Ischemic cholangiopathy （IC） is a severe clinical condition resulting from blood supply impairment in bile ducts， and its etiology includes vascular causes and non-vascular factors. The pathogenesis of IC mainly involves microcirculatory disturbance of the peribiliary blood plexus and biliary epithelial necrosis and fibrosis induced by ischemia-reperfusion injury. The clinical manifestations of IC are highly heterogeneous. The typical symptoms include jaundice， abdominal pain， and cholangitis， while non-specific symptoms， such as fatigue and fever， often cause delays in diagnosis. The diagnosis of IC mainly relies on radiological examination for identifying characteristic stenosis and microcirculatory disturbance， assisted by cholestasis biomarkers including alkaline phosphatase and gamma-glutamyl transferase. Therapeutic strategies include conventional pharmacotherapy， endoscopic intervention， and innovative techniques. Prognostic evaluation emphasizes the dynamic monitoring of alkaline phosphatase and bilirubin and classification based on radiological examination， and long-term management requires individualized monitoring regimens to prevent complications.

Guided by the theory of"kidney generating marrow"and"kidney associating with bladder",the concept of"brain-kidney-bladder"axis was proposed.From the perspective of meridian circulation and physiological function,the conception vessel and governor vessel are the links of the"brain-kidney-bladder"axis.Kidney essence deficiency,brain spirit losing,and dysfunction of bladder are the core pathogenesis of female stress incontinence.From the dysfunction of the"brain-kidney-bladder"axis and the deficiency of conception vessel and governor vessel,an integrated model of"one acupunture,two medication,and three daoyin therapy"was proposed for the treatment of female stress incontinence."One acupunture"is based on the theoretical guidance of"treating on the bone,and even under the navel ying"in Gukong Lun in Suwen,and the regulating conception vessel and dredging governor vessel acupuncture method is used to harmonize yin and yang,replenish qi,and consolidate bladder,using governor vessel points such as Baihui(DU20),Shenting(DU24),Mingmen(DU4),and conception vessel points such as Qihai(RN6),Guanyuan(RN64),Zhongji(RN3),and cooperating with Baliao points(BL31,BL32,BL33,and BL34)of the bladder meridian."Two medication"is guided by the theory that"dispersing conditions should be astringed,and deficient conditions should be warmed"in Zhizhenyao Dalun in Suwen;the treatment method focuses on consolidating conception vessel,dredging governor vessel,and harmonizing and nourishing qi and blood,and the Guren Tongdu Formula is selected."Three daoyin therapy",that is,using the abdominal contraction and anal lifting exercise,the Mawangdui daoyin therapy,and pelvic floor muscle training to cultivate qi,preserve spirit,and maintain the unity of body and mind.

The paper introduces Professor LIU Xing's clinical experience and characteristics of integrative acupuncture and medication in treatment of primary trigeminal neuralgia (PTN). It is believed that the essential pathogenesis of PTN is pathogenic wind, and qi and blood obstruction results from invasion of pathogenic wind. Hence, dispelling wind is the key principle of treatment. Palpation is done at first in the neck, face and buccal mucosal region to detect the masses in treatment. Acupotomy is operated at the masses distributed at Shangguan (GB3), Xiaguan (ST7) and the white line of buccal mucosa, so as to release masses. Additionally, five-wind points (Fengfu [GV16], bilateral Fengchi [GB20], Yifeng [TE17], Bingfeng [SI12] and Fengmen [BL12]), three-nape points (bilateral Naokong [GB19], Tianzhu [BL10] and Jianjing [GB21]) and three-governor-vessel points (Baihui [GV20], Zhiyang [GV9] and Yintang [GV24⁺]) are selected to dispel wind and stop pain. Besides, herbal decoction (wu feng tang) and blood-letting at ear apex are administered in combination. The integration of acupuncture and medication obtains a holistic effect on PTN by dispelling wind pathogen, and promoting qi and blood circulation.
Humans ; Trigeminal Neuralgia/drug therapy* ; Acupuncture Therapy ; Acupuncture Points ; Female ; Male ; Middle Aged ; Drugs, Chinese Herbal/administration & dosage* ; Combined Modality Therapy ; Adult ; Aged

