Objective:To evaluate the safety and feasibility of continuous lamellar pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy (LPD).Methods:Clinical data of 313 patients with periampullary tumors undergoing LPD at the People's Hospital of Zhengzhou University from January 2017 to December 2021 were retrospectively analyzed, including 163 males and 150 females, aged (62.5±6.7) years. Patients were divided into two groups according to the type of pancreaticojejunostomy. Patients undergoing continuous lamellar pancreaticojejunostomy were included in the study group ( n=162) and those undergoing traditional pancreaticojejunostomy were included in the control group ( n=151). Clinical data such as gender, age, level of carbohydrate antigen 199 (CA199), operation time, postoperative hospital stay, and complications were collected. In order to reduce the baseline differences between groups, propensity score matching (PSM) was used. Results:There were significant differences in age and preoperative CA199 between the study group and the control group before PSM (all P<0.05). After PSM for age and CA199, 156 cases were successfully matched, with 78 cases in both the study and control group. Preoperative data were conparable between the two groups after PSM (all P>0.05). The drainage time [16.0 (14.0, 21.0)d vs. 18.0(15.8, 22.0)d] and postoperative hospital stay [20.0(15.0, 24.0)d vs. 21.5(20.0, 25.0)d] were shorter in the study group (all P<0.05). The incidence of grade B/C postoperative pancreatic fistula (POPF) in the study group was lower than that in the control group [7.7%(6/78) vs. 20.5%(16/78), P<0.05]. Conclusion:Compared with traditional pancreaticojejunostomy, continuous lamellar pancreaticojejunostomy could be safe and feasible, which might reduce the incidence of grade B/C POPF and enhance postoperative recovery.

Objective:To compare the efficacy of surgical resection and radiofrequency ablation (RFA) treatment for China liver cancer staging (CNLC) Ia hepatocellular carcinoma (HCC) at difficult-to-reach locations.Methods:A retrospective analysis was conducted on the clinical data of 114 patients with CNLC Ia HCC at Ⅶ、Ⅷ、Ⅳb or Ⅰ segments that were difficult-to-reach locations who were admitted to People's Hospital of Zhengzhou University from December 2018 to December 2023. Among the patients, 85 were males and 29 were females, aged (58.1±1.0) years. The patients were divided into two groups: a RFA group with 31 cases and a surgical resection group with 83 cases. Compare the levels of alanine transaminase (ALT) and aspartate transaminase (AST) before and after surgery, the surgical time, intraoperative blood loss, postoperative hospital stay, postoperative complications, recurrence free survival rate, and cumulative survival rate between the two groups.Results:The comparison of age, gender, ALT, and AST between the two groups showed no statistically significant differences (all P>0.05). The differences in ALT and AST levels before and after surgery in the RFA group were (134.8±38.7) U/L and (195.1±53.9) U/L, respectively, which were significantly lower than those in the surgical resection group [(226.8±17.9) U/L and (229.5±16.2) U/L] ( t=-2.45 and -1.12, P=0.016 and 0.041). The RFA group had shorter operation time [(69.2±11.7) min vs. (210.6±8.9) min], less intraoperative blood loss [(8.7±3.8) ml vs. (238.6±20.8) ml], and shorter postoperative hospital stays [(6.4±1.0) d vs. (13.1±0.4) d] compared to the surgical resection group, with all differences statistically significant (all P<0.05). The overall complication rates were 19.4% (6/31) in the RFA group and 22.9% (19/83) in the surgical resection group, showing no significant difference ( χ2=0.16, P=0.685). No statistically significant diffe-rence was found in recurrence-free survival rates between the two groups ( χ2=0.13, P=0.717). Similarly, there was no statistically significant difference in cumulative survival rates between the groups ( χ2<0.01, P=0.978). Conclusion:For HCC at CNLC Ⅰa in challenging locations, RFA demonstrated shorter operation time and postoperative hospital stay, less intraoperative bleeding, and superior liver function recovery compared with surgical resection, while no significant difference was observed in survival outcomes between the two treatment groups.

