Objective:To analyze the feasibility, safety and clinical efficacy of laparoscopic side-to-side jejunoileal anastomosis in the treatment of non-obese type 2 diabetes patients (BMI≤32.5 kg/m 2). Methods:The clinical data of 135 patients who underwent laparoscopic side-to-side jejunoileal anastomosis at our hospital from Jan 2018 to Oct 2018 were retrospectively analyzed. They were followed up for 12 months until the end of Oct 2019. SPSS software was used to compare patients′ fasting blood glucose, glycosylated hemoglobin, c-peptide, insulin, body weight, BMI with the values after 12 months of the surgery, and then evaluate factors affecting the prognosis.Results:135 patients successfully completed laparoscopic side-to-side jejunoileal anastomosis without conversion to open surgery. After 12 months of the operation, the patients′ fasting blood glucose was (5.80±0.18)mmol/L, glycosylated hemoglobin was 5.9%±0.4%, fasting c-peptide was(1.32±0.21) nmol/L, and fasting insulin was (42±54) mU/L ( t=10.654, 12.657, 11.214, 10.698, all P<0.05). The body weight was (72.4±9.9)kg, BMI was( 25.6±2.8)kg/m 2, and the difference was not statistically significant ( t=7.658, 6.958, P>0.05). In patients with preoperative glycosylated hemoglobin controlled below 8% and the duration of T2DM less than 10 years, the chances being cured was better than that of those with glycosylated hemoglobin>8% and the medical history >10 years. Conclusion:Laparoscopic side-to-side jejunoileal anastomosis in the treatment of non-obese type 2 diabetes is effective, safe and reliable.

Objective To investigate the regulating function of human gingival mesenchymal stem cell (GMSC) on the proliferation and differentiation of B cells and its underlying molecular mechanism. Methods GMSC were isolated and B cells were isolated from peripheral blood. GMSC or fibroblasts were co-cultured with B cells in vitro and assigned into the GMSC group and fibroblast group. The proliferation of B cells was detected in two groups. The expression of IgG1 and IgM in the cell supernatants was measured between two groups. The secretion of interleukin (IL)-6, Perforin, interferon (IFN)-γ and tumor necrosis factor (TNF)-α was compared between two groups. The expression levels ofIL-10 and transforming growth factor (TGF)-β in B cells were detected between two groups. The expression of PC-1 in B cells was measured in two groups. The signaling pathway involved with the regulating effect of GMSC on B cell function was investigated. The regulating effect of GMSC on the role of B cells in activating T cell function was assessed. Results Compared with the fibroblast group, the proliferation of B cells was significantly weakened in the GMSC group (P < 0.05). Co-culture of GMSC and B cells significantly inhibited the secretion of IgG1 and IgM from B cells and the secretion ofIL-6, Perforin, IFN-γ and TNF-α (all P < 0.05). Compared with the fibroblast group, the secretion of IL-10 and TGF-βwas significantly higher in the GMSC group (both P < 0.05). The expression level of PC-1 in the GMSC group was significantly down-regulated (P < 0.05). After adding ALK5, an inhibitor of TGF-β receptor, the inhibitory effect of GMSC upon B cells was significantly weakened (P < 0.05). Compared with the fibroblast group, the ability of B cells to activate and proliferate T cells was significantly attenuated in the GMSC group (P < 0.05). Conclusions GMSC can inhibit B cells and their mediated immune responses. The activation of B cells and other related functions can be suppressed through the TGF-β signaling pathway.

