Obesity is a major global public health challenge and a leading cause of multiple metabolic disorders,including hypertension and diabetes.In China,more than half of the adult population is overweight or obese.While anti-obesity pharmacotherapies(such as GLP-1 receptor agonists)and bariatric surgery have both advanced rapidly,strategies for integrating these two modalities remain unclear.In particular,controversies persist regarding surgical eligibility after drug discontinuation,and standardized clinical guidelines are lacking.In July 2025,the International Federation for the Surgery of Obesity and Metabolic Disorders released the world's first statement focusing on"metabolic bariatric surgery after pharmacotherapy-induced weight loss",which emphasizes the chronic disease model of obesity management and clarifies the synergistic relationship between pharmacotherapy and surgery.This article interprets the statement from the perspectives of treatment strategies,surgical eligibility,and drug-surgery coordination,aiming to provide evidence-based reference for clinicians and to promote standardized,integrated obesity management.

Objective:To evaluate the clinical efficacy of"Shibao Decoction"in the management of late-onset hypogonadism(LOH)caused by deficiency of kidney essence.Methods:Sixty male patients with late-onset hypogonadism of kidney essence defi-ciency type were randomly assigned to the treatment group and the control group,each with 30 cases.The patients in treatment group were treated with oral Shibao Decoction,while the control group was treated with oral Testosterone Undecanoate Capsules.The patients in both groups were treated for 12 weeks.The PADAM symptom score,TCM syndrome score,serum total testosterone(TT),serum free testosterone(FT),sex hormone binding globulin(SHBG),body mass index(BMI),total skeletal muscle mass index(SMI),appendicular skeletal muscle mass index(ASMI),FBG,FINS,and insulin resistance index(HOMA-IR)levels were compared be-tween the two groups.Results:After treatment,PADAM scores for each item and TCM symptoms score decreased,TT and FT in-creased in both groups,all with statistically significant differences from those of pre-treatment(P＜0.05).The level of SHBG in the control group decreased(P＜0.05),which had not changed significantly in the treatment group(P＞0.05).After treatment,SMI and ASMI increased in both groups significantly(P＜0.05).BMI decreased in the control group(P＜0.05),which had not changed significantly in the treatment group(P＞0.05).The level of FINS decreased in the control group(P＜0.05),which had not changed significantly in the treatment group(P＞0.05).FPG had not changed significantly in both groups(P＞0.05),and the insulin resist-ance index(HOMA-IR)had significantly improved in both groups,all with statistically significant differences from those of pre-treat-ment(P＜0.05).After treatment,the total effective rates of PADAM score and TCM syndrome score in the treatment group were 73.3％and 86.6％respectively,and the total effective rates in the control group were 66.7％and 76.6％respectively.The total ef-fective rates of the two scores in the treatment group were slightly higher than those in the control group(P＞0.05).There was no sig-nificant difference in the indicators between the two groups after treatment,and the treatment group is generally comparable with the control group in the therapeutic effects(P＞0.05).And no adverse reactions occurred during treatment in both groups.Conclu-sion:The"Shibao Decoction"has a remarkable therapeutic effect on late-onset hypogonadism caused by deficiency of kidney essence and has good safety.It can be used as an alternative to testosterone undecanoate and is worthy of clinical promotion and application.

Background and Aims:Gastroesophageal reflux disease(GERD)is a common complication following sleeve gastrectomy(SG),particularly in patients with concomitant hiatal hernia,where symptoms tend to be more persistent and refractory,significantly impairing postoperative quality of life.This study aimed to evaluate the efficacy of laparoscopic hiatal hernia repair combined with gastroesophageal fixation in SG patients with severe GERD and hiatal hernia,providing clinical reference for revisional surgical strategies.Methods:The clinical data of 9 patients with severe GERD after SG who underwent laparoscopic hiatal hernia repair and gastroesophageal fixation at Huashan Hospital,Fudan University,between January 2023 and June 2024 were retrospectively analyzed.GerdQ scores,proportion of endoscopically confirmed reflux esophagitis,and proton pump inhibitor(PPI)usage were compared before and after surgery.Surgical parameters and follow-up outcomes were also recorded.Results:All patients successfully completed the surgery without major intraoperative complications,and the mean postoperative hospital stay was 5.22 d.After a mean follow-up period of 15.27 months,the GerdQ score significantly decreased from 11.67±2.00 to 7.22±1.48.The proportion of patients with GerdQ score≥8 decreased from 100.00％to 44.44％,and the rate of endoscopically confirmed GERD dropped from 88.89％to 11.11％;PPI use also significantly declined,with all differences reaching statistical significance(all P＜0.05).Conclusion:Laparoscopic hiatal hernia repair combined with gastroesophageal fixation can effectively alleviate reflux symptoms in SG patients with coexisting hiatal hernia,demonstrating favorable short-term efficacy and high safety.This approach may be a preferable surgical option for selected patients.

