BACKGROUND Computed tomography(CT)technology has been gradually used in the differen-tiation of small mesenchymal tumors of the stomach and intestines from smooth muscle tumours.AIM To explore the value of enhanced CT...BACKGROUND Computed tomography(CT)technology has been gradually used in the differen-tiation of small mesenchymal tumors of the stomach and intestines from smooth muscle tumours.AIM To explore the value of enhanced CT in the differentiation of small mesenchymal tumors of the stomach and intestines from smooth muscle tumours.METHODS Clinical data of patients with gastric mesenchymal or gastric smooth muscle tu-mours who were treated in our hospital from May 2018 to April 2023 were retrospectively analysed.Patients were divided into the gastric mesenchymal tumor group and the gastric smooth muscle tumor group respectively(n=50 cases per group).Clinical data of 50 healthy volunteers who received physical examinations in our hospital during the same period were selected and included in the control group.Serum levels of carcinoembryonic antigen(CEA),alpha-fetoprotein(AFP),carbohydrate antigen 19-9(CA19-9),CA-125 and cytokeratin 19 fragment antigen 21-1 were compared among the three groups.The value of CEA and CA19-9 in the identification of gastric mesenchymal tumours was analysed using the receiver operating characteristic(ROC)curve.The Kappa statistic was used to analyse the consistency of the combined CEA and CA19-9 test in identi-fying gastric mesenchymal tumours.RESULTS CEA levels varied among the three groups in the following order:The gastric mesenchymal tumour group>the control group>the gastric smooth muscle tumour group.CA19-9 levels varied among the three groups in the following order:The gastric mesenchymal group>the gastric smooth muscle group>the control group,the difference was statistically significant(P<0.05).ROC analysis showed that the area under the curve of CEA and CA19-9 was 0.879 and 0.782,respectively.CONCLUSION Enhanced CT has shown value in differentiating small mesenchymal tumors of the stomach and intestines from smooth muscle tumors.展开更多
Objective:Vitamin D receptor(VDR)mediates vitamin D activity.We examined whether VDR expression in excised melanoma tissues is associated with VDR gene(VDR)polymorphisms.Methods:We evaluated VDR protein expression(by ...Objective:Vitamin D receptor(VDR)mediates vitamin D activity.We examined whether VDR expression in excised melanoma tissues is associated with VDR gene(VDR)polymorphisms.Methods:We evaluated VDR protein expression(by monoclonal antibody immunostaining),melanoma characteristics,and carriage of VDR-Fok I-rs2228570(C>T),VDR-Bsm I-rs1544410(G>A),VDR-ApaI-rs7975232(T>G),and VDR-TaqI-rs731236(T>C)polymorphisms(by restriction fragment length polymorphism).Absence or presence of restriction site was denoted by a capital or lower letter,respectively:"F"and"f"for Fok I,"B"and"b"for Bsm I,"A"and"a"for ApaI,and "T"and"t"for TaqI endonuclease.Seventy-four Italian cutaneous primary melanomas(52.1±12.7 years old)were studied;51.4% were stage Ⅰ,21.6% stage Ⅱ ,13.5% stage Ⅲ,and 13.5% stage Ⅳ melanomas.VDR expression was categorized as follows:100% positive vs.<100%;over the median 20%(high VDR expression)vs.≤20%(low VDR expression);absence vs.presence of VDR-expressing cells.Results:Stage I melanomas,Breslow thickness of<1.00 mm,level II Clark invasion,Aa heterozygous genotype,and AaTT combined genotype were more frequent in melanomas with high vs.low VDR expression.Combined genotypes BbAA,bbAa,AATt,BbAATt,and bbAaTT were more frequent in 100%vs.<100%VDR-expressing cells.Combined genotype AATT was more frequent in melanomas lacking VDR expression(odds ratio=14.5;P=0.025).VDR expression was not associated with metastasis,ulceration,mitosis>1,regression,tumor-infiltrating lymphocytes,tumoral infiltration of vascular tissues,additional skin and non-skin cancers,and melanoma familiarity.Conclusions:We highlighted that VDR polymorphisms can affect VDR expression in excised melanoma cells.Low VDR expression in AATT carriers is a new finding that merits further study.VDR expression possibly poses implications for vitamin D supplementation against melanoma.VDR expression and VDR genotype may become precise medicinal tools for melanoma in the future.展开更多
