Objective: To characterize perioperative dynamic changes in immune-cell phenotypes and inflammatory cytokines in patients undergoing CPB (cardiopulmonary bypass) cardiac surgery, and to explore their associations with postoperative outcomes. Methods: In this prospective cohort study, 120 adult patients who underwent elective cardiac surgery under CPB at West China Hospital from May 2022 to March 2023 were enrolled. Perioperative immune-cell phenotypes and concentrations of 40 inflammation-related cytokines were measured. The primary outcomes were the sequential organ failure assessment (SOFA) score at 24 h after surgery and ΔSOFA (the peak SOFA score within 48 h after surgery minus the preoperative SOFA score). Secondary outcomes included major adverse cardiovascular events (MACE), acute kidney injury (AKI), respiratory failure, severe liver injury, and infection. Results: The mean age of enrolled patients was 57±10 years. Of these, 52% (62/120) were male and 90% (108/120) underwent valve surgery. During the rewarming to the end of CPB, neutrophil counts rapidly increased (7.39×10 /L vs preoperative 3.07×10 /L, P<0.001), with significant upregulation of CD11b (7.30×10 /L vs preoperative 3.05×10 /L, P<0.001) and CD54 (7.15×10 /L vs preoperative 2.99×10 /L, P<0.001). Lymphocyte counts increased at the end of CPB (1.75×10 /L vs preoperative 1.12×10 /L, P<0.001) but decreased significantly at 24 h after surgery (0.59×10 /L vs preoperative 1.12×10 /L, P<0.001). Plasma analysis showed that multiple pro-inflammatory cytokines increased during CPB and remained elevated up to 24 h after surgery; five chemokines and the anti-inflammatory cytokine IL-10 peaked at the end of CPB. The SOFA score increased from 1 (1, 2) preoperatively to 7 (5, 10) at 24 h after surgery, with a ΔSOFA of 6 (4, 8). Within 30 days after surgery, 48 patients (40.0%) developed AKI, 17 (14.2%) developed infection, 4 (3.3%) developed severe liver injury, 3 (2.5%) developed respiratory failure, and 3 (2.5%) experienced MACE. During the 2-year follow-up, 8 patients (6.7%) experienced MACE and 5 (4.2%) died. Conclusion: Multi-organ dysfunction is common after cardiac surgery under CPB (median ΔSOFA, 6), accompanied by perioperative activation of multiple immune-cell subsets and upregulation of pro-inflammatory, anti-inflammatory, and chemotactic mediators. This study provides data-driven evidence and research clues for further investigation of the associations between CPB-related immune perturbations and postoperative organ dysfunction and clinical outcomes.

ObjectiveTo observe the effect of Qishao capsules on renal injury in db/db mice with diabetic kidney disease （DKD），and explore its mechanism of protecting the kidney by inhibiting podocyte apoptosis. Methodsdb/m mice （7 mice） were used as the normal group，and db/db mice （35 mice） were randomly divided into a model group，a dapagliflozin group （0.001 g·kg^-1·d^-1），and low-，medium-，and high-dose groups of Qishao capsules （0.341 3，0.682 5，and 1.365 g·kg^-1·d^-1，respectively）. Drug intervention lasted for 8 consecutive weeks. After sampling，the serum renal function indicators ［creatinine（SCr），and urea nitrogen（BUN）］，fasting blood glucose （FBG），24 h urinary protein quantification （24 h-UTP）， and other indicators of the mice were measured. The pathological tissue morphology of the kidney was observed by periodic acid-silver methenamine （PASM） and Masson's trichrome （Masson） staining. Immunohistochemical detection of cysteine-dependent aspartate-specific protease （Caspase）-3 and B-cell lymphoma 2 （Bcl-2） was performed. Western blot was used to detect the protein expression of Caspase-8，Caspase-7，Caspase-3， and other molecules. Terminal