Formation Mechanisms, Interrelationships, and Effects of Cognitive Factors on Diet and Physical Activity During the Post-Bariatric Surgery Period: A Cross-Sectional Study Based on Compensatory Carry-Over Action Model.

Background: Diet and physical activity (PA) are pivotal behaviors for managing energy balance post-bariatric surgery. Given the need for dual behavioral management, understanding the interplay of cognitive factors influencing these behaviors is crucial. This study applied the compensatory carry-over action model (CCAM) to explore the impact of cognitive factors on behaviors and their subsequent effects on subjective health outcomes. Methods: This cross-sectional study was conducted among patients at the third month after bariatric surgery in China. Data on diet and PA status, behavioral cognitive factors (intention, self-efficacy, compensatory belief, transfer cognition), and subjective health outcomes (perceived stress, well-being, quality of life) were collected. Structural equation model (SEM) was employed to test hypotheses in CCAM and assess mediation relationships. Results: Analysis of data from 239 patients revealed the following: (1) Among antecedent cognitive factors, only compensatory belief significantly influenced diet (P<0.001). (2) Intention and self-efficacy directly correlated with their respective behaviors, while compensatory belief affected intention, and transfer cognition impacted self-efficacy (P<0.05), aligning with CCAM hypotheses. (3) PA demonstrated significant influence only on perceived stress (P=0.004), whereas diet significantly affected all subjective health outcomes (P<0.05). (4) Mediation analysis indicated intention partially mediated the relationship between compensatory belief and diet and fully mediated the relationship between compensatory belief and PA. Self-efficacy completely mediated the relationship between transfer cognition and diet and PA. Conclusion: Transfer cognition's carry-over effect did not directly influence behaviors among antecedent cognitions. Interventions should primarily target improving diet by mitigating compensatory belief. Moreover, diet exhibited a more pronounced impact on overall health compared to PA. Consequently, prioritizing dietary intervention over PA intervention is warranted based on the analysis of CCAM and the aim of promoting joint behaviors post-bariatric surgery.

The current status and challenges of perioperative management of patients with a BMI of greater than or equal to 50 kg/m 2 undergoing bariatric surgery in China: a multicenter cross-sectional study.

BACKGROUND: Performing bariatric surgery on patients with a BMI of over 50 kg/m 2 is challenging. This study aimed to explore the status and challenges related to the perioperative management of such patients in China. MATERIALS AND METHODS: A prospective survey was designed to investigate the perioperative management of patients with a BMI of greater than or equal to 50 kg/m 2 undergoing bariatric surgery in China. The questionnaire of our survey included general information, preoperative management measures, surgical procedures performed, technical details regarding anaesthesia, and postoperative management measures. A response from only one attending physician per bariatric centre was accepted. RESULTS: Physicians from a total of 101 hospitals responded to the questionnaire, and the questionnaire data from 98 hospitals were complete. These centres had completed a total of 44 702 bariatric surgeries since the launch of such surgery to December 2021. A total of 3280 patients had a BMI exceeding 50 kg/m 2 . The preferred surgical procedures for patients with super obesity were sleeve gastrectomy by 62 centres, Roux-en-Y gastric bypass by 11 centres, sleeve gastrectomy plus jejunojejunal bypass by 19 centres, one anastomosis gastric bypass by 1 centre, and duodenal switch by 1 centre. The most worrying issues were cardiopulmonary failure and difficulty in extubation. 91 centres believed that preoperative weight loss was beneficial. A low-calorie diet was the specific measure mainly implemented, only three centres considered using intragastric balloon placement. Postoperative management measures varied greatly. CONCLUSION: Bariatric surgery has seen rapid development. Chinese physicians show significant differences regarding the perioperative management for patients with a BMI of over 50 kg/m 2 . The perioperative risks of these patients remain relatively high, making further development of clinical pathways is necessary.

Absolute Quantification of Dynamic Cellular Uptake of Small Extracellular Vesicles via Lanthanide Element Labeling and ICP-MS.

