Aim: To explore the relationship between metabolic biomarkers and cardiac remodeling indices derived from cardiac magnetic resonance (CMR) in obese adults, focusing on the role of insulin (INS) resistance and lipotoxicity in early cardiac changes. Methods: A total of 107 obese adults undergoing preoperative metabolic evaluation were included. CMR was used to assess left ventricular (LV) structure and function. Metabolic biomarkers, including INS, free fatty acids (FFAs), triglycerides (TG), and glycated hemoglobin (HbA1c), were measured. Correlation and multivariable regression analyses were performed to examine associations between biomarkers and CMR-derived cardiac parameters. Logistic regression with receiver operating characteristic (ROC) analysis identified predictors of left ventricular hypertrophy (LVH). Results: In this cohort of obese adults without overt hyperglycemia and with preserved ejection fraction, higher body mass index (BMI) was associated with greater left ventricular mass (LVM), volumes, and cardiac output. In multivariable models, TG (adjusted for BMI) independently predicted LVM, while a combined INS + FFAs model was a strong predictor of LVH [area under the curve (AUC) = 0.757; sensitivity = 88.7%; specificity = 37.8%; P < 0.001]. Results remained consistent when LVM was indexed to height2.7. Conclusions: Metabolic biomarkers reflecting INS resistance and lipotoxicity are associated with early cardiac remodeling in obesity. TG captured the continuous burden of LVM, and the INS + FFAs model offered a practical metabolic prescreen for LVH risk, supporting early cardiovascular risk stratification in obese population.

Obstructive sleep apnea (OSA) is a common sleep disorder characterized by intermittent hypoxia (IH) and is associated with the occurrence and development of nonalcoholic fatty liver disease (NAFLD). However, the specific mechanism by which OSA induces NAFLD remains unclear. Therefore, effective interventions are lacking. This study aims to investigate the role and mechanism of ferroptosis in OSA-related NAFLD using clinical data analyses, cell-based molecular experiments, and animal experiments. Indicators of liver function, lipid accumulation, and ferroptosis are also examined. RNA-seq, qPCR, western blotting, gene intervention, and E3 ligase prediction using UbiBrowser and co-IP are used to explore the potential underlying mechanisms. The results show that ferroptosis increases in the liver tissues of patients with OSA. Chronic IH promotes NAFLD progression in mice and is alleviated by a ferroptosis inhibitor Fer-1. The increased secretion of IL6 by macrophages can promote the expression of MARCH3 in hepatocytes under intermittent conditions, and subsequently promote the ubiquitination and degradation of GPX4 to regulate ferroptosis and lipid accumulation in hepatocytes. Hence, targeted inhibition of MARCH3 may alleviate IH-induced ferroptosis and lipid accumulation in liver tissues and inhibit the progression of NAFLD.

Abstract Background Obesity is a growing health concern in China, closely linked to metabolic disorders such as type 2 diabetes. Laparoscopic Sleeve Gastrectomy (LSG) is effective in promoting weight loss and improving metabolic outcomes. Emerging evidence highlights the role of gut microbiota in metabolic regulation, yet the specific alterations in gut microbiota and their association with metabolic changes post-surgery in Chinese patients remain unclear. Understanding these shifts could provide key insights into optimizing treatment strategies for metabolic improvement following bariatric surgery. Methods Stool samples and clinical data were collected from 30 obese patients before and 6 months after surgery. The composition of the gut microbiota was analyzed through 16S rRNA sequencing, and Spearman correlation analysis was used to determine the association between gut microbiota and clinical indicators. Results The analysis of 30 patients showed a significant decrease in Body Mass Index (BMI) (36.75 ± 4.09 kg/m2 vs 26.37 ± 3.47 kg/m2, p < 0.0001). Glucose metabolism, including Hemoglobin A1C levels, improved significantly (6.05 ± 0.96 vs 5.05 ± 0.25, p < 0.0001), and liver function as well as serum lipid levels were also notably improved. LSG increased the richness and composition of gut microbiota in obese patients post-surgery. These changes in gut microbiota were closely associated with improved clinical metabolic parameters. Conclusion LSG not only significantly reduces body weight while also alleviating metabolic syndrome and comorbidities by altering gut microbiota.