Objective:To analyze the application value of three-dimensional visualization combined with indocyanine green fluorescence staining in laparoscopic resection of patients with complex liver cancer.Methods:The data of patients with complex liver cancer (liver cancer located in liver segments Ⅶ, Ⅷ, Ⅳa, Ⅴ and caudate lobe) who underwent laparoscopic anatomical liver resection in Zhengzhou University People's Hospital from August 2018 to August 2023 were retrospectively analyzed. A total of 334 patients were enrolled, including 249 males and 85 females, with the age of (57.0±10.6) years. Among the 334 patients, patients who underwent laparoscopic liver resection using three-dimensional visualization combined with indocyanine green fluorescence staining were included in the combined group ( n=128), and the other patients who underwent traditional laparoscopic liver resection were included in the traditional group ( n=206). Propensity score was used to match the preoperative indicators and postoperative pathology between the two groups. The two groups were compared in terms of gender, age, maximum diameter of tumor, alpha-fetoprotein, number of tumors, tumor location, American Society of Anesthesiologists (ASA) grade, operation time, portal occlusion time, intraoperative blood loss, surgical margin and postoperative aspartate transaminase (ALT), alanine transaminase (AST), albumin, total bilirubin, and severe postoperative complications (Clavien-Dindo grade≥grade Ⅲ). The Kaplan-Meier method was used to analyze the prognosis, and the log-rank test was used to compare the survival rate. Results:After propensity score matching, 120 cases were included in the combined group and the traditional group, respectively. There were no significant differences in gender, age, maximum diameter of tumor, alpha-fetoprotein, number of tumors, tumor location, and ASA grade between the two groups (all P>0.05). The intraoperative blood loss in the combined group was 200.0 (150.0, 300.0) ml, and the positive surgical margin rate was 6.7% (8/120), which were lower than 300.0 (150.0, 500.0) ml and 15.8% (19/120) in the traditional group, with statistically significant differences ( Z=-2.43, P=0.015, χ2=5.05, P=0.025). There were no statistically significant differences in the operation time, portal occlusion time, and postoperative ALT, AST, albumin, and total bilirubin between the two groups (all P>0.05). Eight cases (6.7%) in the combined group and 11 cases (9.2%) in the traditional group had severe complications after surgery, and all were discharged after treatment. The 1-, 3-, and 5-year recurrence-free survival rates of the combined group were 83.3%, 61.7%, and 58.3% respectively, while that of the traditional group were 71.7%, 52.5%, and 49.2%, respectively, with significant difference ( χ2=4.57, P=0.031). There was no significant difference in the cumulative survival rate between the combined group and the traditional group ( χ2=0.66, P=0.417). Conclusion:Compared with laparoscopic liver resection, laparoscopic liver resection for patients with complex liver cancer using three-dimensional visualization technology combined with indocyanine green fluorescence staining technology can reduce intraoperative blood loss, positive margin rate, and postoperative recurrence.

Objective To observe the value of machine learning(ML)models constructed based on pre-treatment clinical and CT features for predicting acute liver function deterioration(ALFD)in hepatocellular carcinoma(HCC)patients after the first time TACE.Methods Totally 320 HCC patients who underwent the first TACE were retrospectively enrolled and divided into training set(n=256)and test set(n=64)at the ratio of 4∶1.ALFD was evaluated according to clinical,laboratory and image findings within 2 weeks after TACE.Univariate analysis was performed to compare clinical baseline data and diameter of HCC on pre-TACE CT in training set,and parameters being statistical different between patients with and without ALFD were used to construct ML models using 9 different ML algorithms.The efficacy of each model for predicting ALFD in test set was evaluated,and the optimal model was selected.The calibration degree and clinical value of the optimal model were assessed in test set,and the contribution of each parameter was analyzed using SHAP method.Results In training set,76 cases were ALFD and 180 cases were non-ALFD,while in test set,18 cases were ALFD and 46 cases were non-ALFD.Among 9 ML models,the sensitivity,specificity,accuracy,area under the curve,F1 value and Kappa value of extreme gradient boosting(XGBoost)model in test set was 85.12%,89.34%,88.08%,0.927,0.811 and 0.725,respectively.XGBoost model was considered as the optimal one,with predicted probability in test set in good agreement with actual probability and high clinical net benefit.The contribution of patients'age,lesion diameter on pre-TACE CT,glutamic-pyruvic transaminase,glutamic-oxaloacetic transaminase and TACE time were all great for XGBoost model.Conclusion XGBoost model based on pre-treatment clinical and CT features could be used to effectively predict ALFD in HCC patients after the first time TACE.

