IntroductionGastrointestinal perforation caused by ingested foreign bodies typically presents with acute abdominal symptoms. However, migration of a fish bone through the posterior wall of the duodenum into the liver, resulting in liver abscess formation without abdominal pain, is extremely rare and easily misdiagnosed. This case highlights an atypical clinical presentation and important diagnostic considerations.Case descriptionA 56-year-old man presented with recurrent fever for 25 days without abdominal pain or gastrointestinal symptoms. Laboratory tests revealed elevated inflammatory markers. Contrast-enhanced computed tomography demonstrated a liver abscess in segment V and a linear hyperdense structure extending from the duodenum into the hepatic parenchyma, suggesting foreign body migration. Emergency laparoscopic exploration was performed, during which a migrated fish bone was removed, the liver abscess was drained, and the duodenal perforation was repaired. The postoperative course was uneventful, with normalization of body temperature on the first postoperative day. The patient was discharged on postoperative day four and showed no recurrence during follow-up.ConclusionThis case emphasizes that gastrointestinal foreign body perforation and migration should be considered in patients with liver abscess and fever of unknown origin, even in the absence of abdominal pain. Detailed dietary history-taking and careful interpretation of CT imaging are essential for accurate diagnosis, and laparoscopic surgery provides an effective diagnostic and therapeutic approach.

Abstract Background Hepatocellular carcinoma (HCC) remains a major global health burden and a leading cause of cancer-related mortality. Advanced disease is characterized by a profoundly immunosuppressive tumor microenvironment (TME) and limited durable responses to therapy. However, the upstream genetic determinants that drive tumor-associated macrophage (TAM) dysfunction in HCC remain poorly defined. Using an integrative genetic and multi-omics framework, we investigated complement receptor 1 (CR1) as a candidate regulator of this immunosuppressive niche. Methods We combined Mendelian randomization (MR) and metabolite mediation analyses with bulk, single-cell, and spatial transcriptomics to define the role of CR1 in HCC. Public datasets included the TCGA-HCC cohort, a single-cell RNA-sequencing dataset comprising 53,474 high-quality cells from 21 samples, and two spatially profiled HCC sections. Clinical validation was performed in 30 paired HCC and adjacent liver tissues. Functional assays were conducted in THP-1-derived macrophages using CR1 gain- and loss-of-function approaches, phagocytosis assays, and macrophage-CD8 + T-cell co-culture experiments. Results MR analyses implicated CR1 in HCC susceptibility at both the protein and transcript levels. pQTL analysis linked genetically predicted circulating CR1 levels to HCC risk (IVW OR = 1.403, p = 0.017), and mediation analysis identified specific metabolites as candidate intermediates. Integrative multi-omics analyses showed that CR1 was preferentially enriched in TAMs, spatially co-localized with the M2 marker CD206, and associated with reduced CD8 + T-cell infiltration, enhanced T-cell exhaustion signatures, advanced clinicopathological features, and poorer survival. In 30 paired clinical samples, CR1-high tumors exhibited increased M2-like macrophage accumulation and reduced CD8 + T-cell infiltration. Functionally, CR1 overexpression drove macrophages toward an M2-like phenotype, enhanced phagocytic activity, increased PD-L1 expression, and suppressed CD8 + T-cell proliferation as well as IFN-gamma and granzyme B production, whereas CR1 knockdown produced the opposite phenotype. Conclusions Our study provides the first integrated genetic, spatial, and functional evidence that CR1 + TAMs constitute a clinically relevant immunoregulatory axis in HCC. These findings extend current understanding of complement-associated immunosuppression beyond canonical complement cascade activity and support CR1 as a candidate biomarker and therapeutic target for macrophage reprogramming, with potential translational relevance for combination strategies involving immune checkpoint blockade.

