At present, the prevalence of overweight and obesity is increasing rapidly. Baria-tric and metabolic surgery is an effective means to treat obesity and related comorbidities, but only a few obesity patients have received bariatric surgery, and most patients choose to accept drugs to lose weight. Glucagon-like peptide-1 receptor agonists (GLP-1RA), as an emerging drug, has a signi-ficant effect on overweight and obesity patients, and can be used as a beneficial supplement for bariatric surgery, which has a profound impact on bariatric surgery. Based on the relevant literature, the authors discuss the application and influence of GLP-1RA in bariatric and metabolic surgery.

Objective:To investigate the clinical efficacy of single-port and mini-three-port laparoscopic sleeve gastrectomy (MTP-SG) for obesity.Methods:The propensity score matching and retrospective cohort study was conducted. The clinical data of 364 obesity patients in the Chinese Obesity and Metabolic Surgery Database who were admitted to The First Affiliated Hospital of Jinan University from July 2016 to December 2023 were collected. There were 79 males and 285 females, aged (31±9)years. Of 364 patients, 67 cases undergoing single-port laparoscopic sleeve gastrectomy (SP-SG) were divided into the SP group, and 297 cases undergoing MTP-SG were divided into the MTP group. Propensity score matching was done by the 1∶1 nearest neighbor matching method. The clamp value was set as 0.1. Measurement data with normal distribution were expressed as Mean± SD, and t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M( Q1, Q1), and the rank sum test was used for comparison between groups. Count data were expressed as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of 364 patients, 126 cases were successfully matched, including 63 cases in the SP group and 63 cases in the MTP group. After propensity score matching, the confounding bias of gender, body mass, body mass index (BMI), waist circumference, waist hip ratio were eliminated between the two groups. (2) Intraoperative and post-operative conditions. Both groups of patients successfully completed laparoscopic sleeve gastrectomy. After propensity score matching, the operation time, volume of intraoperative blood loss, number of postoperative painkillers used, number of postoperative antiemetics used, duration of postoperative hospital stay, duration of total hospital stay, surgical cost, and total hospitalization cost of the 63 pati-ents in SP group were 101(90,120)minutes, 10(10,10)mL, 1.0(1.0,2.5)times, 3.0(1.0,5.0)times, 4(3,5)days, 7(5,8)days, 4.1(3.5,4.3) ten thousand yuan, and (6.4±0.8) ten thousand yuan, respectively. The above indicators of the 27 patients in MTP group were 100(90,120)minutes, 10(10,15)mL, 2.0(1.0,4.0)times, 4.0(3.0,5.0)times, 3(3,4)days, 5(5,6)days, 3.2(2.8,4.2) ten thousand yuan, and (5.8±0.8) ten thousand yuan, respectively. There were significant differences in number of postoperative antiemetics used, duration of postoperative hospital stay, duration of total hospital stay and total hospitalization cost between the two groups ( Z=-2.39, -3.93, -3.03, t=4.04, P<0.05), and there was no significant difference in operation time, volume of intraoperative blood loss, number of post-operative painkillers used and surgical cost between the two groups ( Z=-0.49, -1.00, -1.23, -1.47, P>0.05). (3) Follow-up. One hundred and ninety five of the 364 patients conducted postoperative 1 month follow-up, including 25 patients in the SP group and 170 patients in the MTP group, and no patient experienced complications such as gastric leakage, infection, or incisional hernia. Both groups of patients had good surgical incisions. After propensity score matching, the change in BMI (ΔBMI), percentage of total weight loss (%TWL), and percentage of excess weight loss (%EWL) of 24 patients in the SP group were (3.7±1.4)kg/m 2, 11.0%±3.0%, 52.6%±30.0%, respectively. The above indicators of 40 patients in the MTP group were (4.1±1.3)kg/m 2, 11.1%±2.8%, 41.8%±19.1%, respectively. Patients who conducted the postoperative 12 month follow-up were 21 and 131 in the SP group and the MTP group, respectively. After propensity score matching, the ΔBMI, %TWL and %EWL of 15 patients in the SP group were (8.7±4.1)kg/m 2, 26.2%±9.8%, 130.0%±45.1%, respectively. The above indicators of 36 patients in the MTP group were (9.8±4.0)kg/m 2, 27.2%± 8.7%, 107.1%±40.7%, respectively. Conclusion:Both SP-SG and MTP-SG can be used to treat obesity patients and achieve satisfactory short-term results.

At present, obesity and overweight patients are increasing year by year in the world. Bariatric surgery is the most effective method for treating obesity at present. Due to its high risk, large trauma, irreversible operation, high cost and patient preference, the overall acceptance degree is not high at present. With the development of endoscopic technology and materials and equipment, various surgical methods emerge one after another. They are less invasive, reversible and similar to traditional bariatric surgery in weight loss effect. They are more and more widely used in obesity and metabolism. Depending on the site of the endoscopic intervention: The authors review the advances in endoscopic bariatric surgery for obesity, including the different principles of surgery and the effects of bariatric surgery on different sites.

