The incidence rate and mortality of hepatocellular carcinoma are still very high. Surgery, ablation therapy, and liver transplantation are crucial in the treatment of liver cancer, but they are prone to recurrence after surgery; In addition, hepatocellular carcinoma is often diagnosed in advanced stages, which makes systemic therapy, especially immunotherapy, an important treatment option. The immune microenvironment of liver cancer has immunosuppressive effects, and overcoming immunosuppression is the key to immunotherapy for the liver cancer. In recent years, multiple clinical trials have shown that immunotherapy, especially the combination of immune checkpoint inhibitors, has better efficacy and survival rates, making it the gold standard for treating patients with advanced hepatocellular carcinoma. This success has prompted research to expand the application of immunotherapy to neoadjuvant, adjuvant, and conversion therapies, as well as patients with liver dysfunction and those awaiting liver transplantation. Although its efficacy has been proven, there are still a large number of patients who develop resistance to immunotherapy, which requires various innovative strategies to address this challenge.

The incidence rate and mortality of hepatocellular carcinoma are still very high. Surgery, ablation therapy, and liver transplantation are crucial in the treatment of liver cancer, but they are prone to recurrence after surgery; In addition, hepatocellular carcinoma is often diagnosed in advanced stages, which makes systemic therapy, especially immunotherapy, an important treatment option. The immune microenvironment of liver cancer has immunosuppressive effects, and overcoming immunosuppression is the key to immunotherapy for the liver cancer. In recent years, multiple clinical trials have shown that immunotherapy, especially the combination of immune checkpoint inhibitors, has better efficacy and survival rates, making it the gold standard for treating patients with advanced hepatocellular carcinoma. This success has prompted research to expand the application of immunotherapy to neoadjuvant, adjuvant, and conversion therapies, as well as patients with liver dysfunction and those awaiting liver transplantation. Although its efficacy has been proven, there are still a large number of patients who develop resistance to immunotherapy, which requires various innovative strategies to address this challenge.

Objective To explore the factors influencing the prognosis of patients with veno-arterial extracorporeal membrane oxygenation(VA-ECMO).Methods A retrospective analysis was conducted on the clinical data of VA-ECMO patients admitted to Affiliated Jinhua Hospital to Zhejiang University School of Medicine from January 2019 to October 2022.The demographic characteristics,previous diseases,and clinical data at the time of extracorporeal membrane oxygenation(ECMO)establishment,such as whether cardiopulmonary resuscitation(CPR)was performed and whether the transfer was from outside the hospital,whether interventional surgery was performed,whether bleeding occurred during VA-ECMO treatment,whether continuous renal replacement therapy(CRRT)was combined,and whether the machine was successfully withdrawn were recorded.Indicators such as albumin(ALB),procalcitonin(PCT),blood lactate acid(Lac),hemoglobin(Hb),and platelet count(PLT)at 24,48,and 72 hours after ECMO establishment were recorded.The ECMO support time,intensive care unit(ICU)stay time,and total hospital stay time were statistically analyzed.The patients were divided into the survival group and the death group based on the prognosis.The differences in the above clinical indicators between the two groups with different prognoses were compared.The indicators with statistically significant differences in the univariate analysis were included in the multivariate COX regression analysis to screen for the risk factors affecting the prognosis of VA-ECMO patients.The receiver operator characteristic curve(ROC curve)was drawn to analyze the predictive value of each risk factor for the prognosis of patients.Results A total of 56 patients were included,among which 37 cases were in the survival group and 19 cases were in the death group.The ECMO support mode was all VA-ECMO.Compared with the survival group,the proportion of combined CRRT and the levels of PCT at 24,48,and 72 hours,48 hours and 72 hours difference,as well as Lac at 48 hours and 72 hours in the death group were significantly increased[the proportion of combined CRRT:78.9%(15/19)vs.35.1%(13/37),PCT(μg/L):24 hours was 26.89(9.51,69.42)vs.3.96(1.83,19.23),48 hours was 32.67(11.37,49.84)vs.4.27(1.08,15.51),72 hours was 24.86(7.73,34.80)vs.2.03(0.62,9.20),48 hours and 72 hours difference was-7.91(-14.91,-2.50)vs.-0.85(-6.17,-0.24);Lac(mmol/L):48 hours was 2.50(1.54,5.70)vs.1.60(1.13,2.79),72 hours was 2.40(1.60,4.90)vs.1.40(0.92,2.54),all P<0.05],while the levels of ALB at 24 hours and 72 hours,Hb at 72 hours,and PLT at 72 hours were significantly decreased[ALB(g/L):24 hours was 26.45±5.08 vs.29.18±2.86,72 hours was 29.06±4.81 vs.31.40±3.67;72 hours was Hb(g/L):90.53±10.84 vs.98.24±13.42,72 hours was PLT(×109/L):38(28,106)vs.100(54,134),all P<0.05],the successful weaning rate was also significantly decreased[52.6%(10/19)vs.89.2%(33/37),P<0.05],and the ECMO support time was significantly prolonged[days:8.0(7.0,11.0)vs.5.0(4.0,8.5),P<0.05].COX regression analysis showed that low ALB at 24 hours after VA-ECMO initiation,high PCT at 24 hours,lower Hb at 72 hours,high Lac at 72 hours,long ECMO support time,combined CRRT during treatment,and failure to successfully wean were independent risk factors affecting the prognosis of patients[relative risk(HR)and 95%confidence interval(95%CI)were 0.819(0.701-0.956),1.028(1.003-1.053),1.069(1.010-1.132),1.859(1.166-2.964),0.819(0.673-0.995),12.925(2.305-72.461),0.040(0.008-0.204),P values were 0.012,0.029,0.022,0.009,0.045,0.004,and 0.000,respectively].ROC curve analysis showed that 24 hours PCT,72 hours Lac,combined CRRT during treatment,and ECMO support time had predictive value for the prognosis of patients,the area under the curve(AUC)was 0.746,0.698,0.719,and 0.703,respectively.The 95%CI was 0.615-0.877,0.554-0.843,0.578-0.860,and 0.566-0.840,respectively.The P values were 0.003,0.016,0.008,and 0.014,respectively.When the cut-off value was 10.03 μg/L,1.55 mmol/L,0.50,5.5 days,the sensitivity were 73.7%,78.9%,78.7%,89.5%,and specificity were 29.7%,45.9%,35.1%,45.9%.Conclusions Low ALB at 24 hours after ECMO establishment,high PCT at 24 hours,low Hb at 72 hours,high Lac at 72 hours,combined CRRT,long ECMO support time,and failure to successfully wean are the related risk factors for the death of VA-ECMO patients.24 hours PCT,72 hours Lac,combined CRRT during treatment,and ECMO support time have predictive value for the prognosis of patients.

Objective To explore the factors influencing the prognosis of patients with veno-arterial extracorporeal membrane oxygenation(VA-ECMO).Methods A retrospective analysis was conducted on the clinical data of VA-ECMO patients admitted to Affiliated Jinhua Hospital to Zhejiang University School of Medicine from January 2019 to October 2022.The demographic characteristics,previous diseases,and clinical data at the time of extracorporeal membrane oxygenation(ECMO)establishment,such as whether cardiopulmonary resuscitation(CPR)was performed and whether the transfer was from outside the hospital,whether interventional surgery was performed,whether bleeding occurred during VA-ECMO treatment,whether continuous renal replacement therapy(CRRT)was combined,and whether the machine was successfully withdrawn were recorded.Indicators such as albumin(ALB),procalcitonin(PCT),blood lactate acid(Lac),hemoglobin(Hb),and platelet count(PLT)at 24,48,and 72 hours after ECMO establishment were recorded.The ECMO support time,intensive care unit(ICU)stay time,and total hospital stay time were statistically analyzed.The patients were divided into the survival group and the death group based on the prognosis.The differences in the above clinical indicators between the two groups with different prognoses were compared.The indicators with statistically significant differences in the univariate analysis were included in the multivariate COX regression analysis to screen for the risk factors affecting the prognosis of VA-ECMO patients.The receiver operator characteristic curve(ROC curve)was drawn to analyze the predictive value of each risk factor for the prognosis of patients.Results A total of 56 patients were included,among which 37 cases were in the survival group and 19 cases were in the death group.The ECMO support mode was all VA-ECMO.Compared with the survival group,the proportion of combined CRRT and the levels of PCT at 24,48,and 72 hours,48 hours and 72 hours difference,as well as Lac at 48 hours and 72 hours in the death group were significantly increased[the proportion of combined CRRT:78.9%(15/19)vs.35.1%(13/37),PCT(μg/L):24 hours was 26.89(9.51,69.42)vs.3.96(1.83,19.23),48 hours was 32.67(11.37,49.84)vs.4.27(1.08,15.51),72 hours was 24.86(7.73,34.80)vs.2.03(0.62,9.20),48 hours and 72 hours difference was-7.91(-14.91,-2.50)vs.-0.85(-6.17,-0.24);Lac(mmol/L):48 hours was 2.50(1.54,5.70)vs.1.60(1.13,2.79),72 hours was 2.40(1.60,4.90)vs.1.40(0.92,2.54),all P<0.05],while the levels of ALB at 24 hours and 72 hours,Hb at 72 hours,and PLT at 72 hours were significantly decreased[ALB(g/L):24 hours was 26.45±5.08 vs.29.18±2.86,72 hours was 29.06±4.81 vs.31.40±3.67;72 hours was Hb(g/L):90.53±10.84 vs.98.24±13.42,72 hours was PLT(×109/L):38(28,106)vs.100(54,134),all P<0.05],the successful weaning rate was also significantly decreased[52.6%(10/19)vs.89.2%(33/37),P<0.05],and the ECMO support time was significantly prolonged[days:8.0(7.0,11.0)vs.5.0(4.0,8.5),P<0.05].COX regression analysis showed that low ALB at 24 hours after VA-ECMO initiation,high PCT at 24 hours,lower Hb at 72 hours,high Lac at 72 hours,long ECMO support time,combined CRRT during treatment,and failure to successfully wean were independent risk factors affecting the prognosis of patients[relative risk(HR)and 95%confidence interval(95%CI)were 0.819(0.701-0.956),1.028(1.003-1.053),1.069(1.010-1.132),1.859(1.166-2.964),0.819(0.673-0.995),12.925(2.305-72.461),0.040(0.008-0.204),P values were 0.012,0.029,0.022,0.009,0.045,0.004,and 0.000,respectively].ROC curve analysis showed that 24 hours PCT,72 hours Lac,combined CRRT during treatment,and ECMO support time had predictive value for the prognosis of patients,the area under the curve(AUC)was 0.746,0.698,0.719,and 0.703,respectively.The 95%CI was 0.615-0.877,0.554-0.843,0.578-0.860,and 0.566-0.840,respectively.The P values were 0.003,0.016,0.008,and 0.014,respectively.When the cut-off value was 10.03 μg/L,1.55 mmol/L,0.50,5.5 days,the sensitivity were 73.7%,78.9%,78.7%,89.5%,and specificity were 29.7%,45.9%,35.1%,45.9%.Conclusions Low ALB at 24 hours after ECMO establishment,high PCT at 24 hours,low Hb at 72 hours,high Lac at 72 hours,combined CRRT,long ECMO support time,and failure to successfully wean are the related risk factors for the death of VA-ECMO patients.24 hours PCT,72 hours Lac,combined CRRT during treatment,and ECMO support time have predictive value for the prognosis of patients.

Objective:To investigate anticoagulant effects of mechanical methods in obese patients undergoing laparoscopic sleeve gastrectomy (LSG).Methods:In this prospective study, 54 obese patients receiving LSG were enrolled . All patients were given post-op mechanical methods for thrombogenic interventions. BMI and the operation-related factors were recorded. Venous blood specimens were taken from each patient before surgery, at the end of pneumoperitoneum (i.e., 0 h after surgery), at 24 hours after surgery for prothrombin time (PT) and activated partial thromboplastin time (APTT), fibrinogen (FIB) and D-dimer (D-D).Results:All 54 obese patients successfully underwent LSG. No severe complications were observed. Before operation, the mean BMI was (43.49±8.29) kg/m 2. DVT-2600 device was applied in all patients for 3 consecutive days after surgery. The PT values increased at 0 h, 24 h after surgery [(12.4±1.2) s, (12.4±0.8) s vs. (11.2±0.8) s, P=0, 0]. The APTT values at 0 h, 24 h after surgery decreased [(29.7±3.6) s, (29.0±3.1) s vs.(31.2±3.3) s, P=0.020, 0.001]. However, the D-D values increased at 0 h,24 h after operation [(213±143) ng/ml ,(445±237) ng/ml vs. (85±108) ng/ml, P=0, 0]. All patients were followed up for 1 month, and no thrombosis -related complications were observed. Conclusion:Mechanical methods for obese patients after LSG can help decrease the risk of deep venous thrombosis.

Objective:To compare the clinical effects of microwave ablation (MWA) and surgical resection in the treatment of small hepatocellular carcinoma(SHCC).Methods:Sixty five SHCC patients with intact clinical data, treated in the Center of Hepatobiliary Surgery, Peking University People's Hospital between Feb 2005 and Aug 2012, were enrolled in this study. Among them, 30 patients were treated by MWA, and the other 35 by hepatectomy. Follow-up was conducted from Mar 2013 to Feb 2021. The differences in long-term survival, intraoperative blood loss, operative time, postoperative complications, performance status (PS), and postoperative hospital stay were compared between the two groups.Results:The survival probability at 1, 3, 5 and 10 years was 93.2%, 82.5%, 55.6% and 41.2%, respectively, in the MWA group, and 97.1%, 82.6%, 67.2% and 48.3%, in the resection group ( P=0.347). The MWA group had less perioperative complications, less blood loss, shorter operation time, better PS score and better hospital stay than the surgical resection group (all P<0.001).There was no statistically significant difference in the survival rate between BCLC stage 0~A1 and A2~A4 patients( P=0.773, 0.536). Conclusions:Microwave ablation in the treatment of small hepatocellular carcinoma can achieve similar results as hepatectomy with less traumatic,better postoperative PS score and shorter postoperative hospital stay.

Objectives To investigate the efficacy of laparoscopic sleeve gastrectomy (LSG)for patients of type 2 diabetes mellitus (T2DM).Methods Between Jun 2013 and Jun 2017,39 T2DM patients were enrolled in this study and underwent LSG.The clinical data of all patients were collected.The fasting plasma glucose (FPG),glycosylated hemoglobin (HbAl c),C-peptide,fasting insulin (FINS),glucagon-like peptide-1 (GLP-1) as well as BMI of all patients were measured before and at 1,6 months after surgery.Results All patients underwent LSG surgery successfully.The mean levels of FPG,HbAlc,C-peptide,FINS and BMI of all patients decreased at 6 months after surgery respectively compared to those before surgery [(6.4 ± 1.2) mmol/L vs.(9.6 ± 2.3) mmol/L,t =9.455,P =0.000;(6.0 ± 0.7) ％ vs.(7.5 ±1.0)％,t=10.538,P=0.000;(2.7±2.2)ng/ml vs.(4.0±2.6) ng/ml,t=3.491,P=0.001;(9.2 ±6.3) μIU/L vs.(15.5 ±11.1) μIU/L,t=4.902,P=0.000;(32.0 ±6.1) kg/m2 vs.(41.0 ± 7.5) kg/m2,t =10.826,P =0.000],however the mean GLP-1 of all patients increased after surgery compared to that before surgery [(4.0 ± 2.1) pmol/L vs.(3.1 ± 2.2) pmol/L,t =-4.242,P =0.000].At 6 months after surgery,32 patients achieved complete remission of T2DM,5 patients gained partial remission of T2DM and 2 patients got no remission of T2DM.Conclusions LSG is effective for obesity patients as well as patients suffering from T2DM.

Objective To explore the feasibility of repairing porcine bile duct defect with decellularized rabbit abdominal aorta matrix scaffold.Methods Sodium dodecyl sulfate and Sodium deoxycholate were used to remove the cells in the blood vessel,and the residual DNA and RNA fragments were removed by nuclease.The prepared scaffold was implanted to repair defect of bile duct in swine,which were sacrificed after 45 days of surgery for histological evaluation.Results HE,Masson and elastic fiber staining showed that the composition and structure of the scaffold maintained their native features after dcellularization treatment.DNA content in acelllular scaffold (0.12 ± 0.01) μg/mg dry weight) was significantly decreased as compared with the native ones (2.31 ± 0.03) μg/mg dry weight,P ＜ 0.05).Collagen content was increased from (152 ±22) μg/mg dry weight in intact aorta to (177 ±21) μg/mg dry weight.Adipose derived mesenchymal stem cells with typical morphology survived well in the decellularized vascular matrix.It was observed that seeded ASCs penetrated into the inner wall of the scaffold.After transplantation,there was no leakage in the anastomosis and collapse of acellular blood vessel matrix.After 45 days of transplantation,repaired bile duct was harvested for histological evaluation.HE and Masson staining revealed that there were a large number of cells distributed in the inner wall of the scaffold,and some suspected epithelial cells and glands were found.Conclusion Decellularized aorta matrix scaffold hold great potential in serving as scaffold repairing defect of bile duct.

Objective To explore the morbidity of surgery in connection with laparoscopic sleeve gastrectomy (LSG) and its effect on obese T2DM.Methods 106 obese T2DM patientes undergoing LSG were divided into 2 groups in group 125 patients did not have oversewing the staple line and group 281 patients had the staple line oversewn in order to reduce bleeding.Results The differences in intraoperative blood loss (35 ± 15) ml vs.(28 ± 18) ml,postoperative recovery time (2.4 ± 0.9) d vs.(2.3 ± 0.9) d,time to taking liquid food (4.7 ± 1.0) d vs.(4.6 ± 1.0) d between two groups were not significant.There were no significant difference of complication between 2 groups (x2 =3.271,P =0.071).Comparing before surgery to 6 month after surgery,the BMI in group 1,was from (39 ± 5) to (29 ±4) kg/m2;in group 2,from (40 ±6) to (31 ±5) kg/m2,FPG in group 1,from (8.4 ± 1.4) to (6.4 ±1.2) mmol/L;in group 2,from (8.2 ± 2.0) to (6.8 ± 1.5) mmol/L,2 hour post-meal blood sugar [group 1,(13.2±4.1) to (9.6±3.2) mmol/L;group 2,(12.2±3.2) to (10.6±2.8) mmol/L] and HbAlc (group 1,7.2％ ±1.2％ to5.5％ ±1.1％;group 2,7.1％ ±1.1％ to 5.9％ ±1.2％) decreased significantly in both groups (P ＜ 0.01).There was 72 (68％) remission cases of T2DM in 106 patients,there were no significant differences of T2DM remission and BMI between 2 groups at 6 months after surgery (P =0.617).Conclusions LSG leads to significant weight loss and T2DM control.

Objective To explore the application of different approaches in single lateral endoscopic thyroidectomy.Methods Ninety one patients with single lateral thyroid nodule who underwent endoscopic thyroidectomy were divided randomly into bilateral axillo-breast approach group (n =45) and transaxillary approach group (n =46).The clinical data and cosmetic outcomes were compared.Results Procedures were successfully performed in 86 patients with no conversion to open surgery,5 patients in transaxillary group were excluded because of the malignant frozen pathology.The total operation time of transaxillary approach group was (61.6 ± 4.9) min,significantly shorter than that of the bilateral axillo-breast approach approach (90.0 ± 6.5) min,P ＜ 0.05.There was no significant difference in time of subcutaneous tunnel construction,muscles disposal,lateral dissection,lower pole resection,parathyroid identification,thyroid lobe resection and bleeding volume between two groups (P ＞ 0.05),while the time of work space creation,upper pole resection in transaxillary approach was significantly shorter than that in the bilateral axillo-breast approach (P ＜ 0.05).All patients of both groups were satisfied with cosmetic results.Conclusions The operation time in transaxillary approach group was shorter than that in bilateral axillo-breast approach group for the single lateral thyroid nodule,but the operation was more difficuh.