Obesity is a global public health problem, and bariatric metabolic surgery is the most effective measure to treat obesity and related complications. With the development of bariatric and metabolic surgery, hospitals at different levels across the country have successively carried out bariatric metabolic surgery, in which laparoscopic sleeve gastrectomy is the most popular. Problems such as postoperative complications and weight regain are increasing due to irregular surgical opera-tions. Combining with their own experience and the characteristics of medical center, the authors summarize the operation details of laparoscopic sleeve gastrectomy in order to further standardize the operation of laparoscopic sleeve gastrectomy and reduce the incidence of postoperative complications.

Spontaneous intracranial hypotension can frequently result in several complications including subdural hygroma, subdural hematoma and cerebral venous thrombosis, but coma rarely. A case of spontaneous intracranial hypotension presented with orthostatic headaches was described. He experienced somnolence, disorientation, incontinence, and then coma, though received conservative treatment. Brain imaging demonstrated acute-on-chronic subdural hematoma, magnetic resonance myelography using heavily T 2-weighted fast spin-echo pulse sequences showed spinal longitudinal extradural collection, and magnetic resonance myelography with intrathecal gadolinium revealed cerebrospinal fluid leak at the level of T 6, T 7. The patient recovered consciousness after surgical evacuation of the hematoma, and the headache disappeared after a targeted epidural blood patch. The hematoma resolved 2 months later and the patient kept free from headache during follow-up.

Objective:To explore the value of metagenomics next generation sequencing of cerebrospinal fluid in the diagnosis test of the pathogen of neurobrucellosis.Methods:Medical records of neurobrucellosis patients who were admitted to Xuanwu Hospital, Capital Medical University from May 2017 to February 2021 were reviewed. Seven patients who underwent cerebrospinal fluid metagenomics next generation sequencing were enrolled. Their clinical characteristics, cerebrospinal fluid results, serological and pathogenic results were analyzed.Results:Among the seven neurobrucellosis patients, including five males and two females, the age was from 21 to 49 [38 (24, 47)] years. Three patients had a history of exposure to cattle and sheep. The duration from onset to diagnosis was 2 to 30 [12 (5, 18)] months. The main neurological manifestations were headache for seven patients, loss of hearing for three patients, paralysis for four patients and urinary and fecal dysfunction for four patients. The blood tests showed that the rose bengal test was positive in three of seven patients, Brucella serum agglutination test was positive in four of six patients, and the blood culture was negative in four patients. The cerebrospinal fluid tests showed that rose bengal test was positive in one of five patients, Brucella serum agglutination test was positive in two of four patients, and the cerebrospinal fluid culture was positive in two of five patients. Cerebrospinal fluid metagenomics next generation sequencing was positive for Brucella in five patients.Conclusions:Comparing with the cerebrospinal fluid Brucella serum agglutination test and cerebrospinal fluid culture, cerebrospinal fluid metagenomics next generation sequencing is sensitive to the diagnosis of neurobrucellosis. It is recommended to perform cerebrospinal fluid metagenomics next generation sequencing in patients with clinically suspected neurobrucellosis or central nervous system infections of which the pathogen cannot be confirmed.

Objective:To explore the relationship of matrix metalloproteinase 2 (MMP-2) protein expression and microvessel density (MVD) in gastric cancer tissues with clinicopathological characteristics of patients as well as the significances.Methods:The disease-free survival (DFS) time, overall survival (OS) time and other clinicopathological data of 60 patients with gastric cancer after radical resection at Pei Country People's Hospital of Xuzhou from January 2010 to December 2015 were retrospectively analyzed. The MMP-2 protein expression and MVD marked by CD105 in 60 specimens of gastric cancer tissues and corresponding adjacent normal tissues were detected by using immunohistochemistry. The correlation of MMP-2 protein expression with MVD and their relationship with clinicopathological characteristics were analyzed.Results:The positive expression rate of MMP-2 protein in gastric cancer tissues was higher than that in adjacent normal tissues, and the difference was statistically significant [75% (45/60) vs. 17% (10/60), χ2 = 59.668, P < 0.05]. The MVD in gastric cancer tissues was higher than that in adjacent normal tissues, and the difference was statistically significant [32±5 vs. 20±4, t = -2.32, P < 0.05]. The expression of MMP-2 protein in gastric cancer tissues had no relationship with gender, age, the longest tumor diameter, tumor location, OS time, and DFS time (all P < 0.05), while the expression of MMP-2 protein in gastric cancer tissues had statistically significant relationship with the depth of tumor invasion, lymph node metastasis, TNM stage, and histological differentiation (all P < 0.05). There were no statistically significant differences in the expressions of MVD marked by CD105 in gastric cancer tissues of patients with different gender, age and tumor location (all P < 0.05). The expressions of MVD marked by CD105 in gastric cancer tissues had statistical differences in patients with different the longest tumor diameter, depth of tumor invasion, lymph node metastasis, TNM stage, histological differentiation, OS time, and DFS time (all P < 0.05). In gastric cancer tissues, the expression of MMP-2 protein and MVD were positively correlated ( r = 0.198, P = 0.027). Conclusions:The MMP-2 protein expression and MVD in gastric cancer tissues are on the increase, and play key roles in the occurrence and development of gastric cancer. They might cooperatively participate in the malignant progression of gastric cancer, and can be used as poor prognostic factors of gastric cancer.

