BackgroundObesity increases the risk of breast cancer, with dysfunctional metabolic activity in subcutaneous adipose tissue (SAT) implicated as a key underlying mechanism. This study sought to explore the correlation between SAT metabolic activity and clinical prognosis among patients with breast cancer.MethodsBody composition parameters at the level of the third lumbar vertebra and clinicopathological data from 74 patients with breast cancer were collected. Two Cox models were established using the least absolute shrinkage and selection operator (LASSO) for variable selection. The two models were compared using the time-dependent area under the receiver operating characteristic curve (AUC) and the net reclassification index (NRI). Furthermore, the confounding effects on the association among the mean standard uptake value of subcutaneous adipose tissue (SUVmean_SAT), American Joint Committee on Cancer (AJCC) stage, and progression status in patients with breast cancer were assessed.ResultsTwenty-five out of 74 patients experienced recurrence during a median follow-up of 18 months. AJCC stage (p < 0.001) and SUVmean_SAT (p = 0.001) were significant independent prognostic factors. The AUC value and NRI of the combined Cox model (SUVmean_SAT plus AJCC stage) were higher than those of the Cox model based on AJCC stage alone. In addition, changes in the effect estimates showed a 12.2% decrease in hazard ratios when SUVmean_SAT was added to the AJCC stage model. High SUVmean_SAT was significantly associated with an increased risk of progression-free survival in patients with breast cancer.ConclusionsA comprehensive assessment incorporating both SUVmean_SAT and AJCC stage may enhance understanding of the impact of adiposity on breast cancer prognosis.

GINS1 is correlated with a poor prognosis in numerous cancers including liver hepatocellular carcinoma (LIHC). Here, efforts have been made to explore the function and underlying mechanism in LIHC through bioinformatics analysis. The mRNA and protein expression data of GINS1 were downloaded from The Cancer Genome Atlas (TCGA) database, the Clinical Proteomic Tumor Analysis Consortium (CPTAC), the University of Alabama at Birmingham CANcer Data Analysis Portal (UALCAN), and the Human Protein Atlas (HPA) database. Moreover, the protein expression of GINS1 was further substantiated by immunohistochemistry staining from 116 clinical samples. Subsequently, the diagnostic and prognostic role of GINS1 in LIHC patients were determined using receiver operating characteristic (ROC) analysis and the Kaplan-Meier plotter (KM-plotter) database. GeneMANIA and STRING databases were respectively used to construct gene and protein-protein interaction (PPI) networks of GINS1. Enrichment analyses were conducted to investigate the functions of GINS1. To assess the genetic alterations, methylation, and prognostic value, cBioPortal, and MethSurv databases were utilized. Additionally, Tumor Immune Estimation Resource (TIMER), Tumor-Immune System Interaction Database (TISIDB), and Gene Expression Profiling Interactive Analysis (GEPIA) were used to explore the correlation with tumor immune. Differential expression analyses validated the upregulation of GINS1 in LIHC. Furthermore, the prognostic and diagnostic values of GINS1 were substantiated by the ROC curve, Kaplan-Meier plotters, and forest plots. Further enrichment, methylation, and tumor immune microenvironment analyses showed an intimate connection with GINS1. In conclusion, GINS1 which is correlated with methylation and immune escape may predict the prognosis of LIHC.

Remnant gastric cancer (RGC) is a serious long-term complication following gastrectomy, for which radical resection remains the standard treatment. With continued advancements in laparoscopic techniques, laparoscopic radical gastrectomy (LRG) has emerged as an important therapeutic option for early-stage and select advanced cases of RGC. This procedure offers reduced surgical trauma, faster postoperative recovery, and a lower incidence of complications. However, several challenges remain in its clinical application. On the one hand, postoperative anatomical changes and intra-abdominal adhesions can limit the surgical field, complicating lymphadenectomy and digestive tract reconstruction. On the other hand, no consensus has been reached regarding the optimal surgical approach, the extent of lymphadenectomy, or the anastomotic technique, resulting in variation in procedural standardization. Nonetheless, with ongoing refinement of laparoscopic techniques, this approach has been increasingly adopted across multiple centers. Its successful implementation largely depends on the surgeons' technical proficiency and clinical experience. This study aims to systematically introduce the experiences of LRG for RGC and provide supplementary information for the existing research data on these techniques.

