Bariatric and metabolic surgery has been in China for more than 30 years, which has developed rapidly. However, it can be predicted that there will be many opportunities and challenges in the future development of bariatric and metabolic surgery, including the replacement of classic surgical methods, the guarantee of surgical safety, the brave exploration of new surgical methods, the decisive abandonment of bad surgical methods, the implementation of surgical standardization, and the breakthrough of basic and clinical research all mean more efforts. With the continuous rise of the incidence rate of metabolic syndrome and the continuous improvement of people′s health needs, these opportunities and challenges are particularly significant. Bariatric and metabolic surgery will also play a crucial role in overcoming obesity and metabolic diseases.

To investigate the effect and mechanism of metformin on intestinal epithelial barrier injury in ulcerative colitis. A cell model of colitis was established by co-culture of human colon cancer cell line Caco-2 and human monocyte cell line THP-1. The colitis model cells were treated with metformin at concentration of for Flow cytometry was used to detect Caco-2 cell apoptosis, and Western blotting was used to detect the protein expression of tight junction proteins and endoplasmic reticulum stress-related proteins. After metformin treatment, the apoptosis rate of Caco-2 cells was decreased from (14.22±2.34)% to 0.61)% (=3.119, <0.05), and the expression levels of tight junction protein-1 and claudin-1 increased (=5.172 and 3.546, both <0.05). In addition, the expression levels of endoplasmic reticulum-related proteins glucose regulated protein (GRP) 78, C/EBP homologous protein (CHOP) and caspase-12, as well as the phosphorylation level of PRKR-like endoplasmic reticulum kinase (PERK) and eukaryotic translation initiation factor 2α (eIF2α) decreased (all <0.05). Metformin may alleviate the intestinal epithelial barrier damage in colitis by reducing intestinal epithelial cell apoptosis and increasing the expression of tight junction proteins, which may be associated with the inhibition of endoplasmic reticulum stress-induced apoptotic pathway.
Apoptosis ; Caco-2 Cells ; Colitis, Ulcerative ; Endoplasmic Reticulum Stress ; Humans ; Metformin/pharmacology*

Objective To observe the clinical efficacy of HE’s needling method (three ways for unblocking) in treating mild simple obesity due to dampness from spleen deficiency.Method Forty eligible subjects with mild simple obesity due to dampness from spleen deficiency were randomized into group A and group B, 20 cases in each group. Group A was intervened by mild unblocking method plus intensive unblocking method from HE’s needling method, and group B was by mild unblocking method plus warm unblocking method. The obesity-related indexes were observed before and after treatment, and the clinical efficacies were compared.Result The body weight and Body Mass Index (BMI) were significantly changed after intervention in the treatment group (P<0.05). The body weight was significantly changed after treatment in the control group (P<0.05). After treatment, there were no significant differences in comparing the obesity-related indexes (body weight, BMI, waist circumference, hip circumference, and waist-hip ratio) between the two groups (P>0.05). The total effective rate was 55.0% in the treatment group versus 10.0% in the control group, and the difference was statistically significant (P<0.01).Conclusion HE’s needling method is effective in treating mild simple obesity due to dampness from spleen deficiency, and mild unblocking method plus intensive unblocking method can produce a more significant efficacy compared to mild unblocking method plus warm unblocking method.

OBJECTIVEThe aim of this study was to investigate the value of free anterolateral thigh myocutaneous flap (ALTMF) and computed tomography angiography (CTA) for the reconstruction of mouth-floor defects after the resection of middle-late stage carcinoma of the mouth floor.

METHODSSixteen cases of middle-late stage carcinomas of the mouth floor underwent radical resection, and mouth-floor and tongue defects were reconstructed with ALTMF. CTA was applied to plan the lateral circumflex femoral artery (LCFA) and its perforating vessel, which was verified during the operation.

RESULTSThe position of the perforating vessel in the operation was fully consistent with that designed by the preoperative CTA. All 16 flaps completely survived. The appearance and function of all cases were both satisfactory. All donor sites were primarily closed and healed without functional morbidity. During the follow-up period of 6-36 months, 15 cases survived with acceptable aesthetic and functional results in mouth floor and tongue reconstruction, except for 1 case (T4N2M0) that died of metastasis carcinoma 10 months after operation.