AIM: To demonstrate the clinical features, the risk factors, the visual prognosis and the recurrence of cytomegalovirus(CMV) retinitis(CMVR) in HIV-negative patients.METHODS: HIV-negative patients with CMVR were invol...AIM: To demonstrate the clinical features, the risk factors, the visual prognosis and the recurrence of cytomegalovirus(CMV) retinitis(CMVR) in HIV-negative patients.METHODS: HIV-negative patients with CMVR were involved in this study. Best corrected visual acuity(BCVA), intraocular pressure(IOP), CMV-DNA load in aqueous and/or serum samples, treatment, follow-up time, recurrence and complications were recorded. Ocular characteristics were evaluated by fundus photographs. Association between ocular factors and visual prognosis were analyzed by regression analysis.RESULTS: Twenty-five eyes of 16 patients were included. All 25 eyes underwent intravitreal injections of anti-viral agents. The mean log MAR BCVA improved from 0.94±0.98(0.98-0.78) initially to 0.77±0.73(0.82-0.68) at last visit, but not significantly. After antiviral treatment, the aqueous CMV DNA load significantly reduced to(3.42±1.47)×10~2 copies/m L(P=0.001), compared with(2.51±3.11)×10~5 copies/m L at baseline. Macular involvement(R~2=0.475, P=0.049) and initial visual acuity(R~2=0.475, P=0.017) were significantly associated with the poor visual prognosis(BCVA<20/400). The extent of retinal lesions(R~2=0.064, P=0.04) was significant associated with the risk of recurrence of CMVR.CONCLUSION: Intravitreal injection of anti-viral agents offers a safe and effective treatment for CMVR. Macular involvement and initial visual acuity significantly associate with visual prognosis. The extent of retinal lesions is significantly associated with the recurrence of CMVR. These ocular factors can be used as predictive risk factors for long term visual prognosis in HIV-negative CMVR patients.展开更多
We here review principal literature data about sleep disorders in menopause and we compared it with data obtained from a systematical screening of a sample of 161 menopausal women through questionnaires and clinical e...We here review principal literature data about sleep disorders in menopause and we compared it with data obtained from a systematical screening of a sample of 161 menopausal women through questionnaires and clinical evaluation. Our data reveal high occurrence of sleep disorders in this group of women if compared to literature data about general population, in the absence of statistically significant differences among the three menopausal stages: we find only a trend toward a higher risk of OSAS (Obstructive Sleep Apnea Syndrome) in PM versus early PM and MT. However, none of women in our survey underwent PSG (polysomnography), essential to confirm the diagnosis of OSAS and none was diagnosed with RLS (Restless Legs Syndrome) (prior to our survey) by the Gynecologist or General Pratictioner: these data reveal the issue of too low attention towards sleep disorders in this contest. Generic “sleep complaints” are clearly associated with depressed mood and worse-quality life along the menopausal process. In our sample, a non-specific definition of insomnia shows a peculiar relationship with a mood disorder: it is only variable not associated with higher BDI and KI scores, in fact. This might suggest that the conditions linked to depression of these women could be more specific sleep disturbances, such as RLS and OSAS.展开更多
The BRAF gene is an important signaling molecule in human cells that is involved in the regulation of cell growth,differentiation,and survival.When the BRAF gene mutates,it can lead to abnormal activation of the signa...The BRAF gene is an important signaling molecule in human cells that is involved in the regulation of cell growth,differentiation,and survival.When the BRAF gene mutates,it can lead to abnormal activation of the signaling pathway,which promotes cell proliferation,inhibits cell apoptosis,and ultimately contributes to the occurrence and development of cancer.BRAF mutations are widely present in various cancers,including malignant melanoma,thyroid cancer,colorectal cancer,non-small cell lung cancer,and hairy cell leukemia,among others.BRAF is an important target for the treatment of various solid tumors,and targeted combination therapies,represented by BRAF inhibitors,have become one of the main treatment modalities for a variety of BRAF-mutation-positive solid tumors.展开更多
