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.

【内容简介】脾脏占位性病变发生率较低，有良性占位和恶性占位，且临床表现缺乏特异性，对于大的脾脏实性占位病变，不排除恶性占位者，应考虑手术探查，行脾切除术。传统开放脾切除手术创伤较大，出血较多，而腹腔镜下脾切除术具有创伤小、出血少、恢复快等优点。本视频通过对1 例脾脏实性占位、考虑脾脏肿瘤患者施行腹腔镜下全脾切除术，详细展现了这一手术过程：患者采用右侧半卧位，利用体位及重力作用使“脾倾斜”有助于暴露术野；离断脾周韧带；暴露脾门；处理胃网膜左血管、胃短血管、脾门脾蒂包括脾上下极血管等；术中需注意预防或避免大出血。该术例为分散型脾动脉及脾门血管的处理提供了一定的借鉴和参考。

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.

Gastric cancer ranks among the most prevalent and lethal malignancies in China， with approximately 30%-40% of patients diagnosed at stage.Although systemic therapy has modestly improved survival in some cases， the overall prognosis remains poor.In recent years， advancements in precision surgical concepts and oncology research have introduced novel individualized treatment strategies centered on immunotherapy， precision molecular subtyping， and multi-omics testing， offering new opportunities for managing stage gastric cancer.However， there is currently no established consensus in China on the standardized implementation of conversion therapy for stage disease.To address this gap， the Chinese Expert Consensus on Precision Surgery for Gastric Cancer Conversion Therapy （2025 Edition） is developed through multidisciplinary collaboration among experts in gastrointestinal surgery， medical oncology，radiology， and pathology.This consensus systematically reviews the latest clinical evidence on conversion therapy， incorporates insights into critical challenges in Chinese clinical practice， and refines key aspects including patient stratification， molecular guided precision therapy， prediction of conversion success， surgical planning， and perioperative management.The document aims to standardize clinical practices for stage gastric cancer conversion therapy and provide clinicians with scientifically robust and practical decisionmaking guidance.

【内容简介】 经自然腔道取标本手术（natural orifice specimen extraction surgery，NOSES）因无需腹部切口取出手术标本，有效减轻了术后疼痛，促进术后康复，近年来在结直肠外科领域被广泛应用。本视频通过对一例61岁男性乙状结肠癌患者施行腹腔镜下乙状结肠癌NOSES，详细展现了术中过程：沿外侧进入Toldt间隙，游离间隙，结扎切断肠系膜下动静脉，裁剪系膜，裸化并切断肠管，行直肠-降结肠overlap吻合，手工缝合共同开口，纵行切开直肠肠壁，经肛取出标本。

【内容简介】正中弓状韧带压迫综合征（median arcuate ligament syndrome，MALS）主要指由正中弓状韧带压迫腹腔干所致的一种临床综合征。MALS 比较罕见，临床表现不典型，术前诊断较为困难，手术（开放或腹腔镜）松解是当前的主要治疗方式。本视频通过对一例35 岁MALS 女性患者实施腹腔镜下正中弓状韧带离断术，详细展现了其诊疗情况及手术过程。手术解除了正中弓状韧带对腹腔干的压迫，保证了靶器官的血液供应，达到了较好的手术预期。

Anal fistula is a common anorectal disorder with various treatment modalities.Traditional procedures such as fistulotomy may cause anal sphincter injury and subsequent fecal incontinence.In order to balance radical treatment with functional preservation， sphincter-preserving techniques have emerged as research focus in recent years.However， only two approaches - ligation of intersphincteric fistula tract （LIFT）and transanal opening of intersphincteric space （TROPIS） - have satisfactorily demonstrated in complex anal fistulas.This article will comprehensively review the pathophysiological basis of fistula formation， procedural details， research advancements， and comparative advantages/limitations of LIFT and TROPIS techniques，aiming to provide optimized therapeutic options for patients with anal fistulas.

Over recent decades， the emergence of immunotherapy has brought new hope to patients with advanced gastric cancer， particularly those with unresectable late-stage disease.Immune checkpoint inhibitors， especially antibodies against programmed cell death protein 1 （PD-1） and its ligand （PDL1）， are playing an increasingly critical role in the treatment of advanced gastric cancer.Based on the epidemiological characteristics of gastric cancer and the fundamental principles of immunotherapy for this disease， this article systematically organizes and summarizes the use of commonly available immune checkpoint inhibitors in clinical trials involving advanced gastric cancer.It also discusses the advantages and limitations of immunotherapy in the treatment of advanced gastric cancer and proposes future directions and research focuses.Building on this foundation， the article further explores the outlook for research in the field of gastric cancer immunotherapy， aiming to offer valuable references for both related research and clinical practice.

