Objective To study the efficacy of minimally invasive treatment for lower extremities venous ulcers.Methods A total of 48 patients with lower extremities venous ulcers(56 hmbs)wereexamined with venography to identify the primary lesion that resulted ulcer. According to the type and degree of hemedynamie abnormality,high ligation of the great saphenous vein combined with endovenous laser treatment,subfascial endoscopic perforator surgery,and external banding valvuloplasty of the superficial femoral vein were done in 8 eases(8 limbs),high ligafion of the great saphenous vein combined with endovenous laser treatment and subfascial endoscopic perforator surgery were carried out in 24 cases(28 limbs),and high figation of the great saphenous vein combined with endovenous laser treatment was performed on 16 cases(20 linbs).In all cases,the ulcers were eircumferentially ligated at the same time.Results After the operations,superficial varicosis,pigmentations,and eczematous relieved remarkably in the 56 limbs.In 51 limbs,heavy feeling,ache,and edema disappeared 14-18 days after operation.The ulcers of the 56 limbs healed l6-48 days after operation.During 4 to 46 months follow up,ulcers recurred in 4 limbs(7.1%).Conclusions It is effective to correct the incompetence of the superficial,perforating,and deep veins and manage the surface of ulcers for lower extremities venous ulcers.Endovenous Iaser treatment and subfascial endoscopic perforator surgery are easily performing,minimally invasive,and safe operations.The recurrence of leg ulcers can be reduced by external banding valvuloplasty of the superficial femoral vein.

Objective To establish gastric bypass surgery model with SD rat and analyze the influence factors and preventive measures so as to accumulate experience and skills for further developing gastric bypass surgery model on diabetic rat( GK rat) . Methods Gastric by-pass surgery was operated on 30 SD rats. Summarized modeling experience and analyzed various factors affecting modeling success. Results 17 rats weresuccessfully survived after surgery and 13 failed, with the mortality rate 43. 3%. Three rats died during operation, including two for anesthesia and one for heart failure;one died due to anastomotic bleeding two hours after surgery. Eight died in the third day after surgery, including two for infection, two for intestinal necrosis, four for anastomotic stenosis or obstruction. One died because of anastomotic leakage caused by mistaking and satiety the fifth day after surgery. There were no other complications such as wound dehiscence occurred in this group . Conclusion Establishing models of gastric bypass surgery with SD rats which is regarded as pre-experiment of building models of gas-tric bypass surgery with GK rats is economical and feasible. Anesthesia and perioperative management, surgical techniques and infection pre-vention and control are the main factors affecting modeling. The survival rate of rat model could be increased if related factors well controlled.

Objective To explore impact of BMI on the clinical efficacy of treatment of type 2 diabetes mellitus after the laparoscopic gastric bypass. Methods Twenty patients were randomly selected from type 2 diabetes mellitus patients with BMI of 25 ~28 kg/m2 after laparoscopic gastric bypass surgery in our hospital from 2010 to 2013,20 patients from type 2 diabetes mellitus patients with BMI of 28~35 kg/m2 and 20 patients from type 2 diabetes mellitus patients with BMI≥35 kg/m2 . Accordingly,the total of 60 patients were divided into low BMI group,middle BMI group and high BMI group. The difference of the rate of blood glucose control and other indicators between three groups were compared and analyzed. Results The rate of blood glucose control in low BMI group was 75%,middle BMI group was 85%, and high BMI group was 90%. There was no statistical difference of the rate of blood glucose control between three groups at 12 months after laparoscopic gastric bypass surgery. The blood glucose and weight obviously improved in all patients,and fasting insulin and postprandial ser-um insulin decreased at 12 months after laparoscopic gastric bypass surgery. Conclusion All the patient of type 2 diabetes mellitus with dif-ferent BMI in three group can acquire satisfying clinical therapeutic effect after the laparoscopic gastric bypass.