Objective To investigate the role and molecular mechanisms of Exo70 in the metastasis of pancreatic cancer cells. Methods Stable cell lines with Exo70 knockdown or overexpression were established using lentiviral infection. The migration ability of pancreatic cancer cells was assessed by Transwell assay. The morphology, particle size, and secretion levels of exosomes were observed using transmission electron microscopy. Changes in the expression of Exo70 and exosomal marker proteins were detected by Western blot. The localization of multivesicular bodies (MVBs) was examined by immunofluorescence. Results Exo70 knockdown inhibited the migration ability of pancreatic cancer cells and substantially reduced the total amount of exosome secretion. By contrast, Exo70 overexpression enhanced the migration ability of pancreatic cancer cells. Immunofluorescence results showed that Exo70 knockdown induced the perinuclear accumulation of CD63 and LAMP2, leading to an increase in MVB accumulation and lysosomal degradation in pancreatic cancer cells. Conclusion Exo70 promotes the normal transport of MVBs and maintains exosome secretion. Its knockdown enhances the lysosomal degradation of MVBs, resulting in impaired exosome biogenesis and secretion and thereby inhibiting the migration of pancreatic cancer cells.

Guided by the theory of"kidney generating marrow"and"kidney associating with bladder",the concept of"brain-kidney-bladder"axis was proposed.From the perspective of meridian circulation and physiological function,the conception vessel and governor vessel are the links of the"brain-kidney-bladder"axis.Kidney essence deficiency,brain spirit losing,and dysfunction of bladder are the core pathogenesis of female stress incontinence.From the dysfunction of the"brain-kidney-bladder"axis and the deficiency of conception vessel and governor vessel,an integrated model of"one acupunture,two medication,and three daoyin therapy"was proposed for the treatment of female stress incontinence."One acupunture"is based on the theoretical guidance of"treating on the bone,and even under the navel ying"in Gukong Lun in Suwen,and the regulating conception vessel and dredging governor vessel acupuncture method is used to harmonize yin and yang,replenish qi,and consolidate bladder,using governor vessel points such as Baihui(DU20),Shenting(DU24),Mingmen(DU4),and conception vessel points such as Qihai(RN6),Guanyuan(RN64),Zhongji(RN3),and cooperating with Baliao points(BL31,BL32,BL33,and BL34)of the bladder meridian."Two medication"is guided by the theory that"dispersing conditions should be astringed,and deficient conditions should be warmed"in Zhizhenyao Dalun in Suwen;the treatment method focuses on consolidating conception vessel,dredging governor vessel,and harmonizing and nourishing qi and blood,and the Guren Tongdu Formula is selected."Three daoyin therapy",that is,using the abdominal contraction and anal lifting exercise,the Mawangdui daoyin therapy,and pelvic floor muscle training to cultivate qi,preserve spirit,and maintain the unity of body and mind.

The Choledochal cyst is an extremely rare congenital anomaly of the bile duct. Early cyst resection and Roux-en-Y hepatojejunostomy are the primary surgical methods for treating choledochal cyst. With the emergence of enhanced recovery after surgery, laparoscopic surgery has effectively reduced the incidence of biliary complications and wound infections, but it still does not meet people's requirements for minimally invasive surgery. Robotic surgery system has the potential to enhance surgical precision and the maneuverability of surgeons due to clear surgical visualization and flexible mechanical arms. The authors review the relevant literatures and conduct a Meta-analysis to evaluate the efficacy of robot-assisted surgery and laparoscopic surgery for choledochal cyst.

