Change in Mineral Status After Bariatric Surgery: a Meta-analysis

BACKGROUND

The risk of protein and vitamin deficiencies after bariatric surgery has been well studied, but the change in mineral status has not gotten enough attention. This study aimed to perform a meta-analysis regarding the change in mineral levels after bariatric surgery and the prevalence of postoperative mineral deficiency, with subgroup analyses of different surgical procedures, study regions, and follow-up time.

METHODS

CENTRAL, PubMed, and EMBASE were searched for related articles. Meta-analysis, subgroup analysis, and sensitivity analysis were performed if necessary.

RESULTS

A total of 107 articles with 47,432 patients were included. The most severe mineral deficiency after bariatric surgery was iron (20.1%), followed by zinc (18.3%), copper (14.4%), chlorine (12.2%), phosphorus (7.5%), and calcium (7.4%). Serum concentrations of potassium, sodium, selenium, manganese, and molybdenum showed no significant change before and after surgery. Subgroup analyses revealed that SG had fewer deficiencies in serum iron, calcium, zinc, magnesium, phosphorus, copper, and selenium than RYGB. OAGB showed a higher incidence of serum iron and zinc deficiencies than RYGB. Studies conducted in different regions also found various mineral statuses after surgery. Studies with follow-up ≥ 5 years had a lower prevalence of zinc, copper, and selenium deficiencies than follow-up < 5 years.

CONCLUSION

A high deficiency rate of serum iron, zinc, copper, chlorine, phosphorus, and calcium was seen after bariatric surgery. The difference in surgical procedures, study regions, and follow-up time may affect postoperative mineral status; more targeted mineral supplement programs are needed considering these influencing factors.

Mid-Long-Term Effect of Metabolic Surgery on Type 2 Diabetes in Nonobese Patients: a Meta-analysis

BACKGROUND

This study aimed to perform a meta-analysis regarding the mid-long-term effect (≥ 2-year follow-up) of metabolic surgery on T2DM in non-obese patients.

METHODS

PubMed, EMBASE and CENTRAL databases were searched for clinical studies from inception to March 2023. Stata 12.0 was used for data aggregation. Sensitivity, subgroup, and meta-regression analyses were performed when feasible.

RESULTS

This meta-analysis included 18 articles involving 548 patients. A pooled rate of 47.5% of T2DM remission was found after metabolic surgery. To be more specific, 83.5% was obtained for hemoglobin A1c (HbA1c) < 7.0%, 45.1% for HbA1c < 6.5%, and 40.4% for HbA1c < 6.0%. Subgroup analysis showed that one-anastomosis gastric bypass (OAGB) had a higher remission rate (93.9%) than other surgeries. Studies conducted in America had a higher remission rate (61.4%) than in Asia (43.6%). Meta-regression analysis displayed that publication year, number of patients, study design, preoperative age, BMI, and quality assessment score were not significantly associated with T2DM remission rate. Additionally, metabolic surgery could result in significant reductions in BMI (-4.133 kg/m2), weight (-9.874 kg), HbA1c (-1.939%), fasting blood glucose, fasting C-peptide, and fasting insulin. However, metabolic surgery seemed to have poorer glycemic control in non-obese than obese T2DM patients.

CONCLUSION

A moderate mid-long-term effect of T2DM remission was observed after metabolic surgery in non-obese patients. However, we still need more prospective multi-institutional studies using the same definitions for diabetes and the same surgical technique for the surgery. Without this, the exact role of bariatric surgery in non-obese patients is unanswered.

Long-Term Results of Bariatric Surgery in Adolescents with at Least 5 Years of Follow-up: a Systematic Review and Meta-Analysis

OBJECTS

The purpose of this study was to investigate the long-term outcomes of bariatric surgery in adolescents with obesity by including studies with a follow-up of at least 5 years.

METHODS

PubMed, EMBASE, and CENTRAL were systematically searched. Studies that met the criteria were included in the analysis.

RESULT

We identified 29 cohort studies with a total population of 4970. Preoperative age ranged from 12 to 21 years; body mass index (BMI) ranged from 38.9 to 58.5 kg/m². Females were the predominant gender (60.3%). After at least 5-year of follow-up, the pooled BMI decline was 13.09 kg/m² (95%CI 11.75-14.43), with sleeve gastrectomy (SG) was 15.27 kg/m², Roux-en-Y gastric bypass (RYGB) was 12.86 kg/m², and adjustable gastric banding (AGB) was 7.64 kg/m². The combined remission rates of type 2 diabetes mellitus (T2DM), dyslipidemia, hypertension (HTN), obstructive sleep apnea (OSA), and asthma were 90.0%, 76.6%, 80.7%, 80.8%, and 92.5%, (95%CI 83.2-95.6, 62.0-88.9, 71.5-88.8, 36.4-100, and 48.5-100), respectively. Postoperative complications were underreported. Combined with the current study, we found a low level of postoperative complications. Iron and vitamin B12 deficiencies were the main nutritional deficiency complications identified so far.

CONCLUSION

For adolescents with severe obesity, bariatric surgery (especially RYGB and SG) is the independent and effective treatment option. After at least 5 years of follow-up, bariatric surgery in adolescents showed a desirable reduction in BMI and significant remission of T2DM, dyslipidemia, and HTN. Surgical and nutrition-related complications still need to be further explored by more long-term studies.

Need assessment for history-taking instruction program using chatbot for nursing students: A qualitative study using focus group interviews

Purpose

A comprehensive health history contributes to identifying the most appropriate interventions and care priorities. However, history-taking is challenging to learn and develop for most nursing students. Chatbot was suggested by students to be used in history-taking training. Still, there is a lack of clarity regarding the needs of nursing students in these programs. This study aimed to explore nursing students' needs and essential components of chatbot-based history-taking instruction program.

Methods

This was a qualitative study. Four focus groups, with a total of 22 nursing students, were recruited. Colaizzi's phenomenological methodology was used to analyze the qualitative data generated from the focus group discussions.

