The purpose of this search was to evaluate the clinical significance of the MRI-based vertebral bone quality (VBQ) score for assessment of bone quality. We searched all published articles regarding the clinical impact of VBQ score in Embase, Cochrane library, and PubMed before June 1st, 2023. The calculational method of VBQ has gradually been standardized. The association between the VBQ score and bone mineral density (BMD) is well established, and the VBQ score is verified to assess the bone condition. The quantitative computed tomography (QCT) BMD as the gold standard to determine the diagnostic threshold of the VBQ score is recommended. Moreover, the VBQ score is a good predictor for some osteoporosis-related postoperative complications. However, there are still some influential factors for the VBQ score that have not fully understood. VBQ score is a simple and reproducible method to assess bone quality that can be achieved on the lumbar MRI. Preoperative VBQ score can predict some osteoporosis-related postoperative complications precisely. However, the diagnostic threshold value VBQ score and the effect of influential factors on the VBQ score may need to be further explored in the future.

Background:: Uncontrolled inflammation plays an important role in the initiation and progression of tumors. The repeated circulation and continuous stimulation of gallbladder epithelium caused by gallstones is an important risk factor for gallbladder cancer. Methods:: To study pathogenesis, samples were collected for chronic cholecystitis caused by gallstones and early and advanced gallbladder cancer with gallstones and subjected to RNA-seq analysis. Gene Ontology and Kyoto Gene and Genome Encyclopedia analyses were used to elucidate the protein–protein interaction network and identify differentially expressed genes. Results:: Nine potential molecular markers, VTN, CHAD, AKR1C4, ABCC2, AOX1, ADH1A, ADH1C, PLA2G2A, and CYP4F3, with elevated expression gradients in cholecystitis and early and advanced gallbladder cancer, were identified. Using qPCR and immunohistochemistry on clinical tissues, we confirmed three factors, VTN, CYP4F3, and AOX1, to be worthy of further research. To demonstrate that these three genes are potential molecular markers for gallbladder cancer, their cellular biological functions were confirmed in gallbladder cancer cell lines through siRNA transfection. Conclusion:: The potential molecular markers CYP4F3, VTN, and AOX1 for cholecystitis and different stages of gallbladder cancer were identified. Further studies on differentially expressed genes vital in gallbladder cancer progression can help provide potential targets for the early diagnosis and treatment of gallbladder cancer.

Background/Aims: Studies have shown the significance of long non-coding RNAs (lncRNAs) in the development of malignant tumors, including cholangiocarcinoma (CCA). However, the molecular mechanisms through which the lncRNA SNHG3 contributes to CCA development remain unknown. Therefore, the purpose of this work was to investigate SNHG3’s role and possible processes in CCA. Materials and Methods: CCK-8, TUNEL, wound healing, and transwell assays were performed to evaluate the viability, apoptosis, migration, and invasion of CCA cells, respectively. Dual-luciferase reporter and RNA pull-down assays were conducted to verify the relationship between SNHG3 and miR-151a-3p and that between STAT5a and miR-151a-3p. Results: SNHG3 and STAT5a were considerably upregulated and miR-151a-3p was downregulated in CCA tissues and cells. SNHG3 knockdown suppressed the proliferation, apoptosis, migration, and invasive ability of HUCC-T1 cells. Mechanistically, SNHG3 directly targeted miR-151a-3p to promote the development of CCA. Treatment with a miR-151a-3p inhibitor reversed the effects of SNHG3 knockdown on the aggressive behavior of HUCC-T1 cells. Furthermore, STAT5a knockdown counteracted the effects of inhibition of SNHG3 and miR-151a-3p on the aggressive behavior of CAA. Conclusion: SNHG3 promotes CCA progression via the miR-151a-3p/STAT5a axis, providing novel insights into the clinical treatment of CCA.

