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 evaluate the application value of perioperative interventional strategy guided by enhanced recovery after surgery (ERAS) in elderly recipients undergoing liver transplantation. Methods Clinical data of 405 liver transplant recipients were retrospectively analyzed. According to age, all recipients were divided into the elderly (≥60 years, n=122) and non-elderly groups (< 60 years, n=283). All patients received perioperative interventions under the guidance of ERAS. Intraoperative and postoperative indexes, incidence of postoperative complications and discharge were analyzed between two groups. Results There were no significant differences in the duration of anesthesia, operation time, anhepatic phase, hemorrhage volume, blood transfusion volume, lactic acid level before abdominal closure, ventilator-assisted time, the length of intensive care unit (ICU) stay, Caprini score, CHIPPS score, time of gastric tube, urinary tube and drainage tube removal, time to first drinking, time to first physical activity and time to first flatus between two groups (all P > 0.05). In the elderly group, the time to first feeding was later than that in the non-elderly group (P < 0.05). There were no significant differences in the incidence of fever, ascites, pulmonary infection, delayed gastric emptying, hemorrhage and inactive venous thrombosis between two groups (all P > 0.05). No significant differences were observed in the levels of aspartate aminotransferase, total bilirubin, direct bilirubin, serum creatinine before discharge and total length of hospital stay between two groups (all P > 0.05). The alanine aminotransferase level in elderly recipients was lower than that in non-elderly counterparts, and the difference was statistically significant (P < 0.05). No unplanned reoperation was performed within postoperative 30 d in two groups. There was no significant difference in the re-hospitalization rate within 30 d after discharge (P > 0.05). Conclusions ERAS-guided interventional strategy contributes to perioperative recovery of elderly recipients undergoing liver transplantation, and yields equivalent postoperative recovery between elderly and non-elderly recipients.

The finite element method is a new method to study the mechanism of brain injury caused by blunt instruments. But it is not easy to be applied because of its technology barrier of time-consuming and strong professionalism. In this study, a rapid and quantitative evaluation method was investigated to analyze the craniocerebral injury induced by blunt sticks based on convolutional neural network and finite element method. The velocity curve of stick struck and the maximum principal strain of brain tissue (cerebrum, corpus callosum, cerebellum and brainstem) from the finite element simulation were used as the input and output parameters of the convolutional neural network The convolutional neural network was trained and optimized by using the 10-fold cross-validation method. The Mean Absolute Error (MAE), Mean Square Error (MSE), and Goodness of Fit ( R ²) of the finally selected convolutional neural network model for the prediction of the maximum principal strain of the cerebrum were 0.084, 0.014, and 0.92, respectively. The predicted results of the maximum principal strain of the corpus callosum were 0.062, 0.007, 0.90, respectively. The predicted results of the maximum principal strain of the cerebellum and brainstem were 0.075, 0.011, and 0.94, respectively. These results show that the research and development of the deep convolutional neural network can quickly and accurately assess the local brain injury caused by the sticks blow, and have important application value for understanding the quantitative evaluation and the brain injury caused by the sticks struck. At the same time, this technology improves the computational efficiency and can provide a basis reference for transforming the current acceleration-based brain injury research into a focus on local brain injury research.
Brain ; Brain Injuries ; Computer Simulation ; Finite Element Analysis ; Humans ; Neural Networks, Computer

Objective: To study the effects of nerve growth factor (NGF) on the proliferation, osteogenic differentiation and mineralization of type 2 diabetic mice bone marrow stromal cell (BMSC), providing basis for clinical application of NGF. Methods: Three 8-week-old male db/db mice and two 8-week-old male C57BL/6J mice were used in the study. BMSC derived from femur were cultured though adherence method. BMSC of C57BL/6J mice and db/db mice was divided into normal group and diabetic group to conduct the osteogenic potential experiment, named experiment one. In experiment two, diabetic BMSC was divided into 3 groups: diabetic control group, NGF group, and K252a+NGF group [K252a was the inhibitor of tyrosine kinase A (TrkA), which was the high affinity receptor of NGF], to investigate effect of NGF on osteogenic potential of diabetic mice BMSC. After seeding BMSC, K252a was added into K252a+NGF group, then NGF was added 30 min later. NGF was added into NGF group and K252a+NGF group, but not diabetic control group. The proliferation of BMSC at 1, 3, 5 and 7 d in experiment one and the proliferation of BMSC at 1, 2 and 3 d in experiment two were evaluated through methyl thiazolyl tetrazolium, and the level of alkaline phosphatase (ALP) at 3, 5 and 7 d in both experiments were measured. After being osteogenic induced for 14 d, mineralized nodules in both experiments were quantitated by alizarin red calcium stain. Five holes were set in every group, and all experiments were repeated 3 times. Results: The BMSC proliferation of diabetic group was significantly higher than that of the normal group at 3, 5 and 7 d (P<0.05). After being osteogenic inducted for 3, 5 and 7 d, ALP level of diabetic group were significantly lower than that of normal group (P<0.05). After being osteogenic inducted for 14 d, calcium nodule count of diabetic group [(23.1±6.4) nodule/field] were significantly lower than that of normal group [(36.9±7.9) nodule/field](P<0.05). At 1, 2 and 3 d, BMSC proliferations of diabetic control group, NGF group and K252a+NGF group were not statistically different (P>0.05). After being osteogenic inducted for 3 and 5 d, ALP level of NGF group was significantly higher than that of diabetic control group (P<0.05). After being osteogenic inducted for 3, 5, and 7 d, ALP level of K252a+NGF group was significantly lower than that of NGF group (P<0.05) and diabetic control group (P<0.05). After being osteogenic induced for 14 d, calcium nodule count of NGF group [(45.2±6.8) nodule/field] was significantly more than that of diabetic control group [(23.1±6.4) nodule/field](P<0.05); while calcium nodule count of K252a+NGF group [(18.0±4.5) nodule/field] was significantly less than that of NGF group (P<0.05) and diabetic control group (P<0.05). Conclusions The differentiation and mineralization of type 2 diabetic mice BMSC was significantly reduced. NGF promoted the osteoblastic differentiation and mineralization of diabetic mice BMSC in viro though combining with TrkA.

