Hepatitis B is a major global public health issue. Through the implementation of comprehensive prevention and control strategies centered on hepatitis B vaccination， China has achieved remarkable progress in hepatitis B prevention and control， while there are still many issues and challenges. This article reviews the development of hepatitis B vaccination strategies in China， analyzes the goal and advances in vaccination in different populations， and problems and challenges， in order to provide a reference for further optimizing vaccination strategies and improving the levels of prevention and control.

Objective:To analyze the application value of three-dimensional visualization combined with indocyanine green fluorescence staining in laparoscopic resection of patients with complex liver cancer.Methods:The data of patients with complex liver cancer (liver cancer located in liver segments Ⅶ, Ⅷ, Ⅳa, Ⅴ and caudate lobe) who underwent laparoscopic anatomical liver resection in Zhengzhou University People's Hospital from August 2018 to August 2023 were retrospectively analyzed. A total of 334 patients were enrolled, including 249 males and 85 females, with the age of (57.0±10.6) years. Among the 334 patients, patients who underwent laparoscopic liver resection using three-dimensional visualization combined with indocyanine green fluorescence staining were included in the combined group ( n=128), and the other patients who underwent traditional laparoscopic liver resection were included in the traditional group ( n=206). Propensity score was used to match the preoperative indicators and postoperative pathology between the two groups. The two groups were compared in terms of gender, age, maximum diameter of tumor, alpha-fetoprotein, number of tumors, tumor location, American Society of Anesthesiologists (ASA) grade, operation time, portal occlusion time, intraoperative blood loss, surgical margin and postoperative aspartate transaminase (ALT), alanine transaminase (AST), albumin, total bilirubin, and severe postoperative complications (Clavien-Dindo grade≥grade Ⅲ). The Kaplan-Meier method was used to analyze the prognosis, and the log-rank test was used to compare the survival rate. Results:After propensity score matching, 120 cases were included in the combined group and the traditional group, respectively. There were no significant differences in gender, age, maximum diameter of tumor, alpha-fetoprotein, number of tumors, tumor location, and ASA grade between the two groups (all P>0.05). The intraoperative blood loss in the combined group was 200.0 (150.0, 300.0) ml, and the positive surgical margin rate was 6.7% (8/120), which were lower than 300.0 (150.0, 500.0) ml and 15.8% (19/120) in the traditional group, with statistically significant differences ( Z=-2.43, P=0.015, χ2=5.05, P=0.025). There were no statistically significant differences in the operation time, portal occlusion time, and postoperative ALT, AST, albumin, and total bilirubin between the two groups (all P>0.05). Eight cases (6.7%) in the combined group and 11 cases (9.2%) in the traditional group had severe complications after surgery, and all were discharged after treatment. The 1-, 3-, and 5-year recurrence-free survival rates of the combined group were 83.3%, 61.7%, and 58.3% respectively, while that of the traditional group were 71.7%, 52.5%, and 49.2%, respectively, with significant difference ( χ2=4.57, P=0.031). There was no significant difference in the cumulative survival rate between the combined group and the traditional group ( χ2=0.66, P=0.417). Conclusion:Compared with laparoscopic liver resection, laparoscopic liver resection for patients with complex liver cancer using three-dimensional visualization technology combined with indocyanine green fluorescence staining technology can reduce intraoperative blood loss, positive margin rate, and postoperative recurrence.

