Objective:To study the alternation of plasma ghrelin in patients with acute pancreatitis (AP) and to evaluate the efficacy of gastric slow wave analysis in predicting the severity of AP.Methods:Clinical data and blood samples of 129 patients with AP and 16 individuals for normal physical examination in the Department of Gastroenterology, Jiangnan University Affiliated Central Hospital (Wuxi No.2 People's Hospital) from September 2018 to August 2024 were prospectively collected. Individuals with normal physical examinations were included in the normal control group, including 9 males and 7 females, aged (50.9±14.2) years. The finally enrolled 125 patients with AP included 82 males and 43 females, aged (49.5±15.6) years, which were grouped according to disease severity. Mild AP (MAP) was included in the MAP group ( n=84), while moderate to severe and severe acute AP were included in the non-MAP group ( n=41). The surface gastrogram of all AP patients was detected on the 2nd and 4th day after admission. The slow waves of gastric electricity were recorded, and gastric growth hormone-releasing hormone, C-reactive protein (CRP), etc. were detected simultaneously. Univariate and multivariate logistic regression analyses were conducted to analyze the influencing factors of AP severity (MAP or non-MAP). Receiver operating characteristic (ROC) curve was used to evaluate the indicators in predicting the severity of AP. Results:The levels of gastric growth hormone-releasing hormone in both the non-MAP group and MAP group on the 2nd and 4th day after admission were lower than those in normal control group (all P<0.05). The percentages of normal gastric electrical slow waves in the first and fourth leads, the mean percentages of normal gastric electrical slow waves in the four leads, and the main frequency on the 2nd day of admission in the non-MAP group were lower than those in the normal control group, and the main power and C-reactive protein were higher than those in the MAP group, the differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed the percentage of normal gastric electrical slow wave in the first lead on the 2nd day of admission ( OR=0.914, 95% CI: 0.869-0.961, P=0.001) and CRP ( OR=1.008, 95% CI: 1.002-1.013, P=0.012) were the influencing factors of the severity of AP. The area under the ROC curve of the percentage of normal gastric electrical slow wave in the first lead on the 2nd day of admission in predicting the severity of AP was 0.705, with a sensitivity of 97.6% and a specificity of 35.7%. Conclusion:The plasma gastric growth hormone-releasing hormone in patients with AP decreases in the early stage. The low percentage of normal slow waves in the first lead of gastric electrocardiogram on the 2nd day of admission is a risk factor for the severity of AP and can be used for the early prediction of the severity.

In recent years, the research on the microbial community within cancer has gradually attracted attention. The microbiota within the tumor affects the immune regulation of liver cancer and may promote the progression of liver cancer through inflammatory responses, metabolic regulation, etc. This article explores the sources and distribution characteristics of microorganisms in liver cancer, their potential mechanism of action in the occurrence and development of liver cancer, and evaluates the application prospects of intratumoral microorganisms in the early diagnosis, treatment response prediction and personalized treatment of liver cancer, especially their potential value in targeted therapy, providing new ideas for microbial intervention in future precision medicine.

