OBJECTIVE

The aim of this study was to determine the different attitudes and perception of obstetrics and gynecology residents on laparoscopic skills training.

A cross-sectional research was conducted in a tertiary hospital’s Department of Obstetrics and Gynecology using a survey questionnaire. The respondents were resident physician trainees using population sampling. An approval to use the survey questionnaire from its developer was obtained. Descriptive statistics was used for analysis of the demographic profile. Pearson product moment correlation was used to determine correlation between expectancy-value constructs, simulation use and surgical experience.

The average hours the residents spent in simulation laparoscopic exercises was 11 h in the last 12 months and at least 1 h per week with supervision (76%). The reasons for using laparoscopic simulation include skill development (94%), proximity to the simulation lab (90%), free time (85%), recommendation of attending surgeon (84%), and requirement for rotation (84%). Among the expectant value constructs, only intrinsic interest utility value (r = −0.390) showed statistical correlation suggesting a weak negative correlation with simulation use. Hours of simulation use were significantly negatively correlated with self-efficacy for learning skills required to become proficient at minimally invasive surgery (MIS) (r = −0.390) and self-efficacy for learning sufficient MIS skills to perform procedures safely (r = −0.351).

The residents were motivated to do well and had greater self-belief and enjoyed performing and mastering the laparoscopic skills training. The residents’ perception revealed that there was an improvement in their MIS skills with the laparoscopic simulation exercises in the short time they spent in the simulation. Despite the residents’ positive attitude and perceptions, voluntary participation was limited. The most commonly cited barriers to the access of the surgical knowledge improvement laboratory and laparoscopy simulation unit were the lack of time due to the workload, conflicting schedules, and COVID-19 pandemic restrictions. Supervision of the residents is of great importance to provide guidance and motivation to the residents in improving their technical skills and performance in the operating room.

INTRODUCTION

Splenic Abscess is an ongoing infectious process with pus accumulation specifically at the spleen, this is associated with a high mortality rate with studies showing 16.6% among those diagnosed, with risk factors mainly present are among immunocompromised state. Among the immunocompetent population, an incidence of 0.14-0.70% were documented. 13 The etiology for this may include hematogenous or contiguous spread of infection as a pathophysiology, with bacterial seeding at the site. Detection of this is through ultrasound or CT scan, with a goal of identify a complex or a simple abscess. Therapeutics lie in choosing splenectomy, placing the patient in an immunocompromised state despite being at a young age against the conservative percutaneous drainage on top of the maximized antibiotic use. A recent meta-analysis showed a mortality rate of 12% among patients with splenectomy and a complication rate of 26%, however the percutaneous drainage had a mortality of 8% and a complication rate of 10% 14 This highlights the clinical awareness and decision among patients with splenic abscess.

Presenting a case of 37-year-old female who came in with left upper quadrant pain. This patient had undergone laparoscopic cholecystectomy 6 months prior to admission with an unremarkable outcome. An onset of left upper quadrant pain was noted 3 months prior to admission and was initially conservatively managed with unrecalled antibiotics. Persistence of this prompted further work up where ultrasound revealed an abscess in the spleen and was then admitted for broad spectrum antibiotics, namely piperacillin-tazobactam and further imaging. CT scan of whole abdomen with contrast was then done which revealed splenomegaly with rim enhancing near fluid attenuating lesions in the mid to inferior pole. The complexity of the abscess prompted the decision for splenectomy, the gold standard for treatment for splenic abscess. Patient had tested negative for HIV.

Splenic abscess is a rare condition, usually presenting with fever and left upper quadrant pain, the patient however did not present with fever despite a complex abscess. Splenic abscess is associated with a high mortality rate. A wide array of differentials is considered in patients with left upper quadrant pain and laboratories are directed into investigating the structural cause for left upper quadrant pain as the spleen has many adjacent organs which may present similarly. The decision to choose splenectomy and percutaneous abscess determines survivability of infection as splenectomy places patient in an immunocompromised state, thus early recognition of splenic abscess, and feasibility of percutaneous drainage is vital to the out-hospital outcome for the patient. Among immunocompetent individuals, given the lower mortality and lower complication rates, it may be ideal to combine both medical and minimally invasive procedures and a rise in complication may then warrant splenectomy.

