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25 November 2018, Volume 23 Issue 06 Previous Issue    Next Issue

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Impact of laparoscopic sleeve gastrectomy on metabolism in obese patients with polycystic ovary syndrome: a report of 33 cases MA Chiye, ZHU Jiangfan, MA Yingzhang, MAN Lin, LU Wei, ZHANG Qiying, ZHANG Yali 2018, 23 (06):  506-510.  DOI: 10.16139/j.1007-9610.2018.06.008 Abstract ( 573 )   PDF (535KB) ( 119 )   Objective To investigate the impact of laparoscopic sleeve gastrectomy (LSG) on metabolic improvement in obese patients with polycystic ovary syndrome(PCOS). Methods Thirty-three obese patients with PCOS who underwent LSG at our hospital were investigated retrospectively including clinical data and parameter changes in PCOS after 3 months and 6 months of follow-up. Results The average age of obese patients was (27±5) years and body mass index (BMI) all was ≥27.5. Patients had symptoms of menstrual disorders or amenorrhea and were diagnosed as PCOS according to Rotterdam ESHRE/ASRM-sponsored PCOS consensus. Preoperative BMI was (36.75±4.96), testosterone (TESTO) (0.489±0.186) μg/L, luteinizing hormone/follicle stimulating hormone (LH/FSH) （1.72±0.90）, homeostatic model assessment-insulin resistance (HOMA-IR) (14.14±16.79) and glycosylated hemoglobin (HbA1c) 6.35 %±1.41 %. Operations were completed successfully without conversion to laparotomy and severe postoperative complications. Follow-up study showed that mean BMI was (29.55±4.65) at 3 months and (25.07±3.81) at 6 months postoperatively. Mean TESTO and LH/FSH were（0.336±0.112） μg/L and (1.68±1.08) at 3 months, （0.216±0.115） μg/L and (1.28±0.95) at 6 months postoperative respectively. Mean HOMA-IR was (3.07±2.14) and (2.35±1.14) at 3 months and 6 months follow-up, and HbA1c was 5.35%±0.40% and 5.22%±0.30%, respectively. The decrease in BMI, TESTO, FPG, HOMA-IR, peptide C, HbA1c, total cholesterol and triglyceride was found obviously at 3 months and 6 months postoperative compared to those preoperative with significant difference (P<0.05). The significant change in LH/FSH did not present at 3 months and 6 months after operation compared that before operation (P>0.05). At 3 months, 11 (33.3%) of 33 cases with menstrual disorders including amenorrhea were in clinical remission and 26 (78.8%) of 33 cases were at 6 months. PCOS in clinical remission was 17 (51.5%) of 33 cases at 3 months of follow-up and 26(78.8%) of 33 cases at 6 months. Conclusions LSG has a significant effect on menstrual disorder and hyperandrogenism in obesity patients with PCOS by the mechanism of improving insulin resistance. References | Related Articles | Metrics

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Effects of preoperative eating behavior on weight loss after bariatric surgery WANG Yunjie, GUO Haijun, CAO Dongliang, MA Yingzhang, ZHU Jiangfan 2018, 23 (06):  511-514.  DOI: 10.16139/j.1007-9610.2018.06.009 Abstract ( 478 )   PDF (379KB) ( 339 )   Objective To investigate the impact of preoperative eating behavior on weight loss after bariatric surgery, and provide relevant reference for predicting effects of bariatric surgery. Methods Of 85 obese patients undergoing laparoscopic sleeve gastrectomy, 44 cases were in restricted diet group, which was further divided into successful restricted diet subgroup (n=27 cases) and failing restricted diet subgroup (n=17 cases), and 41 cases in non-restricted diet group based on the Dutch Eating Behavior Questionnaire. Body weight, body mass index (BMI) and percentage excess weight loss (%EWL) were compared between groups and between subgroups at 6 and 12 months postoperatively. Results All patients completed laparoscopic sleeve gastrectomy successfully. Body weight and BMI of cases in restricted diet group were significantly higher than those in non-restricted diet group, while %EWL was significantly lower at 6 and 12 months postoperatively. In restricted diet group, body weight and BMI of cases in successful subgroup were significantly higher than those in failing subgroup, while %EWL was significantly lower. Conclusions Preoperative eating behavior had much impact on results of bariatric surgery, which could be used as reference for prediction of the results of bariatric surgery. References | Related Articles | Metrics

