Background The objective of this study was to develop a nomogram for the prediction of overall survival (OS) in elderly patients diagnosed with non-functional pancreatic neuroendocrine tumors (NF-pNETs). Methods 1. Patients aged 65 years and older, who were diagnosed with NF-pNETs between 2004 and 2016, were selected for this study from the Surveillance, Epidemiology, and End Results (SEER) database. The enrolled patients were randomly divided into two cohorts - training and validation - in a ratio of 7:3. Multivariate Cox regression analysis was utilized to identify predictors associated with overall survival (OS) for constructing nomograms. The performance of the nomogram was evaluated using various metrics including concordance index (C-index), area under the receiver operating characteristic curve (AUC), calibration plots, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision-curve analysis (DCA). Results The multivariate Cox regression analysis revealed that age at diagnosis, primary site, histology grade, tumor size, N stage, M stage, and surgery status were independent covariates significantly associated with overall survival (OS). These factors were utilized to develop a nomogram. The constructed nomogram demonstrated a C-index greater than 0.75. Furthermore, the area under the curve (AUC) values indicated the superior discriminatory performance of the established nomogram compared to the American Joint Committee on Cancer (AJCC) TNM staging system for predicting OS. Calibration plots exhibited close alignment between predicted and actual survival rates. Additionally, both net reclassification improvement (NRI) and integrated discrimination improvement (IDI) showed positive improvements in the prediction accuracy of the nomogram over the TNM staging system in both training and validation cohorts. Finally, decision curve analysis (DCA) substantiated the substantial clinical utility of the developed nomogram. Conclusion We constructed a nomogram for predicting OS in elderly patients with NF-pNETs to help clinicians assess patient prognosis.

Immune checkpoint inhibitors (ICIs) are commonly used in the treatment of hepatocellular carcinoma (HCC) and performing miracles, however, the immune‑related adverse events(irAE) should not be neglected. Here, we report a patient in their 40s with advanced HCC, who treated with anti-programmed death‑1(PD‑1) monoclonal antibody and experienced immune-mediated hepatitis (IMH) and simultaneously hepatitis B virus (HBV) reactivation. The patient developed fever in the third day after receiving immunotherapy, and severe IMH, manifested as depression, abdominal distension, ascites, repeated low fever and rapid deterioration of liver function within two months, the hepatitis B virus (HBV) DNA quantity was also observed increased significantly from 3.94E+01 IU/ml to 1.1E+04 IU/ml. After receiving corticosteroid impulse therapy, anti-hepatitis B virus therapy and other symptomatic treatments, he was recovered rapidly within one week. Eight months later, the patient received anti-programmed death ligand‑1 (PD-L1) monoclonal antibody, Envafolimab, combined with tyrosine kinase inhibitor based targeted therapy, however, severe irAE and reactivation of HBV didn’t reappear, which might be attributed to the difference of mechanism between anti-PD‑1 and anti-PD‑L1 therapies. In conclusion: Anti- PD-L1 may lead to less adverse effect on immune homeostatic and better safety than anti- PD‑1, besides, anti-PD-L1 therapy, such as Envafolimab, could participated in the immune regulation of anti-HBV. This case helps to strengthen the understanding of the difference between anti- PD‑1 and anti- PD‑L1 therapy, and also provides a hope for a better cure of clearing HBV.

目的 该研究旨在评估护肝药物多烯磷脂酰胆碱与还原型谷酰甘肽共同使用对酒精性肝病的治疗效果,通过开展Meta分析系统评估.方法 在本次研究中,我们使用了多个数据库进行检索,设定检索时间为数据库建库时间至今.最终纳入15篇研究,共1 401例患者.其中,实验组患者使用多烯磷脂酰胆碱和还原型谷胱甘肽联合用药处理,而对照组患者使用两种药物的其中一种处理,然后用RevMan 5.4软件对临床总有效率、肝功能相关指标和不良反应发生率进行荟萃分析.结果 结果显示实验组(多烯磷脂酰胆碱联合使用还原型谷胱甘肽)用在治疗酒精性肝病的总有效率方面显著优于对照组(RR=1.21,95%CI:1.15～1.26,P＜0.000 01),同时能明显降低AST(MD=-26.42,95%CI:-30.57～-22.28,P＜0.000 01)、ALT(MD=-25.00,95%CI:-29.06～-20.94,P＜0.000 01)、TBiL(MD=-20.72,95%CI:-28.16～-13.29,P＜0.000 01)和γ-GT水平(MD=-40.99,95%CI:-48.49～-33.49,P＜0.000 01),并减少不良反应发生情况(RR=0.33,95%CI:0.17～0.64,P=0.009).结论 联合使用多烯磷脂酰胆碱与还原型谷胱甘肽有望在一定程度上提高酒精性肝病的药物治疗效果.

肝细胞癌是常见的恶性肿瘤,其发病机制尚未完全明确.Wnt信号通路与人体内多种病理生理过程相关,其中肝癌的发生、发展可能与经典的Wnt/β-catenin信号通路密切相关.Wnt/β-catein信号通路通过表达癌症相关基因、激活肝星状细胞、调控肝干细胞行为、促进肝癌细胞侵袭转移等方式调控肝癌的发生、发展.Wnt/β-catein信号通路在肝癌发生、发展中的作用有望为肝癌研究提供新的思路.

