Efficacy and safety of camrelizumab combined with TACE for hepatocellular carcinoma: a systematic review and meta-analysis.

OBJECTIVE: Hepatocellular carcinoma (HCC) represents a highly lethal and recurrent neoplasm, with limited effective treatment regimens available. Camrelizumab, as a novel PD1 inhibitor combined with transcatheter arterial chemoembolization (TACE), has been widely used in the treatment of HCC. However, there remains a contentious debate regarding the clinical value of the TACE and camrelizumab combination. This study seeks to investigate the efficacy and safety of this combination treatment regimen in patients with HCC. MATERIALS AND METHODS: The related studies were retrieved from four online databases, including Pubmed, Cochrane Library, EMBASE, and Web of Science, up to June 1, 2023. The selection of studies was based on screening of titles, abstracts, and full-texts. The primary efficacy outcomes included complete response (CR), objective response rate (ORR), and disease control rate (DCR), while safety outcomes evaluated all treatment-related adverse events (AEs). Additionally, secondary outcomes such as overall (OS) and progression-free survival (PFS) were extracted for further survival analysis. The quality of the included trials was assessed using the MINORS tool. Publication bias was evaluated through funnel plot and Egger's test. RESULTS: A total of 17 publications involving 1,377 cases were included. The pooled CR rate, ORR, and DCR of the patients treated with TACE plus camrelizumab had a pooled CR rate of 8% (95% CI: 0.01-0.15, p=0.03), ORR of 47% (95% CI: 0.42-0.52, p<0.00001) and DCR of 82% (95% CI: 0.77-0.88, p<0.00001), respectively. Compared with a control group that did not receive TACE or camrelizumab, the pooled RR of CR rate, ORR, and DCR were 1.61 (95% CI: 1.27-2.04, p<0.0001), 1.56 (95% CI: 1.19-2.05, p=0.001) and 1.55 (95% CI: 1.19-2.03, p=0.001), respectively. Besides, the combination regimen can prolong the OS (HR=2.60, 95% CI: 2.25-3.02, p<0.00001) and PFS (HR=4.90, 95% CI: 1.94-12.38, p=0.0008). However, the incidence of treatment-related AEs was relatively high (77%), with 29% for grade 3 AEs. The most common AEs observed were pain (47%), fever (46%), hepatic function abnormalities (44%), hypoalbuminemia (39%), and hypertension (37%). The combination treatment did not increase the incidence of AEs compared to the control group, except for the hand-foot skin reaction (RR=0.85, 0.74-0.97, p=0.01), hepatic encephalopathy (RR=4.29, 2.51-7.35, p<0.00001) and nausea (RR=1.35, 1.13-1.61, p=0.001). CONCLUSIONS: Combination therapy of TACE plus camrelizumab has shown notable clinical benefits, improved survival, and a manageable safety profile in patients with HCC, but it is essential to monitor and manage the specific toxicities, especially for the camrelizumab-related AEs.

[Prevalence and predictors of intraplaque hemorrhage in stroke patients with intracranial atherosclerosis].

Objective: To investigate the prevalence and predictors of intraplaque hemorrhage (IPH) in ischemic stroke patients with intracranial atherosclerosis. Methods: Ischemic stroke patients with intracranial atherosclerosis who were consecutively admitted to Beijing Tsinghua Changgung Hospital from January 2017 to April 2018 were retrospectively analyzed. High-resolution magnetic resonance vessel wall imaging was used to assess atherosclerotic plaque characteristics of intracranial artery. Possible variables correlated with IPH were compared between IPH and no-IPH groups, as well as in symptomatic IPH and no symptomatic IPH groups. Logistic regression analysis was used to determine the predictors of all IPH and symptomatic IPH in intracranial artery. Results: A total of 276 ischemic stroke patients with intracranial atherosclerosis were included, of which, 41.3% (114/276) were IPH-postive, and 28.1%(32/114) of them were symptomatic. In multivariate regression analysis, maximum wall thickness was independently associated with the presence of all IPH and symptomatic IPH (OR=2.15, 95%CI: (1.42-3.24) and OR=3.46, 95%CI: (1.94-6.17), respectively). Conclusion: The prevalence of IPH in ischemic stroke patients with intracranial atherosclerosis is much higher than expected. Moreover, atherosclerosis plaque burden is independently associated with IPH, but it is non-specific in identifying symptomatic IPH.

[Paired comparative study of risk factors related to aneurysm rupture during hospitalization].

