Colorectal cancer screening:The value of early detection and modern challenges

The screening of colorectal cancer(CRC)is pivotal for both the prevention and treatment of this disease,significantly improving early-stage tumor detection rates.This advancement not only boosts survival rates and quality of life for patients but also reduces the costs associated with treatment.However,the adoption of CRC screening methods faces numerous challenges,including the technical limitations of both noninvasive and invasive methods in terms of sensitivity and specificity.Moreover,socioeconomic factors such as regional disparities,economic conditions,and varying levels of awareness affect screening uptake.The coronavirus disease 2019 pandemic further intensified these challenges,leading to reduced screening participation and increased waiting periods.Additionally,the growing prevalence of early-onset CRC necessitates innovative screening approaches.In response,research into new methodologies,including artificial intelligence-based systems,aims to improve the precision and accessibility of screening.Proactive measures by governments and health organizations to enhance CRC screening efforts are underway,including increased advocacy,improved service delivery,and international cooperation.The role of technological innovation and global health collaboration in advancing CRC screening is undeniable.Technologies such as artificial intelligence and gene sequencing are set to revolutionize CRC screening,making a significant impact on the fight against this disease.Given the rise in early-onset CRC,it is crucial for screening strategies to continually evolve,ensuring their effectiveness and applicability.

Combined development of traditional Chinese medicine and interventional medicine

The combination of Traditional Chinese Medicine and Interventional Radiology has an excellent clinical effect.This paper reviews the principles and methods of the combined application of Traditional Chinese Medicine and Interventional Radiology,aiming to promote the complementary and coordinated development of Traditional Chinese Medicine and Interventional Radiology.

Unraveling the biological link between diabetes mellitus and prostate cancer:Insights and implications

This article is a comprehensive study based on research on the connection between diabetes mellitus(DM)and prostate cancer(PCa).It investigates the potential role of DM as an independent risk factor for PCa,delving into the biological links,including insulin resistance and hormonal changes.The paper critically analyzes previous studies that have shown varying results and introduces mendelian randomization as a method for establishing causality.It emphasizes the importance of early DM screening and lifestyle modifications in preventing PCa,and proposes future research directions for further understanding the DM-PCa relationship.

Prediction models for development of hepatocellular carcinoma in chronic hepatitis B patients

Chronic hepatitis B(CHB)-related hepatocellular carcinoma(HCC)is a major health problem in Asian-Pacific regions.Antiviral therapy reduces,but does not completely prevent,HCC development.Thus,there is a need for accurate risk prediction to assist prognostication and decisions on the need for antiviral therapy and HCC surveillance.A few risk scores have been developed to predict the occurrence of HCC in CHB patients.Initially,the scores were derived from untreated CHB patients.With the development and extensive clinical application of nucleos(t)ide analog(s)(NA),the number of risk scores based on treated CHB patients has increased gradually.The components included in risk scores may be categorized into host factors and hepatitis B virus factors.Hepatitis activities,hepatitis B virus factors,and even liver fibrosis or cirrhosis are relatively controlled by antiviral therapy.Therefore,variables that are more dynamic during antiviral therapy have since been included in risk scores.However,host factors are more difficult to modify.Most existing scores derived from Asian populations have been confirmed to be accurate in predicting HCC development in CHB patients from Asia,while these scores have not offered excellent predictability in Caucasian patients.These findings support that more relevant variables should be considered to provide individualized predictions that are easily applied to CHB patients of different ethnicities.CHB patients should receive different intensities of HCC surveillance according to their risk category.

Successful eight-year survival of unresectable lung adenocarcinoma with bronchial artery infusion chemotherapy:A case report

A case report of eight year complete remission post bronchial artery infusion(BAI)chemotherapy(Pimetrazine and cisplatin)for unresectable lung adenocarcinoma.

Comments on“Effect of type 2 diabetes mellitus in the prognosis of acute-on-chronic liver failure patients in China”

A study addressing the influence of type 2 diabetes on the prognosis of acute-onchronic liver failure patients was reviewed.Some statistical deficiencies were found in the reviewed article,and the sample size was too small to support the study.In addition,age should have been considered as one of the prognostic factors.

