BACKGROUND:The perioperative effect of preoperative administration of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in individuals with obesity scheduled to receive metabolic and bariatric surgery (MBS) remains uncertain. OBJECTIVES:The objective of this systematic review and meta-analysis was to evaluate the efficacy of preoperative GLP-1 RAs in patients with obesity undergoing MBS. SETTING:All over the world. METHODS:Original studies were searched from the inception of PubMed, Embase, and Web of Science up to September 2025. Primary outcomes were the variation of weight from the initial to the preoperative period and postoperative total weight loss percentage (TWL%). Secondary outcomes included the incidence of postoperative complications, postoperative glycated hemoglobin level, and the proportion of patients with remission of diabetes. RESULTS:After screening, 10 studies consisting of 5461 subjects were included in the final meta-analysis. The results showed that preoperative GLP-1 RAs were associated with a moderate reduction in preoperative weight (total median of weight reduction: 4.87 kg vs 3.84 kg; SMD: .4, 95% CI: -.37 to 1.18, P < .01) but did not significantly affect postoperative TWL% (SMD: -.20, 95% CI: -.27 to -.13, P = .21). Preoperative administration of GLP-1 RAs did not significantly increase the incidence of postoperative complications (RR: 1.62, 95% CI: .76-3.45, P = .12) nor improve the comorbidities (P = .23). CONCLUSIONS:Our study indicates that preoperative GLP-1 RAs are generally safe for patients with obesity undergoing MBS. However, this benefit only correlates with a certain degree of preoperative weight loss, and its effect on postoperative weight loss and improvement of comorbidities are limited.

Background:Nonalcoholic fatty liver disease (NAFLD) is a common metabolic disorder characterized by chronic low-grade inflammation. The Dietary Inflammatory Index (DII) reflects the inflammatory potential of habitual diet and has been associated with several cardiometabolic diseases. However, the relationship between DII and NAFLD is not fully clarified. In particular, it remains unclear which metabolic factors mediate this association, and whether findings based largely on NHANES data can be confirmed in independent local populations. Methods:This cross-sectional study included adults from NHANES and an independently collected local cohort. Multivariable logistic regression was used to assess the association between DII and NAFLD. Restricted cubic spline models examined dose-response patterns. Subgroup analyses evaluated the consistency of the findings. Mediation analyses quantified the indirect effects of metabolic factors in the DII-NAFLD association. Results:In the NHANES analysis, higher DII scores were independently associated with an increased risk of NAFLD after adjustment for demographic, socioeconomic, and clinical covariates. Restricted cubic spline analysis indicated a nonlinear association, with NAFLD risk rising more steeply at higher DII levels. Mediation analyses demonstrated that triglycerides, fasting plasma glucose, and insulin partially mediated the DII-NAFLD relationship, although a significant direct effect of DII persisted. Consistent findings were observed in the independent local cohort, where higher dietary inflammatory scores were also associated with greater NAFLD risk. Conclusion:DII was positively associated with NAFLD and showed a nonlinear dose-response pattern. This association was partially explained by glucose and lipid metabolic disturbances, and machine learning analysis identified DII as an important predictor of NAFLD. Consistent findings in the local cohort supported the robustness of this association. However, causal relationships cannot be established due to the cross-sectional design.

BACKGROUND:The efficacy of metabolic and bariatric surgery (MBS) in the treatment of sarcopenic obesity (SO) remains unclear. OBJECTIVES:The purpose of this systematic review and meta-analysis was to evaluate the efficacy of MBS in the SO population to provide some reference value for the implementation of reasonable intervention in this population. SETTING:All over the world. METHODS:PubMed, Embase, Web of Science, and ClinicalTrials.gov were searched for relevant articles up to September 2025. The standard mean difference (SMD) and its 95% confidence interval (CI) were used for the quantitative synthesis of continuous variables, and the risk ratio (RR) and its 95% CI were used for the quantitative analysis of categorical variables. The primary outcomes were the variations of body weight and body mass index from initial to follow-up, the proportion of total weight loss, the proportion of excess weight loss, and the remission of comorbidities. RESULTS:After screening, 7 studies involving 1704 patients were included in our final meta-analysis. The results of our analysis showed that the SO group had more significant variations in body weight (SMD = .89, 95% CI: .32-1.46, P = .002) and body mass index (SMD = 1.08, 95% CI: .41-1.76, P = .0016). There was a trend toward higher percentage of total weight loss and percentage of excess weight loss in the SO versus non-SO groups (SMD = .30, 95% CI: .06-.66, P = .09; SMD = .57, 95% CI: .28-1.42, P = .08). In terms of the remission of comorbidities, the 2 groups were similar (all P values > .05). In addition, the incidence of postoperative complications was similar between the 2 groups (RR = 1.78, 95% CI: .93-3.41, P > .05). CONCLUSIONS:In the SO population, MBS was associated with comparable efficacy and safety outcomes, including moderate weight loss, improvement in comorbidities, and no significant increase in postoperative complications.

