Objectives:To investigate the early related factors for hepatic insufficiency after hemihepatectomy and to construct and validate a nomogram model.Methods:This is a retrospective cohort study.There were 207 patients with liver tumor who underwent hemihepatectomy in the Department of Hepatobiliary Surgery, Cancer Hospital, Chinese Academy of Medical Sciences from October 2016 to December 2022. Using the random number method, patients were randomly divided into a model group( n=166) and a validation group( n=41) according to an 4∶1 ratio. There were 118 males and 48 females in the modeling group,with an age ( M(IQR)) of 59.0(13.3) years (range: 22.0 to 81.0 years),42 patients in the group with postoperative liver insufficiency and 124 patients in the group without postoperative liver insufficiency. There were 32 males and 9 females in the validation group, with an age of 54.0(19.0) years (range: 25.0 to 81.0 years). The first results of the peripheral blood test of patients within 24 hours after surgery were collected,and the independent related factors for incomplete postoperative liver function were determined by multivariate Logistic regression analysis,and related factors of postoperative incomplete liver function were screened by best subset selection. A nomogram model of the related factors of postoperative hepatic insufficiency after hemihepatectomy was constructed using R software,validated by internal and external validation of the model. Results:Multivariate logistic regression analysis showed that elevated D-dimer level and decreased antithrombin Ⅲ (AT-Ⅲ) activity within 24 hours after surgery were independent related factors for the development of postoperative hepatic insufficiency in hemihepatectomized patients. The results of the best subset selection showed that ALT, D-dimer, and AT-Ⅲ activity levels within 24 hours postoperatively were the most relevant factors for postoperative hepatic insufficiency. The R software was applied to build a nomogram prediction model based on the above three indicators in the model set, and the receiver operating characteristic(ROC) curve of the model showed an area under the curve of 0.803 and the calibration curve showed a U-index of -0.012 for the model( P=0.977). The results of the clinical decision analysis and the clinical impact curve indicated that the model had good clinical utility. The internal validation results of the Bootstrap method suggested that the model had reasonable consistency. The area under the ROC curve of the validation group model was 0.806, suggesting that the model had a good generalization prediction ability. Conclusions:The levels of ALT, D-dimer, and AT-Ⅲ activity within 24 hours after hemihepatectomy are valuable indicators for predicting liver insufficiency after hemihepatectomy. The nomogram model is reliable and can be used as an indicator for close postoperative monitoring.

Surgical resection remains the best approach for achieving long-term survival in patients with hepatocellular carcinoma(HCC);however,due to the low early diagnosis rate of HCC patients in China,only 15%-20%of the patients are eligible for surgical resection at the time of initial diagnosis.Even for the patients undergoing surgery,the 5-year recurrence rate after surgery is as high as 50%-70%,resulting in an unsatisfactory prognosis.In recent years,the advances in systemic therapies,especially targeted therapy combined with immunotherapy,have not only extended the survival of patients with advanced liver cancer,but also promoted the application of systemic therapy in the earlier stages of HCC.On the one hand,the progress in systemic therapy has made conversion therapy a possible option for HCC,allowing a substantial number of patients with unresectable HCC at initial diagnosis to get the opportunity for surgical resection after downstaging and achieve a survival rate similar to those with resectable early-stage HCC at initial diagnosis;on the other hand,effective systemic therapy is being applied as neoadjuvant and adjuvant therapies for patients with resectable HCC,aiming to increase the R0 resection rate,reduce postoperative recurrence,and improve overall survival.Meanwhile,it should be clearly noted that although the advances in systemic therapy have significantly altered conventional surgical treatment paradigms,most clinical studies on conversion therapy,neoadjuvant therapy,and adjuvant therapy are small-scale phase II trials,with limited high-grade evidence from evidence-based medicine.It is important to select a reasonable therapeutic goal and develop an individualized treatment regimen based on the characteristics of tumor,and further explorations are needed to search for new biomarkers for predicting the efficacy of conversion therapy and perioperative treatment and identify the population with true benefits.

