Background Roux-en-Y gastric bypass (GBP) is the main surgical procedure used in type 2 diabetes.The objective of this study was to evaluate the different types of GBP in treatment of type 2 diabetes.Methods Patients with type 2 diabetes were randomly divided into two groups:those who underwent gastrojejunal loop anastomosis bypass and those who underwent gastrojejunal Roux-en-Y bypass.Blood glucose alterations,operation time,and operation complicatiors were observed.Results Gastrojejunal loop anastomosis bypass and gastrojejunal Roux-en-Y bypass were both effective in the treatment of selected patients with type 2 diabetes.Compared with gastrojejunal Roux-en-Y bypass,gastrojejunal loop anastomosis bypass had the advantages of easier implementation,shorter operation time,and fewer operation complications.Conclusions Gastrojejunal loop anastomosis is effective in treatment of type 2 diabetes.It is safe,easy to implement,and worthy of clinical popularization.

Objective To investigate the morphological characteristics and types of ventricular wall with dysplastic development and their associations to primary cardiomyopathy.Methods Ninety-two hearts from heart transplant patients were studied soon after explanation from 2004 to 2007.Gross examination/measurement,histopathology and photography were performed.Results Dysplastic development of ventricular wail could be evidenced in patients with various heart diseases but more often in patients with primary cardiomyopathy,though the extension and distribution of dysplastic development of ventricular wall varied between patients with or without primary cardiomyopathy.Severe dysplastic development of ventricular wall is associated with clinical dysplastic cardiomyopathy.The range of extension and degree of dysplasia in the ventricular wall correlated positively to heart dilation/failure and time point of heart failure development.The incidence of severe vantricular wall dysplasia was 27.17% in all transplanted hearts and was 43.1%(25/58) in hearts diagnosed as primary cardiomyopathy (P＜0.05).The main pathological changes of dysplastic hearts were:(1) extensive proliferative hypertrophy of the heart wall,(2) fibrous/fat or fat/fibrous tissue replacement of normal myocardium,(3) disarrangement of myocardial fibers,(4)dysplastic change in the medium-sized intramural arteries.Dysplastic cardiomyopathy was presented mainly as a combination of several forms of dysplasia.The same clinical manifestations of dysplastic cardiomyopathy patients did not always show the same pathologic changes.Fibrous-fat tissue replacement was commonly found in dilated cardiomyopathy and arrhythmogenic right ventricular eardiomyopathy.Disarrangement of myocardium was often accompanied by hypertrophic cardiomyopathy.Dysplasia of intramural arteries could result in heart dilatation due to myocardial ischemia.Conclusion Dysplasia of ventricular wall is a common variation of heart structure.Only severe or diffuse types of dysplasia is associated with cardiomyopathy,especially primary cardiomyopathy.

Objective To evaluate the safety and efficiency of the dobutamine stress echocardiography in patients with hypertrophic cardiomyopathy and estimate the difference between provokable obstruction and resting obstruction in these patients.nethods Echocardiogarphy was performed in 22 patients with HCM(LVOTPG<50 mm Hg at rest, 1 mm Hg=0.133 kPa)at rest and at the end point of dobutamine stress.Dobutamine was administered via an infusion pump, starting at a dose of 5 μg·min-1·kg-1 and increasing every 5 minutes by 5μg·min-1·kg-1 till the maximum dose of 20μg·min-1·kg-1.Fifty-seven patients with HCM(LVOTPG>50 mm Hg at rest)were also studied at rest.Results In these 22 patients, the mean maximum velocity of LVOT was 5.39±1.60 m/s, the mean maximum LVOTPG was 125.7±62.4 mm Hg at the end point of dobutamine stress and the mean dose of dobutamine Was 13.90 ±6.85 μg·min-1·kg-1.Sixteen patients evidenced positive stress results at the end point of dobutamine stress.The main difference between the provokable obstruction and resting obstruction was that in provokable obstruction patients, the SAM positive patients were fewer and the proportion of Maron Ⅱ patients was higher(50%).Conclusions Dobutamine stress echocardiography Was a safe and sensitive way for detecting patients with hypertrophic cardiomyopathy.Provokable obstruction patients had fewer SAM and higher proportion of Maron Ⅱ.

Objective To analyze the status of quality indicators(QI) on specimen acceptability and establish preliminary qual ity specification.Methods Web based External Quality Assessment system was used to collect data of laboratories partici pated in "Medical quality control indicators in clinical laboratory" from 2015 to 2017,including once in 2015 and 2017 and twice in 2016.Rate and sigma scales were used to evaluate incorrect sample type,incorrect sample container,incorrect fill level and anticoagulant sample clotted.The 25th percentile (P25) and 75th percentile (P75) of the distribution of each QI were employed to establish the high,medium and low specification.Results 5 346,7 593,5 950 and 6 874 laboratories sub mitted the survey results respectively.The P50 of biochemistry (except incorrect fill level),immunology and microbiology reach to 6σ.The P50 of clinical laboratory is 4 to 6σ except for incorrect sample container.There is no significant change of the continuous survey results.Based on results in 2017 to establish the quality specification,the P25 and P75 of the four QIs is 0 and 0.084 4 ％,0 and 0.047 6 ％,0 and 0.114 2 ％,0 and 0.078 4 ％,respectively.Conclusion According to the results of the survey,most laboratories had a faire performance in biochemistry,immunology and microbiology,and clinical laboratory needs to be strengthened.Laboratories should strengthen the laboratory information system construction to ensure the actual and reliable data collection,and make a long time monitoring to achieve a better quality.