A considerable body of research has established a strong correlation between obstructive sleep apnea (OSA) and bariatric surgery (BS). Despite this, there has been a lack of systematic analysis and visualization of related publications using bibliometric methods. This research employs bibliometric analysis using the Web of Science Core Collection (WoSCC) to explore the OSA-BS connection from January 1998 to June 2024. Following thorough screening, a total of 1,666 articles were included. Software tools like CiteSpace and VOSviewer were employed to examine the connections among countries, authors, journals, institutions, keywords, and citations. The analysis identified the USA leading in research output (732 articles, 43.9

To the Editor: Obesity and type 2 diabetes (T2D) present significant health issues in China. Despite generally having lower body mass index (BMI) thresholds than Western populations, Chinese individuals often experience higher rates of central obesity, leading to increased metabolic risks even at lower BMI levels. The prevalence of T2D among adults in China is estimated to be 11.2%. Traditional treatments, including lifestyle interventions and medications, often fail to achieve sustained weight loss and effective glycemic control in the long term in patients with obesity and T2D. This prospective multicenter observational study aimed to evaluate the 2-year and 5-year treatment effects of laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on T2D patients in China (Clinical Trials identifier: NCT02217943). All subjects from six high-volume tertiary hospitals were recruited between August 2014 and January 2016 [Supplementary Table 1, https://links.lww.com/CM9/C282]. The study protocol was reviewed and approved by the Independent Ethics Committee or the Institutional Review Committee at each center (Ethical approval number of the leading research institution is 2014-32 [Supplementary Material 1, https://links.lww.com/CM9/C282]), and all subjects provided written informed consent before enrollment. Participants were between 20 years old and 60 years old, with a BMI ranging from 28 kg/m2 to 50 kg/m2 and a diagnosis of T2D for at least six months. Subjects were required to have a C-peptide level greater than 1 ng/mL. Exclusions also applied to individuals with certain medical conditions [Supplementary Material 2, https://links.lww.com/CM9/C282]. At baseline, comprehensive data on demographics, medical history, physical exams, and various laboratory tests were collected. Participants underwent either RYGB or SG. The choice of procedure was determined by the attending surgeons. Outpatient follow-up visits were scheduled at 1-month, 3-, 6-, 12-, 24-, 36-, 48-, and 60-months post-surgery and focused on evaluating subjects' glycemic control, weight loss, and other health metrics. Safety was documented through investigator-observed and subject-reported adverse events (AEs). The outcome of T2D status, defined by the American Society for Metabolic and Bariatric Surgery (ASMBS), was evaluated at 2 years and 5 years. T2D status was classified as complete remission, partial remission, improvement, no change, or recurrence using a composite metric of glycemic control combining HbA1c and FPG (see definition in Supplementary Material 3, https://links.lww.com/CM9/C282). The percentage of subjects achieving HbA1c <7.0% regardless of medication usage, changes in body weight, BMI, blood pressure, lipid profile, and liver enzymes were also evaluated. Predefined procedure-related complications were recorded (see definition in Supplementary Material 4, https://links.lww.com/CM9/C282). The full analysis set was used as the primary analysis set and safety set. The number and percentage of subjects achieving each of the five components of the composite measure of glycemic control were summarized, and 95% confidence intervals (CIs) were provided using the Clopper–Pearson method. The change from baseline for HbA1c and cardiometabolic markers were summarized at each postoperative measurement time point, and 95% CIs were provided using the t distribution. No adjustments for covariates were performed for outcome analysis. All analyses were performed using SAS 9.4 (SAS Institute Inc. Cary, NC, USA). A two-sided P <0.05 was considered statistically significant. A total of 101 subjects were enrolled (76 in RYGB and 25 in SG). The mean age was 37.1 ± 9.7 years and 52.5% were women. The mean baseline BMI was 35.1 ± 5.2 kg/m2 and the mean baseline HbA1c was 8.1 ± 1.7%. Baseline clinical characteristics are summarized in Supplementary Table 2, https://links.lww.com/CM9/C282. No subject switched to open surgery. A total of 79 subjects (78.2%, 79/101; 62 RYGB, 17 SG) completed the 2-year follow-up, while 63 subjects (62.4%; 63/101; 51 RYGB, 12 SG) completed the 5-year follow-up. The T2D status of these subjects are presented in Figure 1A. Bivariate analyses comparing subjects with and without complete or partial remission showed that subjects without complete or partial remission had higher mean (Standard Deviation, SD) FPG at baseline mean (Standard Deviation, SD) (9.8 [3.6] mmol/L vs. 8.3 [2.4] mmol/L; P = 0.0432) and a longer duration of T2D (5.0 [2.8] years vs. 3.1 [2.4] years; P <0.05).Figure 1: Five-year outcomes of glycemic control and weight loss after