On the 110th anniversary of the founding of the Chinese Medical Association, I would like to extend my warmest congratulations and high respect. During the past 110 years, the Chinese Medical Association has protected the health of the people in the years of war, and promoted the vigorous development of the medical cause in the new era. The Chinese Medical Association has always been brave in building the tide of medical development, prospering academia and benefiting the people. On this occasion, the author summarized the development process, practice and achievements of the Chinese College of Intraoperative Ultrasound in Hepatobiliary Surgery. Since its establishment, the Chinese College of Intraoperative Ultrasound in Hepatobiliary Surgery has always been committed to promoting the precise and intelligent development of hepatobiliary surgery. It has been constantly deepening its efforts in academic research, technological innovation, personnel training and other aspects, and injecting continuous power into the vigorous deve-lopment of hepatobiliary surgery in China.

Objective:To investigate the predictive value of telomerase reverse transcriptase (TERT) promoter C228T/C250T mutations in tumor tissues of patients with hepatocellular carcinoma (HCC) for postoperative recurrence after hepatectomy.Methods:Clinical data of 66 patients with HCC who underwent curative surgical resection at the Cancer Hospital, Chinese Academy of Medical Sciences, between January 2013 and May 2016 were retrospectively analyzed, including 54 males and 12 females, aged (53.5±11.1) years. Tumor tissues were collected from all patients. Droplet digital ploymerase chain reation (ddPCR) was employed to detect the TERT promoter C228T/C250T mutations. Survival outcomes were estimated using the Kaplan-Meier method and compared by the log-rank test. Univariate and multivariate Cox regression were used to analyze the impact of TERT promoter C228T/C250T mutations on postoperative recurrence. The predictive performance of TERT mutations for postoperative recurrence was further assessed using receiver operating characteristic (ROC) curve analysis.Results:The prevalence of TERT C228T and C250T mutations in tumor tissues was 43.9% (29/66) and 3.0% (2/66), respectively. Patients were stratified into a TERT promoter mutation group ( n=31) and a non-mutation group ( n=35). Those harboring C228T/C250T mutations exhibited significantly lower recurrence-free survival compared with non-mutated cases ( χ2=10.10, P=0.002). Multivariate Cox regression analysis showed that TERT promoter C228T mutation ( HR=2.24, 95% CI: 1.18-4.25, P=0.013) and TERT promoter C228T/C250T mutations in tumor tissue ( HR=2.49, 95% CI: 1.31-4.75, P=0.006) were associated with an increased risk of postoperative recurrence in patients with HCC. ROC analysis demonstrated the predictive accuracy for recurrence, with an area under the curve of 0.68 (95% CI: 0.55-0.81) for TERT C228T mutation and 0.71 (95% CI: 0.58-0.84) for combined C228T/C250T mutations. Conclusion:TERT promoter C228T/C250T mutations in tumor tissues of HCC patients detected by ddPCR are risk factors for postoperative recurrence and may serve as indicators for predicting recurrence.

On the 110th anniversary of the founding of the Chinese Medical Association, I would like to extend my warmest congratulations and high respect. During the past 110 years, the Chinese Medical Association has protected the health of the people in the years of war, and promoted the vigorous development of the medical cause in the new era. The Chinese Medical Association has always been brave in building the tide of medical development, prospering academia and benefiting the people. On this occasion, the author summarized the development process, practice and achievements of the Chinese College of Intraoperative Ultrasound in Hepatobiliary Surgery. Since its establishment, the Chinese College of Intraoperative Ultrasound in Hepatobiliary Surgery has always been committed to promoting the precise and intelligent development of hepatobiliary surgery. It has been constantly deepening its efforts in academic research, technological innovation, personnel training and other aspects, and injecting continuous power into the vigorous deve-lopment of hepatobiliary surgery in China.

