Laparoscopic repair of gastroduodenal perforation has been widely used in clinical practice. With the advent of barbed sutures, the position of traditional absorbable sutures has been challenged, but the superiority of one over the other in terms of clinical outcomes remains unclear. To evaluate the efficacy and safety of laparoscopic barbed sutures in the repair of gastroduodenal perforations through a meta-analysis. A systematic review, including randomized controlled trials (RCTs) and case‒control studies, was conducted following PRISMA guidelines. From the PubMed, Web of Science, Embase, Cochrane, CNKI, CDDB, and CSTJ databases up to August 23, 2024, relevant studies comparing laparoscopic barbed sutures to conventional sutures were identified. The primary outcomes were suturing time and operative duration, whereas the secondary outcomes included hospital stay and postoperative complications. Sensitivity analysis was conducted to evaluate the robustness of the findings, and publication bias was examined via Egger’s test complemented by the trim-and-fill method. The study was registered on the platform Prospero with the ID CRD42024591576. Five studies with 436 patients were included. Barbed sutures significantly reduced the operative time [standard mean difference (SMD: -0.89; 95

BackgroundLithium carbonate has a narrow therapeutic index, and postoperative anatomical/physiological changes after bariatric surgery may markedly alter its pharmacokinetics.CaseA 25-year-old woman with bipolar disorder on long-term lithium therapy developed altered consciousness and profound sinus bradycardia (nadir 27 bpm) approximately 7 weeks after single-incision laparoscopic sleeve gastrectomy. Laboratory testing revealed hyponatremia, acute kidney injury, and a serum lithium level of 4.16 mmol/L.Interventions and outcomesLithium and other psychotropics were discontinued, fluid resuscitation and inotropic support were initiated, and three consecutive sessions of continuous renal replacement therapy (CRRT) were performed. Serum lithium normalized without rebound, Sinus bradycardia recovered, and the patient was discharged without pacemaker implantation. During follow-up, lithium was permanently discontinued and replaced with lamotrigine. Mood remained stable without cardiac or neurologic sequelae.ConclusionPost-bariatric patients receiving lithium should be considered high risk for intoxication. Routine monitoring with early recognition and multidisciplinary collaboration is essential to prevent complications. This case further shows that even extreme lithium-induced bradycardia can be fully reversible with timely withdrawal and extracorporeal clearance, highlighting the need to address reversible causes before permanent pacing.

As the volume of medical literature accelerates, necessitating efficient tools to synthesize evidence for clinical practice and research, the interest in leveraging large language models (LLMs) for generating clinical reviews has surged. However, there are significant concerns regarding the reliability associated with integrating LLMs into the clinical review process. This study presents a systematic comparison between LLM-generated and human-authored clinical reviews, revealing that while AI can quickly produce reviews, it often has fewer references, less comprehensive insights, and lower logical consistency while exhibiting lower authenticity and accuracy in their citations. Additionally, a higher proportion of its references are from lower-tier journals. Moreover, the study uncovers a concerning inefficiency in current detection systems for identifying AI-generated content, suggesting a need for more advanced checking systems and a stronger ethical framework to ensure academic transparency. Addressing these challenges is vital for the responsible integration of LLMs into clinical research.

