Gastric bypass procedure for type 2 diabetes patients with BMI <28 kg/m2.

OBJECTIVES: To evaluate the Roux-en-Y gastric bypass (GBP) procedure for patients suffering from type 2 diabetes mellitus (T2DM) with body mass index (BMI) <28 kg/m2. METHODS: Thirty-one patients suffering from T2DM were selected to undergo laparoscopic Roux-en-Y gastric bypass surgery and were enrolled at Beijing Shijitan Hospital between November 2012 and December 2014. The fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), C-peptide, fasting insulin (FINS) and glucagon-like peptide-1 (GLP-1) of all patients were measured before and at 1, 3, 6 months after surgery. The results were compared and analyzed. RESULTS: Thirty-one patients suffering from T2DM successfully underwent GBP surgery (a mean age of 46 years), 14 were male and 17 were female. Among them, 7 patients had hypertriglyceridemia (HTG). The patients were followed up for 6 months. No major complications were found. The average BMI was 26.5 ± 1.4 kg/m2 before surgery. The average levels of FPG, HbA1c, C-peptide, FINS of all patients were statistically decreased after surgery, respectively, compared to those before surgery (P < 0.05). However, the mean GLP-1 of all patients was statistically increased after surgery compared to that before surgery (P < 0.05). At 6 months after surgery, 22 patients (71 %) achieved complete remission of T2DM with HbA1c < 6.5 %, 7 patients (23 %) gained partial remission of T2DM with 6.5 % ≤ HbA1c < 7.0 % and 2 patients (6 %) experienced no remission of T2DM. The mean serum triglyceride of 31 patients was statistically decreased after surgery compared to that before surgery (P < 0.05). CONCLUSIONS: This research shows that the GBP procedure is safe and effective for T2DM patients with BMI <28 kg/m2, and the condition of patients with HTG was greatly improved. However, further studies with larger samples and long-term follow-up are needed.

Delayed infected hematoma in retrosternal area following total thyroidectomy: a case report.

Introduction and Importance: Postoperative neck hematoma (PNH), a rare complication following thyroidectomy, occurs in only 1.1-3.15% of cases and can lead to life-threatening outcomes. More rarely, delayed PNHs with atypical clinical manifestations and positions have not yet been reported. Early identification and immediate medical intervention are of utmost importance in such cases. Case Presentation: The authors represented a patient with thyroid cancer adherent to the trachea, who underwent post-thyroidectomy, experienced delayed PNH in the retrosternal region and was infected by respiratory pathogens. Meanwhile, the patient developed recurrent laryngeal nerve (RLN) paralysis after surgery. PNH was not identified in the clinical manifestations; instead, it was detected only through successive cervical ultrasound examinations. Clinical Discussion: Although rare, PNH can lead to serious complications, especially delayed complications or those in atypical positions, without neck swelling. When simultaneously with RLN paralysis, the hematoma may be neglected. Therefore, early diagnosis and treatment are crucial. Conclusion: Clinicians should be vigilant of atypical PNH because neck swelling may be absent. Cervical ultrasonography is essential for diagnosis and can be performed multiple times. Cervical CT scans should be part of the routine procedure, while contrast-enhanced ultrasound can help detect active bleeding. Early postoperative antibiotics are recommended if the tumor is closely attached to the trachea.

Prevalence, Risk Factors, and Metabolic Characteristics of Metabolically Healthy Obesity in Patients Seeking Bariatric Surgery: A Cohort Study.

