Bariatric and metabolic surgery has become a primary treatment for decompensated obesity, with the number of procedures rapidly increasing in China in recent years. Various improved and novel surgical techniques have emerged. Given the characteristics of the Chinese obese population lower body mass index compared to Western populations and frequent pancreatic islet dysfunction laparoscopic Roux-en-Y gastric bypass remains one of the mainstream procedures in China. Although the Procedural Guideline for Laparoscopic Roux-en-Y Gastric Bypass (2019 Edition) has provided standardized surgical steps, mastering and routinely implementing the procedure in clinical practice continues to pose significant challenges. Compared to laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass is more technically demanding and requires a longer learning curve. To avoid suboptimal weight loss or severe postoperative complications resulting from non-standardized techniques, this article summarizes the authors' clinical experience, emphasizing key technical steps: creation of the gastric pouch, standardization of gastrojejunal and jejunojejunal anastomoses, hiatal closure, and full serosalization. These insights aim to improve procedural safety and therapeutic efficacy by offering a set of practical process optimization strategies.
Humans ; Gastric Bypass/methods* ; Laparoscopy/methods* ; Obesity, Morbid/surgery* ; Postoperative Complications/prevention & control* ; China ; Jejunum/surgery* ; Gastrectomy/methods* ; Anastomosis, Surgical/methods* ; Weight Loss

Understanding microbial-host interactions in the oral cavity is essential for elucidating oral disease pathogenesis and its systemic implications. In vitro bacteria-host cell coculture models have enabled fundamental studies to characterize bacterial infection and host responses in a reductionist yet reproducible manner. However, existing in vitro coculture models fail to establish conditions that are suitable for the growth of both mammalian cells and anaerobes, thereby hindering a comprehensive understanding of their interactions. Here, we present an asymmetric gas coculture system that simulates the oral microenvironment by maintaining distinct normoxic and anaerobic conditions for gingival epithelial cells and anaerobic bacteria, respectively. Using a key oral pathobiont, Fusobacterium nucleatum, as the primary test bed, we demonstrate that the system preserves bacterial viability and supports the integrity of telomerase-immortalized gingival keratinocytes. Compared to conventional models, this system enhanced bacterial invasion, elevated intracellular bacterial loads, and elicited more robust host pro-inflammatory responses, including increased secretion of CXCL10, IL-6, and IL-8. In addition, the model enabled precise evaluation of antibiotic efficacy against intracellular pathogens. Finally, we validate the ability of the asymmetric system to support the proliferation of a more oxygen-sensitive oral pathobiont, Porphyromonas gingivalis. These results underscore the utility of this coculture platform for studying oral microbial pathogenesis and screening therapeutics, offering a physiologically relevant approach to advance oral and systemic health research.
Coculture Techniques/methods* ; Humans ; Fusobacterium nucleatum/physiology* ; Gingiva/microbiology* ; Keratinocytes/microbiology* ; Host Microbial Interactions ; Mouth/microbiology* ; Host-Pathogen Interactions ; Epithelial Cells/microbiology* ; Cells, Cultured ; Porphyromonas gingivalis

Objective:To explore the differences of microenviroment between peri-implant tissue and oral mucosal tissue.Methods:The gene chip data GSE43744 was downloaded from the GEO database,bioinformatics tools were used to analyze the differentially ex-pressed genes between the peri-implant tissue and normal oral mucosal tissue in rat.Results:1315 differentially expressed important genes,including 797 upregulated genes and 518 downregulated genes,were screened out.Gene enrichment analysis showed that com-pared with normal oral mucosal tissue,the gene expression of innate immune activity,cell activation,inflammatory response,and func-tional expression related to external and bacterial stimuli in peri-implant tissue were significantly upregulated,while that of extracellular matrix tissue,adhesion,extracellular matrix polysaccharides,response to mechanical stimuli and response to toxic substances was sig-nificantly downregulated.Meanwhile,multiple molecular functions and biological pathways related to T cells were highly expressed,which may play an important role in the peri-implant microenvironment.In addition,PPI network was constructed,and screened 7 core genes including FCER1G,TYROBP,PTPRC,ITGB2,AIF1,EMR1 and RAC2,which may be target genes for studying peri-implant microenvironment.Conclusion:There is a significant difference of microenvironment characteristics between peri-implant tissue and o-ral mucosa.The target genes screened using PPI network may be the key to future research on the peri-implant microenvironment.

