Purpose To identify hepatocellular carcinoma that responds to repetitive transcatheter arterial chemoembolization(TACE)based on CT radiomics.Materials and Methods A total of 96 patients diagnosed as hepatocellular carcinoma in the First Affiliated Hospital of Xinjiang Medical University from February 2018 to May 2024 were randomly divided into a training group(n=67)and internal validation group(n=29)at a ratio of 7∶3.All patients received three or more TACE treatments.Radiomics features were extracted from lipiodol of the target-lesions by semi-automatic segmentation on the axial CT image after TACE within 24 hours.The radiomics model were constructed by five features for differentiating non-response group from response group.Receiver operating characteristic curve analysis and decision curve were performed to evaluate the performance of the model.Results Child-Pugh classification(OR=2.737,P<0.05),BCLC stage(OR=2.907,P<0.05),multifocal tumors(OR=4.505,P<0.01)and alpha-fetoprotein(OR=1.002,P<0.01)were independent risk factors for predicting tumor response after TACE.The area under the curve of the non-contrast CT based model and the arterial-enhanced CT based model were 0.813 and 0.831 in the experimental group;0.748 and 0.788 in the validation group,respectively.Both of the two models showed good prediction performance.Conclusion The radiomics model based on CT imaging features after first TACE is effectively for differentiating non-response group from response group,lipiodol retention patterns from the target lesion can be the imaging biomarkers for TACE response prediction.

Hepatocellular carcinoma(HCC)is a worldwide highly prevalent malignant tumor,and patients with advanced HCC often lose opportunity for surgery.The effect of TACE alone for treating advanced HCC is limited.Comprehensive treatment strategy,including TACE combined with ablation,hepatic arterial infusion chemotherapy,molecular targeted drugs and immune checkpoint inhibitors can promote tumor necrosis,reverse the immunosuppressive microenvironment and prolong patient's survival period through synergistic mechanisms.The research progresses of combination therapy strategy of TACE and other methods for advanced HCC were reviewed in this article.

Hepatocellular carcinoma(HCC)is a worldwide highly prevalent malignant tumor,and patients with advanced HCC often lose opportunity for surgery.The effect of TACE alone for treating advanced HCC is limited.Comprehensive treatment strategy,including TACE combined with ablation,hepatic arterial infusion chemotherapy,molecular targeted drugs and immune checkpoint inhibitors can promote tumor necrosis,reverse the immunosuppressive microenvironment and prolong patient's survival period through synergistic mechanisms.The research progresses of combination therapy strategy of TACE and other methods for advanced HCC were reviewed in this article.

Purpose To identify hepatocellular carcinoma that responds to repetitive transcatheter arterial chemoembolization(TACE)based on CT radiomics.Materials and Methods A total of 96 patients diagnosed as hepatocellular carcinoma in the First Affiliated Hospital of Xinjiang Medical University from February 2018 to May 2024 were randomly divided into a training group(n=67)and internal validation group(n=29)at a ratio of 7∶3.All patients received three or more TACE treatments.Radiomics features were extracted from lipiodol of the target-lesions by semi-automatic segmentation on the axial CT image after TACE within 24 hours.The radiomics model were constructed by five features for differentiating non-response group from response group.Receiver operating characteristic curve analysis and decision curve were performed to evaluate the performance of the model.Results Child-Pugh classification(OR=2.737,P<0.05),BCLC stage(OR=2.907,P<0.05),multifocal tumors(OR=4.505,P<0.01)and alpha-fetoprotein(OR=1.002,P<0.01)were independent risk factors for predicting tumor response after TACE.The area under the curve of the non-contrast CT based model and the arterial-enhanced CT based model were 0.813 and 0.831 in the experimental group;0.748 and 0.788 in the validation group,respectively.Both of the two models showed good prediction performance.Conclusion The radiomics model based on CT imaging features after first TACE is effectively for differentiating non-response group from response group,lipiodol retention patterns from the target lesion can be the imaging biomarkers for TACE response prediction.

