Abstract Background: Patients in pancreatic surgery have a high incidence of malnutrition, and pancreaticoduodenectomy is a highly traumatic procedure that further impairs nutritional status. Chinese expert consensus on whole-course perioperative nutrition management in pancreatic surgery was published based on a national survey in 2020. This study aimed to evaluate the possible changes associated with the consensus over the past 5 years by conducting a nationwide cross-sectional survey among pancreatic surgeons in 2025. Methods: An online questionnaire survey was conducted among Chinese pancreatic surgeons. The questionnaire was divided into five sections: preoperative nutritional management, the placement of nutrition tube during operation, postoperative nutritional management, nutritional management for severe complications, and management of pancreatic exocrine and endocrine functions. Results: A total of 130 valid questionnaires were collected from 40 cities across 31 provinces and regions. Compared with the 2020 survey, the routine implementation rate of preoperative nutritional assessment increased from 62.5% (60/96) to 82.3% (107/130) ( P =0.002), the routine screening rate using Nutritional Risk Screening 2002 increased from 41.7% (40/96) to 65.4% (85/130) ( P <0.001), the participation rate of dietitians increased from 49.0% (47/96) to 70.0% (91/130) ( P =0.001), the intraoperative nasogastric tube placement rate decreased from 78.1% (75/96) to 56.9% (74/130) ( P <0.001). However, the rate of total parenteral nutrition application on the first postoperative day remained as high as 52.3% (68/130), while the proportion of early oral feeding was only 16.2% (21/130). Conclusions: Over the past 5 years, perioperative nutritional management in pancreatic surgery in China has made significant progress in standardization. However, certain differences still exist between clinical practice and consensus recommendations, requiring further promotion.

OBJECTIVE:To develop and externally validate a prognostic nomogram for overall survival (OS) in resected duodenal adenocarcinoma (DA) using routinely available perioperative variables, thereby clarifying risk profiles and supporting clinical management. METHODS:Multicenter analysis of 2289 consecutive DA patients undergoing curative surgery (2012-2022) from China's National Cancer Center database. External validation used 335 patients from Zhejiang Provincial People's Hospital (2022-2024). LASSO-Cox regression selected variables from 89 perioperative factors to construct the nomogram, with web tool implementation. RESULTS:The LASSO-Cox model achieved 1-, 3-, and 5-year AUCs of 0.72 (95% CI, 0.68-0.77), 0.75 (95% CI, 0.72-0.77), and 0.76 (95% CI, 0.73-0.79), outperforming traditional Cox models (P < .01). External validation yielded AUCs of 0.76 (95% CI, 0.66-0.86) and 0.79 (95% CI, 0.74-0.86) for 1- and 3-year OS, and 0.81 (95% CI, 0.74-0.89) for estimated 5-year OS. The model stratified patients into low- and high-risk groups (cutoff 0.40), with low-risk patients showing superior survival. Eight predictors were selected, including modifiable surgical factors such as transfusion and operative time. CONCLUSIONS:We developed and externally validated a postoperative prognostic nomogram for DA using routinely available perioperative variables. In the present study, the model improved postoperative risk stratification and may support counseling, follow-up planning, and multidisciplinary discussion regarding adjuvant therapy; however, it should be viewed as complementary to standard staging and clinical judgment, and broader clinical implementation will require further validation.

Sonazoid, a combined blood pool and Kupffer-cell agent, can be specifically phagocytosed by Kupffer cells in the liver, allowing lesion detection and characterization of focal liver lesions (FLLs) at the post-vascular phase, apart from the vascular phase, which is similar to that of other second-generation ultasound (US) contrast agents. Sonazoid contrast-enhanced US (CEUS) is currently approved for use in some Asian countries. With the increasing use of Sonazoid CEUS for FLLs in clinical practice, developing consensus or guidelines to help standardize its use is required. The expert consensus aimed to review recent evidence and make evidence-based recommendations for radiologists and clinicians involved in the management of liver diseases regarding the use of Sonazoid CEUS in the surveillance or detection, characterization of FLLs, CEUS for interventional and intraoperative use, and tumor treatment response evaluation in patients with FLLs. This consensus was conducted without using artificial intelligence tools in accordance with the TITAN Guidelines 2025.