metabolic surgery (RYGB, SG) in Chinese obese population with T2D. (A) The percentage of subjects achieving each of the five components of the composite measure of glycemic control (definition in Supplementary Material 2,https://links.lww.com/CM9/C282) was summarized for each treatment group (RYGB, SG, Total) at two and five years after bariatric/metabolic surgery. (B) Mean BMI and TWL% in the RYGB and SG groups over a 60-months period compared with baseline metric. BMI: Body mass index; RYGB: Roux-en-Y gastric bypass; SG: Sleeve gastrectomy; TWL: Total weight loss; T2D: Type 2 diabetes. (Note: Denominator and percentages are based on subjects with non-missing data)HbA1c decreased rapidly within the first three months after surgery. The percentages of subjects with HbA1c <7.0% regardless of medication status were 93.3% (91.5% for RYGB and 93.8% for SG) at 2 years and 78.3% (78.0% for RYGB and 80.0% for SG) at 5 years [Supplementary Figure 1, https://links.lww.com/CM9/C282]. Improvement in glycemic control was paralleled by an improvement in homeostasis model assessment of insulin resistance (HOMA-IR) [Supplementary Table 2, https://links.lww.com/CM9/C282]. The percentage of subjects receiving oral anti-hyperglycemic medication and/or insulin decreased rapidly after bariatric/metabolic surgery, although there was a slight rebound in medication use over time [Supplementary Figure 2, https://links.lww.com/CM9/C282]. Significant reductions occurred in body weight and mean BMI at 2 years (total weight loss [TWL%] −22.8%, −22.6% for RYGB and −23.5% for SG; BMI −7.9 ± 3.6, −7.9 ± 3.8 kg/m2 for RYGB and −8.1 ± 2.3 kg/m2 for SG; all P <0.001) and at 5 years (TWL% −20.8%, −20.6% for RYGB and −21.8% for SG; BMI −7.2 ± 2.9, −7.1 ± 3.1 kg/m2 for RYGB and −7.7 ± 2.1 kg/m2 for SG; all P <0.001) [Figure 1B]. Hypertension, dyslipidemia, and elevated ALT, AST, and GGT levels improved from baseline to 5 years in both RYGB and SG, consistent with previous studies.[1] Common AEs included deficiencies in iron (49.5%, 50/101), vitamin D (34.7%, 35/101), and vitamin B12 (32.7%, 33/101), along with incision site pain (26.7%, 27/101), anemia (25.7%, 26/101), abdominal pain (17.8%, 18/101), and vomiting (13.9%, 14/101) [Supplementary Table 3, https://links.lww.com/CM9/C282]. Procedure-related AEs and serious adverse events (SAEs) classified according to the Clavien-Dindo (CD) classification of surgical complications are summarized in Supplementary Table 4, https://links.lww.com/CM9/C282. Most AEs were classified as Grade I (overall 77%, 341/443; RYGB 76.3%, 277/363; and SG 80%, 64/80) or II (overall 21.4%, 95/443; RYGB 21.8%, 79/363; and SG 20%, 16/80) according to the Clavien–Dindo classification of surgical complications. SAEs were reported in 10.5% (8/76) of the RYGB group over five years (four gastrointestinal disorders, two anemia, and two metabolism and nutrition disorders), but in none of the SG group [Supplementary Table 4, https://links.lww.com/CM9/C282]. This study demonstrates that both RYGB and SG have substantial long-term benefits for glycemic control and weight loss in Chinese subjects with T2D. Two previous 5-year studies[2,3] evaluating metabolic surgery for T2D subjects in China showed slightly higher complete remission rates of T2DM compared with our study, possibly due to the absence of rigorous FPG criteria. A meta-analysis[1] of RCTs involving 381 Caucasians with T2D who underwent metabolic surgery showed a 27.5% remission rate at 5 years. The inclusion of adjustable gastric banding (AGB) data may be related to the poorer long-term efficacy. Another meta-analysis[4] with 240 non-severely obese subjects (60% Chinese) showed similar T2D remission rates for RYGB and SG (54.0% and 56.7%, respectively), comparable to our findings. Moriconi et al[5] reported that short T2DM duration and good glycemic control before surgery were the best predictors for 10-year remission in Caucasians, consistent with our findings. This study had some limitations. It was a prospective observational study rather than a randomized controlled study. The choice of surgical procedure was not randomized, which prevents direct comparison between RYGB and SG. Additionally, the dropout rate was relatively high (21.8% at 2 years and 37.6% at 5 years), partly due to data collection challenges during the Coronavirus disease (COVID-19) pandemic. These factors could introduce biases and affect the generalizability of the results. The mean duration of diabetes was greater for the cohort that completed the 5-year visit. Mean age, BMI, body weight, waist circumference, systolic blood pressure (SBP), and the proportion of male subjects were somewhat greater for the cohort that did not complete the 5-year visit. In conclusion, this is a prospective, multicenter, 5-year study of metabolic surgery in subjects with T2DM in China. The results of this study provide evidence that metabolic surgery, including RYGB and SG, offers significant long-term benefits for glycemic control and weight loss in Chinese subjects with T2D. These procedures can lead to partial or complete remission of T2D, improving overall metabolic health. Conflicts of interest The authors thank Olivia Mathis of Ethicon, Inc. for editorial assistance. Financial support for this study was provided by Ethicon Endo-Surgery, Inc.