To investigate the application value of ultrasound in assessing the short-term impact of sleeve gastrectomy (SG) on common carotid artery (CCA) structure and lower limb arterial hemodynamics in patients with metabolic syndrome (MS). Twenty-one patients with MS undergoing SG at our hospital were enrolled as the experimental group, with 29 healthy volunteers as the control group. Ultrasound was employed to measure and compare the lumen diameter (D), adventitial thickness (AT), intima media thickness (IMT), peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) of bilateral CCA as well as the PSV and early diastolic reverse flow velocity (R) of lower limb arteries including common femoral (CFA), proximal superficial femoral (SFA), middle superficial femoral and popliteal arteries (POA) at baseline and 1 month after SG. The correlation between laboratory indicators and ultrasound parameters of CCA was analyzed. The MS group had higher D (P = 0.004 and 0.041, respectively), AT (both P = 0.00), and IMT (both P = 0.00) of right and left CCA, lower EDV of right and left CCA(P = 0.009 and 0.019, respectively), lower PSV of RCCA (P = 0.021) and ultrasound parameters of lower limb arteries at baseline, compared to the control group. One month after SG, the MS group exhibited lower AT (both P = 0.00), IMT (P = 0.001 and 0.00, respectively), PSV and EDV (P = 0.009 and 0.019; P = 0.018 and 0.008, respectively)of right and left CCA, lower D of right CCA (P = 0.030) and certain lower limb arteries compared to preoperative levels. Correlation analysis revealed a positive correlation between white blood cell count (WBC), red blood cell count (RBC), hematocrit (HCT), absolute neutrophil count (NC), monocyte percentage (MP), average glucose (eAG), glycosylated hemoglobin (HbA1c), total cholesterol (TC), very low-density lipoprotein cholesterol (VLDL-C), and ultrasound parameters of CCA (P < 0.05). Patients with MS exhibited significant improvements in partial ultrasound parameters of CCA and lower limb hemodynamic 1 month after SG, with a significant correlation to laboratory indicators, suggesting that ultrasound can offer clinical application value in assessing postoperative changes following SG in patients with MS and validating the effectiveness of SG.

Ovarian tumors are a common ovarian dysfunction that affects women’s daily lives. Although ovarian tumors are generally sensitive to chemotherapy and initially respond well to platinum/taxane-based treatments, the postoperative recurrence rate remains high in advanced cases. Many researchers are dedicated to developing new methods for monitoring and predicting malignant tumors. Traditional approaches use dimensionality reduction techniques, like principal component analysis and deep learning, to select relevant features, followed by univariate or multivariate control charts for monitoring. However, these methods may overlook interactions between features and dimensionality reduction can result in loss of information, potentially affecting the accuracy of the model and leading to delayed alerts and reduced predictive performance. Therefore, this paper develops a new sliding window EWMA control chart based on high-dimensional empirical likelihood ratio tests. This control chart not only monitors data with unknown underlying distributions but is also applicable to high-dimensional data, allowing for monitoring without dimensionality reduction, thus simplifying the process and avoiding information loss. Monte Carlo results show that this method detects changes in indicators and issues alerts more rapidly than the dimensionality-reduced multivariate EWMA control charts. In addition, we further validated the effectiveness of this method through analysis of a tumor resection data example.

Obesity is a predisposing factor for the onset of hypertriglyceridemia-induced acute pancreatitis (HTG-AP). Metabolic and bariatric surgery (MBS) has demonstrated significant short-term efficacy in the treatment of HTG-AP. The current evaluated the long-term efficacy of MBS for the management of recurrent HTG-AP. Between 01 January 2015 and 31 August 2019, a total of 51 patients diagnosed with obesity combined with HTG-AP at our hospital were enrolled in the study. 14 underwent laparoscopic sleeve gastrectomy (LSG), 9 underwent laparoscopic Roux-en-Y gastric bypass (LRYGB), and 28 underwent routine treatment including dietary therapy, pharmacotherapy, and plasma exchange. The aim of the study was to investigate the long-term therapeutic effects of LRYGB, LSG, and routine treatment on recurrent HTG-AP, and to assess patient prognoses under different treatment modalities. The LSG and LRYGB groups achieved significant average weight loss, whereas the changes in the routine treatment group were not significant. The LRYGB group exhibited more weight loss than the LSG group. In both the LSG and LRYGB groups triglyceride levels decreased significantly within the first year after surgery. The routine treatment group exhibited a pancreatitis recurrence rate of 57.14