Objective: The aim of this study is to elucidate the correlation between phase angle and malnutrition, and to determine the malnutrition cutoff points based on phase angle in patients undergoing major pancreatic and biliary surgery.Methods: This is a cross-sectional study analyzing the prospective database of the Department of Hepatopancreatobiliary Surgery at Beijing Hospital, China, from December 2020 to September 2023. Basal data, diet surveys, anthropometry, and body composition were recorded. Phase angle was measured with the InBody 720. The Global Leadership Initiative on Malnutrition (GLIM) criteria were used to diagnose malnutrition. Subgroup analyses were conducted by stratifying age and pancreatic cancer.Results: A total of 185 consecutive cases were included, with a mean age of 63.66 ± 11.96 years. 63.8% (118/185) of the participants were aged 60 years or older, and 43.8% (81/185) were diagnosed with pancreatic cancer. The prevalence of malnutrition was 62.2% among all subjects, 67.8% among the elderly, and 69.1% among pancreatic cancer patients. Phase angle was significantly lower in the malnourished group than in the normal group. Positive correlations were found between phase angle and body mass index (BMI), appendicular skeletal muscle mass index (ASMI), fat-free mass index (FFMI), fat-free mass, total energy intake, grip strength, calf circumference, 6-m timed walk speed, total protein, albumin, and prealbumin. Among all the subjects, participants with a lower phase angle were significantly more likely to suffer from malnutrition than their control group, with a 1.611 times higher risk (95% confidence interval [CI]: 1.013–2.562,P = .044). The cutoff points of the phase angle for determining malnutrition were 4.82 in men (sensitivity 0.744, specificity 0.571, area under the curve 0.667, 95% CI: 0.567–0.766,P = .003), and 4.54 in women (sensitivity 0.750, specificity 0.711, area under the curve 0.757, 95% CI: 0.644–0.869,P < .001). In the subgroup analyses of elderly and pancreatic cancer patients, we obtained consistent results with statistical significance and identified corresponding cutoff points.Conclusion: The present study suggests that the phase angle could be a valid, useful, and simple indicator of malnutrition in patients undergoing major pancreatic and biliary surgery.

Duodenal adenocarcinoma (DA) has a high recurrence rate, making the prediction of recurrence after surgery critically important. Our objective is to develop a machine learning-based model to predict the postoperative recurrence of DA. We conducted a multicenter, retrospective cohort study in China. 1830 patients with DA who underwent radical surgery between 2012 and 2023 were included. Wrapper methods were used to select optimal predictors by ten machine learning learners. Subsequently, these ten learners were utilized for model development. The model's performance was validated using three separate cohorts, and assessed by the concordance index (C-index), time-dependent calibration curve, time-dependent receiver operating characteristic curves, and decision curve analysis. After selecting predictors, ten feature subsets were identified. And ten feature subsets were combined with the ten machine learning learners in a permutation, resulting in the development of 100 predictive models, and the Penalized Regression + Accelerated Oblique Random Survival Forest model (PAM) exhibited the best predictive performance. The C-index for PAM was 0.882 (95

Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive cancer types, characterized by an alarmingly low 5-year survival rate. DNA methylation has been implicated in the progression of various tumors, with DNA methyltransferase 1 (DNMT1) being the most extensively studied enzyme in this context. However, the expression patterns and underlying mechanisms of DNMT1 in PDAC remain poorly understood. The levels of DNMT1 and CBX7 in PDAC tissues and cells were determined by IHC and Western blot. ChIP and dual-luciferase reporter assays confirmed the interaction between DNMT1 and the CBX7 promoter. Cellular functions were evaluated through CCK-8, wound healing, and transwell assays. The expression of MAPK-related proteins was analyzed by Western blot. DNMT1 expression was upregulated in PDAC tissues and cell lines, whereas CBX7 expression was downregulated. Silencing DNMT1 inhibited cell proliferation, migration, and invasion in PDAC by modulating CBX7 expression. Moreover, DNMT1 methylates the CBX7 promoter region, leading to increased ERK phosphorylation, which subsequently drives tumorigenesis and metastasis in PDAC. DNMT1 promotes the malignant progression of PDAC through the CBX7/ERK pathway. Our study provides evidence for potential therapeutic targets for the comprehensive treatment of PDAC.

