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.

Chronic constipation is a common functional bowel disorder that significantly impacts patients'quality of life and mental health.The Surgical Diagnosis and Treatment Guidelines for Constipation were first published in 2008 and revised in 2017,respectively,and have contributed to the growth of constipation surgery in China.With a deeper understanding of the underlying mechanisms and advancements in minimally invasive surgical techniques,the branch has again assembled multidisciplinary experts to enhance the diagnosis and treatment system.Based on the latest local and global evidence and utilizing the GRADE system to assess the quality of evidence and strength of recommendations,they have developed the Guidelines for Surgical treatment of constipation(2025 Edition).The new edition systematically updates information on causes,diagnostic methods,and non-surgical and surgical treatment options for constipation.It clearly defines surgical indications and principles for procedure selection,emphasizing personalized treatment and evidence-based decision-making.This guideline aims to standardize diagnosis and treatment,improve clinical decision-making,and promote consistency and effectiveness in surgical approaches for treating constipation.

Obesity is a major global public health challenge and a leading cause of multiple metabolic disorders,including hypertension and diabetes.In China,more than half of the adult population is overweight or obese.While anti-obesity pharmacotherapies(such as GLP-1 receptor agonists)and bariatric surgery have both advanced rapidly,strategies for integrating these two modalities remain unclear.In particular,controversies persist regarding surgical eligibility after drug discontinuation,and standardized clinical guidelines are lacking.In July 2025,the International Federation for the Surgery of Obesity and Metabolic Disorders released the world's first statement focusing on"metabolic bariatric surgery after pharmacotherapy-induced weight loss",which emphasizes the chronic disease model of obesity management and clarifies the synergistic relationship between pharmacotherapy and surgery.This article interprets the statement from the perspectives of treatment strategies,surgical eligibility,and drug-surgery coordination,aiming to provide evidence-based reference for clinicians and to promote standardized,integrated obesity management.

Complex rectal cancer often requires extended multivisceral resection beyond the total mesorectal excision plane or lateral lymph node dissection(LLND)beyond the conventional range.Owing to the deep pelvic location,limited operating space,and complex local anatomy,conventional open or laparoscopic surgery is associated with restricted visualization,technical difficulty,and increased surgical risk.With the advancement of robot-assisted surgical technology,its high-definition three-dimensional vision,articulated robotic arms with multiple degrees of freedom,and ergonomic improvements effectively overcome the limitations of traditional laparoscopy,allowing precise manipulation in narrow pelvic spaces.These advantages have made robotic surgery increasingly valuable in complex rectal cancer procedures such as LLND and multivisceral resection.This review summarizes recent literature and the authors'clinical experience to discuss the feasibility,advantages,and limitations of robotic-assisted rectal cancer surgery.

Laparoscopic intersphincteric resection(ISR)represents a key technique for achieving maximal sphincter preservation in ultra-low rectal cancer.Based on 400 cases of surgical experience,this study proposes a series of systematic strategies addressing some major technical challenges of ISR.To facilitate precise dissection of the intersphincteric space,a"knife-edge position transanal-priority"approach was adopted,improving exposure and reducing the risk of circumferential margin positivity.To prevent and reduce anastomotic leakage,ISR combined with the modified Bacon(Turnbull-Cutait)delayed anastomosis was introduced as a"stoma-free but safe"alternative.For large anastomotic disruptions,a stoma-therapist-involved management protocol with transanal"U-shaped"repair was implemented to promote healing.Furthermore,a transabdominal levatorplasty was explored to enhance pelvic floor support and improve postoperative continence.Our initial experience suggests that,these strategies contribute to optimizing the balance between oncological radicality and functional preservation,offering a practical and individualized pathway for sphincter-saving surgery in ultra-low rectal cancer.

