Objective To retrospectively analyze multicenter data from domestic sources, aiming to explore the link between intrahepatic cholangiocarcinoma (ICC) tumor size and prognosis, establishing a classification system based on tumor size. Methods Between December 2011 and September 2018, 280 ICC patients from 13 hospitals were included. The tumor size prognosis cutoff was identified by the minimum P-value method, and the classification's overall survival related effectiveness was assessed by Kaplan-Meier analysis. Results All 280 patients were divided into the group of tumor maximum diameter ≤4 cm and >4 cm. Tumor size was confirmed as an independent prognosis factor by multivariate COX regression analysis (HR=2.110, 95% CI: 1.358-3.280). Conclusions The tumor size dichotomy classification system based on the Chinese patient group can expediently predict ICC prognosis and offers an important basis for selecting post-operative individualized adjuvant therapy and follow up plans.

Background and Aims:Intrahepatic cholangiocarcinoma(ICC)is a highly malignant liver tumor,with an increasing incidence worldwide,particularly in Asia.Although radical surgical resection is currently the only potentially curative treatment,the high recurrence rate and low postoperative overall survival(OS)rate of ICC remain major clinical challenges.Adjuvant therapy(AT)and neoadjuvant therapy(NAT)are important strategies to reduce postoperative recurrence and prolong OS.Several studies have shown certain efficacy of these treatments.However,the specific efficacy and safety of combined NAT and AT in ICC treatment require further validation.This study was conducted to evaluate the value of combining NAT and AT in improving the therapeutic outcomes of ICC patients through a multicenter retrospective analysis,so as to provide scientific evidence for optimizing treatment strategies.Methods:The clinicopathologic data of 576 patients with ICC who underwent radical resection and were pathologically confirmed from 13 hospitals in China between December 2011 and December 2017 were retrospectively collected.Patients were grouped based on their treatment modality:NAT+AT group,AT group,and non-NAT/AT group.The three patient groups were matched pairwise in a 1∶1 ratio using propensity score matching(PSM)to balance baseline data.The Kaplan-Meier method was used to analyze OS and disease-free survival(DFS),and subgroup analyses were conducted according to the 8th edition of the AJCC TNM staging system.Results:A total of 395 ICC patients were included in the final analysis,with 42 patients(10.6%)in the NAT+AT group,62 patients(15.7%)in the AT group,and 291 patients(73.7%)in the non-NAT/AT group.Before PSM,significant differences were observed between groups in terms of CA19-9,liver function Child-Pugh classification,intraoperative blood loss,surgical margin,differentiation grade,vascular invasion,ECOG score,and lymph node dissection ratio(all P<0.05).After PSM,there were no significant differences in baseline characteristics between the groups(all P>0.05).After matching,the median OS and DFS in the NAT+AT group were significantly better than in the AT and non-NAT/AT groups(both P<0.05),while there were no significant differences in OS and DFS between the AT and non-NAT/AT groups(both P>0.05).Subgroup analysis showed that in TNM stage I patients,DFS in the NAT+AT group was significantly better than in the non-NAT/AT group(P<0.05),but OS was not significantly different(P>0.05).In TNM stage Ⅱ and Ⅲ patients,both OS and DFS in the NAT+AT and AT groups were significantly better than in the non-NAT/AT group(both P<0.05),and DFS in the NAT+AT group was significantly better than in the AT group in TNM stage Ⅲ patients(P<0.05).Conclusion:NAT combined with AT provides better survival benefits for patients with locally advanced ICC,but its benefit for early-stage ICC patients is limited.However,the retrospective design and sample size limitations of this study may affect the stability of the results,and future large-sample,multicenter,prospective studies are needed for further validation.

