ObjectiveTo assess the relationship between the estimated glomerular filtration rate (eGFR) and the severity of coronary artery stenosis in elder people. MethodsSix hundred and fifty-seven patients who underwent selective coronary artery angiography were divided into 3 groups according to age: group Ⅰ (202 patients aged <60 years), group Ⅱ (181 patients aged from 60 to 69 years) and group Ⅲ (274 patients aged ≥70 years). According to the simplified MDRD equation,impaired renal function and severe renal dysfunction, respectively. Clinical features and the severity of coronary artery stenosis were compared among the 3 groups. ResultsThe level of average eGFR tended to he decreased with the narrowed coronary arteries. The difference of average eGFR between patients with muhivessel versus two-vessel coronary artery disease was of statistical significance in Group Ⅲ(P = 0. 035). After controlling for the effects of smoking, hypertension, dyslipidemia,aging, and diabetes, the Gensini score which reflected the severity of coronary artery stenosis was negatively correlated with the level of eGFR (r =-0. 110, P = 0. 005). ConclusionsIt suggests that the eGFR decrease is associated with the severity of coronary artery stenosis, and there is a linear correlation between eGFR and Gensini score in elder people, eGFR can be used to evaluate the severity of coronary artery disease and prognosis.

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. Due to the insidious onset, poor prognosis, and lack of specificity of HCC, most patients have reached the advanced stage at the time of diagnosis. Conventional treatment methods, such as surgical resection, liver transplantation, radiotherapy, and chemotherapy, have limited therapeutic effects and fail to bring significant benefits to patients. With the improvement of science and technology and medical level in recent years, targeted therapy drugs have gradually entered people’s vision due to the breakthroughs in the treatment of HCC and thus bring new hope to patients with advanced HCC. Targeted drugs have attracted wide attention due to good molecular selectivity, targeted killing of tumor cells, and protection of normal tissue. This article reviews the research advances in targeted therapy for HCC.

Protein phosphatase 2A (PP2A) is a major serine/threonine phosphatase involved in many signaling pathways associated with cell growth and proliferation, and it also regulates many cellular processes. With an in-depth exploration of PP2A in the process of cell activity, especially malignant tumors, the association between PP2A and hepatocellular carcinoma (HCC) has attracted more and more attention in recent years; however, there is still a controversy over whether PP2A can promote or inhibit HCC. This article reviews the research advances in the mechanism of action of PP2A as a tumor factor in the regulation of HCC and target therapy.

Objective To investigate the influencing factors for acute multiple vessels occlusion(MVO)and its impact on the prognosis of patients with anterior circulation acute large vessel occlusion stroke(ALVOS)who achieved successful recanalization after endovascular treatment(EVT).Methods Patients with anterior circulation ALVOS who received successful EVT at the Yijishan Hospital of Wannan Medical College between July 2015 and April 2023 were retrospectively analyzed.Baseline data,including age,sex,onset-to-puncture time(OTP),onset-to-recanalization time(OTR),medical history(including atrial fibrillation,diabetes,hypertension),alcohol and smoking history,admission blood pressure(systolic and diastolic),Alberta stroke program early CT score(ASPECTS),National Institutes of Health stroke scale(NIHSS)score,trial of Org 10172 in acute stroke treatment(TOAST)classification(atherosclerotic type,cardioembolic type,and other etiology types),and 90-day modified Rankin scale(mRS)score were collected.Collateral circulation was assessed based on the degree of contrast agent reflux observed in the occluded arterial supply area during delayed DSA,and patients were classified into poor and good collateral circulation groups.Malignant cerebral edema was defined as a midline shift of ≥5 mm on the follow-up CT scan performed on day 3 post-surgery.The primary endpoint(efficacy indicator)was the 90-day mRS score,with mRS score≤ 2 considered as a good prognosis and mRS score＞2 considered as a poor prognosis.The secondary endpoint(safety indicator)was the 90-day mortality rate.All patients were divided into MVO and non-MVO groups based on whether they had single or multiple intracranial vessel occlusions.Acute MVO was defined as the detection of acute occlusion of other large or medium vessels,in addition to the main vessels(internal carotid artery or M1/M2 segments of the middle crebral artery[MCA]),in CT angiography,MR angiography,or DSA,resulting in ischemia in brain regions distinct from the main occlusion area.Factors that showed statistically significant differences in univariate analysis were further analyzed using multivariate Logistic regression to identify the risk factors for the occurrence of acute MVO and the factors associated with the prognosis of ALVOS patients.Results A total of 846 patients with ALVOS were included,with ages ranging from 26 to 94 years(mean age[69±11]years).The proportion of male patients was 57.2％(484/846).The median admission ASPECTS was 8(7,9)and the median admission NIHSS score was 14(12,18).The incidence of malignant cerebral edema at 3 days post-surgery was 13.4％(112/835),and the 90-day mortality rate was 19.1％(162/846).(1)Among the 846 ALVOS patients,810(95.7％)were in the non-MVO group and 36(4.3％)were in the MVO group.Univariate analysis showed significant differences between the MVO and non-MVO groups in terms of atrial fibrillation,malignant cerebral edema,admission ASPECTS,admission NIHSS scores,TOAST classification,collateral circulation,rate of complete recanalization,and 90-day poor prognosis rate(all P＜0.05).However,there was no statistically significant difference in 90-day mortality between the two groups(P=0.193).Multivariate Logistic regression analysis showed that TOAST classification of cardioembolic type(OR,16.089,95％CI 1.835-141.061,P=0.012)and other etiology types(OR,9.768,95％CI 1.078-88.540,P=0.043)were associated with the occurrence of MVO.(2)Among the 846 ALVOS patients,445 had a good prognosis at 90days,and 401 had a poor prognosis.Univariate analysis showed that,compared to the good prognosis group,the poor prognosis group had a lower proportion of males and smokers,and a higher proportion of patients with older age,higher baseline systolic blood pressure,hypertension,diabetes,and atrial fibrillation(all P＜0.01).Additionally,the poor prognosis group had higher admission NIHSS scores(P＜0.01),lower admission ASPECTS,lower rates of good collateral circulation and complete recanalization,higher rates of malignant cerebral edema and MVO,and statistically significant differences in TOAST classification distribution(all P＜0.01).Multivariate Logistic regression analysis showed that MVO was associated with poor 90-day prognosis in ALVOS patients after EVT(OR,3.368,95％CI 1.149-9.878,P=0.027).Furthermore,older age(OR,1.045,95％CI 1.025-1.066),diabetes(OR,1.719,95％CI 1.080-2.734),higher baseline systolic blood pressure(OR,1.012,95％CI 1.004-1.019),lower admission ASPECTS(OR,0.746,95％CI 0.674-0.826),higher admission NIHSS score(OR,1.115,95％CI 1.070-1.162),without immediate postoperative complete recanalization(OR,0.413,95％CI 0.290-0.592),poor collateral circulation(OR,0.594,95％CI 0.415-0.851),and malignant cerebral edema(OR,6.191,95％CI 3.026-12.670)were all associated with poor 90-day prognosis after EVT in ALVOS patients(all P＜0.05).Conclusions The TOAST classification of cardioembolic type and other etiology types is associated with MVO.MVO is a risk factor for poor outcomes after successful EVT in ALVOS patients.