Background and Aims:Endovascular repair of aortic arch diseases poses a major challenge in vascular surgery due to the need to both effectively exclude the lesion and preserve perfusion of supra-aortic branch vessels.The Castor branched aortic covered stent,with its integrated design and ability to maintain left subclavian artery(LSA)patency,offers potential advantages.When combined with the chimney technique for the left common carotid artery(LCCA),it may provide a minimally invasive and feasible solution for patients with insufficient proximal landing zones.This study aims to evaluate the preliminary feasibility and safety of this combined approach and provide clinical reference for the endovascular management of complex aortic arch pathologies.Methods:A retrospective analysis was conducted on 15 patients with aortic arch diseases who underwent treatment with the Castor branched stent-graft combined with LCCA chimney stenting at the Second Xiangya Hospital of Central South University between February 2023 and December 2024.Baseline characteristics,surgical procedures,perioperative complications,and follow-up outcomes were analyzed to assess technical success,complication rates,and branch vessel patency.Results:Among the 15 patients(11 males,average age 63.8 years),primary diagnoses included aortic dissection(33.4%),aortic arch aneurysm(53.3%),and penetrating aortic ulcer(13.3%).The technical success rate was 100%,with no perioperative deaths or major complications.During the follow-up period(4-26 months,mean 12.9 months),no adverse events such as stroke,paralysis,endoleak,or stent migration occurred.The patency rate of both the LCCA and LSA remained 100%.Conclusion:The Castor branched aortic stent-graft combined with LCCA chimney technique appears to be a technically feasible and safe short-term option for treating aortic arch diseases with insufficient proximal landing zones.It may serve as a promising alternative for complex aortic arch repair;however,large-scale,multicenter studies with long-term follow-up are needed to further validate its efficacy and safety.

Carbon dioxide(CO2),a colorless,odorless,low-density negative contrast agent with no nephrotoxicity or allergic reactions,has seen increasingly widespread application in the field of vascular imaging in recent years,particularly in patients with iodine allergy or renal insufficiency.When combined with digital subtraction angiography,CO2 angiography has demonstrated high-quality imaging in various arterial and venous sites such as the abdominal aorta,renal arteries,iliac arteries,lower limb arteries,and inferior vena cava.It has also shown safety and efficacy in clinical scenarios such as peripheral arterial disease,dialysis access evaluation,and transjugular intrahepatic portosystemic shunt procedures.This review systematically summarizes domestic and international research progress on CO2 angiography,outlines its physicochemical properties,injection dosages and parameters,clinical indications,and imaging characteristics,and compares its image quality with that of iodine-based contrast agents.Common complications,their mechanisms,and preventive measures are also discussed.Although the image quality of CO2 is slightly inferior to that of iodine agents,it remains sufficient for most diagnostic and therapeutic needs,with a low overall incidence of mainly mild and transient adverse effects.With the development of automated injection systems and digital variance angiography technology,CO2 imaging quality is expected to continue improving,and its application scope is likely to expand further.Future efforts should focus on strengthening multicenter clinical research and establishing standardized operational protocols to promote the broader adoption and regulated use of this technology.

Background and Aims:Laparoscopic anatomical liver segmentectomy has been widely applied in the surgical treatment of hepatic tumors due to its safety,feasibility,and effectiveness.The combination of indocyanine green(ICG)fluorescence-guided positive staining and intraoperative laparoscopic ultrasound has become an important technique for precision liver resection,particularly in accurately delineating hepatic segment/subsegment boundaries and achieving negative surgical margins.This study reports a case of anatomical resection of the right posterior segment and the dorsal subsegment of the right anterior segment of the liver,guided by laparoscopic ultrasound combined with ICG positive staining,to evaluate its clinical feasibility and outcomes.Methods:A retrospective analysis was conducted on an elderly female patient with a hepatic space-occupying lesion who underwent laparoscopic anatomical resection of the right posterior segment and right anterior dorsal subsegment using intraoperative ultrasound combined with ICG fluorescence-guided positive staining.Results:Preoperative three-dimensional reconstruction revealed that the tumor was located in the right posterior segment and right anterior dorsal subsegment.Intraoperatively,under laparoscopic ultrasound guidance,the anterior-ventral branch of the right portal vein was punctured and injected with ICG to achieve precise staining of the right anterior-ventral subsegment.The resection was performed along the fluorescent boundary,enabling accurate anatomical removal of the targeted liver segments.Intraoperative blood loss was approximately 100 mL without transfusion.Pathology confirmed a moderately differentiated small-duct type intrahepatic cholangiocarcinoma with negative margins(R0 resection).The patient recovered well and was discharged on postoperative day 19.Follow-up CT at 6 months showed no evidence of recurrence.Conclusion:During anatomical resection of the right posterior segment and right anterior dorsal subsegment of the liver,laparoscopic ultrasound combined with ICG fluorescence-guided positive staining can accurately define segmental boundaries,enhance surgical safety,and ensure complete tumor resection,thus offering significant value in achieving R0 resection.

