Objective:To investigate the immuno-inflammatory regulatory effects of the Qing Gan San Jie Xiao Ying Formula(QGSJXYF)on Hashimoto's thyroiditis(HT)by modulating thyroid cell-derived exosomes to provide experi-mental evidence for its immunomodulatory mechanisms.Methods:Nthy-ori-3-1 thyroid cells were treated with QGSJXYF-medicated serum,with untreated cells serving as controls.Exosomes from both groups were extracted and analyzed using nanoparticle tracking analysis(NTA),transmission electron microscopy(TEM),and Western blot to assess concentration,size distribution,morphology,and the expression of characteristic exosomal markers.An inflammatory model of human T lymphocytes(H9)was established and co-incubated with normal exosomes(EXO-C group)or QGSJXYF-treated exosomes(EXO-T group).The levels of inflammatory cytokines in H9 cells were measured using Western blot(WB)and ELISA.Results:Exosome characterization showed that the particle concentration of Nthy-ori-3-1 cell-derived exosomes in both the control and QGSJXYF groups ranged from 1×109 to 1×1011/mL,with particle diameters between 80～300 nm.The exosomes exhibited a typical spherical or cup-shaped morphology with positive expression of TSG101,CD63,and HSP70.Compared with the inflammation model group and the EXO-C group,the EXO-T group significantly reduced the intracellular expression of IL-17A protein in H9 cells(P<0.05)and suppressed IL-17 and IL-6 levels in the cell supernatant(P<0.01).Conclusion:QGSJXYF may exert its anti-inflammatory and thyroid-protective effects by modulating the functional state of thyroid cell-derived exosomes,regulating the inflamma-tory microenvironment,and inhibiting the expression of inflammatory cytokines associated with Hashimoto's thyroiditis.

Objective:To investigate the impact of fibroblast growth factor(FGF)on recurrence following segmen-tal mastectomy in patients with plasma cell mastitis.Methods:A total of 162 female patients diagnosed with plasma cell mastitis(PCM)were selected from our hospital from October 2021 to May 2023.All patients underwent segmental mastectomy.They were divided into recurrence group(n=28)and non-recurrence group(n=134)according to the follow-up survey on recurrence.Conduct a univariate analysis on the factors influencing recurrence in patients with PCM who undergo segmental mastectomy.After correcting for confounding factors,conduct a multiple linear regression analysis.Using a multivariate logistic regression model to explore the independent risk factors for recurrence in patients undergo-ing segmental mastectomy for PCM.Utilizing logistic regression analysis to explore the independent,multiplicative,or additive interaction between FGF and angiogenic factor in the management of recurrence in PCM patients undergoing segmental mastectomy.The Local Weighted Regression Scatter Method(LOWESS)is used to analyze the two-dimensional curve relationship of continuous variables.Evaluate the predictive efficacy of FGF for PCM recurrence fol-lowing segmental mastectomy using Receiver Operating Characteristic(ROC)curves.Results:The results of univariate analysis showed that the body mass index(BMI),estradiol,prolactin levels,nipple depression,and sinus phase propor-tion of patients in the recurrent group were significantly higher than those in the non recurrent group,and the differ-ences were statistically significant(P＜0.05).Before surgery and 1 and 3 months after surgery,the levels of FGF,vascu-lar endothelial growth factor(VEGF),endostatin(ES),and VEGF/ES in the recurrent group were higher than those in the non recurrent group,with statistically significant differences between the groups(P＜0.05).The intra group comparison results showed that compared with before surgery,all indicators in both groups of patients were significantly reduced at 1 month after surgery(P＜0.05),while in the recurrent group,all indicators were significantly increased at 3 months after surgery(P＜0.001).Logistic regression analysis showed that patients with elevated FGF had a higher risk of recurrence in PCM(P＜0.05).LOWESS analysis found that there is a certain non-linear relationship between PCM recurrence rate and FGF.FGF has good predictive performance for PCM recurrence.After further adjusting for various confounding fac-tors such as BMI,it was found that the angiogenic factor is related to FGF.The interaction results show that there is an additive or multiplicative interaction between FGF and VEGF/ES.Conclusion:FGF elevation increases the risk of re-currence after segmental mastectomy for PCM.FGF and VEGF/ES exhibit additive or multiplicative interactions.FGF has good predictive performance for PCM recurrence.

