Unlike earlier innovations that focused on manipulation and task precision,the latest surgical advancements emphasize data visualization and the acceleration of surgeons’decision-making.Before entering the operating ...Unlike earlier innovations that focused on manipulation and task precision,the latest surgical advancements emphasize data visualization and the acceleration of surgeons’decision-making.Before entering the operating room,digital tools help surgeons develop patient-specific approaches,outline procedural steps,and prepare strategies for managing potential crises.During the operation,relevant data appear at the right moment to assist decision-making and guide performance in formats tailored to the surgeon’s physical and cognitive state,all without causing distractions.In the future operating room,performance data from surgeons will be gathered,integrated,and analyzed to interpret surgeons’behavior and confidence.Advanced techniques,including artificial intelligence,can be employed to automatically detect moments of performance difficulty or cognitive overload.As a result,digital surgery provides timely,context-specific assistance to surgeons in high-stakes situations.Key components of digital surgery are highlighted in this narrative review.展开更多
AIM To establish a rat model for evaluating the maturity of liver regeneration derived from associating liver partition and portal vein ligation for staged hepatectomy(ALPPS).METHODS In the present study, ALPPS, parti...AIM To establish a rat model for evaluating the maturity of liver regeneration derived from associating liver partition and portal vein ligation for staged hepatectomy(ALPPS).METHODS In the present study, ALPPS, partial hepatecotmy(PHx), and sham rat models were established initially, which were validated by significant increase of proliferative markers including Ki-67, proliferating cell nuclear antigen, and cyclin D1. In the setting of accelerated proliferation in volume at the second and fifth day after ALPPS, the characteristics of newborn hepatocytes, as well as specific markers of progenitor hepatic cell, were identified. Afterwards, the detection of liver function followed by cluster analysis of functional gene expression were performed to evaluate the maturity.RESULTS Compared with PHx and sham groups, the proliferation of f LR was significantly higher in ALPPS group(P = 0.023 and 0.001 at second day, P = 0.034 and P < 0.001 at fifth day after stage I). Meanwhile, the increased expression of proliferative markers including Ki-67, proliferating cell nuclear antigen, and cyclin D1 verified the accelerated liver regeneration derived from ALPPS procedure. However, ALPPS-induced Sox9 positive hepatocytes significantly increased beyond the portal triad, which indicated the progenitor hepatic cell was potentially involved. And the characteristics of ALPPSinduced hepatocytes indicated the lower expression of hepatocyte nuclear factor 4 and anti-tryptase in early proliferative stage. Both suggested the immaturity of ALPPS-derived liver regeneration. Additionally, the detection of liver function and functional genes expression confirmed the immaturity of renascent hepatocytes derived in early stage of ALPPS-derived liver regeneration.CONCLUSION Our study revealed the immaturity of ALPPS-derived proliferation in early regenerative response, which indicated that the volumetric assessment overestimated the functional proliferation. This could be convincing evidence that the stage Ⅱ of ALPPS should be performed prudently in patients with marginally adequate f LR, as the ALPPS-derived proliferation in volume lags behind the functional regeneration.展开更多
Minimally invasive surgery is a trend in hepatobiliary surgery.A 56-year-old female patient was admitted to our institution for intrahepatic lithiasis.The CT scan showed multiple calculi in the left liver,dilation of ...Minimally invasive surgery is a trend in hepatobiliary surgery.A 56-year-old female patient was admitted to our institution for intrahepatic lithiasis.The CT scan showed multiple calculi in the left liver,dilation of the left intrahepatic bile duct and liver atrophy of the left lobe.Robotic single-incision left hemihepatectomy by the single-site systemwas successfully applied.With the idea of enhanced recovery after surgery,the patient was discharged on the third day after the operation without any morbidity.Robotic single-incision surgery is more frequent in gynecologic and urological surgery.As far as we know,this is the first robotic single-incision left hemihepatectomy report in the world.展开更多
Enhanced recovery after surgery(ERAS)applies to a series of perioperative optimal measures developed from evidence-based medicine which aims to reduce traumatic stress responses,complications,and accelerating rehabili...Enhanced recovery after surgery(ERAS)applies to a series of perioperative optimal measures developed from evidence-based medicine which aims to reduce traumatic stress responses,complications,and accelerating rehabilitation for patients while undergoing treatment.1 Since 1997,when Dutch surgeon Kehlet conceived the idea of ERAS,it has been applied in many fields of surgery including gastrointestinal surgery,obstetrics-gynecology,urology,orthopedics and cardiothoracic surgery.2e5 However,the concept of applying ERAS in liver surgery is a relatively new idea.In recent years.展开更多
Traumatic acute subdural hematoma is one of the most lethal causes of head injuries,which leads to high mortality.While combined diseases always make it more intractable for the treatment.We present a case of a 68-yea...Traumatic acute subdural hematoma is one of the most lethal causes of head injuries,which leads to high mortality.While combined diseases always make it more intractable for the treatment.We present a case of a 68-year-old female patient with traumatic acute subdural hematoma combined with hydrocephalus after ventriculoperitoneal shunt assisted by the neuronavigation system in January 12,2017.She was undergone ventriculoperitoneal shunt 6 years and 5 months ago on two sides respectively because of hydrocephalus,with the ventriculoperitoneal shunt device on the right side out of work.The initial neurological examination showed a Glasgow Coma Scale of E2V1M5 with no papillary defect.A CT scan of the head revealed a left homogeneously hyperdense and subdural hematoma,with compression of the lateral ventricle(2.6 cm thick)and a 0.5 cm midline shift.To protect the ventriculoperitoneal shunt device,we used neuronavigation system to precisely mark the relative location of the device and“invisible”subdural hematoma,thus to design a perfect incision preoperatively.Subsequently,evacuation of the subdural hematoma was performed via craniotomy without damaging the ventriculoperitoneal shunt device.Postoperative CT of the head showed totally removing of the subdural hematoma.The patient recovered three months later.With the assistant of neuronavigation system,it is much easier for the preoperative planning and to reduce the surgical risk.Our case gives a clue that more approaches can be considered when encountering acute head trauma with the complicated combined diseases.展开更多
In 1991,laparoscopic liver resection(LLR)was firstly reported by Reich and was subsequently firstly reported in China in 1994 by Zhou.1,2 Dramatic improvements had been made in this procedure in the ensuing 26 years.T...In 1991,laparoscopic liver resection(LLR)was firstly reported by Reich and was subsequently firstly reported in China in 1994 by Zhou.1,2 Dramatic improvements had been made in this procedure in the ensuing 26 years.The first and second international consensus conferences on laparoscopic liver resection were held in 2008 and 2014 and will continue to be held every 6 years.The international laparoscopic liver society formed in 2016 and its first international congress will be held in Paris in July 2017.The advantage of LLR had been recognized by patients and surgeons and is gradually replacing conventional open liver resection in some regions of the world.展开更多
