Background and objectivesThe optimal surgical approach for incarcerated or strangulated abdominal wall hernias remains debated. While laparoscopic techniques are well established electively, evidence on their emergency-setting role is limited. This study compared open and laparoscopic repair in patients undergoing emergency surgery for incarcerated or strangulated abdominal wall hernias, focusing on postoperative morbidity, mortality, operative time, and hospital stay.Materials and methodsThis retrospective single-center cohort study included 180 consecutive patients treated between January 2023 and June 2025, analyzed by initially intended approach (open, n = 90; laparoscopic, n = 90; converted patients retained in their original group). Demographics, hernia type, intraoperative findings, complications, mortality, and length of stay were compared using Fisher's exact and Mann–Whitney U tests. Wound-related morbidity (surgical site infection and/or seroma) was analyzed as a composite outcome via multivariate logistic regression adjusted for age, sex, BMI, ASA class, hernia type, smoking, symptom duration, contamination, and bowel resection, with a reduced four-covariate sensitivity model. Propensity-score matching, subgroup analyses by hernia type, and mesh-use/no-bowel-resection sensitivity analyses were also performed; all were prespecified but exploratory, without correction for multiple testing.ResultsGroups were comparable in baseline characteristics (all p > 0.05), with no postoperative deaths. Operative time was longer with laparoscopy (82.0 ± 16.7 vs. 76.0 ± 13.5 min, p = 0.025), while hospital stay was shorter (3.9 ± 1.0 vs. 5.2 ± 0.9 days, p < 0.001) and postoperative ileus less frequent (1.1% vs. 8.9%, p = 0.034). Wound complications were numerically lower after laparoscopy (13.3% vs. 22.2%) but not statistically significant (p = 0.172). No covariate independently predicted wound morbidity on multivariate analysis (technique OR 0.59, 95% CI 0.26–1.33, p = 0.203). Propensity-matched analysis (68 pairs) confirmed the operative-time and length-of-stay findings; the length-of-stay benefit was consistent across all hernia-type subgroups and sensitivity analyses.ConclusionsLaparoscopic repair of strangulated abdominal wall hernias was associated with shorter hospital stay and lower ileus rates, but longer operative time, than open repair, with no significant difference in wound morbidity or mortality. Given the non-randomized design and limited power for the wound-complication comparison (∼35%), these findings—particularly regarding wound morbidity—should be considered hypothesis-generating. Laparoscopic repair may be a reasonable option in carefully selected, hemodynamically stable patients, pending confirmation by adequately powered multicenter trials.
Pseudomyxoma peritonei (PMP) is a rare peritoneal malignancy. Its typical clinical manifestations include abdominal distension, increased abdominal girth, or abdominopelvic masses. It is extremely rare for an umbilical hernia to be the initial manifestation, so this can easily lead to clinical misdiagnosis. A 60-year-old woman presented with a reducible umbilical mass for 10 months. Physical examination revealed marked abdominal distension and a 6-cm firm, irreducible umbilical mass. Serum tumor markers were normal. Computed tomography (CT) showed diffuse low-density abdominopelvic masses consistent with PMP, an appendiceal cystic lesion suggestive of mucinous neoplasm, omental thickening, and periumbilical tumor extension. Ultrasound revealed 9.4-cm ascites with mucin particles and septations. She underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Intraoperatively, extensive gelatinous mucin, a ruptured cystic appendix, and periumbilical tumor involvement were noted. Postoperative pathology confirmed a high-grade appendiceal mucinous tumor with PMP. The immunohistochemistry results were as follows: cytokeratin 20 positive, caudal type homeobox 2 positive, and Ki-67 labeling index of 30%. Telephone follow-up 3 months after surgery indicated that the patient was doing well. PMP presenting with umbilical hernia as the initial symptom is relatively rare and is often misdiagnosed as a simple umbilical hernia. For middle-aged and elderly female patients with umbilical hernia who have concurrent ascites, thickened peritoneum, or a hard and fixed hernia mass, abdominopelvic CT and ultrasound should be performed to rule out PMP to avoid blindly performing hernia repair and delaying diagnosis and treatment.