Objective:To analyze the risk factors for clinically relevant delayed gastric emptying (CR-DGE) following laparoscopic pancreaticoduodenectomy (LPD) and to develop a model to predict the postoperative CR-DGE after LPD using the machine-learning approach with multi-model comparison.Methods:Clinical data of 278 patients with tumors located in the pancreatic head and periampullary region undergoing LPD at People’s Hospital of Zhengzhou University from January 2019 to December 2023 were retrospectively analyzed, including 167 males and 111 females, aged 59 (53, 66) years. According to the occurrence of DGE, patients were divided into the CR-DGE group ( n=94) and the non-CR-DGE group ( n=184). Main clinical characteristics were compared between the groups, including pancreatic duct diameter, intraoperative blood loss and operative time. The perioperative indicators were selected using the least absolute shrinkage and selection operator (LASSO) algorithm. Following variable selection, 278 patients were allocated into a training set ( n=222) and a validation set ( n=56) in an 8∶2 ratio. Eight machine learning models were selected to model the training set: random forest, adaptive boosting, light gradient boosting, multilayer perceptron, support vector machine, K-nearest neighbor algorithm, decision tree and complementary set plain bayes. The area under the curve (AUC) of receiver operating characteristic curve of the validation set was utilized to identify the optimal model. The predictive performance of the optimal model was evaluated using calibration plots and decision curve analysis (DCA). The contribution of each feature to the prediction is assessed using Shapley additive explanation (SHAP). Results:Univariate analysis showed statistically significant differences between the CR-DGE and non-CR-DGE groups in terms of age [66(62, 69) years vs. 56(51, 60), years], diabetes [42.6%(40/94) vs. 11.4%(21/184)], level of fibrinogen [3.43(2.74, 4.18) g/L vs. 3.84(3.19, 4.68) g/L], pancreatic duct diameter [2.00(1.50, 2.70) mm vs. 3.40(1.60, 5.00) mm], intraoperative blood loss [300(200, 600) ml vs. 200(150, 300) ml], operative time [472(430, 502) min vs. 430(365, 475) min], clinically relevant postoperative pancreatic fistula [34.0%(32/94) vs. 3.8%(7/184)], abdominal fluid accumulation [46.8%(44/94) vs. 12.5%(23/184)], postoperative hemorrhage [20.2%(19/94) vs. 3.3%(6/184)], abdominal infection [28.7%(27/94) vs. 11.4% (21/184)] and duration of postoperative gastrointestinal decompression [4.00 (2.00, 6.00) d vs. 3.00 (2.00, 5.00) d] (all P<0.05). The eleven variables selected via LASSO were incorporated into each of the eight machine learning models. Results demonstrated that the random forest model achieved the highest performance in the validation set, with an AUC of 0.894 (95% CI: 0.800-0.985), accuracy of 0.820 and sensitivity of 0.606. Calibration plots and DCA confirmed the robustness of the random forest model. SHAP analysis indicated that age, pancreatic duct diameter and preoperative aspartate aminotransferase were important predictors in the random forest model. Conclusion:The random forest model developed in this study demonstrated a good predictive performance for CR-DGE after LPD and may assist in the early identification of high-risk patients in clinical practice.

Objective:To analyze the application value of three-dimensional visualization combined with indocyanine green fluorescence staining in laparoscopic resection of patients with complex liver cancer.Methods:The data of patients with complex liver cancer (liver cancer located in liver segments Ⅶ, Ⅷ, Ⅳa, Ⅴ and caudate lobe) who underwent laparoscopic anatomical liver resection in Zhengzhou University People's Hospital from August 2018 to August 2023 were retrospectively analyzed. A total of 334 patients were enrolled, including 249 males and 85 females, with the age of (57.0±10.6) years. Among the 334 patients, patients who underwent laparoscopic liver resection using three-dimensional visualization combined with indocyanine green fluorescence staining were included in the combined group ( n=128), and the other patients who underwent traditional laparoscopic liver resection were included in the traditional group ( n=206). Propensity score was used to match the preoperative indicators and postoperative pathology between the two groups. The two groups were compared in terms of gender, age, maximum diameter of tumor, alpha-fetoprotein, number of tumors, tumor location, American Society of Anesthesiologists (ASA) grade, operation time, portal occlusion time, intraoperative blood loss, surgical margin and postoperative aspartate transaminase (ALT), alanine transaminase (AST), albumin, total bilirubin, and severe postoperative complications (Clavien-Dindo grade≥grade Ⅲ). The Kaplan-Meier method was used to analyze the prognosis, and the log-rank test was used to compare the survival rate. Results:After propensity score matching, 120 cases were included in the combined group and the traditional group, respectively. There were no significant differences in gender, age, maximum diameter of tumor, alpha-fetoprotein, number of tumors, tumor location, and ASA grade between the two groups (all P>0.05). The intraoperative blood loss in the combined group was 200.0 (150.0, 300.0) ml, and the positive surgical margin rate was 6.7% (8/120), which were lower than 300.0 (150.0, 500.0) ml and 15.8% (19/120) in the traditional group, with statistically significant differences ( Z=-2.43, P=0.015, χ2=5.05, P=0.025). There were no statistically significant differences in the operation time, portal occlusion time, and postoperative ALT, AST, albumin, and total bilirubin between the two groups (all P>0.05). Eight cases (6.7%) in the combined group and 11 cases (9.2%) in the traditional group had severe complications after surgery, and all were discharged after treatment. The 1-, 3-, and 5-year recurrence-free survival rates of the combined group were 83.3%, 61.7%, and 58.3% respectively, while that of the traditional group were 71.7%, 52.5%, and 49.2%, respectively, with significant difference ( χ2=4.57, P=0.031). There was no significant difference in the cumulative survival rate between the combined group and the traditional group ( χ2=0.66, P=0.417). Conclusion:Compared with laparoscopic liver resection, laparoscopic liver resection for patients with complex liver cancer using three-dimensional visualization technology combined with indocyanine green fluorescence staining technology can reduce intraoperative blood loss, positive margin rate, and postoperative recurrence.

