With the transformation in modern medical models and the increasingly diversified needs of patients， building a harmonious and mutually trusting doctor-patient community relationship has become the key to improving the quality of medical services， enhancing patients’ sense of access to medical care， and promoting medical effects. Medical social worker is an indispensable member of the medical team， whose interdisciplinary background knowledge and professional skills provide unique advantages for building a harmonious doctor-patient community relationship. However， the current subjects of research on the doctor-patient community are still limited to the medical staff and patients， and there is a lack of relevant research that uses interdisciplinary thinking and tools to explore the path of building a doctor-patient community. Therefore， under the guidance of the spiral research idea of action research method， by sorting out the action paths of medical social workers in carrying out pediatric neurosurgery specialist services in the past five years， three analytical tools from management， namely the strategic decision-making process model， the organization- stakeholder fit model， and the value proposition canvas， were used to solve the problems and dilemmas in the different stages of building a doctor-patient community. On these foundations， practical knowledge was produced， providing valuable experience and methods for medical social workers to build a doctor-patient community.

Objective:To investigate the value of biparametric-MRI (bpMRI) based peritumoral radiomics for preoperative prediction of extraprostatic extension (EPE) in prostate cancer (PCa).Methods:In this cross-sectional study, consecutive bpMRI of patients undergoing prostatectomy for PCa were retrospectively collected from the First Medical Center (center 1) and the Third Medical Center (center 2) of Chinese PLA General Hospital. A total of 274 patients were finally enrolled. Patients at center 1 from January 2020 to December 2022 were randomly divided into a training set (149 cases) and an internal validation set (63 cases) by stratified random sampling. Patients at center 2 from January 2023 to March 2024 were assigned to the external test set (62 cases). Patients were categorized into EPE-positive group and EPE-negative group according to pathological assessment postoperatively. In the training set, there were 49 cases in EPE-positive group and 100 cases in EPE-negative group. In the internal validation set, there were 26 cases in EPE-positive group and 37 cases in EPE-negative group. In the external test set, there were 22 cases in EPE-positive group and 40 cases in EPE-negative group. Axial T 2WI and apparent diffusion coefficient (ADC) images were manually annotated to obtain index lesion regions of interest (ROIs), with the peritumoral ROIs subsequently delineated by semi-automatic segmentation technique. Radiomics features were extracted from intra-tumoral, peri-tumoral, and intra-tumoral plus peri-tumoral ROIs. The training set data was employed to select and optimize features to build the radiomics models. The logistic regression analysis was used to develop radiomics, clinical, and integrated models. The predictive performance was assessed by the area under the receiver operating characteristic curve (AUC) in the external test set, and compared by the DeLong test. The sensitivity and specificity were compared by the exact McNemar test. Results:In the external test set, the peri-tumoral radiomics model based on bpMRI showed the highest performance in evaluating EPE, with an AUC of 0.739 (95% CI 0.611-0.842), which was identified as the optimal radiomics model. EPE grade ( OR=6.151, 95% CI 3.371-11.226, P<0.001) was incorporated into the clinical model, with an AUC of 0.780 (95% CI 0.657-0.875) in the external test set. The integrated model had an AUC of 0.817 (95% CI 0.698-0.904) in the external test set. There was no statistically significant difference in comparisons of AUCs among the three models (all P>0.05). The sensitivity of the integrated model (68.2%) showed no significant difference from those of the clinical model and the optimal radiomics model (77.3% and 86.4%, respectively; P=0.500 and P=0.289). However, the specificity of the integrated model (85.0%) was significantly higher than those of the clinical model (67.5%, P=0.016) and the optimal radiomics model (50.0%, P<0.001). Conclusion:A bpMRI-based peritumoral radiomics integrating clinical model demonstrates high performance for preoperative prediction of EPE in PCa.

The professional development of medical social workers currently faces several dilemmas， such as insufficient professionalism， unbroken professional barriers， and an incomplete policy system. To address these dilemmas， medical social workers should clarify the dimensions of their professional capabilities and strive to improve their professional capabilities， building a professional capability framework focusing on problem-solving. Meanwhile， with the popularization of AI technology， the cross-field integration and development of “AI + medical social workers” have brought new opportunities for the professional capability construction of medical social workers. For example， big data can enhance the optimization of electronic health record services； virtual reality （VR） and augmented reality can facilitate the electronic standardization of social worker training for clients； and machine learning can promote the transformation of the social work service model towards “risk prediction and advance intervention，” assisting in improving direct service capabilities. ChatGPT and VR remote consultation systems can be used for supervision services， big data cloud classrooms and robot teaching assistants can broaden learning channels， and natural language processing technology can assist in professional document writing， aiding in enhancing indirect service capabilities. However， applying AI technology to the professional capacity construction of medical social workers may also lead to the alienation of the professional service relationship of medical social workers from needs assessment and relationship building to service intervention， further causing ethical risks brought by demand bias， relationship alienation， and weakened subjectivity. Therefore， it is necessary to rationally view AI’s “double-edged sword” effect. While enjoying the field transformation brought about by high and new technology， it is also imperative to address the subsequent challenges from the perspectives of social work professional assessment and review， educational supervision， and ethical awareness enhancement.

