Objective: To explore a new classification method for adenocarcinoma of esophagogastric junction (AEG). Methods: This study consisted of an anatomical investigation and a retrospective case series. Twelve adult cadaveric specimens were included (8 males, 4 females), with a height of (166.9±11.7)cm (range:155 to 179 cm) and an age of (63.3±7.5) years (range: 56 to 72 years). Additionally, data from 20 patients who underwent radical three-incision total esophagectomy with proximal gastrectomy for middle/upper esophageal cancer at the Department of Gastrointestinal Surgery, Shanxi Provincial Cancer Hospital from March to June 2025 were analyzed (16 males, 4 females; aged (60.5±8.7) years(range: 50 to 71 years)). Pathological examination was performed on intact normal tissues from the esophagogastric junction. Results: Anatomical dissection revealed that the esophagogastric junction is a transitional structure with distinct anatomical landmarks and boundaries, enveloped by a unique sleeve-like membranous structure (Laimer's ligament), exhibiting specific histological features. Surgical specimens showed that the longitudinal veins of the lower esophagus branched gradually as they extended toward the stomach, forming a capillary network 1 to 2 cm above the dentate line before reconverging into thicker gastric mucosal veins approximately 1 cm below the dentate line. Histopathological examination further demonstrated that the transition from esophageal squamous epithelium to gastric columnar epithelium was not abrupt at the "Z-line" but exhibited overlapping, with gastric columnar epithelial cells migrating upward into the submucosa of the esophageal squamous epithelium for several millimeters. Based on anatomical findings and endoscopic landmarks, the Chinese classification of adenocarcinoma of esophagogastric junction (CHAEG) was proposed. Tumors were categorized into three types according to their origin: (1) CHAEG-E (perforator zone type): endoscopic tumor origin at the perforator zone; (2) CHAEG-P (palisade zone type): endoscopic tumor origin at the palisade zone; (3) CHAEG-G (gastric zone type): endoscopic tumor origin at the gastric zone. Each type was further subdivided into six subtypes based on the extent of tumor invasion at the upper and lower poles. Conclusions: This study preliminarily proposes a novel classification method for AEG, which may help resolve controversies regarding the extent of upper and distal resection margins and lymphadenectomy during radical surgery. However, the clinical value of this classification requires further investigation.

In the context of precision medicine, functional magnetic resonance imaging (fMRI) offers a key breakthrough in the diagnosis and treatment of spinal disorders, shifting the focus from morphological to functional assessment. Microstructural imaging techniques such as diffusion tensor imaging (DTI) of the spine enable early identification of pathological changes, such as demyelination and axonal degeneration, in the spinal cord and nerve roots, thereby facilitating ultra-early diagnosis and differential diagnosis. DTI can also assess the severity of neural injury, accurately localize the responsible spinal segments, and guide personalized and minimally invasive surgical planning. Preoperative DTI metrics have been shown to correlate significantly with postoperative functional recovery and have emerged as important imaging biomarkers for predicting outcomes. Furthermore, blood oxygen level-dependent fMRI studies in patients with spinal diseases have revealed functional reorganization and compensatory remodeling within sensorimotor networks in the brain, providing new insights into the central effects of spinal pathologies and underlying neural plasticity. By integrating functional and structural information, fMRI is currently propelling spine surgery toward a new era of earlier, more accurate, and more predictive precision-based care.

