Purpose For patients with advanced or unresectable hepatocellular carcinoma (HCC), safe and effective therapies are urgently needed to improve their long-term prognosis. Although the guidelines recommend first-line treatments such as sorafenib, lenvatinib, and atezolizumab in combination with bevacizumab (T+A) and second-line treatments such as regorafenib, the efficacy comparison between drugs is lacking, that is, a treatment is not recommended as the optimal or alternative choice for a specific patient population. Therefore, we will conduct a high-quality network meta-analysis based on Phase III randomized controlled trials (RCTs) to systematically evaluate and compare overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and serious adverse events (SAE) of different treatment protocols in the context of first-line and second-line therapies, which are critical for clinical decision making and prognostic improvement in advanced HCC patients. Methods The studies of interest were Phase III RCTs evaluating the efficacy or safety of first- or second-line therapies in patients with unresectable or advanced HCC. Literature published in English from the four databases of PubMed, Embase, Cochrane Library, and Web of Science was comprehensively searched from the inception to May 23, 2022. Outcomes of interest included OS, PFS, ORR, and SAE. A league table was developed to show the results of the comparison between different treatments. A histogram of cumulative probability was drawn to discuss the ranking probability of treatments based on different outcomes. The effectiveness and safety of various treatments were comprehensively considered and the two-dimensional diagram was plotted to guide clinical practice. The Gemtc package in R Studio was used for network meta-analysis in a Bayesian framework. Results The results showed that HAIC-FO was superior to T+A regimen, regardless of OS, PFS or ORR. TACE combined with lenvatinib performed better than T+A in PFS, and ORR. In addition to the T+A regimen, Sintilimab combined with IBI305 and camrelizumab combined with apatinib were also associated with longer OS, PFS, and ORR, and their SAE incidence was not higher than that of T+A, especially for camrelizumab combined with apatinib, its safety was better than that of T+A regimen. There were no new treatments or combinations that were more effective than regorafenib. It was important to note that for PFS, the efficacy of apatinib and cabozantinib was not statistically different from that of regorafenib, so these two treatments could be used as alternative treatment options in cases where regorafenib was not tolerated or treatment failed. Conclusions We conducted a network meta-analysis to evaluate the efficacy and safety of multiple treatment modalities by integrating the results of direct and indirect comparisons. This study included high-quality multicenter Phase III RCTs, collated and summarized all treatments involved in advanced or unresectable HCC in first-line and second-line settings, and compared with T+A and regorafenib, respectively, and ranked based on efficacy and safety to support clinical decision making.

Background To evaluate the prognostic value of skeletal muscle index (SMI) and its change in patients with hepatocellular carcinoma (HCC) experiencing curative hepatectomy plus adjuvant transarterial chemoembolization (TACE). Materials and methods A total of 62 patients with HCC who underwent adjuvant TACE after curative hepatectomy were analysed retrospectively. Skeletal muscle area at the third lumbar level was quantitated using computed tomography images and was normalized for height squared to obtain skeletal muscle index (SMI). Skeletal muscle loss (SML) over 6 months was computed with two SMIs before and after hepatectomy plus adjuvant TACE. Correlation analyses were preformed to investigate factors associated with SML. The curves of cause-specific survival (CSS) were analysed using the Kaplan-Meier method. A Cox proportional hazards model was used to assess prognostic factors. Results Low SMI was diagnosed in 23(37.1%) patients preoperatively. The median SML standardized by 6 months was - 1.6% in the entire cohort. Liver cirrhosis and microvascular invasion correlated negatively with SML, respectively (r = - 0.320, P = 0.002; r = - 0.243, P = 0.021). Higher SML (< - 2.42%) predicted a significant reduction in CSS (P = 0.001), whereas low SMI did not(P = 0.687). Following the multivariate analysis for CSS, AFP > 400 ng/ml (HR, 5.643; 95%CI, 3.608-17.833; P < 0.001) and SML < - 2.42%(HR, 6.586; 95%CI, 3.610-22.210; P < 0.001) were independent predictors for poor CSS. Conclusions Skeletal muscle loss during hepatectomy plus adjuvant TACE was remarkable. Higher SML was an independent risk factor for CSS in patients with HCC, especially those with liver cirrhosis.

