Objective:To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with tislelizumab and tyrosine kinase inhibitor (TKI) as a conversion therapy in patients with initially unresectable hepatocellular carcinoma (HCC).Methods:The clinical data of 51 initially unresectable HCC patients admitted to the Department of Hepato-Pancreato-Biliary Surgery, the Eighth Affiliated Hospital of Guangxi Medical University from March 2022 to November 2023 were prospectively collected, including 46 males and 5 females, aged (53±11) years old. All patients received TACE combined with tislelizumab and TKI. For initially unresectable HCC patients who have successfully undergone conversion therapy, surgical resection was performed sequentially. Follow-up was conducted through regular outpatient visits or hospitalization combined with telephone contact, and the surgical conversion, relapse-free survival and adverse reactions of patients were recorded.Results:Among the 51 patients with initial unresectable HCC, there were 12 cases of stage Ib, 14 cases of stage IIa, 10 cases of stage IIb, and 15 cases of stage IIIa in Chinese liver cancer staging. The 51 patients were evaluated according to the modified solid tumor response evaluation criteria, and 15 patients had complete response, 26 had partial response, 5 had stable disease, and 5 had disease progression. The objective response rate was 80.4% (41/51), and the disease control rate was 90.2% (46/51). The conversion success rate was 49.0% (25/51), 2 patients gave up surgery, and the actual conversion rate was 45.1% (23/51). Among the 23 patients who underwent surgical resection, irregular hepatectomy was performed in 11 cases, lobectomy in 8 cases, and hemihepatectomy in 4 cases. Common treatment-related adverse events were hand-foot syndrome, hypertension, gingival bleeding, etc. Most of the drug-related adverse events were grade 1 to grade 2. A total of 10 patients (19.6%, 10/51) had grade 3 drug-related adverse events, and no grade 4 or above adverse events occurred, and no treatment-related deaths occurred. The cumulative recurrence free survival rates of 23 patients with initial unresectable HCC at 6 and 12 months after sequential hepatectomy were 100% and 94.7% respectively.Conclusion:The triple combination therapy of TACE combined with tislelizumab and TKI in the treatment of initial unresectable HCC has good clinical efficacy, and the adverse reactions are safe and controllable.

Hepatocellular carcinoma (HCC) is a common malignant tumor with high incidence and mortality rates in China. Most patients are diagnosed at an advanced stage when seeking medical treatment. Interventional therapy is the main local treatment for HCC. As a new interventional material, CalliSpheres drug-eluting microspheres have more advantages than iodipin in traditional transcatheter chemoembolization, and hepatic artery infusion chemotherapy has higher rates of remission and translation. A series of targeted drugs, such as lenvatinib, donafinib, and apatinib have been approved for application in the treatment of advanced HCC. Immune checkpoint inhibitors have made breakthroughs in the treatment of advanced HCC. Various new drugs are emerging, with clinical studies on various combinations of different therapeutic drugs being gaining new findings. This article aims to discuss the recent applications and clinical research progress of interventional therapy, targeted therapy and immunotherapy in the treatment of advanced HCC so as to provide a reference for the decision-making of HCC.

Transrectal contrast-enhanced ultrasound (CEUS) is an important examination for rectal tumors. The inhomogeneity of the CEUS images has important clinical significance. However, there is no objective method to evaluate this index. In this study, a method based on gray-level co-occurrence matrix (GLCM) is proposed to extract texture features of images and grade these images according the inhomogeneity. Specific processes include compressing the gray level of the image, calculating the texture statistics of gray level co-occurrence matrix, combining feature selection and principal component analysis (PCA) for dimensionality reduction, and training and validating quadratic discriminant analysis (QDA). After ten cross-validation, the overall accuracy rate of machine classification was 87.01%, and the accuracy of each level was as follows: Grade Ⅰ 52.94%, Grade Ⅱ 96.48% and Grade Ⅲ 92.35% respectively. The proposed method has high accuracy in judging grade Ⅱ and Ⅲ images, which can help to identify the grade of inhomogeneity of contrast-enhanced ultrasound images of rectal tumors, and may be used to assist clinical doctors in judging the grade of inhomogeneity of contrast-enhanced ultrasound of rectal tumors.
Discriminant Analysis ; Humans ; Rectal Neoplasms ; Ultrasonography

