Abstract:Incisional hernia is an iatrogenic condition characterized by diverse forms, significant variability, and complex classification. It presents challenges and uncertainties in clinical treatment. Significant progress has been made in the diagnosis of incisional hernias, surgical techniques, and the development of prosthetic materials. Building upon the "Guidelines for the Diagnosis and Treatment of Abdominal Wall Incisional Hernia (2018 Edition)," domestic experts in hernia and abdominal wall surgery have conducted discussions and revisions. These updates, guided by evidence-based medical evaluation standards, address issues such as complex abdominal wall conditions, abdominal wall dysfunction, principles of hernia treatment, methods for defect closure, perioperative management, and follow-up and patient education. The aim is to further enhance the diagnostic and treatment standards for abdominal wall incisional hernias in China.

Abstract:In recent years, the diagnosis and treatment of inguinal hernia have become increasingly refined, with individualized treatment plans gaining greater standardization. Building on the "Guidelines for the Diagnosis and Treatment of Adult Inguinal Hernias (2018 Edition)," over 70 experts from related fields conducted extensive discussions and revised the guidelines based on evidence-based medical evaluation standards. This updated edition focuses on advancements in the diagnosis and treatment of adolescent inguinal hernias, scrotal hernias, management of hernia-related complications, and postoperative education and follow-up. It aims to provide a scientific and standardized reference for domestic medical institutions and healthcare professionals, further enhancing the quality and consistency of inguinal hernia management.

Abstract:Artificial intelligence (AI) has demonstrated great potential in the diagnosis and treatment of pancreatic cancer. It plays an important role in medical imaging analysis, pathological slide recognition, drug efficacy and prognosis prediction, as well as new drug development by leveraging deep learning algorithms. Despite challenges such as data acquisition and model interpretability, advancements in technology and data sharing are expected to further enhance its role in early screening, personalized treatment, and innovative drug discovery for pancreatic cancer, ultimately improving patient outcomes.

Abstract:Pancreatic cancer is a highly aggressive malignancy with a poor prognosis, and surgical resection remains the only potentially curative treatment. However, since most patients are diagnosed at a locally advanced or metastatic stage, the feasibility of upfront surgery is limited. In recent years, neoadjuvant and conversion therapy have emerged as crucial strategies for borderline resectable and locally advanced pancreatic cancer, aiming to increase the R₀ resection rate and improve survival outcomes. Studies have shown that FOLFIRINOX and gemcitabine plus nab-paclitaxel are commonly used neoadjuvant chemotherapy regimens, with the former being more suitable for patients with good performance status, while the latter is better tolerated across a broader patient population due to its lower toxicity. Additionally, radiotherapy, such as stereotactic body radiotherapy (SBRT), can enhance local tumor control, increase tumor cell eradication, and minimize damage to normal tissues, thereby optimizing overall treatment efficacy. Despite the significant advantages of this approach, challenges remain, including the management of toxic side effects and the optimization of treatment protocols. Future research will focus on personalized precision medicine, integrating genomic sequencing and radiomics to refine neoadjuvant/conversion therapy strategies and exploring the combination of chemotherapy, radiotherapy, immunotherapy, and targeted therapy to improve long-term survival in pancreatic cancer patients. This paper summarizes recent advancements in neoadjuvant/conversion therapy combined with radiotherapy for pancreatic cancer and discusses its potential role in modulating tumor biology and optimizing treatment strategies.

Abstract:Indocyanine green (ICG) is one of the near-infrared fluorescent contrast agents approved for clinical use in fluorescence-guided surgery. Although widely applied, it still has some limitations. In recent years, various targeted fluorescent agents have been explored in pancreatic cancer patients; however, there is still no standardized consensus among surgeons regarding fluorescence-guided surgery for pancreatic cancer. In 2023, the first the international consensus report on fluorescent surgery navigation for pancreatic tumors was published, gathering perspectives from 38 pancreatic surgeons worldwide on current practices and future directions. A total of 76 statements were anonymously voted on using the Delphi method, resulting in 61 recommended statements. This consensus offers valuable guidance for the implementation of fluorescence-guided surgery in pancreatic tumor operations in China, yet its clinical application should be adapted in consideration of local expert opinions and patient-specific factors. This article interprets key aspects of the consensus, including the use of ICG, intraoperative fluorescence imaging techniques, and the fluorescence heterogeneity of pancreatic tumors, in combination with the authors' clinical experience, with the aim of providing reference and insight for the application of fluorescence-guided surgery in pancreatic tumors.

