BACKGROUND The effects of viral hepatitis(VH)on type 2 diabetes(T2D)remain controversial.AIM To analyze the causal correlation between different types of VH and T2D using Mendelian randomization(MR).METHODS Single nuc...BACKGROUND The effects of viral hepatitis(VH)on type 2 diabetes(T2D)remain controversial.AIM To analyze the causal correlation between different types of VH and T2D using Mendelian randomization(MR).METHODS Single nucleotide polymorphisms of VH,chronic hepatitis B(CHB),chronic hepatitis C(CHC)and T2D were obtained from the BioBank Japan Project,European Bioinformatics Institute,and FinnGen.Inverse variance weighted,MREgger,and weighted median were used to test exposure-outcome associations.The MR-Egger intercept analysis and Cochran’s Q test were used to assess horizontal pleiotropy and heterogeneity,respectively.Leave-one-out sensitivity analysis was used to evaluate the robustness of the MR analysis results.RESULTS The MR analysis showed no significant causal relationship between VH and T2D in Europeans[odds ratio(OR)=1.028;95%confidence interval(CI):0.995-1.062,P=0.101].There was a negative causal association between CHB and T2D among East Asians(OR=0.949;95%CI:0.931-0.968,P<0.001),while there was no significant causal association between CHC and T2D among East Asians(OR=1.018;95%CI:0.959-1.081,P=0.551).Intercept analysis and Cochran’s Q test showed no horizontal pleiotropy or heterogeneity(P>0.05).Sensitivity analysis showed that the results were robust.CONCLUSION Among East Asians,CHB is associated with a reduced T2D risk,but this association is limited by HBV load and cirrhosis.Although VH among Europeans and CHC among East Asians are not associated with the risk of T2D,focusing on blood glucose in patients with CHC is still relevant for the early detection of T2D induced by CHCmediated pathways of hepatic steatosis,liver fibrosis,and cirrhosis.展开更多
Aortic dissection is the deadliest disease of the cardiovascular system.Type B aortic dissection accounts for 30%-60%of aortic dissections and is mainly treated by endovascular repair of thoracic endovascular aneurysm...Aortic dissection is the deadliest disease of the cardiovascular system.Type B aortic dissection accounts for 30%-60%of aortic dissections and is mainly treated by endovascular repair of thoracic endovascular aneurysm repair(TEVAR).However,patients are prone to various complications after surgery,with central nervous system injury being the most common,which seriously affects their prognosis and increases the risk of disability and death.Therefore,exploring the risk factors of central nervous system injury after TEVAR can provide a basis for its prevention and control.AIM To investigate the risk factors for central nervous system injury after the repair of a thoracic endovascular aneurysm with type B aortic dissection.METHODS We enrolled 306 patients with type B aortic dissection who underwent TEVAR at our hospital between December 2019 and October 2022.The patients were categorized into injury(n=159)and non-injury(n=147)groups based on central nervous system injury following surgery.The risk factors for central nervous system injury after TEVAR for type B aortic dissection were screened by comparing the two groups.Multivariate logistic regression analysis was performed.RESULTS The Association between age,history of hypertension,blood pH value,surgery,mechanical ventilation,intensive care unit stay,postoperative recovery times on the first day after surgery,and arterial partial pressure of oxygen on the first day after surgery differed substantially(P<0.05).Multivariate logistic regression analysis indicated that age,surgery time,history of hypertension,duration of mechanical ventilation,and intensive care unit stay were independent risk factors for central nervous system injury after TEVAR of type B aortic dissection(P<0.05).CONCLUSION For high-risk patients with central nervous system injury after TEVAR of type B aortic dissection,early intervention measures should be implemented to lower the risk of neurological discomfort following surgery in high-risk patients with central nervous system injury after TEVAR for type B aortic dissection.展开更多
