Prevention, diagnosis and treatment of perioperative complications of bariatric and metabolic surgery / 中华胃肠外科杂志

Surgical operation in treating obesity and type 2 diabetes is popularizing rapidly in China. Correct prevention and recognition of perioperation-related operative complications is the premise of ensuring surgical safety. Familiar complications of the operation include deep venous thrombosis, pulmonary artery embolism, anastomotic bleeding, anastomotic fistula and marginal ulcer. The prevention of deep venous thrombosis is better than treatment. The concrete measures contain physical prophylaxis (graduated compression stocking and intermittent pneumatic compression leg sleeves) and drug prophylaxis (unfractionated heparin and low molecular heparin), and the treatment is mainly thrombolysis or operative thrombectomy. The treatment of pulmonary artery embolism includes remittance of pulmonary arterial hypertension, anticoagulation, thrombolysis, operative thrombectomy, interventional therapy and extracorporeal membrane oxygenation (ECMO). Hemorrhage is a rarely occurred but relatively serious complication after bariatric surgery. The primary cause of anastomotic bleeding after laparoscopic gastric bypass is incomplete hemostasis or weak laparoscopic repair. The common bleeding site in laparoscopic sleeve gastrectomy is gastric stump and close to partes pylorica, and the bleeding may be induced by malformation and weak repair technique. Patients with hemodynamic instability caused by active bleeding or excessive bleeding should timely received surgical treatment. Anastomotic fistula in gastric bypass can be divided into gastrointestinal anastomotic fistula and jejunum-jejunum anastomotic fistula. The treatment of postoperative anastomotic fistula should vary with each individual, and conservative treatment or operative treatment should be adopted. Anastomotic stenosis is mainly related to the operative techniques. Stenosis after sleeve gastrectomy often occurs in gastric angle, and the treatment methods include balloon dilatation and stent implantation, and surgical treatment should be performed when necessary. Marginal ulcer after gastric bypass is a kind of peptic ulcer occurring close to small intestine mucosa in the junction point of stomach and jejunum. Ulcer will also occur in the vestige stomach after laparoscopic sleeve gastrectomy, and the occurrence site locates mostly in the gastric antrum incisal margin. Preoperative anti-HP (helicobacter pylorus) therapy and postoperative continuous administration of proton pump inhibitor (PPI) for six months is the main means to prevent and treat marginal ulcer. For patients on whom conservative treatment is invalid, endoscopic repair or surgical repair should be considered. Different surgical procedures will generate different related operative complications. Fully understanding and effectively dealing with the complications of various surgical procedures through multidisciplinary cooperation is a guarantee for successful operation.

Efficacy of laparoscopic or open surgery for gastrointestinal stromal tumors and effects of different risk level on prognosis / 中华消化外科杂志

