Functional dyspepsia （FD） is a prioritized disease category where traditional Chinese medicine （TCM） demonstrates distinct therapeutic advantages. The current western medicine treatment for FD is mainly based on proton pump inhibitors and prokinetic agents， with digestive enzymes， probiotics and antidepressants serving as adjuvant medication， yet such therapies still have certain limitations. TCM treatment for FD includes oral administration of Chinese herbal formulas and Chinese patent medicines， as well as external TCM therapies such as acupuncture and moxibustion， acupoint application， hot medicinal compress therapy， rubbing with ointment， medicinal iontophoresis， auricular acupoint therapy and tui na （Chinese medical massage）. The combined treatment of FD with integrated TCM and western medicine can significantly improve clinical effectiveness and reduce adverse reactions. The common mechanisms underlying the therapeutic effects of both TCM and western medicine revolve around the core pathological processes of FD， mainly focusing on restoring gastrointestinal motility， regulating the levels of brain-gut peptides， modulating intestinal microecology， and ameliorating inflammatory status. The differential mechanisms lie in the precise targeting feature of western medicine versus the holistic-regulating and multi-target characteristics of TCM， and the two approaches exert a synergistic effect to enhance efficacy. This paper proposes to leverage the advantages of TCM in holistic regulation and the strengths of western medicine in targeted treatment， so as to provide personalized and comprehensive treatment regimens for FD patients.

Biliary tract cancer (BTC) is a rare group of malignancies that develop from the epithelial lining of the biliary tree and have a poor prognosis. Although chemotherapy is the standard of care for patients with advanced BTC in China, its clinical benefits are moderate. In recent years, the approval of targeted therapies and immunotherapies has provided new avenues for the management of advanced BTC. Nonetheless, the increasing number of personalized medicine approaches has created a challenge for clinicians choosing individualized treatment strategies based on tumor characteristics. In this article, we discuss recent progress in implementing precision medicine approaches for advanced BTC in China and examine genomic profiling studies in Chinese patients with advanced BTC. We also discuss the challenges and opportunities of using precision medicine approaches, as well as the importance of considering population-specific factors and tailoring treatment approaches to improve outcomes for patients with BTC. In addition to providing a comprehensive overview of current and emerging precision medicine approaches for the management of advanced BTC in China, this review article will support clinicians outside of China by serving as a reference regarding the role of patient- and population-specific factors in clinical decision-making for patients with this rare malignancy.
Humans ; Precision Medicine/methods* ; Biliary Tract Neoplasms/genetics* ; China ; Molecular Targeted Therapy ; Immunotherapy/methods*

Objective To observe CT manifestations of Fitz-Hugh-Curtis syndrome(FHCS).Methods Data of 23 patients with FHCS were retrospectively analyzed,and non-enhanced and enhanced abdominal and pelvic CT manifestations were observed.Results All 23 cases were found with pelvic inflammation,peritonitis,perihepatic inflammation,as well as abdominal and pelvic adhesion.The main manifestations of pelvic inflammation included pelvic effusion(23/23,100％),inflammatory changes of uterus and accessories(17/23,73.91％),and the latter presented as tubal thickening(8/17,47.06％)or tubal cystic dilatation and effusion(9/17,52.94％),with ovarian enlargement(8/9,88.89％)or nodules on uterine surface(1/9,11.11％).The main CT manifestations of peritonitis were peritoneal thickening(23/23,100％)and peritoneal nodules(15/23,65.22％),of perihepatic inflammation were mainly liver capsule enhancement(23/23,100％),subcapsular transient perfusion abnormality(16/23,69.57％),perihepatic effusion(20/23,86.96％)and perihepatic"violin-string sign"(16/23,69.57％).No inflammation in the bare area of liver was noticed.Among 23 cases,3 cases(3/23,13.04％)complicated with mechanical ileus,19 cases(19/23,82.61％)were accompanied by mesenteric or retroperitoneal lymph nodes enlargement with uniform or circular enhancement.Conclusion The main CT manifestations of FHCS included pelvic inflammation,peritonitis,perihepatic inflammation,as well as abdominal and pelvic adhesion,having certain characteristics.

