ABCC8,KCNJ11,and GLUD1 gene mutations were investigated in a male patient with congenital hyperinsulinism and his parents were also investigated.A 1484 G＞A mutation was found in the 10th exon of ABCC8 gene in the patient,which leads to amino acid substitution at the 495 residue of the sulphonylurea receptor SUR1 protein.The patient's father also carried the same heterozygous inactive mutation,while the genotype of the mother was normal,indicating that the gene mutation of the patient was paternally inherited.According to that mutation,it is deduced that the patient may suffer from the focal type of congenital hyperinsulinism.

At present, the formal bariatric surgery approved by the American Society for Metabolic and Bariatric Surgery (ASMBS) includes adjustable gastric banding (AGB), sleeve gastrectomy (Sleeve gastrectomy, SG). ), Roux-en-Y gastric bypass (Roux-en-Y gastric bypass, RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), mini gastric bypass (Mini-gastric bypass, MGB), single anastomosis gastric bypass (OAGB) and partial endoscopic surgery. According to the Chinese Society for Metabolic and Bariatric Surgery (CSMBS), the Chinese Obesity and Metabolic Surgery Database (COMES Database), and the Chinese Obesity and Metabolic Surgery Database (COMES Database), the Chinese Society for Metabolic and Bariatric Surgery (CSMBS) Chinese Obesity and Metabolic Surgery Collaborative, COMES Collaborative), Shanghai Weight Loss and Diabetes Surgery Data Management System, Shandong Province Weight Loss and Metabolic Surgery Case Registration System, Jiangsu Province Weight Loss and Metabolic Surgery Data Registration System, Great North China Weight Loss and Metabolic Surgery Statistics from the clinical data database and the Greater China Weight Loss and Metabolic Surgery Database. The domestically developed and approved bariatric surgery methods include RYGB, SG, MGB, OAGB, BPD-DS, AGB, combined sleeve gastrectomy (SG Plus), Jejunoileal Bypass (Jejunoileal Bypass, JJB), single stoma duodenal transposition (SADI-S), intragastric balloon (Balloon). However, there are still some irregular bariatric surgeries in China, which will cause some uncommon complications and bring great pain to patients. At the same time, it is also a huge challenge for regular bariatric surgeons who perform corrective surgeries. This article will review the revision surgery after bariatric surgery in China in the past 20 years, discusses a series of problems caused by non-standard bariatric surgery and the development of regular bariatric surgery.

Objective To investigate the effect of Zhali Nusi Recipe ( ZNR) on hemorheological parameters, blood - lipid metabolism, the activities of superoxide dismutase ( SOD) and glutathione peroxidase ( GSH-Px) , and the content of malondialdehyde (MDA) in brain tissues of cerebral ischemia-reperfusion rats with the syndrome of phlegm blended with blood stasis. Methods Ninety rats were randomly divided into sham operation group, model group, nimodiping (10.8 mg/kg) group, high-, middle- and low-dose ZNR groups ( in the dosage of 30, 15, 7.5 g/kg, respectively) , 15 rats in each group. Except the sham operation group, the other groups were given intragastric administration of intralipid for 4 weeks, and then were induced into focal cerebral ischemia-reperfusion by middle cerebral artery occlusion with thread-obstruction method. After post-operation medication for 7 days, the rat general situations, the neurological deficiency symptoms, and the water content in brain tissues were observed. The morphological features of brain tissues were observed after HE staining. The blood was taken from the ab dominal aorta to detect the hemorheological parameters and blood lipid levels. Metabolic levels of free radicals in the brain tissue homogenate were also determined. Results Compared with the sham operation group, neurological deficiency scores of the rats and the water content in the brain tissues of model group were significantly enhanced. The hippocampal neurons of model rats presented typical ischemic changes. In the model group, the hemorheological parameters such as whole blood viscosity, plasma viscosity, hematocrit ( HCT) , and erythrocyte aggregation in dexes ( EAI) were significantly increased, and erythrocyte deformation indexes were significantly decreased; the serum levels of total cholesterol ( TC) , triglyceride ( TG) , low-density lipoprotein cholesterol (LDL-C) were significantly increased, and high-density lipoprotein cholesterol ( HDL-C) level was significantly decreased; the activities of SOD and GSH-Px in brain tissues were significantly decreased, and MDA content was increased significantly ( P<0.05 or P<0.01). Compared with the model group, high-, middle-and low-dose ZNR improved the general situations of the cerebral ischemia-reperfusion rats, increased the neurological deficiency scores, reduced the water content in brain tissues, improved the recovery of morphology of cells in cerebral ischemia tissues, reduced whole blood viscosity, plasma viscosity, HCT and EAI of the model rats, promoted erythrocyte deformation indexes, decreased serum TG, TC, LDL-C levels, increased the activities of SOD and GSH-Px in cerebral ischemic tissues, and sig nificantly decreased MDA content (P<0.05 or P<0.01). And high-dose ZNR had the best effect. Conclusion ZNR has certain protective effect on cerebral ischemia-reperfusion rats with the syndrome of phlegm blended with blood stasis, and the mechanism may be closely related with the improvement ofhemorheology, blood lipid and free radical metabolism in model rats.

