Sleeve gastrectomy with transit bipartition is a novel bariatric and metabolic procedure providing significant metabolic benefits while minimizing the risk of malnutrition. However, due to the technical complexity of the Roux-en-Y transit bipartition configuration, several derivative procedures have been developed in clinical practice, including single anastomosis sleeve ileal bypass (SASI), single anastomosis sleeve jejunal bypass (SAS-J), and sleeve gastrectomy with Braun anasto-mosis transit bipartition (B-TB). These procedures vary in complexity, weight loss and metabolic efficacy, nutritional impact, and anti-reflux properties. SASI offers technical simplicity but raises concerns about bile reflux. SAS-J emphasizes nutritional safety, whereas B-TB incorporates a Braun anastomosis to enhance anti-reflux protection. The authors review and compare the clinical charac-teristics and indications of these procedures, aiming to provide a reference for surgeons in selecting individualized metabolic and bariatric surgical strategies.

Sleeve gastrectomy with transit bipartition is a novel bariatric and metabolic procedure providing significant metabolic benefits while minimizing the risk of malnutrition. However, due to the technical complexity of the Roux-en-Y transit bipartition configuration, several derivative procedures have been developed in clinical practice, including single anastomosis sleeve ileal bypass (SASI), single anastomosis sleeve jejunal bypass (SAS-J), and sleeve gastrectomy with Braun anasto-mosis transit bipartition (B-TB). These procedures vary in complexity, weight loss and metabolic efficacy, nutritional impact, and anti-reflux properties. SASI offers technical simplicity but raises concerns about bile reflux. SAS-J emphasizes nutritional safety, whereas B-TB incorporates a Braun anastomosis to enhance anti-reflux protection. The authors review and compare the clinical charac-teristics and indications of these procedures, aiming to provide a reference for surgeons in selecting individualized metabolic and bariatric surgical strategies.

Background and aims:Liver cirrhosis is a complex disease that may result in increased morbidity and mortality following bariatric surgery(BS).This study aimed to explore the outcome of BS in patients with unexpected cirrhosis,focusing on postoperative complications and the progression of liver disease. Methods:A retrospective study of bariatric patients with cirrhosis from four centers in China between 2016 and 2023 was conducted,with follow-up for one year after BS.The primary outcome was the safety of BS in patients with unexpected cirrhosis,while the secondary outcome was the metabolic efficacy of BS in this group postoperatively. Results:A total of 47 patients met the study criteria,including 46 cases of Child-Pugh class A cirrhosis and 1 case of Child-Pugh B.Pathological examination confirmed nodular cirrhosis in 21 patients(44.68％),pseudolobule formation in 1 patient(2.13％),lipedema degeneration with inflammatory cell infiltration in 3 patients(6.38％),and chronic hepatitis in 1 patient(2.13％).The average percentage of total weight loss was 29.73±6.53％at one year postoperatively.During the 30-day postoperative period,the complication rate was 6.38％,which included portal vein thrombosis,gastrointestinal bleeding,and intra-abdominal infection.Moreover,no cases of liver decompensation or mortality were reported during the follow-up period.The remission rates of comorbidities among 41 patients one year after surgery were as fol-lows:dyslipidemia 100％,type 2 diabetes 82.61％,hypertension 84.62％,and obstructive sleep apnea syndrome 85.71％. Conclusions:BS can be safely performed in patients with unexpected cirrhosis in the compensated stage of liver disease,with low postoperative morbidity and no mortality observed during one-year follow-up.

