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

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 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 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 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 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.

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.