[Comparison of 1-year outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy with Roux-en-Y duodenojejunal bypass in the patients of obesity with type 2 diabetes mellitus].

Objective: To compare the 1-year effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy with Roux-en-Y duodenal bypass (SG+RYDJB) on weight loss, remission of diabetes, and postoperative complications in patients with obesity and type 2 diabetes. Methods: A single-center retrospective cohort study was conducted at the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2020. Sixty-four patients with type 2 diabetes and body mass index (BMI) of 27.5-40.0 kg/m2 were included in this study and divided into the RYGB group (n=34) and the SG+RYDJB group (n=30). In both procedures, the biliopancreatic branch was measured 100 cm distal to the Treitz ligament, and the food branch was measured 100 cm distal to the gastric or duodenojejunal anastomosis. Patients were followed up by telephone or WeChat, a free messaging and calling app at 1, 3, 6, and 12 months postoperatively to determine their weight loss and remission of diabetes. The primary outcomes were the weight loss and reduction in blood glucose concentrations at 1 year after surgery and postoperative complications. Other postoperative changes, including body weight, BMI, percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), glycated hemoglobin A1c (HbA1c), and fasting blood glucose at 1 year after surgery were also assessed. Results: There were no significant differences in baseline data between the two groups (all P>0.05). No conversion to open surgery or death occurred in either group. Operation time was longer in the SG+RYDJB than the RYGB group (137.8±22.1 minutes vs. 80.0±24.9 minutes, t=9.779, P<0.001) and the incidence of perioperative complications was higher in the SG+RYDJB than the RYGB group (20% [6/30] vs. 2.9% [1/34], χ2=4.761, P=0.029). However, the postoperative hospital stay was similar between the two groups [3.0 (3.0, 4.3) days vs. 3.0 (4.0, 6.0) days, U=641.500, P=0.071]. Perioperative complications comprised small gastric pouch anastomotic leakage in one patient in the RYGB group and leakage (three patients) and bleeding (two patients with gastrointestinal bleeding and one with trocar site bleeding) in the SG+RYDJB group. Long-term complications were as follows. The incidence of anemia was significantly higher in the RYGB than the SG+RYDJB group (26.5% [9/34] vs. 3.3% [1/30], χ2=6.472, P=0.011). However, there were no significant differences in incidences of postoperative reflux, dumping syndrome, alopecia, diarrhea, constipation or foul-smelling flatus between the two groups (all P>0.05). Compared with 1 year before surgery, the body weights and fasting plasma glucose concentrations of patients in the SG+RYDJB and RYGB group (72.4±10.6 kg vs. 98.5±14.2 kg, respectively; 68.2±10.0 kg vs. 91.9±14.8 kg, respectively), BMI (25.2±2.9 kg/m2 vs. 34.3±4.2 kg/m2, respectively; 24.3±2.4 kg/m2 vs. 32.7±3.7 kg/m2, respectively) (5.5±1.6 vs. 10.6±3.3, respectively; 5.8±2.1 vs. 9.0±3.4, respectively); HbA1c (5.7±0.8 vs. 9.7±1.2, respectively; 9.1±1.9 vs. 5.9±0.9, respectively) were significantly lower at 1 year after surgery (all P<0.05). However, the % TWL (26.5%±6.0% vs. 25.6%±4.4%, t=0.663, P=0.510) and % EWL (109.1%±38.2% vs. 109.4%±40.3%, t=-0.026, P=0.026), rate of complete remission of diabetes at 1 year (80.0% [24/30] vs. 82.4% [28/34], χ2=0.058, P=0.810] did not differ significantly between the two groups (all P>0.05). Conclusions: Although SG+RYDJB surgery compared with RYGB is more difficult to perform, it can achieve similar weight loss and remission of diabetes and is associated with a lower incidence of anemia because of the preservation of the pylorus.

MicroRNA-7-5p regulates osteogenic differentiation of hMSCs via targeting CMKLR1.

