Type 2 Diabetes Mellitus and the Metabolic Syndrome Following Sleeve Gastrectomy in Severely Obese Subjects

BACKGROUND: Data on the effectiveness of sleeve gastrectomy in improving or resolving type 2 diabetes mellitus (T2DM) and the metabolic syndrome (MS) are scarce. METHODS: A twelve-month prospective study on the changes in glucose homeostasis and the MS in 91 severely obese T2DM subjects undergoing laparoscopic SG (SG; n = 39) or laparoscopic Roux-en-Y gastric bypass (GBP; n = 52), matched for DM duration, type of DM treatment, and glycemic control was conducted. RESULTS: At 12 months after surgery, subjects undergoing SG and GBP lost a similar amount of weight (%EBL: SG: 63.00 +/- 2.89%, BPG: 66.06 +/- 2.34%; p = 0.413). On that evaluation, T2DM had resolved, respectively, in 33 out of 39 (84.6%) and 44 out of 52 (84.6%) subjects after SG and GBP (p = 0.618). The rate of resolution of the MS (SG: 62.2%, BPG: 67.3%; p = 0.392) was also comparable. A shorter DM duration (p < 0.05), a DM treatment not including pharmacological agents (p < 0.05), and a better glycemic control (p < 0.05), were significantly associated with T2DM resolution in both surgical groups. Weight loss was not associated with T2DM resolution after SG or GBP, but was associated with resolution of the MS following the two surgical procedures (p < 0.05). CONCLUSIONS: Our data show that at 12 months after surgery, SG is as effective as GBP in inducing remission of T2DM and the MS. Furthermore, our data suggest that SG and GBP represent a successful an integrated strategy for the management of the different cardiovascular risk components of the MS in subjects with T2DM.     

锚定法改良单开门颈椎管成形术配合中药热敷防治术后轴性症状的疗效观察

单开门颈椎管扩大成形术是用于治疗多节段退变的脊髓型颈椎病、颈椎后纵韧带骨化症、无骨折脱位型颈脊髓损伤等颈椎疾患的经典术式,在解除脊髓压迫、改善神经功能方面具有确切而持久的疗效。但也常常伴有术后颈椎总活动度明显减少,同时还常常伴有颈部慢性疼痛、僵硬感、沉重感,亦即轴性症状,而轴性症状与术后颈椎活动度减少呈正相关。笔者应用锚定法改良单开门颈椎管扩大成形术配合中药热敷治疗脊髓型颈椎病、无骨折脱位性颈脊髓损伤等疾患,以防治颈椎管成形术后轴性症状的发生,疗效满意,现报告如下。     

一期微创经皮肾镜取石术(MPCNL)治疗双侧上尿路结石(附20例报告)

目的探讨一期微创经皮肾取石术（MPCNL）治疗双侧上尿路结石的疗效和安全性。方法总结一期微创经皮肾镜取石术治疗双侧上尿路结石20例的效果和并发症。结果双侧肾结石患者7例,结石清除率85％,平均手术时间160min;一侧输尿管上段结石对侧肾结石患者5例,结石清除率89％,平均手术时间142min：双侧输尿管上段结石患者8例,结石清除率92％,平均手术时间128min。手术出血量5-450ml,平均150ml。手术后25％（5／20）的患者出现超过38．0℃的发热,所有患者肾功能恢复正常,无严重术后并发症。结论对于身体情况良好,结石清除相对容易的双侧上尿路结石患者,一期MPCNL是安全可靠的,能减少患者总住院时间和费用。     

Free DIEP and SIEA breast reconstruction to internal mammary intercostal perforating vessels with arterial microanastomosis using a mechanical coupling device

Autologous breast reconstruction with microsurgical free tissue transfer has become routine, and perforator-based adipocutaneous flaps are recognized as an excellent option for many patients. Current efforts to optimize patient outcomes focus on minimizing operative morbidity both at the donor and recipient sites. The DIEAP flap avoids most of the abdominal wall morbidity associated with the TRAM. At the recipient site, however, partial rib resection, for access to the internal mammary (IM) artery and vein as recipient vessels, has a risk of chest wall pain, deformity, and pneumothorax. Perhaps more importantly, sacrifice of the IM vessels precludes their use for potential future coronary revascularization. To avoid this, the intercostal perforating branches from the internal mammary system may be used as recipient vessels for microanastomosis. This has been well described using suture technique, although the use of a mechanical coupling device for arterial anastomosis to the perforator has not been reported. We report nine cases whereby a mechanical coupling device was used to perform both the arterial and venous anastomoses of DIEAP and SIEA flap pedicles to IM intercostal perforating vessels. Flap ischemia time was shorter in all cases, allowed ease of anastomosis for vessel size mismatch, and is technically easier in deep wounds. This technique is a further refinement to free flap breast reconstruction and is a powerful application of the coupling device.     