Objective:To explore the clinical and genetic features in a case of fatal familial insomnia (FFI).Methods:A case of 39 years old woman diagnosed as progressive supranuclear palsy based on the preliminary manifestation of imbalance and frequent falls was reported. The clinical features, imaging characteristics, electroencephalogram and polysomnography of the patient were analyzed, and the blood samples from the patient were collected for the sequencing of prion protein (PRNP) gene.Results:This patient is a middle-aged woman, whose clinical manifestations were posture instability and retropulsion, rapid progressive dementia and dysarthria, sleep-related dyspnea and laryngeal stridor, with autonomic symptoms of hypertension, sweating, tachycardia and irregular breathing. The results of PRNP gene sequencing revealed that the mutation of gene D178N/129M was detected.Conclusions:Laryngeal stridor plays an important role in the diagnosis of FFI. Posture instability and retropulsion are relatively rare in the FFI clinical symptom spectrum. Here, a case of FFI presenting with posture instability and retropulsion during the early stage with Met/Met at the polymorphic codon 129 is reported in China.

Objective: To improve the clinician′s recognition of Gerstmann-Sträussler-Scheinker syndrome (GSS). Methods: The detailed clinical information, neuropsychological examination, cerebrospinal fluid examination, imaging characteristics, electroencephalogram examination and gene detection were analyzed in a case of GSS similar to Creutzfeldt-Jakob disease (CJD) in symptomatology. The differences between the two different prion diseases were compared in combination with the literature review. Results: The patient is a 62-year-old woman, with cerebellar ataxia as the first symptom, followed by rapid dementia, accompanied by pyramidal and extrapyramidal signs. Magnetic resonance imaging showed hyper-intense signal in diffusion weighted imaging in caudatum and cortical ribboning, and protein 14-3-3 was negative. PRNP gene analysis showed P102L gene mutation. Conclusions The typical clinical manifestation of GSS is hereditary ataxia followed by cognitive decline of varying severity. Detection of PRNP plays an important role in the diagnosis of GSS.

Objective: To investigate the effect of cinobufacin combined with As₂O₃ on the angiogenesis of subcutaneous transplantation tumor in colorectal carcinoma BALB/C nude mice. Methods: The colorectal carcinoma transplantation tumor model of BALB/C nude mice was established and divided into 4 groups, 5 mice in each group. The growth state of nude mice was observed by injecting the corresponding reagents into the tumor in As₂O₃ group, cinobufacin group, cinobufacin combined As₂O₃ group and the blank control group (replaced by phosphate buffer), respectively. The nude mice were killed two weeks later, and the tumor tissues, liver and kidney tissues and orbital vein blood were taken. The tumor volume inhibition rate and mass inhibition rate of nude mice were calculated. The histomorphology of tumor, liver and kidney and blood routine were detected. The expressions of vascular endothelial growth factor (VEGF), epidermal growth factor receptor (EGFR), fibroblast growth factor-basic (b-FGF) and CD105 in transplanted tumor tissues were detected by using immunohistochemistry method, and the microvascular density (MVD) of transplanted tumor in nude mice was evaluated. Western blot method was used to detect the protein expression levels of VEGF, EGFR and b-FGF. Results: After 2 weeks of administration, the tumor volume and tumor mass in As₂O₃ group, cinobufacin group and cinobufacin combined As₂O₃ group were lower than those in the blank control group. The volume inhibition rate was 16%, 17%, 72%, and the mass inhibition rate was 31%, 33%, 78%, respectively, and the difference was statistically significant (all P < 0.01); there was no statistical difference between As₂O₃ group and cinobufacin group in the tumor volume and tumor mass (P > 0.05), and cinobufacin combined As₂O₃ group had the most obvious therapeutic effects (all P < 0.05). The immunohistochemistry method showed that the expressions of VEGF, EGFR, b-FGF and MVD were decreased in As₂O₃ group, cinobufacin group and cinobufacin combined As₂O₃ group compared with the blank control group, and there were statistical differences of the four groups (all P < 0.05). There was no statistical difference of the marker changes in As₂O₃ group and cinobufacin group (all P > 0.05), and cinobufacin combined As₂O₃ group had the most significant decrease in the marker changes, and there was a significant difference compared with the other groups (all P < 0.05). Western blot showed that compared with the blank control group, the other three groups could downregulate the protein expressions of VEGF, EGFR and b-FGF in the transplanted tumor of nude mice. And the decreasing expression of each protein in cinobufacin combined As₂O₃ group was the most significant. Pathomorphology examination showed that the histomorphology of liver and kidney of the four groups of nude mice was normal. Blood routine examination showed that compared with the blank control group, the white blood cell count of nude mice in other groups was decreased, and the difference was statistically significant (all P < 0.05). The white blood cell count of cinobufacin combined As₂O₃ group was decreased most significantly; there was no statistically significant difference in hemoglobin and platelet count among the four groups (all P > 0.05). Conclusions Cinobufacin and As₂O₃ show synergistic effects in the tumor angiogenesis and inhibition of transplantation tumor growth of colorectal cancer BALB/C nude mice. Moreover, cinobufacin and As₂O₃ have no obvious toxicity to the hepatic, kidney and hematopoietic tissues.

