Objective:To investigate the impact of metabolic dysfunction-associated steatotic liver disease(MASLD)on the efficacy of immune checkpoint inhibitor(ICI)-based therapy in patients with chronic hepatitis B(CHB)-related...Objective:To investigate the impact of metabolic dysfunction-associated steatotic liver disease(MASLD)on the efficacy of immune checkpoint inhibitor(ICI)-based therapy in patients with chronic hepatitis B(CHB)-related hepatocellular carcinoma(HCC).Methods:A total of 155 patients with CHB-related HCC who received ICI–based therapy(in the Department of Hepatology,Tianjin Second People’s Hospital and Department of Hepatobiliary Oncology,Tianjin Medical University Cancer Institute&Hospital)between April 2021 and December 2023 were evaluated.Patients were divided into two groups:MASLD concurrent with CHB[MASLD-CHB](n=38),and CHB(n=117).Results:The median progression-free survival(PFS,6.9 months vs.9.3 months;P=0.001),progressive disease(57.89%vs.37.61%;P=0.028),and disease control rate(42.11%vs.62.39%;P=0.028)in the MASLD-CHB group were significantly worse than the CHB group.The median overall survival was not attained.The percentage of CD4+PD1+(17.56%vs.8.89%;P<0.001)and CD8+PD1+T cells(10.50%vs.7.42%;P=0.005)in patient samples from the MASLD-CHB group were significantly higher than the CHB group.Concurrent MASLD[hazard ratio(HR)=1.921;95%CI,1.138–3.245;P=0.015]and alpha-fetoprotein levels after 3 months of treatment(HR=2.412;95%CI,1.360–4.279;P=0.003)were independent risk factors for PFS in all patients.Conclusions:ICI-based therapy in patients with CHB-related HCC and concurrent MASLD resulted in poorer efficacy and shorter PFS compared to patients with CHB-related HCC alone.展开更多
Non-alcoholic fatty liver disease(NAFLD)has become the world’s largest chronic liver disease in the 21st century,affecting 20%-30%of the world’s population.As the epidemiology,etiology,and pathogenesis of NAFLD have...Non-alcoholic fatty liver disease(NAFLD)has become the world’s largest chronic liver disease in the 21st century,affecting 20%-30%of the world’s population.As the epidemiology,etiology,and pathogenesis of NAFLD have been studied in-depth,it has been gradually recognized that most patients with NAFLD have one or more combined metabolic abnormalities known as metabolic syndrome.In 2020,the international expert group changed the name of NAFLD to metabolic-associated fatty liver disease(MAFLD)and proposed new diagnostic criteria for MAFLD and MAFLD-related liver cirrhosis,as well as the conceptual framework of other cause-related fatty liver diseases to avoid diagnosis based on the exclusion of other causes and better reflect its pathogenesis.However,there are still many ambiguities in the term,and changing the name does not address the unmet key needs in the field.The change from NAFLD to MAFLD was not just a change of definition.The problems and challenges are summarized as follows:epidemiology,children,rationality of"metabolism,"diagnostic criteria,double/multiple causes,drug discovery,clinical trials,and awareness raising.Metabolic-associated fatty liver disease has complex disease characteristics,and there are still some problems that need to be solved.展开更多
Background To review the treatment and the causes of postoperative epidural hematoma(PEDH)after intracranial tumor resection.Method A retrospective case study was conducted to examine a series of patients who develope...Background To review the treatment and the causes of postoperative epidural hematoma(PEDH)after intracranial tumor resection.Method A retrospective case study was conducted to examine a series of patients who developed PEDH as a complication following intracranial tumor resection between January 2016 and June 2021.The study collected data from hospital charts,including clinical status at admission,imaging results,histopathologic findings,surgical management,complications,and outcomes.Causes of PEDH were evaluated through a review of operative notes and discussions with the surgical team.Results Twenty-five patients(10 males,15 females;median age 42 years,range 11-61 years;median medical history 27 months,range 1-96 months)were enrolled in the study.Regarding tumor location,16 cases exhibited supratentorial brain tumors,4 cases had infratentorial brain tumors,2 cases of tumors occurred in the petroclival region,2 cases in the peritorcular region,and 1 case in the pineal region.Four of these cases were complicated with supratentorial hydrocephalus.The 25 cases in this study were classified into four types based on location.Type 1 refers to EDHs that occur at the adjacent site of the operative field without involvement of the surgical area.Type 2 includes hematomas that occur at the adjacent site of the surgical area and the surgical area.Type 3 includes EDHs that occur in distant areas,and type 4 involves EDHs in the surgical field.The numbers of cases of types 1,2,3,and 4 PEDHs were 16,2,3,and 4 cases,respectively.Most PEDHs were associated with reduced ICP after craniotomy due to intracranial tumor resection and substantial loss of CSF.All patients achieved satisfactory outcomes after hematoma evacuation.Conclusion The decrease in ICP resulting from intracranial tumor resection and CSF loss might lead to PEDHs.By employing optimized surgical techniques and meticulous patient management to prevent rapid decreases in ICP and dural detachment,we can potentially lower the incidence of PEDHs.Additionally,prompt evacuation of hematomas can contribute to positive outcomes.展开更多
