To evaluate the features of carotid web (CW) by ultrasonography.

A total of 66 patients with CW were retrospectively enrolled from January 2018 to June 2019 at Xuanwu Hospital, Capital Medical University. All patients were examined by both ultrasonography and CTA, and were divided into either a<50% stenosis group (54 cases) or a ≥50% stenosis group (12 cases). The ultrasonographic characteristics of CW, including the length, thickness, direction (forward or backward to the flow), acute angle between the web and carotid wall, and thrombus between the web and carotid wall were compared between the two groups. The stenosis degrees of carotid artery were compared between patients with and without ischemic stroke.

Forty-two (42/66, 63.6%) patients were diagnosed with CW by initial CDFI examination, of whom 21 (21/66, 31.8%) were diagnosed with ulcerative plaque and 3 (3/66, 4.5%) were diagnosed with carotid dissection at first but confirmed by second examination. There were no differences in the web length, thickness, direction, or thrombus detected between the two groups (P>0.05). The angle between the web and carotid wall in the<50% stenosis group was significantly smaller than that of the ≥50% stenosis group (median angel 39o vs 73o, P=0.002), and the percentage of patients with an angle≤ 60o in the<50% stenosis group was significantly higher than that of the ≥50% stenosis group (74.1% vs 41.7%, P=0.042). The diameter of the residual carotid artery at CW location in the<50% stenosis group was significantly larger and peak systolic velocity was significantly higher in the<50% stenosis group than in the≥50% stenosis group (P<0.001). The stenosis degrees of carotid artery were not statistically different between patients with and without ischemic stroke (P=0.321).

Ultrasonography can be used to evaluate the characteristics of carotid web in 2D and color mode. When the angle between the CW and carotid wall is large, the carotid artery stenosis ≥ 50% is more likely to happen, but carotid artery stenosis is not the main cause of ischemic stroke.

The aim of the present study was to evaluate the efficiency of sling exercise, therapeuticultrasound, therapeuticultrasound and sling exercise in patients to alleviate pain and improve lumbar function with lumbar disc herniation.

Individuals were selected from a list of patients being followed at the department of Rehabilitation in the third hospital of Hebei Medical University. 30 patients who were diagnosed with lumbar disc herniation were collected, the diagnoses were established upon medical history, physical examination, and results of imaging studies. The patients were randomly divided into three groups: therapeuticultrasound group received 14 sessions of ultrasonic therapy to the lumbar region, Sling exercise group received 14 sessions of sling exercise, and therapeuticultrasound and sling exercise group received therapeuticultrasound and sling exercise therapy 14 sessions of therapeuticultrasound to the lumbar region,7 sessions per week, 2 weeks. The VAS and ODI were compared with the assessment of the patients before and at the end of the therapy.

At the end of treatment, three groups VAS scores (F=3.069, P=0.043) and ODI scores (t=12.676, P<0.001) was lower than that at the beginning of treatment (P<0.05), at the end of treatment the VAS scores (F=59.400, P<0.001) and of the ODI scores (t=12.737, P<0.001) of ultrasonic and sling exercise therapy group was lower than the other group, the difference is significantly.

All three groups could reduce pain and improve lumbar function, and the ultrasonic and sling exercise therapy was most effective for lumbar disc herniation treatment in the three groups.

To analyze the treatment of different types of traumatic cerebral infarction in children, and explore its pathogenesis in combination with literature so as to improve the cure rate and reduce disability rate.

The clinical data of 42 cases of traumatic cerebral infarction in children were retrospectively analyzed in The Hospital of 81^st Group Army PLA from January 2015 to December 2019. The diagnosis of traumatic cerebral infarction in children was made by CT scan and MRI scan. According to different conditions, children with traumatic cerebral infarction were classified, and different treatment strategies were selected. Children with lacunar infarction were treated with calcium antagonists and neurotrophic drugs, supplemented by hyperbaric oxygen and exercise rehabilitation. The children of focal cerebral infarction and complex cerebral infarction treated by junior dehydrant and hormone also included the calcium antagonist and nutritional nerve drugs. The therapeutic regimen perhaps adjusted by the evolution of the disease. The children of extensive cerebral infarction underwent emergency cranial decompression, and was treated by reducing intracranial pressure and preventing complications after operation. The treatment results and recovery were observed.