Background Roux-en-Y gastric bypass (RYGB) surgery is effective in ameliorating type 2 diabetes mellitus (T2DM); but its mechanism remains incompletely understood. Objectives This study aimed to investigate whether RYGB improves glucose metabolism by upregulating hepatic trefoil factor family 3 (TFF3) and thereby activating the PI3K/Akt pathway. Methods Zucker diabetic-fatty (ZDF) rats underwent RYGB or sham surgery (SHAM), and Zucker lean (ZL) rats served as controls (CON). TFF3 expression and PI3K/Akt pathway activity were compared between groups using western blot, immunofluorescence, and RT-qPCR. Adeno-associated virus (AAV) was used to specifically overexpress and interfere with hepatic TFF3. Liver fibrosis and steatosis were assessed using Masson trichrome and Oil Red O staining. HepG2 cells overexpressing or knocking out TFF3 were constructed using lentiviral transfection and CRISPR/Cas9 technology. After verifying the activity of the PI3K/Akt pathway by western blot, rescue experiments were performed on HepG2 cell overexpressing and knocking out TFF3 using LY294002 and 740Y-P, respectively. The activities of gluconeogenic enzymes and glucose uptake capacity in different HepG2 cells were evaluated using qPCR and flow cytometry. Results Compared with the SHAM group, the blood glucose, body weight, insulin resistance, and lipid metabolism of ZDF rats in the RYGB group were significantly improved. The expression of TFF3 and PI3K/Akt phosphorylation in the liver of the RYGB group were higher than those of the rats that had undergone SHAM surgery. In addition, compared with the SHAM group, the liver fibrosis and fatty degeneration of RYGB rats were milder, and the activity of gluconeogenic enzymes was lower. After tail vein injection of AAV that specifically overexpresses liver TTF3 in rats in the SHAM group, rats' insulin resistance, glucose tolerance, gluconeogenic enzymes and other glucose metabolism indicators improved. After tail vein injection of AAV that interferes with liver TFF3 in rats in the RYGB group, rats' glucose metabolism indicators deteriorated. In in vitro experiments, the PI3K/Akt activity of TFF3-knocked-out HepG2 cells was lower than that of other groups. Lower glucose concentration were observed in TFF3-overexpressing cell lines. After rescue experiments, differences were found. The glucose metabolism level of the TFF3-expressing HepG2 cell line was positively correlated with the activity of the PI3K/Akt pathway. Conclusion RYGB regulates the expression of TFF3 in the liver of ZDF rats, thereby activating the PI3K/Akt pathway and improving T2DM.

BACKGROUND:The effective management of acute left-sided obstructive colon cancer (LSOCC) remains challenging. This meta-analysis compared the short-term and long-term outcomes between two prevalent treatment approaches: selective surgery following colonic stenting (CS) and colonic stenting combined with neoadjuvant chemotherapy (CS-NAC). METHODS:We conducted a comprehensive literature search of databases, including PubMed and Web of Science, covering the period from January 2000 to May 2025. Relevant studies comparing CS with CS-NAC were identified and analyzed. Both the short-term and long-term outcomes of the two treatment strategies were evaluated. The meta-analysis calculated pooled odds ratios (ORs), mean differences (MDs), and 95% confidence intervals (95% CIs). This study is registered with PROSPERO (registration number: CRD42024580176). RESULTS:Seven studies were included in the meta-analysis. Compared with the CS strategy, the CS-NAC strategy demonstrated significantly better short-term outcomes, including higher rates of laparoscopic surgery, lower intraoperative stoma rates, fewer overall postoperative adverse events, shorter operative times, and shorter postoperative hospital stays. However, no significant differences were observed between the two strategies in terms of stent-related complications or specific short-term adverse events, including postoperative incision infection rates, anastomotic leakage rates, and pulmonary infection rates. Furthermore, compared with the CS strategy, the CS-NAC strategy significantly improved both 3-year disease-free survival and overall survival. CONCLUSION:Compared with CS alone, the CS-NAC treatment strategy improves laparoscopic surgery rates and 3-year survival outcomes without increasing the risk of certain postoperative adverse events.

OBJECTIVE:This study aims to evaluate and summarize the current state of gender equality for female scientists in obesity research. METHODS:We conducted a comprehensive analysis of governmental funding, high-impact publications/citations, and awards received by female and male scientists engaged in obesity research worldwide. Median citations were compared by sex and year, with group differences assessed using the nonparametric Mann-Whitney U test. RESULTS:Our findings reveal a concerning difference: In most representative countries, a higher proportion of male principal investigators received grant support, with Japan exhibiting the most pronounced gender bias. In highly cited obesity papers, female corresponding authors constituted only 33%, with Japan having the lowest representation at a mere 5%, whereas the Netherlands approached near-equal representation (49%). Furthermore, highly cited obesity papers authored by women generally received fewer citations than those by men across most analyzed years and countries. However, a positive trend emerged in awards: the European Association for the Study of Obesity and the Association for the Study of Obesity recognized female scientists at a higher rate than male scientists. CONCLUSIONS:These findings highlight a complex landscape. Although female scientists have gained increased support and recognition in several countries, significant gender inequality persists in obesity research.

