结核病患者病耻感的研究进展

病耻感是患者因患病而产生的一种负性情绪体验。由于结核病患者缺乏疾病知识及公众对结核病患者的歧视态度,病耻感在结核病患者中广泛存在,并严重影响着患者的身心健康。结核病患者病耻感已受到国外学者的关注,并已编制出多个针对结核病患者病耻感的测评工具,其中使用范围最广的是由Van等编制的结核病相关病耻感量表。结核病患者病耻感水平与患者的性别、居住地、文化程度、婚姻状况、家庭收入等有关。降低病耻感水平对促进患者的康复有重要的意义,但目前干预性研究较少。建议以后的研究着重探索有效降低结核病患者病耻感水平的干预措施。     

减重代谢术后3年内患者体重变化情况及影响因素分析

目的探讨减重代谢术后患者的体重下降情况,并分析其心理社会相关影响因素。 方法2020年1月至2月采用方便抽样法,选取某三级甲等医院减重代谢手术后患者199例为研究对象,采用一般资料问卷、自我效能感量表、一般健康问卷、社会支持评定量表等工具进行问卷调查,采用t检验、方差分析、多重线性回归等进行影响因素分析。 结果减重代谢手术患者术前与术后体质量指数（BMI）的差值为（10.97±7.10）kg/m²,术后减重效果较好,多元线性回归分析结果显示,社会支持、自我效能感、手术方式和居住方式进入回归方程（P<0.05）,共解释患者术后体重下降总变异的28.8%。 结论减重代谢手术患者术后体重下降明显,社会支持水平、自我效能感、手术方式和居住方式是术后减重效果的主要影响因素。     

中老年精神病人病耻感与应对方式、自尊的相关性

目的探讨中老年精神病人的病耻感及其与应对方式和自尊的关系。方法采用精神病患者病耻感评估量表、简易应对方式问卷、自尊量表(SES)对226例精神病人进行问卷调查。结果中老年精神病人的病耻感总分在性别、年龄、是否首发、有无子女上无显著差异(P>0.05);与积极应对方式呈负相关,与消极应对呈正相关(P<0.05);与自尊水平呈负相关(P<0.001)。结论中老年精神病人的应对方式对病耻感有影响,积极应对使病耻感降低。     

减重代谢手术术中不良事件及处理(附视频)

减重代谢手术在全球得到了越来越多的关注,在我国开展的医院和例数也逐年增多。但减重代谢手术面对的患者为良性疾患,患者自身期望较高,再加上肥胖、糖尿病等合并症,手术的风险和并发症也并不少见。本文拟回顾四川大学华西医院在实施减重代谢手术时术中出现的一些典型不良事件,及其处理对策,旨在为广大减重代谢外科医生提供相关手术经验,促进我国减重外科事业更好地健康平安发展。     

减重手术对微量元素的影响

<正>随着肥胖发生率及其相关代谢性疾病发病率的迅猛攀升,肥胖已成为这个时代最重要的世界性公共卫生议题。减重手术为肥胖和2型糖尿病的治疗带来新的曙光,不但是病态性肥胖患者目前唯一有效的治疗方法,而且逐渐发展为代谢性手术。减重手术的手术方式包括垂直束带胃减容术(vertical     

减重手术对多囊卵巢综合征的治疗作用

多囊卵巢综合征(PCOS)是女性常见的内分泌疾病,PCOS容易合并肥胖和代谢综合征,但其代谢紊乱的危害容易被忽视.减重手术可以有效降低体重,恢复下丘脑-垂体轴正常功能,降低心血管风险、提高妊娠几率,预防或逆转代谢综合征.故减重手术可推荐作为PCOS女性尤其是合并代谢综合征患者的有效治疗手段.     

