CD1d protects against hepatocyte apoptosis in non-alcoholic steatohepatitis.

BACKGROUND & AIMS: Hepatocyte apoptosis, a well-defined form of cell death in non-alcoholic steatohepatitis (NASH), is considered the primary cause of liver inflammation and fibrosis. However, the mechanisms underlying the regulation of hepatocyte apoptosis in NASH remain largely unclear. We explored the anti-apoptotic effect of hepatocyte CD1d in NASH. METHODS: Hepatocyte CD1d expression was analyzed in patients with NASH and mouse models. Hepatocyte-specific gene overexpression or knockdown and anti-CD1d crosslinking were used to investigate the anti-apoptotic effect of hepatocyte CD1d on lipotoxicity-, Fas-, and concanavalin (ConA)-mediated liver injuries. A high-fat diet, a methionine-choline-deficient diet, a Fas agonist, and ConA were used to induce lipotoxic and/or apoptotic liver injuries. Palmitic acid was used to mimic lipotoxicity-induced apoptosis in vitro. RESULTS: We identified a dramatic decrease in CD1d expression in hepatocytes of patients with NASH and mouse models. Hepatocyte-specific CD1d overexpression and knockdown experiments collectively demonstrated that hepatocyte CD1d protected against hepatocyte apoptosis and alleviated hepatic inflammation and injuries in NASH mice. Furthermore, decreased JAK2-STAT3 signaling was observed in NASH patient livers. Mechanistically, anti-CD1d crosslinking on hepatocytes induced tyrosine phosphorylation of the CD1d cytoplasmic tail, leading to the recruitment and phosphorylation of JAK2. Phosphorylated JAK2 activated STAT3 and subsequently reduced apoptosis in hepatocytes, which was associated with an increase in anti-apoptotic effectors (Bcl-xL and Mcl-1) and a decrease in pro-apoptotic effectors (cleaved-caspase 3/7). Moreover, anti-CD1d crosslinking effectively protected against Fas- or ConA-mediated hepatocyte apoptosis and liver injury in mice. CONCLUSIONS: Our study uncovered a previously unrecognized anti-apoptotic CD1d-JAK2-STAT3 axis in hepatocytes that conferred hepatoprotection and highlighted the potential of hepatocyte CD1d-directed therapy for liver injury and fibrosis in NASH, as well as in other liver diseases associated with hepatocyte apoptosis. IMPACT AND IMPLICATIONS: Excessive and/or sustained hepatocyte apoptosis is critical in driving liver inflammation and injury. The mechanisms underlying the regulation of hepatocyte apoptosis in non-alcoholic steatohepatitis (NASH) remain largely unclear. Here, we found that CD1d expression in hepatocytes substantially decreases and negatively correlates with the severity of liver injury in patients with NASH. We further revealed a previously unrecognized anti-apoptotic CD1d-JAK2-STAT3 signaling axis in hepatocytes, which confers significant protection against liver injury in NASH and acute liver diseases. Thus, hepatocyte CD1d-targeted therapy could be a promising strategy to manipulate liver injury in both NASH and other hepatocyte apoptosis-related liver diseases.

The current status and challenges of perioperative management of patients with a BMI of ≥50 kg/m2 undergoing bariatric surgery in China: a multi center cross-sectional study.

BACKGROUND: Performing bariatric surgery on patients with a body mass index (BMI) of over 50 kg/m2 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 ≥50 kg/m2 undergoing bariatric surgery in China. The questionnaire of our survey included general information, preoperative management measures, surgical procedures performed, technical details regarding anesthesia, and postoperative management measures. A response from only one attending physician per bariatric center was accepted. RESULTS: Physicians from a total of 101 hospitals responded to the questionnaire, and the questionnaire data from 98 hospitals were complete. These centers had completed a total of 44,702 bariatric surgeries since the launch of such surgery to December 2021. A total of 3,280 patients had a BMI exceeding 50 kg/m2. The preferred surgical procedures for patients with super obesity were sleeve gastrectomy by 62 centers, Roux-en-Y gastric bypass by 11 centers, sleeve gastrectomy plus jejunojejunal bypass by 19 centers, one anastomosis gastric bypass by 1 center, and duodenal switch by 1 center. The most worrying issues were cardiopulmonary failure and difficulty in extubation. 91 centers believed that preoperative weight loss was beneficial. A low-calorie diet was the specific measure mainly implemented, only 3 centers 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/m2. The perioperative risks of these patients remain relatively high, making further development of clinical pathways is necessary.

