The prognosis of drug-induced acute liver failure(ALF)is poor,with a survival rate of 27.1%without liver transplantation.Liver transplantation significantly improved survival rates to 66.2%.[1]The shortage of availabl...The prognosis of drug-induced acute liver failure(ALF)is poor,with a survival rate of 27.1%without liver transplantation.Liver transplantation significantly improved survival rates to 66.2%.[1]The shortage of available grafts can be addressed by living donor liver transplantation(LDLT),an effective and safe method that expands the donor pool,enhances timely transplantation,and improves patient survival.展开更多
Liver transplantation(LT)has made significant progress in the treatment of end stage liver disease(ESLD).However,many patients still die from disease progression while awaiting transplantation.As the number of patient...Liver transplantation(LT)has made significant progress in the treatment of end stage liver disease(ESLD).However,many patients still die from disease progression while awaiting transplantation.As the number of patients on LT waiting lists is increasing,and the organ shortage crisis is obvious,various efforts have been made to increase the pool of available liver grafts[1].In addition to living donor liver transplantation(LDLT),improving the utilization rate of extended criteria donor(ECD)livers is an important way.However,under traditional cold storage,ECD livers are usually associated with a higher risk of ischemic biliary disease,early allograft dysfunction(EAD)or even primary nonfunction(PNF).The frequently described definition in the literature for ECD grafts generally includes elderly,steatotic,long cold ischemia time(CIT),grafts obtained from donation after circulatory death(DCD),split liver grafts,donors with increased risk of infectious disease transmission and prolonged donor intensive care unit stay[2].展开更多
Over the past few years,video live streaming has gained immense popularity as a leading internet application.In current solutions offered by cloud service providers,the Group of Pictures(GOP)length of the video source...Over the past few years,video live streaming has gained immense popularity as a leading internet application.In current solutions offered by cloud service providers,the Group of Pictures(GOP)length of the video source often significantly impacts end-to-end(E2E)latency.However,designing an optimized GOP structure to reduce this effect remains a significant challenge.This paper presents two key contributions.First,it explores how the GOP length at the video source influences E2E latency in mainstream cloud streaming services.Experimental results reveal that the mean E2E latency increases linearly with longer GOP lengths.Second,this paper proposes EGOP(an Enhanced GOP structure)that can be implemented in streaming media servers.Experiments demonstrate that EGOP maintains a consistent E2E latency,unaffected by the GOP length of the video source.Specifically,even with a GOP length of 10 s,the E2E latency remains at 1.35 s,achieving a reduction of 6.98 s compared to Volcano-Engine(the live streaming service provider for TikTok).This makes EGOP a promising solution for low-latency live streaming.展开更多
BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical perf...BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical performance,and economic effects of robotic-assisted donor and recipient hepatectomy in the transplant pathway.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and a priori registration,systematic reviews were included with or without meta-analysis.Four databases were searched through July 2025.Methodological quality was appraised with a measurement tool to assess systematic reviews(AMSTAR 2),and certainty was graded with grading of recommendations assessment,development and evaluation(GRADE).Evidence overlap was calculated via a citation-matrix-based corrected covered area(CCA).Effect sizes were prespecified as risk ratios(RR)for dichotomous outcomes and mean differences for continuous outcomes.RESULTS Five reviews met the inclusion criteria,four with meta-analyses and one consensus review used only for context.Donor(direct)findings were more favorable for robotics in terms of estimated blood loss(≈-117 mL)and length of stay(≈-0.6 days),although with longer operative time(≈+105 minutes).Absolute risks for donor complications were not estimable from ratio-only data.Recipient(indirect)meta-analysis indicated robotics to be favorable in terms of conversion(RR≈0.41)and severe morbidity(RR≈0.81),with a trend toward lower overall morbidity(RR≈0.92)and no difference in 30-day mortality.Differences in length of stay and operative time were small and heterogeneous.Economic evidence(indirect,network meta-analysis)suggested higher procedural costs for robotic vs laparoscopic intervention,but lower hospitalization costs vs open intervention,with laparoscopy the least expensive overall.AMSTAR 2 ratings were moderate-to-high across the reviews,GRADE certainty was low for key donor continuous outcomes,and low-to-moderate for recipient and economic outcomes.Overlap was slight(graded-corpus CCA=0.0%;including a contextual non-transplant review increased CCA to≈1.25%).CONCLUSION Robotic donor hepatectomy confers perioperative advantages at the cost of longer operative time.Recipient and economic findings are indirect and considered hypothesis-generating.Transplant-specific,prospective comparisons using a minimum standardized dataset and uniform outcome definitions are needed to resolve remaining uncertainties and to clarify the cost-utility correlation.展开更多