Background Solid pseudopapillary tumor of the pancreas is a rare low-grade malignant neoplasm. The clinical relevance of lymph node dissection during surgical resection remains controversial due to limited evidence. Method We retrospectively reviewed the clinical records of patients with solid pseudopapillary tumor of the pancreas who underwent surgery at Shandong Provincial Hospital between 2005 and 2024. Lymph node status and clinicopathologic characteristics were analyzed. The patients were divided into 2 groups according to whether the lymph nodes were cleared or not, and the association between lymph node dissection and postoperative outcomes was evaluated. Result A total of 351 patients were included, with a male to female ratio of 63:288. Among 109 patients who underwent lymph node dissection, no lymph node metastasis was identified. Tumor location, age at diagnosis, and clinical presentation did not differ between sexes; however, female patients had significantly larger tumors than male patients (5.74 ± 3.46 cm vs 4.57 ± 2.82 cm, P = .013). A total of 182 patients were followed up after surgery, with a 41-month median follow-up time, including 60 patients with lymph node dissection and 122 patients without lymph node dissection. No tumor recurrence or metastasis occurred in either group, and the complication rates were comparable. Conclusion In the absence of radiologic or intraoperative suspicion of nodal involvement, routine lymph node dissection may be unnecessary in solid pseudopapillary tumor of the pancreas surgery.

Background Hepatocellular carcinoma (HCC) is characterized by a profoundly immunosuppressive tumor microenvironment (TME), which severely limits therapeutic efficacy. By integrating a multi-omics strategy, we identified complement receptor 1 (CR1) as a central regulator of this immunosuppressive milieu. Methods We performed Mendelian randomization (MR) analyses to infer the causal relationship between genetically predicted circulating CR1 levels and HCC risk, followed by metabolite mediation analyses. Bulk, single-cell, and spatial transcriptomic datasets from public cohorts and clinical samples were systematically analyzed to characterize CR1 expression patterns and cellular localization. Tumor microbiome profiling was conducted to explore potential microbe–immune interactions. Functional validation was performed using THP-1–derived macrophages, including gain- and loss-of-function experiments, phagocytosis assays, and macrophage–CD8⁺ T-cell co-culture systems. Results MR analysis identified a causal link between genetically predicted circulating CR1 levels and increased HCC risk (IVW OR = 0.907, P = 0.02), with specific blood metabolites potentially mediating this effect. Multi-omics profiling revealed that CR1 was overexpressed specifically in tumor tissues and predominantly enriched in tumor-associated macrophages (TAMs), where its expression strongly correlated with M2 polarization signatures. Elevated CR1 expression correlated with reduced CD8⁺ T cell infiltration, increased T cell exhaustion, and poorer patient survival. Spatial transcriptomics further confirmed significant co-localization of CR1 with the M2 marker CD206. Functionally, CR1 overexpression reprogrammed macrophages into an M2-like immunosuppressive phenotype, characterized by upregulation of CD206 and IL-10 and enhanced phagocytic activity, while CR1 knockdown promoted an M1-like state. Crucially, in co-culture systems, CR1-high macrophages markedly inhibited CD8⁺ T cell proliferation and effector functions—including IFN-γ production and granzyme B expression—concomitant with increased PD-L1 expression. Tumor microbiome analysis extended our findings, suggesting potential crosstalk between intratumoral bacteria and the CR1-driven immunosuppressive axis. Conclusions Our study identifies CR1 as an environmentally responsive master regulator that reshapes the immunological landscape of HCC by reprogramming TAMs, thereby positioning CR1 as a highly promising therapeutic target for restoring antitumor immunity.

