Primary liver cancer is a common and lethal malignancy in China.Transcatheter arterial chemoembolization(TACE)is globally recognized as the preferred treatment modality for the non-surgical resection of hepatocellular...Primary liver cancer is a common and lethal malignancy in China.Transcatheter arterial chemoembolization(TACE)is globally recognized as the preferred treatment modality for the non-surgical resection of hepatocellular carcinoma(HCC),while transcatheter arterial infusion(TAI)is another effective interventional treatment for HCC.In recent years,hepatic arterial infusion chemotherapy(HAIC)has gained increasing attention as an application-regulated modality for TAI.Owing to the current debate in the medical community regarding the use of HAIC and TACE for the treatment of HCC,the application of both approaches should be considered at a higher level,with a broader perspective and a more normative aspect.Accordingly,we aimed to define the rational combination of liver cancer TAI/HAIC with TACE as infusion transcatheter chemoembolization(iTACE),which suggests that the two interventions are not superior but lead to a mutually beneficial situation.In this review,we sought to discuss the development,specification,application,challenge and innovation,debate,and union of TAI/HAIC and TACE,and the clinical application and latest research on iTACE.We aimed to introduce new concepts of iTACE and expect new breakthroughs in the treatment of liver cancer owing to the combined use of the two major interventional tools.展开更多
Background Depression in adolescents is recognised as a global public health concern,but little is known about the trajectory of its clinical symptoms and pathogenesis.Understanding the nature of adolescents with depr...Background Depression in adolescents is recognised as a global public health concern,but little is known about the trajectory of its clinical symptoms and pathogenesis.Understanding the nature of adolescents with depression and identifying earlybiomarkers can facilitatepersonalised intervention andreducediseaseburden.Aims To track multidimensional outcomes of adolescents with depression and develop objective biomarkers for diagnosis,as well as response to treatment,prognosis and guidance for early identification and intervention.Methods This is a multidimensional cohort study on the Symptomatic trajectory and Biomarkers of Early Adolescent Depression(sBEAD).We planned to recruit more than 1000 adolescents with depression and 300 healthy controls within 5 years.Multidimensional clinical presentations and objective indicators are collected at baseline,weeks 4,8,12 and 24,and years 1,2,3,4 and 5.Conclusions To the best of our knowledge,this is the first longitudinal cohort study that examines multidimensional clinical manifestations and multilevel objective markers in Chinese adolescents with depression.This study aims at providing early individualised interventions for young,depressed patients to reduce the burden of disease.展开更多
Background:Macrovascular invasion(MaVI)occurs in nearly half of hepatocellular carcinoma(HCC)patients at diagnosis or during follow-up,which causes severe disease deterioration,and limits the possibility of surgical a...Background:Macrovascular invasion(MaVI)occurs in nearly half of hepatocellular carcinoma(HCC)patients at diagnosis or during follow-up,which causes severe disease deterioration,and limits the possibility of surgical approaches.This study aimed to investigate whether computed tomography(CT)-based radiomics analysis could help predict development of MaVI in HCC.Methods:A cohort of 226 patients diagnosed with HCC was enrolled from 5 hospitals with complete MaVI and prognosis follow-ups.CT-based radiomics signature was built via multi-strategy machine learning methods.Afterwards,MaVI-related clinical factors and radiomics signature were integrated to construct the final prediction model(CRIM,clinical-radiomics integrated model)via random forest modeling.Cox-regression analysis was used to select independent risk factors to predict the time of MaVI development.Kaplan-Meier analysis was conducted to stratify patients according to the time of MaVI development,progression-free survival(PFS),and overall survival(OS)based on the selected risk factors.Results:The radiomics signature showed significant improvement for MaVI prediction compared with conventional clinical/radiological predictors(P<0.001).CRIM could predict MaVI with satisfactory areas under the curve(AUC)of 0.986 and 0.979 in the training(n=154)and external validation(n=72)datasets,respectively.CRIM presented with excellent generalization with AUC of 0.956,1.000,and 1.000 in each external cohort that accepted disparate CT scanning protocol/manufactory.Peel9_fos_InterquartileRange[hazard ratio(HR)=1.98;P<0.001]was selected as the independent risk factor.The cox-regression model successfully stratified patients into the high-risk and low-risk groups regarding the time of MaVI development(P<0.001),PFS(P<0.001)and OS(P=0.002).Conclusions:The CT-based quantitative radiomics analysis could enable high accuracy prediction of subsequent MaVI development in HCC with prognostic implications.展开更多
BACKGROUND The treatment outcome of transarterial chemoembolization(TACE)in unresectable hepatocellular carcinoma(HCC)varies greatly due to the clinical heterogeneity of the patients.Therefore,several prognostic syste...BACKGROUND The treatment outcome of transarterial chemoembolization(TACE)in unresectable hepatocellular carcinoma(HCC)varies greatly due to the clinical heterogeneity of the patients.Therefore,several prognostic systems have been proposed for risk stratification and candidate identification for first TACE and repeated TACE(re-TACE).AIM To investigate the correlations between prognostic systems and radiological response,compare the predictive abilities,and integrate them in sequence for outcome prediction.METHODS This nationwide multicenter retrospective cohort consisted of 1107 unresectable HCC patients in 15 Chinese tertiary hospitals from January 2010 to May 2016.The Hepatoma Arterial-embolization Prognostic(HAP)score system and its modified versions(mHAP,mHAP2 and mHAP3),as well as the six-and-twelve criteria were compared in terms of their correlations with radiological response and overall survival(OS)prediction for first TACE.The same analyses were conducted in 912 patients receiving re-TACE to evaluate the ART(assessment for re-treatment with TACE)and ABCR(alpha-fetoprotein,Barcelona Clinic Liver Cancer,Child-Pugh and Response)systems for post re-TACE survival(PRTS).RESULTS All the prognostic systems were correlated with radiological response achieved by first TACE,and the six-and-twelve criteria exhibited the highest correlation(Spearman R=0.39,P=0.026)and consistency(Kappa=0.14,P=0.019),with optimal performance by area under the receiver operating characteristic curve of 0.71[95%confidence interval(CI):0.68-0.74].With regard to the prediction of OS,the mHAP3 system identified patients with a favorable outcome with the highest concordance(C)-index of 0.60(95%CI:0.57-0.62)and the best area under the receiver operating characteristic curve at any time point during follow-up;whereas,PRTS was well-predicted by the ABCR system with a C-index of 0.61(95%CI:0.59-0.63),rather than ART.Finally,combining the mHAP3 and ABCR systems identified candidates suitable for TACE with an improved median PRTS of 36.6 mo,compared with non-candidates with a median PRTS of 20.0 mo(logrank test P<0.001).CONCLUSION Radiological response to TACE is closely associated with tumor burden,but superior prognostic prediction could be achieved with the combination of mHAP3 and ABCR in patients with unresectable liver-confined HCC.展开更多
To the Editor:We read with great interest the recent article by Shi et al.pub-lished in Hepatobiliary Pancreatic Diseases International[1].Shi’s study was based on radiological features and clinical factors to constr...To the Editor:We read with great interest the recent article by Shi et al.pub-lished in Hepatobiliary Pancreatic Diseases International[1].Shi’s study was based on radiological features and clinical factors to construct a model to predict the effectiveness of first transarterial chemoembolization(TACE)treatment for hepatocellular carcinoma(HCC)in prolonging patient survival.The results showed that area under the receiver operating characteristic curve was 0.964 for the training cohort and 0.949 for the validation cohort.展开更多
BACKGROUND Subcutaneous implantable cardioverter-defibrillator(S-ICD)implantation requires effective anesthesia.General anesthesia(GA)carries risks like hemodynamic instability,while ultrasound-guided intercostal nerv...BACKGROUND Subcutaneous implantable cardioverter-defibrillator(S-ICD)implantation requires effective anesthesia.General anesthesia(GA)carries risks like hemodynamic instability,while ultrasound-guided intercostal nerve block(US-ICNB)may offer better pain control.This study hypothesized US-ICNB is superior in perioperative safety and pain management.AIM To compare perioperative outcomes of GA and US-ICNB in S-ICD implantation.METHODS This retrospective single-center study included 64 patients who received S-ICD implantation between February 2021 and December 2024.They were divided into GA and US-ICNB groups based on anesthesia type.Demographic data,perioperative parameters(operation time,pain scores,analgesic usage),and postoperative outcomes(complications,defibrillation events)were collected and analyzed.Statistical tests were used to compare the two groups.RESULTS This study included 64 patients(20 in the GA group and 44 in the US-ICNB group).Baseline left ventricular ejection fraction was significantly lower in the US-ICNB group(39.20%±12.00%vs 56.20%±11.50%in GA,P<0.001),while American Society of Anesthesiologists scores and comorbidities were comparable.US-ICNB showed superior pain control,with significantly lower numeric rating scale scores at 6-48 hours(P<0.001)and fewer patients requiring analgesics(P=0.02).The US-ICNB group had shorter operation times(P<0.001),total hospital stays(P<0.001),and later first analgesia times(P<0.001).No anesthesia-related complications occurred in either group.CONCLUSION Both anesthetic methods were safe in the short term.However,US-ICNB was superior in reducing operation and hospital stay times and alleviating peri-operative pain.It has high safety in S-ICD implantation and deserves further clinical promotion,though large-scale,multi-center,randomized controlled trials are needed to confirm these findings.展开更多
