Journal of Surgery & Anesthesia Research
Journal of Surgery & Anesthesia Research is an open access peer-reviewed journal from the publishers of Scientific Research and Community (SRC) which publishes articles in the form of written, video and power-point presentations from the arena of Surgery & Anesthesia. The journal focuses to build up accessing the complete content of articles freely from online for reader’s perusal. Article acceptance will be in the form of research, review, case reports, analysis, magazines, editorials, opinion, communications, mini-review, short communications, picturized, book review, video type and power point presentations (PPTS). Articles can be submitted through online from https://www.onlinescientificresearch.com/submit-online or can send through an e-mail with attachment for surgerysciences@onlinescientificresearch.info
Ultrasound-Guided Airway Assessment in Obese Patients Undergoing Bariatric Surgery a Randomized Clinical Trial
Introduction: Anesthetic planning for obese patients must be effective to avoid unexpected adverse events. The introduction of ultrasound (USG) in medicine has made it possible to identify, assess, and predict the possibility of Difficult Airway (DA). Objective: To evaluate whether ultrasound parameters can be predictors of DA in the obese patient population. Furthermore, to establish correlations between traditional DA indicators and the parameters obtained by ultrasound, with the goal of verifying the agreement and accuracy between the methods. Method: A randomized clinical trial compared the assessment of already validated clinical indicators for predicting DA and USG parameters defined after a literature review. Results: 132 individuals were randomized, subdivided into 66 patients in the conventional airway assessment group and 53 patients in the conventional airway assessment + USG group. The evaluation of basic patient characteristics in the USG and conventional groups showed that both groups were homogeneous in terms of weight (114.3 ± 16.9 kg vs. 116.9 ± 23.8 kg, p: 0.51), height (165.6 ± 8.0 cm vs. 166.3 ± 8.9 cm, p: 0.66), and body mass index (BMI) (41.7 ± 5.7 vs. 42.0 ± 6.6, p: 0.76). USG evaluation of the airway showed that the skin-epiglottis distance (SED) was < 2.7 cm in 73.3% of patients in the USG group, and the skin-hyoid distance (SHD) was < 1.41 cm in 60.4%. The primary outcome was the occurrence of Difficult Intubation (DI), which was significantly higher in the USG group (18.9%) compared to the conventional group (4.5%, p: 0.01). There was no significant difference in the use of a videolaryngoscope (22.6% in the USG group vs. 16.7% in the conventional group, p: 0.42) or intubation-related complications. Conclusion: The integration of USG proved advantageous in clinical practice for airway assessment, reducing the incidence of intubation-related complications and improving the potential management of complex cases.
Copyright (c) 2026 Journal of Surgery & Anesthesia Research
Regional Anesthesia and Sedation. Monitoring with Oximetry and Capnography Increases Patient Safety During Procedure
Regional anesthesia provides numerous benefits to patients throughout the perioperative period, including improved comfort and satisfaction with pain control, less nausea and vomiting, and expeditious recovery and discharge. Sedation during surgery undern regional anesthesia plays a central role in facilitating patient comfort and anxiolysis. In recent decades the commonest medications used for sedation are midazolam, propofol, ketamine, dexmedetomidine, remimazolam and each possesses well-known pros and cons. The phrase “while some sleep, others keep watch,” along with monitoring, plays an important role in patient safety regarding sedation in regional anesthesia or other procedures. There are two important monitors during sedation: pulse oximetry and capnography. However, most anesthesiologists only use the pulse oximeter, even though capnographs are attached to all modern anesthesia machines. This article demonstrates the importance of using both pulse oximetry and capnographs for patient safety during sedation in regional anesthesia and other procedures. The combination of the two monitoring systems certainly increases patient safety.
Seconds to React: Life-Threatening Rocuronium Anaphylaxis in a High-Risk Bariatric Candidate
Anaphylaxis during anesthesia is rare but potentially fatal. Neuromuscular Blocking Agents (NMBAs), particularly rocuronium, are among the most common triggers. We present the case of a 40-year-old male undergoing bariatric surgery who developed severe anaphylaxis immediately after Rocuronium administration during induction. The patient exhibited sudden hypotension, bronchospasm, and generalized urticaria. Rapid diagnosis and management with epinephrine, fluids, antihistamines, and corticosteroids resulted in stabilization, and surgery was postponed. Postoperative allergy testing confirmed IgE-mediated hypersensitivity to rocuronium. This case underscores the need for heightened vigilance when administering NMBAs, early recognition of anaphylaxis, and postoperative allergological evaluation in suspected cases.
Surgical Treatment of Rhinophyma : About a Case and Literature Review
Rhinophyma is an advanced stage of rosacea affecting soft tissues and leading to disruption of the nasal architecture, obstruction of the airways, and disfigurement of the aesthetic units of the nose. It is most often found in Caucasian men over the age of 50 with a male to female ratio of 5 to 1. The exact cause of rhinophyma is unknown; the probable origin is multifactorial. The primary etiology is unregulated superficial vasodilatation. Several hypotheses suggest there may be a potential role of environmental factors and microorganisms such as Helicobacter pylori and Demodex folliculorum. Vitamin deficiency and alcohol or caffeine use may be causative or exacerbating factors.
