Background/Aims: Liver transplantation (LT) following total hepatectomy is a life-saving treatment for hepatocellular carcinoma (HCC). The HCC recurrence after LT hinders the effectiveness of the procedure. The objective of this study is to develop a pre-operative risk stratification model based on a liquid biopsy. Methods: We conducted a comprehensive multi-omics study of 260 HCC patients from three centers, including clinical data, low-coverage whole-genome sequencing of cell-free DNA (cfDNA) from plasma, as well as whole-exome, single-nucleus RNA, and spatial transcriptomics from matched tumor and non-tumor tissues. Results: We identified cfDNA-derived copy number alteration (CNA) signatures associated with post-transplant recurrence. By integrating cfDNA-derived CNA profiles with single-cell transcriptomic data, we traced recurrence-associated cfDNA to a distinct subpopulation of malignant cells within the primary tumor. These cells were embedded in a pro-metastatic microenvironment of specialized endothelial subtypes and cancer-associated fibroblasts. Notably, most recurrence-associated lesions were detectable in cfDNA prior to liver transplantation (LT). Building on these insights, we developed the ZJU Criteria based on CNA fragments and tumor markers, a pre-LT risk prediction tool that integrates conventional clinical factors with cfDNA-derived CNA signatures, and validated it using internal and independent external cohorts. Conclusion Our findings suggest that post-transplant recurrence commonly originates from advanced subclones that emerge late during tumor evolution. The ZJU Criteria provides an accurate, non-invasive strategy that significantly improves pre-LT risk stratification and clinical decision-making for patients with HCC.

Objective To investigate the relationship between serum soluble suppression of tumori-genicity 2(sST2)and cardiac diastolic function in elderly patients with coronary heart disease(CHD)and chronic kidney disease(CKD).Methods A total of 116 elderly CHD patients suffer-ing from CKD taking physical examinations at the Second Medical Center of Chinese PLA General Hospital from April 2021 to July 2022 were recruited,and according to their serum sST2 level,they were divided into high sST2 group(＞28.65 μg/L,58 cases)and low sST2 group(≤28.65μg/L,58 cases).The baseline data of all subjected patients were collected,including N-terminal pro-B-type natriuretic peptide(NT-proBNP),as well as peak early diastolic mitral flow velocity(E),peak early diastolic mitral annular velocity(e'),isovolumetric relaxation time(IVRT)and some other indicators in echocardiography.Serum sST2 level was measured using chemilumines-cence assay.Pearson correlation analysis and multiple linear regression analysis were used for analysis.Results The high sST2 group had significantly larger proportion of diabetes and usingβ-blockers,higher levels of sST2,urea and logNT-proBNP,increased left ventricular mass index,thicker left ventricular posterior wall thickness,and elevated E/e'and IVRT,and lower levels of hemoglobin and triacylglycerol,and decreased e'value when compared with the low sST2 group(P＜0.05,P＜0.01).The correlation analysis showed that sST2 was positively correlated with taking β-blockers,urea and logNT-proBNP levels,and E/e'ratio(r=0.226,P=0.015;r=0.362,P=0.001;r=0.374,P=0.001;r=0.257,P=0.005),and negatively correlated with triglycerides,hemoglobin and e'value(r=-0.227,P=0.014;r=-0.314,P=0.001;r=-0.203,P=0.029).Multiple linear regression analysis displayed that sST2 was linearly correlated with triglycerides,urea and NT-proBNP levels,and E/e'(P＜0.05,P＜0.01).Conclusion Serum sST2 level is cor-related with cardiac diastolic function in elderly patients with comorbidities of CHD and CKD.

Objective To assess the effectiveness of the Regulations on Medical Dispute Prevention and Resolution(hereafter referred to as the Regulations)and to provide evidence-based recommendations for enhancing the legal governance sys-tem of medical dispute management.Methods A cross-sectional study was conducted involving physicians,nurses,techni-cians,clinical department directors,and head nurses.The investigation was conducted through literature review,questionnaire surveys,and expert interviews.Factor analysis and chi-square tests were employed for statistical analysis.Results Significant differences(P＜0.01)were observed among healthcare practitioners in Guangxi concerning their understanding of the Regula-tions,preferences for dispute resolution methods,implementation of informed consent,and risk intervention practices.However,no significant differences emerged in medical quality and safety evaluations or recommendations for surgical accident insurance.Conclusion This study suggests it is a need to refine the legal framework for medical dispute prevention and resolution.It is rec-ommended to strengthen medical personnel's compliance with informed consent obligations and deepen their understanding of rel-evant laws and regulations.Efforts should be intensified to promote third-party mediation mechanisms such as the Medical Dispute Mediation Committee(MedMC)and medical accident insurance coverage.Additionally,pre-dispute risk assessments should be enhanced,and a risk early intervention model integrating artificial intelligence,healthcare practices,and legal regulations should be established.

