Background and Aims:Rhabdoid carcinoma of the colon(RCC)is an exceptionally rare and highly aggressive malignancy characterized by early metastasis and poor prognosis,with no standardized treatment available.We report a case of ascending colon RCC and summarize previously published cases to improve understanding of its clinicopathologic and molecular features.Methods:The clinical data,imaging,pathology,and immunohistochemistry of one patient treated at Xiangya Hospital were retrospectively analyzed.In addition,36 published RCC cases were systematically reviewed.Clinical characteristics,tumor location,immunophenotype,molecular alterations,treatments,and survival outcomes were extracted and summarized.Results:A 71-year-old man presented with abdominal distension,pain,and altered bowel habits.Imaging and colonoscopy indicated an obstructing ascending colon mass.Laparoscopic right hemicolectomy was performed.Pathology revealed poorly differentiated RCC infiltrating the serosa with 4/21 lymph-node metastases.Immunohistochemistry showed AE1/AE3(+),vimentin(+),CDX2(-),CK20(-),and Ki-67(80%+),with retained INI1 expression.Genetic testing indicated KRAS mutation and wild-type BRAFV600E.The patient received no adjuvant therapy and died of peritoneal metastasis within 3 months.Including this case,37 RCC patients(male to female ratio=1.3∶1;mean age 66 years)have been documented.Sixty-two percent of tumors were right-sided.Most exhibited rhabdoid morphology with diffuse vimentin positivity(97.06%)and AE1/AE3 positivity(100.00%),while CDX2 was negative in 85.71%.BRAFV600E mutation was present in 65.00%,and KRAS mutation in 22.73%of tested cases.Among 28 patients with MMR data,60.71%were pMMR and 39.29%dMMR.Although surgery was the primary treatment,78.79%of patients died within 1 year(median survival 6.0 months),with only a few long-term survivors following adjuvant chemotherapy or immunotherapy.Conclusion:RCC is a rapidly progressive colorectal malignancy with extremely poor prognosis and limited response to conventional chemotherapy.Tumor dedifferentiation,INI1 deficiency,and alterations in KRAS/BRAF-MAPK signaling may contribute to its pathogenesis.Surgery remains the mainstay of treatment,but incorporation of immunotherapy,targeted agents,and radiotherapy may offer potential benefits.Further studies are urgently needed to define effective therapeutic strategies.

As a major global public health concern,the standardized management of gastric cancer has been increasingly systematized in several countries and regions,resulting in the development of distinct clinical guidelines.This review provides a systematic comparison of gastric cancer guidelines from China,Japan,the republic of Korea,Europe,and the United States,revealing that although all guidelines adhere to the principles of evidence-based medicine,notable differences remain in methodology,therapeutic recommendations,update frequency,and review mechanisms.Key variations involve indications for neoadjuvant chemotherapy,criteria for endoscopic resection,and the extent of lymph node dissection,largely attributable to regional epidemiologic profiles,stage distribution at diagnosis,healthcare resource allocation,and health policy orientations.Nevertheless,the fundamental therapeutic principles and overarching goals of these guidelines are convergent:standardizing patient care,delivering high-quality treatment,incorporating the latest clinical trial evidence,and establishing expert consensus to inform policy-making.This review highlights how each guideline is developed,their unique elements,major differences,and the underlying reasons for these divergences.

Objective:To explore the expression of filaggrin(FLG)in melanoma tissues and its correlation with clinicopathological features and prognosis in patients.Methods:A total of 70 melanoma patients treated at the People's Hospital Affiliated to Shandong First Medical University from June 2019 to August 2020 were selected as research subjects.Tumor tissues and adjacent tissues obtained during surgery were examined for FLG expression using immunohistochemistry.Based on FLG expression,patients were divided into a positive group and a negative group.The positive expression rates of FLG in tumor tissues,adjacent tissues and melanoma tissues with different pathological features were compared.The patients were followed up for 3 years,and based on prognosis,they were divided into a survival group(n=43)and a death group(n=27).The FLG positive expression rates were compared between the two groups.Kaplan-Meier survival curves were plotted,and survival times were compared.Results:The positive FLG expression rate in melanoma tissues was significantly lower than that in adjacent tissues(P<0.05).The proportions of patients with tumor diameter>1 cm,Breslow thickness>2 mm,local ulcer,TNM stage Ⅲ-Ⅳ,lymph node metastasis,and tumor invasion in positive FLG expression group were significantly lower than those in negative group(P<0.05 or P<0.01).Among the 70 patients,27 cases died and 43 survived,with a survival rate of 61.42%.The positive FLG expression rate was significantly lower in death group than that in survival group(P<0.05).The survival time of FLG-positive patients was significantly longer than that of FLG-negative patients(P=0.010).Multivariate Cox regression analysis revealed that Breslow thickness>2 mm,TNM grade Ⅲ-Ⅳ,lymph node metastasis,and tumor invasion were risk factors for the prognosis of melanoma patients(P<0.01 or P<0.001),while positive FLG expression was a protective factor(P<0.01 or P<0.001).Conclusion:FLG expression is significantly decreased in melanoma tissues and is associated with pathological features such as Breslow thickness,tumor stage,invasion,lymph node metastasis,and prognosis.