Abstract:Background and Aims Postoperative pancreatic fistula (POPF) is one of the most severe and common complications following pancreaticoduodenectomy (PD) and is a major cause of mortality after PD. Given the multiple risk factors associated with PD-POPF, developing an effective predictive model is of significant clinical importance. This study was conducted to explore the predictive performance of the triglyceride-glucose (TyG) index combined with serological indicators for POPF following PD.Methods The preoperative general data, laboratory indicators within one week before surgery, and postoperative complication data of 291 patients who underwent PD at the Department of General Surgery, Second Hospital of Lanzhou University, from January 2019 to June 2024, were retrospectively collected. Patients were randomly divided into a modeling group (203 cases) and a validation group (88 cases) using a computer-generated random number method at a 7∶3 ratio. Univariate Logistic regression and multivariate binary Logistic regression (Back-Wald method) were performed on the modeling group data. Based on regression analysis results, a predictive model was constructed and visualized using a nomogram. The discriminative ability of the nomogram model was evaluated by the area under the receiver operating characteristic (ROC) curve (AUC). A calibration curve was used to assess the agreement between predicted and actual probabilities, and a decision curve analysis was conducted to evaluate the clinical application value of the model. Subgroup analysis was performed on potential factors influencing the outcome variables.Results Among the 291 patients, 70 developed POPF, with 49 cases in the modeling group and 21 in the validation group. There was no statistically significant difference between the two groups (all P>0.05). Univariate analysis in the modeling group identified body mass index (BMI), triglycerides, TyG index, albumin (ALB), platelet count (PLT), absolute lymphocyte count (LYM), and absolute neutrophil count (NEUT) as significant factors associated with POPF (all P<0.05). Multivariate analysis revealed that BMI, TyG index, ALB, PLT, LYM, and NEUT were independent influencing factors for POPF (all P<0.05). A PD-POPF risk prediction model and nomogram were constructed based on these results. The model achieved an AUC of 0.80 (0.73-0.86), and when applied to the validation group, the ROC analysis yielded an AUC of 0.80 (0.70-0.90). The calibration curves of both the modeling and validation groups closely aligned with the standard curve. Subgroup analysis indicated that tumor nature and tumor stage had minimal impact on PD-POPF risk factors, demonstrating good model stability.Conclusion The TyG index, along with BMI, PLT, NEUT, ALB, and LYM, is closely associated with PD-POPF occurrence. The risk prediction model based on the TyG index and these influencing factors exhibits good predictive performance and holds significant clinical value for guiding early intervention.

Abstract:Background and Aims Laparoscopic pancreaticoduodenectomy (LPD) is one of the most technically demanding procedures in general surgery. Its development remains controversial, particularly regarding adherence to oncological principles. In situ LPD, based on the "no-touch" principle, offers a treatment option for pancreatic tumors. However, ensuring surgical safety remains a key challenge due to its technical complexity. This study explored the surgical techniques of in situ LPD performed via the left-sided combined middle approach and evaluated its safety and efficacy.Methods A retrospective analysis was conducted on the clinical data of four patients who underwent in situ LPD using the left-sided combined middle approach between July 2023 and November 2023 at the Department of Pancreatic Surgery of Fudan University Shanghai Cancer Center and the Department of Hepatobiliary Surgery of Yijishan Hospital, Wannan Medical College.Results All 4 patients were female, with an average age of 58 and a mean BMI of 22.1 kg/m². Among them, two had pancreatic head cancer, one had ampullary carcinoma, and one had distal common bile duct carcinoma. Preoperative laboratory indicators, including white blood cell count, platelet count, prothrombin time, alanine aminotransferase, aspartate aminotransferase, albumin, total bilirubin, and direct bilirubin, were all within normal ranges. All patients successfully underwent in situ LPD via the left-sided combined middle approach. The mean operative time was 385 min, with an average intraoperative blood loss of 87.5 mL. After operation, the average drainage tube removal time was 10.3 d, and the mean hospital stay was 10.8 d. One patient developed biochemical leakage, and another experienced abdominal effusion, while no cases of biliary stricture, diarrhea, or chylous leakage were observed.Conclusion In situ LPD via the left-sided combined middle approach allows for thorough lymph node dissection and radical tumor resection while adhering to the "no-touch" principle. This approach is simple to perform and master and does not lead to significant postoperative complications. It is a safe and feasible technique with promise for broader clinical application. Future research should focus on multicenter studies with larger sample sizes to validate its safety and efficacy.