Objective:To investigate the efficacy and safety of percutaneous trans-hepatic choledochoscopic lithotripsy (PTCSL) in the treatment of recurrent hepatobiliary calculi under enhanced recovery after surgery (ERAS) mode.Methods:Clinical data of 88 patients with recurrent hepatobiliary calculi, who were treated with PTCSL at Zhengzhou Central Hospital Affiliated to Zhengzhou University and the First Affiliated Hospital of Xi'an Jiaotong University between June 2022 and June 2024 were retrospectively analyzed, including 34 males and 54 females, aged (52.0±13.8) years. The scheme includes preoperative education, prophylactic antibiotic application, ensuring the quality of surgery, early postoperative feeding and activity, etc. The operation can be divided into two fashions: percutaneous transhepatic cholangial drainage and PTCSL, which can be completed in one stage (one-stage expansion method) or in two stages (staged expansion method). Clinical data such as gender, age, operative time, intraoperative blood loss, residual stone, and surgical complications were recorded.Results:All 88 patients underwent PTCSL under ERAS mode successfully, including 52 cases using one-stage expansion method and 36 cases using staged expansion method. The operative time was (53±20) min, the intraoperative blood loss was (9.7±3.8) ml, the postoperative hospital stay was (3.6±1.7) d, and the hospitalization cost was (17 500±4 700) yuan. Sixty-nine patients (78.4%, 69/88) had one-time stone removal in the first PTCSL. A total of 19 cases of residual stones were managed again by percutaneous sinus soft choledochoscopy, of which 12 cases were managed by one-time choledochoscopy, five cases by two-time choledochoscopy, and two cases by three-time choledochoscopy. The rate of residual stone was significantly higher in one-stage expansion method compared to staged expansion method [28.8% (15/52) vs. 11.1% (4/36), P=0.040]. No death, conversion to open surgery, or severe complications such as intra-abdominal hemorrhage or bile leakage occurred in the patients. No residual stones or recurrence were found during the follow-ups of (7.5±2.1) months after discharge. Conclusion:PTCSL under ERAS mode is safe and effective in the treatment of recurrent hepatobiliary calculi.

Objective:To explore optimal timing and surgical approaches for bile duct repair in patients with bile duct injuries associated with laparoscopic cholecystectomy (LC-BDI).Methods:A retrospective analysis was conducted on the clinical data of 13 patients with LC-BDI treated at Chuxiong Yi Autonomous Prefecture People's Hospital from October 2012 to October 2023. The cohort included 6 males and 7 females, aged (51.2±7.6) years. Clinical parameters such as gender, age, Strasberg classification, timing of surgery, surgical techniques, and complications were recorded. Postoperative follow-up was conducted via telephone to assess complications and reoperation status.Results:Among the 13 LC-BDI patients, 4 cases were diagnosed intraoperatively during LC, while 9 cases were diagnosed postoperatively. The Strasberg classification was as follows: 5 cases of E2, 6 cases of E3, and 2 cases of E4. Except for 2 patients who underwent immediate repair during LC, the remaining 11 patients initially received proximal bile duct or subhepatic space drainage, followed by definitive biliary reconstruction after 6-8 weeks. All 13 patients underwent repair via side-to-side hepaticojejunostomy (SSHJ). Over a mean follow-up period of (68.5±30.8) months, only 1 patient with Strasberg E4 LC-BDI was judged as repair failure at 21 months postoperatively; the remaining 12 cases achieved successful repair.Conclusion:For LC-BDI patients with Strasberg E2 or higher classifications, in the absence of intra-abdominal infection, biliary reconstruction via SSHJ at 6-8 weeks postoperatively demonstrated superior therapeutic efficacy.

Objective:To analyze the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with main splenic artery embolization in the treatment of patients with portal hypertension upper gastrointestinal bleeding complicated with extensive portal vein thrombosis (PVT).Methods:This study was a prospective, single-center, open-label, single-arm clinical trial. In the first phase, 81 patients with portal hypertension upper gastrointestinal bleeding who were admitted to Beijing Shijitan Hospital, Capital Medical University from January 2018 to December 2018 were consecutively enrolled, including 57 males and 24 females, with the age of (51.3±10.4) years. During TIPS surgery, the pressure of the portal vein before and after the balloon blocking the splenic artery was measured to clarify the contribution of the splenic artery to portal hypertension. In the second stage, from January 2019 to December 2022, 104 patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT were re-enrolled, including 71 males and 33 females, with the age of (50.9±12.5) years. TIPS combined with main splenic artery embolization was performed, and portal vein pressure was measured before and after embolization. Follow up on the postoperative esophageal and gastric varices of the patients in the second stage.Results:The portal vein pressures before and after the first stage of balloon occlusion of the splenic artery were (35.2±8.4) mmHg (1 mmHg=0.133 kPa) and (24.2±6.3) mmHg, respectively. The pressure after occlusion was lower than that before occlusion, and the difference was statistically significant ( t=10.54, P<0.001). The portal vein pressures before and after the second stage embolization were (36.1±9.5) mmHg and (21.1±4.7) mmHg respectively. The pressure after embolization was lower than that before embolization, and the difference was statistically significant ( t=13.47, P<0.001). In the second stage, among the 104 patients, the proportion of those whose varicose veins disappeared or improved 6 months after the operation was 43.3%(45/104) and 51.0%(53/104), respectively. There were no patients with aggravation or rebleeding due to rupture. One year later, 8 patients (7.7%) had aggravated or ruptured esophageal and gastric varices with bleeding. Two years later, 12 patients (11.5%) had aggravated or bleeding. Conclusion:TIPS combined with main splenic artery embolization can effectively reduce the portal vein pressure in patients with portal hypertension upper gastrointestinal bleeding complicated with extensive PVT, improve the degree of esophageal and gastric varices, and reduce the risk of gastrointestinal bleeding.