Background:Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. While liver transplantation (LT) provides the best long-term survival, it is constrained by organ scarcity and strict criteria....Background:Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. While liver transplantation (LT) provides the best long-term survival, it is constrained by organ scarcity and strict criteria. Liver resection (LR) is often the initial treatment for patients with solitary tumors and preserved liver function. The high recurrence rates associated with LR has prompted the exploration of sequential living donor liver transplantation (seq LDLT) after LR as a strategy for HCC patients with high-risk of recurrence.Methods:We analyzed data from 27 adult patients who underwent seq LDLT after LR for HCC at Kaohsiung Chang Gung Memorial Hospital (KCGMH) between June 1994 and December 2023. Patients were selected based on high-risk histopathological features post-LR or as part of downstaging strategy. Outcomes measured included overall survival (OS) and disease-free survival (DFS).Results:Among 765 HCC patients who underwent LDLT, 204 received LR before LDLT, and 27 underwent seqL DLT. Five patients (19%) underwent living donor liver transplantation (LDLT) following LR as a downstaging strategy while the rest received seqL DLT as a preemptive strategy. The median age was 53.5 years with 85%males. Chronic hepatitis B was the predominant underlying disease (74%). The 1-, 3-, and 5-year OS and DFS rates were 100%, 96.0%, 96.0%and 100%, 96.2%, 96.2%, respectively, with two patients experiencing HCC recurrence. One patient died from HCC recurrence. High-risk histopathological features included microvascular invasion (52%), satellite nodules (15%), multiple tumors (26%), tumors> 5 cm(19%), and a total tumor diameter> 10 cm (7%).Conclusions:Seq LDLT offers a promising, tailored approach for managing HCC with adverse histopathologic features. Combining seq LDLT, downstaging strategies, and multidisciplinary treatments can achieve satisfactory OS and DFS in carefully selected patients, highlighting the need for refined criteria to identify the best candidates.展开更多
BACKGROUND Pediatric liver transplantation(LT)is the definitive treatment for end-stage liver disease and acute liver failure in children.However,graft size mismatch poses significant challenges,particularly in infant...BACKGROUND Pediatric liver transplantation(LT)is the definitive treatment for end-stage liver disease and acute liver failure in children.However,graft size mismatch poses significant challenges,particularly in infants weighing less than 10 kg.Large-forsize grafts can lead to severe complications,including vascular thrombosis and impaired graft perfusion.Surgical innovations,such as hyper-reduced left lateral segment(HRLLS)grafts and monosegmental grafts(MSG),offer viable solutions by tailoring graft size without compromising vascular or biliary integrity.AIM To analyze the techniques and outcomes of HRLLS and MSG grafts in pediatric liver trabsplantation.METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines,a comprehensive literature search was conducted across PubMed,Scopus,and Google Scholar,including studies up to February 2025.Eligible studies included case-control,observational,and randomized controlled trials reporting clinical outcomes of HRLLS,MSG,or reduced left lateral segment grafts(RLLS)in pediatric LT.The Joanna Briggs Institute Critical Appraisal Checklist was used for quality assessment.Meta-analysis was performed using MetaXL software to pool survival outcomes and assess complication profiles.RESULTS Eighteen studies involving various graft reduction techniques were included.Both HRLLS and MSG demonstrated comparable one-year survival rates exceeding 80%,with some studies reporting rates above 95%.Complications such as hepatic artery thrombosis,portal vein thrombosis,and sepsis were slightly more frequent in HRLLS/RLLS recipients but remained within acceptable limits.Meta-analysis revealed no significant differences in survivability between graft types.CONCLUSION HRLLS and MSG techniques enable successful liver transplantation in small pediatric recipients,achieving longterm outcomes comparable to standard approaches.These graft modification strategies expand donor pool utilization and optimize patient survival while mitigating large-for-size complications.展开更多