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Three-port approach for laparoscopic sleeve gastrectomy SHEN Jiahui, YANG Chengcan, WANG Wenyue, ZHANG Yuxiang, XU Hua, LI Kun, DAI Qiancheng, WANG Bing 2018, 23 (06):  515-518.  DOI: 10.16139/j.1007-9610.2018.06.010 Abstract ( 403 )   PDF (587KB) ( 91 )   Objective To preliminarily evaluate the feasibility, safety and short-term clinical efficacy of three-port laparoscopic sleeve gastrectomy (TPLSG). Methods The clinical data of 39 patients performed laparoscopic sleeve gastrectomy (LSG) between January and July 2018 in our hospital were analyzed retrospectively. There were 20 patients with TPLSG and 19 patients with routine five-port LSG. The operative time and blood lost, surgical complications, postoperative pain and hospital stay, percentage of excess weight loss at 3 months postoperatively were compared between TPLSG and LSG. Results Less postoperative pain and reduced postoperative hospital stay in TPLSG group were found when compared with those in LSG group (P<0.05). There was no significant difference in operative time, operative blood loss, surgical complications and percentage of excess weight loss at 3 months postoperatively between two groups (P>0.05). Conclusions TPLSG would be a safe and effective surgical procedure which could accelerate the perioperative recovery and reduce hospital length of stay. References | Related Articles | Metrics

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Graves′ disease with thyroid cancer: a report of 47 cases HUANG Haiyan, KUANG Jie, YING Xiayang, CHEN Xi, YAN Jiqi 2018, 23 (06):  519-522.  DOI: 10.16139/j.1007-9610.2018.06.011 Abstract ( 561 )   PDF (401KB) ( 150 )   Objective To analyze the patients of Graves′ disease with thyroid cancer retrospectively for reference of standardized treatment. Methods Forty-seven patients diagnosed Graves′ disease with thyroid cancer were treated between January 2013 and October 2017. Clinical data, treatments and short outcomes by follow-up were analyzed. Comparison was conducted between 47 cases and thyroid cancer cases without Graves′ disease during same period in our hospital. Results There were 86 cases with Graves′ disease among whom 47(54.7%) were combined with thyroid cancer. It was found that 25 (53.2%) cases with thyroid cancer had Graves′ disease less than 12 months and 11 (23.4%) cases had both 13-48 months and more than 48 months respectively. All 47 cases were performed operations uneventfully. Preoperative potassium iodide was given only 5 cases. No thyroid crisis occurred, and there was no permanent hypoparathyroidism or permanent nerve injury. Only two cases were found cervical lymph node metastasis during the follow-up period of median 14 months. There was no significant difference between the cases with and without Graves′ disease in terms of thyroid microcarcinoma, multifocal tumors and central, lateral lymph node metastasis. Conclusions Graves′ disease with thyroid cancer might not be rare. Increased risk of thyroid cancer was present in patients with shorter course of Graves′ disease. Graves′ disease might not have a significant influence on the aggressiveness of thyroid cancer. The prognosis of thyroid cancer with Graves′ disease is generally favorable. References | Related Articles | Metrics

