Objective:To analyze the impact of serum alpha-fetoprotein (AFP) and carbohydrate antigen 19-9 (CA19-9) on the prognosis of patients with combined hepatocellular-cholangiocarcinoma (CHC) after radical surgery.Methods:Clinical data of 100 patients diagnosed with CHC by postoperative pathology in Hunan Provincial People's Hospital from January 2009 to January 2019 were retrospectively analyzed, including 73 males and 27 females, aged (52.0±10.9) years. Univariate and multivariate Cox regression analysis were conducted to try to find out the effects of AFP and CA19-9 on postoperative disease-free survival (DFS) of patients with CHC. Subgroup analysis was also performed to analyze the DFS among patients with different levels of AFP and CA19-9. Kaplan-Meier method and log-rank test were used to plot and compare the survival curves between groups.Results:Univariate analysis showed that levels of AFP, CA19-9, alanine transaminase, aspartate transaminase, American Joint Committee on Cancer (AJCC) TNM staging, portal vein invasion, tumor number are associated with postoperative DFS in CHC patients (all P<0.05). The multivariate Cox analysis showed that AFP≥20.6 μg/L ( HR=6.686, 95% CI: 1.985-9.582), CA19-9≥35.2 U/L ( HR=5.790, 95% CI: 1.197-8.855), AJCC tumor TNM staging stage Ⅱ( HR=6.384, 95% CI: 2.069-11.532), and portal vein invasion ( HR=2.384, 95% CI: 1.100-10.125) were risk factors for a shortened DFS in CHC patients after surgery (all P<0.05). Subgroup analysis showed that patients with AFP≥20.6 μg/L and CA19-9≥35.2 U/L ( n=14) had a lower DFS compared to patients with AFP<20.6 μg/L and CA19-9≥35.2 U/L ( n=32), and patients with AFP≥20.6 μg/L and CA19-9<35.2 U/L ( n=20) ( χ2=6.23, 4.98, P=0.014, 0.043). Conclusion:AFP and CA19-9 are risk factors for DFS in CHC patients. Patients with AFP≥20.6 μg/L and CA19-9≥35.2 U/L showed a worse prognosis.

Objective:To analyze the impact of serum alpha-fetoprotein (AFP) and carbohydrate antigen 19-9 (CA19-9) on the prognosis of patients with combined hepatocellular-cholangiocarcinoma (CHC) after radical surgery.Methods:Clinical data of 100 patients diagnosed with CHC by postoperative pathology in Hunan Provincial People's Hospital from January 2009 to January 2019 were retrospectively analyzed, including 73 males and 27 females, aged (52.0±10.9) years. Univariate and multivariate Cox regression analysis were conducted to try to find out the effects of AFP and CA19-9 on postoperative disease-free survival (DFS) of patients with CHC. Subgroup analysis was also performed to analyze the DFS among patients with different levels of AFP and CA19-9. Kaplan-Meier method and log-rank test were used to plot and compare the survival curves between groups.Results:Univariate analysis showed that levels of AFP, CA19-9, alanine transaminase, aspartate transaminase, American Joint Committee on Cancer (AJCC) TNM staging, portal vein invasion, tumor number are associated with postoperative DFS in CHC patients (all P<0.05). The multivariate Cox analysis showed that AFP≥20.6 μg/L ( HR=6.686, 95% CI: 1.985-9.582), CA19-9≥35.2 U/L ( HR=5.790, 95% CI: 1.197-8.855), AJCC tumor TNM staging stage Ⅱ( HR=6.384, 95% CI: 2.069-11.532), and portal vein invasion ( HR=2.384, 95% CI: 1.100-10.125) were risk factors for a shortened DFS in CHC patients after surgery (all P<0.05). Subgroup analysis showed that patients with AFP≥20.6 μg/L and CA19-9≥35.2 U/L ( n=14) had a lower DFS compared to patients with AFP<20.6 μg/L and CA19-9≥35.2 U/L ( n=32), and patients with AFP≥20.6 μg/L and CA19-9<35.2 U/L ( n=20) ( χ2=6.23, 4.98, P=0.014, 0.043). Conclusion:AFP and CA19-9 are risk factors for DFS in CHC patients. Patients with AFP≥20.6 μg/L and CA19-9≥35.2 U/L showed a worse prognosis.