Background:Globally, liver cancer as one of the most frequent fatal malignancies, hits hard and fast. And the lack of effective treatments for liver hepatocellular carcinoma (LIHC), activates the researchers to promote promising precision medicine. Interestingly, emerging evidence proves that cellular senescence is involved in the progression of cancers and is recognized for its hallmark-promoting capabilities. Hence, efforts have been made to construct and validate the senescence risk score signature (SRSS) model as a novel prognostic biomarker for LIHC. Methods:The existing databases were mined for the following bioinformatics analyses. GSE22405, GSE57957, and senescence-related genes (SRGs) from public databases were utilized as a training set and the validation set was constituted by LIHC and pancreatic adenocarcinoma (PAAD) from The Cancer Genome Atlas (TCGA). After overlapping differentially expressed genes (DEGs) with SRGs, differentially expressed SRGs were identified with the progression of liver cancer through univariate and multivariate Cox regression and enrichment analyses. The model that utilized three SRGs was constructed using the least absolute shrinkage and selection operator (LASSO) regression algorithm. Next, to evaluate the predictive performance of the SRSS model, the overall survival (OS) and survival rates were assessed through Kaplan-Meier (KM) and the receiver operating characteristic (ROC) curves. The predictive value for LIHC prognosis was further evaluated by capitalizing on risk score, nomograms, decision curve analysis (DCA) curves, and clinical information including tumor stages, gender, age, and race. Results:DEGs were revealed as enriching in multiple tumor-related biological processes (BPs) and pathways. IGFBP3, SOCS2, and RACGAP1 were identified as the three considerable SRGs for the model. The high-risk group had a worse prognosis [both hazard ratio (HR) >1, P<0.001] and ROC curves showed a reliable predictive model with area under the curve (AUC) predictive values ranging from 0.673-0.816 for different-year survival rates respectively. The univariate and multivariate Cox regression analyses exhibited that risk score was the only credible prognostic predictor (HR >1, P<0.001) among clinical features such as tumor stage, age, etc., in LIHC. The nomograms, and DCA curves, combined with multiple clinical information, proved that the predictive ability of SRSS was strongest, followed by nomogram and traditional tumor node metastasis (TNM) stage was the weakest. Conclusions:In summary, comprehensive analyses supported that the SRSS model can better predict survival and risk in LIHC patients. Promisingly, it may point out a brand-new direction for LIHC therapy.

Hypersplenism and esophageal variceal hemorrhage caused by portal hypertension are common and serious complications of decompensated cirrhosis. In recent years, with the widespread application of various therapeutic methods such as drugs, endoscopy, splenic artery embolization, transjugular intrahepatic portal shunt, and liver transplantation, the role of surgery in the treatment of portal hypertension has gradually diminished, and the indications for surgical treatment have become more strictly defined. However, according to the clinical practice in China, surgical treatment of portal hypertension still holds an important role that other treatments cannot fully replace. In fact, surgical treatment of portal hypertension is widely performed in hospitals at all levels in China, saving numerous lives. Splenectomy combined with pericardial devascularization (SPD) is the most common surgical method for treating hypersplenism and esophageal variceal hemorrhage caused by portal hypertension. Long-term clinical practice has proven that SPD is a safe and effective treatment for hypersplenism and esophageal variceal rupture and hemorrhage due to portal hypertension. With the rapid development of laparoscopic techniques, the minimally invasive advantages of laparoscopic splenectomy combined with pericardial devascularization (LSPD) have become increasingly evident. However, the successful performance of LSPD mainly depends on the skill and proficiency of the surgeon. In this context, this article presents detailed techniques for LSPD.

