Basic performance of domestic surgical robot and the safety and effectiveness of integrated energy equipment / 中南大学学报(医学版)

OBJECTIVES@#Surgical robot system has broken the limitation of traditional surgery and shown excellent performance in surgery, and has been widely used in minimally invasive treatment in most areas of surgery. This study aims to verify the basic performance of the domestic surgical robot system and the safety and effectiveness of the integrated bipolar electrocoagulation and ultrasonic knife.@*METHODS@#The basic performance of the domestic surgical robot system was evaluated by completing the square knot and surgical knot, vertical and horizontal perforation and right ring perforation and suture, as well as picking up beans. Compared with laparoscopy, the safety and effectiveness of the domestic surgical robot after integrated interconnection bipolar electrocoagulation and ultrasonic scalpel were evaluated by detecting the vascular closure performance and the degree of histopathological damage in animals.@*RESULTS@#Compared with freehand knotting, domestic robot knotting speed and circumference were slightly worse, but better than laparoscopic knotting. There was no statistical significance in the tension difference of the surgical knots among the 3 methods (P>0.05), but the tension of the square knots made by the freehand and the domestic surgical robot was greater than that of the laparoscopy (P<0.05). The space required for both the left and right forceps heads of knots was smaller than that of laparoscopy (P<0.001), which successfully completed the 4 quadrant suture tasks, and the time of picking up beans was significantly less than that of laparoscopy (P<0.05). There was no significant difference in the temperature of the liver tissue after the bipolar electrocoagulation between the interconnected domestic surgical robot and the laparoscopy (P>0.05), and the acute thermal injury was observed under the light microscope. The temperature of the liver tissue treated by the domestic robotic ultrasound knife was higher than that of the laparoscopic ultrasound knife (P<0.05).@*CONCLUSIONS@#Domestic surgical robots are obviously superior to laparoscopy in suturing, knotting, and moving objects, and domestic surgical robots' interconnect bipolar electrocoagulation and ultrasonic knife have achieved success in animal experiments, and hemostasis is considered to be safe and effective.

Effects and mechanisms of neural and fluid regulation in bariatric surgery / 中华消化外科杂志

Currently, bariatric surgery, which includes restricted intake, malabsorptive and mixed surgeries, is known to be an effective measurement for the durable treatment of obesity and related comorbidities. By changing the anatomy of gastrointestinal tract, bariatric surgery achieves the principles of restricting food intake, reducing food absorption, increasing satiety and prolonging gastric emptying to help patients lose weight and regulate metabolic mechanism. Through the neuromodulation of brain-vagus-taste receptors, sensation-specific satiety can reduce the food intake. The brain-gut-microbe axis plays a central role in maintaining homeostasis through neuronal pathways in the brain, vagus, spinal nerves, enteric nervous system and signaling pathways. Bariatric surgery can inhibit the development of hypertension, diabetes, non-alcoholic fatty liver, cardio-vascular and cerebrovascular diseases in the regulation of body fluids through adipokines, bile acids, hormones and other signaling factors. Therefore, the improvement of metabolic-related diseases after bariatric surgery is the result of the interaction of multiple factors such as nerves, body fluids, and microorganisms. The authors summarize the literature reports to introduce the mechanism of neural and humoral factor regulation in weight loss and improvement of metabolic-related diseases after bariatric surgery.

Laparoscopic Roux / 中南大学学报(医学版)

Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been proved to be a safe and effective treatment for Type 2 diabetes mellitus (T2DM) patients with body mass index (BMI) >27.5 kg/m

Causes and countermeasures for weight regain after bariatric surgery / 中华消化外科杂志

Although bariatric surgery is the most effective and durable treatment for obesity and related metabolic diseases, weight regain (WR) after surgery is a common problem and cannot be neglected. The causes of WR are complex and require a comprehensive assessment and long-term follow-up conducted by a multidisciplinary team. The treatment for WR should be indivi-dualized according to the anatomical condition, lifestyle habits, psychological state, and compliance of patients. The authors review the current retrospective and prospective studies on the risk factors for WR, and summarize the clinical evidence on the behavioral, pharmacotherapeutic, and surgical interventions. Basing on the available research results, the authors consider that harmonized criteria for WR diagnosis is imperative. It is necessary to further clarify WR predictors, optimal combination of surgical and non-surgical therapies, and to explore the ideal time-point of medication usage by designing prospective studies, which have great importance for maintaining weight loss and preven-tion and treatment of WR after bariatric surgery.

