With the development of social economy and changes of lifestyle, obesity has become a very prominent social problem. Obesity and its-related metabolic diseases such as hypertension and diabetes can promote the occurrence and development of kidney disease, and eventually lead to end-stage renal disease.. Kidney transplantation is the most effective treatment, but obesity increases the risk of surgical complications and poor outcomes. Hence obesity is considered a contraindication for kidney transplantation, as the benefits for obese patients are limited. Therefore, it becomes particularly important for obese patients to gain sufficient weight loss before kidney transplantation, which is not only related to whether transplant candidates are eligible for transplantation, but also the subsequent graft survival rate. Weight loss surgery can help obese patients achieve a significant amount of weight loss more quickly than traditional weight loss methods. In recent years, more and more scholars have applied bariatric surgery to the field of kidney transplantation. Research results have shown that bariatric surgery can improve the transplantation eligibility of kidney transplantation candidates with obesity, increase the survival rate of grafts and the lifetime of patients. Moreover, bariatric surgery can improve kidney function in patients with end-stage renal disease, thereby eliminating the need for kidney transplantation. At present, there is no any literature on the application of bariatric surgery in the field of kidney transplantation in China. This article reviews the current status and prospect of bariatric surgery in the field of kidney transplantation so as to provide reference for clinical practice.

With the development of social economy and changes of lifestyle, obesity has become a very prominent social problem. Obesity and its-related metabolic diseases such as hypertension and diabetes can promote the occurrence and development of kidney disease, and eventually lead to end-stage renal disease.. Kidney transplantation is the most effective treatment, but obesity increases the risk of surgical complications and poor outcomes. Hence obesity is considered a contraindication for kidney transplantation, as the benefits for obese patients are limited. Therefore, it becomes particularly important for obese patients to gain sufficient weight loss before kidney transplantation, which is not only related to whether transplant candidates are eligible for transplantation, but also the subsequent graft survival rate. Weight loss surgery can help obese patients achieve a significant amount of weight loss more quickly than traditional weight loss methods. In recent years, more and more scholars have applied bariatric surgery to the field of kidney transplantation. Research results have shown that bariatric surgery can improve the transplantation eligibility of kidney transplantation candidates with obesity, increase the survival rate of grafts and the lifetime of patients. Moreover, bariatric surgery can improve kidney function in patients with end-stage renal disease, thereby eliminating the need for kidney transplantation. At present, there is no any literature on the application of bariatric surgery in the field of kidney transplantation in China. This article reviews the current status and prospect of bariatric surgery in the field of kidney transplantation so as to provide reference for clinical practice.

Objective:To evaluate the mid-term efficacy of single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) in the treatment of obesity and type 2 diabetes mellitus.Methods:The cohort of this retrospective observational study comprised 118 obese patients with body mass index (BMI) ≥40 kg/m 2 with or without other related metabolic diseases and BMI of (27.5-40.0) kg/m 2 with type 2 diabetes mellitus (T2DM) who had been treated with SADI-S. Patients who had undergone modified surgery or been followed up for less than 1 year were excluded. Clinical data of the included patients [56 men and 62 women aged (34.5±9.7) years], who had undergone SADI-S in China-Japan Union Hospital, Jilin University from October 2018 to August 2022, were collected. Their mean preoperative body mass was (125.9±25.0) kg and BMI (42.8±6.8) kg/m 2. The 60 patients with T2DM had a mean fasting blood glucose of (9.9±3.2) mmol/L and HBA1c of (8.4±1.7) % before surgery. The main outcome measures were mid-term weight loss after surgery (body mass, BMI, excess weight loss, and total weight loss) 1, 2, 3, and 4 years after surgery and efficacy regarding diabetes mellitus (fasting blood glucose, glycated hemoglobin and diabetes remission rate at 1, 2, and 3 years after surgery). Outcomes were defined as follows. Complete remission: HbA1c <6% or fasting blood glucose <6 mmol/L without hypoglycemic medication; partial remission: HBA1c <6.5% or fasting blood glucose <7 mmol/L without hypoglycemic medication; significant improvement: HBA1c <7.0%, stable decrease of at least 1% compared with preoperative HBA1c, and postoperative dose of hypoglycemic medication significantly less; ineffective: no change in HBA1c and no reduction in dosage of hypoglycemic medication. Other outcome measures included intraoperative and postoperative adverse effects and postoperative nutritional indexes. Results:SADI-S was successful in all patients. There was no significant bleeding, conversion to open surgery, or perioperative death. The operation time was (186.1±41.5) minutes, and the postoperative hospital stay 6 (5–7) days. Surgical complications occurred in four patients, comprising peritoneal effusion, internal jugular vein thrombosis, anastomotic leakage, and gastric fistula. Body weight and BMI 1, 2, 3 and 4 years were significantly lower post- than pre-operatively (all P<0.05). Excess weight loss was (81.9±16.2) %, (82.2±15.5) %, (88.3±20.1) %, and (83.2±18.1) % at 1, 2, 3, and 4 years postoperatively, respectively. Total weight loss was (39.7±8.7) %, (40.6±10.6) %, (42.2±11.5) % and (45.4±10.2) %, respectively. The mean fasting blood glucose concentrations of the 60 patients with T2DM were (5.1±1.0) mmol/L, (5.0±0.7) mmol/L, and (5.4±0.9) mmol/L 1, 2 and 3 years postoperatively, respectively. The values for glycosylated hemoglobin were (4.9±0.6) %, (4.8±0.5) %, and (5.1±0.8) %, respectively, all of which are significantly lower than preoperatively (all P<0.05). The complete remission rate of diabetes was 95.0% (38/40), 90.0% (36/40), and 9/13 1, 2, and 3 years postoperatively, respectively. Additionally, the partial remission rate and significant improvement rate were both 100%. Two years postoperatively, the incidence of anemia was 27.8% (10/36), of hypoproteinemia 11.8% (4/34), and of ferritin deficiency 25.8% (8/31), all of which were improved by conservative treatment such as blood transfusion, iron supplementation, and adjustment of diet. Conclusion:SADI-S has a significant mid-term beneficial effect on weight loss and diabetes remission status in patients with obesity and type 2 diabetes.

