Efficacy and Safety of Hepatic Arterial Infusion Therapy with Cinobufacini in Advanced Hepatocellular Carcinoma with Macrovascular Invasion: A Retrospective Cohort Study.

Background: The presence of macrovascular invasion (MVI) is associated with poor prognosis in advanced hepatocellular carcinoma (HCC). This study aims to evaluate the efficacy and safety of Cinobufacini therapy via hepatic arterial infusion (HAI) in advanced HCC patients with MVI. Methods: The clinical records of 130 consecutive patients with unresectable advanced HCC and MVI who had received Cinobufacini or cisplatin plus 5-fluorouracil (CF) treatment via HAI were retrospectively analyzed. The therapeutic efficacy, overall survival (OS), progression-free survival (PFS), and adverse events were compared between the two treatment groups. Results: The Cinobufacini group demonstrated significant curative effects on treatment via HAI compared with the CF group, including the objective response rate (44.9% vs 27.9%, P=0.048), the median OS (14.8 months vs 11.1 months, P=0.010), and the median PFS (10.3 months vs 6.0 months, P=0.006). Result in subgroup analysis of portal vein invasion grade supported the efficacy in Cinobufacini treatment, especially in the median OS of Vp1-2 (18.3 months vs 14.3 months, P=0.043) and Vp3 (15.0 months vs 11.4 months, P=0.046), as well as the median PFS of Vp1-2 (14.8 months vs 10.2 months, P=0.028) and Vp3 (10.8 months vs 6.6 months, P=0.033) compared with CF treatment. Cox proportional hazards model and forest plot analysis of factors confirmed the survival benefit from HAI with Cinobufacini over CF (hazard ratio [HR], 0.61; 95% CI: 0.40-0.91; P=0.010). Multivariable analysis identified portal vein invasion grade (Vp4; HR, 1.78; 95% CI: 1.03-2.16; P=0.032) and AFP (>1000; HR, 1.61; 95% CI: 1.08-1.91; P=0.039) as the independent factors for prognosis. Moreover, the total incidence of adverse events in the Cinobufacini group was significantly lower than in the CF group (60.9% vs 82.0%, P=0.009). Conclusion: Cinobufacini therapy via HAI is a viable strategy for curing advanced HCC with MVI, due to prolonged survival and a superior safety profile.

Efficacy of denosumab on bone metabolism and bone mineral density in renal transplant recipients: A systematic review and meta-analysis.

BACKGROUND: Post-transplant bone disease (PTBD) is a common complication in kidney transplant recipients. This systematic review and meta-analysis evaluates the efficiency and safety of denosumab for the treatment of PTBD in kidney transplant recipients. METHODS: Comprehensive search of PubMed Central, SCOPUS, EMBASE, MEDLINE, Cochrane trial registry, Google Scholar, and Clinicaltrials.gov databases was done for studies, published until April 2023. Primary outcomes included changes in bone mineral density (BMD) and T-scores. Secondary outcomes included incidence of fractures, alterations in bone turnover markers, and the incidence of adverse events. RESULTS: Eleven studies with a total of 511 participants that underwent kidney transplant were included. Denosumab treatment resulted in a significant improvement in lumbar spine BMD (SMD: -0.31, 95% CI: -0.56 to -0.06) and T-score (SMD: -1.07, 95% CI: -1.51 to -0.64), while no differences were detected in hip/femoral neck BMD and the T-score. There was no marked change in the fracture incidence (OR: 0.42, 95% CI: 0.06 to 3.07). However, patients who received denosumab treatment had an increased incidence rate of hypocalcemia (OR: 9.98, 95% CI: 1.72 to 57.88). CONCLUSIONS: Denosumab treatment may improve lumbar spine BMD and T-scores in patients with PTBD. However, it does not significantly affect fracture incidence and may increase the risk of hypocalcemia. These findings underline the necessity for well-powered, randomized controlled trials to further clarify the role of denosumab in managing PTBD.

[Meta-analysis of energetic nutritional intervention for stable chronic obstructive pulmonary disease patients].

OBJECTIVE: To conduct a meta-analysis of randomized controlled trials (RCTs) to clarify whether nutritional intervention (caloric supplementation for at least 2 weeks) can improve the nutritional status and the pulmonary functions, while reduce the frequency of acute exacerbation or mortality of patients with stable COPD. METHODS: RCTs were identified from databases including Medline and Embase, and a hand search for references was also conducted. Two reviewers independently selected the trials for inclusion, assessed the methodological quality of each study, and extracted the data Within each trial and for each outcome, an effect size was calculated. The effect sizes were then pooled by a random or fixed effects model according to the heterogeneity tested among the studies. RESULTS: From 143 references, 10 RCTs (including 354 participants) were included in this meta-analysis. The results of the study, which included body weight (BW), mid arm muscle circumference (MAMC), triceps skinfold thickness (TSF), forced expiratory volume in one second (FEV1) and forced vital capacity (FVC), were expressed in standardized mean difference (SMD, 95% CI): 0.05 (-0.18 - 0.28) kg, -0.16 (-0.57 - 0.25) cm, 0.41 (0.01 - 0.82) cm, 0.04 (-0.39 - 0.48) ml and 0.03 (- 0.40 - 0.46) ml. The effect of energetic nutritional intervention for patients with stable COPD was insignificant; the 95% CI around the pooled effect sizes all included zero. CONCLUSION: Nutritional intervention by caloric supplementation had no effect on improving the nutritional status and the pulmonary functions in patients with stable COPD. There was no evidence that the frequency of acute exacerbation or mortality could be reduced.