Amyotrophic lateral sclerosis(ALS)is a neuromuscular condition resulting from the progressive degeneration of motor neurons in the cortex,brainstem,and spinal cord.While the typical clinical phenotype of ALS involves ...Amyotrophic lateral sclerosis(ALS)is a neuromuscular condition resulting from the progressive degeneration of motor neurons in the cortex,brainstem,and spinal cord.While the typical clinical phenotype of ALS involves both upper and lower motor neurons,human and animal studies over the years have highlighted the potential spread to other motor and non-motor regions,expanding the phenotype of ALS.Although superoxide dismutase 1(SOD1)mutations represent a minority of ALS cases,the SOD1 gene remains a milestone in ALS research as it represents the first genetic target for personalized therapies.Despite numerous single case reports or case series exhibiting extramotor symptoms in patients with ALS mutations in SOD1(SOD1-ALS),no studies have comprehensively explored the full spectrum of extramotor neurological manifestations in this subpopulation.In this narrative review,we analyze and discuss the available literature on extrapyramidal and non-motor features during SOD1-ALS.The multifaceted expression of SOD1 could deepen our understanding of the pathogenic mechanisms,pointing towards a multidisciplinary approach for affected patients in light of new therapeutic strategies for SOD1-ALS.展开更多
Extracellular vesicles(EVs)have arisen as potential therapeutic tools in managing infectious diseases because EVs can regulate cell-to-cell signaling,function as drug transport mechanisms,and influence immune reaction...Extracellular vesicles(EVs)have arisen as potential therapeutic tools in managing infectious diseases because EVs can regulate cell-to-cell signaling,function as drug transport mechanisms,and influence immune reactions.They are obtained from a myriad of sources,such as plants,humans,and animal cells.EVs like exosomes and ectosomes can be utilized in their native form as therapeutics or engineered to encompass antimicrobials,vaccines,and oligonucleotides of interest with a targeted delivery strategy.An in-depth understanding of host-pathogen dynamics provides a solid foundation for exploiting its full potential in therapeutics against infectious diseases.This review mainly offers an extensive summary of EVs,comprising their various origins,formations,and pathogen relationships.It further provides insights into the various techniques utilized in isolating and engineering these vesicles to target infectious diseases and how challenges involving large-scale production and cargo loading efficiency should be addressed for clinical application.Finally,preclinical and clinical implementations of EVs derived from animals,plants,and microorganisms are elucidated,stressing their promise for designing innovative antimicrobial approaches.展开更多
Two decades ago,an important development philosophy emerged that would redefine prosperity:“Lucid waters and lush mountains are invaluable assets.”Known as the“Two Mountains”theory,it challenged the conventional t...Two decades ago,an important development philosophy emerged that would redefine prosperity:“Lucid waters and lush mountains are invaluable assets.”Known as the“Two Mountains”theory,it challenged the conventional trade-off between development and the environment by arguing that they are inseparable.展开更多
Accurate and efficient brain tumor segmentation is essential for early diagnosis,treatment planning,and clinical decision-making.However,the complex structure of brain anatomy and the heterogeneous nature of tumors pr...Accurate and efficient brain tumor segmentation is essential for early diagnosis,treatment planning,and clinical decision-making.However,the complex structure of brain anatomy and the heterogeneous nature of tumors present significant challenges for precise anomaly detection.While U-Net-based architectures have demonstrated strong performance in medical image segmentation,there remains room for improvement in feature extraction and localization accuracy.In this study,we propose a novel hybrid model designed to enhance 3D brain tumor segmentation.The architecture incorporates a 3D ResNet encoder known for mitigating the vanishing gradient problem and a 3D U-Net decoder.Additionally,to enhance the model’s generalization ability,Squeeze and Excitation attention mechanism is integrated.We introduce Gabor