Objective:To explore the clinical effect of the whole-process management scheme of daytime minimally invasive liver resection surgery based on the enhanced recovery after surgery (ERAS) concept.Methods:This is a retrospective case series study. The data of 55 patients who underwent minimally invasive daytime liver resection surgery under the ERAS concept at the Department of General Surgery,Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from January 2023 to August 2024. There were 22 males and 33 females;aged (48.2±15.1) years (range: 16 to 77 years). All patients were classified as Grade 2 according to the American Society of Anesthesiologists physical status classification. Among them, 7 cases were complicated with liver cirrhosis and 10 cases had fatty liver. A multidisciplinary team was formed, consisting of surgeons, anesthesiologists, rehabilitation physicians, psychologists, pharmacists, acute pain management team, operating room nurses, day surgery ward nurses, and ERAS specialized nurses. After strict evaluation by surgeons and anesthesiologists, patients suitable for daytime liver resection surgery were implemented with the ERAS whole-process management plan for liver resection on the basis of routine nursing care.Results:Among the 55 patients, 50 were discharged smoothly within 48 hours, while 5 were transferred to specialized departments for further treatment due to not meeting the discharge criteria, with a smooth daytime discharge rate of 90.9%. Among the 50 patients, 30 underwent laparoscopic surgery and 20 underwent robotic-assisted surgery. The surgery time was (91.6±28.2)minutes(range:45 to 165 minutes), with the intraoperative blood loss of only (30.5±25.5)ml(range:5 to 100 ml). Pathological examination results showed that among the 50 patients, 13 cases had hepatocellular carcinoma, 21 cases had hepatic hemangioma, 4 cases had hepatic cyst, 8 cases had focal nodular hyperplasia, 1 case had low-grade dysplastic nodule, 1 case had hepatolithiasis, 1 case had lymphoma, and 1 case had vascular, fibrous and lymphoid tissue proliferation. There were 44.0% patients who were able to get out of bed on the day of surgery. The hospital stay was (1.8±0.4)days(range:1 to 2 days), and the hospitalization cost was (34 499±20 330)yuan(range:11 724 to 73 488 yuan). No complications requiring special treatment outside the conventional pathway were observed during the hospital stay and follow-up period. At the 2-week outpatient follow-up, no significant abnormalities were found in all patients, and the wound healing was good.Conclusions:The daytime liver resection surgery based on the ERAS whole-process management plan has shown good feasibility in clinical practice. It helps to simplify medical process, shorten hospital stay, and reduce medical costs.

Liver cancers are characterized by high heterogeneity and complexity,posing significant challenges in early diagnosis and prognosis,which burden patients and healthcare systems.Blood metabolomics,an emerging system biology technology,analyzes small molecular metabolites in the blood to reveal metabolic features of tumors,offering novel insights for the early diagnosis and prognosis evaluation of liver cancers.In recent years,substantial progress has been made in identifying specific blood metabolic biomarkers for liver cancers,including hepatocellular carcinoma,intrahepatic cholangiocarcinoma,and metastatic liver cancer,laying the foundation for more precise personalized treatments.However,current studies face limitations such as small sample sizes,insufficient biomarker validation,and the need for standardization.Large-scale,multi-center studies and integrated multi-omics analyses are urgently required to optimize and validate the application of blood metabolomics.This review summarizes the current state of research on blood metabolomics in liver cancers,focusing on its potential and challenges in early diagnosis and prognosis prediction,aiming to provide insights into precision diagnosis and treatment of liver cancers.

Liver cancers are characterized by high heterogeneity and complexity,posing significant challenges in early diagnosis and prognosis,which burden patients and healthcare systems.Blood metabolomics,an emerging system biology technology,analyzes small molecular metabolites in the blood to reveal metabolic features of tumors,offering novel insights for the early diagnosis and prognosis evaluation of liver cancers.In recent years,substantial progress has been made in identifying specific blood metabolic biomarkers for liver cancers,including hepatocellular carcinoma,intrahepatic cholangiocarcinoma,and metastatic liver cancer,laying the foundation for more precise personalized treatments.However,current studies face limitations such as small sample sizes,insufficient biomarker validation,and the need for standardization.Large-scale,multi-center studies and integrated multi-omics analyses are urgently required to optimize and validate the application of blood metabolomics.This review summarizes the current state of research on blood metabolomics in liver cancers,focusing on its potential and challenges in early diagnosis and prognosis prediction,aiming to provide insights into precision diagnosis and treatment of liver cancers.