Insufficiency of Akkermansia muciniphila (Akk) has been implicated in the pathogenesis of metabolic diseases, and administration or restoration of Akk has ameliorated these disorders. Recently, Pasteurized Akk (PA-Akk) has been approved as a functional food. However, the impact of Akk on lipid absorption in the proximal intestine, which is directly exposed to orally administered Akk, remains largely unexplored. In this study, we orally administered Akk and PA-Akk to mice and investigated the subsequent lipid absorption. Long-term administration of Akk resulted in reduced lipid deposits in the liver and adipocytes, along with improved glucose metabolism. This was primarily attributed to a reduction in lipid absorption by epithelial cells in the proximal jejunum. Mechanistically, Akk activated AMP-activated protein kinase (AMPK) and directly inhibit lipids absorption in both mouse and human jejunal epithelial cells. Furthermore, we demonstrated that Akk treatment, but not PA-Akk treatment, promotes the abundance of genera that are highly abundant in the normal jejunum and belong to the phylum Firmicutes. Thus, our study concludes that oral administration of Akk provides beneficial effects on metabolism, partially through inhibiting jejunal lipid absorption and promoting the abundance of core jejunal microbes.

Objective: Ginsenoside Re, a unique tetracyclic triterpenoid compound found in ginseng, has been suggested in previous reports to improve non-alcoholic fatty liver disease (NAFLD) by modulating lipid imbalance. This study aims to elucidate the potential mechanisms of Ginsenoside Re in treating NAFLD through a combination of bioinformatics analysis and biological experiments. Methods: Network pharmacology methods were employed to systematically depict the effective components and mechanisms of Ginsenoside Re in improving NAFLD. Molecular docking was utilized to evaluate the binding affinity of Ginsenoside Re with NAFLD-related targets and identify potential targets. NAFLD-related target genes were obtained from the GEO database for gene enrichment analysis, revealing signaling pathways, biological processes, and gene differential expression. Finally, animal experiments were conducted to verify the mechanism of action of Ginsenoside Re in NAFLD. Results: Network pharmacology analysis revealed that Ginsenoside Re improves NAFLD by modulating targets such as AKT1 and TLR4, findings corroborated by molecular docking, GEO database analysis, and experimental validation. Further investigation found that Ginsenoside Re ameliorates lipid metabolism disorders and inflammatory responses induced by NAFLD by modulating the PI3K/AKT and TLR4/NF-κB signaling pathways. Conclusion: Our study demonstrates the pharmacological effects of Ginsenoside Re in treating NAFLD, implicating multiple components, targets, and pathways. This provides a solid foundation for considering Ginsenoside Re as an alternative therapy for NAFLD, with promising clinical applications.

