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Yufei Gu, Fengyu Zheng, Yingxuan Zhang, Shishi Qiao Department of Hepatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, People’s Republic of ChinaCorrespondence: Shishi Qiao, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, No. 50 Jianshe East Road, Erqi District, Zhengzhou City, Henan Province, People’s Republic of China, Tel +86 18595811956, Email qiaoshishiv@163.comPurpose: We aimed to develop and to validate a novel nomogram based on inflammatory markers to preoperatively predict microvascular invasion (MVI) in patients with solitary primary hepatocellular carcinoma (HCC).Patients and Methods: Data from 658 patients with solitary primary HCC who underwent hepatectomy at the First Affiliated Hospital of Zhengzhou University from June 2018 to October 2021 were retrospectively analyzed. Patients were divided into training (n=441) and validation (n=217) cohorts according to surgical data. Independent risk factors for MVI were identified via univariate and multivariate logistic regression analyses in the training cohort. A novel nomogram was developed based on the independent risk factors identified. Its accuracy was evaluated using a calibration curve and concordance index (C-index). The predictive value was evaluated using the receiver operating characteristic (ROC) curve and decision curve analysis (DCA).Results: Preoperative alpha-fetoprotein > 969 μg/L (P< 0.001), tumor size (P=0.002), neutrophil > 1.8× 109/L (P=0.002), gamma-glutamyl transpeptidase-to-platelet ratio (GPR) > 0.32 (P=0.001), aspartate aminotransferase-to-platelet ratio (APR) > 0.18 (P< 0.001), gamma-glutamyl transpeptidase-to-albumin ratio (GAR) > 2.30 (P=0.001), and gamma-glutamyl transpeptidase-to-lymphocyte ratio > 29.58 (P< 0.001) were identified as preoperative independent risk factors for MVI and were used to establish the nomogram. The C-index of the training and validation cohorts were 0.788 (95% confidence interval [CI]: 0.744– 0.831) and 0.735 (95% CI: 0.668– 0.802), respectively. The calibration curve analysis revealed that the standard curve fit well with the predicted curve. ROC curve analysis demonstrated high efficiency of the nomogram. DCA verified that the nomogram had notable clinical value.Conclusion: Preoperative GPR > 0.32, APR > 0.18, and GAR > 2.30 were independent risk factors for MVI in patients with solitary primary HCC, suggesting their utility as preoperative predictors of MVI. The novel nomogram developed and validated in this study may aid in determining optimal therapeutic approaches for patients with solitary HCC at risk for MVI.Keywords: hepatocellular carcinoma, microvascular invasion, preoperative prediction, nomogram

Guangtong Deng,1 Lei Yao,1 Furong Zeng,2 Liang Xiao,1,* Zhiming Wang1,* 1General Surgery Department, Xiangya Hospital, Central South University, Changsha, People’s Republic of China; 2Xiangya School of Medicine, Central South University, Changsha, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhiming Wang; Liang XiaoGeneral Surgery Department, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha 410008, People’s Republic of ChinaTel +8618773132682Email a846957007@163.com; xiaoliangrick@csu.edu.cnObjective: To preoperatively predict the microvascular invasion (MVI) risk in hepatocellular carcinoma (HCC) using nomogram.Methods: A retrospective cohort of 513 patients with HCC hospitalized at Xiangya Hospital between January 2014 and December 2018 was included in the study. Univariate and multivariate analysis was performed to identify the independent risk factors for MVI. Based on the independent risk factors, nomogram was established to preoperatively predict the MVI risk in HCC. The accuracy of nomogram was evaluated by using receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA).Results: Tumor size (OR=1.17, 95% CI: 1.11–1.23, p

Zhen Wang,1,* Chong Zheng,2,* Siyuan Wen,1 Junfei Wang,1 Zitao Zhang,1 Xusheng Qiu,1 Yixin Chen11Department of Orthopedics, Drum Tower Hospital Clinical College of Nanjing University, Nanjing, People’s Republic of China; 2Department of Orthopedics, Changzhou Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Changzhou, People’s Republic of China*These authors contributed equally to this workPurpose: Infected nonunion after open reduction internal fixation (ORIF) is a serious complication. The aim of this study was to evaluate the usefulness of serum D-dimer for preoperative diagnosis of infected nonunion.Patients and methods: Patients undergoing debridement and external fixation for infected nonunion (n=32) and replacement of internal fixation due to aseptic failure (n=34) were enrolled and compared in this retrospective study. The optimum cutoff value of D-dimer for identification of infected nonunion was determined by calculating the Youden J statistic. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of four preoperative laboratory parameters—serum D-dimer level, white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP)—for diagnosis of infected nonunion were compared.Results: Serum D-dimer level was significantly higher in patients with infected nonunion than in patients with aseptic nonunion: 2.62 mg/mL (range, 0.13–11.90 mg/mL) vs 0.35 mg/mL (range, 0.07–6.46 mg/mL; p1.70 mg/mL) were 75.0% (95% CI: 56.25–87.87) and 91.2% (95% CI: 75.19–97.69).Conclusions: Serum D-dimer level may be useful for preoperative prediction of infected nonunion in patients after ORIF.Keywords: fracture-related infection, laboratory test, preoperative prediction, nonunion