Neutrophil autophagy induced by monosodium urate crystals facilitates neutrophil extracellular traps formation and inflammation remission in gouty arthritis.

Neutrophil extracellular traps (NETs) are composed of chromatin filaments coated with granular and cytosolic proteins, which contribute to the pathogenesis and progression of immune-related diseases. NETs are frequently observed in gouty arthritis, but the related mechanisms remain poorly understood. The aim of our study was to systematically elucidate the molecular mechanisms of self-remitting effects in gouty arthritis, and the causative relationship between neutrophil autophagy and NETs. The air pouch and paw edema model were used to simulate gouty arthritis in mice. Neutrophil infiltration and the formation of NETs were found in gouty arthritis. Interestingly, monosodium urate (MSU) crystals could induce the formation of NETs, degrade inflammatory factors, and alleviate the inflammatory response in gouty arthritis. In addition, MSU crystals resulted in profound molecular alterations in neutrophils using RNA-seq analysis, including autophagy activation. MSU crystals could activate neutrophil autophagy in vitro, and autophagy activators and inhibitors could regulate the formation of NETs. Furthermore, we explored the mechanism of autophagy-induced NETs. Autophagy related protein 7 (ATG7) produced by neutrophils stimulated with MSU crystals worked synergistically with p53 to enter the nucleus, promoting peptidyl arginine deiminase 4 (PAD4) expression, and inducing the formation of NETs. Finally, we substantiated that neutrophil autophagy regulates the severity of gouty arthritis via the formation of NETs in PAD4 -/- mice. Our results indicated that the autophagy of neutrophils regulates the formation of NETs and degrades inflammatory factors. Regulating autophagy and interfering with the formation of NETs represents a potential therapeutic approach against gouty arthritis during clinical practice.

DFT studies of solvent effect in hydrogen abstraction reactions from different allyl-type monomers with benzoyl radical.

Inert allyl-type monomers have been widely documented due to reduce degradation chain transfer. Recently, we and others discovered that the [3 + 2] cyclization reaction process by a photo-driven radical reaction, which can accelerate the polymerization. It was discovered that allyl ether monomers had much higher reactivity than other allyl monomers in the suspension photopolymerization initiated by Type I photoinitiator. Since the hydrogen abstraction reaction (HAR) is the initial step of cyclization, and in order to clarify the influence of solvents effect, three allyl-type monomers were employed, containing "O", "N" and "S" atom as hydrogen donors. The benzoyl radical obtained from cleavage of photoinitiator was chosen as hydrogen acceptors. We explored the hydrogen abstraction reaction in different solvents (methanol, water and DMSO) by quantum chemistry for geometry and energy. An investigation was undertaken regarding the structural orbital by electrostatic potential (ESP) and topological analysis (ELF and LOL). The findings were also combined with the distortion model and transition state theory. We obtained the molecular interactions used independent gradient method in the Hirshfeld molecular density partition (IGMH). The Eckart's correction allowed to examine the driving factors of the hydrogen abstraction reaction tunnels and these reactions constant rates are determined in the range of 500-2500 K depending on the modified Arrhenius form in different solvents effect. Our results can provide an answer for the different reactivities.

Comparison of Single Versus Double Anastomosis Bariatric Metabolic Surgery in Obesity: a Systematic Review and Meta-analysis.

