Objective To observe the changes of pre-and post-operative body fats of obese patients undergoing laparoscopic sleeve gastrectomy which were evaluated by dual-energy X-ray absorptiometry (DEXA) and investigate the correlation of the changes between body fat and insulin resistance.Methods The cohort study was conducted.The clinical data of 10 obese patients who were admitted to the Fourth Affiliated Hospital of China Medical University from October 2015 to February 2017 were collected.Ten obese patients received laparoscopic sleeve gastrectomy (LSG).The pre-and post-operative body fat masses in the different parts and regions of the whole body [whole body,upper limbs,lower limbs,trunk,region of android (region A) and region of gynoid (region G)] were measured by DEXA and pre-and post-operative indexes of insulin resistance (HOMA-IR) were calculated.Observation indicators:(1) fat parameters evaluated by DEXA and test results of other obesity related indicators;(2) test results of insulin sensitivity index.The patients were followed up by the professional team of metabolic surgery using telephone interview,outpatient and inpatient examinations up to February 2017,and DEXA using outpatient and inpatient examinations was performed at 6 months postoperatively.The measurement data with normal distribution were represented as-x ±s,and repeated measurement data were analyzed by the repeated measures ANOVA.The correlation analysis was performed by the Pearson,and the degree of correlation was analyzed by the factor analysis and multiple linear regression.Results (1) Fat parameters evaluated by DEXA and test results of other obesity related indicators:all the 10 patients were followed up.The fat masses and percentages of the whole body,upper limbs,lower limbs,trunk,region A and region G,BMI,waist circumference and HOMA-IR were respectively (55.6± 13.7) kg,(6.2± 1.9) kg,(17.8± 3.6) kg,(31.7± 12.7) kg,(5.6±2.4)kg,(8.8±1.5)kg,50％±3％,54％±5％,50％±4％,52％±3％,57％±4％,52％±4％,(42± 8) kg/m2,(123±23) cm,8.7 ± 5.6 before operation and (37.4± 11.3) kg,(4.0± 1.2) kg,(11.2± 3.0) kg,(20.4±9.6) kg,(3.5± 1.7) kg,(5.1± 1.4) kg,43％±5％,46％±5％,42％±5％,46％±5％,48％±6％,46％ ± 5％,(30 ± 6) kg/m2,(101 ± 20) cm,3.5 ± 2.4 at 6 months postoperatively,with statistically significant differences between pre-and post-operations (F =11.282,6.308,15.789,6.083,7.836,9.027,5.485,7.743,8.620,3.743,4.704,5.421,13.281,14.258,4.465,P＜0.05).The waist-hip ratio and percentage of region A/ percentage of region G (A/G) were 0.94±0.09,1.10±0.09 before operation and 0.93±0.12,1.05±0.13 at 6 months postoperatively,with no statistically significant difference between pre-and post-operations (F=0.324,1.361,P＞0.05).(2) Test results of insulin sensitivity index:there was a positive correlation in the fat masses of the whole body,trunk,region A and region G,BMI,waist circumference and HOMA-IR (r =0.873,0.874,0.894,0.696,0.843,0.816,P＜0.05),and no correlation between the fat masses of the upper and lower limbs and HOMA-IR (r =0.442,0.242,P＞0.05).The principal component of F1 and F2 were constructed by the factor analysis,F1 (trunk for the most) reflected the fat mass of the different parts of the whole body and F2 reflected the fat mass of peripheral limbs,the model of F1 was reasonable (t =5.033,P＜0.05).The contribution rate of the whole body,upper and lower limbs,trunk,region A,region G,BMI and waist circumference were respectively 0.994,0.633,0.487,0.887,0.900,0.897,0.959,0.897 in the F1 and -0.030,0.716,0.829,-0.446,-0.405,0.423,-0.201,-0.283 in the F2,and the whole body fat mass (BFM) made a largest contribution rate for the preoperative HOMA-IR (0.994).There was a positive correlation between decrease of fat mass in region G and improvement of HOMA-IR at 6 months postoperatively (r =0.717,P＜0.05).Conclusion BFM is an important index to evaluate the insulin resistance in female patients,and the decrease of fat mass in the region G is an important factor for the early remission of insulin resistance in female patients after laparoscopic sleeve gastrectomy.