This study aimed to evaluate and compare the predictive performance of negative lymph nodes (NLN), lymph node ratio (LNR), and N stage in pancreatic ductal adenocarcinoma (PDAC) among patients with ≤ 12 retrieved lymph nodes and those with > 12 retrieved lymph nodes. Moreover, the association between the three nodal staging systems and survival was also explored. Clinical data on patients diagnosed with PDAC between 2004 and 2020 were downloaded from the Surveillance, Epidemiology, and End Results (SEER) database. Cox regression was performed to identify independent predictors of cancer specific survival (CSS) and overall survival (OS). Survival probability was calculated and compared by the Kaplan–Meier method and log rank test. Akaike information criterion (AIC) and Harrell's C-index were used to evaluate the prognostic ability of each nodal staging system. All three lymph node staging systems were independent predictors of CSS and OS. A higher NLN, a lower N stage, and a lower LNR were associated with improved survival. Compared with N stage, LNR staging performed better with a lower AIC and higher C-index for predicting the prognosis regardless of the sufficiency of retrieved lymph nodes, while NLN staging performed poorly in both the training and validation set. Subgroup analyses showed that the NLN successfully predicted survival outcomes in both lymph node-positive and node-negative patients. LNR demonstrated better predictive performance in PDAC patients regardless of the sufficiency of retrieved lymph nodes. Notably, for stage N0 disease, NLN was a more important prognostic predictor. The combination of LNR and NLN may offer more precise information on lymph node staging than the current staging system.

Background and aims:Frailty and malnutrition are prevalent among older adult inpatients. Our study aimed to analyze the correlation between frailty and malnutrition and determine their effects on the clinical outcomes in older adult surgical inpatients. Methods:This cross-sectional observational study included older adult inpatients (≥ 65 years old) undergoing scheduled surgery. Anthropometric measurements and hematological examination results were collected at the time of admission. Frailty and malnutrition were assessed using the frailty phenotype and the Global Leadership Initiative on Malnutrition (GLIM) criteria. Nutritional support during hospitalization and clinical outcomes, such as the occurrence of postoperative complications, in-hospital death, length of hospital stays, and hospital costs, were recorded. The chi-squared and rank-sum tests were used for comparison. Univariate and multivariate logistic regression analyses were used to calculate the odds ratios (OR) and 95% confidence intervals (CI) for frailty, malnutrition, and postoperative complications. Results:In 394 patients, the frailty prevalence was 17.3% (68/394), and 146 inpatients (37.1%) were malnourished. The overlapping prevalence rate of frailty and malnutrition was 12.2% (48/394). Frailty and malnutrition were correlated (r = 0.464, p < 0.001). Multivariate analysis revealed that frailty significantly increased the risk of postoperative complications (OR: 2.937, 95% CI: 1.475-5.850, p = 0.002). There were significant differences in the length of hospital stays and hospital costs among the four groups of patients with frailty and malnutrition, frailty and no malnutrition, malnutrition and no frailty, and no frailty and malnutrition (p < 0.001; p < 0.001). Conclusion:A significant positive correlation was observed between frailty and malnutrition. Frailty and malnutrition are significantly associated with adverse clinical outcomes. Therefore, it is necessary to manage frailty and malnutrition to improve the prognosis.

Pancreatic cancer (PC) cachexia, characterized by profound muscle wasting and systemic inflammation, remains a formidable clinical challenge due to its multifactorial nature and complex molecular underpinnings. This study delves into the intricate interplay between microRNA (miRNA) dysregulation and ferroptosis, a form of iron-dependent cell death, in PC cachexia. Specifically, we identified tumor-derived miR-203a-3p as a pivotal miRNA that promotes muscle atrophy by upregulating muscle ferroptosis. Our findings revealed that miR-203a-3p targets zinc finger E-box binding homeobox 1 (ZEB1), subsequently enhancing the expression of the iron transporter solute carrier family 11 member 2 (SLC11A2), thereby facilitating ferroptosis-associated skeletal muscle cell death. Through in vivo experiments using a PC cachexic mouse model, we demonstrated that inhibiting ferroptosis effectively attenuated muscle wasting, highlighting its critical role in the pathogenesis of PC cachexia. These results provide a molecular framework elucidating how miRNA regulation and ferroptosis converge to drive muscle atrophy, offering novel therapeutic avenues for mitigating cachexia in PC patients. By targeting these pathways, we aim to improve muscle preservation and overall survival in this devastating disease.

