Cholangiocarcinoma(CCA)is a highly aggressive and heterogeneous biliary malignancy characterized by challenges in early diagnosis,limit-ed efficacy of traditional chemotherapy,and poor prognosis.Due to its significant heterogeneity at the genomic,epigenetic,and molecular levels,mo-lecular testing and targeted therapy have become increasingly important in CCA management,form-ing an integral part of the era of precision oncolo-gy.The development of next-generation sequenc-ing(NGS)has advanced research into the molecu-lar subtypes and therapeutic targets of CCA,includ-ing FGFR2 fusions/rearrangements,IDH1 muta-tions,and BRAF mutations.Recently,two phase Ⅲ clinical trials,TOPAZ-1 and KEYNOTE-966,have es-tablished the pivotal role of immunotherapy com-bined with chemotherapy in advanced CCA.While precision diagnosis and treatment in CCA have shown promising progress,this field remains in its exploratory phase and faces numerous challenges.This review summarizes recent advancements in the diagnosis,molecular targeted therapy,immuno-therapy,resistance mechanisms,and the develop-ment of novel strategies for CCA.

The aim of this updated guideline is to provide comprehensive recommendations for the management of gout in patients with common comorbidities, such as chronic kidney disease(CKD), cardiovascular disease(CVD), diabetes, osteoarthritis(OA), and gastrointestinal disorders. This guideline was developed by a multidisciplinary expert panel consisting of specialists in endocrinology, rheumatology, nephrology, cardiology, gastroenterology, and methodology. The development process adhered to standard methodologies, including PICO(population, intervention, comparator, and outcomes) question deconstruction, systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation(GRADE) for evidence and recommendation evaluation, Delphi voting, and expert consensus. The guideline presents 26 evidence-based recommendations addressing 7 clinical questions for patients with hyperuricemia and gout in the context of comorbidities. Key recommendations include the maintenance of strict serum urate targets, particularly for patients with CKD stage≥3, chronic gouty arthritis, and OA, in order to prevent disease progression. In patients with CVD or diabetes, intra-articular triamcinolone is preferred over systemic glucocorticoids. Prioritized anti-inflammatory treatments for patients with CKD, gastrointestinal diseases and OA are recommended. The guideline also introduces emerging therapies, such as interleukin-1 inhibitors and selective urate transport inhibitors, as potential treatment options for refractory cases. The update offers a comprehensive, patient-centered approach to managing gout, particularly in individuals with associated comorbidities. Multidisciplinary collaboration and emerging new treatments and evidence ensure the optimization of the recommendations.

Cholangiocarcinoma(CCA)is a highly aggressive and heterogeneous biliary malignancy characterized by challenges in early diagnosis,limit-ed efficacy of traditional chemotherapy,and poor prognosis.Due to its significant heterogeneity at the genomic,epigenetic,and molecular levels,mo-lecular testing and targeted therapy have become increasingly important in CCA management,form-ing an integral part of the era of precision oncolo-gy.The development of next-generation sequenc-ing(NGS)has advanced research into the molecu-lar subtypes and therapeutic targets of CCA,includ-ing FGFR2 fusions/rearrangements,IDH1 muta-tions,and BRAF mutations.Recently,two phase Ⅲ clinical trials,TOPAZ-1 and KEYNOTE-966,have es-tablished the pivotal role of immunotherapy com-bined with chemotherapy in advanced CCA.While precision diagnosis and treatment in CCA have shown promising progress,this field remains in its exploratory phase and faces numerous challenges.This review summarizes recent advancements in the diagnosis,molecular targeted therapy,immuno-therapy,resistance mechanisms,and the develop-ment of novel strategies for CCA.

