Comparison of drug-eluting bead with conventional transcatheter arterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: a randomized clinical trial.

BACKGROUND: Drug-eluting bead transarterial chemoembolization (DEB-TACE) has shown efficacy for treating hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). However, whether DEB-TACE is superior to conventional TACE (cTACE) remains unclear. OBJECTIVE: This randomized controlled trial aimed to compare the efficacy and safety of DEB-TACE versus cTACE in treating HCC with PVTT. METHODS: The study was conducted at a tertiary care center in Southeast China. HCC patients with PVTT were randomized at a 1:1 ratio into the DEB-TACE or cTACE groups. The primary endpoint was progression-free survival (PFS), and the secondary endpoints were overall survival (OS) and the incidence of adverse events (AEs). An independent review committee assessed the radiologic response according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST). AEs were assessed by the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Systemic therapies were not restricted. RESULTS: Between September 2018 and July 2020, 163 patients were randomized to undergo DEB-TACE ( n =82) or cTACE ( n =81). Nine patients were excluded, and 154 patients were included in the final analysis; the median age was 55 years (range, 24-78 years), and 140 (90.9%) were male. The median PFS in the DEB-TACE group was 6.0 months (95% CI, 5.0-10.0) versus 4.0 months (95% CI, 3.0-5.0) in the cTACE group (hazard ratio, 0.63; 95% CI, 0.42-0.95; P =0.027). The DEB-TACE group showed a higher response rate [51 (66.2%) vs. 36 (46.8%); P =0.0015] and a longer median OS [12.0 months (95% CI, 9.0-16.0) vs. 8.0 months (95% CI, 7.0-11.0), P =0.039] than the cTACE group. Multivariate analysis showed that the treatment group, ALBI score, distant metastasis and additional TKIs were the four independent prognostic factors correlated with PFS. In addition, the treatment group, PVTT group and combination with surgery were independently associated with OS. AEs were similar in the two groups, and postembolization syndrome was the most frequent AE. CONCLUSION: DEB-TACE is superior to cTACE in treating HCC patients with PVTT, demonstrating improved PFS and OS with an acceptable safety profile, and may thus emerge as a promising treatment strategy for HCC patients with PVTT. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1800018035.

Vaccines reduced hospital length of stay and fraction of inspired oxygen of COVID-19 patients: A retrospective cohort study.

Few studies have focused on the evaluation of vaccine effectiveness (VE) in mainland China. This study was to characterize the VE including the frequent symptoms, laboratory indices, along with endotracheal intubation, hospital length of stay (LoS), and survival status. This retrospective cohort study included patients with COVID-19 admitted to our hospital. Statistical comparisons of continuous variables were carried out with an independent Student's t-test or Mann-Whitney U test. For categorical variables, the Chi-square test and Fisher exact test were used. Multivariable regression analysis was performed to adjust the confounding factors such as age, gender, body mass index (BMI), residential area, smoking status, the Charlson comorbidity index (CCI) score, followed by investigating the effects of vaccination on critical ill prevention, reduced mortality and endotracheal intubation, LoS and inspired oxygen. This study included 549 hospitalized patients with COVID-19, including 222 (40.43 %) vaccinated participants and 327 (59.57 %) unvaccinated counterparts. There was no obvious difference between the two groups in typical clinical symptoms of COVID-19, clinical laboratory results and mortality. Multivariable analysis showed that COVID-19 vaccine obviously reduced LoS by 1.2 days (lnLoS = -0.14, 95 %CI[-0.24,-0.04]; P = 0.005) and decreased fraction of inspired oxygen by 40 % (OR: 0.60; 95 %CI[0.40,0.90]; P = 0.013) after adjusting age, gender, BMI, residential area, smoking status and CCI score. In contrast, vaccination induced reduction in the critically ill, mortality, and endotracheal intubation compared with the unvaccinated counterparts, but with no statistical differences. Vaccinated patients hospitalized with COVID-19 have a reduced LoS and fraction of inspired oxygen compared to unvaccinated cases in China.

A Convolutional Neural Network with Spatial Location Integration for Nearshore Water Depth Inversion.

