Objective:To explore the clinical efficacy of endoscopic sleeve gastrectomy (ESG) in the treatment of obesity.Method:A 26 year old female patient was admitted on October 20, 2022 due to a progressive increase in weight for 2 years. Her body mass index (BMI) was 30.04 kg/m 2, body fat percentage was 39.2%, and visceral fat grade was 15. ESG was performed using the OverStitch SX endoscopic suture system. Result:The surgery was successful, with approximately 5 ml of intraoperative bleeding.The patient discharged on the first day after surgery. Two weeks after surgery, small bowel follow-through showed a tubular shape of the stomach. At 6 months after surgery, the BMI was 25.2 kg/m 2, body fat percentage was 32%, visceral fat grade was 10. The total body weight loss rate (%TBWL) at 6 months after surgery was 16%, and the excess weight loss rate (%EWL) was 54.5%. Conclusion:ESG is effective for the treatment of obesity.

Objective:To explore the clinical efficacy of endoscopic sleeve gastrectomy (ESG) in the treatment of obesity.Method:A 26 year old female patient was admitted on October 20, 2022 due to a progressive increase in weight for 2 years. Her body mass index (BMI) was 30.04 kg/m 2, body fat percentage was 39.2%, and visceral fat grade was 15. ESG was performed using the OverStitch SX endoscopic suture system. Result:The surgery was successful, with approximately 5 ml of intraoperative bleeding.The patient discharged on the first day after surgery. Two weeks after surgery, small bowel follow-through showed a tubular shape of the stomach. At 6 months after surgery, the BMI was 25.2 kg/m 2, body fat percentage was 32%, visceral fat grade was 10. The total body weight loss rate (%TBWL) at 6 months after surgery was 16%, and the excess weight loss rate (%EWL) was 54.5%. Conclusion:ESG is effective for the treatment of obesity.

Objective To investigate the effect of Water-soluble total alkaloids of Yimucao Injection(YITA)on postpartum uterine involution.Methods A guinea pig abortion model was established by drug method.0.17 g·kg-1 YITA was intragastrically administered to record the amount of bleeding and the contents of E2 and P in serum of guinea pigs after delivery.The uterine coefficient was calculated and the contents of NO,ET-1 and Ca2+ in uterine tissue were measured.The isolated uterine model and the in vivo uterine model were prepared by guinea pigs.The former was given YITA 0.05,0.1 and 0.2 mg·mL-1,and the latter was intramuscularly injected with YITA 10,20 and 40 mg·kg-1.The changes of uterine smooth muscle(USM)contractile activity,frequency and tension were recorded by biological function test system.Results Intragastric administration of YITA could decrease the uterine coefficient(P<0.001),NO content in uterine tissue and serum P content in guinea pigs with medical abortion(P<0.01),significantly increased ET/NO ratio(P<0.001);it tended to increase Ca2+ content in uterine tissue(P<0.1).In the isolated USM test,50 and 100 mg·L-1 YITA significantly increased USM contractile activity in guinea pigs(P<0.05),and 200 mg·L-1 YITA significantly decreased USM contractile minimum in guinea pigs(P<0.05)in the in vivo USM contractile test,YITA enhanced USM contractile activity,and 40 mg·kg-1 YITA significantly increased USM contractile activity and frequency in guinea pigs(P<0.05);10 mg·kg-1 YITA significantly increased USM contractile frequency in guinea pigs(P<0.05)and tended to increase motility(P=0.0569<0.1);20 mg·kg-1 YITA tended to increase frequency(P=0.0898,0.0699 respectively,<0.1).Conclusion YITA has the effect of promoting uterine involution,and the mechanism is related to the regulation of ET/NO balance and the direct promotion of USM contraction.YITA is an effective substance for uterine contraction and hemostasis with leonurus injection in the treatment of postpartum hemorrhage and uterine involution.

Objective:To investigate the pharmacokinetics of sugammadex in reversal of postoperative residual neuromuscular blockade in obese patients.Methods:Sixteen patients of both sexes, aged 18-65 yr, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, with body mass index of ≥25 kg/m 2, scheduled for elective laparoscopic bariatric surgery, were selected.The patients were divided into 2 groups ( n=8 each) according to the degree of obesity: group O (25 kg/m 2≤BMI<40 kg/m 2) and group M (BMI≥40 kg/m 2). In group O and group M, vecuronium was administered by closed-loop muscle relaxant injection system to maintain moderate neuromuscular blockade.The administration was stopped at the end of surgery, and sugammadex 2 mg/kg was injected according to corrected body weight (CBW) of patients when the muscle relaxation monitoring T 2 recovered naturally.The recovery time of neuromuscular blockade and the occurrence of residual neuromuscular blockade within 3 h after surgery were recorded.Arterial blood samples were collected at 2, 3, 5, 10, 15, 20, 30, 60, 120, 240, 360 and 480 min after administration of sugammadex.The concentration of sugammadex in plasma was determined by ultra-performance liquid chromatography-mass spectrometry.The pharmacokinetic parameters were calculated with PKSolver software. Results:No residual neuromuscular blockade occurred, and the pharmacokinetics of sugammadex in plasma were consistent with the linear non-compartmental model in the two groups.Compared with group O, apparent clearance was increased ( P<0.05), and no significant change was found in other pharmacokinetic parameters, recovery time of neuromuscular blockade and concentrations of sugammadex in plasma at different time point ( P>0.05) in group M. Conclusion:The pharmacokinetics of sugammadex in reversal of postoperative residual neuromuscular blockade in obese patients are consistent with the linear non-compartmental model, and the clearance of sugammadex is higher in morbidly obese patients.