目的 探讨腹腔镜胃袖状切除术(laparoscopic sleeve gastrectomy,LSG)对青少年(14～21岁)肥胖人群的短期疗效及影响.方法 回顾性分析武汉大学中南医院肥胖症与代谢病外科中心于2018年5月至2023年7月期间接受LSG的77例中有随访资料的32例青少年单纯性肥胖或肥胖合并代谢疾病病人的临床资料,分析减重代谢手术对于体重改变、糖代谢、脂代谢、肝功能的影响,以及并发症的情况.结果 所有病人均顺利完成腹腔镜手术,无中转开腹及感染、出血、胃漏等术后并发症.术后随访3个月至1年,以下指标均较术前得到明显改善(均P＜0.05):体重[术前(111.7±19.6)kg,术后 1 年(74.3±17.9)kg],体重指数[术前(38.4±5.7)kg/m2,术后 1 年(26.1 ±5.3)kg/m2],血糖,血脂,尿酸[术前(502.6±105.2)μmol/L,术后 6 个月(388.7±8.2)μmol/L],肝功能等.结论 LSG对治疗青少年肥胖病人的肥胖及代谢性疾病安全有效,短期获益明显,可有效缓解肥胖并发症,多学科团队是确保减重代谢手术安全和术后高效随访的前提.

Both obesity and obstructive sleep apnea (OSA) can lead to metabolic dysregulation and systemic inflammation. Similar to obesity, increasing evidence has revealed that immune infiltration in the visceral adipose tissue (VAT) is associated with obstructive sleep apnea-related morbidity. However, the pathological changes and potential molecular mechanisms in visceral adipose tissue of obstructive sleep apnea patients need to be further studied. Herein, by bioinformatics analysis and clinical validation methods, including the immune-related differentially expressed genes (IRDEGs) analysis, protein-protein interaction network (PPI), functional enrichment analysis, a devolution algorithm (CIBERSORT), spearman's correlation analysis, polymerase chain reaction (PCR), Enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry (IHC), we identified and validated 10 hub IRDEGs, the relative mRNA expression of four hub genes (CRP, CD40LG, CCL20, and GZMB), and the protein expression level of two hub genes (CD40LG and GZMB) were consistent with the bioinformatics analysis results. Immune infiltration results further revealed that obstructive sleep apnea patients contained a higher proportion of pro-inflammatory M1 macrophages and a lower proportion of M2 macrophages. Spearman's correlation analysis showed that CD40LG was positively correlated with M1 macrophages and GZMB was negatively correlated with M2 macrophages. CD40LG and GZMB might play a vital role in the visceral adipose tissue homeostasis of obstructive sleep apnea patients. Their interaction with macrophages and involved pathways not only provides new insights for understanding molecular mechanisms but also be of great significance in discovering novel small molecules or other promising candidates as immunotherapies of OSA-associated metabolic complications.

The enhanced response of glucagon and its Drosophila homolog, adipokinetic hormone (Akh), leads to high-caloric-diet-induced hyperglycemia across species. While previous studies have characterized regulatory components transducing linear Akh signaling promoting carbohydrate production, the spatial elucidation of Akh action at the organelle level still remains largely unclear. In this study, we find that Akh phosphorylates extracellular signal-regulated kinase (ERK) and translocates it to peroxisome via calcium/calmodulin-dependent protein kinase II (CaMKII) cascade to increase carbohydrate production in the fat body, leading to hyperglycemia. The mechanisms include that ERK mediates fat body peroxisomal conversion of amino acids into carbohydrates for gluconeogenesis in response to Akh. Importantly, Akh receptor (AkhR) or ERK deficiency, importin-associated ERK retention from peroxisome, or peroxisome inactivation in the fat body sufficiently alleviates high-sugar-diet-induced hyperglycemia. We also observe mammalian glucagon-induced hepatic ERK peroxisomal translocation in diabetic subjects. Therefore, our results conclude that the Akh/glucagon-peroxisomal-ERK axis is a key spatial regulator of glycemic control.

