2023年 · 第103卷第33期

Global obesity has reached epidemic levels in 2020. Obesity increases the incidence of a variety of chronic diseases, such as diabetes, cardiovascular disease, stroke, certain cancers, and obstructive sleep apnea. Energy imbalances resulting from increased caloric intake and reduced physical activity are one of the leading causes of obesity in adults. Lifestyle interventions such as diet and exercise become first-line treatments for obesity. Intermittent fasting is a meal pattern based on periodic fasting, i.e. alternating fasting and eating. Time-limited feeding (TRE) is a form of intermittent fasting where food is eaten daily over a specific period of time, typically in a time window of 8 to 12 h, with or without energy restriction. High body mass index (BMI) is a high risk factor for a variety of health problems. Studies have shown that weight loss can improve metabolism-related markers such as triglycerides, cholesterol, blood sugar, insulin, blood pressure, etc. TRE has been proven to be beneficial in various disease studies such as obesity. Therefore, this meta-analysis included 9 studies with a total of 665 patients (345 in TRE and 320 in controls) with BMI>25 kg/m²In adults aged 18 years and older, the objective was to assess changes in body weight, fat mass, and metabolic indexes after TRE intervention. The results showed that the weight loss was more pronounced in the TRE group compared with the control group (-1.28 kg, 95%CI：-2.05~-0.52，P =0.001), with a significant reduction in BMI (-0.34 kg/m²，95%CI：-0.64~0.04，P=0.03), with significant fat mass reduction (-0.72 kg, 95%CI：1.40~-0.03，P=0.04), decreased diastolic blood pressure (DBP) (-2.26 mmHg, 95%CI：-4.02~-0.50，P=0.01）。 However, there were no statistically significant differences between TRE and the control group in terms of lean body mass, systolic blood pressure, waist circumference, fasting blood glucose, fasting insulin, homeostatic model assessment-insulin resistance, total cholesterol, HDL, LDL, and triglycerides. Subgroup analysis found weight loss in the 8 h eating window group of TRE compared to the control group (P=0.007), whereas the difference was not statistically significant beyond the 8 h eating window (P=0.05）； Body weight loss and fat mass loss in the TRE intervention>12 weeks group (allP<0.05）； Weight loss in the TRE energy-restricted group (P<0.05）。

Esophageal cancer is the seventh most common cause of cancer incidence worldwide and the sixth most common cause of cancer-related death. For a large number of patients with early esophageal cancer, the 5-year survival rate of endoscopic treatment can reach more than 95%, which is comparable to surgical survival rate. Therefore, early endoscopic treatment is the key to improve the prognosis of esophageal cancer. Endoscopic mucosal dissection (ESD) is currently the preferred method for resection of superficial esophageal cancer. However, for esophageal lesions with lesion extent>3/4 week long, the stenosis rate after ESD exceeded 80%. The stenosis rate after ESD was 100% in patients with perimeter esophageal lesions. Esophageal radiofrequency ablation (RFA) is one of the earliest techniques applied to Barrett's esophageal ablation, which has the advantages of simplicity, safety and low esophageal stenosis rate. Therefore, the researchers retrospectively analyzed 105 patients with endoscopically treated early large-scale flat esophageal squamous cell carcinoma (ESCNs) (extending beyond 3/4 of the esophageal perimeter), compared the adverse events of ESD and RFA and the local control of tumor lesions, and then evaluated which method is more effective in treating full-week or near-full-week early esophageal squamous cell carcinoma. Sixty of these patients were treated with ESD and 45 with RFA. There were no significant differences between the two groups in mean age, body mass index (BMI), sex distribution, smoking and drinking habits, and evaluation of deep pretreatment of tumor invasion. Although patients receiving RFA had larger tumors (14.27 vs. 5.70 cm,P<0.05), but the ESD and RFA groups were comparable in terms of local control of tumor lesions and surgery-related complications. Twelve months after treatment, there was no statistically significant difference between the two groups in the local control of tumor lesions, with 58 (96.7%) of 60 patients in the ESD group and 43 (95.6%) of 45 patients in the RFA group having complete remission. There was no statistically significant difference between ESD and RFA in surgery-related complications such as hemorrhage, mediastinal emphysema, and perforation, but the stenosis rate was higher in ESD than in RFA (60% vs 31%,P<0.05）。 The ESD group compared with the RFA group had pain scores (2.27 vs. 2.60,P=0.239) and length of hospital stay (9.77 vs. 9.46,P=0.701) were not statistically significant; However, hospitalization costs were lower in the ESD group than in the RFA group (P<0.05）。