Hepatocellular carcinoma（HCC） is one of the most common malignancies worldwide, and liver transplantation remains the definitive treatment for appropriately selected early‑stage patients. However, limited donor organ availability and prolonged waiting times place candidates at risk of tumor progression, creating an unmet need for effective bridge therapies to maintain transplant eligibility. Yttrium-90（Y‑90） microsphere radioembolization and transcatheter arterial chemoembolization（TACE） are the principal locoregional modalities used as bridging strategies.Although both modalities achieve meaningful local tumor control,they differ substantially in mechanisms of action,efficacy profiles,safety considerations, and indications, and monotherapy may not address the heterogeneity of current clinical scenarios. This review synthesizes the contemporary clinical evidence on Y‑90 radioembolization and TACE as bridging treatments prior to liver transplantation.We compare their biological mechanisms along with relative advantages.In addition,we discuss how advances in biomarkers and radiomics can refine candidate stratification and predict response,enabling more personalized bridging strategies.This review aims to provide a practical framework to improve patient outcomes and maximize transplant success.

Local therapy is an important treatment modality for hepatocellular carcinoma （HCC）. The rapid development of imaging has made it a core support throughout the full-course management of local therapy. This article systematically describes the current status and latest advances in imaging applications in HCC local therapy, following the timeline from pre-treatment to precise postoperative assessment, as well as long-term surveillance and recurrence management, and the extended value of imaging in the era of combination therapy. It focuses on the application value and suitable scenarios of different imaging techniques, such as computed tomography （CT） and magnetic resonance imaging （MRI）, at each stage, and discusses the transformative role of cutting-edge technologies such as radiomics and artificial intelligence in efficacy prediction, precise guidance, and recurrence monitoring. At the same time, it highlights the current challenges in imaging assessment and future development directions.

Objective To evaluate prognostic differences after radiofrequency ablation（RFA） for newly diagnosed hepatocellular carcinoma（HCC） according to tumor location. Methods A retrospective analysis was performed on the clinical data of 70 patients with tumors adjacent to major vessels and 111 patients with tumors distant from major vessels who underwent RFA at the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2022. After propensity score matching（PSM）, 62 matched pairs of patients were included. Kaplan-Meier analysis and the log-rank test were used for survival analysis, and the Cox proportional hazards model was used to analyze factors influencing recurrence-free survival（RFS）.Liver function was also assessed in the two groups after PSM. Results After PSM, each group included 62 patients. In the group with tumors adjacent to major vessels, the 1-,2-,and 3-year RFS rates were 82.2%, 69.3%, and 56.4%, respectively, and the median follow-up period was 42 months. In the group with tumors distant from major vessels, the corresponding 1-,2-,and 3-year RFS rates were 90.3%, 85.4%, and 85.4%, respectively, and the median follow-up period was 60 months. The postoperative RFS rate was significantly better in the group with tumors distant from major vessels than in the group with tumors adjacent to major vessels（P<0.05）.Multivariate analysis after PSM showed that tumor number（HR=2.243,95%CI：1.578-3.187,P<0.001）, maximum tumor diameter（HR=1.793, 95%CI：1.056-3.469,P=0.030）, tumor location（HR=2.458,95%CI：1.015-5.595,P=0.046）,and alanine aminotransferase（HR=1.014, 95% CI：1.001-1.028,P=0.031） were independent risk factors for tumor recurrence. Postoperatively, alanine aminotransferase and aspartate aminotransferase levels were significantly higher in the group with tumors adjacent to major vessels than in the group with tumors distant from major vessels, and the differences were statistically significant（all P<0.05）. Conclusions Tumor location, multifocality, maximum tumor diameter,and alanine aminotransferase are high-risk factors for early recurrence after RFA in patients with HCC,and patients with tumors adjacent to major vessels have a higher postoperative recurrence rate.