Applications and future trend of minimally invasive surgical robots in bariatric and metabolic surgery / 国际外科学杂志

The incidence of obesity is increasing in the world yearly, obesity and its complications pose a serious threat to the health of people at the same time. In recent years with the progress of economy, the development of science and technology and the change of concept, surgical robots are increasingly used in metabolic and bariatric surgery. In this review, the application and development trend of minimally invasive surgical robot in metabolic and bariatric surgery are reviewed, the advantages of surgical robot in metabolic and bariatric surgery are discussed, and the future development are prospected.

Effects of bariatric metabolic surgery on body composition / 中华消化外科杂志

Objective:To explore the effects of bariatric metabolic surgery on body composition.Methods:The retrospective cohort study was conducted. The clinicopathological data of 66 patients with metabolic diseases who were admitted to the Third Xiangya Hospital of Central South University from January 2013 to December 2014 were collected. There were 42 males and 24 females, aged (40±11)years, with a range from 17 to 63 years. Of the 66 patients, 27 undergoing laparoscopic sleeve gastrectomy (LSG) and 39 undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) were allocated into LSG group and LRYGB group, respectively. The body composition of all patients was determined by dual-energy X-ray absorptiometry at preoperation and postoperative 6 months. Observation indicators: (1) the changes of anthropometric parameters, glucolipid metabolism, body fat mass percentage (BF%) and the ratio of Android BF% and Gynoid BF% (A/G ratio) from preoperation to postoperative 6 months; (2) the changes of whole and local body composition from preoperation to postoperative 6 months; (3) analysis of the correlation between BF% and anthropometric parameters, glucolipid metabolism. (4) Follow-up. Follow-up was conducted using outpatient or hospitalization examination to detect the changes of body composition at the time of postoperative 6 month. The follow-up time was up to July 2015. Measurement data with normal distribution were represented as Mean± SD, paired-samples t test was used for intra-group comparison, and independent-samples t test when baseline data were consistency or covariance analysis when baseline data were not consistency was used for inter-group comparison. Measurement data with skewed distribution were represented as M ( P25, P75), and comparison between groups was analyzed using Wilcoxon signed rank test. The correlation test was undertaken with the Pearson bivariate analysis. Results:(1) The changes of anthropometric parameters, glucolipid metabolism, BF% and A/G ratio from preoperation to postoperative 6 months: for patients in the LSG group, the body mass, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), diastolic blood pressure (DBP), systolic blood pressure (SBP), fasting plasma glucose (FPG), HbA1c, high density lipoprotein cholesterol (HDL-C), triglyceride (TG), whole BF%, arms BF%, legs BF%, trunk BF%, Android BF%, Gynoid BF% and A/G ratio at preoperation and postoperative 6 months were (102±17)kg, (37±5)kg/m 2, (118±14)cm, 1.01±0.06, (94±14)mmHg(1 mmHg=0.133 kPa), (137±15)mmHg, (8.1±4.2)mmol/L, 7.3%±2.4%, (1.11±0.26)mmol/L, 2.14 mmol/L(1.73 mmol/L, 2.59 mmol/L), 40%±6%, 46%±10%, 36%±8%, 42%±6%, 45%±6%, 37%±7%, 1.23±0.18 and (82±15)kg, (29±4)kg/m 2, (101±13)cm, 0.95±0.08, (76±10)mmHg, (118±16)mmHg, (7.2±1.2)mmol/L, 5.4%±0.8%, (1.26±0.32)mmol/L, 