In December 2024, the European Association for the Study of the Liver (EASL) released the 2024 edition of EASL clinical practice guidelines: management of hepatocellular carci-noma (HCC). Compared to the 2018 edition, the 2024 edition includes significant updates in several areas, such as personalized surveillance strategies based on individual risk assessment, standardiza-tion of liver imaging protocols and diagnostic criteria, the use of minimally invasive surgical approaches in complex cases, an updated approach to liver transplantation integration, transitions between surgery, locoregional, and systemic therapies, as well as the positioning of radiotherapy and the use of combination immunotherapy at various stages of the disease. The authors systematically interpret the main updates related to treatment strategies in the new guidelines, aiming to provide clinicians with clear decision-making references for treatment.

In December 2024, the European Association for the Study of the Liver (EASL) released the 2024 edition of EASL clinical practice guidelines: management of hepatocellular carci-noma (HCC). Compared to the 2018 edition, the 2024 edition includes significant updates in several areas, such as personalized surveillance strategies based on individual risk assessment, standardiza-tion of liver imaging protocols and diagnostic criteria, the use of minimally invasive surgical approaches in complex cases, an updated approach to liver transplantation integration, transitions between surgery, locoregional, and systemic therapies, as well as the positioning of radiotherapy and the use of combination immunotherapy at various stages of the disease. The authors systematically interpret the main updates related to treatment strategies in the new guidelines, aiming to provide clinicians with clear decision-making references for treatment.

Hepatocellular carcinoma(HCC)is one of the most common malignancies with high morbidity and mortality rates worldwide.With the advances in molecular biology and tumor immunology,molecular-targeted agents represented by tyrosine kinase inhibitors(such as sorafenib and lenvatinib)and immunotherapy represented by PD-1/PD-L1 monoclonal antibodies have brought hope for patients with advanced HCC.The combination of immunotherapy and anti-angiogenic therapy can further improve the treatment outcome of patients.In addition,the optimization and integration of stereotactic body radiotherapy,local treatment,and systemic treatment may maximize the benefits of patients.In the future,through a deep understanding of the heterogeneity of HCC,the development of precision molecular subtyping and individualized treatment,and the establishment of a multidisciplinary collaborative diagnosis and treatment system,systemic therapy is expected to achieve long-term management of advanced HCC.This article reviews the current status and advances in systemic therapy for advanced HCC.

Chlorfenapyr and indenocarb are two new insecticides widely used in the world. In recent years, there have been a few cases of human being being poisoned by chlorfenapyr or indenocarb respectively at home and abroad, but no cases of poisoning caused by chlorfenapyr or indenocarb have been reported. A case of delayed central nervous system damage after chlorfenapyr and indoxacarb poisoning was reported for clinical reference.

Objective To observe the effects of different levels of stroke volume variation (SVV)directed fluid therapy on prognosis in elderly patients.Methods One hundred and ten patients (male 67 cases,female 43 cases,aged 65-80 years,ASA grade Ⅰ or Ⅱ)undergoing abdominal sur-geries were randomized into three groups on the basis of SVV level:1 1%≤SVV≤14% (group H,n=37),7%≤SVV≤10% (group M,n = 37),3% ≤ SVV≤ 6% (group L,n = 36).Each group ac-cepted different fluid therapy strategy.Perioperative intake and outtake volume were recorded.Progno-sis indicators included gastrointestinal function recovery,post and total length of hospital stay and so on were collected.Postoperative complications were also recorded.Results Along with the level of SVV dropped,The volume of colloid and crystalloid among groups were significantly increased (P <0.05).There were no remarkable difference in the time interval of activity off bed,liquid diet,gastrointestinal decompres-sion and catheterization.Group L had a delayed exhaust time compared with group H (P <0.05).Patients in the group M had a shorter time to have semi-liquid diet.The transition of diet was also shortest in the group M.But these differences were not statistically significant.The group M also had a shorter time in first-degree or above nursing time and post and total length of hospital stay compared with group L (P <0.05).The incidence of postoperative infection in group L was higher than other two groups.Incidence of anastomosis leakage in group H was higher than that in other two groups (P <0.05).Conditions of compli-cations in group L were more severe and complicated compared with other two groups.Conclusion 3%≤SVV≤6% may increase the risk of postoperative infection and prolong the time of hospitalization.Patients in the level of 7%≤SVV≤10% may have a better postoperative recovery.This level could be a better goal of perioperative fluid therapy in elderly patients.

OBJECTIVETo investigate the potential therapeutic effect of tamoxifen in treating abnormal skin scar contraction.

METHODSFibroblast-populated collagen lattices, which were made by embedding human dermal fibroblasts within type I collagen forming a three-dimensional culture system, were used as an invitro model. Then media either without or with addition of tamoxifen from 1 mumol/L to 50 mumol/L were added to the collagen lattices. Lattice areas were measured at intervals to assess the influence of tamoxifen on the lattice contraction. To visualize changes in the morphology and vitality of fibroblasts, MTT was added to the lattices.

