The clinical decision in bariatric and metabolic surgery is influenced by several factors. Both patients and medical providers face conflicts when deciding whether to proceed with the surgery and which procedure to choose. Some clinical decision-making studies have provided high-level evidence to assist in selecting patients and surgical methods. Additionally, there are clinical decision support systems tailored to the needs of this specialty. However, there is currently a lack of a high-level clinical decision system for bariatric and metabolic surgery in China. The authors refer to previous research progress and conduct in-depth discussions on the clinical decision-making of bariatric and metabolic surgery based on patient selection and surgical method selection.

Objective:To analyze the incidence and the related factors of umbilical vein catheter (UVC) tip migration within 7 d after umbilical vein catheterization.Methods:This prospective study involved neonates who were successfully indwelled with UVCs in the Department of Neonatology of Gansu Provincial Women and Child-care Hospital from June 2020 to December 2021. The position of the UVC tip, length of umbilical stump, body weight, and abdominal circumference were recorded after the UVCs were inserted successfully, and the changes in these four data at 2, 24, 48, 72 h, and 7 d after catheterization were analyzed and compared. All the subjects were divided into the non-migrate group, inward migration group, and outward migration group. Chi-square test, Mann-Whitney U test, or Kruskal Wallis H test were used for statistical analysis. Results:A total of 157 newborns were enrolled, with 51 cases in the inward migration group, 62 cases in the outward migration group, and 44 cases in the non-migrate group. There were no significant differences among the three groups regarding gestational age, birth weight, gender, born through cesarean section, age at the time of catheterization, use of sedation, and feeding modes (all P>0.05). The migration rates of UVCs tip at 2, 24, 48, 72 h, and 7 d after catheterization were 0, 27.4% (43/157), 27.2% (31/114), 25.3% (21/83), and 29.0% (18/62), respectively. The cumulative migration rates at 24, 48, 72 h, and 7 d were 27.4% (43/157), 47.1% (74/157), 60.1% (95/157), and 72.0% (113/157), respectively. Compared with the non-migrate group, the inward migration group had a shorter umbilical cord stump at 24 and 48 h [0.5 cm (0.4-0.5 cm) vs 0.6 cm (0.5-0.8 cm); 0.4 cm (0.3-0.5 cm) vs 0.5 cm (0.5-0.6 cm), Z=－5.55 and －3.69, both P<0.05], less abdominal circumference increment at 48 and 72 h [0.6 cm (0.5-1.0 cm) vs 0.9 cm (0.7-1.2 cm); 0.6 cm (0.3-0.9 cm) vs 0.9 cm (0.7- 1.3 cm), Z=－2.03 and －2.09, both P<0.05)], and more weight loss percentage [－4.7% (－6.0%-－3.6%) vs －3.1% (－3.7%-－2.2%); －6.0% (－7.5%-－5.0%) vs －3.9% (－5.1%-－2.4%), Z=－3.75 and －2.96, both P<0.05]. The abdominal circumference increased more in the outward migration group at 24, 48, 72 h, and 7 d than those in the non-migrate group [1.6 cm (0.9-1.9 cm) vs 0.7 cm (0.5-0.9 cm); 1.5 cm (1.2-1.8 cm) vs 0.9 cm (0.7-1.2 cm); 1.7 cm (1.3-1.9 cm) vs 0.9 cm (0.7-1.3 cm); 1.6 cm (1.1-1.9 cm) vs 0.9 cm (0.6-1.3 cm), Z=－4.82, －4.79, －3.74, and －3.09, all P<0.05]. Conclusion:The incidence of UVC tip migration is high, which could be affected by dryness and retraction of the umbilical cord stump and the change in neonatal abdominal circumference and body weight.

Objective:To investigate the bleeding characteristic and influencing factors after bariatric surgery.Methods:The retrospective case-control study was conducted. The clinical data of 3 371 patients with obesity who underwent bariatric surgery in the First Affiliated Hospital of Nanjing Medical University from May 2010 to August 2021 were collected. There were 903 males and 2 468 females, aged 31(16?65)years. Observation indicators: (1) occurrence, diagnosis and treatment of bleeding after bariatric surgery; (2) analysis of influencing factors for bleeding after bariatric surgery. (3) Follow-up. Follow-up was conducted through outpatient examinations, telephone interview or WeChat to detect total weight loss rate, resolution of hypertension and remission of type 2 diabetes of the patients with bleeding after bariatric surgery. The follow-up was up to August 2021. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range). Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed by the chi-square test. Ordinal data were analzyed by the non-parametric rank sum test. Univariate analysis was conducted using the corresponding statistical methods based on data type. The binary Logistic regression was used for multivariate analysis. Results:(1) Occurrence, diagnosis and treatment of bleeding after bariatric surgery. There were 27 of 3 371 patients diagnosed with postoperative bleeding, including 13 males and 14 females. There were 18 cases of abdominal bleeding and 9 cases of gastrointestinal bleeding. Among the 27 patients with postoperative bleeding, 8 cases were diagnosed with bleeding on the day after operation, 13 cases were diagnosed on the first day after operation, 4 casess were diagnosed on the second day, and 2 cases were diagnosed on the third day or later. Among the 27 patients with postoperative bleeding, 24 cases had tachycardia as the main clinical manifestation, 11 patients had abnormal abdominal drainage with the drainage volume as 300(range, 100?600)mL, 6 cases had hematocheziain with the volume as 500(range, 120?1 000)mL, 5 cases were manifested as hypotension, 3 cases had hematemesis with the volume as 300(range, 50?800)mL, 2 cases had a significant decrease in hemoglobin on the first day after operation. One patient may have multiple clinical manifestations. Among the 27 patients with postoperative bleeding, 6 cases with abdominal bleeding received emergency laparotomy due to continuous increase of abdominal drainage or hemorrhagic shock, of which one patient died of heart failure after emergency reoperation. The time between primary and secondary operation was 13.5(range, 2.0?45.0)hours, and the volume of blood accumulation was 1 000(range, 600?7 000)mL. The bleeding sites were identified in 5 patients during reoperation, including 2 cases of staple line bleeding after sleeve gastrectomy, 1 case of lesser sac bleeding after Roux-en-Y gastric bypass, 1 case of short gastric vessel bleeding and 1 case of trocar site bleeding. One patient had no obvious active bleeding during reoperation. The remaining 12 cases of abdominal bleeding and 9 cases of gastrointestinal bleeding were treated by conservative therapy. The duration of bleeding lasted for (2.1±0.7)days. (2) Analysis of influencing factors for bleeding after bariatric surgery. Results of univariate analysis showed that gender, hypertension, type 2 diabetes, surgical type were the related factors that affected the bleeding after bariatric surgery ( χ2=6.33, 42.16, 4.49, 14.09, P<0.05). Results of multivariate analysis indicated that surgical type was a independent factor affecting postoperative bleeding in patients undergoing bariatric surgery ( odds ratio=1.69, 95% confidence interval as 1.18?2.41, P<0.05). (3) Follow-up. All the 27 patients were followed up for 16(1?62)months. Eighteen patients reached or exceeded the 12 months follow-up time point. The 1-year total weight loss rate was 36%±12%, the resolution proportion of hypertension was 8/11, and the complete remission proportion of type 2 diabetes was 6/7. Six patients reached or exceeded the 36 months follow-up time point. The 3-year total weight loss rate was 35%±12%, the resolution proportion of hypertension was 4/5, and the complete remission proportion of type 2 diabetes was 1/1. Conclusions:The incidence of post-operative bleeding after bariatric surgery is low. Tachycardia, abnormal abdominal drainage and hypotension have sentinel functions. Surgical type is a independent factor affecting bleeding after bariatric surgery.

Objective:To explore the effect of preoperative energy-restricted well-balanced diet intervention on postoperative nausea and vomiting and related prognostic indicators in patients with sleeve gastrectomy.Methods:Using the convenient sampling method, a total of 408 patients who underwent sleeve gastrectomy in the First Affiliated Hospital of Nanjing Medical University from July 2020 to July 2021 were selected as the research objects. According to the random number table method, they were randomly divided into the intervention group and the control group, with 204 cases in each group. The control group was given routine preoperative dietary care, while the intervention group was given preoperative energy-restricted well-balanced diet intervention. The incidence of postoperative nausea and vomiting, early postoperative drinking water compliance rate and preoperative hyperglycemia were compared between the two groups.Results:The incidence of PONV and the incidence of preoperative hyperglycemia in the intervention group were lower than those in the control group, and the postoperative drinking water compliance rate was higher than that in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Preoperative energy-restricted well-balanced diet intervention can reduce the incidence of postoperative nausea and vomiting in patients with sleeve gastrectomy, increase the postoperative drinking water compliance rate and reduce the incidence of preoperative hyperglycemia.

