Objective:To study the impact of the age-adjusted Charlson comorbidity index (ACCI) on the prognosis of patients with hilar cholangiocarcinoma following laparoscopic surgical resection.Methods:Clinical data of 136 patients with hilar cholangiocarcinoma undergoing laparoscopic surgery at Zhengzhou University People's Hospital between January 2013 and January 2018 were retrospectively analyzed, including 81 males and 55 females, aged (63.6±9.8) years. Patients were divided into two groups based on the median ACCI score of 4.0: the high ACCI group (ACCI>4.0, n=49) and low ACCI group (ACCI≤4.0, n=87). The prognosis was compared between the two group. Univariate and multivariate Cox regression analyses were performed to analyze the effect of ACCI on survival after laparoscopic surgery. Results:The 1- and 3-year cumulative survival rates in low ACCI group were 87.4% and 48.3%, respectively, compared to 53.1% and 4.1% in high ACCI group ( χ2=27.97, P<0.001). Univariate Cox regression analysis indicated that ACCI >4.0 was associated with prognosis ( HR=3.73, 95% CI: 2.44-5.68, P<0.001). Multivariate Cox regression analysis also indicated that ACCI >4.0 was associated with an increased risk of postoperative mortality in patients with hilar cholangiocarcinoma ( HR=2.69, 95% CI: 1.65-4.37, P<0.001). Conclusion:The ACCI is a significant risk factor for survival of patients with hilar cholangiocarcinoma following laparoscopic surgery, which could facilitate a precise preoperative assessment of patient status and choice of surgical approach.

Objective:To investigate the influencing factors for microvascular invasion (MVI) in hepatocellular carcinoma based on three-dimensional visualization and the construction of its nomogram model.Methods:The retrospective cohort study method was conducted. The clinico-pathological data of 190 patients with hepatocellular carcinoma who were admitted to Henan University People′s Hospital from May 2018 to May 2021 were collected. There were 148 males and 42 females, aged (58±12)years. The 190 patients were randomly divided into the training set of 133 cases and the validation set of 57 cases by the method of random number table in the ratio of 7:3. The abdominal three-dimensional visualization system was used to characterize the tumor morphology and other imaging features. Observation indicators: (1) analysis of influencing factors for MVI in hepatocellular carcinoma; (2) construction and evaluation of nomogram model of MVI in hepatocellular carcinoma. Measurement data with normal distribution were expressed as Mean± SD, and independent sample t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M( Q1, Q3), and non-parametric rank sum test was used for comparison between groups. Count data were expressed as absolute numbers, and the chi-square test was used for comparison between groups. Corresponding statistical methods were used for univariate analysis. Binary Logistic regression model was used for multivariate analysis. Receiver operator characteristic (ROC) curves were plotted, and the nomogram model was assessed by area under the curve (AUC), calibration curve, and decision curve. Results:(1) Analysis of influencing factors for MVI in hepatocellular carcinoma. Among 190 patients with hepatocellular carcinoma, there were 97 cases of positive MVI (including 63 cases in the training set and 34 cases in the validation set) and 93 cases of negative MVI (including 70 cases in the training set and 23 cases in the validation set). Results of multivariate analysis showed that alpha-fetoprotein, vascular endothelial growth factor, tumor volume, the number of tumors, and tumor morphology were independent factors affecting the MVI of patients with hepatocellular carcinoma ( odds ratio=5.06, 3.62, 1.00, 2.02, 2.59, 95% confidence interval as 1.61-15.90, 1.28-10.20, 1.00-1.01, 1.02-3.98, 1.03-6.52, P<0.05). (2) Construction and evaluation of nomogram model of MVI in hepatocellular carcinoma. The results of multivariate analysis were incorporated to construct a nomogram prediction model for MVI of hepatocellular carcinoma. ROC curves showed that the AUC of the training set of nomogram model was 0.85 (95% confidence interval as 0.79-0.92), the optimal fractional cutoff based on the Jordon′s index was 0.51, the sensitivity was 0.71, and the specificity was 0.84. The above indicators of validation set were 0.92 (95% confidence interval as 0.85-0.99), 0.50, 0.90, and 0.82, respectively. The higher total score of the training set suggested a higher risk of MVI in hepatocellular carcinoma. The calibration curves of both training and validation sets of nomogram model fitted well with the standard curves and have a high degree of calibration. The decision curve showed a high net gain of nomogram model. Conclusions:Alpha-fetoprotein, vascular endothelial growth factor, tumor volume, the number of tumors, and tumor morphology are independent influencing factors for MVI in patients with hepatocellular carcinoma. A nomogram model constructed based on three-dimensional visualized imaging features can predict MVI in hepatocellular carcinoma.

