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Shannah Erasmus,1,* Zhengyi Lyu,2,* Jie Zhou,3 Jianqiao Fang,3 Yi Liang3 1International Education College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China; 2The Third Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China; 3Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yi Liang, Department of Acupuncture, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, People’s Republic of China, Email liangyiwww@126.comIntroduction: Postoperative hyperalgesic priming, exacerbated by preoperative anxiety, complicates pain management and recovery. Electroacupuncture (EA), a technique that combines traditional acupuncture with electrical stimulation applied through needles to enhance therapeutic effect, offers a potential solution by targeting multiple neurobiological pathways.Objective: This review investigates how EA addresses preoperative anxiety-induced postoperative hyperalgesic priming ie pain chronification, focusing on its mechanisms in three areas: preoperative anxiety, postoperative hyperalgesic priming, and the interaction between EA and these processes.Methods: A literature search across PubMed, ScienceDirect, and Google Scholar identified relevant studies on EA’s effects on neurobiological pathways related to anxiety and pain. The review synthesized findings to understand EA’s role in these contexts.Results: EA alleviates preoperative anxiety by influencing the body’s neurochemical and neurophysiological responses. It reduces inflammation, regulates stress hormones, and improves autonomic function. For postoperative pain chronification, EA modulates pain pathways, reduces inflammation, and affects receptor signaling, gene expression, and neurotransmitter systems.Conclusion: EA offers a promising approach to managing preoperative anxiety and postoperative pain. By addressing both the physiological and neurochemical pathways that contribute to pain and anxiety, EA has the potential to significantly improve clinical outcomes for patients undergoing surgery. Further research is needed to fully understand its mechanisms and optimize its application in clinical settings.Keywords: preoperative anxiety, chronic postoperative pain, hyperalgesic priming, electroacupuncture mechanisms, analgesic, anxiolytic

Yi Li,1– 3,&ast; Yixuan Lu,1,2,&ast; Youdan Zhao,1 Zhi Lyu1,2 1Department of Senior Cadres Ward, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China; 2The School of Clinical Medicine, Fujian Medical University, Fuzhou, People’s Republic of China; 3Department of General Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhi Lyu, Department of Senior Cadres Ward, Zhongshan Hospital of Xiamen University, No. 201-209 hubin South Road, Siming District, Xiamen, 361000, People’s Republic of China, Tel +86-13779950606, Email lyuzhi@xmu.edu.cnBackground: Central obesity, as measured by examination instruments, has been shown to be associated with both OSA and short sleep duration. However, objective measurement tools like CT, MRI, and DXA are expensive, cause radiation exposure, and have limited availability, especially in resource-limited settings. Thus, this study aimed to demonstrate the relevance of Body Mass Index (BMI) and Waist-to-Height Ratio (WHtR) as surrogate indicators of visceral obesity in the assessment of OSA and short sleep duration. We also intend to evaluate whether WHtR, in combination with BMI, can be a suitable surrogate marker for visceral adiposity.Methods: We recruited 333 adults with complete polysomnographic (PSG) records retrospectively. Logistic regression helped to assess the association of BMI and WHtR as surrogates for central adiposity with OSA and short sleep duration. Moreover, ROC curve analysis was conducted to evaluate the predictive ability of BMI and WHtR.Results: Following the relevant adjustments, logistic regression analysis results showed that the combination of WHtR and BMI acting as central obesity surrogates was significantly associated with OSA and short sleep duration (p< 0.05). According to univariate regression analysis, sleep latency and wake after sleep onset were independent predictors of the risk of central obesity in patients with short sleep duration and OSA. Additionally, ROC curve analysis demonstrated that the combination of BMI and WHtR provided a better assessment of central adiposity in patients with OSA and short sleep duration, compared to each measure alone.Conclusion: BMI and WHtR are significantly associated with OSA and short sleep duration, and might serve as a potential surrogate marker for central obesity. Sleep latency and wake after sleep onset can independently predict the risk of central obesity in patients with short sleep time and OSA. Thus, larger prospective studies are needed to verify our findings.Keywords: body mass index, central obesity, obstructive sleep apnea, short sleep duration, waist-to-height ratio