filter banks into the encoder to further strengthen the model’s ability to extract robust and transformation-invariant features from the complex and irregular shapes typical in medical imaging.This approach,which is not well explored in current U-Net-based segmentation frameworks,provides a unique advantage by enhancing texture-aware feature representation.Specifically,Gabor filters help extract distinctive low-level texture features,reducing the effects of texture interference and facilitating faster convergence during the early stages of training.Our model achieved Dice scores of 0.881,0.846,and 0.819 for Whole Tumor(WT),Tumor Core(TC),and Enhancing Tumor(ET),respectively,on the BraTS 2020 dataset.Cross-validation on the BraTS 2021 dataset further confirmed the model’s robustness,yielding Dice score values of 0.887 for WT,0.856 for TC,and 0.824 for ET.The proposed model outperforms several state-of-the-art existing models,particularly in accurately identifying small and complex tumor regions.Extensive evaluations suggest integrating advanced preprocessing with an attention-augmented hybrid architecture offers significant potential for reliable and clinically valuable brain tumor segmentation.展开更多
Background: Brainwave entrainment using binaural beats has shown potential in treating tinnitus, but most studies have focused on one-month treatment durations. Objective: This study aimed to evaluate the time-bound e...Background: Brainwave entrainment using binaural beats has shown potential in treating tinnitus, but most studies have focused on one-month treatment durations. Objective: This study aimed to evaluate the time-bound efficacy of brainwave entrainment using binaural beats, comparing it to a standard tinnitus masker over a three-month duration. Method: Sixty-three individuals having tinnitus with normal hearing sensitivity were enrolled in the study. The participants were categorized into groups Ⅰ, Ⅱ, and Ⅲ. They were provided with delta(4 Hz) and alpha(10 Hz) frequency binaural beats and standard tinnitus masker, respectively, for a duration of three months. The tinnitus handicap inventory(THI) scores, Visual analogue scale(VAS) rating for tinnitus distress, and quality of life parameters were measured. The reductions obtained for each measure during the end of the first, second and third month were measured and compared across the groups. Results: All three groups showed considerable reductions in THI and VAS scores and improvements in the quality of life domains, focusing on physical and psychological health. However, groups Ⅰ and Ⅱ, who received binaural beats stimuli, showed higher benefits than those who received standard tinnitus masker. Conclusion: The results of the current study indicated that binaural beats can be an effective treatment technique for individuals with tinnitus having normal hearing sensitivity. Clinicians and otology/audiology practitioners shall adopt this innovative treatment after further validating these findings.展开更多
BACKGROUND Esophageal cancer carries a poor prognosis with low 5-year survival rates and limited early detection options.The skeletal muscle index at the L3 vertebral level is a well-established prognostic marker in e...BACKGROUND Esophageal cancer carries a poor prognosis with low 5-year survival rates and limited early detection options.The skeletal muscle index at the L3 vertebral level is a well-established prognostic marker in esophageal cancer,but most follow-up computed tomography(CT)scans do not extend to L3 and limiting its utility.Radiomics has emerged as a powerful tool for extracting prognostic information from medical images.AIM To evaluate the influential features for esophageal cancer prognosis by integrating radiomic and body compositionbased indices of skeletal muscle and adipose tissue at the T12 level from both pretreatment and follow-up CT images,in order to assess their value in predicting overall survival(OS).METHODS This retrospective study included 212 esophageal cancer patients who underwent concurrent chemoradiotherapy,with both pretreatment and follow-up chest CT scans available.Body organ analysis(BOA)and radiomic features were extracted from skeletal muscle and adipose tissue at the T12 level using automated tools.Four feature subsets(no-radiomics,pretreatment only,follow-up only,and combined inputs)were developed using logistic regression(LR)with least absolute shrinkage and