BACKGROUND:The triglyceride-glucose index (TyG) has shown comprehensive value in relation to numerous obesity-associated comorbidities, especially cardiovascular diseases. Although their incidence risk and severity are lowered following sleeve gastrectomy (SG), the extent of relief varies. OBJECTIVES:To analyze potential influencing factors of decrease in the TyG index (△TyG) following SG, and establish a predictive model using preoperative data. SETTING:University hospital, China. METHODS:Preoperative and 1-year postoperative data of patients with obesity who underwent SG were collected. After being randomly divided at a proportion of 70%, the patients in the modeling group were further divided into group A (decreased poorly) and group B (decreased satisfactorily) based on the degree of △TyG. After screening the variables with significant differences between the groups, we conducted logistic regression analysis to identify the influencing factors related to △TyG and those with a predictive value. Subsequently, a nomogram was established. Internal, external validations and decision curve analysis (DCA) were performed. Clinical impact curve (CIC) was drawn. RESULTS:The study included 744 patients. Four independent predictors, namely waist-hip ratio (WHR), high-density lipoprotein cholesterol (HDL-c), uric acid (UA), and TyG index were identified. The joint predictor formed by combining these four factors had an area under the curve of .838 (.803-.868) and a significantly better predictive value. The predictive accuracy and clinical net benefit of the nomogram established utilizing the joint predictor were verified. CONCLUSIONS:SG can lead to significant △TyG, with preoperative WHR, HDL-c, UA, and TyG index being independent predictors. The joint predictor can effectively predict the magnitude of the decrease.

Introduction and importance:Mesenteric cysts are rare intra-abdominal lesions, with a prevalence of approximately 1 in 100 000 to 1 in 250 000 adults. Clinical presentation can range from asymptomatic to severe. Chylous mesenteric cysts caused by thoracic duct obstruction are particularly rare and have not been previously reported in obese adolescents. Case presentation:We report the case of a 19-year-old female patient with a rare asymptomatic chylous mesenteric cyst caused by thoracic duct obstruction, which was incidentally discovered during pre-operative evaluation for bariatric surgery. The patient underwent thoracic duct decompression and a personalized low-fat nutrition plan was implemented to mitigate postoperative chyle reflux and address concurrent obesity. Clinical discussion:Mesenteric cysts can have variable clinical presentations and their evaluation relies on a range of imaging modalities. Our case highlights the importance of lymphatic system evaluation in the diagnosis and management of mesenteric cysts, particularly chylous cysts. Surgery targeting lymphatic system abnormalities offers a targeted and less invasive treatment strategy than the traditional surgical resection. Conclusion:This case report emphasizes the importance of imaging evaluation of the lymphatic system for the diagnosis and management of mesenteric cysts. A treatment strategy that combines surgery targeting lymphatic system abnormalities with a personalized nutritional plan can provide a novel and less invasive alternative to traditional surgical resection of chylous mesenteric cysts, addressing the underlying etiology while minimizing surgical trauma and potential complications.

Despite the progress of treatment in gastric cancer (GC), the overall outcomes remain poor in patients with advanced diseases, underscoring the urgency to develop more effective treatment strategies. BH3-mimetic drugs, which inhibit the pro-survival BCL2 family proteins, have demonstrated great therapeutic potential in cancer therapy. Although previous studies have implicated a role of targeting the cell survival pathway in GC, the contribution of different pro-survival BCL2 family proteins in promoting survival and mediating resistance to current standard therapies in GC remains unclear. A systematic study to elucidate the hierarchy of these proteins using clinically more relevant GC models is essential to identify the most effective therapeutic target(s) and rational combination strategies for improving GC therapy. Here, we provide evidence from both in vitro and in vivo studies using a broad panel of GC cell lines, tumoroids, and xenograft models to demonstrate that BCLXL and MCL1, but not other pro-survival BCL2 family proteins, are crucial for GC cells survival. While small molecular inhibitors of BCLXL or MCL1 exhibited some single-agent activity, their combination sufficed to cause maximum killing. However, due to the unsolved cardiotoxicity associated with direct MCL1 inhibitors, finding combinations of agents that indirectly target MCL1 and enable the reduction of doses of BCLXL inhibitors while maintaining their anti-neoplastic effects is potentially a feasible approach for the further development of these compounds. Importantly, inhibiting BCLXL synergized significantly with anti-mitotic and HER2-targeting drugs, leading to enhanced anti-tumour activity with tolerable toxicity in preclinical GC models. Mechanistically, anti-mitotic chemotherapies induced MCL1 degradation via the ubiquitin-proteasome pathway mainly through FBXW7, whereas HER2-targeting drugs suppressed MCL1 transcription via the STAT3/SRF axis. Moreover, co-targeting STAT3 and BCLXL also exhibited synergistic killing, extending beyond HER2-amplified GC. Collectively, our results provide mechanistic rationale and pre-clinical evidence for co-targeting BCLXL and MCL1 (both directly and indirectly) in GC.