Zhengyi Lyu,1,&ast; Qiongying Shen,1,&ast; Shuxin Tian,1,&ast; Liyan Gong,2 Haizhou Lou,3 Guanai Bao,2 Zhuoxuan Wu,3 Chao Lu,2 Weiping Zhang,4 Rui Huang,5 Conghua Ji,6 Siyi Zheng,1 Wei Pan,1 Yinyin Ying,4 Jianwei Jin,4 Yi Liang4 1The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China; 2Zhejiang Cancer Hospital, Hangzhou, Zhejiang, People’s Republic of China; 3Department of Medical Oncology, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, People’s Republic of China; 4Department of Acupuncture, the Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China; 5Department of Acupuncture and Tuina, Wenzhou Central Hospital, Wenzhou, Zhejiang, People’s Republic of China; 6Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yi Liang, Department of Acupuncture, the Third Affiliated Hospital of Zhejiang Chinese Medical University, 219 Moganshan Road, Hangzhou City, Zhejiang Province, 310053, People’s Republic of China, Email liangyiwww@126.comBackground: Transcutaneous Electrical Acupoint Stimulation (TEAS) therapy opens up the possibility for individuals with Cancer-induced bone pain (CIBP) to receive a home-based, patient-controlled approach to pain management. The aim of this study is designed to evaluate the efficacy of patient-controlled TEAS (PC-TEAS) for relieving CIBP in patients with non-small cell lung cancer (NSCLC).Methods/Design: This is a study protocol for a prospective, triple-blind, randomized controlled trial. We anticipate enrolling 188 participants with NSCLC bone metastases who are also using potent opioid analgesics from 4 Chinese medical centers. These participants will be randomly assigned in a 1:1 ratio to either the true PC-TEAS or the sham PC-TEAS group. All participants will receive standard adjuvant oncology therapy. The true group will undergo patient-controlled TEAS intervention as needed, while the sham group will follow the same treatment schedule but with non-conductive gel patches. Each treatment course will span 7 days, with a total of 4 courses administered. There will be 4 assessment time points: baseline, the conclusion of weeks 4, 8, and 12. The primary outcome of this investigation is the response rate of the average pain on the Brief Pain Inventory (BPI) scale at week 4 after treatment. Secondary outcomes include pain related indicators, quality of life scale, mood scales, and routine blood counts on the assessment days. Any adverse events will be promptly addressed and reported if they occur. We will manage trial data using the EDC platform, with a data monitoring committee providing regular quality oversight.Discussion: PC-TEAS interventions offer an attempt to achieve home-based acupuncture treatment and the feasibility of achieving triple blinding in acupuncture research. This study is designed to provide more rigorous trial evidence for the adjuvant treatment of cancer-related pain by acupuncture and to explore a safe and effective integrative medicine scheme for CIBP.Trial Registration: ClinicalTrials.gov NCT05730972, registered February 16, 2023.Keywords: bone cancer pain, TEAS, transcutaneous electrical nerve stimulation, patient-controlled analgesia, integrative medicine, home-based treatment

Jiong Zhou,&ast; Yang Yang,&ast; Mengjun Xu, Zhongfa Lyu, Xianjie Wu Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xianjie Wu, Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, People’s Republic of China, Email wuxianjie@zju.edu.cnObjective: To evaluate and explore the efficacy, safety, and pharmacoeconomics of three common strategies for pediatric alopecia areata.Methods: Chinese pediatric alopecia areata patients meeting the criteria were included and divided into three groups based on the received treatments. The efficacy, adverse events and pharmacoeconomics of these treatments were retrospectively analyzed.Results: Twenty-four pediatric AA patients were recruited in this study. 100% (12/12) of patients from the traditional group achieved SALT100. In the tofacitinib group, 40.0% (2/5) of patients achieved SALT50. 20.0% (1/5) of patients achieved SALT75 and 40.0% (2/5) of patients achieved SALT100. In the MN group, 42.86% (3/7) of patients were non-responders. 14.28 (1/7) of patients achieved SALT75 and 42.86% (3/7) of patients achieved SALT100. The adverse effects (AEs) were mild in all three groups, and none of the patients discontinued the treatments due to the AEs. Comparing the other two groups, the MN treatment would be more time-intensive and more expensive.Conclusion: For newly diagnosed or naive pediatric patients, the traditional treatment was the first-line approach. For long-duration, severe and refractory patients, tofacitinib and microneedling can be alternative options.Keywords: pediatric, alopecia areata, tofacitinib, microneedling, efficacy

