The "Expert consensus on diagnosis and treatment of acute biliary tract infection in the elderly (2025 edition)" was compiled and organized by the Hepatobiliary Pancreatic Surgery Committee of Chinese Aging Well Association. Acute biliary tract infections in the elderly are common among the acute abdominal diseases in the elderly, with atypical clinical manifestations, rapid progression and high fatality rate. The consensus puts forward targeted recommendations around multiple aspects such as the diagnosis, severity assessment, imaging examination, systemic assessment, rational application of antibiotics, intensive care treatment, nutritional support, surgical treatment and endoscopic treatment of acute biliary tract infections in the elderly. The consensus emphasizes that the diagnosis of elderly patients should be combined with comprehensive assessment of clinical manifestations, laboratory tests and imaging examinations, and that treatment should be individualized, and attach importance to multidisciplinary collaboration during the perioperative period. The consensus provides important references for the standardized diagnosis and treatment of acute biliary tract infections in the elderly.

Colorectal liver metastasis (CRLM) is a common and severe complication in patients with intestinal tumors, which significantly reduces the survival rate and the quality of life of patients. Traditional treatments mainly include systemic chemotherapy, interventional therapy and targeted drug therapy, whereas the overall prognosis is relatively poor. In recent years, with the advancement in liver transplantation and the launching of multi-center clinical research, liver transplantation has gradually become a potential therapeutic option for CRLM. However, the indications, contraindications and prognostic factors of liver transplantation for colorectal cancer should be further investigated to guarantee that patients can obtain the optimal efficacy. In this article, the biological mechanism of CRLM and the potential application of liver transplantation in the treatment of CRLM were illustrated, providing novel ideas and reference for clinical management of patients with colorectal cancer and promoting in-depth research and practice in this field.

Hepatocellular carcinoma (HCC) is the third most deadly malignancy worldwide, and its high incidence and mortality rates highlight the urgent need for treatment. Although surgical resection and liver transplantation provide the possibility of radical cure for HCC, most patients still face a high risk of recurrence due to low diagnostic rate during the early stage. The latest treatment strategies, especially the use of immune checkpoint inhibitors (ICIs), have paved a new way to improve clinical prognosis. However, the potential of neoadjuvant therapy in early treatment of HCC has not been fully unleashed. In this article, the role, challenges and future development direction of neoadjuvant therapy in the treatment of resectable HCC were illustrated, aiming to provide a more comprehensive and effective treatment for HCC patients. The existing evidence of neoadjuvant therapy was analyzed and its potential in reducing recurrence and prolonging survival was investigated to bring innovative ideas for the treatment of HCC.

The incidence of hepatocellular carcinoma (HCC) is high in China. The early diagnostic rate of bone metastasis from HCC is low, and clinical prognosis is poor. At present, no definite treatment consensus has been reached, which is one of the difficulties to be resolved for metastatic HCC. The pathogenesis of bone metastasis from HCC remains elusive, which is probably associated with exosomes, epithelial-mesenchymal transition (EMT) and bone microenvironment. Radiotherapy, local surgical resection and other treatments for metastatic lesions can prolong the survival time of patients. However, systematic treatment is still the main therapy for bone metastasis from HCC. Based on systematic treatments, individualized treatments for patients can improve the quality of life and prolong the survival time. In this article, clinical characteristics, mechanism of metastasis and treatment progress of bone metastasis from HCC were illustrated, aiming to provide evidence for clinical work.

Hepatectomy is the main treatment for benign and malignant liver diseases. At present, with persistent development of liver surgery and related disciplines, hepatectomy has become a routine procedure in most hepatobiliary and pancreatic disease centers. When surgery enters the era of laparoscopy, laparoscopic hepatectomy has gradually become the main surgical treatment for liver tumors. Accurate perioperative evaluation, intraoperative bleeding control and postoperative individualized management are the keys to successful operation. Among them, intraoperative bleeding control remain a more important topic for surgeons and anesthesiologists in liver surgery. Consequently, it is necessary to explore a more effective and safer technology to minimize intraoperative bleeding during hepatectomy. Currently, low central venous pressure (LCVP) can effectively minimize intraoperative bleeding, reduce the requirement for blood transfusion, and provide a clearer view of surgical field for surgeons, which has been widely applied in clinical practice. However, studies at home and abroad also show that the application of LCVP in hepatectomy remains controversial. Therefore, in this article, relevant principles, specific implementation patterns and the impact of LCVP on vital organs of patients after hepatectomy were reviewed, aiming to provide reference for clinicians to rationally apply LCVP in hepatectomy.

