ObjectiveTo investigate the risk factors for postpancreatectomy acute pancreatitis （PPAP） after minimally invasive pancreaticoduodenectomy （MIPD） and their association with major complications， to improve the understanding of PPAP and postoperative pancreatic fistula （POPF）， and to reduce the incidence rates of PPAP and POPF. MethodsA retrospective analysis was performed for the clinical data of 114 patients who underwent MIPD in Department of Hepatobiliary and Pancreatic Surgery， The First Affiliated Hospital of University of South China， from March 2015 to December 2023， and the definition of PPAP and its diagnostic criteria provided by the International Study Group of Pancreatic Surgery were used to determine the presence or absence of PPAP. The independent samples t-test or the Mann-Whitney U rank sum test was used for comparison of continuous data between groups， and the Kruskal-Wallis H test was used for comparison between multiple groups， and the Dunn-test was used for further comparison between two groups.； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups.， and the Bonferroni-test was used for further comparison between two groups. The multivariate logistic regression analysis was used to identify the risk factors for PPAP after MIPD. ResultsOf all 114 patients undergoing MIPD， 27 （23.7%） experienced PPAP. The multivariate analysis showed that main pancreatic duct diameter ≤3 mm （odds ratio ［OR］=5.083， 95% confidence interval ［CI］： 1.703 — 15.172， P=0.004）， soft pancreatic texture （OR=5.925， 95%CI： 1.986 — 17.677， P=0.001）， and C-reactive protein ≥180 mg/L on day 1 after surgery （OR=5.419， 95%CI： 1.586 — 18.513， P=0.007） were independent risk factors for the onset of PPAP after MIPD. Clinical analyses showed that the patients with PPAP tended to have significantly higher incidence rates of POPF， peritoneal infection， Clavien-Dindo grade 3/4 complications， discharge with tube， and 90-day postoperative death （χ²=5.676， 5.460， 9.863， 5.439， and 4.207， all P<0.05）. ConclusionMain pancreatic duct diameter， pancreatic texture， and C-reactive protein on day 1 after surgery are closely associated with the onset of PPAP after MIPD， and PPAP can lead to other postoperative complications and even death.

Takotsubo syndrome is a transient, reversible syndrome characterized by acute regional dysfunction of the left ventricle, with symptoms resembling those of acute coronary syndrome. Takotsubo syndrome can lead to left ventricular thrombus formation, which may embolize and cause ischemic stroke. However, such cases are relatively rare. A case of acute ischemic stroke with middle cerebral artery occlusion caused by Takotsubo syndrome is reported in this article. The patient presented primarily with left-sided limb weakness. Cerebral angiography indicated occlusion of the right middle cerebral artery, and complete vascular recanalization was achieved after endovascular thrombectomy. Cranial magnetic resonance imaging indicated multiple infarctions in both the anterior and posterior circulations. Transthoracic echocardiography showed apical thrombus formation in the left ventricle and significantly reduced left ventricular systolic function. After a short course of anticoagulation combined with antiplatelet therapy, the apical thrombus resolved, and left ventricular systolic function significantly improved. This case indicates that although large-vessel occlusion acute ischemic stroke caused by Takotsubo syndrome is relatively rare, comprehensive etiological evaluation should be emphasized in patients with suspected cardioembolic stroke. Dynamic monitoring of echocardiographic changes is important for accurate diagnosis of the underlying cause.

Objective To explore the differences in postoperative recovery between laparoscopic assisted distal gastrectomy(LADG)and total laparoscopic distal gastrectomy(TLDG)for gastric cancer.Methods A retrospective analysis was conducted on clinical data of 99 patients who underwent laparoscopic distal gastrectomy for gastric cancer from May 2019 to April 2024.According to patient preference,49 patients underwent TLDG and 50 patients underwent LADG.The two groups were compared regarding operation duration,intraoperative blood loss,lymph node dissection and metastasis,frequency of postoperative analgesic use,time to gas exhaustion,time to ambulation,postoperative hospital stay,self-care ability score(Barthel Index),total protein,albumin,and white blood cell count,as well as postoperative complications including anastomotic leakage,anastomotic obstruction,gastroparesis,chylous leakage,abdominal infection,incision infection,respiratory system infection and so on.Results Compared with LADG,TLDG resulted in fewer frequency of postoperative analgesic use(median,0 vs.4 times,Z=-5.810,P<0.001)and higher self-care ability scores(median,50.0 points vs.40.0 points,Z=-3.232,P=0.001)after surgery.There were no significant differences in operation duration,intraoperative blood loss,number of lymph nodes obtained,lymph node metastasis,time to gas exhaustion,time to ambulation,postoperative hospital stay,postoperative complications,postoperative total protein,albumin,and white blood cell count between the two groups(P>0.05).Conclusion LADG and TLDG are comparable in surgical efficiency and safety,but TLDG results in less postoperative pain and better self-care ability after surgery,potentially offering advantages in postoperative recovery.