Background and Aims:Gastroesophageal reflux disease(GERD)is a common complication following sleeve gastrectomy(SG),particularly in patients with concomitant hiatal hernia,where symptoms tend to be more persistent and refractory,significantly impairing postoperative quality of life.This study aimed to evaluate the efficacy of laparoscopic hiatal hernia repair combined with gastroesophageal fixation in SG patients with severe GERD and hiatal hernia,providing clinical reference for revisional surgical strategies.Methods:The clinical data of 9 patients with severe GERD after SG who underwent laparoscopic hiatal hernia repair and gastroesophageal fixation at Huashan Hospital,Fudan University,between January 2023 and June 2024 were retrospectively analyzed.GerdQ scores,proportion of endoscopically confirmed reflux esophagitis,and proton pump inhibitor(PPI)usage were compared before and after surgery.Surgical parameters and follow-up outcomes were also recorded.Results:All patients successfully completed the surgery without major intraoperative complications,and the mean postoperative hospital stay was 5.22 d.After a mean follow-up period of 15.27 months,the GerdQ score significantly decreased from 11.67±2.00 to 7.22±1.48.The proportion of patients with GerdQ score≥8 decreased from 100.00％to 44.44％,and the rate of endoscopically confirmed GERD dropped from 88.89％to 11.11％;PPI use also significantly declined,with all differences reaching statistical significance(all P＜0.05).Conclusion:Laparoscopic hiatal hernia repair combined with gastroesophageal fixation can effectively alleviate reflux symptoms in SG patients with coexisting hiatal hernia,demonstrating favorable short-term efficacy and high safety.This approach may be a preferable surgical option for selected patients.

Objective To assess the effectiveness of the Regulations on Medical Dispute Prevention and Resolution(hereafter referred to as the Regulations)and to provide evidence-based recommendations for enhancing the legal governance sys-tem of medical dispute management.Methods A cross-sectional study was conducted involving physicians,nurses,techni-cians,clinical department directors,and head nurses.The investigation was conducted through literature review,questionnaire surveys,and expert interviews.Factor analysis and chi-square tests were employed for statistical analysis.Results Significant differences(P＜0.01)were observed among healthcare practitioners in Guangxi concerning their understanding of the Regula-tions,preferences for dispute resolution methods,implementation of informed consent,and risk intervention practices.However,no significant differences emerged in medical quality and safety evaluations or recommendations for surgical accident insurance.Conclusion This study suggests it is a need to refine the legal framework for medical dispute prevention and resolution.It is rec-ommended to strengthen medical personnel's compliance with informed consent obligations and deepen their understanding of rel-evant laws and regulations.Efforts should be intensified to promote third-party mediation mechanisms such as the Medical Dispute Mediation Committee(MedMC)and medical accident insurance coverage.Additionally,pre-dispute risk assessments should be enhanced,and a risk early intervention model integrating artificial intelligence,healthcare practices,and legal regulations should be established.

Background and Aims:Gastroesophageal reflux disease(GERD)is a common complication following sleeve gastrectomy(SG),particularly in patients with concomitant hiatal hernia,where symptoms tend to be more persistent and refractory,significantly impairing postoperative quality of life.This study aimed to evaluate the efficacy of laparoscopic hiatal hernia repair combined with gastroesophageal fixation in SG patients with severe GERD and hiatal hernia,providing clinical reference for revisional surgical strategies.Methods:The clinical data of 9 patients with severe GERD after SG who underwent laparoscopic hiatal hernia repair and gastroesophageal fixation at Huashan Hospital,Fudan University,between January 2023 and June 2024 were retrospectively analyzed.GerdQ scores,proportion of endoscopically confirmed reflux esophagitis,and proton pump inhibitor(PPI)usage were compared before and after surgery.Surgical parameters and follow-up outcomes were also recorded.Results:All patients successfully completed the surgery without major intraoperative complications,and the mean postoperative hospital stay was 5.22 d.After a mean follow-up period of 15.27 months,the GerdQ score significantly decreased from 11.67±2.00 to 7.22±1.48.The proportion of patients with GerdQ score≥8 decreased from 100.00％to 44.44％,and the rate of endoscopically confirmed GERD dropped from 88.89％to 11.11％;PPI use also significantly declined,with all differences reaching statistical significance(all P＜0.05).Conclusion:Laparoscopic hiatal hernia repair combined with gastroesophageal fixation can effectively alleviate reflux symptoms in SG patients with coexisting hiatal hernia,demonstrating favorable short-term efficacy and high safety.This approach may be a preferable surgical option for selected patients.