Copyright (c) 2025 Journal of Surgery & Anesthesia Research
Safety in Spinal Anesthesia from Asepsis and Antisepsis to Total Recovery from Block
In the early 20th century, glucose was added to local anesthetics, making it the preferred choice of anesthesiologists worldwide. Before offering a patient spinal anesthesia, an anesthesiologist not only must be aware of the indications and contraindications of spinal anesthesia but also must be able to weigh the risks and benefits of performing the procedure. Asepsis and antisepsis of the back should be carried out with alcoholic chlorhexidine or 70% alcohol,allowing it to dry spontaneously. The MRI confirmed Jonnesco’s teachings on the safety of thoracic spinal anesthesia using puncture above T11. Likewise,when a lumbar puncture is performed, it should be performed below L3, preferably as low as possible. Subarachnoid puncture should be performed with a needle of the smallest gauge and tip preferred by the anesthesiologist. If using an introducer, make a puncture in the skin to avoid introducing skin tissue. For safety, use isobaric, hyperbaric and hypobaric solutions. Adjuvants should be injected into separate syringes, as they alter the baricity of local anesthetics. Always remember that the spinal cord was placed inside a bony tube to avoid the injection of any drugs. This educational article shows some ways to perform single shot spinal anesthesia safely for patients.
Luiz Eduardo Imbelloni Luiz Eduardo Imbelloni
Anna Lúcia Calaça Rivoli Anna Lúcia Calaça Rivoli
Sylvio Valença de Lemos Neto Sylvio Valença de Lemos Neto
Currently, the International Body Mass Index defines obesity; morbid obesity refers to BMI>40 obesity or BMI>35 severe obesity and has been combined with obesity-related diseases. With the vigorous development of bariatric surgery at home and abroad, more and more patients with morbid obesity received bariatric surgery and achieved good weight loss [1]. laparoscopic gastric sleeve resection is a new weight loss surgery style that has appeared on the international scene in recent years, its trauma is a small, simple surgical operation, with fewer complications, can maintain the essential structural normal function of the gastrointestinal tract after operation, without any complications [2,3]. Laparoscopic gastric sleeve resection is a new type of weight loss surgery that has emerged internationally in recent years. Which is characterized by minor trauma, simple surgical operation, fewer complications, and the ability to maintain the basic standard structure and function of the gastrointestinal tract after the operation [4,5].
Retrospective Analysis of Clinical Characteristics, Treatment Outcomes and Risk Factors in Appendicitis and Typhlitis
Background: Appendicitis and typhlitis are distinct gastrointestinal inflammatory conditions with overlapping symptoms, posing diagnostic challenges.This retrospective study compared their clinical features, treatments, and outcomes, and identified associated risk factors. Methods: Data from 800 appendicitis and 200 typhlitis patients treated at a tertiary hospital (2021–2023) were analyzed. Demographics, symptoms, lab results, treatments, and outcomes were examined. Univariate and multivariate logistic regressions determined risk factors. Results: Appendicitis patients were younger (median 32 years) than typhlitis patients (median 45 years). Abdominal pain was common in both (98% vs. 92%), but typhlitis patients more often had fever (88% vs. 65%) and diarrhea (75% vs. 12%). Laparoscopic appendectomy was done in 78% of appendicitis cases (10.2% complication rate), while 70% of typhlitis patients received conservative treatment (18% mortality). Multivariate analysis showed perforated appendicitis (OR = 3.2, 95% CI: 2.1–4.8, p < 0.001) and severe neutropenia (OR = 4.1, 95% CI: 2.5–6.8, p < 0.001) were key risk factors for adverse outcomes in each group. Conclusion: Appendicitis and typhlitis have distinct profiles. Early diagnosis and targeted treatment based on risk factors improve outcomes. Clinicians should distinguish between them to optimize management.
Letter to the Editor: Advances and Challenges in Gastric Cancer Research
One of the significant recent findings is the discovery of the role of nociceptive neurons in gastric cancer progression. Timothy C. Wang’s team from the Digestive and Liver Diseases Research Center at Columbia University in the US published a paper in Nature in February 2025. They found that CGRP⁺ peptide - containing sensory neurons interact with gastric cancer cells through the CGRP - RAMP1 axis. In multiple mouse gastric cancer models, these neurons expand significantly in a NGF - TRK pathway - dependent manner. Activating these neurons promotes tumor growth and metastasis, while inhibition or ablation has the opposite effect. In human gastric cancer samples, the density of CGRP⁺ nerves is higher, indicating its potential as a new therapeutic target [1].