Objective:To analyze the risk factors for clinically relevant delayed gastric emptying (CR-DGE) following laparoscopic pancreaticoduodenectomy (LPD) and to develop a model to predict the postoperative CR-DGE after LPD using the machine-learning approach with multi-model comparison.Methods:Clinical data of 278 patients with tumors located in the pancreatic head and periampullary region undergoing LPD at People’s Hospital of Zhengzhou University from January 2019 to December 2023 were retrospectively analyzed, including 167 males and 111 females, aged 59 (53, 66) years. According to the occurrence of DGE, patients were divided into the CR-DGE group ( n=94) and the non-CR-DGE group ( n=184). Main clinical characteristics were compared between the groups, including pancreatic duct diameter, intraoperative blood loss and operative time. The perioperative indicators were selected using the least absolute shrinkage and selection operator (LASSO) algorithm. Following variable selection, 278 patients were allocated into a training set ( n=222) and a validation set ( n=56) in an 8∶2 ratio. Eight machine learning models were selected to model the training set: random forest, adaptive boosting, light gradient boosting, multilayer perceptron, support vector machine, K-nearest neighbor algorithm, decision tree and complementary set plain bayes. The area under the curve (AUC) of receiver operating characteristic curve of the validation set was utilized to identify the optimal model. The predictive performance of the optimal model was evaluated using calibration plots and decision curve analysis (DCA). The contribution of each feature to the prediction is assessed using Shapley additive explanation (SHAP). Results:Univariate analysis showed statistically significant differences between the CR-DGE and non-CR-DGE groups in terms of age [66(62, 69) years vs. 56(51, 60), years], diabetes [42.6%(40/94) vs. 11.4%(21/184)], level of fibrinogen [3.43(2.74, 4.18) g/L vs. 3.84(3.19, 4.68) g/L], pancreatic duct diameter [2.00(1.50, 2.70) mm vs. 3.40(1.60, 5.00) mm], intraoperative blood loss [300(200, 600) ml vs. 200(150, 300) ml], operative time [472(430, 502) min vs. 430(365, 475) min], clinically relevant postoperative pancreatic fistula [34.0%(32/94) vs. 3.8%(7/184)], abdominal fluid accumulation [46.8%(44/94) vs. 12.5%(23/184)], postoperative hemorrhage [20.2%(19/94) vs. 3.3%(6/184)], abdominal infection [28.7%(27/94) vs. 11.4% (21/184)] and duration of postoperative gastrointestinal decompression [4.00 (2.00, 6.00) d vs. 3.00 (2.00, 5.00) d] (all P<0.05). The eleven variables selected via LASSO were incorporated into each of the eight machine learning models. Results demonstrated that the random forest model achieved the highest performance in the validation set, with an AUC of 0.894 (95% CI: 0.800-0.985), accuracy of 0.820 and sensitivity of 0.606. Calibration plots and DCA confirmed the robustness of the random forest model. SHAP analysis indicated that age, pancreatic duct diameter and preoperative aspartate aminotransferase were important predictors in the random forest model. Conclusion:The random forest model developed in this study demonstrated a good predictive performance for CR-DGE after LPD and may assist in the early identification of high-risk patients in clinical practice.