The purpose of this paper is to discuss the development of medical informatization in the era of big data.Through literature review and theoretical analysis,the development of medical informatization in the era of big...The purpose of this paper is to discuss the development of medical informatization in the era of big data.Through literature review and theoretical analysis,the development of medical informatization in the era of big data is deeply discussed.The results show that medical informatization has developed rapidly in the era of big data,and its role in clinical decision-making,scientific research,teaching,and management has become increasingly prominent.The development of medical informatization in the era of big data has important purposes and methods,which can produce important results and conclusions and provide strong support for the development of the medical field.展开更多
In the last two decades,laparoscopic,endoscopic and robotic surgery emerged and greatly developed that is changing the history of surgery.The minimally invasive surgery provides an alternative with less invasion for p...In the last two decades,laparoscopic,endoscopic and robotic surgery emerged and greatly developed that is changing the history of surgery.The minimally invasive surgery provides an alternative with less invasion for patients and brings them with fast postoperative recovery and short hospital stay.The rapid pace of growth in the minimally invasive surgery was spurred and maintained by an increasing number of high quality scientific communications.Many surgeons are continuing to determine and redefine how much could be accomplished through small incisions;more and more clinicians want to keep up to date and search for advances in this subject.To facilitate this task,Laparoscopic,Endoscopic and Robotic Surgery,a new open access journal,is coming to the stage.Not only will it serve as a worldwide platform for surgeons to present their experience and achievements,but it will also share their dynamic developments and innovations in this discipline which will ultimately benefit the patients.展开更多
The separation of electron-hole pairs while inhibiting their recombination under ultrasound irradiation is vital phenomena to the generation of reactive oxygen species(ROS)in sonodynamic therapy(SDT).With this bearing...The separation of electron-hole pairs while inhibiting their recombination under ultrasound irradiation is vital phenomena to the generation of reactive oxygen species(ROS)in sonodynamic therapy(SDT).With this bearing in mind,we have designed and synthesized nano heterostructure of FeMoO_(y)and MoS_(x)(FeMoO_(y)@MoS_(x),FMOS),featuring a MoS_(x)nanoflower core,via a two-step hydrothermal process.This structure is subsequently enveloped with cell membrane to form FMOS@cell membrane(FMOS@CM)nano-sonosensitizer.The growth of FeMoO_(y)on MoS_(x)effectively narrows the bandgap of MoS_(x)and facilitates the separation of ultrasound-activated electrons and holes,which significantly enhances SDT performance under ultrasonic irradiation.Additionally,the material harnesses ultrasonic energy to activate surface electrons,converting Fe^(3+)to Fe^(2+).This conversion increases charge utilization efficiency,promotes the activity of Fenton reaction,and optimizes the chemodynamic therapy(CDT)performance of the material.Moreover,the encapsulation within the cell membrane guarantees the tumor-targeting capability and biocompatibility of FMOS@CM,thereby facilitating a more effective and safer tumor treatment strategy.In conclusion,this study presents a novel methodology for synthesizing sonosensitizers by in situ growth-induced assembly of metal ions.This approach provides innovative insights for the development of a new,precise,high-efficiency,multimodal synergistic treatment platform mediated by ultrasound.展开更多
Adavosertib(ADA)is a WEE1 inhibitor that exhibits a synthetic lethal effect on p53-mutated gallbladder cancer(GBC).However,drug resistance due to DNA damage response compensation pathways and high toxicity limits furt...Adavosertib(ADA)is a WEE1 inhibitor that exhibits a synthetic lethal effect on p53-mutated gallbladder cancer(GBC).However,drug resistance due to DNA damage response compensation pathways and high toxicity limits further applications.Herein,estrone-targeted ADA-encapsulated metal–organic frameworks(ADA@MOF-EPL)for GBC synthetic lethal treatment by inducing conditional factors are developed.The high expression of estrogen receptors in GBC enables ADA@MOF-EPL to quickly enter and accumulate near the cell nucleus through estrone-mediated endocytosis and release ADA to inhibit WEE1 upon entering the acidic tumor microenvironment.Ultrasound irradiation induces ADA@MOF-EPL to generate reactive oxygen species(ROS),which leads to a further increase in DNA damage,resulting in a higher sensitivity of p53-mutated cancer cells to WEE1 inhibitor and promoting cell death via conditional synthetic lethality.The conditional factor induced by ADA@MOF-EPL further enhances the antitumor efficacy while significantly reducing systemic toxicity.Moreover,ADA@MOF-EPL demonstrates similar antitumor abilities in other p53-mutated solid tumors,revealing its potential as a broad-spectrum antitumor drug.展开更多
Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma(HCC)have resulted in improved response rates.This has provided an opportunity for selected pa...Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma(HCC)have resulted in improved response rates.This has provided an opportunity for selected patients with initially unresectable HCC to achieve adequate tumor downstaging to undergo surgical resection,a‘conversion therapy’strategy.However,conversion therapy is a new approach to the treatment of HCC and its practice and treatment protocols are still being developed.Review the evidence for conversion therapy in HCC and develop consensus statements to guide clinical practice.Evidence review:Many research centers in China have accumulated significant experience implementing HCC conversion therapy.Preliminary findings and data have shown that conversion therapy represents an important strategy to maximize the survival of selected patients with intermediate stage to advanced HCC;however,there are still many urgent clinical and scientific challenges for this therapeutic strategy and its related fields.In order to summarize and learn from past experience and review current challenges,the Chinese Expert Consensus on Conversion Therapy for Hepatocellular Carcinoma(2021 Edition)was developed based on a review of preliminary experience and clinical data from Chinese and non-Chinese studies in this field and combined with recommendations for clinical practice.Sixteen consensus statements on the implementation of conversion therapy for HCC were developed.The statements generated in this review are based on a review of clinical evidence and real clinical experience and will help guide future progress in conversion therapy for patients with HCC.展开更多