BackgroundGranulomatous lobular mastitis (GLM) is a rare chronic inflammatory breast disease with a high propensity for recurrence. Refractory cases that involve extensive abscess formation, sinus tracts, and failure of medical therapy remain difficult to manage.Case presentationA 39-year-old multiparous woman presented with a left breast mass that had first been noticed approximately 6 months earlier and had progressively enlarged to involve multiple quadrants. The disease was complicated by abscess formation, areolar ulceration, and sinus tracts. Prior treatment with anti-inflammatory therapy, a course of oral corticosteroid, and a 4-month course of traditional Chinese medicine produced no durable improvement, and the mass subsequently ulcerated. Preoperative evaluation identified hyperprolactinemia and a Rathke cleft cyst on pituitary magnetic resonance imaging.Intervention and managementAfter preoperative prolactin control with bromocriptine, the patient underwent parenchyma-sparing surgery with thorough debridement of necrotic tissue across multiple quadrants. Mildly edematous glandular tissue and clinically involved ducts were preserved and opened to facilitate postoperative drainage. After glandular flap reconstruction, the surgical cavity was irrigated daily through two indwelling drains with 250 mL of normal saline containing dexamethasone acetate, initiated at 20 mg; the dose was reduced by 5 mg (one ampoule) every 3 days to a final dose of 5 mg, after which the cavity was rinsed with normal saline alone until the drains were removed. Syndrome-differentiated oral traditional Chinese medicine was given throughout the postoperative course.ResultsThe drainage fluid became clear and the drains were removed without residual purulent or necrotic material. Serial postoperative ultrasonography demonstrated progressive resolution of the inflammatory changes. At the 2-month follow-up, clinical examination showed no residual disease or recurrence, and the cosmetic outcome was satisfactory; the patient remained free of clinical recurrence during continued outpatient follow-up of approximately 2 years.ConclusionParenchyma-sparing surgery combined with local corticosteroid irrigation achieved short-term local control in a refractory case of GLM. The preliminary result warrants confirmation through longer follow-up and larger prospective studies.
ObjectiveTo compare the clinical and radiographic outcomes of oblique lateral lumbar interbody fusion (OLIF) versus transforaminal lumbar interbody fusion (TLIF) for single-level lumbar adjacent segment disease (ASDis).MethodsA retrospective study was conducted on 107 patients who underwent revision surgery for single-level ASDis. Patients were divided into OLIF group (n = 55) and TLIF group (n = 52). Perioperative parameters (operative time, blood loss), clinical outcomes (VAS for low back and leg pain, Oswestry Disability Index, EQ-5D), radiographic parameters (disc height, segmental lordosis, segmental coronal angle, lumbar lordosis, PI-LL), complication and fusion rates were compared. Follow-up was ≥12 months.ResultsOLIF had significantly longer operative time (308.5 ± 62.7 vs. 271.3 ± 55.9 min, P = 0.002) but less blood loss (362.4 ± 51.3 vs. 608.7 ± 76.5 mL, P < 0.001). No significant differences were found between groups in VAS, ODI, EQ-5D scores at any time point (P > 0.05). OLIF demonstrated superior correction of disc height (Δ3.9 ± 1.4 vs. 2.2 ± 0.8 mm, P < 0.001), segmental lordosis (Δ3.8°±1.7° vs. 2.3°±1.8°, P < 0.001), and segmental coronal angle (Δ1.6°±0.6° vs. 1.2°±0.5°, P < 0.001). No significant differences were observed in lumbar lordosis, PI-LL correction, complication rates (10.91% vs. 9.62%, P = 0.826), cage subsidence (12.73% vs. 11.54%, P = 0.850), reoperation rates (3.64% vs. 1.92%, P = 0.618), or fusion rates (92.73% vs. 92.31%, P = 0.934).ConclusionOLIF and TLIF provide equivalent clinical outcomes for single-level lumbar ASDis. OLIF offers advantages in reducing intraoperative blood loss and restoring segmental radiographic parameters, at the cost of longer operative time. TLIF is associated with shorter surgery. Both techniques have comparable complication and fusion rates. Surgical choice should be individualized.
