Objective: To explore the application effect of manual lymphatic drainage (MLD) combined with adjustable foam particle arm sleeves in patients with stage I upper limb lymphedema following breast cancer surgery. Method...Objective: To explore the application effect of manual lymphatic drainage (MLD) combined with adjustable foam particle arm sleeves in patients with stage I upper limb lymphedema following breast cancer surgery. Methods: A total of 52 patients with stage I upper limb lymphedema, who were treated between January and December 2023 at a tertiary tumor hospital in Guangzhou, Guangdong Province, were enrolled. Patients received MLD combined with adjustable foam particle arm sleeves. Bioelectrical impedance and body composition measurements were taken before and after treatment (one course consisting of 20 sessions) for comparison. Results: After one course of treatment, there was a significant reduction in arm muscle circumference, hydration rate, segmental water analysis, and segmental extracellular water ratio analysis (p Conclusion: MLD combined with adjustable foam particle arm sleeves effectively improves stage I upper limb lymphedema in postoperative breast cancer patients.展开更多
Grouted sleeves can effectively connect precast elements,but the effect of grouted sleeves for increased stiffness and assembled seam for weakening stiffness on the precast column’s mechanical properties is unclear.B...Grouted sleeves can effectively connect precast elements,but the effect of grouted sleeves for increased stiffness and assembled seam for weakening stiffness on the precast column’s mechanical properties is unclear.Based on the full-scale test results of precast columns connected with grouted sleeves and the correctness of the numerical models,the influence analysis of the individual and coupling action of the grouted sleeves and assembled seam on the deformation and bearing capacity of the precast column is carried out.The research results show that grouted sleeves significantly affect the deformation and peak bearing capacity of precast columns;when precast columns are subjected to the action of high axial pressure,grouted sleeves significantly affect the bearing capacity.However,the influence of assembled seams on the peaking capacity of the precast column is more obvious when it was tested under low axial compression.It is recommended that the connection position should be 2 times the height of the grouted sleeve from the bottom of the foundation.展开更多
In Japan, most sudden deaths occurring during bathing happen in the winter, and predominantly to elderly people. One can infer a relation to physical conditions that are specific to aging. Atrial fibrillation, an arrh...In Japan, most sudden deaths occurring during bathing happen in the winter, and predominantly to elderly people. One can infer a relation to physical conditions that are specific to aging. Atrial fibrillation, an arrhythmia, increases with age. This study examined histological changes in the pulmonary vein myocardial sleeves of sudden bathtub death victims and compared them with those of control individuals. We investigated 35 sudden deaths that occurred during bathing and 34 accidental deaths or deaths caused by diseases unrelated to cardiopathies. Pulmonary veins were excised cross-sectionally from the hilar side to the venoatrial junction. Then they were stained with hematoxylin and eosin, resorcin-fuchsin van Gieson, and Congo-red stains. Amyloid deposits in the pulmonary vein myocardial sleeves, as well as the range and severity of scarring, were graded microscopically on a scale of 0-3. In the sudden bathtub death victims, severe scarring was found in the myocardial sleeves of the four pulmonary veins (mean score, 2.0), which was significantly different (p < 0.05) from the control subjects (mean score, 1.4). Cardiomegaly was found in 28 out of the autopsied individuals. In subjects with cardiomegaly, the mean value of pulmonary vein myocardial sleeve scarring was 2.1. In subjects without cardiomegaly, the mean value was 1.8. Comparison revealed that cardiomegaly was associated significantly with scarring progression and degeneration of the myocardial sleeves. Scarring of the pulmonary vein myocardial sleeves was more advanced in victims of sudden bathtub death than in controls without heart disease. Elderly people with scarring of the pulmonary vein myocardial sleeves are likely to develop degenerative variations in their intra-atrial excitation conduction. These results demonstrate that taking hot baths might induce supraventricular arrhythmias such as atrial fibrillation.展开更多
A new paradigm in the treatment of obesity and metabolic disease is developing. The global obesity epidemic continues to expand despite the availability of diet and lifestyle counseling, pharmacologic therapy, and wei...A new paradigm in the treatment of obesity and metabolic disease is developing. The global obesity epidemic continues to expand despite the availability of diet and lifestyle counseling, pharmacologic therapy, and weight loss surgery. Endoscopic procedures have the potential to bridge the gap between medical therapy and surgery. Current primary endoscopic bariatric therapies can be classified as restrictive, bypass, spaceoccupying, or aspiration therapy. Restrictive procedures include the USGI Primary Obesity Surgery Endolumenal procedure, endoscopic sleeve gastroplasty using Apollo Over Stitch, Trans Oral GAstroplasty, gastric volume reduction using the ACE stapler, and insertion of the TERIS restrictive device. Intestinal bypass has been reported using the EndoB arrier duodenal-jejunal bypass liner. A number of space-occupying devices have been studied or are in use, including intragastric balloons(Orbera, Reshape Duo, Heliosphere BAG, Obalon), Transpyloric Shuttle, and Sati Sphere. The Aspire Assist aspiration system has demonstrated efficacy. Finally, endoscopic revision of gastric bypass to address weight regain has been studied using Apollo Over Stitch, the USGI Incisionless Operating Platform Revision Obesity Surgery Endolumenal procedure, Stomaphyx, and endoscopic sclerotherapy. Endoscopic therapies for weight loss are potentially reversible, repeatable, less invasive, and lower cost than various medical and surgical alternatives. Given the variety of devices under development, in clinical trials, and currently in use, patients will have multiple endoscopic options with greater efficacy than medical therapy, and with lower invasiveness and greater accessibility than surgery.展开更多
Obesity is a chronic,multifactorial disease closely linked to a spectrum of cardiometabolic disorders,with its global prevalence rising at an alarming rate.In recent years,minimally invasive,safe,and effective endosco...Obesity is a chronic,multifactorial disease closely linked to a spectrum of cardiometabolic disorders,with its global prevalence rising at an alarming rate.In recent years,minimally invasive,safe,and effective endoscopic bariatric therapies have gained significant attention as alternatives to conventional surgical interventions.This review provides a comprehensive overview of various endoscopic weight-loss procedures,evaluating their advantages and limitations in comparison to surgical approaches to assist clinicians in optimizing patientspecific treatment strategies.Endoscopic bariatric therapies,including intragastric balloons,duodenal-jejunal bypass sleeves,endoscopic sleeve gastroplasty,gastric remodeling procedures,and interventions aimed at delaying gastric emptying are systematically reviewed.The efficacy,safety profiles,and clinical applicability are all synthesized.Endoscopic bariatric therapies exhibit distinct advantages and limitations,with varying indications and contraindications.As part of a multidisciplinary approach to obesity management,these procedures should be integrated with lifestyle modifications and nutritional counseling to maximize therapeutic benefits.Future research should focus on the long-term efficacy,safety,and patient-reported outcomes to refine clinical practice and optimize the role of endoscopic interventions in obesity treatment.展开更多
