Objective:To systematically evaluate the effect of bariatric and metabolic surgery on bone metabolism in obese patients.Methods:Search terms for the present meta-analysis included "bariatric surgery, metabolic surgery, sleeve gastrectomy, gastric bypass, bone metabolic indicators, bone mineral density", both in English and corresponding Chinese. PubMed, WOS, Cochrane, CNKI, and VIP databases were searched for longitudinal studies from the establishment of the database to September 20, 2022. The data on bone mineral density and bone metabolic markers in obese patients before and after bariatric surgery were extracted. RevMan5.4 and Stata17.0 software were used for Meta-analysis.Results:A total of 8 clinical studies with 420 patients were included. The results of the meta-analysis showed that compared with the preoperative baseline, lumbar spine bone mineral density ( WMD=0.05, 95% CI: -0.00~0.1), femoral neck bone mineral density( WMD=0.10, 95% CI: 0.05-0.15), hip bone mineral density( WMD=0.14, 95% CI: 0.10-0.17), and serum vitamin D 3 ( WMD=-4.87, 95% CI: -6.34--3.40)were decreased, while parathyroid hormone ( WMD=10.04, 95% CI: 5.32-14.76) was elevated after surgery. Conclusions:Current evidence demonstrates that metabolic and bariatric surgery can lead to decreased bone mineral density and impairs in bone metabolic markers early after surgery. Roux-en-Y gastric bypass surgery cause more adverse effects on bone metabolism than sleeve gastrectomy. The results imply that all patients undergoing metabolic and bariatric surgery should be monitored for bone metabolism and routinely take vitamin D and calcium supplements.

Objective:To characterize the clinical and epidemiological changes, treatments, and prognoses of primary esophageal small cell carcinoma (PESC). Methods:A retrospective analysis was conducted using the clinical epidemiology data of 529 PESC patients se-lected from the clinical databases of 500,000 esophageal and gastric cardiac carcinomas of the Henan Key Laboratory for Esophageal Cancer Research (1992-2015). Among these patients, 241 cases were included in the survival analysis. The five-year survival rate was calculated using Kaplan-Meier analysis, and the differences in survival rates were compared using the Log-rank analysis model. Re-sults:All 529 PESC cases were analyzed, which accounted for 0.2%of esophageal cancers diagnosed in the same period. The incidence of PESC increased annually (R2=0.574). The survival rates for 1-, 2-, 3-, and 5-year of 241 PESC patients were 55%, 40%, 29%, and 9%, respectively, and the median survival time was 21.9 months. On the basis of the VALSG criteria of lung small cell carcinoma, a statisti-cal difference was observed in the overall survival rates for limited and extensive diseases (P=0.003), with the median survival time of 24.3 and 17.5 months, respectively. Furthermore, significant differences were observed on survival with various treatment modalities (P=0.004). The median survival time of PESC patients treated with combined surgery and radiochemotherapies (28.8 months) was lon-ger than those with either chemotherapy (17.8 months, P=0.015) or chemoradiotherapy (14.5 months, P=0.004). In limited disease pa-tients, the median survival time was longer in patients treated with surgery (27.7 months) than in those without surgery (16.2 months, P=0.007). Notably, the biopsy diagnosis before surgery for PESC was only 40.8%. Conclusion:PESC is a rare malignant carcinoma with increasing incidence. PESC presents poor prognosis, and the survival rate can be improved through combined therapies based on sur-gery. A high misdiagnosis rate for PESC is observed before surgery with biopsy.

