Femoral intertrochanteric fracture is one of the common types of fractures in the elderly. With the general improvement of medical and living standards, the number of elderly people is increasing, and the problem of osteoporosis has also become relatively prominent. Therefore, low violence can usually cause fractures in this area of the elderly, which has a significant negative impact on the quality of life of elderly patients. With the further development of medical technology and internal fixation materials, the emergence of proximal femoral nail antirotation(PFNA) has greatly improved the treatment effect of femoral intertrochanteric fractures in elderly patients. However, with the increasing number of patients treated, internal fixation failures have gradually been reported. In recent years, proximal femoral biomimetic intramedullary nail(PFBN) has been reported to have good clinical efficacy. Therefore, this article mainly elaborates on the theoretical basis, design characteristics, biomechanics, and clinical efficacy research of PFBN, providing more reference for the clinical treatment of femoral intertrochanteric fractures in elderly patients in the future.

In recent years, recombinant human urokinase (rhPro-UK) has been widely used in the treatment of a variety of thromboembolic diseases, with significant efficacy and no obvious adverse reactions. In addition, it has a wide range of applications in many new technology fields. This article focuses on the application of rhPro-UK in the treatment of acute myocardial infarction, cerebrovascular disease, lower extremity deep vein thrombosis, arterial thrombosis and other diseases. rhPro-UK has demonstrated good thrombolytic efficacy and safety in these diseases, especially in patients with acute myocardial infarction, and adjuvant PCI therapy can significantly increase myocardial reperfusion, improve cardiac function, and do not increase the risk of bleeding. For cerebrovascular disease, rhPro-UK can significantly improve the degree of neurological deficit and has a high safety profile. In the treatment of lower extremity deep vein thrombosis, rhPro-UK has shown superior thrombolytic efficacy and safety compared with urokinase. For arterial thrombosis and biological stents, the use of rhPro-UK has also achieved some efficacy, but more research is needed to confirm its efficacy and safety. In addition, ultrasound-mediated drug-loaded thrombolysis systems also have potential applications in rhPro-UK therapy. Future research on rhPro-UK will focus more on the development of new technologies.

In recent years, liver transplantation in China has developed rapidly, and the demand for donor organs is increasing. Faced with the dilemma of organ shortage, using marginal donors or expanding the criteria for standard donors is one of the practical methods to solve the problem. Compared with static cold storage, ex vivo machine perfusion in the liver transplantation can evaluate and repair the vitality of the grafts. The advantages of machine perfusion have been widely recognized when extended criteria donor organs were transplanted. Ex vivo mechanical perfusion strategies mainly include hypothermic(oxygenated) machine perfusion, normothermic machine perfusion, controlled oxygenated rewarming perfusion and ischemic-free liver transplantation, and different machine perfusion strategies have their own characteristics and advantages. This article reviews the development process and the characteristics of various machine perfusion strategies. The future development and application of machine perfusion were prospected in order to promote the widespread application of this technology.

Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a special type of primary liver cancer, which is characterized by dual phenotypic differentiation of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Due to the lack of specific diagnostic markers and therapeutic targets, the preoperative diagnosis is difficult, the treatment is not easy, and the prognosis is poor. Routine serology, imaging examination and histological biopsy are the main methods of preliminary screening and diagnosis of cHCC-CC. Patients with resectable cHCC-CC should be treated with surgical treatment if possible, but whether they should receive liver transplantation remains a careful choice. There is still no unified standard for local treatment and systemic treatment for advanced patients, and its efficacy is still controversial. Systemic treatment including platinum drugs can benefit some patients. The potential value of targeted therapy and immunotherapy in the treatment of advanced cHCC-CC patients has been highlighted. The introduction of multidisciplinary diagnosis and treatment model has provided a strong guarantee for the comprehensive treatment of patients, and the development of xenogenetic model and multi-omics technology has provided a considerable prospect for the realization of individualized treatment for patients. The present situation and progress of diagnosis and treatment of cHCC-CC are discussed in order to provide reference for clinical practice.