Skinny people serum factors promote the differentiation of multipotent stem cells into brown adipose tissue

The original study by Alessio et al reported that skinny people (SP) serum canpromote the formation of brown adipocytes, but not the differentiation of whiteadipocytes. This finding may explain why SP do not often become obese, despiteconsuming more calories than the body needs. More importantly, theydemonstrated that circulating factors in SP serum can promote the expression ofUCP-1 protein, thereby reducing fat accumulation. In this study, only male serumsamples were evaluated to avoid the interference of sex hormones in experiments,but adult males also synthesize estrogen, which is produced by the cells of thetestes. At the same time, adult females secrete androgens, and females synthesizeandrogens that are mainly produced by the adrenal cortex. We believe that theapproach of excluding sex hormone interference by sex selection alone may beflawed, so we comment on the article and debate the statistical analysis of thearticle.

Inhibition of glutathione metabolism can limit the development of pancreatic cancer

Pharmacological inhibitors of glutathione synthesis and circulation,such as buthionine-sulfoximine,inhibit glutathione metabolism.These drugs decrease the aggressiveness of pancreatic cancer,inhibit tumor stem cell survival,and reduce chemotherapy resistance.Nevertheless,buthionine-sulfoximine also decreases the content of glutathione in normal cells,disrupts the balance between reactive oxygen species and glutathione,and eventually induces cell apoptosis.Pancreatic cancer is usually diagnosed at an advanced stage and has a poor prognosis.Consequently,the use of biomarkers to screen high-risk patients can be an effective method.

Sarcopenia in hepatocellular carcinoma:Current knowledge and future directions

Liver cancer is the second most occurring cancer worldwide and is one of the leading causes of cancer-related deaths.Hepatocellular carcinoma(HCC)is the most common(80%-90%)type among malignant liver cancers.Sarcopenia occurs very early in HCC and can predict and provide an opportunity to improve muscle health before engaging in the treatment options such as loco-regional,systemic,and transplant management.Multiple prognostic stating systems have been developed in HCC,such as Barcelona Clinic Liver Cancer,Child-Pugh score and Albumin-Bilirubin grade.However,the evaluation of patients’performance status is a major limitation of these scoring systems.In this review,we aim to summarize the current knowledge and recent advances about the role of sarcopenia in cirrhosis in general,while focusing specifically on HCC.Additionally,the role of sarcopenia in predicting clinical outcomes and prognostication in HCC patients undergoing loco-regional therapies,liver resection,liver transplantation and systematic therapy has been discussed.A literature review was performed using databases PubMed/MEDLINE,EMBASE,Cochrane,Web of Science,and CINAHL on April 1,2021,to identify published reports on sarcopenia in HCC.Sarcopenia can independently predict HCC-related mortality especially in patients undergoing treatments such as loco-regional,surgical liver transplantation and systemic therapies.Basic research is focused on evaluating a balance of anabolic and catabolic pathways responsible for muscle health.Early clinical studies have shown promising results in methods to improve sarcopenia in HCC which can potentially increase prognosis in these patients.As sarcopenia occurs very early in HCC,it can predict and provide an opportunity to improve muscle health before engaging in the treatment options such as loco-regional,systemic,and transplant management.Further,sarcopenia measurement can obviate the confounding caused by the abdominal ascites in these patients.The use of sarcopenia can add to the existing scoring systems to better prognosticate the HCC.

Anti-PD-L1 antibody enhances curative effect of cryoablation via antibody-dependent cell-mediated cytotoxicity mediating PD-L1^(high)CD11b^(+)cells elimination in hepatocellular carcinoma