Trials within cohorts （TwiCs） are design methods derived from randomized controlled trials （RCTS）. They have been widely used in chronic disease areas such as tumors and cardiovascular diseases. The basis of the TwiCs design is a prospective cohort of specific diseases. When RCTS need to be implemented， some patients meeting the inclusion and exclusion criteria are randomly sampled from the cohort to receive "trial interventions"， while the remaining patients in the cohort who meet the inclusion and exclusion criteria continue to receive conventional treatment as control groups. By comparing the efficacy differences between the intervention measures of the trial group and the control group， the efficacy of intervention measures was evaluated. Within the cohort， the same process could be repeated to carry out multiple RCTS， so as to evaluate different intervention measures or compare the efficacy of different doses or timing of interventions. Compared with classical RCTS， TwiCs make it easier to recruit patients from the cohort and have higher external validity， providing a new research paradigm for improving the efficiency and applicability of RCTS in clinical practice. However， TwiCs may also face the challenge of poor compliance of patients in the cohort. Researchers need to take effective measures to control these patients in the design and operation of TwiCs. This article focused on the methodological key points during the implementation of TwiCs， including multi-stage informed consent （patients are informed of consent at three stages： entering the cohort， entering the trial group， and after the trial）， randomization procedures （only random sampling of patients from the cohort to receive "trial interventions"）， sample size calculation， and statistical analysis methods. The article also compared the differences between TwiCs and traditional RCTS and illustrated TwiCs research design and analysis with examples， so as to provide new research ideas and methods for clinical researchers.

Gastrointestinal stromal tumor(GIST),with a certain malignant potential,are currently the most common subepithelial tumors of the gastrointestinal tract.Early diagnosis and prediction of malignant potential are very important for the formulation of a treatment plan and determining the prognosis of GIST.Deep learning technology has made significant progress in the diagnosis of digestive tract diseases,and it can also effectively assist physicians in diagnosing GIST and predicting their malignant potential,preoperatively.The application of deep learning technology in the diagnosis of GIST includes CT,gastrointestinal endoscopy and endoscopic ultrasound.This paper aims to review the application of deep learning technology in the diagnosis and prediction of malignant potential of GIST.

Objective:To analyze the operational efficiency and its changes of traditional Chinese medicine(TCM)hospitals in Guangdong province,and to provide empirical evidence for improving the operational efficiency of TCM hospitals in Guangdong Province.Methods:The three-stage DEA model was used to conduct a static analysis of the operating efficiency of TCM hospitals in Guangdong Province in 2022,and the Malmquist index was used to conduct a dynamic analysis of the changes in the operating efficiency of TCM hospitals in Guangdong Province from 2018 to 2022.Results:After eliminating the influences of environmental variables and random interference,the average values of comprehensive efficiency,pure technical efficiency and average scale efficiency of the TCM hospitals in Guangdong Province in 2022 were 0.970,0.982 and 0.988,respectively.From 2018 to 2022,the total factor productivity index of Guangdong's TCM Hospitals was 1.008.Conclusion:The overall operation efficiency of TCM hospitals in Guangdong is high,but there are obvious regional differences.Further improvement of operation efficiency is mainly restricted by pure technical efficiency.Operational efficiency needs to be further improved through measures such as coordinating the layout of resources in various places,improving the external environment,sounding the internal management system of hospitals,and fine-tuning operational management.