End-stage liver diseases,such as cirrhosis and liver cancer caused by hepatitis B,are often combined with hepatic encephalopathy(HE);ammonia poisoning is posited as one of its main pathogenesis mechanisms.Ammonia is closely related to autophagy,but the molecular mechanism of ammonia's regulatory effect on autophagy in HE remains unclear.Sialylation is an essential form of glycosylation.In the nervous system,abnormal sialylation affects various physiological processes,such as neural development and synapse formation.ST3 β-galactoside α2,3-sialyltransferase 6(ST3GAL6)is one of the significant glycosyltransferases responsible for adding α2,3-linked sialic acid to substrates and generating glycan structures.We found that the expression of ST3GAL6 was upregulated in the brains of mice with HE and in astrocytes after ammonia induction,and the expression levels of α2,3-sialylated glycans and autophagy-related proteins microtubule-associated protein light chain 3(LC3)and Beclin-1 were upregulated in ammonia-induced astrocytes.These findings suggest that ST3GAL6 is related to autophagy in HE.Therefore,we aimed to determine the regulatory relationship between ST3GAL6 and autophagy.We found that silencing ST3GAL6 and blocking or degrading α2,3-sialylated glycans by way of Maackia amurensis lectin-Ⅱ(MAL-Ⅱ)and neuraminidase can inhibit autophagy.In addition,silencing the expression of ST3GAL6 can downregulate the expression of heat shock protein β8(HSPB8)and Bcl2-associated athanogene 3(BAG3).Notably,the overexpression of HSPB8 partially restored the reduced autophagy levels caused by silencing ST3GAL6 expression.Our results indicate that ST3GAL6 regulates autophagy through the HSPB8-BAG3 complex.

Bariatric surgery are recognized worldwide for the treatment of morbid obesity and related comorbidities. Therapeutic guidelines have been issued from many countries. Laparoscopic sleeve gastrectomy and gastric bypass are used widely at present. However, both have shortcomings including insufficient weight loss, weight regain, diabetes relapse and high rate of long-term malnutrition. In recent years, operations of sleeve gastrectomy plus various gastrointestinal bypass have been performed increasingly and showed some advantages in order to overcome the shortcomings of above mentioned both procedures. Among these surgical procedures, sleeve gastrectomy with transit bipartition has the potential advantages of simple operation, satisfactory results and low rate of long-term complications. The authors firstly carried out this operation in China and summarized the surgical process and technical points in this article aiming at providing some references to the colleagues of bariatric and metabolic surgery.

Objective:To evaluate the effect of portal vein restriction combined with hepatic artery ligation on Sprague Dawley(SD) rats liver regeneration and injury.Methods:Twenty-four healthy and clean SD male rats, 250-280 g, 7-8 weeks old, were randomly divided into portal vein ligation (PVL) group, mild restriction group and moderate restriction group with 8 rats in each group. In PVL group, the right, caudal and left branches of portal vein were ligated, and only the right branches of portal vein were preserved. The operation of mild and moderate restriction group was the same as PVL, however, the left branch of the portal vein was slightly and moderately restricted, and the left branch of the hepatic artery was ligated at the same time. At 72 hours after the operation, the left middle lobe was stained with hematoxylin-eosin and the total necrosis score was calculated. The right middle lobe was immunostained for Ki-67 and the number of positive cells was counted. The liver regeneration rate of the right middle lobe was calculated and the serum liver function indexes were measured.Results:The hepatic regeneration rate of right middle lobe in PVL group was (109.1±10.9)%, while that in moderate restriction group was (105.0±12.3)%, which was significantly higher than that in the mild restriction group (67.1±6.4)%, the differences were statistically significant ( P<0.05). The Ki-67 result was also higher in the PVL group than the mild restriction group. The total necrosis score was 4.50(3.25, 6.00) in moderate restriction group, 2.00(1.25, 3.00) in PVL group and 0(0, 0.75) in mild restriction group. The three groups showed a decreasing trend and the differences were statistically significant ( P<0.05). Alanine aminotransferase in mild restriction group was (48.4±11.4) U/L, was significantly lower than that in PVL group (67.2±12.2) U/L and moderate restriction group (74.3±14.2) U/L, the difference was statistically significant ( P<0.05). There were no significant differences in serum levels of aspartate aminotransferase, albumin and total bilirubin among the three groups ( P>0.05). Conclusion:Appropriate portal vein restriction combined with hepatic artery ligation can effectively induce the regeneration of liver tissue on the reserved lobe and control the damage of liver tissue on the occluded lobe.

