Surgical records are the core components of medical documents in clinical centers of surgery. Standardization of surgical records contributes to standardizing surgical procedures, improving the quality of surgery, and ensuring patient safety. To ensure that surgical records more objectively, visually, and comprehensively reflect the actual surgical process, numerous high-level university hospitals' surgical centers have long adhered to the good tradition of documenting surgical records in a “combination of text and images” format. Graphic surgical records not only benefit postoperative review and structured data collection but also facilitate the implementation of high-quality clinical research and surgical training. As early as 2015, Group of Operative Surgery, Chinese Society of Surgery, Chinese Medical Association already formulated the “Expert Consensus on Advocating the use of graphic surgical records”. In recent years, rapid development of information technology has provided technical support for the further promotion of graphical surgical records. After extensive and multiple rounds of professional discussions and investigations, and based on a thorough consideration of relevant national policy requirements, information standards, the 2025 edition of the “Expert Consensus” is intended to be revised, aiming to enhance the standardization of graphical surgical records, improve the quality of surgery and training system, as well as clinical researches, thereby contributing to the development of Healthy China.

Approximately 50% of colorectal cancer patients will develop liver metastases. Synchronous colorectal liver metastasis (CRLM) refers to liver metastasis identified before or upon the diagnosis of colorectal cancer. At present, surgical resection remains the only potential cure for patients with synchronous CRLM. With the advancement of medical technology, surgical strategies for primary and metastatic lesions include staged resection and simultaneous resection. The selection of surgical resection sequence for primary and metastatic lesions in staged resection and the selection of surgical opportunity in simultaneous resection are still controversial. Multiple surgical methods are employed to treat liver metastases. To improve the R0 resection rate of CRLM patients, parenchyma-preserving hepatectomy, two-step hepatectomy and liver transplantation are commonly adopted. Meantime, surgery combined with local treatments such as radiofrequency ablation, microwave ablation and stereotactic radiotherapy can also achieve the therapeutic goal of no evidence of disease. In this article, research progress at home and abroad was reviewed to investigate the optimal surgical strategy for CRLM.

At present, multiple problems exist in clinical education of hepatobiliary surgery, such as traditional education mode and poor clinical operational capability of students, etc. Constructing standardized education models for hepatobiliary surgery has become the demand of educational reform and development. Considering high incidence of hepatobiliary diseases and frequent cases in clinical practice, mastering relevant knowledge plays a critical role in improving clinical treatment ability of medical students. However, traditional education mode is too theoretical to enable students to master practical skills. Besides, surgical treatment of hepatobiliary diseases is complicated and demanding, it is necessary to adopt a novel education mode different from traditional education method. Application of artificial intelligence (AI) can more efficiently integrate education resources. AI-aided design of problem-driven education method can cultivate students' clinical thinking. AI technology can be utilized to create a more simulated virtual imaging system and other tools to improve students' diagnostic capability of hepatobiliary diseases. In addition, it is necessary to strengthen surgical training and enable students to master operating norms in a safe environment using AI, virtual simulation and other technologies. Taken together, AI technology can realize intelligent case identification, virtual simulation training, and enhance education quality.

Fluorescence-guided laparoscopic resection of the right anterior lobe using negative staining is an emerging surgical approach, which has been proven to be safe and efficacious in radical resection of liver cancer. In recent years, laparoscopic hepatectomy has developed rapidly. As a novel method, fluorescence-guided laparoscopic hepatectomy using negative staining improves surgical precision and safety through fluorescent labeling. The combination of these two methods has significant advantages in tumor resection of the right anterior lobe, avoiding the traction and compression of tumors by conventional surgery, preventing hematogenous metastasis caused by rupture and bleeding and conforming to minimally invasive principle. However, it is challenging to control the bleeding in the process of liver splitting during laparoscopic resection of the right anterior lobe. In addition, due to limited laparoscopic visual field, it is inclined to missing the direction during liver splitting. In this article, the advantages and limitations of fluorescence-guided laparoscopic resection of the right anterior lobe using negative staining were illustrated, aiming to provide reference for clinical surgery.

Severe acute pancreatitis (SAP) is one of the most dangerous abdominal emergencies in digestive system diseases, characterized by rapid onset, serious complications and high mortality rate. SAP constantly leads to peripancreatic/pancreatic necrosis, severe systemic inflammatory response and multiple organ failure, among which gastrointestinal failure and intestinal flora disorder are the key links during the aggravation of acute pancreatitis (AP). With the increasing incidence of SAP year by year, it becomes urgent to identify more effective treatment for early-stage SAP. Intestinal cleansing is an effective treatment for SAP. The main mechanisms include reducing the levels of intestinal inflammatory cytokines, decreasing gut pathogenic microorganisms, limiting the displacement of intestinal flora, increasing the abundance of probiotics to maintain flora balance, protecting the integrity of intestinal barrier function, and further lowering the occurrence of complications such as systemic inflammatory response syndrome, thereby preventing the incidence and progression of SAP and improving clinical prognosis. In this article, research progress in intestinal cleansing for improving intestinal function and treating SAP was illustrated.

To evaluate the safety and clinical efficacy of liver transplantation for children with inherited metabolic liver disease.

Clinical data of 44 children with inherited metabolic liver disease who underwent liver transplantation in the Third Affiliated Hospital of Sun Yat-sen University from January 2014 to July 2024 were retrospectively analyzed. Among them, 25 patients were male and 19 female, aged from 6 to 191 months, with a median age of 69 months. Preoperative pediatric end-stage liver disease (PELD) score, Z scores of weight and height, allograft characteristics, postoperative complications and survival and prognosis of liver donors were observed, and compared analysis was conducted with patients undergoing liver transplantation for biliary atresia. Kaplan-Meier survival analysis was used to calculate the survival rates of recipients and grafts. Group comparison was conducted by rank-sum test or t test.

