Objective To discuss the efficacy of transcatheter arterial chemoembolization(TACE)in combination with targeted therapy and immune checkpoint inhibitors for advanced hepatocellular carcinoma(HCC),and to identify the influencing factors.Methods A total of 60 patients with advanced HCC,who were admitted to the Air Force Medical Center of China from January 2016 to December 2022,were enrolled in this study.Thirty patients received TACE combined with targeted therapy and immune checkpoint inhibitors(TACE-L-P group),and the other 30 patients received TACE combined with targeted therapy(TACE-L group).The progression-free survival(PFS),overall survival(OS),disease control rate(DCR),and objective response rate(ORR)were compared between the two groups.Results In the TACE-L group and TACE-L-P group,the median PFS(mPFS)was 7 months and 10 months respectively(P=0.011),the median OS(mOS)was 15.5 months and 29 months respectively(P=0.014).Child-Pugh class B(HR=3.89,95％CI:1.27-11.94,P=0.018)and Barcelona Clinic Liver Cancer(BCLC)stage C(HR=2.83,95％CI:1.32-6.03,P=0.007)were the independent risk factors for OS,while micro wave ablation(HR=0.21,95％CI:0.07-0.63,P=0.005)and TACE-L-P(HR=0.09,95％CI:0.03-0.3,P=0.001)were the independent protection factors for OS.Besides,elevated bilirubin level(HR=1.03,95％CI:1-1.06,P=0.032)and elevated gamma-glutamyl transferase(GGT)level(HR=1.01,95％CI:1-1.01,P=0.002)were the independent risk factors for disease progression,and TACE-L-P(HR=0.27,95％CI:0.09-0.79,P=0.017)was the independent protection factor for disease progression.The ORR and DCR in TACE-L-P group were remarkably higher than those in TACE-L group,which were 43.4％vs 13.3％and 63.4％vs 23.3％respectively,the differences between the two groups were statistically significant(both P＜0.05).Conclusion In treating advanced HCC,TACE combined with targeted therapy and immune checkpoint inhibitors is superior to TACE combined with targeted therapy in therapeutic efficacy.

In the context of high-quality development,enhancing hospital petition management is essential for fostering a harmonious doctor-patient relationship.This study uses a tertiary general hospital in Shanghai as a case to retrospectively analyze the handling of hospital complaints from 2022 to 2024.It examines the current petition landscape,identifies significant issues re-flected in these petitions,and explores the underlying causes of challenges in resolving petition-related conflicts.Furthermore,it discusses the hospital's strategies in innovating management mechanisms,engaging diverse stakeholders,developing professional teams,and comprehensively addressing patient needs.These approaches aim to offer valuable insights for public hospitals to im-prove petition management efficiency as they advance in high-quality development.

In the context of high-quality development,enhancing hospital petition management is essential for fostering a harmonious doctor-patient relationship.This study uses a tertiary general hospital in Shanghai as a case to retrospectively analyze the handling of hospital complaints from 2022 to 2024.It examines the current petition landscape,identifies significant issues re-flected in these petitions,and explores the underlying causes of challenges in resolving petition-related conflicts.Furthermore,it discusses the hospital's strategies in innovating management mechanisms,engaging diverse stakeholders,developing professional teams,and comprehensively addressing patient needs.These approaches aim to offer valuable insights for public hospitals to im-prove petition management efficiency as they advance in high-quality development.

Objective:To investigate the safety and effectiveness of the laparoscopic hepatectomy guided by three-dimensional visualization technology for treating hepatolithiasis in military flying personnel and to discuss the aeromedical assessment.Methods:The diagnosis and treatment of a military flying personnel with hepatolithiasis admitted to the Air Force Medical Center in December of 2021 and the conclusions of aeromedical assessment were analyzed. The literature was reviewed in combination with the progress of new technologies.Results:This case, a 40-year-old male helicopter aerial machinist, had been found gallbladder stones for 12 years, hepatolithiasis for 8 years, and intermittent right upper abdominal pain for more than 3 months. Ultrasound and CT examination showed multiple gallbladder stones, intrahepatic bile duct stones in the right posterior lobe of the liver with bile duct dilatation. Under the guidance of three-dimensional visualization technology, laparoscopic liver segment 6 precise resection, cholecystectomy, common bile duct exploration and stone removal, and T-tube drainage were performed. The patient was well recovered and waivered to flight after 6 months of the operation. As of the submission date, he has safely flown for 50 h.Conclusions:Laparoscopic anatomical hepatectomy guided by three-dimensional visualization technology in the military flying personnel with hepatolithiasis shows good safety and effect, and those who recover well after surgery can be waivered to flight.

Objective:To investigate the safety and effectiveness of the laparoscopic hepatectomy guided by three-dimensional visualization technology for treating hepatolithiasis in military flying personnel and to discuss the aeromedical assessment.Methods:The diagnosis and treatment of a military flying personnel with hepatolithiasis admitted to the Air Force Medical Center in December of 2021 and the conclusions of aeromedical assessment were analyzed. The literature was reviewed in combination with the progress of new technologies.Results:This case, a 40-year-old male helicopter aerial machinist, had been found gallbladder stones for 12 years, hepatolithiasis for 8 years, and intermittent right upper abdominal pain for more than 3 months. Ultrasound and CT examination showed multiple gallbladder stones, intrahepatic bile duct stones in the right posterior lobe of the liver with bile duct dilatation. Under the guidance of three-dimensional visualization technology, laparoscopic liver segment 6 precise resection, cholecystectomy, common bile duct exploration and stone removal, and T-tube drainage were performed. The patient was well recovered and waivered to flight after 6 months of the operation. As of the submission date, he has safely flown for 50 h.Conclusions:Laparoscopic anatomical hepatectomy guided by three-dimensional visualization technology in the military flying personnel with hepatolithiasis shows good safety and effect, and those who recover well after surgery can be waivered to flight.

