In January 2025， the European Society for Medical Oncology （ESMO） released the ESMO clinical practice guideline interim update on the management of biliary tract cancer as a supplementary update to Biliary tract cancer： ESMO clinical practice guideline for diagnosis， treatment and follow-up published in November 2022. This interim update mainly revises the latest evidence-based medical recommendations in the key fields of molecular diagnostics and clinical management since the release of the original guidelines， and it is not a comprehensive update of the entire document. This article summarizes and makes an excerpt of the new recommendations from this interim update.

ObjectiveTo investigate pulmonary function levels and associated influencing factors among rural elderly in Guangzhou， to identify high-risk populations for poor pulmonary function， and to reveal the relationship between the influencing factors of pulmonary function. MethodsWe recruited 1 500 residents aged 60 to 94 years from rural area of Conghua District， Guangzhou City using convenience sampling in 2023. Data on demographics， body measurements， medical history and lifestyle were collected via face-to-face questionnaires and physical examination. Meanwhile， expiratory function parameters including forced expiratory volume in one second （FEV1）， forced vital capacity （FVC）， FEV1/FVC， and the prevalence of airflow obstruction （AFO） were assessed using a portable spirometer. Age and sex distribution of pulmonary function in older adults at 5-year intervals was reported， and risk factors of AFO using multifactorial logistic regression models were analyzed. Furthermore， path analysis was further employed to explore the role of lifestyle in the association between other influencing factors and lung function. ResultsAmong the 1 500 participants， the median age was 71 years （67-75）， and 44.2% were male. Subjects identified as AFOs were generally older， more likely male， less educated， and had lower rates of moderate to vigorous physical activity （＜1 time/week） and lower lean body mass. Mean FEV1/FVC ratio was （82.0±16.4） %. FEV1/FVC was （79.80±17.58） % in men and （83.66±15.22） % in women. Older age， lower education， male sex and leanness were negatively associated with all pulmonary function outcomes （all P values＜0.05）. Path analysis identified that age， gender， marital status， occupation and income may influence pulmonary function indirectly through lifestyle. ConclusionRural elderly in Guangzhou exhibited lower pulmonary function levels， and male sex， non-married status， advanced age， lower education， smoking habits， insufficient engagement in moderate to vigorous physical activity， and lean body type were all associated with worse pulmonary function.

Background While A few studies have suggested associations between ambient temperature and cardiac autonomic function, the relationship between hourly temperature variations and heart rate variability (HRV) remains unclear. Objective To examine the acute effects and lag patterns of short-term ambient temperature exposure on HRV at an hourly temporal resolution during cold and warm seasons, and to further characterize the exposure-response relationships. Methods We conducted a longitudinal panel study involving 1047 eligible participants who ordered repeated 24 h ambulatory electrocardiogram monitoring at the First Affiliated Hospital of Xinjiang Medical University in Urumqi, Xinjiang Uygur Autonomous Region, China, between March 2020 and March 2022. Twelve HRV parameters were extracted, including standard deviation of all NN intervals (SDNN), standard deviation of the 5 min averages of NN intervals (SDANN), standard deviation of NN intervals index (SDNNIDX), root mean square of successive differences of adjacent NN intervals (rMSSD), triangle index (TI), percent of NN50 in the total number of NN intervals (pNN50), total power (TP), ultralow frequency (ULF), very low frequency (VLF), low frequency (LF), high frequency (HF), and ratio of low frequency to high frequency (LF/HF). Hourly meteorological data (mean temperature and relative humidity) were obtained from the nearest monitoring stations to participants' residences. Linear mixed effects models (LME) and generalized additive mixed effects models (GAMM) were employed to assess temperature-HRV associations and lag patterns during cold (from October to March next year) and warm (from April to September) seasons, with stratification by sex and age. Results A total of 1047 Urumqi residents who had repeated 24 h ambulatory electrocardiograms were included in this study. In both cold and warm seasons, the exposure-response relationship between ambient temperature and HRV showed an approximately linear negative correlation with no threshold effect; HRV parameters decreased as ambient temperature increased. The correlation between ambient temperature and HRV usually began at a lag of 6 h and disappeared around 24 h lag. The cold season induced a stronger effect on HRV decline, and for every 1 °C increase in ambient temperature during the cold season from lag 0 to 6 h, SDNN decreased by 0.72%, SDNNIDX decreased by 1.46%, TI decreased by 0.07%, SDANN decreased by 1.23%, rMSSD decreased by 1.00%, pNN50 decreased by 2.74%, TP decreased by 3.30%, ULF decreased by 3.74%, VLF decreased by 3.76%, LF decreased by 2.75%, HF decreased by 2.49%, and LF/HF decreased by 0.74%; for every 1 °C increase in ambient temperature during the warm season, SDNN decreased by 0.56%, SDNNIDX decreased by 1.08%, TI decreased by 0.29%, SDANN decreased by 0.56%, rMSSD decreased by 0.68%, pNN50 decreased by 2.11%, TP decreased by 2.64%, ULF decreased by 3.14%, VLF decreased by 2.74%, LF decreased by 1.85%, HF decreased by 1.68%, and LF/HF decreased by 0.47%. Conclusion Elevated ambient temperatures in Urumqi are significantly associated with decreased HRV in the residents, affecting cardiac autonomic function.