Combined with Capecitabine and Oxaliplatin (CAPOX)
Clinical Characteristics, Treatment Outcomes, and Risk Factors for Complications in Ulcerative Colitis
Background: Ulcerative Colitis (UC) is a chronic inflammatory bowel disease with significant morbidity. This study aimed to characterize clinical patterns, treatment responses, and risk factors for complications in UC patients. Methods: Data from 450 UC patients (aged ≥18 years) treated at a tertiary center (2021–2023) were retrospectively analyzed. Demographics, disease severity (Montreal classification), treatment modalities (5-ASA, immunosuppressants, biologics), and complications (colonic stricture, toxic megacolon, colorectal cancer) were evaluated. Multivariate logistic regression identified risk factors for severe complications. Results: Median age at diagnosis was 32 years (IQR:25–40), with 52% male patients. Pancolitis (Montreal E3) was present in 38% (171/450), and 22% (99/450) had prior corticosteroid failure. Biologic therapy (adalimumab, infliximab) was initiated in 35% (158/450), achieving clinical remission in 68% at 12 months. Severe complications occurred in 12% (54/450), including strictures (6.7%) and toxic megacolon (3.3%). Multivariate analysis identified pancolitis (OR=2.89, 95%CI:1.62–5.16, p<0.001), corticosteroid failure (OR=2.17, 95%CI:1.28–3.68, p=0.004), and delayed diagnosis (>6 months) (OR=1.92,95%CI:1.15–3.18, p=0.013) as independent risk factors for complications. Conclusion: Pancolitis, corticosteroid failure, and delayed diagnosis increase the risk of severe complications in UC. Early initiation of biologic therapy in high-risk patients may improve outcomes.
Unraveling the Complexity of Gastric Cancer through TCGA Subtypes
Gastric cancer remains a significant global health burden, characterized by high heterogeneity. The Cancer Genome Atlas (TCGA) has been pivotal in classifying gastric cancer into distinct molecular subtypes, providing profound insights into its pathogenesis, prognosis, and potential therapeutic strategies.This review comprehensively explores the four TCGA - defined subtypes of gastric cancer: Epstein - Barr Virus (EBV) - positive, Microsatellite unstable (MSI), Genomically Stable (GS), and Chromosomally Unstable (CIN). By dissecting the unique molecular, genetic, and clinical features of each subtype, we aim to elucidate how this classification can enhance our understanding of gastric cancer and drive the development of more personalized treatment approaches.
Retrospective Analysis of Risk Factors for Complications and Treatment Outcomes in Adult Appendicitis: A Single-Center Study
Background: Appendicitis remains a common surgical emergency, but risk factors for complications and optimal treatment strategies require further clarification. This study analyzed clinical characteristics, treatment outcomes, and risk factors for complications in adult appendicitis patients. Methods: Data from 850 adult appendicitis patients (≥18 years) treated at a tertiary center (2021–2023) were retrospectively reviewed. Patient demographics, clinical features, surgical methods, and postoperative complications were analyzed. Univariate/multivariate logistic regression identified risk factors for complications. Results: Median age was 38 years (IQR: 26–52), with 56% male patients. Perforated appendicitis occurred in 28% (238/850), and 12% (102/850) had comorbidities (diabetes/hypertension). Laparoscopic appendectomy (LA) was performed in 78% (663/850), associated with lower complication rates (9.1% vs. 18.6%, p<0.001) and shorter hospital stay (3 vs. 5 days, p<0.001) compared to open appendectomy (OA). Multivariate analysis identified perforation (OR=3.21, 95%CI:2.14–4.83, p<0.001), age ≥60 years (OR=2.58, 95%CI:1.62–4.13, p<0.001), and comorbidities (OR=1.92, 95%CI:1.27–2.91, p=0.002) as independent risk factors for complications. Conclusion: Perforation, advanced age, and comorbidities increase complication risk. LA is associated with superior outcomes and should be prioritized in uncomplicated cases.
Cellular Autophagy and Primary Liver Cancer Research Progress
The concept of cellular autophagy is that in eukaryotic cells, there are two significant organelles involved in cellular degradation, namely, lysosomes and proteasomes, whereas proteasomes usually recognize and degrade only ubiquitinated substrates in a highly selective manner, lysosomal degradation has a more complex pattern. Autophagy is a “self-feeding” phenomenon that maintains cellular homeostasis by targeting damaged organelles and misfolded proteins to the lysosome for degradation, i.e., extracellular substances and plasma membrane proteins can be delivered to the lysosome for degradation by endocytosis. In contrast, cytoplasmic components and organelles can be delivered to the lysosome for degradation by autophagy. Therefore, autophagy is an intracellular catabolic process that targets damaged and excess cellular proteins, organelles, and other cytoplasmic components and plays an essential role in maintaining cellular homeostasis and activities.
Retrospective Analysis of Clinical Characteristics, Treatment Outcomes and Risk Factors for Complications in Appendicitis Patients
Background: Appendicitis is a common acute abdominal disease. This retrospective study aimed to analyze the clinical characteristics, treatment outcomes, and risk factors for complications in appendicitis patients. Methods: Data of 620 appendicitis patients treated at our hospital from January 2021 to December 2023 were retrospectively reviewed. Patient demographics, clinical manifestations, treatment methods, and postoperative outcomes were collected. Univariate and multivariate logistic regression analyses were used to identify risk factors for complications. Results: The median age of the patients was 35 years (IQR: 22-48), with 58.1% being male. Acute appendicitis accounted for 89.2% (553/620), and 32.1% (199/620) of patients presented with perforated appendicitis. Laparoscopic appendectomy was performed in 75.8% (470/620) of cases, showing shorter postoperative hospital stay (median: 3 days vs. 5 days, p < 0.001) and lower complication rates (12.1% vs. 21.7%, p = 0.003) compared to open appendectomy.Multivariate analysis identified advanced age (≥ 60 years, OR = 2.35, 95% CI: 1.42-3.88, p = 0.001), perforated appendicitis (OR = 3.12, 95% CI: 1.98-4.89, p < 0.001), and comorbidities (OR = 1.89, 95% CI: 1.23-2.89, p = 0.003) as independent risk factors for postoperative complications. Conclusion: Advanced age, perforated appendicitis, and comorbidities increase the risk of complications in appendicitis patients. Laparoscopic appendectomy is associated with better postoperative outcomes and should be the preferred treatment when feasible.
