Background: The prognostic factors for survival outcomes in patients with hepatocellular carcinoma (HCC) are not well defined. This study aimed to identify the prognostic factors for HCC and to construct a predictive nomogram model. Methods: A total 165 patients with HCC were identified between 25 January 2010 and 10 November 2021. Independent prognostic factors were identified using univariable and multivariable Cox regression analyses. A nomogram was constructed to predict the patient survival rate. The concordance index (C-index), area under the curve (AUC), and calibration curves were used to assess the predictive accuracy and discrimination of the model. Decision curve analysis was used to confirm the clinical utility of the nomogram. Results: A total of 165 patients were randomly selected retrospectively. Univariable and multivariable analyses revealed that body mass index, albumin, carbohydrate antigen 19-9 (CA19-9), tumor size, and tumor size, lymph node, metastasis (TNM) stage were independent factors for predicting patient survival. We constructed a 1-, 3-, and 5-year survival rate prediction clinical model by using these independent prognostic factors, which yielded C-indexes of 0.838, 0.798 and 0.725, respectively. On the basis of the AUCs and calibration curve and decision curve analyses, we concluded that the prognostic model for HCC exhibited excellent performance. Conclusions: The clinical model demonstrated good calibration, discrimination, clinical utility, and practical decision-making effects for the outcomes of patients with HCC. These findings may help oncologists and surgeons make better clinical decisions.

To compare the effects of multikinase inhibitors (sorafenib/lenvatinib) and immune checkpoint inhibitors (PD-1/PD-L1) on anxiety, depression, and quality of life (QoL) in patients with advanced hepatocellular carcinoma (HCC) and to analyse their correlations with clinical indicators. This retrospective cohort study included 304 patients with advanced HCC (BCLC stage B/C) who received first-line monotherapy between 2018 and 2023. Propensity score matching (1:1) was used to categorize patients into two groups: those treated with multikinase inhibitors (n = 152) and those treated with PD-1/PD-L1 inhibitors (n = 152). Anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), and QoL (EORTC QLQ-C30) were assessed at baseline and during follow-up (every 3 months). Correlations between the treatment duration, survival outcomes, and adverse events (AEs) were analysed. The PD-1/PD-L1 group presented significant reductions in anxiety (HADS-A: mean difference [MD] = − 2.4) and depression (HADS-D: MD = − 2.3) at 6 months (both *p < 0.001), with lower rates of clinically significant anxiety (28.3% vs. 42.1%) and depression (24.3% vs. 38.8%; p < 0.05). QoL improved markedly (6-month MD = + 10.3, p < 0.001), particularly when the treatment was administered as the first-line therapy (MD = + 14.2 vs. second-line MD = + 3.8; interaction p < 0.001). PD-1/PD-L1 inhibitors were associated with longer treatment durations (median 9.5 vs. 5.8 months, p < 0.001) and superior overall survival (median 18.2 vs. 12.5 months; HR = 0.62, p = 0.002). Fatigue (grade ≥ 2) independently predicted depression (OR = 1.82, p = 0.002), whereas immune-related AEs were correlated with a reduced QoL (ρ=−0.22, p = 0.004). Compared with multikinase inhibitors, PD-1/PD-L1 inhibitors significantly improve the psychological outcomes, QoL, and survival of patients with advanced HCC, especially when administered as first-line therapies. Fatigue is a critical modifiable risk factor for depression. These findings support prioritizing immunotherapy when treating atients with advanced hepatocellular carcinoma.