Objective:The incidence of intraductal papillary mucinous neoplasm (IPMN) is rising among elderly patients. This study aims to investigate the clinical features of IPMN in elderly patients (≥ 60 years), analyze risk factors for high-grade dysplasia (HGD) and invasive cancer (IC), and provide treatment recommendations for elderly patients with IPMN. Methods:In this single-center retrospective case-control study, 58 consecutive elderly patients (≥ 60 years) who underwent IPMN surgery at Beijing Hospital between January 2014 and November 2023 were included. Clinical characteristics across IPMN subtypes were compared, risk factors were analyzed, and the predictive values of the 2017 Fukuoka and 2023 Kyoto guidelines were evaluated. Follow-up and survival outcomes were also examined. Results:The proportion of patients with main-duct IPMN (MD-IPMN) and mixed-type IPMN (MT-IPMN) who had diabetes was significantly higher than among those with branch-duct IPMN (BD-IPMN) (p < 0.05). The average postoperative hospital stay for patients with low-grade dysplasia (LGD) was 17.7 days (range, 6-53 days), while for patients with HGD/IC, it was 25.5 days (range, 9-90 days), with a statistically significant difference (p < 0.05). Jaundice, elevated CA19-9, elevated CEA, main duct (MD) > 10 mm, and IPMN subtype were significant predictors of HGD/IC (p < 0.05), with elevated CA19-9 and IPMN subtype identified as independent risk factors (p < 0.05). The 2023 Kyoto guidelines showed higher sensitivity but lower specificity than the 2017 Fukuoka guidelines for detecting HGD/IC (p < 0.05 for both). There was a statistically significant difference in overall survival between patients with LGD and those with HGD/IC following surgery (p < 0.05), while no significant difference in postoperative survival was observed between HGD/IC patients with and without lymph node metastasis (p > 0.05). Conclusions:Surgical resection is recommended for elderly patients with MD-IPMN or MT-IPMN combined with elevated CA19-9. The 2017 Fukuoka guidelines are preferable to the 2023 Kyoto guidelines for managing elderly IPMN patients.

OBJECTIVE:Whole-course nutrition management (WNM) has been proven to improve outcomes and reduce complications. We conducted this randomized controlled trial to validate its effectiveness in patients undergoing pancreatoduodenectomy (PD). METHODS:From 1 December 2020, to 30 November 2023, this single-center randomized clinical trial was conducted at the Department of Hepatobiliopancreatic Surgery in a major hospital in Beijing, China. Participants who were undergoing PD were enrolled and randomly allocated to either the WNM group or the control group. The primary outcome was the incidence of postoperative complications. Subgroup analysis in patients who were at nutritional risk was performed. Finally, a 6-month follow-up was conducted and the economic benefit was evaluated using an incremental cost-effectiveness ratio (ICER). RESULTS:A total of 84 patients were randomly assigned (1:1) into the WNM group and the control group. The incidences of total complications (47.6% vs. 69.0%, P =0.046), total infections (14.3% vs. 33.3%, P =0.040), and abdominal infection (11.9% vs. 31.0%, P =0.033) were significantly lower in the WNM group. In the subgroup analysis of patients at nutritional risk, 66 cases were included (35 cases in the WNM group and 31 cases in the control group). The rate of abdominal infection (11.4% vs. 32.3%, P =0.039) and postoperative length of stay (23.1±10.3 vs. 30.4±17.2, P =0.046) were statistically different between the two subgroups. In the 6-month follow-up, more patients reached the energy target in the WNM group (97.0% vs. 79.4%, P =0.049) and got a higher daily energy intake (1761.3±339.5 vs. 1599.6±321.5, P =0.045). The ICER suggested that WNM saved 31 511 Chinese Yuan (CNY) while reducing the rate of total infections by 1% in the intention-to-treat (ITT) population and saved 117 490 CNY in patients at nutritional risk, while WNM saved 31 511 CNY while reducing the rate of abdominal infections by 1% in the ITT population and saved 101 359 CNY in patients at nutritional risk. CONCLUSION:In this trial, whole-course nutrition management was associated with fewer total postoperative complications, total and abdominal infections, and was cost-effective, especially in patients at nutritional risk. It seems to be a favorable strategy for patients undergoing PD.

