Clinical efficacy of atezolizumab plus bevacizumab in the first-line treatment of advanced huge hepatocellular carcinoma / 中华消化外科杂志

The incidence and mortality of hepatocellular carcinoma (HCC) is very high in China, which seriously threatens human life and health. There were limited treatment options for advanced HCC in the past, and the overall survival of HCC patients was poor. In recent years, immuno-therapy and targeted therapy have been recommended as effective means for the treatment of advan-ced HCC. The authors report a case of advanced huge HCC which has achieved a maintained partial response for 6 months after the treatment of atezolizumab combined with bevacizumab. The tumor shrunk by 32.4% and 47.5% after 3 and 6 months of treatment. Besides, the alpha-fetoprotein and abnormal tumor protein value of the patient continued to decrease without any adverse reactions. The treatment is evaluated as partial response and patients has a good short-term effect.

Optimal cessation period of anti-HBV therapy to block mother-to-child transmission / 中华肝脏病杂志

Hepatitis B virus (HBV) carrier woman of childbearing age with high viral load is an important source of vertical transmission of hepatitis b virus from mother-to-child in China. Routine blockade with immunoglobulin combined with hepatitis B vaccine is used for neonates born to pregnant women with high viral load of hepatitis B virus, but in some cases, immunoprophylaxis fails. The main application of antiviral drugs in pregnancy is to reduce the serum viral load, thereby significantly improve the blocking rate of vertical transmission between mother and infant. Current evidence suggested that if the maternal age is less than 30 years old, with no obvious liver fibrosis or cirrhosis and there is no increase in ALT level >2ULN( upper limit of normal) during the treatment, the treatment with antiviral drugs can be stopped after delivery immediately. Additionally, ALT level should be examined at 4, 12 and 24 weeks after stopping the drug. Antiviral therapy for the occurrence of hepatitis attack should be given if criteria for HBV treatment are met.

Diagnosis and treatment of bacterial infection in patients with end-stage liver disease / 中华肝脏病杂志

Patients with end-stage liver disease have an increased risk of developing bacterial infections, resulting in an increase in the number of hospitalizations and medical expenses, a decline in the quality of life of patients, and an increased fatality rate. Bacterial infections in patients with end-stage liver disease is mainly due to the falling off the body's immune response causing respiratory infections, spontaneous bacterial peritonitis, urinary tract infections and gastrointestinal infections. The diagnosis of bacterial infection is more challenging because the occurrence of infection shows no typical symptoms and signs. The examination of some biological markers has important clinical significance for early diagnosis. The clinical prognosis is entirely marked on the patient conditions, the effective control of infection, appropriate broad-spectrum antibiotics, and empiric therapy. Antibiotics are the choice, but also need to be alert against drug-induced liver damage.

Analysis of gastric gastrointestinal stromal tumors in Shandong Province: a midterm report of multicenter GISSG1201 study / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the treatment status of gastric gastrointestinal stromal tumor (GIST) in Shandong province,by analyzing the clinicopathological features and prognostic factors.</p><p><b>METHODS</b>Clinicopathological and follow-up data of 1 165 patients with gastric GIST between January 2000 and December 2013 from 23 tertiary referral hospitals in Shandong Province were collected to establish a database. The risk stratification of all cases was performed according to the National Institutes of Health(NIH) criteria proposed in 2008. Kaplan-Meier method was used to calculate the survival rate. Log-rank test and Cox regression model were used for univariate and multivariate prognostic analyses.</p><p><b>RESULTS</b>Among 1 165 cases of gastric GIST, 557 were male and 608 were female. The median age of onset was 60 (range 15-89) years. Primary tumors were located in the gastric fundus and cardia in 623 cases(53.5%), gastric body in 346 cases(29.7%), gastric antrum in 196 cases(16.8%). All the cases underwent resection of tumors, including endoscopic resection (n=106), local resection (n=589), subtotal gastrectomy(n=399), and total gastrectomy(n=72). Based on the NIH risk stratification, there were 256 cases (22.0%) at very low risk, 435 (37.3%) at low risk, 251 cases (21.5%) at intermediate risk, and 223 cases (19.1%) at high risk. A total of 1 116 cases(95.8%) were followed up and the median follow-up period was 40 (range, 1-60) months. During the period, 337 patients relapsed and the median time to recurrence was 34 (range 1-60) months. The 1-, 3-, and 5-year survival rates were 98.6%, 86.1% and 73.4%, respectively. The 5-year survival rates of patients at very low, low, intermediate, and high risk were 93.1%, 85.8%, 63.0% and 42.3% respectively, with a statistically significant difference (P=0.000). Multivariate analysis showed that primary tumor site (RR=0.580, 95%CI:0.402-0.835), tumor size (RR=0.450, 95%CI:0.266-0.760), intraoperative tumor rupture(RR=0.557, 95%CI:0.336-0.924), risk classification (RR=0.309, 95%CI:0.164-0.580) and the use of imatinib after surgery (RR=1.993, 95%CI:1.350-2.922) were independent prognostic factors.</p><p><b>CONCLUSIONS</b>The choice of surgical procedure for gastric GIST patients should be based on tumor size. All the routine procedures including endoscopic resection, local excision, subtotal gastrectomy and total gastrectomy can obtain satisfactory curative outcomes. NIH classification has a high value for the prediction of prognosis. Primary tumor site, tumor size, intraoperative tumor rupture, risk stratification and postoperative use of imatinib are independent prognostic factors in gastric GIST patients.</p>

Clinical value of plasma D-dimer detection in acute cerebral hemorrhage / 国际检验医学杂志

Objective To investigate the change and clinical application value of plasma D‐dimer in acute cerebral hemorrhage . Methods The plasma D‐dimer level was detected in 78 individuals of healthy physical examination(healthy control group) and 82 patients with acute cerebral hemorrhage .Results The plasma D‐dimer levels at admission(0 h) had no statistical difference among various groups(P> 0 .05) ;the D‐dimer level at 24 ,48 ,72 h in the small cerebral hemorrhage group was significantly higher than that in the healthy control group(P< 0 .05) ;the D‐dimer level in the massive cerebral hemorrhage group was significantly higher than that in the small cerebral hemorrhage group(P< 0 .05) ;the D‐dimer level in the small cerebral hemorrhage group reached the peak at 24 h ,while which in the massive cerebral hemorrhage group reached the peak at 48 h and was positively correlated with the intracranial hemorrhage volume(r= 0 .914 ,P= 0 .000 < 0 .05) .Conclusion The plasma D‐dimer level in the patients with acute cer‐ebral hemorrhage is obviously increased and shows the increasing trend with the intracranial hemorrhage volume increase ;the more the intracranial hemorrhage volume ,the longer the persistence time of high D‐dimer level .Therefore detecting plasma D‐dimer level has an important significance for monitoring the condition in the patients with acute cerebral hemorrhage .