Objective: Aneurysm rupture during in-hospital period contributes to the exceedingly high morbidity and mortality of inpatients with untreated aneurysm. However, risk factors for aneurysm rupture during hospitalization were scarcely focused in previous reports. The aim of this study was to investigate the risk factors of aneurysm rupture during hospitalization and to propose clinical strategies improving prognosis. Methods: Patients with intracranial aneurysm (lA) rupture during hospitalization were identified in our prospective cohort of consecutive patients admitted to Beijing Tiantan Hospital between Jan 2014 to Dec 2017. The ruptured cases were randomly paired with control cases without rupture during hospitalization (controlling age and gender) in a proportion of 1∶2 from the cohort. An observational comparative study was conducted between the two groups. Results: Tevelve cases with IAs rupture during hospitalization were identified among 4 429 cases with IAs. Twenty-four control cases were matched for gender (male∶female=5∶7) and age distribution. A history of pre-hospital aneurysm rupture was indicated as a risk factor for IA rupture during hospitalization (OR=8.333, 95% CI 1.480-46.936, P=0.011). The irregular shape (OR=10.133, 95% CI 1.941-52.902, P=0.005)and an inflow angle<60°(OR=41.800, 95% CI 4.311-405.335, P=0.000)were morphologic factors associated with IA rupture of inpatients. Conclusions: A history of pre-hospital IA rupture, IAs with irregular shape and an inflow angle <60° were risk factors associated with IAs rupture of inpatients. Unfavorable outcomes were observed in cases with IA rupture during hospitalization. A one-stage hybrid surgical strategy combining diagnosis, evaluation and intervention could reduce the length of preoperative stay, as well as the rupture risk of inpatients with IAs.

[Evolution of the Origin of Jixuecao].

Jixuecao was first recorded in the Shennong bencaojing. The variety of plant referred to is undefined because of a lack of detailed description in the medical books of the Han and Tang dynasties. From the Song dynasty to the Republican period Jixuecao refers to Glechoma longituba (Nakai) Kupr. The name was also recorded as Jinqiancao instead of Jixuecao in the Bencao gangmu shiyi from the Qing dynasty to the Republican period, though it refers to the same plant. In recent times, Jixuecao has evolved to refer to Centella asiatica (L.) Urb, Jinqiancao now refers to Lysimachia christinae Hance, while G. longituba (Nakai) Kupr. is now called Lianqiancao. It is thus determined that G. longituba (Nakai) Kupr. alone is unequivocally the original plant referred to as Jixuecao, and has the longest medicinal history.

[Development of the harvest processing and application of Mulberry leaves].

Mulberry leaf was first recorded in the Shennong Bencao Jing(The Classic of Herbal Medicine)《》 on the list of drugs affixed, and first separate recorded in the Bencao Shiyi(Supplement to Materia Medica)《》. By checking Chinese herbs' literature of the harvest processing and application of mulberry leaves, we found that Mulberry leaves can be harvested in Summer and autumn before the Qing dynasty, but from Qing dynasty to present, those harvested in autumn and winter, which were called frost mulberry leaves or winter mulberry leaves, were seen as better. Before the Republic of China, mulberry leaves were dried in shade or on the fire, after that, they were dried in the sun. It can be found that the harvest processing of mulberry leaves was changing as time went on. The clinical application of mulberry leaves had multiplicity, depending on different picking time and different processing method. It is suggested that research of mulberry leaves on chemistry and pharmacology of picking time, processing method can result in new scientifically clinical application.

[Discussion on medicinal history and germplasm resource of Clinopodium Herba].

By sorting out the literature on materiamedica, it is found that medicinal history of ClinopodiumHerba is rather long which can be traced back to caoxuejiein Lüchan yan ben cao (Mountainous Materia Medica) with definite efficacy and usage; it is generally believed that the original plant of ClinopodiumHerba is Clinopodiumpolycephalum (Vaniot) C. Y. Wu et Hsuan and C. chinensis (Benth.) O. Kuntze are two separate species, also some scholarsclaim that C. polycephalum and C. chinensisare the same plant. But I think C. polycephalum is the main origin of ClinopodiumHerba, and the relationship of C. polycephalum and C. chinensis maybe a species and its variety.

[Evolution of the Origin of Herba Schizonepetae].