Photodynamic therapy (PDT) is a novel treatment in clinical practice, which has been widely employed to treat skin cancer, liver cancer and cholangiocarcinoma, etc. PDT can significantly enhance the quality of life of patients. It utilizes high absorption of photosensitizer by tumors to make the photosensitizer concentration in tumor cells higher than that of surrounding tissues. Under the irradiation of visible light, photo-redox reaction occurs, which induces the death of tumor cells. The incidence of cholangiocarcinoma is on the rise in China. Most cholangiocarcinoma patients have no symptoms at the early stage. As the disease progresses, patients suffer from unexplained fatigue, lack of appetite and weight loss, and bile duct obstruction and jaundice will occur at the advanced stage, which reduces the quality of life of patients. Surgery and other therapies yield low efficacy. PDT, as a novel treatment, has positive therapeutic value for cholangiocarcinoma. In this article, the prospect of PDT and its combination with alternative therapies was illustrated, aiming to provide theoretical basis for clinicians.

The management of common bile duct after common bile duct exploration and stone extraction remains controversial. At present, T-tube drainage and primary suture of common bile duct are commonly adopted. Primary suture of common bile duct has more advantages and is more in line with the concept of enhanced recovery after surgery, which deserves widespread clinical application. However, T-tube drainage is more commonly used in clinical practice because surgeon may still have concerns about primary suture of common bile duct. Understanding the indications, improving suturing techniques, selective placement of stenting tube in common bile duct and mastering the key of placement are effective guarantees for achieving primary suture of common bile duct with better safety and prognosis.

To evaluate clinical efficacy and safety of ICG fluorescence imaging in laparoscopic hepatectomy of hepatocellular carcinoma (HCC).

Clinical data of 47 patients who underwent laparoscopic hepatectomy of HCC in the Third Affiliated Hospital of Sun Yat-sen University from January 2023 to January 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 40 patients were male and 7 female, aged (57±11) years on average. All patients were divided into ICG group (n=21) and traditional group (n=26) according to whether ICG fluorescence imaging was used. Operation time and intraoperative blood loss between two groups were compared by rank-sum test. Tumor margin and the incidence of postoperative complications between two groups were compared by Chi-square test or Fisher’s exact test.

All HCC patients in two groups underwent laparoscopic hepatectomy without conversion to open surgery. In the ICG group, the tumor margin was ≥1 cm in 16 cases and 7 cases in the traditional group, and the difference was statistically significant (χ²=11.284, P<0.05). In the ICG group, the operation time, intraoperative blood loss and the length of postoperative hospital stay were 163 (140, 198) min, 50 (50, 100) ml and 4.0 (4.0, 5.5) d, respectively, compared with 170 (134, 226) min, 50 (28,100) ml and 5.5 (3.0,7.0) d in traditional group, and the differences were not statistically significant (Z=0.857, 0.801, -1.083; all P>0.05). In the ICG group, no postoperative bile leakage and 1 case of peritoneal effusion was observed, while 4 and 0 in the traditional group, and the difference was not statistically significant (both P>0.05).

Compared with traditional laparoscopic resection of HCC, ICG fluorescence imaging can assist surgeons to obtain more favorable tumor margin without prolonging operation time or increasing surgical risk.

To evaluate the efficacy of TACE-hepatic arterial infusion chemotherapy (HAIC) combined with lenvatinib and PD-1 inhibitor in the treatment of stage Ⅲa liver cancer.

Clinical data of 96 patients with stage Ⅲa liver cancer admitted to Cancer Hospital of Guangzhou Medical University from January 2020 to May 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 86 patients were male and 10 female, aged from 33 to 74 years, with a median age of 54 years. All patients were classified as CNLC stage Ⅲa. According to different treatment protocols, all patients were divided into the quadruple-treatment group (n=62) and triple-treatment group (n=34). In the quadruple-treatment group, patients were treated with TACE-HAIC combined with lenvatinib and PD-1 inhibitor, and those in the triple-treatment group were treated with TACE-HAIC combined with lenvatinib. Inter-group equilibrium was obtained by 1∶1 propensity score matching (PSM). Primary end points were overall survival (OS) and progression-free survival (PFS). The incidence of adverse reactions between two groups was compared by Chi-square test or Fisher’s exact test. Survival analysis was performed by Kaplan-Meier method and Log-rank test. The influencing factors of survival were identified by Cox proportional hazard regression model.