Small extracellular vesicles (sEVs) are increasingly reported to play important roles in numerous physiological and pathological processes. Cellular uptake of sEVs is of great significance for functional regulation in recipient cells. Although various sEV quantification, labeling, and tracking methods have been reported, it is still highly challenging to quantify the absolute amount of cellular uptake of sEVs and correlate this information with phenotypic variations in the recipient cell. Therefore, we developed a novel strategy using lanthanide element labeling and inductively coupled plasma-mass spectrometry (ICP-MS) for the absolute and sensitive quantification of sEVs. This strategy utilizes the chelation interaction between Eu3+ and the phosphate groups on the sEV membrane for specific labeling. sEVs internalized by cells can then be quantified by ICP-MS using a previously established linear relationship between the europium content and the particle numbers. High Eu labeling efficiency and stability were demonstrated by various evaluations, and no structural or functional alterations in the sEVs were discovered after Eu labeling. Application of this method revealed that 4020 ± 171 sEV particles/cell were internalized by HeLa cells at 37 °C and 61% uptake inhibition at 4 °C. Further investigation led to the quantitative differential analysis of sEV cellular uptake under the treatment of several chemical endocytosis inhibitors. A 23% strong inhibition indicated that HeLa cells uptake sEVs mainly through the macropinocytosis pathway. This facile labeling and absolute quantification strategy of sEVs with ppb-level high sensitivity is expected to become a potential tool for studying the functions of sEVs in intracellular communication and cargo transportation.

Five-Year Physical and Psychosocial Outcomes in Obese Adolescents With and Without Metabolic Bariatric Surgery.

PURPOSE: Metabolic bariatric surgery (MBS) is increasingly accepted as a treatment for severely obese adolescents. However, its long-term efficacy and safety are not well characterized, particularly in the Eastern Asian population. We aimed to explore the long-term effects of MBS on Chinese adolescents with severe obesity. METHODS: A total of 44 obese adolescents (≤18 years old) underwent MBS at our institution from May 2011 to May 2017. A matched nonsurgical control group, including 43 patients, was recruited from lifestyle modification programs in the same period. All patients completed assessments at presurgery/baseline and five years after surgery. The data were collected and analyzed using the χ2 test and an independent sample t-test. RESULTS: Comparing the surgical and control groups revealed that the surgical patients showed significant weight loss and improvement in comorbidities, while the nonsurgical patients showed a trend of weight gain and increased comorbidities (p < .05). Furthermore, the surgical patients had a higher composite physical quality of life (as determined by the Short Form-36 questionnaire). On the other hand, the patients who underwent MBS had a higher risk of malnutrition. DISCUSSION: Compared with nonsurgical patients, severely obese adolescents who undergo MBS exhibit more effective long-term weight loss, remission of comorbidities, and improved quality of life. Furthermore, more attention should be paid to helping adolescents avoid malnutrition after they undergo MBS.

Functional Characterization of MC4R Variants in Chinese Morbid Obese Patients and Weight Loss after Bariatric Surgery.

Mutations in MC4R are the most common genetic cause of obesity. In the reported Chinese morbid obesity cohort, 10 out of 59 harbor six MC4R variants, including Y35C, T53I, V103I, R165W, G233S, and C277X, among which V103I has a relatively high frequency, while other five variants are rare in the population. The prevalence of MC4R carriers in Chinese morbid obese patients (body mass index ≥ 45 kg m-2 ) is detected as 16.9% in this study. R165W and C277X are loss-of-function variants. The patient with R165W achieves excess weight loss (%EWL) as high as 20.6% and 50.3% at 1 and 8 months after surgery, respectively. G233S is reported for the first time in Asia obese population. The patient harboring G233S has a %EWL as 23.3% one month postsurgery. It is concluded that morbid obese patients with rare MC4R variants can benefit from metabolic surgery. More importantly, the choice of surgery procedure and MC4R variant should be taken into consideration for personalized treatment. In the future, a larger size cohort, accompanied with regular and longer follow-up, would be helpful.