Venous malformations (VMs) involving the brachial plexus are rare clinical entities that can mimic traumatic brachial plexus injuries. A 27-year-old male presented with progressive right upper limb weakness and numbness following an occupational fall with overhanging limb suggesting a traumatic tractional brachial plexus injury. However, magnetic resonance imaging (MRI) revealed an intramuscular VM in the subscapularis muscle which was compressing the cords of the brachial plexus. In view of difficult surgical access for removal associated with high risks of iatrogenic neurological injury, fluoroscopy-guided percutaneous bleomycin sclerotherapy was performed. Significant neurological recovery was observed post-intervention in conjunction with intensive rehabilitation. This case report outlines the diagnostic clues, management challenges, and functional outcomes of a right subscapularis intramuscular VM causing secondary compressive brachial plexopathy.
BackgroundPancreaticoduodenectomy (PD), also known as the Whipple procedure, is a complex surgical procedure for pancreatic head and periampullary lesions. As short-video platforms increasingly shape the way patients and the public access health information, the quality and reliability of PD-related videos have important implications for patient education and public health communication.ObjectiveThis study aimed to evaluate the source, content coverage, quality, reliability, and engagement characteristics of PD-related short videos on TikTok, Bilibili, and YouTube.MethodsSearches were conducted from January 26 to March 16, 2026, using newly registered accounts and Chinese and English keywords related to PD. After predefined inclusion and exclusion criteria were applied, 180 videos were included. Two independent raters with medical backgrounds assessed content coverage, the Global Quality Score (GQS), and the modified DISCERN (mDISCERN) score. Final GQS and mDISCERN scores were calculated as the average of the two raters’ scores. Engagement indicators and uploader characteristics were extracted. Mann–Whitney U tests, Kruskal–Wallis H tests, chi-square tests, Spearman correlation analyses, interrater reliability analyses, and exploratory ROC and multivariable regression analyses were performed.ResultsInterrater agreement was excellent for both GQS and mDISCERN. Among the 180 videos, 159 (88.33%) were uploaded by medical professionals and 21 (11.67%) by non-medical professionals. Medical-professional videos had significantly more likes and comments. In unadjusted comparisons, non-medical videos were longer and had higher GQS scores; however, uploader type was not independently associated with GQS after adjustment for duration and platform. mDISCERN scores did not differ significantly between the two groups. Most videos focused on management or procedural aspects of PD, whereas definitions, symptoms/indications, and outcomes/prognosis were less frequently addressed. Video duration was positively correlated with GQS and mDISCERN, and a sample-derived threshold of 160 s identified videos with GQS ≥4 with an AUC of 0.886. Significant differences in duration, engagement, quality scores, and uploader distribution were observed across platforms.ConclusionPD-related videos on TikTok, Bilibili, and YouTube have some educational value but remain limited by incomplete content coverage and inconsistent reliability. Improving the completeness, transparency, comprehensibility, and platform governance of surgical health videos may help patients access more trustworthy information.