BACKGROUND Obesity impacts 42%of United States adults and results in an estimated economic burden of nearly 1.4 trillion dollars annually.Endoscopic sleeve gastroplasty(ESG)is a United States Food and Drug Administrat...BACKGROUND Obesity impacts 42%of United States adults and results in an estimated economic burden of nearly 1.4 trillion dollars annually.Endoscopic sleeve gastroplasty(ESG)is a United States Food and Drug Administration authorized procedure with an excellent safety,efficacy,and durability profile.The cost-effectiveness of ESG compared to lifestyle modification(LM)in real-world patients with class I-III obesity represents a critical knowledge gap.AIM To approximate the cost-effectiveness of ESG vs LM using a real-world dataset of 860 United States adults with class I-III obesity undergoing ESG.METHODS A 6-state Markov model was employed,including healthy weight,overweight,class I-III obesity,and death.The LM control group was built using transition states previously described in the literature,supplemented by expert opinion.Cycles lasted six-months in the model’s first year and twelve-months thereafter.Existing literature informed approximations of each health state utility,adverse event disutility,and incidence of obesity-associated comorbidities.One-way sensitivity and probabilistic sensitivity analyses were performed.RESULTS The base-case incremental cost-effectiveness ratio(ICER)for ESG vs LM was 5904 dollars per quality-adjusted life year(QALY).In a one-way sensitivity analysis,the utilities assigned to the three obesity classes most greatly influenced the ICER.Probabilistic sensitivity analysis estimated an increase in upper-bound ICER of 8038 dollars per QALY,well under the generally cited United States willingness to pay ratio of 100000 dollars per QALY.CONCLUSION The results of this model support that ESG is overwhelmingly cost-effective compared to LM across all obesity classes.Payors should consider expanding coverage for their members.展开更多
BACKGROUND Sleeve fracture of the patella is an unusual fracture,almost unique to children.The majority of sleeve fractures involve the inferior patellar pole.However,sleeve fractures of the superior pole of the patel...BACKGROUND Sleeve fracture of the patella is an unusual fracture,almost unique to children.The majority of sleeve fractures involve the inferior patellar pole.However,sleeve fractures of the superior pole of the patella are extremely rare in adults.CASE SUMMARY An 18-year-old male patient fell while running in the morning.The patient had tenderness to palpation at the superior pole of the patella,with a palpable gap over the upper part of the patella in both knees.We applied two 4.5-mm suture anchors with the Krackow stitch to repair the sleeve fracture,augmented by autogenous gracilis through performing the figure-of-eight technique.The patient regained approximately the full range of motion of the knee joint without any quadriceps weakness and a normal gait 6 weeks after surgery.CONCLUSION Sleeve fractures of the superior pole of the patella are extremely rare in adults,especially bilateral sleeve fractures.Suture anchors,augmented by autogenous gracilis,provided secure fixation and achieved excellent results in this rare injury.展开更多
1 When the song Heart on My Sleeve first dropped,fans were on cloud nine,fully convinced that their favorite musicians had just dropped a surprise cooperation.But as the song racked up(累计)millions of streams online,...1 When the song Heart on My Sleeve first dropped,fans were on cloud nine,fully convinced that their favorite musicians had just dropped a surprise cooperation.But as the song racked up(累计)millions of streams online,the truth surfaced-the track was created by an Internet user who used artificial intelligence(AI)to perfectly mimic(模仿)human artists'voices.展开更多
Obesity is a significant global health concern, often leading to comorbidities such as cardiovascular diseases, diabetes, and hypertension. Bariatric surgery, including sleeve gastrectomy (SG), is a proven treatment f...Obesity is a significant global health concern, often leading to comorbidities such as cardiovascular diseases, diabetes, and hypertension. Bariatric surgery, including sleeve gastrectomy (SG), is a proven treatment for morbid obesity, offering substantial weight loss and resolution of comorbidities. However, post-surgical complications, particularly anorectal disorders such as hemorrhoids and anal fissures, remain underexplored, especially in Saudi Arabia. This retrospective cohort study aimed to assess the prevalence, risk factors, and impact of anal complications following SG at Almoosa Specialist Hospital in Alhassa, Saudi Arabia. A total of 205 patients who underwent SG between January 2020 and December 2021 were surveyed, with 148 eligible participants included in the final analysis. Results indicated that 8.8% of patients experienced anal complications, with anal fissures (53.8%) and hemorrhoids (38.5%) being the most common. These complications typically occurred 2 - 6 months post-surgery. Lifestyle factors such as physical activity and fluid intake were found to significantly reduce the likelihood of anal issues. Moreover, 69.2% of patients with anal problems reported a negative impact on their quality of life. The study highlights the importance of targeted post-operative care, including lifestyle modifications, to mitigate the impact of anal complications. The findings suggest that ongoing education and comprehensive support for bariatric surgery patients, particularly regarding physical activity and hydration, are critical for improving long-term health outcomes. Further research is needed to explore the long-term progression of anal complications and effective interventions for enhancing patient satisfaction and quality of life.展开更多
BACKGROUND Severe intraabdominal adhesions and ventral hernias pose significant technical challenges in bariatric surgery,especially in patients with a history of complex abdominal procedures.CASE SUMMARY This report ...BACKGROUND Severe intraabdominal adhesions and ventral hernias pose significant technical challenges in bariatric surgery,especially in patients with a history of complex abdominal procedures.CASE SUMMARY This report describes a case involving a 30-year-old morbidly obese man who previously underwent a right lobe hepatectomy for living donor liver transplan-tation.The patient presented with a body mass index of 40.7 kg/m2 and a giant incisional hernia,compounded by extensive intraabdominal adhesions from mul-tiple previous surgeries.A laparoscopic sleeve gastrectomy was performed as the initial step of a staged surgical plan.Adhesiolysis was conducted carefully to address the dense intraabdominal adhesions,and the procedure was completed successfully using standard stapling techniques.Postoperative recovery was smooth,with significant weight loss achieved within the first month.CONCLUSION This case highlights the need for personalized surgical planning and precise techniques in bariatric surgery for patients with past abdominal operations.展开更多