Herba Schizonepetae was firstly recorded in the Sheng nong ben caojing (Shennong's Materia Medica) with the title Jiasu. It could be sure that the original plant of Jiasu is Ocimumbasilicum L. ofLabiatae based on the record of Jiasu's name, morphology, edible property before the Song Dynasty. Beginning from the Ben cao tu jing (Illustrated Classic of Materia Medica) in the Song Dynasty, the source of this drug evolved as SchizonepetatenuisfoliaBriq. ofLabiatae, and it has been in use until now. Hence, the sources of Jiasu should be both O. basilicum L. and the co-existence of S. tenuisfolia Briq in the Qing Dynasty. It is claimed that the hometowns of those herb writers who considered the source ofOcimumbasilicum L. to be the producing areas of cultivation of the edible Ocimumbasilicum L. It was found that the source of Jiasu recorded in the Sheng nong ben cao jing should be O. basilicum L. , hence, it is suggested the title Jiasu should be recorded for the source of O. basilicum L, and the original plant of Herba Schizonepetae was Schizonepetatenuisfolia Briq. of Labiatae, and this medicine should be separately recorded. In fact, Jiasu and Herba Schizonepetae were two different kinds of medicines.

Apoptosis is related to imbalance of Th1/Th2-type cytokine in peripheral blood mononuclear cells of patients with chronic hepatitis B.

KEYWORDS: peripheral blood mononuclear cells; apoptosis; cytokine; hepatitis B virus.

The inhibition of vitamin K3 on rabbit fibroblast proliferation in vitro.

Vitamin K3 that is commonly used to treat hemorrhagic diseases can inhibit human lymphatic neoplasms in vitro. This study was undertaken to investigate the effects of vitamin K3 on rabbit conjunctival fibroblast proliferation in cell culture. Vitamin K3 was added to cultured rabbit conjunctival fibroblasts. Remarkable inhibition was observed at a concentration of 4 mg/l. Because of its lower toxicity, vitamin K3 may prove to be of significant value in the treatment of intraocular proliferative disorders.

Primary sacral tumors and their surgical treatment. A report of 87 cases.

From 1958 through 1988, 87 patients with primary sacral tumor were treated surgically. The lesions consisted of benign tumors (17 patients) such as neurofibroma, chordomas (41), giant cell tumors (21), and malignant growths (8). Fifty-nine patients sustained destruction of S1-3 vertebrae, and 28 had the neogrowth below S3. A total of 99 operations including 13 total and 17 subtotal excision of the sacrum, as well as 12 for recurrent tumors in 99 cases were performed. Ten operations for primary tumors resulted in 3 intraoperative and 7 postoperative deaths. Thus, 89 surgical attempts were stood by the patients. Sixty-seven patients were followed up with an average interval of 5.5 years. Sixty patients showed good functional results and resumed normal life and work, whereas urinary incontinence, constipation and weakness of ankles and feet occurred in 7. The factors conducive to surgical success were stressed. We conclude that with the exception of frank malignancy, surgery should be advised and actively adopted for primary sacral tumors.

Inter-hemispheric propagation of human mesial temporal lobe seizures: a coherence/phase analysis.

Intra- and inter-hemispheric propagation of ictal discharges was analyzed with computer techniques in 10 patients with complex partial seizures of mesial temporal lobe origin in whom depth electrodes had been stereotaxically implanted. Coherence and phase analysis of seizure discharges was used to detect the emergence of linear relationships between all possible pairs of surface and depth recording derivations both between and within hemispheres. This analysis included mesial temporal, lateral temporal, and frontal lobe sites during both the onset and inter-hemispheric propagation of 28 ictal episodes. Although strong intra-hemispheric coherences and linear phase spectra reliably emerged in both the epileptogenic and non-epileptogenic hemispheres during seizure onset and contralateral spread, these relationships were usually not observed for inter-hemispheric comparisons. Only 3 of 10 patients demonstrated some degree of consistency in the emergence of significant wideband coherences and linear phase spectra between left and right mesial temporal sites during the inter-hemispherics propagation of ictal discharges. Mesial temporal lobe sites which demonstrated such a relationship included the amygdala, pes hippocampi, and parahippocampal gyrus. In 7 of 10 patients, lateral temporal derivations were sampled during ictal events; the emergence of linear relationships between left and right lateral temporal derivations during inter-hemispheric propagation was observed for only two. Various frontal lobe sites were monitored in 3 of the 10 patients; the emergence of linear relationships was observed only between left and right orbitofrontal derivations in the one patient for whom this region was sampled. These results suggest that the hippocampal commissure, parts of the corpus callosum, and parts of the anterior commissure may be relatively unimportant for the inter-hemispheric propagation of mesial temporal seizures in man. Future studies in non-human primates may reveal that ictal discharges which originate in the mesial temporal region propagate preferentially via brain-stem pathways to contralateral homologous regions.