deoxynucleotidyl transferase dUTP nick End labeling （TUNEL） staining was used to observe apoptosis in renal tissue. Immunofluorescence staining of Wilms tumor suppressor gene-1 （WT-1） was used to observe podocyte injury. Real-time polymerase chain reaction （Real-time PCR） was employed to detect Caspase-8 and Caspase-3 mRNA expression in the kidneys of experimental mice. Data analysis was conducted using statistical software GraphPad Prism 10. ResultsCompared with the normal group，the model group showed significantly increased 24 h-UTP，SCr，BUN，and FBG （P<0.01）. Additionally， PASM staining of renal tissue showed increased glycogen deposition，glomerular hypertrophy，and thickening of the basement membrane. Masson staining showed collagen fiber proliferation in renal tissue. Transmission electron microscopy showed thickening of the renal tissue basement membrane and fusion or loss of foot processes in the model group. The immunohistochemical results showed that Caspase-3 in the kidneys of the mice in the model group significantly increased （P<0.01），while the Bcl-2 protein expression level decreased significantly （P<0.01）. The number of TUNEL positive cells in renal tissue significantly increased （P<0.01）. The positive expression of WT-1 in podocytes was significantly reduced （P<0.01）. Western blot analysis showed significant upregulation of Caspase-8，Caspase-7，and Caspase-3 protein expression in renal tissue （P<0.01）. The mRNA expression levels of Caspase-8 and Caspase-3 in the kidneys increased significantly （P<0.01）. Compared with the model group，the Qishao capsules groups can significantly reduce the levels of 24 h-UTP，SCr，BUN，and FBG （P<0.01）. The pathological damage of renal tissue and podocyte injury were improved to some extent. Immunohistochemistry in the kidney showed a significant decrease in Caspase-3 （P<0.01） and a significant increase in Bcl-2 protein expression level （P<0.01）. Additionally， there were a significant decrease in the number of TUNEL positive cells in renal tissue （P<0.01），a significant increase in WT-1 positive expression in podocytes （P<0.01），marked downregulation of Caspase-8，Caspase-7，and Caspase-3 protein expression in renal tissue （P<0.05，P<0.01），and a significant decrease in Caspase-8 and Caspase-3 mRNA expression levels （P<0.01）. ConclusionQishao capsules can inhibit podocyte apoptosis by regulating the expression of Caspase-8，Caspase-7， and Caspase-3，thereby improving the diabetic renal injury in db/db mice.

Objective:To investigate the change trend in the burden of 5 common malignant tumors of digestive system (esophageal cancer, gastric cancer, colorectal cancer, pancreatic cancer and liver cancer) in the Chinese population from 1990 to 2021.Methods:The descriptive epidemio-logic method was conducted. The number of new cases, crude incidence rate, age-standardized incidence rate, the number of deaths, crude mortality rate and age-standardized mortality rate of 5 common malignant tumors of digestive system in the Chinese population from 1990 to 2021 of the Global Burden of Disease were collected. The age-standardized rate was calculated based on the standardized demographics of the whole world in the Global Burden of Disease for the year 2021. Observation indicators: (1) The incidence of 5 common malignant tumors of digestive system in the Chinese population from 1990 to 2021; (2) the mortality of 5 common malignant tumors of digestive system in the Chinese population from 1990 to 2021; (3) the change trend of age-standardized incidence rate of 5 common malignant tumors of digestive system in the Chinese population from 1990 to 2021; (4) the change trend of age-standardized mortality rate of 5 common