OBJECTIVE:To assess peracetic acid residues following automated cleaning and disinfection of flexible endoscopes at the endoscopy centre of a tertiary hospital in Zhejiang province, analyse factors influencing residue levels and provide a basis for standardising the disinfection process. METHODS:A cross-sectional survey was conducted at the endoscopy centre of a tertiary hospital in Zhejiang province from May to June 2025. Samples were collected from the lumens of gastroscopes and colonoscopes after final rinsing and drying on days 1, 3, 5 and 7 of disinfectant use, following cleaning and disinfection with two types of automatic cleaning and disinfection machine. A specific disinfectant concentration analyser was used to determine the concentration of peracetic acid residues in the lumens. RESULTS:A total of 279 gastrointestinal endoscopes were tested in this study. On the first day of disinfectant use, the residues in endoscopes processed using machines A and B were 7.36 ± 4.07 mg/L and 17.08 ± 26.11 mg/L, respectively (t = -2.018, P = 0.047). The residue in endoscopes with a service life of 1-3 years was 5.24 ± 6.16 mg/L and that with a service life of 3-5 years was 16.72 ± 25.94 mg/L (t = 2.375, P = 0.020). On the third day of disinfectant use, the residues in endoscopes processed using machines A and B were 4.68 ± 3.32 mg/L and 7.03 ± 4.09 mg/L, respectively (t = -2.436, P = 0.018). The residue in endoscopes with a service life of 1-3 years was 4.32 ± 1.61 mg/L and that in endoscopes with a service life of 3-5 years was 7.35 ± 3.72 mg/L (t = 3.783, P < 0.005). On the fifth day of disinfectant use, the residues in endoscopes processed using machines A and B were 3.97±1.83 mg/L and 5.49 ± 3.37 mg/L, respectively (t = -2.554, P = 0.013). The residue in endoscopes with a service life of 1-3 years was 2.49 ± 1.35 mg/L and that in endoscopes with a service life of 3-5 years was 6.28 ± 3.20 mg/L (t = 5.339, P < 0.005). On the seventh day of disinfectant use, the residues in endoscopes processed using machines A and B were 3.28 ± 2.51 mg/L and 5.25 ± 2.42 mg/L, respectively (t = -3.272, P = 0.002). The residue in endoscopes with a service life of 1-3 years was 2.38 V ± 1.16 mg/L and that in endoscopes with a service life of 3-5 years was 5.44 ± 3.36 mg/L (t = 4.123, P < 0.005). CONCLUSIONS:Peracetic acid residues were detected in both gastroscopes and colonoscopes, with no difference observed between the two instruments. Residual levels decreased with longer rinsing times of the cleaning and disinfection machine, whereas longer endoscope service life was associated with higher residual levels. Peracetic acid residues following endoscope cleaning and disinfection is influenced by both rinsing time of the automatic cleaning and disinfection machine and the service life of the endoscope, suggesting that clinical managers can minimise residue by extending endoscope rinsing duration and reducing lumen wear.

Pancreatic ductal adenocarcinoma (PDAC) is a global health challenge and remains one of the most lethal malignancies; there are only a few therapeutic options. However, significant efforts have led to the identification of major genetic factors that drive the progression and pathogenesis of PDAC. Notably, the research and application of molecular targeted therapies and immunotherapies have rapidly increased and facilitated great progress in the treatment of many malignant tumors, additional targeted therapies and immunotherapy based on next-generation sequencing results provide new opportunities for the diagnosis and treatment of pancreatic tumors. Immune checkpoint inhibitors are also now being incorporated as PDAC therapies, and combinations of molecularly targeted therapies with immunotherapies are emerging as strategies for boosting the immune response. The investigation of biomarkers of a response or primary resistance to immunotherapies is also an emerging research area. Herein, we further discuss the recent technological advances that continue to expand our understanding of PDAC complexity. We discuss the advancements expected in the near future, including biomarker-driven treatments and immunotherapies. We presume that the clinical translation of these research efforts will improve the survival outcomes of this challenging disease, which are currently dismal.

A 68-year-old man came to evaluate a gastric polyp discovered during a routine gastroscopy. After endoscopic mucosal resection, pathological findings confirmed that it’s a hyperplastic polyp. Notably, squamous metaplasia was observed within the hyperplastic polyp, and both squamous and glandular epithelium exhibited high-grade intraepithelial neoplasia. Besides, the diagnosis of autoimmune gastritis was established by comprehensive assessment including gastric endoscopic findings, histopathological examination and serological studies. The patient experienced no postoperative discomfort and had oral medication for two weeks. In this paper, we presents a first case worldwide of hyperplastic polyp with synchronous high-grade intraepithelial neoplasia in both glandular and squamous epithelium in autoimmune gastritist. In previous cases, the occurrence of hyperplastic polyps with neoplastic transformations or squamous metaplasia is very rare, but what we found this time was the concurrance of both lesions on hyperplastic polyps. This extremely rare case not only provides further clinical evidence for the metaplasia and neoplastic transformation potential of hyperplastic polyps, but also highlights the necessity of regular follow-up examination for autoimmune gastritis - a well-established precancerous condition.

