To investigate the association between the systemic inflammatory response index (SIRI) and lung cancer prevalence based on the National Health and Nutrition Examination Survey (NHANES) database.

Benign-malignant differentiation and risk stratification of pulmonary nodules are critical issues in lung cancer screening and clinical management. Conventional assessment mainly relies on imaging evaluation， dynamic follow-up， and pathological confirmation， but its diagnostic performance remains limited in clinical scenarios involving small nodules， ground-glass nodules， and inflammatory lesions. In recent years， advances in radiomics， genomics， transcriptomics， proteomics， metabolomics， and microbiomics have provided multi-level biological evidence for the precise evaluation of pulmonary nodules from the perspectives of imaging phenotype， genetic variation， molecular expression， functional status， metabolic reprogramming， and host-microbe interaction. Compared with single-omics approaches， multi-omics integration， through cross-level information fusion， enables a more comprehensive characterization of the biological heterogeneity of pulmonary nodules and further improves the performance of benign-malignant differentiation and risk stratification. Relevant studies showed that the area under the curve （AUC） increased from 0.80-0.87 to 0.93. This review systematically summarizes recent advances in multi-omics research for benign-malignant differentiation and risk stratification of pulmonary nodules， with a focus on their value in biomarker discovery， risk assessment， and clinical decision support. Current challenges， including lack of standardization， insufficient external validation， and barriers to clinical translation， are also discussed to provide references for future research on precision management of pulmonary nodules.

Background Air pollution poses a significant threat to children's respiratory health. Baotou, a resource-dependent industrial city in northern China dominated by coal, power generation, and steel industries, has limited evidence on the associations of inhalable particulate matter (PM₁₀), fine particulate matter (PM_2.5), and ozone (O₃) with pediatric pneumonia hospitalizations, particularly with respect to season-specific lagged effects. Objective To evaluate the associations of PM₁₀, PM_2.5, and O₃ with pediactric pneumonia hospitalizations and to examine seasonal variations in these associations in the urban districts of Baotou. Methods A time-series study was conducted using daily data on air pollutant concentrations, meteorological factors, and pediatric pneumonia hospitalizations in Baotou from 2017 to 2022. Generalized additive models were applied to examine single-pollutant associations. Cumulative lag models were fitted to assess delayed and cumulative effects, and season-stratified models were constructed to identify season-specific risks. Two-pollutant and multi-pollutant models were further developed to evaluate the robustness of the observed associations. Results The annual mean concentrations of PM_2.5 and PM₁₀ were 38.62 μg·m⁻³ and 85.44 μg·m⁻³, respectively.PM₁₀ and O₃ were the most frequent primary pollutants, accounting for 32.6% and 30.7% of polluted days, respectively. Significant positive associations with lag effects were observed between air pollutants and pediatric pneumonia hospitalizations. In the full-year model, PM₁₀ showed the strongest association at lag 3 (ER=0.77%, 95%CI: 0.50%, 1.04%), whereas PM_2.5 showed the strongest association at lag 1 (ER=1.85%, 95%CI: 1.23%, 2.48%). Seasonal stratification analyses revealed significant associations for PM_2.5 in both the cold season (lag 1, ER=1.57%, 95%CI: 0.83%, 2.31%) and the warm season (lag 7, ER=1.84%, 95%CI: 0.35%, 3.35%). PM₁₀ showed a significant association at lag 7 in the warm season (ER=0.70%, 95%CI: 0.27%, 1.13%). O₃ exhibited significant acute effects only in the warm season, with same-day exposure (lag 0) associated with an ER of 3.79% (95%CI: 1.92%, 5.69%). The estimated risk contribution ranking was PM_2.5 > PM₁₀ for the full year and the cold season, and O₃ > PM_2.5 > PM₁₀ for the warm season. Cumulative lag analysis revealed that PM₁₀ and PM_2.5 exhibited the strongest cumulative associations at lag07 in the full-year and cold-season models, with ERs of 2.20% (95%CI: 1.68%, 2.72%) and 4.20% (95%CI: 3.01%, 5.40%), respectively, and the associations intensified as the lag period extended. In contrast, O₃ in the warm season showed the strongest cumulative association at lag02, with an ER of 5.37% (95%CI: 3.13%, 7.66%), followed by a rapid decline. O₃ in the cold season showed a significant cumulative association at lag07, with an ER of 5.12% (95%CI: 0.00%, 10.49%). In two-pollutant and multi-pollutant models, the associations of PM₁₀ and O₃ remained stable after adjustment for other pollutants. Conclusion From 2017 to 2022, ambient particulate matter and ozone are significantly associated with pediatric pneumonia hospitalizations in the urban districts of Baotou, with evident lagged effects and seasonal variations. Differentiated prevention strategies should be developed according to seasonal pollutant profiles, with priority given to PM_2.5 control in the cold season and O₃ control in the warm season.