With the increase of obese people around the world,the complications associated with obesity are endangering human health,it has became an important factor affecting the quality of life and increasing social and economic burdens.Rouxen-Y gastric bypass (RYGB) is an effective surgical tool for the treatment of obesity and metabolic-related complications,meanwhile,it can also improve or cure the obesity-related metabolic diseases with reducing the body mass of patients.Free fat mass (FFM) is the main component of the human body and plays an important role in metabolic surgery for the prevention of bone loss,control of weight and alleviation of insulin resistance and so on.The loss of body mass is one of the manifestations of the changes in body composition and distribution after RYGB,and its performance is common after metabolic surgery.This article will summary the findings and investigate the reason of decreased FFM after RYGB and the preventive strategy for different reasons,and it will also provide to the principle of individualized management of patients and guide the clinical practice.

Objective The residency training questionnaires survey made at the hospital identified major residency training requirements.Methods Literature review and expert consultation were used in questionnaire design, to survey the residents of 2014 and 2015 and discover matters of their concern, and assess the policy outcomes.Results Matters of their concern were found to be professional strength, teaching and management level, and income respectively.Compared to residents of other hospitals, these residents regard the rationality of the merit pay and subsidies as higher(27.45％ vs.3.70％)in 2014.As to the new policies introduced in 2015, the gap between residents of the hospital and those from other hospitals in seeing the rationality of merit pay and subsidies tends to narrow.Conclusion The new policies have increased the residents' satisfaction on their income.

This article applied stochastic frontier analysis to estimate the efficiency of the 2007 Beijing Medicine Development Foundation,and analyzed the dominant influencing factors of the performance.The following results were found out..(1) The performance of 2007 Beijing Medicine Development Foundation was good in general,however there was a 23％ gap between the actual output and the frontier output.As time passes by,the expected performance will get better.(2) There are large differences existed between various categories of projects and the different levels of institutions and project leaders.The relatively high profile projects,which means large input and more complexity,requires higher level of facility and environmental support,project manager's degree,professional title,while technical efficiency is not obvious for small scale independent innovation projects.

Objective To evaluate the performance of clinical medicine and joint research projects,funded by Capital Medical Research Fund.Method Data of clinical medicine and joint research projects were obtained from the project of Data analysis and evaluation of Capital Medical Development Scientific Research Fund.Out puts include published papers,undergraduate textbooks,prize,patents,students' trainingsnew techniques and follow-up projects; Each project is considered as an evaluation unit,the grant amount as input indicator.Then Data Envelopment Analysis (DEA),software MaxDEA 5.2 were used to calculate the relative performance of these projects.Result The rate of recovery of questionnaire was 77.70％.Among 115projects,the average score of new technology,prize obtained and patent are less than other output indexes.15 projects have no output,7 projects reached the effectiveness of DEA.11 projects obtained the pure technology efficiency,20 projects obtained scale efficiency.Conclusion The funding for projects in 2005 and 2007 are within the appropriate amount,while funding for some projects are excessive; certain projects have less outputs in personnel trainings,publications,the follow-up projects,published papers and achievements.In order to improve project performance,the quantity of published papers and personnel trainings has to be increased.

