The use of bariatric and metabolic surgery as a central treatment for obesity has been steadily increasing. BMI, as a widely used metric for assessing obesity, has considerable relevance in the field of metabolic research. However, its limitations, such as its inability to account for variations in fat distribution, remain a subject of considerable controversy. In recent years, there has been a surge of interest in the relationship between changes in body composition and the risk of metabolic disease. Consequently, the study of the effects of bariatric and metabolic surgery on changes in body composition has become a major focus of bariatric and metabolic surgery research. As a potential replacement for BMI, body composition measurements are expected to improve and standardize the assessment of the effectiveness of bariatric and metabolic surgery. This underscores the urgent need for the development of methods and standards for body composition measurement. This paper undertakes a comprehensive review of the existing evidence on the application of body composition measurement techniques for the efficacy evaluation of bariatric and metabolic surgery. The intent is to provide new insights and pave the way for the exploration of future research directions in this area.

The use of bariatric and metabolic surgery as a central treatment for obesity has been steadily increasing. BMI, as a widely used metric for assessing obesity, has considerable relevance in the field of metabolic research. However, its limitations, such as its inability to account for variations in fat distribution, remain a subject of considerable controversy. In recent years, there has been a surge of interest in the relationship between changes in body composition and the risk of metabolic disease. Consequently, the study of the effects of bariatric and metabolic surgery on changes in body composition has become a major focus of bariatric and metabolic surgery research. As a potential replacement for BMI, body composition measurements are expected to improve and standardize the assessment of the effectiveness of bariatric and metabolic surgery. This underscores the urgent need for the development of methods and standards for body composition measurement. This paper undertakes a comprehensive review of the existing evidence on the application of body composition measurement techniques for the efficacy evaluation of bariatric and metabolic surgery. The intent is to provide new insights and pave the way for the exploration of future research directions in this area.

Objective:To summarize and analyze the clinical data of Chinese patients with colony-stimulating factor 1 receptor (CSF1R)-related leukoencephalopathy, and clarify the phenotypic and genetic characteristics of Chinese patients.Methods:Medical history of patients with CSF1R-related leukoencephalopathy diagnosed from April 1, 2018 to January 31, 2021 in the department of neurology of 22 hospitals in China was collected, and scores of Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment Scale (MoCA), magnetic resonance severity scale were evaluated. Group comparison was performed between male and female patients.Results:A total of 62 patients were included, and the male-female ratio was 1∶1.95. The age of onset was (40.35±8.42) years. Cognitive impairment (82.3%, 51/62) and motor symptoms (77.4%,48/62) were the most common symptoms. The MMSE and MoCA scores were 18.79±7.16 and 13.96±7.23, respectively, and the scores of two scales in male patients (22.06±5.31 and 18.08±5.60) were significantly higher than those in females (15.53±7.41 , t=2.954, P=0.006; 10.15±6.26, t=3.328 , P=0.003). The most common radiographic feature was bilateral asymmetric white matter changes (100.0%), and the magnetic resonance imaging severity scale score was 27.42±11.40, while the white matter lesion score of females (22.94±8.39) was significantly higher than that of males (17.62±8.74 , t=-2.221, P<0.05). A total of 36 CSF1R gene mutations were found in this study, among which c.2381T>C/p.I794T was the hotspot mutation that carried by 17.9% (10/56) of the probands. Conclusions:The core phenotypic characteristics of CSF1R-related leukoencephalopathy in China are progressive motor and cognitive impairment, with bilateral asymmetrical white matter changes. In addition, there exist gender differences clinically, with severer cognitive impairment and imaging changes in female patients. Thirty-six CSF1R gene mutations were found in this study, and c.2381T>C/p. I794T was the hotspot mutation.

