Objective To evaluate the clinical effect of acupoint injection therapy for paralysis of oculomotor nerve with Chinese herbal medicines. Methods A total number of 456 patients from 3 centers with paralysis of oculomot...Objective To evaluate the clinical effect of acupoint injection therapy for paralysis of oculomotor nerve with Chinese herbal medicines. Methods A total number of 456 patients from 3 centers with paralysis of oculomotor nerve were randomly divided into an acupoint injection group and a control group with 228 cases each. Patients in the acupoint injection group were treated with injection of Chinese herbal medicines to Jingming （晴明 BL 1）, Yangbai （阳白GB 14}, Sibai （四白 ST 24 Tongziliao （瞳子髎 GB I） on the affected side, and Ganshu （肝俞 BL 18） on both sides, Compound Angelica Injection was the main drug, and the corresponding acupoints and other injection drugs were also used according to differentiation of syndrome. Patients in the control group were treated with common western medicine. The treatment was given once a day, 10 times constituted one course with 3 days of interval. After 3 courses, the effect was assessed. TCM syndrome score, eyeball movement degree, the sizes of oculi rimae and pupil of the two groups were recorded before and after treatment. Results The effective rate of acupoint injection group was 91.7% （209/228）, and that of the control group was 73.6% （168/228）. There was statistical significance in comparing the difference between the two groups （P〈0.05）. TCM syndrome scores of the two groups after the treatment became less obviously than those before the treatment （P〈0.01, P〈0.05）, the score of acupoint injection group was more reduced than that of the control group （P〈0.05）. Eyeball movement degree and oculi rimae were enlarged and the pupil reduced in the affected eye in both groups after the treatment Call P〈0.05）. The musculus rectus medialis for the eyeball movement in the acupoint injection group was more improved than that of the control group, and the oculi rimae was bigger in the acupoint injection group than that in the control group （both P〈0.05）. Conclusion Acupoint injection therapy with Chinese herbal medicines has assured effect on the treatment of oculomotor paralysis.展开更多
BACKGROUND： Facial paralysis is defined as severe or complete loss of facial muscle motor function. OBJECTIVE： The study was undertaken to explore a bibliometric approach to quantitatively assess the research on cli...BACKGROUND： Facial paralysis is defined as severe or complete loss of facial muscle motor function. OBJECTIVE： The study was undertaken to explore a bibliometric approach to quantitatively assess the research on clinical treatment of facial paralysis using rehabilitation, physiotherapy and acupuncture using Web of Science from 1992 to 2011. DESIGN： Bibliometric approach. DATA RETRIEVAL： A bibliometric analysis based on the publications on Web of Science was performed using key words such as ＂facial paralysis＂, ＂rehabilitation＂, ＂physiotherapy＂ and ＂acupuncture＂. INCLUSIVE CRITERIA： （1） Research articles on the clinical treatment of facial paralysis using acupuncture or physiotherapy （e.g. exercise, electro-stimulation） and other rehabilitation methods; （2） researches on human and animal fundamentals, clinical trials and case reports; （3） Article types： article, review, proceedings paper, note, letter, editorial material, discussion, book chapter. （4） Publication year： 1992-2011 inclusive. Exclusion criteria： （1）Articles on the causes and diagnosis on facial paralysis; （2） Type of articles： correction; （3） Articles from following databases： all databases related to social science and chemical databases in Web of Science. MAIN OUTCOME MEASURES： （1） Overall number of publications; （2） number of publications annually; （3） number of citations received annually; （4） top cited paper; （5） subject categories of publication; （6） the number of countries in which the article is published; （7） distribution of output in journals. RESULTS： Overall population stands at 3 543 research articles addressing the clinical treatment of facial paralysis in Web of Science during the study period. There is also a markedly increase in the number of publications on the subject ＂facial paralysis treatments using rehabilitation＂ during the first decade of the 21 st century, except in 2004 and 2006 when there are perceptible drops in the number of articles published. The only other year during the study period saw such a drop is 1993. Specifically, there are 192 published articles on facial paralysis treated by rehabilitation in the past two decades, far more than the output of physiotherapy treatment. Physiotherapy treatment scored only 25 articles including acupuncture treatment, with over 80% of these written by Chinese researchers and clinicians. Ranked by regions, USA is by far the most productive country in terms of the number of publications on facial paralysis rehabilitation and physiotherapy research. Seeing from another angle, the journals that focus on otolaryngology published the most number of articles in rehabilitation and physiotherapy studies, whereas most acupuncture studies on facial paralysis were published in the alternative and complementary medicine joumals. CONCLUSION： Study of facial paralysis remains an area of active investigation and innovation. Further clinical studies in humans addressing the use of growth factors or stem cells continue to successful facial nerve regeneration.展开更多
Objective: The goal of this study is to explore effective treatments for peripheral facial paralysis and to evaluate the clinical efficacies of warm needling therapy and acupuncture in peripheral facial paralysis.Meth...Objective: The goal of this study is to explore effective treatments for peripheral facial paralysis and to evaluate the clinical efficacies of warm needling therapy and acupuncture in peripheral facial paralysis.Methods: PubMed(1979-2017), the Chinese National Knowledge Infrastructure database(CNKI, 1979-2017), Wanfang databases(1990-2017), and the Chongqing VIP full-text periodical database(VIP, 1989-2017) were searched by computer. Randomized controlled trials of warm needling therapy and acupuncture in the treatment of peripheral facial paralysis were collected. The clinical trials that met the inclusion criteria were selected for quality assessment using the Cochrane 5.0 Handbook for systematic evaluation.RevMan5.3 was used for statistical analysis.Results: A total of 23 articles with 1756 patients met the inclusion criteria.(1) The meta-analysis of 11 articles showed that the total effective rate of warm needling therapy for peripheral facial paralysis was higher than that of acupuncture [RR = 1.18, 95% Cl(1.11,1.25), P< 0.00001].(2) The meta-analysis of 7 articles showed that the total effective rate of warm needling therapy combined with electroacupuncture in the treatment of peripheral facial paralysis was higher than that of acupuncture combined with electroacupuncture [RR= 1.15, 95% Cl(1.09, 1.21), P< 0.00001].(3) The meta-analysis of 5 articles showed that the total effective rate of warm needling therapy combined with other therapies in the treatment of peripheral facial paralysis was higher than that of acupuncture combined with other therapies [RR= 1.08,95% Cl(1.03, 1.14), P=0.002].(4) The meta-analysis of 5 articles showed that warm needling therapy could improve the House-Brackmann(H-B) scores of patients with peripheral facial paralysis more than acupuncture [mean difference(MD)=-2.85, 95% Cl(-5.08,-0.62), Z = 2.51, P = 0.01], indicating that warm needling therapy provides superior improvement in the function of facial nerve innervation in the patients. No adverse events were reported in the included studies. The methodological quality of the included studies was generally low.Conclusion: The results of this meta-analysis showed that warm needling therapy is superior to acupuncture in treating peripheral facial paralysis, providing a therapeutic option for the treatment of peripheral facial paralysis. However, due to the small sample size and the low quality of the included studies, the above conclusion still needs to be validated with high-quality, large-scale, randomized, blinded controlled trials.展开更多