Objective:To investigate the predictive value of telomerase reverse transcriptase (TERT) promoter C228T/C250T mutations in tumor tissues of patients with hepatocellular carcinoma (HCC) for postoperative recurrence after hepatectomy.Methods:Clinical data of 66 patients with HCC who underwent curative surgical resection at the Cancer Hospital, Chinese Academy of Medical Sciences, between January 2013 and May 2016 were retrospectively analyzed, including 54 males and 12 females, aged (53.5±11.1) years. Tumor tissues were collected from all patients. Droplet digital ploymerase chain reation (ddPCR) was employed to detect the TERT promoter C228T/C250T mutations. Survival outcomes were estimated using the Kaplan-Meier method and compared by the log-rank test. Univariate and multivariate Cox regression were used to analyze the impact of TERT promoter C228T/C250T mutations on postoperative recurrence. The predictive performance of TERT mutations for postoperative recurrence was further assessed using receiver operating characteristic (ROC) curve analysis.Results:The prevalence of TERT C228T and C250T mutations in tumor tissues was 43.9% (29/66) and 3.0% (2/66), respectively. Patients were stratified into a TERT promoter mutation group ( n=31) and a non-mutation group ( n=35). Those harboring C228T/C250T mutations exhibited significantly lower recurrence-free survival compared with non-mutated cases ( χ2=10.10, P=0.002). Multivariate Cox regression analysis showed that TERT promoter C228T mutation ( HR=2.24, 95% CI: 1.18-4.25, P=0.013) and TERT promoter C228T/C250T mutations in tumor tissue ( HR=2.49, 95% CI: 1.31-4.75, P=0.006) were associated with an increased risk of postoperative recurrence in patients with HCC. ROC analysis demonstrated the predictive accuracy for recurrence, with an area under the curve of 0.68 (95% CI: 0.55-0.81) for TERT C228T mutation and 0.71 (95% CI: 0.58-0.84) for combined C228T/C250T mutations. Conclusion:TERT promoter C228T/C250T mutations in tumor tissues of HCC patients detected by ddPCR are risk factors for postoperative recurrence and may serve as indicators for predicting recurrence.

Objective:To investigate the effect of preoperative radiotherapy on postoperative recurrence in central hepatocellular carcinoma patients treated by hepatectomy.Methods:A retrospective cohort study was conducted. Clinicopathological data of 142 patients with central hepatocellular carcinoma who underwent surgical treatment at the Cancer Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College from January 2016 to January 2019 were retrospectively collected. According to whether they received preoperative radiotherapy or not, the patients were divided into preoperative radiotherapy group (30 cases) and surgery-only group (112 cases). The main observation indexes were recurrence-free survival (RFS), intraoperative bleeding amount, operation time and the occurrence of postoperative complications. Kaplan-Meier method was used for survival analysis, and log-rank test was used for intergroup comparisons; the differences between the two groups for each factor were evaluated by standardized mean difference (SMD); Cox proportional hazards model was used to analyze the influencing factors of RFS in central hepatocellular carcinoma patients with hepatectomy. Propensity score matching (PSM), regression model-adjusted propensity score (CAPS) and inverse probability of treatment weighting (IPTW) methods were used to investigate the relationship between exposure factors and confounding variables and RFS. Sensitivity analysis was performed using E-value to assess the potential impact of unmeasured confounders on outcomes.Results:Men comprised 96.7% (29/30) and 87.5% (98/112) of the preoperative radiotherapy and surgery-only groups, with ages of (55±10) years old and (54±12) years old, respectively. Before matching by the PSM method, there were differences in gender, proportion of patients with hepatitis C, alanine aminotransferase, serum albumin, alpha-fetoprotein, satellite nodules by postoperative pathology, and number of tumors between the two groups (all SMD > 0.1). A total of 26 pairs of patients were successfully matched, and there was no difference in baseline characteristics between the preoperative radiotherapy group and the surgery-only group after matching (all SMD < 0.1). Univariate Cox regression analysis showed that preoperative radiotherapy, number of tumors, maximum diameter of tumor, and satellite nodules by postoperative pathology were the influencing factors of RFS (all P < 0.05); multivariate Cox regression analysis showed that preoperative radiotherapy was an independent protective factor of RFS in central hepatocellular carcinoma patients with hepatectomy ( HR = 0.55, 95% CI: 0.31-0.97, P = 0.038), and maximum diameter of tumor ( HR = 1.08, 95% CI: 1.02-1.15, P = 0.005) and satellite nodules by postoperative pathology ( HR = 1.97, 95% CI: 1.21-3.19, P = 0.006) were independent risk factors of RFS. Preoperative radiotherapy was associated with superior RFS in patients with central hepatocellular carcinoma (PSM, HR = 0.41, 95% CI: 0.20-0.86, P = 0.018; CAPS, HR = 0.42, 95% CI: 0.20-0.87, P = 0.019; IPTW, HR = 0.41, 95% CI: 0.22-0.76, P = 0.005). Before matching, the 1-, 3-, and 5-year postoperative RFS rates in the preoperative radiotherapy group were 77%, 56% and 45%, respectively, and the surgery-only group were 48%, 32% and 28%, respectively. RFS in the preoperative radiotherapy group was superior to that in the surgery-only group before and after matching ( χ2 = 5.65, P = 0.017; χ2 = 6.00, P = 0.014). The E-value for unmeasured confounders altering the conclusions was 2.39, suggesting reliable and stable results. After matching, intraoperative bleeding [ M ( Q1, Q3)] for patients in the preoperative radiotherapy group and the surgery-only group was 300 ml (125 ml, 600 ml) and 400 ml (200 ml, 600 ml), respectively ( U = 0.51, P = 0.611), and the proportions of patients with the operation time >180 min were 92.3% (24/26) and 84.6% (22/ 26), respectively ( χ2 = 0.75, P = 0.385), and the rates of mild postoperative complications were 100.0% (26/26) and 92.3% (24/26), respectively ( χ2 = 2.08, P = 0.149), the differences were not statistically significant. Conclusions:Preoperative radiotherapy for hepatectomy in patients with central hepatocellular carcinoma is safe and effective, and has the advantage of reducing postoperative recurrence.