BACKGROUND: Bariatric surgery is an effective treatment for morbid obesity. However, a subset of individuals seeking bariatric surgery may exhibit a metabolically healthy obesity (MHO) phenotype, suggesting that they may not experience metabolic complications despite being overweight. OBJECTIVE: This study aimed to determine the prevalence and metabolic features of MHO in a population undergoing bariatric surgery. METHODS: A representative sample of 665 participants aged 14 or older who underwent bariatric surgery at our center from January 1, 2010 to January 1, 2020 was included in this cohort study. MHO was defined based on specific criteria, including blood pressure, waist-to-hip ratio, and absence of diabetes. RESULTS: Among the 665 participants, 80 individuals (12.0%) met the criteria for MHO. Female gender (P = .021) and younger age (P < .001) were associated with a higher likelihood of MHO. Smaller weight and BMI were observed in individuals with MHO. However, a considerable proportion of those with MHO exhibited other metabolic abnormalities, such as fatty liver (68.6%), hyperuricemia (55.3%), elevated lipid levels (58.7%), and abnormal lipoprotein levels (88%). CONCLUSION: Approximately 1 in 8 individuals referred for bariatric surgery displayed the phenotype of MHO. Despite being metabolically healthy based on certain criteria, a significant proportion of individuals with MHO still exhibited metabolic abnormalities, such as fatty liver, hyperuricemia, elevated lipid levels, and abnormal lipoprotein levels, highlighting the importance of thorough metabolic evaluation in this population.

Giant lipoma in the Retzius space resected under laparoscopy: A case report.

Lipoma is a common type of benign soft tissue tumor that can occur in the shoulders, neck and back, in addition to other body parts. The Retzius space is a small anatomical space between the pubic symphysis and the bladder located extraperitoneally and filled with loose fatty connective tissue. Giant lipomas are rare in the Retzius space. A 61-year-old Chinese male arrived at Beijing Yanhua Hospital (Beijing, China) due to frequent urination, and CT scan images of the lower abdomen observed a large pelvic mass and left inguinal hernia. Preoperative clinical manifestations and auxiliary examination suggested that the tumor originated from the urinary bladder wall. The maximum tumor diameter was ~25 cm and abdominal pressure was increased. Therefore, laparoscopic pelvic tumor resection combined with inguinal hernia repair was attempted. Intraoperatively, the tumor was found to originate from the Retzius space and the postoperative pathological diagnosis was lipoma. The present case report may serve as a reference for minimally invasive treatment of this type of rare disease in future.

Long-term weight loss outcome of laparoscopic Roux-en-Y gastric bypass predicted by weight loss at 6 months in Chinese patients with BMI ≥ 32.5 kg/m2.

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is classic bariatric procedure with long-term safety and efficacy. However, no studies have focused on predicting long-term weight loss after LRYGB in Chinese patients with body mass index (BMI) ≥ 32.5 kg/m2. To explore the relationship between initial and long-term weight loss after LRYGB in patients with BMI ≥ 32.5 kg/m2. All patients were followed-up to evaluate BMI, percentage of excess weight loss (%EWL), and comorbidities. Linear and logistic regression were performed to assess the relationship between initial and long-term weight loss. Receiver operating characteristic curve was used to determine optimal cutoff value. We enrolled 104 patients. The median preoperative BMI was 41.44 (37.92-47.53) kg/m2. %EWL ≥ 50% at 5 years was considered as successful weight loss, and 75.00% of the patients successfully lost weight. The cure rates of hypertension, hyperlipidemia, and type 2 diabetes mellitus at 1 year were 84.38%, 33.93%, and 60.82%, respectively. %EWL at 6 months and 5 years were positively correlated and its relationship could be described by following linear equation: %EWL5 years = 43.934 + 0.356 × %EWL6 months (P < .001; r2 = 0.166). The best cutoff %EWL at 6 months after LRYGB to predict 5-year successful weight loss was 63.93% (sensitivity, 53.85%; specificity, 84.62%; area under the curve (AUC) = 0.671). In Chinese patients with BMI ≥ 32.5 kg/m2, %EWL at 6 months and 5 years were positively correlated and %EWL at 5 years could be calculated by following linear equation: %EWL5 years = 43.934 + 0.356 × %EWL6 months.

Analysis of Correlation between Age and Satisfied Total Weight Loss Percentage Outcome at 1 Year after Bariatric Surgery using the Restricted Cubic Spline Function: A Retrospective Study in China.