Background:Targeted drug therapy and transcatheter arterial chemoembolization (TACE) is the most effective control method for middle and late-stage hepatocellular carcinoma (HCC). Regorafenib as the second-line treatment of patients with advanced HCC, combined with TACE treatment still achieved good results in clinic. However, there is no relevant research at present. However, there is no relevant research at present. This study was to investigate the efficacy and safety of regorafenib combined with TACE in the treatment of patients with advanced HCC after the failure of first-line targeted treatment.Methods:Fifty-nine patients with advanced HCC received second-line regorafenib treatment between October 2019 and September 2021 were enrolled in the study. Patients were treated with routine TACE. Oral administration of regorafenib was started 1 week after the operation for 3 weeks and then stopped for 1 week. Objective response rate (ORR), disease control rate (DCR), median progression-free survival (m-PFS), and safety were evaluated according to the modified Response Evaluation Criteria in Solid Tumors (m-RECIST). In our study, most of the analyses are descriptive.Results:One patient achieved complete response (CR), and 24 patients achieved partial response (PR). stable disease (SD) was observed in 14 patients, while progression disease (PD) was observed in 20 patients. The ORR was 42.3% (25/59), and the DCR was 66.1% (39/59). The longest follow-up was 23 months, and the shortest was 1 month. Disease progression was found in 45 patients during follow-up. Among these patients, the longest interval before the detection of disease progression was 16 months, and the shortest was 1 month. Among patients who had disease progression, the median PFS was 8 months. Adverse events (AEs) were observed in 59 patients. These included hand-foot reaction (n=50, 84.7%), weight decrease (n=18, 30.5%), hypertension (n=8, 13.6%), proteinuria (n=1, 1.7%), weakness (n=12, 20.3%), diarrhea (n=1, 1.7%), and hoarseness (n=9, 15.3%). No treatment-related death occurred.Conclusions:Regorafenib combined with TACE achieved a good ORR and DCR among patients with advanced HCC receiving second-line targeted therapy, with only 9 patients experiencing grade 3 or 4 adverse reactions. Therefore, regorafenib combined with TACE is effective and safe in the treatment of advanced HCC.

Background:At present, there is no standard for the posterior treatment of hepatocellular carcinoma (HCC). This study isTo evaluate and compare the safety and efficacy of transcatheter arterial chemoembolization (TACE) combined with regorafenib and anti-PD-1 antibody with continued TACE combined with regorafenib in patients with HCC after the failure of second-line treatment with regorafenib.Methods:We enrolled patients with advanced HCC who were treated with sorafenib and sequential regorafenib. All patients were treated with TACE and found to have tumor progression in 2021. After tumor progression, patients were treated with TACE combined with regorafenib and PD-1 antibody or with continued TACE combined with regorafenib according to the wishes of the patient. Efficacy was evaluated after 1 month of treatment. The objective response rate (ORR), disease-control rate (DCR), and safety were evaluated according to adverse reactions of patients.Results:Nine patients were treated with TACE combined with regorafenib and PD-1 antibody, and the 9 patients continued to receive TACE combined with regorafenib. There was no significant difference in baseline data between the 2 groups. In the PD-1 group five patients achieved a partial response (PR), three achieved stable disease (SD), and one patient had progressive disease (PD) after 1 month of treatment. The ORR was 55.6% and the DCR was 88.9%. In the continued TACE-regorafenib group, four patients achieved PR, one achieved SD, and four patients achieved PD after 1 month of treatment, while the ORR was 44.4% and the DCR was 55.6%. There was a significant difference in the DCR between the two groups (P=0.012), while adverse events were similar in both.Conclusions:TACE combined with regorafenib and PD-1 antibody had a higher DCR and was more effective than continued TACE combined with regorafenib in patients with HCC who failed second-line treatment with regorafenib. However, PD-1 antibody therapy might increase the risk of death by causing an uncontrollable immune response. Given the risk of an immune response, patients may choose to continue TACE combined with regorafenib, given the similar ORR of the two treatments.