BACKGROUND Chinese surgeons often rely on intraoperative exploration of the esophageal hiatus to determine the need for concurrent type I hiatal hernia(HH)repair during laparoscopic sleeve gastrectomy.However,no stand...BACKGROUND Chinese surgeons often rely on intraoperative exploration of the esophageal hiatus to determine the need for concurrent type I hiatal hernia(HH)repair during laparoscopic sleeve gastrectomy.However,no standardized criteria for the esophageal hiatus size or indications for exploration exist in China.AIM To investigate normal anatomical parameter ranges of the esophageal hiatus in patients with obesity.METHODS A total of 158 patients,aged 20-49 years,was analyzed from January 2020 to June 2024.The patients were classified into the no reflux esophagitis(RE)no HH group(HHG),RE group,and type I HHG.The transverse and sagittal diameters and cross-sectional area of the esophageal hiatus were measured using multiplanar reconstruction of the computed tomography images.RESULTS Body mass index was positively correlated with area and transverse and sagittal diameters of the esophageal hiatus(r=0.72,0.69,and 0.54,respectively;P<0.01).In the no RE no HHG and RE group,the esophageal hiatus size in the subgroup with obesity was greater than that in the non-obesity subgroup(area:326.15±78 mm2 vs 208.12±64.44 mm2,transverse diameters:15.97±2.06 mm vs 13.37±1.99 mm,sagittal diameters:15.7±2.08 mm vs 11.73±2.08 mm;P<0.01).Patients with obesity showed no significant differences in esophageal hiatus size with or without RE or HH.CONCLUSION The esophageal hiatus size increased with body mass index and was larger in patients with obesity than in those without obesity.展开更多
Background:Sleeve lobectomy(SL)presents an attractive option compared to pneumonectomy(PN)for patients with central or locally advanced non-small cell lung cancer(NSCLC).This study aimed to assess the advantages of SL...Background:Sleeve lobectomy(SL)presents an attractive option compared to pneumonectomy(PN)for patients with central or locally advanced non-small cell lung cancer(NSCLC).This study aimed to assess the advantages of SL over PN for NSCLC via a meta-analysis.Methods:We performed a systematic review and cumulative analysis of comparative studies that reported both postoperative and survival outcomes for SL and PN.This was accomplished through a thorough search of electronic databases,including PubMed,EMBASE,and the Cochrane library,from inception to April 2023.Results:A total of 5727 patients(SL:1945;PN:3782)from thirty-one studies were analyzed.The meta-analysis focused on perioperative mortality,local recurrence,and overall survival.The SL group exhibited a significantly lower rate of perioperative mortality(OR=0.43,95%CI=0.32–0.60,P<0.0001).However,no significant difference was observed in local recurrence rates between SL and PN(OR=1.25;95%CI,0.92 to 1.69;P=0.16).Additionally,the survival rates at 1 year and 5 years in the SL cohort(1-year:0.14,95%CI:0.12 to 0.17,p<0.0001;5-year:2.15,95%CI:1.77 to 2.61,p<0.0001)along with the survival in patients with pN0 or pN1 at 5 years(OR=0.13,95%CI 0.04 to 0.22;P=0.006)were notably superior compared to those undergoing PN.Conclusions:Sleeve lobectomy should be regarded as a viable alternative to pneumonectomy for treating NSCLC.展开更多
BACKGROUND Laparoscopic sleeve gastrectomy(LSG)can lead to complete resolution of hypertension in most patients with obesity within one year.However,the preoperative factors related to this resolution are still unclea...BACKGROUND Laparoscopic sleeve gastrectomy(LSG)can lead to complete resolution of hypertension in most patients with obesity within one year.However,the preoperative factors related to this resolution are still unclear.AIM To clarify the impact of relevant factors,particularly perirenal fat,on postoperative hypertension resolution.METHODS In this retrospective single-center study,a total of 138 patients with obesity and hypertension were included,all of whom underwent LSG in the hospital and were followed up for one year.Multivariate logistic regression models were used to identify independent risk factors for postoperative hypertension resolution.Generalized additive models were employed to clarify the nonlinear relationships between these factors and hypertension resolution,and their predictive values were compared using fivefold cross-validation.RESULTS After LSG,107 patients(77.5%)experienced hypertension resolution,while 31 patients(22.5%)did not achieve resolution.Both the preoperative perirenal fat area(PrFA)and perirenal fat thickness were independent risk factors for postoperative hypertension resolution(P<0.001 vs P=0.002).These factors are curvilinearly correlated with the hypertension resolution rate,but PrFA has a better predictive value than perirenal fat thickness dose(area under the curve=0.846 vs 0.809).Compared with those with PrFA≥18 cm2,patients with PrFA<18 cm2 had a higher hypertension resolution rate[87%vs 68.1%;odds ratio(95%confidence interval)=3.513(1.367-9.902),P=0.012].CONCLUSION PrFA is a preoperative predictor of postoperative hypertension resolution.It is curvilinearly associated with the resolution rate,and patients with PrFA<18 cm²have better hypertension resolution outcomes after LSG.展开更多
Laparoscopic sleeve gastrectomy(LSG),as an effective treatment for morbid obesity and its metabolic complications,exerts its therapeutic effects by significantly reducing body weight and improving metabolic disorders....Laparoscopic sleeve gastrectomy(LSG),as an effective treatment for morbid obesity and its metabolic complications,exerts its therapeutic effects by significantly reducing body weight and improving metabolic disorders.Its core mechanisms involve multi-level regulation of free fatty acid(FFA)metabolism and chronic low-grade inflammatory states(represented by tumor necrosis factor-alpha,TNF-α).This paper systematically reviews the direct impact of LSG on FFA dynamics including lipolysis,tissue uptake,and oxidation,as well as the molecular pathways through which it indirectly regulates TNF-αby reducing adipose tissue inflammation,improving intestinal barrier function,and modulating epigenetic modifications such as SCD gene methylation.Postoperatively,FFA and TNF-αform a bidirectional promoting feedback loop.LSG effectively breaks this vicious cycle of mutual promotion between the two under obese conditions by reducing FFA levels and inhibiting TNF-αexpression.Lower FFA levels alleviate inflammatory signal activation,while reduced TNF-αinhibits lipolysis,collectively promoting the restoration of insulin sensitivity.A thorough understanding of these mechanisms provides a theoretical basis for optimizing surgical strategies and developing targeted therapies.展开更多
