Journal of Surgery & Anesthesia Research
Editor-in-chief: Cesare Formisano Associate Professor Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples University of California Italy Journal of Surgery & Anesthesia Research is a dynamic platform dedicated to advancing innovative research and clinical excellence in surgery and anesthesia. It connects global experts, shares cutting-edge discoveries, and promotes improved patient care through impactful scientific contributions. It encourages knowledge sharing and collaboration across the global scientific community. Its mission is to promote scientific excellence and improve patient care and surgical outcomes. Special Issue Title: Innovations in Modern Surgery and Anesthesia: Advances, Challenges, and Future Perspectives This Special Issue of the Journal of Surgery & Anesthesia Research focuses on the latest innovations, advances, and emerging trends in modern surgery and anesthesia. It provides a platform for researchers, surgeons, anesthesiologists, and healthcare professionals to share innovative techniques, clinical discoveries, and evidence-based approaches that are transforming patient care. Article acceptance will be in the form of research, review, case reports, magazines, short communications, picturized, book review, video type and power point presentations (PPTS). Articles can be submitted through online from https://srcpublishers.com/surgery-anesthesia-research/user/register or can send through an e-mail with attachment for surgerysciences@onlinescientificresearch.info 1.5* Impact Factor 84.5% Citations 90% Acceptance
Meta-Analysis of Hiatal Hernia Repair: Mesh Versus Suture Techniques
Background: Hiatal Hernia Repair (HHR) is a common surgical intervention to correct herniation of abdominal contents through the esophageal hiatus, which can lead to gastroesophageal reflux, dysphagia, and other complications. The use of mesh reinforcement versus suture-only repair remains controversial. Objective: This meta-analysis systematically evaluates outcomes of mesh versus suture HHR, focusing on recurrence, reoperation rates, postoperative complications, and symptom resolution. Methods: A comprehensive search was conducted in PubMed, MEDLINE, Cochrane Library, and Scopus up to September 2025. Randomized controlled trials, cohort, and case-control studies comparing mesh and suture techniques were included. Data were extracted on recurrence, reoperation, complications, and symptom resolution. Pooled Odds Ratios (ORs) were calculated using random-effects models. Results: Twenty-five studies with 3,500 patients were included. Mesh reinforcement significantly reduced recurrence (OR 0.48, 95% CI 0.32–0.72) and reoperation rates (OR 0.58, 95% CI 0.39–0.87) compared to suture repair. Postoperative dysphagia was slightly higher with mesh, but overall complications were similar. Symptom resolution was comparable between groups. Subgroup analysis suggested biosynthetic meshes (Phasix™ ST) had the best outcomes. Conclusions: Mesh reinforcement improves surgical outcomes in HHR, particularly in reducing recurrence and reoperation rates. Choice of mesh and patient selection are critical. Long-term studies are warranted to validate durability and safety.
Copyright (c) 2026 Journal of Surgery & Anesthesia Research
Anesthetic Concerns and Management in the Obese Parturient: A Comprehensive Clinical Review
The converging forces of a global obesity pandemic and advancing maternal age have dramatically reshaped modern obstetric anesthesia practice. Obesity, defined as a body mass index (BMI) of 30 kg/m² or higher, introduces vast physiological, anatomical, and metabolic changes that significantly compromise maternal functional reserves. This article provides an extensive, multi-system, evidence-based analysis of the anesthetic concerns and perioperative management of the obese parturient. We comprehensively trace the compounding impacts of maternal adiposity on cardiovascular and respiratory frameworks, delineating how mechanical constraints induce rapid arterial desaturation and accelerated ventricular strain. Moving beyond systemic physiology, we examine the structural distortions of the neuraxial landscape, where obscured bony landmarks and altered epidural architecture heighten first-pass placement failure. To counter these barriers, we detail technical interventions, featuring the routine implementation of pre-procedural ultrasound mapping, specialized needle selections, and optimal patient biomechanics. Airway management protocols are deeply analyzed, highlighting the integration of the ramped positioning matrix, continuous positive airway pressure (CPAP), high-flow nasal oxygen (HFNO), and the definitive management of the 'Cannot Intubate, Cannot Oxygenate' (CICO) emergency via advanced scalpel-bougie front-of-neck access. Finally, the review addresses the intricate management of difficult peripheral intravenous access and the systemic implications of frequent comorbidities, including preeclampsia, obstructive sleep apnea (OSA), and metabolic dysfunction. Concluding with an exhaustive clinical matrix governing elective versus emergent lower segment cesarean sections (LSCS), this text establishes a robust, highly detailed framework for multidisciplinary obstetric care.
