Hepatocellular carcinoma (HCC) lacks effective prognostic biomarkers. We explored the role of palmitoylation-coexpressed long non-coding RNAs (lncRNAs) in HCC progression and tumor microenvironment (TME) remodeling. Using TCGA data, we constructed an 8-lncRNA signature (PCLS) via LASSO and multivariate Cox regression. The PCLS robustly stratified HCC patients into risk groups; high-risk patients exhibited worse overall survival and immunosuppressive TME features. Furthermore, PCLS predicted differential responses to immunotherapy and conventional chemotherapeutic agents. The PCLS signature serves as a powerful prognostic tool, reflecting palmitoylation-mediated lncRNA regulation and TME heterogeneity, offering potential to guide personalized immunotherapy and chemotherapy strategies for HCC management.

Ferroptosis-a regulated, iron-dependent cell death driven by lipid peroxidation-has been implicated in vascular pathology, yet how endoplasmic reticulum (ER) stress couples to ferroptotic execution in vascular smooth muscle cells (VSMCs) remains unclear. We investigated whether the PERK-EIF2α-ATF4-CHAC1 signalling axis links ER stress to ferroptosis in human aortic SMCs. Human aortic smooth muscle cells (HASMCs) and primary aortic smooth muscle cells (AoSMCs) were exposed to erastin (± ferrostatin-1), with pharmacologic modulation using buthionine sulfoximine (BSO; glutamate-cysteine ligase inhibitor) and salubrinal (selective EIF2α dephosphorylation inhibitor). Viability (CCK-8), ER-stress markers (p-PERK, p-EIF2α, GRP78, ATF4, CHAC1) and ferroptosis effectors (GPX4, ACSL4, ALOX15) were quantified by Western blotting and densitometry. Immunofluorescence assessed GPX4 and p-EIF2α/CHAC1 colocalization. Lipid peroxidation was evaluated by C11-BODIPY 581/591 imaging and malondialdehyde (MDA) content; labile Fe2+ was measured by calcein-AM quenching; apoptosis was examined by TUNEL. Statistics used t-tests or one-way ANOVA. Erastin reduced viability and activated the EIF2α-ATF4-CHAC1 pathway in both HASMCs and AoSMCs, as evidenced by increased p-EIF2α/ATF4/CHAC1 and decreased GPX4, with concomitant upregulation of ACSL4 and ALOX15. GPX4 immunofluorescence declined, while C11-BODIPY and MDA indicated robust lipid peroxidation, and calcein-AM revealed expansion of the labile Fe2+ pool; ferrostatin-1 mitigated these changes. BSO further amplified p-PERK→p-EIF2α → ATF4 → CHAC1 signalling and deepened GPX4 loss, whereas salubrinal sustained EIF2α phosphorylation, augmented ATF4/CHAC1, and further depressed GPX4. Across conditions, effects were consistent in both cell types and reached statistical significance (most p < 0.05 to < 0.01). ER-stress signalling via PERK-EIF2α-ATF4-CHAC1 constitutes a proximal driver of ferroptosis in human aortic SMCs by eroding glutathione tone and disabling GPX4, thereby promoting lipid peroxidation in an iron-rich milieu. Pharmacologic tuning of EIF2α phosphorylation and glutathione biosynthesis modulates ferroptotic susceptibility, nominating EIF2α-ATF4-CHAC1, GPX4/GSH homeostasis and iron handling as actionable nodes to preserve VSMC integrity in oxidizing vascular environments.

Purpose: To evaluate digital subtraction angiography (DSA) imaging features, interventional treatment efficacy, and risk factors for rebleeding in postpancreatectomy hemorrhage (PPH). Methods: This retrospective study analyzed PPH patients undergoing interventional therapy (2013-2022). DSA was performed in all cases, with positive findings prompting intervention. Statistical analysis of DSA angiography manifestations, bleeding sites, success rate of interventional treatment and hemostasis. Univariate and multivariate logistic regression analysis was used to analyze the independent risk factors for rebleeding after interventional treatment for PPH. Results: A total of 192 patients were included. (1) DSA Examination: All 192 patients underwent DSA examination, the positive rate of the initial DSA examination was 78.65 % (151/192). The primary imaging manifestations included contrast medium spillage and pseudoaneurysm formation, with hemorrhage sites being the gastroduodenal artery (60 cases), hepatic artery (35 cases), superior mesenteric artery (38 cases), etc. (2) Interventional Therapy: 142 patients underwent interventional therapy (108 embolizations and 34 stent placements), resulting in a success rate of 90.85 % (129/142). (3) Independent risk factors for rebleeding after intervention in patients with PPH included: the surgical duration (P = 0.035), bleeding volume(P < 0.001), pancreatic fistula(P = 0.001), ECOG score(P = 0.011), pre-interventional leukocyte counts(P = 0.012), and the neutrophil/lymphocyte ratio(P = 0.047). Conclusion: Interventional diagnosis and treatment of PPH can facilitate prompt diagnosis and intervention, resulting in a high success rate of hemostasis and notable outcomes. However, it is important to note that some patients remain at risk for rebleeding after successful interventional hemostasis, necessitating close monitoring of clinical indices and proactive intervention for patients experiencing rebleeding. (c) 2026 Asian Surgical Association and Taiwan Society of Coloproctology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).