Background Sleeve gastrectomy (SG) is the most commonly performed bariatric surgery worldwide, including in China. Despite its prevalence, significant variations exist in its practice. This consensus aims to standardize SG practices in China. Methods A modified Delphi method was employed to gather expert opinions from 50 Chinese bariatric surgeons. Participants voted on 80 statements covering indications, contraindications, preoperative/postoperative management, and surgical techniques. Results Consensus was achieved on 54 out of 80 statements. Key areas include SG being the preferred choice for patients with high surgical risk and severe obesity. Agreement was reached on surgical techniques such as staple line reinforcement and the management of hiatal hernias found during surgery. Consensus was also achieved on aspects of preoperative and postoperative care, including routine endoscopy and the use of the enhanced recovery after surgery (ERAS) protocol. Conclusions This consensus provides valuable guidelines for standardizing SG practices in China. It provides evidence-based recommendations to standardize SG practice, improve outcomes, and guide future research directions.

Traditional Magnetic Resonance Elastography (MRE) presents stiffness and structural images separately, requiring manual ROI delineation for liver stiffness assessment. This introduces observer variability and may overlook significant lesions, failing to accurately represent whole-liver stiffness distribution patterns. The present study implemented multimodal image fusion integrating stiffness maps with structural images using: (1) acquisition on a 3.0T MRI with optimized T1-weighted imaging (TR/TE = 157.62/1.17 ms) and MRE (60 Hz vibrations); (2) computational preprocessing of DICOM data into 3D volumes; (3) precise co-registration and fusion calculation; and (4) quantitative liver stiffness distribution analysis across different cirrhosis stages. The stiffness-structural fusion imaging technique integrated anatomical structures with stiffness patterns in a single visualization, enabling simultaneous assessment of liver morphology and stiffness distribution. Comparative analysis revealed a clear differentiation between cirrhotic patients and healthy controls, with cirrhotic livers showing significantly higher proportions of advanced fibrosis. This technique eliminated variability due to manual ROI placement and established a standardized framework for comprehensive whole-liver assessment. The stiffness-structural fusion imaging technique provides comprehensive visualization of liver stiffness with precise anatomical correlation, potentially improving diagnostic accuracy compared to conventional MRE. This approach eliminates observer variability, enables standardized whole-liver assessment, and establishes a quantitative framework for monitoring disease progression and treatment response, while facilitating improved clinician-patient communication and offering a foundation for advanced radiomics in liver cirrhosis staging.

The optimal treatment for displaced or comminution fifth metatarsal base fractures remain debated. Ninety displaced or comminution fifth metatarsal base fractures patients were randomly selected into three groups: the ulnar hook plate fixation group (n=30), the immobilization treatment group (n=18), and the early functional group (n=30). The assessed factors included the duration until union, time to resume daily activities, American Orthopaedic Foot and Ankle Society (AOFAS) scores, Foot and Ankle Disability Index (FADI) scores, visual analog scale (VAS) ratings and occurrence of complications. The VAS scores showed no significant differences observed among the three treatments. The mean AOFAS score and mean FADI after treatment in the plate group and exhibited significant better than that of the immobilization group and the early functional group at 1 moth, 3 months and 6 months (P<0.05). After a duration of 12 months, all three treatments exhibited comparable outcomes and facilitated restoration of daily activities. In the plate group, one patient developed a wound infection, one patient experienced sural nerve injury or irritation, and three patients exhibited implant prominence. One patient encountered nonunion in the immobilization group.The union time and the time of return to daily activities and the early functional group exhibited significant shorter durations than that of the immobilization group and the plate group(P<0.05). Overall, the early functional treatment is recommended for managing displaced or comminution fifth metatarsal base fractures.