malignant tumors of digestive system in the Chinese population from 1990 to 2021. The Joinpoint regression model was constructed for trend analysis, specifically to calculate the annual percentage change, average annual percentage change (AAPC), and their 95% confidence interval ( CI) for age-standardized incidence and mortality rates for each cancer type at different time periods. Results:(1) The incidence of 5 common malignant tumors of digestive system in the Chinese population from 1990 to 2021. The number of new cases of esophageal cancer, gastric cancer, colorectal cancer, pancreatic cancer and liver cancer in the Chinese population changed from 207 495, 407 471, 158 389, 37 818 and 96 434 in 1990 to 320 805, 611 799, 658 321, 118 665 and 196 637 in 2021. The crude incidence rates of the above cancer types changed from 17.64/100 000, 34.64/100 000, 13.46/100 000, 3.21/100 000, 8.20/100 000 in 1990 to 22.55/100 000, 43.00/100 000, 46.27/100 000, 8.34/100 000, 13.82/100 000 in 2021. The new cases of esophageal cancer, stomach cancer, colorectal cancer, pancreatic cancer, and liver cancer all showed an increasing trend, with absolute changes of 54.61%, 50.15%, 315.64%, 213.78%, and 103.91%, respectively. (2) The mortality of 5 common malignant tumors of digestive system in the Chinese population from 1990 to 2021. The number of deaths of esophageal cancer, gastric cancer, colorectal cancer, pancreatic cancer and liver cancer in the Chinese population changed from 210 821, 374 066, 119 303, 38 883 and 94 937 in 1990 to 296 443, 445 013, 275 129, 119 602 and 172 068 in 2021. The crude death rates of the above cancer types changed from 17.92/100 000, 31.80/100 000, 10.14/100 000, 3.31/100 000, 8.07/100 000 in 1990 to 20.84/100 000, 31.28/100 000, 19.34/100 000, 8.41/100 000, 12.09/100 000 in 2021. Death cases of esophageal cancer, stomach cancer, colorectal cancer, pancreatic cancer, and liver cancer all showed an increa-sing trend, with absolute changes of 40.61%, 18.97%, 130.61%,207.59%, and 81.24%, respectively. (3) The change trend of age-standardized incidence rate of 5 common malignant tumors of digestive system in the Chinese population from 1990 to 2021. The change trends of age-standardized incidence rates of esophageal cancer, gastric cancer, colorectal cancer, pancreatic cancer, and liver cancer in the Chinese population were divided into 5, 5, 4, 5, and 5 periods, respectively, and the AAPCs of age-standardized incidence rates of the above cancer types were -1.60% (95% CI as -1.78% to -1.42%), -1.60% (95% CI as -1.78% to -1.43%), 1.66% (95% CI as 1.39% to 1.94%), 0.72% (95% CI as 0.36% to 1.08%), and -0.31% (95% CI as -0.39% to -0.23%). (4) The change trend of age-standardized mortality rate of 5 common malignant tumors of digestive system in the Chinese population from 1990 to 2021. The change trend of age-standardized mortality rates of esophageal cancer, gastric cancer, colorectal cancer, pancreatic cancer, and liver cancer in the Chinese population were divided into 5, 5, 4, 5, and 4 periods, respectively, and the AAPC of age-standardized mortality rates for each of the above mentioned cancer types were -1.96% (95% CI as -2.03% to -1.90%), -2.44% (95% CI as -2.50% to -2.38%), -0.49% (95% CI as -0.58% to -0.41%), 0.56% (95% CI as 0.48% to 0.63%), and -0.68% (95% CI as -0.89% to -0.52%). Conclusions:From 1990 to 2021, the disease burden of esophageal cancer, gastric cancer and liver cancer in the Chinese population show a downward trend. The standardized incidence of colorectal cancer shows an upward trend, and the standardized mortality rate shows a downward trend. The disease burden of pancreatic cancer shows an upward trend.