OBJECTIVE: To analyze the disease patterns and acupoint selection characteristics of acupuncture for epilepsy in ancient acupuncture texts, providing references and ideas for clinical acupuncture treatment of epilepsy. METHODS: Texts from the Chinese Medical Classics (5th edition) regarding acupuncture for epilepsy are reviewed. The frequency of acupoints, meridian association, distribution, specific points, corresponding epilepsy subtypes, and needling techniques are statistically analyzed. The Apriori algorithm is used for association rule analysis, and a complex network analysis is conducted for high-frequency acupoints and their corresponding subtypes and treatments. RESULTS: A total of 205 acupuncture prescriptions are identified. Ancient texts favored differentiation-based treatments for epilepsy, primarily classified into epilepsy, wind epilepsy, and five epilepsy. Commonly used acupoints include Baihui (GV20), Jiuwei (CV15), Shenmen (HT7), Shenting (GV24), and Xinshu (BL15), with a focus on the acupoints of the governor vessel, the bladder meridian, and the conception vessel. The acupoints on the head, face are combined with the acupoints on the limbs, with skillful use of the five-shu points and intersection acupoints. The most frequent combinations are Shenmen (HT7)-Baihui (GV20), Shenting (GV24)-Baihui (GV20), and Xinshu (BL15)-Shenmen (HT7). Visual network analysis revealed that Baihui (GV20)-Shenting (GV24), Baihui (GV20)-Shenmen (HT7), and Baihui (GV20)-Zhaohai (KI6) are core acupoint combinations. Treatment mainly involved moxibustion or combined acupuncture and moxibustion. CONCLUSION The acupoint selection for epilepsy treatment in ancient texts is precise, frequently using Baihui (GV20), Jiuwei (CV15), Shenmen (HT7), Shenting (GV24), and Xinshu (BL15), etc., with emphasis on calming epilepsy, awakening the spirit, relaxing tendons, and nourishing the heart.
Acupuncture Points ; Humans ; Epilepsy/history* ; History, Ancient ; Acupuncture Therapy/history* ; Medicine in Literature/history* ; Meridians ; China

Objective:To investigate the effects of different doses of dexmedetomidine (DEX) pretreatment combined with intraoperative nalbuphine anesthesia on hemodynamics and recovery quality in patients undergoing transabdominal myomectomy.Methods:A total of 100 patients scheduled for elective transabdominal myomectomy at Mingguang People’s Hospital were selected from Jan. 2021 to Jan. 2025 were randomly divided into four groups ( n=25) : the control group (group C) received saline infusion before anesthesia induction; the low-dose (group D1), medium-dose (group D2), and high-dose DEX groups (group D3) received 0.5, 1.0, and 1.5 μg/kg DEX, respectively. All patients followed a unified anesthesia induction and maintenance protocol. Intraoperative hemodynamic parameters (MAP, HR) were monitored, and postoperative recovery time, Ramsay sedation score, and VAS pain score were assessed. Adverse reactions were recorded. Results:The medium-dose DEX group (group D2) demonstrated the best performance in hemodynamic stability, recovery quality, and adverse reaction control. Group D2 showed the smallest fluctuations in MAP and HR, the shortest recovery time (12.31±2.11 min), the lowest postoperative VAS score (2.11±0.82 points), and the lowest incidence of postoperative agitation (4.00%). The high-dose DEX group (group D3) exhibited excessive inhibition, leading to significantly higher incidences of hypotension (24.00%) and bradycardia (24.00%), as well as prolonged recovery time (20.12±3.52 min). The low-dose DEX group (group D1) showed limited effects, with no significant differences compared to the control group.Conclusion:Pretreatment with 1.0 μg/kg DEX combined with nalbuphine anesthesia provides the best clinical outcomes in transabdominal myomectomy, effectively stabilizing hemodynamics, optimizing recovery quality, and reducing adverse reactions. Insufficient or excessive doses may diminish its benefits.

