In situ tumor vaccine has become an important strategy in cancer immunotherapy owing to its ability to induce immune responses locally and overcome tumor heterogeneity. However, the abnormal structure and mechanical properties of the tumor’s physical microenvironment significantly limit the efficiency of vaccine delivery and immune efficacy. In this review, the key factors in the tumor’s physical microenvironment, including solid pressure, interstitial fluid pressure, matrix stiffness, and tissue microstructure, are systematically discussed. Their obstructive roles in immune cell infiltration, antigen presentation, and immune activation are analyzed. The potential of approaches, such as radiotherapy, anti-angiogenic therapy, extracellular matrix degradation agents, nanomaterials, and hydrogel delivery platforms, in reshaping the tumor’s physical microenvironment is explored. This review aims to offer theoretical and practical guidance for optimizing in situ vaccine strategies through the regulation of the tumor’s physical microenvironment, ultimately advancing the precision and effectiveness of cancer immunotherapy.

The "body schema" of acupuncture and moxibustion is centered on the meridian system and represents a corporeal perspective of "heaven-connection", embodying the harmony between nature and humanity. It integrates the cyclic schema of the heavenly cycling, the meridian growth and decline schema of the guaqi theory, the twelve zodiac demarcation schema from astrological and astronomical studies, and the nine-palace and eight-trigrams schema of temporal and spatial locations. It presents the theoretical origins of the harmony between nature and humanity in acupuncture and moxibustion along with medical thoughts under the background of social concepts. The numerical arts of acupoint number and acupuncture-moxibustion quantity, those of acupuncture-moxibustion time and taboos, as well as the time-based acupuncture-moxibustion patterns, all of these thoroughly reflect the application of the body schema of acupuncture and moxibustion by early medical practitioners in ancient time. The study on the body philosophy in acupuncture and moxibustion should start from the original appearance of early classical acupuncture-moxibustion theory, trace the source of body philosophy of acupuncture and moxibustion, seek the truth of temporal body medicine, and perfect the body philosophy research of contemporary acupuncture and moxibustion, so as to improve the dual attributes of acupuncture and moxibustion in humanities and science.
Moxibustion/history* ; Humans ; Acupuncture Therapy/history* ; History, Ancient ; Meridians ; Astrology

In 2012, a total of eight medical books were compiled from Tianhui medical bamboo slips unearthed in Chengdu, Sichuan, China, which for the first time, recorded bafa (ba technique) and acupuncture technique. Bafa is only found in Tianhui medical bamboo slips. Based on the records in medical bamboo slips, it is believed that the essential theory of bafa refers to an outlook of life for the harmony between form and spirit, meaning "the heart mind is the monarch of form". It is the initial view of physique centered on five-zang organs. In clinical application, bafa is used for prevention of diseases in four seasons, specially for wubi (five-bi disorders) and wufeng (five-wind disorders), covering a extensive parts of the body. Compared with the stone technique, "bafa must work on meridian points, while stone on meridians". Bafa is often used for deficiency syndrome, while stone technique is for excess syndrome. Hence, these two types of technique should be applied cautiously. It is speculated that bafa is an external therapeutic method based on the theory of meridian medicine in the Han Dynasty.
Humans ; Acupuncture Therapy/methods* ; China ; History, Ancient ; Meridians ; Medicine, Chinese Traditional/history* ; Books/history* ; Acupuncture Points ; Medicine in Literature

Objective To evaluate the diagnostic value of black blood computed tomography(BBCT)in vulnerable plaques at the carotid bifurcation.Methods The imaging data of 73 patients with suspected carotid atherosclerosis were retrospectively analyzed.The signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of conventional computed tomography angiography(CTA)ima-ges and BBCT images were compared by paired sample t-test.The 5-level scoring method was applied to evaluate the image quality subjectively,and the Friedman test was used to compare the differences in the subjective evaluation of image quality among the groups.Taking high-resolution magnetic resonance vessel wall imaging(HRMR-VWI)as the gold standard,the diagnostic value between BBCT and conventional CTA was compared,and the consistency of BBCT and HRMR-VWI in the evaluation of vulnerable plaques was calculated.Results The standard deviation(SD)value of BBCT images was lower than that of conventional three-phase CTA images,indicating better quality of BBCT images(P＜0.001).The mean CT value and CNRplaque-lumen of non-calcified plaques were higher in BBCT images than those in conventional three-phase CTA images,suggesting that BBCT had a higher contrast with sur-rounding tissues and could better display the fine structure of non-calcified plaques(P＜0.001).BBCT images achieved the highest scores in the subjective evaluation of image quality(P＜0.001).Compared with conventional CTA images,BBCT had higher sensi-tivity(88.2％vs 29.4％)and accuracy(90.9％vs 54.5％)in identifying vulnerable plaques(P＜0.001).The Kappa value between BBCT and HRMR-VWI was 0.813,showed good consistency.Conclusion The image quality of neck BBCT is superior to that of conventional CTA.BBCT has a better effect than conventional CTA in identifying vulnerable plaques at the carotid bifurcation,which is comparable to HRMR-VWI.