Objective:To analyze the operational efficiency and its changes of traditional Chinese medicine(TCM)hospitals in Guangdong province,and to provide empirical evidence for improving the operational efficiency of TCM hospitals in Guangdong Province.Methods:The three-stage DEA model was used to conduct a static analysis of the operating efficiency of TCM hospitals in Guangdong Province in 2022,and the Malmquist index was used to conduct a dynamic analysis of the changes in the operating efficiency of TCM hospitals in Guangdong Province from 2018 to 2022.Results:After eliminating the influences of environmental variables and random interference,the average values of comprehensive efficiency,pure technical efficiency and average scale efficiency of the TCM hospitals in Guangdong Province in 2022 were 0.970,0.982 and 0.988,respectively.From 2018 to 2022,the total factor productivity index of Guangdong's TCM Hospitals was 1.008.Conclusion:The overall operation efficiency of TCM hospitals in Guangdong is high,but there are obvious regional differences.Further improvement of operation efficiency is mainly restricted by pure technical efficiency.Operational efficiency needs to be further improved through measures such as coordinating the layout of resources in various places,improving the external environment,sounding the internal management system of hospitals,and fine-tuning operational management.

Objective:To analyze the operational efficiency and its changes of traditional Chinese medicine(TCM)hospitals in Guangdong province,and to provide empirical evidence for improving the operational efficiency of TCM hospitals in Guangdong Province.Methods:The three-stage DEA model was used to conduct a static analysis of the operating efficiency of TCM hospitals in Guangdong Province in 2022,and the Malmquist index was used to conduct a dynamic analysis of the changes in the operating efficiency of TCM hospitals in Guangdong Province from 2018 to 2022.Results:After eliminating the influences of environmental variables and random interference,the average values of comprehensive efficiency,pure technical efficiency and average scale efficiency of the TCM hospitals in Guangdong Province in 2022 were 0.970,0.982 and 0.988,respectively.From 2018 to 2022,the total factor productivity index of Guangdong's TCM Hospitals was 1.008.Conclusion:The overall operation efficiency of TCM hospitals in Guangdong is high,but there are obvious regional differences.Further improvement of operation efficiency is mainly restricted by pure technical efficiency.Operational efficiency needs to be further improved through measures such as coordinating the layout of resources in various places,improving the external environment,sounding the internal management system of hospitals,and fine-tuning operational management.

Objective:To analyze the operational efficiency and its changes of traditional Chinese medicine(TCM)hospitals in Guangdong province,and to provide empirical evidence for improving the operational efficiency of TCM hospitals in Guangdong Province.Methods:The three-stage DEA model was used to conduct a static analysis of the operating efficiency of TCM hospitals in Guangdong Province in 2022,and the Malmquist index was used to conduct a dynamic analysis of the changes in the operating efficiency of TCM hospitals in Guangdong Province from 2018 to 2022.Results:After eliminating the influences of environmental variables and random interference,the average values of comprehensive efficiency,pure technical efficiency and average scale efficiency of the TCM hospitals in Guangdong Province in 2022 were 0.970,0.982 and 0.988,respectively.From 2018 to 2022,the total factor productivity index of Guangdong's TCM Hospitals was 1.008.Conclusion:The overall operation efficiency of TCM hospitals in Guangdong is high,but there are obvious regional differences.Further improvement of operation efficiency is mainly restricted by pure technical efficiency.Operational efficiency needs to be further improved through measures such as coordinating the layout of resources in various places,improving the external environment,sounding the internal management system of hospitals,and fine-tuning operational management.

Objective:To analyze the operational efficiency and its changes of traditional Chinese medicine(TCM)hospitals in Guangdong province,and to provide empirical evidence for improving the operational efficiency of TCM hospitals in Guangdong Province.Methods:The three-stage DEA model was used to conduct a static analysis of the operating efficiency of TCM hospitals in Guangdong Province in 2022,and the Malmquist index was used to conduct a dynamic analysis of the changes in the operating efficiency of TCM hospitals in Guangdong Province from 2018 to 2022.Results:After eliminating the influences of environmental variables and random interference,the average values of comprehensive efficiency,pure technical efficiency and average scale efficiency of the TCM hospitals in Guangdong Province in 2022 were 0.970,0.982 and 0.988,respectively.From 2018 to 2022,the total factor productivity index of Guangdong's TCM Hospitals was 1.008.Conclusion:The overall operation efficiency of TCM hospitals in Guangdong is high,but there are obvious regional differences.Further improvement of operation efficiency is mainly restricted by pure technical efficiency.Operational efficiency needs to be further improved through measures such as coordinating the layout of resources in various places,improving the external environment,sounding the internal management system of hospitals,and fine-tuning operational management.