Robotic surgery has emerged as a new frontier in liver transplantation.Given the novelty of its application to recipient procedures,a comprehensive overview is crucial.This narrative review synthesizes the fragmented,...Robotic surgery has emerged as a new frontier in liver transplantation.Given the novelty of its application to recipient procedures,a comprehensive overview is crucial.This narrative review synthesizes the fragmented,foundational data on fully robotic recipient adult living donor liver transplantation(LDLT)on the basis of an appraisal of initial case reports and preliminary comparative studies.The literature was identifiedvia PubMed.The literature demonstrates the technical feasibility and favorable safety profileof the robotic approach.A significantreduction in morbidity was observed,as evidenced by a lower comprehensive complication index,reduced blood loss and transfusion need,and a lower incidence of postoperative infections.These benefitswere reflected in significantlyshorter intensive care unit and hospital stays.While the robotic approach was associated with prolonged operative and ischemia times,the studies revealed that these approaches did not compromise outcomes,with higher 6-month recipient survival noted in the robotic group.Fully robotic recipient LDLT is a groundbreaking technique,although the current evidence consists of initial case reports and non-randomized comparative data from a single center.The available literature suggests a promising safety profileand significantshort-term benefits,but these preliminary findingsrequire validation through multicenter,high-level research.展开更多
BACKGROUND Pediatric living-donor liver transplantation is considered a safe alternative for the treatment of children with end-stage liver disease.Experienced tertiary centers and specialized medical staff are necess...BACKGROUND Pediatric living-donor liver transplantation is considered a safe alternative for the treatment of children with end-stage liver disease.Experienced tertiary centers and specialized medical staff are necessary to ensure compatible long-term survival rates and quality-of-life for these children.AIM To report the results and the 10-year learning curve of a pediatric living-donor liver transplantation program.METHODS We conducted a retrospective cohort study of pediatric recipients from 2013 to 2023.Post-transplant outcomes and patient survival rates were compared between two 5-year periods of the program.RESULTS A total of 25 and 48 patients underwent transplantation in the first(2013-2017)and second period(2018-2023),respectively.Portal vein and hepatic artery thrombosis occurred in 11(15.1%)and seven(9.6%)patients,respectively.Biliary complications were observed in 39 of 73 patients(53.4%).A lower warm ischemia time was observed in the second period compared to the first(32.6±8.6 minutes vs 38.4±9.8 minutes,P=0.018,respectively).Patient survival rates at 1 and 5 years were 84%in the first period and 91.7%in the second period,with no significant difference(P=0.32).CONCLUSION The reported indications and outcomes align with the current literature.Our findings provide crucial evidence regarding the feasibility of establishing a living donor program with consistent results over time.展开更多
Graft procurement in adult living donor liver transplantation(LDLT)faces persistent challenges in balancing volumetric adequacy and donor safety.This study introduces two-stage portal vein ligation and reperfusion for...Graft procurement in adult living donor liver transplantation(LDLT)faces persistent challenges in balancing volumetric adequacy and donor safety.This study introduces two-stage portal vein ligation and reperfusion for graft procurement in LDLT(PVLR-LT),which aims to expand the left lateral lobe for achieving adequate grafts,thereby circumventing technical and anatomical limitations of conventional approaches.In a rat model,the PVLR-LT group underwent selective portal vein ligation(step I)to induce targeted hypertrophy,followed by reperfusion and transplantation(step II).Outcomes were compared among PVLR-LT,negative controls,and standard-volume controls.Staged portal flow modulation effectively redistributed hepatic mass allocation,yielding grafts with graft recipient weight ratio approximately double that of negative controls and equivalent to standard-volume controls.Donors experienced no mortality,with only transient enzyme elevation.Recipient survival in the PVLR-LT group significantly exceeded that of the negative control group and was non-inferior to that of the standard-volume control group,while hepatic enzyme peaks were markedly lower than those in standard-volume control recipients.This study provides a promising proof of concept,establishing the feasibility of using PVLR-LT to convert the surgically straightforward left lateral segment into right lobe-sized grafts through staged portal flow modulation and demonstrating the translational potential for laparoscopic LDLT.展开更多
