Abstract:Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age and is closely associated with obesity. In recent years, the role of bariatric and metabolic surgery in improving obesity complicated with PCOS has gradually attracted attention. The Chinese Society of Thyroid and Metabolism Surgery, Chinese Society of Surgery, Chinese Medical Association, Chinese Society for Metabolic & Bariatric Surgery, Chinese College of Surgeons, Chinese Medical Doctor Association, Metabolic Disease Professional Committee of the Chinese Medical Education Association, and the National Key Laboratory of Reproductive Medicine and Offspring Health jointly developed this consensus based on the latest domestic and foreign guidelines, clinical research evidence, and expert opinions. In the consensus, the diagnostic criteria, preoperative evaluation, surgical indications, selection of surgical methods, perioperative management, and postoperative PCOS follow-up are recommended to provide standardized guidance for bariatric metabolic surgery for obese patients with PCOS.

Abstract:Intestinal obstruction is one of the most common and challenging acute abdominal conditions in general surgery, and its prevention and treatment have always been a key focus in clinical practice. The advent of ileus tubes has provided a new approach to the treatment, prevention, and auxiliary diagnosis of intestinal obstruction. It has significantly improved the success rate of non-surgical treatment and played an essential role in preventing recurrence and assisting in diagnosis. In recent years, with the widespread application of the ileus tubes, an increasing number of hospitals have begun using this treatment method. However, there are still considerable controversies regarding to the indications of ileus fubes, management of complications, efficacy evaluation, and the timing of surgical intervention. Given the lack of authoritative reference standards for the standardized use of ileus tubes and the absence of relevant guidelines or consensus to guide their clinical practice at home and abroad, experts in this field in our country have formed an editorial panel at the initiative of the Anorectal Physicians Branch of the Chinese Medical Doctor Association, and the Bowel Obstruction Branch of the Hunan Province Geriatric Society. Based on the latest evidence from clinical practice and relevant research findings, the expert panel developed the "Expert consensus on clinical application of ileus tubes in prevention and treatment of bowel obstruction." This consensus aims to provide guidance for physicians in general surgery, gastroenterology, interventional medicine, and related specialties, hoping to promote the standardized clinical application of ileus tubes in China.

Abstract:Incidental gallbladder cancer (IGC) is a type of gallbladder cancer identified during or after cholecystectomy for benign gallbladder diseases through intraoperative or postoperative pathological examination. Since gallbladder cancer often coexists with benign conditions such as gallstones and polyps, and routine abdominal ultrasound has limited sensitivity in early diagnosis, IGC accounts for more than two-thirds of all gallbladder cancer cases. To improve early diagnosis rates, high-risk patients should undergo high-resolution ultrasound after surgery, combined with the use of radiomics and molecular biomarkers to reduce misdiagnosis and missed diagnoses. Most IGC patients are diagnosed at early stages, with a high incidence of residual disease. Delayed radical surgery can effectively improve prognosis. However, for patients with locally advanced disease, radical surgery should not be performed indiscriminately, and conversion surgery may be a better option. The optimal timing for delayed radical surgery is within 2 to 8 weeks after the initial surgery, with specific timing based on the resolution of acute inflammation and the evaluation of tumor staging and metastasis. For patients with T1b and T2 stage cancer, liver segment IVb/V resection and lymph node dissection are recommended to ensure curative outcomes. The application of laparoscopic techniques in gallbladder cancer treatment is becoming increasingly widespread, with confirmed surgical safety and tumor control effects, leading to growing support for minimally invasive treatment among hepatobiliary surgeons. Additionally, indocyanine green-guided fluorescence laparoscopic technology allows for precise lymph node dissection and liver resection, reducing the risk of postoperative complications. In light of the complex anatomy in the hepatic hilum and hepatoduodenal ligament region in IGC patients, performing delayed radical surgery using the 3D laparoscopic PH approach (based on the portal vein and hepatic artery as the anatomical axis) helps prevent organ damage and tumor dissemination. This review summarizes the current surgical treatment of IGC and discusses the application of the PH approach in laparoscopic gallbladder cancer radical surgery.