After PSM, the median OS in the quadruple-treatment group was 32.0 months (95%CI: 10.985-53.015), and 14.0 months in the triple-treatment group (95%CI: 6.548-21.452), and the difference was statistically significant (χ²=9.071, P=0.003). The median PFS in the quadruple-treatment group was 19.0 months (95%CI: 9.655-28.345), and 6.0 months in the triple-treatment group (95%CI: 3.197-8.803), and the difference was statistically significant (χ²=7.811, P=0.005). Cox’s regression analysis showed that treatment method (HR=0.318, 95%CI: 0.144-0.701; P=0.004) and frequency of TACE-HAIC (HR=0.415, 95%CI: 0.197-0.873; P=0.020) were the independent influencing factors of OS. Treatment method was an independent influencing factor of PFS (HR=0.439, 95%CI: 0.238-0.810; P=0.008). No toxicity-related death occurred in this study. No significant difference was found in the incidence of any grade and grade 3/4 adverse reactions (all P>0.05).

The quadruple therapy of TACE-HAIC combined with lenvatinib and PD-1 inhibitor can significantly improve the survival benefit of patients with stage Ⅲa liver cancer without sacrificing the incidence of adverse reactions.

To investigate the hot spots and trends of microvascular invasion (MVI) in predicting clinical prognosis of hepatocellular carcinoma (HCC) worldwide through bibliometric and visual analysis.

Studies related to MVI in predicting clinical prognosis of HCC were obtained from Web of Science core literature database from January 2014 to March 2024. Study types included article and review in English. Statistical and visual analyses of the published articles were performed from the aspects of year, author, institution, country, journal and keywords by using CiteSpace software.

From 2014 to 2024, 1 778 articles were published in the field of HCC-MVI research, showing an overall increasing trend year by year, with a citation frequency of 6 843. These articles were published from 49 countries. The five countries with the highest number of articles were China (1 156), the United States (176), South Korea (157), Japan (119) and Italy (85), mainly from Europe, Asia and North America. The most active country was China and the most active institution was Naval Medical University from China. The most active and cited authors were Lau WY and Bruix J. Chinese institutions conducted less international cooperation, while other countries carried out closer cooperation. The United States had the highest degree of centralization and closer cooperation with other countries. The clustering and timeline map of key nodes in the co-cited network showed that angiogenesis has been the hotspot with the longest duration of research since 2014. Prediction model was the latest keyword with the highest frequency in recent two years. The highlight map of keywords revealed that before 2021, studies mainly focused on biomarkers, liver transplantation and the selection of surgical resection. The recurrence and prognosis after hepatectomy were the hot spots after 2014. In 2015, HCC-related biomarkers and long-term survival rate became the hot spots. The number of predictor-related studies has been significantly increased. Recently, the interests in this field began to shift to radiomics study of HCC and related nomogram calculation. Radiomics and nomogram calculation were the prominent keywords in recent three years, which are currently the important research directions in HCC-MVI field.

CiteSpace-based visualization analysis shows that the research on MVI in predicting clinical prognosis of HCC after surgical resection has been ever advanced in recent decade. Vascular disease has drawn widespread attention. With the advancement of radiomics, the construction of radiomic models captivates extensive attention.

To evaluate the efficacy and safety of cinobufotalin in the treatment of postoperative pain in patients with primary liver cancer (PLC) undergoing hepatic arterial infusion chemotherapy (HAIC).

Clinical data of 161 PLC patients treated with HAIC in Sun Yat-sen University Cancer Center from September 2021 to January 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 152 patients were male and 9 female, aged from 27 to 74 years, with a median age of 54 years. All patients were divided into the cinobufotalin group (n=71) and control group (n=90) according to whether they received cinobufotalin treatment. The degree of pain was assessed by visual analogue scale (VAS). The incidence of moderate and severe pain and use of analgesic drugs between two groups were compared by Chi-square test. The effect of different factors on cinobufotalin in the treatment of moderate and severe pain was analyzed by forest plot. The changes of platelet (Plt) count and liver function indexes between two groups were compared by t-test or Mann-Whitney U test.

