Objective:To evaluate a novel anti-reflux sleeve gastrectomy (LSGFD) in comparison with laparoscopic sleeve gastrectomy combined with hiatal hernia repair (LSG+HHR) for the treatment of obesity-combined gastroesophageal reflux disease (GERD).Method:Seventy-three patients admitted at Xinjiang Uygur Autonomous Region People's Hospital from Jan 2020 to Jan 2022 underwent LSGFD(41 cases) or LSG+HHR(32 cases), and the patients' preoperative and 1-year postoperative GERD questionnaire scores (Gerd-Q), acidometry and manometry and other relevant clinical data were collected and compared.Results:The postoperative BMI of the two groups was significantly lower than that of the preoperative period, and the difference was statistically significant ( P<0.05); the comparison of the percentage of postoperative body mass loss between the two groups was not statistically significant ( P>0.05). Differences in postoperative Gerd-Q score, acid reflux analysis and esophageal dynamics analysis of the two groups were statistically significant compared with the preoperative period ( P<0.05), DeMeester score of LSGFD decreased significantly compared with that of LSG+HHR ( P<0.05). There was no significant difference in intraoperative blood loss, hospitalization time and duration of the operation between the two groups ( P>0.05) The incidence of post-discharge complications (nausea or vomiting, anemia) and the recurrence rate of GERD were lower in the LSGFD group,though there was no statistically significant difference ( P>0.05). Conclusion:LSGFD is better than LSG+HHR in treating obesity combined with GERD.

Objective To investigate the effect of laparoscopic Roux-en-Y gastric bypass surgery(LRYGB)in the treatment of obese diabetes.Methods The clinical data of 20 obese diabetic patients who received LRYGB from 2012 to 2018 in the Minimally Invasive and Herniac Abdominal Surgery Center of Xinjiang People's Hospital were retrospectively analyzed.Result The all 20 surgeries were successfully completed,and 1 case was converted to open surgery.The surgical time ranged from 60 to 420 minutes,with an average of(150±105.64)minutes,the intraoperative blood loss ranged from 20 to 100,with an average of(37.5±20.99)ml,and the postoperative hospital stay ranged from 5 to 15,with an average of(8.25±2.51)days.Complications occurred in 7 cases(35.00％)within 5 years after surgery,all of which were Clavien Dindo grade Ⅱ.The body weight,BMI,glycosylated blood glucose,fasting blood glucose,and the percentage of total weight loss(TWL％)at 1,3,and 5 postoperatively improved compared with those before surgery(P＜0.05).15 cases(75.00％)of type 2 diabetes were completely relieved by LRYGB 5 years after operation.Conclusion Laparoscopic gastric bypass surgery is an effective way to reduce weight and blood sugar in obese patients with type 2 diabetes.

Objective To investigate the levels of γδ T cells and their subpopulations in bone marrow(BM)of patients with myelodysplastic syndrome(MDS),it aims to explore the immune deficiency status of BM microenvi-ronment in MDS patients.Methods BM samples were collected from MDS patients before and after treatment,as well as from normal donors.Multicolor flow cytometry was utilized to detect bone marrow γδ T cells and subpopulation levels.The changes of the T cell subsets after treatment were also analyzed.Results The levels of BM γδ T cells and follicular helper γδ T cells from MDS patients were significantly lower than those of normal donors(P<0.05).Among γδ T cells at different stages of differentiation,only the frequencies of na?ve γδ T cells from MDS patients decreased significantly(P = 0.037),and there was no significant difference observed about central memory,effector memory,and terminally differentiated γδ T cells in MDS patients compared to normal donors(P>0.05).Although there was a slight decrease in PD1+γδ T cells and an increase in TIM3+γδ T cells,these differences were not statistically significant(P>0.05).In patients who achieved a curative effect,the proportions of γδ T cells and naive γδ T cells increased significantly after treatment,and the effector memory γδ T cells decreased significantly after treatment(P<0.05).After treatment,85.71%(6/7)of MDS patients showed a decrease in γδ+TIM3+ T cell levels to varying degrees.Conclusions The levels of γδ T cells and their subpopulations in the BM microenvironment of patients with MDS exhibit varying degrees of abnormalities.However,in patients who receive effective treatment,these abnormal γδ T cells can recover.By detecting the levels of γδ T cells and subpopulations,we can gain insights into the immune deficiency status of MDS.This information might serve as an indicator to assess treatment efficacy and provide valuable insights for anti-tumor immunotherapy.

More and more cases of aldosterone-and cortisol-producing adenoma (A/CPA) have been reported in recent years.In order to further understand the clinical characteristics of patients with A/CPA,we report 2 cases of A/CPA treated in our hospital,and analyzes them in combination with domestic reports.We recommend that clinicians routinely perform Low Dose Dexamethasone Suppression Test on every primary aldosteronism patient prior to adrenal vein sampling (AVS) or adrenal adenoma surgery to rule out the possibility of Cushing's syndrome so as to avoid the wrong judgment of AVS results and avoid adrenal hypofunction or adrenal crisis after operation.