In recent years, antiangiogenic drugs based on VEGF and VEGFRs signaling pathway have been widely used in the treatment of malignant tumors. Apatinib is an orally bioavailable small-molecule antiangiogenic agent and can specifically inhibit the tyrosine kinase activity of VEGFR, thereby inhibiting tumor angiogenesis. Apatinib is the first-level recommendation of third-line treatment of gastric cancer in CSCO Guidelines for the Diagnosis and Treatment of Gastric Cancer published in 2018. Apatinib has been proved to be effective and safe in gastric, lung and breast cancers. In addition, the drug shows great potential in the treatment of a variety of solid tumors. This article reviews the recent progress on the mechanism, clinical efficacy, related efficacy predictors of apatinib and its combination with other antitumor drugs.

Objective To obtain myoclonic epilepsy with ragged-red fibers (MERRF)-specific cardiomyocytes by the differentiation in vitro of inducing pluripotent stem cells (iPSC) derived from a MERRF patient and evaluate the application of the prepared cardiomyocytes in construction of MERRF syndrome model.Methods The patient-derived iPSCs and H9 embryonic stem (ES) cells,the control cell line,were unidirectionally differentiated into cardiomyocytes n in vitro.The obtained cardiomyocytes were identified and validated by detecting the presence of cardiomyocyte-specific markers using immunofluorescence staining and RT-PCR.The beating frequencies were recorded to compare the functional evaluation for the two groups of cardiomyocyte.Results Both the patient-derived iPSC and H9 ES cells were differentiated into cardiomyocytes successfully.The average beating frequencies of MERRF-induced cardiomyocytes (iCMs) were 13,24,15 and 18 times/min on the day 10,13,15 and 16 during the cell differentiation process.The average beating frequencies of H9-iCMs were 80,96,120 and 120 times/min,respectively.The beating ability of iPSC-differentiated cardiomyocytes was significantly lower than that of corresponding control (all P ＜ 0.05).Conclusion The patient-derived iPSCs may differentiated into cardiomyocytes.Based on the functional evaluation for these cardiomyocytes,the model for MERRF syndrome with mitochondrial mutations was generated and characterized in vitro.

Objective To explore the clinical value of serum CA125 and HE4 combined with transvaginal color Doppler(TVCD)examination in early screening of ovarian cancer among high-risk populations.Methods The included research subjects were divided into 3 groups:100 cases in the healthy group,80 cases in the high-risk group and 32 cases in the ovarian cancer group.The serum CA125 and HE4 levels and ultrasonic scores were compared among 3 groups.Results The HE4 and CA125 levels and ultrasound scores in the ovarian cancer group were significantly increased compared with the other two groups,the difference was statistically significant(P＜0.01);the positive detection rate of CA125 plus HE4 levels combined with ultrasonic examination in the high-risk group was higher than that of other detection method(P＜0.05);the sensitivity and specificity of CA125+HE4 combined with vaginal ultrasound screening were obviously higher than those of other screening method,the difference was statistically significant(P＜0.05);the specificity of HE4 was significantly higher than that of CA125,but its sensitivity was lower than that of CA125(P＜0.05).Conclusion CA125 and HE4 combined with TVCD is helpful for early screening of ovarian cancer in high-risk populations,easy to save medical cost and improves its detection rate.

Objective To know the vaccination status of BCG in Gaoxin district of Chongqing and explore the associated impact factors on seroconversion rate .Methods PPD was used to test the seroconversion status after PDG vaccination in infants under 3 months .Results There was no significant differences of seroconversion rate between different sex ,birth weight and vaccination age (P>0 .05) .But the rate was significantly higher in infants with normal birth weight than that in fetal macrosomia which was signif-icantly higher than that in low-birth weight .The rate was significantly decreased in infants of 1-2 months ,2-3 months and 0-1 months in order .The rate of infant with vaccination scar was significantly higher than that without scar (χ2 =80 .057 ,P<0 .01) . Conclusion There was no significant differences of seroconversion rate between different sex ,birth weight and vaccination age ,and the scar can indirectly show the seroconversion condition of vaccination .