Obesity is a global epidemic with enormous social and economic burdens. Bariatric metabolic surgery (BMS) is the most effective treatment for obesity, and its mechanism has been explored. More and more clinical studies have confirmed that the brain-enteric-bacterial axis plays an important role in the pathophysiological mechanism of obesity, but there is a lack of review in this field. In this paper, the brain-entero-bacterial axis mechanism of changes in the nervous system, metabolism, endocrine system, immune system and microbial group in patients with obesity after BMS was reviewed, in order to clarify the mechanism of BMS treatment for obesity and provide relevant basis and reference for postoperative weight management in patients with obesity.

目的 应用定量CT(quantitative CT,QCT)技术检测不同病理类型非小细胞肺癌患者化疗后肝脏脂肪含量变化,探讨肝脏脂肪含量变化与化疗后肝功能损伤的关系.方法 2017年1月·2020年12月河南省人民医院经手术组织病理检查证实的非小细胞肺癌患者130例,其中60例肺腺癌患者(肺腺癌组)术后采用培美曲赛+铂类方案化疗,30例肺鳞癌患者(肺鳞癌组)术后采用多西他赛+铂类方案化疗,40例术后未化疗者为未化疗组.记录3组性别比例、年龄、体质量指数(BMI)、吸烟史、饮酒史及合并高血压、脂肪肝情况;术前和化疗3个月3组行胸部CT平扫,应用QCT技术于肝门静脉所在层面测量肝脏脂肪含量,测定谷丙转氨酶(GPT)、谷草转氨酶(GOT)、碱性磷酸酶(ALP)、谷氨酰转肽酶(GGT)水平,计算化疗后肝脏脂肪含量、GPT、GOT增加值;采用Spearman相关法分析肺腺癌组化疗3个月后肝脏脂肪含量增加值与GPT、GOT增加值的相关性;采用多因素logistic回归分析肺腺癌组化疗3个月后肝脏脂肪含量增加的影响因素.结果 (1)3组年龄,BMI,男性、合并高血压、合并脂肪肝、有吸烟及饮酒史比率比较差异均无统计学意义(P＞0.05).(2)3组术前肝脏脂肪含量及GPT、GOT、ALP、GGT水平比较差异均无统计学意义(P＞0.05).(3)肺腺癌组化疗 3 个月后肝脏脂肪含量[10.55(7.38,16.03)％]及 GPT[30.60(17.38,55.23)u/L]、GOT[26.70(21.00,32.10)u/L]水平均高于术前[9.35(6.03,12.08)％、22.25(15.43,35.83)u/L、20.10(17.10,23.88)u/L](P＜0.05),ALP、GGT水平与术前比较差异均无统计学意义(P＞0.05).未化疗组、肺鳞癌组化疗3个月后肝脏脂肪含量及GPT、GOT、ALP、GGT水平与术前比较差异均无统计学意义(P＞0.05).(4)肺腺癌组化疗3个月后肝脏脂肪含量、GPT、GOT增加值分别为 3.30(-1.63,8.55)％、6.00(-4.65,21.85)u/L、5.50(0.03,12.28)u/L.肺腺癌组化疗 3个月后肝脏脂肪含量增加值与GPT、GOT增加值均呈正相关(r=0.433,P=0.001;r=0.389,P=0.002).(5)化疗3个月后,肺腺癌组肝脏脂肪含量增加41例,未增加19例.脂肪含量增加者BMI≥24 kg/m2比率(70.7％)高于脂肪含量未增加者(42.1％)(x2=4.501,P=0.034),年龄≥65岁、男性、合并高血压、合并脂肪肝及术前GPT、GOT、ALP、GGT水平与脂肪含量未增加者比较差异无统计学意义(P＞0.05).BMI(OR=3.972,95％CI:1.123～14.051,P=0.032)是肺腺癌组化疗3个月后肝脏脂肪含量增加的影响因素.结论 肺腺癌患者术后化疗3个月肝脏脂肪含量增加、肝功能受损,肝脏脂肪含量增加越多肝功能受损程度越严重;BMI≥24 kg/m2者化疗后脂肪肝的发生风险增大.