The clinical burden of colorectal cancer (CRC) is high. Population-based screening and early detection are essential to improve the long-term clinical outcome. Nonetheless, a significant proportion of patients still present at an advanced stage, including with acute large bowel obstruction. Image-enhanced endoscopy and artificial intelligence can improve the detection and diagnosis of colonic adenomas and early cancer. Endoscopic resection is regarded as the preferred curative treatment option for colonic adenoma and T0 and T1 CRC limited to the superficial submucosa. Emergency colonic stenting as bridge to interval curative surgery is increasingly accepted as a first-line option when technically feasible. Minimally invasive resection techniques such as laparoscopic colectomy and robot-assisted colorectal surgery have also come of age. These techniques reduce post-treatment morbidity, shorten the recovery process and can be cost-effective while maintaining long-term oncological cure. These outcome measures are relevant to our patients; therefore, minimally invasive approaches to curative resection should be embraced.
Humans ; Colorectal Neoplasms/surgery* ; Minimally Invasive Surgical Procedures/methods* ; Laparoscopy/methods* ; Colectomy/methods* ; Robotic Surgical Procedures/methods* ; Treatment Outcome ; Colonoscopy/methods*

Visual minimally invasive acupotomy is applicable for the diseases with the pathological characteristics of soft tissue injury, including disorders of spine, four limbs and joints, peripheral nerve compression and chronic soft tissues. The diseases with superior effect obtained are cervicogenic headache, lumbar disc herniation, carpal tunnel syndrome and flexor tendon stenosing tenosynovitis. Under the guidance with ultrasound, visual minimally invasive acupotomy is advantaged at preoperative diagnosis, intraoperative guidance and postoperative evaluation in clinical practice so that it is precise, safe and reliable in clinical treatment. Visual minimally invasive acupotomy is essentially a kind of "ultra-minimally invasive" technique in treatment, focusing on the self-rehabilitation of the body induced by external treatment measures. It is highly complementary to the repair and reconstruction of minimally invasive surgery of modern medicine in clinical application.
Humans ; Acupuncture Therapy/methods* ; Minimally Invasive Surgical Procedures

OBJECTIVE: To observe the regulatory effects of moxibustion at "Guanyuan" (CV4) on the synthesis of extragonadal estradiol (E₂) and the expression of estrogen receptor (ER) in ovariectomized rats, aiming to explore the mechanism of moxibustion treatment for perimenopausal syndrome. METHODS: Forty-eight SD female rats of SPF grade were randomly divided into a sham-operation group, a model group and a moxibustion group, with 16 rats in each group. The model group and the moxibustion group underwent bilateral ovariectomy by the back incision method. Ten days after surgery, moxibustion was applied at "Guanyuan" (CV4) in the moxibustion group, 30 min each time, once a day for 10 days. After intervention, in the 3 groups, the body mass and uterus weight were measured; the serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and E₂, as well as the skin and hypothalamus levels of E₂ were detected by ELISA; the mRNA expression of aromatase (P450arom) in the skin and hypothalamus was detected by real-time PCR; the expression of ERα and ERβ in the hypothalamus, skin, and uterus was observed by immunofluorescence staining, and the density of positive cells was calculated using the Aipathwell digital pathology image analysis software. RESULTS: Compared with the sham-operation group, the body mass was increased (P<0.01) and the uterus weight was decreased (P<0.001) in the model group. Compared with the model group, the body mass was decreased in the moxibustion group (P<0.01). Compared with the sham-operation group, in the model group, the serum, hypothalamus and skin levels of E₂ were decreased (P<0.01, P<0.05), while the serum levels of FSH and LH were increased (P<0.01); the expression of ERα and ERβ in the skin, hypothalamus and uterus was decreased (P<0.05, P<0.001). Compared with the model group, in the moxibustion group, the serum levels of E₂ and LH, as well as the hypothalamus and skin levels of E₂ were increased (P<0.05, P<0.01); the mRNA expression of P450arom, as well as the expression of ERα and ERβ in the skin and hypothalamus were increased (P<0.05). CONCLUSION Moxibustion at "Guanyuan" (CV4) reduces the body mass of ovariectomized rats by enhancing the synthesis of extragonadal E₂ and increasing the expression of ER in the skin and hypothalamus, yet it does not alleviate uterine atrophy.
Animals ; Female ; Moxibustion ; Rats ; Ovariectomy ; Acupuncture Points ; Rats, Sprague-Dawley ; Humans ; Receptors, Estrogen/genetics* ; Estrogens/metabolism* ; Estradiol/metabolism* ; Hypothalamus/metabolism* ; Follicle Stimulating Hormone/blood* ; Aromatase/genetics* ; Luteinizing Hormone/blood* ; Skin/metabolism*