Neuroendocrine neoplasms (NENs) are biologically heterogeneous tumors in which differentiation/grade and hormonal functionality are intersecting but non-equivalent axes. This review focuses on functional and non-functional well-differentiated neuroendocrine tumors (NETs), principally gastroenteropancreatic and pancreatic NETs, and critically evaluates how site, lineage, stage, tumor burden, genomic and epigenetic alterations, immune-stromal remodeling, metabolic adaptation, microbiome-associated signals, and treatment pressure converge on metastasis and recurrence. Apparent outcome differences by functionality are inconsistent after clinicopathological adjustment: non-functional presentation is often enriched for delayed diagnosis and adverse features, whereas functional subtypes range from typically indolent insulinomas to clinically aggressive hormone-producing tumors. We reconcile these observations through a layered model in which lineage-defining alterations and chromatin/telomere programs establish cellular state; signaling and metabolic plasticity enable stress adaptation; and hypoxia, angiogenesis, immune cells, fibroblasts, extracellular matrix, and therapy create selective niches for dissemination and relapse. We also define computational strategies for heterogeneous multi-omics integration and a staged biomarker-validation pathway. Evidence remains dominated by pancreatic NETs, and causal support is weakest for microbiome-functionality relationships and several proposed cross-omic links. A spectrum-based framework is therefore most useful when it generates testable, site- and grade-specific hypotheses rather than treating functionality as an isolated prognostic variable.

This report describes indocyanine green (ICG) fluorescence guidance combined with intraoperative ultrasonography (IOUS) for laparoscopic parenchyma-sparing excision of selected perivascular focal nodular hyperplasia (FNH). In two patients with segment IV lesions abutting the portal vein, preoperative ICG administration (0.5 mg/kg, 24 h prior) enabled real-time intraoperative fluorescence imaging integrated with ultrasonography. The dual-modality navigation provided clear visual contrast, facilitating precise lesion delineation and margin assessment. Both patients underwent successful wedge excision with negative surgical margins, with estimated blood loss of 50-20 mL, respectively. Incidental punctate hyperfluorescent foci were observed on the liver surface; one excised focus showed benign hyperplastic changes on histology, while the clinical significance of the remaining foci remains uncertain. These cases suggest that ICG fluorescence may assist laparoscopic parenchyma-sparing excision of selected perivascular FNH lesions, though further studies are needed to define its reproducibility, limitations, and clinical value.

BackgroundSplenic hilar aneurysms exceeding 2 cm in diameter typically warrant surgical intervention given their elevated risk of fatal rupture. While complete splenectomy has historically been the conventional approach to mitigate operative complexity, this procedure carries significant postoperative concerns including compromised immune function and increased thrombotic risks associated with splenic absence.Case presentationIn two cases of splenic artery aneurysms (SAAs) deeply embedded within the pancreatic tail at the splenic hilar region, we performed laparoscopic resection of the splenic artery aneurysm and distal pancreas. Intraoperative indocyanine green (ICG) fluorescence imaging was employed to map perfusion patterns of the spleen, demonstrating sequential greening and subsequent fading of the splenic upper pole. This confirmed preserved arterial inflow and venous drainage, thus confirming maintained vascularization following splenic artery ligation. The patients achieved an uneventful recovery and were discharged without complications.ConclusionsWe described the first use of a technique that integrates distal pancreatectomy with ICG-guided partial splenic preservation for complex splenic hilar aneurysms. This strategy facilitates precise resection of the aneurysm and non-viable spleen, thereby maximizing functional preservation and establishing itself as a promising option for managing these challenging lesions.