In 42 cases of traumatic cerebral infarction in children, 35 cases (83.3%) were good recovery, 4 cases (9.5%) were moderate disability, 2 cases (4.8%) were severe disability, 1 case (2.4%) died, and no vegetative state. The good recovery rate of lacunar infarction was 100%, that of focal cerebral infarction was 62.5%, that of mixed cerebral infarction was 60%, and that of extensive cerebral infarction was 50%.

It is of great significance to improve the therapeutic effect and prognosis of children with traumatic cerebral infarction to adopt different treatment schemes for different types of cerebral infarction.

To characterize the patients with supratentorial hypertensive intracerebral hemorrhage (ICH) in the Tibetan Plateau over an altitude of 4000 meters.

A total of 68 cases with supratentorial hypertensive ICH were retrospectively included in Ali Regional People’s Hospital from January 2017 to September 2018. The clinical and laboratory data were collected. A simple linear correlation analysis was applied to analyze the correlation between the amount of bleeding and sex, age, nationality, time from onset , systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), serum triglyceride (TG), and cholesterol. According to computed tomography (CT) findings, 68 cases were divided into the basal ganglia ICH group (33 cases) and the lobar ICH group (35 cases). The characteristics between two groups were analyzed using t-test or χ² test.

The data of sex, age, nationality, time from onset, SBP, DBP, Hb, TG, and cholesterol of 68 cases on admission did not show any definitive correlation with the hematoma volumes (P＞0.05). The SBP and DBP of patients in the basal ganglia ICH group were significantly higher than that in the lobar ICH group, respectively [(184.9±28.5) mmHg vs (164.6±24.4) mmHg; (113.0±18.1) mmHg vs (103.0±18.4) mmHg] (t=0.499, 0.486; P=0.002, 0.033).

The relevant factors of hematoma volumes in patients with ICH in plateau area were not yet clear. Diastolic and systolic blood pressure of patients in the basal ganglia ICH group was higher than that in those in lobar ICH group.

To compare the efficacy evaluation of electrospun composite biomaterials and a porcine small intestine submucosa mesh for hernia repair.

A randomized, single-blind, controlled multicenter trial was performed in 3 hospitals in Shanghai. Eligible adult patients with primary unilateral reducible groin hernias were randomly assigned (1∶1) to electrospun composite biomaterials (experimental group) or porcine small intestine submucosa (control group) mesh groups. Patients were treated with the tARB technique and assessed at 1,3 and 6 months after the surgery. The primary endpoint was hernia recurrence. The secondary endpoints were postoperative complications including groin pain and operative site infections.

172 patients were assigned to experimental (n=86) and control (n=86) groups. At 6 months follow-up, postoperative complications occurred in 5 patients (5/86, 5.95%) and 2 (2/86, 2.35%) patients in the control and experimental groups, respectively (P>0.05). There was no significant difference in VAS or SVS score between the two groups.

We demonstrate that electrospun composite biomaterial mesh can be used as a ideal choice for inguinal hernia repair. Electrospun composite biomaterial has the characteristics of low recurrence rate, absorbability and long-term comfort.It can be further applied in clinical practice in the future.

Pancreaticoduodenectomy(PD)remains one of the most complicated hepatobiliary operations. The development of minimally invasive surgery for PD has always been an hot spot. Laparoscopic pancreaticoduodenectomy(LPD) has not been widespread carried out due to its difficulty and long learning curve. LPD accounts for 9% of all PD, according to the National Cancer Data base. Compared with laparoscopic surgery, robotic surgery system has significant advantages in the field of minimally invasive PD, including stereotactic amplified vision, filtering hand tremor and simulating the wrist. The article would review the surgical techniques and notes, which could provide clinical reference for other surgeons.