Results

Three main themes and 12 subthemes emerged. The main themes included limitations of clinical practice for history-taking, perceptions of chatbot used in history-taking instruction programs, and the need for history-taking instruction programs using chatbot. Students had limitations in clinical practice for history-taking. When developing chatbot-based history-taking instruction programs, the development should reflect students' needs, including feedback from the chatbot system, diverse clinical situations, chances to practice nontechnical skills, a form of chatbot (i.e., humanoid robots or cyborgs), the role of teachers (i.e., sharing experience and providing advice) and training before the clinical practice.

Conclusion

Nursing students had limitations in clinical practice for history-taking and high expectations for chatbot-based history-taking instruction programs.

lncRNA PCGEM1 Regulates the Progress of Colorectal Cancer through Targeting miR-129-5p/SOX4

Prostate cancer gene expression marker 1 (PCGEM1) has abnormal expression level in a variety of malignant tumor. However, the relationship between PCGEM1 and colorectal cancer is still unclear yet. This study is aimed at identifying the role of PCGEM1 in colorectal cancer. qRT-PCR was used to examine the expressions of the expression of lncRNA PCGEM1 and SOX4 in CRC tissues and cell lines. The biological functions of lncRNA PCGEM1 and SOX4 were examined by CCK-8 assay, Transwell assay, immunohistochemistry, western blotting, RNA interference, and gene overexpression techniques. Bioinformatics analysis was used to find the potential downstream molecule of PCGEM1 and miR-129-5p. The relationship between PCGEM1, miR-129-5p, and SOX4 was assessed by dual luciferase activity assay. We found that PCGEM1 is overexpressed in colorectal cancer cells and tissues, while miR-129-5p is underexpressed. SOX4 is overexpressed in colorectal cancer cells and tissues. Functionally, PCGEM1 silencing can significantly inhibit the proliferation, invasion, and migration of colorectal cancer cells. Mechanically, PCGEM1 acted as a sponge for miR-129-5p and absorbed its expression, and miR-129-5p was found to target SOX4, constructing the axis of PCGEM1/miR-129-5p/SOX4 in colorectal cancer. In conclusion, PCGEM1 mediates the proliferation, invasion, and migration of colorectal cancer cells by targeting miR-129-5p/SOX4 axis.

Nursing Students' Perceptions of Using Virtual Patients to Prepare for Clinical Practice

BACKGROUND

Educators are called on to provide opportunities for students to practice and integrate skills and knowledge to ensure preparation for the complexities of today's health care environment. This study explored nursing students' perceptions of using virtual patients to prepare for clinical practice.

METHOD

This study used an exploratory qualitative design. Four focus group interviews were conducted with 25 third-year nursing students. Data were collected and analyzed using thematic content analysis.

RESULTS

Four main themes and eight subthemes emerged. Main themes included personal engagement, learning environment, organizational factors, and improvement needed. Subthemes included being a computer game player, becoming confident in clinical practice, convenient to practice, an authentic stressful learning environment, organization, better to be combined with mannequin-based simulation, technology difficulties, and aural factors.

CONCLUSION

Although some perceived disadvantages were identified, the use of virtual patients could be an effective strategy to improve nursing students' preparation for clinical preparation. [J Nurs Educ. 2022;61(7):398-402.].

Increases in Future AR Count and Size: Overview of the ARTMIP Tier 2 CMIP5/6 Experiment

The Atmospheric River (AR) Tracking Method Intercomparison Project (ARTMIP) is a community effort to systematically assess how the uncertainties from AR detectors (ARDTs) impact our scientific understanding of ARs. This study describes the ARTMIP Tier 2 experimental design and initial results using the Coupled Model Intercomparison Project (CMIP) Phases 5 and 6 multi-model ensembles. We show that AR statistics from a given ARDT in CMIP5/6 historical simulations compare remarkably well with the MERRA-2 reanalysis. In CMIP5/6 future simulations, most ARDTs project a global increase in AR frequency, counts, and sizes, especially along the western coastlines of the Pacific and Atlantic oceans. We find that the choice of ARDT is the dominant contributor to the uncertainty in projected AR frequency when compared with model choice. These results imply that new projects investigating future changes in ARs should explicitly consider ARDT uncertainty as a core part of the experimental design.

The Effect of Peer Support on Individuals with Overweight and Obesity: A Meta-Analysis

Background: Scarce data exists about the effect of peer support on individuals with overweight or obesity. This study aimed to conduct a meta-analysis regarding the effect of peer support on weight, BMI, waist circumference, blood pressure, quality of life, social support and depressive symptoms in individuals with overweight and obesity. Methods: PubMed, Embase, and CENTRAL were searched for relevant studies from their inceptions to 1 Mar 2020, and 14 randomized controlled trials (RCTS) were included. Data were pooled with Review Manager 5.3. Results: Significantly small improvement in weight (-0.78 kg) was found in individuals who received peer support than those who received usual care (MD= -0.78 kg, 95% CI-1.33 to -0.22, P=0.02). And peer support appeared to be associated with significant decrease in BMI levels (MD= -0.16 kg/m2, 95% CI -0.32 to -0.01, P=0.04). However, there was no statistically significant improvement in the levels of waist circumference, systolic blood pressure, diastolic blood pressure, quality of life, social support and depressive symptoms after peer support. Conclusion: Peer support appears to be associated with decreased weight and BMI levels in individuals with overweight and obesity. However, additional research is warranted due to insufficient evidence for the effects of peer support on the other health indicators.

The effect of dispatch of national medical teams to Wuhan on its control and prevention of COVID-19

Objectives

As a unique prevention and control measure, the dispatch of national medical teams to Wuhan has played a key role in protecting Wuhan against COVID-19. This study aimed to quantitatively evaluate the effect of this key measure in reducing infections and fatalities.

Study design

A scenario analysis is used in this study, where the forming of scenarios is on the basis of the stages of medical to Wuhan. We divided the evaluation into 4 scenarios: Scenario Ⅰ—no dispatch, Scenario Ⅱ—dispatch of 4599 medical staff, Scenario Ⅲ—dispatch of 16,000 staff, and Scenario Ⅳ—dispatch of 32,000 staff.

Methods

The extended Susceptible-Exposed-Infectious-Recovered-Death model was adopted to quantify the effect of the dispatch of national medical teams to Wuhan on COVID-19 prevention and control.

