Publisher Correction: Analysis of the Human Protein Atlas Image Classification competition.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Author Correction: Analysis of the Human Protein Atlas Image Classification competition.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Publisher Correction: Analysis of the Human Protein Atlas Image Classification competition.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Regional geometric differences between regurgitant and non-regurgitant mitral valves in patients with coronary artery disease.

OBJECTIVE: Demonstrate that regional geometric differences exist between regurgitant and non-regurgitant mitral valves (MV's) in patients with coronary artery disease and due to the heterogenous and regional nature of ischemic remodeling in patients with coronary artery disease (CAD), that the available anatomical reserve and likelihood of developing mitral regurgitation (MR) is variable in non-regurgitant MV's in patients with CAD. METHODS: In this retrospective, observational study intraoperative three-dimensional transesophageal echocardiographic data was analyzed in patients undergoing coronary revascularization with MR (IMR group) and without MR (NMR group). Regional geometric differences between both groups were assessed and MV reserve which was defined as the increase in antero-posterior (AP) annular diameter from baseline that would lead to coaptation failure was calculated in three zones of the MV from antero-lateral (zone 1), middle (zone 2), and posteromedial (zone 3). MEASUREMENTS AND MAIN RESULTS: There were 31 patients in the IMR group and 93 patients in the NMR group. Multiple regional geometric differences existed between both groups. Most significantly patients in the NMR group had significantly larger coaptation length and MV reserve than the IMR group in zones 1 (p-value = .005, .049) and 2 (p-value = .00, .00), comparable between the two groups in zone 3 (p-value = .436, .513). Depletion of the MV reserve was associated with posterior displacement of the coaptation point in zones 2 and 3. CONCLUSIONS: There are significant regional geometric differences between regurgitant and non-regurgitant MV's in patients with coronary artery disease. Due to regional variations in available anatomical reserve and the risk of coaptation failure in patients with CAD, absence of MR is not synonymous with normal MV function.

Co-teaching in medicine and nursing in training nurse anesthetists: a before-and-after controlled study.

BACKGROUND: Clarifying the effectiveness of co-teaching in medicine and nursing (CMN) is important as it is crucial in clinical practice to improve the quality of patient care and prognosis. In this study, we aimed to determine the efficacy of CMN in nurse anesthetist training. METHOD: The study comprised a 6-month training session and a before-and-after controlled study. In total, 59 nurses were recruited. The first 30 nurses were enrolled in the conventional single-teaching in nursing (SN) group and only took nursing-related courses. The next 29 students were enrolled in the CMN group and received both general medical and nursing-specific curricula. Before and after training, medical and nursing collaboration competency scores and knowledge scores were compared between the two groups. At the end of the study, qualitative comments on teaching satisfaction and clinical reasoning skills improvement were queried, and content analysis was performed. RESULTS: Participants in the CMN group outperformed those in the SN group in tests of medical and nursing collaboration abilities as well as knowledge. The CMN group outperformed the SN group in terms of teaching satisfaction evaluation, particularly in terms of fostering learning in the anesthetist specialty, improving clinical practice, fostering motivation, and influencing how people think about challenges at work. Furthermore, participants in the CMN group felt that their clinical reasoning abilities had improved. CONCLUSION: In comparison to the SN group, the CMN group had enhanced outcomes of patient care, medical and nursing collaboration, and clinical reasoning skills.

Analysis of the Human Protein Atlas Image Classification competition.

Pinpointing subcellular protein localizations from microscopy images is easy to the trained eye, but challenging to automate. Based on the Human Protein Atlas image collection, we held a competition to identify deep learning solutions to solve this task. Challenges included training on highly imbalanced classes and predicting multiple labels per image. Over 3 months, 2,172 teams participated. Despite convergence on popular networks and training techniques, there was considerable variety among the solutions. Participants applied strategies for modifying neural networks and loss functions, augmenting data and using pretrained networks. The winning models far outperformed our previous effort at multi-label classification of protein localization patterns by ~20%. These models can be used as classifiers to annotate new images, feature extractors to measure pattern similarity or pretrained networks for a wide range of biological applications.