Abstract:Gallbladder cancer is the most common malignant tumor of the biliary system, characterized by insidious growth, rapid progression, and skip metastasis. The 5-year overall survival rate is only 5%. Although targeted immunotherapies have emerged in recent years, they are still in the exploratory phase for the treatment of gallbladder cancer, and radical surgical resection remains the only potentially curative treatment. The main goal of surgery is to completely remove the tumor and perform systematic lymph node dissection to reduce the risk of recurrence. Thanks to advances in surgical techniques and continuous optimization of perioperative management, postoperative complications, and hospital mortality in patients undergoing extended radical surgery for gallbladder cancer have decreased. However, the complex mechanisms of gallbladder cancer spread and metastasis make it challenging to determine the optimal scope of surgical resection. Clinical guidelines from different countries and hepatobiliary surgery centers often vary on surgical options, especially regarding the reasonable extent of liver resection, the scope of lymph node dissection and its impact on prognosis, and whether routine extrahepatic bile duct resection should be performed. There remains significant controversy in these areas. Future extensive prospective cohort studies are still needed to provide more evidence-based medical data for the surgical treatment of gallbladder cancer. When designing a surgical plan, surgeons must consider preoperative examination results, intraoperative findings, and pathological evaluation of frozen sections. A balance must be struck between radical treatment and safety and effectiveness. The most appropriate surgical method for each patient should be chosen while also emphasizing establishing a multidisciplinary collaborative system. Based on accurate tumor staging, postoperative adjuvant therapies should be integrated to continue making progress in improving patient prognosis.

Abstract:Intrahepatic cholangiocarcinoma (ICC) typically has an insidious onset, and most patients have already progressed to advanced stages by the time of initial diagnosis, missing the opportunity for radical surgery. Surgical treatment is the main approach for ICC, but the high early recurrence rate after surgery and poor prognosis remain significant challenges. In recent years, there have been continuous breakthroughs in chemotherapy, immunotherapy, targeted therapy, and combination therapies for ICC, ushering in a new era for systemic treatment. With the improvement of treatment effects, conversion therapy, and neoadjuvant therapy have emerged as prominent topics of interest. However, with the deepening of clinical diagnosis and treatment practices, complex and unresolved issues have gradually emerged, triggering extensive discussions among scholars at home and abroad. Currently, there is no clear, standardized diagnostic and therapeutic process for conversion therapy and neoadjuvant therapy in the guidelines of the National Comprehensive Cancer Network or the Chinese Society of Clinical Oncology. This article aims to comprehensively review the latest progress in neoadjuvant and conversion therapy for ICC and deeply explore the controversial focuses therein, with the expectation of providing useful references for clinical practice and promoting the further development of this field.

Abstract:Biliary surgery has a long history, with biliary strictures being a common clinical issue in this field. These strictures primarily include benign strictures, malignant strictures, and biliary strictures of unknown etiology. The nature of the biliary stricture directly determines the treatment approach. For strictures that are difficult to characterize with CT and MRCP/MRI, endoscopic ultrasound, and related technologies are important tools for the diagnosis and treatment. The rise of technologies such as confocal laser endomicroscopy, optical coherence tomography, and next-generation sequencing has expanded the diagnostic and therapeutic options for biliary strictures. Furthermore, endoscopic surgeons or treatment teams who are proficient in both endoscopic techniques and surgical procedures have unique strengths when dealing with complex anatomical structures or resectable biliary tumors. Although significant advancements have been made in biliary surgery in recent years, particularly in endoscopic technology, surgical techniques, and diagnostic methods, several challenges still remain to be addressed. Here, the authors provide a review of the current status, advancements, and challenges in the endoscopic surgical treatment of biliary strictures, with the aim of offering insights for clinical practice.