Sorafenib is the first-line chemotherapeutic therapy for advanced hepatocellular carcinoma(HCC).However,sorafenib resistance significantly limits its therapeutic efficacy,and the mechanisms underlying resistance have ...Sorafenib is the first-line chemotherapeutic therapy for advanced hepatocellular carcinoma(HCC).However,sorafenib resistance significantly limits its therapeutic efficacy,and the mechanisms underlying resistance have not been fully clarified.Here we report that a circular RNA,circRNA-SORE(a circular RNA upregulated in sorafenib-resistant HCC cells),plays a significant role in sorafenib resistance in HCC.We found that circRNA-SORE is upregulated in sorafenib-resistant HCC cells and depletion of circRNA-SORE substantially increases the cell-killing ability of sorafenib.Further studies revealed that circRNA-SORE binds the master oncogenic protein YBX1 in the cytoplasm,which prevents YBX1 nuclear interaction with the E3 ubiquitin ligase PRP19 and thus blocks PRP19-mediated YBX1 degradation.Moreover,our in vitro and in vivo results suggest that circRNA-SORE is transported by exosomes to spread sorafenib resistance among HCC cells.Using different HCC mouse models,we demonstrated that silencing circRNA-SORE by injection of siRNA could substantially overcome sorafenib resistance.Our study provides a proof-of-concept demonstration for a potential strategy to overcome sorafenib resistance in HCC patients by targeting circRNA-SORE or YBX1.展开更多
Importance:While laparoscopic pancreaticoduodenectomy(LPD)is being adopted with increasing enthusiasm worldwide,it is still challenging for both technical and anatomical reasons.Currently,there is no consensus on the ...Importance:While laparoscopic pancreaticoduodenectomy(LPD)is being adopted with increasing enthusiasm worldwide,it is still challenging for both technical and anatomical reasons.Currently,there is no consensus on the technical standards for LPD.Objective:The aim of this consensus statement is to guide the continued safe progression and adoption of LPD.Evidence Review:An international panel of experts was selected based on their clinical and scientific expertise in laparoscopic and open pancreaticoduodenectomy.Statements were produced upon reviewing the literature and assessed by the members of the expert panel.The literature search and its critical appraisal were limited to articles published in English during the period from 1994 to 2019.The Web of Science,Medline,and Cochrane Library and Clinical Trials databases were searched,The search strategy included,but was not limited to,the terms'laparoscopic','pancreaticoduodenectomy,'pancreatoduodenectomy','Whipple's operation',and'minimally invasive surgery'.Reference lists from the included articles were manually checked for any additional studies,which were included when appropriate.Delphi method was used to establish expert consensus and the AGREE II-GRS Instrument was applied to assess the methodological quality and externally validate the final statements.The statements were further discussed during a one-day face-to-face meeting at the 1st Summit on Minimally Invasive Pancreatico-Biliary Surgery in Wuhan,China.Findings:Twenty-eight international experts from 8 countries constructed the expert panel.Sixteen statements were produced by the members of the expert panel.At least 80%of responders agreed with the majority(80%)of statements.Other than three randomized controlled trials published to date,most evidences were based on level 3 or 4 studies according to the AGREE II-GRS Instrument.Conclusions and Relevance:The Wuhan international expert consensus meeting on LPD has produced a set of clinical practice statements for the safe development and progression of LPD.LPD is currently in its development and exploration stages,as defined by the international IDEAL framework for surgical innovation.More robust randomized controlled trial and registry study are essential to proceed with the assessment of LPD.展开更多
The treatment of hepatocellular carcinoma(HCC)has been dominated by multikinase inhibitors for more than a decade.However,drug resistance can severely restrict the efficacy of these drugs.Using CRISPR/CAS9 genome libr...The treatment of hepatocellular carcinoma(HCC)has been dominated by multikinase inhibitors for more than a decade.However,drug resistance can severely restrict the efficacy of these drugs.Using CRISPR/CAS9 genome library screening,we evaluated Kelch-like ECH-associated protein 1(KEAP1)as a key regulator of sorafenib’s susceptibility in HCC.We also investigated whether KEAP1’s knockdown can stabilize nuclear factor(erythroid-derived 2)-like 2(NRF2)protein levels that led to sorafenib’s resistance,including an NRF2 inhibitor that can synergize with sorafenib to abolish HCC’s growth in vitro and in vivo.Furthermore,we clarified that fibroblast growth factor 21(FGF21)is an important downstream regulator of NRF2 in HCC.Intriguingly,we observed that FGF21 bound to NRF2 through the C-terminus of FGF21,thereby stabilizing NRF2 by reducing its ubiquitination and generating a positive feedback loop in sorafenib-resistant HCC.These findings,therefore,propose that targeting FGF21 is a promising strategy to combat HCC sorafenib’s resistance.展开更多
The treatment for hepatocellular carcinoma(HCC)is promising in recent years,but still facing critical challenges.The first targeted therapy,sorafenib,prolonged the overall survival by months.However,resistance often o...The treatment for hepatocellular carcinoma(HCC)is promising in recent years,but still facing critical challenges.The first targeted therapy,sorafenib,prolonged the overall survival by months.However,resistance often occurs,largely limits its efficacy.Sorafenib was found to target the electron transport chain complexes,which results in the generation of reactive oxygen species(ROS).To maintain sorafenib resistance and further facilitate tumor progression,cancer cells develop strategies to overcome excessive ROS production and obtain resistance to oxidative stress-induced cell death.In the present study,we investigated the roles of ROS in sorafenib resistance,and found suppressed ROS levels and reductive redox states in sorafenib-resistant HCC cells.Mitochondria in sorafenib-resistant cells maintained greater functional and morphological integrity under the treatment of sorafenib.However,cellular oxygen consumption rate and mitochondria DNA content analyses revealed fewer numbers of mitochondria in sorafenib-resistant cells.Further investigation attributed this finding to decreased mitochondrial biogenesis,likely caused by the accelerated degradation of peroxisome proliferator-activated receptor y coactivator ip(PGC1P).Mechanistic dissection showed that upregulated UBQLN1 induced PGCip degradation in a ubiquitination-independent manner to attenuate mitochondrial biogenesis and ROS production in sorafenib-resistant cells under sorafenib treatment.Furthermore,clinical investigations further indicated that the patients with higher UBQLN1 levels experienced worse recurrence-free survival.In conclusion,we propose a novel mechanism involving mitochondrial biogenesis and ROS homeostasis in sorafenib resistance,which may offer new therapeutic targets and strategies for HCC patients.展开更多
Since projection-based 3D bioprinting(PBP)could provide high resolution,it is well suited for printing delicate structures for tissue regeneration.However,the low crosslinking density and low photo-crosslinking rate o...Since projection-based 3D bioprinting(PBP)could provide high resolution,it is well suited for printing delicate structures for tissue regeneration.However,the low crosslinking density and low photo-crosslinking rate of photocurable bioink make it difficult to print fine structures.Currently,an in-depth understanding of the is lacking.Here,a research framework is established for the analysis of printability during PBP.The gelatin methacryloyl(GelMA)-based bioink is used as an example,and the printability is systematically investigated.We analyze the photo-crosslinking reactions during the PBP process and summarize the specific requirements of bioinks for PBP.Two standard quantized models are established to evaluate 2D and 3D printing errors.Finally,the better strategies for bioprinting five typical structures,including solid organs,vascular structures,nerve conduits,thin-wall scaffolds,and micro needles,are presented.展开更多
