Bariatric surgery is an effective method for the treatment of obesity and type 2 diabetes mellitus. Morbidly obese patients usually have metabolic syndromes, as such, surgeons need to choose the reasonable surgical methods for patients according to their individuality and particularity. Hiatal hernia is a very common disease prevalent in obese patients and could induce gastroesophageal reflux, which increases the difficulty of bariatric surgery and proposes higher demands on choice of surgical methods to surgeons. It is important to recognize the presence of the hiatal hernia preoperatively and choose a more effective procedure of bariatric surgery to decrease the incidence of postoperative complications.

As one of the most common bariatric surgeries performed in clinics,vertical sleeve gastrectomy (VSG) is highly efficient for treating morbid obesity and diabetes,with its underlying mechanisms elusive and controversial.More and more studies regard obesity and diabetes as a kind of gastrointestinal disease.Moreover,the fact that gastrointestinal tract is the direct target of bariatric procedures potentially makes it a key player in weight loss and blood glucose control after surgery.From this aspect,authors thus discuss the molecular mechanisms of VSG for treating type 2 diabetes mellitus in this review.

Objective: To analyze epidemiological and genetic characteristics of the fifth avian influenza A (H7N9) wave in Suzhou, and to provide scientific basis for prevention and control of H7N9 virus infection. Methods: Respectively, influenza A/B, H1N1 (pdm09), H3, H5N1, and H7N9 real-time PCR kits were used to detected pharyngeal swab samples which were collected from severe acute respiratory syndrome infection (SARI) cases in Suzhou. The H7N9-positive samples were further examined for virus isolation and gene sequencing. Results: The H7N9 virus was mainly prevalent in winter in Suzhou City. In the fifth H7N9 virus epidemic, the overall fatality rate of human infection with H7N9 virus in Suzhou city was 40% (22/55). Additionally, most were older people (median age was 58 years) and more than 80% of H7N9 patients had live poultry exposure history. The nucleic acid homology of HA gene was 98.7-100%. There were no mutations in the key sites of the HA gene sequence. Conclusions The H7N9 virus can not be effectively spread in the crowd currently, with no significant changes in receptor binding sites (RBS). In addition, exposure to live poultry or contaminated environment is still the main source of human infection with H7N9. At present, the viruses circulating in Suzhou city are low pathogenic to poultry.

Objective To investigate the osteogenic ability of dextran sulfate/recombinant human bone morphogenetic protein-2/chitosan (DS/rhBMP2/CS) nano microspheres combined with coralline hydroxyapatite (CHA) in repair of segmental bone defects.Methods DS/rhBMP2/CS microspheres prepared by ionic crosslinking method were adsorbed into CHA by lyophilization.Seventy-two New Zealand rabbits were randomly divided into 3 equal groups after they had been made into models of bone defect at the right radius.The defects in the 3 groups were implanted respectively with CHA,rhBMP2/CHA and DS/rhBMP2/ CS/CHA.Another 18 animals served as a blank control group.Blood and bone samples were obtained at 4,8 and 12 weeks after implantation.The serum BGP was detected,and the bone grafts were scanned by micro-CT for calculation of volume ratio of the new bone.Hematoxylin and eosin (HE) staining was performed after bone decalcification.Results All the 72 animals recovered well without any infection or graft exposure.Gross observation at postoperative 12 weeks showed that the DS/rhBMP2/CS/CHA group was the best in the quality,quantity and strength of the new bone,as well as in the healing of bone defects.The serum levels of bone gamma-carboxyglutamic-acid-containing protein at all time points in the DS/rhBMP2/CS/CHA group were significantly higher than those in the CHA and rhBMP2/CHA groups (P ＜ 0.05).Micro-CT scanning demonstrated obvious progress in bone formation,cortical bone and marrow cavity at all time points in the DS/rhBMP2/CS/CHA group which showed significantly faster bone reconstruction synchronized with material degradation and significantly higher volume ratio of the new bone than the other 2 groups (P ＜ 0.05).Histological examinations showed better morphology of mature cortical bone and new marrow cavity at all time points in the DS/rhBMP2/CS/CHA group than in the other 2 groups.Conclusion Since DS/rhBMP2/CS/CHA possesses a better mechanism of sustained-releasing rhBMP2 to induce bone formation because of its reticular and hole-hole-connected structure,it may perform better in repairing segmental bone defects than simple CHA or rhBMP2/CHA.