Hyperuricemia is a chronic metabolic disease resulting from purine metabolic dysfunction and is classified under the category of"blood turbidity"in traditional Chinese medicine.Our team termed it"acid turbidity,"and its pathogenesis is closely related to the dynamic evolution of the clear and the turbid components.With the change of modern people's diet structure,the incidence of hyperuricemia is increasing annually owing to the intake of fatty,sweet foods and alcohol.Therefore,this paper explores hyperuricemia from the"indigestion of spleen and stomach"theory.The core pathogenesis of hyperuricemia is indigestion of spleen and stomach,the inversion of clear and turbid substances,and endogenous acid turbidity.The initial manifestation of hyperuricemia is the internal retention of acid turbidity and ascending-descending disharmony;the gradual manifestation of this disease is that indigestion causes heat,and acid turbidity transforms into poison;the final manifestation of this disease is that secular indigestion causes deficiency and the inversion of clear and turbid substances.It can be summarized into three syndromes:syndromes of internal retention of dampness-turbidity,dampness-heat toxin amassment,and dampness-heat due to spleen deficiency.Therefore,this paper proposes to treat the disease according to different syndromes,with ascending the clear and descending the turbid as the core of treatment.And the therapeutic approach employs the flexible application of three methods:transportation,resolving,and transformation.For syndrome of internal retention of dampness-turbidity,treatment focuses on promoting spleen transportation to eliminate dampness;for syndrome of dampness-heat toxin amassment,the strategy is to resolve indigestion and purge heat;and for syndrome of dampness-heat due to spleen deficiency,the aim is to resolve turbidity and clear heat.By ascending the clear and descending the turbid,so that"returning the clear and the turbid to the original,"the spleen and stomach regain harmony,functions of ascending and descending are reestablished,and hyperuricemia can be effectively managed.

Objective:To explore the application value of the "Dual-Wing" traction technique in the medial & head lateral laparoscopic left hemicolectomy with radical resection.Methods:The "Dual-Wing " traction technique is based on the theory of mesenteric anatomy. The assistant lifts the proper mesentery of the digestive tract to be resected or the adjacent mesenteric tissue connected to it,thereby elevating the target organ and its mesentery as a whole away from the mesenteric bed. By utilizing the tension transmission between the proper mesenteries of adjacent organs to create counter-tension,the surgeon's operative actions are always maintained along the line of maximum counter-tension.After incising the mesenteric fusion line,this technique assists the surgeon in entering the fusion plane. A descriptive case series study method was adopted to retrospectively analyze the clinical and pathological data of 37 colorectal cancer patients who underwent laparoscopic left hemicolectomy with the "Dual-Wing" traction technique via a medial and cephalad approach, performed by the Department of Gastrointestinal Surgery at Dongjie Campus of the First Hospital of Quanzhou, Fujian Medical University, from May 2023 to November 2023.Results:All patients successfully underwent laparoscopic left hemicolectomy via the medial & head lateral approach using the "Dual-Wing" traction technique.The surgery adhered to the principles of total mesocolic excision and safely mobilized the left colon and its mesentery from the correct anatomical plane. In the entire group of patients,there were 14 males and 23 females; the mean operative time was 94.1±18.3 minutes; the mean intraoperative blood loss was 9.8±5.4 ml; the mean number of lymph nodes dissected was 18.1±3.9; the mean number of positive lymph nodes was 1.4±1.6; the pathological specimen resection margin grading was Grade A in 29 cases, Grade B in 8 cases, and no Grade C cases; the tumor TNM staging was Stage I in 3 cases, Stage IIA in 7 cases, Stage IIB in 6 cases, Stage IIIA in 2 cases, Stage IIIB in 15 cases, and Stage IIIC in 4 cases; the mean time to first flatus postoperatively was 35.7±7.5 hours; the mean length of hospital stay was 9.1±1.7 days. There were no intraoperative injuries to the pancreas or spleen. Postoperative complications occurred in 3 cases. No anastomotic leakage was observed in the entire group, and there were no deaths following the surgery.Conclusion:The application of the "Dual-Wing" traction technique to establish a stable surgical scenario can significantly reduce the demands on the assistant. It is conducive to maintaining mesenteric tension and fully exposing the surgical field. It also allows for the rapid identification and maintenance of the correct anatomical plane. For colorectal cancer patients, the surgery is safe and feasible, with satisfactory short-term therapeutic effects.

