Abstract:The birth of modern surgery is attributed to the continuous accumulation of knowledge in human anatomy, and the rapid development of surgery also promotes in-depth understanding of fine organ anatomy. The liver as the largest solid organ in the human body has a unique dual blood supply system and complex intrahepatic vascular structures, make it prone to uncontrollable bleeding during surgery. Therefore, liver surgery has long been one of the most difficult operations in general surgery and requires a longer learning curve. In the past 30 years, with the rapid popularity of laparoscopic hepatectomy (LH), surgeons have discovered that the use of liver membrane structures, to which insufficient attention has been paid previously, can more conveniently and accurately dissect the internal and external vessels of the liver and locate the liver plane, and reduce intraoperative bleeding. At present, there are not many systematic explanations focusing on the application of liver membrane structure in LH. Therefore, the authors address the issues in this field.

Abstract:Background and Aims The robot-assisted laparoscopic hepatectomy (RALH) can overcome some technical limitations in traditional laparoscopic hepatectomy (LH), and also improve the operating flexibility and accuracy. However, results of previous Meta-analysis created controversial consequences on whether RALH is indeed superior to LH. Therefore, this study was performed to reevaluate the efficacy and safety of RALH for the treatment of liver tumors by a new Meta-analysis.Methods Both Chinese and English literature of all studies comparing RALH and LH in the treatment of liver tumors were collected by searching several national and international databases. The retrieval time was set from January 2000 to February 2021. After literature screening and quality assessment, Meta-analysis was performed by using the RevMan5.3 software.Results A total of 30 studies were included, involving 3 480 patients, with 1 332 cases in RALH group and 2 148 cases in LH group. Results of Meta-analysis showed that in RALH group compared with LH group, the operative time was longer (MD=45.66, 95% CI=26.60-64.72, P<0.000 01), intraoperative conversion rate was lower (RR=0.66, 95% CI=0.50-0.86, P=0.002), intraoperative blood transfusion rate was higher (RR=1.88, 95% CI=1.30-2.71, P=0.000 7) and total cost was higher (MD=0.51, 95% CI=0.44-0.57, P<0.000 01). However, there were no significant differences in terms of the intraoperative blood loss, hepatic portal occlusion rate, incidence of postoperative complications, length of postoperative hospital stay, mortality, and the R₀ and R₁ resection rates (all P>0.05).Conclusion Based on the current evidence, RALH is safe and effective. Although it has higher total cost and longer operative duration, there is almost no difference with LH in other main outcome indicators, suggesting that they have similar surgical efficacy and safety, and more clinical randomized controlled trials are still needed for verification in the future.

Abstract:Background and Aims Liver resection (LR) and transcatheter arterial chemoembolization (TACE) are widely used in the treatment of rupture and bleeding of primary liver cancer (PLC). However, there are still great differences in the efficacy results from relevant reports. So far, the consensus on the most appropriate treatment strategy to reduce in-hospital mortality and improve long-term survival has not been established. Therefore, this study was conducted to compare the clinical efficacy and prognosis of LR and TACE in the treatment of PLC rupture and bleeding through a retrospective analysis, so as to provide the optimal treatment strategy for this condition.Methods Using a retrospective case-control design, 195 patients with ruptured PLC treated in three medical centers from June 2013 to June 2018 were enrolled, and divided into LR group (64 cases) and TACE group (131 cases) according to the treatment methods. After balancing the baseline characteristics by propensity score matching (PSM), the 1-, 2- and 3-year overall survival (OS) rates between the two groups were compared, and the risk factors affecting the OS of patients were analyzed.Results A total of 29 pairs of patients in the two groups were successfully matched after PSM with a 1∶1 ratio. There was no statistical difference in 30-d mortality between LR group and TACE group (3.4% vs. 10.3%, P=0.611). The 1-, 2- and 3-year OS rates were 75.9%, 41.4% and 12.9% for LR group, and were 55.5%, 14.4%, and 0 for TACE groups, respectively; the median OS was 18.5 (95% CI=12.9-24.1) months for LR group and 12.5 (95% CI=10.4-14.6) months for TACE group, and the difference had statistical significance (χ²=4.843, P=0.028). Univariate analysis showed that portal vein invasion, portal hypertension, ascites, multiple lesions, tumor diameter >10 cm, Child-Pugh grade, BCLC stage, AFP >400 ng/mL and treatment method were risk factors affecting the OS of patients with ruptured hemorrhagic PLC (all P<0.05); multivariate Cox analysis revealed that multiple lesions, Child-Pugh grade, AFP >400 ng/mL and treatment method were independent risk factors for the OS of patients with ruptured hemorrhagic PLC (all P<0.005).Conclusion Treatment method is an independent prognostic factor for patients with ruptured hemorrhagic PLC, the comprehensive treatment containing LR can offer more survival benefits than TACE to patients with this condition.