OBJECTIVE: To evaluate the effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery for treatment of type 2 diabetes (TD) in patients with a body mass index (BMI) < 27.5 kg/m. METHODS: We retrospectively analyzed the data of patients who underwent LRYGB surgery from March, 2012 to June, 2018 in the General Hospital of Guangzhou Military Command and Jinshazhou Hospital of Guangzhou University of Chinese Medicine. The changes in the parameters of glucose metabolism and physical indicators of the patients in the first, second and third years after the surgery were analyzed in patients in low BMI group and high BMI group. RESULTS: All the 74 patients underwent LRYGB successfully without conversion to open surgery. One year after the surgery, fasting blood glucose (FBG), HbA1c, postprandial blood glucose, fasting insulin, HOMA-IR, fasting C-peptide, BMI, body weight and waistline were significantly improved compared with their preoperative values in low BMI group ( < 0.05). At 2 years after the operation, FBG, HbA1c, postprandial blood glucose, HOMA-IR, BMI, body weight and waistline were significantly improved compared with the preoperative values in low BMI group ( < 0.05). In the third year, FBG, HOMA-IR, fasting C-peptide, body weight and waistline were significantly improved compared with the preoperative values in low BMI group ( < 0.05). There was no significant difference in the parameters of glucose metabolism and islet function between low BMI group and high BMI group at different stages. No serious complications occurred in these patients after the surgery. CONCLUSIONS LRYGB is effective for treatment of T2D in Chinese patients with a BMI < 27.5. After the surgery, the patient show reduced waistline without significant weight loss. The long-term results of the surgery still require further investigations with a larger samples and longer follow-up.
Body Mass Index ; Diabetes Mellitus, Type 2 ; surgery ; Gastric Bypass ; statistics & numerical data ; Humans ; Laparoscopy ; Retrospective Studies ; Treatment Outcome ; Weight Loss

Obesity and its complications, such as type 2 diabetes, hypertension, hyperlipidemia, nonalcoholic fatty liver, are serious global public health problems. Endoscopic sleeve gastroplasty (ESG) can reduce the length and width of the stomach by simulating the anatomical structure of surgical sleeve gastrectomy to reduce the capacity of the stomach, and is safe and effective to reduce weight. ESG has the advantages of non- invasiveness, no gastrectomy, repeatability, simple operation, no incision scar, few complications, short hospital stay and quick postoperative recovery. As an intermediate means of medical treatment and surgery, ESG provides a new method for weight loss for obese patients who cannot tolerate or are unwilling to undergo surgery. Herein we trace the origin of ESG, analyze the unique advantages of ESG suture, explore the technical improvement in the development of ESG, and briefly describe the weight reduction effect of ESG and compare the curative effect of ESG with laparoscopic sleeve gastrectomy. ESG has undergone rapid development and maturity but also faces such challenges as the lack of established standard procedures, unclear weight reduction mechanism, and clarification of the indications for operation. Still, ESG is expected to become the mainstream technique for weight reduction.
Diabetes Mellitus, Type 2 ; Gastrectomy ; Gastroplasty ; Humans ; Laparoscopy ; Obesity, Morbid ; Treatment Outcome ; Weight Loss

