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
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
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
The effects of the high pressure die casting(HPDC)processes on porosity,microstructure,and mechanical properties of heat-treatment-free aluminum silicon(Al-Si)alloys have long been a focal point in automotive die-cast...The effects of the high pressure die casting(HPDC)processes on porosity,microstructure,and mechanical properties of heat-treatment-free aluminum silicon(Al-Si)alloys have long been a focal point in automotive die-casting research.In this work,the combined effect of shot sleeve materials and slow shot speeds on porosity,microstructure and mechanical properties of a newly designed HPDC Al-Si alloy was investigated.Results show that employing a ceramic shot sleeve or increasing the slow shot speed significantly reduces both the average size and area fraction of externally solidified crystals(ESCs),as well as the average pore size and volume fraction.When the slow shot speed is increased from 0.05 m·s^(-1)to 0.1 m·s^(-1),the pore volume fraction decreases by 10.2%in steel-shot-sleeve samples,compared to a substantial 67.1%reduction in ceramic-shot-sleeve samples.At a slow shot speed of 0.1 m·s^(-1),castings produced with a ceramic shot sleeve exhibit superior mechanical properties:8.3%higher yield strength,17.4%greater tensile strength,and an 81.4%improvement in elongation,relative to those from a steel shot sleeve.These findings provide valuable insights for minimizing porosity and coarse ESCs in die castings,offering promising potential for broader industrial applications.展开更多
Quantitative detection of sleeve grouting compactness is a technical challenge in civil engineering testing.This study explores a novel quantitative detection method based on ultrasonic time-frequency dual-domain anal...Quantitative detection of sleeve grouting compactness is a technical challenge in civil engineering testing.This study explores a novel quantitative detection method based on ultrasonic time-frequency dual-domain analysis.It establishes a mapping relationship between sleeve grouting compactness and characteristic parameters.First,this study made samples with gradient defects for two types of grouting sleeves,G18 and G20.These included four cases:2D,4D,6D defects(where D is the diameter of the grouting sleeve),and no-defect.Then,an ultrasonic input/output data acquisition system was established.Three-dimensional sound field distribution data were obtained through an orthogonal detection layout and pulse reflection principles.Finally,a novel quantification detection with a comprehensive defect index(DI)was established by comprehensively considering eight feature parameters,such as time-frequency domain Kurtosis factor(KU),Skewness factor(SK),Formfactor(FF),Crest factor(CF),Impulse factor(IF),Clearance factor(CLF),Wavelet packet energy entropy(WPEE),and Hilbert energy peak(HEP).Construct a DI index by quantifying the difference between defect signals and defect free signals in the time-frequency domain.Experimental results show that,under no-defect conditions,the values of feature parameters are significantly lower than those under defect conditions.Among these,the KU,FF,CF,WPEE and HEP exhibit strong correlations with grout sleeve compactness.The proposed DI index in both types of grout sleeves showed good universality with a linear fit goodness of 0.847–0.962.However,G20 the larger inner diameter and length of the sleeve result in a more complex medium effect during ultrasonic propagation,making its DI index more sensitive to defects than the G18 sleeve.Therefore,the presented method is effective for quantitative detection and analysis of the compactness of grouting sleeves.展开更多
In open-ended piles, inner friction is developed between inner pile shaf and the inner soil. Inner frictional resistance depends largely on the degree of soil plugging, which is influenced by many factors including pi...In open-ended piles, inner friction is developed between inner pile shaf and the inner soil. Inner frictional resistance depends largely on the degree of soil plugging, which is influenced by many factors including pile diameter, relative density and end conditions of piles. In this paper, effects of inner sleeves on inner frictional resistance are discussed. The experiments were conducted on a medium-dense sandy ground using laboratory-scale piles. It was observed that the piles penetrated under partially-plugged or unplugged state. The results suggest that inner fiictional resistance, Qin increases with sleeve height, l linearly and requires 2D （D is pile outer diameter） of l to produce a large as 50% of Qt by Qin （Qt is total resistance）. The results also indicate that bearing capacity increases with wall thickness at the pile tip, which can be attributed to the increase in annular area. The results also indicate that soil plug height is independent of sleeve height. The results also reveal that the penetration of straight piles is closer to unplugged state than the sleeved piles. The results of incremental filling ratio and plug length ratio also indicate that the degree of soil plugging is affected by the sleeve height.展开更多
