Research advances in transcatheter arterial chemoembolization combined with targeted agents or anti-PD-1/PD-L1 monoclonal antibody in treatment of patients with unresectable hepatocellular carcinoma / 临床肝胆病杂志

Transcatheter arterial chemoembolization (TACE) is recommended by domestic and international guidelines for the treatment of patients with unresectable hepatocellular carcinoma (uHCC), and it is one of the most common treatment methods for patients with uHCC. The chemotherapy drugs commonly used in TACE for HCC include epirubicin, cisplatin, and fluorouracil, while it is still unclear which chemotherapy drug has a better clinical effect. This article summarizes the studies of different TACE regimens using different chemotherapy drugs in the treatment of patients with uHCC in the recent five years. TACE combined with sorafenib can significantly improve the survival of patients with advanced HCC and has been recommended for the treatment of such patients by Chinese Society of Clinical Oncology guidelines, and the efficacy of TACE combined with other tyrosine kinase inhibitors (TKI) has become a research hotspot. Studies have shown that compared with TACE combined with sorafenib in the treatment of patients with advanced HCC, TACE combined with lenvatinib can achieve a significantly longer progression-free survival time and a tendency of increase in median overall survival time. However, due to the variation of target receptors or downstream signals, resistance to molecular-targeted agents is still a challenging problem. TKI combined with immune checkpoint inhibitors may be a promising strategy for the treatment of patients with uHCC. Some studies suggest that triple therapy using TACE combined with TKIs and anti-PD-1/PD-L1 monoclonal antibody has better efficacy in improving the survival of patients with uHCC. This article reviews the studies of the efficacy and safety of TACE combined with targeted agents and TACE combined with anti-PD-1/PD-L1 monoclonal antibody in the treatment of patients with uHCC in the recent five years.

Post-stroke recrudescence / 中华神经医学杂志

Poststroke recrudescence (PSR) is a reappear phenomenon in the neurological symptoms of chronic stroke in the setting of toxic metabolic factors. Infection, hyponatremia, and use of benzodiazepine are important precipitants. In this paper, the risk factors, pathogenesis, clinical characteristics, diagnosis and treatment methods of PSR are reviewed to enhance the understanding of the disease among clinicians.

Experiences of diagnosis and treatment of fat embolism syndrome / 中华神经医学杂志

Objective To investigate the clinical characteristics of fat embolism syndrome (FES) and explore the diagnosis and therapy efficacy.Methods The etiology,clinical manifestations,laboratory and radiological characteristics,diagnosis,treatments and outcomes of 11 patients with FES,admitted to our hospital from 2004 to 2014,were retrospectively analyzed.Results There were 9 patients with traumatic long bone fracture,2 with artificial knee joint replacement in 11 patients.Disturbance of consciousness was noted in 10 patients,dyspnea in one in the first onset.There were 2 with "snow storm appearance" in chest X-ray,8 with abnormality in pulmonary CT and 3 with multiple cerebral infarction in MRI.The rates of final diagnosis and misdiagnosis within 72 h were 63.63％ and 36.36％,respectively.After comprehensive treatment,7 patients were cured,one was at vegetative state and 3 died,with a mortality rate of 27.2％.Conclusions The main causes of FES include traumatic long bone fracture and operation of joint.Early definite diagnosis and effective combined modality therapy are key points of successful treatment.