Objective:To analyze the influencing factors of achieving textbook outcome (TO) after pancreaticoduodenectomy (PD) in patients with pancreatic ductal adenocarcinoma, and to construct a nomograph model to explore its predictive value in TO.Methods:The clinical data of 205 patients with pancreatic ductal adenocarcinoma treated by PD in Henan University People's Hospital from January 2019 to December 2022 were analyzed retrospectively, including 88 males and 117 females with the age of (61.3±9.8) years old. Patients were divided into two groups based on whether they achieved TO after surgery: TO group ( n=113) and non-TO group ( n=92). Clinical data such as age, gender, intraoperative blood loss, operation time, blood transfusion volume, pancreatic CT value, and tumor differentiation degree were collected. Logistic regression analysis screened the influencing factors of PD postoperative TO and built a nomogram model. The performance of the nomogram model was evaluated using receiver operating characteristic (ROC) curve, calibration diagram, and decision curve analysis. Results:Multivariate logistic regression analysis showed that the higher the degree of tumor differentiation was in patients with pancreatic ductal adenocarcinoma (high differentiation to medium differentiation: OR=7.20, 95% CI: 1.20-43.28; high differentiation to low differentiation: OR=16.55, 95% CI: 2.01-136.11), CT value>38.45 Hu ( OR=0.29, 95% CI: 0.13-0.65), blood transfusion volume ≤350 ml ( OR=8.05, 95% CI: 2.94-22.01) and operative time ≤407.5 min ( OR=10.88, 95% CI: 3.90-30.41), the easier it was to achieve TO after PD (all P<0.05). Based on the above influencing factors, a nomogram model of the postoperative effect of PD on TO was established, and the consistency index of this column graph model was 0.863 (95% CI: 0.816-0.911). The sensitivity and specificity of ROC curve were 0.804 and 0.752, respectively. The calibration diagram showed that the calibration curve fits well with the ideal curve, and the decision curve showed that the model had obvious positive net benefit. Conclusion:The degree of tumor differentiation, CT value, blood transfusion volume, and operation time are independent influencing factors for the achievement of TO after PD in patients with pancreatic ductal adenocarcinoma, and the nomogram model constructed based on which has good predictive performance for TO.

Objective:To investigate the expression levels of miRNA-21 (miR-21) and miRNA-330 (miR-330) in serum exosomes of non-small cell lung cancer (NSCLC) patients with brain metastases, and the correlation of the two with the prognosis of patients.Methods:A prospective cohort study was conducted. A total of 125 NSCLC patients who were admitted to the Affiliated People's Hospital of Shandong First Medical University from March 2021 to September 2022 were prospectively selected, and the brain metastasis was determined by CT, contrast-enhanced magnetic resonance imaging of the head, or surgical pathology. The NSCLC patients were divided into the metastatic group (58 cases) and the non-metastatic group (67 cases) according to whether they had brain metastases, and 50 patients with benign lung diseases and 50 healthy subjects who underwent physical examination in the same period were selected as benign group and healthy control group respectively. Serum samples were collected from all subjects (including patients' pre-treatment samples), the exosomes were extracted, and real-time fluorescence quantitative polymerase chain reaction was used to determine the relative expression of miR-21 and miR-330 in exosomes at the transcriptional level, and electrochemiluminescence immunoassay was used to detect the levels of serum tumor markers [neuron-specific enolase (NSE), carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCCA)]. The levels of miR-21 and miR-330 in serum exosomes and serum tumor markers in the 4 groups were compared, and the correlation between miR-21 and miR-330 in serum exosomes of NSCLC patients with brain metastases before treatment and the correlation between miR-21, miR-330 and serum tumor markers were analyzed by Pearson method. Using brain metastases identified by CT, contrast-enhanced magnetic resonance imaging of the head or surgical pathology as the gold standard, the receiver operating characteristic (ROC) curves were drawn to determine