Gallbladder cancer (GBC) is a highly aggressive malignancy, with limited survival profiles after curative surgeries. This study aimed to develop a practical model for predicting the postoperative overall survival (OS) in GBC patients. Patients from three hospitals were included. Two centers (N = 102 and 100) were adopted for model development and internal validation, and the third center (N = 85) was used for external testing. Univariate and stepwise multivariate Cox regression were used for feature selection. A nomogram for 1-, 3-, and 5-year postoperative survival rates was constructed accordingly. Performance assessment included Harrell's concordance index (C-index), receiver operating characteristic (ROC) curves and calibration curves. Kaplan-Meier curves were utilized to evaluate the risk stratification results of the nomogram. Decision curves were used to reflect the net benefit. Eight factors, TNM stage, age-adjusted Charlson Comorbidity Index (aCCI), body mass index (BMI), R0 resection, blood platelet count, and serum levels of albumin, CA125, CA199 were incorporated in the nomogram. The time-dependent C-index consistently exceeded 0.70 from 6 months to 5 years, and time-dependent ROC revealed an area under the curve (AUC) of over 75

Background: The incidence of duodenal adenocarcinoma is increasing, with limited studies on this disease published. This multicenter retrospective study aimed to analyze the clinicopathologic features of duodenal adenocarcinoma and identify prognostic factors for postoperative survival. Methods: Demographic characteristics, clinicopathologic features, treatment outcomes, and survival of patients with duodenal adenocarcinoma undergoing surgical treatment at 16 Chinese medical centers from 2012 to 2023 were retrospectively analyzed. Results: Among the 2,189 patients with duodenal adenocarcinoma included, 50.07% had extra-ampullary duodenal adenocarcinoma and 49.93% had peri-ampullary duodenal adenocarcinoma. The 1-, 3-, and 5-year overall survival rates for patients who underwent radical surgery were 91.78%, 69.30%, and 55.86%, respectively. The median overall survival was 73 months (range, 64-84), and the median progression-free survival was 64 months (range, 52-76). No differences in survival were observed between the laparotomy and minimally invasive surgery groups (log-rank P 1 / 4 .562); furthermore, no significant between-group differences in operation time, lymph node dissection, postoperative complications, or in-hospital mortality were observed (P > .05). The minimally invasive surgery group experienced less intraoperative blood loss (250 mL vs 100 mL, P < .001), fewer intraoperative blood transfusions (24.97% vs 18.84%, P = .002), and shorter hospital stays (28 days vs 23 days, P < .001). Multivariate Cox regression analysis revealed that advanced age, advanced stage, longer operation time, intraoperative blood transfusion, and postoperative hemorrhage were independent risk factors for poor prognosis. Conclusion: Radical surgery was associated with favorable overall survival among patients with duodenal adenocarcinoma, and no difference in survival was observed between patients with extra-ampullary duodenal adenocarcinoma and peri-ampullary duodenal adenocarcinoma. Minimally invasive surgery is a reliable alternative for duodenal adenocarcinoma treatment. (c) 2024 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Objective: The aim of this study was to examine the effects of patient-centered communication, patient participation, and patient preference on patient trust in the context of China. Methods: A cross-sectional survey was conducted involving 217 cancer patients in China. Mediation and moderation analyses were performed to examine the relationships among the study variables. Results: First, patient-centered communication increased patient participation in decision-making, which, in turn, enhanced patient trust. Second, patient-centered communication did not have a direct effect on patient trust. Third, patient preference for a passive role in decision-making weakened the relationship between patient participation and patient trust. Conclusion: The results underscore the significant effect of facilitating patient participation in linking patientcentered communication to patient trust. However, medical communication should also respond to patients' preferred roles in the decision-making process. Practice implications: Doctors should provide patients with opportunities to ask questions and express their concerns. In addition, they should evaluate patients' preferred degree of involvement before inviting them to contribute so as to respect their preferences and values.

