As essential nutrients for human beings， electrolytes play a central role in nutritional and metabolic support treatment. To further standardize the use of electrolyte preparations in parenteral nutrition， China International Exchange and Promotive Association for Medical and Health Care Clinical Nutrition Health Branch， Chinese Medical Doctor Association Nutritionist Professional Committee， Chinese Society of Parenteral and Enteral Nutrition， and Chinese Nutrition Society Branch of Clinical Nutrition，invited authoritative experts in the fields of critical medicine， emergency medicine， internal medicine，surgery， and pharmacology in China to create this expert consensus. This consensus was based on the latest guidelines and evidence-based medicine at home and abroad， and combined with the actual clinical medical environment in China. This consensus covered the following topics: electrolytes monitoring during parenteral nutrition， risk assessment and nutritional treatment of refeeding syndrome， electrolytes supplementation during parenteral nutrition for various diseases （including severe diseases， heart failure， post-surgical short bowel syndrome， perioperative period， trauma， diabetic foot， chronic kidney disease， liver disease， neonates），and the compatibility principles of electrolyte preparations in parenteral nutrition. Finally， 13 clinical questions and 26 recommendations were proposed aiming at providing scientific， standardized， and practical guidance for the rational application of electrolytes in parenteral nutrition.

Objective

To construct a co-culture model of gastric cancer organoids and CLDN18.2-chimeric antigen receptor T （CAR-T） cells， and to investigate the relationship between CAR-T cytotoxicity and clinicopathological factors， especially the intensity of CLDN18.2 expression.

Methods

Clinical and pathological data were collected from 73 patients with gastric cancer admitted in the Seventh Affiliated Hospital of Sun Yat-sen University from September 2022 to August 2023. CLDN18.2 expression in tumor tissues was detected using immunohistochemical staining. Gastric cancer organoids were established and the CLDN18.2 expression profile was verified by both immunohistochemical and immunofluorescence staining. CLDN18.2-CAR-T cells were developed and co-cultured with 12 gastric cancer organoid models.CAR-T cell cytotoxicity was evaluated using lactic dehydrogenase （LDH） release assays， enzyme linked immunosorbent assay （ELISA） for cytokine detection， and fluorescence imaging of cell killing. Univariate and correlation analyses were performed to explore the relationship between CLDN18.2 expression and CAR-T cell cytotoxicity.

Results

Organoids retained the expression characteristics of CLDN18.2 in the primary tumors. Co-culture experiments demonstrated that CAR-T cells killed the organoids effectively.Univariate analysis of clinicopathological factors confirmed that CLDN18.2 expression intensity was a factor influencing CAR-T cell cytotoxicity. Correlation analysis indicated significantly positive correlation between cytotoxicity and CLDN18.2 expression level （r=0.73， P=0.007）.

Conclusion

A successful co-culture model was constructed for in vitro validation of CAR-T therapeutic efficacy and development of highly active CLDN18.2-targeted CAR-T cells.

Objective

To explore the clinical effect of the technique of wrapping the hepatic portal artery via the ligamentum teres hepatis in the prevention of hepatic portal arterial hemorrhage after laparoscopic pancreaticoduodenectomy （LPD）.

Methods

The data of 127 patients who underwent LPD from September 2019 to June 2024 were retrospectively analyzed and divided into the wrapped group （75 patients） and the non-wrapped group （52 patients）. The perioperative data of the two groups were compared to evaluate the clinical effectiveness of this technique.

Results

There was no significant difference in preoperative data between the two groups. The operative time in the wrapped group was 306 （270-356） min，which was slightly longer than ［300 （290-330） min］in the non-wrapped group， and the difference was not statistically significant （Z=0.823， P=0.411）. There was no portal arterial hemorrhage in the wrapped group， while there were 5 cases of portal arterial hemorrhage （4 cases of gastroduodenal artery， 1 case of common hepatic artery） in the non-wrapped group， and the difference was statistically significant （χ²=5.180，P=0.023）.

Conclusion

It is safe and feasible to wrap the hepatic portal artery in LPD by ligamentum teres hepatis， which can effectively prevent the incidence of hepatic portal arterial hemorrhage after LPD and is worthy of clinical promotion.

