BACKGROUND: Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting. METHODS: To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks. RESULTS: A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population ( P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment ( P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor. CONCLUSIONS Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.
Humans ; Male ; Retrospective Studies ; Diabetes Mellitus, Type 2/complications* ; Obesity, Morbid ; Anastomotic Leak/epidemiology* ; Gastrectomy/methods* ; Reoperation/methods* ; Registries ; Laparoscopy/methods* ; Treatment Outcome

Objective To study the clinical effects of the Tanreqing injection combined with Danshen-Chuanxiongqin injection for the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and its effects on plasma NO and endothelin-1 (ET-1) levels. Methods A total of 79 patients with AECOPD in our hospital from May 2014 to January 2017 were enrolled in this study. The subjects were randomly divided into the control group (n=39) and the combined therapy group (n=40). The control group were treated with Tanreqing injection, the combined therapy group were treated with Tanreqing injection combined with Danshen-Chuanxiongqin injection.The two groups were treated for 10 days.The clinical effects of the two groups after treatment were compared. The MPAP, PASP, PADP, PaO2, PaCO2, SaO2, NO and ET-1 of the two groups before and after treatment were compared. Results The total efficacy rate of the combined therapy group was 97.5% (39/40), which was significantly higher than 82.1% (32/39) of the control group (x2=5.178,P=0.023).After treatment,the MPAP(25.19 ± 8.71 mmHg vs.35.28 ± 9.52 mmHg,t=4.917),PASP (44.35 ± 12.26 mmHg vs.57.24 ± 11.17 mmHg,t=4.881),PADP(17.16 ± 4.05 mmHg vs.26.40 ± 3.85 mmHg, t=10.38),PaCO2(42.70 ± 6.31 mmHg vs. 51.44 ± 6.83 mmHg, t=5.910)of the combined therapy group were significantly lower than those of the control group(P<0.05).After treatment,the PaO2(73.95 ± 7.82 mmHg vs. 67.21 ± 7.16 mmHg,t=3.993),SaO2(94.86% ± 5.11% vs.83.63% ± 4.27%,t=10.586)of the combined therapy group were significantly higher than those of the control group (P<0.05). After treatment, the plasma NO (55.82 ± 10.08 μmol/L vs.46.34 ± 8.50 μmol/L,t=4.513)of the combined therapy groupwas significantly higher than the control group(P<0.05)and the plasma ET-1(80.41 ± 8.95 ng/L vs.87.68 ± 9.24 ng/L,t=3.552)of the combined therapy groupwere significantly lower than the control group (P<0.05). Conclusions The Tanreqing injection combined with Danshen-Chuanxiongqin injection showed good efficacy for the patients with AECOPD,and the therapy can reduce the pulmonary arterial hypertension and ET-1, improve the lung tissue oxygen supply and NO release, and improve the cardiopulmonary function.

Objective To investigate the risk factors contributing to hyperlipidemia and fatty liver in pilots.Methods Two hundred and forty-six pilots received the physical examination and were asked to fill out a questionnaire.Physical examination information included height,weight,abdominal ultrasonography result and blood lipid.The questionnaire included the pilots' age,flying hours time,physical exercise amount,working pressure,sleep condition,optimistic mood status,dietary habits,nutrition knowledge awareness,smoking and drinking habit.According to the results of physical examination,the pilots with hyperlipidemia and(or) fatty liver were selected as case group,and the pilots without hyperlipidemia or fatty liver were in control group.The scores of two groups were compared.According to the caculated BMI,pilots were also divided into normal(BMI 18.5-23.9 kg/m2)overweight(BMI 24 27.9 kg/m2) obesity(BMI＞27.9 kg/m2) groups.The differences on prevalence of hyperlipidemia and fatty liver were compared among different BMI groups.Results ①There were 225 valid questionnaires out of 246 pilots and the valid rate was 91.5％.There were 60 pilots had fatty liver and the prevalence of fatty liver was 26.7％(60/225).There were 42 pilots had hyperlipidemia and the prevalence of hyperlipidemia was 18.7％ (42/225).According to the physical examination,there were 138 pilots in control group and 87 pilots in case group.②In case group,pilots' age,daily cigarette consumption and daily alcohol consumption were higher than those in control group (Z=2.008,2.934,2.153,P＜0.05).The pilots' BMI of case group were higher than that of control group (t=35.793,P＜0.05).The scores of exercise and sleep of case group were lower than those of control group (t=19.518,5.701,P＜0.05).③The detection rates of overweight and obesity in case group were higher than those in control group (x2 =16.327,13.157,P＜0.05).The prevalence differences of hyperlipidemia and fatty liver were statistically significant among different BMI groups (x2 =37.505,P＜0.05).④The smoking and drinking rates of case group were higher than those of control group (x2 =8.636,4.497,P＜0.05).Conclusions The main risk factors of hyperlipidemia and fatty liver in pilots are obesity and lack of exercise.Other factors like age,sleepquality,smoking or drinking habit have certain extent impacts on the diseases.Pilots should strengthen the physical exercise and control BMI to effectively reduce the incidence of hyperlipidemia and fatty liver in order to prolong the pilot's flying career.