Objective:Although bariatric surgeries are widely performed around the world,patients frequently experience the recurrence of pre-existing gastroesophageal reflux disease(GERD)symptoms or develop new symptoms,some of ...Objective:Although bariatric surgeries are widely performed around the world,patients frequently experience the recurrence of pre-existing gastroesophageal reflux disease(GERD)symptoms or develop new symptoms,some of which are resistant to medical treatment.This study investigates the effect and outcome of magnetic sphincter augmentation(MSA),a minimally invasive treatment for GERD,in this population.Methods:A thorough search of the PubMed,Cochrane,Scopus,Web of Science,and Google Scholar databases from inception until June 6,2024 was performed to retrieve relevant studies that evaluated the effects of MSA on the GERD health-related quality of life(GERD-HRQL)score and the reduction in proton pump inhibitor(PPI)use in patients who underwent bariatric surgery.The“meta”package in RStudio version 2023.12.0 t 369 was used.Results:A total of eight studies were included in the systematic review and seven studies were included in the meta-analysis.MSA significantly reduced the GERD-HRQL score(MD?27.55[95%CI:30.99 to24.11],p<0.01)and PPI use(RR?0.23[95%CI:0.16 to 0.33],p<0.01).Conclusion:MSA is a viable treatment option for patients with GERD symptoms who undergo bariatric surgery.This approach showed promising results in terms of reducing the GERD-HRQL score and reducing the use of PPI.展开更多
Obesity is a major global health issue,contributing to numerous comorbidities such as type 2 diabetes mellitus,hypertension,and cardiovascular diseases.While bariatric surgery remains the gold standard for treating se...Obesity is a major global health issue,contributing to numerous comorbidities such as type 2 diabetes mellitus,hypertension,and cardiovascular diseases.While bariatric surgery remains the gold standard for treating severe obesity,its invasive nature has led to the development of minimally invasive alternatives.Endoscopic sleeve gastroplasty(ESG)is a promising,minimally invasive procedure for weight loss,offering significant weight reduction without the need for surgical incisions.This editorial evaluates the efficacy and safety of ESG,highlighting its weight loss outcomes,safety profile,and comparison with other bariatric procedures,including intragastric balloon,laparoscopic sleeve gastrectomy,and robotic sleeve gastrectomy.ESG has shown substantial weight loss with a mean total weight loss ranging from 15.03%to 17.51%at 12 months and sustained weight reduction over 36 months.The safety profile is favorable,with low rates of serious adverse events and minimal complications compared to surgical alternatives.ESG is particularly suited for patients with mild to moderate obesity or those not eligible for surgical options.However,further long-term studies and standardized protocols are needed to refine patient selection and optimize treatment outcomes.展开更多
This paper examines the cultural symbolism of the character“袖”(sleeve)through an analysis of its historical evolution,linking the intricate relationship between traditional clothing design and linguistic expression...This paper examines the cultural symbolism of the character“袖”(sleeve)through an analysis of its historical evolution,linking the intricate relationship between traditional clothing design and linguistic expression.Drawing on frameworks from cognitive linguistics,particularly metaphor and metonymy,the study investigates the diverse metaphorical uses of“袖”in the Chinese language.Through corpus-based analysis,findings reveal that these metaphorical expressions are shaped by cultural traditions,daily practices,and cognitive mechanisms.While many traditional usages of the term have diminished in modern discourse,it retains a rich spectrum of metaphorical meanings,reflecting the unique interconnection between language and culture in Chinese society.This research provides a nuanced understanding of the interplay between Chinese characters and traditional clothing,offering fresh perspectives for metaphor studies within cognitive linguistics.展开更多
BACKGROUND Obesity is a significant global health concern,with laparoscopic sleeve gastrectomy(LSG)being the most commonly performed bariatric surgery in the Middle East,including Saudi Arabia,due to its simplicity an...BACKGROUND Obesity is a significant global health concern,with laparoscopic sleeve gastrectomy(LSG)being the most commonly performed bariatric surgery in the Middle East,including Saudi Arabia,due to its simplicity and effectiveness in achieving weight loss.However,the long-term effects of LSG on gastroesophageal reflux disease(GERD)and Barrett’s esophagus(BE)remain areas of active investigation.AIM To determine the prevalence of GERD and BE 5 years post-LSG in a Saudi Arabian population.METHODS A retrospective cohort study was conducted at a tertiary bariatric referral center in Saudi Arabia.Patients who underwent LSG 5 years prior and completed postoperative gastroscopy were included.Data on demographics,comorbidities,GERD symptoms,and endoscopic findings were extracted.GERD was defined clinically,esophagitis was graded per the Los Angeles classification,and BE was defined histologically.Multivariate logistic regression was used to identify predictors of GERD,endoscopic esophagitis(EE),and BE.RESULTS The study included 114 patients(mean age:44 years;61%female).GERD prevalence increased from 16%preoperatively to 64%5 years post-LSG,with 54%of cases representing de novo GERD.EE prevalence rose to 30%,with 23%of cases being de novo.BE was detected in 2.6%of patients,all presenting with short-segment BE without intestinal metaplasia.On univariate analysis,the pre-LSG body mass index was significantly associated with EE(P=0.038),and age was significantly associated with BE(P=0.037).However,on multivariate analysis,only hypertension was independently associated with GERD development(odds ratio=5.09;P=0.01).No factors were significantly associated with EE or BE on multivariate analysis.CONCLUSION This study highlights the significant increase in GERD and EE prevalence 5 years post-LSG,with a relatively low but notable incidence of BE.The findings underscore the need for long-term endoscopic surveillance,particularly for older patients,even in populations with lower baseline.展开更多
In the Shenzhen region,where strong karst development is widely distributed,karst caves pose significant difficulties and risks to pile foundation construction.This paper,based on the Yanba Expressway Municipalization...In the Shenzhen region,where strong karst development is widely distributed,karst caves pose significant difficulties and risks to pile foundation construction.This paper,based on the Yanba Expressway Municipalization Reconstruction Project and referencing previous engineering experiences,proposes the application of sleeve valve pipe grouting technology for pre-treatment of small-to medium-sized and bead-shaped karst caves.Specific implementation measures and construction precautions are presented.Practical results demonstrate that the pre-treated karst cave areas achieved stable soil conditions,providing favorable prerequisites for subsequent pile foundation construction.The method proves convenient and feasible in operation,substantially reducing safety and quality risks during construction.This successful practice offers valuable experience for similar projects.展开更多
