In China, more than 80% of patients with hepatocellular carcinoma (HCC) have varying degrees of cirrhosis caused by hepatitis B virus infection. Unlike in Western countries, hepatectomy remains one of the main treatment options for patients with HCC and cirrhosis in China. The severity of cirrhosis varies considerably among individual patients with HCC. Although liver function may remain within the normal range during the compensated stage, progressive cirrhosis significantly reduces hepatic functional reserve and regenerative capacity. As a result, the incidence of postoperative complications and liver failure increases after hepatectomy. Therefore, hepatectomy that preserves as much liver parenchyma as possible is required to ensure surgical safety in patients with different degrees of cirrhosis. At present, the impact of different degrees of cirrhosis on the risk of posthepatectomy liver failure in patients with HCC is not fully understood. In addition, no consensus has been established regarding the optimal surgical approach for patients with HCC and varying severities of cirrhosis. This gap represents an important factor affecting the safety of hepatectomy. Reducing the incidence of postoperative liver failure and mortality in patients with HCC and cirrhosis remains an important issue that requires further investigation. The Chinese Chapter of the International Hepato-Pancreato-Biliary Association, Group of Liver Surgery of the Chinese Society of Surgery, invited leading domestic experts in hepatobiliary surgery and hepatology to discuss the role of cirrhosis severity in the safety assessment of hepatectomy for HCC and strategies to improve surgical safety. This consensus aims to assist hepatobiliary surgeons in making appropriate surgical decisions for patients with HCC and cirrhosis, and to improve surgical safety.
This comprehensive review examined the application of the distal transradial approach (dTRA) in percutaneous coronary intervention (PCI). The dTRA, characterized by its unique anatomical access site in the anatomical snuffbox, demonstrates distinct features for both puncture and hemostasis techniques. dTRA offers several advantages compared with conventional transradial access, including shorter hemostasis time, reduced incidence of access-site hematoma and compartment syndrome, lower rates of radial artery occlusion, enhanced patient and operator comfort, and a potential for retrograde recanalization of the occluded radial arteries. However, it also presents challenges, including a steeper learning curve, limitations related to a smaller arterial diameter, and constraints in patients with taller stature or specific anatomical variations. Clinically, dTRA has been used in diverse patient cohorts, including patients with acute coronary syndrome, those undergoing complex PCI procedures, and individuals with preexisting radial artery occlusion. Although ongoing clinical controversies exist regarding its universal adoption, these could be addressed through technical refinements, standardized training, and device innovations. Future directions include optimizing procedural protocols, expanding evidence from randomized trials, and exploring technological advancements to enhance feasibility. Overall, this review summarizes and evaluates the current evidence to provide a foundational reference for the broader implementation and further investigation of dTRA in PCI.
Heart transplantation, an effective treatment for end-stage heart failure, significantly improves survival rates in patients with advanced heart failure, with a median survival of more than 10 years. However, posttransplant arrhythmias remain a common complication and are primarily associated with denervation, graft ischemia time, and rejection. Despite considerable advances in arrhythmia management in recent years, posttransplant arrhythmias continue to affect patients’ quality of life. Therefore, understanding the mechanisms, assessing risks, and implementing effective management strategies for posttransplant arrhythmias are crucial for improving long-term outcomes in heart transplant recipients. In this review, we summarize the pathophysiology, clinical subtypes, and management strategies for posttransplant arrhythmias, present recent advances, and outline future research directions.
Background: The global incidence of myelodysplastic syndromes (MDS), myeloproliferative neoplasms (MPN), and MDS/MPN overlap syndromes has risen markedly since 1990. China’s experience with the burden of MDS, MPN, and MDS/MPN offers critical insights into global trends. However, previous studies lacked a comprehensive analysis of the long-term disease burden in China, particularly in relation to global trends. This study aimed to analyze temporal trends in the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) associated with MDS, MPN, and MDS/MPN in China and globally from 1990 to 2021 and to predict future trends. Methods: We used data extracted from the Global Burden of Disease 2021 study, including incidence, prevalence, mortality, and DALYs of MDS, MPN, and MDS/MPN. We calculated the estimated annual percentage changes to assess trends and employed the Das Gupta decomposition analysis to quantify contributions from population growth, aging, and epidemiological changes. Future projections (2022–2040) for age-standardized incidence (ASIR) and mortality (ASMR) rates were generated using a Bayesian Age–Period–Cohort model. Results: From 1990 to 2021, the global burdens of MDS, MPN, and MDS/MPN increased substantially. Incident cases, prevalent cases, deaths, and DALYs increased by 99%, 106%, 196%, and 138%, respectively. China experienced a pronounced increase in incident cases (+148%), prevalent cases (+148%), deaths (+281%), and DALYs (+152%). China’s ASIR in 2013 and age-standardized prevalence in 2007 surpassed the global averages, although its ASMR and age-standardized DALYs rate remained lower. Decomposition analysis indicated that the rising burden in China was driven primarily by population aging and epidemiological changes, whereas globally, population growth and aging were the main drivers. Model projections suggest a gradual decline in ASIR for China and a more pronounced global decline by 2040, whereas ASMR is projected to increase in China but decline globally. Conclusions: The burdens of MDS, MPN, and MDS/MPN increased markedly from 1990 to 2021, with China experiencing faster growth rates than the global average. The drivers of this increase differ between China and the global context. These findings underscore the need for tailored prevention and control strategies, particularly in aging populations such as those in China.
