Objective To explore the efficacy and safety of oxycodone and midazolam for endoscopic retrograde cholangio-pancreatography(ERCP)under awake sedation.Methods Patients scheduled for elective ERCP in the department of gastroenterology of Xuzhou Central Hospital from January 2021 to December 2022 were prospectively recruited and randomly divided into the control group(pethidine combined with diazepam)and the experimental group(oxycodone combined with midazolam).Visual Analogue Scale(VAS)score,Ramsay Sedation Scale(RSS)score,heart rate(HR),respiratory rate(RR),blood oxygen saturation(SpO2),mean arterial pressure(MAP)and postoperative C-reactive protein and blood amylase levels were observed and compared between the two groups of patients before the procedure(T0),at the time of entry(T1),at the time of the opening of the endoscope into the duodenal papilla(T2),at the time of exit(T3).Additionally,incidence of adverse events,patient and endoscopist satisfaction were compared between the two groups.Results A total of 60 patients were included,30 in each group.The difference in the trends of VAS and RSS scores over time between the two groups was statistically significant(Ptime×treatment＜0.05).Compared to the control group,the experimental group had lower VAS scores and higher RSS scores at T1,T2 and T3(P＜0.05).The differences in SpO2 and MAP changes over time between the two groups were statistically significant(Ptime×treatment＜0.05),with higher values observed in the experimental group at T1-T3(P＜0.05).The incidence of pain,coughing and agitation in the experimental group was lower during the procedure(P＜0.05).Both endoscopist and patient satisfaction were significantly higher in the experimental group(P＜0.05).Conclusion Compared with pethidine combined with diazepam,oxcyodone combined with midazolam as a preoperative medication for awake sedation in ERCP treatment is more effective and safer.

Gastric cancer is a high-incidence malignancy that poses a serious threat to public health in China, ranking among the top three cancers in both incidence and mortality. The majority of patients are diagnosed at an advanced stage, resulting in limited treatment options and poor prognosis. To address key challenges in gastric cancer diagnosis and treatment, a research team led by Professor Jiafu Ji at Peking University Cancer Hospital has focused on the project "Development and Dissemination of Precision Medicine Approaches in Gastric Cancer Management". Through a series of high-quality multicenter clinical studies, the team established a set of new international standards in perioperative treatment, individua-lized drug selection, intelligent noninvasive diagnostics, and novel immunotherapy strategies. These advances have significantly improved treatment efficacy and reduced surgical trauma, achieving key technological breakthroughs in diagnosis, therapy, and mechanistic understanding, and systematically enhancing outcomes for gastric cancer patients. The project ' s findings had a broad international impact, including hosting China ' s first International Gastric Cancer Congress. Through nationwide dissemination, they have promoted the development of precision diagnosis and treatment of gastric cancer as a discipline, and led the formulation of the National Health Commission's guidelines for gastric cancer diagnosis and treatment. In recognition of its achievements, the project was awarded the First Prize of the 2024 Chinese Medical Science and Technology Award.
Stomach Neoplasms/genetics* ; Humans ; Precision Medicine/methods* ; China ; Immunotherapy/methods*

Distinguishing pseudoprogression (PsP) from true progression (TP) in patients with high-grade gliomas after treatment remains a critical challenge, as their appearances on conventional MRI are often similar. Accurate differentiation between the two is of great clinical significance for guiding and adjusting therapeutic strategies. MRI functional imaging can reveal key tissue characteristics such as water molecule diffusion, microvascular perfusion, and metabolic changes within lesions after treatment, thereby providing valuable objective evidences for differentiating PsP from TP. Especially in recent years, the radiomics analysis method based on large-scale MRI image data has further improved the accuracy in distinguishing PsP from TP. This article reviews the research progress on applications of various MRI techniques and combination of radiomics with other artificial intelligence methods in differentiating PsP from TP in high-grade gliomas, aiming to enhance the clinicians' understanding of differential diagnosis of PsP and TP in high-grade gliomas, and offer ideas and directions for emerging MRI application in this field.