Objective To compare the efficacy of laparoscopic or open surgery for gastrointestinal stromal tumors (GISTs) and investigate effects of different risk level on prognosis.Methods The retrospective cohort study was adopted.The clinical data of 192 patients with GISTs who were admitted to Zhongshan Hospital of Fudan University from January 2008 to December 2013 were collected.Among the 192 patients,88 undergoing laparoscopic surgeries were allocated into the laparoscopic surgery group,104 patients undergoing open surgeries were allocated into the open surgery group.The following indicators were observed:(1) operative status:surgical procedure,operation time,volume of intraoperative blood loss.(2) Status of postoperative recovery:time of gastrointestinal function recovery,time of drainage tube removal,complications and duration of hospital stay.(3) Follow-up status.(4) Prognosis of patients in different risk level.The follow-up using outpatient examination and telephone interview was performed to assess patients' survival,tumor recurrence and metastasis until June 2015.Measurement data with normal distribution were presented as (x) ± s and comparison between groups was evaluated by the t test.Comparison of count data was analyzed by the chi-square test.The Kaplan-Meier method was used to draw survival curve and calculate the overall survival rate and relapse-free survival rate.Results (1) Operative status:of the 88 patients in the laparoscopic surgery group,1 underwent laparoscopic wedge gastrectomy + cholecystectomy + appendectomy,6 underwent laparoscopic wedge gastrectomy + cholecystectomy,14 underwent laparoscopic assisted partial gastrectomy,67 underwent laparoscopic wedge gastrectomy.Of the 104 patients in the open surgery group,1 underwent partial gastrectomy + splenectomy,2 underwent partial gastrectomy combined with distal pancreatectomy + splenectomy,2 underwent total gastrectomy,7 underwent distal subtotal gastrectomy,7 underwent wedge gastrectomy + partial or total adjacent organ resection,8 underwent proximal subtotal gastrectomy,8 underwent wedge gastrectomy + cholecystectomy,69 underwent wedge gastrectomy.The operation time and volume of intraoperative blood loss were (105 ± 33)minutes and (43 ± 16)mL in the laparoscopic surgery group,(121 ± 52)minutes and (199 ± 81) mL in the open group,respectively,with statistically significant differences between the 2 groups (t =-2.104,2.632,P ＜ 0.05).(2) Status of postoperative recovery:the time of gastrointestinal function recovery,time of drainage tube removal and duration of hospital stay were (4.6 ± 1.8) days,(5.8 ± 2.2) days,(7.1 ± 2.9) days in the laparoscopic surgery group and (5.2 ± 1.6) days,(7.1 ± 2.8) days,(8.7 ± 4.3) days in the open surgery group,respectively,with statistically significant differences between the 2 groups (t =-2.783,-3.891,-3.078,P ＜ 0.05).Wound infection,gastric emptying delay,anastomotic leakage,lung infection and bleeding were detected in 1,3,0,0,0 patients in the laparoscopic surgery group and in 0,2,2,2,1 patients in the open surgery group,respectively,with no statistically significant difference between the 2 groups (x2=0.421,P ＞ 0.05).(3) Follow-up status:Of the 192 patients,149 received follow-ups.Of 88 patients in the laparoscopic surgery group,68 were followed up for an average time of 39 months.Of 104 patients in the open surgery group,81 were followed up for an average time of 51 months.During the follow-up,tumor recurrence rate in the laparoscopic surgery group and open surgery group was respectively 8.8％ (6/68) and 21.0％ (17/81),with no statistically significant difference between the 2 groups (x2=1.888,P ＞0.05).Postoperative 1-,3-,5 year survival rates were 98.5％,92.9％,87.4％ and 91.7％,85.2％,76.9％ in the laparoscopic surgery group and open surgery group,respectively,with no statistically significant difference between the 2 groups (x2 =1.967,P ＞ 0.05).(4) Prognosis of patients in different risk level:of the 149 who received the follow-up,the tumor recurrence rate of patients in low,intermediate and high recurrence risk was 7.0％ (5/71),13.6％ (6/44) and 35.3％ (12/34),respectively,with a statistically significant difference among the above indexes (x2 =14.637,P ＜ 0.05),showing statistically significant differences between low risk and high risk patients and between intermediate risk and high risk patients (x2=13.263,6.279,P ＜ 0.05),while no statistically significant difference between low risk and intermediate risk patients (x2 =0.894,P ＞ 0.05).Five-year relapse-free survival rate of low,intermediate and high risk patients was 94.2％,80.0％ and 61.8％ respectively,with a statistically significant difference (x2=13.547,P ＜ 0.05),showing statistically significant differences between low risk and high risk patients,intermediate risk and high risk patients (x2 =4.357,12.336,P ＜ 0.05),while no statistically significant difference between low risk and intermediate risk patients (x2 =0.696,P ＞ 0.05).Conclusions Compared to open resection,laparoscopic GISTs resection offers better short-term outcomes,however,the two surgical techniques offer equal long-term outcomes.Patients of high risk have poor prognosis.