Objective

To evaluate the safety and efficacy of plane dissection （PD） versus telescopic dissection （TD） in totally extraperitoneal （TEP） laparoscopic hernioplasty， with special focus on the quality of surgical field vision.

Methods

A retrospective analysis was conducted on 146 patients who underwent PD from January 2017 to October 2023 in Dongguan Hospital of Guangzhou University of Chinese Medicine and Chashan Hospital Affiliated to Guangdong Medical University. Propensity score matching （PSM） was used to minimize the impact of confounding factors. Among the patients who received operation at the same period，292 cases were matched with TD group in the optimal proportion of 12. The primary outcomes included peritoneal damage， vascular injury， clarity of surgical field vision， operation time， intraoperative blood loss，and complications. Secondary outcomes were length of hospital stay， postoperative pain， recurrence rate，and so on.

Results

After PSM， the two groups were comparable in terms of key prognostic factors. The PD group had significantly better clarity of surgical field vision compared to the TD group （grade : χ²=5.310，P=0.021； grade: 4.074， P=0.044）， less intraoperative blood loss， and shorter operation time （t=2.875， 4.484；P=0.004， ＜0.001）. The TD group had higher costs than the PD group （t=6.869， P＜0.001）. There were no statistically significant differences between the two groups in terms of length of hospital stay and followup duration. The overall complication rate was significantly different between the two groups （χ²=6.778，P=0.009）， mainly due to differences in peritoneal injuries （χ²=6.665， P=0.010）. Although one case in the TD group had bleeding exceeding 500 ml and one case of aortic injury， there were no statistical differences in severe complications classified by the Clavien-Dindo system between the two groups （χ²=0.501， P=0.479）.Additionally， there were no incisional infections or chronic pain in either group.

Conclusions

Both PD and TD demonstrate effectiveness and reliability in TEP surgery. PD shows superior performance in terms of clarity of surgical field vision， reducing peritoneal injuries， shortening operation time， and reducing intraoperative blood loss and expenses. Therefore， PD has significant potential for application in TEP surgery.

Breast cancer is one of the malignant tumours with the highest incidence rate among women and has become a major killer threatening women’s health. There are various treatment modalities for breast cancer， including surgery， radiotherapy， chemotherapy， endocrine therapy and targeted therapy.Combination therapy is effective in prolonging patient survival. But resistance to chemotherapy is increasing，and the search for new therapeutic targets is an urgent clinical problem in order to achieve better clinical outcomes for breast cancer patients. E1A binding protein P300 （EP300） is a widely expressed transcriptional co-activator and histone acetyltransferase that acetylates conserved lysine residues in histones to promote activated transcription of genes. EP300 is a protein molecule with multiple functional structural domains that can modulate the interactions between multiple proteins. EP300 has important and diverse biological functions in cell proliferation， cell cycle regulation， apoptosis， DNA damage repair and stem cell-like properties. EP300 has now been shown to be associated with tumour recurrence in breast cancer and suggests poor prognosis. The relationship between EP300 and the development of breast cancer is now reviewed.

Serine protease 2 （PRSS2） is a serine protease， which is usually expressed in the cytoplasm of cells within tissues and organs such as the esophagus， gastrointestinal tract and pancreas.It serves as a ligand for low-density lipoprotein receptor-related protein 1 （LRP1）， an activator of matrix metalloproteinases， and a potent activator of digestive enzymes. PRSS2 mediates multiple mechanisms，including the remodeling of the tumor immune microenvironment， epithelial-mesenchymal transition， KRAS oncogenic mutations， and the induction of pancreatic inflammation-cancer transformation， thereby promoting the occurrence and development of pancreatic cancer. This article summarizes the molecular structure and functional characteristics of PRSS2 and reviews relevant research on its role in pancreatic cancer. The aim is to provide theoretical reference for further elucidating the mechanisms of PRSS2 in pancreatic cancer.