At 24-48 h after HAIC, the incidence of moderate and severe pain in the cinobufotalin group was 6% (4/71), significantly lower than 18% (16/90) in the control group (χ²=4.30, P=0.04). Within 24 h after HAIC, the incidence of moderate and severe pain in the cinobufotalin and control groups was 37% (26/71) and 36% (32/90), respectively, and the difference was not statistically significant (χ²=0.00, P>0.05). Forest plot subgroup analysis showed that the incidence of severe pain at 24-48 h after HAIC among male patients, aged 50 years, positive HBsAg, ALT>50 U/L, AST>40 U/L, TB>17.1 μmol/L, no use of iodized oil, lesion size>10 cm, no portal vein tumor thrombus and albumin-bilirubin (ALBI) in the cinobufotalin group was significantly lower than that in the control group (OR=0.88, 0.87, 0.88, 0.80, 0.84, 0.80, 0.80, 0.85, 0.90, 0.83; all P<0.05). After HAIC, no significant difference was observed in the use of analgesic drugs, the changes of Plt and liver function indexes and the incidence of adverse reactions between two groups (all P>0.05).

HAIC combined with cinobufotalin can reduce the incidence of moderate and severe pain, improve the quality of life and enhance the compliance with treatment in patients with PLC.

To assess clinical efficacy of platelet transfusion before liver and spleen resection in preventing intraoperative and postoperative bleeding for hepatocellular carcinoma (HCC) patients complicated with cirrhotic portal hypertension.

Clinical data of 118 HCC patients complicated with cirrhotic portal hypertension who underwent combined liver and spleen resection in Beijing Ditan Hospital affiliated to Capital Medical University from January 2010 to January 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 70 patients were male and 48 female, aged from 35 to 68 years, with a median age of 57 years. According to whether platelet transfusion was performed before surgery, all patients were divided into the platelet transfusion and non-platelet transfusion groups. According to preoperative platelet (Plt) count, the patients were divided into three stratified subgroups of Plt≤30×10⁹/L, 31-49×10⁹/L and ≥50×10⁹/L groups, respectively. The effect of platelet transfusion on intraoperative bleeding, postoperative abdominal drainage, hemoglobin loss, incidence of postoperative bleeding, length of hospital stay and other indexes was analyzed in different stratified subgroups, and its role in promoting postoperative platelet recovery was assessed. Two-group comparison was performed by t-test and Chi-square test.

Subgroup analysis showed that compared with non-platelet transfusion group, intraoperative blood loss, the total amount of abdominal drainage at postoperative 2 d and hemoglobin loss were significantly reduced and the length of hospital stay was significantly shortened (t=-3.596, -3.316, -4.000, 4.815; all P<0.05), and the incidence of postoperative bleeding was decreased in patients with Plt ≤30×10⁹/L (χ²=5.051, P<0.05). The differences were not statistically significant between the Plt 31-49×10⁹/L and ≥50×10⁹/L subgroups (both P<0.05). At postoperative 1 and 24 h, Plt in the platelet transfusion group was significantly higher than that in the non-platelet transfusion group (t=6.410, 8.583; both P<0.05), whereas no significant difference was noted in Plt at postoperative 48 h and 7 d between two groups (both P>0.05).

For HCC patients complicated with cirrhotic portal hypertension with preoperative Plt ≤30×10⁹/L, preoperative platelet transfusion can effectively stop bleeding. Routine platelet transfusion should be conducted before surgery. However, routine platelet transfusion is not recommended for patients with preoperative Plt >30×10⁹/L. Preoperative platelet transfusion exerts insignificant effect upon long-term Plt level.

To investigate the survival and prognosis of distal cholangiocarcinoma (DCCA) and its prognostic factors.

Clinicopathological data of 116 DCCA patients who underwent pancreaticoduodenectomy from January 2011 to December 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 71 patients were male and 45 female, aged from 31 to 82 years, with a median age of 65 years. The survival and prognosis were followed up. Survival analysis was performed by Kaplan-Meier method and Log-rank test. The influencing factors of survival and prognosis were analyzed by multivariate Cox’s regression analysis.

