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 Jejunal interposition is an important option for restoring gastrointestinal continuity in patients with complex esophageal cancer in whom the stomach is unavailable for reconstruction due to previous gastrectomy, tumor involvement, failed gastric conduit, or other constraints. Although the jejunum offers a caliber similar to the esophagus, a rich blood supply, and preserved peristaltic function, anatomical variations in mesenteric length and vascular arcades render long-segment and high-level reconstruction susceptible to excessive tension, mesenteric torsion, venous congestion, and inadequate distal perfusion. This consensus aims to provide standardized recommendations for the application of jejunal interposition in this specific patient population. Methods This consensus was developed in accordance with the WHO Handbook for Guideline Development and Chinese national guideline development standards, with reference to the Appraisal of Guidelines for Research & Evaluation Ⅱ(AGREE Ⅱ), Reporting Items for Practice Guidelines in Healthcare (RIGHT), and Scientific, Transparent and Applicable Rankings (STAR) checklists. The project was registered on the international practice guidelines registry platform (PREPARE-2026CN1384). The working group systematically searched Chinese and English evidence addressing 12 clinical questions. Evidence was graded using the Oxford Centre for Evidence-Based Medicine (OCEBM) 2009 system, with structured appraisal of risk of bias, inconsistency, indirectness, and imprecision. Recommendations were formulated through two rounds of Delphi surveys and a face-to-face consensus meeting, with an agreement threshold of ≥75%. Results The consensus generated 12 recommendations covering indications, selection between jejunum and colon, preoperative assessment, surgical approach and reconstruction route, pedicled jejunal interposition (PJI), supercharged pedicled jejunal interposition (SPJ), indocyanine green (ICG) perfusion assessment, perioperative nutrition, management of anastomotic leakage, long-term follow-up, and special treatment scenarios. Given that the available direct evidence is predominantly derived from single-center retrospective cohorts and case series, recommendations extrapolated from general esophagectomy or other gastrointestinal surgical evidence are deliberately phrased with caution. Conclusion Jejunal interposition is a safe and effective approach for digestive tract reconstruction in patients with complex esophageal cancer in whom the stomach is unavailable. This consensus emphasizes that clinical decision-making should be individualized based on the patient's prior treatment history, reconstruction height, vascular anatomy, technical availability, and institutional experience in the Chinese context.

The innate immune system can be boosted in response to subsequent triggers by pre-exposure to microbes or microbial products, known as “trained immunity”. Compared to classical immune memory, innate trained immunity has several different features. Firstly, the molecules involved in trained immunity differ from those involved in classical immune memory. Innate trained immunity mainly involves innate immune cells (e.g., myeloid immune cells, natural killer cells, innate lymphoid cells) and their effector molecules (e.g., pattern recognition receptor (PRR), various cytokines), as well as some kinds of non-immune cells (e.g., microglial cells). Secondly, the increased responsiveness to secondary stimuli during innate trained immunity is not specific to a particular pathogen, but influences epigenetic reprogramming in the cell through signaling pathways, leading to the sustained changes in genes transcriptional process, which ultimately affects cellular physiology without permanent genetic changes (e.g., mutations or recombination). Finally, innate trained immunity relies on an altered functional state of innate immune cells that could persist for weeks to months after initial stimulus removal. An appropriate inducer could induce trained immunity in innate lymphocytes, such as exogenous stimulants (including vaccines) and endogenous stimulants, which was firstly discovered in bone marrow derived immune cells. However, mature bone marrow derived immune cells are short-lived cells, that may not be able to transmit memory phenotypes to their offspring and provide long-term protection. Therefore, trained immunity is more likely to be relied on long-lived cells, such as epithelial stem cells, mesenchymal stromal cells and non-immune cells such as fibroblasts. Epigenetic reprogramming is one of the key molecular mechanisms that induces trained immunity, including DNA modifications, non-coding RNAs, histone modifications and chromatin remodeling. In addition to epigenetic