BACKGROUND Fibroblast growth factor(FGF)15/19,which is expressed in and secreted from the distal ileum,can regulate hepatic glucose metabolism in an endocrine manner.The levels of both bile acids(BAs)and FGF15/19 are ...BACKGROUND Fibroblast growth factor(FGF)15/19,which is expressed in and secreted from the distal ileum,can regulate hepatic glucose metabolism in an endocrine manner.The levels of both bile acids(BAs)and FGF15/19 are elevated after bariatric surgery.However,it is unclear whether the increase in FGF15/19 is induced by BAs.Moreover,it remains to be understood whether FGF15/19 elevations contribute to improvements in hepatic glucose metabolism after bariatric surgery.AIM To investigate the mechanism of improvement of hepatic glucose metabolism by elevated BAs after sleeve gastrectomy(SG).METHODS By calculating and comparing the changes of body weight after SG with SHAM group,we examined the weight-loss effect of SG.The oral glucose tolerance test(OGTT)test and area under the curve of OGTT curves were used to assess the anti-diabetic effects of SG.By detecting the glycogen content,expression and activity of glycogen synthase as well as the glucose-6-phosphatase(G6Pase)and phosphoenolpyruvate carboxykinase(Pepck),we evaluated the hepatic glycogen content and gluconeogenesis activity.We examined the levels of total BA(TBA)together with the farnesoid X receptor(FXR)-agonistic BA subspecies in systemic serum and portal vein at week 12 post-surgery.Then the histological expression of ileal FXR and FGF15 and hepatic FGF receptor 4(FGFR4)with its corresponding signal pathways involved in glucose metabolism were detected.RESULTS After surgery,food intake and body weight gain of SG group was decreased compare with the SHAM group.The hepatic glycogen content and glycogen synthase activity was significantly stimulated after SG,while the expression of the key enzyme for hepatic gluconeogenesis:G6Pase and Pepck,were depressed.TBA levels in serum and portal vein were both elevated after SG,the FXR-agonistic BA subspecies:Chenodeoxycholic acid(CDCA),lithocholic acid(LCA)in serum and CDCA,DCA,LCA in portal vein were all higher in SG group than that in SHAM group.Consequently,the ileal expression of FXR and FGF15 were also advanced in SG group.Moreover,the hepatic expression of FGFR4 was stimulated in SG-operated rats.As a result,the activity of its corresponding pathway for glycogen synthesis:FGFR4-Ras-extracellular signal regulated kinase pathway was stimulated,while the corresponding pathway for hepatic gluconeogenesis:FGFR4-cAMP regulatory element-binding protein-peroxisome proliferator-activated receptorγcoactivator-1αpathway was suppressed.CONCLUSION Elevated BAs after SG induced FGF15 expression in distal ileum by activating their receptor FXR.Furthermore,the promoted FGF15 partly mediated the improving effects on hepatic glucose metabolism of SG.展开更多
Cone penetration testing (CPT) is a cost effective and popular tool for geotechnical site characterization. CPT consists of pushing at a constant rate an electronic penetrometer into penetrable soils and recording con...Cone penetration testing (CPT) is a cost effective and popular tool for geotechnical site characterization. CPT consists of pushing at a constant rate an electronic penetrometer into penetrable soils and recording cone bearing (q<sub>c</sub>), sleeve friction (f<sub>c</sub>) and dynamic pore pressure (u) with depth. The measured q<sub>c</sub>, f<sub>s</sub> and u values are utilized to estimate soil type and associated soil properties. A popular method to estimate soil type from CPT measurements is the Soil Behavior Type (SBT) chart. The SBT plots cone resistance vs friction ratio, R<sub>f</sub> [where: R<sub>f</sub> = (f<sub>s</sub>/q<sub>c</sub>)100%]. There are distortions in the CPT measurements which can result in erroneous SBT plots. Cone bearing measurements at a specific depth are blurred or averaged due to q<sub>c</sub> values being strongly influenced by soils within 10 to 30 cone diameters from the cone tip. The q<sub>c</sub>HMM algorithm was developed to address the q<sub>c</sub> blurring/averaging limitation. This paper describes the distortions which occur when obtaining sleeve friction measurements which can in association