GINS1 regulates DNA replication in the initiation and elongation phases and plays an important role in the progression of various malignant tumors. However, the role of GINS1 in hepatocellular carcinoma (HCC) remains largely unclear. In this study, we investigated the role and underlying mechanisms of GINS1 in contributing to HCC metastasis. We found that GINS1 was significantly upregulated in HCC tissues and cell lines, especially in HCC tissues with vascular invasion and HCC cell lines with highly metastatic properties. Additionally, high expression of GINS1 was positively correlated with the progressive clinical features of HCC patients, including tumor number (multiple), tumor size (>5 cm), advanced tumor stage, vascular invasion and early recurrence, suggesting that GINS1 upregulation was greatly involved in HCC metastasis. Moreover, Kaplan-Meier survival analysis revealed that high GINS1 expression predicted a poor prognosis. Both in vitro and in vivo, silencing of GINS1 inhibited proliferation, migration, invasion and metastasis, while overexpression of GINS1 induced opposite effects. Mechanistically, we found that ZEB1 was a crucial regulator of GINS1-induced epithelial-mesenchymal transition (EMT), and GINS1 promoted EMT and tumor metastasis through β-catenin signaling. Overall, the present study demonstrated that GINS1 promoted ZEB1-mediated EMT and tumor metastasis via β-catenin signaling in HCC.

For recurrent choledocholithiasis, abdominal adhesions in previous surgeries lead to changes in anatomical structures, and a secondary injury occurs easily when performing another operation for laparoscopic common bile duct exploration (LCBDE), which was once considered a relative contraindication. In view of the limitations of the current surgical technique, this study summarized the surgical approaches and crucial anatomical landmarks for reoperation for LCBDE. Four general surgical approaches were proposed to expose the common bile duct, including the ligamentum teres hepatis approach, the anterior hepatic duodenal ligament approach, the right hepatic duodenal ligament approach, and the hybrid approach. Additionally, this study highlighted seven crucial anatomical landmarks: the parietal peritoneum, the gastrointestinal serosa, the ligamentum teres hepatis, the inferior margin of the liver, the gastric antrum, the duodenum, and the hepatic flexure of the colon, which were helpful to safely separate abdominal adhesions and expose the common bile duct. Moreover, to shorten the time of choledocholithotomy, a sequential method was innovatively applied for the removal of the stones in common bile duct. Mastering the above surgical approaches, including identifying crucial anatomical landmarks and adopting the sequential method will improve the safety of reoperation for LCBDE, shorten the operation time, promote the fast recovery of patients, reduce postoperative complications, and contribute to the popularization and application of this technique.

For recurrent choledocholithiasis, abdominal adhesions in previous surgeries lead to changes in anatomical structures, and a secondary injury occurs easily when performing another operation for laparoscopic common bile duct exploration (LCBDE), which was once considered a relative contraindication. In view of the limitations of the current surgical technique, this study summarized the surgical approaches and crucial anatomical landmarks for reoperation for LCBDE. Four general surgical approaches were proposed to expose the common bile duct, including the ligamentum teres hepatis approach, the anterior hepatic duodenal ligament approach, the right hepatic duodenal ligament approach, and the hybrid approach. Additionally, this study highlighted seven crucial anatomical landmarks: the parietal peritoneum, the gastrointestinal serosa, the ligamentum teres hepatis, the inferior margin of the liver, the gastric antrum, the duodenum, and the hepatic flexure of the colon, which were helpful to safely separate abdominal adhesions and expose the common bile duct. Moreover, to shorten the time of choledocholithotomy, a sequential method was innovatively applied for the removal of the stones in common bile duct. Mastering the above surgical approaches, including identifying crucial anatomical landmarks and adopting the sequential method will improve the safety of reoperation for LCBDE, shorten the operation time, promote the fast recovery of patients, reduce postoperative complications, and contribute to the popularization and application of this technique.

Surgical resection and ablation therapy have been shown to achieve the purpose of a radical cure for liver cancer with a size of less than 3 cm; however, tiny liver cancer lesions of diameters smaller than 2 cm remain challenging to diagnose and cure due to the failure of the generation of new blood vessels within tumors. Emerging evidence has revealed that optical molecular imaging combined with nanoprobes can detect tiny cancer from the perspective of molecular and cellular levels and kill cancer cells by the photothermal effect of nanoparticles in real time, thereby achieving radical goals. In the present study, we designed and synthesized multicomponent and multifunctional ICG-CuS-Gd@BSA-EpCAM nanoparticles (NPs) with a potent antineoplastic effect on tiny liver cancer. Using subcutaneous and orthotopic liver cancer xenograft mouse models, we found that the components of the NPs, including ICG and CuS-Gd@BSA, showed synergistic photothermal effects on the eradication of tiny liver cancer. We also found that the ICG-CuS-Gd@BSA-EpCAM NPs exhibited triple-modal functions of fluorescence imaging, magnetic resonance imaging, and photoacoustic imaging, with targeted detection and photothermal treatment of tiny liver cancer under near-infrared light irradiation. Together, our study demonstrates that the ICG-CuS-Gd@BSA-EpCAM NPs in combination with optical imaging technique might be a potential approach for detecting and noninvasively and radically curing tiny liver cancer by the photothermal effect.