目的 观察高危溃疡致胃肠道出血血管造影表现及动脉栓塞治疗效果.方法 对49例经胃镜证实高危溃疡致胃肠道出血患者行血管造影及栓塞治疗,观察造影表现、栓塞前后溃疡变化,评价栓塞疗效.结果 造影总阳性率51.02％(25/49),栓塞成功率100％,止血总有效率83.67％(41/49),再出血率10.20％(5/49),无严重并发症发生.术后复查胃镜提示溃疡Forrest分级均下降,无活动性出血表现,高危溃疡由急性期向愈合期转变.结论 高危溃疡致急性胃肠道出血动脉造影总阳性率高,栓塞治疗安全有效.

Purpose: To evaluate the efficacy and safety of placement of a modified microcoil for precise preoperative localization of solitary pulmonary nodules (SPNs) before video-assisted thoracoscopic surgery (VATS). Materials and Methods: This prospective, single-arm, multicenter study included patients who underwent computed tomography (CT)-guided modified microcoil insertion prior to SPN resection by VATS between January 2018 and June 2018. The patient demographics, nodule characteristics, and histopathologic findings were recorded. The primary endpoints included efficacy and safety. Results: A total of 96 patients (41 men and 55 women; mean age, 59.3 years +/- 8.9) with 96 SPNs were eligible for enrolment in the study. The mean maximal transverse diameter of the nodules was 10.3 mm +/- 5.2 (range, 8-20 mm). The mean time between CT-guided microcoil insertion and the start of the surgical procedure was 14.6 hours (range, 12-24 hours). The duration of the preoperative CT-guided microcoil localization procedure was 29 minutes +/- 9 (range, 10-35 minutes), and the intraoperative fluoroscopy time was 0.7 minutes +/- 0.7 (range, 0.5-3 minutes). The clinical success rate was 96.9% (93/96), and all nodules were successfully resected using VATS. One patient experienced asymptomatic pneumothorax, but there were no cases of pulmonary hemorrhage. Conclusions: SPN localization with the modified microcoil is feasible and safe. The modified microcoil can facilitate the thoracoscopic resection of SPNs.

目的 比较颈内静脉路径方法和改良式股静脉路径法的插管时间及并发症发生率.方法 选取2017年12月至2019年12月于北京友谊医院行肝静脉压力梯度测定的60例患者,按随机数表法分为两组,每组30例.改良式股静脉路径组采用7F的RDC guiding导管配合5.5F双腔球囊导管行肝静脉压力梯度测定.观察颈内静脉路径组和改良式股静脉路径组的所需插管时间和并发症发生率.结果 60例患者的球囊导管置管全部成功,改良式股静脉路径组成功插管平均透视时间为(145±25)s,明显少于颈内静脉路径组的(227±34)s,差异有统计学意义(t=10.511,P<0.01).改良式股静脉路径组操作引发的室上性心动过速发生率(3.33％;1/30)明显少于颈内静脉路径(36.67％,11/30)(χ2=21.600,P<0.01),改良式股静脉路径组操作引发的焦虑紧张发生率(6.67％,2/30)明显少于颈内静脉路径(23.33％,7/30)(χ2=29.400,P<0.01).结论 对于单纯行HVPG测量的患者,改良式股静脉路径法能缩短手术时间,是安全快捷的基本满足临床需要的操作方法.

目的 观察电视辅助肺结节胸腔镜切除术(VATS)术前定位微弹簧圈相关并发症,并分析其影响因素.方法 回顾性分析160例肺结节患者(160个结节),均于VATS切除结节前行CT引导下微弹簧圈定位,统计定位术后并发症,分析其影响因素.结果 160例结肺节均以微弹簧圈成功定位,术中26例出现气胸,37例发生肺内出血,未见空气栓塞.所有患者于次日接受VATS,术中均未发现微弹簧圈移位.单因素分析结果显示,患者体位(P=0.04)、结节距胸膜距离(P=0.03)及穿刺次数(P＜0.01)与微弹簧圈定位术后发生气胸相关,结节距胸膜距离(P=0.03)与微弹簧圈定位术后发生肺内出血相关.多因素分析结果显示,患者体位、结节距胸膜距离及穿刺次数是微弹簧圈定位术后发生气胸的独立危险因素(P均＜0.05),结节距胸膜距离则是肺内出血的独立危险因素(P=0.01).结论 肺结节VATS术前微弹簧圈定位可出现气胸和肺内出血,前者与结节距胸膜距离、患者体位及穿刺次数相关,后者仅与结节距胸膜距离相关.