For iliac branch device (IBD) procedures, contralateral femoral access is generally regarded as the standard route, whereas upper-extremity access is usually reserved for selected anatomically challenging cases. However, both approaches may be difficult or undesirable in patients with a short common iliac artery (CIA), an unfavourable aortic bifurcation, prior endograft reconstruction, or access-related concerns. This study aimed to describe a modified balloon-anchored technique for IBD deployment via ipsilateral femoral access and to evaluate its technical feasibility and early outcomes. This retrospective, two-centre study included consecutive patients who underwent IBD deployment via ipsilateral femoral access between May 2023 and February 2024. Eligibility was limited to patients in whom contralateral femoral access was considered unsuitable because of predefined hostile anatomical or procedural features, including CIA length < 50 mm, an unfavourable aortic bifurcation or iliac tortuosity that limited coaxial sheath advancement, prior EVAR or aorto-iliac stent-graft configuration, or relevant access limitations. Computed tomography angiography (CTA) from the aortic arch to the femoral arteries was reviewed, and the modified balloon-anchored technique was applied according to a standardised algorithm. Technical success was defined as successful IBD deployment with preserved IIA branch patency and no type I or III endoleak on final angiography and CTA within 30 days. Twenty-three patients (91.3

The Dual Aspiration Technique (DATE) is a new approach for thrombectomy in iliofemoral deep vein thrombosis (DVT), using 2 catheters to combine negative aspiration pressure with venous flow. In an early study of 10 patients, DATE achieved complete or near-complete thrombus clearance with a single pass and no major adverse events. The technique was efficient, with an average procedure time under 30 minutes. These promising results suggest that DATE could offer a safer and more effective alternative to traditional thrombectomy methods. Larger studies are needed to confirm its efficacy.

May-Thurner Syndrome (MTS) is a vascular condition that affects over 20% of the population and significantly increases the risk of iliofemoral deep venous thrombosis. Accurate and early diagnosis of MTS using computed tomography (CT) remains a clinical challenge due to the subtle anatomical compression and variability across patients. In this paper, we propose MTS-Net, an end-to-end 3D deep learning framework designed to capture spatial-temporal patterns from CT volumes for reliable MTS diagnosis. MTS-Net builds upon 3D ResNet-18 by embedding a novel dual-enhanced positional multi-head self-attention (DEP-MHSA) module into the Transformer encoder of the network's final stages. The proposed DEP-MHSA employs multi-scale convolution and integrates positional embeddings into both attention weights and residual paths, enhancing spatial context preservation, which is crucial for identifying venous compression. To validate our approach, we curate the first publicly available dataset for MTS, MTS-CT, containing over 747 gender-balanced subjects with standard and enhanced CT scans. Experimental results demonstrate that MTS-Net achieves average 0.79 accuracy, 0.84 AUC, and 0.78 F1-score, outperforming baseline models including 3D ResNet, DenseNet-BC, and BabyNet. Our work not only introduces a new diagnostic architecture for MTS but also provides a high-quality benchmark dataset to facilitate future research in automated vascular syndrome detection. We make our code and dataset publicly available at:https://github.com/Nutingnon/MTS_dep_mhsa.