Objective To investigate the effect of continuous thoracic paravertebral block anal-gesia guided by sonography on pulmonary function after thoracotomy.Methods Sixty patients,male 29 cases,female 31 cases,aged 18-60 years,BMI 1 6-28 kg/m2 ,ASA grade Ⅰ or Ⅱ,who had under-went thoracotomy were divided randomly into 2 groups,30 cases each:group G with general anesthe-sia and postoperative patient controlled intravenous analgesia (PCIA),whereas group GP with general anesthesia combined with continuous thoracic paravertebral block (CTPVB)and postoperative continuous CTPVB.CTPVB were performed before induction as the patient was conscious so that the effect of CTPVB could be tested by blocking range.Both resting and coughing visual analogue scales (VAS)were recorded at the points of 30 minutes after extubation (T1 ),2 hours after operation (T2 ),6 hours after operation (T3 ),24 hours after operation (T4 )and 48 hours after operation (T5 ). Forced vital capacity (FVC),forced expiratory volume in the first second (FEV1 )and maximal mid expiratory flow (MMF)were measured by spirometer and the three maximal values were recorded at time points of entry of operating room (T0 ),T4 and T5 .Blood gas analysis was employed at corre-sponding time points by a blood gas analyzer and oxygen inhalation was ceased 30 minutes before drawing blood from radial artery.PaCO 2 ,PaO 2 and alveolararterial oxygen difference (PA-a O 2 )were recorded.Adverse effects were observed.Results Compared with group G,VAS when resting and coughing in group GP at T1-T5 decreased significantly (P <0.05).Compared with T0 ,FVC,FEV1 , MMF and PaO 2 at T4 ,T5 in both groups decreased significantly (P <0.05),PA-a O 2 increased signifi-cantly (P <0.05 ).Compared with group G,PaO 2 in group GP at T4 ,T5 increased and PA-a O 2 in group GP at T4 ,T5 decreased significantly (P <0.05).Conclusion CTPVB guided by sonography had excellent effect.It can not only improve pulmonary function after thoracotomy significantly but also promote intrapulmonary oxygenation.

Objective To explore the influence factors of hyperarousal,personality characteristics and coping strategies on the vulnerability to stress-related sleep disturbance.Methods A total of 345 sleep good healthy volunteers were recruited bypurposive sampling technique.Every participant completed an extensive survey that included the general condition questionnaire,Ford Insomnia Response to Stress Test (FIRST),PreSleep Arousal Scale (PSAS),NEO Personality Inventory-Revised (NEOPI-R),Coping Inventory for Stressful Situations (CISS) and Heart Rate Variability(HRV).All participants were classified as High risk group andLow risk group by using the FIRST criterion.Results The high risk group was younger than the low risk group (27.91±8.22 vs 24.82±7.73,P＜0.01),and had a higher percentage of females (34.7％ vs 53.4％,P＜0.05).The high risk group showed significantly higher scores in PSAS total (30.11±6.22),pesleep cognitive arousal (17.73± 4.51),presleep somatic arousal (12.78 ± 3.23),neuroticism (3.13 ± 0.51),emotion oriented (48.98 ± 10.54),but lower score in extraversion (2.96±0.54),then those indicators of the low risk group (28.52±5.82,16.32±4.32,11.41±2.75; 3.11±0.56,2.87±0.47,46.23±11.21,3.11±0.56,P＜0.01 or 0.05).There were significant difference between the two group in LF/HF (1.51 ±0.19 vs 1.17±0.11,P＜0.01),HF((311.21 ±72.32) ms2/Hz vs (490.43 ± 91.74)ms2/Hz,P＜0.01),LF((469.49±85.67)ms2/Hzvs (573.21±98.75) ms2/Hz,P＜0.01) in HRV.Results of linear regression analysis showed that gender,and scores of PSAS total,cognitive arousal,presleep cognitive arousal,presleep somatic arousal,neuroticism,emotion oriented and LF/HF were significant correlation with FIRST score (P＜0.01 or 0.05).Conclusion Presleep cognitive and somatic arousal,neurotic character may be the premorbid characteristics of stress-related sleep disturbance,and bad stress coping strategies are easy to promote the development of insomnia.