Objectives To explore the relationship between illness perceptions and health behavior in the subjects. Methods Revised illness perception questionnaire and health promoting lifestyle profileⅡ (HPLPⅡ) were used to measure 101 patients′illness perception and health behavior between the groups. Results The HPLPⅡscore of LEAD was(2.17 ± 0.29) with the score of dimension. The course of disease, prognosis and perception of emotion were negatively related to health behaviour; personal control and primaty congtion of drsease were postively related to health behaviour (all P<0.01). Conclusion Medical personnel should pay attention to the relationship between illness perceptions and health behavior in patients with LEAD and effective measures should be taken to improve the patients′illness perceptions, promote their choices and persistence in health behavior and improve the quality of life.

Objective To study the effects of butylphthalide (NBP) on memory and apoptosis related protein as well as neuronal pathology in hippocampus of vascular dementia (VD) rats. Methods VD model was generated by the permanent occlusion of bilateral common carotid arteries in SD rats to produce the forebran ischemia. Male SD rats were randomly allocated into sham-operation group, VD model group, NBP treatment group and nimodipine treatment group. The function of memory was tested by the Morris water maze. The neuronal pathological changes and the expression of Bcl-2 and Bax proteins in the hippocampus were observed with hematoxylin-eosin (HE) staining and immunohistochemical staining, respectively. Results The impaired memory of VD rats was proved by the lengthened mean escape latency [(78.79±21.93)vs.(16.96±7.44),P＜0.05] and the neuron in hippocampus was severely damaged. The decveased ratio of Bcl-2/Bax resulted from the overexpression of Bax proteins in VD model group versus the sham-operation group [(43.00±6.72)vs.(6.00±1.29),P＜0.05]. The treatment of NBP notably improved the memory function of VD rats and reduced the hippocampus pathological injury (P＜0.05). The expression of Bcl-2 protein raised [(33.14±8.05)vs.(21.81±4.97),P＜0.05] along with reduced expression of Bax protein [(32.93±4.99)vs.(43.00±6.72),P＜0.05] after NBP treatment. However, there was no significant difference in the treatment effects between nimodipine and NBP group (P＞0.05). Conclusions NBP treatment could improve memory of VD rats and reduce the hippocampus pathological lesion by inhibiting the apoptosis related protein.

Objective To investigate early and differential diagnosis of Alzheimer disease and vascular dementia (VD)using FDG-PET scan. Methods Clinical data was collected from AD,VD and normal control(NC). 18F-2-fluo-ro-deoxy-D-glucose(18F-FDG)PET scan was conducted to detect the cerebral FDG metabolism. The average standard uptake value (SUV) of cerebral regions was expressed as semiquantitative index relative to ipsilateral cerebellum. Re-sults There were no differences in age and the mean total scores of the mini mental status examination (MMSE) between patients with VD and those with AD.The AD group showed that the SUV was significantly decreased in the right frontal, parietal,temporal lobe,hippocampus,temporo-parietal junction,and bilateral posterior cingulate cortex compared to the VD and in the bilateral posterior cingulate cortex,temporo-parietal junction,frontal and temporal lobe comparing to the NC(P≤0.01). SUV was significantly increased in the right parietal,posterior cingulate cortex and hippocampus whereas was significantly decreased in the left frontal lobe,temporo-parietal junction and thalamus in the VD compared with NC group(P≤0.01). Conclusion AD patients have typical features of 18F-FDG PET which may be helpful for the diagnosis of AD in the early stage.

Objective:To explore the difference of brain structure between patients with early-onset depression with and without suicidal ideation and its relationship with the severity of depression.Methods:Totally 37 patients with early-onset depressive disorder with suicidal ideation and 23 patients with early-onset depressive disorder without suicidal ideation were examined by psychological assessment and magnetic resonance imaging(MRI)from 2019 to 2020.Voxel-based morphometry (VBM) technology was used to compare the differences in brain structure between the two groups of subjects, and further analyze the relationship between the gray matter volume of the different brain areas and the severity of depression. The demographic and clinical data were analyzed by SPSS 24.0 statistical software package. The comparison between the two groups was performed by double sample t-test and chi square test. SPM8 software was used for VBM statistical analysis, and double sample t test was used for image analysis and comparison between the two groups. Pearson correlation analysis was performed between the mean gray matter volume of the two groups and the scores of HAMD-17 and Beck scale for suicide ideation(BSI). Results:Compared with the group without suicide ideation, the volume of gray matter in the right middle frontal gyrus(MNI: x, y, z=28.5, 33.0, 43.5, FWE correction for mass level, P<0.05)and left angular gyrus of the suicide idea group increased(MNI: x, y, z=-37.5, -73.5, 48.0, FWE correction for mass level, P<0.05). There was no significant correlation between the gray matter volume of the right middle frontal gyrus and the HAMD-17 scale, BSI scale in patients with early-onset depression ( r=0.073, r=-0.153, both P>0.05). Conclusion:There are structural differences in the right middle frontal gyrus and left angular gyrus between patients with early-onset depression with suicidal ideation and patients with early-onset depression without suicidal ideation, and there was no significant correlation between gray matter volume and depression severity.