OBJECTIVE: This study aims to explore the relationship between age and whether the percentage of total weight loss (TWL%) is ≥ 25% or not at 1 year after bariatric surgery (BS). We aimed to provide evidence for the stratified treatment of spatients with obesity at different ages. METHODS: The primary outcome evaluated was whether TWL% was no less than 25% at 1 year after BS. A TWL% ≥ 25% was defined as a satisfied TWL% outcome. Logistic regression analysis and the restricted cubic spline (RCS) function were used to analyze the relationship between age and the satisfied TWL% outcome at 1 year after BS. RESULTS: Two hundred and ninety-one patients were included in our study. After adjusting for potential confounders, the odds ratios (ORs) of the corresponding quartiles of age associated with satisfied TWL% outcome were 1.00 (reference), 1.117 [95% confidence interval (95% CI) = 0.540-2.311], 1.378 (95% CI = 0.647-2.935), and 0.406 (95% CI = 0.184-0.895). RCS analysis revealed a non-linear inverted L-shaped association between age and satisfied TWL% outcome at 1 year after BS (non-linear P = 0.033). CONCLUSION: Age was an independent predictor of satisfied TWL% outcome one year following BS, and our study considered 32 years as a potential cut-off point. For Chinese patients over the age of 32 who are eligible for BS, it may be beneficial to do BS earlier as the probability of achieving a satisfied TWL% outcome may decrease with age.

An Assessment of the Effect of Bariatric Surgery on Cardiovascular Disease Risk in the Chinese Population Using Multiple Cardiovascular Risk Models.

Background: Many studies have reported that bariatric surgery may reduce postoperative cardiovascular risk in patient with obesity, but few have addressed this risk in the Chinese population. Objective: To assess the impact of bariatric surgery on cardiovascular disease (CVD) risk in the Chinese population using the World Health Organization (WHO) risk model, the Global risk model, and the Framingham Risk Score. Methods: We retrospectively analyzed data collected on patient with obesity who underwent bariatric surgery at our institution between March 2009 and January 2021. Their demographic characteristics, anthropometric variables, and glucolipid metabolic parameters were assessed preoperatively and at their 1-year postoperative follow-up. Subgroup analysis compared body mass index (BMI) < 35 kg/m2 and BMI ≥ 35 kg/m2, as well as gender. We used the 3 models to calculate their CVD risk. Results: We evaluated 61 patients, of whom 26 (42.62%) had undergone sleeve gastrectomy (SG) surgery and 35 (57.38%) Roux-en-Y gastric bypass (RYGB) surgery. Of the patients with BMI ≥ 35 kg/m2, 66.67% underwent SG, while 72.97% with BMI < 35 kg/m2 underwent RYGB. HDL levels were significantly higher at 12 months postoperatively relative to baseline. When the models were applied to calculate CVD risk in Chinese patients with obesity, the 1-year CVD risk after surgery were reduced lot compared with the preoperative period. Conclusion: Patient with obesity had significantly lower CVD risks after bariatric surgery. This study also demonstrates that the models are reliable clinical tools for assessing the impact of bariatric surgery on CVD risk in the Chinese population.

Comparison between cutting versus retraction of anterior cervical musculature during endoscopic thyroidectomy.

To compare the different techniques of managing the anterior cervical muscle group during endoscopic thyroidectomy via the trans-thoraco-areolar approach. A total of 90 patients with thyroid tumors less than 3 cm were evaluated. The time for each intraoperative step, total surgery duration, intraoperative blood loss volume, pathology results, number of lymph nodes dissected and patient satisfaction with esthetics were assessed. Intraoperative blood loss volume, drainage volume on the first postoperative day, number of lymph nodes dissected in the central region, postoperative hospitalization duration, number of transient laryngeal nerve palsy cases, and number of transient hypocalcemia cases were similar between the muscle transection (MT) and muscle retraction (MR) groups. The MT group had significantly higher postoperative pain scores after 12 hours, but pain scores at 48 hours postoperatively were not significantly different between the 2 groups. In the unilateral thyroidectomy subgroup, the durations of isthmus resection, freeing the lateral thyroid, exposing the laryngeal recurrent nerve, and management of the inferior pole were similar for both muscle management methods. The muscle dissection and suture time was significantly longer for the MT group than that for the MR group; in contrast, the upper pole management time of the muscle resection group was significantly shorter. In the bilateral resection subgroup, both muscle management methods required similar durations for managing the contralateral upper pole after ipsilateral thyroidectomy. However, intraoperative blood loss was significantly higher for MR than for MT, while postoperative pain was relatively mild. In the malignant tumor subgroup, duration of inferior thyroid pole management was significantly less for MT than for MR. There are significant differences between the 2 muscle management methods in handling and suturing muscles. Both methods have satisfactory postoperative outcomes for resection of thyroid nodules with diameters ≤3 cm. For tumors located in the upper pole, transection of the anterior cervical muscles confers higher feasibility of the thyroidectomy technique; however, suturing becomes difficult in such scenarios.