To the Editor:Living donor liver transplantation continues to be a widely ac-cepted treatment for end-stage liver diseases[1].However,biliary complications remain a significant challenge,attributable to both surgical ...To the Editor:Living donor liver transplantation continues to be a widely ac-cepted treatment for end-stage liver diseases[1].However,biliary complications remain a significant challenge,attributable to both surgical and nonsurgical factors.These complications include bile leakage,biliary stricture,and choledocholithiasis,with a reported incidence of biliary stricture in pediatric living donor liver recip-ients ranging from 10%to 35%[2].Commonly employed thera-peutic approaches for biliary complications are endoscopic retro-grade cholangiopancreatography(ERCP),percutaneous transhepatic cholangioscopic lithotomy(PTCSL),and surgery,with ERCP often being the preferred initial treatment.展开更多
AIM:To assess the validity of the Milan and University of California San Francisco(UCSF) criteria and examine the long-term outcome of orthotopic liver transplantation(OLT) in patients with hepatocellular carcinoma(HC...AIM:To assess the validity of the Milan and University of California San Francisco(UCSF) criteria and examine the long-term outcome of orthotopic liver transplantation(OLT) in patients with hepatocellular carcinoma(HCC) in a single-center study.METHODS:This study is a retrospective review of prospectively collected data.Between 1998 and 2009,56 of 356 OLTs were performed in patients with HCC.Based on pathological examination of liver explants,patients were retrospectively categorized into 3 groups:Milan +(n = 34),Milan-/UCSF +(n = 7) and UCSF-(n = 14).RESULTS:Median follow-up period was 39.5(1-124) mo.The 5-year overall survival rates in the Milan +,Milan-/UCSF + and UCSF-groups were 87.7%,53.6% and 33.3%,respectively(P < 0.000).Within these groups,tumor recurrence was determined in 5.8%,14.3% and 40% of patients,respectively(P < 0.011).Additionally,the presence of microvascular invasion within the explanted liver had a negative effect on the 5-year disease free survival(74.7% vs 46.7%,P < 0.044).CONCLUSION:The Milan criteria are reliable in the selection of suitable candidates for OLT for the treatment of HCC.For cases of OLT involving living donors,the UCSF criteria may be applied.展开更多
With the advances in transplant oncology in recent years, the role of liver transplantation has expanded to make curative treatment a possibility for a wider patient population. We highlight strategies in Hong Kong, C...With the advances in transplant oncology in recent years, the role of liver transplantation has expanded to make curative treatment a possibility for a wider patient population. We highlight strategies in Hong Kong, China that have enabled preoperative prognostication for judicious patient selection, downstaging therapy to definitive treatment, and postoperative therapies that have provided a growing role for liver transplantation in patients with more advanced hepatocellular carcinoma.展开更多
Face liveness detection is essential for securing biometric authentication systems against spoofing attacks,including printed photos,replay videos,and 3D masks.This study systematically evaluates pre-trained CNN model...Face liveness detection is essential for securing biometric authentication systems against spoofing attacks,including printed photos,replay videos,and 3D masks.This study systematically evaluates pre-trained CNN models—DenseNet201,VGG16,InceptionV3,ResNet50,VGG19,MobileNetV2,Xception,and InceptionResNetV2—leveraging transfer learning and fine-tuning to enhance liveness detection performance.The models were trained and tested on NUAA and Replay-Attack datasets,with cross-dataset generalization validated on SiW-MV2 to assess real-world adaptability.Performance was evaluated using accuracy,precision,recall,FAR,FRR,HTER,and specialized spoof detection metrics(APCER,NPCER,ACER).Fine-tuning significantly improved detection accuracy,with DenseNet201 achieving the highest performance(98.5%on NUAA,97.71%on Replay-Attack),while MobileNetV2 proved the most efficient model for real-time applications(latency:15 ms,memory usage:45 MB,energy consumption:30 mJ).A statistical significance analysis(paired t-tests,confidence intervals)validated these improvements.Cross-dataset experiments identified DenseNet201 and MobileNetV2 as the most generalizable architectures,with DenseNet201 achieving 86.4%accuracy on Replay-Attack when trained on NUAA,demonstrating robust feature extraction and adaptability.In contrast,ResNet50 showed lower generalization capabilities,struggling with dataset variability and complex spoofing attacks.These findings suggest that MobileNetV2 is well-suited for low-power applications,while DenseNet201 is ideal for high-security environments requiring superior accuracy.This research provides a framework for improving real-time face liveness detection,enhancing biometric security,and guiding future advancements in AI-driven anti-spoofing techniques.展开更多
基金approved by the Ethics Committee of the Second Affiliated Hospital,Zhejiang University School of Medicine(2024-0690).
