Chiari malformation type I (CMI) is a congenital neurological disorder characterized by the herniation of the cerebellar tonsils through the foramen magnum, which impairs cerebrospinal fluid circulation at the craniocervical junction. The primary hypothesis regarding its pathogenesis involves a mismatch between the posterior cranial fossa volume and the developing nervous tissue, leading to crowding and subsequent herniation. CMI presents a wide range of clinical manifestations, including cerebrospinal fluid-related symptoms, brainstem and cranial nerve compression, and spinal cord dysfunction, typically diagnosed through magnetic resonance imaging. The surgical treatment of adult CMI remains controversial due to its heterogeneous manifestations and the lack of standardized surgical protocols. Posterior fossa decompression (PFD), with or without duraplasty (hereinafter referred to as PFDD), remains the most common intervention. In this review, we focus on the following aspects to provide an overview of the current surgical strategies: 1. Surgical indications; 2. The extent of bony decompression in PFD; 3. Choosing between PFD, PFDD, and the dura-splitting technique; 4. Atlantoaxial fixation; 5. Techniques for intradural procedures; 6. Timing and approach for syrinx shunting. Additionally, emerging surgical innovations, such as endoscopic techniques, offer promising avenues for treatment.

The quantitative effects of alcohol consumption on cirrhosis and hepatocellular carcinoma (HCC) in hepatitis B virus (HBV) infection are unknown. This study aimed to establish a dose-dependent model of alcohol consumption on the risks of cirrhosis and HCC.

PubMed, Embase, the Cochrane Library, Web of Science, and four Chinese databases were searched for studies published from their inception to 15 May 2024. A random-effects model was used to pool the data on the incidence of cirrhosis and HCC, and a dose-dependent model of alcohol’s effect on cirrhosis and HCC was established.

A total of 33,272 HBV patients from 45 studies were included. Compared with non-drinkers, the overall pooled odds ratio (OR) for cirrhosis was 2.61 (95% confidence interval [CI]: 1.46–4.66; I2 = 94%, p < 0.001), and the OR for HCC was 2.27 (95% CI: 1.50–3.43; I2 = 90%, p < 0.001) among drinkers. Compared with low-level drinkers, the estimated pooled OR for cirrhosis was 2.34 (95% CI: 1.59–3.44; I2 = 87%, p < 0.001), and the OR for HCC was 2.42 (95% CI: 1.90–3.09; I2 = 80%, p < 0.001) among high-level drinkers. Furthermore, a linear dose-dependent analysis showed that each daily consumption of 12 g of alcohol increased the risk of cirrhosis by 6.2% and the risk of HCC by 11.5%.

Alcohol dose-dependently increases the risks of cirrhosis and HCC in patients with HBV infection, and patients with daily alcohol consumption of more than 12 g should be strictly monitored.

With progress in basic and clinical research on hepatic encephalopathy in cirrhosis worldwide, the Chinese Society of Hepatology of the Chinese Medical Association has invited experts in relevant fields to revise the 2018 “Chinese Guidelines on the Management of Hepatic Encephalopathy in Cirrhosis.” The updated guidelines provide recommendations for the clinical diagnosis, treatment, and both primary and secondary prevention of hepatic encephalopathy in cirrhosis.

China has made remarkable progress in controlling chronic hepatitis B virus (HBV) infection over the past three decades. The prevalence of hepatitis B surface antigen has declined from 9.72% in 1992 to 5.86% in 2020, with a striking reduction from 9.67% to 0.30% among children under five. Universal hepatitis B vaccination has been pivotal, preventing more than 40 million infections and seven million HBV-related deaths since 1992. Nevertheless, an estimated 75 million individuals are currently living with chronic HBV infection in China. Among them, only 59.78% are aware of their infection status, and about 30 million remain undiagnosed. Of those diagnosed, 38.25% (approximately 17 million) meet the criteria for antiviral treatment, yet only 17.33% (about three million) are receiving treatment. To accelerate progress toward the World Health Organization’s elimination targets, China has updated its clinical guidelines to expand treatment eligibility and improve diagnosis and treatment coverage. Moreover, Chinese pharmaceutical companies and academic institutions are actively engaged in developing novel therapies with promising efficacy, aiming to achieve a functional cure. China’s holistic approach, combining evidence-based public health interventions with active clinical management and innovative pharmaceutical development, provides valuable experience for global HBV elimination initiatives. This review aimed to summarize China's progress in HBV control, identify remaining gaps in diagnosis and treatment, and highlight strategic approaches, including public health interventions, clinical policy updates, and pharmaceutical innovation, toward achieving HBV elimination.

Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death worldwide. Multiple treatment modalities are available for the management of HCC, depending on its stage as determined by the Barcelona Clinic Liver Cancer staging system. Because liver transplantation (LT) theoretically removes the cancer and replaces the organ at risk for future malignancy, LT is often considered the most definitive and one of the most efficacious treatment options for HCC. Nevertheless, the success and efficacy of liver transplantation depend on various tumor characteristics. As a result, multiple criteria have been developed to assess the appropriateness of a case of HCC for LT, with the pioneering Milan Criteria established in 1996. Over the past 20 to 30 years, these criteria have been critically evaluated, expanded, and often liberalized to make LT for patients with HCC a more universally applicable option. Furthermore, the development of other treatment modalities has enabled downstaging and bridging strategies for HCC prior to LT. In this narrative and comprehensive review, we provided an update on recent trends in the epidemiology of HCC, selection criteria for LT, implementation of LT across different regions, treatment modalities available as bridges, downstaging strategies, alternatives to LT, and, finally, post-LT surveillance.

Pancreatic cancer encompasses a heterogeneous group of malignancies, primarily divided into endocrine and exocrine types, with pancreatic ductal adenocarcinoma representing approximately 90% of cases. While the incidence of pancreatic cancer is relatively low, accounting for about 3% of all cancers in the United States, it has a disproportionately high mortality rate, responsible for around 7% of cancer-related deaths. In 2024, it is estimated that there will be 66,440 new diagnoses and 51,750 fatalities associated with this disease. The overall five-year survival rate remains alarmingly low at just 13%, primarily due to late-stage diagnosis; over 80% of pancreatic ductal adenocarcinoma patients present with unresectable tumors and metastases at the time of diagnosis. This review aims to highlight recent advancements in imaging and laboratory tests that are paving the way for innovative screening and diagnostic approaches. Some of the modalities discussed in detail include endoscopic ultrasound (EUS) and its modifications, such as EUS elastography, EUS contrast-enhanced, and EUS Fine Needle Aspiration, as well as multi-detector computed tomography scans, magnetic resonance imaging, and positron emission tomography scans. Furthermore, laboratory tests, such as multi-marker analysis and circulating tumor DNA, alongside traditional markers like carcinoembryonic antigen, carbohydrate antigen 19-9, and carbohydrate antigen 125, are explored. The role of radiomics and proteomics in the early detection of pancreatic cancer is also discussed. These developments hold the promise of improving early detection, which is crucial for enhancing patient outcomes in pancreatic cancer. On the treatment front, conventional therapies, including platinum-based therapies and monoclonal antibodies, are reviewed, alongside innovative therapies such as immunotherapies, chimeric antigen receptor T-cell therapy, and cancer vaccines. It has been increasingly recognized that the intricate patho-mechanisms underlying tumorigenesis in pancreatic cancers necessitate a deeper understanding to facilitate targeted therapeutic strategies. We also explore various newer therapies currently in clinical trials, assessing their practicality and effectiveness in real-world settings.

Inflammatory bowel disease (IBD) is an idiopathic intestinal inflammatory condition affecting the ileum, colon, and rectum, including ulcerative colitis and Crohn’s disease. Clinical symptoms include abdominal pain, diarrhea, and even bloody stools. The intestinal barrier is the first line of defense between the intestinal tract and the external environment, and maintaining its stability is essential for intestinal health. On one hand, it enables the digestion and absorption of water and nutrients; on the other, it plays a crucial role in reducing the absorption of toxins and the invasion of pathogens. Damage to the intestinal barrier has become one of the most important factors in the onset and progression of IBD. However, there is currently no literature that systematically reviews the mechanisms of the intestinal barrier in the pathogenesis of IBD and the factors influencing it. In this paper, we aimed to systematically elaborate on the role of the intestinal barrier in IBD through the perspectives of oxidative stress, intestinal flora, and cellular autophagy. Our goal was to explore the mechanisms of the intestinal barrier in IBD more deeply and to provide new insights for the diagnosis and treatment of IBD. This article will summarize the composition of the intestinal barrier, the factors affecting it, and strategies to protect it.

Memory loss is a symptom of several neurological disorders, including dementia and Alzheimer’s disease (AD). It can significantly impact individuals, their loved ones, and society as a whole. Current pharmaceutical interventions have shown some improvement in individuals’ quality of life, but more needs to be done to reduce the burden of memory loss and AD. This paper investigates herbal remedies for memory loss, with a particular focus on the mechanisms underlying their effects. By consulting several South Asian printed books, numerous traditionally used medicinal plants with memory-enhancing properties were identified. A review of published studies showed that many of these plants have reported properties related to memory enhancement and the treatment of AD. Some of the relevant mechanistic actions reported for these plants include acetylcholinesterase inhibition, anti-inflammatory activity, antioxidant effects, and neuroprotective properties. There is also evidence that some plants exhibit a combination of different mechanisms, making them especially promising as therapeutic agents for memory loss. Our review shows the existence and potential of medicinal plants in addressing memory loss. Additionally, some reports provide a scientific basis for the use of these plants in conditions characterized by memory decline, such as AD. This study underscores the importance of further research to evaluate the efficacy of traditionally used medicinal plants in the management of memory loss.