Arctigenin attenuated spatial memory impairment in pR5 mice by regulating mitochondrial energy metabolism.

OBJECTIVES: Arctigenin (ATG) is a natural product with a variety of biological activity, which can improve the pathological changes of Alzheimer's disease (AD) model mice through multiple mechanisms. This study aims to further elucidate the potential mechanism by which ATG improves memory impairment in AD mice. METHODS: Here, we used pR5 mice as an experimental model, and ATG was administered continuously for 90 days. Novel object recognition, Y-maze, and Morris water maze were used to evaluate the therapeutic effect of ATG on memory impairment in AD mice. Immunohistochemical and immunofluorescence analyses were used to evaluate the effects of ATG on tau hyperphosphorylation and neuroinflammation, respectively. Finally, proteomics techniques were used to explore the possible mechanism of ATG. KEY FINDINGS: ATG significantly improved memory impairment in pR5 mice and inhibited tau phosphorylation in the hippocampus and neuroinflammation in the cortex. According to the proteomic analysis, the altered cognitive function of ATG was associated with the proteins of the tricarboxylic acid cycle and the electron transport chain. CONCLUSION: These results suggest that ATG is a potential therapeutic agent for diseases related to aberrant energy metabolism that can treat AD by improving mitochondrial function.

Preparation of a polypeptide fluorescent probe based on aggregation induced luminescence and its application in the detection of early dental caries / 国际生物医学工程杂志

Objective:To prepare a peptide fluorescent probe based on aggregation-induced emission and to investigate its application in the detection of early caries.Methods:Eight aspartate-serine-serine (DSS) were combined with aggregation-induced emission material to prepare peptide fluorescent probes, and an artificial demineralization model was established in vitro. The samples were immersed in the peptide fluorescent probe solution for 1 min, and a fluorescence imaging system was applied to examine the tooth samples and collect images and fluorescence data. Scanning electron microscopy was also applied to observe the phenotype of the teeth, and electron microscopy was applied to detect the calcium-phosphorus ratio on the enamel surface of the teeth. Polarized light microscopy was also applied to observe the enamel area of the teeth. Results:The fluorescence intensity of demineralized teeth was clearly observed to be lower than that of normal teeth in the peptide fluorescent probe-treated area, and the difference was statistically significant ( P < 0.05). The results of scanning electron microscopy showed that the enamel surface of the demineralized group had more irregular pores, while the enamel surface of the undemineralized group was flatter with only some irregular accumulation of flakes. The results of polarized light microscopy showed that a clear birefringence could be observed in the enamel region of normal teeth, while a black area or the disappearance of the birefringence effect accompanied by a partial black dark shadow could be observed in the enamel region of demineralized teeth. Conclusions:An aggregation-induced luminescence-based peptide fluorescent probe was successfully prepared, which can precisely localize the enamel and show some application value in early caries detection.

Low-Dose Copper Exposure Exacerbates Depression-Like Behavior in ApoE4 Transgenic Mice.

Depression is one of the most common neuropsychiatric disorders. Although the pathogenesis of depression is still unknown, environmental risk factors and genetics are implicated. Copper (Cu), a cofactor of multiple enzymes, is involved in regulating depression-related processes. Depressed patients carrying the apolipoprotein ε4 allele display more severe depressive symptoms, indicating that ApoE4 is closely associated with an increased risk of depression. The study explored the effect of low-dose Cu exposure and ApoE4 on depression-like behavior of mice and further investigates the possible mechanisms. The ApoE4 mice and wild-type (WT) mice were treated with 0.13 ppm CuCl2 for 4 months. After the treatment, ApoE4 mice displayed obvious depression-like behavior compared with the WT mice, and Cu exposure further exacerbated the depression-like behavior of ApoE4 mice. There was no significant difference in anxiety behavior and memory behavior. Proteomic analysis revealed that the differentially expressed proteins between Cu-exposed and nonexposed ApoE4 mice were mainly involved in the Ras signaling pathway, protein export, axon guidance, serotonergic synapse, GABAergic synapse, and dopaminergic synapse. Among these differentially expressed proteins, immune response and synaptic function are highly correlated. Representative protein expression changes are quantified by western blot, showing consistent results as determined by proteomic analysis. Hippocampal astrocytes and microglia were increased in Cu-exposed ApoE4 mice, suggesting that neuroglial cells played an important role in the pathogenesis of depression. Taken together, our study demonstrated that Cu exposure exacerbates depression-like behavior of ApoE4 mice and the mechanisms may involve the dysregulation of synaptic function and immune response and overactivation of neuroinflammation.