To analyze correlation among serum homocysteine (Hcy) ,Cysteine C (CysC) levels and severi‐ ty of coronary artery disease .Methods : A total of 220 coronary heart disease (CHD) patients treated in our hospital from Sep 2015 to Dec 2017 were selected as CHD group .According to Gensini score ,CHD group were divided into mild stenosis group (n＝ 63 ) ,moderate stenosis group (n＝ 71 ) and severe stenosis group (n＝ 86 ).Another 200 healthy people were enrolled as healthy control group .Serum Hcy and CysC levels were measured and compared a‐mong all groups .Correlation among serum Hcy , CysC levels and severity of coronary artery disease were analyzed . Results : Compared with healthy control group ,there were significant rise in serum Hcy [ (8.29 ± 1.02) μmol／L vs. (16. 14 ± 3.01) μmol／L] and CysC [ (0. 65 ± 0.11) mg／L vs.(1. 21 ± 0.12) mg／L] levels in CHD group .P＝0. 001 all.Compared with mild stenosis group ,there were significant rise in serum Hcy [(9. 31 ± 1.12) μmol／L vs.(12. 13 ± 3.32) μmol／L vs.(14.61 ± 3.82) μmol／L] and CysC [ (1.05 ± 0.21) mg／L vs.(1. 51 ± 0. 52) mg／L vs.(3.42 ± 1.01) mg／L] levels in moderate stenosis group and severe stenosis group ,and those of severe stenosis group were significantly higher than those of moderate stenosis group , P＝0.001 all.Pearson correlation analysis indicated that serum Hcy ( r＝0.431 , P＝0.004) , CysC ( r＝0.640 , P＝0. 003) levels were significant positively correlated with Gensini score .Conclusion :Serum Hcy and CysC levels is closely correlated with severity of coronary artery disease . Its detect is help for therapeutic effect and prognosis assessment for CHD patients .

Objective To evaluate the application of 3D printing technology in the treatment of displaced acetabular fractures ( DAF ) complicated with unstable injury to the posterior pelvic ring. Meth-ods A retrospective study was conducted of all the 19 DAF patients complicated with unstable posterior pelvic ring who had been treated from August 2009 to June 2015 in our hospital. They were 12 men and 7 women, aged from 24 to 62 years ( average, 39. 8 years ) . Twelve DAFs were complicated with ipsilateral unstable injury to the posterior pelvic ring, 5 with contralateral unstable injury to the posterior pelvic ring, and 2 with bilateral unstable injury to the posterior pelvic ring. Preoperatively, 3D digital models of the pelvis were reconstructed for the 19 patients using their CT scanning data. Their pelvic models were printed using 3 D printing technology for visual evaluation of their fractures and design of individualized surgical proce-dures. Results With the help of their 3D printing models, the 19 patients obtained successful operations within a mean time of 3. 2 hours. Their intraoperative blood loss averaged 658. 5 mL. They were followed up for an average of 10. 7 months ( range, from 8 to 24 months ) . According to Matta′s criteria for pelvic reduc-tion, 14 cases achieved anatomical reduction, 2 satisfactory reduction and 3 unsatisfactory reduction. Ac-cording to Mears's criteria for reduction of the posterior pelvic ring, 13 cases achieved anatomical reduction, 4 satisfactory reduction and 2 unsatisfactory reduction. The 19 acetabular fractures healed after 9 to 18 weeks ( average, 14. 5 weeks ) . The pelvic fractures healed after 8 to 17 weeks ( average, 13. 5 weeks ) . According to the Merle d'Aubigne-Postel criteria at the last follow-ups, the hip functions were excellent in 7, good in 9, fair in one, and poor in 2 cases. According to the Majeed's functional evaluation, the pelvic functions were excellent in 10 cases, good in 7, fair in one, and poor in one. Complications were incision infection in one, heterotopic ossi-fication in 2, avascular necrosis of the femoral head in one and traumatic arthritis in one. Conclusion In thetreatment of DAF complicated with unstable injury to the posterior pelvic ring, application of 3D printing technology can provide direct visualization of the pelvic and acetabular fractures which facilitate preoperative evaluation and design of individualized surgical protocols, leading to fine outcomes.