Background:Hepatocellular carcinoma (HCC) is the second leading cause of death globally. Furthermore, HCC patients have poor long-term survival following curative resection because of a high rate of tumor recurrence. Little is known about the genomic trajectory from primary to early recurrent HCC. The HCC patient survival rate has improved because of improved diagnostic protocols. Increasing numbers of lncRNAs have been revealed to be involved in the carcinogenesis and progression of HCC. Among them, The aim of our study was to examine the prognostic value of Loxl1-As1 expression in patients with HCC. Methods:In this study, we analyzed Loxl1-As1 expression in HCC using tissue microarray and fluorescence in situ hybridization. The expression of lncRNA Downregulated in metastatic HCC (Loxl1-As1) in cell lines and tissues was detected by quantitative real-time polymerase chain reaction and in situ hybridization (ISH); cell counting kit-8, colony formation, and flow cytometry were performed to investigate the role of Loxl1-As1 in HCC cell proliferation, cell cycle progression, and apoptosis in vitro; migration was investigated in HCC cell lines in vitro; and Western blot was used to detect the downstream of Loxl1-As1. Results:Clinically, Loxl1-As1 correlated with poor prognosis of HCC. Loxl1-As1 was downregulated in HCC tissues and cell lines. The ISH assay revealed that Loxl1-As1 expression was significantly decreased in 177 paraffin-embedded samples from patients with HCC compared with non-tumor tissues and Loxl1-As1 expression directly correlated with patient prognosis. In vitro studies indicated that Loxl1-As1 promoted the proliferation and clonogenicity of HCC cells and the expression of Loxl1-As1 suppressed the growth, migration, and metastasis of HCC cells in vitro. Conclusions:Collectively, the findings demonstrate that Loxl1-As1 is over-expressed in HCC patients and associated with a poor prognosis. Additionally, Loxl1-As1 plays an important role in HCC progression. These findings support the notion that lncRNA Loxl1-As1 might be a new driver biomarker and future therapeutic target for HCC patients.

BACKGROUND:Patients with middle and advanced hepatocellular carcinoma (HCC) frequently experience significant anxiety and depression, severely affecting their quality of life. AIM:To examine the anxiety and depression status of patients with middle and advanced HCC, the influencing factors, and the correlation between these psychological factors and quality of life. METHODS:We collected baseline data from 100 patients with HCC, assessing anxiety and depression levels using the Hamilton Anxiety Rating Scale (HAMA) and Hamilton Depression Rating Scale (HAMD). Quality of life was evaluated with the Functional Assessment of Cancer Therapy-Hepatobiliary Questionnaire. Multivariate logistic regression analyzed clinical and psychosocial factors affecting anxiety and depression, while Pearson correlation assessed relationships among HAMA, HAMD, and Functional Assessment of Cancer Therapy-Hepatobiliary Questionnaire scores. RESULTS:Results indicated that 64% of patients exhibited anxiety and 65% showed depression symptoms. Key influencing factors included Barcelona Clinic Liver Cancer C stage, multiple tumors, social support, prior treatments (such as liver resection and transcatheter arterial chemoembolization/hepatic artery infusion chemotherapy), as well as HAMA and HAMD scores. Anxiety and depression correlated negatively with quality of life, with coefficients of -0.671 and -0.575 for HAMA and HAMD, respectively. CONCLUSION:Anxiety and depression are prevalent among patients with middle and advanced HCC, impacting quality of life. This underscores the need for psychological health considerations in liver cancer treatment and establishing psychological interventions is essential.