过去10年我国减重代谢手术的研究进展

目的利用计量分析的方法对我国过去10年发表的减重代谢手术相关的中文临床型文献进行回顾性分析，归纳分析我国减重代谢手术研究进展。 方法以检索词（"减重手术""代谢手术""袖状胃切除""胃旁路术"和"胃绑带术"）检索万方和中国知网数据库在2009年1月1日到2018年12月31日所收录的减重代谢手术相关研究文献，通过对引文中每年发表论文数量，发表论文最多的作者、机构及相关杂志，论文被引次数等相关指标进行整理及分析。 结果总共有1222篇减重代谢手术相关引文被检索到。减重代谢手术相关论文的年发表量呈现先增长后稳定的趋势，从2009年年发表量34篇，在2015年增至175篇，此后呈现相对稳定。朱江帆、王存川、郑成竹等学者在减重代谢手术相关领域发表相关论文最多，暨南大学附属第一医院、第二军医大学附属长海医院、南京医科大学第一附属医院等机构在减重代谢领域处于国内领先水平。中华肥胖与代谢病电子杂志、腹腔镜外科杂志、中国实用外科杂志是目前发表减重代谢手术最多的期刊。 结论我国目前的减重代谢手术基本成熟，但尚需多中心前瞻性临床试验进一步证实减重代谢手术治疗2型糖尿病的有效性。     

中国肥胖代谢外科数据库：2020年度报告

目的统计分析2020年中国肥胖代谢外科手术开展情况。 方法基于中国肥胖代谢外科数据库（COMES Database）,精确统计分析2020年1月1日至2020年12月31日中国减重手术开展的种类、例数,以及专职人员、多学科团队（MDT）及院内数据库建设情况。以此为基础,经多种途径例如文献搜索、企业资料、医院及医护人员提供的信息等,综合推算2020年的减重手术情况。 结果全国共有138家医院及减重中心参与COMES数据库年度统计,地域涵盖32个省（自治区、直辖市、特别行政区）的62个城市,总手术量12837例,其中腹腔镜手术12514例（97.5%）,包括袖状胃切除术10303例（82.3%）、胃旁路术922例（7.4%）、袖状胃联合手术1146例（9.2%）、OAGB/MGB手术100例（0.8%）、胃折叠术29例（0.2%）、BPD/DS手术6例（0.05%）。内镜减重手术13例（0.1%）,机器人辅助手术128例（1.0%）,修正手术182例（1.4%）。122家（88.4%）医院有专职减重外科医生（共387位）,101家（73.2%）医院有专职减重个案管理师（共183位）。113家（81.9%）医院成立了MDT,85家（61.6%）医院建立了院内减重手术数据库。综合推算全国减重手术实际总数量约为14037例。 结论本年度全国减重手术总数量较2019年大幅度增加,主流手术仍是LSG和LRYGB;专职的减重外科医生及个案管理师人数也较前增加,大部分医院成立了MDT及建立了院内减重手术数据库。我们期待各中心基于庞大的病例基数,做好手术的安全质量管理、患者的长期随访及临床数据的完整性,产生更多高质量的临床研究成果,从而提高肥胖代谢外科的医疗质量及临床疗效,使广大患者受益。     

青少年肥胖症代谢手术后3年效应观察与分析

目的探究青少年肥胖症病人接受减重代谢手术后中期效益及影响。 方法回顾性分析2014年11月至2015年10月于长春嘉和外科医院接受减重代谢手术的16例青少年肥胖症患者（13~21岁）的临床资料,对他们术前及术后3年间的体重、体质量指数（BMI）、甘油三酯（TC）、高密度脂蛋白（HDL）及低密度脂蛋白（LDL）进行统计分析。 结果16名入组患者的平均体重、BMI、空腹TC、LDL在术后3年均有不同幅度下降,平均空腹HDL有所升高,数据分析均有统计学意义（P<0.05）。 结论减重代谢手术可以明确并且持续性地减轻青少年肥胖症病人的体重,同时改善血脂异常问题。青少年一旦达到肥胖II级应当尽早手术。     

