ObjectiveTo observe the clinical efficacy and safety of modified Duhuo Jisheng Decoction （独活寄生汤， DJD） as an adjuvant to chemotherapy in the treatment of multiple myeloma （MM） of kidney deficiency and blood stasis syndrome. MethodsA total of 65 patients with MM of kidney deficiency and blood stasis syndrome were randomly divided into a treatment group （32 cases） and a control group （33 cases）. The control group received a standardized chemotherapy regimen， while the treatment group additionally received modified DJD. Both groups received 28 days as one course of treatment for a total of three courses. The primary outcome was the total effective rate of traditional Chinese medicine （TCM） syndromes. The total TCM syndrome score， Numerical Rating Scale （NRS） score for bone pain， Karnofsky Performance Status （KPS） score， and laboratory indicators including hemoglobin（Hb）， β2-microglobulin（β2-MG）， and serum creatinine（SCr））， were compared between the two groups before and after treatment. After treatment， the clinical efficacy according to western medicine criteria and the incidence of adverse reactions were also evaluated. ResultsThe total effective rate of TCM syndrome was 93.75% （30/32） in the treatment group， significantly higher than 75.76% （25/33） in the control group （P＜0.05）. The total clinical effective rate according to western medicine criteria was 87.50% （28/32） in the treatment group and 78.79% （26/33） in the control group， with no statistically significant difference between the two groups （P＞0.05）. After treatment， the TCM syndrome scores and NRS scores significantly decreased， while KFS scores increased in both groups （P＜0.01）. The treatment group had significantly lower total TCM syndrome scores and NRS scores and higher KPS score than the control group （P＜0.05）. The treatment group showed an increase in Hb levels and decreases in β2-MG and SCr levels， whereas the control group showed only an increase in Hb level （P＜0.05）. The SCr level in the treatment group was lower than that in the control group （P＜0.05）. The incidence of drug-related peripheral neuropathy was 25.00% （8/32） in the treatment group， significantly lower than 51.52% （17/33） in the control group （P＜0.05）. ConclusionModified DJD as an adjunct to chemotherapy for MM with kidney deficiency and blood stasis syndrome can significantly reduce clinical symptoms， relieve bone pain， improve quality of life， and reduce the incidence of drug-related peripheral neuropathy. It may also exert a protective effect against MM-related renal impairment and demonstrates a favorable safety profile.

Objective: To study the effect of metformin sensitizing pancreatic cancer cells with radiotherapy, with a focus on elucidating the underlying mechanisms of radiotherapy resistance. In particular, the role of the PERK/P-eIF2/ATF4 signaling pathway in mediating these effects was preliminarily explored. Methods : Pancreatic cancer cell lines(PANC-1 and PANC-2) were categorized into control, radiotherapy, and drug treatment groups. Following the respective treatments, cell proliferation inhibition was assessed using the CCK-8 assay, colony formation assays, and cell death staining. Senescence was quantified by β-galactosidase(SA-β-Gal) staining. The expression of cell cycle regulators(P21, P16, γ-H2AX), apoptosis markers(Bax, Bcl-2, Cleaved caspase-3), and pathway-related proteins(PERK, P-eIF2, ATF4) was evaluated by Western blot and immunofluorescence. To further investigate the role of the PERK/P-eIF2/ATF4 axis in metformin-mediated modulation of pancreatic cancer cell senescence and radiosensitization, selective inhibitors(GSK2606414) and agonists(MK-28) of PERK were employed. Results : Radiotherapy markedly upregulated senescence-associated markers(P21, P16, γ-H2AX, and β-galactosidase activity) in pancreatic cancer cells. Senescent cells exhibited enhanced proliferative activity and increased tumor volume both in vitro and in vivo. Metformin mitigated radiotherapy-induced senescence by reducing the expression of senescence markers and significantly suppressing the clonogenic and proliferative capacity of treated cells. Mechanistically, radiotherapy activated the PERK signaling pathway, leading to increased expression of PERK, P-eIF2, and ATF4, thereby driving cellular senescence. Pharmacological inhibition of PERK reduced β-galactosidase activity, while PERK activation further promoted the expression of senescence-associated proteins—an effect that was reversed by metformin. Conclusion Metformin inhibits the activation of the PERK/P-eIF2/ATF4 signaling pathway in pancreatic cancer cells following radiotherapy, thereby delaying cellular senescence and reducing the associated radiotherapy resistance of senescent cells. This modulation contributes to the sensitization of pancreatic cancer cells to radiotherapy.

Objective To investigate the feasibility and safety of using catheter fenestration technology in transcatheter arterial chemoembolization(TACE)for hepatocellular carcinoma(HCC)supplied by the right inferior phrenic artery(RIPA).Methods From March 2023 to May 2023,five HCC patients,whose HCC lesions were supplied by RIP A,received TACE by using catheter fenestration technology to accomplish the superselective catheterization of RIPA after the conventional microcatheter catheterization of RIPA failed.Results Superselective catheterization of RIPA and TACE were successfully accomplished in all the 5 patients,with a surgical success rate of 100％.The time spent for superselective catheterization of RIPA was(3.2±2.39)minutes.After TACE,the levels of the tumor indicators were decreased when compared with the pre-TACE values,while the liver function indexes showed no obvious damage.Based on the mRECIST criteria,PR was obtained in 3 patients and CR was obtained in 2 patients.None of the five patients developed serious adverse reactions.Conclusion In treating patients with HCC supplied by RIPA,the use of catheter fenestration technology can safely and effectively improve the success rate of superselective catheterization of RIPA during TACE.