Background:Liver cancer remains one of the tricky malignancies nowadays. GINS complex subunit 3 (GINS3), part of the GINS tetrameric complex, is significantly upregulated in many cancers, including liver hepatocellular carcinoma (LIHC). With the development of liver cancer treatment, immune and molecular targeted therapy gradually becomes a promising treatment. However, the key target for liver cancer is still indistinct. Herein, the underneath mechanism of GINS3 was investigated to verify its role as a biomarker in LIHC.Methods:Genomic expression, genetic alteration, and methylation analyses were obtained from The Cancer Genome Atlas (TCGA), Clinical Proteomic Tumor Analysis Consortium (CPTAC), The University of Alabama at Birmingham CANcer (UALCN), and Human Protein Atlas (HPA), cBioPortal, and MethSurv databases. Subsequently, the diagnostic and prognostic role of GINS3 in LIHC were analyzed based on data from receiver operating characteristic (ROC), Kaplan-Meier plotter (KM-plotter), and univariate and multivariate cox regression analyses. The functional analyses were conducted with GeneMANIA and STRING databases, gene-gene, and protein-protein interaction (PPI) networks, Gene Ontology (GO) term, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. Tumor Immune Estimation Resource (TIMER), Tumor-Immune System Interaction Database (TISIDB), and Gene Expression Profiling Interactive Analysis (GEPIA) were utilized to explore the internal connection with the immune escape.Results:Through the analyses of genomic expression, GINS3 was significantly upregulated in LIHC and positively correlated with higher T classification. ROC analysis indicated GINS3 as a potential biomarker in the diagnosis of LIHC. KM-plotter, univariate and multivariate cox regression analyses both associated GINS3 with poor prognosis in LIHC patients. GINS3 genetic alteration, gene-gene interaction, PPI networks, and enrichment analysis further revealed that GINS3 played a pivotal role in the progression of LIHC. Furthermore, hypermethylation of GINS3 at different cytosine-guanine (CpG) sites was correlated with better or worse overall survival (OS) in LIHC and GINS3 was also closely correlated with m6A modification. Moreover, results supported that GINS3 could influence the tumor microenvironment and relate to the immune checkpoints.Conclusions:Taken together, comprehensive analyses from this study supported GINS3 as a novel targeted biomarker in LIHC.

Distal pancreatic carcinoma is a highly malignant tumor with strong invasiveness, often growing to the edge of the pancreas and penetrating the pancreatic capsule to infiltrate surrounding tissues. In conventional distal pancreatosplenectomy (DPS), tumor cells are prone to spread along the direction of blood and lymphatic reflux due to surgical compression. Additionally, inflammation makes it challenging to achieve R0 resection, leading to a lower patient survival rate. To address these limitations, radical antegrade modular pancreatosplenectomy (RAMPS) was developed, emphasizing deeper excision, including the left anterior renal fascia, the left anterior renal adipose sac, and even the left adrenal gland, to improve the R0 resection rate. With the advancement of minimally invasive surgical techniques, laparoscopic RAMPS (L-RAMPS) is being considered technically safe and feasible in oncology. However, due to technical difficulties and a lack of supporting evidence for clinical application, only a few institutions are currently conducting L-RAMPS. In this context, this article presents detailed techniques for laparoscopic posterior radical antegrade modular pancreatosplenectomy (L-pRAMPS), offering promise for future clinical applications.