目的 观察电视胸腔镜手术(VATS)前CT引导下肺结节记忆合金定位弹簧圈对精准定位肺小结节的价值.方法 对92例患者共102个肺小结节(直径≤2 cm)于VATS前行CT引导下记忆合金定位弹簧圈定位,定位后24 h内行VATS手术切除结节,观察定位效果及并发症.结果 102个肺小结节定位成功率为98.04％(100/102),定位操作时间8～45 min,平均(17.26±5.92)min;2例2个结节VATS术中发现弹簧圈自肺组织内脱出滞留于胸壁;定位后少量气胸发生率10.78％(11/102),少量肺泡出血发生率12.75％(13/102),均无症状而未予处理.102个结节均经VATS成功切除,无中转开胸病例.结论 VATS术前CT引导下肺结节记忆合金定位弹簧圈可有效定位肺小结节,且安全性较好.

目的 观察和比较肝中静脉和肝右静脉行肝静脉压力梯度测定的操作成功率及插管透视时间.方法 采用前瞻性研究方法,选取2017年11月至2019年12月于首都医科大学附属北京友谊医院行经颈内静脉路径球囊法测定肝静脉压力梯度的27例患者,分别于肝中静脉和肝右静脉行压力梯度测定,分别观察肝中静脉和肝右静脉的插管成功率和所需插管透视时间.结果 肝中静脉置管成功率(26/27,96.30％)明显高于肝右静脉(18/27,66.67％),肝中静脉球囊导管置管平均插管透视时间(187±28)s明显少于肝右静脉(256±33)s,上述差异均具有统计学意义(P<0.05).结论 在经颈静脉路径球囊导管肝静脉压力梯度测量中,肝中静脉相对于肝右静脉,是更加便捷的血管路径,应该作为首选插管静脉支.

BACKGROUND & AIMS:Proton pump inhibitors (PPIs) have been reported to be associated with cholangitis and might possibly be carcinogenic. However, few studies have been conducted to investigate the association of PPIs with cholangiocarcinoma (CCA). Thus, a hospital-based case-control study was carried out in China to explore the association between PPIs and CCA.METHODS:In this study, 1468 CCA cases (826 intrahepatic cholangiocarcinoma (ICC) and 642 extrahepatic cholangiocarcinoma (ECC)) were included, which were observed at Beijing Friendship Hospital, from February 2002 to October 2018. We retrospectively extracted PPI use and other possible risk factors from clinical records, followed by an investigation of the relationship with CCA via calculation of odds ratios (ORs), adjusted odds ratios (AORs), and 95% confidence intervals (CIs) using logistic regression analysis.RESULTS:PPIs were used by 135 (9.2%) CCA cases and 173 (5.9%) controls. We found that PPI use was associated with a 1.61-fold elevated CCA odds (P < .001) (AOR = 1.61, 95% CI = 1.28-2.05; P < .001). After stratification by CCA subtypes, the AORs of PPIs were consistent for both CCA subtypes, with ORs of 1.36 (AOR = 1.36, 95% CI = 1.02-1.83; P = .003) and 1.95 (AOR = 1.95, 95% CI = 1.46-2.62; P < .001) for ICC and ECC respectively. Our results also showed that PPI use was slightly linked to the odds of CCA in a dose-dependent manner.CONCLUSION:PPI use was correlated with a significant 61% increased odds of CCA, particularly in the ECC. However, the retrospective design and observational nature cannot establish causation. Larger scale, multi-centre prospective studies are required for further validation.

目的 探讨明胶海绵颗粒和弹簧圈用于下消化道出血的介入栓塞治疗后对肠黏膜的影响.方法 采用回顾性研究方法,选取2011年12月至2019年12月于首都医科大学附属北京友谊医院行下消化道出血介入栓塞治疗的患者56例,术中采用弹簧圈为栓塞材料的29例患者归为弹簧圈组;采用明胶海绵颗粒为栓塞材料的27例患者归为明胶海绵颗粒组,收集其术后2～3周行肠镜检查的资料,对比观察两组患者的即时止血成功率和肠镜检查结果.结果 明胶海绵颗粒组和弹簧圈组患者的即时止血成功率均为100％.明胶海绵颗粒组患者的内镜下肠缺血表现比率(51.85％)显著高于弹簧圈组(10.34％),差异具有统计学意义(P<0.0001).结论 下消化道出血的介入治疗中,在减少栓塞术后肠缺血并发症方面,弹簧圈优于明胶海绵颗粒,是一种安全有效的栓塞材料.