Objective:To evaluate the mid-term efficacy of single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) in the treatment of obesity and type 2 diabetes mellitus.Methods:The cohort of this retrospective observational study comprised 118 obese patients with body mass index (BMI) ≥40 kg/m 2 with or without other related metabolic diseases and BMI of (27.5-40.0) kg/m 2 with type 2 diabetes mellitus (T2DM) who had been treated with SADI-S. Patients who had undergone modified surgery or been followed up for less than 1 year were excluded. Clinical data of the included patients [56 men and 62 women aged (34.5±9.7) years], who had undergone SADI-S in China-Japan Union Hospital, Jilin University from October 2018 to August 2022, were collected. Their mean preoperative body mass was (125.9±25.0) kg and BMI (42.8±6.8) kg/m 2. The 60 patients with T2DM had a mean fasting blood glucose of (9.9±3.2) mmol/L and HBA1c of (8.4±1.7) % before surgery. The main outcome measures were mid-term weight loss after surgery (body mass, BMI, excess weight loss, and total weight loss) 1, 2, 3, and 4 years after surgery and efficacy regarding diabetes mellitus (fasting blood glucose, glycated hemoglobin and diabetes remission rate at 1, 2, and 3 years after surgery). Outcomes were defined as follows. Complete remission: HbA1c <6% or fasting blood glucose <6 mmol/L without hypoglycemic medication; partial remission: HBA1c <6.5% or fasting blood glucose <7 mmol/L without hypoglycemic medication; significant improvement: HBA1c <7.0%, stable decrease of at least 1% compared with preoperative HBA1c, and postoperative dose of hypoglycemic medication significantly less; ineffective: no change in HBA1c and no reduction in dosage of hypoglycemic medication. Other outcome measures included intraoperative and postoperative adverse effects and postoperative nutritional indexes. Results:SADI-S was successful in all patients. There was no significant bleeding, conversion to open surgery, or perioperative death. The operation time was (186.1±41.5) minutes, and the postoperative hospital stay 6 (5–7) days. Surgical complications occurred in four patients, comprising peritoneal effusion, internal jugular vein thrombosis, anastomotic leakage, and gastric fistula. Body weight and BMI 1, 2, 3 and 4 years were significantly lower post- than pre-operatively (all P<0.05). Excess weight loss was (81.9±16.2) %, (82.2±15.5) %, (88.3±20.1) %, and (83.2±18.1) % at 1, 2, 3, and 4 years postoperatively, respectively. Total weight loss was (39.7±8.7) %, (40.6±10.6) %, (42.2±11.5) % and (45.4±10.2) %, respectively. The mean fasting blood glucose concentrations of the 60 patients with T2DM were (5.1±1.0) mmol/L, (5.0±0.7) mmol/L, and (5.4±0.9) mmol/L 1, 2 and 3 years postoperatively, respectively. The values for glycosylated hemoglobin were (4.9±0.6) %, (4.8±0.5) %, and (5.1±0.8) %, respectively, all of which are significantly lower than preoperatively (all P<0.05). The complete remission rate of diabetes was 95.0% (38/40), 90.0% (36/40), and 9/13 1, 2, and 3 years postoperatively, respectively. Additionally, the partial remission rate and significant improvement rate were both 100%. Two years postoperatively, the incidence of anemia was 27.8% (10/36), of hypoproteinemia 11.8% (4/34), and of ferritin deficiency 25.8% (8/31), all of which were improved by conservative treatment such as blood transfusion, iron supplementation, and adjustment of diet. Conclusion:SADI-S has a significant mid-term beneficial effect on weight loss and diabetes remission status in patients with obesity and type 2 diabetes.