Background:A significant proportion of patients with obesity have comorbid hyperuricemia (HUA). However, the curative effect of sleeve gastrectomy (SG) on HUA remains debated. Objective:To clarify the remission effect of SG on HUA, analyze potential influencing factors, and establish a predictive model using preoperative data. Methods:Pre- and post-operative data from 130 patients with obesity and HUA who underwent SG in our hospital were collected and evaluated for the therapeutic effect on HUA. Binary logistic regression analysis was employed to screen the influencing factors and the ones with predictive value. Predictive model was constructed, then evaluated using the area under the receiver operating characteristic (ROC) curve (AUC) and internal and external validations. Complete remission of HUA was defined as a follow-up SUA level that no longer met the reference value for diagnosing HUA, i.e., an SUA concentration of <428 μmol/L (in males) or <357 μmol/L (in females), according to the reference value in our hospital's laboratory. Results:The mean follow-up duration is 20.4 months. After ≥ one year post SG, the complete remission rate of HUA was 58%. Preoperative hip circumference (HC) and preoperative serum uric acid (SUA) level were found to be predictive variables, the AUC values of which, along with their combination in predicting this outcome, were 0.696, 0.731, 0.738, respectively, p >0.05. The joint predictive model was found to have a sensitivity and specificity of 0.776 and 0.738, respectively, and its reliability was confirmed by internal and external validations. Conclusion:Some patients can achieve HUA complete remission following SG after 1 year. Preoperative SUA concentration and HC can be utilized to predict this outcome in Chinese patients with obesity. The joint predictive model offers potentially better clinical value.

Purpose:Obesity and related complications are managed by One Anastomosis Gastric Bypass (OAGB) and Single Anastomosis Duodeno-Jejunal Bypass with Sleeve Gastrectomy (SADJB-SG), both of which are adapted from traditional gastric bypass procedures. However, there are no current comparative studies on the safety and efficacy of these two surgical procedures. Patients and Methods:Preoperative baseline data of patients who had undergone OAGB and SADJB-SG surgeries from June 2019 to June 2021 were retrospectively analyzed at our bariatric facility. Postoperative data, including weight changes, improvement in type 2 diabetes (T2DM), and complication rates were collected over 2 years. This was followed by a comprehensive evaluation of the safety and efficacy of the two surgical procedures. Results:A total of 63 patients completed the follow-up in this study. At the 24-month follow-up, excess weight loss percentage (EWL%) for the OAGB and SADJB-SG was 73.970±5.005 and 75.652±7.953, respectively (P-value = 0.310); total weight loss percentage (TWL%) was 24.006±8.231 and 23.171±6.600, respectively (P-value = 0.665). The diabetes remission rates for the two groups were 71.429% and 69.048%, respectively (P-value = 0.846). The cost for OAGB was 55088.208±1508.220 yuan, which was significantly lower than the 57538.195±1374.994 yuan for SADJB-SG (P-value< 0.001). Conclusion:The two surgical procedures are reliable in terms of safety and efficacy, and each has distinct advantages. While OAGB has reduced operational expenses, SADJB-SG offers a broader range of applicability.

