The Effects of Laparoscopic Adjustable Gastric Banding on the Proximal Pouch and the Esophagus

Background: Pouch development is a potentially serious problem following gastric banding, and re-operation is often demanded to maintain long-term function of the lap band. Laparoscopic gastric banding was performed with two different calibrations of the pouch. Within a period of 12 months, postoperative pouch behavior with regard to volume and shape was evaluated retrospectively, as were changes in the distal esophagus. Methods: The pouches of 14 patients with intraperitoneal band positioning were calibrated at 25 ml. The volumes of 54 patients operated by a suprabursal technique were set at 15 ml. We performed three radiological examinations and calculated the volumes using the ellipsoid formula d1 x d2 x d3 x π/6. Four morphologically different pouch types have been observed: regular, concentric, eccentric-medial and eccentric-lateral. The ϕ-angle corresponds to the angle between the spinal column and the gastric band. Results: In the first group, the pouch volume increased from 21.2 ml ± 21.2 to 87.9 ml ± 64.6 (p=0.006) and the BMI fell from 47.1 kg/m² ± 8.4 to 38.1 kg/m² ± 7.0 (p=0.001). The pouch volume of the second group increased from 10.4 ml ± 5.8 to 38.8 ml ± 29.1 (p<0.001), and the BMI reduced from 48.4 kg/m² ± 6.9 to 39.3 kg/m² ± 6.7 (p<0.001). If the ϕ-angle is smaller than 4°,the pouch is of the eccentric-medial type. Conclusions: The transbursal operative technique is responsible for the development of the eccentric-medial pouch. If the anterior sero-muscular fixative sutures tear, an eccentric-lateral pouch results. All pouch types are affected by changes at the pouch-esophageal junction and by pathological developments in the distal and middle oesophagus.     

Tourette综合征的发病危险因素分析

目的探讨Tourette综合征(TS)发病的危险因素。 方法2000 01—2004 12采用病例对照研究的方法，对温州医学院附属一院100例TS患儿及100名对照病例的相关资料进行非条件Logistic回归和主成分分析。 结果非条件Logistic回归多因素分析显示，该病有统计学显著性意义的危险因素是TS家族史、注意缺陷伴多动障碍(ADHD)、过敏性哮喘、母亲孕早期受精神刺激、高热(T>39℃)和极低频磁场暴露，其标准回归系数分别为1.3987、3.6385、1.7657、1.7250、1.8973和1.0677。主成分分析提取了4个主成分，其方差累积贡献率为57.025%。 结论TS的发病与遗传因素和环境因素有关。     

Insulin aspart: a novel rapid-acting human insulin analogue

In order to improve therapy and increase the quality of life for diabetic patients, it has been of significant interest to develop rapid-acting insulin preparations that mimic the physiological meal-time profile of insulin more closely than soluble human insulin. Insulin aspart (B28Asp human insulin) is a novel rapid-acting insulin analogue that fulfils this criterion. The B28Asp modification weakens the self-association of the insulin molecule and provides a more rapid absorption from the sc. injection site. The preclinical evaluation in vitro and in vivo demonstrates that apart from the more rapid absorption, insulin aspart is equivalent to human insulin. Thus, insulin aspart is equivalent to human insulin on key in vitro parameters such as insulin receptor affinity, insulin receptor dissociation rate, insulin receptor tyrosine kinase activation, IGF-I receptor binding affinity, metabolic and mitogenic potency. In accordance with the equivalent in vitro profiles, the toxico-pharmacological properties of insulin aspart and human insulin are also identical. The available data for insulin aspart and other rapid-acting insulin analogues supports that in vitro assays are sensitive and valuable in the preclinical evaluation of insulin analogues. Clinical studies demonstrate that insulin aspart has a pharmacokinetic and pharmacodynamic profile superior to that of soluble human insulin. In Type 1 diabetic patients on a basal-bolus injection regimen, insulin aspart given immediately before the meals provides an improved postprandial glycaemic control and an improved long-term metabolic control, as compared to soluble human insulin given 30 min before the meals, without increasing the risk of hypoglycaemia. Taken together, the data support the hope that insulin aspart will allow the diabetic patient to combine a more flexible lifestyle with better glycaemic control, without any increased safety risk.     

胆道术后严重大出血54例临床分析

目的 分析胆道术后严重出血的临床病程和治疗效果。方法 回顾性分析2016-2018年海军军医大学附属东方肝胆外科医院胆道外科行手术治疗的胆道疾病病人中需要行介入治疗（内镜和血管造影治疗）或再次手术的严重大出血者54例临床资料。结果 胆道术后严重出血的发生率为1.7%（54/3183）。胆道术后严重出血相关的总体死亡率为0.53%（17/3183）。54例病人中,有3例行内镜检查,仅1例行内镜治疗成功止血;34例接受介入血管造影检查的病人中,23例接受了介入性栓塞治疗（包括介入性钢圈栓塞、覆膜支架等血管介入治疗）,18例止血成功,成功率为78.3%（18/23）。35例行再次剖腹止血手术,其中19例将手术作为一线治疗方案,16例为内镜或介入治疗失败后行补救性治疗。结论 胆道术后严重出血原因较多,临床表现多样,早期发现和治疗至关重要。应综合考虑发病时间、伴发并发症情况和初次手术方案制定治疗决策。介入治疗临床安全性和止血成功率较高,但在介入治疗止血失败的情况下应紧急中转手术治疗。     

高效液相色谱法同时测定健康人尿液中草酸和枸橼酸的含量

目的建立HPLC同时测定人尿草酸和枸橼酸含量的方法。方法采用Agilent SB C18(250mm×4.6mm,5μm)色谱柱;Agilent zorbax extend-C18(4.6mm×12.5mm,5μm)为保护柱;以0.018mol.L-1磷酸二氢钾(含0.010mol.L-1四丁基硫酸氢铵和2.69×10-5mol/L EDTA,pH2.4~2.5)为流动相;检测波长210nm;流速1.5mL.m in-1;柱温25℃;进样量20μL;以50mg/mL磺基水杨酸沉淀尿蛋白。结果草酸最低检测限为0.4μg.mL-1。线性范围为1.563~100μg.mL-1,平均回收率为97.66%,日内及日间精密度RSD<13.50%。枸橼酸最低检测限为0.8μg.mL-1。线性范围为3.125~200μg.mL-1,平均回收率为97.71%,日内及日间精密度RSD<8.25%。结论该方法简便,灵敏度高,重复性好,可用于尿路草酸钙结石成因的研究。