Objective:To evaluate the safety and feasibility of continuous lamellar pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy (LPD).Methods:Clinical data of 313 patients with periampullary tumors undergoing LPD at the People's Hospital of Zhengzhou University from January 2017 to December 2021 were retrospectively analyzed, including 163 males and 150 females, aged (62.5±6.7) years. Patients were divided into two groups according to the type of pancreaticojejunostomy. Patients undergoing continuous lamellar pancreaticojejunostomy were included in the study group ( n=162) and those undergoing traditional pancreaticojejunostomy were included in the control group ( n=151). Clinical data such as gender, age, level of carbohydrate antigen 199 (CA199), operation time, postoperative hospital stay, and complications were collected. In order to reduce the baseline differences between groups, propensity score matching (PSM) was used. Results:There were significant differences in age and preoperative CA199 between the study group and the control group before PSM (all P<0.05). After PSM for age and CA199, 156 cases were successfully matched, with 78 cases in both the study and control group. Preoperative data were conparable between the two groups after PSM (all P>0.05). The drainage time [16.0 (14.0, 21.0)d vs. 18.0(15.8, 22.0)d] and postoperative hospital stay [20.0(15.0, 24.0)d vs. 21.5(20.0, 25.0)d] were shorter in the study group (all P<0.05). The incidence of grade B/C postoperative pancreatic fistula (POPF) in the study group was lower than that in the control group [7.7%(6/78) vs. 20.5%(16/78), P<0.05]. Conclusion:Compared with traditional pancreaticojejunostomy, continuous lamellar pancreaticojejunostomy could be safe and feasible, which might reduce the incidence of grade B/C POPF and enhance postoperative recovery.

Objective:To compare the efficacy of surgical resection and radiofrequency ablation (RFA) treatment for China liver cancer staging (CNLC) Ia hepatocellular carcinoma (HCC) at difficult-to-reach locations.Methods:A retrospective analysis was conducted on the clinical data of 114 patients with CNLC Ia HCC at Ⅶ、Ⅷ、Ⅳb or Ⅰ segments that were difficult-to-reach locations who were admitted to People's Hospital of Zhengzhou University from December 2018 to December 2023. Among the patients, 85 were males and 29 were females, aged (58.1±1.0) years. The patients were divided into two groups: a RFA group with 31 cases and a surgical resection group with 83 cases. Compare the levels of alanine transaminase (ALT) and aspartate transaminase (AST) before and after surgery, the surgical time, intraoperative blood loss, postoperative hospital stay, postoperative complications, recurrence free survival rate, and cumulative survival rate between the two groups.Results:The comparison of age, gender, ALT, and AST between the two groups showed no statistically significant differences (all P>0.05). The differences in ALT and AST levels before and after surgery in the RFA group were (134.8±38.7) U/L and (195.1±53.9) U/L, respectively, which were significantly lower than those in the surgical resection group [(226.8±17.9) U/L and (229.5±16.2) U/L] ( t=-2.45 and -1.12, P=0.016 and 0.041). The RFA group had shorter operation time [(69.2±11.7) min vs. (210.6±8.9) min], less intraoperative blood loss [(8.7±3.8) ml vs. (238.6±20.8) ml], and shorter postoperative hospital stays [(6.4±1.0) d vs. (13.1±0.4) d] compared to the surgical resection group, with all differences statistically significant (all P<0.05). The overall complication rates were 19.4% (6/31) in the RFA group and 22.9% (19/83) in the surgical resection group, showing no significant difference ( χ2=0.16, P=0.685). No statistically significant diffe-rence was found in recurrence-free survival rates between the two groups ( χ2=0.13, P=0.717). Similarly, there was no statistically significant difference in cumulative survival rates between the groups ( χ2<0.01, P=0.978). Conclusion:For HCC at CNLC Ⅰa in challenging locations, RFA demonstrated shorter operation time and postoperative hospital stay, less intraoperative bleeding, and superior liver function recovery compared with surgical resection, while no significant difference was observed in survival outcomes between the two treatment groups.

