Objective:To investigate the causal effects of plasma lipidomics on pancreatitis using Mendelian ran-domization(MR)and evaluate the roles of intra-pancreatic fat deposition(IPFD)and gallstone disease in this relation-ship.Methods:A bidirectional MR analysis was conducted,with 179 plasma lipids as exposures and acute pancreati-tis(AP)and chronic pancreatitis(CP)as outcomes.Data were sourced from genome-wide association studies(GWAS),the UK Biobank,and the FinnGen project.Two-step Mendelian randomization(TSMR)and multivariable Mendelian ran-domization(MVMR)analyses were applied to assess the mediating roles of IPFD and gallstone disease in the associa-tion between plasma lipids and pancreatitis.Results:MR analysis identified two sterols negatively associated with AP(P＜0.05)and seven sterols negatively associated with CP(P＜0.05).One phospholipid showed a positive association with CP(P＜0.05).IPFD was positively associated with both AP and CP.Gallstone disease was confirmed as a risk fac-tor for AP.However,TSMR analysis indicated that neither IPFD nor gallstone disease mediated the relationship be-tween plasma lipids and pancreatitis.Conclusion:The causal relationship exists among plasma lipomics and AP/CP,also between IPFD,cholelithiasis and pancreatitis.These findings highlight novel risk factors and potential biomarkers to support early diagnosis and intervention for pancreatitis.

Objective:To investigate biomarkers that are significantly associated with the immune checkpoint(ICs)genes of colorectal cancer(CRC)and have a key impact on the prognosis of patients,and to search for related sensitive drugs by using bioinformatics methods.Methods:Genes with up-regulated expression in TCGA database and associated with poor prognosis of patients were screened,and molecules with high correlation with immune checkpoint were extracted to verify their impact on the prognosis of patients with colorectal cancer.Finally,their im-pact on immune cell infiltration and correlation were detected,and sensitive drugs that act on target genes were ana-lyzed and searched.Results:Colorectal cancer patients with up-regulated expression of tissue inhibitor of metallo-proteinase 1(TIMP1)had poor prognosis.Different TIMP1 expression levels showed significant differences in the infil-tration levels of various immune cells.Further drug sensitivity analysis predicted that bleomycin and middotolin could be highly sensitive to samples with high TIMP1 expression.Conclusion:TIMP1 is expected to be a new predictive biomarker to identify the benefits of cancer immunotherapy,and bleomycin and middotolin may be potential individualized treatment options for patients with high expression of TIMP1.

Objective:To investigate the relationship between the longitudinal trajectory of perioperative changes in TSH and recovery after microwave ablation of benign thyroid nodules.Methods:251 BTN patients admitted to our hospital from October 2021 to October 2024 were selected as the study subjects,and the group-based trajectory mod-eling(GBTM)model grouping principle was applied to determine the development trajectory of TSH levels.Multiple lin-ear regression was used to analyze the relationship between thyroid function and serum inflammatory factors before and after surgery in patients with different TSH level development trajectories;Cox regression was used to analyze the relationship between TSH level change trajectories and therapeutic efficacy and trend test was performed;binary log-binomial regression model was applied to calculate the relative risk(RR)of postoperative complication rates in different groups of patients.Results:In patients with BTN,four different trajectories of TSH level development were identified:low-stable(90 cases),low-growth(47 cases),medium-growth(63 cases),and high-growth(51 cases).There was a sta-tistically significant difference in surgical efficacy between the developmental trajectories of different TSH levels(P＜0.05),and the low-stable type had the highest apparent and overall efficacy rates,followed by the low-growth type.The postoperative and preoperative thyroid function indexes and serum inflammatory factors of patients with different TSH level development trajectories showed statistical differences(P＜0.05),the postoperative index levels of FT3 and FT4 were lower than preoperative,and the postoperative index levels of IL-8,hs-CRP,and TNF-α were higher than the preoperative ones,and the postoperative indexes of thyroid function(FT3,FT4)and serum inflammatory factors of the four groups of patients(IL-8,hs-CRP,TNF-α)showed statistically significant differences(P＜0.05).The results of multiple linear regression showed that TSH levels were negatively correlated(P＜0.05)with thyroid function indices(FT3,FT4)and positively correlated(P＜0.05)with serum inflammatory factors(IL-8,hs-CRP,TNF-α).The results of COX re-gression analysis showed that the difference in trend test was statistically significant(P＜0.001)among low-growth,medium-growth,and high-growth types,using low-stable type as a reference.The difference in the total postopera-tive complication rate among the four groups was statistically significant(P＜0.05),and the risk of total postoperative complications was elevated in patients with low-growth,medium-growth,and high-growth types compared with low-stable types(RR>1,P＜0.05).Conclusion:TSH levels were closely associated with recovery after microwave ablation of benign thyroid nodules,TSH levels were negatively correlated with FT3 and FT4,and positively correlated with IL-8,hs-CRP,and TNF-α.The low-stabilized type had the highest apparent and total efficiency,followed by the low-growth type.