Objective:To compare bowel function 12 months after surgery between side-to-end anastomosis (SEA) and end-to-end anastomosis (EEA) groups of patients who had undergone rectal cancer resection.Methods:This single-center, prospective, open-label, phase III randomized controlled trial was approved by the Ethics Committee of Peking University People's Hospital (2018PHB040-01) and registered at ClinicalTrials. org (NCT03669237). Inclusion criteria were as follows: (1) histologically confirmed rectal adenocarcinoma; (2) tumor located 0 to 12 cm from the anal verge; (3) age≥18 years; and (4) planned R0 resection with primary reconstruction. Exclusion criteria included: (1) emergency surgery; (2) cognitive impairment; (3) non-primary anastomosis; (4) history of left-sided colonic or anorectal surgery; and (5) preexisting chronic defecation dysfunction. Eligible rectal cancer patients scheduled for elective sphincter-preserving surgery at Peking University People's Hospital were prospectively enrolled between October 2018 and March 2021 and randomly assigned to either the EEA group or the SEA group via computer-generated numbers prior to entering the operating room. All patients underwent standard radical tumor resection. Bowel function was evaluated by the low anterior resection syndrome (LARS) questionnaire. It consists of five single-choice questions and yields a total score ranging from 0 to 42. Defecation function is categorized into three levels: no LARS (0-20 points), minor LARS (21-29 points), and major LARS (30-42 points). The primary endpoint was the LARS score 12 months after surgery. Secondary endpoints included LARS scores from 1 to 11 months and during long-term follow-up(>12 months). The final follow-up was completed in July 2022. All randomized patients were included in the intention-to-treat set (ITTS). The full analysis set (FAS) was defined as ITTS patients with valid outcome data. All primary statistical analyses were performed in the FAS, and results were further compared in the per-protocol set (PPS) based on the actual treatment received.Results:A total of 323 patients underwent eligibility assessment, of whom 71 did not meet the inclusion criteria and 52 declined to participate. Ultimately, 200 patients were randomized. Median age was 64 years and 85 were women. The SEA and EEA groups comprised 102 and 98 patients, respectively. A total of 181 patients (90.5%) were included in the FAS, and 170 (85.0%) were included in the PPS. Among these, the 12-month LARS score was evaluated in 178 patients (98.3%) in the FAS and in 167 (98.2%) in the PPS. Median LARS score at 1–12 months were significantly lower in the SEA group in both the FAS dataset [12 months:8 (interquartile range [IQR], 0–22) vs. 14 (IQR, 8–29); Z=2.687, P=0.007] and the PPS dataset [12 months: 8 (IQR, 0–22) vs. 14 (IQR, 6–29); Z=2.543, P=0.011]. During long-term follow-up, the median LARS score was also significantly lower in the SEA group in the FAS dataset [2 (IQR, 0–4) vs. 11 (IQR, 2–23); Z=2.968, P=0.003] and the PPS dataset [2 (IQR, 0–14) vs. 11 (2, 27); Z=2.687, P=0.007]. Conclusion:Compared with the EEA group, bowel function was superior in the SEA group 1 year after surgery and during long-term follow-up.

Objective To investigate the relationship between serum soluble suppression of tumori-genicity 2(sST2)and cardiac diastolic function in elderly patients with coronary heart disease(CHD)and chronic kidney disease(CKD).Methods A total of 116 elderly CHD patients suffer-ing from CKD taking physical examinations at the Second Medical Center of Chinese PLA General Hospital from April 2021 to July 2022 were recruited,and according to their serum sST2 level,they were divided into high sST2 group(＞28.65 μg/L,58 cases)and low sST2 group(≤28.65μg/L,58 cases).The baseline data of all subjected patients were collected,including N-terminal pro-B-type natriuretic peptide(NT-proBNP),as well as peak early diastolic mitral flow velocity(E),peak early diastolic mitral annular velocity(e'),isovolumetric relaxation time(IVRT)and some other indicators in echocardiography.Serum sST2 level was measured using chemilumines-cence assay.Pearson correlation analysis and multiple linear regression analysis were used for analysis.Results The high sST2 group had significantly larger proportion of diabetes and usingβ-blockers,higher levels of sST2,urea and logNT-proBNP,increased left ventricular mass index,thicker left ventricular posterior wall thickness,and elevated E/e'and IVRT,and lower levels of hemoglobin and triacylglycerol,and decreased e'value when compared with the low sST2 group(P＜0.05,P＜0.01).The correlation analysis showed that sST2 was positively correlated with taking β-blockers,urea and logNT-proBNP levels,and E/e'ratio(r=0.226,P=0.015;r=0.362,P=0.001;r=0.374,P=0.001;r=0.257,P=0.005),and negatively correlated with triglycerides,hemoglobin and e'value(r=-0.227,P=0.014;r=-0.314,P=0.001;r=-0.203,P=0.029).Multiple linear regression analysis displayed that sST2 was linearly correlated with triglycerides,urea and NT-proBNP levels,and E/e'(P＜0.05,P＜0.01).Conclusion Serum sST2 level is cor-related with cardiac diastolic function in elderly patients with comorbidities of CHD and CKD.