Objective To observe the value of machine learning(ML)models constructed based on pre-treatment clinical and CT features for predicting acute liver function deterioration(ALFD)in hepatocellular carcinoma(HCC)patients after the first time TACE.Methods Totally 320 HCC patients who underwent the first TACE were retrospectively enrolled and divided into training set(n=256)and test set(n=64)at the ratio of 4∶1.ALFD was evaluated according to clinical,laboratory and image findings within 2 weeks after TACE.Univariate analysis was performed to compare clinical baseline data and diameter of HCC on pre-TACE CT in training set,and parameters being statistical different between patients with and without ALFD were used to construct ML models using 9 different ML algorithms.The efficacy of each model for predicting ALFD in test set was evaluated,and the optimal model was selected.The calibration degree and clinical value of the optimal model were assessed in test set,and the contribution of each parameter was analyzed using SHAP method.Results In training set,76 cases were ALFD and 180 cases were non-ALFD,while in test set,18 cases were ALFD and 46 cases were non-ALFD.Among 9 ML models,the sensitivity,specificity,accuracy,area under the curve,F1 value and Kappa value of extreme gradient boosting(XGBoost)model in test set was 85.12%,89.34%,88.08%,0.927,0.811 and 0.725,respectively.XGBoost model was considered as the optimal one,with predicted probability in test set in good agreement with actual probability and high clinical net benefit.The contribution of patients'age,lesion diameter on pre-TACE CT,glutamic-pyruvic transaminase,glutamic-oxaloacetic transaminase and TACE time were all great for XGBoost model.Conclusion XGBoost model based on pre-treatment clinical and CT features could be used to effectively predict ALFD in HCC patients after the first time TACE.

Objective:To evaluate the safety and feasibility of continuous lamellar pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy (LPD).Methods:Clinical data of 313 patients with periampullary tumors undergoing LPD at the People's Hospital of Zhengzhou University from January 2017 to December 2021 were retrospectively analyzed, including 163 males and 150 females, aged (62.5±6.7) years. Patients were divided into two groups according to the type of pancreaticojejunostomy. Patients undergoing continuous lamellar pancreaticojejunostomy were included in the study group ( n=162) and those undergoing traditional pancreaticojejunostomy were included in the control group ( n=151). Clinical data such as gender, age, level of carbohydrate antigen 199 (CA199), operation time, postoperative hospital stay, and complications were collected. In order to reduce the baseline differences between groups, propensity score matching (PSM) was used. Results:There were significant differences in age and preoperative CA199 between the study group and the control group before PSM (all P<0.05). After PSM for age and CA199, 156 cases were successfully matched, with 78 cases in both the study and control group. Preoperative data were conparable between the two groups after PSM (all P>0.05). The drainage time [16.0 (14.0, 21.0)d vs. 18.0(15.8, 22.0)d] and postoperative hospital stay [20.0(15.0, 24.0)d vs. 21.5(20.0, 25.0)d] were shorter in the study group (all P<0.05). The incidence of grade B/C postoperative pancreatic fistula (POPF) in the study group was lower than that in the control group [7.7%(6/78) vs. 20.5%(16/78), P<0.05]. Conclusion:Compared with traditional pancreaticojejunostomy, continuous lamellar pancreaticojejunostomy could be safe and feasible, which might reduce the incidence of grade B/C POPF and enhance postoperative recovery.

