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.

In the study, the inhibitory effect of epigallocatechin gallate (EGCG) on Calcium oxalate nephrolithiasis and its possible mechanism were investigated. The rat Calcium oxalate nephrolithiasis model was induced through the combined oral administration of ethylene glycol and ammonium chloride, which was intervened with EGCG. Rat blood samples were collected to detect blood creatinine (Cr), blood urea nitrogen (BUN) and blood calcium. Rat urine samples were collected to observe and compare 24-hour urine volume, oxalic acid (Ox) and calcium in urine. Renal samples were collected to prepare tissue slices and observe the pathological changes in Calcium oxalate nephrolithiasis. The expression of osteopontin (OPN) in renal tissues was evaluated by Real-time PCR and Western blot. According to the results, compared with normal rats, rats in the nephrolithiasis model showed significant increases in Cr, BUN, urine Calcium, urine Ox and renal OPN expression (P < 0.05), but obvious decrease in 24-hour urine volume (P < 0.05); Compared with rats with nephrolithiasis, those processed with EGCG revealed remarkable declines in Cr, BUN, urine Calcium and urine Ox (P < 0.05), with significant rise in 24-hour urine volume (P < 0.05) in a concentration-dependent manner. Additionally, compared with the control group, nephrolithiasis rats showed significant pathological changes in Calcium oxalate calculus. After ECCG treatment, the renal pathological changes and OPN expression attenuated significantly in a concentration-dependent manner. The results showed that EGCG inhibits the formation of calcium oxalate nephrolithiasis in rats and shows a notable protective effect on renal functions.
Animals ; Blood Urea Nitrogen ; Calcium ; blood ; Calcium Oxalate ; metabolism ; Catechin ; administration & dosage ; analogs & derivatives ; Creatinine ; blood ; Disease Models, Animal ; Humans ; Kidney ; drug effects ; metabolism ; Male ; Nephrolithiasis ; blood ; drug therapy ; genetics ; Osteopontin ; genetics ; metabolism ; Rats ; Rats, Wistar

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 study the effect of gadolinium chl oride hexahydrate (GDCL3) on the structure and lipid peroxide (LPO) of rat hep atocellular mitochondria during liver cold ischemia storage. 　Methods　Forty Wistar rats were randomized into 8 gr oups ( 5 in each group). Group 1～4 served as control. The other 4 groups were p retreated with GDCL3 (7mg/kg). The ultrastructures of hepatocellular mitocho ndria were observed by electron microscope and LPO of hepatocellular mitochondri a were investigated. 　Results　LPO o f hepatocellular mitochondria in group 1h, 2h, 3h pretreated with GDCL3 for 1、 2、 3 h were 1.0±0.3、1.7±0.2、2.0±1.0, LPO was suppressed sign ificantly compared with control group (2.2±1.0、2.8±1.0、3.5±1.0、 P<0.05). With time prclonging of liver storage, the damage of hepatocellular mitochondria ultrastructure became more severe and LPO of hepatocellular mitoch ondria increased significantly. Pretreated with GDCL3, the damage of hepatocel lular mitochondria ultrastructures were lessened and the elevation of LPO was s uppressed significantly (1 hour、 2 hours、3 hours，P<0.05). 　Conclusion　Mitochondria damage is one of the sensitive characters of liver cold ischemia injury, GDCL3 inhibits rat hepatoc ellular injury during liver cold ischemia storage.

Objective:To analyze immune mechanisms of total glycoside from Cornus officinalis (TGCO) against rheumatoid arthritis.Methods:Rat immunized by CⅡ in CFA were treated with TGCO ,at different times after immunization,CⅡ-specific antibodies in serum,lymphnode cells(LNC) IFN-? production was studied and cell proliferation response were also detected.Results:Treatment inhibit disease severity to a greater extent. TGCO effectively decreased anti-CⅡantibody titer in serum, considerably reduced IFN-? secretion before the onset arthritis and the acute stage of arthritis and suppressed T cell differentiation or proliferation.Conclusion:The both lead to supprese arthritis.

Objective To study the current research status of minichromosome maintenance protein 2 (MCM2), the cell cycle proliferation marker, in the diagnosis of colorectal carcinoma. Methods Literatures about the application of MCM2 in the study of colorectal carcinoma were collected and reviewed.Results MCM2, as a marker of cell dysplasia and malignancy, was usually used in the study of carcinoma. The study on expression of MCM2 in the cell of colorectum in different proliferational stage might help to screen colorectal carcinoma as early as possible. Conclusion As a relatively specific and sensitive marker of cell proliferation, MCM2 might become a promising mark for diagnosing colorectal carcinoma in the early stage.

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 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.