结核病患者受歧视及产生病耻感的现状及研究进展

结核病是严重危害人类健康的慢性传染性疾病,病耻感在结核病患者中广泛存在,导致治疗延误,对个人和社会都造成严重后果。结核病患者遭受的歧视主要有家庭歧视、社会歧视、医疗机构歧视,以此产生的病耻感使患者进一步承受了心理上的痛苦,从而采取消极态度应对治疗和生活,造成不良的预后。结核病患者的病耻感在不同人口学特征的人群中程度不一。目前,中国乃至全球范围内缺乏有代表性的与结核病患者受歧视相关的调查报告,作者从结核病患者受歧视的现状、影响因素、产生原因及消除方法等多个方面梳理了目前国内外的相关研究工作,希望为改良对结核病患者的治疗和管理策略提供更多依据。     

Laparoscopy for primary and secondary bariatric procedures

Recently obesity has been defined as a disease and has turned bariatric surgery into a part of a chronic illness management. Obesity induces several comorbidities leading to cardiovascular disease and mortality. The effects of bariatric surgery on these comorbidities used to be classified as weight-loss induced. However bariatric surgery has recently been termed metabolic surgery because of the suspected direct, weight loss independent effect of bariatric procedures on the physiopathological mechanisms causing excess fat storage and insulin resistance. This review describes the standard procedures commonly performed and their specific outcomes on metabolic diseases in order to work towards more patient tailored treatment of obesity and to reduce side effects. Furthermore this review focuses on gaps in understanding the pathogenesis of obesity and its treatment with bariatric surgery. Surgery failures as well as new techniques are discussed and evaluated.     

Medical and surgical management of obesity and diabetes: what's new?

We conducted a narrative review of the medical and surgical management of people with obesity and diabetes. Results of this review showed that a 5–10% loss in body weight can be achieved with a change in lifestyle, diet and behaviour and with approved pharmacological therapies in people with obesity and diabetes. New targeted therapies are now available for patients with previously untreatable genetic causes of obesity. Compared to medical treatment, metabolic and bariatric surgery is associated with significantly higher rates of remission from type 2 diabetes and lower rates of incident macrovascular and microvascular complications and mortality. The National Institute for Health and Care Excellence and the American Diabetes Association endorse metabolic and bariatric surgery in obese adults with type 2 diabetes and there may also be a role for this in obese individuals with type 1 diabetes. The paediatric committee of the American Society for Metabolic and Bariatric Surgery have recommended metabolic and bariatric surgery in obese adolescents with type 2 diabetes. Earlier and more aggressive treatment with metabolic and bariatric surgery in obese or overweight people with diabetes can improve morbidity and mortality.     

Treatment of obesity in older persons—A systematic review

The study aims to systematically review the available evidence regarding weight loss interventions (lifestyle, surgical, and pharmacological) for obesity in adults aged over 60 years. A search of prospective, randomized studies took place in January 2018, on Medline (Web of Science) and PubMed databases. Search terms included the following: elderly, obese, hypocaloric, pharmacotherapy, and bariatric surgery. Abstracts were screened for eligibility. A total of 256 publications regarding lifestyle interventions were identified; of these, 69 studies were eligible. As no eligible studies were identified for pharmacotherapy or bariatric surgery, the search was broadened to include non‐ randomized studies. Four pharmacotherapy and 66 surgery studies were included. Lifestyle intervention had similar weight loss efficacy in older compared with younger people, with positive effects on a number of relevant outcomes, including physical function and cardiovascular parameters. There was little data regarding obesity pharmacotherapy in older persons. The available data for bariatric surgery indicate comparable weight loss and resolution of type 2 diabetes, with similar or slightly higher complication rates in older compared with younger people. Older age alone should not be considered a contraindication to intensive lifestyle or surgical intervention for obesity. There are insufficient data to guide clinical decisions regarding obesity pharmacotherapy in older people.     

Neurodegenerative disease and obesity: what is the role of weight loss and bariatric interventions?