Establishment of A Mixed Chimeric Mouse Model of Allogeneic Bone Marrow Transplantation and Its Influencing Factors / 中国实验血液学杂志

OBJECTIVE@#To establish a mouse mixed chimerism (MC) model of nonmyeloablative allogeneic bone marrow transplantation(allo-BMT) and explore its affecting factors.@*METHODS@#The MC model was established by nonmyeloablative allo-BMT followed by high-dose post-transplant cyclophosphamide (PTCY). 123 mice in the experiments was retrospectively analyzed, and the factors related with the chimerism were explored with the univariate and multivariate logistic regression analysis. A multivariate linear regression was performed by R project to obtain a mathematical model for predicting the chimeric level with relevant affecting factors.@*RESULTS@#The model presented mixed chimerism on day 14 after transplantation, and was characterized by a donor lymphocyte infusion (DLI) which significantly promoted donor engraftment on day 15, but transfplantation of PBS in control group was failed. Among 123 mice, 47 (38.21%) mice were MC, while 76 (61.79%) mice were non-MC in 123 mice, respectively; univariate analysis showed that the baseline body weight of mice (P=0.001, 17.84±1.19 g vs 18.50±0.94 g), total body irradiation(TBI，P=0.048) and the using of cyclophosphamide (P=0.16) were affected the chimeric state of mice, while the number of infusing cells and the time of detection showed no significant effects. Multivariate regression analysis showed that under certain conditions, the body weight of mice on day 0 was an independent factor affecting chimeric levels (OR=0.493, 95% CI 0.307-0.791, P=0.003). Through R project multiple linear regression, the math model was achieved, which was chimerism=6.09-12×weight(g)+80.03×TBI(Gy)-4.4×cell-counts (× 10@*CONCLUSION@#The experiment presents a method for establishing a mixed chimeric mice model after non-myeloablative bone marrow transplantation and constructs a mathematical model with relevant factors affected chimerism status.

Study on effect of "Trichosanthis Fructus-Allii Macrostemonis Bulbus" on atherosclerosis in ApoE~(-/-) mice based on liver metabonomics / 中国中药杂志

In this study, ultra-performance liquid chromatography coupled with quadrupole time-of-flight tandem mass spectrometry(UPLC-Q-TOF-MS)-based liver metabolomics approach was used to explore the mechanism of "Trichosanthis Fructus-Allii Macrostemonis Bulbus" in improving atherosclerosis(AS) of mice with apolipoprotein E gene knockout(ApoE~(-/-)). AS mouse model was induced by high-fat diet. The pathological and biochemical indexes such as the histopathological changes, body weight, liver weight, blood lipid level and inflammatory factors in the liver of mice were determined. The metabolic profiling of mice liver samples was performed with UPLC-Q-TOF-MS. Multiple statistical analysis methods including partial least squares discriminant analysis(PLS-DA) and orthogonal partial least squares discriminant analysis(OPLS-DA) were employed to screen and identify biomarkers. The levels of related enzymes including LCAT, sPLA2, EPT1 and ACER1 were detected. The results showed that "Trichosanthis Fructus-Allii Macrostemonis Bulbus" significantly reduced the areas of aortic plaque and fat vacuoles of liver in AS mice and decreased the accumulation of lipid droplets and liver coefficient. "Trichosanthis Fructus-Allii Macrostemonis Bulbus" also regulated the levels of blood lipid and inflammatory injury in the liver. The metabolites of the control group, the model group and the "Trichosanthis Fructus-Allii Macrostemonis Bulbus" group could be distinguished significantly. Fifteen potential biomarkers related to AS were discovered and preliminarily identified, seven of which could be regulated by "Trichosanthis Fructus-Allii Macrostemonis Bulbus" in a trend of returning to normal. Metabolic pathway analysis screened out two major metabolic pathways. "Trichosanthis Fructus-Allii Macrostemonis Bulbus" obviously regulated the levels of LCAT, sPLA2, EPT1 and ACER1. It was inferred that "Trichosanthis Fructus-Allii Macrostemonis Bulbus" could play a major role in AS treatment by regulating glycerophospholipid and sphingolipid metabolism disorders in the liver, with the mechanism probably relating to the intervention of the expression of LCAT, sPLA2, EPT1 and ACER1.

