Analysis of clinical characteristics of adolescents undergoing metabolic and bariatric surgery / 国际外科学杂志

Objective:To analyze the clinical characteristics of obese adolescents undergoing metabolic and bariatric surgery for the purpose to guide clinical decision-making and practice of metabolic and bariatric surgery in adolescents.Methods:The perioperative clinical profile of 123 adolescent patients under the age of 21 years who underwent metabolic and bariatric surgery in Beijing Friendship Hospital, Capital Medical University from 2018 to 2021 were extracted, and compared their clinical data with the overall data of 6807 patients in the 2021 GC-MBD Annual Report. Analyzed the clinical characteristics of adolescent weight loss metabolic surgery patients from multiple aspects such as preoperative complications, surgical methods, surgical outcomes, and follow-up. Statistical analysis was conducted using SPSS25.0 software.Results:Among adolescent bariatric surgery patients, the proportion of female patients (74.0%) was higher than that of male patients (26.0%). Except for the incidence of polycystic ovary syndrome (31.9%), which was higher than the overall rate, the proportion of other related diseases or symptoms was low and usually mild. The changes of systolic blood pressure ( Z=-5.73, P<0.001), body weight ( Z=-5.69, P<0.001), umbilical abdominal circumference ( Z=-2.40, P=0.017), glycosylated hemoglobin ( Z=-5.23, P<0.001), fasting insulin ( Z=-2.95, P<0.003), fasting C-peptide ( Z=-4.59, P<0.001), triglyceride ( Z=-2.75, P=0.006) at 3 months after operation were statistically significant compared with those before operation. The changes of systolic blood pressure ( Z=-3.42, P=0.001), body weight ( Z=-5.14, P<0.001), umbilical abdominal circumference ( Z=-2.86, P=0.004) and glycosylated hemoglobin ( Z=-2.67, P<0.008), fasting C-peptide ( Z=-2.09, P=0.037), high-density lipoprotein ( Z=-2.08, P=0.038) at 6 months after operation were statistically significant compared with those before operation. Conclusions:The outcomes of bariatric surgery in obese adolescents are similar to those in adults. The indications and timing of bariatric surgery need to be further explored. In view of the high proportion of females, poor self-management ability and low follow-up compliance of adolescent patients, it is urgent to construct a full-cycle care model suitable for adolescent patients with bariatric surgery to improve their self-management ability, follow-up compliance and long-term clinical outcomes.

A meta-analysis of cholelithiasis after metabolic and bariatric surgery / 国际外科学杂志

Objective:To analyze the incidence of gallstone formation after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) by meta-analysis.Methods:English terms for this meta-analysis included "bariatric surgery, gastric bypass, Roux-n-Y gastric bypass, RYGB, sleeve gastrectomy, SG, cholelithiasis, cholecystectomy, gallstone". Researched articles in Pubmed, Medline and Embase databases were searched up to February 2023 and retrieved for further analysis. The quality of each article was evaluated with Newcastle-Ottawa Scale (NOS). Generated data were analyzed with Revman 5.4.Results:Nine relevant cohort studies were retrieved for this meta-analysis, including a total of 24 255 RYGB patients and 4 500 SG patients. All articles met the requirements after the quality evaluation of NOS. The meta-analysis results showed that the incidence of postoperative gallstones in RYGB group was higher than that in SG group ( P<0.001). In subgroup analysis, by administering ursodeoxycholic acid (UDCA) for gallstone prevention, the incidence had no difference between the two groups ( P=0.090), while in the study without UDCA, the incidence of gallstones after RYGB was higher than SG ( P=0.005). In the studies with follow-up time no more than 24 months, the incidence of postoperative gallstones in RYGB group was higher than that in SG group ( P=0.050), but there was no statistical difference when following-up beyond 24 months ( P=0.240). Conclusions:Within 2 years after surgery, RYGB patients have more chances to develop gallstones than SG patients. However, beyond 2-year follow-up, there is no difference between the two procedures. Prophylactical utilization of UDCA after RYGB can effectively reduce the incidence of gallstone formation.