Objective:To observe the clinical therapeutic effect on refractory peripheral facial paralysis treated with the combination of warming-needle moxibustion and stuck-needle-pulling therapy.Methods:A total of 33 patients...Objective:To observe the clinical therapeutic effect on refractory peripheral facial paralysis treated with the combination of warming-needle moxibustion and stuck-needle-pulling therapy.Methods:A total of 33 patients with refractory peripheral facial paralysis were treated with the combination of warming-needle moxibustion and stuck-needle-pulling technique.The treatment was given once daily and there were 2 days at interval after consecutive 5 treatments.A total of 10 treatments made one course and consecutive 2 courses of treatment were required.Before and after treatment,HouseBrackmann(H-B)facial nerve grading scale score was adopted to evaluate the degree of facial paralysis in the patients and the clinical effect was assessed.Results:After treatment,the mean H-B score was higher than that before treatment in the patients,indicating a statistical significance(P<0.05).After treatment,of 33 cases,12 cases were cured,9 cases effective remarkably,8 cases effective and 4 cases no effect.The total effective rate was 87.88%.Conclusion:The combination treatment of warming-needle moxibustion and stuck-needle-pulling technique achieves a definite effect on refractory peripheral facial paralysis.展开更多
BACKGROUND Thyrotoxic periodic paralysis(TPP)is an endocrine emergency caused by thyrotoxicosis,manifesting mainly as periodic myasthenia and hypokalemia,and posing a serious threat to the patient's health.Fatigue...BACKGROUND Thyrotoxic periodic paralysis(TPP)is an endocrine emergency caused by thyrotoxicosis,manifesting mainly as periodic myasthenia and hypokalemia,and posing a serious threat to the patient's health.Fatigue,strenuous exercise,alcohol abuse,high carbohydrate intake and insulin injections are common triggers of paralysis.This article reports a case of severe TPP induced by insulin injection,elucidates the characteristics and pathogenesis of the disease,analyses the risk factors for triggering TPP,and hopefully provides more clinical data for TPP patients.CASE SUMMARY A 38-year-old Asian man presented to the emergency department with a oneweek history of limb weakness and worsening half-day.His medical history included poorly controlled type 2 diabetes and he had been switched to Aspart50 a week earlier.He was alert and oriented with upper extremity strength grade 3 and lower extremity strength grade 1.Emergency department tests showed hypokalemia of 1.6 mmol/L.The paramedics administered 1.5 g of potassium intravenously,followed by 4.0 g orally.Weakness in the arms and legs improved.He was referred to endocrinology where he was diagnosed with Graves'disease,with suboptimal control and insulin injections possibly causing TPP.We stopped his insulin and he was discharged with a potassium level of 4.0 mmol/L.CONCLUSION Insulin is a trigger for TPP and should be avoided in patients with hyperthyroidism.Early recognition and treatment of TPP is crucial,especially in patients presenting with hypokalemic periodic paralysis.展开更多
From 1986 to 1995, the author treated 60 cases of peripheral facial paralysis, of which 50 cases were treated with electric needles and 10 cases in the control group with filiform needles.
Objective:To observe the differences in the therapeutic effect on refractory facial paralysis between meridian sinew needling therapy and routine penetrating needling therapy.Methods:A total of 46 patients with refrac...Objective:To observe the differences in the therapeutic effect on refractory facial paralysis between meridian sinew needling therapy and routine penetrating needling therapy.Methods:A total of 46 patients with refractory facial paralysis were randomly divided into a meridian sinew needling group and a routine penetrating needling group,23 cases in each one.The same acupoints were selected in the two groups.Besides using routine acupuncture technique,a part of acupoints were stimulated with the meridian sinew needling technique in the meridian sinew needling group.In the routine penetrating needling group,a part of acupoints were stimulated with the routine penetrating needling technique.In both of the groups,the needles were retained for 30 min and the treatment was given once every two days,10 treatments made one course.A total of 3 courses of treatment were required at the interval of 2 days.The score and grade of facial nerve function were recorded before and after treatment in the patients of the two groups.The clinical therapeutic effect was evaluated.Results:After treatment,the scores of facial nerve function were significantly improved compared with that before treatment in the patients of the two groups(both P<0.05).The difference value of the score of facial nerve function before and after treatment in the meridian sinew needling group was higher than that in the routine penetrating needling group,indicating a statistical significance(P<0.05).The grades of facial nerve function after treatment were different significantly as compared with those before treatment in the patients of the two groups(both P<0.05).However,the difference was not significant between the two groups after treatment(P>0.05).After treatment,the total effective rate in the meridian sinew needling group was 100%,which was higher than 91.3%in the routine penetrating needling group,while without statistical significant difference(P>0.05).Conclusion:Meridian sinew needling therapy of acupuncture greatly improves facial nerve function as compared with routine penetrating needling therapy.It would be an potential effective acupuncture technique for refractory facial paralysis.展开更多
Objective:To compare the clinical therapeutic effect on epiphora as sequela of peripheral facial paralysis treated with pricking technqiue of fire needling therapy at Chengqi(承泣ST1)and acupuncture treatment at conve...Objective:To compare the clinical therapeutic effect on epiphora as sequela of peripheral facial paralysis treated with pricking technqiue of fire needling therapy at Chengqi(承泣ST1)and acupuncture treatment at conventional acupoints.Methods:From September 2018 through to October 2018,64 cases of epiphora as sequela of peripheral facial paralysis were collected from the Department of Acupuncture-Moxibustion in Suzhou TCM Hospital.According to random number table,they were divided into an observation group and a control group,32 cases in each one.In the observation group,pricking technique of fire needling therapy was used at ST1,once every two days.In the control group,acupuncture with filiform needle was applied to Jingming(睛明BL1),Taiyang(太阳EX-HN5),Tongziliao(瞳子髎GB1),Sibai(四白ST2)and Quanliao(颧髎SI18)on the affected side as well as Hegu(合谷LI4)on the contralateral side,once per day.The 10-day treatment was as one 1 course and the consecutive 3 courses of treatment were required in either of the groups.Before and after treatment,Munk grade,clinical effective rate and the number of treatments were observed in the evaluation of therapeutic effect.Results:After treatment,Munk grade was improved in the patients of the two groups(both P<0.05).The improvement range in the observation group was larger than that of the control group(P<0.05).The treatment in either group achieved the obviously therapeutic effect on epiphora as sequela of peripheral facial paralysis.The effective rate in the observation group was 90.32%,higher than 61.29%in the control group(P<0.05).The mean number of treatments of the curative case were 5.11 in the observation group and were 13.73 in the control group,indicating the statistical significance in difference(P<0.05).Conclusion:Pricking technique of fire needling therapy at ST1 achieves the better effect on epiphora as sequela of peripheral facial paralysis as compared with acupuncture at conventional acupoints.展开更多
