In select patients with type C esophageal atresia, primary anastomosis is not appropriate and a staged approach is required. We aim to summarize our experience in the management of type C EA using a staged approach. A retrospective chart-review of patients with type C EA admitted to Beijing Children’s Hospital between July 2020 to October 2023 were conducted. Those diagnosed with type C EA who were not amendable to primary anastomosis were included for analysis. Clinical information was recorded, and follow- up was performed. Seven (five boys) patients with type C EA who received staged repair were included in the study. Initial surgeries included thoracotomy and thoracoscopy. 71

Background: Managing refractory esophageal strictures (RES) presents formidable challenges. Although endoscopic balloon dilation (EBD) is the first step for esophageal stricture, the clinical outcomes of EBD for RES after esophageal atresia (EA) repair are not established. Methods: All EA patients with esophageal balloon strictures (EBS) from October 2016 to October 2022 treated by EBD in our institution were retrospectively reviewed. The primary endpoint was to evaluate the clinical outcomes and the risk factors for poor outcomes of EBD for RES. The secondary endpoint was to evaluate the risk factors for pathological weight in RES patients. Results: 87 patients with RES were included in our study. After the first session of EBDs, 40.2 % experienced a recurrence of esophageal strictures. The median number (IQR) of the first session of EBD was 13.0 (8.0, 16.0), and the median number (IQR) of total dilations of achieving long-term clinical success was 14.0 (10.0, 19.0) with 81.6 % achieving long-term clinical success with less than 20 EBDs. In followup, all patients achieved a total oral diet. On multivariable analysis, the presence of GERD (OR 4.17, 95%Cl 1.29-13.51, p = 0.017), LGEA (long-gap esophageal atresia) (OR 5.19, 95 % Cl 1.15-23.52, p = 0.033), eccentric stricture shape (OR 3.34, 95%Cl 1.06-10.53, p = 0.040), and longer stricture length (OR 10.22, 95%Cl 1.14-92.01, p = 0.038) were statistically significant associated with increased endoscopic dilations. The presence of LGEA (OR 3.25, 95%Cl 1.03-10.20, p = 0.044) was significantly associated with recurrence after short-term clinical success. Additionally, Older age at first dilation after LEAP, stricture level at 1/3 upper (ref= 1/3 middle), and LGEA were identified as risk factors for developing pathological weight. Conclusion: Endoscopic balloon dilation is an effective method for treating RES after EA repair. GERD, LGEA, eccentric stricture shape, and longer stricture length are the risk factors for increased dilation times. Older age at first dilation after LEAP, stricture level at 1/3 upper, and LGEA were identified as risk factors for developing pathological weight. (c) 2024 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/).

Background Biliary atresia (BA) is a severe liver disease in neonates, which is caused by obliteration of the intra- and the extrahepatic biliary duct leading to cholestasis, and progressive liver injury and fibrosis. Epithelial-mesenchymal transformation (EMT) of bile duct epithelial cells is considered to be a key mechanism in the pathogenesis of liver fibrosis. The present study aimed to explore the role and underlying mechanism of ferroptosis in EMT and liver fibrosis. Methods Thirty-four cases of BA liver tissue and twenty-two cases of adjacent normal liver tissue from hepatoblastoma were subjected to RNA-sequencing and proteomic analysis to verify the expression differences of EMT and fibrosis between BA and non-BA liver tissues, as well as the correlation between the expression level of the differential gene SFXN3 in BA and clinical pathological characteristics. A mouse liver model of biliary atresia induced by rotavirus in rhesus monkeys was constructed to verify the expression differences of EMT and fibrosis-related genes. A fibrosis model was constructed by inducing cholangiocytes with TGF-β, and the effects of SFXN3 knockdown and overexpression on cellular ferroptosis, EMT, and fibrosis were studied. Results We found that EMT-related molecules were significantly upregulated in BA patients. In addition, RT-PCR and Western blot experiments on liver of BA mice also revealed significant activation of fibrosis and EMT-related molecules In terms of mechanism, we found that SFXN3 was significantly upregulated in the fibrotic liver of patients (IDDF2024-ABS-0285 Figure 1). And it is positively correlated with the degree of fibrosis, EMT and clinical assay index. We discovered through colocalization that SFXN3 is localized to the biliary epithelial cells (IDDF2024-ABS-0285 Figure 2). Mechanically, we found that nuclear receptor coactivator NCOA4, a master regulator of ferritin phagocytosis, significantly activates and degrades ferritin during EMT, thereby releasing large amounts of ferrous, further leading to SFXN3-dependent mitochondrial iron overload. Conversely, knockdown of NCOA4 or SFXN3 with small interfering RNAs could effectively ameliorate ferroptotic cell death, cellular or mitochondrial iron overload and lipid peroxides accumulation (IDDF2024-ABS-0285 Figure 3). Conclusions Overall, our findings underscore that ferritinophagy activation and SFXN3-dependent mitochondrial iron overload play critical roles in ferroptosis and EMT in biliary atresia.