the occurrence of brain metastases in NSCLC patients based on the levels of miR-21, miR-330 and their combination in the serum exosomes before treatment. NSCLC patients were divided into the poor prognosis group and the good prognosis group according to whether or not they died of tumor during the follow-up period, and the clinical characteristics and levels of miR-21 and miR-330 in serum exosomes before treatment were compared between the two groups. The independent influencing factors of death due to tumor in NSCLC patients were analyzed by multivariate logistic regression.Results:Among 125 NSCLC patients, 68 (54.4%) were male and 57 (45.6%) were female; the age was (63±5) years old, ranging from 49 to 82 years old; 89 patients (71.2%) were adenocarcinoma and 36 patients (28.8%) were squamous cell carcinoma. The transcriptional level relative expression of miR-21 in serum exosomes of healthy control group, benign group, non-metastatic group and metastatic group increased sequentially, the transcriptional level relative expression of miR-330 decreased sequentially, the protein concentrations of NSE, CEA and SCCA increased sequentially, and the differences between each two groups were statistically significant (all P<0.001). Pearson correlation analysis showed that in the serum exosomes of NSCLC patients with brain metastases before treatment, miR-21 was positively correlated with serum NSE, CEA and SCCA levels ( r values were 0.641, 0.785 and 0.612, respectively; P values were 0.015, 0.011 and 0.019, respectively), miR-330 in the serum exosomes before treatment was negatively correlated with serum NSE, CEA, and SCCA levels ( r values were -0.612, -0.689 and -0.587, respectively; P values were 0.016, 0.021 and 0.013, respectively), and miR-21 was positively correlated with miR-330 in the serum exosomes before treatment ( r = -0.529, P = 0.023). ROC curve analysis showed that the area under the curve of miR-21, miR-330 and their combination in serum exosomes before treatment for determining the occurrence of brain metastases in NSCLC patients were 0.861 (95% CI: 0.792-0.931), 0.894 (95% CI: 0.840-0.947) and 0.906 (95% CI: 0.849-0.963), and the differences were statistically significant (all P < 0.001). The optimal cut-off value of miR-21 relative expression was 1.625, and the corresponding sensitivity and specificity were 77.4% and 71.5%, respectively; the optimal cut-off value of miR-330 was 0.611, and the corresponding sensitivity and specificity were 81.1% and 74.9%, respectively; the sensitivity and specificity when the two were combined to reach the optimal cut-off value were 84.5% and 73.8%, respectively. NSCLC patients were followed up for a median time of 19 months (95% CI: 17-21 months), and 23 cases (18.4%) died due to the tumor during the follow-up period. The proportions of patients with age ≥60 years old, clinical stage Ⅲ-Ⅳ and brain metastases and the relative expression of miR-21 in serum exosomes before treatment in the poor prognosis group were higher than those in the good prognosis group, the relative expression of miR-330 in the serum exosomes before treatment was lower than that in the good prognosis group, and the differences were all statistically significant (all P < 0.05). Multivariate logistic regression analysis showed that the high age (≥60 years old vs. <60 years old, OR = 3.750, 95% CI: 1.191-11.806, P = 0.024), late clinical stage (stage Ⅲ-Ⅳ vs. stage Ⅰ-Ⅱ, OR = 4.667, 95% CI: 1.303-16.716, P = 0.018), brain metastasis (with metastasis vs. non-metastasis, OR = 2.573, 95% CI: 1.008-6.611, P = 0.049), and elevated relative expression of miR-21 in serum exosomes before treatment ( OR = 2.585, 95% CI: 1.198-6.152, P = 0.008) were the independent risk factors for death due to tumor in NSCLC patients, and elevated relative expression of miR-330 in serum exosomes before treatment was an independent protective factor for death due to tumor ( OR = 0.821, 95% CI: 0.715-0.954, P < 0.001). Conclusions:miR-21 level is high and miR-330 level is low in serum exosomes of NSCLC patients with brain metastases before treatment, and there is a negative correlation between them, and they are closely related to various serum tumor markers of NSCLC patients with brain metastases and NSCLC patients' prognosis; the combination of the two may predict the occurrence status of brain metastases in NSCLC.