Heat inactivation of serum interferes with the immunoanalysis of antibodies to SARS-CoV-2

The detection of serum antibodies to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is emerging as a new tool for the coronavirus disease-2019 (COVID-19) diagnosis. Since many coronaviruses are sensitive to heat, heating inactivation of samples at 56 {degrees}C prior to testing is considered a possible method to reduce the risk of transmission, but the effect of heating on the measurement of SARS-CoV-2 antibodies is still unclear. By comparing the levels of SARS-CoV-2 antibodies before and after heat inactivation of serum at 56 {degrees}C for 30 minutes using a quantitative fluorescence immunochromatographic assay, we shown that heat inactivation significantly interferes with the levels of antibodies to SARS-CoV-2. The IgM levels of all the 34 serum samples (100%) from COVID-19 patients decreased by an average level of 53.56%. The IgG levels were decreased in 22 of 34 samples (64.71%) by an average level of 49.54%. Similar changes can also be observed in the non-COVID-19 diseases group (n=9). Of note, 44.12% of the detected IgM levels were dropped below the cut-off value after heating, suggesting heat inactivation can lead to false-negative results of these samples. Our results indicate that heat inactivation of serum at 56 {degrees}C for 30 minutes interferes with the immunoanalysis of antibodies to SARS-CoV-2. Heat inactivation prior to immunoanalysis is not recommended and the possibility of false-negative results should be considered if the sample was pre-inactivated by heating.

Fetal growth, fetal development, and placental features in women with polycystic ovary syndrome: analysis based on fetal and placental magnetic resonance imaging / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

OBJECTIVE@#Polycystic ovary syndrome (PCOS), a common endocrine-metabolic dysfunction in reproductive-aged women, may be involved in compromised pregnancy and offspring outcomes. This study aimed to investigate whether maternal PCOS affects fetal growth, fetal development, and placental features.@*METHODS@#This retrospective case-control study included 60 pregnant women with PCOS (PCOS group) and 120 healthy pregnant women without PCOS (control group). Fetal magnetic resonance imaging (MRI) was performed followed by an ultrasound examination and indications for imaging, including known or suspected fetal pathology, history of fetal abnormality in previous pregnancy or in a family member, and concern for placenta accreta. Fetal MRI images were analyzed for head circumference (HC), abdomen circumference (AC), lung-to-liver signal intensity ratio (LLSIR, a prenatal marker of fetal lung maturity), lengths of liver and kidney diameters in fetuses, and placental relative signal intensity on T2-weighted single-shot fast spin echo (SSFSE) imaging (rSI@*RESULTS@#Compared to the control group, the PCOS group showed the following characteristics: (1) smaller biparietal diameter and femur length in fetuses (P=0.026 and P=0.005, respectively), (2) smaller HC in fetuses (evident after 32 weeks; P=0.044), (3) lower LLSIR and smaller dorsoventral length of liver in fetuses (evident before 32 weeks; P=0.005 and P=0.019, respectively), and (4) smaller placental thickness (evident before 32 weeks; P=0.017). No significant differences in placental rSI@*CONCLUSIONS@#There exist alterations of fetal growth, fetal development, and placental features from women with PCOS.