Phylogenetic and Molecular Analysis of an H7N7 Avian Influenza Virus Isolated in East Dongting Lake in 2012 / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>In March 2012, an H7N7 subtype avian influenza virus (AIV) named A/wild goose/Dongting/PC0360/2012 (H7N7) (DT/PC0360) was recovered from a wild goose in East Dongting Lake. We performed whole-genome sequencing of the isolate, and analyzed the phylogenetic and molecular characterization.</p><p><b>METHODS</b>RNA was extracted from environment samples (including fecal samples from wild bird or domestic ducks, and water samples) for detecting the presence of Influenza A Virus targeting Matrix gene, using realtime RT-PCR assay. The positive samples were performed virus isolation with embryonated eggs. The subtype of the isolates were identified by RT-PCR assay with the H1-H16 and N1-N9 primer set. The whole-genome sequencing of isolates were performed. Phylogenetic and molecular characterizations of the eight genes of the isolates were analyzed.</p><p><b>RESULTS</b>Our results suggested that all the eight gene segments of DT/PC0360 belonged to the Eurasian gene pool, and the HA gene were belonged to distinct sublineage with H7N9 AIV which caused outbreaks in Mainland China in 2013. The hemagglutinin cleavage site of HA of DT/PC0360 showed characterization of low pathogenic avian influenza virus.</p><p><b>CONCLUSION</b>Strengthening the surveillance of AIVs of wild waterfowl and poultry in this region is vital for our knowledge of the ecology and mechanism of transmission to prevent an influenza pandemic.</p>

Analysis of genetic features of influenza B virus in Hunan province from 2007 to 2010 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the gene variations of influenza B virus isolated in Hunan province from 2007 to 2010.</p><p><b>METHODS</b>A total of 42 strains of influenza B virus,which were isolated in the Influenza Surveillance Network Laboratories in Hunan province between year 2007 and 2010, were selected for the study. The hemagglutinin 1 (HA1) and neuraminidase (NA) genes of the selected strains were amplified by RT-PCR, and the sequence of the purified product were detected and homologically compared with the sequence of influenza vaccine strains isolated from Northern Hemisphere by WHO during the same period. In addition, the phylogenetic trees were constructed to characterize the molecular features.</p><p><b>RESULTS</b>In the Victoria branch of the HA1 gene phylogenetic tree, the strains isolated from year 2007 to 2009 were included in the V1 sub-branch, as well as the vaccine strain Malaysia/2506/2004; the strains isolated in year 2010 were involved in the V2 sub-branch, similar to the vaccine strains Brisbane/60/2008. In the Yamagata branch,the strains isolated in year 2007 were in the Y1 sub-branch,different from the strains isolated between year 2008 and 2010, which were in the Y2 sub-branch, instead. All virus in NA gene phylogenetic tree were included in the Yamagata branch, indicated their Yamagata origin. The genetic sequence analysis of the 7 strains isolated in year 2010 revealed that the viruses were classified as genotype 2 and genotype 15. The results of homological comparison between HA1 molecule and the influenza vaccine strains recommended by WHO were as below: Victoria lineage, 98.6% - 99.1% in 2007, 98.6% - 99.1% in 2008, 98.1% - 99.1% in 2009, and 97.6% - 99.1% in 2010; and Yamagata lineage, 97.9% - 98.5% in 2007, 97.9% - 98.5% in 2009 and 97.9% - 98.2% in 2010. The major mutations of the strains isolated in year 2007 were found in sites R48K, K88R, P108A, D197N and S230G. While the major mutations of the strains isolated between year 2009 and 2010 were sited in K88R, S150I, N166Y, D197N and S230G.</p><p><b>CONCLUSION</b>The prevalent influenza B virus isolated in Hunan province from 2007 to 2010 has mutated and evolved continuously.</p>

Serological survey of pandemic influenza A (H1N1) virus infection among population in Hunan Province / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To understand the infection condition and analytical methods of Influenza A (H1N1) virus in the population of Hunan Province during different periods.</p><p><b>METHODS</b>Quick surveys on the positive rate of Influenza A (H1N1) virus hemagglutination inhibition (HI) test have been conducted for 5 times successively from November 2009 to March 2010 in 14 medical and health institutions of Changsha city, whose results were then compared with those from the sampling surveys of whole Hunan province.</p><p><b>RESULTS</b>2131 subjects were involved in this study; the total population standardized rates of antibody positive investigated for 5 times were 9.32% , 14.62%, 31.08%, 28.43% and 22.80% respectively; the population of 6-17-years-old has the highest rate of antibody positive; only 9.84% of the antibody positive subjects attributed to vaccine inoculation; there was no significant difference in the standardized positive rates between the quick serological surveys and the corresponding sampling survey of Hunan province (P > 0.05).</p><p><b>CONCLUSION</b>The positive rate of A (H1N1) virus antibody reached the peak in late January 2010; quick investigations in small region could be used to evaluate the infection prevalence during pandemic of infectious diseases.</p>