OBJECTIVE:To investigate the effect of entecavir plus Ganshuang granule(肝爽颗粒,GSG)on advanced fibrosis and cirrhosis in patients with chronic hepatitis B virus infection.METHODS:One hundred thirty-five patients wer...OBJECTIVE:To investigate the effect of entecavir plus Ganshuang granule(肝爽颗粒,GSG)on advanced fibrosis and cirrhosis in patients with chronic hepatitis B virus infection.METHODS:One hundred thirty-five patients were randomly assigned to one of two cohorts:GSG cohort(n=69)or placebo cohort(n=66).The GSG cohort received entecavir plus GSG and the placebo cohort received entecavir plus placebo for 48 weeks.Liver biopsy was performed at baseline and between weeks 44 and 48 during this placebo-controlled trial.We assessed histological improvement(greater than a two-point decrease using the Knodell in fl ammatory score and no worsening of the Ishak fibrosis score)and fibrosis regression(a decrease of at least one point in the Ishak fibrosis score).RESULTS:There were 95.7% of patients(66/69)in the GSG cohort and 66.7%(44/66)of patients in the placebo cohort who showed necroin t.The mean reduction in flth ammation improvemene Knodell necroinflammatory score was 5.1 and 2.6,respectively.There were 89.9%(62/69)of patients in the GSG cohort and 31.8%(21/66)of patients in the placebo cohort who showed at least a one-point improvement in the Ishak fibrosis score.The mean reduction in the Ishak fibrosis score was 1.7 and 0.4,respectively.CONCLUSION:Patients with advanced fibrosis and cirrhosis caused by chronic hepatitis B showed more improvement in liver histology in a shorter time after treatment with entecavir plus GSG compared with entecavir plus placebo.展开更多
Background:High-frequency irreversible electroporation(H-FIRE)is a novel,next-generation nanoknife technology with the advantage of relieving irreversible electroporation(IRE)-induced muscle contractions.However,the d...Background:High-frequency irreversible electroporation(H-FIRE)is a novel,next-generation nanoknife technology with the advantage of relieving irreversible electroporation(IRE)-induced muscle contractions.However,the difference between IRE and H-FIRE with distinct ablation parameters was not clearly defined.This study aimed to compare the efficacy of the two treatments in vivo.Methods:Ten Bamaminiature swinewere divided into two group:five in the 1-day group and five in the 7-day group.The efficacy of IRE and H-FIRE ablation was compared by volume transfer constant(Krans),rate constant(Kep)and extravascular extracellular volume fraction(Ve)value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI),size of the ablation zone,and histologic analysis.Each animal underwent the IRE andH-FIRE.Temperatures of the electrodesweremeasured during ablation.DCE-MRI images were obtained 1,4,and 7 days after ablation in the 7-day group.All animals in the two groups were euthanized 1 day or 7 days after ablation,and subsequently,IRE and H-FIRE treated liver tissues were collected for histological examination.Student’s t test or Mann-Whitney U test was applied for comparing any two groups.One-way analysis of variance(ANOVA)test and Welch’s ANOVA test followed byHolm-Sidak’smultiple comparisons test,one-wayANOVAwith repeatedmeasures followed by Bonferroni test,or Kruskal-Wallis H test followed by Dunn’s multiple comparison test was used for multiple group comparisons and post hoc analyses.Pearson correlation coefficient test was conducted to analyze the relationship between two variables.Results:Higher Ve was seen in IRE zone than in H-FIRE zone(0.14±0.02 vs.0.08±0.05,t=2.408,P=0.043)on day 4,but no significant difference was seen in Ktrans or Kep between IRE and H-FIRE zones at all time points(all P>0.05).For IRE zone,the greatest Ktrans was seen on day 7,which was significantly higher than that on day 1(P=0.033).The ablation zone size of H-FIRE was significantly larger than IRE 1 day(4.74±0.88 cm^(2)vs.3.20±0.77 cm^(2),t=3.241,P=0.009)and 4 days(2.22±0.83 cm^(2)vs.1.30±0.50 cm^(2),t=2.343,P=0.041)after treatment.Apoptotic index(0.05±0.02 vs.0.73±0.06 vs.0.68±0.07,F=241.300,P<0.001)and heat shock protein 70(HSP70)(0.03±0.01 vs.0.46±0.09 vs.and 0.42±0.07,F=64.490,P<0.001)were significantly different between the untreated,IRE and H-FIRE zones,but no significant difference was seen in apoptotic index or HSP70 between IRE and H-FIRE zone(both P>0.05).Electrode temperature variations were not significantly different between the two zones(18.00±3.77℃ vs.16.20±7.45℃,t=0.682,P=0.504).The Ktrans value(r=0.940,P=0.017)and the Kep value(r=0.895,P=0.040)of the H-FIRE zone were positively correlated with the number of hepatocytes in the ablation zone.Conclusions:H-FIRE showed a comparable ablation effect to IRE.DCE-MRI has the potential to monitor the changes of H-FIRE ablation zone.