Hua Xiang

Background: To evaluate transcatheter arterial chemoembolization (TACE) combined with systemic therapy versus TACE monotherapy in advanced hepatocellular carcinoma (HCC), and to compare the efficacies of lenvatinib and donafenib when combined with TACE and immune checkpoint inhibitors (ICIs). Methods: This retrospective study included 176 patients with advanced HCC receiving initial TACE, categorized into combination therapy (n = 128) or TACE monotherapy (n = 48) groups. A subgroup analysis compared TACE plus ICIs combined with lenvatinib (n = 78) or donafenib (n = 33). Propensity score matching (PSM) was utilized to minimize baseline confounding variables. Progression-free survival (PFS) and overall survival (OS) were analyzed. Results: Combination therapy achieved a significantly higher objective treatment effective rate than monotherapy (75.0% vs. 41.7%, P < 0.001), with significantly prolonged PFS and OS, a benefit maintained after PSM. Among the specific regimens, the lenvatinib-based combination yielded a higher objective effective rate than donafenib (83.3% vs. 63.6%, P = 0.023). Post-PSM, the lenvatinib group maintained a significant PFS advantage ( P = 0.007), while OS showed a marginal trend toward improvement ( P = 0.057). Multivariate analysis identified treatment without combined systemic therapy and ineffective treatment response as independent predictors of inferior OS. Severe TACE-related adverse events (Grade 3/4) were comparable between combination and monotherapy cohorts (18.8% vs. 14.6%, P = 0.518), as well as between the lenvatinib and donafenib subgroups (21.8% vs. 15.2%, P = 0.422). Conclusion: TACE combined with systemic therapy significantly improves clinical outcomes in advanced HCC without increasing severe toxicity. Furthermore, the triple therapy of TACE, ICIs, and lenvatinib confers superior PFS and tumor response rates compared to the donafenib-based regimen, along with a trend toward OS improvement that did not reach statistical significance.

Background: Transarterial chemoembolization (TACE) is a standard treatment for intermediate-stage hepatocellular carcinoma (HCC), but its efficacy varies due to patient heterogeneity. Combining TACE with systemic therapies, such as targeted agents or immune checkpoint inhibitors, has shown promise in improving outcomes, though controversies regarding survival benefits and safety persist. This study investigates whether synchronized systemic therapy enhances the therapeutic efficacy of TACE in intermediate and advanced-stage HCC. Methods: This single-center, retrospective study included 142 patients with intermediate and advanced-stage HCC (BCLC B or C) who received TACE as initial treatment between February 2019 and August 2022 at Hunan Provincial People’s Hospital. Patients were divided into two groups: combination therapy (TACE plus systemic therapy, n=41) and TACE monotherapy (n=101). Progression-free survival (PFS), overall survival (OS), treatment response (per mRECIST criteria), and adverse events (AEs) were compared. Cox regression and Kaplan-Meier analyses were used to assess survival outcomes. Results: No significant differences were observed in baseline characteristics, except for a higher proportion of Child-Pugh A patients in the combination group (90.2% vs. 67.3%, P= 0.005). Median PFS was similar between the combination and monotherapy groups (5.5 vs. 6.0 months, P= 0.832), with no significant differences in BCLC-B (18.3 vs. 17.4 months, P= 0.516) or BCLC-C (4.1 vs. 3.7 months, P= 0.255) subgroups. However, the combination group showed a trend toward improved OS (24.8 vs. 16.7 months, P= 0.282), with a significant benefit in BCLC-C patients (17.9 vs. 11.0 months, P= 0.048). Grade 3 or 4 AEs were comparable between groups (7.2% vs. 14.9%, P= 0.187). Conclusion: Combining systemic therapy with TACE does not improve PFS but may enhance OS in BCLC-C patients. The safety profile is comparable, particularly in patients with preserved liver function. These findings highlight the importance of patient selection and warrant further prospective studies to optimize treatment strategies.

Giant, ulcerated triple-negative breast cancer (TNBC) presents major therapeutic challenges. We report a 39-year-old woman with a 14.3 cm ulcerated TNBC (cT4bNxM0) who developed infection after intravenous chemotherapy. To achieve rapid local control, a multidisciplinary team elected to perform transarterial chemoembolization (TACE), followed by systemic chemo-immunotherapy using nab-paclitaxel and the PD-1 inhibitor Toripalimab. This multimodal approach led to marked tumor regression and improvement of skin ulceration, enabling curative surgery with modified radical mastectomy and complex reconstruction. Pathology postoperative showed a complete response (Miller-Payne grade 5, ypT0N0M0). This single case suggests that integrating TACE with multimodal neoadjuvant treatment sequences may be feasible in selected patients with extreme presentations of locally advanced TNBC, particularly in patients with extensive tumor burden or poor tolerance to systemic therapy. The approach may enhance local control and elicit synergistic immune activation, offering a potential paradigm for managing extreme TNBC presentations. Further studies are required to clarify the safety, efficacy, and potential immunomodulatory effects of this approach.