Mingyu Yang,&ast; Meng Li,&ast; Zhuozhen Lyu, Zhen Yang Department of Infectious Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 25000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhen Yang, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324, JingWu Road, Jinan, Shandong, 25000, People’s Republic of China, Tel +86 15168867123, Email yangzhen@sdfmu.edu.cnAbstract: Cholangiocarcinoma (CCA), the second most common liver neoplasm, has a poor overall 5-year survival rate of less than 10%. A deeper understanding of the molecular pathogenesis contributing to CCA progression is essential for developing better therapeutic approaches to manage this disease. Ferroptosis, an oxidative iron-dependent form of regulated cell death, has been reported to be involved in tumorigenesis and progression. In particular, ferroptosis and inflammation, which are common issues in cholangiocarcinogenesis and CCA development, might be in concert with disease progression. Notably, the key feature of cancer cells is “iron addiction”, which is crucial for the high metabolic demand in carcinogenesis and cancer progression. Additionally, iron metabolism is of great importance in ferroptosis. Moreover, that cancer cells are vulnerable to ferroptosis might be a possible mechanism of CCA development. Although the underlying mechanism of how ferroptosis is implicated in CCA development requires further investigation, developing a new strategy combined with a pro-ferroptotic treatment would be an exciting CCA treatment approach in the future.Keywords: cholangiocarcinoma, ferroptosis, inflammation, iron metabolism, treatment target

Zhiyong Lyu,1 Jing Li,2 Jinghui Zhen,1 Wei Shi,3 Qingying Meng,1 Wei Zhou,1 Jingyun An,1 Kaihu Yao,3,&ast; Fang Dong1,&ast; 1Department of Clinical Laboratory Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China; 2Department of Clinical Laboratory, Capital Institute of Pediatrics, Beijing, People’s Republic of China; 3Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Fang Dong; Kaihu Yao, Department of Clinical Laboratory Center, Beijing Children’s Hospital Affiliated to Capital Medical University, No. 56 Nan Lishi Road, Beijing, 100045, People’s Republic of China, Email fangd32@163.com; yaokaihu@bch.com.cnIntroduction: Streptococcus pneumoniae (S. pneumoniae) is a major pathogen causing death in children. Few studies have evaluated the importance of S. pneumoniae in the identified bacteria in clinical work. This retrospective study aimed to reveal the rank of S. pneumoniae in determined bacteria isolated from children in Beijing, China, as well as the antimicrobial resistance of this pathogen.Methods: The number of specimen for bacterial culture and of bacterial species were cumulated and ranked based on the data of the two largest children’s hospitals in Beijing from 2015 to 2021. The temporal change of S. pneumoniae culture, as well as the clinical data of S. pneumoniae isolates were collected and analyzed. The minimum inhibitory concentrations of antimicrobial agents were determined by BD Phoenix 100 automated system or Vitek 2 automated system for antimicrobial susceptibility testing. The breakpoints recommended by CLSI were adopted.Results: During the 7-year study period, a total of 45,631 bacterial isolates were cultured from 462,144 submitted specimens, in which S. pneumoniae was the third frequent agent following S. aureus and H. influenza, and accounting for 8.79% of the isolates (4011/45,631). In the 4011 S. pneumoniae isolates, 2239 and 997 ones were, respectively, isolated from sputum and bronchial lavage fluid. Most of S. pneumoniae strains were identified in winter (34.7%) and spring (26.1%), and were mainly isolated from patients under 5 years old (77.1%). Low susceptible rate (27.6%) of CSF isolates was determined to penicillin according to the parenteral meningitis breakpoints, while high susceptible rate (56.9%) of non-CSF isolates was obtained according to the parenteral non-meningitis breakpoints. The isolates showed low sensitivity to erythromycin and tetracycline (< 5%). All isolates were susceptible to vancomycin and linezolid.Conclusion: The present results demonstrated that S. pneumoniae was one of the most commonly detected bacteria in current pediatric clinical tests, especially in young children under 5 years old, which emphasized the importance of prevention. Penicillin could still be the first empiric choice to treat non-meningitis pneumococcal infections, while erythromycin should not be involved in the treatment.Keywords: Streptococcus pneumoniae, antimicrobial resistance, children, China