Objective:To analyze the influencing factors of abnormal 15-minute retention rate of indocyanine green (ICG R15) (≥10%) in patients with hepatocellular carcinoma, and to construct a nomogram model, and to evaluate the prediction efficiency of the nomogram model.Methods:The clinical data of 190 patients with hepatocellular carcinoma in Zhengzhou University People's Hospital from December 2017 to June 2022 were retrospectively analyzed, including 148 males and 42 females, aged (57.8±9.9) years. According to ICG R15, the patients were divided into ICG R15 normal group ( n=134, ICG R15<10%) and ICG R15 abnormal group ( n=56, ICG R15≥10%). Univariate and multivariate logistic regression were used to analyze the influencing factors of abnormal ICG R15, and the nomogram model was established. The predictive ability of the model was evaluated by receiver operating characteristic (ROC) curve and C-index, and the model was verified by calibration curve and decision analysis curve. Results:Abnormal ICG R15 group the proportion of liver cirrhosis, albumin ≤35 g/L, hemoglobin ≤110 g/L, platelet count ≤100×10 9/L, prothrombin time >13 s, alanine aminotransferase >40 U/L, aspartate aminotransferase >40 U/L, total bilirubin >34.2 μmol/L, and the largest tumor diameter >5.0 cm, spleen volume >383.1 cm 3, spleen volume to of non-tumor liver volume (SNLR) >0.276 and liver tumor volume >117.2 cm 3 were higher than that of ICG R15 normal group, and the differences were statistically significant (all P<0.05). Logistic regression analysis showed that liver cirrhosis ( OR=3.89, 95% CI: 1.28-11.80, P=0.016), spleen volume >383.1 cm 3( OR=5.17, 95% CI: 1.38-19.38, P=0.015), SNLR >0.276 ( OR=5.54, 95% CI: 1.44-21.26, P=0.013) and total bilirubin >34.2 μmol/L( OR=10.20, 95% CI: 1.88-55.39, P=0.007) increased the risk of abnormal ICG R15. A nomogram model was constructed based on the above risk factors. The C-index of the model was 0.915 (95% CI: 0.872-0.957), and the area under the ROC curve predicted by the nomogram model was 0.915 (95% CI: 0.871-0.958). The calibration curve showed that the correlation index of the abnormal ICG R15 predicted by the nomogram was similar to actual situation. Decision analysis curve showed high returns. Conclusion:Liver cirrhosis, spleen volume >383.1 cm 3, SNLR>0.276 and total bilirubin >34.2 μmol/L were indepentlent risk factors for abnormal ICG R15 in patients with hepatocellur carcinoma. The clinical prediction model of ICG R15 abnormality constructed by nomogram has good prediction efficiency, which can provide a reference for evaluating preoperative liver reserve function of patients with hepatocellular carcinoma.

