Background and Aims:Acute pancreatitis(AP)is an acute inflammatory disease of the pancreas caused by abnormal activation of pancreatic enzymes.Although gallstones,hyperlipidemia,and alcohol use are the most common causes,a subset of patients develop AP secondary to rare etiologies that are often misdiagnosed or diagnosed late,leading to recurrence or inappropriate management.This study aims to summarize the clinical characteristics,diagnostic strategies,and treatment outcomes of four cases of AP caused by uncommon etiologies,supported by a literature review.Methods:Clinical data of 4 patients admitted to the Department of Hepatobiliary and Pancreatic Surgery,the Third Xiangya Hospital of Central South University,between November 2021 and September 2024,were retrospectively analyzed.Their etiological characteristics,diagnostic approaches,and treatment strategies were reviewed in combination with relevant literature.Results:The underlying causes of AP were intraductal papillary mucinous neoplasm,pancreatic neuroendocrine tumor,pancreatic ductal adenocarcinoma,and duodenojejunal intussusception.All cases initially presented as idiopathic AP.Three patients underwent definitive surgical treatment and recovered well,while one patient with pancreatic cancer received only palliative care due to delayed diagnosis and died three months later.Conclusion:AP secondary to rare etiologies often mimics common forms in clinical presentation but poses diagnostic challenges.For patients with recurrent or idiopathic AP,clinicians should emphasize etiological tracing and utilize advanced imaging and endoscopic modalities for early identification.Timely etiological intervention,particularly surgical management when appropriate,is essential for preventing recurrence and improving prognosis.

Background and Aims:Infected necrotizing pancreatitis(INP),particularly with diffuse distribution,is a life-threatening condition.The optimal initial intervention-minimally invasive step-up therapy vs.direct open necrosectomy-remains controversial.Moreover,the impact of necrosis morphology("wet"or"dry")and the presence of severe acute pancreatitis(SAP)on treatment selection has not been fully clarified.This study aimed to compare the efficacy and safety of these two approaches in diffuse INP and to evaluate the guiding value of CT-based necrosis type and SAP status in clinical decision-making.Methods:A retrospective analysis was conducted on 458 patients with diffuse INP admitted to the Third Xiangya Hospital of Central South University from January 2012 to March 2023.Patients were divided into a minimally invasive step-up group(n=256)and a direct open surgery group(n=202).SAP was defined according to the determinant-based classification,and necrosis was categorized as"wet"or"dry"based on CT features.The primary endpoint was a composite of death or major complications,while secondary endpoints included mortality,length of hospital stay,and incision-related complications,were compared between the two groups,with subgroup analyses performed accordingly.Results:Overall,the open surgery group had higher rates of the primary endpoint(62.4%vs.48.1%,P=0.003)and mortality(27.2%vs.16.8%,P=0.008)compared with the step-up group.Among SAP patients,the step-up approach resulted in a significantly lower primary endpoint rate(66.7%vs.97.7%,P=0.003).In non-SAP patients,the primary endpoint rates were similar,but open surgery was associated with a shorter hospital stay[(36.5±10.4)d vs.(45.6±18.6)d,P<0.001]and higher incidences of wound infection and incisional hernia(both P<0.001).Multivariate analysis identified infection onset time,effusion characteristics,gas bubbles,and necrosis location as independent predictors of prolonged hospitalization in the step-up group(all P<0.05).Patients with"wet"necrosis benefited more from the step-up approach,whereas those with"dry"necrosis experienced shorter hospitalization following open surgery.Conclusion:For diffusely distributed INP,treatment strategies should be individualized based on SAP status and necrosis liquefaction/imaging characteristics.The step-up minimally invasive approach is preferred for SAP patients and those with"wet"necrosis on CT,while direct open necrosectomy may be advantageous for"dry"necrosis(particularly with limited liquefaction)by shortening hospital stay and reducing certain major outcomes,though at the cost of increased incision infection and incision herina.CT imaging features and SAP classification can serve as valuable tools for risk stratification and guiding individualized timing and modality of intervention.

