Background::The effect of bariatric surgery on type 2 diabetes mellitus (T2DM) control can be assessed based on predictive models of T2DM remission. Various models have been externally verified internationally. However, long-term validated results after laparoscopic sleeve gastrectomy (LSG) surgery are lacking. The best model for the Chinese population is also unknown.Methods::We retrospectively analyzed Chinese population data 5 years after LSG at Beijing Shijitan Hospital in China between March 2009 and December 2016. The independent t-test, Mann–Whitney U test, and chi-squared test were used to compare characteristics between T2DM remission and non-remission groups. We evaluated the predictive efficacy of each model for longterm T2DM remission after LSG by calculating the area under the curve (AUC), sensitivity, specificity, Youden index, positive predictive value (PPV), negative predictive value (NPV), and predicted-to-observed ratio, and performed calibration using Hosmer–Lemeshow test for 11 prediction models. Results::We enrolled 108 patients, including 44 (40.7%) men, with a mean age of 35.5 years. The mean body mass index was 40.3 ± 9.1 kg/m 2, the percentage of excess weight loss (%EWL) was (75.9 ± 30.4)%, and the percentage of total weight loss (% TWL) was (29.1 ± 10.6)%. The mean glycated hemoglobin A1c (HbA1c) level was (7.3 ± 1.8)% preoperatively and decreased to (5.9 ± 1.0)% 5 years after LSG. The 5-year postoperative complete and partial remission rates of T2DM were 50.9% [55/108] and 27.8% [30/108], respectively. Six models, i.e., "ABCD", individualized metabolic surgery (IMS), advanced-DiaRem, DiaBetter, Dixon et al’s regression model, and Panunzi et al’s regression model, showed a good discrimination ability (all AUC >0.8). The "ABCD" (sensitivity, 74%; specificity, 80%; AUC, 0.82 [95% confidence interval [CI]: 0.74–0.89]), IMS (sensitivity, 78%; specificity, 84%; AUC, 0.82 [95% CI: 0.73–0.89]), and Panunzi et al’s regression models (sensitivity, 78%; specificity, 91%; AUC, 0.86 [95% CI: 0.78–0.92]) showed good discernibility. In the Hosmer–Lemeshow goodness-of-fit test, except for DiaRem ( P <0.01), DiaBetter ( P <0.01), Hayes et al ( P = 0.03), Park et al ( P = 0.02), and Ramos-Levi et al’s ( P <0.01) models, all models had a satifactory fit results ( P >0.05). The P values of calibration results of the "ABCD" and IMS were 0.07 and 0.14, respectively. The predicted-to-observed ratios of the "ABCD" and IMS were 0.87 and 0.89, respectively. Conclusion::The prediction model IMS was recommended for clinical use because of excellent predictive performance, good statistical test results, and simple and practical design features.

Objective:To present the surgical details of manual double-layer suturing in patients with obesity combined type 2 diabetes mellitus by three-incision laparoscopic single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy .Methods:Clinical data and follow-up information of 52 obesity combined type 2 diabetes mellitus patients (BMI 27.59-43.71 kg/m2) who underwent three-incision laparoscopic single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy from Jan 2019 to Jul 2022 at Beijing Shijitan hospital were retrospectively analyzed.Results:The procedure was successful in all patients. The median operative time was 120 (90, 120) min, and the median intraoperative bleeding was 20.0 (10.0, 27.5) ml. No fistula or serious surgical complications were observed in the patients at 1 month postoperatively. Compared with the preoperative period, the patient's weight decreased [(93.22±15.21) kg vs. (69.97±11.06) kg, t=21.707, P<0.01], BMI decreased [(33.11±4.09) kg/m 2vs. (24.86±2.95) kg/m 2, t=23.224, P<0.01], and the patient's fasting glucose level decreased [9.52 (7.57, 12.96) mmol/L vs. 5.47 (4.66, 6.39) mmol/L, Z=6.11, P<0.01]. The remission rate of various obesity comorbidities was greatly improved. Conclusion:Under the condition of three-incision laparoscopy, the pure manual duodenal and jejunal double-layer suture method is safe, feasible, and effective for patients with obesity combined with type 2 diabetes mellitus.

Objective:To evaluate the application of Moorehead-Ardelt Ⅱ questionnaire (MA Ⅱ) in assessment of the quality of life (QOL) among obese patients after bariatric surgery.Methods:One hundred and five patients with obesity were enrolled, the weight, body mass index (BMI), comorbidities and MA Ⅱ scores before and after operation were counted. The difference between the QOL of pre- and post-operation was analyzed.Results:All the patients completed the questionnaire. The Cronbach α coefficient of the questionnaire was higher than 0.7. The post-operational scores of 6 items were significantly higher than that of pre-operation. ( P<0.001). The proportion of "poor" and "very poor" QOL in the pre-operational patients was 43.8%, compared with 0 in the post-operative patients;the proportion of "good" and "very good" QOL in the pre-operatve patients was 4.7%, compared to 86.7% in the post-operative patients ( χ2=146.863, P<0.001). Conclusions:MA Ⅱ questionnaire is a professional, easy oprated tool for assessment of QOL associated with obesity.