Aim To validate the role of the albumin-derived neutrophil-to-lymphocyte (ALB-dNLR) score in diagnosing malnutrition in medical inpatients over 70 years old. Methods This is a retrospective cross-sectional study involving 7 departments from 14 Chinese hospitals. The ALB-dNLR score was calculated, and outcomes between groups with positive and negative ALB-dNLR scores were compared after propensity score matching (PSM). Afterwards, the outcomes were compared between the groups receiving nutrition support and those not receiving support among malnourished patients diagnosed using the Global Leadership Initiative Malnutrition (GLIM) criteria after PSM. Results Out of 10,184 cases, 6165 were eligible. 2200 cases were in the positive ALB-dNLR score group. After PSM, 1458 pairs were analyzed, showing lower in-hospital mortality (0.8 % vs. 2.1 %, p = 0.005) and a lower nosocomial infection rate (5.9 % vs. 11.0 %, p < 0.001) in the negative ALB-dNLR score group. In malnourished patients, 259 pairs were analyzed after PSM. It showed better outcomes in mortality (0.8 % vs. 3.5 %, p = 0.033), nosocomial infection rate (5.4 % vs. 15.4 %, p < 0.001), length of stay (LOS) (13.8 ± 10.3 vs. 18.4 ± 14.1, p < 0.001), and total hospital cost (3315.3 ± 2946.4 vs. 4795.3 ± 4198.2, p < 0.001) in the support group. In malnourished patients with ALB-dNLR score as the sole etiological criterion, 94 pairs were calculated. It showed better outcomes in mortality (0.0 % vs. 6.4 %, p = 0.029), nosocomial infection rate (7.4 % vs. 18.1 %, p = 0.029), LOS (13.7 ± 8.3 vs. 19.8 ± 15.2, p = 0.001), and total hospital cost (3379.3 ± 2955.6 vs. 4471.2 ± 4782.4, p = 0.029) in the support group. Conclusions The ALB-dNLR score was validated to predict in-hospital mortality in medical inpatients over 70 years old. Malnutrition patients diagnosed by the GLIM criteria and using the ALB-dNLR score might benefit from nutrition support.

Aim: We aim to evaluate the safety and efficiency of lesion location-guided lymph node dissection and standardized lymph node sampling in treating resectable pancreatic head cancer, in order to provide evidence to standard surgical treatment of pancreatic ductal adenocarcinoma (PDAC).Methods: Consecutive sixty pancreatic head cancer patients were recruited prospectively and received total mesopancreatic resection (TMpE) and lesion location-guided lymphadenectomy from 2018 to 2021. The surgeons harvested and grouped the lymph nodes from the fresh specimen. Forty-five consecutive patients from 2016 to 2018 who received traditional procedure are included as the control group. Perioperative and outcome parameters were compared between two groups and subgroup analysis were also done between uncinate process and non uncinate process groups.Results: The perioperative mortality and the incidence of major complications were comparable without statistical significance between two groups (all Ps > 0.05). The postoperative length of hospital stay did not prolonged and the total hospitalization cost does not increased in the study group (P > 0.05). The secondary operation rate of study group decreased significantly [0.0%(0/60) vs. 8.9%(4/45), P=0.031]. The standardized lymph node sampling might increase the amount of detected nodes (23.27±8.87 vs. 15.07±3.99, P=0.001) and changed the TNM staging in some cases. Lesion location-guided lymphadenectomy might increase overall survival (OS) [21.0 months, 95%CI(17.4, 24.5) vs. 15.3 mouths, 95%CI(10.9,19.6), P=0.039] especially in non-uncinate process subgroup [22.9 months, 95%CI(19.0, 26.8) vs. 15.0 mouths, 95%CI(8.5,21.4), P=0.034].Conclusion: Lesion location-guided lymphadenectomy and standardized lymph node sampling are safe and efficient operation strategies in treating resectable PDAC, which may lead to precision therapy and prolong OS.Funding: This work was supported by the Capital Characteristic Clinical Project of Beijing Municipal Science & Technology Commission (No. Z181100001718216) and Beijing Hospital Nova Project (No.BJ-2020-082). Declaration of Interest: None to declare. Ethical Approval: This study was approved by the Ethics Committee of the Beijing Hospital (Approval letter No.2018BJYYEC-196-02).