Rapid identification of Cordyceps and its products using DNA barcoding method / 中国中药杂志

Cordyceps is one of the most valuable traditional Chinese medicines. There are various counterfeits in markets because of high price and limited output. In this study,116 Cordyceps,146 hosts and 29 related products were collected and detected by using normal DNA barcoding technology and specific PCR method. The results indicated that Cordyceps and its adulterants could be distinguished from each other through DNA barcoding technology based on ITS and COⅠsequences. Two pairs specific primers ITSSF1/ITSSR1 and ITSSF2/ITSSR2 were developed to amplify 297 bp and 136 bp ITS regions of Cordyceps sinensis,respectively. It could be used to identify C. sinensis specifically and rapidly. Furthermore,specific primers ITSSF1/ITSSR1 and ITSSF2/ITSSR2 combined with ITS and COⅠsequences could differentiate powder Cordyceps from fermentation mycelia and could identify related products. Therefore,the method developed from this study could be applied to identify the powder of Cordyceps from fermentation mycelia and related products efficiently.

Inhibition of peiminine on invasion and migration of human lung cancer A549 cells by decreasing epithelial-mesenchymal transition process via PI3K/Akt/mTOR pathway / 中草药

Objective: To detect the influence of peiminine on the invasion and migration of human lung cancer A549 cells. Methods A549 cells were treated with peiminine at the final concentrations of 0, 50, 100, and 200 μmol/L, respectively. The influence of peiminine on the invasion and migration of A549 cells and its underlying mechanisms were investigated by cell invasion experiment, cell scratch experiment, real-time quantitative PCR, ELISA, and Western blotting. Results Compared with 0 μmol/L peiminine group, the cell transmembrane number and scratch wound healing rate and expressions of MMP-9 and MMP-2 in the group treated with different concentrations of peiminine significantly decreased (P < 0.01). Compared with 0 μmol/L peiminine group, the mRNA expression of E-cadherin increased significantly (P < 0.01), while the mRNA expressions of N-cadherin and vimentin decreased significantly (P < 0.01). Compared with 0 μmol/L peiminine group, FN protein expression was significantly decreased in all the groups with different concentrations of peiminine group except treatment with 50 μmol/L peiminine after 24 h (P < 0.05, 0.01). Compared with 0 μmol/L peiminine group, the ratio of p-PI3K/PI3K and p-mTOR/mTOR in all concentrations of peiminine groups and p-Akt/Akt in 100 and 200 peiminine groups were significantly decreased (P < 0.05, 0.01). Conclusion Peiminine can inhibit the invasion and migration of A549 cells, which may be related to the activation of PI3K/Akt/mTOR pathway and decreasing the epithelial- mesenchymal transition process.

Globally Ecological Suitability Analysis of Phellodendron chinense and Phellodendron amurense / 中国实验方剂学杂志

Objective: Phellodendri Cortex, one of the "three wood medicine materials", is a Chinese traditional medicinal material and also a national second-class protected plant in China. Its is considered as excellent trees for the Natural Forest Conservation Program and the Grain-to-Green Program because of its high economic value and ecological value. The Phellodendron Cortex is divided into Phellodendron chinense and P. amurense according to species and origins. The global potential suitable areas predicted by Global Geographic Information System for Medicinal Plant (GMPGIS) can provide data for us to decide which specie can be selected in different areas. Method: Sample ecological information was collected from global genuine areas, main producing areas and wild distribution areas, and a total of 364 sampling sites of P. chinense and 247 sampling sites of P. amurense were used by GMPGIS to analyze the suitable growth areas in the world. Result: A clear geographical line existed between P. chinense and P. amurense. P. chinense was mainly distributed in tropical monsoon climate and had the most suitable areas in Asia, Europe, North America, South America and Oceania, including 65 countries and regions such as China, the United States, France, Brazil, Japan, Italy and New Zealand. P. amurense was mainly distributed in temperate monsoon climate and had the most suitable areas in Asia, Europe, and North America, including 30 countries and regions such as the United States, China, Russia and Canada.. Conclusion: The results of GMPGIS can provide scientific data for selecting correct species and cultivation areas for Phellodendris Cortex in future.

