Volume 105 · Issue 37 · 2025

In recent years, obesity as a chronic and relapsing disease, has become a major public health challenge in China. The government has issued multiple policies to promote the establishment of weight management centers. Drawing on years of experience in centralized weight management centers development, national policies, and hospital-specific characteristics, this article elaborates on the necessity, standardization, progress, and challenges of building weight management centers, focusing on discipline development, academic principles, clinical interventions, and future directions. Guideline for chronic weight management and clinical practice of anti-obesity medications (2024 version) emphasize the need for multi-dimensional assessment and staged goal management for obesity. They propose a "treat to success" model, advocating for early pharmacological intervention combined with lifestyle modifications to disrupt metabolic compensatory mechanisms. The construction of weight management centers has been gradually shifted from loosely coordinated multidisciplinary teams towards a centralized management system. This integrates resources from endocrinology, nutrition, surgery, and other relevant fields. However, challenges persist, including inconsistent implementation philosophies and an underdeveloped professional certification system for specialized personnel. Artificial intelligence (AI) technology empowers obesity management through data integration, personalized interventions, and remote monitoring, yet attention should be paid to data security and patient capabilities. The development of novel anti-obesity medications and minimally invasive technologies offers promising new directions for long-term weight management. Looking ahead, future efforts need to strengthen policy implementation, build robust centralized weight management centers platforms, advance multi-target drug development, and deeply integrate AI technologies, which are essential to achieve the goal of lifecycle-wide obesity prevention and control.

Rapid eye movement sleep behavior disorder (RBD) is a parasomnia characterized by dream enactment behaviors and rapid eye movement sleep without atonia (RWA). It is associated with a significantly increased risk of conversion to neurodegenerative diseases. Currently, the clinical diagnosis and management of RBD remain insufficiently standardized, while early identification and intervention are crucial for improving disease outcomes. To raise awareness and attention among clinicians towards RBD and provide guidance for its standardized management, experts in the fields of neurology and sleep medicine in China formulated the guideline for diagnosis and treatment of RBD. This guideline was established in accordance with the current evidence-based medicine to standardize the diagnosis and treatment of RBD in China. Based on systematic literature reviews and international grading systems for recommendations and evidence levels, the guideline systematically summarized the epidemiology, etiology, classification, pathogenesis, clinical manifestations, auxiliary examinations, diagnosis, differential diagnosis, treatment, as well as prognosis and outcomes of RBD. A total of five recommendations were formulated in the field of treatment. The guideline aimed to provide scientific and standardized guidance for the clinical management of RBD.

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome characterized by the undue activation of cytotoxic T lymphocytes, natural killer cells due to various triggers, and the stimulation of mononuclear phagocyte system, resulting in excessive secretion of inflammatory cytokines. Lymphoma is a major trigger for secondary HLH. In order to improve the understanding of lymphoma-associated HLH (LA-HLH) among clinicians, based on the "Chinese Expert Consensus on Diagnosis and Treatment of Lymphoma-associated Hemophagocytic Lymphohistiocytosis (2022 edition)" and current published evidence, the China Anti-Cancer Association Lymphoma Committee, the China Anti-Cancer Association Hematology Oncology Committee and the Chinese Expert Alliance for Hemophagocytic Lymphohistiocytosis organized 57 experts in related fields to revise the diagnosis and treatment of LA-HLH, reaching this expert consensus. A total of 14 recommendations were put forward from 8 aspects, including clinical classification, early diagnosis, stratified treatment, and efficacy evaluation. On this basis, the diagnosis and treatment procedures of LA-HLH in China were updated, aiming to improve the diagnosis and treatment level of LA-HLH and guide standardized treatment in China.

To evaluate the efficacy of orlistat combined with pioglitazone and metformin in the treatment of obese patients with type 2 diabetes mellitus (T2DM).