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver, and it is also one of the leading causes of tumor-related death worldwide. Due to hidden early symptoms, most patients are diagnosed in the intermediate-advanced HCC upon admission. For them, surgical resection, local ablation and liver transplantation are potential therapeutic options, whereas most patients have lost the opportunity of surgery. Along with recent in-depth exploration of the molecular mechanism of HCC and successful development of multiple targeted drugs, systemic therapy has become increasingly prominent in the treatment of HCC. Among them, targeted therapy combined with immunotherapy showcases significant therapeutic advantages. At present, multiple regimens of targeted therapy combined with immunotherapy have completed phase Ⅲ clinical trials and verified their efficacy and safety, which have been widely applied in clinical practice. Therefore, the combination of targeted therapy and immunotherapy will applied more through the whole process of treatment for intermediate-advanced HCC, which is expected to significantly improve the survival and prognosis of patients. In this article, the latest research progress in the field of first-line treatment for intermediate-advanced HCC was reviewed, providing theoretical basis and clinical guidance for targeted therapy combined with immunotherapy for HCC.

Liver transplantation has become the most effective therapeutic option for end-stage liver disease. Graft rejection is the main obstacle to the long-term survival of organ transplantation recipients. Although widespread use of immunosuppressants can significantly improve the short-term prognosis and survival of patients, long-term use of immunosuppressants will increase the risk of adverse events, such as drug poisoning, systemic infection and tumor recurrence, and exerts limited effect on improving the overall survival rate of grafts. Therefore, how to induce the immune tolerance of liver transplantation and maintain the long-term survival of grafts without use of immunosuppressants remains an urgent scientific challenge in the field of organ transplantation. In recent years, the mechanism research and clinical trials of tolerogenic dendritic cell (tolDC) in immune tolerance after liver transplantation have achieved initial outcomes. In this article, biological characteristics, immunomodulation and application of tolDC in clinical liver transplantation were reviewed, and the application value of tolDC in inducing immune tolerance in liver transplantation was evaluated.

Echinococcosis is a zoonotic parasitic disease that is distributed widely around the world, with hidden onset and long incubation period, which seriously threatens human health. The interaction between immune escape and host immune system is complex, and especially the helper T(Th) cell subsets and their secreted cytokines play a key role in disease progression. In this article, the role of IL-23/IL-17 axis in echinococcosis was reviewed. IL-23 is secreted by activated dendritic cells and macrophages, which can promote the differentiation of Th17 cells and secrete IL-17. Studies have shown that the changes of IL-23 and IL-17 levels in cystic echinococcosis are closely associated with the infection stage and immune response, and affected by drug intervention. In alveolar echinococcosis, IL-23 and IL-17 levels are increased in the early stage of infection, and are associated with disease activity in the late stage. IL-23/IL-17 axis can regulate inflammatory response and immune cell function through the JAK/STAT signaling pathway, which plays an important role in immune regulation of echinococcosis. Further study of the mechanism underlying IL-23/IL-17 axis in echinococcosis will contribute to developing novel therapeutic targets and biomarkers, providing new ideas for early diagnosis, prognostic evaluation and immunotherapy of echinococcosis.

Pancreatic cancer is a highly-invasive malignancy, with an increasing incidence rate. Upon admission, most cases are diagnosed with advanced stage, complicated with unresectable locally advanced or metastatic diseases. Recurrence is commonly seen even in individuals undergoing radical resection. For high-risk groups, there is no widely-accepted screening method. Diagnosis, treatment evaluation and recurrence detection mainly depend on imaging examination. Effective methods are urgently required to assist diagnosis, efficacy evaluation and recurrence detection. Emerging technologies such as circulating tumor DNA (ctDNA), circulating tumor cells and exosomes have gradually matured and applied, which showcase potential advantages in the study of pancreatic cancer. In this article, research progress in the application of ctDNA in the early diagnosis of pancreatic cancer was reviewed.

Alzheimer's disease (AD) is a neurodegenerative disease characterized by memory loss and cognitive impairment, which has the highest incidence in the world. Pyroptosis is an inflammatory programmed cell death pattern discovered in recent years. Studies have shown that AD is closely related to pyroptosis. It has been confirmed that amyloid-beta protein and Tau proteins are involved in the occurrence of pyroptosis, and inflammasome and pro-inflammatory cytokines are involved in the pathogenesis of AD in the pathway of pyroptosis activation. Pyroptosis may be the main form of neuronal death. Pyroptosis mediated neuroinflammation plays a central role in the pathogenesis and progression of AD. Inhibition of pyroptosis and downstream inflammatory processes can alleviate the related pathological changes of AD and provide a new clinical therapeutic target.