Major BMS are modified through loop rather than Roux-en-Y type reconstruction recently, and this study systematically reviews the BMS from the perspective of SA (single anastomosis) and DA (double anastomosis) procedures, aiming to research the differences among bariatric procedures. A total of 39 studies compared SA- and DA-BMS were finally eligible for analysis after searching in PubMed, Web of Science, and Cochrane Library. Compared with DA, SA shortens operative time and decreases complications especially obstruction, internal hernia, and reoperation. SA-GB (gastric bypass) has significantly higher %TWL and T2DM remission rate than DA-GB 1- and 5-year postoperatively. SA-DS (duodenal switch) has similar 1-year %TWL and lower 5-year %TWL, and comparable 1- and 5-year T2DM remission with DA-DS. SA provides significant advantages about simplicity and safety. This, together with the shorter learning curve, makes SA a promising choice.

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.

Cross-species single-cell transcriptomic analysis of animal gastric antrum reveals intense porcine mucosal immunity.

As an important part of the stomach, gastric antrum secretes gastrin which can regulate acid secretion and gastric emptying. Although most cell types in the gastric antrum are identified, the comparison of cell composition and gene expression in the gastric antrum among different species are not explored. In this study, we collected antrum epithelial tissues from human, pig, rat and mouse for scRNA-seq and compared cell types and gene expression among species. In pig antral epithelium, we identified a novel cell cluster, which is marked by high expression of AQP5, F3, CLCA1 and RRAD. We also discovered that the porcine antral epithelium has stronger immune function than the other species. Further analysis revealed that this may be due to the insufficient function of porcine immune cells. Together, our results replenish the information of multiple species of gastric antral epithelium at the single cell level and provide resources for understanding the homeostasis maintenance and regeneration of gastric antrum epithelium.

Constructing and Validating a Dynamic Nomogram to Predict Response to Bariatric Surgery: A Multicenter Retrospective Study.

PURPOSE: Suboptimal response is one of the major problems for bariatric surgery, and constructing an individualized model for predicting outcomes of bariatric surgery is essential. Thus, the aim of this study is to develop a nomogram to predict the response to bariatric surgery. MATERIALS AND METHODS: 509 patients who underwent bariatric surgery between 2019 to 2020 from 6 centers were retrieved and assessed. Multiple Imputation was used to replace missing data. Patients with %TWL ≥ 20% 1 year after bariatric surgery were classified as patients with optimal response, while the others were patients with suboptimal response. A web-based nomogram was constructed and validated. ROC curve and calibration curve were used to determine the predictive ability of our model. RESULTS: 56 (11.0%) patients were classified as patients with suboptimal response, and they showed advanced age, lower pre-operative BMI, smaller waist circumference, higher fasting glucose, higher HbA1c and lower fasting insulin compared to patients with optimal response. A forward likelihood ratio logistic regression analysis indicated that age (OR = 0.943, 95% CI: 0.915-0.971, p < 0.001), pre-operative BMI (OR = 1.109, 95% CI: 1.002-1.228, p = 0.046) and waist circumference (OR = 1.043, 95% CI: 1.000-1.088, p = 0.048) were essential factors contributing to the response to bariatric surgery. Lastly, a web-based nomogram was constructed to predict the response to bariatric surgery and demonstrated an AUC of 0.829 and 0.798 upon internal and external validation. CONCLUSION: Age, BMI and fasting glucose were proved to be essential factors influencing the response to bariatric surgery. The nomogram constructed in this study demonstrated good adaptivity.

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.

Skeletal muscle HSF1 prevents insulin resistance by improving glucose utilization.

