Gastroesophageal reflux disease (GERD) is one of the most important diseases in the foregut surgery, and its treatment has evolved from the classical Nissen fundoplication to various modified surgical procedures with robotic assistance, which have significantly improved patient outcomes and quality of life. The complex association between sleeve gastrectomy and GERD has revealed the potential impact of surgery on the anatomical structures and anti-reflux barriers, driving the pace of research on combined procedures and novel surgical approaches. Future trends in the surgical management of GERD will focus more on individualized care, integrating techniques such as high-resolution esophageal manometry, 24 h esophageal impedance-pH monitoring, salivary pepsinogen testing, and endoscopy to optimize precise surgical management of GERD.

Objective:To investigate and compare the short-term efficacy of robot-assisted versus laparoscopic sleeve gastrectomy with Dor fundoplication for the treatment of obesity with gastroesophageal reflux disease (GERD).Methods:A retrospective analysis was conducted on the clinical data of 46 patients with obesity combined with GERD who underwent robot-assisted sleeve gastrectomy combined with Dor fundoplication or laparoscopic sleeve gastrectomy combined with Dor fundoplication at the People's Hospital of Xinjiang Uygur Autonomous Region from May 2021 to Nov 2023. Patients were divided into the RSGFD group and the LSGFD group based on the surgical procedure. Perioperative parameters, weight loss outcomes, and changes in Gastroesophageal Reflux Disease Questionnaire (GERD-Q) scores were compared between the two groups.Results:There were no statistically significant differences between the two groups in terms of operative time, postoperative length of hospital stay, or postoperative complication rate (all P>0.05). Both groups showed significant decreases in weight and BMI at 6 months and 1 year postoperatively compared to preoperative values (all P<0.05). There were no statistically significant differences in %EWL and %TWL between the two groups at 6 months and 1 year postoperatively ( t=0.142, 0.437, 1.246, 1.898, all P>0.05). At 1 year postoperatively, GERD-Q scores were significantly decreased in both groups ( Z=-4.329, -3.879, both P<0.001). There was no statistically significant difference in GERD symptom improvement between the two groups ( Z=0.577, P=0.749). Conclusion:RSGFD and LSGFD demonstrate comparable efficacy in the treatment of obesity complicated by GERD.

Gastroesophageal reflux disease (GERD) is a chronic digestive system disorder triggered by multiple factors, which is clinically prevalent and affects patients' quality of life. Laparoscopic fundoplication serves as the mainstay of surgical treatment for GERD, requiring standardized preoperative examinations to assess patients' reflux status and esophageal motility for individualized selection of fundoplication techniques. Intraoperative regulation of the fundoplication tension with a bougie aims to balance the anti-reflux efficacy and the risk of postoperative dysphagia. Additionally, membranous anatomy research guided by embryonic development facilitates optimization of surgical approaches and provides a theoretical basis for surgical innovation. This article deeply discusses the status of GERD diagnosis and treatment, as well as the surgical anti-reflux mechanisms, from multiple aspects including pathogenesis, diagnosis, and surgical management. We also contemplate the existing challenges in the embryonic development and anatomy of the anti-reflux barrier.

Gastroesophageal reflux disease (GERD) is a chronic digestive system disorder triggered by multiple factors, which is clinically prevalent and affects patients' quality of life. Laparoscopic fundoplication serves as the mainstay of surgical treatment for GERD, requiring standardized preoperative examinations to assess patients' reflux status and esophageal motility for individualized selection of fundoplication techniques. Intraoperative regulation of the fundoplication tension with a bougie aims to balance the anti-reflux efficacy and the risk of postoperative dysphagia. Additionally, membranous anatomy research guided by embryonic development facilitates optimization of surgical approaches and provides a theoretical basis for surgical innovation. This article deeply discusses the status of GERD diagnosis and treatment, as well as the surgical anti-reflux mechanisms, from multiple aspects including pathogenesis, diagnosis, and surgical management. We also contemplate the existing challenges in the embryonic development and anatomy of the anti-reflux barrier.