Lipoma is a common type of benign soft tissue tumor that can occur in the shoulders, neck and back, in addition to other body parts. The Retzius space is a small anatomical space between the pubic symphysis and the bladder located extraperitoneally and filled with loose fatty connective tissue. Giant lipomas are rare in the Retzius space. A 61-year-old Chinese male arrived at Beijing Yanhua Hospital (Beijing, China) due to frequent urination, and CT scan images of the lower abdomen observed a large pelvic mass and left inguinal hernia. Preoperative clinical manifestations and auxiliary examination suggested that the tumor originated from the urinary bladder wall. The maximum tumor diameter was ~25 cm and abdominal pressure was increased. Therefore, laparoscopic pelvic tumor resection combined with inguinal hernia repair was attempted. Intraoperatively, the tumor was found to originate from the Retzius space and the postoperative pathological diagnosis was lipoma. The present case report may serve as a reference for minimally invasive treatment of this type of rare disease in future.

Purpose:Gastroesophageal reflux disease (GERD) is a common complication after laparoscopic sleeve gastrectomy (LSG); This study aimed to construct a model that can predict the incidence of GERD after LSG by exploring the correlation between the results of high-resolution esophageal manometry (HREM) and the incidence of GERD after LSG. Patients and Methods:We collected the clinical data of patients who had undergone HREM before bariatric surgery from September 2013 to September 2019 at the bariatric center of our hospital. The Gerd-Q scores during the postoperative follow-up were collected to determine the incidence of GERD. A logistic regression analysis was performed to explore the correlation of the HREM results and general clinical data with the incidence of GERD after LSG. Results:The percentage of synchronous contractions, lower esophageal sphincter (LES) resting pressure, and history of smoking were correlated with the development of GERD after LSG, with the history of smoking and percentage of synchronous contractions as risk factors and LES resting pressure as a protective factor. The training set showed an area under the ROC curve (AUC) of the nomogram model of 0.847. The validation set showed an AUC of 0.761. The decision and clinical impact curves showed a high clinical value for the prediction model. Conclusion:The HREM results correlated with the development of GERD after LSG, with the percentage of synchronous contractions and LES resting pressure showing predictive value. Combined with the history of smoking, the predictive model showed a high confidence and clinical value.

BACKGROUND:Bariatric surgery is an effective treatment for morbid obesity. However, a subset of individuals seeking bariatric surgery may exhibit a metabolically healthy obesity (MHO) phenotype, suggesting that they may not experience metabolic complications despite being overweight.OBJECTIVE:This study aimed to determine the prevalence and metabolic features of MHO in a population undergoing bariatric surgery.METHODS:A representative sample of 665 participants aged 14 or older who underwent bariatric surgery at our center from January 1, 2010 to January 1, 2020 was included in this cohort study. MHO was defined based on specific criteria, including blood pressure, waist-to-hip ratio, and absence of diabetes.RESULTS:Among the 665 participants, 80 individuals (12.0%) met the criteria for MHO. Female gender (P = .021) and younger age (P < .001) were associated with a higher likelihood of MHO. Smaller weight and BMI were observed in individuals with MHO. However, a considerable proportion of those with MHO exhibited other metabolic abnormalities, such as fatty liver (68.6%), hyperuricemia (55.3%), elevated lipid levels (58.7%), and abnormal lipoprotein levels (88%).CONCLUSION:Approximately 1 in 8 individuals referred for bariatric surgery displayed the phenotype of MHO. Despite being metabolically healthy based on certain criteria, a significant proportion of individuals with MHO still exhibited metabolic abnormalities, such as fatty liver, hyperuricemia, elevated lipid levels, and abnormal lipoprotein levels, highlighting the importance of thorough metabolic evaluation in this population.

Introduction and Importance:Postoperative neck hematoma (PNH), a rare complication following thyroidectomy, occurs in only 1.1-3.15% of cases and can lead to life-threatening outcomes. More rarely, delayed PNHs with atypical clinical manifestations and positions have not yet been reported. Early identification and immediate medical intervention are of utmost importance in such cases.Case Presentation:The authors represented a patient with thyroid cancer adherent to the trachea, who underwent post-thyroidectomy, experienced delayed PNH in the retrosternal region and was infected by respiratory pathogens. Meanwhile, the patient developed recurrent laryngeal nerve (RLN) paralysis after surgery. PNH was not identified in the clinical manifestations; instead, it was detected only through successive cervical ultrasound examinations.Clinical Discussion:Although rare, PNH can lead to serious complications, especially delayed complications or those in atypical positions, without neck swelling. When simultaneously with RLN paralysis, the hematoma may be neglected. Therefore, early diagnosis and treatment are crucial.Conclusion:Clinicians should be vigilant of atypical PNH because neck swelling may be absent. Cervical ultrasonography is essential for diagnosis and can be performed multiple times. Cervical CT scans should be part of the routine procedure, while contrast-enhanced ultrasound can help detect active bleeding. Early postoperative antibiotics are recommended if the tumor is closely attached to the trachea.

