Obesity and diabetes mellitus (T2DM) are metabolic related diseases with high incidence rate at present. Obesity is considered as one of the risk factors of T2DM. At present, the interaction mechanism between obesity and T2DM has not been clearly studied.Adipose tissue is an endocrine organ related to the pathophysiology of obesity and its complications. Adipose tissue can not only store a lot of energy, but also secrete many hormones, oxidative stress and inflammatory factors, which may be related to the occurrence and development of T2DM. Under long-term and low-dose stimulation, the sustainable low grade inflammation of fat is considered to be an important mechanism for the occurrence and development of obese T2DM. Therefore, this paper mainly summarizes the research progress of low grade fat inflammation in obese T2DM.

Obesity is one of the main risk factors for gastroesophageal reflux disease (GERD). With the development of social economy, the global obesity population shows a continuous growth trend, leading to an increase in the incidence rate of GERD. Obesity, especially the central obesity, is closely related to GERD. The increase of intra-abdominal pressure caused by obesity may lead to the destruction of "anti-reflux barrier" through a variety of mechanical mechanisms, and the various cytokines produced by visceral adipose tissue in obesity population may contribute to the occurr-ence and development of GERD through various biological effects. The authors explore the mechanism of obesity in the occurrence and development of GERD from both mechanical and biological effects, aiming to help clinical physicians improve their understanding of GERD.

Obesity is an independent risk factor of gastroesophageal reflux disease, which is usually related to the existence of esophageal hiatal hernia.Similarly, hiatal hernia is an independent risk factor of gastroesophageal reflux disease, which is prevalent in about 40% of obese patients.Although laparoscopic sleeve gastrectomy is becoming more and more popular in weight-loss surgery, and it is safe and effective, it may be accompanied by symptoms of gastroesophageal reflux disease and the need for esophageal hiatal hernia repair.In addition, the effect of laparoscopic sleeve gastrectomy combined with hiatus hernia repair on the symptoms of gastroesophageal reflux disease is controversial and the efficacy is not clear.Therefore, this article mainly reviews the influence of laparoscopic sleeve gastrectomy combined with hiatus hernia repair on obesity with gastroesophageal reflux disease and the existing problems.

Obesity and type 2 diabetes (T2DM) are all the metabolic diseases with high incidence rate. There is a clear correlation between the them. Weight-loss surgery is the important treatment of surgical method for obesity and T2DM.However, the mechanism of T2DM for weight loss surgery is not yet clear.The secretion level of glucagon like peptide-1 (GLP-1) was affected after weight loss surgery. The secretion of GLP-1 can delay gastric emptying, increase satiety, improve insulin resistance (IR) and promote β insulin release, inhibition of glucagon synthesis and secretion, and improvement of pancreatic function β cell function. All of these changes were conducive to glycemic control. Therefore, this paper aims to summarize and describe the relationship between the effect of laparoscopic sleeve gastrectomy (LSG) on blood glucose and GLP-1/dipeptidyl peptidase-4 (DPP-4) pathway in obese T2DM patients.

Obesity has been recognized as a health problem worldwide because of its negative effects. Obesity has increased the incidence rate of some diseases. Among them, gastroesophageal reflux disease (GERD) is more typical. Recently, GERD has become more and more popular among obese people. Scholars have begun to pay attention to the association between obesity and GERD. Some literatures and data point out that obesity is one of the important factors related to GERD. In the face of these problems, surgical and non-surgical treatment can be used, but recently, surgical treatment, especially weight loss surgery, has become more and more popular. In order to provide reference for clinicians and patients, this paper reviews the relationship between obesity and GERD, and the treatment methods and development of obesity complicated with GERD in recent years.

OBJECTIVETo investigate the clinical efficacy of argon plasma coagulation (APC) combined with laparoscopic hiatal hernia repair and fundoplication in the treatment of hiatal hernia associated with Barrett esophagus.

METHODSA total of 61 cases of hiatal hernias with Barrett esophagus from June 2010 to January 2014 in the Department of Minimal Invasive Surgery, Hernia and Abdominal wall Surgery, People's Hospital of Xinjiang Uyhur Autonomous Region were prospectively enrolled and were randomly allocated into two groups by computer system. Twenty-nine patients received esomeprazole 40 mg/d after APC treatment for 8 weeks (APC with medicine group). Thirty-two patients underwent laparoscopic hiatal hernia repair and Nissen fundoplication after APC treatment (APC with surgery group). All the patients were reviewed by gastroscope and pathologic examination at half a year and one year after operation respectively. Differences of disease improvement and recurrence between the two groups were evaluated.