Objective:To analyze the effect of long-acting somatostatin treatment on blood glucose, blood lipid, insulin resistance and islet function in patients with acromegaly after surgical treatment.Methods:Self-control study before and after treatment was used. A total of 30 subjects who were diagnosed as acromegalyand received surgical treatment in Beijing Tiantan Hospital from January 2016 to January 2018 were enrolled in this study. Because patients′ growth hormone (GH) level was notc ompletely controlled after surgery, all the patients were treated with long-acting octreotide for more than 1 year. Before and 1 year after treatment, oral glucose tolerance testing (OGTT) was performed at pretreatment and 1 year after initiation of treatment with long-acting octreotide. Homeostatic model assessment (HOMA) was used to estimate insulin resistance (HOMA-IR) and β-cell function (HOMA-β). The HOMA-IR and HOMA-β were detected by 75 g glucose, insulin, C peptide release test and growth hormone suppression test to evaluate the therapy effects on insulin resistance and islet function.Results:The levels of GH, insulin-like growth factor 1(IGF-1), HOMA-IR, HOMA-β, and triacylglycerol(TG) were all decreased after 1 year of octreotide treatment compared with that before treatment: (2.8 ± 2.5) μg/L vs. (12.1 ± 10.5) μg/L, (356.8 ± 209.2) μg/L vs. (698.1 ± 207.3) μg/L, 1.56 ± 1.08 vs. 2.71 ± 1.52, 1.01 ± 0.97 vs. 4.87 ± 3.57, (1.12 ± 0.49) mmol/L vs. (1.76 ± 0.92) mmol/L, and the differences were statistically significant ( P<0.05). After treatment, the level of fasting blood glucose was increased compared with that before treatment: (5.83 ± 1.19) mmol/L vs.(5.11 ± 1.73) mmol/L, and the difference was statistically significant ( P<0.05). While there were no significant changes in postprandial 2 h blood glucose and glycosylated hemoglobin (GHb), total cholesterol (TC), low-density lipoprotein cholesterol(LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels before and after treatment ( P>0.05). Conclusions:Long-acting somatostatin therapy can effectively improve the insulin sensitivity of acromegaly patients, reduce β cell function, and slightly increase fasting blood glucose. It has no adverse effect on GHb, and can reduce the level of TG of the patients.

Objective:To explore the clinical characteristics of patients with pituitary thyrotropin-secreting adenoma and evaluate the effect of preoperative short-acting octreotide treatment on hyperthyroidism.Methods:A retrospective analysis was performed in 40 patients with pituitary thyrotropin adenoma diagnosed in Beijing Tiantan Hospital from January 2008 to January 2018. The general data, laboratory examinations and imaging findings were reviewed and analyzed. The clinical effect of preoperative octreotide on hyperthyroidism was evaluated.Results:The age of onset year of the 40 patients (male: female = 24∶16) was (30.5±5.1) years. Among them, 35 patients (87.5%) were with macroadenoma. The most common symptoms were thyroid hypermetabolism syndrome, followed by headache, dizziness, visual field damage and hypogonadism. The thyroid function of 30 patients (75%) recovered to normal within 3-5 days after the octreotide treatment. The total effective rate of the octreotide was 90.0%. The level of free thyroxine (FT 4) before treatment in patients with more than 10 times of effective cumulative dose was significantly higher than that in patients with less than 10 doses. Conclusions:Thyroid hypermetabolism syndrome and pituitary occupying effect are the most common clinical manifestations of thyrotropin-secreting adenoma. Preoperative octreotide treatment can effectively control hyperthyroidism. The level of FT 4 is a crucial factor affecting the efficacy of octreotide.

A novel coronavirus pneumonia (NCP) epidemic has occurred in Wuhan, Hubei Province since December 2019, caused by a novel coronavirus (2019-nCoV) never been seen previously in human. China has imposed the strictest quarantine and closed management measures in history to control the spreading of the disease. However, severe trauma can still occur in the NCP patients. In order to standardize the emergency treatment and the infection prevention and control of severe trauma patients with hidden infection, suspected or confirmed infection of 2019-nCoV, Trauma Surgery Branch of Chinese Medical Doctors' Association organized this expert consensus. The consensus illustrated the classification of the NCP patients, severe trauma patients in need of emergency surgery, emergency surgery type, hierarchical protection for medical personnel and treatment places. Meanwhile, the consensus standardized the screening, injury severity evaluation, emergency surgical treatment strategy and postoperative management strategy of severe trauma patients during the epidemic period of NCP, providing a basis for the clinical treatment of such kind of patients.

