Objective Recent studies have found that Roux-en-Y gastric bypass( RYGB) can inhibit the levels of blood glucose in type 2 diabetes,but its mechanism still remains unknown. In present study,we observed the effect of RYGB on insulin and GLP-1of type 2 diabetes mice. Methods The 12-week-old male SD rats were divided into four groups:group A ( no surgery,normal diet) ,Group B ( no surgery,DM diet+STZ injection) ,group C ( gastric bypass surgery+normal diet) ,group D ( gastric bypass surgery+DM diet+STZ injection) . One week after surgery rehabilitation,the diabetes model was built by STZ ( revulsant of the classical diabetes model) and high-fat-control diet. After four months,the changes of blood glucose,OGTT,body weight,food intake,water intake in each group were examined. Furthermore,the patho-logical changes of insulin and pancreatic were detected by HE staining. Meanwhile,the liver PEPCK gene and protein expression were detec-ted by using RT-PCR and Western blot. Results Four groups of rats all have significant changes in diet and weight. HE staining suggests the disseminated hyperemia and edema in pancreas and showed that islet has been severe damaged. Compared with no treatment normal diet,nor-mal rat+DM diet+STZ injection,has a markedly elevated blood glucose level 3 days later,insulin,OGTT,GLP,and ITT all have remarkable changes in different time periods,with a statistically significance (P<0. 05). Compared with the normal rat+DM diet+STZ injection group, RYGB + DM diet+ STZ injection group showed that these indicators of pancreas pathological changes significantly,glucose,insulin,OGTT, GLP,ITT all have significantly drop,as well as the gene and protein expression of PEPCK (P<0. 05). Conclusion RYGB can exert influ-ence on the change of insulin,OGTT,GLP,ITT and PEPCK in islets of type 2 diabetes rats,which may play a positive role in the further clini-cal applications.

Objective:To explore the effect of different diagnostic criteria on occupational noise-induced deafness (Onid) , and to provide theoretical basis for the revision of ONID diagnostic criteria.Methods:From January 2016 to January 2018, the physical examination results of noise-exposed workers during occupational health examination in Qingyuan Occupational Disease Prevention and Treatment Hospital were retrospectively investigated in September 2019, with Gbz 49-2014《diagnosis of occupational noise deafness》as the study object, 471 workers suspected of Onid were weighted with different combinations of high frequency hearing threshold, and the better ear weight was calculated, compared with the diagnostic criteria of 2007 and 2014, the degree of hearing loss was evaluated. SPSS 22.0 was used for statistical analysis, χ 2 test was used for counting data, and non-parametric test was used for measuring bias data. Results:The average age of 471 subjects was (40.32±7.01) years, and the average age of exposure to noise was (7.11±3.44) years. On the basis of the 2007 edition diagnostic standard, the suspected ONID diagnostic rate of different high frequency auditory threshold was increased by 16.35% and 30.15% at 3.0 kHz, 6.0 kHz increased by 20.17%, 3.0 kHz+4.0 kHz increased by 22.29%, 3.0 kHz+6.0 kHz increased by 17.20%, 4.0 kHz+6.0 kHz increased by 25.27%, the differences were statistically significant ( P<0.05) , the frequency of 3.0 kHz+4.0 kHz+6.0 kHz increased by 22.29%. Using the 2014 edition diagnostic standard, the diagnostic rate of Onid was reduced by 30.15% and 13.80%, 6 kHz is 9.98% lower, 3.0 kHz+4.0 kHz is 7.86% lower, 3.0 kHz+6.0 kHz is 12.95% lower, 4.0 kHz+6.0 is 4.88% lower, the high frequency of 3.0 kHz+4.0 kHz+6.0 kHz decreased by 7.86%, the differences were statistically significant ( P<0.05) . Conclusion:The diagnosis rate of suspected Onid is increased by weighting different high frequency hearing threshold, in which the weighted 4kHz high frequency has the greatest influence on the result, and the weighted 3 kHz high frequency has the least.

