The trinity of physique-qi-spirit is a view of life in traditional Chinese medicine （TCM） that integrates both theoretical interpretation and technical operation. Its connotation includes two aspects， the three elements of physique， qi， and spirit composing human life， and these three elements exist as an inseparable unity. Based on the concept of the trinity of physique-qi-spirit， this article explores three key points from the technical operation level， defining "qi" as an intangible， non-physical substance； briefly analyzing the mechanism of the trinity of physique-qi-spirit from the perspective of qi theory； and discussing the state of life optimization achieved through their integration. Understanding the connotation of the trinity of physique-qi-spirit from a technical operation level helps to maximize its unique advantages in self-health management.

Based on the trinity life view of ''physique， Qi， and spirit''， Chaihu Jia Longgu Mulitang treats the patient's physical symptoms， disorders of Qi movement， and disorders of consciousness， covering the overall treatment and comprehensive nursing of physique， Qi， and spirit. It is widely applied and recognized for its efficacy in modern clinical practice. This paper explored the treatment effect of Chaihu Jia Longgu Mulitang from the trinity life view of ''physique， Qi， and spirit''. This formula mainly targeted patients with Qi deficiency caused by cold， leading to a syndrome of Qi stagnation and water retention in the Triple Energizer Meridian of Hand Lesser Yang （TE）， as well as fire-heat syndrome in the Large Intestine Meridian of Hand Yang Brightness （LI） and Stomach Meridian of Foot Yang Brightness （ST）， accompanied by disorder of nutrient-blood and subsequent spirit and soul unrest. Accurately judging the imbalance of the patient's physique， Qi， and spirit and using an appropriate combination of medicinals can achieve balance among the three to achieve the best effect. The treatment strategy of Chaihu Jia Longgu Mulitang is as follows： For disorders of Qi movement， such as Qi deficiency， Qi stagnation， and gastrointestinal fire-heat， Ginseng Radix et Rhizoma and Bupleuri Radix-Scutellariae Radix， and Rhei Radix et Rhizoma are used in combination. For physical symptoms such as water retention and disorder of nutrient-blood， Poria-Pinelliae Rhizoma-Zingiberis Rhizoma Recens， as well as Cinnamomi Ramulus-Jujubae Fructus are used in combination. Finally， Os Draconis-Ostreae Concha-Plumbum Rubrum is used to calm the spirit and soothe the soul. According to existing research， Chaihu Jia Longgu Mulitang has shown good efficacy in treating a variety of complex clinical diseases. This article provides a comprehensive interpretation of Chaihu Jia Longgu Mulitang from the perspective of the trinity life view of ''physique， Qi， and spirit''， offering new insights for clinical syndrome differentiation， treatment， and prescription.

Hepatocellular carcinoma(HCC),commonly known as primary liver cancer,is a major cause of malignant tumors and cancer-related deaths in China,accounting for approximately 85％of all cancer cases in the country.Several guidelines have been used to diagnose and treat liver cancer.However,these guidelines provide a broad definition for classifying advanced liver cancer,with an emphasis on a singular approach,without considering treatment options for individual patients.Therefore,it is necessary to establish a comprehensive and practical expert consensus,specifically for China,to enhance the diagnosis and treatment of HCC using the Delphi method.The classification criteria were refined for Chinese patients with HCC,and the corresponding optimal treatment regimen recommendations were developed.These recommendations took into account various factors,including tumor characteristics,vascular tumor thrombus grade,distant metastasis,liver function status,portal hypertension,and the hepatitis B virus replication status of patients with primary HCC,along with treatment prognosis.The findings and rec-ommendations provide detailed,scientific,and reasonable individualized diagnosis and treatment strategies for clinicians.