Mycobacterium tuberculosis (MTB) and Mycobacterium bovis (M. bovis) are closely related pathogenic mycobacteria known to cause chronic pulmonary infections in both humans and animals. Despite sharing nearly identical genomes and virulence factors, these two bacteria display variations in host tropism, epidemiology, and clinical presentations. M. bovis Bacillus Calmette-Gue ' rin (BCG) is an attenuated strain of M. bovis commonly utilized as a vaccine for tuberculosis (TB). Nevertheless, the molecular underpinnings of these distinctions and the intricacies of host-pathogen interactions remain areas of ongoing research. In this study, a comparative transcriptomic analysis was conducted on human leukemia macrophages (THP-1) infected with either MTB H37Rv or M. bovis BCG (Tokyo strain) to elucidate common and strain-specific responses at the transcriptional level. RNA sequencing was utilized to characterize the transcriptomes of human primary macrophages infected with MTB or BCG at 6 and 24 h post-infection. The findings indicate that both MTB and BCG induce substantial and dynamic alterations in the transcriptomes of THP-1, with a notable overlap in the quantity and extent of differentially expressed genes (DEGs). Moreover, gene ontology (GO) enrichment analysis unveiled shared pathways related to immune response, cytokine signaling, and apoptosis. The immune response of macrophages to bacterial infections at 6 h exhibited significantly greater intensity compared to that at 24 h. Furthermore, distinct gene sets displaying notable variances between MTB and BCG infections were identified. The profound impact of MTB infection on macrophage gene expression, particularly within the initial 6 h, was evident. Additionally, downregulation of pathways such as Focal adhesion, Rap1 signaling pathway, and Regulation of actin cytoskeleton was observed. The pathways associated with inflammation reactions and cell apoptosis exhibited significant differences, with BCG triggering macrophage apoptosis and MTB enhancing the survival of intracellular bacteria. Our findings reveal that MTB and BCG provoke similar yet distinct transcriptional responses in human macrophages, indicating variations in their pathogenesis and ability to adapt to host environments. These results offer novel insights into the molecular mechanisms governing host-pathogen interactions and may contribute to a deeper understanding of TB pathogenesis.

The intricate processes that govern the interactions between peripatetic immune cells and distal renal injury in obesity are not fully understood. Employing transcriptomic analysis of circulating extracellular vesicles (EVs), a marked amplification of small RNA (miR-3960) is discerned within CD3-CD19+ B cells. This RNA is found to be preferentially augmented in kidney tissues, contrasting with its subdued expression in other organs. By synthesizing dual-luciferase reporter assay with co-immunoprecipitation analysis, it is pinpointed that miR-3960 specifically targets the nuclear gene TRMT5, a pivotal actor in the methylation of mitochondrial tRNA. This liaison instigates aberrations in the post-transcriptional modifications of mitochondrial tRNA, engendering deficiencies within the electron respiratory chain, primarily attributable to the diminution of the mitochondrial bioenergetic compound (NDUFA7) complex I. Such perturbations lead to a compromised mitochondrial respiratory capacity in renal tubular cells, thereby exacerbating tubular injury. In contrast, EV blockade or miR-3960 depletion markedly alleviates renal tubular injury in obesity. This investigation unveils a hitherto unexplored pathway by which obesity-induced circulating immune cells remotely manipulate mitochondrial metabolism in target organs. The strategic targeting of obese EVs or infiltrative immune cells and their specifically secreted RNAs emerges as a promising therapeutic avenue to forestall obesity-related renal afflictions.

Metabolic dysfunction-associated steatohepatitis (MASH) is the progressive form of metabolic dysfunction-associated steatotic liver disease (MASLD), and closely associated with a high risk of liver-related morbidity and mortality. Although enhanced neutrophil infiltration of the liver is a histological hallmark of MASH, the morphological pattern of hepatic neutrophils and their relevance to the definition of MASH remain unknown. This clinicopathological study aimed to determine the association of neutrophilic crown-like structures (CLSs) in liver biopsies and evaluate their relevance to the histological diagnosis of MASH. A total of 483 morbidly obese adults who underwent bariatric surgery were recruited. Neutrophilic CLSs in liver biopsies were detected by immunohistochemistry for neutrophil elastase and proteinase 3. All participants were classified into 4 histological subgroups: no MASLD (118, 24.4%), MASLD (76, 15.7%), borderline MASH (185, 38.3%), and definite MASH (104, 21.5%). In the discovery cohort (n = 379), the frequency of neutrophilic CLSs increased in line with the severity of liver disease. The number of neutrophilic CLSs was positively correlated with established histological characteristics of MASH. At a cutoff value of <0.3 per 20× microscopic field, the number of neutrophilic CLSs yielded a robust diagnostic accuracy to discriminate no MASLD and MASLD from borderline MASH and definite MASH; a cutoff at >1.3 per 20× microscopic field exhibited a statistically significant accuracy to distinguish definite MASH from other groups (no MASLD, MASLD, and borderline MASH). The significance of neutrophilic CLSs in identifying borderline MASH and definite MASH was confirmed in an external validation cohort (n = 104). The frequency of neutrophilic CLSs was significantly higher than that of macrophagic CLSs. In conclusion, neutrophilic CLSs in the liver represent a typical histological characteristic of MASH and may serve as a promising indicator to improve the diagnostic accuracy of MASH during histological assessment of liver biopsies.