Objective To explore the feasibility and accuracy of spectral CT calcium suppression technique in the diagnosis of new traumatic rib fractures.Methods A total of 30 patients with a clear history of trauma and clinical diagnosis of rib fracture or suspected traumatic fracture were retrospectively selected.Rib spectral CT and MRI plain scan were performed within 24 h.All ribs were divided into 24 regions(the left and right ribs were divided into 12 regions respectively).Two physicians independently analyzed whether the ribs in each region had cortical discontinuity and used the spectral CT calcium suppression color image to evaluate whether the ribs had bone marrow edema.Bone marrow edema accompanied by cortical discontinuity was diagnosed as a new rib fracture,otherwise it was not a new rib fracture.Kappa test was used to analyze the consistency of the diagnosis results of the two physicians.χ2 test was used to compare the fracture type and bone marrow edema between spectral CT and MRI images.The CT values of all regions were measured with the MRI results as the reference standard,and the independent sample t test was used to analyze whether it was statistically significant.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of spectral CT calcium suppression technique for rib fractures.Results The accuracy of spectral CT calcium suppression technique in the diagnosis of bone marrow edema of rib fracture was 96.9%.The CT value of bone marrow edema region[(7.6±23.8)HU]was significantly higher than that of normal rib region[(-54.4±18.4)HU](P＜0.000 1).The area under the curve(AUC)of spectral CT calcium suppression technique in the diagnosis of rib bone marrow edema was 0.989,and the cutoff value was-22.8.Conclusion Spectral CT calcium suppression technique has high sensitivity to new traumatic rib fractures,and can intuitively and quantitatively analyze bone marrow edema through pseudo-color images,providing a reference for clinical diagnosis of new rib fractures.

Objective To explore the value of the Transformer model based on multi-sequence MRI to predict isocitrate dehydrogenase(IDH)mutation status in patients with glioma.Methods The multi-sequence MRI data of 500 glioma patients(103 mutation-type and 397 wild-type)were analyzed retrospectively from the publicly available dataset Cancer Imaging Archive.The prediction model was constructed through the Transformer deep learning algorithm.Area under the curve(AUC)of the receiver operating characteristic(ROC)curve was used to evaluate the predictive performance,and the five-fold crossover was used for validation of the predictive model.Results The clinical,multi-sequence MRI,and combined clinical+multi-sequence MRI models based on the Transformer deep learning algorithm could be used to predict the IDH mutation status of patients with glioma,and the combined clinical+multi-sequence MRI model had the highest diagnostic efficacy compared with the former two,with an AUC of 0.904[95％confidence interval(CI)0.875-0.928],and the sensitivity and specificity of 86.41％and 86.40％,respectively.DeLong's test showed that the difference in AUC between the combined clinical+multi-sequence MRI model and the clinical model was statistically significant(Z=3.327,P＜0.001).Conclusion The Transformer model based on multi-sequence MRI can effectively identify patients with IDH mutation-type glioma and IDH wild-type glioma.