Objective: To evaluate the safety and efficacy of knotless barbed sutures for wound closure in elective degenerative short-segment posterior lumbar surgery. Methods: This is a prospective randomized controlled trial study. Patients who met the inclusion and exclusion criteria undergoing elective posterior lumbar surgery at the Department of Orthopedics,Peking University Third Hospital from March 2024 to May 2025 were enrolled and randomly assigned to either the trial group or the control group using a random number table. Wound closure in the trial group was performed using barbed sutures for the deep fascia, superficial fascia, and intradermal layers; while the control group received conventional sutures. The incision length, deep fascia, superficial fascia, and intradermal wound closure times, and total wound closure time were compared between the two groups, and the suturing speed per unit length was calculated. Postoperative drainage volume, drainage tube removal time, weight of soiled dressings at the first dressing change, total length of hospital stays (LOS), postoperative LOS, wound healing status, and incidence of incision-related complications were recorded. Functional outcomes were assessed using the Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI), and visual analog scale (VAS) for pain at the 3-month postoperative follow-up. Data analysis was taken by independent sample t test or Mann-Whitney U test, Chi-square test or Fisher exact test. Results: A total of 114 patients were included in this study. There were 51 males and 63 females,aged(61.1±9.0)years(range:48 to 75 years). There were 57 patients in each group. No significant difference was found in incision length between the two groups ((11.0±1.8) cm vs. (11.1±1.8) cm, t=-0.399, P=0.690). The suturing speed was significantly faster in the trial group than in the control group ((1.1±0.3) min/cm vs. (1.7±0.4) min/cm, t=-7.200, P<0.01). The trial group demonstrated significantly shorter closure times for the deep fascia, superficial fascia, intradermal layer, and total wound closure time compared to the control group (all P<0.01). No significant differences were found between the two groups in terms of total operative time, total operating room time, postoperative drainage volume, drainage tube removal time, total LOS, or 3-month postoperative JOA, VAS, and ODI scores (all P>0.05). However, the trial group had a significantly shorter postoperative LOS than the control group ((6.0±1.9) d vs. (6.8±2.9) d, t=-2.391 P=0.017). Conclusion: For short-segment posterior lumbar surgery, barbed sutures significantly reduce layered and total wound closure times and decrease postoperative hospitalization, while demonstrating non-inferiority to conventional sutures in operative duration, drainage management, complication rates, and functional outcomes.

Objective: To evaluate the efficacy of cytoreductive surgery (CRS) combined with tyrosine kinase inhibitor(TKI) for the treatment of recurrent and metastatic gastrointestinal stromal tumor(GIST) and to identify the prognostic factors. Methods: This is a retrospective cohort study. A total of 89 patients diagnosed with recurrent and/or metastatic GIST at the Department of General Surgery,the Sixth Affiliated Hospital of Sun Yat-sen University from December 2007 to August 2024 were included. Among them,67 were male and 22 were female,with an age of (56.0±11.9)years (range: 26 to 79 years). Patients were divided into two groups based on whether CRS was performed: the CRS combined with TKI therapy group (51 patients) and the TKI therapy alone group(38 patients). Clinical and pathological data,as well as prognostic data,were compared between groups using independent sample t-test,Wilcoxon rank-sum test, χ2 test,or Fisher's exact test. Cox proportional hazards regression model was used for prognostic factor analysis. Results: The CRS combined with TKI therapy group demonstrated superior median overall survival compared to the TKI therapy alone group (102.0 months vs. 65.5 months,P<0.05),with benefits remaining stable after inverse probability weighting (IPTW). For patients with newly diagnosed recurrence and/or metastasis,upfront CRS combined with imatinib showed improved progression-free survival(PFS) compared to imatinib alone (67.0 months vs. 24.0 months,P<0.05). However,following first-line imatinib failure,there was no significant difference in PFS between CRS combined with TKI therapy and TKI therapy alone (P=0.330). Among the 51 patients who underwent CRS,47 patients (74.6%) achieved complete cytoreduction (CC0/1). The incidence of Clavien-Dindo grade Ⅲ to Ⅳ complications was 17.5%(11/63),with no perioperative mortality. Survival analysis revealed that the CC0/1 group had superior median PFS time(22.0 months (95%CI: 18.0 to 67.0 months) vs. 13.0 months (95%CI: 3.0 months to not reached),P<0.01) and median overall survival time(not reached (95%CI: 85.6 months to not reached) vs. 31.5 months (95%CI: 25.1 months to not reached), P<0.01) compared to the CC2/3 group. Multivariate Cox analysis indicated that the completeness of cytoreduction was an independent prognostic factor for PFS (HR=5.804,95%CI: 1.841 to 18.296,P<0.01). Conclusions: CRS can improve the prognosis of patients with recurrent or metastatic GIST,especially at its initial diagnosis.

Cervical radiculopathy is one of the common degenerative disorders encountered in spinal surgery. With the continuous advancement of surgical instruments and techniques, spinal surgery has entered the era of "visualized minimally invasive treatment."Guided by the principles of minimal invasiveness, precision, and functional preservation, cervical endoscopic surgery has rapidly evolved into a comprehensive technical system characterized by "posterior approaches as the mainstay，anterior approaches as complementary options，and the coexistence of uniportal and biportal techniques." Compared with traditional open procedures, spinal endoscopy offers significant advantages in soft-tissue protection, preservation of cervical stability, reduced intraoperative blood loss, and accelerated postoperative recovery, while achieving comparable or superior clinical outcomes. With the ongoing development of navigation systems and robot-assisted technologies, cervical endoscopic surgery is progressing toward greater precision and intelligence. In the future, standardization of surgical procedures and perioperative management, the establishment of multicenter long-term follow-up databases, and the integration of artificial-intelligence-based training systems will further enhance the safety, accuracy, and reproducibility of cervical endoscopic techniques, promoting a shift from surgeon-dependent experience to a standardized, evidence-driven treatment paradigm.