reprogramming, different cellular metabolic pathways are involved in the regulation of innate trained immunity, including aerobic glycolysis, glutamine catabolism, cholesterol metabolism and fatty acid synthesis, through a series of intracellular cascade responses triggered by the recognition of PRR specific ligands. In the view of evolutionary, trained immunity is beneficial in enhancing protection against secondary infections with an induction in the evolutionary protective process against infections. Therefore, innate trained immunity plays an important role in therapy against diseases such as tumors and infections, which has signature therapeutic effects in these diseases. In organ transplantation, trained immunity has been associated with acute rejection, which prolongs the survival of allografts. However, trained immunity is not always protective but pathological in some cases, and dysregulated trained immunity contributes to the development of inflammatory and autoimmune diseases. Trained immunity provides a novel form of immune memory, but when inappropriately activated, may lead to an attack on tissues, causing autoinflammation. In autoimmune diseases such as rheumatoid arthritis and atherosclerosis, trained immunity may lead to enhance inflammation and tissue lesion in diseased regions. In Alzheimer’s disease and Parkinson’s disease, trained immunity may lead to over-activation of microglial cells, triggering neuroinflammation even nerve injury. This paper summarizes the basis and mechanisms of innate trained immunity, including the different cell types involved, the impacts on diseases and the effects as a therapeutic strategy to provide novel ideas for different diseases.

Objective To observe the effect of acupuncture at Zusanli(ST36)points combined with Sanhuang Decoction fumigation for postoperative hemorrhoid wound healing and repair.Methods A total of 110 postoperative hemorrhoidal patients were randomly divided into observation group and control group,55 cases in each group.The control group was treated by Potassium Permanganate Solution for sitz bath,and the observation group was treated by acupuncture at Zusanli points combined with Sanhuang Decoction fumigation on the basis of the control group's treatment.The course of treatment for the two groups covered 14 days.After two weeks of treatment,the clinical efficacy of the two groups were evaluated,and changes in the anal canal resting pressure,anal canal systolic blood pressure,anal maximal squeeze pressure,as well as the wound granulation tissue,wound area,wound effusion,and wound edema,and wound pain scores of the patients were observed before and after the treatment.The changes of levels of tumor necrosis factor α(TNF-α)and interleukin 6(IL-6)in the two groups before and after treatment were compared.Moreover,the total complication rate and wound healing time of the two groups were compared.Results(1)The total effective rate was 96.36%(53/55)in the observation group and 74.55%(41/55)in the control group.The efficacy of the observation group was superior to that of the control group,the difference being statistically significant(P<0.05).(2)After treatment,the anal canal resting pressure,anal canal systolic blood pressure,anal maximal squeeze pressure of patients in the two groups were significantly improved(P<0.05),and the improvement in the observation group was significantly superior to that in the control group,the difference being statistically significant(P<0.05).(3)After treatment,the wound granulation tissue,wound area,wound effusion,and wound edema,and wound pain scores of patients in the two groups were significantly improved(P<0.05),and the improvement in the observation group was significantly superior to that in the control group,the difference being statistically significant(P<0.05).(4)After treatment,levels of serum TNF-α and IL-6 were significantly improved in both groups(P<0.05),and the improvement in the observation group was significantly superior to that in the control group,the difference being statistically significant(P<0.05).(5)The total complication rate of the observation group was 7.27%(4/55),and that of the control group was 27.27%(15/55),and the total complication rate of the observation group was significantly lower than that of the control group,the difference being statistically significant(P<0.05).(6)The wound healing time of the observation group was significantly shorter than that of the control group,the difference being statistically significant(P<0.05).Conclusion Acupuncture at Zusanli points combined with Sanhuang Decoction fumigation for postoperative hemorrhoidal patients can effectively relieve their symptoms such as perianal pain and edema,improve the anal function,reduce inflammatory responses and the incidence of complications,promote wound repair.