文摘The prognosis of drug-induced acute liver failure(ALF)is poor,with a survival rate of 27.1%without liver transplantation.Liver transplantation significantly improved survival rates to 66.2%.[1]The shortage of available grafts can be addressed by living donor liver transplantation(LDLT),an effective and safe method that expands the donor pool,enhances timely transplantation,and improves patient survival.
文摘Liver transplantation(LT)has made significant progress in the treatment of end stage liver disease(ESLD).However,many patients still die from disease progression while awaiting transplantation.As the number of patients on LT waiting lists is increasing,and the organ shortage crisis is obvious,various efforts have been made to increase the pool of available liver grafts[1].In addition to living donor liver transplantation(LDLT),improving the utilization rate of extended criteria donor(ECD)livers is an important way.However,under traditional cold storage,ECD livers are usually associated with a higher risk of ischemic biliary disease,early allograft dysfunction(EAD)or even primary nonfunction(PNF).The frequently described definition in the literature for ECD grafts generally includes elderly,steatotic,long cold ischemia time(CIT),grafts obtained from donation after circulatory death(DCD),split liver grafts,donors with increased risk of infectious disease transmission and prolonged donor intensive care unit stay[2].
基金supported by Henan Province Major Science and Technology Project(241100210100).
文摘Over the past few years,video live streaming has gained immense popularity as a leading internet application.In current solutions offered by cloud service providers,the Group of Pictures(GOP)length of the video source often significantly impacts end-to-end(E2E)latency.However,designing an optimized GOP structure to reduce this effect remains a significant challenge.This paper presents two key contributions.First,it explores how the GOP length at the video source influences E2E latency in mainstream cloud streaming services.Experimental results reveal that the mean E2E latency increases linearly with longer GOP lengths.Second,this paper proposes EGOP(an Enhanced GOP structure)that can be implemented in streaming media servers.Experiments demonstrate that EGOP maintains a consistent E2E latency,unaffected by the GOP length of the video source.Specifically,even with a GOP length of 10 s,the E2E latency remains at 1.35 s,achieving a reduction of 6.98 s compared to Volcano-Engine(the live streaming service provider for TikTok).This makes EGOP a promising solution for low-latency live streaming.
文摘BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical performance,and economic effects of robotic-assisted donor and recipient hepatectomy in the transplant pathway.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and a priori registration,systematic reviews were included with or without meta-analysis.Four databases were searched through July 2025.Methodological quality was appraised with a measurement tool to assess systematic reviews(AMSTAR 2),and certainty was graded with grading of recommendations assessment,development and evaluation(GRADE).Evidence overlap was calculated via a citation-matrix-based corrected covered area(CCA).Effect sizes were prespecified as risk ratios(RR)for dichotomous outcomes and mean differences for continuous outcomes.RESULTS Five reviews met the inclusion criteria,four with meta-analyses and one consensus review used only for context.Donor(direct)findings were more favorable for robotics in terms of estimated blood loss(≈-117 mL)and length of stay(≈-0.6 days),although with longer operative time(≈+105 minutes).Absolute risks for donor complications were not estimable from ratio-only data.Recipient(indirect)meta-analysis indicated robotics to be favorable in terms of conversion(RR≈0.41)and severe morbidity(RR≈0.81),with a trend toward lower overall morbidity(RR≈0.92)and no difference in 30-day mortality.Differences in length of stay and operative time were small and heterogeneous.Economic evidence(indirect,network meta-analysis)suggested higher procedural costs for robotic vs laparoscopic intervention,but lower hospitalization costs vs open intervention,with laparoscopy the least expensive overall.AMSTAR 2 ratings were moderate-to-high across the reviews,GRADE certainty was low for key donor continuous outcomes,and low-to-moderate for recipient and economic outcomes.Overlap was slight(graded-corpus CCA=0.0%;including a contextual non-transplant review increased CCA to≈1.25%).CONCLUSION Robotic donor hepatectomy confers perioperative advantages at the cost of longer operative time.Recipient and economic findings are indirect and considered hypothesis-generating.Transplant-specific,prospective comparisons using a minimum standardized dataset and uniform outcome definitions are needed to resolve remaining uncertainties and to clarify the cost-utility correlation.