Objective To explore the efficacy and safety of oxycodone and midazolam for endoscopic retrograde cholangio-pancreatography(ERCP)under awake sedation.Methods Patients scheduled for elective ERCP in the department of gastroenterology of Xuzhou Central Hospital from January 2021 to December 2022 were prospectively recruited and randomly divided into the control group(pethidine combined with diazepam)and the experimental group(oxycodone combined with midazolam).Visual Analogue Scale(VAS)score,Ramsay Sedation Scale(RSS)score,heart rate(HR),respiratory rate(RR),blood oxygen saturation(SpO2),mean arterial pressure(MAP)and postoperative C-reactive protein and blood amylase levels were observed and compared between the two groups of patients before the procedure(T0),at the time of entry(T1),at the time of the opening of the endoscope into the duodenal papilla(T2),at the time of exit(T3).Additionally,incidence of adverse events,patient and endoscopist satisfaction were compared between the two groups.Results A total of 60 patients were included,30 in each group.The difference in the trends of VAS and RSS scores over time between the two groups was statistically significant(Ptime×treatment＜0.05).Compared to the control group,the experimental group had lower VAS scores and higher RSS scores at T1,T2 and T3(P＜0.05).The differences in SpO2 and MAP changes over time between the two groups were statistically significant(Ptime×treatment＜0.05),with higher values observed in the experimental group at T1-T3(P＜0.05).The incidence of pain,coughing and agitation in the experimental group was lower during the procedure(P＜0.05).Both endoscopist and patient satisfaction were significantly higher in the experimental group(P＜0.05).Conclusion Compared with pethidine combined with diazepam,oxcyodone combined with midazolam as a preoperative medication for awake sedation in ERCP treatment is more effective and safer.

Distinguishing pseudoprogression (PsP) from true progression (TP) in patients with high-grade gliomas after treatment remains a critical challenge, as their appearances on conventional MRI are often similar. Accurate differentiation between the two is of great clinical significance for guiding and adjusting therapeutic strategies. MRI functional imaging can reveal key tissue characteristics such as water molecule diffusion, microvascular perfusion, and metabolic changes within lesions after treatment, thereby providing valuable objective evidences for differentiating PsP from TP. Especially in recent years, the radiomics analysis method based on large-scale MRI image data has further improved the accuracy in distinguishing PsP from TP. This article reviews the research progress on applications of various MRI techniques and combination of radiomics with other artificial intelligence methods in differentiating PsP from TP in high-grade gliomas, aiming to enhance the clinicians' understanding of differential diagnosis of PsP and TP in high-grade gliomas, and offer ideas and directions for emerging MRI application in this field.

Objective To explore the effect of etomidate-propofol mixture anaesthesia in painless gastrointestinal endoscopy.Methods Eighty-two patients who underwent painless gastrointestinal endoscopy from September 2023 to November 2023 were divided into etomidate-propofol mixture group(observation group,n=41)and propofol group(control group,n=41)by using the random number table method.Morphine-benzedrine group(MBG)scores were recorded 30 min before the examination and before leaving the recovery room in both groups.Percutaneous arterial oxygen saturation(SpO2),heart rate(HR)and mean arterial pressure(MAP)were noted at anesthesia induction(T0),before entering the endoscope(T1),5 min after anesthesia induction(T2),and awakening(T3).Gastrointestinal endoscopy time,awakening time,recovery room stay time,total propofol consumption,and adverse reactions were also documented.Results MBG scores in both groups significantly increased before leaving the recovery room compared to 30 min before the examination,the observation group had lower MBG scores before leaving the recovery room in comparison with the control group,there were statistically significant(P＜0.05).From T1 to T3,MAP,SpO2,HR were higher in the observation group than those in the control group,there were statistically significant(P＜0.05).The observation group had shorter awakening time and recovery room stay time,there were statistically significant(P＜0.05).The observation group had lower total propofol consumption,there was statistically significant(P＜0.05).The observation group also exhibited a lower incidence of hypotension,hypoxemia,and injection pain,there were statistically significant(P＜0.05),with no statistically significant difference in the incidence of other adverse reactions(P＞0.05).Conclusion Etomidate-propofol combination anesthesia can reduce postoperative MBG scores in painless gastrointestinal endoscopy,contributing to a decreased risk of potential propofol addiction and abuse.Additionally,it stabilizes circulatory and respiratory functions,reduces adverse reactions rate,and shortens awakening time and recovery room stay time.Its application is worthy of further promotion.