Abstract:Background and Aims Hepatocellular carcinoma (HCC) has an insidious onset and high mortality. Tumor makers have great importance in early detection, prognostic estimation and efficacy monitoring. Studies have demonstrated that inflammatory indices are closely associated with the prognosis of HCC. Therefore, this study was conducted to investigate the relations of preoperative integrated inflammatory marker alkaline phosphatase to albumin ratio (AAR) and gamma-glutamyl transpeptidase to platelet ratio (GPR) with the postoperative prognosis of HCC.Methods The clinical data of 347 eligible HCC patients undergoing hepatectomy in the Department of Hepatobiliary Surgery of Xijing Hospital from January 2014 to December 2017 were retrospectively analyzed. The patients were randomly divided into training set (243 cases) and validation set (104 cases) in a ratio of 7∶3 by a random number generator. The optimal cutoff values of AAR and GPR were obtained by the X-tile software according to the survival data in training set. The associations of AAR, GPR and their combination index (AAR-GPR) as well as other clinicopathologic variables with the survival of patients were analyzed in training set and validation set, respectively. The differences in survival rates among patients with different AAR or GPR values or different AAR-GPR scores (those with both AAR and GPR above the cutoff values were defined as 2, and the remaining conditions were classified as 1) were compared in training set and validation set, respectively. The prognostic prediction values among AAR, GPR and AAR-GPR were compared by analysis of R3.2 software.Results The median follow-up time of the 347 patients was 45 months. A total of 147 patients died, and the cumulative 1-, 3- and 5-year survival rates were 84.6%, 59.4% and 52.2%, respectively. There were no statistically significant differences (P>0.05) between training set and validation set except for AJCC stage (χ²=6.21，P=0.045). The optimal cutoff value for AAR was 2.61 and for GPR was 0.39. Results of analyses in both training and validation sets showed that AAR (training set: HR=1.904, P=0.003; validation set: HR=2.245, P=0.008), GPR (training set: HR=2.159, P=0.002; validation set: HR=2.646, P=0.006) and AAR-GPR (training set: HR=2.872, P<0.001; validation set: HR=4.643, P<0.001) were independent risk factors for postoperative survival. The prognostic prediction value of AAR-GPR (C-index: 0.831, likelihood ratio: 24.36) was superior to that of either AAR (C-index: 0.765, likelihood ratio: 12.11) or GPR (C-index: 0.772, likelihood ratio: 13.43) alone.Conclusion Both AAR and GPR are independent risk factors for survival after HCC resection. Compared with AAR or GPR alone, their combination index can significantly improve the predictive efficiency and predict postoperative survival more accurately. Since this is a single-center study, further validation is still needed by large-sample size and multi-center high-quality studies.