Hepatocellular carcinoma is the most common malignant tumor of the liver, and more than half of the patients are in the middle and late stage, seriously threatening the life and health of the Chinese people. Although surgical resection remains the only treatment option for liver cancer patients to achieve a cure, the low surgical resection rate and high postoperative recurrence rate greatly limit the survival benefits of patients. Recently, with the continuous successful development and clinical application of systemic new drugs, multi-mode therapy such as TKIs combined ICIs has sprung up, breaking the limitations of a single treatment model, and has become an important corner of "surgery-based comprehensive treatment" for liver cancer. Neoadjuvant therapy, adjuvant therapy and conversion therapy have gradually become the focus of new research, and their success is expected to further improve the survival prognosis of patients with liver cancer, but there are still many challenges. The author reviews the current first-line systematic treatment of liver cancer, and elaborates on the characteristics and advantages of its clinical application.

Hepatocellular carcinoma is a significant disease that seriously threatens the life and health of our people, and chronic hepatitis B virus infection is the most important cause of hepatocellular carcinoma in China. Radical surgery is an essential treatment for hepatocellular carcinoma patients who are expected to achieve long-term survival. However, the high recurrence and metastasis rate after surgery significantly affects the long-term prognosis. Postoperative recurrence of hepatocellular carcinoma is characterized by a bimodal pattern, with early recurrence leading to higher mortality and poorer survival prognosis. Postoperative adjuvant therapy can help to reduce the recurrence rate and improve the overall efficacy, but there is no standardized postoperative adjuvant therapy regimen at home and abroad. Studies have shown that antiviral therapy, interventional therapy, targeted therapy, immunotherapy, radiation therapy, and traditional Chinese medicine may have a specific effect on reducing the recurrence of hepatocellular carcinoma after surgery and prolonging overall survival. Key issues such as how to accurately assess and screen the population with a high risk of postoperative recurrence of hepatocellular carcinoma, select the best postoperative adjuvant treatment modality and timing and determine the duration of postoperative adjuvant treatment still need to be confirmed by high-quality fundamental research breakthroughs and multicenter clinical randomized controlled studies. In this article, the authors will discuss the characteristics of postoperative recurrence of hepatocellular carcinoma, the selection of adjuvant treatment strategies, and the problems faced based on the latest research progress and in light of the reality of hepatocellular carcinoma occurrence in China.

Objective:To compare the clinical efficacy of radiofrequency ablation and liver resection in the treatment of gastrointestinal stromal tumor liver metastasis.Methods:A retrospective cohort study was conducted, collecting medical records of 46 patients with gastrointestinal stromal tumor liver metastasis treated at the First Medical Center of the Chinese People′s Liberation Army General Hospital from January 2018 to December 2022. Patients were divided into radiofrequency ablation group ( n=20) and liver resection group ( n=26) based on the treatment method. Short-term efficacy and long-term prognosis between the two groups were compared. Short-term efficacy was evaluated based on intraoperative bleeding volume, operative time, hospital stay, hospitalization costs, while long-term efficacy was assessed by progression-free survival and overall survival. Normally distributed measurement data were expressed as mean±standard deviation ( ± s) and compared using the t-test. Non-normally distributed measurement data were expressed as M( Q1, Q3) and compared using the Wilcoxon rank-sum test. Count data were expressed as frequency (%) and compared using the chi-square test. The long-term prognosis of patients in both groups was compared using the Kaplan-Meier curve. Results:The intraoperative blood loss, operative time, postoperative hospital stay, and hospitalization costs for the radiofrequency ablation group were 5 (3, 5) mL, 60 (55, 60) min, 4.0 (3.0, 4.0) d, and 4.6 (3.8, 5.3) ten thousand yuan, respectively; for the liver resection group, these were 100 (50, 275) mL, 180 (155, 215) min, 7.0 (4.5, 9.5) d, and 8.6 (6.1, 10.8) ten thousand yuan, respectively, with statistically significant differences between the two groups( P<0.05). The median progression-free survival for the liver resection group was 37 months, with 1 and 3-year progression-free survival rates of 96% and 50%, respectively. For the radiofrequency ablation group, the median progression-free survival was 20.5 months, with 1 and 3-year progression-free survival rates of 65% and 20%, respectively, showing statistically significant differences between the two groups ( P<0.05). The 1, 3, and 5-year overall survival rates for the liver resection group were 100%, 100%, and 78.3%, respectively, while for the radiofrequency ablation group, they were 100%, 100%, and 82.2%, respectively, with no statistically significant difference ( P>0.05). Conclusions:Both liver resection and radiofrequency ablation can be considered as treatment options for gastrointestinal stromal tumor liver metastasis, with comparable long-term efficacy. Liver resection has a clear advantage in terms of local tumor control compared to radiofrequency ablation, which has the advantages of fewer complications, faster recovery, and shorter hospital stay.