Objective:To investigatetheclinicalefficacy and satetyoflaparoscopic abdominoperineal resection with pelvicperitoneum colsure for low rectal cancer.Methods:A comprehesive search was conducted across multiple da-tabases,including the Cochrane Library、PubMed、Embase、CBM、VIP、CNKI、and WanFang Data,focusing on studies re-lated to pelvic peritoneum colsure(PPC)-oriented laparoscopic abdominoperineal resection from database inception to July,2024.Then,meta-analysis was performed using RevMan 5.3 software.Results:A total of 12 studies involving 999 patients were included.The results showed that there was no significant difference in intraoperative blood loss.The laparoscopic pelvicperitoneum colsure takes a longer time,with a statistically significant difference(WMD=12.37,95%CI=2.27～22.46,P=0.02),but the postoperative exhaust time and hospitalization time are shorter,with a statistically significant difference(WMD=0.40,95%CI=0.07～0.72,P=0.02;WMD=-2.36,95%CI=-3.33～-1.38,P＜0.00001).In terms of postoperative complications,the overall complication rate was higher in the group that did not undergo pelvic-peritoneum colsure,with a statistically significant difference(OR=0.12,95%CI=0.08～0.18,P＜0.00001).The incidence of postoperative intestinal obstruction,perineal incisional hernia,pelvic effusion infection,and radiation enteritis was higher,and the differences were statistically significant(OR=0.24,95%CI=0.13～0.45,P＜0.00001,OR=0.23,95%CI=0.11～0.49,P=0.0001,OR=0.27,95%CI=0.14～0.51,P＜0.0001,OR=0.24,95%CI:0.07～0.81,P=0.03).Conclusion:In lapa-roscopic abdominoperineal resection,closing the pelvicperitoneum has lower postoperative complications,shorter post-operative exhaust time and hospitalization time,and longer operation time,which has better clinical efficacy and safety.

Pancreatic surgery remains one of the most challenging fields in general surgery due to its complex anatomy and high risk of complications.In recent years,the integration of digital intelligent technologies-such as three-dimensional(3D)reconstruction,fluorescence navigation,augmented/mixed reality(AR/MR),and artificial intelligence(AI)-has provided new strategies for achieving precision,safety,and intelligence in pancreatic surgery.This review summarizes the innovations and clinical applications of these technologies throughout the full perioperative process,including preoperative planning,intraoperative navigation,and postoperative monitoring.Preoperatively,the deep learning-based nnU-Net framework enables high-precision 3D reconstruction of peripancreatic vessels and pancreaticobiliary ducts for individualized surgical planning.Intraoperatively,multimodal image fusion combining indocyanine green fluorescence imaging with AR/MR navigation allows real-time visualization and spatial localization of key anatomical structures,enhancing surgical accuracy and safety.Postoperatively,AI-driven models integrated with wearable sensors and multimodal data support intelligent risk prediction and early intervention for complications.The systematic application of digital intelligence is reshaping the paradigm of pancreatic surgery,driving the transition from experience-based to data-driven and from surgeon-dependent to intelligent decision-making.With continuous algorithmic refinement and accumulation of clinical evidence,digital empowerment will further advance pancreatic surgery toward personalization,precision,and intelligence.

Background and Aims:Gastric cancer remains a common malignancy worldwide with a poor prognosis and limited response to current therapies.Ferroptosis,a novel form of regulated cell death,has emerged as a promising therapeutic target in cancer.Terminal nucleotidyltransferase 5B(TENT5B)is downregulated in various tumors,but its role in gastric cancer and ferroptosis remains unclear.This study aimed to investigate the expression pattern and biological function of TENT5B in gastric cancer and to elucidate its underlying mechanisms in regulating ferroptosis.Methods:The expression of TENT5B in gastric cancer was analyzed using TCGA and GEO datasets,and further validated in gastric cancer tissues and cell lines by qRT-PCR and Western blotting.CCK-8,colony formation,wound healing,and Transwell assays were performed to evaluate the effects of TENT5B overexpression on cell proliferation and migration.Ferroptosis was assessed by measuring cell viability,lipid ROS,and MDA levels.Bioinformatics analysis,mRNA stability assays,and rescue experiments were conducted to explore the molecular mechanisms.A subcutaneous xenograft mouse model was used to validate the in vivo effects.Results:TENT5B was significantly downregulated in gastric cancer tissues and cells.Overexpression of TENT5B inhibited cell proliferation and migration while promoting ferroptosis.Mechanistically,TENT5B enhanced PRKAA2 mRNA stability and upregulated its expression,thereby exerting tumor-suppressive effects.In vivo,TENT5B overexpression suppressed tumor growth and elevated PRKAA2 expression.Conclusion:TENT5B functions as a tumor suppressor in gastric cancer by stabilizing PRKAA2 mRNA,promoting ferroptosis,and inhibiting cancer progression.These findings suggest that TENT5B may serve as a promising molecular target for ferroptosis-based therapeutic strategies in gastric cancer.