Objective To analyze the correlation between preoperative nutritional status, frailty, sarcopenia, body composition, and anthropometry in geriatric inpatients undergoing major pancreatic and biliary surgery. Methods This is a cross-sectional study of the database from December 2020 to September 2022 in the department of hepatopancreatobiliary surgery, Beijing Hospital. Basal data, anthropometry, and body composition were recorded. NRS 2002, GLIM, FFP 2001, and AWGS 2019 criteria were performed. The incidence, overlap, and correlation of malnutrition, frailty, sarcopenia, and other nutrition-related variables were investigated. Group comparisons were implemented by stratification of age and malignancy. The present study adhered to the STROBE guidelines for cross-sectional study. Results A total of 140 consecutive cases were included. The prevalence of nutritional risk, malnutrition, frailty, and sarcopenia was 70.0, 67.1, 20.7, and 36.4%, respectively. The overlaps of malnutrition with sarcopenia, malnutrition with frailty, and sarcopenia with frailty were 36.4, 19.3, and 15.0%. There is a positive correlation between every two of the four diagnostic tools, and all six p -values were below 0.002. Albumin, prealbumin, CC, GS, 6MTW, ASMI, and FFMI showed a significantly negative correlation with the diagnoses of the four tools. Participants with frailty or sarcopenia were significantly more likely to suffer from malnutrition than their control groups with a 5.037 and 3.267 times higher risk, respectively (for frailty, 95% CI: 1.715–14.794, p = 0.003 and for sarcopenia, 95% CI: 2.151–4.963, p <0.001). Summarizing from stratification analysis, most body composition and function variables were worsen in the ≥70 years group than in the younger group, and malignant patients tended to experience more intake reduction and weight loss than the benign group, which affected the nutrition diagnosis. Conclusion Elderly inpatients undergoing major pancreatic and biliary surgery possessed high prevalence and overlap rates of malnutrition, frailty, and sarcopenia. Body composition and function deteriorated obviously with aging.

超声技术是肝脏疾病诊治不可或缺的基本技术，包括术前、术中及术后应用。术前应用主要为肝脏疾病的诊断，特别是肿瘤的诊断、鉴别诊断及定位，此外还包括对肝弥漫性病变，如肝硬化、脂肪肝等的严重程度评估，术后超声主要用于治疗后病灶及残余肝脏的随访。术前和术后超声多为超声医学科医师的工作，而术中超声（intraoperative ultrasound，IOUS）则是肝脏外科领域的内容，在肝脏外科应用的历史超过40年[1]。特别是近年来，随着精准肝切除和微创外科理念的兴起与推广，熟练掌握IOUS技术成为肝脏外科医师孜孜不倦的探索与追求。

Aim To evaluate the role of Sonazoid enhanced ultrasound assistant laparoscopic radiofrequency ablation in treating liver malignancy.Methods Consecutive patients are recruited. Rates of complication and postoperative length of stay are compared between the study and control groups. Progression-free survival (PFS) of colorectal liver metastasis (CRLM) after ablation are compared. Complete ablation rates are compared and optimal tumor size is calculated by ROC curve analysis. Risk factors of incomplete ablation are determined by logistic regression analysis.Results Totally 73 patients with 153 lesions were included. No significant differences in the rate of complication were found between the study and control groups. PFS of CRLM in laparoscopic, intraoperative CEUS, and laparoscopic CEUS groups are all longer than their control groups. Complete ablation rates of laparoscopic, intraoperative CEUS, and laparoscopic CEUS groups are all higher than in their control groups with statistical significance. A tumor size of 2.15 cm is determined to be the optimal cut-off with the area under the ROC curve of 0.854, 95% CI (0.764, 0.944), p = 0.001. In logistic regression analysis, tumor size [OR 20.425, 95% CI (3.136, 133.045), p = 0.002] and location of segments VII and VIII [OR 9.433, 95% CI (1.364, 65.223), p = 0.023] are calculated to be the risk factors of incomplete ablation, meanwhile, intraoperative CEUS shows to be a protective factor in univariate analysis [OR 0.110, 95% CI (0.013, 0.915), p = 0.041].Conclusion Sonazoid-enhanced ultrasound assistant laparoscopic radiofrequency ablation is safe and effective to treat liver malignancy. We should pay attention to the ablation planning of larger tumors and tumors in special locations.