[Summary] The incidence of obesity and obesity‐related diseases (such as T2DM) increases year by year in the world. Metabolic surgery has increasingly been applied to patients with severe obesity. Studies have indicated that metabolic surgery is effective in obesity and obesity‐related diseases. Since patients undergoing metabolic surgery are obese or severely obese ,whose physiological and pathological changes are different with those of non‐obese patients ,a comprehensive assessment and management during perioperative period and after the operation were needed. This article mainly expounds preoperative evaluation and preparation ,management of surgery process and postoperative nutrition and endocrine management.

Objective To explore the metabolic characteristics of rheumatoid arthritis (RA) patients with type 2 diabetes (T2DM) and provide evidence for the management of cardiovascular risk factors. Methods One hundred and four RA patients with T2DM and 100 healthy subjects with matched age and sex were the subjects of study. The metabolic parameters of the two groups was compared and the ratio of metabolic abnormalities in RA with T2DM group was analyzed. Comparisons between groups were analyzed by t-test and Chi-square analysis. Results The average duration of RA and T2DM were (8±6) and (10±5) years respectively; 55.8% patients with CRP>10 mg/L and 72.1% patients with ESR>30 mm/1 h. There was no significant difference in body mass index between the two groups [(23.3 ±3.1) kg/m2 vs (23.4 ±2.8) kg/m2, P=0.991]. The systolic blood and diastolic blood pressures of RA patients with T2DM were significantly higher than those of the control group (P<0.01). There was no significant difference in blood uric acid [(0.27 ± 0.11) mmol/L vs (0.27 ±0.12) mmol/L, P=0.957]. There was no significant difference in the levels of total cholesterol (TC) [(4.6 ±1.0) mmol/L vs (4.5 ±0.5) mmol/L, P=0.547], but the levels of triglyceride (TG), high density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) [TG (1.4±0.8) mmol/L vs (1.1 ±0.3) mmol/L, t=2.871, P=0.005; HDL-C (1.1 ±0.3) mmol/L vs (1.5 ±0.4) mmol/L, t=-7.064, P<0.01;LDL-C (2.6±0.8) mmol/L vs (2.4±0.4) mmol/L, t=2.003, P=0.047] were significantly different in the two groups. 36.5% patients were with hypertension, 17.3% patients were with high TC, 30.7% patients were with high TG, 26.9% patients were with low HDL-C, and 27.8% patients were with high LDL-C. Conclusion High incidence of hypertension, poor blood sugar control, and lipid metabolism disorders are prominent metabolic disorders in RA patients with T2DM. Clinicians, particularly rheumatologists, need to give adequate attention to these conditions.

Objective To investigate the effects of Dishevelled (DVL) on apoptosis of diffuse large B-cell lymphoma (DLBCL) cell line OCI-Ly10, and to explore its possible mechanism. Methods Lentivirus plasmid overexpressing DVL2 was constructed, and after virus was packaged, it was transfected into OCI-Ly10 cells. Flow cytometry was used to detect the apoptosis rate of OCI-Ly10 cells with or without the stimulation by TNF-α recombinant protein. Then the gene expression of anti-apoptotic genes, GADD45β and A20, in NF-κB pathway was detected by RT-PCR. Results The virus was sucessfully transfected into OCL-Ly10 cells which overexpressed DVL2. The apoptosis rate of OCL-Ly10 cells overexpressing DVL2 without the stimulation by TNF-α was increased compared with that of the negative control group [(15.46 ±2.37) % vs. (11.72±3.53)%, P=0.03], the A20 mRNA expression level was decreased compared with that of the negative control group [(0.66 ±0.01) vs. 1, P=0.04], and the relative expression level of GADD45β mRNA was not significantly decreased compared with that of the negative control group [(0.79 ±0.15) vs. 1, P=0.642]. The apoptosis rate of DVL2 overexpression OCI-Ly10 cells stimulated by TNF-α was significantly higher than that of the negative control group treated by TNF-α [(22.78±4.56)%vs. (12.79±2.89)%, P=0.007]. The gene expression of A20 and GADD45β in DVL2 overexpression cells stimulated by TNF-α was significantly increased, however, the magnitude of increase in DVL2 overexpression cells was less than that in the negative control group treated by TNF-α [A20: (3.75 ±0.14) times vs. (6.89 ±0.10) times, P=0.008; GADD45β:(4.750±0.21) times vs. (6.14±0.08) times, P=0.03]. Conclusion DVL can promote the apoptosis of OCI-Ly10 cells, and its mechanism may be related with anti-apoptotic genes that inhibits its downstream via NF-κB pathway.