目的 探讨腹腔镜胃袖状切除术(laparoscopic sleeve gastrectomy,LSG)对肥胖及其合并代谢性疾病的疗效.方法 回顾性分析武汉大学中南医院肥胖症与代谢病外科中心于2017年8月至2021年3月期间接受LSG的439例单纯性肥胖或肥胖合并代谢性疾病病人的临床资料.分析手术对体重改变、多余体重减少百分比(percent excess weight loss,％EWL)、糖脂代谢和肝功能的影响.结果 所有病人均顺利完成腹腔镜手术,无中转开腹.术后1、3、12、24、36个月时％EWL分别为(45.00±36.84)％、(72.17±28.25)％、(109.82±43.27)％、(101.62±34.35)％、(93.77±33.22)％.随访最长时间为36个月,未出现严重后遗症.术后1、3、12、24、36个月肥胖合并代谢异常如血糖、血脂、尿酸、丙氨酸转氨酶、天冬氨酸转氨酶等生化指标得到明显改善(P<0.05).结论 LSG对肥胖症病人减重效果确切、安全,并且对肥胖相关代谢性疾病有显著的疗效.

目的 探讨基于加速术后康复(enhanced recovery after surgery,ERAS)理念的清单管理模式在减重代谢外科手术病人围手术期管理中的效果.方法 以在武汉大学中南医院肥胖症与代谢病外科中心进行减重代谢手术的132例病人为研究对象,其中2021年1-2月进行手术的病人为对照组(67例),2021年11-12月进行手术的病人为干预组(65例),对照组采用常规减重代谢手术病人围手术期管理模式,干预组采取基于ERAS理念的清单管理模式,分为术前、术中、术后与出院几个环节.评价两组病人围手术期快速康复效果、焦虑情况、减重代谢术后专业知识的知晓率、病人及医务人员对减重代谢围手术期管理的满意度.结果 与对照组比较,干预组病人快速康复效果更明显,对照组和干预组住院时间分别为(9.57±1.88)d和(8.12±1.72)d,术后首次肛门排气时间分别为(2.05±0.22)d和(1.91±0.35)d,首次下床活动时间分别为(0.61±0.12)d和(0.54±0.20)d,差异均有统计学意义(均P<0.05).相比于对照组,干预组病人在出院时焦虑情况下降更明显,对减重代谢术后专业知识的知晓率更高,同时病人及医务人员对减重代谢围手术期管理的满意度也明显上升,差异均有统计学意义(均P<0.05).结论 将基于ERAS理念的清单式管理模式应用于减重代谢外科手术病人的围手术期管理,能够有效促进病人快速康复,减轻病人焦虑情绪和住院时间,提高医疗工作效率和病人就医体验.