文摘Background:Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. While liver transplantation (LT) provides the best long-term survival, it is constrained by organ scarcity and strict criteria. Liver resection (LR) is often the initial treatment for patients with solitary tumors and preserved liver function. The high recurrence rates associated with LR has prompted the exploration of sequential living donor liver transplantation (seq LDLT) after LR as a strategy for HCC patients with high-risk of recurrence.Methods:We analyzed data from 27 adult patients who underwent seq LDLT after LR for HCC at Kaohsiung Chang Gung Memorial Hospital (KCGMH) between June 1994 and December 2023. Patients were selected based on high-risk histopathological features post-LR or as part of downstaging strategy. Outcomes measured included overall survival (OS) and disease-free survival (DFS).Results:Among 765 HCC patients who underwent LDLT, 204 received LR before LDLT, and 27 underwent seqL DLT. Five patients (19%) underwent living donor liver transplantation (LDLT) following LR as a downstaging strategy while the rest received seqL DLT as a preemptive strategy. The median age was 53.5 years with 85%males. Chronic hepatitis B was the predominant underlying disease (74%). The 1-, 3-, and 5-year OS and DFS rates were 100%, 96.0%, 96.0%and 100%, 96.2%, 96.2%, respectively, with two patients experiencing HCC recurrence. One patient died from HCC recurrence. High-risk histopathological features included microvascular invasion (52%), satellite nodules (15%), multiple tumors (26%), tumors> 5 cm(19%), and a total tumor diameter> 10 cm (7%).Conclusions:Seq LDLT offers a promising, tailored approach for managing HCC with adverse histopathologic features. Combining seq LDLT, downstaging strategies, and multidisciplinary treatments can achieve satisfactory OS and DFS in carefully selected patients, highlighting the need for refined criteria to identify the best candidates.
文摘BACKGROUND Pediatric liver transplantation(LT)is the definitive treatment for end-stage liver disease and acute liver failure in children.However,graft size mismatch poses significant challenges,particularly in infants weighing less than 10 kg.Large-forsize grafts can lead to severe complications,including vascular thrombosis and impaired graft perfusion.Surgical innovations,such as hyper-reduced left lateral segment(HRLLS)grafts and monosegmental grafts(MSG),offer viable solutions by tailoring graft size without compromising vascular or biliary integrity.AIM To analyze the techniques and outcomes of HRLLS and MSG grafts in pediatric liver trabsplantation.METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines,a comprehensive literature search was conducted across PubMed,Scopus,and Google Scholar,including studies up to February 2025.Eligible studies included case-control,observational,and randomized controlled trials reporting clinical outcomes of HRLLS,MSG,or reduced left lateral segment grafts(RLLS)in pediatric LT.The Joanna Briggs Institute Critical Appraisal Checklist was used for quality assessment.Meta-analysis was performed using MetaXL software to pool survival outcomes and assess complication profiles.RESULTS Eighteen studies involving various graft reduction techniques were included.Both HRLLS and MSG demonstrated comparable one-year survival rates exceeding 80%,with some studies reporting rates above 95%.Complications such as hepatic artery thrombosis,portal vein thrombosis,and sepsis were slightly more frequent in HRLLS/RLLS recipients but remained within acceptable limits.Meta-analysis revealed no significant differences in survivability between graft types.CONCLUSION HRLLS and MSG techniques enable successful liver transplantation in small pediatric recipients,achieving longterm outcomes comparable to standard approaches.These graft modification strategies expand donor pool utilization and optimize patient survival while mitigating large-for-size complications.