Abstract:Background and Aims Pancreatic cancer is a highly aggressive malignancy that imposes a significant disease burden both in China and globally. It not only substantially increases healthcare expenditures but also profoundly influences health policy decisions. This study aims to systematically assess the disease burden of pancreatic cancer in China and worldwide over the past 30 years and to analyze future trends using a prospective predictive model, providing a scientific basis for the development of effective prevention and control strategies.Methods Data on incidence, prevalence, mortality, and disability-adjusted life years (DALY) of pancreatic cancer, stratified by sex and standardized for age, were extracted from the Global Burden of Disease (GBD) database for the period 1990—2021. The autoregressive integrated moving average (ARIMA) model was used to predict the disease burden trends of pancreatic cancer for the next 15 years.Results The results showed that from 1990 to 2021, the incidence, prevalence, mortality, and DALY rates of pancreatic cancer exhibited an increasing trend in both China and worldwide. Males had significantly higher incidence and mortality rates than females, with a faster growth rate. The highest incidence and mortality rates were observed in economically developed regions such as North America and Europe, while lower rates were noted in less developed regions such as Africa and South Asia. However, with economic development and lifestyle changes, the pancreatic cancer burden in these low-incidence regions is also gradually increasing. Over time, the growth rate of pancreatic cancer incidence and mortality in China has surpassed the global average, and with an aging population, the disease burden is expected to rise further in the future.Conclusion There are significant variations in the pancreatic cancer burden across genders and regions. Strengthening health education and early screening for high-risk populations, optimizing personalized treatment strategies, and increasing investment in basic research on pancreatic cancer are essential to mitigating the growing disease burden. This study provides crucial scientific evidence for the formulation of pancreatic cancer prevention and control strategies, contributing to improved patient outcomes and reduced socioeconomic burden.

Abstract:Background and Aims Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant digestive system tumor with an inferior prognosis, and its early diagnosis and treatment remain significant challenges. In recent years, RNA methylation modifications (such as m6A and m5C) have attracted considerable attention for their roles in tumor development; however, their regulatory mechanisms and clinical significance in PDAC remain unclear. This study was conducted to identify prognosis-related long noncoding RNAs (lncRNAs) associated with m6A and m5C in PDAC, construct a reliable prognostic prediction model, and explore their relationship with the tumor immune microenvironment.Methods Based on RNA-seq data from the TCGA-PDAC cohort, differentially expressed lncRNAs (DElncRNAs) related to m6A and m5C were identified through differential expression analysis and Pearson correlation analysis. The samples were randomly divided into a training set (n=89) and a validation set (n=89). Key DElncRNAs were selected using LASSO-Cox regression to construct a prognostic model, and patients were categorized into high- and low-risk groups based on risk scores. Kaplan-Meier survival analysis, ROC curves, and multivariate Cox regression were used to evaluate the model's predictive performance. Furthermore, CIBERSORT and ESTIMATE scores were used to analyze immune cell infiltration characteristics and tumor microenvironment (TME) differences between the high- and low-risk groups.Results To construct the prognostic model, four m6A- and m5C-related DElncRNAs (LINC00857, LINC02038, TSPOAP1-AS1, and TRPC7-AS1) were identified. Patients in the high-risk group had significantly lower overall survival than those in the low-risk group (P<0.05), and the risk score was an independent prognostic factor for PDAC (HR=1.551, 95% CI=1.297-1.854, P<0.001). ROC curve analysis showed that the risk score model exhibited high predictive efficiency in both the training and validation sets (AUC values for 1, 3, and 5 years: 0.766, 0.875, 0.879; 0.685, 0.711, 0.792, respectively). Immune analysis revealed increased infiltration of M0 macrophages with lower TME scores in the high-risk group (all P<0.05), suggesting an immunosuppressive microenvironment.Conclusion This study successfully established a PDAC prognostic model based on m6A- and m5C-related DElncRNAs and confirmed its independent predictive value. High-risk patients exhibited M0 macrophage enrichment and immunosuppressive microenvironment characteristics, possibly contributing to poor prognosis.

