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Background@#MicroRNAs (miRNAs) exert an essential contribution to obesity and type 2 diabetes mellitus (T2DM). This study aimed to investigate the differences of miRNAs in the presence and absence of T2DM in patients with obesity, as well as before and after bariatric surgery in T2DM patients with obesity. Characterization of the common changes in both was further analyzed. @*Methods@#We enrolled 15 patients with obesity but without T2DM and 15 patients with both obesity and T2DM. Their preoperative clinical data and serum samples were collected, as well as 1 month after bariatric surgery. The serum samples were analyzed by miRNA sequencing, and the miRNAs profiles and target genes characteristics were compared. @*Results@#Patients with T2DM had 16 up-regulated and 32 down-regulated miRNAs compared to patients without T2DM. Improvement in metabolic metrics after bariatric surgery of T2DM patients with obesity was correlated with changes in miRNAs, as evidenced by the upregulation of 20 miRNAs and the downregulation of 30 miRNAs. Analysis of the two miRNAs profiles identified seven intersecting miRNAs that showed opposite changes. The target genes of these seven miRNAs were substantially enriched in terms or pathways associated with T2DM. @*Conclusion@#We determined the expression profiles of miRNAs in the obese population, with and without diabetes, before and after bariatric surgery. The miRNAs that intersected in the two comparisons were discovered. Both the miRNAs discovered and their target genes were closely associated with T2DM, demonstrating that they might be potential targets for the regulation of T2DM.
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Objective:To compare the safety of continuous suture and interrupted suture in Laparoscopic Sleeve Gastrectomy and Omentopexy.Methods:The retrospective study include 121 patients who underwent Laparoscopic Sleeve Gastrectomy and Omentopexy in the Department of Obesity and Metabolic Surgery of the First Affiliated Hospital of Jinan University from January 2019 to March 2020.Among the 121 patients, 40 were males and 81 females, with an average age of (30.17±10.16) and (27.10±11.03), respectively. Among them, 70 patients used continuous suture during OP (continuous suture group), and 51 patients used intermittent suture (interrupted suture group). The operation time, intraoperative blood loss, postoperative pain score, postoperative complications were compared between the two groups. Normally distributed measurement data were measured as (mean ± standard) deviation ( Mean± SD), and t test was used to count the comparison between the two groups. The χ2 test was used to compare the measurement data between groups. The rank data used Wilconxon rank sum test. Results:(1) Intraoperative conditions: the operative time and intraoperative blood loss in the continuous suture group were (124.89±37.69) min and (7.3±2.5) mL, respectively. In the interrupted suture group, the above indexes were (124.80±35.53) min and (7.0±2.5) mL, respectively. There was no significant difference between the two groups ( t=0.012, 0.709, P>0.05). (2) Postoperative conditions: postoperative pain score and postoperative hospital stay in the continuous suture group were: mild pain in 45 cases, moderate pain in 25 cases, painless and severe pain in 0 cases, (9.3±3.2) d, respectively. In the interrupted suture group, the above indicators were 39 cases of mild pain, 12 cases of moderate pain, 0 cases of painless and severe pain, (8.7±2.1) d, and there was no statistical significance between the two groups ( Z=-1.431, P>0.05, t=1.149, P>0.05). In the continuous suture group, postoperative abdominal distension occurred in 8 cases, nausea and vomiting in 32 cases, gastroesophageal reflux in 17 cases by upper digestive tract imaging, contrast agent slowly passed through the residual stomach/anastomotic site in 14 cases, gastric volvulus in 6 cases, and no postoperative infection or anastomotic leakage occurred. In the interrupted suture group, the above indexes were 10 cases, 25 cases, 14 cases, 10 cases, gastric volvulus in 1 cases, and no postoperative infection or anastomotic leakage occurred. There was no significant difference in the above indicators between the two groups ( χ2=1.559, 0.010, 0.155, 0.003, 1.308, P>0.05). Conclusions:In laparoscopic sleeve gastrectomy and omentopexy, there is no significant difference between the continuous suture and interrupted suture in terms of operation time, intraoperative blood loss and postoperative complications. The surgeon can choose a suitable suture method based on his own judgment and experience.