RESULTSIn APC with medicine group, the Barrett's esophagus was relieved after one or two times of APC treatment, however, gastroscope and pathology revealed recurrence of Barrett's esophagus in 7 cases at half a year, and cumulative 16 cases of recurrences were detected after one year follow-up(16/29, 55.2%). In APC with surgery group, only one patient had recurrent Barrett's esophagus at half a year, and a total of two at one year follow-up by gastroscope examination(2/32, 6.3%). Significantly low recurrence rate of Barrett's esophagus was observed in APC with surgery group compared to APC with medicine group(P<0.01). Furthermore, recurrent hiatal hernia was detected in only one case in APC with surgery group. No esophageal cancer was found in both groups during follow-up.

CONCLUSIONAPC combined with laparoscopic hiatal hernia repair and fundoplication is an ideal method for patients with hiatal hernia and Barrett's esophagus.

Objective To investigate the expression of NADPH oxidase Nox-4 induced by stress in gastric mucosa and its role in inflammation.Methods Twenty male SPF Kunming mice were randomly divided into chronic restraint stress group(stress group) and control group.Stress mice were restrained in selfmade restraint device for 2 hours each day.The rest of the time,the mice in the two groups had free access to food and water normally,experiment lasted 14 days.The histopathological changes of gastric mucosa were assessed by HE staining under light microscope.The expression of Nox-4 in gastric mucosa of mice was carried out by immunohistochemical method.The relative expression levels of Nox-4,antioxidant protein (Mn-SOD,GSH,Catalase) and inflammatory factors(IL-8,IL-1β,TNF-α) in gastric mucosa were detected by real-time quantitative RT-PCR and ELISA.Results Basal cell proliferation,neutrophil,eosinophil and plasma cell infiltration and inflammatory changes were observed in the lamina propria and glandular epithelium of stress mice,while no obvious abnormalities were found in control mice.The expression of Nox-4 in stress group was deeper and more abundant than that in control group,mainly expressed in lamina propria and glandular epithelium.The mRNA expression levels of Nox-4 in gastric mucosa of stress group was(2.42±0.51) times higher than that of control group,and blood concentration of stress group was(2.23±0.67) times higher than that of control group(t=-46.32,P＜0.001).The RT-PCR of antioxidant proteins in gastric mucosa showed that the transcription levels of Mn SOD,GSH and Catalase in stress group were significantly lower than that of control group (Mn-SOD:0.59± 0.10,GSH:0.58± 0.11,Catalase:0.57± 0.09),and there were significant differences between the two groups(t=13.57,11.67,15.01,P＜0.01).RT-PCR results showed that the transcription levels of IL-8,IL-1β,TNF-α in stress group were significantly higher than those in control group (IL-8:1.47±0.34,IL-1β:1.48 ± 0.42,TNF-α:1.51 ± 0.37),and there were significant differences in two groups(t=-18.45,-19.14,-20.85,P＜0.01).ELISA results showed that the serum levels of inflammatory factors in stress group were significantly higher than those in control group(2.25±0.37,3.59±0.45,3.41±0.34),and the differences were statistically significant(t=-47.11,-79.36,-96.32,P＜0.01).Pearson correlation analysis showed that there was a positive correlation between serum concentration of Nox-4 and inflammatory factors(IL-8,IL-1β,TNF-αt) in stress group(r=0.97,0.99,0.98,P＜0.01).Spearman rank correlation analysis showed that the grade of gastric mucosal inflammation was positively correted with serum levels of Nox-4 and inflammatory factors (IL-8,IL-1β,TNF-α) (r =0.96,0.92,0.91,0.94,all P＜ 0.01)Conclusion Stress may lead to gastric mucosal lesion by overexpression of proinflammatory factors through destroying the balance of oxidation/antioxidant system in gastric mucosa.