Introduction: Transcatheter arterial chemoembolization (TACE) is widely applied for locoregional malignant lesions control in intermediate and selected advanced hepatocellular carcinoma (HCC). Various inflammation indices, such as neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammatory index (SII), and Lymphocyte-to-C Reactive Protein Ratio (LCR) have been explored as tools for predicting the efficacy of TACE. However, the role and predictive value for dynamic changes of peripheral inflammatory indicators pre- and post-TACE remains unclear.Objective: To explore the association between the alteration in inflammatory index and the efficacy and prognosis of TACE and to provide more evidence for early prediction of the efficacy of TACE.Methods: This was a retrospective single-center study. HCC patients who received TACE as initial treatment were enrolled. The relationship between the alteration of inflammation indices (calculated as post-TACE minus pre-TACE measurements) and TACE efficacy and prognosis was investigated. Progression-free survival (PFS) was the primary endpoint, and treatment efficacy was evaluated based on mRECIST criteria.Results: Before propensity score matching (PSM), the change in LMR was significantly associated with treatment effective rate, with the unelevated ΔLMR group achieving a 79.4% treatment effective rate compared to 36.4% in the elevated group (p < 0.001). The estimated median PFS was 9.7 months and 4.5 months in the unelevated and elevated group, with a significant difference (p = 0.016). After PSM, the treatment effective rate was 48.7 and 38.5% (p = 0.214), and the estimated median PFS was 8.9 and 5.5 months (p = 0.173) for the unelevated and elevated group, respectively.Conclusion: Our study demonstrated that alteration of indices of peripheral inflammation, including ΔNLR, ΔLMR, ΔSII, and ΔPLR, may not be valuable prognostic markers for HCC patients who received TACE.

Expert consensus proposes an emergency treatment protocol for portal hypertension bleeding. Herein, the emergency treatment procedures, which include first aid, medical, interventional, and surgical treatments, are described. In addition, the indications, contraindications, operating norms, precautions, and prevention of complications of portal hypertension are described to optimize the first aid process.

Background: Traumatic aortic pseudoaneurysms (PSAs) classified as grade III aortic injuries are conventionally repaired as procedural emergencies, generally within 24 h of arrival. These patients typically require adequate resuscitation and treatment of multiple traumatic injuries, which complicate optimal management strategies of aortic PSAs. This study reviews the experience of an Asian single center to evaluate the efficacy and safety of delayed (> 24 h) endovascular repair for PSAs. Methods: Twenty-seven patients with blunt aortic injury (BTAI) were brought to our institution between February 2014 and May 2020. Patients with other grades of aortic injuries (grade I, II, or IV) were excluded from the study, and the remaining patients with grade III aortic injuries were placed into the early (< 24 h) and delayed (> 24 h) groups according to the timing of repair. Medical records and follow-up computed tomography (CT) scans were reviewed to document the outcomes of the procedures. Primary outcomes included mortality and complications. Results: During this period, there were 14 patients (13 males and 1 females) with aortic PSAs, and each patient received thoracic endovascular aortic repair (TEVAR). Of these 14 patients, 1 underwent emergent TEVAR, and 13 underwent delayed repair (median 7 days, range, 3–14 days). Over a period of 8 years, the overall survival of our series was 100%. No paraplegia, stroke, ischemia of limb or other serious procedural complications were observed during the duration of follow-up. Conclusion: The experience of our center indicates that delayed repair for selected PSAs could be permissible, which enables a repair in more controlled circumstances.

Background: Although the research on the risk factors of anterior communicating artery (AComA) aneurysm has made great progress, the independent effect of each risk factor on the rupture of AComA aneurysm is controversial among different studies. We will perform a protocol for systematic review and meta-analysis to investigate risk factors for AComA aneurysm rupture and quantify their independent effects. Methods: A systematic search according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines in PubMed, Embase, and the Cochrane Library databases was conducted from inception to August 31, 2021 for published studies concerning risk factors for AComA aneurysm rupture. In the absence of statistical heterogeneity (ie, P > .10 and I ² < 50%), we will use a fixed-effects model to pool the results across sufficient studies. Otherwise, we will present the results employing the random-effects model. Quality assessment of the included studies will be evaluated using the Newcastle–Ottawa Scale. Statistical analyses will be performed using Stata16 (Stata Corporation, College Station, TX, USA) software. Results: The findings of this study will be submitted to peer-reviewed journals for publication. Conclusion: This systematic review will provide evidence to determine the risk factors that affect the rupture of the AComA aneurysm and quantify their independent effects. Ethics and dissemination: Since the proposed study uses pre-published data, ethical approval is not required. Review registration number: CRD42021284262. (https://www.crd.york.ac.uk/PROSPERO/).

Background: Previous studies have revealed obesity, nutrition, lifestyle, genetic and epigenetic factors may be risk factors for the occurrence and development of non-alcoholic fatty liver disease (NAFLD). However, the effect of total polyunsaturated fatty acid (PUFA) consumption on the risk of NAFLD is uncertain. Therefore, this study aimed to determine whether the total PUFA intake is independently associated with the risk of NAFLD and explore the threshold of PUFA intake better illustrate the correlation between them in Chinese Han adults.Methods: The present study was a retrospective case–control study. A total of 534 NAFLD patients and 534 controls matched by gender and age in the same center were included in this study. Using a semi-quantitative food frequency questionnaire in a health examination center in China to collect information about dietary intake and calculate nutrient consumption. A multivariate logistic regression model was used to estimate the association between total PUFA daily intake and its quartile and the incidence of NAFLD.Results: Multivariate analyses suggested a significant association between total PUFA intake and the occurrence of NAFLD. A non-linear relationship between total PUFA consumption and NAFLD risk was detected after adjusting for potential confounding factors. There was a significant connection between PUFA and the risk of NAFLD (OR: 1.32, 95% CI: 1.23–1.41,P < 0.0001) when PUFA intake is between 18.8 and 29.3 g/day.Conclusions: The relationship between total PUFA intake and NAFLD is non-linear. Total PUFA was positively related to the risk of NAFLD when PUFA intake is between 18.8 and 29.3 g/day among Chinese Han adults.