ObjectiveThis study aimed to determine the ideal morphology of the anterior hairline contour and hair-bearing proportion in Chinese females, thereby improving preoperative planning protocols and enhancing clinical efficacy in both surgical hair transplantation and non-surgical camouflage interventions.MethodsNinety participants completed a questionnaire-based study using digitally modified images of a female model. First, participants were randomly recruited to rate digitally altered images to investigate the most aesthetically preferred hairline contours. Five hairline contours (round, M-shaped, triangular, rectangular, and bell-shaped) were assessed across five dimensions: overall impression, naturalness, attractiveness, youthfulness, and agreeableness (on a 0–10 scale). Subsequently, respondents were asked to adjust the anterior hair-bearing proportion in the image until they reached their highest level of satisfaction. The height ratio (HR) and width ratio (WR) were calculated to quantify the hair bearing proportion.ResultsRound, triangular, and M-shaped hairline contours were rated significantly higher than rectangular and bell-shaped contours in terms of overall appearance, naturalness, attractiveness, youthfulness, and agreeableness (all p < 0.001). The most preferred hair-bearing proportion corresponded to an HR of 0.505(IQR 0.455–0.584) and a WR of 0.373(IQR 0.356–0.387).ConclusionParticipants demonstrated a clear preference for round anterior hairline contours, with triangular and M-shaped contours also considered aesthetically favorable. An HR of approximately 0.505 and a WR of 0.373 represent the optimal anterior hair-bearing proportions. These population-specific findings provide quantitative evidence to support individualized planning for hair transplantation and nonsurgical aesthetic interventions.
Background/objectivesStereotactic biopsy of brainstem lesions must balance diagnostic and molecular information against procedure-related neurological risk. We updated the evidence base after a reviewer-directed literature coverage and overlap audit.MethodsThis PRISMA 2020 systematic review and meta-analysis was registered in PROSPERO (CRD420261432357). Searches covered English and Chinese bibliographic databases, trial registries, and Google Scholar, with forward and backward citation tracking during revision. Diagnostic yield and overall complications were analyzed with logit random-effects models; permanent neurological morbidity and procedure-related mortality were analyzed with binomial-normal generalized linear mixed models (GLMMs). Molecular clinical utility was synthesized narratively because its constructs and denominators were heterogeneous.ResultsSeventy-six reports met review-level eligibility (71 full-text and 5 abstract/conference reports), and 55 independent studies contributed to at least one preferred quantitative synthesis. Diagnostic yield was 1,814/1,956, with a pooled estimate of 93.5% (95% CI, 91.5%–95.0%). Overall complications were 162/1,797, with a pooled estimate of 10.5% (95% CI, 8.5%–12.8%). Permanent neurological morbidity was reported in 17 compatible studies (14/859; GLMM 0.83%, 95% CI, 0.22%–3.03%). Procedure-related mortality was 11/1,765 (crude 0.62%, exact 95% CI, 0.31%–1.11%); the primary GLMM estimate was 0.30% (95% CI, 0.07%–1.24%), whereas continuity-corrected models produced higher estimates. Diagnostic yield remained 93.7% (95% CI, 91.3%–95.5%) after excluding studies with fewer than 20 participants, although observed yield was inversely associated with study size.ConclusionsIn selected published cohorts, stereotactic biopsy provided high diagnostic yield. Overall complications were clinically meaningful, while observed procedure-related mortality was below 1% and permanent morbidity was uncommon but imprecisely estimated. Population, era, technique, outcome definition, and small-study analyses support cautious individualized interpretation rather than a universal biopsy recommendation.PROSPERO registrationCRD420261432357
BackgroundThe arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis, yet up to 50% of AVFs fail within the first year due to stenosis or thrombosis. The high-sensitivity C-reactive protein to albumin ratio (HRR) integrates inflammation and nutritional status, but its association with AVF failure has not been systematically evaluated.MethodsThis retrospective cohort study included 279 patients who underwent first-time AVF creation. HRR was calculated as hsCRP (mg/L) divided by albumin (g/L). The primary outcome was AVF failure (stenosis ≥50% or thrombosis requiring intervention). Multivariate Cox regression adjusted for age, sex, BMI, diabetes, hypertension, smoking, and vessel diameter. Model performance was assessed using time-dependent ROC, calibration curve, and decision curve analysis (DCA).ResultsDuring a median follow-up of 50 months, 141 patients (50.5%) developed AVF failure.In multivariate analysis, higher HRR was independently associated with increased AVF failure risk (HR per unit increase = 1.65, 95% CI: 1.33–2.05, P < 0.001), independent of vessel diameter (HR = 0.21, 95% CI: 0.08–0.57, P = 0.002). A landmark analysis stratified at 24 months demonstrated that the