Definitive chemoradiotherapy (dCRT) has become a cornerstone in the treatment of locally advanced esophageal cancer; however, local control remains suboptimal, and persistent lesions or locoregional recurrences after treatment are not uncommon. For patients without distant metastases but with local failure, whether surgical intervention can still offer curative potential remains a major clinical dilemma. Salvage esophagectomy (SE) offers potential long-term survival for selected patients, but this procedure is performed in the context of severe fibrosis, impaired local blood supply, and obscured anatomical planes following chemoradiotherapy, resulting in significantly higher perioperative risk compared to primary esophagectomy. Consequently, controversies exist regarding patient selection, preoperative restaging, choice of surgical approach, extent of lymphadenectomy, gastrointestinal reconstruction, and perioperative management. In recent years, with the refinement of restaging modalities such as PET/CT, the accumulation of experience in high-volume centers, and emerging evidence from clinical studies, the clinical role of SE has gradually shifted from a "high-risk salvage measure" to a "selective curative strategy aimed at achieving long-term survival in carefully selected patients". Nevertheless, standardized guidelines for patient selection, technical approaches, and perioperative management are still lacking. Based on current evidence and clinical experience, experts organized by the Integrated Esophageal Cancer Committee of Chinese Anti-Cancer Association systematically reviewed key issues regarding SE, including its definition, indications, preoperative evaluation, choice of surgical approach, lymphadenectomy, gastrointestinal reconstruction, and perioperative management, and formulated a Chinese expert consensus. This consensus aims to provide guidance for standardized assessment, appropriate referral, individualized surgical decision-making, and optimized perioperative management of patients with locoregional failure after dCRT. Ultimately, this will increase the likelihood of R0 resection, reduce the risk of severe complications, and promote the safer, more judicious, and standardized implementation of SE in high-risk scenarios.

Objective:This study aims to investigate the feasibility and safety of implanting leadless pacemakers in the low septum and its impact on cardiac electrical synchronization.Methods:A total of 36 patients who received leadless pacemaker implantation at Fuwai Central China Cardiovascular Hospital from January 2021 to August 2023 were included in this study.According to implantation sites of leadless pacemakers,patients were divided into mid-septal group(n=16)and low-septal group(n=20).The clinical characteristics and cardiac electrical synchronization were compared between the two groups.Results:There were 21 male patients,mean age was(68±13)years old.There was no statistical difference in the type of brady-arrhythmia between the two groups(P=0.73).There were 61 implant attempts in these 36 patients,and there was no significant difference in the number of attempts,procedure time,and pacemaker parameters between the two groups,but the average procedure time tended to be shorter in the low-septal group([84±37]minutes vs.[105±35]minutes,P=0.09).In terms of electrical synchronization,there was no statistical difference in QRS duration between the low-septal group and the mid-septal group([162.0±21.1]ms vs.[174.0±14.8]ms,P=0.20).There were no vascular puncture complications,cardiac perforation,or pericardial tamponade during the procedure.There were no complications and readmissions related to the leadless pacemaker during follow-up period.Conclusions:Our results show that the implantation of a leadless pacemaker in the low ventricular septum is safe and effective,has a similar impact on cardiac electrical synchronization as mid-septal pacing.

Objective:The purpose of this study was to develop a dynamic prediction model for patients with gastric signet ring cell cancer (GSRCC)following laparoscopic radical gastrectomy in order to improve the precision and usefulness of prognoses prediction for overall survival and disease-free survival.Methods:From 2011 to 2018, 914 National Cancer Center patients participated in the study. To find independent prognostic indicators and create a prognostic nomogram model, univariate and multivariate regression analyses were performed. Calibration curves, receiver operating characteristic curves, and consistency indices were used to assess the model's performance. To make clinical application more convenient, two web-based prediction tools were created.Results:A training set of 639 cases and a validation set of 275 instances were randomly selected from among the patients. Important predictive variables such as age, tumor size, location, pN and pT staging, and postoperative chemotherapy were all incorporated in the model (all P<0.05). The model's consistency index and area under the receiver operating characteristic curves were both higher than 0.7, and the calibration curves demonstrated a good fit between the expected and actual values, indicating high accuracy and consistency in postoperative survival prediction for patients with gastric signet ring cell carcinoma. Conclusion:We successfully developed two dynamic prediction models in this study, which improved its clinical practicability using web-based tools and is anticipated to be crucial to clinical practice going forward.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective To investigate the clinical treatment effect and safety of 3D microscopy technology for adjuvant neuraxial tumor resection on neuraxial tumor diseases.Methods A total of 37 patients with neuraxial tumors treated from January 2019 to July 2023,15 patients treated with 3D microscope tumor resection(3D group),and 22 patients treated with general microscope tumor resection(ordinary group)were analyzed.The perioperative indexes,clinical efficacy indexes and safety indexes were compared between the two groups.Results The operation time was(223.78±46.46)min in the ordinary group and(182.93±39.28)min in the 3D group,which was significantly lower than that in the ordinary group(P<0.05),and there was no significant difference in other perioperative indicators between the two groups(P>0.05).All patients had significantly reduced their postoperative pain symptoms and recovered their neurological function to a certain extent.There were statistically significant differences between the two groups(P<0.01),but there was no statistical difference between the two groups(P>0.05),and the McCormick spinal cord function rating was grade I.at one year after surgery.Conclusion The use of 3D microscopy and general microscopy for neuraxial tumor surgery has good clinical efficacy.However,the operation time can be significantly shortened under 3D microscopy,thereby reducing the risk of surgical complications and has better clinical safety.