BACKGROUND Postoperative intestinal paralysis is common in gastrointestinal surgery,and the study of electroacupuncture mechanisms is of great significance.AIM To explore the neuroimmune regulatory mechanism of electr...BACKGROUND Postoperative intestinal paralysis is common in gastrointestinal surgery,and the study of electroacupuncture mechanisms is of great significance.AIM To explore the neuroimmune regulatory mechanism of electroacupuncture at the Zusanli acupoint(ST36)in postoperative intestinal paralysis following gastrointestinal surgery.METHODS A total of 156 patients admitted to the Affiliated Hospital of Jiangnan University between January 2022 and October 2024 for postoperative intestinal paralysis following gastrointestinal surgery were randomly divided into two groups:A control group and an electroacupuncture group,with 75 patients in each.The control group received conventional Western medical treatment,while the electroacupuncture group received electroacupuncture in addition to this,at the bilateral Zusanli acupoints.Both groups received treatment for 7 days.Clinical efficacy,gastrointestinal function recovery,and gastrointestinal hormone[motilin(MTL),gastrin(GAS)],neurotransmitter[vasoactive intestinal peptide(VIP),nitric oxide(NO)],and inflammatory cytokine[tumor necrosis factor-α(TNF-α),serum interleukin-6(IL-6),interleukin-1β(IL-1β)]levels were compared between the two groups before and seven days after treatment.Adverse reactions were also recorded.RESULTS The electroacupuncture group demonstrated a higher overall treatment effectiveness rate and faster recovery of bowel sounds,as well as faster first defecation and first flatus than the control group(P<0.05).After seven days of treatment,MTL and GAS levels were significantly higher and VIP,NO,TNF-α,IL-6 and IL-1βlevels were significantly lower in the electroacupuncture group than in the control group(P<0.05).No adverse reactions were observed in either group during treatment.CONCLUSION Electroacupuncture at the Zusanli acupoint can enhance clinical efficacy,promote the recovery of gastrointestinal function,and regulate the neuroimmune microenvironment in patients with intestinal paralysis after gastrointestinal surgery.This mechanism may involve excitation of the vagus nerve and activation of the cholinergic antiinflammatory pathway through electroacupuncture stimulation of the Zusanli acupoint.展开更多
Dysphagia caused by true bulbar paralysis after stroke is a common and serious complication that severely affects patients’eating ability and quality of life,and significantly increases the risk of complications such...Dysphagia caused by true bulbar paralysis after stroke is a common and serious complication that severely affects patients’eating ability and quality of life,and significantly increases the risk of complications such as pneumonia and malnutrition.Electroacupuncture at swallowing points stimulates Swallowing 1 and Swallowing 2 acupoints,acting on key areas such as the glossopharyngeal nerve and vagus nerve,stimulating the reconstruction of nerve reflex arcs and the recovery of swallowing function.Therefore,this article analyzes the mechanism and clinical efficacy of electroacupuncture at swallowing points for the treatment of dysphagia caused by true bulbar paralysis after stroke,aiming to provide theoretical support and practical basis for clinical application.展开更多
BACKGROUND Chemotherapy-induced cardiotoxicity is a significant complication in cancer therapy,limiting treatment efficacy and worsening patient outcomes.Recent studies have implicated the gut microbiome and its key m...BACKGROUND Chemotherapy-induced cardiotoxicity is a significant complication in cancer therapy,limiting treatment efficacy and worsening patient outcomes.Recent studies have implicated the gut microbiome and its key metabolites,such as shortchain fatty acids(SCFAs)and trimethylamine-N-oxide(TMAO),in mediating inflammation,oxidative stress,and cardiac damage.The gut-heart axis is increasingly recognized as a pivotal pathway linking microbiota dysregulation to chemotherapy-related cardiac dysfunction.AIM To systematically review existing evidence on the role of gut microbiome alterations in chemotherapy-induced cardiotoxicity and evaluate emerging microbiome-based therapeutic strategies aimed at mitigating cardiovascular risk in cancer patients.METHODS A systematic literature search was conducted in PubMed,Scopus,and Web of Science for studies published between January 2013 and December 2024.Studies were included if they examined chemotherapy-induced cardiotoxicity in relation to gut microbiota composition,microbial metabolites(e.g.,SCFAs,TMAO),or microbiome-targeted interventions.Selection followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data extraction focused on microbiota alterations,mechanistic pathways,cardiac outcomes,and quality assessments using standardized risk-of-bias tools.RESULTS Eighteen studies met the inclusion criteria.Chemotherapy was consistently associated with gut dysbiosis characterized by reduced SCFA-producing bacteria and increased TMAO-producing strains.This imbalance contributed to gut barrier disruption,systemic inflammation,and oxidative stress,all of which promote myocardial damage.SCFA depletion weakened anti-inflammatory responses,while elevated TMAO levels exacerbated cardiac fibrosis and dysfunction.Preclinical studies showed promising cardioprotective effects from probiotics,prebiotics,dietary interventions,and fecal microbiota transplantation,though human data remain limited.CONCLUSION Gut microbiome dysregulation plays a crucial role in the development of chemotherapy-induced cardiotoxicity.Altered microbial composition and metabolite production trigger systemic inflammation and cardiac injury.Microbiome-targeted therapies represent a promising preventive and therapeutic approach in cardio-oncology,warranting further clinical validation through well-designed trials.展开更多