Importance:Type D esophageal atresia (EA) with tracheoesophageal fistula (TEF) is characterized by EA with both proximal and distal TEFs. It is a rare congenital anomaly with a very low incidence. Objective:To investigate diagnostic and treatment strategies for this rare condition. Methods:We retrospectively reviewed the clinicopathological features of patients with EA/TEF treated at our institution between January 2007 and September 2021. Results:Among 386 patients with EA/TEF, 14 (3.6%) had type D EA/TEF. Only two patients were diagnosed with proximal TEF preoperatively. Seven patients were diagnosed intraoperatively. Five patients were missed for diagnosis during the initial surgery but was later confirmed by bronchoscopy. During the neonatal period, seven patients underwent a one-stage repair of proximal and distal TEF via thoracoscopy or thoracotomy. Due to missed diagnosis and other reasons, the other 7 patients underwent two-stage surgery for repair of the proximal TEF, including cervical incision and thoracoscopy. Ten of the 14 patients experienced postoperative complications including anastomotic leakage, pneumothorax, esophageal stricture, and recurrence. Patients who underwent one-stage repair of distal and proximal TEF during the neonatal period showed a higher incidence of anastomotic leak (4/7). In contrast, only one of seven patients with two-stage repair of the proximal TEF developed an anastomotic leak. Interpretation:Type D EA/TEF is a rare condition, and proximal TEFs are easily missed. Bronchoscopy may aim to diagnose and determine the correct surgical approach. A cervical approach may be more suitable for repairing the proximal TEF.

Recurrent tracheoesophageal fistula (rTEF) is a rare complication following initial esophageal atresia (EA) surgical repair, posing challenges in localization the fistula during surgery due to severe thoracic adhesions and structural ambiguity from previous operations. We introduced two new localization methods for rTEF patients during surgery and aimed to compare the impact of using these localization techniques versus not using them on the surgical outcomes for rTEF patients. We retrospectively analyzed the clinical data of rTEF cases that underwent thoracoscopic repair at our hospital from September 2017 to December 2024. Patients were divided into localization group and non-localization group based on whether using intraoperative localization techniques, and comparative analysis of clinical variables was conducted between groups. A total of 106 patients were included in this study, undergoing a total of 113 thoracoscopic rTEF repair surgeries at our center. Their fistula type included 89 cases of tracheoesophageal fistula (TEF), 19 cases of esophageal-pulmonary fistula (EPF), 3 cases of esophageal bronchial fistula (EBF), and 2 cases of combined EPF and TEF. All cases were categorized based on whether using localization techniques, resulting in the localization group (n = 52) and the non-localization group (n = 61). The median operation time in the localization group (2.5 h) was significantly lower than in the latter (3.0 h) (P = 0.001), and regardless of the fistula type being TEF or EPF. Additionally, the average postoperative hospital stay was significantly shorter in the localization group (17.7 ± 7.5 days) than in the non-localization group (23.6 ± 20.0 days) regarding the fistula type of TEF (P = 0.03). The use of localization techniques in thoracoscopic surgery for rTEF leads to better outcomes, evidenced by reduced operation time and hospital stay, suggesting enhanced surgical accuracy and improved patient postoperative recovery. LEVEL III.