Abstract:The difficult radical cure of intrahepatic bile duct stones is attributed to their tendency to leave residues and recur. Therefore, it is crucial to raise awareness of the importance of standardized treatment. The inability to perform true anatomical liver resection and effectively correct bile duct stenosis are the root causes of stone retention and recurrence. Precise and comprehensive preoperative assessment is the prerequisite for standardized treatment. Attention should be focused on evaluating the distribution of stones, biliary strictures, the function of the Oddi sphincter, as well as the anatomical variations of the hepatic artery, bile duct, and portal vein. Therefore, the author proposed the LHO classification and CRL classification to guide decision-making. High-quality and meticulous surgery is the core of standardized treatment. Timely and correct management of complications and standardized postoperative follow-up throughout the process are the guarantee and continuation of standardized treatment. By integrating various techniques such as perihilar surgical techniques, and strictly adhering to the "removing lesions, removing all stones, correcting strictures, and ensuring unobstructed drainage" principle, standardized treatment can improve the safety and effectiveness of the treatment of intrahepatic bile duct stones, reducing the stone retention and recurrence rates.

Abstract:Gallstones are the primary benign disease diagnosed and treated in biliary surgery. With the development of medical technology and the increasing awareness of health among the population, the detection rate of gallstones has been increasing annually, with the majority being asymptomatic or mild cases. Currently, the clinical treatment of gallstones mainly includes observation, conservative, or surgical treatment (laparoscopic cholecystectomy). However, there remains some controversy regarding the clinical management of these patients. For asymptomatic or mild gallstones, the main point of contention in both academic and clinical settings is how to determine the indications for cholecystectomy. This article reviews relevant literature from both domestic and international sources, addressing the controversies surrounding the clinical management of gallstones and the determination of indications for cholecystectomy, and elaborates on these issues from multiple perspectives.

Abstract:Intrahepatic cholangiocarcinoma (ICC) is a malignancy with an insidious onset and extremely high mortality, often resulting in the inability to perform radical surgery due to vascular invasion and metastasis. The middle hepatic vein (MHV), located adjacent to the left and right hepatic veins and the second hepatic hilum, is an essential component of the hepatic vascular system. Patients with ICC involving the MHV face significant treatment challenges, and there is considerable debate regarding the optimal treatment decisions. Conversion therapy has provided new hope for patients with initially unresectable ICC, particularly for those with MHV invasion, who have an urgent need for such treatment. This article combines relevant research findings and clinical experience of the authors' team to discuss several challenges in conversion therapy for ICC with MHV invasion, aiming to provide reference for the clinical management of these patients.

Abstract:Intrahepatic cholangiocarcinoma (ICC) is a highly aggressive liver malignancy characterized by a subtle onset and rapid progression. Most patients are diagnosed at advanced stages, making radical surgical resection impossible, and the overall prognosis is poor. The ability to convert initially unresectable ICC to resectable tumors through multimodal comprehensive treatment is significant for prolonging patient survival. In recent years, with the application of immunotherapy and targeted therapy in advanced ICC, as well as improvements in surgical techniques, radiation therapy, hepatic arterial infusion chemotherapy, and selective internal radiation therapy, along with updates in treatment strategies and concepts, some initially unresectable ICC tumors have become resectable following downstaging with various treatment modalities, which has brought new hope for improving conversion resection success rates and patient prognosis. However, conversion therapy for ICC still faces numerous challenges and controversies, including the lack of a recognized standard treatment regimen, limited overall conversion success rates, a lack of long-term follow-up data to demonstrate survival benefits after conversion resection, and unresolved issues such as whether patients who achieve clinical complete remission should undergo resection or be monitored. Given that most current studies on ICC conversion therapy are small-sample, retrospective studies or case reports, lacking high-level evidence from randomized controlled trials, and the majority of studies include various types of biliary tract cancers without considering the heterogeneity across different anatomical locations, the relevance of these findings for guiding ICC conversion treatment strategies is limited. There is an urgent need for high-quality, multi-center, large-sample, prospective clinical studies and basic research to explore optimal ICC translational therapy regimens with rapid efficacy, high objective response rates, and good safety profiles, identify patient populations with potential benefits from different treatments, and develop individualized treatment strategies to improve conversion success rates and ultimately enhance patient prognosis. This article reviews the progress in the conversion treatment of unresectable ICC, intending to provide a reference for clinical practice.