Gastroesophageal reflux disease (GERD) is one of the most important diseases in the foregut surgery, and its treatment has evolved from the classical Nissen fundoplication to various modified surgical procedures with robotic assistance, which have significantly improved patient outcomes and quality of life. The complex association between sleeve gastrectomy and GERD has revealed the potential impact of surgery on the anatomical structures and anti-reflux barriers, driving the pace of research on combined procedures and novel surgical approaches. Future trends in the surgical management of GERD will focus more on individualized care, integrating techniques such as high-resolution esophageal manometry, 24 h esophageal impedance-pH monitoring, salivary pepsinogen testing, and endoscopy to optimize precise surgical management of GERD.

Objective:To investigate and compare the short-term efficacy of robot-assisted versus laparoscopic sleeve gastrectomy with Dor fundoplication for the treatment of obesity with gastroesophageal reflux disease (GERD).Methods:A retrospective analysis was conducted on the clinical data of 46 patients with obesity combined with GERD who underwent robot-assisted sleeve gastrectomy combined with Dor fundoplication or laparoscopic sleeve gastrectomy combined with Dor fundoplication at the People's Hospital of Xinjiang Uygur Autonomous Region from May 2021 to Nov 2023. Patients were divided into the RSGFD group and the LSGFD group based on the surgical procedure. Perioperative parameters, weight loss outcomes, and changes in Gastroesophageal Reflux Disease Questionnaire (GERD-Q) scores were compared between the two groups.Results:There were no statistically significant differences between the two groups in terms of operative time, postoperative length of hospital stay, or postoperative complication rate (all P>0.05). Both groups showed significant decreases in weight and BMI at 6 months and 1 year postoperatively compared to preoperative values (all P<0.05). There were no statistically significant differences in %EWL and %TWL between the two groups at 6 months and 1 year postoperatively ( t=0.142, 0.437, 1.246, 1.898, all P>0.05). At 1 year postoperatively, GERD-Q scores were significantly decreased in both groups ( Z=-4.329, -3.879, both P<0.001). There was no statistically significant difference in GERD symptom improvement between the two groups ( Z=0.577, P=0.749). Conclusion:RSGFD and LSGFD demonstrate comparable efficacy in the treatment of obesity complicated by GERD.

Tumor progression is closely related to tumor tissue metabolism and reshaping of the microenvironment. Oral squamous cell carcinoma (OSCC), a representative hypoxic tumor, has a heterogeneous internal metabolic environment. To clarify the relationship between different metabolic regions and the tumor immune microenvironment (TME) in OSCC, Single cell (SC) and spatial transcriptomics (ST) sequencing of OSCC tissues were performed. The proportion of TME in the ST data was obtained through SPOTlight deconvolution using SC and GSE103322 data. The metabolic activity of each spot was calculated using scMetabolism, and k-means clustering was used to classify all spots into hyper-, normal-, or hypometabolic regions. CD4T cell infiltration and TGF-β expression is higher in the hypermetabolic regions than in the others. Through CellPhoneDB and NicheNet cell-cell communication analysis, it was found that in the hypermetabolic region, fibroblasts can utilize the lactate produced by glycolysis of epithelial cells to transform into inflammatory cancer-associated fibroblasts (iCAFs), and the increased expression of HIF1A in iCAFs promotes the transcriptional expression of CXCL12. The secretion of CXCL12 recruits regulatory T cells (Tregs), leading to Treg infiltration and increased TGF-β secretion in the microenvironment and promotes the formation of a tumor immunosuppressive microenvironment. This study delineates the coordinate work axis of epithelial cells-iCAFs-Tregs in OSCC using SC, ST and TCGA bulk data, and highlights potential targets for therapy.
Humans ; Carcinoma, Squamous Cell/metabolism* ; Squamous Cell Carcinoma of Head and Neck ; Mouth Neoplasms/metabolism* ; Immunosuppression Therapy ; Transforming Growth Factor beta ; Head and Neck Neoplasms ; Gene Expression Profiling ; Tumor Microenvironment