BACKGROUND Hemorrhage following pancreaticobiliary surgery is a high-risk complication,with a mortality rate of 16%-38%.At present,minimally invasive endovascular intervention comprising superselective arterial emboli...BACKGROUND Hemorrhage following pancreaticobiliary surgery is a high-risk complication,with a mortality rate of 16%-38%.At present,minimally invasive endovascular intervention comprising superselective arterial embolization(SAE)and covered stent implantation(CSI)is the treatment of choice.However,in certain cases,both SAE and CSI become infeasible.AIM To evaluate the effectiveness of coil-assisted N-butyl cyanoacrylate(NBCA)embolization in comparison with that of CSI in managing delayed hemorrhage after hepatobiliary–pancreatic surgery when SAE is infeasible.METHODS Ninety-eight continuous patients(n=105 cases;mean age,58.4 years)with delayed massive hemorrhage who were treated with coil-assisted NBCA embolization(NBCA group,n=45)and/or CSI(CSI group,n=60)were retrospectively evaluated between March 2014 and December 2023.Data on technical and clinical success,30-day mortality,and severe intervention-related adverse events were collected and analyzed.RESULTS The technical and clinical success rates in the NBCA group(100%and 93.3%,respectively)were significantly higher than those in the CSI group(88.3%and 73.3%,respectively),with a statistically significant difference between the two groups(P=0.019 and 0.010,respectively).The 30-day mortality rates and major intervention-related complications were 17.8%and 0%,respectively,in the NBCA group and 18.3%and 1.7%in the CSI group,respectively,with no statistically significant difference between the two groups.CONCLUSION In terms of technical and clinical success,coil-assisted NBCA embolization was more effective than CSI for managing delayed hemorrhage after hepatobiliary–pancreatic surgery when SAE was not feasible.展开更多
BACKGROUND Hepatic artery infusion chemotherapy(HAIC)is a widely used local therapeutic approach for intermediate to advanced-stage hepatocellular carcinoma(HCC),exhibiting considerable efficacy.However,the prevalence...BACKGROUND Hepatic artery infusion chemotherapy(HAIC)is a widely used local therapeutic approach for intermediate to advanced-stage hepatocellular carcinoma(HCC),exhibiting considerable efficacy.However,the prevalence of postoperative pain highlights the importance of pain management.Owing to the limitations inherent in existing pain management strategies,this study investigates and assesses the analgesic effectiveness of a multimodal treatment protocol in mitigating pain after HAIC procedures.AIM To provide patients with a more comprehensive and effective pain management strategy.METHODS A total of 100 patients with primary HCC who underwent HAIC were randomly assigned to a control group(n=50)and a multimodal group(n=50).Baseline characteristics and perioperative data were collected.Upon enrollment,patients in the multimodal group received parecoxib(40 mg)30 minutes before HAIC,followed by 48 hours of patient-controlled analgesia with sufentanil.In contrast,the control group underwent standard preoperative preparation(psychological support)and received dezocine(5 mg)intraoperatively,with intravenous flurbiprofen(100 mg)administered every 12 hours for 48 hours postoperatively.RESULTS Compared to the control group,the multimodal analgesia group exhibited significantly lower resting and movement visual analog scale pain scores at postoperative 0,2,4,6,and 12 hours(P<0.05).Furthermore,the multimodal group experienced a reduced incidence of postoperative nausea and vomiting,as well as a lower overall frequency of adverse events,compared to the control group(P<0.05).Patient satisfaction was also significantly higher in the multimodal group than in the control group(P<0.05).CONCLUSION Our study demonstrates that multimodal analgesia is effective in reducing postoperative pain,minimizing adverse reactions,and improving patient satisfaction in HCC patients undergoing HAIC.This approach provides valuable clinical strategies for optimizing pain management in this patient population.展开更多
BACKGROUND Hepatic encephalopathy(HE)is a primary complication following transjugular intrahepatic portosystemic shunt(TIPS),but the utility of pharmacological prophylaxis for HE is unclear.AIM To assess the HE incide...BACKGROUND Hepatic encephalopathy(HE)is a primary complication following transjugular intrahepatic portosystemic shunt(TIPS),but the utility of pharmacological prophylaxis for HE is unclear.AIM To assess the HE incidence post-TIPS across various groups and the prophylactic efficacies of various medications.METHODS A thorough literature search was performed in PubMed,Web of Science,EMBASE,and the Cochrane Library databases from their inception to November 24,2024,to collect data regarding HE incidence.The main outcome was HE incidence post-TIPS.A meta-analysis using a random effects model was performed to obtain odds ratios(ORs)and 95%confidence intervals.Statistical analyses were conducted using Stata and RevMan software.RESULTS This meta-analysis included nine studies with 1140 patients;647 received pharmacological agents including lactulose,rifaximin,albumin,and l-ornithin-l-aspartate,and 493 did not(controls).(1)In the single-group meta-analysis,the control group had higher short-and long-term HE rates than the drug intervention group.Among patients with and without prior HE,the non-intervention group's HE rates were also higher;(2)Pharmacological prevention post-TIPS significantly reduced HE incidence[OR=0.59(0.45,0.77),P=0.0001].Compared with the no prophylaxis,rifaximin reduced the risk of HE after TIPS[OR=0.52(0.29,0.95),P=0.03],but lactulose did not;(3)In patients without prior HE,pharmacological prevention significantly reduced post-TIPS HE incidence[OR=0.62(0.41,0.95),P=0.03];and(4)Network meta-analysis showed no significant differences among five prevention strategies.CONCLUSION The HE incidence after TIPS was relatively high,and the use of drugs after TIPS may reduce the HE incidence.However,research,especially large-scale randomized controlled trials,is still lacking.展开更多
Background:Intestinal obstruction is a prevalent complication in patients with colorectal cancer following surgery,with a significant impact on health outcomes.Dachengqi decoction(DCQD)is a traditional Chinese medicin...Background:Intestinal obstruction is a prevalent complication in patients with colorectal cancer following surgery,with a significant impact on health outcomes.Dachengqi decoction(DCQD)is a traditional Chinese medicine(TCM)that is employed in clinical settings for the treatment of intestinal obstruction.However,the pharmacological mechanisms and active components of this medicinal preparation remain to be fully elucidated.The objective of this study was to examine the possible mechanisms and active constituents of DCQD in addressing intestinal obstruction subsequent to colorectal cancer surgery.Methods:A comprehensive search was conducted on the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform and the Traditional Chinese Medicine Integrated Database for the active chemical constituents of DCQD.In addition,the PubChem,Swiss Target Prediction and Uniprot databases were utilised to predict the drug targets.The possible target genes associated with intestinal obstruction were obtained from the GeneCards,Online Mendelian Inheritance in Man,PharmGKB,and Therapeutic Target Database databases,and were analysed using the Database for Annotation,Visualisation and Integrated Discovery platform for Gene Ontology(GO)functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis.Cytoscape was utilised to visualise key components,targets,and pathways,and molecular docking technology was employed to verify the binding of core targets and key components.Results:A total of 41 active chemical components and 141 intersecting targets were screened,and it was determined that the intersecting targets of TCM and disease were significantly enriched in 44 GO entries and 93 KEGG pathways.Subsequent screening identified 3 key components(isosinensetin,tetramethoxyluteolin,and 5,7,4’-trimethylapigenin)and 9 core targets(TP53,STAT3,ESR1,SRC,EGFR,AKT1,CTNNB1,BCL2,and PIK3CA).The molecular docking results demonstrated that all 3 key components exhibited strong binding to the core targets.Conclusions:The present study identified the pharmacological basis by which DCQD exerts beneficial effects against intestinal obstruction and provided insights into its mechanism of action,providing scientific evidence for precise clinical utilisation and areas for new drug development.展开更多
BACKGROUND Despite the promising prospects of using artificial intelligence and machine learning(ML)for disease classification and prediction purposes,the complexity and lack of explainability of this method make it d...BACKGROUND Despite the promising prospects of using artificial intelligence and machine learning(ML)for disease classification and prediction purposes,the complexity and lack of explainability of this method make it difficult to apply the constructed models in clinical practice.We developed and validated an interpretable ML model based on magnetic resonance imaging(MRI)radiomics and clinical features for the preoperative prediction of the pathological grades of hepatocellular carcinomas(HCCs).This model will help clinicians better understand the situation and develop personalized treatment plans.AIM To develop and validate an interpretable ML model for preoperative pathological grade prediction in HCC patients via a combination of multisequence MRI radiomics and clinical features.METHODS MRI and clinical data derived from 125 patients with HCCs confirmed by postoperative pathological examinations were retrospectively analyzed.The patients were randomly split into training and validation groups(7:3 ratio).Univariate and multivariate logistic regression analyses were performed to identify independent clinical predictors.The tumor lesions observed on axial fatsuppressed T2-weighted imaging(FS-T2WI),arterial phase(AP),and portal venous phase(PVP)images were delineated in a slice-by-slice manner using 3D-slicer to generate volumetric regions of interest,and radiomic features were extracted.Interclass correlation coefficients were calculated,and least absolute selection and shrinkage operator regression were conducted for feature selection purposes.Six predictive models were subsequently developed for