The choledocho-pancreatico-duodenal junction (CPDJ) refers to the specific anatomical region where the bile duct,pancreatic duct,and duodenum converge,which is prone to various diseases,including inflammation,stones,tumors,malformations,injuries, and functional disorders. The common clinical manifestations of diseases at the CPDJ are caused by obstruction of the bile duct,pancreatic duct,and duodenum. Unexplained biliary and/or pancreatic duct dilation refers to the clinical sign of bile duct and/or pancreatic duct dilation observed on imaging without an apparent space-occupying lesion. Such patients may be asymptomatic and have normal laboratory test results,or they may only exhibit mild elevations in alkaline phosphatase, γ-glutamyl transpeptidase,and bilirubin levels. Among these cases, some biliary and pancreatic duct dilations are physiological,while others are caused by early-stage or atypical tumors that are not easily detectable on imaging. Currently,there is a lack of unified understanding in the clinical diagnosis and treatment of diseases at the CPDJ,particularly unexplained biliary and pancreatic duct dilation, leading to frequent cases of missed diagnosis, misdiagnosis, and overtreatment. This consensus aims to standardize the diagnosis and treatment process for diseases at the CPDJ, enhance professionals' understanding of the complexity, specificity,and common characteristics of these diseases,and minimize missed diagnoses, misdiagnoses,nonstandard treatments,and overtreatment to the greatest extent possible.

Objective: To evaluate the clinical efficacy of unilateral biportal endoscopy contralateral inclinatory approach (UBE-CIA) in the treatment of lumbar foraminal stenosis. Methods: A retrospective case series study was conducted on 32 patients with lumbar foraminal stenosis who underwent UBE-CIA at Department of Orthopaedics, the Second Affiliated Hospital of Anhui Medical University between March 2021 and December 2024. There were 14 males and 18 females, with an age of (54.7±12.3) years (range:27 to 77 years). In terms of clinical indicators, the visual analogue scale (VAS) for pain and the Oswestry disability index (ODI) were recorded preoperatively,postoperatively, and at final follow-up. The modified MacNab criteria were used to evaluate clinical efficacy. Regarding radiological indicators, the changes in the foraminal area and facet joint area were measured preoperatively and postoperatively. Repeated measures analysis of variance was used for comparing repeated measurement data, and the Student-Newman-Keuls test was used for pairwise comparisons. Paired sample t-test was used for comparing radiological data. Results: All 32 patients underwent operations successfully with an operative time of (91.9±33.4) min (range:43 to 172 min) and postoperative hospital stay of (5.8±1.7)d (range:2 to 10 d). All patients were followed up for (17.1±4.6) months (range:7 to 30 months). The VAS score for lower extremity pain in patients before surgery was 7.2±1.0, which decreased to 2.0±0.8 one week after surgery and further to 0.8±0.5 at the last follow-up (F=406.822, P<0.01); the VAS score for low back pain before surgery was 4.5±1.2, which dropped to 1.8±0.9 one week after surgery and further to 0.7±0.5 at the last follow-up (F=175.579, P<0.01); the ODI before surgery was (69.0±8.7)%, which decreased to (25.9±6.0)% one week after surgery and further to (10.3±2.5)% at the last follow-up (F=662.586, P<0.01). All differences were statistically significant. The excellent and good rate according to the modified MacNab criteria was 93.8% (30/32). The foraminal area increased from (61.4±14.6) mm² to (108.4±16.9) mm², with a statistically significant difference (t=-18.190, P<0.01). The facet joint preservation rate was (85.8±3.9)%. Conclusions: UBE-CIA provides excellent clinical efficacy for lumbar foraminal stenosis. It effectively relieves lower limb and back pain, significantly improves functional disability, and achieves effective decompression of the exiting nerve root, providing an effective treatment option for complex foraminal stenosis diseases.