Oxidative Stress-Induced ADAR1/2 Dysfunction Promotes Hepatocellular Carcinoma Cell Damage via Redox Imbalance
Hepatocellular Carcinoma (HCC) progression is tightly linked to oxidative stress, yet the role of RNA Adenosine Deaminases (ADARs) in this process remains unclear. Here, we demonstrate that hydrogen peroxide (H₂O₂)-induced oxidative stress downregulates ADAR1/2 expression in HCC cells, leading to reduced A-to-I RNA editing and exacerbated cell damage. Mechanistically, ADAR loss impaired antioxidant defense by dysregulating SOD2/CAT expression and disrupting Nrf2 signaling. Our findings establish ADARs as critical regulators of redox homeostasis in HCC, offering novel therapeutic opportunities.
Clinicopathological Features and Prognostic Factors in Colorectal Cancer
Background: Colorectal Cancer (CRC) remains a major global health burden. This retrospective study aimed to analyze clinicopathological features, treatment outcomes, and prognostic factors in CRC patients. Methods: Data from 480 CRC patients treated at a tertiary center (2021–2023) were retrospectively analyzed. Patient demographics, tumor characteristics,treatment modalities, and survival data were evaluated. Survival was assessed using Kaplan-Meier method, and prognostic factors were identified via Cox regression. Results: The median age was 62 years (IQR: 55–70), with 58% male patients. Right-sided CRC (42%) showed more advanced stages (III/IV: 65%) compared to left-sided (52%, p=0.023). Surgical resection improved overall survival (OS) vs. non-surgical treatment (median OS: 62 vs. 28 months, p<0.001). Multivariate analysis identified tumor stage (HR=3.89, 95% CI: 2.71–5.61, p<0.001), lymph node metastasis (HR=2.17, 95% CI: 1.45–3.24, p=0.001), and KRAS mutation (HR=1.68, 95% CI: 1.12–2.52, p=0.013) as independent risk factors. Conclusion: Right-sided CRC exhibits more aggressive features. Surgical resection and molecular profiling (e.g., KRAS) are critical for prognosis. These findings inform personalized CRC management.
RNA Adenosine Deaminases Modulate Oxidative Stress-Mediated Hepatocellular Carcinoma Cell Damage via KEAP1/Nrf2 Axis
This study investigates the role of RNA adenosine deaminases (ADAR1/2) in oxidative stress-induced Hepatocellular Carcinoma (HCC) cell damage. We demonstrate that hydrogen peroxide (H₂O₂)-mediated oxidative stress downregulates ADAR1/2 expression, impairing A-to-I RNA editing of antioxidant genes. Mechanistically, ADAR2 deficiency reduces KEAP1 editing, activating Nrf2 signaling and promoting HCC cell survival. These findings establish ADARs as critical regulators of redox homeostasis in HCC, providing novel therapeutic targets.
Retrospective Analysis of Clinical Characteristics, Treatment Outcomes, and Prognostic Factors in Hepatocellular Carcinoma Patients
This retrospective study aimed to analyze the clinical characteristics, treatment outcomes, and prognostic factors of Hepatocellular Carcinoma (HCC) patients. Data from 350 HCC patients admitted to our medical center between January 2021 and December 2023 were retrospectively reviewed. Patient demographics, tumor characteristics, treatment modalities, and survival data were collected and analyzed. The results showed that surgical resection significantly improved overall survival (OS) compared to non-surgical treatments (median OS: 32 months vs. 15 months, p < 0.001). Multivariate analysis identified tumor size ≥5 cm (HR = 2.31, 95% CI: 1.56 - 3.42, p < 0.001), microvascular invasion (HR = 1.89, 95% CI: 1.21 - 2.96, p = 0.005), and Child-Pugh class B/C (HR = 1.78, 95% CI: 1.12 - 2.83, p = 0.017) as independent risk factors for poor prognosis. These findings provide valuable insights for clinical decision-making and personalized treatment strategies in HCC management.