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At present, the formal bariatric surgery approved by the American Society for Metabolic and Bariatric Surgery (ASMBS) includes adjustable gastric banding (AGB), sleeve gastrectomy (Sleeve gastrectomy, SG). ), Roux-en-Y gastric bypass (Roux-en-Y gastric bypass, RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), mini gastric bypass (Mini-gastric bypass, MGB), single anastomosis gastric bypass (OAGB) and partial endoscopic surgery. According to the Chinese Society for Metabolic and Bariatric Surgery (CSMBS), the Chinese Obesity and Metabolic Surgery Database (COMES Database), and the Chinese Obesity and Metabolic Surgery Database (COMES Database), the Chinese Society for Metabolic and Bariatric Surgery (CSMBS) Chinese Obesity and Metabolic Surgery Collaborative, COMES Collaborative), Shanghai Weight Loss and Diabetes Surgery Data Management System, Shandong Province Weight Loss and Metabolic Surgery Case Registration System, Jiangsu Province Weight Loss and Metabolic Surgery Data Registration System, Great North China Weight Loss and Metabolic Surgery Statistics from the clinical data database and the Greater China Weight Loss and Metabolic Surgery Database. The domestically developed and approved bariatric surgery methods include RYGB, SG, MGB, OAGB, BPD-DS, AGB, combined sleeve gastrectomy (SG Plus), Jejunoileal Bypass (Jejunoileal Bypass, JJB), single stoma duodenal transposition (SADI-S), intragastric balloon (Balloon). However, there are still some irregular bariatric surgeries in China, which will cause some uncommon complications and bring great pain to patients. At the same time, it is also a huge challenge for regular bariatric surgeons who perform corrective surgeries. This article will review the revision surgery after bariatric surgery in China in the past 20 years, discusses a series of problems caused by non-standard bariatric surgery and the development of regular bariatric surgery.
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Laparoscopic bariatric and metabolic surgery in China began in 2000. After 20 years of development, it has realized the transformation from nothing to existence and then to rapid development. In this paper, the number of Chinese and English literatures on weight loss and metabolism published in China in the past 20 years, the source of literature institutions, published journals, literature types, key words and other aspects are analyzed. The results show as follows: the number of published literatures is generally increasing, bariatric surgery has changed from gastric bypass and gastric banding to gastric bypass and sleeve gastrectomy, revisional surgery and intestinal flora have been the focus of research in recent years. However, the development of laparoscopic bariatric surgery in China is still in its infancy, and there is few high-level evidence-based multicenter prospective randomized controlled study. Therefore, the authors suggest that more and larger sample, multicenter, randomized controlled studies should be carried out in the future and it requires to develop guidelines suitable for Chinese population. In order to promote the further development of bariatric and metabolic surgery in China, we should establish national data and register clinical data, strergthon the combination of clinical research and basic research and conduct deeper research based on the database.
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Postprandial hyperinsulinemic hypoglycemia (PHH) is one of the serious complications after bariatric surgery, it can lead life-threatening neuroglycopenic symptoms, such as seizures, disorientation, impairment of version and loss of consciousness without any premonitory. The presentation, prevalence, diagnosis, pathology and treatment are reviewed in this summary.
