Expert Consensus on Nutritional Support for Children with Congenital Heart Disease(2023 Edition)

The second edition of the expert consensus on pediatric nutrition was formed based on a global update of pedia-tric nutrition guidelines or consensus worldwide,the management of congenital heart disease,and the results of multi-center clinical nutrition research for congenital heart disease following thefirst Chinese consensus edition of 2016.The consensus was also shaped by the results of three discussion sessions and two questionnaires con-ducted by the 13-member collaboration group.This process was informed by both clinical guidelines and expert consensus.The quality of literature,both in English and Chinese,and the level of recommendations were evaluated using the Grading of Recommendations Assessment,Development,and Evaluations(GRADE)system.

热消融治疗肺部亚实性结节专家共识(2021年版)

局部热消融技术在肺部结节治疗领域正处在起步与发展阶段,为了肺结节热消融治疗的临床实践和规范发展,由"中国医师协会肿瘤消融治疗技术专家组""中国医师协会介入医师分会肿瘤消融专业委员会""中国抗癌协会肿瘤消融治疗专业委员会""中国临床肿瘤学会消融专家委员会"组织多学科国内有关专家,讨论制定了"热消融治疗肺部亚实性结节专家共识(2021年版)"。主要内容包括:(1)肺部亚实性结节的临床评估;(2)热消融治疗肺部亚实性结节技术操作规程、适应证、禁忌证、疗效评价和相关并发症;(3)存在的问题和未来发展方向。

Reduced expression of E-cadherin/catenin complex in hepatocellular carcinomas

AIM: To examine the immunoreactivity of E-cadherin and four subtypes of catenin family in human hepatocellular carcinomas (HCCs) and to investigate the correlation between expression of E-cadherin/ catenin complex and clinicopathologic parameters of HCC patients. METHODS: An immunohistochemical study for E-cadherin and catenins was performed on 97 formalin-fixed, paraffin-embedded specimens of HCC. RESULTS: Reduced expression of E-cadherin, α-, β-, γ-catenin and p120 was observed in 69%, 76%, 63%, 71% and 73%, respectively. Both expressions of E-cadherin and catenin components were significantly correlated with tumor grade (P = 0.000). It showed significant difference between expression of catenin members and tumor stage (P = 0.003, P = 0.017, P = 0.007 and P = 0.000, respectively). The reduced expression of E-cadherin in HCCs was significantly correlated with intrahepatic metastasis (IM) and capsular invasion (P = 0.008, P = 0.03, respectively). A close correlation was also observed between the expression of catenins and the tumor size (P = 0.002, P = 0.034, P = 0.016 and P = 0.000, respectively). In addition, the expression of each catenin was found correlated with IM (P = 0.012, P = 0.049, P =0.026 and P = 0.014, respectively). No statistically significant difference was observed between the expression level of E-cadherin/catenin complex and lymph node permission, vascular invasion and satellite nodules. Interestingly, only expression of p120 showed correlation with AFP value (P = 0.035). The expression of E-cadherin was consistent with α-, β-, γ-catenin and p120 expression (P = 0.000). Finally, the abnormal expression of E-cadherin/catenin complex was significantly associated with patients' survival (P = 0.0253, P = 0.0052, P = 0.003, P = 0.0105 and P = 0.0016, respectively). Nevertheless, no component of E-cadherin/catenin complex was the independent prognostic factor of HCC patients. CONCLUSION: Down-regulated expressions of E-cadherin, catenins and p120 occur frequently in HCCs and contribute to the progression and development of tumor. It may be more exact and valuable to detect the co-expression of E-cadherin/catenin complex than to explore one of them in predicting tumor invasion, metastasis and patient's survival.