Among 305 children undergoing liver transplantation, the proportion of children with inherited metabolic liver disease was 14.4%(44/305), secondary to 56.7%(173/305) of biliary atresia. The types of donor liver included 8 cases of living donor liver transplantation, 14 cases of total liver transplantation from organ donation after citizen death, 2 cases of reduced-size liver transplantation from organ donation after citizen death, and 20 cases of split liver transplantation from organ donation after citizen death, respectively. Preoperative Z score for height and weight in children with inherited metabolic liver disease were (-1.4±1.7) and (－0.6±1.5), significantly higher than (－2.1±0.9) and (－1.3±1.5) in those with biliary atresia (t=3.489, 2.675; both P<0.05). However, PELD scores between two groups were 13 (－1-22) and 15 (7-22), and the difference was not statistically significant (Z=-0.934, P>0.05). In the spectrum of complications after liver transplantation, the incidence of pulmonary infection rate was 6.8%(3/44), followed by 4.5%(2/44) for acute rejection and 4.5%(2/44) for acute upper respiratory tract infection. The cumulative 1-, 2-and 3-year survival rates of the recipients and grafts were 95.45%, 95.45%, 95.45% and 95.45%, 95.45%, 93.18%, respectively. After liver transplantation, a majority of metabolic indexes and nervous system symptoms were alleviated to varying degrees. In addition, the growth and development status were improved to certain extent, especially at 1 year after liver transplantation, the Z scores for height and weight were significantly increased.

The quantity of children with inherited metabolic liver disease is high. Liver transplantation has emerged as an important treatment for inherited metabolic liver disease. The timing and perioperative management of liver transplantation for each disease are different, which should be analyzed and selected according to individual condition. Multiple surgical approaches, especially split liver transplantation, can alleviate the shortage of donor liver to some extent. PELD scoring system cannot fully meet clinical needs of these children. It is urgent to formulate a more reasonable organ allocation scoring standard to ensure that these children can undergo liver transplantation in a timely manner.

To systematically evaluate the safety and efficacy of indocyanine green (ICG) fluorescence imaging-guided laparoscopic hepatectomy (FIGLTR).

Relevant clinical studies published before July 21, 2024 were systematically searched from PubMed, Web of Science, Embase, CNKI, Wanfang Data and Chongqing VIP databases. The searching keywords included indocyanine green, fluorescence imaging, laparoscopic, hepatectomy, liver cancer and liver tumor. Clinical data were extracted after evaluating the quality of included studies. The overall results were subject to meta-analysis using Review Manager 5.4 software. The comprehensive effect was evaluated by fixed effect or random effect models. The publication bias was assessed by funnel chart. The asymmetry of funnel chart was assessed by Begg test and/or Egger test.

In this meta-analysis, 28 retrospective cohort studies and 4 RCTs were included, comprising 2 630 patients including 1 386 in the non-FIGLTR group and 1 244 in the FIGLTR group. Meta-analysis showed that operation time (MD=12.60, 95%CI: 2.99-22.21), intraoperative blood loss (MD=52.19, 95%CI: 32.41-71.96), blood transfusion rate (OR=1.90, 95%CI: 1.17-3.09), R0 resection rate (OR=0.38, 95%CI: 0.24-0.62), overall incidence of postoperative complications (OR=1.61, 95%CI: 1.30-2.00) and the length of postoperative hospital stay (MD=0.86, 95%CI: 0.21-1.52) in the non-FLIGLTR group were significantly increased than those in the FIGLTR group (all P<0.05). However, no statistical significance was observed in the hepatic portal occlusion time (MD=-0.92, 95%CI: -4.64-2.80), the minimum resection margin width (MD=-3.12, 95%CI: -9.61-3.37) and the total length of hospital stay (MD=-0.18, 95%CI: -2.85-2.50) (all P>0.05). Sensitivity analysis and funnel chart analysis confirmed that the results of meta-analysis were stable and reliable.

Meta-analysis demonstrates that FIGLTR can improve the R0 resection rate of patients with liver cancer without affecting the minimum resection margin width. It yields higher safety, faster recovery and lower incidence of complications compared with non-FIGLTR.

To construct a prediction model for pathologic complete response (pCR) in liver cancer patients after neoadjuvant/conversion therapy followed by sequential surgical resection based on CT radiomics and clinical features, and to evaluate its predictive value.

Clinical data of 74 liver cancer patients undergoing neoadjuvant/conversion therapy, followed by sequential surgical resection in Nanfang Hospital of Southern Medical University from December 2019 to December 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 65 patients were male and 9 female, aged from 22 to 74 years, with a median age of 52 years. According to postoperative tumor specimens (n=80), they were randomly divided into the training (n=40) and validation sets (n=40). Feature indexes were extracted and screened based on CT radiomics of the patients, and the radiomics score (Rad-score) was obtained. A nomogram prediction model for pCR was constructed based on multivariate Logistic analysis of clinical factors and CT radiomics in the training set. The consistency of nomogram prediction model was evaluated by C-index and Hosmer-Lemeshow goodness-of-fit test. Bootstrap method was used for internal verification to evaluate the accuracy of calibration curve. The area under the ROC curve (AUC) was utilized to evaluate the degree of discrimination of nomogram prediction model. Decision curve analysis (DCA) was drawn to evaluate clinical utility of the prediction model. Clinical impact curve (CIC) was delineated to evaluate clinical effectiveness of the prediction model. The diagnostic efficiency of the prediction model was assessed by Delong test. The visual graph of Rad-score was drawn to display the diagnostic performance of the radiomics model.