Tumor progression is closely related to tumor tissue metabolism and reshaping of the microenvironment.Oral squamous cell carcinoma(OSCC),a representative hypoxic tumor,has a heterogeneous internal metabolic environment.To clarify the relationship between different metabolic regions and the tumor immune microenvironment(TME)in OSCC,Single cell(SC)and spatial transcriptomics(ST)sequencing of OSCC tissues were performed.The proportion of TME in the ST data was obtained through SPOTlight deconvolution using SC and GSE103322 data.The metabolic activity of each spot was calculated using scMetabolism,and k-means clustering was used to classify all spots into hyper-,normal-,or hypometabolic regions.CD4T cell infiltration and TGF-β expression is higher in the hypermetabolic regions than in the others.Through CellPhoneDB and NicheNet cell-cell communication analysis,it was found that in the hypermetabolic region,fibroblasts can utilize the lactate produced by glycolysis of epithelial cells to transform into inflammatory cancer-associated fibroblasts(iCAFs),and the increased expression of HIF1A in iCAFs promotes the transcriptional expression of CXCL12.The secretion of CXCL12 recruits regulatory T cells(Tregs),leading to Treg infiltration and increased TGF-β secretion in the microenvironment and promotes the formation of a tumor immunosuppressive microenvironment.This study delineates the coordinate work axis of epithelial cells-iCAFs-Tregs in OSCC using SC,ST and TCGA bulk data,and highlights potential targets for therapy.

Tumor progression is closely related to tumor tissue metabolism and reshaping of the microenvironment.Oral squamous cell carcinoma(OSCC),a representative hypoxic tumor,has a heterogeneous internal metabolic environment.To clarify the relationship between different metabolic regions and the tumor immune microenvironment(TME)in OSCC,Single cell(SC)and spatial transcriptomics(ST)sequencing of OSCC tissues were performed.The proportion of TME in the ST data was obtained through SPOTlight deconvolution using SC and GSE103322 data.The metabolic activity of each spot was calculated using scMetabolism,and k-means clustering was used to classify all spots into hyper-,normal-,or hypometabolic regions.CD4T cell infiltration and TGF-β expression is higher in the hypermetabolic regions than in the others.Through CellPhoneDB and NicheNet cell-cell communication analysis,it was found that in the hypermetabolic region,fibroblasts can utilize the lactate produced by glycolysis of epithelial cells to transform into inflammatory cancer-associated fibroblasts(iCAFs),and the increased expression of HIF1A in iCAFs promotes the transcriptional expression of CXCL12.The secretion of CXCL12 recruits regulatory T cells(Tregs),leading to Treg infiltration and increased TGF-β secretion in the microenvironment and promotes the formation of a tumor immunosuppressive microenvironment.This study delineates the coordinate work axis of epithelial cells-iCAFs-Tregs in OSCC using SC,ST and TCGA bulk data,and highlights potential targets for therapy.

Tumor progression is closely related to tumor tissue metabolism and reshaping of the microenvironment.Oral squamous cell carcinoma(OSCC),a representative hypoxic tumor,has a heterogeneous internal metabolic environment.To clarify the relationship between different metabolic regions and the tumor immune microenvironment(TME)in OSCC,Single cell(SC)and spatial transcriptomics(ST)sequencing of OSCC tissues were performed.The proportion of TME in the ST data was obtained through SPOTlight deconvolution using SC and GSE103322 data.The metabolic activity of each spot was calculated using scMetabolism,and k-means clustering was used to classify all spots into hyper-,normal-,or hypometabolic regions.CD4T cell infiltration and TGF-β expression is higher in the hypermetabolic regions than in the others.Through CellPhoneDB and NicheNet cell-cell communication analysis,it was found that in the hypermetabolic region,fibroblasts can utilize the lactate produced by glycolysis of epithelial cells to transform into inflammatory cancer-associated fibroblasts(iCAFs),and the increased expression of HIF1A in iCAFs promotes the transcriptional expression of CXCL12.The secretion of CXCL12 recruits regulatory T cells(Tregs),leading to Treg infiltration and increased TGF-β secretion in the microenvironment and promotes the formation of a tumor immunosuppressive microenvironment.This study delineates the coordinate work axis of epithelial cells-iCAFs-Tregs in OSCC using SC,ST and TCGA bulk data,and highlights potential targets for therapy.