeding in 6 patients,high fever in 2 patients,bowel obstruction in 1 patient and abdominal pain in 1 patient.The causes of the readmission of 21 patients:8 had improper food intake including 5 with premature solid food intake,1 with premature semi-fluid food intake,1 with irritating food intake and 1 with swallowing whole tablets;3 had postoperative over-anxiety;1 had Petersen hiatal hernia;1 had anastomotic ulcer;1 had anastomotic edema;1 had abdominal abscess.Of 6 patients with uncertain causes,4 had gastrointestinal bleeding and didn't receive endoscopy;1 had postoperative unexplained abdominal pain and underwent laboratory and imaging examinations and gastroscopy,showing no trouble finding;1 had high fever,and no abnormality was detected by imaging examination.Of 21 patients,19 underwent conservative treatment (rehydration and acid suppression) and then discharged from hospital after improvement,without readmission;1 with abdominal abscess was cured after emergency debridement and drainage;1 with Petersen hiatal hernia was cured by emergency surgery.The median duration of hospital stay in 21 patients with readmission was 7 days (range,3-40 days).(2) Risk factors analysis affecting 30-day readmission after bariatric and metabolic surgery:the results of univariate analysis showed that gender,preoperative adephagia habit and duration of postoperative hospital stay were related factors affecting 30-day readmission after bariatric and metabolic surgery (x2 =5.330,6.498,4.574,P＜0.05).The results of multivariate analysis showed that male and preoperative adephagia habit were independent risk factors affecting 30-day readmission after bariatric and metabolic surgery (OR=2.489,2.912,95％ confidence interval:1.006-6.161,1.196-7.088,P＜0.05).Conclusions Nausea,vomiting and dehydration are common manifestations of patients with 30-day readmission after bariatric and metabolic surgery,and it might be associated with improper food intake.Male and preoperative adephagia habit are independent risk factors affecting 30-day readmission after bariatric and metabolic surgery.

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 observe the adjuvant therapy efficacy of Saccharomyces boulardii sachets in liver cirrhosis patients with spontaneous bacterial peritonitis(SBP).Methods 72 liver cirrhosis patients with SBP were randomly divided into the observation group and control group.The patients in the control group (30 cases) were giv-en routine medical treatment such as anti-infection,correction of hypoproteinemia,liver protection,and diuresis,etc. At the base of the control group,the patients in the observation group (32 cases) were orally given Saccharomyces boulardii ( Baili Pharmaceutical Factory,French) 0.5g for one time,two times daily for 10 days.The changes of serum interleukin-6(IL-6),pmcalcitonin (PCT) and hypersensitive c-reactive protein (hs-CRP) levels in the two groups were observed and compared before and after treatment, and curative effect and safety were also observed. Results Before treatment,the serum IL-6,PCT and hs-CRP levels in the two groups had no obviously statistical difference(all P>0.05),but after treatment,the serum IL-6,PCT and hs-CRP levels of the observation group were much lower than those of the control group[(60.50 ±19.10) pg/mL vs (98.32 ±17.20) pg/mL,(1.80 ± 0.34)μg/L vs (6.38 ±3.56)μg/L,(6.20 ±4.15) mg/L vs (20.28 ±8.30) mg/L,t=8.147,7.246,8.529,all P<0.01].Meanwhile,the total effective rate of the observation group was significantly higher than that of the control group(93.75%vs 73.33%,χ2 =4.771,P<0.05).The incidence rate of DAR between the two groups had no obvi-ously statistical difference(9.38% vs 13.33%,χ2 =0.242,P>0.05).Conclusion Saccharomyces boulardii can significantly reduce serum IL-6,PCT and hs-CRP levels of liver cirrhosis patients with SBP,and reduce inflamma-tion reaction to control development of SBP.

Objective To translate the Personal Diabetes Questionnaire(PDQ),and test the relia bility and validity of the Chinese version of PDQ.Methods Through forward translation,back translation,cultural adjustment,etc.,the Personal Diabetes Questionnaire (PDQ) was introduced to localize it.60 eligible patients with diabetes were selected in a tertiary hospital to make a preliminary investigation.The results were statistically analyzed in order to assess the reliability and validity of the Chinese version of PDQ.Results The Chinese version of PDQ had good reliability,whose total internal consistency coefficient was 0.831 and test-retest reliability was 0.801.The questionnaire has good validity.Total Content Validity Index was 0.938.I-CVI was between 0.800 and 1.000.The questionnaire's dimensions had good parallel validity with glycosylated hemoglobin (HbAlc) and body mass index (BMI).Conclusions The Chinese Version of the personal diabetes questionnaire has good reliability and validity,which can be widely used as the evaluation tool of diabetes self-management education.

Objective To design an appropriate preoperative questionnaire in Chinese bariatric surgery.Methods Bariatric surgery center carried out laparoscopic bariatric operation from January 2010,preoperative questionnaire before the operation were supplied.Till January 2014,a total of 401 patients replied to the survey.The questionnaires were designed through three stages:translated from the Cleveland Clinic (USA) and applied in 30 patients for the first survey; adjustments and changes to the contents of the questionnaire for 90 patients according to Chinese conditions in the second phase; in the third stage,the third edition questionnaire was used in 281 patients.The satisfaction degree of the doctors and patients about the content of the questionnaire was evaluated.Results For the three versions of the questionnaire,the doctor satisfaction rate was 73.3％,86.7％ and 96.8％.Patients' satisfaction rate of three versions were 30.0％,40.0％,76.9％,not satisfactory rate was 20.0％,11.1％,2.8％.Conclusions The current preoperative questionnaire includes 11 categories with 101 items of the third edition,doctors and patients satisfaction rate is higher,and it is suitable for Chinese bariatric surgery.