Ningcen Li,1,2,&ast; Yi Guo,1,3,4,&ast; Yinan Gong,1– 3 Yue Zhang,1,2 Wen Fan,5 Kaifang Yao,1,2 Zhihan Chen,1,2 Baomin Dou,1,2 Xiaowei Lin,1,3,4 Bo Chen,1– 3 Zelin Chen,1– 3 Zhifang Xu,1– 3 Zhongxi Lyu1– 3 1Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin City, People’s Republic of China; 2School of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin City, People’s Republic of China; 3National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin City, People’s Republic of China; 4School of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin City, People’s Republic of China; 5Suzuka University of Medical Science, Suzuka City, Japan&ast;These authors contributed equally to this workCorrespondence: Zhifang Xu; Zhongxi LyuSchool of Acupuncture & Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, No. 10 Poyang Lake Road, Tuanbo New Town, Jinghai District, Tianjin, 301617, People’s Republic of ChinaTel/Fax +86 22-5959-6290Email xuzhifangmsn@hotmail.com; 1025117807@qq.comAbstract: Inflammation plays a significant role in the occurrence and development of multiple diseases. This study comprehensively reviews and presents literature from the last five years, showing that acupuncture indeed exerts strong anti-inflammatory effects in multiple biological systems, namely, the immune, digestive, respiratory, nervous, locomotory, circulatory, endocrine, and genitourinary systems. It is well known that localized acupuncture-mediated anti-inflammatory effects involve the regulation of multiple populations and functions of immune cells, including macrophages, granulocytes, mast cells, and T cells. In acupuncture stimulation, macrophages transform from the M1 to the M2 phenotype and the negative TLR4 regulator PPARγ is activated to inhibit the intracellular TLR/MyD88 and NOD signaling pathways. The downstream IκBα/NF-κB and P38 MAPK pathways are subsequently inhibited by acupuncture, followed by suppressed production of inflammasome and proinflammatory mediators. Acupuncture also modulates the balance of helper T cell populations. Furthermore, it inhibits oxidative stress by enhancing SOD activity via the Nrf2/HO-1 pathway and eliminates the generation of oxygen free radicals, thereby preventing inflammatory cell infiltration. The anti-inflammatory effects of acupuncture on different biological systems are also specific to individual organ microenvironments. As part of its anti-inflammatory action, acupuncture deforms connective tissue and upregulates the secretion of various molecules in acupoints, further activating the NF-κB, MAPK, and ERK pathways in mast cells, fibroblasts, keratinocytes, and monocytes/macrophages. The somatic afferents present in acupuncture-activated acupoints also convey sensory signals to the spinal cord, brainstem, and hypothalamic neurons. Upon information integration in the brain, acupuncture further stimulates multiple neuro-immune pathways, including the cholinergic anti-inflammatory, vagus-adrenal medulla-dopamine, and sympathetic pathways, as well as the hypothalamus-pituitary-adrenal axis, ultimately acting immune cells via the release of crucial neurotransmitters and hormones. This review provides a scientific and reliable basis and viewpoints for the clinical application of acupuncture in various inflammatory conditions.Keywords: inflammation, acupuncture, immune, vagus, sympathetic nerve