Background:Chronic insomnia disorder (CID) is considered a major public health problem worldwide. Therefore, innovative and effective technical methods for studying the pathogenesis and clinical comprehensive treatment of CID are urgently needed.Methods:Real-time fMRI neurofeedback (rtfMRI-NF), a new intervention, was used to train 28 patients with CID to regulate their amygdala activity for three sessions in 6 weeks. Resting-state fMRI data were collected before and after training. Then, voxel-based degree centrality (DC) method was used to explore the effect of rtfMRI-NF training. For regions with altered DC, we determined the specific connections to other regions that most strongly contributed to altered functional networks based on DC. Furthermore, the relationships between the DC value of the altered regions and changes in clinical variables were determined.Results:Patients with CID showed increased DC in the right postcentral gyrus, Rolandic operculum, insula, and superior parietal gyrus and decreased DC in the right supramarginal gyrus, inferior parietal gyrus, angular gyrus, middle occipital gyrus, and middle temporal gyrus. Seed-based functional connectivity analyses based on the altered DC regions showed more details about the altered functional networks. Clinical scores in Pittsburgh sleep quality index, insomnia severity index (ISI), Beck depression inventory, and Hamilton anxiety scale decreased. Furthermore, a remarkable positive correlation was found between the changed ISI score and DC values of the right insula.Conclusions:This study confirmed that amygdala-based rtfMRI-NF training altered the intrinsic functional hubs, which reshaped the abnormal functional connections caused by insomnia and improved the sleep of patients with CID. These findings contribute to our understanding of the neurobiological mechanism of rtfMRI-NF in insomnia treatment. However, additional double-blinded controlled clinical trials with larger sample sizes need to be conducted to confirm the effect of rtfMRI-NF from this initial study.

目的 探讨实时功能磁共振神经反馈(real-time functional magnetic resonance imaging neurofeedback,rtfMRI-NF)调控杏仁核活动对失眠障碍患者脑功能局部一致性(regional homogeneity,ReHo)及情绪相关神经递质的影响.方法 20例失眠障碍患者采用rtfMRI-NF上调杏仁核活动,每周训练1次,连续3周.rtfMRI-NF首次训练前、第3次训练结束后行匹兹堡睡眠质量指数、失眠严重指数量表、汉密尔顿抑郁量表、汉密尔顿焦虑量表评分;检测血清情绪相关神经递质5-羟色胺、谷氨酸、多巴胺、γ-氨基丁酸、去甲肾上腺素水平;行静息态功能磁共振成像检查,计算训练前后各脑区ReHo值,并进行比较.采用Pearson相关法分析失眠障碍患者训练前后右侧脑岛ReHo 值变化值与血清5-羟色胺、谷氨酸水平变化值的相关性.结果 失眠障碍患者训练后血清5-羟色胺[(0.213±0.110)μmol/L]、谷氨酸[(46.430±19.454)μmol/L]水平均低于训练前[(0.554±0.298)、(70.142±26.333)μmol/L](t=4.795,P＜0.001;t=3.312,P=0.002),多巴胺、γ-氨基丁酸、去甲肾上腺素水平与训练前比较差异均无统计学意义(P＞0.05).失眠障碍患者训练后匹兹堡睡眠质量指数评分[(11.350±3.409)分]、失眠严重指数量表评分[(13.550±6.103)分]、汉密尔顿抑郁量表评分[(15.900±7.809)分]均低于训练前[(13.600±3.555)、(16.750±5.594)、(18.700±7.140)分](P＜0.05),汉密尔顿焦虑量表评分[(16.100±12.340)分]与训练前[(19.350±10.762)分]比较差异无统计学意义(t=1.719,P=0.101).失眠障碍患者训练后右侧脑岛(-0.001±0.356)、右侧岛盖部额下回(0.044±0.372)、右侧尾状核(-0.355±0.208)、右侧豆状核(-0.246±0.255)、右侧颞极颞上回(-0.269±0.349)、右侧三角部额下回(-0.079 土 0.325)、右侧眶部额下回(-0.423±0.247)、右侧中央沟盖(-0.102±0.372)ReHo值均低于训练前(0.265±0.408、0.346±0.371、-0.189±0.267、-0.003±0.360、0.042±0.450、0.109±0.242、-0.259±0.256、0.199±0.413)(P＜0.05).失眠障碍患者训练后右侧脑岛ReHo降低值与血清5-羟色胺、谷氨酸水平降低值均呈正相关(r=0.530,P=0.016;r=0.460,P=0.041).结论 失眠障碍患者经rtfMRI-NF训练后血清5-羟色胺、谷氨酸水平降低,右侧脑岛神经元活动ReHo 下降,二者变化程度呈正相关,进而改善抑郁情绪、缓解失眠症状.