Breast cancer (BC) is the most common type of malignancy and the leading cause of cancer-associated mortality in women worldwide. As such, assessing the metabolic changes during human breast carcinogenesis is key for developing disease prevention methods and treatment. In the present study, non-targeted metabolomics with chemometrics based on ultra-high performance liquid chromatography-high-resolution mass spectrometry were performed to assess differences in serum metabolite patterns between patients with BC and healthy individuals. A total of 3,246 metabolites in the sera of healthy controls and patients with BC were found. Kyoto Encyclopedia of Genes and Genomes pathway analysis demonstrated that arginine, proline, nicotinate, nicotinamide, caffeine and arachidonic acid metabolism, as well as fatty acid biosynthesis were significantly altered in patients with BC in comparison with controls. These results suggested that serum metabolic profiling has potential for discovering molecular biomarkers for the detection of BC. It may also further the understanding of the underlying mechanisms associated with this disease.

Background: Endoscopic thyroidectomy (ET) offers superior cosmetic outcomes compared to traditional open thyroidectomy but is associated with higher postoperative drainage volumes (DV) and potential complications. Although ET via the areola approach (ETAA) has been used, the factors influencing DV after ETAA remain poorly understood. Therefore, this study aimed to identify clinical parameters that can objectively evaluate the factors influencing drainage volume after ETAA. Methods: This retrospective cohort study enrolled consecutive patients with thyroid disease who underwent ETAA at The First Affiliated Hospital of Jinan University between February and September 2016. After adjusting for potential confounders, univariate and ordinal logistic regression analyses determined the association between DV and clinical variables. Results: We identified hyperthyroidism, operation time, and male gender as independent risk factors for increased DV. Specifically, hyperthyroidism was linked to higher DV across the first and second 24-hour periods [odds ratio (OR) =2.97, P=0.049], while longer operation times and male gender also significantly influenced DV (<= 100 min: OR =0.11, P=0.02; >100, <= 150 min: OR =0.39, P=0.049; male gender OR =0.23, P=0.02). Notably, high DV in the second 24 hours predicted even higher DV in the third 24 hours (<30 mL: OR =0.04, P<0.001; 30-60 mL: OR =0.22, P=0.01). These findings suggest that patients with these risk factors should be closely monitored during ETAA, and postponing drain removal in patients with large DV in the early postoperative period may be warranted. Conclusions: This study enhances our understanding of the factors affecting DV after ETAA and highlights the need for tailored postoperative care strategies.

There is a lack of evidence for treatment of some conditions including complication management, suboptimal initial weight loss, recurrent weight gain, or worsening of a significant obesity complication after one anastomosis gastric bypass (OAGB). This study was designed to respond to the existing lack of agreement and to provide a valuable resource for clinicians by employing an expert-modified Delphi consensus method. Forty-eight recognized bariatric surgeons from 28 countries participated in the modified Delphi consensus to vote on 64 statements in two rounds. An agreement/disagreement among ≥ 70.0

Rationale and Objectives: Although low muscle mass is associated with decreased lung function, studies exploring the relationship between muscle fat content and lung function impairment are scarce. This study aimed to evaluate the association of muscle mass and fatty infiltration with lung function in young adults with obesity. Materials and Methods: We performed a retrospective cross-sectional study of patients aged 18-45 years with obesity who had impaired pulmonary function (case group, n = 66) and those with normal pulmonary function (control group, n = 198) by matching age, sex, body mass index (BMI), and height to assess whether muscle characteristics differed. Muscle mass and muscle fat content were assessed by MRI using a chemical shift-encoded sequence (IDEAL-IQ). Results: A total of 264 patients were enrolled (124 females; mean age 32.0 years). The case group had lower muscle mass than the control group (p = 0.012), and there was an association between low muscle mass and lung function impairment (odds ratio (OR), 3.74; 95% con-fidence interval (CI), 1.57-8.93). Furthermore, muscle fat content was significantly higher in cases compared to controls (7.4 (2.7) % vs. 6.2 (2.5) %, p = 0.001). Multiple logistic regression analysis showed that muscle fat content was associated with a higher risk of impaired lung function (OR, 2.10; 95% CI, 1.65-2.66), regardless of adiposity and muscle mass. Conclusion: Both muscle fat content and muscle mass are associated with impaired lung function in young adults with obesity.