Low-Temperature Plasma Reduces the Risk of Abdominal Infection in Hepatocellular Carcinoma Patients
This study aimed to explore the impact of Low-Temperature Plasma (LTP) on the risk of abdominal infection in Hepatocellular Carcinoma (HCC) patients.A total of 120 HCC patients were randomly divided into the experimental group (treated with LTP combined with traditional treatment) and the control group (treated with traditional treatment only). The incidence of abdominal infection, levels of inflammatory factors, and immune function indicators were compared between the two groups. The results showed that the incidence of abdominal infection in the experimental group was significantly lower than that in the control group (P < 0.05). The levels of inflammatory factors such as C-Reactive Protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) in the experimental group were significantly lower than those in the control group at 3 days, 7 days, and 14 days after treatment (P < 0.05).The immune function indicators including CD3+, CD4+, and the CD4+/CD8+ ratio in the experimental group were significantly higher than those in the control group at 7 days and 14 days after treatment (P < 0.05). In conclusion, LTP can effectively reduce the risk of abdominal infection in HCC patients, reduce the levels of inflammatory factors, and improve immune function.
Retrospective Analysis of Clinical Characteristics Treatment Outcomes and Risk Factors in Appendicitis and Colitis
Background: Appendicitis and colitis are common gastrointestinal inflammatory disorders with distinct etiologies and management approaches. This retrospective study compared clinical profiles, treatment modalities, and risk factors for adverse outcomes between appendicitis and colitis. Methods: Data from 1,000 patients (800 appendicitis, 200 colitis) treated at a tertiary center (2021–2023) were analyzed. Demographics, symptoms, laboratory findings, treatments, and outcomes were compared. Univariate/multivariate logistic regression identified risk factors for complications (appendicitis) and severe flares (colitis). Results: Appendicitis patients were younger (median age 32 vs. 45 years, p<0.001), with higher rates of acute abdominal pain (98% vs. 75%, p<0.001).Colitis patients more frequently had chronic diarrhea (82% vs. 15%, p<0.001) and weight loss (65% vs. 20%, p<0.001). Laparoscopic appendectomy was m performed in 78% of appendicitis cases (complication rate 10.2%), while 60% of colitis patients received biologic therapy (response rate 68%). Multivariate analysis showed perforated appendicitis (OR=3.5, 95%CI:2.3–5.2, p<0.001) and corticosteroid resistance (OR=2.8, 95%CI:1.7–4.5, p=0.002) as independent risk factors for poor outcomes. Conclusion: Appendicitis and colitis exhibit distinct clinical and therapeutic profiles. Early surgical intervention for complicated appendicitis and targeted biologic therapy for refractory colitis improve outcomes.
RBPs Related to The Metastatic Process of Hepatocellular Carcinoma
Hepatocellular carcinoma metastasis is often the leading cause of treatment failure in hepatocellular carcinoma. It is now recognized that metastasis is a complex process involving multiple factors and that aberrant expression or dysfunction of RBP, leading to an imbalance in the expression of proto-oncogenes and oncogenes, is inextricably involved in the process of tumor metastasis, which will be discussed in the review. In this review, we will discuss the mechanism and role of RBP in the metastasis of hepatocellular carcinoma. Basic regulatory strategies of RBP most RBPs contain one or more conventional RBDs, which recognize and bind specific sequences in RNAs in order to play their roles. The RBDs, together with some repetitive sequences, form the basic modules, which, through various combinations and permutations, enable the RBPs to accurately search for RNAs for recognition in the cell and participate in regulating RNAs.
Serum Claudin-18.2 Expression and Gut Microbiota Dysregulation in Hepatocellular Carcinoma: Correlation with Immune Checkpoint Inhibitor Response
Background: Hepatocellular Carcinoma (HCC) remains a therapeutic challenge, with Immune Checkpoint Inhibitors (ICIs) offering limited response rates. This study investigates the prognostic value of serum Claudin-18.2 (CLDN18.2) and gut microbiota in HCC patients treated with anti-PD-1 therapy. Methods: A prospective cohort of 220 HCC patients (BCLC stage B/C) receiving camrelizumab was enrolled. Serum CLDN18.2 levels were measured by ELISA, and stool microbiota was analyzed via 16S rRNA sequencing. Primary endpoints included objective response rate (ORR), overall survival (OS), and progression-free survival (PFS). Results: High serum CLDN18.2 (>150 ng/mL) was observed in 48% of patients and correlated with larger tumor size (≥5 cm: OR=2.31, p=0.002), microvascular invasion (MVI: OR=1.89, p=0.014), and lower ORR to ICIs (18% vs. 39%, p<0.001). Multivariate analysis showed high CLDN18.2 independently predicted worse OS (HR=2.17, 95% CI: 1.38-3.42, p=0.001) and PFS (HR=1.94, 95% CI: 1.22-3.09, p=0.005) (Table 1). Gut microbiota analysis identified Ruminococcus gnavus and Alistipes indistinctus as key predictors of ICI resistance. High R. gnavus abundance was associated with reduced ORR (12% vs. 35%, p<0.001) and shorter OS (HR=2.45, 95% CI: 1.56-3.86, p<0.001) (Table 2). Combined CLDN18.2 and R. gnavus improved prognostic accuracy (C-index=0.81 vs. 0.69 for single markers, p=0.003). Patients with both high CLDN18.2 and R. gnavus had the worst outcomes (median OS=7.8 months vs. 16.5 months in low-risk groups, p<0.001) (Table 3). Mechanistically, R. gnavus promoted PD-L1 expression via TLR4/MyD88 signaling in vitro. Conclusion: Serum CLDN18.2 and R. gnavus are independent predictors of ICI resistance in HCC. Their combination may optimize patient selection for ICIs, paving the way for microbiota-targeted adjuvant therapies.