CONCLUSIONCTA can accurately locate the LCFA and artery perforator. Preoperative perforator planning using CTA in ALTMF transplantation is a reliable and useful method thatresults in safe operation with optimal outcome. The ALTMF is an ideal choice for the reconstruction of soft tissue defects after the resection of middle-late staie carcinoma of the mouth floor

Angiography ; Carcinoma ; Free Tissue Flaps ; Humans ; Mouth Floor ; Myocutaneous Flap ; Patient Care Planning ; Reconstructive Surgical Procedures ; Thigh ; Tomography ; Tongue

OBJECTIVEThis study aims to evaluate the effect of customized titanium mesh, which was designed by mirror imaging and rapid prototyping technique, with Medpor applied for orbital fracture with enophthalmos.

METHODSOrbital axial, coronal, and sagittal CT scan, and three-dimension CT examination were performed routinely in. 18 cases of orbital fracture with enophthalmos preoperatively. Based on the CT data, prosthesis model was designed by reverse engineering and rapid prototyping technique. The customized titanium mesh and Medpor were applied for orbital reconstruction and enophthalmos correction. Orbital reduction and globe projection were evaluated by postoperative CT scan and clinical follow-up visits.

RESULTSCT scans revealed that the customized titanium mesh with Medpor had great accuracy to reconstruct the orbital fracture and correct the enophthalmos in all patients without serious complications. The eye and facial appearance and function recovered significantly. No serious complication occurred in the operation and after operation.

CONCLUSIONThe customized titanium mesh, based on mirror imaging and rapid prototyping technique, can accurately reconstruct the orbital fractures with enophthalmos. The application of Medpor can effectively correct enophthalmos and eyeball mobility malformation.

Enophthalmos ; therapy ; Facial Bones ; Humans ; Orbit ; Orbital Fractures ; surgery ; Polyethylenes ; Postoperative Period ; Prostheses and Implants ; Reconstructive Surgical Procedures ; Surgical Mesh ; Titanium ; Tomography, X-Ray Computed

Objective To observe the characteristics of different level of normal abdominal aorta’s time-flow,time-velocity curve and to investigate the hemodynamic factors in role of the occurrence and development of abdominal aorta’s disease.Methods PC-MRI scanning was performed on 60 normal volunteers T12/L1-L4/5 disc at the level of abdominal aorta,time-flow and time-veloci-ty curve were generated respectively.The characteristics of blood flow curves at different levels of abdominal aorta were observed. Results The time-flow,time-velocity curve of the normal abdominal aorta in different levels have 2nd phase (no diastolic reflux) and 3rd phase (diastolic reflux).Conclusion The characteristics of blood flow curves of different levels of abdominal aorta are dif-ferent.

Objective To explore the application value of PACS virtual print server in optimizing the working procedure in the Department of Radiology, and expanding and extending the conventional function of PACS. Methods PACS vir-tual print server was established, original PACS system and imaging equipment were connected, and its economic and social benefits were observed. Results After the application of PACS virtual print server, the working process was im-proved. It provided convenience for the patients, and at the same time improved the working efficiency and service quality in the Department of Radiology, realizing the double achievements of economic benefits and social benefits. The saving rate of films reached up to 18%, and the saving rate of papers was around 6%. Diagnostic reports of X ray and CT in emergency were obtained within 30 min;reports of X ray were obtained within 1h for normal examination;reports of CT and MRI were obtained in the same day afternoon if the examination was in the morning, and were obtained the next day morning if the examination was in the afternoon. Conclusion The application of PACS virtual print server pro-vides new function and value for PACS by optimizing the working procedure in the Department of Radiology and achieving integrated printing with demand. It improves the service quality in the Department of Radiology and enhances patients and clinicians'satisfaction.