Circular noncoding RNA circ_0007334 sequestrates miR-577 to derepress KLF12 and accelerate colorectal cancer progression.

Colorectal cancer (CRC) is a prevalent malignant tumor with a poor prognosis. Circular RNA (circRNA) circ_0007334 is related to cell proliferation in CRC. This study is designed to explore the role and mechanism of circ_0007334 in CRC progression. Circ_0007334, microRNA-577 (miR-577) and kruppel-like factor 12 (KLF12) levels were measured by real-time quantitative PCR (RT-qPCR). Exosomes were detected by a transmission electron microscope and nanoparticle tracking analysis (NTA). CD63, TSG101, matrix metallopeptidase-2 (MMP-2), MMP-9, VEGFA and KLF12 protein levels were examined by western blot assay. The binding relationship between miR-577 and circ_0007334 or KLF12 was predicted by circRNA interactome or Starbase and verified by a dual-luciferase reporter and RNA immunoprecipitation (RIP) assays. Cell viability, colony number, migration, invasion and angiogenesis were detected by cell counting kit-8 (CCK-8), colony formation, wound healing, transwell and tube formation assays. The biological role of circ_0007334 was examined by the xenograft tumor model in vivo. Circ_0007334 and KLF12 were increased, and miR-577 was decreased in CRC tissues and cells. Also, circ_0007334 expression was upregulated in CRC cell-derived exosomes. Circ_0007334 deficiency repressed cell viability, colony formation, migration, invasion, and angiogenesis in CRC cells. Mechanically, circ_0007334 could regulate KLF12 expression by sponging miR-577. Circ_0007334 downregulation or exosomal circ_0007334 silencing blocked CRC tumor growth in vivo. These results presented that circ_0007334 deficiency exerts a tumor-suppressor by the miR-577/KLF12 axis in CRC, and indicated that exosomal circ_0007334 could hinder CRC tumor growth and angiogenesis in vivo. Our findings provided a novel therapeutic strategy for CRC.

circ_0101802 functions as a sponge of miR-1236-3p to facilitate the proliferation, migration and invasion of colorectal cancer via regulating MACC1.

Circular RNAs (circRNAs) have been shown to be involved in the progression of many diseases, including cancer. However, the role of circ_0101802 in the proliferation, migration and invasion of colorectal cancer (CRC) has not been studied. Our results showed that circ_0101802 was highly expressed in CRC tumor tissues and cells. Functional experiments suggested that circ_0101802 knockdown could inhibit the proliferation, migration and invasion of CRC cells in vitro and CRC tumorigenesis in vivo. In the terms of mechanism, we discovered that circ_0101802 could act as a sponge of miR-1236-3p, and miR-1236-3p could target MACC1. The rescue experiments revealed that miR-1236-3p inhibitor could reverse the inhibition effect of circ_0101802 silencing on CRC proliferation, migration and invasion, and MACC1 overexpression also could abolish the negative regulation of miR-1236-3p on CRC proliferation, migration and invasion. More important, our data confirmed that circ_0101802 sponged miR-1236-3p to positively regulate MACC1. In summary, our results revealed that circ_0101802 functioned as a tumor promoter in CRC, which could facilitate CRC proliferation, migration and invasion via regulating the miR-1236-3p/MACC1 axis.

Risk Factors and Prognosis of New-Onset Chronic Kidney Disease Following Orthotopic Liver Transplantation: A Retrospective Case-Control Study.