Mechanisms of resistance to sorafenib and the corresponding strategies in hepatocellular carcinoma

Sorafenib, the unique drug as first-line treatment for advanced hepatocellular carcinoma (HCC), has opened a window of hope after searching for effective agents to combat HCC for decades. However, the overall outcomes are far from satisfactory. One of the explanations is the genetic heterogeneity of HCC, which has led to identifying predictive biomarkers for primary resistance to sorafenib, and then applying the concept of personalized medicine, or seeking therapeutic strategies such as combining sorafenib with other anticancer agents. Some of the combinations have demonstrated a better effectiveness than sorafenib alone, with good tolerance. The acquired resistance to sorafenib has also drawn attention. As a multikinase inhibitor, sorafenib targets several cellular signaling pathways but simultaneously or sequentially the addiction switches and compensatory pathways are activated. Several mechanisms are involved in the acquired resistance to sorafenib, such as crosstalks involving PI3K/Akt and JAK-STAT pathways, hypoxia-inducible pathways, epithelial-mesenchymal transition, etc . Based on the investigated mechanisms,some other molecular targeted drugs have been applied as second-line treatment for treat HCC after the failure of sorafenib therapy and more are under evaluation in clinical trials. However, the exact mechanisms accounting for sorafenib resistance remains unclear. Further investigation on the crosstalk and relationship of associated pathways will better our understanding of the mechanisms and help to find effective strategies for overcoming sorafenib resistance in HCC.

Controversy over the use of intraoperative blood salvage autotransfusion during liver transplantation for hepatocellular carcinoma patients

Intraoperative blood salvage autotransfusion (IBSA) is used in various surgical procedures. However, because of the risk of reinfusion of salvaged blood contaminated by tumor cells, the use of IBSA in hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT) is controversial. The critical points include whether tumor cells can be cleared by IBSA, whether IBSA increases the risk of recurrence or metastasis, and what are the indications for IBSA. Moreover, is it warranted to take the risk of tumor dissemination by using IBSA to avoid allogeneic blood transfusion? Do the remaining tumor cells after additional filtration by leukocyte depletion filters still possess potential tumorigenicity? Does IBSA always work well? We have reviewed the literature and tried to address these questions. The available data indicate that IBSA is safe in LT for HCC, but randomized, controlled and prospective trials are urgently required to clarify the uncertainty.

Radiofrequency ablation for hepatic hemangiomas: A consensus from a Chinese panel of experts

Recent studies have shown that radiofrequency(RF) ablation therapy is a safe, feasible, and effective procedure for hepatic hemangiomas, even huge hepatic hemangiomas. RF ablation has the following advantages in the treatment of hepatic hemangiomas: minimal invasiveness, definite efficacy, high safety, fast recovery, relatively simple operation, and wide applicability. It is necessary to formulate a widely accepted consensus among the experts in China who have extensive expertise and experience in the treatment of hepatic hemangiomas using RF ablation, which is important to standardize the application of RF ablation for the management of hepatic hemangiomas, regarding the selection of patients with suitable indications to receive RF ablation treatment, the technical details of the techniques, therapeutic effect evaluations, management of complications, etc. A final consensus by a Chinese panel of experts who have the expertise of using RF ablation to treat hepatic hemangiomas was reached by means of literature review, comprehensive discussion, and draft approval.

Reduced expression of P120 catenin in cholangiocarcinoma correlated with tumor clinicopathologic parameters

AIM:To investigate the relationship between the expression of P120 and the clinicopathologic parameters in intrahepatic cholangiocarcinoma(ICC) . METHODS:An immunohistochemical study of E-cadherin and P120 catenin was performed on 42 specimens of ICC with a Dako Envision kit. RESULTS:The expression of E-cadherin and P120 was reduced in 27 cases(64.3%) and 31 cases(73.8%) ,respectively. Both E-cadherin and P120 expressions were significantly correlated with the tumor histological grade(χ2 = 9.333,P = 009 and χ2 = 11.71,P = 0.003) ,TNM stage(χ2= 8.627,P = 0.035 and χ2 = 13.123,P = 0.004) ,intrahepatic metastasis(χ2= 7.292,P = 0.007 and χ2 = 4.657,P = 0.041,respectively) and patients' survival(χ2= 6.351,P = 0.002 and χ2 = 4.023,P = 0.000,respectively) . In addition,the expression of P120 was in concordance with that of E-cadherin(χ2 = 13.797,P = 0.000) ,indicating that the expression of P120 may be dependent on that of E-cadherin. Finally,only P120 expression was found to be an independent prognostic factor in Cox regression model(r = 0.088,P = 0.049) . CONCLUSION:Down-regulated expression of E-cadherin and P120 occurs frequently in ICC and contributes to the progression and development of tumor. Both of them may be valuable biologic markersfor predicting tumor invasion,metastasis and patients' survival,but only P120 is an independent prognostic factor for ICC.