Abstract:Background and Aims There has been no consistent conclusion about the effect of Glissonean pedicle transection method and Pringle's maneuver in hepatectomy for hepatocellular carcinoma (HCC), and has no verification from the large multicenter clinical trials as well at present time. This study was conducted to evaluate the efficacy of the two methods in hepatectomy for HCC through Meta-analysis, so as to provide reference for the selection of inflow occlusion methods during hepatectomy for HCC.Methods The clinical studies comparing Glissonean pedicle transection method and Pringle's maneuver in liver resection for HCC were collected by computer-based searching in Chinese and English databases, with the retrieval time from inception of the database to October 2021. After the quality assessment and data extraction of the included studies, Meta-analysis was performed with RevMan5.3 software.Results A total of 15 studies was included involving 1 349 patients, of whom, Glissonean pedicle transection was used in 684 cases (Glissonean pedicle transection group) and Pringle's maneuver was performed in 665 cases (Pringle group). Results of Meta-analysis showed that the levels of alanine aminotransferase (MD=-96.67, 95% CI=-156.69--36.65, P=0.002; MD=-55.57, 95% CI=-87.03--24.11, P=0.000 5; MD=-41.33, 95% CI=-70.92--11.73, P=0.006) and aspartate aminotransferase (MD=-71.92，95% CI=-130.02--13.81, P=0.02; MD=-41.45, 95% CI=-60.62--22.28，P=0.000 1; MD=-38.89, 95% CI=-71.14--6.65， P=0.02) on postoperative day (POD) 1, 3 and 7 as well as the levels of total bilirubin (MD=-4.47, 95% CI=-7.75--1.18, P=0.002; MD=-5.09, 95% CI=-10.05--0.12, P=0.04) on POD 3 and 7 were lower in Glissonean pedicle transection group than those in Pringle group, and there were no significant differences in albumin levels on POD 1, 3 and 7 between the two groups (all P>0.05); the amount of intraoperative blood loss (MD=-98.48, 95% CI=-145.53--51.43, P<0.000 1) and transfusion rate (OR=0.25, 95% CI=0.13--0.46, P<0.000 1) in Glissonean pedicle transection group were lower than those in Pringle group, and the operative time had no significant difference between the two groups (P>0.05); the overall postoperative complications (OR=0.31, 95% CI=0.22--0.43, P<0.000 1) and hospital stay (MD=-2.94, 95% CI=-4.12--1.76, P<0.000 01) were less than those in Pringle group.Conclusion Glissonean pedicle transection is a safe and effective vascular occlusion method in hepatectomy for HCC. Compared with Pringle's maneuver, Glissonean pedicle transection can effectively alleviate liver injury, reduce intraoperative bleeding, postoperative complications and shorten hospital stay. However, surgeons should select a suitable method for occlusion based on their own personal experience, patients' conditions, and specific situation during surgery.

Abstract:Background and Aims Hepatocellular carcinoma (HCC) is the most prevalent primary liver cancer, with insidious onset and poor prognosis, and ranks the third leading cause of cancer-related deaths worldwide. KIF4A is highly expressed in a variety of malignancies and strongly associated with poor prognosis. However, the role and mechanism underlying KIF4A in HCC remain unclear. Therefore, this study was conducted to investigate the expression and prognostic value of KIF4A in HCC, and the associated mechanism.Methods The expression data and clinical parameters associated with HCC were obtained from the Cancer Genome Atlas (TCGA) and the expression levels of KIF4A in HCC and its relationship with clinicopathologic features were analyzed using software such as R language and Perl package. The prognostic value of KIF4A in HCC was evaluated by the Kaplan-Meier survival analysis and time-dependent ROC curves. The independent risk factors for the prognosis of HCC patients were determined by univariate and multivariate Cox regression analysis. A nomogram for predicting the prognosis of HCC patients was constructed by including relevant clinicopathologic factors using R software. Immunohistochemical staining was performed to verify the expression levels of KIF4A in the clinical specimens of HCC tissues and their adjacent noncancerous tissues. The molecular signaling pathways potentially regulated by KIF4A in HCC were analyzed by GSEA enrichment analysis.Results The expression level of KIF4A in HCC tissues was significantly higher than that in normal liver tissues (P<0.001). The overall survival (OS) time of patients with high KIF4A expression was shorter than that of those with low KIF4A expression (P=0.002), and the area under curve (AUC) of ROC curves for the 1-, 3-, and 5-year OS were 0.783, 0.662 and 0.574, respectively. The clinical stage (HR=2.084, 95% CI=1.590-2.733，P<0.001), T stage (HR=1.980, 95% CI=1.541-2.543，P<0.001) and KIF4A expression level (HR=1.113, 95% CI=1.062-1.167，P<0.001) were significantly associated with OS, and high expression of KIF4A (HR=1.089, 95% CI=1.034-1.147， P=0.001) was an independent risk factor for the prognosis of HCC patients. The nomogram results showed that KIF4A expression had a significant effect on the total score, while other clinicopathologic factors had relatively little effect on the total score. Immunohistochemical detection confirmed that KIF4A was positively expressed in HCC tissues, whereas it was weakly positively or negatively expressed in adjacent liver tissues. The results of GSEA enrichment analysis suggested that KIF4A was possibly involved in the regulation of nine signaling pathways that included base excision repair, cell cycle, DNA replication, mismatch repair, mTOR signaling pathway, nucleotide excision repair, P53 signaling pathway, pathways in cancer, and phosphatidylinositol signaling system.Conclusion KIF4A is highly expressed in HCC tissue and significantly correlated with the clinical stage and histological grade as well as poor prognosis of HCC patients, suggesting that KIF4A may be a potential molecular marker for prognostic prediction and targeted therapy for HCC patients.

