This study aimed to establish a noninvasive preoperative radiomics–clinical model combining contrast–enhanced computed tomography (CT) features and serum biomarkers to accurately predict the risk of heterogeneous recurrence patterns in resectable pancreatic ductal adenocarcinoma (PDAC), with the goal of optimizing personalized postoperative management. This retrospective study included 290 patients with pathologically confirmed PDAC who underwent curative resection between May 2014 and December 2023. Patients were randomly divided into the training and test cohorts: overall recurrence model (n = 203 vs. 87), local recurrence model (n = 132 vs. 56), and distant metastasis model (n = 111 vs. 47). Radiomic features extracted from preoperative contrast–enhanced CT were selected using Lasso–Cox regression and combined with clinical variables to construct combined models. Model performance was assessed using time–dependent AUC curves, calibration curves, and decision curve analysis. Radiomics–clinical models incorporating carbohydrate antigen 19–9 (CA19–9), American Joint Committee on Cancer (AJCC) stage, tumor enhancement patterns, and radiomics scores achieved superior predictive performance over radiomics–only or clinical–only models. The 12–month AUCs were 0.801 for overall recurrence, 0.896 for distant metastasis, and 0.808 for local recurrence. Calibration and DCA confirmed good agreement and clinical utility. High– and low–risk groups stratified by model scores showed significantly different RFS (P < 0.001). The preoperative radiomics–clinical model accurately predicts the risk of distinct recurrence patterns in resectable PDAC, supporting individualized treatment planning.

Background: Postoperative recurrence is a major contributor to poor prognosis in hepatocellular carcinoma (HCC) after curative resection. Tyrosine kinase inhibitors (TKIs) are commonly used for recurrent HCC, yet substantial interpatient heterogeneity limits their universal benefit, and reliable tools to individualize post-recurrence therapy are lacking. Methods: We retrospectively analyzed 454 patients with recurrent HCC following curative resection. Overlap weighting based on propensity scores was applied to balance baseline characteristics between TKI-treated and non-TKI-treated groups and to assess the survival benefit of TKI therapy. Machine learning-based survival models were independently developed for each treatment cohort using multiple algorithms and internally validated. A counterfactual inference framework was implemented to estimate individualized survival outcomes under alternative treatment strategies and to identify the optimal therapy for each patient. Results: After overlap weighting, TKI therapy was associated with improved survival compared with non-TKI treatment, including longer recurrence-free survival (median, 24 vs. 12 months; HR = 0.355, P < 0.001) and overall survival (median, 36 vs. 18 months; HR = 0.486, P = 0.001). In the non-TKI cohort, an eight-feature survival support vector machine (Surv-SVM) model achieved strong predictive performance (C-index: 0.796 in training, 0.766 in validation). In the TKI cohort, a four-feature random survival forest (RSF) model showed the highest discrimination (C-index: 0.856 and 0.838). Both models demonstrated good calibration and stable timedependent performance. Counterfactual analysis revealed potential treatment mismatch in 23.4% of patients, including 20.7% who received non-TKI therapy but were predicted to benefit more from TKI treatment. Conclusion: TKI therapy provides significant survival benefit in recurrent HCC after curative resection. Our machine learning-based, counterfactual framework enables individualized estimation of treatment benefit, supporting personalized post-recurrence therapy and facilitating precision management in this high-risk population.