Introduction:Several clinical studies have demonstrated the benefits of surgery for patients with hepatocellular carcinoma (HCC). The goal of our study was to identify prognostic factors associated with overall survival (OS) and recurrence-free survival (RFS) in patients with HCC and develop nomograms to predict these factors. Material and methods:We retrospectively conducted follow-up evaluations of 176 patients with HCC up to 10 years after their tumors were removed. All of these patients were from a single hospital, and all of the enrolled patients were divided into two groups: those who survived less than 3 years and those who survived more than 3 years. Independent prognostic factors associated with OS and RFS were determined via univariate and multivariate Cox regression model analyses. Two prognostic nomogram models were built on the basis of the data and evaluated via the concordance index (C-index). The calibration curves indicated that the two nomograms performed well over a 5-year period. Additionally, the area under the receiver operating characteristic (ROC) curve and the time-dependent area under the ROC curve (AUC) were determined, and decision curve analyses (DCAs) were conducted. Results:The nomograms successfully discriminated patients with HCC. Prognostic factors for OS and RFS were identified, and nomograms were successfully built. The calibration discrimination was good for both the OS and RFS nomogram prediction models (C-indexes: 0.815 and 0.80, respectively). Our nomograms and calibration curves demonstrated favorable results with strong predictive accuracy and ROC curves, and according to the DCA, our nomogram results showed a greater net clinical benefit. The Kaplan-Meier plots for OS and RFS were generated via the log-rank test, the p-value of which was < 0.001. Ultimately, the nomograms successfully discriminated patients with HCC. Conclusions:We established nomogram survival prediction models to predict the prognosis of HCC after invasive treatment and achieved an acceptable level of accuracy in both OS and RFS analyses. These models may be valuable for guiding the selection of clinical treatment strategies and may also facilitate clinical decision making.

Background and Goals: There are currently no standard treatments for chronic atrophic gastritis and traditional Chinese medicine may be effective. This study aims to investigate the efficacy and safety of Weierkang pills in treating chronic atrophic gastritis. Materials and Methods: There were 108 patients in our study. They were randomly assigned to 2 groups. In group A, patients received Weierkang pills and patients in group B received folic acid combined with teprenone. Symptoms, endoscopic scores, and biopsy specimens were compared at baseline and 3 months after treatment. Meanwhile, the expressions of vascular endothelial growth factor and trefoil factor 3 (TFF3) in biopsy specimens were also compared. Results: Our study showed that the total effective rates of atrophy/intestinal metaplasia in group A reached the same level as group B (51.7% vs. 40.0%, P=0.419). Weierkang significantly improved the total effective rate of atrophy/intestinal metaplasia in gastric angle compared with group B (64.7% vs. 33.3%, P=0.024). Weierkang can significantly lower the total Kyoto risk score (2.6±1.1 vs. 3.3±1.0, P=0.002) and atrophy score (1.4±0.6 vs. 1.8±0.5, P=0.001) after treatment. In addition, Weierkang improves symptoms (1.3±1.3 vs. 2.3±1.8, P=0.003) and epigastric pain (0.2±0.4 vs. 0.5±0.6, P=0.041). The expression of TFF3 in gastric mucosa decreased significantly after treatment with Weierkang (P=0.002). Conclusions: Weierkang can improve the endoscopic appearance and pathologic changes of chronic atrophic gastritis patients. Symptoms also improved. TFF3 may be involved the pathophysiology mechanism.

Inflammatory bowel disease (IBD) is defined as an immune dysregulation disease with poor prognosis. Various therapies based on gut microbe modulation have been proposed. In this study, we aim to explore the therapeutic effect of B. adolescentis on IBD, as well as the immune and microecology mechanism of B. adolescentis in IBD. The fecal level of B. adolescentis was decreased in the IBD patients compared with the normal people in our cohort and the GMrepo database. To further clarify the role of B. adolescentis in IBD, we induced chronic colitis with three cycles of dextran sulfate sodium (DSS). We found B. adolescentis gavage exhibited protective effects as evidenced by the significantly decreased diarrhea score, spleen weight, and increased colon length. Accordingly, the cumulative histological grading was decreased in the B. adolescentis administration group. In addition, tight junction protein and mucin family were enhanced after B. adolescentis treatment. Furthermore, distinct effects were found with decreased pro-inflammatory cytokines such as TNF-α, IL-6, IL-1β, IL-18, IL-22, IL-9 and increased anti-inflammatory cytokines IL-10, IL-4, IL-5. Importantly, the colon lamina propria in the B. adolescentis group consisted of more Treg and Th2 cells, which inhibited extreme gut inflammation. Additionally, 16srRNA sequencing showed an evident increase in the B:F ratio in the B. adolescentis group. In particular, B. adolescentis application inhibited the excessive growth of Akkermansia and Escherichia-Shigella in genus level. In conclusion, B. adolescentis refined the DSS-induced chronic colitis by stimulating protective Treg/Th2 response and gut microbiota remodeling. B. adolescentis regularly treatment might improve the therapeutic effects for inflammatory bowel disease.

