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.

With the development of modern society, the incidence rate of cervicogenic headache (CEH) in the population is younger and increasing year by year. CEH is a common and unique form of headache, characterized by inflammation or physiological changes in cervical structures such as bones, intervertebral discs, or soft tissues, resulting in chronic, unilateral head pain as the main manifestation of the syndrome. The nature of pain often manifests as involving pain. The combination of traditional Chinese and western medicine in the treatment of CEH has gradually become a research hotspot in this field. This article reviews recent domestic and foreign literature on CEH and reviews the latest research progress of traditional Chinese and western medicine treatment in cervical headache.

Objective:To investigate the role of indoxyl sulfate (IS) in myocardial hypertrophy and fibrosis through organic anion transporter-3 (OAT-3) and oxidative stress in H9C2 cells.Methods:Rat myocardial cells (H9C2) were cultured and divided into four groups: Control group, IS group, siRNA negative control group (siOAT-3), and siOAT-3+ IS group. The control group was cultured routinely without IS stimulation. The IS group was stimulated with 250 μmol IS. The siRNA negative control group was transfected with 20 nmol/L OAT-3 siRNA, and the siOAT-3+ IS group was transfected with OAT-3 siRNA 48 hours later, then stimulated with IS for 24 hours. Real-time polymerase chain reaction (RT-PCR) was used to detect and analyze the mRNA expression levels of OAT-3, NADPH oxidase-4 (Nox-4), antioxidant proteins [nuclear factor E2 related factor 2 (Nrf-2), heme oxygenase 1 (HO-1)], myocardial hypertrophy markers [atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), β-myosin heavy chain gene (β-MHC)], and fibrosis markers [transforming growth factor β1 (TGF-β1), Smad homologous protein 3 (Smad-3), collagen type Ⅰ (Collagen Ⅰ)] in each group. H9C2 cells were further divided into three groups: Control group, IS group, and N-acetylcysteine (NAC) group. The NAC group was pre-treated with the antioxidant NAC before stimulation with 250 μmol IS for 24 hours. RT-PCR was used to detect the mRNA expression levels of the above indicators.Results:The mRNA expression level of OAT-3 in the IS group was significantly higher than that in the control group, while the mRNA expression levels of OAT-3 in the siOAT-3 group and the siOAT-3+ IS group were significantly lower than those in the IS group (all P<0.001). Compared with the Control group, the mRNA relative expression levels of Nox-4, ANP, BNP, β-MHC, TGF-β1, Smad-3, and Collagen Ⅰ in H9C2 cells of the IS group were significantly increased (all P<0.001), while the mRNA expression levels of Nrf-2 and HO-1 were significantly decreased (all P<0.001). Compared with the IS group, the mRNA relative expression levels of Nox-4, ANP, BNP, β-MHC, TGF-β1, Smad-3, and Collagen Ⅰ in H9C2 cells of the siOAT-3 group and the siOAT-3+ IS group were significantly lower (all P<0.001), while the mRNA expression levels of Nrf-2 and HO-1 were significantly increased (all P<0.001). Pre-treatment with NAC significantly inhibited the high expression of Nox-4, ANP, BNP, β-MHC, TGF-β1, Smad-3, and Collagen Ⅰ mRNA induced by IS (all P<0.001), while significantly increasing the mRNA expression levels of Nrf-2 and HO-1 (all P<0.01). Conclusions:IS promotes myocardial hypertrophy and fibrotic factor overexpression in H9C2 cells through OAT-3 and oxidative stress.

Gastroesophageal reflux disease (GERD) is a global digestive system disease caused by the reflux of gastric contents into the esophagus and the injury of esophageal mucosa. At present, the pathogenesis of GERD is not completely clear. Studies have found that GERD is closely related to intestinal flora disorder and small intestine bacterial overgrowth (SIBO). Changes in intestinal flora can participate in the occurrence and development of GERD by activating immune and inflammatory reactions, affecting gastroesophageal motility and other mechanisms. In addition, intestinal flora can also indirectly regulate and affect the pathogenesis of GERD by causing some metabolic diseases. This paper aims to review the relationship between GERD and intestinal flora.

Gastroesophageal reflux disease (GERD) is a gastrointestinal motility disorder that results from the reflux of stomach contents into the esophagus or oral cavity, causing symptoms or complications. The typical symptoms of GERD are heartburn and regurgitation of gastric contents into the oropharynx. Heartburn is the sensation of burning or discomfort behind the sternum. Heartburn may radiate into the neck, is typically worse after meals or when in a reclining position, and may be eased by antacids. Regurgitation is the backflow of gastric contents into the mouth or hypopharynx. Epigastric pain can also be a symptom of GERD. Extraesophageal symptoms of GERD include dental erosions, laryngitis, cough, and asthma. In recent years, great progress has been made in understanding the molecular basis of GERD, suggesting that its pathogenesis is more complex and multifactorial. In this paper, the molecular pathogenesis was taken as the starting point, including the mechanism of genes in the pathogenesis and development of GERD, the mechanism of NF-κB pathway in the pathogenesis and development of GERD, the role of proteinase-activated receptor-2 in the pathogenesis of GERD, the association between abnormal serotonin pathway and GERD, and the relationship between reactive oxygen species and GERD, to summarize the pathogenesis of gastroesophageal reflux disease.

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 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.

Objective:To investigate the changes of coagulation/fibrinolysis factors in patients with type A aortic dissection (AD) at early and middle stages after ascending aorta replacement+ total arch replacement+ elephant nose stenting.Methods:According to the inclusion and exclusion criteria, patients with type A AD who underwent cardiac surgery in Xinjiang Uygur Autonomous Region People′s Hospital from August 2017 to August 2018 were selected as the study group. According to the duration of onset, patients were divided into acute AD group (course <2 weeks) and chronic AD group (course ≥2 weeks). Both groups were treated with ascending aorta replacement + total arch replacement + elephant nose stenting. Fasting venous blood was drawn from the two groups, and the blood indexes [prothrombin time (PT), activated partial thrombo plastin time (APTT), fibrinogen (Fib), bone morphogenetic proteins (BMP)] and fibrinolysis indexes [D-dimer, tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor (PAI)] were detected by enzyme-linked immunosorbent assay (ELISA).Results:The ELISA result showed that changes of PT, APTT, Fib, BMP, D-dimer, and PAI in patients with acute and chronic AD at 12 months after operation were significantly lower than those before operation ( P<0.05). The changes of t-PA in patients with acute and chronic AD at 12 months after operation were significantly higher than those before operation ( P<0.05). There was no significant difference in postoperative effective rate, in-hospital mortality, length of stay, incidence of complications and early and mid-term survival rate between the two groups ( P>0.05). Conclusions:Ascending aorta replacement+ total arch replacement+ elephant nose stent is effective in the treatment type A AD, and can significantly improve the expression of coagulation/ fibrinolysis markers in early and middle period after operation.