Objective To investigate the risk factors contributing to hyperlipidemia and fatty liver in pilots.Methods Two hundred and forty-six pilots received the physical examination and were asked to fill out a questionnaire.Physical examination information included height,weight,abdominal ultrasonography result and blood lipid.The questionnaire included the pilots' age,flying hours time,physical exercise amount,working pressure,sleep condition,optimistic mood status,dietary habits,nutrition knowledge awareness,smoking and drinking habit.According to the results of physical examination,the pilots with hyperlipidemia and(or) fatty liver were selected as case group,and the pilots without hyperlipidemia or fatty liver were in control group.The scores of two groups were compared.According to the caculated BMI,pilots were also divided into normal(BMI 18.5-23.9 kg/m2)overweight(BMI 24 27.9 kg/m2) obesity(BMI＞27.9 kg/m2) groups.The differences on prevalence of hyperlipidemia and fatty liver were compared among different BMI groups.Results ①There were 225 valid questionnaires out of 246 pilots and the valid rate was 91.5％.There were 60 pilots had fatty liver and the prevalence of fatty liver was 26.7％(60/225).There were 42 pilots had hyperlipidemia and the prevalence of hyperlipidemia was 18.7％ (42/225).According to the physical examination,there were 138 pilots in control group and 87 pilots in case group.②In case group,pilots' age,daily cigarette consumption and daily alcohol consumption were higher than those in control group (Z=2.008,2.934,2.153,P＜0.05).The pilots' BMI of case group were higher than that of control group (t=35.793,P＜0.05).The scores of exercise and sleep of case group were lower than those of control group (t=19.518,5.701,P＜0.05).③The detection rates of overweight and obesity in case group were higher than those in control group (x2 =16.327,13.157,P＜0.05).The prevalence differences of hyperlipidemia and fatty liver were statistically significant among different BMI groups (x2 =37.505,P＜0.05).④The smoking and drinking rates of case group were higher than those of control group (x2 =8.636,4.497,P＜0.05).Conclusions The main risk factors of hyperlipidemia and fatty liver in pilots are obesity and lack of exercise.Other factors like age,sleepquality,smoking or drinking habit have certain extent impacts on the diseases.Pilots should strengthen the physical exercise and control BMI to effectively reduce the incidence of hyperlipidemia and fatty liver in order to prolong the pilot's flying career.

The chromosome 17q21.31 inversion is a 900-kb common structural polymorphism found primarily in European population. Although the genetic flux within inversion region was assumed to be considerable suppressed, it is still unclear about the details of genetic exchange between the H1 (non-inverted sequence) and H2 (inverted sequence)haplotypes of this inversion. Here we describe a refined map of genetic exchanges between pairs of gene arrangements within the 17q21.31 region. Using HapMap phase Ⅱ data of 1,546 single nucleotide polymorphisms, we successfully deduced 96 H1 and 24 H2 haplotypes in European samples by neighbor-joining tree reconstruction. Furthermore, we identified 15 and 26 candidate tracts with reciprocal and non-reciprocal genetic exchanges, respectively.In all 15 regions harboring reciprocal exchange, haplotypes reconstructed by clone sequencing did not support these exchange events, suggesting that such signals of exchange between two sister chromosomes in certain heterozygous individual were caused by phasing error regions. On the other hand, the finished clone sequencing across 4 of 26 tracts with non-reciprocal genetic flux confirmed that this kind of genetic exchange was caused by gene conversion.In summary, as crossover between pairs of gene arrangements had been considerably suppressed, gene conversion might be the most important mechanism for genetic exchange at 17q21.31.

OBJECTIVETo discuss the mechanism of the traditional Chinese medicine Keyouling oral liquid in the treatment of condyloma acuminatum(CA) and the adjustment of cellular immunity function.

METHODSThe IL-18 and TNF-alpha levels of peripheral serum and wart tissue of patterned rats and CA patients exposed to Keyouling were determined by means of double-antibody sandwich ELISA, and the NK cellular activity of the spleen of the patterned rats and that of the peripheral blood of the CA patients exposed to Keyouling were determined by means of 3H-TdR isotype release.

RESULTSThe IL-18 and TNF-alpha levels, the NK cellular activity of the high-dosage group showed significant difference from those of the pattern group and low-dosage group in animal experiment(P < 0.05); the IL-18 and TNF-alpha levels of peripheral serum and wart tissues, and the NK cellular activity of the peripheral blood of the treatment group showed significant difference from those of the control group after treatment(P < 0.01, P < 0.05).

CONCLUSIONSKeyouling oral liquid has significant positive adjusting effect, which can markedly ameliorate the cellular immunadeficiency of the patterned animals and reinforce the cellular immunocompetence of CA patients.

Adolescent ; Adult ; Animals ; Condylomata Acuminata ; drug therapy ; immunology ; Female ; Humans ; Interleukin-18 ; blood ; Killer Cells, Natural ; drug effects ; immunology ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Rats ; Rats, Sprague-Dawley ; Tumor Necrosis Factor-alpha ; analysis