Multivariate Logistic analysis showed that positive AFP after treatment was an independent influencing factor of pCR (OR=5.250, 95%CI: 1.069-25.789; P<0.05). A total of 4 148 radiomic features were extracted by Radiomics, and 11 radiomic features were screened by Lasso analysis and 10-fold cross-validation. AFP combined with Rad-score were used to construct a nomogram prediction model for pCR (combined model). The calibration curve of the combined model yielded high consistency between the predicted and actual pCR probability. The C-index in the training and validation sets was 0.887 and 0.895. Hosmer-Lemeshow test showed a high goodness of fit (χ²=5.96, 4.78; both P>0.05). Internal verification using Bootstrap method in the training and validation sets demonstrated that the average absolute error of the calibration curve of the combined model was 0.063 and 0.040, with high accuracy. DCA and CIC analyses showed that the combined model possessed high clinical utility and clinical effectiveness rate. In the training and validation sets, the AUC of the combined model was 0.887 and 0.895. The AUC of clinical and radiomics models in the training set was 0.887, 0.667 and 0.857, respectively. The diagnostic efficiency of combined model was significantly better than that of clinical model (Z=2.797, P=0.005 2). The diagnostic efficiency of combined model in the validation set was also significantly better than that of clinical model (Z=2.027, P=0.042 7). Rad-score waterfall plot revealed the proportion of incorrect prediction was not high, and the visualization effect was good.

The combined model based on CT radiomics and AFP possesses high prediction value for pCR after neoadjuvant/conversion therapy followed by sequential surgical resection for liver cancer and yields the optimal diagnostic efficiency.

To evaluate clinical efficacy and safety of lenvatinib and PD-1 inhibitor pretreatment combined with TACE sequential therapy for CNLC stage Ⅲ hepatocellular carcinoma (HCC).

Clinical data of 57 patients diagnosed with CNLC stage Ⅲ HCC in Henan Provincial People's Hospital from January 2021 to December 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 43 patients were male and 14 female, aged from 34 to 74 years, with a median age of 57 years. According to different treatment regimens, they were divided into two groups. In the LenPT group (n=19), lenvatinib and PD-1 inhibitor pretreatment were given, followed by TACE sequential therapy. In the TaLP group (n=38), TACE therapy was delivered, followed by lenvatinib and PD-1 inhibitor treatment. Clinical efficacy, influencing factors and safety between two treatment regimens were observed. Liver function and albumin-bilirubin (ALBI) score in two groups were compared by t-test or rank sum test. Disease control rate (DCR) between two groups was compared by Chi-square test. Survival analysis was performed by Kaplan-Meier method and Log-rank test. The influencing factors of survival were analyzed by Cox regression models.

After 6-month treatment, the DCR in the LenPT group was 89%(17/19), significantly higher than 50%(19/38) in the TaLP group (χ²=8.482, P=0.004). The median progression-free survival (PFS) in the LenPT group was 9.0 months, significantly longer than 6.0 months in the TaLP group (χ²=5.106, P=0.024). Multivariate Cox regression analysis showed that treatment regimen was an independent influencing factor of PFS (HR=1.956, 95%CI: 1.025-3.732; P=0.042). At 5-7 d after the first TACE, the ALT level in the LenPT group was 58(40-81) U/L, significantly lower than 80(60-96) U/L in the TaLP group (Z=-2.015, P<0.05). In the LenPT group, the ALBI score at 1 year after treatment was (-1.96±0.34), significantly lower than (-1.30±0.22) in the TaLP group (t=-6.666, P<0.001). In the LenPT group, Child-Pugh score was 6(5-7), significantly lower than 8(7-9) in the TaLP group (Z=-3.918, P<0.05). All adverse reactions during the treatment were relieved after corresponding treatment in two groups.

Compared with TACE followed by lenvatinib and PD-1 inhibitor treatment, lenvatinib and PD-1 inhibitor pretreatment combined with TACE sequential therapy can improve DCR, prolong PFS, alleviate liver function damage of patients with CNLC stage Ⅲ HCC. In addition, adverse events are generally controllable, indicating that this procedure is safe and efficacious in clinical practice.

To evaluate the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MRI in differential diagnosis of dysplastic nodules (DN) and small well-differentiated hepatocellular carcinoma (sWDHCC) induced by liver cirrhosis, and to construct a differential diagnosis model.

Clinical imaging data of 116 patients pathologically diagnosed with DN or sWDHCC in the Third Affiliated Hospital of Sun Yat-sen University from January 2015 to December 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 98 patients were male and 18 female, aged from 31 to 74 years, with a median age of 59 years. All patients received Gd-EOB-DTPA enhanced MRI to evaluate the imaging features of the lesions in in-phase and out-of-phase MRI, fat-suppression T1WI, fat-suppression T2WI, diffusion-weighted imaging (DWI), arterial phase, venous phase and hepatobiliary phase, and to assess whether the margins of the lesions were clear. Imaging characteristics between two groups were compared by Chi-square test. The independent influencing factors of differential diagnosis were identified by multivariate Logistic regression analysis and a regression model was constructed. The differential diagnostic efficiency of this model for sWDHCC and DN was evaluated by the ROC curve.