Bariatric surgery presents a significant alleviation for non-alcoholic fatty liver disease (NAFLD), which relies in part on achieving substantial weight loss in post-surgical period. We aimed to understand the effect of bariatric surgery on NAFLD remission via metabolomics and to validate the results in a general population-based cohort. In a pilot study, ten patients with NAFLD who underwent bariatric surgery were enrolled. The remission of hepatic steatosis was assessed by MRI-derived proton density fat fraction (PDFF) before and 3-month after surgery. Temporal associations of body mass index (BMI) reduction, alteration in metabolomic biomarkers, and NAFLD remission were quantified by using cross-lagged models, which were then validated in a general population-based cohort (n = 1258). At 3-month after surgery, BMI reduction of 6.9 (SD 1.9) kg/m2 and MRI-PDFF reduction of 9.6

BACKGROUND:Distinguishing bariatric surgical effects on reversing nonalcoholic fatty liver disease (NAFLD) remain unclear. To assess discrepancies in histological response and changes in magnetic resonance imaging-proton density fat fraction (MRI-PDFF) after bariatric surgery. METHODS:This prospective multicenter cohort included 138 NAFLD patients who underwent bariatric surgery and were followed up for 1 year. We obtained paired liver biopsy samples (n = 40), paired proteomic data (n = 23), and sequential MRI-PDFF at 3-, 6-, and 12-month (n = 80, 65, 52, respectively) follow-ups. RESULTS:At 1 year, a ≥2-point improvement in NAFLD activity score (NAS) was observed in 80.0% of patients; nonalcoholic steatohepatitis (NASH) improved without fibrosis worsening in 42.1%; fibrosis improved without NASH worsening in 78.8% (95% confidence interval [CI]: 66.0-91.2, 26.8-58.2, and 63.0-91.3) (all P <0.001). MRI-PDFF discriminated the presence and grading of hepatic steatosis (area under the curve [AUC], 0.94 and 0.95, respectively), indicating liver fat remission (<3.3% or 5.0% at 1 year) in 72.2% or 90.4% of patients (95% CI: 58.4%-83.5% or 78.9%-95.5%; all P <0.001). A ≥78.8% relative decline in MRI-PDFF within 1 year differentiated NAS improvement from non-NAS improvement (AUC, 0.912; 95% CI: 0.79-1.00). Compared to non-NASH remission, NASH remission was associated with significant pre- or postoperative regulation of protein expression levels. CONCLUSIONS:These findings can help evaluate the expected histological response, and aid in understanding the proteomic features resulting from the beneficial surgical effects on NAFLD and its advanced stages in patients with obesity.

Sleeve gastrectomy (SG) is widely recognized as the leading bariatric procedure worldwide. However, leakage, its major complication, remains a significant concern. This study focuses on the challenges of managing leakage, especially when conventional endoscopic treatments are ineffective. Although a novel one-step approach as reported by Pulimuttil James Zachariah from Wei-Jei Lee’s team has demonstrated promise, further investigations and reports on its efficacy are currently insufficient. Between January 2021 and November 2023, we analyzed five patients treated at our center for SG leakage. Patient data include demographics, comorbidities, surgical details, and outcomes. The study details Laparo-Endoscopic Gastrostomy procedures performed post-SG leakage diagnosis, highlighting differences between acute and chronic instances. The study effectively implemented Zachariah’s one-step approach, achieving favorable results in all five cases. Patient characteristics, presentation, postoperative progression, and additional treatments were documented. The outcome supports Zachariah’s assertion that the one-step approach is a simple, safe, and cost-effective approach for SG leakage, avoiding digestive tract reconstruction. Despite potential limitations, including challenges in closing large defects and extended healing times, the procedure’s effectiveness in decompression, drainage, and nutritional support significantly contributes to its elevated healing rate. The study emphasizes the importance of timely abdominal drain removal based on clinical conditions, challenging traditional practices for better clinical outcomes.