Results

The dispatch dramatically cuts the channels for the transmission of the virus and succeeds in raising the cure rates while reducing the fatality rates. If there were no dispatch at all, a cumulative total of 158,881 confirmed cases, 18,700 fatalities and a fatality rate of 11.77% would have occurred in Wuhan, which are 3.2 times, 4.8 times and 1.5 times the real figures respectively. The dispatch has avoided 108,541 confirmed cases and 14,831 fatalities in this city.

Conclusions

The proven successful measure provides valuable experience and enlightenment to international cooperation on prevention and control of COVID-19, as well as a similar outbreak of new emerging infectious diseases.

Bile acid, glucose, lipid profile, and liver enzyme changes in prediabetic patients 1 year after sleeve gastrectomy

Background

Few articles have studied individuals with prediabetes after sleeve gastrectomy. Bile acid and lipid levels remain inconsistent in postbariatric patients. The purpose of this study was to explore bile acid, glucose, lipid, and liver enzyme changes in patients with different diabetes statuses who underwent sleeve gastrectomy. The impact of bariatric surgery and its potential benefits for prediabetic patients was also discussed.

Methods

A total of 202 overweight and obese patients who underwent bariatric surgery in our hospital between January 2016 and October 2018 were retrospectively reviewed. Patients were divided into prediabetes (n = 32), nondiabetes (n = 144), and diabetes (n = 26) groups and analysed. Glucose and lipid data were collected from medical records at baseline and at each follow-up visit.

Result

Significant improvements in body weight, glucose and lipid levels, and liver enzymes (P ≤ 0.05) in prediabetic patients were found throughout the first year postoperatively. Improvement in glycaemic control was first seen one month postoperatively, followed by persistent improvement in the next 12 months. Total bile acid (TBA) decreased, which was associated with ALT improvement in prediabetic patients 1-year post-surgery. There were no significant differences in HbA1c, glucose, or triglycerides (TGs) between prediabetic and T2DM patients or between prediabetic and nondiabetic patients at 12 months post-surgery.

Conclusion

LSG is highly effective at interfering with glucose and lipid levels as well as total bile acid levels in prediabetic patients in the first year postoperatively. Thus, LSG is indeed an alternative for overweight and obese prediabetic patients.

Bioinformatic Identification of Hub Genes and Analysis of Prognostic Values in Colorectal Cancer

The purpose of this study is to discover novel hub genes which are helpful for diagnosis, prognosis, and targeted therapy in colorectal cancer (CRC) by using bioinformatics analysis. GSE74602, GSE110225, and GSE113513 were extracted from the gene expression omnibus (GEO). Differentially expressed genes (DEGs) in expression profiles were identified by GEO2R. Gene ontology and Kyoto Encyclopedia of Genes and Genomes analyses of the DEGs were carried out in the Database for Annotation, Visualization, and Integrated Discovery (DAVID). String database and cytoscape were used for building protein-protein interaction (PPI) network and module analysis. The UALCAN was used for in-depth analysis of data of CRC patients from The Cancer Genome Atlas (TCGA) to identify expression levels and overall survival rates of hub genes. The DEGs included 107 up-regulation genes and 232 down-regulation genes. Twenty-nine (29) hub genes and two significant modules were screened from PPI network. The expression levels of hub genes in TCGA were verified. Survival analysis curve indicated high expression of CCNA2, CCNB1, DLGAP5, were related to high survival rates, and low expression of TIMP1 were associated with high survival rates. These results suggest that DEGs may be the hub genes of CRC, and CCNA2, CCNB1, DLGAP5, TIMP1 may be the potential prognostic markers of CRC.

Different surgical techniques that influenced internal hernia prevalence rate after laparoscopic roux-en-Y gastric bypass: a retrospective analysis of 331 cases

BACKGROUND

Internal hernia (IH) is a serious complication following laparoscopic Roux-en-Y gastric bypass (LRYGB), and closure of mesenteric defect has been recommended to reduce this complication. But what kind of material about suture and how to close the mesenteric defects were still controversial. The main aim of this study was to compare the incidence rate of internal hernia after LRYGB between patients with different surgical techniques.

METHOD

Three hundred and thirty-one patients underwent LRYGB between June 2004 and December 2017 in one single institute were retrospective analysed. The IH rate was evaluated according to different surgical methods and surgical materials before and 12 months after LRYGB.

RESULTS

All the cases were subdivided into three groups based on the suturing method, Roux limb position, and Suture material. The mean follow up time was 36 ± 12 months, and the total incident rate of IH was 1.8% (n = 6). In the six IH cases, the duration of IH occurred time ranged from 1 month to 36 months postoperatively, and for the IH sites, one for intestinal defect, three for transverse mesocolon defect and two Peterson defect respectively. There was a significant difference about IH rate between interrupted suture and running suture groups (p = 0.011), and there were no significant differences between the other two groups.

CONCLUSION

Compare with interrupted suture, running suture may prevent IH after LRYGB. Patient's gender, age, body mass index(BMI), glycometabolism condition, and Roux limb position and suture material had no effects on the IH prevalence after LRYGB.

[Voxel-based morphometry study of the brain structures in patients with congenital hereditary hearing loss]

Objective: To analyze the physiological basics for changes of cerebral functions in patients with congenital hereditary hearing loss (CHHL), by using voxel-based morphometry (VBM). Methods: From June 2016 to June 2017, we recruited volunteers from Yangzhou Special Education School and CHHL patients from the Department of Otorhinolaryngology, Subei People's Hospital as a case group with a total of 14 cases (8 males and 6 females), with an average age from 10 to 18 (13.13 ± 0.39). At the same time,patients with no ear diseases were recruited as a control group, a total of 23 cases (10 males and 13 females), with an average age from 10 to18 (13.50 ± 0.49). Brain scanning with resting state functional magnetic resonance imaging was performed on all subjects, and 3D T1WI was collected and processed by the analyzing software. Two sample t-tests were conducted with alphasim correction at the threshold level of P<0.001. Different morphologies of cerebral cortex were identified between patients with CHHL and their normal controls retrospectively. Results: Compared to their normal controls, patients with CHHL had no significant difference in terms of brain volume, gray matter volume, white matter volume, and cerebrospinal fluid volume ((1 397.53±103.98)cm(3) vs. (1 439.45±128.84)cm(3), (765.19±60.27)cm(3) vs. (800.139±77.64)cm(3), (392.89±40.38)cm(3) vs. (414.54±49.22)cm(3), (314.17±25.81)cm(3) vs. (296.47±51.42)cm(3), all P>0.05). However, compared to their normal controls, patients with CHHL had significantly increased (P<0.001) gray matter in the following cerebral gyri: right temporal pole: middle temporal gyrus, right inferior temporal gyrus, left middle occipital gyrus, right inferior parietal gyrus, and left middle frontal gyrus, left superior occipital gyrus, right superior frontal gyrus, and left superior frontal gyrus. Furthermore, compared to their normal controls, patients with CHHL had significantly decreased (P<0.001) gray matter in the following cerebral gyri: left parahippocampal gyrus, right fusiform gyrus, right middle frontal gyrus, left inferior temporal gyrus, right middle occipital gyrus, left insula, right inferior frontal gyrus, left precentral gyrus, and right superior parietal gyrus. Conclusions: Patients with CHHL show global changes in cerebral cortex not limited to auditory associated cerebral areas. This suggests that adaptable reshaping of global brain structures and functions has occurred in patients with CHHL.

