Objective To evaluate the physiological function and the anatomic structure of the first metatarsophalangeal joint for the patient withhallux valgus after a remodeling operation with the Keller’s method. Methods From April 2004 to November 2006, the first metatarsophalangeal joints in 11 patients (22 feet) with hallux valgus were remodeled with the Keller’s operation. There were 3 males and 8 females, aged 5173 years. Accordingto the Piggot typing standard, there were 17 feet of type Ⅱ (deflexion) and 5 feet of type Ⅲ (semiluxation). The hallux valgus angles(HVAs) were 2449° (average, 37°). The intermetatarsal angles (IMAs) were 90135° (average, 115°). The curative effect and the anatomic structure were evaluated by the followup and the Xray examination. Results All the cases werefollowed up for 6 to 30 months after operation (average, 14 months). According to the standard of ZHU Li Hua, et al, the results were excellent in 18 feet,good in 3 feet, and poor in 1 foot. The Xray films showed that the first meta tarsophalangeal joint of 14 feet developed mortarlike false articulation, and 8 feet developed partial false articulation. HVAs were 716° (average, 11°).IMAs were 90135° (average, 11.5°). According to the Piggot typing standard, there were 12 feet of typeⅠ(fitter) and 10 feet of type Ⅱ (deflexion). Conclusion For the patients with hallux valgus, the remodeling ofthe first metatarsophalangeal joint by the Keller’s operation can rectify HVA, improve the stability of the joints, and prevent occurrence of the insufficient muscle strength after operation.
Objective To compare the difference in the expressions of forkhead box protein 3 (FoxP3) and adenosine 2a receptor (A2aR) in gastric cancer tissues and its adjacent tissues, and to investigate the relationship between the elevated expression of FoxP3/A2aR and clinicopathological features in gastric cancer. Methods Gastric cancer tissues and their adjacent tissues from 52 patients with gastric cancer were collected, who underwent surgery in the Affiliated Hospital of Xuzhou Medical University from July 2015 to November 2016, immunohistochemical staining was used to detect the expressions of FoxP3 and A2aR. Results ① The high-expression rate of FoxP3 in gastric cancer tissues was 69.2% (36/52), which was higher than that of adjacent tissues (11.5%, 6/52), P<0.001. The high-expression rate of A2aR in gastric cancer tissues was 69.2% (36/52), which was higher than that of adjacent tissues (25.0%, 13/52),P<0.001. ② The expression of FoxP3 was positively correlated with the expression of A2aR in gastric cancer tissues (r=0.76, P<0.05). ③ In gastric cancer tissues, high-expressions of FoxP3 and A2aR were not related to gender, age, diameter of tumor, tumor location, degree of differentiation, gross type, and histological type (P>0.05), but both associated with TNM stage, T stage, number of lymph node metastasis, and distant metastasis (P<0.05), the high-expression rates of FoxP3 and A2aR in patients with stage Ⅲ+Ⅳ were higher than those of patients with stage Ⅰ+Ⅱ, the high-expression rates of FoxP3 and A2aR in patients with stage T3+T4 were higher than those of patients with stage T1+T2, the high-expression rates of FoxP3 and A2aR in patients with distant metastasis were higher than those of patients without distant metastasis, and the high-expression rates of FoxP3 and A2aR increased gradually with the increase in the number of lymph node metastasis. Conclusion There are high expressions of FoxP3 and A2aR in gastric cancer tissues, and both of them may play important role in promoting the occurrence and development of gastric cancer.
