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
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
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
Precast concrete structures have gained popularity due to their advantages.However,the seismic performance of their connection joints remains an area of ongoing research and improvement.Grouted Sleeve Connection(GSC)o...Precast concrete structures have gained popularity due to their advantages.However,the seismic performance of their connection joints remains an area of ongoing research and improvement.Grouted Sleeve Connection(GSC)offers a solution for connecting reinforcements in precast components,but their vulnerability to internal defects,such as construction errors and material variability,can significantly impact performance.This article presents a finite element analysis(FEA)to evaluate the impact of internal grouting defects in GSC on the structural performance of precast reinforced concrete columns.Four finite elementmodels representing GSC with varying degrees of defects were used to investigate the effects on mechanical properties,including bearing capacity,stress-deformation behavior,and stiffness degradation.The study highlights the significant impact of internal grouting defects on the mechanical performance of GSC,with findings indicating a decrease in stiffness,increased plastic deformation,and reduced energy dissipation as the proportion of internal defects rises.The analysis reveals that the internal defects in GSC act as stress concentration points,leading to early crack formation and accelerated damage under cyclic loading.By improving construction quality and reducing the prevalence of grouting defects,the adverse effects on the performance of GSC can be mitigated.Compared to defect-free specimens,those with defects of 30%exhibited a 31.23%reduction in horizontal bearing capacity,highlighting the importance of minimizing defects in practical engineering applications.展开更多
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.
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.
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Precast concrete structures have gained popularity due to their advantages.However,the seismic performance of their connection joints remains an area of ongoing research and improvement.Grouted Sleeve Connection(GSC)offers a solution for connecting reinforcements in precast components,but their vulnerability to internal defects,such as construction errors and material variability,can significantly impact performance.This article presents a finite element analysis(FEA)to evaluate the impact of internal grouting defects in GSC on the structural performance of precast reinforced concrete columns.Four finite elementmodels representing GSC with varying degrees of defects were used to investigate the effects on mechanical properties,including bearing capacity,stress-deformation behavior,and stiffness degradation.The study highlights the significant impact of internal grouting defects on the mechanical performance of GSC,with findings indicating a decrease in stiffness,increased plastic deformation,and reduced energy dissipation as the proportion of internal defects rises.The analysis reveals that the internal defects in GSC act as stress concentration points,leading to early crack formation and accelerated damage under cyclic loading.By improving construction quality and reducing the prevalence of grouting defects,the adverse effects on the performance of GSC can be mitigated.Compared to defect-free specimens,those with defects of 30%exhibited a 31.23%reduction in horizontal bearing capacity,highlighting the importance of minimizing defects in practical engineering applications.
