This research is to develop a weight-loss walking rehabilitation training system based on differential air pressure. The system adopted Proportion-Integral-Derivative (PID) algorithm to improve the precision of weight loss, taking MSP430F149 microprocessor of Texas Instruments as the core of pressure control system. The training software is designed based on Microsoft Visual C++ 6.0 of Microsoft. The system can provide comfortable training environment for patients with lower limb motor function impediment, and can collect electromyographic signals from patients, so as to further the scientific and normative management of the patient's information. Based on this training system, the initial bearing weight, bearing weight after maximum weight loss, and maximum weight loss percentage of 10 normal adults’ lower limbs were collected. It was found that the intraclass correlation coefficient (ICC) values were all greater than 0.6. The training system has a good reliability, which can provide scientific data for clinical weight-loss lower limb rehabilitation training.
ObjectiveTo evaluate the efficacy of laparoscopic sleeve gastrectomy (LSG) in the treatment of obesity with different degrees of obesity.MethodsThe clinicopathologic data of patients received LSG in this hospital from October 2016 to October 2018 were analyzed retrospectively. The effect of LSG on postoperative weight loss in patients with different degrees of obesity were analyzed too.Results① A total of 161 patients with simple obesity were included in this study, including 40 cases of degree Ⅰ obesity, 41 cases of degree Ⅱ obesity, 61 cases of degree Ⅲ obesity, and 19 cases of super obesity. All operations were successfully completed, there was no conversion to laparotomy or mortality. The postoperative bleeding occurred in 4 (2.5%) cases, nausea and vomiting occurred in 97 (60.2%) cases during hospitalization, and 143, 130, and 122 cases were followed up in 1-, 2-, and 3-year after operation. The body mass indexes (BMIs) were decreased significantly in postoperative 1-, 2-, and 3-year (P<0.05) as compared with their preoperative values, respectively. The excess BMI loss percentage(EBMIL%) in postoperative 1-, 2-, and 3-year were (87.4±25.7)%, (84.6±30.5)%, and (88.8±20.4)%, respectively. The rates of weight regaining were 3.8% (5/130) and 4.9% (6/122) in 2- and 3-year following-up, respectively. ② There were no remarkable changes in the trend of BMI in patients with degree Ⅰ and Ⅱ obesity [the EBMIL% changes from postoperative year-1 to year-3 were (–2.3±1.1)% and (3.3±1.5)%, respectively]. Conversely, there were remarkable changes in the trend of BMI in patients with degree Ⅲ obesity and super obesity [the EBMIL% changes from postoperative year-1 to year-3 were (–7.1±1.9)% and (–11.6±5.3)%, respectively].ConclusionsFrom the results of this study, LSG has a good effect on weight loss in the treatment of patients withdegree Ⅰ and Ⅱ obesity. The long-term efficacy of LSG in patients with degree Ⅲ and super obesity, whether to take other bariatric procedures, whether to perform the second operation, and the timing of the second operation need to be further explored.
