Objective To explore the effectiveness of an integrated laparoscopic simulation training course (best essential surgical technique training, BEST) in enhancing laparoscopic peritoneal suturing techniques in surgical residents.Methods As an integrated two-stage program, the BEST course applied basic laparoscopic training system with simple molds in phase Ⅰ training, and then adopted advanced laparoscopic training system, 3D Laparoscope and ex-vivo animal models in phase Ⅱ training. The laparoscopic suturing techniques were practiced in phase Ⅱ training. From August 2021 to July 2024, surgical residents in the second year of the national standardized training program were divided into pilot and control groups based on whether they had undergone the BEST course. Two cases of laparoscopic peritoneal suture were performed by the surgical residents under supervision in the department of gastrointestinal surgery. The operative time, quality of suture, and independent completion rate were compared between the two groups.Results A total of 33 surgical residents (19 in pilot group and 14 in control group) were included in this study, and a total of 66 cases of laparoscopic peritoneal suture were performed (38 in pilot group and 28 in control group). The operative time was significantly shorter in pilot group than that in control group (15.7 min vs. 17.5 min, P=0.025). The quality of suture was significantly better in pilot group compared to control group (P=0.023). In pilot group, all peritoneal sutures were performed by residents independently, whereas in control group, 3 cases (10.7%) were assisted by the supervisor, and the independent completion rate was different significantly (P=0.039).Conclusions The BEST course can help improve surgical residents′ laparoscopic peritoneal suturing techniques and could be promoted in the national standardized training program for surgical residents.

Objective To compare the oncologic safety, surgical efficacy, and aesthetic outcomes between conventional breast-conserving surgery and axillary single-port incision insufflation endoscopic breast-conserving surgery with mini-latissimus dorsi surgery in early breast cancer patients. Methods A retrospective analysis of clinical data from 62 female patients with early breast cancer was performed. Patients were divided into two groups on the basis of surgical method: the conventional group (37 cases) and the endoscopic group (25 cases).The clinical baseline data, surgical results, and postoperative effects of the two groups were compared. Results According to the clinical baseline data, the endoscopic group had a greater maximum tumor diameter and a greater tumor-to-breast volume ratio due to expanded indications for breast-conserving surgery (P<0.001), whereas the other data revealed no statistically significant difference between the two groups (P>0.05). Compared with those in the conventional group, the total incision length in the endoscopic group was shorter [3.40(3.15, 3.60) cm vs. 7.30 (6.50, 7.60) cm, P<0.001], the postoperative drainage volume was lower (206.20±35.11 ml vs. 223.95±26.17 ml, P=0.026), but the operative time was longer (254.92±22.67 min vs. 146.78±13.01 min, P<0.001). The incision margin positive rate was 0% (0/25) in the endoscopic group, which was significantly lower than the 10.8% (4/37) in the conventional group (P=0.141). The endoscopic group had a lower incidence of complications (4% vs. 27%, P=0.047) and superior JBCS aesthetic scores at the 6-month follow-up (76% vs. 43.2%, P=0.006). Conclusion Axillary single-port incision insufflation endoscopic breast-conserving surgery with mini-latissimus dorsi surgery is not inferior to conventional procedures in terms of oncologic safety (margin-negative rate) and offers advantages in terms of scar concealment, fewer complications, and better aesthetic outcomes, especially suitable for early breast cancer patients with small-to-medium breast volumes, tumors located in the outer quadrants and mastectomy ratios of >20%.

Objective To discuss the efficacy of transcatheter arterial chemoembolization(TACE)in combination with targeted therapy and immune checkpoint inhibitors for advanced hepatocellular carcinoma(HCC),and to identify the influencing factors.Methods A total of 60 patients with advanced HCC,who were admitted to the Air Force Medical Center of China from January 2016 to December 2022,were enrolled in this study.Thirty patients received TACE combined with targeted therapy and immune checkpoint inhibitors(TACE-L-P group),and the other 30 patients received TACE combined with targeted therapy(TACE-L group).The progression-free survival(PFS),overall survival(OS),disease control rate(DCR),and objective response rate(ORR)were compared between the two groups.Results In the TACE-L group and TACE-L-P group,the median PFS(mPFS)was 7 months and 10 months respectively(P=0.011),the median OS(mOS)was 15.5 months and 29 months respectively(P=0.014).Child-Pugh class B(HR=3.89,95％CI:1.27-11.94,P=0.018)and Barcelona Clinic Liver Cancer(BCLC)stage C(HR=2.83,95％CI:1.32-6.03,P=0.007)were the independent risk factors for OS,while micro wave ablation(HR=0.21,95％CI:0.07-0.63,P=0.005)and TACE-L-P(HR=0.09,95％CI:0.03-0.3,P=0.001)were the independent protection factors for OS.Besides,elevated bilirubin level(HR=1.03,95％CI:1-1.06,P=0.032)and elevated gamma-glutamyl transferase(GGT)level(HR=1.01,95％CI:1-1.01,P=0.002)were the independent risk factors for disease progression,and TACE-L-P(HR=0.27,95％CI:0.09-0.79,P=0.017)was the independent protection factor for disease progression.The ORR and DCR in TACE-L-P group were remarkably higher than those in TACE-L group,which were 43.4％vs 13.3％and 63.4％vs 23.3％respectively,the differences between the two groups were statistically significant(both P＜0.05).Conclusion In treating advanced HCC,TACE combined with targeted therapy and immune checkpoint inhibitors is superior to TACE combined with targeted therapy in therapeutic efficacy.