The NLRP3 inflammasome is a multi-protein complex that mediates intense inflammatory responses. Its activation and function are influenced by various factors, including the recognition of pathogen-associated molecular patterns and damage-associated molecular patterns, cellular stress responses, and metabolic disorders. Recent research has extensively studied the role of the NLRP3 inflammasome in tumors. Findings indicate that tumor cells and macrophages can regulate the activation of the NLRP3 inflammasome, promoting tumor development and progression. Conversely, the NLRP3 inflammasome can also exhibit anti-tumor effects through immune cells, such as dendritic cells. This has led to the development of treatment strategies, creating a comprehensive treatment system that includes sensitizers for radiotherapy and chemotherapy, inhibitors of the NLRP3 inflammasome pathway, and direct targeting of the NLRP3 inflammasome.Cholangiocarcinoma is a highly invasive and heterogeneous malignant tumor. Due to its non-specific symptoms, patients often present with advanced stages of the disease, and the mortality rate continues to rise annually. A deeper exploration of the mechanisms underlying cholangiocarcinoma's occurrence and development is essential for improving diagnosis and treatment strategies. The application of multi-omics analysis in cholangiocarcinoma research lays a foundation for understanding its pathogenesis and potential treatments. This article systematically reviews the latest advancements in NLRP3 inflammasome research, including its regulatory mechanisms, role in promoting tumor development, and effects in anti-tumor immunotherapy. Additionally, by summarizing the mechanisms involved in cholangiocarcinoma, we hypothesize that the NLRP3 inflammasome may play a significant role in the occurrence and development of cholangiocarcinoma. Therefore, we conduct a multi-angle analysis of the potential relationship between the two and propose a hypothesis model. The goal of this article is to explore the role of the NLRP3 inflammasome in tumors and its potential relationship with cholangiocarcinoma, offering new insights for research on the link between cholangiocarcinoma-related inflammation and the disease itself.

With the rising diagnostic rate of gallbladder polypoid lesions (GPLs), differentiating benign cholesterol polyps from gallbladder adenomas with a higher preoperative malignancy risk is crucial. This study aimed to establish a preoperative prediction model capable of accurately distinguishing between gallbladder adenomas and cholesterol polyps using machine learning algorithms. We retrospectively analysed the patients’ clinical baseline data, serological indicators, and ultrasound imaging data. Using 12 machine learning algorithms, 110 combination predictive models were constructed. The models were evaluated using internal and external cohort validation, receiver operating characteristic curves, area under the curve (AUC) values, calibration curves, and clinical decision curves to determine the best predictive model. Among the 110 combination predictive models, the Support Vector Machine + Random Forest (SVM + RF) model demonstrated the highest AUC values of 0.972 and 0.922 in the training and internal validation sets, respectively, indicating an optimal predictive performance. The model-selected features included gallbladder wall thickness, polyp size, polyp echo, and pedicle. Evaluation through external cohort validation, calibration curves, and clinical decision curves further confirmed its excellent predictive ability for distinguishing gallbladder adenomas from cholesterol polyps. Additionally, this study identified age, adenosine deaminase level, and metabolic syndrome as potential predictive factors for gallbladder adenomas. This study employed the machine learning combination algorithms and preoperative ultrasound imaging data to construct an SVM + RF predictive model, enabling effective preoperative differentiation of gallbladder adenomas and cholesterol polyps. These findings will assist clinicians in accurately assessing the risk of GPLs and providing personalised treatment strategies.

Background:With the increasing prevalence of obesity and type 2 diabetes, the number of patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) coexisting with hepatic steatosis is steadily rising. However, the impact of hepatic steatosis on tumor recurrence following radical resection remains unclear. Methods:We retrospectively analyzed a cohort of 733 HBV-infected patients diagnosed with HCC who underwent curative liver resection. Propensity score matching (PSM) was performed at a 1:2 ratio using 12 covariates to reduce selection bias and explore the association between preoperative hepatic steatosis and recurrence-free survival (RFS). Furthermore, we constructed a postoperative recurrence prediction model based on hepatic steatosis and other clinicopathological factors using 101 combinations of machine learning algorithms. The optimal model was identified through comprehensive evaluation and validation. Results:After PSM, survival analysis revealed that patients without hepatic steatosis had significantly better RFS compared to those with steatosis. Multivariate Cox regression analysis confirmed that preoperative hepatic steatosis was an independent risk factor for recurrence following radical resection ( P = 0.006, HR:1.564, 95% CI:1.137-2.150). A recurrence prediction model was developed using hepatic steatosis and additional clinicopathological features through machine learning. Among the 101 models tested, the Random Survival Forest (RSF) model exhibited the best predictive performance, achieving a C-index of 0.719 in the training cohort. The model demonstrated high predictive accuracy for 1-, 2-, and 3-year recurrence, with AUC of 0.782, 0.856, and 0.898, respectively. Compared to conventional staging systems such as BCLC and CNLC, our model achieved superior performance, and decision curve analysis (DCA) demonstrated favorable clinical utility. Conclusion:Preoperative hepatic steatosis is an independent predictor of recurrence after radical resection in patients with HBV-related HCC. The RSF-based machine learning model incorporating hepatic steatosis and other clinicopathological factors effectively predicts postoperative recurrence risk and may facilitate personalized clinical decision-making in this patient population.