Metabolic and bariatric surgery (MBS) is widely considered the most effective option for treating obesity, a chronic, relapsing, and progressive disease. Recently, the American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) issued new guidelines on the indications for MBS, which have superseded the previous 1991 National Institutes of Health guidelines. The aim of this study is to establish the first set of consensus guidelines for selecting procedures in Class I and II obesity, using an Expert Modified Delphi Method. In this study, 78 experienced bariatric surgeons from 32 countries participated in a two-round Modified Delphi consensus voting process. The threshold for consensus was set at an agreement or disagreement of ≥ 70.0% among the experts. The experts reached a consensus on 54 statements. The committee of experts reached a consensus that MBS is a cost-effective treatment option for Class II obesity and for patients with Class I obesity who have not achieved significant weight loss through non-surgical methods. MBS was also considered suitable for patients with Type 2 diabetes mellitus (T2DM) and a body mass index (BMI) of 30 kg/m 2 or higher. The committee identified intra-gastric balloon (IGB) as a treatment option for patients with class I obesity and endoscopic sleeve gastroplasty (ESG) as an option for patients with class I and II obesity, as well as for patients with T2DM and a BMI of ≥ 30 kg/m 2 . Sleeve gastrectomy (1) and Roux-en-Y gastric bypass (RYGB) were also recognized as viable treatment options for these patient groups. The committee also agreed that one anastomosis gastric bypass (OAGB) is a suitable option for patients with Class II obesity and T2DM, regardless of the presence or severity of obesity-related medical problems. The recommendations for selecting procedures in Class I and II obesity, developed through an Expert Modified Delphi Consensus, suggest that the use of standard primary bariatric endoscopic (IGB, ESG) and surgical procedures (SG, RYGB, OAGB) are acceptable in these patient groups, as consensus was reached regarding these procedures. However, randomized controlled trials are still needed in Class I and II Obesity to identify the best treatment approach for these patients in the future.

Obesity is primarily caused by excessive intake as well as absorption of sugar and lipid. Postprandial surge in distention pressure and intestinal motility accelerates the absorption of nutrients. The response of intestinal epithelial cells to mechanical stimulation is not fully understood. Piezo1, a mechanosensitive ion channel, is widely expressed throughout the digestive tract. However, its function in intestinal nutrient absorption is not yet clear. In our study, excessive lipid deposition was observed in the duodenum of obese patients, while duodenal Piezo1–CaMKK2–AMPKα was decreased when compared to normal-weight individuals. Under high-fat diet condition, the Piezo1iKO mice exhibited abnormally elevated sugar and lipid absorption as well as severe lipid deposition in the duodenum and liver. These phenotypes were mainly caused by the inhibition of duodenal CaMKK2–AMPKα and the upregulation of SGLT1 and DGAT2. In contrast, Yoda1, a Piezo1 agonist, was found to reduce intestinal lipid absorption in diet induced obese mice. Overexpression of Piezo1, stretch and Yoda1 inhibited lipid accumulation and the expression of DGAT2 and SGLT1, whereas knockdown of Piezo1 stimulated lipid accumulation and DGAT2 in Caco-2 cells. Our study reveals a previously unexplored mechanical regulation of nutrient absorption in intestinal epithelial cells, which may shed new light on the therapy of obesity.

