Drivers and composition of hospitalization costs in patients undergoing laparoscopic tension-free hiatal hernia repair: A quantile regression study.

The main objective of this study is to investigate the prognostic value of serum protein induced by vitamin K absence or antagonist-II (PIVKA-II) in predicting postoperative outcomes for hepatocellular carcinoma (HCC) patients after surgical resection. Serum PIVKA‑II levels were compared between early‑stage (stage I+II) and advanced‑stage (stage III+IV) HCC patients. Correlations between PIVKA‑II and clinicopathological features were examined. Kaplan‑Meier curves were plotted to assess overall survival (OS) and recurrence‑free survival (RFS) by PIVKA‑II levels. Receiver operating characteristic (ROC) analysis compared the predictive performance of PIVKA‑II and α ‑fetoprotein (AFP), with DeLong 's test evaluating differences in area under the curve. Univariate and multivariate Cox regression analyses were conducted to identify independent prognostic factors for postoperative survival and recurrence. Serum PIVKA‑II levels were significantly elevated in HCC patients compared with controls ( P < 0.01), and were higher in advanced‑stage than early‑stage HCC ( P < 0.01). PIVKA‑II correlated significantly with tumor diameter, tumor node metastasis classification, lymph node infiltration, distant metastasis, differentiation, and complication incidence (all P < 0.05). Patients with high PIVKA‑II (≥100 mAU/ml) had shorter median OS and RFS than those with low levels (<100 mAU/ml) ( P < 0.01). PIVKA‑II outperformed AFP in predicting 5‑year survival and recurrence ( P < 0.05), and combined use improved predictive accuracy ( P < 0.05). Multivariate Cox regression identified PIVKA‑II ≥100 mAU/ml as an independent prognostic factor for both OS and RFS ( P < 0.05). Our study confirms that serum PIVKA-II can serve as a prognostic predictor for HCC patients after surgical treatment.

Cystic echinococcosis is a zoonotic disease caused by Echinococcus granulosus. Although Echinococcal cysts are most frequently located in the liver (59-75%), in rare circumstances they may develop in extra-hepatic locations. Because extrahepatic cysts are rare and lack the characteristic appearance of hepatic cysts, diagnosis can be challenging. In the present retrospective study, the medical records of 41 patients surgically treated for intra-abdominal extrahepatic hydatid cyst disease were analysed to collect the following: Demographic data, cyst localization, serological test results, surgical findings and procedures, length of hospital stay, post-operative medical treatments and recurrence status. Based on this analysis, the female-to-male ratio was 27:14, with a mean age of 42.9±15.1 years (range, 19-75 years). Diagnosis was based on ultrasound, computed tomography or magnetic resonance imaging, and confirmed pre-operatively for 29 patients. Isolated kidney involvement was the most common finding (31.7%), whereas 12 patients had cysts in multiple locations. Isolated extrahepatic cysts were present in 30 patients (73.2%) and 11 (26.8%) had concurrent hepatic cysts. Surgery was performed on 34 patients for extrahepatic cysts alone, and on 7 (17%) for both hepatic and extrahepatic cysts; recurrence occurred in 4 patients (9.7%). Hepatic involvement (P=0.003), multiple cysts (P=0.033), multi-site involvement (P=0.033), history of surgery (P=0.002), concurrent liver surgery (P=0.019) and positive serology (P=0.030) were identified as risk factors for recurrence. The present results show that although imaging remains the cornerstone of extrahepatic cyst diagnosis, the disease was confirmed by radiology in only one-third of cases. Hydatid disease should be suspected in endemic regions; and surgery remains the most effective and commonly used treatment.

Endometriosis in adolescents: A state-of-the-art review.

