Background and Aims:Intrahepatic cholangiocarcinoma(ICC)is a highly malignant liver tumor,with an increasing incidence worldwide,particularly in Asia.Although radical surgical resection is currently the only potentially curative treatment,the high recurrence rate and low postoperative overall survival(OS)rate of ICC remain major clinical challenges.Adjuvant therapy(AT)and neoadjuvant therapy(NAT)are important strategies to reduce postoperative recurrence and prolong OS.Several studies have shown certain efficacy of these treatments.However,the specific efficacy and safety of combined NAT and AT in ICC treatment require further validation.This study was conducted to evaluate the value of combining NAT and AT in improving the therapeutic outcomes of ICC patients through a multicenter retrospective analysis,so as to provide scientific evidence for optimizing treatment strategies.Methods:The clinicopathologic data of 576 patients with ICC who underwent radical resection and were pathologically confirmed from 13 hospitals in China between December 2011 and December 2017 were retrospectively collected.Patients were grouped based on their treatment modality:NAT+AT group,AT group,and non-NAT/AT group.The three patient groups were matched pairwise in a 1∶1 ratio using propensity score matching(PSM)to balance baseline data.The Kaplan-Meier method was used to analyze OS and disease-free survival(DFS),and subgroup analyses were conducted according to the 8th edition of the AJCC TNM staging system.Results:A total of 395 ICC patients were included in the final analysis,with 42 patients(10.6%)in the NAT+AT group,62 patients(15.7%)in the AT group,and 291 patients(73.7%)in the non-NAT/AT group.Before PSM,significant differences were observed between groups in terms of CA19-9,liver function Child-Pugh classification,intraoperative blood loss,surgical margin,differentiation grade,vascular invasion,ECOG score,and lymph node dissection ratio(all P<0.05).After PSM,there were no significant differences in baseline characteristics between the groups(all P>0.05).After matching,the median OS and DFS in the NAT+AT group were significantly better than in the AT and non-NAT/AT groups(both P<0.05),while there were no significant differences in OS and DFS between the AT and non-NAT/AT groups(both P>0.05).Subgroup analysis showed that in TNM stage I patients,DFS in the NAT+AT group was significantly better than in the non-NAT/AT group(P<0.05),but OS was not significantly different(P>0.05).In TNM stage Ⅱ and Ⅲ patients,both OS and DFS in the NAT+AT and AT groups were significantly better than in the non-NAT/AT group(both P<0.05),and DFS in the NAT+AT group was significantly better than in the AT group in TNM stage Ⅲ patients(P<0.05).Conclusion:NAT combined with AT provides better survival benefits for patients with locally advanced ICC,but its benefit for early-stage ICC patients is limited.However,the retrospective design and sample size limitations of this study may affect the stability of the results,and future large-sample,multicenter,prospective studies are needed for further validation.

Background and Aims:Intrahepatic cholangiocarcinoma(ICC)is a highly malignant liver tumor,with an increasing incidence worldwide,particularly in Asia.Although radical surgical resection is currently the only potentially curative treatment,the high recurrence rate and low postoperative overall survival(OS)rate of ICC remain major clinical challenges.Adjuvant therapy(AT)and neoadjuvant therapy(NAT)are important strategies to reduce postoperative recurrence and prolong OS.Several studies have shown certain efficacy of these treatments.However,the specific efficacy and safety of combined NAT and AT in ICC treatment require further validation.This study was conducted to evaluate the value of combining NAT and AT in improving the therapeutic outcomes of ICC patients through a multicenter retrospective analysis,so as to provide scientific evidence for optimizing treatment strategies.Methods:The clinicopathologic data of 576 patients with ICC who underwent radical resection and were pathologically confirmed from 13 hospitals in China between December 2011 and December 2017 were retrospectively collected.Patients were grouped based on their treatment modality:NAT+AT group,AT group,and non-NAT/AT group.The three patient groups were matched pairwise in a 1∶1 ratio using propensity score matching(PSM)to balance baseline data.The Kaplan-Meier method was used to analyze OS and disease-free survival(DFS),and subgroup analyses were conducted according to the 8th edition of the AJCC TNM staging system.Results:A total of 395 ICC patients were included in the final analysis,with 42 patients(10.6%)in the NAT+AT group,62 patients(15.7%)in the AT group,and 291 patients(73.7%)in the non-NAT/AT group.Before PSM,significant differences were observed between groups in terms of CA19-9,liver function Child-Pugh classification,intraoperative blood loss,surgical margin,differentiation grade,vascular invasion,ECOG score,and lymph node dissection ratio(all P<0.05).After PSM,there were no significant differences in baseline characteristics between the groups(all P>0.05).After matching,the median OS and DFS in the NAT+AT group were significantly better than in the AT and non-NAT/AT groups(both P<0.05),while there were no significant differences in OS and DFS between the AT and non-NAT/AT groups(both P>0.05).Subgroup analysis showed that in TNM stage I patients,DFS in the NAT+AT group was significantly better than in the non-NAT/AT group(P<0.05),but OS was not significantly different(P>0.05).In TNM stage Ⅱ and Ⅲ patients,both OS and DFS in the NAT+AT and AT groups were significantly better than in the non-NAT/AT group(both P<0.05),and DFS in the NAT+AT group was significantly better than in the AT group in TNM stage Ⅲ patients(P<0.05).Conclusion:NAT combined with AT provides better survival benefits for patients with locally advanced ICC,but its benefit for early-stage ICC patients is limited.However,the retrospective design and sample size limitations of this study may affect the stability of the results,and future large-sample,multicenter,prospective studies are needed for further validation.

