Bin Xiong

Background and objectives: Unresectable hepatocellular carcinoma (uHCC) with portal vein tumor thrombus (PVTT) indicates a poor prognosis. This study aims to evaluate the efficacy and safety of transarterial chemoembolization (TACE) combined with hepatic arterial infusion chemotherapy (HAIC), apatinib, and camrelizumab in patients with uHCC accompanied by PVTT. Methods: This multicenter retrospective study included patients with uHCC and PVTT who were treated at five tertiary medical centers in China between December 2021 and April 2025. Propensity score matching (PSM) was performed to minimize potential confounding bias. Treatment efficacy was assessed by objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS). The primary endpoints were PFS and OS, whereas secondary endpoints included ORR and safety. Results: Among the 222 patients who met the eligibility criteria, 105 received TACE-HAIC combined with apatinib and camrelizumab (THAC group), and 117 received TACE combined with apatinib and camrelizumab (TAC group). After PSM, 86 matched patients were included in each group, and baseline characteristics were well balanced between the two groups. The THAC group achieved significantly higher intrahepatic tumor ORR (70.9% vs. 47.7%, P = 0.002) and DCR (94.2% vs. 79.1%, P = 0.004) than the TAC group. Similarly, for PVTT, the THAC group demonstrated significantly higher ORR (61.6% vs. 41.9%, P = 0.009) and DCR (90.7% vs. 74.4%, P = 0.005). The median PFS was significantly longer in the THAC group than in the TAC group (12 months vs. 7 months; HR = 0.287; 95%CI: 0.204–0.403; P<0.001). Likewise, the median OS was significantly prolonged in the THAC group (24 months vs. 16 months; HR = 0.198; 95%CI: 0.135–0.291; P0.05). All adverse events were manageable, and no grade 5 adverse events were observed. Conclusions: In patients with uHCC accompanied by PVTT, the THAC regimen was associated with superior survival outcomes compared with the TAC regimen while maintaining an acceptable safety profile. These findings suggest that THAC may represent a feasible and effective therapeutic option for this patient population.

To evaluate the efficacy and outcomes of transjugular intrahepatic portosystemic shunt (TIPS) in treating pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS). We conducted a retrospective analysis of patients diagnosed with severe PA-HSOS at our institution between January 2016 and October 2025. Baseline clinical characteristics and follow-up data were extracted from medical records. All included patients had failed prior conventional medical therapy. A total of 125 patients diagnosed with HSOS was screened and 33 patients ultimately included in this study, of whom 17 were male. Clinical presentations comprised ascites in 31 patients, and variceal bleeding in 2 patients. During a median follow-up of 42 months (ranging from 2 to 118 months), there were four deaths, only one related to liver failure. The overall survival rates at 1, 3 and 5 years were 93.8%, 90.3% and 82.1%, respectively. Clinical improvement was observed in most patients, with ascites resolving in 31 patients one month after the procedure, and the hepatic vein was clearly displayed on post-TIPS imaging in 26 patients, confirming successful shunt patency. Notably, no cases of overt hepatic encephalopathy were observed during the follow-up period. TIPS is associated with favorable clinical and survival outcomes in patients with PA-HSOS refractory to medical management, and represents a viable therapeutic alternative for this condition.

The optimal assessment of tumor response in hepatocellular carcinoma (HCC) after drug-eluting bead transarterial chemoembolization (DEB-TACE) remains unclear. This study aimed to develop a CT-based radiomics model for the preoperative prediction of tumor response to DEB-TACE in patients with HCC. Patients with HCC who received DEB-TACE as initial treatment from two centers were included and divided into training, internal validation and external validation cohorts. LASSO and logistic regression were used to identify the optimal radiomics features and independent predictors of tumor response, respectively, Then, a combination model was developed and assessed. 335 patients were included in this study. Radscore was calculated based on 15 identified optimal radiomics features, and maximum tumor diameter and tumor capsule were independent predictors of tumor response. A nomogram was generated based on the clinical predictors and Radscore. In the training cohort, the AUC of nomogram was significantly superior to that of both clinical (0.915 vs 0.800, P=0.004) and the radiomics models (0.915 vs 0.842, P=0.010). Calibration curves and decision curve analysis (DCA) demonstrated good consistency between the nomogram predictions and actual outcomes as well as clinical net benefit across all cohorts. The prognostic stratification based on the nomogram effectively predicted patients with potential objective response of tumor and survival. This radiomics model had an excellent performance to predict tumor response in HCC after DEB-TACE, which may serve as a reliable tool to assist with the selection of patients for DEB-TACE.

Pyrrolizidine alkaloid–induced hepatic sinusoidal obstruction syndrome (PA-HSOS) is highly prevalent in Asia, primarily due to the widespread use of traditional herbal medicines containing hepatotoxic pyrrolizidine alkaloids. This condition poses significant clinical challenges, including diagnostic difficulties and limited therapeutic options, frequently leading to severe liver damage and portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) treatment has emerged as a key intervention for managing complications associated with PA-HSOS, such as refractory ascites and variceal bleeding, by reducing portal pressure and supporting liver function recovery. However, TIPS has not been widely accepted as a salvage therapy for severe PA-HSOS unresponsive to anticoagulation therapy, mainly due to concerns about post-TIPS complications, particularly hepatic encephalopathy. Consequently, careful patient selection and risk stratification are critical. This review synthesizes the current evidence on PA-HSOS in Asia, evaluates the clinical utility of TIPS, and discusses strategies to optimize outcomes while minimizing adverse effects. Specifically, we review the epidemiology, pathophysiology, and diagnostic advancement of PA-HSOS, with a particular focus on the evolving role of TIPS in its management.

