// <![CDATA[ $('.header-date').hide();$('#titleAuthors').hide();$('#abstractHeader').hide(); // ]]> Qian Zhu1, *, Guo-Liang Qiao2, *, Xiao-Chuan Zeng1, *, Yun Li1, Jian-Jun Yan3, Rui Duan1, Zhi-Yong Du4 1Department of General Surgery, Jingmen First People's Hospital, Jingmen 448000, Hubei Province, China 2Department of Medical Oncology, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Beijing, 100038, China 3First Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China 4Department of Hepatobiliary Surgery, Central Hospital of Wuhan, Wuhan 430014, Hubei Province, China *These authors have contributed equally to this work Correspondence to: Zhi-Yong Du, email: duzhiyong88@163.com Rui Duan, email: duanrui@sina.com Keywords: hepatocellular carcinoma, initiation factors, microarray, prognosis, tumor progression Received: October 07, 2015 Accepted: June 04, 2016 Published: June 22, 2016

Hepatopulmonary syndrome (HPS) is a serious pulmonary complication of progressive liver disease that leads to a poor clinical prognosis. Patients with HPS may develop acute respiratory failure, which requires intensive care and therapy. At present, the only effective treatment is liver transplantation; therefore, early diagnosis and timely treatment are of considerable significance. The three main features of HPS are liver disease, oxygenation disorder, and intrapulmonary vascular dilatation (IPVD). Diagnosing HPS is challenging due to the difficulty in detecting the presence or absence of IPVD. As such, imaging examination is very important for detecting IPVD. This paper reviews the imaging methods for diagnosing HPS such as ultrasound, dynamic pulmonary perfusion imaging, pulmonary angiography, and computed tomography.

Background: Transarterial chemoembolization (TACE) is widely used for unresectable hepatocellular carcinoma (HCC) and as adjuvant therapy to prevent postoperative recurrence. However, accurate prognostic models for HCC patients undergoing TACE remain underutilized clinically. Methods: This retrospective study included 265 HCC patients who underwent TACE, randomly assigned to training and validation sets (6:4 ratio). Recurrence-related risk factors were identified using Cox regression and further screened by Least Absolute Shrinkage and Selection Operator (LASSO) regression. A prognostic nomogram was constructed, with decision curve analysis (DCA) assessing its clinical utility. Results: Univariate Cox regression identified sex, vascular invasion, ascites, modified albumin–bilirubin grade (mALBI), China Liver Cancer (CNLC) staging, white blood cell count, neutrophils, fibrinogen (Fib), and neutrophil-to-lymphocyte ratio as significant risk factors (all HR > 1, P < 0.05). Albumin (ALB), prognostic nutritional index, and alkaline phosphatase-to-albumin ratio (AAPR) were protective factors (all HR < 1, P < 0.05). Multivariate analysis identified elevated Fib and higher CNLC stage as independent predictors (all P < 0.05). LASSO extracted vascular invasion, neutrophils, ALB, activated partial thromboplastin time, Fib, and AAPR as prognostic variables. Areas under the ROC curve at 6 months, 1 year, and 2 years were 0.717, 0.794, and 0.884, respectively. DCA demonstrated greater net clinical benefit than Barcelona Clinic Liver Cancer and CNLC staging systems. Risk stratification by nomogram tertiles showed significantly earlier recurrence in high-risk patients (all P < 0.05). Conclusion: This TACE-based prognostic nomogram integrating clinical and laboratory parameters accurately predicts postoperative recurrence and enables individualized risk stratification, assisting clinicians in tailoring interventions and delivering personalized therapy.

Hepatectomy is widely used for complex hepatobiliary stones, but when diseased bile ducts involve adjacent vessels, traditional methods, relying on extensive dissection or energy devices, often fail to ensure both complete resection and vascular protection, raising risks of bleeding, bile leakage, and liver dysfunction. This protocol introduces a "blunt-and-sharp combination" technique guided by vascular protection, integrating preoperative imaging and intraoperative ultrasound. In a laparoscopic left hemihepatectomy for complex stones, preoperative scans mapped stone distribution and the middle hepatic vein (MHV) course; intraoperative ultrasound localizes the MHV trunk and branches in real time. Sharp dissection of the fibrous bile duct's outer layer is performed with an ultrasonic scalpel, dense MHV-adherent tissue is bluntly peeled away, and low-power electrocoagulation minimizes thermal injury. After exposing the MHV trunk, separate the liver along its sheath plane, clip small branches with biologic clips, and preserve the main trunk. Steps include ultrasound-guided MHV identification, first porta hepatis dissection, selective left liver inflow occlusion, parenchymal splitting along the ischemic line, alternating blunt and precise coagulation to free adhesions, complete removal of the left hemiliver and diseased bile duct tree, and choledochoscopic stone clearance verification. The results of this case include that the operative time was 180 min, blood loss was 50 mL, no bile leakage, and liver function normalized on post-operative day 1. This approach achieves precise anatomical control, fulfilling dual aims of complete biliary resection and vessel preservation. It offers a standardized, minimally invasive, and safe solution for laparoscopic management of complex hepatobiliary stones with vascular involvement, with strong potential for clinical adoption.