selection operator for feature selection,followed by Cox regression.Prognostic models-including nomogram,support vector classifier,LR,and extra trees classifier-were constructed to predict 1-,2-,and 3-year OS.RESULTS The model integrating both BOA and radiomics from pretreatment and follow-up CT,combined with clinical data,achieved the best performance for 2-year OS prediction,with an area under the time-dependent receiver operating characteristic curve of 0.91,sensitivity of 0.81,and specificity of 0.88 using the LR model.The most predictive features included both clinical variables,body composition indices,and radiomic features,particularly from follow-up VAT.Follow-up imaging contributed significantly to model performance,reinforcing its value in treatment response evaluation.CONCLUSION This is the first study to demonstrate that BOA indices and their corresponding radiomics at the T12-level from both pretreatment and follow-up CT scans-combined with clinical data-can provide accurate prognostic information for esophageal cancer.This approach offers a practical alternative when L3-level imaging is unavailable and supports the clinical integration of automated T12-based imaging biomarkers.The integration of these imaging features with clinical parameters enhances the prediction of survival outcomes and contributes to non-invasive,personalized treatment planning.展开更多
Terahertz(THz)radiation possesses unique properties that make it a promising light source for applications in various fields,particularly spectroscopy and imaging.Ongoing research and development in THz technology has...Terahertz(THz)radiation possesses unique properties that make it a promising light source for applications in various fields,particularly spectroscopy and imaging.Ongoing research and development in THz technology has focused on developing or improving THz sources,detectors,and applications.At the PBP-CMU Electron Linac Laboratory(PCELL)of the Plasma and Beam Physics Research Facility in Chiang Mai University,high-intensity THz radiation has been generated in the form of coherent transition radiation(TR)and investigated since 2006 for electron beams with energies ranging from 8 to 12 MeV.In this study,we investigate and optimize the coherent TR arising from short electron bunches with energies ranging from 8 to 22 MeV using an upgraded linear-accelerator system with a higher radio-frequency(RF)power system.This radiation is then transported from the accelerator hall to the experimental room,in which the spectrometers are located.Electron-beam simulations are conducted to achieve short bunch lengths and small transverse beam sizes at the TR station.Radiation properties,including the radiation spectrum,angular distribution,and radiation polarization,are thoroughly investigated.The electron-bunch length is evaluated using the measuring system.The radiation-transport line is designed to achieve optimal frequency response and high transmission efficiency.A radiation-transmission efficiency of approximately 80-90%can be achieved with this designed system,along with a pulse energy ranging from 0.17 to 0.25μJ.The expected radiation spectral range covers up to 2 THz with a peak power of 0.5-1.25 MW.This coherent,broadband,and intense THz radiation will serve as a light source for THz spectroscopy and THz time-domain spectroscopy applications at the PCELL in the near future.展开更多
Background The diagnostic delay of cardiac amyloidosis(CA)is known to be substantially long.A prolonged time from symptoms onset to diagnosis negatively impacts quality of life and life expectancy of the affected pati...Background The diagnostic delay of cardiac amyloidosis(CA)is known to be substantially long.A prolonged time from symptoms onset to diagnosis negatively impacts quality of life and life expectancy of the affected patients.We aim to describe the role of the incidental finding of amyloid deposits in prostatic tissue as an early marker of CA.Methods A systematic cardiological evaluation,comprising ECG,echocardiogram and 99mTc-DPD scintigraphy,was offered to a cohort of 19 patients with incidental prostatic amyloidosis(PA)findings,propectively detected between 2014-2023,to assess cardiac involvement.Results The median age of the patients was 80.2 years(IQR:74.9-82.6 years).Histopathological study revealed amyloid deposits within the walls of small vessels(predominantly small arteries)in 18 patients and mainly