Stroke has been in a high incidence,and stroke sequelae have become the main cause of motor dysfunction.The treatment of flaccid paralysis is critical to stroke recovery.In recent years,traditional treatment,especiall...Stroke has been in a high incidence,and stroke sequelae have become the main cause of motor dysfunction.The treatment of flaccid paralysis is critical to stroke recovery.In recent years,traditional treatment,especially acupuncture therapy has achieved certain effects for the treatment of post-stroke flaccid paralysis.Acupuncture treatment can promote the recovery of nerve conduction,increase muscle strength and improve joint flexibility,and correct abnormal movement patterns of limbs.Acupuncture combined with rehabilitation training will be the focus for the treatment of post-stroke flaccid paralysis.In this review,the combination of different acupuncture therapies with modern rehabilitation for the treatment of post-stroke flaccid paralysis has been summarized in order to effectively promote the recovery of motor function and significantly improve their life quality.展开更多
Cardiovascular disease remains the leading global cause of mortality,projected to increase by 73.4%from 2025 to 2050 despite declining age-standardized rates.Contemporary interventions,such as percutaneous coronary in...Cardiovascular disease remains the leading global cause of mortality,projected to increase by 73.4%from 2025 to 2050 despite declining age-standardized rates.Contemporary interventions,such as percutaneous coronary intervention and statins,reduce major adverse cardiovascular events(MACE)by 25%-30%,yet a 20%five-year MACE risk persists in high-risk cohorts.These approaches,histor-ically focused on luminal stenosis,fail to address systemic atherogenesis drivers like endothelial dysfunction and inflammation.Specifically,dietary linoleic acid restriction(<5 g/day)reduces oxidized low-density lipoprotein by approximately 15%by limiting peroxidation-prone bisallylic bonds,mitigating arterial inflam-mation,a key atherogenic trigger.Enhanced external counterpulsation,through pulsatile shear stress,enhances nitric oxide-mediated coronary perfusion,alle-viating angina in approximately 70%of refractory cases unresponsive to revascu-larization.Nanoparticle-facilitated chelation targets atherosclerotic plaques with precision,reducing calcium content by up to 30%in preclinical models,offering a novel avenue for lesion reversal.These innovations collectively address residual risk by tackling root causes,oxidative stress,endothelial dysfunction,and plaque instability,potentially halving MACE rates with widespread adoption.Despite promising preliminary data,gaps remain in long-term safety and scalability.Robust clinical trials are needed to validate these approaches,which collectively aim to transform cardiovascular disease management by prioritizing prevention and vascular restoration,potentially reducing coronary events to a public health rarity.展开更多
Regenerative medicine is a promising therapeutic avenue for previously incurable diseases.As the risk of chronic and degenerative diseases significantly increases with age,the elderly population represents a major coh...Regenerative medicine is a promising therapeutic avenue for previously incurable diseases.As the risk of chronic and degenerative diseases significantly increases with age,the elderly population represents a major cohort for stem cell-based therapies.However,the regenerative potential of stem cells significantly decreases with advanced age and deteriorating health status of the donor.Therefore,the efficacy of autologous stem cell therapy is significantly compromised in older patients.To overcome these limitations,alternative strategies have been used to restore the age-and disease-depleted function of stem cells.These methods aim to restore the therapeutic efficacy of aged stem cells for autologous use.This article explores the effect of donor age and health status on the regenerative potential of stem cells.It further highlights the limitations of stem cell-based therapy for autologous treatment in the elderly.A comprehensive insight into the potential strategies to address the“age”and“disease”compromised regenerative potential of autologous stem cells is also presented.The information provided here serves as a valuable resource for physicians and patients for optimization of stem cellbased autologous therapy for aged patients.展开更多
Tau plays a crucial role in several neurodegenerative diseases,collectively referred to as tauopathies.Therefore,targeting potential pathological changes in tau could enable useful therapeutic interventions.However,ta...Tau plays a crucial role in several neurodegenerative diseases,collectively referred to as tauopathies.Therefore,targeting potential pathological changes in tau could enable useful therapeutic interventions.However,tau is not an easy target because it dynamically interacts with microtubules and other cellular components,which presents a challenge for tau-targeted drugs.New cellular models could aid the development of mechanism-based tau-targeted therapies.展开更多
Therapy discontinuation in inflammatory bowel disease,particularly involving immunomodulators,biologics,and small molecules,remains a controversial and evolving topic.This letter reflects on developments following the...Therapy discontinuation in inflammatory bowel disease,particularly involving immunomodulators,biologics,and small molecules,remains a controversial and evolving topic.This letter reflects on developments following the publication by Meštrovićet al,emphasizing the complex balance between risks of relapse,antidrug antibody formation,and potential complications of long-term immunosuppression.Recent evidence underscores high relapse rates following withdrawal-especially of anti-tumor necrosis factor agents-and highlights the lack of robust data for newer biologics.Updated guidelines from European Crohn’s and Colitis Organization,British Society of Gastroenterology,and American College of Gastroenterology all support cautious and individualized approaches,with strict criteria and close follow-up,particularly in Crohn’s disease.For ulcerative colitis,therapeutic cycling remains insufficiently addressed.We proposed a flowchart to support clinical decision-making and stress the importance of shared decisionmaking in the era of personalized medicine since,despite new drug classes and evolving strategies,the therapeutic ceiling in inflammatory bowel disease has yet to be fully overcome.展开更多
BACKGROUND The liver represents a common site of distant metastasis in patients with esophageal cancer(EC).Conventional chemotherapy(CMT)presents limited efficacy for EC,and EC patients with liver metastases typically...BACKGROUND The liver represents a common site of distant metastasis in patients with esophageal cancer(EC).Conventional chemotherapy(CMT)presents limited efficacy for EC,and EC patients with liver metastases typically experience a poor prognosis,highlighting an urgent need to explore novel treatment approaches.This study evaluated the overall efficacy and safety of CMT vs CMT combined with immune checkpoint inhibitors(ICIs)in the treatment of EC patients with liver metastases.Furthermore,prognostic factors influencing outcomes in this patient population were identified.AIM To evaluate the efficacy and safety of first-line chemoimmunotherapy for EC patients with liver metastases and to analyze prognostic factors.METHODS This retrospective study included 126 EC patients with liver metastases at Zhejiang Cancer Hospital between 2014 and 2024.Patients receiving CMT were compared with those receiving CMT+ICI.Analyzed variables included clinicopathological features,treatment history,characteristics of metastasis,systemic and local treatments,overall survival(OS),and treatment-related adverse events(TRAEs).Prognostic factors were evaluated using univariate and multivariate Cox proportional-hazards regression models.Finally,efficacy outcomes and TRAE profiles were compared between the two groups.RESULTS A significant difference in median OS was identified between the two groups(10.8 months in the CMT group vs 20.8 months in the CMT+ICI group,P=0.004).The CMT+ICI group also demonstrated a significantly longer median progression-free survival of 11.7 months(P<0.001).Patients receiving combination therapy exhibited significantly improved systemic objective response rate and disease control rate.Multivariate analysis identified key factors significantly influencing OS in EC patients with liver metastases:Karnofsky Performance Status score≥70,receipt of local therapy for liver metastases,and the number of cycles of CMT and immunotherapy received.Furthermore,the incidence of TRAEs did not significantly differ between the CMT+ICI and CMT groups.CONCLUSION For EC patients with liver metastases,the combination of CMT and ICIs demonstrates significantly superior efficacy compared with CMT alone,while maintaining manageable TRAEs.展开更多
