Bile reflux is a common physiological phenomenon in the body,which is caused by the retrograde movement of bile into the stomach and above.Long-term bile reflux causes bile reflux gastritis.It can also lead to intestinal metaplasia,Barrett's esophagus,and even gastric cancer,esophageal cancer,pharyngeal cancer risk factors.Therefore,long-term frequent bile reflux should be regarded as pathological bile reflux.bile reflux is divided into primary bile reflux and secondary bile reflux.The common clinical symptoms of bile reflux include abdominal distension,bitter mouth,upper abdominal pain,nausea and vomiting.Primary bile reflux can occur without transgastric surgery,whereas secondary bile reflux often occurs after gastrointestinal surgery.This article reviews the pathogenesis,diagnosis and corresponding treatment progress of bile reflux,so as to provide reference for further research on bile reflux.

Type 2 diabetes mellitus (T2DM) is a health problem in the world,patients are often accompanied by obesity.The experimental animal design of bariatric surgery is helpful for the development of less invasive operation method,higher safety in the treatment of T2DM and newdrugs for blood glucose control.This article will review the literatures in recent years which about bariatric surgery,and provide reference for animal experiment design,to introduce the experimental animal design of bariatric surgery for the treatment of T2DM and the mechanism of blood glucose balance after the surgery.

Objective To investigate the correlations between expression of CASC2 and hepatocellular carcinoma(HCC) prognosis.Methods A total of 129 patients including 80 males and 49 females with HCC were includedin this study,ranging from 21 to 73 years in Xuanwu Hospital of Capital Medical University and Beijing You'an Hospital were retrospectively analyzed from September 2007 to January 2014.Expression of CASC2 was assessed using reverse transcription quantitative-polymerase chain reaction in HCC tissue and the adjacent normal tissue.The correlations between CASC2 mRNA level and clinicopathological parameters was investigated.The relationship between the expression of CASC2 and the prognosis of patients with HCC was analyzed by Kaplan-Meier method.A log-rank analysis was performed to identify group differences.Univariate and multivariate Cox analysis were used to analyze the variables affecting the patient's prognosis.Results In 129 HCC samples,the level of CASC2 expression (0.84 ± 0.05) was lower than (3.35 ± 0.11) adjacent normal tissue (P ＜ 0.05).There were significant differences between CASC2 expression and tumor size,histological differentiation,and tumor stage in 129 HCC speciments.The median expression level of CACS2 in HCC tissues,0.84-fold,was used as the cut-off value to divide the 129 patients into two groups:low-expression group (n =72) and high-expression group (n =57).Overall survival rate of HCC patients with high CACS2 expression was significantly higher than those of patients with low CACS2 expression(P ＜0.05).Multivariate analysis indicated that histological differentiation (HR =0.20,95％ CI:0.05 ～ 0.59),tumor stage (HR =1.71,95％ CI:1.02 ～ 2.99) and CACS2 expression (HR =O.51,95％ CI:O.08 ～0.92) were an independent predictor of overall survival.Conclusion Low expression of CACS2 might be associated with the occurrence and development of HCC.

Increased serum urotensin II (UII) levels in human cirrhotic populations have been recently shown, but the long-term effects of UII receptor antagonist on the cirrhosis have not been investigated. To investigate the therapeutic effects of urotensin II receptor (UT) antagonist palosuran on rats with carbon tetrachloride (CCl)-induced cirrhosis, the hepatic and systemic hemodynamics, liver fibrosis, the metalloproteinase-13 (MMP-13)/tissue inhibitor of metalloproteinase-1 (TIMP-1) ratio, hepatic Rho-kinase activity, and the endothelial nitric oxide synthase (eNOS) activity are measured in CCl-cirrhotic rats treated with palosuran or vehicle for 4 weeks. Primary hepatic stellate cells (HSCs) are used to investigate the changes in UII/UT expression and the in vitro effect of palosuran. Compared with the vehicle-treated cirrhotic rats, treatment with palosuran can reduce the portal pressure (PP), decrease the risk of liver fibrosis and the level of α smooth muscle actin, collagen-I (COL-I), and transforming growth factor β expression. However, treatment with palosuran can increase MMP-13/TIMP-1, pvasodilator-stimulated phosphoprotein (p-VASP), and p-eNOS expression. Moreover, in vitro UII/UT mRNA expression increases during HSC activation. MMP-13/TIMP-1, COL-I, and p-VASP are inhibited after palosuran treatment. Our data indicate that long-term administration of palosuran can decrease PP in cirrhosis, which results from decreased hepatic fibrosis and enhanced eNOS-dependent HSC vasodilatation.