predictive effect of HRR was directionally consistent across early (HR = 1.60, 95% CI: 1.27–2.02) and late (HR = 1.47, 95% CI: 0.66–3.29) follow-up periods (P for interaction = 0.766), although the late-phase estimate was imprecise due to the reduced sample size. The model demonstrated moderate discrimination at 24 months (AUC = 0.608, 95% CI: 0.519–0.701) and good calibration. DCA confirmed that incorporating HRR provided positive net clinical benefit across clinically relevant threshold probabilities. The proportional hazards assumption was satisfied (global P = 0.97). Sensitivity analysis using multiple imputation yielded consistent results.ConclusionsPreoperative HRR is an independent predictor of AVF failure. Although the model demonstrated weak to moderate discrimination (24-month AUC = 0.608), decision curve analysis confirmed a positive net clinical benefit, supporting its potential utility in preoperative risk stratification. This simple, widely available laboratory-based marker may assist clinicians in identifying high-risk patients and individualizing surveillance intensity, though external validation is warranted.
Cutibacterium acnes is an anaerobic bacterium that contributes to the balance of the skin microbiota but is also responsible for prosthetic joint infections (PJIs). Phenotypic and genotypic characterization of C. acnes isolated from infected implants could identify specific traits associated with a higher risk of PJI. To address this hypothesis, the phenotypic and genotypic traits of 20 clinical isolates were analyzed and compared with those of seven strains isolated from the skin microbiota of healthy participants. In particular, the antibiotic susceptibility profile and the ability of bacteria to aggregate and form biofilms in vitro were investigated. In addition, the genomes of all isolates were sequenced to determine whether PJI-causing microorganisms share a distinctive phylogenetic profile. Antibiotic susceptibility, biofilm formation, and aggregate formation did not differ between commensal and pathogen isolates. By contrast, extracellular DNA was mostly present in clinical isolates compared with commensal C. acnes. Phylogenetic analysis failed to evidence differences between pathogens and commensal strains, while a phylogenetic distance was observed between sequence types. Results suggest that C. acnes isolated from PJIs and healthy skin share common phenotypic and genotypic traits, making them indistinguishable. Hence, further studies on the phenotypic and genotypic characteristics of C. acnes are needed, as the association between diverse phylotypes and diseases remains unclear and debated.
BackgroundAnastomotic leak is a critical complication following colorectal surgery, contributing to reintervention, readmission, prolonged hospitalization, and substantial downstream healthcare costs. Despite advances in surgical technique and perioperative care, leak rates following left-sided colectomy have not meaningfully declined. Dehydrated human amnion/chorion membrane (DHACM) is a placental allograft that contains and releases a broad array of biological mediators implicated in angiogenesis, fibroblast recruitment, and extracellular matrix remodeling. While these properties suggest a potential role in anastomotic healing, clinical data in colorectal surgery remain limited.MethodsThis retrospective, multicenter, observational cohort study evaluated consecutive adult patients who received DHACM during left-sided colectomy with primary colorectal anastomosis and circumferential application of DHACM between January 2016 and June 2024. Patients receiving a protective stoma were excluded. The primary outcome was the incidence of anastomotic leak within 30 days according to the International Study Group of Rectal Cancer (ISGRC) criteria. Secondary outcomes included 30-day readmission, reoperation, length of stay, emergency department visits, and mortality. Outcomes were summarized descriptively.ResultsA total of 287 patients met inclusion criteria, including a heterogeneous population undergoing surgery for both benign and malignant indications. Five patients (1.7%) experienced an anastomotic leak: four Grade B events managed nonoperatively and one event requiring reoperation, with an intact anastomosis noted intraoperatively and classified as Grade C based on reoperation. The 30-day all-cause readmission rate was 3.1%, median postoperative length of stay was 2 days (IQR: 1.25–3), and no deaths occurred. No graft-related adverse events were reported. Exploratory subgroup analyses did not identify meaningful differences in leak rates across operative or clinical characteristics.ConclusionsIn this real-world multicenter pilot study of DHACM applied around the colorectal anastomosis in patients undergoing left-sided colectomy without a protective stoma, low rates of anastomotic leak and 30-day all-cause readmission were observed. Although limited by its retrospective, single-arm design and lack of an internal comparator, these hypothesis-generating findings support the feasibility and tolerability of DHACM as a surgical adjunct at the colorectal anastomosis and provide a rationale for prospective, controlled evaluation in colorectal surgery.