Objective To evaluate the application value of dual-source CT coronary angiography in low tube voltage setting and the influence of heart rate on image quality and radiation doses.Methods 323 patients suspected of coronary artery disease received retrospective ECG-gating coronary angiography with dual-source CT scanner,who were divided into low tube voltage group (100 kVp,n =201) and conventional voltage group (120 kVp,E group,n =122).No beta-blockers were taken before CT scan.All patients in low tube voltage group were divided into four groups according to the heart rate (HR):group A,HR≤59 beats per minute (bpm),n =50; group B,60≤HR ＜69 bpm,n =64; group C,70≤HR ＜91bpm,n =62;group D,HR ≥ 91 bpm,n =25.All images were transferred to a workstation for further processing.The best R-R interval reconstruction images of all groups were evaluated.The value of pitch,CT volume dosage index(CTDIvol),dose length product(DLP) and effective dose(E)were recorded.The pitch,the score of imaging quality of coronary artery segments and the radiation dose were compared with One-Way ANOVA.The influence of heart rate on image quality and radiation doses of coronary artery was analyzed.Results The value of pitch in groups A-D was 0.24 ± 0.03,0.29 ± 0.04,0.33 ± 0.05,0.38 ± 0.06,respectively,with statistical difference (F =62.57,P ＜ 0.05).The value of CTDIvol in groups A-E was (21.59±7.97),(20.24±6.03),(18.23±7.55),(18.14 ±5.75),(38.62±16.21)mGy,respectively,with statistical difference (F =85.16,P ＜ 0.05).The value of E in group A-E was (5.31 ±2.18),(4.85 ±1.70),(4.49 ± 1.86),(4.37 ±1.50),(8.75 ± 4.07) mSv,respectively,with statistical difference(F =44.83,P ＜ 0.05).The image score was (4.65 ±0.46),(4.55 ± 0.53),(4.55 ±0.53),(4.47 ±0.72),(4.66 ± 0.44) (F =1.89,P ＞ 0.05).Conclusions No beta-blockers was taken before CT scan,and a high quality image could be acquired by using dual-source CT coronary angiography in low tube voltage setting(100 kVp).When the auto ECG-gating is selected,medium and low HR have little influences on radiation dose,while the radiation dose could be decreased significantly at higher HR,but the possibility to obtain the high quality image decreased.

Objective To investigate the combined detection of serum cancer antigen(CEA)blank,carbohydrate antigen 125 (CA125)and cytokeratin 19 fragment(CYFRA21-1),neuron specific enolase(NSE)in the diagnosis of solitary pulmonary nodules. Methods 150 cases of patients with solitary pulmonary nodules diagnosed in our hospital from January 2015 to March 2017 were selected as the research subjects,including 51 lung cancer patients(Lung Cancer Group)and 51 benign lung disease patients(benign group).60 healthy people in the same period were selected as control group.The serum levels of CEA,CA125,CYFRA21-1 and NSE were detected in three groups of patients,and the clinical value of the combined detection of various indexes in the differential diagnosis of solitary pulmonary nodules was analyzed.Results The serum levels of CEA,CA125,CYFRA21-1 and NSE in patients with lung cancer were significantly higher than those in the benign and control groups(P<0.05);The sensitivity of CEA,CA125, CYFRA21-1 and NSE in differential diagnosis of malignant solitary pulmonary nodules was 32.32%,27.27%,33.33% and 40.40%,respectively.The specificity was 62.75%,52.94%,60.78%,70.59,respectively;The sensitivity of CEA + NSE+ CY-FRA21-1+CA125 in the differential diagnosis of malignant solitary pulmonary nodules was 81.82%,the specificity was 88.24%, the rate of missed diagnosis was 18.18%,the misdiagnosis rate was 11.76%,the positive predictive value was 93.10%,and the negative predictive value was 71.43%.Conclusion The combined detection of serum CEA,CA125,CYFRA21-1 and NSE has im-portant clinical value in the differential diagnosis of malignant solitary pulmonary nodules.

Objective To observe the change of MR perfusion value in patients with hepatocellular carcinoma (HCC) before and after transcatheter arterial chemoembolization (TACE). Methods A total of 22 patients with HCC underwent MR perfusion weighted imaging (MR PWI) before TACE and 3-10 days after TACE. The mean time to enhance (MTE), negative enhancement integral (NEI), time to peak (TTP) and maximum slope of decrease (MSD) before and after TACE were acquired and compared. Results The time intension curve (TIC) of HCC region was observed to descend rapidly before TACE, while descended slowly after TACE. The value of MTE and TTP after TACE were lower than those before TACE (P<0.05), and the value of NEI after TACE was higher than that before TACE (P<0.05). The value of MSD after TACE were lower than that before TACE, but no statistical significance was found (P>0.05). Conclusion MR PWI is a very sensitive imaging technique that be used to monitor blood flow changes of HCC before and after TACE and evaluate efficacy of TACE.