Objective:To summarize the clinical characteristics and treatment of pituitary thyrotropin mixed secreting adenoma.Methods:The clinical data of 9 patients with pituitary thyrotropin mixed secreting adenoma from January 2008 to December 2019 in Beijing Tiantan Hospital, Capital Medical University, were retrospectively analyzed.Results:Among 9 patients, male was in 7 cases, and female in 2 cases; age was (35.7 ± 13.5) years; course of disease was (3.8 ± 3.1) years; mixed thyrotropin and growth hormone secreting adenoma was in 6 cases; most of them were accompanied with different degrees of thyrotoxicosis, 6 with acromegaly and 2 with amenorrhea and lactation. All the tumors were pituitary macroadenoma, with aggressive growth. Only 1 patient was completely relieved after operation, and most patients needed combined treatment to control the disease.Conclusions:Mixed thyrotropin and growth hormone secreting adenoma is the most common type of the disease, the clinical manifestations are complex, and the tumor is aggressive growth, surgical treatment can not be completely relieved and radiotherapy and/or combination of medicine treatment can help to improve the condition.

Objective: To explore the correlation between serum uric acid level and disease activity in patients with growth hormone-secreting pituitary adenoma. Methods: The clinical data of 76 patients with growth hormone-secreting pituitary adenoma in the Department of Endocrinology of Beijing Tiantan Hospital, Capital Medical University from 2012 to 2018 were retrospectively analyzed. The patients were divided into 4 groups according to serum uric acid quartiles with 19 cases each, uric acid <233.9 μmol/L in Q₁ group, uric acid 233.9 to 275.9 μmol/L in Q₂ group, uric acid 276.0 to 366.7 μmol/L in Q₃ group, uric acid >366.7 μmol/L in Q₄ group. The sex, age, duration of disease, height, weight and blood pressure were collected, and the body mass index (BMI) was calculated. The fasting blood glucose (FBG), glycated hemoglobin, fasting insulin (FINS), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), uric acid, basal growth hormone, insulin-like growth factor-1 (IGF-1) were examined, and the IGF-1 index and homeostasis model assessment of insulin resistance (HMOA-IR) were calculated. Pearson correlation analysis was performed to explore the correlation between serum uric acid levels and disease activity. Results: In 76 patients, 8 cases were diagnosed with hyperuricemia, accounting for 10.5%. There were no statistical differences in sex constituent, duration of disease, systolic blood pressure, diastolic blood pressure, FBG, glycated hemoglobin, TG, TC, LDL-C, growth hormone and IGF-1 index among 4 groups (P>0.05). As uric acid level increased, age and HDL-C decreased gradually from Q₁ group to Q₄ group: (43.58 ± 8.95), (42.58 ± 10.89), (36.58 ± 9.79), (35.37 ± 11.51) years, (1.28 ± 0.22), (1.29 ± 0.23), (1.17 ± 0.28), (1.04 ± 0.22) mmol/L; while BMI, uric acid, IGF-1 and HOMA-IR increased gradually: (25.75 ± 2.86), (27.33 ± 3.94), (26.16 ± 2.94), (28.76 ± 3.69) kg/m², (190.73 ± 28.80), (249.57 ± 12.00), (325.75 ± 25.61), (430.39 ± 58.41) mmol/L, (594.50 ± 222.45), (733.06 ± 212.42), (774.90 ± 287.87), (962.00 ± 323.36) μg/L, 2.09 (1.64, 2.09), 3.02 (0.94, 3.55), 3.53 (2.31, 6.48), 4.09 (2.52, 5.41), there were statistical differences (P<0.05 or <0.01). Pearson correlation analysis result showed that uric acid was positive correlation with IGF-1, IGF-1 index, HOMA-IR, TG and systolic blood pressure (r = 0.491, 0.341, 0.372, 0.240 and 0.266; P<0.01 or <0.05), and uric acid was negative correlation with HDL-C (r = -0.367, P<0.01). After adjustment for sex, age, duration of disease and BMI, uric acid was still positive correlation with IGF-1 and IGF-1 index (r = 0.352 and 0.318, P<0.01). Conclusions Serum uric acid level is associated with disease activity in patients with growth-hormone secreting pituitary adenoma.