Pancreatic duct stents are essential devices for managing chronic pancreatitis,ductal strictures,and postoperative fistula.Conventional plastic and metal stents effectively facilitate pancreatic drainage but often cause infection,restenosis,or migration upon long-term implantation.An ideal stent should provide excellent biocompatibility,efficient drainage,and controllable biodegradation.With advances in material science and medical-engineering integration,stent technology has evolved from inert implantation to intelligent degradation.Biodegradable polymers and metals,particularly magnesium alloys(Mg-Zn-Mn),offer tunable mechanical strength,corrosion resistance,and in vivo degradability.Mg-2Zn-1.0Mn alloy achieves balanced strength and corrosion control through compositional optimization and surface modification.Polymeric stents such as polylactic acid and polydioxanone demonstrate favorable drainage and avoid secondary removal.Composite biodegradable stents,exemplified by the multi-rate ARCHIMEDES model,have received international approval.Supported by 3D printing and smart functionalization-such as drug-eluting or shape-memory designs-next-generation pancreatic stents may achieve integrated functions of support,repair,and tumor inhibition.Future research should emphasize interdisciplinary material design,degradation kinetics under physiological conditions,and long-term biocompatibility to accelerate clinical translation.

Pancreatic cancer is highly aggressive and often diagnosed at an advanced stage,leaving most patients ineligible for radical resection.This study retrospectively analyzed four patients with locally advanced or advanced pancreatic cancer to evaluate the clinical efficacy and safety of high-intensity focused ultrasound(HIFU)ablation combined with chemotherapy as a neoadjuvant and conversion therapy.All cases were reviewed and individualized treatment plans were formulated through a multidisciplinary team evaluation.All patients received HIFU plus gemcitabine and nab-paclitaxel chemotherapy,with assessments of tumor volume,vascular involvement,surgical conversion,symptom relief,and adverse events.Three patients achieved marked tumor shrinkage and reduction of vascular invasion,enabling successful R0 resection without recurrence during follow-up.The remaining patient achieved disease stability,significant pain relief,and maintained good quality of life under repeated HIFU therapy.All treatments were well tolerated,and no severe adverse reactions occurred.The combination of HIFU and chemotherapy demonstrated synergistic local and systemic effects,effectively achieving tumor downstaging,improving resectability,and alleviating symptoms.As a safe,noninvasive,and repeatable therapeutic approach,this strategy offers a promising option for patients with advanced pancreatic cancer.Further large-scale prospective studies are warranted to validate its long-term efficacy and elucidate underlying mechanisms.

Background and Aims:Pancreatic cancer is one of the most aggressive malignancies of the digestive system and is associated with an inferior prognosis.In recent years,its incidence has shown a trend toward younger onset.Early-onset pancreatic cancer(EOPC),defined as pancreatic cancer diagnosed at≤50 years of age,has been increasing annually and may possess distinct biological and prognostic characteristics.Given the limited data from China,this study aimed to investigate the clinicopathological features and prognostic outcomes of EOPC patients.Methods:Clinical data of 113 patients with EOPC admitted to Xiangya Hospital,Central South University,from January 2017 to December 2023 were retrospectively analyzed.Variables included demographic characteristics,clinicopathological features,and survival information.Kaplan-Meier survival curves were plotted,and differences in survival between the surgical and non-surgical groups were compared.Results:The median age at diagnosis was 46(42-49)years,and males accounted for 65.49%of cases.Blood type A(40.71%)and type O(34.51%)were most common.The main presenting symptoms were abdominal pain(69.91%),weight loss(62.83%),jaundice(43.36%),and abdominal distension(36.28%).Imaging findings showed bile duct dilation in 32.74%,pancreatic duct dilation in 39.82%,vascular invasion in 59.29%,and distant metastasis in 52.21%of patients.Histopathology revealed that adenocarcinoma and ductal adenocarcinoma accounted for 93.81%of all cases,with predominantly moderate or poor differentiation(76.10%).Tumors were the most frequently located in the pancreatic head(65.42%).TNM staging showed lymph node metastasis in 77.88%and stage Ⅳ disease in 52.21%.Laboratory tests demonstrated markedly elevated CA19-9 levels.Kaplan-Meier analysis indicated a median overall survival of 18.6 months for the entire cohort,with significantly longer survival in the surgical group compared with the non-surgical group(29.4 months vs.13.8 months,P=0.001 5).Conclusion:EOPC predominantly affects males and tends to arise in the pancreatic head.It is often diagnosed at an advanced stage or with distant metastasis and is characterized by poor differentiation and strong invasiveness.Surgical resection markedly improves survival and remains the key to prolonged prognosis.Young individuals presenting with unexplained abdominal pain,weight loss,or jaundice should be carefully evaluated through imaging to enable early diagnosis and timely surgical intervention.Future multicenter,large-sample prospective studies are warranted to validate these findings further.