Objective To explore the morbidity of surgery in connection with laparoscopic sleeve gastrectomy (LSG) and its effect on obese T2DM.Methods 106 obese T2DM patientes undergoing LSG were divided into 2 groups in group 125 patients did not have oversewing the staple line and group 281 patients had the staple line oversewn in order to reduce bleeding.Results The differences in intraoperative blood loss (35 ± 15) ml vs.(28 ± 18) ml,postoperative recovery time (2.4 ± 0.9) d vs.(2.3 ± 0.9) d,time to taking liquid food (4.7 ± 1.0) d vs.(4.6 ± 1.0) d between two groups were not significant.There were no significant difference of complication between 2 groups (x2 =3.271,P =0.071).Comparing before surgery to 6 month after surgery,the BMI in group 1,was from (39 ± 5) to (29 ±4) kg/m2;in group 2,from (40 ±6) to (31 ±5) kg/m2,FPG in group 1,from (8.4 ± 1.4) to (6.4 ±1.2) mmol/L;in group 2,from (8.2 ± 2.0) to (6.8 ± 1.5) mmol/L,2 hour post-meal blood sugar [group 1,(13.2±4.1) to (9.6±3.2) mmol/L;group 2,(12.2±3.2) to (10.6±2.8) mmol/L] and HbAlc (group 1,7.2％ ±1.2％ to5.5％ ±1.1％;group 2,7.1％ ±1.1％ to 5.9％ ±1.2％) decreased significantly in both groups (P ＜ 0.01).There was 72 (68％) remission cases of T2DM in 106 patients,there were no significant differences of T2DM remission and BMI between 2 groups at 6 months after surgery (P =0.617).Conclusions LSG leads to significant weight loss and T2DM control.

Objective To study the treatment principles and surgical skills in laparoscopic subtotal cholecystectomy (LSC) for acute cholecystitis.Methods We retrospectively analyzed the clinical data of patients who underwent LSC for acute cholecystitis from Jan.2006 to Dec.2015 at the Beijing Shijitan Hospital,Capital Medical University.We dissected any serious pericholecystic adhesions according to the principle that "It is better that the gallbladder rather than other tissue is injured",and the technique that "After the gallbladder anterior wall is excised,the gallbladder ampulla and duct are split along the longitudinal direction of the cholecystic duct,then the opened cholecystic duct is sutured inside the gallbladder".Results LSC was completed successfully in 96 patients.There were no conversion to open surgery,and no bile duct injury.The mean surgery time was (108.0 ± 37.0) min,the mean blood loss was (121.0 ± 62.0) ml,the mean peritoneal drainage was (105.0 ± 32.0) ml.The drainage tube was removed at a mean of (3.4 ±1.2) d after surgery.The mean hospitalization time after surgery was (6.1 ± 2.2) d.Surgical complications occurred in 2 patients with bleeding after surgery.One patient underwent laparoscopic exploration to stop bleeding.Another patient underwent conservative treatment and the bleeding stopped spontaneously.There were 3 patients who had mild bile leakage.All these patients recovered well after drainage.No patient developed bile duct stenosis or obstructive jaundice on follow-up.Conclusions LSC for acute cholecystitis was safe.Bile duct injuries could be avoided if we follow the principle of "It is better that the gallbladder rather than other tissue is injured" and the technique of "After the gallbladder anterior wall is excised,the gallbladder ampulla and duct are split along the longitudinal direction of the gallbladder,then the opened cholecystic duct is sutured inside the gallbladder".

Objective To investigate the effect of FTO gene on laparoscopic Roux-en-Y gastric bypass for type 2 diabetes.Methods From Jan 2014 to 2015 Jun,32 T2DM patients received LRYGB in Beijing Shijitan Hospital.According to single nucleotide polymorphism of FTO rs9939609 gene,patients were divided into TF genotype (20 cases),and AT/AA genotype (12 cases).Results Following the degression of BMI from (36.4 ±3.3) kg/m2 to (28.1 ±2.8) kg/m2,fasting blood glucose and HbA1c in group A significantly improved [(8.9 ± 1.6) mmol/L vs.(5.6 ± 1.2) mmol/L,t =8.274,P =0.000;(8.5％ ± 1.9％) vs.(6.2％ ± 0.8％),t =5.032,P =0.000].Following the degression of BMI from (39.5 ±5.6) kg/m2 to (29.7 ± 5.1) kg/m2,fasting blood glucose and HbA1c in group B significantly improved [(10.8 ± 2.8) mmol/L vs.(4.9 ± 0.6) mmol/L,t =7.589,P =0.000;(9.0％ ± 1.8％) vs.(6.1％ ±0.9％),t =5.324,P =0.000].Insulin resistance index in both groups significantly improved [(12.6±10.7) vs.(4.9±5.6),t=5.402,P=0.000;(16.0±5.6) vs.(1.7±1.3),t=9.025,P=0.000].Fasting blood glucose and the insulin resistance index in group B patients was significantly lower than that in group A patients (P ＜ 0.05).Conclusion T2DM patients with FTO rs9939609 gene phenotype AT/AA have better prognosis than those with TT in postoperative diabetes improvement.