Experimental therapies targeting immune and stromal cells,such as mast cells,cancer-associated fibroblasts,dendritic cells,and tumor endothelial cells,in the treatment of gastrointestinal solid tumors pose new and com...Experimental therapies targeting immune and stromal cells,such as mast cells,cancer-associated fibroblasts,dendritic cells,and tumor endothelial cells,in the treatment of gastrointestinal solid tumors pose new and complex surgical and medico-legal challenges.These innovative treatments require that informed consent not be limited to simple acceptance of the medical procedure,but instead reflect a true relational and cognitive process grounded in understanding,free choice,and the ability to revoke consent at any time.In particular,it is essential that the patient understands the experimental nature of the therapy,its development stage,potential benefits and risks,as well as the implications for their health and personal dignity.In the case of stromal cell-based treatments,which may exert complex immunomodulatory effects or activate angiogenic pathways that are not yet fully understood,patients must be made fully aware that they are participating in a non-standardized therapy whose outcomes,whether beneficial or harmful,cannot yet be predicted with certainty.This requires particularly careful medical communication,using simple yet scientifically accurate explanations delivered in appropriate language,along with a final verification of the patient’s actual understanding.展开更多
基金Supported by designated project of 2008 Scientific Plan of TCM and Integrative Medicine of Hebei Administration of TCM:2008080
文摘Objective To evaluate the clinical effect of acupoint injection therapy for paralysis of oculomotor nerve with Chinese herbal medicines. Methods A total number of 456 patients from 3 centers with paralysis of oculomotor nerve were randomly divided into an acupoint injection group and a control group with 228 cases each. Patients in the acupoint injection group were treated with injection of Chinese herbal medicines to Jingming （晴明 BL 1）, Yangbai （阳白GB 14}, Sibai （四白 ST 24 Tongziliao （瞳子髎 GB I） on the affected side, and Ganshu （肝俞 BL 18） on both sides, Compound Angelica Injection was the main drug, and the corresponding acupoints and other injection drugs were also used according to differentiation of syndrome. Patients in the control group were treated with common western medicine. The treatment was given once a day, 10 times constituted one course with 3 days of interval. After 3 courses, the effect was assessed. TCM syndrome score, eyeball movement degree, the sizes of oculi rimae and pupil of the two groups were recorded before and after treatment. Results The effective rate of acupoint injection group was 91.7% （209/228）, and that of the control group was 73.6% （168/228）. There was statistical significance in comparing the difference between the two groups （P〈0.05）. TCM syndrome scores of the two groups after the treatment became less obviously than those before the treatment （P〈0.01, P〈0.05）, the score of acupoint injection group was more reduced than that of the control group （P〈0.05）. Eyeball movement degree and oculi rimae were enlarged and the pupil reduced in the affected eye in both groups after the treatment Call P〈0.05）. The musculus rectus medialis for the eyeball movement in the acupoint injection group was more improved than that of the control group, and the oculi rimae was bigger in the acupoint injection group than that in the control group （both P〈0.05）. Conclusion Acupoint injection therapy with Chinese herbal medicines has assured effect on the treatment of oculomotor paralysis.
文摘BACKGROUND： Facial paralysis is defined as severe or complete loss of facial muscle motor function. OBJECTIVE： The study was undertaken to explore a bibliometric approach to quantitatively assess the research on clinical treatment of facial paralysis using rehabilitation, physiotherapy and acupuncture using Web of Science from 1992 to 2011. DESIGN： Bibliometric approach. DATA RETRIEVAL： A bibliometric analysis based on the publications on Web of Science was performed using key words such as ＂facial paralysis＂, ＂rehabilitation＂, ＂physiotherapy＂ and ＂acupuncture＂. INCLUSIVE CRITERIA： （1） Research articles on the clinical treatment of facial paralysis using acupuncture or physiotherapy （e.g. exercise, electro-stimulation） and other rehabilitation methods; （2） researches on human and animal fundamentals, clinical trials and case reports; （3） Article types： article, review, proceedings paper, note, letter, editorial material, discussion, book chapter. （4） Publication year： 1992-2011 inclusive. Exclusion criteria： （1）Articles on the causes and diagnosis on facial paralysis; （2） Type of articles： correction; （3） Articles from following databases： all databases related to social science and chemical databases in Web of Science. MAIN OUTCOME MEASURES： （1） Overall number of publications; （2） number of publications annually; （3） number of citations received annually; （4） top cited paper; （5） subject categories of publication; （6） the number of countries in which the article is published; （7） distribution of output in journals. RESULTS： Overall population stands at 3 543 research articles addressing the clinical treatment of facial paralysis in Web of Science during the study period. There is also a markedly increase in the number of publications on the subject ＂facial paralysis treatments using rehabilitation＂ during the first decade of the 21 st century, except in 2004 and 2006 when there are perceptible drops in the number of articles published. The only other year during the study period saw such a drop is 1993. Specifically, there are 192 published articles on facial paralysis treated by rehabilitation in the past two decades, far more than the output of physiotherapy treatment. Physiotherapy treatment scored only 25 articles including acupuncture treatment, with over 80% of these written by Chinese researchers and clinicians. Ranked by regions, USA is by far the most productive country in terms of the number of publications on facial paralysis rehabilitation and physiotherapy research. Seeing from another angle, the journals that focus on otolaryngology published the most number of articles in rehabilitation and physiotherapy studies, whereas most acupuncture studies on facial paralysis were published in the alternative and complementary medicine joumals. CONCLUSION： Study of facial paralysis remains an area of active investigation and innovation. Further clinical studies in humans addressing the use of growth factors or stem cells continue to successful facial nerve regeneration.