To assess the clinical efficacy of a new single-incision axillary vein puncture technique for implanting totally implantable venous access ports (TIVAPs). A retrospective review of patient data from January 2023 to June 2023 at The Affiliated Suzhou Hospital of Nanjing Medical University was conducted. The study included adult patients with solid malignancies scheduled for intravenous chemotherapy and TIVAPs implantation. Patients were categorized into single-incision group (Group S) and dual-incision group (Group D) based on different venous access approaches. Baseline information, primary tumors, immediate adverse events, indwelling time, and early and late adverse events were collected. A total of 338 patients were included in the analysis, with 117 in Group S. and 221 in Group D. Baseline characteristics were comparable between the groups. The technical success rate was 99.1% in Group S and 98.6% in Group D, demonstrating similarity. The mean operative time was 26 min in Group S, significantly shorter than the 36 min in Group D (p < 0.05). Group D experienced more occurrences of localised ecchymosis and painful. Overall, Group S exhibited superiority over Group D in terms of immediate adverse events (p < 0.05). Follow-up data revealed comparable adverse events rates between the two groups. In conclusion, the study indicates that the single-incision axillary vein puncture technique can be safely implemented by an experienced team with a low incidence of adverse events. This approach can serve as a valuable alternative for clinical TIVAPs placement.

OBJECTIVE:To evaluate the safety and efficacy of single versus dual Proglide strategies for large-bore access closure (16-24F) after endovascular aortic repair (EVAR). METHODS:A multi-center, retrospective cohort study was conducted including patients who underwent percutaneous access EVAR from March 2023 to July 2024. Patients were categorized into two groups: those using dual Proglide strategy (DP group) and those using single Proglide strategy (SP group). The technical success was defined as achieving complete hemostasis without using a bailout procedure. The primary endpoint was access-related complications. Vascular complications and bleeding events were evaluated in accordance with the Valve Academic Research Consortium (VARC)-3 criteria. RESULTS:A total of 97 patients with 142 access sites were included in the DP group, while 112 patients with 165 access sites were assigned to the SP group. The baseline characteristics were similar. The technical success rates were comparable (DP vs. SP, 99.3% vs. 100%, P=0.940). The mean number of total devices used per access site was significantly lower in the SP group, with a mean of 1.22±0.41, compared to 2.04±0.19 in the DP group (P<0.001). Overall, the access-related complication rates were similar, with 6.3% for the DP group and 6.1% for the SP group (P=0.920). No major access-related complications were reported. CONCLUSION:The single Proglide strategy emerges as a viable alternative in EVAR, reducing the use of closure devices while maintaining high safety and efficacy.

To evaluate the safety and efficacy of single versus dual Proglide strategies for large-bore access closure (16–24F) after endovascular aortic repair (EVAR). A multi-center, retrospective cohort study was conducted including patients who underwent percutaneous access EVAR from March 2023 to July 2024. Patients were categorized into two groups: those using dual Proglide strategy (DP group) and those using single Proglide strategy (SP group). The technical success was defined as achieving complete hemostasis without using a bailout procedure. The primary endpoint was access-related complications. Vascular complications and bleeding events were evaluated in accordance with the Valve Academic Research Consortium (VARC)-3 criteria. A total of 97 patients with 142 access sites were included in the DP group, while 112 patients with 165 access sites were assigned to the SP group. The baseline characteristics were similar. The technical success rates were comparable (DP vs. SP, 99.3% vs. 100%, P=0.940). The mean number of total devices used per access site was significantly lower in the SP group, with a mean of 1.22±0.41, compared to 2.04±0.19 in the DP group (P<0.001). Overall, the access-related complication rates were similar, with 6.3% for the DP group and 6.1% for the SP group (P=0.920). No major access-related complications were reported. The single Proglide strategy emerges as a viable alternative in EVAR, reducing the use of closure devices while maintaining high safety and efficacy.