Tandem enrichment of serum exosomes and exosomal RNA with titanium dioxide.

Exosomes have great potential as biomarker carriers for disease diagnosis and prognosis. In recent years, exosomal RNA (exoRNA) has become a promising candidate for the early diagnosis and prognosis of cancers, and its pathophysiological roles in various diseases have been revealed. For example, exosome-derived mRNAs, miRNAs, circRNAs, and lncRNAs function as signalling molecules to regulate tumour growth, angiogenesis, invasion, metastasis, and the response to chemotherapy. However, the isolation of exosomes and exoRNA with high quality and purity remains challenging due to the relatively small size of exosomes and the limited amount of RNA in exosomes. In this work, we developed a novel tandem enrichment method to isolate exoRNA from serum based on the specific interaction between titanium dioxide (TiO2) and the phosphate groups on the lipid bilayer of exosomes and of the exoRNA. TiO2-based RNA isolation was first demonstrated and optimized in HeLa cells. A total of 130.9 ± 8.34 µg of RNA was rapidly enriched from approximately 5 × 106 HeLa cells within 10 min. This was a 41.5% higher yield than that using a commercial Ultrapure RNA Kit. TiO2-based tandem enrichment of exoRNA was then performed using human serum, obtaining 64.53±3.41 ng of exoRNA from 500 µL of human serum within 30 min. A total of 2,137,902 reads, including seven types of exoRNAs, were identified from the exosomes. This method is compatible with various downstream RNA processing techniques and does not use toxic or irritating reagents, such as phenol or chloroform, providing a simple, economical, rapid, and safe approach for exoRNA extraction from biological samples.

Determinants of Dietary Adherence Among Chinese Patients After Bariatric Surgery Based on the Attitude-Social Influence-Efficacy Model.

PURPOSE: To explore main determinants of dietary adherence among Chinese patients after bariatric surgery based on the Attitude-Social influence-Efficacy (ASE) model. METHODS: A cross-sectional survey was conducted by using convenience sampling method to select 288 participants in a tertiary hospital in Jiangsu, China. General information and disease-related information were collected as well as applying the Dietary Adherence Scale after Bariatric Surgery (DASBS) and Attitude-Social influence-Efficacy Questionnaire after Bariatric Surgery (ASEQBS). Univariate analysis, correlation analysis, and multivariate analysis were used to identify determinants of dietary adherence among patients after bariatric surgery. RESULTS: A total of 288 questionnaires were effectively collected. The mean DASBS score was 54.90 ± 10.08 among post-bariatric patients. Univariate analysis results showed that education level, time since surgery, smoking, exercise, participation in peer support groups, and participation in nutrition counseling had significant effects on postoperative diet adherence level of patients (P < 0.05). The correlation analysis results showed that the total score of dietary adherence was positively correlated with the total score of intention, attitude, social influence, and self-efficacy, and the correlation coefficients were 0.511, 0.550, 0.460, and 0.484, respectively (P < 0.05). The results of multiple linear regression analysis showed that time since surgery, attitude, intention, social influence, exercise, and self-efficacy entered the regression equation (P < 0.05). The standardized regression coefficients of attitude and intention are 0.237 and 0.196, respectively. The regression model could explain 44.0% of the total variation. CONCLUSION: The dietary adherence of Chinese post-bariatric patients is at an upper-middle level, which needs to be further improved. Time since surgery, exercise, intention, attitude, social influence, and self-efficacy had significant effects on patients' dietary adherence. Attitude had the greatest effect on dietary adherence, followed by intention. The results shed light on that these factors should be emphasized to take personalized intervention strategy in designing dietary intervention program, in order to improve the patient's dietary adherence and surgical outcomes.

Aging deteriorated liver Ischemia and reperfusion injury by suppressing Tribble's proteins 1 mediated macrophage polarization.