Abstract:Background and Aims N⁶-methyladenosine (m6A) epigenetic modification plays a crucial role in post-transcriptional gene expression regulation and various physiological and pathological processes, including tumorigenesis. The m6A reader IGF2BP2 significantly enhances mRNA stability and translation efficiency and is abnormally expressed in multiple cancers. However, the specific biological function of IGF2BP2 in pancreatic cancer remains unclear. Therefore, this study investigated the expression of the m6A reader IGF2BP2 in pancreatic cancer and its effects on pancreatic cancer cell functions.Methods The expression levels of m6A-related writers, erasers, and readers were analyzed using The Cancer Genome Atlas (TCGA), the Genotype-Tissue Expression (GTEX) database, and the Gene Expression Omnibus (GEO). Kaplan-Meier survival analysis was conducted to assess the relationship between IGF2BP2 expression and the prognosis of pancreatic cancer patients. Immunohistochemistry was used to validate IGF2BP2 expression in clinical specimens of pancreatic cancer tissues and adjacent normal tissues. Functional experiments, including CCK-8 assay, flow cytometry for cell cycle analysis, colony formation assay, and Transwell migration assay, were performed to evaluate changes in cell proliferation, cell cycle distribution, colony formation ability, and migration capacity after IGF2BP2 knockdown in pancreatic cancer cells.Results TCGA-GTEX and GEO database analyses showed that IGF2BP2 was highly expressed in pancreatic cancer tissues (both P<0.05) and that its high expression was associated with poor overall survival (both P<0.05). Immunohistochemical staining of clinical specimens confirmed that IGF2BP2 protein expression was higher in pancreatic cancer than in adjacent normal tissue. Functional experiments demonstrated that IGF2BP2 knockdown significantly reduced the proliferation ability of pancreatic cancer cells, arrested more cells in the G0-G1 phase, decreased colony formation, and impaired cell migration (all P<0.05).Conclusion The m6A reader IGF2BP2 is highly expressed in pancreatic cancer tissues and is closely associated with poor prognosis in patients with this disease. Its mechanism of action may be related to the promotion of cancer cell growth and migration.

Abstract:Background and Aims Long noncoding RNA (lncRNA) nuclear-enriched abundant transcript 1 (NEAT1) is an oncogenic lncRNA that promotes the progression of various cancers through the competing endogenous RNA (ceRNA) mechanism. Using the TargetScan database, we previously identified binding sites between NEAT1 and microRNA-124-3p (miR-124-3p), as well as between miR-124-3p and catenin beta-1 (CTNNB1). Therefore, this study was conducted to investigate the expression of NEAT1, miR-124-3p, and CTNNB1 in pancreatic cancer and their interactions affecting pancreatic cancer cell functions.Methods A dual-luciferase reporter assay was used to validate the relationships among NEAT1, miR-124-3p, and CTNNB1. The expression levels of NEAT1 and miR-124-3p, as well as CTNNB1 protein expression, were detected in pancreatic cancer tissues and adjacent normal tissues, as well as in pancreatic cancer PANC-1 cells and normal pancreatic epithelial H6C7 cells. PANC-1 cells were transfected with NEAT1 siRNA alone or co-transfected with a miR-124-3p inhibitor. After transfection, changes in PANC-1 cell biological functions, epithelial-mesenchymal transition related protein expression, and tumor growth ability in mice were assessed.Results The dual-luciferase reporter assay confirmed the targeting relationships between NEAT1 and miR-124-3p, as well as between miR-124-3p and CTNNB1. NEAT1 and CTNNB1 expression levels were significantly upregulated, while miR-124-3p expression was downregulated in pancreatic cancer tissues (vs. adjacent tissues) and in PANC-1 cells (vs. H6C7 cells) (all P<0.05). NEAT1 siRNA transfection led to decreased NEAT1 and CTNNB1 expression and increased miR-124-3p expression in PANC-1 cells. However, co-transfection with a miR-124-3p inhibitor suppressed the expression changes in miR-124-3p and CTNNB1 (all P<0.05). NEAT1 siRNA transfection significantly reduced PANC-1 cell proliferation, migration, and invasion, while promoting apoptosis. Additionally, E-cadherin protein expression was upregulated, whereas N-cadherin and vimentin protein expression were downregulated. Tumor growth in mice was also significantly inhibited (all P<0.05). These changes were attenuated upon co-transfection with the miR-124-3p inhibitor (all P<0.05).Conclusion NEAT1 may act as a ceRNA by competitively binding to miR-124-3p, thereby attenuating miR-124-3p-mediated inhibition of CTNNB1. This leads to CTNNB1 upregulation, ultimately promoting the malignant biological behavior of pancreatic cancer cells.