Objective:To investigate the value of biparametric-MRI (bpMRI) based peritumoral radiomics for preoperative prediction of extraprostatic extension (EPE) in prostate cancer (PCa).Methods:In this cross-sectional study, consecutive bpMRI of patients undergoing prostatectomy for PCa were retrospectively collected from the First Medical Center (center 1) and the Third Medical Center (center 2) of Chinese PLA General Hospital. A total of 274 patients were finally enrolled. Patients at center 1 from January 2020 to December 2022 were randomly divided into a training set (149 cases) and an internal validation set (63 cases) by stratified random sampling. Patients at center 2 from January 2023 to March 2024 were assigned to the external test set (62 cases). Patients were categorized into EPE-positive group and EPE-negative group according to pathological assessment postoperatively. In the training set, there were 49 cases in EPE-positive group and 100 cases in EPE-negative group. In the internal validation set, there were 26 cases in EPE-positive group and 37 cases in EPE-negative group. In the external test set, there were 22 cases in EPE-positive group and 40 cases in EPE-negative group. Axial T 2WI and apparent diffusion coefficient (ADC) images were manually annotated to obtain index lesion regions of interest (ROIs), with the peritumoral ROIs subsequently delineated by semi-automatic segmentation technique. Radiomics features were extracted from intra-tumoral, peri-tumoral, and intra-tumoral plus peri-tumoral ROIs. The training set data was employed to select and optimize features to build the radiomics models. The logistic regression analysis was used to develop radiomics, clinical, and integrated models. The predictive performance was assessed by the area under the receiver operating characteristic curve (AUC) in the external test set, and compared by the DeLong test. The sensitivity and specificity were compared by the exact McNemar test. Results:In the external test set, the peri-tumoral radiomics model based on bpMRI showed the highest performance in evaluating EPE, with an AUC of 0.739 (95% CI 0.611-0.842), which was identified as the optimal radiomics model. EPE grade ( OR=6.151, 95% CI 3.371-11.226, P<0.001) was incorporated into the clinical model, with an AUC of 0.780 (95% CI 0.657-0.875) in the external test set. The integrated model had an AUC of 0.817 (95% CI 0.698-0.904) in the external test set. There was no statistically significant difference in comparisons of AUCs among the three models (all P>0.05). The sensitivity of the integrated model (68.2%) showed no significant difference from those of the clinical model and the optimal radiomics model (77.3% and 86.4%, respectively; P=0.500 and P=0.289). However, the specificity of the integrated model (85.0%) was significantly higher than those of the clinical model (67.5%, P=0.016) and the optimal radiomics model (50.0%, P<0.001). Conclusion:A bpMRI-based peritumoral radiomics integrating clinical model demonstrates high performance for preoperative prediction of EPE in PCa.