EFFECTS OF EXENDIN-4 ON ENDOPLASMIC RETICULUM STRESS-MEDIATED INSULIN RESISTANCE IN 3T3-L1 ADIPOCYTES

Objective

Endoplasmic reticulum stress (ERS) is suspected as an important factor in the initiation of insulin resistance.

Aim

To explore the effects of exendin-4 (Ex-4) on the endoplasmic reticulum stress (ERS)-mediated insulin resistance in 3T3-L1 adipocytes. In our study, 3T3-L1 adipocytes were pre-treated with ERS inhibitors tauroursodeoxycholic acid (TUDCA), Ex-4 and an ERS inducer tunicamycin (TM) then induced insulin resistance. Glucose consumption of the adipocytes was measured. Western blots determined the protein levels of ERS markers and insulin signaling pathway.

Results

TM treatment reduced insulin-stimulated glucose consumption by 19.7% in 3T3-L1 adipocytes. This repression was blunted by 24h pre-treatment with TUDCA or Ex-4. Ex-4 augmented insulin-stimulated glucose consumption in adipocytes by 14.9%. Western blotting showed that TM treatment significantly increased the ER stress markers including p-IRE, p-JNK, p-PERK, p-eIF2a and ATF6 expression, whereas 24h pre-treatment of adipocytes with TUDCA or Ex-4 alleviated the ER stress. Ex-4 alleviates ERS-induced insulin resistance by upregulating the expression of phosphorylated Akt.

Conclusion

ERs mediates insulin resistance in 3T3-L1 adipocytes, and exendin-4 significantly improves this insulin resistance.

[Comparative analysis of sleep monitoring between young and middle-aged and elderly OSA patients]

Objective:The aim of this study is to compare the night sleep hypoxia degree and sleep structure of young and middle-aged and elderly patients with OSA, so that PSG has more important application value.Method:A total of 438 patients diagnosed with OSA from February 2017 to January 2019 were selected,including 119 patients in the youth group with an average age of (28.5±5.1）years,and 319 patients in the middle and elderly group with an average age of (45.8±2.7)years.The results recorded by PSG in the two groups were retrospectively analyzed. Result:①The AHI, ODI, OAI, MAI and ASaO₂of OSA patients in the junior group were significantly higher than those in the middle-aged and elderly group, while CAI was not statistically significant between the two groups (P=0.419).②The NREM stage Ⅰ (61.1±4.3)% in the junior group was significantly higher than that in the junior group (53.3±3.4)%.NREM stage Ⅱ (33.2±2.3)% and NREM stage Ⅲ+Ⅳ (4.3±1.3)% in the junior group were higher than those in the middle-aged group (29.2±3.9)% and stage Ⅲ+Ⅳ (2.6±0.9)%, while the percentage of REM stage and microarousal index were not statistically significant between the two groups.③Young OSA patients were associated with hypertension and 47.0% middle-aged and elderly patients were associated with hypertension.There was no statistical difference between the two groups in whether hypertension was associated with hypertension or not.Conclusion:The NREM phase is particularly susceptible to age, and age affects slow wave sleep. The sleep structure of middle-aged and older people demonstrates their sleep characteristics: reduced total sleep time,slow wave sleep,low sleep efficiency,and delayed sleep. The young people's nighttime hypoxia is more serious. AHI,ODI,OAI,MAI,ASaO₂ and other indicators are significantly higher than the middle-aged and elderly people, but the sleep structure 2 groups are similar, indicating that young people have strong sleep physiological compensation and Adjustment ability.

A novel circular RNA hsa_circ_0008035 contributes to gastric cancer tumorigenesis through targeting the miR-375/YBX1 axis

Circular RNAs (circRNAs) play an important regulatory role in a variety of human cancers, including gastric cancer. The mechanisms for the circRNAs in gastric cancers are not fully understood. This study aims to uncover the mechanism by which circRNAs regulate gastric cancer tumorigenesis. Among the microarray data, we screened dysregulated circRNAs and identified an up-regulated circRNA, hsa_circ_0008035. Functionally, the hsa_circ_0008035 silencing by the siRNA transfection inhibited the proliferation and invasion of gastric cancer cells. Mechanically, hsa_circ_0008035 acted as a sponge for the miR-375 and absorbed its expression, and miR-375 was found to target YBX1 3'-UTR, constructing a hsa_circ_0008035/miR-375/YBX1 axis. Taken together, these findings are evidence that circRNA hsa_circ_0008035 promotes gastric cancer cell proliferation and invasion by regulating miR-375/YBX1.