Objective To explore the immune mechanism in the systemic lupus erythematosus MRL/lpr mice at different months of age, and to provide the basis for research of its pathogenesis. Methods 3-,4-,5- and 6-month old female MRL/lpr mice, and wild type C57 female mice were used in this study, 10 mice per each group. Their organ coefficients were determined. ELISA was performed to detect the serum levels of double stranded DNA(ds-DNA) antibody. The interleukins IL-2,IL-4,IL-17 and tumor necrosis factor-α(TNF-α)in spleen tissue were detected. Flow cytometry was used to assess the content of spleen lymphocyte CD3 cells and CD4/CD8 cell ratio. Results Compared with the 3-month old wild-type C57 mice,the spleen coefficient,the blood concentration of ds-DNA antibody,IL-2 and TNF-α in the 3- to 6-month old MRL/lpr mice were significantly increased(P < 0.05). There was no significant difference between the concentrations of interleukin IL-4(P> 0.05). The blood concentration of IL-17 in the 5- and 6-month old MRL/lpr mice was significantly lower(P < 0.05 or P < 0.01)than that in the 3-month old MRL/lpr mice. The rest indexes of MRL/lpr mice showed no obvious changes or significant difference in the mice at different ages. Compared with the 3-month old C57 mice,the spleen CD3 lymphocyte concentration in the MRL/lpr mice was significantly decreased(P< 0.01). With the increasing age, the CD3 lymphocyte concentration and D4 +/CD8 +cell ratio in the MRL/lpr mice were decreased, however, showing a non-significant difference(P ﹥0.05). Conclusions The data obtained in this study indicate that 3-month old lupus MRL/lpr mice have already immune injury,increasing with the increase of age of the mice.

Obesity and its complications, such as type 2 diabetes, hypertension, hyperlipidemia, nonalcoholic fatty liver, are serious global public health problems. Endoscopic sleeve gastroplasty (ESG) can reduce the length and width of the stomach by simulating the anatomical structure of surgical sleeve gastrectomy to reduce the capacity of the stomach, and is safe and effective to reduce weight. ESG has the advantages of non- invasiveness, no gastrectomy, repeatability, simple operation, no incision scar, few complications, short hospital stay and quick postoperative recovery. As an intermediate means of medical treatment and surgery, ESG provides a new method for weight loss for obese patients who cannot tolerate or are unwilling to undergo surgery. Herein we trace the origin of ESG, analyze the unique advantages of ESG suture, explore the technical improvement in the development of ESG, and briefly describe the weight reduction effect of ESG and compare the curative effect of ESG with laparoscopic sleeve gastrectomy. ESG has undergone rapid development and maturity but also faces such challenges as the lack of established standard procedures, unclear weight reduction mechanism, and clarification of the indications for operation. Still, ESG is expected to become the mainstream technique for weight reduction.
Diabetes Mellitus, Type 2 ; Gastrectomy ; Gastroplasty ; Humans ; Laparoscopy ; Obesity, Morbid ; Treatment Outcome ; Weight Loss

Intragastric balloon (IGB) placement under endoscopy is a non-invasive method for weight loss.By placing a space-occupying balloon in the stomach, IGB treatment can achieve better effect of weight loss than medications.Herein we review the development of IGB, its effect on weight loss and the mechanism, and the eligible individuals for IGB treatment.We also examine the high-intensity postoperative management following IGB placement, which is important for maintaining long-term weight loss, and discuss the future development of IGB.The patients should understand that on the basis of ensuring a high safety, the weight-losing effect of IGB can be limited and relies heavily on postoperative management.Patients should make a decision on IGB placement after careful consideration of their own physical, economic, and psychological conditions, lifestyle and the line of work in addition to the indications of IGB.IGB placement combined with high-intensity postoperative management and active interventions of lifestyle and dietary habits help to achieve long-term effect of weight loss and improve obesity-related complications.
Endoscopy ; Gastric Balloon ; Humans ; Life Style ; Obesity ; Obesity, Morbid/surgery* ; Treatment Outcome ; Weight Loss