A prospective multicenter randomized controlled trial. A total of 122 obese patients with T2DM were enrolled from November 2020 to April 2023 at Shanghai Tenth People′s Hospital, Tong Ren Hospital Shanghai Jiao Tong University School of Medicine, Minhang Hospital of Fudan University, and Shanghai Traditional Chinese Medicine Hospital. Patients were randomly assigned (1∶1) via a central randomization system to either the control group or the orlistat group. Both groups received a combination preparation of pioglitazone and metformin. On this basis, the control group and the orlistat group took 120 mg of placebo or orlistat, respectively, three times a day. Changes in glycated hemoglobin (HbA1c), body composition, glucose metabolism and lipid metabolism were compared between the two groups after 12 weeks of treatment.

Among the 122 patients (68 males, 54 females), the age was (44.6±11.1) years, and the mean body mass index (BMI) was [M(Q₁,Q₃)] 31.2(29.4, 34.4) kg/m², with 62 patients in the control group and 60 patients in the orlistat group. At baseline, there were no statistically significant differences between the two groups in terms of age, gender, BMI, body composition, and indicators of glucose and lipid metabolism (all P0.05). After treatment, the orlistat group showed a greater reduction in fasting blood glucose compared to the control group [(-0.7±1.1) vs (-0.2±1.9) mmol/L, P=0.049]. Both groups exhibited lower HbA1c levels post-treatment(both P0.05), with no significant difference between the control and orlistat groups in post-treatment HbA1c (6.6%±1.2% vs 6.3%±0.6%) or HbA1c reduction (-0.6%±1.2% vs -0.7%±0.7%, all P0.05). The orlistat group demonstrated a significant decrease in the homeostasis model assessment of insulin resistance (HOMA-IR) compared to baseline [3.1(2.1, 5.2) vs 4.1(2.4,7.7), P0.001] and the control group post-treatment [3.1(2.1, 5.2) vs 4.1 (2.4,7.0), P=0.044]. Body weight and BMI were reduced in the orlistat group (both P0.05), whereas no significant changes were observed in the control group (both P0.05). The orlistat group also showed a greater reduction in abdominal subcutaneous fat area and visceral fat area compared to the control group (both P0.05). There were no statistically significant differences in total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and free fatty acids between the two groups before and after treatment (all P0.05).

The combination of orlistat with pioglitazone and metformin effectively promotes weight loss, improves fat distribution, alleviates insulin resistance, and reduces fasting blood glucose in obese patients with T2DM.

Comparison of the impact of intensified lifestyle and glucagon-like peptide-1 receptor agonist (GLP-1RA) combined with lifestyle intervention on body composition in adult patients with overweight or obesity.

The clinical data of 197 overweight or obese patients who were treated at the Zhongshan Hospital, Fudan University from February 2022 to June 2024 were retrospectively analyzed, including 75 males and 122 females, aged (36.7±10.9) years. Patients were divided into an intensified lifestyle intervention group (n=84) and a GLP-1RA combined with lifestyle therapy group (n=113) based on the intervention approach. Collected clinical data of patients. After adjusting for gender, age, and baseline BMI using generalized linear models, analyze the association between the changes in various indicators [including body weight, body mass index (BMI), body fat percentage, fat mass (FM), fat mass index (FMI), fat-free mass (FFM), and fat-free mass index (FFMI)] and the intervention methods.

Body weight, BMI, waist circumference, diastolic blood pressure, FM, FFM, FMI, FFMI, fasting blood glucose, insulin resistance index, alanine aminotransferase, and controlled attenuation parameter were lower in the intensive lifestyle intervention group compared to the GLP-1RA combined with lifestyle intervention group (all P0.05). There was no statistically significant difference between the two groups in terms of age, gender, systolic blood pressure, body fat percentage, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, aspartate aminotransferase, and elasticity values (all P0.05). After 12 weeks of intervention, the results of the generalized linear model showed that the reduction magnitudes of body weight, FFM, and FFMI were associated with the intervention methods (all P0.05). The GLP-1RA combined with lifestyle intervention group showed greater reductions in body weight [(7.8±4.3) vs (5.1±4.5) kg], FFM [(2.2±2.1) vs (1.0±1.9) kg], and FFMI [(0.7±0.5) vs (0.3±0.5) kg/m²] compared to the intensive lifestyle intervention group (all P0.05). After 24 weeks of intervention, both groups exhibited decreases in post-weight-loss body weight, BMI, body fat percentage, FM, FFM, FMI, and FFMI compared to pre-weight-loss values (all P0.001). The results of the generalized linear model indicated that the reduction magnitudes of body fat percentage, FM, FFM, FMI, and FFMI were associated with the intervention methods (all P0.05). The intensive lifestyle intervention group showed greater reductions in body fat percentage (5.8%±3.0% vs 3.9%±4.2%), FM[(8.9±4.1) vs (7.0±5.7) kg], and FMI [(3.1±1.4) vs (2.4±1.9) kg/m²] compared to the GLP-1RA combined with lifestyle intervention group, while the reductions in FFM [(1.5±2.5) vs (2.8±3.4) kg] and FFMI [(0.5±0.9) vs (0.9±1.2) kg/m²] were smaller (all P0.05).