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is classic bariatric procedure with long-term safety and efficacy. However, no studies have focused on predicting long-term weight loss after LRYGB in Chinese patients with body mass index (BMI) ≥ 32.5 kg/m2. To explore the relationship between initial and long-term weight loss after LRYGB in patients with BMI ≥ 32.5 kg/m2. All patients were followed-up to evaluate BMI, percentage of excess weight loss (%EWL), and comorbidities. Linear and logistic regression were performed to assess the relationship between initial and long-term weight loss. Receiver operating characteristic curve was used to determine optimal cutoff value. We enrolled 104 patients. The median preoperative BMI was 41.44 (37.92–47.53) kg/m2. %EWL ≥ 50% at 5 years was considered as successful weight loss, and 75.00% of the patients successfully lost weight. The cure rates of hypertension, hyperlipidemia, and type 2 diabetes mellitus at 1 year were 84.38%, 33.93%, and 60.82%, respectively. %EWL at 6 months and 5 years were positively correlated and its relationship could be described by following linear equation: %EWL5 years = 43.934 + 0.356 × %EWL6 months (P < .001; r2 = 0.166). The best cutoff %EWL at 6 months after LRYGB to predict 5-year successful weight loss was 63.93% (sensitivity, 53.85%; specificity, 84.62%; area under the curve (AUC) = 0.671). In Chinese patients with BMI ≥ 32.5 kg/m2, %EWL at 6 months and 5 years were positively correlated and %EWL at 5 years could be calculated by following linear equation: %EWL5 years = 43.934 + 0.356 × %EWL6 months.

This study aims to explore the relationship between age and whether the percentage of total weight loss (TWL

目的 探索住专一体化模式下普通外科手术分解分类带教的方法.方法 按照住院医师和专培医师培养要求,将普通外科常见手术及重大手术进行分类及分解,使不同层次的培训对象都能在手术中获得独立操作机会.结合Milestone,为住院医师和专培医师制定分阶段递进式的手术技术培养计划.对进入研究的住院医师和专培医师进行基线测试,并在出科时进行考核,与既往常规培养模式进行比较,探索该方案的有效性.结果 将普通外科常见手术及重大手术进行分解,分别由住院医师和专培医师进行独立操作,并由指导医师或上级医师完成手术的核心部分.以此为基础,为住院医师和专培医师制定分阶段递进式的手术技术培养计划,并制定手册.住专一体化模式下住院医师基线成绩为(33.08±3.85)分,既往常规培训模式基线成绩为(32.96±3.55)分,二者差异无统计学意义(P>0.05);住专一体化模式下住院医师出科成绩为(41.67±5.19)分,既往常规培训模式出科成绩为(39.14±5.67)分,二者差异具有统计学意义(P<0.05).住专一体化模式下专培医师基线成绩为(35.13±5.32)分,既往常规培训模式基线成绩为(34.93±6.04)分,二者差异无统计学意义(P>0.05);住专一体化模式下专培医师出科成绩为(45.27±5.20)分,既往常规培训模式出科成绩为(42.14±4.42)分,二者差异具有统计学意义(P<0.05).结论 与既往常规培养模式相比,住专一体化手术培养模式下的普通外科手术分解分类带教能够显著提高培训对象的手术操作能力.

