Hepatocellular carcinoma(HCC)is a common malignant tumor worldwide,and its incidence and mortality are among the highest for many years.Due to its insidious onset,most patients are already at advanced stages when diagnosed.Improving the prognosis and survival rate of patients through conversion therapy has become a research focus lately.In recent years,with the continuous progress of biotechnology and drug development,new therapies represented by targeted and immunotherapy drugs have been widely used in HCC conversion therapy.Compared with other conversion therapy regimens,these drugs can effectively prolong the progression free survival and overall survival of patients and have advantages such as controllable adverse reactions.In addition,the combination of targeted drugs and immunotherapy drugs also plays a positive role in improving the survival benefit of HCC patients.This article aims to review the latest research progress of targeted therapy and immunotherapy in the first-and second-line treatments of HCC,and to discuss their safety and future development.

The biological characteristics of hepatocellular carcinoma(HCC)lead to a high incidence of portal vein tumor thrombus.It progresses rapidly,and the opportunity for radical surgical resection can be lost in a short term,resulting in poor prognosis.Reasonable down-staging treatment is a research focus for patients with unresectable HCC complicated with portal vein tumor thrombus to achieve a resectable range.This article reviews the potential population of HCC complicated with portal vein tumor thrombus with conversion therapy for HCC,analyzes the application of hepatic artery infusion chemotherapy,transcatheter arterial chemoembolization,radiotherapy,regional and systemic drug therapy in conversion therapy,and points out that the combination of multidisciplinary comprehensive treatments is the key to improve the prognosis of HCC patients with portal vein tumor thrombus.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

In recent years,clinical decision-making system has been developed and refined by incorporating patient's characteristics,tumor markers,clinlabomics and radiomics and has served a complementary role with classic hepatocellular carcinoma clinical staging systems among therapeutic choices of hepatocellular carcinoma during past decade.With the promotion of liver cancer screening programs,increasing patients with very early or early-stage hepatocellular carcinoma may attain upfront cure by partial liver resection,transplantation or local ablation.Advanced hepatocellular carcinoma with vascular invasion has been identified as inappropriate candidates of upfront curative therapies among several cohorts and clinical practice consensus.A heterogenous proportion of intermediate stage hepatocellular carcinomas have been reported to attain upfront cure with usually short recurrence-free survival(RFS)among several prospective cohorts.An unneglectable of patients with advanced stage hepatocellular carcinomas has been reported to subsequent curative resection after downstaging by conversion therapies.Subsequent resection after neoadjuvant therapies have improved the RFS and overall survival of patients with intermediate hepatocellular carcinoma.

Objective To observe the correlations between left atrial myocardial strain and left ventricular function in children with Duchenne muscular dystrophy(DMD).Methods Fifty-one DMD children(DMD group)and 42 healthy one(control group)were prospectively enrolled.The parameters of routine ultrasound and three-dimensional speckle-tracking echocardiography(3D-STE)were compared between groups,and the correlations between left atrial strain parameters and left ventricular function parameters were analyzed.Results The mitral annular lateral wall velocity(e'),left ventricular ejection fraction(LVEF),left atrial ejection fraction(LAEF),left atrioventricular coupling index(LACI),left ventricular global longitudinal strain(LVGLS),left atrial strain during reservoir phase(LASr)and left atrial strain during conduit phase(LAScd)were all lower,while mitral early diastolic peak flow velocity/e'(E/e'),left atrial stiffness index(LASI)and left atrial filling index(LAFI)were higher in DMD group than those in control group(all P＜0.05).In DMD group,LAEF,LASr and LAScd were moderately positively correlated with LVGLS(r=0.409,0.437,0.440,all P＜0.05),LAFI and LASI were weakly negatively correlated with LVGLS(r=-0.207,-0.223,both P＜0.05),while LASr was moderately positively correlated with e'(r=0.419,P＜0.05).Conclusion The left atrial myocardial strain was correlated with left ventricular systolic and diastolic function in DMD children.

Objective To retrospectively analyze the clinical risk factors and prognosis of perioperative myocardial injury(MINS)in non-cardiac surgery patients admitted to the intensive care unit(ICU).Methods A total of 478 postoperative patients admitted to the Department of Intensive Medicine,Minhang Hospital,Fudan University from Jan 2020 to Dec 2023 were selected.They were divided into MINS group(n=302)and normal group(n=176)based on whether myocardial injury occurred within 7 days after surgery.The differences in clinical characteristics between the two groups were compared,and risk factors for perioperative myocardial injury were identified.Risk factors for mortality in the MINS group were analyzed with 30-day mortality as the clinical endpoint.Results The prevalence of acute physiology and chronic health evaluation Ⅱ(Apache Ⅱ)score,coronary artery disease,and chronic kidney disease were all higher in the MINS group than those in the normal group,with statistically significant differences(P<0.05).The proportion of emergency surgeries,co-infection,and perioperative hypotension were significantly different between the MINS group and the normal group(P<0.05).Multivariate logistic regression analysis revealed that chronic kidney disease,emergency surgery,co-infection,and intraoperative and postoperative hypotension were risk factors for MINS occurrence.Prognostic analysis indicated that perioperative hypotension was a risk factor for 30-day mortality in MINS patients.Conclusion MINS is closely associated with patients'underlying conditions,timing of surgery,and perioperative hypotension status,and especially perioperative hypotension affects the final outcomes.