Introduction: Dysregulation of iron metabolism is closely associated with the development of obesity and obstructive sleep apnea (OSA), but little is known about the relationship between serum transferrin (TF) level and OSA severity. We aimed to verify this relationship and fit into account for obesity-related confounders among bariatric candidates. Methods: We compared data retrospectively collected in 270 bariatric candidates. A propensity score-matched (PSM) analysis was used to determine the impact of iron metabolism on OSA severity independently of obesity. Univariate analysis was used to evaluate the relationship between serum TF level and the severity of OSA reflected by hypoxia and night awakenings parameters. Serum TF level to predict the severity of OSA was assessed by using univariate and multiple logistic regression model. Results: The preliminary analysis showed that serum ferritin (113 ng/mL [50–203] vs. 79 ng/mL [40–130], p = 0.009) and TF (2.72 g/L [2.46–3.09] vs. 2.65 g/L [2.34–2.93], p = 0.039) level was significantly higher in the moderate/severe OSA group than the no/mild OSA group. After PSM analysis, there were 75 patients in each group and only serum TF level remained significant (p = 0.014). The proportion of patients with combined T2D and hyperlipidemia also remained higher in moderate/severe OSA groups. Univariate analysis showed that the group with higher degree of hypoxia had higher serum TF levels no matter the severity of OSA was grouped by oxygen desaturation index (ODI; 2.79 g/L [2.56–3.06] vs. 2.55 g/L [2.22–2.84], p < 0.001) or minimum oxygen saturation (SpO2nadir; 2.75 g/L [2.50–3.03] vs. 2.56 g/L [2.24–2.92], p = 0.009). Univariate and multiple logistic regression analysis further showed that serum TF level emerged as a significant and independent factor associated with OSA severity especially grouped by ODI (odds ratio: 2.91, 95% CI: 1.36–6.23, p = 0.006). Conclusion: The existence of OSA exacerbates obesity comorbidities, particularly type 2 diabetes and hyperlipidemia. Serum TF level is associated with the severity of OSA independently of obesity and might be a potential identification and therapeutic targets.

目的 探索数字健康管理对袖状胃切除术后患者饮食模式和健康行为方式依从性、自我效能的影响.方法 采用类试验设计,研究组(32例)和对照组(33例)患者分别来自两个独立的减重中心.研究组给予数字健康管理,对照组按常规体重自我管理,分别随访1年,观察患者饮食模式和健康行为方式依从性、自我效能差异.结果 研究组袖状胃切除术后,患者的饮食模式和总体健康行为方式依从性均明显优于对照组;研究组患者的一般自我效能感相较于对照组也明显提高,差异具有统计学意义(P<0.05).结论 数字健康管理模式可提高袖状胃切除患者术后饮食模式和健康行为方式依从性,对保证手术安全和疗效,预防体重反弹有积极作用.

BACKGROUND & AIMS:Lactate has recently been reported to accumulate in the livers of patients progressing from simple steatosis to non-alcoholic steatohepatitis (NASH). However, the underlying mechanism(s) of lactate accumulation and the role of lactate in the progression of non-alcoholic fatty liver disease (NAFLD) are essentially unknown. METHODS:We compared the acetylome in liver samples taken from healthy individuals, patients with simple steatosis and patients with NASH to identify potential targets of acetylation with a role in lactate metabolism. Interactions between the acetylated target and acetyltransferases were measured in multiple cell lines. An acetyltransferase inhibitor was injected into high-fat diet (HFD)-fed mice to determine the role of lactate on NAFLD progression in vivo. RESULTS:Hyperacetylation of lactate dehydrogenase B (LDHB) was found to be associated with lactate accumulation in NAFL and NASH livers in humans and mice. P300/CBP-associated factor (PCAF)-mediated acetylation of LDHB K82 was found to significantly decrease LDHB activity and impair hepatic lactate clearance, resulting in lactate accumulation. Acetylated LDHB induced lactate accumulation which exacerbated lipid deposition and inflammatory responses by activating histone hyperacetylation in HFD-induced NASH. The administration of embelin, a PCAF inhibitor, and the generation of an acetylation-deficient mutant of LDHB ameliorated NASH. CONCLUSION:PCAF-dependent LDHB acetylation plays a key role in hepatic lipid accumulation and inflammatory responses by impairing lactate clearance; this process might be a potential therapeutic target for the treatment of NASH. LAY SUMMARY:Lactate is known to accumulate in the livers of patients during the progression of non-alcoholic fatty liver disease (NAFLD); however, the underlying mechanism(s) of this accumulation and its importance in disease progression are unknown. Herein, we show that the acetylation of an enzyme involved in lactate metabolism leads to impaired lactate clearance and exacerbates NAFLD progression.