[Study on the correlation between meteorological factors and allergic rhinitis in outpatients in Yangzhou]

Objective:To investigate the characteristics of allergic rhinitis in Yangzhou area and its correlation with meteorological factors. Method:The characteristics of 17 491 cases of AR were analyzed in Yangzhou from 2015 to 2017. Meteorological environmental parameters, including mean temperature, air pressure, wind speed, humidity and AQI index, were monitored at the same period. The relationship between the onset characteristics of AR patients and meteorological factors was also analyzed. Result:The number of patients with allergic rhinitis in 2015, 2016 and 2017 were 6 167, 5 620 and 5 704. The total difference of the number of patients in 3 years was not statistically significant (P＞0.05). Each year the number of patients reached the peak in October, April, the lowest in February, and less than the other seasons in the summer (P<0.05). The number of visits per year reached peak in October, the lowest in February, and significantly less in summer than in other seasons (P<0.05). The number of children under the age of 12 is relatively small, and the number of patients aged 20 to 40 is the largest. In different age groups, the number of male patients was higher than that of women. There was a positive correlation between the average temperature and AQI index of the average allergic rhinitis patients(r=0.635, P=0.027; r=0.587, P=0.045), and the average temperature and average humidity of the patients with average allergic rhinitis were negatively correlated with regional average humidity and average wind speed(r=-0.193, P=0.045; r=-0.862, P=0.000). Conclusion:The incidence of allergic rhinitis in Yangzhou area has obvious age regularity and seasonality, and there may be some correlation between meteorological factors(especially AQI index) and the incidence of allergic rhinitis in patients.

[Analysis of the recurrence related factors of sinonasal inverted papilloma]

Objective:To evaluate the influence risk factors of recurrence and the methods for reducing recurrence of sinonasal inverted papilloma (SNIP). Method:Clinical data of 34 patients with SNIP were analyzed retrospectively. All of them were unilateral onset. The diagnosis was confirmed pathologically and the range of lesions was determined by endoscopic and imaging examination; clinical classification according to Krouse classification method; All operations were performed under nasal endoscope, of which 20 cases were operated by simple nasal endoscope, and 14 cases were operated by endoscopic anterior lacrimal recess approach. The patients were followed up for 12-36 months. The curative effects were observed and the prognostic factors of the patients were analyzed. Result:Thirty-four cases of SNIP patients with postoperative recurrence rate was 17.65% (6/34); simple nasal endoscopic surgery in 20 cases, the recurrence rate was 25.00%(5/20); endoscopic anterior lacrimal recess approach in 14 cases, the recurrence rate was 7.14%(1/14), the difference was statistically insignificant (χ²=1.807, P>0.05). Four cases in stage Ⅰ had no recurrence；20 cases in stage Ⅱ, the recurrence rate was 15.0%(3/20); 9 cases in stage Ⅲ, the recurrence rate was 33.3%(3/9); 1 case in stage Ⅳ had no recurrence, the recurrence rate of the patients with different stages were statistically insignificant (χ²=2.692, P>0.05). Conclusion:Simple endoscopic resection of the tumor and endoscopic anterior lacrimal recess surgery are effective methods for the treatment of SNIP. The nasal surgery history and tumor origin are the risk factors for recurrence. The operation completely tumorresection,detailed preoperative examination and postoperative regular endoscopic examination are the keys to preventing recurrence.

[Two cases of piriform pit carcinoma were repaired with thyroid lobe]

Two cases with piriform fossa cancer underwent larynx lateral wall repair surgery. Case 1: The patient was admitted to the hospital because of pharyngeal discomfort with swallowing pain for 2 months Electronic laryngoscopy revealed neoplasm in the left piriform fossa. Space occupying lesion in left piriform fossa and paranasal space was found in MRI scan. The pathological diagnosis of this patient was squamous cell squamous cell carcinoma (T2N1M0). Case 2: The patient was admitted to the hospital because of blood in the sputum for more than 1 year. The electronic laryngoscope suggested neoplasm in the pharyngeal space and left vocal cord paralysis.Soft tissue thickening of the oropharynx and hypopharyngeal right wall was found in MRI scan. The pathological diagnosis of this patient was squamous cell carcinoma (T1N2M0).

Laparoscopic metabolic surgery for the treatment of type 2 diabetes in Asia: a scoping review and evidence-based analysis

Background

Laparoscopic metabolic surgery has been previously shown to be an effective treatment for obese patients with type 2 diabetes (T2DM). The objective of this scoping review is to determine the impact of metabolic surgery for the treatment of type 2 diabetes in Asia and perform an evidence-based analysis.

Methods

We performed a literature search in PubMed for research on laparoscopic metabolic surgery for the treatment of T2DM in Asia region. We classified the included studies based on the Oxford Center for Evidence Based Medicine guidelines. And performed and evidence analysis.

Results

In total, 205 articles were identified. 62.9% of the studies were from East Asia. The evidence of 26 studies are level I, 59 are level II. Laparoscopic sleeve gastrectomy (LSG) was the most commonly reported surgical procedure (63.1%) in Asia. The number of laparoscopic metabolic surgery for T2DM in Asian countries has increased rapidly over the last 8 years. We identified 16 studies which showed that laparoscopic metabolic surgery is an effective and safe treatment for T2DM in patients with a BMI of > 25 kg/m² to < 35 kg/m² in Asia.

Conclusions

Our results suggest that laparoscopic metabolic surgery might be an effective and safe treatment for T2DM patients with BMI < 35 kg/m², and that LSG is the most commonly performed surgical procedure for this in Asia.

Effect of Bariatric Surgery on Thyroid Function in Obese Patients: a Systematic Review and Meta-Analysis

We aimed to make a meta-analysis regarding the effect of bariatric surgery on thyroid function in obese patients. PubMed, EMBASE, CENTRAL, and four Chinese databases were searched for clinical studies. Data were pooled using Review Manager 5.3, and subgroup and sensitivity analyses were performed if necessary and feasible. As a result, 24 articles were included into meta-analysis. Bariatric surgery was associated with significant decrease in TSH, FT3, and T3 levels. However, FT4, T4, and rT3 levels were not significantly changed postoperatively. In addition, bariatric surgery had a favorable effect on overt and subclinical hypothyroid, with reduction of thyroid hormone requirements postoperatively. In conclusion, TSH, FT3, and T3 decrease are expected following bariatric surgery, as well as non-significant change of T4, FT4, and rT3 levels.

[Hypoglossal nerve stimulation therapy for obstructive sleep apnea hypopnea syndrome]

Obstructive sleep apnea hypopnea syndrome(OSAHS) is a clinical and critical disease to health, which the accuratly pathogenesis is not very explicit. The mainstream research suggested that dysfunction of upper airway dilator muscles is one of the hazard factors. Genioglossus innervated by the hypoglossal nerve plays crucial roles. It could expand volume of pharyngeal cavity, and increase airflow rate when stimulate it.With the development of anatomy and physiology, hypoglossal nerve stimulation(HGNS) entered into clinical trials, and had made tremendous progress since 2001. Most of clinical trials show that, it could dramatically improve the smooth general peculiarity of the upper respiratory tract in patients with OSAHS in the sleeping state.