Objective:To compare the safety and efficacy of transarterial chemoembolization (TACE) combined with donafenib and programmed death protein 1 (PD-1) inhibitors and TACE combined with donafenib in the treatment of unresectable hepatocellular carcinoma (uHCC).Methods:Clinical data of 148 patients with uHCC treated at the First Affiliated Hospital of Zhengzhou University from December 2021 to December 2022 were retrospectively analyzed, including 127 males and 21 females, aged (56.6±9.9) years. Patients were divided into two groups: the TACE combined with donafenib and PD-1 inhibitors group (TACE+ DP, n=73) and TACE combined with single donafenib (TACE+ D, n=75). The overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and the occurrence of treatment-related adverse events (TRAEs) of the two groups of patients were observed. Kaplan-Meier analysis was used for survival assessment, and the log-rank test was used for comparison. The related factors affecting the prognosis of patients were indentified and analyzed. Results:The median PFS of patients in the TACE+ D group and the TACE+ DP group were 7.2 months (95% CI: 5.7-8.3 months) and 10.5months (95% CI: 8.9-11.3 months), respectively. The median OS was 13.2 months (95% CI: 12.3-13.7 months) and 16.9 months (95% CI: 15.1-19.8 months), respectively. All these differences were statistically significant ( χ2=17.81, 26.92, respectively, both P<0.001). The ORR and DCR of TACE+ DP group were both higher than those in TACE+ D group [53.4% (39/73) vs 36.0% (27/75), χ2=4.55, P=0.031; and 90.4% (66/73) vs 77.3% (58/75), χ2=4.66, P=0.044]. No grade 4 or above adverse events occurred in either the TACE+ DP or the TACE+ D group. The most common treatment-related adverse events in TACE+ D and TACE+ DP group were hand-foot syndrome [46.7% (35/75) vs 49.3% (36/73)], hypertension [26.7% (20/75) vs 30.1% (22/73)], fatigue [22.7% (17/75) vs 24.7% (18/73)], diarrhea [26.7% (20/75) vs 28.8% (21/73)], and thrombocytopenia [25.3% (19/75) vs 28.8% (21/73)]. There was no significant difference in the incidence and severity of TRAEs between the groups ( χ2=0.08, P=0.774). TACE+ DP treatment was a favorable prognostic factor for PFS ( HR=0.33, 95% CI: 0.22-0.49, P<0.001) and OS ( HR=0.19, 95% CI: 0.11-0.33, P<0.001) of patients. Conclusion:Compared to TACE combined with donafenib, TACE combined with donafenib and PD-1 inhibitors, with good efficacy and safety, significantly improved the treatment response and survival in patients with uHCC.

