Mechanisms and therapeutic strategies to combat the recurrence and progression of hepatocellular carcinoma after thermal ablation

Thermal ablation(TA),including radiofrequency ablation(RFA)and microwave ablation(MWA),has become the main treatment for early-stage hepatocellular carcinoma(HCC)due to advantages such as safety and minimal invasiveness.However,HCC is prone to local recurrence,with more aggressive malignancies after TA closely related to TA-induced changes in epithelial-mesenchymal transition(EMT)and remodeling of the tumor microenvironment(TME).According to many studies,various components of the TME undergo complex changes after TA,such as the recruitment of innate and adaptive immune cells,the release of tumor-associated antigens(TAAs)and various cytokines,the formation of a hypoxic microenvironment,and tumor angiogenesis.Changes in the TME after TA can partly enhance the anti-tumor immune response;however,this response is weak to kill the tumor completely.Certain components of the TME can induce an immunosuppressive microenvironment through complex interactions,leading to tumor recurrence and progression.How the TME is remodeled after TA and the mechanism by which the TME promotes HCC recurrence and progression are unclear.Thus,in this review,we focused on these issues to highlight potentially effective strategies for reducing and preventing the recurrence and progression of HCC after TA.

Coordination and order risk assessment of water and land resource system based on periphery and synergetics theories

Coordinated and orderly water and land resource system is vital to ensure the economic and social development of a region.Grain production in Heilongjiang Province has increased consecutively every year since 2003,and numerous water and land resource-related problems have become increasingly prominent and have had significant adverse effects on social and economic development and stability in the region.In this study,Heilongjiang Province and its 13 prefecture-level cities were selected as the study area,and the degrees of coordination of the social,economic and ecological subsystems were evaluated using periphery theory and the theory of synergetics.To ensure that the assessment was objective and accurate,weights were calculated using the projection pursuit technique,and similarity degrees were calculated using a modified(by introducing the chi-square distance)order of preference by similarity to ideal solution(TOPSIS)technique.Moreover,to reflect the variations in the overall degree of coordination in Heilongjiang Province,the risk level of the coordination of the water and land resource system was predicted through the year 2020 using a dynamic neural network.This study provides a reference for establishing effective and balanced coordination between society and water and land resources.

Transarterial chemoembolization combined with sorafenib and iodine-125 seed brachytherapy for hepatocellular carcinoma with portal vein tumor thrombus:a retrospective controlled study

To the Editor:Portal vein tumor thrombus(PVTT)is present in 10%to 40%of patients with hepatocellular carcinoma(HCC)at diagnosis and has a profound adverse effect on progno-sis.[1]Sorafenib is recommended as the first-line treatment for patients with advanced HCC,including those who have PVTT.However,its efficacy is modest.[1,2]A combination of transarterial chemoembolization(TACE)and sorafenib(TACE-S)has been reported to be associated with improved outcomes.[1,3]But unfortunately,its efficacy in controlling PVTT remained limited,with an objective response rate(ORR)of only 9.7%.[3]Previous studies have demonstrated that iodine-125(125I)seed brachytherapy targeting PVTT can lead to a significant reduction in tumor thrombus with few complications.[4,5]We hypothesized that TACE-S combined with 125I seed brachytherapy(TACE-S-I)could improve the control of PVTT and confer a greater survival benefit.Therefore,we conducted this study to evaluate the efficacy and safety of TACE-S-I compared with TACE-S in HCC patients with PVTT.This study was approved by our institutional review board(No.2020-hg-ks-03).