Latest ArticlesTo analyze the clinical data of 126 patients with hepatic myelopathy （HM），to summarize their clinical manifestations and prognostic features，and to provide a reference for clinical diagnosis and treatment.
Related clinical data were collected from 126 HM patients who attended The First Hospital of Lanzhou University from January 1，2016 to June 30，2025，and according to their muscle strength on admission，they were divided into grade<3 group，grade 3 group，and grade 4 group. The three groups were compared in terms of the clinical data including etiology，symptoms，clinical signs，past history，personal history，laboratory test results，imaging findings，treatment，and outcome. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups，and the least significant difference t-test was used for further comparison between two groups； the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups，and the Bonferroni correction method was used for further comparison between two groups； the chi-square test was used for comparison of categorical data between multiple groups.
All 126 patients with HM were comorbid with liver cirrhosis，with a male/female ratio of 2.7∶1，an age of 23 — 73 years，a mean age of 53.9±9.3 years，and a median age of 54 years. The top three etiologies of liver cirrhosis were hepatitis B in 78 patients （61.9%），hepatitis C in 9 patients （7.1%），and alcoholic hepatitis in 8 patients （6.3%）. During the course of the disease，all 126 patients with HM showed weakness in both lower limbs，among whom 9 patients （7.1%） also had the symptoms of lower limb pain and numbness. Among the 126 patients，3 （2.4%） had grade 0 muscle strength，4 （3.2%） had grade 1 muscle strength，9 （7.1%） had grade 2 muscle strength，39 （31.0%） had grade 3 muscle strength，and 71 （56.3%） had grade 4 muscle strength. Comparison of related data between the three groups of patients with varying grades of muscle strength showed that as for comorbidities，there were significant differences between the three groups in the constituent ratios of overt hepatic encephalopathy （OHE） （χ2=6.254，P=0.044），ascites （χ2=6.248，P=0.044），and liver failure （χ2=7.704，P=0.029）； as for laboratory markers，there were significant differences between the three groups in red blood cell count （RBC） （F=5.334，P=0.006），hemoglobin （HGB） （F=4.627，P=0.012），aspartate aminotransferase （AST） （H=6.866，P=0.032），alanine aminotransferase （H=6.444，P=0.040），albumin （Alb） （F=6.331，P=0.002），cholinesterase （ChE） （H=11.064，P=0.004），total cholesterol （TC） （F=4.843，P=0.009），prothrombin activity （PTA） （F=3.937，P=0.022） and international normalized ratio （INR） （H=6.448，P=0.040）. Compared with the grade 4 group，the grade<3 group had significantly lower levels of RBC，HGB，and ChE （all P<0.05） and a significantly higher level of AST （P<0.05）； compared with the grade 3 group，the grade<3 group had significant reductions in Alb，TC，and PTA （all P<0.05） and a significant increase in INR （P<0.05）. At discharge，27 patients （21.4%） achieved improvement，and 99 patients （78.6%） showed no response，among whom 2 patients died.
HM has the main clinical manifestation of symmetrical spastic paraplegia of both lower limbs，and it is more common in men. The main causes of HM include hepatitis B，hepatitis C，and alcoholic hepatitis. Muscle strength in HM patients is associated with the comorbidity of OHE，ascites，or liver failure，and patients with weak muscle strength tend to have low levels of RBC，HGB，Alb，ChE，TC，and PTA and high levels of AST and INR，suggesting that the changes in these indicators may be correlated with the degree of muscle strength impairment. HM often has a poor prognosis，and there are currently no effective treatment methods.
To construct and validate a risk assessment model for post-transplant diabetes mellitus （PTDM） using multiple machine learning algorithms，and to realize the early identification of PTDM.