Objective:To evaluate the efficacy, safety, and prognostic factors of transarterial chemoembolization (TACE) combined with molecular targeted therapy (MTT) and camrelizumab in patients with unresectable recurrent hepatocellular carcinoma (urHCC).Methods:Clinical data of 83 patients with urHCC treated at the First Affiliated Hospital of the University of Science and Technology of China between October 2018 and October 2023 were retrospectively analyzed, including 75 males and 8 females, aged (55.2±10.7) years. Among them, 43 patients received TACE combined with MTT and camrelizumab (observation group), while 40 received TACE combined with MTT alone (control group). Kaplan-Meier curves were plotted to compare overall survival (OS) and progression-free survival (PFS) between the groups. Treatment response was assessed according to the mRECIST criteria, and objective response rate (ORR) and disease control rate (DCR) were compared. Adverse events (AEs) were monitored in both groups.Results:The observation group demonstrated longer median OS (31.8 vs 19.9 months, χ2=11.26, P=0.001) and median PFS (14.5 vs 7.4, months, χ2=4.08, P=0.043) compared to the control group. The ORR and DCR in the observation group were 51.2% (22/43) and 90.1% (39/43), respectively, both higher than those in the control group [25.0% (10/40) and 70.0% (28/40), respectively]. The differences were statistically significant ( χ2=5.99, 5.71; P=0.023, 0.025; respectively). Multivariate Cox analysis showed that different treatment regimens were influencing factors for post-treatment survival in patients with urHCC (control group vs treatment group: HR=2.633, 95% CI: 1.483- 4.677, P<0.001), as well as for PFS (control group vs treatment group: HR=1.781, 95% CI: 1.116-2.842, P=0.015). No treatment-related deaths or unexpected AEs occurred in either group. The most common systemic therapy-related AE was hand-foot syndrome, observed in 15 patients (34.9%, 15/43) in the observation group and 9 (22.5%, 9/40) in the control group ( χ2=1.55, P=0.236). Conclusions:Compared to TACE combined with MTT alone, TACE combined with MTT and camrelizumab demonstrates superior efficacy and acceptable safety in treating unresectable recurrent HCC.

Objective:To analyze the efficacy and safety of modified associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in the treatment of patients with primary liver cancer.Methods:Clinical data of 83 patients with hepatocellular carcinoma (HCC) undergoing hemihepatectomy in the Department of Hepatobiliary and Pancreatic Tumor Surgery of Gansu Provincial Cancer Hospital between January 2022 and November 2023 were retrospectively analyzed, including 53 males and 30 females, aged (54.0±6.5) years. According to the treatment protocol, patients were divided into the control group ( n=41), in which patients underwent traditional ALPPS, and the observation group ( n=42), in which patients underwent modified ALPPS (occlusion of portal venous branch using vascular clips, combined with radiofrequency ablation for physical separation of the diseased lobe, without liver mobilization). The completion rate of staged surgery, interval between surgeries, future liver remnant (FLR) growth rate at 7 days after first-stage surgery, alanine transaminase (ALT) and aspartate transaminase (AST) levels at 5 days after fisrt-stage surgery, and postoperative complications (ascites, nausea, and vomiting, etc.) were compared between the groups. Results:The completion rate of staged surgery was 95.2% (40/42) in the observation group and 90.2% (37/41) in the control group ( χ2=0.62, P=0.431). The ALT and AST levels at 5 days after first-stage surgery were (550.4±86.0) U/L and (327.1±52.8) U/L in the observation group, respectively, which were significantly lower than those in the control group (861.6±106.3) U/L and (533.8±73.7) U/L, respectively ( t=13.13 and P<0.001, t=12.93 and P<0.001). The FLR growth rate were higher in the observation group than that in the control group [(80.4±10.3)% vs (49.3±5.7)%; t=13.13, P<0.001] and the interval between procedures were also shorter in the observation group (10.9±2.1 vs 22.4±4.8, d; t=9.65, P<0.001). The intraoperative blood loss of the first-stage surgery was lower in the observation group than that in the control group (350.5±45.2 vs 825.5±21.7, ml; t=21.43, P<0.001). The total complication rates after the first-stage surgery were 11.9% (5/42) in the observation group and 19.5% (8/41) in the control group, while after the second-stage surgery, the complication rates were 7.5% (3/40) and 18.9% (7/37), respectively, with no statistically significant differences ( χ2=0.65 and P=0.419, χ2=1.81 and 0.177, respectively). Conclusion:The modified ALPPS offers better postoperative liver function, reduced surgical trauma, accelerated FLR growth, and a shorter interval between procedures, demonstrating a favorable safety in the treatment of primary liver cancer.