Over the past three decades years, the treatment of gastric cancer has shifted from traditional open surgery to minimally invasive surgery. Cutting-edge technologies such as three-dimensional and 4K ultra-high-definition imaging systems, indocyanine green fluorescence navigation, and robotic surgical systems have been widely used in clinical practice, facilitating precise intraoperative anatomy and lymph node dissection. For early gastric cancer, endoscopic submucosal dissection, as the standard surgical procedure, can improve the 5-year survival rate and reduce the local recurrence rate. For locally advanced gastric cancer, neoadjuvant chemotherapy combined with minimally invasive surgery has increased the R0 resection rate and improved the prognosis of patients. For advanced gastric cancer, conversion therapy combined with minimally invasive surgery has brought hope for extended survival to patients with stage Ⅳ disease, and the application of immune checkpoint inhibitors has further promoted the progress of advanced gastric cancer treatment. With the advancement of technology and the improvement of policies, artificial intelligence and 5G remote surgery have become important directions in the minimally invasive surgical treatment of gastric cancer. In the future, it is necessary to accumulate evidence through multi-center prospective studies, optimize the evaluation of function-preserving surgery, develop cross-platform artificial intelligence tools, conduct cost-benefit analyses, and resolve ethical and legal disputes to promote the development of minimally invasive surgical treatment of gastric cancer towards precision and intelligence, achieving a dual improvement in efficacy and accessibility.

Nuanjian Jian(Decoction for Warming Liver Meridian),originating from Jing Yue Quan Shu(Jingyue's Complete Works)written by Zhang Jingyue,is composed of Angelicae Sinensis Radix(Danggui),Lycii Fructus(Gouqizi),Poria(Fuling),Fructus Foeniculi(Xiaohuixiang),Cinnamomi Cortex(Rougui),Linderae Radix(Wuyao),and Aquilariae Lignum Resinatumd(Chenxiang)or Aucklandiae Radix(Muxiang).Nuanjian Jian is a widely-used classical formula for warming the liver and kidneys,promoting qi circulation and alleviating pain.It was included in the Ancient Classical Formulas Catalog(First Batch)published by the National Administration of Traditional Chinese Medicine in 2018,and was primarily used to treat lower abdominal pain,hernia,and other disorders differentiated as the syndrome of cold stagnation in the liver and kidneys.Based on the principles of key information verification for classical formulas,this article systematically reviewed the ancient and modern literature on Nuangan Jian,and conducted a comprehensive textual research and analysis of its origin,composition,dosage,method of making a decoction and taking medicines,processing,modifications,historical and modern applications,and experimental studies.The study concluded that the composition and dosage of this formula are relatively clear.The contemporary single-dose equivalents are calculated as Danggui 9.33 g,Gouqizi 11.19 g,Fuling 7.46 g,Xiaohuixiang 7.46 g,Rougui 5.60 g,Wuyao 7.46 g,and Chenxiang 3.73 g.The decoction is prepared by adding 300 mL of water and 4 g of ginger,boiling until reduced to 140 mL,and taken 2-3 times daily,2 hours after meals.Modern practitioners have expanded the indications of this formula,extending its use from hernia and lower abdominal pain to various disorders in andrology,gynecology,and gastroenterology.The indications have the core pathogenesis of cold stagnation in the liver meridian,and usually affect the liver while also involve the spleen,kidneys,and lower energizer.Diseases of the lower abdomen,genitals,and breasts belonging to the region of the liver-meridian route,are also commonly treated with Nuangan Jian.The findings of this study provide a reference for the further development of this classical formula.