OBJECTIVE:The purpose of this study was to investigate and compare the learning curve and clinical outcomes of all-inside arthroscopic and open techniques in the treatment of chronic lateral ankle instability (CLAI). METHOD:This was a retrospective cohort analysis of 100 consecutive patients who received all-inside arthroscopic or open Brostrom-Gould surgery. These patients with CLAI were all surgically treated by the same surgeon. We applied the CUSUM analysis to assess the surgeons' learning curves, determine the cut-off point, and subsequently divide the patients into learning and proficiency groups. We recorded and compared baseline data, the preoperative and postoperative clinical function scores (AOFAS, K-P, and Tegner scores), VAS scores, time to full weight-bearing, surgery-related parameters (operation time, and postoperative hospital stays), and complications for both surgical methods during their learning and proficiency phases. RESULT:The CUSUM analysis identified a learning curve cutoff at 12 cases for open surgery and 22 cases for arthroscopic surgery. In the open surgery group, significant differences were observed in operation time between the learning and proficiency phases (P < 0.05). However, no significant differences were found in clinical function scores and postoperative full weight-bearing time. Similar trends were seen in the arthroscopic surgery group, with significant improvements in operation timeand postoperative hospitalization time in the proficiency phase compared to the learning phase (P < 0.05). However, no significant differences were found in clinical function scores between either surgical method's learning and proficiency stages. Additionally, when comparing the two surgical approaches at the same stage, significant differences emerged in VAS scores, postoperative full weight-bearing time, operation timeand postoperative hospitalization time (P < 0.05), with the arthroscopic technique showing advantages in reduced postoperative discomfort and faster recovery times. CONCLUSION:Although arthroscopic surgery takes longer to achieve proficiency, it offers the advantages of reduced postoperative discomfort and faster recovery times during both the learning and proficiency phases while achieving comparable clinical outcomes.

Abstract Background Obesity is closely associated with upper gastrointestinal disorders. The recommendations for routine preoperative esophagogastroduodenoscopy (EGD) before bariatric surgery remains a topic of debate. This study aimed to describe the pathological endoscopic findings in individuals qualified for bariatric surgery. Methods Retrospective analysis was conducted on preoperative gastroscopy reports of patients who underwent bariatric surgery at our hospital between October 2022 and October 2023. Results A total of 405 patients were included in the study. The two most prevalent endoscopic findings during EGD in this patient cohort were chronic superficial gastritis (326/405, 80.5%) and reflux esophagitis (82/405, 20.2%). Some patients exhibited two or more abnormalities. Patients with reflux esophagitis were older, had a higher proportion of men, higher BMI, higher rates of smoking and drinking compared to those without it (P = 0.033, P < 0.001, P = 0.003, P = 0.001, and P = 0.003, respectively). Morbid obesity (P = 0.037), smoking habits (P = 0.012), and H. pylori infection (P = 0.023) were significant risk factors for reflux esophagitis in male patients, while age (P = 0.007) was the sole risk factor in female patients. No statistically significant differences were observed in surgical procedures between LA-A and B groups (P = 0.382), but statistically significant differences were noted between the nondiabetic and diabetic groups (P < 0.001). Conclusions Preoperative EGD can unveil a broad spectrum of pathologies in patients with obesity, suggesting the need for routine examination before bariatric surgery. The findings of this study can guide bariatric surgeons in developing tailored treatments and procedures, thus significantly enhancing prognosis. Gastroscopy should be performed routinely in Chinese patients planning to undergo bariatric surgery.

Splenic abscess is a rare complication often associated with sleeve gastrectomy (SG) due to factors including local infections, distant infections, tumors, ischemia, and trauma, which presents substantial challenges. We report four cases of gastrosplenic fistula and/or splenic abscess after SG. Patient data, including demographics, comorbidities, diagnostic procedures, treatments, and outcomes, were recorded. Surgical techniques for SG adhered to established protocols. Four patients had a male-to-female ratio of 2:2, with an average age of 39.8 years and an average preoperative BMI of 38.9 kg/m2. All patients were readmitted due to recurrent fever and chills caused by splenic abscesses detected on CT scans, with an average admission duration of 16.5 weeks. Treatments varied from fasting and antibiotics to percutaneous drainage and surgical interventions. The average treatment duration post-diagnosis of splenic abscess was 37.25 weeks. Managing gastrosplenic fistula and/or splenic abscess is complex, underscoring the significance of prompt diagnosis and proper treatment. This highlights the need for heightened awareness among healthcare professionals to promptly recognize and manage this rare complication after SG.