BACKGROUND:Many studies have covered the prevalence of obesity in different populations. However, studies on the prevalence and predictors of obesity among medical staff are lacking. The aim of our study is to investigate the prevalence of obesity among medical staff and to identify the related predictors. METHODS:Using a snowballing recruitment strategy in the form of an electronic questionnaire, a cross-sectional survey was conducted among 1201 medical staff from cooperative hospitals between January and March 2022. We designed a questionnaire to investigate the participants' demographic, lifestyle, diet, physical activity, and work status. RESULTS:The overall prevalence of obesity was 8.5%, with males (13.7%) having a greater incidence than females (5.7%) (p < 0.001). Multiple logistic regression analyses showed that alcohol drinking (OR, 2.34; 95% CI 1.23-4.42, p = 0.01), sugar-sweetened beverages consumed > 3/week (OR, 2.50; 95% CI 1.02-6.15, p = 0.046), and working a night shift > 1/week (OR, 2.17; 95% CI 1.02-4.61, p = 0.043) were independent predictive factors for obesity in men. For women, having midnight snack having midnight snack (OR, 2.93;95% CI 1.24-6.96, p = 0.015), good sleep quality (OR, 4.47; 95% CI 1.10-21.70, p = 0.038), and working a night shift > 1/week (OR, 3.62; 95% CI 1.73-7.57, p = 0.001) were independently associated with obesity. CONCLUSIONS:Obesity presented a low prevalence among medical staff. Alcohol drinking, drinking sugar-sweetened beverages > 3/week, and night shift > 1/week predicted a higher risk of obesity in males. In females, having midnight snack, good sleep quality, and night shift > 1/week were independently associated with obesity. LEVEL OF EVIDENCE:V, descriptive study.

Gut microbiota is linked to human metabolic diseases. The previous work showed that leucine deprivation improved metabolic dysfunction, but whether leucine deprivation alters certain specific species of bacterium that brings these benefits remains unclear. Here, this work finds that leucine deprivation alters gut microbiota composition, which is sufficient and necessary for the metabolic improvements induced by leucine deprivation. Among all the affected bacteria, B. coccoides is markedly increased in the feces of leucine-deprived mice. Moreover, gavage with B. coccoides improves insulin sensitivity and reduces body fat in high-fat diet (HFD) mice, and singly colonization of B. coccoides increases insulin sensitivity in gnotobiotic mice. The effects of B. coccoides are mediated by metabolizing tryptophan into indole-3-acetic acid (I3AA) that activates the aryl hydrocarbon receptor (AhR) in the liver. Finally, this work reveals that reduced fecal B. coccoides and I3AA levels are associated with the clinical metabolic syndrome. These findings suggest that B. coccoides is a newly identified bacterium increased by leucine deprivation, which improves metabolic disorders via metabolizing tryptophan into I3AA.

Changes in microRNAs (miRNAs) are relevant to bariatric surgery and its comorbidities. The characteristics of changes in miRNAs of the early postoperative period following both bariatric procedures, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), as well as the factors that related to the effectiveness of early weight loss remain unclear. We recruited 18 patients who performed SG and 15 patients who performed RYGB. Their preoperative and 1-month postoperative clinical data and fasting serum samples were collected, and the latter were analyzed by RNA-sequencing. Differential expression analysis of miRNAs was performed by the R-tool. Functional classification annotation and pathway enrichment analysis of targeted genes were analyzed by KOBAS software. The change profiles of miRNAs for both surgeries and their correlation with clinical characteristics and weight loss effectiveness were further analyzed. A total of 85 differentially expressed miRNAs were identified before and after SG, while a total of 76 were found before and after RYGB. The target genes of these miRNAs were similar in the Gene Ontology enrichment analysis in SG and RYGB, and the enrichment analysis in the Kyoto Encyclopedia of Genes and Genomes was mainly related to metabolic pathways. Hsa-miR-493-5p, hsa-miR-184, and hsa-miR-3199 exhibited similar changes in SG and RYGB, and the former two were correlated with clinical characteristics. Hsa-miR-6729-5p, hsa-miR-4659b-5p, and hsa-miR-2277-5p were correlated with the weight loss effectiveness of SG, while hsa-miR-4662a-5p was correlated with the weight loss effectiveness of RYGB. Short-term metabolic improvement and weight loss occurring after SG and RYGB surgery might be related to changes in miRNAs, which act on multiple biological pathways by regulating genes. In addition, some clinical characteristics and miRNAs were related to the effectiveness of early weight loss after SG and RYGB surgery. ChiCTR2200058333.

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.