Objective: To compare the hepatobiliary injury difference of newborn BALB/c mice infected by different titers of rhesus rotavirus(RRV). Methods: Neonatal mice(n=80) were randomly separated into 4 groups and were intraperitoneally inoculated with different titers of rotavirus: High titer group(1×10⁷ PFU/ml); Medium titer group(1×10⁶ PFU/ml); Low titer group(2.5×10⁵ PFU/ml); Control group (only culture medium) within the first 24 hours after birth. All mice were sacrificed at day 12 after RRV inoculation then the liver and blood samples were collected. Meanwhile, mice were observed daily for at least 12 days, including their weight, skin color and survival situation. Liver functions were examined by serum biochemical test and morphologic changes in the biliary tract were observed. Tissue sections underwent H&E staining and immunohistochemically analysis for the presence of CK19. Results: Compared with the normal mice, the mice in the experimental group had different degrees of skin jaundice, weight lost, survival rate decreased, liver function damage. In the experimental group, the symptom of low titer group was light, and could be restored to normal, however, when compared with the low titer group, the mice in the high titer group were serious, their skin jaundice was more obvious, weight was significantly reduced and irreversible, survival rate was lower(50%), liver function of TBIL, DBIL, TBA, ALT, ALP were significantly increased.Further analysis showed that the high titer group had high bile duct obstruction rate (80%), with no case of obstruction in the low titer group. Histologic analysis also showed intrahepatic bile duct atresia in the high titer group, a large number of inflammatory cell infiltrated around the portal area, while the morphology of intrahepatic bile duct was almost normal and just a small amount of inflammatory cell infiltrated around the portal area in the low titer group. Conclusions Different titers of rotavirus had different effects on the newborn mice hepatobiliary system: high titer was easy to cause biliary atresia, and low titer caused hepatitis.

This study examined the mRNA expression of NALP3 in the spleen of the mice with hypersplenism due to portal hypertension (PH). The mouse hypersplenism models were established by oral administration of tetrachloromethane (2 mL/kg/week for 12 weeks by oral gavage). All the mice were randomly divided into a control group and an experimental group. The blood routine test was conducted, spleen index was calculated and spleen was histologically examined. Portal vein sera were taken for detection of the level of uric acid. The mRNA expressions of NALP3 and IL-1beta in the spleen were detected by reverse transcriptase-polymerase chain reaction (RT-PCR). The results showed that the platelet count was significantly lower in the experimental group [(674+/-102)x10(9)/L] than in the control group [(1307+/-181)x10(9)/L] (P<0.05), while the spleen index was significantly higher [(9.83+/-1.36) mug/g] in the experimental group than in the control group [(4.11+/-0.47) mug/g] (P<0.05). The histopathological changes of spleen followed the pattern of congestive splenomegaly. No significant difference was found in the uric acid level in the portal vein between the control group and the experiment group. The mRNA expressions of NALP3 and IL-1beta were up-regulated significantly in the spleen in the experimental group as compared with those in the control group (P<0.05). It was concluded that NALP3 and IL-1beta may play important roles in the pathogenesis of hypersplenism.

Objective To evaluate the clinical results of total laparoscopic hepatectomy for hepatolithiasis. Methods The clinical data of 72 patients with intrahepatic lithiasis receiving total laparoscopic hepatectomy in our hospital from July 2005 to April 2009 were retrospectively analyzed. Results The mean age of the 72 patients was (43. 8±21.7) yrs (16-65 yrs). For laparoscopic hepatectomy, it was anatomical left liver resection in 34 patients, anatomical resection of left lateral liver in 19 and resection of S6 in 16. The operative duration was (262.5± 115.5)min (125-320 min). The median intraoperative blood loss was 150 ml (50-400 ml). The occurring rate of postoperative complications was 12.50 %. Complications included bile duct infection in 8 patients, bile leakage in 6, gastroparesis in 1,postoperative early inflammatory ileus in 1 and subcapsular fluid collection of liver in 1. All the complications were cured by non-surgical means. Conclusion In the era of minimally invasive surgery, total laparoscopic hepatectomy has gradually become the prominent treatment for hepatolithiasis.