Objective To compare the clinical efficacy of surgical resection and microwave ablation in patients with multifocal hepatocellular carcinoma at China Liver Cancer（CNLC） stage Ⅰb and Ⅱa, and to provide evidence for treatment selection. Methods A retrospective analysis was performed on 112 patients with CNLC stage Ⅰb/Ⅱa multifocal hepatocellular carcinoma who were treated at Shengjing Hospital of China Medical University from December 2013 to December 2023 and met the inclusion and exclusion criteria. According to treatment modality, patients were assigned to the resection group （85 cases） or the ablation group （27 cases）. Propensity score matching（PSM） was used to compare overall survival, disease-free survival, and perioperative outcomes, including postoperative hospital stay, hospitalization costs, and postoperative complications. Results After 1∶3 matching by PSM, 22 patients remained in the ablation group and 66 in the resection group. There were no statistically significant differences in baseline characteristics between the two groups （all P>0.05）. Regarding long-term survival outcomes,the 1-, 3-, and 5-year overall survival rates were 89.4%,77.2%, and 59.7% in the resection group and 100%, 84.2%, and 33.1% in the ablation group, respectively, with no significant difference between the groups （P>0.05）. The 1-, 3-, and 5-year disease-free survival rates were 62.1%,40.9%, and 23.5% in the resection group and 72.7%, 43.8%, and 26.3% in the ablation group, respectively, also with no significant difference （P>0.05）. In terms of perioperative outcomes, compared with the resection group, the ablation group had significantly shorter postoperative hospital stay （median：7.0 d vs 11.5 d） and lower hospitalization costs （median：38 509.5 yuan vs 62 346.5 yuan） （both P<0.05）. There was no significant difference in the incidence of postoperative complications of Clavien-Dindo grade Ⅱ or higher between the two groups（all P>0.05）, indicating comparable safety between the two treatment modalities. Conclusion For patients with CNLC stage Ⅰb/Ⅱa multifocal hepatocellular carcinoma, microwave ablation achieves long-term survival outcomes comparable to those of surgical resection and offers advantages in postoperative hospital stay, hospitalization costs, and postoperative complications.

Objective To compare the efficacy of subsegmental radiofrequency ablation（SS-RFA） and conventional radiofrequency ablation （RFA） in the treatment of solitary early hepatocellular carcinoma（HCC）. Methods A prospective non-randomized cohort study was conducted. A total of 34 patients with solitary lesions and a maximum tumor diameter of <5 cm admitted to the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Army Medical University, from October 2022 to July 2024 were enrolled. Seventeen patients received SS-RFA, and the remaining 17 patients received conventional RFA. Postoperative complications, postoperative changes in liver function indicators, and long-term recurrence were compared between the two groups. Results All patients successfully underwent ablation, and no severe postoperative complications occurred. Both groups showed similar transient postoperative fluctuations in liver function indicators. Compared with the RFA group, the ablation zone diameter in the SS-RFA group was significantly larger at 15 min after ablation （[47.85±7.32] mm vs [38.18±5.84] mm, P<0.001） and at 2 d after ablation （[54.85±10.2] mm vs [42.24±5.29] mm, P<0.001）. The 1-year recurrence-free survival （RFS） rate in the SS-RFA group was 94.1% and the 2-year RFS rate was 88.2%; in the RFA group, the corresponding 1- and 2-year RFS rates were 82.4% and 50.2%, respectively. The RFS rate was significantly higher in the SS-RFA group than in the RFA group （P=0.011）. Conclusion SS-RFA is safe and effective for patients with solitary early HCC. Compared with conventional RFA, it provides a longer recurrence-free survival period.

Objective To investigate the prognostic value of the platelet-albumin-bilirubin index （PALBI） in patients with early hepatocellular carcinoma （HCC） undergoing microwave ablation and to develop a prognostic prediction model. Methods A retrospective analysis was performed on the clinical and follow-up data of 149 patients with HCC who underwent microwave ablation at Shengjing Hospital of China Medical University from January 2012 to December 2023. The inverse Kaplan-Meier method was used to estimate the median follow-up time. The optimal cutoff value was determined using receiver operating characteristic （ROC） curves, and the association between PALBI level and clinicopathological characteristics was analyzed. Kaplan-Meier curves and Cox regression analysis were used to assess survival differences and identify independent prognostic factors. A nomogram prediction model was then constructed, and its performance was evaluated using the concordance index （C-index）, ROC curves, calibration curves, and decision curve analysis. Results The median follow-up time was 58 months （95% CI： 51-64）. PALBI level was associated with tumor diameter, alpha-fetoprotein, hepatitis B virus infection, Child-Pugh class, portal hypertension, and tumor number （P<0.05）. Kaplan-Meier analysis showed that the 2-, 3-, and 5-year overall survival rates in the low-PALBI and high-PALBI groups were 94.7%/62.3%, 83.0%/41.8%, and 66.0%/23.6%, respectively, and the corresponding recurrence-free survival rates were 91.5%/50.9%, 77.7%/29.1%, and 58.5%/16.4%, respectively （P<0.05）. Multivariate Cox regression analysis showed that age, tumor diameter, and PALBI were independent prognostic factors for overall survival （OS）; cirrhosis, tumor diameter, and PALBI were independent prognostic factors for recurrence-free survival （RFS）. Based on these findings, the nomogram model achieved ROC areas under the curve of 0.84, 0.80, and 0.81 for predicting 2-, 3-, and 5-year OS, respectively, and 0.83, 0.78, and 0.81 for predicting RFS, respectively. The calibration curves showed good agreement between predicted and observed outcomes. Conclusion PALBI is an independent prognostic factor in patients with HCC undergoing microwave ablation. The nomogram model developed based on PALBI can effectively predict postoperative survival and provides new evidence for individualized prognostic assessment in this specific population.