Postoperative infection of internal fixation of closed fractures the lower limbs in adults represents a devastating complication, characterized by diagnostic challenges, prolonged treatment duration and high disability rates. Current management of these infections faces multiple challenges, such as difficulties in early accurate diagnosis, and various controversies about the treatment plan, leading to poor overall diagnosis and treatment results. To address these issues, based on evidence-based medicine and principles with emphasis on scientific rigor, clinical applicability and innovation, the Trauma Branch of the Chinese Medical Association, Orthopedic Branch of the Chinese Medical Doctor Association, Orthopedics Branch of the Chinese Medical Association, and Trauma Orthopedics and Polytrauma Group of the Resuscitation and Emergency Committee of the Chinese Medical Doctor Association have collaboratively organized a panel of relevant experts to develop the Guideline for diagnosis and treatment of infection after internal fixation of closed lower limb fractures in adults ( version 2025). The guideline proposed 10 recommendations, aiming to provide a foundation for standardized diagnosis and treatment of postoperative infection in adults with closed lower limb fractures.

Objective To explore the effect of hypoxia-inducible factor-1α(HIF-1α)inhibitor LW6 on ferroptosis in septic cardiomyopathy rats.Methods Rat septic cardiomyopathy model was prepared using cecal ligation and puncture(CLP)method.Thirty-six specific pathogen-free(SPF)6-8 weeks male SD rats were randomly divided into the sham-operated group,CLP group,CLP+solvent group,LW6 group,ferrostatin-1(Fer-1)group,and LW6+Fer-1 group.The degree of myocardial damage in each group was evaluated through hematoxylin-eosin stai-ning and detection of lactate dehydrogenase and creatine kinase content in cardiac tissue.Myocardial mitochondrial damage was observed by transmission electron microscopy.Ferroptosis level was determined by detecting iron ion concentration,reduced glutathione,malondialdehyde,and reactive oxygen species.Protein expression levels of HIF-1α,solute carrier family 7 member 11(SLC7A11),and glutathione peroxidase 4(GPX4)in cardiac tissue were detected by Western blotting.Results Compared with the CLP group and the CLP+solvent group,the LW6 group could ameliorate myocardial damage,alleviate mitochondrial damage,inhibit ferroptosis-related indicators(all P＜0.05),reduce HIF-1α protein expression levels(P＜0.05),and enhance SLC7A11 and GPX4 protein expression levels(both P＜0.05).Conclusion LW6 decreases HIF-1α expression and ferroptosis levels through the SLC7A11/GPX4 pathway,and ameliorates sepsis-induced cardiomyopathy.

Perihilar cholangiocarcinoma(PHCC)has an insidious onset,is highly aggressive,and carries a poor prognosis.Radical surgical resection is crucial for improving patient survival.Due to the complex anatomy of the hepatic hilum,conventional laparoscopic surgery faces numerous challenges.In recent years,robotic surgery has shown significant potential in PHCC procedures,owing to its high-definition naked-eye 3D visualization,precise maneuvers,and superior dexterity.However,its widespread adoption remains limited by high costs,restricted intraoperative working space,and the absence of tactile feedback.Drawing on international research progress and our own clinical experience,this article analyzes optimization strategies including assessment of local tumor involvement,rational trocar placement,lymphatic and neural plexus dissection,determination of the extent of hepatectomy,vascular resection and reconstruction,bile duct reconstruction,and choledochojejunostomy.The aim is to explore approaches to overcoming these challenges and breaking through existing limitations,thereby providing new strategies and technical pathways for precise minimally invasive treatment of PHCC.

Perihilar cholangiocarcinoma(PHCC)has an insidious onset,is highly aggressive,and carries a poor prognosis.Radical surgical resection is crucial for improving patient survival.Due to the complex anatomy of the hepatic hilum,conventional laparoscopic surgery faces numerous challenges.In recent years,robotic surgery has shown significant potential in PHCC procedures,owing to its high-definition naked-eye 3D visualization,precise maneuvers,and superior dexterity.However,its widespread adoption remains limited by high costs,restricted intraoperative working space,and the absence of tactile feedback.Drawing on international research progress and our own clinical experience,this article analyzes optimization strategies including assessment of local tumor involvement,rational trocar placement,lymphatic and neural plexus dissection,determination of the extent of hepatectomy,vascular resection and reconstruction,bile duct reconstruction,and choledochojejunostomy.The aim is to explore approaches to overcoming these challenges and breaking through existing limitations,thereby providing new strategies and technical pathways for precise minimally invasive treatment of PHCC.