Objective:To explore the independent risk factors of portal vein thrombosis (PVT) in liver cirrhosis, and to establish and evaluate a risk prediction model for PVT in patients with cirrhosis.Methods:A total of 295 cases of cirrhosis hospitalized in Renmin Hospital of Wuhan University from December 2019 to October 2021 were divided into a modeling set ( n=207) and an internal validation set ( n=88) by the random number table. In addition, patients with cirrhosis hospitalized in Yichang Central People's Hospital, Wuhan Puren Hospital, No.2 People's Hospital of Fuyang City and People's Hospital of China Three Gorges University during the same period were collected as an external validation set ( n=92). The modeling set was divided into PVT group ( n=56) and non-PVT group ( n=151). Univariate analysis was used to preliminarily screen the related indicators of PVT, and then multivariate logistic regression analysis with forward stepwise regression was used to determine independent risk factors for PVT. A nomogram prediction model was constructed based on the independent risk factors obtained. The internal and external validation set were used to verify the predictive ability of the model. Distinction degree was used to evaluate the ability of the model to distinguish patients with or without PVT. Hosmer-Lemeshow goodness-of-fit test was used to evaluate the consistency between predicted risk and the actual risk of the model. Results:Univariate analysis showed that smoking, history of splenectomy, trans-jugular intrahepatic portosystemic shunt (TIPS), gastrointestinal bleeding and endoscopic variceal treatment, and levels of hemoglobin, alanine aminotransferase, aspartate aminotransferase and D-dimer were significantly different between the PVT group and the non-PVT group ( P<0.05). Multivariate logistic regression analysis found that smoking ( P=0.020, OR=31.21, 95% CI: 1.71-569.40), levels of D-dimer ( P=0.003, OR=1.12, 95% CI: 1.04-1.20) and hemoglobin ( P=0.039, OR=0.99, 95% CI: 0.97-1.00), history of TIPS ( P=0.011, OR=18.04, 95% CI: 1.92-169.90) and endoscopic variceal treatment ( P=0.001, OR=3.21, 95% CI: 1.59-6.50) were independent risk factors for PVT in patients with liver cirrhosis. Receiver operator characteristic (ROC) curve analysis showed that the area under the ROC curve (AUC) for the internal validation set was 0.802 (95% CI: 0.709-0.895) ( P<0.001), and the AUC for the external validation set was 0.811 (95% CI: 0.722-0.900) ( P<0.001). Both AUC were larger than 0.75. The calibration curve of Hosmer-Lemeshow goodness-of-fit test showed that the P values of both internal validation set ( χ2=3.602, P=0.891) and the external validation set ( χ2=11.025, P=0.200) were larger than 0.05. Conclusion:Smoking, history of TIPS or endoscopic variceal treatment, levels of D-dimer and hemoglobin are independent risk factors for PVT in patients with liver cirrhosis. The prediction nomogram model based on the above factors has strong predictive ability.