OBJECTIVE: To evaluate the effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery for treatment of type 2 diabetes (TD) in patients with a body mass index (BMI) < 27.5 kg/m. METHODS: We retrospectively analyzed the data of patients who underwent LRYGB surgery from March, 2012 to June, 2018 in the General Hospital of Guangzhou Military Command and Jinshazhou Hospital of Guangzhou University of Chinese Medicine. The changes in the parameters of glucose metabolism and physical indicators of the patients in the first, second and third years after the surgery were analyzed in patients in low BMI group and high BMI group. RESULTS: All the 74 patients underwent LRYGB successfully without conversion to open surgery. One year after the surgery, fasting blood glucose (FBG), HbA1c, postprandial blood glucose, fasting insulin, HOMA-IR, fasting C-peptide, BMI, body weight and waistline were significantly improved compared with their preoperative values in low BMI group ( < 0.05). At 2 years after the operation, FBG, HbA1c, postprandial blood glucose, HOMA-IR, BMI, body weight and waistline were significantly improved compared with the preoperative values in low BMI group ( < 0.05). In the third year, FBG, HOMA-IR, fasting C-peptide, body weight and waistline were significantly improved compared with the preoperative values in low BMI group ( < 0.05). There was no significant difference in the parameters of glucose metabolism and islet function between low BMI group and high BMI group at different stages. No serious complications occurred in these patients after the surgery. CONCLUSIONS LRYGB is effective for treatment of T2D in Chinese patients with a BMI < 27.5. After the surgery, the patient show reduced waistline without significant weight loss. The long-term results of the surgery still require further investigations with a larger samples and longer follow-up.
Body Mass Index ; Diabetes Mellitus, Type 2 ; surgery ; Gastric Bypass ; statistics & numerical data ; Humans ; Laparoscopy ; Retrospective Studies ; Treatment Outcome ; Weight Loss

OBJECTIVE: To evaluate the effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery for treatment of type 2 diabetes (TD) in patients with a body mass index (BMI) < 27.5 kg/m. METHODS: We retrospectively analyzed the data of patients who underwent LRYGB surgery from March, 2012 to June, 2018 in the General Hospital of Guangzhou Military Command and Jinshazhou Hospital of Guangzhou University of Chinese Medicine. The changes in the parameters of glucose metabolism and physical indicators of the patients in the first, second and third years after the surgery were analyzed in patients in low BMI group and high BMI group. RESULTS: All the 74 patients underwent LRYGB successfully without conversion to open surgery. One year after the surgery, fasting blood glucose (FBG), HbA1c, postprandial blood glucose, fasting insulin, HOMA-IR, fasting C-peptide, BMI, body weight and waistline were significantly improved compared with their preoperative values in low BMI group ( < 0.05). At 2 years after the operation, FBG, HbA1c, postprandial blood glucose, HOMA-IR, BMI, body weight and waistline were significantly improved compared with the preoperative values in low BMI group ( < 0.05). In the third year, FBG, HOMA-IR, fasting C-peptide, body weight and waistline were significantly improved compared with the preoperative values in low BMI group ( < 0.05). There was no significant difference in the parameters of glucose metabolism and islet function between low BMI group and high BMI group at different stages. No serious complications occurred in these patients after the surgery. CONCLUSIONS LRYGB is effective for treatment of T2D in Chinese patients with a BMI < 27.5. After the surgery, the patient show reduced waistline without significant weight loss. The long-term results of the surgery still require further investigations with a larger samples and longer follow-up.
Body Mass Index ; Diabetes Mellitus, Type 2 ; Gastric Bypass ; Humans ; Laparoscopy ; Obesity, Morbid ; Retrospective Studies ; Treatment Outcome ; Weight Loss