Background and Aims:In recent years,with the continuous progress of systemic therapy,hepatic arterial infusion chemotherapy(HAIC)combined with immune checkpoint inhibitors and anti-angiogenic agents has demonstrated significant efficacy in the treatment of advanced hepatocellular carcinoma(HCC).However,direct comparisons between different immunotherapeutic targets,such as PD-1 and PD-L1 inhibitors,in terms of clinical benefit and safety remain limited.This study aimed to compare the efficacy and safety of HAIC plus bevacizumab and sintilimab(HAIC-BP1)versus HAIC plus bevacizumab and atezolizumab(HAIC-BPL)in advanced HCC.Methods:A retrospective analysis was conducted on 88 patients with advanced HCC who received first-line HAIC-BP1or HAIC-BPL at Sun Yat-sen University Cancer Center between January 2020 and December 2022.Progression-free survival(PFS),overall survival(OS),objective response rate(ORR),disease control rate(DCR),and adverse events(AEs)were compared between the two groups.Cox regression analysis was performed to identify prognostic factors affecting PFS.Results:A total of 47 patients were included in the HAIC-BP1 group and 41 patients in the HAIC-BPL group,with no statistically significant differences in baseline characteristics between the two groups(all P>0.05).The ORR(59.6%vs.65.9%)and DCR(72.3%vs.80.5%)did not significantly differ between the HAIC-BP1 group and the HAIC-BPL group(both P>0.05).After a median follow-up of 16.3 months,there were no significant differences in median OS(21.3 months vs.22.4 months)or median PFS(6.7 months vs.6.2 months)between the HAIC-BP1 group and the HAIC-BPL group(both P>0.05).The incidence of AEs was similar,and no treatment-related deaths occurred.Multivariate Cox regression analysis identified tumor diameter>10 cm as an independent adverse prognostic factor for PFS(HR=0.48,95%CI=0.27-0.83,P=0.009).Conclusion:Both HAIC-BP1 and HAIC-BPL demonstrated comparable efficacy and favorable safety profiles as first-line treatment options for advanced HCC.Tumor diameter>10 cm was an independent unfavorable prognostic factor for PFS,underscoring the importance of patient stratification in clinical decision-making.

Background and Aims:In recent years,with the continuous progress of systemic therapy,hepatic arterial infusion chemotherapy(HAIC)combined with immune checkpoint inhibitors and anti-angiogenic agents has demonstrated significant efficacy in the treatment of advanced hepatocellular carcinoma(HCC).However,direct comparisons between different immunotherapeutic targets,such as PD-1 and PD-L1 inhibitors,in terms of clinical benefit and safety remain limited.This study aimed to compare the efficacy and safety of HAIC plus bevacizumab and sintilimab(HAIC-BP1)versus HAIC plus bevacizumab and atezolizumab(HAIC-BPL)in advanced HCC.Methods:A retrospective analysis was conducted on 88 patients with advanced HCC who received first-line HAIC-BP1or HAIC-BPL at Sun Yat-sen University Cancer Center between January 2020 and December 2022.Progression-free survival(PFS),overall survival(OS),objective response rate(ORR),disease control rate(DCR),and adverse events(AEs)were compared between the two groups.Cox regression analysis was performed to identify prognostic factors affecting PFS.Results:A total of 47 patients were included in the HAIC-BP1 group and 41 patients in the HAIC-BPL group,with no statistically significant differences in baseline characteristics between the two groups(all P>0.05).The ORR(59.6%vs.65.9%)and DCR(72.3%vs.80.5%)did not significantly differ between the HAIC-BP1 group and the HAIC-BPL group(both P>0.05).After a median follow-up of 16.3 months,there were no significant differences in median OS(21.3 months vs.22.4 months)or median PFS(6.7 months vs.6.2 months)between the HAIC-BP1 group and the HAIC-BPL group(both P>0.05).The incidence of AEs was similar,and no treatment-related deaths occurred.Multivariate Cox regression analysis identified tumor diameter>10 cm as an independent adverse prognostic factor for PFS(HR=0.48,95%CI=0.27-0.83,P=0.009).Conclusion:Both HAIC-BP1 and HAIC-BPL demonstrated comparable efficacy and favorable safety profiles as first-line treatment options for advanced HCC.Tumor diameter>10 cm was an independent unfavorable prognostic factor for PFS,underscoring the importance of patient stratification in clinical decision-making.