Neurodegenerative diseases are amongst the leading causes of worldwide disability, morbidity and decreased quality of life. They are increasingly associated with the concomitant worldwide epidemic of obesity. Although the prevalence of both AD and PD continue to rise, the available treatment strategies to combat these conditions remain ineffective against an increase in global neurodegenerative risk factors. There is now epidemiological and mechanistic evidence associating obesity and its related disorders of impaired glucose homeostasis, type 2 diabetes mellitus and metabolic syndrome with both AD and PD. Here we describe the clinical and molecular relationship between obesity and neurodegenerative disease. Secondly we outline the protective role of weight loss, metabolic and caloric modifying interventions in the context of AD and PD. We conclude that the application of caloric restriction through dietary changes, bariatric (metabolic) surgery and gut hormone therapy may offer novel therapeutic strategies against neurodegenerative disorders. Investigating the protective mechanisms of weight loss, metabolic and caloric modifying interventions can increase our understanding of these major public health diseases and their management.     

Nutritional deficiencies after bariatric surgery

Lifestyle intervention programmes often produce insufficient weight loss and poor weight loss maintenance. As a result, an increasing number of patients with obesity and related comorbidities undergo bariatric surgery, which includes approaches such as the adjustable gastric band or the 'divided' Roux-en-Y gastric bypass (RYGB). This Review summarizes the current knowledge on nutrient deficiencies that can develop after bariatric surgery and highlights follow-up and treatment options for bariatric surgery patients who develop a micronutrient deficiency. The major macronutrient deficiency after bariatric surgery is protein malnutrition. Deficiencies in micronutrients, which include trace elements, essential minerals, and water-soluble and fat-soluble vitamins, are common before bariatric surgery and often persist postoperatively, despite universal recommendations on multivitamin and mineral supplements. Other disorders, including small intestinal bacterial overgrowth, can promote micronutrient deficiencies, especially in patients with diabetes mellitus. Recognition of the clinical presentations of micronutrient deficiencies is important, both to enable early intervention and to minimize long-term adverse effects. A major clinical concern is the relationship between vitamin D deficiency and the development of metabolic bone diseases, such as osteoporosis or osteomalacia; metabolic bone diseases may explain the increased risk of hip fracture in patients after RYGB. Further studies are required to determine the optimal levels of nutrient supplementation and whether postoperative laboratory monitoring effectively detects nutrient deficiencies. In the absence of such data, clinicians should inquire about and treat symptoms that suggest nutrient deficiencies.     

Bariatric surgery: a review of procedures and outcomes

The prevalence of obesity has increased in recent decades, and obesity is now one of the leading public health concerns on a worldwide scale. There is accumulating agreement that bariatric surgery is currently the most efficacious and enduring treatment for clinically severe obesity, and as a result, the number of bariatric surgery procedures performed has risen dramatically in recent years. This review will summarize historic and contemporary bariatric surgical techniques, including gastric bypass (open and laparoscopic), laparoscopic adjustable gastric banding, and biliopancreatic diversion (with or without duodenal switch). Data are presented on bariatric surgery outcomes, focusing on weight loss and obesity-related comorbidities. We also review possible complications from surgery. Bariatric surgery patients undergo many dramatic lifestyle changes, and comprehensive presurgical screening conducted by a multidisciplinary team is important to prepare patients for the numerous changes necessary for successful outcome. In addition, comprehensive presurgical screening can aid the treatment team in identifying patients who would benefit from additional services prior to or following surgery. Further research focused on presurgical variables that predict outcome-especially the longer term outcome-of bariatric surgery is needed. At present, approximately 1% of eligible individuals with morbid obesity receive bariatric surgery. In addition, there appears to be inequity in access to weight loss surgery. Given the accumulating evidence that bariatric surgery is efficacious in producing significant and durable weight loss, improving obesity-related comorbidities, and extending survival, the U.S. healthcare system should examine ways to improve access to this treatment for obesity.     

The impact of bariatric surgery on nonalcoholic steatohepatitis

Nonalcoholic steatohepatitis (NASH) is a stage of nonalcoholic fatty liver disease (NAFLD), and in most patients, is associated with obesity and the metabolic syndrome. The current best treatment of NAFLD and NASH is weight reduction with the current options being life style modifications, with or without pharmaceuticals, and bariatric surgery. Bariatric surgery is an effective treatment option for individuals who are severely obese (body mass index ≥ 35 kg/m(2)), and provides for long-term weight loss and resolution of obesity-associated diseases in most patients. Regression and/or histologic improvement of NASH have been documented after bariatric surgery. We review the available literature reporting on the impact of the various bariatric surgery techniques on NASH.     