OBJECTIVE:To develop a machine learning diagnostic model based on MMP7 and other serological testing indicators for early and efficient diagnosis of biliary atresia (BA). METHODS:A retrospective analysis was conducted on patient information from those hospitalized for pathological jaundice at Beijing Children's Hospital between January 1, 2019, and December 31, 2023. Patients with serum MMP7, liver stiffness measurements, and other routine serological tests were included in the study. Six machine learning models were constructed, including logistic regression (LR), random forest (RF), decision tree (DET), support vector machine classifier (SVC), neural network (MLP), and extreme gradient boosting (XGBoost), to diagnose BA. The area under the receiver operating characteristic curve was used to evaluate the diagnostic efficacy of the various models. RESULTS:A total of 98 patients were included in the study, comprising 64 BA patients and 34 patients with other cholestatic liver diseases. Among the six machine learning models, the XGBoost algorithm model and RF algorithm model achieved the best predictive performance, with an AUROC of nearly 100% in both the training and validation sets. In the training set, these two algorithm models achieved an accuracy, precision, recall, F1 score, and AUROC of 1. Through model interpretation analysis, serum MMP7 levels, serum GGT levels, and acholic stools were identified as the most important indicators for diagnosing BA. The nomogram constructed based on the XGBoost algorithm model also demonstrated convenient and efficient diagnostic efficacy. CONCLUSION:Machine learning models, especially the XGBoost algorithm and RF algorithm models, constructed based on preoperative serum MMP7 and serological tests can diagnose BA more efficiently and accurately. The most important influencing factors for diagnosis are serum MMP7, serum GGT, and acholic stools.

Background Biliary atresia (BA) is the most common serious neonatal biliary disease, characterized by progressive biliary inflammation and fibrosis. We aim to comprehensively and systematically investigate the complex pathological process of BA from multiple molecular dimensions, combining transcriptomics, proteomics, metabolomics, and single-cell RNA sequencing. Methods Transcriptomic, proteomic, and metabolomic techniques were utilized for detecting and integrating the molecular characteristics of BA liver tissues. By combining single-cell RNA sequencing data, we were able to pinpoint the immune cells regulated by the abnormal metabolite in BA. In vitro experiments were detected to reveal the role and mechanism of the abnormal metabolite signaling pathway in the progression of BA. In vivo, the effect of inhibiting abnormal signaling pathway on alleviating bile duct injury and fibrosis was verified in the rotavirus type A (RRV) induced mouse model. Results We found the aberrant regulation and activation of the sphingolipid metabolism pathway was observed in BA by transcriptomic, proteomic, and metabolomic data analysis. By integrating BA single-cell RNA sequencing data, we found that Sphingosine-1-Phosphate Receptor 4 (S1PR4), a receptor of Sphingosine-1-Phosphate signaling, was primarily expressed in CX3CR1+CD8+ effector T (Teff) cells. In vitro experiments demonstrated that S1P promoted the migration of CX3CR1+CD8+Teff cells, and S1P/S1PR4 signaling facilitated the differentiation of CX3CR1+CD8+Teff cells into CD8+ tissue-resident memory T (TRM) cells. Co-culture of CD8+TRM cells could induce apoptosis of cholangiocytes. In the RRV mouse model, S1PR4 inhibitor could alleviate liver inflammation and fibrosis by inhibiting the accumulation of CD8+TRM cells (IDDF2024-ABS-0207 Figure 1. S1P S1PR4 promotes the differentiation of CD8 TRM cells aggravating bile duct injury in biliary atresia). Conclusions This study used multi-omics data integration to reveal aberrant regulation of the sphingolipid metabolism pathway in BA. The activated S1P/S1PR4 signaling pathway in BA liver recruited CX3CR1+CD8+Teff cells to accumulate around the cholangiocytes. S1P/S1PR4 signaling promoted the differentiation of CX3CR1+CD8+Teff cells into CD8+TRM cells, subsequently triggering apoptosis and injury of cholangiocytes, thus exacerbating the progression of BA. Targeting S1P/S1PR4 signaling activation is a promising therapeutic strategy for BA treatment.

Cholestatic liver diseases (CLD) are characterized by impaired normal bile flow, culminating in excessive accumulation of toxic bile acids. The majority of patients with CLD ultimately progress to liver cirrhosis and hepatic failure, necessitating liver transplantation due to the lack of effective treatment. Recent investigations have underscored the pivotal role of the gut microbiota-bile acid axis in the progression of hepatic fibrosis via various pathways. The obstruction of bile drainage can induce gut microbiota dysbiosis and disrupt the intestinal mucosal barrier, leading to bacteria translocation. The microbial translocation activates the immune response and promotes liver fibrosis progression. The identification of therapeutic targets for modulating the gut microbiota-bile acid axis represents a promising strategy to ameliorate or perhaps reverse liver fibrosis in CLD. This review focuses on the mechanisms in the gut microbiota-bile acids axis in CLD and highlights potential therapeutic targets, aiming to lay a foundation for innovative treatment approaches.

