The pathogenesis of hepatocellular carcinoma （HCC） involves inflammation and liver fibrosis caused by chronic liver injury， leading to the abnormal proliferation and mutation of liver stem cells and the formation of tumor cells. Although great progress has been made in Western medicine treatment of HCC， the 5-year survival rate of patients remains below 20%， with the limitations such as strong drug resistance and adverse reactions. In recent years， traditional Chinese medicine （TCM） has gradually gained attention in the field of antitumor therapy due to its unique advantages of regulating tumor microenvironment and signaling pathways through multiple components and targets. The Hedgehog signaling pathway plays an important role in cell proliferation， differentiation， and tumor metastasis， and its role in the development and progression of liver cancer has attracted more and more attention. This article reviews the mechanisms and research advances in the anti-HCC effect of TCM monomers and compound prescriptions through targeted regulation of the Hedgehog signaling pathway， in order to provide new ideas for TCM prevention and treatment of HCC.

Objective To investigate the application value of tenofovir alafenamide fumarate(TAF)in patients with first-time hepatitis B virus-related decompensated cirrhosis(HBV-DC)and its impact on renal function and lipid metabolism.Methods A total of 57 patients with first-time HBV-DC who were hospitalized and received TAF antiviral therapy in The Affiliated Hospital of Xuzhou Medical University from January 1,2020 to December 31,2022 were enrolled,and all of them received TAF antiviral therapy.Related data were collected at baseline and at weeks 12,24,and 48 of treatment,including virological and serological indicators,liver and renal function,serum phosphorus,and blood lipids.The paired t-test or single group repeated measures ANOVA were used for comparison of normally distributed continuous data,the Friedman test was used for comparison of non-normally distributed continuous data,and the chi-square test or the Fisher's exact test were used for categorical data.Results A total of 52 patients completed the 48 weeks of follow-up.After 12,24,and 48 weeks of treatment,the patients achieving HBV DNA seroconversion accounted for 38.5%,63.5%,and 84.6%,respectively;the alanine aminotransferase normalization rate were 71.2%,82.7%,and 82.7%,respectively;the proportion of the patients with Child-Pugh class A disease increased to 55.8%,73.1%,and 92.3%,respectively.Within the 48 weeks of treatment,there were significant increases in the levels of cystatin C(χ2=35.163,P＜0.001)and serum phosphorus(F=8.600,P＜0.001)and low-density lipoprotein cholesterol(χ2=10.064,P=0.018).The ratio of total cholesterol/high-density lipoprotein cholesterol decreased continuously from 3.61(2.61～5.84)to 3.27(2.70～4.36)(χ2=5.000,P=0.172).Conclusion TAF can rapidly inhibit HBV replication and significantly improve liver function in HBV-DC patients,with no significant impact on renal function.However,blood lipid should be closely monitored.

Objective To investigate the clinical efficacy of the anchor suture bridge technique in treating avulsion fractures at the tibial insertion point of the posterior cruciate ligament(PCL)in the knee joint.Methods In this study,we reviewed 80 patients with PCL tibial avulsion fractures treated using the anchor suture bridge technique in our department from February 2010 to December 2023.Follow-ups were conducted starting at 3 months post-surgery,then every 3 months until 12 months post-surgery.Clinical and follow-up data of each patient were analyzed.The Lysholm and Hospital for Special Surgery Knee-Rating Scale(HSS)scores of knee function before surgery and at the last follow-up were compared to assess the surgical treatment outcome.Results The 80 patients were followed up for an average of(12.16±1.08)months post-surgery.Re-examination X-rays showed that all fractures had healed,with an average healing time of(3.66±0.51)months.All patients recovered well,with primary healing of surgical incisions and no complications such as neurovascular injury,skin necrosis,incision infection,fracture displacement,or ligament laxity.Postoperative knee Lysholm and HSS scores were significantly higher than preoperative scores.At the last follow-up,the Lysholm score increased from(46.30±6.10)preoperatively to(90.85±3.27),and the HSS score increased from(45.30±5.80)to(91.15±2.66),with statistically significant differences(P＜0.025).Conclusion The anchor suture bridge technique is effective in treating avulsion fractures of the PCL tibial insertion point in the knee joint.It has a high safety profile and leads to good postoperative knee function recovery,with no serious postoperative complications,demonstrating excellent clinical efficacy.

