Type 2 diabetes can be treated by gastrointestinal surgery, but the underlying mechanism is unclear. This review summarizes the possible mechanisms which include weight loss, gastrointestinal hormones, foregut hypothesis, hindgut hypothesis, adipocytokines, and inflammatory factors.
Diabetes Mellitus, Type 2 ; metabolism ; physiopathology ; surgery ; Digestive System Surgical Procedures ; Gastric Bypass ; Gastrointestinal Hormones ; metabolism ; Humans ; Weight Loss

Background Increasingly,evidence from population,clinic-based and laboratory studies supports an independent association between obstructive sleep apnea syndrome (OSAS) and an increased risk of type 2 diabetes; however,this observation has yet to be replicated in China and the potential mechanisms that link these two conditions are not clear.Methods A total of 179 Han Chinese subjects were enrolled in this study.All subjects underwent polysomnography,the oral glucose tolerance-insulin releasing test (OGTT-IRT) and serum HbA1c measurement.Indexes including homeostasis model assessment-IR (HOMA-IR),Matsuda index,HOMA-β,early phase insulinogenic index (△I30 / △G30),AUC-I180 and oral disposition index (DIo) were calculated for the assessment of insulin resistance and pancreatic β-cell function.Results Based on OGTT,25.4％,44.6％ and 54.5％ subjects were diagnosed having glucose metabolic disorders respectively in control,mild to moderate and severe OSAS groups (P ＜0.05).Serum HbA1c levels were highest in subjects with severe OSAS (P ＜0.05).In contrast,compared with normal subjects,HOMA-β,△I30/△G30 and DIo were lower in severe OSAS group (P ＜0.05).In stepwise multiple linear regressions,0-min glucose and HbA1c were positively correlated with the percentage of total sleep time below an oxyhemoglobin saturation of 90％ (T90) (Beta =0.215 and 0.368,P ＜0.05); 30-min and 60-min glucose was negatively correlated with the lowest SpO2 (LSpO2) (Beta =-0.214 and -0.241,P ＜0.05).HOMA-β and Dlowere negatively correlated with T90 (Beta =-0.153 and-0.169,P ＜0.05) while body mass index (BMI) was the only determinant of HOMA-IR and Matsuda index.Conclusions OSAS is associated with impairment in glucose tolerance and pancreatic β-cell function in Han Chinese subjects while insulin sensitivity is mainly determined by obesity.

OBJECTIVETo investigate long-term survival after multivisceral resection in patients with locally advanced right colon cancer.

METHODSThe clinical data and survival of 13 patients with locally advanced right colon cancer were retrospectively analyzed.

RESULTSThere were 8 males and 5 females with a mean age of 58.6 years. Location of the primary tumor included hepatic flexure(n=6), transverse colon(n=2), and ascending colon(n=5). Three patients had duodenal invasion alone, 9 had involvement of duodenum and other organs, and 1 had pancreas and stomach involvement. Right colectomy and pancreaticoduodenectomy and(or) resection of other organs were performed. The 1-, 3-, and 5-year survival rates were 69%, 54%, and 30%, respectively.

CONCLUSIONRight colectomy combined with multivisceral resection is a promising procedure for selected patients with locally advanced colon cancer.

Adult ; Aged ; Colonic Neoplasms ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo explore the metabolism-related risk factors of cholelithiasis among residents in Beijing.

METHODSThe clinical data including previous disease history, findings of physical examination, and results of cholecystosonography of 2270 patients with cholelithiasis identified in the Health Screening Center of Peking Union Medical College Hospital between August 2007 and August 2010 were retrospectively reviewed (the case group). Meanwhile, 4336 healthy individuals during the same period were randomly chosen as the control group.

RESULTSTotal cholesterol, triglyceride, low-density lipoprotein cholesterol, fasting blood glucose, body mass index, and systolic blood pressure were positively correlated with the incidence of cholelithiasis (P < 0.05), while high-density lipoprotein cholesterol was negatively correlated (P < 0.05). Diastolic blood pressure showed no association with cholelithiasis (P > 0.05).

CONCLUSIONCholelithiasis is resulted from multiple factors including elevated blood lipids, blood glucose, and systolic blood pressure among residents in Beijing.

Adult ; Aged ; Blood Glucose ; Blood Pressure ; Case-Control Studies ; China ; epidemiology ; Cholelithiasis ; epidemiology ; metabolism ; Female ; Humans ; Lipids ; blood ; Male ; Middle Aged ; Risk Factors

OBJECTIVETo analyze the risk factors of colorectal cancer-related anemia.

METHODThe clinical data of 319 patients with colorectal cancer were retrospectively analyzed for the possible risk factors of tumor-related anemia including tumor location, clinical stage, clinical symptoms, pathology, gender, and age.