Objective: To investigate the relationship between health literacy and sports injuries among high school students with athletic specialization, so as to provide theoretical basis for the intervention of sports injury occurrence of sports special students. Methods: A total of 443 high school students with athletic specialization aged 16-18 years old from 21 urban and rural areas in Shangrao City, Ganzhou City and Nanchang City of Jiangxi Province were selected by convenient sampling method from March to April 2023, and the health literacy and sports injury incidence were investigated. The assessment of sports injury was based on the Monitoring Method of Child and Adolescent Injury, and the assessment of health literacy level was conducted using the Interactive Health Literacy Questionnaire of Chinese Adolescents. χ 2 test was used to compare the reported rate of sports injuries among the demographic and sports training groups and the correlation between health literacy and sports injuries. Binary Logistic regression analysis was used to infer the correlation between the health literacy level of high school students with athletic specialization and the occurrence of sports injuries. Results: The prevalence of sports injury was 49.4% in high school students with athletic specialization. Binary Logistic regression analysis showed that the risk of sports injury of high school students with athletic specialization with medium and low level of health literacy was significantly increased compared with high level (medium level: OR = 1.98,95% CI =1.12-3.51; low level: OR =2.08, 95% CI =1.18-3.68), high school students with athletic specialization in low level of health awareness of sports injury risk was higher than other dimensions of health literacy level (middle level: OR =2.77, 95% CI =1.48-5.19; low level: OR =2.01, 95% CI =1.04-3.88)( P <0.05). The results of stratified analysis showed that among male students with athletic specialization and students with track and field, students with moderate/low overall health literacy had a higher risk of sports injuries compared to high level students (male students: low level, OR =2.46, 95% CI =1.15-5.28; track and field: intermediate level, OR =2.17, 95% CI =1.06-4.43, low level, OR =2.09, 95% CI =1.02-4.30; P <0.05). Conclusions There is a correlation between the health literacy level of high school students with athletic specialization and the occurrence of sports injuries. Students health awareness should be improved to reduce the risk of sports injuries.

Objective:To evaluate the possible mediation effect of smoking and healthy diet score on the association between educational level and the risk of lung cancer incidence.Methods:After excluding individuals with missing educational levels and cancer information at baseline, 446?772 participants in the UK Biobank (UKB) prospective cohort study were included. Cox regression models were used to investigate the associations of educational level and smoking and healthy diet score with the incidence of lung cancer. Mediating effect analysis was conducted to analyze the mediating effect of smoking and healthy diet score on the correlation between educational level and lung cancer.Results:During a median follow-up of 7.13 years, 1?994 new- onset lung cancer cases were observed. Per 1 standard deviation (5 years) increase in educational level was associated with a 12% lower risk of lung cancer ( HR=0.88, 95% CI: 0.84-0.92). The corresponding level 1-5 in the International Standard Classification for Education (ISCED) were mapped to UKB self‐report highest qualification to estimate the educational level. A higher rank means a higher educational level. Compared with level ISCED-1, the HR(95% CI) of level ISCED-2, ISCED-3, ISCED-4 and ISCED-5 were respectively 0.83 (0.72-0.94), 0.67 (0.53-0.85), 0.76 (0.65-0.89) and 0.72 (0.64-0.80) for lung cancer. Education years were negatively correlated with smoking, with β coefficients (95% CI) being -0.079 (-0.081- -0.077), but positively correlated with healthy diet score ( β=0.042, 95% CI: 0.039-0.045). Analysis of mediating effect indicated that the association of educational level with lung cancer risk was mediated by smoking and healthy diet score, the proportions of mediating effect were 38.952% (95% CI: 31.802%-51.659%) and 1.784% (95% CI: 0.405%-3.713%), respectively. Conclusion:Smoking and healthy diet score might mediate the effect of educational level on the incidence of lung cancer, indicating that improving the level of education can reduce the risk of lung cancer by changing lifestyles such as smoking and diet.

