Severe acute pancreatitis (SAP) is a critical condition characterized by an imbalance between systemic inflammatory response syndrome (SIRS) and compensatory anti‐inflammatory response syndrome (CARS). Disruptions in intestinal microbiota exacerbate this imbalance; however, the mechanisms by which commensal bacteria regulate SAP‐induced SIRS and/or CARS remain unclear. This study reports that the abundance of the gut commensal Akkermansia is significantly reduced in fecal samples from patients with acute pancreatitis (AP) and is inversely associated with the severity of systemic inflammatory responses. Using Foxp3‐DTR and IL‐10‐KO mice, it is found that Akkermansia muciniphila and its derived protein Amuc_1409 can suppress SAP‐induced pancreatic and systemic inflammation by increasing peripheral regulatory T cells (Tregs) and enhancing the IL‐10 expression. Mechanistically, Amuc_1409 interacts with Ube2k to reduce the ubiquitination degradation of Foxp3, and it promotes the differentiation of Tregs and the production of IL‐10, effectively alleviating inflammation induced by SAP. These findings highlight A. muciniphila and its derivative Amuc_1409 as promising probiotic and biomolecule for managing acute pancreatitis and potentially other inflammatory conditions.

Severe acute pancreatitis (SAP) is a life-threatening condition characterized by excessive reactive oxygen species (ROS) production and impaired mitochondrial function, resulting from disrupted autophagic flux. Current clinical treatment for SAP fails to address the condition comprehensively, with the treatment targeting only a single pathogenesis. Herein, we report an innovative acid-responsive biomimetic nanozyme. This system features a hollow Prussian blue (PB) core, serving as an ROS scavenger encapsulated within a porous ZIF-8 shell, enabling the efficient delivery of celastrol that activates autophagic flux. Encased in a macrophage membrane, this system selectively targets inflamed pancreatic tissues and is readily internalized by pancreatic acinar cells. This dual-scavenging mechanism effectively attenuates inflammatory cytokine levels and restores mitochondrial homeostasis in three distinct SAP mouse models. Overall, this study presents a promising synergistic strategy for the dual scavenging of damaged mitochondria and ROS, offering a novel therapeutic approach to the treatment of SAP.

Purpose: Postoperative pain management for patients undergoing hepatic resection is still a challenge due to the risk of perioperative liver dysfunction. The transversus abdominis plane (TAP) block is a promising regional analgesic technique. However, the correct guidelines regarding the dose and regimen of local anesthetics in patients undergoing hepatic resection have yet to be established completely. This study aimed to evaluate the safety and efficacy of ultrasound-guided BD-TAP block with a large dose of ropivacaine in laparoscopic hepatectomy. Patients and Methods: This prospective, blinded, randomized, controlled study was conducted with 50 patients who were scheduled for selective laparoscopic hepatectomy. Patients who received a BD-TAP block (3 mg/kg of ropivacaine diluted to 60 mL) with general anesthesia were categorized into the BD-TAP block group (n = 25), and those who received general anesthesia were categorized into the control group (n = 25). The primary outcomes were consumption of sufentanil within 48 hours post-operation and plasma ropivacaine concentration. The secondary outcomes were the severity of pain (at rest and upon coughing), nausea and/or vomiting, and quality of recovery. Results: Compared with the control group, the patients in BD-TAP block group had a significant reduction of postoperative sufentanil consumption at 2 hours (P = 0.019), 24 hours (P = 0.001), and 48 hours (P = 0.001), and the visual analog scale (VAS) scores on coughing were significantly lower at postoperative 2 hours (P = 0.004). There were no statistically significant differences in postoperative nausea and/or vomiting, flatus, catheter removal, off-bed activity, liver function, or postoperative hospital stay. The mean peak total ropivacaine concentration was 1,067.85 ng/mL, which occurred 1 hour after administering the block, and mean free ropivacaine concentration was 52.32 ng/mL. The highest individual peak plasma concentration was 2,360.90 ng/mL at 45 min postinjection, and the free ropivacaine concentration was 139.29 ng/mL. Conclusion: Ultrasound-guided BD-TAP block provides effective postoperative analgesia after laparoscopic hepatectomy. This study also confirms that ultrasound-guided BD-TAP blocks with 3 mg/kg ropivacaine during laparoscopic hepatectomy almost never results in the plasma ropivacaine concentrations associated with neurotoxicity.

