Objective To investigate the technique and dosage selection of indocyanine green(ICG)fluorescence staining in laparoscopic anatomical hemihepatectomy.Methods A retrospective cross-sectional study was conducted.The clinical date of the patients who underwent laparoscopic anatomical hemihepatectomy in the Cancer Hospital of the Chinese Academy of Medical Sciences from October 2020 to October 2023 was collected and analyzed,and the management of the Glissonean pedicle,the method and effect of ICG fluorescence staining during the operation,the dose of ICG injection,and the postoperative recovery were analyzed.Results A total of 91 laparoscopic anatomical hemihepatectomies were enrolled in this study,including 28 right hemihepatectomies and 63 left hemihepatectomies.The Glissonean pedicle was dissected intra-sheath in 9 cases and extra-sheath in 82 cases.ICG fluorescence staining was all performed using the negative staining method,of which 69 cases(75.8%)were successfully stained.The success rate of staining in the extra-sheath dissection and low-dose ICG group was higher than that in the intra-sheath dissection and high-dose ICG group.The average operation time was(168.5±32.2)minutes,the intraoperative bleeding volume was(152.4±56.3)ml,and the intraoperative blood transfusion rate was 6.6%(6/91),the average postoperative hospital stay was(8.5±2.6)days.One case was converted to laparotomy due to exophytic growth of the tumor compressing the Glissonean pedicle.Four cases had Clavien-Dindo Ⅰ-Ⅱ complications,all of which improved after treatment.There were 3 cases of grade Ⅲa complications,all of which were caused by bile leakage and abdominal cavity infection.They were cured by puncture and drainage.And there were no serious complications above grade Ⅲb.Conclusions In laparoscopic anatomical hemihepatectomy,the ICG fluorescence staining method was recommended to use the negative staining method of the extra-sheath dissection of the Glissonean pedicle,and a lower dose of ICG could help to increase the success rate of fluorescence staining.

Hemophilic arthritis(HA),caused by recurrent bleeding,can seriously affect patient quality of life and consumes extensive social and medical resources.There is thus a need to establish an animal model of HA for research;however,this is limited by ethical requirements.Here we review the recent literature and summarize research progress into animal models of HA at home and abroad,from the aspects of species selection,modeling method,histopathology,and imaging evaluation method.Species selection includes rodents such as mice,New Zealand rabbits,beagles,miniature pigs,and crab-eating macaques.Modeling method comprise gene knockout trauma models,gene knockout spontaneous models,and injection models.Among these,the gene knockout spontaneous model closely mimics the pathological process of spontaneous bleeding and concurrent arthritis in human HA,making it more relevant to human HA.However,due to high modeling costs,phenotypic instability,and low survival rates,this model is not the preferred choice for animal experimental studies.In contrast,gene knockout trauma models exhibit characteristics such as short modeling time,strong stability,and high success rates,thus being widely utilized in animal experimental research.Evaluation of HA models involves various imaging method including MRI,micro-CT,MSKUS/PD,in addition to various gross scoring method.By reviewing the progress of HA model research,more experimental evidence is provided for investigating the pathogenesis and validating the efficacy of HA treatments,thereby compensating for the lack of clinical data,particularly in the field of traditional Chinese medicine therapy.

Objective:To explore the effect of triglyceride glucose(TyG) index, single nucleotide polymorphism of Toll-like receptor 4(TLR4) and NOD-like receptor thermal protein domain associated protein 3(NLRP3) genes, and its interaction on the risk of gout.Methods:A total of 315 male patients with gout and 499 men for health checkup at the same period were selected. General data were collected through questionnaires, and peripheral venous blood was collected for biochemical test. Three single nucleotide polymorphisms(SNPs) of NLRP3 and TLR4 were detected with multiplex ligase assay reaction, and logistic regression analysis was applied to compare the correlation between NLRP3 and TLR4 alleles and gout risk. The interaction of SNP and TyG index with gout was analyzed by generalized multi-factor dimensionality reduction(GMDR) model and logistic regression.Results:After adjusting for smoking, drinking, and other factors, the risk of gout increased by 61.1% for each standard deviation increase in TyG index. CC genotypes of rs10754558, rs10759932, and rs7525979 were high risk genotypes of gout in Han ethnicity. GMDR results showed significant differences in the interaction models of rs10754558-TyG index, rs7525979-TyG index, and rs10759932-TyG index between control group and gout group( P<0.05), suggesting an interaction between the three genotypes of SNPs selected and TyG index. Stratified analysis of the three selected SNPs and TyG index showed that after adjusting for age, smoking, and other factors, the high TyG index patients carrying C/C or C/G genotype at rs10754558 displayed an increased risk of gout compared with those carrying GG genotype and low TyG index( OR=2.127, P<0.05). Conclusion:The CC genotypes of rs10754558, rs10759932, and rs7525979 are high risk genotypes for gout in Han ethnicity. The interaction between rs10754558 and TyG index may increase the risk of gout development.