BACKGROUND:This study aimed to differentiate between benign and malignant gallbladder polyps preoperatively by developing a prediction model integrating preoperative transabdominal ultrasound and clinical features using machine-learning algorithms. METHODS:A retrospective analysis was conducted on clinical and ultrasound data from 1,050 patients at 2 centers who underwent cholecystectomy for gallbladder polyps. Six machine-learning algorithms were used to develop preoperative models for predicting benign and malignant gallbladder polyps. Internal and external test cohorts evaluated model performance. The Shapley Additive Explanations algorithm was used to understand feature importance. RESULTS:The main study cohort included 660 patients with benign polyps and 285 patients with malignant polyps, randomly divided into a 3:1 stratified training and internal test cohorts. The external test cohorts consisted of 73 benign and 32 malignant polyps. In the training cohort, the Shapley Additive Explanations algorithm, on the basis of variables selected by Least Absolute Shrinkage and Selection Operator regression and multivariate logistic regression, further identified 6 key predictive factors: polyp size, age, fibrinogen, carbohydrate antigen 19-9, presence of stones, and cholinesterase. Using these factors, 6 predictive models were developed. The random forest model outperformed others, with an area under the curve of 0.963, 0.940, and 0.958 in the training, internal, and external test cohorts, respectively. Compared with previous studies, the random forest model demonstrated excellent clinical utility and predictive performance. In addition, the Shapley Additive Explanations algorithm was used to visualize feature importance, and an online calculation platform was developed. CONCLUSION:The random forest model, combining preoperative ultrasound and clinical features, accurately predicts benign and malignant gallbladder polyps, offering valuable guidance for clinical decision-making.

BackgroundAccurately identifying difficult laparoscopic cholecystectomy (DLC) preoperatively remains a clinical challenge. Previous studies utilizing clinical variables or morphological imaging markers have demonstrated suboptimal predictive performance. This study aims to develop an optimal radiomics-clinical model by integrating preoperative CT-based radiomics features with clinical characteristics.MethodsA retrospective analysis was conducted on 2,055 patients who underwent laparoscopic cholecystectomy (LC) for cholecystitis at our center. Preoperative CT images were processed with super-resolution reconstruction to improve consistency, and high-throughput radiomic features were extracted from the gallbladder wall region. A combination of radiomic and clinical features was selected using the Boruta-LASSO algorithm. Predictive models were constructed using six machine learning algorithms and validated, with model performance evaluated based on the AUC, accuracy, Brier score, and DCA to identify the optimal model. Model interpretability was further enhanced using the SHAP method.ResultsThe Boruta-LASSO algorithm identified 10 key radiomic and clinical features for model construction, including the Rad-Score, gallbladder wall thickness, fibrinogen, C-reactive protein, and low-density lipoprotein cholesterol. Among the six machine learning models developed, the radiomics-clinical model based on the random forest algorithm demonstrated the best predictive performance, with an AUC of 0.938 in the training cohort and 0.874 in the validation cohort. The Brier score, calibration curve, and DCA confirmed the superior predictive capability of this model, significantly outperforming previously published models. The SHAP analysis further visualized the importance of features, enhancing model interpretability.ConclusionThis study developed the first radiomics-clinical random forest model for the preoperative prediction of DLC by machine learning algorithms. This predictive model supports safer and individualized surgical planning and treatment strategies.