Objective:To investigate the changes of liver volume and liver function in patients with extensive hepatic vein occluded Budd-Chiari syndrome (BCS) treated with transjugular intrahepatic portosystem shunt (TIPS).Methods:The clinical data of 29 BCS patients from Affiliated Hospital of Xuzhou Medical University during March 2016 to June 2019 were retrospectively collected and analyzed. The BCS was caused by extensive hepatic vein occlusion and patients were treated with TIPS. Pre- and postoperative abdominal CT/MRI images were collected and analyzed, and hepatic volume was measured with 3D-reconstruction. The liver volume and liver function during before and post the surgery were also collected and analyzed with preoperative value.Results:Patients including 8 males and 21 females, aged (33.3±6.3) years, were enrolled in this study. TIPS was successfully performed in all patients, with a technical success rate 100%. No serious complications related to TIPS occurred. Patients were followed up for 12-33 months (median, 16 months). Compared with preoperative [(2 124.6±420.9) cm 3] , the hepatic volume of time points after operation [1 week: (1 926.3±372.3) cm 3; 3 months: (1 480.6±183.1) cm 3; 6 months: (1 461.9±153.0) cm 3; 12 months: (1 469.3±148.5) cm 3] were all significantly reduced, and the differences were statistically significant ( P<0.05). Compared with preoperative values, the hepatic function indexes at each time point after operation were significantly improved ( P<0.05). The complete remission rate of ascites was 96.4% (27/28), 100.0% (28/28) and 100.0% (28/28) at 3, 6 and 12 months, respectively. Conclusion:The extensive hepatic vein occlusive BCS patients were benefit from TIPS therapy. Six months after operation, the hepatic volume and the hepatic function returned to normal level.

Objective:To study the use of three-dimensional (3D) visualization in diagnosis and interventional treatment of patients with Budd-Chiari syndrome (BCS) presenting with inferior vena cava obstruction and dangerous collateral branches.Methods:The data of 28 patients with BCS presenting with inferior vena cava obstruction and dangerous collateral branches treated at the Affiliated Hospital of Xuzhou Medical University from September 2018 to January 2021 were retrospectively analyzed. There were 11 males and 17 females with a mean age of 49.0 years. Enhanced MR images of these 28 patients were used to build 3D visualization of inferior vena cava. Anteroposterior and left lateral digital subtraction angiography (DSA) of inferior vena cava were performed. The inferior vena cava of these patients was recanalized under guidance of 3D visualization, and patency of inferior vena cava was determined on follow up.Results:3D visualization of inferior vena cava was successfully constructed in all the 28 patients, and 51 dangerous collateral branches were displayed. One, 2, 3 and 4 dangerous collateral branches were found in 13, 8, 6 and 1 patients, respectively. The average angle between the preoperative planning puncture route and the long axis of the proximal end of inferior vena cava was 22.2°. The orifices and courses of the dangerous collaterals and the shape of inferior vena cava could be clearly displayed on 3D visualization in all the 28 patients (100.0%), which were significantly better than the 6 patients (21.4%) using DSA obtained in the anteroposterior and left lateral positions (χ 2=20.045, P<0.05). The inferior vena cava was successfully recanalized in all the 28 patients without complications. On follow up of these patients for 2 to 30 months (mean 18.4 months), the inferior vena cava was patent in 25 patients. Three patients developed inferior vena cava re-obstruction at 3, 4 and 14 months after interventional treatment, respectively. Conclusion:3D visualization was useful in the diagnosis and interventional treatment of patients with BCS presenting with inferior vena cava obstruction and dangerous collateral branches.

Objective The objective of this study was to investigate the effect of microRNA-409-3p(miRNA-409-3p) expression on proliferation of cervical cancer Hela cells and chemotherapy sensitivity of cisplatin. Methods HeLa cells were divided into normal control,miRNA-409-3p mimic and RNA control groups. The mRNA expression of miRNA-409-3p was detected by RT-qPCR. The cell viability was detected by CCK-8 assay,and the expression of Fip200,LC3 and Caspase-3 was detected by Western blot. Results The relative expression level of microRNA-409-3p mRNA in cervical cancer tissues was significantly lower than that in normal cervical tissues and adjacent tissues(P<0. 05). After transfection of microRNA-409-3p mimic,the relative ex-pression level of microRNA-409-3p mRNA in the microNA-409-3p mimic group was significantly up-regulated compared with the normal control group(P<0. 05). The relative expression level of miRNA-409-3p mRNA in the RNA control group was not dif-ferent from that in the normal control group(P>0. 05). The proliferative rate of HeLa cells int the microRNA-409 mimic group was significantly lower than that in normal control and RNA control groups(P<0. 05). After cisplatin treatment,the proliferation of Hela cells was significantly inhibited in the miRNA-409-3p mimic group(P<0. 05);the expression of Fip200 protein and LC3II/LC3I ratio in the microRNA-409-3p mimic group were significantly lower than those in the normal control and RNA control groups(P<0. 05). Conclusion The low expression of microRNA-409-3p in cervical cancer tissue may be related to the occurrence and de-velopment of cervical cancer. Upregulation of microRNA-409-3p level can inhibit the proliferation of HeLa cells and increase the sensitivity of HeLa cells to cisplatin.