BACKGROUND:Existing studies have preliminarily summarized the potential association between muscle activity of the affected lower limb and gait stability during walking in patients undergoing anterior cruciate ligament reconstruction.However,there are some issues such as incomplete observation of muscle categories,incomplete observation of walking action phases,and failure to consider synergistic effects among multiple muscle groups,which urgently require further improvement in this study.OBJECTIVE:To monitor muscle synergy information of the affected leg during walking in patients undergoing anterior cruciate ligament reconstruction and to analyze the association between muscle synergy information and gait stability.METHODS:Twenty-four male patients aged(21.66±4.09)years undergoing anterior cruciate ligament reconstruction,were recruited.Electromyographic and center of pressure data were collected from the affected lower limb during walking.A non-negative matrix decomposition algorithm was used to extract the number of muscle synergic elements from the affected leg,the time spent in peak activation of each muscle synergic element,and the muscle relative weight indexes.Correlation analysis was then performed with the center of pressure indexes.RESULTS AND CONCLUSION:Six types of muscle synergies were identified in the affected leg.The number of muscle synergic elements showed no significant correlation with the distance and speed of lateral displacement of the center of pressure.Regarding the peak activation time of muscle synergic elements,synergic element 3 in the dominant gait loading response period showed a significant negative correlation with the lateral displacement distance of the center of pressure(r=-0.413,P=0.045)and a significant negative correlation with the lateral displacement velocity of the center of pressure(r=-0.470,P=0.020).The activation time of the remaining types of muscle synergic elements was not significantly related with patient's gait stability indices.In terms of muscle relative weights,the rectus femoris muscle of synergistic element 1 in the dominant gait loading response period showed a significant negative correlation with the lateral displacement distance of the center of pressure(r=-0.592,P=0.005)and a significant negative correlation with the lateral displacement speed of the center of pressure(r=-0.529,P=0.014).Additionally,the relative weight of the biceps femoris muscle of synergistic element 3 in the dominant gait loading response period showed a significant negative correlation with the lateral displacement distance of the center of pressure(r=-0.428,P=0.037).To conclude,the central system in patients undergoing anterior cruciate ligament reconstruction regulates the synergistic muscle activity of the affected leg during walking to enhance gait stability in two primary ways:by prolonging the activation time of the muscle synergists during the dominant loading response period and enhancing the activation of the quadriceps muscle,in order to enhance the control of eccentric contractions of the knee joint during the landing of the affected leg and improve the stability of the knee joint;and by increasing the activation of the biceps femoris muscle during the loading response period,which increases the degree of knee flexion and enhances the lower limb's cushioning function during the landing of the affected leg.

[Purpose]To analyze the epidemiology and disease burden of gastric cancer in China,Japan and Republic of Korea from 1990 to 2021 and to predict changing trends from 2022 to 2031.[Methods]Data were obtained from the Global Burden of Disease(GBD)database.Age-stan-dardized incidence rate(ASIR),age-standardized mortality rate(ASMR),crude incidence rate(CIR),crude mortality rate(CMR),and disability-adjusted life years(DALY)rate for China,Japan and Republic of Korea from 1990 to 2021 were analyzed.Joinpoint regression software was used to analyze trends and calculate annual percentage changes.The autoregressive integrated moving average(ARIMA)model was applied to predict incidence and mortality from 2022 to 2031.[Results]In 2021,China had 611 799 new gastric cancer cases and 445 013 deaths,with an ASIR of 29.05/105 and an ASMR of 21.51/105,both significantly higher than those in Japan and Republic of Korea.Among men in China,both the ASIR(44.48/105)and ASMR(32.61/105)were the highest among the three countries,exceeding those in Japan(38.77/105,20.26/105)and Re-public of Korea(38.98/105,20.50/105).Among women,China had the highest number of new cases,but its ASIR(15.23/105)was slightly lower than Republic of Korea's(15.57/105)and higher than Japan's(14.66/105).However,China's ASMR among women(12.02/105)remained significantly higher than Japan's(7.64/105)and Republic of Korea's(8.08/105).From 1990 to 2021,ASIR,ASMR and DALY rates for gastric cancer declined in all three countries,but the reduction in China was significantly smaller than that in Japan and Republic of Korea,with Republic of Korea showing the steepest declines across all indicators.ARIMA model predictions indicated significant differences in disease burden among the three countries from 2022 to 2031.ASIR is projected to continue declining in China and Republic of Korea,reaching 22.87/105 and 12.45/105,respectively by 2031,while in Japan it is predicted to rise to 26.55/105.ASMR is projected to decline in all three countries,reaching 13.71/105(China),10.44/105(Japan),and 9.08/105(Republic of Korea)in 2031.[Conclusion]Among China,Japan and Republic of Korea,China had the highest ASIR and ASMR of gastric cancer in 2021.Moreover,from 1990 to 2021,the reductions in ASIR,ASMR and DALY rates for gastric cancer were the smallest in China compared to Japan and Republic of Korea.These findings suggest that the disease burden of gastric cancer remains substantial in China,high-lighting the need for increased efforts in gastric cancer screening and early diagnosis and treatment.