with q<sub>c</sub> blurring result in significant errors in the calculated R<sub>f</sub> values. This paper outlines a novel and highly effective algorithm for obtaining accurate sleeve friction and friction ratio estimates. The f<sub>c</sub> optimal filter estimation technique is referred to as the OSFE-IFM algorithm. The mathematical details of the OSFE-IFM algorithm are outlined in this paper along with the results from a challenging test bed simulation. The test bed simulation demonstrates that the OSFE-IFM algorithm derives accurate estimates of sleeve friction from measured values. Optimal estimates of cone bearing and sleeve friction result in accurate R<sub>f</sub> values and subsequent accurate estimates of soil behavior type.展开更多
BACKGROUND Bariatric procedures are considered superior to medical therapies in managing type 2 diabetes mellitus(T2DM).Laparoscopic Roux-en-Y gastric bypass(LRYGB)and laparoscopic sleeve gastrectomy(LSG)are the most ...BACKGROUND Bariatric procedures are considered superior to medical therapies in managing type 2 diabetes mellitus(T2DM).Laparoscopic Roux-en-Y gastric bypass(LRYGB)and laparoscopic sleeve gastrectomy(LSG)are the most commonly used procedures for weight loss and comorbidity resolution worldwide.However,it is not yet known whether the degree of T2DM is influenced by the choice of bariatric procedure.AIM To quantitatively compare T2DM resolution over 1-5 years follow-up by LRYGB and LSG in morbidly obese patients.METHODS We searched the selected databases for full-text English language clinical studies that compared the effectiveness of LRYGB and LSG for T2DM resolution.Review manager 5.3 was used for data analysis,and the overall effect summary was represented in a forest plot.RESULTS From 1,650 titles retrieved by an initial search,we selected nine studies for this research.We found insignificant differences for T2DM resolution by LRYGB and LSG,with an odds ratio of 0.93(95%CI:0.64-1.35,Z statistics=0.38,P=0.71).Additionally,subset analyses for T2DM resolution showed insignificant differences after 24 mo(χ^2=1.24,df=4,P=0.87,overall Z effect=0.23),36 mo(χ^2=0.41,df=2,P=0.81,overall Z effect=0.51),and 60 mo(χ^2=4.75,df=3,P=0.19,overall Z effect=1.20)by LRYGB and LSG.This study reports a T2DM remission rate of 82.3%by LRYGB and 80.7%by LSG.CONCLUSION This study reports similar T2DM resolution rates by both LRYGB and LSG during 1-5 years of follow-up.However,long-term follow-up of 10 years is needed to further substantiate these findings.展开更多
BACKGROUND It has been established that bariatric surgery,including laparoscopic sleeve gastrectomy(LSG),has a positive impact on type 2 diabetes mellitus(T2DM).However,less frequently T2DM is reported as a risk facto...BACKGROUND It has been established that bariatric surgery,including laparoscopic sleeve gastrectomy(LSG),has a positive impact on type 2 diabetes mellitus(T2DM).However,less frequently T2DM is reported as a risk factor for complications with this type of surgery.AIM To evaluate the safety of LSG in T2DM.METHODS A retrospective cohort study was conducted over patients admitted for LSG from January 2008 to May 2015.Data was collected through digitized records.Any deviation from normal postoperative care within the first 60 d was defined as an early complication,and further categorized into mild or severe.RESULTS Nine hundred eighty-four patients underwent LSG,among these 143(14.5%)were diagnosed with T2DM.There were 19 complications in the T2DM group(13.3%)compared to 59 cases in the non-T2DM(7.0%).Out of 19 complications in the T2DM group,12 were mild(8.4%)and 7 were severe(4.9%).Compared to the non-T2DM group,patients had a higher risk for mild complications(Odds-ratio 2.316,CI:1.163-4.611,P=0.017),but not for severe ones(P=0.615).An increase of 1% in hemoglobin A1c levels was associated with a 40.7% increased risk for severe complications(P=0.013,CI:1.074-1.843)but not for mild ones.CONCLUSION Our data suggest that LSG is relatively safe for patients with T2DM.Whether preoperative control of hemoglobin A1c level will lower the complications rate has to be prospectively studied.展开更多