pathological grade prediction:FS-T2WI,AP,PVP,integrated radiomics,clinical,and combined radiomics-clinical(RC)models.The effectiveness of these models was assessed by calculating their area under the receiver operating characteristic curve(AUC)values.The clinical applicability of the models was evaluated via decision curve analysis.Finally,the contributions of the different features contained in the model with optimal performance were interpreted via a SHapley Additive exPlanations analysis.RESULTS Among the 125 patients,87 were assigned to the training group,and 38 were assigned to the validation group.The maximum tumor diameter,hepatitis B virus status,and monocyte count were identified as independent predictors of pathological grade.Twelve optimal radiomic features were ultimately selected.The AUC values obtained for the FS-T2WI model,AP model,PVP model,radiomics model,clinical model,and combined RC model in the training group were 0.761[95%confidence interval(CI):0.562-0.857],0.870(95%CI:0.714-0.918),0.868(95%CI:0.714-0.959),0.917(95%CI:0.857-0.959),0.869(95%CI:0.643-0.973),and 0.941(95%CI:0.857-0.945),respectively;in the validation group,the AUC values were 0.724(95%CI:0.625-0.833),0.802(95%CI:0.686-1.000),0.797(95%CI:0.688-1.000),0.901(95%CI:0.833-0.906),0.865(95%CI:0.594-1.000),and 0.932(95%CI:0.812-1.000),respectively.The combined RC model demonstrated the best performance.Additionally,the decision curve analysis revealed that the combined RC model had satisfactory prediction efficiency,and the SHapley Additive exPlanations value analysis revealed that the“FS-T2WI-wavelet-HLL_gldm_Large Dependence High Gray Level Emphasis”feature contributed the most to the model,exhibiting a positive effect.CONCLUSION An interpretable ML model based on MRI radiomics provides a noninvasive tool for predicting the pathological grade of HCCs,which will help clinicians develop personalized treatment plans.展开更多
BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a highly effective treat-ment for complications associated with portal hypertension.However,stent fracture,although extremely rare,represents a potentia...BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a highly effective treat-ment for complications associated with portal hypertension.However,stent fracture,although extremely rare,represents a potentially serious complication following TIPS creation.Timely identification and management are crucial for preventing further adverse events.CASE SUMMARY We report a 56-year-old male patient who underwent a TIPS procedure for re-current melena caused by portal hypertension secondary to hepatitis B and experienced a stent fracture 15 months post-procedure.He was readmitted 30 months after the initial TIPS due to recurrent esophagogastric variceal bleeding and ascites.An attempt to revise the dysfunctional shunt via a stent-in-stent approach was unsuccessful.Consequently,a parallel TIPS procedure was success-fully performed via the proximal end of the fractured stent to decompress the portal venous system.At the 1-month follow-up,the patient exhibited no recur-rent variceal bleeding,and his ascites had significantly decreased.Twelve-month postoperative monitoring revealed no hepatic encephalopathy and no recurrence of bleeding or ascites.Additionally,we review the existing literature on post-TIPS stent fractures to explore the underlying mechanisms contributing to this com-plication.CONCLUSION Early recognition and prompt intervention are essential in managing stent fractures after TIPS creation to mitigate potential risks and ensure optimal patient outcomes.展开更多
BACKGROUND The gut microbiome is associated with hepatic encephalopathy(HE),but research results on the gut microbiome characteristics of patients with liver cirrhosis with and without HE are inconsistent.AIM To study...BACKGROUND The gut microbiome is associated with hepatic encephalopathy(HE),but research results on the gut microbiome characteristics of patients with liver cirrhosis with and without HE are inconsistent.AIM To study the gut microbiota characteristics of patients with liver cirrhosis with and without HE.METHODS We searched the PubMed,Web of Science,EMBASE,and Cochrane databases using two keywords,HE,and gut microbiome.According to the inclusion and exclusion criteria,suitable literature was screened to extract data on the diversity and composition of the fecal microbiota in patients with liver cirrhosis with and without HE.The data were analyzed using RevMan and STATA.RESULTS Seventeen studies were included:(1)A meta-analysis of 7 studies revealed that the Shannon index in liver cirrhosis patients with HE was significantly lower than that in patients without HE[-0.20,95%confidence interval(CI):-0.28 to-0.13,I2=20%];(2)The relative abundances of Lachnospiraceae(-2.73,95%CI:-4.58 to-0.87,I2=38%)and Ruminococcaceae(-2.93,95%CI:-4.29 to-1.56,I2=0%)in liver cirrhosis patients with HE was significantly lower than those in patients without HE;(3)In patients with HE,Enterococcus,Proteobacteria,Enterococcaceae,and Enterobacteriaceae proportions increased,but Ruminococcaceae,Lachnospiraceae,Prevotellaceae,and Bacteroidetes proportions decreased;(4)Differences in the fecal metabolome between liver cirrhosis patients with and without HE were detected;and(5)Differential gut microbiomes may serve as diagnostic and prognostic tools.CONCLUSION The gut microbiomes of patients with liver cirrhosis with and without HE differ.Some gut microbiomes may distinguish liver cirrhosis patients with or without HE and determine patient prognosis.展开更多
BACKGROUND Patients with cirrhosis with hepatopulmonary syndrome(HPS)have a poorer prognosis.The disease has a subtle onset,symptoms are easily masked,clinical attention is insufficient,and misdiagnosis rates are high...BACKGROUND Patients with cirrhosis with hepatopulmonary syndrome(HPS)have a poorer prognosis.The disease has a subtle onset,symptoms are easily masked,clinical attention is insufficient,and misdiagnosis rates are high.AIM To compare the clinical characteristics of patients with cirrhosis,cirrhosis combined with intrapulmonary vascular dilatation(IPVD),and HPS,and to establish predictive models for IPVD and HPS.METHODS Patients with cirrhosis were prospectively screened at a liver-specialized university teaching hospital.Clinical information and blood samples were collected,and biomarker levels in blood samples were measured.Patients with cirrhosis were divided into three groups:Those with pure cirrhosis,those with combined IPVD,and those with HPS based on contrast-enhanced transthoracic echocardiography results and the pulmonary alveolar-arterial oxygen gradient values.Univariate logistic regression and Least Absolute Shrinkage and Selection Operator(LASSO)regression methods were utilized to identify risk factors for IPVD and HPS,and nomograms were constructed to predict IPVD and HPS.RESULTS A total of 320 patients were analyzed,with 101 diagnosed with IPVD,of whom 54 were diagnosed with HPS.There were statistically significant differences in clinical parameters among these three groups of patients.Among the tested biomarkers,sphingosine 1 phosphate,angiopoietin-2,and platelet-derived growth factor BB were significantly associated with IPVD and HPS in patients with cirrhosis.Following LASSO logistic regression screening,prediction models for IPVD and HPS were established.The area under the receiver operating characteristic curve for IPVD prediction was 0.792(95%confidence interval[CI]:0.737-0.847),and for HPS prediction was 0.891(95%CI:0.848-0.934).CONCLUSION This study systematically compared the clinical characteristics of patients with cirrhosis,IPVD,and HPS,and constructed predictive models for IPVD and HPS based on clinical parameters and laboratory indicators.These models showed good predictive value for IPVD and HPS in patients with cirrhosis.They can assist clinicians in the early prognosis assessment of patients with cirrhosis,ultimately benefiting the patients.展开更多
Clinical target volume (CTV) delineation is crucial for tumor control and normal tissue protection. This study aimed to define the locoregional extension patterns of nasopharyngeal carcinoma (NPC) and to improve CTV d...Clinical target volume (CTV) delineation is crucial for tumor control and normal tissue protection. This study aimed to define the locoregional extension patterns of nasopharyngeal carcinoma (NPC) and to improve CTV delineation. Magnetic resonance imaging scans of 2366 newly diagnosed NPC patients were reviewed. According to incidence rates of tumor invasion, the anatomic sites surrounding the nasopharynx were classified into high-risk (>30%), medium-risk (5%-30%), and low-risk (<5%) groups. The lymph node (LN) level was determined according to the Radiation Therapy Oncology Group guidelines, which were further categorized into the upper neck (retropharyngeal region and level Ⅱ), middle neck (levels Ⅲ and Va), and lower neck (levels Ⅳ and Vb and the supraclavicular fossa). The high-risk anatomic sites were adjacent to the nasopharynx, whereas those at medium- or low-risk were separated from the nasopharynx. If the high-risk anatomic sites were involved, the rates of tumor invasion into the adjacent medium-risk sites increased; if not, the rates were significantly lower (P < 0.01). Among the 1920 (81.1%) patients with positive LN, the incidence rates of LN metastasis in the upper, middle, and lower neck were 99.6% , 30.2%, and 7.2%, respectively, and skip metastasis happened in only 1.2% of patients. In the 929 patients who had unilateral upper neck involvement, the rates of contralateral middle neck and lower neck involvement were 1.8% and 0.4%, respectively. Thus, local disease spreads stepwise from proximal sites to distal sites, and LN metastasis spreads from the upper neck to the lower neck. Individualized CTV delineation for NPC may be feasible.展开更多