"The Expert Group on Tumor Ablation Therapy of Chinese Medical Doctor Association, The Tumor Ablation Committee of Chinese College of Interventionalists, The Society of Tumor Ablation Therapy of Chinese Anti-Cancer Association and The Ablation Expert Committee of the Chinese Society of Clinical Oncology" have organized multidisciplinary experts to formulate the consensus for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The expert consensus reviews current literatures and provides clinical practices for thermal ablation of GGN. The main contents include: (1) clinical evaluation of GGN, (2) procedures, indications, contraindications, outcomes evaluation and related complications of thermal ablation for GGN and (3) future development directions.
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Objective:To evaluate the significance of S1 posterior edge inlet view for placement of percutaneous sacroiliac screws.Methods:1. CT data of the pelvis were collected from 134 normal adults and introduced into Mimics Medical 21.0 system. Anatomical parameters of sacral vertebrae were measured and analyzed to observe the anatomical disparities between the anterior and posterior edges of S1 vertebral body. A mathematical model was established using the data acquired. 2. Manual placement of sacroiliac screws was performed using a conventional S1 posterior edge inlet view on the pelvic specimens from 5 adult cadavers in simulation of actual surgical situations. After placement, the inlet views from both the S1 anterior and posterior edges were taken to observe the imaging differences and to check if the screws had pierced the sacral canal. 3. A retrospective study was conducted of the 11 patients with posterior pelvic ring fracture who had been treated at Department of Orthopaedics, Tongji Hospital from January 2019 to October 2020. Their fractures were fixated by percutaneous sacroiliac screws under the guidance of a C-arm X-ray machine. The manual placement of the screws was guided intraoperatively by the inlet views from both the S1 anterior and posterior edges to secure a safe placement. Pelvic CT examinations were performed to check any screw dislocation.Results:1. CT measurements in the normal adults showed that the angle of S1 anterior edge inlet view (20.71°±11.89°) was smaller than that of S1 posterior edge inlet view (41.99°±11.67°) and the width of S1 upper end plate [(32.22±3.41) mm] greater than that of S1 lower end plate [(20.10±3.28) mm], showing significant disparities in anatomy between the anterior and posterior edges of S1 vertebral body ( P<0.05). 2. In 2 of the 5 cadaveric specimens, imaging differences were observed between the inlet views of the anterior and posterior edges of S1 and the screws pierced out of the sacral canal. 3. Satisfactory closed reduction was achieved in all the 11 patients. A total of 17 screws were placed, with 12 ones into S1 and 5 ones into S2. Operation time ranged from 84 to 141 min (average, 114.4 min), fluoroscopy frequency from 69 to 101 times (average, 89.6 times), and intraoperative blood loss from 110 to 463 mL(average, 296.6 mL). No screw dislocation was observed on postoperative CT. Conclusion:As there is a difference between the inlet views of the anterior and posterior edges of S1 vertebral body, the inlet view of the posterior edge of S1 can display the posterior edge of S1 more clearly so as to improve the safety of placement of percutaneous sacroiliac screws.

Objective To evaluate the prognosis-related factors of colorectal cancer patients with positive PD-L1 expression in liver metastases after hepatectomy. Methods We reviewed retrospectively the clinical data of 68 colorectal cancer patients with positive PD-L1 expression in liver metastases receiving personalized comprehensive treatment which was mainly consisted of surgical resection. We observed the results and prognosis after surgical resection and analyzed related factors. Results Univariate analysis showed that no radiotherapy, N stage, RAS mutation status, T stage, dMMR, Duck stage, disease free interval from primary to metastases≤12 months and largest hepatic tumor diameter > 5 cm had obvious significance (all P < 0.05). Multivariate logistic analysis regression revealed that without dMMR (P=0.012), Duck A stage (P=0.000), disease free interval from primary to metastases > 12 months (P=0.020) and largest hepatic tumor diameter < 5 cm (P=0.006) were independent protective factors for the prognosis of colorectal cancer patients with positive PD-L1 expression in liver metastases after surgical resection. Conclusion Personalized comprehensive treatment which is mainly consisted of surgical resection still has a good effect on colorectal cancer patients with positive PD-L1 expression in liver metastases after hepatectomy. Without dMMR, Duck A stage, disease free interval from primary to metastases > 12 months and largest hepatic tumor diameter ≤5cm are independent protective factors for patients' prognosis.