Introduction: Sleeve Gastrectomy (SG) is becoming more popular due to its weight reducing effect and promising anti-diabetic efficacy. However, long term results are still lacking. Methods: The study focuses on anti-d...Introduction: Sleeve Gastrectomy (SG) is becoming more popular due to its weight reducing effect and promising anti-diabetic efficacy. However, long term results are still lacking. Methods: The study focuses on anti-diabetic efficacy of SG through retrospective analysis of data for patients who underwent SG in Germany from 2005 to 2011. Anti-diabetic efficacy was assessed at 1, 2 and up to 4 years after surgery. Results: 5400 morbidly obese patients underwent SG. Of these 5400 patients 13.2% (n = 712) were insulin treated (IT) and 21.6% (n = 1165) were non-insulin treated (NIT). Total follow-up was accomplished in 41.24% of patients. Percentage of remission and improvement (RI) at 1 year was 83.8% (80.2% for insulin treated (IT) vs. 85.1% for non-insulin treated (NIT)). RI% at 2 years dropped to 77.6% (76.9% for IT vs. 77.9% for NIT patients). With late follow up (up to 4 years), RI% was 65.9% (58.8% for IT vs. 66.7% for NIT patients). Difference between IT and NIT patients was insignificant. Conclusion: SG shows promising ant-diabetic efficacy at 1 year, 2 years and up to 4 years after surgery. This efficacy gradually drops with prolonged time interval after surgery and seems to be insignificantly higher among NIT vs. IT patients.展开更多
Background:The effect of bariatric surgery on type 2 diabetes mellitus(T2DM)control can be assessed based on predictive models of T2DM remission.Various models have been externally verified internationally.However,lon...Background:The effect of bariatric surgery on type 2 diabetes mellitus(T2DM)control can be assessed based on predictive models of T2DM remission.Various models have been externally verified internationally.However,long-term validated results after laparoscopic sleeve gastrectomy(LSG)surgery are lacking.The best model for the Chinese population is also unknown.Methods:We retrospectively analyzed Chinese population data 5 years after LSG at Beijing Shijitan Hospital in China between March 2009 and December 2016.The independent t-test,Mann–Whitney U test,and chi-squared test were used to compare characteristics between T2DM remission and non-remission groups.We evaluated the predictive efficacy of each model for longterm T2DM remission after LSG by calculating the area under the curve(AUC),sensitivity,specificity,Youden index,positive predictive value(PPV),negative predictive value(NPV),and predicted-to-observed ratio,and performed calibration using Hosmer–Lemeshow test for 11 prediction models.Results:We enrolled 108 patients,including 44(40.7%)men,with a mean age of 35.5 years.The mean body mass index was 40.3±9.1 kg/m^(2),the percentage of excess weight loss(%EWL)was(75.9±30.4)%,and the percentage of total weight loss(%TWL)was(29.1±10.6)%.The mean glycated hemoglobin A1c(HbA1c)level was(7.3±1.8)%preoperatively and decreased to(5.9±1.0)%5 years after LSG.The 5-year postoperative complete and partial remission rates of T2DM were 50.9%[55/108]and 27.8%[30/108],respectively.Six models,i.e.,"ABCD",individualized metabolic surgery(IMS),advanced-DiaRem,DiaBetter,Dixon et al’s regression model,and Panunzi et al’s regression model,showed a good discrimination ability(all AUC>0.8).The"ABCD"(sensitivity,74%;specificity,80%;AUC,0.82[95%confidence interval[CI]:0.74–0.89]),IMS(sensitivity,78%;specificity,84%;AUC,0.82[95%CI:0.73–0.89]),and Panunzi et al’s regression models(sensitivity,78%;specificity,91%;AUC,0.86[95%CI:0.78–0.92])showed good discernibility.In the Hosmer–Lemeshow goodness-of-fit test,except for DiaRem(P<0.01),DiaBetter(P<0.01),Hayes et al(P=0.03),Park et al(P=0.02),and Ramos-Levi et al’s(P<0.01)models,all models had a satifactory fit results(P>0.05).The P values of calibration results of the"ABCD"and IMS were 0.07 and 0.14,respectively.The predicted-to-observed ratios of the"ABCD"and IMS were 0.87 and 0.89,respectively.Conclusion:The prediction model IMS was recommended for clinical use because of excellent predictive performance,good statistical test results,and simple and practical design features.展开更多
基金Supported by National Natural Science Foundation of China,No.U21A20411.