[Prognostic factors of patients with T2N0M0 upper tract urothelial carcinoma: a single-center retrospective study of 235 patients]

OBJECTIVE

To evaluate the impacts of the prognostic factors of T2N0M0 upper tract urothelial carcinoma (UTUC) for Chinese patients.

METHODS

A retrospective study was conducted including 235 patients who were diagnosed with T2N0M0 UTUC in our hospital and received radical nephroureterectomy (RNU) or partial ureterectomy during January 2000 and December 2013. The 3 and 5-year cancer-specific survival rates and bladder recurrence-free survival rates of all the patients were valued using Kaplan-Meier method, and the survival curves with statistical significance between the two were compared using the Log-rank test. Variables with significant differences in the univariate analysis were subjected to the multivariate analysis by Cox regression model.

RESULTS

A total of 235 patients were included in this study, including 95 (40.4%) male patients and 140 (59.6%) female patients. The mean age was 66.73±10.49 years.The median follow-up time was 53 (rang: 3-142) months, and during the follow-up, 74 (31.5%) patients died of UTUC after a median of 35 months,and 96 (40.9%) patients developed intravesical recurrence after a median of 19.5 months. The 3 and 5-year cancer-specific survival rates of all the patients were 89.1% and 85.9%, respectively; the bladder recurrence-free survival rates were 85.5% and 80.2%, respectively. The independent prognostic factors of cancer-specific mortality were tumor age elder than 55 years (HR=3.138, 95%CI: 1.348-7.306, P=0.008) and diameter larger than 5 cm (HR=3.320, 95%CI: 1.882-5.857, P<0.001). The independent prognostic factors of bladder recurrence-free survival were ureter tumor (HR=1.757, 95%CI: 1.159-2.664, P=0.008) and lower tumor grade (HR=1.760, 95% CI: 1.151-2.692, P=0.009).

CONCLUSION

T2N0M0 UTUC has a better cancer-specific survival. The intravesical recurrence was equivalent to non-muscle invasive UTUC but earlier. The tumor diameter larger than 5 cm and the patient age elder than 55 years were independently associated with cancer-specific mortality; the primary tumor located in ureter and lower tumor grade were more likely to develop intravesical recurrence.

Early diagnosis and outcome prediction of neonatal hypoxic-ischemic encephalopathy with color Doppler ultrasound

PURPOSE

To describe the ultrasound presentation of the brain and cerebral hemodynamics in neonates with hypoxic-ischemic encephalopathy (HIE) by comparison with control subjects.

MATERIAL AND METHODS

During June 2012 to April 2013, full term neonates who had clinical evidence of HIE were enrolled. Healthy newborns without HIE were used as a control group. Cerebral parenchyma, size of lateral ventricles and hemodynamic parameters of cerebral arteries were studied using two-dimensional duplex and color Doppler ultrasound. Neonates with moderate and severe HIE were followed-up with ultrasound for at least 3 months.

RESULTS

A total of 158 consecutive neonates (82 boys and 76 girls), including 54 with mild HIE, 60 with moderate HIE and 44 with severe HIE were included. One hundred and twenty healthy newborns were randomly selected as a control group. Abnormal ultrasound findings of brain parenchyma were found in 25/54 (46.3%) neonates with mild HIE whereas they were found in 58/60 (96.7%) neonates with moderate HIE and 44/44 (100%) neonates with severe HIE. Almost all neonates with severe HIE had decreased cerebral artery blood flow velocity and increased resistance index of cerebral arteries. Of the 104 neonates with moderate or severe HIE, follow-up ultrasound examination revealed cystic parenchymal lesions in 12/104 (11.5%), progressive ventricular dilatation and brain atrophy in 12/104 (11.5%), mild ventricular dilatation in 15/104 (14.4%) and leukoencephalomalacia in 2/104 (1.9%) neonates.

CONCLUSION

Ultrasound features such as the size of lateral ventricles, altered brain parenchymal echogenicity and cerebral blood flow parameters are useful for the early diagnosis of HIE and help predict outcome.

[A case of nasopharyngeal inflammatory myofibroblastic tumorafter radiotherapy of nasopharyngeal carcinoma]

Inflammatory myofibroblastic tumor（IMT）is composed of the cable shape myofibroblastic cells which constitute soft tissue tumors.IMT is mostly encountered in the lung, its occurrence in the head and neck is relatively rare. Herein, we reported 1 case of IMT after radiotherapy of nasopharyngeal carcinoma(NPC)in the nasopharynx.The clinical symptoms and nasal pharynx imaging findings of IMT are similar to the NPC.Thus,the pathological and immunohistochemistrical examinations maybe helpful to make a correct diagnosis.

Broadband photonic microwave phase shifter based on controlling two RF modulation sidebands via a Fourier-domain optical processor

An all-optical photonic microwave phase shifter that can realize a continuous 360° phase shift over a wide frequency range is presented. It is based on the new concept of controlling the amplitude and phase of the two RF modulation sidebands via a Fourier-domain optical processor. The operating frequency range of the phase shifter is largely increased compared to the previously reported Fourier-domain optical processor based phase shifter that uses only one RF modulation sideband. This is due to the extension of the lower RF operating frequency by designing the amplitude and phase of one of the RF modulation sidebands while the other sideband is designed to realize the required RF signal phase shift. The two-sideband amplitude-and-phase-control based photonic microwave phase shifter has a simple structure as it only requires a single laser source, a phase modulator, a Fourier-domain optical processor and a single photodetector. Investigation on the bandwidth limitation problem in the conventional Fourier-domain optical processor based phase shifter is presented. Comparisons between the measured phase shifter output RF amplitude and phase responses with theory, which show excellent agreement, are also presented for the first time. Experimental results demonstrate the full -180° to + 180° phase shift with little RF signal amplitude variation of less than 3 dB and with a phase deviation of less than 4° over a 7.5 GHz to 26.5 GHz frequency range, and the phase shifter exhibits a long term stable performance.