OBJECTIVE: To analyze the current status of diagnosis and management of acute appendicitis (AA) in China. METHODS: Questionnaire survey was used to retrospectively collect data of hospitalized patients with AA from 43 medical centers nationwide in 2017 (Sort by number of cases provided: Jinling Hospital of Medical School of Nanjing University, The First Affiliated Hospital of Xinjiang Medical University, Lu'an People's Hospital, Tengzhou Central People's Hospital, Dalian Central Hospital, The Affiliated Hospital of Xuzhou Medical University, Dongying People's Hospital, Jinjiang Hospital of Traditional Chinese Medicine, Huangshan Shoukang Hospital, Xuyi People's Hospital, Nanjing Jiangbei People's Hospital, Lanzhou 940th Hospital of PLA, Heze Municipal Hospital, The First College of Clinical Medical Science of China Three Gorges University, Affiliated Jiujiang Hospital of Nanchang University, The Second People's Hospital of Hefei, Affiliated Central Hospital of Shandong Zaozhuang Mining Group, The Third People's Hospital of Kunshan City, Xuzhou First People's Hospital, The 81st Group Army Hospital of PLA, Linyi Central Hospital, The General Hospital of Huainan Eastern Hospital Group, The 908th Hospital of PLA, Liyang People's Hospital, The 901th Hospital of Joint Logistic Support Force, The Third Affiliated Hospital of Chongqing Medical University, The Fourth Hospital of Jilin University, Harbin Acheng District People's Hospital, The First Affiliated Hospital of Zhengzhou University, Nanjing Luhe People's Hospital, Taixing Municipal People's Hospital, Baotou Central Hospital, The Affiliated Hospital of Nantong University, Linyi People's Hospital, The 72st Group Army Hospital of PLA, Zaozhuang Municipal Hospital, People's Hospital of Dayu County, Taixing City Hospital of Traditional Chinese Medicine, Suzhou Municipal Hospital, Beijing Guang'anmen Hospital, Langxi County Hospital of Traditional Chinese Medicine, Nanyang Central Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University).The diagnosis and management of AA were analyzed through unified summary. Different centers collected and summarized their data in 2017 and sent back the questionnaires for summary. RESULTS: A total of 8 766 AA patients were enrolled from 43 medical centers, including 4 711 males (53.7%) with median age of 39 years and 958 (10.9%) patients over 65 years old. Of 8 776 patients, 5 677 cases (64.6%) received one or more imaging examinations, and the other 3 099 (35.4%) did not receive any imaging examination. A total of 1 858 (21.2%) cases received medical treatment, mainly a combination of nitroimidazoles (1 107 cases, 59.8%) doublet regimen, followed by a single-agent regimen of non-nitroimidazoles (451 cases, 24.4%), a nitroimidazole-free doublet regimen (134 cases, 7.2%), a triple regimen of combined nitroimidazoles (116 cases, 6.3%), nitroimidazole alone (39 cases, 2.1%) and nitroimidazole-free triple regimen (3 cases, 0.2%). Of the 6 908 patients (78.8%) who underwent surgery, 4 319 (62.5%) underwent laparoscopic appendectomy and 2589 (37.5%) underwent open surgery. Ratio of laparotomy was higher in those patients under 16 years old (392 cases) or over 65 years old (258 cases) [15.1%(392/2 589) and 10.0%(258/2 589), respectively, compared with 8.5%(367/4 316) and 8.0%(347/4 316) in the same age group for laparoscopic surgery, χ²=91.415, P<0.001; χ²=15.915,P<0.001]. Patients with complicated appendicitis had higher ratio of undergoing open surgery as compared to those undergoing laparoscopic surgery [26.7%(692/2 589) vs. 15.6%(672/4 316), χ²=125.726, P<0.001].The cure rates of laparoscopic and open surgery were 100.0% and 99.8%(2 585/2 589) respectively without significant difference (P=0.206). Postoperative complication rates were 4.5%(121/2 589) and 4.7%(196/4 316) respectively, and the difference was not statistically significant (χ²=0.065, P=0.799). The incidence of surgical site infection was lower (0.6% vs. 1.7%, χ²=17.315, P<0.001), and hospital stay was shorter [6(4-7) days vs. 6(5-8) days, U=4 384 348.0, P<0.001] in the laparoscopic surgery group, while hospitalization cost was higher (median 12 527 yuan vs. 9 342 yuan, U=2 586 809.0, P<0.001). CONCLUSIONS The diagnosis of acute appendicitis is still clinically based, supplemented by imaging examination. Appendectomy is still the most effective treatment at present. Laparoscopic appendectomy has become the main treatment strategy, but anti-infective drugs are also very effective.
Acute Disease ; Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Appendectomy ; Appendicitis ; diagnosis ; therapy ; China ; Female ; Health Care Surveys ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