Aggravated liver injury has been reported in aged ischemia/reperfusion-stressed livers; however, the mechanism of aged macrophage inflammatory regulation is not well understood. Here, we found that the adaptor protein TRIB1 plays a critical role in the differentiation of macrophages and the inflammatory response in the liver after ischemia/reperfusion injury. In the present study, we determined that aging promoted macrophage-mediated liver injury and that inflammation was mainly responsible for lower M2 polarization in liver transplantation-exposed humans post I/R. Young and aged mice were subjected to hepatic I/R modeling and showed that aging aggravated liver injury and suppressed macrophage TRIB1 protein expression and anti-inflammatory function in I/R-stressed livers. Restoration of TRIB1 is mediated by lentiviral infection-induced macrophage anti-inflammatory M2 polarization and alleviated hepatic I/R injury. Moreover, TRIB1 overexpression in macrophages facilitates M2 polarization and anti-inflammation by activating MEK1-ERK1/2 signaling under IL-4 stimulation. Taken together, our results demonstrated that aging promoted hepatic I/R injury by suppressing TRIB1-mediated MEK1-induced macrophage M2 polarization and anti-inflammatory function.

Effects of a 12-Week Transtheoretical Model-Based Exercise Training Program in Chinese Postoperative Bariatric Patients: a Randomized Controlled Trial.

PURPOSE: This study aims to investigate the effectiveness of the transtheoretical model (TTM)-based exercise training on TTM variables, exercise adherence, and physical function in patients in the early stages after bariatric surgery (BS). MATERIALS AND METHODS: We conducted a single-blinded, prospective, randomized controlled trial (RCT) to evaluate the effects of TTM-based exercise training on BS patients immediately after surgery. Participants (n = 120) were randomized into a TTM-based exercise training group (n = 60) and a control group (n = 60). Main outcomes included TTM variables (measured by exercise stages of change (ESCs), exercise self-efficacy (ESE), and decisional balance), exercise adherence, and physical function (determined by the 6-min walk distance (6MWD)). Secondary outcomes were physical activity, anthropometrics, and body composition. We performed all analyses in accordance with the intention-to-treat principle. RESULTS: Retention rates for the interventions were 91.7% for the intervention group and 90.0% for the control group. Compared with the control group, the 12-week TTM-based intervention significantly helped participants advance through ESCs, demonstrate higher ESE, perceive more benefits and fewer barriers to exercise, and show higher exercise adherence and better physical function afterward (all P < 0.05). However, we observed no statistically significant difference between the two groups in anthropometric parameters or body composition after intervention. CONCLUSION: The TTM-based exercise intervention had significant positive effects on the TTM variables, which could further help increase patients' exercise adherence and physical function immediately after BS. TRIAL REGISTRATION: This study was retrospectively registered at the Chinese Clinical Trial Registry (website: www.chictr.org.cn , registry number: ChiCTR2000039319).

Survival outcomes in prostate cancer patients with a prior cancer.

BACKGROUND: To shed light on the survival outcomes of prostate cancer (PCa) patients diagnosed after a prior cancer and identify prognostic factors for overall survival (OS) and cancer-specific survival (CSS) in PCa patients. METHODS: In the primary group, a total of 1,778 PCa patients with a prior cancer were identified in the Surveillance, Epidemiology, and End Results (SEER) database from 2005 to 2015, retrospectively. Baseline characteristics and causes of death (COD) of these patients were collected and compared. In the second group, a total of 10,296 PCa patients [5,148 patients with PCa as the only malignancy and 5,148 patients with PCa as their second primary malignancy (SPM)] diagnosed between 2010 and 2011 were extracted to investigate the impact of prior cancers on survival outcomes. RESULTS: In PCa patients with a prior cancer, the most common type of prior cancer was from gastrointestinal system (29.92%), followed by urinary system (21.37%). Patients were more likely to die of the prior caner, and those with prior cancer from respiratory system had the worst survival outcomes. Moreover, the overall ratios in patients with stage (PCa) I-II and III-IV diseases were 0.21 and 1.65, indicating that patients with higher stage diseases were more likely to die of PCa. In the second group, patients with PCa as the SPM had worse OS than those with PCa as the first primary cancer. Lastly, prognostic factors for OS and CSS in PCa patients were explored. CONCLUSIONS: PCa remains to be an important COD for patients with a prior malignancy, especially for those with high-stage diseases. PCa patients with a prior cancer had worse survival outcomes than those without.