The study aims to investigate the correlations between the T score, Hounsfield units (HU) value, and vertebral bone quality (VBQ) score, and to compare their discrimination capability for patients with osteoporotic vertebral compression fracture (OVCF). One hundred and sixty-three eligible participants were enrolled (49 OVCF group,114 non-OVCF group). The T score, HU value, and VBQ score were collected retrospectively. Then, those three parameters were compared between the OVCF and non-OVCF groups and the correlations among the three were assessed. Finally, the discrimination capability of those parameters was compared by the receiver operating characteristic (ROC) curves. The OVCF group showed a lower T score, lower HU value, and higher VBQ score (all P < 0.001) than the non-OVCF group. Correlations were observed among the T score, HU value, and VBQ score (all P < 0.001, HU VS. mean T score, r = 0.66; HU VS. minimum T score, r = 0.67; VBQ VS. mean/ minimum T score, r=-0.33; VBQ VS. HU, r=-0.45). The HU value indicated the maximum area under curve (AUC), followed by the VBQ score and then the T score. Moreover, the AUC of combining the VBQ score and the HU value was similar to that of the HU value. Both the HU value and the VBQ score had superior discrimination capability for patients with OVCF compared to the T score, especially for the HU value. For patients with routinely performed lumbar MRI or CT scans, the HU value or the VBQ score may provide alternative options for assessing the bone condition.

Compared with the healthy patients, patients with osteoporosis had a lower Hounsfield unit (HU) value and a higher vertebral bone quality (VBQ) score. Both the HU value and VBQ score can simply distinguish patients with osteoporosis (OP), with a cutoff value of HU value < 97.06 and VBQ score > 3.08. INTRODUCTION:The purpose of this study is to determine whether the opportunistic use of computed tomography (CT) or magnetic resonance imaging (MRI) is effective for identifying spine surgical patients with OP. METHODS:We retrospectively evaluated 109 lumbar spine surgery patients who received lumbar quantitative CT (QCT) and MRI. Using the area under the curve, the CT-based HU value and MRI-based VBQ score were calculated. Then, based on the QCT results, receiver operating characteristic (ROC) curves were constructed to determine the diagnostic performance of the HU value and VBQ score. RESULTS:The HU value was significantly lower in the OP group, and the VBQ score was significantly higher in the OP group. Using the area under the curve, the diagnostic performance of the HU value and VBQ score for OP were 0.959 and 0.880, respectively. The diagnostic threshold values determined with optimal sensitivity and specificity were an HU value of 97.06 and a VBQ score of 3.08. CONCLUSION:Opportunistic use of CT and MRI can simply distinguish patients with OP, which are expected to be potential alternatives to T-score for the osteoporosis screening.

The current treatment for osteosarcoma (OS) is based on surgery combined with systemic chemotherapy, however, gene therapy has been hypothesized to improve patient survival rates. The density-enhanced protein domain 1 protein (DEPDC1) functions as a crucial determinant in the advancement of OS, which is highly expressed in OS cells. The current study was designed to delve into the effect and mechanism of DEPDC1 and phosphotyrosine-picked threonine tyrosine kinase (TTK) in OS. The expression of DEPDC1 and TTK in OS cells was detected by western blotting. Furthermore, the assessment of glycolysis encompassed the quantification of extracellular acidification rate, glucose uptake rate, lactate concentration, and the expression of glucose transporter 1, hexokinase 2, and pyruvate kinase M2. Finally, the functions of DEPDC1 and TTK in autophagy and ras-extracellular signal-regulated kinase signaling were determined by western blotting after interfering with DEPDC1 in SaOS-2 cells. The results revealed that DEPDC1 and TTK were upregulated in OS cell lines and interfering with DEPDC1 inhibited glycolysis and autophagy in OS cells. Furthermore, the STRING database suggested that DEPDC1 and TTK perform targeted binding. Notably, the results of the present study revealed that DEPDC1 upregulated RAS expression through TTK and enhanced ERK activity, thereby affecting glycolysis and autophagy in OS cells. Collectively, the present investigation demonstrated that DEPDC1 affected autophagy-dependent glycolysis levels of OS cells by regulating RAS/ERK signaling through TTK.