Gd-EOB-DTPA enhanced MRI showed that 116 lesions from 116 patients included 44 DN and 72 sWDHCC. Univariate analysis showed that the proportion of patients with arterial phase hyperenhancement (APHE), DWI hyperintensity and T2WI hyperintensity in the sWDHCC group was significantly higher than that in the DN group (χ²=68.280, 7.408, 5.500; all P<0.05). Multivariate Logistic regression analysis demonstrated that APHE (OR=0.001, 95%CI: 0.000-0.009) and washout in venous phase (OR=0.058, 95%CI: 0.010-0.353) were the independent influencing factors in differentiating sWDHCC from DN (both P<0.05). The regression model was constructed: Y=3.836-6.588× arterial phase features-2.840×venous phase features. The area under the ROC curve (AUC), sensitivity and specificity of this model in differentiating sWDHCC from DN were 0.94, 0.90 and 0.89, respectively. The AUC of APHE, DWI hyperintensity and T2WI hyperintensity was 0.86, 0.63 and 0.61, respectively. The AUC of the regression model was significantly larger than that of APHE, DWI hyperintensity and T2WI hyperintensity (Z=3.103, 6.176, 6.795; all P<0.05).

Washout during APHE and venous phase of Gd-EOB-DTPA enhanced MRI are the imaging features for differential diagnosis between sWDHCC and DN. This regression model based on imaging features possesses high differential diagnostic value.

To compare clinical efficacy between enucleation and anatomical resection in the treatment of giant hepatic hemangioma.

Clinical data of 42 patients with giant hepatic hemangiomas admitted to the Affiliated Central Hospital of Shaoxing University from January 2017 to April 2024 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 30 female, aged from 33 to 68 years, with a median age of 54 years. 18 cases were diagnosed with hemangiomas in the right lobe and 24 cases in the left lobe. According to different surgical methods, all patients were divided into the resection and enucleation groups. The operation time, liver function, length of hospital stay, hospitalization expense and incidence of complications were observed between two groups. Relevant indexes between two groups were compared by t-test and Mann-Whitney U-test. The rate comparison was conducted by Chi-square test or Fisher's exact test.

In patients with hemangiomas in the right lobe, the operation time in the enucleation group was (219±10) min, significantly shorter than (417±10) min in the resection group (t=2.48, P<0.05). However, no statistical significance was observed in liver function indexes such as ALT, AST and TB levels between two groups (all P>0.05). In patients with hemangiomas in the left lobe, no statistical significance was noted in all indexes during and after operation between two groups (all P>0.05). None of 42 cases was converted to open surgery. No postoperative complications such as bile leakage, bleeding and fever occurred in patients with hemangiomas in the left lobe. Postoperative bile leakage occurred in 3 cases of hemangiomas in the left lobe, including 1 case in the resection group and 2 in the enucleation group. All patients were cured by conservative treatment, and no complications such as fever and abdominal infection occurred.

For giant hepatic hemangioma, laparoscopic enucleation of hepatic hemangioma can preserve normal liver tissues to the largest extent, especially for the right hepatic hemangioma, and requires shorter operation time.

To evaluate the safety and efficacy of Emprint^TM microwave ablation system with Thermosphere^TM technology in the treatment of perivascular and non-perivascular liver cancer.

Clinical data of 135 liver cancer patients treated with microwave ablation system in Department of Ultrasound of the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. The local ethical committee approval was received. Among them, 120 patients were male and 15 females, aged from 27 to 83 years, with a median age of 55 years. All patients underwent ultrasound-guided ablation of liver cancer using Emprint^TM microwave ablation system. All patients were divided into the perivascular (n=26) and non-perivascular groups (n=109) according to adjacent relationship between tumors and intrahepatic vessels. Propensity score matching (PSM) was used to balance the confounding factors between two groups. The evaluation indexes included technical effective rate, local tumor progression (LTP), intrahepatic distant metastasis (IDM), extrahepatic metastasis (EM) and major complications. The rates were compared by Chi-square test or Fisher's exact test.

At 1 month after ablation, imaging examination showed that all patients did not have residual lesions or recurrence, and the effective rate of ablation was 100%. Within 1 year after ablation, no LTP or EM was observed in two groups. IDM occurred in both two groups. In the perivascular group, the 1-year incidence rates of IDM before and after PSM were 7.7%(2/26) and 8.7%(2/23), and 15.6% (17/109) and 14.8%(8/54) in the non-perivascular group. No statistical significance was noted between 2 groups before and after PSM (χ²=1.084, 0.534; both P>0.05). The incidence of major complications was 3.0%(4/135), all of which occurred in the non-perivascular group, including 2 cases of bile lake formation, 1 case of postoperative gastrointestinal bleeding and 1 case of intestinal fistula. No statistical significance was observed between two groups (P=1.00). After PSM, the incidence of major complications in the non-perivascular group was 5.6%(3/54), and no statistical significance was found between two groups (P=0.55).

The novel microwave ablation system with Thermosphere^TM technology is a safe and efficacious treatment for perivascular liver cancer, which provides a new treatment option for such complicated cases.

To investigate the incidence and risk factors of immediate complications after orthotopic liver transplantation.

Clinical data of 1 079 patients undergoing orthotopic liver transplantation in the First Affiliated Hospital of Xi'an Jiaotong University from January 2014 to December 2023 were retrospectively analyzed. The informed consents of all patients and/or family members were obtained and the local ethical committee approval was received. Among them, 848 patients were male and 231 female, aged from 6 months to 71 years, with a median age of 48 years. Medical records and biochemical indexes of all patients were collected. The incidence and risk factors of immediate complications after orthotopic liver transplantation were evaluated. The risk factors of postoperative immediate complications were assessed by Logistic regression analysis.