Development and Validation of a Questionnaire to Assess the Determinants of Dietary Adherence Among Patients After Bariatric Surgery.

PURPOSE: This study was aimed to develop a questionnaire to assess the determinants of dietary adherence among patients after bariatric surgery based on the attitude-social influence-efficacy (ASE) model and to evaluate its psychometric properties. PATIENTS AND METHODS: According to semi-structured interview, Delphi expert consultation and pilot study, the initial questionnaire was formed and applied to investigate 319 patients after bariatric surgery in a tertiary hospital in Jiangsu Province, China. The reliability and validity of the scale were tested. RESULTS: The 28-item of the attitude-social influence-efficacy questionnaire after bariatric surgery (ASEQBS) was formed. The results of exploratory factor analysis showed that four factors, including intention, attitude, social influence, and self-efficacy, could be extracted, and the cumulative variance contribution rate reached 59.98%. Confirmatory factor analysis showed the model fit well. The content validity index of each item was 0.800-1.000, and the content validity index of the ASEQBS was 0.857. The total Cronbach's α of the ASEQBS was 0.920, the split-half reliability was 0.774, and the retest reliability was 0.922. CONCLUSION: The results suggest that ASEQBS is a valid and reliable measure of determinants of dietary adherence. It may be useful to evaluate the influence factors of dietary adherence and helpful to evaluate the efficacy of tailored dietary intervention programs.

Trajectory Analysis and Predictors of the Percentage of Body Fat Among Chinese Sleeve Gastrectomy Patients.

BACKGROUND: The weight loss in Chinese patients after sleeve gastrectomy is different, and the differences can be evaluated through the trajectories of the percentage of body fat (BF%). Patients' baseline psychosocial factors may be associated with these trajectories. MATERIALS AND METHODS: We selected 267 patients who received sleeve gastrectomy for the first time. The BF% at baseline and 1, 3, 6, 12 months after surgery and baseline psychosocial variables were retrospectively collected. The trajectory model was established according to BF% based on the growth mixture model. The baseline psychosocial variables were compared among different trajectory classes. RESULTS: Four types of trajectory classes were obtained. The differences in preoperative dietary self-efficacy, exercise self-efficacy, depression, social support, working status, alcohol consumption, and gender among the classes were statistically significant. The pairwise comparison of the above variables revealed that the differences of gender, dietary self-efficacy and exercise self-efficacy among classes were highly effective. CONCLUSION: Female gender, low dietary self-efficacy and low exercise self-efficacy were predictors for poor BF% trajectory in sleeve gastrectomy patients. Health professionals can early identify patients who are most likely to lose weight in a not-ideal manner based on the above predictors.

The Correlation Between RDW, MPV and Weight Indices After Metabolic Surgery in Patients with Obesity and DM/IGR: Follow-Up Observation at 12 Months.

INTRODUCTION: Red blood cell distribution width (RDW) and mean platelet volume (MPV) are both new biomarkers for the prognosis of many diseases. This study aimed to observe the predictive values of RDW and MPV for weight loss after different metabolic surgeries in patients with obesity and abnormal glucose metabolism [diabetes mellitus or impaired glucose regulation (DM/IGR)]. METHODS: We retrospectively analyzed the body weight (BW), body mass index (BMI) and blood routine index of 98 patients with obesity and DM/IGR who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). RESULTS: Levels of RDW and MPV in both groups were significantly higher than before 1 month after surgery and then gradually decreased. Twelve months after surgery, the RDW level in the RYGB group was significantly lower than that before surgery. In the RYGB group, the RDW level of patients in the high-level percentage weight loss (%BW) (≥ 31.90) at 6 and 12 months after surgery decreased significantly compared to those in the corresponding low level. %BW and change in BW and BMI (ΔBW and ΔBMI) at 6 and 12 months after surgery in the high-level RDW (≥ 12.90) before surgery were significantly higher than those in the low level in the RYGB group. No significant difference in weight index was found in the high and low levels of the MPV before surgery in either group at other follow-up time points. CONCLUSIONS: Preoperative baseline RDW and postoperative RDW levels can preliminarily predict the effect of different metabolic surgeries in patients with obesity and DM/IGR.