Dear Editor, With great interest, we read the article by Liu et al.1 who performed a retrospective cohort study to compare the safety and feasibility of robotic pancreaticoduodenectomy (PD) in elderly and younger patients. They concluded that robotic PD was safe and feasible in elderly patients and suggested that elderly patients with careful patient selection should be considered for robotic PD. Here are some queries we have for the authors. First, no new adjuvant therapies such as chemotherapy, radiotherapy, or postoperative adjuvant are found in the excluded criteria for the patients with malignant tumors especially for borderline-resectable or locally advanced pancreatic ductal adenocarcinoma, while we find pancreatic ductal adenocarcinoma accounts for the commonest indication in the two groups in the article (35.1% in the elder group, 30.2% in the younger group). Selection of new adjuvant therapy exhibited fewer postoperative pancreatic fistula and postoperative hemorrhage but increased incidence of delayed gastric emptying compared with patients treated with upfront surgery2. To some extent, the accuracy of the results, particularly postoperative complications, was impacted by the absence of this component. Second, we noticed that the preoperative jaundice rate was 71.4 and 62.4% in the elderly and younger groups of patients, respectively. In recent years, there has always been discussion on whether preoperative biliary draining (PBD) should be carried out prior to PD. Gong3 revealed that the morbidity, postoperative pancreatic fistula, and infection rate in patients with PBD were significantly higher than those in patients without it. Other surgeons suggested performing PBD in patients with malignant biliary obstruction before PD, and they found PBD did not affect the incidence of postoperative complications nor did it affect postoperative survival4. These articles demonstrate that PBD has a considerable effect on postoperative complications and patient survival, but we were unable to locate any pertinent information within this study. Finally, resections of the portal vein or superior mesenteric vein with PD were performed in some cases in this study, but we did not find any data about them in the results and discussion sections. More and more centers are performing PD with vein resection, but there are still different opinions about the technique. Some studies showed higher rates of complications such as biliary fistula, delayed gastric emptying, cardiopulmonary abnormalities, hemorrhage, 30-day mortality in the group of vein resection5. Others demonstrated no significant difference in perioperative risk between PD and PD with vein resection6. Without this part, will the reliability and integrity of the results be comprised? Further reasonable concerns should be taken into account for next-step utility. Ethical approval It is not necessary. Sources of funding Basic research projects in Yunnan Province (joint special project of Science and Technology Department-Kunming Medical University). Author contribution All authors equally contributed to the analysis and writing of the manuscript. Conflicts of interest disclosure None. Guarantor Xiaoping Wei, MD-PhD, Department of HPB Surgery, The Second Affiliated Hospital of Kunming Medical University, E-mail: [email protected].

aDepartment of general surgery, the first affiliated hospital of Kunming Medical University, Kunming, Yunnan, China bDepartment of HPB surgery, the second affiliated hospital of Kunming Medical University, Kunming, Yunnan, China Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. Published online ■ ■ *Corresponding author. Address: Department of HPB surgery The second affiliated hospital of Kunming Medical University 374 Burma Road, Kunming, Yunnan,China, 650101, Fax:86 87165351281, Phone: 86 13888990023. E-mail address: [email protected] (X. Wei). This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. http://creativecommons.org/licenses/by-nc-sa/4.0/

ObjectiveTo study the role of indocyanine green （ICG） fluorescence imaging in biliary tract recognition during laparoscopic difficult biliary tract surgery. MethodsThe clinical data of 54 patients with laparoscopic difficult biliary surgery admitted to The Second Affiliated Hospital of Kunming Medical University from August 2019 to August 2022 were retrospectively collected. All patients had extrahepatic bile duct stones and had a history of upper abdominal surgery. Among them, 25 patients underwent ICG fluorescence imaging surgery （fluorescence imaging group） and 29 patients underwent conventional laparoscopic surgery （conventional surgery group）. The intraoperative and postoperative conditions of two groups were compared. ResultsCompared with the conventional surgery group, the operation time ［（110.68±19.03）min vs（147.83±28.59）min］, the time to find bile duct ［（30.92±9.72）min vs（56.52±18.84）min］, and the amount of bleeding ［（43.61±30.67）mL vs（87.93±15.67）mL）］ were significantly reduced （P＜0.05）, the time of exhaust, extubation, hospitalization and total cost of hospitalization were significantly reduced （P＜0.05） in the fluorescence imaging group. There was no statistically significant difference total complications rate between fluorescence imaging group and conventional surgery group （4.00% vs 27.59%, χ2=3.814, P＞0.05）. ConclusionICG fluorescence imaging technology can display the biliary system in real time during operation. Compared with conventional laparoscopic surgery, it can reduce the time to find bile ducts, reduce the amount of bleeding, shorten the operation time, improve the safety of surgery, and reduce the burden of patients. It has good clinical application value.