Effects of metabolic and bariatric surgery on bone metabolism in patients with obesity: A meta-analysis / 国际外科学杂志

Objective:To systematically evaluate the effect of bariatric and metabolic surgery on bone metabolism in obese patients.Methods:Search terms for the present meta-analysis included "bariatric surgery, metabolic surgery, sleeve gastrectomy, gastric bypass, bone metabolic indicators, bone mineral density", both in English and corresponding Chinese. PubMed, WOS, Cochrane, CNKI, and VIP databases were searched for longitudinal studies from the establishment of the database to September 20, 2022. The data on bone mineral density and bone metabolic markers in obese patients before and after bariatric surgery were extracted. RevMan5.4 and Stata17.0 software were used for Meta-analysis.Results:A total of 8 clinical studies with 420 patients were included. The results of the meta-analysis showed that compared with the preoperative baseline, lumbar spine bone mineral density ( WMD=0.05, 95% CI: -0.00~0.1), femoral neck bone mineral density( WMD=0.10, 95% CI: 0.05-0.15), hip bone mineral density( WMD=0.14, 95% CI: 0.10-0.17), and serum vitamin D 3 ( WMD=-4.87, 95% CI: -6.34--3.40)were decreased, while parathyroid hormone ( WMD=10.04, 95% CI: 5.32-14.76) was elevated after surgery. Conclusions:Current evidence demonstrates that metabolic and bariatric surgery can lead to decreased bone mineral density and impairs in bone metabolic markers early after surgery. Roux-en-Y gastric bypass surgery cause more adverse effects on bone metabolism than sleeve gastrectomy. The results imply that all patients undergoing metabolic and bariatric surgery should be monitored for bone metabolism and routinely take vitamin D and calcium supplements.

Management and outcomes of gastric leak after sleeve gastrectomy: results from the 2010-2020 national registry / 中华医学杂志(英文版)

BACKGROUND@#Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting.@*METHODS@#To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks.@*RESULTS@#A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population ( P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment ( P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor.@*CONCLUSIONS@#Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.

Research progress of stimulus-responsive transdermal drug delivery systems / 中国药房

Stimulus-responsive transdermal drug delivery systems can achieve specific drug release and improve drug utilization. According to the different stimulation modes， these preparations can be divided into endogenous stimulus-responsive， exogenous stimulus-responsive and combined stimulus-responsive transdermal drug delivery systems. The endogenous stimulation- responsive transdermal drug delivery system can respond specifically to changes in temperature and pH of the lesion site through carrier materials， so as to deliver drugs to the target site. Exogenous stimulus-responsive transdermal drug delivery system can use light， heat， magnetic， electric and other external stimulation to make the carrier material phase change， so as to achieve drug delivery. The combined stimulus-responsive transdermal drug delivery system is a combination of two or more stimulus-responsive percutaneous drug delivery systems， such as temperature-pH dual-responsive drug delivery system. At present， the relevant studies of stimulus-responsive transdermal drug delivery systems are mostly in the experimental stage， and further evaluation of stability， toxicity and skin irritation is needed in the future to lay a theoretical foundation for clinical application.

Study on the characteristics of postoperative cholelithiasis in patients undergoing bariatric surgery / 国际外科学杂志

Objective:To explore the incidence and occurrence time of gallstone disease after bariatric surgery.Methods:Retrospectively analyzed the clinical data of 187 patients with morbid obesity who underwent bariatric surgery in the Department of General Surgery, Beijing Friendship Hospital, Capital Medical University from Dec. 2017 to Aug. 2019. All patients did not receive prophylactic ursodeoxycholic acid. All patients were underwent abdominal ultrasound and MRI examination preoperatively, and at least one abdominal ultrasound, MRI examination postoperatively. The incidence and occurrence time of gallstones and biliary sludge in patients with different bariatric surgery were analyzed respectively. Measurement data conforming to the normal distribution were described as mean ± standard deviation ( Mean± SD). Measurement data consistent with skewed distribution were described as median (lower quartile, upper quartile). Counting data were described as a percentage (%). Kruskal-Wallis test was used for comparison among groups, and then Bonferroni correction was used for pairwise comparison. Results:The follow-up time was up to Dec. 31, 2020, with a median follow-up time of 27.0 (22.0, 31.0) months. Thirty-four patients (18.2%, 34/187) developed gallstones after bariatric surgery. Individually, it was 18.0%(30/167) in LSG group, 22.2%(2/9) in LRYGB group, 11.1%(1/9) in LOAGB group and 50.0%(1/2) in LOAGB revisional surgery group. Eighteen patients (9.6%, 18/187) were found biliary sludge formation, among which 8.4% (14/167), 22.2% (2/9), and 22.2% (2/9) underwent LSG, LRYGB, and LOAGB, respectively. The rates of weight loss and BMI loss in patients with postoperative gallstone-formation were 21.4 (18.7, 23.6)% and 21.4 (18.6, 23.5) %, respectively. Three patients (1.6%, 3/187) had newly developed symptomatic gallstones, and all of them underwent LSG. The mean occurrence time for biliary sludge and gallstone was 85.5 (28.8, 98.8) and 103.5 (93.0, 179.3) days, respectively. Statistical difference in occurrence time was only found between postoperative gallstone and biliary sludge formation ( P=0.009). Conclusion:Without drug intervention, the incidence of gallstone after bariatric surgery was about 18.2% (34/187), which requires close clinical attention. Abdominal ultrasonography and the T2WI sequence of upper abdominal MRI can help to diagnose gallstone and monitor its changes.