Objective To discuss the feasibility and safety of sevoflurane inhale anesthesia with portable combined inhalation anesthesia induction device in solving the difficulty of children entering the operation room.Methods One hundred pediatric patients were enrolled into the study.The pediatric patients were randomly divided into two groups,50 cases in each group.Group A was fraught with a new mode of administration,using portable combined inhalation anesthesia induction device with sevoflurane 2 ml before entering the operation room;group B was fraught with a traditional mode of administration,using in-tramuscular injection with ketamine 4-5 ml/kg before entering the operation room.The analog scale of anes-thetic effect,the number of body movement,adverse reaction were compared between the two groups. Results Compared with group B,time of falling asleep and retention time in the operating room was signif-icantly shorter (P <0.01).And body movement during vein puncture decreased significantly (P <0.01). Moreover,the incidence of adverse affect showed significant reduce compared with group B (P < 0.05 ). Conclusion The combined inhalation anesthesia induction device is simple to produce and easy to carry.To solve the difficulty of convoying children into the operating room,combined inhalation anesthesia induction device with sevoflurane is more effective, safer and more humanized way when compared with the traditional one.

Objective To investigate the effects of different doses of dexmedetomidine and propofol on electrocorticography (ECoG)during epileptic resection.Methods One hundred cases of epileptic patients undergoing epileptic resection were randomized into five groups (n=20 cases).Af-ter exposure of the cortex,patients were allocated to propofol group or dexmedetomidine group,the propofol were injected intravenously with different target-controlled-infusion (TCI)concentrations at 1.5 μg/ml (group C1),5.0 μg/ml (group C2)respectively.The dexmedetomidine were injected with a loading dose of 0.5 μg/kg within 1 5 min,then followed by a speed of 0.25 μg·kg-1 ·h-1 (group D1 ),0.5 μg·kg-1 ·h-1 (group D2),and 1.0 μg·kg-1 ·h-1 (group D3)respectively.After 1 5 min of steady infusion,the characteristics of ECoG were recorded.Results Compared with the other four groups,the epileptic spike-wave,αandβwaves were significantly decreased,whileδwave was significantly increased in group C2 (P < 0.05 ).Sometimes burst-suppression-patterns were recorded under propofol. With the dose of dexemedetomidine increasing in groups D1,D2,D3,the epileptic spike-wave,αwave andβwave gradually decreased,while δwave gradually increased (P <0.05).Conclusion Propofol produces dose-dependent inhibition on ECoG,but the epileptic spike-wave still can be differentiated if the plasma con-centration lower than 1.5 μg/ml.Compared with propofol,dexmedetomidine injected with 0.25-0.5 μg· kg-1 ·h-1 ,has few disturbance on epileptic spike-wave differentiation and location during ECoG monito-ring,and is more eligible for epileptic resection anesthesia.

Objective To evaluate the clinical results of operative treatments for the complex posterior tibial plateau fractures via posterior approach. Methods Eleven cases with complex posterior tibial plateau fracture from June 2008 through June 2010 were reviewed retrospectively. There were 7 males and 4females, with age from 33 years to 60 years (average, 47.8 years). According to AO classification, there were 41-B2.2.4 type in 2 cases, 41-B3.1.2 type in 3, 41-B3.3.2 type in 3, 41-B3.1.2 type combined 41-B3.3.2 type in 2, 41-C3.3 type in 1. Carlson posterior lateral approach were used in 5 cases, posterior medial approach were used in 3 cases, and posterior medial and/or lateral approach combined with anterior approach were used in 3 cases. All fractures were fixed with plates. Autogenous ilium grafts were used if necessary.Results All cases were followed up. The average follow-up time was 1.6 years (range, 3-24 months). At the final follow-up visit, bone union was obtained in all cases. The mean Rasmussen score was 16.7 (range, 15-18), and the mean HSS was 86.2 (range, 75-96). The postoperative knee range of motion were 0°-135°, 0°-130° and -10°-125° in 5 cases with posterior lateral plateau fractures, 3 cases with posterior medial plateau fractures and 3 cases with anterior and posterior plateau and intercondylar fractures respectively. There was no vascular and nerve injuries. Loosing or breaking of hardware's was not found. Conclusion The Carlson posterior lateral and/or medial approach is preferred for the complex posterior plateau fractures, with the advantages of direct reduction and stabilization.