In weight loss treatment, the intensive lifestyle retains more lean body mass than the GLP-1RA combined lifestyle.

To identify the association between metabolic and functional dysregulation of adipose macrophages in obesity and type 2 diabetes.

Major cell types of adipose tissue were dissected with canonical markers from the single-cell sequencing dataset HRA002549, which profiled the stromal vascular fraction from 2 healthy controls (2 females), 3 obese patients (1 female), and 3 obese patients with type 2 diabetes (1 female). Subtypes of macrophages were then discerned by unsupervised clustering and functional annotation. Single-cell level metabolic activities were profiled with a flux-balance algorithm. The alternation of metabolic activity in obesity was identified with metabolic differential and enrichment analysis. The associations between metabolic and functional alternation were identified with Spearman′s correlation tests.

A total of four subpopulations of adipose tissue macrophages with different functional characteristics were identified. The distribution of each macrophage subpopulation in adipose tissue differed between the healthy control group, the obese group, and the obese group with type 2 diabetes (all P0.05). Differential analysis identified the activation of pro-inflammatory and metabolic-sensing pathways including phosphatidylinositol 3-kinase/protein kinase B (PI3K-Akt), Janus kinase/signal transducer and activator of transcription (JAK-STAT) and AMP-activated protein kinase (AMPK) pathways under both obese and type 2 diabetic conditions. Differential analysis of metabolic activities revealed significant alternations in metabolism profiles of adipose macrophages in obese and obese with type 2 diabetes groups, including decreased fatty acid synthesis, increased fatty acid oxidation, arachidonic acid synthesis, and elevated lysine metabolism activity. Correlation analysis identified significant correlations between macrophage functional dysregulation and disruption in fatty acid oxidation and branched-chain amino acid metabolism (all P0.05).

In obesity and obesity with type 2 diabetes, adipose macrophages exhibit systematic metabolic dysregulation, with abnormal activation of reactions in branched-chain amino acid metabolism and fatty acid oxidation.

To analyze the role of glucose-regulated protein 78 (GRP78) in regulating endoplasmic reticulum stress (ERS) in the pathogenesis of aplastic anemia (AA).

The general information was collected prospectively on AA patients treated at Tianjin Medical University General Hospital from April 2022 to December 2023. According to the therapeutic effect, the newly treated AA patients were divided into the AA group, and the AA patients in remission were divided into the R-AA group. Healthy hematopoietic stem cell transplantation donors during the same period were divided into the normal control (NC) group. Bone marrow samples were collected and CD8⁺T lymphocytes were isolated to compare the expression of ERS-related genes. GRP78 protein expression level was detected and compared, and a correlation analysis with cytokines was conducted. In vitro cell experiments were conducted on bone marrow CD8⁺T lymphocytes in the AA group, which were divided into a blank group (no treatment), a tunicamycin (TM) group (10 μmol/L TM), a 4-phenylbutyrate (4-PBA) group (0.6 μmol/L 4-PBA), and a PERK inhibitor (PI) group (20 nmol/L PI). Based on different treatment concentrations, the TM group was divided into TM1 group (2 μmol/L of TM), TM2 group (4 μmol/L of TM), and TM3 group (8 μmol/L of TM). The 4-PBA group was divided into 4-PBA1 group(0.2 μmol/L of 4-PBA), 4-PBA2 group(0.4 μmol/L of 4-PBA), and 4-PBA3 group(0.8 μmol/L of 4-PBA). The PI group was divided into PI1 group(10 nmol/L of PI), PI2 group (20 nmol/L of PI), and PI3 group(30 nmol/L of PI). The expression levels of GRP78, CHOP proteins and the phosphorylation levels of p-PERK/PERK were detected and compared among the blank group, TM group, 4-PBA group, and PI group. The expression of perforin and granzyme B was compared among the subgroups of the TM group, 4-PBA group, and PI group.