ObjectiveTo compared weight loss and metabolic improvement effects of laparoscopic sleeve gastrectomy (LSG) in treatment of obese males and females. MethodsAccording to the inclusion and exclusion criteria, the obese patients were retrospectively collected, who underwent LSG from January 2020 to June 2021 in the Affiliated Hospital of Xuzhou Medical University, and there were complete preoperative data and postoperative follow-up data at month 1, 3, 6, and 12. The weight loss and metabolic improvement effects of obese males and females were compared, as well as the remissions of diabetes and hyperlipidemia at the 12th month after surgery were observed. ResultsA total of 129 eligible obese patients were included, including 44 obese males and 85 obese females. The preoperative body mass index (BMI), fasting blood glucose (FBG) level, and insulin level of the obese males were higher than those of the obese females (P<0.05). ① Weight loss effect after LSG: For both obese males and females, the change value (Δ) of BMI (all change values of the indexes were the difference between preoperative and postoperative value in this study), the percentage of excess body weight loss (EWL%), and percentage of total body weight loss showed continuous upward trends within the observation time range (P<0.05). And it was found that the obese males’ ΔBMI was higher than that of the obese females at the 1st and 3rd month after surgery (P<0.05), and the EWL% of the obese males was lower than that of the obese females at the 3rd, 6th, and 12th month after operation (P<0.05). ② Metabolic improvement effect after LSG: Blood glucose and lipid metabolism indicators in both male and female patients（ΔFBG, ΔINS, ΔHbA1c, ΔTC and ΔTG) changed the fastest at 1 month after operation, and the change became flat after 3 months, except for males ΔTC index (P>0.05), the overall difference between male and female patients at each time point after operation was statistically significant (P<0.05). After operation, the ΔFBG (at the 1st, 3rd, 6th, and 12th month) and Δinsulin (at the 3rd, 6th, and 12th month) in the obese males were higher than those in the obese females (P<0.05). The remission rates of diabetes and hyperlipidemia in the obese males and females at the 12th month after surgery were both higher, but there was no significant difference between the two groups [64.7% (11/17) versus 81.0% (17/21), χ2=0.578, P=0.447; 73.9% (17/23) versus 84.4% (27/32), χ2=0.378, P=0.539]. ConclusionsFrom the results of this study, LSG is an effective method in treatment of obesity and its complications for both males and females. Bariatric surgery should be suggested to perform as soon as possible for obese males with poor metabolic status.
Objective To analyze retrospectively the overall situation of medical rescue in the Third People’s Hospital of Chengdu after the Wenchuan earthquake, so as to provide references for the emergency preparedness for the disaster of earthquake. Methods The analysis was based on the data provided by the Department of Information, the Medical Record Library, the Department of Emergency, the Department of Orthopaedics and other related departments of the Hospital up to 8 a.m. of July 12. The software of Microsoft EXCEL was used for data input, and SPSS 11.5 was used for statistical analysis. Results Up to July 12, 563 cases from the disaster area had been treated in the hospital, of whom 249 were admitted into the outpatient department and 314 into the inpatient department, including 287 men and 276 women, with a median age of 42 years (28, 57) in the outpatient department and a median age of 46 years (33, 65) in the inpatient department. The inpatients’ age was older than the outpatients’s (P=0.003). Most outpatients were sent to the hospital within the first 3 days after the quake (73.50%), while less than half of the inpatients were sent to the hospital during this period of time. The wounded were mainly from Dujiangyan, Aba Prefecture and Pengzhou, which was correlated with the transportation distance, the casualty and the condition of the local hospitals. The wounded were mainly admitted into the Departments of Orthopaedics (69.3%), Neurosurgery (15.6%) and General Surgery (3.7%). The total cost in the Department of Orthopaedics was the highest, followed by the Intensive Care Unit (ICU) and the Department of Neurosurgery. However, the median cost in the ICU was the highest, followed by the Department of Neurosurgery and the Department of Nephrology. Only 9 out of the 563 patients died, including 5 outpatients and 4 inpatients, of whom 8 deaths were due to craniocerebral injury and 1 died of crush syndrome. Conclusion Based on the data, it is of vital importance to develop an emergent plan for the medical rescue after an earthquake disaster, and to strengthen the reserve of medical supplies, personnel training, scientific field triage as well as the construction of information platforms.