[Purpose]To analyze the trends of disease burden for lung cancer worldwide and in China from 1990 to 2021.[Methods]Data of the disease burden of lung cancer and population demographics in 1990 and 2021 stratified by sex and age groups for global,five SDI quintiles re-gions,and eight countries including China,Japan,Republic of Korea,United Kingdom,France,United States,Canada,and Australia were extracted from the Global Burden of Disease Study 2021(GBD 2021)database.The age-standardized mortality rate(ASMR)and age-standard-ized disability-adjusted life year rate(ASDR)of lung cancer attributable to 7 level-3 risk factors in China for 1990 and 2021 were also extracted.Counterfactual analysis was used to decompose changes in lung cancer deaths and DALY from 1990 to 2021 into four contributing factors:popu-lation size,population structure,age-standardized incidence or prevalence,and lung cancer case fatality or disease severity.The percentage changes in lung cancer deaths and DALY attributed to these four factors were calculated respectively.[Results]In 2021,there were 934 704 new cases and 814 364 deaths of lung cancer in China.From 1990 to 2021,the incidence,preva-lence,mortality,and DALY rates of lung cancer in China increased faster than those worldwide and in high-middle SDI regions,which was similar to Japan and Republic of Korea.In contrast,the mortality rates of lung cancer decreased in United States and United Kingdom;and the DALY rates of lung cancer decreased in United States,United Kingdom,Canada and Australia.From 1990 to 2021,the age-related lung cancer deaths and DALY in China increased by 193.91％and 146.20％,respectively.The primary contributor to the increase in lung cancer deaths was population aging(102.82％)among men and rising age-standardized incidence(119.00％)among women,while the primary contributor to the increase in DALY was rising age-standardized prevalence for both men(153.12％)and women(218.77％).In 2021,the top three risk factors contributing to lung cancer ASMR and ASDR in China were smoking,particulate matter pollution and occupational carcinogen exposure.Compared with 1990,the ASMR of lung cancer and its proportion at-tributable to particulate matter pollution and low dietary fruits were decreased,while the propor-tions in ASDR of lung cancer attributable to smoking and secondhand smoke increased.[Conclu-sion]Lung cancer is a major public health challenge in China.Compared with worldwide,high-middle SDI regions and certain developed countries,China has experienced faster growth in the incidence,prevalence,mortality and DALY of lung cancer,especially among women.To reduce disease burden,sustained efforts on lung cancer prevention and control are urgently required in China.

[Purpose]To analyze the epidemiological characteristics of esophageal cancer world-wide and in China.[Methods]Data were extracted from the GLOBOCAN 2022 database.The in-cidence and mortality of esophageal cancer worldwide and in China were analyzed,stratified by sex,age group,and human development index(HDI).Spearman correlation analysis was conducted to evaluate the association between the HDI and the mortality-to-incidence ratio(MIR)of esophageal cancer.[Results]In 2022,there were an estimated 511 054 new cases and 445 391 deaths from esophageal cancer globally,with age-standardized incidence and mortality rates(ASIR and ASMR)of 5.0/105 and 4.3/105,respectively.In China,there were an estimated 224 012 new cases and 187 467 deaths accounting for 43.8％and 42.1％of global totals,respectively.Both the new cases and deaths of esophageal cancer in China ranked the first worldwide.The ASIR and ASMR in China were 8.3/105 and 6.7/105,both were as twice as the global average.The ASIR and ASMR for males were higher than those for females.The incidence and mortality of esophageal cancer increased with age,and more than 50％of global cases and deaths in individuals aged over 70 years old occurred in China.Additionally,a significantly negative correlation was ob-served between HDI and MIR of esophageal cancer(ρ=-0.67,P＜0.001),and MIR in China(0.81)was comparable to that of countries or regions with a very high HDI.[Conclusion]The burden of esophageal cancer remains significant worldwide and in China,particularly among males and the elderly.The MIR of esophageal cancer in China is still relatively high.The primary and secondary prevention measures should be strengthened to reduce the incidence and mortality of esophageal cancer.

