Incidental gallbladder cancer(IGC)is a type of gallbladder cancer identified during or after cholecystectomy for benign gallbladder diseases through intraoperative or postoperative pathological examination.Since gallbladder cancer often coexists with benign conditions such as gallstones and polyps,and routine abdominal ultrasound has limited sensitivity in early diagnosis,IGC accounts for more than two-thirds of all gallbladder cancer cases.To improve early diagnosis rates,high-risk patients should undergo high-resolution ultrasound after surgery,combined with the use of radiomics and molecular biomarkers to reduce misdiagnosis and missed diagnoses.Most IGC patients are diagnosed at early stages,with a high incidence of residual disease.Delayed radical surgery can effectively improve prognosis.However,for patients with locally advanced disease,radical surgery should not be performed indiscriminately,and conversion surgery may be a better option.The optimal timing for delayed radical surgery is within 2 to 8 weeks after the initial surgery,with specific timing based on the resolution of acute inflammation and the evaluation of tumor staging and metastasis.For patients with T1b and T2 stage cancer,liver segment IVb/V resection and lymph node dissection are recommended to ensure curative outcomes.The application of laparoscopic techniques in gallbladder cancer treatment is becoming increasingly widespread,with confirmed surgical safety and tumor control effects,leading to growing support for minimally invasive treatment among hepatobiliary surgeons.Additionally,indocyanine green-guided fluorescence laparoscopic technology allows for precise lymph node dissection and liver resection,reducing the risk of postoperative complications.In light of the complex anatomy in the hepatic hilum and hepatoduodenal ligament region in IGC patients,performing delayed radical surgery using the 3D laparoscopic PH approach(based on the portal vein and hepatic artery as the anatomical axis)helps prevent organ damage and tumor dissemination.This review summarizes the current surgical treatment of IGC and discusses the application of the PH approach in laparoscopic gallbladder cancer radical surgery.

Incidental gallbladder cancer(IGC)is a type of gallbladder cancer identified during or after cholecystectomy for benign gallbladder diseases through intraoperative or postoperative pathological examination.Since gallbladder cancer often coexists with benign conditions such as gallstones and polyps,and routine abdominal ultrasound has limited sensitivity in early diagnosis,IGC accounts for more than two-thirds of all gallbladder cancer cases.To improve early diagnosis rates,high-risk patients should undergo high-resolution ultrasound after surgery,combined with the use of radiomics and molecular biomarkers to reduce misdiagnosis and missed diagnoses.Most IGC patients are diagnosed at early stages,with a high incidence of residual disease.Delayed radical surgery can effectively improve prognosis.However,for patients with locally advanced disease,radical surgery should not be performed indiscriminately,and conversion surgery may be a better option.The optimal timing for delayed radical surgery is within 2 to 8 weeks after the initial surgery,with specific timing based on the resolution of acute inflammation and the evaluation of tumor staging and metastasis.For patients with T1b and T2 stage cancer,liver segment IVb/V resection and lymph node dissection are recommended to ensure curative outcomes.The application of laparoscopic techniques in gallbladder cancer treatment is becoming increasingly widespread,with confirmed surgical safety and tumor control effects,leading to growing support for minimally invasive treatment among hepatobiliary surgeons.Additionally,indocyanine green-guided fluorescence laparoscopic technology allows for precise lymph node dissection and liver resection,reducing the risk of postoperative complications.In light of the complex anatomy in the hepatic hilum and hepatoduodenal ligament region in IGC patients,performing delayed radical surgery using the 3D laparoscopic PH approach(based on the portal vein and hepatic artery as the anatomical axis)helps prevent organ damage and tumor dissemination.This review summarizes the current surgical treatment of IGC and discusses the application of the PH approach in laparoscopic gallbladder cancer radical surgery.

ABSTRACT:Objective To construct V-set and immunoglobulin domain containing 4 (Vsig4)nanobodies (Nbs) as specific macrophage probes so as to use them as molecular probes of macrophagocytes.Methods A nanobody phage library was generated by using peripheral blood lymphocytes isolated from an alpaca immunized with recombinant Vsig4 protein.After three rounds of selection against recombinant Vsig4.The Nbs were subjected to sequencing and genome alignment to obtain VHH sequence.Nbs were isolated and tested for Vsig4 specificity in an ELISA using recombinant Vsig4.The affinity capacity of Nbs was verified by the cell line stably expressing Vsig4. Results A nanobody phage library with an estimated 7.27 × 107 clones with 70% insertion was successfully constructed.Totally 1 3 6 Vsig4-positive clones were sequenced and aligned according to different CDR3 sequences. In summary,1 5 Vsig4 nanobodies were obtained and grouped into 3 different CDR3 epitopes.The affinity of representing nanobody and Vsig4 was analyzed via ELISA;Nb1 1 9 showed the highest affinity against both recombinant and native Vsig4.Conclusion We successfully constructed and screened Vsig4 specific nanobody number 1 1 9 with high affinity and specificity.It can help with macrophage detection and in vivo monitoring.

Objective To assess the protective effect of vaccination in routine application on hepatitis B virus (HBV) exposed infants and to clarify whether hepatitis B immunoglobulin (HBIG) administration of pregnant women may reduce the risk of maternal-fetal transmission of HBV. Methods Serum samples of 6398 pregnant women at gestation of 15-20 weeks from 6 urban and 8 rural areas across Jiangsu province were previously tested for serologic markers of HBV by ELISA from July 2002 to August 2004. In this study, infants born to 419 HBV carrier mothers were taken as the study group, while infants born to 453 non-carrier mothers were taken as the control group by stratified random sampling. They were followed-up and screened for HBV markers during October 2009 to March 2010. Information including HBIG administration during pregnancy, HBV vaccination and HBIG administration of the infants were collected. χ2 test or Fisher′s exact method were used to compare the rates and the comparison of the means was by t test. Results The follow-up rates of the study group and control group were 71.12% (298/419) and 72.41% (328/453), respectively. Of the 298 infants born to HBV carrier mothers, 11 (3.7%) were positive for HBsAg, while none of the 328 infants born to non-carrier mothers was HBsAg positive (χ2=12.32, P<0.01). All of the 11 children were born to mothers with both HBsAg and HBeAg positive, and nine of the 11 children were not injected HBIG or not immunized with hepatitis B vaccine within 24 hours after birth, with only one received regular vaccination and detailed information was unknown in one case. The positive rates of anti-HBs in the study group and the control group were 69.46% and 69.21% respectively (χ2=0.01, P=0.95). HBsAg positive rate of the children born to pregnant women treated with HBIG during late pregnancy (n=92) was 2.17% (n=2), whereas that in the children born to women not treated with HBIG (n=197) was 4.57% (χ2=0.98, P=0.51). Conclusions The protective effect of immunoprophylaxis in routine application against perinatal HBV infection in Jiangsu province is good. Efforts are required to emphasize the importance of HBIG administration in infants born to HBV carrier mothers, especially in HBeAg positive mothers within 24 hours after delivery. Treatment of HBsAg positive pregnant women with HBIG in third trimester would not decrease the risk of maternal-fetal transmission of HBV.

BACKGROUND: Stromal cell-derived factor 1 (SDF1), a potential inhibitor of infection by lymphophilic HIV-1 strains, can help to block the pathway of HIV-1 invasion into the human body.OBJECTIVE: Genotype and polymorphism of SDF1-3 'A allele associated with HIV-1 infection were investigated in She Ethnic Group in the south of China so as explore the possible causes of uninfection by HIV-1 strains among this population.DESIGN: Single sample study.SETTING: Department of Biochemistry and Molecular Biology, Gannan Medical College.PARTICIPANTS: Totally 186 She Ethnic subjects without HIV-1 infection collected randomly from those whose three generations belonged to She Ethnic Group, and inhabited in Qianshan County of Jiangxi Province,Ningde area of Fujian Province and Jingning She County of Zhejiang Province, from January to December 1995.METHODS: The whole blood samples from 186 She Ethnic subjects were collected randomly, and then their genomic DNA samples were extracted respectively. Allelic polymorphism was examined by the polymerase chain reaction and restriction-fragment-length polymorphisms (PCR-RFLP).MAIN OUTCOME MEASURES: The distribution of SDF1-3'A allele in She Ethnic Group in the south of China.RESULTS: The data of 186 She Ethnic subjects entered the result analysis without any loss in the midway. The frequency of SDF1-3 'A allele in She Ethnic Group samples was 19.6%, and the allelic distribution of the gene was in accordance with Hardy-Weinberg equilibrium. No difference was found between male and female individuals.CONCLUSION: The frequency of SDF1-3 'A allele of She Ethnic Group in the south of China was similar to that of Dai Nationality in Yunnan.Based on its slow-down effect on clinical course of AIDS, the mutation of SDF1-3'A is significant in the prevention and treatment of AIDS in She Ethnic Group in the south of China.