Transjugular intrahepatic portosystemic shunt （TIPS） is currently an effective procedure for the complications of portal hypertension. In recent years， rapid progress has been made in the field of TIPS in terms of technical approaches， prognostic models， and an expanding range of indications. The EASL recently issued the clinical practice guidelines on TIPS to comprehensively address all aspects of TIPS in patients with liver cirrhosis. This article makes an excerpt of the key recommendations in the guidelines.

Objective To investigate the factors influencing the occurrence of coma in patients with acute basilar artery occlusion(BAO)and the favorable prognosis in the coma patients after receiving mechanical thrombectomy(MT).Methods The clinical data and imaging materials of 102 patients with acute BAO,who received MT at the First Affiliated Hospital of Soochow University of China from January 2016 to April 2024,were retrospectively analyzed.According to whether the patient had a coma or not on admission,the patients were divided into non-coma group and coma group.The clinical data and imaging findings were compared between the two groups.Multivariate logistic regression analysis was performed to identify the factors influencing the occurrence of coma.The modified Rankin scale(mRS)score was used to evaluate 90-day clinical prognosis.The patients of coma group were further divided into favorable prognosis subgroup(mRS:0-3 points)and poor prognosis subgroup(mRS:4-6 points).Baseline date and surgical data were compared between the two subgroups,and multivariate logistic regression analysis was conducted to identify the factors associated with a favorable prognosis in coma patients after receiving mechanical thrombectomy.Results Of the 102 patients with acute BAO,54 were in unconscious state on admission(coma group)and 48 were in conscious state(non-coma group)on admission.Multivariate logistic regression analysis revealed that coexisting cardiovascular diseases with severe cardiac insufficiency or moderate to severe coronary artery stenosis(P=0.009)and low BATMAN score(P＜0.001)were the independent risk factors for the occurrence of coma in acute BAO patients.Among the 54 unconscious patients who received MT treatment,favorable prognosis was obtained in 13 and poor prognosis was seen in 41.Multivariate logistic regression analysis indicated that high BATMAN score(P=0.017)was the independent influencing factor for favorable prognosis in acute BAO patients with coma after receiving MT therapy.Conclusion Acute BAO patients having coexisting cardiovascular diseases with severe cardiac insufficiency or moderate to severe coronary artery stenosis or having low BATMAN score are more likely to develop coma.Acute BAO patients with coma having high BATMAN score are more likely to obtain a favorable prognosis after receiving MT therapy.

ObjectiveTo evaluate the efficacy and safety of first-line transcatheter arterial chemoembolization （TACE） combined with targeted therapy and immunotherapy in the treatment of patients with stage Ⅱb/Ⅲa hepatocellular carcinoma （HCC） based on China Liver Cancer Staging （CNLC）. MethodsA total of 198 patients who received first-line TACE combined with targeted therapy and immunotherapy or received TACE alone from January 2015 to December 2022 in the First Affiliated Hospital of Soochow University were enrolled in this study， and after propensity score matching， there were 50 patients in combination group and 50 patients in TACE group. The Kaplan-Meier method was used to calculate median overall survival （mOS） and median progression-free survival （mPFS）. Modified Response Evaluation Criteria in Solid Tumors was used to evaluate objective response rate （ORR） and disease control rate （DCR）， and Common Terminology Criteria for Adverse Events v5.0 was used to evaluate adverse events. The chi-square test was used for comparison of categorical data between two groups； the t-test was used for comparison of normally distributed continuous data between two groups， and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two groups. The Kaplan-Meier method was used to estimate survival time and calculate 95% confidence interval （CI）， and the Log-rank test was used for comparison of mOS and mPFS between two groups. ResultsThe combination group had an mOS of 30.1 months （95%CI： 21.9‍ ‍—‍ ‍38.3）， and the TACE group had an mOS of 14.5 months （95%CI： 11.0 ‍—‍‍ ‍18.0）， with a significant difference between the two groups （χ²=17.8， P<0.001）； the combination group had an mPFS of 10.3 months （95%CI： 8.8‍ ‍—‍ ‍11.8）， and the TACE group had an mPFS of 7.1 months （95%CI： 5.8‍ — ‍8.4）， with a significant difference between the two groups （χ²=10.4， P<0.001）. There were significant differences between the combination group and the TACE group in ORR （84% vs 58%， P<0.05） and DCR （94% vs 80%， P<0.05）. There was no significant difference between the combination group and the TACE group in the incidence rate of adverse events （24% vs 16%， P=0.317）， and no adverse event-related deaths were observed in either group. ConclusionCompared with TACE alone， TACE combined with targeted therapy and immunotherapy has a better efficacy in the treatment of patients with CNLC stage Ⅱb/Ⅲa HCC， without increasing the incidence rate of severe adverse events.