Aim To investigate the effects of rosavin on hepatocellular steatosis and its mechanism of action.Methods AML-12 and HepG2 cells were induced to undergo hepatocellular steatosis by free fatty acids(FFA),and the optimal inducing concentration was determined by oil red O staining and CCK-8 assay.The cell activity was detected by CCK-8 assay after ro-savin treatment,and the lipid droplet accumulation was observed by oil red O staining.The levels of triglycer-ide(TG),total cholesterol(TC),glutamic oxalacetic transaminase(AST),glutamic pyruvic transaminase(ALT),superoxide dismutase(SOD),glutathione per-oxidase(GSH-Px),and malondialdehyde(MDA)were detected by kits.The potential targets of rosavin in non-alcoholic fatty liver disease(NAFLD)were ana-lyzedby network pharmacology and molecular docking,and the expression of core candidate targets before and after the rosavin intervention was detected by real-time fluorescence quantitative PCR.Results Hepatocyte steatosis was induced by FFA,and the intervention of rosavin(25,50 μmol·L-1)reduced the number of intracellular lipid droplets in hepatocytes in a dose-de-pendent manner,also lowered the cellular levels of TG,TC,AST,ALT,elevated the levels of SOD and GSH-Px,and reduced the levels of MDA.Network pharma-cological analysis and molecular docking yielded five core candidate targets:NOS3,MAPK14,PPARG,TNF-α,and IGF-1,and real-time fluorescence quantitative PCR showed that the action of loxavir significantly re-duced the gene expression of TNF-α and PPARG in hepatocytes after FFA induction.Conclusions Rosa-vin can attenuate the inflammatory response,oxidative stress level,and lipid accumulation in hepatocytes by modulating TNF-α and PPARG,thereby ameliorating FFA-induced hepatocellular steatosis.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

In recent years,clinical decision-making system has been developed and refined by incorporating patient's characteristics,tumor markers,clinlabomics and radiomics and has served a complementary role with classic hepatocellular carcinoma clinical staging systems among therapeutic choices of hepatocellular carcinoma during past decade.With the promotion of liver cancer screening programs,increasing patients with very early or early-stage hepatocellular carcinoma may attain upfront cure by partial liver resection,transplantation or local ablation.Advanced hepatocellular carcinoma with vascular invasion has been identified as inappropriate candidates of upfront curative therapies among several cohorts and clinical practice consensus.A heterogenous proportion of intermediate stage hepatocellular carcinomas have been reported to attain upfront cure with usually short recurrence-free survival(RFS)among several prospective cohorts.An unneglectable of patients with advanced stage hepatocellular carcinomas has been reported to subsequent curative resection after downstaging by conversion therapies.Subsequent resection after neoadjuvant therapies have improved the RFS and overall survival of patients with intermediate hepatocellular carcinoma.

Objective To retrospectively analyze the clinical risk factors and prognosis of perioperative myocardial injury(MINS)in non-cardiac surgery patients admitted to the intensive care unit(ICU).Methods A total of 478 postoperative patients admitted to the Department of Intensive Medicine,Minhang Hospital,Fudan University from Jan 2020 to Dec 2023 were selected.They were divided into MINS group(n=302)and normal group(n=176)based on whether myocardial injury occurred within 7 days after surgery.The differences in clinical characteristics between the two groups were compared,and risk factors for perioperative myocardial injury were identified.Risk factors for mortality in the MINS group were analyzed with 30-day mortality as the clinical endpoint.Results The prevalence of acute physiology and chronic health evaluation Ⅱ(Apache Ⅱ)score,coronary artery disease,and chronic kidney disease were all higher in the MINS group than those in the normal group,with statistically significant differences(P<0.05).The proportion of emergency surgeries,co-infection,and perioperative hypotension were significantly different between the MINS group and the normal group(P<0.05).Multivariate logistic regression analysis revealed that chronic kidney disease,emergency surgery,co-infection,and intraoperative and postoperative hypotension were risk factors for MINS occurrence.Prognostic analysis indicated that perioperative hypotension was a risk factor for 30-day mortality in MINS patients.Conclusion MINS is closely associated with patients'underlying conditions,timing of surgery,and perioperative hypotension status,and especially perioperative hypotension affects the final outcomes.