经皮穿刺椎弓根成形术治疗椎弓根溶骨病变

[目的]探讨应用椎弓根成形术治疗椎弓根溶骨病变的方法以及治疗效果。[方法]在CT或者高分辨率的双C型臂X线机透视导引下,通过专用穿刺针将骨水泥注射到椎弓根破坏部位,并对穿刺的准确性、注射剂量、临床效果以及并发症进行观察和讨论。[结果]本院自2002年12月~2006年4月,共实施5例,全部病例手术后2~24h症状缓解。病人能够活动,停用止痛药物,恢复日常活动,改善了生活质量。手术后CT扫描无椎管内泄漏。[结论]尽管椎弓根部位解剖结构复杂,穿刺注射难度大,只要正确掌握方法是治疗椎弓根溶骨破坏的有效方法。     

自然流产模型小鼠绒毛滋养层细胞凋亡及相关调控蛋白的表达

目的探讨自然流产模型小鼠绒毛滋养层细胞凋亡异常与自然流产的关系。方法建立正常妊娠模型CBAXBALB/c和自然流产模型CBAXDBA/2。采用DNA缺口原位末端标记技术(TUNEL)测定两组模型孕13 d绒毛滋养层细胞凋亡情况;免疫组织化学SABC法测定两组模型孕13 d绒毛组织Bcl-2、Bax、Fas、FasL 4种凋亡调控蛋白的表达,并以MBIS-2000医用彩色病理图像免疫组织化学测量系统对其表达进行半定量分析,结果用平均灰度值表示。结果自然流产模型小鼠绒毛滋养层细胞凋亡指数明显高于正常妊娠模型(P<0.01)。Bax表达亦高于正常妊娠模型(P<0.05);FasL表达低于正常妊娠模型(P<0.01);Fas和Bcl-2表达两组无明显差异。结论早孕期绒毛滋养层细胞凋亡异常是自然流产机制之一,Bcl-2/Bax,Fas/FasL途径可能是诱导早孕期绒毛滋养层细胞凋亡的重要因素。     

Validation of a screening questionnaire for hip and knee osteoarthritis in old people

Background  

To develop a sensitive and specific screening tool for knee and hip osteoarthritis in the general population of elderly people.     

肝癌组织中蛋白酶ICH-1的表达及与乙、丙型肝炎病毒感染的关系

目的　探讨蛋白酶ICH 1在原发性肝细胞性肝癌 (HCC)发生中的作用及与乙型肝炎病毒 (HBV)和丙型肝炎病毒 (HCV)感染的关系。方法　应用免疫组织化学方法对 40例原发性肝癌和癌旁组织中蛋白酶ICH 1 (ICH 1L和ICH 1S)、HBsAg及HCV非结构区 5抗原 (NS5抗原 )的表达进行观察。结果　 40例肝癌中 1 5例ICH 1L阳性 ,阳性率为 37.5 % ,2 1例ICH 1S阳性 ,阳性率为 52 .5 %。癌细胞ICH 1表达较正常肝细胞增加 ,而又明显低于癌旁肝细胞 (P <0 .0 5)。 2 3例HBsAg和NS5阳性病例中 (其中两者共同阳性 3例 ) ,ICH 1L阳性 1 0例 ,占ICH 1L阳性总例数的 66 .7% (1 0 / 1 5) ,ICH 1S阳性 1 3例 ,占ICH 1S阳性总例数的 61 .9%。结论　蛋白酶ICH 1表达异常与肝细胞癌变有关 ,在肝癌发生过程中可能起一定作用。HBV和HCV感染可能是引起ICH 1表达异常的两种较重要的病因。     

The risk of stroke following coronary revascularization -- a population-based long-term follow-up study

OBJECTIVE: To study the incidence and risk factors of stroke after coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA). DESIGN: During 1983-1992, coronary revascularization procedures (n = 2160) were recorded in patients aged 35-64 years as part of the population-based FINMONICA Myocardial Infarction Register. The FINMONICA Stroke Register and National Hospital Discharge Register were used to ascertain subsequent stroke events in such patients. RESULTS: During the average follow-up of 5.83 years, 155 patients (7.2%) had a stroke. The cumulative incidence of stroke was 1.55% in the first year after revascularization and varied between 0.8 and 1.4% during subsequent years. In Cox proportional hazard models the relative risk of stroke was 3.01 (p = 0.0007) for a previous stroke, 2.61 (p = 0.0001) for diabetes mellitus, 2.15 (p = 0.007) for low income (compared with high income), 2.06 (p = 0.03) for male sex, and 1.43 (p = 0.02) for a 10-year increment in age. CONCLUSION: The incidence of stroke during the first year after revascularization was five times higher than among the age- and sex-matched general population. Patients with a previous stroke, diabetes mellitus, advanced age, male sex and low socioeconomic status need special attention because of increased risk of stroke after CABG or PTCA.     

KiSS-1和E钙黏蛋白在贲门癌组织中的表达及临床意义

目的检测KiSS-1及上皮细胞E钙黏蛋白（E—cadherin）在贲门癌组织中的表达，探讨其临床意义及两者的相关性。方法采用免疫组织化学方法检测80例贲门癌、20例正常贲门组织中KiSS-1及E钙黏蛋白的表达情况。分析其与相关临床病理参数的关系以及两者表达的相关性。结果KiSS-1的表达与贲门癌的临床分期、淋巴结转移呈负相关（均P〈0．05），与分化程度无相关性（均P〉0．05）；E钙黏蛋白的表达与贲门癌的临床分期、淋巴结转移、分化程度均呈负相关（均P〈0．05）。Spearman等级相关分析显示，KiSS-1与E钙黏蛋白在贲门癌中的表达呈正相关（rs=0．722，P〈0．05）。结论KiSS-1与E钙黏蛋白可能在抑制贲门癌的侵袭和转移过程中起重要作用。