The 1-, 3- and 5-year overall survival rates of patients with DCCA after operation were 75.2%, 41.9% and 31.5%, respectively. Multivariate Cox’s regression analysis showed that the expression level of epidermal growth factor receptor (EGFR) (RR=1.600, 95%CI: 1.086-2.357), metastatic lymph node ratio (MLNR) (RR=2.899, 95%CI: 1.365-6.158) and degree of tumor differentiation (RR=2.009, 95%CI: 1.245-3.243) were the independent risk factors for long-term survival of DCCA patients after operation. The 1-,3- and 5-year survival rates of patients with MLNR=0 were 83.0%, 50.7% and 42.5%, and 80.5%, 37.4% and 37.4% for those with 0<MLNR≤0.17, and 48.2%, 0 and 0 for those with MLNR>0.17, respectively. The higher the MLNR, the worse the prognosis (χ²=26.834, P=0.006). The 1-, 3- and 5-year survival rates of EGFR-negative patients were 80.3%, 50.3% and 41.2%, and 81.3%, 16.2% and 16.2% for those with weak expression of positive EGFR, and 27.8%, 0 and 0 for those with moderate and high expression of positive EGFR, respectively. The higher the EGFR expression, the worse the overall survival (χ²=20.848, P=0.017). The 1-, 3- and 5-year survival rates of highly-differentiated DCCA patients were 92.9%, 68.8% and 68.8%, and 83.8%, 40.3% and 32.3% for those with moderately-differentiated DCCA, and 50.8%, 19.8% and 19.8% for those with poorly-differentiated DCCA, respectively. The lower the degree of tumor differentiation, the worse the prognosis (χ²=32.493, P=0.004).

Pancreaticoduodenectomy remains the optimal treatment for patients with DCCA. The expression levels of MLNR, EGFR and the degree of tumor differentiation are the independent risk factors of postoperative survival of DCCA patients. The higher the MLNR, the worse the prognosis. The higher the EGFR expression level, the worse the prognosis. The lower the degree of tumor differentiation, the worse the prognosis.

To evaluate the safety and efficacy of laparoscopic common bile duct exploration (LCBDE) combined with choledochoscopy and antegrade indwelling of nasobiliary catheter with duodenoscopy, and primary suture of common bile duct.

200 patients with common bile duct stones admitted to the Third Affiliated Hospital of Naval Medical University and Xuancheng People’s Hospital from January 2020 to January 2022 were enrolled in this study. Among them, 73 patients were male and 127 female, aged from 17 to 93 years, with a median age of 64 years. All patients were randomly divided into triple-endoscopy (n=100) and double-endoscopy groups (n=100). In the triple-endoscopy group, LCBDE combined with choledochoscopy and antegrade indwelling nasobiliary catheter with duodenoscope, and primary suture of common bile duct was adopted. In the double-endoscopy group, LCBDE with choledochoscopic lithotomy and primary suture of common bile duct was employed. The operation time and intraoperative blood loss between two groups were compared by t test and rank-sum test. The incidence of complications between two groups was compared by Chi-square test. The safety and efficacy of triple-endoscopy combined surgery were evaluated.

No significant differences were observed in intraoperative blood loss, conversion rate to open surgery, removal time of postoperative abdominal drainage tube and the length of postoperative hospital stay between two groups (all P>0.05). The operation time in the triple-endoscopy group was (92±18) min, significantly longer than (79±17) min in the double-endoscopy group (t=5.339, P<0.001). The incidence of postoperative bile leakage in the triple-endoscopy group was 1%(1/100), significantly lower than 7%(7/100) in the double-endoscopy group (χ²=4.688, P=0.030). All patients with bile leakage were recovered at 1-2 weeks after drainage. No intraoperative pancreatitis was observed in two groups. In the triple-endoscopy group, 1 patient developed recurrence of common bile duct stones and 1 case of common bile duct stenosis, and 3 and 1 in the double-endoscopy group, with no statistical significance between two groups (χ²=1.192, P=0.275).

LCBDE combined with choledochoscopy lithotomy and antegrade indwelling nasobiliary catheter and primary suture of common bile duct can accelerate postoperative rehabilitation, shorten the length of postoperative hospital stay and reduce the incidence of bile leakage.