BACKGROUND AND AIM:Intestinal ischemia-reperfusion (I/R) injury is a significant clinical problem linked to conditions like acute mesenteric ischemia and intestinal obstruction. This study explores the mechanisms of bone morphogenetic proteins (BMPs)-Smads and Notch pathways in I/R injury. METHODS:The study employed both in vitro experiments and animal models to analyze the interactions between BMP2/4, the Smad1/5 pathway, and the Notch signaling pathway. Various assays, including western blotting, immunohistochemistry, and RNA sequencing, were utilized to measure molecular and cellular changes. The effects of BMP and Notch pathway inhibitors were also assessed. Specifically, barrier function, cell damage, and inflammatory responses were investigated. RESULTS:Elevated levels of BMP2/4 were observed following intestinal I/R, leading to the activation of the Smad1/5 pathway, which contributed to mucosal barrier damage and increased inflammatory responses. Blocking BMPs or intervening in Notch intracellular domain (NICD), hairy and enhancer of split-1 (HES-1), and Smad6 produced significant regulatory effects on cell damage, inflammatory responses, and barrier function integrity in both in vivo and in vitro models. CONCLUSIONS:The findings indicate that BMP2/4 exacerbate intestinal I/R injury through the Smad1/5 pathway, promoting mucosal barrier breakdown and inflammation. The Notch pathway appears to counteract these effects, offering potential therapeutic targets. Further research may focus on developing strategies to modulate these pathways to improve clinical outcomes in intestinal I/R injury.

High-altitude exposure impacts hundreds of millions globally, posing a unique health challenge due to extreme stressors including hypobaric hypoxia and intense ultraviolet radiation. The gut microbiota, a microbial community residing in the intestinal tract, plays a pivotal role in maintaining host health through homeostasis. Emerging evidence highlights the gut microbiome's dual roles in facilitating host adaptation to high-altitude environments and in mediating maladaptive responses. This review explores the potential changes and mechanisms of the gut microbiota and its metabolites in mediating host adaptation and pathogenesis related to high-altitude exposure, alongside summarizing effective strategies for targeted microbiota modulation to prevent and treat altitude-related disorders. Furthermore, we discuss the influence of microbiota on drug metabolism in high-altitude populations and its potential role as diagnostic and prognostic biomarkers. Although current research remains exploratory, the gut microbiome has garnered significant interest in high-altitude medicine. With advancing investigations, microbiota-targeted interventions may emerge as critical breakthroughs for altitude disease management, paving the way for improved human adaptation to extreme environments and precision health strategies for plateau populations.

Over the past few years, bariatric surgery has emerged as a potent remedy for obesity and its related metabolic issues, with its effects on peripheral immune cells garnering considerable attention. Obesity, recognized as a chronic metabolic condition, is intricately connected to dysfunctions spanning a range of immune cell types. Among peripheral immune cells, T cells, B cells and monocytes, obesity markedly alters their counts and functions, driving the inflammation and metabolic dysfunction characteristic of the condition. The modifications in these immune cell cohorts are inextricably intertwined with the augmentation of postoperative metabolic functions and have the potential to exert a salutary effect on complications associated with obesity. The present review primarily examined the latent influence of bariatric surgery on the number and function of peripheral immune cells, thereby offering novel perspectives and therapeutic targets for the immunotherapy of obesity.

Pain relief following bariatric surgery (BS) can be difficult because many patients have obstructive sleep apnea and are more prone to breathing problems caused by excessive opioid use post-surgery. Using nerve blocks is an effective alternative since they enhance patient comfort and decrease the side effects of opioids. In our review, we comprehensively reviewed present methods to alleviate pain after BS including the transversus abdominis plane block (TAPB), the erector spinae plane block (ESPB), the quadratus lumborum block (QLB), the external oblique intercostal block (EOIB), and the rectus sheath block (RB), aiming to summarized the respective and relative advantages of each nerve block for post-BS analgesia. The review concluded that TAPB is the optimized post-BS nerve block for somatic pain and ESPB relieves somatic and visceral pain which can both be combined with RB. Anterior QLB relieves visceral pain and EOIB can be done without the interference of fat. This review also identified key points for future research to improve post-BS nerve blocks.

