Obesity and airway collapse are closely associated, yet the underlying mechanisms remain unclear. This study aimed to evaluate airway collapsibility in relation to markers of adiposity and high-sensitivity C-reactive protein (hs-CRP) levels in obese individuals. We conducted a cross-sectional study comparing changes in the lumen area and circularity of proximal airways using chest CT imaging in four groups: obese individuals (BMI 30–39.9 kg/m2) with low hs-CRP (< 3 mg/L), obese individuals with moderate hs-CRP (3–8 mg/L), morbidly obese individuals (BMI ≥ 40 kg/m2) with moderate hs-CRP, and morbidly obese individuals with high hs-CRP (> 8 mg/L). Morbidly obese individuals with high hs-CRP exhibited the most pronounced airway collapse, with regional asymmetry in collapsibility. hs-CRP was significantly associated with BMI, android and gynoid fat mass, and subcutaneous adipose tissue area (all P < 0.001). In multivariate analysis, change in airway circularity was associated with BMI and change in airway lumen area was associated with BMI and hs-CRP, but neither was related to adiposity distribution. The inflammatory aspects of obesity, reflected by hs-CRP, may exacerbate proximal airway collapse and regional ventilation abnormalities beyond the mechanical effects of fat accumulation.

BACKGROUND:Postoperative nausea and vomiting (PONV) is the most common side effect after laparoscopic sleeve gastrectomy (LSG), affecting patients' postoperative recovery and increasing the medical and economic burden. This study aimed to analyze the relationship between serum pepsinogen and PONV. METHODS:Patients with obesity who underwent LSG in our center between January 2021 and December 2022 were divided into PONV and NoPONV groups and analyzed retrospectively. Binary logistic regression analysis was used to determine the independent risk factors for PONV. RESULTS:219 female patients were enrolled, with an average BMI of 36.74 ± 8.34 kg/m2 and aged 32.61 ± 6.18 years. PONV occurred in 157 patients (71.7%). The influencing factors of PONV with different severity were analyzed, and the results showed that the severity of postoperative pain (χ2 = 13.169, p-values = 0.004), PGI (χ2 = 14.625, p-values = 0.002), PGII (χ2 = 25.916, p-values = 0.000), and PGR (χ2 = 17.697, p-values = 0.001) had statistical significance. Binary logistic regression showed that PGI was a risk factor for PONV with a OR (ng/mL) value of 1.013 (95% CI: 1.001-1.024, p-values = 0.037), while PGR was a protective factor for PONV with an OR(ng/mL) value of 0.952 (95% CI: 0.925-0.979, p-values = 0.001). CONCLUSIONS:The incidence of PONV after LSG is high. Higher PGI may be a risk factor for promoting PONV after LSG. The higher the preoperative PGI, the later the onset of PONV; the longer the duration, the more serious the degree.

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 preopera-tive 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. Im-provement 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 identi-fied seven intersecting miRNAs that showed opposite changes. The target genes of these seven miRNAs were substantially en-riched 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.

IntroductionBariatric surgeries induce well-documented weight loss and resolve obesity comorbidities. Sexual function is one of the aspects of life quality and may benefit from surgery. Few studies have revealed the impact of bariatric surgeries on sexual function in Chinese men with obesity. MethodsThis is a retrospective cohort study of patients undergoing bariatric surgery [laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB)]. Data were collected between September 2017 and February 2022. The International Index of Erectile Function (IIEF) questionnaire was used to evaluate erectile function, intercourse satisfaction, orgasmic function, sexual desire, and overall satisfaction. Sex hormones and other blood tests were evaluated before and at least 1 year after the surgery. ResultsFifty-nine Chinese male patients completed the IIEF questionnaire. The multivariate logistic regression analysis revealed that body mass index (BMI) was the single independent risk factor of the severity of erectile dysfunction (ED). Preoperative testosterone levels had negative correlations with BMI and waist circumference. Thirty-seven patients completed the postoperative questionnaire with a mean follow-up of 23.2 months. ConclusionBMI and waist circumference were negatively correlated with testosterone levels. BMI was an independent risk factor for the severity of ED. LSG and LRYGB led to positive and sustained improvement in sexual function of men with obesity. The two procedures had a comparable effect, more subjects being needed. Sex hormone levels also could be reversible. However, more weight loss did not predict a positive change in sexual function. A greater BMI loss might predict a greater increase in testosterone.

