Objective:To evaluate the efficacy of pre fenestration vs left common carotid-left subclavian artery(LCCA-LSA) bypass for left subclavian artery (LSA) reconstruction in Stanford B aortic dissection patients undergoing thoracic endovascular repair(TEVAR).Methods:The clinical and follow-up data of 120 patients with Stanford type B aortic dissection who were treated with TEVAR and reconstructed by pre fenestration or LCCA-LSA bypass from Jul 2009 to Aug 2023 at the Department of Vascular surgery of Provincial Hospital, Shandong First Medical University were analyzed retrospectively.Results:Patients were retrospectively divided into pre fenestration group (40 cases) and hybrid repair (bypass) group (80 cases). The average operation time [(146.9±37.6) vs.(332.4±106.2)min, P<0.001] and hospital stay [(15.8±5.6) vs. (22.9±9.0)d P<0.001] in the pre fenestration group were lower than those in the hybrid repair group, and the preoperative complications in the pre fenestration group were slightly higher than that in hybrid repair group (97.5% vs. 91.3%). One patient in the pre fenestration group failed the surgery, and the technical success rate was 97.5%. The postoperative complications in the pre fenestration group were lower than hybrid repair group (22.5% vs. 26.3%). There was one experiencing secondary intervention in the pre fenestration group and 6 in the hybrid repair group. Two patients died postoperatively, all in hybrid repair group. Conclusion:Both pre fenestration and left common carotid-left subclavian artery(LCCA-LSA) bypass(hybrid procedure) are safe and feasible methods for reconstruction of LSA in Stanford B aortic dissection patients undergoing TEVAR.

Objective:To evaluate the diagnostic value of micro flow imaging (MFI) supported by Image Pro Plus (IPP) software for BI-RADS classification of breast nodules and the correlation between its parameters and Ki-67 expression level.Methods:A total of 205 cases of breast solid nodules with ultrasound BI-RADS classification of 4 categories were enrolled in this study. BI-RADS classification, CDFI score, MFI score, CDFI-IPP score and MFI-IPP score by IPP software were performed for each nodule. Ki-67 immunohistochemical staining of invasive ductal carcinoma was performed to analyze the correlation between MFI-IPP-VI and Ki-67 expression levels.Results:The combined BI-RADS classification for diagnosis of malignant nodules had the largest area under the ROC curve, which was significantly higher than that of BI-RADS, MFI-IPP-VI, MFI score, CDFI-IPP-VI, and CDFI score (all P<0.05). The combined BI-RADS classification had the best diagnostic efficacy for the diagnosis of malignant nodules with a sensitivity of 96.4%, specificity of 65.6% and accuracy of 82.4%. In addition, the agreement between experienced and inexperienced sonographers applying MFI-IPP-VI was higher than MFI (Kappa=0.780 vs. Kappa=0.743). The mean value of Ki-67 in invasive ductal carcinoma was 21.93%±16.37%, and Spearman's correlation analysis showed a positive correlation between MFI-IPP-VI and Ki-67 expression level ( r=0.815, P<0.05). Conclusions:MFI-IPP can assist sonographers to classify breast nodules by BI-RADS, providing an effective basis for puncture biopsy. MFI-IPP-VI offers the possibility of noninvasively predicting the expression level of Ki-67 in invasive ductal carcinoma.

Objective:To investigate the expression of Cullin associated NEDD8 dissociated protein 1 in colorectal cancer and its effect on the biological behavior of colorectal cancer.Method:A total of 70 pairs of colorectal cancer and paired normal tissue specimens were collected from Jun to Dec 2017 at the Department of Gastrointestinal Surgery at Peking University People's Hospital. Immunohistochemistry was used to detect the expression of Cullin associated NEDD8 dissociated protein 1 and analyze its relationship with clinical pathological indicators and prognosis. CCK8, colony formation assay, transwell assay, and wound healing assay were used to evaluate the effects of Cullin associated NEDD8 dissociated protein 1 on the proliferation, migration, and invasion ability of colon cancer cells.Result:Compared with normal tissues, Cullin associated NEDD8 dissociated protein 1 was highly expressed in colorectal cancer (Immunohistochemistry score: 3.685±1.257 vs. 2.000±0.851, Z=6.536, P<0.001). The expression level of Cullin associated NEDD8 dissociated protein 1 was significantly correlated with T stage ( χ2=5.67, P=0.017), N stage ( χ2=7.20, P=0.007), and pathology stage ( χ2=4.66, P=0.031). Patients with high expression of Cullin associated NEDD8 dissociated protein 1 had a worse prognosis than those with low expression ( χ2=4.80, P=0.037). Knocking down Cullin associated NEDD8 dissociated protein 1 significantly reduced the proliferation, colony formation, and invasive migration ability of DLD1 cells (all P<0.05). Conclusion:Cullin associated NEDD8 dissociated protein 1 is significantly overexpressed in colorectal cancer and has a promoting effect on the occurrence and development of colorectal cancer.

