Anterior mediastinal masses and thymic cysts

Cystic lesions of the anterior mediastinum in children suggest a well-known group of benign lesions that are comparatively frequent.Thymic cysts(TCs)are mostly positioned in the anterior mediastinum and some patients in the neck.Benign TCs classified as congenital intra-thoracic mesothelial cysts are commonly asymptomatic and have slight clinical significance.Multilocular TC,which can mimic another anterior mediastinal cystic tumor and is seen in adults,is more clinically important.It is a sporadic mediastinal lesion thought to arise in the course of acquired inflammation.Congenital mediastinal cysts represent 3%-6%of all mediastinal tumors and 10%-18%of radiologically reported mediastinal masses.Mediastinal TCs are uncommon and it is hard to know their true incidence.About 60%of cases with mediastinal TCs are asymptomatic,and the remainder of patients complains of nonspecific symptoms(e.g.,chest pain,dyspnea,or cough).The literature suggests that most cysts are benign,but an indefinite percentage may have a neoplastic process and result in significant compressive symptoms over time.Clinical symptoms of TCs vary depending on the location.In addition,frequent symptoms at the appearance of enlarged benign thymic and mediastinal cysts generally contain compressive symptoms(e.g.,respiratory distress,thymic pain,and symptoms related to Horner syndrome,hoarseness,dysphonia,dyspnea,orthopnea,wheezing,and fever).Many TCs have cystic density and a neat border and are simple to diagnose with radiological imaging.However,some TCs are hard to identify before surgery and may be misidentified as thymomas depending on their site and computed tomography results.Excision by thoracotomy,median sternotomy,or video-assisted techniques is essential for conclusive diagnosis,management,and abolition of relapse of anterior mediastinal masses and TCs.Histopathologic examination may be required after surgery.Considering the extent of the mass and the preliminary inability to make a definitive diagnosis,en bloc excision of the cyst was thought to be preferred to circumvent likely complications(e.g.,perforation,spillage of the contents,or incomplete excision).

Treatment of spinal cord injury with biomaterials and stem cell therapy in non-human primates and humans

Spinal cord injury results in the loss of sensory,motor,and autonomic functions,which almost always produces permanent physical disability.Thus,in the search for more effective treatments than those already applied for years,which are not entirely efficient,researches have been able to demonstrate the potential of biological strategies using biomaterials to tissue manufacturing through bioengineering and stem cell therapy as a neuroregenerative approach,seeking to promote neuronal recovery after spinal cord injury.Each of these strategies has been developed and meticulously evaluated in several animal models with the aim of analyzing the potential of interventions for neuronal repair and,consequently,boosting functional recovery.Although the majority of experimental research has been conducted in rodents,there is increasing recognition of the importance,and need,of evaluating the safety and efficacy of these interventions in non-human primates before moving to clinical trials involving therapies potentially promising in humans.This article is a literature review from databases(PubMed,Science Direct,Elsevier,Scielo,Redalyc,Cochrane,and NCBI)from 10 years ago to date,using keywords(spinal cord injury,cell therapy,non-human primates,humans,and bioengineering in spinal cord injury).From 110 retrieved articles,after two selection rounds based on inclusion and exclusion criteria,21 articles were analyzed.Thus,this review arises from the need to recognize the experimental therapeutic advances applied in non-human primates and even humans,aimed at deepening these strategies and identifying the advantages and influence of the results on extrapolation for clinical applicability in humans.

Multilocular thymic cysts-a diagnostic challenge on computed tomography

A recent case report provided a patient scenario,wherein,a 39-year-old male patient presented with occasional palpitations,headache,and fever.Evaluation of tumor markers did not show any abnormal results.Subsequently,a computed tomography(CT)scan was undertaken,and its findings were affirmative of thymic cancer.Finally,the postoperative histopathological assessment of the mass,after its resection,confirmed it as an anterior mediastinal multilocular thymic cyst(MTC),with concurrent acute upper respiratory tract infection and acute myocarditis.Accordingly,this case report advocates the need for a preoperative histopathological examination with CT imaging to minimize the risk of confusing an MTC with a malignant thymic tumor.