Objective: To study the extraction of Guarana peel polysaccharides (GPP) by two different methods and to investigate the effect of extracted polysaccharides on haemoglycaemia and lipids in mice. Methods: The polysaccharides were extracted by aqueous alcoholic precipitation with two different solvents, methanol/ethanol mixed solvent or 95% ethanol and the mice were fed and tested for changes in endogenous related substances, respectively. Results: The concentration of polysaccharide extracted by methanol/ethanol mixed solvent was 116.367 μg/mL, while the concentration of polysaccharide extracted by 95% ethanol was 101.465 μg/mL. The polysaccharide extracted by the former method did not significantly affect the blood glucose level of the mice, while the latter method did not significantly affect the lipid level of the mice. Conclusion: Methanol/ethanol mixed solvent extraction of Guarana peel polysaccharides had higher extraction rate and more significant effect on blood glucose control in mice, while 95% ethanol extraction of Guarana peel polysaccharides had more significant effect on lipid control in mice.

Interleukin-21 (IL-21) is an important antitumor cytokine that contributes to the proliferation and differentiation of CD8 + T cells. It has been proven to enhance the response to immune checkpoint inhibitors (ICIs) in various solid tumors. However, its role in hepatocellular carcinoma (HCC) has not yet been clarified. In this research, we aimed to investigate the antitumor effect of IL-21 in HCC and its effect on ICI treatment. Through transcriptome sequencing analysis and immunohistochemistry validation, we found that patients with high IL-21 expression had a better prognosis. HCCs with high expression of IL-21 had higher infiltration of CD8 + T cells, increased expression of immune checkpoints, and an improved response to ICI treatment. In conclusion, IL-21 can enhance the efficacy of ICI treatment and improve the prognosis of patients by promoting the infiltration of CD8 + T cells and the expression of immune checkpoint-related genes.

Nuclear factor of activated T cells 2 (NFATC2) is reported to contribute to the initiation and progression of various cancers; however, its expression and function in cholangiocarcinoma (CCA) tissues remain elusive. Herein, we investigated the expression pattern, clinicopathologic characteristics, cell biological functions, and potential mechanisms of NFATC2 in CCA tissues. Real-time reverse-transcription PCR (RT-qPCR) and immunohistochemistry were performed to analyze the expression of NFATC2 in human CCA tissues. Cell counting kit 8, colony formation, flow cytometry, Western blotting, and Transwell assays, and in vivo xenograft and pulmonary metastasis models, were used to explore the effect of NFATC2 on the proliferation and metastasis of CCA. A dual-luciferase reporter system, oligonucleotide pull-down, chromatin immunoprecipitation, immunofluorescence, and coimmunoprecipitation were performed to reveal the potential mechanisms. We found that NFATC2 was upregulated in CCA tissues and cells, and its aberrantly high levels were associated with a poorer differentiation pattern. Functionally, NFATC2 overexpression promoted CCA cell proliferation and metastasis, whereas knockdown of NFATC2 led to opposite result. Mechanistically, NFATC2 could be enriched in the promoter region of neural precursor cell-expressed developmentally downregulated protein 4 (NEDD4) to facilitate its expression. Furthermore, NEDD4 targeted fructose-1, 6-bisphosphatase 1 (FBP1) and inhibited FBP1 expression via ubiquitination. In addition, silencing NEDD4 rescued the effects of NFATC2 overexpression on CCA cells. NEDD4 was upregulated in human CCA tissues, and its expression levels were positively correlated with those of NFATC2. We thus conclude that NFATC2 promotes the progression of CCA via the NEDD4/FBP1 axis, emphasizing the oncogenic role of NFATC2 in CCA progression.