Mechanism of high temperature promoting artemisinin biosynthesis in Artemisia annua / 中国中药杂志

Artemisia annua also known as Qinghao, is a kind of traditional Chinese medicine. Its active ingredient is artemisinin, a sesquiterpene lactone compound with a peroxy bridging group structure. A. annua is an effective antimalarial drug. Artemisinin, a secondary metabolite in A. annua, can be induced by many physical and chemical factors, such as salinity, moisture, light, and plant hormones. Temperature, as an important growth factor, also has a great influence on the synthesis of artemisinin. This article aims to study the effect of high temperature on inducing artemisinin biosynthesis in A. annua. The A. annua seedlings were placed at 25, 40 °C, and the samples were taken after 0, 3, 12 and 36 h. The content of artemisinin in each sample was determined by liquid chromatography-mass spectrometry. Total RNA was extracted from the samples, and then transcriptome sequencing and real-time fluorescence quantitative PCR were used to quantitatively analyze the expression of the key enzyme genes in artemisinin synthesis pathway and competition pathway. The results showed that artemisinin content was increased by 20%, 42% and 68% after 3, 12, 36 h of treatment at 40 °C. The expression levels of FDS, ALDH1, CYP71AV1 and ADS were up-regulated by 4.3, 3.3, 2.5, 1.9 times, and the expression levels of SQS and BPS were down-regulated by 37% and 90% respectively. In summary, high temperature can promote the biosynthesis of artemisinin by promoting the expression of synthetase genes in artemisinin synthesis pathway and inhibiting the expression of synthetase genes in artemisinin-competition pathway.

Rapid identification of Gekko gecko by loop-mediated isothermal amplification based on 12S rRNA sequence / 中国中药杂志

Gekko gecko (Tokay Gecko) is a valuable traditional Chinese medicine. In this study, the loop-mediated isothermal amplification (LAMP) technique was introduced for visual rapid identification of G. gecko from adulterants. A total of sixty-five 12S rRNA sequences of fourteen species of G. gecko and its adulterants were obtained. The results showed that G. gecko could be identified from its adulterants through BLAST analysis based on 12S rRNA regions. The 12S rRNA sequences of ten batches of G. gecko were conserved. There were only two haplotypes and three variation sites in the available regions for primers design. Six specific LAMP primers were successfully designed online based on 12S rRNA sequences. The visual rapid detection of G. gecko could be achieved with the optimized conditions (64 °C for 1 h and 80 °C for 5 min). And the required minimal template concentration was 5 μg·L⁻¹ while conventional PCR with 0.5 mg·L⁻¹. Consequently, the LAMP method established from this study was rapid, specific, highly sensitive, and simple. It could be applied to detect G. gecko from its adulterants efficiently.

Statues and research strategy of molecular breeding in Artemisia annua / 中国中药杂志

Malaria is one of the three most deadly diseases in the world. Artemisinin is the first line and effective drug for treating malaria, and only can be extracted from Artemisia annua. Therefore, it is of great significance to cultivate new varieties of A. annua with high artemisinin content. Based on the germplasm bank and the whole genome, transcriptome and genetic map, the authors can explore high-quality genes, stress-resistant genes and genetic markers which have been used for rapid breeding of superior varieties of A. annua. So these methods of molecular breeding will become the main breeding direction of A. annua in the future. The breeding times of new varieties of A. annua can be shortened with molecular breeding technology. Based on the genetic background and the current situation of molecular breeding of A. annua, the strategy and technical route of molecular breeding were discussed and worked out in this paper, which provided a guidance and scientific reference for molecular breeding of A. annua in the future.