BackgroundSymptomatic carotid atherosclerotic stenosis is a major cause of ischemic stroke. In patients with heavily calcified plaque and limited physiologic reserve for open revascularization, conventional carotid artery stenting may fail because rigid calcium prevents adequate luminal expansion. Intravascular lithotripsy (IVL) is an adjunctive plaque-modification strategy for selected calcified carotid lesions, although evidence remains limited and carotid IVL is investigational.Case presentationAn 83-year-old man with hyperlipidemia, hypertension, hypothyroidism, protein S deficiency, prior myocardial infarction, and lower-extremity deep vein thrombosis on apixaban presented with acute ischemic stroke manifested by dysarthria, global aphasia, and right hemiparesis. Brain MRI showed acute left-hemisphere borderzone infarcts involving deep white matter and basal ganglia, consistent with ipsilateral carotid atheroembolism and/or relative hypoperfusion. CTA and cerebral angiography demonstrated approximately 60% left internal carotid artery stenosis, with heavy concentric calcification spanning a lesion length greater than 10 mm at the carotid bifurcation.Management and outcomeAfter multidisciplinary review of carotid endarterectomy, TCAR, and transfemoral options, IVL-assisted carotid angioplasty and stenting under continuous embolic protection was selected given advanced age, prior myocardial infarction, acute neurologic impairment, and limited functional reserve. Using distal embolic protection and proximal balloon-guide flow arrest, IVL was performed across the calcified plaque, followed by deployment of a new-generation integrated 3-in-1 carotid stent. Angiographic stenosis improved from approximately 60% to approximately 20% by NASCET methodology without periprocedural stroke, vasospasm, dissection, hemodynamic instability, or access-site complication. Admission NIHSS was 29; discharge NIHSS and mRS were 6 and 3, respectively. At approximately 1-month follow-up he was alert and oriented ×3 with fluent language and good comprehension. No further antithrombotic regimen switch occurred during outpatient follow-up, and no perioperative complications were reported.ConclusionIn this elderly patient with acute ischemic stroke and heavily calcified symptomatic carotid stenosis, IVL with angioplasty and a 3-in-1 carotid stent achieved early technical success without periprocedural complication and with short-term clinical stability. This case supports further investigation of IVL-based carotid revascularization in carefully selected patients who are poor candidates for open surgery and highlights the need for standardized follow-up, neurologic outcome reporting, and prospective evaluation of long-term patency and stroke prevention.