Aim To detect the effect of Bio on impro-ving insulin resistance and explore its molecular mech-anism. Methods The HepG2 liver cells were derivat-ed by high concentration insulin to establish the insulin resistance cell model, and the cells were intervened by Bio. The glucose consumption was measured by glu-cose oxidase and peroxidase ( GOD-POD) assay. The expression of PPARγmRNA was detected by RT-PCR. The expression of PPARγ protein was detected by Western blot method. Results The glucose consump-tion was significantly decreased in the insulin resist-ance cells after incubated with 1 . 72 × 10 -5 mol · L-1 insulin ( P<0. 05 ) . 10 -5 ,10 -6 ,10 -7 mol · L-1 Bio increased the glucose consumption 135%,62%,39%separately in the insulin resistance cells. RT-PCR a-nalysis of PPARγ showed that Bio raised the PPARγmRNA. Western blot analysis displayed that the pro-tein of PPARγ with Bio was increased. Conclusion Bio can improve the insulin resistance of the HepG2 cells, and the molecular mechanism may be relevant with raising PPARγ expression.

BACKGROUND:Vacuum sealing drainage is currently considered as a safe and effective for fasciotomy wounds in the treatment of compartment syndrome. But the wounds after treatment are often not self-closed, which needs skin grafts that can cause secondary injury. Studies have shown that shoelaces technology is useful for leg fasciotomy wounds in the surgical treatment of lower leg compartment syndrome, but so far there are few domestic reports. OBJECTIVE:To compare the vacuum sealing drainage and shoelace technique for treatment of leg fasciotomy wounds. METHODS:A total of 36 patients, with 46 leg fasciotomy wounds, were randomized into vacuum sealing drainage and shoelace technique groups, 23 wounds in each group. In the vacuum sealing drainage group, patients were subjected to vacuum sealing drainage after fasciotomy based on fracture reduction and external fixation;in the shoelace technique group, the fasciotomy wounds were covered with polyethylene/ethanol hydrated seaweed salt foam fol owed by shoelace technique. After 1 month, wound size, wound closure time, infection, further intervention and daily treatment cost were compared between the two groups. RESULTS AND CONCLUSION: Wound closure time was significantly higher in the vacuum sealing drainage group compared to the shoelace technique group (P < 0.05). Eight wounds in the vacuum sealing drainage group required skin grafts; while, no skin graft was necessary in the shoelace technique group. In the shoelace technique group, the vessel loops had to be replaced in five wounds. There was no wound infection, increased compartment pressure and skin flap necrosis postoperatively in both two groups. Both vacuum sealing drainage and the shoelace technique are safe, reliable and effective methods for closure of leg fasciotomy wounds. Vacuum sealing drainage requires longer time to definite wound closure and is far more expensive than the shoelace technique, especially when additional skin grafting is required.

In our screening for photosensitizers from natural resources, four alkaloids were isolated from Glycosmis pentaphylla by various chromatography techniques. Their structures were identified as glycoborinine (1), glybomine B (2), carbalexin A (3) and N-p-coumaroyltyramine (4) by spectral analysis. Their photoactivated antimicrobial activities were evaluated by thin-layer chromatography (TLC) agar overlay assay against Staphylococcus aureus and Bacillus subtilis. It was found that compounds 1 and 4 showed photo-activated antimicrobial activities. Meantime, photo-activated DNA binding activities of these compounds were also assessed by using a specially prepared 1.8 kb DNA fragment and restriction enzymes. Under UVA irradiation, compound 1 showed moderate inhibition on Nde I, Xba I, Nco I and Bcl I which have either 5'-TpA or 5'-ApT and trace or no inhibition on other restriction enzymes. It showed a similar inhibition pattern with the reference 8-methoxypsoralen. However, compounds 2-4 showed no inhibition against any of the restriction enzymes.

Objective To study prognostic factors after surgical resection for distal bile duct cancer. Methods A retrospective muhicenter clinical analysis,including Beijing Shijitan Hospital,Peking University People's Hospital and Peking University First Hospital,was made for 103 patients of distal bile duct cancer receiving surgical resection from 1995 to 2009.Potential clinicopathological prognostic factors were examined bv univariate and multivariate survival analysis. Results The 1.3 and 5 years overall survival rate was 72%,41%and 25% respectively (median survival time,24.13 months).Univariate analysis revealed operative modality,lymph node status,surgical margin and TNM stage as significant factors influencing postoperative survival.Positive surgical margin,lymph node metastasis and TNM stage were significant independent predictors of poor prognosis by a Cox proportional hazards regression model. Condusions Surgical margin margin,lymph node metastasis and TNM stage were the most important prognostic factors for bile duct carcinoma after resection.Radical pancreaticoduodenectomy was the choice of therapy for distal bile duct carcinoma.