Background and Aims:Intrahepatic cholangiocarcinoma(ICC)is a highly malignant liver tumor,with an increasing incidence worldwide,particularly in Asia.Although radical surgical resection is currently the only potentially curative treatment,the high recurrence rate and low postoperative overall survival(OS)rate of ICC remain major clinical challenges.Adjuvant therapy(AT)and neoadjuvant therapy(NAT)are important strategies to reduce postoperative recurrence and prolong OS.Several studies have shown certain efficacy of these treatments.However,the specific efficacy and safety of combined NAT and AT in ICC treatment require further validation.This study was conducted to evaluate the value of combining NAT and AT in improving the therapeutic outcomes of ICC patients through a multicenter retrospective analysis,so as to provide scientific evidence for optimizing treatment strategies.Methods:The clinicopathologic data of 576 patients with ICC who underwent radical resection and were pathologically confirmed from 13 hospitals in China between December 2011 and December 2017 were retrospectively collected.Patients were grouped based on their treatment modality:NAT+AT group,AT group,and non-NAT/AT group.The three patient groups were matched pairwise in a 1∶1 ratio using propensity score matching(PSM)to balance baseline data.The Kaplan-Meier method was used to analyze OS and disease-free survival(DFS),and subgroup analyses were conducted according to the 8th edition of the AJCC TNM staging system.Results:A total of 395 ICC patients were included in the final analysis,with 42 patients(10.6%)in the NAT+AT group,62 patients(15.7%)in the AT group,and 291 patients(73.7%)in the non-NAT/AT group.Before PSM,significant differences were observed between groups in terms of CA19-9,liver function Child-Pugh classification,intraoperative blood loss,surgical margin,differentiation grade,vascular invasion,ECOG score,and lymph node dissection ratio(all P<0.05).After PSM,there were no significant differences in baseline characteristics between the groups(all P>0.05).After matching,the median OS and DFS in the NAT+AT group were significantly better than in the AT and non-NAT/AT groups(both P<0.05),while there were no significant differences in OS and DFS between the AT and non-NAT/AT groups(both P>0.05).Subgroup analysis showed that in TNM stage I patients,DFS in the NAT+AT group was significantly better than in the non-NAT/AT group(P<0.05),but OS was not significantly different(P>0.05).In TNM stage Ⅱ and Ⅲ patients,both OS and DFS in the NAT+AT and AT groups were significantly better than in the non-NAT/AT group(both P<0.05),and DFS in the NAT+AT group was significantly better than in the AT group in TNM stage Ⅲ patients(P<0.05).Conclusion:NAT combined with AT provides better survival benefits for patients with locally advanced ICC,but its benefit for early-stage ICC patients is limited.However,the retrospective design and sample size limitations of this study may affect the stability of the results,and future large-sample,multicenter,prospective studies are needed for further validation.

Objective:To investigate the effects of different doses of dexmedetomidine (DEX) pretreatment combined with intraoperative nalbuphine anesthesia on hemodynamics and recovery quality in patients undergoing transabdominal myomectomy.Methods:A total of 100 patients scheduled for elective transabdominal myomectomy at Mingguang People’s Hospital were selected from Jan. 2021 to Jan. 2025 were randomly divided into four groups ( n=25) : the control group (group C) received saline infusion before anesthesia induction; the low-dose (group D1), medium-dose (group D2), and high-dose DEX groups (group D3) received 0.5, 1.0, and 1.5 μg/kg DEX, respectively. All patients followed a unified anesthesia induction and maintenance protocol. Intraoperative hemodynamic parameters (MAP, HR) were monitored, and postoperative recovery time, Ramsay sedation score, and VAS pain score were assessed. Adverse reactions were recorded. Results:The medium-dose DEX group (group D2) demonstrated the best performance in hemodynamic stability, recovery quality, and adverse reaction control. Group D2 showed the smallest fluctuations in MAP and HR, the shortest recovery time (12.31±2.11 min), the lowest postoperative VAS score (2.11±0.82 points), and the lowest incidence of postoperative agitation (4.00%). The high-dose DEX group (group D3) exhibited excessive inhibition, leading to significantly higher incidences of hypotension (24.00%) and bradycardia (24.00%), as well as prolonged recovery time (20.12±3.52 min). The low-dose DEX group (group D1) showed limited effects, with no significant differences compared to the control group.Conclusion:Pretreatment with 1.0 μg/kg DEX combined with nalbuphine anesthesia provides the best clinical outcomes in transabdominal myomectomy, effectively stabilizing hemodynamics, optimizing recovery quality, and reducing adverse reactions. Insufficient or excessive doses may diminish its benefits.

Objective To explore the core acupoints and compatibility rules of acupuncture and moxibustion for epilepsy by using complex network method. Methods A prescription database was established through inclusion and exclusion criteria for searching literatures for databases from China National Knowledge Infrastructure, VIP, Wanfang, Web of Science, EMBASE, and Pubmed. SPSS Modeler software was used to analyze the frequency and correlation of acupoints, and Gephi0.10.1 software was used to establish a complex network model to explore the core acupoints and acupoint selection rules of prescriptions for epilepsy. Results Ultimately, 144 valid literatures were included, 199 prescriptions were extracted, involving 102 acupoints. Baihui acupoint had the highest frequency of use, specific acupoints were mainly Five-shu acupoint, the Eight Meridian Intersection acupoint, and the Back-shu acupoint. In selection of meridians, most acupoints were selected from governor meridian. Association rule analysis showed that Baihui-Taichong had the highest level of support and confidence. The analysis of complex network topology showed that 36 acupoints such as Baihui, Dazhui, Yaoqi and Fenglong were the core acupoints in the treatment of epilepsy by acupuncture and moxibustion. The analysis of acupoint communities revealed three major acupoint groups including governor meridian passing through treatment group, far and near matching acupoint group of the four limbs and head, and differentiation group of Zang-fu and body fluid for epilepsy treatment. Conclusion Acupoint compatibility of epilepsy by acupuncture and moxibustion should be mainly based on principle of the governor meridian combined with the differentiation of viscera and body fluid, and attention should be paid to distal-proximal point association.