Optimizing care for gastric cancer with overt bleeding:Is systemic therapy a valid option?

Gastric cancer(GC)and gastroesophageal junction cancer(GEJC)represent a significant burden globally,with complications such as overt bleeding(OB)further exacerbating patient outcomes.A recent study by Yao et al evaluated the effectiveness and safety of systematic treatment in GC/GEJC patients presenting with OB.Using propensity score matching,the study balanced the comparison groups to investigate overall survival and treatment-related adverse events.The study's findings emphasize that systematic therapy can be safe and effective and contribute to the ongoing debate about the management of advanced GC/GEJC with OB,highlighting the complexities of treatment decisions in these high-risk patients.

Effect of N-Acetylcysteine Combined with Lung Rehabilitation Therapy on Exercise Endurance and Quality of Life of Patients with Rheumatoid Arthritis-Related Interstitial Lung Disease

Objective:To explore the effect of N-acetylcysteine combined with lung rehabilitation therapy on exercise endurance and quality of life in patients with rheumatoid arthritis-related interstitial lung disease(RA-ILD).Methods:Fifty-six patients with RA-ILD admitted to Xijing Hospital from May 2022 to January 2024 were randomly divided into two groups:a non-rehabilitation group and a pulmonary rehabilitation group,with 28 patients in each group.Both groups received routine treatment.Additionally,the non-rehabilitation group received N-acetylcysteine treatment,while the lung rehabilitation group received lung rehabilitation treatment in addition to N-acetylcysteine.The improvement in exercise endurance and dyspnea between the two groups after treatment was compared and the quality of life of the patients was observed.Results:After treatment,the exercise endurance score in the lung rehabilitation group(335.67±45.29)was higher than that in the non-rehabilitation group(P<0.05).The dyspnea score in the lung rehabilitation group(0.72±0.16)was lower than that in the non-rehabilitation group(P<0.05).Additionally,FVC(3.18±0.58 L),FEV1(2.28±0.56 L),FEV1/FVC(69.69±5.56),and DLCO(60.53±5.92 mL/mmHg/min)were higher in the lung rehabilitation group compared to the non-rehabilitation group after treatment(P<0.05).Conclusion:Lung rehabilitation therapy combined with N-acetylcysteine treatment can effectively improve dyspnea symptoms,lung function,and exercise endurance in patients with RA-ILD.This approach helps to improve patient’s quality of life and is beneficial for their prognosis.

Percutaneous aspiration and drainage with adjuvant medical therapy for treatment of hepatic hydatid cysts

AIM:To determine the efficacy and success of percutaneous aspiration irrigation and reaspiration(PAIR) in the management of hepatic hydatidosis.METHODS:Twenty-six patients with 32 hepatic hydatid cysts had PAIR.Twenty-two patients received at least 2 wk of drug therapy before the procedure was carried out to reduce the risk of recurrence from spillage during the procedure.The procedure was performed under local anesthesia with a 19-gauge 20 cm long needle,the cyst was punctured,cystic content(approximately 30 mL) was aspirated by a 12-14 F pigtail catheter and aspirated fluids were sent for analysis.Once the cyst was almost empty,two-thirds of the net amount of material aspirated was replaced by hypertonic saline and left in the cavity for about 30 min,with the catheter left in place for reaspiration of most of the fluid.When the amount of fluid drained was less than 10 mL per 24 h,the drainage catheter was removed.RESULTS:All 32 cysts showed evidence of immediate collapse after completion of the procedure,and before discharge from hospital,ultrasound examination showed fluid reaccumulation in all cysts.Serial follow-up showed a progressive decrease in the size and change in the appearance of cysts.To confirm the sterility of these cystic cavities,seven cysts were reaspirated on average 3 mo after the procedure.Investigations revealed no viable scolices.CONCLUSION:PAIR using hypertonic saline is very effective and safe with proper precautions.

