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.

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 determine the acute effects of heel-to-toe drops(5,0,-11 mm)of running shoes on the loading of the patellofemoral joint and Achilles tendon(AT)in runners with patellofemoral pain(PFP)during running.Methods Sixteen runners with PFP completed a running test while wearing running shoes with different heel-to-toe drops.The retroreflective markers and ground reaction force were measured using an infrared motion capture system and a three-dimensional force plate.The patellofemoral joint stress(PFJS)and AT force were calculated based on biomechanical models of the patellofemoral joint and AT.Results When runners with PFP ran in negative-heel shoes,the PFJS(P<0.001)during 39%-47%of the stance phase,maximum PFJS,and cumulative PFJS(P<0.05)during the stance phase were lower than those in positive-heel shoes.Meanwhile,the AT force(P<0.001)during 12%-46%of the stance phase and cumulative AT force(P=0.001)during the stance phase were larger than those in positive-heel shoes.The AT force(P<0.001)during 12%-31%of the stance phase and cumulative AT force(P=0.023)during the stance phase in negative-heel shoes were higher than those in zero-heel shoes.Conclusions Compared with runners with positive-heel shoes,runners with PFP running in negative-heel shoes had decreased PFJS and cumulative PFJS.This may potentially reduce the risk of further development of PFP.However,compared with zero-and positive-heel shoes,running in negative-heel shoes increases the AT force and cumulative AT force.This may increase the risk of AT injury.Runners with PFP are recommended to undergo acclimatization before shifting to negative-heel shoes.This would limit further progression of PFP without increasing the risk of AT injury.

Objective To determine the acute effects of heel-to-toe drops(5,0,-11 mm)of running shoes on the loading of the patellofemoral joint and Achilles tendon(AT)in runners with patellofemoral pain(PFP)during running.Methods Sixteen runners with PFP completed a running test while wearing running shoes with different heel-to-toe drops.The retroreflective markers and ground reaction force were measured using an infrared motion capture system and a three-dimensional force plate.The patellofemoral joint stress(PFJS)and AT force were calculated based on biomechanical models of the patellofemoral joint and AT.Results When runners with PFP ran in negative-heel shoes,the PFJS(P<0.001)during 39%-47%of the stance phase,maximum PFJS,and cumulative PFJS(P<0.05)during the stance phase were lower than those in positive-heel shoes.Meanwhile,the AT force(P<0.001)during 12%-46%of the stance phase and cumulative AT force(P=0.001)during the stance phase were larger than those in positive-heel shoes.The AT force(P<0.001)during 12%-31%of the stance phase and cumulative AT force(P=0.023)during the stance phase in negative-heel shoes were higher than those in zero-heel shoes.Conclusions Compared with runners with positive-heel shoes,runners with PFP running in negative-heel shoes had decreased PFJS and cumulative PFJS.This may potentially reduce the risk of further development of PFP.However,compared with zero-and positive-heel shoes,running in negative-heel shoes increases the AT force and cumulative AT force.This may increase the risk of AT injury.Runners with PFP are recommended to undergo acclimatization before shifting to negative-heel shoes.This would limit further progression of PFP without increasing the risk of AT injury.

Objective To investigate the expression of Nodal and its receptors in different tissues and organs of different development stages of mice.Methods Ten pairs(male and female each for a pair) of mice were divided into the four groups:3 pairs served as adult mice group,the rest 7 pairs were allowed to mate,among them 3 pregnant mice served as the fetal group,and 3 pregnant mice served as the neonatal group and 1 pregnant mouse served as filial group.The multiple tissues and organs such as brain,liver,kidney,heart,lung were selected from fetal,neonatal,filial and adult mice for preparing the protein samples.Western blot was performed to detect the expression of Nodal and its type Ⅰ receptors of ALK7 and ALK4 as well as auxiliary receptor Cripto-1.Results Only cerebrum,cerebellum,liver and kidney had Nodal express in the four different mouse ontogenetic stages,in which only liver and kidney simultaneously expressed Nodal and its receptor protein in the whole four ontogenetic stages.Besides,most tissues and organs of adult mice expressed Nodal and its receptor protein,which was significantly different from the fetal,neonatal and filial mice.Conclusion Nodal signaling might have a certain effect on the growth and development of mouse liver and kidney during the late development stage.

Objective To investigate the effect of hot compress with traditional Chinese herbs with wine and vinegar on lumbago after cesarean section. Methods Ninety patients with lumbago after cesarean section were divided into the control group and the observation group equally according to their admission number. Both groups were cured by the injection at the pressure pain point, the observation group by hot compress of traditional Chinese herbs of Reyanbao with wine and vinegar. The treatment effect between both groups were observed. Results The effective rates of the experiment group and the control group were 93.3%and 68.9%, respectively. The difference was statistically significant (χ2=12.433, P<0.05). Conclusions Based on injection on the pressure pain point, lumbago after cesarean section can be effectively relieved with the extra treatment by hot compress with traditional Chinese herb of Reyanbao with wine and vinegar. The treatment is simple and safe and worthy of being applied clinically.

Objective To detect the plasma amino-terminal pro-B-type natriuretic peptide (NT-ProBNP) of children with congenital heart disease(CHD) prior to heart surgery,to analysize its sensitivity,specificity and Youden index by receiver operating characteristic(ROC) curve,to explore the cut-off values of plasma NTProBNP for the diagnosis of congestive heart failure(CHF) in children under 5 years old before and after age stratification.Method The plasma NT-proBNP was detected for 100 children with CHD prior to heart surgery (experimental group) and 100 normal children(control group) between January 2011 to January 2013.Age stratification(0 ～ 1 year group,～3 years group and ～ 5 year group) was conducted in children with CHF younger than 5 years old to explore the cut-off values of plasma NT-ProBNP for the diagnosis of CHF.Results The NT-proBNP of 34 patients with CHF(n =100) was in accordance to Ross criteria The cut-off values were 502 ng/ L before age stratification,and they were 552 ng/L,449 ng/L,349 ng/L after age stratification for 0 ～ 1 year group,～ 3 years group and ～ 5 group.Conclusion The cut-off values of plasma NT-ProBNP for CHF were 552 ng/L、449 ng/L、349 ng/L for 0 ～ 1 year group,～ 3 years group and ～ 5 year group.

Objective To establish the HPLC fingerprint for the quality control of Yanhuanglian Injections.Methods HPLC Chromatography method was used.The conditions included a Shim-pack CLC-ODS column(250 mm?6.0 mm,5 ?m),the gredient elution was adopted with acetonitrile-buffer solution(1∶1),the detection wavelength was at 285 nm,and the flow rate was 1.0 mL/min.The Operating Standard of Similarty Evaluation System for Chromatographic Fingerprint of Chinese Materia Medica(Version 2004A)was used to calculate.Results Similarity of 13 batches of injections was over 0.95,the fingerprint of Yanhuanglian Injections was established,and 12 common peaks were indicated.Conclusion This method can be applied to the quality control of Yanhuanglian Injections.