Hepatocellular carcinoma （HCC） imposes a significant global disease burden， and the development of HCC is closely associated with an immunosuppressive tumor microenvironment. Systemic therapy for advanced HCC has entered the era of immune combination therapy. The ORIENT-32 study has established the regimen of sintilimab combined with bevacizumab as the first-line therapy， and multiple real-world studies have confirmed its clinical value. Overcoming drug resistance remains a major challenge during the application of various combination regimens of targeted therapy and immunotherapy， including this particular regimen. Current research focus is gradually shifting toward deciphering its clinical phenotypes and molecular mechanisms， while promoting the clinical translation of biomarkers from static prediction to dynamic monitoring. In the future， overcoming drug resistance， optimizing combination strategies， and achieving precise individualized treatment are key to enhancing the survival benefit of patients. This article systematically evaluates the efficacy and safety of the sintilimab+bevacizumab regimen in a real-world setting， preliminarily discusses its drug resistance mechanism， and reviews the research advances in the biomarkers for predicting treatment response and guiding drug resistance overcoming， in order to provide a basis for optimizing the precise treatment strategies for advanced HCC.

Objective To investigate the predictive value of serum circular RNA(circRNA)CDYL and circRNA ACAP2 expression levels for major adverse cardiovascular events(MACE)in pa-tients with acute myocardial infarction(AMI).Methods A total of 98 AMI patients were enrolled into the observation group,and divided into MACE group(n=45)and no-MACE group(n=53)based on whether they experienced MACE.Another 98 healthy individuals who underwent physical ex-amination during the same period were selected as the control group.The expression levels of serum cir-cRNA CDYL and circRNA ACAP2 were compared among groups.Multivariate logistic regression analysis was used to identify factors influencing the occurrence of MACE in AMI patients.Receiver operating characteristic(ROC)curve analysis was conducted to evaluate the predictive value of serum circRNA CDYL and circRNA ACAP2 levels for MACE in AMI patients.Results The serum circRNA CDYL level in the observation group was significantly lower than that in the control group,while the circRNA ACAP2 level was significantly higher(P＜0.05).The circRNA CDYL level in the MACE group was significantly lower,and the circRNA ACAP2 level was significantly higher than that in the no-MACE group(P＜0.05).Heart rate and circRNA ACAP2 were identified as independent risk factors for MACE in AMI patients,whereas circRNA CDYL served as independent protective factor(P＜0.05).The area under the ROC curve(AUC)for predicting MACE in AMI patients using se-rum circRNA CDYL,circRNA ACAP2 and their combination were 0.814,0.821 and 0.921,re-spectively.The sensitivity and specificity of combined prediction using serum circRNA CDYL and circRNA ACAP2 were 91.11％and 79.25％,respectively.The combined prediction efficacy of serum circRNA CDYL and circRNA ACAP2 was superior to their individual prediction(Zcombined-circRNA CDYL=1.975,Zcombined-circRNAACAP2=2.064,P=0.048,0.039).Conclusion Serum circRNA CDYL lev-el is down-regulated and circRNA ACAP2 level is up-regulated in AMI patients,and circRNA ACAP2 is an independent risk factor for MACE,while circRNA CDYL is a independent protective factor.The combined value of circRNA CDYL and circRNA ACAP2 in predicting the occurrence of MACE is higher.

Objective To analyse the concept of subjective financial distress in cancer patients.Methods Papers in regarding the subjective financial distress were retrieved from the databases such as China National Knowledge Infrastructure(CNKI),Wangfang Database,PubMed,Cochrane Library,Web of Science,CINAHL,and Embase from the inceptions to 16th October,2022.Walker and Avant's concept analysis was performed to analyse the acquired articles.Results A total of 48 articles were retrieved and included in the study.Walker and Avant's concept analysis showed that the subjective financial distress in the patients was subject to the 3 defining attributes:perceived economic risk,coping behaviours,and negative emotional reactions.The antecedents of this distress included individual factors,disease and treatment factors,and social factors.The consequences of them were the increase in negative health behaviours and poorer quality of life.Conclusions The attributes,antecedents and consequences of subjective financial distress,as identified through the conceptual analysis,can serve as a reference for subsequent researches.In future studies,it would be beneficial by further exploring the connotation by considering China's healthcare system.

Financial toxicity is widely present among caregivers of cancer patients and has adverse effects on the health outcomes of patients and their caregivers. This article reviews the relevant concepts, current status and impacts, evaluation tools, influencing factors, and interventions of financial toxicity of caregivers for cancer patients, aiming to provide a basis for the research on financial toxicity of caregivers for cancer patients.

This paper is to clarify the concept of caregiver mutuality,introduce the main measuring tools of caregiver mutuality,analyze its influencing factors and its impact on caregivers. It elaborates the intervention measures of caregiver mutuality,in order to provide basis for better research.

Objective:To explore the mutuality among main caregivers of pancreatic cancer patients with surgery, and its correlations with the perceived social support and resilience.Methods:From March to July 2019, this study selected 150 main caregivers of pancreatic cancer patients with surgery of the First Affiliated Hospital with Nanjing Medical University as subjects by convenience sampling. All of patients were investigated with the General Information Questionnaire, the Mutuality Scale (MS) , Perceived Social Support Scale (PSSS) and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10) . A total of 150 questionnaires were sent out and 144 valid of them were collected.Results:Among 144 main caregivers of pancreatic cancer patients after surgery, the total average score of MS was (2.75±0.73) . Pearson correlation analysis results showed that the mutuality of main caregivers had positive correlations with the perceived social support and resilience with statistical differences ( P<0.05) . Hierarchical regression analysis showed that the genders, income, perceived social support and resilience went into the regression equation; except for the general information, the perceived social support and resilience could explain 24.5% of the variation. Conclusions:Main caregivers of pancreatic cancer patients with surgery have the above medium level of mutuality which has close correlations with the perceived social support and resilience. Medical staff should pay attention to maintaining the positive relations between caregivers and patients so as to promote the physical and mental health of caregivers.