Weight loss at six months is the surrogate of long-term treatment outcomes for obese Chinese with a BMI less than 35 kg/m2 undergoing Roux-en-Y gastric bypass.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) is considered the gold standard procedure for bariatric surgery that leads to sustained weight loss and amelioration of obesity-related comorbidities. OBJECTIVES: To verify long-term efficacy and safety and to investigate the influence of early weight loss on post-RYGB long-term weight maintenance in obese Chinese with body mass index (BMI) < 35 kg/m2. METHODS: All patients were followed up for evaluating the variations in their BMI, percentage of excess weight loss (%EWL), and total body percentage weight loss (%TWL). Linear regression models were applied to evaluate the effects of early weight loss on successful weight maintenance. Optimal cutoff values were analyzed via plotting the receiver operative characteristic (ROC) curve. RESULTS: In the current study, 143 patients were recruited. Preoperative BMI and weight were recorded as 32.24 (29.39-33.12) kg/m2, and 88.90 ± 9.52 kg, respectively. At 1, 3, and 5 years, successful weight loss i.e., greater than 25% TWL was attained by 46.85%, 37.76%, and 37.06% of patients, respectively. The obtained data revealed that %TWL at 0.5 years was considerably associated with %TWL for up to 5 years (P-value <0.001). Based on the ROC curve, %TWL of 24.39% at 0.5 years best predicted effective weight loss at 5 years (sensitivity 71.70%, specificity 82.22%). CONCLUSION: RYGB is a safe and effective approach for weight loss and %TWL at 6 months might be used for predicting weight maintenance up to 5 years post-RYGB in obese Chinese with a BMI <35 kg/m2.

Comparison of the open tension-free mesh-plug, transabdominal preperitoneal (TAPP), and totally extraperitoneal (TEP) laparoscopic techniques for primary unilateral inguinal hernia repair: a prospective randomized controlled trial.

BACKGROUND: The open tension-free mesh-plug hernia technique, transabdominal preperitoneal (TAPP) technique, and totally extraperitoneal (TEP) laparoscopic technique all are common surgical procedures for primary unilateral inguinal hernia repair. However, the choice of the right surgical procedure still is controversial in China. This study aimed to compare open tension-free hernioplasty with two laparoscopic hernia repairs. METHODS: In this study, 164 male patients with primary unilateral inguinal hernia were randomized to undergo an open operation with mesh-plug and patch, TAPP, or TEP. RESULTS: Completion of the study required 3 years, from February 2006 to February 2009. Of the 164 patients, 62 underwent open repair, 50 had TAPP, and 52 had TEP. The patients then were followed up for 15.6 ± 8.5 months. The average operating time for the open repair group was significantly shorter than for the other two groups (p < 0.001). The cost for the open repair group also was significantly less than for the other two groups (p < 0.001). By contrast, the pain scores in the open mesh group were significantly higher than in the other two groups (p < 0.001). The hospital stay and the recovery time both were significantly longer in open repair group than in the other two groups (p < 0.001). No major complications or recurrence was found in any of the groups. CONCLUSIONS: The findings show that open tension-free mesh-plug hernia repair, TAPP, and TEP are safe and effective for patients with primary unilateral inguinal hernia. Both TAPP and TEP are superior to open repair in terms of less postoperative pain and faster recovery time. The authors therefore recommend laparoscopic repair techniques as the preferable choice of surgical procedure. However, they think open repair will remain a practical solution in China because of its lower cost, short learning period, and need for no special equipment.

In vitro and in vivo studies of biodegradable Zn-Li-Mn alloy staples designed for gastrointestinal anastomosis.