Managing the Defeated Dermatome: Clinical Dilemmas, Decision-Making, and Technical Execution of Repeat Subarachnoid Blocks
Background: Subarachnoid block (SAB), or spinal anaesthesia, is a cornerstone of modern regional anaesthesia, highly valued for its rapid onset, profound blockade, and minimal systemic drug burden across various surgical specialties. Despite its perceived simplicity, an unexpected block failure rapidly transitions a routine workflow into a high-stress scenario, imposing significant physical and psychological burdens on patients while increasing medicolegal vulnerability for the surgical team. Objective: This article provides a comprehensive evaluation of managing failed subarachnoid blocks, detailing the underlying mechanisms of failure, clinical decision-making timelines, safe rescue execution techniques, dosage adjustments, and associated complications. Discussion: When faced with an inadequate or absent block, anaesthesiologists must navigate limited rescue pathways, including local infiltration, systemic sedation, conversion to general anaesthesia (GA), or executing a repeat subarachnoid block. While GA serves as a reliable safety net, it introduces distinct risks-particularly in obstetric populations, such as difficult airways and gastric aspiration. Consequently, repeating the SAB emerges as a highly effective alternative. However, to safely manage and execute a repeat block, clinicians must accurately deduce the root cause of the initial failure. Spinal anaesthesia failure is a complex interplay of anatomy, physics, and pharmacology that can be categorized into three distinct clinical phases: failure to access the subarachnoid space, failure of local aesthetic distribution within the cerebrospinal fluid (CSF), and failure of drug action at the neural membranes. Conclusion: Successfully managing a failed SAB relies on accurate phase-based troubleshooting and a precise understanding of the altered pharmacodynamic landscape before attempting a second intrathecal injection.
Optimizing First-Pass Success in Subarachnoid Block: A Comprehensive Narrative Review
Subarachnoid block (SAB), or spinal anesthesia, is a foundational technique in modern regional anesthesia, providing rapid, dense, and reliable surgical anesthesia for lower abdominal, obstetric, urological, and orthopedic surgeries. Traditionally relied upon as a landmark-guided, tactile procedure, the first-pass success (FPS) rate of SAB historically ranges from only 60% to 70% in unselected patient populations. Multiple needle passes, bony contacts, and redirections significantly escalate the risk of patient discomfort, post-dural puncture headache (PDPH), spinal hematoma, epidural vein puncture, and transient neurological symptoms. Achieving a high FPS rate has therefore evolved from a metric of clinical efficiency into a primary safety parameter. This narrative review examines contemporary, Evidence-Based strategies designed to maximize FPS in subarachnoid blocks. It evaluates the impact of patient-related predictors of difficulty, examines advanced mechanical positioning aids and multimodal instructions, contrasts structural approaches (midline vs. paramedian), explores needle design variations, and presents the definitive role of preprocedural and real-time neuraxial ultrasound. By integrating technology with refined clinical ergonomics, anesthesia providers can transition SAB from an empirical, blind procedure into a high-precision, highly successful intervention on the first pass.
Refractory Chronic Abdominal Pain: An Unusual Manifestationof Superior Mesenteric Artery Thrombosis
Mesenteric ischemia is an uncommon but potentially life-threatening condition, associated with high morbidity and mortality when diagnosis is delayed. Thrombosis of the Superior Mesenteric Artery (SMA) is one of the main causes of arterial mesenteric ischemia and is typically characterized by sudden onset of severe abdominal pain. However, in selected cases, particularly when the obstruction is partial or develops progressively, the clinical presentation may be insidious, mimicking more common gastrointestinal disorders. Chronic postprandial abdominal pain, progressive weight loss, nausea, vomiting, and intolerance to oral intake are typical features of chronic or subacute mesenteric ischemia. The coexistence of dyspeptic symptoms or upper gastrointestinal bleeding may further obscure the diagnosis and lead to delays in appropriate management. Contrast-enhanced computed tomography currently represents the diagnostic modality of choice, allowing early detection of vascular involvement before the development of irreversible intestinal ischemia. We report a case of partial mural thrombosis of the superior mesenteric artery presenting as chronic epigastric pain and upper gastrointestinal bleeding, highlighting the diagnostic challenges and the importance of considering vascular etiologies in patients with refractory abdominal symptoms.