Abstract:Background and Aims Acute pancreatitis (AP) accompanied by intestinal injury and intestinal barrier dysfunction can significantly worsen AP prognosis. Currently, there is no effective clinical treatment for AP-related intestinal dysfunction. Ulinastatin (UTI) is a conventional drug used for AP treatment due to its ability to inhibit trypsin activity and exert anti-inflammatory effects. However, whether UTI directly improves AP-related intestinal injury remains unclear. Therefore, this study was conducted to investigate the therapeutic effects and potential mechanisms of UTI in AP-related intestinal dysfunction.Methods Thirty rats were equally randomized into three groups and received intraperitoneal injections of PBS (control group), 20% L-arginine (AP group), or 20% L-arginine + UTI (UTI group). Tail vein blood samples were collected at 0, 24, and 48 h after the initial injection of L-arginine (or PBS), and the rats were euthanized after the final blood collection to obtain pancreatic and terminal ileum tissues. Serum levels of amylase, lipase, intestinal fatty acid-binding protein (I-FABP), and diamine oxidase (DAO) were measured using ELISA. Histopathological examinations of the pancreas and terminal ileum were conducted. Western blot was used to detect the protein expression levels of tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), interleukin 1β (IL-1β), and interleukin 10 (IL-10) in terminal ileum tissue. Western blot and qRT-PCR were used to assess the protein and mRNA expression levels of Toll-like receptor 4 (TLR4) and nuclear factor κB (NF-κB) p-p65 in the terminal ileum.Results Compared with the control group, both the AP and UTI groups exhibited significant AP changes (elevated serum amylase and lipase levels, pancreatic histopathological damage) and AP-related intestinal injury (decreased I-FABP and DAO levels, ileal histopathological damage). However, these alterations were significantly less severe in the UTI group compared to the AP group (all P<0.01). Compared with the control group, both the AP and UTI groups showed significantly increased protein expression of pro-inflammatory factors (TNF-α, IL-1β, IL-6) and the anti-inflammatory factor IL-10 in the ileal tissue; however, the UTI group exhibited significantly lower levels of pro-inflammatory factors and higher levels of IL-10 compared to the AP group (all P<0.01). Additionally, compared with the control group, both the AP and UTI groups displayed significant upregulation of TLR4 and NF-κB p-p65 protein and mRNA expressions in ileal tissue, but the upregulations were significantly lower in the UTI group compared to the AP group (all P<0.01).Conclusion UTI can inhibit the activation of the TLR4/NF-κB signaling pathway in the ileal tissue of AP rats, thereby reducing pro-inflammatory cytokine levels and increasing anti-inflammatory cytokine levels. Therefore, in addition to its anti-pancreatitis effects, UTI may have a direct therapeutic effect on AP-related intestinal dysfunction.

Abstract:Background and Aims Coactivator-associated arginine methyltransferase 1 (CARM1) is involved in the regulation of RNA and protein processing. Recent studies have revealed its crucial role in tumorigenesis and cancer progression. However, the correlation between CARM1 expression, pan-cancer prognosis, and the immune microenvironment remains unclear. This study was conducted to investigate the relationship between CARM1 expression and pan-cancer prognosis, immune microenvironment, and its potential biological mechanisms using bioinformatics approaches.Methods Using the TCGA, GTEx, and HPA databases, the expression pattern of CARM1 in various cancers and its prognostic relevance were analyzed. The correlation between CARM1 expression and the tumor microenvironment, as well as immune checkpoint genes, were analyzed using TCGA data. The PPI network of CARM1-interacting genes was constructed using the STRING database. GSEA was performed to investigate the potential biological mechanisms of CARM1 in pan-cancer.Results Compared to normal tissues, CARM1 was upregulated in most tumor tissues, and its expression was associated with prognosis in multiple cancers. CARM1 expression was correlated with immune cell infiltration and immune checkpoint gene expression. Enrichment analysis suggested that CARM1 might alter the biological function of urinary system tumors by affecting ribosome biogenesis. Additionally, it may influence the biological functions of digestive system tumors by modulating arginine biosynthesis, DNA replication, and the cell cycle.Conclusion CARM1 is aberrantly expressed in tumor tissues and may serve as a prognostic biomarker for multiple cancers. It is associated with the tumor microenvironment and immune checkpoint gene expression in pan-cancer and may contribute to tumorigenesis through multiple biological pathways, making it a potential therapeutic target for pan-cancer treatment.