BACKGROUND We have undertaken this investigation to explore the perioperative risk factors of new-onset chronic kidney disease (NOCKD) after orthotopic liver transplantation (OLT), and to provide an early prediction model for the screening of NOCKD high-risk populations. MATERIAL AND METHODS A retrospective case-control study was performed in adult recipients who received OLT in our center between January 2018 and January 2020. Perioperative data were collected using the center's electronic medical record system. Logistics regression analysis was used to determine risk factors for NOCKD within 1 year following OLT. Kaplan-Meier and log-rank tests were used to evaluate the 1-year survival of recipients with NOCKD or without NOCKD. RESULTS A total of 174 patients were included in this study, and 29 patients developed NOCKD after OLT. Logistic multivariate regression analysis showed that preoperative diabetes, high model for end-stage liver disease (MELD) score, postoperative acute kidney injury (AKI), and postoperative renal replacement therapy (RRT) were independent risk factors for NOCKD 1 year after OLT. The 1-year survival rate of NOCKD recipients waas significantly lower than that of patients who did not receive NOCKD. CONCLUSIONS Diabetes mellitus, MELD score, postoperative AKI, and requirement for postoperative RRT are independent risk factors for NOCKD after OLT, which may have great potential for personalized decision making and predicting the 1-year postoperative mortality of the recipient.

Application of online case-based learning in the teaching of clinical anesthesia for residents during the COVID-19 epidemic.

OBJECTIVE: COVID-19 prevention and control demand a reduction in crowd gathering, which has a significant impact on traditional teaching and offline case-based learning (CBL). In order to mitigate the impact of the COVID-19 outbreak on clinical teaching, we aimed to compare the effects of an online CBL with traditional teaching model on learning outcomes of anesthesia residents. METHODS: Residents rotated in the Department of Anesthesiology in Beijing Tsinghua Changgung Hospital from January 2020 to February 2021 were included in Group W (n = 19), which implemented the W-CBL teaching model. The performance of residents was evaluated with theory test and 2 survey questionnaires (A and B) were conducted after 1 month of rotating. All 20 residents rotating in the Department of Anesthesiology at our hospital from January 2018 to December 2019 were included in Group C, which implemented the traditional teaching model. Their examination results were acquired through the teaching files and survey questionnaire (A) were administered through WeChat. RESULTS: During the 1-month rotation, a total of 10 cases were discussed in Group W. The average score for theory test was higher in Group W than that in Group C (84.57 ± 4.87 vs. 79.35 ± 3.70, P = 0.001). The satisfaction rate was also in favor of Group W regarding to clinical thinking, communication skills, learning interest and self-learning ability (P < 0.05). CONCLUSIONS: Online CBL based on WeChat platform is an effective and acceptable teaching strategy in comparison to lecture-based learning (LBL) among residents embarking on clinical anesthesia courses.

Determination of aquacultured whiteleg shrimp (Litopanaeus vannemei) quality using a sensory method with chemical standard references.

BACKGROUND: Fresh shrimp are highly perishable seafood and a reliable spoilage assessment method is necessary to ensure sufficient quality control. The current quality evaluation method employed by the US Food and Drug Administration (FDA)/National Oceanic and Atmospheric Administration (NOAA) uses subjective terms 'odor of decomposition' to reject shrimp shipments, which lacks reference standards to anchor the concept and can cause ambiguity. The present study aimed to develop chemical reference standards to assist in a more objective and consistent sensory evaluation of shrimp quality. RESULTS: Chemical references were developed and used by the descriptive panel to demonstrate the aroma quality indicators of shrimp. The most important aroma attributes describing shrimp quality changes were 'salty water-like', 'natto water-like' and 'sour milk-like' based on the results of multiple linear regression analysis. The overall rating consistency of the key quality indicators was confirmed by trained a descriptive panel such that the intensity scores in two separated evaluation sessions (30 days apart) were not significant different (P > 0.05). The sensory ratings also corresponded well with presumed FDA/NOAA grades of shrimp. An untrained panel also confirmed 'salty water-like' as the main indicator of freshness and 'natto water-like' as the main indicator of spoilage, whereas the discriminative capacity was lower compared to the trained panel. CONCLUSION: The developed chemical references of key aroma quality indicators allowed the trained and untrained panels to distinguish shrimp of different freshness levels. The results indicate the potential of using chemical references as a new evaluation tool for on-site quality inspection or industrial quality assurance/quality control of shrimp with improved objectivity and consistency. © 2021 Society of Chemical Industry.