A total of 36 patients were included, with 20 in the AA group [9 males and 11 females, aged (44±19) years], 16 in the R-AA group [10 males and 6 females, aged (35±17) years] and 18 in the NC group [4 males and 14 females, aged (44±8) years]. The mRNA expression levels of GRP78 (respectively 4.78±1.72, 1.37±0.98 and 1.04±0.67) and PERK (respectively 7.19±3.44, 3.42±1.46 and 2.47±1.15) in the AA group were higher than those in the R-AA group and the NC group (all P0.05). The expression rate of GRP78 protein in the AA group [M (Q₁, Q₃)] was higher than that in the NC group [10.30% (9.25%, 13.75%) vs 3.27% (2.41%, 4.37%), P=0.003], and the expression of GRP78 protein was positively correlated with interleukin (IL)-2 (r=0.68, P=0.021) and γ-interferon (IFN-γ) (r=0.64, P=0.036). In vitro cell experiments showed that the expression levels of GRP78 protein in the TM group were higher than those in the blank group, the expression levels of GRP78 protein in the 4-PBA group and PI group were both lower than those in the blank group. The CHOP protein expression level in the PI group was lower than that in the blank group (all P0.05). The p-PERK/PERK phosphorylation level in the PI group was lower than that in the blank group (P=0.046). The perforin expression levels in the TM1, TM2, and TM3 groups were all higher than those in the blank group, and the perforin expression level in the TM3 group was higher than that in the TM1 and TM2 groups; the expression levels of granzyme B in the TM1, TM2, and TM3 groups were all higher than those in the blank group; the expression levels of granzyme B in the TM2 and TM3 groups were higher than those in the TM1 group (all P0.05). The expression levels of perforin in the 4-PBA1, 4-PBA2, and 4-PBA3 groups were all lower than those in the blank group; the perforin expression levels in the 4-PBA3 group were lower than those in the 4-PBA1 and 4-PBA2 groups (all P0.05). The expression levels of perforin and granzyme B in the PI1, PI2, and PI3 groups were all lower than those in the blank group (P0.05).

GRP78 regulates ERS and activates CD8⁺T lymphocytes, which may be involved in the immune pathogenesis of AA.

A retrospective collection of clinical data was conducted on patients with connective tissue diseases (CTD) complicated by cytopenia (which could not be attributed to any currently named hematological diseases) who were hospitalized and treated in the Department of Hematology, Tianjin Medical University General Hospital from May 2022 to May 2024. Based on the prognosis, the patients were divided into the remission group (including complete remission and partial remission) and the non-remission group (clinically non-remission). Follow-up was conducted until December 2024 or until the patient′s death, with an analysis of their clinical manifestations, laboratory findings, and prognosis, etc. A total of 45 patients were included, comprising 2 males and 43 females, with an age of (57±15) years. The follow-up duration [M (Q₁, Q₃)] was 9 (6, 18) months. Thirty-seven patients (82.2%) had other organ involvement, with 23 patients (51.1%) experiencing infections, 7 patients (15.6%) having thrombosis, 7 patients (15.6%) having neoplastic diseases. Forty-two patients (93.3%) exhibited bicytopenia or pancytopenia, with a median neutrophil-to-lymphocyte ratio of 2.4 (1.0, 6.6). In 91% (41/45) of the patients, reticulocyte counts were not low, and all patients demonstrated active bone marrow in the iliac crest and/or sternum. Among the 37 patients (82.2%) with positive antinuclear antibodies, a negative correlation was observed between antinuclear antibody titers and red blood cell levels (r=-0.40,P=0.015). There were 30 cases in the remission group and 15 cases in the non-remission group. The ferritin levels in the non-remission group were higher than those in the remission group [838 (61, 1 695) vs 123 (30, 279)μg/L, P=0.035]. Patients with immune-related pancytopenia complicated by CTD exhibited no inversion of the neutrophil-to-lymphocyte ratio, no low reticulocyte counts, and active bone marrow proliferation. Their antinuclear antibody titers were negatively correlated with the degree of red blood cell reduction, and the ferritin levels were higher in the non-remission group.