RESULTSOf these 319 cases, 141 (44.20%) had anemia. The incidence of anemia was 62.20% among patients with right hemicolon cancers (including caecum cancer), and was 23.82% among patients with rectal cancer and 36.23% among those with transverse descending or sigmoid colon cancer. Cardia insufficiency, melena, tumor location, T staging, hypoproteinemia were also found to be related with anemia. Anemia and hypoproteinemia were the risk factors for perioperative blood transfusion (odds ratio = 3.004, odds ratio = 8.356, respectively).

CONCLUSIONSThe colorectal cancer-related anemia is not associated with the clinical stage of the tumor, while cardiac insufficiency, melena, tumor location, tumor stage, and hypoproteinemia constitute the possible risk factors. Anemia and hypoproteinemia are the risk factors of perioperative blood transfusion.

Adult ; Aged ; Aged, 80 and over ; Anemia ; etiology ; Colorectal Neoplasms ; complications ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors

Objective To improve the protocols of red blood cells ( RBCs) processing devices ( automatic medical RBC centrifuge, type:BBS926).Methods RBCs separated from 400 ml of whole blood collected from healthy donors were frozen at -80℃.After thawing , the cells were processed by the washing device .Based on the original protocol ( protocol 1), a modified protocol (protocol 2) was established and used to evaluate the quality of the frozen RBCs .In the test group (protocol 2), the amount of washing buffers and the washing steps were revised to form the optimized protocol .RBCs processed with the two protocols were evaluated by different assays .Results The indexes from the standards for frozen-thawed RBCs: the amount of hemoglobin ( Hb) of RBCs from protocol 1 and protocol 2 was 37.55 ±3.58 and 42.18 ±3.35 g(P<0.05),respectively;the amount of free hemoglobin(FHb) was 0.51 ±0.08 g/L and 0.53 ±0.07 g/L (P>0.05);the residual amount of white blood cells (WBCs) was (1.90 ±0.99) ×107 and (1.92 ±1.04) ×107(P>0.05);The osmolarities were 334 ±8.03 mOsm and 327 ±9.06 mOsm(P>0.05);both the bacteria and fungi tests were negative for the RBCs processed with the two protocols .Among other indexes ,the hemolysis rate for RBCs from protocol 1 and protocol 2 was (12.44 ±8.24)%and (12.02 ±5.78)%(P>0.05), the deformation index was 21.40 ±1.41 and 21.42 ±1.45 (P>0.05), the RBC recovery was(72.02 ±3.70)%and (77.18 ±5.58)%(P<0.05),the cell apopto-sis rate was(1.12 ±0.54)%and (1.10 ±0.61)%(P>0.05),and the processing time was (79.00 ±0.71)min and (79.60 ±0.55)min (P>0.05).Conclusion The RBCs processed by the two protocols meet the national standards for frozen-thaw RBCs.Hb amounts and cell recoveries of the RBCs are enhanced by treatment with protocol 2.Protocol 2 proves to be better than protocol 1.

OBJECTIVETo investigate the anatomic characteristics of splenic flexure, surgical techniques, and oncologic outcomes in 52 patients with non-obstructive splenic flexure colon cancer.

METHODSClinical data of 52 patients with non-obstructive splenic flexure colon cancer from March 2004 to March 2011 in the Department of General Surgery at the Henan Province Tumor Hospital were analyzed retrospectively.

RESULTSThere were 37 patients of regular type, 5 of mobile type, and 10 of adhesive type. All the patients received radical operation. Eighteen patients received pre-small intestine anastomosis, including 12 cases with regular type, 4 with mobile type, and 2 with adhesive type. The difference in pre-small intestine anastomosis among the three types was not statistically significant(P=0.062). In addition, 32 cases received retro-ileum anastomosis. There were no significant differences in operative time, intraoperative blood loss, number of lymph node dissection and positive lymph node, and postoperation complication rate among the three types. Follow up was available in all the cases. Five-year survival rates of cases with regular type, mobile type and adhesive type were 62.5%, 59.2% and 58.7% respectively(P>0.05).

CONCLUSIONSRadical resection can provide satisfactory survival for splenic flexure colon cancer patients. The anatomy of splenic flexure does not affect the type of anastomosis. Retro-ileum anastomosis is a simple and effective method for reconstruction after radical resection of the tumor.