BackgroundChronic insomnia disorder (CID) is a highly prevalent sleep disorder, which influences people's daily life and is even life threatening. However, whether the resting-state regional homogeneity (ReHo) of disrupted brain regions in CID can be reshaped to normal after treatment remains unclear. MethodsA novel intervention real-time functional magnetic resonance imaging neurofeedback (rtfMRI-NF) was used to train 28 CID patients to regulate the activity of the left amygdala for three sessions in 6 weeks. The ReHo methodology was adopted to explore its role on resting-state fMRI data, which were collected before and after training. Moreover, the relationships between changes of clinical variables and ReHo value of altered regions were determined. ResultsResults showed that the bilateral dorsal medial pre-frontal cortex, supplementary motor area (SMA), and left dorsal lateral pre-frontal cortex had decreased ReHo values, whereas the bilateral cerebellum anterior lobe (CAL) had increased ReHo values after training. Some clinical scores markedly decreased, including Pittsburgh Sleep Quality Index, Insomnia Severity Index, Beck Depression Inventory, and Hamilton Anxiety Scale (HAMA). Additionally, the ReHo values of the left CAL were positively correlated with the change in the Hamilton depression scale score, and a remarkable positive correlation was found between the ReHo values of the right SMA and the HAMA score. ConclusionOur study provided an objective evidence that amygdala-based rtfMRI-NF training could reshape abnormal ReHo and improve sleep in patients with CID. The improved ReHo in CID provides insights into the neurobiological mechanism for the effectiveness of this intervention. However, larger double-blinded sham-controlled trials are needed to confirm our results from this initial study.

Abstract Background: The interaction between osteoporosis-related bone microenvironment (BMD)and tumor may accelerate bone metastasis. However, the relationship between osteoporosis and lung cancer bone metastasis is unknown. Methods: We performed opportunistic screening for osteoporosis using chest low-dose computerized tomography (LDCT) to assess a relationship between osteoporosis and bone metastases from lung cancer. We used quantitative computed tomography (QCT) software to measure spinal trabecular BMD; we evaluated the density distribution by the American College of Radiology QCT diagnostic criteria for osteoporosis. The diagnosis of bone metastases was based on imaging methods. We obtained optimal cut-off for age by X-tile analysis. Univariate and multivariate COX survival analysis was used to compare the relationship between osteoporosis and bone metastases from lung cancer, and whether age and sex had an effect on the relationship. Results: At baseline, 401 patients with lung cancer, mean age ± standard deviation (SD) 61.7 ± 9.7 years, underwent LDCT opportunistic screening for lung cancer and osteoporosis, including 240 men (mean age ± SD 62.3 ± 9.7 years) and 161 women (mean age ± SD 60.7 ± 9.6 years). During a median follow-up of 21.3 months, 59 patients with lung cancer progressed to bone metastases. Regression analysis showed that the risk of lung cancer bone metastasis for men with osteoporosis was adjusted hazard ratios (HR) 95% confidence interval (CI)(0.27 0.14-0.50), P<0.001. After adjusting for age and sex, regression analysis showed that the lung cancer with osteoporosis for men was adjusted HR 95%CI(0.29 0.14-0.57), P<0.001 ,and greater for patients aged 63 older (adjusted HR 95%CI, 0.32 0.15-0.69 P<0.001). The progression time of bone metastases in patients with lung cancer and osteoporosis was faster, but not statistically different than the progression time of patients without osteoporosis. Conclusion: Overall, our study showed that osteoporosis diagnosed by low-dose chest CT opportunistic screening was associated with bone metastases from lung cancer. The findings proved that osteoporosis was an important risk factor for bone metastases from lung cancer, but osteoporosis cannot accelerate the time to progression of bone metastases. Our study highlights the clinical value of screening for osteoporosis in the prevention and treatment of bone metastases from lung cancer. Trial registration: The study approved by the Ethics Committee of the Henan Provincial 65 People's Hospital.(Ethical Approval Number: 2021 Aaron trial Examination No. (68)).