Objective To analyze the application of three-dimensional visualization in interventional treatment of Budd-Chiari syndrome (BCS) with the hepatic vein occlusion type.Methods A retrospective study was conducted on 15 patients with BCS of the hepatic vein occlusion type who were admitted to the Affiliated Hospital of Xuzhou Medical University from January 2017 to June 2018.The study included 8 males and 7 females with a mean age of (36.7±14.4) years.All patients were examined with MRI enhanced scanning and the original MRI data of the DICOM format were extracted.The digital data were then extracted and reconstructed by the Mimics software to obtain a three-dimensional visualization model.The hepatic vein was recanalized under the guidance of the three-dimensional visualization model.Results The three-dimensional visualization model was successfully constructed.Of all the 15 three-dimensional visualization models,right hepatic vein ostial stenosis occurred in 4 patients and occlusion in 11 patients.The middle hepatic vein and the left hepatic vein formed a common trunk in 15 patients,and ostial stenosis and occlusion of the common trunk occurred in 3 and 12 patients,respectively.Communicating branches between the right and middle hepatic veins occurred in 6 patients.Accessory hepatic veins occurred in 3 of 15 patients,and the accessory hepatic vein ostium was stenosed in 3 patients.Communicating branches between the accessory hepatic vein and the right hepatic vein occurred in 2 patients,and communicating branches between the accessory hepatic vein and the middle hepatic vein occurred in 1 patient.All patients were treated successfully with interventional treatment without any complications.One,2,and 3 hepatic veins were recanalized in 7,5 and 3 patients,respectively.Conclusion The three-dimensional visualization was valuable in displaying the location,pattern and collateral vessels of the hepatic veins in BCS patients with the hepatic vein occlusion type.It was helpful for accurate preoperative assessment and to make individualized interventional treatment plans.

Objective: To explore the clinical value of 3D-DSA technology in the diagnosis and treatment guidance of hepatic artery chemoembolization. Methods: Liver cancer patients in the treatment groups were collected to receive 3D-DSA imaging guidance at the Affiliated Hospital of Xuzhou Medical University between March and May 2017. In addition, routine 2D-DSA imaging was selected for treatment-received group. Intra-operative blood vessels and tumor-like lesions were observed. The total exposure dose (CAK, unit mGy), cumulative irradiation intensity per unit area (DAP, unit mGy.cm2) and dosage of contrast agent (ml) were calculated separately for two groups of patients. The same senior physicians and technicians operated both groups of patients. Comparisons of measurement were analyzed by t-test and chi-square test was used for count data. Results: Data of twenty patients were collected from the two groups. Tumor location, target vessels structure and shape of development were clear in all patients in the treatment group. The control group had 17 cases of tumor development and the target vascular structure was clear in 16 cases. CAK mean treatment group was lower than control group (554.11 + 38.87) mGy and (644.53 + 26.70) mGy, and DAP mean treatment group was lower than the control group (125.25 + 7.54) mGy·cm² and (143.49 + 6.18) mGy·cm². The two groups were compared (P value < 0.05), and the differences were statistically significant. The mean dose of contrast agent in the two groups were lower than control group (64.42 + 3.92) ml, (70.79 + 4.47) ml, and the differences between the two groups were statistically significant (P < 0.05). Conclusion 3D-DSA imaging technology can provide effective diagnosis and guidance in the treatment of hepatic artery chemoembolization. It can effectively reduce the radiation exposure dose and radiation intensity, and it is of high clinical value for interventional embolization of liver cancer.

Objective To investigate the application of damage control surgery (DCS) concept in treatment of pancreas trauma. Methods The clinical data of 22 cases of pancreas trauma from January 2009 to June 2016 were analyzed retrospectively, including degree of injury, therapies and effect. Results Following DCS concept, 3 cases were given conservative treatment, and 19 cases were treated by operation, including debridement, hemostasis, suture, simple drainage and preserved pancreas function;21 cases were cured and 1 died;pancrestic fistula occurred in 11 cases, abdominal infection occurred in 6 cases and injured pancreatitis occurred in 1 cases by conservative treatment;false cyst occurred in 1 cases 6 weeks after operation. All patients were followed up for 12-36 months, with an average of (25.1 ± 1.7) months, and No significant impact was seen on the lives or work of 21 patients after surgery. Conclusions Pancreas trauma needs early-stage diagnosis and active treatment. Rational application of dcs concept can reduce the mortality and improve the outcome effectively.