Objective:To analyze the application value of three-dimensional visualization combined with indocyanine green fluorescence staining in laparoscopic resection of patients with complex liver cancer.Methods:The data of patients with complex liver cancer (liver cancer located in liver segments Ⅶ, Ⅷ, Ⅳa, Ⅴ and caudate lobe) who underwent laparoscopic anatomical liver resection in Zhengzhou University People's Hospital from August 2018 to August 2023 were retrospectively analyzed. A total of 334 patients were enrolled, including 249 males and 85 females, with the age of (57.0±10.6) years. Among the 334 patients, patients who underwent laparoscopic liver resection using three-dimensional visualization combined with indocyanine green fluorescence staining were included in the combined group ( n=128), and the other patients who underwent traditional laparoscopic liver resection were included in the traditional group ( n=206). Propensity score was used to match the preoperative indicators and postoperative pathology between the two groups. The two groups were compared in terms of gender, age, maximum diameter of tumor, alpha-fetoprotein, number of tumors, tumor location, American Society of Anesthesiologists (ASA) grade, operation time, portal occlusion time, intraoperative blood loss, surgical margin and postoperative aspartate transaminase (ALT), alanine transaminase (AST), albumin, total bilirubin, and severe postoperative complications (Clavien-Dindo grade≥grade Ⅲ). The Kaplan-Meier method was used to analyze the prognosis, and the log-rank test was used to compare the survival rate. Results:After propensity score matching, 120 cases were included in the combined group and the traditional group, respectively. There were no significant differences in gender, age, maximum diameter of tumor, alpha-fetoprotein, number of tumors, tumor location, and ASA grade between the two groups (all P>0.05). The intraoperative blood loss in the combined group was 200.0 (150.0, 300.0) ml, and the positive surgical margin rate was 6.7% (8/120), which were lower than 300.0 (150.0, 500.0) ml and 15.8% (19/120) in the traditional group, with statistically significant differences ( Z=-2.43, P=0.015, χ2=5.05, P=0.025). There were no statistically significant differences in the operation time, portal occlusion time, and postoperative ALT, AST, albumin, and total bilirubin between the two groups (all P>0.05). Eight cases (6.7%) in the combined group and 11 cases (9.2%) in the traditional group had severe complications after surgery, and all were discharged after treatment. The 1-, 3-, and 5-year recurrence-free survival rates of the combined group were 83.3%, 61.7%, and 58.3% respectively, while that of the traditional group were 71.7%, 52.5%, and 49.2%, respectively, with significant difference ( χ2=4.57, P=0.031). There was no significant difference in the cumulative survival rate between the combined group and the traditional group ( χ2=0.66, P=0.417). Conclusion:Compared with laparoscopic liver resection, laparoscopic liver resection for patients with complex liver cancer using three-dimensional visualization technology combined with indocyanine green fluorescence staining technology can reduce intraoperative blood loss, positive margin rate, and postoperative recurrence.

Objective:To analyze the clinical characteristics, RAN-binding protein 2 ( RANBP2) gene variations, and prognosis in Chinese acute necrotizing encephalopathy (ANE) patients. Methods:A retrospective analysis of ANE cases registered in the Peking Union Medical College Hospital Encephalitis Registry System from 2022 to 2024, involving patients from Peking Union Medical College Hospital and other hospitals, was conducted. A descriptive study was performed on the clinical characteristics, treatments and prognosis, cerebrospinal fluid examination results, and imaging findings of these patients based on adjusted ANE diagnostic criteria. Whole-exome sequencing technology was used to detect gene mutations in these patients.Results:A total of 18 ANE cases were included, ranged in age from 2 to 72 [20(5, 43)] years. The male-to-female ratio was 4∶5. All patients were found with precipitating infections including COVID-19, influenza A virus and Mycoplasma pneumoniae infections. All patients presented with fever, with varying degrees of consciousness disturbance observed in 16 cases, and seizures in 10 cases. All patients underwent lumbar puncture, with normal or mildly elevated white cell counts [3(2, 13)×10 6/L] and mildly to moderately elevated protein levels [1.90(0.92, 4.65) g/L]. A total of 6 patients were found with extremely elevated interleukin-6 level [950(164, 2 000) pg/ml] in cerebrospinal fluid. Bilateral symmetric thalamic lesions were typical imaging features of ANE, while involvement of other areas such as cortical and subcortical white matter, brainstem, and cerebellum was also observed. A total of 14 patients performed genetic tests while 4 patients were identified with RANBP2 gene mutations (c.1754C>T in 3 cases, c.1966A>G in 1 case). All patients received immunotherapy, and 7 patients died at discharge while other patients presented with neurological sequelae of varying degrees. Conclusions:ANE is a rare and severe parainfectious encephalopathy that can occur in both children and adults. Clinically, it is characterized by rapidly progressing encephalopathy following systematic infection, with bilateral symmetric thalamic lesions. The detection of RANBP2 gene mutations could help make the diagnosis.