Objective:To explore the clinical effect of laparoscopic anatomical hepatic segment Ⅷ (S8) resection.Methods:Of 16 patients with liver cancer who underwent laparoscopic anatomical hepatic S8 resection at the National Cancer Center from October 2020 to October 2022 were were enrolled, including 13 males and 3 females, aged (59.1±10.9) years. The operation time, intraoperative blood loss, occurrence of intraoperative blood transfusion, and postoperative complications were retrospectively analyzed. Recurrence and survival were followed up by outpatient and telephone reviews.Results:Laparoscopic anatomical hepatic S8 resection was successfully performed in 16 patients without conversion to laparotomy. Among them, 10 patients underwent the intraoperative ultrasound guided hepatic parenchymal approach, and 6 underwent laparoscopic Glissonean pedicle puncture for the positive staining of S8 using indocyanine green. The operation time was (274.8±82.8) min, and the intraoperative blood loss was [ M( Q1, Q3)] 100.0 (50.0, 200.0) ml. There were no intraoperative blood transfusion or postoperative complication. The drainage tube was successfully removed and the patients were discharged 5 to 7 days after surgery. The patients were followed up for 5 to 24 months and all survived. Two patients had tumor recurrence. Conclusion:Laparoscopic anatomical S8 resection is safe and feasible.