Objective:To explore the impact of early postoperative hypocaloric parenteral nutrition on perioperative infectious complications in patients undergoing hepatectomy for primary hepatic carcinoma.Methods:The data of 205 patients who underwent hepatectomy for primary hepatic carcinoma in the Division of Hepatobiliary and Transplantation Surgery at Nanjing Drum Tower Hospital between February 2020 and December 2022 were collected by a single center prospective cohort study. The patients were divided into a hypocaloric group ( n=108) and a normal calorie group ( n=97) based on whether they received hypocaloric parenteral nutrition within 72 hours postoperatively. The influence of early parenteral nutrition caloric on perioperative infectious complications was analyzed. Measurement data with normal distribution were expressed as mean±standard deviation ( ± s) and compared using t-test. Measurement data with skewed distribution were expressed as M( Q1, Q3) and compared using the Wilcoxon rank-sum test. Comparison of categorical data was performed using the chi-square test or Fisher′s exact test. To adjust for confounding factors, patients were grouped for comparison based on whether they experienced infectious complications within the 30-day postoperative follow-up period. Factors that may influence postoperative infectious complications were first analyzed using univariate analysis, and variables with statistical significance were then included in multivariate analysis. Results:A total of 82 patients experiencing infectious complications, resulting in an incidence rate of 40.0%. Patients in the hypocaloric parenteral nutrition group had significantly lower rates of hyperglycemic events (17.6% vs 29.9%, P=0.038) and gastrointestinal reactions (12.0% vs 22.7%, P=0.043) compared to the normal calorie parenteral nutrition group, with no intergroup differences in other nutrition-related complications. Univariate analysis results revealed that hypocaloric parenteral nutrition, hepatocellular carcinoma, malnutrition assessed by the GLIM criteria, open surgery, major hepatectomy, perioperative hyperglycemic events, and the presence of pleural or ascitic fluid were potential influencing factors for the occurrence of infectious complications ( P<0.05). Multivariate analysis results suggested that malnutrition ( OR=2.707, 95% CI: 1.153-6.354, P=0.022), open surgery ( OR=2.103, 95% CI: 1.073-4.122, P=0.030), perioperative hyperglycemic events ( OR=2.630, 95% CI: 1.228-5.631, P=0.013), and the presence of pleural or ascitic fluid ( OR=2.714, 95% CI: 1.388-5.306, P=0.004) were risk factors for perioperative infectious complications in patients undergoing hepatectomy for primary hepatic carcinoma, while early postoperative hypocaloric parenteral nutrition ( OR=0.388, 95% CI: 0.199-0.757, P=0.006) was a protective factor. Conclusion:For patients undergoing hepatectomy for primary hepatic carcinoma, early postoperative hypocaloric parenteral nutrition may reduce the incidence of perioperative infectious complications compared to normal caloric parenteral nutrition, thereby improving patient clinical outcomes.