Objective:To analyze the medication characteristics of ancient prescriptions for pediatric epilepsy (PE) through data mining; To summarize the compatibility law; To provide a reference for the treatment selection of Chinese materia medica and the development of patent drugs related to PE in clinic.Methods:Those with definite composition, dosage and efficacy for the treatment of PE was screened from the data of TCM prescription designed by Institute of Traditional Chinese Medicine Information, China Academy of Traditional Chinese Medicine. Excel 2013 was used to analyze the frequency of Chinese materia medica and its flavor and meridian tropism in the included prescriptions. The arules package in R 3.6.3 was used for association analysis based on Apriori algorithm. The sankey package and ggraph package of R 3.6.3 were used to draw the network diagram of the property, taste, meridian tropism and association rules of high-frequency Chinese medicine, so as to realize data visualization.Results:A total of 360 ancient prescriptions for the treatment of PE were included, and the dosage form was mainly pills. Most of the prescriptions were composed of 1 to 10 kinds of Chinese materia medica, with a total of 192 (53.33%, 192/360) prescriptions. 152 kinds of Chinese materia medica were included. The most commonly used types of Chinese materia medica were Glycyrrhizae Radix et Rhizoma, Moschus, Saposhnikoviae Radix, Gastrodiae Rhizoma, and Aconiti Lateralis Radix Praeparata. The properties of high-frequency Chinese materia medica (frequency≥30) were characterized by warm and mild, and the tastes were mainly pungent, bitter and sweet, and the meridians were mainly spleen and liver meridians. Through Apriori association analysis, the commonly used combination drugs were Bovis Calculus-Moschus, Ginseng Radix et Rhizoma-Poria and Saposheikovize Radix-Glycyrrhizae Radix et Rhizoma. Similarly, the commonly used triple drugs included Gastrodiae Rhizoma-Aconiti Lateralis Radix Praeparata-Bombyx Batryticatus, Poria-Glycyrrhizae Radix et Rhizoma-Ginseng Radix et Rhizoma, and Moschus-Bovis Calculus-Realgar.Conclusions:The ancient prescriptions for the treatment of PE is mainly composed of wind-calming, resuscitation and tonifying drug. The core prescription ideas of the ancient prescriptions are as follows: dispelling phlegm and dispelling wind, warming the meridian and dispelling yang, resuscitating and relieving spasms, clearing heat and reducing depression, and tonifying qi and blood.