文摘Robotic surgery has emerged as a new frontier in liver transplantation.Given the novelty of its application to recipient procedures,a comprehensive overview is crucial.This narrative review synthesizes the fragmented,foundational data on fully robotic recipient adult living donor liver transplantation(LDLT)on the basis of an appraisal of initial case reports and preliminary comparative studies.The literature was identifiedvia PubMed.The literature demonstrates the technical feasibility and favorable safety profileof the robotic approach.A significantreduction in morbidity was observed,as evidenced by a lower comprehensive complication index,reduced blood loss and transfusion need,and a lower incidence of postoperative infections.These benefitswere reflected in significantlyshorter intensive care unit and hospital stays.While the robotic approach was associated with prolonged operative and ischemia times,the studies revealed that these approaches did not compromise outcomes,with higher 6-month recipient survival noted in the robotic group.Fully robotic recipient LDLT is a groundbreaking technique,although the current evidence consists of initial case reports and non-randomized comparative data from a single center.The available literature suggests a promising safety profileand significantshort-term benefits,but these preliminary findingsrequire validation through multicenter,high-level research.
文摘BACKGROUND Pediatric living-donor liver transplantation is considered a safe alternative for the treatment of children with end-stage liver disease.Experienced tertiary centers and specialized medical staff are necessary to ensure compatible long-term survival rates and quality-of-life for these children.AIM To report the results and the 10-year learning curve of a pediatric living-donor liver transplantation program.METHODS We conducted a retrospective cohort study of pediatric recipients from 2013 to 2023.Post-transplant outcomes and patient survival rates were compared between two 5-year periods of the program.RESULTS A total of 25 and 48 patients underwent transplantation in the first(2013-2017)and second period(2018-2023),respectively.Portal vein and hepatic artery thrombosis occurred in 11(15.1%)and seven(9.6%)patients,respectively.Biliary complications were observed in 39 of 73 patients(53.4%).A lower warm ischemia time was observed in the second period compared to the first(32.6±8.6 minutes vs 38.4±9.8 minutes,P=0.018,respectively).Patient survival rates at 1 and 5 years were 84%in the first period and 91.7%in the second period,with no significant difference(P=0.32).CONCLUSION The reported indications and outcomes align with the current literature.Our findings provide crucial evidence regarding the feasibility of establishing a living donor program with consistent results over time.
基金supported by grants from the General Program of National Natural Science Foundation of China(No.82470683)National Key Research and Development Program of China(No.2021YFA1100500)+2 种基金The Innovation Team of Hangzhou Medical College(No.CXLJ202401)Key Research&Development Program of Zhejiang Province(No.2022C03108)Ningbo Top Medical and Health Research Program(No.2024020818).
文摘Graft procurement in adult living donor liver transplantation(LDLT)faces persistent challenges in balancing volumetric adequacy and donor safety.This study introduces two-stage portal vein ligation and reperfusion for graft procurement in LDLT(PVLR-LT),which aims to expand the left lateral lobe for achieving adequate grafts,thereby circumventing technical and anatomical limitations of conventional approaches.In a rat model,the PVLR-LT group underwent selective portal vein ligation(step I)to induce targeted hypertrophy,followed by reperfusion and transplantation(step II).Outcomes were compared among PVLR-LT,negative controls,and standard-volume controls.Staged portal flow modulation effectively redistributed hepatic mass allocation,yielding grafts with graft recipient weight ratio approximately double that of negative controls and equivalent to standard-volume controls.Donors experienced no mortality,with only transient enzyme elevation.Recipient survival in the PVLR-LT group significantly exceeded that of the negative control group and was non-inferior to that of the standard-volume control group,while hepatic enzyme peaks were markedly lower than those in standard-volume control recipients.This study provides a promising proof of concept,establishing the feasibility of using PVLR-LT to convert the surgically straightforward left lateral segment into right lobe-sized grafts through staged portal flow modulation and demonstrating the translational potential for laparoscopic LDLT.