Abstract Objective To demonstrate if patients with cholecystolithiasis at low risk of common bile duct stones (CBDS) require magnetic resonance cholangiopancreatography (MRCP) before laparoscopic cholecystectomy (LC). This study investigated the clinical value of routine MRCP before LC in patients with gallstones. Methods We adopted a non-randomized controlled experiment according to whether MRCP performed prior to LC, 277 patients with cholecystolithiasis at low risk of CBDS were divided into two groups:142 patients in the control group only underwent abdominal ultrasound, while 135 patients in the experimental group underwent both abdominal ultrasound and MRCP. The results of laboratory test, abdominal ultrasound and MRCP, surgical complications, length of stay and hospitalization costs were compared between the two groups. Result The detection rates of CBDS, cystic duct stones, gallbladder adenomyomatosis and anatomical variants of biliary tract by preoperative MRCP were higher than those by abdominal ultrasound (P < 0.05). The incidence of postoperative complications in the experimental group was significantly lower than that in the control group (0% vs. 5.63%, P < 0.05). The length of stay in the experimental group was shorter than that in the control group (P < 0.05). Conclusion Routine MRCP before LC can detect CBDS, cystic duct stones and anatomical variants of biliary tract that cannot be diagnosed by ultrasound. MRCP helps surgeons better understand the anatomical variation of extrahepatic bile duct, plan the operation rationally and efficiently reduce the occurrence of postoperative complications. Moreover, MRCP shorten the length of stay without increasing the hospitalization costs.

Objective:To investigate anticoagulant effects of mechanical methods in obese patients undergoing laparoscopic sleeve gastrectomy (LSG).Methods:In this prospective study, 54 obese patients receiving LSG were enrolled . All patients were given post-op mechanical methods for thrombogenic interventions. BMI and the operation-related factors were recorded. Venous blood specimens were taken from each patient before surgery, at the end of pneumoperitoneum (i.e., 0 h after surgery), at 24 hours after surgery for prothrombin time (PT) and activated partial thromboplastin time (APTT), fibrinogen (FIB) and D-dimer (D-D).Results:All 54 obese patients successfully underwent LSG. No severe complications were observed. Before operation, the mean BMI was (43.49±8.29) kg/m 2. DVT-2600 device was applied in all patients for 3 consecutive days after surgery. The PT values increased at 0 h, 24 h after surgery [(12.4±1.2) s, (12.4±0.8) s vs. (11.2±0.8) s, P=0, 0]. The APTT values at 0 h, 24 h after surgery decreased [(29.7±3.6) s, (29.0±3.1) s vs.(31.2±3.3) s, P=0.020, 0.001]. However, the D-D values increased at 0 h,24 h after operation [(213±143) ng/ml ,(445±237) ng/ml vs. (85±108) ng/ml, P=0, 0]. All patients were followed up for 1 month, and no thrombosis -related complications were observed. Conclusion:Mechanical methods for obese patients after LSG can help decrease the risk of deep venous thrombosis.

目的 探讨避免腹腔镜胃袖状切除(laparoscopic sleeve gastrectomy,LSG)术后胃漏和胃出血的技术要点.方法 2014年6月～2020年6月对266例肥胖患者行LSG,术前BMI 28.2～78.1,(42.3±8.2).技术要点:①选用36F胃支撑管(Bougie);②根据切除胃壁的厚度选择直线切割器的钉腿高度;③切割闭合时先按下手柄使切割器处于闭合状态,1 min后再激发释放缝钉;④胃切除缝合后残胃注气,确认无漏气;⑤拔除trocar前再次确认残胃无渗血;⑥术后第1天残胃造影确认无造影剂外漏,再饮水.结果 266例均成功实施LSG,手术时间(82.7±25.5)min,术中出血量(24.7±17.5)ml,术后住院时间(3.9±1.2)d.术后无胃漏发生.1例术后8 h怀疑残胃出血,急诊腹腔镜探查,见上腹部有凝血块约200 ml,未见胃残端及腹腔内出血.出院1个月BMI降至21.3～69.8,(37.9±7.8),未发生胃漏及胃出血.结论 在行LSG时,重视以上技术要点,可能有助于避免术后胃漏和胃出血的发生.