Objective:To investigate the factors influencing recipient liver regeneration after full-size split liver transplantation (fSLT).Methods:The clinical data of patients undergoing split liver transplantation in the Affiliated Li Huili Hospital of Ningbo University from May 2019 to Sep 2023 were retrospectively collected. Graft volume (GV) and initial graft volume (IGV) at (30±7) days after operation were measured, and postoperative liver regeneration rate (LRR) was calculated. The patients undergoing fSLT were divided into high regeneration group and low regeneration group with LRR=30% as boundary. The differences of donor and recipient data and perioperative data between the two groups were compared.Results:A total of 52 patients were included. The low fSLT regeneration group (16 cases) was compared with the high fSLT regeneration group (36 cases), and in high fSLT regeneration group donor age was lower, the donor liver steatosis was less, GRWR was lower, the incidence of hepatitis B virus-related liver disease was lower, the postoperative diagnosis of malignant liver disease was lower, the intraoperative blood loss was less, and the postoperative platelet count was higher. The levels of liver enzyme and total bilirubin (TBiL) were higher than those in high regeneration group ( P<0.05). Conclusions:Donor age, donor liver steatosis, GRWR, hepatitis B virus associated liver disease, and recipient pathogenesis are important factors affecting liver regeneration after fSLT. Postoperative platelet and liver enzyme levels are important indicators for monitoring liver regeneration after fSLT.

Objective:To compare the clinical outcomes between percutaneous Kirschner wire leverage plus plaster fixation and elastic intramedullary nailing in the treatment of radial neck fractures in children.Methods:A retrospective study was conducted to analyze the 60 children with radial neck fracture who had been treated by percutaneous Kirschner wire leverage plus plaster fixation at Department of Pediatric Orthopedics, Children's Hospital of Soochow University from January 2016 to July 2023 (set as an internal fixation-free group). They were 30 males and 30 females (34 left and 26 right sides) with an age of (7.7±3.0) years. At the same time, another cohort of 60 patients were chosen as an intramedullary nailing group who had been treated by percutaneous Kirschner wire leverage plus elastic intramedullary nailing and matched in age and gender with those in the internal fixation-free group. The preoperative fracture angulation, operative time, hospitalization time, fracture angulation on the first postoperative day, fracture angulation at 1 month postoperatively, rate of angulation loss after reduction, Mayo elbow performance score (MEPS) at the last follow-up and complications were compared between the 2 groups.Results:There was no significant difference between the 2 groups in their preoperative general data, showing comparability ( P<0.05). The 120 pediatric patients were followed up for (7.5±3.2) months. The operative time [(27.4±15.0) min] and hospitalization time [(3.4±1.9) d] in the internal fixation-free group were significantly shorter than those in the intramedullary nailing group [(45.4±13.5) min and (4.4±1.3) d] ( P<0.05). The preoperative fracture angulation (50.8°±1.9°), fracture angulation on the first postoperative day (11.3°±1.2°), fracture angulation at 1 month postoperatively (12.1°±1.3°), rate of angulation loss after reduction (2.9%±0.5%), and MEPS at the last follow-up [(90.4±2.0) points] in the internal fixation-free group showed no significant differences from those in the intramedullary nailing group [49.5°±1.7°, 11.1°±1.2°, 13.3°±1.5°, 3.9%±1.4%, and (90.2±2.3) points] ( P>0.05). None of the patients in the internal fixation-free group developed pin-tail irritation sign or premature epiphyseal closure after surgery, whereas 3 patients in the intramedullary nailing group developed pin-tail irritation sign and 2 ones premature epiphyseal closure after surgery, showing a significant difference in the complication rate between the 2 groups [0 (0/60) versus 8.3% (5/60)] ( P<0.05). Conclusions:Percutaneous Kirschner wire leverage plus plaster fixation and close elastic intramedullary nailing can both achieve satisfactory outcomes in the treatment of radial neck fractures in children. However, percutaneous Kirschner wire leverage plus plaster fixation needs shorter operative time and hospitalization time, leads to fewer complications, and requires no reoperation to remove internal fixation.