Neoadjuvant therapy for pancreas cancer: Past lessons and future therapies

Pancreatic adenocarcinoma remains a most deadly malignancy, with an overall 5-year survival of 5%. A subset of patients will be diagnosed with potentially resectable disease, and while complete surgical resection provides the only chance at cure, data from trials of postoperative chemoradiation and/or chemotherapy demonstrate a modest survival advantage over those patients who undergo resection alone. As such, most practitioners believe that completion of multimodality therapy is the optimal treatment. However, the sequence of surgery, chemotherapy and radiation therapy is frequently debated, as patients may benefit from a neoadjuvant approach by initiating chemotherapy and/or chemoradiation prior to resection. Here we review the rationale for neoadjuvant therapy, which includes a higher rate of completion of multimodality therapy, minimizing the risk of unnecessary surgical resection for patients who develop early metastatic disease, improved surgical outcomes and the potential for longer overall survival. However, there are no prospective, randomized studies of the neoadjuvant approach compared to a surgeryfirst strategy; the established and ongoing investigations of neoadjuvant therapy for pancreatic cancer are discussed in detail. Lastly, as the future of therapeutic regimens is likely to entail patient-specific genetic and molecular analyses, and the treatment that is best applied based on those data, a review of clinically relevant biomarkers in pancreatic cancer is also presented.

Results of percutaneous sclerotherapy and surgical treatment in patients with symptomatic simple liver cysts and polycystic liver disease

AIM: To evaluate the results of the treatment of simple liver cysts (solitary and multiple) and polycystic liver disease (PLD) using percutaneous sclerotherapy and/or surgical procedures in a single tertiary referral centre. METHODS: Retrospective analysis of 54 patients referred for evaluation and possible treatment of simple liver cysts (solitary and multiple) and PLD, from January 1997 to July 2006. RESULTS: Simple liver cysts were treated in 41 pts (76/) with a mean size of 12.6 cm. The most common reason for referral was abdominal pain or discomfort (85/). Percutaneous sclerotherapy was performed as initial treatment in 30 pts, showing cyst recurrence in 6 pts (20/). Surgical treatment was initially performed in 11 pts with cyst recurrence in 3 pts (27/). PLD was treated in 13 pts (24/) with a mean size of the dominant cyst of 13 cm. Percutaneous sclerotherapy for PLD was performed in 9 pts with recurrence in 7 pts (77.8/). Surgical treatment for PLD was undertaken in 4 pts (30.8/) with recurrence in all. Eventually, 2 pts with PLD in the presence of polycystic kidney disease underwent liver-and kidney transplantation because of deterioration of liver and kidney function. CONCLUSION: The majority of patients with simple liver cysts and PLD are referred for progressive abdominal pain. As initial treatment, percutaneous sclerotherapy is appropriate. Surgical deroofing is indicated in caseof cyst recurrence after percutaneous sclerotherapy. However, the results of percutaneous sclerotherapy and surgical treatment for PLD are disappointing. Partial liver resection is indicated when there is suspicion of a pre-malignant lesion.

When combination therapy isn't working: Emerging therapies for the management of inflammatory bowel disease

Although antagonists of tumor necrosis factor have resulted in major therapeutic benefits in inflammatory bowel disease, the magnitude and durability of response are variable. Similar to previously available drugs such as 5-aminosalicylates and immunomodulators, the therapeutic effect is not universal leaving many people searching for options. The development of newer agents has benefited from advances in the understanding of the pathophysiology of the disease. Uncontrolled activation of the acquired immune system has an important role, and lymphocytes, cytokines, and adhesion molecules are broadly targeted for therapeutic intervention. There is increasing evidence of an important role of the innate immune system and the intestinal epithelium, and the therapeutic paradigm is also shifting from immunosuppression to the reinforcement of the intestinal barrier, and modification of the disease process. In this review, we explore the limitation of current therapy as well as mechanisms of actions of new drugs and the efficacy and adverse events from data from clinical trials.