A retrospective analysis was performed for the clinical data of the patients who underwent allogeneic liver transplantation in The First Hospital of Shanxi Medical University from April 1，2020 to December 31，2024，and they were randomly divided into a training set and a validation set at a ratio of 7∶3. The LASSO regression analysis combined with 5-fold cross-validation was used for feature selection. Seven machine learning models were developed in the training set，i.e.，logistic regression （LR），decision tree （DT），Naive Bayes （NB），random forest （RF），K-nearest neighbor （KNN），extreme gradient boosting （XGBoost），and adaptive boosting （AdaBoost）. In the validation set，various methods were used to assess the predictive performance of each model，such as accuracy，precision，recall rate，specificity，F1 score，area under the receiver operating characteristic curve （AUROC），and area under the precision-recall curve （AUPRC）. The Brier score and decision curve analysis were used to assess the calibration and clinical practicability of the models，and the SHAP method was used to analyze feature importance. The independent-samples t test or the Wilcoxon rank-sum test was used for comparison of continuous data between two groups，and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.
A total of 135 liver transplant recipients were enrolled，among whom 26 developed PTDM，and there were 94 patients in the training set and 41 in the validation set. Feature extraction and screening identified 7 key features of sex，overweight or obesity，anhepatic phase，time of operation，length of hospital stay，early postoperative hypomagnesemia，and impaired fasting glucose （IFG）. In the validation set，the XGBoost model showed the best predictive performance，with an AUROC of 0.907 （95% confidence interval ［CI］：0.807 — 0.989），an AUPRC of 0.649 （95%CI：0.339 — 0.955），an accuracy of 0.878，a precision of 0.667，a recall rate of 0.750，an F1-score of 0.706，a specificity of 0.909，and a Brier score of 0.104. The decision curve analysis showed that when the threshold probability was below 0.667，application of the XGBoost model in clinical decision-making provided relatively high net benefit. The SHAP analysis showed that the length of hospital stay ranked first in terms of feature importance，followed by time of operation，overweight or obesity，sex，IFG，anhepatic phase，and early postoperative hypomagnesemia.
The risk assessment model for PTDM in liver transplant recipients based on XGBoost algorithm has excellent performance and can effectively identify high-risk individuals； however，multicenter large-sample data are needed for further validation.
To investigate the safety and efficacy of transparent cap-assisted peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy （EHL）.
A retrospective analysis was performed for the clinical data of 60 patients with large common bile duct stones who were admitted to Department of Gastroenterology，Jilin People’s Hospital，from May 1，2023 to January 31，2026，and according to the treatment method，the patients were divided into transparent cap-assisted peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy group and peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy group，with 30 patients in each group. The two groups were compared in terms of the rate of successful single-session stone fragmentation and removal，procedural time，duration of electrohydraulic lithotripsy，clinical success rate，and complications. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups，and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.
Compared with the peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy group，the transparent cap-assisted peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy group had a significantly higher technical success rate （83.33% vs 60.00%，χ2=4.022，P=0.045） and significantly shorter procedural time ［46.00 （42.25 — 49.00） min vs 54.50 （42.00 — 65.00） min，Z=2.012，P=0.044］ and duration of electrohydraulic lithotripsy ［8.00 （6.25 — 11.75） min vs 13.50 （9.25 — 17.75） min，Z=2.749，P=0.006］. Both groups achieved a clinical success rate of 100%，with no significant difference in the incidence rate of complications （P>0.05）.
Transparent cap-assisted peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy has a high rate of successful single-session stone fragmentation and removal and a short procedural time，with good safety and efficacy，and therefore，it holds promise for clinical application.
To investigate the risk factors for post-acute pancreatitis diabetes mellitus （PPDM-A） in patients with acute pancreatitis （AP），to construct a nomogram prediction model，and to provide a reference for the development of individualized treatment regimens.
A total of 351 patients with AP who were admitted to Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University from June 2021 to January 2025 were prospectively enrolled，and they were randomly divided into modeling group with 246 patients and validation group with 105 patients at a ratio of 7∶3. According to the presence or absence of PPDM-A in the patients with AP，the modeling group was further divided into PPDM-A group with 86 patients and non-PPDM-A group with 160 patients. Clinical data were collected from all patients. The least absolute shrinkage and selection operator （LASSO） regression analysis was used to determine independent variables，and a Logistic regression analysis was used to investigate the influencing factors for PPDM-A. R software was used to construct a nomogram model. The receiver operating characteristic curve was used to assess the discriminatory ability of the model，and the Hosmer-Lemeshow test was used to test the model fitting degree，and the calibration curve was used to evaluate the model consistency； and decision curve analysis （DCA） was used to assess its clinical application value. The independent-samples t test was used for comparison of continuous data between two groups，and the chi-square test was used for comparison of categorical data between two groups.
