Biliary tract cancers(BTCs),encompassing gallbladder cancer and intra-and extra-hepatic cholangiocarcinoma,primarily manifest as highly invasive adenocarcinomas with a notably poor prognosis.BTCs typically initiate insidiously,and even surgically resectable patients confront a heightened risk of recurrence,with postoperative adjuvant chemotherapy offering limited survival benefits.For unresectable or metastatic BTCs,systemic antitumor drug therapy remains the primary treatment.Recently,significant progress has been made in the treat-ment of advanced BTCs with the emergence of immune checkpoint inhibitors(ICIs)and molecularly targeted drugs alongside traditional chemotherapy.This progress has substantially broadened clinical treatment options and improved patient prognoses.Combining first-line chemotherapy with immunotherapy has emerged as a favorable treatment strategy over conventional chemotherapy.Additionally,the com-bination of chemotherapy with immunotherapy,anti-angiogenic targeted therapy,dual immunotherapy,or dual immunotherapy has exhib-ited promising outcomes.Explorations into second-line immunotherapy have also been actively explored.This article provides an overview of the current status and recent advances in immunotherapy for advanced BTCs.

As one of the important contents and links of doctor-patient communication, the quality of breaking bad news will affect the development of doctor-patient relationship. Bad news informed not only involves the feedback of clinical medical diagnosis results, but also involves special knowledge training and clinical experience accumulation, as well as ethical, legal, social custom and other factors. At present, it is still a difficult problem troubling physicians in the medical environment. From the different perspectives of doctors, patients and family members, this paper sorted out the domestic and international status of breaking bad news, revealed its internal dilemmas, and summarized the informing strategies to cope with these dilemmas, with a view to providing references for hospital managers and medical staff to earlier identify and properly inform, helping both doctors and patients to get rid of the dilemma of notification and improve the doctor-patient relationship.

OBJECTIVETo compare clinical efficacy differences between"regulating conception-governor vessel" acupuncture method and clomiphene for infertility of polycystic ovarian syndrome (PCOS).

METHODSOne hundred patients of PCOS were randomly assigned into an observation group and a control group, 50 cases in each one. The patients in the observation group were treated with"regulating Conception-Governor Vessel" acupuncture method at Zhongwan (CV 12), Guanyuan (CV 4), Qihai (CV 6), Zhongji (CV 3), Mingmen (GV 4), Yaoyangguan (GV 3) and Yaoshu (GV 2). The acupuncture treatment started at the end of menstruation, once every other day; after four treatments, the follicle was tested with B ultrasound; when follicle was longer than 18 mm or above, the acupuncture treatment was given once a day until follicle was discharged and acupuncture treatment finished. The patients in the control group were treated with oral administration of clomiphene from 5 days into menstruation, 50 mg per day for 5 consecutive days. Both groups were treated for three menstruation cycle. The menstrual cycles, endometrial thickness, endometrium types (A, B and C), cervical mucus scores, basal body temperature (BBT), cases of ovulation, cases of pregnancy were observed.The levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E), prolactin (PRL), progesterone (P) and testosterone (T) in serum were detected before and after the treatment.

RESULTSAfter the treatment, the menstrual cycles were shortened (both<0.05),the endometrial thickness and cervical mucus scores were increased in the two groups (<0.05,<0.01); the improvement of endometrial thickness and cervical mucus score in the observation group were higher than those in the control group (both<0.01). The percentages of type-A endometrium in both groups were higher than those before the treatment (both<0.05); the number of type-A endometrium in the observation group was higher than that in the control group (<0.05). The ovulation rate was 88.0% (44/50) in the observation group, which was superior to 70.0% (35/50) in the control group (<0.05). After treatment, the levels of LH were reduced in the two groups (<0.05,<0.01), which was more significant in the observation group (<0.05).

CONCLUSIONSThe"regulating Conception-Governor Vessel" acupuncture method could improve menstrual cycles, increase endomet-rial thickness and promote the development of follicles in PCOS patient; in addition, it could decrease serum LH level, improve the ovarian functions and increase ovulation rate, which is superior to oral administration of clomiphene.

ObjectiveTo evaluate the reliability of Foot Posture Index (FPI-6) for Chinese adolescent idiopathic scoliosis (AIS) patients. MethodsFrom July, 2021 to April, 2022, 35 AIS patients were recruited from Guangdong Second Hospital of Traditional Chinese Medicine and non-specially. They were evaluated with FPI-6 by two raters on the same days, and by one of the raters a week later. The intra-class correlation coefficient (ICC) of inter-rater and test-retest was calculated and Bland-Altman diagram was drawn; the correlation among the items score and total score was analyzed with Spearman correlation coefficient. ResultsThe ICCs were above 0.75 except talar head palpation, and eversion and inversion of the calcaneus. There was no significant difference in foot posture classification among the three evaluation results (χ² = 4.000, P > 0.05). There was a significant positive correlation between each item score and total score (r > 0.3, P < 0.01). ConclusionFPI-6 is reliable for people with mild AIS.

Objective To analyze the characteristics of the muscle strength around the knee joint of chondromalacia patellae patients, and to explore the difference with normal people.Methods In March, 2021, 70 knee-onset chondromalacia patellae patients (experimental group) and 35 normal people (control group) were measured isokinetic muscle strength of flexion and extension of knee in angular velocities of 60°/s and 180°/s.Results At 60°/s and 180°/s, the peak torque, the peak torque-to-weight ratio and the total work of the flexor and extensor muscles on the affected side in the experimental group were lower than that of the control group (U > 1097.0, P<0.001). The peak torque, the peak torque-to-weight ratio and the total work of the flexor and extensor muscles at 60°/s and extensor muscles at 180°/s were lower on the affected side than on the healthy side in the experimental group (|Z| > 2.121, P<0.05). The peak torque ratios at 60°/s and 180°/s were more in the affected knees than in the healthy knees of experimental group and in the control group (U > 1810.0, |Z| >3.691, P<0.01).Conclusion The explosive force and endurance of the knee flexor and extensor has weakened in patients with chondromalacia patellae, and there is imbalance in knee joint muscle strength.