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*

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Objective To investigate the renal function recovery and perioperative risk factors for chronic kidney disease in patients after acute Stanford type A aortic dissection (ATAAD) repair. Methods A retrospective study was conducted on patients who underwent ATAAD repair at the Xiamen Cardiovascular Hospital, Xiamen University from 2020 to 2021, and their clinical data were analyzed. Results A total of 255 patients were included, with 200 males and 55 females, and an average age of (52.80±12.46) years. The incidence of acute kidney injury (AKI) after ATAAD repair was 43.9%. Dissection involving the renal artery [OR=2.144, 95%CI (1.234, 3.765), P=0.007], intraoperative urine output [OR=0.761, 95%CI (0.625, 0.911), P=0.004], and intraoperative red blood cell transfusion [OR=1.288, 95%CI (1.088, 1.543), P=0.004] were significantly associated with early AKI after ATAAD repair. Long-term renal function follow-up data were available for 232 patients, among whom 40 (17.2%) patients developed chronic kidney disease (CKD). Independent predictors for CKD included lower body mass index [OR=0.827, 95%CI (0.723, 0.931), P=0.003], preoperative cardiac tamponade [OR=5.344, 95%CI (1.65, 17.958), P=0.005], preoperative renal hypoperfusion syndrome [OR=12.629, 95%CI (5.003, 35.373), P<0.001], postoperative peak serum creatinine time>3 d [OR=7.566, 95%CI (2.799, 22.731), P<0.001], and AKI grade [grade 1: OR=4.418, 95%CI (1.339, 15.361), P=0.016; grade 2: OR=8.345, 95%CI (1.762, 40.499), P=0.007; grade 3: OR=9.463, 95%CI (2.602, 37.693), P<0.001]. Conclusion AKI related to ATAAD repair can recover in the early postoperative period, but both the duration and severity of AKI will affect long-term renal function. In addition, patients' nutritional status, preoperative cardiac tamponade, and renal hypoperfusion syndrome are also independent risk factors for long-term renal dysfunction.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Object:To investigate the impact of carbon nanoparticle tracing on the number of lymph nodes harvested in obese patients during radical gastrectomy for gastric cancer.Methods:Clinical data of 127 patients undergoing D 2 radical gastrectomy in the Affiliated Tumor Hospital of Zhengzhou University from Jan 2015 to Dec 2019 were retrospectively analyzed. According to whether the patients were injected with carbon nano particles during operation, they were divided into two groups: 64 patients without carbon nano particles during operation served as control group; 63 patients with carbon nano particles were included into experimental group. Results:The operation time of the control group was (160±31) min and that of the experimental group was (168±28) min ( t=-1.521, P=0.445). Intraoperative blood lose in the control group was (234±82) ml and that in the experimental group was (238±84) ml ( t=-0.295, P=0.846). The number of lymph nodes harvested in the first station, in the second station, the number of total lymph nodes and the number of lymph nodes with diameter <5 mm in the control group were less than those in the experimental group(10.4±3.8 vs. 24.5±10.6, t=-10.054),(6.6±2.8 vs. 16.8±7.3, t=-10.381),(17.1±6.4 vs. 41.2±17.6, t=-10.293),(3.9±2.5 vs. 21.2±9.1, t=-14.662) (all P<0.05), while the number of positive lymph nodes was not statistically different between the two groups all (5.9±6.2 vs. 4.2±3.4, t=-1.963, P>0.05). Black staining of lymph nodes in nano carbon group: 1 542 black stained lymph nodes were detected in the experimental group, the black staining rate of lymph nodes was 59.44% (1 542/2 594). Conclusion:Intraoperative application of carbon nanoparticles can significantly increase the number of harvested lymph nodes in obese (BMI≥25 kg/m 2) gastric cancer patients after radical resection.

Objective:To investigate the effects of preoperative endoscopic mucosal injection of carbon nanoparticle tracer and intraoperative serosa injection of carbon nanoparticle tracer on the acquisition of lymph nodes in total gastrectomy for gastric cancer.Methods:The retrospective cohort study was conducted. The clinical data of 118 patients with gastric cancer who underwent total gastrectomy in the Affiliated Tumor Hospital of Zhengzhou University between May 2017 and April 2018 were collected. There were 79 males and 39 females, aged from 26 to 81 years, with an average age of 59 years. Of 118 patients, 56 patients undergoing preoperative endoscopic mucosal injection of carbon nanoparticle tracer were divided into observation group and 62 patients undergoing intraoperative serosa injection of carbon nanoparticle tracer were divided into control group. Observation indicators: the total number of lymph node dissected, the number of positive lymph node dissected, the number of lymph node dissected at the first station and the number of lymph node dissected at the second station. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent-sample t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed using the rank sum test. Results:The total number of lymph node dissected, the number of positive lymph node dissected, the number of lymph node dissected at the first station, the number of lymph node dissected at the second station of the observation group were 48±16, 3(range, 0-25), 26±9, 23±7, respectively. The above indicators of the control group were 41±13, 4(range, 0-28), 25±8, 16±5, respectively. There were significant differences in the total number of lymph node dissected and the number of lymph node dissected at the second station between the two groups ( t=2.494, 6.588, P<0.05), and there was no significant difference in the number of positive lymph node dissected and the number of lymph node dissected at the first station between the two groups ( Z=0.747, t=1.689, P>0.05). Conclusions:Carbon nanoparticle labeled lymph node staining using preoperative endoscopic mucosal injection of carbon nanoparticle tracer or intraoperative serosa injection of carbon nanoparticle tracer is safe and effective in total gastrectomy for gastric cancer. Compared with intraoperative serosa injection of carbon nanoparticle tracer, preoperative endoscopic mucosal injection of carbon nanoparticle tracer can increase the total number of lymph node dissected, especially the number of lymph node dissected at the second station of gastric cancer.