Background Biliary atresia (BA) is a severe neonatal hepatobiliary disease that leads to progressive liver fibrosis and liver failure. Hepatic stellate cells (HSCs) have been identified as the main contributors to liver fibrogenesis, with their activation playing a crucial role in fibrosis development. Yiqihuoxue prescription (YQHX), a traditional herbal formula, has demonstrated effective anti-fibrotic properties in multiple hepatic diseases. This study aims to investigate the function and underlying mechanisms of YQHX in HSCs activation and liver fibrogenesis in BA. Methods We conducted a series of experiments using rhesus-rotavirus (RRV)-induced BA mice model and cultured HSCs. Neonatal mice were intraperitoneally injected with RRV within 12 hours of birth. Starting from day five, YQHX group received YQHX by oral gavage daily for 9 days. Pups were sacrificed on day 14 for tissue collection and analysis, and serum was collected to measure liver function. H&E and Masson's trichrome staining were performed for the examination of histological changes. A fibrosis model was established by inducing HSCs activation with tgfβ, and the effects of YQHX on cellular ferroptosis and fibrosis were investigated. UPLC-HRMS was utilized to identify the chemical components in YQHX, and molecular docking analysis was performed between them and NCOA4. Results We found that YQHX ameliorates hepatic injury and fibrosis in the RRV-induced BA mice model (IDDF2024-ABS-0308 Figure 1). In vitro experiments demonstrate that YQHX inhibits HSCs activation by suppressing their proliferation/migration and promoting apoptosis (IDDF2024-ABS-0308 Figure 2), which also occurs in the tgfβ-induced HSCs activation model (IDDF2024-ABS-0308 Figure 3, IDDF2024-ABS-0308 Figure 4). Mechanistically, we found that seven of the top ten compounds in YQHX exhibited molecular docking with NCOA4, a major regulator of ferritinophagy, thereby reducing the release of ferrous iron. We observed a decrease in NCOA4 expression with increasing YQHX concentration.YQHX enhanced the inhibition of activated HSCs after the knockdown of NCOA4 with lentivirus. Consequently, YQHX improved cellular iron overload and oxidative stress by inhibiting the expression of NCOA4, thereby suppressing the activation of HSCs (IDDF2024-ABS-0308 Figure 5). Conclusions YQHX can ameliorate hepatic fibrosis by targeting NCOA4 to induce the ferritinophagy of activated HSCs, providing a promising therapeutic strategy for hepatic fibrosis in BA.

BackgroundBiliary atresia (BA) is the most common form of severe neonatal obstructive jaundice. The etiology and pathogenesis of BA are multifactorial, and different factors may interact to produce heterogeneous pathological features and clinical outcomes. Despite different pathological features, all patients received the same treatment strategy. This study performed integrative clustering analysis based on multiple high-throughput datasets to identify the molecular subtypes of BA and provide a new treatment strategy for personalized treatment of the different subtypes of BA.MethodsThe RNA sequence dataset GSE122340 in the Gene Expression Omnibus (GEO) database was downloaded; 31 BA and 20 control normal liver tissues were collected at our center for transcriptome sequencing, and clinical and follow-up data of BA patients were available. Molecular subtypes were identified using integrated unsupervised cluster analysis involving gene expression, biliary fibrosis, and immune enrichment scores based on the transcriptome dataset, and the results were validated using independent datasets.ResultsBased on the results of the integrated unsupervised clustering analysis, four molecular subtypes were identified: autoimmune, inflammatory, virus infection-related, and oxidative stress. The autoimmune subtype with a moderate prognosis was dominated by autoimmune responses and morphogenesis, such as the Fc-gamma receptor and Wnt signaling pathway. The biological process of the inflammatory subtype was mainly the inflammatory response, with the best prognosis, youngest age at surgery, and lowest liver stiffness. The virus infection-related subtype had the worst prognosis and was enriched for a variety of biological processes such as viral infection, immunity, anatomical morphogenesis, and epithelial mesenchymal transition. The oxidative stress subtype was characterized by the activation of oxidative stress and various metabolic pathways and had a poor prognosis. The above results were verified independently in the validation sets.ConclusionsThis study identified four molecular subtypes of BA with distinct prognosis and biological processes. According to the pathological characteristics of the different subtypes, individualized perioperative and preoperative treatment may be a new strategy to improve the prognosis of BA.