Anatomical right superior segmentectomy has always been a difficult surgical procedure in laparoscopic liver resection. How to accurately judge the interface between liver segments, so as to achieve a true sense of anatomic resection based on portal territory is a new requirement in the era of precision liver surgery. The portal vein puncture and indocyanine green (ICG) fluorescence positive staining technique can effectively solve this problem, which has a series of advantages and certain technical requirements in anatomical right superior segmentectomy. ICG fluorescence staining can intuitively define the three-dimensional range of the liver segment, which is a more accurate navigation mode that helps liver surgeons identify the range of the right superior liver segment, thus conducting surgery more safely and normatively. The authors consult relevant studies and combined with clinical practice to explore the application value of laparoscopic ultrosound guided puncture and positive staining technique in anatomical right superior segmentectomy.

Objective:To develop a learning scale of scientific methods for medical students and to evaluate the reliability and validity of the scale.Methods:Based on the principles of planned behavior theory, the original scale was developed through literature analysis, pre-interview and experts' consultation. A preliminary survey was conducted among 105 medical undergraduates with random cluster sampling, and the primary scale was formed by exploratory factor analysis. Then, 851 undergraduates were selected as the objects of formal survey, and the formal scale was finally determined by the reliability and validity evaluation and confirmatory factor analysis. SPSS 22.0 and AMOS 22.0 softwares were used for statistical analysis of the measurement data.Results:The formal scale was composed of 5 latent variables, 9 observed variables and 51 items. The overall Cronbach’s α coefficient and the overall retest reliability were 0.97 and 0.89, respectively. Composite reliability and KMO values of each latent variable were more than 0.80, and the values of average variance extraction were over 0.50. The fitness test ( P=0.155) showed acceptable fitting quality with the main fit indices of χ2/ df=1.41, RMR=0.04, RMSEA=0.02, etc. Conclusion:The learning scale of scientific methods shows satisfactory reliability, validity and fitness, which can be applied as a measuring tool to evaluate the learning behavior of scientific methods for medical students.

Objective:To compare the effects of five different types of videolaryngoscopes in patients with a simulated difficult airway.Methods:575 patients who needed endotracheal intubation in Nanjing Hospital Affiliated to Nanjing Medical University from May 2021 to September 2021 were randomly divided into 5 groups [UE videolaryngoscope group (U group), GlideScope videolaryngoscope group (G group), C-MAC videolaryngoscope group (C group), Airtraq videolaryngoscope group (A group) and A. P.advance videolaryngoscope group (AP group)], with 115 patients in each group. They all wore cervical collar to simulate difficult airway. The main observation index was the success rate of first endotracheal intubation. Secondary observation indicators included overall success rate, laryngoscope exposure field, intubation time, operator′s subjective score, cause of failure, adverse events, and complications of intubation.Results:The patients′ mouth opening degree was reduced from (46±6)mm to (24±4)mm ( P<0.05) after wearing the cervical collar; The success rate of the first endotracheal intubation were 96%(UE), 92%(C-MAC), 86%(GlideScope), 85%(Airtraq), and 60%(AP.Advance) respectively, with statistically significant difference ( P<0.05); Compared with AP group and G group, the incidence of soft tissue injury or bleeding in U group and C group were lower ( P<0.05); There were significant difference in the overall success rate of videolaryngoscopes, laryngoscope visual field exposure, intubation time, the subjective score of the operator and adverse events ( P<0.05); There was no significant difference in the complications of intubation among the groups ( P>0.05). Conclusions:Among 575 patients with a simulated difficult airway with limited neck mobility and limited mouth opening, there were significant differences in the use of five videolaryngoscopes. Among them, UE video laryngoscope had the highest first intubation success rate and lowest tissue trauma rate, C-MAC video laryngoscope, GlideScope video laryngoscope and Airtraq video laryngoscope followed in performance, while A. P.Advance video laryngoscope performed the worst.