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Long-term outcome of total parathyroidectomy with autotransplantation in treatment of renal secondary hyperparathyroidism WANG Hongying, HUANG Junwen, ZOU Qiang, CHEN Jing, ZHANG Minmin, ZHANG Weichen, LAO Zhengyin 2018, 23 (06):  523-527.  DOI: 10.16139/j.1007-9610.2018.06.012 Abstract ( 512 )   PDF (507KB) ( 100 )   Objective To explore the long-term outcome of total parathyroidectomy with forearm autotransplantation (TPTX+AT) in the treatment of patients with secondary hyperparathyroidism (SHPT) of renal disease. Methods A total of 124 patients with SHPT were subjected to TPTX+AT from January 1999 to November 2017 and were analyzed. The clinical data including symptom relief, calcium, phosphate and intact parathyroid hormone (iPTH) in serum before and after the surgery were collected. Recurrence rate, persistent hypoparathyroidism and mortality rate were analyzed. Results After operation, symptoms relieved significantly. Calcium, phosphate and iPTH in serum decreased significantly 1 month postoperative when compared those preoperative, and could be maintained well for a long period. It was shown that 10 patients(8.06%) had recurrence, 7 patients(5.64%) had persistent hypoparathyroidism and 19 patients (15.32%) died after follow-up until to May 2018. Conclusions TPTX+AT could be performed to treat patients with SHPT that relieves symptoms effectively and improves calcium and phosphorus metabolism for a long period. Recurrence rate, persistent hypoparathyroidism and mortality might be maintained at a lower level. References | Related Articles | Metrics

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Clinicopathological characteristics and selection of adjuvant treatment by different age in premenopausal breast cancer ZHU Xiaoping, CHEN Xiaosong, YANG Xingxia, ZHU Juanying 2018, 23 (06):  528-532.  DOI: 10.16139/j.1007-9610.2018.06.013 Abstract ( 330 )   PDF (453KB) ( 98 )   Objective To analyze clinicopathological features and selection of adjunctive treatment by different age in premenopausal breast cancer. Methods The data of clinicopathological feature and adjunctive therapy were collected from 571 premenopausal women with breast cancer between January 2009 and December 2016. The patients were divided into 3 groups: 44 cases in group 1, age ≤35, 86 cases in group 2, age 36-40, and 441 cases in group 3, age >40. Clinicopathological feature and adjunctive therapy were compared for the difference among 3 groups. Results It was shown that there were significant differences in body mass index (BMI) and positive HER2 rate among 3 groups (P<0.05). Less patients in group 1 had BMI >25 compared with the patients in other 2 groups. HER2 positive rate of patients in group 1 was 20.45%, much more than in other 2 groups (12.79% in group 2 and 15.87% in group 3). More patients in group 1 selected breast-conserving surgery (22.73%) and sentinel lymph node biopsy (43.18%). There was no statistical difference in postoperative adjunctive chemotherapy, radiotherapy, endocrine therapy and targeted therapy among 3 groups. Less patients in group 3 received ovarian function suppression compared with the other 2 groups(P<0.001). Conclusions It was indicated in this study that patients ≤35 years old with premenopausal breast cancer had lower BMI and higher HER2 positive rate, and they preferred breast-conserving surgery and sentinel lymph node biopsy. References | Related Articles | Metrics

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Impact of trace element supplementation on inflammatory response in postoperative patients with sepsis LI Meiling, LI Lei, ZHANG ruyuan, LIU Jialin, QU Hongping 2018, 23 (06):  533-538.  DOI: 10.16139/j.1007-9610.2018.06.014 Abstract ( 468 )   PDF (642KB) ( 71 )   Objective To evaluate the impact of trace element in postoperative patients with sepsis on inflammatory response. Methods The postoperative patients with sepsis from August 2013 to July 2014 at intensive care unit in our hospital who need intravenous nutrition because of enteral nutrition in 72 hours less than 84 J(20 kal)/(kg·d) were inclu-ded. Concentrations of copper, zinc and iron in serum were detected with atomic absorption spectrophotometry on first day and tenth day. Relation of trace element concentrations to clinical and infection parameters was analyzed. A prospective randomized and controlled study was performed including 40 cases with only intravenous nutrition. Twenty cases were given 10 days of multiple-trace element intravenously 10 mL per day as group of multiple-trace element supplementation (MTES). Results There were 97 in 184 cases with sepsis who coincided with incision criteria enrolled in this study. At first day diagnosed as sepsis 62.89% of cases had iron deficient and 16.49% had zinc deficient. The concentrations of iron and zinc in serum related to APACHE Ⅱ scores negatively with correlation coefficient -0.284 and -0.297, respectively. Concentration of iron in serum related to the better sign time of treatment of infection and the duration of antibiotic treatment negatively (correlation coefficients -0.313 and -0.217, respectively). It was shown in prospective randomized and controlled study that procalcitatonin and C-reactive protein reduced significantly and concentration of serum copper, zinc and iron had trends of increase in MTES group. Concentration of C-reactive protein reduced significantly in MTES group when compared to control group (P=0.006) and fewer cases developed septic shock (25% vs 65%, P=0.011). Conclusions Lower concentrations of zinc and iron in serum were present in postoperative patients with sepsis which related to extent of severity and to the results in treatment of infection. References | Related Articles | Metrics