展开更多
Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma(HCC)have resulted in improved response rates.This has provided an opportunity for selected pa...Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma(HCC)have resulted in improved response rates.This has provided an opportunity for selected patients with initially unresectable HCC to achieve adequate tumor downstaging to undergo surgical resection,a‘conversion therapy’strategy.However,conversion therapy is a new approach to the treatment of HCC and its practice and treatment protocols are still being developed.Review the evidence for conversion therapy in HCC and develop consensus statements to guide clinical practice.Evidence review:Many research centers in China have accumulated significant experience implementing HCC conversion therapy.Preliminary findings and data have shown that conversion therapy represents an important strategy to maximize the survival of selected patients with intermediate stage to advanced HCC;however,there are still many urgent clinical and scientific challenges for this therapeutic strategy and its related fields.In order to summarize and learn from past experience and review current challenges,the Chinese Expert Consensus on Conversion Therapy for Hepatocellular Carcinoma(2021 Edition)was developed based on a review of preliminary experience and clinical data from Chinese and non-Chinese studies in this field and combined with recommendations for clinical practice.Sixteen consensus statements on the implementation of conversion therapy for HCC were developed.The statements generated in this review are based on a review of clinical evidence and real clinical experience and will help guide future progress in conversion therapy for patients with HCC.展开更多
文摘BACKGROUND Computed tomography(CT)technology has been gradually used in the differen-tiation of small mesenchymal tumors of the stomach and intestines from smooth muscle tumours.AIM To explore the value of enhanced CT in the differentiation of small mesenchymal tumors of the stomach and intestines from smooth muscle tumours.METHODS Clinical data of patients with gastric mesenchymal or gastric smooth muscle tu-mours who were treated in our hospital from May 2018 to April 2023 were retrospectively analysed.Patients were divided into the gastric mesenchymal tumor group and the gastric smooth muscle tumor group respectively(n=50 cases per group).Clinical data of 50 healthy volunteers who received physical examinations in our hospital during the same period were selected and included in the control group.Serum levels of carcinoembryonic antigen(CEA),alpha-fetoprotein(AFP),carbohydrate antigen 19-9(CA19-9),CA-125 and cytokeratin 19 fragment antigen 21-1 were compared among the three groups.The value of CEA and CA19-9 in the identification of gastric mesenchymal tumours was analysed using the receiver operating characteristic(ROC)curve.The Kappa statistic was used to analyse the consistency of the combined CEA and CA19-9 test in identi-fying gastric mesenchymal tumours.RESULTS CEA levels varied among the three groups in the following order:The gastric mesenchymal tumour group>the control group>the gastric smooth muscle tumour group.CA19-9 levels varied among the three groups in the following order:The gastric mesenchymal group>the gastric smooth muscle group>the control group,the difference was statistically significant(P<0.05).ROC analysis showed that the area under the curve of CEA and CA19-9 was 0.879 and 0.782,respectively.CONCLUSION Enhanced CT has shown value in differentiating small mesenchymal tumors of the stomach and intestines from smooth muscle tumors.