Mode-multiplexed transmission over conventional graded-index multimode fibers

We present experimental results for combined mode-multiplexed and wavelength multiplexed transmission over conventional graded-index multimode fibers. We use mode-selective photonic lanterns as mode couplers to precisely excite a subset of the modes of the multimode fiber and additionally to compensate for the differential group delay between the excited modes. Spatial mode filters are added to suppress undesired higher order modes. We transmit 30-Gbaud QPSK signals over 60 WDM channels, 3 spatial modes, and 2 polarizations, reaching a distance of 310 km based on a 44.3 km long span. We also report about transmission experiments over 6 spatial modes for a 17-km single-span experiment. The results indicate that multimode fibers support scalable mode-division multiplexing approaches, where modes can be added over time if desired. Also the results indicate that mode-multiplexed transmission distance over 300 km are possible in conventional multimode fibers.

Impact of early adolescent psychiatric and personality disorder on long-term physical health: a 20-year longitudinal follow-up study

BACKGROUND

Evidence regarding the long-term separate and combined impact of adolescent psychiatric disorder and personality disorder (PD) on physical health is absent.

METHOD

A total of 736 people randomly selected in childhood were contacted for home or telephone interviews four times over 20 years. DSM Axis I disorders and Axis II PDs were assessed at mean age 13.7 years in 1983 and physical health was assessed in 1985-1986, 1991-1994 and 2001-2004.

RESULTS

Comparisons were made between 506 adolescents without Axis I disorder or PD and adolescents with Axis I disorder or PD or both. Adolescents with an Axis I disorder (n=150) had significantly higher odds of pain and physical illness and poorer physical health. Adolescents with a PD (n=149) had higher odds of pain and physical illness and poorer physical health and a more rapid decline in physical health. In addition, the 81 participants with an Axis I disorder without co-morbid PD had poorer physical health, but this effect did not reach statistical significance, whereas the 80 participants with a PD but no Axis I disorder reported significantly more pain and more rapid decline in physical health. However, the 69 participants with co-morbid Axis I disorder and PD had the highest rates of pain and physical illness and the worst physical health.

CONCLUSIONS

Co-morbid PD accounted for many of the associations of adolescent Axis I disorder with physical health over the ensuing two decades. Co-morbid adolescent Axis I disorder and PD represent a particularly high risk for physical health.

Study on the fluorescence properties of a new intramolecular charge transfer compound 1,5-diphenyl-3-(N-ethylcarbazole-3-yl)-2-pyrazoline

The fluorescence properties of a newly synthesized compound, 1,5-diphenyl-3-(N-ethylcarbazole-3-yl)-2-pyrazoline (DEP) have been studied. On excitation at 352 nm, the fluorescence spectrum exhibits a large red shift with an increase in the polarity of solvents. The intensity of the band is different in different solvents as well. The change in the dipole moment in various solvents at room temperature has been characterized by the absorption and steady state fluorescence techniques and calculated based on the Lippert-Mataga equation. DEP has an increase of dipole moment of 2.83 D units on excitation to the lowest singlet state. It is concluded that photo-induced charge transfer from N (1) to C (3) actually exists in the excited state of the pyrazoline moiety. Its fluorescence property is relative to viscosity and temperature of solvents. The phi(f) of DEP in neutral medium or basic medium is higher than acidic medium. In addition, when the concentration of DEP is higher than 10(-3) M, its fluorescence is quenched by the collision of each molecule. The red shift of the maximum emission of DEP attributes to the formation of aggregates and the conjugate system is strengthened.

Effect of one-step 100% ethanol fixation and modified manual microdissection on high-quality RNA recovery from esophageal carcinoma specimen

This paper attempts to determine an optimal fixation protocol for stabilizing RNA during microdissection so as to obtain high-quality RNA from specific cell populations procured from esophageal carcinoma specimens, and to develop a manual microdissection that can facilitate the procurement. The special features of our protocol include one-step dehydration of tissue sections in 100% ethanol immediately after cryosectioning, a self-made T-shape plate (T plate) and "exclusion microdissection" procedure. The quality of RNA isolated from dissected cells was analyzed by neutral agarose gel electrophoresis and reverse transcription-polymerase chain reaction (RT-PCR) to detect genes of different abundance levels. One-step 100% ethanol fixation of cryosections effectively stabilized RNA integrity for agelong period of time while maintaining histological morphology comparable to that using the conventional procedure, indicating that it is a valid protocol for preservation of RNA in microdissected samples. In conjunction with the application of the T plate and 'exclusion microdissection' procedure, which efficiently simplifies manual microdissection procedure, allowing maximal procurement of target cells from complex primary tissues, full use of every single specimen for maximal procurement of target cells from the sections was allowed. The RNA isolated from 5 different stage-specific cell populations of an esophageal carcinoma specimen was of high quality and sufficient in quantity for various downstream molecular analyses. Our method is suitable for a wide spectrum of expression analysis in diverse clinical settings.

[Study on apoptosis of fibroblasts from abnormal scars in media containing low level of serum and interleukin 1 beta]

OBJECTIVE

To investigate the effects of low serum and interleukin 1 beta on inducing apoptosis of fibroblasts from abnormal scars and normal skins.

METHODS

6 samples from keloid, hypertrophic scar and normal skin were collected respectively. Apoptosis of different fibroblasts in media containing low level of serum and interleukin 1 beta were studied by detecting Bax and Bcl-2 protein expressions and specific DNA ladder by means of cell culture, immunohistochemistry and agrose electrophoresis.

RESULTS

1. In low level of serum, hardly occurs apoptosis of fibroblasts from keloids in correspondence with no changes of the radio of Bax/Bcl-2 proteins, and apoptosis of fibroblasts from normal skins occurs in correspondence with increasing of the radio of Bax/Bcl-2 proteins, whereas, slightly occurs apoptosis of fibroblasts from hypertrophic scars in correspondence with no change of the radio of Bax/Bcl-2 proteins. 2. In media containing interleukin 1 beta apoptosis of all three kinds of fibroblasts occurs, whereas, apoptosis of fibroblasts from keloids and hypertrophic scars takes place more seriously than that from normal skins in correspondence with increasing of the Bax/Bcl-2 radio of fibroblasts from keloids, decreasing of the Bax/Bcl-2 radio of ones from normal skins and no change of the Bax/Bcl-2 radio of ones from hypertrophic scars.