BACKGROUND:Gallbladder adenoma represents a precancerous lesion of gallbladder cancer. However, distinguishing it from cholesteryl polyps of the gallbladder before surgery is challenging. Thus, we aimed to comprehensively explore various risk factors contributing to the formation of gallbladder adenoma to facilitate an informed diagnosis and treatment by clinicians. METHODS:We conducted a retrospective analysis of patients who had undergone cholecystectomy at the Affiliated Hospital of Qingdao University between January 2015 and December 2022. Following postoperative pathological examination, patients were categorized into cholesterol polyp and adenoma groups. We analyzed their baseline characteristics, ultrasound imaging variables, and biochemical data using logistic, lasso, and stepwise regression. Subsequently, we constructed a preoperative prediction model based on the independent risk factors. RESULTS:Regression analysis of 520 gallbladder polyps and 288 gallbladder adenomas in the model group revealed that age, gallbladder wall thickness, polyp size, echogenicity, pedunculation, and adenosine deaminase (ADA) levels were independent predictors of gallbladder adenoma, all with P < 0.05. Using these indicators, we established a regression equation: Logistic (P) = -5.615 + 0.018 ∗ age - 4.64 ∗ gallbladder wall thickness + 1.811 ∗ polyp size + 2.855 ∗ polyp echo + 0.97∗ pedunculation + 0.092 ∗ ADA. The resulting area under the curve (AUC) value was 0.894 (95 % CI: 0.872-0.917, P < 0.01), with a sensitivity of 89.20 %, specificity of 79.40 %, and overall accuracy of 84.41 % for adenoma detection. CONCLUSION:Age, polyp size, gallbladder wall thickness, polyp echogenicity, pedunculation, and ADA levels emerge as independent risk factors for gallbladder adenoma.

Background . HLA-DR+ T cell, accounting for 1.2%–5.8% of peripheral lymphocyte, is a type of activated T lymphocyte. This retrospective study aimed to evaluate the prognostic value of HLA-DR+ T cell for progression-free survival (PFS) and overall survival (OS) in hepatocellular carcinoma (HCC) patients after curative surgery. Patients and Methods . Clinicopathological data of 192 patients who underwent curative resection for hepatocellular carcinoma in the affiliated hospital of Qingdao University between January 2013 and December 2021 were collected and analyzed. Statistical tests used in this study were the chi-square test and Fisher’s exact test. The prognostic value of the HLA-DR+ T cell ratio was analyzed using univariate and multivariate Cox regression analyses. The Kaplan–Meier curves were drawn by the R programming language. Results . HCC patients were divided into high (≥5.8%) and low (<5.8%) HLADR+ T cell ratio groups. Cox regression analysis indicated that a high HLA-DR+ T cell ratio was positively related to the PFS in HCC patients ( P = 0.003) and AFP-positive (≥20 ng/ml) HCC patients ( P = 0.020). HCC patients and AFP-positive HCC patients in the high HLA-DR+ T cell ratio group were prone to have a higher T cell ratio, a higher CD8+T cell ratio, and a lower B cell ratio than the low HLA-DR+ T cell ratio group. However, the HLA-DR+ T cell ratio was not a statistically significant predictor for OS in HCC patients ( P = 0.57) as well as PFS ( P = 0.088) and OS ( P = 0.63) in AFP-negative HCC patients. Conclusions . This study confirmed that the HLA-DR+ T cell ratio was a significant predictor of PFS in HCC patients and AFP-positive HCC patients after curative surgery. This association may have guiding significance for the follow-up work of HCC patients after surgery.

ObjectiveTo investigate the gene mutations of Chinese patients with pancreatic cancer in the coastal regions of Eastern China, and to provide a basis for individualized treatment. MethodsA total of 40 patients who were admitted and diagnosed with malignant pancreatic tumor after surgical treatment in The Affiliated Hospital of Qingdao University, Qingdao Municipal Hospital, Yantaishan Hospital, and Yantai Sino-France Friendship Hospital from January 2017 to June 2019 were enrolled. Next-generation sequencing (NGS) was used to detect gene mutations in tumor tissue and somatic cells, and the map of gene mutations was plotted to analyze genomic alterations. The chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for comparison between groups. ResultsAmong the 40 patients, 34 (85.0%) had pancreatic ductal adenocarcinoma, 3 (7.5%) had solid pseudopapillary neoplasm of the pancreas, 1 (2.5%) had pancreatic neuroendocrine tumor, and 2 (5.0%) had unclear typing. KRAS (80.0%, 32/40), TP53 (70.0%, 28/40), CDKN2A (32.5%, 13/40), SMAD4 (17.5%, 7/40), and AKT2 (17.5%, 7/40) were the most common mutations, and there was no significant difference in survival time between the patients with these five common gene mutations (all P＞0.05). ConclusionNGS technology can provide comprehensive and accurate information of genomic alterations and may provide novel potential biomarkers for the diagnosis and precise treatment of pancreatic cancer. The analysis of mutant genes also lays a foundation for the individualized treatment of pancreatic cancer.