Objective To observe the solo-allied expression of Survivin, Smad4/dpc4 and APC gene, and study the relationship between the three genes and biological behavior of colorectal cancer. Methods The expressions of Survivin, Smad4/dpc4 and APC gene were detected by SP immunohistochem-istry among the cases from 40 eu-intestine ,80 large intestinal adenoma and 80 CRC. Results The positive rate of survivin protein in the eu-intestine, the large intestinal adenoma and CRC was 0,35.0% ,75.0% , respectively. The positive rate of Smad4/dpc4 protein was 100% , 95. 0% , 78. 8% , and the positive rate of APC protein was 100% ,80.0% ,45.0% , respectively. In the eu-intestine, APC + Smad4/dpc4 Z- expressed in 40 cases, with the incidence of 100%. In the large intestinal adenoma, APC + Smad4 expressed in 38 patients, with the incidence of 47. 5% , and the three genes expressed in 29 patients with the incidence of 23. 8%. In the CRC, two genes expressed in 57 patients, with the incidence of 71. 3% , and three genes expressed in 28 patients, with the incidence of 35.0%. Conclusion The detection of survivin was a new indicator in early diagnosis of CRC. It was significant in the diagnosis of CRC that energetic search for the positive rate level realm of survivin. The catastrophe or absence of Smad4/dpc4 gene not only induced the genesis of CRC but also encouraged its growth. Smad4/dpc4 was ant- carcinomatous gene intimately correlated to the CRC. Detection of APC gene had very important significance, it could be helpful to conduct the research of tumorous aetiology, nosogenesis and early diagnosis. The allied detection of Survivin, Smad4/dpc4, APC gene played a very important role in early diagnosing and healing the CRC.

Objective To evaluate the histological response and the clinical value in laparescopic colorectal surgery combined with preoperative regional intra-arterial chemotherapy(PRAC). Methods In cases of rectal cancer and fiver metastases selective regional intra-arterial chemotherapy and iodinated oil embolism was carried out in 23 cases of colorectal carcinoma. After 1 to 11 days laparoseopic radical resection was done, specimens were sent for histopathological examination. We analyzed the correlation between tumor differentiation and TNM stage, compared the effect of PRAC with PRAC + embolism by the criteria of histological response of chemotherapy. χ2-test was used to compare interclass correlation.Results The histological effect in the 23 cases of PRAC level 0 was in 2 cases, level Ⅰ in 7 cases, level Ⅱ in 10 cases, and level Ⅲ in 2 cases. The overall effective rate was 91% (21/23). In the 15 cases with lymph node metastases, the effective rate was 87% (13/15). There was no significant statistic correlation between tumor differentiation or TNM stage and histological response. PRAC associated embolism had a better histological response compared to PRAC alone. Conclusions Preoperative regional intra-arterial chemotherapy had marked therapeutic effect on histological response to the colorectal carcinoma patients of various tumor differentiations and TNM stage, especially combining with the embolism to rectal cancer could improve the efficacy.

This study examined the mRNA expression of NALP3 in the spleen of the mice with hypersplenism due to portal hypertension(PH).The mouse hypersplenism models were established by oral administration of tetrachloromethane(2 mL/kg/week for 12 weeks by oral gavage).All the mice were randomly divided into a control group and an experimental group.The blood routine test was conducted,spleen index was calculated and spleen was histologically examined.Portal vein sera were taken for detection of the level of uric acid.The mRNA expressions of NALP3 and IL-1β in the spleen were detected by reverse transcriptase-polymerase chain reaction(RT-PCR).The results showed that the platelet count was significantly lower in the experimental group[(674±102)× 109/L]than in the control group[(1307± 181)× 109/L](P<0.05),while the spleen index was significantly higher[(9.83±1.36)μg/g]in the experimental group than in the control group[(4.11±0.47)μg/g](P<0.05).The histopathological changes of spleen followed the pattern of congestive splenomegaly.No significant difference was found in the uric acid level in the portal vein between the control group and the experiment group.The mRNA expressions of NALP3 and IL-1β were up-regulated significantly in the spleen in the experimental group as compared with those in the control group(P<0.05).It was concluded that NALP3 and IL-1β may play important roles in the pathogenesis of hypersplenism.