Among the 246 patients，86 developed PPDM-A，resulting in an incidence rate of 34.96%. There were significant differences between the PPDM-A group and the non-PPDM-A group in the proportion of patients with an age of ≥60 years （65.12% vs 40.62%，P<0.05），male sex （75.58% vs 55.63%，P<0.05），a body mass index （BMI） of ≥24 kg/m2 （63.95% vs 37.50%，P<0.05），alcoholic AP （56.98% vs 36.87%，P<0.05），moderate-to-severe AP （54.65% vs 35.00%，P<0.05），or a computed tomography severity index （CTSI） score of ≥4 points （48.84% vs 28.75%，P<0.05），as well as significant differences in the levels of blood calcium （1.46±0.35 mmol/L vs 1.89±0.37 mmol/L，P<0.05） and random blood glucose （Glu） （17.68±4.12 mmol/L vs 11.68±4.27 mmol/L，P<0.05）. The LASSO regression analysis obtained 8 independent variables. The Logistic regression analysis showed that age，sex，BMI，alcoholic AP，moderate-to-severe AP，CTSI score，and Glu were risk factors for PPDM-A （all P<0.05），while blood calcium was a protective factor （P<0.05）. The model had an area under the ROC curve （AUC） of 0.932 （95% confidence interval ［CI］：0.903 — 0.962） in the modeling group，and the Hosmer-Lemeshow goodness-of-fit test yielded χ2=7.346 （P=0.728），the accuracy of model fitting was good； the calibration curve showed that the predicted probability was consistent with the actual probability，indicating that the consistency was good. The model had an AUC of 0.835 （95%CI：0.753 — 0.917） in the validation group，and the Hosmer-Lemeshow goodness-of-fit test yielded χ2=7.014 （P=0.711），the accuracy of model fitting was good； the calibration curve showed that the predicted probability was consistent with the actual probability，indicating that the consistency was good. The DCA results of the modeling group showed that the model exhibited a high clinical value in evaluating PPDM-A when the threshold probability was 0.13 — 0.94.
Age，sex，BMI，alcoholic AP，moderate-to-severe AP，blood calcium，CTSI score，and Glu are influencing factors for PPDM-A. The nomogram model constructed based on the above influencing factors shows good performance in predicting the risk of PPDM-A and can thus provide a reference for developing prevention strategies for PPDM-A in clinical practice.
To systematically clarify the expression profile of splicing factor 3B subunit 6 （SF3B6） in pancreatic cancer，its clinical prognostic value，and its regulatory effect on the malignant phenotype of cancer cells through bioinformatics analysis，clinical sample validation，and in vitro functional experiments，and to assess its potential as a novel tumor biomarker.
Transcriptomic and clinical data were downloaded from The Cancer Genome Atlas and Xena public databases at The University of California Santa Cruz to investigate the difference in the expression of SF3B6 between pancreatic cancer tissue and normal pancreatic tissue，and the association of SF3B6 with the prognosis and clinical indices of patients with pancreatic cancer was analyzed. Three pancreatic ductal adenocarcinoma cell lines and one normal pancreatic ductal epithelial cell line were cultured，and RT-qPCR was used to measure the expression level of SF3B6 in pancreatic cancer. A total of 43 patients with pancreatic cancer who underwent surgery in Binzhou Medical University Hospitalfrom January 2024 to December 2025 were enrolled as subjects，and Western blot and RT-qPCR were used to measure the expression of SF3B6 in pancreatic cancer tissue. Based on the median expression level of SF3B6 measured by RT-qPCR，the patients were divided into high and low expression groups. The association of SF3B6 expression with clinical features and prognosis was assessed. A pancreatic cancer cell line with stable low SF3B6 expression was constructed，and CCK-8 assay and Transwell migration and invasion assays were used to observe the impact of SF3B6 on the biological behaviors of the pancreatic cancer cell line，including proliferation，migration，and invasion. The independent-samples t test was used for comparison of normally distributed continuous data between two groups，and a one-way analysis of variance was used for comparison between multiple groups，while the least significant difference t-test or the Games-Howell test was used for further comparison between two groups； the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two groups. The chi-square test was used for comparison of categorical data between two groups. A Logistic regression analysis was used to investigate the influencing factors for the expression of SF3B6，and the univariate and multivariate Cox proportional-hazards regression model analyses were used to investigate the risk factors for prognosis.