Objective:To analyze the clinical and ultrasonographic characteristics of papillary thyroid carcinoma(PTC)and explore their correlation with cervical lymph node metastasis(CLNM),thereby constructing a nomogram pre-diction model for assessing the risk of CLNM in PTC.Methods:A total of 553 patients(corresponding to 553 nod-ules)with papillary thyroid carcinoma(PTC),confirmed by postoperative pathology,who underwent ultrasonography and had complete clinical data at the Second Hospital of Shandong University between December 2019 and December 2022,were included.228 patients(228 nodules)hadcervical lymph node metastasis,and 325 patients(325 nodules)were without cervical lymph node metastasis.All patients were categorized into metastasis and non-metastasis groups based on the presence or absence of cervical lymph node metastasis.These groups were then randomly di-vided into training and validation sets in a 7:3 ratio.Differences in clinical and ultrasonographic characteristics between the two groups were compared,and a nomogram was constructed.Results:Univariate analysis revealed statistically significant differences between the metastasis group and the non-metastasis group in terms of age,presence of Hashimoto's thyroiditis,multifocality,taller-than-wide shape,calcification,capsular contact,and blood flow(P<0.05).Logistic regression analysis in the training set indicated that age,presence of Hashimoto's thyroiditis,multifocality,taller-than-wide shape,calcification,and blood flow were associated with lymph node metastasis in papillary thyroid carcinoma(PTC)(P<0.05).These indicators were incorporated into a nomogram model,which demonstrated high predictive performance,good calibration,and significant clinical utility in both the training and validation sets.Conclu-sion:The nomogram prediction model,constructed based on clinical and ultrasonographic features,effectively predicts the risk of cervical lymph node metastasis(CLNM)in patients with papillary thyroid carcinoma(PTC).Patients who were older,had concomitant Hashimoto's thyroiditis,or exhibited a nodule aspect ratio≥1 were less likely to have concurrent CLNM.Conversely,patients presenting with multiple nodules,nodules with microcalcifications,or nodules demonstrating central or rich/peripheral vascularity were more likely to have concurrent CLNM.

Objective:To investigate the effect of KRAS,NRAS and BRAF gene mutations on the efficacy of pre-operative short-course radiotherapy combined with chemotherapy and postoperative liver metastasis in patients with stage Ⅱ～Ⅲ mid-low rectal cancer.Methods:The clinical data of 149 patients with stage Ⅱ～Ⅲ low rectal cancer admitted to Dongnan Hospital of Xiamen University from January 2017 to June 2020 were retrospectively analyzed.All patients received neoadjuvant therapy with preoperative short-course radiotherapy combined with chemotherapy and radical surgery,and were followed up until June 30,2023.The mutations of KRAS,NRAS and BRAF genes were de-tected by pathological tissue before surgery.The effect of neoadjuvant therapy was evaluated according to tumor re-gression grade(TRG).The risk factors of postoperative liver metastasis were analyzed by Logistic multivariate analysis.Results:There were 44 cases of KRAS,10 cases of NRAS and 12 cases of BRAF gene mutation in 149 patients with stage Ⅱ～Ⅲ low rectal cancer,and the mutation rates were 29.53%,6.71%and 8.05%.The incidence of positive vas-cular invasion in patients with KRAS gene mutation was higher than negative(P＜0.05).In NRAS mutation patients,the incidence of positive lymph node metastasis was higher than negative(P＜0.05),and the incidence of maximum tumor diameter≥5 cm was higher than that of maximum tumor diameter＜5 cm(P＜0.05).The clinical stage of BRAF muta-tion was higher in stage Ⅲ than in stage Ⅱ(P＜0.05),and the incidence of positive lymph node metastasis was higher than negative(P＜0.05).During the follow-up period,liver metastasis occurred in 42 patients,and the liver metastasis rate was 28.18%.The KRAS,NRAS and BRAF gene mutations in the effective group were 25.81%,2.15%and 3.23%,lower than those in the ineffective group(35.71%,14.29%and 17.07%,P＜0.05).Multiple factors found clinical stage Ⅲ(OR=10.620,95%CI:2.645～22.575),lymph node metastasis was positive(OR=8.774,95%CI:1.878～19.645),neoadju-vant therapy failed(OR=3.373,95%CI:1.014～11.218),KRAS gene mutation(OR=6.245,95%CI:1.876～20.789),BRAF gene mutation(OR=9.497,95%CI:1.754～19.335)were independent risk factors for postoperative liver metastasis of stage Ⅱ～Ⅲ mid-low rectal cancer.Conclusion:Mutations in the KRAS and BRAF genes of middle are associated with poorer efficacy of neoadjuvant therapy in patients with stage Ⅱ～Ⅲ mid-low rectal cancer and are also indepen-dent risk factors for postoperative liver metastasis.

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.

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.

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.

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.

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.