Nearshore water depth plays a crucial role in scientific research, navigation management, coastal zone protection, and coastal disaster mitigation. This study aims to address the challenge of insufficient feature extraction from remote sensing data in nearshore water depth inversion. To achieve this, a convolutional neural network with spatial location integration (CNN-SLI) is proposed. The CNN-SLI is designed to extract deep features from remote sensing data by considering the spatial dimension. In this approach, the spatial location information of pixels is utilized as two additional channels, which are concatenated with the input feature image. The resulting concatenated image data are then used as the input for the convolutional neural network. Using GF-6 remote sensing images and measured water depth data from electronic nautical charts, a nearshore water depth inversion experiment was conducted in the waters near Nanshan Port. The results of the proposed method were compared with those of the Lyzenga, MLP, and CNN models. The CNN-SLI model demonstrated outstanding performance in water depth inversion, with impressive metrics: an RMSE of 1.34 m, MAE of 0.94 m, and R2 of 0.97. It outperformed all other models in terms of overall inversion accuracy and regression fit. Regardless of the water depth intervals, CNN-SLI consistently achieved the lowest RMSE and MAE values, indicating excellent performance in both shallow and deep waters. Comparative analysis with Kriging confirmed that the CNN-SLI model best matched the interpolated water depth, further establishing its superiority over the Lyzenga, MLP, and CNN models. Notably, in this study area, the CNN-SLI model exhibited significant performance advantages when trained with at least 250 samples, resulting in optimal inversion results. Accuracy evaluation on an independent dataset shows that the CNN-SLI model has better generalization ability than the Lyzenga, MLP, and CNN models under different conditions. These results demonstrate the superiority of CNN-SLI for nearshore water depth inversion and highlight the importance of integrating spatial location information into convolutional neural networks for improved performance.

Coupling coordination relationship between geology-geomorphology and ecology in Northeast China.

Northeast China is an important ecological barrier and commodity grain base in China. The coupling coordination relationship between geology-geomorphology and ecology has become a critical background condition for ecosystem protection and sustainable development. Taking Northeast China as a case (accounting for about 13% of China's land area), 9 divisions are divided according to the characteristics of regional ecology and geology-geomorphology, and 17 indicators are selected to build an evaluation index system. Methods of analytic hierarchy process, entropy weight and game theory are used to determine the index weights. Based on the coupling coordination degree (CCD) model, the spatial coupling coordination characteristics of geology-geomorphology and ecology are studied. The variation characteristics of the Normalized Difference Vegetation Index (NDVI) are evaluated by Sen+Mann-Kendall (Sen+MK) method. Our results are as follows. (1) The coupling between geology-geomorphology and ecology is strong, but the spatial differentiation of CCD is obvious. Nine divisions are evaluated as two high-level, three medium-level and three low-level coordination types and one mild imbalance type. (2) The plain divisions Ⅰ and Ⅳ where the typical black soil belt is located are high coordination types. Restricted by geology-geomorphological conditions or ecological conditions, mountain divisions Ⅲ and Ⅶ and plain division Ⅴ are moderate coordination types, mountain divisions Ⅱ and Ⅷ and plateau division Ⅸ are low coordination types, and mountain division Ⅵ is mild imbalance type. (3) The variation trend of NDVI shows a significant increase in divisions Ⅲ, Ⅴ, Ⅰ, Ⅱ and Ⅶ. it shows a significant decrease in part of divisions Ⅳ, Ⅵ, Ⅷ and Ⅸ, and ecological management and construction should be strengthened in these divisions. The research shows that the CCD model method is feasible for evaluating the relationship between geology-geomorphology and ecology and can provide eco-geological background information for Northeast China.

Complete Response of Hepatocellular Carcinoma with Macroscopic Vascular Invasion and Pulmonary Metastasis to the Combination of Drug-Eluting Beads Transarterial Chemoembolization and Huaier Granule: A Case Report.

BACKGROUND: Hepatocellular carcinoma (HCC) associated with macroscopic vascular invasion and distant metastasis is an advanced-stage disease with an extremely poor prognosis and low survival rate. Therefore, there is an urgent need to develop novel therapeutic strategies to extend the lives of patients with advanced HCC. CASE PRESENTATION: We represent a case of HCC with macroscopic vascular invasion and pulmonary metastasis responding dramatically to the combination treatment with drug-eluting beads transarterial chemoembolization (DEB-TACE) and Huaier granule. A 64-year-old man with hepatitis B virus (HBV)-induced liver cirrhosis was diagnosed with advanced HCC involved renal vein and inferior vena cava accompanied by pulmonary metastasis. The patient received three cycles of on-demand DEB-TACE from 9th September 2016 to 22nd August 2017 and combined with Huaier granule 20 g three times a day orally. Eight months following the treatment, complete response occurred with regression of HCC and vascular thrombus and disappearance of pulmonary metastasis. The levels of AFP had decreased from 8165.8ng/mL to within the normal range (1.7 ng/mL). This is the first case report of complete response of HCC to the combination treatment with DEB-TACE and Huaier granule. At the most recent follow-up, he remained in remission 36 months after cessation of treatment without clinical or imaging evidence of disease recurrence. The current overall survival is 54 months since the initial treatment. CONCLUSION: Data from this clinical case report suggest that the combination treatment with DEB-TACE and Huaier granule is a promising therapeutic option for advanced HCC with macroscopic vascular invasion and distant metastasis.