Objective:To study the clinical features and prognostic impact of transarterial chemoembolization (TACE), immune checkpoint inhibitors (ICIs), and tyrosine kinase inhibitors (TKIs) combination therapy regimens in the treatment of patients with hepatitis B virus-related intermediate-and advanced-stage hepatocellular carcinoma with secondary cholestasis.Methods:Patients with HBV-related intermediate-and advanced-stage hepatocellular carcinoma (HBV) who visited the Affiliated Hospital of Xuzhou Medical University between January 1, 2020, and December 31, 2022, were enrolled. TACE+TKIs +ICIs combination therapy was used to treat all patients. The occurrence and factors influencing cholestasis, as well as the impact on prognosis after combined therapy, were analyzed. The measurement data were compared using a t-test and a non-parametric rank sum test. The count data was compared using the χ2 test. The survival rates were compared using a log-rank test between different groups. Results:A total of 106 cases with HBV-related intermediate-and advanced-stage hepatocellular carcinoma were enrolled. The probabilities of secondary cholestasis within 3 and 6 months, 1, 2, and 3 years after TACE+ICIs+TKIs combination therapy were 9.4%, 12.3%, 14.2%, 24.5%, and 24.5%, respectively. Patients with secondary cholestasis had persistent symptoms and rapid progression. During the treatment course, the median survival time was significantly longer in patients with hepatocellular carcinoma without secondary cholestasis than that of patients with cholestasis (26.9 months vs. 13.7 months, respectively, P < 0.05). Secondary cholestasis, baseline aspartate aminotransferase, and prothrombin activity levels were independent risk factors that affected the survival and prognosis of patients treated with combination therapy. There was no statistically significant difference in the occurrence of other adverse reactions between the two groups with secondary and non-secondary cholestasis during the treatment course (47.5% vs. 43.3%, χ2=0.058, P = 0.810). Conclusion:TACE+ICIs+TKIs therapy combination is relatively common in the treatment of patients with HBV-related intermediate-and advanced-stage hepatocellular carcinoma with secondary cholestasis. Moreover, accelerated disease progression is an independent risk factor affecting the survival and prognosis of patients.

Objective To investigate the influencing factors for recompensation in patients with first-time decompensated hepatitis B cirrhosis. Methods A total of 438 patients with first-time decompensated hepatitis B cirrhosis who attended The Affiliated Hospital of Xuzhou Medical University from September 1, 2011 to December 31, 2019 were enrolled, and all patients received comprehensive treatment including antiviral therapy. According to the outcome at the end of follow-up, the patients were divided into recompensation group and persistent decompensation group, and the independent influencing factors for recompensation were analyzed. Long-term survival rate was compared between the patients with different states of compensation. The Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data. A multivariate Cox proportional-hazards regression model analysis was used to investigate the influencing factors for recompensation. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for comparison. Results Among the 438 patients with decompensated hepatitis B cirrhosis, 199 (45.4%) achieved recompensation after antiviral therapy. There were significant differences between the recompensation group and the persistent decompensation group in sustained virologic response (SVR) ( χ 2 =72.093, P < 0.001), single or multiple complications ( χ 2 =9.834, P =0.002), presence or absence of gastrointestinal bleeding ( χ 2 =6.346, P =0.012), serum creatinine (SCr) ( Z =-1.035, P =0.011), blood sodium concentration ( Z =-1.606, P =0.019), hemoglobin ( Z =1.455, P =0.006), and alanine aminotransferase (ALT) level ( Z =-2.194, P < 0.001). Baseline ALT level (odds ratio [ OR ]=1.002, 95% confidence interval [ CI ]: 1.000-1.003, P =0.009), SVR ( OR =5.760, 95% CI : 3.634-9.129, P < 0.001), and SCr ( OR =0.990, 95% CI : 0.981-1.000, P =0.047) were independent influencing factors for recompensation. The recompensation group had a significantly higher 5-year survival rate than the persistent decompensation group (87.9% vs 72.0%, χ 2 =9.886, P =0.025). Conclusion After comprehensive treatment, including antiviral therapy, approximately 45.4% of patients can achieve recompensation.Patients with elevated baseline ALT and achieved SVR were more likely to achieve recompensation, patients with elevated baseline serum creatinine had difficulty achieving recompensation, and patients with recompensation had a better long-term prognosis than patients with persistent decompensation.