Micro-invasive embedding combined with montelukast sodium for children cough variant asthma:a randomized controlled trial / 中国针灸

<p><b>OBJECTIVE</b>To observe the effects of micro-invasive embedding combined with montelukast sodium and simple montelukast sodium for children cough variant asthma (CVA).</p><p><b>METHODS</b>A total of 240 patients were randomly assigned into an observation group and a control group, 120 cases in each one. Considering of cases dropping, 101 patients in the observation group and 105 cases in the control group were included. Montelukast sodium chewable tablets were applied before sleep for 3 months in the control group, 5 mg a time, once a day. Based on the treatment as the control group, micro-invasive embedding was used for 3 months in the observation group, twice in the first month and once in the other two months. The acupoints were Feishu (BL 13), Danzhong (CV 17), Dingchuan (EX-B 1), and Zusanli (ST 36). Follow-up was conducted 9 months after treatment in the two groups. The cough score, serum immunoglobulin (IgE, IgG, IgA), platelet activating factor (PAF) were observed before and after treatment. The indices were compared before and after treatment and at follow-up, including pulmonary function indices[peak expiratory flow rate (PEF), forced expiratory volume at the 1st second (FEV1)], and small airway function indices[forced expiratory flow rate with remaining 25% vital capacity (MEF25%), forced expiratory flow rate with remaining 50% vital capacity (MEF50%), forced expiratory flow rate with remaining 75% vital capacity (MEF75%) and mid expiratory flow rate (MEF25%-75%)]. Also, the total effects were evaluated.</p><p><b>RESULTS</b>①The total effective rate in the observation group was 93.1% (94/101), which was better than 87.6% (92/105) in the control group (<0.05). The cough disappearance time of the cured children in the observation group was (10.38±2.64) d, and it was shorter than (10.72 ±2.60) d of those in the control group (<0.05). After treatment, the cough score apparently decreased compared with those before treatment in the two groups (both<0.05), with better result in the observation group (<0.05). At follow-up, the recurrence frequency of the observation group was (1.43±1.20), and it was less than (1.91±1.71) in the control group (<0.05). ②The levels of serum IgA and IgG after treatment in the two groups increased, and those of serum IgE and PAF decreased, compared with those before treatment. There was statistically significance except IgG in the control group before and after treatment (all<0.05), with better Results in the observation group after treatment (all<0.05). ③ Compared with those before treatment, all the pulmonary function indices were improved obviously after treatment and at follow-up in the two groups (all<0.05), without statistically significance between the two groups (both>0.05). ④ There was no statistically significance before and after treatment on small airway function indices in the two groups (all>0.05). The indices at follow-up increased compared with those before treatment in the two groups (all<0.05), with better Results in the observation group (all<0.05).</p><p><b>CONCLUSIONS</b>Micro-invasive embedding combined with montelukast sodium achieved de-finite effect for children CVA, which can improve the body's immune and microcirculation. The effect is better than that of simple montelukast sodium on improving small airway function, etc.</p>

History and development trend of minimally invasive surgical treatment for obesity and diabetes in China / 中华胃肠外科杂志

Obesity and type 2 diabetes mellitus have already become one of the most serious society-facing problems. Since the first report in the 1950s, gastrointestinal surgery has greatly developed as the golden standard in obesity treatment. With the convincing research and evidence, it is found that gastrointestinal surgery not only can cause weight loss, but can relieve, even cure many metabolic diseases associated with obesity, especially for type 2 diabetes mellitus. The operational manners, including adjustable gastric banding, Roux-en-Y gastric bypass, mini gastric bypass, sleeve gastrectomy, etc., are proved to be safe and effective in treating obesity and type 2 diabetes mellitus, and all of these operations can be performed with laparoscopy. Currently, gastrointestinal surgeons are focusing on the operation treatment for type 2 diabetes mellitus, and more and more gastrointestinal operations are applied in many medical centers in China. However, there are a lot of details that need to be standardized. It is believed, with the evolution of surgical technique, standardization of diagnosis and treatment, and breakthrough in the basic research, the metabolic surgery will get more development in the future.