OBJECTIVE: To investigate the function of microRNA-7-5p in human mesenchymal stem cells (hMSCs) and its underlying potential mechanism in osteogenic differentiation. PATIENTS AND METHODS: Expression levels of osteogenic genes (ALP, RUNX2), microRNA-7-5p and CMKLR1 in hMSCs were detected by quantitative real time-polymerase chain reaction (qRT-PCR). After transfection of microRNA-7-5p mimics or inhibitor, the effect of microRNA-7-5p on osteogenic differentiation of hMSCs was detected by Alizarin red staining, ALP activity determination and Western blot, respectively. The potential target gene of microRNA-7-5p was predicted online and further verified by luciferase reporter gene assay. Rescue experiments were conducted to explore whether the effect of microRNA-7-5p on osteogenic differentiation of hMSCs could be reversed by CMKLR1. RESULTS: Expression levels of ALP, RUNX2 and microRNA-7-5p were gradually elevated with the prolongation of osteogenic differentiation, whereas CMKLR1 was reduced. Overexpression of microRNA-7-5p increased levels of ALP and RUNX2. The amount of calcified nodules was increased after microRNA-7-5p overexpression. CMKLR1 was the target gene of microRNA-7-5p. The effect of microRNA-7-5p on osteogenic differentiation of hMSCs could be reversed by CMKLR1. CONCLUSIONS: MicroRNA-7-5p promotes osteogenic differentiation of hMSCs via targeting CMKLR1.

Coronal approach to zygomaticomaxillary complex fractures.

OBJECTIVE: Trauma of the zygomaticomaxillary complex constitutes 45% of all midface fractures. In the author's medical unit, the proportion is 40% of all fractures of the facial skeleton. Most zygomaticomaxillary complex fractures can be treated via local incisions, however; multiple, comminuted and late fractures require wide exposure of the fragments in order to adequately reposition them and to apply rigid fixation. PATIENTS AND METHODS: Thirty-one cases of comminuted or multiple fractures of the zygomaticomaxillary complex were treated with open reduction and rigid fixation by a coronal approach and analyzed for indications and postoperative complications. Twenty three patients had a hemi coronal approach and eight had a bicoronal approach. RESULTS: Among the early complications noted were one case of hemorrhage, no infections, and two patients experienced paresthesia/ anesthesia in the supra orbital region, two patients in the temporal/parietal region, six patients experienced facial nerve weakness related to nerve retraction and moderate surgical edema was observed in three patients. Late complications included two cases of alopecia/baldness along the incision, one case of persistent paresthesia in the operative area. As far as the esthetics in relation to the incision was concerned, all patients were extremely satisfied. CONCLUSIONS: The results of this study suggest that a coronal approach will facilitate accurate reduction and fixation of fragments and will allow good cosmetic result with minimal or no complications. The coronal incisions should be the first choice in case of comminuted, multiple and late zygomaticomaxillary complex fractures. However, indications for the use of coronal incisions must be strictly applied.

Digital subtraction angiography (DSA) guided sequential sclerotherapy for maxillofacial vein malformation.

OBJECTIVES: Venous malformations commonly occur in the head and neck and affect the patient's appearance and also cause pain, ulcers, and bleeding. Current treatment options have many limitations and it is necessary to explore alternate methods to address these malformations. This work was aimed to explore the best method for treating patients with maxillofacial vein malformation. PATIENTS AND METHODS: Guided by digital subtraction angiography, 43 patients with maxillofacial vein malformation were treated with sequential sclerotherapy intervention. RESULTS: Patients were followed up for 7 months to 3 years. Lesions completely recessed in 7 cases. Recession rates were greater than 50% in 28 cases, 25-50% in 5 cases, and less than 25% in 3 cases. No severe complications occurred. CONCLUSIONS: Sclerotherapy with ethanol and pingyangmycin is a safe and effective method of treating maxillofacial vein malformation.