Objective:To study combined adjuvant transcatheter arterial chemoembolization (TACE) with anti-tumor drug treatment on early hepatocellular carcinoma (HCC) recurrence in patients with microvascular invasion (MVI) after partial hepatectomy with curative intent.Methods:The clinical and pathological data of 169 patients with HCC who underwent partial hepatectomy with curative intent from January 2015 to December 2018 at the Affiliated Hospital of Qingdao University were retrospectively analyzed. MVI was diagnosed by postoperative histopathology. There were 147 males and 22 females, with the median age 56 years(ranged 32-79 years). The patients were divided into surgery group ( n=62, patients who did not receive adjuvant therapy), TACE group ( n=42, patients who only received TACE) and combined group ( n=65, patients who received TACE with anti-tumor drug) according to the therapies after resection. Patients in each group were further divided into grade M1 (mild) and grade M2 (severe) subgroups according to the severity of MVI. All patients were followed-up for observing tumor recurrence. The relapse-free survival in the three groups were compared using the Kaplan-Meier method and the log-rank test was used to compare the tumor-free survival rates. Results:The tumor-free survival rates of 169 patients at 1 and 2 years after operation were 59.2% and 40.8%. The tumor-free survival rates at 1 and 2 years after operation were 45.2% and 25.8% in surgery group, 61.9% and 40.5% in TACE group, 70.8% and 52.3% in combined group respectively. The differences among the three groups were significant: TACE group was better than surgery group, and combined group was better than TACE group, combined group was better than surgery group (all P<0.05). In TACE group and combined group, tumor-free survival rates of M1patients better than M2 patients, and the difference was significant ( P<0.05). Among M1 patients and M2 patients, tumor-free survival rates of combined group patients were better than surgery group and TACE group, the difference was significant (all P<0.05). The cumulative tumor-free survival rate was not significantly affected by different antineoplastic agents. Conclusion:Adjuvant TACE reduced the early recurrence rate of HCC patients with MVI. Adjuvant TACE combined with anti-tumor drug further reduced early tumor recurrence.

患者男性,45岁,因"体验发现腹腔占位性病变1周"于2019年12月就诊于青岛大学附属医院.患者自诉无不适,既往体健,体检腹部无压痛、未触及异常包块,实验室检查基本正常.腹部CT示右上腹腔见团块状软组织肿块影(约6.0 cm×6.4 cm),肿物内密度欠均匀.增强扫描呈不均匀延迟强化,病变局部与胃窦壁界限不清,考虑胃间质瘤可能性大,见图1.行腹腔镜远端胃大部切除术,术中见肿瘤位于胃窦部前壁(约7.0 cm×6.0 cm×5.5 cm),未侵透浆膜.术后病理示胃浆膜面可见一结节样肿物(约7.0 cm× 5.5 cm×5.0 cm),有包膜,切面呈灰红、灰黄、半透明胶冻状,质稍韧.低倍显微镜下肿瘤呈结节状生长,位于黏膜下层,浸润肌层,浆膜面边界清晰.高倍显微镜下肿瘤细胞呈短梭形、梭形、卵圆形的纤维母细胞样,间质黏液样,可见丰富分枝状纤细毛细血管,核分裂像罕见,见图2,3.免疫组织化学示:梭形细胞SMA、S-100、CD10为阳性,见图4～6,CD117、CD34、DOG-1、ALK均为阴性.增殖细胞核抗原Ki-67低增殖(约1％).根据病理学及免疫组织化学结果,诊断为胃丛状纤维黏液瘤,淋巴结未见肿瘤转移.患者随访至今,术后1、3个月复查恢复良好.