Objective:To explore the biological efficacy and molecular mechanism of the new 6449Da active peptide against gastric adenocarcinoma.Methods:Effect 6449Da active peptides on SGC-7901 gastric adenocarcinoma cells line was studied and mRNA and protein expression levels of key factors relating to apoptosis, proliferation and notch signaling pathway was detcted.Results:The 6449Da functional fragment WSGC peptide located on the cell membrane relatively specifically inhibited the growth of gastric adenocarcinoma cells, but had a weak effect on normal gastric mucosal cells [cell doubling time , SGC-7901, 1.2 μmol/ml: (38.22±6.80) h vs. 0 μmol/ml: (25.65±1.82) h, P<0.05; GES-1, 1.2 μmol/ml: (33.37±3.15) h vs. 0 μmol/ml: (29.25±1.26) h, P>0.05].After treatment of SGC-7901 cells by IC80 (48 h),the cell apoptosis rate was higher than that in the control group (IC80: 0.421±0.036 vs. control group: 0.028±0.004, P<0.001), while the cell proliferation coefficient,number of transmembrane invasive cells and relative migration rate were all lower than those of the control group (all P<0.01).Compared with the control group, the mRNA and protein expression levels of Bax and Caspase-3 were higher than those in the control group(all P<0.01).Compared with the control group, the mRNA and protein expression levels of Ki67, PCNA, NOTCH1,Jagged 1, MAML3, CSL and HES1 were significantly lower than those in the control group (all P<0.01).After treatment with WSGC bioactive peptides, tumor weight was significantly lower than that of the control group [40 nmol/g: (0.463±0.031) g, 80 nmol/g: (0.340±0.040) g vs. control group: (1.667±0.373) g, all P<0.01]. Conclusion:6449Da functional fragment WSGC active peptide relatively specifically interferes with the growth of gastric adenocarcinoma cells by inhibiting the Notch signaling pathway, and has the biological effects of promoting apoptosis,inhibiting proliferation, transmembrane invasion and migration.

Gastroesophageal reflux disease (GERD) is one of the most important diseases in the foregut surgery, and its treatment has evolved from the classical Nissen fundoplication to various modified surgical procedures with robotic assistance, which have significantly improved patient outcomes and quality of life. The complex association between sleeve gastrectomy and GERD has revealed the potential impact of surgery on the anatomical structures and anti-reflux barriers, driving the pace of research on combined procedures and novel surgical approaches. Future trends in the surgical management of GERD will focus more on individualized care, integrating techniques such as high-resolution esophageal manometry, 24 h esophageal impedance-pH monitoring, salivary pepsinogen testing, and endoscopy to optimize precise surgical management of GERD.

Gastroesophageal reflux disease (GERD), a common chronic disease of the digestive system, has a severe impact on the quality of life of patients and simultaneously increases the medical burden. The symptoms of GERD are diverse and atypical, and diagnosis requires a comprehensive assessment of symptoms, endoscopic findings, reflux monitoring, and therapeutic responses. Lifestyle interventions and pharmacological treatment remain the preferred basic treatment modalities for GERD, which have a favorable relieving effect on most of the population. Patients who do not respond to conservative treatment can undergo endoscopic anti-reflux surgery and surgical procedures. For patients with concomitant esophageal hiatal hernia, esophageal hiatal hernia repair can be performed simultaneously. With the high prevalence of obesity and the popularization of bariatric surgery, GERD in the obese population and those after bariatric surgery has gradually received more attention. This article summarizes the current status of the diagnosis and treatment of GERD and prospects the new technologies and research directions in the future.