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Objective@#To investigate the application value of caesarean section scar or bikini line incisional approach in laparoscopic sleeve gastrectomy.@*Methods@#The retrospective cohort study was conducted. The clinical data of 162 patients with obesity and metabolic diseases who were admitted to the First Affiliated Hospital of Jinan University between March 2018 and April 2019 were collected. There were 51 males and 111 females, aged (35±8)years, with a range from 12 to 47 years. Of 162 patients, 72 undergoing laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incisional approach and 90 undergoing laparoscopic sleeve gastrectomy via traditional incisional approach were respectively allocated into concealed incision group and traditional incision group. Observation indicators: (1) surgical situations; (2) intraoperative situations; (3) postoperative situations; (4) follow-up. Follow-up using outpatient examination, telephone interview, and WeChat was performed to detect the postoperative complications at 1, 3, 6 months and 1, 2, 5 years postoperatively up to May 2019. Measurement data with normal distribution were represented as Mean±SD, and the t test was used for comparison between groups. Count data were represented as absolute numbers, and were analyzed by the chi-square test or fisher exact probability. Ordinal data were analyzed by the Wilcoxon rank sum test.@*Results@#(1) Surgical situations: patients in the concealed incision group and traditional incision group underwent successfully laparoscopic sleeve gastrectomy, without conversion to open surgery, reoperation, or perioperative death. (2) Intraoperative situations: the operation time and volume of intraoperative blood loss of the concealed incision group were (102±17)minutes and (11±4)mL, respectively, versus (105±19)minutes and (11±4)mL of the traditional incision group (t=-1.232, -0.676, P>0.05). There were 6 cases and 21 cases with additional surgical ports during operation in the concealed incision group and traditional incision group, respectively, with a significant difference between the two groups (χ2=6.280, P<0.05). (3) Postoperative situations: in the concealed incision group, 56 patients were very satisfied with scar appearance and 16 patients were satisfied with scar appearance. In the traditional incision group, 42 patients were very satisfied with scar appearance and 48 patients were satisfied with scar appearance. There was a significant difference in the overall satisfaction with the incision scar between the two groups (Z=-4.012, P<0.05). Duration of postoperative hospital stay and total hospital expenses of the concealed incision group were (4.9±0.9)days and (64 408±5 123)yuan, versus (5.2±1.5)days and (64 953±3 477)yuan of the traditional incision group (t=-1.788, -0.804, P>0.05). There were 19 and 14 patients with gastroesophageal reflux in the concealed incision group and traditional incision group, respectively, with no significant difference between the two groups (χ2=2.894, P>0.05). There was no postoperative complication such as infection, hemorrhage or anastomotic leakage in either group. (4) Follow-up: 32 of 162 patients were lost to follow-up, including 10 in the concealed incision group and 22 in the traditional incision group; other 130 patients were followed up for 1-14 months, with a median follow-up time of 7 months. During the follow-up, 1 patient in the traditional incision group was hospitalized again at 3 months after surgery due to upper gastrointestinal bleeding, and was cured after symptomatic supportive treatment. One patient in the concealed incision group was admitted to the local hospital for functional obstruction at 1 month after surgery and was discharged after symptomatic treatment. Other patients had no readmission due to postoperative complications.@*Conclusion@#Laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incision is safe and feasible, with good cosmetic effects.
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Bariatric surgery has been widely accepted around the world and recognized for long-term and effective weight loss, based on long-term follow-up of large sample sizes. Though more than 70 years of development, bariatric surgery is not only on open technique, it is usually done by laparoscopy. But with the advance of the new technology, laparoscopy is no longer a unique technique. With the development of new robotic system and endoscopic system, bariatric and metabolic surgery has come to a new era. There is no doubt that bariatric surgery is still on the change as the development of scientific technology. Laparoscopic technique is still the mainstream of bariatric and metabolic surgery. With the decrease in the price of robotic system and the appearance of domestic robotic system, the robotic technique will also be accepted by many surgeons. The endoscopic technique is a tendency for bariatric and metabolic surgery because of effective weight loss, small trauma and low complication rates.