Zn-0.8 wt.% Li-0.1 wt.% Mn wire with the diameter of 0.3 mm was fabricated and further processed into gastrointestinal staple, and its in vitro and in vivo biodegradation behavior and biocompatibility were studied systematically. The experimental Zn-Li-Mn alloy staple could deform from the original U-shape to B-shape without fracture, indicating its good mechanical property. Due to the residual stress concentration caused by anastomosis deformation, the feet and leg arc part of the staple were more prone to degradation. The Zn-Li-Mn alloy staple sustained integrity after immersion in Hanks' solution and simulated gastric fluid (SGF) for 28 days, and the degradation rate in SGF was about 4 times of that in Hanks' solution. Furthermore, Zn-Li-Mn alloy staples were utilized for gastrointestinal anastomosis in pig models, with clinically-used titanium alloy staples as a comparison. No anastomotic leakage and severe inflammation were observed after operation. The Zn-Li-Mn alloy staple maintained mechanical integrity within 8 weeks' implantation. The gastrointestinal tissue healed after 12 weeks, and no obvious side effects were detected during the whole implantation period, demonstrating the good biocompatibility of Zn-Li-Mn alloy staple. Thus, Zn-Li-Mn alloy staple fabricated in this work displayed the promising potential in the gastrointestinal anastomosis.

Early Weight Loss after Laparoscopic Sleeve Gastrectomy Predicts Sustained Weight Maintenance Among Chinese Individuals with a BMI < 35 kg/m2.

OBJECTIVES: This study assessed the efficacy and safety of laparoscopic sleeve gastrectomy (LSG) in Chinese individuals with a body mass index (BMI) under 35 kg/m2 and to explore the association between early weight loss and sustained weight maintenance. METHODS: Patients whose BMI < 35 kg/m2 were recruited. Changes in BMI, total weight loss (%TWL), and excess weight loss (%EWL) were evaluated, with successful weight loss being a %EWL of > 50% and a %TWL of > 25%. Binary logistic regression was employed to assess relationships between %EWL and %TWL and to calculate a joint predictor. The association between early weight loss and sustained weight maintenance was assessed as a function of %EWL, %TWL, and this joint predictor, with receiver operating characteristic (ROC) curves being used for optimal cutoff threshold identification. RESULTS: In total, 143 individuals with average preoperative weight and BMI values of 88 (82, 95) kg and 31.99 (29.41, 33.15) kg/m2, respectively, were enrolled in present study. At 5 years, 48.00% of patients achieved successful weight loss. Both 3-month %EWL and %TWL were significantly related to sustained weight loss at 5 years (P < 0.05). ROC curves were used to identify %TWL of 19.54% at 3 months as the most reliable predictor of weight loss at a 5-year follow-up (sensitivity: 61.11%, specificity: 76.92%). CONCLUSION: LSG had long-term safety and efficacy, and %TWL at 3 months can predict sustained 5-year weight loss in Chinese individuals with BMI < 35 kg/m2.

Primary SADI-S in Chinese with Diabetes and BMI < 35 kg/m2: a Retrospective Study with 2-Year Follow-up.

BACKGROUND: Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a bariatric procedure based on the standard duodenal switch surgery. It was first introduced in 2007 as a procedure for individuals with clinically severe obesity. Till date, primary SADI-S has not been used on Chinese with diabetes and body mass index (BMI) < 35 kg/m2. OBJECTIVES: Here, we account the use of this novel surgery in Chinese with diabetes and BMI < 35 kg/m2. METHODS: All relevant medical information, involving patients with diabetes and BMI < 35 kg/m2, who received primary SADI-S at Beijing Shijitan Hospital from June 2017 to December 2018, was retrospectively assessed. RESULTS: Twenty-six patients were selected for evaluation, and all of them completed a 2-year follow-up. The age, diabetic duration, and preoperative BMI were 35.5 (range 20-63) years, 3.5 (range 0.5-18) years, and 34.40 (range 28.74-34.96) kg/m2, respectively. At 24 months, the percentage of total body weight loss (%TWL) and BMI were 26.26 (range 13.33-43.88) and 24.72 (range 17.96-29.07) kg/m2, respectively. There were no serious complications or sequelae within a 2-year follow-up. In addition, for diabetes, 20/23 people achieved complete remission, whereas 3 achieved partial remission. CONCLUSION: SADI-S is a highly effective and feasible bariatric surgery for Chinese having diabetes and BMI < 35 kg/m2. However, care must be taken to follow a strict criteria for patient selection and to monitor patients carefully for the detection of postoperative nutritional sequelae.