Objective To evaluate the teaching performance of the traditional Chinese medicine(TCM)course for the first three grades of the"4+4"reform pilot class in clinical medicine at Peking Union Medical College.Methods An anonymous survey was conducted using Questionnaire Star and the responses from TCM Teaching Questionnaire completed by students were statistically analyzed and summarized.Results Most students expressed interest in TCM and deemed it necessary to study TCM course.They believed that teachers well prepared for teach-ing performance and the teaching content was well-aligned with the textbooks,syllabus,and lecture slides.The teaching content was closely integrated with clinical practice,and students were satisfied with the teaching methods and approaches.Conclusions Teaching evaluations help teachers to summarize their teaching experiences and im-prove the teaching quality of the TCM course.

Objective:To explore the risk factors of bortezomib-related peripheral neuropathy (BIPN) and the clinical and electrophysiological characteristics of patients in treatment of multiple myeloma (MM).Methods:The clinical data of 71 newly diagnosed MM patients treated with BD (bortezomib + dexamethasone) regimen in Yancheng First People's Hospital from March 2016 to December 2019 were retrospectively analyzed. The bone marrow morphology, immunology, cytogenetics, molecular biology (MICM), routine electrophysiological examination before and after treatment were performed. All patients were divided into the peripheral neuropathy (PN) group and the non-PN group according to the presence or not of BIPN, and the clinicopathological differences of both groups were also compared; a binary logistic regression model was used to analyze the factors affecting the occurrence of PN. The electrophysiological characteristics were summarized and fluorescence in situ hybridization (FISH) was used to detect karyotype of BIPN patients.Results:Among 71 MM patients, there were 40 cases (56.3%) of PN and 31 cases (43.7%) of non-PN. The proportion of patients at international staging system (ISS) staging Ⅲ, and the levels of IgA, IgG, IgM, serum creatinine, β 2-microglobulin (β 2-MG) in the PN group were higher than those in the non-PN group, and hemoglobin (Hb) level in the PN group was lower than that in the non-PN group, and the differences were statistically significant (both P < 0.05). Binary logistic regression analysis showed that increased IgA ( OR = 1.151, 95% CI 1.012-1.309, P = 0.033), increased IgG ( OR = 1.055, 95% CI 1.000~1.112, P = 0.049), increased IgM ( OR = 1.010, 95% CI 1.001-1.018, P = 0.022), increased serum creatinine ( OR = 1.037, 95% CI 1.011~1.065, P = 0.005), increased β 2-MG ( OR = 1.564, 95% CI 1.039-2.354, P = 0.032) were risk factors for BIPN. Among 40 patients with BIPN, 33 cases (82.5%) of sensory nerve conduction velocity (SCV) were abnormal, 23 cases (57.5%) of motor nerve conduction velocity (MCV) were abnormal; 31 cases (77.5%) showed demyelination damage, 9 cases (22.5%) had axonal damage. Among 40 patients with BIPN, 24 cases underwent FISH detection, including 19 cases (79.2%) with chromosomal mutations, of which 12 cases (50.0%) were mixed subtype abnormal. Conclusions:MM patients with high levels of β 2-MG, IgA, IgG, IgM and serum creatinine are more prone to PN when treated with bortezomib. The electrophysiology of patients with BIPN is mainly characterized by demyelination of sensory nerves.

Objective:To investigate the clinicopathological features, diagnosis, differential diagnosis and treatment of nodal marginal zone lymphoma (NMZL) with elevated monoclonal IgM.Methods:The clinical data of one NMZL patient with elevated monoclonal IgM treated at Yancheng No.1 People's Hospital in July 2020 were retrospectively analyzed, and the related literature was analyzed.Results:The patient was a 57-year-old female and the main clinical manifestations were fatigue and bone pain in left rib. Serum immunofixation electrophoresis showed IgM-κ type M proteinemia, bone marrow cytology showed a few plasmacytoid lymphocytes, bone marrow biopsy and immunohistochemistry showed B-cell non-Hodgkin lymphoma, bone marrow genetic testing showed MYD88 L265p and CXCR4 were both negative, postoperative pathology result of retroperitoneal lymph node biopsy was marginal zone lymphoma (mature small B type, prone to NMZL),and immunohistochemistry results: CD3, CD5, CD138, κ, λ, CD10, Cyclin D1 were negative, CD20, Pax-5, CD23 (FDC), bcl-2 were positive; Ki-67 positive index < 5%. The final diagnosis was NMZL with elevated monoclonal IgM. Partial remission was achieved after 8 cycles of reduced-dose CHOP regimen; thalidomide was used in the maintenance treatment, the disease condition was stable until August in 2021 and the follow-up was continuing.Conclusions:NMZL with elevated monoclonal IgM is relatively rare. Its diagnosis should be differentiated from Waldenstr?m macroglobulinemia and other inert B-cell lymphomas. Currently, there is no standard treatment and following the principle of individualized treatment can improve the prognosis of patients.