Objective To observe CT manifestations of Fitz-Hugh-Curtis syndrome(FHCS).Methods Data of 23 patients with FHCS were retrospectively analyzed,and non-enhanced and enhanced abdominal and pelvic CT manifestations were observed.Results All 23 cases were found with pelvic inflammation,peritonitis,perihepatic inflammation,as well as abdominal and pelvic adhesion.The main manifestations of pelvic inflammation included pelvic effusion(23/23,100％),inflammatory changes of uterus and accessories(17/23,73.91％),and the latter presented as tubal thickening(8/17,47.06％)or tubal cystic dilatation and effusion(9/17,52.94％),with ovarian enlargement(8/9,88.89％)or nodules on uterine surface(1/9,11.11％).The main CT manifestations of peritonitis were peritoneal thickening(23/23,100％)and peritoneal nodules(15/23,65.22％),of perihepatic inflammation were mainly liver capsule enhancement(23/23,100％),subcapsular transient perfusion abnormality(16/23,69.57％),perihepatic effusion(20/23,86.96％)and perihepatic"violin-string sign"(16/23,69.57％).No inflammation in the bare area of liver was noticed.Among 23 cases,3 cases(3/23,13.04％)complicated with mechanical ileus,19 cases(19/23,82.61％)were accompanied by mesenteric or retroperitoneal lymph nodes enlargement with uniform or circular enhancement.Conclusion The main CT manifestations of FHCS included pelvic inflammation,peritonitis,perihepatic inflammation,as well as abdominal and pelvic adhesion,having certain characteristics.

Objective:To evaluate whether individualized dialectical treatment decoction taken for≥6 months after radical surgery for stageⅡ-Ⅲ colorectal cancer(CRC)is superior to surgery alone at preventing early(within 2 years)recurrence and metastasis.Methods:Patients with CRC who underwent radical surgery were enrolled consecutively in The First Affiliated Hospital of Henan University of CM and The First Affiliated Hospital of Henan University.The primary outcome was defined as early recurrence and metastasis for patients who underwent≥6 months of traditional Chinese medicine(TCM)treatment versus those who did not after surgery(Non-TCM).Multivariable modified Pois-son regression was used to model the primary outcome,and propensity score matching(PSM)was included in the regression-based sensit-ivity analysis.Results:A total of 103 patients received TCM treatment and 384 did not.In the entire cohort,the multivariable modified Pois-son regression model showed that the adjusted risk for early recurrence and metastasis was lower in the TCM group10.7%(12/103)vs.21.4%(82/384),relative risk(RR):0.448,95%confidence interval[CI]:0.261-0.769).PSM analysis was used at a 1:2 ratio,resulting in 99 pa-tients in the TCM group and 198 patients in the Non-TCM group.The TCM group still showed a lower risk for early recurrence and metastas-is 11.1%(11/99)vs.21.2%(42/198),RR:0.464,95%CI:0.227-0.948.The results of sensitivity analysis were consistent with multivariable ana-lysis.In this prespecified subgroup analysis,the difference in the rate of the primary outcome between the TCM and the Non-TCM groups was greater among males and those with N2 and moderately-highly differentiated tumors.Kaplan-Meier survival analysis showed that the incidence of early-recurrence-and metastasis-free survival was significantly higher in the TCM group than the Non-TCM groups.Conclusions:For patients with stage Ⅱ-Ⅲ colorectal cancer after radical surgery,individualized dialectical treatment with TCM was associated with a lower risk of early recurrence and metastasis.