Objective To investigate the MRI features of primary hepatic neuroendocrine tumor (PHNET). Methods Clinical information and MR imaging features of 13 histopathologically confirmed PHNET patients were retrospectively reviewed. All patients underwent routine MRI examination including T2WI and chemical shift imaging, diffusion weighted imaging (DWI) and dynamic contrast-enhanced imaging. All lesions were divided into two groups according to the maximum diameter (≥ 30 mm for large lesion group and<30 mm for small lesion group). The following MRI features of lesions were evaluated:location, size, growth pattern, signal intensity (T1WI, T2WI, DWI, in-and opposed-phase) and dynamic contrast-enhancement pattern. The pathologic features were also analyzed. Results The PHNET can be single lesion(n=7)or multiple lesions(n=6)in which 4 cases showed diffuse pattern.One hundred and six lesions in 13 patients were detected.The median diameter of all lesions was 20 mm(ranging from 3 to 200 mm).Fourteen lesions were found in≥30 mm group and 92 lesions in<30 mm group.(1)In≥30 mm group,all lesions had well-defined margin,heterogeneous hyperintensity on T2WI,heterogeneous hypointensity on T1WI and halo sign on DWI. All lesions showed cystic degeneration, necrosis and pseudo-capsule. Three lesions showed dilation of bile duct around the lesion, and three lesions hemorrhaged and three lesions signal dropped on out-of-phase.On arterial phase,7 lesions showed ring-like enhancement,and the other 7 lesions showed heterogeneous enhancement;then on portal venous phase and delayed phase, 8 lesions showed persistent enhancement and the other 6 lesions showed"wash-out"appearance.Three cases showed lymphadenopathy in the peritoneum and liver hilum. (2) In<30 mm group, 76 lesions showed well-circumscribed edge and the other 16 lesions had ill-defined margin. Eighty two lesions showed relatively homogeneous hyperintensity on T2WI and relatively homogeneous hypointensity on T1WI. One lesion showed heterogeneous hyperintensity on T2WI and heterogeneous hypointensity on T1WI.Nine lesions showed halo and nodular hyperintensity and the other 83 lesions nodular hyperintensity on DWI.Ten lesions demonstrated cystic degeneration and necrosis. Ten lesions showed pseudocapsule. All lesions showed no dilation of bile duct, hemorrhage and signal drop on out-of-phase. On arterial phase, 31 lesions showed ring-like enhancement, 3 lesions showed heterogeneous enhancement and 58 lesions showed homogeneous enhancement;on portal venous phase and delayed phase,62 lesions showed persistent enhancement and 30 lesions showed"wash-out"sign. No lymphadenopathy was found in this group. In the pathologic analysis, hemorrhage and central necrosis were detected in the gross specimens.And in the 13 cases of PHNET,1,3 and 9 cases were classified into G1, G2 and G3 grade, respectively. Conclusions The PHNET can be single or multiple with various sizes. The large lesions often show heterogeneous signal intensity on T2WI and T1WI with cystic degeneration, necrosis, hemorrhage, pseudo-capsule and dilated bile duct, peripheral hyperintensity on DWI, ring-enhancement or heterogeneous slight enhancement in arterial phase, while small lesions often show ring-enhancement or homogeneous obvious enhancement in arterial phase.

With the rapid development of molecular biology,molecular targeted therapy has become an important tumor therapy after surgery,radiotherapy and chemotherapy.It plays an increasingly important role in tumor therapy.Molecular targeted therapy reflects that the clinical medicine tends to precision,but also contains a profound philosophical thought and philosophical basis.On the one hand,the clinical application of molecular targeted therapy reflects the profound philosophical thoughts of the universality of the connection,the universality and theparticularity,and the whole and the part.On the other hand,the further application and development of molecular targeted therapy also need the guidance of philosophical theory.

Objective To understand the characteristics of pathogenic bacteria and drug resistance of ventilator-associated pneu-monia(VAP)in neonatal intensive care unit (NICU),and to explore the corresponding prevention and control measures,and to pro-vide the basis for the VAP antibiotic treatment.Methods A total of 80 children with respiratory failure and ventilator assisted breathing were selected from the NICU as objects in this study.The clinical data,pathogenic bacteria and drug resistance were ana-lyzed retrospectively.Results In 80 cases,the incidence of VAP was 43.75% (35/80),a total of 70 strains of pathogenic bacteria were isolated,gram negative bacilli accounted for the highest proportion,accounting for 81.43% (57/70).Pseudomonas aeruginosa, Klebsiella pneumoniae were the most common gram negative bacilli.Gram positive cocci accounted for 8.57% (13/70),which domi-nated by methicillin resistant Staphylococcus aureus,in addition to susceptible to vancomycin,but resistant to the other antibiotics. Conclusion Gram negative bacillus are the main bacteria in VAP cases,and which are multiple drug-resistant pathogens.

Objective To investigate the efficacy of initial polytherapy in the patients with newly diagnosed infantile spasm by evaluating the ambulatory electronecephalogram (EEG) profiles and serum neuron specific enolase ( NSE ) level.Methods Data from 108 cases of newly diagnosed infantile spasm from Sep.2007 to Nov.2010 in the Department of Pediatrics,the First Hospital of Jilin University,were respectively analyzed for the EEG profiles and serum NSE level.The patients were treated with multiple drugs.Results ( 1 )After treatment,EEG showed normal shape in 56 cases ( 62.2％ ),sporadic sharp and slow waves without hypsarrhythmia in 32 cases( 35.6％ ),and hypsarrhythmia in 2 cases (2.2％).The overall effective rate was 97.8％.(2) Serum NSE in 35 seizure-free cases were examined at the time points of hospital admission,48 hours and one month after seizure cessation,respectively.NSE level was significantly decreased at 48 hours after seizure control than that at hospital admission ( t =6.54,P ＜ 0.05 ) ; NSE at one month after seizure free was further decreased compared with that at admission point ( t =9.29,P ＜ 0.05 ).Conclusion Polytherapy for infantile spasms can ameliorate the abnormal EEGs.NSE level is decreased after seizure cessation.Intelligence is improved 6 months after seizure free and polytherapy may improve the prognosis of the children with infantile spasms.