Characteristics and ozone formation potential of volatile organic compounds in emissions from a typical Chinese coking plant.

Coking industry is an important volatile organic compounds (VOCs) emission source in China, however, detailed information on VOCs emissions is lacking. Therefore, we selected a typical mechanized coking plant and collected air samples according to the Emission Standard of Pollutants for Coking Chemical Industry (GB16171-2012). Using gas chromatography-mass spectrometry method, we analyzed the VOCs in the air samples, and applied maximum increment reactivity (MIR) rule to estimate ozone formation potential (OFP) of the VOCs emitted from the coke production. More than 90 VOCs species were detected from the coking plant, including alkanes, alkenes, alkynes, aromatic hydrocarbons, halogenated hydrocarbons and oxygenated VOCs. The concentrations of VOCs (ρ(VOCs)) generated at different stages of the coking process are significantly different. ρ(VOCs) from coke oven chimney had the highest concentration (87.1 mg/m3), followed by coke pushing (4.0 mg/m3), coal charging (3.3 mg/m3) and coke oven tops (1.1 mg/m3). VOCs species emitted from the coke production processes were dominated by alkanes and alkenes, but the composition proportions were different at the different stages. Alkenes were the most abundant emission species in flue gases of the coke oven chimney accounting for up to 66% of the total VOCs, while the VOCs emissions from coke pushing and coal charging were dominated by alkanes (36% and 42%, respectively), and the alkanes and alkenes emitted from coke oven top were similar (31% and 29%, respectively). Based on above results, reduction of VOCs emissions from coke oven chimney flue gases is suggested to be an effective measure, especially for alkenes.

microRNA-107 protects against inflammation and endoplasmic reticulum stress of vascular endothelial cells via KRT1-dependent Notch signaling pathway in a mouse model of coronary atherosclerosis.

Coronary atherosclerosis is a long-term, sustained, and evolving inflammatory disease manifested with the remodeling of the coronary arteries. The purpose of this study is to explore the potential role of microRNA-107 (miR-107) in vascular endothelial cells (VECs) in coronary atherosclerosis by regulating the KRT1 gene and the Notch signaling pathway. A mouse model of coronary atherosclerosis was established. The relationship between miR-107 and KRT1 was analyzed and verified by dual-luciferase reporter assay. The functional role of miR-107 in coronary atherosclerosis was determined using ectopic expression and depletion. Blood lipid levels and atherosclerotic index (AI) were measured in atherosclerotic mice. Expression pattern of miR-107, KRT1, Notch signaling pathway, inflammatory/anti-inflammatory factors, and endoplasmic reticulum (ER) stress-related genes was evaluated by means of reverse transcription quantitative polymerase chain reaction, western blot analysis, and enzyme-linked immunosorbent assay. Meanwhile, cell-cycle distribution and cell apoptosis in VECs were assessed by flow cytometry. Atherosclerotic mice exhibited higher blood lipid levels, AI, apoptotic index, and KRT1-positive expression as well as inhibited Notch signaling pathway when compared with normal mice. The miR-107 was revealed to bind to KRT1; miR-107 upregulation or KRT1 silencing resulted in reductions in blood lipid levels and AI, inhibition in cell apoptosis, inflammation, and ER stress. Restored miR-107 or downregulated KRT1 activated the Notch signaling pathway. These results supported the notion that miR-107-targeted KRT1 inhibition activated the Notch pathway, thereby, protecting against the coronary atherosclerosis. Findings in this study might provide a novel biomarker for the coronary atherosclerosis treatment.

Quantum Identity Authentication in the Counterfactual Quantum Key Distribution Protocol.