目的:通过监测、流行病学和最终结果(SEER)数据库对美国肝细胞癌(HCC)患者 2017～2021 年的生存率进行预测.方法:本研究的数据来源于SEER数据库.使用周期分析法对SEER数据库中 2002～2016 年HCC的数据进行整理和评估,针对不同组别的年龄、性别、种族、婚姻状况和手术情况的HCC预测未来3 年和5 年生存率.结果:在2002～2016 年,HCC患者的相对生存率整体呈上升趋势,其中2002～2006 年HCC患者的 3 年和5 年生存率分别为36.4%和 26.9%,2007～2011 年HCC患者的 3 年和 5 年生存率分别为 39.9%和 30.3%,2012～2016 年HCC患者的3 年和5 年生存率分别为48.6%和38.1%.通过预测,2017～2021 年HCC患者的预期3 年和5 年生存率相比2002～2016 年有较为明显的上升趋势,分别为49.40%和43.55%.此外,HCC患者的相对生存率在不同组别的年龄、性别、种族、婚姻状况和手术情况中呈现出不同的变化趋势.结论:周期分析法可有效预测2017～2021 年美国HCC的生存率.了解过去2002～2016 年HCC患者的3 年和5 年生存率和未来5 年的预期生存率对治疗方略,提供降低HCC发病率和死亡率的策略的发展有着重要意义.

肝癌是十大恶性肿瘤之一,目前在我国常见恶性肿瘤中排名第4,在肿瘤致死率中排名第2,严重威胁人民的生命和健康.肝癌在临床上的治疗手段非常有限,特别是中晚期肝癌患者,5年生存率不足15％.近些年腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)技术逐步在国内外兴起,HIPEC在一些肿瘤手术后的应用表现出明显的优势,能有效抑制肿瘤在腹膜播散,延长患者的无腹膜复发生存时间,该技术目前的使用方案尚未完全统一,在肝癌上的使用属于探讨阶段.本文就HIPEC的技术优势,国内外HIPEC在患者选择、治疗温度、药物种类与剂量等方面的差异,及HIPEC在肝癌方面的研究进展进行综述.

Background: The objective of this study was to develop a practical nomogram for predicting the cancer-specific survival (CSS) of patients with small-intestine adenocarcinoma . Methods: Patients diagnosed with small-intestine adenocarcinoma between 2010 and 2015 were selected for inclusion in this study from the Surveillance, Epidemiology, and End Results (SEER) database. The selected patients were randomly divided into the training and validation cohorts at a ratio of 7:3. The predictors of CSS were identified by applying both forward and backward stepwise selection methods in a Cox regression model . The performance of the nomogram was measured by the concordance index (C-index), the area under receiver operating characteristic curve (AUC) , calibration plots, the net reclassification improvement (NRI), the integrated discrimination improvement (IDI) , and decision-curve analysis (DCA). Results: Multivariate Cox regression indicated that factors including age at diagnosis, sex, marital status, insurance status, histology grade, SEER stage, surgery status, T stage, and N stage were independent covariates associated with CSS. These factors were used to construct a predictive model, which was built and virtualized by a nomogram. The C-index of the constructed nomogram was 0.850. The AUC values indicated that the established nomogram displayed better discrimination performance than did the seventh edition of the American Joint Committee on Cancer TNM staging system in predicting CSS. The IDI and NRI also showed that the nomogram exhibited superior performance in both the training and validation cohorts. Furthermore, the calibrated nomogram predicted survival rates that closely corresponded to actual survival rates, while the DCA demonstrated the considerable clinical usefulness of the nomogram. Conclusion: We have constructed a nomogram for predicting the CSS of small-intestine adenocarcinoma patients . This prognostic model may improve the ability of clinicians to predict survival in individual patients and provide them with treatment recommendations.

OBJECTIVE:To study the expressions of Fas and Fas-Ligand (FasL) genes in rats with acute pancreatitis (AP) and their relation to apoptosis of pancreatic acinar cells.METHODS:Rat models of acute pancreatitis with varied severity were established by retrograde injection of sodium taurocholate at different concentrations via the apancreatobiliary duct. The expressions of Fas and FasL mRNAs and proteins were detected by reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry. The apoptosis of acinar cells was quantified by in situ nick ending-labeling technique.RESULTS:of expressions fas, FasL mRNA and protein were colocalized in normal pancreatic acinar cells. In pancreatic tissue with less severe inflammation, the expressions of Fas and FasL mRNA increased significantly, and the apoptosis index of the acinar cells was also elevated; with the increase in the severity of the pancreatitis, the expression of Fas and FasL mRNAs were gradually lowered and apoptosis index of the acinar cells was increased.CONCLUSION:Fas/FasL system might be involved in the renewal and homeostasis of normal pancreatic tissue, and constitute an important pathway mediating the apoptosis of pancreatic acinar cells in AP.

急性胰腺炎是一种严重的疾病,它的原因目前还不是很清楚.胰腺炎的总死亡率近似10%,可是重症急性胰腺炎的死亡率达20%～30%[1],大部分病人的死因不是胰腺局部炎症或胰腺感染,而是多系统器官功能衰竭的结果.这种器官功能衰竭似乎与其他毫不相关的疾病(比如脓毒血症、严重创伤、烧伤)引起的器官功能衰竭一样.