The incidence of immediate complications after liver transplantation was 12.97%(140/1 079), among which the top five complications were postoperative infection [5.65%(61/1 079)], postoperative bleeding [3.34%(36/1 079)], other organ failure [3.24%(35/1 079)] and vascular complications [1.95%(21/1 079)], liver graft failure or immune rejection [1.30%(14/1 079)], respectively. Pulmonary infection (n=36) and abdominal infection (n=16) were the most common postoperative infections. Other organ failure mainly included postoperative renal failure (n=25). Among vascular complications, there were 14 cases of hepatic artery thrombosis after liver transplantation and 4 cases of portal vein thrombosis or stenosis after liver transplantation. The overall Charlson comorbidity index (CCI) score of all patients was (3.1±1.3). The CCI score of patients with immediate complications was (3.3±1.2), significantly higher than (3.0±1.3) of those without immediate complications (t=2.16, P<0.05). Multivariate Logistic regression analysis showed that CCI, TB, INR, admission to ICU, non-neoplastic liver diseases and alcoholic cirrhosis were the independent risk factors for immediate complications after liver transplantation (OR=1.428, 1.003, 1.857, 2.243, 2.159, 2.970; all P<0.05). The incidence of postoperative infection and bleeding in the high CCI group were 8.13%(23/283) and 5.30%(15/283), significantly higher than 4.77%(38/796) and 2.64%(21/796) in the low CCI group (χ²=4.401, 4.588; both P<0.05).

The incidence of immediate complications after liver transplantation is relatively high. The incidence of postoperative infection and bleeding is remarkably elevated in patients with CCI score of ≥4. Elevated CCI score, high bilirubin, high INR, admission to ICU, non-neoplastic liver diseases and alcoholic cirrhosis are the independent risk factors for immediate complications after liver transplantation.

To construct a bimodal model based on serum indexes and MRI for grading diagnosis of liver fibrosis, and to evaluate their diagnostic efficiency.

Clinicopathological data of 174 patients receiving multi-phase abdominal contrast-enhanced MRI in the Third Affiliated Hospital of Sun Yat-sen University from March 2022 to June 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. 104 patients were retrospectively included in the training set, and 70 cases were prospectively enrolled in the test set. Among them, 120 patients were male and 54 female. The median age was 53 years old. MRI multi-phase quick three-dimensional (Quick-3D) sequence, relative liver enhancement rate in hepatobiliary phase (RLE-HBP), magnetic resonance elastography (MRE) indexes, and other serum indexes such as AST-to-platelet ratio index (APRI), fibrosis-4 (FIB-4) and Forns index were collected. Pathological examination of liver biopsy was considered as the gold standard for grading diagnosis of liver fibrosis. Spearman's correlation analysis was used to evaluate the relationship between independent variables and Metavir fibrosis stage. Intra-class correlation coefficient (ICC) was utilized to test the intra-group consistency of evaluation indexes. According to the Akachi information criterion (AIC), Logistic regression was used to construct the bimodal model for grading diagnosis of liver fibrosis (RLE-HBP+FIB-4, RLE-HBP+Forns). The area under the ROC curve (AUC) and Delong test were adopted to analyze the diagnostic performance of the bimodal model.

Correlation analysis showed a strong positive correlation between MRE and the severity of liver fibrosis (r_s=0.817, P<0.001). RLE-HBP had a moderate negative correlation with the severity of liver fibrosis (r_s=-0.493, P<0.001). The consistency evaluation indicated that the ICC of MRE and RLE-HBP remained high (0.893, 0.909) in the training and test sets. AIC modeling revealed that RLE-HBP was the key predictor of all stages of fibrosis. FIB-4 and Forns index selectively increased the AUC of the model in the diagnosis from ≥F1 to ≥F4 liver fibrosis. Delong test showed that the bimodal models of RLE-HBP+FIB-4 and RLE-HBP+Forns had equivalent diagnostic efficiency to MRE in the diagnosis of advanced liver fibrosis (≥F3) (Z=1.273, 1.441, both P>0.05), which was superior to the single-mode RLE-HBP model. The accuracy of the bimodal model in the test set exceeded 70%, validating their clinical applicability.

Based on serum indexes and MRI, a bimodal model for grading diagnosis of liver fibrosis are successfully constructed. Compared with MRE, RLE-HBP combined with FIB-4 or Forns index provide equivalent diagnostic accuracy for advanced liver fibrosis, which exceed that of RLE-HBP alone.

To investigate the application of indocyanine green (ICG) fluorescence imaging in perfusion and functional evaluation of liver graft, and analyze its relationship with the incidence of early allograft dysfunction (EAD) after liver transplantation.

Clinical data of 17 patients undergoing orthotopic liver transplantation in Beijing Chaoyang Hospital, Capital Medical University from January 2021 to February 2022 were retrospectively analyzed. The informed consents of all patients and(or) their families were obtained and the local ethical committee approval was received. Among them, 12 patients were male and 5 female, aged from 34 to 72 years, with a median age of 51 years. In liver transplantation, ICG was injected intravenously after vascular anastomosis. The changes of fluorescence intensity on the surface of liver graft were quantitatively recorded by ICG fluorescence imaging, and the curve of changes of fluorescence intensity was drawn. Its relationship with perfusion and EAD of liver graft was evaluated.

EAD occurred in 4 of 17 patients undergoing orthotopic liver transplantation. No adverse events or adverse reactions related to ICG injection were observed intraoperatively and during postoperative follow-up. Postoperative color Doppler ultrasound detected no thrombosis and normal blood flow in the liver grafts of all patients. The changes of lactic acid level before and after surgery (OR=1.420, 95%CI: 0.956-5.678, P=0.045) and the parameters of fluorescence curve parameter a (OR=8.150, 95%CI:1.022-16.498, P=0.028) were the independent predictors for postoperative EAD. The optimal cut-off value of parameter a was 0.011, and the area under the ROC area under the curve was 0.885 (95%CI: 0.723-1.000). The sensitivity and specificity of predicting the incidence of EAD at 7 d after liver transplantation were 0.75 and 0.77, respectively.