Objective:To investigate the effect of behavioral lifestyle on the CT values of urinary tract stones, as well as the relationship between behavioral lifestyle and the therapeutic effect of extracorporeal shock wave lithotripsy (ESWL).Methods:A total of 265 patients with urinary tract stones who underwent ESWL treatment at Affiliated Hospital of Jining Medical University from January 2019 to June 2023 were selected. According to the CT values of the stones, the subjects were divided into high CT value group (CT value > 1 000 HU, n=106) and low CT value group (CT value ≤ 1 000 HU, n=159). A retrospective survey was conducted to assess the patients' behavioral lifestyles, and general data, CT values, number of lithotripsy sessions, lithotripsy time, lithotripsy efficiency, and incidence of complications were compared between the two groups. SPSS 22.0 software was used for statistical analysis. The χ2 test and t-test were used for group comparisons, and Pearson correlation analysis was used to examine the relationship between stone CT values and different behavioral lifestyles. Results:The high CT value group had lower average daily water intake((1 242±347)mL vs (1 784±376)mL), average daily fresh fruit intake((135±43)g vs (196±51)g), and average daily exercise time((18±12)min vs (32±14)min) compared with the low CT value group( t=-11.850, -9.926, -8.434, all P<0.01). In contrast, the high CT value group had higher average daily salt intake((8.3±2.2)g vs (6.5±1.7)g) and average daily animal protein intake ((72±18)g vs (54±16)g) compared with the low CT value group ( t=7.495, 8.531, both P<0.01). The high CT value group required more lithotripsy sessions and longer lithotripsy time than the low CT value group ( t=6.192, 7.507, both P<0.05), while lithotripsy efficiency was lower than the low CT value group ( χ2=33.181, P<0.01). The incidence of complications was higher in the high CT value group compared to the low CT value group ( χ2=3.915, P=0.048), with statistically significant differences. Conclusion:Appropriate water intake, diet, and exercise habits are beneficial in reducing stone CT values, improving the efficacy of ESWL treatment, and decreasing the incidence of complications.

Objective To investigate the effect of ultrasound-guided bilateral superior laryngeal nerve internal branch block combined with endotracheal surface anesthesia in patients with hypertensive cerebral hemorrhage for the duration of postoperative tube insertion.Methods A total of 100 emergency hypertensive intracerebral hemor-rhage surgical patients who visited our hospital from October 2021 to April 2023 were included as the research subjects.They were randomly divided into four groups,25 patients in each group.After surgery,group U received bilateral superior laryngeal nerve internal branch block under guidance of ultrasound combined with endotracheal surface anesthesia,group C1 received bilateral superior laryngeal nerve internal branch block under guidance of ultrasound,group C2 received endotracheal surface anesthesia,and group C3 did not undergo any procedure after surgery.Hemodynamic changes(HR,MAP,and SpO2)at different time points during the postoperative tube insertion in four groups of patients were recorded.The frequency of restlessness within 10 hours after surgery,the dosage of dexmedetomidine and urapidil,the volume of wound drainage,and the satisfaction of bed nurses were also recorded.Results There was no statistically significant difference in general conditions among the four groups(P>0.05).There was no statistically significant difference in HR and MAP at different time points in Group U(P>0.05),while the differences among the other three groups were statistically significant(P<0.05).At the same time point,the MAP and HR of group U and C1 were significantly lower than those of group C3(P<0.05),and the MAP of group U was significantly lower than that of group C2(P<0.05).There was no statistical difference in SPO2 among the four groups of patients at the same time point(P>0.05);The frequency of restlessness,dosage of dexmedetomidine and urapidil,and volume of wound drainage in the U and C1 groups were significantly lower than those in the C2 and C3 groups(P<0.05).Except for the difference in restlessness frequency(P<0.05),there was no statistical difference in other indicators between group U and C1;There was a statistical difference in satisfaction among the four groups of nurses(P<0.05,C3>C2>C1>U group).No nerve block related complications were observed in the U and C1 group.Conclusion Ultrasound-guided bilateral superior laryngeal nerve branch block combined with endotracheal surface anesthesia can maintain hemodynamics steadily of the postoperative patients in the NICU to varying degrees and reduce the frequency of postoperative restlessness,the dosage of sedative and anti-hypertensive drugs,while reducing the flow of wound drainage,and improve the satisfaction of bed nurses.