Metabolic endoscopy represents a promising alternative in the management of steatotic liver disease,particularly metabolic dysfunction-associated steatohep-atitis(MASH),a progressive form of metabolic dysfunction-asso...Metabolic endoscopy represents a promising alternative in the management of steatotic liver disease,particularly metabolic dysfunction-associated steatohep-atitis(MASH),a progressive form of metabolic dysfunction-associated steatotic liver disease(MASLD).With the rising global prevalence of MASLD—affecting over one-third of the adult population—and its close association with obesity,insulin resistance,and metabolic syndrome,there is an urgent need for inno-vative,minimally invasive therapies that can reverse liver fibrosis and prevent progression to cirrhosis and hepatocellular carcinoma.Traditional management of MASLD relies on lifestyle modifications and bariatric surgery,yet these app-roaches are hampered by issues of adherence,invasiveness,and accessibility.This review examines endoscopic bariatric metabolic therapies including endoscopic sleeve gastroplasty(ESG),intragastric balloons(IGB),duodenal mucosal resur-facing(DMR),and duodeno-jejunal bypass liners(DJBL),as well as revisional procedures like endoscopic revisional gastroplasty(ERG)and transoral outlet reduction(TORe).Clinical studies and meta-analyses indicate that metabolic en-doscopy is safe and effective for liver fibrosis in MASH.ESG appears to offer the greatest fibrosis reduction,while IGB and DJBL yield modest improvements,and DMR shows no significant effect.Among revisional therapies,ERG has dem-onstrated fibrosis reduction,although the benefits of TORe remain to be fully evaluated.展开更多
文摘Objective: To explore the application effect of manual lymphatic drainage (MLD) combined with adjustable foam particle arm sleeves in patients with stage I upper limb lymphedema following breast cancer surgery. Methods: A total of 52 patients with stage I upper limb lymphedema, who were treated between January and December 2023 at a tertiary tumor hospital in Guangzhou, Guangdong Province, were enrolled. Patients received MLD combined with adjustable foam particle arm sleeves. Bioelectrical impedance and body composition measurements were taken before and after treatment (one course consisting of 20 sessions) for comparison. Results: After one course of treatment, there was a significant reduction in arm muscle circumference, hydration rate, segmental water analysis, and segmental extracellular water ratio analysis (p Conclusion: MLD combined with adjustable foam particle arm sleeves effectively improves stage I upper limb lymphedema in postoperative breast cancer patients.
基金supported by the National Natural Science Foundation of China(Grant No.51908013)Basic Scientific Research Foundation for Municipal University(X21076)。
文摘Grouted sleeves can effectively connect precast elements,but the effect of grouted sleeves for increased stiffness and assembled seam for weakening stiffness on the precast column’s mechanical properties is unclear.Based on the full-scale test results of precast columns connected with grouted sleeves and the correctness of the numerical models,the influence analysis of the individual and coupling action of the grouted sleeves and assembled seam on the deformation and bearing capacity of the precast column is carried out.The research results show that grouted sleeves significantly affect the deformation and peak bearing capacity of precast columns;when precast columns are subjected to the action of high axial pressure,grouted sleeves significantly affect the bearing capacity.However,the influence of assembled seams on the peaking capacity of the precast column is more obvious when it was tested under low axial compression.It is recommended that the connection position should be 2 times the height of the grouted sleeve from the bottom of the foundation.
文摘In Japan, most sudden deaths occurring during bathing happen in the winter, and predominantly to elderly people. One can infer a relation to physical conditions that are specific to aging. Atrial fibrillation, an arrhythmia, increases with age. This study examined histological changes in the pulmonary vein myocardial sleeves of sudden bathtub death victims and compared them with those of control individuals. We investigated 35 sudden deaths that occurred during bathing and 34 accidental deaths or deaths caused by diseases unrelated to cardiopathies. Pulmonary veins were excised cross-sectionally from the hilar side to the venoatrial junction. Then they were stained with hematoxylin and eosin, resorcin-fuchsin van Gieson, and Congo-red stains. Amyloid deposits in the pulmonary vein myocardial sleeves, as well as the range and severity of scarring, were graded microscopically on a scale of 0-3. In the sudden bathtub death victims, severe scarring was found in the myocardial sleeves of the four pulmonary veins (mean score, 2.0), which was significantly different (p < 0.05) from the control subjects (mean score, 1.4). Cardiomegaly was found in 28 out of the autopsied individuals. In subjects with cardiomegaly, the mean value of pulmonary vein myocardial sleeve scarring was 2.1. In subjects without cardiomegaly, the mean value was 1.8. Comparison revealed that cardiomegaly was associated significantly with scarring progression and degeneration of the myocardial sleeves. Scarring of the pulmonary vein myocardial sleeves was more advanced in victims of sudden bathtub death than in controls without heart disease. Elderly people with scarring of the pulmonary vein myocardial sleeves are likely to develop degenerative variations in their intra-atrial excitation conduction. These results demonstrate that taking hot baths might induce supraventricular arrhythmias such as atrial fibrillation.
文摘A new paradigm in the treatment of obesity and metabolic disease is developing. The global obesity epidemic continues to expand despite the availability of diet and lifestyle counseling, pharmacologic therapy, and weight loss surgery. Endoscopic procedures have the potential to bridge the gap between medical therapy and surgery. Current primary endoscopic bariatric therapies can be classified as restrictive, bypass, spaceoccupying, or aspiration therapy. Restrictive procedures include the USGI Primary Obesity Surgery Endolumenal procedure, endoscopic sleeve gastroplasty using Apollo Over Stitch, Trans Oral GAstroplasty, gastric volume reduction using the ACE stapler, and insertion of the TERIS restrictive device. Intestinal bypass has been reported using the EndoB arrier duodenal-jejunal bypass liner. A number of space-occupying devices have been studied or are in use, including intragastric balloons(Orbera, Reshape Duo, Heliosphere BAG, Obalon), Transpyloric Shuttle, and Sati Sphere. The Aspire Assist aspiration system has demonstrated efficacy. Finally, endoscopic revision of gastric bypass to address weight regain has been studied using Apollo Over Stitch, the USGI Incisionless Operating Platform Revision Obesity Surgery Endolumenal procedure, Stomaphyx, and endoscopic sclerotherapy. Endoscopic therapies for weight loss are potentially reversible, repeatable, less invasive, and lower cost than various medical and surgical alternatives. Given the variety of devices under development, in clinical trials, and currently in use, patients will have multiple endoscopic options with greater efficacy than medical therapy, and with lower invasiveness and greater accessibility than surgery.