Loco-regional therapies for patients with hepatocellular carcinoma awaiting liver transplantation: Selecting an optimal therapy

Hepatocellular carcinoma(HCC) is a common, increasingly prevalent malignancy. For all but the smallest lesions, surgical removal of cancer via resection or liver transplantation(LT) is considered the most feasible pathway to cure. Resection- even with favorable survival- is associated with a fairly high rate of recurrence, perhaps since most HCCs occur in the setting of cirrhosis. LT offers the advantage of removing not only the cancer but the diseased liver from which the cancer has arisen, and LT outperforms resection for survival with selected patients. Since time waiting for LT is time during which HCC can progress, locoregional therapy(LRT) is widely employed by transplant centers. The purpose of LRT is either to bridge patients to LT by preventing progression and waitlist dropout, or to downstage patients who slightly exceed standard eligibility criteria initially but can fall within it after treatment. Transarterial chemoembolization and radiofrequency ablation have been the most widely utilized LRTs to date, with favorable efficacy and safety as a bridge to LT(and for the former, as a downstaging modality). The list of potentially effective LRTs has expanded in recent years, and includes transarterial chemoembolization with drug-eluting beads, radioembolization and novel forms of extracorporal therapy. Herein we appraise the various LRT modalities for HCC, and their potential roles in specific clinical scenarios in patients awaiting LT.

Tetracysteine as a Reporter for Gene Therapy

Objective To study the feasibility of using tetracysteine （TC） reporter in gene therapy. Methods Effects of TC reporter and conventional reporter genes encoding green fluorescence protein （GFP） and luciferase （Luc） on expression and function of the therapeutic gene MGMT^P140K were compared. Cytotoxicity and drug resistance were studied by Western blot. TC reporter used in therapy was analyzed by flow cytometry （FCM）. Results The TC reporter had no toxicity to cells and neither affected the expression or activity of therapeutic gene as compared to GFP and Luc. TC could be used in blood sample detection. Conclusion TC is a new kind of reporter gene for lentiviral vector in future gene therapy.

Study on Treatment of Polycystic Ovarian Syndrome with Infertility by Combined Therapy of Chinese Herbal Medicine and Compound Cyproterone Acetate

Objective: To evaluate the effect of combined therapy of Chinese herbal medicine and compound cyproterone acetate (CPA) in treating non-obesity polycystic ovarian syndrome (PCOS) and to explore its mechanism in improving withdrawal ovulation. Methods: Eighty-six patients of non-obesity P-COS, typed as Shen-deficiency with blood stasis Syndrome or Shen-deficiency with Phlegm-Dampness Syndrome by Syndrome Differentiation in traditional Chines medicine, were randomly divided into three groups: (1) The TCM group (n = 26) was treated with Chinese drugs for 6 menstrual cycles; (2) The western medicine (WM) group (n=30) was treated with 1 tablet of CPA for 21 days, with the treatment beginning from the 5th day of menstruation. The treatment was given for 3 menstrual cycles by repetitious medication, which stopped and restarted on the 5th day of withdrawal bleeding. Then the ovulation promoting therapy was applied by using clomifene citrate and human chorionic gonadotropin (CC/hCG) for 3 menstrual cycles; (3) The TCM-WM group (n=30) was treated with the medications used for the above two groups. The menstrual cycle, the volume and duration of the menstruation, as well as the improvement of acne and pilosis [Ferriman-Gallway (F-G) scoring] were observed after 3 cycles ended. Moreover, condition of ovulation was monitored by B-ultrasonography at the 4th- 6th cycle and status of pregnancy was observed. Results: Compared with before treatment, the blood level of luteinizing hormone (LH) and testosterone (T) in all 3 groups after treatment significantly decreased (P<0. 05), with its ratio to follicle-stimulating hormone (LH/FSH) recovered to normal, but without markedly change in levels of FSH, estradiol (E2) and prolactin (PRL). The menstrual cycle in most patients got regular and acne significantly alleviated (P<0. 05), and the improvement of infrequent menstruation and acne was better in the WM group and the TCM-WM group than that in the TCM group, but pilosis showed no significant improvement in all three groups. The periodical ovulation rate in the TCM-WM group (73. 1%) and the WM group (68. 3%) was significantly higher than that in the TCM group (40%). The pregnancy rate in the TCM-WM group (53. 8%) was significantly higher than that in the other two groups (26.1% and 25% respectively, all P<0.05). Conclusion: Using combined therapy of TCM and composite CPA followed by o-vulation promoting agents of TCM and WM to treat patients of non-obesity PCOS could relieve the clinical symptoms, improve the abnormal blood level of sex hormones and significantly elevate the pregnancy rate.