An overview of patients with urothelial bladder cancer over the past two decades: a Surveillance, Epidemiology, and End Results (SEER) study.

BACKGROUND: To explore the overall trends of incidence rate (IR), mortality and survival outcomes of patients with urothelial bladder cancer (UBC) over the past two decades. METHODS: Patients diagnosed with UBC from 1993 to 2012 were extracted from the Surveillance, Epidemiology and End Result (SEER) 18 database. Baseline characteristics and treatment types of included patients were collected retrospectively. Moreover, the age-adjusted IRs and annual percent changes (APCs) were obtained. Afterwards, we calculated the standardized mortality ratios (SMRs) for bladder cancer (BC), cardiovascular disease (CVD) and all-cause mortality by comparing UBC cases with the general population. Finally, survival outcomes of UBC patients were analyzed and compared. RESULTS: A total of 220,405 UBC patients were identified, including 167,036 (75.79%) male patients and 53,369 (24.21%) female patients, with an average age of 70.84 years old. Most patients were White (89.85%), with older age (71.67%, >65 years old), lower T stage diseases (78.11%, < T2) and lower median household income (55.37%). When compared with patients diagnosed between 1993 and 2002, those diagnosed between 2003 and 2012 had older age (mean: 71.15 vs. 70.16 years old, P<0.001), higher proportion of men (76.22% vs. 74.83%, P<0.001) and lower median household income (56.69% vs. 52.50%, P<0.01). Overall, the IR of UBC increased slightly before 2003 and maintained a stable trend of about 20 per 100,000 person-years after 2003. Additionally, CVD was recognized as an important cause of death (COD) of UBC patients. UBC patients were 44.5 times more likely to die of CVD when compared with the general population. Furthermore, the 3-, 5- and 10-year overall survival (OS) and cancer-specific survival (CSS) rates were 0.709, 0.609 and 0.421, and 0.861, 0.831 and 0.789, respectively. Finally, survival outcomes between patients diagnosed in the two periods (1993-2002 vs. 2003-2012) were not significantly different. CONCLUSIONS: The IR of UBC increased slightly before 2003 and remained stable after 2003. UBC patients had higher CVD burden than the general population. Hence, cardiovascular health should be emphasized to reduce mortality after UBC diagnosis. Lastly, survival outcomes of UBC patients in the last two decades showed no significant difference.

Can Chinese T2D patients with BMI 20-32.5 kg/m2 benefit from loop duodenojejunal bypass with sleeve gastrectomy?