PURPOSE:To assess the accuracy and safety of intracardiac electrocardiography (IC-ECG) in positioning catheter tips for Totally Implantable Venous Access Device (TIVAD) placement. METHODS:This study conducts a retrospective analysis of patient data collected from The Affiliated Suzhou Hospital of Nanjing Medical University. Patients were categorized into two groups based on the method used for catheter tip positioning: the IC-ECG group and the X-ray group. Propensity Score Matching (PSM) is employed to balance the baseline characteristics of the two groups in a 1:2 ratio. The primary outcomes of interest are the ideal position rate of the TIVAD tip and the incidence of complications. Additionally, multivariable logistic regression analysis will be utilized to identify risk factors associated with complications. The area under the ROC curve (AUC) will be calculated to evaluate the diagnostic performance of the detection methods. RESULTS:During the period from January 2023 to June 2024, a total of 493 adult oncology patients received TIVAD. After applying PSM, 465 patients were included in the retrospective analysis, comprising 221 males (47.5%) and 244 females (52.5%), with a mean age of 62.6 years. The ideal position rates for the catheter tips were 150 cases (96.8%) in IC-ECG group and 301 cases (97.1%) in X-ray group (p = 0.834). The distance from the catheter tip to the carina was measured at 1.60 ± 0.356 and 1.41 ± 0.34 vertebral body units, respectively (p < 0.01). The overall complication rates were comparable between the two groups. Multivariate logistic regression analysis indicated that BMI is an independent risk factor for TIVAD-related complications (OR = 0.437, 95% CI: 0.319-0.563, p < 0.001). The ROC curve analysis revealed that the area under the curve (AUC) for BMI was 0.926 (95% CI: 0.886-0.926, p < 0.001). CONCLUSION:Intracardiac electrocardiography (IC-ECG)-guided catheter tip positioning for TIVAD placement has demonstrated accuracy, feasibility, and safety. Given its potential to reduce radiation exposure, improve safety, and offer cost-effectiveness, IC-ECG presents a promising method for catheter tip positioning in TIVAD procedures. Based on these advantages, IC-ECG could be considered a preferable method in clinical practice.

ObjectiveTo evaluate the safety and efficacy of the area reduction post-closure technique for bedside weaning of veno-arterial extracorporeal membrane oxygenation (V-A ECMO).MethodsA retrospective study was conducted from December 2022 to November 2023, analyzing data from patients who underwent V-A ECMO weaning at our center. The area reduction post-closure technique, utilizing two ProGlide devices (Abbott Vascular, Santa Clara, CA), was adopted as a standard practice. The technical success was defined as achieving complete hemostasis without a bailout open repair. The complications associated with access included hemorrhagic events, pseudoaneurysm formation, limb ischemia, distal embolization, and wound infections.ResultsA total of 18 patients were included. The median age of the cohort was 72.0 years [interquartile range (IQR), 57.5–81.5 years], with a male-to-female ratio of 2:1. The median size of arterial sheath utilized was 18.0 Fr (IQR, 17.0–20.0 Fr). The median duration of the procedure was 10.0 min (IQR, 9.0–13.0 min), and the median length of total hospital stay was 31.0 days (IQR, 25.5–39.0 days). Furthermore, the technique demonstrated a success rate of 100%. One patient (5.6%) experienced minor bleeding, which was successfully managed through compression. No additional complications associated with access were observed after the procedure.ConclusionsThe post-closure area reduction technique emerges as a viable option for bedside weaning of V-A ECMO. Nonetheless, it is essential that this technique be validated through larger comparative studies.

To describe the downsizing post-closure technique for access hemostasis during emergency endovascular repair (EVAR) in ruptured abdominal aortic aneurysms (RAAA). A cohort of eight patients underwent emergency EVAR through 16 femoral access sites for infrarenal RAAA. The downsizing post-closure technique, which involves a reduction in the size of the large-bore access by advancing a 10F sheath, was consistently applied. Technical success was defined as complete hemostasis without a bailout intervention. Primary outcome measure was the incidence of access-related complications. Secondary outcome measures included manual compression time, hemostasis time, hospital stay, additional use of Proglide, and the 30-day mortality rate. The technique resulted in a 100

ObjectiveThis study aimed to evaluate the feasibility of a hybrid Glubran-supported single-Proglide technique for large bore femoral access closure during percutaneous access endovascular aneurysm repair (EVAR).MethodsA retrospective cohort study was performed for all percutaneous EVARs at our center from January 2023 to June 2023. All patients received the hybrid Glubran-supported single-Proglide technique involving a mixture of surgical glue and Lipiodol injection after single suture placement for femoral access closure. Technical success was defined as achieving complete hemostasis without a bailout strategy. Vascular complications and bleeding were defined by Valve Academic Research Consortium-3 (VARC-3) criteria. Vascular access changes and 30-day mortality were recorded.ResultsThe technique success rate for the entire study population was 100% (55 femoral access in 37 patients; median age: 72; 78% males). The mean sheath size was 20.4 ± 2.3F. The mean manual compression time was 3.5 ± 1.4 min, the mean hemostasis time was 9.0 ± 2.5 min, and the mean procedural time was 103.9 ± 34.7 min. One patient (1.6%) developed an access site infection and recovered conservatively. No VARC-3 vascular complications and access changes were observed. No 30-day mortality happened.ConclusionsThe hybrid Glubran-supported single-Proglide technique is feasible for large bore access closure during EVAR and may be a viable alternative; however, larger prospective studies are required to confirm its efficacy.