To evaluate the efficacy and safety of laparoscopic intraperitoneal onlay mesh repair with the keyhole technique (IPST) versus the Sugarbaker technique for the treatment of parastomal hernia.

A retrospective analysis was conducted on 31 patients with parastomal hernia following abdominoperineal resection (Miles′ operation) for rectal cancer. These patients underwent laparoscopic repair, either with the IPST (n=16, 51.6%) or the Sugarbaker technique (n=15, 48.4%), in the Second Department of General Surgery, Shanghai Ninth People′s Hospital, Shanghai Jiao Tong University School of Medicine, between Jan. 2020 and Jun. 2023. Patient demographic data, postoperative complications, and the primary outcome-recurrence rate-were collected. Postoperative follow-up exceeded 12 months.

No mortality was recorded within 6 months postoperatively. One patient (6.7%) in the Sugarbaker group was readmitted due to postoperative fever and recovered conservatively during follow-up. The recurrence rate was 13.3%(2 cases) in the Sugarbaker group and 12.5%(2 cases) in the IPST group. Furthermore, no significant differences were observed between the IPST and Sugarbaker groups regarding intraoperative details or postoperative complications, including abdominal distension, surgical site infection, intestinal obstruction, enteric fistula, chronic postoperative pain, or recurrence.

Both the Sugarbaker and IPST techniques have been demonstrated to be effective, feasible, safe, and to yield similar clinical outcomes in the surgical management of parastomal hernia, particularly with respect to their low recurrence rates.

To investigate the clinical efficacy and safety of stepwise percutaneous cholangioscopy-guided laser technique for treating biliary-enteric anastomotic stricture after pancreaticoduodenectomy (PD).

Clinical data of 11 patients with biliary-enteric anastomotic stricture after PD who underwent treatment with stepwise percutaneous cholangioscopy-guided laser technique in the Department of Hepatobiliary and Pancreatic Surgery, Hangzhou First People′s Hospital Affiliated to Medical School of Westlake University from Jul. 2020 to Jun. 2025 were retrospectively analyzed. The puncture approach, interval time, number of procedures, operative time, intraoperative blood loss, and perioperative complications (including postoperative bile leakage and bleeding) were recorded and analyzed, along with long-term outcomes.

All 11 patients successfully completed the procedures without conversion to laparotomy. A right hepatic approach was used in 4 cases and a left hepatic approach in 7 cases. The median interval from puncture to operation was 7 days. The median operative time was 153 min, and the median intraoperative blood loss was 10 ml. Three patients underwent two-stage procedures. Postoperatively, fever occurred in 3 patients, no postoperative bleeding, bile leakage, or other complications were observed. The median postoperative bilirubin level was 21.3 μmol/L, and the median time to catheter removal was 7 days. During follow-up (median 24 months), no obvious abdominal pain or jaundice occurred, and no patient required readmission for reoperation.

With meticulous preoperative planning and refined operative technique, the stepwise percutaneous cholangioscopy-guided laser technique is safe and effective for treating biliary-enteric anastomotic stricture after PD, with no restenosis of the biliary-enteric anastomosis observed in long-term follow-up.

To investigate the efficacy and safety of direct visualization diagnosis andmanagement of complex biliary diseases via percutaneous transhepatic choledochoscopy.

A retrospective cohort study was conducted on patients who underwent percutaneous transhepatic diagnostic or therapeutic procedures at the Department of Hepatobiliary and Liver Transplantation Surgery, Nanjing Drum Tower Hospital Affiliated to Nanjing University, from Jan. 2024 to Dec. 2025. Outcome measures included surgery success rate, complication incidence, biliary biopsy success rate, pathological concordance rate, and residual biliary stone rate.