Recently,genetically targeted cancer therapies have been a topic of great interest.Synthetic lethality provides a new approach for the treatment of mutated genes that were previously considered unable to be targeted i...Recently,genetically targeted cancer therapies have been a topic of great interest.Synthetic lethality provides a new approach for the treatment of mutated genes that were previously considered unable to be targeted in traditional genotype-targeted treatments.The increasing researches and applications in the clinical setting made synthetic lethality a promising anticancer treatment option.However,the current understandings on different conditions of synthetic lethality have not been systematically assessed and the application of synthetic lethality in clinical practice still faces many challenges.Here,we propose a novel and systematic classification of synthetic lethality divided into gene level,pathway level,organelle level,and conditional synthetic lethality,according to the degree of specificity into its biological mechanism.Multiple preclinical findings of synthetic lethality in recent years will be reviewed and classified under these different categories.Moreover,synthetic lethality targeted drugs in clinical practice will be briefly discussed.Finally,we will explore the essential implications of this classification as well as its prospects in eliminating existing challenges and the future directions of synthetic lethality.展开更多
Dramatic progresses had been made in the operation in the past 26 years.Procedure was extended to major liver resection,isolated resection of caudate lobe,living donor liver resection and associating liver partition w...Dramatic progresses had been made in the operation in the past 26 years.Procedure was extended to major liver resection,isolated resection of caudate lobe,living donor liver resection and associating liver partition with portal vein ligation for staged hepatectomy(ALPPS).Laparoscopic liver resection became a new group of HPB surgery and the international laparoscopic liver society was established in Paris followed by the first international congress of the society held in Paris in July 2017.This biannual congress would be top convention for surgeons specialized in laparoscopic liver surgery.The advantage of laparoscopic liver resection had been recognized by patients and surgeons and is gradually replacing conventional open liver resection in some experienced institutes worldwide.Most procedures,such as laparoscopic local resection and left lateral segmentectomy,could be routinely performed,but some procedures including laparoscopic hemihepatectomy still need to be further evaluated.For now,the establishment of a training system for laparoscopic liver surgeons became the most important issue for the popularization of laparoscopic liver resection.展开更多
Background:Due to absence of large,prospective,randomized,clinical trial data,the potential survivalbenefit of lymphadenectomy with different number of regional lymph nodes(LNs)remains controversial.We aim to create a...Background:Due to absence of large,prospective,randomized,clinical trial data,the potential survivalbenefit of lymphadenectomy with different number of regional lymph nodes(LNs)remains controversial.We aim to create a predicting model to help estimate individualized potential survival benefit oflymphadenectomy with more regional LNs for patients with resected gallbladder cancer(GBC).Methods:Patients with resected GBC were selected from the Surveillance,Epidemiology,and End Resultsdatabase who were diagnosed between 2004 and 2014.Covariates included age,race,sex,grade,histologicalstage,tumor sizes and receipt of non-primary surgery.Two types of multivariate survival regression modelswere constructed and compared.The best model performance was tested by the external validation data fromour hospital.Results:A total of 1,669 patients met the inclusion criteria for this study.The lognormal survival modelshowed the best performance and was tested by the external validation data,including 193 patients withresected GBC from our hospital.Nomograms,which based on the accelerated failure time parametricsurvival model,were built to estimate individualized survival.C-index,was up to 0.754 and 0.710 in internalvalidation for more and less regional LNs removed,respectively.Both of internal and external calibrationcurves showed good agreement between predicted and observed outcomes in the 1-,3-,and 5-year overallsurvival(OS).Conclusions:A predicting model can be used as a decision model to predict which patients may obtainbenefit from lymphadenectomy with more regional LNs.展开更多
Background:Although laparoscopic liver resection(LLR)has been increasingly popular worldwide,there is lack of predictive model to evaluate the feasibility and safety of LLR.The aim of this study was to establish a sco...Background:Although laparoscopic liver resection(LLR)has been increasingly popular worldwide,there is lack of predictive model to evaluate the feasibility and safety of LLR.The aim of this study was to establish a scoring system for predicting the possibility of conversion and complication,which could facilitate the patient selection for clinicians and communication with patients and their relatives during the informed consent process.Methods:Consecutively 696 patients between August 1998 and December 2016 underwent LLR were recruited.The entire cohort was divided randomly into development and validation cohorts.The scoring system for conversion and complication were established according to risk factors identified from multiple logistic analysis.Subgroup analysis was performed to assess the clinical application.And the C-index and decision curve analysis(DCA)were conducted to evaluate the discrimination in comparison with other predictive models.Results:Six hundred and ninety-six patients were enrolled eventually.The rate of conversion in the development and validation cohorts was 8.3%and 10.3%,respectively.Compared with 12.6%complication rate in the development cohort,12.9%was concluded in the validation cohort.Upon on the identified risk factors,the risk stratification model was established and validated.Subsequent subgroup analysis indicated low risk patients presented superior surgical outcomes compared with high risk patients.Besides,the C-index and DCA implied our models had better capacities of predicting conversion and complication in comparison with previous scoring systems.Conclusions:This novel scoring system presents the remarkable capacities of predicting conversion,complication in LLR.And thereby,it could be a useful instrument to facilitate the patient selection for clinicians and communication with patients and their relatives during the informed consent process.展开更多
文摘Unlike earlier innovations that focused on manipulation and task precision,the latest surgical advancements emphasize data visualization and the acceleration of surgeons’decision-making.Before entering the operating room,digital tools help surgeons develop patient-specific approaches,outline procedural steps,and prepare strategies for managing potential crises.During the operation,relevant data appear at the right moment to assist decision-making and guide performance in formats tailored to the surgeon’s physical and cognitive state,all without causing distractions.In the future operating room,performance data from surgeons will be gathered,integrated,and analyzed to interpret surgeons’behavior and confidence.Advanced techniques,including artificial intelligence,can be employed to automatically detect moments of performance difficulty or cognitive overload.As a result,digital surgery provides timely,context-specific assistance to surgeons in high-stakes situations.Key components of digital surgery are highlighted in this narrative review.