Background: The prognostic values of staging parameters require continual re?assessment amid changes in diag?nostic and therapeutic methods. This study aimed to identify the prognostic factors and failure patterns of ...Background: The prognostic values of staging parameters require continual re?assessment amid changes in diag?nostic and therapeutic methods. This study aimed to identify the prognostic factors and failure patterns of non?meta?static nasopharyngeal carcinoma(NPC) in the intensity?modulated radiotherapy(IMRT) era.Methods: We reviewed the data from 749 patients with newly diagnosed, biopsy?proven, non?metastatic NPC in our cancer center(South China, an NPC endemic area) between January 2003 and December 2007. All patients under?went magnetic resonance imaging(MRI) before receiving IMRT. The actuarial survival rates were estimated using the Kaplan–Meier method, and survival curves were compared using the log?rank test. Multivariate analyses with the Cox proportional hazards model were used to test for the independent prognostic factors by backward eliminating insigniicant explanatory variables.Results: The 5?year occurrence rates of local failure, regional failure, locoregional failure, and distant failure were 5.4, 3.0, 7.4, and 17.4%, respectively. The 5?year survival rates were as follows: local relapse?free survival, 94.6%; nodal relapse?free survival, 97.0%; distant metastasis?free survival, 82.6%; disease?free survival, 75.1%; and overall survival, 82.0%. Multivariate Cox regression analysis revealed that orbit involvement was the only signiicant prognostic fac?tor for local failure(P = 0.011). Parapharyngeal tumor extension, retropharyngeal lymph node involvement, and the laterality, longest diameter, and Ho's location of the cervical lymph nodes were signiicant prognostic factors for both distant failure and disease failure(all P < 0.05). Intracranial extension had signiicant prognostic value for distant failure(P = 0.040).Conclusions: The key failure pattern for NPC was distant metastasis in the IMRT era. With changes in diagnostic and therapeutic technologies as well as treatment modalities, the signiicant prognostic parameters for local control have also been altered substantially.展开更多
The parapharyngeal space(PPS) is an inverted pyramid-shaped deep space in the head and neck region, and a variety of tumors, such as salivary gland tumors, neurogenic tumors, nasopharyngeal carcinomas with parapharyng...The parapharyngeal space(PPS) is an inverted pyramid-shaped deep space in the head and neck region, and a variety of tumors, such as salivary gland tumors, neurogenic tumors, nasopharyngeal carcinomas with parapharyngeal invasion, and lymphomas, can be found in this space. The differential diagnosis of PPS tumors remains challenging for radiologists. This study aimed to develop and test a modified method for locating PPS tumors on magnetic resonance(MR) images to improve preoperative differential diagnosis. The new protocol divided the PPS into three compartments: a prestyloid compartment, the carotid sheath, and the areas outside the carotid sheath. PPS tumors were located in these compartments according to the displacements of the tensor veli palatini muscle and the styloid process, with or without blood vessel separations and medial pterygoid invasion. This protocol, as well as a more conventional protocol that is based on displacements of the internal carotid artery(ICA), was used to assess MR images captured from a series of 58 PPS tumors. The consequent distributions of PPS tumor locations determined by both methods were compared. Of all 58 tumors, our new method determined that 57 could be assigned to precise PPS compartments. Nearly all(13/14; 93%) tumors that were located in the pre-styloid compartment were salivary gland tumors. All 15 tumors within the carotid sheath were neurogenic tumors. The vast majority(18/20; 90%) of trans-spatial lesions were malignancies. However, according to the ICA-based method, 28 tumors were located in the pre-styloid compartment, and 24 were located in the post-styloid compartment, leaving 6 tumors that were difficult to locate. Lesions located in both the pre-styloid and the post-styloid compartments comprised various types of tumors. Compared with the conventional ICA-based method, our new method can help radiologists to narrow the differential diagnosis of PPS tumors to specific compartments.展开更多
Nasopharyngeal adenoid cystic carcinoma (NACC) is a rare malignancy with high local invasiveness. To date, there is no consensus on the imaging characteristics of NACC. To address this, we retrospectively reviewed 10 ...Nasopharyngeal adenoid cystic carcinoma (NACC) is a rare malignancy with high local invasiveness. To date, there is no consensus on the imaging characteristics of NACC. To address this, we retrospectively reviewed 10 cases of NACC and summarized the magnetic resonance imaging (MRI) features. MR images of 10 patients with histologically validated NACC were reviewed by two experienced radiologists. The location, shape, margin, signal intensity, lesion texture, contrast enhancement patterns, local invasion, and cervical lymphadenopathy of all tumors were evaluated. Clinical and pathologic records were also reviewed. No patients were positive for antibodies against Epstein-Barr virus (EBV). The imaging patterns of primary tumors were classified into two types as determined by location, shape, and margin. Of all patients, 7 had tumors with a type 1 imaging pattern and 3 had tumors with a type 2 imaging pattern. The 4 tubular NACCs were all homogeneous tumors, whereas 3 (60%) of 5 cribriform NACCs and the sole solid NACC were heterogeneous tumors with separations or central necrosis on MR images. Five patients had perineural infiltration and intracranial involvement, and only 2 had cervical lymphadenopathy. Based on these results, we conclude that NACC is a local, aggressive neoplasm that is often negative for EBV infection and associated with a low incidence of cervical lymphadenopathy. Furthermore, MRI features of NACC vary in locations and histological subtypes.展开更多
This study aimed to determine and quantitate the mammographic and sonographic characteristics in 13 cases of solid neuroendocrine breast carcinoma(NEBC) and to analyze the association of radiological findings with the...This study aimed to determine and quantitate the mammographic and sonographic characteristics in 13 cases of solid neuroendocrine breast carcinoma(NEBC) and to analyze the association of radiological findings with the clinical and histopathologic findings.The clinical data and imaging findings of 13 female patients with histologically confirmed solid NEBC were reviewed.Imaging data were evaluated by two radiologists for a consensual diagnosis.All patients presented with one palpable mass;only 1 experienced occasional breast pain,and 5 complained of fluid discharge.In 7 patients,the masses were firm and mobile.Regional lymph node metastasis was noted in only 1 patient.For the 10 patients who underwent mammography,6 had a mass,1 had clustered small nodules with clustered punctuate microcalcifications,2 had asymmetric focal density,and 1 had solitary punctuate calcification.Most of the masses had irregular shape with indistinct or microlobulated margins.For the 9 patients who underwent ultrasonography(US),9 masses were depicted,all of which were hypoechoic,mostly with irregular shape and without acoustic phenomena.Different types of acoustic phenomena were also identified.One patient had developed distant metastases during follow-up.NEBC has a variety of presentations,but it is mostly observed on mammograms as a dense,irregular mass with indistinct or microlobulated margins.Sonographically,it typically presents as an irregular,heterogeneously hypoechoic mass with normal sound transmission.Histories of nipple discharge and calcification observed using imaging are not rare.展开更多
The application of simultaneous integrated boost-intensity modulated radiotherapy(SIB-IMRT)in pediatric and adolescent nasopharyngeal carcinoma(NPC)is underevaluated.This study aimed to evaluate long-term outcome and ...The application of simultaneous integrated boost-intensity modulated radiotherapy(SIB-IMRT)in pediatric and adolescent nasopharyngeal carcinoma(NPC)is underevaluated.This study aimed to evaluate long-term outcome and late toxicities in pediatric and adolescent NPC after SIB-IMRT combined with chemotherapy.Thirty-four patients(aged 8–20 years)with histologically proven,non-disseminated NPC treated with SIB-IMRT were enrolled in this retrospective study.The disease stage distribution was as follows:stage I,1(2.9%);stage III,14(41.2%);and stage IV,19(55.9%).All patients underwent SIBIMRT and 30 patients also underwent cisplatin-based chemotherapy.The prescribed dose of IMRT was64–68 Gy in 29–31 fractions to the nasopharyngeal gross target volume.Within the median follow-up of 52months(range,9–111 months),1 patient(2.9%)experienced local recurrence and 4(11.8%)developed distant metastasis(to the lung in 3 cases and to multiple organs in 1 case).Four patients(11.8%)died due to recurrence or metastasis.The 5-year locoregional relapse–free survival,distant metastasis–free survival,disease-free survival,and overall survival rates were 97.1%,88.2%,85.3%,and 88.2%,respectively.The most common acute toxicities were grades 3–4 hematologic toxicities and stomatitis.Of the 24 patients who survived for more than 2 years,16(66.7%)and 15(62.5%)developed grades 1–2 xerostomia and ototoxicity,respectively.Two patients(8.3%)developed grade 3 ototoxicity;no grade 4 toxicities were observed.SIB-IMRT combined with chemotherapy achieves excellent long-term locoregional control in pediatric and adolescent NPC,with mild incidence of late toxicities.Distant metastasis is the predominant mode of failure.展开更多
文摘Primary liver cancer is a common and lethal malignancy in China.Transcatheter arterial chemoembolization(TACE)is globally recognized as the preferred treatment modality for the non-surgical resection of hepatocellular carcinoma(HCC),while transcatheter arterial infusion(TAI)is another effective interventional treatment for HCC.In recent years,hepatic arterial infusion chemotherapy(HAIC)has gained increasing attention as an application-regulated modality for TAI.Owing to the current debate in the medical community regarding the use of HAIC and TACE for the treatment of HCC,the application of both approaches should be considered at a higher level,with a broader perspective and a more normative aspect.Accordingly,we aimed to define the rational combination of liver cancer TAI/HAIC with TACE as infusion transcatheter chemoembolization(iTACE),which suggests that the two interventions are not superior but lead to a mutually beneficial situation.In this review,we sought to discuss the development,specification,application,challenge and innovation,debate,and union of TAI/HAIC and TACE,and the clinical application and latest research on iTACE.We aimed to introduce new concepts of iTACE and expect new breakthroughs in the treatment of liver cancer owing to the combined use of the two major interventional tools.