文摘BACKGROUND The effects of viral hepatitis(VH)on type 2 diabetes(T2D)remain controversial.AIM To analyze the causal correlation between different types of VH and T2D using Mendelian randomization(MR).METHODS Single nucleotide polymorphisms of VH,chronic hepatitis B(CHB),chronic hepatitis C(CHC)and T2D were obtained from the BioBank Japan Project,European Bioinformatics Institute,and FinnGen.Inverse variance weighted,MREgger,and weighted median were used to test exposure-outcome associations.The MR-Egger intercept analysis and Cochran’s Q test were used to assess horizontal pleiotropy and heterogeneity,respectively.Leave-one-out sensitivity analysis was used to evaluate the robustness of the MR analysis results.RESULTS The MR analysis showed no significant causal relationship between VH and T2D in Europeans[odds ratio(OR)=1.028;95%confidence interval(CI):0.995-1.062,P=0.101].There was a negative causal association between CHB and T2D among East Asians(OR=0.949;95%CI:0.931-0.968,P<0.001),while there was no significant causal association between CHC and T2D among East Asians(OR=1.018;95%CI:0.959-1.081,P=0.551).Intercept analysis and Cochran’s Q test showed no horizontal pleiotropy or heterogeneity(P>0.05).Sensitivity analysis showed that the results were robust.CONCLUSION Among East Asians,CHB is associated with a reduced T2D risk,but this association is limited by HBV load and cirrhosis.Although VH among Europeans and CHC among East Asians are not associated with the risk of T2D,focusing on blood glucose in patients with CHC is still relevant for the early detection of T2D induced by CHCmediated pathways of hepatic steatosis,liver fibrosis,and cirrhosis.
文摘Aortic dissection is the deadliest disease of the cardiovascular system.Type B aortic dissection accounts for 30%-60%of aortic dissections and is mainly treated by endovascular repair of thoracic endovascular aneurysm repair(TEVAR).However,patients are prone to various complications after surgery,with central nervous system injury being the most common,which seriously affects their prognosis and increases the risk of disability and death.Therefore,exploring the risk factors of central nervous system injury after TEVAR can provide a basis for its prevention and control.AIM To investigate the risk factors for central nervous system injury after the repair of a thoracic endovascular aneurysm with type B aortic dissection.METHODS We enrolled 306 patients with type B aortic dissection who underwent TEVAR at our hospital between December 2019 and October 2022.The patients were categorized into injury(n=159)and non-injury(n=147)groups based on central nervous system injury following surgery.The risk factors for central nervous system injury after TEVAR for type B aortic dissection were screened by comparing the two groups.Multivariate logistic regression analysis was performed.RESULTS The Association between age,history of hypertension,blood pH value,surgery,mechanical ventilation,intensive care unit stay,postoperative recovery times on the first day after surgery,and arterial partial pressure of oxygen on the first day after surgery differed substantially(P<0.05).Multivariate logistic regression analysis indicated that age,surgery time,history of hypertension,duration of mechanical ventilation,and intensive care unit stay were independent risk factors for central nervous system injury after TEVAR of type B aortic dissection(P<0.05).CONCLUSION For high-risk patients with central nervous system injury after TEVAR of type B aortic dissection,early intervention measures should be implemented to lower the risk of neurological discomfort following surgery in high-risk patients with central nervous system injury after TEVAR for type B aortic dissection.