文摘To the Editor:Living donor liver transplantation continues to be a widely ac-cepted treatment for end-stage liver diseases[1].However,biliary complications remain a significant challenge,attributable to both surgical and nonsurgical factors.These complications include bile leakage,biliary stricture,and choledocholithiasis,with a reported incidence of biliary stricture in pediatric living donor liver recip-ients ranging from 10%to 35%[2].Commonly employed thera-peutic approaches for biliary complications are endoscopic retro-grade cholangiopancreatography(ERCP),percutaneous transhepatic cholangioscopic lithotomy(PTCSL),and surgery,with ERCP often being the preferred initial treatment.
文摘AIM:To assess the validity of the Milan and University of California San Francisco(UCSF) criteria and examine the long-term outcome of orthotopic liver transplantation(OLT) in patients with hepatocellular carcinoma(HCC) in a single-center study.METHODS:This study is a retrospective review of prospectively collected data.Between 1998 and 2009,56 of 356 OLTs were performed in patients with HCC.Based on pathological examination of liver explants,patients were retrospectively categorized into 3 groups:Milan +(n = 34),Milan-/UCSF +(n = 7) and UCSF-(n = 14).RESULTS:Median follow-up period was 39.5(1-124) mo.The 5-year overall survival rates in the Milan +,Milan-/UCSF + and UCSF-groups were 87.7%,53.6% and 33.3%,respectively(P < 0.000).Within these groups,tumor recurrence was determined in 5.8%,14.3% and 40% of patients,respectively(P < 0.011).Additionally,the presence of microvascular invasion within the explanted liver had a negative effect on the 5-year disease free survival(74.7% vs 46.7%,P < 0.044).CONCLUSION:The Milan criteria are reliable in the selection of suitable candidates for OLT for the treatment of HCC.For cases of OLT involving living donors,the UCSF criteria may be applied.
文摘With the advances in transplant oncology in recent years, the role of liver transplantation has expanded to make curative treatment a possibility for a wider patient population. We highlight strategies in Hong Kong, China that have enabled preoperative prognostication for judicious patient selection, downstaging therapy to definitive treatment, and postoperative therapies that have provided a growing role for liver transplantation in patients with more advanced hepatocellular carcinoma.
基金funded by Centre for Advanced Modelling and Geospatial Information Systems(CAMGIS),Faculty of Engineering and IT,University of Technology Sydney.Moreover,Ongoing Research Funding Program(ORF-2025-14)King Saud University,Riyadh,Saudi Arabia,under Project ORF-2025-。
文摘Face liveness detection is essential for securing biometric authentication systems against spoofing attacks,including printed photos,replay videos,and 3D masks.This study systematically evaluates pre-trained CNN models—DenseNet201,VGG16,InceptionV3,ResNet50,VGG19,MobileNetV2,Xception,and InceptionResNetV2—leveraging transfer learning and fine-tuning to enhance liveness detection performance.The models were trained and tested on NUAA and Replay-Attack datasets,with cross-dataset generalization validated on SiW-MV2 to assess real-world adaptability.Performance was evaluated using accuracy,precision,recall,FAR,FRR,HTER,and specialized spoof detection metrics(APCER,NPCER,ACER).Fine-tuning significantly improved detection accuracy,with DenseNet201 achieving the highest performance(98.5%on NUAA,97.71%on Replay-Attack),while MobileNetV2 proved the most efficient model for real-time applications(latency:15 ms,memory usage:45 MB,energy consumption:30 mJ).A statistical significance analysis(paired t-tests,confidence intervals)validated these improvements.Cross-dataset experiments identified DenseNet201 and MobileNetV2 as the most generalizable architectures,with DenseNet201 achieving 86.4%accuracy on Replay-Attack when trained on NUAA,demonstrating robust feature extraction and adaptability.In contrast,ResNet50 showed lower generalization capabilities,struggling with dataset variability and complex spoofing attacks.These findings suggest that MobileNetV2 is well-suited for low-power applications,while DenseNet201 is ideal for high-security environments requiring superior accuracy.This research provides a framework for improving real-time face liveness detection,enhancing biometric security,and guiding future advancements in AI-driven anti-spoofing techniques.
