Objective

To develop the Chinese Expert Consensus on Medical Knowledge Dissemination in Metabolic and Bariatric Surgery （2024 Edition） （The Consensus）， aiming to promote the professionalization and standardization of medical knowledge dissemination in metabolic and bariatric surgery in China.

Methods

The Delphi method was employed to gather expert opinions.Based on a comprehensive analysis of domestic and international models and content of medical knowledge dissemination in metabolic and bariatric surgery， as well as relevant guidelines for obesity and metabolic diseases in China， 11 experts with extensive experience in this field discussed and summarized 46 consensus statements.An initial draft was created， followed by a first-round expert survey.After incorporating feedback from the survey，a revised version was used to create a second-round questionnaire， which was completed by 214 experts.The final consensus was developed after further revisions.

Results

The Consensus includes 46 consensus statements addressing three main areas below： the current status of medical knowledge dissemination in metabolic and bariatric surgery， approaches to medical knowledge dissemination， and key points and considerations for delivering high-quality dissemination in this field.

Conclusion

The Consensus is both scientifically rigorous and practical， providing standards and guidelines for implementing medical knowledge dissemination in metabolic and bariatric surgery in China.

Objective

To analyze and compare the clinical outcomes of ghost ileostomy and looptype ileostomy following laparoscopic radical resection in patients with middle and low rectal cancer.

Methods

Data of 161 patients with middle and low rectal cancer who underwent elective laparoscopic radical resection in the 940th Hospital of Joint Logistics Support Force between June 2018 and June 2021 were retrospectively collected.Based on propensity score matching， the patients were divided into the ghost ileostomy group and the loop-type ileostomy group， with 49 patients in each group.The general clinical characteristics， intraoperative conditions， intraoperative and postoperative complications， stoma-related complications， and changes in inflammatory markers before and after surgery between the two groups were compared.

Results

Compared with the loop-type ileostomy group， the ghost ileostomy group had less hospitalization costs （P=0.010）， shorter operative and hospitalization time （P＜0.05）， less intraoperative blood loss （P=0.001）， and lower rates of reoperation within three months postoperatively， stoma state at six months postoperatively， and days of antibiotic use （P＜0.05）.There were no statistically significant differences in preoperative inflammatory markers such as WBC， PCT， and IL-6 between the two groups.However， the levels of inflammatory markers on day 1， 2， 3， and 5 postoperatively were significantly lower in the ghost ileostomy group compared to the loop-type ileostomy group （P＜0.05）.

Conclusions

Ghost ileostomy is a safer， more effective surgical method that reduces hospitalization time and costs.Its application in laparoscopic radical resection for rectal cancer is associated with fewer complications and stoma-related issues， contributing to better patient outcomes.

Objective

To investigate the correlation and consistency of computed tomography（CT） and bioelectrical impedance analysis （BIA） in the determination of skeletal muscle mass in presurgery patients with gastric cancer.

Methods

170 patients diagnosed as gastric cancer and treated with radical surgery from December 2022 to December 2023 in the Department of General Surgery of the Second Hospital of Lanzhou University were continuously enrolled， and their muscle mass was measured by CT and BIA respectively， the interval between the two checks should not exceed 1 month.According to the skeletal muscle mass index at the level of the third lumbar vertebra （L3-SMI）， they were divided into muscle mass reduction group and normal group， and the differences in general data and appendicular skeletal muscle mass index （ASMI） between the two groups were compared and stratified by gender and body mass index （BMI），for analysis of diagnosis relevance and consistency of the two methods.

Results

Among the 170 patients，there were 114 males （67.06%） and 56 females （32.94%） with an average age of （58.72±12.60） years.There were 70 cases （41.18%） of reduced muscle mass diagnosed by CT， and significant differences existed in L3-SMI， age， BMI and NRS2002 score， ASA， HU between the muscle mass reduction group and the normal group （P＜0.001）.80 patients （47.06%） were diagnosed with decreased muscle mass by BIA.There was no significant difference in the incidence of muscle mass reduction rate in the total population measured by the two instruments （χ²=1.913，P=0.275）.The correlation model between L3-SMI and ASMI， gender， BMI and age showed high liner correlation （R²=0.724， P＜0.001）.Stratified analysis showed a stronger correlation between the two measurements in the BMI range of ［18.5-24.0） kg/m² （R²=0.715， P＜0.05）.In male patients，the correlation between the two measures was stronger than that in female patients （R²=0.613， P＜0.05）.There was moderate consistency between the two measures （k=0.643， P＜0.001）.

Conclusion

There is good correlation between CT and BIA in the diagnosis of muscle mass loss in gastric cancer patients， especially in BMI ［18.5-24.0） kg/m² and male patients， while the two diagnostic results are moderately consistent， which may be related to the different influencing factors of measuring L3-SMI and ASMI.

Objective

Based on the bibliometric analysis of sentinel lymph node research in gastric cancer， the research hotspots and trends in this field were discussed by systematically searching all relevant literature up to July 31， 2024.

Methods

The Web of Science core collection database was searched to obtain related studies.The bibliometric analysis and data visualization were carried out using VOSviewer 1.6.20 and CiteSpace 6.2.R6 software to analyze the country， institution， author， journal and keywords.