INTRODUCTION: Transjugular intrahepatic portosystemic shunt (TIPS) can effectively reduce portal hypertension (PH) and may be associated with improvement in muscle status; however, its impact on the gut microbiota and muscle condition remains unclear. Therefore, this prospective study aimed to evaluate gut microbiota alterations in patients with sarcopenia and PH after TIPS treatment. METHODS: Gut microbiota analysis was prospectively conducted in 20 cirrhotic patients with sarcopenia and PH receiving TIPS and their first-degree healthy family between December 2019 and July 2021 in our center. Fecal samples were collected before and 3 months after TIPS and analyzed by 16S rRNA sequencing. Microbial diversity and composition were assessed using standard bioinformatic pipelines. Sarcopenia was defined by L3 skeletal muscle index according to European Association for the Study of the Liver criteria. RESULTS: Compared with healthy controls, cirrhotic patients with sarcopenia and PH exhibited significantly reduced α-diversity (Chao1, Shannon, Simpson; all P < 0.001) and distinct β-diversity clustering, confirming gut dysbiosis. Although TIPS did not significantly alter overall α-diversity, a significant increase in the order Burkholderiales and a reduction in Pseudomonadales and Staphylococcales were detected after TIPS. Analysis of the family taxonomic rank revealed that TIPS was followed by an increase in a greater abundance of Ruminococcaceae and Sutterellaceae and decreased levels of Tannerellaceae, Marinifilaceae, and Pseudomonadaceae. At the genus level, after TIPS placement, increased levels of Lachnospiraceae _ND3007_group, Intestinibacter , Fusicatenibacter , and Faecalibacterium and lower abundances of Pseudomonas , Prevotella , Peptostreptococcus , Parabacteroides , Muribaculaceae , and Butyricimonas were detected. Sarcopenia reversal was observed in 25% of patients, characterized by enrichment of short-chain fatty acid-producing genera such as Faecalibacterium and Streptococcus , whereas patients without improvement showed high abundance of Fusicatenibacter and low levels of beneficial taxa. DISCUSSION: TIPS induces significant taxonomic shifts without changing overall diversity in cirrhotic patients with sarcopenia and PH, suggesting partial microbial restoration. Enrichment of short-chain fatty acid-producing bacteria may correlates with improved sarcopenia, whereas proinflammatory taxa may indicate poor recovery and higher risk of complications. These findings highlight the gut-muscle-liver axis and support microbiome-based biomarkers and interventions to optimize outcomes after TIPS.

Background: Transcatheter arterial embolization (TAE) is an established treatment of hemoptysis in patients with destroyed lung. Purpose: To identify the relevant risk factors for the recurrence of hemoptysis after TAE in patients with destroyed lung combined with hemoptysis. Material and Methods: A retrospective analysis was performed on 179 patients with destroyed lung and hemoptysis who underwent TAE between January 2014 and September 2023. Immediate and clinical success rates were assessed after TAE. Kaplan–Meier analysis estimated hemoptysis-free survival. The Cox regression model was used to identify factors associated with recurrence. Results: Among 179 patients (124 men, 55 women; mean age = 57.24 ± 12.30 years), immediate and clinical success rates were 92.2% and 89.5%, respectively. Freedom from hemoptysis at 24 h was achieved in 91.5% of patients. Cox regression analysis identified the average number of embolized vessels per damaged lobe as an independent predictor of recurrence (hazard ratio [HR] = 1.346, 95% confidence interval [CI] = 1.001–1.810; P <0.05). Patients with ≥4 embolized vessels per lobe had a significantly higher risk of recurrence than those with fewer vessels. Non-bronchial systemic arteries (NBSAs), particularly intercostal and subclavian artery branches, were key bleeding sources, with the ratio of NBSAs to bronchial arteries (BAs) embolized being approximately 1.38:1. Conclusion: Although meticulous attention to NBSAs during TAE is essential, our study identifies the average number of embolized vessels per lobe as an independent predictor of recurrence. This indicates a disease state with high revascularization potential, necessitating long-term strategies that also address the underlying lung pathology.

Background: Nanosecond pulsed electric field (nsPEF) ablation has demonstrated limited and transient efficacy in suppressing tumor progression. Oncolytic peptide LTX-315 is known to elicit a strong antitumor immune response and durable immune memory. This study aimed to investigate whether LTX-315 could enhance nsPEF-induced antitumor immunity in liver cancer. Methods: Both cell assays and mouse models were used to evaluate the therapeutic efficacy of nsPEF, LTX-315, and combination therapy. Flow cytometry and immunofluorescence were performed to assess the tumor immune microenvironment. Co-culture models were established to evaluate the functional modulation of immune cells. Results: nsPEF upregulated the programmed cell death 1 ligand 1 (PD-L1) expression in liver cancer cells, leading to CD8 ⁺ T-cell dysfunction. LTX-315 reduced the nsPEF-mediated elevated PD-L1 level and restored the cytotoxicity of CD8+ T cells. Furthermore, LTX-315 acted with nsPEF to induce enhanced immunogenic cell death for the activation of dendritic cells and CD8+ T cells. In addition, LTX-315 improved antigen processing and presentation in nsPEF-treated liver cancer cells. Notably, the combination of nsPEF and LTX-315 achieved durable tumor control and prolonged survival of the tumor-bearing mice, by promoting the migration of dendritic cells to tumor-draining lymph nodes, the infiltration of immune cells within the tumor and potential immune memory to prevent tumor metastasis. Conclusions: LTX-315 functions as an immune stimulant to improve the antitumor efficacy of nsPEF. The combination of nsPEF and LTX-315 represents a promising interventional immunotherapy strategy for liver cancer. Key points: LTX-315; Antitumor immune response; nsPEF; Liver cancer.