ObjectiveTo investigate the effect of the remnant stomach after gastric bypass (GB) surgery on the weight loss and glucose metabolism in rats with obese and type 2 diabetes mellitus (T2DM).MethodsHigh fat feeding for one month combined with intraperitoneal injection of low-dose streptozotocin was used to induce obese rats with T2DM. Twenty-four rats with obese and type T2DM successfully established were randomly divided into resectional gastric bypass (R-GB) group, GB surgery (GB group), and sham operation (SO) group, eight rats in each group. The weight loss and anti-diabetic effect of the R-GB and GB were compared. Body weight, food intake, and fasting blood glucose (FBG) were measured at week 1 before operation and week 1–8 after the operation. Oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) were performed using tail venous blood at week 1 before operation and on week 8 after operation (at 0, 30, 60, 90, and 120 min). The levels of serum glucagon like peptide-1 (GLP-1), gastrin, insulin, and glucagon at week 1 before operation and at week 8 after operation were detected, meanwhile the homeostasis model assessment insulin resistance (HOMA-IR) index was calculated.Results① The body weight and food intake of the rats in the R-GB group and GB group were lower than those in the SO group after operation (P<0.05) and which were lower than before operation (P<0.05), but the differences were not significant between the R-GB group and GB group after operation (P>0.05). ② The levels of FBG in the R-GB group only at week 1–4 after operation were lower than those before operation (P<0.05), while which in the GB group at week 1–8 after operation were lower than those before operation and were lower than in the SO group (P<0.05), but which in the R-GB group only at week 2–4 after operation were lower than in the SO group and which were higher than that in the GB group from 3 to 8 weeks after operation (P<0.05). ③ The area under receiver operating characteristic curves (AUCs) of blood glucoses of OGTT and ITT and HOMA-IR index at week 8 after operation were lower than those before operation (P<0.05) in the GB group and which were lower than those the other two groups (P<0.05). ④ The AUC of gastrin level at week 8 after operation was lower than that before operation in the R-GB group and which lower than that in the other two groups (P<0.05). The AUC values of insulin and glucagon levels at week 8 after operation were lower than those before operation in the GB group and which lower than those in the other two groups (P<0.05). The AUC of GLP-1 level at week 8 after operation was higher than that before operation in the GB group and which higher than that in the other two groups (P<0.05).ConclusionsGB could remarkably improve glucose metabolism and weight loss in obese rat with T2DM. Gastric remnant gastrectomy following GB has a remarkable anti-diabetic effect, but it doesn’t effect on weight loss.
ObjectiveTo understand the present situation and effect of da Vinci robot in the treatment of obesity.MethodThe literatures about the application of da Vinci surgical robot in metabolic surgery for weight loss were reviewed.Resultsda Vinci surgical robot was a minimally invasive surgical system in recent years. Because of its unique structure, it broke through the limitations of traditional laparoscopic surgery, such as lack of field of vision, two-dimensional imaging, unstable lens, limited range of movement, and so on. It provided a solution way for metabolic surgery for weight loss with narrow operation space and high technical difficulty. At present, there were differences in operation time and postoperative complications between da Vinci surgical robot and laparoscopic weight loss.ConclusionsIn recent years, da Vinci surgical robot has been widely used in metabolic surgery for weight loss. It not only overcomes many limitations of laparoscopic assisted weight loss surgery, but also it is safe, feasible, and has a similar clinical effect. It provides a new choice for metabolic surgery for weight loss.
Laparoscopic Roux-en-Y gastric bypass (RYGB) is a classic operation in the field of obesity metabolic surgery. It not only obviously reduces body weight but also exhibits notable therapeutic efficacy in treating metabolic diseases such as type 2 diabetes. However, it can result in complications such as postoperative dumping syndrome and a lack of satiety after meals. So our team has further modified the RYGB, introducing a long and narrow pouch in RYGB (LN-RYGB), its core is reserving the length of the gastric pouch, then the long and narrow pouch could make maintaining a small gastric volume for a prolonged period, make food pass through slowly, and reduce reflux and decrease the incidences of dumping syndrome and intestinal bile acid reflux relevant to RYGB. The gastric contents could be thoroughly mixed, not only leading to a stronger satiety after meals but also reducing risk of postoperative bounce back. Furthermore, ulcer complications relevant to RYGB markedly declined, the therapeutic outcome is better especially in patients with type 2 diabetes. In future, more results and data relevant to LN-RYGB can be accumulated in clinic to further confirm its safety and effectiveness. Mearnwhile, it should still be paid attended to that LN-RYGB still faccs certain difficulties and has a clear indication. At present, the indications of RYGB are served as reference, and postoperative malnutrition and element deficiency need to be prevented and a long-term follow-up is also necessary.