Casein kinase 2 (CK2) has become a potential therapeutic target in gastric cancer; however, the underlying mechanism remains incompletely understood. TAp73, a structural homolog of the tumor suppressor p53, acts as a critical regulator of the Warburg effect. Recent study reveals that aberrant CK2 signaling is able to inhibit TAp73 function. Here we determine that TAp73 is overexpressed in AGS-1 but not in SNU-5 gastric cancer cell line as compared with normal gastric cells. In addition, we show that TAp73 expression is required for the maintenance of glucose uptake and lactate release in AGS-1 but not in SNU-5 gastric cancer cells. Importantly, the use of CX-4945, a selective inhibitor of protein kinase CK2, inhibits cell growth and invasion, and promotes cell apoptosis in AGS-1 with decreased TAp73 expression as well as downregulated glucose uptake and lactate release. Although TAp73 knockdown resulted in significant decreases in TAp73 expressions in SNU-5 cell line, no differences in glucose uptake and lactate release were observed between SNU-5 and normal gastric cells. Moreover, TAp73 gene overexpression promotes glucose uptake and lactate release and abolishes the anti-cancer effects of CX-4945 in gastric cancer cell line AGS-1. The impacts of CX-4945 on glycolysis and tumorigenesis were strongly limited in SNU-5 gastric cancer cell line. These findings suggest that CX-4945 elicits an anti-Warburg effects in gastric cancer overexpressing Tap73 and inhibits gastric tumorigenesis.

目的 探讨腹腔镜与开腹手术治疗糖尿病并发急性化脓性阑尾炎患者的临床效果及可行性.方法 选取自2014年7月至2017年7月收治的200例糖尿病并发急性化脓性阑尾炎患者为研究对象.将所有患者随机均分为A组和B组,每组各100例.A组行开腹手术治疗,B组行腹腔镜阑尾切除术(LA)治疗,比较两组患者的治疗疗效及手术安全性.结果 B组患者的手术时间为(38.6±9.8)min,显著低于A组的(51.9±10.6)min,两组间比较,差异有统计学意义(P<0.05);B组患者的切口长度明显短于A组(P<0.05),B组患者的术中出血量肛门排气时间、住院时间、术后止痛次数均低于A组,两组间比较,差异均有统计学意义(P<0.05).结论 腹腔镜治疗糖尿病并发急性化脓性阑尾炎的治疗疗效明显优于开腹手术,可有效缩短手术时间,术后恢复快,且术后并发症的发生率更低.

Objective To explore the application value of three-dimensional (3D) visualization combined with intraoperative indocyanine green (ICG) fluorescence imaging in laparoscopic hepatectomy for primary liver cancer (PLC). Methods Clinical data of 51 patients with PLC who underwent laparoscopic hepatectomy using 3D visualization combined with intraoperative ICG fluorescence imaging in Zhongnan Hospital of Wuhan University from June 2017 to June 2018 were retrospectively analyzed. Among them, 24 patients were male and 27 female, aged (57±15) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. 3D reconstruction of the liver was performed by 3D visualization before operation to clarify the anatomy of hepatic vascular system and its relationship with the tumors. The resection line was determined with intraoperative ICG fluorescence imaging and color Doppler ultrasound and precise hepatectomy was performed subsequently. The operation time, intraoperative blood loss, incidence of complications and perioperative mortality were observed. Results All 51 patients underwent laparoscopic hepatectomy successfully. No patient was transferred to open surgery. The operation time was (260±150) min, the intraoperative blood loss was (196±104) ml, and the postoperative length of hospital stay was (9±3) d. No postoperative liver failure or perioperative death occurred. Postoperative complications occurred in 5 cases, all of which were Clavien-Dindo grade II. All patients were cured and discharged after receiving conservative treatments. During the postoperative follow-up, recurrence or metastasis of liver cancer occurred in 4 patients. Conclusions 3D visualization combined with ICG fluorescence imaging can display the relationship between the liver cancer and hepatic vascular structure clearly, and accurately predict the range of liver resection and improve the safety of laparoscopic hepatectomy. Key words: Laparoscopes; Hepatectomy; Carcinoma, hepatocellular; Imaging, three-dimensional; Indocyanine green; Fluorescence imaging