Objective To investigate the clinical effectiveness and safety of apatinib mesylate combined with gemcitabine+cisplatin(GC)and camrelizumab in the treatment of advanced gallbladder cancer,and to provide evidence for the clinical treatment of patients with advanced gallbladder cancer.Methods A total of 75 patients with advanced gallbladder cancer admitted to Henan Provincial People's Hospital and The Affiliated Cancer Hospital of Zhengzhou University from January 2022 to December 2023 were retrospectively included.According to treatment plans,they were divided into study group(apatinib mesylate combined with GC+camrelizumab)and control group(GC+camrelizumab).The 1-year survival rate,objective response rate(ORR),disease control rate(DCR),progression-free survival(PFS),overall survival(OS),and adverse reactions were compared between the two groups.Inter-group comparisons were performed using the chi-square test/Fisher's exact test,the t-test,and the Mann-Whitney U test for categorical data,continuous data in normal distribution,and continuous data in non-normal distribution,respectively.The Kaplan-Meier survival curves were generated and compared using the log-rank test.Results The ORR and DCR of the study group were 35.0%and 80.0%,respectively,which were not significantly different from those of the control group(bothP>0.05).The 1-year survival rate of the study group differed significantly from that of the control group(45.0%vs 20.0%,P<0.05).The median PFS was 7.73(95%confidence interval[CI]:4.39-11.01)months in the study group and 4.17(95%CI:3.48-4.85)months in the control group,and the difference was statistically significant(P<0.01).The median OS was 11.77(95%CI:8.07-15.47)months in the study group and 7.97(95%CI:5.84-10.09)months in the control group,which were not statistically significant(P>0.05).Across all grades of adverse reactions,the study group showed significantly higher incidence rates of hand-foot syndrome(62.5%vs 34.3%,χ2=5.945,P<0.05)and elevated blood pressure(42.5%vs 20.0%,χ2=4.343,P<0.05)than the control group.There were no significant differences in the incidence rates of adverse reactions of grade Ⅲ or above between the two groups(all P>0.05).Conclusion Apatinib mesylate combined with GC+camrelizumab is superior to GC+camrelizumab in prolonging the PFS but not in terms of the OS,with controllable toxic side effects,which is a safe and effective treatment regimen.

Objective To analyze the value of abnormal expression of serum alpha fetoprotein variant 3(AFP-L3)and β2 microglobulin(β2-MG)in predicting complications after interventional surgery in patients with liver cancer.Methods Clinical information of totally 92 patients with liver cancer who underwent inter-ventional surgery in the hospital from January 2020 to December 2023 were retrospectively collected and the patients were divided into complication group(33 cases)and non-complication group(59 cases)according to whether complications occurred after interventional surgery.The levels of AFP-L3 and β2-MG were detected respectively.Multivariate Logistic regression was used to analyze the the factors influencing the occurrence of complications in patients with liver cancer.Receiver operating characteristic(ROC)curve was used to evaluate the val-ue of the levels of AFP-L3 and β2-MG to predict complications in patients with liver cancer.Results Compared with the non-complication group,the proportion of patients with a history of diabetes,positive hepatitis B vi-rus(HBV)-DNA,poorly differentiated histology,and the levels of AFP-L3 and β2-MG were higher in the complication group(P＜0.05),and the course of liver cancer was longer(P＜0.05).Multivariate Logistic re-gression analysis showed that the levels of AFP-L3 and β2-MG were independent risk factors for complications after interventional surgery in patients with liver cancer.The area under the curve(AUC)of AFP-L3 and β2-MG levels in predicting complications after interventional surgery in patients with liver cancer were 0.874 and 0.854,respectively,with sensitivity of 89.77％and 74.79％,and specificity of 87.21％and 84.82％,respec-tively.The cut off values were 92.281 μg/L and 4.430 mg/L,respectively.The AUC of the combination of AFP-L3 and β2-MG levels in predicting postoperative complications was 0.910,which was significantly better than the predictive value of the single indicator(P＜0.05).Conclusion High levels of serum AFP-L3 and β2-MG may be independent risk factors for complications after interventional surgery in patients with liver canc-er.The combined detection of the two serum indicators has higher predictive value for postoperative complica-tions.It provides a new means to evaluate complications in patients with liver cancer after interventional sur-gery.