Biliary tract cancers (BTC), a heterogeneous disease with poor prognosis, including gallbladder cancer (GBC), intrahepatic cholangiocarcinoma (ICC), and extrahepatic cholangiocarcinoma (ECC). Although surgery is currently the primary regimen to treat BTC, most BTC patients are diagnosed at an advanced stage and miss the opportunity of surgical eradication. As a result, non-surgical therapy serves as the main intervention for advanced BTC. In recent years, immunotherapy has emerged as one of the most promising therapies in a number of solid cancers, and it includes immune checkpoint inhibitors (ICIs) monotherapy or combined therapy, tumor vaccines, oncolytic virus immunotherapy, adoptive cell therapy (ACT), and cytokine therapy. However, these therapies have been practiced in limited clinical settings in patients with BTC. In this review, we focus on the discussion of latest advances of immunotherapy in BTC and update the progress of multiple current clinical trials with different immunotherapies.

Objective:To analyze the online learning behaviors and learning results of students under different teaching modes with different learning motivations, and to provide a reference for optimizing the development of online teaching.Methods:Samples of students taking the physiology small private online course (SPOC) in 2019 and 2020, and students taking the massive open online courses (MOOC) in the same year were selected in the study to discuss the differences in learning behaviors of students under different teaching modes and learning effects on students with different learning motivations. The online learning behaviors of students were analyzed based on their learning engagement, interactive behavior and learning motivation. SPSS 25.0 was used to analyze the data with statistical methods such as function calculation, frequency statistics, regression analysis, rank sum test, correlation test and chi-square test.Results:The learning participation level ( z=14.36, P<0.001), and the human-machine and interpersonal learning interaction level ( z=-11.70, -16.18, both P<0.001) of SPOC learners in 2020 were higher than those in 2019. The overall interactive level was moderately correlated with performances of students ( r=0.42, 0.52, both P<0.001), and the correlation between interpersonal behavior and grades was much more stronger ( r=0.60, 0.55, both P<0.001). The performance composition of SPOC and MOOC learners in 2019 was completely different ( χ2=857.45, P<0.001). The learning effect of externally motivated students was significantly better than that of internally motivated students ( z=-28.42, P<0.001). Conclusion:The teaching mode adopted by the school can affect the learning effect by influencing the students' online learning engagement and interactive behavior. Besides, students' own learning motivation also plays a key role in their academic performance.

Objective To explore the personality change in patients with epilepsy during the interictal period and the correlation between clinical features and personality change. Methods One hundred and fifteen patients with idiopathic or cryptogenic epilepsy were chosen as the epileptic group and 42 age- and sex-matched healthy subjects served as controls. All participants were evaluated by Mini Mental Status Examination and Brief Psychiatric Rating Scale to ensure the normality of cognition and mental state.Personality was evaluated by adult version of Eysenck Personality Questionnaire (EPQ)in interictal epilepsy patients and healthy controls.Scores of psychoticism (P),extraversion (E),neuroticism (N) and lie (L)were obtained using computer software. Pearson correlation analysis and logistic regression were used to investigate the scores of EPQ and influential factors.Results P and N scores were significantly elevated in epilepsy patients compared with controls ( P scores:50.48 ± 9.55 vs 46.59 ± 7.28,N scores:51.13 ±12.89 vs 46.83 ± 9.40 ; t =2.374,2.266,both P ＜ 0.05 ),while E scores were significantly decreased (51.74 ± 10.74 vs 60.37 ± 9.84;t =- 4.511,P ＜ 0.01 ).There were no significant differences in L scores.Multivariate analysis showed that disease duration was independently correlated to P scores (β =0.043,P＜0.05),while education was correlated to E scores (β =0.109,P ＜ 0.05 ).There were no significant correlations between personality scores,patient age,gender,age of onset,frequency,seizure type,National Hospital Seizure Severity Scale scores,family history,history of status epilepticus and antiepileptic drugs usage.Conclusions High psychoticism and neuroticism and low cxtraversion scores are correlated to patients with epilepsy during the interictal period.Disease duration is an independent risk factor for psychoticism personality,and education level is an independent risk factor for extraversion personality in epilepsy patients.