Abstract:Background and Aims Hepatocellular carcinoma (HCC) is currently responsible for one of the leading causes of cancer death worldwide. Accumulating evidence demonstrated that long noncoding RNAs (lncRNAs) can be used as biomarkers of tumor prognosis. However, the relationship between lncRNAs and the survival prognosis of HCC remains unclear. This study was conducted to screen the immune-related lncRNAs associated with the prognosis of HCC, and then construct a prognostic risk model.Methods The transcriptome data and clinical data of HCC were obtained from the Cancer Genome Atlas (TCGA), and the immune-related lncRNAs were extracted. The prognostic immune-related lncRNAs were screened by univariate Cox regression analysis, and were further incorporated into multivariate Cox regression analysis. A prognostic risk model was established using the lncRNAs determined by the optimal AIC value, by which the patient's risk scores were calculated. The patients were divided into low-risk group and high-risk group according to the median risk value. Survival analysis of the two groups of patients was performed and their survival curves were drawn by Kaplan-Meier method. The efficiency of the prognostic risk model was assessed by drawing ROC curve. The associations of clinicopathologic variables and risk score with the overall survival of the patients were determined by univariate and multivariate Cox regression analysis.Results A total of 143 immune-related lncRNAs were extracted from HCC (Cor>0.6, P<0.001). Seventeen prognostic immune-prognostic-related lncRNAs were screened by univariate Cox regression analysis, and 8 of them (AL139384.1, MAPKAPK5-AS1, LINC02362, SLC25A30-AS1, DANCR, AC124798.1, LINC02499 and AC023157.3) were obtained after incorporation into multivariate Cox regression analysis to establish a prognostic risk model. The survival rate of patients in low-risk group was significantly higher than that of patients in high-risk group (P<0.05). The area under the ROC curve of the prognostic risk model was 0.774, and the multivariate Cox regression analysis showed that the risk score was an independent factor influencing the prognosis of HCC patients (HR=1.608, 95% CI=1.351-1.913, P<0.001).Conclusion The establishment of prognostic risk model based on 8 immune-related lncRNAs can effectively predict the survival prognosis of HCC patients, and the risk score is an independent prognostic factor for HCC.