Retrospective Comparison of SADI-S Versus RYGB in Chinese with Diabetes and BMI< 35kg/m2: a Propensity Score Adjustment Analysis.

BACKGROUND: As a modification of the duodenal switch (DS), single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) has recently become very popular and is successful for weight loss and T2DM remission. However, current studies have been mostly aimed at patients with severe obesity. OBJECTIVES: In this study, we firstly compare primary SADI-S to the Roux-en-Y gastric bypass (RYGB) in Chinese with diabetes and BMI< 35 kg/m2. METHODS: Using a propensity score (PS) matching analysis, we analyzed all patients with diabetes and BMI< 35 kg/m2 who underwent primary SADI-S or RYGB. All surgeries were conducted by a single surgeon at a Chinese center from June 2017 to January 2019. RESULTS: Twenty-six patients who underwent SADI-S and 65 patients who underwent RYGB were included in our analysis. Of these, 26 (100%) of patients in the SADI-S group and 43 (66%) of patients in the RYGB group completed the 24-month follow-up. No severe perioperative complication was observed in either group. There was a statistically higher percentage of total weight loss with SADI-S at the 2-year follow-up when compared to RYGB (p = 0.017 after PS correction). After PS adjustment, 76.5% of patients in the SADI-S group and 82.4% of patients in the RYGB group achieved complete remission of T2DM (p = 1.000). Nutritional outcomes were similar in the two groups. CONCLUSION: In Chinese with diabetes and BMI< 35 kg/m2, with comparable T2DM remission and nutritional outcomes, primary SADI-S allows for better weight loss than RYGB. Compared with RYGB, SADI-S is also a safe, effective, and feasible treatment for these patients.

Early Weight Loss Following Laparoscopic Sleeve Gastrectomy Is Predictive of Long-Term Weight Loss in Morbidly Obese Chinese.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is a bariatric surgical approach often used to treat Chinese individuals suffering from morbid obesity. OBJECTIVES: To verify the long-term safety and efficiency of LSG and to evaluate the predictive effect of initial weight loss on long-term weight maintenance after LSG in morbidly obese Chinese. METHODS: Follow-up was conducted by telephone or in hospital. We measured the body mass index (BMI), percentage of total body weight loss (%TWL), and excess weight loss (%EWL), and assessed patients for the alleviation of co-morbidities. Relationships between initial weight loss and successful weight maintenance were assessed via linear regression analyses, while optimal cutoff values were determined based on receiver operative characteristic (ROC) curves. RESULTS: We included 384 patients in this study. Before surgery, these patients had median weight and BMI values of 110 (91.00-130.75) kg and 38.49 (32.82-44.12) kg/m2, respectively. Successful weight loss of > 50% EWL was accomplished in 91.21%, 82.69%, and 79.37% of patients at 1, 3, and 5 years after surgery. In addition, the %EWL at 6 months was significantly correlated with the %EWL up to 5 years (P < 0.001) in morbidly obese Chinese. Based on the ROC curve, the EWL of 56.54% at 6 months was the best predictor of successful weight loss at 5 years (sensitivity 72.38%, specificity 82.69%) in morbidly obese Chinese. CONCLUSION: LSG has long-term safety and efficacy for morbidly obese Chinese patients. The %EWL at 6 months can be used to predict weight maintenance up to 5 years after LSG.

DNASE1L3 as a Prognostic Biomarker Associated with Immune Cell Infiltration in Cancer.