基金Supported by National Natural Science Foundation of China,No.81602056 and No.82273393the Young Talents Promotion Project of Shandong Medical Association in 2023,No.2023-GJ-0087.
文摘Obesity is a chronic,multifactorial disease closely linked to a spectrum of cardiometabolic disorders,with its global prevalence rising at an alarming rate.In recent years,minimally invasive,safe,and effective endoscopic bariatric therapies have gained significant attention as alternatives to conventional surgical interventions.This review provides a comprehensive overview of various endoscopic weight-loss procedures,evaluating their advantages and limitations in comparison to surgical approaches to assist clinicians in optimizing patientspecific treatment strategies.Endoscopic bariatric therapies,including intragastric balloons,duodenal-jejunal bypass sleeves,endoscopic sleeve gastroplasty,gastric remodeling procedures,and interventions aimed at delaying gastric emptying are systematically reviewed.The efficacy,safety profiles,and clinical applicability are all synthesized.Endoscopic bariatric therapies exhibit distinct advantages and limitations,with varying indications and contraindications.As part of a multidisciplinary approach to obesity management,these procedures should be integrated with lifestyle modifications and nutritional counseling to maximize therapeutic benefits.Future research should focus on the long-term efficacy,safety,and patient-reported outcomes to refine clinical practice and optimize the role of endoscopic interventions in obesity treatment.
文摘BACKGROUND Obesity impacts 42%of United States adults and results in an estimated economic burden of nearly 1.4 trillion dollars annually.Endoscopic sleeve gastroplasty(ESG)is a United States Food and Drug Administration authorized procedure with an excellent safety,efficacy,and durability profile.The cost-effectiveness of ESG compared to lifestyle modification(LM)in real-world patients with class I-III obesity represents a critical knowledge gap.AIM To approximate the cost-effectiveness of ESG vs LM using a real-world dataset of 860 United States adults with class I-III obesity undergoing ESG.METHODS A 6-state Markov model was employed,including healthy weight,overweight,class I-III obesity,and death.The LM control group was built using transition states previously described in the literature,supplemented by expert opinion.Cycles lasted six-months in the model’s first year and twelve-months thereafter.Existing literature informed approximations of each health state utility,adverse event disutility,and incidence of obesity-associated comorbidities.One-way sensitivity and probabilistic sensitivity analyses were performed.RESULTS The base-case incremental cost-effectiveness ratio(ICER)for ESG vs LM was 5904 dollars per quality-adjusted life year(QALY).In a one-way sensitivity analysis,the utilities assigned to the three obesity classes most greatly influenced the ICER.Probabilistic sensitivity analysis estimated an increase in upper-bound ICER of 8038 dollars per QALY,well under the generally cited United States willingness to pay ratio of 100000 dollars per QALY.CONCLUSION The results of this model support that ESG is overwhelmingly cost-effective compared to LM across all obesity classes.Payors should consider expanding coverage for their members.
文摘BACKGROUND Sleeve fracture of the patella is an unusual fracture,almost unique to children.The majority of sleeve fractures involve the inferior patellar pole.However,sleeve fractures of the superior pole of the patella are extremely rare in adults.CASE SUMMARY An 18-year-old male patient fell while running in the morning.The patient had tenderness to palpation at the superior pole of the patella,with a palpable gap over the upper part of the patella in both knees.We applied two 4.5-mm suture anchors with the Krackow stitch to repair the sleeve fracture,augmented by autogenous gracilis through performing the figure-of-eight technique.The patient regained approximately the full range of motion of the knee joint without any quadriceps weakness and a normal gait 6 weeks after surgery.CONCLUSION Sleeve fractures of the superior pole of the patella are extremely rare in adults,especially bilateral sleeve fractures.Suture anchors,augmented by autogenous gracilis,provided secure fixation and achieved excellent results in this rare injury.
文摘1 When the song Heart on My Sleeve first dropped,fans were on cloud nine,fully convinced that their favorite musicians had just dropped a surprise cooperation.But as the song racked up(累计)millions of streams online,the truth surfaced-the track was created by an Internet user who used artificial intelligence(AI)to perfectly mimic(模仿)human artists'voices.
文摘Obesity is a significant global health concern, often leading to comorbidities such as cardiovascular diseases, diabetes, and hypertension. Bariatric surgery, including sleeve gastrectomy (SG), is a proven treatment for morbid obesity, offering substantial weight loss and resolution of comorbidities. However, post-surgical complications, particularly anorectal disorders such as hemorrhoids and anal fissures, remain underexplored, especially in Saudi Arabia. This retrospective cohort study aimed to assess the prevalence, risk factors, and impact of anal complications following SG at Almoosa Specialist Hospital in Alhassa, Saudi Arabia. A total of 205 patients who underwent SG between January 2020 and December 2021 were surveyed, with 148 eligible participants included in the final analysis. Results indicated that 8.8% of patients experienced anal complications, with anal fissures (53.8%) and hemorrhoids (38.5%) being the most common. These complications typically occurred 2 - 6 months post-surgery. Lifestyle factors such as physical activity and fluid intake were found to significantly reduce the likelihood of anal issues. Moreover, 69.2% of patients with anal problems reported a negative impact on their quality of life. The study highlights the importance of targeted post-operative care, including lifestyle modifications, to mitigate the impact of anal complications. The findings suggest that ongoing education and comprehensive support for bariatric surgery patients, particularly regarding physical activity and hydration, are critical for improving long-term health outcomes. Further research is needed to explore the long-term progression of anal complications and effective interventions for enhancing patient satisfaction and quality of life.
文摘BACKGROUND Severe intraabdominal adhesions and ventral hernias pose significant technical challenges in bariatric surgery,especially in patients with a history of complex abdominal procedures.CASE SUMMARY This report describes a case involving a 30-year-old morbidly obese man who previously underwent a right lobe hepatectomy for living donor liver transplan-tation.The patient presented with a body mass index of 40.7 kg/m2 and a giant incisional hernia,compounded by extensive intraabdominal adhesions from mul-tiple previous surgeries.A laparoscopic sleeve gastrectomy was performed as the initial step of a staged surgical plan.Adhesiolysis was conducted carefully to address the dense intraabdominal adhesions,and the procedure was completed successfully using standard stapling techniques.Postoperative recovery was smooth,with significant weight loss achieved within the first month.CONCLUSION This case highlights the need for personalized surgical planning and precise techniques in bariatric surgery for patients with past abdominal operations.
