This study aims to assess the clinical efficacy and feasibility of the Perclose ProGlide Suture-Mediated Closure System (Abbott Vascular, Redwood City, CA, USA) for transbrachial access. A total of 100 patients from July 2020 to December 2023 were included in this retrospective study. Among them, 40 patients underwent ProGlide-guided suture closure following brachial artery (BA) puncture, while 60 patients received traditional manual compression. After successful ultrasound-guided puncture of the BA, a sheath of appropriate diameter (5–7F) was inserted. The Perclose ProGlide system was utilized in patients requiring ipsilateral upper limb intravenous infusion or dynamic blood pressure monitoring. All other patients underwent standard manual compression. No significant differences in major complications, including hematoma, pseudoaneurysm, or active bleeding, were observed between the two groups (P = 0.407). Additionally, there were no reported cases of arterial occlusion, ischemia, or venous thrombosis in either cohort. In the manual compression group, three patients required reintervention due to bleeding or hematoma, whereas no such incidents occurred in the ProGlide group (P = 0.151). Two patients in the manual compression group reported long-term numbness around the puncture site, while no similar neurological dysfunction was observed in the ProGlide group (P = 0.243). Although selection bias was present in this retrospective study, the Perclose ProGlide system presents a beneficial closure method for patients undergoing transbrachial access.

Background:Traditional open gastric cancer surgery has evolved from porous to reduced-hole, single-hole, or even natural cavity surgery to laparoscopic surgery, due to the continuous development of minimally invasive concepts and medical technologies, as well as awareness for the concept of rapid recovery. Conventional laparoscopic radical gastrectomy is quite mature in age at the moment, but how to progress to minimally invasive surgery without increasing the difficulty of surgery while ensuring clinical safety and feasibility is worth further investigation. Therefore, the clinical safety and feasibility of reduced port laparoscopic radical gastrectomy were assessed in this study. Methods:Information on the clinical data of patients undergoing laparoscopic radical gastric cancer surgery in a single centre between May 2020 and May 2022 was collected, and a total of 232 patients were included in this study according to the study protocol design. The clinical data of 232 patients with gastric cancer treated by two different surgical methods, namely, reduced port laparoscopic surgery (RPLS) or conventional laparoscopic surgery (CLS), were retrospectively analysed. The intraoperative indices, postoperative pathological indices, and short-term postoperative complications (within 30 days) of the two different surgical methods were evaluated, as well as the surgical methods' feasibility and short-term postoperative recovery effect. Results:There was no significant difference between the general data of patients with RPLS and CLS (P > 0.05). Compared with CLSG, the operation time, digestive tract reconstruction time and lymph node dissection time of RPLSG are shorter. The intraoperative blood loss was less, and the incision was minimally invasive (P < 0.05). In the short-term postoperative effect, the level of white blood cell count on the first day, the time of getting out of bed, the time of removing drainage tube, the time of hospitalization and the VAS of pain on the first, third and fifth days after operation, RPLSG was obviously superior to CLSG (P < 0.05). There was no significant difference between RPLSG and CLSG in terms of pathological indices (P > 0.05). Conclusions:The treatment of gastric cancer with RPLS has good safety, feasibility and short-term postoperative effects, which is in line with the implementation of the modern concept of rapid rehabilitation surgery.

Objective: Apurinic/apyrimidinic endonuclease 1 (APEX1), a key enzyme responsible for DNA base excision repair, has been linked to development and progression of cancers. In this work, we aimed to explore the role of APEX1 in hepatocellular carcinoma (HCC) and elucidate its molecular mechanism. Methods: The expression of APEX1 in HCC tissues and matched adjacent normal tissues (n = 80 cases) was evaluated by immunohistochemistry. Web-based tools UALCAN and the Kaplan-Meier plotter were used to analyze the Cancer Genome Atlas database to compare expression of APEX1 mRNA to 5-year overall survival. APEX1 was stably silenced in two HCC cell lines, Hep 3B and Bel-7402, with shRNA technology. An in vivo tumorigenesis model was established by subcutaneously injecting sh-APEX1-transfected Bel-7402 cells into mice, and tumor growth was determined. We performed high-throughput transcriptome sequencing in shAPEX1-treated HCC cells to identify the key KEGG signaling pathways induced by silencing of APEX1. Results: APEX1 was significantly upregulated and predicted poor clinical overall survival in HCC patients. Silencing APEX1 inhibited the proliferation of HCC cells in vivo and in vitro, and it repressed invasion and migration and increased apoptosis and the percentage of cells in G1. Differentially expressed genes upon APEX1 silencing included genes involved in TNF signaling. A positive correlation between the expression of APEX1 and MAP2K6 was noted, and overexpressing MAP2K6 overcame cancer-related phenotypes associated with APEX1 silencing. Conclusion: APEX1 enhances the malignant properties of HCC via MAP2K6. APEX1 may represent a valuable prognostic biomarker and therapeutic target in HCC.