基金supported by the National Natural Science Foundation of China (Grant No. 62375202)Natural Science Foundation of Tianjin (Grant No. 23JCYBJC00950)+2 种基金Tianjin Health Science and Technology Project Key Discipline Special (Grant No. TJWJ2022XK034)Tianjin Key Medical Discipline (Specialty) Construction Project (Grant No.TJYXZDXK-059B)Research Project in Key Areas of TCM in 2024 (Grant No. 2024022)
文摘Objective:To investigate the impact of metabolic dysfunction-associated steatotic liver disease(MASLD)on the efficacy of immune checkpoint inhibitor(ICI)-based therapy in patients with chronic hepatitis B(CHB)-related hepatocellular carcinoma(HCC).Methods:A total of 155 patients with CHB-related HCC who received ICI–based therapy(in the Department of Hepatology,Tianjin Second People’s Hospital and Department of Hepatobiliary Oncology,Tianjin Medical University Cancer Institute&Hospital)between April 2021 and December 2023 were evaluated.Patients were divided into two groups:MASLD concurrent with CHB[MASLD-CHB](n=38),and CHB(n=117).Results:The median progression-free survival(PFS,6.9 months vs.9.3 months;P=0.001),progressive disease(57.89%vs.37.61%;P=0.028),and disease control rate(42.11%vs.62.39%;P=0.028)in the MASLD-CHB group were significantly worse than the CHB group.The median overall survival was not attained.The percentage of CD4+PD1+(17.56%vs.8.89%;P<0.001)and CD8+PD1+T cells(10.50%vs.7.42%;P=0.005)in patient samples from the MASLD-CHB group were significantly higher than the CHB group.Concurrent MASLD[hazard ratio(HR)=1.921;95%CI,1.138–3.245;P=0.015]and alpha-fetoprotein levels after 3 months of treatment(HR=2.412;95%CI,1.360–4.279;P=0.003)were independent risk factors for PFS in all patients.Conclusions:ICI-based therapy in patients with CHB-related HCC and concurrent MASLD resulted in poorer efficacy and shorter PFS compared to patients with CHB-related HCC alone.
基金Tianjin Key Medical Discipline(Specialty)Construction Project(TJYXZDXK-059B)Tianjin Health Science and Technology Project key discipline special(TJWJ2022XK034)Research Project of Chinese Traditional Medicine and Chinese Traditional Medicine Combined with Western Medicine of Tianjin Municipal Health and Family Planning Commission(2021022)。
文摘Non-alcoholic fatty liver disease(NAFLD)has become the world’s largest chronic liver disease in the 21st century,affecting 20%-30%of the world’s population.As the epidemiology,etiology,and pathogenesis of NAFLD have been studied in-depth,it has been gradually recognized that most patients with NAFLD have one or more combined metabolic abnormalities known as metabolic syndrome.In 2020,the international expert group changed the name of NAFLD to metabolic-associated fatty liver disease(MAFLD)and proposed new diagnostic criteria for MAFLD and MAFLD-related liver cirrhosis,as well as the conceptual framework of other cause-related fatty liver diseases to avoid diagnosis based on the exclusion of other causes and better reflect its pathogenesis.However,there are still many ambiguities in the term,and changing the name does not address the unmet key needs in the field.The change from NAFLD to MAFLD was not just a change of definition.The problems and challenges are summarized as follows:epidemiology,children,rationality of"metabolism,"diagnostic criteria,double/multiple causes,drug discovery,clinical trials,and awareness raising.Metabolic-associated fatty liver disease has complex disease characteristics,and there are still some problems that need to be solved.
文摘Background To review the treatment and the causes of postoperative epidural hematoma(PEDH)after intracranial tumor resection.Method A retrospective case study was conducted to examine a series of patients who developed PEDH as a complication following intracranial tumor resection between January 2016 and June 2021.The study collected data from hospital charts,including clinical status at admission,imaging results,histopathologic findings,surgical management,complications,and outcomes.Causes of PEDH were evaluated through a review of operative notes and discussions with the surgical team.Results Twenty-five patients(10 males,15 females;median age 42 years,range 11-61 years;median medical history 27 months,range 1-96 months)were enrolled in the study.Regarding tumor location,16 cases exhibited supratentorial brain tumors,4 cases had infratentorial brain tumors,2 cases of tumors occurred in the petroclival region,2 cases in the peritorcular region,and 1 case in the pineal region.Four of these cases were complicated with supratentorial hydrocephalus.The 25 cases in this study were classified into four types based on location.Type 1 refers to EDHs that occur at the adjacent site of the operative field without involvement of the surgical area.Type 2 includes hematomas that occur at the adjacent site of the surgical area and the surgical area.Type 3 includes EDHs that occur in distant areas,and type 4 involves EDHs in the surgical field.The numbers of cases of types 1,2,3,and 4 PEDHs were 16,2,3,and 4 cases,respectively.Most PEDHs were associated with reduced ICP after craniotomy due to intracranial tumor resection and substantial loss of CSF.All patients achieved satisfactory outcomes after hematoma evacuation.Conclusion The decrease in ICP resulting from intracranial tumor resection and CSF loss might lead to PEDHs.By employing optimized surgical techniques and meticulous patient management to prevent rapid decreases in ICP and dural detachment,we can potentially lower the incidence of PEDHs.Additionally,prompt evacuation of hematomas can contribute to positive outcomes.