Neoadjuvant radiotherapy is an important strategy for patients with resectable hepatocellular carcinoma (HCC) with high-risk recurrence profiles. In China, HCC is primarily caused by hepatitis virus infection, making it sensitive to radiotherapy. Based on this characteristic, this paper systematically elaborates on the objectives of preoperative neoadjuvant radiotherapy, the applicable patient populations, the technical prerequisites for its combination with surgery, its clinical application advantages, future directions, and proposes a "surgery-oriented" radiotherapy concept. Traditional stereotactic body radiotherapy (SBRT), when used as preoperative therapy for large hepatocellular carcinoma, can easily lead to perhepatic adhesions which increases surgical difficulty and risks. To address this challenge, our team has proposed a patented method for generating a resection-mimicking dose distribution with high-dose radiotherapy for large HCC. This approach optimizes dose distribution and precisely protects the future liver remnant, significantly reducing postoperative recurrence without substantially increasing surgical difficulty. Neoadjuvant radiotherapy offers unique advantages, including high local control rates, durable response, reduced risk of microvascular invasion, low progression rates, and favorable safety profiles, while also providing a time window of liver function recovery for surgery. This paper also explores the strategy selection for combining neoadjuvant radiotherapy with systemic therapy, the timing of surgery, and points out that promoting this technology requires collaborative innovation between hepatobiliary surgeons and radiation oncologists to optimize radiotherapy design and its integration with surgery. Practical experience indicates that neoadjuvant radiotherapy has the potential to improve the prognosis of patients with high-risk resectable HCC, though more high-level clinical evidence is needed to support its use in the future.

Post-operative recurrence (POR) of colonic Crohn's Disease (CD) after segmental (SC) or subtotal colectomy (STC) is scarcely described. Therefore, we aimed to report the rates and predictors of POR in this setting. Multicentre, nationwide, retrospective study including colonic CD patients undergoing SC or STC. Clinical, endoscopic, radiologic and surgical POR were assessed and POR-free survival was compared between procedures. Cox regression determined predictors of post-colectomy POR. Inverse probability of treatment weighting (IPTW) was carried out for sensitivity analyses. A total of 224 patients were included (157 SC, 67 STC). Clinical POR occurred less frequently after SC than after STC (38% vs 63%, p = 0.001), as did endoscopic POR (50% vs 71%, p = 0.012); whereas radiologic and surgical POR rates were similar (p = 0.1 and p = 0.992, respectively). Clinical POR-free survival at 1 and 5 years was higher after SC than after STC (82% and 64.8% vs 67.6% and 39%, log-rank p = 0.001). Endoscopic POR-free survival followed a similar pattern (log-rank p < 0.001). In multivariable Cox regression, SC remained protective against clinical (HR 0.54 [0.36-0.81]) and early endoscopic POR (HR 0.54 [0.35-0.82]). After IPTW, SC was still associated with a significantly lower risk of clinical and endoscopic POR. Clinical and endoscopic POR rates are significantly lower following SC compared with STC in colonic CD, while radiologic and surgical recurrence rates were similar. SC shows a protective effect regarding clinical and early endoscopic POR. These data support segmental resection of colonic CD when feasible.

Predicting the Postoperative Recurrence Risk in Soft-Tissue Sarcomas of the Extremities and Trunk Using MRI-Based Nomogram.

A novel machine learning-based model for precise prediction of postoperative recurrence in gallbladder cancer: development and multicenter validation across four centers.

Clinically, recurrent polyp growth is a characteristic feature of pediatric Peutz-Jeghers syndrome (PJS) patients. However, the clinical characteristics of pediatric PJS patients grouped by postoperative recurrence time remain undefined. Furthermore, differences in clinical features between serine/threonine kinase 11 (STK11)-positive and -negative patients, and the influence of STK11 mutation types on polyp recurrence time need to be elucidated. Our study aimed to characterize pediatric PJS based on postoperative polyp recurrence time and STK11 mutation status. We collected clinical data from 74 pediatric PJS patients diagnosed at Hunan Children's Hospital over the past decade. STK11 genomic profiling was performed using Sanger sequencing combined with multiplex ligation-dependent probe amplification (MLPA) or whole exome sequencing (WES). Variables associated with gastrointestinal polyp recurrence were identified through least absolute shrinkage and selection operator (LASSO) regression, followed by multivariate logistic regression analysis of significant variables. All 74 pediatric PJS patients who experienced polyp recurrence post-polypectomy were stratified by recurrence time (>3, 1-3, and ≤1 year). Notably, 49.2% (31/63) of STK11-positive (STK11pos) patients recurred within ≤1 year after polypectomy, while 81.8% (9/11) of STK11-negative (STK11neg) patients with recurrence >3 years after polypectomy. LASSO and multivariate logistic regression identified multiple jejunal polyps (odds ratio [OR]: 4.18, 95% confidence interval [CI]: 1.09-15.98) and giant small bowel polyps (OR: 4.06, 95% CI: 1.15-14.34) as independent risk factors for recurrence ≤1 year after polypectomy. Compared to STK11neg patients, STK11pos patients, especially when combined with a positive PJS family history exhibited significantly earlier symptom onset, higher gastrointestinal giant polyp burden, and higher polyp burden in the jejunum/colon versus ileum. Analysis of 63 STK11pos patients revealed diverse mutation types/sites and identified 15 novel pathogenic variants. STK11pos patients with de novo mutations exhibited a significantly higher incidence of hematochezia, along with a greater overall burden of giant polyps in the colon. No significant association was found between major mutation subtypes (frameshift, missense, deletion, and nonsense) and recurrence time, though missense mutations showed a trend toward earlier recurrence. This study reveals distinct clinical profiles across polyp recurrence intervals and between STK11-positive and -negative patients, while delineating the STK11 mutation landscape in pediatric PJS. These findings provide the genomic resource for pediatric PJS, offering critical insights into disease mechanisms and clinical management.