Excess cholesterol is positively correlated with colorectal cancer (CRC). Current therapeutic strategies for modulating cholesterol levels in CRC are limited and often come with complications. Here, we demonstrated that microbiome shunting of intestinal cholesterol to anticancer metabolites is a safe and applicable therapeutic approach for CRC. By screening major microbial metabolic products of cholesterol, we found that 4-cholesten-3-one (4-C-3) was selectively depleted in fecal samples and tumor tissues of patients with CRC. 4-C-3 exhibits strong antitumor effects on human CRC cell lines, patient-derived organoids, and patient-derived xenograft (PDX) models. Mechanistically, 4-C-3 suppresses CRC tumorigenesis by dually targeting the epidermal growth factor receptor (EGFR) and Kirsten rat sarcoma viral oncogene homologue (KRAS). 4-C-3 directly binds to EGFR, blocking its signal transduction by inhibiting the binding of EGFR ligands. Additionally, 4-C-3 inhibits oncogenic KRAS variants, such as KRASG12D, by suppressing nucleotide exchange activity and effector engagement. By targeting both EGFR and KRAS, 4-C-3 reduces primary resistance to anti-EGFR therapies caused by KRAS mutations in CRC. As a proof-of-concept study, we showed that delivery of 4-C-3 by Oscillibacter ruminantium , a 4-C-3- producing commensal bacterium that is reduced in CRC patients, or a nonpathogenic Escherichia coli strain engineered to specifically convert intestinal cholesterol into 4-C-3, removed intratumoral cholesterol and led to rapid tumor regression in multiple models of CRC. These results suggest that microbial therapies for restoring intestinal cholesterol homeostasis represent a new therapeutic avenue for CRC. ### Competing Interest Statement The authors have declared no competing interest.

Background/Purpose Patients with gout are at risk for increased serum uric acid (SUA) levels and gout attacks in the short term after undergoing bariatric surgery, and the purpose of this study was to evaluate the benefits of short-term treatment with uric acid-lowering medication after bariatric surgery for the control of gout attacks and SUA levels in patients with gout.Methods 71 patients who underwent SG from January 2020 to December 2022 were prospectively included. These patients were diagnosed with hyperuricemia before surgery and had a history of gout attacks. Patients were classified into a drug-treatment group (DTG, n = 32) and a non-drug-treatment group (NDTG, n = 39) according to whether they took uric acid-lowering medication after surgery. Changes in the number of gout attacks, body mass index (BMI), and SUA levels at 1 week, 1 month, 3 months, and 6 months after bariatric surgery were measured in both groups.Results In the DTG, 22 patients (68.8%) experienced an increase in SUA within 1 week, 3 patients (9.4%) had an acute attack of gout within the first month, and no patients had a gout attack thereafter. In the NDTG, 35 patients (89.7%) experienced an increase in SUA within 1 week, 7 patients (17.9%) had an acute gout attack within the first month, and 4 patients (10.3%) experienced gout attacks between month 1 and month 3 postoperatively. Both groups were free of gout attacks between the 3rd and 6th postoperative month and showed a significant decrease in SUA and BMI by the sixth month.Conclusion In patients with gout, continued use of uric acid-lowering medication after bariatric surgery is beneficial in reducing the number of gout attacks and the risk of rising SUA.

Bariatric surgery stands as the most potent treatment for achieving substantial weight reduction and alleviating the complications associated with obesity. However, it is not the treatment of choice for patients with obesity combined with type 2 diabetes mellitus, and the benefit of bariatric surgery varies widely among individuals. There is a noticeable inconsistency in the outcomes following these procedures. The ability to predict how an individual will respond to bariatric surgery is a valuable asset in clinical practice. And the importance of postoperative interventions should not be underestimated. Proactive measures targeting both pre- and post-operative eating habits and lifestyle adjustments are of greater significance than the investigation into pre-operative factors alone. The judicious application of medication, endoscopic intervention and conversional surgeries after bariatric surgery can yield superior outcomes in managing recurrent weight regain and the recurrence of diabetes, albeit with consideration for the associated complication rates.