BACKGROUND:We evaluated a third spleen-preserving approach-indocyanine green-guided laparoscopic partial spleen-preserving distal pancreatectomy-for benign or low-grade pancreatic body/tail tumors, in comparison with the Warshaw technique. METHODS:This was a single-center retrospective cohort study conducted between January 2020 and November 2024. Thirty-seven patients underwent laparoscopic partial spleen-preserving distal pancreatectomy (n = 15; preserving short gastric and superior polar vessels) versus Warshaw (n = 22). Intraoperative indocyanine green fluorescence was used to assess splenic perfusion. Outcomes included operative metrics, major morbidity (clinically relevant postoperative pancreatic fistula per International Study Group on Pancreatic Surgery 2016), radiologic splenic infarction, platelet counts, and health-related quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30). RESULTS:Operative duration (222.1 ± 39.5 minutes vs 208.2 ± 29.9 minutes; P = .23), blood loss (199.5 ± 25.8 mL vs 188.8 ± 29.1 mL; P = .31), and clinically relevant postoperative pancreatic fistula (13.6% vs 13.3%; P = 1.00) did not differ between the 2 groups. Laparoscopic partial spleen-preserving distal pancreatectomy yielded lower radiologic splenic infarction (0% vs 31.8%; P = .028) and lower platelet counts on postoperative day 7 (≈156 vs 218 × 109/L; P = .01). Health-related quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30) was assessed at baseline and at 1, 3, 6, and 12 months. Although overall trajectories were similar, global health status scores favored laparoscopic partial spleen-preserving distal pancreatectomy at 1 and 12 months (both P < .05). CONCLUSION:By conserving the short gastric and superior polar vessels with indocyanine green-guided perfusion mapping, Laparoscopic partial spleen-preserving distal pancreatectomy preserves viable splenic parenchyma, reducing splenic infarction and postoperative thrombocytosis without increasing operative time, blood loss, or clinically relevant postoperative pancreatic fistula. Laparoscopic partial spleen-preserving distal pancreatectomy represents a viable third spleen-preserving option that broadens minimally invasive, organ-preserving strategies for distal pancreatectomy.

Cholangiocarcinoma (CCA) is an aggressive biliary malignancy with limited diagnostic tools and poor prognosis. Early detection remains challenging due to nonspecific symptoms and a lack of reliable biomarkers. Exosomes, as stable carriers of molecular cargos, have emerged as promising sources for non-invasive cancer biomarkers. Here, we integrated multiple GEO datasets to identify exosome-related differentially expressed genes (ERDEGs) associated with CCA. Through differential expression analysis, machine-learning feature selection, and immune infiltration profiling, we identified two key exosome-related genes, WNT5A and PFN2 , as potential diagnostic biomarkers. Both genes showed robust diagnostic performance across internal and external validation cohorts. Functional enrichment revealed strong associations with extracellular matrix organization, EMT activation, and immune regulation pathways. Molecular docking suggested potential therapeutic compounds targeting these genes. Immunohistochemistry further confirmed significant overexpression of WNT5A and PFN2 in CCA tissues compared with adjacent controls. Collectively, our findings highlight WNT5A and PFN2 as promising exosome-related biomarkers that may improve early diagnosis and offer new therapeutic opportunities for cholangiocarcinoma.

Clinically relevant postoperative pancreatic fistula (CR-POPF) following laparoscopic pancreaticoduodenectomy (LPD) is a critical complication that significantly worsens patient outcomes. However, the heterogeneity of its risk factors and the clinical utility of predictive models remain to be fully elucidated. This study aims to systematically analyze the risk factors for CR-POPF and develop an optimized predictive model using machine learning algorithms, providing an evidence-based approach for individualized risk assessment in patients undergoing LPD. A retrospective study was conducted, including 210 patients with periampullary cancer who underwent laparoscopic pancreaticoduodenectomy (LPD) at the Hepatobiliary Surgery Center, Olympic Stadium Campus, Shandong Provincial Hospital Affiliated to Shandong First Medical University, from January 2017 to January 2024. Patients were classified into the clinically relevant pancreatic fistula (CR-POPF) group (n = 34) and the non-clinically relevant pancreatic fistula (non-CR-POPF) group (n = 176) according to the 2016 criteria of the International Study Group of Pancreatic Surgery (ISGPS). Potential risk factors were identified through intergroup comparisons, and independent risk factors were determined using univariate and multivariate logistic regression analyses. Based on these findings, a predictive model for CR-POPF was developed using machine learning algorithms. CR-POPF was associated with higher BMI, monocyte levels, platelet count, total bilirubin, AST, ALT, and lower albumin. Pathological diagnosis of ampullary carcinoma and soft pancreatic texture were significantly more common in the CR-POPF group. Multivariate analysis identified soft pancreatic texture as an independent predictor (OR = 4.99, 95