Background: It was generally accepted that obesity could increase the morbidity and mortality of surgical patients. However, the influence of body mass index (BMI) on short-term and long-term surgical outcomes of laparoscopic hepatectomy (LH) for patients with liver carcinoma remains unclear. The aim of this study was to evaluate the influence of BMI on surgical outcomes. Methods: From August 2003 to April 2016, 201 patients with liver carcinoma who underwent LH were enrolled in our study. Based on their BMI in line with the WHO’s definition of obesity for the Asia-Pacific region, patients were divided into three groups: underweight (BMI< 18.5 kg/m²), normal weight (18.5≤BMI< 23 kg/m²), and overweight (BMI≥ 23 kg/m²). Demographics and surgical outcomes of laparoscopic hepatectomy were compared in different BMI stratification. We investigated overall survival and relapse-free survival across the BMI categories. Results: Of the 201 patients, 23 (11.44%) were underweight, 96 (47.76%) were normal weight, and 82 (40.80%) were overweight. The overall complication rate in the underweight group was much higher than that in the normal weight and overweight groups (p=0.048). Postoperative complications, underweight patients developed grade III or higher Clavien-Dindo classifications (p=0.042). Among the three BMI groups, there were no significant differences in overall and relapse-free survival with Kaplan-Meier analysis (p=0.104 and p=0.190, respectively). On the other hand, gender, age, liver cirrhosis, bile leak, ascites, and Clavien classification (III-IV) were not independent risk factors for overall and relapse-free survival in multivariable Cox proportional hazards models. Conclusions: BMI status does not affect patients with liver carcinoma long-term surgical outcomes concerned to overall survival and relapse-free survival after laparoscopic hepatectomy. However, being underweight was associated with an increased perioperative complication rate, and perioperative careful monitoring might be required after hepatectomy for underweight with liver carcinoma.

Objectives: This study aimed to investigate the effectiveness of transcutaneous auricular vagal nerve stimulation (taVNS) in alleviating postoperative pain following thoracoscopic lobectomy. Methods: In this randomized controlled trial, 70 adult patients were randomly assigned in a 1:1 ratio to receive either active or sham taVNS. Stimulation was initiated in the preoperative room, maintained throughout surgery, and discontinued after extubation in the post-anesthesia care unit, at which point the device was removed. Additional 2-hour sessions were conducted each morning on postoperative days 1 and 2. Patient-controlled intravenous analgesia and serratus anterior plane block were provided to all the patients. The primary outcome was sufentanil consumption during the first 24 hours after surgery. Results: A total of 67 participants completed the study. Sufentanil consumption showed no statistically significant difference between the active group (33 ± 13 μg) and the sham group (32 ± 9 μg) (mean difference=1.20, 95% confidence interval=−4.23 to 6.63, P-value=0.661). Compared to the sham group, taVNS produced a statistically significant reduction in the numerical rating scale for resting pain (P-value=0.001) and deep breathing pain (P-value<0.001) postoperatively. taVNS also significantly reduced the incidence of rebound pain (58% vs. 18%; P-value=0.001) and chronic postsurgical pain at three months (27% vs. 6%; P-value=0.018). Discussion: taVNS did not reduce postoperative opioid consumption but alleviated acute postoperative pain, lowered the incidence of rebound pain and chronic postsurgical pain. These preliminary findings have uncertain clinical significance and require further investigation. Clinical Trial Registration: Chinese Clinical Trial Registry (ChiCTR2400081062).

The tremendous development of laparoscopic hepatectomy helps to relieve the difficulties encountered during open hepatectomy. Therefore, a difficulty scoring system was produced to assess the difficulty grade of laparoscopic hepatectomy. The aim of this study was to explore whether the IWATE-DSS is comparable to the long-term outcomes of LH for hepatocellular carcinoma. Clinical data from all consecutive patients who underwent laparoscopic hepatectomy for hepatocellular carcinoma at the Sir Run Run Shaw Hospital, Hangzhou, were prospectively collected and reviewed. The difficulty level of the operations was graded using the IWATE-DSS. The perioperative and postoperative outcomes of laparoscopic hepatectomy were compared at each difficulty level. A total of 300 patients underwent laparoscopic hepatectomy for HCC during the study period. The perioperative and postoperative outcomes were significantly different between the groups according to the IWATE-DSS. There were significant differences in both the intraoperative (bleeding control p = 0.000; surgical time p = 0.000; estimated blood loss p = 0.033) and postoperative variables (postoperative hospital stay p = 0.005) among these four groups. The 5-year disease-free survival decreased significantly along with the LH difficulty score (p = 0.000). The 5-year overall survival also decreased significantly along with the LH difficulty score (p = 0.000). IWATE-DSS was significantly correlated with short- and long-term outcomes in patients who underwent laparoscopic hepatectomy for HCC.