Castleman disease presenting with jaundice: A case report and review of literature

BACKGROUND Castleman disease(CD) is a rare lymphoproliferative disorder that presents with various symptoms. CD accompanied with jaundice is uncommon since there are only 11 cases reported in the literature.CASE SUMMARY Here we report a 62-year-old woman who was admitted to the hospital with signs and symptoms of intermittent jaundice. Biochemical tests showed higher serum levels of total and direct bilirubin, and normal serum levels of tumor markers and interleukin-6. Contrast-enhanced computed tomography detected a6 cm × 4 cm × 2.5 cm mass between the hepatoduodenal ligament and the inferior vena cava. The mass was successfully excised and the patient had a complete resolution of symptoms. A diagnosis of idiopathic unicentric CD was made based upon histological examination, which demonstrated the pathological features of CD of mixed type, including hyperplasia of follicular lymphoids with abundant plasma cells, degenerative germinal centers, interfollicular vascularity and hyaline degeneration. The diagnosis was corroborated by immunohistochemical analysis which detected multiple biomarkers.CONCLUSION This is the first study that describes the clinicopathological features of CD presenting with jaundice, which may deepen and extend our understanding of this disease.

Radiofrequency ablation of hepatocellular carcinoma: Current status,challenges, and prospects

Local ablation technologies, such as radiofrequency ablation (RFA), microwave ablation (MWA) andcryoablation, have become a standard treatment option for hepatocellular carcinoma (HCC) less than5 cm in size, particularly in individuals who are not candidates for hepatectomy. Except for equivalentprognosis and efficiency, RFA has various advantages over surgical excision, including a lower rate ofcomplications, a cheaper cost, more normal tissue preservation, and a shorter hospital stay. However, therate of tumor recurrence and/or distant metastasis after RFA therapy is still high. RFA has been widelyemployed in multiple cancers, large cancer, and lesion identified at “high-risk” sites in recent years, withthe advancement of ablation types and operating techniques, particularly the combined use of manytechnologies. The real value of RFA technology has been more fully reflected.We will examine the status,progress, and problems of RFA in the treatment of HCC in this review.

Combined local therapy and CAR-GPC3 T-cell therapy in advanced hepatocellular carcinoma:a proof-of-concept treatment strategy

Dear Editor,Available evidence regarding the most suitable treatment strategies for hepatocellular carcinoma(HCC)with inferior vena cava tumor thrombus(IVCTT)is extremely limited,and the median overall survival time for these patients after liver resection is only 17.76 months[1].Other local or systemic treatments for HCC with IVCTT result in a median overall survival time ranging from 5.88 to 15.36 months[1–3].Thus,new therapeutic strategies are urgently needed to improve the survival of HCC patients with IVCTT.Chimeric antigen receptor(CAR)T-cell therapy has seen success in treating B-cell neoplasms with impressive outcomes[4].However,this therapy alone has shown limited efficacy on solid tumors,such as HCC[5].

基于大数据智能的煤矿水害预测数据建模研究

针对当前煤矿水害预测过程中内存消耗量大、预测结果精准度低等问题。提出了基于大数据智能的煤矿水害预测数据建模研究。根据电平翻转法,采用矿井水文监控系统采集矿井水文数据信息,使用Bayes判决理论剔除与数据模型构建无关的数据。将数据处理结果导入FEFLOW平台中,展开水文地质参数划分,构建煤矿地下水模型。将地下水模型数据代入GM(1,2)模型中,完成煤矿水害预测数据模型构建。实验结果表明,该模型可有效地弥补当前模型的不足,将内存消耗量控制在20%~25%之间,精准度控制在98.5%左右,提高了预测结果的科学性,为煤矿的安全生产提供了数据支撑。