MicroRNAs (miRNAs) are small non-coding RNA molecules that regulate numerous genes in cells. Abnormal expression of miRNAs can lead to cancer. However, the roles and underlying mechanisms of miRNAs in hepatocellular carcinoma (HCC) are not fully understood. Using molecular biology techniques, we designed eukaryotic expression vectors with enhanced expression of miR-101-3p to transfect human hepatocellular carcinoma cell lines. Subsequent to this, cell cloning experiments, CCK8 assays, and Transwell migration experiments were executed to assess their impact on liver cancer cell proliferation and invasion. Dual-luciferase assays were employed to validate the molecular interaction between miR-101-3p and Birc5. Through rescue experiments aimed at manipulating the expression levels of Birc5, we scrutinized the influence of miR-101-3p on liver cancer cell proliferation and invasion. Furthermore, Western blot analysis was utilized to monitor alterations in the expression levels of E-cadherin, N-cadherin, and vimentin proteins within each cell group. In vivo investigations were conducted using nude mice implanted with hepatocellular carcinoma cells transfected with Birc5. Additionally, further exploration was carried out by combining this model with the PI3K/AKT pathway inhibitor miltefosine to elucidate its effects on tumor proliferation. In vitro functional analysis of miR-101-3p revealed that treatment of HCC cells with its corresponding mimic significantly inhibited cell proliferation, colony formation, invasion, and epithelial-mesenchymal transition. Additionally, miR-101-3p exerts its anti-tumor effects by targeting the shared gene Birc5. Experiments using nude mouse models demonstrate that Birc5 promotes tumor proliferation by phosphorylating the PI3K/AKT signaling pathway. Inhibiting the PI3K/AKT signaling pathway shows suppressive effects on liver cancer proliferation. MiR-101-3p plays crucial roles in inhibiting the proliferation, invasion and epithelial-mesenchymal transition of HCC cells by targeting Birc5 and downregulating the PI3K-AKT signaling pathway. These findings provide new insights for the molecular treatment of HCC.

BackgroundConsiderable studies show that ETS variant 4 (ETV4) plays an important roles in multitudinous tumor. This study investigated its function in cholangiocarcinoma (CCA) progression and revealed the underlying mechanisms.MethodsThe expression of ETV4 in CCA was evaluated using TCGA database and the single-cell analysis based on GSE189903 dataset. ETV4 expression in CCA human specimens was detected by reverse transcription-quantitative PCR, immunohistochemistry, and western blot. Cell Counting Kit-8, EdU, colony formation, wound healing, and Transwell assays were used to analyze the effects of ETV4. Extracellular acidification rate, oxygen consumption rate, glucose uptake, and lactate production were used to measure glycolysis in CAA cells. Western blot was performed to explore glycolysis-related proteins. Tumor growth was evaluated in mice xenograft tumors.ResultsETV4 was up-regulated in CCA epithelial cells. The high-expression of ETV4 was associated with poor prognosis of patients with CCA. ETV4 overexpression enhanced the proliferation, migration, invasion, and glycolysis of CCA cells; ETV4 silencing led to the contrary effects. Mechanistically, ETV4 activates TGF-β/Smad2/3 signaling pathway. In mice xenograft mode, ETV4 silencing inhibits the tumor growth, the expression of glycolysis-related proteins and TGF-β/Smad2/3 pathway proteins.ConclusionsETV4 functions as an essential factor in the roles of TGF-β1 in CCA cells, and may be a promising target for TGF-β1-mediated CCA progression.