Objective To explore the effects of stomach tube connector for preventing overfall and provide a theoretical basis for generalization of the new-type connector. Methods This study selected 157 patients required for long-term indwelling gastric tube in the First People's Hospital of Xuzhou from May 2016 to January 2017. Patients were divided into experimental group (n=78, stomach tube for preventing overfall) and control group (n=79, conventional stomach tube) with the random number table. This study recorded the success rate of indwelling gastric tube and adverse reactions of patients between two groups. The gastric tube was removed two months later. And then, the bacterial cultures were carried out. The characters of gastric tube and the injury of nasal mucosa were observed. Besides, the hand contamination of nurses between two groups and the the patients' satisfaction was investigated. Results The success rate of indwelling gastric tube, incidence of adverse reactions and injuries of nasal mucosa, and change of characters of gastric tube of experimental group and control group was 91.03%(71/78) vs 88.61%(70/79),7.69%(6/78) vs 7.59%(6/79), 15.38%(12/78) vs 17.72% (14/79),8.97% (7/78) vs 10.13% (8/79) with no significant differences (P> 0.05). The positive rate of bacterial cultures of gastric tube was 10.13% in control group, while there was no pathogenic bacteria in experimental group with a significant difference (P<0.05). The hand contamination rate of nurses was 8.97%(7/78) in experimental group significantly lower than that [24.05% (19/79)]in control group (P<0.01). The patients' satisfaction degree was 91.03% in experimental group which was higher than that in control group (69.62%)with a significant difference (P< 0.05). Conclusions The stomach tube connector for preventing overfall can effectively prevent nasogastric feeding overfall and avoid bacteria contamination in stomach tube connector and hand contamination of nurses. The operator was simplicity and safe with high patients' satisfaction. It is worth to be used widely in clinical application.

Objective To analyze the characteristic of trauma in 246 fatal falls. Methods We collect 246 cases of fatal falls from Pudong district of Shanghai from 2005 to 2014, and then analyze the characteristics of trauma by using different parameters. Results The height in suicides by fall is higher than accidents by fall (25.7m:13.98m). In all fatal falls, head has a higher possibility in suffering trauma than other body regions (75.2%), while neck has a lower possibility (6.5%). The possibility of head trauma in accidents by fall is higher than suicides by fall (89.4%:75.2%). Conclusion Comparing with suicides by fall, victims in accidents by fall have lack of protection from limbs. Besides, the low rate of ifnding neck trauma suggests legal physicians should be more careful in examining this area.

Objective To summarize the experience of nursing the patients with liver transplantation complicated with early portal vein thrombosis treated with post-embolectomic anticoagulation. Method The clinical data of 5 cases of liver transplantation-induced portal vein thrombosis treated with post-embolectomic anticoagulation was reviewed to summarize the curative effect , key points for disease conditions and anticoagulative nursing. Results The anticoagulative effect was not good in only one case. 4 other cases were recovered by embolectomy and postoperative anticoagulation therapy as well as related nursing measures. Conclusion The nursing measures such as close observation of the disease processing, early reasonable anticoagulation, accurate medication, prevention of patent complication are critical for preventing the recurrence of portal vein thrombosis after liver transplantation.

ObjectiveTo investigate the effect of n-butanol extract from Potentilla anserina (NP) intervention on hypoxia-induced Ca2+ overload and SERCA2 expression of rat cardiomyocytes.MethodsPrimary cultured myocardial cell from SD neonatal rat (1-3 d) was used in the establishment of hypoxia model.After hypoxia for 3 h,the Ca2+ concentration of myocardial cells was measured with fura-2/AM fluorescent probe,and the biochemical indicator intracellular Ca2+-ATPase was examined and the mRNA and its protective protein levels of the sarcoplasmic reticulum (SR) Ca2+-ATPases (SERCA2) were assayed with RT-PCR,Western-blotting,and immune-cytochemical staining in each group.ResultsThe results showed that NP decreased Ca2+ concentration,increased the activity of Ca2+-ATPase,and improved the mRNA and protein expression of SERCA2 in hypoxia-injured myocardial cells as compared with the model group.ConclusionThese results indicate that NP could attenuate the Ca2+ overload.The mechanism might be explained as that NP could elevate the SERCA2 level,increase the activity of myocardium in rats,and further enhance the capacity of SR Ca2+ re-uptake.