Objective:To investigate the early clinical characteristics of elderly patients with severe burns and the risk factors on prognosis.Methods:This study was a retrospective case series study. Clinical data of 124 elderly patients with severe burns who met the inclusion criteria and were admitted to the 12 hospitals from January 2015 to December 2020 were collected, including 4 patients from the Fourth People's Hospital of Dalian, 5 patients from Fujian Medical University Union Hospital, 22 patients from Guangzhou Red Cross Hospital of Jinan University, 5 patients from Heilongjiang Provincial Hospital, 27 patients from the First Affiliated Hospital of Naval Medical University, 9 patients from the First Affiliated Hospital of Nanchang University, 10 patients from Affiliated Hospital of Nantong University, 9 patients from Tongren Hospital of Wuhan University & Wuhan Third Hospital, 12 patients from the 924 th Hospital of PLA, 6 patients from Zhangjiagang First People's Hospital, 4 patients from Taizhou Hospital of Zhejiang Province, and 11 patients from Zhengzhou First People's Hospital. The patients' overall clinical characteristics, such as gender, age, body mass index, total burn area, full-thickness burn area, inhalation injury, causative factors, whether combined with underlying medical diseases, and admission time after injury were recorded. According to the survival outcome within 28 days after injury, the patients were divided into survival group (89 cases) and death group (35 cases). The following data of patients were compared between the two groups, including the basic data and injuries (the same as the overall clinical characteristics ahead); the coagulation indexes within the first 24 hours of injury such as prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time, D-dimer, fibrinogen degradation product (FDP), international normalized ratio (INR), and fibrinogen; the blood routine indexes within the first 24 hours of injury such as white blood cell count, platelet count, neutrophil-to-lymphocyte ratio, monocyte count, red blood cell count, hemoglobin, and hematocrit; the organ function indexes within the first 24 hours of injury such as direct bilirubin, total bilirubin, urea, serum creatinine, aspartate aminotransferase, alanine aminotransferase, total protein, albumin, globulin, blood glucose, triglyceride, total cholesterol, alkaline phosphatase, creatine kinase, electrolyte indexes (potassium, sodium, chlorine, calcium, magnesium, and phosphorus in blood), uric acid, myoglobin, and brain natriuretic peptide; the infection and blood gas indexes within the first 24 hours of injury such as procalcitonin, C-reactive protein, pH value, oxygenation index, base excess, and lactate; treatment such as whether conducted with mechanical ventilation, whether conducted with continuous renal replacement therapy, whether conducted with anticoagulation therapy, whether applied with vasoactive drugs, and fluid resuscitation. The analysis was conducted to screen the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns. Results:Among 124 patients, there were 82 males and 42 females, aged 60-97 years, with body mass index of 23.44 (21.09, 25.95) kg/m 2, total burn area of 54.00% (42.00%, 75.00%) total body surface area (TBSA), and full-thickness burn area of 25.00% (10.00%, 40.00%) TBSA. The patients were mainly combined with moderate to severe inhalation injury and caused by flame burns. There were 43 cases with underlying medical diseases. The majority of patients were admitted to the hospital within 8 hours after injury. There were statistically significant differences between patients in the 2 groups in terms of age, total burn area, full-thickness burn area, and inhalation injury, and PT, APTT, D-dimer, FDP, INR, white blood cell count, platelet count, urea, serum creatinine, blood glucose, blood sodium, uric acid, myoglobin, and urine volume within the first 24 hours of injury (with Z values of 2.37, 5.49, 5.26, 5.97, 2.18, 1.95, 2.68, 2.68, 2.51, 2.82, 2.14, 3.40, 5.31, 3.41, 2.35, 3.81, 2.16, and -3.82, respectively, P<0.05); there were statistically significant differences between two groups of patients in whether conducted with mechanical ventilation and whether applied with vasoactive drugs (with χ2 values of 9.44 and 28.50, respectively, P<0.05). Age, total burn area, full-thickness burn area, serum creatinine within the first 24 hours of injury, and APTT within the first 24 hours of injury were the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns (with odds ratios of 1.17, 1.10, 1.10, 1.09, and 1.27, 95% confidence intervals of 1.03-1.40, 1.04-1.21, 1.05-1.19, 1.05-1.17, and 1.07-1.69, respectively, P<0.05). Conclusions:The elderly patients with severe burns had the injuries mainly from flame burns, often accompanied by moderate to severe inhalation injury and enhanced inflammatory response, elevated blood glucose levels, activated fibrinolysis, and impaired organ function in the early stage, which are associated with their prognosis. Age, total burn area, full-thickness burn area, and serum creatinine and APTT within the first 24 hours of injury are the independent risk factors for death within 28 days after injury in this population.