Background and Aims:Acute pancreatitis(AP)is an acute inflammatory disease of the pancreas caused by abnormal activation of pancreatic enzymes.Although gallstones,hyperlipidemia,and alcohol use are the most common causes,a subset of patients develop AP secondary to rare etiologies that are often misdiagnosed or diagnosed late,leading to recurrence or inappropriate management.This study aims to summarize the clinical characteristics,diagnostic strategies,and treatment outcomes of four cases of AP caused by uncommon etiologies,supported by a literature review.Methods:Clinical data of 4 patients admitted to the Department of Hepatobiliary and Pancreatic Surgery,the Third Xiangya Hospital of Central South University,between November 2021 and September 2024,were retrospectively analyzed.Their etiological characteristics,diagnostic approaches,and treatment strategies were reviewed in combination with relevant literature.Results:The underlying causes of AP were intraductal papillary mucinous neoplasm,pancreatic neuroendocrine tumor,pancreatic ductal adenocarcinoma,and duodenojejunal intussusception.All cases initially presented as idiopathic AP.Three patients underwent definitive surgical treatment and recovered well,while one patient with pancreatic cancer received only palliative care due to delayed diagnosis and died three months later.Conclusion:AP secondary to rare etiologies often mimics common forms in clinical presentation but poses diagnostic challenges.For patients with recurrent or idiopathic AP,clinicians should emphasize etiological tracing and utilize advanced imaging and endoscopic modalities for early identification.Timely etiological intervention,particularly surgical management when appropriate,is essential for preventing recurrence and improving prognosis.

Background and Aims:Infected necrotizing pancreatitis(INP),particularly with diffuse distribution,is a life-threatening condition.The optimal initial intervention-minimally invasive step-up therapy vs.direct open necrosectomy-remains controversial.Moreover,the impact of necrosis morphology("wet"or"dry")and the presence of severe acute pancreatitis(SAP)on treatment selection has not been fully clarified.This study aimed to compare the efficacy and safety of these two approaches in diffuse INP and to evaluate the guiding value of CT-based necrosis type and SAP status in clinical decision-making.Methods:A retrospective analysis was conducted on 458 patients with diffuse INP admitted to the Third Xiangya Hospital of Central South University from January 2012 to March 2023.Patients were divided into a minimally invasive step-up group(n=256)and a direct open surgery group(n=202).SAP was defined according to the determinant-based classification,and necrosis was categorized as"wet"or"dry"based on CT features.The primary endpoint was a composite of death or major complications,while secondary endpoints included mortality,length of hospital stay,and incision-related complications,were compared between the two groups,with subgroup analyses performed accordingly.Results:Overall,the open surgery group had higher rates of the primary endpoint(62.4%vs.48.1%,P=0.003)and mortality(27.2%vs.16.8%,P=0.008)compared with the step-up group.Among SAP patients,the step-up approach resulted in a significantly lower primary endpoint rate(66.7%vs.97.7%,P=0.003).In non-SAP patients,the primary endpoint rates were similar,but open surgery was associated with a shorter hospital stay[(36.5±10.4)d vs.(45.6±18.6)d,P<0.001]and higher incidences of wound infection and incisional hernia(both P<0.001).Multivariate analysis identified infection onset time,effusion characteristics,gas bubbles,and necrosis location as independent predictors of prolonged hospitalization in the step-up group(all P<0.05).Patients with"wet"necrosis benefited more from the step-up approach,whereas those with"dry"necrosis experienced shorter hospitalization following open surgery.Conclusion:For diffusely distributed INP,treatment strategies should be individualized based on SAP status and necrosis liquefaction/imaging characteristics.The step-up minimally invasive approach is preferred for SAP patients and those with"wet"necrosis on CT,while direct open necrosectomy may be advantageous for"dry"necrosis(particularly with limited liquefaction)by shortening hospital stay and reducing certain major outcomes,though at the cost of increased incision infection and incision herina.CT imaging features and SAP classification can serve as valuable tools for risk stratification and guiding individualized timing and modality of intervention.

Early onset antinuclear antibody positive juvenile idiopathic arthritis is classified as a new separate type proposed by the International Experimental Organization for Pediatric Rheumatology in 2018，which differs from the classic classification method of the International Federation of Rheumatology Associations in 2001.Early onset antinuclear antibody positive juvenile idiopathic arthritis is defined by the onset before the age of 6 years，asymmetric arthritis，high incidence of chronic iridocyclitis，ANA positivity，and HLA-B27 related diseases，which are more common in girls.The clinical management of early onset antinuclear antibody positive juvenile idiopathic arthritis is challenging，and the awareness of this disease also needs to be improved.This article elaborates on the latest progress of early onset antinuclear antibody positive juvenile idiopathic arthritis in the aspects of epidemiology，etiology and pathogenesis，clinical manifestations and diagnostic criteria，differential diagnosis，treatment，outcome，and prognosis，in order to deepen the understanding of clinicians，improve the diagnosis and treatment level of this type of juvenile idiopathic artbritis，and make early diagnosis.