In this paper, a quantum identity authentication protocol is presented based on the counterfactual quantum key distribution system. Utilizing the proposed protocol, two participants can verify each other's identity through the counterfactual quantum communication system. The security of the protocol is proved against individual attacks. Furthermore, according to the characteristics of the counterfactual quantum key distribution system, we propose an authenticated counterfactual quantum key distribution protocol based on a novel strategy of mixing the two types of quantum cryptographic protocols randomly. The authenticated quantum key distribution can also be used to update the extent of the authentication keys.

Vendor-Neutral Right Ventricular Strain Measurement.

OBJECTIVE: To test the feasibility and reliability of using a vendor-neutral platform to evaluate right ventricular (RV) strain. Reliability was determined by comparing intra- and inter-observer variability between RV strain assessments. The secondary objective was to assess strain's correlation with conventional RV functional parameters to evaluate its feasibility as a RV systolic functional assessment tool. DESIGN: This is a retrospective study. SETTING: Tertiary hospital. PARTICIPANTS: A total of 15 patients who underwent elective coronary artery bypass graft surgery were selected for inclusion. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Images obtained during routine, intraoperative, two-dimensional transesophageal echocardiography (2D TEE) were assessed for longitudinal strain (LS) and conventional parameters, including fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), Doppler tissue imaging (DTI)-derived tricuspid lateral annular systolic velocity wave (S'), and RV dimensions using vendor-neutral software. There was good to excellent intra- and inter-observer reproducibility (intraclass correlation coefficient [ICC] from 0.75 to 1.00) with the exception of basal free wall longitudinal strain (FWLS) (for intra- and inter-observer reproducibility, ICC = 0.670 and 0.749, respectively). FWLS and global longitudinal strain (GLS) showed moderate to strong positive correlation with FAC, TAPSE, and S' (correlation coefficients from 0.667 to 0.721). CONCLUSION: It is feasible to assess RV strain across multiple platforms in a reproducible and reliable fashion. Furthermore, RV strain demonstrated good correlation with conventional RV functional parameters, suggesting its feasibility as a sensitive RV function assessment tool.

Impact of food choice on sodium intake patterns from multiple NHANES surveys.

To examine how the food consumption from various food groups would impact American adults' sodium intake and whether this impact structurally changes over time, data were obtained from six-cycle National Health and Nutrition Examination Survey (NHANES) 1999-2010. Foods were categorized by the first two digits of the USDA food code. Regression models were employed to investigate the associations between the consumption of each food group and sodium intake, and whether there were changes in the associations in consecutive six cycles. Results show that the calorie consumption of oils, beverages and water, fruit juices, fruits, lamb, fruit products, and sugars and sweets had no significant impact on individuals' sodium intake, while calorie consumption of tomatoes, fish, dark-green vegetables, and crackers contributes the most to sodium intake. The contribution to sodium intake of most food groups does not change significantly over time, with the exception of salad dressing whose contribution to sodium intake increased in four consecutive years when compared to that of 1999-2000. The sodium amount contributed by one calorie consumption (sodium density) of most food was above the daily recommendation level, 1.2 mg per calorie per day. Lowering individuals' sodium intake involves either guiding individuals to consume more fruit related products or decreasing the amount of sodium in most food groups at the production or food preparation stages.

Fusion of infrared and visible images for night-vision context enhancement.

Because of the poor lighting conditions at night time, visible images are often fused with corresponding infrared (IR) images for context enhancement of the scenes in night vision. In this paper, we present a novel night-vision context enhancement algorithm through IR and visible image fusion with the guided filter. First, to enhance the visibility of poorly illuminated details in the visible image before the fusion, an adaptive enhancement method is developed by incorporating the processes of dynamic range compression and contrast restoration based on the guided filter. Then, a hybrid multi-scale decomposition based on the guided filter is introduced to inject the IR image information into the visible image through a multi-scale fusion approach. Moreover, a perceptual-based regularization parameter selection method is used to determine the relative amount of the injected IR spectral features by comparing the perceptual saliency of the IR and visible image information. This fusion method can successfully transfer the important IR image information into the fused image, and simultaneously preserve the details and background scenery in the input visible image. Experimental results show that the proposed algorithm is able to achieve better context enhancement results in night vision.