Background: and Purpose Symptomatic intracranial hemorrhage (sICH) following endovascular thrombectomy (EVT) is a severe complication associated with adverse functional outcomes and increased mortality rates. Currently, a reliable predictive model for sICH risk after EVT is lacking. Methods: This study used data from patients aged ≥20 years who underwent EVT for anterior circulation stroke from the nationwide Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke (TREAT-AIS). A predictive model including factors associated with an increased risk of sICH after EVT was developed to differentiate between patients with and without sICH. This model was compared existing predictive models using nationwide registry data to evaluate its relative performance. Results: Of the 2,507 identified patients, 158 developed sICH after EVT. Factors such as diastolic blood pressure, Alberta Stroke Program Early CT Score, platelet count, glucose level, collateral score, and successful reperfusion were associated with the risk of sICH after EVT. The TREAT-AIS score demonstrated acceptable predictive accuracy (area under the curve [AUC]=0.694), with higher scores being associated with an increased risk of sICH (odds ratio=2.01 per score increase, 95% confidence interval=1.64–2.45, P<0.001). The discriminatory capacity of the score was similar in patients with symptom onset beyond 6 hours (AUC=0.705). Compared to existing models, the TREAT-AIS score consistently exhibited superior predictive accuracy, although this difference was marginal. Conclusions The TREAT-AIS score outperformed existing models, and demonstrated an acceptable discriminatory capacity for distinguishing patients according to sICH risk levels. However, the differences between models were only marginal. Further research incorporating periprocedural and postprocedural factors is required to improve the predictive accuracy.

Objective To explore the effectiveness of an integrated laparoscopic simulation training course (best essential surgical technique training, BEST) in enhancing laparoscopic peritoneal suturing techniques in surgical residents.Methods As an integrated two-stage program, the BEST course applied basic laparoscopic training system with simple molds in phase Ⅰ training, and then adopted advanced laparoscopic training system, 3D Laparoscope and ex-vivo animal models in phase Ⅱ training. The laparoscopic suturing techniques were practiced in phase Ⅱ training. From August 2021 to July 2024, surgical residents in the second year of the national standardized training program were divided into pilot and control groups based on whether they had undergone the BEST course. Two cases of laparoscopic peritoneal suture were performed by the surgical residents under supervision in the department of gastrointestinal surgery. The operative time, quality of suture, and independent completion rate were compared between the two groups.Results A total of 33 surgical residents (19 in pilot group and 14 in control group) were included in this study, and a total of 66 cases of laparoscopic peritoneal suture were performed (38 in pilot group and 28 in control group). The operative time was significantly shorter in pilot group than that in control group (15.7 min vs. 17.5 min, P=0.025). The quality of suture was significantly better in pilot group compared to control group (P=0.023). In pilot group, all peritoneal sutures were performed by residents independently, whereas in control group, 3 cases (10.7%) were assisted by the supervisor, and the independent completion rate was different significantly (P=0.039).Conclusions The BEST course can help improve surgical residents′ laparoscopic peritoneal suturing techniques and could be promoted in the national standardized training program for surgical residents.

Pulmonary lymphangioleiomyomatosis is a rare disease characterized by the abnormal proliferation of pulmonary lymphatic smooth muscle cells. It is common in women and often accompanied by recurrent pneumothorax, chylothorax and progressive dyspnea, imaging characterized by diffuse cystic lesions in both lungs. Pulmonary lymphangioleiomyomatosis progresses aggressively and has a very poor prognosis, with a lack of effective medical treatment options in the advanced stages. Lung transplantation is a safe and effective method for the treatment of advanced pulmonary lymphangioleiomyomatosis, which may significantly improve the survival rate and quality of life of patients. The median survival period after surgery can reach 12 years. This article reviews the pathogenesis, diagnosis, treatment of pulmonary lymphangioleiomyomatosis, and the current status and existing problems of lung transplantation in pulmonary lymphangioleiomyomatosis, aiming to provide a reference for the clinical treatment and subsequent research of pulmonary lymphangioleiomyomatosis.

Background: and Purpose Symptomatic intracranial hemorrhage (sICH) following endovascular thrombectomy (EVT) is a severe complication associated with adverse functional outcomes and increased mortality rates. Currently, a reliable predictive model for sICH risk after EVT is lacking. Methods: This study used data from patients aged ≥20 years who underwent EVT for anterior circulation stroke from the nationwide Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke (TREAT-AIS). A predictive model including factors associated with an increased risk of sICH after EVT was developed to differentiate between patients with and without sICH. This model was compared existing predictive models using nationwide registry data to evaluate its relative performance. Results: Of the 2,507 identified patients, 158 developed sICH after EVT. Factors such as diastolic blood pressure, Alberta Stroke Program Early CT Score, platelet count, glucose level, collateral score, and successful reperfusion were associated with the risk of sICH after EVT. The TREAT-AIS score demonstrated acceptable predictive accuracy (area under the curve [AUC]=0.694), with higher scores being associated with an increased risk of sICH (odds ratio=2.01 per score increase, 95% confidence interval=1.64–2.45, P<0.001). The discriminatory capacity of the score was similar in patients with symptom onset beyond 6 hours (AUC=0.705). Compared to existing models, the TREAT-AIS score consistently exhibited superior predictive accuracy, although this difference was marginal. Conclusions The TREAT-AIS score outperformed existing models, and demonstrated an acceptable discriminatory capacity for distinguishing patients according to sICH risk levels. However, the differences between models were only marginal. Further research incorporating periprocedural and postprocedural factors is required to improve the predictive accuracy.

