Objective To investigate the effects of rectus abdominis area(RAA),visceral fat area(VFA),and the ratio of visceral to subcutaneous fat area(V/S ratio)on the risk of surgical site infection(SSI)following open radical surgery for hepatocellular carcinoma(HCC)and their predictive value in the perioperative period and potential utility for intervention.Methods In this retrospective case-control study,280 patients who underwent open radical HCC surgery between December 2019 and October 2024 were included.After excluding 17 patients due to incomplete data or other exclusion criteria,the remaining 263 patients were categorized into two groups:66 in the SSI group and 197 in the non-SSI group.VFA,subcutaneous fat area(SFA),and RAA were quantified using preoperative abdominal computed tomography(CT)scans.Propensity score matching was performed to create two well-balanced cohorts,each consisting of 59 patients.Multivariate logistic regression analysis and receiver operating characteristic(ROC)curve analysis were conducted to identify and evaluate potential risk factors for SSIs.Additionally,a nomogram was developed to assess the predictive performance of these risk factors through ROC curve analysis,calibration plots,and decision curve analysis.Results Preoperative laboratory results revealed significantly elevated white blood cell counts,C-reactive protein levels,and procalcitonin in the SSI group,along with reduced hemoglobin and serum albumin levels compared to the control group(P=0.003).Imaging analyses demonstrated markedly increased RAA(P=0.032),VFA(P=0.015),and V/S ratio(P=0.002)in the SSI group.Univariate and multivariate logistic regression analyses identified RAA,VFA,and the V/S ratio as critical risk factors for SSIs.ROC curve analyses further confirmed the robust predictive capacity of the V/S ratio(AUC=0.88)and RAA(AUC=0.79).A nomogram constructed based on these indicators achieved an AUC of 0.836,indicating excellent discrimination ability,strong concordance between predicted and observed out-comes,and clinically significant net benefit across a range of common threshold probabilities.Conclusions RAA,VFA,and the V/S ratio are critical predictors of SSI following open radical HCC surgery.The nomogram constructed based on these factors exhibits robust discrimination,calibration,and clinical utility,allowing clini-cians to accurately identify high-risk patients and implement targeted interventions to reduce SSI incidence and enhance patient outcomes.

Objective To investigate the effects of rectus abdominis area(RAA),visceral fat area(VFA),and the ratio of visceral to subcutaneous fat area(V/S ratio)on the risk of surgical site infection(SSI)following open radical surgery for hepatocellular carcinoma(HCC)and their predictive value in the perioperative period and potential utility for intervention.Methods In this retrospective case-control study,280 patients who underwent open radical HCC surgery between December 2019 and October 2024 were included.After excluding 17 patients due to incomplete data or other exclusion criteria,the remaining 263 patients were categorized into two groups:66 in the SSI group and 197 in the non-SSI group.VFA,subcutaneous fat area(SFA),and RAA were quantified using preoperative abdominal computed tomography(CT)scans.Propensity score matching was performed to create two well-balanced cohorts,each consisting of 59 patients.Multivariate logistic regression analysis and receiver operating characteristic(ROC)curve analysis were conducted to identify and evaluate potential risk factors for SSIs.Additionally,a nomogram was developed to assess the predictive performance of these risk factors through ROC curve analysis,calibration plots,and decision curve analysis.Results Preoperative laboratory results revealed significantly elevated white blood cell counts,C-reactive protein levels,and procalcitonin in the SSI group,along with reduced hemoglobin and serum albumin levels compared to the control group(P=0.003).Imaging analyses demonstrated markedly increased RAA(P=0.032),VFA(P=0.015),and V/S ratio(P=0.002)in the SSI group.Univariate and multivariate logistic regression analyses identified RAA,VFA,and the V/S ratio as critical risk factors for SSIs.ROC curve analyses further confirmed the robust predictive capacity of the V/S ratio(AUC=0.88)and RAA(AUC=0.79).A nomogram constructed based on these indicators achieved an AUC of 0.836,indicating excellent discrimination ability,strong concordance between predicted and observed out-comes,and clinically significant net benefit across a range of common threshold probabilities.Conclusions RAA,VFA,and the V/S ratio are critical predictors of SSI following open radical HCC surgery.The nomogram constructed based on these factors exhibits robust discrimination,calibration,and clinical utility,allowing clini-cians to accurately identify high-risk patients and implement targeted interventions to reduce SSI incidence and enhance patient outcomes.

ObjectiveTo investigate the effect and mechanism of Biejiajian Wan on liver fibrosis by regulating the polarization of macrophages. MethodRaw264.7 cells were cultured in vitro by serum pharmacological method， and the hypoxia model of RAW264.7 cells was established by stimulating RAW264.7 cells with cobalt chloride （CoCl₂）. The cells were randomly divided into blank group， CoCl₂ hypoxia model group （200 mmol·L^-1）， Biejiajian Wan low-dose group （200 mmol·L^-1+0.55 g·kg^-1 Fuzheng Quyu capsules）， medium-dose group （200 mmol·L^-1+1.1 g·kg^-1 Biejiajian Wan）， and high-dose group （200 mmol·L^-1+2.2 g·kg^-1 Biejiajian Wan） and Fuzheng Quyu capsule group （200 mmol·L^-1+0.56 g·kg^-1 Biejiajian Wan）. Cell proliferation was detected by cell counting kit-8 （CCK-8）， and the gene expression of hypoxia inducible factor-1α （HIF-1α）， interleukin-1β （IL-1β） and interleukin-6 （IL-6） in macrophages was detected by real time fluorescence quantitative polymerase chain reaction （Real-time PCR）. The expression of macrophage polarization-related protein and HIF-1α/nuclear factor-kappa B （NF-κB） signaling pathway-related protein was tested by Western blot， and the distribution and expression of NF-κB signaling pathway-related protein and HIF-1α were determined by cell immunofluorescence. ResultCompared with the conditions in the blank group， the proliferation of RAW264.7 cells was inhibited after CoCl₂ stimulation for 24 hours （P<0.05）， the mRNA expression of HIF-1α， IL-1β and IL-6 in the model group were increased （P<0.05）， the protein expression of HIF-1α and M1 macrophage phenotypic proteins IL-6 and tumor necrosis factor-α （TNF-α） was boosted while that of M2 macrophage phenotypic protein interleukin-10 （IL-10） was reduced （P<0.05）， the protein expression of NF-κB p65， phosphorylation （p）-NF-κB p65， phosphorylated NF-κB inhibits protein kinase α/β （p-IKKα/β） and phosphorylated NF-κB inhibits protein α (p-IκBα） was elevated （P<0.05）， the nuclear expression of HIF-1α and NF-κB p65 was promoted. Compared with the conditions in the model group， after 24 hours of treatment with corresponding drug-containing serum， each treatment group promoted the proliferation of RAW264.7 cells （P<0.05）， the mRNA expression levels of HIF-1α， IL-1β and IL-6 in macrophages were reduced （P<0.05）， the protein expression of HIF-1α， IL-6 and TNF-α was decreased， while that of CD163 and IL-10 was increased （P<0.05）， the protein expression of NF-κB p65， p-NF-κB p65， p-IKKα/β and p-IκBα was lowered （P<0.05）， the nuclear expression of HIF-1α and NF-κB p65 was inhibited. ConclusionBiejiajian Wan could modulate the polarization of macrophages， attenuate the injury of macrophage-associated inflammatory response under hypoxia， and thus delay the progression of liver fibrosis， which might be related to its regulation of HIF-1α/NF-κB signaling pathway.