Background and Aims:Spontaneous isolated superior mesenteric artery dissection(SISMAD)is a relatively common type of visceral artery dissection,typically presenting with acute abdominal pain.In severe cases,it may lead to intestinal ischemia or even necrosis.With the widespread use of imaging techniques such as CT angiography(CTA),the detection rate of SISMAD has significantly increased.However,there is still controversy regarding its optimal treatment strategy,especially in choosing between conservative management and endovascular intervention,as no unified standard currently exists.This study aimed to compare the short-and medium-term outcomes of the two treatment modalities by retrospectively analyzing the clinical data of SISMAD patients treated at our center in order to provide evidence for individualized treatment decisions.Methods:A retrospective analysis was conducted on 174 patients diagnosed with SISMAD at Ningbo Second Hospital between January 2018 and December 2023.Among them,30 patients received conservative treatment,and 144 underwent endovascular intervention(including stent implantation alone or in combination with coil embolization of the false lumen).All patients were diagnosed using CTA or superior mesenteric artery angiography and classified accordingly.Patients were followed up at 1 month and 1 year after treatment to assess clinical symptom relief and radiological outcomes,including dissection remodeling and stent patency.Results:In the conservative group,the symptom relief rate was 90.0%at 1 month and 92.8%at 1 year;in the interventional group,the corresponding rates were 99.3%and 98.6%.The difference in symptom relief at 1 month was statistically significant(P=0.016),while the difference at 1 year was not(P>0.05).Subgroup analysis by classification showed that the interventional group generally had higher symptom relief rates than the conservative group across all types.However,none of the differences reached statistical significance(all P>0.05).The conservative group showed poorer symptom control in type Ⅲpatients,including one death.The technical success rate of endovascular treatment was 99.3%,with no cases of stent displacement or occlusion within 1 year.The complete remodeling rate was 86.8%,and the stent patency rate was 100.0%.Some patients had minor mural thrombus formation within the stent without evidence of flow obstruction.Conclusion:Endovascular intervention offers a high technical success rate and favorable short-and medium-term efficacy in SISMAD patients,particularly for type Ⅱ and Ⅲ cases with compromised true lumen perfusion.Treatment strategies should be tailored based on the dissection type and the degree of true lumen compression to improve clinical outcomes and reduce associated risks.

Background and Aims:Totally implantable venous access port(TIVAP)are widely used for chemotherapy,blood transfusion,and nutritional support in patients with malignancies.Among them,upper arm port(UAP)are increasingly recommended in clinical practice due to their advantages in avoiding thoracic complications and providing more concealed incisions.Currently,two main implantation techniques are used for UAP:the tunnel needle-transverse incision technique and the puncture point-transverse incision technique.This study aims to compare the clinical outcomes of these two techniques in patients with hematological malignancies,focusing on safety and cosmetic appearance,to provide evidence for clinical decision-making.Methods:A retrospective analysis was conducted on 412 patients with hematological malignancies who underwent UAP implantation at Xiangya Hospital of Central South University between December 2021 and December 2024.Based on the implantation method,patients were divided into the tunnel needle-transverse incision group(n=200)and the puncture point-transverse incision group(n=212).Intraoperative variables(operative time,intraoperative pain score,catheter kinking at the pocket,intraoperative blood loss)and postoperative indicators(incidence of complications and incision aesthetic satisfaction)were compared between the two groups.Results:There were no significant differences in baseline characteristics between the two groups(all P>0.05),indicating comparability.The puncture point-transverse incision group showed superior performance in operative time[(32.99±4.91)min vs.(41.42±5.35)min],catheter kinking rate(1.4％vs.8.5％),and incision aesthetic satisfaction(7.99±0.58 vs.6.26±0.86)compared with the tunnel needle-transverse incision group(all P<0.05).Although the puncture point group had slightly more intraoperative bleeding[(4.52±1.02)mL vs.(4.16±0.83)mL],the difference,while statistically significant,was of limited clinical relevance.No significant differences were observed between the two groups in intraoperative pain scores or incidence of postoperative complications(both P>0.05).Conclusion:The puncture point-transverse incision technique offers significant advantages in terms of operative efficiency,reduced catheter kinking,and improved incision aesthetics,without compromising safety.It represents a promising alternative to the traditional tunnel needle-transverse incision method and has strong potential for broader clinical adoption.The puncture point-transverse incision technique offers advantages such as shorter operative time,lower catheter kinking rate,and higher incision aesthetic satisfaction.It is a promising alternative to the traditional tunnel needle-transverse incision technique and has good potential for clinical application and promotion.