Since the publication of Chinese first national “Clinical practice guidelines for primary liver cancer” in 2011,the management of hepatocellular carcinoma has evolved from standardization to individualization,from single-discipline decision-making to multidisciplinary collaboration,and from empirical approaches to evidence-based protocols. This review outlines the progression of China′s liver cancer guidelines from 2011 to 2024, focusing on key updates and trends in high-risk population screening,diagnostic assessment,staging systems,local and systemic treatment strategies,perioperative management,treatment response evaluation,and follow-up models. The evolution of these guidelines reflects Chinese ongoing efforts grounded in changes in disease etiology,therapeutic advancements,and the accumulation of real-world evidence. Notable developments include the establishment of the China liver cancer staging,the first-line recommendation of immune-targeted combination therapies, the integration of multimodal imaging and artificial intelligence,and the expansion of conversion and neoadjuvant treatment strategies. Collectively, these innovations have promoted a more precise, standardized, and globally aligned liver cancer care system. Looking ahead,future guidelines are expected to emphasize intelligent assessment models,liquid biopsy,biomarker-driven therapy,and real-world data integration to further improve early detection and long-term survival outcomes for Chinese patients.

Objective To explore the application of plasma 7 microRNA (miR7) testing in the differential diagnosis of very early-stage hepatocellular carcinoma (HCC). Methods This study is a multicenter real-world study. Patients with single hepatic lesion (maximum diameter≤2 cm) who underwent plasma miR7 testing at Zhongshan Hospital, Fudan University, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Anhui Provincial Hospital, and Peking University People’s Hospital between January 2019 and December 2024 were retrospectively enrolled. Patients were divided into very early-stage HCC group and non-HCC group, and the clinical pathological characteristics of the two groups were compared. The value of plasma miR7 levels, alpha-fetoprotein (AFP), and des-gamma-carboxy prothrombin (DCP) in the differential diagnosis of very early-stage HCC was evaluated using receiver operating characteristic (ROC) curves and area under the curve (AUC). In patients with both negative AFP and DCP (AFP＜20 ng/mL, DCP＜40 mAU/mL), the diagnostic value of plasma miR7 for very early-stage HCC was analyzed. Results A total of 64 528 patients from 4 hospitals underwent miR7 testing, and 1 682 were finally included, of which 1 073 were diagnosed with very early-stage HCC and 609 were diagnosed with non-HCC. The positive rate of miR7 in HCC patients was significantly higher than that in non-HCC patients (67.9% vs 24.3%, P＜0.001). ROC curves showed that the AUCs for miR7, AFP, and DCP in distinguishing HCC patients from the non-HCC individuals were 0.718, 0.682, and 0.642, respectively. The sensitivities were 67.85%, 43.71%, and 44.45%, and the specificities were 75.70%, 92.78%, and 83.91%, respectively. The pairwise comparison of AUCs showed that the diagnostic efficacy of plasma miR7 detection was significantly better than that of AFP or DCP (P＜0.05). Although its specificity was slightly lower than AFP and DCP, the sensitivity was significantly higher. Among patients negative for both AFP and DCP, miR7 maintained an AUC of 0.728 for diagnosing very early-stage HCC, with 67.82% sensitivity and 77.73% specificity. Conclusions Plasma miR7 testing is a potential molecular marker with high sensitivity and specificity for the differential diagnosis of small hepatic nodules. In patients with very early-stage HCC lacking effective molecular markers (negative for both AFP and DCP), miR7 can serve as a novel and effective molecular marker to assist diagnosis.

Objective:To investigate the change trend of hepatectomy for hepatocellular carcinoma and efficacy of fluorescent laparoscopic hepatectomy in a single center from 2014?2023.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 17 232 patients of hepatocellular carcinoma who were admitted to Zhongshan Hospital of Fudan University from January 2014 to December 2023 were collected. There were 14 404 males and 2 828 females, aged 58(range, 11?94)years. Observation indicators: (1) change trend of hepatectomy for hepatocellular carcinoma and application of fluorescent laparoscopy in 2014?2023; (2) propensity score matching between patients undergoing fluorescent and conventional laparoscopic hepatectomy; (3) intraoperative and postoperative conditions of patients in the fluorescent laparoscopy group and the conventional laparoscopy group after propensity score matching. 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 between groups was conducted using the nonparametic rank sum test. Propensity score matching was performed using the 1∶3 nearest neighbor matching method, with the caliper value of 0.01. Results:(1) Change trend of hepatectomy for hepatocellular carcinoma and application of fluorescent laparoscopy in 2014-2023. Among 17 232 patients of hepatocellular carcinoma, 4 074 cases underwent laparoscopic surgery, and 13 158 cases underwent open surgery or conversion from laparoscopic to open surgery. From 2014 to 2023, the proportions of laparos-copic surgery in hepatectomy were 8.993%(117/1 301), 6.804%(99/1 455), 9.379%(145/1 546), 17.511%(287/1 639), 23.828%(427/1 792), 24.572%(459/1 868), 29.662%(544/1 834), 31.568%(584/1 850), 38.080%(599/1 573), and 34.246%(813/2 374), respectively. The proportions of Grade Ⅲ surgery in laparoscopic hepatectomy were 11.966%(14/117), 7.071%(7/99), 12.414%(18/145), 21.254%(61/287), 28.337%(121/427), 27.887%(128/459), 34.375%(187/544), 34.644%(214/584), 35.726%(214/599), and 42.681%(347/813), respectively. From 2016 to 2023, the proportions of the application of fluorescent laparoscopy in laparoscopic hepatectomy were 2.069%(3/145), 5.923%(17/287), 8.431%(36/427), 10.022%(46/459), 17.647%(96/544), 24.829%(145/584), 9.182%(55/599), and 12.915%(105/813), respectively. (2) Propensity score matching between patients undergoing fluorescent and conventional laparoscopic hepatectomy. Among the 4 074 patients who underwent laparoscopic liver resection, 503 cases using fluorescent laparoscopy were assigned to the fluorescent laparoscopy group, 3 571 cases using conventional laparoscopy were assigned to the conventional laparoscopy group. A total of 1 794 patients were successfully matched, with 483 cases in the fluorescent laparoscopy group and 1 311 cases in the conventional laparoscopy group. After propensity score matching, the confounding biases of the maximum tumor diameter and the year of surgery were eliminated, and the two groups were comparable. (3) Intraoperative and postoperative conditions of patients in the fluorescent laparoscopy group and the conventional laparoscopy group after propensity score matching. After propensity score matching, there was no perioperative death in either the fluorescent laparoscopy group or the conventional laparoscopy group.The operation time of patients in the fluorescent laparoscopy group was 240(150,328)minutes, the portal triad clamping time was 30(15,45)minutes, the volume of intraoperative blood loss was 50(30,100)mL, the number of patients with complication 72, respectively. For patients in the conventional laparoscopy group, the above indicators were 180(131,240)minutes, 23(15,30)minutes, 55(50,100)mL, and 248, respectively. There were significant differences in the above indicators between the two groups ( Z=?7.593, ?7.372, ?4.941, χ2=3.873, P<0.05). Conclusion:The proportion and difficulty level of laparoscopic hepatectomy for hepatocellular carcinoma in Zhongshan Hospital of Fudan University have shown an upward trend during 2014?2023. Compared with conventional laparoscopy, patients undergoing fluorescent laparoscopic hepatectomy have longer operation time and portal triad clamping time, but less intraoperative blood loss and lower iproportion of complications.

Most patients with hepatocellular carcinoma(HCC)are diagnosed at an intermediate or advanced stage,losing the opportunity for surgical resection.Conversion therapy,which uses non-surgical approaches to render initially unresectable tumors resectable,has gradually become part of routine clinical practice and a research focus.However,multiple challenges remain,including the lack of clear criteria for identifying"potentially resectable"cases,difficulty in selecting individualized systemic regimens from multiple approved options and determining whether to combine them with locoregional therapy,controversy over the necessity of surgery in patients achieving radiological complete response,the need for optimization of perioperative assessment and management,uncertainty in determining the optimal timing of surgery,and the absence of consensus on postoperative sequential systemic therapy regimens and duration.Addressing these issues requires multidisciplinary collaboration and high-quality evidence from multicenter randomized controlled trials.With the accumulation of clinical experience,growing evidence,and advances in treatment,more patients with initially unresectable HCC are expected to gain surgical opportunities and achieve long-term disease-free survival.

Objective:To investigate the application effect of health education based on self-determination theory combined with mouth-opening training in patients with multiple jaw fractures so as to improve patients' compliance with postoperative rehabilitation.Methods:The randomized controlled trial methods were adopted. A total of 350 patients with multiple jaw fractures who were admitted to the Department of Oral and Maxillofacial Surgery at the First Affiliated Hospital of Zhengzhou University from January 2022 to July 2023 were selected by convenience sampling method. They were divided into the study group and the control group using the random number table method, 175 cases in each group. The control group received routine perioperative nursing and mouth-opening training. On this basis, the study group received health education based on self-determination theory combined with mouth-opening training. The postoperative Visual Analogue Score (VAS), fear of occlusion score, compliance with rehabilitation training, restriction of mouth opening, Self-rating Anxiety Scale (SAS) score, Self-rating Depression Scale (SDS) score, and satisfaction degree were compared between the two groups.Results:Finally, 342 patients completed the study. Among 172 patients in the study group, there were 80 males and 92 females, with an age of (38.73 ± 9.15) years. Among 170 patients in the control group, there were 82 males and 88 females, with an age of (40.22 ± 10.06) years. The VAS scores of the study group on postoperative days 1, 3, and 7 were (4.92 ± 0.56), (3.68 ± 0.52), and (2.28 ± 0.44), respectively, all lower than those of the control group (5.10 ± 0.60), (4.03 ± 0.55), and (2.66 ± 0.53), and the differences were statistically significant ( t=2.87, 6.05, 7.22, all P<0.05). Fear of occlusion scores of the study group on postoperative days 1, 3 and 7 were (3.88 ± 0.52), (2.67 ± 0.65) and (1.45 ± 0.32), respectively, all lower than those of the control group (4.05 ± 0.39), (3.12 ± 0.73) and (1.68 ± 0.35), and the differences were statistically significant ( t=3.42, 6.02, 6.34, all P<0.05). The total compliance rate of rehabilitation training in the research group was 95.35% (164/172), which was higher than the control group ′s 84.12% (143/170), and the difference was statistically significant ( χ2=11.74, P<0.05). After intervention, SAS score and SDS score of the study group were (36.18 ± 7.15) and (33.08 ± 8.21), respectively, witch were lower than those of the control group (38.34 ± 6.63) and (35.20 ± 7.39), and the differences were statistically significant ( t=2.90, 2.51, both P<0.05). Total satisfaction score of the study group (83.50 ± 12.68) was higher than that of the control group (79.52 ± 14.92), the difference was statistically significant( t=2.66, P<0.05). Conclusions:Health education based on self-determination theory combined with mouth-opening training can help alleviate postoperative pain and fear of occlusion in patients with multiple jaw fractures, improve their compliance with rehabilitation training as well as rehabilitation effect.

Objective:To investigate the change trend of hepatectomy for hepatocellular carcinoma and efficacy of fluorescent laparoscopic hepatectomy in a single center from 2014?2023.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 17 232 patients of hepatocellular carcinoma who were admitted to Zhongshan Hospital of Fudan University from January 2014 to December 2023 were collected. There were 14 404 males and 2 828 females, aged 58(range, 11?94)years. Observation indicators: (1) change trend of hepatectomy for hepatocellular carcinoma and application of fluorescent laparoscopy in 2014?2023; (2) propensity score matching between patients undergoing fluorescent and conventional laparoscopic hepatectomy; (3) intraoperative and postoperative conditions of patients in the fluorescent laparoscopy group and the conventional laparoscopy group after propensity score matching. 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 between groups was conducted using the nonparametic rank sum test. Propensity score matching was performed using the 1∶3 nearest neighbor matching method, with the caliper value of 0.01. Results:(1) Change trend of hepatectomy for hepatocellular carcinoma and application of fluorescent laparoscopy in 2014-2023. Among 17 232 patients of hepatocellular carcinoma, 4 074 cases underwent laparoscopic surgery, and 13 158 cases underwent open surgery or conversion from laparoscopic to open surgery. From 2014 to 2023, the proportions of laparos-copic surgery in hepatectomy were 8.993%(117/1 301), 6.804%(99/1 455), 9.379%(145/1 546), 17.511%(287/1 639), 23.828%(427/1 792), 24.572%(459/1 868), 29.662%(544/1 834), 31.568%(584/1 850), 38.080%(599/1 573), and 34.246%(813/2 374), respectively. The proportions of Grade Ⅲ surgery in laparoscopic hepatectomy were 11.966%(14/117), 7.071%(7/99), 12.414%(18/145), 21.254%(61/287), 28.337%(121/427), 27.887%(128/459), 34.375%(187/544), 34.644%(214/584), 35.726%(214/599), and 42.681%(347/813), respectively. From 2016 to 2023, the proportions of the application of fluorescent laparoscopy in laparoscopic hepatectomy were 2.069%(3/145), 5.923%(17/287), 8.431%(36/427), 10.022%(46/459), 17.647%(96/544), 24.829%(145/584), 9.182%(55/599), and 12.915%(105/813), respectively. (2) Propensity score matching between patients undergoing fluorescent and conventional laparoscopic hepatectomy. Among the 4 074 patients who underwent laparoscopic liver resection, 503 cases using fluorescent laparoscopy were assigned to the fluorescent laparoscopy group, 3 571 cases using conventional laparoscopy were assigned to the conventional laparoscopy group. A total of 1 794 patients were successfully matched, with 483 cases in the fluorescent laparoscopy group and 1 311 cases in the conventional laparoscopy group. After propensity score matching, the confounding biases of the maximum tumor diameter and the year of surgery were eliminated, and the two groups were comparable. (3) Intraoperative and postoperative conditions of patients in the fluorescent laparoscopy group and the conventional laparoscopy group after propensity score matching. After propensity score matching, there was no perioperative death in either the fluorescent laparoscopy group or the conventional laparoscopy group.The operation time of patients in the fluorescent laparoscopy group was 240(150,328)minutes, the portal triad clamping time was 30(15,45)minutes, the volume of intraoperative blood loss was 50(30,100)mL, the number of patients with complication 72, respectively. For patients in the conventional laparoscopy group, the above indicators were 180(131,240)minutes, 23(15,30)minutes, 55(50,100)mL, and 248, respectively. There were significant differences in the above indicators between the two groups ( Z=?7.593, ?7.372, ?4.941, χ2=3.873, P<0.05). Conclusion:The proportion and difficulty level of laparoscopic hepatectomy for hepatocellular carcinoma in Zhongshan Hospital of Fudan University have shown an upward trend during 2014?2023. Compared with conventional laparoscopy, patients undergoing fluorescent laparoscopic hepatectomy have longer operation time and portal triad clamping time, but less intraoperative blood loss and lower iproportion of complications.

Most patients with hepatocellular carcinoma(HCC)are diagnosed at an intermediate or advanced stage,losing the opportunity for surgical resection.Conversion therapy,which uses non-surgical approaches to render initially unresectable tumors resectable,has gradually become part of routine clinical practice and a research focus.However,multiple challenges remain,including the lack of clear criteria for identifying"potentially resectable"cases,difficulty in selecting individualized systemic regimens from multiple approved options and determining whether to combine them with locoregional therapy,controversy over the necessity of surgery in patients achieving radiological complete response,the need for optimization of perioperative assessment and management,uncertainty in determining the optimal timing of surgery,and the absence of consensus on postoperative sequential systemic therapy regimens and duration.Addressing these issues requires multidisciplinary collaboration and high-quality evidence from multicenter randomized controlled trials.With the accumulation of clinical experience,growing evidence,and advances in treatment,more patients with initially unresectable HCC are expected to gain surgical opportunities and achieve long-term disease-free survival.

Objective:To investigate the application effect of health education based on self-determination theory combined with mouth-opening training in patients with multiple jaw fractures so as to improve patients' compliance with postoperative rehabilitation.Methods:The randomized controlled trial methods were adopted. A total of 350 patients with multiple jaw fractures who were admitted to the Department of Oral and Maxillofacial Surgery at the First Affiliated Hospital of Zhengzhou University from January 2022 to July 2023 were selected by convenience sampling method. They were divided into the study group and the control group using the random number table method, 175 cases in each group. The control group received routine perioperative nursing and mouth-opening training. On this basis, the study group received health education based on self-determination theory combined with mouth-opening training. The postoperative Visual Analogue Score (VAS), fear of occlusion score, compliance with rehabilitation training, restriction of mouth opening, Self-rating Anxiety Scale (SAS) score, Self-rating Depression Scale (SDS) score, and satisfaction degree were compared between the two groups.Results:Finally, 342 patients completed the study. Among 172 patients in the study group, there were 80 males and 92 females, with an age of (38.73 ± 9.15) years. Among 170 patients in the control group, there were 82 males and 88 females, with an age of (40.22 ± 10.06) years. The VAS scores of the study group on postoperative days 1, 3, and 7 were (4.92 ± 0.56), (3.68 ± 0.52), and (2.28 ± 0.44), respectively, all lower than those of the control group (5.10 ± 0.60), (4.03 ± 0.55), and (2.66 ± 0.53), and the differences were statistically significant ( t=2.87, 6.05, 7.22, all P<0.05). Fear of occlusion scores of the study group on postoperative days 1, 3 and 7 were (3.88 ± 0.52), (2.67 ± 0.65) and (1.45 ± 0.32), respectively, all lower than those of the control group (4.05 ± 0.39), (3.12 ± 0.73) and (1.68 ± 0.35), and the differences were statistically significant ( t=3.42, 6.02, 6.34, all P<0.05). The total compliance rate of rehabilitation training in the research group was 95.35% (164/172), which was higher than the control group ′s 84.12% (143/170), and the difference was statistically significant ( χ2=11.74, P<0.05). After intervention, SAS score and SDS score of the study group were (36.18 ± 7.15) and (33.08 ± 8.21), respectively, witch were lower than those of the control group (38.34 ± 6.63) and (35.20 ± 7.39), and the differences were statistically significant ( t=2.90, 2.51, both P<0.05). Total satisfaction score of the study group (83.50 ± 12.68) was higher than that of the control group (79.52 ± 14.92), the difference was statistically significant( t=2.66, P<0.05). Conclusions:Health education based on self-determination theory combined with mouth-opening training can help alleviate postoperative pain and fear of occlusion in patients with multiple jaw fractures, improve their compliance with rehabilitation training as well as rehabilitation effect.

Since the publication of Chinese first national “Clinical practice guidelines for primary liver cancer” in 2011,the management of hepatocellular carcinoma has evolved from standardization to individualization,from single-discipline decision-making to multidisciplinary collaboration,and from empirical approaches to evidence-based protocols. This review outlines the progression of China′s liver cancer guidelines from 2011 to 2024, focusing on key updates and trends in high-risk population screening,diagnostic assessment,staging systems,local and systemic treatment strategies,perioperative management,treatment response evaluation,and follow-up models. The evolution of these guidelines reflects Chinese ongoing efforts grounded in changes in disease etiology,therapeutic advancements,and the accumulation of real-world evidence. Notable developments include the establishment of the China liver cancer staging,the first-line recommendation of immune-targeted combination therapies, the integration of multimodal imaging and artificial intelligence,and the expansion of conversion and neoadjuvant treatment strategies. Collectively, these innovations have promoted a more precise, standardized, and globally aligned liver cancer care system. Looking ahead,future guidelines are expected to emphasize intelligent assessment models,liquid biopsy,biomarker-driven therapy,and real-world data integration to further improve early detection and long-term survival outcomes for Chinese patients.

Progress in the systemic therapies,represented by the molecular target therapies and immune checkpoint inhibitors(ICIs),have significantly improved the prognosis of unresectable hepatocellular carcinoma(uHCC),but long term survial remains limitted.As one of the major combination of systemic and surgical therapies,conversion therapy provides potentially curative opportunity to some uHCC patients.It is widely reported from different domestic centers.The first Chinese expert consensus about it was released in 2021.Yet at the same time,there are many key issues in the practice and theory remains to be resolved.Actively thinking,exploring and finally resolving these issues are essential for establishing and promoting the standardized theoretical system of uHCC conversion therapy.