Adult ; Aged ; Anastomosis, Surgical ; Colon, Transverse ; anatomy & histology ; pathology ; surgery ; Colonic Neoplasms ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Objective To understand the status and influential factors of those neglect of left-behind children in rural area,and to provide bases for the development of intervention measures.Methods 2917 students were selected as the study subjects from Changfeng county of Anhui province with cluster sampling method and were evaluated by a Parents-Child Conflict Tactics Scales and questionnaire on influential factors.Results 1694 left-behind children,accounted for 58.1％ of the total students,were surveyed in this investigation.The prevalence rates of neglect,among total children,left-behind children,non-left-behind children were 67.4％,70.2％,63.5％,respectively.The prevalence of neglect among left-behind children was higher than that among non-left-behind children (x2=14.322,P＜0.000).There were no significant associations with the neglect rate of left-behind children regarding gender or age differences.Result from multivariate logistic regression analysis indicated that the neglect among the left-behind children were associated with family dysfunction(OR values of moderate and serious family dysfunctions compared to good family function were 1.628 and 2.341,respectively)and the rate of keeping in touch with parents(OR values of sometimes and seldom keeping in touch compared to regular in touch were 1.299 and 1.844,respectively).The starting age of being left-behind(OR values of starting age that being left-behind from 6 to 10 and ≤5 years relative to starting age of left-behind ≥11 years were 0.703 and 0.630,respectively)appeared to be the protection factor to the neglect of those left-behind children.Conclusion Our findings indicated that the status of neglect among the left-behind children was serious.Prevention programs on the issue should target on a number of factors,including the characteristics of the chldren them-selves,as well as on the family of the children.

Objective To investigate the clinical efficacy and safety profile of astragalus injection combined with decitabine injection in the treatment of myelodysplastic syndromes (MDS).Methods According to admission,67 patients with MDS were divided into treatment group (n =38) and control group (n =29).The control group was given the decitabine injection 25 mg · m-2,daily intravenous drip for 1 h from the first day to the fifth day at each course (4 weeks a course).Treatment group was treated with astragalus injection 30 mL on the basis of control group.Both groups were treated for 4 courses.The clinical efficacy,white blood cell (WBC) count,platelet count,cluster of differentiation 34(CD34) and CD117 levels,and the adverse drug reactions were compared between the two groups.Results After treatment,the total effective rate of the treatment group and the control group were 65.79％ (25 cases/38 cases) and 41.38％ (12 cases/29 cases),the differences were statistically significant (P ＜ 0.05).After treatment,the WBC counts of the treatment group and the control group were (2.82 ±0.42) × 109/L,(2.31 ± 0.26) × 109/L;while the platelet counts were (92.51 ± 17.09) × 109/L and (82.01 ± 10.07) × 109/L;the CD34 expression rates were (7.91 ± 1.88) ％ and (9.13 ± 2.54) ％,respectively,the expression rate of CD117 (9.02 ± 1.63)％ and (10.01 ± 1.53)％,and the differences between the two groups were statistically significant (P ＜ 0.05).The median survival time of treatment group and control group were (32.29 ±9.00),(27.17 ± 10.53) months,the median progression free survival were (22.91 ± 6.61),(21.26 ± 10.02) months,and the differences were statistically significant (P ＜0.05).The adverse drug reactions in the treatment group were nausea and vomiting (5 cases) and fever (3 cases),while those in the control group were nausea and vomiting (6 cases) and fever (5 cases),infection (1 case),liver and kidney injury (1 case).The incidences of adverse drug reactions of the treatment group and the control group were 21.05％ (8 cases/38 cases) and 44.83％ (13 cases/29 cases),with statistically significant difference (P ＜0.05).Conclusion Astragalus injection combined with decitabine injection was effective and safe,it could promote the maturation and differentiation of myeloid cells.

OBJECTIVETo study the prevalence of tumor related anemia in patients with cancer in the digestive system.

METHODSA total of of 10 218 inpatients were diagnosed with cancer in the digestive system at the Peking Union Hospital from January 2000 to June 2009, which included esophageal cancer(n=1118), gastric cancer(n=2418), carcinoma of duodenum(n=134), carcinoma of small intestine(n=85), hepatocellular cancer(n=1508), cholangiocarcinoma(n=546), pancreatic cancer (n=1242), colon cancer(n=1582), and rectal cancer(n=1585). Patients with hemolytic anemia or hepatorenal dysfunction were excluded. Data pertaining to sex, age and hemoglobin were obtained by chart review.

RESULTSAccording to the China criteria of anemia, the overall anemia rate was 27.5% (2813/10 218). The prevalence of anemia was 64.7% for small bowel cancer, 60.5% for duodenal cancer, 42.6% for colon cancer, 36.6% for cholangiocarcinoma, 33.3% for gastric cancer, 22.6% for pancreatic cancer, 20.4% for rectal cancer, 18.7% for hepatocellular cancer, and 10.0% for esophageal cancer. Anemia was more common in older patients in those with gastric cancer, cholangiocarcinoma, pancreatic cancer, colon cancer and rectal cancer. There were more male anemic patients in those with cancer in the small intestine or cholangiocarcinoma. However, females were more commonly seen in those with hepatocellular cancer or pancreatic cancer.

CONCLUSIONSAnemia is common in patients with cancer in the digestive system. The prevalence of anemia is higher in patients with cancer in the duodenum carcinoma or small intestine, followed by colon cancer and gastric cancer, and then esophageal cancer. Anemia may be associated with age or gender in some types of cancer in the digestive system.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anemia ; complications ; epidemiology ; China ; epidemiology ; Digestive System Neoplasms ; complications ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult