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 investigate the effect of pediatric early warning score(PEWS) on the evaluation of severity of emergency children admitted to pediatric intensive care unit(PICU). Methods: A total of 1 069 cases hospitalized through emergency room into PICU in Guiyang Children′s Hospital, from January to December in 2017 were analyzed, and the PEWS was recorded for the first time in emergency room and PICU, while receiver operating curve was used to analyze the efficacy of PEWS to diagnose the children, who were at risk of clinical deterioration and required transfer to the PICU, which included the sensitivity, specificity, Youden index.The diagnostic value of PEWS in asse-ssing the severity of disease in critically ill children was explored. Results: The 1 069 severe cases of PICU ranged from 1 month to 13 years and 8 months, and PEWS score was (4.6±0.8) scores in the emergency room, and (5.1±0.5) scores in the PICU, so there were significant differences of the PEWS score between the death group [(8.0±0.5) scores] and the survival group [(4.8±0.8) scores] in the emergency room and PICU(all P<0.05). The PEWS score of the respiratory, nervous, circulatory and digestive system groups in PICU was (5.8±0.5) scores, while other systemic diseases (blood, kidney, poisoning, and so on) PEWS score was(4.2±0.5) scores; which showed significant differences between 2 groups(t=4.60, P<0.05). In PICU, the score of PEWS was greater than or equal to 4.7, which was the demarcation point to distinguish the critical condition and predict the death risk of the patient. Conclusions PEWS is of great significance for assessing the children sent to PICU.Patients with mainly respiratory, circulatory, neurological, and digestive system diseases have higher PEWS scores.The PEWS score of other system diseases is significantly reduced.It is suggested that PEWS is not able to reflect the disease of such a system and needs to be taken seriously.

OBJECTIVE To investigate the relationship between the distribution of eosinophils(Eos) of nasal secretion and serum specific IgE(sIgE) titer in patients with allergic rhinitis, and to evaluate the diagnostic value of Eos in nasal secretion for allergic rhinitis. METHODS A total of 60 allergic rhinitis patients from Department of Otolaryngology, Beijing Shunyi Hospital of Traditional Chinese Medicine during Jan.2016 to June 2017 were selected as treatment group, and another 60 cases of non-allergic rhinitis and 30 normal persons in the corresponding time period were chosen as control group. Eos in nasal secretions and serum sIgE were measured in all the subjects and the relationship between Eos distribution and serum sIgE level was analyzed. RESULTS The Eos distribution and serum level of sIgE was consistent(κ=0.264, P=0.000) and statistical significance was found. The area of ROC of the Eos in nasal secretion was 0.881, the standard deviation was 0.025 and 95％ confidence interval was 0.841 to 0.924. The Udden index of ROC reached the maximum when the Eos in nasal secretion smear was graded as level 3, the sensitivity was 88.5％ and specificity was 99.4％. CONCLUSION Eos cytological examination of nasal secretions has some auxiliary value in the diagnosis of allergic rhinitis. It is a cheap, simple and rapid method, which can be used as an effective reference index for diagnosing allergic rhinitis in primary hospital.

Objective To investigate the association of distinct myositis specific autoantibodies (MSAs) with long-term survival of patients with polymyositis (PM) and dermatomyositis (DM).Methods We analyzed the clinical data and outcome of patients with PM and DM who were hospita-lized in the department of rheumatology of China-Japan Friendship hospital from 1994 to 2015,and evaluated the impact of MSAs on the prognosis of patients.Multivariate Cox regression analysis was used to identify the prognostic risk factors for PM/DM patients.Results A total of 383 PM/DM patients were followed up for 1-333 months.Cumulative survival and 10-year survival rate of all patients were 68.6％ and 76.2％,respectively.The survival rate of 80.4％ and 77.1％ at 3 and 5 years in patients with MSAs,which were lower than those of patients with-out MSAs,who had the survival rate of 90.1％ and 87.4％ at 3 and 5 years,respectively(x2=3.90 and 3.98,P＜0.05).There was significant difference for long-term survival in all MSAs positive groups (x2=40.654,P=0.000).Anti-MDA5 positive patients who had the 10-year survival rate of 28.7％ had the worst prognosis,while anti-HMGCR positive patients who had the l0-year survival rate of 100％ had the best outcome in all groups.Multivariate Cox regression analysis showed that independent risk factors associated with the long-term survival of patients were age of onset,complicated with malignancies,dysphagia,rapidly progress interstitial lung disease,antiMDA5 antibody positive,increased serum aspartate transferase and C reaction protein.Conclusion MSAs are strongly associated with the prognosis of patients with PM/DM.Patients with MSAs has worse 5-year overall survival than those without MSAs,which indicates that screening MSAs and aggressive treatment for PM/DM patients at very early stage of disease may improve the outcome.

Objective To analyze the epidemiological characteristics, clinical manifestations, diagnosis and treatment effect of brucella in=nfection, and to provide practical foundation and valuable experience for clinical treatment and prevention of brucellosis.Methods One hundred and nineteen patients with brucella infection hospitalized at the First Hospital of Lanzhou University from January 1st 2011 to July 30th 2011 were enrolled.Clinical data including gender, age, contact history with bovine and clinical manifestations such as fever, sweating and joint and muscle pain were extracted.Diagnosis and treatment effect of these patients were all recorded.The epidemiological characteristics and clinical manifestations were analyzed.Results The majority of patients were middle-aged male, and the number of male cases were 2.5 times of female cases.The brucella infections were observed all seasons in Lanzhou, while most cases were observed between May and July.A total of 78 cases had clear animal contact history.Among them, 53 cases (44.54%) had contact history with bovine.Main clinical manifestations included fever (n=84, 70.59%), muscle and joint pain (n=93, 78.15%), sweating (n=52, 43.70%), fatigue (n=29, 24.37%), and the most common clinical symptoms was joint and muscle pain.Blood routine test showed neutropenia (n=25, 21.01%), increase in blood sedimentation (n=34, 28.57%) and blood coagulation dysfunction (n=30, 25.21%).Liver function examination showed increase in ALT (n=37, 31.09%) and AST (n=43, 36.13%).Other examination showed that splenomegaly (n=28, 23.52%) was the most common finding, and liver diffuse lesions (n=22, 18.49%) ranked second.The most common drugs were doxycycline (n=79, 66.39%), rifampin (n=60, 50.42%) and cephalosporins (n=50, 42.02%).Among them, 45 cases (37.82%) were treated with combination therapy of rifampin and doxycycline, and 31 cases were treated with combination therapy of doxycycline and rifapentine or cephalosporins.Totally 112 cases (94.12%) recovered.Conclusions The majority of patients with brucellosis are male.The clinical manifestations of brucellosis are varied.Clinicians should pay attention to identify and prevent misdiagnosis.The timely and effective treatment should be provided according to patients' conditions.The relevant departments should also strengthen supervision and education of brucellosis.

Objective To investigate the diagnostic value of combined detection of serum gastrin-releasing peptide precursor (ProGRP),neuron specific enolization enzyme(NSE)and carcinoembryonicantigen(CEA)in small cell lung cancer(SCLC). Methods 471 patients with lung tumor from department of respiratory medicine and thoracic surgery and 162 healthy people from medical examination center were studied.Serum levels of ProGRP,NSE and CEA were detected by using electrochemi-cal luminescence method.ROC curves were drawn and the area under the curve (AUC)was calculated.Results The levels of ProGRP and NSE were significantly higher in patients with SCLC than those in NSCLC,lung benign disease group and normal control group (P <0.01).The levels of CEA were significantly higher in SCLC than those in patients with lung be-nign disease group and normal control group (P <0.05).The AUC of ProGRP,NSE and CEA in the diagnosis of SCLC were 0.933,0.777 and 0.554,respectively.The sensitivity of ProGRP,NSE and CEA in the diagnosis of SCLC were 82.6%,60.4%,41.6% and the specificity were 95.2%,83.3% and 71.7% respectively.The sensitivity of combined detec-tion of ProGRP,NSE and CEA was 91.3% and the specificity was 65.3%.Conclusion The serum ProGRP detection has a higher diagnostic value for SCLC.The combined detection of ProGRP,NSE and CEA is useful in the early diagnosis of SCLC.

Objective To introduce triage standard for non-traumatic chest pain and SOAPIE triage method into triage work for acute chest pain patients, and to investigate its effect. Methods Based on triage standard for non-traumatic chest pain and SOAPIE triage method, a new triage record was established. And triage time, triage accuracy and patient satisfaction were compared with conventional methods. Results The triage time of the research group was (1. 94 ± 0. 30) minutes, which was significantly lower than (2. 27 ± 0. 35) minutes of the control group (t =6. 99,P <0. 05). The triage accuracy of the research group was 96. 0%, which was significantly higher than 82. 0% of the control group (χ2 =10. 01,P<0. 05). The score of patients′satisfaction was (98. 94 ± 1. 06), which was significantly higher than (89. 30 ± 5. 95) of the control group (t=15. 96,P <0. 01). Conclusions The new triage method can shorten the triage time, improve the triage accuracy and patients′satisfaction, which is worthy of promotion.

Objective To explore the association between waist-to-height ratio (WHtR) and dyslipidemia in Chinese adults and to find out an optimal threshold of WHtR for predicting dyslipidemia.Methods A total of 221 270 adults from 4 health checkup centers nationwide were selected by using cluster random sampling method.Height,body weight,waist circumference (WC),total cholesterol (TC),triglyceride (TG),high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol(LDL-C) were measured.Body mass index (BMI) and WHtR were then calculated.The area under the receiver operating characteristic curve(AUC) was analyzed and optimal cutoffs were estimated by maximizing the sums of sensitivity and specificity.Results WHtR showed the largest AUCs in the participants with higher TC,TG and LDL-C,followed by increased WC and BMI.In male and female,the optimal thresholds of WHtR,WC and BMI for predicting dyslipidemia were 0.49-0.50 and 0.47-0.49,83-85and 73-76 cm,and 24-25 and 22-23 kg/m2,respectively.Conclusion WHtR may be superior to WC and BMI for predicting dyslipidemia,and an unisex cutoff of 0.5 should be recommended.

Objective To explore the detection rate and major risk factors of nodular thyroid diseases among adults.Methods A total of 35 495 adults who carried out health checkup during January 1st,2009 and December 31th,2010 in our center were assessed for the occurance of nodular thyroid diseases and the size and number of thyroid nodules by age and gender.Chi-square test,rank sum test and Chi-square trend test were used for data analysis.Results The total detection rate of nodular thyroid diseases was 33.87％ (female vs male:41.76％ vs 29.68％).The prevalence of single thyroid nodule was decreased with age,as opposed to multi-thyroid nodules.Single thyroid nodule was more commonly seen in males,which was reversed in multi-thyroid nodules.Small,middle and large thyroid nodules were found in 77.49％,18.19％ and 4.32％ males or 72.57％,21.59％ and 5.84％ females,respectively.Moreover,thyroid cancer was detected in 0.4‰ of those with nodular thyroid diseases.Conclusions The detection rate of nodular thyroid diseases among adult health checkup receivers was higher,which calls on the needs of intensive monitor and effective prevention of the condition.

ObjectivesTo explore the characteristic of different subtypes of depression on prefrontal lobe and hippocampus by proton magnetic resonance spectroscopy (1H-MRS),and its relationship.Methods 46 patients of depression,which were met with the third edition of the Chinese Classification of Mental Disorders (CC-MD-Ⅲ ) since December 2010 to March 2012 from Mental Diseases Prevention and Treatment Institute,were examined at prefrontal lobe and hippocampus by multi-voxel 1 H-MRS.They were divided into male ( n =25) and female ( n =21 ),early-onset subtype ( n =26) and late-onset subtype ( n =20 ),short-duration of illness ( n =23 )and long-duration of illness ( n =23 ) by different criteria.The N-acetylaspartate ( NAA),Choline-congtaining compounds (Cho),and Creatine compounds (Cr) were measured and the ratios of NAA/Cr,Cho/Cr were determined.ResultsOn left prefrontal lobe,the NAA/Cr ratios in patients of male ( 1.83 ± 0.19),late-onset subtype (1.86 ±0.16),and short-duration of illness ( 1.83 ±0.17) showed higher than those in female ( 1.70 ±0.12,t=2.711,P ＜ 0.01 ),early-onset subtype ( 1.70 ± 0.19,t =3.028,P ＜ 0.01 ),and long-duration of illness ( 1.71±0.20,t =2.192,P＜0.05).Both on left prefrontal and on left thalamus,the ratios of NAA/Cr were positively correlated with the age of onset ( r=0.493 and 0.478,P＜0.01 ),and were negatively correlated with the duration of illness ( r =- 0.482 and - 0.470,P ＜ 0.01 ).ConclusionsDifferent subtypes of depression maybe have different characteristics of 1H-MRS due to the age of onset and the duration of illness.