Sunscreen products have been widely used with the increase in public awareness of sun protection. As sunscreens are structurally stable and resistant to degradation, the concern for their biotoxicity and impact on marine environment has been heightened increasingly, and several countries and regions have successively issued bans on relevant sunscreen products. However, these bans have not yet affected the key international rules and regulations related to sunscreen products. The risks of different sunscreens to marine ecosystems and potential risks to human themselves still need to be evaluated through further multidisciplinary researches.

ObjectiveTo investigate the influencing factors for persistent low-level viremia (LLV) in chronic hepatitis B(CHB) patients receiving long-term entecavir antiviral therapy. MethodsThe CHB patients who received entecavir antiviral therapy for at least one year in The Affiliated Hospital of Xuzhou Medical University from November 2018 to June 2020 were enrolled as subjects, and according to HBV DNA load at the end of the observation period, the patients were divided into LLV group and sustained virological response (SVR) group. Demographic features and laboratory markers were observed for all patients. The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. A multivariate logistic regression analysis was used to investigate the influencing factors for LLV in patients receiving long-term entecavir treatment. ResultsA total of 560 CHB patients were enrolled, with 204 in the LLV group and 356 in the SVR group. There were significant differences between the two groups in age (Z=-3.530, P＜0.001), sex (χ2=4.270, P=0.039), presence or absence of liver cirrhosis (χ2=53.879, P＜0.001), medication compliance (χ2=5.326, P=0.021), HBeAg positive rate (χ2=90.681, P＜0.001), baseline HBV DNA load before treatment (Z=-8.337, P＜0.001), baseline HBsAg quantification (Z=-10.472, P＜0.001), and medication type (χ2=7.558, P=0.006). The multivariate logistic regression analysis showed that baseline HBeAg status before treatment (odds ratio ［OR］=3.381, 95% confidence interval ［CI］: 1.985-5.756, P＜0.001), HBV DNA load before treatment (OR=1.223, 95%CI: 1.050-1.424, P=0.010), and HBsAg quantification before treatment (OR=2.448, 95%CI: 1.743-3.438, P＜0.001) were risk factors for LLV in long-term entecavir antiviral therapy. ConclusionIn clinical practice, CHB patients with high HBV DNA load, high HBsAg quantification, and positive HBeAg tend to have a high risk of LLV even after long-term entecavir antiviral therapy. Therefore, such population should be taken seriously with the dynamic monitoring of HBsAg quantification, HBV DNA load, and HBeAg status.

