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.

Objective:To investigate the changes in plasma ghrelin and influencing factors of weight loss effects after laparoscopic sleeve gastrectomy combined with fundoplication surgery (LSGFD).Methods:The retrospective cohort study was conducted. The clinical data of 115 obesity patients who were admitted to the People′s Hospital of Xinjiang Uygur Autonomous Region from April to June 2023 were collected. There were 37 males and 78 females, aged (37±9)years. Of 115 pati-ents, 93 cases undergoing laparoscopic sleeve gastrectomy (LSG) were divided into the LSG group, and 22 cases undergoing LSGFD were divided into the LSGFD group. Measurement data with normal distribution were represented as Mean± SD, and the independent sample t test was used for com-parison between groups. Count data were described as absolute numbers, and the chi-square test was used for comparison between groups. Repeated measurement data were analyzed using the repeated ANOVA, and their variances were tested using a spherical test. The Logistic regression model was used for univariate and multivariate analyses. Results:(1) Changes in preoperative and postoperative plasma ghrelin in two groups of patients. The plasma ghrelin of patients at preopera-tive and postoperative 6 months changed from (16±14)×10 2 ng/L to (10±4)×10 2 ng/L in the LSG group and changed from (12±11)×10 2 ng/L to (11±3)×10 2 ng/L in the LSGFD group. There was no significant difference in the time effect, inter group effect, and interaction effect of changes in plasma ghrelin between the LSG group and the LSGFD group before and after surgery at 6 months ( Ftime=2.199, Fgroup=0.001, Finteraction=0.793, P>0.05). There was a significant difference in plasma ghrelin in the LSG group before and after surgery at 6 months ( t=4.148, P<0.05), and there was no significant difference in plasma ghrelin in the LSGFD group before and after surgery at 6 months ( t=0.622, P>0.05). (2) Changes in preoperative and postoperative weight loss and metabolic related indicators in two groups of patients. ① There was a significant difference in the time effect of changes in body mass between the LSG group and the LSGFD group before and after surgery at 6 months ( Ftime=242.285, P<0.05), and there was no significant difference in the inter group effect and interaction effect of changes in body mass between the LSG group and the LSGFD group before and after surgery at 6 months ( Fgroup=1.163, Finteraction=0.606, P>0.05). There were significant differences in body mass in the LSG group or the LSGFD group before and after surgery at 6 months ( t=23.597, 14.680, P<0.05). ② There was a significant difference in the time effect of changes in body mass index (BMI) between the LSG group and the LSGFD group before and after surgery at 6 months ( Ftime=382.431, P<0.05), and there was no significant difference in the inter group effect and interaction effect of changes in BMI between the LSG group and the LSGFD group before and after surgery at 6 months ( Fgroup=1.619, Finteraction=1.085, P>0.05). There were significant differences in BMI in the LSG group or the LSGFD group before and after surgery at 6 months ( t=25.645, 16.628, P<0.05). ③ There was a significant difference in the time effect of changes in excess weight loss (%EWL) between the LSG group and the LSGFD group after surgery at 1 to 6 months ( Ftime=666.136, P<0.05), and there was no significant difference in the inter group effect and interaction effect of changes in %EWL between the LSG group and the LSGFD group after surgery at 1 to 6 months ( Fgroup=0.127, Finteraction=0.498, P>0.05). ④ There was no significant difference in the time effect, inter group effect, and interaction effect of changes in fasting blood glucose between the LSG group and the LSGFD group before and after surgery at 6 months ( Ftime=1.573, Fgroup=1.872, Finteraction=0.948, P>0.05). There was a significant difference in fasting blood glucose in the LSG group before and after surgery at 6 months ( t=2.675, P<0.05), and there was no significant difference in fasting blood glucose in the LSGFD group before and after surgery at 6 months ( t=1.074, P>0.05). ⑤ There were significant differences in the inter group effect and interaction effect of changes in triglyceride between the LSG group and the LSGFD group before and after surgery at 6 months ( Fgroup=8.419, Finteraction=3.180, P<0.05), and there was no significant diffe-rence in the time effect of changes in triglyceride between the LSG group and the LSGFD group before and after surgery at 6 months ( Ftime=1.398, P>0.05). Results of individual effect shown that there was no significant difference in triglyceride in the LSG group or the LSGFD group before and after surgery at 3 months ( F=2.956, 3.248, P>0.05), and there were significant differences in trigly-ceride in the LSG group or the LSGFD group after surgery at 1 month and 6 months ( F=14.152, 3.477, P<0.05). There was a significant difference in triglyceride in the LSG group before and after surgery at 6 months ( t=3.164, P<0.05), and there was no significant difference in triglyceride in the LSGFG group before and after surgery at 6 months ( t=0.023, P>0.05). ⑥ There were significant differences in the time effect and inter group effect of changes in total cholesterol between the LSG group and the LSGFD group before and after surgery at 6 months ( Ftime=3.662, Fgroup=7.591, P<0.05), and there was no significant difference in the interaction effect of changes in total cholesterol between the LSG group and the LSGFD group before and after surgery at 6 months ( Finteraction=0.626, P>0.05). There was a significant difference in cholesterol in the LSG group before and after surgery at 6 months ( t=3.253, P<0.05), and there was no significant difference in total cholesterol in the LSGFG group before and after surgery at 6 months ( t=1.567, P>0.05). ⑦ There were significant differences in the time effect and inter group effect of changes in uric acid between the LSG group and the LSGFD group before and after surgery at 6 months ( Ftime=15.306, Fgroup=4.244, P<0.05), and there was no significant difference in the interaction effect of changes in uric acid between the LSG group and the LSGFD group before and after surgery at 6 months ( Finteraction=0.968, P>0.05). There were significant differ-ences in uric acid in the LSG group or the LSGFG group before and after surgery at 6 months ( t=6.152, 3.660, P<0.05). (3) Analysis of influencing factors on postoperative weight loss effects. Results of multivariate analysis showed that preoperative BMI, postoperative 6 months plasma ghrelin were independent protective factors for postoperative weight loss effects ( odds ratio=0.881, 0.673, 95% confidence interval as 0.817-0.950, 0.577-0.787, P<0.05). Conclusions:The decrease in plasma ghrelin in patients after LSGFD is not as obvious as that in patients after LSG, but it can achieve the same weight loss and metabolic improvement effects as after LSG. The lower preoperative BMI and postoperative 6 months plasma ghrelin are independent protective factors for postoperative weight loss effects.