Xiang Li,1 Jinzhu Bai,2 Yi Hong,2 Junwei Zhang,2 Hehu Tang,2 Zhen Lyu,2 Shujia Liu,2 Shizheng Chen,2 Jiesheng Liu2 1Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China; 2Department of Spine and Spinal Cord Surgery, Beijing Bo’ai Hospital, China Rehabilitation Research Center; School of Rehabilitation, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Jinzhu BaiDepartment of Spine and Spinal Cord Surgery, Beijing Bo’ai Hospital, China Rehabilitation Research Center; School of Rehabilitation, Capital Medical University, No. 10 North Jiaomen Road, Fengtai District, Beijing, 100068, People’s Republic of ChinaEmail baijinzhu@126.comPurpose: To investigate the long-term (> 7 years) clinical outcomes of percutaneous endoscopic lumbar discectomy for lumbar degenerative disease to address postoperative problems including postoperative dysesthesia (POD), residual back pain and segmental instability.Methods: Inclusion and exclusion criteria were established. All patients who met the above criteria were treated by PELD using the transforaminal approach. Limited discectomy was performed to preserve the disc material in the intervertebral space as much as possible. The Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score for back pain (VAS-B) and leg pain (VAS-L) and Modified MacNab’s criterion were used for clinical evaluation. Radiographic parameters including height of intervertebral disc and segmental instability were also evaluated.Results: Forty-two patients (24 men and 18 women) who met our inclusion and exclusion criteria were included in our study. The average follow-up period was 95.71± 5.63 months (ranging from 87 to 105 months). There were no neurological complications associated with the operation. POD was found in 14.29% of patients, while only 2 patients (4.76%) complained of mild dysesthesia at final follow-up. Two patients (4.76%) required revision surgery during the follow-up period. The final follow-up ODI, JOA score, VAS-B and VAS-L were significantly better than preoperative values. The average disc-height ratio was 84.52± 5.66% of the preoperative disc height. No instability at the operation level was noted at final follow-up.Conclusion: Our study showed that PELD using the transforaminal approach can provide favorable results after a long-term follow-up period. POD is a common complication at initial prognosis. Limited discectomy can preserve the disc height well and minimize the risk of residual back pain.Keywords: percutaneous endoscopic lumbar discectomy, transforaminal approach, long-term follow-up, back pain

［Objective］Since the implementation of the Shanghai Master Plan (2017-2035), with the development of five new Shanghai towns (Jiading, Qingpu, Songjiang, Fengxian, and Nanhui) and the Yangtze River Delta integration ascending to national strategies, Shanghai urban rail transit planning network is also undergoing further adjustments. Among them, circle lines and express lines (shorten as circle/express lines) are the focus of discussion, and it is necessary to study the functional planning, passenger flow characteristics and planning principles of circle/express lines. ［Method］Using the passenger flow data of existing urban rail transit lines, the characteristics and functions of circle/express lines passenger flow are analyzed; by comparing the previous research conclusions and actual operation status of circle/express lines, the planning experience of circle/express lines is summarized. Based on the urban development plan requirements in the new era, the shortcomings of circle/express lines in the existing plan are analyzed, and the functional requirements and planning principles of them in the new round of plan adjustments are proposed. ［Result & Conclusion］The passenger flow carried by the circle line is divided into three categories: passenger flow along line service range, transit passenger flow and arrival/departure passenger flow of the line. The corresponding circle line can play service functions for the above three scenarios. In addition to the existing circle line—Shanghai Rail Transit Line 4, the second circle line can be planned to meet the needs of passenger flow distribution along the line. It is recommended that the second circle line can be located between the middle and outer ring roads, making use of the planned Shanghai Rail Transit Line 26, and better closer to the middle ring line. The planning of express lines from suburbs to central urban area should be further strengthened. There are direct access and hub access two forms of express lines entering the central urban area network. Hub access requires highly convenient hub station for this purpose, while direct access to the network features relatively high cost. The corresponding indicator calculation method of express line travel time may be selected based on the connection closeness degree between new towns and the central urban area.