目的 分析腹膜后肾上腺外良性神经鞘瘤与节细胞神经瘤的CT表现,探讨CT对两者的鉴别诊断价值.资料与方法 回顾性分析经手术病理证实的24例腹膜后肾上腺外良性神经鞘瘤及16例腹膜后肾上腺外节细胞神经瘤患者的临床资料及CT图像特征,并进行组间比较.结果 24个神经鞘瘤灶与20个节细胞神经瘤灶在边缘、有无钙化、有无出血、长径、平扫CT值、动静脉期强化差值(ΔCTV-A)等方面差异无统计学意义(P>0.05);两组病灶部位、形态、短长径比、有无囊变坏死、有无包绕大动脉、有无伸入椎间孔、动脉期强化值(ΔCTA)、静脉期强化值(ΔCTV)等比较,差异有统计学意义(P<0.01).神经鞘瘤病灶共24个,多呈偏侧生长,14个(58％)见于盆腹膜外骶前区,19个(79％)呈圆形或卵圆形,短长径比为0.80±0.14,13个(54％)见囊变坏死,1个(4％)包绕大动脉,11个(46％)伸入椎间孔.节细胞神经瘤病灶共20个,易跨中线生长,8个(40％)见于腹主动脉前/后方,16个(80％)形态不规则,短长径比为0.64±0.16,1个(5％)见囊变坏死,11个(55％)包绕腹腔干等大动脉,1个(5％)伸入椎间孔,强化程度低于神经鞘瘤.结论 腹膜后肾上腺外良性神经鞘瘤及节细胞神经瘤的CT表现各具特征,CT增强扫描有助于两者鉴别诊断.

Objective To evaluate and compare the value of uterine artery embolization (UAE) and UAE with methotrexate (MTX) chemotherapy in the treatment of ectopic pregnancy. Methods The clinical data of 34 patients with cervical pregnancy and cesarean scar pregnancy were retrospectively reviewed. The technique, clinical outcomes and complications of UAE and UAE along with the administration of MTX were evaluated. Results The fertility of all the patients were successfully preserved, and normal menses resumed within 1.0 to 4.5 months after UAE. The time to resolution of the serum β-hCG was not significantly different between the two groups (P>0.05). The duration of hospitalization was significantly longer in UAE+MTX group than in UAE group. Conclusions UAE with curettage is a saft and effective treatment for cervical and cesarean scar pregnancy. Key words: Pregnancy, ectopic; Uterine artery; Chemoembolization, therapeutic; Curettage

Background Cesarean scar pregnancy (CSP) is a very rare but life-threatening entity and there is no optimal management strategy. Here we report a successfully conservative treatment of CSP.Methods We retrospectively analyzed the clinical data of 54 women with CSP, who underwent uterine artery embolization between January 2007 and September 2012 at the Peking University People's Hospital. We evaluated the clinical outcomes, the technique and the complications of uterine artery embolization.Results Of the 54 patients, 2 patients with hemorrhage after induced abortion received bilateral uterine artery embolization treatment alone, and 52 patients underwent suction curettage after bilateral uterine artery embolization. All 54 women were successfully cured, without any severe complications, and uterine function was restored. During the follow-up, one patient had accidental normal interuterine pregnancy and received induced abortion during the first trimester.Conclution Uterine artery embolization combined with suction curettage is an effective and safe conservative treatment for cesarean scar pregnancy.

<正>患者男,49岁,主因"食欲缺乏、乏力2月余"就诊。外院B超示脾占位、胰腺占位。入院CT:胃底后部、脾脏及胰尾间见12.2cm×14.4cm×13.1cm巨大等密度软组织肿块,边缘欠规则,平扫CT值约30HU,增强后轻度强化,动脉期CT值为42HU,静脉期CT值为52HU;病灶与胃底关系密切,表面见溃疡形成,并包埋脾动