ObjectiveTo systematically evaluate the efficacy and safety of mesenchymal stem cells （MSC） in the treatment of acute-on-chronic liver failure （ACLF）. MethodsThis study was conducted according to PRISMA guidelines， with the PROSPERO registration number of CRD42024517851. PubMed， Embase， Wanfang Data， VIP， CNKI， CBM， and the Cochrane Library were searched for randomized controlled trials （RCT） and cohort studies on MSC in the treatment of ACLF published up to November 1， 2023， and the articles were screened according to inclusion and exclusion criteria. After data extraction and quality assessment， RevMan 5.3 software was used to perform the Meta-analysis. ResultsA total of 11 articles involving 803 subjects were included in this meta-analysis. The results showed that for the patients with ACLF， MSC could improve 8-week survival rate （odds ratio ［OR］=2.71， 95% confidence interval ［CI］： 1.58‍ ‍—‍ ‍4.67， P=0.000 3）， 12-week survival rate （OR=2.24， 95%CI： 1.36‍ ‍—‍ ‍3.69， P=0.001）， 24-week survival rate （OR=2.09， 95%CI： 1.37‍ ‍—‍ ‍3.17， P=0.000 6）， and 48-week survival rate （OR=2.09， 95%CI： 1.29‍ ‍—‍ ‍3.40， P=0.003） and reduce 12-week Model for End-Stage Liver Disease （MELD） score （mean difference ［MD］=-3.27， 95%CI： -6.07 to -0.48， P=0.02） and 24-week MELD score （MD=-2.24， 95%CI： -3.16 to -1.33， P<0.000 01）； it could also reduce the level of total bilirubin after 4 weeks of treatment （MD=-36.86， 95%CI： -48.72 to -25.01， P<0.000 01） and increase 4-week albumin level （MD=2.11， 95%CI： 0.62‍ ‍—‍ ‍3.61， P=0.006） and 24-week albumin level （MD=3.54， 95%CI： 2.06‍ ‍—‍ ‍5.02， P<0.000 01）. Adverse events were evaluated in 6 studies， with no serious adverse events. ConclusionMSC have a good safety in treatment and can improve the survival rate of patients and enhance liver function to some extent， and therefore， it holds promise for clinical application.

Objective To explore the short-term surgical outcomes of the modified surgical procedure for uniportal thoracoscopic right middle lobectomy (RML). Methods In this modified approach, the incision was created at sixth or seventh intercostal space inferior to the subscapular angle. The surgeon stood on the opposite side of the operating table. The surgery was performed by serial division of the anterior oblique fissure, the vein, bronchus, artery, and horizontal fissure following the single-direction strategy. As for patients with malignant lesions, hilar and mediastinal lymph node dissection was performed. Clinical characteristics and early surgical outcomes were collected and analyzed. Results Fifty two patients were included in this study in the Department of Thoracic Surgery, West China Hospital, Sichuan University between January 2021 and June 2023. There were 20 males and 32 females at an average age of 48.0±10.5 years. No conversion or perioperative mortality was occurred. Mean surgical time was 68.1±16.8 min, mean blood loss was 16.5±4.9 mL, median chest tube duration was 2 (2-22) d and median postoperative hospital stay was 3 (3-24) d. There was no intraoperative or postoperative complication but one patient developed postoperative prolonged air leak (>5 d). Mean postoperative visual-analog scale on postoperative day 1, day 2 and day 3 was 1.5±0.8, 1.7±0.4, 0.8±0.7, respectively. Conclusion Trans-posterior-approach uniportal thoracoscopic single-direction RML is a safe, feasible, and effective procedure, which provides an appropriate direction and angle for dissection and stapling, solving the challenge of conventional uniportal RML lobectomy.