Background and ObjectivesTo investigate the impact of pathogenic bacterial distribution in the nasal cavity on postoperative nasal function recovery in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) after endoscopic sinus surgery (ESS), and to analyze the risk factors for postoperative recurrence.MethodsA total of 178 CRSwNP patients who underwent ESS in our hospital from May 2021 to May 2023 were selected. Based on preoperative nasal secretion pathogen culture results, patients were categorized into the pathogen-negative group (42 cases), bacterial-positive group (90 cases), and fungal-positive group (46 cases). The nasal symptom visual analogue scale (VAS) score, Lund-Kennedy endoscopic score, and Lund-Mackay computed tomography (CT) score were assessed preoperatively and at 12 weeks postoperatively. Patients were followed up for 24 months and categorized into the recurrence group (36 cases) and the recurrence-free group (142 cases) based on postoperative recurrence. Relevant risk factors for recurrence were analyzed.ResultsAmong the 178 patients, the bacterial positivity rate was 50.56% (mainly Corynebacterium, Staphylococcus, and Haemophilus influenzae), while the fungal positivity rate was 25.84% (mainly Candida albicans and Aspergillus). Postoperatively, the nasal symptom VAS scores for individual items, Lund-Kennedy endoscopic scores, and Lund-Mackay CT scores showed significant improvement compared to preoperative values (P < 0.05). Comparisons among the 3 groups revealed a trend of pathogen-negative group < bacterial-positive group < fungal-positive group in nasal symptom VAS scores, Lund-Kennedy endoscopic scores, and Lund-Mackay CT scores, with significant differences observed between each pair of groups (P < 0.05). Univariate analysis showed that the proportions of asthma, history of revision surgery, eosinophilic (EOS)-type nasal polyps, and preoperative Lund-Mackay CT scores were all higher in the recurrence group than in the recurrence-free group (P < 0.05). Multivariate analysis identified history of revision surgery (OR = 6.963, 95% CI: 2.275-21.313), EOS-type nasal polyps (OR = 4.566, 95% CI: 1.449-14.392), and high preoperative Lund-Mackay CT scores (OR = 1.928, 95% CI: 1.475-2.522) as independent risk factors for postoperative recurrence (P < 0.05). Corynebacterium infection might reduce the risk of recurrence (P = 0.065).ConclusionNasal bacterial and fungal colonization in patients with CRSwNP are associated with poor postoperative nasal function recovery, with fungal colonization leading to the worst prognosis. Postoperative recurrence is closely related to EOS-type nasal polyps, a history of previous surgery, and a high preoperative Lund-Mackay CT score. Corynebacterium may serve as a protective microbial population.