The bioinformatics analysis showed that SF3B6 was highly expressed in pancreatic cancer tissue （P<2.2×10-16） and significantly affected the overall survival （P=0.011） and progression-free survival （P=0.002） of patients with pancreatic cancer. Sex，age，clinical stage，and TNM stage were not influencing factors for SF3B6 expression （all P>0.05），and SF3B6 could be used as an independent risk factor for the survival outcome of patients with pancreatic cancer （overall survival：hazard ratio=2.26，95% confidence interval：1.13 — 4.50，P=0.021； progression-free survival：hazard ratio=2.37，95% confidence interval：1.22 — 4.58，P=0.010）. Cellular and tissue experiments confirmed the high expression level of SF3B6 in pancreatic cancer cell lines （P<0.05），and the expression level of SF3B6 increased with the increase in the malignancy of pancreatic cancer，showing the highest relative expression level in PANC-1 cells with the highest degree of malignancy； the expression level of SF3B6 in the solid tissue of pancreatic cancer was significantly higher than that in paracancerous tissue （P<0.01）. The expression level of SF3B6 might affect the overall survival of patients with pancreatic cancer （P<0.05），while it showed no significant association with age，sex，pathological grade，maximum tumor diameter，or clinical stage （all P>0.05）. Knockdown of SF3B6 significantly inhibited the proliferation，migration，and invasion of pancreatic cancer cells （all P<0.01）.
SF3B6 is highly expressed in pancreatic cancer，and the high expression of SF3B6 can promote the proliferation，migration，and invasion of pancreatic cancer cells. Therefore，SF3B6 can be used as a potential biomarker for prognostic evaluation.
Distal cholangiocarcinoma （dCCA） often has subtle symptoms in its early stage，and the optimal surgical timing is often missed at the time of diagnosis. This article reports a patient with dCCA who attended the hospital due to obstructive jaundice. Although the patient had a history of liver fluke infection and positive serological results，persistent stricture of the common bile duct remained unrelieved after adequate drainage and infection control. Due to the longitudinal growth pattern of the tumor，multiple endoscopic biopsies yielded false-negative results. Multidisciplinary consultation recommended a 1-month follow-up，but the patient failed to return to hospital for review and was found to have liver metastasis （stage Ⅳ） at the time of confirmed diagnosis，and thus the patient missed the opportunity for radical surgery. This article summarizes the common pitfalls and lessons in the early diagnosis of dCCA and proposes that for highly suspected cases in clinical practice，it is crucial to conduct multidisciplinary diagnosis and treatment，integrate dynamic imaging and tumor marker monitoring，and implement proactive structured evaluations，so as to avoid diagnostic and therapeutic delays and ultimately improve the prognosis of patients.
Periampullary carcinoma is a malignant tumor of the biliopancreatic system originating from the ampulla of Vater，with the main pathological subtypes of intestinal-type and pancreatobiliary-type adenocarcinoma. Primary periampullary squamous cell carcinoma is relatively rare in clinical practice，with great difficulties in preoperative diagnosis and a lack of clinical experience and standardized diagnosis and treatment regimens. This article reports a case of primary periampullary squamous cell carcinoma in a male patient aged 55 years. The patient was admitted due to cutaneous and scleral jaundice for 2 weeks. Laboratory examination revealed obstructive jaundice，impaired liver function，and an increase in carbohydrate antigen 19-9，and radiological examination showed obstruction of the distal common bile duct and a space-occupying lesion in the ampullary region，leading to a preliminary clinical diagnosis of periampullary carcinoma of Vater. After admission，endoscopic retrograde cholangiopancreatography was first performed to relieve obstructive jaundice，and then biopsy of the ampullary lesion was conducted，with pathological findings highly suspicious for malignancy. Radical pancreaticoduodenectomy was performed after improvement in liver function，and postoperative pathology confirmed the diagnosis of moderately differentiated squamous cell carcinoma of the ampulla. PET-CT reexamination on day 52 after surgery showed well-healed surgical anastomosis and multiple hypermetabolic nodules in the right hepatic lobe，which could not rule out tumor metastasis. This case report can provide a reference for improving awareness of this rare disease and optimizing related diagnosis and treatment decisions in clinical practice.