Objective:To investigate the evaluation efficacy and predictive prognostic value of alpha-fetoprotein (AFP) response in tyrosine kinase inhibitors (TKIs) in combination with PD-1 inhibitors (α-PD-1) for intermediate-to-advanced hepatocellular carcinoma (HCC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 205 patients with intermediate-to-advanced HCC who were admitted to 9 medical centers, including Mengchao Hepatobiliary Hospital of Fujian Medical University et al, from March 2020 to July 2022 were collected. There were 178 males and 27 females, aged (52±12)years. Based on AFP response at 6-8 weeks after treatment, patients were divided into the AFP response group (AFP level decreased by ≥50% compared to baseline) and the AFP no response group (AFP level decreased by <50% compared to baseline). Observation indicators: (1) AFP response evaluation of anti-tumor efficacy; (2) comparison of patient prognosis; (3) analysis of factors affecting patient prognosis. Measurement data with normal distrubution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range) and M( Q1, Q3). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. The Kaplan-Meier method was used to draw survival curve and calculate survival rate, and the Log-Rank test was used for survival analysis. The COX proportional risk model was used for univariate analysis and the COX stepwise regression model was used for multivariate analysis. Results:(1) AFP response evaluation of anti-tumor efficacy. Before treatment, all 205 patients were positive of AFP, with a baseline AFP level of 1 560(219,3 400)μg/L. All 205 patients were treated with TKIs in combination with α-PD-1, and the AFP level was 776(66,2 000)μg/L after 6 to 8 weeks of treatment. Of the 205 patients, 88 cases were classified as AFP response and 117 cases were classified as AFP no response. According to the response evaluation criteria in solid tumors version 1.1, the objective response rate (ORR) and disease control rate (DCR) were 42.05%(37/88) and 94.32%(83/88) in patients of the AFP response group and 16.24% (19/117) and 64.10% (75/117) in patients of the AFP no response group, showing significant differences between them ( χ2=16.846, 25.950, P<0.05). According to the modified response evaluation criteria in solid tumors, the ORR and DCR were 69.32% (61/88) and 94.32% (83/88) in patients of the AFP response group and 33.33% (39/117) and 64.10% (75/117) in patients of the AFP no response group, showing significant differences between them ( χ2=26.030, 25.950, P<0.05). (2) Comparison of patient prognosis. All 205 patients were followed up for 12.4(range, 2.4-34.0)months after treatment. The median progression free survival time and total survival time were 5.5 months and 17.8 months, respectively. The 1-year, 2-year progression free survival rates were 20.8% and 7.2%, and the 1-year, 2-year overall survival rates were 68.7% and 31.5%, respectively. The median progression free survival time, 1-year and 2-year progression free survival rates were 9.7 months, 39.6% and 14.2% in patients of the AFP response group and 3.7 months, 7.8% and 2.0% in patients of the AFP no response group, showing a significant difference in progression free survival between them ( χ2=43.154, P<0.05). The median overall survival time, 1-year and 2-year overall survival rates were not reached, 85.2% and 56.3% in patients of the AFP response group and 14.6 months, 56.3% and 14.5% in patients of the AFP no response group, showing a significant difference in overall survival between them ( χ2=33.899, P<0.05). (3) Analysis of factors affecting patient prognosis. Results of multivariate analysis showed that invasion of large blood vessels, extrahepatic metastasis, combined hepatic artery intervention therapy, and AFP response were independent factors influencing progression free survival in patients with intermediate-to-advanced HCC who were treated with TKIs in combination with α-PD-1 ( hazard ratio=1.474, 1.584, 0.631, 0.367, 95% confidence interval as 1.069-2.033, 1.159-2.167, 0.446-0.893, 0.261-0.516, P<0.05), and Eastern Cooperative Oncology Group score, invasion of large blood vessels, extrahepatic metastasis, and AFP response were independent factors influencing overall survival in patients with intermediate-to-advanced HCC who were treated with TKIs in combination with α-PD-1 ( hazard ratio= 1.347, 1.914, 1.673, 0.312, 95% confidence interval as 1.041-1.742, 1.293-2.833, 1.141-2.454, 0.197-0.492, P<0.05). Conclusions:AFP response at 6-8 weeks after treatment can effectively evaluate anti-tumor efficacy of TKIs in combination with α-PD-1 for intermediate-to-advanced HCC. AFP response is the independent factor influencing progression free survival and overall survival in patients with intermediate-to-advanced HCC who were treated with TKIs in combination with α-PD-1.

The"season-visceral-related"theory originated from Huangdi Neijing,and its content contains the"holism of five viscera"and"correspondence between nature and humans"in the theoretical system of traditional Chinese medicine(TCM).Recently,the prevalence of post-stroke cognitive impairment(PSCI)has gradually increased with the increasing incidence of stroke.TCM believes that PSCI is located in the brain,however,the causative factors such as phlegm,depression,deficiency,and stasis are caused by the lesions of the five zang viscera.Therefore,PSCI can not be treated with the brain alone.Based on the"season-visceral-related"theory,this article discusses the etiology,pathogenesis,and treatment ideas for PSCI from the four seasons and five zang viscera.Xiaoyao Pill was selected as a treatment for patients with qi imbalance in spring to disperse stagnated liver qi to relieve qi stagnation.Tianwang Buxin Dan was selected as a treatment for patients with blood loss and spirit injury in the summer to nourish the blood and calm the heart and brain.Kaixin Powder was selected as a treatment for patients with spleen deficiency and phlegm blockage in late summer to strengthen the spleen,awaken the mind,and remove stasis.Wenfei Jiangzhuo Decoction was selected as a treatment for patients with qi deficiency and spirit departure in autumn to nourish the lungs,reduce turbidity,and nourish the mind.Dihuang Yinzi was selected as a treatment for patients with marrow reduction and internal toxin in winter to expel phlegm and fill the mind.Treating PSCI using the"season-visceral-related"theory reflects the overall concept of TCM and the hypothesis of syndrome differentiation and treatment and provides novel method for treating PSCI.