Objective To observe the value of machine learning(ML)models constructed based on pre-treatment clinical and CT features for predicting acute liver function deterioration(ALFD)in hepatocellular carcinoma(HCC)patients after the first time TACE.Methods Totally 320 HCC patients who underwent the first TACE were retrospectively enrolled and divided into training set(n=256)and test set(n=64)at the ratio of 4∶1.ALFD was evaluated according to clinical,laboratory and image findings within 2 weeks after TACE.Univariate analysis was performed to compare clinical baseline data and diameter of HCC on pre-TACE CT in training set,and parameters being statistical different between patients with and without ALFD were used to construct ML models using 9 different ML algorithms.The efficacy of each model for predicting ALFD in test set was evaluated,and the optimal model was selected.The calibration degree and clinical value of the optimal model were assessed in test set,and the contribution of each parameter was analyzed using SHAP method.Results In training set,76 cases were ALFD and 180 cases were non-ALFD,while in test set,18 cases were ALFD and 46 cases were non-ALFD.Among 9 ML models,the sensitivity,specificity,accuracy,area under the curve,F1 value and Kappa value of extreme gradient boosting(XGBoost)model in test set was 85.12%,89.34%,88.08%,0.927,0.811 and 0.725,respectively.XGBoost model was considered as the optimal one,with predicted probability in test set in good agreement with actual probability and high clinical net benefit.The contribution of patients'age,lesion diameter on pre-TACE CT,glutamic-pyruvic transaminase,glutamic-oxaloacetic transaminase and TACE time were all great for XGBoost model.Conclusion XGBoost model based on pre-treatment clinical and CT features could be used to effectively predict ALFD in HCC patients after the first time TACE.

Objective:To investigate the clinical efficacy of intraoperative regional lymph-adenectomy and extended lymphadenectomy in resectable hilar cholangiocarcinoma.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 187 patients of hilar cholangiocarcinoma who were admitted to Henan University People′s Hospital from January 2014 to January 2018 were collected. There were 105 males and 82 females, aged (57±9)years. Of the 187 patients, 62 patients undergoing hilar cholangiocarcinoma resection with extended lymphadenectomy were divided into the extended group, and 125 patients under-going hilar cholangiocarcinoma resection with regional lymphadenectomy were divided into the regional group. Observation indicators:(1) propensity score matching status and comparison of clinical data of patients between the two groups after matching; (2) intraoperative and postoperative conditions; (3) follow-up. Comparison of measurement data with normal distribu-tion between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the rank sum test. The Kaplan-Meier method was used to plot calculate survival rate and survival curve. The Log-rank test was used for survival analysis. Propen-sity score matching was performed using the 1∶1 nearest neighbor matching method, with the caliper value of 0.1. Results:(1) Propen-sity score matching status and comparison of clinical data of patients between the two groups after matching. Of the 187 patients, 104 patients were success-fully matched, with 52 cases in each of the extended group and the regional group. After propensity score matching, the elimination of tumor diameter, neural invasion, Bismuth classification, and TNM staging confounding bias ensured comparability. (2) Intraoperative and postoperative conditions. After pro-pensity score matching, the operation time of the extended group was (341±83)minutes, the number of lymph node dissected was 12.3±4.5, the number of positive lymph node dissected was 2.2±0.7, cases of postoperative new lymphadenectasis was 17. The above indicators of the regional group were (311±73)minutes, 9.2±3.4, 1.5±0.5, 44, respectively. There were significant differences in the above indica-tors between patients of the two groups ( t=-1.99, -3.92, -5.57, χ2=31.18, P<0.05). (3) Follow-up. After propensity score matching, all 104 patients were followed up after surgery, with the follow-up time of 29(range, 3-49)months. The postoperative 3-year overall survival rate was 44.2% of the extended group, versus 30.8% of the regional group, showing a significant difference between the two groups ( χ2=4.41, P<0.05). Conclusions:The perioperative safety of regional lymphadenec-tomy and extended lymphadenectomy in the radical resection of hilar cholangiocarcinoma are com-parable. Extended lymphadenectomy can increase the number of positive lymph node detected and improve the postoperative survival rate of patients.