OBJECTIVE: To evaluate the effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery for treatment of type 2 diabetes (TD) in patients with a body mass index (BMI) < 27.5 kg/m. METHODS: We retrospectively analyzed the data of patients who underwent LRYGB surgery from March, 2012 to June, 2018 in the General Hospital of Guangzhou Military Command and Jinshazhou Hospital of Guangzhou University of Chinese Medicine. The changes in the parameters of glucose metabolism and physical indicators of the patients in the first, second and third years after the surgery were analyzed in patients in low BMI group and high BMI group. RESULTS: All the 74 patients underwent LRYGB successfully without conversion to open surgery. One year after the surgery, fasting blood glucose (FBG), HbA1c, postprandial blood glucose, fasting insulin, HOMA-IR, fasting C-peptide, BMI, body weight and waistline were significantly improved compared with their preoperative values in low BMI group ( < 0.05). At 2 years after the operation, FBG, HbA1c, postprandial blood glucose, HOMA-IR, BMI, body weight and waistline were significantly improved compared with the preoperative values in low BMI group ( < 0.05). In the third year, FBG, HOMA-IR, fasting C-peptide, body weight and waistline were significantly improved compared with the preoperative values in low BMI group ( < 0.05). There was no significant difference in the parameters of glucose metabolism and islet function between low BMI group and high BMI group at different stages. No serious complications occurred in these patients after the surgery. CONCLUSIONS LRYGB is effective for treatment of T2D in Chinese patients with a BMI < 27.5. After the surgery, the patient show reduced waistline without significant weight loss. The long-term results of the surgery still require further investigations with a larger samples and longer follow-up.
Body Mass Index ; Diabetes Mellitus, Type 2 ; Gastric Bypass ; Humans ; Laparoscopy ; Obesity, Morbid ; Retrospective Studies ; Treatment Outcome ; Weight Loss

Intragastric balloon (IGB) placement under endoscopy is a non-invasive method for weight loss.By placing a space-occupying balloon in the stomach, IGB treatment can achieve better effect of weight loss than medications.Herein we review the development of IGB, its effect on weight loss and the mechanism, and the eligible individuals for IGB treatment.We also examine the high-intensity postoperative management following IGB placement, which is important for maintaining long-term weight loss, and discuss the future development of IGB.The patients should understand that on the basis of ensuring a high safety, the weight-losing effect of IGB can be limited and relies heavily on postoperative management.Patients should make a decision on IGB placement after careful consideration of their own physical, economic, and psychological conditions, lifestyle and the line of work in addition to the indications of IGB.IGB placement combined with high-intensity postoperative management and active interventions of lifestyle and dietary habits help to achieve long-term effect of weight loss and improve obesity-related complications.
Endoscopy ; Gastric Balloon ; Humans ; Life Style ; Obesity ; Obesity, Morbid/surgery* ; Treatment Outcome ; Weight Loss

Background and purpose: Solid pseudopapillary tumor of the pancreas (SPTP) is rare, and there are some differences between benign and malignant SPTP not only in clinical treatment but also in future prognosis. The purpose of this study was to investigate the characteristics of benign and malignant SPTP and differential diagnosis on computed tomography scan, in order to improve the accuracy of preoperative diagnosis. Methods: A total of 69 SPTP patients cofirmed by pathology were included. Each patient was diagnosed through the clinical and CT features by 3 radiologists. Results: Thirteen (18.84％) patients (9 females and 4 males) were confirmed as malignant SPTP. The tumors in 56 (81.16％) patients (45 females and 11 males) were diagnosed as benign SPTP. There was no significant difference in gender (P=0.458) between the groups. The mean age of malignant SPTP patients was significantly higher than that of benign SPTP patients [39 (16-56) years vs 31 (14-56) years, P=0.001]. The mean tumor size was 6.2(2.2-12.0)cm in malignant group and 5.5(1.2-13.0) cm in benign group, respectively. The size of tumor was equal or larger than 5.0 cm in 31 patients (benign vs malignant 21∶10, P=0.014). Twenty-eight lesions showed incomplete fibrous pseudocapsule (benign vs malignant 19∶9, P=0.028). There were no significant differences in lesion location, morphology, proportion of cystic or solid component between malignant and benign groups (P＞0.05). Conclusion: Malignant SPTP patients were significantly older than benign SPTP patients. The large tumor size (≥5 cm) and incomplete fibrous pseudocapsule may suggest malignancy of SPTP.

Objective To establish gastric bypass surgery model with SD rat and analyze the influence factors and preventive measures so as to accumulate experience and skills for further developing gastric bypass surgery model on diabetic rat( GK rat) . Methods Gastric by-pass surgery was operated on 30 SD rats. Summarized modeling experience and analyzed various factors affecting modeling success. Results 17 rats weresuccessfully survived after surgery and 13 failed, with the mortality rate 43. 3%. Three rats died during operation, including two for anesthesia and one for heart failure;one died due to anastomotic bleeding two hours after surgery. Eight died in the third day after surgery, including two for infection, two for intestinal necrosis, four for anastomotic stenosis or obstruction. One died because of anastomotic leakage caused by mistaking and satiety the fifth day after surgery. There were no other complications such as wound dehiscence occurred in this group . Conclusion Establishing models of gastric bypass surgery with SD rats which is regarded as pre-experiment of building models of gas-tric bypass surgery with GK rats is economical and feasible. Anesthesia and perioperative management, surgical techniques and infection pre-vention and control are the main factors affecting modeling. The survival rate of rat model could be increased if related factors well controlled.