ObjectiveTo observe the changes of body composition in patients with obesity after sleeve gastrectomy (SG) and know the factors affecting the effective weight loss. MethodsThe obese patients who received SG treatment at the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University from October 2019 to October 2022 were included according to the inclusion and exclusion criteria. The anthropometric parameters, lipid metabolism indexes, and body composition data were collected before surgery (1 d) and at 1-, 3-, 6-, and 12-month after surgery. The risk factors affecting the effective weight loss were analyzed. ResultsA total of 170 patients were included in the study. ① The anthropometric parameters such as body weight, body mass index, waist circumference, hip circumference, and waist-to-hip ratio at different time points after surgery as compared with the baseline (1 day before surgery) values were decreased (P<0.05) and showed continuous downward trends after surgery (P<0.05), meanwhile the percentage total weight loss and percentage excess weight loss (%EWL) indicators showed continuous upward trends (P<0.05). ② The lipid metabolic indexes such as triglyceride, total cholesterol, and uric acid, except for the total cholesterol indexes at the 6th and 12th month had no statistical differences as compared with the baseline value (P>0.05) and the uric acid was increased at the 1st month after surgery (P<0.05), the other indexes at different time points after surgery showed continuous downward trends as compared with the baseline values (P<0.05). ③ All the body composition parameters except percentage fat-free mass of the left and right lower limbs (P>0.05) at different time points after surgery as compared with the baseline values were decreased (P<0.05), and some body composition indicators, such as fat mass, percentage fat mass, visceral fat area, and obesity degree continued to decrease within 1 year after surgery (P<0.05). ④ There were 93 patients with reaching the standard of effective weight loss (%EWL was 50% or more). The multivariate logistic regression analysis showed that the lower fat mass of right lower limb, the higher probability of effective weight loss [OR (95%CI)=0.452 (0.290, 0.703), P<0.001]. The area under the receiver operating characteristic curve of the fat mass of the right lower limb was 0.782 [95%CI=(0.672, 0.893), P<0.001], its sensitivity and specificity were 0.679 and 0.792, respectively, and the cut-off value was 7.35 kg. ConclusionsThe results of this study suggest that SG can markedly improve the anthropometric and lipid metabolism indicators of patients with obesity, and achieve effective weight loss in a short-time. The body composition from the whole body to limbs and trunk might be changed. The fat mass of the right lower limb is closely related to the short-term effective weight loss after surgery and it has a moderate ability to distinguish achieving effective weight loss.
ObjectiveTo explore the effect of different ventilation modes on pulmonary complications (PCs) after laparoscopic weight loss surgery in obese patients. MethodsThe obese patients who underwent laparoscopic weight loss surgery in the Xiaolan People’s Hospital of Zhongshan from January 2019 to June 2023 were retrospectively collected, then were assigned into pressure-controlled ventilation-volume guaranteed (PCV-VG) group and volume controlled ventilation (VCV) group according to the different ventilation modes during anesthesia. The clinicopathologic data of the patients between the PCV-VG group and VCV group were compared. The occurrence of postoperative PCs was understood and the risk factors affecting the postoperative PCs for the obese patients underwent laparoscopic weight loss surgery were analyzed by multivariate logistic regression analysis. ResultsA total of 294 obese patients who underwent laparoscopic weight loss surgery were enrolled, with 138 males and 156 females; Body mass index (BMI) was 30–55 kg/m2, (42.40±4.87) kg/m2. The postoperative PCs occurred in 63 cases (21.4%). There were 160 cases in the PCV-VG group and 134 cases in the VCV group. The anesthesia time, tidal volume at 5 min after tracheal intubation, peak inspiratory pressure and driving pressure at 5 min after tracheal intubation, 60 min after establishing pneumoperitoneum, and the end of surgery, as well as incidence of postoperative PCs in the PCV-VG group were all less or lower than those in the VCV group (P<0.05). The indicators with statistical significance by univariate analysis in combination with significant clinical indicators were enrolled in the multivariate logistic regression model, such as the smoking history, American Society of Anesthesiologists classification, hypertension, BMI, operation time, forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity, and intraoperative ventilation mode. It was found that the factors had no collinearity (tolerance>0.1, and variance inflation factor<10). The results of the multivariate logistic regression analysis showed that the patients with higher BMI and intraoperative VCV mode increased the probability of postoperative PCs (P<0.05). ConclusionsFrom the preliminary results of this study, for the obese patients underwent laparoscopic weight loss surgery, the choice of ventilation mode is closely related to the risk of developing postoperative PCs. In clinical practice, it is particularly important to pay attention to the risk of postoperative PCs for the patients with higher degree obesity.