基金supported by the National Key R&D Program of China(grant number 2022ZD0211700)National Natural Science Foundation of China(grant no.81771466)+1 种基金Health Science and Technology Project of Guangzhou(grant no.20211A010037)Guangzhou Municipal Psychiatric Disease Clinical Transformation Laboratory,Guangzhou,China(grant no.201805010009).
文摘Background Depression in adolescents is recognised as a global public health concern,but little is known about the trajectory of its clinical symptoms and pathogenesis.Understanding the nature of adolescents with depression and identifying earlybiomarkers can facilitatepersonalised intervention andreducediseaseburden.Aims To track multidimensional outcomes of adolescents with depression and develop objective biomarkers for diagnosis,as well as response to treatment,prognosis and guidance for early identification and intervention.Methods This is a multidimensional cohort study on the Symptomatic trajectory and Biomarkers of Early Adolescent Depression(sBEAD).We planned to recruit more than 1000 adolescents with depression and 300 healthy controls within 5 years.Multidimensional clinical presentations and objective indicators are collected at baseline,weeks 4,8,12 and 24,and years 1,2,3,4 and 5.Conclusions To the best of our knowledge,this is the first longitudinal cohort study that examines multidimensional clinical manifestations and multilevel objective markers in Chinese adolescents with depression.This study aims at providing early individualised interventions for young,depressed patients to reduce the burden of disease.
基金supported by grants from the National Key R&D Program of China(2017YFA0205200,2017YFC1308701,and 2017YFC1309100)National Natural Science Foundation of China(82001917,81930053,81227901,81771924,81501616,81571785,81771957,and 61671449)the Natural Science Foundation of Guangdong Province,China(2016A030311055 and 2016A030313770)。
文摘Background:Macrovascular invasion(MaVI)occurs in nearly half of hepatocellular carcinoma(HCC)patients at diagnosis or during follow-up,which causes severe disease deterioration,and limits the possibility of surgical approaches.This study aimed to investigate whether computed tomography(CT)-based radiomics analysis could help predict development of MaVI in HCC.Methods:A cohort of 226 patients diagnosed with HCC was enrolled from 5 hospitals with complete MaVI and prognosis follow-ups.CT-based radiomics signature was built via multi-strategy machine learning methods.Afterwards,MaVI-related clinical factors and radiomics signature were integrated to construct the final prediction model(CRIM,clinical-radiomics integrated model)via random forest modeling.Cox-regression analysis was used to select independent risk factors to predict the time of MaVI development.Kaplan-Meier analysis was conducted to stratify patients according to the time of MaVI development,progression-free survival(PFS),and overall survival(OS)based on the selected risk factors.Results:The radiomics signature showed significant improvement for MaVI prediction compared with conventional clinical/radiological predictors(P<0.001).CRIM could predict MaVI with satisfactory areas under the curve(AUC)of 0.986 and 0.979 in the training(n=154)and external validation(n=72)datasets,respectively.CRIM presented with excellent generalization with AUC of 0.956,1.000,and 1.000 in each external cohort that accepted disparate CT scanning protocol/manufactory.Peel9_fos_InterquartileRange[hazard ratio(HR)=1.98;P<0.001]was selected as the independent risk factor.The cox-regression model successfully stratified patients into the high-risk and low-risk groups regarding the time of MaVI development(P<0.001),PFS(P<0.001)and OS(P=0.002).Conclusions:The CT-based quantitative radiomics analysis could enable high accuracy prediction of subsequent MaVI development in HCC with prognostic implications.
文摘BACKGROUND The treatment outcome of transarterial chemoembolization(TACE)in unresectable hepatocellular carcinoma(HCC)varies greatly due to the clinical heterogeneity of the patients.Therefore,several prognostic systems have been proposed for risk stratification and candidate identification for first TACE and repeated TACE(re-TACE).AIM To investigate the correlations between prognostic systems and radiological response,compare the predictive abilities,and integrate them in sequence for outcome prediction.METHODS This nationwide multicenter retrospective cohort consisted of 1107 unresectable HCC patients in 15 Chinese tertiary hospitals from January 2010 to May 2016.The Hepatoma Arterial-embolization Prognostic(HAP)score system and its modified versions(mHAP,mHAP2 and mHAP3),as well as the six-and-twelve criteria were compared in terms of their correlations with radiological response and overall survival(OS)prediction for first TACE.The same analyses were conducted in 912 patients receiving re-TACE to evaluate the ART(assessment for re-treatment with TACE)and ABCR(alpha-fetoprotein,Barcelona Clinic Liver Cancer,Child-Pugh and Response)systems for post re-TACE survival(PRTS).RESULTS All the prognostic systems were correlated with radiological response achieved by first TACE,and the six-and-twelve criteria exhibited the highest correlation(Spearman R=0.39,P=0.026)and consistency(Kappa=0.14,P=0.019),with optimal performance by area under the receiver operating characteristic curve of 0.71[95%confidence interval(CI):0.68-0.74].With regard to the prediction of OS,the mHAP3 system identified patients with a favorable outcome with the highest concordance(C)-index of 0.60(95%CI:0.57-0.62)and the best area under the receiver operating characteristic curve at any time point during follow-up;whereas,PRTS was well-predicted by the ABCR system with a C-index of 0.61(95%CI:0.59-0.63),rather than ART.Finally,combining the mHAP3 and ABCR systems identified candidates suitable for TACE with an improved median PRTS of 36.6 mo,compared with non-candidates with a median PRTS of 20.0 mo(logrank test P<0.001).CONCLUSION Radiological response to TACE is closely associated with tumor burden,but superior prognostic prediction could be achieved with the combination of mHAP3 and ABCR in patients with unresectable liver-confined HCC.
基金supported by a grant from the Nursing Re-search Program of the First Affiliated Hospital of Zhejiang Univer-sity School of Medicine(No.2022ZYHL045).
文摘To the Editor:We read with great interest the recent article by Shi et al.pub-lished in Hepatobiliary Pancreatic Diseases International[1].Shi’s study was based on radiological features and clinical factors to construct a model to predict the effectiveness of first transarterial chemoembolization(TACE)treatment for hepatocellular carcinoma(HCC)in prolonging patient survival.The results showed that area under the receiver operating characteristic curve was 0.964 for the training cohort and 0.949 for the validation cohort.