Elevated homocysteine levels in human immunodeficiency virus-infected patients under antiretroviral therapy: A meta-analysis

AIM: To evaluate the association between the levels of homocysteine(Hcy), folate, vitamin B12 in human immunodeficiency virus(HIV)-infected patients who were treated with antiretroviral therapy(ART) or not treated with ART.METHODS: The Pub Med and Scielo databases were searched. Eligible studies regarding plasma Hcy level in HIV-infected patients were firstly identified. After careful analysis by two independent researches, the identified articles were included in the review according to two outcomes(1) Hcy, folate and vitamin B12 blood concentration in HIV-infected subjects vs health controls and;(2) Hcy blood concentration in HIV-infected subjects under ART vs not treated with ART. RevM an(version 5.2) was employed for data synthesis.RESULTS: A total of 12 studies were included in outcome 1(1649 participants, 932 cases and 717 controls). Outcome 1 meta-analysis demonstrated higher plasma Hcy(2.05 μmol/L; 95% CI: 0.10 to 4.00, P < 0.01) and decreased plasma folate concentrations(-2.74 ng/m L; 95%CI:-5.18 to-0.29, P < 0.01) in HIV-infected patients compared to healthy controls. No changes in vitamin B12 plasma concentration were observed between groups. All studies included in the outcome 2 meta-analysis(1167 participants; 404 HIVinfected exposed to ART and 757 HIV-infected non-ART patients) demonstrated higher mean Hcy concentration in subjects HIV-infected under ART compared to nonART HIV subjects(4.13 μmol/L; 95%CI: 1.34 to 6.92, P < 0.01).CONCLUSION: This meta-analysis demonstrated that the levels of Hcy and folate, but not vitamin B12, were associated with HIV infection. In addition, Hcy levels were higher in HIV-infected patients who were under ART compared to HIV-infected patients who were not exposed to ART. Our results suggest that hyperhomocysteinemia should be included among the several important metabolic disturbances that are associated with ART in patients with HIV infection.

Advances in radiotherapy and targeted therapies for rectal cancer

The last decade witnessed a significant progress in understanding the biology and immunology of colorectal cancer alongside with the technical innovations in radiotherapy.The stepwise implementation of intensitymodulated and image-guided radiation therapy by means of megavolt computed tomography and helical tomotherapy enabled us to anatomically sculpt dose delivery,reducing treatment related toxicity.In addition,the administration of a simultaneous integrated boost offers excellent local control rates.The novel challenge is the development of treatment strategies for medically inoperable patient and organ preserving approaches.However,distant control remains unsatisfactory and indicates an urgent need for biomarkers that predict the risk of tumor spread.The expected benefit of target?ed therapies that exploit the tumor genome alone is so far hindered by high cost techniques and pharmaceuticals,hence hardly justifying rather modest improvements in patient outcomes.On the other hand,the immune landscape of colorectal cancer is now better clarified with regard to the immunosuppressive network that promotes immune escape.Both N2 neutrophils and myeloid-derived suppressor cells(MDSC)emerge as useful clinical biomarkers of poor prognosis,while the growing list of anti-MDSC agents shows promising ability to boost antitumor T-cell immunity in preclinical settings.Therefore,integration of genetic and immune biomarkers is the next logical step towards effective targeted therapies in the context of personalized cancer treatment.