A total of 269 non-diabetic chronic kidney disease (CKD) patients were enrolled in this study. Among them, 175 patients (65.1%) were assigned to the control group and received conventional therapy with maximally tolerated doses of renin-angiotensin-aldosterone system inhibitors, while 94 patients (34.9%) were assigned to the dapagliflozin group and received oral dapagliflozin 10 mg/day in addition to the conventional therapy. The results showed that the urine protein quantity in the dapagliflozin group was lower than those in the control group at 3, 6, 12, 18, and 24 months of follow-up (all P<0.05), and the blood albumin level was higher than those in the control group at 18 and 24 months of follow-up (all P<0.05). The Kaplan-Meier survival curve analysis results showed that the cumulative renal survival rate of the dapagliflozin group was significantly higher than that of the control group (Log-rank test, χ2=5.078, P=0.024). Multivariable Cox regression analysis results revealed that using dapagliflozin was independently associated with a reduced risk of the composite endpoint in non-diabetic CKD patients ( HR=0.400, 95% CI 0.163-0.983, P=0.046). There was no statistical difference in adverse reactions between the two groups (all P>0.05). It is indicated that dapagliflozin has a renal protective effect independent of hypoglycemic action and good safety.

Objective:To evaluate the safety and efficacy of secondary transport on extracorporeal membrane oxygenation (ECMO) for critically ill children.Methods:This was a retrospective cohort study. Data from 222 pediatric patients who underwent ECMO transport from May 2019 to May 2024 at 5 ECMO centers and Chinese Database of Pediatric Extracorporeal Life Support Organization were collected. The cases were divided into primary and secondary transport groups by nature of transport. The clinical data, including demographics, ECMO indications, transport distance, pre-transport lab results, prognosis and complications were analyzed. Two independent samples t-test, Wilcoxon test, and χ2 test or Fisher′s exact probability method were used to compare the differences between 2 groups and evaluate the safety and efficacy of secondary transport. Results:Among the 222 children transported with ECMO, there were 135 males and 87 females, with an age of 3.0 (0.2, 7.0) years. There were 202 cases in the primary transport group and 20 cases in the secondary transport group. All secondary transport patients had failed attempts at weaning ECMO before transfer. The patients in the secondary transport group were older, had higher rates of surgical cannulation, circulatory support, and pre-ECMO lactate levels compared to the primary transport group (7.0 (2.8, 10.0) vs. 3.0 (0.2, 6.0) years old, 55.0% (11/20) vs. 3.6% (7/202), 80.0% (16/20) vs. 41.6% (84/202), (10±4) vs. (7±6) mmol/L, Z=3.41, χ 2=66.31, 10.99, t=2.24, all P<0.05). In the secondary transport group, the vasoactive-inotropic scores of patients on circulatory support and the oxygenation index for patients requiring respiratory support were higher than those in the primary transport group (83±33 vs. 82±68, 51.0±1.8 vs. 37.4±10.2, t=2.36, 2.63, respectively; both P<0.05). There were no statistically significant differences between the 2 groups in sex, transport distance, pre-ECMO creatinine, arterial blood gas BE values, and ECMO duration (all P>0.05). No life-threatening complications occurred during the transport in either group. Two patients in the secondary transport group underwent heart transplantation, and 1 patient underwent radiofrequency ablation. The overall survival rate between the 2 groups showed no statistically significant difference (45.0% (9/20) vs. 55.4% (112/202), χ2=1.15, P>0.05). Conclusions:Secondary ECMO transport for critically ill children don't increase mortality or life-threatening complications during transport. ECMO patients who cannot receive effective treatment locally can benefit from secondary transport to an advanced ECMO center provides further treatment opportunities.

Given the escalating number of cancer patients and the consequent rise in demand for radiation therapy in China, there is an urgent need to establish and improve a talent cultivation system for radiation dosimetrists. The United States, with an early-established cultivation system for radiation dosimetrists, boasts relatively mature and comprehensive systems of academic education and qualification certification. This study summarized and analyzed the educational and certification patterns for radiation dosimetrists in the United States based on public data from relevant institutions, related literature, and interviews with American radiation dosimetrists. Meanwhile, this study delved into and assessed the shortcomings in China′s radiation dosimetry education, examination, certification, and career advancement pathways. Furthermore, this study offered suggestions and recommendations for constructing a novel pattern tailored to the cultivation of radiation dosimetrists in China, in order to facilitate the high-quality development of the medical dosimetry discipline.