The relation of blood culture results of sepsis in children with serum procalcitonin levels / 临床儿科杂志

ObjectiveTo explore the roles of procalcitonin in differentiating bacterial infection from other inlfammatory processes and identifying bacterial species.MethodsThe blood culture results of 253 hospitalized children diagnosed with sepsis from January 2010 to June 2014 were analyzed retrospectively and its relationship with PCT was also analyzed. ResultsIn 253 children with sepsis, the blood culture results of 124 children showed positive (49.01%). There were 71 (28.06%) cases of Gram-positive infection and 53 (20.95%) cases of Gram-negative infection. The median level of PCT in 253 patients was 1.6 (0.4-4.5) ng/ml. According to the PCT levels, all patients were divided into low level group (0.05-0.5 ng/ml,n=86), middle level group (0.5-2.0 ng/ml,n=55), high level group (2.0-10 ng/ml,n=75) and extremely high level group (10-300 ng/ml,n=37). The positive rates of bacterial culture were signiifcantly different among different levels of PCT (χ2=69.14,P<0.01). In low lev-el group the positive rate of bacterial culture was the lowest and in other three groups the positive rate was all above 60%. The detection rate of Gram-positive and Gram-negative bacteria was signiifcantly different among different levels of PCT (P<0.01). In high level group the detection rate of Gram-positive bacteria was the highest while in extremely high level group the rate of Gram-negative bacteria was the highest.ConclusionsThe level of PCT is helpful for the differentiation of bacterial infection from other inlfammatory processes in children with sepsis and abnormally elevated PCT level may indicates Gram-negative infection.

Efficacy analysis of laparoscopic sleeve gastrectomy in treatment of obesity with type 2 diabetes mellitus / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and safety of laparoscopic sleeve gastrectomy(LSG) for the treatment of obesity with type 2 diabetes mellitus(T2DM).</p><p><b>METHODS</b>Clinical data of 32 obesity patients with T2DM patients undergoing LSG from May 2010 to February 2012 in our department were retrospectively analyzed. Their body weight indexes (body weight, waist circumference, BMI, EWL), blood glucose indexes [glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), insulin resistance index (HOMA-IR)], and blood lipid indexes [total cholesterol, triglyceride, low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C)] were measured 1, 3, 6, 12 months after operation and compared with preoperative levels. Improvement in complications was observed.</p><p><b>RESULTS</b>All the patients completed operation under laparoscopy except 1 case because of abdominal cavity adhesion. The average operative time was (115.0±19.6) min, and the average blood loss (69.0±29.7) ml. No operative death, anastomotic leakage, or surgical site infection were found. The body weight, waist circumference and BMI at 1, 3, 6, and 12 months after surgery were significantly lower(all P<0.05) showing a decreasing trend over time. EWL showed significant increasing trend (P<0.05). During 12 months of follow-up, no over-low weight was observed. From 1 month after surgery, HbA1c, FPG and HOMA-IR decreased significantly (P<0.05). HbA1c and FPG maintained stable level at 12 and 6 months after operation respectively. FPG of 28 patients returned to normal 3 months after operation. Clinical complete remission rate of T2DM was 87.5%(28/32), and clinical partial remission rate was 12.5%(4/32) at the 12-month follow-up. Serum total cholesterol, triglyceride and LDL-C decreased obviously after surgery(P<0.05).</p><p><b>CONCLUSION</b>LSG procedure is a safe and effective surgical method in treatment of obesity with T2DM.</p>

A modified technique for esophagojejunostomy or esophagogastrostomy after laparoscopic gastrectomy.