BACKGROUND: T cell dysfunction, which includes exhaustion, anergy, and senescence, is a distinct T cell differentiation state that occurs after antigen exposure. Although T cell dysfunction has been a cornerstone of cancer immunotherapy, its potential in transplant research, while not yet as extensively explored, is attracting growing interest. Interferon regulatory factor 4 (IRF4) has been shown to play a pivotal role in inducing T cell dysfunction. METHODS: A novel ultra-low-dose combination of Trametinib and Rapamycin, targeting IRF4 inhibition, was employed to investigate T cell proliferation, apoptosis, cytokine secretion, expression of T-cell dysfunction-associated molecules, effects of mitogen-activated protein kinase (MAPK) and mammalian target of rapamycin (mTOR) signaling pathways, and allograft survival in both in vitro and BALB/c to C57BL/6 mouse cardiac transplantation models. RESULTS: In vitro , blockade of IRF4 in T cells effectively inhibited T cell proliferation, increased apoptosis, and significantly upregulated the expression of programmed cell death protein 1 (PD-1), Helios, CD160, and cytotoxic T lymphocyte-associated antigen (CTLA-4), markers of T cell dysfunction. Furthermore, it suppressed the secretion of pro-inflammatory cytokines interferon (IFN)-γ and interleukin (IL)-17. Combining ultra-low-dose Trametinib (0.1 mg·kg -1 ·day -1 ) and Rapamycin (0.1 mg·kg -1 ·day -1 ) demonstrably extended graft survival, with 4 out of 5 mice exceeding 100 days post-transplantation. Moreover, analysis of grafts at day 7 confirmed sustained IFN regulatory factor 4 (IRF4) inhibition, enhanced PD-1 expression, and suppressed IFN-γ secretion, reinforcing the in vivo efficacy of this IRF4-targeting approach. The combination of Trametinib and Rapamycin synergistically inhibited the MAPK and mTOR signaling network, leading to a more pronounced suppression of IRF4 expression. CONCLUSIONS Targeting IRF4, a key regulator of T cell dysfunction, presents a promising avenue for inducing transplant immune tolerance. In this study, we demonstrate that a novel ultra-low-dose combination of Trametinib and Rapamycin synergistically suppresses the MAPK and mTOR signaling network, leading to profound IRF4 inhibition, promoting allograft acceptance, and offering a potential new therapeutic strategy for improved transplant outcomes. However, further research is necessary to elucidate the underlying pharmacological mechanisms and facilitate translation to clinical practice.
Animals ; Mice ; Mice, Inbred BALB C ; Mice, Inbred C57BL ; Interferon Regulatory Factors/metabolism* ; Heart Transplantation/methods* ; T-Lymphocytes/immunology* ; Sirolimus/therapeutic use* ; Pyridones/therapeutic use* ; Graft Survival/drug effects* ; Pyrimidinones/therapeutic use* ; Cell Proliferation/drug effects* ; Apoptosis/drug effects* ; Male ; Signal Transduction/drug effects*