BACKGROUND: Loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG) is a simplified biliopancreatic diversion with duodenal switch. OBJECTIVES: This study investigated the therapeutic outcomes of LDJB-SG and predictors of type 2 diabetes (T2D) remission in Chinese patients with a body mass index (BMI) of 20 to 32.5 kg/m2. SETTING: A university hospital. METHODS: This retrospective study included 28 T2D patients with a BMI of 20 to 32.5 kg/m2 who underwent LDJB-SG. T2DM remission, weight loss, postoperative nutrition status, and complications at 1- and 3-year follow-up were assessed. Remission of T2DM was defined as a fasting blood glucose <7 mmol/L and HbA1C <6.5% for 1 year without pharmacological intervention. RESULTS: At 1-year follow-up after LDJB-SG, the T2D remission rate was 75% (21/28), and the mean total weight loss was 23.6%. The 3-year T2D remission rate and percent of total weight loss were 68.4% (13/19) and 20.3%, respectively. Univariate and multivariate analysis indicated that duration of T2D was the only risk factor associated with T2D remission (P < .05). LDJB-SG improved the metabolic syndrome by increasing the high-density lipoprotein cholesterol level (P = .0157), decreasing waist circumference (P < .0001), and decreasing triglycerides (P = .0053). Postoperative complications of LDJB-SG included malodorous flatus (64.3%), accidental diarrhea induced by greasy food (57.1%), de novo gastroesophageal reflux disease (28.6%), anemia (25%), fatigue (21.4%), underweight (17.9%), intolerance to cooked rice (10.7%), constipation (7.1%), and steatorrhea (3.6%). CONCLUSION: LDJB-SG resulted in acceptable T2D remission and metabolic improvement at 1- and 3-year follow-up in Chinese T2D patients with a BMI of 20 to 32.5 kg/m2. T2D duration may serve as the predictor of T2D remission. LDJB-SG should be performed with caution because of the high incidence of postoperative complications.

Lipopolysaccharide and inflammatory cytokines levels decreased after sleeve gastrectomy in Chinese adults with obesity.

Obesity is linked to a low-grade systemic inflammation and lipopolysaccharide (LPS) is a key factor. Sleeve gastrectomy (SG) can significantly cause weight loss, but few reports have looked into the changes of LPS and inflammatory cytokines after surgery. To explore the potential short-term impact of SG on LPS and inflammatory cytokines and their relationship to early metabolic changes in obesity. 30 Chinese adults with obesity (BMI 39.37 ± 8.22 kg/m2, 25 female) receiving SG were included in this study. Fasting blood samples were collected at baseline and 30 days after SG. Serum LPS markedly reduced from 336.50 (73.54, 500) pg/mL to 5.00 (5.00, 5.24) pg/mL at 1 month after SG (p < 0.05). There was a significant decrease in plasma IL-6, IL-8, and serum CRP after SG (all p < 0.05). Insulin resistance improved remarkably after surgery as displayed by reductions in fasting insulin level (FINS, p < 0.001), and HOMA-IR (p < 0.001). In addition, visceral fat area (VFA) decreased from 209.70 ± 39.96 cm2 to 193.28 ± 43.68 cm2 after SG (p < 0.001). LPS was positively correlated with FINS (r = 0.391, p = 0.033) and HOMA-IR (r = 0.38, p = 0.038) before SG. Meanwhile, VFA was positively associated with CRP (r = 0.388, p = 0.034) before surgery. When assessing 30-days postoperative changes, a positive correlation was found between the variations of LPS, IL-8 and the reduction of VFA. After multivariate analyses, only the reduced IL-8 level was independently associated with the reduction of VFA (p = 0.015). In conclusion, SG can significantly relieve the inflammation in obesity in the short term and LPS might be an earlier predictor of inflammatory changes after surgery.

Short-Term Outcomes of Sleeve Gastrectomy plus Jejunojejunal Bypass: a Retrospective Comparative Study with Sleeve Gastrectomy and Roux-en-Y Gastric Bypass in Chinese Patients with BMI ≥ 35 kg/m2.