Objective: To explore the relationship between preoperative thyroglobulin (Tg) levels and recurrence risk as well as treatment response in patients with differentiated thyroid cancer (DTC). Methods: A retrospective analysis was conducted on the clinical data of 604 patients with DTC who underwent total thyroidectomy at Shanghai Renji Hospital from January 1, 2020, to December 31, 2024. The postoperative recurrence status of patients was recorded, with follow-up ending on June 30, 2025. Determine the cut-off value of preoperative Tg for predicting patient prognosis using the maximum selected rank statistic method. Multivariate Cox proportional hazards regression model was used to analyze the risk factors for postoperative recurrence in DTC patients. Survival curves were plotted using the Kaplan-Meier method, and the log-rank test was used to evaluate the differences in postoperative disease-free survival rates and treatment response among DTC patients with different preoperative Tg levels. Results: Among the 604 patients, 417 were female and 187 were male, with the age of 45.0(36.0, 57.0) years. The preoperative Tg was 20.2 (10.4, 44.3) μg/L, and the follow-up period was 1.40 (0.85, 2.84) years. Multivariate Cox proportional hazards regression model analysis revealed that preoperative Tg levels≥36.2 μg/L (HR=14.180, 95%CI:1.745-115.200) was a risk factor for postoperative recurrence in DTC. Patients with the preoperative Tg level of<36.2 μg/L had a higher 3-year disease-free survival rate compared to those with the preoperative Tg level of≥36.2 μg/L (99.8% vs 92.3%, P<0.001). The proportion of patients with the favorable treatment response was lower among those with the preoperative Tg level of≥36.2 μg/L compared to those with the preoperative Tg level of<36.2 μg/L, whereas the proportions of patients with biochemical incomplete, structural incomplete, and indeterminate responses were higher among those with the preoperative Tg level of≥36.2 μg/L (all P<0.05). Conclusions: Preoperative Tg levels are significantly associated with the recurrence risk and treatment response in DTC patients. The Tg level of≥36.2 μg/mL indicates a high recurrence risk and poor treatment response.

Pilonidal sinus disease (PSD) is a chronic inflammatory condition most commonly observed in the sacrococcygeal region and predominantly affecting young individuals. Although various treatment modalities are currently employed, none has demonstrated definitive superiority, as recurrence rates-an important indicator of treatment success-remain considerable. This study aimed to evaluate the comparative treatment success of commonly used PSD management strategies based on postoperative recurrence rates. Patients with comparable sociodemographic characteristics were allocated into four treatment groups: microsinusectomy, surgical resection followed by phenol application, platelet-rich plasma (PRP), and laser therapy. All patients were followed for a minimum of two years. Treatment outcomes were assessed primarily in terms of postoperative recurrence. Among the evaluated modalities, laser therapy demonstrated the lowest overall recurrence rate (15.6%). However, in cases of mixed-location PSD, laser treatment was associated with the highest recurrence rate (83.3%). These findings suggest that treatment success may vary depending on anatomical localization. Laser therapy may provide favorable outcomes in selected anatomical locations but appears less effective in mixed-location disease. Detailed anatomical classification should be incorporated into future studies, and outcomes should be reassessed using different laser treatment protocols to optimize patient selection and therapeutic success.

Identification of risk factors and construction of a nomogram for predicting postoperative stone recurrence in patients with infective upper urinary tract stones.

Background: Severe obesity is associated with an increased prevalence of hiatal hernias (HH) and gastroesophageal reflux disease (GERD). Both fundoplication (FP) and gastric bypass (GB) are utilized in this population, but comparative outcomes are not well-established. This review aims to compare surgical outcomes of FP versus GB for managing GERD and HH in adults with severe obesity. Methods: A systematic search was conducted for studies published up to June 2025. Inclusion criteria: adult patients with obesity (BMI ≥ 30) with HH/GERD undergoing first FP or GB. Key outcomes were postoperative reflux, complications, recurrence, and reoperation. Results: Five studies met inclusion criteria. Both FP and GB effectively manage GERD. In a propensity-matched cohort, GB significantly reduced early hernia recurrences compared to FP, but long-term recurrence and reoperation rates were similar between groups. Another study found similar recurrence rates between GB and FP; however, fewer symptomatic recurrences occurred with GB. A large retrospective study reported a lower complication rate for GB versus FP (7% vs. 10%, p &lt; 0.05) and no significant differences in reflux scores. Conclusions: Both FP and GB offer benefits in managing GERD and HH in patients with severe obesity. Future research should focus on comparing efficacy, standardizing outcome measures, and evaluating patient-centered outcomes.

