Interaction between tumor cells and immune cells in the tumor microenvironment is important in cancer development. Immune cells interact with the tumor cells to shape this process. Here, we use single-cell RNA sequencing analysis to delineate the immune landscape and tumor heterogeneity in a cohort of patients with HBV-associated human hepatocellular carcinoma (HCC). We found that tumor-associated macrophages suppress tumor T cell infiltration and TIGIT-NECTIN2 interaction regulates the immunosuppressive environment. The cell state transition of immune cells towards a more immunosuppressive and exhaustive status exemplifies the overall cancer-promoting immunocellular landscape. Furthermore, the heterogeneity of global molecular profiles reveals co-existence of intra-tumoral and inter-tumoral heterogeneity, but is more apparent in the latter. This analysis of the immunosuppressive landscape and intercellular interactions provides mechanistic information for the design of efficacious immune-oncology treatments in hepatocellular carcinoma.

Fascial repair alone can be performed for symptomatic small hernias because of its advantage of minimal morbidity. Stoma relocation without formal laparotomy can be advocated for larger hernias. A combination of local resite together with mesh reinforcement may be the alternative for further improvement of results.

Background: Hepatocellular carcinoma (HCC) is highly prevalent in Hong Kong due to the high prevalence of chronic hepatitis B infection. Liver cancer is the fourth most common cancer and the third most common cause of cancer death. Due to the high case load, there is a high level of local expertise in treating HCC, and the full spectrum of treatment modalities is available. This document summarizes how these modalities should be used based on the latest evidence. Summary: In 2 meetings held in early 2017, a multidisciplinary group of Hong Kong clinicians, including liver surgeons, interventional radiologists, clinical oncologists, and medical oncologists, met to update local consensus statements for management of HCC. These statements are based on the latest evidence and give detailed guidance on how to deploy these modalities, in particular for cases of HCC which are not suited to surgical resection. Key Messages: These statements give detailed information on how to decide if a patient is a candidate for resection, methods to improve candidacy for resection, and guidance for use of various nonsurgical interventions to manage patients ineligible for resection.

Introduction This cross-sectional study aimed at evaluating impacts of healthcare simulation training, either in-situ or lab-based, on personal strengths of healthcare workers (HCWs) and organizational outcomes during the COVID-19 pandemic. Methods COVID-19 Taskforce was established to formulate standardized scenario-based simulation training materials in late-January 2020. Post-training questionnaires made up of 5-point Likert scales were distributed to all participants to evaluate their personal strengths, in terms of i) assertiveness, ii) mental preparedness, iii) self-efficacy, iv) internal locus of control, and v) internal locus of responsibility. Independent sample t-tests were used to analyze between-group difference in “In-situ” and “Lab-based” group; and one-sample t-tests were used to compare change in personal strengths with reference point of 3 (Neutral). Kirkpatrick’s Model served as the analytical framework for overall training effects. Results Between 05 February and 18 March 2020, 101 sessions of simulation training were conducted in “In-Situ” at either Accident & Emergency Department (20, 20%) or Intensive Care Unit (15, 14%) and “Lab-based” for Isolation (30, 30%) and General Wards (36, 36%). 1,415 hospital staff members, including 1,167 nurses (82%), 163 doctors (12%) and 85 patient care assistants (6%), were trained. All domains of personal strengths were scored 4.24 or above and statistically significantly increased when comparing with reference population ( p < .001). However, no significant differences between in-situ and lab-based simulation were found ( p > .05), for all domains of personal strengths. Conclusion Healthcare simulation training enhanced healthcare workers’ personal strengths critical to operational and clinical outcomes during the COVID-19 pandemic.

Background and Objective Hong Kong, like many parts of Asia, faces a high burden of hepatocellular carcinoma (HCC) caused by high endemic rates of hepatitis B virus infection. Hong Kong clinicians have developed a high level of expertise in HCC treatment across surgical, transarterial, ablative, radiotherapeutic and systemic modalities. This publication summarizes the latest evidence-based recommendations on how these modalities should be used. Methods In two meetings held in 2020, a multidisciplinary panel of surgeons, oncologists and interventional radiologists performed a narrative review of evidence on the management of HCC, with an emphasis on treatment of HCC not amenable to surgical resection. Close attention was paid to new evidence published since the previous version of these statements in 2018. Key Content and Findings The expert panel has formulated 60 consensus statements to guide the staging and treatment of unresectable HCC. Since the previous version of these statements, considerable additions have been made to the recommendations on use of targeted therapies and immunotherapies because of the large volume of new evidence. Conclusions Our consensus statements offer guidance on how to select HCC patients for surgical or non-surgical treatment and for choosing among non-surgical modalities for patients who are not candidates for resection. In particular, there is a need for more evidence to aid physicians in the selection of second-line systemic therapies, as currently most data are limited to patients with disease progression on first-line sorafenib.

Nowadays, patients' safety is the top priority for medical services around the world. However, it is believed that many of the adverse events in hospitals are preventable. Type and screen (T&S) procedures require intense practical training by each medical practitioner in each hospital. This study applied an interactive Virtual Reality (VR) technology to supplement the traditional approach to facilitate procedural training. The VR system made use of the Unity3D for application development. To investigate the reliability and validity of the conceptual medical training model, a survey was conducted to measure the content, motivation and enhanced readiness of practitioners. The partial least squares (PLS) modelling was carried out to investigate the correlation between each pair of measured variables. The study results indicated that the learning model has good reliability for each measurement factor and validates the survey study. The PLS modelling also indicated a significant correlation between each pair of measured variables. The project developed a VR training program for training in T&S procedures. The study provides important implications on the development of a practical VR training program for medical practitioners, as well as valuable insights for the development of similar VR training programs in the future.

There is no significant difference in the survival rates between the two groups. Adjuvant chemotherapy may not be useful.

HighlightsAssociating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has rarely been reported for patients with hepatocellular carcinoma (HCC).ALPPS is feasible even in the context of HCC with a background of chronic hepatitis B related liver fibrosis.The hypertrophy rate of the liver remnant was slower and the time needed between the two stages of the operation was longer.