BACKGROUND:Visceral hemangiomatosis is a benign tumor (rarer than hemangioma) that has not been reported to occur in the pancreas, duodenum, or choledoch. It can be easily confused with other pancreatic tumors or choledocholithiasis. Herein, we describe a case of a child with pancreaticoduodenal and choledochal hemangiomatosis and the key characteristics for the accurate diagnosis of pancreatic tumors based on previous reports and our findings.CASE PRESENTATION:We report a case of a 2-year and 9-month-old child who presented with repeated and fluctuating jaundice for 3 months with a history of endoscopic stone removal in a local hospital, following the diagnosis of choledocholithiasis. An abdominal computed tomography revealed a previously undiagnosed pancreatic head tumor and celio-mesenteric trunk (a rare vascular variation). This was misdiagnosed as a pancreatic neuroendocrine tumor. Since the patient's parents refused FNA biopsy and insisted on surgery, pancreaticoduodenectomy was performed; however, postoperatively, the child was correctly diagnosed with pancreaticoduodenal and choledochal hemangiomatosis. Although the patient was in good condition and had gained 4 kg in weight 3 months postoperatively, pancreaticoduodenectomy could have been avoided if an accurate diagnosis had been established before or during the operation.CONCLUSION:Our report highlights the difficulty in diagnosing visceral hemangiomatosis. Radiologists, endoscopists, and surgeons should consider this possibility in cases of repeated and fluctuating jaundice that cannot be explained by choledocholithiasis alone.

PURPOSE:The removal of common bile duct stones (CBDS) is routinely performed as either a 1-stage or 2-stage procedure. Despite many developments in both methods, the optimal approach has not been established to date. This study aimed to investigate the value and short-term outcomes of hybrid laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) combined with intraoperative endoscopic nasobiliary drainage (IO-ENBD) after primary duct closure (PDC) and intraoperative cholangiography (IOC) in patients with concomitant gallbladder stones (GBS) and CBDS.MATERIALS AND METHODS:Forty-seven patients with GBS and CBDS who underwent LC and LCBDE, PDC with IO-ENBD, and IOC were retrospectively enrolled. Stone characteristics and removal, operative data, and postoperative outcomes were recorded and analyzed.RESULTS:A total of 46 (97.87%) procedures were completed without conversion to open surgery. The mean operating time was 127.15±8.36 minutes (range, 97 to 158 min). Three patients (6.38%) had residual stones during IOC but achieved 100% stone clearance eventually. Postoperative pancreatitis and bile leakage rates were 4.26% and 2.13%, respectively.CONCLUSION:A hybrid procedure combining LC and LCBDE, PDC with IO-ENBD, and IOC is safe and feasible for concomitant GBS and CBDS.

BACKGROUND Numerous deregulated long non-coding RNAs (lncRNAs) accompany the initiation and progression of carcinogenesis. The present study aimed to explore the prognostic significance of lncRNA-SNHG3 on intrahepatic cholangiocarcinoma (ICC) patients. METHODS LncRNA microarray assays were used to evaluate lncRNA expression profiling in three pairs of ICC tissues and adjacent non-tumorous tissues. RT-qPCR was performed to further validate the accuracy of the microarray results. RESULTS lncRNA microarray and RT-qPCR assays revealed that SNHG3 expression levels were significantly increased in ICC tissues compared to the adjacent non-tumor tissues. A high SNHG3 expression level was significantly correlated with shorter OS in ICC patients. A multivariate regression analysis discovered that SNHG3 could serve as an independent prognostic factor for predicting the OS of ICC patients. CONCLUSION We found SNHG3 to be an independent risk factor for predicting the prognosis of ICC. SNHG3 shows a strong promise in the development of novel therapeutic targets for the treatment of ICC.