Objective To explore the strategy for grading evaluation of neuroendocrine deficiencies in patients with craniopharyngioma. Methods According to published research literature of Beijing Tiantan Hospital and related guidelines and book, the neuroendocrine deficiencies in patients with craniopharyngioma and variables for evaluation were defined. The evaluation criteria according to weighted scores was established. The neuroendocrine deficiencies were graded into 4 levels. Grad 0 standed for normal neuroendocrine function. Grade 3 standeds for the most severe neuroendocrine impairement. Thirty-seven patients who were diagnosed with craniopharyngioma pathologically after neurosurgery were consecutively recruited. The neuroendocrine function was graded according to the variables and grading strategy during hospitalization. Results In this study, the patients with neuroendocrine deficiencies were graded into 0, 1, 2 and 3 accounting for 0, 18.9%(7/37), 67.6% (25/37) and 13.5%(5/37) respectively. Impairment of hypothalamic function was present in each grade. The patients with more hypothalamic function impairment had more severe manifestations. Diabetes insipidus was the most frequent hypothalamic impairment. Pituitary-target glands function impairment had even distribution in patients with each grade, while the proportion of patients with hyperprolatinemia (stalk effect) gradually increased with the grade level. Conclusions The evaluation criteria and function grading system can be used to evaluate the degree of neuroendocrine deficiencies effectively in patients with craniopharyngioma, and also to evaluate the impairment of hypothalamic function and impairment of pituitary-target glands function.

Objective To observe the efficacy and safety of recombinant human growth hormone ( rhGH) replacement therapy in GHD childhood with craniopharyngioma after surgery. Methods This study retrospectively reviewed the records of 18 inpatients with secondary GHD diagnosed by insulin tolerance test ( ITT ) after craniopharyngioma surgery at the Department of Endocrinology, Beijing Tiantan Hospital, from January 2012 to December 2015. The clinical benefits and risks of 18 patients were evaluated systematically, and then were divided into rhGH treatment group(n=9) and control group(n=9). The parameters of height, growth velocity(GV), height standard deviation score (HtSDS), insulin-like growth factors-1 (IGF-Ⅰ), insulin-like growth factor binding protein 3 (IGFBP3) and adverse events rate were recorded after treatment for six months. MRI was followed up every 3 to 6 months to observe the difference of the tumor recurrence and second malignant neoplasm between two groups. Results All 18 patients with craniopharyngioma presented with multiple pituitary-target glands hormone deficiency after surgery. Among these patients, 17 cases (95% ) presented with hypothyroidism or adrenal insufficiency, 7 cases (39% ) with delayed puberty, and 12 cases(67% ) with central diabetes insipidus. Based on pituitary-target gland axis function deficiency, these patients were given appropriate L-thyroxine, prednisone, and desmopressin(DDAVP) replacement therapy, respectively. The median time of 9 patients starting rhGH replacement was 48(36,72)months after surgery. The levels of height, GV, IGF-Ⅰ, HtSDS, and IGFBP3 were significant increased after rhGH treatment for 6 months as compared with pre-treatment and control group (all P<0. 05). In addition, changes of height, GV, HtSDS, and IGF-Ⅰ levels before and after treatment in rhGH treatment group were significantly higher than those in control group (all P< 0. 05). During the period of treatment, there were no serious adverse events to be observed in rhGH treatment group, except 1 case of mild headache in the control group. The differences of biochemical and endocrine parameters such as thyroid function, liver and renal function, blood glucose, etc. were without statistical significance compared with pre-treatment after rhGH treatment ( P > 0. 05 ). The tumor recurrence and second malignant neoplasm were not detected by MRI scanning in rhGH treatment group,but there were 3 cases in the control group. Conclusion Multiple pituitary-target glands axis deficiencies were observed in childhood patients with craniopharyngioma after neurosurgery, and the evident deficiency of GH-IGF-Ⅰ axis was observed. rhGH replacement therapy in short-term would significantly improve the parameters of growth and development of patients with GHD after craniopharyngioma neurosurgery. No recurrence tumor in situ and second malignant neoplasms were detected during the period of rhGH replacement therapy.