Abstract BackgroundWe investigated the impact of elevated glucose levels on the early recurrence of hepatocellular carcinoma (HCC)after open radical hepatectomy.MethodsThis retrospective cohort study analyzed. The clinical data of 112 patients with hepatocellular carcinoma who underwent open radical hepatectomy from January 2013 to December 2014 at the Affiliated Hospital of Qingdao University. After radical resection of the hepatocellular carcinoma, 86 patients with an average fasting blood glucose(FBG) level of 3.9–6.1 mmol/L and 26 patients with an FBG level ≥ 6.1 mmol/L were divided into the normal group and hyperglycemic group, respectively. The recurrence rate of hepatocellular carcinoma was compared between the two groups 1 and 2 years after the operation.ResultsThe postoperative 1- and 2-year recurrence rates of HCC were 19.8% (17/86) and 33.7% (29/86), respectively, in the normal group and42.3% (11/26) and 61.5% (16/26), respectively, in the hyperglycemic group; there were significant differences between the two groups (χ2 = 6.719,P = 0.01;χ2 = 6.427༌P = 0.011). The univariate analysis showed that FBG, history of alcohol drinking, extent of hepatectomy, histopathological differentiation, maximal tumor diameter, satellite lesion, and the postoperative adjuvant treatment were risk factors affecting the tumor-free survival rate after open radical resection of hepatocellular carcinoma (P < .05).The results of the multivariate analysis showed that FBG levels ≥ 6.1 mmol/L, low histopathological differentiation, and no postoperative adjuvant treatment were independent risk factors affecting tumor-free survival rate after radical resection of hepatocellular carcinoma (P < .05).ConclusionAn elevated FBG level has a stimulating effect on the early recurrence of tumor after open radical resection of hepatocellular carcinoma. Therefore, postoperative monitoring and blood glucose control may facilitate a decrease in the early recurrence rate in patients with hepatocellular carcinoma.

BACKGROUND:Plexiform fibromyxoma (PF) is a rare mesenchymal tumor of the stomach. The clinical features of PF frequently include upper abdominal pain, abdominal discomfort, hematemesis, melena, pyloric obstruction and an upper abdominal mass. We herein report a case of PF resected by laparoscopic radical distal gastrectomy plus Roux-en-Y gastrojejunostomy.CASE SUMMARY:The patient was admitted to hospital, due to a 1-wk history of an abdominal space-occupying lesion identified during a health examination. He underwent complete resection by laparoscopic radical distal gastrectomy plus Roux-en-Y gastrojejunostomy. During the operation, the tumor was located in the anterior wall of the gastric antrum (approximately 7 cm × 6 cm × 5.5 cm) and did not show evidence of invasion of the serosa. Histology showed that the tumor cells were oval fibroblast-like and spindle-shaped cells, with numerous thin-walled blood vessels and abundant myxoid stroma. Cellular atypia and mitosis were both rare. Immunohistochemistry showed that the tumor cells were immunoreactive for smooth muscle actin, S-100 and CD-10, but were negative for CD-117, CD-34, DOG-1, and ALK. In this case, S-100 was positive and no significant disease was observed during the follow-up period.CONCLUSION:The fact that PF is a rare tumor with only a few cases in this region can lead to misdiagnosis of this entity and pose a real diagnostic challenge for general surgeons and pathologists when encountering such patients and differentiating PF from other primary tumors of gastric mesenchymal origin. Our report may help increase awareness of this rare, but important new disease entity.