Laryngeal squamous cell carcinoma (LSCC) is the most common and prevalent malignant tumor in head and neck squamous cell carcinoma. Recent studies have shown that circular RNAs (circRNAs) play a vital role in cancer development, but their specific role in the tumorigenesis and development of LSCC remains unclear. We selected five pairs of LSCC tumor tissues and paracancerous tissues for RNA sequencing. Reverse transcription-quantitative PCR (RT-qPCR), Sanger sequencing, and fluorescence in situ hybridization were utilized to study the expression, localization, and clinical significance of circTRIO in LSCC tissues, and TU212 and TU686 cell lines. Furthermore, cell counting Kit-8, colony-forming assay, Transwell, and flow cytometry assays were assessed to illustrate the crucial role played by the circTRIO in proliferation, colony-forming ability, migration, and apoptosis in LSCC cells. Finally, the molecule's role as a microRNA (miRNA) sponge was analyzed. In the results, we screened out a promising upregulated novel circRNA-circTRIO in LSCC tumor tissues compared with paracancerous tissues using RNA sequencing. Then, we used qPCR to evaluate the expression of circTRIO in 20 additional paired LSCC tissues and two cells, and the results showed that circTRIO was highly expressed in LSCC and that this high expression was closely related to the malignant progression of LSCC. Furthermore, we examined circTRIO expression in the Gene Expression Omnibus data sets GSE142083 and GSE27020, and circTRIO expression was considerably higher in tumor tissues compared with the adjacent tissues. Kaplan-Meier survival analysis showed that the expression of circTRIO was associated with worse disease-free survival. The Gene Set Enrichment Analysis biological pathway evaluation results demonstrated that circTRIO was mainly enriched in cancer pathways. Moreover, we confirmed that silencing circTRIOs can help to significantly inhibit LSCC cell proliferation and migration while triggering apoptosis. Upregulated circTRIO expression levels may play an important role in the tumorigenesis and development of LSCC.

Background: Intraoperative cholangiography (IOC) has been the gold standard for diagnosing biliary atresia (BA). Our study attempted to diagnose BA using laparoscopic fluorescein cholangiography (LFC).Methods: We retrospectively included 18 patients with preoperative suspected BA as the case group and 4 without extrahepatic biliary obstruction requiring laparoscopic surgery as the control group. All patients received indocyanine green (ICG) intravenously at 0.05 mg/Kg. The first 6 patients in the case group underwent IOC and LFC simultaneously, and the control group completed LFC. The imaging characteristics of LFC were recorded and summarized by the conventional and fluorescence mode of the endoscopic fluorescence imaging system (DPM-ENDOCAM-03). On this basis, 12 patients in the case group were diagnosed as BA according to LFC without IOC, and all 18 patients completed open Kasai surgery to confirm the diagnosis.Results: Laparoscopic fluorescence mode in BA detected liver fluorescence but no visualization of the extrahepatic bile ducts. However, the extrahepatic bile ducts in the control group were visible. Based on the imaging char-acteristics summarized from the LFC of the first 6 cases with BA in the case group, the remaining 12 cases who only underwent LFC were also successfully diagnosed with BA. Furthermore, the formation of hepatic hilar fibrous mass was found in all the patients during the open Kasai procedure, which confirmed the BA diagnosis.Conclusions: LFC appears as a specific pattern in BA and may be used for intraoperative diagnosis of BA. It has the advantages of simplicity, short time-consuming, and no radiation damage.

Clinical phenotypes and gene characteristics of a patient diagnosed with Mowat-Wilson syndrome (MWS) with Hirschsprung′s disease (HSCR) and vaginal atresia in the Department of Neonatal Surgery, Beijing Children′s Hospital, Capital Medical University in March 2021 were analyzed retrospectively.The eight-month-old girl was admitted to the hospital with symptoms of constipation for nine days and abdominal distension for two days.Lower digestive tract radiography and rectal mucosa biopsy results suggested HSCR.The child also had specific facial features and motor development delay.Whole exome test showed a de novo heterozygous mutation, ZEB2 gene c. 2761C>T (p.R921*). After laparoscopic-assisted Soave procedure, the child had normal bowel movements, and no surgery-related compli-cations occurred during the follow-up period.The child′s motor development improved after rehabilitation treatment.According to literature review, 2 female cases show similar clinical manifestations to this girl, but the genotypes were different.This patient expands the clinical phenotype of ZEB2 gene pathogenicity.