Metabolic dysfunction-associated steatohepatitis(MASH)has become a leading indication for liver transplantation.Bariatric surgery is a proven intervention for weight loss and metabolic improvement in MASH but concerns...Metabolic dysfunction-associated steatohepatitis(MASH)has become a leading indication for liver transplantation.Bariatric surgery is a proven intervention for weight loss and metabolic improvement in MASH but concerns over surgical risk in patients with advanced liver disease has expanded interest in endoscopic sleeve gastroplasty(ESG)as a less invasive alternative.This review examine the efficacy,safety,and metabolic impact of ESG vs traditional bariatric surgery(Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy)in patients with MASH,with and without cirrhosis.We analyze current evidence on weight loss outcomes,histologic and biochemical improvements in MASH,resolution of metabolic syndrome,and perioperative risks associated with these procedures.Special attention is given to the feasibility of ESG in compensated cirrhosis(Child-Pugh A/B)and the potential role of bariatric interventions in delaying or avoiding liver transplantation.As the prevalence of MASH-related cirrhosis rises,refining bariatric strategies for this high-risk population is imperative.ESG may offer a lower procedural risk profile,but current data are largely limited to small,observational studies with short-term follow-up.A tailored,multidisciplinary approach is essential to optimize weight management and liver health in MASH patients,with future studies needed to clarify the long-term efficacy and safety of ESG in MASH.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 Endoscopic bariatric therapies(EBT)have been developed as an adjunctive therapy to treat persistent obesity and recurrent weight gain and dumping symptoms after metabolic and bariatric surgery(MBS).While th...BACKGROUND Endoscopic bariatric therapies(EBT)have been developed as an adjunctive therapy to treat persistent obesity and recurrent weight gain and dumping symptoms after metabolic and bariatric surgery(MBS).While the efficacy of revisional EBTs has been documented,no studies to date have examined how these procedures impact quality of life(QOL)and internalized weight bias(IWB).AIM To understand how endoscopic revisional therapies impact QOL,IWB,and dumping syndrome.METHODS Analysis included 19 participants treated for post-MBS recurrent weight gain and/or dumping syndrome.The short-form 36 survey,weight bias internalization scale,and the Sigstad scoring system were used to measure QOL,IWB,and dumping syndrome pre-and≥4 weeks post-EBT.RESULTS At 6-months,total body weight loss was 8.6%±7.15%(n=16),at 12-months was 13.4%±7.46%(n=16).Short-form 36 scores for all 8 scales significantly increased from pre-to post-procedure with the greatest improvement in the scales related to emotional(mean improvement=59.6,P<0.05)and physical health(mean improvement=31.1,P<0.05).Both total Sigstad score(mean difference=4.947,P<0.05)and total weight bias internalization score(mean difference=0.761,P<0.05)significantly decreased from pre-to post-procedure.CONCLUSION Findings suggest that revisional EBT may improve post-MBS QOL across a broad spectrum of outcomes beyond optimizing body weight.As early EBT results indicate positive mental and physical health outcomes,further research is needed to evaluate the relationship between these improvements,body weight and interdisciplinary post-MBS care.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 One-anastomosis gastric bypass(OAGB)and sleeve gastrectomy(SG)are surgical procedures increasingly performed for weight loss and to achieve remission of diabetes mellitus.Literature comparing the medium-ter...BACKGROUND One-anastomosis gastric bypass(OAGB)and sleeve gastrectomy(SG)are surgical procedures increasingly performed for weight loss and to achieve remission of diabetes mellitus.Literature comparing the medium-term efficacy of these two procedures is scarce.As such,a meta-analysis comparing OAGB and SG in terms of diabetes remission(DR)and percentage of excess weight loss(EWL)is warranted.AIM To compare OAGB and SG in terms of DR and EWL%in the medium term.METHODS A comprehensive literature search was conducted in PubMed/MEDLINE,Cochran Library,and Web of Science for relevant articles,from inception through April 2025,using the keywords“one-anastomosis gastric bypass”,“sleeve gastrectomy”,“mini-gastric bypass”,“diabetes remission”,“one-anastomosis”,and“excess weight loss”.Clinical trials,prospective,retrospective and case-control studies were included;cross-sectional studies,case reports,editorials,and opinions were excluded.The Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale were used to assess the quality of included studies,and RevMan version 5.4 was used for data analyses.RESULTS A total of 1360 articles were identified,and 35 studies were retrieved of which 32 were included in the final analysis.Three full texts were excluded as they did not include data on DR or EWL%.OAGB achieved higher DR than SG at 1 year following surgery[odds ratio(OR)=1.77,95%confidence interval(CI):1.22-2.57,I^(2)=76%].However,DR rates were similar at 3 years and 5 years following surgery(OR=0.82,95%CI:0.61-1.10,I^(2)=23%and OR=0.92,95%CI:0.31-2.72,I^(2)=75%,respectively).OAGB showed higher EWL%at 1 year(OR=9.30,95%CI:6.45-12.15,I^(2)=91%),3 years(OR=10.02,95%CI:9.40-10.64,I^(2)=22%),and 5 years(OR=11.61,95%CI:3.74-19.48,I^(2)=97%).OAGB showed higher late complications than adjustable SG.The results were not different in sub-group analysis including only clinical trials,observational studies,and removing studies including super-obese patients and studies contributing most to heterogeneity.CONCLUSION In the medium term,DR rates were similar between OAGB and SG;however,OAGB showed higher EWL%than SG,and late complications were higher in OAGB.Clinical trials investigating the predictors of DR and EWL%are recommended.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
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.
