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*

Objectives:To develop a novel prediction model for mitral valve repair failure based on machine learning algorithms.Methods:Clinical and echocardiographic data were analyzed on patients,who underwent mitral valve repair in Fuwai Hospital from 2009 January 1st to 2022 December 31st.End points included immediate mitral valve repair failure (mitral replacement secondary to mitral repair failure) and recurrence regurgitation (moderate or severe mitral regurgitation before discharge).Risk factors of mitral valve repair failure were analyzed by XGBoost and shapley additive explanation (SHAP),and a machine learning model was established based on mixture of experts (MoE) as a risk prediction model and compared with conventional mitral valve repair complexity scores.Results:A total of 2314 patients were included in this study.Mitral repair was unsuccessful in 4.2％ (98 of 2314) of patients.Patient factors such as tricuspid regurgitation pressure gradient,A3 and A3P3 lesions,left ventricular end-systolic volume,and left atrium anterior and posterior diameter are associated with mitral valve repair failure;in addition,surgeon factors,such as cumulative repair failure rate,cumulative repair volume,and surgeon seniority,are also risk factors for mitral valve repair failure.The MoE model has an AUC value of 0.79,and the prediction performance is significantly better than traditional complexity scores.Conclusions:The MoE based machine learning model can predict the risk of mitral valve repair failure well.This evaluation system can effectively assist surgeons in assessing the risk of mitral valve repair failure and in selecting suitable treatment options for patients.

Objective: To explore the mediating effect of self-efficacy for exercise on social support and kinesiophobia in patients with rheumatoid arthritis (RA), so as to provide insights into alleviating fear for exercise and formulating exercise intervention programs. Methods: RA patients hospitalized in a tertiary hospital in Harbin City from June to December 2023 were selected, and the levels of kinesiophobia, self-efficacy for exercise and social support were investigated using the Tampa Scale of Kinesiophobia (Chinese version), the Self-Efficacy for Exercise and the Social Support Rating Scale, respectively. The mediating effect of self-efficacy for exercise on social support and kinesiophobia was examined using a structural equation model. Results: A total of 216 people were investigated, including 45 males (20.83%) and 171 females (79.17%), with the median age of 54.00 (interquartile range, 13.75) years. There were 159 of patients living in the urban areas, accounting for 73.61%. There were 102 of patients with a disease course of 1 to 5 years, accounting for 47.22%. The median scores of kinesiophobia, self-efficacy for exercise and social support were 31.00 (interquartile range, 5.00), 5.00 (interquartile range, 2.00) and 39.50 (interquartile range, 17.00), respectively. Social support had a direct negative effect on kinesiophobia (effect value=-0.358, P<0.05) and a indirect negative effect on kinesiophobia through self-efficacy for exercise (effect value=-0.887, P<0.05), and the mediating effect contributed 93.86% to the total effect. Conclusion Social support can directly or indirectly influence kinesiophobia through self-efficacy for exercise among patients with RA.

Objectives:To develop a novel prediction model for mitral valve repair failure based on machine learning algorithms.Methods:Clinical and echocardiographic data were analyzed on patients,who underwent mitral valve repair in Fuwai Hospital from 2009 January 1st to 2022 December 31st.End points included immediate mitral valve repair failure (mitral replacement secondary to mitral repair failure) and recurrence regurgitation (moderate or severe mitral regurgitation before discharge).Risk factors of mitral valve repair failure were analyzed by XGBoost and shapley additive explanation (SHAP),and a machine learning model was established based on mixture of experts (MoE) as a risk prediction model and compared with conventional mitral valve repair complexity scores.Results:A total of 2314 patients were included in this study.Mitral repair was unsuccessful in 4.2％ (98 of 2314) of patients.Patient factors such as tricuspid regurgitation pressure gradient,A3 and A3P3 lesions,left ventricular end-systolic volume,and left atrium anterior and posterior diameter are associated with mitral valve repair failure;in addition,surgeon factors,such as cumulative repair failure rate,cumulative repair volume,and surgeon seniority,are also risk factors for mitral valve repair failure.The MoE model has an AUC value of 0.79,and the prediction performance is significantly better than traditional complexity scores.Conclusions:The MoE based machine learning model can predict the risk of mitral valve repair failure well.This evaluation system can effectively assist surgeons in assessing the risk of mitral valve repair failure and in selecting suitable treatment options for patients.