Investigate the long-term protective effects of gastric bypass surgery on the kidneys of hypertensive obese rats to better understand the role of gastric bypass surgery in preventing renal injury in humans with hypertension and obesity. Compare 6-week-old spontaneously hypertensive rats, including 30 Roux-en-Y gastric bypass (RYGB) and 30 sham operations. Body weight and blood pressure were monitored before and up to 12 months after the operation. Blood lipids, blood creatinine, and blood urea nitrogen were measured. Kidney pathology was assessed using HE staining, while renal fibrosis was observed via Masson staining. Inflammatory indicators were examined by ELISA. The expression of the NLRP3 gene in the kidney was measured using immunofluorescence and western blot, and the changes in key pathways including ASC/IL-1β protein were verified. RYGB reduced the body weight of hypertensive obese rats and had a protective effect on blood pressure. Additionally, the bypass effectively mitigated renal inflammation and fibrosis. Moreover, RYGB modulated the expression of NLRP3 and prevented kidney damage via the ASC/IL-1 pathway. This study validates that RYGB effectively attains sustained blood pressure control in hypertensive obese rats and has a potential kidney-protective mechanism via the NLRP3-ASC/IL-1β pathway.

Lipid droplets (LDs), which are active organelles, derive from the monolayer membrane of the endoplasmic reticulum and encapsulate neutral lipids internally. LD-associated proteins like RAB, those in the PLIN family, and those in the CIDE family participate in LD formation and development, and they are active players in various diseases, organelles, and metabolic processes (i.e., obesity, non-alcoholic fatty liver disease, and autophagy). Our synthesis on existing research includes insights from the formation of LDs to their mechanisms of action, to provide an overview needed for advancing research into metabolic diseases and lipid metabolism.

Hyperuricemia is closely linked to obesity. As lifestyles and dietary patterns evolve, the prevalence of hyperuricemia has been on the rise. Bariatric surgery, an efficacious intervention for morbid obesity and its associated metabolic disorders, not only manages the weight of patients with severe obesity but also exerts beneficial therapeutic effects on hyperuricemia and gout. Moreover, it demonstrates substantial efficacy against other obesity-related metabolic conditions. However, the dramatic fluctuations in serum uric acid levels and acute gouty attacks in the immediate postoperative period are issues that should not be overlooked, and effective preventative strategies for some related adverse complications are still underexplored. This review discusses and reviews the advancements in the treatment of obese patients with hyperuricemia through bariatric surgery. By reviewing pertinent literature, it summarizes the short-term and long-term therapeutic outcomes of bariatric surgery for hyperuricemia, as well as common adverse reactions. Furthermore, by discussing preoperative and postoperative interventional measures and influential factors, this review aims to provide novel perspectives for the clinical management of hyperuricemia and offer insights for the prevention of related complications.

Hyperuricemic nephropathy (HN) is renal injury caused by hyperuricemia (HUA). While sleeve gastrectomy (SG) has shown promise in improving renal injury in patients with obesity-related HN, the mechanisms are not fully understood. This study induced an obesity-combined HN model in male ob/ob mice and measured serum uric acid (SUA), creatinine, and other biochemical indicators 6 weeks post-surgery. Renal histological changes were evaluated through staining techniques, and the study also assessed renal adenosine monophosphate-activated protein kinase (AMPK) and nuclear factor erythroid 2-related factor 2 (Nrf2) phosphorylation levels and urate transporter ABCG2 expression. In vitro experiments involved Nrf2 knockdown in AMPK-activated HK-2 cells and ChIP to confirm Nrf2 binding to the ABCG2 promoter. Results showed that SG reduced SUA levels, serum creatinine, and blood urea nitrogen, increased p-AMPK, p-Nrf2 protein, and ABCG2 expression, and alleviated renal fibrosis and inflammation. In vitro, Nrf2 knockdown down-regulated ABCG2 expression, and ChIP confirmed Nrf2’s role in ABCG2 transcription. The study suggests that SG may improve renal injury in HN mice by modulating the AMPK/Nrf2 pathway and upregulating ABCG2 transcription.