Objective

To explore the causal link among gut microbiome， blood metabolites and gastric cancer by mediated Mendelian randomization （MR） analysis in East Asian population.

Methods

At first， summary statistics of 500 gut microbiomes， 112 blood metabolites， 7 921 gastric cancer patients， and 159 201 controls were obtained from the publicly available genome-wide association studies （GWAS） database for two-sample MR analysis.In addition， a two-step approach was used to quantify the proportion of blood metabolite-mediated effects of gut microbiome on gastric cancer.The inverse variance weighted （IVW）method was the primary effect estimation method， while the MR-Egger， weighted median， simple mode，and weighted mode were used as supplements to the IVW method， and sensitivity analyses were utilized to validate the reliability of the MR results.

Results

14 gut microbes were significantly associated with gastric cancer in East Asians， of which 8 were identified as risk factors.Two-step MR analysis identified three metabolic functional pathways （rhamnose degradation， arginine degradation I， and pentose phosphate pathway of non-oxidative branch） that were causally associated with gastric cancer in East Asians through the mediation of two blood metabolites （hydrocortisone and vitamin K）， with vitamin K showing the highest mediation proportion （13.5% and 16.2%）.

Conclusion

Blood metabolites represented by hydrocortisone and vitamin K， may mediate the pathogenic process of gastric cancer by gut microbiota， providing new ideas for the diagnosis， treatment， and early prevention of gastric cancer.

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.

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.

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.

【内容简介】 胆管癌是一种常见的原发恶性肿瘤，进展迅速，病死率高，手术治疗仍是目前最有效的选择，然而许多进展期患者极易错过最佳时间而丧失手术机会，如何进一步提高患者的生存获益，指导临床的诊疗决策，值得深入研究。作者回顾了目前胆管癌在靶向和免疫治疗方面的最新研究成果，总结其临床诊治方面取得的进展，并提出在进展期胆系肿瘤中，靶向治疗加免疫治疗并联合局部治疗的立体综合治疗方案（免疫治疗3.0）可以有效提高客观缓解率（objective response rate，ORR）和降期转化率，给患者带来长期获益的观点。

Objective

To establish a simulated hypoxia model of venous smooth muscle cells（SMCs）， and to investigate the effect of hypoxia on the behaviorial characteristics of SMCs derived from the human normal great saphenous veins （GSVs）.

Methods

Fifteen tissue samples were collected from patients undergoing distal arterial bypass grafting surgery without GSVs injuries in the 80th Group Army Hospital of the People’s Liberation Army from May 2020 to May 2021.SMCs were isolated and cultured， then the cobalt chloride （CoCl₂） group and the control group were assigned.Using specific staining， proliferation，migration， adhesion， senescence and the structure of cytoskeletal filaments in SMCs were observed.mRNA and protein expression of Bax， Bcl-2， caspase-3， matrix metalloproteinases （MMP）-2， MMP-9， tissue inhibitor of metalloproteinases （TIMP）-1， and TIMP-2 were detected by fluorescent quantitative polymerase chain reaction and immunoblotting.

Results

The quantity of adhesion， migration， senescence， proliferation and mRNA and protein expression of Bcl-2， MMP-2， MMP-9， TIMP-1， and TIMP-2 in SMCs in the CoCl₂ group were significantly increased compared with the control group （t=5.994， 5.687， 13.898， 25.979，11.704， 20.705， 16.363， 12.228， 11.473， 9.618， 14.780， 14.691， 64.185， 14.915， all P＜0.05）.mRNA and protein expression of Bax and caspase-3 were significantly decreased （t=27.297， 15.430， 17.851， 17.801， all P＜0.05）.

Conclusion

Under hypoxic conditions， the phenotype and function of SMCs derived from the human NGSVs are dysregulated， suggesting that SMCs switch from the contractile phenotype to the secretory or synthetic phenotype， and more dedifferentiate， and apoptotic decrease through the intrinsic pathway.

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.