Excess fat mass accumulation can lead to a wide range of metabolic and cardiovascular complications.It includes immune cell infiltration and altered secretion of anti-and proinflammatory mediators,which contribute to systemic,low-grade inflammation.Bariatric surgery may reverse the altered secretory profile observed in the adipose tissue of severe obesity patients.This article will review available literature documenting the impact of surgeryinduced weight loss on tissue expression or circulating levels of a broad spectrum of inflammatory mediators.

Objective To observe the effects of proximal gastric electrical stimulation (GES) on body weight and gastrointestinal motility in SD rats,and investigate the regulation of gastric nerve stimulation and serum gastrointestinal hormones by neuro-humoral regulation.Methods 12 SD rats were divided into experimental group (n =6) and control group (n =6),with gastric electrical stimulator implanted,and in experimental group dual-channel GES was activated.General status was observed for 4 weeks after GES activation,including body weight,feeding and water intake,urine and stool volumes,the resting gastric volume and gastric emptying were monitored via the establishment of intestinal fistula,and serum gastrointestinal hormones change was detected.Results During 4-week GES process,one rat had gastric retention and died at 1 week after GES activated.Compared with the control group,body weight,food intake,urine and stool volumes levels of the rats in experimental group decreased significantly (t =4.005,2.530,3.350,all P＜0.05).Resting gastric volume was significantly lower than that in the control group [(2.93 ± 0.50) ml vs.(5.10 ± 0.53) ml,Z =2.460,P =0.014],and the intestinal juice drainage was lower than the control group [(0.18 ±0.15)ml vs.(0.44 ±0.05)ml,Z =2.513,P =0.012],while serum GLP-1 levels were similar between the two groups [(0.44 ± 0.05) ml vs.(0.18 ± 0.15) ml,Z =1.026,P =0.305],but Ghrelin was significantly higher than that in the control group [(1.65 ± 0.58) vs.(0.65 ±0.36),Z =2.380,P =0.017].Conclusion The proximal GES may lead to the change of the body weight,food intake,gastrointestinal function and motility,possibly by stimulating nerve reflex inducing gastrointestinal hormones secretion and affect gastrointestinal function.

Objective To evaluate the clinical efficacy of video-assisted retroperitoneal debridement (VARD) in the treatment of infected pancreatic necrosis (IPN).Methods 48 infected necrotizing pancreatitis patients underwent video-assisted retroperitoncal debridement from Jan 2013 to Aug 2017.Results There were 30 males and 18 females.After operation,4 patients suffered from postoperative bleeding and underwent angiography.One patient had gastrointestinal fistula,4 patients had newly devoloped organ dysfunction altogether,7 patients had postoperative complications.The incidence of complications was 14.58％ (7/48).3 cases died,the mortality was 6.25％ (3/48).Conclusion The video-assisted retroperitoneal debridement for pancreatic necrotic tissue is effective,safe and minimally invasive for the treatment of infected necrosis of the pancreas.

Objective To observe the outcomes of no necrotic cavity lavage after debridement and drainage in patients with infected pancreatic necrosis (IPN).Methods From February 2014 to August 2017,there were 89 patients who were diagnosed as IPN undergoing minimally invasive surgery with no necrotic cavity lavage and large caliber-wide channel drainage in Department of General Surgery,Xuanwu Hospital,Capital Medical University.There were 57 male and 32 female patients aging of (49.5± 14.4)years (ranging from 23 to 84 years).The body mass index of 89 patients was (25.4± 3.8) kg/m2 (ranging from 17.6 to 36.7 kg/m2).Among the 89 patients,37 cases(41.6％) of biliary pancreatitis,10 cases (11.2％) of alcoholic pancreatitis,16 cases (18.0％) of hyperlipidemic pancreatitis,and 26 cases (29.2％) of other reasons.Results Of 89 patients,IPN in 6 patients (6.7％) resolved using only percutaneous catheter drainage;another 83 patients underwent laparoscopic debridement (n =3,3.4％) or video-assisted debridement (n =80,89.9％).No patient was conversed to laparotomy.The average operation frequency and surgery time was (2.3±1.7) times and (56.5±31.7) minutes.The median bleeding volume and total length of stay was 10(0-600) ml and 34(6-172) days separately.The complication rate(Clavien-Dindo grade ≥Ⅲ) was 9.0％ (8/89) which involved mainly abdominal hemorrhage (5/8) and digestive tract fistula formation (3/8).The overall mortality rate was 6.7％ (6/89).Among them,3 cases died of abdominal infection,bacteremia and multiple organ failure,2 cases died of pulmonary infection and bacteremia and 1 case died of fungal infection.Conclusion No necrotic cavity lavage after debridement and drainage operation is considered effective and safe for IPN patients.

