Cuiling Zhu

Background Postoperative hypoxemia (PH) is the most common postoperative pulmonary complication (PPC) of bariatric surgery. However, clinically validated tools and tests are lacking to predict the risk of hypoxemia after bariatric surgery in patients with obesity. Therefore, this study developed and validated a nomogram model for predicting the probability of hypoxemia within 24 h after laparoscopic sleeve gastrectomy (LSG) in patients with obesity. Methods The prediction model was based on a retrospective study of 195 patients with obesity who underwent LSG between January 2018 and December 2023 at Shanghai Tenth People’s Hospital. Multivariate logistic regression analysis was performed to identify independent predictors of postoperative hypoxemia. Model performance was evaluated using receiver operating characteristic curves, calibration curves, clinical decision curve analysis, and clinical impact curves. This prediction model was internally validated with bootstrap resampling and further externally validated in 105 patients who underwent LSG at Beijing Friendship Hospital and The Third People’s Hospital of Chengdu. Results The nomogram prediction model included preoperative body mass index (BMI), platelet count (PLT), fibrinogen level (FIB), and the triglyceride-glucose (TyG) index. This prediction model demonstrated favorable discrimination, calibration, and clinical validity in both the training and validation sets. We published the nomogram online as a simple and useful calculator. Conclusions The prediction model accurately predicted the risk of postoperative hypoxemia in patients with obesity and may help professionals identify high-risk patients early and make informed clinical decisions. Trial registration: NCT04548232

Background: Diabetic retinopathy (DR), one of the most common microvascular complications of diabetes mellitus (DM), remains to be a major driver of vision loss worldwide. Vitamin D has been reported to be involved in DR pathogenesis, but results have been inconsistent. We aimed to explore the relationship between blood 25-hydroxyvitamin D, 25(OH)D, level and the risk of DR in patients with type 2 diabetes (T2DM).Methods: A total of 535 adults with T2DM from our department were included. Demographic information, biochemical data, 25(OH)D, and sex hormones were collected. Fundus photography was performed to determine the presence of DR. Participants were grouped into the DR group and the non-DR (NDR) group according to the fundus examinations and four groups based on serum 25(OH)D levels as follows: normal, insufficient, deficient, and severely deficient. Multivariate logistic regression analysis was used to evaluate the association between 25(OH)D and risk of DR.Results: Males but not females with DR had significantly decreased levels of 25(OH)D (16.4 ± 5.6 ng/ml vs. 21.0 ± 5.0 ng/ml, P = 0.001) and increased proportion of severe 25(OH)D deficiency (14.8% vs. 6.7%, P = 0.022) compared to those without DR. Likewise, there was a gradually increasing percentage of DR with the reduction of 25(OH)D levels only in males (35.7%, 44.4%, 53.2%, 70.3%, P = 0.022). Intriguingly, total testosterone (TT) levels decreased markedly in males with DR (12.9 ± 5.2 nmol/L vs. 14.2 ± 5.5 nmol/L, P = 0.035) compared to their counterparts and correlated positively with 25(OH)D (β = 0.161, P = 0.007), which did not occur in females. After multivariate adjustment, we observed a significant inverse association between serum 25(OH)D and the occurrence of DR in males, showing that the adjusted ORs (AORs) and 95% confidence interval for DR were 0.233 (0.070–0.779) in the normal group, 0.280 (0.103–0.756) in the insufficient group, and 0.477 (0.196–1.164) in the deficiency group with the severely deficient group as a reference (P_-trend = 0.003). However, such a significant association was not observed in females (P_-trend = 0.137).Conclusion: We concluded a gender-specific relationship between serum 25(OH)D and the incidence of DR in T2DM, supported by a significant inverse association between serum 25(OH)D and DR only in males, which could be mediated by a marked reduction in TT levels.

Bone morphogenetic protein 4 (BMP-4) has been proven to regulate white adipogensis. We aimed to demonstrate the correlation of BMP-4 with fat distribution and Exenatide treatment on it. We enrolled 69 obese patients. Anthropometric and metabolic indexes were collected. Fat distribution was measured by dual-energy X-ray absorptiometry. BPM-4 levels were assessed using enzyme-link immunosorbent assay kit. 30 obese patients were treated with Exenatide twice a day. Change in body weight, metabolic-related indices and BPM-4 levels were evaluated after 18 weeks. 1) The mean(±SD) BMP-4 levels were 763.98 ± 324.11 pg/ml in the obese. BPM-4 levels were significantly positively correlated with estimated visceral adipose tissue mass in all subjects and also in females (r = 0.377, r = 0.625, respectively,all P < 0.05). BPM-4 levels were also significantly positively correlated with body mass index, hip circumference and total fat% in females (r = 0.375,r = 0.429,r = 0.493,respectively, all P < 0.05). BPM-4 levels were negatively correlated with total cholesterol(TC) in all subjects and males also (r = −0.373,r = −0.332,respectively, all P < 0.05). BPM-4 levels were also significantly positively correlated with free triiodothyronine in males (r = 0.441, P < 0.05). 3) Multivariate analyses showed that TC was risk factor of BMP-4 concentration in males and Est.VAT Area was risk factor of BMP-4 levels in females. 4) BMP-4 levels were significantly higher in the obesity with slightly increased thyroid stimulating hormone(TSH) than the obesity without slightly increased TSH (902.08 ± 354.74 pg/ml vs. 720.24 ± 306.41 pg/ml, P < 0.05). 5) Exenatide treatment leads to a significant decreased in BMP-4 from 860.05 ± 352.65 pg/ml to 649.44 + 277.49 pg/ml independent of weight loss(P < 0.05). BMP-4 levels were associated with the visceral adipose tissue and may play a certain role in fat distribution and subclinical hypothyroidism in obesity. Exenatide treatment reduced BMP-4 levels independent of weight loss. Clinicaltrials.gov Identifier: NCT02118376 , Registered 16 April.