Objective To investigate management strategy of minimally invasive surgery for common bile duct stones. Methods Three hundred and four cases of common bile duct stones were divided into 3 groups receiving respectively endoscopic papillary balloon delation plus laparoscopic cholecystectomy ( EPBD group, 35 cases ), endoscopic sphincterotomy plus LC ( EST group, 138 cases), and Laparoscopic common bile duct exploration plus LC (LCBDE group, 131 cases). Results There was no significant difference in treatment success rate, short-term complications and bile duct retained stones among these three group ( x2 = 1. 930, 0. 038, and 0. 427 respectively, P > 0. 05 ). There was significant difference among these three groups in operation time ( F = 17.941, P = 0. 000 ), and the operation time in LCBDE group was shorter than that in other two groups( EPBD-EST: P = 0. 122, EST-LCBDE:P = 0. 000, EPBD-LCBDE:P = 0. 020 ). There was significant difference among these three groups in postoperative hospital stay (F =24. 016,P =0. 000) ,and the postoperative hospital stay in EPBD group was shorter than that in other two groups ( EPBD-EST: P = 0. 000, EST-LCBDE : P = 0. 198, EPBD-LCBDE : P = 0. 000 ). In EPBD group,bile duct recurrent stones was found in 2 cases(6. 7% ) and cholangitis in 1 case(33% ) and no duodenal papilla stenosis was encountered; In LCBDE group, bile duct recurrent stones were found in 7 cases (6. 0% ), cholangitis in 3 cases ( 2. 6% ), and there was no duodenal papilla stenosis; In EST group, bile duct recurrent stones were complicated in 18 cases ( 15.8% ), duodenal papilla stenosis in 9 cases (7.9%), and cholangitis in 14 cases( 12. 3% ). There were significant differences among these three groups for these three complications( x2 = 6. 482, 9. 160, and 12. 020 respectively,P < 0. 05 ), and the rate of complications in EST group was higher than that in other two groups. Conclusion For common bile duct stones, EPBD is the first choice followed by LCBDE while EST is only indicated for very few cases.

AIM: To study the change of myocardial ceramide during myocardial ischemia/reperfusion and the relationship between ceramide and apoptosis and oxidative stress. METHODS: After inducing myocardial ischemia/reperfusion (I/R) injury in mice with pituitrin (Pit), myocardial SOD activity and MDA content were measured. DNA agarose gel electrophoresis and fluorescent staining of DAPI were done to check up apoptosis. The content of myocardial ceramide (?g/kg) was measured through HPTLC and scan of thin plate. RESULTS: The myocardium of I/R model group had the phenomenon of DNA ladder. Apoptosis index and ceramide content in I/R model group were higher than those in normal control group (P

Objective To study the anti-myocardial ischemia-reperfusion injury effect of Sini Decoction's active fraction(SNDAF).Methods Experimental animals were randomly individed into normal,model,Sini Decoction(SND),and SNDAF groups.Rat hearts were perfused by the Langendorff method.The model of myocardial ischemia-reperfusion injury was reproduced by adjusting the flow of perfused liquid.The perfused liquid of normal and model groups was KH buffer saturated by oxygen.The perfused liquid with SND or SNDAF was mixed with KH buffer.The coronary flow and contract power of myocardium at 0 min of ischemia and 1,5,10,20,30,40,and 50 min of reperfusion were tested,respectively.The incidence of reperfusion arrhythmias(IRA) in the first 1 minute of reperfusion was calculated.Mice were given drugs by ig for 3 d and then myocardial ischemia-reperfusion models were established by ip pituitrin(20 U/kg).ECG of mice was recorded at 0—80 min after ip administration. SOD activity,and the contents of MDA and LA in myocardium of mice were measured.Results Both SND and SNDAF could reinforce myocardial contract and reduce the IRA in the first minute of reperfusion.SND had better effect on IRA than that of SNDAF.SNDAF had better effect on myocardial contract than that of SND.SND and SNDAF could significantly drop ECG J point raise induced by ischemia,and increase SOD activity,and decrease contents of MDA and LA significantly in ischemia myocardium.There were no significant difference between SND and SNDAF.Conclusion SNDAF could improve oxidative injury and suppress(ischemia) of myocardium,reinforce myocardial contract,and reduce the incidence of arrhythmias during(myocardia) ischemia-reperfusion.

