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Analysis of the layout and proportion of classic and innovative surgical procedures of bariatric and metabolic surgery throughout the world, the sleeve gastrectomy is beco-ming the most accepted and respected surgical procedure with its increasingly prominent advan-tages, and its operation number has even exceeded the "gold standard" surgery of the roux-en-Y gastric bypass. This trend is even more pronounced in China. With a small number of physicians lacking experience in gastrointestinal surgery and more and more young physicians joining in the field of bariatric and metabolic surgery, operation related complications and the consequences of insufficient perioperative management experience have occurred successively in clinical practice, such as gastrointestinal leakage, bleeding, lumen and anastomotic stenosis, internal hernia and obstruction, venous thromboembolism, etc. Bariatric and metabolic surgery is a branch of gastro-intestinal surgery, and physicians in the field should have the ability to prevent, predict and manage short- and long-term complications after surgery. The authors believe that through the comprehen-sive evaluation of laboratory indexes, patient signs and related examinations, physicians should have the basic qualities of decisively choosing the surgical timing, choosing the right decision-making, and taking effective measures.
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Bariatric and metabolic surgery in China has went through 20 years,which is a tortuous but fruitful experience.However, it is undeniable that there are still many shortcomings in Chinese bariatric and metabolic surgery,mainly including the different views of endocrinologists and bariatric surgeons on the medium and long-term efficacies of operations, the insufficient understandings and low recognitions of the patients for bariatric surgery,the inaccurate mastery of surgical indications by some bariatric surgery teams,the inappropriate choices of surgical methods,uneven surgical techniques,untimely managements of postoperative complications,and nonstandard postoperative follow-ups.Under the positive guidance of the industry association, the implementation of standardization of data collection, reporting system and industry training, the advocacy of standardizedmanagement of multi-center prospective research, and the increase of media publicity will surely break the bottleneck of the bariatric surgery in China and usher in a new starting point of rapid development.
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[Summary] With the rapid development of economy ,obesity and type 2 diabetes (T2DM ) have become a serious social problem in China. Metabolic surgery was started to carry out in late 20th century in our country . Currently ,there were many deficiencies in the selection of operation indication ,surgical pattern and procedure ,prevention and treatment of complications ,perioperative management and postoperative follow‐up. Therefore ,to standardize nationwide surgical treatment of obesity and diabetes ,to reduce the incidence of postoperative complications ,Chinese Society for Metabolic & Bariatric Surgery (CSMBS) ,surgeon branch of Chinese Medical Doctor Association called domestic famous experts together to jointly draft a practical manual :Guide to Surgical Treatment of Obesity and Type 2 Diabetes in China (2014). With the spread of this guide ,the number of metabolic surgery increased significantly ,the procedure and management of surgery were further standardized.
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ObjectiveTo measure the iodine content of normal thyroid and the sternocleidomastoid muscle with gemstone spectral imaging (GSI),in order to offer diagnostic reference for iodine excess or iodine deficiency disorders.MethodsA total of 226 cases of patients with suspected neck or cervical disease underwent GSI of the neck,the thyroid and the sternocleidomastoid muscle.One hundred and nineteen cases were male and 107 female,aged 18 to 77 years,average age(46 ± 17) years.Data were transmitted to AW 4.4 workstation and processed using GSI Viewer software to obtain the best contrast-to-noise ratio(CNR) of thyroid to sternocleidomastoid muscle and corresponding singe-energy images.Iodine content of left and right thyroid lobes and both sides of sternocleidomastoid muscle as well as iodine content ratio of thyroid to sternocleidomastoid muscle were calculated in the iodine-based images.ResultsTotal iodine content of the left and the right lobes of the thyroid was (1.5233 ±0.4318)mg/cm3,of the left lobe was (1.5230 ± 0.4271 )mg/cm3,of the right lobe was (1.5236 ± 0.4365 )mg/cm3,there was no significant difference statistically between the two(t =0.0084,P ＞ 0.05).The iodine content of the male was (1.6395 ± 0.4105)mg/cm3,and of the female was (1.4238 ± 0.3832)mg/cm3,there was statistically a significant difference between the two(t =3.4743,P ＜ 0.01 ).Iodine content ratio of thyroid to sternocleidomastoid muscle was 96.6271 ± 33.2442,the ratio in male was 94.6250 ± 37.3621 and in female was 98.0000 ± 29.0737,there was no statistical difference between the two(t =0.3817,P ＞ 0.05).The iodine content of thyroid decreased gradually with age,the difference between groups was statistically significant(F =9.66,P ＜ 0.01 ).The iodine content in ＜ 40 age group[(1.7256 ± 0.4631)mg/cm3] was higher than that in 40 - 60 age group[(1.4517 ±0.3643)mg/cm3] and ＞ 60 age group [(1.4368 ± 0.3465)mg/cm3; q =5.6195,5.4158,all P ＜ 0.01).Conclusions It is easy to calculate thyroid iodine content with gemstone spectral imaging,which can reflect the iodine level of our body,and is helpful for the diagnosis of iodine excess or iodine deficiency disorders.
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<p><b>OBJECTIVE</b>To study whether diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) can reflect angiogenesis and the expression of the vascular endothelial growth factor (VEGF) by analyzing the correlation between the features of DWI and angiogenesis in prostate cancer (PCa).</p><p><b>METHODS</b>We studied the clinical and pathological data of 38 patients with histologically proven PCa, who were examined in the supine position with a 1.5T superconductive magnetic scanner (Siemens Sonata) with a pelvic phased array multi-coil. DWI was obtained by echo planar imaging (EPI) sequence. Another 33 cases of benign prostate hyperplasia (BPH) and 15 healthy volunteers were detected for the ADC value in the PCa and BPH tissues and the peripheral zone (PZ). All the PCa samples were examined for microvascular density (MVD) and VEGF.</p><p><b>RESULTS</b>The ADC values of PCa, BPH and PZ were (49.32 +/- 12.68) x 10(-5) mm2/s, (86.73 +/- 26.75) x 10(-5) mm2/s and (126.25 +/- 27.21) x 10(-5) mm2/s, the former lower than the latter two (P < 0.05). The expressions of MVD and VEGF in PCa were higher than in BPH (P < 0.05). The correlation was negative between the ADC value and MVD of PCa (r = -0.510, P < 0.05) , and positive between the expressions of VEGF and MVD (r = 0.481, P < 0.05). The ADC values of the VEGF-positive and -negative groups were (47.27 +/- 9.55) x 10(-5) mm2/s and (55.06 +/- 11.6) x 10(-5) mm2/s (P < 0.05).</p><p><b>CONCLUSION</b>The ADC value reflects the angiogenesis in differentiated prostate cancer, and DWI therefore helps to evaluate the biological features of PCa in vivo.</p>