Objective: To explore the safety and effectiveness of transthoracic endoscopic thyroid surgery in thyroid surgery. Methods: Retrospectively analyzed 230 patients with thyroid tumor aged from 19 to 71 years, including 67 males and 163 females, who were admitted to General minimally invasive surgery, First Affiliated Hospital of Henan University of Chinese Medicine from March 2018 to August 2019. All patients were divided into traditional operation group (n=95) and endoscopic group (n=135) according to the operation method. The general information of the two groups of patients before surgery, including the time of surgery and tumor removal, amount of bleeding during surgery, postoperative drainage and extubation time, were compared. And the hospital stay, hoarseness, postoperative bleeding, incision infection, numbness, twitching, satisfaction and other related indicators were calculated also. SPSS 22.0 software was used for statistical analysis. Normally distributed measurement data were expressed as Mean±SD, and conparisons between groups were calculated by t test or χ² test. The non-normally distributed data were expressed as M(P₂₅, P₇₅) and were analyzed by the Mann-Whitney U test. Results: Compared with the preoperative general data, the number of nodules in the traditional group was 3.00 (2.00, 3.00), and the number of nodules in the endoscope group was 2.00 (1.00, 3.00). The difference was statistically significant (Z=-4.461, P<0.01). The maximum diameter of the tumor in the traditional group is 1.00 (1.00, 2.00) cm, and the maximum diameter of the tumor in the endoscope group is 1.00 (1.00, 2.00) cm. The two are statistically significant (Z=-2.041, P=0.041). There were no significant differences in age, gender, course of disease, nodule type, cystic change, nodule location, aspect ratio, nodule echo, nodular morphology, and nodular calcification (all P>0.05). Comparison of intraoperative indicators, the operation time of the traditional group was shorter than that of the endoscope group [(67.51 ± 9.27) min vs (89.86 ± 10.32) min, t=11.462, P<0.01]; the tumor removal time of the traditional group was also shorter than that of the endoscope group [( 28.37 ± 8.94) min vs (33.35 ± 7.39) min, t=5.456, P<0.01]; the blood loss in the traditional group was significantly more than that in the endoscope group [(51.34 ± 3.26) ml vs (20.65 ± 5.89) ml, t=14.723, P<0.01]. The recurrent laryngeal nerve was explored intraoperatively in both groups with a detection rate of 100%, the anesthesia was good in both groups, and the drainage tubes were indwelling in both groups. The drainage volume of the traditional group was significantly higher than that of the endoscope group [(135.76 ± 60.55) ml vs (69.12 ± 37.13) ml, t=10.805, P<0.01]. The extubation time was longer in the traditional group than in the endoscope group [(5.54 ± 1.44) d vs (4.66 ± 1.55) d, t=2.384, P=0.023]. In terms of hospitalization time, the traditional group was significantly longer than the endoscope group [(10.48 ± 5.37) d vs (7.25 ± 3.68) d, t=11.549, P<0.01]. There were 11 cases of hoarseness in the traditional group and 4 cases of hoarseness in the endoscope group, and there has statistically significant (χ²=6.790, P=0.009). There were 5 cases of postoperative bleeding in the traditional group, 1 case of postoperative bleeding in the endoscope group, the difference between the two was statistically significant (χ²=4.365, P=0.037); 5 cases of incision infection in the traditional group, none in the endoscope group, and the difference was statistically significant (P=0.012); 4 cases of numbness convulsions in the traditional group, none in the endoscope group, and there was statistical significance (P=0.028); 87 cases of satisfaction in the traditional group, and 134 cases of satisfaction in the endoscope group, and the difference was statistically significant (χ²=6.825, P=0.009). Conclusions Transthoracic endoscopic thyroid surgery has fewer complications in thyroid surgery and quicker postoperative recovery. It is worthy of widespread promotion, but the specific implementation plan needs to be further optimized.

This study is aimed to evaluate the clinical application of the millimeter wave and magnetism light compound therapy. The EHF-98B MMW. RL compound therapy apparatus made in the University of Electronic Technology(Chengdu) was used in 171 patients. The superficial, skin lesions or the visceral reflected skin regions (acupoints) were directly exposed to the light from the apparatus. All the cases were divided into five groups, namely skin mucosa superficial lesions, trauma of the bone and joint soft tissue, surgical incision, ENT infections, and rare intricate diseases. The therapeutic effects observed in the groups were analyzed and evaluated by means of 4 levels. As for the 171 patients, the cure rate was 42.7% (73 patients), the effective rate 25.1%(43 patients), the improvement rate 31%(53 patients), and no effect constituted 1.2%(2 patients). The total effective rate was 98.8%. This therapy was especially effective for treating chronic cervicitis, cervical erosion, soft tissue trauma, surgical incision. Also it was effective for treating some rare intricate diseases, e.g. sterility, vitiligo, Behcet disease. So the millimeter wave and magnetism light compound therapy may find wide clinical applications.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Combined Modality Therapy ; Female ; Humans ; Infant ; Infant, Newborn ; Joint Diseases ; therapy ; Magnetics ; therapeutic use ; Male ; Microwaves ; therapeutic use ; Middle Aged ; Otorhinolaryngologic Diseases ; therapy ; Phototherapy ; Skin Diseases, Infectious ; therapy ; Soft Tissue Injuries ; therapy

Aim To study pharmacokinetics and bioavailablity of domestic penicillin V dispersion tablet in healthy volunteers. Methods According to the crossover design, each volunteer in two groups was orally given a single dose ( 0.75 g ) of domestic penicillin V dispersion tablet or imported penicillinV tablet alternately and the plasma concentrations were determined by RP HPLC. The pharmacokinetic parameters were obtained by using ATPK program and calculated on the basis of open single compartment model. Results After a single oral dose( 0.75 g ), the t 1/2(ke) was ( 0.75 ? 0.10 ) h and ( 0.70 ? 0.14 ) h ,the c max was( 8.44 ? 2.40 ) mg?L -1 and ( 8.75 ? 3.04 ) mg?L -1 at ( 0.56 ? 0.11 ) h and ( 0.63 ? 0.17 ) h and AUC 0～4 was( 8.44 ? 2.40 ) mg?h?L -1 and ( 8.75 ? 3.04 ) mg?h?L -1 for two formulations, respectively. Relative bioavailability of domestic penicillin V dispersion tablet was ( 90.50 ? 8.84 )%. Conclusion The result shows that the two formulations are bioequivalent.