BACKGROUND:Accurate delineation of tumor margin is essential for complete resection of early gastric cancer (EGC). The objective of this study is to assess the performance of magnifying endoscopy with narrow-band imaging (ME-NBI) for the accurate demarcation of EGC margins.METHODS:We searched PubMed, EMBASE, Web of Science, and Cochrane Library databases up to March 2020 to identify eligible studies. The diagnostic accuracy of ME-NBI for EGC margins was calculated, and subgroup analyses were performed based on tumor size, depth of tumor invasion, tumor-occupied site, macroscopic type, histological type, Helicobacter pylori (H. pylori), and endoscopists' experience. Besides, we also evaluated the negative and positive resection rates of the horizontal margin (HM) of EGC after endoscopic submucosal dissection (ESD) and surgery.RESULTS:Ten studies comprising 1018 lesions were eligible in the databases. The diagnostic accuracy of ME-NBI for the demarcation of EGC margins was 92.4% (95% confidence interval (CI): 86.7%-96.8%). According to ME-NBI subgroup analyses, the rate of accurate evaluation of EGC margins was not associated with H. pylori infection status, tumor size, depth of tumor invasion, tumor-occupied site, macroscopic type, histological type, and endoscopists' experience, and no statistical differences were found in subgroup analyses. Moreover, the negative and positive resection rates of HM after ESD and surgery were 97.4% (95% CI: 92.1%-100%) and 2.6% (95% CI: 0.02%-7.9%), respectively.CONCLUSIONS:ME-NBI enables a reliable delineation of the extent of EGC.

Background: Hepatic arterial infusion chemotherapy (HAIC) is one option for treating massive tumors and unresectable hepatocellular carcinoma (HCC). However, there is a lack of remedial treatment after these treatments are ineffective or failed. Summary: Some studies have discovered that HAIC has greater survival in patients with advanced HCC. A previous study has shown that HAIC is effective in the treatment of advanced HCC, and the data on randomized clinical trials are limited and unclear. Key Message: More clinical trials and research are needed in order to make HAIC a standard and recommended therapy for advanced HCC. Our review focuses on the clinical applications of hepatic artery infusion treatment.

Hepatocellular carcinoma (HCC) is a deadly tumor with high heterogeneity. Aerobic glycolysis is a common indicator of tumor growth and plays a key role in tumorigenesis. Heterogeneity in distinct metabolic pathways can be used to stratify HCC into clinically relevant subgroups, but these have not yet been well-established. In this study, we constructed a model called aerobic glycolysis index (AGI) as a marker of aerobic glycolysis using genomic data of hepatocellular carcinoma from The Cancer Genome Atlas (TCGA) project. Our results showed that this parameter inferred enhanced aerobic glycolysis activity in tumor tissues. Furthermore, high AGI is associated with poor tumor differentiation and advanced stages and could predict poor prognosis including reduced overall survival and disease-free survival. More importantly, the AGI could accurately predict tumor sensitivity to Sorafenib therapy. Therefore, the AGI may be a promising biomarker that can accurately stratify patients and improve their treatment efficacy.