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.

Objective: To analyze the short-term clinical effects of robot-assisted and laparoscopic repair of the hiatal hernia. Methods: The clinical data of 56 patients underwent minimally invasive hiatal hernia repair from January 2021 to January 2022 in the Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region were retrospectively analyzed. There were 32 males and 24 females, aging (59.7±10.7) years (range: 28 to 75 years). All patients were divided into laparoscopy group (n=27) and robot group (n=29) according to surgical procedures. Perioperative conditions, hospital stay, and improvement in symptoms before and after surgery were compared between the two groups by the t test, Wilcoxon rank-sum test and χ² test. Results: All surgical procedures were successfully completed, without conversion to laparotomy or change in operation mode. There were no serious complications related to the operation. The intraoperative blood loss of the robot group was less than that of the laparoscopic group (M (IQR)): (20 (110) ml vs. 40 (80) ml, Z=-4.098, P<0.01). The operation time ((111.7±33.6) minutes vs. (120.4±35.0) minutes, t=-0.943, P=0.350) and hospitalization time ((3.9±1.4) days vs. (4.7±1.9) days, t=-1.980, P=0.053) of the robot group and the laparoscopic group were similar. Follow-up for 12 months after the operation showed no postoperative complications and recurrence. The score of the health-related quality of life questionnaire for gastroesophageal reflux disease in the robot group decreased from 10.8±2.8 before the operation to 6.5±0.6 after the operation, and that in the laparoscopic group decreased from 10.6±2.1 before the operation to 6.3±0.6 after the operation. There was no difference in the influence of different surgical methods on the change in score (t=0.030,P=0.976). Conclusion: Compared with laparoscopic repair of the hiatal hernia, robot-assisted hiatal hernia repair has the advantages of less bleeding, rapid postoperative recovery and good short-term effect.
Male ; Female ; Humans ; Hernia, Hiatal/complications* ; Retrospective Studies ; Robotics ; Herniorrhaphy/methods* ; Quality of Life ; Laparoscopy/methods* ; Recurrence ; Fundoplication/methods*

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.