Abstract:Background and Amis Gallbladder cancer (GBC) is the most common malignant tumor of the biliary tract, accounting for approximately 80%-95% of biliary tract cancers. This type of tumor has a poor prognosis, and currently, there are no effective tools for evaluating the prognosis of GBC. Therefore, this study was performed to investigate the factors influencing the prognosis of GBC patients to provide a reference for clinical practice.Methods The clinical data and follow-up information from 160 GBC patients treated in the Hunan Provincial People's Hospital from January 2018 to January 2024 was retrospectively conducted. The clinicopathologic characteristics of GBC patients were analyzed. Kaplan-Meier and Log-rank tests were used to calculate and compare the differences in overall survival (OS) among GBC patients with different clinicopathologic characteristics and treatment methods. Multivariate analysis using Cox regression was performed to identify independent prognostic factors for GBC.Results Among the 160 patients, 113 were females and 47 were males. The median age of the patients was 62 years, with the main clinical manifestations being abdominal pain/distention (55.63%), jaundice (40.63%), appetite loss (30.62%), and weight loss (19.38%). Serum tumor markers, including CA19-9, CA125, CEA, and CA724, were elevated in 58.75%, 30.63%, 30.00%, and 20.63% of GBC patients, respectively. Clinical stage classification revealed that 139 patients (86.87%) had stage Ⅲ/Ⅳ disease, 132 patients (82.5%) had T3/T4 stage, 91 patients (56.87%) had N1/N2 stage, and 54 patients (33.75%) had M1 stage. The pathological type of GBC was predominantly adenocarcinoma (92.50%), with the majority classified as moderately differentiated (19.38%), moderately to poorly differentiated (34.37%), and poorly differentiated (24.37%). Neural or vascular invasion was present in 29.37% and 21.25% of patients, respectively. Univariate analysis showed that diabetes, jaundice, liver function (Child-Pugh classification), tumor marker levels (CA19-9, CA125, CEA, CA724, CYFRA 21-1), clinical TNM stage, degree of differentiation, vascular or neural invasion, surgical treatment, and other treatments (chemotherapy, immunotherapy, targeted therapy, traditional Chinese medicine, etc.) were significantly associated with the prognosis of GBC patients (all P<0.05). Multivariate Cox regression analysis revealed that diabetes, elevated CA125, and TNM stage were independent risk factors for poor prognosis in GBC, while chemotherapy-based drug treatment was an independent protective factor (all P<0.05).Conclusion Diabetes, elevated CA125, TNM staging, and treatment methods are closely related to the prognosis of GBC patients. Targeted treatment strategies should be developed for patients with risk factors, and surgery or chemotherapy-based drug therapy should be prioritized to improve patient prognosis.

Abstract:Background and Aims Intrahepatic cholangiocarcinoma (ICC) is a highly malignant liver tumor, with an increasing incidence worldwide, particularly in Asia. Although radical surgical resection is currently the only potentially curative treatment, the high recurrence rate and low postoperative overall survival (OS) rate of ICC remain major clinical challenges. Adjuvant therapy (AT) and neoadjuvant therapy (NAT) are important strategies to reduce postoperative recurrence and prolong OS. Several studies have shown certain efficacy of these treatments. However, the specific efficacy and safety of combined NAT and AT in ICC treatment require further validation. This study was conducted to evaluate the value of combining NAT and AT in improving the therapeutic outcomes of ICC patients through a multicenter retrospective analysis, so as to provide scientific evidence for optimizing treatment strategies.Methods The clinicopathologic data of 576 patients with ICC who underwent radical resection and were pathologically confirmed from 13 hospitals in China between December 2011 and December 2017 were retrospectively collected. Patients were grouped based on their treatment modality: NAT+AT group, AT group, and non-NAT/AT group. The three patient groups were matched pairwise in a 1∶1 ratio using propensity score matching (PSM) to balance baseline data. The Kaplan-Meier method was used to analyze OS and disease-free survival (DFS), and subgroup analyses were conducted according to the 8th edition of the AJCC TNM staging system.Results A total of 395 ICC patients were included in the final analysis, with 42 patients (10.6%) in the NAT+AT group, 62 patients (15.7%) in the AT group, and 291 patients (73.7%) in the non-NAT/AT group. Before PSM, significant differences were observed between groups in terms of CA19-9, liver function Child-Pugh classification, intraoperative blood loss, surgical margin, differentiation grade, vascular invasion, ECOG score, and lymph node dissection ratio (all P<0.05). After PSM, there were no significant differences in baseline characteristics between the groups (all P>0.05). After matching, the median OS and DFS in the NAT+AT group were significantly better than in the AT and non-NAT/AT groups (both P<0.05), while there were no significant differences in OS and DFS between the AT and non-NAT/AT groups (both P>0.05). Subgroup analysis showed that in TNM stage I patients, DFS in the NAT+AT group was significantly better than in the non-NAT/AT group (P<0.05), but OS was not significantly different (P>0.05). In TNM stage Ⅱ and Ⅲ patients, both OS and DFS in the NAT+AT and AT groups were significantly better than in the non-NAT/AT group (both P<0.05), and DFS in the NAT+AT group was significantly better than in the AT group in TNM stage Ⅲ patients (P<0.05).Conclusion NAT combined with AT provides better survival benefits for patients with locally advanced ICC, but its benefit for early-stage ICC patients is limited. However, the retrospective design and sample size limitations of this study may affect the stability of the results, and future large-sample, multicenter, prospective studies are needed for further validation.