基金the National Natural Science Foundation of China, No. 81600617
文摘BACKGROUND Fibroblast growth factor(FGF)15/19,which is expressed in and secreted from the distal ileum,can regulate hepatic glucose metabolism in an endocrine manner.The levels of both bile acids(BAs)and FGF15/19 are elevated after bariatric surgery.However,it is unclear whether the increase in FGF15/19 is induced by BAs.Moreover,it remains to be understood whether FGF15/19 elevations contribute to improvements in hepatic glucose metabolism after bariatric surgery.AIM To investigate the mechanism of improvement of hepatic glucose metabolism by elevated BAs after sleeve gastrectomy(SG).METHODS By calculating and comparing the changes of body weight after SG with SHAM group,we examined the weight-loss effect of SG.The oral glucose tolerance test(OGTT)test and area under the curve of OGTT curves were used to assess the anti-diabetic effects of SG.By detecting the glycogen content,expression and activity of glycogen synthase as well as the glucose-6-phosphatase(G6Pase)and phosphoenolpyruvate carboxykinase(Pepck),we evaluated the hepatic glycogen content and gluconeogenesis activity.We examined the levels of total BA(TBA)together with the farnesoid X receptor(FXR)-agonistic BA subspecies in systemic serum and portal vein at week 12 post-surgery.Then the histological expression of ileal FXR and FGF15 and hepatic FGF receptor 4(FGFR4)with its corresponding signal pathways involved in glucose metabolism were detected.RESULTS After surgery,food intake and body weight gain of SG group was decreased compare with the SHAM group.The hepatic glycogen content and glycogen synthase activity was significantly stimulated after SG,while the expression of the key enzyme for hepatic gluconeogenesis:G6Pase and Pepck,were depressed.TBA levels in serum and portal vein were both elevated after SG,the FXR-agonistic BA subspecies:Chenodeoxycholic acid(CDCA),lithocholic acid(LCA)in serum and CDCA,DCA,LCA in portal vein were all higher in SG group than that in SHAM group.Consequently,the ileal expression of FXR and FGF15 were also advanced in SG group.Moreover,the hepatic expression of FGFR4 was stimulated in SG-operated rats.As a result,the activity of its corresponding pathway for glycogen synthesis:FGFR4-Ras-extracellular signal regulated kinase pathway was stimulated,while the corresponding pathway for hepatic gluconeogenesis:FGFR4-cAMP regulatory element-binding protein-peroxisome proliferator-activated receptorγcoactivator-1αpathway was suppressed.CONCLUSION Elevated BAs after SG induced FGF15 expression in distal ileum by activating their receptor FXR.Furthermore,the promoted FGF15 partly mediated the improving effects on hepatic glucose metabolism of SG.
文摘Cone penetration testing (CPT) is a cost effective and popular tool for geotechnical site characterization. CPT consists of pushing at a constant rate an electronic penetrometer into penetrable soils and recording cone bearing (q<sub>c</sub>), sleeve friction (f<sub>c</sub>) and dynamic pore pressure (u) with depth. The measured q<sub>c</sub>, f<sub>s</sub> and u values are utilized to estimate soil type and associated soil properties. A popular method to estimate soil type from CPT measurements is the Soil Behavior Type (SBT) chart. The SBT plots cone resistance vs friction ratio, R<sub>f</sub> [where: R<sub>f</sub> = (f<sub>s</sub>/q<sub>c</sub>)100%]. There are distortions in the CPT measurements which can result in erroneous SBT plots. Cone bearing measurements at a specific depth are blurred or averaged due to q<sub>c</sub> values being strongly influenced by soils within 10 to 30 cone diameters from the cone tip. The q<sub>c</sub>HMM algorithm was developed to address the q<sub>c</sub> blurring/averaging limitation. This paper describes the distortions which occur when obtaining sleeve friction measurements which can in association with q<sub>c</sub> blurring result in significant errors in the calculated R<sub>f</sub> values. This paper outlines a novel and highly effective algorithm for obtaining accurate sleeve friction and friction ratio estimates. The f<sub>c</sub> optimal filter estimation technique is referred to as the OSFE-IFM algorithm. The mathematical details of the OSFE-IFM algorithm are outlined in this paper along with the results from a challenging test bed simulation. The test bed simulation demonstrates that the OSFE-IFM algorithm derives accurate estimates of sleeve friction from measured values. Optimal estimates of cone bearing and sleeve friction result in accurate R<sub>f</sub> values and subsequent accurate estimates of soil behavior type.