PURPOSE: Anaphylactic shock is sometimes accompanied by local interstitial edema due to increased vascular permeability. We performed magnetic resonance imaging (MRI) to compare edema in the larynx and brain of anesthetized rats during anaphylactic hypotension versus vasodilator-induced hypotension. METHODS: Male Sprague Dawley rats were subjected to hypotension induced by the ovalbumin antigen (n=7) or a vasodilator sodium nitroprusside (SNP; n=7). Apparent diffusion coefficient (ADC) and T2-relaxation time (T2RT) were quantified on MRI performed repeatedly for up to 68 min after the injection of either agent. The presence of laryngeal edema was also examined by histological examination. Separately, the occurrence of brain edema was assessed by measuring brain water content using the wet/dry method in rats with anaphylaxis (n=5) or SNP (n=5) and the non-hypotensive control rats (n=5). Mast cells in hypothalamus were morphologically examined. RESULTS: Mean arterial blood pressure similarly decreased to 35 mmHg after an injection of the antigen or SNP. Hyperintensity on T2-weighted images (as reflected by elevated T2RT) was found in the larynx as early as 13 min after an injection of the antigen, but not SNP. A postmortem histological examination revealed epiglottic edema in the rats with anaphylaxis, but not SNP. In contrast, no significant changes in T2RT or ADC were detectable in the brains of any rats studied. In separate experiments, the quantified brain water content did not increase in either anaphylaxis or SNP rats, as compared with the non-hypotensive control rats. The numbers of mast cells with metachromatic granules in the hypothalamus were not different between rats with anaphylaxis and SNP, suggesting the absence of anaphylactic reaction in hypothalamus. CONCLUSION: Edema was detected using the MRI technique in the larynx during rat anaphylaxis, but not in the brain.
Anaphylaxis ; Animals ; Arterial Pressure ; Brain ; Brain Edema ; Capillary Permeability ; Diffusion ; Edema ; Hypotension ; Hypothalamus ; Laryngeal Edema ; Larynx ; Magnetic Resonance Imaging ; Male ; Mast Cells ; Nitroprusside ; Ovalbumin ; Rats ; Rats, Sprague-Dawley

PURPOSE: Anaphylactic shock is sometimes accompanied by local interstitial edema due to increased vascular permeability. We performed magnetic resonance imaging (MRI) to compare edema in the larynx and brain of anesthetized rats during anaphylactic hypotension versus vasodilator-induced hypotension. METHODS: Male Sprague Dawley rats were subjected to hypotension induced by the ovalbumin antigen (n=7) or a vasodilator sodium nitroprusside (SNP; n=7). Apparent diffusion coefficient (ADC) and T2-relaxation time (T2RT) were quantified on MRI performed repeatedly for up to 68 min after the injection of either agent. The presence of laryngeal edema was also examined by histological examination. Separately, the occurrence of brain edema was assessed by measuring brain water content using the wet/dry method in rats with anaphylaxis (n=5) or SNP (n=5) and the non-hypotensive control rats (n=5). Mast cells in hypothalamus were morphologically examined. RESULTS: Mean arterial blood pressure similarly decreased to 35 mmHg after an injection of the antigen or SNP. Hyperintensity on T2-weighted images (as reflected by elevated T2RT) was found in the larynx as early as 13 min after an injection of the antigen, but not SNP. A postmortem histological examination revealed epiglottic edema in the rats with anaphylaxis, but not SNP. In contrast, no significant changes in T2RT or ADC were detectable in the brains of any rats studied. In separate experiments, the quantified brain water content did not increase in either anaphylaxis or SNP rats, as compared with the non-hypotensive control rats. The numbers of mast cells with metachromatic granules in the hypothalamus were not different between rats with anaphylaxis and SNP, suggesting the absence of anaphylactic reaction in hypothalamus. CONCLUSION: Edema was detected using the MRI technique in the larynx during rat anaphylaxis, but not in the brain.
Anaphylaxis ; Animals ; Arterial Pressure ; Brain ; Brain Edema ; Capillary Permeability ; Diffusion ; Edema ; Hypotension ; Hypothalamus ; Laryngeal Edema ; Larynx ; Magnetic Resonance Imaging ; Male ; Mast Cells ; Nitroprusside ; Ovalbumin ; Rats ; Rats, Sprague-Dawley