Objective: To investigate the effects of artesunate treatment on chronic graft-versus-host disease (cGVHD). Methods: Recipient BALB/c mice received 8 × 10⁶ bone marrow cells with 8×10⁶ spleen cells from B10D2 mice. Artesunate solubilized in acetone was injected intraperitoneally every day at the dose of 1 mg/kg at Day 28 after BMT. The clinical scores, survival and histopathological damage were analyzed. The frequency of Th17 and Tregs in PB and spleens from the mice were evaluated by flow cytometry. In addition, CD4⁺ T cells from the spleens of mice were cultured in vitro, then stimulated with artesunate, the frequency of Th17 and Tregs in these splenocytes were evaluated by flow cytometry. Results: Artesunate administration diminished clinical and histopathological damage, and improved the survival of cGVHD mice[(46.57±7.83)% vs (55.71±6.99)%, χ²=5.457, P=0.020]; Artesunate contributed to Tregs development [(4.45±0.04)% vs (8.40±0.23)%, t=15.679, P<0.001; (6.62±0.24)% vs (10.48±0.48)%, t=6.587, P=0.003] while decreased Th17 cells [(1.51±0.18)% vs (0.58±0.19)%, t=7.233, P<0.001; (1.48±0.38)% vs (0.71±0.18)%, t=3.653, P=0.011] expressions in both PB and spleens, and decreased the Th17/Treg ratio (0.34±0.05 vs 0.09±0.03, t=7.621, P=0.002; 0.19±0.03 vs 0.06±0.02, t=6.993, P=0.002). Moreover, artesunate suppressed the Th17 cells expressions [(0.82±0.37) % vs (3.39±1.22) %, t=4.044, P=0.007] and contributed to Tregs development [(34.63±1.29) % vs (14.28±1.69) %, t=19.119, P<0.001], and also decreased the Th17/Treg ratio (0.24±0.09 vs 0.02±0.01, t=4.780, P=0.003) in vitro. Conclusions Artesunate suppressed the Th17 cells expressions and contributed to Tregs development, which provided new sights into the development of a novel drug for cGVHD, e.g., artemisinin.

Objective: To monitor the WT1 mRNA level and its dynamic changes in patients with myelodysplastic syndromes (MDS) after hypomethylating agents (HMA) , as well as to assess the significance of WT1 mRNA levels and its dynamic changes in evaluating the efficacy of HMA and distinguishing the disease status of heterogeneous patients with stable disease (SD) . Methods: Bone marrow or peripheral blood samples of 56 patients with MDS who underwent hypomethylating agents (≥4 cycles) from November 2009 to March 2018 were tested by real-time quantitative polymerase chain reaction (PCR) to detect the expression of WT1 mRNA, and to observe the correlation between the dynamic changes of WT1 mRNA expression and clinical efficacy and prognosis of patients. Results: WT1 mRNA expression levels of MDS patients decreased significantly after 3 cycles of hypomethylating agent treatment. Besides, the WT1 mRNA expression levels of patients increased significantly after diseases progression. According to the dynamic changes of WT1 mRNA expression levels during SD, 45 cases could be further divided into increased group and non-increased group. In those SD patients with increased WT1 mRNA expression level, the ratio of suffering disease progression or transformation to AML was 95.65% (22/23) , whereas the ratio turned to be 9.09% (2/22) for the non-increased group (χ²=33.852, P<0.001) . Compared with those SD patients reporting no increase in WT1 mRNA expression level, the overall survival[17 (95%CI 11-23) months vs not reached, P<0.001] and progression-free survival [13 (95%CI 8-18) months vs not reached, P<0.001] of those SD patients reporting increase in WT1 mRNA expression level were significantly shorter. Conclusion WT1 mRNA expression level is a useful indicator to assess the efficacy of hypomethylating agents in MDS patients. Especially in patients with SD, detection of the changes in WT1 mRNA expression level is able to predict disease progression and help to make clinical decision.

Objective:To investigate the development status of mental health service of Shanghai mental health agencies,and to provide reference for further strengthening the standardized management of service agencies.Methods:In Shanghai,107 mental health service agencies (including psychiatric institutions,non-specialist medical institutions,non-specialist enterprise and public institutions,social institutions) were selected from Shanghai psychological service industry association.Each person in charge of these agencies was interviewed with an adapted 5 l-item questionnaire.A total of 89 valid questionnaires were collected.In this study,25 items of the questionnaire (belonging to the parts of agency information,mental health service situation and management of mental health service) were selected and analyzed.Results:All the surveyed agencies had been registered.The average age of these agencies for setting up mental health service was 8.9 years,and the average age of psychiatric institutions was the longest (18.6 years).Besides,psychiatric institutions attracted most of the clients (83.9％) in 2015.Among the professionals,only 32.5％ were full time,74.0％ were female,41.5％ were between 31 and 40 years old and 63.8％ were undergraduates.Psychiatrists,psychotherapists,counselors and psychometric person accounted for 78.0％ of the professionals in these agencies.Only 52.3％ of the agencies had full-time management personnel for mental health service.The most used method of assessing the quality of service and staff assessment was to obtain feedback from the client/family members (81.0％) and the assessment of the services (78.8％).Conclusion:The development of mental health service in Shanghai mental health agencies has been more normalized,but there is still a lack of full-time professionals.In addition,there is a lack of unified supervision and management mechanism for professionals.