ObjectiveTo explore the application effect of Jianpi Huoxue prescription combined with acupuncture in patients with chronic atrophic gastritis （CAG） of gastric blood stasis type. MethodA total of 86 patients with CAG admitted to Wuhan First Hospital from November 2021 to March 2023 were selected and randomly divided into two groups. The control group was treated with conventional Western medicine， while the observation group was treated with Jianpi Huoxue prescription combined with acupuncture. The clinical efficacy， traditional Chinese medicine （TCM） syndrome score， pathological score， negative conversion rate of Helicobacter pylori （Hp）， inflammatory indicators ［neutrophils/lymphocytes （NLR） and interleukin （IL）-1β］， changes in levels of gastric protease （PG） Ⅰ， PG Ⅰ/PG Ⅱ， and gastrin-17 （G-17）， and drug safety during treatment were observed after treatment in both groups. ResultAfter treatment， the total effective rate of the observation group ［95.35% （41/43）］ was significantly better than that of the control group ［79.07% （34/43）］， and the difference was statistically significant （χ²=5.108， P<0.05）. After treatment， the scores of the primary and secondary TCM syndromes in the observation group and the control group were significantly decreased （P<0.05）. After treatment， the scores of primary and secondary TCM syndromes in the observation group were significantly lower than those in the control group （P<0.05）. After treatment， the pathological scores of gastric mucosa atrophy， activity， chronic inflammation， intestinal metaplasia， and dysplasia were significantly lower in the observation group and control group （P<0.05）. After treatment， the pathological scores of gastric mucosa atrophy， activity， chronic inflammation， intestinal metaplasia， and dysplasia in the observation group were significantly lower than those in the control group （P<0.05）. After treatment， the Hp conversion rate in the observation group was significantly increased compared with the control group （P<0.05）. After treatment， the levels of inflammatory indicators NLR and IL-1β in the observation group and control group were significantly lower （P<0.05）， and the levels of inflammatory indicators NLR and IL-1β in the observation group were significantly lower than those in the control group （P<0.05）. After treatment， the levels of PGI and PGⅠ/PGⅡ in the observation group and control group were significantly higher （P<0.05）， and the levels of PGI and PGⅠ/PGⅡ in the observation group were significantly higher than those in the control group （P<0.05）. After treatment， the G-17 level of the observation group and the control group was different at different time points （P<0.05）， and the G-17 level of the observation group was higher at different time points than that of the control group （P<0.05）. The G-17 level of the observation group had an increasing trend compared with the control group （P<0.05）. There was no significant difference in the risk of adverse reactions between the two groups. ConclusionThe combination of Jianpi Huoxue prescription and acupuncture can effectively alleviate symptoms， increase Hp negative conversion rate， inhibit inflammation， and regulate PG and G-17 levels in CAG patients， thus controlling or even reversing gastric mucosal atrophy and reducing the probability of its progression to gastric cancer.