Objective:To explore the clinical effect of the whole-process management scheme of daytime minimally invasive liver resection surgery based on the enhanced recovery after surgery (ERAS) concept.Methods:This is a retrospective case series study. The data of 55 patients who underwent minimally invasive daytime liver resection surgery under the ERAS concept at the Department of General Surgery,Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from January 2023 to August 2024. There were 22 males and 33 females;aged (48.2±15.1) years (range: 16 to 77 years). All patients were classified as Grade 2 according to the American Society of Anesthesiologists physical status classification. Among them, 7 cases were complicated with liver cirrhosis and 10 cases had fatty liver. A multidisciplinary team was formed, consisting of surgeons, anesthesiologists, rehabilitation physicians, psychologists, pharmacists, acute pain management team, operating room nurses, day surgery ward nurses, and ERAS specialized nurses. After strict evaluation by surgeons and anesthesiologists, patients suitable for daytime liver resection surgery were implemented with the ERAS whole-process management plan for liver resection on the basis of routine nursing care.Results:Among the 55 patients, 50 were discharged smoothly within 48 hours, while 5 were transferred to specialized departments for further treatment due to not meeting the discharge criteria, with a smooth daytime discharge rate of 90.9%. Among the 50 patients, 30 underwent laparoscopic surgery and 20 underwent robotic-assisted surgery. The surgery time was (91.6±28.2)minutes(range:45 to 165 minutes), with the intraoperative blood loss of only (30.5±25.5)ml(range:5 to 100 ml). Pathological examination results showed that among the 50 patients, 13 cases had hepatocellular carcinoma, 21 cases had hepatic hemangioma, 4 cases had hepatic cyst, 8 cases had focal nodular hyperplasia, 1 case had low-grade dysplastic nodule, 1 case had hepatolithiasis, 1 case had lymphoma, and 1 case had vascular, fibrous and lymphoid tissue proliferation. There were 44.0% patients who were able to get out of bed on the day of surgery. The hospital stay was (1.8±0.4)days(range:1 to 2 days), and the hospitalization cost was (34 499±20 330)yuan(range:11 724 to 73 488 yuan). No complications requiring special treatment outside the conventional pathway were observed during the hospital stay and follow-up period. At the 2-week outpatient follow-up, no significant abnormalities were found in all patients, and the wound healing was good.Conclusions:The daytime liver resection surgery based on the ERAS whole-process management plan has shown good feasibility in clinical practice. It helps to simplify medical process, shorten hospital stay, and reduce medical costs.

Objective To analyze the distribution of disease types of the epilepsy patients in southern Sichuan,and to provide guidances for the clinical diagnosis and treatment of epilepsy.Methods The complete medical records of inpatients with epilepsy in southern Sichuan who were clearly diagnosed in the Affiliated Hospital of Southwest Medical University from August 2014 to July 2017 were collected and sorted,and classified according to the latest revision of the epilepsy disease standard of the International AntiEpilepsy Alliance in 2017,and the distribution of disease types of these patients were statistically analyzed.Results A total of 454 patients with epilepsy were included in the study,with a male to female ratio of 1.54∶ 1,and the average age is (39.38 ±22.38) years.There were 71 patients under 15 years old,139 cases from 15 years old to 40 years old,189 cases from 41 years old to 65 years old,and 55 cases from over 65 years old.The patients in all ages were mainly classified as generalized onset,and the patients with different origins were mainly motor seizures.The focal onset were most common in the patients with epileptiform spasm from 40 days to 14 years old.The patients of generalized onset were mostly tonic-clonic seizures and under 65 years old.And the patients of unknown onset were mainly concentrated in 15-65 years old and mainly epileptic spasms.Conclusions Most of the patients with epilepsy in southern Sichuan are middle-aged and elderly,and the patients of all ages of different origins are mainly motor seizure,and the distribution of disease types of these patients are different.Moreover,the tonic-clonic seizure and epileptiform spasm are the most common types in these patients.

Objective To investigate the effects of trace element strontium on the improvement of rat lipid metabolism disor‐der ,prevention and treatment effects on non‐alcoholic fatty acid liver disease (NAFLD) and its possible mechanism .Methods Fifty SD rats were randomly divided into 5 groups .The control group used the common fodder and the other four groups adopted the high fat fodder for 13‐week feeding .During the final 9 weeks ,the strontium 18 mg/L group and the strontium 36 mg/L group were sepa‐rately fed with 18 mg/L and 36 mg/L of strontium water .During the final 4 weeks ,the simvastatin group was gavaged with simvas‐tatin 10 mg/kg .The rats were killed at the end of 14 weeks and the liver index ,serum ALT ,AST ,TG ,TC ,LDL‐C and HDL‐C ,and liver TG ,TC levels were measured .The liver tissue frozen section was performed .The fatty change and its distribution were ob‐served by oil red O staining .Results Compared with the control group ,the liver indexc ,liver TG and TC levels ,serum TC and LDL‐C in the NAFLD model group were statistically increased (P<0 .05);compared with the NAFLD model group ,the levels of serum TC and LDL‐C in the strontium 18 mg/L group were decreased ,but serum HDL‐C was also decreased(P<0 .05);in liver in‐dex ,liver TC and TG levels ,serum TC and LDL‐C in the strontium 36 mg/L group were decreased(P<0 .05) .The oil red O stai‐ning showed that the liver tissue in the NAFLD model group contained a large amount of red staining fat particles ;but which in the strontium 18 mg/L group ,strontium 36 mg/L group and the simvastatin group were decreased to some extents .Conclusion The long term high concentration trace element strontium intake has the effect for improving the rat lipid metabolic disorder and preven‐ting and treating NAFLD .