Objective:To explore the effect of different diagnostic criteria on occupational noise-induced deafness (Onid) , and to provide theoretical basis for the revision of ONID diagnostic criteria.Methods:From January 2016 to January 2018, the physical examination results of noise-exposed workers during occupational health examination in Qingyuan Occupational Disease Prevention and Treatment Hospital were retrospectively investigated in September 2019, with Gbz 49-2014《diagnosis of occupational noise deafness》as the study object, 471 workers suspected of Onid were weighted with different combinations of high frequency hearing threshold, and the better ear weight was calculated, compared with the diagnostic criteria of 2007 and 2014, the degree of hearing loss was evaluated. SPSS 22.0 was used for statistical analysis, χ 2 test was used for counting data, and non-parametric test was used for measuring bias data. Results:The average age of 471 subjects was (40.32±7.01) years, and the average age of exposure to noise was (7.11±3.44) years. On the basis of the 2007 edition diagnostic standard, the suspected ONID diagnostic rate of different high frequency auditory threshold was increased by 16.35% and 30.15% at 3.0 kHz, 6.0 kHz increased by 20.17%, 3.0 kHz+4.0 kHz increased by 22.29%, 3.0 kHz+6.0 kHz increased by 17.20%, 4.0 kHz+6.0 kHz increased by 25.27%, the differences were statistically significant ( P<0.05) , the frequency of 3.0 kHz+4.0 kHz+6.0 kHz increased by 22.29%. Using the 2014 edition diagnostic standard, the diagnostic rate of Onid was reduced by 30.15% and 13.80%, 6 kHz is 9.98% lower, 3.0 kHz+4.0 kHz is 7.86% lower, 3.0 kHz+6.0 kHz is 12.95% lower, 4.0 kHz+6.0 is 4.88% lower, the high frequency of 3.0 kHz+4.0 kHz+6.0 kHz decreased by 7.86%, the differences were statistically significant ( P<0.05) . Conclusion:The diagnosis rate of suspected Onid is increased by weighting different high frequency hearing threshold, in which the weighted 4kHz high frequency has the greatest influence on the result, and the weighted 3 kHz high frequency has the least.

Objective:To evaluate the effect of esketamine combined with ultrasound-guided dorsal penile nerve block (DPNB) on negative postoperative behavioral changes (NPOBCs) in pediatric patients undergoing circumcision under general anesthesia.Methods:One-hundred and ninety-five pediatric patients, aged 4-8 yr, with body mass index of 10-35 kg, of American Society of Anesthesiologists Physical Status classificationⅠ or Ⅱ, undergoing elective circumcision under general anesthesia, were selected and divided into 3 groups ( n=65 each) using a random number table method: esketamine group (group E), DPNB group (group D) and esketamine combined with DPNB group (group ED). Propofol 1.5 mg/kg was intravenously injected, and the patients were admitted to the operating room after consciousness disappeared in the 3 groups. Esketamine 0.5 mg/kg was intravenously injected in E and ED groups, and the equal volume of normal saline was given in group D. D and ED groups underwent bilateral DPNB with 0.25 % ropivacaine 0.15 ml/kg under ultrasound guidance, with the maximum total amount of the drug not exceeding 10 ml. Fentanyl 1.0 μg/kg and propofol 2.0 mg/kg were intravenously injected prior to the skin incision in the three groups. If intraoperative body movement occurred, propofol 10 mg was added, which could be repeated. The occurrence of intraoperative body movement, respiratory depression and amount of propofol added was recorded. When postoperative pain (FLACC score >4) occurred, flurbiprofen 1 mg/kg was intravenously injected for analgesia, and the usage of flurbiprofen was recorded. When emergence agitation(PEAD score>10) occurred, propofol 1 mg/kg was intravenously injected for sedation, and the occurrence of emergence agitation was recorded. Parents were followed up by telephone at 1, 7 and 30 days postoperatively to assess the occurrence of NPOBCs using the PHBQ scale. Results:Fifty-six patients in group E and 59 patients in D and ED groups finally completed the study.Compared with group E, the incidence of intraoperative body movement was significantly decreased, the amount of additional propofol was reduced, the emergence agitation score, incidence of emergence agitation and severe agitation and usage rate of postoperative flurbiprofen were decreased, and the incidence of separation anxiety at 7 and 30 days postoperatively was decreased in D and ED groups, and the incidence of intraoperative respiratory depression was significantly decreased, and the incidence of NPOBCs at 7 and 30 days postoperatively was decreased in group ED ( P<0.05). Compared with group D, the incidence of intraoperative respiratory depression was significantly decreased, the amount of additional propofol was decreased, the usage rate of postoperative flurbiprofen and incidence of sleep anxiety at 1 day postoperatively were decreased ( P<0.05), and no significant change was found in the incidence of NPOBCs at each time point after operation in group ED ( P>0.05). Conclusions:Esketamine combined with ultrasound-guided DPNB can reduce the occurrence of NPOBCs in pediatric patients undergoing circumcision under general anesthesia.