To investigate the efficacy of endoscopic photodynamic therapy (PDT) combined with biliary stenting in the treatment of unresectable cholangiocarcinoma.

Clinical data of 21 patients with unresectable cholangiocarcinoma admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2019 to December 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 12 patients were male and 9 female, aged from 53 to 87 years, with a median age of 74 years. Four cases were diagnosed with Bismuth type Ⅰ-Ⅱ hilar cholangiocarcinoma and 17 cases of the middle and lower common bile duct carcinoma. According to different treatments, all patients were divided into PDT + stenting group (n=7) and single stenting group (n=14). The operation time, total length of hospital stay and stent patency time between two groups were compared by rank-sum test. The incidence of postoperative complications was compared by Fisher’s exact test. Survival test was conducted by Kaplan-Meier method and Log-rank test.

The operation time, total length of hospital stay and stent patency time in PDT + stenting group were 98 (64,120) min, 15 (10,17) d and 8 (4,10) months, significantly longer than 30 (23,49) min, 6 (5,8) d and 4 (3,6) months in the single stenting group (Z=3.331, 3.122, 2.298; all P<0.05). The total hospitalization expense in the PDT + stenting group was (6.3±0.9) ×10⁴ Yuan, significantly higher than (3.5±0.8) ×10⁴ Yuan in the single stenting group (t=7.796, P<0.001). In the PDT + stenting group, 2 cases were diagnosed with postoperative abdominal pain, 1 case of acute pancreatitis, 2 cases of biliary tract infection and 1 case of photosensitive reaction. In the single stenting group, 3 cases experienced postoperative abdominal pain, 4 cases of acute pancreatitis and 2 cases of biliary tract infection. The difference in the incidence of postoperative complications was not statistically significant between two groups (P>0.999). In the PDT + stenting and single stenting groups, the median survival time was 10.1 and 5.2 months. The overall survival in the PDT + stenting group was significantly better than that in the single stenting group (χ²=10.95, P<0.001).

Compared with single stenting, PDT combined with biliary stenting can significantly prolong stent patency time and postoperative survival time without increasing the incidence of postoperative complications in patients with unresectable cholangiocarcinoma.

To explore the potential causal relationship between Crohn’s disease (CD) and nonalcoholic fatty liver disease (NAFLD) based on two-sample Mendelian randomization (MR) method.

The datasets of CD and NAFLD were obtained from IEU Open GWAS database. The causality between CD and NAFLD was analyzed by using five methods: inverse variance weighted (IVW) method, MR-Egger regression, weighted median estimator (WME), simple mode and weighted mode. The stability and reliability of the research results were evaluated by Cochran’s Q test, MR-Egger regression, MR-PRESSO, Leave-one-out, funnel diagram and forest plot.

The causal effects obtained by these five methods were in the same direction. IVW analysis showed that there was causal relationship between CD and NAFLD (OR=1.034, 95%CI: 1.007-1.061, P=0.013). Heterogeneity analysis revealed no significant heterogeneity between IVW test (Q=29.041, P=0.969) and MR-Egger test (Q=29.021, P=0.960). No outlier single nucleotide polymorphisms (SNPs) were detected by MR-PRESSO analysis, and horizontal pleiotropy was excluded (P=0.888). MR-Egger regression analysis (P=0.209) also detected no evidence of horizontal pleiotropy. Leave-one-out analysis showed that no single SNPs significantly affected the overall effect.

From the perspective of heredity, this study preliminarily reveals that CD may have causal relationship with the increase of NAFLD risk. Positive correlation between CD and NAFLD is a risk factor for increasing the risk of NAFLD.

To analyze the relationship between the expression level of hyaluronan and proteoglycan link protein 1 (HAPLN1) and the prognosis of hepatocellular carcinoma (HCC) patients, and to investigate its correlation with immune cell infiltration of HCC.