BACKGROUND:Obesity have been showed to be strongly associated with psychiatric disorders, but the exact causality and the direction of the relationship remain inconclusive. Thus, we aimed to identify the causal associations between obesity and psychiatric disorders using two-sample Mendelian randomization (MR).METHODS:Single-nucleotide polymorphisms associated with obesity, including body mass index (BMI), waist-hip ratio (WHR), and waist-hip ratio adjusted for BMI (WHRadjBMI), were extracted from a genome-wide association study of 694,649 European ancestry from the GIANT consortium. Summary level data for 10 psychiatric disorders were obtained from the Psychiatric Genomics Consortium. Inverse-variance weighted (IVW) method was used as the primary analysis, while several sensitivity analyses were applied to evaluate heterogeneity and pleiotropy.RESULTS:The main MR results suggested higher BMI or WHR was positively causally associated with an increased risk of attention deficit hyperactivity disorder (ADHD), anorexia nervosa (AN), post-traumatic stress disorder (PTSD), major depressive disorder (MDD) and Alzheimer's disease (ALZ), but negatively causally associated with an increased risk of obsessive-compulsive disorder (OCD) and schizophrenia. For the reverse direction, ADHD and MDD were associated with an increased risk of obesity, but schizophrenia and ALZ were associated with a decreased risk of obesity.CONCLUSION:Our findings support evidence of causal relationships between obesity and ADHD, MDD, PTSD, ALZ, SCZ, AN, and OCD, and confirmed the bidirectional causal relationships between obesity and ADHD, MDD, SCZ, and ALZ.

腹腔镜单吻合口胃旁路术是指采用腹腔镜技术，在胃小弯侧制作一个容量40 ml 的细长小胃囊，将距Treitz 韧带150~200 cm处的空肠与小胃囊进行吻合，通过缩小胃容积和旷置小肠的长度，从而获得减轻体质量，治愈或缓解2 型糖尿病等代谢疾病的术式。本文结合手术视频介绍四孔“七步法”腹腔镜单吻合口胃旁路术的操作步骤和手术技术等要点。

Background Bariatric and metabolic surgery (BMS) is an effective treatment for obesity and its complications, but its effect on pregnancy outcomes is inconclusive. The present study aimed to investigate women’s pregnancy status and outcomes as well as the impact of pregnancy intervals after BMS. Methods The menstrual cycle and fertility status of women who underwent BMS in our centre between July 2010 and January 2021 were retrospectively analyzed and followed up until one-year post-delivery. The pregnancy outcomes after BMS were observed, including changes in weight, pregnancy interval, pregnancy complications, weight and health status of the newborn (premature birth, admission to neonatology, or deformity). Results We identified 31 women who were successfully conceived after BMS. There were statistical differences in weight and menstrual status before and post-operation (P < 0.05), and 77.97% of them had remission or recovery of obesity-related comorbidities. Eighteen patients delivered successfully after BMS, but there were still 12 cases of spontaneous abortion and 1 case of induced abortion. The abortion rate in pregnancy intervals less than 2 years was higher than those ≥2 years (P = 0.045). Of the women who delivered successfully, 5 had pregnancy-specific complications, including gestational diabetes mellitus and hypertensive disorder of pregnancy. However, the growth and development of the newborn are normal since the birth follow-up. Conclusion The present results suggest that the abortion rate in pregnancy intervals less than 2 years was higher than those ≥2 years. It is recommended that postoperative patients avoid pregnancy until their weight is stable to reduce the risk of adverse pregnancy outcomes.

背景与目的:随着减重手术在中国逐渐普及化,术前常规检查的标准化显得至关重要.目前,腹腔镜袖状胃切除术(LSG)或腹腔镜胃旁路术(LRYGB)术前是否常规行胃镜检查仍有争议.本研究旨在分析拟行减重手术的患者术前消化系统症状和胃镜结果的关系,及术前消化系统症状是否可能成为改变手术方式的依据,并比较术前胃镜结果与术后病理结果间的差异,由此探讨术前常规胃镜检查的必要性.方法:回顾性分析2019年11月—2021年11月期间暨南大学附属第一医院胃肠外科/减重中心行减重手术且行术前胃镜检查的患者病历资料.分析患者术前消化系统症状、术前胃镜结果与改变手术方式的关系;判断胃镜结果与术后病理结果的一致性.结果:共纳入458例患者,平均年龄(31.3±9.3)岁;平均BMI(38.9±7.5)kg/m2.103例(22.5％)存在术前消化系统症状,371例行LSG,87例行LRYGB;其中82例(17.9％)术中改变手术方式,在原计划LSG或者LRYGB的基础上加行食管裂孔疝修补术、胃间质瘤切除术、胃底切除术和胃底折叠术.胃镜结果异常的有456例(99.6％),且均有胃部病变(100.0％),包括胃炎、胃溃疡、胃息肉等;十二指肠相关病变53例(11.6％),主要为炎症和溃疡;食管相关病变117例(25.7％),以食管炎居首位(94.0％).患者术前胃镜结果是否异常与有无消化系统症状无明显关系(P＞0.05);消化系统症状与手术方式的改变明显有关(P=0.008),其中主要是因行LSG患者的手术方式的改变与消化系统症状有关(P=0.008),而行LRYGB患者手术方式的改变与消化系统症状无明显关系(P=1).将371例行LSG患者的术前胃镜结果与术后病理结行一致性分析,结果显两者诊断不一致(κ=0.072,P--0.000).结论:在无消化道症状患者中开展术前胃镜检查可有助于早期发现消化系统疾病,术前消化系统症状可一定程度作为改变手术方式的依据.

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.

