Xin Hu

Objective: The difficulty in diagnosing hepatocellular carcinoma (HCC) at an early stage is a common challenge faced in the management of malignant liver tumors in both adults and children. Serum alpha-fetoprotein (AFP) is currently the most widely used screening marker; however, it lacks sufficient sensitivity for early-stage HCC and exhibits physiologically elevated levels in infants and young children, which interferes with the accurate diagnosis of hepatoblastoma (HB). Aldo-keto reductase 1B10 (AKR1B10) is a liver cancer-associated protein that has attracted significant attention in recent years. It is frequently overexpressed in adult HCC and can be secreted into the bloodstream; however, its expression and function in pediatric liver tumors have not been reported to date. This study aimed to explore the potential research value of AKR1B10 in pediatric liver malignancies and provide a theoretical basis for expanding its clinical applications. Methods: This narrative review summarizes the molecular structure, catalytic properties, tissue expression patterns, and core molecular mechanisms driving the onset and progression of HCC associated with AKR1B10, as well as its serum diagnostic efficacy and current status of clinical translation in adult HCC. Based on the molecular overlap between adult and pediatric liver tumors in the three signaling pathways—Wnt/β-catenin, lipid metabolism, and retinoic acid signaling—and using theoretical deduction and cross-disease comparative analysis, this study proposes, for the first time, a hypothesis to extend AKR1B10 research to the field of pediatric liver tumors. Proposed Hypotheses: Based on adult HCC evidence and shared molecular pathways, we hypothesize that: (1) AKR1B10 may be upregulated in HB, which could help address the diagnostic blind spots caused by physiological fluctuations in AFP levels during infancy and early childhood; (2) AKR1B10 may serve as an auxiliary serum biomarker for AFP-negative or low-expressing HB subtypes. Conclusion: To our knowledge, this narrative review is the first to propose the potential research value of AKR1B10 in pediatric liver malignancies. This study aims to provide a theoretical foundation and translational direction for future research on AKR1B10 in the pediatric field.

Dialysis-dependent chronic kidney disease (DD-CKD), a severe form of end-stage renal disease (ESRD), currently affects more than three million patients globa... Dialysis-dependent chronic kidney disease (DD-CKD), a severe form of end-stage renal disease (ESRD), currently affects more than three million patients globa...

Background: Fever is a common side effect following thermal ablation in patients with hepatocellular carcinoma (HCC), yet its impact on prognosis remains unclear. Materials and Methods: This retrospective study included initial HCC patients who underwent US-guided percutaneous microwave ablation at 13 hospitals between January 2006 and February 2021. All patients were categorized into afebrile, transient low-grade fever (TLF), and prolonged or high-grade fever (PHF) groups. Primary outcomes included very early recurrence (VER) and early recurrence (ER), secondary outcomes were disease-free survival (DFS) and overall survival (OS). Fever cut-offs for VER/ER were established using restrictive cubic splines and an adjusted Cox model. Survival analyses used the Kaplan–Meier method. Results: A total of 1458 initial HCC patients (mean age, 59±11[SD]; 1146 men). Compared to afebrile individuals, patients with TLF (temperatures ranging 37.0–38.8°C for 1–2 days), showed independent protective effects against VER (HR, 0.73; 95% CI: 0.57–0.95; P =0.02) and ER (HR, 0.66; 95% CI: 0.54–0.81; P P =0.96) and ER (HR, 0.86; 95% CI: 0.69–1.07; P =0.17). With a median follow-up of 47 months (IQR: 26–79), the median DFS for TLF patients was 40 months, superior to afebrile (30 months, P =0.019) and PHF patients (33 months, P =0.049). The 5-year OS rate for TLF patients was 73.2%, higher than afebrile (69.3%, P =0.02) and PHF patients (66.7%, P =0.03). No significant difference was found in DFS and OS between afebrile and PHF patients ( P =0.90 and 0.71). Notably, TLF patients exhibited the highest lymphocyte counts increasing median 7 days after ablation ( P P =0.01 vs. PHF). Conclusion: Transient low-grade fever following percutaneous microwave ablation in hepatocellular carcinoma patients demonstrated protection against early recurrence, possibly attributed to the short-term activation of lymphocytes.