The regulation of muscle glucose utilization has significant potential for the treatment of type 2 diabetes mellitus (T2DM) and obesity. Heat shock factor 1 (HSF1) is involved in cellular metabolism and regulation of muscle metabolism. However, it is unclear how HSF1 regulates muscle glucose metabolism. In the present study, the development of obesity in mice was associated with HSF1 downregulation. Serum samples and muscle biopsies were obtained from obese and healthy humans. Fasting glucose and insulin levels and the homeostasis model assessment of insulin resistance value showed that obesity was associated with insulin resistance. The skeletal muscle level of HSF1 was decreased in obese and ob/ob mice. HSF1 was selectively over-expressed in the skeletal muscles of high fat diet (HFD)-fed mice. Muscle HSF1 over-expression successfully triggered glycolytic-to-oxidative myofiber switch and increased fatty acid metabolism and insulin sensitivity in the skeletal muscles of HFD-fed mice. Moreover, HSF1 improved energy expenditure and blocked muscle accumulation of triglycerides in HFD-fed mice. Consequently, muscle HSF1 mitigated the impaired muscle insulin signaling and insulin resistance in HFD-fed mice. In conclusion, T2DM and obesity in HFD-fed mice may be treated with selective HSF1-directed programming of exercise-like effects in skeletal muscle. These findings may aid the development of a new therapeutic approach for obesity and T2DM.

A comparison of hydrogen abstraction reaction between allyl-type monomers with thioxanthone-based photoinitiators without amine synergists.

The photodriven radical-mediated [3 + 2] cyclization reaction was found to yield polymers efficiently without being hindered by degradative chain transfer. The first reaction is a hydrogen abstraction process in which one hydrogen atom migrates from the α-methylene group of an allyl monomer to the triplet state (or fragments) of the photoinitiator, thus yielding primary allyl radicals as primary radicals and then begins chain propagation via a 3 + 2 cyclization reaction. Allyl ether monomers were found to be significantly higher than other allyl monomers even with the absence of amine-like synergists. In order to clarify the procedure of the hydrogen abstraction mechanism, we used four allyl-type monomers as hydrogen donors and three thioxanthone photoinitiators as hydrogen acceptors by the quantum chemistry method in terms of geometry and energy. The results were interpreted with transition-state theory and the interaction/deformation model. Then, the tunneling factors of hydrogen abstraction reactions were also investigated by Eckart's correction. The results show allyl ether systems are more reactive than other allyl systems, and it would provide us with new insights into these hydrogen abstractions.

Loop versus Roux-en-Y duodenojejunal bypass with sleeve gastrectomy for type 2 diabetes: short-term outcomes of a single-center randomized controlled trial.

BACKGROUND: Duodenojejunal bypass with sleeve gastrectomy (DJB-SG) is a novel bariatric surgery composed of sleeve gastrectomy (SG) and duodenojejunal anastomosis. Both loop and Roux-en-Y DJB-SGs were reported to have acceptable hypoglycemic and weight loss outcomes, but it remains unclear which reconstruction method is better regarding therapeutic efficacy and safety for type 2 diabetes (T2D). OBJECTIVE: This study was undertaken to prospectively compare the short-term therapeutic outcomes and surgical safety of loop versus Roux-en-Y DJB-SG. SETTING: University hospital. METHODS: A total of 96 patients with T2D with body mass index of 27.5-40 kg/m2 were randomized in a 1:1 ratio to undergo loop or Roux-en-Y DJB-SG from January 2020 to December 2020. The primary end point was to determine the 1-year T2D remission rate. Additionally, medical cost, operative outcomes, weight loss, metabolic improvement, nutritional status, and gastrointestinal disorders at 1-year follow-up also were determined. RESULTS: The preoperative data were comparable at baseline. The 1-year follow-up rate was 89.6% (43 of 48 patients) for loop DJB-SG and 93.8% (45 of 48 patients) for Roux-en-Y DJB-SG. The T2D remission rates were 93.02% (40 of 43) for loop DJB-SG and 88.89% (40 of 45) for Roux-en-Y DJB-SG at 1-year follow-up. Loop DJB-SG patients exhibited higher total weight loss (30.85% ± 7.24% versus 26.11% ± 7.12%), shorter operative times, and less medical cost than Roux-en-Y DJB-SG patients. However, there was no statistical difference regarding lipid profiles, major postoperative complications, nutritional status, and gastrointestinal disorders between the 2 groups. CONCLUSION: Despite similar hypoglycemic effects, loop DJB-SG was simpler and exhibited better weight loss and less medical cost than Roux-en-Y DJB-SG. Thus, loop DJB-SG was better than Roux-en-Y DJB-SG for T2D.