Objective To explore the reasonability of posterior approach incision length in an unselected patient cohort with minimally invasive total hip arthroplasty (THA) and compare the clinical results of different incision lengths. Methods A consecutive unselected 256 patients who underwent primary unilateral THA between March 2001 and December 2007 were studied prospectively. Prior to the operation, the incision length was not deliberately selected for the patients. A posterior approach was used for all procedures with minimally invasive surgical techniques. The patients were divided into three groups according to the incision length at the end of surgery: mini-incision group ( ＜ 10 cm, 99 patients) , moderate incision group (10-14 cm, 112 patients) and standard incision group ( ＞ 14 cm, 45 patients). The in-hospital data including age, sex, diagnosis,body mass index (BMI),operation duration, intraoperative blood loss, total blood loss, preservation of the external rotators, anatomic repair of the capsule as well as postoperative radiographs were collected for analysis of the intraoperative and postoperative complications. The pain was estimated by using the individual visual analog scale (VAS) and the functional outcome evaluated by Harris hip score preoperatively and postoperatively. Results All the patients were followed up for an average period of 6.1 years (2.5-9.2 years). The incision length was shortened and optimized ( ＜ 14 cm) in 211 patients. There showed decrease of BMI, less intraoperative blood loss, less pain, satisfactory outcome but higher proportion of abnormal abduction angle of the acetabular prosthesis in the early postoperative period in the mini-incision group, with statistical difference compared with the other two groups (P ＜ 0.05). The preservation of the piriformis tendon, anatomic repair of the joint capsule, operation duration and Harris score at 6th postoperative week in the moderate incision group were similar to those in the mini incision group but showed statistical difference in comparison with the standard incision group ( P ＜0. 05). Conclusions Minimally invasive THA with a smaller posterior incision can attain safe and effective curative effect for the unselected patient cohort. A smaller but not necessarily miniincision may allow minimal soft tissue trauma for the surgeon to perform the procedure well and ensure a long-term clinical results.

Objective To analyze the risk factors related to intraoperative femur fracture in hip replacement and discuss the treatment countermeasures. Methods The medical records and radiographs of 38 patients with intraoperative femur fracture who were treated at Tianjin Orthopedic Hospital from December 2002 to December 2009 were retrospectively studied. Fractures were classified according to the Amstutz system or AAOS standard and the treatment methods were selected accordingly. Reduction and fixation was performed in 25 patients including 14 patients treated with interfragmentary or cerclage fixation, five with plate fixations and six with cortical strut graft. Shank prosthesis was replaced in 12 patients. Results The mean follow up period was 4.5 years, which showed successful union of the fractures in 36 patients and delayed union in two. Replacement of the prosthesis was needed in one patient for prosthesis loosening four years postoperatively. Conclusions Osteoporosis, violence, abnormal femur canal and over large prosthesis are the main causes of intraoperative femur fracture in hip replacement.Proper selection of treatment method according to fracture types may attain fracture union with a stable implant.

Three ASA Ⅱ male patients aged 22-46 yr weighing 50-75 kg underwent operation on language areas from June to September 2009 in our hospital. Anesthesia was induced with propofol 2-2.5 mg/kg, fentanyl 4-5 μg/kg and atracurimm 0.6 mg/kg. The esophago-pharyngeal tube was inserted into esophagus and oropharynx under direct vision. The esophageal balloon was inflated with 10-15 ml of air and the pharyngeal balloon with 40-60 ml of air. After the correct position of the tube was confirmed, the patients were mechanically ventilated.Anesthesia was maintained with propofol 50-70 μg · kg- 1 · min- 1 , remifentanil 0.15-0.25 μg· kg- 1 · min- 1 and atracurium 0.3-0.4 μg·kg-1·h-1. The pharyngeal balloon was deflated during wake-up test. The patients were asked to count continuously and answer question as instructed to locate the language areas. After the language areas had been located, the pharyngeal balloon was inflated again. The tidal volume was set at 500-510 ml and measured 500-512 ml. The airway pressure measured 16-18 cm H2O. The hemodynamics was stable and blood gas indexes were within the normal range. The language in response to questions was clear in one patient, not very clear in the second patient and vague in the third patient. Hypoxemia hypercapnea and intracranial hypertension were not observed during operation and wake-up test. After the patients became conscious, the balloons were deflated and the vital signs were stable. The patients were transferred to ICU after removal of esophago-pharyngeal tube. No postoperative complications occurred.