A total of 16 patients were enrolled. Among them, 9 (9/16, 56.3%) underwent choledochoscopy with biopsy, 6 (6/16, 37.5%) received lithotripsy and stone extraction, and 3 (3/16, 18.8%) underwent balloon dilation for biliary stricture—with 1 (1/3, 33.3%) of the latter each group combining biopsy and stone extraction. 11 (11/16, 68.8%) patients were achieved predefined surgical plan.5 (5/9, 55.6%) cases were obtained tissue samples. Notably, 2 (2/16, 12.5%) patients preoperatively diagnosed with hilar cholangiocarcinoma were reclassified via biopsy as having hepatocellular carcinoma with biliary tumor thrombi, leading to a complete revision of their treatment regimens. Operative times varied by procedure: choledochoscopy with biopsy (44.2 ± 18.0 min), balloon dilation with stenting (38.3±5.8 min), and lithotripsy with stone extraction (76.7 ± 22.7 min). Mean intraoperative blood loss was 9.1±8.4 ml, with no patients requiring blood transfusion, interventional hemostasis, or surgical hemostasis. 1 patient developed minor bile leakage from an intra-abdominally displaced drainage tube, which resolved following endoscopic retrograde cholangiopancreatography (ERCP). No patients were transferred to the intensive care unit due to complications, and there were no cases of tumor seeding along the sinus tract and mortality case.

Percutaneous transhepatic choledochoscopy under direct visualization is a safe and feasible approach for diagnosing and treating complex biliary diseases. Sinus tract establishment remains a key technical challenge. Integration of multidisciplinary equipment is recommended, and direct-visualization biopsy via choledochoscopy provides a reliable pathway for definitive pathological diagnosis.

Laparoscopic surgery is an important branch of minimally invasive surgery. Due to its advantages of less trauma, faster postoperative recovery and fewer complications, it has been widely used in abdominal tumor surgery in various surgical subspecialties such as hepatobiliary, pancreatic and gastrointestinal surgery. However, laparoscopic surgery also faces limitations such as reliance on two-dimensional vision, increased operational complexity, and high requirements for surgeons′ experience, and its accuracy and safety still need to be improved. Recently, with its powerful data processing, image recognition and automatic decision-making capabilities, artificial intelligence (AI) has developed rapidly in cross-disciplinary applications in medicine, promoting the development of laparoscopic surgery toward precision and intelligence. In this review, we summarize the current applications of AI in laparoscopic abdominal tumor surgery, including preoperative evaluation and planning, intraoperative localization, prediction of postoperative complications, and postoperative rehabilitation. We also analyze the existing challenges in the application of these technologies, including data bias, model interpretability and ethical issues. Furthermore, from the clinical perspective of the hepatobiliary surgery subspecialty, we discuss the future technological development trends and clinical translation prospects in this field. This review aims to provide a reference for promoting the interdisciplinary integration of artificial intelligence and laparoscopic surgery and improving the level of surgical diagnosis and treatment.

To investigate the application value of preoperative endoscopic biliary and pancreatic stenting in local resection of pancreatic head and neck tumors.

A retrospective descriptive study was conducted. Clinical data of 26 patients who underwent local resection of pancreatic head and neck tumors from January 2019 to December 2022 were collected, including 10 males and 16 females, with a median age of 54 years (range, 17~72 years). All patients received preoperative endoscopic stent placement. Observation indicators: (1) perioperative conditions; (2) postoperative conditions. Measurement data were expressed as absolute numbers.

(1) Perioperative conditions: All patients underwent endoscopic retrograde cholangiopancreatography (ERCP) for stent placement before surgery, among whom 20 received stent placement on the day of surgery. A pancreatic duct stent was placed in all patients, and a biliary stent was additionally placed in 21 patients. Two patients with multiple lesions in the pancreatic head and tail underwent distal pancreatectomy plus local resection of the pancreatic head, while the others with single lesions underwent local resection of pancreatic tumors only. Eleven patients underwent Roux-en-Y pancreaticojejunostomy during local tumor resection. (2) Postoperative conditions: No surgery-related death occurred in the 26 patients, with a mean hospital stay of 20.8 days. Grade B pancreatic fistula occurred in 13 patients, biochemical fistula in 7, and no grade C fistula was observed. Delayed gastric emptying occurred in 3 patients (grade C in 2, grade A in 1). Postoperative hemorrhage occurred in 4 patients (grade A in 1, grade B in 3). Biliary fistula occurred in 1 patient. Five patients had intra-abdominal encapsulated effusion.