基金Supported by the Major Scientific and Technological Project of Zhejiang Province,China,No.2015C03026
文摘AIM To establish a rat model for evaluating the maturity of liver regeneration derived from associating liver partition and portal vein ligation for staged hepatectomy(ALPPS).METHODS In the present study, ALPPS, partial hepatecotmy(PHx), and sham rat models were established initially, which were validated by significant increase of proliferative markers including Ki-67, proliferating cell nuclear antigen, and cyclin D1. In the setting of accelerated proliferation in volume at the second and fifth day after ALPPS, the characteristics of newborn hepatocytes, as well as specific markers of progenitor hepatic cell, were identified. Afterwards, the detection of liver function followed by cluster analysis of functional gene expression were performed to evaluate the maturity.RESULTS Compared with PHx and sham groups, the proliferation of f LR was significantly higher in ALPPS group(P = 0.023 and 0.001 at second day, P = 0.034 and P < 0.001 at fifth day after stage I). Meanwhile, the increased expression of proliferative markers including Ki-67, proliferating cell nuclear antigen, and cyclin D1 verified the accelerated liver regeneration derived from ALPPS procedure. However, ALPPS-induced Sox9 positive hepatocytes significantly increased beyond the portal triad, which indicated the progenitor hepatic cell was potentially involved. And the characteristics of ALPPSinduced hepatocytes indicated the lower expression of hepatocyte nuclear factor 4 and anti-tryptase in early proliferative stage. Both suggested the immaturity of ALPPS-derived liver regeneration. Additionally, the detection of liver function and functional genes expression confirmed the immaturity of renascent hepatocytes derived in early stage of ALPPS-derived liver regeneration.CONCLUSION Our study revealed the immaturity of ALPPS-derived proliferation in early regenerative response, which indicated that the volumetric assessment overestimated the functional proliferation. This could be convincing evidence that the stage Ⅱ of ALPPS should be performed prudently in patients with marginally adequate f LR, as the ALPPS-derived proliferation in volume lags behind the functional regeneration.
基金supported by grants from the National Natural Science Foundation of China(No.82072625)Key Research and Development Project of Zhejiang Province(No.2021C03127)+3 种基金National Natural Science Foundation of China(No.81827804)National Natural Science Foundation of China(No.81772546)Zhejiang Clinical Research Center of Minimally Invasive Diagnosis and Treatment of Abdominal Diseases(No.2018E50003)Key Research and Development Project of Zhejiang Province(No.2018C03083).
文摘Minimally invasive surgery is a trend in hepatobiliary surgery.A 56-year-old female patient was admitted to our institution for intrahepatic lithiasis.The CT scan showed multiple calculi in the left liver,dilation of the left intrahepatic bile duct and liver atrophy of the left lobe.Robotic single-incision left hemihepatectomy by the single-site systemwas successfully applied.With the idea of enhanced recovery after surgery,the patient was discharged on the third day after the operation without any morbidity.Robotic single-incision surgery is more frequent in gynecologic and urological surgery.As far as we know,this is the first robotic single-incision left hemihepatectomy report in the world.
文摘Enhanced recovery after surgery(ERAS)applies to a series of perioperative optimal measures developed from evidence-based medicine which aims to reduce traumatic stress responses,complications,and accelerating rehabilitation for patients while undergoing treatment.1 Since 1997,when Dutch surgeon Kehlet conceived the idea of ERAS,it has been applied in many fields of surgery including gastrointestinal surgery,obstetrics-gynecology,urology,orthopedics and cardiothoracic surgery.2e5 However,the concept of applying ERAS in liver surgery is a relatively new idea.In recent years.
基金This work was supported by the Program for Health and Family Planning Commission of Hangzhou Municipality,China(2017A73)Medicine and Health Science and Technology Projects of Zhejiang Province,China(2018270408)+1 种基金National Natural Science Foundation of China(81402044)Natural Science Foundation of Zhejiang Province of China(LY14H160017,LY14H160025).
文摘Traumatic acute subdural hematoma is one of the most lethal causes of head injuries,which leads to high mortality.While combined diseases always make it more intractable for the treatment.We present a case of a 68-year-old female patient with traumatic acute subdural hematoma combined with hydrocephalus after ventriculoperitoneal shunt assisted by the neuronavigation system in January 12,2017.She was undergone ventriculoperitoneal shunt 6 years and 5 months ago on two sides respectively because of hydrocephalus,with the ventriculoperitoneal shunt device on the right side out of work.The initial neurological examination showed a Glasgow Coma Scale of E2V1M5 with no papillary defect.A CT scan of the head revealed a left homogeneously hyperdense and subdural hematoma,with compression of the lateral ventricle(2.6 cm thick)and a 0.5 cm midline shift.To protect the ventriculoperitoneal shunt device,we used neuronavigation system to precisely mark the relative location of the device and“invisible”subdural hematoma,thus to design a perfect incision preoperatively.Subsequently,evacuation of the subdural hematoma was performed via craniotomy without damaging the ventriculoperitoneal shunt device.Postoperative CT of the head showed totally removing of the subdural hematoma.The patient recovered three months later.With the assistant of neuronavigation system,it is much easier for the preoperative planning and to reduce the surgical risk.Our case gives a clue that more approaches can be considered when encountering acute head trauma with the complicated combined diseases.
文摘In 1991,laparoscopic liver resection(LLR)was firstly reported by Reich and was subsequently firstly reported in China in 1994 by Zhou.1,2 Dramatic improvements had been made in this procedure in the ensuing 26 years.The first and second international consensus conferences on laparoscopic liver resection were held in 2008 and 2014 and will continue to be held every 6 years.The international laparoscopic liver society formed in 2016 and its first international congress will be held in Paris in July 2017.The advantage of LLR had been recognized by patients and surgeons and is gradually replacing conventional open liver resection in some regions of the world.
文摘The purpose of this paper is to discuss the development of medical informatization in the era of big data.Through literature review and theoretical analysis,the development of medical informatization in the era of big data is deeply discussed.The results show that medical informatization has developed rapidly in the era of big data,and its role in clinical decision-making,scientific research,teaching,and management has become increasingly prominent.The development of medical informatization in the era of big data has important purposes and methods,which can produce important results and conclusions and provide strong support for the development of the medical field.