Objective To observe the outcomes of no necrotic cavity lavage after debridement and drainage in patients with infected pancreatic necrosis (IPN).Methods From February 2014 to August 2017,there were 89 patients who were diagnosed as IPN undergoing minimally invasive surgery with no necrotic cavity lavage and large caliber-wide channel drainage in Department of General Surgery,Xuanwu Hospital,Capital Medical University.There were 57 male and 32 female patients aging of (49.5± 14.4)years (ranging from 23 to 84 years).The body mass index of 89 patients was (25.4± 3.8) kg/m2 (ranging from 17.6 to 36.7 kg/m2).Among the 89 patients,37 cases(41.6％) of biliary pancreatitis,10 cases (11.2％) of alcoholic pancreatitis,16 cases (18.0％) of hyperlipidemic pancreatitis,and 26 cases (29.2％) of other reasons.Results Of 89 patients,IPN in 6 patients (6.7％) resolved using only percutaneous catheter drainage;another 83 patients underwent laparoscopic debridement (n =3,3.4％) or video-assisted debridement (n =80,89.9％).No patient was conversed to laparotomy.The average operation frequency and surgery time was (2.3±1.7) times and (56.5±31.7) minutes.The median bleeding volume and total length of stay was 10(0-600) ml and 34(6-172) days separately.The complication rate(Clavien-Dindo grade ≥Ⅲ) was 9.0％ (8/89) which involved mainly abdominal hemorrhage (5/8) and digestive tract fistula formation (3/8).The overall mortality rate was 6.7％ (6/89).Among them,3 cases died of abdominal infection,bacteremia and multiple organ failure,2 cases died of pulmonary infection and bacteremia and 1 case died of fungal infection.Conclusion No necrotic cavity lavage after debridement and drainage operation is considered effective and safe for IPN patients.

Objective To assess the evidence-based support of short-term efficacy of sleeve gastrectomy and Roux-en-Y gastric bypass in obesity with metabolic syndrome by laparoscopy.Methods Electronic literature search was performed on PubMed,EMBASE,Cochrane Library,CNKI database for the efficacy of sleeve gostrectomy and Roux-en-Y gastric bypass in the treatment of obese patients with metabolic syndrome from Jan.2011 to Jun.2016.The inclusion and exclusion criteria were selected for quality evaluation,data extraction.Review Manager 5.3 software was used to conduct the statistical analysis.Results Thirteen articles were included in the Meta-analysis,including 5 randomized controlled trails,eight case-control studies with 18,850 cases,including 2,559 cases in the sleeve gastrectomy group and 16,291 cases in the Roux-en-Y gastric bypass group.The results of the Meta-analysis showed that there was no significant difference in the remission rate of type 2 diabetes rnellietus between sleeve gastrectomy and Roux-en-Y gastric bypass group (78.7％ vs 83.0％;RR =0.94,95％ CI:0.81 ～ 1.09,P ＞0.05),the reduction of body mass index was significantly higher in Roux-en-Y gastric bypass group than sleeve gastrectomy group from the short-term follow-up (MD =-2.03,95％ CI:-3.25 ～ 0.81,P ＜ 0.05).Both two surgeries can reduce the incidence of high blood lipids and hypertension,but there was no significant difference between them as well as type 2 diabetes mellitus remission.Conclusion Both sleeve gastrectomy and Roux-en-Y gastric bypass are effective in treating obesity complicated with metabolic syndrome,and can reduce the incidence of type 2 diabetes mellitus,hypertension and hyperlipidemia and reduce the body weight.Roux-en-Y gastric bypass is superior to sleeve gastrectomy in the treatment of obesity.