Extra-Uterine Hydatidiform Mole: A Case Report
The extra-uterine Hydatidiform Mole (MH) is an extremely rare condition, with only about twenty cases reported in the literature, primarily located in the fallopian tubes or ovaries. We report here the case of a 30-year-old patient, nulligravida and nulliparous, who presented to the emergency department with clinical signs suggestive of a ruptured c (EP). Clinical examination and imaging confirmed the presence of a mass in the right fallopian tube with significant hemoperitoneum, necessitating emergency surgical intervention. The patient underwent a salpingectomy, and histopathological analysis revealed a partial mole. This case highlights the rarity and diagnostic complexity of extra-uterine MH, which requires prompt management and rigorous monitoring of βHCG levels to ensure complete remission. Chemotherapy is reserved for cases with malignant progression.
Transesophageal Echocardiography, A Rescue Imaging for Intraoperative Assessment of Posterior Left Ventricular Aneurysms-A Case Report
Transesophageal echocardiographic visualization of left ventricular posterior aneurysms serves as a valuable tool intraoperatively in guiding management. We present a case of a 71-year-old male who presented with left ventricular pseudoaneurysm of infero-basal and posterior wall which underwent a patch closure. This paper emphasises the importance of transesophageal echocardiography in visualizing heart structures especially posterior.
Development of Gender- and Age-Specific Ponderal Index (PI)Percentile Curves Using Quantile Regression (QR) in Pakistan
Background: Accurate assessment of human growth and nutritional status is critical for early detection of malnutrition, over nutrition, and metabolic disorders. Traditional anthropometric indices such as Body Mass Index (BMI) have recognized limitations, particularly in pediatric and ethnically diverse populations, necessitating the development of more sensitive and population-specific measures. The Ponderal Index (PI), which normalizes body mass relative to height cubed, offers a potentially superior metric for evaluating proportionality, especially in neonates and children. However, population specific growth references for PI are lacking in Pakistan, where unique growth patterns influenced by genetic, environmental, and socioeconomic factors prevail. Objectives: This study aims to develop gender- and age-specific percentile reference curves for PI in the Pakistani population utilizing advanced statistical modelling techniques, specifically quantile regression, to accurately characterize the distributional properties across the lifespan. The primary objectives include establishing normative standards, comparing the performance of different percentile estimation methods, and validating the utility of PI as a growth and health risk indicator. Methods: A cross-sectional, nationally representative sample of approximately 10,000 apparently healthy Pakistani individuals aged 2 years to over 60 years was recruited via multistage stratified random sampling across diverse geographic, socioeconomic, and ethnic strata. Anthropometric measurements including weight and height were obtained following standardized protocols, and PI was calculated as body weight (kg) divided by height (m) cubed. Data quality assurance involved double data entry, validation, and outlier management. Descriptive analyses characterized the distribution of PI across subgroups. Separate gender-specific quantile regression models were fitted for key percentiles (5th, 10th, 25th, 50th, 75th, 85th, 90th, 95th), incorporating fractional polynomial transformations of age to capture non-linear growth trajectories. Model selection was guided by AIC, BIC, residual diagnostics, and bootstrap validation to ensure robustness. Normative percentile curves were generated and visually depicted for clinical and epidemiological applications. Results: The dataset exhibited a right-skewed distribution of PI, with mean values of 14.80 (SD=3.57) overall, and significant gender differences females demonstrating higher PI than males across all age groups (p<0.001). PI peaked during early childhood (mean =18.75 at 2–5 years) and declined progressively with age, with distinct sex-specific trajectories. Quantile regression (QR) models revealed non-linear, heteroscedastic relationships between age and PI, with polynomial and fractional polynomial terms providing optimal fit. The generated percentile curves demonstrated a characteristic decline in PI during adolescence, stabilization in early adulthood, and gradual reduction thereafter, with females consistently maintaining higher proportionality indices. Validation procedures confirmed the models' predictive accuracy, stability, and applicability. Conclusions: The study successfully establishes comprehensive, gender- and age-specific percentile standards for PI in the Pakistani population using robust QR techniques. These population-specific growth references offer enhanced sensitivity over traditional indices for early identification of growth abnormalities, nutritional deficiencies, and metabolic risks. Implementation of these standards in clinical practice and public health monitoring can improve individualized growth assessment, facilitate early intervention, and inform health policy tailored to Pakistan’s demographic needs. Future longitudinal studies are recommended to validate the predictive utility of PI percentiles for metabolic and non-communicable disease outcomes.