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the National Key Research and Development Program of China(Grant No.2022YFB3404201)the National Natural Science Foundation of China(Grant Nos.52175335,52405342)+1 种基金the Natural Science Foundation Joint Foundation of Liaoning province(Grant No.2023-B SB A-108)the Fundamental Research Funds for the Central Universities(Grant No.N2402005)。
文摘The effects of the high pressure die casting(HPDC)processes on porosity,microstructure,and mechanical properties of heat-treatment-free aluminum silicon(Al-Si)alloys have long been a focal point in automotive die-casting research.In this work,the combined effect of shot sleeve materials and slow shot speeds on porosity,microstructure and mechanical properties of a newly designed HPDC Al-Si alloy was investigated.Results show that employing a ceramic shot sleeve or increasing the slow shot speed significantly reduces both the average size and area fraction of externally solidified crystals(ESCs),as well as the average pore size and volume fraction.When the slow shot speed is increased from 0.05 m·s^(-1)to 0.1 m·s^(-1),the pore volume fraction decreases by 10.2%in steel-shot-sleeve samples,compared to a substantial 67.1%reduction in ceramic-shot-sleeve samples.At a slow shot speed of 0.1 m·s^(-1),castings produced with a ceramic shot sleeve exhibit superior mechanical properties:8.3%higher yield strength,17.4%greater tensile strength,and an 81.4%improvement in elongation,relative to those from a steel shot sleeve.These findings provide valuable insights for minimizing porosity and coarse ESCs in die castings,offering promising potential for broader industrial applications.
基金supported in part by the National Natural Science Foundation of China Grant 11962006the Natural Science Foundation of Jiangxi Province of China Grant 20232BAB204067.
文摘Quantitative detection of sleeve grouting compactness is a technical challenge in civil engineering testing.This study explores a novel quantitative detection method based on ultrasonic time-frequency dual-domain analysis.It establishes a mapping relationship between sleeve grouting compactness and characteristic parameters.First,this study made samples with gradient defects for two types of grouting sleeves,G18 and G20.These included four cases:2D,4D,6D defects(where D is the diameter of the grouting sleeve),and no-defect.Then,an ultrasonic input/output data acquisition system was established.Three-dimensional sound field distribution data were obtained through an orthogonal detection layout and pulse reflection principles.Finally,a novel quantification detection with a comprehensive defect index(DI)was established by comprehensively considering eight feature parameters,such as time-frequency domain Kurtosis factor(KU),Skewness factor(SK),Formfactor(FF),Crest factor(CF),Impulse factor(IF),Clearance factor(CLF),Wavelet packet energy entropy(WPEE),and Hilbert energy peak(HEP).Construct a DI index by quantifying the difference between defect signals and defect free signals in the time-frequency domain.Experimental results show that,under no-defect conditions,the values of feature parameters are significantly lower than those under defect conditions.Among these,the KU,FF,CF,WPEE and HEP exhibit strong correlations with grout sleeve compactness.The proposed DI index in both types of grout sleeves showed good universality with a linear fit goodness of 0.847–0.962.However,G20 the larger inner diameter and length of the sleeve result in a more complex medium effect during ultrasonic propagation,making its DI index more sensitive to defects than the G18 sleeve.Therefore,the presented method is effective for quantitative detection and analysis of the compactness of grouting sleeves.
文摘In open-ended piles, inner friction is developed between inner pile shaf and the inner soil. Inner frictional resistance depends largely on the degree of soil plugging, which is influenced by many factors including pile diameter, relative density and end conditions of piles. In this paper, effects of inner sleeves on inner frictional resistance are discussed. The experiments were conducted on a medium-dense sandy ground using laboratory-scale piles. It was observed that the piles penetrated under partially-plugged or unplugged state. The results suggest that inner fiictional resistance, Qin increases with sleeve height, l linearly and requires 2D （D is pile outer diameter） of l to produce a large as 50% of Qt by Qin （Qt is total resistance）. The results also indicate that bearing capacity increases with wall thickness at the pile tip, which can be attributed to the increase in annular area. The results also indicate that soil plug height is independent of sleeve height. The results also reveal that the penetration of straight piles is closer to unplugged state than the sleeved piles. The results of incremental filling ratio and plug length ratio also indicate that the degree of soil plugging is affected by the sleeve height.