BACKGROUND:Under hypoxic environment, hypoxia inducible factor-1 plays an important role in regulation of hypoxia-induced gene expression in the intervertebral disc. Hypoxia-inducible factor-1 consists of α and βsubunits, and which hypoxia inducible factor-1α determines the stability and activity of hypoxia-inducible factor-1. OBJECTIVE: To observe the expression of hypoxia inducible factor-1α in the human lumbar nucleus pulposus of different herniated types and to judge their relationships. METHODS:A total of 60 nucleus pulposus samples were harvested from the lumbar vertebra, including 41 from L4-5 and 19 from L5-S1, and then divided into protruded group and sequestered group, with 30 cases in each group. Meanwhile, another 10 samples of lumbar nucleus pulposus served as controls. Hematoxylin-eosin staining and streptavidin-biotin peroxidase complex immunohistochemical technique were used to observe the expression of hypoxia inducible factor-1α in the human lumbar nucleus pulposus in different groups. RESULTS AND CONCLUSION:The expression level of hypoxia inducible factor-1α was (58.2±7.5)% in the sequestered group, (27.3±2.3)% in the protruded group, and (10.5±4.7)% in the control group, which was significantly higher in the sequestered group than the other two groups (P < 0.01). These findings indicate that the expression of hypoxia inducible factor-1α in the lumbarnucleus pulposus is associated with the herniated types, which is the highest in the prolapse sequestered type.

BACKGROUND:Under hypoxic environment, hypoxia-inducible factor 1α plays a dualregulatory role in cel apoptosis. Severity of hypoxia is the key to determine whether cels appear to have apoptosis or adapt to survive. When the cels are exposed to chronic or extreme hypoxia, a lack of protection mechanisms from hypoxia-inducible factor-1α can induce cel apoptosis. OBJECTIVE: To research the expression of hypoxia-inducible factor 1α in human lumbar nucleus pulposus of different herniated types and its relationships with cel apoptosis. METHODS: The nucleus pulposus was harvested from 60 cases of herniation of lumbar intervertebral discs, L4-5 in 41 cases and L5-S1 in 19 cases. The nucleus pulposus tissues were equaly divided into protruded and sequestered groups. Meanwhile, the nucleus pulposus tissues from another 10 cases of lumbar spine fracture were taken as control group. Expression of hypoxia-inducible factor 1α and apoptosis of lumbar nucleus pulposus cels were observed and detected with immunohistochemical technique and TUNEL method. Correlation of hypoxia-inducible factor 1α and apoptosis in human lumbar nucleus pulposus of different herniated types was analyzed. RESULTS AND CONCLUSION: The expression of hypoxia-inducible factor 1α was visualized in each case, but it was significantly higher in the sequestered group than in the protruded group and control group (P < 0.01). Apoptosis of nucleus pulposus cels were found in al the three groups, but the apoptotic rate was also higher in the sequestered group than in the protruded group and control group (P < 0.01). Expression of hypoxia-inducible factor 1α was positively correlated with cel apoptosis in human lumbar nucleus pulposus (P < 0.01). Overal, the expression of hypoxia-inducible factor1α in degenerative human lumbar nucleus pulposus is associated with herniated types, which is the highest in the sequestered type. The relationship between hypoxia-inducible factor 1α and apoptosis is positive.