The infiltration of CD8 + T cells in the tumor microenvironment is associated with better survival and immunotherapy response. However, their roles in gastric cancer have not been explored so far. In here, the profiles of GC gene expression were collected from The Cancer Genome Atlas database. Single-cell transcriptomic data originated from GSE134520. Cell clustering, annotation, and CD8 + T-cell differential genes were from the TISCH database. We determined 896 CD8 + T-cell differential genes by scRNA-seq analysis. After integrating immune-related genes, 174 overlapping genes were obtained and a novel risk model was subsequently built. The performance of CD8 + T-cell-associated gene signature was assessed in the training and external validation sets. The gene signature showed independent risk factors of overall survival for GC. A quantitative nomogram was built to enhance the clinical efficacy of this signature. Furthermore, low-risk individuals showed higher mutation status, higher immune checkpoint expression, low Tumour Immune Dysfunction and Exclusion (TIDE) scores, and higher IPS-PD-1 combined IPS-CTLA4 scores, indicating a greater response to immunotherapy. In addition, analysis of IMvigor210 immunotherapy cohort demonstrated that low-risk individuals had a favorable response to prognosis and immunotherapy. In conclusion, we generated a CD8 + T-cell-related signature that can serve as a promising tool for personalized prognosis prediction and guiding decisions regarding immunotherapy in GC patients.

Abstract Objectives This study aimed to assess the safety and efficacy of a modified percutaneous post-closure technique for bedside arterial cannula removal of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Materials: Between December 2022 and August 2023, the data of all VA-ECMO patients weaned at our center were retrospectively reviewed. A modified post-closure technique with two ProGlide devices (Abbott Vascular, Santa Clara, CA) was adopted as a routine practice. The success of the technique was defined as achieving immediate hemostasis without a bailout open repair. The post-procedural complications included bleeding events, pseudoaneurysm, limb ischemia, distal embolization, and infection at the access site. Results Overall, nine patients were included in this study. The mean age was 69.7 ± 12.9 years with a male-to-female ratio of 2:1. The mean arterial sheath size was 16.7 ± 1.3 Fr. The mean duration of the procedure was 10.9 ± 2.2 min, and the mean length of stay in the intensive care unit after weaning was 16.2 ± 4.5 days. The efficacy of the technique achieved a success rate of 100%. A single patient (11.1%) developed minor bleeding, successfully managed with compression, and no more problems were observed following the procedure. Conclusions A modified post-closure technique was a feasible and safe strategy for VA-ECMO bedside weaning and may be considered an alternative option.

Objective This study aimed to assess the long-term complications and evolution of groin access using the sequential suture and plug vascular closure devices (VCDs) technique during endovascular aneurysm repair (EVAR). Methods We retrospectively reviewed data from all patients who underwent EVAR with more than 12 months of follow-up at our center between January 2022 and September 2022. The study included 64 patients with a mean age of 66.3 ± 13.9 years and a male-to-female ratio of 82.8%. We employed the sequential suture and plug VCDs technique as the standard practice for access closure. Technical success was defined as achieving complete hemostasis without needing bailout endovascular or surgical interventions. Access-related complications were assessed at 30 days and during the most recent follow-up computed tomography (CT) scan, with the severity graded according to the Society of Interventional Radiology (SIR) classification. Results The sequential suture and plug VCDs technique demonstrated a 100% success rate across the study population. The mean follow-up time from the procedure to the most recent scan was 16.1 ± 2.2 months, and the mean sheath size used was 20.5 ± 2.3 Fr. Short-term complications occurred in 4.1% of cases, comprising minor access bleeding incidents (n = 3) and pseudoaneurysm (n = 1). No long-term complications were observed during the study period, with no major complications reported. Additionally, the accessed vessels exhibited a significant increase in calcification score (1.02 ± 1.05 vs. 1.36 ± 1.08; p = 0.027) between the baseline and the last follow-up scan, while there were no significant changes in diameter. Conclusions The sequential suture and plug VCDs technique represents a safe method for access closure during EVAR, demonstrating low rates of short-term and long-term complications. However, further investigation through larger multi-center studies is warranted.