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Objective:To investigate the safety and efficacy of metabolic surgery in obese and type 2 diabetes patients with viral hepatitis cirrhosis.Methods:The data of 8 patients with viral hepatitis cirrhosis undergoing metabolic surgery at Department of General Surgery ,Beijing Tiantan Hospital, Capital Medical University from Aug 2012 to Dec 2021 were retrospectively analyzed.Results:Among the 8 patients, 2 underwent laparoscopic Roux-en-Y gastric bypass and 6 underwent laparoscopic sleeve gastrectomy. The Child-Pugh classification of all patients before operation was classified as Grade A. The operation process was successful with no complications such as ascites, bleeding , digestive tract and gastric leakage or obstruction during the perioperative period. There was no abnormal liver function and decompensation during the median 2.5 year's (3 month to 8 years) follow-up period. The weight loss after the operation was obvious, when 1 year after operation, percentage of excess weight loss (EWL%)>54.78% and the surgery was also conducive to the control of blood glucose in diabetes patients.Conclusion:Metabolic surgery is safe and feasible for obese and type 2 diabetes patients with viral hepatitis cirrhosis.
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Objective:To investigate the clinical effect of laparoscopic sleeve gastrectomy (LSG) in the treatment of obesity with non-alcoholic fatty liver disease (NAFLD).Methods:The clinical data of 115 obese patients with NAFLD who underwent LSG surgery at Beijing Tiantan Hospital were analyzed.Results:LSG was successful in a 115 patients, and the body weight and BMI decreased gradually, and were significantly lower than the preoperative level (all P<0.001). EWL% increased and was 73.1%±30.1% at 12 months after operation. The postoperative triglyceride level decreased and was significantly lower than the preoperative level (all P<0.05). Most patients were complicated with abnormal liver function before surgery, and ALT, AST and GGT levels decreased to the normal range 3 months after surgery (all P<0.05). Albumin level was significantly higher 3 months after operation than before operation ( P<0.001). At 12 months postoperatively, the severity grade of fatty liver on ultrasound was significantly lower than that before surgery ( P<0.001). Conclusion:Laparoscopic sleeve gastrectomy can significantly improve lipid metabolism index, liver function index and fatty liver index in NAFLD patients along with weight loss .
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Objective Acute necrotizing pancreatitis (ANP) may cause lung injury.This study explores two factors that are associated with lung damage from ANP,the expression of tumor suppressor factor CYLD and nuclear factor-kappa B (NF-κB).Methods 72 adult Sprague-Dawley rats were randomly divided into 3 groups:sham operation,ANP,and GdCl3 treatment groups (n=24 for each group).A retrograde injection of 5％ sodium taurocholate into the biliopancreeatic duct of rats induced ANP,and the animals were killed 1,3,6,and 12 hours after the ANP induction.AMs were harvested by bronchoalveolar lavage technique,and TNF-a and IL-1β levels in bronchoalveolar lavage fluid (BALF) were evaluated.Lung tissue was checked with histological examinations,and the activity of NF-κB and CYLD in AM were measured by western blot.Results TNF-α and IL-1β secreted by AM were gradually elevated,peaked on the sixth hour,had maximums of (491.3 ±20.3)ng/L and (178.83±11.32)ng/L respectively,and decreased on the twelfth hour.The levels of TNF-α and IL-1β in the ANP group were significantly higher than the sham operation group (P＜0.05),and the GdC13 group levels were obviously lower than ANP group.In the sham operation group,the expression of NF-κB was low and CYLD was high.In the ANP group,when compared to the sham operation group,the expression of NF-κB rose after 3 hours and continued to rise with time progression (P＜0.05).In contrast,CYLD protein expression in the ANP group dropped after 3 hours and continued to gradually decrease (P＜0.05).The CYLD and NF-κB protein expression in GdCl3 groups had similar trends as the ANP group.GdCl3 group CYLD levels began to rise at 6 hours (P＜0.05),and NF κB levels began to fall at 1 hour (P＜0.05).The expression of NF-κB and CYLD possessed a negative correlation in both the ANP and GdCl3 groups (r =-0.918,r=-0.723,P＜ 0.01).Conclusions Therefore,in acute lung injury associated with acute pancreatitis,CYLD expression decreased with evident phases,such as a decrease in levels after 3 hours,and NF κB expression increased.Also,GdCl3 may be responsible for upregulation of CYLD expression and downregulation of NF-κB expression,and confirmed that CYLD had a negative effect on NF-κB.Perhaps GdCl3 could be used in the future to ameliorate the lung injury associated with ANP.
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Objective To investigate the effects of gastric bypass on glycometabolism and improvement of islet β cell function and insulin resistance in patients with type 2 diabetes. Methods Eight patients with type 2 diabetes combined with gastric carcinoma who treated with gastric bypass were studied prospectively. Fasting and postprandial plasma glucose levels, fasting and postprandial insulin C-peptide levels, and body mass index (BMI) were measured right before the surgery and at intervals of 1 week, 2 weeks, 1 month and 3 months after the surgery. Glycosylated hemoglobin (HbA1c) levels were measured before and 3 months after the surgery. The outcome of the diabetes after 3 months of the surgery was also monitored. Results Fasting and postprandial plasma glucose levels decreased (P ＜ 0.05) and fasting and postprandial insulin C-peptide levels increased (P ＜ 0.05) after the surgery. HbA1c levels also decreased (P ＜ 0.05) after 3 months of the surgery. There was no significant change of BMI at all intervals after the surgery(P＞ 0.05). All of the 8 patients reached the total effective standard and 6 patients reached the clinical remission standard after 3 months of the surgery. Conclusions It suggests that gastric bypass can significantly lower plasma glucose levels in type 2 diabetes, which does not depend on the loss of weight. The control of plasma glucose by gastric bypass may be due to the improvement of islet β cell function and increasing secretion of endogenous insulin.
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Objective To discuss the role of activation of nuclear factor ?appa B(NF-?B) in apoptosis of alveolar macrophages(AM) induced by gadolinium chloride(GdCl3) in acute necrotizing pancreatitis(ANP).Methods Thirty sixty adult SD rats were randomized into three groups: normal control group,ANP group and the group treated by GdCl3.ANP was induced by intraductal administration of 5% sodium taurocholate,while the normal control rats received an infusion of normal saline.In GdCl3 treatment group,GdCl3 was injected into dorsal vein of penis right after ANP model was established.AM were harvested by bronchoalveolar lavage six hours after model was established.The generation of TNF-? and IL-1? in bronchoalveolar lavage fluid(BALF),and the level of myeloperoxidase in lung tissue were evaluated.The expression of NF-?B protein in AM was determined by western blot.The apoptosis of AM was detected by agarose gel electrophoresis and flow cytometer.The histological examination of lung tissue was checked.Results The levels of TNF-? and IL-1? in ANP group were significantly higher than the control group and GdCl3 treatment group(P