AbstractBackgroundThe Barcelona Clinic Liver Cancer (BCLC) staging system is an internationally recognized clinical staging system for hepatocellular carcinoma (HCC). However, this staging system does not address the staging and surgical treatment strategies for patients with spontaneous rupture hemorrhage in HCC. In this study, we aimed to investigate the prognosis of patients with BCLC stage A undergoing liver resection for HCC with spontaneous rupture hemorrhage and compare it with the prognosis of patients with BCLC stage A undergoing liver resection without rupture.MethodsClinical data of 99 patients with HCC who underwent curative liver resection surgery were rigorously followed up and treated at Shandong Provincial Hospital from January 2013 to January 2023. A retrospective cohort study design was used to determine whether the presence of ruptured HCC (rHCC) is a risk factor for recurrence and survival after curative liver resection for HCC. Prognostic comparisons were made between patients with ruptured and non‐ruptured BCLC stage A HCC (rHCC and nrHCC, respectively) who underwent curative liver resection.ResultsrHCC (hazard ratio [HR] = 2.974, [p] = 0.016) and tumor diameter greater than 5 cm (HR = 2.819, p = 0.022) were identified as independent risk factors for overall survival (OS) after curative resection of BCLC stage A HCC. The postoperative OS of the spontaneous rupture in the HCC group (Group I) was shorter than that in the BCLC stage A group (Group II) (p = 0.008). Tumor invasion without penetration of the capsule was determined to be an independent risk factor for recurrence‐free survival (RFS) after liver resection for HCC (HR = 2.584, p = 0.002).ConclusionHCC with concurrent spontaneous rupture hemorrhage is an independent risk factor for postoperative OS after liver resection. The BCLC stage A1 should be added to complement the current BCLC staging system to provide further guidance for the treatment of patients with spontaneous rupture of HCC.

Background Disseminating disease knowledge through concise videos on various platforms is an innovative and efficient approach. However, it remains uncertain whether pancreatic neuroendocrine tumor (pNET)-related videos available on current short video platforms can effectively convey accurate and impactful information to the general public. Objective Our study aims to extensively analyze the quality of pNET-related videos on TikTok and Bilibili, intending to enhance the development of pNET-related social media content to provide the general public with more comprehensive and suitable avenues for accessing pNET-related information. Methods A total of 168 qualifying videos pertaining to pNETs were evaluated from the video-sharing platforms Bilibili and TikTok. Initially, the fundamental information conveyed in the videos was documented. Subsequently, we discerned the source and content type of each video. Following that, the Global Quality Scale (GQS) and modified DISCERN (mDISCERN) scale were employed to appraise the educational value and quality of each video. A comparative evaluation was conducted on the videos obtained from these two platforms. Results The number of pNET-related videos saw a significant increase since 2020, with 9 videos in 2020, 19 videos in 2021, 29 videos in 2022, and 106 videos in 2023. There were no significant improvements in the mean GQS or mDISCERN scores from 2020 to 2023, which were 3.22 and 3.00 in 2020, 3.33 and 2.94 in 2021, 2.83 and 2.79 in 2022, and 2.78 and 2.94 in 2023, respectively. The average quality scores of the videos on Bilibili and Tiktok were comparable, with GQS and mDISCERN scores of 2.98 on Bilibili versus 2.77 on TikTok and 2.82 on Bilibili versus 3.05 on TikTok, respectively. The source and format of the videos remained independent factors affecting the two quality scores. Videos that were uploaded by professionals (hazard ratio=7.02, P=.002) and recorded in specialized popular science formats (hazard ratio=12.45, P<.001) tended to exhibit superior quality. Conclusions This study demonstrates that the number of short videos on pNETs has increased in recent years, but video quality has not improved significantly. This comprehensive analysis shows that the source and format of videos are independent factors affecting video quality, which provides potential measures for improving the quality of short videos.