OBJECTIVE: Reconstruction of the digestive tract involving esophageal anastomosis after laparoscopic gastrectomy is a surgically difficult procedure. In this study, a newly developed transoral pretilted circular anvil, a "the oral to the abdomen" method, was proven to be effective. METHOD: A total of 34 consecutive patients underwent esophageal anastomosis using the OrVil in our hospital from July 2009 to February 2011. The esophagus was transected and a small hole was then made in the esophageal stump through which the nasogastric tube of the OrVil was passed to insert the anvil into the abdominal cavity. After fixation with a stapler and a glove at the jejunal loop or the remnant stomach, the abdominal cavity was entered through the minilaparotomy. Pneumoperitoneum and airtightness were reestablished after the glove edge was turned over to seal off the protector. Eventually, intracorporeal esophagojejunostomy or esophagogastrostomy was accomplished under the guidance of laparoscopy. RESULTS: There were 34 patients in the study: 1 with Zollinger-Ellison syndrome, 7 with stromal tumors in cardia, 23 with adenocarcinoma in the stomach, and 3 with cardia adenocarcinoma involving the lower esophagus. The surgical margins for all tumor patients were negative for tumor cells. The mean operative time was 175.0 minutes (90 to 240 min) and the mean intraoperative blood loss was 195.6 mL (50 to 800 mL). The 34 patients underwent successful laparoscopic surgeries with no open conversions. For 32 patients, there were no technological complications in the transoral insertion of the anvil to the esophageal stump. There were no anastomotic leaks after the surgery. CONCLUSIONS: The use of the OrVil device, a "the oral to the abdomen" method, changes the direction of the anvil insertion and significantly decreases both difficulty and duration of the laparoscopic surgery. More importantly, if the mass is at a higher position, this approach can achieve a higher surgical margin compared with the hand-sewn purse-string suture technique, thus avoiding the need to undergo a thoracotomy (Supplemental Digital Content 1, http://links.lww.com/SLE/A83).

Laparoscopic surgery of gastric gastrointestinal stromal tumor / 中华胃肠外科杂志

Gastric gastrointestinal stromal tumor(GIST) is the most common mesenchymal neoplasms of the gastro-intestinal tract.For its unique biological behavior with KIT gene expression and the particular clinical characteristics with the recurrent nature, surgery and molecular targeted therapy is the main treatment of gastric GIST. Laparoscopic technology has been used in the surgical treatment of gastric GIST and is the future trend. In this article, we shed some light on the standardize surgical procedures of radical laparoscopic gastrectomy, obeying the surgical principles, accurate intraoperative localization, and surgery combined with targeted therapy.

Clinical application of reverse puncture device(RPD) in laparascopic esophagogastrectomy (esophagojejunostomy): a report of 18 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>The authors report the newly developed reconstruction technique after laparoscopic total gastrectomy (LTG) or laparoscopic distal gastrectomy (LDG): intracorporeal circular stapling esophagojejunostomy(esophagojejunostomy) using the reverse puncture device(RPD).</p><p><b>METHODS</b>After LTG or LDG, The anvil is then transorally inserted into the esophagus by using the RPD system. Double-stapling esophagojejunostomy with a circular stapler is performed intracorporeally, and the jejunal stump is closed with an Echelon.</p><p><b>RESULTS</b>There was no intraoperative complication or conversion to open surgery, the mean operation time was 155 min and blood loss was 75 ml. Postoperative fluorography revealed no anastomosis leakage or stenosis Patients resumed an oral liquid diet on postoperative day 2, and discharged at day 8.</p><p><b>CONCLUSIONS</b>We have successfully performed LTG or LDG, reconstruction using our technique in 18 patients without any anastomosis complications. We believe that our procedure is a safe and reliable reconstruction method, which is especially useful in obese patients, in whom conventional extracorporeal anastomosis is often difficult.</p>