文摘Objective:Vitamin D receptor(VDR)mediates vitamin D activity.We examined whether VDR expression in excised melanoma tissues is associated with VDR gene(VDR)polymorphisms.Methods:We evaluated VDR protein expression(by monoclonal antibody immunostaining),melanoma characteristics,and carriage of VDR-Fok I-rs2228570(C>T),VDR-Bsm I-rs1544410(G>A),VDR-ApaI-rs7975232(T>G),and VDR-TaqI-rs731236(T>C)polymorphisms(by restriction fragment length polymorphism).Absence or presence of restriction site was denoted by a capital or lower letter,respectively:"F"and"f"for Fok I,"B"and"b"for Bsm I,"A"and"a"for ApaI,and "T"and"t"for TaqI endonuclease.Seventy-four Italian cutaneous primary melanomas(52.1±12.7 years old)were studied;51.4% were stage Ⅰ,21.6% stage Ⅱ ,13.5% stage Ⅲ,and 13.5% stage Ⅳ melanomas.VDR expression was categorized as follows:100% positive vs.<100%;over the median 20%(high VDR expression)vs.≤20%(low VDR expression);absence vs.presence of VDR-expressing cells.Results:Stage I melanomas,Breslow thickness of<1.00 mm,level II Clark invasion,Aa heterozygous genotype,and AaTT combined genotype were more frequent in melanomas with high vs.low VDR expression.Combined genotypes BbAA,bbAa,AATt,BbAATt,and bbAaTT were more frequent in 100%vs.<100%VDR-expressing cells.Combined genotype AATT was more frequent in melanomas lacking VDR expression(odds ratio=14.5;P=0.025).VDR expression was not associated with metastasis,ulceration,mitosis>1,regression,tumor-infiltrating lymphocytes,tumoral infiltration of vascular tissues,additional skin and non-skin cancers,and melanoma familiarity.Conclusions:We highlighted that VDR polymorphisms can affect VDR expression in excised melanoma cells.Low VDR expression in AATT carriers is a new finding that merits further study.VDR expression possibly poses implications for vitamin D supplementation against melanoma.VDR expression and VDR genotype may become precise medicinal tools for melanoma in the future.
基金Supported by National Natural Science Foundation of China(No.82070948)Beijing Talent Project(No.2020027)Shunyi District“Beijing Science and Technology Achievements Transformation Coordination and Service Platform”Construction Fund(No.SYGX202010)。
文摘AIM: To demonstrate the clinical features, the risk factors, the visual prognosis and the recurrence of cytomegalovirus(CMV) retinitis(CMVR) in HIV-negative patients.METHODS: HIV-negative patients with CMVR were involved in this study. Best corrected visual acuity(BCVA), intraocular pressure(IOP), CMV-DNA load in aqueous and/or serum samples, treatment, follow-up time, recurrence and complications were recorded. Ocular characteristics were evaluated by fundus photographs. Association between ocular factors and visual prognosis were analyzed by regression analysis.RESULTS: Twenty-five eyes of 16 patients were included. All 25 eyes underwent intravitreal injections of anti-viral agents. The mean log MAR BCVA improved from 0.94±0.98(0.98-0.78) initially to 0.77±0.73(0.82-0.68) at last visit, but not significantly. After antiviral treatment, the aqueous CMV DNA load significantly reduced to(3.42±1.47)×10~2 copies/m L(P=0.001), compared with(2.51±3.11)×10~5 copies/m L at baseline. Macular involvement(R~2=0.475, P=0.049) and initial visual acuity(R~2=0.475, P=0.017) were significantly associated with the poor visual prognosis(BCVA<20/400). The extent of retinal lesions(R~2=0.064, P=0.04) was significant associated with the risk of recurrence of CMVR.CONCLUSION: Intravitreal injection of anti-viral agents offers a safe and effective treatment for CMVR. Macular involvement and initial visual acuity significantly associate with visual prognosis. The extent of retinal lesions is significantly associated with the recurrence of CMVR. These ocular factors can be used as predictive risk factors for long term visual prognosis in HIV-negative CMVR patients.