1.21 mmol/L(0.88 mmol/L, 1.55 mmol/L), 36%±8%, 41%±9%, 34%±10%, 38%±8%, 41%±8%, 35%±10%, 1.20±0.17, respectively. There was no significant difference in the intra-group comparison of the Gynoid BF% and A/G ratio ( t=1.903, 1.730, P>0.05) and there were significant differences in the intra-group comparison of the rest of above indicators ( t=12.748, 13.283, 9.013, 3.804, 6.031, 6.226, 2.393, 4.287, -2.900, 3.193, 2.932, 5.198, 2.167, 3.357, 3.116, P<0.05). For patients in the LRYGB group, the body mass, BMI, WC, WHR, DBP, SBP, FPG, HbA1c, HDL-C, TG, whole BF%, arms BF%, legs BF%, trunk BF%, Android BF%, Gynoid BF% and A/G ratio at preoperation and postoperative 6 months were (80±12)kg, (28±4)kg/m 2, (98±9)cm, 0.96±0.05, (85±10)mmHg, (134±17)mmHg, (8.6±2.8)mmol/L, 8.3%±1.7%, (1.13±0.26)mmol/L, 2.06 mmol/L(1.15 mmol/L, 3.30 mmol/L), 30%±8%, 29%±11%, 23%±9%, 37%±7%, 40%±7%, 29%±8%, 1.42±0.26 and (69±9)kg, (24±3)kg/m 2, (91±8)cm, 0.93±0.05, (80±9)mmHg, (129±18)mmHg, (7.4±1.8)mmol/L, 7.0%±1.5%, (1.18±0.29)mmol/L, 1.29 mmol/L(0.85 mmol/L, 2.02 mmol/L), 25%±8%, 23%±12%, 20%±9%, 29%±9%, 32%±10%, 25%±9%, 1.29±0.25, respectively. There was no significant difference in the intra-group comparison of the SBP and HDL-C ( t=1.733, -1.073, P>0.05) and there were significant differences in the intra-group comparison of the rest of above indicators ( t=10.525, 10.200, 7.129, 2.887, 2.805, 2.517, 3.699, 2.608, 7.997, 8.018, 6.029, 8.342, 8.069, 5.813, 6.391, P<0.05). There were significant differences in DBP, SBP, HbA1c, trunk BF%, Android BF% and A/G ratio at postoperative 6 months between LSG group and LRYGB group ( F=6.408, t=2.641, F=20.673, 5.140, 5.735, 4.714, P<0.05). (2) The changes of whole and local body composition from preoperation to postoperative 6 months: for patients in the LSG group, the whole fat mass, muscle mass, fat-free mass at preoperation and postoperative 6 months were (38.74±9.68)kg, (57.71±11.62)kg, (60.14±11.95)kg and (26.64±8.29)kg, (48.65±13.80)kg, (51.00±14.27)kg, respectively, showing significant differences in the intra-group comparison of the above indicators ( t=5.256, 5.413, 5.315, P<0.05); the arms fat mass, muscle mass, fat-free mass were (5.19±1.67)kg, (5.78±1.58)kg, (6.10±1.64)kg and (3.73±1.19)kg, (5.10±1.53)kg, (5.43±1.57)kg, respectively, showing significant differences in the intra-group comparison of the above indicators ( t=7.564, 5.405, 5.363, P<0.05); the legs muscle mass and fat-free mass were (19.05±4.19)kg, (19.93±4.35)kg and (15.93±4.71)kg, (16.81±4.87)kg, respectively, showing significant differences in the intra-group comparison of the above indicators ( t=5.623, 5.568, P<0.05); the trunk fat mass and fat-free mass were (21.93±4.90)kg, (29.7±5.94)kg and (14.69±4.79)kg, (24.78±7.02)kg respectively, showing significant differences in the intra-group comparison of the above indicators ( t=8.903, 5.421, P<0.05); the Android fat mass and fat-free mass were (4.16±1.19)kg, (5.01±1.12)kg and (2.57±0.90)kg, (3.83±1.20)kg respectively, showing significant differences in the intra-group comparison of the above indicators ( t=8.288, 7.637, P<0.05); the Gynoid fat mass and fat-free mass were (5.51±1.42)kg, (9.27±1.86)kg and (3.85±1.16)kg, (7.65±2.31)kg, respectively, showing significant differences in the intra-group comparison of the above indicators ( t=7.461, 5.672, P<0.05); the skeletal muscle index were (8.86±1.38)kg/m 2 and (7.49±1.71)kg/m 2, respectively, showing a significant differences in the intra-group comparison ( t=5.724, P<0.05). For patients in the LRYGB group, the whole