Potassium-competitive acid blockers and proton-pump inhibitors for healing of erosive esophagitis: a systematic review and network meta-analysis.

Background: Proton-pump inhibitors (PPIs) and potassium-competitive acid blockers (P-CABs) are recommended for erosive esophagitis (EE), with good safety and tolerance. However, it is unclear which is the best treatment option for EE. Objectives: This study aimed to evaluate the comparative efficacy of P-CABs and PPIs for healing EE patients, seeking an appropriate treatment choice in the 4- or 8-week treatment and standard or double dose. Design: A systematic review and network meta-analysis. Data sources and methods: Relevant databases were searched to collect randomized controlled trials of PPIs and P-CABs in the treatment of EE up to 31 May 2023. Studies on standard or double-dose PPIs or P-CABs which were published in English and assessed 4- or 8-week healing effects in EE were included. A network meta-analysis was performed to evaluate the efficacy of the treatments under the frequentist framework. Sensitivity and subgroup analyses of patients with different baseline EE were also conducted. Results: In all, 34 studies involving 25,054 patients and 9 PPIs, 6 P-CABs, or placebo treatment interventions were included. The pooled 4-week healing rate was significantly statistically lower than the pooled 8-week healing rate for most treatments. Besides, the higher healing rate of double-dose treatment than standard-dose treatment was not observed in the initial treatment of most drugs. The main analysis only included studies conducted for both patients with and without severe EE at baseline, and the proportion of severe EE included in the study was >10%, Keverprazan 20 mg qd ranked best with a surface under the cumulative ranking curve (SUCRA) value of 84.7, followed by Ilaprazole 10 mg qd with a SUCRA value of 82.0, for the healing rate at 8 weeks. Sensitivity analysis showed that the results were robust. Subgroup analysis showed that most P-CABs had higher healing rates than PPIs, particularly for patients with severe EE. And the healing rate of Keverprazan 20 mg qd at 8 weeks ranked best in the subgroup without or with severe EE at baseline. Conclusion: This study showed that an 8-week treatment seemed more effective than the 4-week treatment for healing EE patients. The healing effect of Keverprazan (20 mg qd) ranked best in 8-week treatment, for both severe and non-severe EE patients. Trial registration: The study protocol was registered with INPLASY (registration number INPLASY2023120053).

A review and network meta-analysis of different medications for treating erosive esophagitis: potassium-competitive acid blockers and proton-pump inhibitors Why was the study done? Proton-pump inhibitors (PPIs) and potassium-competitive acid blockers (P-CABs) are commonly used to treat Erosive esophagitis (EE) due to their good safety and tolerance. This study aimed to compare the effectiveness of P-CABs and PPIs in healing EE patients. We wanted to determine the best treatment choice in terms of the duration of treatment (4 or 8 weeks) and the dosage (standard or double-dose). What did the researchers do? The researchers searched relevant databases for randomized controlled trials that studied the use of PPIs and P-CABs in treating EE up until May 31, 2023. They included studies that evaluated the healing effects of standard or double-dose PPIs or P-CABs over a period of 4 or 8 weeks. A network meta-analysis was performed to compare the effectiveness of these treatments. They also conducted sensitivity analysis and subgroup analysis to examine the effects on patients with different levels of EE. What did the researchers find? The results showed that the healing rate after 4 weeks of treatment was significantly lower than the healing rate after 8 weeks for most treatments. Additionally, the higher healing rate observed with double-dose treatment compared to standard-dose treatment was not seen in the initial treatment of most drugs. In the main analysis, which included studies with patients both with and without severe EE at the beginning, Keverprazan 20mg qd was ranked as the most effective treatment with a healing rate of 84.7, followed by Ilaprazole 10mg qd with a healing rate of 82.0 at 8 weeks. The results were robust in sensitivity analysis. Subgroup analysis showed that most P-CABs had higher healing rates than PPIs, especially for patients with severe EE. What do the findings mean? Treating EE patients for 8 weeks was more effective than treating them for 4 weeks. Keverprazan (20mg once a day) with the 8-week treatment is the optimal method.