This study aimed to evaluate the efficacy and safety of duodenal-jejunal bypass liner (DJBL) for obesity and type 2 diabetes mellitus. A comprehensive search of electronic databases was conducted up to September 15, 2022. Thirty studies involving 1751 patients were included. At 12 months post-implantation, the reduction in body mass index (BMI) was 4.8 kg/m2 (95% CI 4.1, 5.5), with an excess weight loss of 41.3% (95% CI 33.4%,49.2%) and a total weight loss of 13.1% (95% CI 10.1%, 16.0%). Significant decrease was observed in HbA1c and fasting glucose, with a standardized mean difference of - 0.72 (95% CI - 0.95, - 0.48) and - 0.62 (95% CI - 0.82, - 0.42), respectively. However, these improvements in weight loss and glycemic control were only partially sustained after explantation. In situ, DJBL significantly improves blood pressure and lipid levels. The pooled early removal rate was 19%, and the incidence of severe adverse events was 17%, including device migration (6%), gastrointestinal hemorrhage (4%), device obstruction (4%), and hepatic abscess (2%). DJBL offers significant improvement in weight loss and glycemic control, as well as cardiovascular parameters while in situ. Further studies are warranted to better understand the long-term efficacy and safety of DJBL. The benefits of DJBL need to be carefully weighed against the risks in clinical decision-making.

Background:Since boosting stem cell resilience in stressful environments is critical for the therapeutic efficacy of stem cell-based transplantations in liver disease, this study aimed to establish the efficacy of a transient plasmid-based preconditioning strategy for boosting the capability of mesenchymal stromal cells (MSCs) for anti-inflammation/antioxidant defenses and paracrine actions in recipient hepatocytes.Methods:Human adipose mesenchymal stem cells (hADMSCs) were subjected to transfer, either with or without the nuclear factor erythroid 2-related factor 2 (Nrf2)/Dickkopf1 (DKK1) genes, followed by exposure to TNF-α/H2O2. Mouse models were subjected to acute chronic liver failure (ACLF) and subsequently injected with either transfected or untransfected MSCs. These hADMSCs and ACLF mouse models were used to investigate the interaction between Nrf2/DKK1 and the hepatocyte receptor cytoskeleton-associated protein 4 (CKAP4).Results:Activation of Nrf2 and DKK1 enhanced the anti-stress capacity of MSCs in vitro. In a murine model of ACLF, transient co-overexpression of Nrf2 and DKK1 via plasmid transfection improved MSC resilience against inflammatory and oxidative assaults, boosted MSC transplantation efficacy, and promoted recipient liver regeneration due to a shift from the activation of the anti-regenerative IFN-γ/STAT1 pathway to the pro-regenerative IL-6/STAT3 pathway in the liver. Importantly, the therapeutic benefits of MSC transplantation were nullified when the receptor CKAP4, which interacts with DKK1, was specifically removed from recipient hepatocytes. However, the removal of the another receptor low-density lipoprotein receptor-related protein 6 (LRP6) had no impact on the effectiveness of MSC transplantation. Moreover, in long-term observations, no tumorigenicity was detected in mice following transplantation of transiently preconditioned MSCs.Conclusions:Co-stimulation with Nrf2/DKK1 safely improved the efficacy of human MSC-based therapies in murine models of ACLF through CKAP4-dependent paracrine mechanisms.

Objective: The aim of this study was to evaluate the influence of transoral endoscopic thyroidectomy vestibular approach (TOETVA) on voice changes and swallowing function disorders.Materials and Methods: We retrospectively reviewed 215 patients who underwent thyroid surgery with TOETVA (105 cases, endoscopic group) and open approach (110 cases, open group). Major outcomes, the changes in voice and swallowing function in the 2 groups of patients before and after surgery were analyzed by using both subjective and objective evaluation indexes. Subjective evaluation indexes included the Voice Handicap Index, voice GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) classification, and swallowing impairment score; the objective indicators included the fundamental frequency (F0), fundamental frequency perturbation (jitter), amplitude perturbation (shimmer), and maximum phonation time.Results: In terms of subjective evaluation indexes, there were no significant differences (all P>0.05) between the groups regarding Voice Handicap Index (1 and 3 mo after surgery) and GRBAS (1 and 3 mo after surgery). The incidence rates of swallowing disorder in the endoscopic group were higher than that in the open group according to the outcomes of swallowing impairment score at 1 and 3 months after surgery (both P<0.05). In addition, no significant changes in terms of jitter, shimmer, and maximum phonation time in both groups of patients at 1 and 3 months after surgery compared with their preoperative values (all P>0.05).Conclusions: Voice and swallowing disorders may occur in some patients, either TOETVA or open thyroid surgery, which in most cases will recover within 3 months after surgery. The time to swallowing function recovery is relatively prolonged in patients following TOETVA, which may be probably associated with neck adhesion and fixation after the operation.