OBJECTIVES: Deoxyribonuclease 1 like 3 (DNASE1L3) is critically involved in apoptosis and immune response, however, its role in cancer has yet to be deciphered. We aimed to explore the prognostic value of DNASE1L3 across a series of malignancies. METHODS: Based on Oncomine database and Tumor Immune Estimation Resource (TIMER), expression profiling of DNASE1L3 was detailed in malignancies. Using PrognoScan, Kaplan-Meier Plotter, GEPIA2, and bc-GenEcMiner v4.5, prognostic value of DNASE1L3 was estimated in diverse cancers. Based on TIMER, association between DNASEL13 expression and immune infiltration was examined in various cancers. Then, mRNA level of DNASE1L3 in hepatocellular carcinoma (HCC) samples (n=22) and stomach adenocarcinoma (STAD) samples (n=17) was measured with qRT-PCR. Immunohistochemistry was performed to confirm expression of DNASE1L3 in paraffin-embedded tissues of HCC (n=9) and lung adenocarcinoma (n=20). RESULTS: DNASE1L3 was downregulated in multiple cancers, including breast invasive carcinoma (BRCA), cholangiocarcinoma (CHOL), liver hepatocellular carcinoma (LIHC), and lung adenocarcinoma (LUAD). A lower level of DNASE1L3 correlated with poorer prognosis in various cancers, especially in breast, liver, kidney, stomach, lung adenocarcinoma and sarcoma (SARC). Moreover, DNASE1L3 was positively related to immune cell infiltration in many cancers, including BRCA, LIHC, STAD, LUAD, and SARC. DNASE1L3 was significantly associated with CCR7/CCL19 in cancers. DNASE1L3 was downregulated in HCC and STAD tissues as demonstrated by qRT-PCR, as well as in HCC and LUAD samples, as shown by immunohistochemistry. CONCLUSION: DNASE1L3 has potential to serve as a prognostic biomarker in cancer of the breast, kidney, liver, stomach, lung adenocarcinoma and sarcoma. Down-regulation of DNASE1L3 may participate in immune escape via CCR7/CCL19 axis.

Key Candidate Prognostic Biomarkers Correlated with Immune Infiltration in Hepatocellular Carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is the most common subtype of primary liver cancer, which causes ~800,000 deaths annually world-wide. Immune checkpoint inhibitor (ICI) has reformed cancer therapy and achieved unprecedented results in various malignancies, including HCC. However, the response rate of immunotherapy is very low in HCC. Considereing the complicated and unique immune status in liver, we hypothesize that critical molecules will affect prognosis and correlate with immune context in the tumor microenvironment of HCC. METHODS: Using Kaplan-Meier plotter, GEPIA2 and Integrative Molecular Database of Hepatocellular Carcinoma (HCCDB), survival genes and their prognostic value were estimated in HCC. Based on Tumor Immune Estimation Resource (TIMER), association between survival genes and immune infiltration was examined in HCC. FunRich and STRING were used to analyze gene ontology and protein-protein interaction (PPI) Network, qRT-PCR was used to measure mRNA level of candidates; and a Cell Counting Kit-8 was used to measure proliferation of HCC cell line. RESULTS: Using multiple databases, we identified 36 key prognostic genes highly expressed in HCC and associated with poor survival of patients. Meanwhile, the 36 gene signatures correlated with immune infiltration in HCC. Moreover, these genes were significantly associated with exhausted T cells and polymorphonuclear myeloid-derived suppressor cells (PMN-MDSCs) in HCC. Among the 36 key genes, SKA3, SGOL2, SPINDOC, TEDC2, TMCO3 and NUP205 were highly expressed in tumor samples compared with adjacent normal tissues in our HCC cohort (n=22). Additionally, proliferation of SMMC7721 cell line was inhibited when it interfered with SiRNA of each gene. CONCLUSION: The 36 genes may serve as potential prognostic biomarkers and molecular targets to ameliorate tumor immune microenvironment (TIME) in HCC and therefore represent a novel avenue for individualized immunotherapy in HCC.

K-Wire Retractor, a Trocar-Free Liver Retraction Technique in Bariatric Surgery.