文摘In the last two decades,laparoscopic,endoscopic and robotic surgery emerged and greatly developed that is changing the history of surgery.The minimally invasive surgery provides an alternative with less invasion for patients and brings them with fast postoperative recovery and short hospital stay.The rapid pace of growth in the minimally invasive surgery was spurred and maintained by an increasing number of high quality scientific communications.Many surgeons are continuing to determine and redefine how much could be accomplished through small incisions;more and more clinicians want to keep up to date and search for advances in this subject.To facilitate this task,Laparoscopic,Endoscopic and Robotic Surgery,a new open access journal,is coming to the stage.Not only will it serve as a worldwide platform for surgeons to present their experience and achievements,but it will also share their dynamic developments and innovations in this discipline which will ultimately benefit the patients.
基金supported by Beijing Life Science Academy(BLSA)(No.2023400CA0100)the National Natural Science Foundation of China(No.52172289)Fundamental Research Funds for the Central Universities and the Funds of the Natural Science Foundation of Hangzhou(No.2024SZRYBH180004).
文摘The separation of electron-hole pairs while inhibiting their recombination under ultrasound irradiation is vital phenomena to the generation of reactive oxygen species(ROS)in sonodynamic therapy(SDT).With this bearing in mind,we have designed and synthesized nano heterostructure of FeMoO_(y)and MoS_(x)(FeMoO_(y)@MoS_(x),FMOS),featuring a MoS_(x)nanoflower core,via a two-step hydrothermal process.This structure is subsequently enveloped with cell membrane to form FMOS@cell membrane(FMOS@CM)nano-sonosensitizer.The growth of FeMoO_(y)on MoS_(x)effectively narrows the bandgap of MoS_(x)and facilitates the separation of ultrasound-activated electrons and holes,which significantly enhances SDT performance under ultrasonic irradiation.Additionally,the material harnesses ultrasonic energy to activate surface electrons,converting Fe^(3+)to Fe^(2+).This conversion increases charge utilization efficiency,promotes the activity of Fenton reaction,and optimizes the chemodynamic therapy(CDT)performance of the material.Moreover,the encapsulation within the cell membrane guarantees the tumor-targeting capability and biocompatibility of FMOS@CM,thereby facilitating a more effective and safer tumor treatment strategy.In conclusion,this study presents a novel methodology for synthesizing sonosensitizers by in situ growth-induced assembly of metal ions.This approach provides innovative insights for the development of a new,precise,high-efficiency,multimodal synergistic treatment platform mediated by ultrasound.
基金supported by the National Natural Science Foundation of China(82202873,32200566)the Natural Science Foundation of Zhejiang Province(LQ22H160003)the Fundamental Research Funds for the Central Universities(2262022-00141)。
文摘Adavosertib(ADA)is a WEE1 inhibitor that exhibits a synthetic lethal effect on p53-mutated gallbladder cancer(GBC).However,drug resistance due to DNA damage response compensation pathways and high toxicity limits further applications.Herein,estrone-targeted ADA-encapsulated metal–organic frameworks(ADA@MOF-EPL)for GBC synthetic lethal treatment by inducing conditional factors are developed.The high expression of estrogen receptors in GBC enables ADA@MOF-EPL to quickly enter and accumulate near the cell nucleus through estrone-mediated endocytosis and release ADA to inhibit WEE1 upon entering the acidic tumor microenvironment.Ultrasound irradiation induces ADA@MOF-EPL to generate reactive oxygen species(ROS),which leads to a further increase in DNA damage,resulting in a higher sensitivity of p53-mutated cancer cells to WEE1 inhibitor and promoting cell death via conditional synthetic lethality.The conditional factor induced by ADA@MOF-EPL further enhances the antitumor efficacy while significantly reducing systemic toxicity.Moreover,ADA@MOF-EPL demonstrates similar antitumor abilities in other p53-mutated solid tumors,revealing its potential as a broad-spectrum antitumor drug.
文摘Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma(HCC)have resulted in improved response rates.This has provided an opportunity for selected patients with initially unresectable HCC to achieve adequate tumor downstaging to undergo surgical resection,a‘conversion therapy’strategy.However,conversion therapy is a new approach to the treatment of HCC and its practice and treatment protocols are still being developed.Review the evidence for conversion therapy in HCC and develop consensus statements to guide clinical practice.Evidence review:Many research centers in China have accumulated significant experience implementing HCC conversion therapy.Preliminary findings and data have shown that conversion therapy represents an important strategy to maximize the survival of selected patients with intermediate stage to advanced HCC;however,there are still many urgent clinical and scientific challenges for this therapeutic strategy and its related fields.In order to summarize and learn from past experience and review current challenges,the Chinese Expert Consensus on Conversion Therapy for Hepatocellular Carcinoma(2021 Edition)was developed based on a review of preliminary experience and clinical data from Chinese and non-Chinese studies in this field and combined with recommendations for clinical practice.Sixteen consensus statements on the implementation of conversion therapy for HCC were developed.The statements generated in this review are based on a review of clinical evidence and real clinical experience and will help guide future progress in conversion therapy for patients with HCC.
基金supported by the National Natural Science Foundation of China under Grant No.81772546(to X.C.),No.81827804(to X.C.)and No.81902367(to J.X.)Zhejiang Provincial Natural Science Foundation of China under Grant No.LQ19H160026(to J.X.)and LGF18H160011(to Y.L.)+6 种基金China Postdoctoral Science Foundation under Grant No.2020M671755(to J.X.)Key Research and Development Project of Zhejiang Province under Grant No.2018C03083(to X.C.)Zhejiang Clinical Research Center of Minimally Invasive Diagnosis and Treatment of Abdominal Diseases under Grant No.2018E50003(to X.C.)Special fund for basic scientific research operating expenses of Zhejiang University under Grant No.2019XZZX005-4-05(to Y.L.)Hepatobiliary and Pancreatic Cancer Research of Hubei Chen Xiaoping Science and Technology Development Foundation under Grant No.CXPJJH11900001-2019308(to J.X.)CXPJJH11900001-2019209(to X.L.)CXPJJH11900009-03(to X.L.).