Objective:To investigate the expression of Toll-like receptor 8 (TLR8) in diffuse large B-cell lymphoma (DLBCL) and its correlation with clinicopathological characteristics and prognosis of patients.Methods:The data in the Oncomine database was used to analyze the difference of TLR8 mRNA expression between DLBCL tumor tissues and normal lymphocytes, and the result was verified in two independent subsets GSE 25638 and GSE 32018 of the NCBI-GEO database. The OSDLBCL online survival analysis tool was used to analyze the correlation of TLR8 mRNA relative expression level with overall survival (OS) and progression-free survival (PFS) of DLBCL patients. Gene ontology bioprocess (GO_BP) enrichment analysis was performed by using GSEA software. The correlation of TLR8 mRNA expression with tumor immune cell infiltration degree and immune checkpoint-related molecule expression was analyzed by TIMER online tool website. A total of 53 DLBCL patients who underwent lymph node biopsy in Yancheng No. 1 People's Hospital from June 2020 to June 2021 were selected. Immunohistochemistry was used to detect the expression of TLR8 protein, and its relationship with the clinicopathological characteristics of patients was analyzed.Results:The analysis result of data from Oncomine and GEO databases showed that the relative expression levels of TLR8 mRNA in tumor tissues of patients with DLBCL or activated B cell-like DLCBL were higher than those in normal lymphocytes (all P < 0.001). The results of OSDLBCL online survival analysis indicated that the OS ( P = 0.020) and PFS ( P = 0.004) in DLBCL patients with high TLR8 mRNA expression were worse than those in patients with low TLR8 mRNA expression. The level of TLR8 was related to the abnormal function of immune response, cytokine metabolism and DNA damage monitoring; the result of TIMER online analysis showed that the expression level of TLR8 mRNA was positively related to the degree of neutrophil infiltration ( r = 0.78, P < 0.001) and the expression of immunosuppressive molecules [HAVCR2 ( r = 0.85, P < 0.001), LAG3 ( r = 0.63, P < 0.001), CD274 ( r = 0.77, P < 0.001), TIGIT ( r = 0.32, P = 0.037), and C10ORF54 ( r = 0.34, P = 0.029)]. Among 53 DLBCL patients, 29 patients (54.7%) had low expression of TLR8 protein and 24 patients (45.3%) had high expression of TLR8 protein. There were statistical differences in the expressions of TLR8 protein in DLBCL patients with different serum lactate dehydrogenase and β 2-microglobulin levels (both P < 0.05). Conclusions:TLR8 is highly expressed in DLBCL patients, and TLR8 may be a prognostic marker of DLBCL.

Objective:To investigate the familial inheritances, clinical features, treatments and outcomes of familial Waldenstrom macroglobulinemia (WM) patients.Methods:The clinical manifestations, laboratory examinations, diagnosis and treatments, and follow-up data of 6 familial WM patients who were admitted to Yancheng No.1 People's Hospital from June 2002 to July 2019 were retrospectively analyzed, and the literature was reviewed.Results:Among 6 WM patients, 4 patients had dizziness and fatigue at the onset, 1 patient had recurrent low-grade fever and abnormal sweating as the first manifestations, 1 patient was hospitalized due to pulmonary infection, and WM was found later. Two brothers of the patients were diagnosed with WM, another 2 brothers of the patients had IgM-type monoclonal gammopathy of undetermined significance (MGUS) during the physical examination. All the 6 patients were middle-aged/elderly men, with a median age of 63 years old (51-70 years old). The median follow-up time were 71.5 months (4-217 months), and by the end of the follow-up (June 2020), 2 cases died of pulmonary infection, and 1 of them developed acute myeloid leukemia; the other 4 cases were in regular chemotherapy. Two IgM-MGUS patients were followed up without symptoms.Conclusions:WM patients have familial aggregation, and their clinical manifestations are highly heterogeneous. Patients with family history may have poor prognosis. It is necessary to strengthen the awareness of WM and family history screening.

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.