Abstract:Background and Aims With the development and progress of medical imaging technology as well as the strengthening awareness of health maintenance examination among the population, the detection rate of benign liver tumors is continually increasing in clinical practice. Because the lesion volume changes slightly over time, treatment is generally not required. However, it is often difficult to identify the nature of the rare benign space-occupying liver lesions, and sometimes it is difficult to distinguish them from malignant liver tumors. Therefore, timely clinical intervention is necessary. The purpose of this study was to investigate the diagnosis and treatment of rare benign tumors of the liver, and discuss the clinical characteristics, imaging features, pathological features, development and evolution of different tumors, so as to reduce misdiagnosis and make reasonable treatment plan, especially clarify the surgical indications and thereby, avoid overtreatment.Methods The clinical data of 43 patients with rare benign liver tumor (20 cases of hepatic focal nodular hyperplasia, 14 cases of hepatic angiomyolipoma, 4 cases of hepatocellular adenoma, 2 cases of inflammatory pseudotumor, and one case each of liver fibroma, liver schwannoma and liver medullary lipoma) treated in the First Affiliated Hospital of Nan Chang University during May 2014 to May 2019 were reviewed. The clinical diagnosis and treatment results were analyzed.Results The preoperative clinical symptoms of the patients had no specificity, and 11 patients showed related clinical symptoms, of which the most common were abdominal pain, abdominal distension and nausea and vomiting caused by compression of the gastrointestinal tract. The overall diagnostic accuracy of preoperative imaging examination was 51.2% (22/43), and the most frequent misdiagnosis was liver cancer. The surgical methods included open surgery and laparoscopic surgery (31 cases of open surgery and 12 cases of laparoscopic surgery). The average operative time was (195.5±80.3) min, and the average intraoperative blood loss was (419.7±362.3) mL. Postoperative blood transfusion was required for 7 patients, with an average of 4 U. Postoperative complications occurred in 3 (7.0%) patients (1 case of bile leakage, 1 case of pulmonary infection with bilateral pleural effusion, and 1 case of infectious fever), and there was no reoperation or death. Postoperative hospital stay was 3-17 d. In patients undergoing laparoscopic surgery compared with those undergoing open surgery, the intraoperative blood loss of was significantly decreased (468.4 mL vs. 287.5 mL, P=0.027) and the length of postoperative hospital stay was significantly reduced (7.7 d vs. 6.2 d, P=0.040), while no significant differences were noted in other variables (all P>0.05). Follow-up period was conducted for 17.6-77.5 months, during which time no tumor recurrence was observed, and in 10 cases of the 11 the symptomatic patients, the symptoms regressed or disappeared.Conclusion The clinical symptoms of rare benign space-occupying liver lesions lack specificity. Preoperative diagnosis mostly relies on imaging examination, and the diagnostic accuracy is low. The most common misdiagnosis is liver cancer, and imaging omics approach can improve the diagnostic accuracy. Full understanding of the clinical characteristics and features of rare benign space-occupying liver lesions should be prepared to avoid misdiagnosis. Surgery is the most effective treatment, and laparoscopic hepatectomy is recommended. The surgical indications should be strictly grasped, excessive treatment should be avoided, and individualized treatment should be made according to the specific conditions of patients, to improve the level of surgical diagnosis and treatment of rare benign space-occupying liver lesions.

Abstract:Background and Aims Liver fibrosis is a pathological reaction of a series of fibrous tissue proliferation in the liver, and it may cause insufficient or failed regeneration of the liver after hepatectomy. This study was conducted to investigate the effects of transforming growth factor β (TGF-β) pathway on liver function and liver regeneration in animal models of liver fibrosis after partial liver resection, and the possible mechanism.Methods Liver fibrosis was induced by intraperitoneal injection of CCl₄ in 40 SD rats. Then, 32 of them underwent 70% partial resection of the liver, and were sacrificed at postoperative day (POD) 1, 3, 5, and 7 with 8 rats in each time point for determination of the serum liver function parameters, and the mRNA and protein expression levels of TGF-β1 and Smad in liver tissue. The other 8 rats underwent sham operation for control. In addition, using the same modeling procedure, the influence of TGF-β/Smad pathway inhibitor (intraperitoneal injection of GW788388 before operation) on liver function and liver regeneration capacity in rats with liver fibrosis after partial hepatectomy.Results In rats in partial hepatectomy group compared with those in sham operation group, the serum levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were significantly increased on POD 1, and the gradually decreased with time (all P<0.05); the mRNA and protein levels of TGF-β and Smad in the liver tissue were significantly increased, both reached a peak on POD 3 (both P<0.05), and then decreased, and returned to the levels of rats in sham operation group on POD 7 (both P>0.05). In rats undergoing GW788388 injection before hepatectomy compared with those undergoing hepatectomy alone, the increasing amplitudes of AST and ALT were greater, and the expressions of cell proliferation mark Ki-67 and stem cell mark LGR5 were significantly reduced (all P<0.05).Conclusion The TGF-β/Smad signaling pathway plays an important role in terms of liver function protection and liver regeneration promotion in rats with liver fibrosis after partial hepatectomy. The possible mechanism may be associated with the regulatory effect in cell proliferation and stem cell differentiation of this pathway