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Objective To investigate the application value of caesarean section scar or bikini line incisional approach in laparoscopic sleeve gastrectomy.Methods The retrospective cohort study was conducted.The clinical data of 162 patients with obesity and metabolic diseases who were admitted to the First Affiliated Hospital of Jinan University between March 2018 and April 2019 were collected.There were 51 males and 111 females,aged (35± 8)years,with a range from 12 to 47 years.Of 162 patients,72 undergoing laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incisional approach and 90 undergoing laparoscopic sleeve gastrectomy via traditional incisional approach were respectively allocated into concealed incision group and traditional incision group.Observation indicators:(1) surgical situations;(2) intraoperative situations;(3) postoperative situations;(4) follow-up.Follow-up using outpatient examination,telephone interview,and WeChat was performed to detect the postoperative complications at 1,3,6 months and 1,2,5 years postoperatively up to May 2019.Measurement data with normal distribution were represented as Mean±SD,and the t test was used for comparison between groups.Count data were represented as absolute numbers,and were analyzed by the chisquare test or fisher exact probability.Ordinal data were analyzed by the Wilcoxon rank sum test.Results (1) Surgical situations:patients in the concealed incision group and traditional incision group underwent successfully laparoscopic sleeve gastrectomy,without conversion to open surgery,reoperation,or perioperative death.(2) Intmoperative situations:the operation time and volume of intraoperative blood loss of the concealed incision group were (102± 17) minutes and (11±4) mL,respectively,versus (105± 19) minutes and (11 ±.4) mL of the traditional incision group (t=-1.232,-0.676,P＞0.05).There were 6 cases and 21 cases with additional surgical ports during operation in the concealed incision group and traditional incision group,respectively,with a significant difference between the two groups (x2=6.280,P＜0.05).(3) Postoperative situations:in the concealed incision group,56 patients were very satisfied with scar appearance and 16 patients were satisfied with scar appearance.In the traditional incision group,42 patients were very satisfied with scar appearance and 48 patients were satisfied with scar appearance.There was a significant difference in the overall satisfaction with the incision scar between the two groups (Z =-4.012,P＜0.05).Duration of postoperative hospital stay and total hospital expenses of the concealed incision group were (4.9±0.9) days and (64 408±5 123) yuan,versus (5.2± 1.5) days and (64 953± 3 477)yuan of the traditional incision group (t =-1.788,-0.804,P＞0.05).There were 19 and 14 patients with gastroesophageal reflux in the concealed incision group and traditional incision group,respectively,with no significant difference between the two groups (x2=2.894,P＞0.05).There was no postoperative complication such as infection,hemorrhage or anastomotic leakage in either group.(4) Follow-up:32 of 162 patients were lost to follow-up,including 10 in the concealed incision group and 22 in the traditional incision group;other 130 patients were followed up for 1-14 months,with a median follow-up time of 7 months.During the follow-up,1 patient in the traditional incision group was hospitalized again at 3 months after surgery due to upper gastrointestinal bleeding,and was cured after symptomatic supportive treatment.One patient in the concealed incision group was admitted to the local hospital for functional obstruction at 1 month after surgery and was discharged after symptomatic treatment.Other patients had no readmission due to postoperative complications.Conclusion Laparoscopic sleeve gastrectomy via caesarean section scar or bikini line incision is safe and feasible,with good cosmetic effects.
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Bariatric surgery has been widely accepted around the world and recognized for long-term and effective weight loss,based on long-term follow-up of large sample sizes.Though more than 70 years of development,bariatric surgery is not only on open technique,it is usually done by laparoscopy.But with the advance of the new technology,laparoscopy is no longer a unique technique.With the development of new robotic system and endoscopic system,bariatric and metabolic surgery has come to a new era.There is no doubt that bariatric surgery is still on the change as the development of scientific technology.Laparoscopic technique is still the mainstream of bariatric and metabolic surgery.With the decrease in the price of robotic system and the appearance of domestic robotic system,the robotic technique will also be accepted by many surgeons.The endoscopic technique is a tendency for bariatric and metabolic surgery because of effective weight loss,small trauma and low complication rates.
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Objective To establish an HPLC quantitative method for the content determination of baicalin in Kangdeling capsule .Methods The chromatography column was Agilent Tc-C18-WR (4 .6 mm × 250 mm ,5μm) ,and the column temper-ature was 30 ℃ .The mobile phase consisted of acetonitrile and 0 .5‰ phosphoric acid (26 ∶ 74 ) .The flow rate was 1 .0 ml/min ,and the detection wavelength was 265 nm .Results The retention time of baicalin was about 16 min .The calibra-tion equation was Y=22 114 .67 X -112 836 .7(r=0998 8)with good linearity in the range of 5 .410-108 .2 μg/ml for baicalin . The average recovery was 98 .78% while RSD were 0 .74% .Conclusion This method is simple ,time-saving and accurate which could be used to routine analysis of baicalin in Kangdeling capsule .
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The stability of hemocompatibility of Ti6Al4V alloy and DLC film/Ti6Al4V gradient material has been studied. The platelet consumption ratio of Ti6Al4V alloy to DLC film/Ti6Al4V gradient material has been measured respectively by digital image analysis method. It has been found that the platelet consumption ratio of Ti6Al4V alloy increased remarkedly about 50% after 2,000 m sliding tribological test under the lubrication of Hank's solution, while that of DLC film/Ti6Al4V gradient material almost didn't increase under the same condition, which means that the DLC film/Ti6Al4V gradient material has better stability of hemocompatibility.