The aim of this updated guideline is to provide comprehensive recommendations for the management of gout in patients with common comorbidities, such as chronic kidney disease(CKD), cardiovascular disease(CVD), diabetes, osteoarthritis(OA), and gastrointestinal disorders. This guideline was developed by a multidisciplinary expert panel consisting of specialists in endocrinology, rheumatology, nephrology, cardiology, gastroenterology, and methodology. The development process adhered to standard methodologies, including PICO(population, intervention, comparator, and outcomes) question deconstruction, systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation(GRADE) for evidence and recommendation evaluation, Delphi voting, and expert consensus. The guideline presents 26 evidence-based recommendations addressing 7 clinical questions for patients with hyperuricemia and gout in the context of comorbidities. Key recommendations include the maintenance of strict serum urate targets, particularly for patients with CKD stage≥3, chronic gouty arthritis, and OA, in order to prevent disease progression. In patients with CVD or diabetes, intra-articular triamcinolone is preferred over systemic glucocorticoids. Prioritized anti-inflammatory treatments for patients with CKD, gastrointestinal diseases and OA are recommended. The guideline also introduces emerging therapies, such as interleukin-1 inhibitors and selective urate transport inhibitors, as potential treatment options for refractory cases. The update offers a comprehensive, patient-centered approach to managing gout, particularly in individuals with associated comorbidities. Multidisciplinary collaboration and emerging new treatments and evidence ensure the optimization of the recommendations.

‍The Japanese Society of Gastroenterology （JSGE） first published evidence-based clinical practice guidelines for cholelithiasis in 2010， followed by a revision in 2016. In April 2023， JSGE published the 2021 edition of evidence-based clinical practice guidelines for cholelithiasis based on the clinical issues associated with cholelithiasis in the databases such as Medline， Cochrane， and Igaku Chuo Zasshi and the latest evidence in literature published in the past five years. The revised edition reviews related clinical questions in the previous edition from the aspects of the epidemiology， pathogenesis， diagnosis， treatment， prognosis， and complications of cholelithiasis and reclassifies them into three categories， with 52 questions in total， among which there are 29 background questions dealing with basic background knowledge， 19 clinical questions， and 4 future research questions requiring further accumulation of evidence， thereby providing guidance for decision making in the clinical management of patients with cholelithiasis.

OBJECTIVE: To explore the genetic etiology of a patient with glycogen accumulation type Ⅰa with gout as the main clinical feature. METHODS: Clinical data of the patient was collected. The patient and her parents were subjected to next generation sequencing (NGS). Suspected pathogenic variation was verified by Sanger sequencing. RESULTS: The patient, a 30-year-old women, mainly manifested hyperuricemia, chronic gouty arthritis, fasting hypoglycemia, hypertriglyceridemia, hyperlactatemia, hepatomegaly, urolithiasis, and gradually developed liver nodules and renal dysfunction. NGS revealed that she has carried c.648G>T (exon 5) and c.260delG (exon 2) compound heterozygous variants of the G6PC gene, which were respectively inherited from her father (phenotypically normal) and mother (with hyperuricemia). The c.260delG variant was unreported previously. Bioinformatic analysis indicated that both variants are pathogenic. CONCLUSION The compound heterozygous variants of the G6PC gene probably underlay the glycogen storage disease Ⅰa in this patient. G6PC gene mutations should be excluded in young women with hyperuricemia and /or gout.

OBJECTIVE To discuss the application of tachypleus amebocyte lysate test in transfusion reaction. METHODS Based on agglutination when tachypleus amebocyte lysate test encountered bacterial endotoxin, the quantity of the bacterial endotoxin was tested. RESULTS Twenty-three cases were analyzed with tachypleus amebocyte lysate test, the main reasons were excessive pyrogen, improper combined drug compatibility, excessive agents or unqualified pyrogen of the agent added, pollutions on transfusion devices and air in the treatment room, disobeying axenic operation rules, overlong drug dispensing, too fast transfusion speed, etc. CONCLUSIONS On prevention of transfusion reaction, all the axenic operation rules should be strictly followed, single dose transfusion, to reduce transfusion reaction.

Objective To investigate the relationship between the TRAb-producing cell precursors and different clinical stages of Graves' disease.Methods Peripheral lymphocytes were infected with Epstein-Barr virus,a kind of lymphocyte precursor stimulator,and were stimulated to produce TRAb.Results Of the total wells containing Ig-producing B cell precursors,there were 34.6% and 29.1% from 2 untreated patients,30% from 1 relapsing patient and only 1.3% and 3.8% from 2 healthy controls that secreted TRAb,respectively.As for the wells containing B cell precursors from 2 remission patients with undetectable TRAb in circulation,the percentage (10.7%) of TRAb-containing wells from one was higher than that from the other (5.3%).And the latter had similar percentage of TRAb-positive wells with the controls.The isotype of TRAb in supernatants of our EBV-transformed B lymphocytes was predominantly IgM.Conclusion The frequencies of TRAb-specific precursors were different at three distinct clinical stages of the disease.