基金Supported by the National famous veteran TCM expert YANG Jun inheritance studiothe Project for the National Key Basic Research and Development Program(973):2010CB530500+1 种基金Key Science and Technology National Program of Anhui Province:1604b0602020Construction project "Innovation team of acupuncture theory,technology and application" of the platform for research and innovation in colleges and universities in Anhui:2015 TD 033~~
文摘Objective: The goal of this study is to explore effective treatments for peripheral facial paralysis and to evaluate the clinical efficacies of warm needling therapy and acupuncture in peripheral facial paralysis.Methods: PubMed(1979-2017), the Chinese National Knowledge Infrastructure database(CNKI, 1979-2017), Wanfang databases(1990-2017), and the Chongqing VIP full-text periodical database(VIP, 1989-2017) were searched by computer. Randomized controlled trials of warm needling therapy and acupuncture in the treatment of peripheral facial paralysis were collected. The clinical trials that met the inclusion criteria were selected for quality assessment using the Cochrane 5.0 Handbook for systematic evaluation.RevMan5.3 was used for statistical analysis.Results: A total of 23 articles with 1756 patients met the inclusion criteria.(1) The meta-analysis of 11 articles showed that the total effective rate of warm needling therapy for peripheral facial paralysis was higher than that of acupuncture [RR = 1.18, 95% Cl(1.11,1.25), P< 0.00001].(2) The meta-analysis of 7 articles showed that the total effective rate of warm needling therapy combined with electroacupuncture in the treatment of peripheral facial paralysis was higher than that of acupuncture combined with electroacupuncture [RR= 1.15, 95% Cl(1.09, 1.21), P< 0.00001].(3) The meta-analysis of 5 articles showed that the total effective rate of warm needling therapy combined with other therapies in the treatment of peripheral facial paralysis was higher than that of acupuncture combined with other therapies [RR= 1.08,95% Cl(1.03, 1.14), P=0.002].(4) The meta-analysis of 5 articles showed that warm needling therapy could improve the House-Brackmann(H-B) scores of patients with peripheral facial paralysis more than acupuncture [mean difference(MD)=-2.85, 95% Cl(-5.08,-0.62), Z = 2.51, P = 0.01], indicating that warm needling therapy provides superior improvement in the function of facial nerve innervation in the patients. No adverse events were reported in the included studies. The methodological quality of the included studies was generally low.Conclusion: The results of this meta-analysis showed that warm needling therapy is superior to acupuncture in treating peripheral facial paralysis, providing a therapeutic option for the treatment of peripheral facial paralysis. However, due to the small sample size and the low quality of the included studies, the above conclusion still needs to be validated with high-quality, large-scale, randomized, blinded controlled trials.
基金Supported by Guangdong Graduate Innovation Program Project:2017SFKC13。
文摘Objective:To observe the clinical therapeutic effect on refractory peripheral facial paralysis treated with the combination of warming-needle moxibustion and stuck-needle-pulling therapy.Methods:A total of 33 patients with refractory peripheral facial paralysis were treated with the combination of warming-needle moxibustion and stuck-needle-pulling technique.The treatment was given once daily and there were 2 days at interval after consecutive 5 treatments.A total of 10 treatments made one course and consecutive 2 courses of treatment were required.Before and after treatment,HouseBrackmann(H-B)facial nerve grading scale score was adopted to evaluate the degree of facial paralysis in the patients and the clinical effect was assessed.Results:After treatment,the mean H-B score was higher than that before treatment in the patients,indicating a statistical significance(P<0.05).After treatment,of 33 cases,12 cases were cured,9 cases effective remarkably,8 cases effective and 4 cases no effect.The total effective rate was 87.88%.Conclusion:The combination treatment of warming-needle moxibustion and stuck-needle-pulling technique achieves a definite effect on refractory peripheral facial paralysis.
文摘BACKGROUND Thyrotoxic periodic paralysis(TPP)is an endocrine emergency caused by thyrotoxicosis,manifesting mainly as periodic myasthenia and hypokalemia,and posing a serious threat to the patient's health.Fatigue,strenuous exercise,alcohol abuse,high carbohydrate intake and insulin injections are common triggers of paralysis.This article reports a case of severe TPP induced by insulin injection,elucidates the characteristics and pathogenesis of the disease,analyses the risk factors for triggering TPP,and hopefully provides more clinical data for TPP patients.CASE SUMMARY A 38-year-old Asian man presented to the emergency department with a oneweek history of limb weakness and worsening half-day.His medical history included poorly controlled type 2 diabetes and he had been switched to Aspart50 a week earlier.He was alert and oriented with upper extremity strength grade 3 and lower extremity strength grade 1.Emergency department tests showed hypokalemia of 1.6 mmol/L.The paramedics administered 1.5 g of potassium intravenously,followed by 4.0 g orally.Weakness in the arms and legs improved.He was referred to endocrinology where he was diagnosed with Graves'disease,with suboptimal control and insulin injections possibly causing TPP.We stopped his insulin and he was discharged with a potassium level of 4.0 mmol/L.CONCLUSION Insulin is a trigger for TPP and should be avoided in patients with hyperthyroidism.Early recognition and treatment of TPP is crucial,especially in patients presenting with hypokalemic periodic paralysis.
文摘From 1986 to 1995, the author treated 60 cases of peripheral facial paralysis, of which 50 cases were treated with electric needles and 10 cases in the control group with filiform needles.
文摘Objective:To observe the differences in the therapeutic effect on refractory facial paralysis between meridian sinew needling therapy and routine penetrating needling therapy.Methods:A total of 46 patients with refractory facial paralysis were randomly divided into a meridian sinew needling group and a routine penetrating needling group,23 cases in each one.The same acupoints were selected in the two groups.Besides using routine acupuncture technique,a part of acupoints were stimulated with the meridian sinew needling technique in the meridian sinew needling group.In the routine penetrating needling group,a part of acupoints were stimulated with the routine penetrating needling technique.In both of the groups,the needles were retained for 30 min and the treatment was given once every two days,10 treatments made one course.A total of 3 courses of treatment were required at the interval of 2 days.The score and grade of facial nerve function were recorded before and after treatment in the patients of the two groups.The clinical therapeutic effect was evaluated.Results:After treatment,the scores of facial nerve function were significantly improved compared with that before treatment in the patients of the two groups(both P<0.05).The difference value of the score of facial nerve function before and after treatment in the meridian sinew needling group was higher than that in the routine penetrating needling group,indicating a statistical significance(P<0.05).The grades of facial nerve function after treatment were different significantly as compared with those before treatment in the patients of the two groups(both P<0.05).However,the difference was not significant between the two groups after treatment(P>0.05).After treatment,the total effective rate in the meridian sinew needling group was 100%,which was higher than 91.3%in the routine penetrating needling group,while without statistical significant difference(P>0.05).Conclusion:Meridian sinew needling therapy of acupuncture greatly improves facial nerve function as compared with routine penetrating needling therapy.It would be an potential effective acupuncture technique for refractory facial paralysis.