ObjectiveTo observe the clinical efficacy of acupuncture combined with bloodletting and cupping in the treatment of chronic spontaneous urticaria（CSU） and to explore its potential mechanisms of action. MethodsSeventy CSU patients were randomly divided into loratadine group and acupuncture + bloodletting group， with 35 patients in each group. The loratadine group received oral loratadine tablets， 10 mg once daily in the evening. The acupuncture + bloodletting group received acupuncture at Zhongwan （CV 12）， Guanyuan （CV 4）， Tianshu （ST 25）， Zusanli （ST 36）， Sanyinjiao （SP 6）， Xuehai （SP 10）， Quchi （LI 11）， Hegu （LI 4）， Taichong （LR 3）， Baihui （GV 20）， and Shenting （GV 24）， once daily，along with bloodletting and cupping at Dazhui （GV 14） and Geshu （BL 17）， every other day. Both groups were treated for 4 weeks. The 7-day urticaria activity score（UAS7） was assessed before and after the treatment， and levels of serum immunoglobulin E （IgE）， interleukin-4 （IL-4）， interleukin-5 （IL-5）， eosinophil cationic protein （ECP）， plasma tissue factor （TF）， activated factor Ⅶ （FⅦa）， prothrombin fragment 1+2 （F1+2）， D-dimer （D-D） and complement component 5a （C5a） were detected. ResultsA total of 65 patients were included in the final analysis， 32 in the loratadine group and 33 in the acupuncture + bloodletting group. Before treatment， there was no significant difference in UAS7 score， serum IgE， IL-4， IL-5， ECP levels， or plasma TF， FⅦa， F1+2， D-D， C5a levels between groups （P＞ 0.05）. After treatment， both groups showed significant reductions in UAS7 score， serum IgE， IL-4， IL-5， and plasma TF， FⅦa， F1+2， D-D， and C5a levels compared to those before treatment （P＜0.01）. However， after treatment， there was no significant difference in UAS7 score and serum ECP， IgE， IL-4， IL-5 levels between groups （P＞0.05）. The acupuncture + bloodletting group showed lower plasma TF， FⅦa， F1+2， D-D and C5a levels compared to the loratadine group （P＜0.05 or P＜0.01）. ConclusionAcupuncture combined with bloodletting and cupping can effectively improve the skin symptoms of CSU patients and reduce the levels of inflammatory factors. The potential mechanism of action may involve the regulation of the coagulation-complement-mast cell activation axis， thereby inhibiting mast cell degranulation.

This study systematically elucidates the contemporary understanding of the theory of"the lung and large intestine being interior-exteriorly related"within both traditional Chinese and Western medical theoretical frameworks,while providing an in-depth summary of national medical master Han Mingxiang's clinical experience in diagnosing and treating phlegm-heat obstructing lung syndrome in acute exacerbation chronic obstructive pulmonary disease(AECOPD).Theoretically,this doctrine originates from the Huangdi Neijing and has been developed into a comprehensive system by subsequent medical practitioners.Modern medical research from embryological,microbiological,and other perspectives has confirmed the close physiological and pathological relationship between the lung and intestine,particularly evidenced by the proposed"gut-lung axis"theory.Based on over 6 decades of clinical practice,professor Han identified the core pathogenesis of AECOPD as involving"phlegm,blood stasis,toxins,and deficiency,"with phlegm-heat obstructing lung syndrome being the most prevalent manifestation.The pathological characteristics include impaired lung qi descent,internal accumulation of phlegm-heat,and intestinal obstruction.The therapeutic approach emphasizes"clearing heat and resolving phlegm,relieving cough and asthma"as the primary treatment principle,focusing on"clearing lung heat,eliminating phlegm pathogens,and descending rebellious qi",while adhering to the concept of"simultaneous treatment of lung and intestine."In terms of herbal prescription,professor Han skillfully employs modified Xuanbai Chengqi decoction,which integrates lung-ventilating,phlegm-resolving,and purgative effects.Importantly,he emphasizes the precise timing and dosage of purgative herbs,particularly for patients with deficiency patterns,advocating discontinuation or dose reduction once intestinal patency is achieved to avoid overtreatment.For remission phase management,professor Han advocates the"reinforcing earth to generate metal"approach using modified Bufei decoction combined with Yigong powder,which strengthens spleen qi to nourish lung function.This therapeutic strategy embodies the fundamental treatment principle of"treating the acute manifestations first,then addressing the root cause."This research not only deepens the understanding of classical Chinese medical theories but also provides more scientifically grounded intervention strategies for the clinical prevention and treatment of lung distension.The findings offer valuable insights into integrative approaches for AECOPD management,combining traditional wisdom with contemporary medical understanding.