The 6061-T6 ultra-thin aluminum alloy with a thickness of 0.5 mm was welded using micro-joint friction stir welding technology. The effects of three kinds of stirring heads with different shaft shoulder morphology on the forming quality， microstructure， mechanical properties， welding thermal cycle， and force process of the 6061-T6 thin-wall butt joint were studied. The flow behavior characteristics of the plastic metal in the three welding cross-sections were analyzed in sequence. The results show that the forming effect of the weld surface is significantly affected by welding heat input. The hardness distribution trend of the joint cross-section formed by three kinds of stirring heads with different shaft shoulder morphology is a “W” shape. The highest hardness values in the center of the nucleation zone and the lowest hardness values in the thermo-mechanical affected zone of the needle-free three-involute diversion groove shaft shoulder welded joint are the highest among the three shaft shoulder welded joints. The mechanical properties of the joint formed by the three-involute guide groove with the needle shaft shoulder are outstanding， and the tensile strength， yield strength， and elongation after fracture are higher than those of the other two. The three tensile fracture forms are mainly ductile fractures. The process parameters of the thermal cycle and force can accurately reflect the changing trend of the welding state. The energy required to maintain the weld metal softening is from the heat generated by friction between the shaft shoulder and the workpiece and the work done by the axial and forward forces of the shaft shoulder. The axial force and forward force changed with the softening degree of the welded metal， playing a dynamic regulating role in the migration of plastic metal in the weld. The shoulder surface has a strong effect on the upper part of the weld， driving the plastic metal migration between the forward side and the backward side. The needle of the stirring head promotes the interaction between the plastic metal and the backing plate， providing a driving force for the flow of the upper and lower parts of the weld metal. The optimal heat generation potential is the combined result of the stirring needle and the involute groove， which work together to form a well-formed weld.

Wind turbines can contribute to frequency regulation by releasing rotor kinetic energy， which is an effective way to ensure frequency stability in power systems with high wind power penetration. However， the rotor speed recovery process may cause a secondary frequency drop （SFD） in the system. To address this issue， a wind turbine speed recovery strategy based on the asymptotic characteristics of an exponential function is proposed， following both qualitative and quantitative analysis of the frequency support and speed recovery. First， during the recovery period， the rotor speed is restored according to the power reference value defined by an exponential function. After the speed is recovered， the control switches to maximum power point tracking （MPPT） to manage the turbine's output power. Second， the parameters of the exponential decay coefficient are tuned based on various constraints. Finally， simulation results validate that the proposed strategy effectively mitigates SFDs while ensuring a smooth rotor speed recovery process.

BackgroundAlpha-fetoprotein-producing gastric cancer (AFPGC) represents a particularly aggressive subtype of gastric carcinoma characterized by elevated rates of vascular invasion, lymphatic dissemination, hepatic metastasis, and an unfavorable clinical outcome. Treatment strategies for AFPGC have historically lacked specificity. Herein, a case is presented involving AFPGC in which the patient exhibited a notable response to combined anti-PD-1 antibody immunotherapy and SOX chemotherapy, potentially achieving a cure. This report marks the first application of this regimen in neoadjuvant therapy for AFP gastric cancer, followed by radical resection and postoperative adjuvant therapy.Case summaryA 62-year-old male patient presented with persistent upper abdominal distension and discomfort lasting over 2 months. Initial investigations revealed markedly elevated serum alpha-fetoprotein (AFP) levels, and subsequent pathological examination confirmed the diagnosis of AFPGC via gastroscopy. Due to the patient’s condition, surgical resection was initially deemed unfeasible. Therefore, a chemo-immunotherapy regimen consisting of SOX chemotherapy and the PD-1 inhibitor tislelizumab was administered for 3 cycles. Following this, successful laparoscopic radical gastrectomy was performed. The treatment protocol was continued with an additional 3 cycles postoperatively. At the time of this case report, the patient maintained a good quality of life with no evidence of disease recurrence or adverse events.ConclusionThe present report highlights a case of AFPGC where significant therapeutic success was achieved through a combined regimen of chemotherapy and immunotherapy, both before and after surgery. The use of anti-PD-1 antibody (tislelizumab) in combination with SOX regimen (S-1 and oxaliplatin) demonstrated effective treatment of AFPGC, potentially offering a curative approach. This approach represents a promising targeted therapy option for patients with AFPGC.