Objective:To investigate the application value of peripheral blood circulating tumor cell (CTC) classification in the prediction of preoperative microvascular invasion of hepato-cellular carcinoma (HCC).Methods:The retrospective case-control study was conducted. The clinico-pathological data of 102 HCC patients who were admitted to Zhengzhou University People's Hospital from September 2018 to September 2020 were collected. There were 71 males and 31 females, aged from 29 to 80 years, with a median age of 57 years. Observation indicators: (1) surgical situations; (2) results of CTC detection and microvascular invasion in HCC patients; (3) results of CTC classification and the best cut-off value of CTC classification in the prediction of microvascular invasion in HCC; (4) influencing factors for microvascular invasion in HCC; (5) comparison of clinicopathological features in HCC patients with different cell counts in mesenchymal phenotype of CTC (M-CTC). Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent sample t test. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and comparison between groups was analyzed using the nonparametric rank sum U test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. The receiver operating characteristic (ROC) curve was used to determine the best cut-off value for the risk of microvascular invasion in patients. Univariate and multivariate analysis were performed using the Logistic regression model. Results:(1) Surgical situations. All 102 patients underwent surgery successfully, including 17 cases undergoing local hepatectomy, 43 cases under-going segmentectomy, 22 cases undergoing hepatic lobectomy, 13 cases undergoing hemilectomy and 7 cases undergoing enlarged hemilectomy. The operation time and the volume of intraoperative blood loss were 235(147,293)minutes and 300(110,500)mL of the 102 patients, respectively. (2) Results of CTC detection and microvascular invasion in HCC patients. Of 102 patients, there were 36 casas with epithelial phenotype of CTC (E-CTC), 86 cases with hybrid phenotype of CTC (H-CTC), 30 cases with M-CTC, respectively, and the total CTC (T-CTC) were positive in 89 cases. Results of postoperative pathological examination showed that there were 40 cases with micro-vascular inva-sion and 62 cases without microvascular invasion in the 102 patients. Of the 40 patients with micro-vascular invasion, the count of E-CTC, H-CTC, M-CTC and T-CTC were 0(0,1) per 5 mL, 4(2,5) per 5 mL, 1(0,2) per 5 mL and 5(3,8) per 5mL, respectively. The above indicators of the 62 cases without microvascular invasion were 0(0,1) per 5 mL, 3(1,5) per 5 mL, 0(0,0) per 5 mL and 3(2,6) per 5 mL, respectively. There were significant differences in the count of M-CTC and T-CTC between patients with and without microvascular invasion ( Z=-4.83, -2.96, P<0.05). (3) Results of CTC classi-fication and the best cut-off value of CTC classification in the prediction of microvascular invasion in HCC. The ROC curve showed that best cut-off value of M-CTC and T-CTC counts in the prediction of microvascular invasion in HCC were 1 per 5 mL and 4 per 5 mL, respectively, with the area under curve, the corresponding specificity, sensitivity were 0.70 (95% confidence interval as 0.60-0.81, P<0.05), 75.8%, 62.9% and 0.67 (95% confidence interval as 0.57-0.78, P<0.05), 60.0%, 72.5%, respec-tively. (4) Influencing factors for microvascular invasion in HCC. Result of univariate analysis showed that alpha fetoprotein (AFP), aspartate aminotransferase (AST), tumor diameter, tumor number, tumor margin, Barcelona clinic liver cancer staging, M-CTC counts and T-CTC counts were related factors influencing microvascular invasion in HCC ( odds ratio=3.13, 0.43, 4.92, 5.65, 2.54, 2.93, 8.25, 4.47, 95% confidence interval as 1.34-7.33, 0.19-0.98, 2.09-11.58, 2.35-13.63, 1.13-5.75, 1.27-6.74, 3.13-21.75, 1.88-10.61, P<0.05). Result of multivariate analysis showed that tumor diameter >5 cm, tumor number as multiple and M-CTC counts ≥1 per 5 mL were independent risk factors influencing microvascular invasion in HCC ( odds ratio=2.97, 4.14, 4.36, 95% c onfidence interval as 1.01-8.70, 1.14-15.02, 1.36-13.97, P<0.05). (5) Comparison of clinicopathological features in HCC patients with different cell counts in M-CTC. The 102 HCC patients were divided into the high M-CTC group of 30 cases with M-CTC counts ≥1 per 5 mL and the low M-CTC group of 72 cases with M-CTC counts <1 per 5 mL, according to the best cut-off value of M-CTC counts. Cases with hepatitis, cases with AFP >400 μg/L, cases with AST >35 U/L, cases with irregular tumor margin, cases with tumor diameter >5 cm, cases with tumor number as multiple and cases with micro-vascular invasion were 22, 17, 13, 21, 18, 16 and 22 in the high M-CTC group of 30 cases. The above indicators were 35, 18, 48, 26, 25, 21 and 18 in the low M-CTC group of 72 cases. There were significant differences in the above indicators between the high M-CTC group and the low M-CTC group ( χ2=5.25, 9.42, 4.80, 9.79, 5.55, 5.35, 20.75, P<0.05). Conclusions:The epithelial-mesen-chymal phenotype of peripheral blood CTC can be used to predict the preoperative microvascular invasion in HCC. Tumor diameter >5 cm, tumor number as multiple and M-CTC counts ≥1 per 5 mL are independent risk factors influencing microvascular invasion in HCC patients.