文摘We here review principal literature data about sleep disorders in menopause and we compared it with data obtained from a systematical screening of a sample of 161 menopausal women through questionnaires and clinical evaluation. Our data reveal high occurrence of sleep disorders in this group of women if compared to literature data about general population, in the absence of statistically significant differences among the three menopausal stages: we find only a trend toward a higher risk of OSAS (Obstructive Sleep Apnea Syndrome) in PM versus early PM and MT. However, none of women in our survey underwent PSG (polysomnography), essential to confirm the diagnosis of OSAS and none was diagnosed with RLS (Restless Legs Syndrome) (prior to our survey) by the Gynecologist or General Pratictioner: these data reveal the issue of too low attention towards sleep disorders in this contest. Generic “sleep complaints” are clearly associated with depressed mood and worse-quality life along the menopausal process. In our sample, a non-specific definition of insomnia shows a peculiar relationship with a mood disorder: it is only variable not associated with higher BDI and KI scores, in fact. This might suggest that the conditions linked to depression of these women could be more specific sleep disturbances, such as RLS and OSAS.
基金supported by the Natural Science Foundation of China(grant number 82002456)China Postdoctoral Science Foundation(grant number 2022M723207)+10 种基金the Medical Scientific Research Foundation of Zhejiang Province,China(grant number 2023KY666)Zhejiang Traditional Chinese Medicine Science Fund Project(grant number 2024ZL372)Qiantang Cross Fund Project(grant number 2023-16)National Natural Science Foundation of China of Zhejiang Cancer Hospital Cultivation Project(grant number PY2023006)the Medical Scientific Research Foundation of Zhejiang Province,China(grant number 2024KY812)the Natural Science Foundation of Zhejiang Province(grant number LQ24H160036)Beijing Health Technologies Promotion Program[grant number BHTPP2022041]Peking University Clinical Scientist Training Program and the Fundamental Research Funds for the Central Universities[grant number BMU2024PYJH010]Science Foundation of Peking University Cancer Hospital[grant number PY202333]the Beijing Natural Science Foundation[grant number 7232248]Beijing Hospitals Authority Youth Programme[grant number QML20231902].
文摘The BRAF gene is an important signaling molecule in human cells that is involved in the regulation of cell growth,differentiation,and survival.When the BRAF gene mutates,it can lead to abnormal activation of the signaling pathway,which promotes cell proliferation,inhibits cell apoptosis,and ultimately contributes to the occurrence and development of cancer.BRAF mutations are widely present in various cancers,including malignant melanoma,thyroid cancer,colorectal cancer,non-small cell lung cancer,and hairy cell leukemia,among others.BRAF is an important target for the treatment of various solid tumors,and targeted combination therapies,represented by BRAF inhibitors,have become one of the main treatment modalities for a variety of BRAF-mutation-positive solid tumors.
基金Supported by a Major Science and Technology Special Project for the Prevention and Treatment of HIV/AIDS,Viral Hepatitis and Other Major Infectious Diseases of China Thirteenth 5-year plan(No.2018ZX10732401-003-015)。
文摘OBJECTIVE:To investigate the effect of entecavir plus Ganshuang granule(肝爽颗粒,GSG)on advanced fibrosis and cirrhosis in patients with chronic hepatitis B virus infection.METHODS:One hundred thirty-five patients were randomly assigned to one of two cohorts:GSG cohort(n=69)or placebo cohort(n=66).The GSG cohort received entecavir plus GSG and the placebo cohort received entecavir plus placebo for 48 weeks.Liver biopsy was performed at baseline and between weeks 44 and 48 during this placebo-controlled trial.We assessed histological improvement(greater than a two-point decrease using the Knodell in fl ammatory score and no worsening of the Ishak fibrosis score)and fibrosis regression(a decrease of at least one point in the Ishak fibrosis score).RESULTS:There were 95.7% of patients(66/69)in the GSG cohort and 66.7%(44/66)of patients in the placebo cohort who showed necroin t.The mean reduction in flth ammation improvemene Knodell necroinflammatory score was 5.1 and 2.6,respectively.There were 89.9%(62/69)of patients in the GSG cohort and 31.8%(21/66)of patients in the placebo cohort who showed at least a one-point improvement in the Ishak fibrosis score.The mean reduction in the Ishak fibrosis score was 1.7 and 0.4,respectively.CONCLUSION:Patients with advanced fibrosis and cirrhosis caused by chronic hepatitis B showed more improvement in liver histology in a shorter time after treatment with entecavir plus GSG compared with entecavir plus placebo.
基金This work was supported by a grant from the National Natural Science Foundation of China(No.81771944).