RESULTSTamoxifen had an inhibitory effect on lattice contraction by a dose- and time-dependent pattern. 5 mumol/L or less of tamoxifen didn't show any influence on lattice contraction but 30 mumol/L or higher completely inhibited contraction. At intermediate concentrations from 10 mumol/L to 20 mumol/L the degree of lattice contraction was dose- and time-dependent, which was demonstrated by the reversibility of inhibition. Both the inhibition of contraction and the reversibility of inhibition appeared to correlate with changes in fibroblast morphology.

CONCLUSIONTamoxifen could inhibit the contraction of fibroblast-populated collagen lattices, indicating that tamoxifen may have potential effect on abnormal scar contraction in vivo.

Cicatrix ; drug therapy ; Collagen ; physiology ; Dose-Response Relationship, Drug ; Fibroblasts ; drug effects ; physiology ; Humans ; Skin ; cytology ; drug effects ; Tamoxifen ; pharmacology ; therapeutic use ; Time Factors

OBJECTIVETo lower down the antigenicity of heterogenous swine acellular dermal tissue, and to explore the feasibility of clinical using it as a composite graft for human patients.

METHODSSplit-thickness skin was harvested from healthy swines and then processed by two methods. The swine acellular dermal matrix (sADM) was prepared by removing cells from the skin with trypsin and Triton X-100. Then the cross-linked sADM (sADM(1)) and non-cross-linked sADM (sADM(0)) were embedded subcutaneously in rabbits and also transplanted onto the burn wounds of patients. The histological changes and also transplantation results were observed.

RESULTS(1) In animals with sADM(0) embedded subcutaneously, the grafted tissue was invaded immediately by host cells with obvious inflammatory reaction and tissue degradation. But there was less inflammatory reaction, and with no obvious skin degradation and contraction with sADM(1). (2) In ten burn patients with III degree burn wounds and one patient with wound in chest after scar removal, sADM and ultra-thin skin (UTS) composite graft were grafted on the wounds with autologous thin skin (ATS) and autologous razor-thin or UTS as the control. Nineteen pieces of composite skin of sADM with UTS were grafted on the wounds with survival rate of 78.9%, exhibiting no evident difference with that of ATS. When sADM(0) and UTS were grafed, there exhibited remarkable early inflammatory reaction and wound contraction with similar external appearance with that of UTS. Whereas when sADM(1) and UTS were grafted, there appeared less early inflammatory reaction and wound contraction, resulting in an even appearance and soft to touch similar to that with ATS. But ulceration occurred, with exposure of sADM(1), exposure and severe macrophage reaction to foreign body in 6 wounds of 3 cases 12.8 +/- 6.9 weeks after sADM(1) and UTS grafting.

CONCLUSIONGrafting of sADM as a dermal substitute of composite skin could alleviate early post-grafting immune reaction and improve UTS grafting results. But the delayed graft rejection couldn't be avoided.

Animals ; Burns ; surgery ; Dermatologic Surgical Procedures ; Dermis ; immunology ; transplantation ; Humans ; Rabbits ; Skin ; immunology ; injuries ; Skin Transplantation ; methods ; Skin, Artificial ; Swine ; Time Factors ; Transplantation, Heterologous ; Wound Healing

AIM: To study the effects of Rhodiola(Rho), nitric oxid e (NO), hem oglobin (HB) on the multiple organ dysfunction syndrome(MODS) in early stage aft er burn in rabbits. METHODS:The rabbits were divided into the sh am burn group (SB), burn group (B), orally taken Rho group (R), burn and Rho therapy group (BR ). The changes of hemodynamics were monitored. The index of pulmonary permeabili ty was calculated. These data reflected separately the functions of heart, live r, lung, kidney and blood coagulation system were also determined. NO contents i n ser um and bronchoalveolar lavage fluid (BALF) were measured by Griess method. The l e vels of serum HB were measured. RESULTS:① The dysfunctions of hear t, liver and kidney achieved the criterion of MODS in group B at 48 h postburns (B 48 h ). The N O content of group B significantly increased in serum and BALF at B 48 h . ② The cardiac index (CI) and creatine phosphokinase (CK), urea nitrogen (BUN) markedly raised or decreased in group BR at 48 h postburns (BR 48 h ) than B 48 h . The NO cont ents in serum and BALF markedly raised. ③ HB contents in serum markedly raised in group B and BR at 0 h postburns (B 0 h , BR 0 h ) than group SB, B 48 h , R, BR 48 h , but NO was reverse. CONCLUTIONS: ① HB contents in serum markedly raise d at 0 h post burns, but NO was reverse. ② Rho promoted the increases of NO synthesis and the blood perfusion of organs, which might be one of mechanisms to prevent the devel opment of MODS.