Abstract:Background and Aims Laparoscopic cholecystectomy (LC) is a common surgical method for the treatment of gallbladder diseases. However, some patients experience symptoms such as dyspepsia after surgery, which can affect their quality of life. Compound azinomide enteric-coated tablets, a novel drug, may improve dyspeptic symptoms after LC. This study was conducted to explore the clinical efficacy of compound azinomide enteric-coated tablets in treating post-LC dyspepsia symptoms through a multicenter clinical trial.Methods A multicenter, superior efficacy, open-label, parallel-controlled design was used. Patients with postoperative dyspepsia were enrolled in 7 centers between January 2023 and May 2024. Patients were randomly assigned to either the observation or control groups using a random number table. The observation group received compound azinomide enteric-coated tablets, while the control group was treated with a combination of oryzae pancreatin tablets and ursodeoxycholic acid tablets. Both groups were treated for 4 weeks. The primary endpoints included gastrointestinal symptom scores and quality of life scores assessed before and at 14 and 28 d after treatment. Additionally, the incidence of adverse reactions and cost-effectiveness ratio (CER) were compared between the groups.Results A total of 303 patients were included, with 150 in the observation group and 153 in the control group. Baseline characteristics were balanced between the groups before treatment (all P>0.05). After treatment, the observation group showed significantly higher effective rates at 14 d and 28 d than the control group (44.7% vs. 29.4%; 98.0% vs. 73.9%, both P<0.05). The observation group also had significantly lower symptom scores and quality of life scores at both 14 and 28 d, with a significantly higher improvement rate in symptom scores compared to the control group (all P<0.05). Further analysis of the improvement rate and treatment efficacy for individual symptoms revealed that, except for the 14-d improvement in abdominal pain/discomfort, the observation group showed better improvement in all other symptoms at 14 d and in all symptoms at 28 d compared to the control group (all P<0.05). No adverse reactions were observed in either group. The CER for the observation group was 283.78 yuan/efficacy rate at 14 d and 128.57 yuan/efficacy rate at 28 d, while the control group's CER was 729.93 yuan/efficacy rate at 14 d and 290.22 yuan/efficacy rate at 28 d.Conclusion Compound azinomide enteric-coated tablets demonstrated good clinical efficacy in treating dyspepsia symptoms after LC with excellent safety and high cost-effectiveness. Despite some limitations, the results provide a new treatment option for dyspepsia after LC. Larger-scale randomized controlled trials are needed to validate this study's conclusions further.