fat mass, muscle mass, bone mineral content, fat-free mass at preoperation and postoperative 6 months were (23.58±7.80)kg, (51.76±8.35)kg, (2.55±0.48)kg, (54.31±8.63)kg and (16.88±6.86)kg, (49.41±7.70)kg, (2.47±0.50)kg, (51.88±8.05)kg, respectively, showing significant differences in the intra-group comparison of the above indicators ( t=9.001, 3.974, 4.354, 4.075, P<0.05); the arms fat mass were (2.72±2.37)kg and (1.73±1.02)kg, respectively, showing significant differences in the intra-group comparison of the above indicators ( t=3.470, P<0.05); the legs fat mass, muscle mass, fat-free mass were (5.21±2.46)kg, (16.68±3.50)kg, (17.60±3.66)kg and (4.01±2.12)kg, (15.63±2.90)kg, (16.54±3.05)kg, respectively, showing significant differences in the intra-group comparison of the above indicators ( t=6.592, 3.372, 3.319, P<0.05); the trunk fat mass were (14.87±4.11)kg and (10.38±4.00)kg, respectively, showing a significant difference in the intra-group comparison of the above indicators ( t=8.431, P<0.05); the Android fat mass and fat-free mass were (2.61±0.86)kg, (3.96±0.87)kg and (1.81±0.79)kg, (3.78±0.67)kg respectively, showing significant differences in the intra-group comparison of the above indicators ( t=8.032, 2.153, P<0.05); the Gynoid fat mass and fat-free mass were (3.14±1.17)kg, (7.89±1.58)kg and (2.44±0.96)kg, (7.43±1.26)kg, respectively, showing significant differences in the intra-group comparison of the above indicators ( t=6.112, 3.207, P<0.05); the skeletal muscle index were (8.04±1.22)kg/m 2 and (7.43±1.13)kg/m 2, respectively, showing significant differences in the intra-group comparison ( t=4.953, P<0.05). There were significant differences in whole muscle mass, whole fat-free mass, arms fat mass, legs muscle mass, legs fat-free mass, trunk fat-free mass, Android fat-free mass, Gynoid fat-free mass and skeletal muscle index at postoperative 6 months between LSG group and LRYGB group ( F=13.846, 13.614, 23.696, 7.100, 7.127, 15.243, 16.921, 8.625, 5.497, P<0.05). (3) Analysis of the correlation between BF% and anthropometric parameters, glucolipid metabolism: the whole BF% of 66 patients was positively correlated with body mass, BMI, WC and WHR ( r=0.405, 0.663, 0.625, 0.331, P<0.05); the arms BF% was positively correlated with body mass, BMI, WC and WHR ( r=0.432, 0.682, 0.639, 0.309, P<0.05); the legs BF% was positively correlated with body mass, BMI and WC ( r=0.366, 0.646, 0.564, P<0.05); the trunk BF% was positively correlated with body mass, BMI, WC and WHR ( r=0.332, 0.560, 0.554, 0.335, P<0.05); the Android BF% was positively correlated with body mass, BMI, WC and WHR ( r=0.327, 0.537, 0.543, 0.336, P<0.05); the Gynoid BF% was positively correlated with BMI and WC ( r=0.561, 0.488, P<0.05), and negatively correlated with FPG ( r=-0.491, P<0.05); the A/G ratio was negatively correlated with BMI ( r=-0.334, P<0.05), and positively correlated with FPG ( r=0.506, P<0.05); the skeletal muscle index was positively correlated with body mass, BMI, WC and WHR ( r=0.757, 0.641, 0.609, 0.519, P<0.05), and negatively correlated with HDL-C ( r=-0.369, P<0.05). (4) Follow-up: 66 patients were followed up at the time of postoperative 6 month. Conclusions:Both LSG and LRYGB significantly change body composition. LRYGB is superior to LSG in reducing trunk BF% and Android BF%. The effects of the two surgical methods on fat mass and bone mineral content are similar. LSG lead to a more significant decrease in whole muscle mass, and LRYGB lead to a more significant decrease in legs muscle mass and skeletal muscle index.