Percutaneous aspiration and sclerotherapy of a giant simple hepatic cyst causing obstructive jaundice:A case report and review of literature

BACKGROUND Giant simple hepatic cysts causing intrahepatic duct dilatation and obstructive jaundice are uncommon.A variety of measures with different clinical efficacies and invasiveness have been developed.Nonsurgical management,such as percutaneous aspiration and sclerotherapy,is often applied.CASE SUMMARY The case is a 39-year-old female with a 5-mo history of cutaneous and scleral icterus,loss of appetite,and dark urine.Lab tests showed jaundice and liver function abnormalities.Imaging revealed a giant simple hepatic cyst obstructing the intrahepatic bile ducts.A combination of percutaneous catheter aspiration and lauromacrogol sclerotherapy was successfully performed and the effects were satisfactory with the size of cyst decreasing from 13.7 cm×13.1 cm to 3.0 cm×3.0 cm.Further literature review presented the challenges of managing giant simple hepatic cysts that cause obstructive jaundice and compared the safety and efficacy of a combination of percutaneous aspiration and lauromacrogol sclerotherapy with other management strategies.CONCLUSION Giant simple hepatic cysts can cause obstructive jaundice,and a combination of percutaneous catheter aspiration and sclerotherapy with lauromacrogol are suggested to treat such cases.

Sustained volume decreases in simple renal cysts after sclerotherapy using NBCA with or without hydrodissection

The present study aimed to determine the effectiveness of sclerotherapy using NBCA(Histoacryl Blue(?);B.Braun,Melgungen,Germany),with or without hydrodissection,for the treatment of simple renal cysts.Materials and Methods:Patients who presented to an interventional radiology clinic for the diagnosis of symptomatic renal cysts which had previously been identified at an outpatient clinic were selected for inclusion in this study.A total of 28 patients were randomly divided into 2 groups,based on whether or not they underwent hydrodissection along with ultrasound-guided NBCA-based sclerotherapy.Sonographs were performed at 0,7,and 180 days postprocedure to record the residual volume of the renal cysts and to determine the efficacy of the procedure.Results:A total of 32 cysts in 28 patients were treated with sclerotherapy,18(64%) females and 10(36%) males.The average age of the patients was 61.8 years(range:33-89 years).All patients reported an improvement in symptoms associated with the existing renal cysts at 7 and 180 days post-procedure,and at 7 days post-procedure a statistically significant reduction in cyst volume was observed(all patients:96.8%;group A:96%;group B:97.6%).The reduced cyst volume was still observed 180 days post-procedure(all patients:98.6%;group A:98.2%;group B:98.9%).There was no significant difference between the two treatment groups.Conclusion: There is a significant and persistent reduction in the volume of renal cysts,in addition to an improvement of the associated symptoms,after treatment with NBCA-based sclerotherapy,with or without hydrodissection.

Combining chemotherapy and targeted therapies in metastatic colorectal cancer

Colorectal cancer remains one of the major causes of cancer death worldwide. During the past years, the development of new effective treatment options has led to a considerable improvement in the outcome of this disease. The advent of agents such as capecitabine, irinotecan, oxaliplatin, cetuximab and bevacizumab has translated into median survival times in the range of 2 years. Intense efforts have focused on identifying novel agents targeting specific growth factor receptors, critical signal transduction pathways or mediators of angiogenesis. In addition, several clinical trials have suggested that some of these molecularly targeted drugs can be safely and effectively used in combination with conventional chemotherapy. In this article we review various treatment options combining cytotoxic and targeted therapies currently available for patients with metastatic colorectal cancer.

Sclerotherapy as a primary or salvage procedure for aneurysmal bone cysts:A single-center experience