ICG fluorescence imaging is safe and feasible for perfusion and functional evaluation in liver transplantation. The change of fluorescence signal time is analyzed by establishing the model of fluorescence intensity curve with multiple parameters and calculating fluorescence intensity curve parameter, which has high predictive value for the incidence of postoperative EAD.

To evaluate the safety and efficacy of laparoscopic microwave ablation (MWA) via retroperitoneal approach in the treatment of recurrent hepatocellular carcinoma (HCC).

Clinical data of 29 patients with recurrent HCC who underwent laparoscopic MWA via retroperitoneal approach in the Affiliated Hospital of Kunming University of Science and Technology from January 2020 to December 2022 were retrospectively analyzed. Among them, 16 patients were male and 13 female, aged from 34 to 72 years, with a median age of 45 years. The tumors were all located in the right lobe, with a total of 41 lesions, including 9 in segment 5, 12 in segment 6, 11 in segment 7 and 9 in segment 8, respectively. 18 patients were diagnosed with a single lesion, 10 cases with 2 lesions and 1 case with 3 lesions. The average maximum diameter of the tumor was (2.9±0.9) cm. Preoperative and postoperative tumor indexes, liver function and postoperative complications were analyzed. Clinical efficacy of laparoscopic MWA through retroperitoneal approach for recurrent HCC was evaluated.

All 29 patients successfully completed MWA. The operation time was (135±30) min. Intraoperative blood loss was (178±46) ml. The indwelling time of drainage tube was (4.1±1.3) d. The liver function of all patients was restored to normal at postoperative 2 weeks. A slight amount of pneumoperitoneum was observed in 1 case. After conservative treatment, the patient did not develop any subsequent complications. 9 cases presented with atelectasis and pleural effusion. Following puncture drainage and anti-infection treatment, these patients were discharged after stable condition. 2 patients experienced a slight amount of ascites, and did not develop subsequent complications such as fever and abdominal abscess. No perioperative complications such as abdominal bleeding, infection, liver failure and bile leakage occurred in the remaining patients. The length of postoperative hospital stay was (8.3±5.3) d. The complete ablation rate was 95%(38/41), and the local residual rate was 5%(2/41). The postoperative median overall survival was 23 months, and the 6-month, 1- and 2-year cumulative overall survival rates were 100%, 96.6% and 48.5%, respectively. The 6-month, 1- and 2-year cumulative progression-free survival rates were 100%, 66.7% and 24.0%, respectively.

For patients with recurrent HCC, laparoscopic MWA through retroperitoneal approach can achieve favorable efficacy, high safety, low incidence of postoperative complications, mild trauma and rapid recovery.

To evaluate the effect of early off-bed activity on the safety and level of comfort of patients with liver cancer during hepatic arterial infusion chemotherapy (HAIC).

In this prospective study, 102 patients with liver cancer who underwent HAIC in the Third Affiliated Hospital of Naval Military Medical University from December 2023 to March 2024 were enrolled. Among them, 92 patients were male and 10 female, aged from 38 to 66 years, with a median age of 55 years. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into the control (n=51) and study groups (n=51) based on convenient sampling method. Patients in the control group received TACE routine nursing. In the study group, the optimal evidence-based medical evidence was obtained through literature retrieval. Combined with the actual status of patients, they were advised for first off-bed activity at 12 h after HAIC. The incidence of adverse events, complications, level of comfort and degree of satisfaction were observed and compared between two groups. Fatigue and level of comfort scores were compared by t-test. The degree of satisfaction was compared by Chi-square test.

There was no statistically significant difference in the incidence of adverse events between the study groups and the control group. In the study and control groups, 2, 3, 2, 1, 2 and 11, 14, 21, 7 and 9 patients developed pain, insomnia, low back pain, urine retention and constipation, and the differences were statistically significant (χ²=7.141, 8.541, 20.265, 4.883, 4.993; all P<0.05). The scores of fatigue and level of comfort in the study group were 54.6±2.7 and 89.1±0.7, while 78.1±3.2 and 71.5±1.2 in the control group, and the differences were statistically significant (t=-9.255, 6.176; both P<0.05). The degree of satisfaction of patients in the study group was 98%(50/51), significantly higher than 78%(40/51) in the control group (χ²=9.444, P<0.05).

Off-bed activity at 12 h after HAIC exerts no effects on the safety of patients with liver cancer during HAIC. Changing bed rest duration can elevate the level of comfort, and improve the degree of satisfaction of patients.

To investigate the clinicopathological features, survival and prognosis of patients with hilar cholangiocarcinoma (hCCA) and hilar-type intrahepatic cholangiocarcinoma (hICC), aiming to provide references for differential diagnosis and surgical plan in clinical diagnosis and treatment.

Clinical data of 158 patients with cholangiocarcinoma admitted to the Affiliated Hospital of North Sichuan Medical College from January 2015 to December 2021 were retrospectively analyzed. The informed consents of all patients or their families were obtained and the local ethical committee approval was received. Among them, 58 patients were male and 100 female, aged from 32 to 85 years, with a median age of 62 years, 90 cases of hICC and 68 hCCA. Baseline data, laboratory examination, surgical records, pathological examination reports and other potential prognostic factors were collected. Postoperative outpatient follow-up was conducted to record the survival time of patients. Clinicopathological features of all patients were compared by t-test, Wilcoxon rank-sum test, Chi-square test or Fisher's exact test. Survival analysis was performed by Kaplan-Meier method and Log-rank test.