Palladium-catalyzed allylic etherification of phenols with vinyl ethylene carbonate.

The palladium-catalyzed decarboxylative reactions of phenols and vinyl ethylene carbonate to produce allylic aryl ethers under mild conditions have been established. Adopting an inexpensive PdCl2(dppf) catalyst promotes the efficient conversion of phenols to the corresponding allylic aryl ethers via the formation of a new C-O bond in good isolated yields with complete regioselectivities, acceptable functional group tolerance and operational simplicity. The robust procedure could be completed smoothly by conducting a scaled-up reaction with comparable efficiency to afford the target product.

Recent Advances of Pyridinone in Medicinal Chemistry.

Pyridinones have been adopted as an important block in medicinal chemistry that could serve as hydrogen bond donors and acceptors. With the help of feasible synthesis routes via established condensation reactions, the physicochemical properties of such a scaffold could be manipulated by adjustment of polarity, lipophilicity, and hydrogen bonding, and eventually lead to its wide application in fragment-based drug design, biomolecular mimetics, and kinase hinge-binding motifs. In addition, most pyridinone derivatives exhibit various biological activities ranging from antitumor, antimicrobial, anti-inflammatory, and anticoagulant to cardiotonic effects. This review focuses on recent contributions of pyridinone cores to medicinal chemistry, and addresses the structural features and structure-activity relationships (SARs) of each drug-like molecule. These advancements contribute to an in-depth understanding of the potential of this biologically enriched scaffold and expedite the development of its new applications in drug discovery.

Serum proteome profiling reveals differentially expressed proteins between subjects with metabolically healthy obesity and nonalcoholic fatty liver disease.

Nonalcoholic fatty liver disease (NAFLD) is the leading risk factor for common chronic liver disease and is often regarded as a prevalent metabolic disorder tightly associated with obesity. However, the existence of metabolically healthy obesity (MHO) indicates that some important factors may participate in protecting individuals with MHO free of NAFLD, even with excessive adiposity. To explore factors independent of obesity that may be involved in the occurrence of NAFLD, we performed an iTRAQ-based proteomic study to identify proteins differentially expressed in serum between NAFLD and MHO subjects. Compared with the MHO group, ten proteins were upregulated and five were downregulated significantly in the NAFLD group. Gene Ontology analysis indicated significant changes in the immune response and triglyceride metabolism-related pathways between MHO and NAFLD. We further validated three candidates markedly dysregulated in NAFLD by Western blotting and ELISA, including two upregulated proteins (afamin and apolipoprotein H) and one downregulated protein (apolipoprotein C-1). Detection of serum apolipoprotein H levels in a large-scale cohort with MHO and different stages of NAFLD indicated that apolipoprotein H may be a potential blood biomarker for distinguishing NAFLD from MHO and an independent risk factor for predicting NAFLD.

Density Functional Theory Guide for an Allyl Monomer Polymerization Mechanism: Photoinduced Radical-Mediated [3 + 2] Cyclization.

Polymerization of allyl ether monomers has previously been considered a free-radical addition polymerization mechanism, but it is difficult to achieve because of the high electron density of their double bond. To interpret the mechanism of photopolymerization, we therefore proposed a radical-mediated cyclization (RMC) reaction, which has been validated by results from quantum chemistry calculations and real-time infrared observation. Our RMC reaction begins with the radical abstracting one allylic hydrogen atom from the methylene group of allyl ether to generate an allyl ether radical with a delocalized π3 3 bond. Then, the radical reacts with the double bond of a second allyl ether molecule to form a five-membered cyclopentane-like ring (CP) radical. The CP radical abstracts a hydrogen atom from a third ether molecule. At last, a new allyl ether radical is generated and the next circulation as chain propagation begins. The distortion/interaction model was employed to explore the transient state of reaction, and real-time infrared was chosen to clarify the RMC reaction mechanism initiated by different photoinitiators. These results demonstrated that the RMC mechanism can give new insights into these fundamental processes.