Objective To detect the expression levels of collagen1 (colla-1),transforming growth factor-β1 (TGF-β1),a-smooth muscle actin (α-SMA) and nicotinamide adenine dinucleotide phosphate oxidase 4 (NOX-4) in mouse esophagus submitted to chronic restraint stress (CRS),in order to discuss stress-induced esophageal fibrosis and the role of oxidative stress.Methods 20 male Kunming mice were randomly divided into two groups,CRS and normal control (NC).The mice in CRS group were submitted to 2 h per day of restraint stress using home-made device for a period of 14 days,and the mice in both group were treated the same at rest of the time.Fibrotic changes of esophageal tissue were observed using Masson staining.The expression levels of NOX-4 and related fibrotic cytokines in esophageal tissues were detected by several methods such as immunohistochemistry,enzyme-linked immunosorbent assay (ELISA) and realtime polymerase chain reaction (qRT-PCR).Results Body weight in CRS group was significantly lower than NC group (8.75 ± 1.69 vs 12.69 ± 3.16),with statistically significant difference (t =3.11,P ＜ 0.05).Masson staining revealed that CRS mice showed distinct fibrosis of epithelial interstitium,while there was no distinct changes observed in NC mice.Immunohistochemical staining revealed intense staining for NOX-4 in epithelial,mucosal and submucosal layers of esophagi in CRS mice.ELISA showed that the serum level of NOX-4 in CRS mice was higher than NC mice (1.442 ± 0.05 vs 0.449 ± 0.08),with statistically significant difference (t =-27.32,P ＜ 0.01).Real-time PCR results showed that the expression of colla-1,TGF-β1,α-SMA and NOX-4 in CRS mice were as (2.443 ±0.36,2.78 ±0.13,2.244 ±0.18,2.448 ±0.440) times higher than NC mice,with statistically significant difference (t =-11.19,-38.86,-19.90,-10.37,P ＜ 0.01).Conclusions Fibrotic cytokines such as colla-1,TGF-β1 and α-SMA may participate in formation of stress induced esophageal fibrosis,and oxidative stress may play crucial role in the process of esophageal fibrosis.

Objective To investigate the expression of malondialdehyde ( MDA) in esophageal mu-cosa of different types of gastroesophageal reflux disease ( GERD) patients and its role in the esophageal in-flammation. Methods According to the inclusion and exclusion criteria, 42 patients hospitalized in the the Xinjiang Uygur Autonomous Region People's Hospital from December 2017 to October 2018 were selected as the research group. 8 healthy subjects completed physical examination were set up as healthy control group. GERD completed GERDQ score, 24 h pH monitoring, and taken 3 cm on the dentate line of the esophagus as a specimen. The study group was divided into non-erosive reflux disease (NERD) group (17 cases) and Ero-sive reflux disease [erosive esophagitis (RE)] group (25 cases). Then hematoxylin-eosin (HE) staining, immunohistochemistry, real-time polymerase chain reaction ( qPCR ) , enzyme-linked immunosorbent assay (ELISA) methods were used to detect inflammation, oxidative stress (MDA), antioxidant enzyme [manga-nese superoxide dismutase (Mn SOD), glutathione (GSH), catalase (CAT)], and proinflammatory cyto-kines [monocyte chemotactic protein-1 (MCP-1), interlukin-8 (IL-8), tumor necrosis factorα(TNF-α)]. Results There was no significant difference in body mass index ( BMI ) between the three groups ( P >0. 05). 24 h pH monitoring of esophagus showed that the indexes of weak acid reflux (40. 05). In RE group , the infiltration of immune cells (neutrophils, eosinophils), nipple lengthening, edema and other inflammatory changes were found in the esophageal mucosa, and the inflammation score reached the peak, which was signif-icantly higher than that in NERD group, with statistical significant difference (P<0. 001). The positive ex-pression of MDA in the two groups ( NERD, RE) was higher than that in the control group, and the MDA ex-pression in the RE group was almost covered with the full layer esophagus. The serum MDA concentration in the NERD and RE groups was significantly higher than that in the control group (P<0. 001). Compared with the NERD group, the serum MDA in the RE group reached the peak (P<0. 01). The relative expression of mRNA ( Mn SOD, GSH and CAT) in NERD group and RE group was significantly decreased, and there was a significant difference between the three groups (P<0. 001). Compared with the NERD group, the mRNA expression level of Mn SOD and CAT in RE group was significantly decreased (P<0. 01). The relative ex-pression of mRNA (MCP-1, IL-8, TNF- α) increased significantly in the two groups (NERD, RE), and there was a statistically significant difference between the three groups ( P <0. 001 ) . Compared with the NERD group, the expression of its inflammatory factors in the RE group significantly increased (P<0. 01). Conclusions The expression level of MDA in different types of GERD is significantly higher, which may be closely related to esophageal inflammation induced by acid reflux.