Data from the third Chinese National Stroke Registry (from August 2015 to March 2018) was analyzed, focusing on patients with acute ischemic stroke (AIS). Participants were divided into quartiles (Q₁-Q₄) based on their serum blood urea nitrogen to albumin ratio (BAR) and tracked for one year. The study included 4 635 AIS patients with a median age of 63(54,70) years. Males constituted 68.78% (n=3 188) of the study population. The median National Institutes of Health Stroke Scale (NIHSS) score was 3(2,6). During the follow-up, 172 deaths occurred, with a mortality rate of 1.73%, 2.24%, 3.62%, and 7.25% in Q₁-Q₄, respectively. Multivariable Cox regression showed a 2.35 times higher mortality risk in the Q₄ group compared to the Q₁ group (HR=2.35, 95%CI: 1.41-3.92). The multivariable RCS analysis found no nonlinear link between BAR and all-cause mortality (P=0.139). ROC analysis showed a 1-year mortality prediction AUC of 0.667(95%CI:0.624-0.711) for BAR, with a cut-off of 4.103 mg/g, sensitivity of 71.4%, and specificity of 55.8%. When combined BAR with traditional risk factors, the AUC for predicting one-year mortality increased to 0.764 (95%CI: 0.727-0.801). BAR may be linked to one-year mortality in AIS patients, suggesting its potential for risk prediction and stratification.

In recent years, the prevalence of metabolic diseases such as obesity and type 2 diabetes has continued to increase rapidly globally, and the efficacy of traditional conservative treatment for patients with moderate and severe obesity and severe metabolic disorders is insufficient. Bariatric and metabolic surgery (MBS) has become an important means for the management of obesity and related diseases due to its significant long-term weight loss and metabolic improvement effects. This article focuses on the expansion of surgical indications, the evaluation of new surgical methods and the combined effect of new weight-loss drugs and surgery. Surgical indications have been extended from the traditional BMI threshold to a wider population, including patients with low BMI and patients with specific metabolic diseases, which have a significant improvement effect on type 2 diabetes, hypertension, non-alcoholic fatty liver disease and other diseases. New surgical methods such as single anastomotic stomach bypass and single anastomotic duodenoileal bypass combined with gastric sleeve resection have outstanding potential in weight loss and metabolic improvement, but the long-term safety and efficacy need to be further verified. New weight-loss drugs represented by glucagon-like peptide-1 receptor agonists are combined with MBS to improve the therapeutic effect through complementary mechanisms, but they still face challenges in terms of economic burden and long-term follow-up data collection. In the future, the MBS field needs to promote the development of more accurate, safe and efficient treatment models through multi-center long-term follow-up data, precision medicine and low-cost drug research and development.

At present, anterior cruciate ligament (ACL) reconstruction (ACLR) has become the main treatment for ACL injury. However, the proportion of patients returning to high-level exercise after surgery is still low, and there is a high risk of re-injury, showing the complexity and importance of restoring joint dynamic stability after ACLR. Therefore, this paper discusses the remodeling changes of various brain regions (including motor, cognitive, sensory and other related brain regions) after ACLR and their clinical significance, and explores the influence of these remodeling features on postoperative dysfunction of ACLR and the significance of rehabilitation intervention, so as to provide reference and practical basis for understanding and treating motor dysfunction after ACLR from the brain central level in the future, and help patients return to exercise more successfully, safely and efficiently.