Objective:To summarize the experience and early outcomes of transapical mitral valve-in-valve procedure with J-Valve in patients with bioprostheses degeneration.Methods:The clinical data of 29 patients who underwent mitral transcatheter valve-in-valve implantation with J-Valve from April 2020 to March 2021 were retrospectively analyzed. There were male 16 and female 13 patients with average age (72.0±11.6) years. Patients underwent previous mitral valve replacement with bioprostheses of Hancock Ⅱ in 17, Edwards SAV in 7, Edwards Perimount in 3, Balmedic in 1, Mosaic in 1. The size of mitral bioprostheses included 25 # for 8 patients, 27 # for 17 patients, and 29 # for other 4 patients. The operations were performed in the hybrid operation room. Under X-ray fluoroscopy and TEE monitoring, the retro-preseted J-valve was implanted into the mitral bioprosthetic valve via the intercostal space and apical puncture. Results:One patient was converted urgently to mediate sternotomy, and the transcatheter mitral valve was reset after opening left atrium on cardiopulmonary bypass due to the migration of transcatheter valve. twenty eight patients were successfully completed transcatheter mitral valve-in-valve procedure with technical success achieving in 96.6% . Among the 28 patients who successfully were completed valve-in-valve procedure, 1 died and 27 were discharged in well condition. The mean mitral transvalvular gradient was (7.6±2.2)mmHg(1 mmHg=0.133 kPa), no death or other major complications occurred during the follow-up.Conclusion:The application of J-Valve interventional valve in patients with bioprosthesis degeneration can achieve favourable early outcomes, even if the patient was replaced with a small bioprosthesis in the previous operation, the hemodynamic effect was still satisfactory.

Objective:To investigate the effect of early debridement and open reduction combined with internal and external fixation on open fracture of tibia and fibula.Methods:The clinical data of 82 patients with open tibiofibular fractures admitted to the 901st Hospital of the Joint Logistic Support Force of the Chinese People′s Liberation Army from June 2017 to May 2018 were retrospectively analyzed. There were 42 males and 40 females, aged 20-62 years, with an average age (34.8±16.1) years. According to different surgical methods, they were divided into control group ( n=32) and observation group ( n=50). The patients in the control group received early debridement and limited internal fixation, the patients in the observation group received early debridement and open reduction combined with internal and external fixation. The operation time, blood loss, healing time, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, white blood cell count (WBC), excellent rate and complication rate were observed in both groups. The measurement data were expressed as mean±standard deviation( Mean± SD), comparison between groups was analyzed using independent sample t test, count data were expressed as percentage (%), comparison between groups was performed using chi-square test. Results:The operative time (98.35±15.14) min in the observation group were higher than those in the control group (79.26±13.22) min, blood loss (120.53±41.66) mL and healing time (16.84±5.07) min in the observation group were significantly lower than those in the control group [(79.26±13.22) min, (210.59±56.60) mL, (19.48±5.46) min]. The difference was statistically significant ( t values were 5.85, 7.76, 2.20, P<0.05). Compared with control group, the level of ESR (18.91±2.70) mm/h, CRP (39.20±3.13) ng/L, WBC (7.04±1.12)×10 3/L were significantly lower than control group [(27.36±3.28) mm/h, (45.63±4.06) ng/L, (11.06±1.51)×10 3/L]. The difference was statistically significant ( t values were 12.17, 7.63, 12.95, P<0.05). Compared with control groups′s excellent and good rate, the excellent and good rate of observation group was higher, but the difference was not statistically significant ( P>0.05). The incidence of complications in the observation group (6.00%, 3/50) was significantly lower than that in the control group (31.25%, 10/50) ( P<0.05). Conclusions:Early debridement and open reduction combined with internal and external fixation is an effective method for the treatment of open fracture of tibia and fibula. Compared with internal fixation, it has the advantages of shorter healing time, less blood loss and lower incidence of complications. And it can also reduce the inflammatory response of patients.