Objective To explore the effect of hypoxia-inducible factor-1α(HIF-1α)inhibitor LW6 on ferroptosis in septic cardiomyopathy rats.Methods Rat septic cardiomyopathy model was prepared using cecal ligation and puncture(CLP)method.Thirty-six specific pathogen-free(SPF)6-8 weeks male SD rats were randomly divided into the sham-operated group,CLP group,CLP+solvent group,LW6 group,ferrostatin-1(Fer-1)group,and LW6+Fer-1 group.The degree of myocardial damage in each group was evaluated through hematoxylin-eosin stai-ning and detection of lactate dehydrogenase and creatine kinase content in cardiac tissue.Myocardial mitochondrial damage was observed by transmission electron microscopy.Ferroptosis level was determined by detecting iron ion concentration,reduced glutathione,malondialdehyde,and reactive oxygen species.Protein expression levels of HIF-1α,solute carrier family 7 member 11(SLC7A11),and glutathione peroxidase 4(GPX4)in cardiac tissue were detected by Western blotting.Results Compared with the CLP group and the CLP+solvent group,the LW6 group could ameliorate myocardial damage,alleviate mitochondrial damage,inhibit ferroptosis-related indicators(all P＜0.05),reduce HIF-1α protein expression levels(P＜0.05),and enhance SLC7A11 and GPX4 protein expression levels(both P＜0.05).Conclusion LW6 decreases HIF-1α expression and ferroptosis levels through the SLC7A11/GPX4 pathway,and ameliorates sepsis-induced cardiomyopathy.

Objective To explore the differences in postoperative recovery between laparoscopic assisted distal gastrectomy(LADG)and total laparoscopic distal gastrectomy(TLDG)for gastric cancer.Methods A retrospective analysis was conducted on clinical data of 99 patients who underwent laparoscopic distal gastrectomy for gastric cancer from May 2019 to April 2024.According to patient preference,49 patients underwent TLDG and 50 patients underwent LADG.The two groups were compared regarding operation duration,intraoperative blood loss,lymph node dissection and metastasis,frequency of postoperative analgesic use,time to gas exhaustion,time to ambulation,postoperative hospital stay,self-care ability score(Barthel Index),total protein,albumin,and white blood cell count,as well as postoperative complications including anastomotic leakage,anastomotic obstruction,gastroparesis,chylous leakage,abdominal infection,incision infection,respiratory system infection and so on.Results Compared with LADG,TLDG resulted in fewer frequency of postoperative analgesic use(median,0 vs.4 times,Z=-5.810,P<0.001)and higher self-care ability scores(median,50.0 points vs.40.0 points,Z=-3.232,P=0.001)after surgery.There were no significant differences in operation duration,intraoperative blood loss,number of lymph nodes obtained,lymph node metastasis,time to gas exhaustion,time to ambulation,postoperative hospital stay,postoperative complications,postoperative total protein,albumin,and white blood cell count between the two groups(P>0.05).Conclusion LADG and TLDG are comparable in surgical efficiency and safety,but TLDG results in less postoperative pain and better self-care ability after surgery,potentially offering advantages in postoperative recovery.

Takotsubo syndrome is a transient, reversible syndrome characterized by acute regional dysfunction of the left ventricle, with symptoms resembling those of acute coronary syndrome. Takotsubo syndrome can lead to left ventricular thrombus formation, which may embolize and cause ischemic stroke. However, such cases are relatively rare. A case of acute ischemic stroke with middle cerebral artery occlusion caused by Takotsubo syndrome is reported in this article. The patient presented primarily with left-sided limb weakness. Cerebral angiography indicated occlusion of the right middle cerebral artery, and complete vascular recanalization was achieved after endovascular thrombectomy. Cranial magnetic resonance imaging indicated multiple infarctions in both the anterior and posterior circulations. Transthoracic echocardiography showed apical thrombus formation in the left ventricle and significantly reduced left ventricular systolic function. After a short course of anticoagulation combined with antiplatelet therapy, the apical thrombus resolved, and left ventricular systolic function significantly improved. This case indicates that although large-vessel occlusion acute ischemic stroke caused by Takotsubo syndrome is relatively rare, comprehensive etiological evaluation should be emphasized in patients with suspected cardioembolic stroke. Dynamic monitoring of echocardiographic changes is important for accurate diagnosis of the underlying cause.