Based on the TCGA database, the expression of HAPLN1 in HCC and its relationship with clinicopathological features and prognosis were analyzed. The risk factors of prognosis of HCC were screened by univariate and multivariate Cox’s regression analyses. The nomogram model was constructed to quantitatively analyze the survival and prognosis. ROC curve was delineated to evaluate the predictive value of HAPLN1 for clinical prognosis of HCC patients. The pathway and cell function of differentially-expressed genes between the high and low HAPLN1 expression groups were subject to Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses using Cluster Profile software package for HAPLN1-related pathways were visualized by using Gene Set Enrichment Analysis (GSEA). The correlation between HAPLN1 and 24 types of immune cells in HCC was analyzed by CIBERSORT core algorithm. The enrichment of 24 types of immune cells in HCC in high and low HAPLN1 expression groups was assessed by ssGSEA algorithm. The correlation between immune checkpoints and HAPLN1 in HCC was further investigated.

TCGA database analysis showed that the expression level of HAPLN1 was up-regulated in HCC tissues, significantly higher than that in matched normal liver tissues (P=0.002). HCC patients with high expression of HAPLN1 had shorter overall survival (HR=1.560, 95%CI: 1.100-2.218, P=0.013). HAPLN1 expression was significantly correlated with T stage, vascular invasion and pathological stage (χ²=9.149, 9.518, 6.614; all P<0.05). Multivariate Cox’s regression analysis showed that T stage (HR=2.622, 95%CI: 1.692-4.062; P<0.05) and HAPLN1 expression (HR=1.622, 95%CI: 1.072~2.585; P=0.023) were the independent risk factors for clinical prognosis of HCC patients. Prognostic nomogram analysis revealed that HAPLN1 had high predictive value for clinical prognosis of HCC (AUC=0.737, 95%CI: 0.685-0.788). GO and KEGG enrichment analyses showed that the differentially-expressed genes of HAPLN1 were mainly enriched in the functional pathways such as apical plasma membrane, signal receptor activation and signal ligand activity and bile secretion, etc. Immune cell correlation analysis showed that HAPLN1 was closely associated with multiple immune cells in HCC, and was positively correlated with immune checkpoints.

HCC patients with high expression of HAPLN1 have poor prognosis. The nomogram model based on the expression of HAPLN1 combined with pathological TNM staging provides effective reference for predicting clinical prognosis of HCC patients. HAPLN1 may promote the progression of HCC through regulating tumor immune microenvironment.

To investigate the expression level of ring finger protein, transmembrane 2 (RNFT2) in hepatocellular carcinoma (HCC) and its effect on cell proliferation, invasion and prognosis.

The expression levels of RNFT2 in HCC, normal liver and HCC tissues with different tumor stages and pathological grades were obtained by using UALCAN. R2 genomics analysis and visualization platform were used to analyze the difference of RNFT2 expression level between HCC and normal liver tissues. The correlation between the expression of RNFT2 and survival of HCC patients was analyzed by gene expression profile (GepLiver) in liver cells and tissues. Clinical samples were collected from 24 pairs of HCC and adjacent tissues of HCC patients undergoing surgical resection at the First Affiliated Hospital of Xi’an Jiaotong University from January to December 2021. Among them, 19 patients were male and 5 female, aged from 42 to 71 years, with a median age of 52 years. The expression levels of RNFT2 protein in the HCC and adjacent tissues, and normal liver cells and HCC cells were detected by Western blot. The expression levels of RNFT2 in HCCLM3 and Huh7 cells were down-regulated using small interfering RNA (siRNA). The effect of RNFT2 knockdown on the proliferation, migration and invasion of HCC cells was analyzed by EdU-based assay and Transwell chamber test. One-way ANOVA, LSD-t test and t-test were used to analyze the differences among different groups. Survival analysis was performed by Kaplan-Meier method and Log-rank test.