CONCLUSION

Characters of different fibroblasts are different.

Evidence that the death receptor DR4 is a DNA damage-inducible, p53-regulated gene

DR4 (TRAIL-R1), a member of the tumor necrosis factor receptor superfamily, is a cell surface receptor that triggers the apoptotic machinery upon binding to its ligand tumor necrosis factor-related apoptosis-inducing ligand (TRAIL). Although three other TRAIL receptors DR5, DcR1, and DcR2 are induced by DNA damage and are regulated by the wild-type p53 tumor suppressor, it was not known whether these factors also affect DR4 expression. In this study, we found that DR4 expression is also enhanced by DNA damage whether induced by ionizing radiation or by chemotherapeutic agents. The induction was observed predominantly in cells containing wild-type p53 and was similar to the regulation patterns of DR5 and Fas, two other members of the family which are known to be regulated by p53. Transfection of HPV 16 E6 gene into cells with wild-type p53, which decreased the level of p53 protein, resulted in suppression of DR4 induction by DNA-damaging agents. Conversely, introduction of exogenous wild-type p53 through adenovirus infection has led to upregulation of endogenous DR4 in cells with mutant p53. Moreover, the transcription inhibitor actinomycin D abolished DNA-damaging agent-induced DR4 expression. Thus, DR4 appears to be a DNA damage-inducible, p53-regulated gene.

[Study on type I and type III procollagen mRNA and in situ collagen proteins expressions in hypertrophic scars after intralesional Kenalog treatment]

OBJECTIVE

This is to investigate the mechanism of effects of Kenalog on type I and III collagen syntheses and degradation in hypertrophic scars.

METHODS

Intralesional injection of Kenalog was performed on 6 patients with hypertrophic scars. On the 3rd day and 7th day after the treatment, 6 samples from the 6 patients each were collected and type I and III collagen proteins and in situ procollagen mRNA expressions were studied by means of immunohistochemistry and molecular biology.

RESULTS

On the 7th day after intralesional injection of Kenalog, type I collagen proteins reduced (P < 0.05) and type III collagen proteins did not reduced significantly (P > 0.05). On the 3rd day after intralesional injection of Kenalog, both type I and type III procollagen mRNA expressions were significantly inhibited and on the 7th day both procollagen mRNA expressions decreased further.

CONCLUSIONS

Intralesional Kenalog may inhibit type I procollagen mRNA expression more than type III. Gene expressive intensions of type I and III procollagen were higher in hypertrophic scars than in normal skin.

Biochemical and genetic interactions between Drosophila caspases and the proapoptotic genes rpr, hid, and grim

In Drosophila melanogaster, the induction of apoptosis requires three closely linked genes, reaper (rpr), head involution defective (hid), and grim. The products of these genes induce apoptosis by activating a caspase pathway. Two very similar Drosophila caspases, DCP-1 and drICE, have been previously identified. We now show that DCP-1 has a substrate specificity that is remarkably similar to those of human caspase 3 and Caenorhabditis elegans CED-3, suggesting that DCP-1 is a death effector caspase. drICE and DCP-1 have similar yet different enzymatic specificities. Although expression of either in cultured cells induces apoptosis, neither protein was able to induce DNA fragmentation in Drosophila SL2 cells. Ectopic expression of a truncated form of dcp-1 (DeltaN-dcp-1) in the developing Drosophila retina under an eye-specific promoter resulted in a small and rough eye phenotype, whereas expression of the full-length dcp-1 (fl-dcp-1) had little effect. On the other hand, expression of either full-length drICE (fl-drICE) or truncated drICE (DeltaN-drICE) in the retina showed no obvious eye phenotype. Although active DCP-1 protein cleaves full-length DCP-1 and full-length drICE in vitro, GMR-DeltaN-dcp-1 did not enhance the eye phenotype of GMR-fl-dcp-1 or GMR-fl-drICE flies. Significantly, GMR-rpr and GMR-grim, but not GMR-hid, dramatically enhanced the eye phenotype of GMR-fl-dcp-1 flies. These results indicate that Reaper and Grim, but not HID, can activate DCP-1 in vivo.

[Study on in situ expression of type I and III procollagen mRNAs in different parts of keloid and normal skin]

OBJECTIVE

Based on the histomorphologic differences of three parts of keloid, i.e., invasive, proliferative and senile regions, the study was carried out to explore the differences of expression of type I and type III procollagen mRNAs in the three different parts of keloid and normal skin.

METHOD

Four samples of keloid from four patients and two samples of normal skin were collected. The expression of pro alpha 1 (I) and pro alpha 1 (III) procollagen mRNAs in keloid and normal skin was investigated by in situ hybridization techniques.

RESULT

Both type I and III procollagen mRNAs levels increased in keloid, especially type I, resulting in elevated ratios of type I to III procollagen mRNA. In keloid, expressive intention of type I and type III procollagen mRNAs was higher in the papillary layer than in the reticular layer. Also the expressive intention of type I and type III in keloid was higher in invasive and proliferative regions than in the senile region. However, expressive intention of type I and type III procollagen mRNAs in the invasive region of keloid was similar to that in the proliferative region.

CONCLUSION

The differences of expression of type I and type III procollagen mRNAs in different pathological regions of keloid and normal skin is one cause of forming different pathological regions in keloid.

[Treatment of thoracolumbar tuberculosis complicated with paraplegia]

OBJECTIVE

To explore characteristics of thoracolumbar tuberculosis complicated with paraplegia, relationship between efficacy and approach of operation, and to discuss indication and applicability of conservative treatment.

METHOD

Forty-eight cases with thoracolumbar tuberculosis complicated with paraplegia were classified into two groups. Thirty-two cases in the operational group were treated with extrapleural, extraperitoneal approach and transpleural, extraperitoneal approach. Sixteen cases in the nonoperational group were treated conservatively.

RESULT

The recovered cases in the operational and the nonoperational groups respectively accounted for 75% and 88%.

CONCLUSION

Thoracolumbar tuberculosis complicated with paraplegia can be cured by either operative or conservative treatment, and the efficacy of operation directly related with operational approach.