Bariatric surgery has been proven to be the most effective intervention for the treatment of obesity and obesity-related complications. In recent decades, medical experts as well as scholars in China have been actively promoting and pushing the development of bariatric surgery, and conducting a series of clinical and basic research. As a result of their unremitting efforts, research in the field of bariatric surgery in China has developed extremely rapidly. The authors examined the overview of literature research in the field of bariatric surgery in China through bibliometric analysis, and analyzed the current status, hot spots, trends, and frontiers of research in this field, with the aim of providing references for future research and development.

Background: MicroRNAs (miRNAs) exert an essential contribution to obesity and type 2 diabetes mellitus (T2DM). This study aimed to investigate the differences of miRNAs in the presence and absence of T2DM in patients with obesity, as well as before and after bariatric surgery in T2DM patients with obesity. Characterization of the common changes in both was further analyzed. Methods: We enrolled 15 patients with obesity but without T2DM and 15 patients with both obesity and T2DM. Their preoperative clinical data and serum samples were collected, as well as 1 month after bariatric surgery. The serum samples were analyzed by miRNA sequencing, and the miRNAs profiles and target genes characteristics were compared. Results: Patients with T2DM had 16 up-regulated and 32 down-regulated miRNAs compared to patients without T2DM. Improvement in metabolic metrics after bariatric surgery of T2DM patients with obesity was correlated with changes in miRNAs, as evidenced by the upregulation of 20 miRNAs and the downregulation of 30 miRNAs. Analysis of the two miRNAs profiles identified seven intersecting miRNAs that showed opposite changes. The target genes of these seven miRNAs were substantially enriched in terms or pathways associated with T2DM. Conclusion We determined the expression profiles of miRNAs in the obese population, with and without diabetes, before and after bariatric surgery. The miRNAs that intersected in the two comparisons were discovered. Both the miRNAs discovered and their target genes were closely associated with T2DM, demonstrating that they might be potential targets for the regulation of T2DM.

Chronic alcohol consumption causes liver steatosis, cell death, and inflammation. Melatonin (MLT) is reported to alleviate alcoholic liver disease (ALD)-induced injury. However, its direct regulating targets in hepatocytes are not fully understood. In the current study, a cell-based screening model and a chronic ethanol-fed mice ALD model were used to test the protective mechanisms of MLT. MLT ameliorated ethanol-induced hepatocyte injury in both cell and animal models (optimal doses of 10 μmol/L and 5 mg/kg, respectively), including lowered liver steatosis, cell death, and inflammation. RNA-seq analysis and loss-of-function studies in AML-12 cells revealed that telomerase reverse transcriptase (TERT) was a key downstream effector of MLT. Biophysical assay found that epidermal growth factor receptor (EGFR) on the hepatocyte surface was a direct binding and regulating target of MLT. Liver specific knock-down of Tert or Egfr in the ALD mice model impaired MLT-mediated liver protection, partly through the regulation of nuclear brahma-related gene-1 (BRG1). Long-term administration (90 days) of MLT in healthy mice did not cause evident adverse effect. In conclusion, MLT is an efficacious and safe agent for ALD alleviation. Its direct regulating target in hepatocytes is EGFR and downstream BRG1-TERT axis. MLT might be used as a complimentary agent for alcoholics.

Obesity poses a serious threat to human health, and although bariatric surgery has been proven effective treatment for morbidly obese patients, its surgical risks and high medical costs limit its clinical application and popularity. Endoscopic sleeve gastroplasty (ESG), as a relatively new endoscopic surgery technique for weight loss, has satisfactory weight loss effects compared to laparoscopic sleeve gastrectomy and lifestyle interventions, while preserving the normal structure of the stomach. Its weight loss effects and safety have been validated in multicenter studies abroad. Although, ESG has not yet been widely performed in China, with the gradual maturity of this technique, its prospects are worth attention in the field of weight loss. In the future, large-scale, long-term, multi-center studies are urgently needed in China to clarify the long-term effects, remission of comorbidities, and occurrence of complications of ESG surgery in obese and metabolic disease patients.