Objective To investigate the expression profile, clinical significance, biological function, and molecular regulatory mechanism of nucleoporin 43 （Nup43） in intrahepatic cholangiocarcinoma（ICC）, and to provide a theoretical basis and potential target for precision treatment of ICC. Methods （1） The Cancer Genome Atlas（TCGA） database was used to analyze differences in Nup43 mRNA expression between cholangiocarcinoma tissues and adjacent normal tissues.（2） Immunohistochemical staining was performed to detect Nup43 protein expression in cancer tissues and paired adjacent normal tissues from 106 ICC patients, and its associations with clinicopathological features and prognosis were analyzed.（3） siRNA-mediated gene silencing was used to downregulate Nup43 expression in the ICC cell line RBE, and CCK-8 and Transwell assays were conducted to assess its effects on cell proliferation and migration.（4） The Ubibrowser1.0 database was used to predict potential ubiquitination substrates of Nup43. Co-immunoprecipitation（Co-IP）, ubiquitination assays, and Western blot were then used to validate its interaction with p53 and the underlying regulatory mechanism. （5） Rescue experiments demonstrated that Nup43 exerts a pro-tumor effect by negatively regulating p53. Results TCGA data and immunohistochemical staining showed that Nup43 was highly expressed at both the mRNA and protein levels in ICC tissues（P<0.05）.High Nup43 expression was associated with increased tumor size （P<0.001）, advanced TNM stage（P<0.001）, vascular invasion（P=0.030）, nerve invasion（P=0.026）, and poorer tumor differentiation（P<0.001） in ICC patients. Moreover, the high-expression group had significantly shorter overall survival than the low-expression group（P=0.002 2）.Cell experiments confirmed that Nup43 silencing significantly inhibited the proliferative activity and migratory capacity of RBE cells（P<0.05）.Mechanistic studies indicated that Nup43 may be involved in the ubiquitin-mediated degradation of p53.Nup43 could bind exogenously to p53 and promote its ubiquitination and degradation. Rescue experiments verified that cells in the co-silencing Nup43 and p53 group showed a clear recovery in proliferative activity and the number of transmembrane cells compared with the Nup43 knockdown group alone. Conclusion Nup43 is highly expressed in ICC tissues and is closely associated with poor prognosis and malignant clinicopathological features. By promoting p53 ubiquitination and degradation, Nup43 enhances ICC cell proliferation and metastasis. Its expression level is closely correlated with poor prognosis in patients, suggesting that Nup43 may serve as an important prognostic biomarker and a potential therapeutic target for ICC.

Objective To assess the clinical effectiveness and technical benefits of a laparoscopic ultrasound‑guided microwave ablation technique, referred to here as the "thermo‑shrinkage" method, for the treatment of giant hepatic hemangiomas, and to inform individualized surgical decision‑making. Methods We performed a retrospective review of 87 patients with hepatic hemangiomas treated at the Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College,Huazhong University of Science and Technology, from May 2023 to December 2024. Patients underwent either thermo‑shrinkage ablation alone （n=45） or thermo‑shrinkage ablation combined with resection（n=42）. Both groups employed the same core thermo‑shrinkage technique. We compared perioperative metrics, complication rates, and long-term efficacy. Results Baseline tumor size was comparable between groups （combined：[9.5±3.4] cm vs ablation alone：[9.0±2.9] cm;P>0.05）. The ablation‑only group demonstrated significantly shorter operative time （[49.8±20.5] min vs [128.7±46.3] min）, shorter postoperative hospital stay（[5.0±1.0] d vs [5.7±1.6] d）, faster recovery of bowel function（[1.8±1.0] d vs [2.6±1.3] d）, and shorter duration of postoperative Ⅳ analgesia（[1.6±1.1] d vs [2.7±1.2] d）（all P<0.05）. Systemic inflammatory response, measured by interleukin-6, was lower after ablation alone （[18.3±3.5] pg/L） than after combined treatment（[24.9±4.7] pg/L）（t=-8.364,P=0.041）.Radiological complete response（rCR） was achieved in 100% of patients in the combined group （42/42） versus 80.0% in the ablation‑only group （36/45）（χ²=6.305,P<0.05）.Neither group experienced severe complications,and overall complication rates （42.9% vs 26.7%） were not significantly different（χ²=2.135,P>0.05）. Conclusion The thermo‑shrinkage technique,through a proposed dual mechanism of surface "armoring" and internal tumor contraction, enables safe, efficient, and visually guided treatment of giant hepatic hemangiomas. Ablation alone provides a clear minimally invasive benefit with faster postoperative recovery and lower immediate inflammatory response,while combining ablation with resection yields higher radiologic complete response rates and potentially more definitive tumor control.