Objective:To investigate the construction of containing CT imaging features Nomograms model of postoperative intraluminal thromus (ILT) formation in patients with aortic dissective aneurysm (ADA).Methods:One hundred and twenty patients with Stanford type B ADA treated with overlapping stent endoluminal repair and multilayer spiral CT (MSCT) examination in Affiliated Hospital of Jining Medical College from May 2020 to February 2022 were selected. The patients were divided into the modeling population (84 patients) and the validation population (36 patients) according to a 7∶3 ratio. The factors influencing postoperative ILT formation in ADA patients were analyzed by univariate and Logistic multifactor regression models, and the prediction model of postoperative ILT formation was constructed based on the influencing factors.Results:In the modeled population, the rate of ILT formation within 1 month after luminal repair with overlapping stents was 27.38%(23/84), including 5 cases in the aortic arch and 18 cases in the abdominal aorta. In the modeled population, the results of univariate analysis showed that the sex, age, body mass index(BMI), smoking, drinking, hypertension, hyperlipidemia, rupture diameter, rupture distance from left subclavicular artery, involvement of important branches, uneven thickening of aneurysm wall, low density on plain scan and operation timing between the ILT formation group and non-ILT formation group had no statistically significant ( P>0.05). The diabetes mellitus, irregular inner wall, calcified plaque, postoperative anticoagulant therapy, B-type brain natriuretic peptide (BNP), fibrinogen (Fib), D-dimer (D-D) and C-reactive protein (CRP) between the two groups had statistical differences: 43.48%(10/23) vs. 11.48%(7/61), 86.96%(20/23) vs. 57.38%(35/61), 91.30%(21/23) vs. 62.30%(38/61), 21.74%(5/23) vs. 57.38%(35/61), (523.60 ± 128.74) ng/L vs.(271.83 ± 109.65) ng/L, (3.82 ± 0.96) g/L vs. (2.85 ± 0.83) g/L, (601.37 ± 75.62) μg/L vs. (389.20 ± 68.79)μg/L, (0.63 ± 0.19) mg/L vs. (0.48 ± 0.15) mg/L, P<0.05. The results of Logistic multifactor regression analysis showed that diabetes mellitus, irregular inner wall, calcified plaque, postoperative anticoagulant therapy and BNP, Fib, D-D CRP levels were influential factors for postoperative ILT formation in Stanford type B ADA patients ( P<0.05). The C-index of the model was 0.903 and 0.894 for the modeled and validated populations, respectively, which had good discrimination and was good at predicting ILT formation after operation in Stanford type B ADA patients. The model had good clinical utility in predicting postoperative ILT formation in Stanford B ADA patients. Conclusions:The Nomograms model can help to screen and identify patients with high risk of ILT formation at an early clinical stage.

Objective:To investigate the risk factors and their warning value for the occurrence of sepsis in patients with severe multiple trauma.Methods:A retrospective cohort study was conducted to analyze the clinical data of 92 patients with severe multiple trauma admitted to Yuyao People′s Hospital from July 2019 to October 2021. There were 71 males and 21 females, with the age range of 36-55 years [(45.5±13.6)years]. The injury severity score (ISS) was 20-29 points [(25.3±6.4)points]. The patients were divided into sepsis group ( n=32) and non-sepsis group ( n=60) according to whether sepsis occurred during hospitalization. Data were recorded for the two groups, including gender, age, basic diseases, cause of injury, number of injury sites, ISS, post-injury complications, and levels of aryl hydrocarbon receptor (AHR), C-reactive protein (CRP) and procalcitonin (PCT) at 1, 3 and 5 days after injury. The above data were analyzed to identify their correlation with the occurrence of sepsis in patients with severe multiple trauma by univariate analysis. The independent risk factors for sepsis in patients with severe multiple trauma were determined by multivariate Logistic regression analysis. The warning value of the single or combined risk factors for the occurrence of sepsis in patients with severe multiple trauma was evaluated by the receiver operating characteristic (ROC) curve and area under the curve (AUC). Results:By univariate analysis, it was demonstrated that the occurrence of sepsis was correlated with ISS, level of AHR at day 1 after injury, level of CRP at day 3 after injury and level of PCT at day 3 after injury ( P<0.05 or 0.01), but not with age, sex, basic diseases, level of AHR at 3, 5 days after injury, level of PCT at 1, 5 days after injury and level of CRP at 1, 5 days after injury (all P>0.05). By multivariate Logistic regression analysis, higher ISS ( OR=1.12, 95% CI 1.01, 1.24, P<0.05), level of AHR at day 1 after injury ( OR=1.30, 95% CI 1.10, 1.52, P<0.01) and level of PCT at day 3 after injury ( OR=1.81, 95% CI 1.08, 3.03, P<0.05) were found to be strongly correlated with the occurrence of sepsis. ROC curve analysis showed that higher ISS (AUC=0.69, 95% CI 0.57, 0.76) and level of AHR at day 1 after injury (AUC=0.79, 95% CI 0.68, 0.90) had warning value for the occurrence of sepsis, and the warning efficiency of combined panel was much better (AUC=0.86, 95% CI 0.77, 0.95). Conclusions:Higher ISS, level of AHR at day 1 after injury and level of PCT at day 3 after injury are independent risk factors for the occurrence of sepsis in patients with severe multiple trauma. ISS, AHR and combination of both exhibit good warning value for the occurrence of sepsis in patients with severe multiple trauma.