Objective: To compare postoperative outcomes between Lichtenstein and Darns repairs in obstructed inguinal hernias. Study Design: Prospective quasi-experimental study. Setting: General Surgery Department, Arif Memorial Teaching Hospital. Period: September 2023 to February 2024. Methods: Sixty patients with obstructed inguinal hernia were recruited through non-probability purposive sampling and non-randomized into two groups of 30 each. Group 1 underwent Lichtenstein repair, while Group 2 underwent Darn repair. Postoperative pain, wound infection, seroma formation, and recurrence were assessed over a 6-month follow-up. Data were analyzed using SPSS version 25, applying independent t-tests and likelihood ratio tests, with p ≤ 0.05 considered significant. Results: The mean age was 43.5 ± 11.6 years in the Lichtenstein group and 42.8 ± 10.4 years in the Darn group (p = 0.797). Seroma formation was noted in 13.3% of Lichtenstein versus 23.3% of Darn repairs, postoperative pain in 36.7% versus 46.7%, and wound infection in 10% versus 16.7%. No recurrences were observed during follow-up. None of the outcome differences were statistically significant (p &gt; 0.05). Conclusion: Lichtenstein and Darn repairs demonstrated comparable short-term outcomes in obstructed inguinal hernia. Lichtenstein repair remains preferable where mesh is available, while Darn repair provides a suitable alternative in settings with limited resources.

Postoperative recurrence is a major contributor to the dismal prognosis of patients with pancreatic cancer (PC). Defining the molecular features of PC with recurrence is crucial for the development of effective therapeutic strategies. This study aims to identify metabolic and intrinsic metabolism of PC associated with early recurrence. We analysed resected primary tumours from patients with PC with early (E-Rec) and late (L-Rec) recurrence using an integrated multiomics workflow and spatial metabolomics. Multiplex immunofluorescence quantified carnitine shuttle system (CSS) heterogeneity, and functional in vitro assays alongside in vivo models evaluated pharmacological inhibition of carnitine transport in combination with chemotherapy or immunotherapy. Multiomics analysis revealed SLC6A14 was a key CSS-related gene driving early recurrence of PC. Spatial metabolomics showed elevated carnitine levels in cancer-associated fibroblasts (CAFs) from L-Rec and in tumour cells from E-Rec. Mechanistically, cancer cells used carnitine secreted from PPARγ+ CAFs via SLC6A14 uptake, activating the AMPK/PPARα/CPT1B signalling cascade to enhance fatty acid β-oxidation. In vivo experiments demonstrated that pharmacological inhibition of carnitine transport by meldonium, tetrahydropalmatine or quinidine suppressed tumour growth and sensitised tumours to chemotherapy and immunotherapy. PC cells exploit carnitine secreted by PPARγ+ CAFs via SLC6A14-mediated uptake to promote tumour recurrence. Targeting the CSS, particularly in combination with chemotherapy or immunotherapy, represents a promising avenue for mitigating recurrence in PC.

The broader clinical application of Bispecific T-cell engagers (BiTEs) is hindered by their short half-life, on-target off-tumor toxicity, and limited therapeutic effect for solid tumors. Herein, we constructed a bimetallic-enriched triple-kill nanobomb manganese/Co2+-dopamine@BiTE/HPT (MnO2/Co-DA@BiTE/HPT) based on metal-polyphenol to improve the immunosuppressive tumor microenvironment by activating innate and adaptive immunity, thereby enhancing the treatment efficacy of BiTEs (PD-L1/CD3). A hyaluronic acid-modified PD-L1 aptamer (HPT) was introduced to improve the active targeting of the nanobombs and bind with PD-L1 overexpressing colorectal cancer. Bimetallic (Mn2+/Co2+) activated the STING pathway; simultaneously, photothermal therapy (PTT) induces DNA fragmentation to cooperate with bimetallic to amplify the STING signal to "heat" the "cold" tumor microenvironment. The "hot" tumor with a large amount of T-cell infiltration facilitated BiTE recruitment of T cells to kill tumor cells. Furthermore, the efficient therapeutic potency of the triple-kill nanobombs (STING, BiTE, and PTT) was determined in subcutaneous colorectal cancer, distal, lung metastasis, and postoperative recurrence models, which indicated that MnO2/Co-DA@BiTE/HPT could improve the immune microenvironment, produce long-term immune memory, inhibit tumor growth, and prevent tumor recurrence and metastasis.