Objective To evaluate the diagnostic value of black blood computed tomography(BBCT)in vulnerable plaques at the carotid bifurcation.Methods The imaging data of 73 patients with suspected carotid atherosclerosis were retrospectively analyzed.The signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of conventional computed tomography angiography(CTA)ima-ges and BBCT images were compared by paired sample t-test.The 5-level scoring method was applied to evaluate the image quality subjectively,and the Friedman test was used to compare the differences in the subjective evaluation of image quality among the groups.Taking high-resolution magnetic resonance vessel wall imaging(HRMR-VWI)as the gold standard,the diagnostic value between BBCT and conventional CTA was compared,and the consistency of BBCT and HRMR-VWI in the evaluation of vulnerable plaques was calculated.Results The standard deviation(SD)value of BBCT images was lower than that of conventional three-phase CTA images,indicating better quality of BBCT images(P＜0.001).The mean CT value and CNRplaque-lumen of non-calcified plaques were higher in BBCT images than those in conventional three-phase CTA images,suggesting that BBCT had a higher contrast with sur-rounding tissues and could better display the fine structure of non-calcified plaques(P＜0.001).BBCT images achieved the highest scores in the subjective evaluation of image quality(P＜0.001).Compared with conventional CTA images,BBCT had higher sensi-tivity(88.2％vs 29.4％)and accuracy(90.9％vs 54.5％)in identifying vulnerable plaques(P＜0.001).The Kappa value between BBCT and HRMR-VWI was 0.813,showed good consistency.Conclusion The image quality of neck BBCT is superior to that of conventional CTA.BBCT has a better effect than conventional CTA in identifying vulnerable plaques at the carotid bifurcation,which is comparable to HRMR-VWI.

Objective To explore the feasibility and accuracy of spectral CT calcium suppression technique in the diagnosis of new traumatic rib fractures.Methods A total of 30 patients with a clear history of trauma and clinical diagnosis of rib fracture or suspected traumatic fracture were retrospectively selected.Rib spectral CT and MRI plain scan were performed within 24 h.All ribs were divided into 24 regions(the left and right ribs were divided into 12 regions respectively).Two physicians independently analyzed whether the ribs in each region had cortical discontinuity and used the spectral CT calcium suppression color image to evaluate whether the ribs had bone marrow edema.Bone marrow edema accompanied by cortical discontinuity was diagnosed as a new rib fracture,otherwise it was not a new rib fracture.Kappa test was used to analyze the consistency of the diagnosis results of the two physicians.χ2 test was used to compare the fracture type and bone marrow edema between spectral CT and MRI images.The CT values of all regions were measured with the MRI results as the reference standard,and the independent sample t test was used to analyze whether it was statistically significant.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of spectral CT calcium suppression technique for rib fractures.Results The accuracy of spectral CT calcium suppression technique in the diagnosis of bone marrow edema of rib fracture was 96.9%.The CT value of bone marrow edema region[(7.6±23.8)HU]was significantly higher than that of normal rib region[(-54.4±18.4)HU](P＜0.000 1).The area under the curve(AUC)of spectral CT calcium suppression technique in the diagnosis of rib bone marrow edema was 0.989,and the cutoff value was-22.8.Conclusion Spectral CT calcium suppression technique has high sensitivity to new traumatic rib fractures,and can intuitively and quantitatively analyze bone marrow edema through pseudo-color images,providing a reference for clinical diagnosis of new rib fractures.

Objective To explore the value of the Transformer model based on multi-sequence MRI to predict isocitrate dehydrogenase(IDH)mutation status in patients with glioma.Methods The multi-sequence MRI data of 500 glioma patients(103 mutation-type and 397 wild-type)were analyzed retrospectively from the publicly available dataset Cancer Imaging Archive.The prediction model was constructed through the Transformer deep learning algorithm.Area under the curve(AUC)of the receiver operating characteristic(ROC)curve was used to evaluate the predictive performance,and the five-fold crossover was used for validation of the predictive model.Results The clinical,multi-sequence MRI,and combined clinical+multi-sequence MRI models based on the Transformer deep learning algorithm could be used to predict the IDH mutation status of patients with glioma,and the combined clinical+multi-sequence MRI model had the highest diagnostic efficacy compared with the former two,with an AUC of 0.904[95％confidence interval(CI)0.875-0.928],and the sensitivity and specificity of 86.41％and 86.40％,respectively.DeLong's test showed that the difference in AUC between the combined clinical+multi-sequence MRI model and the clinical model was statistically significant(Z=3.327,P＜0.001).Conclusion The Transformer model based on multi-sequence MRI can effectively identify patients with IDH mutation-type glioma and IDH wild-type glioma.

Waldenstrom's macroglobulinemia (WM) is a lymphoplasmacytic lymphoma associated with immunoglobulin M (IgM), due to its rarity in domestic and international reports, it is often overlooked in clinical treatment, and gradually progressing to end-stage renal disease and affecting patient's prognosis. In recent years, there has been an increase in treatment options for WM. This study reviewed the diagnosis and treatment of a patient with WM complicated by chronic renal failure, and analyzed the progress in diagnosis and treatment of this disease by reviewing relevant literatures from both domestic and international sources.