文摘Sorafenib is the first-line chemotherapeutic therapy for advanced hepatocellular carcinoma(HCC).However,sorafenib resistance significantly limits its therapeutic efficacy,and the mechanisms underlying resistance have not been fully clarified.Here we report that a circular RNA,circRNA-SORE(a circular RNA upregulated in sorafenib-resistant HCC cells),plays a significant role in sorafenib resistance in HCC.We found that circRNA-SORE is upregulated in sorafenib-resistant HCC cells and depletion of circRNA-SORE substantially increases the cell-killing ability of sorafenib.Further studies revealed that circRNA-SORE binds the master oncogenic protein YBX1 in the cytoplasm,which prevents YBX1 nuclear interaction with the E3 ubiquitin ligase PRP19 and thus blocks PRP19-mediated YBX1 degradation.Moreover,our in vitro and in vivo results suggest that circRNA-SORE is transported by exosomes to spread sorafenib resistance among HCC cells.Using different HCC mouse models,we demonstrated that silencing circRNA-SORE by injection of siRNA could substantially overcome sorafenib resistance.Our study provides a proof-of-concept demonstration for a potential strategy to overcome sorafenib resistance in HCC patients by targeting circRNA-SORE or YBX1.
基金This study was supported by grants from The National Natural Science Foundation of China(81772950)Tongji Hospital Clinical Research Flagship Program(2019CR203)to RQ.
文摘Importance:While laparoscopic pancreaticoduodenectomy(LPD)is being adopted with increasing enthusiasm worldwide,it is still challenging for both technical and anatomical reasons.Currently,there is no consensus on the technical standards for LPD.Objective:The aim of this consensus statement is to guide the continued safe progression and adoption of LPD.Evidence Review:An international panel of experts was selected based on their clinical and scientific expertise in laparoscopic and open pancreaticoduodenectomy.Statements were produced upon reviewing the literature and assessed by the members of the expert panel.The literature search and its critical appraisal were limited to articles published in English during the period from 1994 to 2019.The Web of Science,Medline,and Cochrane Library and Clinical Trials databases were searched,The search strategy included,but was not limited to,the terms'laparoscopic','pancreaticoduodenectomy,'pancreatoduodenectomy','Whipple's operation',and'minimally invasive surgery'.Reference lists from the included articles were manually checked for any additional studies,which were included when appropriate.Delphi method was used to establish expert consensus and the AGREE II-GRS Instrument was applied to assess the methodological quality and externally validate the final statements.The statements were further discussed during a one-day face-to-face meeting at the 1st Summit on Minimally Invasive Pancreatico-Biliary Surgery in Wuhan,China.Findings:Twenty-eight international experts from 8 countries constructed the expert panel.Sixteen statements were produced by the members of the expert panel.At least 80%of responders agreed with the majority(80%)of statements.Other than three randomized controlled trials published to date,most evidences were based on level 3 or 4 studies according to the AGREE II-GRS Instrument.Conclusions and Relevance:The Wuhan international expert consensus meeting on LPD has produced a set of clinical practice statements for the safe development and progression of LPD.LPD is currently in its development and exploration stages,as defined by the international IDEAL framework for surgical innovation.More robust randomized controlled trial and registry study are essential to proceed with the assessment of LPD.
基金supported by the National Natural Science Foundation of China(81702981,81827804,81902367,81772546and LQ18H160010)Zhejiang Provincial Natural Science Foundation of China(LY20H160021 and Y15H160052)+1 种基金China Postdoctoral Science Foundation(2020T130584 and 2020M671755)Health Innovation Talent Support Project of Zhejiang Medical and Health Science and Technology Plan(2021447581)。
文摘The treatment of hepatocellular carcinoma(HCC)has been dominated by multikinase inhibitors for more than a decade.However,drug resistance can severely restrict the efficacy of these drugs.Using CRISPR/CAS9 genome library screening,we evaluated Kelch-like ECH-associated protein 1(KEAP1)as a key regulator of sorafenib’s susceptibility in HCC.We also investigated whether KEAP1’s knockdown can stabilize nuclear factor(erythroid-derived 2)-like 2(NRF2)protein levels that led to sorafenib’s resistance,including an NRF2 inhibitor that can synergize with sorafenib to abolish HCC’s growth in vitro and in vivo.Furthermore,we clarified that fibroblast growth factor 21(FGF21)is an important downstream regulator of NRF2 in HCC.Intriguingly,we observed that FGF21 bound to NRF2 through the C-terminus of FGF21,thereby stabilizing NRF2 by reducing its ubiquitination and generating a positive feedback loop in sorafenib-resistant HCC.These findings,therefore,propose that targeting FGF21 is a promising strategy to combat HCC sorafenib’s resistance.
基金supported by the National Natural Science Foundation of China under No.81827804(to C.X.),Grant No.81772546(to C.X.),No.81902367(to XJ.),and No.82072625(to L.X.)China Postdoctoral Science Foundation under Grant No.2020M671755(to X.J.)+3 种基金Natural Science Foundation of Zhejiang Province under Grant No.LY15H160014(to C.L.)Zhejiang Clinical Research Center of Minimally Invasive Diagnosis and Treatment of Abdominal Diseases under Grant No.2018E50003(to C.X.)Key Research and Development Project of Zhejiang Province under Grant No.2018C03083(to C.X.),and 2020C03122(to W.Y.)Health innovation Talent Support Project of Zhejiang Medical and Health Science and Technology Plan under Grant No.2021447581(to XJ.).
文摘The treatment for hepatocellular carcinoma(HCC)is promising in recent years,but still facing critical challenges.The first targeted therapy,sorafenib,prolonged the overall survival by months.However,resistance often occurs,largely limits its efficacy.Sorafenib was found to target the electron transport chain complexes,which results in the generation of reactive oxygen species(ROS).To maintain sorafenib resistance and further facilitate tumor progression,cancer cells develop strategies to overcome excessive ROS production and obtain resistance to oxidative stress-induced cell death.In the present study,we investigated the roles of ROS in sorafenib resistance,and found suppressed ROS levels and reductive redox states in sorafenib-resistant HCC cells.Mitochondria in sorafenib-resistant cells maintained greater functional and morphological integrity under the treatment of sorafenib.However,cellular oxygen consumption rate and mitochondria DNA content analyses revealed fewer numbers of mitochondria in sorafenib-resistant cells.Further investigation attributed this finding to decreased mitochondrial biogenesis,likely caused by the accelerated degradation of peroxisome proliferator-activated receptor y coactivator ip(PGC1P).Mechanistic dissection showed that upregulated UBQLN1 induced PGCip degradation in a ubiquitination-independent manner to attenuate mitochondrial biogenesis and ROS production in sorafenib-resistant cells under sorafenib treatment.Furthermore,clinical investigations further indicated that the patients with higher UBQLN1 levels experienced worse recurrence-free survival.In conclusion,we propose a novel mechanism involving mitochondrial biogenesis and ROS homeostasis in sorafenib resistance,which may offer new therapeutic targets and strategies for HCC patients.