Objective:To investigate the long-term outcome of centrally located hepatocellular carcinoma treated by radical resection and adjuvant radiotherapy(RT).Methods:A retrospective study was used to collect and analyze the clinical and pathological data of 193 patients with centrally located HCC who underwent surgery from Jun 2015 to Jun 2020. According to whether RT was used, these patients were allocated into liver resection (LR) combined RT (88 cases) and LR alone group (105 cases).Results:The 1-, 3-, and 5-year OS rates were 98%, 85%, and 74% for patients in the LR+RT group, and 79%, 66%, and 59% for patients in the LR group, respectively. The 1-, 3-, 5-year RFS rates were 76%, 55% and 44% for patients in the LR+RT group, and 51%, 40%, and 37% for patients in the LR group, respectively. OS and RFS was significantly different in LR+RT group compared with that in LR group (χ 2=5.825, P=0.016;χ 2=5.230, P=0.022, respectively). Cox analysis showed that RT was the independent prognostic factor for centrally located HCC in OS and RFS ( P=0.009, P=0.017, respectively). Subgroup analysis suggested that RT could reduce early recurrence ( HR=0.41,95% CI:0.21-0.80, P=0.002). Conclusion:Liver resection combined with adjuvant radiotherapy for centrally located HCC is safe and effective.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China. Surgery is the most important way to treat HCC currently. The high recurrence rate after hepatectomy is the most important reason to affect its prognosis, and it is also the key clinical problem to be solved. According to the recurrence time, the recurrence can be divided into early recurrence and late recurrence. The prognosis of patients with early recurrence is worse than that of patients with late recurrence. Therefore, it is very important for surgical decision-making to identify the two kinds of recurrence. This article reviews the research progress of early recurrence cut-off time of hepatocellular carcinoma after radical hepatectomy.

Objective:To investigate the long-term outcome of centrally located hepatocellular carcinoma with microvascular invasion(MVI)after radical resection.Methods:A retrospective cohort study was used to collect and analyze the clinical and pathological data of 81 patients with centrally located HCC who underwent surgery in the Cancer Hospital Chinese Academy of Medical Sciences from January 2016 to January 2018. According to the classification of MVI, patients were divided into 41 low-level group (MVI M1) and 40 high-level group (MVI M2). The 1, 3, 5-year OS and relapse free survival were calculated in all patients. The main outcomes were overall survival (OS), disease-free survival (DFS) and postoperative complications. OS and DFS of patients was estimated using Kaplan-Meier method and the difference between groups was assessed using Log-rank test. COX proportional-hazards regression models were used to estimate the association between exposure factors and prognosis. The measurement data of normal distribution were expressed by mean±standard deviation ( ± s), and t-test was used for comparison between the two groups. Measurement data with non-normal distribution were represented by M ( Q1, Q3), and rank sum test was used for comparison between the two groups.Chi-square test was used for comparison between the two groups of count data. Results:The 1-, 3-, 5-year OS and relapse free survival were 88%, 76%, 73%, and 57%, 42%, 27% for all 81 centrally located HCC patients, respectively. The DFS and OS of the MVI M1 group were 26(11, 39) months and 36(25, 53) months, respectively, and the MVI M2 group were 9(4, 29) months and 22(10, 45)months, respectively, and the difference was statistically significant ( P<0.05). In survival analysis, OS and DFS was significantly different in MVI M1 group compared with that in MVI M2 group ( HR=4.69, 95% CI: 1.539-14.286, P=0.0027; HR=1.92, 95% CI: 1.111-3.333, P=0.016). The incidence of postoperative mild complications in the MVI M1 group and the MVI M2 group was 95.1% and 90.0%, respectively. There was no significant difference between the two groups ( P=0.379). Cox analysis showed that MVI M2 was the independent prognostic factors for centrally located HCC in OS and DFS ( P<0.05). Conclusion:Surgical treatment for centrally located HCC with MVI is safe and effective, and MVI classification is an independent risk factor for its prognosis.

In order to stimulate the patients' active participation in the process of robot-assisted rehabilitation training of stroke patients, the rehabilitation robots should provide assistant torque to patients according to their rehabilitation needs. This paper proposed an assist-as-needed control strategy for wrist rehabilitation robots. Firstly, the ability evaluation rules were formulated and the patient's ability was evaluated according to the rules. Then the controller was designed. Based on the evaluation results, the controller can calculate the assistant torque needed by the patient to complete the rehabilitation training task and send commands to motor. Finally, the motor is controlled to output the commanded value, which assists the patient to complete the rehabilitation training task. The control strategy was implemented to the wrist function rehabilitation robot, which could achieve the training effect of assist-as-needed and could avoid the surge of assistance torque. In addition, therapists can adjust multiple parameters in the ability evaluation rules online to customize the difficulty of tasks for patients with different rehabilitation status. The method proposed in this paper does not rely on the information from force sensor, which reduces development costs and is easy to implement.