Objectives:To investigate the early related factors for hepatic insufficiency after hemihepatectomy and to construct and validate a nomogram model.Methods:This is a retrospective cohort study.There were 207 patients with liver tumor who underwent hemihepatectomy in the Department of Hepatobiliary Surgery, Cancer Hospital, Chinese Academy of Medical Sciences from October 2016 to December 2022. Using the random number method, patients were randomly divided into a model group( n=166) and a validation group( n=41) according to an 4∶1 ratio. There were 118 males and 48 females in the modeling group,with an age ( M(IQR)) of 59.0(13.3) years (range: 22.0 to 81.0 years),42 patients in the group with postoperative liver insufficiency and 124 patients in the group without postoperative liver insufficiency. There were 32 males and 9 females in the validation group, with an age of 54.0(19.0) years (range: 25.0 to 81.0 years). The first results of the peripheral blood test of patients within 24 hours after surgery were collected,and the independent related factors for incomplete postoperative liver function were determined by multivariate Logistic regression analysis,and related factors of postoperative incomplete liver function were screened by best subset selection. A nomogram model of the related factors of postoperative hepatic insufficiency after hemihepatectomy was constructed using R software,validated by internal and external validation of the model. Results:Multivariate logistic regression analysis showed that elevated D-dimer level and decreased antithrombin Ⅲ (AT-Ⅲ) activity within 24 hours after surgery were independent related factors for the development of postoperative hepatic insufficiency in hemihepatectomized patients. The results of the best subset selection showed that ALT, D-dimer, and AT-Ⅲ activity levels within 24 hours postoperatively were the most relevant factors for postoperative hepatic insufficiency. The R software was applied to build a nomogram prediction model based on the above three indicators in the model set, and the receiver operating characteristic(ROC) curve of the model showed an area under the curve of 0.803 and the calibration curve showed a U-index of -0.012 for the model( P=0.977). The results of the clinical decision analysis and the clinical impact curve indicated that the model had good clinical utility. The internal validation results of the Bootstrap method suggested that the model had reasonable consistency. The area under the ROC curve of the validation group model was 0.806, suggesting that the model had a good generalization prediction ability. Conclusions:The levels of ALT, D-dimer, and AT-Ⅲ activity within 24 hours after hemihepatectomy are valuable indicators for predicting liver insufficiency after hemihepatectomy. The nomogram model is reliable and can be used as an indicator for close postoperative monitoring.

Humans ; Consensus ; Liver Neoplasms/therapy* ; China

Hepatocellular carcinoma is still a severe threat to people′s health of China. Most patients have advanced disease at the time of first diagnosis and lose the opportunity of radical surgery. In the past, the traditional medical drug treatment and radiotherapy are ineffective, which make the treatment of hepatocellular carcinoma into a bottleneck. With the emergence of target therapy represented as tyrosine kinase inhibitors and immunotherapy represented by programmed death-1 antibody and programmed death-ligand 1 antibody, the treatment of hepatocellular carcinoma has entered a new era and patients with advanced hepatocellular carcinoma have seen a new hope. The systemic therapy represented by target therapy and immunotherapy has not only greatly improved the survival of patients with advanced hepatocellular carcinoma, but also changed the treatment concept of hepatocellular carcinoma from single-drug therapy to combined therapy with multiple means. The treatment of hepatocellular carcinoma has changed from the era of surgery as the king to the era of surgery as the mainstay of whole-process management and comprehensive treatment. The authors review previous studies and their own experience to elaborate on the comprehensive treat-ment strategy for hepatocellular carcinoma based on surgical treatment in the era of targeted therapy and immunotherapy.

Objective:To evaluate the efficacy and safety of 192Ir brachytherapy combined with external beam radiation for the treatment of unresectable hilar cholangiocarcinoma. Methods:The clinical data of 26 patients with unresectable hilar cholangiocarcinoma admitted to Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine from February 2016 to July 2018 were retrospectively analyzed. All patients received 192Ir brachytherapy combined with external beam radiation. First, percutaneous hepatobiliary stent implantation was given, followed by external beam radiotherapy (radiotherapy dose 45 Gy, 25 times), and then 192Ir brachytherapy (radiotherapy dose 20 Gy, 4 times), a total of 4 to 6 cycles of chemotherapy. The short-term and long-term efficacy were evaluated, and the Karnofsky performance status (KPS) score, CA19-9, total bilirubin (TBIL), direct bilirubin (DBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST) level changes and percutaneous transhepatic biliary drainage (PTCD) tube indwelling time were analyzed. Adverse reactions were recorded according to the Radiation Therapy Oncology Group (RTOG) injury classification standard. Results:Three months after the end of treatment, 4 cases (15.4%) were completely remitted, 20 cases (76.9%) were partially remitted, 2 cases (7.7%) were stable, and there was no disease progression. The objective remission rate was 92.3% (24/26). The 1-year and 2-year local control rates were 75.0% and 62.5% respectively, and the 1-year and 2-year overall survival rates were 57.7% and 26.9% respectively. The KPS score was 70.39±10.76 one month after the treatment, which was significantly higher than the 60.00±10.58 before treatment ( t=-27.00, P<0.001). The levels of CA19-9 before treatment and 1 month, 2 months and 3 months after treatment were (390.88±202.62) U/ml, (322.45±204.06) U/ml, (254.00±160.49) U/ml, (182.85±124.05) U/ml, which showed a gradual decrease trend, and there was a statistically significant difference ( F=126.94, P<0.001). TBIL [(250.88±80.83) μmol/L, (153.98±61.74) μmol/L, (93.45±38.12) μmol/L, (53.82±26.75) μmol/L], DBIL [(205.82±66.68) μmol/L, (133.23±58.53) μmol/L, (64.31±36.25) μmol/L, (40.55±26.16) μmol/L], ALT [(163.92±54.12) U/L, (68.23±28.86) U/L, (45.73±21.94) U/L, (32.66±12.88) U/L], AST [(177.69±58.68) U/L, (79.23±32.87) U/L, (49.77±25.45) U/L, (35.54±16.10) U/L] showed progressive decline, with statistically significant differences ( F=315.60, P<0.001; F=385.30, P<0.001; F=284.24, P<0.001; F=311.80, P<0.001), and liver function was improved. The PTCD tube was removed after treatment in all patients, with a median time of 54 days (49-96 days). During the treatment, bone marrow suppression, nausea and vomiting, abdominal pain and biliary tract infection occurred. All of them improved after symptomatic treatment. No serious complications such as bile leakage and biliary hemorrhage occurred. Conclusion:192Ir brachytherapy combined with external beam radiation has a reliable curative effect in the treatment of unresectable hilar cholangiocarcinoma. It can improve the quality of life of patients, and the adverse reactions can be tolerated. It provides a feasible and safe treatment method for the clinic.

Objective:To explore the relationship between vegetarian diets and vitamin B 12 levels in Chinese pregnant women. Methods:A cross-sectional survey was used to explore the relationship between vegetarian diets and vitamin B 12 levels in Chinese pregnant women based on data from the Chinese National Nutrition and Health Surveillance (2015-2017). Maternal serum vitamin B 12 concentration was determined by electrochemiluminescence. Background and diet information of all subjects were collected using general and food frequency questionnaires. General Linear Model was used to analyze the difference in serum vitamin B 12 levels between vegetarian and non-vegetarian pregnant women and multivariate logistic regression for examining the relationship between vegetarian diets and vitamin B 12 deficiency (vitamin B 12<150 pmol/L) in pregnant women. Results:A total of 8 366 pregnant women were included in the analysis, and vegetarians accounted for 1.2% (102/8 366). The median serum vitamin B 12 concentrations were 155.8(93.6-212.4) pmol/L and 187.2(127.4-267.6) pmol/L ( Z=－4.22, P<0.001), and the vitamin B 12 deficiency rates were 48.0% (49/102) and 35.0% (2 896/8 264) in vegetarian and non-vegetarian women, respectively. The vitamin B 12 deficiency rate in vegetarian women was 0.89-fold higher than in non-vegetarians (95% CI: 1.24-2.89). Among the vegetarian and non-vegetarian pregnant women, vitamin B 12 deficiency rates during the first, second, and third trimesters were 34.8%(16/46), 54.3%(19/35), 66.7%(14/21), and 20.4%(521/2 559), 32.6%(941/2 886), 50.9%(1 430/2 807), noting for an increasing trend ( Z=23.54 and 2.57, P=0.010 and P<0.001). Conclusions:Vegetarian pregnant women are at high risk of vitamin B 12 deficiency. Compared with non-vegetarian women, vegetarian pregnant women in China have lower vitamin B 12 levels and a higher risk of vitamin B 12 deficiency. Moreover, the risk of vitamin B 12 deficiency will gradually increase during pregnancy.

Objective:To analyze effects of parity on women′s nutrition and health status.Methods:This study was based on the data bank of "Chinese Nutrition and Health Surveillance of Children and Adolescents Aged 0-17 years old and Lactating Mothers from 2016 to 2017". Using a multi-stage stratified random sampling method, 17 771 women at 0 to 24 months postpartum from 31 provinces in Mainland China were included in this study. Questionnaires were used to collect data on women′s general demographic characteristics, parity, mode of delivery, pre-pregnancy weight, pre-delivery weight, diseases before and during pregnancy, postpartum hemorrhage. Current body height, body weight, waist circumference, and blood pressure were measured. Blood hemoglobin, blood glucose and blood lipids were detected. Pre-pregnancy BMI, gestational weight gain, postpartum weight retention, postpartum BMI, the rates of anemia, hypertension, diabetes, and dyslipidemia were calculated. Survey sample weights were calculated according to the sampling design and number of children under 2 years old from the sixth population census data of China. Effects of parity on the observational indicators after adjusting for confounding factors were analyzed by multivariate linear regression and multivariate logistic regression.Results:The age of 17 771 women was (29.5±5.0) years old, 12.2% (2 172) were over 35 but less than 40 years old, and 3.2% (563) were over 40 years old; the women with one parity, two parities, and three parities accounted for 47.3% (8 413), 48.5% (8 620) and 4.2% (738), respectively; urban women accounted for 49.9% (8 875), and rural women accounted for 50.1% (8 896). The results from multivariate linear regression showed that the pre-pregnancy BMI of women with two and three parities was 0.55 kg/m 2 and 0.76 kg/m 2 higher than women with one parity, respectively; the results of multivariate logistic regression showed that the OR(95% CI) of pre-pregnancy anemia was 1.45(1.04-2.02) for women with three parities compared with women with one parity, and the OR(95% CI) of anemia during pregnancy for women with two parities was 1.20(1.06-1.35) compared with women with one parity. Conclusion:Parity is associated with pre-pregnancy BMI and risk of anemia before and during pregnancy in women of reproductive age.

Objective:To analyze effects of parity on women′s nutrition and health status.Methods:This study was based on the data bank of "Chinese Nutrition and Health Surveillance of Children and Adolescents Aged 0-17 years old and Lactating Mothers from 2016 to 2017". Using a multi-stage stratified random sampling method, 17 771 women at 0 to 24 months postpartum from 31 provinces in Mainland China were included in this study. Questionnaires were used to collect data on women′s general demographic characteristics, parity, mode of delivery, pre-pregnancy weight, pre-delivery weight, diseases before and during pregnancy, postpartum hemorrhage. Current body height, body weight, waist circumference, and blood pressure were measured. Blood hemoglobin, blood glucose and blood lipids were detected. Pre-pregnancy BMI, gestational weight gain, postpartum weight retention, postpartum BMI, the rates of anemia, hypertension, diabetes, and dyslipidemia were calculated. Survey sample weights were calculated according to the sampling design and number of children under 2 years old from the sixth population census data of China. Effects of parity on the observational indicators after adjusting for confounding factors were analyzed by multivariate linear regression and multivariate logistic regression.Results:The age of 17 771 women was (29.5±5.0) years old, 12.2% (2 172) were over 35 but less than 40 years old, and 3.2% (563) were over 40 years old; the women with one parity, two parities, and three parities accounted for 47.3% (8 413), 48.5% (8 620) and 4.2% (738), respectively; urban women accounted for 49.9% (8 875), and rural women accounted for 50.1% (8 896). The results from multivariate linear regression showed that the pre-pregnancy BMI of women with two and three parities was 0.55 kg/m 2 and 0.76 kg/m 2 higher than women with one parity, respectively; the results of multivariate logistic regression showed that the OR(95% CI) of pre-pregnancy anemia was 1.45(1.04-2.02) for women with three parities compared with women with one parity, and the OR(95% CI) of anemia during pregnancy for women with two parities was 1.20(1.06-1.35) compared with women with one parity. Conclusion:Parity is associated with pre-pregnancy BMI and risk of anemia before and during pregnancy in women of reproductive age.