Application and safety evaluation of an anti-aflatoxigenic chitosan pouch containing turmeric essential oil in the storage of traditional Chinese health food.

Aflatoxin contamination is one of the most important factors jeopardizing the quality of traditional Chinese health food (TCHF) during storage. Based on our previous work, we investigated the stability of chitosan (CH) films containing turmeric essential oil (TEO) and employed CH-TEO films as inner pouches, then stored them with inoculated Coix seed, nutmeg, and Ziziphi Spinosae Semen (ZSS). We found that the stability of CH-TEO was most affected by high temperature, and these pouches dramatically decreased aflatoxin accumulation and maintained levels of marker components of each TCHF. We found that glycerol tristearat in Coix seed and jujuboside A and spinosin in ZSS were negatively correlated with aflatoxin accumulation. After three months of storage with a CH-TEO pouch, we found little change in marker components contents, but observed that Coix seed had the relative lower sensory characteristics score. In addition, acute and 90-day subchronic toxicity test in Coix seed stored with the largest amount of TEO showed no significant signs of toxicity or treatment-related changes in animals. The present study is the first report on the study of a green, efficient, and low toxicity solution for aflatoxic contamination in TCHF, and provides strong support for its future use.

Single-Anastomosis Duodenal Switch: Conceptual Difference between East and West.

Single-anastomosis duodenal switch (SADS) has become increasingly popular. This review compared the conceptual difference between Eastern (SADS-E) and Western (SADS-W) countries. After searching for SADS through PubMed and high-impact journals, 19 articles with 2280 patients were included for analysis. We found SADS-W was reserved for patients with a high body mass index (BMI) without type 2 diabetes mellitus (T2DM). Surgeons performing SADS-W used larger bougies and preferred shorter common channels. However, SADS-E was mainly preferred in T2DM patients with a low BMI. SADS-E bypassed less bowel and used smaller bougies. The spectra of major postoperative complications, nutritional deficiencies, and gastrointestinal disorders were different between SADS-E and SADS-W. SADS-W yielded better weight loss and better T2DM remission than SADS-E. SADS are effective bariatric and metabolic procedures with promising therapeutic outcomes and acceptable safety.

Three-Year Outcomes of Sleeve Gastrectomy Plus Jejunojejunal Bypass: a Retrospective Case-Matched Study with Sleeve Gastrectomy and Gastric Bypass in Chinese Patients with BMI ≥35 kg/m2.

BACKGROUND: Sleeve gastrectomy plus jejunojejunal bypass (SG+JJB) is a novel bariatric procedure. In this study, we compared the 3-year outcomes of SG+JJB to those of sleeve gastrectomy (SG) and gastric bypass (RYGB). METHODS: This retrospective study included 113 patients (SG, N=31; RYGB, N=33; SG+JJB, N=49) with a preoperative BMI≥35 kg/m2. Among them, 31 pairs of patients who underwent SG+JJB/SG and 33 pairs who underwent SG+JJB/RYGB were matched by sex, age (±2 years), and BMI (±2 kg/m2). Postoperative weight loss, diabetes remission, and patient complaints at the 3-year follow-up were compared. RESULTS: SG+JJB yielded higher 3-year total weight loss (TWL) than SG alone (35.5±9.1% vs 31.5±7.3%, P=0.031) and equivalent 3-year %TWL to RYGB. The diabetes remission rate of SG+JJB was similar to that of SG or RYGB. SG+JJB resulted in a higher incidence of malodorous flatus than SG (25.8% vs 0, P<0.05). Compared to RYGB, SG+JJB resulted in a higher incidence of postoperative de novo gastroesophageal reflux disease (GERD) symptoms (30.3% vs 0, P<0.05). CONCLUSIONS: In the present study, we found that SG+JJB yielded higher weight loss than SG and similar weight loss to RYGB at the 3-year follow-up. SG+JJB increased the risk of malodorous flatus compared to SG and de novo GERD symptoms compared to RYGB.