Thirty years of metabolic engineering for biosynthesis of polyhydroxyalkanoates / 生物工程学报

Polyhydroxyalkanoate (PHA) is a family of biodegradable polyesters synthesized by microorganisms. It has various monomer structures and physical properties with broad application prospects. However, its large-scale production is still hindered by the high cost. In the past 30 years, metabolic engineering approach has been used to tune the metabolic flux, engineer and introduce pathways. The efficiency of PHA synthesis by microorganisms has been significantly improved, and the diversity of PHA monomer, structure and substrate have also been enriched. Meanwhile, by changing cell morphology and PHA particle size, more efficient downstream production process has achieved and PHA production costs have been reduced. In recent years, "Next generation industrial biotechnology" (NGIB) based on extremophiles, especially halophilic Halomonas spp., has been rapidly developed. NGIB has achieved the opening and continuous production of PHA, which simplifies the production process and saves energy and fresh water. Combined with metabolic engineering, Halomonas spp. can be transformed into low-cost production platform of numerous PHA. It is expected to improve the market competitiveness and promote the commercialization of PHA.

Application value of π-shaped Roux-en-Y esophagojejunostomy in totally laparoscopic total gastrectomy / 中华消化外科杂志

Objective To investigate the application value of π-shaped esophagojejunostomy in totally laparoscopic total gastrectomy.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 3 patients who underwent totally laparoscopic total gastrectomy in the Beijing Friendship Hospital of Capital Medical University between October 2016 and March 2017 were collected.Patients received π-shaped Roux-en-Y esophagojejunostomy.Patients who were diagnosed with Ⅱ and above stages by pathological examination underwent postoperative adjuvant chemotherapy with oxaliplatin + tegafur gimeracil oteracil.Observation indicators:(1) surgical and postoperative recovery situations;(2) follow-up and survival situations.The follow-up using outpatient examination and telephone interview was performed to detect postoperative adjuvant therapy and survival up to March 2018.Results (1) Surgical and postoperative recovery situations:3 patients underwent successfully totally laparoscopic total gastrectomy,and π-shaped Roux-en-Y esophagojejunostomy was also performed.Case 1 had injury of spleen vessel when No 11 p lymph nodes were dissected and then received successful hemostasis,and case 2 and 3 didn't have complication.Operation time,digestive tract reconstruction time,volume of intraoperative blood loss,time to anal exsufflation and postoperative drainage-tube removal time of case 1,2 and 3 were respectively 376 minutes,290 minutes,284 minutes and 26 minutes,30 minutes,24 minutes and 500 mL,100 mL,200 mL and 2 days,3 days,3 days and 4 days,4 days,5 days.Case 3 with left pleural effusion was cured by puncture and drainage treating,and case 1 and 2 didn't have complication.Three patients were not complicated with anastomotic stoma-related complicaions.Results of postoperative pathological examination:number of lymph node dissected and TNM staging of case 1,2 and 3 were respectively 20,17,20 and TlaN0M0 staging,T3N3M0 staging,T1bN0M0 staging.Duration of hospital stay in case 1,2 and 3 was respectively 7 days,8 days and 11 days.(2) Follow-up and survival situations:3 patients were followed up,and follow-up time of case 1,2 and 3 was respectively 18 months,16 months,12 months.During the follow-up,case 2 received postoperative adjuvant therapy,and then underwent palliative treatment of Paclitaxel and Xeloda after the case was rechecked out multiple liver metastases at postoperative month 12.Case 1 and 3 had disease-free survival.Conclusion The π-Shaped esophagojejunostomy is safe and feasible for totally laparoscopic total gastrectomy,and it can be used as an alternative to digestive tract reconstruction.