Objective:This study aimed to compare the clinical outcomes of laparoscopic pancreaticoduodenectomy (LPD) versus open pancreaticoduodenectomy (OPD).Methods:The clinical data of 386 patients who successfully underwent pancreaticoduodenectomy at the People's Hospital of Zhengzhou University from June 2017 to December 2019 were retrospectively analyzed. According to the different surgical methods, patients were divided into the LPD group ( n=122) and the OPD group ( n=264). The differences in operation time, intraoperative blood loss, postoperative hospital stay, postoperative complications, postoperative oncology survival outcomes and prognosis between groups were compared. Results:Of 386 patients in this study, there were 232 males and 154 females, aged (57.8±11.0) years. The operation time of the LPD group was (330.69±80.55) min which was significantly longer than that of the OPD group (241.13±77.24) min. The intraoperative blood loss 300.00(200.00, 400.00) ml was also significantly less than the OPD group 400.00(262.50, 500.00) ml, and the length of postoperative stay in the LPD group (12.21±5.24) d was significantly less than the OPD group (16.61±6.63) d, (all P<0.05). There were 36 patients (29.51%) in the LPD group and 81 patients (30.68%) in the OPD group who developed postoperative complications, with no significant difference between groups ( P>0.05). Postoperative oncology outcomes showed that the number of lymph nodes dissected in the LPD group was significantly more than that in the OPD group [(12.65±5.03) vs (10.07±5.09)], ( P<0.05). There were no significant differences between the two groups in tumor pathology type, size, degree of differentiation and R 0 resection rates (all P>0.05). All patients were followed up for 6-36 months, with a median follow-up of 20 months. The survival rates of patients with malignant tumors after following-up for more than 1 year in the LPD group was 84.72%(61/72), that in the OPD group was 85.81%(133/155), with no significant difference between groups ( P>0.05). Conclusion:LPD was safe and feasible with its advantages of minimally invasiveness.

Objective:To investigate the consistency of indirect calorimetry, Harris-Benedict (H-B) formula method and rule of thumb in calculating the daily total energy expenditure (TDEE) of patients with acute pancreatitis (AP), and provide the basis for the formulation of reasonable nutritional support program.Methods:A total of 66 AP patients admitted to Henan Provincial People's Hospital from June 2020 to December 2020 were included and retrospectively analyzed, including 35 males and 31 females with an average age of 41.8 years. They were divided into mild acute pancreatitis (MAP) group ( n=20) and moderate to severe AP group ( n=46) according to severity. TDEE was calculated by indirect calorimetry, H-B formula and rule of thumb, and Pearson correlation analysis and Bland-Altman diagram were used to analyze the correlation and consistency of the three methods, respectively. Results:There were no statistical significances in the TDEE of MAP group calculated by indirect calorimetry, H-B formula method and rule of thumb (both P>0.05). TDEE calculated by indirect calorimetry were higher than that of calculated by H-B formula and thumb method both in moderate and severe AP groups, and the difference was statistically significant (both P<0.05). Pearson correlation analysis showed that H-B formula method was positively correlated with the TDEE calculated by indirect calorimetry, and the correlation was 0.61 ( P<0.05). Bland-Altman plot analysis showed the consistence of the two methods. TDEE calculated by rule of thumb was positively correlated with that calculated by indirect calorimetry, and the correlation was 0.75 ( P<0.05). The bland-Altman plot analysis showed a good consistency between the two methods. Conclusion:For MAP patients, TDEE can be calculated by the H-B formula method and rule of thumb. In moderate and severe AP patients, TDEE should be calculated by indirect calorimetry as the basis for the formulation of nutritional support plan.

Objective:To investigate the value of tumor budding in the clinicopathology and prognosis of pancreatic neuroendocrine tumors.Methods:The Cliniccal data of 105 pancreatic neuroendocrine tumor patients underwent resection in Henan Provincial People's Hospital from Jan 2010 to Dec 2016 were retrospectively analyzed. Tumor budding was calculated through hematoxylin-eosin (HE) and immunohistochemical stained slides. Based on the receiver operating characteristic curve (ROC), the number of tumor budding ≥10 was defined as the high-grade budding group, and <10 as the low-grade budding group. Multiple analysis was performed to determine the relationship between tumor budding and clinicopathology as well as prognosis.Results:High-grade budding group was observed in 35 cases and low-grade group in 70. High-grade budding were more common in tumors with advanced T stage, high risk of lymphatic metastasis, preoperative liver metastasis, vascular invasion and postoperative recurrence (respectively χ 2=9.043, 4.286, 10.130, 12.090, 9.260, all P<0.05). Multivariate COX regression analysis showed that tumor budding ( P=0.018), tumor grade ( P=0.026), preoperative liver metastasis ( P=0.042), vascular invasion( P=0.048) was independent risk factors predicting poor prognosis. Conclusion:Tumor budding is highly correlated with clinicopathological parameters which reflect the aggressiveness of pancreatic neuroendocrine tumor, it is also an important prognostic factor.