ObjectiveThis?study?aims?to?evaluate?the?effect?of?customized?titanium?mesh,?which?was?designed?by?mirror?imaging?and?rapid?prototyping?technique,?with?Medpor?applied?for?orbital?fracture?with?enophthalmos.?Methods???Orbital?axial,?coronal,?and?sagittal?CT?scan,?and?three-dimension?CT?examination?were?performed?routinely?in?18?cases?of?orbital?fracture?with?enophthalmos?preoperatively.?Based?on?the?CT?data,?prosthesis?model?was?designed?by?reverse?engineering?and?rapid?prototyping?technique.?The?customized?titanium?mesh?and?Medpor?were?applied?for?orbital?reconstruction?and?enophthalmos?correction.?Orbital?reduction?and?globe?projection?were?evaluated?by?postoperative?CT?scan?and?clinical?follow-up?visits.?Results???CT?scans?revealed?that?the?customized?titanium?mesh?with?Medpor?had?great?accuracy?to?reconstruct?the?orbital?fracture?and?correct?the?enophthalmos?in?all?patients?without?serious?complications.?The?eye?and?facial?appearance?and?func-tion?recovered?significantly.?No?serious?complication?occurred?in?the?operation?and?after?operation.?Conclusion???The?custo-mized?titanium?mesh,?based?on?mirror?imaging?and?rapid?prototyping?technique,?can?accurately?reconstruct?the?orbital?fractures?with?enophthalmos.?The?application?of?Medpor?can?effectively?correct?enophthalmos?and?eyeball?mobility?malformation.

Objective The?aim?of?this?study?was?to?investigate?the?value?of?free?anterolateral?thigh?myocutaneous?flap?(ALTMF)?and?computed?tomography?angiography?(CTA)?for?the?reconstruction?of?mouth-floor?defects?after?the?resection?of?middle-late?stage?carcinoma?of?the?mouth?floor.?Methods???Sixteen?cases?of?middle-late?stage?carcinomas?of?the?mouth?floor?underwent?radical?resection,?and?mouth-floor?and?tongue?defects?were?reconstructed?with?ALTMF.?CTA?was?applied?to?plan?the?lateral?circumflex?femoral?artery?(LCFA)?and?its?perforating?vessel,?which?was?verified?during?the?operation.?Results???The?position?of?the?perforating?vessel?in?the?operation?was?fully?consistent?with?that?designed?by?the?preoperative?CTA.?All?16?flaps?completely?survived.?The?appearance?and?function?of?all?cases?were?both?satisfactory.?All?donor?sites?were?primarily?closed?and?healed?without?functional?morbidity.?During?the?follow-up?period?of?6–36?months,?15?cases?survived?with?acceptable?aesthetic?and?functional?results?in?mouth?floor?and?tongue?reconstruction,?except?for?1?case?(T4N2M0)?that?died?of?metastasis?carcinoma?10?months?after?operation.?Conclusion???CTA?can?accurately?locate?the?LCFA?and?artery?perforator.?Preoperative?perforator?planning?using?CTA?in?ALTMF?transplantation?is?a?reliable?and?useful?method?thatresults?in?safe?operation?with?optimal?outcome.?The?ALTMF?is?an?ideal?choice?for?the?reconstruction?of?soft?tissue?defects?after?the?resection?of?middle-late?stage?carcinoma?of?the?mouth?floor.

Objective To investigate the effects of three laparoscopic bariatric operations on relieving type 2 diabetes in morbid obese patients. Methods From 2005 to 2009, 15 morbid obese patients with type 2 diabetes received bariatric operations in Shengjing Hospital including lapband operation (7 cases) , sleeve gastrectomy (7 cases) and gastric bypass(4 cases). All patients were followed up for more than 1 year. Results All patients recovered without major complications. Body weight decreased and BMI was respectively (27. 6 ± 2. 0) kg/m2, ( 26. 9 ± 1. 4) kg/m2 and (27. 5 ± 3. 0) kg/m21 year after operation. The excess BMI loss in three groups were (76. 4% ± 6. 8% ) , (83. 7% ± 4. 6% ), (85. 7% ±9. 5% ) 1 year after operation. On the other side, the fasting glucose levels and glycohemoglobin in gastric bypass group were much lower than that in other two groups. Conclusion All these operations were effective in controling the weights and fasting glucose levels, while the gastric bypass method is better than other two methods in weight and serum glucose control. Sleeve gastrectomy was better in weight and glucose control than lap band operation.