Abstract:Background and Aims Laparoscopic transcystic bile duct exploration (LTCBDE) has become the preferred method for treating secondary bile duct stones due to its advantages of minimal trauma, fast recovery, and low complication rates. However, challenges remain in the dilation of the cystic duct, the insertion of the choledochoscope, and the exploration of the common hepatic duct and intrahepatic bile ducts. This study was performed to explore the clinical application and effectiveness of the programmed modified LTCBDE in the treatment of gallbladder stones combined with common bile duct stones.Methods A retrospective analysis was conducted on the clinical data of 248 patients who underwent programmed modified LTCBDE at the Affiliated Suzhou Ninth Hospital of Soochow University from January 2018 to January 2024. The surgical strategies and treatment outcomes were summarized. Data from 913 patients who underwent laparoscopic common bile duct exploration (LCBDE) during the same period were also collected to compare surgical outcomes and postoperative complications between the two groups.Results Through programmed surgical steps, the innovative "diaphragm" incision technique, and improved bile duct probe application, 244 patients (98.4%) successfully underwent LTCBDE, while 4 patients were converted to LCBDE due to failure to insert a 4.9 mm choledochoscope through the cystic duct. After operation, 1 patient (0.4%) had residual bile duct stones, which were successfully removed through T-tube tract stone extraction (this patient was converted to LCBDE during the procedure). Additionally, 1 case of bile leakage and 1 case of abdominal infection (each 0.4%) occurred, both of which resolved with conservative treatment. No cases of intra-abdominal bleeding, bile duct stenosis, or bile duct injury were reported. The average operative time in the programmed modified LTCBDE group was comparable to that of the LCBDE group (85.2 min vs. 88.0 min, P=0.398), but the postoperative hospital stay was significantly shorter (6.2 d vs. 8.3 d, P<0.001), and the incidence of complications was lower (1.6% vs. 4.7%, P=0.044).Conclusion The programmed modified LTCBDE is a standardized, safe, and effective procedure with a low complication rate. It is worthy of further clinical promotion and application.

Abstract:Background and Aims Complex choledocholithiasis often coexists with stenosis of the ampulla of Vater, which increases the difficulty and complexity of treatment. If only the stones in the bile duct are removed without addressing the ampullary stenosis, the disease is prone to recurrence. Previously, most treatments involved the use of endoscopic retrograde cholangiopancreatography (ERCP) to guide the wire for sphincterotomy and stone extraction, followed by laparoscopic cholecystectomy. However, ERCP has limitations in handling complex cases. In response, our team pioneered a new method of treating choledocholithiasis combined with stenosis of the ampulla of Vater via a transabdominal approach. This study was performed to investigate the feasibility and efficacy of this method, aiming to provide a new therapeutic option for clinical practice.Methods A randomized controlled study was conducted with 120 patients treated at Chengdu Second People's Hospital from 2021 to 2023 for gallbladder stones and choledocholithiasis with stenosis of the ampulla of Vater. Patients were divided into an observation group and a control group, with 60 cases in each group. The observation group underwent laparoscopic cholecystectomy with choledochotomy for stone extraction, followed by retrograde guidance of duodenal papillary sphincterotomy through the opened bile duct, simultaneously treating gallbladder, bile duct stones, and stenosis of the ampulla of Vater. The control group underwent traditional ERCP approach for sphincterotomy, stone extraction, and laparoscopic cholecystectomy. Perioperative variables were collected for both groups and the surgical outcomes were compared.Results Among the 120 patients, 54 were male and 66 were female. There were no statistically significant differences between the two groups in terms of stone extraction success rate, intraoperative blood loss, postoperative 24-h total bilirubin, direct bilirubin, transaminases, white blood cell count, jaundice relief time, or incidence rates of bile leakage, retroperitoneal bleeding/infection, and severe pancreatitis (all P>0.05). The observation group had significantly shorter average operative time and postoperative hospital stay compared to the control group (98.67 min vs. 110.8 min, P<0.05; 3.81 d vs. 5.61 d, P<0.05). Additionally, the observation group had a significantly lower incidence of postoperative hyperamylasemia and/or hyperlipasemia and mild pancreatitis (1.67% vs. 25.00%, P<0.001; 0 vs. 10%, P=0.027).Conclusion The novel transabdominal approach is superior to the ERCP approach in terms of reducing surgery time and hospitalization time, and it carries a lower risk of postoperative mild pancreatitis and hyperamylasemia and/or hyperlipasemia. The stone extraction success rate is comparable to that of ERCP, making it a viable alternative treatment option.