This paper introduces Professor WANG Jihong's clinical experience in treating refractory lateral epicondylitis using the Wang's crescent technique of blade needle. Based on the classical theories of Huangdi Neijing (the Yellow Emperor's Inner Classic) such as the "twelve sinew meridians" "short needling" and "shu needling", Professor WANG applies a self-designed blade needle with crescent needling method. This approach forms a distinctive treatment philosophy characterized by "sinew meridians as the foundation, selecting points at the pain site; using chicken-claw needling technique deliverd at both internal and external; integration of heaven, earth, and man, using both short and shu needling; treating tendon injuries and inflammation with the crescent technique of blade needle". It embodies the therapeutic concept of "treating tendons and bones simultaneously, harmonizing yin and yang", and shows unique advantages in the treatment of this condition.
Acupuncture Therapy/methods* ; Humans ; Tennis Elbow/therapy* ; Male ; Middle Aged ; Adult ; Needles ; Female ; Acupuncture Points

This article introduces the clinical experience of Professor WANG Jihong in treatment of post-stroke hypermyotonia with Lai's tongyuan therapy (therapy for removing obstruction and consolidating vital essence). Regarding the pathogenesis of this disease, Professor WANG Jihong emphasizes a "trinity" approach, "the mind disturbed, qi and blood unbalanced, and yuan (vital essence) not consolidated". In treatment, "the unblocking, conducting and nourishing are taken as the fundamental" to "prevent from over-dredging, balancing yin and yang, and avoiding over-replenishing". In clinical practice, the combined measure is adopted with acupuncture, tuina and herbal medicine. In acupuncture, the acupoints are selected according to the front-back combination of the points of the conception vessel and the governor vessel (basic prescription: Yintang [GV24⁺], Baihui [GV20] and Niesanzhen; prescription for promoting the governor vessel: Dazhui (GV14), Jinsuo [GV8], Xinshu [BL15], Pishu [BL20] and etc.; and the prescription for consolidating the vital essence: Danzhong (CV17), Zhongwan [CV12], Tianshu [ST25], Qihai [CV6]) and etc., as well as those on the four limbs for "opening, closing and pivoting of yin and yang" (on the upper limbs of the affected side: Jiquan [HT1], Jianyu [LI15], Quchi [LI11], Quze [PC3] and etc.; on the lower limbs of the affected side: Huantiao [GB30], Liangqiu [ST34], Xuehai [SP10], Yanglingquan [GB34]) and etc. The above points co-act on regulating the conception vessel and the governor vessel, and balancing yin and yang. Tuina is delivered on the governor vessel, the bladder meridian of foot-taiyang and wind points on the area between the head and nape, so as to promote the governor vessel, benefit the orifices, strengthen the spine and relax tendons. Herbal medicine works on nourishing the liver to soften tendons, nourishing blood to remove wind, regulating qi to replenish the spleen, consolidating the root to cultivate the vital essence, activating blood circulation to unblock meridians, and removing stasis to resolve phlegm. Tongyuan therapy provides a certain instruction in treatment of post-stroke hypermyotonia.
Humans ; Acupuncture Therapy ; Acupuncture Points ; Stroke/complications* ; Male ; Female ; Middle Aged ; Aged ; Drugs, Chinese Herbal ; Adult