Liver resection is an important method for the treatment of benign and malig-nant hepatobiliary diseases. Due to severe surgical injury, complicated surgical procedures and operation difficulty, the postoperative complications are relatively more common, and infections are the frequent complications. Postoperative infection not only increases the economic burden and treatment difficulty of patients, but also affects the prognosis. There are many risk factors leading to postoperative infection. Controlling and improving these factors are effective measures to reduce or avoid postoperative infection. By reviewing the domestic and abroad literatures, and combined with the clinical experiences, the authors discuss the types of postoperative infection, the related risk factor and the corresponding prevention and treatment strategies after liver resection.

Objective:The study aimed to study the efficacy and safety of combined dual therapy using anti-programmed death (PD)-1 and tyrosine kinase inhibitor (TKI) with combined triple therapy using anti-PD-1, TKI and locoregional intervention triple therapy in patients with postoperative refractory recurrent liver cancer.Methods:Patients with postoperative refractory recurrent liver cancer who had undergone either anti-PD-1 and TKI dual therapy or anti-PD-1, TKI and locoregional intervention triple therapy between July 2016 and March 2019 at the First Medical Center, Chinese PLA General Hospital were retrospectively studied. Tumor responses were assessed by the modified response evaluation criteria in solid tumors and overall survival and progression free survival were compared. Adverse events were evaluated according to the National Cancer Institute Common Terminology Criteria for Adverse Events.Results:Of 63 patients who were included in this study, there were 25 patients in the dual therapy group (16 males and 9 females, aged 54.3±8.8 years) and 38 patients in the triple therapy group (31 males and 7 females, aged 55.5±8.4 years). The 1-year survival rate of the triple therapy group was significantly higher than the dual therapy group (94.5%vs 54.9%) ( P<0.01). The disease control rate was 64.0% (16/25) in the dual therapy group and 84.2% (32/38) in the triple therapy group, and the difference was not significant ( P>0.05). The incidence of treatment-related adverse events in the triple therapy group and the dual therapy group were 78.9% (30/38) and 80% (20/25), respectively. There was no treatment-related death in the 2 groups. Conclusions:Anti-PD-1 and TKI dual therapy and anti-PD-1, TKI and locoregional intervention triple therapy were effective and tolerable treatments for postoperative refractory recurrent liver cancer. The latter treatment had a significantly better clinical benefit on survival outcomes.

Laparoscopic anatomic hepatectomy (LAH) has been widely approved as an essential procedure for safety and availability, and has gradually become the mainstream method of hepatec-tomy. Through a renewed understanding of the Laennec capsule, the authors have found that there exists a natural gap between the Laennec capsule and the adjacent tissues, such as Glisson pedicles and hepatic veins. Consequently, Laennec capsule can serve as the anatomical approach for LAH. The left lobe, right anterior lobe and right posterior lobe has an independent Glisson pedicle respectively, which can be used to perform Glisson pedicle transection sectionectomy via Laennec capsule approach without damaging the liver parenchyma. The exposure of hepatic veins on the detached plane can also be achieved through this approach. Laennec capsule approach provides a new idea for laparoscopic anatomic liver sectionectomy, which is safe, reliable, convenient and highly repeatable.

The morbidity and mortality of hepatocellular carcinoma (HCC) remain high. HCC patients in China usually accompanied with viral hepatitis or even cirrhosis at the same time that led to poor preoperative liver function and liver reserve function. As a result, the requirements of operative method and resection of extent for patients with HCC were high. Anatomic hepatectomy is an effective method for the treatment of HCC, which is beneficial to the long-term survival of patients. Anatomical hepatectomy can completely remove the tumor while preserving the liver parenchyma to the greatest extent, which is different from regular hepatectomy. Theoretically, anatomical hepatectomy is the best surgical treatment for HCC. With the development and progress of laparoscopic hepatectomy, surgeons can operate laparoscopic anatomical segmentectomy, but it is still difficult to determine the interface between segments during operation. Laparoscopic anatomical hepatectomy guided by indocyanine green fluorescence is safe and feasible, which is helpful for surgeons to identify the interface between hepatic segments and to perform laparoscopic anatomical segementectomy safely and normatively.