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Objectives Methods Results Conclusions Pancreatic serous cystic neoplasm (SCN) is a benign cystic neoplasm that is likely to be surgically resected due to preoperative misdiagnosis or tentative diagnosis even using endoscopic ultrasonography (EUS). We aimed to analyze EUS findings of SCN associated with misdiagnosis.Between January 2012 and September 2023, histologically confirmed pancreatic SCN were included and EUS features were reviewed.Overall, 294 patients with 300 surgically resected SCNs were included. The median age of the patients was 51 years and 75.9% were females. The lesions were predominantly located in the body/neck/tail of the pancreas (63.0%). The overall preoperative diagnostic rate of SCN was 36.3%, with the most common misdiagnosis being intraductal papillary mucinous neoplasm (IPMN) (31.3%), while 16.3% remained undefined. The preoperative diagnostic rate of SCN varied across different endosonographic morphologies, with oligocystic, macrocystic, microcystic, and solid patterns yielding rates of 12.8%, 37.9%, 76.5%, and 19.2%, respectively. Notably, the presence of central scar and vascularity improved the diagnostic accuracy and correctly identified 41.4% and 52.3% of the lesions. While mucus or pancreatic duct (PD) communication significantly increased the likelihood of misdiagnosis, particularly as IPMN. Multivariate analysis revealed a morphological pattern, mucin‐producing signs, wall thickening, vascularity, and PD communication were independent factors related to preoperative misdiagnosis, with an overall accuracy of 82.3%.Preoperative diagnosis of SCN remains challenging. The microcystic pattern emerged as a reliable feature, while mucin‐producing signs, including mural nodules, mucus, and PD communication, pose diagnostic pitfalls despite the presence of typical central scar or vascularity commonly in SCN. [ABSTRACT FROM AUTHOR]

Aim: To assess the efficacy and safety of intracorporeal esophagojejunostomy in patients undergoing laparoscopic total gastrectomy (LTG) for gastric cancer., Methods: A retrospective review of 81 consecutive patients who underwent LTG with the same surgical team between November 2007 and July 2014 was performed. Four types of intracorporeal esophagojejunostomy using staplers or hand-sewn suturing were performed after LTG. Data on clinicopatholgoical characteristics, occurrence of complications, postoperative recovery, anastomotic time, and operation time among the surgical groups were obtained through medical records., Results: The average operation time was 288.7 min, the average anastomotic time was 54.3 min, and the average estimated blood loss was 82.7 mL. There were no cases of conversion to open surgery. The first flatus was observed around 3.7 d, while the liquid diet was started, on average, from 4.9 d. The average postoperative hospital stay was 10.1 d. Postoperative complications occurred in 14 patients, nearly 17.3%. However, there were no cases of postoperative death., Conclusion: LTG performed with intracorporeal esophagojejunostomy using laparoscopic staplers or hand-sewn suturing is feasible and safe. The surgical results were acceptable from the perspective of minimal invasiveness.

Objective: To investigate the role of indoleamine 2,3-dioxygenase (IDO) in immune tolerance in patients with chronic hepatitis B (CHB)., Methods: Peripheral venous blood samples were collected from 50 CHB patients, and HBV viral load, T lymphocyte subsets and of IDO mRNA, protein and activity were detected with the blood samples from 50 healthy donors as the control. The correlations between HBV viral load, T lymphocyte subsets and IDO were statistically analyzed., Results: In CHB patients, the mRNA and protein levels and activity of IDO were all significantly higher than those in control group [mRNA: (2.110-/+0.615)x10(3) vs (0.143-/+0.026)x10(3); protein: 0.22-/+0.06 vs 0.02-/+0.0017; activity: 26.07-/+8.12 vs 4.98-/+1.65; P<0.05]. IDO mRNA level was positively correlated to HBV viral load (r=0.502, P<0.001) and ALT (r=0.65, P<0.01), and IDO mRNA, protein and activity were inversely correlated to CD4+ T cells (r=-0.622, -0.682, and -0.549, respectively, P<0.05), CD8+ T cells (r=-0.487, -367, and -294, respectively, P<0.05) and the ratio of CD4/CD8 (r=-0.426, -0.533, and -0.397, respectively, P<0.05)., Conclusion: IDO is closely correlated to HBV viral load and responsible for immunotolerance against HBV. Suppression of IDO can be a new therapeutic approach to reverse immunotolerance in CHB.