Objective:To compare the efficacy of surgical resection and radiofrequency ablation (RFA) treatment for China liver cancer staging (CNLC) Ia hepatocellular carcinoma (HCC) at difficult-to-reach locations.Methods:A retrospective analysis was conducted on the clinical data of 114 patients with CNLC Ia HCC at Ⅶ、Ⅷ、Ⅳb or Ⅰ segments that were difficult-to-reach locations who were admitted to People's Hospital of Zhengzhou University from December 2018 to December 2023. Among the patients, 85 were males and 29 were females, aged (58.1±1.0) years. The patients were divided into two groups: a RFA group with 31 cases and a surgical resection group with 83 cases. Compare the levels of alanine transaminase (ALT) and aspartate transaminase (AST) before and after surgery, the surgical time, intraoperative blood loss, postoperative hospital stay, postoperative complications, recurrence free survival rate, and cumulative survival rate between the two groups.Results:The comparison of age, gender, ALT, and AST between the two groups showed no statistically significant differences (all P>0.05). The differences in ALT and AST levels before and after surgery in the RFA group were (134.8±38.7) U/L and (195.1±53.9) U/L, respectively, which were significantly lower than those in the surgical resection group [(226.8±17.9) U/L and (229.5±16.2) U/L] ( t=-2.45 and -1.12, P=0.016 and 0.041). The RFA group had shorter operation time [(69.2±11.7) min vs. (210.6±8.9) min], less intraoperative blood loss [(8.7±3.8) ml vs. (238.6±20.8) ml], and shorter postoperative hospital stays [(6.4±1.0) d vs. (13.1±0.4) d] compared to the surgical resection group, with all differences statistically significant (all P<0.05). The overall complication rates were 19.4% (6/31) in the RFA group and 22.9% (19/83) in the surgical resection group, showing no significant difference ( χ2=0.16, P=0.685). No statistically significant diffe-rence was found in recurrence-free survival rates between the two groups ( χ2=0.13, P=0.717). Similarly, there was no statistically significant difference in cumulative survival rates between the groups ( χ2<0.01, P=0.978). Conclusion:For HCC at CNLC Ⅰa in challenging locations, RFA demonstrated shorter operation time and postoperative hospital stay, less intraoperative bleeding, and superior liver function recovery compared with surgical resection, while no significant difference was observed in survival outcomes between the two treatment groups.

Objective:To analyze the application value of three-dimensional visualization combined with indocyanine green fluorescence staining in laparoscopic resection of patients with complex liver cancer.Methods:The data of patients with complex liver cancer (liver cancer located in liver segments Ⅶ, Ⅷ, Ⅳa, Ⅴ and caudate lobe) who underwent laparoscopic anatomical liver resection in Zhengzhou University People's Hospital from August 2018 to August 2023 were retrospectively analyzed. A total of 334 patients were enrolled, including 249 males and 85 females, with the age of (57.0±10.6) years. Among the 334 patients, patients who underwent laparoscopic liver resection using three-dimensional visualization combined with indocyanine green fluorescence staining were included in the combined group ( n=128), and the other patients who underwent traditional laparoscopic liver resection were included in the traditional group ( n=206). Propensity score was used to match the preoperative indicators and postoperative pathology between the two groups. The two groups were compared in terms of gender, age, maximum diameter of tumor, alpha-fetoprotein, number of tumors, tumor location, American Society of Anesthesiologists (ASA) grade, operation time, portal occlusion time, intraoperative blood loss, surgical margin and postoperative aspartate transaminase (ALT), alanine transaminase (AST), albumin, total bilirubin, and severe postoperative complications (Clavien-Dindo grade≥grade Ⅲ). The Kaplan-Meier method was used to analyze the prognosis, and the log-rank test was used to compare the survival rate. Results:After propensity score matching, 120 cases were included in the combined group and the traditional group, respectively. There were no significant differences in gender, age, maximum diameter of tumor, alpha-fetoprotein, number of tumors, tumor location, and ASA grade between the two groups (all P>0.05). The intraoperative blood loss in the combined group was 200.0 (150.0, 300.0) ml, and the positive surgical margin rate was 6.7% (8/120), which were lower than 300.0 (150.0, 500.0) ml and 15.8% (19/120) in the traditional group, with statistically significant differences ( Z=-2.43, P=0.015, χ2=5.05, P=0.025). There were no statistically significant differences in the operation time, portal occlusion time, and postoperative ALT, AST, albumin, and total bilirubin between the two groups (all P>0.05). Eight cases (6.7%) in the combined group and 11 cases (9.2%) in the traditional group had severe complications after surgery, and all were discharged after treatment. The 1-, 3-, and 5-year recurrence-free survival rates of the combined group were 83.3%, 61.7%, and 58.3% respectively, while that of the traditional group were 71.7%, 52.5%, and 49.2%, respectively, with significant difference ( χ2=4.57, P=0.031). There was no significant difference in the cumulative survival rate between the combined group and the traditional group ( χ2=0.66, P=0.417). Conclusion:Compared with laparoscopic liver resection, laparoscopic liver resection for patients with complex liver cancer using three-dimensional visualization technology combined with indocyanine green fluorescence staining technology can reduce intraoperative blood loss, positive margin rate, and postoperative recurrence.