Objective:To investigate the influencing factors of the therapeutic effect of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) in patients with epidermal growth factor receptor (EGFR) mutant advanced non-small cell lung cancer (NSCLC).Methods:The clinical data of 104 EGFR mutant advanced NSCLC patients who received EGFR-TKI treatment in Wuxi No.2 Hospital Affiliated to Nanjing Medical University from January 2015 to October 2019 were collected. The correlation of different types of EGFR mutation with the clinicopathological characteristics, the hematological examination results and the treatment mode of patients was analyzed. Cox proportional hazard model was used to analyze the association of the progression-free survival (PFS) time of patients receiving EGFR-TKI treatment with the different types of EGFR mutation, the clinicopathological characteristics, hematological related indexes and treatment mode. Kaplan-Meier method was used to analyze the independent influencing factors for the PFS of the stratified patients.Results:The overall disease control rate (DCR) of patients receiving EGFR-TKI treatment was 92.3% (96/104). Cox univariate analysis showed that the levels of carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), D-dimer, and previous surgical treatment history of patients receiving EGFR-TKI treatment were associated with PFS of patients (all P < 0.05). Cox multi-factor analysis showed that EGFR mutation type ( HR =2.371, 95% CI 1.298-4.332, P = 0.005), combination therapy ( HR = 0.489, 95% CI 0.245-0.978, P = 0.043) and choice of therapeutic drugs ( HR = 0.261, 95% CI 0.113-0.606, P = 0.002) were independent influencing factors for the PFS of patients receiving EGFR-TKI treatment. The PFS of EGFR 19 exon-mutant patients with advanced NSCLC was longer than that of those with EGFR 21 exon-mutant (median PFS time: 14.0 months vs.9.5 months, P<0.05); the PFS of combination of radiotherapy or chemotherapy was longer than that of EGFR-TKI single therapy (median PFS time: 15.0 months vs. 9.0 months, P<0.05), the PFS of patients receiving erlotinib was better than that of those receiving gefitinib ( P<0.05). According to EGFR mutation types, it was found that EGFR 19 exon-mutant patients receiving EGFR-TKI in first-line treatment could obtain better PFS than those who receiving EGFR-TKI in second-line and above treatment (median PFS time: 14.0 months vs. 9.5 months, P<0.05). When receiving EGFR-TKI, EGFR 19 exon-mutant patients with CA125 <85 U/ml could obtain longer PFS time than those with CA125 ≥85 U/ml (median PFS time: 14.0 months vs. 6.5 months, P<0.05). Conclusions:The therapeutic effect of EGFR-TKI in EGFR-mutant patients with advanced NSCLC is positive. EGFR 19 exon-mutant NSCLC patients with low-level CA125 receiving EGFR-TKI in first-line treatment can obtain better PFS.

AIM: To study the effects and mechanism of down-regulating lncRNA LINC00176 on cisplatin resistance and autophagy in lung cancer A549/DDP cells. METHODS: The qRT-PCR method was used to determine the expression changes of LINC00176 in normal bronchial epithelial 16HBE cells and lung cancer A549, A549/DDP, NCI-H1299 and SK-MES-1 cells. A549/DDP cells were divided into Control group, si-NC group, and si-LINC00176 group, si-LINC00176+ Anti-miR-NC group, and si-LINC00176+ Anti-miR-138-5p group. MTT experiment detected the half inhibitory concentration (IC

OBJECTIVE: To study the genetic variants of a child with Autism Spectrum Disorder (ASD) combined with epilepsy, and explore its possible pathogenic mechanism. METHODS: Clinical data of the child were collected and evaluated, whole-exome sequencing (WES) technology was used to explore the genetic variants sites of the child and his parents and candidate genes were filtered out. Sanger sequencing were performed to verify the variants identified by WES and PolyPhen2 was utilized to predict the function of these variants. qPCR was carry out to determine the expression of the variant gene. RESULTS: The proband carried a compound heterozygous mutation in the SIK3 gene (Chr11 q23.3, NM_025164.6), which contains a missense mutation c.1295A>G (p.N432S) inherited from the father and a deletion [c.2389_2391del(p.797del)] inherited from the mother. Both mutation sites are highly conservative, and PolyPhen2 predicted (c.1295A>G [p.N432S]) to be harmful. Compared to the mother, expression of SIK3in mRNA level in the peripheral blood of the proband and his father were both significantly decreased; compared to normal child, SIK3 expression in the peripheral blood of the proband and two other children with ASD were all decreased significantly too. In addition, studies on mice found that Sik3 gene has a marked higher level of expression in the brain. CONCLUSION The SIK3 gene variants may probably be associated with ASD. The detailed mechanism needs to be studied further, which may involve lipid metabolism dysfunction in the brain.
Animals ; Autism Spectrum Disorder/genetics* ; Epilepsy/genetics* ; Male ; Mice ; Mutation ; Mutation, Missense ; Protein Kinases ; Protein Serine-Threonine Kinases/genetics* ; Whole Exome Sequencing