Objective:To investigate the change trend in the burden of 5 common malignant tumors of digestive system (esophageal cancer, gastric cancer, colorectal cancer, pancreatic cancer and liver cancer) in the Chinese population from 1990 to 2021.Methods:The descriptive epidemio-logic method was conducted. The number of new cases, crude incidence rate, age-standardized incidence rate, the number of deaths, crude mortality rate and age-standardized mortality rate of 5 common malignant tumors of digestive system in the Chinese population from 1990 to 2021 of the Global Burden of Disease were collected. The age-standardized rate was calculated based on the standardized demographics of the whole world in the Global Burden of Disease for the year 2021. Observation indicators: (1) The incidence of 5 common malignant tumors of digestive system in the Chinese population from 1990 to 2021; (2) the mortality of 5 common malignant tumors of digestive system in the Chinese population from 1990 to 2021; (3) the change trend of age-standardized incidence rate of 5 common malignant tumors of digestive system in the Chinese population from 1990 to 2021; (4) the change trend of age-standardized mortality rate of 5 common malignant tumors of digestive system in the Chinese population from 1990 to 2021. The Joinpoint regression model was constructed for trend analysis, specifically to calculate the annual percentage change, average annual percentage change (AAPC), and their 95% confidence interval ( CI) for age-standardized incidence and mortality rates for each cancer type at different time periods. Results:(1) The incidence of 5 common malignant tumors of digestive system in the Chinese population from 1990 to 2021. The number of new cases of esophageal cancer, gastric cancer, colorectal cancer, pancreatic cancer and liver cancer in the Chinese population changed from 207 495, 407 471, 158 389, 37 818 and 96 434 in 1990 to 320 805, 611 799, 658 321, 118 665 and 196 637 in 2021. The crude incidence rates of the above cancer types changed from 17.64/100 000, 34.64/100 000, 13.46/100 000, 3.21/100 000, 8.20/100 000 in 1990 to 22.55/100 000, 43.00/100 000, 46.27/100 000, 8.34/100 000, 13.82/100 000 in 2021. The new cases of esophageal cancer, stomach cancer, colorectal cancer, pancreatic cancer, and liver cancer all showed an increasing trend, with absolute changes of 54.61%, 50.15%, 315.64%, 213.78%, and 103.91%, respectively. (2) The mortality of 5 common malignant tumors of digestive system in the Chinese population from 1990 to 2021. The number of deaths of esophageal cancer, gastric cancer, colorectal cancer, pancreatic cancer and liver cancer in the Chinese population changed from 210 821, 374 066, 119 303, 38 883 and 94 937 in 1990 to 296 443, 445 013, 275 129, 119 602 and 172 068 in 2021. The crude death rates of the above cancer types changed from 17.92/100 000, 31.80/100 000, 10.14/100 000, 3.31/100 000, 8.07/100 000 in 1990 to 20.84/100 000, 31.28/100 000, 19.34/100 000, 8.41/100 000, 12.09/100 000 in 2021. Death cases of esophageal cancer, stomach cancer, colorectal cancer, pancreatic cancer, and liver cancer all showed an increa-sing trend, with absolute changes of 40.61%, 18.97%, 130.61%,207.59%, and 81.24%, respectively. (3) The change trend of age-standardized incidence rate of 5 common malignant tumors of digestive system in the Chinese population from 1990 to 2021. The change trends of age-standardized incidence rates of esophageal cancer, gastric cancer, colorectal cancer, pancreatic cancer, and liver cancer in the Chinese population were divided into 5, 5, 4, 5, and 5 periods, respectively, and the AAPCs of age-standardized incidence rates of the above cancer types were -1.60% (95% CI as -1.78% to -1.42%), -1.60% (95% CI as -1.78% to -1.43%), 1.66% (95% CI as 1.39% to 1.94%), 0.72% (95% CI as 0.36% to 1.08%), and -0.31% (95% CI as -0.39% to -0.23%). (4) The change trend of age-standardized mortality rate of 5 common malignant tumors of digestive system in the Chinese population from 1990 to 2021. The change trend of age-standardized mortality rates of esophageal cancer, gastric cancer, colorectal cancer, pancreatic cancer, and liver cancer in the Chinese population were divided into 5, 5, 4, 5, and 4 periods, respectively, and the AAPC of age-standardized mortality rates for each of the above mentioned cancer types were -1.96% (95% CI as -2.03% to -1.90%), -2.44% (95% CI as -2.50% to -2.38%), -0.49% (95% CI as -0.58% to -0.41%), 0.56% (95% CI as 0.48% to 0.63%), and -0.68% (95% CI as -0.89% to -0.52%). Conclusions:From 1990 to 2021, the disease burden of esophageal cancer, gastric cancer and liver cancer in the Chinese population show a downward trend. The standardized incidence of colorectal cancer shows an upward trend, and the standardized mortality rate shows a downward trend. The disease burden of pancreatic cancer shows an upward trend.