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Subfascial endoscopic perforator surgery combined with endovenous laser ablation in treatment of lower extremity varicose veins PAN Yuqin, LI Yang, MAO Jieqi, LI Ke, GAN Shujie 2018, 23 (06):  539-541.  DOI: 10.16139/j.1007-9610.2018.06.015 Abstract ( 415 )   PDF (365KB) ( 125 )   Objective To evaluate the feasibility of subfascial endoscopic perforator surgery (SEPS) combined with endovenous laser treatment (EVLT) in treatment of lower extremity varicose vein. Methods A total of 81 limbs with valve insufficiency of venous perforators diagnosed by ascending phlebography from August 2016 to October 2017 were selected including 40 limbs received SEPS combining with EVLT and preservation of greater saphenous vein as study group and 41 limbs received classic stripping of greater saphenous vein with high ligation as control group. Results Varicosities and tributaries of patients in 2 groups were all disappeared with skin pigmentation lightened and ulcer healed. The symptoms did not recur during the period of follow-up from 5 to 11 months. The operation time in study group was less than that in control group (1.1 h vs 3.0 h, P<0.01) and the incision number was less in study group than in control group (2.1 vs 5.8, P<0.01). Decrease in hospital stay (1.1 d vs 3.9 d, P<0.01) and ecchymosis area of lower extremities (5.2 cm2 vs 20.3 cm2, P<0.01) in study group was found when compared those in control group. The difference all had statistical significance. Conclusions SEPS combined with EVLT and preservation of greater saphenous vein in treatment of lower extremity varicose vein would be minimal invasive and recover quickly. References | Related Articles | Metrics

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Succinyl gelatin has effect on thrombin generation HOU Ruijiao, HUANG Chunmei, JIN Shanliang 2018, 23 (06):  542-545.  DOI: 10.16139/j.1007-9610.2018.06.016 Abstract ( 346 )   PDF (450KB) ( 144 )   Objective To investigate the effect of succinyl gelatin （GEL） on thrombin generation and the mechanisms in vitro. Methods Blood samples were obtained from 12 healthy adult volunteers and were diluted with succinyl gelatin (GEL group) and sodium lactated Ringer's solution (LR group). The dilution ratios of citrated blood volume to plasma substitute volume were baseline value, 10∶2, 10∶4 and 10∶6. The effect of GEL and LR on blood coagulation factors and platelet function was studied. Results The blood coagulation factor activity decreased significantly when dilution degree increased in both groups. However, there were no significant differences of blood coagulation factor activity between 2 groups. GEL decreased the expression of platelet P-selectin, while expression of phosphatidylserine, glycoprotein Ⅱb/Ⅲa and platelet volume were not significantly changed in both GEL group and LR group. GEL had also no effect on amount of platelet. Conclusions Gelatin decreased the expression of P-selectin on platelet surface and frustrated the explosion stage of thrombin generation, leading to impairment of velocity and peak of thrombin generation. References | Related Articles | Metrics