ACTG1 Inhibits PI3K/Akt Signaling Pathway to Promote Apoptosis in Gastric Cancer Cells Through Modulating Phosphatidylinositol3-Kinase Regulatory Subunits
Gastric Cancer (GC) remains a leading cause of cancer-related mortality, with the PI3K/Akt pathway critically involved in its pathogenesis. This study identifies ACTG1 as a novel regulator of PI3K/Akt signaling, demonstrating its role in inducing caspase-dependent apoptosis. Through gain- and lossof-function experiments in SGC-7901 and HGC-27 cells, we show that ACTG1 overexpression reduces p-PI3K (Tyr458) by 62% and p-Akt (Ser473) by 58%, while increasing apoptotic cell populations by 2.8-3.2-fold. Clinically, ACTG1 expression negatively correlates with p-Akt levels in GC tissues (n=80, r=-0.41, p<0.01). These findings establish ACTG1 as a potential therapeutic target for PI3K/Akt-driven gastric cancer.
Integrative Analysis of Exosomal MIR-122-5p and Gut Microbiota in Predicting Prognosis and Sorafenib Response in Hepatocellular Carcinoma
Hepatocellular Carcinoma (HCC) is a leading cause of cancer-related death, with limited predictive biomarkers for prognosis and targeted therapy. This study evaluates the prognostic value of exosomal miR-122-5p and gut microbiota in HCC patients treated with sorafenib. A total of 180 HCC patients (Child-Pugh A/B, BCLC stage B/C) were prospectively enrolled. Plasma exosomal miR-122-5p levels were quantified by qRT-PCR, while stool samples underwent 16S rRNA sequencing. Clinical outcomes included Overall Survival (OS), Progression-Free Survival (PFS), and sorafenib response. Results: Exosomal miR-122-5p levels correlated with tumor size (r=0.32, p < 0.001), AFP levels (r=0.28, p=0.003), and microvascular invasion (MVI) (OR=2.14, 95% CI: 1.23–3.72, p=0.007). High miR-122-5p (> median) was associated with shorter OS (HR=2.31, 95% CI: 1.45–3.68, p < 0.001) and PFS (HR=1.89, 95% CI: 1.12–3.18, p=0.017) in multivariate analysis (Table 1). Gut microbiota analysis identified Bacteroides fragilis and Enterococcus faecalis as enriched in non-responders to sorafenib. High B. fragilis abundance was associated with reduced OS (HR=2.05, 95% CI: 1.28–3.28, p=0.004) and PFS (HR=1.78, 95% CI: 1.09–2.90, p=0.021). Combined miR-122-5p and B. fragilis improved prognostic accuracy (C-index=0.79 vs. 0.68 for single markers,p=0.002) (Table 2). In sorafenib-treated patients, the combination of high miR-122-5p and B. fragilis predicted poor response (OR=4.32, 95% CI: 2.11–8.85,p < 0.001), with median OS of 8.2 months vs. 15.6 months in low-risk groups (Table 3). Conclusion: Exosomal miR-122-5p and B. fragilis are independent prognostic biomarkers for HCC. Their combination enhances prediction of sorafenib response and survival, offering opportunities for personalized precision medicine.
KEAP1 Dysregulation in Hepatocellular Carcinoma: Functional Characterization and Therapeutic Targeting
Hepatocellular Carcinoma (HCC), the most prevalent primary liver cancer, remains a global health challenge due to its aggressive biology and limited therapeutic options. Kelch-like ECH-associated protein 1 (KEAP1), a critical regulator of the NRF2 antioxidant pathway, has emerged as a key player in HCC pathogenesis. This comprehensive study employs in vitro, ex vivo, and in vivo models to investigate the functional consequences of KEAP1 dysregulation in HCC, focusing on tumor cell proliferation, migration, chemoresistance, and immune microenvironment modulation. Through siRNA-mediated knockdown, CRISPR-Cas9 genome editing, and pharmacological interventions, we demonstrate that KEAP1 deficiency promotes oncogenic phenotypes via NRF2 hyperactivation, while also inducing metabolic reprogramming and immune evasion. Clinical correlation analyses using TCGA-LIHC dataset and tissue microarrays further validate the prognostic significance of KEAP1 expression in HCC patients. Our findings establish KEAP1 as a multifunctional oncogenic driver and highlight the therapeutic potential of targeting the KEAP1-NRF2 axis in HCC, particularly in overcoming chemoresistance and enhancing immunotherapeutic responses.