Objective To evaluate the impact of the growth speed of cerebral infarction on the occurrence of symptomatic intracranial hemorrhage(sICH)in patients with acute anterior circulation ischemic stroke after mechanical thrombectomy.Methods The clinical data of patients with acute ischemic stroke(AIS),who received mechanical thrombectomy at the First Affiliated Hospital of Soochow University of China from June 2016 to December 2022,were retrospectively analyzed.After thrombectomy,the patients were divided into sICH group and non-sICH group according to Heidelberg criteria.The clinical data and imaging findings were compared between the two groups.Multivariate logistic regression analysis was used to identify the independent risk factors for sICH after thrombectomy,and the area under the receiver operating characteristic curve(AUC)was used to evaluate the efficacy of the growth speed of cerebral infarction in predicting sICH.Results A total of 218 patients were enrolled in this study,sICH group had 23 patients and non-sICH group had 195 patients.The differences in NIHSS score,collateral circulation status,core infarction volume,and growth speed of cerebral infarction between the two groups were statistically significant(all P＜0.05).Multivariate logistic regression analysis showed that rapid growth speed of cerebral infarction was an independent risk factor for sICH occurring after mechanical thrombectomy.For predicting sICH,the sensitivity and specificity of the growth speed of cerebral infarction were 78.3％and 69.7％respectively,with an AUC of 0.751 and a predicted value of 7.6 mL/h.Conclusion The rapid growth speed of cerebral infarction is a predictive factor for sICH occurring after mechanical thrombectomy in patients with acute anterior circulation ischemic stroke.The risk of sICH becomes higher after mechanical thrombectomy when the growth speed of cerebral infarction is faster than 7.6 mL/h.

Objective To investigate the efficacy and safety of transarterial chemoembolization (TACE) combined with camrelizumab and apatinib in the treatment of advanced hepatocellular carcinoma (HCC). Methods From July 2019 to June 2021, 19 patients with advanced HCC who met the inclusion and exclusion criteria in the First Affiliated Hospital of Soochow University were enrolled in this study. All patients received TACE combined with camrelizumab and apatinib. Tumor response was assessed according to Modified Response Evaluation Criteria in Solid Tumors (mRECIST), and adverse events were assessed according to Common Terminology Criteria for Adverse Events (v5.0). The Kaplan-Meier method was used to analyze progression-free survival and overall survival and calculate 95% confidence interval (CI). Results The median follow-up time was 14.0 months for the 19 patients. As of the last follow-up based on mRECIST, 7 patients (7/19, 36.8%) achieved complete response, 9 (9/19, 47.4%) achieved partial response, and 2 (2/19, 10.5%) achieved stable disease. During follow-up, overall objective response rate and overall disease control rate reached 84.2% and 94.7%, respectively; the median duration of response reached 8.0 (3.4-13.0) months, and median progression-free survival reached 9.5 (95% CI : 4.7-14.3) months; the 6-month survival rate reached 100%, and the 12-month survival rate reached 78.9%. Among the 19 patients, 7 (36.8%) experienced serious adverse events. The most common adverse events of all grades included post-embolization syndrome after TACE (17/19, 89.5%), liver injury (14/19, 73.7%), hematologic toxicity (8/19, 42.1%), and proteinuria (8/19, 42.1%). Conclusion TACE combined with camrelizumab and apatinib has marked efficacy and controllable adverse events in the treatment of advanced HCC, which provides a potential new option for the first-line treatment of advanced HCC.