Esophagogastric variceal bleeding is a common complication and the leading cause of death in advanced liver cirrhosis， and endoscopic variceal ligation （EVL） and endoscopic cyanoacrylate injection （ECI） are commonly used treatment strategies. Thrombocytopenia is one of the most common hematological complications in liver cirrhosis， and patients with severe thrombocytopenia have the potential risk of bleeding， which may affect treatment decision-making by clinicians and endoscopists. This article reviews the evolution of guidelines and clinical research advances regarding EVL/ECI in China and globally， in order to provide a basis for decision making among clinicians.

Background and Aims:Rhabdoid carcinoma of the colon(RCC)is an exceptionally rare and highly aggressive malignancy characterized by early metastasis and poor prognosis,with no standardized treatment available.We report a case of ascending colon RCC and summarize previously published cases to improve understanding of its clinicopathologic and molecular features.Methods:The clinical data,imaging,pathology,and immunohistochemistry of one patient treated at Xiangya Hospital were retrospectively analyzed.In addition,36 published RCC cases were systematically reviewed.Clinical characteristics,tumor location,immunophenotype,molecular alterations,treatments,and survival outcomes were extracted and summarized.Results:A 71-year-old man presented with abdominal distension,pain,and altered bowel habits.Imaging and colonoscopy indicated an obstructing ascending colon mass.Laparoscopic right hemicolectomy was performed.Pathology revealed poorly differentiated RCC infiltrating the serosa with 4/21 lymph-node metastases.Immunohistochemistry showed AE1/AE3(+),vimentin(+),CDX2(-),CK20(-),and Ki-67(80%+),with retained INI1 expression.Genetic testing indicated KRAS mutation and wild-type BRAFV600E.The patient received no adjuvant therapy and died of peritoneal metastasis within 3 months.Including this case,37 RCC patients(male to female ratio=1.3∶1;mean age 66 years)have been documented.Sixty-two percent of tumors were right-sided.Most exhibited rhabdoid morphology with diffuse vimentin positivity(97.06%)and AE1/AE3 positivity(100.00%),while CDX2 was negative in 85.71%.BRAFV600E mutation was present in 65.00%,and KRAS mutation in 22.73%of tested cases.Among 28 patients with MMR data,60.71%were pMMR and 39.29%dMMR.Although surgery was the primary treatment,78.79%of patients died within 1 year(median survival 6.0 months),with only a few long-term survivors following adjuvant chemotherapy or immunotherapy.Conclusion:RCC is a rapidly progressive colorectal malignancy with extremely poor prognosis and limited response to conventional chemotherapy.Tumor dedifferentiation,INI1 deficiency,and alterations in KRAS/BRAF-MAPK signaling may contribute to its pathogenesis.Surgery remains the mainstay of treatment,but incorporation of immunotherapy,targeted agents,and radiotherapy may offer potential benefits.Further studies are urgently needed to define effective therapeutic strategies.

As a major global public health concern,the standardized management of gastric cancer has been increasingly systematized in several countries and regions,resulting in the development of distinct clinical guidelines.This review provides a systematic comparison of gastric cancer guidelines from China,Japan,the republic of Korea,Europe,and the United States,revealing that although all guidelines adhere to the principles of evidence-based medicine,notable differences remain in methodology,therapeutic recommendations,update frequency,and review mechanisms.Key variations involve indications for neoadjuvant chemotherapy,criteria for endoscopic resection,and the extent of lymph node dissection,largely attributable to regional epidemiologic profiles,stage distribution at diagnosis,healthcare resource allocation,and health policy orientations.Nevertheless,the fundamental therapeutic principles and overarching goals of these guidelines are convergent:standardizing patient care,delivering high-quality treatment,incorporating the latest clinical trial evidence,and establishing expert consensus to inform policy-making.This review highlights how each guideline is developed,their unique elements,major differences,and the underlying reasons for these divergences.