文摘BACKGROUND Subcutaneous implantable cardioverter-defibrillator(S-ICD)implantation requires effective anesthesia.General anesthesia(GA)carries risks like hemodynamic instability,while ultrasound-guided intercostal nerve block(US-ICNB)may offer better pain control.This study hypothesized US-ICNB is superior in perioperative safety and pain management.AIM To compare perioperative outcomes of GA and US-ICNB in S-ICD implantation.METHODS This retrospective single-center study included 64 patients who received S-ICD implantation between February 2021 and December 2024.They were divided into GA and US-ICNB groups based on anesthesia type.Demographic data,perioperative parameters(operation time,pain scores,analgesic usage),and postoperative outcomes(complications,defibrillation events)were collected and analyzed.Statistical tests were used to compare the two groups.RESULTS This study included 64 patients(20 in the GA group and 44 in the US-ICNB group).Baseline left ventricular ejection fraction was significantly lower in the US-ICNB group(39.20%±12.00%vs 56.20%±11.50%in GA,P<0.001),while American Society of Anesthesiologists scores and comorbidities were comparable.US-ICNB showed superior pain control,with significantly lower numeric rating scale scores at 6-48 hours(P<0.001)and fewer patients requiring analgesics(P=0.02).The US-ICNB group had shorter operation times(P<0.001),total hospital stays(P<0.001),and later first analgesia times(P<0.001).No anesthesia-related complications occurred in either group.CONCLUSION Both anesthetic methods were safe in the short term.However,US-ICNB was superior in reducing operation and hospital stay times and alleviating peri-operative pain.It has high safety in S-ICD implantation and deserves further clinical promotion,though large-scale,multi-center,randomized controlled trials are needed to confirm these findings.
基金Supported by Tengfei Project of Third Affiliated Hospital of the Naval Medical University,No.TF2024TJYQ02.
文摘BACKGROUND Hemorrhage following pancreaticobiliary surgery is a high-risk complication,with a mortality rate of 16%-38%.At present,minimally invasive endovascular intervention comprising superselective arterial embolization(SAE)and covered stent implantation(CSI)is the treatment of choice.However,in certain cases,both SAE and CSI become infeasible.AIM To evaluate the effectiveness of coil-assisted N-butyl cyanoacrylate(NBCA)embolization in comparison with that of CSI in managing delayed hemorrhage after hepatobiliary–pancreatic surgery when SAE is infeasible.METHODS Ninety-eight continuous patients(n=105 cases;mean age,58.4 years)with delayed massive hemorrhage who were treated with coil-assisted NBCA embolization(NBCA group,n=45)and/or CSI(CSI group,n=60)were retrospectively evaluated between March 2014 and December 2023.Data on technical and clinical success,30-day mortality,and severe intervention-related adverse events were collected and analyzed.RESULTS The technical and clinical success rates in the NBCA group(100%and 93.3%,respectively)were significantly higher than those in the CSI group(88.3%and 73.3%,respectively),with a statistically significant difference between the two groups(P=0.019 and 0.010,respectively).The 30-day mortality rates and major intervention-related complications were 17.8%and 0%,respectively,in the NBCA group and 18.3%and 1.7%in the CSI group,respectively,with no statistically significant difference between the two groups.CONCLUSION In terms of technical and clinical success,coil-assisted NBCA embolization was more effective than CSI for managing delayed hemorrhage after hepatobiliary–pancreatic surgery when SAE was not feasible.
基金Supported by Beijing Medical Award Foundation of China,No.YXJL-2023-0638-0048.
文摘BACKGROUND Hepatic artery infusion chemotherapy(HAIC)is a widely used local therapeutic approach for intermediate to advanced-stage hepatocellular carcinoma(HCC),exhibiting considerable efficacy.However,the prevalence of postoperative pain highlights the importance of pain management.Owing to the limitations inherent in existing pain management strategies,this study investigates and assesses the analgesic effectiveness of a multimodal treatment protocol in mitigating pain after HAIC procedures.AIM To provide patients with a more comprehensive and effective pain management strategy.METHODS A total of 100 patients with primary HCC who underwent HAIC were randomly assigned to a control group(n=50)and a multimodal group(n=50).Baseline characteristics and perioperative data were collected.Upon enrollment,patients in the multimodal group received parecoxib(40 mg)30 minutes before HAIC,followed by 48 hours of patient-controlled analgesia with sufentanil.In contrast,the control group underwent standard preoperative preparation(psychological support)and received dezocine(5 mg)intraoperatively,with intravenous flurbiprofen(100 mg)administered every 12 hours for 48 hours postoperatively.RESULTS Compared to the control group,the multimodal analgesia group exhibited significantly lower resting and movement visual analog scale pain scores at postoperative 0,2,4,6,and 12 hours(P<0.05).Furthermore,the multimodal group experienced a reduced incidence of postoperative nausea and vomiting,as well as a lower overall frequency of adverse events,compared to the control group(P<0.05).Patient satisfaction was also significantly higher in the multimodal group than in the control group(P<0.05).CONCLUSION Our study demonstrates that multimodal analgesia is effective in reducing postoperative pain,minimizing adverse reactions,and improving patient satisfaction in HCC patients undergoing HAIC.This approach provides valuable clinical strategies for optimizing pain management in this patient population.
文摘BACKGROUND Hepatic encephalopathy(HE)is a primary complication following transjugular intrahepatic portosystemic shunt(TIPS),but the utility of pharmacological prophylaxis for HE is unclear.AIM To assess the HE incidence post-TIPS across various groups and the prophylactic efficacies of various medications.METHODS A thorough literature search was performed in PubMed,Web of Science,EMBASE,and the Cochrane Library databases from their inception to November 24,2024,to collect data regarding HE incidence.The main outcome was HE incidence post-TIPS.A meta-analysis using a random effects model was performed to obtain odds ratios(ORs)and 95%confidence intervals.Statistical analyses were conducted using Stata and RevMan software.RESULTS This meta-analysis included nine studies with 1140 patients;647 received pharmacological agents including lactulose,rifaximin,albumin,and l-ornithin-l-aspartate,and 493 did not(controls).(1)In the single-group meta-analysis,the control group had higher short-and long-term HE rates than the drug intervention group.Among patients with and without prior HE,the non-intervention group's HE rates were also higher;(2)Pharmacological prevention post-TIPS significantly reduced HE incidence[OR=0.59(0.45,0.77),P=0.0001].Compared with the no prophylaxis,rifaximin reduced the risk of HE after TIPS[OR=0.52(0.29,0.95),P=0.03],but lactulose did not;(3)In patients without prior HE,pharmacological prevention significantly reduced post-TIPS HE incidence[OR=0.62(0.41,0.95),P=0.03];and(4)Network meta-analysis showed no significant differences among five prevention strategies.CONCLUSION The HE incidence after TIPS was relatively high,and the use of drugs after TIPS may reduce the HE incidence.However,research,especially large-scale randomized controlled trials,is still lacking.
基金funded by the Jining Key Research and Development Plan(No.2024YXNS267).
文摘Background:Intestinal obstruction is a prevalent complication in patients with colorectal cancer following surgery,with a significant impact on health outcomes.Dachengqi decoction(DCQD)is a traditional Chinese medicine(TCM)that is employed in clinical settings for the treatment of intestinal obstruction.However,the pharmacological mechanisms and active components of this medicinal preparation remain to be fully elucidated.The objective of this study was to examine the possible mechanisms and active constituents of DCQD in addressing intestinal obstruction subsequent to colorectal cancer surgery.Methods:A comprehensive search was conducted on the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform and the Traditional Chinese Medicine Integrated Database for the active chemical constituents of DCQD.In addition,the PubChem,Swiss Target Prediction and Uniprot databases were utilised to predict the drug targets.The possible target genes associated with intestinal obstruction were obtained from the GeneCards,Online Mendelian Inheritance in Man,PharmGKB,and Therapeutic Target Database databases,and were analysed using the Database for Annotation,Visualisation and Integrated Discovery platform for Gene Ontology(GO)functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis.Cytoscape was utilised to visualise key components,targets,and pathways,and molecular docking technology was employed to verify the binding of core targets and key components.Results:A total of 41 active chemical components and 141 intersecting targets were screened,and it was determined that the intersecting targets of TCM and disease were significantly enriched in 44 GO entries and 93 KEGG pathways.Subsequent screening identified 3 key components(isosinensetin,tetramethoxyluteolin,and 5,7,4’-trimethylapigenin)and 9 core targets(TP53,STAT3,ESR1,SRC,EGFR,AKT1,CTNNB1,BCL2,and PIK3CA).The molecular docking results demonstrated that all 3 key components exhibited strong binding to the core targets.Conclusions:The present study identified the pharmacological basis by which DCQD exerts beneficial effects against intestinal obstruction and provided insights into its mechanism of action,providing scientific evidence for precise clinical utilisation and areas for new drug development.