BACKGROUND: Bariatric surgery represents the most effective treatment for obesity and its related comorbidities. The present study aims to evaluate the efficacy and safety of sleeve gastrectomy plus jejunojejunal bypass (SG + JJB). METHODS: This retrospective study included 244 obese patients with BMI ≥ 35 kg/m2 undergoing SG + JJB (n = 83), SG (n = 82), and Roux-en-Y gastric bypass (RYGB) (n = 79). Postoperative weight loss, metabolic outcomes, nutrition status, and patients' complaints at 1-year follow-up were compared. Subgroup analyses (36 pairs of SG + JJB/SG and 37 pairs of SG + JJB/RYGB) were performed to compare weight loss and lipid profiles after matching with gender, age, and BMI. RESULTS: In subgroup case-matched study, SG + JJB exhibited superior weight loss effect to SG regarding total weight loss (38.8 ± 8.7% vs 35.0 ± 6.1%, P = 0.011) and excessive weight loss (95.3 ± 20.4% vs 86.9 ± 13.7%, P = 0.033) at 1-year follow-up. The postoperative metabolic outcomes, nutritional status, and patients' complaints were similar between SG + JJB and SG. SG + JJB yielded similar weight loss, T2DM remission, and hypertension resolution to RYGB at 1-year follow-up, but less postoperative complications than RYGB regarding anemia (4.8% vs 22.8%), vitamin D deficiency (47.0% vs 65.8%), vitamin B12 deficiency (8.4% vs 25.3%), hypoalbuminemia (1.2% vs 8.9%), diarrhea (6.0% vs 21.5%), dumping syndrome (0 vs 7.6%), and fatigue (25.3% vs 40.5%) (P < 0.05). In subgroup case-matched study, RYGB improved total cholesterol and low-density lipoprotein better than SG + JJB (P < 0.05). CONCLUSIONS: In short-term follow-up, SG + JJB offered better weight loss than SG and similar weight loss to RYGB. SG + JJB resulted in less postoperative nutritional deficiency and complications than RYGB except for lipid and hypertension improvement.

[Implementation of enhanced recovery after surgery in nutritional management of patients undergoing metabolic surgery].

Metabolic surgery is a gastrointestinal surgical procedure to treat obesity and its related co-morbidities with rapid development in recent years. Patients undergoing metabolic surgery have preoperative nutritional disorders, and the nutrition management for these patients is the key point of perioperative management. During the perioperative period, current research has preliminarily confirmed that perioperative managements including supplementation of micronutrients, preoperative evaluation of the weight loss, preoperative fasting and carbohydrate oral intake based on the full application of ERAS and characteristics of the patients undergoing metabolic surgery, are safe and effective in clinical practice. As for the postoperative diet strategy, current literature remains non-unified to identify the duration and the content of the nutrition managements. Domestic clinical reports about the postoperative nutrition managements after metabolic surgery are rare and lack of unified and good reference standard. Meanwhile, divergence still existed in current literature regarding to the content of the postoperative nutrition managements. Therefore, it is necessary to develop the standardized protocol for nutrition managements which is offering basis and reference for the clinical application of perioperative nutrition managements after metabolic surgery.

Photolyses of mammalian oxy-hemoglobin studied by nanosecond photoacoustic calorimetry.

Enthalpy and conformational volume changes in photolyses of oxy-hemoglobin (HbO(2)) of human, bovine, pig, horse and rabbit are investigated by photoacoustic calorimetry. In the experiment, a pulsed Nd:YAG laser is used as an exciting source, and a PVDF film transducer and a PZT transducer are used to detect the photoacoustic signals. Based on the time scales of the excitation and detection systems as well as the photolysis processes of HbO(2), it can be indicated that the measured enthalpy and conformational volume changes are related to slow geminate recombination and tertiary relaxation in photolyses of HbO(2), which are with the time scale of 30-40 ns and 100-150 ns, respectively. The results show that the enthalpy and conformational volume changes are different for both photolysis processes of HbO(2) and also for various mammals. The different results among the five mammals are analyzed and discussed briefly.

Photo-dissociation quantum yields of mammalian oxyhemoglobin investigated by a nanosecond laser technique.

The photo-dissociations of oxyhemoglobin of several mammals, such as human, bovine, pig, horse, and rabbit, have been studied. By means of optical pump-probe technique, the quantum yields for photo-dissociation of these oxyhemoglobin have been determined at pH 7 and 20 degrees C. A nanosecond laser at 532 nm is used as the pumping source, and a xenon lamp through a monochrometer provides a probe light at 432 nm. The experimental results show that the quantum yields of these mammalian oxyhemoglobin are different from each other, especially for that of rabbit. By analyzing the amino acid sequences and tetramer structures as well as the flexibility and hydrophobicity of the different hemoglobin, possible explanations for the differences are proposed.