Kelch-like ECH-associated protein 1 (KEAP1)
YBX1 in Breast Cancer: From Molecular Mechanisms to Therapeutic Opportunities
Breast cancer, a heterogeneous malignancy with high metastatic potential, remains a global health burden. The Y-box binding protein 1 (YBX1), a multifunctional nucleic acid-binding protein, has emerged as a pivotal regulator in breast cancer progression, mediating Epithelial-Mesenchymal Transition (EMT), Cancer Stem Cell (CSC) maintenance, and therapeutic resistance. This review synthesizes preclinical and clinical evidence from 2023–2025, detailing YBX1’s structural features, molecular mechanisms in tumorigenesis, prognostic/diagnostic significance, and emerging therapeutic strategies. Data from 12+ cohorts (n > 2,500) demonstrate that high YBX1 expression correlates with poor survival (HR = 2.15, P < 0.001) and treatment resistance. Targeting YBX1 via small molecules, RNA therapies, and immune combinations shows promise in preclinical models, highlighting its potential as a precision oncology target.
Retrospective Analysis of Etiology Treatment Outcomes and Risk Factors in Intestinal Obstruction
Background: Intestinal Obstruction (IO) remains a critical gastrointestinal emergency with diverse etiologies. This study analyzed clinical characteristics, treatment outcomes, and risk factors for mortality in IO patients. Methods: Data from 500 IO patients (2021–2024) were retrospectively reviewed. Etiologies, treatment modalities (surgical/non-surgical), and outcomes were analyzed. Multivariate logistic regression identified risk factors for mortality. Results: Adhesive obstruction (45%) and malignancy (32%) were the most common etiologies. Surgical intervention was performed in 68% (340/500),with higher success rates in adhesive vs. malignant obstruction (82% vs. 55%, p<0.001). Overall mortality was 9% (45/500). Independent risk factors for mortality included age ≥65 years (OR=2.8, 95%CI:1.5–5.2, p=0.003), malignant etiology (OR=3.5, 95%CI:1.9–6.4, p<0.001), and delayed surgery (>48 hours, OR=2.1, 95%CI:1.2–3.7, p=0.012). Conclusion: Malignancy and advanced age are key risk factors for IO mortality. Timely surgery improves outcomes in adhesive obstruction, while multidisciplinary care is critical for malignant IO.
Impact of Complications on the Quality of Life of Patients Who Underwent Surgery for Adult Spinal Deformity
Study Design: A multicenter, retrospective review of surgical patients with adult spine deformity. Objective: Analyze the impact on the quality of life of patients who suffer complications in adult spine deformity surgery. Summary of Background Data: Adult spine deformity surgery is classically associated with a high rate of complications, in particular it is estimate around 40%. The knowledge of the impact these complications could be a useful to improve the outcome in quality of life of patients. Methods: Retrospective analysis of a prospective database of a cohort of patients who underwent spinal deformity surgery. Patients with 4 or more instrumented vertebras and 2 years follow-up of were included. We created two groups based on the development or not of complications. VAS, ODI and SRS22, as a quality of life questionnaires, were used. Statistical analysis was performed using: T Student and U Mann-Whitney tests depending if variables were adjusted or not to normality; independent and related samples were analyzed with W Wilcoxon test. Results: 65 patients from primary surgery completed all the protocols (75.4% female) , mean age of the cohort was 68 ± 6.21 years, the average number of levels fused was 7 ± 3.37, with an operative time of 305.47 ± 116.90 minutes with 406.50 ± 92.7 mL of estimated blood loss. 24 patients suffered complications including PJK, instrumentation rupture, malposition material and infection. The results of the quality of life of patients with complications showing a significant statistical improvement in all parameters except the function subdomain (Pre- Complication: 2.55 ± 0.66; Post-Complication 2.93 ± 0.85, p = 0.082) and satisfaction subdomain (Pre-Complication 3.25 ± 1.25; Post-Complication 3.84 ± 0.91, p = 0.095) of the SRS-22 regarding the preoperative. The disability, that the ODI shows, is better and statistically significant than the preoperative one although it remains at high levels (Pre-Complication 57.58 ± 16.01; Post-Complication 43.47 ± 17.1, p < 0.05). Considering the pain in the VAS back [(Pre-Complication 8 (5.50-9); Post Complication 4 (1.50-7.50), p < 0.05] and VAS leg [(Pre-Complication: 8 (5-8); Post 2 (0.50-5), p < 0.05] this significant improvement after complication. Quality of life parameters in patients with complications were affected, although with no statistically significant differences in comparison to the group of patients without re- surgery for some complication. Conclusions: The impact on quality of life of subjects who suffer complications in comparison to those that do not is reflected in greater functional limitations and worse results in subdomains of the SRS-22 questionnaire, despite improving after the surgery and without significant differences in comparison to the group of patients free from complications.