Background:: The performance of automatic liver segmentation and manual sampling MRI strategies needs be compared to determine interchangeability. Objective:: To compare automatic liver segmentation and manual sampling strategies (manual whole liver segmentation and standardized manual region of interest) for performance in quantifying liver volume and MRI-proton density fat fraction (MRI-PDFF), identifying steatosis grade, and time burden. Methods:: Fifty patients with obesity who underwent liver biopsy and MRI between December 2017 and November 2018 were included. Sampling strategies included automatic and manual whole liver segmentation and 4 and 9 large regions of interest. Intraclass correlation coefficient (ICC), Bland–Altman, linear regression, receiver operating characteristic curve, and Pearson correlation analyses were performed. Results:: Automatic whole liver segmentation liver volume and manual whole liver segmentation liver volume showed excellent agreement (ICC=0.97), high correlation (R2=0.96), and low bias (3.7%, 95% limits of agreement, -4.8%, 12.2%) in liver volume. There was the best agreement (ICC=0.99), highest correlation (R2=1.00), and minimum bias (0.84%, 95% limits of agreement, -0.20%, 1.89%) between automated whole liver segmentation MRI-PDFF and manual whole liver segmentation MRI-PDFF. There was no difference of each paired comparison of receiver operating characteristic curves for detecting steatosis (P=0.07–1.00). The minimum time burden for automatic whole liver segmentation was 0.32 s (0.32–0.33 s). Conclusion:: Automatic measurement has similar effects to manual measurement in quantifying liver volume, MRI-PDFF, and detecting steatosis. Time burden of automatic whole liver segmentation is minimal among all sampling strategies. Manual measurement can be replaced by automatic measurement to improve quantitative efficiency.

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.

目的 探究小规模限制性在线课程(SPOC)+以团队为基础的教学模式(TBL)在胸外科临床技能教学中的价值.方法 选取2020年1月-2023年2月在首都医科大学附属北京胸科医院进行临床实习的40名实习生及新入职医生为研究对象,按照均衡、随机化原则将其分为对照组、试验组,每组20名.在两组的胸外科临床技能教学中,对照组采用传统教学模式,试验组采用SPOC+TBL教学模式,对比两组的出科考试成绩、临床技能操作成绩、教学效果评价.结果 试验组的基础理论、病例分析、临床技能理论成绩高于对照组(P＜0.05);试验组的胸腔镜操作、开胸关胸操作、血管离断缝合操作、气管离断吻合操作成绩高于对照组(P＜0.05);试验组的学习兴趣、临床思维能力增强、文献查阅能力提升、临床实践能力提高、教学认可度评分也均高于对照组(P＜0.05).结论 在胸外科临床技能教学中采用SPOC+TBL教学模式,能提高教学对象的出科成绩和临床技能考核成绩,且教学对象对该教学模式的教学效果评价较高.

目的 探讨三维重建结合胸部CT对低年资胸外科医师手术教学中的应用效果.方法 采用自身对照研究,研究时间为2018年7月-2021年10月,研究对象为28位低年资胸外科医师.以10套试卷评估学员的基线,每套试卷5道题,分别关于病灶位置、肺动脉、段间肺静脉、所属支气管及变异、手术设计.采用三维重建结合CT进行教学,教授学员了解肺亚段血管、支气管在CT上的位置,引导学生在脑海中进行虚拟三维重建,并在手术中验证.教学后进行理论测试和自我评价.结果 教学前基线分数为(54.1±5.2),教学后为(68.6±5.1)(P<0.001).主要失分题目为肺动脉、静脉的判断.经过教学后,学员可以在胸部平扫薄层CT上辨别肺亚段动静脉.双肺下叶静脉和支气管是教学的难点.学员自我评价肺血管三维重建较传统CT教学效果更好,学习更快.结论 采用三维重建方法可以提高学员CT阅片水平和对手术的理解,值得进一步推广.

AIMS:To summarize the Greater China Metabolic and Bariatric Surgery Database (GC-MBD) and to compare patient characteristics and different procedures performed with data from published reports from other international bariatric surgery registries. MATERIALS AND METHODS:Data were extracted from the GC-MBD registry in 2021. Baseline demographic characteristics, obesity-related comorbidities and operational information were analysed. Descriptive comparisons of these data were made with the published reports from four other international/national databases, including the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) registry, the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database of the United States, the National Bariatric Surgical Registry (NBSR) of the United Kingdom, and the Scandinavian Obesity Surgery Registry (SOReg). RESULTS:Fifty-three centres in China registered 6807 cases in the GC-MBD. Compared with published data from the IFSO registry, MBSAQIP, NBSR and SOReg, patients in China undergoing surgery were younger and had a lower body mass index. The incidence of other obesity-related comorbidities, except for gastroesophageal reflux disease, was also higher than in Western countries. Furthermore, more patients underwent sleeve gastrectomy, less revisional bariatric surgery was reported in China, and jejunojejunal bypass with sleeve gastrectomy, uncommon in other countries, was China's second-leading bariatric procedure. CONCLUSIONS:By establishing comprehensive national registries such as the GC-MBD, real-world information can be gathered on clinical practice and patient outcomes. Insights into variations in clinical practice can be identified by comparing reports from different countries, which can help in making and evaluating healthcare policies on the best clinical practices at a national level.