Objective This study aims to develop a prognostic risk prediction model for gastric cancer based on m1A/m5C/m6A/m7G regulated genes and to investigate the relationship between this model and immunology.Methods The Cancer Genome Atlas(TCGA)gastric cancer dataset was utilized to identify m1A/m5C/m6A/m7G regulated genes with significant expression differences.A prognostic risk score(RS)model was constructed using univariate Cox regression analysis and the LASSO algorithm.The RS model was validated using the Kaplan-Meier(K-M)statistic and cell lines for RT-qPCR biological validation.A nomogram model was created using univariate and multivariate Cox regression analyses.The CIBERSORT algorithm and ESTIMATE package were employed to conduct immune correlation analysis.Results A prognostic RS model based on eight methylation regulated genes was developed to classify patients with gastric cancer as high-risk or low-risk.These eight genes showed significant expression in gastric cancer cell lines(P＜0.05).The TCGA-gastric cancer training set and GSE62254-validation set showed a substantial connection(P＜0.001)between overall survival rate(OS)and grouping status.The nomogram survival models accurately predicted 1-year(C-index = 0.703),3-year(C-index = 0.729),and 5-year(C-index = 0.734)survival rates.Immune correlation analysis showed that compared to the low-risk group,the high-risk group had higher immune scores and higher expression of immune checkpoint-related genes(P＜0.05).Conclusion We created a reliable prognostic RS model based on m1A/m5C/m6A/m7G regulated genes that can predict gastric cancer prognosis and guide individualized immunotherapy decisions.

Objective:To investigate the clinical and pathological features and improve the acknowledgement of intraductal tubulopapillary neoplasm (ITPN) of pancreas.Methods:Six cases with ITPN in the Shandong Provincial Hospital Affiliated to Shandong First Medical University combined with 40 cases from PubMed and CNKI were retrospectively analyzed. There were 25 males and 21 females, aged (58.6±16.0) years. The clinical manifestations, pathological features, treatment and so on were analyzed.Results:All cases were treated with surgery. The main clinical symptoms were upper abdominal pain and discomfort (23 cases, 50.0%), followed by jaundice (9 cases, 19.6%). Seven cases (15.2%) had no clinical symptoms. Three cases (6.5%) had low back discomfort, chills and other rare symptoms, and 4 cases (8.7%) had no clinical symptoms mentioned in the literature. Tumors of 27 cases (58.7%) located in the head of the pancreas, 9 cases (19.6%) in the body and tail, 4 cases (8.7%) in the whole pancreas, 3 cases (6.5%) in the body, 2 cases (4.3%) in ampulla and 1 case (2.2%) in head and body. Most of the tumors located in the main pancreatic duct. Microscopically, back-to-back tubular glands were densely arranged, parts of them with papillary structure, with obvious cell atypia and many mitoses. Twenty-two cases (47.8%) of ITPN were completely confined to the pancreatic duct, and 24 cases (52.2%) were with associated invasive carcinoma. Tumor cells were positive for cytokeratin 7 and mucin 1, but negative for cytokeratin 20, synaptophysin, chromogranin and trypsin. Mucin 2, mucin 5AC and mucin 6 were negative in most cases. Ki-67 ranged from 10% to 70%.Conclusion:Pancreatic ITPNs were mostly located in the pancreatic head, confined to the main pancreatic duct, and were mostly manifested as pain and discomfort in the upper abdomen. Surgery was the main treatment. Tumors cells of ITPN were arranged in tubular and papillary, with severe epithelial atypia and special immunophenotype, parts of cases accompanied with associated invasive carcinoma.

Objective:To study the rate of capsule contracture after operation of the textured surfaces breast implants and the smooth surfaces breast implants, to provide evidence for plastic surgeons to select the type of breast implants during breast augmentation.Methods:This study started from January 2018 to May 2019. Chinese and English databases including Wanfang Science and Technology Periodical Full-text Database, VIP Chinese Science and Technology Periodical Full-text Database (VIP) and CNKI, PubMed, Cochrane Library, Web of Science, Science Drirect Online were searched by computer. Some relevant studies were collected for this meta-analysis.Results:We identified 9 studies including a total of 13165 subjects for the meta-analysis. The OR value of the study was 0.43 (95% CI: 0.35, 0.51), and the incidence rate of capsule contracture in the experimental group was lower than that in the control group. In cumulative meta-analysis and sensitivity test, the conclusion was stable. And there was no publication bias found by Egger regression test. Conclusions:The textured surfaces breast implants are better than the smooth surfaces breast implants in terms of incidence rate of capsule contracture after augmentation mammoplasty.