文摘Objective:To compare the clinical therapeutic effect on epiphora as sequela of peripheral facial paralysis treated with pricking technqiue of fire needling therapy at Chengqi(承泣ST1)and acupuncture treatment at conventional acupoints.Methods:From September 2018 through to October 2018,64 cases of epiphora as sequela of peripheral facial paralysis were collected from the Department of Acupuncture-Moxibustion in Suzhou TCM Hospital.According to random number table,they were divided into an observation group and a control group,32 cases in each one.In the observation group,pricking technique of fire needling therapy was used at ST1,once every two days.In the control group,acupuncture with filiform needle was applied to Jingming(睛明BL1),Taiyang(太阳EX-HN5),Tongziliao(瞳子髎GB1),Sibai(四白ST2)and Quanliao(颧髎SI18)on the affected side as well as Hegu(合谷LI4)on the contralateral side,once per day.The 10-day treatment was as one 1 course and the consecutive 3 courses of treatment were required in either of the groups.Before and after treatment,Munk grade,clinical effective rate and the number of treatments were observed in the evaluation of therapeutic effect.Results:After treatment,Munk grade was improved in the patients of the two groups(both P<0.05).The improvement range in the observation group was larger than that of the control group(P<0.05).The treatment in either group achieved the obviously therapeutic effect on epiphora as sequela of peripheral facial paralysis.The effective rate in the observation group was 90.32%,higher than 61.29%in the control group(P<0.05).The mean number of treatments of the curative case were 5.11 in the observation group and were 13.73 in the control group,indicating the statistical significance in difference(P<0.05).Conclusion:Pricking technique of fire needling therapy at ST1 achieves the better effect on epiphora as sequela of peripheral facial paralysis as compared with acupuncture at conventional acupoints.
文摘BACKGROUND Postoperative intestinal paralysis is common in gastrointestinal surgery,and the study of electroacupuncture mechanisms is of great significance.AIM To explore the neuroimmune regulatory mechanism of electroacupuncture at the Zusanli acupoint(ST36)in postoperative intestinal paralysis following gastrointestinal surgery.METHODS A total of 156 patients admitted to the Affiliated Hospital of Jiangnan University between January 2022 and October 2024 for postoperative intestinal paralysis following gastrointestinal surgery were randomly divided into two groups:A control group and an electroacupuncture group,with 75 patients in each.The control group received conventional Western medical treatment,while the electroacupuncture group received electroacupuncture in addition to this,at the bilateral Zusanli acupoints.Both groups received treatment for 7 days.Clinical efficacy,gastrointestinal function recovery,and gastrointestinal hormone[motilin(MTL),gastrin(GAS)],neurotransmitter[vasoactive intestinal peptide(VIP),nitric oxide(NO)],and inflammatory cytokine[tumor necrosis factor-α(TNF-α),serum interleukin-6(IL-6),interleukin-1β(IL-1β)]levels were compared between the two groups before and seven days after treatment.Adverse reactions were also recorded.RESULTS The electroacupuncture group demonstrated a higher overall treatment effectiveness rate and faster recovery of bowel sounds,as well as faster first defecation and first flatus than the control group(P<0.05).After seven days of treatment,MTL and GAS levels were significantly higher and VIP,NO,TNF-α,IL-6 and IL-1βlevels were significantly lower in the electroacupuncture group than in the control group(P<0.05).No adverse reactions were observed in either group during treatment.CONCLUSION Electroacupuncture at the Zusanli acupoint can enhance clinical efficacy,promote the recovery of gastrointestinal function,and regulate the neuroimmune microenvironment in patients with intestinal paralysis after gastrointestinal surgery.This mechanism may involve excitation of the vagus nerve and activation of the cholinergic antiinflammatory pathway through electroacupuncture stimulation of the Zusanli acupoint.
文摘Dysphagia caused by true bulbar paralysis after stroke is a common and serious complication that severely affects patients’eating ability and quality of life,and significantly increases the risk of complications such as pneumonia and malnutrition.Electroacupuncture at swallowing points stimulates Swallowing 1 and Swallowing 2 acupoints,acting on key areas such as the glossopharyngeal nerve and vagus nerve,stimulating the reconstruction of nerve reflex arcs and the recovery of swallowing function.Therefore,this article analyzes the mechanism and clinical efficacy of electroacupuncture at swallowing points for the treatment of dysphagia caused by true bulbar paralysis after stroke,aiming to provide theoretical support and practical basis for clinical application.
文摘BACKGROUND Chemotherapy-induced cardiotoxicity is a significant complication in cancer therapy,limiting treatment efficacy and worsening patient outcomes.Recent studies have implicated the gut microbiome and its key metabolites,such as shortchain fatty acids(SCFAs)and trimethylamine-N-oxide(TMAO),in mediating inflammation,oxidative stress,and cardiac damage.The gut-heart axis is increasingly recognized as a pivotal pathway linking microbiota dysregulation to chemotherapy-related cardiac dysfunction.AIM To systematically review existing evidence on the role of gut microbiome alterations in chemotherapy-induced cardiotoxicity and evaluate emerging microbiome-based therapeutic strategies aimed at mitigating cardiovascular risk in cancer patients.METHODS A systematic literature search was conducted in PubMed,Scopus,and Web of Science for studies published between January 2013 and December 2024.Studies were included if they examined chemotherapy-induced cardiotoxicity in relation to gut microbiota composition,microbial metabolites(e.g.,SCFAs,TMAO),or microbiome-targeted interventions.Selection followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data extraction focused on microbiota alterations,mechanistic pathways,cardiac outcomes,and quality assessments using standardized risk-of-bias tools.RESULTS Eighteen studies met the inclusion criteria.Chemotherapy was consistently associated with gut dysbiosis characterized by reduced SCFA-producing bacteria and increased TMAO-producing strains.This imbalance contributed to gut barrier disruption,systemic inflammation,and oxidative stress,all of which promote myocardial damage.SCFA depletion weakened anti-inflammatory responses,while elevated TMAO levels exacerbated cardiac fibrosis and dysfunction.Preclinical studies showed promising cardioprotective effects from probiotics,prebiotics,dietary interventions,and fecal microbiota transplantation,though human data remain limited.CONCLUSION Gut microbiome dysregulation plays a crucial role in the development of chemotherapy-induced cardiotoxicity.Altered microbial composition and metabolite production trigger systemic inflammation and cardiac injury.Microbiome-targeted therapies represent a promising preventive and therapeutic approach in cardio-oncology,warranting further clinical validation through well-designed trials.
文摘Stroke has been in a high incidence,and stroke sequelae have become the main cause of motor dysfunction.The treatment of flaccid paralysis is critical to stroke recovery.In recent years,traditional treatment,especially acupuncture therapy has achieved certain effects for the treatment of post-stroke flaccid paralysis.Acupuncture treatment can promote the recovery of nerve conduction,increase muscle strength and improve joint flexibility,and correct abnormal movement patterns of limbs.Acupuncture combined with rehabilitation training will be the focus for the treatment of post-stroke flaccid paralysis.In this review,the combination of different acupuncture therapies with modern rehabilitation for the treatment of post-stroke flaccid paralysis has been summarized in order to effectively promote the recovery of motor function and significantly improve their life quality.