基金sponsored by the National Key Research and Development Program of China(2018YFA0703000)the National Natural Science Foundation of China of China(No.U1909218)the Science Fund for Creative Research Groups of the National Natural Science Foundation of China(No.T2121004).
文摘Since projection-based 3D bioprinting(PBP)could provide high resolution,it is well suited for printing delicate structures for tissue regeneration.However,the low crosslinking density and low photo-crosslinking rate of photocurable bioink make it difficult to print fine structures.Currently,an in-depth understanding of the is lacking.Here,a research framework is established for the analysis of printability during PBP.The gelatin methacryloyl(GelMA)-based bioink is used as an example,and the printability is systematically investigated.We analyze the photo-crosslinking reactions during the PBP process and summarize the specific requirements of bioinks for PBP.Two standard quantized models are established to evaluate 2D and 3D printing errors.Finally,the better strategies for bioprinting five typical structures,including solid organs,vascular structures,nerve conduits,thin-wall scaffolds,and micro needles,are presented.
基金supported by the Opening Fund of Engineering Research Center of Cognitive Healthcare of Zhejiang Province(No.2018KFJJ09)Scientific Research Fund of Zhejiang Provincial Education Department(Y201941406)+2 种基金National Natural Science Foundation of China(Nos.81827804 and 81800540)Zhejiang Clinical Research Center of Minimally Invasive Diagnosis and Treatment of Abdominal Diseases(No.2018E50003)Science and Technology Innovative Activity Plan and New Seedling Talent Plan for College Students in Zhejiang Province(No.2020R401217)。
文摘Recently,genetically targeted cancer therapies have been a topic of great interest.Synthetic lethality provides a new approach for the treatment of mutated genes that were previously considered unable to be targeted in traditional genotype-targeted treatments.The increasing researches and applications in the clinical setting made synthetic lethality a promising anticancer treatment option.However,the current understandings on different conditions of synthetic lethality have not been systematically assessed and the application of synthetic lethality in clinical practice still faces many challenges.Here,we propose a novel and systematic classification of synthetic lethality divided into gene level,pathway level,organelle level,and conditional synthetic lethality,according to the degree of specificity into its biological mechanism.Multiple preclinical findings of synthetic lethality in recent years will be reviewed and classified under these different categories.Moreover,synthetic lethality targeted drugs in clinical practice will be briefly discussed.Finally,we will explore the essential implications of this classification as well as its prospects in eliminating existing challenges and the future directions of synthetic lethality.
文摘Dramatic progresses had been made in the operation in the past 26 years.Procedure was extended to major liver resection,isolated resection of caudate lobe,living donor liver resection and associating liver partition with portal vein ligation for staged hepatectomy(ALPPS).Laparoscopic liver resection became a new group of HPB surgery and the international laparoscopic liver society was established in Paris followed by the first international congress of the society held in Paris in July 2017.This biannual congress would be top convention for surgeons specialized in laparoscopic liver surgery.The advantage of laparoscopic liver resection had been recognized by patients and surgeons and is gradually replacing conventional open liver resection in some experienced institutes worldwide.Most procedures,such as laparoscopic local resection and left lateral segmentectomy,could be routinely performed,but some procedures including laparoscopic hemihepatectomy still need to be further evaluated.For now,the establishment of a training system for laparoscopic liver surgeons became the most important issue for the popularization of laparoscopic liver resection.
基金This work was supported by Key Research and Development Plan Projects of Zhejiang Province(No.2017C01018).
文摘Background:Due to absence of large,prospective,randomized,clinical trial data,the potential survivalbenefit of lymphadenectomy with different number of regional lymph nodes(LNs)remains controversial.We aim to create a predicting model to help estimate individualized potential survival benefit oflymphadenectomy with more regional LNs for patients with resected gallbladder cancer(GBC).Methods:Patients with resected GBC were selected from the Surveillance,Epidemiology,and End Resultsdatabase who were diagnosed between 2004 and 2014.Covariates included age,race,sex,grade,histologicalstage,tumor sizes and receipt of non-primary surgery.Two types of multivariate survival regression modelswere constructed and compared.The best model performance was tested by the external validation data fromour hospital.Results:A total of 1,669 patients met the inclusion criteria for this study.The lognormal survival modelshowed the best performance and was tested by the external validation data,including 193 patients withresected GBC from our hospital.Nomograms,which based on the accelerated failure time parametricsurvival model,were built to estimate individualized survival.C-index,was up to 0.754 and 0.710 in internalvalidation for more and less regional LNs removed,respectively.Both of internal and external calibrationcurves showed good agreement between predicted and observed outcomes in the 1-,3-,and 5-year overallsurvival(OS).Conclusions:A predicting model can be used as a decision model to predict which patients may obtainbenefit from lymphadenectomy with more regional LNs.
基金This study was supported by Department of Education of Zhejiang Province,China(grant No.Y201737942).
文摘Background:Although laparoscopic liver resection(LLR)has been increasingly popular worldwide,there is lack of predictive model to evaluate the feasibility and safety of LLR.The aim of this study was to establish a scoring system for predicting the possibility of conversion and complication,which could facilitate the patient selection for clinicians and communication with patients and their relatives during the informed consent process.Methods:Consecutively 696 patients between August 1998 and December 2016 underwent LLR were recruited.The entire cohort was divided randomly into development and validation cohorts.The scoring system for conversion and complication were established according to risk factors identified from multiple logistic analysis.Subgroup analysis was performed to assess the clinical application.And the C-index and decision curve analysis(DCA)were conducted to evaluate the discrimination in comparison with other predictive models.Results:Six hundred and ninety-six patients were enrolled eventually.The rate of conversion in the development and validation cohorts was 8.3%and 10.3%,respectively.Compared with 12.6%complication rate in the development cohort,12.9%was concluded in the validation cohort.Upon on the identified risk factors,the risk stratification model was established and validated.Subsequent subgroup analysis indicated low risk patients presented superior surgical outcomes compared with high risk patients.Besides,the C-index and DCA implied our models had better capacities of predicting conversion and complication in comparison with previous scoring systems.Conclusions:This novel scoring system presents the remarkable capacities of predicting conversion,complication in LLR.And thereby,it could be a useful instrument to facilitate the patient selection for clinicians and communication with patients and their relatives during the informed consent process.