BACKGROUND: While emotional distress, encompassing anxiety and depression, has been associated with negative clinical outcomes, its impact across various clinical departments and general hospitals has been less explored. Previous studies with limited sample sizes have examined the effectiveness of specific treatments (e.g., antidepressants) rather than a systemic management strategy for outcome improvement in non-psychiatric inpatients. To enhance the understanding of the importance of addressing mental health care needs among non-psychiatric patients in general hospitals, this study retrospectively investigated the impacts of emotional distress and the effects of early detection and management of depression and anxiety on hospital length of stay (LOS) and rate of long LOS (LLOS, i.e., LOS >30 days) in a large sample of non-psychiatric inpatients. METHODS: This retrospective cohort study included 487,871 inpatients from 20 non-psychiatric departments of a general hospital. They were divided, according to whether they underwent a novel strategy to manage emotional distress which deployed the Huaxi Emotional Distress Index (HEI) for brief screening with grading psychological services (BS-GPS), into BS-GPS ( n = 178,883) and non-BS-GPS ( n = 308,988) cohorts. The LOS and rate of LLOS between the BS-GPS and non-BS-GPS cohorts and between subcohorts with and without clinically significant anxiety and/or depression (CSAD, i.e., HEI score ≥11 on admission to the hospital) in the BS-GPS cohort were compared using univariable analyses, multilevel analyses, and/or propensity score-matched analyses, respectively. RESULTS: The detection rate of CSAD in the BS-GPS cohort varied from 2.64% (95% confidence interval [CI]: 2.49%-2.81%) to 20.50% (95% CI: 19.43%-21.62%) across the 20 departments, with a average rate of 5.36%. Significant differences were observed in both the LOS and LLOS rates between the subcohorts with CSAD (12.7 days, 535/9590) and without CSAD (9.5 days, 3800/169,293) and between the BS-GPS (9.6 days, 4335/178,883) and non-BS-GPS (10.8 days, 11,483/308,988) cohorts. These differences remained significant after controlling for confounders using propensity score-matched comparisons. A multilevel analysis indicated that BS-GPS was negatively associated with both LOS and LLOS after controlling for sociodemographics and the departments of patient discharge and remained negatively associated with LLOS after controlling additionally for the year of patient discharge. CONCLUSION Emotional distress significantly prolonged the LOS and increased the LLOS of non-psychiatric inpatients across most departments and general hospitals. These impacts were moderated by the implementation of BS-GPS. Thus, BS-GPS has the potential as an effective, resource-saving strategy for enhancing mental health care and optimizing medical resources in general hospitals.
Humans ; Retrospective Studies ; Male ; Length of Stay/statistics & numerical data* ; Female ; Middle Aged ; Adult ; Psychological Distress ; Inpatients/psychology* ; Aged ; Anxiety/diagnosis* ; Depression/diagnosis*

Objective:To summarize the clinical characteristics, diagnosis and treatment experience of salivary pleomorphic adenoma in children. Methods:Thirty patients with salivary pleomorphic adenomas treated in Beijing Childrens Hospital from January 2008 to December 2022 were retrospectively reviewed, including 11 boys and 19 girls, with the age ranging from 0.3 to 14.4 years（median age 10.4 years）. Initial presentation, medical history, imaging workups, surgical approaches, complications, rates of recurrence were evaluated. Results:Major salivary gland lesions were most common（n=24, 80%）; 53.3%（16 of 30） arising in the submandibular glands and 26.7%（8 of 30） in the parotid. Minor salivary gland lesions（n=6, 20%） were removed from the palate, tongue, face, trachea, nasopharynx, and upper mediastinumand. Preoperative imaging was reviewed in all patients and consisted of 26 ultrasound exams, 2 computerized tomography（CT） exams, and 15 magnetic resonance imaging（MRI） exams. Fine needle aspiration biopsy was performed in 12 patients. Surgical excision was performed in all patients. Postoperative complications included transient facial paresis（n=3）, Pneumonia and pleural effusion（n=1）. Average length of follow-up was 36.7 months; confirmed recurrence occurred in one patients. Conclusion:The symptoms of salivary gland pleomorphic adenoma in children are different according to the location of the tumor. The treatment is complete surgical resection, and a small amount of normal tissue around the tumor should be removed to reduce recurrence.
Humans ; Male ; Female ; Child ; Adenoma, Pleomorphic/diagnosis* ; Adolescent ; Retrospective Studies ; Salivary Gland Neoplasms/diagnosis* ; Child, Preschool ; Infant ; Neoplasm Recurrence, Local

Proteasome activator PA28γ,also known as Ki antigen,REGγ or PSME3,is first found as Ki antigen in the serum of a patient with systemic lupus erythematosus,which belongs to 11S proteasome activator family together with PA28α and PA28β.In the amino acid sequence,PA28γ has 25%homology with PA28α and PA28β and its seven-subunit homomer is a 20S proteasome acti-vator,which mainly exists in the nucleus and participates in ubiquitin and ATP-dependent or independent protein degradation.More and more studies have reported the role of PA28γ in human immune-related diseases.This article reviews the function of PA28γ as a proteasome activator and its role in immune-related diseases including cancer,inflammation and virus infection-related diseases and other diseases in recent years,so as to reveal the role of PA28γ in the occurrence and development of immune-related diseases and its potential as a target for immunotherapy.