Background and Aims:Gastroesophageal reflux disease(GERD)is a common complication following sleeve gastrectomy(SG),particularly in patients with concomitant hiatal hernia,where symptoms tend to be more persistent and refractory,significantly impairing postoperative quality of life.This study aimed to evaluate the efficacy of laparoscopic hiatal hernia repair combined with gastroesophageal fixation in SG patients with severe GERD and hiatal hernia,providing clinical reference for revisional surgical strategies.Methods:The clinical data of 9 patients with severe GERD after SG who underwent laparoscopic hiatal hernia repair and gastroesophageal fixation at Huashan Hospital,Fudan University,between January 2023 and June 2024 were retrospectively analyzed.GerdQ scores,proportion of endoscopically confirmed reflux esophagitis,and proton pump inhibitor(PPI)usage were compared before and after surgery.Surgical parameters and follow-up outcomes were also recorded.Results:All patients successfully completed the surgery without major intraoperative complications,and the mean postoperative hospital stay was 5.22 d.After a mean follow-up period of 15.27 months,the GerdQ score significantly decreased from 11.67±2.00 to 7.22±1.48.The proportion of patients with GerdQ score≥8 decreased from 100.00％to 44.44％,and the rate of endoscopically confirmed GERD dropped from 88.89％to 11.11％;PPI use also significantly declined,with all differences reaching statistical significance(all P＜0.05).Conclusion:Laparoscopic hiatal hernia repair combined with gastroesophageal fixation can effectively alleviate reflux symptoms in SG patients with coexisting hiatal hernia,demonstrating favorable short-term efficacy and high safety.This approach may be a preferable surgical option for selected patients.

Obesity is a major global public health challenge and a leading cause of multiple metabolic disorders,including hypertension and diabetes.In China,more than half of the adult population is overweight or obese.While anti-obesity pharmacotherapies(such as GLP-1 receptor agonists)and bariatric surgery have both advanced rapidly,strategies for integrating these two modalities remain unclear.In particular,controversies persist regarding surgical eligibility after drug discontinuation,and standardized clinical guidelines are lacking.In July 2025,the International Federation for the Surgery of Obesity and Metabolic Disorders released the world's first statement focusing on"metabolic bariatric surgery after pharmacotherapy-induced weight loss",which emphasizes the chronic disease model of obesity management and clarifies the synergistic relationship between pharmacotherapy and surgery.This article interprets the statement from the perspectives of treatment strategies,surgical eligibility,and drug-surgery coordination,aiming to provide evidence-based reference for clinicians and to promote standardized,integrated obesity management.

Gene editing technology utilizes artificial nucleases to insert, replace, or delete specific sequences in desired genomic regions. The discovery of CRISPR/Cas9 nucleases was a milestone in the development of advanced gene editing tools, which revolutionized the field due to their simplicity and versatility. However, the limited precision of Cas9 nucleases remains a notable obstacle. Recently, derivative technologies such as prime editing have earned considerable attention for their enhanced efficiency and precision. The prime editing system consists of two components: the SpCas9 nickase (H840A) fused with reverse transcriptase (MLV-RT) and an engineered prime editing guide RNA (pegRNA). This system can irreversibly introduce various types of genetic changes into the genome, including 12 possible types of point mutations, as well as insertions, deletions and their combinations, without the need for DNA double-strand breaks (DSBs) or donor DNA templates. Prime editing offers several advantages in terms of editing accuracy, versatility, PAM constraints, and off-target effects. The editing results of prime editing system is highly accurate and can be tailored to specific needs. In addition, the system can be edited near or far from PAM sites, making it less constrained by PAM site restrictions. Moreover, it demonstrates high genome-wide specificity. The system also supports a variety of edits, demonstrating immense potential, especially in large DNA fragment editing—an area that relied heavily on CRISPR/Cas9 nucleases before. The development of prime editing, especially bi-direction prime editor, shed new light on large DNA fragment manipulations, including deletions, insertions, replacements, gene integration, as well as chromosomal translocations, inversions, and tandem duplications. Despite the significant progress made with prime editing technology, its application still faces challenges, especially low editing efficiency, which limits its potential in broader research and clinical settings. Consequently, researchers are exploring strategies to enhance the efficiency of prime editing. This review highlights several approaches to improving prime editing efficiency. These include optimizing pegRNA by refining PBS and RT parameters, increasing pegRNA stability and expression levels, and developing automated pegRNA design software. Additionally, efforts are being made to optimize the prime editing system proteins, such as screening for Cas9 and reverse transcriptase variants and performing codon optimization. The final aspect is the regulation of endogenous factors, including the inhibition of mismatch repair mechanisms and the modulation of chromatin environment. These approaches significantly enhance the practicality of prime editing in research and clinical contexts. In conclusion, prime editing represents a major advancement in the field of gene editing, offering powerful tools and methods for both basic research and clinical applications. This review will introduce the discovery, improvement and applications of prime editors, with a focus on prime editing mediated large DNA fragment manipulations. Hopefully, these insights will serve as valuable references for future research and applications of prime editing technology.