Background and Aims:In the era of minimally invasive surgery,the role of pancreatic tumor enucleation(PTE)in treating benign or low-grade malignant tumors is gaining attention.The Da Vinci robot offers advantages such as enhanced visualization and flexible instrument manipulation,which can ensure the safe implementation of PTE.However,whether robotic pancreatic tumor excision(RPTE)is superior to laparoscopic pancreatic tumor enucleation(LPTE)remains undetermined.Therefore,this study was performed to explore this aspect. Methods:The clinical data of 38 patients who underwent surgical treatment for benign or low-grade malignant tumors in the Third Xiangya Hospital of Central South University from April 2020 to May 2024 were collected.Among them,18 cases underwent RPTE(RPTE group),and 20 cases underwent LPTE(LPTE group).Relevant clinical variables were compared between the two groups,and subgroup comparisons were further conducted for patients with tumors in the head and neck/body/tail of the pancreas. Results:The average operative time for the entire group was 125 min,with an average intraoperative blood loss of 67.89 mL,and no C-grade pancreatic fistula occurred.The incidence rates of B-grade pancreatic fistula,postoperative bleeding,and readmission were 39.5％,21.1％,and 18.4％,respectively,with an average postoperative hospital stay of 11.44 d.Overall,the RPTE group had shorter operative time and less intraoperative blood loss than the LPTE group(both P＜0.05).There were no statistically significant differences between the two groups regarding the incidence of B-grade pancreatic fistula,intraoperative bleeding,readmission rate,and postoperative hospital stay(all P＞0.05).Subgroup analysis showed that for patients with head tumors,the RPTE group had shorter operative time,less intraoperative blood loss,and a lower incidence of postoperative bleeding than the LPTE group(all P＜0.05).However,the differences in the incidence of B-grade pancreatic fistula,readmission rate,and postoperative hospital stay were not statistically significant(all P＞0.05).In patients with neck/body/tail tumors,the RPTE group also had shorter operative time and less intraoperative blood loss(both P＜0.05),but the differences in incidence of B-grade pancreatic fistula,incidence of postoperative bleeding,readmission rate,and postoperative hospital stay were not statistically significant(all P＞0.05). Conclusion:Minimally invasive PTE for the treatment of benign or low-grade malignant pancreatic tumors is safe.Compared to LPTE,RPTE can significantly reduce operative time and intraoperative blood loss and shows certain advantages in reducing postoperative complications,particularly for patients with head tumors.However,the conclusion of this study needs to be confirmed by larger prospective studies.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Objective: To explore the relationship between junior high school students lifestyles and 20 m shuttle run test (20 m SRT) performance, so as to provide a theoretical basis for promoting a healthy lifestyle among junior high school students. Methods: From April to June 2021, a total of 2 397 junior high school students aged 12-17 years in Yushan, Wuyuan, Hengfeng and Yugan counties of Shangrao City, Jiangxi Province were selected by random cluster stratified sampling. A questionnaire survey and 20 m SRT test were conducted. Logistic regression analysis was used to explore the association between lifestyles and 20 m SRT scores. Results: The passing rate of 20 m SRT for middle school students was 83.3%. Chi square test results showed that there were statistically significant differences between gender, grade, household registration, type of schooling, father s education and the 20 m SRT scores of junior high school students ( χ 2=25.26, 25.04, 6.99, 7.96, 16.22, P <0.05). Significant differences were found in 20 m SRT scores between vigorous and moderate physical activity and breakfast behavior in the last seven days ( χ 2=6.78, 6.29, 9.13, P < 0.05). The results of Logistic regression analysis showed that after controlling for confounding factors, "no vigorous physical activity in the last seven days" was positively correlated with the lower performance of 20 m SRT ( OR =1.31, 95% CI =1.03- 1.67 , P < 0.05). "Breakfast skipping" was positively correlated with 20 m SRT lower performance (frequent eating, OR =1.37, 95% CI = 1.09 -1.73, P <0.01). Conclusion Vigorous physical activity and regular breakfast consumption behavior are associated with higher performance 20 m SRT of junior high school students. Schools should encourage students to develop a habit of actively exercising and consuming breakfast regularly in order to ensure the healthy development of cardiopulmonary endurance levels.