Objective To investigate the association of the polymorphisms of the FGB gene rs4220 and rs1044291 loci with plasma fibrinogen (Fg) level and gallstones in Xinjiang, China. Methods Blood samples were collected from 150 Uygur and Han patients with gallstones and 150 Uygur and Han individuals without gallstones who were hospitalized or underwent physical examination in The People's Hospital of Xinjiang Uygur Autonomous Region from December 2017 to May 2020. Plasma Fg level was measured, and based on the previous results of whole exon sequencing of the FGB gene, the SNaPshot method was used to identify the genotype at rs4220 and rs1044291 loci of the FGB gene. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups; a multivariate logistic regression analysis was used to investigate the association between each variable and gallstones. Results For the Chinese Han population, the gallstones group had a significantly higher plasma Fg level than the control group [2.90 (2.43-3.49) g/L vs 2.47 (2.06-3.02) g/L, Z =-3.62, P < 0.01), while there was no significant difference in the Uyghur population. There were no significant differences in the frequencies of genotypes and alleles at the rs4220 and rs1044291 loci of the FGB gene between the gallstones group and the control group in both Uyghur and Han populations (all P > 0.05). For the Chinese Han population, the subjects carrying GG genotype at the rs4220 locus in the gallstones group had a significantly higher plasma Fg level than those in the control group [2.84(2.32-3.61) g/L vs 2.34(2.05-2.75) g/L, Z =-3.04, P < 0.05], and the subjects carrying T genotype at the rs1044291 locus had a significantly higher plasma Fg level than those in the control group (3.08±0.75 g/L vs 2.48±0.48 g/L, t =2.80, P < 0.05). For the Uyghur population, only the subjects carrying A genotype at the rs4220 locus in the gallstones group had a significantly lower plasma Fg level than those in the control group [2.84(2.08-3.06) g/L vs 3.10(2.85-3.98) g/L, Z =-2.41, P < 0.05]. There was no significant difference in plasma Fg level between the subjects carrying different genotypes within the gallstones group or the control group for both Uyghur and Han populations (all P > 0.05). Conclusion The influence of FGB gene polymorphism on plasma Fg level may be associated with race, and FGB gene polymorphisms at the rs4220 and rs1044291 loci may be involved in the pathogenesis of gallstones by regulating Fg level in the population in Xinjiang.

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.

Objective:To investigate the chronic restraint stress induced expressions of acid sensitive receptors and its role in the esophageal inflammation and oxidative stress.Methods:Twenty male specific pathogen free (SPF) Kunming mice were randomly divided into two groups: stress group and control group (each group, n=10). Stress mice were restrained in self-made restraint device for 2 hours per day and lasted for total 14 days. The histopathological changes of esophageal mucosa were observed by hematoxylin eosin (HE) staining under light microscope. The expression of nicotinamide adenine dinucleotide phosphate (Nox-4) was detected by immunohistochemistry, real time fluorescent quantitative polymerase chain reaction (qRT-PCR) and enzyme linked immunosorbent assay (ELISA). The mRNA expressions of acid sensitive receptors were detected by qRT-PCR. Results:HE staining showed that stress mice had obvious infiltrations of neutrophils and eosinophils, and also showed inflammatory change in esophgus, while no significant abnormality was found in the esophagus of control mice. The inflammotory scores in stress group were significantly higher than that in control group ( P<0.001). Immunohistochemistry showed that Nox-4 was mainly expressed in the lamina propria, mucosa and submucosa of esophagus. The mRNA expression levels of Nox-4 in stress group was (2.67±0.62) times higher than control group, with statistically significant difference ( P<0.001). In addition, the plasma concentration of Nox-4 in stress group was significantly higher than that of control group [(0.42±0.01)ng/ml vs (2.13±0.35)ng/ml, P<0.001]. The transcription levels of acid sensitive receptors in stressed mice, such as transient receptor potential vanilloid-1 (TRPV-1), TRPV-4, acid-sensing ion channel-1 (ASIC-1), ASIC-2 and ASIC-3 were significantly higher than those in the control group, with statistically significant difference ( P<0.001). Pearson correlation analysis showed that there was a positive correlation between Nox-4 mRNA expression and TRPV-1, TRPV-4, ASIC-1, ASIC-2, ASIC-3 mRNA expression in stress group ( r=0.97, 0.94, 0.98, 0.95 and 0.99, P<0.01). Conclusions:Stress may increases the expression of acid sensitive receptors and result in an esophageal inflammation and oxidative stress, which may contribute to the formation of esophageal hypersensitivity.

More and more clinical studies have found that weight-loss surgery is a long-term and effective way to treat obesity. Laparoscopic sleeve gastrectomy (LSG) has been widely used in recent years due to its advantages of simple operation, high safety and obvious curative effect. With the increasing popularity of LSG, clinicians are aware of the possibility of many complications. In this paper, the common complications of obesity after LSG and its prevention and treatment status were reviewed. The risk factors of common complications of obesity after LSG were analyzed, and the prevention and treatment experience was summarized, so as to provide reference for clinical peers.