The related symptoms of patients with congenital microtia after ear reconstruction surgery mainly include pain, psychological problems, fatigue, and sleep disorders. Measures of chest strap compression bandage, diversion of attention and use of analgesics; psychological counseling, establishment of WeChat communication group, and organizing communication meetings; proper lying position, earmuffs, emotional reassurance were taken to improve symptoms. This article provides a summary review of the management measures for related symptoms, aiming to draw more attention from healthcare professionals and to provide a reference for constructing symptom management programs in the future, promoting the patients’ physical and mental health recovery and enhancing their quality of life.

The related symptoms of patients with congenital microtia after ear reconstruction surgery mainly include pain, psychological problems, fatigue, and sleep disorders. Measures of chest strap compression bandage, diversion of attention and use of analgesics; psychological counseling, establishment of WeChat communication group, and organizing communication meetings; proper lying position, earmuffs, emotional reassurance were taken to improve symptoms. This article provides a summary review of the management measures for related symptoms, aiming to draw more attention from healthcare professionals and to provide a reference for constructing symptom management programs in the future, promoting the patients’ physical and mental health recovery and enhancing their quality of life.

Objective:To evaluate the role of interleukin-4 (IL-4) in renal fibrosis induced by acute kidney injury (AKI) in mice.Methods:Twenty-four male C57BL/6 mice, aged 8-10 weeks, weighing 20-30 g, were divided into 4 groups ( n =6 each) using a random number table method: control group (group CON), AKI group, control plus anti-IL-4 antibody group (group CON-A), and AKI plus anti-IL-4 antibody group (group AKI-A). In AKI-A and AKI groups, folic acid was intraperitoneally injected to induce AKI in anesthetized mice, and the anti-IL-4 antibody 40 mg/kg and the equal volume of PBS were intraperitoneally injected, respectively, at 3, 6, 9 and 12 days after injection. The equal volume of PBS and anti-IL-4 antibody was given at the corresponding time point in CON and CON-A groups, respectively.The orbital blood samples were taken on day 14 after injecting folic acid for determination of the serum blood urea nitrogen (BUN) and creatinine (Cr) concentrations.The animals were then sacrificed, and renal tissues were obtained for examination of the pathological changes (using Sirius red staining and Masson staining) and for determination of the expression of fibronectin(FN), collagen-Ⅰ(Col-Ⅰ) and α-smooth muscle actin (α-SMA) (by Western blot) and expression of CD206, Arg-1 and FIZZ1 mRNA (by real-time polymerase chain reaction). The area of renal fibrosis was measured. Results:Compared with group CON, the serum BUN and Cr concentrations were significantly increased, the area of renal fibrosis was increased, and the expression of FN, Col-Ⅰ, α-SMA and CD206, Arg-1 and FIZZ1 mRNA in renal tissues was up-regulated in group AKI ( P<0.05), and no significant change was found in the parameters mentioned above in group CON-A( P>0.05). Compared with group AKI, the serum BUN and Cr concentrations were significantly decreased, the area of renal fibrosis was reduced, and the expression of FN, Col-Ⅰ, α-SMA and CD206, Arg-1 and FIZZ1 mRNA in renal tissues was down-regulated in group AKI-A ( P<0.05). Conclusion:IL-4 is involved in the process of renal fibrosis following AKI, and the mechanism may be associated with the regulation of macrophage M2 polarization in mice.