Background: Hepatocellular Carcinoma (HCC) is the second primary causes of cancer death globally, And the sixth mostly common malignant liver tumor with poor clinical results. The long term survival of HCC patients was effected and influenced by the low rate of early diagnosis and high risk of recurrence and metastasis in post operative .Although the survival of HCC patients had improved due to improved diagnosis, In Addition Increasing amount of long non-coding RNAs (lncRNAs) have been revealed to be implicated in the carcinogenesis and progression of HCC. The potential role of Loxl1-As1 in the progression and metastasis of HCC is still not clear and needs exploring and more researching. Methods: By using a lncRNA microarray, we identified a novelty of lncRNA Loxl1-As1 .The expression of lncRNA high downregulated in metastatic HCC (Loxl1-As1) in cell lines and tissues was detected by quantitative real-time PCR (qRT-PCR) and in situ hybridization (ISH).and CCK-8, colony formation and flow cytometry were performed to investigate the role of Loxl1-As1 in HCC cell proliferation, cell cycle and apoptosis in vitro and migration were investigated in HCC cell lines bot in vitro, Western blot was used to detect the downstream of Loxl1-As1. Results: Clinically investigation,Loxl1-As1 correlated with good and favorable prognosis of HCC patients. and Loxl1-As1 was down-regulated in HCC tissues and cell lines. The ISH assay revealed that Loxl1-As1 expression was significantly decreased in 177 paraffin-embedded samples from patients with HCC compared with Non-tumor tissues (adjacent tissues )and Loxl1-as1 expression directly correlated with patient prognosis. In vitro studies indicated that Loxl1-as1 promoted HCC cells’ proliferation and clonogenicity, the expression of Loxl1-as1 suppressed the growth, migration, and metastasis of HCC cells in vitro . Conclusions: Collectively, Our findings reveal a novelty Loxl1-As1for HCC progression and these study demonstrated that Loxl1-As1, overexpressed in HCC and associated with good prognosis , and it’s an important role in the progression and metastasis of HCC. Finally we suggest that lncRNA Loxl1-As1 might be a potential biomarker and therapeutic target for HCC,

BACKGROUND:Laparoscopic hepatectomy (LH) was first introduced in the 1990s and has now become widely accepted for the treatment of hepatocellular carcinoma (HCC). Laparoscopic liver resection (LLR) is considered a safe and effective approach for liver disease. However, the role of laparoscopic hepatectomy in HCC with cirrhosis remains controversial and needs to be further assessed, and the present literature review aimed to review the surgical and oncological outcomes of Laparoscopic hepatectomy (LH). According to Hong and colleagues laparoscopic resection for liver cirrhosis is a very safe and feasible procedure for both ideal cases and select patients with high risk factors [29]. The presence of only 1 of these factors does not represent an absolute contraindication for LH.METHODS AND RESULTS:We selected 23 studies involving about 1363 HCC patients treated with LH. 364 (27%) patients experienced major resections. The mean operative time was 244.9 minutes, the mean blood loss was 308.1 mL and blood transfusions were required in only 4.9% of patients. There were only 2 (0.21%) postoperative deaths and overall morbidity was 9.9%. Tumor recurrence ranged from 6 to 25 months. The 1-year, 3-year, and 5-year disease free Survival (DFS) rates ranged from 71.9% to 99%, 50.3% to 91.2%, and 19% to 82% respectively. Overall survival rates ranged from 88% to 100%, 73.4% to 94.5%, and 52.6% to 94.5% respectively.CONCLUSIONS:In our summery LH is lower risk and safer than conventional open liver surgery and is just as efficacious. Also, the LH approach decreased blood-loss, operation time, postoperative morbidity and had a lower conversion rate compared to other procedures whether open or robotic. Finally, LH may serve as a promising alternative to open procedures.

Laparoscopic gastrectomy (LG) using intracorporeal anastomosis has recently become more prevalent due to the advancements of laparoscopic surgical instruments. However, intracorporeally hand-sewn anastomosis (IHSA) is still uncommon because of technical difficulties. In this study, we evaluated various types of IHSA following LG with respect to the technical aspects and postoperative outcomes.Seventy-six patients who underwent LG using IHSA for treatment of gastric cancer between September 2014 and June 2018 were enrolled in this study. We described the details of IHSA in step-by-step manner, evaluated the clinicopathological data and surgical outcomes, and summarized the clinical experiences.Four types of IHSA have been described: one for total gastrectomy (Roux-en-Y) and 3 for distal gastrectomy (Roux-en-Y, Billroth I, and Billroth II). The mean operation time and anastomotic time was 288.7 minutes and 54.3 minutes, respectively. Postoperative complications were observed in 13 patients. All of the patients recovered well with conservative surgical management. There was no case of conversion to open surgery, anastomotic leakage, or mortality.LG using IHSA was safe and feasible and had several advantages compared to mechanical anastomosis. The technique lengthened operating time, but this could be mitigated by increased surgical training and experience.