Biliary complication caused by hepatic cystic echinococcosis （HCE） intrabiliary rupture is one of the most common and serious complications of HCE， which is mainly diagnosed by its clinical manifestations and imaging examinations. Surgical treatment is the most effective method for intrabiliary rupture of HCE， which needs to decompress biliary tract， and keep the bile duct unobstructed on the basis of radical surgery or conservative surgery， and reasonably deal with the postoperative complications.Choledochotomy T-tube drainage is more commonly applied nowadays， and double T-tube drainage are placed in the fistula and the biliary tract. Endoscopic retrograde cholangiopancreatography， as an important preoperative and postoperative technique for intrabiliary rupture of HCE， can effectively remove the contents broken into the biliary tract and further reduce infection risk. This article reviews the clinical manifestations，diagnosis， and treatment of biliary complications of HCE， with the aim of improving the prognosis by early detection， diagnosis， and treatment.

Hepatocellular carcinoma （HCC） is the most common primary malignant tumor of the liver， and its complex pathogenesis has been the focus of researches. With the in-depth exploration of the interaction between metabolic dysfunction and tumor immune microenvironment， there is increasing evidence that they play a key role in tumor evolution， immune escape， and immunotherapy response.Metabolic dysfunction involves a variety of biochemical processes such as glycolysis， amino acid metabolism，which are often abnormal in tumor cells to meet the energy and material requirements of rapid growth and proliferation. At the same time， these metabolic abnormalities also affect immune cells in the tumor microenvironment， thus affecting their immune response and anti-tumor activity. In recent years， a number of reports have revealed the importance of metabolic dysfunction in regulating immune cell function， immune escape mechanism and anti-tumor immune response in the immune microenvironment of HCC. However，there is still lack of systematic review and in-depth analysis of how metabolic dysfunction affecting the cellular components and functions of the HCC immune microenvironment. This study summarizes the latest research progress on the interaction between metabolic dysfunction and HCC immune microenvironment，explores its potential application in immunotherapy， proposes possible metabolic targets， and provides new directions and ideas for future HCC treatment.

Esketamine is a non-competitive N-methyl-D-aspartate receptor antagonist with significant analgesic effects， and has shown important advantages in the antidepressant treatment， anesthesia induction and maintenance. Compared with traditional analgesic drugs， esketamine has a unique mechanism of action， higher potency and relatively fewer side effects， and its application in perioperative analgesia has attracted more and more attention. This article reviews the analgesic mechanism of esketamine and its application in perioperative analgesia， in order to provide reference for its application in perioperative analgesia.

Objective

To evaluate the efficacy and safety of the local application of corticosteroids in the treatment of idiopathic granulomatous mastitis （IGM）.

Methods

A systematic search was conducted in databases including PubMed， Embase， Cochrane Library， Web of Science， China National Knowledge Infrastructure （CNKI）， CBM， Wanfang， and VIP up to April 2024 to identify relevant randomized controlled trials. The quality of the included studies was assessed， and a meta-analysis and subgroup analysis were performed to obtain the pooled effect size for the outcomes of interest.

Results

A total of 8 trials involving 596 patients were included. Local corticosteroid administration in the trial group included intralesional injection and topical corticosteroid ointments， while the control group mainly received systemic treatment （oral corticosteroids） and aspiration/drainage procedures. The meta-analysis results showed that local application of corticosteroids （including intralesional injection and topical ointments） was significantly improved effectiveness compared to oral corticosteroids or aspiration/drainage therapy （RR=1.34， 95% CI: 1.10-1.63，P=0.004）. The incidence of adverse effects was also lower in the local corticosteroid group compared to the control group （RR=0.42， 95% CI: 0.22-0.80， P=0.009）. Local corticosteroid treatment had advantages in terms of the time to treatment effectiveness （MD=-3.51， 95% CI: -4.62- -2.40， P＜0.000 01） and hospital stay （MD=-6.69， 95% CI: -7.34- -6.04， P＜0.000 01）， with no significant difference in recurrence rates between groups （RR=0.85， 95% CI: 0.36-2.01， P=0.71）.

Conclusions

Local corticosteroids application can improve the response rate in patients with IGM， reduce the incidence of adverse effects， and result in shorter time to treatment effectiveness. This approach can serve as an effective treatment method to optimize the outcomes of IGM therapy and improve patient treatment experience and safety.