Objective:To analyze the clinical efficacy of different intervention regimens combined with Sintilimab and Lenvatinib in the treatment of liver cancer.Methods:Using a case-control study method, a retrospective analysis was conducted on 72 patients with advanced liver cancer admitted to Huangshi Central Hospital from January 2020 to January 2023. They were divided into two groups according to the treatment plan. The TACE group (36 cases) received transcatheter hepatic artery embolization chemotherapy (TACE)+ Sintilimab+ Lenvatinib, while the HAIC group (36 cases) received hepatic artery infusion chemotherapy (HAIC)+ Sintilimab+ Lenvatinib. The research data and clinical efficacy of two groups were analyzed, liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil)], and tumor between the two groups. Markers [serum alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199)]and drug safety. Telephone and outpatient follow-up were conducted on patients after treatment, calculate the disease progression rate and mortality rate of two groups of patients, and follow up until the patient′s condition progresses or until March 1, 2024. Measurement data with normal distribution were expressed as mean±standard deviation ( ± s), t-test was used between the two groups. Chi-square test was used between the two groups of count data. Results:The objective response rate of TACE group was 27.78%, while that of HAIC group was 52.78%. The objective response rate of HAIC group was higher, and the difference between the two groups was statistically significant ( P<0.05); Before treatment, the levels of AST, ALT, and TBil in the two groups were compared, with P>0.05; After treatment, the AST of the TACE group was (36.65±4.80) U/L, ALT was (55.40±5.90) U/L, and TBil was (19.65±2.25) μmol/L, while the HAIC group was (25.95± 4.92) U/L, (41.15±6.15) U/L, and (14.40±2.13) μmol/L, respectively. The levels of various indicators in the HAIC group were lower, and the difference between the two groups was statistically significant ( P<0.05); Before treatment, there was no statistically significant difference in the levels of AFP, CEA, and CA199 between the two groups ( P>0.05); Before treatment, there was no statistically significant difference in the levels of alpha fetoprotein, carcinoembryonic antigen, and CA199 between the two groups ( P>0.05); After treatment, the levels of alpha fetoprotein, carcinoembryonic antigen, and CA199 in the TACE group were (152.50±20.10) ng/mL, (3.93±1.42) ng/mL, and (20.35±3.50) IU/mL, respectively, while those in the HAIC group were (102.35±18.10) ng/mL, (2.85±1.26) ng/mL, and (21.48±3.31) IU/mL, respectively. The levels of alpha fetoprotein and carcinoembryonic antigen in the HAIC group decreased more significantly ( P<0.05); The incidence of adverse reactions in the TACE group was 33.33%, while in the HAIC group it was 25.00%. There was no statistically significant difference in the incidence of adverse reactions between the two groups ( P>0.05). All patients completed treatment. In the TACE group, there were 4 cases of disease progression and 1 case of death, with an incidence of adverse prognosis of 13.89%. In the HAIC group, there was 1 case of disease progression and no death, with an incidence of adverse prognosis of 2.78%. There was no statistical significance between the two groups( P=0.088). Conclusion:For liver cancer patients, the combination of HAIC+ Sintilimab+ Lenvatinib is more effective in improving liver function and tumor marker levels compared to the combination of HAIC+ Sintilimab+ Lenvatinib.

Objective:To explore the diagnosis and treatment of lymphoepithelioma-like intrahepatic cholangiocarcinoma(LEL-ICC).Methods:The retrospective and descriptive study was conducted. The data of 7 patients with pathological diagnosis of LEL-ICC after hepatectomy who were treated in Lishui Central Hospital in Zhejiang Province from December 1, 2009 to January 30, 2024 were collected. There were 2 males and 5 females. The age range was from 40 to 64 years old, with a median age of 52 years old. All 7 patients showed no obvious clinical symptoms.We analysed the imaging manifestations, pathological features, treatmentsand prognoses of patients.Postoperative follow-upswere conducted via telephone, with a focus on whether the patient had relapsed. The deadline was February 20, 2024.Results:Five cases underwent ultrasound examination, of which 4 cases showed hypoechogenicity and 1 case showed hyperechogenicity. 7 cases underwent MRI examination, showing low signal on T1WI, high signal on T2WI, and high signal on diffusion-weighted imaging. 2 cases had type A enhancement, 2 cases had type B enhancement, and 3 cases had type C enhancement. All 7 cases received surgical treatment, 2 cases were received prophylactic transarterial chemoembolization (TACE) after surgery, and 3 cases were received systemic chemotherapy after surgery; All 7 cases underwent postoperative follow-up, with a follow-up time of 1-166 months and a median follow-up time of 56 months. One case developed hilar and retroperitoneal lymph node metastasis after surgery for 6 months, and underwent surgical treatment. After surgery, chemotherapy was performed. 25 months later, right adrenal gland metastasis reappeared, and after combined treatment, the metastatic lesion was reduced and the patient received surgical treatment and chemotherapy, and there is currently no recurrence. The remaining 6 cases showed no recurrence.Conclusions:LEL-ICC lacks specific clinical symptoms and imaging manifestations, diagnosis relies on histopathological and immunohistochemical examinations. Comprehensive treatment with surgical intervention as the main approach can lead to better prognosis for patients.