Role of endoscopy in the bariatric surgery of patients

Obesity is an increasingly serious health problem in nearly all Western countries.It represents an important risk factor for several gastrointestinal diseases,such as gastroesophageal reflux disease,erosive esophagitis,hiatal hernia,Barrett’s esophagus,esophageal adenocarcinoma,Helicobacter pylori infection,colorectal polyps and cancer,non-alcoholic fatty liver disease,cirrhosis,and hepatocellular carcinoma.Surgery is the most effective treatment to date,resulting in sustainable and significant weight loss,along with the resolution of metabolic comorbidities in up to 80%of cases.Many of these conditions can be clinically relevant and have a significant impact on patients undergoing bariatric surgery.There is evidence that the chosen procedure might be changed if specific pathological upper gastrointestinal findings,such as large hiatal hernia or Barrett’s esophagus,are detected preoperatively.The value of a routine endoscopy before bariatric surgery in asymptomatic patients(screening esophagogastroduodenoscopy)remains controversial.The common indications for endoscopy in the postoperative bariatric patient include the evaluation of symptoms,the management of complications,and the evaluation of weight loss failure.It is of critical importance for the endoscopist to be familiar with the postoperative anatomy and to work in close collaboration with bariatric surgery colleagues in order to maximize the outcome and safety of endoscopy in this setting.The purpose of this article is to review the role of the endoscopist in a multidisciplinary obesity center as it pertains to the preoperative and postoperative management of bariatric surgery patients.     

Patient motivations and expectations prior to bariatric surgery: A qualitative systematic review

Bariatric surgery is the most effective treatment for weight loss in individuals with severe and complex obesity. While the extant literature has mostly explored clinical outcomes of surgery, recent research has also examined patients' experiences prior to treatment. This systematic review synthesized findings from qualitative studies investigating patients' motives and expectations prior to undergoing bariatric surgery for weight loss. Twenty‐eight studies published in English involving 580 participants were identified for inclusion. Data extraction and thematic synthesis yielded four global themes: physiological, emotional, cognitive, and interpersonal/environmental. These represented seven subthemes describing patients' presurgery experiences: relationship with food, physical health, activities of living, personal identity, social relations, presurgery information, and beliefs about surgery. In addition to improving physical and medical comorbidities associated with obesity, participants believed that postsurgery weight loss would produce positive psychosocial impacts by strengthening their personal identities, their relationships, and improving their engagement in public and professional life. The complex and widespread nature of the changes patients expected would result from bariatric surgery highlights the importance of providing pretreatment education focused on psychosocial well‐being, as well as concurrent psychological support alongside surgery, to best inform individual treatment selection and clinical practice.     

Bariatric surgeries: beyond restriction and malabsorption

Behavioral and pharmaceutical intervention to treat obesity and its comorbidities typically results in only a 5-10% weight loss. Thus, bariatric surgery is the most effective obesity treatment with some surgeries resulting in 30% sustained weight loss. Although this degree of weight loss has profound metabolic impact, these surgeries seem to have metabolic effects that are independent of weight loss. In support of this is the clinical literature showing rapid resolution of Type 2 diabetes mellitus (T2DM) that occurs before significant weight loss. To gain a complete understanding of the weight loss-independent effects of bariatric surgery, animal models have been developed. These are becoming more widely implemented and allow the use of pair-fed or weight-matched sham-operated controls in order to gain mechanistic insights into the mode of action of bariatric surgery. Increases in anorectic gut hormones, such as glucagon-like peptide-1 and peptide YY, or decreases in the orexigenic hormone ghrelin have been seen and are implicated as mediators of weight loss-independent actions of bariatric surgery. Changes in nutrient processing and sensing may also have a mechanistic role that is independent of, or that regulates, gut hormone responses to these surgeries. Ultimately, the hope is that understanding the mechanisms of bariatric surgeries will aid in the development of less invasive surgeries or pharmacological therapies that are more specifically, and perhaps individually, targeted at weight loss and/or resolution of T2DM.