BACKGROUND:A duodenal web refers to partial or complete obstruction of the duodenum due to a membranous web. When looking at the serosal side of the intestine during duodenal web excision, especially during laparoscopic surgery, determining the web origin might be challenging. This study aimed to determine the efficacy of intraduodenum indocyanine green injection and near-infrared light during laparoscopic surgery in enhancing the ability to identify duodenal web localization.METHODS:We used intraduodenum indocyanine green injection to unequivocally recognize the duodenal web and facilitate laparoscopic excision. The clinical analysis was based on a male neonatal case with duodenal web admitted to our hospital. After the patient was placed in the supine position, 5 mL of ICG was injected via a 6-Fr nasogastric tube. The fluorescence was visualized in the white light and near-infrared light dual-mode of the camera system, localizing the duodenal precisely and in real-time.RESULTS:Laparoscopically, the duodenal web was accurately identified and removed with intraduodenum indocyanine green visualization under near-infrared light. The procedure was completed successfully, and the patient showed good postoperative outcomes.CONCLUSIONS:Intraduodenum indocyanine green injection during laparoscopic surgery is a feasible adjuvant for duodenal web localization, showing improvements in terms of outcomes compared to previous methods of determining the duodenal web location.

BackgroundBiliary atresia (BA) is the most common cholestatic liver disease in neonates. Herein, we aimed at characterizing the gut microbiota and fecal bile acid profiles of BA patients, defining the correlations between them, and evaluating the relationship between the clinical pathogenesis and changes in the gut microbiota and bile acid profiles.MethodsA total of 84 fecal samples from BA patients (n = 46) and matched healthy controls (HCs, n = 38) were subjected to sequencing by 16S rRNA gene amplification, and fecal bile acid were analyzed by targeted metabolomics.FindingsCompared with the controls, a structural separation of the intestinal flora of BA patients was uncovered, which was accompanied by changes in the composition of fecal bile acids. In the BA group, Actinobacillus, Monoglobus, and Agathobacter were enriched in patients without cholangitis (p < 0.05). Selenomonadaceae and Megamonas were more abundant in patients without recurrent cholangitis episodes (p < 0.05), while Lachnospiraceae and Ruminococcaceae were enriched in patients with multiple recurrences of cholangitis (p < 0.05). Postoperative jaundice clearance was associated with Campylobacter and Rikenellaceae (p < 0.05), and tauroursodeoxycholic acid was associated with jaundice clearance (p < 0.001).ConclusionBA patients are characterized by different compositions of gut microbiota and bile acids, and their interaction is involved in the process of liver damage in BA, which may be closely related to the occurrence of postoperative cholangitis and jaundice clearance.

PURPOSE:We aim to share our experience of esophageal elongation by bougienage and delayed primary thoracoscopic anastomosis for pure esophageal atresia (EA) without tracheoesophageal fistula (TEF).METHODS:Fifteen patients with pure EA treated with delayed primary thoracoscopic anastomosis combined with or without esophageal elongation by bougienage were retrospectively analyzed.RESULTS:Four patients were managed without bougienage, and their surgical repair was performed thoracoscopically after natural esophageal growth. Among the remaining 11 patients, the average tension-free distance before elongation was 5 (4.5-6) vertebral bodies, and the mean age at the start and end of the bougienage period was 123 (63-280) days and 173 (106-350) days, respectively, with an average duration of 50 (29-82) days. The average age at the definitive operation in this series was 184 (107-385) days, with a mean operative duration of 186 (95-300) min. Neither anastomotic leakage nor TEF occurred, and oral feeding was partially or completely established in 13 patients during hospitalization. Among all patients, one was lost to follow-up, and others were followed up with an average duration of 47.7 (9.8-97.1) months. All patients had different degrees of anastomosis stricture, and 8 patients had gastroesophageal reflux. Oral feeding was completely established in 12 patients; however, tube feeding was required in 2 patients.CONCLUSIONS:The management of pure EA is complicated and inconclusive. Esophageal elongation by bougienage and delayed primary thoracoscopic anastomosis for long-gap pure EA without TEF is safe and effective.