Objective:To explore the influence of rivaroxaban on vascular endothelial function and p38MAPK/NF-κB pathway in the rats with arteriosclerosis obliterans. Methods:The rats were divided into the sham operation group,the model group,rivaroxaban low dose group,rivaroxaban medium dose group and rivaroxaban high dose group. The contents of nitric oxide (NO) and endothelin (ET-1) in serum were detected, the number of endothelial cells in serum was studied, and the expression level of p38MAPK, p-p38MAPK and NF-κB were measured. Results:Compared with that of the model group, the number of endothelial cells in venous blood of rivaroxaban groups decreased. The content of NO in serum of rivaroxaban groups was significantly higher than that of the model group,and the content of ET-1 was significantly lower than that of the model group(P<0.05). The expression level of p-p38MAPK in arterial vessels of rivaroxaban groups was significantly lower than that of the model group,and the expression level of NF-κB was sig-nificantly higher than that of the model group(P<0.05),and the effects were all in a dose-dependent manner. Conclusion:Rivarox-aban can improve vascular endothelial function in the rats with arteriosclerosis obliterans,and the effects may be achieved by modula-ting the p38MAPK / NF-κB pathway.

Objective T o explore the com position characteristic of event related potential (E R P ) in dif-ferent visual acuity levels, and to provide theoretical basis for the objective assessm ent of visual acuity. Methods M onocular stim ulus w as perform ed on 16 selected subjects. T he subjects w ere required to look straight at the screen ahead and count the am ount of stim uli from different directions. T he pictures of optotype stim ulus w hich corresponding to three different visual acuity levels w ere show ed in the center of the screen. The ERP results w ere recorded separately. Results (1) The P1 am plitudes of m atch stim uli recorded under the supra-threshold visual acuity level w ere higher than that of m atch stim uli recorded under the threshold and sub-threshold visual acuity levels. T here w as no significant difference betw een the P 1 am plitudes of m atch stim uli recorded under the threshold and sub-threshold visual acuity levels. T he tendency of conflict stim uli w as sim ilar to that of m atch stim uli under three visual acuity levels. (2) In the 340-500 m s post-stim ulus range, P 300 com ponent w as found under supra-threshold and threshold visual acuity levels; no P 300 com ponent w as found in corresponding tim e w indow under sub-threshold visual acuity. T he differences of P 300 am plitudes am ong three visual acuity levels w ere statistically significant. T he am plitudes from high to low w ere the supra-threshold, threshold and sub-threshold visual acuity levels. Conclusion E R P can be a potential new m ethod for the objective assessm ent of visual acuity in forensic m edicine.

Objective T o study the effect of different attentional conditions on the event-related potential (E R P ) com ponents generated by the visual inform ation stim uli related to visual acuity, and provide a theoretical reference for clinical forensic visual objective evaluation. Methods W ith visual acuity opto-types as norm al form of visual inform ation stim uli, 15 volunteers as study subjects w ere supposed to ac-count the visual acuity optotypes under the attentional condition of visual stim uli. Furtherm ore, the sub-jects w ere required to listen to the storytelling carefully under the non-attentional condition of visual stim uli, and after the exam ination, they needed to answ er the story-related questions. A ll the E E G re-sults of tw o different attentional conditions from the subjects w ere recorded by 32 channel E R P system . Results U nder tw o attentional conditions, P 1 and P 300 com ponents w ere evoked by the visual acuity opto-types on supra-threshold and threshold visual acuity levels, w hile only P 1 com ponent w ere evoked by the visual acuity optotypes on sub-threshold levels. In the E R P w aveform s evoked by the visual acuity optotypes on supra-threshold, P 1 and P 300 am plitudes under attentional condition w ere larger than that un-der non-attentional condition. Conclusion A ttentional conditions can influence the detection of visual acuity. P 300 com ponent can be used to distinguish the visual acuity levels w ith supra-threshold and sub-threshold under non-attentional condition.

Objectives:Economic growth and rapid development of health technology in China have created opportunities to strengthen health technology assessment (HTA) capacity.Over the time,HTA institutions have been established to conduct HTA related work.This study reviewed the current status of HTA in China and analysed the challenges of HTA development in the context of health reform under"new normal"economy.Methods:Literature review and webpage searches were used to document the development of HTA in China.An institutional survey has also been conducted to collect information on the HTA research institutions in China.Results:The number of articles and research projects on HTA were rising and are continuing to rise.HTA development has made substantial progress in China in terms of growing number of research institutions and qualified HTA workforce.However,HTA has notable weaknesses such as low capacity for conducting HTA research,limited experience in HTA researchers,and lack of knowledge translation.Conclusion:Currently,the translation of HTA findings to policy-making is limited and the integration of HTA in the policy-making processes is still in its infancy.The HTA development in China has had opportunities due to demands of health care,health insurance,and health technology as a result of health reform.Capacity building and institutionalization of HTA are urgently needed for further development of HTA in China.

Mild cognitive im pairm ent caused by craniocerebral traum a is the key points and difficulties in judicial authentication. This article has com parative analysis of eachmode of event-related potential (classical O ddball, E riksen flanker task and so on), which can provide a more objective m ethod for such craniocerebral traum a cases in clinical forensic judicial authentication.