Presently, spleen-preserving distal pancreatectomy is predominantly utilized for benign or low-grade malignant tumors of the pancreatic body and tail. The splenic blood vessel-preserving Kimura technique and non-splenic blood vessel-preserving Warshaw technique represent the two primary procedures. In prior reports, total splenectomy was most frequently performed when splenic blood vessels could not be preserved, and severe splenic congestion and ischemia were identified following the dissection of splenic blood vessels. This paper introduces a new method of spleen-preserving distal pancreatectomy, entailing a distal pancreatectomy with partial spleen preservation, illustrated through the presentation of two surgical cases. During physical examination, two patients were identified to have benign or low-grade malignant masses in the pancreatic tail. Preoperative examination indicated that the lesion was closely associated with the splenic blood vessels or splenic hilum. During surgery, neither the Kimura technique nor the Warshaw technique could be executed. After resecting the pancreatic body and tail, and a portion of the spleen, the superior pole of the spleen was successfully preserved by maintaining the short gastric blood vessels therein. This technical report demonstrates the viability of this novel spleen-preserving distal pancreatectomy, a distal pancreatectomy with partial spleen preservation, for benign and low-grade malignant pancreatic body and tail lesions. The innovative technique achieves partial spleen preservation by effectively preserving the short gastric blood vessels in the superior pole of the spleen.

OBJECTIVE:To investigate the efficacy of contrast-enhanced ultrasound (CEUS)-guided radiofrequency ablation (RFA) in the treatment of liver cancer and its effect on patients' immune function.METHODS:Clinical data of 84 liver cancer patients admitted to the Shandong Qishan Hospital from March 2018 to March 2020 were retrospectively analyzed. According to differences in treatment methods, patients were divided into a research group (42 cases treated by CEUS-guided RFA) and a control group (42 cases treated by RFA under conventional ultrasound). Clinical efficacy of two groups was observed two months after surgery. Liver function as well as IgA, IgG and IgM levels were evaluated. The incidence of complications, quality of life and survival were compared between the two groups.RESULTS:The complete inactivation rate of large lesions in the research group was 23.81%, which was significantly higher than that of the control group (4.76%). Before treatment, the two groups showed similar levels of IgA, IgG and IgM. After treatment, significantly increased levels were observed in both groups, but the research group had higher IgA, IgG and IgM levels as compared to the control group (P < 0.05). The quality of life scores increased in both groups after the intervention, and the score in the research group was significantly higher than that in the control group (P < 0.05). The progression-free survival of patients in the research group (12.28±5.42) was longer than that of patients in the control group (8.50±4.47; P < 0.05).CONCLUSIONS:Comparing to RFA guided by conventional ultrasound, RFA guided by CEUS can reduce liver damage, lower the incidence of complications, enhance the body's immune system, and improve local control rate and progression-free survival time in patients with liver cancer.

An intraductal papillary mucinous neoplasm of the biliary tract (BT-IPMN) in the caudate lobe of the liver is a rare tumor originating from the bile duct. Approximately 40% of the intraductal papillary neoplasms of the biliary tract (IPNB) secrete mucus and can grow in the intrahepatic or extrahepatic bile ducts. A 65-year-old woman presented with recurrent episodes of right upper pain. She developed her first episode 8 years ago, which resolved spontaneously. The frequency of symptoms has increased in the last 2 years. She underwent laparoscopic hepatectomy and choledochal exploration and was pathologically diagnosed with a rare BT-IPMN of the caudate lobe after admission. Here, we review studies on IPNB cases and systematically describe the pathological type, diagnosis, and treatment of IPNB to provide a valuable reference for hepatobiliary surgeons in the diagnosis and treatment of this disease.