Objective To investigate what kind of obese patients appropriate to adopt the laparoscopic adjustable gastric banding volume reduction surgery.Methods A retrospective study was performed to review the clinical data of 40 patients who required reoperation to remove the gastric banding after LAGB from November 2003 to March 2013 at the Department of Minimally Invasive Surgery,Changhai Hospital.Selected 40 patients who required LAGB from January 2006 to October 2008 as control group.We conducted a case-control study to analyze.Chi-square test and multivariate and non-conditional Logistie regression analysis were used to identify the risk factors of removing of gastric banding.Results Age and gender were not statistically significant different (P ＞ 0.05).Multiple factors of Logistic regression showed that BMI≥35 kg/m2,postoperative clinic visits per year ＜ 3 and on the basis of gastrointestinal disease were risk factors for the removal of gastric banding (Wald =3.908,7.375,5.209,P ＜ 0.05).Conclusion The risk factors for the removal of gastric banding include BMI,postoperative clinic visits and the basis of gastrointestinal disease.In the treatment of obesity with LAGB should take full account of the above factors.

BACKGROUND: The spinal instability would accelerate the degeneration of normal disk. The injuries of anterior longitudinal ligament (ALL) and intervertebral disk were usually caused by cervical trauma, which leaded to spinal instability. Currently, there were few animal researches about the degeneration of injured intervertebral disk affected by ALL destruction.OBJECTIVE: To investigate the degeneration of injured intervertebral disk after spinal instability in the rabbit model of different degrees of ALL and disc destruction.METHODS: A total of 24 New-Zealand rabbits were randomly divided into intervertebral disk injury group (Group A, n=6), partial injury of ALL with disc injury group (Group B, n=6), injury of bony attachment point of ALL with disc injury group (Group C, n=6) and entirely injury of ALL with disc injury group (Group D, n=6). The L2-L3 intervertebral disk and ALL were injured through abdominal cavity. Different groups received different treatments. Computed tomography (CT) scans of the injured disc were performed at the postoperative 4 and 8 weeks, and the middle high of injured discs was calculated on CT sagittal reconstruction. Three rabbits were selected from each group. Hematoxylin-eosin staining of injured disc was performed after the animals were killed. Results were examined under the light microscope.RESULTS AND CONCLUSION: (1) At postoperative 4 weeks, the middle height of injured discs in Group D was decreased significantly compared with Group A (P < 0.05). There were hyperosteogeny and calcification in Group C and Group D. There were nucleus pulposus cells reduction and inflammatory reaction in Group C and Group D on histological staining. (2) At postoperative 8 weeks, the middle height of injured discs respective was decreased significantly compared with Group A (P < 0.05). The hyperosteogeny and calcification became clearer in Group C and Group D than before. There were morphologic changes of nucleus pulposus cells and fibrillation by hematoxylin-eosin staining, and the degree of disc degeneration was Group D > Group C > Group B > Group A. (3) In conclusion, the injury of ALL would accelerate the degeneration of correspondingly injured disk, and the degree of injury of ALL was positively correlated with the degeneration of disk.

BACKGROUND:Endogenous hydrogen sulfide can be used as a new gaseous signaling molecule, and has important signal transfer function and biological regulation effects. OBJECTIVE:To study the neuroprotective effects of hydrogen sulfide in rats with acute cauda equina syndrome. METHODS: The 72 Sprague-Dawley rats were randomly assigned to three groups. Experimental group, model group: laminectomy was performed at the lumbar 4 (L4) level of the vertebra, and a piece of silicone (10 mm long, 1 mm thick, and 1 mm wide) was placed under the laminae of the L5-6 vertebra to produce the animal model of cauda equina syndrome. Sham surgery group: a simple laminectomy was performed in L4, but silicone was not implanted. In the experimental group, 20 μmol/kg NaHS was injected intraperitonealy at 1 hour before model establishment. Model and sham surgery groups: an equal volume of saline was injected intraperitonealy. At 12, 24, 48 and 72 hours after model establishment, malonaldehyde and glutathione levels in cauda equina nerve tissue were detected. Simultaneously, hematoxylin-eosin staining and TUNEL staining were performed at 48 hours. RESULTS AND CONCLUSION:Hematoxylin-eosin staining demonstrated that cauda equina nerve tissue was dense and regular, with complete myelin sheath, no axon sweling in the sham surgery group. Cauda equina nerve tissue was sparse, with the presence of demyelination, and partial axons and myelin sheath sweling in the model group. Cauda equina nerve tissue was tight, with axonal sweling and demyelination in the experimental group. TUNEL staining demonstrated that the number of positive cels was less in the spinal cord and dorsal root ganglia in the sham surgery group. Abundant positive cels were detected in the spinal cord and dorsal root ganglia in the model group. The number of positive cels was significantly lower in the experimental group than that in the model group. Malonaldehyde levels were lower in the sham surgery and experimental groups than in the model group (P < 0.05, P < 0.01), but glutathione levels were higher than model group (P < 0.05,P < 0.01). These results indicated that hydrogen sulfide could decrease oxidative stress and protect cauda equina nerve in rats with acute cauda equina syndrome.