文摘BACKGROUND Despite the promising prospects of using artificial intelligence and machine learning(ML)for disease classification and prediction purposes,the complexity and lack of explainability of this method make it difficult to apply the constructed models in clinical practice.We developed and validated an interpretable ML model based on magnetic resonance imaging(MRI)radiomics and clinical features for the preoperative prediction of the pathological grades of hepatocellular carcinomas(HCCs).This model will help clinicians better understand the situation and develop personalized treatment plans.AIM To develop and validate an interpretable ML model for preoperative pathological grade prediction in HCC patients via a combination of multisequence MRI radiomics and clinical features.METHODS MRI and clinical data derived from 125 patients with HCCs confirmed by postoperative pathological examinations were retrospectively analyzed.The patients were randomly split into training and validation groups(7:3 ratio).Univariate and multivariate logistic regression analyses were performed to identify independent clinical predictors.The tumor lesions observed on axial fatsuppressed T2-weighted imaging(FS-T2WI),arterial phase(AP),and portal venous phase(PVP)images were delineated in a slice-by-slice manner using 3D-slicer to generate volumetric regions of interest,and radiomic features were extracted.Interclass correlation coefficients were calculated,and least absolute selection and shrinkage operator regression were conducted for feature selection purposes.Six predictive models were subsequently developed for pathological grade prediction:FS-T2WI,AP,PVP,integrated radiomics,clinical,and combined radiomics-clinical(RC)models.The effectiveness of these models was assessed by calculating their area under the receiver operating characteristic curve(AUC)values.The clinical applicability of the models was evaluated via decision curve analysis.Finally,the contributions of the different features contained in the model with optimal performance were interpreted via a SHapley Additive exPlanations analysis.RESULTS Among the 125 patients,87 were assigned to the training group,and 38 were assigned to the validation group.The maximum tumor diameter,hepatitis B virus status,and monocyte count were identified as independent predictors of pathological grade.Twelve optimal radiomic features were ultimately selected.The AUC values obtained for the FS-T2WI model,AP model,PVP model,radiomics model,clinical model,and combined RC model in the training group were 0.761[95%confidence interval(CI):0.562-0.857],0.870(95%CI:0.714-0.918),0.868(95%CI:0.714-0.959),0.917(95%CI:0.857-0.959),0.869(95%CI:0.643-0.973),and 0.941(95%CI:0.857-0.945),respectively;in the validation group,the AUC values were 0.724(95%CI:0.625-0.833),0.802(95%CI:0.686-1.000),0.797(95%CI:0.688-1.000),0.901(95%CI:0.833-0.906),0.865(95%CI:0.594-1.000),and 0.932(95%CI:0.812-1.000),respectively.The combined RC model demonstrated the best performance.Additionally,the decision curve analysis revealed that the combined RC model had satisfactory prediction efficiency,and the SHapley Additive exPlanations value analysis revealed that the“FS-T2WI-wavelet-HLL_gldm_Large Dependence High Gray Level Emphasis”feature contributed the most to the model,exhibiting a positive effect.CONCLUSION An interpretable ML model based on MRI radiomics provides a noninvasive tool for predicting the pathological grade of HCCs,which will help clinicians develop personalized treatment plans.
文摘BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a highly effective treat-ment for complications associated with portal hypertension.However,stent fracture,although extremely rare,represents a potentially serious complication following TIPS creation.Timely identification and management are crucial for preventing further adverse events.CASE SUMMARY We report a 56-year-old male patient who underwent a TIPS procedure for re-current melena caused by portal hypertension secondary to hepatitis B and experienced a stent fracture 15 months post-procedure.He was readmitted 30 months after the initial TIPS due to recurrent esophagogastric variceal bleeding and ascites.An attempt to revise the dysfunctional shunt via a stent-in-stent approach was unsuccessful.Consequently,a parallel TIPS procedure was success-fully performed via the proximal end of the fractured stent to decompress the portal venous system.At the 1-month follow-up,the patient exhibited no recur-rent variceal bleeding,and his ascites had significantly decreased.Twelve-month postoperative monitoring revealed no hepatic encephalopathy and no recurrence of bleeding or ascites.Additionally,we review the existing literature on post-TIPS stent fractures to explore the underlying mechanisms contributing to this com-plication.CONCLUSION Early recognition and prompt intervention are essential in managing stent fractures after TIPS creation to mitigate potential risks and ensure optimal patient outcomes.
文摘BACKGROUND The gut microbiome is associated with hepatic encephalopathy(HE),but research results on the gut microbiome characteristics of patients with liver cirrhosis with and without HE are inconsistent.AIM To study the gut microbiota characteristics of patients with liver cirrhosis with and without HE.METHODS We searched the PubMed,Web of Science,EMBASE,and Cochrane databases using two keywords,HE,and gut microbiome.According to the inclusion and exclusion criteria,suitable literature was screened to extract data on the diversity and composition of the fecal microbiota in patients with liver cirrhosis with and without HE.The data were analyzed using RevMan and STATA.RESULTS Seventeen studies were included:(1)A meta-analysis of 7 studies revealed that the Shannon index in liver cirrhosis patients with HE was significantly lower than that in patients without HE[-0.20,95%confidence interval(CI):-0.28 to-0.13,I2=20%];(2)The relative abundances of Lachnospiraceae(-2.73,95%CI:-4.58 to-0.87,I2=38%)and Ruminococcaceae(-2.93,95%CI:-4.29 to-1.56,I2=0%)in liver cirrhosis patients with HE was significantly lower than those in patients without HE;(3)In patients with HE,Enterococcus,Proteobacteria,Enterococcaceae,and Enterobacteriaceae proportions increased,but Ruminococcaceae,Lachnospiraceae,Prevotellaceae,and Bacteroidetes proportions decreased;(4)Differences in the fecal metabolome between liver cirrhosis patients with and without HE were detected;and(5)Differential gut microbiomes may serve as diagnostic and prognostic tools.CONCLUSION The gut microbiomes of patients with liver cirrhosis with and without HE differ.Some gut microbiomes may distinguish liver cirrhosis patients with or without HE and determine patient prognosis.
基金Supported by the National Key Research and Development Program of China,No.2022YFC2305002Beijing Natural Science Foundation,No.7232079+1 种基金Middle-aged and Young Talent Incubation Programs(Clinical Research)of Beijing Youan Hospital,No.BJYAYY-YN2022-12,No.BJYAYY-YN2022-13,and No.BJYAYY-YN2022-01the China Postdoctoral Science Foundation,No.2023M732410 and No.2024T170595.
文摘BACKGROUND Patients with cirrhosis with hepatopulmonary syndrome(HPS)have a poorer prognosis.The disease has a subtle onset,symptoms are easily masked,clinical attention is insufficient,and misdiagnosis rates are high.AIM To compare the clinical characteristics of patients with cirrhosis,cirrhosis combined with intrapulmonary vascular dilatation(IPVD),and HPS,and to establish predictive models for IPVD and HPS.METHODS Patients with cirrhosis were prospectively screened at a liver-specialized university teaching hospital.Clinical information and blood samples were collected,and biomarker levels in blood samples were measured.Patients with cirrhosis were divided into three groups:Those with pure cirrhosis,those with combined IPVD,and those with HPS based on contrast-enhanced transthoracic echocardiography results and the pulmonary alveolar-arterial oxygen gradient values.Univariate logistic regression and Least Absolute Shrinkage and Selection Operator(LASSO)regression methods were utilized to identify risk factors for IPVD and HPS,and nomograms were constructed to predict IPVD and HPS.RESULTS A total of 320 patients were analyzed,with 101 diagnosed with IPVD,of whom 54 were diagnosed with HPS.There were statistically significant differences in clinical parameters among these three groups of patients.Among the tested biomarkers,sphingosine 1 phosphate,angiopoietin-2,and platelet-derived growth factor BB were significantly associated with IPVD and HPS in patients with cirrhosis.Following LASSO logistic regression screening,prediction models for IPVD and HPS were established.The area under the receiver operating characteristic curve for IPVD prediction was 0.792(95%confidence interval[CI]:0.737-0.847),and for HPS prediction was 0.891(95%CI:0.848-0.934).CONCLUSION This study systematically compared the clinical characteristics of patients with cirrhosis,IPVD,and HPS,and constructed predictive models for IPVD and HPS based on clinical parameters and laboratory indicators.These models showed good predictive value for IPVD and HPS in patients with cirrhosis.They can assist clinicians in the early prognosis assessment of patients with cirrhosis,ultimately benefiting the patients.
文摘Clinical target volume (CTV) delineation is crucial for tumor control and normal tissue protection. This study aimed to define the locoregional extension patterns of nasopharyngeal carcinoma (NPC) and to improve CTV delineation. Magnetic resonance imaging scans of 2366 newly diagnosed NPC patients were reviewed. According to incidence rates of tumor invasion, the anatomic sites surrounding the nasopharynx were classified into high-risk (>30%), medium-risk (5%-30%), and low-risk (<5%) groups. The lymph node (LN) level was determined according to the Radiation Therapy Oncology Group guidelines, which were further categorized into the upper neck (retropharyngeal region and level Ⅱ), middle neck (levels Ⅲ and Va), and lower neck (levels Ⅳ and Vb and the supraclavicular fossa). The high-risk anatomic sites were adjacent to the nasopharynx, whereas those at medium- or low-risk were separated from the nasopharynx. If the high-risk anatomic sites were involved, the rates of tumor invasion into the adjacent medium-risk sites increased; if not, the rates were significantly lower (P < 0.01). Among the 1920 (81.1%) patients with positive LN, the incidence rates of LN metastasis in the upper, middle, and lower neck were 99.6% , 30.2%, and 7.2%, respectively, and skip metastasis happened in only 1.2% of patients. In the 929 patients who had unilateral upper neck involvement, the rates of contralateral middle neck and lower neck involvement were 1.8% and 0.4%, respectively. Thus, local disease spreads stepwise from proximal sites to distal sites, and LN metastasis spreads from the upper neck to the lower neck. Individualized CTV delineation for NPC may be feasible.