Results

A total of 604 articles were included.The countries， institutions and authors with the highest number of publications were Japan， Keio University， and Kitagawa Y， respectively.Ann Surg Oncol was the mostly published journal， and Ann Surg was the mostly influential journal in the field.The cited journals mainly focused on the fields of “ Surgery， Clinical， Biology”； and the fields of the cited journals were mainly in the field of “ Medicine， Molecular， Nursing”.The mostly cited reference was J Surg Oncol 2011： The clinical use of indocyanine green as a near-infrared fluorescent contrast agent for image-guided oncologic surgery.Keyword cluster analysis divided the keywords into four categories： personalized precision surgery，sentinel lymph node tracing of gastric cancer， sentinel lymph node pathological diagnosis and sentinel lymph node navigation surgery.Multicenter studies， sentinel lymphatic basin dissection， indocyanine green， and sentinel navigation surgery were the current research hotspots.

Conclusions

Sentinel lymph node has a broad application prospect and has obtained preliminary results in the precision treatment and biology of gastric cancer.The results of this study can provide reference for scholars who carry out research on sentinel lymph nodes in gastric cancer.

Objective

To investigate the mechanisms underlying gallstone formation and liver injury induced by the lithogenic diet using a mouse model.

Methods

Twelve C57BL/6J mice were divided into two groups by random number table method： stone-forming group and control group， with six mice in each group.The stone-forming group was fed a lithogenic diet that promoted gallstone formation to establish a model of gallstone-induced liver injury， while the control group received a regular diet.Liver tissues were stained with hematoxylin-eosin staining （HE） and immunohistochemical staining （IHC）， and analyzed using Western blotting （WB）， quantitative real-time PCR （qPCR）， enzyme linked immunosorbent assay （ELISA），flow cytometry， and other techniques.

Results

Compared to the mice in the control group， those in the stone-forming group exhibited gallstones.Pathological examination of their livers revealed significant liver injury.Additionally， levels of serum alkaline phosphatase （ALP）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， bilirubin， and bile acid （BA） were significantly elevated.The mRNA levels of nitric oxide synthase 2 （NOS2） and interleukin-1β （IL-1β） were significantly increased （P＜0.001）， and the expression levels of lactate dehydrogenase （LDH） and reactive oxygen species （ROS） in AML12 cells were significantly increased （P＜0.000 1）.Activation of the nuclear factor kappa-B （NF-κB） signaling pathway in the liver was observed along with polarization towards M1-type macrophages.

Conclusion

The consumption of a lithogenic diet leads to gallstone formation and subsequent liver injury through promoting M1-type macrophage polarization which further mediates hepatocyte damage.

Colorectal cancer （CRC） is one of the most common malignancies worldwide， with high rates of incidence and mortality， and lung is a frequent site of metastasis.Surgical resection remains the primary treatment for CRC patients with pulmonary metastases， yet postoperative pulmonary recurrence is common.This review provides an overview of recent advances in managing recurrent pulmonary metastasis following pulmonary metastasectomy in CRC， with a focus on local therapies （radiofrequency ablation， microwave ablation， stereotactic body radiation therapy and so on） and systemic therapies（such as chemotherapy， targeted therapy， immunotherapy）.Future researches should focus on optimizing individualized treatment strategies， identifying effective biomarkers， and enhancing multidisciplinary collaboration to improve patients' outcomes.The goal remains to boost long-term survival rates and quality of life while reducing treatment-related toxicity.

The primary clinical treatment for low rectal cancer is radical surgery， with total mesorectal excision （TME） being the most commonly used surgical technique.Due to the proximity of low rectal cancer to the anus， traditional laparoscopic-assisted TME presents significant challenges in performing precise operations within the pelvis and around the rectum， especially for patients with “difficult pelvis” conditions， such as obesity， a narrow pelvis， or male anatomy.Transanal total mesorectal excision（TaTME） improves visualization of the anatomical plane， enabling precise identification of the distal margin and reducing the incidence of positive circumferential resection margins （CRM）， thereby increasing rates of sphincter preservation.Additionally， TaTME may enhance specimen quality and preserve organ function.This paper briefly explores the relationship between TaTME， natural orifice specimen extraction surgery（NOSES） and natural orifice translumenal endoscopic surgery （NOTES）， as well as the minimally invasive and functional outcomes of TaTME， aiming to provide theoretical foundations and empirical evidence for further research and clinical practice in this area.

Adiponectin is a multifunctional protein secreted by adipocytes， playing a crucial role in the energy metabolism and cancer development.In recent years， numerous studies have revealed close association between low levels of adiponectin and the occurrence and progression of colorectal cancer.Adiponectin binds to its receptors and regulates various biological behaviors of colorectal cancer cells， such as survival， apoptosis， metastasis， and adhesion， through pathways like AMPK， STAT3， and PI3K/Akt.It is considered to have anti-cancer potential.Therefore， understanding the mechanisms of adiponectin in colorectal cancer is of great significance for the prevention and treatment of tumors.This review aims to summarize and elucidate the roles of adiponectin in the occurrence and progression of colorectal cancer， with a focus on its anti-cancer mechanisms.