ObjectiveTo construct and validate a machine learning-based risk prediction model for poor wound healing after anorectal surgery, enabling early identification and individualized intervention.MethodsClinical data from 246 patients (Jan 2022–Dec 2024) were retrospectively collected. Wound healing status at 4 weeks post-surgery defined outcome (good: n = 191; poor: n = 55). Independent predictors were identified via multivariate Logistic stepwise regression. Patients were split 7:3 into training and internal validation sets. Three models—Logistic regression, gradient boosting machine (GBM), and random forest (RF)—were developed. Performance was assessed via AUC, calibration curves, Brier scores, and decision curve analysis. Temporal validation was performed using 152 patients from the same center (Jan 2025–Dec 2025) as an independent time-based cohort.ResultsBMI, diabetes, stool consistency, and preoperative perianal infection were common core predictors. In internal validation, AUCs were 0.893 (Logistic), 0.897 (RF), and 0.877 (GBM). In temporal validation, AUCs were 0.874 (Logistic), 0.865 (GBM), and 0.853 (RF). Logistic regression showed the smallest AUC fluctuation across training, internal, and temporal sets (0.864→0.893→0.874) and lowest Brier scores (0.092–0.123), indicating best calibration and generalizability. GBM achieved the highest training AUC (0.925) but significant performance decay in validation (ΔAUC = 0.048), suggesting overfitting. After grid search with 10-fold cross-validation, RF attained internal AUC of 0.897 and sensitivity of 0.800, close to Logistic regression, but temporal performance (AUC=0.853, Brier=0.129) was slightly inferior.ConclusionLogistic regression demonstrated the best overall discriminative ability, calibration, clinical net benefit, and cross-cohort generalizability, and is recommended as the preferred tool for individualized risk assessment. RF, after thorough optimization, shows promise as an alternative. GBM was limited by sample size and exhibited overfitting, warranting further validation in larger studies. This study provides a quantitative framework for early risk stratification in anorectal surgery patients.
Complex hernias with loss of domain present significant surgical challenges. Preoperative strategies such as botulinum toxin A (BTA) injections and progressive preoperative pneumoperitoneum (PPP) combined with structured prehabilitation and active patient participation may facilitate abdominal wall reconstruction. We report the case of a 65-year-old female with a complex incisional hernia. The patient underwent preoperative BTA injections followed by PPP before elective repair. This case highlights the value of a multimodal, patient-centered optimization pathway in facilitating successful abdominal wall reconstruction.
BackgroundNeoadjuvant therapy (NAT) has become central to the management of borderline resectable pancreatic ductal adenocarcinoma (BRPC). This surgical narrative review offers a contemporary synthesis of evidence and guidelines, with emphasis on pretreatment staging, post-NAT surgical selection, intraoperative vascular tactics, and postoperative care.MethodsWe conducted a structured narrative review of randomized and prospective studies, high-quality observational cohorts, and major international guidelines published through 31 December 2025. A systematic search of PubMed was performed, and key data were synthesized to inform a practical decision-making framework.ResultsAlthough BRPC remains defined largely by vascular anatomy, biological and conditional factors are increasingly incorporated into decision-making. NAT is preferred initially, with resection reserved for carefully selected responders. For post-NAT restaging, contrast-enhanced CT and CA19-9 kinetics are the mainstays, while FDG-PET, DWI-MRI, radiomics, and biomarkers serve as problem-solving adjuncts when findings are equivocal. Surgical exploration is guided by physiologic recovery, absence of metastatic progression, and multidisciplinary consensus. Staging laparoscopy remains useful for detecting occult metastases. Intraoperative vascular resection is margin-driven, not routine: venous resection is standard, arterial resection is selective, and periarterial divestment spares the artery in some cases. Short-term surgical morbidity does not appear to be increased by NAT, yet the absence of uniform protocols for post-reconstruction anticoagulation represents an important area for future investigation.ConclusionsNAT has fundamentally transformed the management of BRPC, establishing a surgical pathway that is dictated by tumor biology and sequentially timed according to treatment response and clinical course. Optimizing outcomes ultimately depends on standardized restaging protocols, judicious selection of patients who truly benefit from resection, and the concentration of complex vascular procedures in high-volume, experienced centers. A practical algorithm is proposed to synthesize these decision points for clinical use.