Objective To investigate the clinical effectiveness and safety of apatinib mesylate combined with gemcitabine+cisplatin(GC)and camrelizumab in the treatment of advanced gallbladder cancer,and to provide evidence for the clinical treatment of patients with advanced gallbladder cancer.Methods A total of 75 patients with advanced gallbladder cancer admitted to Henan Provincial People's Hospital and The Affiliated Cancer Hospital of Zhengzhou University from January 2022 to December 2023 were retrospectively included.According to treatment plans,they were divided into study group(apatinib mesylate combined with GC+camrelizumab)and control group(GC+camrelizumab).The 1-year survival rate,objective response rate(ORR),disease control rate(DCR),progression-free survival(PFS),overall survival(OS),and adverse reactions were compared between the two groups.Inter-group comparisons were performed using the chi-square test/Fisher's exact test,the t-test,and the Mann-Whitney U test for categorical data,continuous data in normal distribution,and continuous data in non-normal distribution,respectively.The Kaplan-Meier survival curves were generated and compared using the log-rank test.Results The ORR and DCR of the study group were 35.0%and 80.0%,respectively,which were not significantly different from those of the control group(bothP>0.05).The 1-year survival rate of the study group differed significantly from that of the control group(45.0%vs 20.0%,P<0.05).The median PFS was 7.73(95%confidence interval[CI]:4.39-11.01)months in the study group and 4.17(95%CI:3.48-4.85)months in the control group,and the difference was statistically significant(P<0.01).The median OS was 11.77(95%CI:8.07-15.47)months in the study group and 7.97(95%CI:5.84-10.09)months in the control group,which were not statistically significant(P>0.05).Across all grades of adverse reactions,the study group showed significantly higher incidence rates of hand-foot syndrome(62.5%vs 34.3%,χ2=5.945,P<0.05)and elevated blood pressure(42.5%vs 20.0%,χ2=4.343,P<0.05)than the control group.There were no significant differences in the incidence rates of adverse reactions of grade Ⅲ or above between the two groups(all P>0.05).Conclusion Apatinib mesylate combined with GC+camrelizumab is superior to GC+camrelizumab in prolonging the PFS but not in terms of the OS,with controllable toxic side effects,which is a safe and effective treatment regimen.

Objective To observe the value of machine learning(ML)models constructed based on pre-treatment clinical and CT features for predicting acute liver function deterioration(ALFD)in hepatocellular carcinoma(HCC)patients after the first time TACE.Methods Totally 320 HCC patients who underwent the first TACE were retrospectively enrolled and divided into training set(n=256)and test set(n=64)at the ratio of 4∶1.ALFD was evaluated according to clinical,laboratory and image findings within 2 weeks after TACE.Univariate analysis was performed to compare clinical baseline data and diameter of HCC on pre-TACE CT in training set,and parameters being statistical different between patients with and without ALFD were used to construct ML models using 9 different ML algorithms.The efficacy of each model for predicting ALFD in test set was evaluated,and the optimal model was selected.The calibration degree and clinical value of the optimal model were assessed in test set,and the contribution of each parameter was analyzed using SHAP method.Results In training set,76 cases were ALFD and 180 cases were non-ALFD,while in test set,18 cases were ALFD and 46 cases were non-ALFD.Among 9 ML models,the sensitivity,specificity,accuracy,area under the curve,F1 value and Kappa value of extreme gradient boosting(XGBoost)model in test set was 85.12%,89.34%,88.08%,0.927,0.811 and 0.725,respectively.XGBoost model was considered as the optimal one,with predicted probability in test set in good agreement with actual probability and high clinical net benefit.The contribution of patients'age,lesion diameter on pre-TACE CT,glutamic-pyruvic transaminase,glutamic-oxaloacetic transaminase and TACE time were all great for XGBoost model.Conclusion XGBoost model based on pre-treatment clinical and CT features could be used to effectively predict ALFD in HCC patients after the first time TACE.