文摘Background:High-frequency irreversible electroporation(H-FIRE)is a novel,next-generation nanoknife technology with the advantage of relieving irreversible electroporation(IRE)-induced muscle contractions.However,the difference between IRE and H-FIRE with distinct ablation parameters was not clearly defined.This study aimed to compare the efficacy of the two treatments in vivo.Methods:Ten Bamaminiature swinewere divided into two group:five in the 1-day group and five in the 7-day group.The efficacy of IRE and H-FIRE ablation was compared by volume transfer constant(Krans),rate constant(Kep)and extravascular extracellular volume fraction(Ve)value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI),size of the ablation zone,and histologic analysis.Each animal underwent the IRE andH-FIRE.Temperatures of the electrodesweremeasured during ablation.DCE-MRI images were obtained 1,4,and 7 days after ablation in the 7-day group.All animals in the two groups were euthanized 1 day or 7 days after ablation,and subsequently,IRE and H-FIRE treated liver tissues were collected for histological examination.Student’s t test or Mann-Whitney U test was applied for comparing any two groups.One-way analysis of variance(ANOVA)test and Welch’s ANOVA test followed byHolm-Sidak’smultiple comparisons test,one-wayANOVAwith repeatedmeasures followed by Bonferroni test,or Kruskal-Wallis H test followed by Dunn’s multiple comparison test was used for multiple group comparisons and post hoc analyses.Pearson correlation coefficient test was conducted to analyze the relationship between two variables.Results:Higher Ve was seen in IRE zone than in H-FIRE zone(0.14±0.02 vs.0.08±0.05,t=2.408,P=0.043)on day 4,but no significant difference was seen in Ktrans or Kep between IRE and H-FIRE zones at all time points(all P>0.05).For IRE zone,the greatest Ktrans was seen on day 7,which was significantly higher than that on day 1(P=0.033).The ablation zone size of H-FIRE was significantly larger than IRE 1 day(4.74±0.88 cm^(2)vs.3.20±0.77 cm^(2),t=3.241,P=0.009)and 4 days(2.22±0.83 cm^(2)vs.1.30±0.50 cm^(2),t=2.343,P=0.041)after treatment.Apoptotic index(0.05±0.02 vs.0.73±0.06 vs.0.68±0.07,F=241.300,P<0.001)and heat shock protein 70(HSP70)(0.03±0.01 vs.0.46±0.09 vs.and 0.42±0.07,F=64.490,P<0.001)were significantly different between the untreated,IRE and H-FIRE zones,but no significant difference was seen in apoptotic index or HSP70 between IRE and H-FIRE zone(both P>0.05).Electrode temperature variations were not significantly different between the two zones(18.00±3.77℃ vs.16.20±7.45℃,t=0.682,P=0.504).The Ktrans value(r=0.940,P=0.017)and the Kep value(r=0.895,P=0.040)of the H-FIRE zone were positively correlated with the number of hepatocytes in the ablation zone.Conclusions:H-FIRE showed a comparable ablation effect to IRE.DCE-MRI has the potential to monitor the changes of H-FIRE ablation zone.
文摘Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma(HCC)have resulted in improved response rates.This has provided an opportunity for selected patients with initially unresectable HCC to achieve adequate tumor downstaging to undergo surgical resection,a‘conversion therapy’strategy.However,conversion therapy is a new approach to the treatment of HCC and its practice and treatment protocols are still being developed.Review the evidence for conversion therapy in HCC and develop consensus statements to guide clinical practice.Evidence review:Many research centers in China have accumulated significant experience implementing HCC conversion therapy.Preliminary findings and data have shown that conversion therapy represents an important strategy to maximize the survival of selected patients with intermediate stage to advanced HCC;however,there are still many urgent clinical and scientific challenges for this therapeutic strategy and its related fields.In order to summarize and learn from past experience and review current challenges,the Chinese Expert Consensus on Conversion Therapy for Hepatocellular Carcinoma(2021 Edition)was developed based on a review of preliminary experience and clinical data from Chinese and non-Chinese studies in this field and combined with recommendations for clinical practice.Sixteen consensus statements on the implementation of conversion therapy for HCC were developed.The statements generated in this review are based on a review of clinical evidence and real clinical experience and will help guide future progress in conversion therapy for patients with HCC.