Cryoablation(CRA)and microwave ablation(MWA)are two main local treatments for hepatocellular carcinoma(HCC).However,which one is more curative and suitable for combining with immunotherapy is still controversial.Herein,CRA induced higher tumoral PD-L1 expression and more T cells infiltration,but less PD-L1^(high)CD11b^(+)myeloid cells infiltration than MWA in HCC.Furthermore,CRA had better curative effect than MWA for anti-PD-L1 combination therapy in mouse models.Mechanistically,anti-PD-L1 antibody facilitated infiltration of CD8^(+)T cells by enhancing the secretion of CXCL9 from cDC1 cells after CRA therapy.On the other hand,anti-PD-L1 antibody promoted the infiltration of NK cells to eliminate PD-L1^(high)CD11b^(+)myeloid cells by antibody-dependent cell-mediated cytotoxicity(ADCC)effect after CRA therapy.Both aspects relieved the immunosuppressive microenvironment after CRA therapy.Notably,the wild-type PD-L1 Avelumab(Bavencio),compared to the mutant PD-L1 atezolizumab(Tecentriq),was better at inducing the ADCC effect to target PD-L1^(high)CD11b^(+)myeloid cells.Collectively,our study uncovered the novel insights that CRA showed superior curative effect than MWA in combining with anti-PD-L1 antibody by strengthening CTL/NK cell immune responses,which provided a strong rationale for combining CRA and PD-L1 blockade in the clinical treatment for HCC.

Malignant obstruction in the ileocecal region treated by selfexpandable stent placement under the fluoroscopic guidance: A case report

BACKGROUND Malignant tumors of the ileocecal region often cause intestinal obstruction.Emergency surgery is the main treatment for patients presenting with an obstruction.However,this procedure is associated with a high mortality rate and frequent complications.The placement of colon stents is commonly performed for obstructions in the distal colon and is a less invasive and safer procedure.However,obstructions in the proximal colon are more challenging to treat by stent placement due to the increased distance from the anus.CASE SUMMARY This case report concerns an 88-year-old man with malignant intestinal obstruction in the ileocecal region.He was contraindicated for general anesthesia and surgical enterostomy.The placement of a self-expandable metallic stent seems an alternative to surgery,although stenting in this area is thought to be difficult and few studies have been reported so far.After three attempts at different interventional approaches,a stent was successfully placed in the obstructed segment under fluoroscopic guidance.After the procedure,the patient's abdominal distension and abdominal pain were significantly better than before.CONCLUSION For patients with proximal colonic obstruction,self-expandable metallic stent placement under fluoroscopic guidance could be considered as a feasible treatment to relieve abdominal distension and pain in patients with acute bowel obstruction.It has the characteristics of high safety and high patient tolerance.However,further study is still needed.

Comment“Asymptomatic small intestinal ulcerative lesions:Obesity and Helicobacter pylori are likely to be risk factors”

There are many causes of anemia.It is unreasonable to simply associate anemia with asymptomatic ulcers in the small intestine.

A subpopulation of CD146^(+) macrophages enhances antitumor immunity by activating the NLRP3 inflammasome

As one of the main tumor-infiltrating immune cell types, tumor-associated macrophages (TAMs) determine the efficacy of immunotherapy. However, limited knowledge about their phenotypically and functionally heterogeneous nature restricts their application in tumor immunotherapy. In this study, we identified a subpopulation of CD146+ TAMs that exerted antitumor activity in both human samples and animal models. CD146 expression in TAMs was negatively controlled by STAT3 signaling. Reducing this population of TAMs promoted tumor development by facilitating myeloid-derived suppressor cell recruitment via activation of JNK signaling. Interestingly, CD146 was involved in the NLRP3 inflammasome-mediated activation of macrophages in the tumor microenvironment, partially by inhibiting transmembrane protein 176B (TMEM176B), an immunoregulatory cation channel. Treatment with a TMEM176B inhibitor enhanced the antitumor activity of CD146+ TAMs. These data reveal a crucial antitumor role of CD146+ TAMs and highlight the promising immunotherapeutic approach of inhibiting CD146 and TMEM176B.

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].

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.

Chinese Medical Association consensus for standardized diagnosis and treatment of pancreatic neuroendocrine neoplasms

Pancreatic neuroendocrine neoplasms(pNENs)are rare and highly heterogeneous tumors originating from pluripotent stem cells with neuroendocrine differentiation in the pancreas,constituting approximately 3%of all pancreatic tumors.^([1])The global incidence of pNENs has been increasing recently,and most cases are sporadic and more common in women.^([1,2])pNENs are clinically divided into functioning and nonfunctioning tumors depending on whether the tumors are accompanied by a clinical syndrome related to specific hormone overproduction.