文摘BACKGROUND Chinese surgeons often rely on intraoperative exploration of the esophageal hiatus to determine the need for concurrent type I hiatal hernia(HH)repair during laparoscopic sleeve gastrectomy.However,no standardized criteria for the esophageal hiatus size or indications for exploration exist in China.AIM To investigate normal anatomical parameter ranges of the esophageal hiatus in patients with obesity.METHODS A total of 158 patients,aged 20-49 years,was analyzed from January 2020 to June 2024.The patients were classified into the no reflux esophagitis(RE)no HH group(HHG),RE group,and type I HHG.The transverse and sagittal diameters and cross-sectional area of the esophageal hiatus were measured using multiplanar reconstruction of the computed tomography images.RESULTS Body mass index was positively correlated with area and transverse and sagittal diameters of the esophageal hiatus(r=0.72,0.69,and 0.54,respectively;P<0.01).In the no RE no HHG and RE group,the esophageal hiatus size in the subgroup with obesity was greater than that in the non-obesity subgroup(area:326.15±78 mm2 vs 208.12±64.44 mm2,transverse diameters:15.97±2.06 mm vs 13.37±1.99 mm,sagittal diameters:15.7±2.08 mm vs 11.73±2.08 mm;P<0.01).Patients with obesity showed no significant differences in esophageal hiatus size with or without RE or HH.CONCLUSION The esophageal hiatus size increased with body mass index and was larger in patients with obesity than in those without obesity.
文摘Background:Sleeve lobectomy(SL)presents an attractive option compared to pneumonectomy(PN)for patients with central or locally advanced non-small cell lung cancer(NSCLC).This study aimed to assess the advantages of SL over PN for NSCLC via a meta-analysis.Methods:We performed a systematic review and cumulative analysis of comparative studies that reported both postoperative and survival outcomes for SL and PN.This was accomplished through a thorough search of electronic databases,including PubMed,EMBASE,and the Cochrane library,from inception to April 2023.Results:A total of 5727 patients(SL:1945;PN:3782)from thirty-one studies were analyzed.The meta-analysis focused on perioperative mortality,local recurrence,and overall survival.The SL group exhibited a significantly lower rate of perioperative mortality(OR=0.43,95%CI=0.32–0.60,P<0.0001).However,no significant difference was observed in local recurrence rates between SL and PN(OR=1.25;95%CI,0.92 to 1.69;P=0.16).Additionally,the survival rates at 1 year and 5 years in the SL cohort(1-year:0.14,95%CI:0.12 to 0.17,p<0.0001;5-year:2.15,95%CI:1.77 to 2.61,p<0.0001)along with the survival in patients with pN0 or pN1 at 5 years(OR=0.13,95%CI 0.04 to 0.22;P=0.006)were notably superior compared to those undergoing PN.Conclusions:Sleeve lobectomy should be regarded as a viable alternative to pneumonectomy for treating NSCLC.
基金Supported by the National Natural Science Foundation of China,No.82270914 and No.82401043.
文摘BACKGROUND Laparoscopic sleeve gastrectomy(LSG)can lead to complete resolution of hypertension in most patients with obesity within one year.However,the preoperative factors related to this resolution are still unclear.AIM To clarify the impact of relevant factors,particularly perirenal fat,on postoperative hypertension resolution.METHODS In this retrospective single-center study,a total of 138 patients with obesity and hypertension were included,all of whom underwent LSG in the hospital and were followed up for one year.Multivariate logistic regression models were used to identify independent risk factors for postoperative hypertension resolution.Generalized additive models were employed to clarify the nonlinear relationships between these factors and hypertension resolution,and their predictive values were compared using fivefold cross-validation.RESULTS After LSG,107 patients(77.5%)experienced hypertension resolution,while 31 patients(22.5%)did not achieve resolution.Both the preoperative perirenal fat area(PrFA)and perirenal fat thickness were independent risk factors for postoperative hypertension resolution(P<0.001 vs P=0.002).These factors are curvilinearly correlated with the hypertension resolution rate,but PrFA has a better predictive value than perirenal fat thickness dose(area under the curve=0.846 vs 0.809).Compared with those with PrFA≥18 cm2,patients with PrFA<18 cm2 had a higher hypertension resolution rate[87%vs 68.1%;odds ratio(95%confidence interval)=3.513(1.367-9.902),P=0.012].CONCLUSION PrFA is a preoperative predictor of postoperative hypertension resolution.It is curvilinearly associated with the resolution rate,and patients with PrFA<18 cm²have better hypertension resolution outcomes after LSG.
基金Medical Science and Technology Disciplinary Reserve Talent Program under the Kunming Municipal Health Science and Technology Talent Cultivation Project(Project No.:2024-SW(Reserve)-45)Health Research Project of the Kunming Municipal Health Commission(Project No.:2023-03-06-012)。
文摘Laparoscopic sleeve gastrectomy(LSG),as an effective treatment for morbid obesity and its metabolic complications,exerts its therapeutic effects by significantly reducing body weight and improving metabolic disorders.Its core mechanisms involve multi-level regulation of free fatty acid(FFA)metabolism and chronic low-grade inflammatory states(represented by tumor necrosis factor-alpha,TNF-α).This paper systematically reviews the direct impact of LSG on FFA dynamics including lipolysis,tissue uptake,and oxidation,as well as the molecular pathways through which it indirectly regulates TNF-αby reducing adipose tissue inflammation,improving intestinal barrier function,and modulating epigenetic modifications such as SCD gene methylation.Postoperatively,FFA and TNF-αform a bidirectional promoting feedback loop.LSG effectively breaks this vicious cycle of mutual promotion between the two under obese conditions by reducing FFA levels and inhibiting TNF-αexpression.Lower FFA levels alleviate inflammatory signal activation,while reduced TNF-αinhibits lipolysis,collectively promoting the restoration of insulin sensitivity.A thorough understanding of these mechanisms provides a theoretical basis for optimizing surgical strategies and developing targeted therapies.