Objective:To investigate levels of autophagy in T cells and B cell of patients with systemic lupus erythematosus ( SLE) and its clinical significance.Methods: 68 SLE patients without treatment within 4 weeks were enrolled in this study.We accessed the levels of autophagy in T cells and B cells of 23 healthy controls and 68 patients before and after treatment by flow cytometry,and analyzed their correlations with serum levels of C3 and anti-dsDNA antibodies,SLEDAI score,et al.Results: Before treatment,a significantly increased levels of LC3-Ⅱ was observed in SLE patients than healthy controls, the active group ( SLEDAI score≥10) was significantly higher than the stable group(SLEDAI score<10),and the newly diagnosed group was significantly higher than the recurrent group(all P<0.05).While the levels of LC3-Ⅱ was decreased in B lymphocytes in SLE patients,the active group was significantly lower than stable group,and the active group was significantly lower than the newly diagnosed group(all P<0.05). Correlation analysis found that,a positively correlation was observed for the levels of LC3-Ⅱwith SLEDAI score in T lymphocyte( rs=0.289,P<0.05),and the levels of C3 were positively correlated the levels of LC3-Ⅱ in B lymphocyte(rs=0.371,P<0.01).After treatment for five days, levels of autophagy in T lymphocytes of SLE patients with good prognosis ( SLEDAI score decreased ≥4 ) significantly decreased(P<0.05).Also,three days after treatment,levels of autophagy in B lymphocytes of SLE patients with good prognosis were increased significantly ( P<0.05 ) .However, SLE patients with poor prognosis had no such difference ( P>0.05 ) . Conclusion:Levels of autophagy in T and B lymphocytes of SLE patients are abnormal compared to healthy controls,and these changes are associated with disease activity.Also,these changes are expected to be the indicators of disease activity and potential therapeutic targets in SLE.

ABSTRACT:To improve the ability of correct classification and identification of rodents in different kinds of foci of zoonosis in Ningxia Hui Autonomous Region in China ,rodents samples from different habitats of Ningxia were collected .Sequences of COI gene were amplified and sequenced from 154 samples .Based on these sequences ,the pairwise genetic distance were calcu‐lated ,and a Neighbor Joining tree were constructed .According to the NJ tree ,20 clusters with high bootstrap support were found from 19 morphological species .The striped dwarf hamsters were divided into two clusters ,which suggested that there were two cryptic species with stripe on the back .The pika from Helan Mountain showed close relationship with Ochotona pal‐lasi ,and the genetic distance was as low as 3 .6% .Results show that DNA barcodes could be used to accurately identify speci‐mens of rodents and correct morphological identification errors .It could discover appearance indistinguishable implied species and could better study the classification and evolution of rodents .

This paper analyzed the system,methods,content,scope and standards of last two competition in order to further improve the clinical skills competition for national medical students in China.According to the characteristics of medical education,the paper proposed several opinions and suggestions as follows:repechage should be cancelled in competition system and objective structured clinical examination should be used in competition; the content,scope and criteria of the competition should take the actual ability of the medical students at graduation into consideration.

With the dwindling of fossil fuels supply and the urgent need for the development of low-carbon economy, microalgae bioenergy, both renewable and environmentally friendly, has become one of the worldwide focuses. Given its benefit to the security of national energy supply, microalgae energy is particularly significant for China, with more than 50% crude oil imported and limited arable land for grain and edible oil production. In this article, both the advantages of microalgae bioenergy and the challenges of its development are addressed, which involves fundamental research and technology development as well as commercial production. Furthermore, strategies are proposed for China's microalgae bioenergy development, and its prospects are projected.
Biofuels ; Biotechnology ; methods ; trends ; Conservation of Energy Resources ; methods ; Microalgae ; growth & development ; metabolism

V infection group than in no infection group,while positive rate of other autoantibodies was not statistically different between the two groups.Conclusion Renal EBV infection may involve in the pathogenesis of LN by inducing the production of anti-Sm-Ab.

Objective To study a wavelet method for acquiring the characters of pulse wave based on the principle of wavelet transform which can effectively solve the problem of inaccuracy of the conventional methods. Method The method of wavelet module maximum was used to divide the pulse wave according to periods and basically decomposed it, by arranging in time order and symbolizing the module maximum character points of pulse wave signal at the ascending and descending edges as well as the crest and trough. Result Through the method, the unobvious dicrotism, trail wave and the anomalistic wave appearing at the ascending and descending edge of the main wave, and multi-scale characters and all kinds of characters in time domain of pulse signal were further acquired more accurately. Conclusion Simplicity, quickness and accuracy are achieved by focusing on the character points of pulse signals. It provides a new means for further studies of classification and identification of pulse signals.