Preoperative endoscopic biliary and pancreatic stenting is safe and feasible in local resection of pancreatic tumors. It extends the indications of local resection, helps protect the biliary and pancreatic ducts, reduces surgical difficulty, improves surgical success rate, accelerates postoperative recovery, and reduces the incidence of postoperative pancreatic fistula and biliary fistula.

Compare the prognostic effects of laparoscopic common bile duct exploration with "T" tube drainage (LCBDE) and laparoscopic common bile duct exploration and stone extraction via cystic duct (LTCBDE) in patients with secondary common bile duct stones.

A total of 116 patients with secondary common bile duct stones admitted to our hospital from February 2020 to February 2023 were selected as the research subjects. According to the surgical methods, the patients were categorized into the LTCBDE group (n=57) and the LCBDE group (n=59). The propensity score matching method was used to balance the differences between the two groups. After reducing the potential confounding factors, the basic data, perioperative indicators, stress indicators and complications of the two groups of patients were analyzed by t test, χ² test or Fisher's exact probability test. P<0.05 was considered statistically significant.

After matching, there were statistically significant differences between the two groups in postoperative drainage time, postoperative 24 h visual analogue scale score, postoperative fluid infusion volume, incision length, postoperative hospital stay, gastrointestinal function recovery time, intraoperative blood loss, return to normal life time, operation time, anal exhaust recovery time (P<0.05). Three days after surgery, the levels of interleukin-6 (IL-6) in the two groups were lower than those before surgery (P<0.05), and the levels of adrenocorticotropic hormone (ACTH), cortisol (Cor), natural killer cell (NK) and norepinephrine (NE) in the two groups were higher than those before surgery (P<0.05). However, the levels of IL-6, ACTH, Cor, NK and NE in LTCBDE group were lower than those in LCBDE group (P<0.05). The total incidence of complications in LCBDE group was higher than that in LTCBDE group, and the difference was statistically significant (P< 0.05). There was no significant difference in recurrence rate between LTCBDE group and LCBDE group (25.0% vs. 27.8%) (χ²=0.071, P=0.789).

Compared with LCBDE, LTCBDE has advantages such as low stress response and low complication rate. This study more strongly recommends LTCBDE for the treatment of secondary common bile duct stones.

To investigate the efficacy and safety of laparoscopic cholecystectomy in elderly patients.

Clinical data of 621 patients who underwent cholecystectomy for acute cholecystitis from January 2023 to December 2024 were retrospectively analyzed. Patients were divided into an elderly group (n=82, age ≥70 years) and a control group (n=539, age <70 years). Statistical analysis was performed using SPSS 22.0 software. Categorical data were analyzed using the χ² test or exact test. Normally distributed continuous data were presented as (

There were significant differences between the two groups in age, body mass index (BMI), ASA classification, comorbidities [cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), renal insufficiency], operation time, and length of hospital stay (P<0.05). The elderly group had higher incidences of postoperative pulmonary infection, intra-abdominal infection, and overall complications, as well as a longer postoperative hospital stay (P<0.05). The higher proportion of comorbidities (e.g., cardiovascular disease, diabetes mellitus) and poorer ASA classification in the elderly group may be important contributors to the increased incidence of postoperative pulmonary and intra-abdominal infections. Multivariate analysis showed that diabetes mellitus, ASA grade Ⅲ, and operation duration >80 minutes were independent risk factors for increased postoperative morbidity. Cardiovascular disease, chronic renal insufficiency, and length of hospital stay were factors independently associated with discharge rate.

Laparoscopic cholecystectomy is relatively safe in elderly patients under the premise of adequate evaluation of comorbidities and optimized perioperative management (such as blood glucose control and shortening operation time by an experienced surgical team). The risk of postoperative complications is acceptable.