Objective To investigate the related factors of gastroparesis syndrome after radical distal gastrectomy and the curative effect of different treatment regimens.Methods Univariate analysis and unconditional multivariate Logistic regression analysis werc used to analyze the influencing factors in 41 patients with postsurgical gastroparesis syndrome (PGS) and 719 patients without PGS.Results There were significant differences in surgical methods,gastrointestinal reconstruction,pyloric obstruction,abdominal infection,postoperative hyperglycemia,postoperative low protein,postoperative anemia,postoperative nutrition,operation time and bleeding volume between PGS patients and non-PGS patients (P ＜ 0.05).Multivariate Logistic regression analysis showed that patients with Billroth-Ⅱ gastrointestinal reconstruction,abdominal infection,postoperative hyperglycemia,postoperative anemia,postoperative low protein,prolonged operation,and bleeding were risk factors for PGS (OR ＞ 1,P ＜ 0.05).Laparoscopic surgery was the protective factor of gastroparesis (OR ＜ 1,P ＜ 0.05).The recovery time of combined drug therapy was significantly better than that of single drug (P ＜ 0.05).The length of hospital stay and hospitalization expense in PGS group were significantly higher than non-PGS group.Conclusion Avoidance of the above risk factors in perioperative period can prevent the occurrence of gastroparesis.Combined treatment can accelerate the recovery of gastroparesis.

Objective To investigate the related factors of gastroparesis syndrome after radical distal gastrectomy and the curative effect of different treatment regimens.Methods Univariate analysis and unconditional multivariate Logistic regression analysis werc used to analyze the influencing factors in 41 patients with postsurgical gastroparesis syndrome (PGS) and 719 patients without PGS.Results There were significant differences in surgical methods,gastrointestinal reconstruction,pyloric obstruction,abdominal infection,postoperative hyperglycemia,postoperative low protein,postoperative anemia,postoperative nutrition,operation time and bleeding volume between PGS patients and non-PGS patients (P ＜ 0.05).Multivariate Logistic regression analysis showed that patients with Billroth-Ⅱ gastrointestinal reconstruction,abdominal infection,postoperative hyperglycemia,postoperative anemia,postoperative low protein,prolonged operation,and bleeding were risk factors for PGS (OR ＞ 1,P ＜ 0.05).Laparoscopic surgery was the protective factor of gastroparesis (OR ＜ 1,P ＜ 0.05).The recovery time of combined drug therapy was significantly better than that of single drug (P ＜ 0.05).The length of hospital stay and hospitalization expense in PGS group were significantly higher than non-PGS group.Conclusion Avoidance of the above risk factors in perioperative period can prevent the occurrence of gastroparesis.Combined treatment can accelerate the recovery of gastroparesis.

Objective:To investigate the effect of early enteral nutrition combined with Bacillus in the treatment of patients with digestive tract perforation.Methods:59 patients with emergency digestive tract perforation were randomly divided into experimental group (EN plus Bacillus,n =31) and control group (TPN,n =28).The patients in the experimental group were given enteral nutrition plus Bacillus after first days (＜ 24 h),and the control group was treated with parenteral nutrition support on the first day after surgery.The average hospitalization time,length of ICU stay,incidence of complications,and serum C-reactive protein in the two groups were analyzed.Results:The average length of hospitalization time,ICU stay,recovery of bowel function and eating time were significantly shorter in the experimental group than in the control group(P ＜ 0.05).There was no significant difference in nutrition index between the two groups during the perioperative period (P ＞ 0.05).The C-reactive protein in the experimental group was significantly lower than that in the control group fourth days after operation (P ＜ 0.05).The incidence of postoperative wound infection in the experimental group was significantly lower than that of the control group (P ＜ 0.05).There was no significant difference in the incidence of other complications.Conclusion:Early administration of enteral nutrition combined with Bacillus can significantly shorten the intestinal function recovery time,decreasethe average hospitalization days,reduce the postoperative wound infection rate and thus improve the outcome of patients with digestive tract perforation.