Objective:To systematically evaluate and summarize the real care experience of family caregivers of pancreatic cancer patients.Methods:We searched The Cochrane Library, Joanna Briggs Institute (JBI) , PubMed, Embase, Institute for Scientific Information (ISI) Web of Science, PsycINFO, CINAHL, China Biology Medicine, China National Knowledge Infrastructure (CNKI) and VIP databases through computer systems to collect qualitative studies on care experience of family caregivers of patients with pancreatic cancer, and the search time was from the database establishment to October 2019. With reference to the Critical Appraisal Tool of Australian JBI Evidence-based Health Care Center (2016) for qualitative research, the collection integration method was used to integrate the existing conclusions.Results:A total of 7 literatures were included, and 44 complete and defined findings were extracted. The similar results were summarized into 10 new categories, and were combined into two integrated results including that the family caregivers of patients with pancreatic cancer experienced self-adjustment and showed positive feelings and responses during care, and they still faced difficulties and challenges in care which affecting their life trajectory.Conclusions:Family caregivers of patients with pancreatic cancer have both negative and positive experiences throughout the care process. Medical staff should be committed to promoting the growth of the personal role of caregivers, adapting and coping, and addressing the existing unmet needs.

With the development of minimally invasive surgery, many open surgery has been replaced by intracavity surgery. In laparoscopic surgery, an electric fibroid morcellator must be used to remove large tissue specimens from a small abdominal incision. Of course, there are some complications in the use, in order to follow the principle of no tumor, the doctor used the laparoscopic pouch in clinical operation to reduce the risk of spreading potential tumor tissue. There are various kinds of pouches, which are classified according to their existing state before use, it can be classified into two categories:overlapping and non-overlapping. The advantages and disadvantages of different bags and pockets are also analyzed. It provides a theoretical basis for technological innovation and equipment improvement.
Laparoscopy ; instrumentation ; Minimally Invasive Surgical Procedures

Objective To investigate CT and MRI findings of primary malignant fibrous histiocytoma (MFH)in the kidney. Methods The clinical data and imaging findings of 7 patients with primary renal MFH proved by histopathology were reviewed retrospectively.Results Tumors were unilateral in all patients,in which 5 cases were in the left kidney and 2 cases in the right kidney.The maximum diameter of the lesions ranged from 3.5 to 17.1 cm,with a mean of (8.7±3.9)cm.All the masses showed shallow lobulated or oval, with obscure boundary.On CT plain scan,heterogeneous isodensity/hypodensity were showed in 7 cases,necrosis occured in 7 cases, intratumoral hemorrhage in 2 cases and calcification in 3 cases.MRI also showed heterogeneous signal intensity.No obvious pseudocapsule was found in 6 cases.On dynamic contrast enhancement scan mild-moderate progressive enhancement was showed in corticomedullary and parenchymal phase in all 7 cases.In delay phase slightly decreased enhancement were showed in 5 cases,and similar or slightly higher enhancement corresponding to the parenchymal phase was showed in 2 cases.However,lower enhancement was showed in the tumors on all 3 phases than that in the renal cortex.Besides,the tumors invaded the renal vein (n=1)and the adjacent structure (n=3).Conclusion No specific imaging findings of primary renal MFH are found.The dynamic contrast enhancement might be helpful for its diagnosis to some extent,and clinical data should be integrated with imaging findings together to differentiate renal MFH from other renal neoplasms.The final diagnosis relies on pathology and immunohistochemistry examination.

BACKGROUND:Bone marrow mesenchymal stem cells (BMSCs) have been induced to differentiate into cardiomyocyte-like cells in vitro.OBJECTIVE:To explore the association between GATA-4, Nkx-2.5 and α-myosin heavy chain (α-MHC) expression and cell morphological changes and structure formation in the process of BMSCs differentiation into cardiomyocyte-like cells.METHODS:By using myocardial lysate, BMSCs were induced to differentiate into cardiomyocytes.Immunocytochemistry staining was used to detect cardiac troponin T (cTnT) and connexin43, for the identification of cardiomyocytes. In the process of directional differentiation, RT-PCR was used to detect the expression of GATA-4,Nkx2.5 and α-MHC.RESULTS AND CONCLUSION:During the directional differentiation of BMSCs, the cells were changed from long fusiform to short rod, forming protrusions that were interconnected to form mesh-like, bamboo-like or myotube-like structure. When the cells were interconnected like a bamboo, cTNT and connexin43 positive cells were visible, and then the number of positive cells increased with the presence of myotube-like structure. RT-PCR results showed that during the induced directional differentiation of BMSCs, GATA-4, Nkx2.5 and α-MHC mRNA levels increased continuously. When interconnected cells formed a mesh-like structure, GATA-4 expression reached the peak and then kept a high level. When adjacent cells were fused into a myotube-like structure, α-MHC reached the peak. Additionally, the expression of Nkx2.5presented a time-dependent increase trend. Overall, during the induced differentiation of BMSCs into cardiomyocyte-like cells, the expression of cardiomyocyte specific genes, characterized by temporality and spatiality, is related to the changes of cell morphology and special structure formation.