目的 分析腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)治疗肥胖合并非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)病人的短期临床疗效.方法 回顾性分析2017年8月至2018年12月在武汉大学中南医院肝胆胰外科收治的行LSG的60例肥胖合并NAFLD病人的临床资料,术后随访3～6个月,评估术后体重 、糖脂代谢 、肝功能指标的变化,并采用无创性肝脏瞬时弹性超声(FibroTouch)测定肝脏的硬度值(liver stiffness measure,LSM)和脂肪受控衰减参数(fat controlled attenuation parameter,CAP).聚焦分析手术对胰岛素抵抗 、肝脏脂肪含量和肝纤维化情况的影响.结果 术前的体质量指数(body mass index,BMI)与LSM和CAP呈显著正相关(P<0.05),无创性肝纤维化指标与LSM和CAP呈显著正相关(P<0.05),胰岛素抵抗模型与CAP呈显著正相关(P<0.05).术后平均随访4个月(3.13～5.97个月):多余体重减少百分比为(73.2±12.6)％;BMI、空腹血糖 、糖化血红蛋白 、总胆固醇 、三酰甘油均显著降低(P<0.05);高密度脂蛋白胆固醇显著增加(P<0.05).转氨酶 、胰岛素抵抗模型 、无创性肝纤维化指标 、LSM和CAP显著降低(P<0.05).术前51.6％ 的病人进展期肝纤维化(F3以上),术后降为21.4％.术前所有病人均有脂肪肝,轻 、中 、重度脂肪肝分别占1.7％ 、8.3％ 、90.0％,术后25.0％ 病人恢复正常,轻 、中 、重度脂肪肝占比为14.3％ 、25.0％ 、35.7％.结论 LSG可有效治疗肥胖合并NAFLD,近期效果显著.

减重与代谢外科自20世纪50年代发源,至今经历了60多年的发展.当代最主流的术式为腹腔镜Roux-en-Y胃旁路术和腹腔镜袖状胃切除术.虽然《中国肥胖与2型糖尿病外科治疗指南(2014)》对减重术式有一定规范和量化了主要参数,但实际操作做到规范是对手术安全性和手术疗效的保障.不规范和不标准的减重手术会引起系列并发症和减重效果不佳 、复胖等一系列问题.