Chinese consumer preference for beef with geographical indications and other attributes.

As the demand for beef products grows in the Chinese market, understanding consumer preferences for beef, especially those related to quality labelling, is essential. The recent agreement between China and the European Union to promote Geographical Indications (GIs) provides a new insight into preferences for beef with quality labelling. This paper assesses consumer preferences for beef products with GIs and other attributes. A nationwide survey is conducted including 1210 respondents in China by a choice experiment attributing GI label, 'green', 'hazard-free', and 'organic' labels, feeding regimes (grain-fed, grass-fed), country of origin (China, Ireland, Australia, Brazil), and price (30, 40, 80, 100 ¥/500 g). The random parameter logit model with error component reveals that Chinese consumers have a significant preference for grain-fed beef and domestic beef, and they are willing to pay a premium price for GI-labelled beef compared with other attributes. The interaction between GIs and country of origin is included to indicate the positive price impact of GIs on imported beef products. Demographic factors such as place of residence and occupation are found to affect consumer preferences for GIs.

Efficacy and safety of terlipressin infusion during liver surgery: a protocol for systematic review and meta-analysis.

INTRODUCTION: Liver disease causes 2 million deaths annually, accounting for 4% of all deaths worldwide. Liver surgery is one of the effective therapeutic options. Bleeding is a major complication during liver surgery. Perioperative bleeding and allogeneic blood transfusion may deteriorate the prognosis. Terlipressin (TP), a synthetic analogue of the antidiuretic hormone, may reduceblood loss during abdominal surgery. Several clinical centres have attempted to use TP during liver surgery, but the evidence for its effectiveness in reducing blood loss and the need for allogeneic blood transfusion, as well as its safety during the perioperative period, remains unclear. The aim of this systematic review and meta-analysis is to evaluate the efficacy and safety of TP in reducing blood loss and allogeneic blood transfusion needs during liver surgery. METHODS AND ANALYSIS: We will search PubMed, EMBASE, the Cochrane Library and Web of Science for studies on perioperative use of TP during liver surgery from inception to July 2023. We will limit the language to English, and two reviewers will independently screen and select articles. The primary study outcomes are estimated blood loss and the need for allogeneic blood transfusion. Secondary outcomes include operating time, intensive care unit stay, length of stay, intraoperative urine output, acute kidney injury rate, postoperative complications, hepatic and renal function during follow-up, and TP-related adverse effects. We will include studies that met the following criteria: (1) randomised controlled trials (RCTs), cohort studies or case-control studies; (2) the publication time was till July 2023; (3) adult patients (≥18 years old) undergoing elective liver surgery; (4) comparison of TP with other treatments and (5) the study includes at least one outcome. We will exclude animal studies, case reports, case series, non-original articles, reviews, paediatric articles, non-controlled trials, unpublished articles, non-English articles and other studies that are duplicates. We will use Review Manager V.5.3 software for meta-analysis and perform stratification analysis for the study quality of RCTs based on the Jadad score. For cohort or case-control studies, the study quality will be analysed based on Newcastle-Ottawa Scale scores. Grading of Recommendations, Assessment, Development and Evaluation will be used to assess confidence in the cumulative evidence. For primary outcomes, we will conduct subgroup analyses based on meta-regression. We will also perform leave-one-out sensitivity analyses to evaluate the effect of each individual study on the combined results by removing the individual studies one by one for outcomes with significant heterogeneity. The protocol follows the Cochrane Handbook for Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines. ETHICS AND DISSEMINATION: This study is a secondary analysis of existing data; therefore, it does not require ethical approval. We will disseminate the results through peer-reviewed publications. PROSPERO REGISTRATION NUMBER: CRD42023450333.