Abstract:Background and Aims Hypoxia is one of the key features of microenvironment of hepatocellular carcinoma (HCC). Hypoxia can induce the expressions of coding genes and non-coding RNAs thus, affecting the progression of HCC. Previous studies demonstrated that the hypoxia responsive long non-coding RNA (lncRNA) AC114803 is related to the prognosis of renal cell carcinoma. However, its role in HCC has not been studied. Therefore, this study was performed to investigate the relationship between AC114803 expression and hypoxia and its function in HCC cells.Methods After hypoxia exposure, the hypoxia-regulated lncRNAs in Hep3B cells were detected by lncRNA microarray, and then were verified in HCCLM3 and Hep3B cells by qRT-PCR. The expression of AC114803 in HCC tissues and its relationship with the prognosis of patients were analyzed in TCGA samples. In HCCLM3 and Hep3B cells after transfection with AC114803 overexpression plasmids, the changes in proliferative and migration abilities were determined by CCK-8 assay and wound healing assay, and changes in expressions of the relevant proteins were measured by Western blot analysis.Results LncRNA microarray analysis showed AC114803 was one of the significantly changed lncRNAs in Hep3B cells under hypoxia condition, and qRT-PCR verification showed that only the expression in AC114803 was significantly up-regulated in either HCCLM3 cells or Hep3B cells (all P<0.05). TCGA data analysis showed that the expression of AC114803 in HCC tissues were significantly higher than that in normal liver tissues, and the survival rate in patients with high AC114803 expression was significantly lower than in those with low AC114803 expression (both P<0.05). After AC114803 overexpression, the proliferation and migration abilities of HCC cells (HCCLM3 and Hep3B) were significantly enhanced, and the expressions of the mesenchymal markers N-cadherin and vimentin as well as the anti-apoptotic protein bcl-2 and CCND1 were significantly up-regulated, while the epithelial marker E-cadherin and the pro-apoptotic protein bax were significantly down-regulated (all P<0.05).Conclusion Hypoxia can induce the expression of AC114803 in HCC cells, and high expression of AC114803 is closely associated with the poor prognosis of HCC patients. The action of AC114803 may probably be associated with promoting cell proliferation and migration by regulating the epithelial-mesenchymal transition process.