Febrile Atrioventricular Block Revealing a Trigone Abscess: A Misleading Presentation of Mitral Endocarditis
Introduction: Infective Endocarditis (IE) is a life-threatening infection, often affecting damaged valves but occasionally occurring in patients without known cardiac history. Atypical presentations may delay diagnosis. Observation: We present the case of a 68-year-old man with no known heart disease, admitted for respiratory symptoms. Initial work-up suggested pneumonia. Persistent fever and symptomatic bradycardia revealed a high-grade Atrioventricular Block (AVB). Echocardiography identified mitral valve vegetation. Transesophageal echocardiography confirmed an aorto-mitral trigonal abscess. Discussion: Perivalvular abscesses, especially in the aorto-mitral region, are severe IE complications and frequently cause conduction disorders. AVB should prompt urgent evaluation with transesophageal echocardiography. Despite appropriate antibiotics and urgent surgery (mitral valve replacement, abscess drainage, pacing), the patient died from septic shock and multiorgan failure. Conclusion: This case emphasizes the need for high suspicion of IE in atypical presentations. Early imaging, multidisciplinary management, and timely surgery are key to improving outcomes in complicated IE.
Copyright (c) 2025 Journal of Surgery & Anesthesia Research
Metastatic Urothelial Carcinoma of Occult Primary Origin Revealed by a Necrotic Inguinal Lymph Node: A Rare Case Report
Introduction: Occult primary urothelial carcinoma is an extremely rare entity that may present as isolated lymph node involvement without visible bladder or ureteral lesions, making diagnosis particularly challenging. Case Presentation: We report the case of a 91-year-old man presenting with a left inguinal swelling evolving over four years. Examination revealed a necrotic, f istulized mass with no urothelial lesions on cystoscopy. Biopsy showed a poorly differentiated carcinoma (CK7+/CK20+/p63+/p40+/GATA3−), initially suggesting squamous differentiation, but the lymphatic distribution and suspicious ureteral thickening supported an occult urothelial origin. A multidisciplinary management approach was undertaken. Systemic chemotherapy was not initiated due to age and comorbidities. Local wound care and antibiotic therapy led to partial improvement and clinical stabilization without visceral progression. is exceedingly rare. Discussion: This case illustrates the diagnostic complexity of dedifferentiated urothelial carcinomas with atypical immunohistochemical profiles. Loss of GATA3 expression, though uncommon, does not exclude urothelial origin, especially in high-grade tumors. Presentation as isolated inguinal lymphadenopathy Conclusion: Diagnosis of occult urothelial carcinoma requires multidisciplinary collaboration and careful integration of clinical, radiological, and pathological data. In elderly or frail patients, a conservative, symptom-oriented approach is often the most appropriate. Reporting such rare cases is essential to improve understanding of the atypical presentations and dissemination pathways of urothelial carcinoma.
Continuous Lumbosacral Plexus Blocks for Hip and Femur Surgery Analgesia in Elderly Patients Using a Neurostimulator. A Retrospective Study Comparing Psoas and Inguinal Compartment Access
Background: Lumbar plexus block has been used effectively as an anesthetic technique for anesthesia and analgesia in elderly patients with femur and hip fractures. Access to the lumbar plexus can be achieved via a posterior approach (within the psoas compartment) or an anterior approach (in the inguinal compartment), with single short administration or continuous infusion of local anesthetic. The aim of this retrospective study was to compare the analgesic efficacy of an elastomeric pump in two access points, identified by neurostimulation, and its complications. Method: This study was recorded in an Excel spreadsheet from July 2010 to February 2019, including 100 patients over the age of 60 years old who underwent corrective surgery for femur or hip fractures underwent continuous lumbar plexus block for postoperative analgesia. An elastomeric pump was used with 400 ml of 0.1% levobupivacaine excess of enantiomeric solution, at a flow rate of 10 ml/hour. A pain scale (grades 0 to 3) was used, assessed in the anterior thigh region at 4, 8, 12, 16, 20, 24, 30, and 40 hours. Results: There was a predominance of females (77%) compared to males (23%). Access to both compartments was achieved with neurostimulation and catheter placement, successfully in all 100 patients. No complications occurred. The best analgesic outcome was obtained with the psoas compartment. T here was no bacterial growth upon catheter removal. Conclusion: The retrospective study showed that there was significant difference, the quality of analgesia is better with the catheter installed in the psoas compartment compared to inguinal access. In both approaches, there were no postoperative complications.
Giant Mesenteric Cyst and Ventral Hernia with Loss of Domain: Combined Approach
Mesenteric cysts are extremely rare benign intra-abdominal tumors (1:100,000–250,000 hospital admissions). Recurrence after complete surgical resection is uncommon (0–13%), and massive recurrence more than three decades later constitutes an exceptional event. We present the case of a 59-year-old female patient with recurrence of a mesenteric cyst 33 years after the initial resection, associated with a giant ventral hernia with loss of domain (Tanaka Index 28%) and symptomatic cholelithiasis, successfully treated with a combined single-stage surgical approach.
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.
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.
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.