Abstract:Background and Aims Elderly patients undergoing laparoscopic radical resection of colon cancer often experience decreased sleep quality, which may hinder postoperative recovery. Although pharmacological interventions are commonly used in clinical practice to improve postoperative sleep, conventional medications may lead to adverse effects such as delirium and dependence. This study aimed to evaluate the effect of a non-pharmacological intervention—buccal acupuncture combined with ultrasound-guided stellate ganglion block (SGB)—on postoperative sleep quality in elderly patients.Methods A total of 60 elderly patients who underwent laparoscopic radical resection of colon cancer at the Forth Hospital of Changsha from February to August 2024 were enrolled. Using a random number table, the patients were divided into two groups: 30 in the control group (SGB alone) and 30 in the study group (SGB combined with buccal acupuncture). Perioperative mean arterial pressure (MAP), heart rate (HR), postoperative visual analogue scale (VAS) scores, Pittsburgh Sleep Quality Index (PSQI) scores, and the incidence of adverse events were recorded and analyzed.Results There were no statistically significant differences in baseline characteristics between the two groups (all P>0.05). The study group showed significantly lower intraoperative and postoperative HR and MAP compared to the control group (all P<0.05). VAS scores at 6, 24, and 48 h postoperatively, as well as PSQI scores on postoperative days 1, 3, and 5, were significantly lower in the study group (all P<0.05). Additionally, the incidence of drowsiness was significantly reduced (P<0.05). No significant differences were found between the two groups in terms of nausea, vomiting, or agitation (all P>0.05).Conclusion The combination of buccal acupuncture and SGB during the perioperative period can effectively improve postoperative sleep quality, alleviate pain, and reduce adverse reactions in elderly patients undergoing laparoscopic radical resection of colon cancer. This safe and effective non-pharmacological intervention holds promising clinical application value.

Abstract:Background and Aims Unplanned reoperation is a critical indicator for evaluating the quality of surgical treatment and prognosis in patients with gastrointestinal perforation. Identifying its underlying causes, recognizing relevant risk factors, and developing effective preventive strategies are essential for optimizing treatment outcomes and improving patient prognosis. This study aimed to investigate the causes and risk factors of unplanned reoperation following surgery for gastrointestinal perforation, in order to provide clinical guidance for targeted interventions.Methods The clinical data of 303 patients who underwent surgery for gastrointestinal perforation at the Department of General Surgery, Shijiazhuang People's Hospital, from January 2020 to July 2023, were retrospectively analyzed. Among them, 218 were males and 85 were females, with a mean age of (61.05±17.95) years. Seventeen patients experienced unplanned reoperations after operation, while 286 did not. Univariate analysis and multivariate Logistic regression were performed to identify the risk factors associated with unplanned reoperation. A predictive model was developed and its performance was assessed using the receiver operating characteristic (ROC) curve.Results Among the 17 patients who underwent unplanned reoperation, 14 were males and 3 were females, with a mean age of (65.76±15.11) years. The primary causes of reoperation included postoperative fistula (7 cases), postoperative bleeding (4 cases), surgical site infection (2 cases), wound dehiscence (2 cases), and stoma-related complications (2 cases). Univariate analysis indicated that gender, comorbidities, hypoproteinemia, history of abdominal surgery, ASA score, surgical grade, and disease duration were significantly associated with unplanned reoperation (all P<0.05). Multivariate Logistic regression revealed that male gender (OR=99.62, 95% CI=4.90-2 025.29, P<0.05), hypoproteinemia (OR=8.59, 95% CI=1.81-40.91, P<0.05), history of abdominal surgery (OR=17.28, 95% CI=3.42-87.32, P<0.05), higher ASA score (OR=11.89, 95% CI=2.73-51.72, P<0.05), higher surgical grade (OR=17.15, 95% CI=2.47-118.93, P<0.05), and longer disease duration (OR=1.04, 95% CI=1.02-1.07, P<0.05) were independent risk factors. The ROC curve analysis showed that the predictive model constructed based on the above factors had a sensitivity of 0.90, a specificity of 0.88, and an area under the curve of 0.94 (95% CI=0.88-0.99, P<0.001).Conclusion The leading causes of unplanned reoperation after gastrointestinal perforation surgery are postoperative fistula and bleeding. Male gender, hypoproteinemia, and other high-risk factors significantly increase the likelihood of reoperation. Although most such surgeries are performed emergently, comprehensive preoperative assessment of relevant risk factors is crucial to reduce the incidence of unplanned reoperation, and improve patient outcomes.