Introduction: Endoscopic thyroidectomy (ET) has been successfully established as an excellent surgical approach. This study summarizes and describes the crucial anatomical landmarks for clinical applied anatomy in trans-areolar ET, which may help further improve the quality and safety of trans-areolar ET. Materials and Methods: Five hundred forty patients who underwent trans-areolar ET from January 2015 to June 2018 at our institution were evaluated. Several crucial anatomical landmarks were described during the surgical procedures. The surgical outcomes, including the operative time, conversion, intraoperative blood loss, postoperative complications, and postoperative stay, were collected. Results: All patients successfully underwent trans-areolar ET without conversion. The mean operative time was 142.18 +/- 49.91 minutes (150.84 +/- 50.32 minutes for total thyroidectomy and 110.20 +/- 32.4 for lobectomy with isthmusectomy). The mean intraoperative blood loss was 20.45 +/- 10.89 mL. The postoperative stay was 5.42 +/- 1.49 days. The postoperative complication rate was 7.78%, including transient hypocalcemia in 30 patients, transient recurrent laryngeal nerve palsy in 3 patients, and skin ecchymosis in 9 patients. Conclusions: An understanding of crucial anatomical landmarks for clinical applied anatomy may improve the quality and safety of trans-areolar ET and subsequently help promote the development of ET.

Objective To explore the application value of scar hidden laparoscopic appendectomy (SHLA). Methods A retrospectively analysis was made on clinical data of 107 patients underwent SHLA and 134 patients underwent conventional laparoscopic appendectomy (CLA) from July 2011 to June 2016. The operative time, operative blood loss, postoperative exhaust time, pain score, postoperative complications, postoperative hospital stay and cosmetic score were compared between the two groups. Results All the operations of both groups were successful without conversion to open surgery. There were 1 case of wound infection in the SHLA group and 1 case of wound infection and 1 case of incision fat necrosis in the CLA group. There were no significant differences in operative time [(48. 0 ± 15. 9) min vs. (45. 2 ± 11. 5) min, t=1. 585, P=0. 114], operative blood loss [(12. 9 ± 8. 4) ml vs. (14. 0 ± 10. 7) ml, t= -0. 870, P=0. 385], postoperative exhaust time [(1. 3 ± 0. 7) d vs. (1. 3 ± 0. 5) d, t=0. 000, P=1. 000], pain score [(4. 9 ± 1. 2) points vs. (5. 2 ± 1. 5) points, t= -1. 683, P=0. 094], postoperative complications [0. 9% vs. 1. 5%, χ2=0. 000, P=1. 000], and postoperative hospital stay [(3. 2 ± 1. 1) d vs. (3. 5 ± 1. 4) d, t= -1. 814, P=0. 071] between SHLA and CLA. The cosmetic score in the SHLA group was higher than that in the CLA group [(4. 4 ± 0. 6) points vs. (4. 0 ± 0. 9) points, t=3. 949, P=0. 000]. Conclusion SHLA is safe and feasible for acute appendicitis with favourable cosmetic results.

目的探讨DNA拓扑异构酶Ⅱ(TopoⅡ)蛋白在原发性乳腺癌组织中的表达及其与预后的相关性.方法选择经术后病理证实的原发性乳腺癌患者100例,采用免疫组织化学SP法检测乳腺癌组织中TopoⅡ、雌激素受体(ER)、孕激素受体(PR)、p53的表达情况,分析TopoⅡ蛋白与临床病理特征的关系及其与ER、PR、p53和预后的相关性.结果100例患者乳腺癌组织中TopoⅡ蛋白阳性表达率为58.00％,明显高于ER、PR、p53的38.00％、35.00％、27.00％(P<0.05).有淋巴结转移的TopoⅡ蛋白阳性表达率为84.21％,明显高于无淋巴结转移的41.94％(P<0.05).TopoⅡ蛋白阳性表达与淋巴结转移和ER、PR、p53表达均呈正相关(r=0.947、0.785、0.627、0.468,均P<0.05).结论TopoⅡ蛋白在原发性乳腺癌组织中可高表达,可能为评估乳腺癌患者预后的指标之一.

Endoscopic thyroidectomy via complete areola approach (ETCAA) is becoming the preferred choice of some patients due to the perfect cosmetic result. Endoscope holder plays an important role in the procedures. Research on the learning curve is helpful in training of endoscope holder and improvement of the whole procedure.