Objective:To understand the status of supervision of mental health service industry in Shanghai, and to provide reference for further strengthening the construction of mental health service system in Shanghai. Methods: In Shanghai, 107 mental health service agencies (including psychiatric institutions, non-specialist medical institutions, non-specialist enterprise and public institutions, social institutions) were selected from Shanghai psychological service industry association. The survey was conducted with the Questionnaire on Current Situation of Mental Health Professional Service Agencies in Shanghai (agency survey), including the "relevant information of agency" and the "management of the agency in the field of mental health services"(whether the agency had supervision requirements on the mental health service personnel, whether the agency organized supervision, the source of supervisors and payment method), and the Questionnaire on Current Situation of Mental Health Service Professionals in Shanghai (professional survey), including "basic information on demography "and" psychological professional work" (the number of hours of supervision in 2015, the cost of supervision, and the form of supervision and payment method). These two parts of questionnaire were selected and analyzed. Results: Agency survey results showed that 80％ of non-specialist enterprises had no supervision requirements for mental health service personnel, supervisor in non-specialist medical institutions were mainly from psychiatric institution (52.9％). The cost of supervision in most psychiatric institutions was paid by the agency (39.1％) and the cost of supervision in most public institutions was paid by professional (37％). The professional institutions under the jurisdiction of other departments within the unit required less supervision of the professional staff than the independent institutions (P ＜ 0.001). Professional survey results showed that the number of supervision hours of mental health service professional in social institutions was more than that in the other three types of institutions (P ＜0.001), of which 47.9％ chosen to pay the cost of supervision by themselves. The proportion of their own payment in social institutions was higher than that in the other three types of institutions (P ＜0.001). Conclusion:The social institutions in Shanghai have the best supervision of social institutions, followed by the supervision of the medical institutions. The supervision of non-medical enterprises and their personnel needs to be improved.

Objective To analyze the stress distributions under static loading and impact simulation in the process of tibial plateau fracture using finite element analysis,providing evidence for individualized diagnosis and treatment of tibial plateau fracture.Methods A healthy male volunteer was recruited.A 3D finite element model of a whole knee joint with ligaments,menisci and articular surfaces was generated using CT,MRI and 3D finite element software.The knee joint model was given the nature and parameters after reconstruction.According to the features of tibial plateau fracture,different operating conditions were designed.The stress distributions under static loading and impact simulation in the process of tibial plateau fracture were characterized by finite element analysis.Results Under static loads on the lateral condyle of the tibia,the stress was mainly concentrated on the front edge of the tibial plateau,especially the lateral stress.The stress on the medial condyle of the tibia was significantly increased,and the medial stress extended downwards to the tibial shaft.When the vertical stress moved towards outside,it extended from both sides of the internal and external condyles downwards to the tibia,and the value of lateral platform stress was slightly larger than that on the inside.In collisions,the stresses distributed on the neutral position were the same with the static loads.The stress on the medial condyle of the tibia was significantly increased,extending downwards the tibial shaft when it fell to the inside slope.When it fell to the outside slope,the stress on the tibial plateau was mainly distributed on most of the front edges of lateral and medial platforms,and the stress distributed on the fibula increased obviously.Conclusions The medial tibial plateau plays a major role in bearing stress loads.The stress is more concentrated on the lateral platform but distributed on a larger area of the medial platform,extending downwards the metaphysis.Therefore,small split fractures are likely to occur on the outer edge of the platform while fractures of a large fragment are likely to occur on the medial platform,even involving the metaphysis.

AIM:To investigate the expression and potential role of complement 5a receptor (C5aR) in chro-nic graft-versus-host disease (cGVHD).METHODS:The expression of C5aR on lymphocytes and the frequency of CD4+CD25+ Foxp3+ regulatory T cells (Tregs) in 20 cGVHD patients and 9 healthy donors was detected by flow cytometry.The correlation between the expression of C5aR and the percentage of Tregs in the cGVHD patients was analyzed.In addition, the splenocytes from the mice were cultured in vitro, and stimulated these splenocytes with recombinant mouse C5a protein (rmC5a).The peripheral blood mononuclear cells (PBMCs) from cGVHD patients were cultured in vitro, which was inhibited by C5aR antagonist (C5aRA).The frequency of Tregs in these splenocytes and the PBMCs were evaluated by flow cytometry.RESULTS:The expression of C5aR on the lymphocytes was significantly increased in the cGVHD patients compared with the healthy donors, while the percentage of Tregs was markedly lower in the cGVHD patients.The expression of C5aR was negatively correlated with the percentage of Tregs.Furthermore, the development of Tregs was suppressed by rmC5a stimulation, but was promoted by C5aRA in vitro.CONCLUSION:C5aR elevation is associated with Treg reduction in cGVHD, indicating that C5aR may play a potential role in suppressing Tregs, resulting in the incidence of cGVHD.