Preoperative contributing factors and the remission of diabetes after metabolic surgery: the mediating role of preoperative triglyceride.

BACKGROUND AND OBJECTIVE: Limited understanding exists regarding the factors affecting the prognosis of surgical treatment for type 2 diabetes mellitus (T2DM), particularly in Chinese patients. In this study, we examined a cohort of early and intermediate obese T2DM patients to explore the potential impact of preoperative lipid metabolism in metabolic surgery on the postoperative remission of T2DM. METHODS: Participants with T2DM and obesity underwent metabolic surgery. Clinical data, including baseline body mass index, percentage of excess weight loss, and preoperative biochemical indicators, were collected and analyzed. A multidisciplinary team conducted patient follow-up. Remission was defined as sub-diabetic hyperglycemia (HbA1c < 48 mmol/mol, fasting glucose 100-125 mg/dl) without pharmacological intervention for at least 12 months. RESULTS: Over a median follow-up of 27 months, 96 T2DM patients with metabolic surgery were studied, with no laparotomies required. Among these patients, 61 (63.5%) achieved complete remission, and 85 (88.5%) experienced remission. In multivariable analysis models, preoperative fasting blood glucose (FBG) significantly correlated with all postoperative outcomes. Furthermore, mediation analysis indicated that preoperative triglycerides (TG) mediated 26.31% of the association between preoperative FBG and postoperative remission. Both preoperative FBG and TG were negatively associated with the postoperative remission of T2DM. CONCLUSION: In summary, our findings suggest that lower preoperative fasting glucose levels enhance the likelihood of postoperative T2DM remission. Moreover, preoperative TG could potentially play a mediating role in the postoperative remission of T2DM. Therefore, evaluating and managing fasting glucose and lipids before the procedure may aid in assessing the prognosis of metabolic surgery. Level of evidence Level III, designed cohort.

TIL-Derived CAR T Cells Improve Immune Cell Infiltration and Survival in the Treatment of CD19-Humanized Mouse Colorectal Cancer.

Chimeric antigen receptor-engineered T cells (CAR Ts) targeting CD19 have shown unprecedented prognosis in treating hematological cancers. However, the lack of a tumor-specific antigen as the target and an inhospitable tumor environment limit the clinical application of CAR T in solid tumors. Tumor-infiltrating T lymphocytes (TIL) exhibit diverse T cell receptor clonality and superior tumor-homing abilities. Therefore, in our study, human CD19-target TIL CAR-Ts armed with CD3ζ and 4-1BB signaling domains were constructed. Mouse colorectal cancer CT26 cells expressing human CD19 (hCD19+-CT26) were developed to assess the anti-tumor activity of TIL CAR-T cells, both in vitro and in vivo. Compared with splenic CAR T adoptive transfer, TIL CAR-T administration showed superior tumor suppression ability in hCD19+-CT26 tumor-bearing mice. Furthermore, more T cells were found at the tumor site and had lower exhaustion-related inhibitory receptor (T cell immunoglobulin and mucin domain-containing protein 3, Tim3) expression and higher immune memory molecule (CD62L) expression. Overall, we provided an artificial tumor-specific antigen in solid tumors and demonstrated that combined CAR-expressing TIL-Ts (TIL CAR-Ts) exhibited strong anti-tumor activity, with improved T cell infiltration and immune memory. Our humanized tumor antigen presented platform of mice suggests that TIL CAR-T-based adoptive therapy could be a promising strategy for solid cancer treatment.

Laparoscopic Roux-en-Y gastric bypass for type 2 diabetes mellitus in nonobese Chinese patients.

BACKGROUND: Although bariatric surgery performed for morbid obesity has been shown to significantly improve type 2 diabetes mellitus (T2DM), data on its effectiveness to improve T2DM in nonobese patients are scarce. The present pilot study evaluated the clinical effects of laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) in Chinese T2DM patients with body mass index (BMI) ≤27.5 kg/m. MATERIALS AND METHODS: A total of 68 consecutive patients with uncontrolled T2DM underwent LRYGB from May 2010 to March 2012. All patients were subjected to follow-up controls with anthropometric and metabolic indices at 1, 3, 6, and 12 months after surgery. Glycemic control was evaluated. RESULTS: One year after the surgery, LRYGB resulted in 69.4%±52.2% excess weight loss percentage (%EWL), remission of T2DM in 80.9% of all the patients. In the group of T2DM patients with BMI≤27.5 kg/m (n=28), 9 (32.1%) cases showed T2DM remission, 10 (35.7%) showed glycemic control, 7 (25%) showed improvement, and 2 (7.1%) were unchanged. The change in BMI, waist circumference, and the plasma levels of FPG, HbA1C, triglycerides, HDL-C, and insulin were statistically significance at 1 year (P<0. 05). There was no perioperative mortality, but 6 (8.8%) patients experienced complications. CONCLUSIONS: LRYGB resulted in significant weight loss and remission of T2DM in Chinese patients. Despite a lower response rate of surgery treatment compared with obese patients, T2DM patients with BMI≤27.5 kg/m still exhibited improvement and remission of T2DM. Diabetic patients should consider bariatric surgery, especially if traditional pharmacotherapy has not been effective. Longer follow-up is required for better evaluation.