Objective To explore the effect of fish oil fat emulsion as perioperative nutritional support on patients with liver cirrhosis and portal hypertension.Methods Randomized controlled clinical trial was performed between September 2011 and September 2017 in patients with liver cirrhosis and portal hypertension who underwent pericardial devascularization and splenectomy.Hypocaloric total parenteral nutritional support (TPN) started from the first day after the operation for 5 consecutive days.Patients were divided into experimental group and control group according to thetype of fat emulsion used.43 patients in experimental group were applied for fish oil fat emulsion injection (10％ Omegaven) + medium long chain structure fat emulsion (20％STG) and 42 patients in control group were applied for medium long chain structure fat emulsion (20％STG).Liver function (total bilirubin and alanine aminotransferase),nutrition index (serum albumin and prealbumin),inflammatory mediators (TNF-α,IL-6 and IL-10) were measured before and after the operation,and the clinical outcomes were observed.Results There was no statistically significant difference in liver function and nutritional indices between the experimental group and the control group (P＞0.05).The inflammatory mediators like TNF-u,IL-6 and IL-10 on the first day after surgery were significantly higher than those before surgery in both groups [experiment group:(225.54±54.78) vs.(61.49±16.47),(74.94±6.36) vs.(39.84±2.77),(77.53±11.4) vs.(46.05±6.13) ng/L;control group:(229.26±62.15) vs.(63.48±13.76),(77.23±7.83)vs.(40.64±3.34),(73.89±7.97)vs.(44.88±5.72) ng/L;P＜ 0.01].With the progress of time,the proinflammatory factors like TNF-α and IL-6 decreased after the operation and the range of decrease was higher in experiment group than in control group [d4-d 1:(-56.88± 31.63) vs.(-35.96±20.02),(-13.52±5.20) vs.(-6.38±2.84) ng/L;d7-d1:(-150.67±42.58) vs.(-132.79±53.35),(-27.04±8.97) vs.(-20.85±6.38) ng/L;P＜ 0.05].The range of increase in anti-inflammatory media IL-10 was higher in experiment group than in the control group (d4-d1:(14.22±13.08) vs.(5.64±3.58) ng/L;d7-d1:(17.78±5.58) vs.(-37.96±11.43) ng/L;P＜0.05).The incidence of grade Ⅲ complications and total complications (4.7％ vs.21.4％,23.3％ vs.45.2％) and hospitalization time [(10.12 ±1.48) vs.(12.33±2.04) d] in the experimental group were significantly lower than those in the control group (P＜0.05).Conclusions In patients with liver cirrhosis and portal hypertension,perioperative nutritional support of fish oil fat emulsion can reduce systemic inflammatory response and operative complications and promote rapid recovery through its two-way regulation of inflammatory mediators.

Objective To explore the influence of enhanced recovery after surgery (ERAS) on oxidative stress in old patients after radical resection of colorectal cancer.Methods The clinical data of old patients (≥65 years) after radical resection of colorectal cancer from June 2014 to June 2016 were retrospectively analyzed.Seventy-one patients receiving ERAS served as case group,and 74 patients receiving traditional treatment as control group.Visual analogue score(VAS) score and oxidative stress were assessed in the two groups.Results The levels of malondialdehyde(MDA) [(20.05±2.81) nmol/mL] and reactive oxygen species(ROS) (5 536.8±717.3) in case group were significantly lower than those in control group [(25.36±3.02) nmol/mL and (6 925.1±826.7)] at 1st day after operation (P<0.05).The levels of MDA[(6.27±1.80) nmol/mL and ROS (3 185.4±414.6) in case group were significantly lower than those in control group [11.46±3.55] nmol/mL and (3 713.6±553.2)] at 2nd week after operation (P<0.05).The level of superoxide dismutase(SOD) in case group was (82.7±14.9) U/mL,significantly higher than in control group [(40.5±12.3) U/mL,P<0.05].The level of glutathione(GSH) in case group was (62.8±12.6) μg/mL,significantly higher than in control group [(36.0±10.2) μg/mL,P<0.05].The level of VitC in case group was (36.2±13.1) mg/L,significantly higher than in control group [(18.8±8.0) mg/L,P<0.05].The level of VitE in case group was (12.1±4.5) mg/L,significantly higher than in control group [(5.4±2.6) mg/L,P<0.05].VAS scores in case group were significantly lower than those in control groups in both resting state and motion state at 1st week and 2nd week after operation (P<0.05).The incidence of complications in case group was lower than in control group (P<0.05).Conclusions ERAS could reduce the states of oxidative stress and promote the recovery of the patients.

Objective To describe the clinical features of peliosis hepatics (PH).Methods With one case report and review of the related literatures,.the etiology,clinical manifestations,diagnosis,differential diagnosis,management and prognosis of PH were described.Results The etiology of PH remains unknown.Diagnose preoperatively is difficult for lack of specific clinical features,and PH is definitively diagnosed histologically.Surgical treatment may be one of the effective treatment methods.Conclusions PH is a rare liver benign disease which may be taken into consideration for nonspecific manifestations of liver lesions.