AIM: To study the effects of Sini Decoction's effective component(SNDE) on myocardial apoptosis and ceramide content during myocardial ischemla/reperfusion. METHODS: The mice of Kunming species were randomly divided into 3 groups: control,myocardial ischemia/reperfusion and SNDE.After inducing myocardial ischemia/reperfusion injury of mice in vivo with pituitrin(Pit),myocardial SOD activity and MDA content were measured.DNA agarose gel electrophoresis and fluorescent stain of DAPI were done to check up apoptosis.The content of myocardial ceramide(?g/kg) was measured through HPTLC and scan of thin plate. RESULTS: The myocardium of model group has the phenomenon of DNA ladder.The apoptosis index and the ceramide content in model group were higher than those of control group(P

AIM: To detect the effect of Sini decoction on glutathione S-transferase (GST) mRNA expression in the ischemic myocardium. METHODS: Kunming mice were randomly divided into control group, ischemic group and Sini decoction group. Total RNA was extracted from the myocardium of mice in each group. The effect of Sini decoction on the expression of GST gene was detected by RT-PCR. RESULTS: The expression of GST mRNA in Sini decoction group was significantly up-regulated compared with the ischemic group and control group. CONCLUSION: Sini decoction can promote the expression of GST gene, which may be related to its protective effect on ischemic myocardium.

AIM: To screen the differentially expressed genes among normal, ischemic and Sini decoction-treated myocardium using DNA microarray.METHODS: Kunming mice were randomly divided into control group, ischemic group and Sini decoction group. Total RNA was extracted from myocardium of each group. cDNA microarray chips containing 2 304 cDNAs were used to investigate the gene expression pattern of each group. RESULTS: Up-and down-regulated genes were 33 and 70 in ischemic group vs control group, respectively. Up-and down-regulated genes were 23 and 52 respectively in Sini decoction group vs ischemic group. CONCLUSIONS: The analysis of gene expression pattern of ischemic myocardium based on cDNA microarray can realize high-throughput screening of the genes. Further analysis of those obtained genes information will be helpful to understand the molecular mechanism of myocardial ischemia and the therapeutic mechanism of Sini decoction.

AIM: To investigate the effect of Sini decoction (SND)on the ultrastructure of small intestinal epithelial cells in rats with intestinal ischemia-reperfusion. METHODS: Thirty-two Sprague-Dawley rats of both sexes were randomly divided into 4 groups: (1) Control group in which sham operation was performed; (2) Model group in which intestinal I/R was produced by clamping super mesenteric artery(SMA) for 1 hour and declamping SMA for 3 hours; (3) SND1 group in which SD (0.6 g/200 g rat) was given via stomach tube 3 d before intestinal I/R; (4) SND2 group in which SD (1.2 g/200 g rat)was given via stomach tube 3 d before intestinal I/R. A strip of small intestine was taken from distal end of ileum for electron microscopic examination. The two-dimensional structural parameters and three-dimensional structural parameters of mitochondria were calculated. RESULTS: (1)Morphological changes of small intestine: In control group, epithelial cells were orderly arranged, with normal mitochondria and intestinal villi. In model group, the gaps between epithelial cells widened. There were a lot of apoptotic cells. Microvilli were short and swelled. Mitochondria were swelled obviously with broken ridges. Endoplasmatic reticulum was severely dilated. In SND1 and SND2 groups, microvilli and epithelial cells were orderly arranged relatively, mitochondria was slightly swelled. (2) Structural parameters of mitochondria: In model group, there were the least mitochondria and the swelling of mitochondria was severe. In SND1 and SND2 groups, the mitochondria was more than that of model group and the swelling were slight. CONCLUSION: Sini decoction can protect small intestine from ischemia-reperfusion injury without dose-dependent effect.