Objective To evaluate the safety and feasibility of a single‑incision synchronous triple‑endoscope approach, i.e., laparoscopy combined with duodenoscopy and peroral cholangioscopy, for the treatment of gallbladder stones concurrent with small‑diameter common bile duct stones. Methods We retrospectively analyzed 96 patients with gallbladder stones concurrent with small‑diameter common bile duct stones meeting inclusion criteria who were treated at the Affiliated Puren Hospital of Wuhan University of Science and Technology between September 2023 and December 2024. Patients were assigned according to the surgical method： the single‑incision triple‑endoscope group （observation,n=35） and the conventional multi‑port/endoscope triple‑approach group （control,n=61）. We compared intraoperative parameters, postoperative complications, liver function tests （preoperative and on postoperative days 3 and 7）, pain scores （preoperative and on postoperative days 3 and 7）, and patient satisfaction at postoperative day 7 and 1 month. Results There were no statistically significant differences between groups in intraoperative blood loss （[18.20±13.08] mL vs [20.98±10.68] mL）,operative time（[106.83±43.09] min vs [104.66±30.62] min）,or overall postoperative complication rate （5.7% [2/35] vs 3.3% [2/61]）（all P>0.05）.The observation group demonstrated significantly faster postoperative recovery markers than the control group： shorter time to first flatus （[21.97±9.24] h vs [26.77±9.27] h）,shorter time to first bowel movement （[46.26±15.23] h vs [55.70±12.60] h）, and shorter postoperative hospital stay （[5.26±2.05] d vs [6.56±3.05] d）（all P<0.05）.By postoperative day 3, both groups showed significant reductions in serum alanine aminotransferase, aspartate aminotransferase,and total bilirubin compared with preoperative values（all P<0.05）;between‑group differences in these liver function indices were not statistically significant （P>0.05）. Pain assessed by the visual analogue scale（VAS） was significantly lower in the observation group（P<0.05）.Patient satisfaction at postoperative day 7 and at 1 month improved more markedly in the observation group（P<0.05）. Conclusion The single‑incision synchronous triple‑endoscope approach for gallbladder stones with concomitant small‑diameter common bile duct stones appears safe and feasible. Compared with the conventional approach, it provides reduced postoperative pain, faster recovery, superior cosmetic results, and a low complication rate.

Objective To evaluate whether serum levels of miR-27a-5p and miR-361-5p are associated with disease severity and prognosis in patients with acute pancreatitis（AP）. Methods This retrospective cohort included 127 consecutive AP patients admitted to Cangzhou People's Hospital from August 2021 to August 2023. Patients were stratified by Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE Ⅱ） score at admission into a mild group（n=78） and a severe group（n=49）, and by 28-day outcome into a good-prognosis group （n=85） and a poor-prognosis group（n=42）.Serum miR-27a-5p and miR-361-5p were quantified by quantitative reverse-transcription polymerase chain reaction（qRT-PCR）.Pearson correlation assessed relationships between each miRNA and APACHE Ⅱ score.Univariate and multivariate logistic regression identified independent predictors of poor 28-day outcome.Receiver operating characteristic（ROC） curve analysis evaluated discriminatory performance of individual and combined miRNA measures; decision curve analysis（DCA） appraised clinical net benefit. Results Compared with the mild group, the severe group had significantly lower serum miR-27a-5p and higher miR-361-5p and APACHE Ⅱ scores （all P<0.05）. Correlation analysis showed miR-27a-5p was negatively correlated with APACHE Ⅱ score （r=-0.367,P<0.05）,whereas miR-361-5p was positively correlated（r=0.580,P<0.05）.Relative to patients with good outcomes, those with poor prognosis had higher C-reactive protein （CRP）,higher APACHE Ⅱ scores, and higher miR-361-5p, but lower miR-27a-5p（all P<0.05）.On multivariate analysis,higher APACHE Ⅱ score（OR=1.925,95%CI：1.163-3.186） and elevated miR-361-5p（OR=2.684,95%CI：1.609-4.477） were independent risk factors for poor prognosis,while higher miR-27a-5p was independently protective（OR=0.637,95%CI：0.499-0.814）（all P<0.05）.The combined miR-27a-5p+miR-361-5p model achieved an area under the curve（AUC） of 0.943 for predicting 28-day outcome,significantly exceeding the AUCs of miR-27a-5p or miR-361-5p alone（miR-27a-5p：Z=2.718,P < 0.05;miR-361-5p：Z=2.418,P<0.05）.Decision curve analysis demonstrated that the combined model provided a superior net clinical benefit across a range of threshold probabilities. Conclusion Serum miR-27a-5p is decreased and miR-361-5p is increased in more severe AP; both markers correlate with APACHE Ⅱ scores and 28-day outcomes. Combined measurement of miR-27a-5p and miR-361-5p offers strong discriminatory power and potential clinical usefulness for early prognostic stratification in AP.