Objective:Based on a propensity score matchied analysis, the impact of neoadjuvant therapy, namely the transcatheter arterial chemoembolization (TACE) combined with the targeted and immunotherapy, on the prognosis of patients undergoing liver resection for hepatocellular carcinoma (HCC).Methods:Clinical data of 226 patients who underwent surgical resection for HCC of China Liver Cancer (CNLC) stage Ib, IIa, IIb, and IIIa at the Second Affiliated Hospital of Anhui Medical University from February 2020 to December 2024 were retrospectively analyzed, including 201 males and 25 females, aged 64.6±9.4 years. Patients were divided into the neoadjuvant therapy group ( n=25) and the direct surgery group ( n=201). Propensity score matching was used to analyze the liver fibrosis-4 score, platelet count, prothrombin time, activated partial thromboplastin time, and tumor number of the two groups. Postoperative pathological assessment of liver resection was performed. The Kaplan-Meier method was used to analyze the prognosis, and the log-rank test was used to compare the survival rates of the two groups. Results:After propensity score 1: 3 matching, there were no statistically significant differences (all P>0.05) regarding the baseline characteristics of the two groups. Pathological assessment after hepatectomy: the complete pathological response rate was 8% (2/25), and the major pathological response rate was 36% (9/25). The recurrence-free survival rates at 1, 2, and 3 years after surgery in the direct surgery group and the neoadjuvant therapy group were 52.0%, 48.0%, and 42.7% versus 76.0%, 72.0%, and 68.0%, respectively ( χ2=4.76, P=0.029). The overall survival rates at 1, 2, and 3 years after surgery in the direct surgery group and the neoadjuvant therapy group were 80.0%, 78.7%, and 77.3% versus 100.0%, 96.0%, and 96.0%, respectively ( χ2=4.31, P=0.038). Conclusion:Neoadjuvant therapy could reduce the risk of postoperative recurrence and prolong patients survival

Objective:To establish a patient-derived tumor xenograft (PDX) model of primary liver cancer (PLC), and to analyze the pathological features, proliferation and drug-related gene mutation characteristics of the primary tumor and the PDX model of primary liver cancer.Methods:A retrospective analysis was conducted on the tumor samples of 64 PLC patients who underwent hepatectomy in the Department of Hepatobiliary Surgery of Tianjin First Central Hospital from January 2019 to December 2020. Among them, there were 46 males and 18 females, with an average age of (60.7±9.4) years. The degree of tumor differentiation and whether there was vascular invasion were recorded. The pathology of the primary tumor and each generation of PDX models was observed. Immunohistochemical staining was used to detect the characteristic proteins and proliferation-related protein of PLC. The genes related to drug use in PLC PDX models were analyzed in the primary tumor.Results:Among the tumor tissues of 64 PLC patients, 31 cases (48.4%) were successfully transplanted into nude mice and passaged to subsequent generations. In the primary tumor tissues and PDX models of hepatocellular carcinoma (HCC), the cancer nodules were clearly distinguishable, the cancer cells were arranged disorderly, and distributed in nests or cords. The tumor cell nuclei were large and deeply stained. In the primary tumor tissues and each generation of PDX models of intrahepatic cholangiocarcinoma (ICC), there were ICC adenocarcinoma-like structures, with well-differentiated tumor glands and glandular structures composed of cuboidal or columnar tumor cells, presenting as small individual glands or interwoven glands. The degree of differentiation of the PDX models of HCC and ICC patients was basically consistent with that of the primary tumors. Immunohistochemistry showed that proliferating cell nuclear antigen staining of the primary tumors and PDX model transplanted tumors of HCC and ICC patients was strongly positive. The Ki-67 staining positive rate of the primary tumors and PDX model transplanted tumors of HCC was > 80%, and that of ICC was > 70%. Alpha-fetoprotein was strongly positive in the primary tumors and PDX model transplanted tumors of HCC and ICC. The common mutations of transplanted tumors and the primary tumors of P24 HCC patients were 90%, and those of P43 ICC patients were 89%, 94%, and 94%, respectively.Conclusion:The constructed PDX model is highly consistent with the biological characteristics of the primary tumor.