当代社会经济快速发展,人们生活水平改善迅速,能量过剩导致的肥胖症发病率在世界范围内逐年升高,而我国肥胖症患者人数已跃居世界第一[1].肥胖代谢手术作为治疗肥胖症的重要手段之一,已在全球范围内被广泛应用[2-4].我国的肥胖代谢手术,依靠长期科普及良好的减重效果逐渐被需要做手术的肥胖症患者所接受,手术例数也呈逐年上升趋势[5].电子胃镜作为上消化道病变的重要检测手段,在上消化道疾病的早期排查及治疗中起关键性作用[6 ,7],也成为肥胖代谢外科手术应用中的重要角色.

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.

随着经济社会的快速发展和生活方式的巨大改变,肥胖症的发病率在世界范围内越来越高,肥胖还会引起肥胖相关的代谢并发症[1].我国成年人肥胖率已超过10％,且有进一步增长的趋势[2].循证医学证据表明,对于重度肥胖患者,减重手术可以有良好的减重效果,同时还可治疗2型糖尿病,具有缓解相关代谢疾病等效果[3].根据2018年最新版国际肥胖与代谢病外科联盟全球数据注册系统数据报告[4],已有38.2％的肥胖患者接受Roux-en-Y胃旁路术(Roux-en-Y gastric bypass,RYGB),46.0％的肥胖患者接受袖状胃切除术(sleeve gastrectomy,SG).据中国肥胖代谢外科数据库统计,2019年我国减重手术已逾 11 700例,其中85.78％为 SG,11.43％为 RYGB[5].

Bariatric and metabolic surgery has been developing in China for 20 years, with late beginning, high starting and rapid development. As the number of metabolic surgeries is increasing year by year, all kinds of clinical and basic researches are gradually increasing, and China has become an important force to promote bariatric and metabolic surgery in the world. At the era of rapid development of bariatric and metabolic surgery, there are many problems such as identifica-tion of surgical indications, selection of surgical methods, prevention and treatment of postoperative complications. The authors conduct an in-depth discussion the problems in the development of bariatric and metabolic surgery, in order to promote rapid and heath development of the new subjects.

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.

To explore the intestinal microbiota composition affected by the two most widely used procedures of bariatric surgery, laparoscopic sleeve gastrectomy (LSG) and laparoscopic roux-en-Y gastric bypass (LRYGB), in Chinese obesity patients. Stool samples were collected from the obese patients before (n = 87) and with follow-up after the surgery (n = 53). After DNA extraction, 16S rDNA (V3 + V4 regions) sequencing was completed on Illumina HiSeq 2500 sequencing platform. The samples were analyzed base on four groups, pre-LSG (n = 54), pre-LRYGB (n = 33), post-LSG (n = 33), and post-LRYGB (n = 20). The linear mixed models were used to analyze the alteration of intestinal microbiota before and after the surgeries of LSG or LRYGB. Student’s t test and χ2 test were used for analysis of independent groups; Metastats analysis was used to compare the relative abundance of bacteria, and Pearson correlation and Spearman correlation analysis were used to test the correlation between indicated groups. 87 patients were included and 53 (60.92%) of them completed the follow-up (9.60 ± 3.92 months). Body mass index (BMI) decreased from 37.84 ± 6.16 kg/m2 to 26.22 ± 4.33 kg/m2 after LSG and from 45.75 ± 14.26 kg/m2 to 33.15 ± 10.99 kg/m2 after LRYGB. The relative abundance of 5 phyla and 42 genera were altered after the surgery in the cohort. Although no alteration of Firmicutes was observed at phylum level, 54.76% of the altered genera belong to phylum Firmicutes. Both LSG and LRYGB procedures increased the richness and evenness of intestinal microbiota in obese patients after the surgery. Particularly, 33 genera altered after LSG and 19 genera altered after LRYGB, in which 11 genera were common alterations in both procedures. Both LSG and LRYGB altered the composition of intestinal microbiota in Chinese obesity patients, and particularly increased the richness and evenness of microbiota. Genera belonging to phylum Firmicutes were the most altered bacteria by bariatric surgery. The procedure of LSG resulted in much more pronounced alteration of the intestinal microbiota abundance than that observed in LRYGB. While different genera were altered after LSG and LRYGB procedures, 10 genera were the common altered genera in both procedures. Bacteria altered after LSG and LRYGB were functionally associated with BMI, and with relieving of the metabolic syndromes.

艾滋病,获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS),由感染人类免疫缺陷病毒(human immunodeficiency virus,HIV)所致,是中国重要的公共卫生问题[1].随现阶段监控及防治力度加强,艾滋病患者合并其他疾病的治疗方式也需得到关注.肥胖症合并代谢疾病可选用减重手术方式治疗[2,3],国外已有相关报道证实HIV病患者合并肥胖症行减重手术是安全有效的[4],但在我国尚无的相关报道.现报道广州市第八人民医院普外科与暨南大学附属第一医院合作,于2020年9月1日进行1例合并肥胖症的HIV病患者行腹腔镜袖状胃切除术的相关情况.

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.