Organ transplantation, particularly pediatric liver transplantation (LT), has transformed medical practice over the past six decades, providing life-saving interventions for children with end-stage liver disease. This review demonstrated the historical milestones of pediatric organ transplantation, emphasizing Japan's contributions, mainly through the National Center for Child Health and Development. While early transplantation efforts in the 1950s and 1960s faced significant challenges, breakthroughs in preservation methods, immunosuppressive therapies, surgical techniques, and innovations such as living donor LT in Asia have greatly improved success rates. Japan's pediatric LT landscape is distinct, primarily due to its reliance on living donor LT, shaped by cultural and religious influences that have traditionally restricted deceased donor organ donation. This review manuscript discusses Japan's pioneering role in expanding the indications for pediatric LT to include rare conditions such as inherited metabolic disorders and hepatoblastoma. It highlights recent innovations such as hyper-reduced lateral segment grafts, machine perfusion, and minimally invasive surgery that have further improved outcomes. International collaboration has facilitated the sharing of expertise, advancing pediatric liver transplantation practice worldwide. Despite these achievements, challenges remain, particularly in light of Japan's declining birth rate, which threatens the sustainability of pediatric transplant services. This review emphasizes the need for centralized transplant facilities, greater awareness of brain-dead organ donation, and continued medical advances to ensure that pediatric LT remains a viable, life-saving option for future generations.
Humans ; Liver Transplantation/trends* ; Japan ; Child ; Living Donors

BACKGROUND: Pre-transplant exposure to immune checkpoint inhibitors (ICIs) significantly increases the risk of allograft rejection after liver transplantation (LT); however, whether ICI-related rejection leads to increased graft loss remains controversial. Therefore, this study aimed to investigate the association between ICI-related allograft rejection and perioperative graft loss. METHODS: This was a retrospective analysis of adult liver transplant recipients with early biopsy-proven T-cell-mediated rejection (TCMR) at Liver Transplantation Center of Sun Yat-sen Memorial Hospital from June 2019 to September 2024. The pathological features, clinical characteristics, and perioperative graft survival were analyzed. RESULTS: Twenty-eight patients who underwent early TCMR between June 2019 and September 2024 were included. Based on pre-LT ICI exposure, recipients were categorized into ICI-related TCMR (irTCMR, n = 12) and conventional TCMR (cTCMR, n = 16) groups. Recipients with irTCMR had a higher median Banff rejection activity index (RAI) (6 vs . 5, P = 0.012) and more aggressive tissue damage and inflammation. Recipients with irTCMR showed higher proportion of treatment resistance, achieving a complete resolution rate of only 8/12 compared to 16/16 for cTCMR. Graft loss occurred in 5/12 of irTCMR recipients within 90 days after LT, with no graft loss in cTCMRs recipients. Cox analysis demonstrated that irTCMR with an ICI washout period of <30 days was an independent risk factor for perioperative graft loss (hazard ratio [HR], 6.540; 95% confidence interval [CI], 1.067-40.067, P = 0.042). CONCLUSION IrTCMR is associated with severe pathological features, increased resistance to treatment, and higher graft loss in adult liver transplant recipients.
Humans ; Liver Transplantation/adverse effects* ; Male ; Female ; Middle Aged ; Retrospective Studies ; Graft Rejection/immunology* ; Immune Checkpoint Inhibitors/therapeutic use* ; Adult ; T-Lymphocytes/drug effects* ; Graft Survival/immunology* ; Aged