Background: Repeat laparoscopic hepatectomy (LRH) offers an option for recurrent tumors in liver remnants following an initial liver resection of recurrent hepatocellular carcinoma (HCC), colorectal liver metastasis (CRLM) and cholangiocellular carcinoma (CCC), showing advantages in some outcomes. The objective of the study was to evaluate the feasibility, safety, and potential benefits of LRH in comparison with repeat open hepatectomy (ORH) for recurrent liver cancer. Methods: A systematic review was performed in compliance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) and AMSTAR (Assessing the methodological quality of systematic reviews) guidelines. We performed a systematic search of PubMed, Embase, Cochrane Library, and Web of Science to identify studies that compared LRH with ORH from inception to September 30, 2019. Outcomes of interest included operation time, intraoperative estimated blood loss, length of hospital stay, complication rate, transfusion and RO resection rate. The protocol was registered with the PROSPERO register of systematic reviews. Results: 10 retrospective observational studies were suitable for this analysis, involving 767 patients with 334 undergoing LRH (43.5%) and 433 undergoing ORH (56.5%). Compared with ORH, LRH had less intraoperative blood loss (SMD = -1.03; 95% CI: 1.48 similar to-0.59, P < 0.001), less overall postoperative complications (OR = 0.40; 95% CI: 0.16-0.99, P = 0.048), less major complications (OR = 0.31, 95% CI: 0.15-0.62, P = 0.001), shorter hospital stay (SMD = - 0.98; 95% CI: 1.41 similar to-0.54, P < 0.001) and higher RO resection rate (OR = 2.30, 95% CI: 1.39-3.81, P = 0.001). It was comparable in operation time (WMD = -7.66; 95% CI: 52.50-37.19, P = 0.738), transfusion rate (OR = 0.33; 95% CI:0.11-1.05, P = 0.060), and mortality (OR = 0.76; 95% CI: 0.27-2.18, P = 0.615) between LRH and ORH. Conclusion: Our results indicate that LRH is a safe and effective technique. Benefits, especially less intra-operative blood loss, less complications rate, shorter hospital stay and higher RO resection, might be offered in the laparoscopic approach.

Background: Management of malignant diseases in elderly patients has become a global clinical issue because of increased life expectancy worldwide. Advancements in surgical techniques and perioperative management have reduced age-related contraindications for LPD. Past articles have reported that elderly patients undergoing laproscopic pancreatoduodenectomy (LPD) are at an increased risk compared to younger patients. The aim of this article is to compare a multicenter center risk of LPD in elderly and nonelderly patients. Methods: Retrospective review (n = 237) of perisurgical outcomes in patients undergoing LPD during the months of September 2012 to December 2017. Outcomes in elderly patients (aged >= 75 years) were compared with those in nonelderly patients. Results: Transfer to ICU was more frequent in elderly patients (odds ratio [OR] 6.49,P = .001) and the mean hospital stay was longer (21.4 days compared with 16.6 days), (P = .0033) than for nonelderly patients. There was no statistically significant difference in operation time (P = .494), estimated blood loss (P = .0519), blood transfusion (P = .863), decreased gastric emptying (P = .397), abdominal pain (P = .454), food intake (P = .241), time to self-ambulation (P = 1), reoperation (P = .543), postoperative pancreatic fistula (POPF) grade A (P = .454), POPF grade B (P = .736), POPF grade C (P = .164), hemorrhage (P = .319), bile leakage (P = .428), infection (P = .259), GI bleeding (P = .286), morbidity (P = .272) or mortality (P = .449) between the 2 groups. Conclusions: Elderly patients who underwent LPD in this study had good overall outcomes after LPD that were similar to young patients. The perioperative and long-term outcomes of LPD are not worse. Rates of ICU admission and hospital stays increased in elderly patients undergoing LPD when compared with nonelderly ones. LPD can be performed on elderly patients with similar outcomes as younger patients; therefore, age itself should not be a contraindication for LPD for pancreatic cancer, but it suggests that elderly patients with comorbidities should be more stringently selected for surgery.

Idebenone (IDBN) is an antioxidant compound, structurally related to coenzyme Q10. It’s therapeutic potential is growing in different areas. Over the two decades ago, for potential treatments of mitochondrial diseases have been suggested, relatively few have undergone controlled clinical trials. This review focuses on the recent history of manuscripts of idebenone, coenzyme Q10 and exercise in both primary disorders and secondary disorders. Despite prior clinical impressions that IDBN had a positive effect and significant benefit on Mitochondrial disorders.