Efficacy analysis of Da Vinci robotic and laparoscopic total mesorectal excision for low rectal cancer / 中华消化外科杂志

Objective:To compare the clinical efficacies of Da Vinci robotic and laparoscopic total mesorectal excision (TME) for low rectal cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 64 patients with low rectal cancer who were admitted to the Third Xiangya Hospital of Central South University from October 2015 to January 2019 were collected. There were 42 males and 22 females, aged from 40 to 84 years, with a median age of 59 years. Of the 64 patients, 31 undergoing Da Vinci robotic TME and 33 undergoing laparoscopic TME were allocated into robotic group and laparoscopic group, respectively. Observation indicators: (1) surgical situations and postoperative recovery; (2) postoperative pathological examination; (3) follow-up. Follow-up using outpatient examination and telephone interview was conducted to detect long-term complications and pelvic autonomic nerve injury up to January 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M ( P25, P75), and comparison between groups was analyzed using the rank sum test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data between groups was analyzed using the Mann-Whitney U test. Results:(1) Surgical situations and postoperative recovery: cases with anus preservation, cases with defunctioning stoma, cases with intraoperative conversion to laparotomy, cases with intraoperative blood transfusion, operation time, volume of intraoperative blood loss, time to postoperative first out-of-bed activities, time to postoperative first flatus, time to postoperative diet resumption, duration of hospital stay, cases with incision infection, cases with postoperative hemorrhage, cases with anastomotic fistula, cases with pulmonary infection, cases with urinary retention, comprehensive complication index for the whole group, comprehensive complication index for patients with complications, and treatment expenses of the robotic group were 30, 23, 0, 1, (285±73)minutes, (147±112)mL, (1.6±0.8)days, (3.6±1.1)days, (3.2±1.5)days, (9.8±2.8)days, 1, 4, 3, 1, 4, 15.0±12.0, 22.6(20.9, 27.3), (11.7±1.2)×10 4 yuan, respectively. The above indicators of the laparoscopic group were 22, 13, 2, 2, (253±57)minutes, (211±123) mL, (1.8±0.8) days, (3.9±1.6)days, (4.1±1.9)days, (11.8±4.3)days, 2, 5, 3, 3, 2, 20.0±12.0, 24.2(10.5, 30.8), (7.7±1.3)×10 4 yuan, respectively. There were significant differences in the cases with anus preservation, volume of intraoperative blood loss, duration of hospital stay, and treatment expenses between the two groups ( χ2=8.581, t=-2.065, -2.133, 12.700, P<0.05). There was no significant difference in the cases with defunctioning stoma, operation time, time to postoperative first out-of-bed activities, time to postoperative first flatus, time to postoperative diet resumption, comprehensive complication index for the whole group, or comprehensive complication index for patients with complications between the two groups ( χ2=2.425, t=1.957, -0.679, -0.846, -1.941, -1.867, Z=-0.850, P>0.05). There was no significant difference in the cases with intraoperative conversion to laparotomy, cases with intraoperative blood transfusion, cases with incision infection, cases with postoperative hemorrhage, cases with anastomotic fistula, cases with pulmonary infection, or cases with urinary retention between the two groups( P>0.05). One patient with anastomotic fistula in the robotic group was clipped under endoscopy, and the other patients with complications were cured after symptomatic treatment. (2) Postoperative pathological examination: distance from tumor to surgical margin, tumor diameter, case with positive or negative surgical margin, cases with highly, highly-moderately, moderately, moderately-poorly, poorly differentiated tumor (tumor differentiation degree), cases in stage Ⅰ, Ⅱ, Ⅲa+ b, Ⅲc+ Ⅳ (tumor pathological stage), the number of lymph node dissected were 1.0 cm(0.3 cm, 2.0 cm), (3.5±1.1)cm, 2, 29, 3, 7, 14, 5, 2, 5, 18, 4, 4, 16.0±2.8 of the robotic group, respectively, versus 1.3 cm(0.5 cm, 3.0 cm), (4.2±1.4)cm, 2, 30, 1, 7, 16, 6, 3, 1, 19, 7, 6, 13.9±3.8 of the laparoscopic group. There was a significant difference in the number of lymph node dissected between the two groups ( t=2.420, P<0.05) . There was no significant difference in the distance from tumor to surgical margin, tumor diameter, tumor differentiation degree, or tumor pathological stage between the two groups ( Z=-0.980, t=-1.912, Z=-0.809, -1.595, P>0.05). There was no significant difference in the surgical margin between the two groups ( P>0.05). (3) Follow-up: of the 31 patients in the robotic group, 29 were followed up for 3-24 months, with a median follow-up time of 12 months. Of the 33 patients in the laparoscopic group, 30 were followed up for 3-36 months, with a median follow-up time of 15 months. Cases with intestinal obstruction, cases with timely stoma closure, cases with local recurrence, cases with distant metastasis, cases with death, Wexner score at postoperative 12 months, international prostate symptom score at postoperative 12 months, times of nocturia at postoperative 12 months, international index of erectile function of the robotic group were 2, 20, 3, 2, 2, 0.0(0.0, 0.0), 4.5(1.3, 8.8), 1.5(1.0, 2.0), 2.0(1.3, 10.8), respectively. The above indicators were 4, 7, 3, 2, 3, 1.0(0.0, 3.0), 8.0(2.0, 14.3), 2.0(1.0, 4.0), 3.0(1.0, 11.8) of the laparoscopic group. There was no significant difference in the cases with intestinal obstruction, cases with timely stoma closure, cases with local recurrence, cases with distant metastasis, or cases with death between the two groups ( P>0.05). There were significant difference in the Wexner score and times of nocturia at postoperative 12 months between the two groups ( Z=-2.202, -1.986, P<0.05). There was no significant difference in the international prostate symptom score and international index of erectile function at postoperative 12 months between the two groups ( Z=-0.885, 0.094, P>0.05). Conclusion:Both Da Vinci robotic and laparoscopic TME for low rectal cancer are safe and effective, of which the former can improve the anal sphincter retention rate, reduce the nocturia frequency and enhance the protection of defecation function under the premise of radical resection of tumor.