Compared with hCCA, CA19-9 level was higher (Z=2.712, P<0.05), tumor diameter was larger (Z=-2.457, P<0.05), the incidence of satellite lesions was higher (χ²=4.621, P<0.05) and AJCC T staging was later in hICC patients (χ²=10.109, P<0.05). However, the level of bilirubin was higher (Z=2.549, P<0.05), and the proportion of preoperative biliary drainage was higher in hCCA patients (χ²=4.594, P<0.05). Compared with hCCA, hICC patients were more inclined to adopting extended hepatectomy, including left and right hepatectomy or left and right trihepatectomy (χ²=10.681, P<0.05). The portal vein resection rate was higher in hICC patients (χ²=5.274, P<0.05). The patients were followed up for 0.2-57.4 months, with a median follow-up time of 18 months. During postoperative follow-up, 43 hICC patients and 15 hCCA patients died. The median overall survival (OS) of patients with hICC and hCCA was 23.8 and 44.9 months, and the difference was statistically significant (χ²=8.324, P=0.004).

Compared with hCCA, hICC patients have advanced clinicopathological features, more aggressive biological behavior and worse prognosis. It is of clinical significance to differentially diagnose hICC from hCCA, determine treatment regimens and predict clinical prognosis of hICC and hCCA patients.

To investigate the efficacy and safety of different treatments for unresectable intrahepatic cholangiocarcinoma (ICC).

Literature search was performed from PubMed database to find all studies in English related to the treatment of unresectable ICC by subject words combined with free words. The key words were cholangiocarcinoma, cholangiocellular carcinoma, unresectable, advanced, hepatic arterial infusion chemotherapy/HAIC, chemotherapy, radiotherapy, transarterial radioembolization/TARE, transarterial chemoembolization/TACE, PD-1/PD-L1 and protein kinase inhibitors, etc. The retrieval time was from January 1 to June 1, 2024. The primary endpoints were 1-, 2- and 3-year overall survival (OS) rate, and the secondary endpoints were objective response rate (ORR), median progression-free survival (PFS) and incidence rate of adverse reactions. Meta-analysis was carried out by Stata 17.0 software. Treatment methods included chemotherapy, combination therapy, FOLFOX-hepatic arterial infusion chemotherapy (HAIC), immunotherapy, radiotherapy, TACE and yttrium-90 (Y-90).

A total of 43 articles comprising 8 538 patients were included for meta-analysis. Meta-analysis showed that the 1-, 2- and 3-year OS rates in the HAIC and combination therapy groups were 70.2%, 44.4%, 16.9%, and 65.0%, 27.8%, 19.9%, respectively. The 1-, 2- and 3-year OS rates in the TACE, Y-90 and chemotherapy groups were 43.0%, 24.4%, 19.9%, and 45.4%, 19.3%, 10.3%, and 38.0%, 12.6% and 4.9%, respectively. The 1- and 2-year OS rates in the immunotherapy and radiotherapy groups were 65.0%, 19.0%, and 3.6%, 1.5%, respectively. Patients in the TACE, combination therapy and HAIC groups obtained the highest ORR of 50.8%, 47.4% and 45.3%, respectively. The median PFS in the combination therapy group was the longest up to 6.76 months, followed by 4.39 and 4.09 months in the chemotherapy and HAIC groups. The most common adverse reaction was elevated AST/ALT ratio, accounting for 56.6%. Severe adverse reactions were cholestasis (3.0%) and peptic ulcer (0.8%).

For patients with unresectable ICC, FOLFOX-HAIC yields higher efficacy, similar adverse reactions, less severe adverse reactions and high safety compared with alternative treatment options.

To investigate the causal relationship between inflammatory cytokines and pancreatic ductal adenocarcinoma (PDAC) by two-sample Mendelian randomization (MR) method.

The genetic variation data of 91 inflammation-related proteins collected from genome-wide association studies (GWAS) and PDAC outcome data from FinnGen database were used for data analysis. The result of inverse variance weighted (IVW) analysis was utilized as the main outcome index. MR-Egger, weighted median, simple mode and weighted mode methods were used as supplementary analyses. A series of sensitivity analyses, including heterogeneity test, pleiotropic test and leave-one-out analysis, were used to evaluate the reliability of the results.

A total of 46 single nucleotide polymorphism (SNP) related to PDAC were screened in this study, and all SNP showed robust correlations (F>10). MR analysis showed that interleukin-22 receptor subunit α1 (IL22RA1), interleukin-15 receptor subunit α (IL15RA), IL-1α and cysteine aspartatespecific proteinase 8 (caspase-8) might have causal relationship with PDAC, among which IL22RA1 (OR=1.79, 95%CI: 1.01-3.19) was positively correlated with the risk of PDAC. However, IL15RA (OR=0.82, 95%CI: 0.69-0.98), IL-1α (OR=0.59, 95%CI: 0.42-0.83) and caspase-8 (OR=0.70, 95%CI: 0.50-0.96) had negative causal relationships with the incidence of PDAC (all P<0.05). In addition, the results of MR-Egger, weighted median, simple mode and weighted mode methods were basically consistent with those of IVW analysis. MR-Egger and Cochran's Q tests found no horizontal pleiotropy or heterogeneity. Leave-one-out analysis detected no SNP which had significant impact on the estimated effect, indicating that the causal relationship was stable to certain extent.