Objective To analyze and explore the management for tunnel bleeding during endoscopic thyroidectomy via complete areola approach . Methods A retrospective analysis was made on clinical data of 37 patients suffering tunnel bleeding caused by trocars during puncture out of 1080 cases of endoscopic thyroidectomy via complete areola approach from June 2005 to March 2014.Parameters reviewed included bleeding tunnel , bleeding site, operative time, operative blood loss, postoperative drainage, postoperative hospital stay , and postoperative complications . Results The total incidence of tunnel bleeding was 3.4%(37/1080).Hereinto, the incidence of bleeding in observation tunnel was 2.7%(29/1080), which was significantly higher than that in the main operating tunnel (0.2%, 2/1080) and the auxiliary operating tunnel (0.6%, 6/1080) (χ2 =34.830, P=0.000).The incidence of bleeding in the middle part of the tunnel was 2.9% (31/1080), which was significantly higher than that at the exterior edge (0.5%, 5/1080) and the inner edge (0.1%, 1/1080) (χ2 =43.524, P=0.000).The tunnel bleeding was successfully treated in 37 cases without postoperative bleeding .The mean operating time was 112.6 ±17.5 min;the mean intraoperative blood loss was 22.5 ±9.6 ml;the mean drainage volume after 2 postoperative days was 91.2 ±17.9 ml;the mean postoperative hospital stay was 3.8 ±1.5 d.Local skin ecchymosis occurred in 3 cases and subcutaneous hydrops occurred in 1 case postoperatively , which were recovered after symptomatic treatment . Conclusions Bleeding often occurs in observation tunnel and the middle part of the tunnel . It is effective to treat bleeding at the exterior edge by using harmonic scalpel , and in the middle part of the tunnel and at the inner edge by using percutaneous suturing .

Objective To study the treatment and prevention of massive hemorrhage ( bleeding volume >300 ml ) in endoscopic thyroidectomy hemorrhage. Methods A total of 3812 cases undergoing total endoscopic thyroidectomy via breast approach between March 2002 and June 2014 were reviewed retrospectively.Massive hemorrhage ocurred in 9 cases (0.2%), 5 of which were observed during operation ( including 2 cases of"temporary not bleeding after high pressure"phenomenon) and 4 of which were observed postoperatively (3 h-9 d after operation, including 2 cases of delayed hemorrhage) .The amount of bleeding was 300-800 ml, with an average of 416.7 ml. Results The hemorrhage was stopped successfully in all the 9 cases.Of the 5 cases of intraoperative hemorrhage, endoscopy was completed in 4 cases and conversion to open surgery was required in 1.Of the 4 cases of postoperative hemorrhage, endoscopy was completed in 3 cases and open surgery was conducted in 1 case.Hemostatic methods included use of ultrasonic scalpel solidification, ligation of blood vessels, resection of the bleeding glands, and bandaging compression. The location of bleeding was in subcutaneous tunnel of chest wall in 3 cases, in anterior jugular vein in 1 case, in thyroid gland in 3 cases, and in thyroid gland section in 2 cases.No severe complications or death happened. Conclusions The incidence of hemorrhage in endoscopic thyroidectomy is low and easy to be observed, which can be treated and prevented.But the delayed hemorrhage and the phenomenon of "temporary not bleeding after high pressure"should be carefully observed.

1996年GAGNER［1］报道了首例腔镜甲状旁腺切除术， H册SCHER等［2］在1997年报道了首例腔镜甲状腺切除术，随后腔镜甲状腺切除术因其理想的美容效果日渐被广泛应用。喉返神经（ recurrent laryngeal nerve ， RLN）损伤是甲状腺切除术的严重并发症之一，可引起呛咳、声音嘶哑、窒息，甚至危及生命［3－4］。 LAHEY等［5］于1938年首先提出了在甲状腺切除术中常规解剖显露RLN以降低损伤率的观点，对此学界一直存在争议，本文就腔镜甲状腺切除术中RLN显露与保护的研究进展综述如下。

The aim of this study was to evaluate the effect and cosmetic results of endoscopic thyroidectomy (ETE) via the areola approach for patients with thyroid diseases.