Background: Esophageal diverticulum (ED) is an extremely rare complication of congenital esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) surgery. We aimed to investigate feasible methods for the treatment of this rare complication.Methods: We retrospectively reviewed all patients with EA/TEF at Beijing Children's Hospital from January 2015 to September 2019. The clinicopathological features of patients with ED after EA/TEF surgery were recorded. Follow-up was routinely performed after surgery until December 2020.Results: Among 198 patients with EA/TEF, ED only occurred in four patients (2.02%; one male, three female). The four patients had varying complications after the initial operation, including anastomotic leakage (3/4), esophageal stenosis (3/4), and recurrence of TEF (1/4). The main clinical symptoms of ED included recurrent pneumonia (4/4), coughing (4/4), and dysphagia (3/4). All ED cases occurred near the esophageal anastomosis. Patients' age at the time of diverticulum repair was 6.6–16.8 months. All patients underwent thoracoscopic esophageal diverticulectomy (operation time: 1.5–3.5 h). Anastomotic leakage occurred in one patient and spontaneously healed after 2 weeks. The other three patients had no peri-operative complications. All patients were routinely followed up after surgery for 14–36 months. During the follow-up period, all patients could eat orally, had good growth and weight gain, and showed no ED recurrence or anastomotic leakage on esophagogram.Conclusions: ED is a rare complication after EA/TEF surgery and is a clear indication for diverticulectomy. During the midterm follow-up, thoracoscopic esophageal diverticulectomy was safe and effective for ED after EA/TEF surgery.

BACKGROUND:A number of studies have demonstrated the critical role of long non-coding RNA gastric cancer high expressed transcript 1 (GHET1) in many cancers. This meta-analysis provides an evidence-based evaluation of the prognostic role of GHET1 in cancer.MATERIALS AND METHODS:Literature searches were conducted in several databases including Medline, Cochrane, EMBASE, CNKI, and Wanfang. The pooled odds ratio (OR) and hazard ratio (HR) with 95% confidence interval (CI) were used to evaluate the role of GHET1 in cancer. The study protocol was registered at PROSPERO (ID: CRD42018111252).RESULTS:Sixteen studies, containing 1315 patients, were analyzed in this meta-analysis. The pooled results indicated that GHET1 overexpression was significantly associated with poor overall survival (OS) and disease-free survival (DFS) in cancer. Moreover, up-regulation of GHET1 expression predicted larger tumor size, positive lymph node metastasis, positive distant metastasis, and advanced TNM (tumor-node-metastases) stage in human cancers.CONCLUSION:There is a significant correlation between up-regulation of GHET1 and both poor prognosis and advanced clinicopathological cancer characteristics. GHET1 may be a potential prognostic predictor for human cancers.

Long intergenic non-coding RNA 1614 (LINC01614) is highly expressed in several malignant tumor types, suggesting that it may act as an oncogene. However, the specific roles of LINC01614 in malignant tumors have remained elusive. To examine the expression pattern of LINC01614 in various malignancies, a comprehensive pan-cancer analysis was performed using public databases, including 53 normal tissue types and 32 cancer datasets with samples from 9,091 patients. The results were validated using reverse transcription-quantitative PCR analysis of tissue specimens from patients. LINC01614 expression was upregulated in most malignant tumors, thus demonstrating diagnostic potential. Furthermore, upregulation of LINC01614 was associated with poor overall survival in the majority of cases. However, the association with clinical outcome was highly cancer-dependent; LINC01614 appeared to be an oncogene and diagnostic/prognostic biomarker in cancers of the digestive, respiratory, nervous and endocrine systems, as well as breast and head and neck cancer, but not in the cancers of the reproductive system or some of the urinary system. High LINC01614 expression was also markedly associated with the epithelial-mesenchymal transition (EMT) and associated signaling pathways. Overall, the present results suggest that LINC01614 is an EMT-associated oncogene that influences the metastasis and prognosis of several cancers, thus highlighting its potential as a novel diagnostic and prognostic marker.

BackgroundMyxoid liposarcoma has a distinct migration aptitude; however, pancreatic metastasis is rare.Case presentationWe report on the case of a 40-year-old female patient who suffered solitary pancreatic metastasis of myxoid liposarcoma and had a right thigh myxoid liposarcoma radical resection 5 years ago. The patient underwent a medial pancreatectomy and pancreaticojejunostomy for solitary pancreatic metastasis of myxoid liposarcoma. After 12months of disease-free survival, the patient underwent an extended radical resection for the recurrence of the right thigh primary myxoid liposarcoma and received postoperative radiotherapy. Currently, the disease-free survival time after the last operation has been 22months.ConclusionsWe reviewed the relevant literature and suggest that radical surgery might result in a good prognosis for patients with solitary pancreatic metastasis of myxoid liposarcoma.