The disease treatment of patients with gastrointestinal cancer is accompanied by impaired bodily functions. Frailty is very common in patients with gastrointestinal cancer, and is closely related to its various adverse health outcomes, which seriously affects their prognosis. This article reviews the risk factors, correlation with adverse health outcomes and intervention methods of frailty in gastrointestinal cancer patients. It is pointed out that medical and nursing staff should identify the frailty state of patients with gastrointestinal cancer as soon as possible and make early interventions to improve the prognosis of patients.

Objective:To construct a scientific and reasonable early warning evaluation index system for high-risk pregnancy during childbirth, so as to provide a content framework for the establishment of an information management platform.Methods:Convenience sampling was used to select 15 experts from 2 colleges and universities, 5 ClassⅢ Grade A general hospitals and 2 ClassⅢ Grade A maternal and child health hospitals in Henan Province as the subject of consultation. The early warning evaluation indicators of high-risk pregnancy during childbirth were determined through literature research, group discussion, and Delphi expert consultation method. Convenience sampling method was adopted to select 288 pregnant women admitted to the hospital for delivery from February to April 2020 in a ClassⅢ Grade A hospital in Henan Province as the research object. The early warning evaluation index system for high-risk pregnancy during childbirth was used to evaluate pregnant women.Results:The final early warning evaluation index system for high-risk pregnancy during childbirth included 7 first-level indicators and 27 second-level indicators. The expert authority coefficients of the two rounds of consultation were 0.91 and 0.93, respectively, and the Kendall harmony coefficients were 0.241 and 0.385, respectively ( P<0.001) . The area under the ROC curve predicted by the early warning evaluation index system for high-risk pregnancy during childbirth was> 0.85, and the best cut-off point was 9.98. Conclusions:The constructed early warning evaluation index system for high-risk pregnancy during childbirth has comprehensive content and high reliability, which will help midwives to identify high-risk pregnancy during childbirth.

Objective:To study whether aspirin has inhibitory effect on microglia activation induced by Poly-IC and its mechanism.Methods:Microglia cell line BV2 were cultured in vitro to establish a Poly-IC stimulation-induced microglia cell immune activation model. The experiment groups were divided into control group (no treatment), model group (Poly-IC 10 μg/ml), high dose aspirin group (1 mmol/L aspirin), low dose aspirin group (0.1 mmol/L aspirin), high dose aspirin pretreatment group (Poly-IC 10 μg/ml + 1 mmol/L aspirin) and low dose aspirin pretreatment group (Poly-IC 10 μg/ml + 0.1 mmol/L aspirin). The phagocytosis ability of microglia cells, reactive oxygen species (ROS) and Iba1 protein expression were detected by using immunofluorescence method. The expression of the inflammatory cytokines Il-1β, Il-6, Il-10, TNF-α and cox-2 mRNA in microglia cells were detected by real-time quantitative PCR (RT-qPCR).Results:Compared with the control group, the morphology of microglia cells in model group changed significantly, and the phagocytosis ability and production of reactive oxygen species (ROS) increased. At the meantime, the expression of Iba1 protein was strongly decreased. In the model group, The mRNA expressions of IL-1β(20.55±1.92), IL-6 (63.98±7.83), TNF-α (16.84±3.19), COX-2 (6.78±0.42) were higher than IL-1β(1.01±0.14), IL-6 (0.95±0.17), TNF-α (1.22±0.38), COX-2 (0.87±0.11) in the control group. (Il-1β ( t=26.14), Il-6 ( t=10.22), TNF-α ( t=17.06) and COX-2 ( t=37.07), all P<0.01). In the aspirin pretreatment group, the phagocytic ability of microglia cells was inhibited compared with the model group, and the production of reactive oxygen species (ROS) reduced. The expression of Iba1 protein was also partly recovered. Meanwhile, the effect of the high aspirin dose pretreatment group on pro-inflammatory factors IL-1β(9.95±0.52), IL-6 (39.64±6.89), TNF-α(1.57±0.42), COX-2 (2.47±0.14)were lower than those in the model group significantly.(IL-1β: t=14.18, IL-6: t=3.69, TNF-α: t=16.68, COX-2: t=27.03, all P<0.01). Conclusion:Aspirin has an inhibitory effect on microglial activation induced by Poly-IC, which may be related with inhibiting the expression of inflammatory factors.