Background and aimsAt present, evidence on the association between high-density lipoprotein cholesterol (HDL-C) levels and aggravation of acute pancreatitis (AP) is limited. This study aimed to investigate the relationship between the lowest HDL-C level during intensive care units (ICU) stay and AP aggravation and to determine the optimum cutoff lowest HDL-C level.MethodsPatients admitted to the ICU of the Shandong Provincial Hospital for AP from 2015 to 2021 were included. The lowest HDL-C level during ICU stay was set as the independent variable, and the progression or non-progression to severe AP (SAP) was set as the dependent variable. Univariate and multivariate analyses were performed to determine the relationship between the two variables, and receiver operating characteristic (ROC) curves were plotted to analyze the predictive ability of the lowest HDL-C level for progression to SAP.ResultsThis study included 115 patients. The difference in the lowest HDL-C level between the SAP and moderately SAP groups was significant (P < 0.05). After adjusting for covariates, the lowest HDL-C level showed a negative correlation with the occurrence of SAP, with a relative risk of 0.897 (95% confidence interval: 0.827–0.973). The area under the ROC curve for prediction of AP aggravation by the lowest HDL-C level was 0.707, and the optimum cutoff lowest HDL-C level was 0.545 mmol/L.ConclusionNo less than 0.545 mmol/L of the HDL-C level during ICU stay may be an independent protective factor for the aggravation of AP.

Purpose:Monocarboxylate transporter 4 (MCT4) is an important component of cancer cell glycolytic metabolism. It has been confirmed that MCT4 is highly expressed in hepatocellular carcinoma (HCC) cells and tissues and is significantly associated with poor prognosis of HCC patients. However, research on its downstream molecules that affect HCC is still insufficient. The aim of current research was to investigate the MCT downstream molecule and its role of in HCC development.Patients and Methods:After MCT4 expression was knocked down by RNA interference, RNA sequencing and quantitative real-time PCR were used to screen for differentially expressed genes in an HCC cell line (HCCLM3). Immunohistochemistry in HCC tissue microarray was carried out to evaluate the Trafficking Protein Particle Complex Subunit 5 (TRAPPC5) expression. Cell proliferation, migration, and invasion were evaluated by CCK-8 assay, colony formation assay, transwell and wound-healing test, respectively. Xenograft experiment was employed to investigate the function of TRAPPC5 on tumor growth in vivo. Related signaling pathway proteins were evaluated by Western blot.Results:TRAPPC5 expression was significantly downregulated after knocking down of MCT4 in HCCLM3. TRAPPC5 was highly expressed in HCC tissues, and it could enhance the proliferation, migration, invasion and epithelial-mesenchymal transition (EMT) process of HCC cells. In vivo experiment showed that TRAPPC5 could promote HCC tumorigenesis.Conclusion:In the process of MCT4 affecting the progression of HCC, TRAPPC5 is one of the most important related molecules. TRAPPC5 suppression could significantly reduce HCC cell proliferation, migration and invasion and could serve as a therapeutic target in HCC.

Backgroud At present, there is no definitive conclusion about the relative prognostic factors on intrahepatic cholangiocarcinoma perihilar large duct type (iCCAphl) and iCCA peripheral small duct type (iCCApps). Aim of the study To compare the prognoses of two different types of iCCA, and identify the independent risk factors affecting the long-term survival of patients undergoing radical resection for iCCA. Methods This study included 89 patients with iCCA who underwent radical resection at the Department of Hepatobiliary Surgery of the East Yard of the Shandong Provincial Hospital between January 2013 and March 2022. According to the tumor origin, these patients were divided into the iCCAphl group (n = 37) and iCCApps group (n = 52). The prognoses of the two groups were compared using Kaplan–Meier analysis, whereas the independent risk factors of their prognoses were identified using Cox univariate and multivariate regression analyses. Results In the iCCApps group, the independent risk factors for overall survival included diabetes history (p = 0.006), lymph node metastasis (p = 0.040), and preoperative carbohydrate antigen 19-9 (p = 0.035). In the iCCAphl group, the independent risk factors for overall survival included multiple tumors (p = 0.010), tumor differentiation grade (p = 0.008), and preoperative jaundice (p = 0.009). Conclusions Among the iCCA patients who underwent radical resection, the long-term prognosis of iCCApps maybe better than that of iCCAphl. The prognoses of these two types of iCCA were affected by different independent risk factors.