Liver transplantation is an effective treatment for end-stage liver disease. Liver transplantation is technically complex and associated with significant trauma. In recent years,minimally invasive surgical techniques,such as laparoscopy and robotic surgery,have rapidly developed and been widely applied across various surgical fields. Minimally invasive surgery offers advantages including reduced trauma,less bleeding,and faster postoperative recovery,and has become a mainstream trend in surgical development. In the field of liver transplantation,laparoscopic and robotic donor hepatectomy techniques for living donor liver transplantation have made significant progress. However, due to difficulties in exposing the anastomotic sites of the donor liver and challenges in vascular anastomosis,the application of minimally invasive techniques in donor liver implantation has progressed relatively slowly. With advancements in laparoscopic and robotic surgical techniques and related instruments,laparoscopic donor liver implantation has gradually become feasible. Currently,multiple liver transplant centers worldwide have begun to progressively perform laparoscopic or robot-assisted liver transplantation in recipients,demonstrating potential advantages in reducing surgical trauma and accelerating postoperative recovery. However,there is currently a lack of guidelines or consensus on the application of minimally invasive surgery in liver transplant recipients. Therefore,Branch of Organ Transplantation of Chinese Medical Association,Surgery Group of Chinese Society of Surgery of Chinese Medical Association,and Branch of Organ Transplant Physicians of Chinese Medical Doctor Association invited experts in the field to discuss clinical issues. Combining published guidelines,consensus statements,and research advancements,they formulated the "Technical guidelines for minimally invasive surgery in liver transplant recipients（2025）", aiming to provide reasonable guidance and references for clinical practitioners in the field of liver transplantation.
Humans ; Liver Transplantation/methods* ; Minimally Invasive Surgical Procedures/methods* ; Laparoscopy ; Robotic Surgical Procedures ; Practice Guidelines as Topic

This study investigates the therapeutic effect and underlying mechanism of Compound Ziyin Granules(CZYG) on postmenopausal osteoporosis(PMOP) induced by bilateral ovariectomy in rats. Six-month-old female SD rats were randomly divided into sham-operated(sham) group, ovariectomy(OVX) model group, high-, medium-, and low-dose CZYG groups, and alendronate sodium(AS) group. After 30 days of model establishment, treatment was administered by gavage once daily for 8 weeks, followed by sample collection. Enzyme-linked immunosorbent assay(ELISA) was used to measure serum levels of calcium ions, alkaline phosphatase(AKP), estrogen(E_2), osteoprotegerin(OPG), osteocalcin(BGP), tartrate-resistant acid phosphatase(TRAP), and type Ⅰ procollagen N-terminal propeptide(PINP). Hematoxylin-eosin(HE) staining was used to observe the histopathological changes in the femurs of rats, while micro-computed tomography(micro-CT) was used to analyze the microstructure of the distal femur. Western blot analysis was performed to measure the expression levels of bone metabolism-related proteins, including wingless-type MMTV integration site family member 2(Wnt2), β-catenin, low-density lipoprotein receptor-related protein 5(LRP5), glycogen synthase kinase-3β(GSK-3β). The mRNA expression levels of Wnt2, β-catenin, LRP5, GSK-3β, p-GSK-3β were determined by quantitative real-time PCR(qRT-PCR). Thirty days after bilateral ovariectomy, compared to the sham group, the OVX group showed significant increases in body weight and significant decreases in uterine coefficient. After 8 weeks of treatment, compared to the OVX group, CZYG(medium and high doses) and AS reduced body weight, with high-dose CZYG and AS significantly increasing the uterine coefficient. Serum levels of AKP and TRAP were significantly elevated, while levels of calcium, E_2, BGP, and OPG were significantly decreased in the OVX group. Compared to the OVX group, CZYG and AS significantly reduced serum levels of AKP and TRAP, while high-dose CZYG and AS notably increased the levels of E_2, BGP, OPG, and PINP. Micro-CT and HE staining results indicated that CZYG(medium and high doses) and AS significantly increased bone tissue volume, trabecular number, bone mineral density, and improved the microstructure of the femur. Compared to the OVX group, high-dose CZYG and AS significantly upregulated the protein and mRNA expression levels of Wnt2, β-catenin, and LRP5, and downregulated the phosphorylation level of p-GSK-3β. These results suggest that CZYG can improve PMOP by promoting estrogen secretion, improving bone metabolism indicators, increasing trabecular number and bone mineral density. Its mechanism may be related to the regulation of the Wnt/β-catenin signaling pathway.
Animals ; Female ; Rats, Sprague-Dawley ; Osteoporosis, Postmenopausal/genetics* ; Rats ; Wnt Signaling Pathway/drug effects* ; Humans ; Drugs, Chinese Herbal/administration & dosage* ; beta Catenin/genetics* ; Osteoprotegerin/metabolism* ; Ovariectomy ; Calcium/blood* ; Bone Density/drug effects*