Objective To investigate the impact of prior non-pancreatic cancer on the survival outcomes of patients with localized pancreatic neuroendocrine tumors (PanNETs). Methods We reviewed the Surveillance, Epidemiology, and End Results database and selected patients with localized PanNETs diagnosed between 1973 and 2015. We divided the patients into two groups according to the presence or absence of prior non-pancreatic malignancy. Before and after propensity score matching, we compared the clinicopathological characteristics and studied the overall survival and cancer-specific survival. Results A total of 357 (12.9%) of 2778 patients with localized PanNETs had prior cancer. A total of 1211 cases with only a localized PanNET and 133 cases with a localized PanNET and prior cancer had complete data and met the inclusion criteria of the current study. Patients with prior cancer were associated with advanced age (>65 years, 57.9% prior cancer vs. 31.0% no prior cancer, P<0.001), later year of diagnosis (87.2% vs. 80.2%, P=0.049), a higher proportion of poorly differentiated/undifferentiated grade tumors (4.5% vs. 1.5%, P=0.025), and a higher proportion of no primary site surgery (19.5% vs. 10.4%, P=0.003). Prostate (29.32%), breast (18.05%), other genitourinary and retroperitoneal (16.54%), and gastrointestinal (12.78%) cancers were the most common prior cancer types. Most of the prior cancers (95.49%) were localized and regional, and only 4.51% of the prior cancers were distant. Patients with interval periods between the prior cancer and PanNET of ≤36 months, 36-60 months, 60-120 months, and >120 months accounted for 33.08%, 13.53%, 24.06%, and 29.32% of all cases with prior cancers, respectively. Univariate and multivariate Cox proportional hazards analyses were performed. The presence/absence of prior cancers did not impact survival outcomes of patients with localized PanNETs before and after propensity score matching (PSM). Further subgroups analysis showed that, patients with localized PanNETs and prior distant cancer had worse cancer-specific survival than patients with prior local/regional cancer or patients without prior cancer (P<0.001). No significant differences in cancer-specific survival were observed in terms of the different sites of the prior cancers and the different interval periods of prior cancers and PanNETs (P<0.05). Conclusions Patients with localized PanNETs and a history of prior cancer had survival outcomes that were comparable to those of patients with no history of prior cancer. Patients with localized PanNETs and prior cancer could be candidates for clinical trials if they satisfy all other conditions; aggressive and potentially curative therapies should be offered to these patients.

目的 探讨腹腔镜下减重手术中克氏针挡肝技术的可行性及安全性.方法 2019年1～9月我科在110例减重手术中采用克氏针挡肝技术完成肝脏牵拉:腹腔镜直视下以克氏针在剑突下2 cm左侧穿刺腹壁,肠钳挑起肝脏后将克氏针经肝下置于膈肌脚从而抬起肝脏、暴露术野.结果 110例克氏针挡肝技术均获得良好的术野暴露,无须其他肝脏牵拉技术.完成克氏针挡肝时间(34.4±10.1)s,手术时间(88.2±28.0)min,术中出血中位数20(10,50)ml.术中均未发现肝刺裂伤、肝包膜下血肿等并发症.术后均未发现穿刺点再出血、感染等克氏针挡肝技术相关并发症,均未出现吻合口出血、胃漏及吻合口漏等严重手术并发症.术后住院时间(3.6±1.2)d,住院费用(62383.7±10021.2)元.术前ALT、AST分别为44.0(25.8,71.8)U/L、28.0(19.0,45.3)U/L,显著低于术后第1天AST、ALT分别为51.5(30.8,83.0)U/L、41.0(26.0,63.5)U/L(P均=0.000);术后1个月ALT、AST分别为42.5(29.0,67.0)U/L、29.0(22.0,43.0)U/L,与术前比较差异均无显著性(P=0.634,P=0.784).结论 在减重手术中,克氏针挡肝技术安全、可行,可以作为一种常规的肝脏牵拉技术.

Ingestion of jujube pits is a common clinical problem, which can be difficult to diagnose and life-threatening if accompanied with intestinal perforation and peritonitis. In this study, 18 cases of intestinal perforation caused by ingestion of jujube pits were reviewed and summarized to discuss the clinical characteristics, diagnosis and treatments.

目的 探讨脐内2 cm小切口单孔腹腔镜胃袖状切除术(laparoscopic sleeve gastrectomy,LSG)的安全性、可行性,并总结手术经验.方法 回顾性分析2017年5月～2018年7月于我中心行脐内2 cm小切口单孔LSG的8例肥胖患者的临床资料及随访结果,男2例,女6例,BMI 29.4～46.88,36.52±10.96.合并2型糖尿病(type 2 diabetes mellitus,T2DM)2例.术中均采用克氏针挡肝技术.结果 8例手术均顺利完成,无术中增加戳孔或转为开放.手术时间60～120 min,(98.7±57.8)min,术中出血量5～50 ml,术后住院2～4 d.无戳孔感染、脂肪液化、出血、胃漏、脐疝等并发症.术后1～2个月获得随访6例.结论 脐内2 cm小切口单孔LSG安全、可行,可以采用克氏针挡肝技术.

目的 探讨三孔法腹腔镜胃袖状切除术(laparoscopic sleeve gastrectomy,LSG)的可行性,总结手术经验.方法 回顾性分析2017年5月～2018年3月三孔法LSG治疗18例肥胖患者的临床资料及随访结果.BMI 29.10～49.93,38.46±11.56.合并2型糖尿病7例.观察孔位于脐或脐上,主操作孔位于右锁骨中线与肋缘交界处,辅助操作孔位于剑突下2 cm.克氏针于剑突下方刺入,腹腔镜监视下经肝左外叶脏面插入右侧膈肌脚,即"克氏针挡肝技术".结果 18例手术均顺利完成,手术时间(82.8±47.0)min,术中出血量5～120 ml,术后住院(4.0±2.6)d.术后1～2个月随访,无出血、胃漏、脐疝等并发症.结论 三孔法LSG安全性、可行性值得肯定.克氏针挡肝技术对实现减孔至关重要.