Correlation between changes of body fat distribution and insulin resistance after Roux-en-Y gastric bypass / 国际外科学杂志

Objective To investigate the effect of laparoscopic Roux-en-Y gastric bypass(LYGB) on body fat distribution,and relationship between the changes of body fat distribution and improvement of insulin resistance.Methods A total of 65 patients with type 2 diabetes who underwent LYGB were selected for a retrospective analysis.Metabolic parameters,anthropometric measurements,body composition and fat distribution measured by dual-energy X-ray absorptiometry (DEXA) were collected separately before and 6 months post LYGB.All data of pre-and postoperation were compared with pair t test,Pearson correlation analysis was used to evaluate correlation of two variables.Results Weight,body mass index,waist circumference,waist-to-hip ratio,triglyceride,fasting plasma glucose,fasting insulin and homeostatic model assessment for insulin resistance (HOMA-IR) were significantly decreased in 6 months after surgery (P ＜ 0.05).Total fat mass,body fat mass of trunk,upper and lower limbs decreased significantly (P ＜0.05).Percent fat mass at the whole body,Android region,upper and lower limbs decreased significantly (P ＜0.05).After 6 months postoperatively,abdominal obesity indices waist circumfernce decreased from (98.10±13.03) cm to (91.60±7.68) cm (P＜0.01) and percent fat mass at the Android region decreased from (35.71 ±10.24)％ to (29.44 ± 12.11) ％ (P＜0.05),HOMA-IR decreased from 3.62 ± 5.18 to 1.79 ± 1.52 (P ＜ 0.05).The improvement of postoperative insulin resistance is positively correlated with the changes in waist circumference (P ＜0.01) and percent fat mass of Android region (P ＜0.05).Conclusions The body fat distribution changes after LYGB,change of abdominal fat distribution is positively correlated to the improvement of insulin resistance.

Influence of vitamin D deficiency in bariatric surgery / 国际外科学杂志

Vitamin D plays an important role in cellular differentiation and Calcium phosphate metabolism.At the same time,the role of Vitamin D in glycolipid metabolism had attracted a lot of attention.Bariatric surgery is an effective treatment to achieve therapeutic endpoints for comorbidities associated with obesity,but vitamin D status is always insufficient before and after surgery.In this review,the author aim to (1) discuss the deficiency of vitamin D in bariatric patients,(2) to summarize the impact of vitamin D on glycolipid metabolism and the outcome of bariatric surgery,(3) to discuss the supplementation for the deficiency of vitamin D.

Interaction between functional nano-hydroxyapatite and cells and the underlying mechanisms / 中南大学学报(医学版)

OBJECTIVE@#To explore the interaction between arginine functionalized hydroxyapatite (HAP/Arg) nanoparticles and endothelial cells, and to investigate mechanisms for endocytosis kinetics and endocytosis.
@*METHODS@#Human umbilical vein endothelial cells (HUVECs) were selected as the research model.Cellular uptake of HAP/Arg nanoparticles were observed by laser scanning confocal microscopy.Average fluorescence intensity of cells after ingestion with different concentrations of HAP/Arg nanoparticles were determined by flow cytometer and atomic force microscopy.
@*RESULTS@#The HAP/Arg nanoparticles with doped terbium existed in cytoplasm, and most of them distributed around the nucleus area after cellular uptake by HUVECs. Cellular uptake process of HAP/Arg nanoparticles in HUVECs was in a time and concentration dependent manner. 4 h and 50 mg/L was the best condition for uptake. HAP/Arg nanoparticles were easier to be up-taken into the cells than HAP nanoparticles without arginine functionalized.
@*CONCLUSION@#HAP/Arg nanoparticles are internalized by HUVECs cells through an active transport and energy-dependent endocytosis process, and it is up-taken by cells mainly through caveolin-mediated endocytosis, but the clathrin-dependent endocytic pathway is also involved..