MR analysis shows that IL22RA1 is positively correlated with the risk of PDAC, whereas IL15RA, IL-1α and caspase-8 are negatively correlated with the incidence of PDAC. Analysis of PDAC-related inflammatory cytokines offers evidence for novel treatment strategy for PDAC in clinical practice.

To investigate the diagnosis and treatment of severe acute pancreatitis (SAP) in a child.

Clinical data of a child with SAP admitted to Lanzhou University Second Hospital in February 2023 were retrospectively analyzed. On February 2, 2023, a 10-year-old boy was hospitalized due to "persistent epigastric pain with intermittent vomiting for 2 d after eating greasy food". Physical examination: body temperature of 36.8℃, heart rate of 167 beats/min, respiratory rate of 45/min, blood pressure of 92/52 mmHg (1 mmHg=0.133 kPa). He was unconscious and delirious, manifested with pale face, wet and cold skin all over the body, cyanosis of mouth and lips, and insensitive pupil light reflex. The abdominal muscles of the whole abdomen were tense. He was unable to cooperate with physical examination. No tenderness or rebound pain was observed. The patient showed weakly-positive inspiratory three-concave sign, and low and dull heart sound. Laboratory examination: Scr level of 224.3 μmol/L, amylase level of 1 252 U/L, serum lipase level of >2 000 U/L, lactate dehydrogenase level of 521 U/L, B-type natriuretic peptide of 2 934 pg/mL, WBC of 36.3×10⁹/L, Hb of 157 g/L, Plt of 347×10⁹/L, blood potassium level of 7.83 mmol/L, blood sodium level of 120 mmol/L and blood chlorine level of 87.9 mmol/L, respectively. Abdominal ultrasound demonstrated fatty liver, gallbladder effusion, pancreatic enlargement complicated with peripancreatic effusion. Based on clinical manifestations and detection results, the child was diagnosed with SAP complicated with multiple organ failure, diffuse peritonitis and septic shock.

Upon admission, the child was given with positive pressure ventilation using resuscitation bag, invasive ventilator-assisted ventilation by tracheal intubation, albumin expansion, norepinephrine for increasing blood pressure and epinephrine for strengthening heart function. Continuous renal replacement therapy (CRRT) was delivered after general consultation. Imipenem was given for anti-infection and propofol for sedation. Symptomatic treatment, such as nourishing myocardium, inhibiting acid, inhibiting the secretion of pancreatic enzyme and enema with traditional Chinese medicine, was also delivered. After 2 weeks, the child was given with ventilator weaning after proper improvement, and CRRT was terminated. Enteral nutrition therapy was performed by placing jejunal tube. After 5 d, dark red fluid and bloody stool were discharged via gastrointestinal decompression tube. Gastroscopy showed multiple varicose veins at the gastric fundus and gastric greater curvature, manifested with tortuosity especially at the gastric fundus, and local nodules with a maximum diameter of approximately 1 cm. He was positive for red color sign. After Department of General Surgery consultation, emergent open peripancreatic necrotic abscess resection and splenectomy were performed on February 24, 2023. At postoperative 1 month, the child was discharged after regular anti-infection treatment. After 1-year follow-up, the child resumed normal study and life.

For pediatric SAP, prompt diagnosis and interventions should be delivered to prevent subsequent complications. It's of importance to timely conversion of medical and surgical treatment in the management of pediatric SAP. Prospective multi-center trials are required to formulate evidence-based guidelines and optimize the treatment and management of pediatric SAP.

To screen early diagnostic and prognostic markers of pancreatic ductal adenocarcinoma (PDAC) based on multi-omics analysis of serum and tissue exosomes.

The samples were collected from 8 PDAC patients undergoing surgery and 3 healthy donors admitted to Zhongnan Hospital of Wuhan University in 2020. Exosomes were isolated from tissues and serum of healthy donors and PDAC patients. The particle size and protein content were identified by electron microscope and molecular markers. Subsequently, PDAC-specific exosomal microRNA (miRNA) was identified by miRNA transcriptomics. The verified samples were obtained from 22 PDAC patients and 20 healthy donors to further verify the identified miRNAs. In the final analysis, the diagnostic ability of these miRNAs for PDAC was evaluated by the area under the ROC curve (AUC) and Brier score. Kaplan-Meier method and Log-rank test were used for survival analysis.

5 miRNAs with low expression levels (hsa-miR-142-3p, hsa-miR-199b-3p, hsa-miR-221-3p, hsa-miR-222-3p and hsa-miR-584-5p) and 1 with high expression level were identified and verified. Two miRNAs with the highest expression levels were miR142-3p and miR148a-3p. Compared with adjacent tissues and healthy donor sera, these two miRNAs were further verified in tissue-derived extracellular vesicles (Ti-EVs) and serum-derived extracellular vesicles (Se-EVs) of PDAC patients. Kaplan-Meier curve showed that the down-regulated expression levels of miR142-3p and miR148a-3p were significantly correlated with poor prognosis of overall survival (OS) and recurrence-free survival (RFS) of PDAC patients (χ²=36.314, 5.218 and 7.047, 4.924; all P<0.05). The prediction error curve indicated that the combination of miR142-3p, miR148a-3p and CA19-9 yielded the smallest prediction error. ROC analysis revealed that the AUC based on the combination of miR142-3p and miR148a-3p combined with CA19-9 model was 0.747, larger than that of the model using CA19-9 alone.

The exosomes of pancreatic cancer, miRNA-142-3p and miRNA-148a-3p, play an anti-oncogene role in PDAC. PDAC patients with low expression of miRNA-142-3p or miRNA-148a-3p achieve poor prognosis, which are novel potential diagnostic and prognostic markers for PDAC.