BACKGROUND:Chronic hepatitis B virus (HBV) infection is a major risk factor for the occurrence and development of cirrhosis and hepatocellular carcinoma (HCC). Microvascular invasion (MVI) of HCC is closely related to postoperative recurrence. We aimed to investigate the effect of HBV DNA replication levels and anti-HBV treatment on the occurrence of MVI in HCC. METHODS:A retrospective analysis of the clinical and pathological data of 660 patients undergoing hepatectomy for hepatocellular carcinoma at the Affiliated Hospital of Qingdao University from January 2015 to December 2017 is included in this study. RESULTS:This study involved a total of 660 patients with an MVI incidence rate of 46.8% (309/660). Univariate analysis revealed that positive HBV surface antigen (HBsAg), detectable HBV DNA load, and administration of antiviral treatment were significantly associated with the formation of MVI. Multivariable logistic regression analysis in patients with positive seral HBsAg showed that detectable HBV DNA load (OR = 5.33, P < 0.001) was an independent risk factor for MVI. Antiviral treatment for more than six months (OR = 0.37, P = 0.002) was an independent protective factor against MVI. Patient groups with severe MVI had significantly higher rates of HBV infection (P = 0.017), a detectable HBV DNA load (> 100 IU/ml) rate (P < 0.001), and obvious low antiviral treatment rate (P = 0.021). CONCLUSIONS:HBV DNA replication level is an independent risk factors for the formation of HCC MVI, and anti-hepatitis B virus treatment has an inhibitory effect on MVI formation.

Objective: To investigate the relationship between metabolic syndrome and pancreatic cancer in elderly patients. Methods: This study analyzed retrospectively the clinical data of 203 pancreatic cancer patients aged above 60 years who were on hospital admission from July 2009 to December 2013. A set of 210 patients without endocrine diseases, digestive diseases, and tumors, matched for age, sex, and body height with the cancer group served as control. The interrelationships between metabolic syndrome and its components, and pancreatic cancer in the elderly patients were studied using univariate and multivariate analyses. In addition, the interrelationships between the clinical features of the elderly patients with pancreatic cancer and metabolic syndrome were subjected to univariate and multivariate analyses. Results: Elderly pancreatic cancer patients differed statistically from the control group with respect to comorbidities of diabetes, and elevated BMI, TG, TC and fasting blood glucose, (chi(2) = 8.812, 4.632, 4.538, 7308, and 48.178, respectively, p < 0.05). New-onset diabetes mellitus (DM, duration <= 2 years) had closer correlation with pancreatic cancer in the elderly patients than longterm diabetes. The levels of glycosylated hemoglobin and CA119 in pancreatic cancer group and in patients with diabetes of control group were significantly elevated (p < 0.05), and the increase in CA199 level in the cancer group was closely associated with glycosylated hemoglobin. Conclusion: Metabolic syndrome and its components (diabetes, high fasting blood glucose, high triacylglycerol, and elevated glycosylated hemoglobin) are independent risk factors for pancreatic cancer in the elderly. The clinical features in the elderly pancreatic cancer patients are not specific.

Background: Crohn's disease (CD) is a lifelong disease characterized by purulent inflammation in the gastrointestinal tract from any part of the mouth to the anus. Various studies have reported complications of the CD. However, arterial thrombosis is an extremely rare complication of CD. We report a patient with CD with extensive thrombosis of the extremities and mesenteric arteries. Methods: A 41-year-old man came to our hospital for 2 months of discomfort in the right upper abdomen and had previous left lower extremity arterial occlusive disease and left upper limb ischemic contraction for more than 2 months. The patient developed fever and abdominal pain repeatedly after admission; because of the increased abdominal pain, we urgently performed a laparotomy for him. And according to the findings in the surgery, we decided to perform partial small intestine resection, cholecystectomy, common bile duct exploration, and T-tube drainage. Results: Pathological findings of postoperative specimens showed Crohn's disease and mesenteric atherosclerosis with mesenteric artery thrombosis. We performed a series of treatments such as 5-aminosalicylic acid, intravenous infusion, broad-spectrum antibiotic infection treatment, nutritional support, and low molecular weight heparin. The patient was successfully discharged from the hospital. Conclusions: The occurrence of IBD with arterial thromboembolism is extremely rare but can lead to serious consequences. During IBD treatment, we should be aware of the possibility of TEs (especially arterial TEs) and should be alert to the possibility of arterial TEs in young patients with IBD with active and extensive disease.