Health Related Quality of Life and Spinopelvic Parameters in Sagittal Imbalance Patients: A Comparison of Multilevel Smith Petersen Osteotomy (SPO) and Pedicle Subtraction Osteotomy(PSO)
Study Design: A multicenter, retrospective review of surgical patients with sagittal imbalance. Objective: Determine if the use of one type of osteotomy is justified instead of the other by basing on improvements in the quality of life and radiographical parameters after sagittal imbalance correction. Summary of Background Data: ASD includes broad ranges of clinical and radiographical conditions that could be associated with a decrease in quality of life of patients. SPO and PSO are the techniques most commonly used to correct sagittal imbalance. Methods: Retrospective study with patients from two hospitals who suffered from sagittal imbalance and underwent PSO/SPO with a minimum one-year follow-up. Radiographic parameters measured were Thoracic Kyphosis (TK), Lumbar Lordosis (LL), Coob Angle (Cobb), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Health Related Quality of Life was obtained by ODI, SRS-22, and VAS. Two analyses: (1) Pre-/postoperative data comparison of each technique (paired sample t-test). (2) Magnitude of change comparison between SPO and PSO (independent samples t-test). Results: 65 patients with a mean age of 67.7 (±9.59) years, 70.8% female. Two groups: SPO (48 cases with a mean of 2.13 osteotomies), PSO (17, one PSOin each). In the SPO group significant improvements were seen TK (Pre: 31.38 ± 16.92; Post: 41.37 ± 11.67, p < 0.001), LL (Pre: 31.20 ± 15.69; Post: 38.63 ± 9.62, p < 0.001), and Cobb (Pre: 25.42 ± 15.84; Post: 9.49 ± 8.60, p < 0.001), as well as in the quality of life questionnaires. In the PSO group significant improvements were determined in TK (Pre: 32.26 ± 19.48; Post: 42.51 ± 16.23, p = 0.003), LL (Pre: 20.71 ± 12.50; Post: 38.54 ± 8.62, p < 0.001), and SVA (Pre: 156.00 ± 37.79; Post: 98.65 ± 38.72, p < 0.001) and in total SRS-22 (Pre: 2.13 ± 0.42; Post: 3.10 ± 0.87, p < 0.001) and self- image subdomain (Pre: 2.06 ± 0.54; Post: 2.99 ± 0.77, p = 0.002), mental health (Pre: 2.06 ± 0.54; Post: 3.59 ± 1.08, p < 0.001), and function (Pre: 2.31 ± 0.43; Post: 2.96 ± 0.92, p = 0.010). The comparison between SPO/PSO revealed no significant improvements in both techniques. Regarding quality of life, significant better scoring was obtained in VAS-PSO group (-3.29 ± 5.77) in comparison with SPO-group (-2.73 ± 3.49), p = 0.009. However, as a whole, quality of life improves more in both osteotomies groups. Conclusions: Significant quality of life improvements are seen in patients with sagittal imbalance after being treated with SPO and PSO techniques.Differences between both techniques were not found.
Esteban Blanco Marta Esteban Blanco Marta
Lombao Iglesias Domingo Lombao Iglesias Domingo
Textile Sutures Used in Dental Surgery and their Associated Problems
A variety of suture materials are available for primary wound closure following oral surgical procedures. The tissue reactions to the various suture materials used in oral surgical interventions have been analyzed. Databases have been searched relating to cotton, nylon, polyglecaprone 25, polytetrafluoroethylene (ePTFE), Polyglactin 910, polyglycolic acid (PGA), polylactic acid, silk, surgery, suture, and tissue reaction. An interesting compilation has been done from various reliable sources. A number of investigations have been included. Few studies reported that polyglecaprone 25 had positive effects on wound-healing as compared to silk. More studies reported that silk elicits more intense tissue inflammatory response and delayed wound healing as compared to other suture materials (including ePTFE, polyglecaprone-25, PGA, and nylon). Polyglactin 910 sutures were associated with the development of stitch abscess in one clinical study. A number of studies reported that tissue reactions are minimal with nylon sutures. Tissue reactions to suture materials used for oral surgical interventions may vary depending on the surface properties and bacterial adherence properties of the material.
Therapeutic Role of Transforaminal Steroid Injection for the Management of Radicular Pain: Survival Rate in Patients with Radicular Pain Secondary to Degenerative Lumbar Pathology
Background: The effectiveness of transforaminal epidural steroid injection (TFESI) as a therapeutic tool for radicular pain (RP) in the short term has been demonstrated, however, in the medium or long term it is controversial. Objectives: The objective of this work is to evaluate its usefulness as a therapeutic tool through survival analysis. Study Design: Method: Retrospective evaluation of 93 patients with RP secondary to degenerative pathology (DP) of the lumbar spine, submitted to TFESI, by the same spine surgeon, analyzing demographic variables and clinical results according to McNab score, as well as analysis of survival rate of TFESI using Kaplan Meier curve. Results: Of the 93 patients, 59% was male and 41% female, with a mean age of 64 years, with an average follow-up of 27 months. The most frequently infiltrated level was L4-L5 (55.9%) and sciatica was the most common symptom (88.1%) of the patients. The most frequent diagnosis found was disc herniation in 51.6%. 87% of the patients reported improved their symptoms according to the McNab Score, indicating excellent, good or fair results. Only 12.9% indicates poor results. 12.9% of the patients required surgery or a second TFESI within the first three months. The survival rate obtained in our study was of 81% at 51 months. Conclusion: The results obtained in our study showed favorable results with a survival rate of 81% at 51 months for the TFESI, suggesting its efficacy for the management of RD in the medium and long term, thus being able to avoid more invasive procedures with their potential risks.
Transforaminal Epidural Steroid Injection (TFESI)
Ignacio Cirillo Totera Ignacio Cirillo Totera