BACKGROUND Aneurysmal bone cysts(ABC)are benign cystic bone tumors of an osteolytic and locally aggressive nature.As an alternative to the primary treatment of choice,which consists of curettage with bone grafting,alternative treatment methods with promising results have been described.At our department,we have,in recent years,used percutaneous sclerotherapy with polidocanol.The objective of this study was to identify the healing rate and safety of sclerotherapy with polidocanol.AIM To identify the efficacy and safety of sclerotherapy with polidocanol in primary and recurrent ABC.METHODS Twenty-two consecutive patients(median age 12.5 years;range 1-27)with 23 ABCs treated with sclerotherapy with polidocanol from 2016-2021 were included retrospectively.Eleven patients(48%)had undergone different forms of previous treatment with recurrence.Under general anesthesia and fluoroscopic guidance,repeated percutaneous injections of 4mg polidocanol/kg body weight were performed.Through review of the electronic medical records,the following were identified:healing and recurrence rate,number of treatments,gender,age,comorbidity,location of the tumor and side effects/complications,as well as any previous surgery for ABC.The median length of radiographic follow-up was 19.5 mo.RESULTS All ABCs except one(96%)showed healing or stable disease after a median of 4(range 1-8)injections.Complete clinical and radiographic healing was observed in 16 cysts(70%),while partial radiographic healing with resolution of pain was seen in 6 cases(26%)and considered as stable disease.The cyst that failed to heal had previously undergone curettage twice with recurrence.One patient with a large pelvic ABC experienced,right after two injections,a sudden drop in blood pressure,which could quickly be reversed.One patient with a juxtaphyseal ABC in the femoral neck showed a minor limb length discrepancy because of deformity.Beyond that,no complications were observed.CONCLUSION Percutaneous sclerotherapy with polidocanol appears to be a safe alternative for treatment of aneurysmal bone cysts.In our series of both primary and recurrent cysts,it showed the ability to achieve healing or stable disease in 22 of 23 cases(96%).Further studies are needed to decide if this provides a long-lasting effect.

Revolutionizing gastric cancer treatment:The potential of immunotherapy

Gastric cancer,a prevalent malignancy worldwide,ranks sixth in terms of frequency and third in fatality,causing over a million new cases and 769000 annual deaths.Predominant in Eastern Europe and Eastern Asia,risk factors include family medical history,dietary habits,tobacco use,Helicobacter pylori,and Epstein-Barr virus infections.Unfortunately,gastric cancer is often diagnosed at an advanced stage,leading to a grim prognosis,with a 5-year overall survival rate below 5%.Surgical intervention,particularly with D2 Lymphadenectomy,is the mainstay for early-stage cases but offers limited success.For advanced cases,the National Comprehensive Cancer Network recommends chemotherapy,radiation,and targeted therapy.Emerging immunotherapy presents promise,especially for unresectable or metastatic cases,with strategies like immune checkpoint inhibitors,tumor vaccines,adoptive immunotherapy,and nonspecific immunomodulators.In this Editorial,with regards to the article“Advances and key focus areas in gastric cancer immunotherapy:A comprehensive scientometric and clinical trial review”,we address the advances in the field of immunotherapy in gastric cancer and its future prospects.

Pathologically successful conversion hepatectomy for advanced giant hepatocellular carcinoma after multidisciplinary therapy:A case report and review of literature

BACKGROUND Hepatocellular carcinoma(HCC)is one of the leading causes of death due to its complexity,heterogeneity,rapid metastasis and easy recurrence after surgical resection.We demonstrated that combination therapy with transcatheter arterial chemoembolization(TACE),hepatic arterial infusion chemotherapy(HAIC),Epclusa,Lenvatinib and Sintilimab is useful for patients with advanced HCC.CASE SUMMARY A 69-year-old man who was infected with hepatitis C virus(HCV)30 years previously was admitted to the hospital with abdominal pain.Enhanced computed tomography(CT)revealed a low-density mass in the right lobe of the liver,with a volume of 12.9 cm×9.4 cm×15 cm,and the mass exhibited a“fast-in/fast-out”pattern,with extensive filling defect areas in the right branch of the portal vein and an alpha-fetoprotein level as high as 657 ng/mL.Therefore,he was judged to have advanced HCC.During treatment,the patient received three months of Epclusa,three TACE treatments,two HAIC treatments,three courses of sintilimab,and twenty-one months of lenvatinib.In the third month of treatment,the patient developed severe side effects and had to stop immunotherapy,and the Lenvatinib dose had to be halved.Postoperative pathological diagnosis indicated a complete response.The patient recovered well after the operation,and no tumor recurrence was found.CONCLUSION Multidisciplinary conversion therapy for advanced enormous HCC caused by HCV infection has a significant effect.Individualized drug adjustments should be made during any treatment according to the patient's tolerance to treatment.