Objective To examine the association between inflammatory markers and complicated appendicitis, develop machine‑learning prediction models using selected biomarkers and demographic data, and evaluate their predictive performance to support early diagnosis and management. Methods We performed a retrospective study of 330 consecutive patients with acute appendicitis admitted to the Hepatobiliary and Pancreatic Surgery Department of Nanjing Jiangning Hospital from January 2024 to June 2025. Patients were classified as non‑complicated appendicitis（n=151） or complicated appendicitis（n=179） based on intraoperative findings and pathology. Demographic and laboratory inflammatory variables were collected. Using a hold‑out approach, patients were randomly split 7∶3 into a training set（n=230） and a test set（n=100）. Training and test set demographics： training set, including 116 males, 114 females,125 complicated cases; test set, including 55 males, 45 females, 54 complicated cases.Feature selection was performed by least absolute shrinkage and selection operator（LASSO） regression followed by multivariable logistic regression to identify variables significantly associated with complicated appendicitis. Seven machine‑learning models were then trained on the selected features： logistic regression（LR）, decision tree（DT）, random forest（RF）, extreme gradient boosting（XGBoost）,light gradient boosting machine（LightGBM）, support vector machine （SVM）, and artificial neural network （ANN）. Model performance on the test set was assessed by area under the curve （AUC）, F1 score, sensitivity, specificity and accuracy. Model interpretability and variable importance were examined with SHAP （Shapley additive explanations）. Results LASSO and multivariable logistic regression identified five predictive features： systemic immune‑inflammation index （SII）,C‑reactive protein/albumin ratio（CAR）, neutrophil percentage/albumin ratio（NPAR）,platelet‑to‑lymphocyte ratio（PLR）,and age.Among the seven models evaluated on the independent test set,XGBoost achieved the best performance with an AUC of 0.786（95%CI：0.686-0.876）, specificity 91.11%, accuracy 75.52%, and F1 score 0.733. SHAP analysis indicated that CAR, age, and NPAR contributed most to model predictions. Conclusion Models based on SII, CAR, NPAR, PLR and age can discriminate complicated from non‑complicated appendicitis; among them, the XGBoost model demonstrated the best predictive performance. This approach shows promise as an early, laboratory‑based decision support tool to aid triage and management of patients with suspected complicated appendicitis.

In recent years, increasing attention has been paid to the role of the gut microbiota in host energy metabolism, inflammatory regulation, and the maintenance of internal homeostasis. Accumulating evidence indicates that dysbiosis is closely associated with obesity, insulin resistance, type 2 diabetes, nonalcoholic fatty liver disease, and metabolic syndrome. The gut microbiota may participate in metabolic regulation through multiple mechanisms, including effects on energy intake and storage, short-chain fatty acid and bile acid metabolism, gut barrier homeostasis, chronic low-grade inflammation, and gut-brain axis signaling. As a representative intervention for reconstructing the gut microbiota, fecal microbiota transplantation （FMT） has demonstrated definitive efficacy in recurrent Clostridioides difficile infection and has gradually been extended to obesity, metabolic syndrome, constipation, and depressive disorders. Current evidence suggests that the direct effect of FMT on weight loss remains inconsistent; however, it shows potential in improving insulin sensitivity, body fat distribution, certain lipid parameters, and chronic low-grade inflammation. Its efficacy is influenced by multiple factors, including donor screening, the recipient's baseline microbiota, transplantation route, and dietary habits. This review summarizes the relationship between the gut microbiota and obesity/metabolic disorders, the mechanisms of FMT, and its current applications in related diseases.