Efficacy of PCV-VG mode for lung protective ventilation in patients requiring one-lung ventilation during thoracoscopic surgery / 中华麻醉学杂志

Objective To evaluate the efficacy of pressure-controlled volume-guaranteed (PCVVG) mode for lung protective ventilation in patients requiring one-lung ventilation (OLV) during thoracoscopic surgery.Methods Sixty patients,aged 50-70 yr,with body mass index of 18-26 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective radical resection of esophageal cancer performed via video-assisted thoracoscope under general anesthesia,were divided into 2 groups (n=30 each) using a random number table:volume-controlled ventilation group (group V) and PCV-VG group (group P).The ventilator settings were adjusted,with a tidal volume 10 ml/kg and respiratory rate 10-12 breaths/min during two-lung ventilation,and with a tidal volume 6 ml/kg and respiratory rate 12-16 breaths/min during OLV.The inspiratory/expiratory ratio was 1 ∶ 2,pressure restriction was 35 cmH2O,and 33％ oxygen was inhaled at 2 L/min.The end-tidal pressure of carbon dioxide was maintained at 35-40 mmHg.Visual analog scale score was maintained ≤ 3 after operation.After admission to the operation room (T0) and at 1,3 and 7 days after operation (T1-3),forced vital capacity (FVC),forced expiratory volume in first second (FEV1),and maximal mid-expiratory flow (MMEF) were measured,arterial blood samples were collected for blood gas analysis,arterial carbon dioxide partial pressure and arterial oxygen partial pressure (PaO2) were recorded,and alveolar-arterial oxygen tension difference (PA-a O2) was calculated.Clinical Pulmonary Infection Score was assessed at T1,T2 and T3.The chest tube removal time and length of postoperative hospital stay were recorded.Results Compared with the baseline at T0,FVC,FEV1,MMEF and PaO2 were significantly decreased,and PA-aO2 was increased at T1-3 in the two groups (P＜0.05).Compared with group V,FVC,FEV1,MMEF and PaO2 were significantly increased,PA-aO2 and Clinical Pulmonary Infection Score were decreased,and the chest tube removal time and length of postoperative hospital stay were shortened at T1-3 in group P (P＜0.05).Conclusion PCV-VG mode can achieve lung protective ventilation,which is helpful in improving outcomes in the patients requiring OLV during thoracoscopic surgery.

Simultaneous Determination of Eight Effective Compounds of Fufang Xueshuantong ;Capsule in Rat Plasma by LC-MS/MS / 中国中医药信息杂志

Objective To establish a sensitive and specific LC-MS/MS method for measurement of notoginsenoside R1, ginsenoside Rg1, ginsenoside Re, ginsenoside Rb1, ginsenoside Rd, tanshinone Ⅰ, astragaloside Ⅳ and harpagosidein of Fufang Xueshuantong Capsule in rat plasma. Methods The HPLC separation was performed on Thermo Hypersil GOLD column (2.1 mm× 100mm, 5 μm) at 30 ℃, injecting 10 μL and using acetonitrile-water (0.1% formic acid) as the mobile phrase (B was acetonitrile, A was 0.1%formic acid;0-10 min, 25%-55%B;10-20 min, 55%-70%B) with the flow rate of 0.2 mL/min. Detection was performed on a tandem quadrapole mass spectrometer using positive electrospray ionization, SRM scan mode. Results The eight compounds showed good linearity in wide ranges (notoginsenoside R1 1.00-800 ng/mL, ginsenoside Rg1 0.950-760 ng/mL, ginsenoside Re 1.44-1440 ng/mL, ginsenoside Rb1 1.33-1330 ng/mL, ginsenoside Rd 9.90-990 ng/mL, harpagosidein 1.01-1010 ng/mL, astragaloside Ⅳ 1.16-928 ng/mL, tanshinone Ⅰ 10.0-800 ng/mL). In addition, the accuracy and recovery were around 85%-115%and 50%-70%. The RSD of intra and inter day precision were lower than 15%. Conclusion The method is specific, rapid and sensitive. Therefore, it can be applied to pharmacokinetic study of eight effective compounds in Fufang Xueshuantong Capsule.