Abstract:Background and Aims Chronic skin ulcers are a significant disease affecting patients' daily lives and psychological well-being. Abnormalities in the cells and extracellular matrix within the tissue may disrupt the balance of the microenvironment, hindering the normal skin repair process and leading to delayed healing of the ulcer. There is currently a lack of research on the mechanisms underlying the development of chronic ulcers and their diagnostic biomarkers. Single-cell sequencing, a newly developed high-throughput sequencing method in recent years, uses gene sequencing at the single-cell resolution to precisely reveal disease mechanisms and has been applied in various diseases. This study used single-cell transcriptome sequencing (scRNA-Seq) to investigate the cellular heterogeneity in chronic skin ulcer tissue to elucidate the potential molecular mechanisms behind delayed healing and provide new insights for clinical treatment.Methods The scRNA-Seq technology was used to compare the differences in cell subpopulations and gene expression between chronic ulcer tissue and normal skin tissue. Single cells were sorted using a microfluidic platform, and cDNA libraries were constructed for subsequent differential gene analysis and functional enrichment analysis.Results scRNA-Seq analysis revealed significant immune-metabolic remodeling features in chronic ulcer tissue: the number of B cells, monocytes, and macrophages in ulcer tissue increased by 2.1 to 3.5 times compared to the normal tissue control. This was accompanied by widespread activation of collagen synthesis genes (COL1A1/COL3A1) and synergistic suppression of immune regulators (e.g., granzyme family GZMA/GZMB/H). Cross-cell subpopulation functional network analysis showed that hypoxia response mediated by the HIF-1 signaling pathway and PI3K/Akt pathway abnormalities formed a positive feedback loop, exacerbating the imbalance in the secretion of inflammatory factors (CXCL3/8, TGFBI) and compensatory upregulation of mitochondrial oxidative phosphorylation.Conclusion Chronic skin ulcers exhibit significant differences in cellular heterogeneity and gene expression, suggesting that chronic ulcers are not simply tissue defects but a complex pathological process dominated by chronic inflammation and immune dysregulation. The coordinated dysregulation of multiple cell subpopulations in the ulcer microenvironment, along with persistent inflammatory responses and metabolic abnormalities, is interconnected through the HIF-1/TNF/MAPK pathway network. Downregulation of granzyme gene family members and abnormal histone modifications may contribute to immune clearance defects, providing a theoretical basis for developing novel therapies targeting epigenetic regulation or mitochondrial function.

Abstract:Background and Aims Reconstructing huge abdominal wall defects after abdominal wall tumor resection is a significant challenge for surgeons. Here, we summarize the experience of our team in repairing these defects using an anterolateral thigh chimeric perforator flap combined with artificial materials, within a multidisciplinary collaborative framework, aiming to provide a reference for other practitioners.Methods The clinicopathologic data of 7 patients who underwent primary reconstruction of large abdominal wall defects after malignant tumor resection, using an anterolateral thigh chimeric perforator flap combined with artificial materials, at Xiangya Hospital, Central South University, between October 2019 and April 2024, were retrospectively analyzed. The clinical outcomes were evaluated.Results All 7 patients successfully underwent both tumor resection and primary abdominal wall reconstruction without surgery-related mortality. The wound in all patients healed in one stage, with no severe complications such as surgical site infections or flap necrosis. During a follow-up period of 6 to 54 months, 2 patients experienced tumor recurrence, one of whom died (exact cause unknown), while the other continued anti-tumor treatment. The remaining 5 patients were alive without recurrence. One patient developed abdominal wall bulging, but no obvious incisional hernia occurred in any of the patients.Conclusion The use of an anterolateral thigh chimeric perforator flap combined with artificial materials for repairing large abdominal wall defects after abdominal tumor resection can achieve satisfactory therapeutic outcomes. This approach is a feasible and safe method for abdominal wall reconstruction.