文摘BACKGROUND Bariatric procedures are considered superior to medical therapies in managing type 2 diabetes mellitus(T2DM).Laparoscopic Roux-en-Y gastric bypass(LRYGB)and laparoscopic sleeve gastrectomy(LSG)are the most commonly used procedures for weight loss and comorbidity resolution worldwide.However,it is not yet known whether the degree of T2DM is influenced by the choice of bariatric procedure.AIM To quantitatively compare T2DM resolution over 1-5 years follow-up by LRYGB and LSG in morbidly obese patients.METHODS We searched the selected databases for full-text English language clinical studies that compared the effectiveness of LRYGB and LSG for T2DM resolution.Review manager 5.3 was used for data analysis,and the overall effect summary was represented in a forest plot.RESULTS From 1,650 titles retrieved by an initial search,we selected nine studies for this research.We found insignificant differences for T2DM resolution by LRYGB and LSG,with an odds ratio of 0.93(95%CI:0.64-1.35,Z statistics=0.38,P=0.71).Additionally,subset analyses for T2DM resolution showed insignificant differences after 24 mo(χ^2=1.24,df=4,P=0.87,overall Z effect=0.23),36 mo(χ^2=0.41,df=2,P=0.81,overall Z effect=0.51),and 60 mo(χ^2=4.75,df=3,P=0.19,overall Z effect=1.20)by LRYGB and LSG.This study reports a T2DM remission rate of 82.3%by LRYGB and 80.7%by LSG.CONCLUSION This study reports similar T2DM resolution rates by both LRYGB and LSG during 1-5 years of follow-up.However,long-term follow-up of 10 years is needed to further substantiate these findings.
文摘BACKGROUND It has been established that bariatric surgery,including laparoscopic sleeve gastrectomy(LSG),has a positive impact on type 2 diabetes mellitus(T2DM).However,less frequently T2DM is reported as a risk factor for complications with this type of surgery.AIM To evaluate the safety of LSG in T2DM.METHODS A retrospective cohort study was conducted over patients admitted for LSG from January 2008 to May 2015.Data was collected through digitized records.Any deviation from normal postoperative care within the first 60 d was defined as an early complication,and further categorized into mild or severe.RESULTS Nine hundred eighty-four patients underwent LSG,among these 143(14.5%)were diagnosed with T2DM.There were 19 complications in the T2DM group(13.3%)compared to 59 cases in the non-T2DM(7.0%).Out of 19 complications in the T2DM group,12 were mild(8.4%)and 7 were severe(4.9%).Compared to the non-T2DM group,patients had a higher risk for mild complications(Odds-ratio 2.316,CI:1.163-4.611,P=0.017),but not for severe ones(P=0.615).An increase of 1% in hemoglobin A1c levels was associated with a 40.7% increased risk for severe complications(P=0.013,CI:1.074-1.843)but not for mild ones.CONCLUSION Our data suggest that LSG is relatively safe for patients with T2DM.Whether preoperative control of hemoglobin A1c level will lower the complications rate has to be prospectively studied.
文摘Introduction: Sleeve Gastrectomy (SG) is becoming more popular due to its weight reducing effect and promising anti-diabetic efficacy. However, long term results are still lacking. Methods: The study focuses on anti-diabetic efficacy of SG through retrospective analysis of data for patients who underwent SG in Germany from 2005 to 2011. Anti-diabetic efficacy was assessed at 1, 2 and up to 4 years after surgery. Results: 5400 morbidly obese patients underwent SG. Of these 5400 patients 13.2% (n = 712) were insulin treated (IT) and 21.6% (n = 1165) were non-insulin treated (NIT). Total follow-up was accomplished in 41.24% of patients. Percentage of remission and improvement (RI) at 1 year was 83.8% (80.2% for insulin treated (IT) vs. 85.1% for non-insulin treated (NIT)). RI% at 2 years dropped to 77.6% (76.9% for IT vs. 77.9% for NIT patients). With late follow up (up to 4 years), RI% was 65.9% (58.8% for IT vs. 66.7% for NIT patients). Difference between IT and NIT patients was insignificant. Conclusion: SG shows promising ant-diabetic efficacy at 1 year, 2 years and up to 4 years after surgery. This efficacy gradually drops with prolonged time interval after surgery and seems to be insignificantly higher among NIT vs. IT patients.