Additive Manufacturing and Its Medical Applications / 生物医学工程学杂志

Additive manufacturing (AM) is a collection of technologies based on the layer-by-layer manufacturing. Characterized by its direct manufacturing and rapidity, it has been regarded by the Economist Journal as one of the key techniques which will trigger the third industry reformation. The present article, beginning with a brief introduction of the history of AM and the process of its major technologies, focuses on the advantages and disadvantages and medical applications of the technique.

Present Status of Reliability Research on the Effects of Medical Instrument at the Instrument-tissue Interface / 生物医学工程学杂志

The interaction between medical instrument and target tissue during the surgery occurs in instrument-tissue interface. The reliability research on the interface is directly related to the safety and effectiveness of medical instrument in the clinical application. This paper illustrates the necessity of reliability research on instrument-tissue interface. Two main contents are synthetically reviewed the present paper: (1) reliability research on medical instruments; (2) biological tissue properties and its mechanical response.

Diagnosis and treatment of severe obesity complicated with type 2 diabetes mellitus / 中华消化外科杂志

The incidence of obesity increases worldwide every year,positioned as an important disease by WHO,and it has become an important public health problem.National survey shows that overweight and obesity rates were 22.8％ and 7.1％ respectively in Chinese adults in 2002,affecting 270 million people.At present,bariatric surgery is a safe and effective treatment for severe obese patients.In July 2011,a patient with Ⅲ degree obesity (weight 148 kg and BMI 51 kg/m2) complicated with type 2 diabetes mellitus was admitted to the Third Xiangya Hospital of Central South University.The treatment plan was made after diagnosis and treatment of muhidisciplinary team and the patient underwent laparoscopic sleeve gastrectomy.The patient was followed up to September 2012 and recovered well without severe surgical complications,and the weight and BMI were decreased to 75 kg and 25 kg/m2 respectively.

A new system for noninvasive esophageal varices pressure measurement based on airflow and laser technology / 中国医疗器械杂志

<p><b>OBJECTIVE</b>Combined the optical principle with automatic control technology and computer real-time image detection technology to develop a non-contact system for noninvasive esophageal varices pressure measurement.</p><p><b>METHODS</b>The system included the adjustable air pump, laser device, image collection and analysis program. The feasibility and accuracy of the system were verified by in vitro experiments.</p><p><b>RESULTS</b>The bionic vascular pressure measured by this system had good correlation and repeatability with the actual pressure.</p><p><b>CONCLUSIONS</b>This system is accurate, feasible and has good application prospects.</p>

Visfatin level after laparoscopic Roux-en-Y gastric bypass surgery in patients with Type 2 diabetes / 中南大学学报(医学版)

OBJECTIVE@#To investigate the change in serum visfatin level after laparoscopic Roux-en-Y gastric bypass surgery in patients with Type 2 diabetes mellitus (T2DM) and to explore the relationship between visfatin insulin resistance and diabetes.@*METHODS@#Thirty-three patients with Type 2 diabetes were studied before and after the gastric bypass surgery. The level of fasting serum visfatin was measured by enzyme-linked immunosorbent assay. Fasting plasma glucose (FPG), glycated hemoglobin (HbA1c) and fasting insulin (FINS) were measured before and after the gastric bypass surgery.@*RESULTS@#Compared with before the operation, the indicators of HbA1c, FINS, and insulin resistance index (HOMA-IR) were decreased after the laparoscopic Roux-en-Y gastric bypass surgery. The body mass index (BMI) [(24.53 ± 0.62) kg/m² vs (26.71 ± 0.69) kg/m2] was decreased, with significant difference (P<0.001). The serum visfatin level [(9.79 ± 0.64) ng/mL] was significantly lower than before the operation [(38.24 ± 5.32) ng/mL], with significant difference (P<0.001).@*CONCLUSION@#Serum level of visfatin is decreased in T2DM patients who undergo gastric bypass surgry, reflecting an improvement in insulin resistance and diabetes.