文摘Metabolic dysfunction-associated steatohepatitis(MASH)has become a leading indication for liver transplantation.Bariatric surgery is a proven intervention for weight loss and metabolic improvement in MASH but concerns over surgical risk in patients with advanced liver disease has expanded interest in endoscopic sleeve gastroplasty(ESG)as a less invasive alternative.This review examine the efficacy,safety,and metabolic impact of ESG vs traditional bariatric surgery(Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy)in patients with MASH,with and without cirrhosis.We analyze current evidence on weight loss outcomes,histologic and biochemical improvements in MASH,resolution of metabolic syndrome,and perioperative risks associated with these procedures.Special attention is given to the feasibility of ESG in compensated cirrhosis(Child-Pugh A/B)and the potential role of bariatric interventions in delaying or avoiding liver transplantation.As the prevalence of MASH-related cirrhosis rises,refining bariatric strategies for this high-risk population is imperative.ESG may offer a lower procedural risk profile,but current data are largely limited to small,observational studies with short-term follow-up.A tailored,multidisciplinary approach is essential to optimize weight management and liver health in MASH patients,with future studies needed to clarify the long-term efficacy and safety of ESG in MASH.
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 Endoscopic bariatric therapies(EBT)have been developed as an adjunctive therapy to treat persistent obesity and recurrent weight gain and dumping symptoms after metabolic and bariatric surgery(MBS).While the efficacy of revisional EBTs has been documented,no studies to date have examined how these procedures impact quality of life(QOL)and internalized weight bias(IWB).AIM To understand how endoscopic revisional therapies impact QOL,IWB,and dumping syndrome.METHODS Analysis included 19 participants treated for post-MBS recurrent weight gain and/or dumping syndrome.The short-form 36 survey,weight bias internalization scale,and the Sigstad scoring system were used to measure QOL,IWB,and dumping syndrome pre-and≥4 weeks post-EBT.RESULTS At 6-months,total body weight loss was 8.6%±7.15%(n=16),at 12-months was 13.4%±7.46%(n=16).Short-form 36 scores for all 8 scales significantly increased from pre-to post-procedure with the greatest improvement in the scales related to emotional(mean improvement=59.6,P<0.05)and physical health(mean improvement=31.1,P<0.05).Both total Sigstad score(mean difference=4.947,P<0.05)and total weight bias internalization score(mean difference=0.761,P<0.05)significantly decreased from pre-to post-procedure.CONCLUSION Findings suggest that revisional EBT may improve post-MBS QOL across a broad spectrum of outcomes beyond optimizing body weight.As early EBT results indicate positive mental and physical health outcomes,further research is needed to evaluate the relationship between these improvements,body weight and interdisciplinary post-MBS care.
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.
文摘BACKGROUND One-anastomosis gastric bypass(OAGB)and sleeve gastrectomy(SG)are surgical procedures increasingly performed for weight loss and to achieve remission of diabetes mellitus.Literature comparing the medium-term efficacy of these two procedures is scarce.As such,a meta-analysis comparing OAGB and SG in terms of diabetes remission(DR)and percentage of excess weight loss(EWL)is warranted.AIM To compare OAGB and SG in terms of DR and EWL%in the medium term.METHODS A comprehensive literature search was conducted in PubMed/MEDLINE,Cochran Library,and Web of Science for relevant articles,from inception through April 2025,using the keywords“one-anastomosis gastric bypass”,“sleeve gastrectomy”,“mini-gastric bypass”,“diabetes remission”,“one-anastomosis”,and“excess weight loss”.Clinical trials,prospective,retrospective and case-control studies were included;cross-sectional studies,case reports,editorials,and opinions were excluded.The Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale were used to assess the quality of included studies,and RevMan version 5.4 was used for data analyses.RESULTS A total of 1360 articles were identified,and 35 studies were retrieved of which 32 were included in the final analysis.Three full texts were excluded as they did not include data on DR or EWL%.OAGB achieved higher DR than SG at 1 year following surgery[odds ratio(OR)=1.77,95%confidence interval(CI):1.22-2.57,I^(2)=76%].However,DR rates were similar at 3 years and 5 years following surgery(OR=0.82,95%CI:0.61-1.10,I^(2)=23%and OR=0.92,95%CI:0.31-2.72,I^(2)=75%,respectively).OAGB showed higher EWL%at 1 year(OR=9.30,95%CI:6.45-12.15,I^(2)=91%),3 years(OR=10.02,95%CI:9.40-10.64,I^(2)=22%),and 5 years(OR=11.61,95%CI:3.74-19.48,I^(2)=97%).OAGB showed higher late complications than adjustable SG.The results were not different in sub-group analysis including only clinical trials,observational studies,and removing studies including super-obese patients and studies contributing most to heterogeneity.CONCLUSION In the medium term,DR rates were similar between OAGB and SG;however,OAGB showed higher EWL%than SG,and late complications were higher in OAGB.Clinical trials investigating the predictors of DR and EWL%are recommended.
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.