文摘目的分析体质量指数(Body mass index,BMI)与老年慢性心力衰竭(Chronic heart failure,CHF)患者血浆胱抑素C(cystatinC,Cys-C)、N末端B型利钠肽原(N-terminal pro-B-type natriuretic peptide,NT-proBNP)水平相关性,并分析血浆Cys-C、NT-proBNP评估老年CHF患者预后价值。方法选择2021年7月—2022年10月在本院接受治疗的192例老年慢性心力衰竭(CHF)患者作为研究对象,按照BMI指数分为肥胖组(49例)、超重组(68例)和正常组(75例)三组。对比各亚组患者血浆Cys-C、NT-proBNP水平差异,采用Pearson相关性分析的方式探究老年CHF患者BMI指数与血浆Cys-C、NT-proBNP相关性,对入组患者实施12个月随访,将患者按照预后情况区分为死亡组和存活组,对比两亚组患者血浆Cys-C、NT-proBNP水平差异并评估预后评估价值。结果肥胖组患者血浆Cys-C、NT-proBNP水平高于超重组,超重组患者血浆Cys-C、NT-proBNP水平高于正常组,差异具有统计学意义(P<0.05);入组老年CHF患者的BMI指数与其血浆Cys-C、NT-proBN水平均呈现明显的正相关性(r=0.7104,P<0.0001)(r=0.6603,P<0.0001);随访12个月显示,死亡组患者的血浆Cys-C、NT-proBNP水平显著高于存活组患者,差异具有统计学意义(P<0.05);血浆Cys-C、NT-proBNP对老年CHF预后评估曲线下面积(area under curv,AUC)为0.6930(P=0.0009)、0.7982(P<0.0001)。结论老年CHF患者随BMI指数升高,血浆Cys-C、NT-proBNP水平逐渐升高,血浆Cys-C、NT-proBNP对老年CHF临床结局具有一定的预测价值,进一步研究有推广应用于老年CHF预后评估潜力。
基金supported by Clinical Cooperation Ability Construction Project of Chinese and Western Medicine for Major and Difficult Diseases(Department of Medical Administration,National Administration of Traditional Chinese Medicine[2018]No.3)
文摘Background:The effect of bariatric surgery on type 2 diabetes mellitus(T2DM)control can be assessed based on predictive models of T2DM remission.Various models have been externally verified internationally.However,long-term validated results after laparoscopic sleeve gastrectomy(LSG)surgery are lacking.The best model for the Chinese population is also unknown.Methods:We retrospectively analyzed Chinese population data 5 years after LSG at Beijing Shijitan Hospital in China between March 2009 and December 2016.The independent t-test,Mann–Whitney U test,and chi-squared test were used to compare characteristics between T2DM remission and non-remission groups.We evaluated the predictive efficacy of each model for longterm T2DM remission after LSG by calculating the area under the curve(AUC),sensitivity,specificity,Youden index,positive predictive value(PPV),negative predictive value(NPV),and predicted-to-observed ratio,and performed calibration using Hosmer–Lemeshow test for 11 prediction models.Results:We enrolled 108 patients,including 44(40.7%)men,with a mean age of 35.5 years.The mean body mass index was 40.3±9.1 kg/m^(2),the percentage of excess weight loss(%EWL)was(75.9±30.4)%,and the percentage of total weight loss(%TWL)was(29.1±10.6)%.The mean glycated hemoglobin A1c(HbA1c)level was(7.3±1.8)%preoperatively and decreased to(5.9±1.0)%5 years after LSG.The 5-year postoperative complete and partial remission rates of T2DM were 50.9%[55/108]and 27.8%[30/108],respectively.Six models,i.e.,"ABCD",individualized metabolic surgery(IMS),advanced-DiaRem,DiaBetter,Dixon et al’s regression model,and Panunzi et al’s regression model,showed a good discrimination ability(all AUC>0.8).The"ABCD"(sensitivity,74%;specificity,80%;AUC,0.82[95%confidence interval[CI]:0.74–0.89]),IMS(sensitivity,78%;specificity,84%;AUC,0.82[95%CI:0.73–0.89]),and Panunzi et al’s regression models(sensitivity,78%;specificity,91%;AUC,0.86[95%CI:0.78–0.92])showed good discernibility.In the Hosmer–Lemeshow goodness-of-fit test,except for DiaRem(P<0.01),DiaBetter(P<0.01),Hayes et al(P=0.03),Park et al(P=0.02),and Ramos-Levi et al’s(P<0.01)models,all models had a satifactory fit results(P>0.05).The P values of calibration results of the"ABCD"and IMS were 0.07 and 0.14,respectively.The predicted-to-observed ratios of the"ABCD"and IMS were 0.87 and 0.89,respectively.Conclusion:The prediction model IMS was recommended for clinical use because of excellent predictive performance,good statistical test results,and simple and practical design features.