OBJECTIVES: To evaluate the one-year outcomes of valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) using SAPIEN 3 valve for treating mitral bioprosthetic valve failure. METHODS: A retrospective analysis was conducted on 26 patients with mitral bioprosthetic valve failure who underwent ViV-TMVR at West China Hospital, Sichuan University, between November 2022 and July 2024. The age of patients was 71.5 (64.5, 74.5) years, and 69.2% were female. Bioprosthetic valve failure occurred at (9.7±3.7) years after initial surgical implantation, with the most common failure mode being mixed stenosis and regurgitation (53.8%). The SAPIEN 3 valve was implanted via either a transseptal or transapical approach. Echocardiography was performed preoperatively, immediately post-procedure, and at 1 month, 6 months, and 1 year post-procedure. Outcomes included all-cause mortality, New York Heart Association (NYHA) functional class, Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 score, and postoperative complications. RESULTS: The procedure was performed via the transseptal approach in 21 patients (80.8%) and the transapical approach in 5 patients (19.2%). All procedures were technically successful. No paravalvular leakage was observed immediately post-procedure, and mitral valve hemodynamics improved significantly. At the 1-year follow-up, 2 patients had died. Two patients (8.3% of survivors) were of NYHA functional class Ⅲ, and KCCQ-12 score improved to (88.4±14.6) points (both P<0.01). Echocardio-graphy at 1 year postoperatively showed significant reductions in peak mitral valve velocity [to (2.29±0.32) m/s] and mean transvalvular pressure gradient [to (9.5±3.5) mmHg, 1 mmHg=0.133 kPa] compared to baseline (both P<0.05). No moderate or severe mitral regurgitation or paravalvular leakage was observed. The proportion of patients with moderate-to-severe pulmonary hypertension decreased from 65.4% preoperatively to 13.0% at 1 year (P<0.05). CONCLUSIONS ViV-TMVR with the SAPIEN 3 valve for mitral biopro-sthetic valve failure is associated with high procedural success, significantly improved valve hemodynamics of the mitral value, alleviation of pulmonary hypertension, enhanced quality of life, and a low rate of complications at 1 year after the operation.
Humans ; Female ; Male ; Retrospective Studies ; Aged ; Bioprosthesis ; Heart Valve Prosthesis ; Mitral Valve/surgery* ; Heart Valve Prosthesis Implantation/methods* ; Middle Aged ; Prosthesis Failure ; Treatment Outcome ; Mitral Valve Insufficiency/surgery*

This study systematically elucidates the contemporary understanding of the theory of"the lung and large intestine being interior-exteriorly related"within both traditional Chinese and Western medical theoretical frameworks,while providing an in-depth summary of national medical master Han Mingxiang's clinical experience in diagnosing and treating phlegm-heat obstructing lung syndrome in acute exacerbation chronic obstructive pulmonary disease(AECOPD).Theoretically,this doctrine originates from the Huangdi Neijing and has been developed into a comprehensive system by subsequent medical practitioners.Modern medical research from embryological,microbiological,and other perspectives has confirmed the close physiological and pathological relationship between the lung and intestine,particularly evidenced by the proposed"gut-lung axis"theory.Based on over 6 decades of clinical practice,professor Han identified the core pathogenesis of AECOPD as involving"phlegm,blood stasis,toxins,and deficiency,"with phlegm-heat obstructing lung syndrome being the most prevalent manifestation.The pathological characteristics include impaired lung qi descent,internal accumulation of phlegm-heat,and intestinal obstruction.The therapeutic approach emphasizes"clearing heat and resolving phlegm,relieving cough and asthma"as the primary treatment principle,focusing on"clearing lung heat,eliminating phlegm pathogens,and descending rebellious qi",while adhering to the concept of"simultaneous treatment of lung and intestine."In terms of herbal prescription,professor Han skillfully employs modified Xuanbai Chengqi decoction,which integrates lung-ventilating,phlegm-resolving,and purgative effects.Importantly,he emphasizes the precise timing and dosage of purgative herbs,particularly for patients with deficiency patterns,advocating discontinuation or dose reduction once intestinal patency is achieved to avoid overtreatment.For remission phase management,professor Han advocates the"reinforcing earth to generate metal"approach using modified Bufei decoction combined with Yigong powder,which strengthens spleen qi to nourish lung function.This therapeutic strategy embodies the fundamental treatment principle of"treating the acute manifestations first,then addressing the root cause."This research not only deepens the understanding of classical Chinese medical theories but also provides more scientifically grounded intervention strategies for the clinical prevention and treatment of lung distension.The findings offer valuable insights into integrative approaches for AECOPD management,combining traditional wisdom with contemporary medical understanding.