ObjectiveTo investigate the effect of the remnant stomach after gastric bypass (GB) surgery on the weight loss and glucose metabolism in rats with obese and type 2 diabetes mellitus (T2DM).MethodsHigh fat feeding for one month combined with intraperitoneal injection of low-dose streptozotocin was used to induce obese rats with T2DM. Twenty-four rats with obese and type T2DM successfully established were randomly divided into resectional gastric bypass (R-GB) group, GB surgery (GB group), and sham operation (SO) group, eight rats in each group. The weight loss and anti-diabetic effect of the R-GB and GB were compared. Body weight, food intake, and fasting blood glucose (FBG) were measured at week 1 before operation and week 1–8 after the operation. Oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) were performed using tail venous blood at week 1 before operation and on week 8 after operation (at 0, 30, 60, 90, and 120 min). The levels of serum glucagon like peptide-1 (GLP-1), gastrin, insulin, and glucagon at week 1 before operation and at week 8 after operation were detected, meanwhile the homeostasis model assessment insulin resistance (HOMA-IR) index was calculated.Results① The body weight and food intake of the rats in the R-GB group and GB group were lower than those in the SO group after operation (P<0.05) and which were lower than before operation (P<0.05), but the differences were not significant between the R-GB group and GB group after operation (P>0.05). ② The levels of FBG in the R-GB group only at week 1–4 after operation were lower than those before operation (P<0.05), while which in the GB group at week 1–8 after operation were lower than those before operation and were lower than in the SO group (P<0.05), but which in the R-GB group only at week 2–4 after operation were lower than in the SO group and which were higher than that in the GB group from 3 to 8 weeks after operation (P<0.05). ③ The area under receiver operating characteristic curves (AUCs) of blood glucoses of OGTT and ITT and HOMA-IR index at week 8 after operation were lower than those before operation (P<0.05) in the GB group and which were lower than those the other two groups (P<0.05). ④ The AUC of gastrin level at week 8 after operation was lower than that before operation in the R-GB group and which lower than that in the other two groups (P<0.05). The AUC values of insulin and glucagon levels at week 8 after operation were lower than those before operation in the GB group and which lower than those in the other two groups (P<0.05). The AUC of GLP-1 level at week 8 after operation was higher than that before operation in the GB group and which higher than that in the other two groups (P<0.05).ConclusionsGB could remarkably improve glucose metabolism and weight loss in obese rat with T2DM. Gastric remnant gastrectomy following GB has a remarkable anti-diabetic effect, but it doesn’t effect on weight loss.
ObjectiveTo compare the curative effect of biliopancreatic diversion with duodenal switch (BPD/DS) with different gastrointestinal anastomotic position in the rat with obese diabetes. MethodsThe obese diabetic rat models were induced by high-fat feeding for 1 month combined with intraperitoneal injection of low-dose streptozotocin (35 mg/kg), then which were divided into modified BPD/DS (M-BPD/DS), BPD/DS, sleeve gastrectomy (SG), and sham operation (SO) groups according to the operation performed. Eight rats in each group were randomly selected for following experimental observation. The situation of weight loss, glucose reduction, nutrition, and esophagitis were compared among 4 groups, especially between the M-BPD/DS and BPD/DS groups. Results① The body mass and food intake of rats in the M-BPD/DS and BPD/DS groups at 1–4 month(s) after operation (except food intake at the 4th month) were lower than those in the SO group (P<0.05), but it was found that the food intake of the M-BPD/DS group was higher than that of the BPD/DS group at the first month after operation (P<0.05). ② The fasting blood glucose levels of the M-BPD/DS and BPD/DS groups were lower than those of the SO group (P<0.05) and were lower than those before the operation (P<0.05), but which had no statistical difference between the M-BPD/DS and BPD/DS groups (P>0.05). ③ The area under receiver operating characteristic curve (AUC) of blood glucose level by oral glucose tolerance test, insulin tolerancetest (ITT), and the homeostasis model assessment-insulin resistance index at the 1st and 4th month after operation of the M-BPD/DS and BPD/DS groups were lower of the SO group (P<0.05) and before operation (P<0.05), but which had no statistical difference between the M-BPD/DS and BPD/DS groups (P>0.05). It was also found that the AUCs of ITT values at the 4th month after operation of the M-BPD/DS and BPD/DS groups were higher than those of the 1st month after operation (P<0.05). ④ The AUCs of the glucagon like peptide-1 (GLP-1) levels at the 1st and 4th month after operation of the M-BPD/DS and BPD/DS groups were higher than those of the SO group (P<0.05), while the AUCs of the insulin index were lower than those of the SO group (P<0.05) at 1 and 4 months after operation. At the 1st and 4th month after operation, the AUCs of the GLP-1 were higher and the insulin were lower than those before operation (P<0.05) in the M-BPD/DS and BPD/DS groups, which had no statistical difference between the M-BPD/DS and BPD/DS groups (P>0.05). ⑤ The albumin, calcium, and ferrum at the 1st and 4th month after operation of the M-BPD/DS and BPD/DS groups were statistically lower than those of the SO group (P<0.05) and lower than those before operation (P<0.05). ⑥ The thickness of esophageal squamous epithelium and rate of nipple elongation of the M-BPD/DS group were lower than those of the BPD/DS group (P<0.05). ConclusionThe results of this experiment suggest that moving the gastrointestinal anastomosis above the pylorus simplifies the operationof BPD/DS without affecting its weight loss and glucose lowering effect , and may have a protective effect on the esophagus.