Objective To evaluate clinical features, diagnosis and treatment of anorectal malignant melanoma (ARMM).Methods The clinical data of 15 patients of ARMM in our hospital and 18 patients in the First Affiliated Hospital of China Medical University from 1990 to 2010 were reviewed.Twenty-five patients underwent curative surgical resection, 14 patients underwent abdominoperineal excision of the rectum (APR), and 11 patients underwent local excision (LE).Survival analysis was carried out.Fisher's exact test and Log-rank test was used to compare the effects of these two different surgical procedures.Results ARMM had a female predominance, the mean age was 22 -77(54.5 ± 7.6) years.The major clinical signs included hematochezia, anus pain.The misdiagnosis rate was 67% (22/33).The average tumor size was (3.5 ±1.7) cm.Thirty-one petients(94% ,31/33) had ARMM within 5 cm from anus margin.Mean survival time was (14.0 ± 6.5)months.The overall 1-,3-,and 5-year survival rates were 48% ,22% , and 10% , respectively.Local recurrence after curative LE was higher than APR (LE,64% vs APR, 21% , P = 0.049) , The overall 3-year disease-specific survival rates after curative LE was not significantly different from that of APR (LE, 28% vs APR ,31%, x2 = 0.268, P = 0.582).Conclusions Anorectal malignant melanoma has a high rate of misdiagnosis.Radical resection could not prolong the survival time significantly in anorectal malignent melanoma patients.

Objective To investigate the clinical and pathological features of rectal carcinoid and factors influencing the prognosis. Methods Clinical data of 29 cases with postoperative pathology identified diagnosis of rectal carcinoid from May 1998 to May 2008 in the two hospitals were retrospectively reviewed. Endoscopic submucosal resection of the tumor was conducted in 5 cases,local resection in 14 cases, local expanded resection of the tumor in 4 cases, transsacral local wide resection in 2 cases, radical operation in 4 cases. Results Median age at treatment was 32～71 (54±11) years. Median follow-up was (61±4) months (3 months-10 years), follow-up rate was 76%. During a follow-up, there were no cases with recurrence among the 13 patients with tumor size<1 cm, 1 case recurred in the 5 patients with turmor size between 1 to 2 cm, and 3 cases died from postoperative liver metastasis among the 4 patients with tumor size > 2 cm. The 5-, 10-year disease-specific survival rates were 87% and 80% respectively. Conclusions Surgery is the best therapy for rectal carcinoid, the choice of operative mode must be made according to the size,infiltration of the tumor, the condition of infiltrated lymph node and hepatic metastasis.

Objective To observe the difference of anoreetal dynamics between Milligan-Morgan hemorrhoidectomy plus internal sphinctemtomy and simple Milligan-Morgan bemorrhoidectomy in the treatment of annulus mixed hemorrhoids.Method Measured the anal resting pressure,maximal anal contractive pressure,rectal sensation thresholds,maximal rectal tolerable dose and maximal rectal compliance 1 day before and 3 months after Milligan-Morgan hemorrhoidectomy plus internal sphincterotomy (therapy group,50 cases)and simple Milligan-Morgan bemorrhoidectomy(control group,52 cases)by anorectal manometric device made in Sweden.Results The anal resting pressures of therapy group and eontrol group reduced signifieanfly 3 months after operation compared with that 1 day before operation(P＜ 0.01 or ＜ 0.05),but there was significant difference between the two groups in 3 months after operation(P＜0.05).The maximal anal contractive pressure,reetal sensation thresholds,maximal rectal tolerable dose and maximal rectal compliance were no significant difference between the two groups in 3 months after operation (P ＞0.05).Conclusion Anal sphineterotomy can change the high anal pressure significantly in the treatment of annulus hemorrhoids without copracrasia,it is a proper operation method.