基金supported by grants from the Key Laboratory Construction Project of Guangzhou City,China (121800085)the Health & Medical Collaborative Innovation Project of Guangzhou City,China (201400000001)+2 种基金the National Science & Technology Pillar Program during the Twelfth Five-year Plan Period (2014BAI09B10)the National Natural Science Foundation of China (81201746)the Planned Science and Technology Project of Guangdong Province,China (2013B020400004)
文摘Background: The prognostic values of staging parameters require continual re?assessment amid changes in diag?nostic and therapeutic methods. This study aimed to identify the prognostic factors and failure patterns of non?meta?static nasopharyngeal carcinoma(NPC) in the intensity?modulated radiotherapy(IMRT) era.Methods: We reviewed the data from 749 patients with newly diagnosed, biopsy?proven, non?metastatic NPC in our cancer center(South China, an NPC endemic area) between January 2003 and December 2007. All patients under?went magnetic resonance imaging(MRI) before receiving IMRT. The actuarial survival rates were estimated using the Kaplan–Meier method, and survival curves were compared using the log?rank test. Multivariate analyses with the Cox proportional hazards model were used to test for the independent prognostic factors by backward eliminating insigniicant explanatory variables.Results: The 5?year occurrence rates of local failure, regional failure, locoregional failure, and distant failure were 5.4, 3.0, 7.4, and 17.4%, respectively. The 5?year survival rates were as follows: local relapse?free survival, 94.6%; nodal relapse?free survival, 97.0%; distant metastasis?free survival, 82.6%; disease?free survival, 75.1%; and overall survival, 82.0%. Multivariate Cox regression analysis revealed that orbit involvement was the only signiicant prognostic fac?tor for local failure(P = 0.011). Parapharyngeal tumor extension, retropharyngeal lymph node involvement, and the laterality, longest diameter, and Ho's location of the cervical lymph nodes were signiicant prognostic factors for both distant failure and disease failure(all P < 0.05). Intracranial extension had signiicant prognostic value for distant failure(P = 0.040).Conclusions: The key failure pattern for NPC was distant metastasis in the IMRT era. With changes in diagnostic and therapeutic technologies as well as treatment modalities, the signiicant prognostic parameters for local control have also been altered substantially.
文摘The parapharyngeal space(PPS) is an inverted pyramid-shaped deep space in the head and neck region, and a variety of tumors, such as salivary gland tumors, neurogenic tumors, nasopharyngeal carcinomas with parapharyngeal invasion, and lymphomas, can be found in this space. The differential diagnosis of PPS tumors remains challenging for radiologists. This study aimed to develop and test a modified method for locating PPS tumors on magnetic resonance(MR) images to improve preoperative differential diagnosis. The new protocol divided the PPS into three compartments: a prestyloid compartment, the carotid sheath, and the areas outside the carotid sheath. PPS tumors were located in these compartments according to the displacements of the tensor veli palatini muscle and the styloid process, with or without blood vessel separations and medial pterygoid invasion. This protocol, as well as a more conventional protocol that is based on displacements of the internal carotid artery(ICA), was used to assess MR images captured from a series of 58 PPS tumors. The consequent distributions of PPS tumor locations determined by both methods were compared. Of all 58 tumors, our new method determined that 57 could be assigned to precise PPS compartments. Nearly all(13/14; 93%) tumors that were located in the pre-styloid compartment were salivary gland tumors. All 15 tumors within the carotid sheath were neurogenic tumors. The vast majority(18/20; 90%) of trans-spatial lesions were malignancies. However, according to the ICA-based method, 28 tumors were located in the pre-styloid compartment, and 24 were located in the post-styloid compartment, leaving 6 tumors that were difficult to locate. Lesions located in both the pre-styloid and the post-styloid compartments comprised various types of tumors. Compared with the conventional ICA-based method, our new method can help radiologists to narrow the differential diagnosis of PPS tumors to specific compartments.
文摘Nasopharyngeal adenoid cystic carcinoma (NACC) is a rare malignancy with high local invasiveness. To date, there is no consensus on the imaging characteristics of NACC. To address this, we retrospectively reviewed 10 cases of NACC and summarized the magnetic resonance imaging (MRI) features. MR images of 10 patients with histologically validated NACC were reviewed by two experienced radiologists. The location, shape, margin, signal intensity, lesion texture, contrast enhancement patterns, local invasion, and cervical lymphadenopathy of all tumors were evaluated. Clinical and pathologic records were also reviewed. No patients were positive for antibodies against Epstein-Barr virus (EBV). The imaging patterns of primary tumors were classified into two types as determined by location, shape, and margin. Of all patients, 7 had tumors with a type 1 imaging pattern and 3 had tumors with a type 2 imaging pattern. The 4 tubular NACCs were all homogeneous tumors, whereas 3 (60%) of 5 cribriform NACCs and the sole solid NACC were heterogeneous tumors with separations or central necrosis on MR images. Five patients had perineural infiltration and intracranial involvement, and only 2 had cervical lymphadenopathy. Based on these results, we conclude that NACC is a local, aggressive neoplasm that is often negative for EBV infection and associated with a low incidence of cervical lymphadenopathy. Furthermore, MRI features of NACC vary in locations and histological subtypes.
文摘This study aimed to determine and quantitate the mammographic and sonographic characteristics in 13 cases of solid neuroendocrine breast carcinoma(NEBC) and to analyze the association of radiological findings with the clinical and histopathologic findings.The clinical data and imaging findings of 13 female patients with histologically confirmed solid NEBC were reviewed.Imaging data were evaluated by two radiologists for a consensual diagnosis.All patients presented with one palpable mass;only 1 experienced occasional breast pain,and 5 complained of fluid discharge.In 7 patients,the masses were firm and mobile.Regional lymph node metastasis was noted in only 1 patient.For the 10 patients who underwent mammography,6 had a mass,1 had clustered small nodules with clustered punctuate microcalcifications,2 had asymmetric focal density,and 1 had solitary punctuate calcification.Most of the masses had irregular shape with indistinct or microlobulated margins.For the 9 patients who underwent ultrasonography(US),9 masses were depicted,all of which were hypoechoic,mostly with irregular shape and without acoustic phenomena.Different types of acoustic phenomena were also identified.One patient had developed distant metastases during follow-up.NEBC has a variety of presentations,but it is mostly observed on mammograms as a dense,irregular mass with indistinct or microlobulated margins.Sonographically,it typically presents as an irregular,heterogeneously hypoechoic mass with normal sound transmission.Histories of nipple discharge and calcification observed using imaging are not rare.
基金Natural ScienceFoundation of China(No.81071836)Sun Yat-sen University5010 Projects(No.050243)
文摘The application of simultaneous integrated boost-intensity modulated radiotherapy(SIB-IMRT)in pediatric and adolescent nasopharyngeal carcinoma(NPC)is underevaluated.This study aimed to evaluate long-term outcome and late toxicities in pediatric and adolescent NPC after SIB-IMRT combined with chemotherapy.Thirty-four patients(aged 8–20 years)with histologically proven,non-disseminated NPC treated with SIB-IMRT were enrolled in this retrospective study.The disease stage distribution was as follows:stage I,1(2.9%);stage III,14(41.2%);and stage IV,19(55.9%).All patients underwent SIBIMRT and 30 patients also underwent cisplatin-based chemotherapy.The prescribed dose of IMRT was64–68 Gy in 29–31 fractions to the nasopharyngeal gross target volume.Within the median follow-up of 52months(range,9–111 months),1 patient(2.9%)experienced local recurrence and 4(11.8%)developed distant metastasis(to the lung in 3 cases and to multiple organs in 1 case).Four patients(11.8%)died due to recurrence or metastasis.The 5-year locoregional relapse–free survival,distant metastasis–free survival,disease-free survival,and overall survival rates were 97.1%,88.2%,85.3%,and 88.2%,respectively.The most common acute toxicities were grades 3–4 hematologic toxicities and stomatitis.Of the 24 patients who survived for more than 2 years,16(66.7%)and 15(62.5%)developed grades 1–2 xerostomia and ototoxicity,respectively.Two patients(8.3%)developed grade 3 ototoxicity;no grade 4 toxicities were observed.SIB-IMRT combined with chemotherapy achieves excellent long-term locoregional control in pediatric and adolescent NPC,with mild incidence of late toxicities.Distant metastasis is the predominant mode of failure.