Objective To investigate the clinicopathological features and correlation between synchronous multiple early gastric cancer (SMEGC)and single early gastric cancer (EGC).Methods From January 2008 to December 2016,the clinical data of 994 patients with EGC who underwent open or laparoscopic gastrectomy surgery were collected from the electronic medical data base of the First Affiliated Hospital of Nanjing Medical University and Xuzhou No.1 People's Hospital.The data of patients including gender,age,tumor morphologys,tumor location,tumor size,histological type,depth of invasion,lymph nodes metastasis,lymphovascular metastasis,peripheral nerve invasion,and blood types were analyzed.T test and Chi square test were used for statistical analysis.Results Among 994 EGC patients,27 cases (2.7％) were SMEGC,and 967 cases (97.3％) were single EGC.The percentage of male and female of single EGC were 71.4％ (690/967) and 28.6％ (277/967),respectively;the percentage of male and female of SMEGC were 88.9％ (24/27) and 11.1％ (3/27),respectively,and there was statistically significant difference in the gender composition ratio between single EGC and SMEGC (x2 =3.975,P=0.046).The incidence of ulcer in single EGC and SMEGC were 50.6％ (489/ 967) and 29.6 ％ (8/27),respectively,and the difference in the incidence of ulcers between single EGC and SMEGC was statistically significant (x2 =4.653,P=0.031).There were no statistically significant differences between single EGC and SMEGC in gross morphology,depth of invasion,lymph nodes metastasis,lymphovascular metastasis,peripheral nerve invasion,tumor location,pathological type and blood types (all P＞0.05).In the SMEGC patients,the incidence of main lesions invading the mucosa was 48.1％ (13/27) and submucosa invasion was 51.9％ (14/27);and for minor lesions,the corresponding incidences were 77.8％ (21/27) and 22.2％ (6/27),respectively,and the difference was statistically significant (x2 =5.063,P＜0.05).There were no statistically significant differences between the main lesions and minor lesions in tumor size,pathological type,with or without ulcers,gross morphology and tumor location (all P＞0.05).Conclusions The main risk factors of SMEGC are male and no ulcerative lesions.The clinicopathological features are similar between main lesions and minor lesions in SMEGC.

Objective To investigate the efficacy and safety of domestic exenatide injection versus imported exenatide injection in type 2 diabetic patients with inadequate glycemic control on monotherapy or combination therapy of metformin and insulin secretagogues. Methods A multicenter, randomized, parallel-controlled, and non-inferiority trial was carried out. A total of 240 subjects were randomized at a 1:1 ratio to add domestic exenatide injection (trial group) or imported exenatide injection (control group) on the background therapies. The primary endpoint of efficacy was HbA1C change from baseline to week 16. The secondary endpoints of efficacy were the proportion of HbA1C<7.0%, and the changes in fasting plasma glucose (FPG), 2 h plasma glucose after standard meal (2hPG), 7-point self monitoring of blood glucose (7P-SMBG), and body weight from baseline to week 16. Results Among subjects of per-protocol sets, adjusted mean HbA1C reduction was -1.07% in the trial group versus -1.06% in the control group after 16 weeks of treatment. The lower boundary of the two-sided 95% confidence intervals of the mean HbA1C reduction difference between the trial and control groups was -0.29%, which was more than -0.35%, suggesting that the predefined statistical criterion for non-inferiority was achieved. The proportions of subjects achieving HbA1C<7.0% at the end of the 16-week treatment were 56.19% and 54.08% in the trial and control groups, respectively (P>0.05). The changes in FPG, 2hPG, 7P-SMBG and body weight from baseline to week 16 were comparable between the two groups (all P>0.05). Moreover, the incidences of hypoglycemia and adverse events were similar between the two groups (both P>0.05). Conclusion In type 2 diabetic patients inadequately controlled by monotherapy or combination therapy of metformin and insulin secretagogues, the efficacy of cotreatment with domestic exenatide injection is not inferior to that of imported product ones, with a similar safety profile.

To realize dynamic and standardized periodical quality control of medical equipment. A set of auto reminder module for medical equipment quality control was established by using the user-defined flow of medical equipment operation maintenance system, and the continuous improvement was realized for medical equipment quality control in some hospital. Dynamic medical equipment quality control was formed from the static one, so that the efficiency of medical equipment quality control was enhanced greatly. References were provided for other hospitals in dynamic and informatzied medical equipment quality control and testing.