The transcriptome sequencing data of HCC and normal liver tissues in TCGA and GEO databases were analyzed by UALCAN and R2 platforms. The results showed that the expression level of RNFT2 mRNA in HCC tissues was significantly higher than that in normal liver tissues (t=19.343, 7.133, 6.934; all P<0.001). Western blot of 24 pairs of HCC and matched adjacent tissues showed that the relative expression of RNFT2 protein in HCC was 2.1 (1.1, 3.3), significantly higher than 1.1 in adjacent tissues (0.5, 1.7) (Z=-2.536; P<0.05). Analysis of TCGA database by UALCAN platform found that RNFT2 mRNA was associated with tumor staging and pathological grading (F=5.082,8.008; both P<0.05). The expression of RNFT2 mRNA in stage Ⅱ and Ⅲ HCC tissues was significantly higher than that in stage Ⅰ HCC tissues (LSD-t=0.161, 0.162; both P<0.05), and the expression of RNFT2 mRNA in high pathological grade (grade Ⅲ and grade Ⅳ) was significantly higher than that in low pathological grade (grade Ⅰ and grade Ⅱ) (LSD-t=0.196, 0.142, 0.384, 0.360; all P<0.05). GepLiver platform analysis of the survival data of HCC patients in TCGA database showed that high expression of RNFT2 mRNA prompted that the overall survival, disease-specific survival, disease-free survival and progression-free survival of HCC patients were significantly shortened (HR=1.86, 1.73, 1.60, 1.82; all P<0.05). The expression of RNFT2 in HCC cell line was significantly higher than that in normal liver cells (P<0.05). RNFT2 knockdown significantly weakened the proliferation, migration and invasion of HCCLM3 and Huh7 cells (all P<0.05).

The expression level of RNFT2 is up-regulated in HCC tissues, which is associated with poor prognosis of HCC patients. RNFT2 knockdown significantly inhibits the proliferation, migration and invasion of HCC cells.

Liver cancer is a common malignant tumor. Hepatectomy is the optimal treatment of liver cancer. Patients with liver cancer develop varying degrees of liver function impairment before surgery, leading to abnormal substance metabolism. After hepatectomy, patients experience severe surgical trauma and intense stress response, and often suffer from malnutrition. Perioperative malnutrition in patients with liver cancer will suppress the body’s repair ability, affect clinical prognosis and reduce the quality of life of patients. Therefore, it is of significance to provide perioperative nutritional support for patients with liver cancer. Enteral nutrition support, as a vital pattern of nutrition support, has gradually captivated attention in the perioperative application of liver cancer. In this article, the latest research progress in perioperative nutritional risk screening, the opportunity of enteral nutritional support, the patterns and preparations of enteral nutritional support were reviewed, aiming to provide theoretical basis for nutritional intervention in patients with liver cancer.

Although the incidence of subcutaneous emphysema in laparoscopic surgery is low, severe subcutaneous emphysema can lead to extensive subcutaneous tissue infection, abdominal wall cellulitis and carbon dioxide embolism, which can prolong the length of hospital stay, affect clinical prognosis and even threaten patients’ lives. The risk factors of subcutaneous emphysema in laparoscopic surgery include patients aged>65 years, BMI<25 kg/m², excessively long distance between the puncture site of Trocar and surgical site, excessively large angle between the direction of puncture and that of surgical site, repeated displacement of Trocar, number of surgical incision>4, operation time>6 h, high gas flow rate and intra-abdominal pressure, and robot-assisted surgery, etc. Surgeons should identify high-risk populations, perform each surgery cautiously, summarize surgical experience and improve clinical prognosis of patients. In this article, the risk factors of subcutaneous emphysema in laparoscopic surgery were reviewed, aiming to prevent the incidence of subcutaneous emphysema and reduce the risk of surgery.

Postoperative gastrointestinal dysfunction is a common complication after hepatectomy for liver cancer. It can delay oral feeding, impair nutrient absorption, prolong the length of hospital stay and increase medical expenses, and even induce postoperative intestinal obstruction, which exerts significant impact on postoperative rehabilitation and quality of life of patients. In this article, current status, mechanism, evaluation, prevention and treatment of gastrointestinal dysfunction after hepatectomy for liver cancer were reviewed, aiming to provide reference for improving gastrointestinal function and enhancing clinical prognosis of patients after hepatectomy.

The imbalance of gut microbiota is closely correlated with the incidence, development and prognosis of hepatobiliary and pancreatic diseases, which can cause the imbalance of gut microbiota. These two events affect and interact with each other. Fecal microbiota transplantation (FMT) is a promising method to reconstruct gut microbiota and improve prognosis of hepatobiliary and pancreatic diseases. In recent years, FMT has received widespread attention in multiple clinical trials, and has been gradually applied in clinical research of hepatobiliary and pancreatic diseases. In this article, the relationship between gut microbiota and hepatobiliary and pancreatic diseases was illustrated, and research progress in the application of FMT in hepatobiliary and pancreatic diseases was summarized.