Multi-disciplinary treatment for type 2 diabetes mellitus combing with obesity / 中华消化外科杂志

Type 2 diabetes mellitus (T2DM) usually becomes complicated and unmanageable when combing with metabolic syndromes of obesity,hypertension and hyperlipidemia.Medical treatment generally adopts non-surgical management,such as diet control,exercise and oral medications; surgical treatment can improve the condition of patients with T2DM and the metabolic syndromes.In this article,the multi-disciplinary treatment of a patient with T2DM and obesity in the Third Xiangya Hospital of Central South University was analyzed,so as to provide a new way for the treatment of this disease.

Surgical risks for patients with hepatolithiasis undergoing hepatectomy / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the risk of hepatectomy by detecting liver functional reserve preoperatively for patients with primary hepatolithiasis.@*METHODS@#The clinical data of 134 patients with primary hepatolithiasis who underwent hepatectomy were reviewed. In terms of evaluation methods for preoperative liver functional reserve they were divided into a Child-Pugh group (group CP) and an indocyanine green group (group ICG). The preoperative and intraoperative parameters, and the incidence of postoperative complications were analyzed.@*RESULTS@#Liver failure was more common in group CP (12.85%) than that in group ICG (1.56%, P<0.05). The overall complication rate in group CP (37.14%) was higher than in group ICG (18.75%, P<0.05).@*CONCLUSION@#ICG15 retention test is more accurate in evaluating liver functional reserve than Child-Pugh scoring system. It may predict the postoperative liver failure in patients with primary hepatolithiasis undergoing hepatectomy, decrease postoperative complications, and increase operation safety.

A case of severe acute pancreatitis and cholangitis presenting as initial complaints of hepatocellular carcinoma / 中南大学学报(医学版)

Jaundice occurs in 19%-40% of the hepatocellular carcinoma (HCC) patients. HCC associated jaundice may be divided into hepatocellular and icteric types in terms of its underlying pathophysiology. The jaundice of icteric type is caused by obstruction of the bile duct through cancer embolus, blood clot, biliary sludge, tumor compression or infiltration. Jaundice and epigastric discomforts are the main clinical manifestations. In the present case, severe acute pancreatitis and acute cholangitis presenting as initial complaints of icteric type HCC were quite rare. A tumor located at the central lobe of the liver and a cancer embolus at the lower part of the common bile duct (CBD) were detected by CT scan. Curative resection of HCC with CBD exploration eradicated both the tumor and the embolus, and no recurrence was found after a 36 month follow-up.

Glucose-dependent insulinotropic peptide in Type 2 diabetes after gastric bypass surgery / 中南大学学报(医学版)

Glucose-dependent insulinotropic peptide (GIP), the incretins, is synthesized and released from the duodenum and proximal jejunum. Continual high-fat diet powerfully stimulated GIP secretion, leading to obesity and harmful lipid deposition in islet cells and peripheral tissues, and giving rise to insulin resistance and major disturbances in the secretion of insulin. We can improve Type 2 diabetes by compromising GIP action. The exclusion of proximal small intestine and reduction of GIP secretion may be the important reasons for Type 2 diabetes after gastric bypass surgery.

Study on implant material of carbon/carbon composites / 生物医学工程学杂志

This study was aimed to evaluate the biocompatibility and mechanical property of carbon/carbon composites. At first, carbon/carbon composites were prepared by chemical vapor deposition, and the mechanical property of carbon/carbon composites was tested. The biocompatibility of carbon/carbon composites was evaluated by cytotoxicity test, sensitization test, micronucleus test and implantation test. Mechanical property test showed such carbon/carbon composites are of good compression property and tension property. Cytotoxicity test showed that the leaching liquor of samples has no effect on the growth and proliferation of L-929 cells. The medullary micronucleus frequency of mouse was 2.3 per thousand +/- 0.7 per thousand in experiment group. The sensitization test showed that the skin of the subjects of experiment group had slight erythema and edema, which was 0.188 +/- 0.40 according to Magnusson and Kligman classification. Implantation test revealed that there was slight inflammation around the tissue after the implantation of sample. At 12 weeks, scanning electron microscopy and histopathological exam indicated that the samples of experiment group were of good histocompatibility; and in comparison with control group, there was no significant differences (P > 0.05). So these kinds of samples have good biocompatibility, mechanical property and prospects of clinical application.