Obesity and its related metabolic diseases have become a global public health challenge. Traditional weight loss methods have limited efficacy in patients with moderate to severe obesity, while bariatric surgery, although effective, carries a relatively high risk. Endoscopic weight loss techniques, due to their minimally invasive nature, safety, and reversibility, have gradually become an important supplement to obesity treatment. This article systematically reviews the research progress of gastric and small intestine-related endoscopic bariatric procedures, including intragastric balloon therapy, endoscopic sleeve gastroplasty, gastric bypass stents, and duodenal mucosal resurfacing.The authors believe that gastric-related procedures are suitable for patients whose primary goal is weight loss. Among these, the adjustable intragastric balloon offers the highest flexibility, being non-invasive and reversible with good short-term weight loss effects, making it suitable for bridging to bariatric surgery in patients with severe obesity. Endoscopic sleeve gastroplasty achieves weight loss effects closest to those of bariatric surgery, with favorable long-term weight loss outcomes, and is suitable for weight loss treatment in patients with contraindications to bariatric surgery. Gastric drainage procedures result in poor patient experience due to issues related to fistula tubes; moreover, the small sample size of studies on gastric-related endoscopic procedures means they are not considered representative. In contrast, small intestine-related procedures are more suitable for patients focusing on the improvement of metabolic diseases. Overall, endoscopic techniques exhibit significant short-term efficacy, but their long-term efficacy and standardization still require further research. In the future, it will be necessary to integrate artificial intelligence-assisted operations and individualized treatment strategies to optimize efficacy and expand clinical application.

Objective:To construct a symptom network for type 2 diabetes mellitus (T2DM) patients, identify bridging symptoms and core symptoms, and explore influencing factors, providing references for precise and efficient symptom management.Methods:A convenience sampling method was used to select 340 T2DM patients hospitalized in the Endocrinology Department of Affiliated Hospital of North Sichuan Medical College from December 2023 to February 2024. A general information survey and the Chinese version of Diabetes Symptom Checklist-Revised were used to collect data. Multiple linear regression analysis was performed to explore the influencing factors of T2DM patients' lack of vitality. Network analysis was used to identify core symptoms and bridging symptoms among symptom clusters. A total of 340 questionnaires were distributed, and 336 valid questionnaires were returned, resulting in a valid response rate of 98.8% (336/340) .Results:The most common symptoms in T2DM patients included thirst and dry mouth, foamy urine, and overall fatigue. The most troublesome symptoms were overall fatigue, lack of vitality, and thirst and dry mouth. In the symptom network, lack of vitality had the highest intensity ( rs=7.980) and closeness centrality ( rc=0.014), followed by overall fatigue ( rs=7.940) and feeling down ( rs=7.200). Overall fatigue ( rbs=7.190, rbc=0.380) was identified as the strongest bridging symptom in the network. Univariate analysis showed that age, education level, diabetes duration, diabetes complications, and regular blood glucose monitoring were significant factors affecting lack of vitality in T2DM patients ( P<0.05). Multiple linear regression analysis indicated that education level, regular blood glucose monitoring, and diabetes complications were significant factors affecting lack of vitality ( P<0.05) . Conclusions:Lack of vitality is the core symptom in T2DM patients, and overall fatigue is the bridging symptom connecting different symptom clusters. The lack of vitality is influenced by factors such as education level, regular blood glucose monitoring, and diabetes complications. Healthcare providers should use symptom network analysis to timely identify core symptoms, bridging symptoms, and their influencing factors, and develop precise and efficient interventions to improve symptom management and reduce the symptom burden in T2DM patients.