BACKGROUND: Liver retractor helps in the provision of an adequate operative field in bariatric surgery. Though several retractors have been introduced, an optimal retraction method is yet to be desired. We have developed a K-wire retractor, a simple trocar-free liver retractor used in our bariatric surgery. The efficacy and safety of the K-wire retractor were examined. METHODS: A retrospective review was performed on patients undergoing laparoscopic bariatric surgery from January 2016 to April 2019. Based on the application of liver retractors during surgery, patients were divided into the K-wire retractor group and the suture-based retractor group for comparative analyses. Patients with severe liver injury or missing data, or treated with other types of retractors were excluded. RESULTS: A total of 317 patients were included in our study and there was no conversion to open surgery. There were no significant differences in patient demographics (age, gender, BMI) and types of bariatric surgery between the two groups. The time taken for placement of retractor was significantly shorter in the K-wire retractor group, in addition to higher operative view score and lesser ALT/AST elevation compared with the suture-based retractor group. Although the K-wire retractor group was less inclined to require additional retraction techniques, patients with BMI ≥ 50 Kg/m2 were associated with higher risk (OR:3.8; 95% CI: 1.2, 12.8) of requiring additional retractors. There were no severe K-wire retractor-related complications observed. CONCLUSION: The trocar-free K-wire liver retractor is safe, simple, and effective as a standard liver retraction method in bariatric surgery.

Single-Incision Transumbilical Laparoscopic Sleeve Gastrectomy with a Stomach Retractor in 20 Superobese Patients-a Video Vignette.

BACKGROUND: The safety and feasibility of single-incision transumbilical laparoscopic sleeve gastrectomy (SITU-LSG) have been proven in obese patients, with great aesthetics. However, it is not performed in superobese patients (BMI ≥ 50 kg/m2). We aimed to introduce the technical details of SITU-LSG with a stomach retractor in superobese patients. METHODS: Twenty superobese patients with a range of BMI from 50.00 to 55.77 kg/m2 underwent stomach retractor-assisted SITU-LSG. An intraoperative laparoscopic video has been anonymized and edited to demonstrate the course of the operation on superobese patient. RESULTS: The stomach retractor has a mini grasper end, which can be opened with external force and closed without force, and it was inserted from a 1.5-mm incision at the left upper abdomen. A Kirschner needle (K-needle) was inserted into the right diaphragmatic crura to retract the liver so that the pylorus and fundus of the stomach could be exposed adequately. Traction on the omentum majus and insertion of 34 Fr. Bougie tube were achieved with the aid of the stomach retractor. When endovascular gastrointestinal anastomosis staplers (Endo-GIAs) were used to resect the stomach, the resected gastric tissue was retracted by the stomach retractor. During the reinforce of staple line, the stomach retractor was used to press the proximal end of staple line into the purse string and immobilize the gastric sleeve. After surgery, the patients underwent uneventful postoperative courses. CONCLUSIONS: The stomach retractor facilitates SITU-LSG. The combinatory procedure is safe, feasible, and effective in superobese patients.

Laparoscopic Sleeve Gastrectomy Affects Coagulation System of Obese Patients.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is nowadays the most popular bariatric procedure for obesity. However, whether LSG increases the risk of thrombosis remains unclear. The aim of this study was to investigate potential effects of LSG on coagulation system. METHODS: Fifty-five obese patients underwent LSG between 2016 and 2018. The LSG was performed with pneumoperitoneum pressure maintained at 13 mmHg. Venous blood specimens were collected from each patient before surgery, at the end of pneumoperitoneum (i.e., 0 h after surgery), and at 24 h after surgery to determine prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), platelet count (PLT), D-dimer (D-D), red blood cell count (RBC), hematocrit (HCT), plateletcrit (PCT), cholesterol (CHOL), triglyceride (TRIG), and serum calcium (Ca). All patients were examined on the veins of the lower limbs by color Duplex sonography (CDS) before surgery and at 24 h after surgery, respectively. RESULTS: All patients successfully underwent LSG. No severe surgery-related complications were observed during 1-month follow-up after operation. Preoperative BMI was 43.6 ± 8.3 kg/m2. The levels of coagulation factors were within the normal range before surgery, except a relatively higher PLT. The PT and D-D were increased at 0 h and 24 h after surgery (P < 0.05), whereas APTT was decreased (P < 0.05). The postoperative FIB remained similar to the preoperative one (P > 0.05). The CDS identified no thrombus in the veins of the lower limbs, either before surgery or at 24 h after surgery. CONCLUSIONS: LSG may cause postoperative hypercoagulability of patients with obesity.