Abstract:Pancreatic cancer (PC) is a highly malignant digestive system tumor with extremely high mortality and recurrence rates. While traditional surgical resection and chemotherapy remain the main treatment options, challenges such as high postoperative recurrence and poor prognosis persist. Therefore, exploring more effective comprehensive treatment strategies is crucial for improving patient survival and prognosis. This review systematically summarizes recent advances in systemic therapy for PC, with a focus on the application and efficacy of chemotherapy, targeted therapy, and immunotherapy. Additionally, it discusses the potential of neoadjuvant therapy, integrated traditional Chinese and Western medicine approaches, and conversion therapy in enhancing the effects of conventional chemotherapy. Studies have shown that targeted therapy can enhance antigen presentation and reduce side effects, while immune checkpoint inhibitors, cancer vaccines, and adoptive cell immunotherapy help mitigate tumor immune evasion and improve the tumor microenvironment. Despite continuous innovation in treatment approaches, clinical management of PC, particularly for advanced-stage patients, still faces significant challenges. Future research should focus on early diagnosis, precision medicine, and personalized treatment strategies to further improve cure rates and patient survival quality, providing more effective therapeutic options for clinical practice.

Abstract:Pancreatic neuroendocrine neoplasms (pNENs) are rare and highly heterogeneous pancreatic tumors with insidious clinical manifestations. They have a high propensity for distant metastasis, with liver metastases being the most common, significantly impacting patient prognosis. Despite extensive research on treating pNEN with liver metastases in recent years, many controversies and gaps remain. With the advancement of multidisciplinary treatment approaches, therapeutic strategies for pNEN liver metastases have been continuously refined, encompassing surgical resection, local therapies (such as radiofrequency ablation and transarterial interventions), and systemic treatments (including chemotherapy, targeted therapy, immunotherapy, radionuclide therapy, and endocrine therapy). Combination therapy has become an emerging trend. Radical surgery remains the preferred option for resectable cases, while for inoperable or treatment-intolerant patients, a rational combination of local and systemic therapies can improve survival outcomes. Additionally, endocrine therapy is crucial in symptom relief and quality-of-life improvement for patients with functional pNEN. Multidisciplinary collaboration in formulating individualized treatment plans can significantly enhance patient prognosis. This review summarizes recent advancements in treating pNEN liver metastases, providing a reference for clinical decision-making.

Abstract:Acute pancreatitis (AP) is a severe digestive system emergency characterized by high morbidity and mortality, with a complex pathogenesis involving multiple signaling pathways. Among them, the RhoA/ROCK signaling pathway plays a crucial role in the onset and progression of AP, influencing pancreatic inflammation, fibrosis, microcirculatory regulation, and interactions with other signaling pathways. Studies have shown that inhibiting the RhoA/ROCK signaling pathway can effectively alleviate AP severity, reduce inflammatory cytokine levels, and improve pancreatic microcirculation, offering new therapeutic insights and potential strategies for AP treatment. Therefore, this review systematically summarizes the structure and function of the RhoA/ROCK signaling pathway, explores its mechanistic role in AP progression, and further discusses its potential clinical applications. By integrating existing research findings, this paper aims to provide new perspectives on the role of this signaling pathway in AP and offer a theoretical foundation for future basic research and clinical applications.

Abstract:Exocrine pancreatic insufficiency (EPI) is a condition caused by a reduction in the secretion or activity of pancreatic juice and its digestive enzymes, particularly pancreatic lipase. EPI can lead to symptoms such as abdominal pain, bloating, steatorrhea, malnutrition, and weight loss, and may even increase the risk of osteoporosis and cardiovascular diseases. Diagnosis mainly relies on direct and indirect functional tests, while treatment is centered on pancreatic enzyme replacement therapy combined with comprehensive management strategies. This article summarizes the research progress on the definition, common causes, diagnostic methods, treatment, and prevention strategies of EPI, aiming to provide insights for optimizing its diagnosis and management.