Objective: To investigate the preventive effects of gelatin sponge debris pre-filling on bone cement leakage during percutaneous kyphoplasty (PKP) for vertebral osteoporotic fracture with cortical bone rupture. Methods: The data of 256 cases (294 segments) of osteoporotic vertebral compression fracture (OVCF) treated with PKP from January 2014 to July 2016 were retrospectively analyzed. There were 106 segments in 92 males and 188 segments in 164 females. In 119 cases, a total of 132 segments were pre-filled with gelatin sponge debris before bone cement injection. The average age was 74.4±7.7 years. In 137 cases, 162 segments were not pre-filled with gelatin sponge debris, with average age of 73.3±6.4 years. The incidences of cement leakage, visual analogue scale (VAS), Oswestry disability index (ODI), the change of anterior vertebral height and kyphosis angle before and after operation were compared between the two groups. Results: In gelatin sponge group, the incidence of cement leakage was 12.6% (15/119), including 3.4% (4/119), 0.8% (1/119), 1.7% (2/119), 5.0% (6/119) and 1.7% (2/119) of the endplate type, the lateral type, the anterior type, the posterior type and the mixed type. The incidence of cement leakage in non-gelatin sponge group was 23.4% (32/137), including 4.4% (6/137), 5.1% (7/137), 5.1% (7/137), 5.8% (8/137) and 2.9% (4/137) of the endplate type, the lateral type, the anterior type, the posterior type and the mixed type. The difference of total cement leakage rate between the two groups was significant (χ²=4.912, P=0.027). There was no significant difference in leakage rates among different types (P>0.05). Postoperative symptoms were improved in both groups. VAS score and ODI index were improved at 1, 3 and 6 months after operation (P<0.05). However, there was no significant difference in VAS score and ODI index at preoperative and post-operative follow-up between groups. There were no significant difference between the two groups in the height of the anterior edge of the injured vertebra before operation (17.3±3.2 mm, 17.5±5.4 mm), the kyphosis angle before operation (18.9°±2.0°, 18.7°±2.3°), the height of the anterior edge of the injured vertebra after operation (22.7±3.6 mm, 22.4±5.4 mm), and the kyphosis angle after operation (11.2°±1.4°, 11.9°±1.8°). Conclusion Gelatin sponge debris pre-filling can effectively reduce bone cement leakage after PKP in patients with vertebral cortical bone rupture. There was no significant effect on the improvement of symptoms after PKP.

Objective To assess the brain development of newborns with cardiac septal defects by MRI.Methods The brain MR images of 150 newborns with cardiac septal defects and 50 normal newborns were analyzed retrospectively.We evaluated the brain development by measuring the four indices of lateral ventricle:anterior horn index (F/F'),body index (D/D'),caudate nucleus index (C/C')and Evans index.Independent samples t test was used to compare the differences between the two groups,and the possible positive diagnostic cut-off points were calculated by using the nonparametric ROC analysis.Results There were no significant differences between the congenital heart disease group and the control group in the two indices:F/F'[(0.301±0.035)vs (0.296±0.031);t=1.035,P>0.05]and Evans index [(0.239±0.052)vs (0.233±0.025);t=0.778,P>0.05].The values of D/D'[(0.261±0.039)vs (0.234±0.032);t=3.873,P<0.05)] and C/C'[(0.138±0.018)vs (0.124±0.015);t=4.479,P<0.05]were significantly higher in the congenital heart disease group than in the control group.In the congenial heart disease group,the area under the ROC curve obtained by D/D'and C/C'were 0.698 and 0.750,respectively.The maximum Yuedeng index corresponding to the D/D'value and the C/C'value were 0.28 and 0.12,respectively. Conclusion The body index(D/D')and the caudate nucleus index(C/C')are sensitive to evaluate the differences of the brain volume between the newborns with cardiac septal defects and the normal newborns.It is helpful to find the abnormal brain volume when the value of D/D'is greater than 0.28 and the value of C/C'is greater than 0.12.

Objective To improve the diagnostic level of the holoprosencephaly (HPE) disease in children by imaging analysis. Methods From May 2007 to August 2015, 14 cases of HPE in children were collected (7 males and 7 females, aged 2 days to 8 years, mean 14 months). Two cases were showed as sucking difficulty and convulsions frequently after birth. Mental and motor development defects were showed in 12 cases, in which 4 cases were associated with cleft lip and palate deformities and 1 case with microcephaly. Of the 14 cases, CT scan was performed in 7 cases and MRI scan in 7 cases. Results All 14 cases were consistent with the diagnostic criteria of HPE according to the imaging findings of literatures reviewed. Four cases were showed as semilobar HPE, 8 cases were lober HPE, and 2 cases were middle interhemispheric fusion variant. There were thirteen cases were associated with corpus callosum agenesis, including 2 cases were with heterotopic gray matter. Putamen and caudate partia fusion were showed in 6 cases, and thalamus partia fusion in 3 cases. One case was associated with schizencephaly, 4 cases were palate malformation, one case was microcephaly, and one case was cerebellar hypoplasia. Conclusion CT and MRI scan could contribute to diagnosis and classification of holoprosencephaly, and determine whether HPE was associated with other neurological abnormalities. MRI scan should be the first choice for HPE diagnosis.