Objective To observe the changes of renal tubular injury and the extent of interstitial fibrosis in the C57BL/6 mouse models of chronic kidney disease(CKD),and provide experimental animal evidence for study of the pro-gression of acute kidney injury(AKI)to chronic kidney disease as well as its mechanisms. Methods Twenty-four 8-week-old male C57BL/6 mice were randomly and equally divided into control group, low-dose, medium-dose, and high-dose cisplatin groups,6 mice in each group. Mice in the cisplatin groups were administrated with 5,7 or 10 mg/kg cispla-tin by intraperitoneal injection once a week for 4 weeks. Plasma creatinine and 24-hour urinary protein were detected to as-sess the renal function. The mice were sacrificed, and plasma and kidney samples were collected for subsequent tests. Pathological changes were observed using periodic acid-Schiff(PAS)staining. To evaluate renal tubules injury, the ex-pression of kidney injury molecule 1(KIM-1)was examined by immunohistochemistry and the level of urinary N-Acetyl-β-D-glucosaminidase was detected with a commercial kit. The infiltration of CD3-positive T cells and F4/80-positive macro-phages was observed by immunohistochemistry(IHC)and immunofluorescence. The expression of collagen I and α-smooth muscle actin(α-SMA)were tested by immunohistochemistry to assess the renal fibrosis, while total kidney collagen was detected by Picrosirius red staining. Results In contrast to the normal control group,the kidney injury became more seri-ous in the cisplatin-treated mice as cisplatin concentration increased. Particularly,significant kidney damage was observed in the high-dose cisplatin group. Compared with the control group,the plasma creatinine and 24-hour urinary protein were significantly increased in the high-dose cisplatin group(P<0.05 and P<0.001)indicating impaired renal function. Mor-phologically,numerous clear vacuoles and necrosis were present in renal tubule epithelial cells in the high-dose cisplatin group. The expression of KIM-1 was markedly up-regulated and the level of urinary NAG was elevated. Infiltration of CD3-positive T cells and F4/80-positive macrophages was enhanced in the mice of high-dose cisplatin group. Data from immuno-histochemistry and picrosirius red staining showed that mice of the high-dose cisplatin group developed renal fibrosis evi-denced by markedly up-regulated expression of collagen I and α-SMA. Conclusions Repeated administration of 10 mg /kg cisplatin for 4 weeks can induce chronic renal insufficiency in mice,which may serve as a novel model for the research on underlying mechanisms of progression from acute kidney injury to chronic kidney disease.

Objective To establish the SD rat aortic dissection(AD)model by using both BAPN and AngⅡ,in order to investigate AD's pathogenesis. Methods 90 three weeks old SD rats were equally divided into three groups randomly:control group,medicine gavage group and blank medicine gavage group. Rats in control group were fed on a regular diet;BAPN ( 1g/ kg per day)was forced into rats'stomach in the medicine gavage group;the same volume saline was forced into rats' stomach in the blank medicine gavage group. 4 weeks later,when the rats were 7 weeks old,we stopped giving them BAPN, but to implant an omicro-osmotic pump subcutaneously in the abdomen. The pumps in control group and blank medicine gavage group were filled with 0. 9％ saline,the medicine gavage group'pumps were filled with AngⅡsolution( 1 μg·kg- 1 ·min- 1 ). 1 week later,all the survivals were dissected after anesthesia and the aortic vessels were acquired. All the acquired aortic ves-sels were proceed pathological examination. All the rats dead during the process of the experiment were dissected immediately to get the aortic vessels and proceed pathological examination. Results All rats in control group and blank medicine gavage group were survival,there was no aortic dissection or death. In medicine gavage group, 15 rats developped aortic dissection, 12 a-mong them were died of aortic dissection rupture,the aortic dissection formation rate was 50％ . Conclusion Using BAPN and AngⅡ to establish the SD rat AD model is feasible,it is simple and practicable,meanwhile,it has high aortic dissection for-mation rate. The process is similar with human's aortic dissection process.

Objective To investigate living quality of patients after orthotopic cardiac transplantation and to provide scientific evidence for specific strategy of therapy and improvement of living quality of patients with cardiac transplantation. Methods SF-36 and the social support questionnaire were used to analyze living quality of 79 patients who received orthotopic cardiac transplantation in the Department of Cardiovascular surgery of Affiliated Union Hospital of Fujian Medical University. The mode of SF-36 was from the investigative numerical value of residents in Sichuan province. Description, t-test and Spearman correlation analysis were used to study the related factors. Results Compared with a reference general population, the heart transplant recipients showed a significantly worse living quality score on all domains of the SF-36 scales (P＜0. 05), except the domain of somatic pain. Among the patients after cardiac transplantation, living quality was more significantly improved in ＞2-year survival group than that in ＜one-year survival group (P＜0. 05),except the domain of somatic pain. The relationships between the social support and living quality were analyzed,and it was found that as compared with a reference general population, the heart transplant recipients showed significantly lower scores on all domains of the social support questionnaire (P＜0. 01 ). The total social support scores were positively related to mental health related living quality (P＜0.05, r = 0.223 - 0.710), except the domain of somatic pain. Conclusion Compared with a general population, heart transplant recipients demonstrated a significantly worsened living quality. But evidence showed the living quality can be improved gradually with the prolongation of the survival time after heart transplantation. Social support was related to the living quality of heart transplantation patients. Improvement of availability on social support will probably improve living quality.