Objective To report a case of tibial synovial sarcoma and review relevant literature to enhance understanding of this disease.Methods The clinical data of a patient with tibial synovial sarcoma treated at Kaifeng Central Hospital were retrospectively analyzed.A literature search was conducted in domestic and international databases,including China National Knowledge Infrastructure(CNKI),Wanfang Data,PubMed,Web of Science,and Embase,up to July 2024.Relevant literature was comprehensively reviewed to summarize the imaging and pathological characteristics,treatment,and prognosis of synovial sarcoma.Results A 29-year-old female patient was admitted with left lower extremity pain.X-ray examination revealed a proximal tibia space-occupying lesion suggestive of malignancy,and a mid-tibial space-occupying lesion considered benign.Contrast-enhanced computed tomography(CT)and plain magnetic resonance imaging(MRI)of the proximal tibial lesion also suggested malignancy.Ultrasound-guided biopsy of the proximal tibial tumor revealed a poorly differentiated malignant tumor.Immunohistochemistry results indicated monophasic synovial sarcoma,requiring genetic testing for definitive diagnosis.The patient underwent wide resection of the proximal left tibial malignancy with tumor-type artificial joint replacement,combined with curettage and bone cement filling for the left mid-tibial lesion under anesthesia.Postoperative pathology of space-occupying lesions in the proximal tibia confirmed monophasic synovial sarcoma,and fluorescence in situ hybridization(FISH)demonstrated a rupture of the synovial sarcoma translocation gene(SYT)(i.e.,SS18 positive).There was no recurrence or metastasis found in the patient during the reexamination 6 months after postoperative chemotherapy.As of July 2024,15 cases of genetically confirmed primary intraosseous synovial sarcoma have been reported internationally.Symptoms included pain and swelling,with a medical history of 1-2 years.The X-ray and CT findings showed osteolytic destruction with bone cortical discontinuity.In 13 cases,the intraosseous masses extended to the extraosseous area;in 2 cases,punctate calcifications were detected within the masses.Plain MRI scan showed iso-signal or hypo-signal on T1WI and hyper-signal,iso-signal,and hypo-signal on fat-suppressed T2WI,and enhanced MRI scan demonstrated heterogeneous enhancement.Pathological examination showed spindle-shaped cells under microscopy.Immunohistochemistry results showed positive epithelial membrane antigen(EMA),broad-spectrum cytokeratin(AE1/AE3),Ewing's sarcoma marker(CD99),and transducin-like enhancer of Split 1(TLE1).Twelve patients underwent surgical treatment;6 patients received adjuvant chemotherapy after surgery,of whom 4 developed local recurrence or distant metastasis at initial diagnosis,and 3 died during follow-up.Among the 6 patients who did not receive adjuvant chemotherapy,3 suffered from recurrence or distant metastasis.Conclusions Primary intraosseous synovial sarcoma is a rare malignant tumor with non-specific clinical manifestations.Imaging features typically include osteolytic destruction and intraosseous masses extending extraosseously,suggesting an intraosseous origin.Pathology and immunohistochemistry aid diagnosis,but definitive confirmation relies on further genetic testing.At present,the main treatment regimens for synovial sarcoma involve comprehensive therapies such as surgery and adjuvant chemotherapy,and the prognosis of patients is poor.