Inhalable mucosal vaccines elicit mucosal immunity non-invasively but are hindered by lung barriers like mucociliary clearance and phagocytosis, which typically necessitate multiple doses. Herein, we developed an innovative inhalable porous microsphere (pMS) vaccine using a single Food and Drug Administration-approved material, featuring a dual-scale design: an aerodynamic diameter of 4.84 µm for optimal deep lung deposition and a geometric size of 14.7 µm to evade phagocytosis for long-term retention. Notably, respiratory motion facilitates the penetration of pMS through the mucus layer into the pulmonary interstitium, where it gradually releases antigens and adjuvants. Remarkably, a single inhalation induced durable immunity, sustaining high levels of IgG and IgA for one year, alongside enhancing tissue-resident memory T cells in the lung and promoting germinal center expansion in the lymph node. This provided long-term protective efficacy, significantly inhibiting lung tumor metastasis even a year after inhalation. Beyond prophylaxis, this vaccine demonstrated remarkable therapeutic efficacy across multiple preclinical models, including the in situ lung tumor model, postoperative recurrence prevention model, and clinically relevant Patient-Derived tumor Xenograft (PDX) model. The dry powder pMS platform is scalable, stable, and clinically translatable, emerging as a versatile therapeutic strategy to adapt to diverse Lung-related diseases.

Extracellular vesicles (EVs) mediate tumor-host communication and represent a promising liquidbiopsy source for metastasis risk assessment, yet quantitative detection of low-abundance, epitope-defined EV subpopulations in plasma remains technically challenging. Here, we establish a nanoscale flow cytometry workflow on the CytoFLEX platform for sensitive single-EV phenotyping by optimizing violet side scatter (VSSC) triggering, defining an acquisition window that minimizes coincidence or "swarm" effects, and applying fluorescence-based analysis with stringent background controls. Using this framework, we quantified EV-associated tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) at the single particle level, with good inter-assay reproducibility (CV ~ 11-13%), and resolved low-abundance TRAIL⁺ EVs at approximately 1% abundance within total EV events. Due to the low abundance of EV-associated TRAIL in pancreatic ductal adenocarcinoma (PDAC) plasma, ELISA lacked sufficient analytical sensitivity to accurately reflect EV-associated TRAIL levels, whereas flow-based enumeration preserved quantitative resolution. Clinically, plasma EV-associated TRAIL was significantly elevated in PDAC patients with liver metastasis and demonstrated predictive utility for postoperative liver metastatic recurrence (AUC = 0.766). These results support nanoscale flow cytometry as a robust platform for plasma EV biomarker profiling and identify EV-associated TRAIL as an informative indicator of liver metastatic risk in PDAC.

BackgroundIt is mostly challenging to ablate great saphenous vein (GSV) completely including the below-knee level.ObjectiveThe aim of this study was to evaluate the effectiveness of cyanoacrylate ablation (CAA) and catheter directed foam sclerotherapy (CDFS) combination in full length ablation of GSV with mid-term results.Materials and MethodsPatients undergoing CAA and CDFS of the GSV between January 2015 and December 2021 were reviewed. Preoperative and postoperative CEAP class, symptoms, recurrence, and Doppler findings were compared.ResultsPostoperative overall closure rate at the first year was 99.5% ± 0.01 and at 5 years was found to be 93.8 ± 0.02%. Symptom free survival rate at the first year was 98.8% ± 0.01 and the cumulative 5-years symptom free survival rate was 73.0 ± 0.10%. Venous Clinical Severity Scores decreased from 5.9 ± 1.3 to 0.8 ± 0.4. Aberdeen Varicose Vein Questionnaire scores decreased from 19.7 ± 6.1 to 4.7 ± 1.8.ConclusionWhen techniques are evaluated, CAA and CDFS combination (Glue + Foam) may be preferable as a simple and shorter application with full-length complete occlusion of GSV and less early postoperative discomfort. Long-term outcomes and cost analyses of larger series still need to be documented.