This paper reports a gravity-flow filter elution assay that permits the simultaneous detection of DNA double strand breaks (DSBs, as neutral elutable DNA) and DNA single strand breaks (SSBs, as alkaline elutable DNA). This assay is based on a modification of a conventional gravity-flow alkaline elution procedure. The elution fraction resulting from cell lysis before the application of the alkaline elution buffer provides an estimate of DNA DSBs, while the fraction eluted by the alkaline buffer (pH 12.3) measures the extent of DNA SSBs. Data show that, in addition to its good detection sensitivity for SSBs, this method provides a sensitive measure of DNA DSBs. As an illustration of its specificity, this method unambiguously distinguished DNA SSBs induced by X-irradiation of mouse leukemia L1210 cells from DNA DSBs occurring in cells undergoing nucleosomal DNA fragmentation and apoptosis. The neutral elution fraction is a good predictor of loss of cell viability induced either by selenite at pharmacological levels or by growth factor depletion. The filter elution method reported is more specific and informative than a nick translation assay for the detection of DNA strand breaks.

回顾性分析2018年5月至2019年5月北京大学第九临床医学院普外科行全腹腔镜全胃切除术新型手工缝合法食管空肠吻合技术治疗13例食管贲门癌患者的临床资料，平均完成食管空肠吻合时间（32±5） min，平均手术时间（218±61） min，中位术中出血量100 （100~300） ml，平均术中获取淋巴结（30±12）个。术后1例患者出现吻合口瘘，经保守治疗后好转，其余患者未出现吻合口并发症。

Objectives Deoxyribonuclease 1 like 3 (DNASE1L3) is critically involved in apoptosis and immune response, however, its role in cancer has yet to be deciphered. We aimed to explore the prognostic value of DNASE1L3 across a series of malignancies. Methods Based on Oncomine database and Tumor Immune Estimation Resource (TIMER), expression profiling of DNASE1L3 was detailed in malignancies. Using PrognoScan, Kaplan-Meier Plotter, GEPIA2, and bc-GenEcMiner v4.5, prognostic value of DNASE1L3 was estimated in diverse cancers. Based on TIMER, association between DNASEL13 expression and immune infiltration was examined in various cancers. Then, mRNA level of DNASE1L3 in hepatocellular carcinoma (HCC) samples (n=22) and stomach adenocarcinoma (STAD) samples (n=17) was measured with qRT-PCR. Immunohistochemistry was performed to confirm expression of DNASE1L3 in paraffin-embedded tissues of HCC (n=9) and lung adenocarcinoma (n=20). Results DNASE1L3 was downregulated in multiple cancers, including breast invasive carcinoma (BRCA), cholangiocarcinoma (CHOL), liver hepatocellular carcinoma (LIHC), and lung adenocarcinoma (LUAD). A lower level of DNASE1L3 correlated with poorer prognosis in various cancers, especially in breast, liver, kidney, stomach, lung adenocarcinoma and sarcoma (SARC). Moreover, DNASE1L3 was positively related to immune cell infiltration in many cancers, including BRCA, LIHC, STAD, LUAD, and SARC. DNASE1L3 was significantly associated with CCR7/CCL19 in cancers. DNASE1L3 was downregulated in HCC and STAD tissues as demonstrated by qRT-PCR, as well as in HCC and LUAD samples, as shown by immunohistochemistry. Conclusion DNASE1L3 has potential to serve as a prognostic biomarker in cancer of the breast, kidney, liver, stomach, lung adenocarcinoma and sarcoma. Down-regulation of DNASE1L3 may participate in immune escape via CCR7/CCL19 axis.

目的:回顾性分析2010年6月至2016年1月在北京世纪坛医院接受腹腔镜袖状胃切除手术的263例肥胖患者的临床资料，术后随访BMI和多余体重减轻百分比（%EWL）。通过Logistic回归分析评估早期体重减轻与成功体重维持之间的关系。结果表明，术后6个月时的%EWL与术后5年的%EWL呈显著正相关（ P<0.05）。根据ROC曲线确定最佳截止值为56.54，按此临界值将患者分为组1（6个月%EWL≤56.54%）和组2（6个月%EWL>56.54%）。手术后5年，79.4%的患者成功减重超过50%EWL。术后5年，组1患者56.9%成功减重超过50%EWL，组2患者94.4%成功减重超过50%EWL。腹腔镜袖状胃切除术后6个月的%EWL影响手术后5年的%EWL。