Objective To compare the effectiveness between a new hand-sewn intestinal anastomosis and stapled anastomosis during Roux-en-Y anastomosis of gastric cancer. Methods Retrospectively, we collected 200 gastric cancer patients who underwent radical distal or total gastrectomy from January 2014 to June 2017 in our hospital, and divided them into observation group (new hand-sewn anastomosis, n=100) and control group (stapled anastomosis, n=100) according to the type of anastomosis. The time and cost taken to perform the anastomosis, the incidence of postoperative complications (including anastomotic leakage, bleeding, and stenosis), and hospital stay were compared. Results The cost of anastomosis in the observation group was significantly lower than that of the control group [(194.1±13.5) RMB vs (5 270.3±852.7) RMB, P<0.001], and the time taken to perform was just slightly longer in the observation group [(8.34 ± 0.65) minvs (8.29±0.61 ) min, P=0.540], additionally the incidences between the observation group and the control group, in regards to anastomotic bleeding [0 (0/100) vs 3% (3/100), P=0.246], leakage [0 (0/100) vs 1% (1/100), P=1.000], stenosis [0 (0/100) vs 2% (2/100), P=0.497], and hospital stay [(18.8±7.4) d vs (19.2±6.2) d, P=0.175], showed no significant difference between the 2 groups. Conclusion The new hand-sewn anastomosis technology is safe and effective, easy to learn, and it can save money and time, which is worth promoting.
ObjectiveTo evaluate the efficacy of laparoscopic sleeve gastrectomy (LSG) in the treatment of obesity with different degrees of obesity.MethodsThe clinicopathologic data of patients received LSG in this hospital from October 2016 to October 2018 were analyzed retrospectively. The effect of LSG on postoperative weight loss in patients with different degrees of obesity were analyzed too.Results① A total of 161 patients with simple obesity were included in this study, including 40 cases of degree Ⅰ obesity, 41 cases of degree Ⅱ obesity, 61 cases of degree Ⅲ obesity, and 19 cases of super obesity. All operations were successfully completed, there was no conversion to laparotomy or mortality. The postoperative bleeding occurred in 4 (2.5%) cases, nausea and vomiting occurred in 97 (60.2%) cases during hospitalization, and 143, 130, and 122 cases were followed up in 1-, 2-, and 3-year after operation. The body mass indexes (BMIs) were decreased significantly in postoperative 1-, 2-, and 3-year (P<0.05) as compared with their preoperative values, respectively. The excess BMI loss percentage(EBMIL%) in postoperative 1-, 2-, and 3-year were (87.4±25.7)%, (84.6±30.5)%, and (88.8±20.4)%, respectively. The rates of weight regaining were 3.8% (5/130) and 4.9% (6/122) in 2- and 3-year following-up, respectively. ② There were no remarkable changes in the trend of BMI in patients with degree Ⅰ and Ⅱ obesity [the EBMIL% changes from postoperative year-1 to year-3 were (–2.3±1.1)% and (3.3±1.5)%, respectively]. Conversely, there were remarkable changes in the trend of BMI in patients with degree Ⅲ obesity and super obesity [the EBMIL% changes from postoperative year-1 to year-3 were (–7.1±1.9)% and (–11.6±5.3)%, respectively].ConclusionsFrom the results of this study, LSG has a good effect on weight loss in the treatment of patients withdegree Ⅰ and Ⅱ obesity. The long-term efficacy of LSG in patients with degree Ⅲ and super obesity, whether to take other bariatric procedures, whether to perform the second operation, and the timing of the second operation need to be further explored.