Artificial intelligence (AI) technology is revolutionizing the precision diagnosis and treatment system in digestive system malignancies. In the preoperative stage, deep learning-driven multimodal data can significantly enhance the accuracy of early lesion detection and organ function assessment, while optimizing the prediction of the efficacy neoadjuvant therapy response with radiomics features. During surgery, the automatic surgical phase alorithm and intelligent pathology testing can effectively coordinate the surgical process; the combination of AI with augmented reality navigation system (AR) and mixed reality technology (MR) can improve the accuracy of intraoperative navigation; enhances intraoperative navigation accuracy; and the autonomous surgical robots can improve their ability to perform key tasks during surgery using sophisticated motion control algorithms. In postoperative management, federated learning promotes secure cross-institutional data sharing and alleviates the problem of data silos; and the development of interpretable models can also provide clearer decision-making basis for complication prediction and prognosis management. However, the current clinical translation process still faces three core challenges: (1) Quality control problems: the dual constraints of insufficient model generalization ability and lack of unified evaluation standards; (2) Methodological challenges: the logical opacity of decision-making and the cognitive barriers of the algorithm's causal reasoning process still affect its credibility; (3) Ethical and legal vacuum: the attribution of medical responsibility is unclear, and the legal system has not yet fully adapted to the development of AI applications. Based on this, the future should focus on: (1) Developing transparent AI systems to achieve a paradigm shift from "black box prediction" to "white box deductions"; (2) Establishing systematic AI evaluation standards and ethical and legal regulatory frameworks; (3) Promoting the construction of specialized biorepositories database and causal graph library for digestive oncology. The aim is to help AI upgrade from an auxiliary tool to an intelligent decision-making partner.

Objective:To compare the clinical outcomes of thoracic endovascular aortic repair (TEVAR) using self-radiopaque marker guided physician modified fenestration with stent-graft in situ fenestration technology with or without the implantation of branch stents for the treatment of aortic arch diseases.Methods:The clinical data of 653 patients with aortic arch diseases who underwent TEVAR using fenestration from Dec 2015 to Jun 2023 at two vascular surgery centers were retrospectively analyzed.Results:A total of 454 patients received branch stent implantation, while 199 did not. The incidence of non-aortic-related complications within 30 days post-operation was higher in the branch stent implantation group compared to the non-implantation group (8.6% vs. 3.5%, P=0.020). The overall follow-up rate was 93.8%, with median follow-up time of 37 months and 52 months for the branch stent implantation group and non-implantation group, respectively. Kaplan-Meier survival analysis showed no significant statistical difference between the two groups in terms of cumulative all-cause survival ( P=0.223), free from endoleak ( P=0.106), and free from branch artery occlusion ( P=0.130). Conclusions:The implantation of branch stents following in situ fenestration with stent-graft technology in TEVAR did not significantly affect overall survival, endoleak incidence, or branch artery occlusion rates in patients with aortic arch diseases. Therefore, the decision to implant branch stents should be tailored according to the specific pathology and anatomical characteristics of the aortic arch.

Objective:To investigate the effect of acellular dermal matrix (ADM) combined with hydroconductive dressing (HD) on wound healing of diabetic foot.Methods:In this study, 141 admitted patients with diabetic foot from Jun 2022 to Jun 2024 were randomly divided into three groups: control group, ADM group and ADM+HD group. The clinical data of all patients were collected and the differences of each index were compared.Results:There were 47 cases in each group. After 4 weeks of treatment, there were significant differences in wound area and VAS score among the three groups ( P<0.05). The number of ADM replacement in ADM+HD group was less and the incidence of adverse reactions was lower than that in ADM group ( P<0.05). Conclusion:ADM combined with HD has significant advantages in accelerating wound healing, relieving pain, reducing the number of dressing changes and reducing the incidence of infection.

Objective:To investigate and compare the short-term efficacy of robot-assisted versus laparoscopic sleeve gastrectomy with Dor fundoplication for the treatment of obesity with gastroesophageal reflux disease (GERD).Methods:A retrospective analysis was conducted on the clinical data of 46 patients with obesity combined with GERD who underwent robot-assisted sleeve gastrectomy combined with Dor fundoplication or laparoscopic sleeve gastrectomy combined with Dor fundoplication at the People's Hospital of Xinjiang Uygur Autonomous Region from May 2021 to Nov 2023. Patients were divided into the RSGFD group and the LSGFD group based on the surgical procedure. Perioperative parameters, weight loss outcomes, and changes in Gastroesophageal Reflux Disease Questionnaire (GERD-Q) scores were compared between the two groups.Results:There were no statistically significant differences between the two groups in terms of operative time, postoperative length of hospital stay, or postoperative complication rate (all P>0.05). Both groups showed significant decreases in weight and BMI at 6 months and 1 year postoperatively compared to preoperative values (all P<0.05). There were no statistically significant differences in %EWL and %TWL between the two groups at 6 months and 1 year postoperatively ( t=0.142, 0.437, 1.246, 1.898, all P>0.05). At 1 year postoperatively, GERD-Q scores were significantly decreased in both groups ( Z=-4.329, -3.879, both P<0.001). There was no statistically significant difference in GERD symptom improvement between the two groups ( Z=0.577, P=0.749). Conclusion:RSGFD and LSGFD demonstrate comparable efficacy in the treatment of obesity complicated by GERD.