Objective: To evaluate the clinical manifestations, pathological features, treatment methods and prognosis of aggressive fibromatosis of the head and neck. Methods: One patient with aggressive fibromatosis of the neck was analyzed, and the relevant literature was reviewed. Results: Head and neck lesions account for approximately 12 to 15% of aggressive fibromatosis, which is a rare type of borderline tumor that is commonly characterized by a hard texture, painlessness (but occasionally with pain), hidden growth and poor mobility. Such tumors can result in facial deformity and invasion of the skull base or main nerves, and blood vessels and can compress the airway. MRI is the preferred method for preoperatively determining the size and location of the lesion. The characteristic low T1 and T2 signals of collagen fiber are helpful for the diagnosis of the tumor. The disease has clear pathological features, with tumors consisting of long spindle fibroblasts and myofibroblasts arranged in parallel fascicles with various levels of collagen formation. The tumor cells exhibit the characteristics of infiltrative growth, ill-defined cell membranes and variable amounts of cytoplasm. Pathologic mitosis and atypia are not seen. Characteristic immunohistochemical features include expression of Vim(+), HHF-35(+), CD34(-), S-100(-) and Ki-67(+). The disease is locally invasive, and patients may relapse easily, but distant metastases are not observed. The primary treatment is surgical resection. Chemotherapy, hormone therapy and biological treatments have auxiliary functions in the treatment of these tumors. Conclusion Aggressive fibromatosis of the head and neck has no specific clinical features; the diagnosis depends primarily on pathological examination. The main treatment is radical surgical resection. Radiotherapy, chemotherapy and biological treatment can be used in combination with surgery in cases of incomplete resection or recurrence.

Objective To establish the rabbit model of main portal vein VX2 tumor thrombus by using orthotopic implantation and to observe its radiological and pathological features.Methods 24 New Zealand white rabbits were randomly divided into study group (n=16) and control group (n=8).In study group,VX2 tumor tissue fragments were fixed on the inner wall of the main portal vein by using a surgical approach.In control group, autologous muscle fragments were fixed on the inner wall of the main portal vein in the same way.CT examinations were performed in both group on 7 days, 14 days, 21 days and 28 days after the procedure.At each observation point,3 rabbits of the study group were inspected by using digital subtraction angiography (DSA),and then sacrificed for histologic examination.Meanwhile,1 rabbit of the control group was sacrificed for histologic examination after CT scanning.The survival time of the remaining rabbits were recorded.Results Among 16 rabbits of the study group, successful implantations were achieved in 15 rabbits (93.8%).Tumor thrombus formed in the main portal vein successfully for all these 15 rabbits.The mean survival time of the remaining 3 rabbits in the study group was (39.3±2.1) days.The imaging characteristic of tumor thrombus could be demonstrated by CT and DSA examinations.Tumor thrombus and the inner neovascularization were confirmed by histological examination.Conclusion It is feasible to establish an animal model of main portal vein tumor thrombus by orthotopic implantation.The radiological and pathological features of animal model are similar to hepatocellular carcinoma patients with portal vein tumor thrombus.

Objective To make an interpretation for the time-related evolving process of magnetic resonance imaging (MRI) signal of hepatic tumors after microwave ablation (MWA) treatment.Methods A total of 56 patients with malignant hepatic tumors (56 lesions in total) were enrolled in this study.Upper abdominal MRI plain scan and enhanced scan were performed in all patients at the second day,one month and 6 months after MWA treatment.The MRI signal features of ablation zones at different time points on T1WI,T2WI,DWI as well as on contrast-enhanced T1WI were documented,and the judgment of whether there was tumor recurrence was made.Results Two days after MWA,the ablation zone was manifested as target-like structure on T1WI and T2WI,which was characterized by central high signal ablation zone with low signal band around on T1WI and low signal ablation zone surrounded by high signal band on T2WI.One and 6 months after MWA,the volume of ablation area was atrophied,the target-like structure could still be observed on T1WI and T2WI,and the signal of ablation zone became intensified.Contrast-enhanced MRI revealed that abnormal high perfusion sign could be observed around the ablation zone,and on MRI scans performed at two days,one and 6 months after MWA,the ablation zone showed no enhancement.DWI indicated that two days after MWA the signal around the ablation zone was heightened,which decreased gradually in one and 6 months after MWA.Conclusion The signal of the ablation zone of hepatic tumor after MWA is evolving over time.Correct interpretation of MRI signal of ablation zone is helpful for the judgment of curative effect and for the making of therapeutic plan.