Impact of type 2 diabetes mellitus on short-term and long-term outcomes of patients with esophageal squamous cell cancer undergoing resection: a propensity score analysis

Background:The association between type 2 diabetes mellitus(T2DM)and the risk of esophageal cancer remains unclear.The present study aimed to evaluate the impact of T2DM on short-term outcomes and long-term survival in patients with esophageal squamous cell cancer(ESCC).Methods:The present retrospective study included 862 patients diagnosed with ESCC between January 2001 and December 2010.Among them,280 patients had T2DM.A 1:1 propensity score-matched cohort consisting of 280 patients with and 280 without T2DM was selected from the 862 patients.The associations between T2DM and clinico-pathologic characteristics were assessed using theχ2 or Fisher’s exact test.Survival of ESCC patients with and without T2DM was calculated by using the Kaplan-Meier method and compared by using the Cox regression model between the two groups.Results:The occurrence rate of anastomotic leakage was significantly higher in patients with T2DM than in those without T2DM(P<0.001).In the subgroup with weight loss rate≤5.05%,ESCC patients with T2DM had a signifi-cant longer overall survival than did those without T2DM(P=0.003),whereas in the subgroup with weight loss rate>5.05%,the patients without T2DM showed a longer survival(P=0.001).Univariate and multivariate analysis results showed that T2DM was not an independent prognostic factor for patient survival.Conclusions:Type 2 diabetes mellitus is not an independent prognostic factor in patients with ESCC.However,the combination of T2DM with severe weight loss would be a predictor of poor prognosis.

Characterization of DNA damage response deficiency in pancreatic cancer patients from China

To the editor,Pancreatic ductal adenocarcinoma(PDAC)has the worst prognosis among all common malignant solid tumors,with a 5-year overall survival(OS)rate of less than 10%[1].Few effective targets for anticancer ther-apy have been confirmed in pancreatic cancer.Recently,it was substantiated that pancreatic cancer patients carry-ing deleterious mutations of the DNA damage response(DDR)genes are more likely to benefit from platinum-based chemotherapy[2]and poly(adenosine diphosphate-ribose)polymerase(PARP)inhibitor[3].

Hepatic arterial infusion of oxaliplatin plus raltitrexed in unresectable hepatocellular carcinoma with or without portal vein tumour thrombosis

Background Unresectable hepatocellular carcinoma(HCC)has a poor prognosis.According to the HCC management guidelines in China,the standard treatment of Barcelona Clinic Liver Cancer(BCLC)stage B or C HCC with portal vein tumour thrombosis(PVTT)is chemoembolization.However,some patients with BCLC stage B or C HCC with PVTT respond poorly to chemoembolization.We aimed to compare tumour responses and survival benefits between patients with unresectable HCC with or without PVTT.Methods We reviewed 119 consecutive patients with unresectable HCC with PVTT(n=67)and without PVTT(n=52)who underwent hepatic arterial infusion of oxaliplatin plus raltitrexed between January 2018 and April 2021.Overall survival,progression-free survival,tumour responses,and adverse events were compared between the groups.Results There were no significant between-group differences in the objective response rates and median progression-free survival.The median overall survival was significantly longer in the group without PVTT than in that with PVTT(17.0 vs 10.4 months,respectively;P=0.024).Conclusion Hepatic arterial infusion of oxaliplatin plus raltitrexed may be efficacious in patients with unresectable HCC with or without PVTT.

Role of image-guided percutaneous thermal ablation in the management of colorectal cancer Iiver metastases

Colorectal cancer(CRC)is the second most common cause of cancer death in the developed world and the third most common malignancy worldwide,with more than 1 million people affected.Approximately half of this population develops colorectal liver metastases(CLM)with a significant increase in morbidity and mortality,yet only a minority of these patients(10-15%)can undergo hepatectomy(1).Image-guided percutaneous thermal ablation(TA)destroys cancer cells by delivering heat directly into the tumor using radiofrequency(RFA)or microwave(MWA)energy,via special needles/electrodes.