Objective:To explore the efficacy and safety of urethroplasty combining the reconstruction of urethral plate with the enlargement of urethral cavity in the treatment of short penile urethral atresia or severe stricture.Methods:From January 2017 to September 2020, 10 patients, 22 to 78 years old and the average age 48, with short penile urethral atresia or severe stricture were treated in the Department of Urology, Henan University People’s Hospital, Henan Provincial People’s Hospital. The lengths of the stenotic or atresic segment were 0.2-0.5 cm, with an average length of 0.3 cm. They were all treated with one-stage urethroplasty to reconstructe urethral plate and enlarge urethral cavity with free prepuce skin grafts or pedicled flaps adjacent to the stenosis. By the guidance of urethral dilator, the strictured urethra was incised longitudinally on the ventral side of penis to the distance of 0.5 cm into the normal urethral mucosa at both ends. The stricture or atresic scar tissue of the urethra was removed. The distal and proximal corpus spongiosum were appropriately dissociated, and the urethral mucosa at the both ends of the dorsal side was anastomosed intermittently to reconstruct the urethral plate. Free prepuce skin grafts were used in 4 cases, and pedicled flaps adjacent to the stenosis were used in 6 cases to enlarge the urethral cavity.Results:In this study, the operation time ranged from 75 minutes to 100 minutes, with an average of 85.6 minutes. Intraoperative blood loss ranged from 20 ml to 65 ml, with an average of 45.5 ml. Followed up from 3 months to 3 years postopreatively, all of them did not have painful erection and penile curvature during erection, and felt the same as before in sexual life. Urinary flow rates were significantly improved in 9 cases, and the maximum flow rate was more than 15 ml/s. One recurred patient was cured after urethral dilatation.Conclusions:The one-stage urethroplasty combined the reconstruction of urethral plate with the enlargement of urethral cavity. The urethral plate was reconstructed through urethral resection of narrow segment and the urethral cavity was enlarged with free skin or pedicled flap. This technique has the advantages of a simple and safe operation with a high success rate and a less complication rate. It is an effective procedure to repair short penile urethral atresia or severe stricture.

Objective:To explore the efficacy and safety of urethroplasty combining the reconstruction of urethral plate with the enlargement of urethral cavity in the treatment of short penile urethral atresia or severe stricture.Methods:From January 2017 to September 2020, 10 patients, 22 to 78 years old and the average age 48, with short penile urethral atresia or severe stricture were treated in the Department of Urology, Henan University People’s Hospital, Henan Provincial People’s Hospital. The lengths of the stenotic or atresic segment were 0.2-0.5 cm, with an average length of 0.3 cm. They were all treated with one-stage urethroplasty to reconstructe urethral plate and enlarge urethral cavity with free prepuce skin grafts or pedicled flaps adjacent to the stenosis. By the guidance of urethral dilator, the strictured urethra was incised longitudinally on the ventral side of penis to the distance of 0.5 cm into the normal urethral mucosa at both ends. The stricture or atresic scar tissue of the urethra was removed. The distal and proximal corpus spongiosum were appropriately dissociated, and the urethral mucosa at the both ends of the dorsal side was anastomosed intermittently to reconstruct the urethral plate. Free prepuce skin grafts were used in 4 cases, and pedicled flaps adjacent to the stenosis were used in 6 cases to enlarge the urethral cavity.Results:In this study, the operation time ranged from 75 minutes to 100 minutes, with an average of 85.6 minutes. Intraoperative blood loss ranged from 20 ml to 65 ml, with an average of 45.5 ml. Followed up from 3 months to 3 years postopreatively, all of them did not have painful erection and penile curvature during erection, and felt the same as before in sexual life. Urinary flow rates were significantly improved in 9 cases, and the maximum flow rate was more than 15 ml/s. One recurred patient was cured after urethral dilatation.Conclusions:The one-stage urethroplasty combined the reconstruction of urethral plate with the enlargement of urethral cavity. The urethral plate was reconstructed through urethral resection of narrow segment and the urethral cavity was enlarged with free skin or pedicled flap. This technique has the advantages of a simple and safe operation with a high success rate and a less complication rate. It is an effective procedure to repair short penile urethral atresia or severe stricture.