Objective To understand the awareness level of iodine deficiency (ID) impairments and the attitude on edible iodized salt,and its consumption among doctors and nurses in cities,in order to provide scientific evidence for health education on iodine deficient disorders (IDD) in the future.Methods The questionnaire was self-designed,and spread through the web page of Wenjuanxing,an online server company,from May 6 to June 6,2017.At the end of the survey,a total of 481 valid questionnaires were reclaimed,in which ratio of gender was female 63.8％ (307/481),male 36.2％ (174/481).The data were analyzed by SPSS 22.0,including logistic regression analysis with backward according to the statistical significant level of P ＜ 0.05.Results Among doctors and nurses,90.4％ (435/481) knew ID impairments;72.8％ (350/481) answered intelligent disability as the most serious problem of ID;55.5％ (267/481)misunderstood that the areas in which they lived were not ID areas,although all cities surveyed were ID areas;41.0％ (197/481) of doctors and nurses misunderstood that coastal residents did not need to consume iodized salt.About the evaluation of iodine nutrition status of current population,15.6％ (75/481) of respondents judged as iodine excess.About consuming edible salt,76.3％ (367/481) selected iodized,9.6％ (46/481)non-iodized,and 14.1％ (68/481) both iodized and non-iodized.The results of logistic regression analysis showed the factors that prevents health care workers from choosing iodized salt were:"living in coastal areas","think him or her as iodine adequate","know that iodine deficiency can affect the development of children but still adhere to the consumption of non-iodized salt";the factors that promoted the choice of iodized salt for medical staff were "insist on buying iodized salt,and do not choose non-iodized salt",and 75.8％ (238/314)of them knew that intelligent disability as the most serious problem of ID.Conclusions Most doctors and nurses have high level of knowledge on ID and its control.But lack of information,as well as misunderstanding of "coastal areas iodine adequate" and worry about "excess iodine causes thyroid diseases and cancer",which would hinder the active consumption of iodized salt.Health education for them should be conducted through professional ways,stressing on the threaten of ID environment,sharing the information about national and local progress on control of IDD and iodized salt safety,and clarifying the relationship between iodine salt or iodine and thyroid cancer and nodules.

Objective: To observe the analgesic and anti-inflammatory effect of mandelic acid. Methods: Fifty Kunming mice were randomly divided into 5 groups:the blank control group (0. 1 ml/10 g), mandelic acid high (300 mg·kg-1), medium (200 mg ·kg-1 ) and low (140 mg·kg-1 ) dose groups, and the positive control ( aspirin) group, ig, qd. The analgesic effect of mandelic acid was observed by writhing test and hot plate method in mice. The ear swelling model caused by dimethyl benzene in mice was a-dopted to observe the analgesic effect. Results:Mandelic acid in each dose group could make the number of writhing in mice signifi-cantly reduced and pain threshold extended, and when compared with the blank control group, the difference was statistically significant (P<0. 01). The writhing times of mice mandelic acid high dose group was fewer than that of the positive control group, and there was no statistically significant between the groups (P>0. 05). In low and medium dose group, the writhing times of mice were more than those of the positive control group, and there was a significant difference between the low dose group and the positive control group( P<0. 05). The pain threshold of the mice in each mandelic acid dose group was higher than that of the positive control group, the pain threshold increased significantly in the high dose group before and after the administration, and the difference was statistically signifi-cant when compared with the positive control group (P<0. 05). The effect of mandelic acid on the ear swelling of mice was not signifi-cant, and when compared with the blank control group, the difference was not significant (P>0. 05). Conclusion:Mandelic acid has significant analgesic effect, while anti-inflammatory effect is not obvious.