Objective To investigate the effects of treatment with nicorandil after Percutaneous Coronary Intervention(PCI)in patients with Acute Coronary Syndrome(ACS)on inflammation-related markers,and to assess its effects on vascular endothelial function.Methods Sixty-six ACS patients who underwent PCI in the Department of Cardiovascular Medicine of the Second Affiliated Hospital of Dalian Medical University from August 2022 to January 2023 were used as the study sample,and were divided into the control group and the experimental group according to the method of completely randomized design,with 33 cases in each group.The control group was treated with conventional therapy,and the experimental group was treated with nicorandil.Inflammatory indexes,homocysteine(Hcy)and adverse reactions in serum were compared between the two groups.Results After nicorandil treatment,the levels of postoperative inflammation-related factors in the control group were higher than that in the experimental group,and the difference was statistically significant(P<0.05);The levels of Hcy after nicorandil treatment were lower than that in the control group,and the difference was statistically significant(P<0.05);and the rate of adverse reactions in the experimental group was higher than that in the control group,and there was no statistical difference(P>0.05).Conclusion Nicorandil application in elderly ACS patients after PCI has a definite efficacy,can optimize the vascular-related inflammatory indexes,reduce homocysteine levels to improve coronary vascular endothelial function,and is suitable for further promotion.

Objective To analyze the clinical characteristics of pyogenic liver abscess(PLA)and explore the rationality and the duration of antibacterial treatment.Methods The clinical data of patients diagnosed as pyogenic liver abscess in our hospital from January 1,2020 to December 31,2022 were analyzed to explore their clinical characteristics.The rationality of antibacterial treatment was evaluated by setting evaluation criteria.The duration of antibacterial use in different treatment outcomes was counted.Results A total of 89 patients were included in the analysis.The average age was(62.0±15.6)years old,with the male accounting for 61.80%.Diabetes for 53.9%was the most common complication.Among 59 patients(66.3%)with positive culture of pos or blood,51 cases(57.3%)were Klebsiella Pneumoniaes.Among the empirical and target treatment,45 cases(50.6%)and 17 cases(28.8%)of antibacterial regimens were evaluated as unreasonable,respectively.Recovery treatment time was(17.0±7.6)d,and actual treatment time was(21.1±7.3)d.Conclusion Diabetes was the most common high-risk factor of PLA,and Klebsiella Pneumoniae was the main pathogenic bacteria.It is necessary to strengthen the management of antibacterial drugs,explore the appropriate duration of antibacterial treatment,and reduce the overuse of antibacterial drugs.

Objective:To evaluate the feasibility of using Patient Health Questionnaire-4 (PHQ-4) to screen for depression and anxiety in inpatients in general hospitals.Methods:Using the convenient sampling method, a total of 695 inpatients from 10 ClassⅡ Grade A and above comprehensive hospitals in Nanjing from January to June 2021 were selected as the research objects. They were investigated by PHQ-4, Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7 (GAD-7) to compare the screening results of different measuring tools for depression and anxiety. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of PHQ-4, Kappa test was used to analyze the consistency, Cronbach's α coefficient was used to evaluate the internal consistency of the scale, and Pearson correlation analysis was used to evaluate the calibration correlation validity. A total of 695 questionnaires were sent out in this study, and 672 were effectively collected, with an effective recovery rate of 96.69% (672/695) .Results:Among 672 inpatients in general hospitals, the detection rate of depression and anxiety in patients using PHQ-4 was 38.39% (258/672), while that in patients using PHQ-9 and GAD-7 was 41.82% (281/672), and the difference showed no statistical significance (χ 2=1.64, P=0.20). Cronbachs'α coefficient of PHQ-4 was 0.913, and the half reliability coefficient was 0.888. The Kappa value of the consistency test between PHQ-4, PHQ-9, and GAD-7 for depression and anxiety screening results was 0.756 ( P<0.01). The correlation coefficients between the total scores of PHQ-4, PHQ-9 and GAD-7 in 672 inpatients from general hospitals were 0.822 and 0.802, respectively (both P<0.01). The area under the ROC curve of PHQ-4 was 0.936. With a critical score of 3, the sensitivity and specificity of PHQ-4 were 81.9% and 92.8%, respectively. Conclusions:The detection rate of PHQ-4 and PHQ-9 and GAD-7 on depression and anxiety state of inpatients in general hospital is similar, and has good reliability and validity, which is suitable for the screening of depression and anxiety of inpatients in general hospital.