BACKGROUND:The methylprednisolone pulse therapy in early period of spinal cord injury can attenuate the pathological degree of spinal cord injury, however no breakthrough was found within recent 20 years.
OBJECTIVE:To observe the protection effects of sodium aescinate on the nerve cellapoptosis and expression of glial fibrial ary acidic protein (GFAP) in the early spinal cord injured rats.
METHODS:Spinal cord injury models were established with the modified Al en’s method in 180 Sprague-Dawley rats, and were randomly divided into three groups, with 60 rats in each group. Immediately after injury, the rats in three groups were intraperitoneal y injected with sodium aescinate (5 mg/kg), methylprednisolone (100 mg/kg) and equal saline, respectively, once per day. At 8 hours, 24 hours, 96 hours and 7 days, 14 days after injury, rats were sacrificed and the injured segments were resected for hematoxylin-eosin staining and immunohistochemical staining, the nerve cellapoptosis and GFAP expression were detected.
RESULTS AND CONCLUSION:The apoptotic nerve cells were seen at 8 hours after injury and the number of apoptotic cells reached the peak at 7 days, the edema was attenuated at 14 days without less nerve cellapoptosis in al groups, significantly fewer apoptotic nerve cells can be seen in sodium aescinate and methylprednisolone groups compared with the control group (P<0.05) at each time. The expression of GFAP was increased in the time dependant manner in al groups, the increase was slow in methylprednisolone group but sharp in sodium aescinate group and control group within 96 hours. There was no difference between control group and sodium aescinate group within 24 hours (P>0.05), which was lower than methylprednisolone group (P<0.05);after 96 hours, methylprednisolone group and sodium aescinate group were both significantly lower than control group (P<0.05). Furthermore, the decreasing expression was observed in al groups after 7 days. Sodium ascinate has obvious protection effects on nerve cells in spinal cord injured rats and promotes neurological function through decreasing GFAP expression after injury. The efficacy of sodium ascinate is equal to that of methylprednisolone within 2 hours.

Objective To optimize the culture method for rheumatoid arthritis fibroblast-like synoviocytes in vitro,and observe the effect of Dishevelled (Dvl) 2 on vascular endothelial growth factor (VEGF) in rheumatoid arthritis fibroblast-like synoviocytes (RA-FLS).Methods Synovium from RA patients who underwent knee arthroplasties were cut into small piece,and RA-FLS were isolated and cultured in vitro using tissue block method.Dvl 2 lentivirus overexpressing plasmid was constructed and transfected into RAFLS.Q-polymerase chain reaction (PCR) and enzyme linked immunosorbent assay (ELISA) were used to detect the mRNA and protein expression levels of VEGF.Then we used 10 ng/ml tumor necrosis factor (TNF)-α recombinant protein to stimulate the transfected RA-FLS.24 h after stimulation,mRNA and protein expression of VEGF were detected again.Student's t test was used for two group analyses.Results RA-FLS was successfully isolated and cultured in vitro.The multiplicity of infection was 30 and was in conjunction with appropriate concentration of polybrene to promote transfection.Transfection efficiency could meet the test requirements.The mRNA of Dvl 2 increased for 79-fold than the control group.Compared with the control group,Dvl 2 could mildly inhibit RA-FLS secretion of VEGF.After TNF-α stimulation,Dvl 2 could significantly inhibit the VEGF's mRNA (2.15±0.10,2.92±0.47 fold,t=-3.924,P=0.003) and protein [(285±100) pg/ml,(155±61) pg/ml,t=-2.714,P=0.022] expression compared with the control group.Conclusion Dvl 2 can inhibit the effect of TNF-α induced secretion of VEGF in RA-FLS.The specific mechanism needs further study.