Objective To explore the clinical application value of left atrial function with feature tracking cardiac magnetic resonance imaging (FT-CMR) by evaluating preliminarily left atrial strain and strain rate in patients with atrial fibrillation. Methods Thirty patients with paroxysmal atrial fibrillation, thirty patients with persistent atrial fibrillation and twenty-two healthy subjects were enrolled. All the subjects underwent cardiac magnetic resonance imaging with the real steady-state free precession(SSFP) sequence. FT-CMR parameters included left atrial strain and strain rate parameters, left atrial volume and function parameters were detected by using offline cardiovascular analysis software, respectively. Left atrial strain and strain rate parameters included left atrial total strain(Εs), passive strain(Εe), active strain(Εa), peak positive strain rate(SRs), peak early negative strain rate(SRe)and peak late negative strain rate(SRa). Volume and function parameters included maximum of left atrial volume(LAVmax), minimum of left atrial volume(LAVmin), total left atrial emptying fraction(LATEF), passive left atrial emptying fraction(LAPEF)and active left atrial emptying fraction(LAAEF). The differences in the general data among the paroxysmal atrial fibrillation group, the persistent atrial fibrillation group and the control group were compared by usingχ2 test or ANOVA analysis. The differences in all parameters between the atrial fibrillation group and the control group, the paroxysmal atrial fibrillation group and the persistent atrial fibrillation group were compared by using independent t test. Left atrial strain and strain rate parameters on an intra-observer and inter-observer were determined by intraclass correlation coefficient(ICC)analyses. Results Compared to control group, LAVmax and LAVmin in atrial fibrillation group were significantly increased(t=9.737,7.889,P<0.001);The LATEF and LAPEF had no significant difference, the LAAEF in two groups had statistically significant difference(t=-4.762,P<0.001).The absolute value of Es, Ee, Ea, SRs, SRe, SRa in atrial fibrillation group were significantly reduced than in control group(t=-7.732,-6.610,-6.493,-7.546, 6.864, 5.917,P<0.001). Compared with paroxysmal atrial fibrillation group, LAVmax and LAVmin in persistent atrial fibrillation group were increased obviously, LATEF and LAPEF were significantly decreased, and the differences were statistically significant(t=-4.575,-5.524, 4.002, 4.028,P<0.001).The LAAEF in two groups had no statistically significant difference. Compared with strain and strain rate in two groups, absolute value of Es, Ee, Ea, SRs, SRe, SRa in persistent atrial fibrillation group significantly decreased than in paroxysmal atrial fibrillation(t=4.310, 3.128, 4.465, 5.496,-3.290,-3.863,P<0.001). The intra-group and inter-group had well correlation coefficients between the observers in the left atrial strain and strain rate parameters of the subjects(ICC=0.85—0.94,0.81—0.90). Conclusions FT-CMR technique can be used to assess the left atrial strain and strain rate in patients with atrial fibrillation;Left atrial reservoir, conduit and booster-pump functions in patients with atrial fibrillation were impaired. Patients with persistent atrial fibrillation had worse left atrial function throughout the entire cardiac cycle compared with those with paroxysmal atrial fibrillation.

Objective To observate theZhulian acupuncture exciting method in different time of hypoxia ischemia brain injury in rat brain tissue malondialdehyde (MDA), monoamine oxidase (MAO), nitric oxide (NO) and glutathione peroxidase (GSH-PX) content.Methods 7 days old rats were randomly divided into a excitation method acupuncture group I, a excitation method acupuncture group II, a model group, a sham operation group, a normal control group, 10 rats in each group. Excitation method acupuncture group I and normal control group were given stimulation ofZhulian acupuncture exciting method one type technique from 24 h model manipulation, excitation method acupuncture II group from the beginning of the eighth day given Stimulation ofZhulian acupuncture exciting method one type technique. The sham operation group and the model group were not treated by acupuncture. The animals were sacrificed at the twenty-first day after making the model, determined brain tissue MDA、MAO、NO and GSH-PX Content.Results Compared with the model group, MDA (3.4 ± 0.87 nmol/mgvs. 5.50 ± 1.58 nmol/mg) content decreased in the excitation method acupuncture group I (P<0.05). The NO (12.43 ± 3.47μmol/mgvs. 17.10 ± 5.82μmol/mg) content decreased in the excitation method acupuncture group II (P<0.05). MAO (32.12 ± 11.15 U/mg, 31.01 ± 9.92 U/mgvs. 40.90 ± 11.02 U/mg) content were decreased in both excitation method acupuncture group I and group II (P<0.05), while the GSH-PX (2.61 ± 1.20 U/mg, 2.61 ± 1.37 U/mgvs. 1.43 ± 0.49 U/mg) content were increased (P<0.01). ConclusionZhulian acupuncture exciting method one type technique can decrease the content of MDA, MAO and NO reduce the content of hypoxic-ischemic brain injury in rat brain tissue, increase the content of GSH-PX, promote the removal of immature rats with hypoxic ischemic brain damage brain tissue metabolism, and protect brain function.