BackgroundSmall bowel metastasis from esophageal squamous cell carcinoma (ESCC) is an exceedingly rare event, typically diagnosed only during emergency surgery for obstruction or perforation. The underlying metastatic mechanisms and optimal management strategies remain poorly defined.Case presentationA 54-year-old woman with stage IVB ESCC (cT3N3M1; left supraclavicular lymph node metastasis) developed recurrent complete intestinal obstruction while receiving systemic chemo-immunotherapy and local radiotherapy. Emergency laparotomy revealed multiple serosal small bowel metastases causing segmental stenosis. Approximately 20 cm of jejunum was resected with primary side-to-side anastomosis, and a decompressive tube jejunostomy was placed. The postoperative course was uneventful, and the obstruction resolved. However, due to a rapid decline in performance status, no further anticancer therapy could be administered, and the patient died of cachexia and electrolyte imbalance two months after surgery.ConclusionsIn patients with known esophageal cancer, the development of “atypical” small bowel obstruction should raise immediate suspicion for peritoneal metastasis, even when conventional imaging fails to demonstrate discrete masses. Prompt surgical exploration can achieve both definitive diagnosis and effective palliation. This case also highlights the probable lymphatic route of metastatic spread and underscores the urgent need to integrate molecular biomarkers into surveillance strategies for rare but lethal metastatic patterns.
Cosmetic liposuction is among the most frequently performed aesthetic procedures worldwide, with multiple technique refinements developed to improve efficiency, recovery, and safety. These include suction-assisted (SAL), power-assisted (PAL), ultrasound-assisted (UAL), laser-assisted (LAL), water-assisted (WAL), and radiofrequency-assisted liposuction (RFAL). Comparative evidence focused exclusively on isolated cosmetic cases remains limited. A systematic search of PubMed, EMBASE, and Web of Science was conducted to identify clinical studies on isolated cosmetic liposuction published between 2000 and 2025. Randomized trials, cohort studies, and extensive case series were included. The primary outcome was the incidence of procedure-related complications. Secondary outcomes, including efficacy, patient satisfaction, recovery, skin tightening, and durability, were synthesized qualitatively because of heterogeneity in outcome reporting. Thirteen studies met the inclusion criteria. Only one included study provided fully extractable numerical safety data for overall complications, seroma, and infection. Therefore, these safety outcomes are presented descriptively rather than as pooled meta-analytic estimates. The available evidence indicated low reported rates of overall complications, seroma, and infection, while serious complications remained rare (<0.1%). Qualitative synthesis showed that all modalities achieved comparable fat reduction and contour improvement. Studies generally reported improved operative efficiency with PAL, reduced early postoperative pain and blood loss with WAL, and modest short-term skin tightening with LAL/RFAL. Patient satisfaction was consistently high (≥80%) across techniques. Contemporary cosmetic liposuction techniques demonstrate favorable safety profiles, while evidence regarding efficacy, recovery, patient satisfaction, skin tightening, and durability should be interpreted cautiously because it was derived primarily from heterogeneous qualitative evidence.
ObjectivesTo verify whether a single low dose of dexmedetomidine could reduce emergence agitation (EA) among pediatric dental patients undergoing outpatient general anesthesia in a clinical dental setting.Study designProspective randomized clinical trial.MethodsThis study included 90 children scheduled for elective dental procedures. Patients were randomly assigned to three groups: midazolam (MID, 0.02 mg/kg, n = 30), dexmedetomidine (DEX, 0.2 μg/kg, n = 30), and normal saline (NS, n = 30). The primary endpoint was EA, with time to extubation (TOE), time to wake-up (TOW), hemodynamic fluctuations and anesthesia-related complications considered as the secondary outcome.ResultsThe incidence of EA in the DEX group was significantly lower than that in the saline group, while the incidence in the Mid group showed no significant difference compared with the other two groups after a Bonferroni correction. The three groups showed statistically significant differences in TOW recovery time, with the DEX group having the longest, the Mid group intermediate, and the saline group the shortest.ConclusionA single low dose of dexmedetomidine at induction significantly reduces EA in pediatric dental outpatients, without compromising day-surgery discharge feasibility despite a modest prolongation of recovery time.Clinical Trial Registrationhttps://www.chictr.org.cn/showproj.html?proj=215673