Objective:To investigate the clinical efficacy of laparoscopic sleeve gastrectomy (LSG) for obesity complicated with obstructive sleep apnea syndrome (OSAS).Methods:The retrospective and descriptive study was conducted. The clinical data of 74 patients with obesity complicated with OSAS who were admitted to People's Hospital of Xinjiang Uygur Autonomous Region from January 2017 to June 2018 were collected. There were 40 males and 34 females, aged (39±10)years, with a range from 20 to 56 years. Observation indicators: (1) surgical and postoperative situations; (2) follow-up; (3) correlation analysis between obesity indicators and OSAS indicators; (4) analysis of factors influencing the postoperative efficacy of OSAS. Follow-up using hospitalization examination was conducted to detect the incidence of complications and the improvement of obesity and OSAS indicators after patients discharge. The follow-up was up to June 2019. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers or percentages. Repeated measurement data was analyzed using the mixed-effects model. Correlation analysis was conducted using the Pearson correlation coefficients. Multivariate analysis was conducted using the COX proportional risk regression model. Results:(1) Surgical and postoperative situations: 74 patients underwent LSG successfully, without conversion to open surgery, including 12 cases undergoing LSG combined with laparoscopic cholecystectomy and 9 cases undergoing LSG combined with esophageal hiatal hernia repair. The operation time and volume of intraoperative blood loss of 74 patients were (88±22)minutes and (57±25)mL. There was no severe postoperative complications and perioperative mortality. The duration of postoperative hospital stay of 74 patients were 5 days (range, 3-8 days). (2) Follow-up: among 74 patients, 71 were followed up at 1 month, 68 were followed up at 3 months, 64 were followed up at 6 months and 61 were followed up at 12 months after operation, respectively. The body mass, body mass index (BMI), abdominal circumference, chest circumference, neck circumference, apnea hypopnea index (AHI), average oxyhemoglobin saturation (ASaO 2), lowest oxygen saturation, epworth sleepiness scale score, excess weight loss rate of the 71 patients who were followed up at 1 month after operation were (108±16)kg, (38±5)kg/m 2, (121±14)cm, (122±13)cm, (41.3±2.5)cm, (25±15)times/hour, 88.1%±3.8%, 70.0%±9.3%, 17.8±2.3, 30%±8%, respectively. The above indicators of the 68 patients who were followed up at 3 month after operation were (96±14)kg, (33±5)kg/m 2, (113±13)cm, (120±12)cm, (39.7±2.3)cm, (17±11)times/hour, 90.2%±3.1%, 78.5%±7.1%, 15.0±2.2, 52%±13%, respectively. The above indicators of the 64 patients who were followed up at 6 month after operation were (88±11)kg, (31±4)kg/m 2, (105±11)cm, (113±11)cm, (37.5±1.7)cm, (10±7)times/hour, 92.4%±2.2%, 84.2%±3.5%, 13.6±1.7, 63%±14%, respectively. The above indicators of the 61 patients who were followed up at 12 month after operation were (80±8)kg, (28±3)kg/m 2, (97±8)cm, (108±10)cm, (36.5±1.4)cm, (6±4)times/hour, 93.7%±1.4%, 88.0%±3.1%, 9.2±1.5, 75%±16%, respectively. There were significant differences in the body mass, BMI, abdominal circumference, chest circumference, neck circumference, AHI, ASaO 2, lowest oxygen saturation, epworth sleepiness scale score of patients before and after operation ( F=109.855, 108.632, 90.565, 27.846, 96.353, 49.969, 48.561, 115.938, 257.762, P<0.05). There were 39 cases with AHI<5 times/hour in the 61 patients who were followed up at 12 month after operation, and the clinical complete response rate of OSAS was 63.93%(39/61). (3) Correlation analysis between obesity indicators and OSAS indicators: results of the Pearson correlation analysis showed that the AHI was positively correlated with the body mass and BMI ( r=0.267, 0.317, P<0.05) and negatively correlated with the ASaO 2 and lowest oxygen saturation ( r=-0.525, -0.551, P<0.05), and there was no correlation between AHI and neck circumference ( P>0.05) in the 74 patients before operation. The lowest oxygen saturation was negatively correlated with the body mass and BMI ( r=-0.330, -0.400, P<0.05), and there was no correlation between lowest oxygen saturation and neck circumference ( P>0.05) in the 74 patients before operation. The AHI was negatively correlated with the ASaO 2 and lowest oxygen saturation ( r=-0.406, -0.373, P<0.05), and there was no correlation between AHI and the body mass, BMI or neck circumference ( P>0.05) in the 61 patients who were followed up at 12 month after operation. There was no correlation between lowest oxygen saturation and the body mass, BMI or neck circumference ( P>0.05) in the 61 patients who were followed up at 12 month after operation. (4) Analysis of factors influencing the postoperative efficacy of OSAS: results of the multivariate analysis showed that preoperative AHI was an independent influence factor for postoperative efficacy of OSAS ( hazard ratio=1.039, 95% confidence interval: 1.016-1.063, P<0.05). Conclusion:LSG can effectively reduce the body mass and improve OSAS of patients with obesity complicated with OSAS in the short term.