Objective:To understand the current status and trends of domestic research on esophageal cancer in the elderly.Methods:In the three major databases of CNKI, Wanfang, and VIP, studies related to elderly esophageal cancer were retrieved using the keywords "elderly" and "esophageal cancer" from the inception of the databases until December 7, 2024.Following the manual screening of the extracted studies, CiteSpace and VOSviewer software were employed to perform a visual analysis of publication trends, authors, institutions, and keywords.Results:A total of 1, 165 articles were included in the study.The first article appeared in 1989, and the number of publications has been increasing year by year, reaching a peak in 2014.The author with the highest number of publications is Zhu Shuchai, and the institution is The Fourth Hospital of Hebei Medical University.Keyword clustering formed ten clusters including "esophageal cancer, elderly, nedaplatin, nursing, thoracoscopic, prognosis, risk factors, enteral nutrition, treatment, and esophageal stenosis." Emerging keywords include surgical treatment, thoracoabdominal laparoscopy, prognosis, and apatinib.Conclusions:Currently, targeted therapy is a research hot spot and frontier.It is anticipated that ongoing advancements in treatment methods will contribute to improved outcomes and quality of life for elderly patients with esophageal cancer.

Objective:To understand the current status and trends of domestic research on esophageal cancer in the elderly.Methods:In the three major databases of CNKI, Wanfang, and VIP, studies related to elderly esophageal cancer were retrieved using the keywords "elderly" and "esophageal cancer" from the inception of the databases until December 7, 2024.Following the manual screening of the extracted studies, CiteSpace and VOSviewer software were employed to perform a visual analysis of publication trends, authors, institutions, and keywords.Results:A total of 1, 165 articles were included in the study.The first article appeared in 1989, and the number of publications has been increasing year by year, reaching a peak in 2014.The author with the highest number of publications is Zhu Shuchai, and the institution is The Fourth Hospital of Hebei Medical University.Keyword clustering formed ten clusters including "esophageal cancer, elderly, nedaplatin, nursing, thoracoscopic, prognosis, risk factors, enteral nutrition, treatment, and esophageal stenosis." Emerging keywords include surgical treatment, thoracoabdominal laparoscopy, prognosis, and apatinib.Conclusions:Currently, targeted therapy is a research hot spot and frontier.It is anticipated that ongoing advancements in treatment methods will contribute to improved outcomes and quality of life for elderly patients with esophageal cancer.

Over the past three decades years, the treatment of gastric cancer has shifted from traditional open surgery to minimally invasive surgery. Cutting-edge technologies such as three-dimensional and 4K ultra-high-definition imaging systems, indocyanine green fluorescence navigation, and robotic surgical systems have been widely used in clinical practice, facilitating precise intraoperative anatomy and lymph node dissection. For early gastric cancer, endoscopic submucosal dissection, as the standard surgical procedure, can improve the 5-year survival rate and reduce the local recurrence rate. For locally advanced gastric cancer, neoadjuvant chemotherapy combined with minimally invasive surgery has increased the R0 resection rate and improved the prognosis of patients. For advanced gastric cancer, conversion therapy combined with minimally invasive surgery has brought hope for extended survival to patients with stage Ⅳ disease, and the application of immune checkpoint inhibitors has further promoted the progress of advanced gastric cancer treatment. With the advancement of technology and the improvement of policies, artificial intelligence and 5G remote surgery have become important directions in the minimally invasive surgical treatment of gastric cancer. In the future, it is necessary to accumulate evidence through multi-center prospective studies, optimize the evaluation of function-preserving surgery, develop cross-platform artificial intelligence tools, conduct cost-benefit analyses, and resolve ethical and legal disputes to promote the development of minimally invasive surgical treatment of gastric cancer towards precision and intelligence, achieving a dual improvement in efficacy and accessibility.

Chimeric antigen receptor (CAR)-T cell therapy has achieved remarkable success in the treatment of hematological malignancies. Based on the immunomodulatory capability of CAR-T cells, efforts have turned toward exploring their potential in treating autoimmune diseases. Bibliometric analysis of 210 records from 128 academic journals published by 372 institutions in 40 countries/regions indicates a growing number of publications on CAR-T therapy for autoimmune diseases, covering a range of subtypes such as systemic lupus erythematosus, multiple sclerosis, among others. CAR-T therapy holds promise in mitigating several shortcomings, including the indiscriminate suppression of the immune system by traditional immunosuppressants, and non-sustaining therapeutic levels of monoclonal antibodies due to inherent pharmacokinetic constraints. By persisting and proliferating in vivo, CAR-T cells can offer a tailored and precise therapeutics. This paper reviewed preclinical experiments and clinical trials involving CAR-T and CAR-related therapies in various autoimmune diseases, incorporating innovations well-studied in the field of hematological tumors, aiming to explore a safe and effective therapeutic option for relapsed/refractory autoimmune diseases.