AIM:To investigate the effect of doublecortin-like kinase 1(DCLK1)on the biological properties of gastric cancer stem cells,and to explore its possible mechanism.METHODS:Serum-free suspension culture of gastric cancer stem cells and targeted inhibition of DCLK1 activity in gastric cancer stem cells with DCLK1 inhibitor DCLK1-IN-1 were performed.The expression levels of DCLK1,stemness-related proteins(SOX2 and OCT4),proliferation-related pro-teins(cyclin D1 and c-MYC),drug resistance-related proteins(ABCG2 and TOP2A),epithelial-mesenchymal transition-related proteins(E-cadherin,vimentin and Snail),and PI3K/AKT/mTOR signaling pathway-related proteins in gastric cancer stem cells were examined by Western blot.The effects of DCLK1 on viability and drug resistance of gastric cancer stem cells were determined by CCK-8 assay,and the effects of DCLK1 on self-renewal of gastric cancer stem cells were de-termined by methylcellulose spheroid-forming assay.Wound-healing and Transwell assays were performed to assess the ef-fect of DCLK1 on the migration and invasion of gastric cancer stem cells.RESULTS:The expression levels of DCLK1 and stemness-related proteins SOX2 and OCT4 in gastric cancer stem cells were significantly higher than those in parental cells(P＜0.01).The proliferation,drug resistance,migration and invasion of gastric cancer stem cells in DCLK1 inhibi-tion group were significantly lower than those in Sphere cell group(P＜0.01).The expression levels of proliferation-related proteins(c-MYC and cyclin D1)and drug resistance-related proteins(TOP2A and ABCG2)were down-regulated,the ex-pression of epithelial marker E-cadherin was up-regulated,the expression of mesenchymal markers vimentin and Snail was down-regulated,and the expression levels of PI3K/AKT/mTOR signaling pathway-related proteins and their phosphoryla-tion levels were reduced in DCLK1 inhibition group(P＜0.05).CONCLUSION:DCLK1 is highly expressed in gastric cancer stem cells,which may be involved in the proliferation,drug resistance and invasion of gastric cancer stem cells by regulating PI3K/AKT/mTOR signaling pathway.It suggests that DCLK1 can be used as a potential target for gastric cancer stem cells.

High glucose level, bacterial infection, and persistent inflammation within the microenvironment are key factors contributing to the delay of diabetic ulcers healing, while traditional therapeutic methods generally fail to address these issues simultaneously. Here, we present a spatiotemporally responsive cascade bilayer microneedle (MN) patch for accelerating diabetic wound healing via local glucose depletion and sustained nitric oxide (NO) release for long-term antibacterial and anti-inflammatory effects. The MN patch (G/AZ-MNs) possesses a degradable tip layer loading glucose oxidase (GOx), as well as a dissolvable base layer encapsulating l-arginine (Arg)-loaded nanoparticles (NPs). After wound administration, the base part rapidly dissolved, resulting in prompt separation of the MN tip within the wound tissue, which subsequently responded to the overexpressed matrix metalloproteinase-9 (MMP-9) in diabetic lesions, leading to the responsive release of GOx. The released enzyme catalyzed glucose into gluconic acid and hydrogen peroxide (H₂O₂), which not only reduced glucose level within the diabetic wound, but also initiated the cascade reaction between H₂O₂ with the Arg that was released from NPs, thereby achieving continuous production of NO for 7 days. Our findings demonstrate that a single administration of the MN patch could effectively heal non-infected or biofilm-infected diabetic wounds with the multifunctional properties.