文摘Cardiovascular disease remains the leading global cause of mortality,projected to increase by 73.4%from 2025 to 2050 despite declining age-standardized rates.Contemporary interventions,such as percutaneous coronary intervention and statins,reduce major adverse cardiovascular events(MACE)by 25%-30%,yet a 20%five-year MACE risk persists in high-risk cohorts.These approaches,histor-ically focused on luminal stenosis,fail to address systemic atherogenesis drivers like endothelial dysfunction and inflammation.Specifically,dietary linoleic acid restriction(<5 g/day)reduces oxidized low-density lipoprotein by approximately 15%by limiting peroxidation-prone bisallylic bonds,mitigating arterial inflam-mation,a key atherogenic trigger.Enhanced external counterpulsation,through pulsatile shear stress,enhances nitric oxide-mediated coronary perfusion,alle-viating angina in approximately 70%of refractory cases unresponsive to revascu-larization.Nanoparticle-facilitated chelation targets atherosclerotic plaques with precision,reducing calcium content by up to 30%in preclinical models,offering a novel avenue for lesion reversal.These innovations collectively address residual risk by tackling root causes,oxidative stress,endothelial dysfunction,and plaque instability,potentially halving MACE rates with widespread adoption.Despite promising preliminary data,gaps remain in long-term safety and scalability.Robust clinical trials are needed to validate these approaches,which collectively aim to transform cardiovascular disease management by prioritizing prevention and vascular restoration,potentially reducing coronary events to a public health rarity.
文摘Regenerative medicine is a promising therapeutic avenue for previously incurable diseases.As the risk of chronic and degenerative diseases significantly increases with age,the elderly population represents a major cohort for stem cell-based therapies.However,the regenerative potential of stem cells significantly decreases with advanced age and deteriorating health status of the donor.Therefore,the efficacy of autologous stem cell therapy is significantly compromised in older patients.To overcome these limitations,alternative strategies have been used to restore the age-and disease-depleted function of stem cells.These methods aim to restore the therapeutic efficacy of aged stem cells for autologous use.This article explores the effect of donor age and health status on the regenerative potential of stem cells.It further highlights the limitations of stem cell-based therapy for autologous treatment in the elderly.A comprehensive insight into the potential strategies to address the“age”and“disease”compromised regenerative potential of autologous stem cells is also presented.The information provided here serves as a valuable resource for physicians and patients for optimization of stem cellbased autologous therapy for aged patients.
文摘Tau plays a crucial role in several neurodegenerative diseases,collectively referred to as tauopathies.Therefore,targeting potential pathological changes in tau could enable useful therapeutic interventions.However,tau is not an easy target because it dynamically interacts with microtubules and other cellular components,which presents a challenge for tau-targeted drugs.New cellular models could aid the development of mechanism-based tau-targeted therapies.
文摘Therapy discontinuation in inflammatory bowel disease,particularly involving immunomodulators,biologics,and small molecules,remains a controversial and evolving topic.This letter reflects on developments following the publication by Meštrovićet al,emphasizing the complex balance between risks of relapse,antidrug antibody formation,and potential complications of long-term immunosuppression.Recent evidence underscores high relapse rates following withdrawal-especially of anti-tumor necrosis factor agents-and highlights the lack of robust data for newer biologics.Updated guidelines from European Crohn’s and Colitis Organization,British Society of Gastroenterology,and American College of Gastroenterology all support cautious and individualized approaches,with strict criteria and close follow-up,particularly in Crohn’s disease.For ulcerative colitis,therapeutic cycling remains insufficiently addressed.We proposed a flowchart to support clinical decision-making and stress the importance of shared decisionmaking in the era of personalized medicine since,despite new drug classes and evolving strategies,the therapeutic ceiling in inflammatory bowel disease has yet to be fully overcome.
基金Supported by National Natural Science Foundation of China,No.82303672Zhejiang Provincial Health Commission and Zhejiang Provincial Administration of Traditional Chinese Medicine through the Targeted Project for Medical and Health Research,No.2025ZL017and China Primary Health Care Foundation,No.ZLMY20240311001ZJ.
文摘BACKGROUND The liver represents a common site of distant metastasis in patients with esophageal cancer(EC).Conventional chemotherapy(CMT)presents limited efficacy for EC,and EC patients with liver metastases typically experience a poor prognosis,highlighting an urgent need to explore novel treatment approaches.This study evaluated the overall efficacy and safety of CMT vs CMT combined with immune checkpoint inhibitors(ICIs)in the treatment of EC patients with liver metastases.Furthermore,prognostic factors influencing outcomes in this patient population were identified.AIM To evaluate the efficacy and safety of first-line chemoimmunotherapy for EC patients with liver metastases and to analyze prognostic factors.METHODS This retrospective study included 126 EC patients with liver metastases at Zhejiang Cancer Hospital between 2014 and 2024.Patients receiving CMT were compared with those receiving CMT+ICI.Analyzed variables included clinicopathological features,treatment history,characteristics of metastasis,systemic and local treatments,overall survival(OS),and treatment-related adverse events(TRAEs).Prognostic factors were evaluated using univariate and multivariate Cox proportional-hazards regression models.Finally,efficacy outcomes and TRAE profiles were compared between the two groups.RESULTS A significant difference in median OS was identified between the two groups(10.8 months in the CMT group vs 20.8 months in the CMT+ICI group,P=0.004).The CMT+ICI group also demonstrated a significantly longer median progression-free survival of 11.7 months(P<0.001).Patients receiving combination therapy exhibited significantly improved systemic objective response rate and disease control rate.Multivariate analysis identified key factors significantly influencing OS in EC patients with liver metastases:Karnofsky Performance Status score≥70,receipt of local therapy for liver metastases,and the number of cycles of CMT and immunotherapy received.Furthermore,the incidence of TRAEs did not significantly differ between the CMT+ICI and CMT groups.CONCLUSION For EC patients with liver metastases,the combination of CMT and ICIs demonstrates significantly superior efficacy compared with CMT alone,while maintaining manageable TRAEs.
文摘Experimental therapies targeting immune and stromal cells,such as mast cells,cancer-associated fibroblasts,dendritic cells,and tumor endothelial cells,in the treatment of gastrointestinal solid tumors pose new and complex surgical and medico-legal challenges.These innovative treatments require that informed consent not be limited to simple acceptance of the medical procedure,but instead reflect a true relational and cognitive process grounded in understanding,free choice,and the ability to revoke consent at any time.In particular,it is essential that the patient understands the experimental nature of the therapy,its development stage,potential benefits and risks,as well as the implications for their health and personal dignity.In the case of stromal cell-based treatments,which may exert complex immunomodulatory effects or activate angiogenic pathways that are not yet fully understood,patients must be made fully aware that they are participating in a non-standardized therapy whose outcomes,whether beneficial or harmful,cannot yet be predicted with certainty.This requires particularly careful medical communication,using simple yet scientifically accurate explanations delivered in appropriate language,along with a final verification of the patient’s actual understanding.
