Livers

Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world. HCC largely develops in patients with chronic liver diseases, including chronic hepatitis and liver cirrhosis. The surveillance in such patients is extremely important for the detection of HCC as soon as possible. The comprehensive management of HCC is also required because its recurrence frequently occurs. Alpha-fetoprotein (AFP) is widely accepted as a serological tumor marker for HCC and has great diagnostic value. However, its seropositivity is not necessarily suitable for the early detection of HCC. Some novel serological proteins and blood-based biomarkers have been developed in HCC patients who are seronegative for AFP at an early stage. Other serological indicators to predict the recurrence or unfavorable prognosis of HCC have been identified. Moreover, biomarkers to predict treatment outcomes have also been established in those patients. This review summarizes current trends of these serological proteins and blood-based biomarkers for HCC and discusses how to utilize the biomarkers for the early detection and conventional management of HCC.

Laparoscopic cholecystectomy is among the most frequent abdominal operations worldwide, and its safety has improved across three decades. Major vascular injury nonetheless remains a rare but disproportionately lethal complication, capable of producing hepatic ischaemia, biliary stricture, liver failure and death. Bile duct injury has dominated the safety literature; vascular injury—isolated or, more often, combined with bile duct injury as a vasculobiliary injury—has been treated largely as bleeding to be controlled. This review argues that this framing is mistaken. Drawing on the observational literature, guidelines and emerging technologies, it advances one thesis: outcome depends far less on the vessel or repair technique than on where the injury sits on a predictable, systems-level cascade running from distorted anatomy, through cognitive fixation and unsafe dissection, to delayed recognition and non-expert management. We formalise this as the Vasculobiliary Injury Cascade, a three-phase model—predisposition, injury and trajectory—in which every transition is a defensible point of interruption and the determinants of survival lie disproportionately in the final phase. From it we derive a mechanism-specific account of prevention separating arterial misidentification from portal dissection injury, a three-layer defence integrating anatomical recognition, operative decision-making and technology, and a management approach of early recognition and timely referral rather than improvised repair.

Background and Objectives: Patients with decompensated cirrhosis often present with multiple concurrent complications, but the prognostic value of the cumulative complication burden remains unclear. This study evaluated the association between the number of concurrent cirrhosis-related complications and 30-day and 60-day mortality and assessed whether complication burden added prognostic information beyond MELD-Na. Materials and Methods: This prospective cohort study included 128 consecutive adults with decompensated cirrhosis admitted to Da Nang Hospital between January and September 2025. Six cirrhosis-related complications were ascertained during the first 48 h of hospitalization: ascites, jaundice, overt hepatic encephalopathy, acute variceal bleeding, spontaneous bacterial peritonitis, and hepatorenal syndrome. Complication burden was defined as the total number of concurrent complications. The primary outcomes were all-cause mortality within 30 and 60 days. Multivariable logistic regression assessed the independent association of complication count with mortality, and predictive performance was compared among MELD-Na, complication count, and their combined model. Results: The median complication count was 2 (interquartile range, 1–3), and 80 patients (62.5%) had at least two complications. Thirty-day and 60-day mortality occurred in 40 (31.3%) and 48 patients (37.5%), respectively. Mortality increased progressively with complication burden. Thirty-day mortality rose from 14.3% among patients with one complication to 23.9%, 54.5%, and 90.0% among those with two, three, and four complications, respectively. Corresponding 60-day mortality rates were 21.4%, 30.4%, 59.1%, and 100.0% (p for trend < 0.001 for both outcomes). Each additional complication was independently associated with increased 30-day mortality (adjusted odds ratio, 2.51; 95% confidence interval, 1.34–4.69) and 60-day mortality (adjusted odds ratio, 2.75; 95% confidence interval, 1.48–5.12). Adding complication count to MELD-Na yielded AUCs of 0.835 and 0.806 for 30-day and 60-day mortality, respectively, with only modest, non-significant improvements in discrimination. Conclusions: Cirrhosis complication burden was independently associated with short-term mortality and provided partly complementary prognostic information beyond MELD-Na, although its incremental predictive value was modest and requires external validation in larger, multicenter cohorts.