Objective:To investigate the predictive value of portal vein (PoV) blood circulating tumor cells (CTCs) count in patients with pancreatic cancer on the postoperative prognosis.Methods:The data of 58 patients receiving radical resection of pancreatic cancer and PoV CTCs detection at People's Hospital of Zhengzhou University from Aug 2018 to Jun 2020 were collected. According to the cut-off value of PoV CTCs>10/5 ml made by receiver operating characteristic curve (ROC), patients were divided into high CTCs group and low CTCs group and the differences in clinicopathological parameters and prognosis of the two groups were compared.Results:Postoperative progression-free survival rate of the low CTCs group was higher than that of the high CTCs group ( χ 2=12.97, P<0.001).Univariate COX regression analysis showed that tumor diameter >4 cm, lymph node invasion, TNM staging, CTCs>10/5 ml, postoperative CA199>37 U/m were risk factors for postoperative prognosis. Multivariate COX regression analysis demonstrated that TNM stage ( OR=2.782, P=0.024), CTCs count >10/5 ml ( OR=2.583, P=0.047), postoperative CA199>37 U/m ( OR=3.775, P=0.004) were the independent risk factors of prognosis. Conclusion:A higher PoV CTCs count was a risk factor for poor prognosis of patients with pancreatic cancer after radical resection.

Objective To evaluate fusion indocyanine green fluorescence imaging in laparoscopic anatomical hepatectomy.Methods The clinical data of 75 liver cancer patients undergoing laparoscopic anatomic hepatectomy (LAH) at the Department of Hepatobiliary and Pancreatic Surgery,Henan Provincial People's Hospital from Apr 2017 to Sep 2018 were retrospectively analyzed.Patients were divided into the indocyanine green fluorescence fusion imaging technique (FIGFI-LAH) group (35 cases) and laparoscopic anatomical hepatectomy (LAH) group (40 cases).Results Pathologically positive margin was found in 1 case in FIGFI-LAH group and 9 cases in LAH group (x2 =4.649,P =0.031).There were no significant differences in the mean operative time,intraoperative blood loss,blood transfusion rate,and rate of conversion to open surgery (P ＞ 0.05).Conclusion The use of FIGFI technique in laparoscopic anatomical hepatectomy for liver cancer effectively reduces the positive rate of surgical margin.

Objective To observe BQ123 on lung tissue injury following ischemia-reperfusion of hind limbs in rats.Methods A total of 30 male SD rats were randomly divided into control,I-R,and BQ123 groups,with 10 rats in each group. After 4- hour of ischemia and 4-hour of reperfusion to the hind limbs, ET-1 was measured by radioimmunoassay, levels of myeloperoxidase (MPO) and malondialehyde (MDA) were examined by biochemical method,and the content of P-selectin was examined by ELISA. Immunohistochemical method was used to detect the expressions of Fas,Bcl-2 and Caspase-3 in lung tissues. Pulmonary apoptosis was examined by means of TdT-mediated dUTP nick end labeling ( TUNEL) . Results Compared with the control group,the levels of ET-1,MPO,MDA and P-selectin in lung tissues were all increased significantly in I-R group ( P<0. 01). The expressions of Fas,Bcl-2 and Caspase-3 were 0. 294±0. 003,0. 108±0. 005,and 0. 174±0. 003,significantly up-regulated in the I-R group. The apoptosis rate [(18. 83±2. 86)%] was significantly increased in the I-R group (P<0. 01). Compared with I-R group,the tissue contents of ET-1,MPO,MDA and P-selectin were significantly lowered in BQ123 group (P<0. 01). The expression levels of Fas (0. 115±0. 007) and Caspase-3 (0. 159±0. 006) were decreased,but the expression of Bcl-2 was increased (0. 128±0. 005). The apoptosis rate in BQ123 group was significantly lower [(10. 67±2. 16)%,P<0. 01].Conclusion BQ123 may have protective effects on lung tissue after limb ischemia-reperfusion in rats by means of improving neutrophil aggregation and reducing the expression of proteins related to cell apoptosis.