Objective:Based on multivariate analysis of the influencing factors of fecal pollution after radical re-section in children with congenital megacolon,a risk prediction model was constructed and evaluated.Methods:A total of 200 children with Hirschsprung's disease who underwent radical surgery at Nanyang Central Hospital of Henan Province from June 2020 to June 2023 were selected,and all children were followed up for 1 year.According to the occurrence of postoperative fecal incontinence,the children were divided into the non-occurrence group and the oc-currence group.Univariate Logistic regression analysis was performed on all possible influencing factors,and the back-ward stepwise regression method was used to screen out the relevant factors affecting postoperative fecal inconti-nence in children with Hirschsprung's disease after radical surgery.A risk prediction model was constructed based on these relevant factors,and its efficacy was verified using calibration curves,the Hosmer-Lemeshow test,and ROC curves.Results:Postoperative fecal incontinence occurred in 19.50%(39/200)of the children.A statistically signifi-cant difference was observed between the non-occurrence group and the occurrence group in terms of the following data(P＜0.05):age,preoperative nutritional support,need for auxiliary defecation before surgery,length of the dis-eased intestinal segment,educational level of caregivers,preoperative hypoproteinemia,resection range,postoperative diet compliance of the children,postoperative defecation training of the children,postoperative enterocolitis,and post-operative anal dilatation therapy.Multivariate Logistic regression analysis showed that preoperative nutritional support,need for auxiliary defecation before surgery,length of the diseased intestinal segment,educational level of caregivers,postoperative diet compliance of the children,postoperative defecation training of the children,postoperative entero-colitis,and postoperative anal dilatation therapy were all independent influencing factors for postoperative fecal inconti-nence in children with Hirschsprung's Disease after radical surgery(P＜0.05).Among these factors,the educational level of caregivers was the strongest predictor of postoperative fecal incontinence in children with Hirschsprung's dis-ease after radical surgery.Results of the calibration curve showed that the concordance index of the risk prediction model for postoperative fecal incontinence in children with Hirschsprung's Disease after radical surgery was 0.837.The Hosmer-Lemeshow test results indicated no statistically significant difference between the predicted values and the actual values of risk prediction(P＜0.05),suggesting that the model had a good fit and high prediction accuracy.Re-sults of the ROC curve showed that the area under the curve(AUC)of the risk prediction model for predicting postop-erative fecal incontinence in children with Hirschsprung's Disease after radical surgery was 0.887(95%CI:0.762～1.000,P＜0.05),with a sensitivity of 0.914,a specificity of 0.763,and a Youden index of 0.677.These findings indicate that the risk prediction model has moderate discriminative ability and good predictive performance.Conclusion:Preop-erative nutritional support,need for auxiliary defecation before surgery,length of the diseased intestinal segment,edu-cational level of caregivers,postoperative diet compliance of children,postoperative defecation training of children,postoperative enterocolitis,and postoperative anal dilatation therapy are all independent influencing factors for postop-erative fecal incontinence in children with Hirschsprung's disease after radical surgery.The risk prediction model for postoperative fecal incontinence in children with Hirschsprung's disease after radical surgery,established based on multivariate analysis,is helpful for early identification of high-risk groups and timely implementation of individualized in-tervention measures.

Objective:To systematically explore the expression characteristics,molecular functions,and clinical prognostic associations of the SNX22 in thyroid carcinoma(THCA)through bioinformatics analysis and clinical data vali-dation,providing a novel perspective for precision medicine in thyroid cancer.Methods:Gene expression and clinical data of THCA were obtained from the TCGA and GEO databases(GSE3678,GSE65144,GSE82208).R software was used for data preprocessing,differentially expressed gene(DEG)screening,and survival analysis.The expression pat-terns,prognostic value,and immune regulatory roles of SNX22 were evaluated using PPI networks,TIMER/SCNA im-mune correlation analysis,and ESTIMATE scores.Results:Thirteen intersecting DEGs were identified from GEO data-sets,with SNX22 showing significantly higher expression in THCA tumor tissues than in normal tissues(P<0.05).Kaplan-Meier analysis revealed that high SNX22 expression was significantly associated with overall survival(OS)in THCA pa-tients(P=0.001,HR=1.70),with an ROC curve AUC of 0.745.Subgroup analysis indicated significantly elevated SNX22 expression in patients aged≤45 years and with N1 staging(P<0.05).Immune correlation analysis showed that SNX22 expression positively correlated with infiltration of multiple immune cells(P<0.05),while copy number deletions were as-sociated with reduced immune cell infiltration(P<0.05).Conclusion:SNX22 is highly expressed in thyroid cancer and is significantly associated with poor prognosis and immune microenvironment remodeling,thus having the potential to serve as a prognostic marker and immunotherapy target.