in the stroma in the remaining case.All of them were immunohistochemically positive for transthyretin(ATTR)except one patient,with known myeloma,which was unconclusive fo ATTR.Clonal dyscrasia was excluded in the rest of the patients.Thirteen patients(68.4%)underwent all cardiological tests,4 patients(21.1%)underwent only ECG and echocardiographic evaluation and two patients(10.5%)refused to undergo any cardiological study.Among 13 individuals undergoing the complete evaluation,six patients were eventually diagnosed with CA(46.15%).All of them were asymptomatic from a cardiovascular point of view at the time of the prostate biopsy.Conclusion The finding of PA should prompt a complete cardiovascular examination,given the significant percentage of patients eventually diagnosed with early-stage CA.Multidisciplinary collaboration among different medical specialists must be encouraged,given the potential clinical impact of CA early diagnosis.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)in segments VII and VIII poses technical challenges for both liver resection and radiofrequency ablation(RFA).Robotic-assisted techniques may enhance safety and precision,but co...BACKGROUND Hepatocellular carcinoma(HCC)in segments VII and VIII poses technical challenges for both liver resection and radiofrequency ablation(RFA).Robotic-assisted techniques may enhance safety and precision,but comparative evidence remains limited.AIM To compare the clinical outcomes of robotic liver resection(R-LR)and robotic intraoperative RFA(RIO-RFA)for HCC located in liver segments VII and VIII.METHODS We retrospectively analyzed 93 HCC patients in segments VII/VIII with de novo(n=57)or first recurrent(n=36).HCC who underwent R-LR or RIO-RFA between 2015 and 2024.Propensity score matching was performed to reduce selection bias.Primary outcomes were overall survival(OS)and recurrence-free survival(RFS).Kaplan-Meier curves,log-rank tests,and Cox regression were used to identify prognostic factors for OS and RFS.RESULTS In the de novo group,OS and RFS did not differ significantly between R-LR and RIO-RFA before or after propensity score matching.In contrast,the recurrent group showed significantly improved OS and RFS with R-LR(P=0.005 and P=0.012,respectively).Subgroup analyses revealed that low-risk de novo patients with smaller tumors achieved superior OS after R-LR,whereas carefully selected low-risk recurrent patients undergoing RIO-RFA(smaller tumors,absence of complications)achieved outcomes comparable to R-LR.Platelet count,tumor size,and postoperative complications constituted key prognostic factors.CONCLUSION For HCC in challenging liver segments VII and VIII,R-LR and RIO-RFA achieve comparable outcomes in de novo cases,whereas R-LR confers superior survival in recurrent disease.R-LR should be prioritized for small de novo HCCs and for recurrent disease overall;RIO-RFA may serve as an effective alternative in carefully selected lowrisk recurrent patients.Tumor size,platelet count,and postoperative complications are key prognostic indicators to guide individualized treatment.展开更多
文摘Amyotrophic lateral sclerosis(ALS)is a neuromuscular condition resulting from the progressive degeneration of motor neurons in the cortex,brainstem,and spinal cord.While the typical clinical phenotype of ALS involves both upper and lower motor neurons,human and animal studies over the years have highlighted the potential spread to other motor and non-motor regions,expanding the phenotype of ALS.Although superoxide dismutase 1(SOD1)mutations represent a minority of ALS cases,the SOD1 gene remains a milestone in ALS research as it represents the first genetic target for personalized therapies.Despite numerous single case reports or case series exhibiting extramotor symptoms in patients with ALS mutations in SOD1(SOD1-ALS),no studies have comprehensively explored the full spectrum of extramotor neurological manifestations in this subpopulation.In this narrative review,we analyze and discuss the available literature on extrapyramidal and non-motor features during SOD1-ALS.The multifaceted expression of SOD1 could deepen our understanding of the pathogenic mechanisms,pointing towards a multidisciplinary approach for affected patients in light of new therapeutic strategies for SOD1-ALS.
基金funded by the National Science Foundation grant(IOS-1900377),received by QLM and EPSCoR GRSP Round 19 grant received by SVTW.