Objective:To understand the current situation of the quality of life of medical staff in the context of responding to public health emergencies and discuss its influencing factors,so as to scientifically mobilize the enthusiasm and stability of medical staff in response to public health emergencies and promote the new quality productivity of the medical system under public crises. Methods:The convenient sampling and snowball-sampling were used to investigate medical staff with using World Health Organization Quality of Life Brief Scale,the Utrecht Work Engagement Scale and the Practice Environment Scale,and establish decision tree and neural network models to analyze the factors affecting the quality of life of medical staff. Results:Quality of life of medical staff was (62.61±14.99). The practice environment,work engagement,work willingness,educational background had influence on the quality of life of medical staff (P<0.05),and the influence degree was gradually reduced by the results of the neural network model. Conclusion:The quality of life of medical staff is not high. The practice environment,the work engagement,work willingness is the main influencing factor. Two models have their advantages and disadvantages,which combined use makes the results more meaningful.

Objective:To understand the current situation of the quality of life of medical staff in the context of responding to public health emergencies and discuss its influencing factors,so as to scientifically mobilize the enthusiasm and stability of medical staff in response to public health emergencies and promote the new quality productivity of the medical system under public crises. Methods:The convenient sampling and snowball-sampling were used to investigate medical staff with using World Health Organization Quality of Life Brief Scale,the Utrecht Work Engagement Scale and the Practice Environment Scale,and establish decision tree and neural network models to analyze the factors affecting the quality of life of medical staff. Results:Quality of life of medical staff was (62.61±14.99). The practice environment,work engagement,work willingness,educational background had influence on the quality of life of medical staff (P<0.05),and the influence degree was gradually reduced by the results of the neural network model. Conclusion:The quality of life of medical staff is not high. The practice environment,the work engagement,work willingness is the main influencing factor. Two models have their advantages and disadvantages,which combined use makes the results more meaningful.

Objective To evaluate the feasibility,safety and efficacy of three-port laparoscopic sleeve gastrectomy(LSG).Methods Clinical data of 130 patients with obesity who underwent LSG from April 2020 to January 2021 and completed follow-up in time were analyzed retrospectively.All patients were divided into two groups as surgical method,there were 52 cases in three-port group and 78 cases in four-port group.Perioperative indicators and improvement of obesity in two groups were compared.Results All procedures were performed via LSG.Compared with four-port group,the mean operative time of three-port group was shorter[(88.35±22.64)min vs.(98.29±26.25)min,P=0.027].There were no significant differences in amount of bleeding intraoperative,postoperative pain,postoperative drainage,hospital stay after operation,postoperative complication rate and weight loss 6 months and 2 years after surgery(P>0.05).Conclusions Under the premise of no increase in surgical complications and operative time,three-port LSG can reduce the number and size of surgical scars,which is conducive to skin beauty,and obtain the same weight loss effect as four-port LSG,and can be used as a routine operation for sleeve gastrectomy.

Objective: To examine the association between smoking status and related mortality among elderly people aged 60 and above in urban and rural areas of Beijing City. Methods: Based on Beijing City Elderly Comprehensive Health Cohort Study from 2009 to 2014, a total of 4 499 eligible older adults included in the baseline survey were followed up and investigated to collect information on survival and death. The Cox proportional hazards regression model was used to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs), and the dose-response relationship was estimated between the smoking index, the years of quitting and mortality. Results: The median (IQR) age of 4 499 subjects was 70.00 (10.00) years old, including 1 814 (40.32%) males. The proportion of non-smokers, former smokers and current smokers was 69.50% (3 127/4 499), 13.20% (594/4 499) and 17.30% (778/4 499), respectively. After adjusting for confounding factors such as demographic and sociological characteristics, lifestyle, etc., the results of multivariate Cox regression analysis showed that, compared to non-smokers, former smokers had a 30.6% increased risk of all-cause mortality [HR (95%CI): 1.306 (1.043-1.636)] and the HR (95%CI) of all-cause, malignant tumor and lung cancer mortality among current smokers has increased by 50.0% [HR (95%CI): 1.500 (1.199-1.877)], 80.3% [HR (95%CI): 1.803 (1.226-2.652)] and 212.6% [HR (95%CI): 3.126 (1.626-6.012)], respectively. The smoking index was positively associated with the increased risk of all-cause, malignant tumor and lung cancer mortality, while the years of smoking cessation were negatively associated with that risk (P<0.05). Conclusion: Smoking is associated with tobacco-related mortality among elderly people in Beijing City.
Aged ; Male ; Humans ; Child ; Female ; Beijing ; Cohort Studies ; Lung Neoplasms ; Smoking ; Tobacco Smoking