文摘Objective:Although bariatric surgeries are widely performed around the world,patients frequently experience the recurrence of pre-existing gastroesophageal reflux disease(GERD)symptoms or develop new symptoms,some of which are resistant to medical treatment.This study investigates the effect and outcome of magnetic sphincter augmentation(MSA),a minimally invasive treatment for GERD,in this population.Methods:A thorough search of the PubMed,Cochrane,Scopus,Web of Science,and Google Scholar databases from inception until June 6,2024 was performed to retrieve relevant studies that evaluated the effects of MSA on the GERD health-related quality of life(GERD-HRQL)score and the reduction in proton pump inhibitor(PPI)use in patients who underwent bariatric surgery.The“meta”package in RStudio version 2023.12.0 t 369 was used.Results:A total of eight studies were included in the systematic review and seven studies were included in the meta-analysis.MSA significantly reduced the GERD-HRQL score(MD?27.55[95%CI:30.99 to24.11],p<0.01)and PPI use(RR?0.23[95%CI:0.16 to 0.33],p<0.01).Conclusion:MSA is a viable treatment option for patients with GERD symptoms who undergo bariatric surgery.This approach showed promising results in terms of reducing the GERD-HRQL score and reducing the use of PPI.
文摘Obesity is a major global health issue,contributing to numerous comorbidities such as type 2 diabetes mellitus,hypertension,and cardiovascular diseases.While bariatric surgery remains the gold standard for treating severe obesity,its invasive nature has led to the development of minimally invasive alternatives.Endoscopic sleeve gastroplasty(ESG)is a promising,minimally invasive procedure for weight loss,offering significant weight reduction without the need for surgical incisions.This editorial evaluates the efficacy and safety of ESG,highlighting its weight loss outcomes,safety profile,and comparison with other bariatric procedures,including intragastric balloon,laparoscopic sleeve gastrectomy,and robotic sleeve gastrectomy.ESG has shown substantial weight loss with a mean total weight loss ranging from 15.03%to 17.51%at 12 months and sustained weight reduction over 36 months.The safety profile is favorable,with low rates of serious adverse events and minimal complications compared to surgical alternatives.ESG is particularly suited for patients with mild to moderate obesity or those not eligible for surgical options.However,further long-term studies and standardized protocols are needed to refine patient selection and optimize treatment outcomes.
文摘This paper examines the cultural symbolism of the character“袖”(sleeve)through an analysis of its historical evolution,linking the intricate relationship between traditional clothing design and linguistic expression.Drawing on frameworks from cognitive linguistics,particularly metaphor and metonymy,the study investigates the diverse metaphorical uses of“袖”in the Chinese language.Through corpus-based analysis,findings reveal that these metaphorical expressions are shaped by cultural traditions,daily practices,and cognitive mechanisms.While many traditional usages of the term have diminished in modern discourse,it retains a rich spectrum of metaphorical meanings,reflecting the unique interconnection between language and culture in Chinese society.This research provides a nuanced understanding of the interplay between Chinese characters and traditional clothing,offering fresh perspectives for metaphor studies within cognitive linguistics.
文摘BACKGROUND Obesity is a significant global health concern,with laparoscopic sleeve gastrectomy(LSG)being the most commonly performed bariatric surgery in the Middle East,including Saudi Arabia,due to its simplicity and effectiveness in achieving weight loss.However,the long-term effects of LSG on gastroesophageal reflux disease(GERD)and Barrett’s esophagus(BE)remain areas of active investigation.AIM To determine the prevalence of GERD and BE 5 years post-LSG in a Saudi Arabian population.METHODS A retrospective cohort study was conducted at a tertiary bariatric referral center in Saudi Arabia.Patients who underwent LSG 5 years prior and completed postoperative gastroscopy were included.Data on demographics,comorbidities,GERD symptoms,and endoscopic findings were extracted.GERD was defined clinically,esophagitis was graded per the Los Angeles classification,and BE was defined histologically.Multivariate logistic regression was used to identify predictors of GERD,endoscopic esophagitis(EE),and BE.RESULTS The study included 114 patients(mean age:44 years;61%female).GERD prevalence increased from 16%preoperatively to 64%5 years post-LSG,with 54%of cases representing de novo GERD.EE prevalence rose to 30%,with 23%of cases being de novo.BE was detected in 2.6%of patients,all presenting with short-segment BE without intestinal metaplasia.On univariate analysis,the pre-LSG body mass index was significantly associated with EE(P=0.038),and age was significantly associated with BE(P=0.037).However,on multivariate analysis,only hypertension was independently associated with GERD development(odds ratio=5.09;P=0.01).No factors were significantly associated with EE or BE on multivariate analysis.CONCLUSION This study highlights the significant increase in GERD and EE prevalence 5 years post-LSG,with a relatively low but notable incidence of BE.The findings underscore the need for long-term endoscopic surveillance,particularly for older patients,even in populations with lower baseline.
文摘In the Shenzhen region,where strong karst development is widely distributed,karst caves pose significant difficulties and risks to pile foundation construction.This paper,based on the Yanba Expressway Municipalization Reconstruction Project and referencing previous engineering experiences,proposes the application of sleeve valve pipe grouting technology for pre-treatment of small-to medium-sized and bead-shaped karst caves.Specific implementation measures and construction precautions are presented.Practical results demonstrate that the pre-treated karst cave areas achieved stable soil conditions,providing favorable prerequisites for subsequent pile foundation construction.The method proves convenient and feasible in operation,substantially reducing safety and quality risks during construction.This successful practice offers valuable experience for similar projects.
文摘Metabolic endoscopy represents a promising alternative in the management of steatotic liver disease,particularly metabolic dysfunction-associated steatohep-atitis(MASH),a progressive form of metabolic dysfunction-associated steatotic liver disease(MASLD).With the rising global prevalence of MASLD—affecting over one-third of the adult population—and its close association with obesity,insulin resistance,and metabolic syndrome,there is an urgent need for inno-vative,minimally invasive therapies that can reverse liver fibrosis and prevent progression to cirrhosis and hepatocellular carcinoma.Traditional management of MASLD relies on lifestyle modifications and bariatric surgery,yet these app-roaches are hampered by issues of adherence,invasiveness,and accessibility.This review examines endoscopic bariatric metabolic therapies including endoscopic sleeve gastroplasty(ESG),intragastric balloons(IGB),duodenal mucosal resur-facing(DMR),and duodeno-jejunal bypass liners(DJBL),as well as revisional procedures like endoscopic revisional gastroplasty(ERG)and transoral outlet reduction(TORe).Clinical studies and meta-analyses indicate that metabolic en-doscopy is safe and effective for liver fibrosis in MASH.ESG appears to offer the greatest fibrosis reduction,while IGB and DJBL yield modest improvements,and DMR shows no significant effect.Among revisional therapies,ERG has dem-onstrated fibrosis reduction,although the benefits of TORe remain to be fully evaluated.