文摘Extracellular vesicles(EVs)have arisen as potential therapeutic tools in managing infectious diseases because EVs can regulate cell-to-cell signaling,function as drug transport mechanisms,and influence immune reactions.They are obtained from a myriad of sources,such as plants,humans,and animal cells.EVs like exosomes and ectosomes can be utilized in their native form as therapeutics or engineered to encompass antimicrobials,vaccines,and oligonucleotides of interest with a targeted delivery strategy.An in-depth understanding of host-pathogen dynamics provides a solid foundation for exploiting its full potential in therapeutics against infectious diseases.This review mainly offers an extensive summary of EVs,comprising their various origins,formations,and pathogen relationships.It further provides insights into the various techniques utilized in isolating and engineering these vesicles to target infectious diseases and how challenges involving large-scale production and cargo loading efficiency should be addressed for clinical application.Finally,preclinical and clinical implementations of EVs derived from animals,plants,and microorganisms are elucidated,stressing their promise for designing innovative antimicrobial approaches.
文摘Two decades ago,an important development philosophy emerged that would redefine prosperity:“Lucid waters and lush mountains are invaluable assets.”Known as the“Two Mountains”theory,it challenged the conventional trade-off between development and the environment by arguing that they are inseparable.
基金the National Science and Technology Council(NSTC)of the Republic of China,Taiwan,for financially supporting this research under Contract No.NSTC 112-2637-M-131-001.
文摘Accurate and efficient brain tumor segmentation is essential for early diagnosis,treatment planning,and clinical decision-making.However,the complex structure of brain anatomy and the heterogeneous nature of tumors present significant challenges for precise anomaly detection.While U-Net-based architectures have demonstrated strong performance in medical image segmentation,there remains room for improvement in feature extraction and localization accuracy.In this study,we propose a novel hybrid model designed to enhance 3D brain tumor segmentation.The architecture incorporates a 3D ResNet encoder known for mitigating the vanishing gradient problem and a 3D U-Net decoder.Additionally,to enhance the model’s generalization ability,Squeeze and Excitation attention mechanism is integrated.We introduce Gabor filter banks into the encoder to further strengthen the model’s ability to extract robust and transformation-invariant features from the complex and irregular shapes typical in medical imaging.This approach,which is not well explored in current U-Net-based segmentation frameworks,provides a unique advantage by enhancing texture-aware feature representation.Specifically,Gabor filters help extract distinctive low-level texture features,reducing the effects of texture interference and facilitating faster convergence during the early stages of training.Our model achieved Dice scores of 0.881,0.846,and 0.819 for Whole Tumor(WT),Tumor Core(TC),and Enhancing Tumor(ET),respectively,on the BraTS 2020 dataset.Cross-validation on the BraTS 2021 dataset further confirmed the model’s robustness,yielding Dice score values of 0.887 for WT,0.856 for TC,and 0.824 for ET.The proposed model outperforms several state-of-the-art existing models,particularly in accurately identifying small and complex tumor regions.Extensive evaluations suggest integrating advanced preprocessing with an attention-augmented hybrid architecture offers significant potential for reliable and clinically valuable brain tumor segmentation.
文摘Background: Brainwave entrainment using binaural beats has shown potential in treating tinnitus, but most studies have focused on one-month treatment durations. Objective: This study aimed to evaluate the time-bound efficacy of brainwave entrainment using binaural beats, comparing it to a standard tinnitus masker over a three-month duration. Method: Sixty-three individuals having tinnitus with normal hearing sensitivity were enrolled in the study. The participants were categorized into groups Ⅰ, Ⅱ, and Ⅲ. They were provided with delta(4 Hz) and alpha(10 Hz) frequency binaural beats and standard tinnitus masker, respectively, for a duration of three months. The tinnitus handicap inventory(THI) scores, Visual analogue scale(VAS) rating for tinnitus distress, and quality of life parameters were measured. The reductions obtained for each measure during the end of the first, second and third month were measured and compared across the groups. Results: All three groups showed considerable reductions in THI and VAS scores and improvements in the quality of life domains, focusing on physical and psychological health. However, groups Ⅰ and Ⅱ, who received binaural beats stimuli, showed higher benefits than those who received standard tinnitus masker. Conclusion: The results of the current study indicated that binaural beats can be an effective treatment technique for individuals with tinnitus having normal hearing sensitivity. Clinicians and otology/audiology practitioners shall adopt this innovative treatment after further validating these findings.