Abstract:Background and Aims Papillary thyroid carcinoma (PTC), the most common type of thyroid cancer, has been rapidly increasing in incidence worldwide, posing a serious threat to individual health and public healthcare systems. Exposure to low-to-moderate doses of ionizing radiation is more relevant to the daily lives of the general population and, therefore, raises greater public health concerns. It has also been widely recognized as a potential factor in immune system remodeling. This study was conducted to investigate the impact of low-to-moderate dose ionizing radiation on the tumor immune microenvironment of PTC, aiming to reveal the potential hazards of such radiation exposure in PTC patients.Methods Two datasets (GSE29265 and GSE35570) containing RNA-seq data and corresponding clinical information were retrieved and downloaded from the GEO database. These datasets included thyroid cancer samples from patients exposed to ionizing radiation due to the Chernobyl disaster, as well as sporadic thyroid cancer cases. After data cleaning, merging, batch effect correction, differential gene expression analysis, functional enrichment analysis, immune cell infiltration analysis, and tumor microenvironment analysis were performed using R language.Results In tumor samples, the radiation-exposed group exhibited significant differential gene expression compared to the sporadic group, with three genes upregulated and 27 genes downregulated. These differentially expressed genes were primarily enriched in biological functions closely related to immune responses, including chemokine activity, immune cell chemotaxis, and tumor immunity. Immune cell infiltration analysis indicated that radiation exposure had a limited impact on immune cell infiltration in normal samples. However, in tumor samples, the immune and ESTIMATE scores were significantly lower in the radiation-exposed group than in the sporadic group. Further analysis revealed that total T cells, CD4⁺ T cells, CD8⁺ T cells, B cells, and cytotoxic lymphocytes exhibited significantly lower infiltration levels in the tumor microenvironment of the radiation-exposed group than the sporadic group.Conclusion Although low-to-moderate dose ionizing radiation has a relatively minor impact on normal thyroid tissue, it significantly reduces the infiltration of various immune cell subtypes in the PTC tumor microenvironment. This reduction in immune infiltration may have important implications for disease progression.

Abstract:Cholangiocarcinoma (CCA) is a highly malignant digestive system tumor. Due to the non-specific early clinical symptoms of the disease, diagnosis is often delayed, leading to poor prognosis. In recent years, the incidence of CCA has been steadily increasing, making it one of the major malignant tumors of the liver and biliary system globally. This review discusses the current status and progress in the treatment of CCA, focusing on the application and effectiveness of curative resection, liver transplantation, palliative therapies (including radiofrequency ablation, interventional therapy, immunotherapy, targeted therapy, etc.), and chemotherapy. Additionally, with the development of molecular targeted drugs and immunotherapy, treatment strategies for CCA are gradually improving. Although treatment methods continuously evolve, challenges remain in treating patients at advanced stages. Future research should focus on improving early diagnostic technologies, developing new therapeutic drugs, and integrating traditional and modern medical approaches to provide more effective treatment options for patients.

Abstract:Bile duct injuries can be classified into iatrogenic and non-iatrogenic categories. Non-iatrogenic bile duct injuries include immune, infectious, vascular, ischemic, genetic, idiopathic, and neoplastic causes. After injury, the biliary epithelial cells undergo closely linked pathological processes, such as inflammatory repair, epithelial regeneration, and fibrous repair. These processes interact with inflammatory and stromal cells through autocrine and paracrine mechanisms, coordinating the repair process to maintain the structural and functional integrity of the bile ducts. In the absence of effective intervention, bile duct injuries can lead to bile leakage, biliary strictures, and even progress to cirrhosis, severely affecting the patient's quality of life. Currently, treating bile duct injuries is no longer limited to traditional surgical methods but also includes non-surgical treatments such as immune modulation, bile acid regulation, and gut microbiota adjustment. With the development of medical technology, novel treatments such as gene therapy, stem cell/organoid technology, and endoscopic retrograde cholangiopancreatography/tissue-engineered scaffolds are gaining attention and are expected to become effective treatment options for bile duct injuries in the future. This review focuses on the etiology and pathological mechanisms during the repair process of bile duct injuries and summarizes existing and potential treatment approaches, providing a reference for future research and clinical management of bile duct injuries.