China currently has the largest population of overweight and obese individuals globally. Bariatric surgery is by far the most effective approach to address obesity and associated metabolic conditions. To manage the significant growth of obesity, China's bariatric and metabolic surgery has assumed a pivotal role. Despite a delayed start compared to other nations, China has made significant progress in bariatric metabolic surgery over the past two decades. Presently, the annual number of surgeries ranks ahead worldwide. However, the proportion of eligible obese patients undergoing bariatric surgery in China remains lower than global averages. Looking ahead, China's bariatric metabolic surgery field offers ample room for growth and improvement. This paper aims to highlight the achievements in bariatric and metabolic surgery within China while also addressing challenges, such as the high proportion of laparoscopic sleeve gastrectomy, adherence to operation standards and guidelines, postoperative management and loss of follow-up, and quality control of database. By analyzing the current landscape and challenges, it is anticipated that China's bariatric metabolic surgery will continue to make remarkable progress in the future, bolstered by the collective dedication of the medical community.

Objective:To investigate the efficacy of laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients aged 10 to 21 years.Methods:We conducted a retrospective analysis of clinical data from 89 out of 200 patients who underwent LSG at the Gastrointestinal Surgery/Weight Loss Center of the First Affiliated Hospital of Jinan University between January 2015 and December 2020. The primary outcome measures were the completion rate of LSG, the incidence of perioperative complications, and weight-related indicators 3, 6, 12, and ≥24 months postoperatively. Additionally, we compared glucose metabolism, lipid metabolism, vitamin levels, liver function, and other relevant biochemical variables before and after surgery. Normally distributed continuous data are presented as x±s. Because the numbers of patients at each follow-up time point were not identical with the number of patients in the study cohort preoperatively, independent sample t-tests were used for intergroup comparisons. Non-normally distributed continuous data are presented as M( Q1, Q3), and Mann-Whitney U tests were used for intergroup comparisons. Results:Among the 89 patients, 35 were male (39.3%), the mean age was (18±2) years, and mean body mass index (BMI) 38.5±4.8 kg/m2; 37 of the patients having a BMI greater than 40 kg/m2. Additionally, 63 patients (70.8%) had fatty livers, 34 (38.2%) hyperuricemia, 31(34.8%) sleep apnea syndrome, 20 (22.4%) gastroesophageal reflux, eight (8.9%) type 2 diabetes, and two (2.2%) hypertension. All 89 patients underwent LSG surgery successfully, with no conversions to open surgery. During the perioperative period, there were no cases of major bleeding, gastric leakage, or infections. Notable postoperative symptoms included nausea, vomiting, and pain, most of which improved by the second postoperative day. BMI values 3, 6, and 12 months postoperatively had decreased to 31.5±5.8 kg/m2, 28.6±4.3 kg/m2, and 26.3±4.4 kg/m2, respectively. All of these BMI values differed significantly from preoperative values (all P<0.05). At 12 and ≥24 months postoperatively, the percentages of total weight loss were (31.3±9.3)% and (33.1±10.5)%, respectively, both differing significantly from 3 months postoperatively (20.5±5.1)% (all P<0.05). The percentages of excess weight loss at 12 and ≥24 months postoperatively were 91% (70%, 113%) and 95% (74%, 118%) , respectively, both differing significantly from the percentage of total weight loss 3 months postoperatively (56% [45%, 72%]) (both P<0.05). Alanine transaminase and aspartate transaminase serum concentrations decreased from preoperative values of 44.4 (25.5, 100.5) U/L and 29.0 (9.5, 48.0) U/L to 14.0 (10.8, 18.3) U/L and 13.0 (10.5, 17.3) U/L, respectively, ≥24 months postoperatively. Hemoglobin A1c decreased from 5.6 (5.3, 5.8)% preoperatively to ≥24 months postoperatively 5.3 (5.0, 5.4)%. High-density lipoprotein increased from 1.0 (0.9, 1.2) mmol/L preoperatively to 1.4 (1.1, 1.6) mmol/L ≥24 months postoperatively. Vitamin B12 decreased from 350.0 (256.8, 441.3) μg/L preoperative to 230.3(195.4, 263.9) μg/L ≥24 months postoperatively. All differed significantly from preoperative values (all P<0.05). Conclusion:LSG has favorable efficacy in morbidly obese patients aged 10 to 21 years. However, further confirmation is required through long-term, multicenter, randomized, controlled trials.

Obesity poses a serious threat to human health, and although bariatric surgery has been proven effective treatment for morbidly obese patients, its surgical risks and high medical costs limit its clinical application and popularity. Endoscopic sleeve gastroplasty (ESG), as a relatively new endoscopic surgery technique for weight loss, has satisfactory weight loss effects compared to laparoscopic sleeve gastrectomy and lifestyle interventions, while preserving the normal structure of the stomach. Its weight loss effects and safety have been validated in multicenter studies abroad. Although, ESG has not yet been widely performed in China, with the gradual maturity of this technique, its prospects are worth attention in the field of weight loss. In the future, large-scale, long-term, multi-center studies are urgently needed in China to clarify the long-term effects, remission of comorbidities, and occurrence of complications of ESG surgery in obese and metabolic disease patients.