基金Supported by Taiwan National Science and Technology Council,No.NSTC114-2221-E-035-036Taichung Veterans General Hospital/Feng Chia University Joint Research Program,No.TCVGH-FCU1148207.
文摘BACKGROUND Esophageal cancer carries a poor prognosis with low 5-year survival rates and limited early detection options.The skeletal muscle index at the L3 vertebral level is a well-established prognostic marker in esophageal cancer,but most follow-up computed tomography(CT)scans do not extend to L3 and limiting its utility.Radiomics has emerged as a powerful tool for extracting prognostic information from medical images.AIM To evaluate the influential features for esophageal cancer prognosis by integrating radiomic and body compositionbased indices of skeletal muscle and adipose tissue at the T12 level from both pretreatment and follow-up CT images,in order to assess their value in predicting overall survival(OS).METHODS This retrospective study included 212 esophageal cancer patients who underwent concurrent chemoradiotherapy,with both pretreatment and follow-up chest CT scans available.Body organ analysis(BOA)and radiomic features were extracted from skeletal muscle and adipose tissue at the T12 level using automated tools.Four feature subsets(no-radiomics,pretreatment only,follow-up only,and combined inputs)were developed using logistic regression(LR)with least absolute shrinkage and selection operator for feature selection,followed by Cox regression.Prognostic models-including nomogram,support vector classifier,LR,and extra trees classifier-were constructed to predict 1-,2-,and 3-year OS.RESULTS The model integrating both BOA and radiomics from pretreatment and follow-up CT,combined with clinical data,achieved the best performance for 2-year OS prediction,with an area under the time-dependent receiver operating characteristic curve of 0.91,sensitivity of 0.81,and specificity of 0.88 using the LR model.The most predictive features included both clinical variables,body composition indices,and radiomic features,particularly from follow-up VAT.Follow-up imaging contributed significantly to model performance,reinforcing its value in treatment response evaluation.CONCLUSION This is the first study to demonstrate that BOA indices and their corresponding radiomics at the T12-level from both pretreatment and follow-up CT scans-combined with clinical data-can provide accurate prognostic information for esophageal cancer.This approach offers a practical alternative when L3-level imaging is unavailable and supports the clinical integration of automated T12-based imaging biomarkers.The integration of these imaging features with clinical parameters enhances the prediction of survival outcomes and contributes to non-invasive,personalized treatment planning.
基金supported by the National Research Council of Thailand(No.NRCT-5-RSA63004-16)Chiang Mai University.S.Pakluea acknowledges scholarship support from the Science Achievement Scholarship of Thailand(SAST).
文摘Terahertz(THz)radiation possesses unique properties that make it a promising light source for applications in various fields,particularly spectroscopy and imaging.Ongoing research and development in THz technology has focused on developing or improving THz sources,detectors,and applications.At the PBP-CMU Electron Linac Laboratory(PCELL)of the Plasma and Beam Physics Research Facility in Chiang Mai University,high-intensity THz radiation has been generated in the form of coherent transition radiation(TR)and investigated since 2006 for electron beams with energies ranging from 8 to 12 MeV.In this study,we investigate and optimize the coherent TR arising from short electron bunches with energies ranging from 8 to 22 MeV using an upgraded linear-accelerator system with a higher radio-frequency(RF)power system.This radiation is then transported from the accelerator hall to the experimental room,in which the spectrometers are located.Electron-beam simulations are conducted to achieve short bunch lengths and small transverse beam sizes at the TR station.Radiation properties,including the radiation spectrum,angular distribution,and radiation polarization,are thoroughly investigated.The electron-bunch length is evaluated using the measuring system.The radiation-transport line is designed to achieve optimal frequency response and high transmission efficiency.A radiation-transmission efficiency of approximately 80-90%can be achieved with this designed system,along with a pulse energy ranging from 0.17 to 0.25μJ.The expected radiation spectral range covers up to 2 THz with a peak power of 0.5-1.25 MW.This coherent,broadband,and intense THz radiation will serve as a light source for THz spectroscopy and THz time-domain spectroscopy applications at the PCELL in the near future.