Objective:To explore the effect of CO2 fractional laser combined with glucocorticoid(GC)on T follicular helper cell(Tfh)and B cell subsets in patients with advanced vitiligo(VL).Methods:Patients with advanced VL(128 cases)who were treated in Affiliated Hospital of Hebei University of Engineering from August 2019 to March 2022 were selected as research objects,and divided into group A(64 cases,CO2 fractional laser combined with GC)and group B(64 cases,CO2 fractional laser)according to different treatment methods,clinical efficacy and safety of the two groups were compared.Another healthy subjects(64 cases)were selected as control group.Collected clinical data of the three groups of subjects for comparative analysis.Randomized walking model was used to evaluate the effect of CO2 fractional laser combined with GC on immune function and inflammatory response in patients with advanced VL.Results:Compared with group B,group A had a higher clinical total effective rate(P<0.05)and a lower probability of adverse reactions(P<0.05).After treatment,compared with control group,proportion of Tfh2 and Tfh17 in group A had no significant difference(P>0.05),while proportion of Tfh2 and Tfh17 in group B still had significant difference(P<0.05);compared with group B,proportion of Tfh2 in group A after treatment was higher(P<0.05),while proportion of Tfh17 type was lower(P<0.05).After treat-ment,compared with control group,proportion of memory transformed B cell in group B was still significantly different(P<0.05).After treatment,compared with control group,levels of IgA,IgE and IgM in group B were still significantly different(P<0.05);compared with group B,level of IgM in group A was higher after treatment(P<0.05).After treatment,compared with control group,levels of IL-21 and IL-1β in group B were still significantly different(P<0.05);compared with group B,level of IL-10 in group A after treatment was higher(P<0.05),while levels of IL-21 and IL-1β were lower(P<0.05).Evaluation results of random walking model showed that the improvement of immune function and inflammatory reaction in group A was better than that in group B.Conclusion:CO2 fractional laser combined with GC can improve the immune function and inflammatory reaction of patients with advanced VL better after treatment,and the probability of adverse reactions is lower.

Objective To investigate the feasibility and safety of bedside transesophageal echocardiography(TEE)-guided atrial septostomy in patients undergoing extracorporeal membrane oxygenation(ECMO)support.Methods Eight patients(2 females and 6 males)who developed pulmonary edema during VA-ECMO treatment between January 2020 and October 2024 were enrolled.All patients underwent bedside TEE-guided atrial septal puncture,followed by gradual balloon dilation using an Inoue balloon(diameter:18-24 mm).The endpoint for dilation was defined as mean left atrial pressure＜15 mmHg.Post-procedure evaluation included assessment of the septal defect size,mean left atrial pressure,and improvement in bilateral pulmonary edema.Results The mean age of all 8 patients was(43.50±16.84)years old.Atrial septostomy was successfully performed in all patients.The mean balloon dilation diameter was(22.75±2.68)mm,resulting in a mean septal defect size of(6.31±0.37)mm.The mean left atrial pressure significantly decreased from(26.63±1.77)mmHg pre-procedure to(12.75±1.28)mmHg post-procedure(P＜0.001).All patients demonstrated marked improvement in bilateral pulmonary edema,and six patients also showed a significant reduction in the severity of mitral regurgitation following the procedure.No procedure-related complications were observed.Conclusions Bedside TEE-guided atrial septostomy is safe and effective for reducing left heart loading during ECMO support and improving pulmonary edema.

Objective:To investigate the value of MRI perfusion multiple parameters in preoperative classification of glioma and differential diagnosis of single brain metastases.Methods:A retrospective analysis was conducted on 78 patients initially diagnosed with glioma or single brain metastasis admitted to Cangzhou People's Hospital from January 2018 to July 2024,including 36 cases of glioma and 42 cases of single brain metastasis.Preoperative brain magnetic resonance imaging was performed to measure dynamic sensitive contrast magnetic resonance imaging(DSC-MRI),dynamic enhanced magnetic resonance imaging(DCE-MRI),and microvascular diameter imaging(VSI)parameters.Compare multiple parameters of magnetic resonance perfusion in patients with gliomas,solitary brain metastases,and gliomas of different pathological grades.Draw the working characteristic curve of the subjects and calculate the area under the curve(AUC)to analyze the diagnostic