Abstract:Background and Aims Ferroptosis may serve as a new target for antitumor therapy, and apoptosis inducing factor, mitochondrion-associated 2 (AIFM2) is a key regulator of ferroptosis. This study was conducted to analyze the expression level of AIFM2 in hepatocellular carcinoma (HCC), and its relationship with clinicopathologic factors and prognosis of patients, and to investigate the regulatory network of AIFM2 in HCC.Methods The differential expression of AIFM2 in HCC and normal liver tissue was analyzed using Oncomine database and the correlation between the expression of AIFM2 and the clinicopathologic characteristics of patients was determined using UALCAN database. The LinkFinder module of the LinkedOmics data platform was used for GO analysis and KEGG analysis, and the LinkedOmics database was used to analyze the protein kinases, miRNAs, and transcription factors associated with AIFM2 expression. Analysis of the protein interaction networks associated with AIFM2 was performed by the GeneMANIA database, and the frequency and type of AIFM2 mutations in HCC was defined by cBioPortal.Results The AIFM2 mRNA expression and DNA copy number in HCC tissues were higher than that in normal tissues (both P?0.05). AIMF2 was significantly associated with advanced tumors, lymph node metastasis, higher pathological grades, and TP53 mutations (all P<0.05). Patients with high expression of AIFM2 had significantly worse prognosis than those with low expression of AIFM2 (P=0.034). GO and KEGG analysis showed that AIFM2-related genes were mainly enriched in pathways related to mitochondrial and ribosomal functions, and were closely related to cellular oxidative phosphorylation and post-transcriptional translation. GSEA analysis showed that various protein kinases (MAPK1/3/7), miRNAs (miR-30 family) and transcription factors (NFAT) were significantly associated with the expression of AIFM2. C-bioportal analysis showed that the main variant form of AIFM2 in HCC was high mRNA expression but low mutation frequency.Conclusions AIFM2 is highly expressed in HCC and is associated with poor prognosis of patients. AIFM2 is a potential marker for diagnosis and prognosis of HCC. The revealed regulatory network of AIFM2 in HCC lays a foundation for the follow-up study of AIFM2 in HCC.

Abstract:Circular RNAs (circRNAs) are a class of endogenous non-coding RNAs, with a closed circular structure formed through the back-splicing of linear RNAs. CircRNAs widely exist in eukaryotic cells and can be detected in many types of body fluid samples, presenting with stable structure, highly conserved and specific expression, and are important regulators of tumors. CircRNAs exert a "sponge action" mainly by adsorbing microRNAs (miRNAs) or RNA binding proteins (RBPs) to regulate the expression of downstream target genes, and play important role in a variety of diseases, especially in tumors. They are involved in many biological processes such as proliferation, migration, invasion, cell cycle, apoptosis, epithelial-mesenchymal transformation and signaling pathway of tumor cells. Recent studies have shown that circRNAs have critical regulatory functions affecting the occurrence and development of hepatocellular carcinoma (HCC), and they are expected to become the diagnostic biomarkers and therapeutic targets of HCC. Here, the authors address the research progress of the roles of circRNAs in the initiation and progression of HCC.

Abstract:Although medicine has made unprecedented advancements over the last decades, hepatocellular carcinoma (HCC) is still a major unsolved problem. Despite the great progress that has been achieved in respects of exploring the risk factors, molecular characteristics and epidemiology of HCC, there is still a lack of effective means to HCC. With the deepening of research on HCC, hepatic stellate cells (HSCs) have been demonstrated to play a key role in the pathogenesis, development and prognosis of HCC. Here, the authors address HSCs in terms of it regulating HCC through direct and indirect ways, and the prevention and treatment of HCC by targeting the abilities of HSCs.

Abstract:Posthepatitic cirrhosis is usually complicated with portal hypertension, and the latter often causes hypersplenism. Yet, there is controversy about whether splenectomy is necessary for those patients with combined hypersplenism. Those who hold the view of spleen preservation believe that splenectomy will impair immune function, increase the chance of infection and the occurrence of liver tumors, and meanwhile increase the risk of portal vein thrombosis. Those who advocate for splenectomy believe not only that as one of the main surgical treatment methods for portal hypertension, synchronous splenectomy can decrease the portal vein pressure, reduce the occurrence of gastrointestinal bleeding and correct cytopenia, but that the diseased spleen will lead to immune suppression, and splenectomy can improve the immune function of patients, and simultaneously, it can also promote the regeneration of liver cells, improve liver function and inhibit the progression of liver fibrosis. At present, the two sides have different opinions on some issues comparing patients with splenectomy and spleen preservation, such as liver blood flow and portal vein pressure, liver function and blood system, occurrence of thrombosis, immune system and progress of liver fibrosis. Therefore, based on the existing clinical and experimental studies, the authors address the current status and research progress regarding whether splenectomy should be performed in patients with hypersplenism caused by cirrhotic portal hypertension, so as to improve clinical understanding and provide relevant information for clinical decision making.