文摘Background The diagnostic delay of cardiac amyloidosis(CA)is known to be substantially long.A prolonged time from symptoms onset to diagnosis negatively impacts quality of life and life expectancy of the affected patients.We aim to describe the role of the incidental finding of amyloid deposits in prostatic tissue as an early marker of CA.Methods A systematic cardiological evaluation,comprising ECG,echocardiogram and 99mTc-DPD scintigraphy,was offered to a cohort of 19 patients with incidental prostatic amyloidosis(PA)findings,propectively detected between 2014-2023,to assess cardiac involvement.Results The median age of the patients was 80.2 years(IQR:74.9-82.6 years).Histopathological study revealed amyloid deposits within the walls of small vessels(predominantly small arteries)in 18 patients and mainly in the stroma in the remaining case.All of them were immunohistochemically positive for transthyretin(ATTR)except one patient,with known myeloma,which was unconclusive fo ATTR.Clonal dyscrasia was excluded in the rest of the patients.Thirteen patients(68.4%)underwent all cardiological tests,4 patients(21.1%)underwent only ECG and echocardiographic evaluation and two patients(10.5%)refused to undergo any cardiological study.Among 13 individuals undergoing the complete evaluation,six patients were eventually diagnosed with CA(46.15%).All of them were asymptomatic from a cardiovascular point of view at the time of the prostate biopsy.Conclusion The finding of PA should prompt a complete cardiovascular examination,given the significant percentage of patients eventually diagnosed with early-stage CA.Multidisciplinary collaboration among different medical specialists must be encouraged,given the potential clinical impact of CA early diagnosis.
基金Supported by Feng Chia University/Chung Shan Medical University,No.FCU/CSMU 112-001Taiwan National Science and Technology Council,No.NSTC 114-2221-E-035-036.
文摘BACKGROUND Hepatocellular carcinoma(HCC)in segments VII and VIII poses technical challenges for both liver resection and radiofrequency ablation(RFA).Robotic-assisted techniques may enhance safety and precision,but comparative evidence remains limited.AIM To compare the clinical outcomes of robotic liver resection(R-LR)and robotic intraoperative RFA(RIO-RFA)for HCC located in liver segments VII and VIII.METHODS We retrospectively analyzed 93 HCC patients in segments VII/VIII with de novo(n=57)or first recurrent(n=36).HCC who underwent R-LR or RIO-RFA between 2015 and 2024.Propensity score matching was performed to reduce selection bias.Primary outcomes were overall survival(OS)and recurrence-free survival(RFS).Kaplan-Meier curves,log-rank tests,and Cox regression were used to identify prognostic factors for OS and RFS.RESULTS In the de novo group,OS and RFS did not differ significantly between R-LR and RIO-RFA before or after propensity score matching.In contrast,the recurrent group showed significantly improved OS and RFS with R-LR(P=0.005 and P=0.012,respectively).Subgroup analyses revealed that low-risk de novo patients with smaller tumors achieved superior OS after R-LR,whereas carefully selected low-risk recurrent patients undergoing RIO-RFA(smaller tumors,absence of complications)achieved outcomes comparable to R-LR.Platelet count,tumor size,and postoperative complications constituted key prognostic factors.CONCLUSION For HCC in challenging liver segments VII and VIII,R-LR and RIO-RFA achieve comparable outcomes in de novo cases,whereas R-LR confers superior survival in recurrent disease.R-LR should be prioritized for small de novo HCCs and for recurrent disease overall;RIO-RFA may serve as an effective alternative in carefully selected lowrisk recurrent patients.Tumor size,platelet count,and postoperative complications are key prognostic indicators to guide individualized treatment.