Objective·To evaluate the relationship between body mass index(BMI)and chronic metabolic diseases.Methods·The elderly(≥60 years old)who were underwent physical examination in the Physical Examination Center of Renji Hospital,Shanghai Jiao Tong University School of Medicine from 2014 to 2021 were studied.Their results of biochemical indicators were collected.Their height,body weight,and blood pressure were measured by trained nurses.The history of chronic metabolic diseases was collected by self-reported questionnaire.Systolic blood pressure≥140 mmHg(1 mmHg=0.133 kPa),diastolic blood pressure≥90 mmHg,or self-reported hypertension history was defined as hypertension.Fasting blood glucose≥7.0 mmol/L or self-reported history of diabetes was defined as diabetes.Total cholesterol≥6.2 mmol/L,triglyceride≥2.3 mmol/L,or self-reported history of dyslipidemia was defined as dyslipidemia.The relationship between BMI and hypertension,diabetes,and dyslipidemia was evaluated by using receiver operator characteristic(ROC)curve analysis and binary logistic regression.Results·Data of 59 083 subjects were collected[30 807 men and 28 276 women,average age:(67.9±6.3)years old].The prevalence of hypertension,diabetes and dyslipidemia was 76.5%(45 219/59 083),24.1%(14 225/59 083)and 50.0%(29 544/59 083),respectively.Compared to the elderly people aged 60?74 years,those aged 75 years and above had a higher proportion of hypertension and diabetes,and a lower proportion of dyslipidemia and no metabolic abnormalities.With ROC analysis,the BMI cut-off values for hypertension,diabetes,and dyslipidemia were 24.3,23.9,and 23.9 kg/m2.The BMI cut-off values for hypertension and diabetes in elderly men were similar to those in elderly women(for hypertension:24.3 kg/m2 in elderly men vs 24.2 kg/m2 in elderly women;for diabetes:24.0 kg/m2 in elderly men vs 23.7 kg/m2 in elderly women);however,BMI cut-off value for dyslipidemia was obviously higher in elderly men than that in elderly women(24.0 kg/m2 in elderly men vs 22.5 kg/m2 in elderly women).The BMI cut-off value for chronic metabolic diseases was higher in the elderly people aged 60?74 years than that in the elderly people aged 75 years and above(24.2?24.7 kg/m2 vs 22.9?23.8 kg/m2).Conclusion·Elderly people aged 60?74 years should maintain the BMI below 24.0 kg/m2,while those aged 75 years and above should aim for the BMI below 23.0 kg/m2,so as to reduce the risk of chronic metabolic diseases.

BACKGROUND:Clinical use of vascular stents involves high medical costs,but it may also bring long-term benefits in reducing cardiovascular events and improving the quality of life in patients.Economics evaluation can help decision makers better understand the balance between the cost and benefit of treatment. OBJECTIVE:To analyze the related articles of health economics and discuss the hot spots in the study of the effect and problems of vascular stents in medical quality management. METHODS:The articles concerning health economics evaluation of vascular stents were retrieved from the core set of the Web of Science.The VOSviewer_1.6.19 software was used to make a visualization analysis of the annual publication volume,institutions,countries,keywords,etc.Finally,the research hot spots on the effects and problems of vascular stents were analyzed from the perspective of health economics and medical quality management. RESULTS AND CONCLUSION:(1)120 articles in English were finally included.In the past 10 years,the highest number of articles published in this field was in 2019,with 10 articles.The institution with the largest number of articles published was Harvard University in the United States with 20 articles,and the country with the largest number of articles published was the United States with 58 articles.(2)Keyword cluster analysis demonstrated that the cost-effectiveness analysis of bare metal stents and drug-eluting stents in coronary disease,the cost-effectiveness analysis of angioplasty stent intervention,and the effect of coronary stents in percutaneous coronary intervention are the research hot spots in the field of health economics evaluation of vascular stent research.(3)In the context of medical quality management,the paper further summarized the research hot spots on the therapeutic effect of vascular stents as follows:long-term effect of vascular stents,safety,drug release mechanism research,personalized therapy,restenosis problems,and stent insertion technology.(4)The results of highly cited literature analysis exhibited that drug-eluting stents release drugs to reduce the risk of vascular restenosis,and the restenosis rate is lower than that of bare metal stents,but the cost is usually higher.Biodegradable stents combine the advantages of bare metal stents and drug-eluting stents,that is,avoiding long-term stent existence and reducing the risk of restenosis,but their cost may be higher,and there may be some complications in the short term,and they are not widely used at present.(5)In addition to the direct stent cost,factors that need to be considered when comparing the cost-effectiveness of vascular stents include the risk and cost of stent re-intervention,the risk and cost of complications,the duration and cost of drug therapy,and the quality of life of patients.Therefore,while the initial cost of drug-eluting and biodegradable stents may be higher than bare metal stents,they may lead to better clinical outcomes in the long term,resulting in a more favorable cost effect.(6)Future research directions should focus on making personalized vascular stent treatment decisions,observing the long-term effect of stent treatment,the impact of the stent on patients'quality of life,formulating health policies,rational allocation of medical resources,and the establishment of long-term follow-up mechanisms.