value of multi parameter magnetic resonance perfusion for gliomas.Spearman analysis was used to investigate the correlation between multiple parameters of magnetic resonance perfusion and pathological grading of glioma patients.Results:Cerebral blood volume(rCBV),cerebral blood flow(rCBF),volume transport constant(Ktrans),extracellular space volume ratio(Ve)and VSI values of glioma patients were significantly higher than those of single brain metastases,and the differences were statistically significant(t=25.066,26.892,22.856,70.455,27.984,P<0.05).The sensitivity of rCBV,rCBF,Ktrans,Kep,Ve,and VSI in diagnosing gliomas were 79.44%,78.54%,80.11%,63.32%,74.61%,and 77.29%,respectively.The specificity was 77.27%,76.49%,78.14%,61.38%,72.58%,and 75.13%,respectively.The AUC was 0.861,0.843,0.815,0.532,0.883,and 0.762,respectively;The sensitivity,specificity,and AUC of the combined detection of rCBV,rCBF,Ktrans,Kep,Ve,and VSI for diagnosing gliomas were 85.98%,82.24%,and 0.911,respectively.The diagnostic efficacy of the combined detection for gliomas was superior to that of individual indicators(Z=0.431,0.335,0.512,0.408,0.369,0.358,P<0.05).The rCBV,rCBF,Ktrans,Ve and VSI values of patients with grade Ⅰ,Ⅱ,Ⅲ and Ⅳ glioma increased successively,and the comparison between groups was statistically significant(F=119.972,100.884,74.180,74.180,118.485,P<0.05).The values of rCBV,rCBF,Ktrans,Ve and VSI were significantly positively correlated with the pathological grade of glioma patients(r=0.685,0.726,0.745,0.668,0.714,P<0.05).Conclusion:There are great differences in the multiple parameters of MRI perfusion between brain glioma and single brain metastases.Therefore,MRI perfusion multiple parameters have high differential diagnosis value,and are helpful for preoperative diagnosis and pathological classification of brain glioma,and have clinical guiding significance.

Objective:To establish a prognostic model and explore its clinical application based on disease progression within 24 months(POD24)in patients with multiple myeloma(MM).Methods:A total of 289 patients newly diagnosed with MM at Wuxi People's Hospital from January 2007 to June 2022 were selected as the training group for retrospective analysis.A prognostic model based on POD24 was constructed using Cox univariate and multivariate analyses of overall survival(OS).A total of 184 patients from The First Affiliated Hospital of Soochow University from August 2015 to December 2019 were included in the validation group to verify the predictive efficacy of the model.Results:Age,β2-microglobulin,Calcium,and POD24 were independent prognostic factors for MM.Patients in the high-risk group(≥2 points)had shorter OS(25.0 months vs.60.0 months)and progression-free survival(PFS)(14.0 months vs.56.0 months)than those in the low-risk group(<2 points).In addition,OS and PFS differed between the high-and low-risk groups in the entire validation group,as well as in each patient subgroup(P<0.05).Conclusions:The prognostic model based on POD24,age,β2 microglobulin,and Calcium holds prognostic value for patients newly diagnosed with MM in clinical practice.

Objective:To evaluate the effect of digital design combined with 3D printing technology in the repair of mandibular defects with fibular myocutaneous flap.Methods:From July 2017 to August 2022, 25 patients with mandibular defects repaired by fibular musculocutaneous flap after oral tumor surgery were retrospectively analyzed. The cohort consisted of 25 patients (16 male, 9 female) aged 19-68 (42.5±5.3) years. The patients were divided into two groups according to different fibula shaping methods: Study group (11 cases): digital design combined with 3D printing technology was used for fibula shaping; Control group (14 cases): conventional fibula shaping was performed based on the surgeon's experience.Results:The fibula shaping time in the study group was (51.2±4.2) min, which was shorter than that in the control group (79.1±8.0) min ( P<0.001). The study group showed higher satisfaction scores for facial appearance compared to the control group [(8.3±0.8) vs (6.9±0.6) points, P<0.001]. The survival rates were 11/11 in the study group and 13/14 in the control group, with a significantly higher survival rate observed in the study group ( P<0.001). At 3 months postoperatively, the mouth opening measurements were (3.5±0.2) cm in the study group and (3.5±0.1) cm in the control group, showed no statistically significant difference ( P=0.334). Conclusion:The application of digital design combined with 3D printing technology in fibula musculocutaneous flap reconstruction of mandibular defects reduces fibula shaping time, improves flap survival rates, and yields higher patient satisfaction with facial aesthetics.