Metabolic dysfunction-associated fatty liver disease （MAFLD） has become the most common chronic liver disease worldwide. Its pathological process is centered on the “two-hit” theory，with gut-liver axis dysregulation running through the entire disease course from steatosis to liver cirrhosis and even hepatocellular carcinoma，and it forms an extensive cross-system regulatory mechanism with the metabolic，cardiovascular，renal，and psychological and nervous systems through multi-dimensional pathways such as the “gut-liver-brain axis”，the “liver-kidney axis”，and the “liver-heart axis”. Disease progression is not limited to the liver itself，and it also involves functional imbalance of multiple organ systems throughout the body. This article systematically elaborates on the association mechanism of “liver pathological progression-multi-axis regulation-comorbidity occurrence” in MAFLD，proposes synergistic management strategies integrating early screening based on risk stratification，targeted intervention，and multidisciplinary diagnosis and treatment，and analyzes the limitations of current research and future development directions，in order to provide a theoretical basis and practical guidance for precise diagnosis and treatment and individualized management of MAFLD.
Metabolic dysfunction-associated fatty liver disease （MAFLD） is a chronic liver disease with a persistently high prevalence rate worldwide. Its pathogenesis involves metabolic disorders in multiple systems，and there is still a lack of a complete theoretical regulatory framework. Lactate was once regarded as a terminal metabolic waste product of the glycolytic pathway； however，studies in recent years have been exploring its biological functions as a key signaling molecule，and the close association between dysregulated lactate metabolism and the development and progression of MAFLD has gradually become a research hotspot in the field of metabolic liver diseases. This article systematically introduces the core pathways and regulatory patterns of lactate metabolism，elaborates on the overall functional characteristics of lactate in the development and progression of MAFLD，and reviews the molecular mechanisms by which lactate mediates hepatic lipid metabolism disorders and drives inflammatory cascades through epigenetic regulatory mechanisms such as protein lactylation. In addition，it briefly describes the potential effect of lactate in modulating liver metabolic homeostasis via the gut-liver axis and summarizes the latest research advances in lactate metabolism and MAFLD. This article highlights that targeting lactate metabolic pathways is a critical entry point for deepening the understanding of the pathophysiological mechanisms of MAFLD，and it points out that non-canonical regulatory modes represented by lactylation are key breakthrough directions for future research. It also proposes that developing early diagnostic biomarkers and intervention targets for MAFLD based on the lactate metabolic network holds important theoretical value and clinical translation potential.
Metabolic dysfunction-associated fatty liver disease （MAFLD） is the most common chronic liver disease，and it has become a major global health issue. Excessive lipid accumulation in the liver is the core pathological event of MAFLD，which triggers lipotoxicity and leads to cell apoptosis，necrosis，and inflammatory cascades by mediating endoplasmic reticulum stress，oxidative stress，organelle dysfunction，and ferroptosis，thereby promoting the progression of simple hepatic steatosis to steatohepatitis and fibrosis. In this process，very-long-chain fatty acids （VLCFAs），as essential components of cell membranes and lipid metabolism，have attracted increasing attention for their role in lipotoxicity mechanisms. This article reviews the role of VLCFAs in lipid metabolism processes and lipotoxicity mechanisms，focusing on how VLCFAs participate in metabolic regulation through key proteins and disrupt cell membranes to induce oxidative stress，and how their metabolites and derivatives drive inflammatory responses，ultimately promoting the progression of MAFLD.
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