Objective: To investigate gait differences between patients with cervical spondylotic myelopathy (CSM) and healthy individuals, and to further analyze gait characteristics across different disease severities and gender subgroups, utilizing vision-based gait analysis and plantar pressure technology. Methods: This is a cross-sectional study. From April to August 2024, 147 CSM patients and 154 asymptomatic volunteers were recruited at the Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University. There were 168 males and 133 females, aged (54.1±10.4)years (range:28 to 76 years). Propensity score matching using the nearest neighbor method (caliper value 0.02) was performed with gender, age, and body mass index as matching variables. Gait parameters were obtained by analyzing walking videos captured via a smartphone computer vision algorithm (OpenPose framework). Plantar pressure distribution was measured using wireless sensor insoles (sampling rate 50 to 100 Hz). Intergroup comparisons were conducted using independent sample t-tests, and multi-group comparisons used analysis of variance. The diagnostic cut-off values for gait-related indicators were determined via receiver operating characteristic (ROC) curves, area under the curve (AUC), and the Youden index. Results: After PSM, a total of 102 matched pairs were obtained. There were no statistically significant differences in the general data between the CSM group and the healthy control group after matching (all P>0.05). At self-selected walking speed, the CSM group exhibited slower gait speed ((0.63±0.19) m/s vs. (0.83±0.26) m/s, t=9.310, P<0.01) and cadence ((39.38±16.99) steps/min vs. (46.12±13.63) steps/min, t=4.595, P<0.01), shorter stride length ((0.43±0.09) m vs. (0.52±0.12) m, t=9.434, P<0.01) and step length ((0.85±0.19) m vs. (1.01±0.23) m, t=8.998, P<0.01), prolonged gait cycle ((1.23±0.17) s vs. (1.14±0.17) s, t=-3.715, P=0.001), increased proportions of stance phase ((66.96±5.40)% vs. (54.11±9.57)%, t=16.952, P<0.01) and double support phase ((33.13±10.74)% vs. (21.78±8.46)%, t=16.699, P<0.01), and a decreased proportion of swing phase ((33.03±5.40)% vs. (45.73±9.41)%, t=11.701, P<0.01). Multiple kinematic parameters (hip flexion angle, ankle dorsiflexion angle) were significantly lower in the CSM group (all P<0.01). Plantar medial pressure was increased ((44.62±15.81)% vs. (39.07±13.11)%, t=-3.471, P=0.016), while lateral pressure was decreased ((55.38±15.81)% vs. (60.93±13.11)%, t=2.721, P=0.019). Among these parameters, the stance phase proportion demonstrated the highest diagnostic accuracy (AUC=0.944, sensitivity=88.9%, specificity=89.2%), with an optimal cut-off value of 64.75%. Conclusions: Significant differences in gait speed, stride length, gait cycle, hip flexion angle, ankle dorsiflexion angle,plantar medial and lateral pressure exist between CSM patients and healthy controls. A stance phase proportion greater than 64.75% can serve as a primary gait parameter for assisting in the diagnosis of CSM.

Perioperative coagulopathy is frequently complex in liver transplant recipients. Strengthening perioperative coagulation management in these patients is one of the key factors for ensuring surgical success, reducing mortality, and improving recipient outcomes. At present, there is a lack of unified standards for perioperative coagulation management in liver transplant recipients across different transplant centers. Therefore,the Perioperative Management Group of Chinese Society of Organ Transplantation of Chinese Medical Association organized relevant experts to follow the principles of evidence-based medicine,combined with relevant literature,expert experience,and research results from various transplant centers,to develop the "Guideline for perioperative coagulation management in adult liver transplant recipients（2026 edition）". This guideline aims to provide recommendations for perioperative coagulation management in adult liver transplant recipients. The goal is to establish a multidisciplinary perioperative coagulation management system for these patients,optimize coagulation management,reduce complications caused by coagulation disorders,and improve post-transplant survival rates of liver transplant recipients.

Small nucleolar RNAs (snoRNAs) are a class of important non-coding RNAs traditionally involved in the modification and processing of ribosomal RNA. Recent studies have revealed that snoRNAs are aberrantly expressed in various gastrointestinal malignancies-including gastric cancer, colorectal cancer, and esophageal cancer-and contribute to tumorigenesis and progression by regulating gene expression and modulating key biological processes such as tumor cell proliferation, apoptosis, invasion, migration, metabolism, drug resistance, and stemness maintenance. Although extensive research has focused on the roles of snoRNAs in cancer, their precise molecular mechanisms and clinical utility remain incompletely understood. This review summarizes the expression profiles and functional mechanisms of snoRNAs in gastrointestinal cancers and discusses their potential as biomarkers or therapeutic targets, aiming to provide new insights for early diagnosis and precision therapy of these malignancies.