Objective To observe the value of ultrasound convolutional neural network(CNN)model for assisting distinguishment of cervical lymph node lymphoma and atypical reactive hyperplasia.Methods Totally 335 cases of cervical lymph node lymphoma and 335 cases of atypical reactive hyperplasia were retrospectively enrolled,including 520 cases in development group(260 cases of lymphoma and 260 cases of atypical reactive hyperplasia)and 150 cases in validation group(75 cases of lymphoma and 75 cases of atypical reactive hyperplasia).Patients in development group were divided into training set(182 cases of lymphoma and 182 cases of atypical reactive hyperplasia)and test set(78 cases of lymphoma and 78 cases of atypical reactive hyperplasia)at the ratio of 7∶3.One target lymph node was selected for each case,and one gray-scale ultrasound image and one CDFI were included for training,testing CNN models and verifying the auxiliary efficacy of the models.Based on ultrasound images in training set,5 CNN models,including AlexNet,VGG16,ResNet18,DenseNet161 and EfficientNet-B0,were constructed and trained for distinguishing cervical lymph node lymphoma and atypical reactive hyperplasia,and the models were tested in test set to screen out the best one with the highest classification accuracy.The efficacy of the best CNN model for assisting distinguishment of cervical lymph node lymphoma and atypical reactive hyperplasia was observed.Results Among 5 CNN models,the accuracy of ResNet18 model in test set was the highest(78.21％),and ResNet18 model was regarded as the best CNN model,its sensitivity,specificity and accuracy for assisting distinguishment of cervical lymph node lymphoma and atypical reactive hyperplasia were all higher than those of independent diagnosis made by ultrasound physicians(all P＜0.01).Conclusion The constructed ResNet18 model could be used to effectively assist differentiating cervical lymph node lymphoma and atypical reactive hyperplasia.

Objective:To establish a pure water direct dilution-inductively coupled plasma mass spectrometry (ICP-MS) detection method for rapid determination of urinary iodine.Methods:Pure water was used to directly dilute the urine samples. The washing solution was 5.0 g/L ascorbic acid, the internal standard solution was 5.0 g/L ascorbic acid and 100 μg/L 128Te, the standard solution was prepared with the solution of lyophilized urine iodine biological component analysis reference material. The method was evaluated in terms of linear range, detection limit, quantification limit, precision and method comparision experiment. Results:The linear correlation coefficient of the standard curve for iodine concentration range from 0 to 50.0 μg/L was 0.999 7, with a detection limit of 0.2 μg/L and a quantification limit of 0.6 μg/L. The spiked recovery rates of low, medium, and high concentration iodine standard solutions added to actual urine samples were 100.8%, 99.1% and 99.7%, respectively, with relative standard deviations of 0.8%, 1.3% and 1.6%, respectively. There was no statistically significant difference ( t = - 0.14, P = 0.890) between the results of measuring actual urine and assessment urine using this method and "Determination of Iodine in Urine-Part 2: Inductively Coupled Plasma Mass Spectrometry (WS/T 107.2-2016)". Conclusions:We have successfully established a pure water direct dilution-ICP-MS method for determining urinary iodine. This method provides accurate and highly sensitive results, making it suitable for sudden public health emergencies and large-scale clinical measurement of urinary iodine.

Objective To observe the value of ultrasound convolutional neural network(CNN)model for assisting distinguishment of cervical lymph node lymphoma and atypical reactive hyperplasia.Methods Totally 335 cases of cervical lymph node lymphoma and 335 cases of atypical reactive hyperplasia were retrospectively enrolled,including 520 cases in development group(260 cases of lymphoma and 260 cases of atypical reactive hyperplasia)and 150 cases in validation group(75 cases of lymphoma and 75 cases of atypical reactive hyperplasia).Patients in development group were divided into training set(182 cases of lymphoma and 182 cases of atypical reactive hyperplasia)and test set(78 cases of lymphoma and 78 cases of atypical reactive hyperplasia)at the ratio of 7∶3.One target lymph node was selected for each case,and one gray-scale ultrasound image and one CDFI were included for training,testing CNN models and verifying the auxiliary efficacy of the models.Based on ultrasound images in training set,5 CNN models,including AlexNet,VGG16,ResNet18,DenseNet161 and EfficientNet-B0,were constructed and trained for distinguishing cervical lymph node lymphoma and atypical reactive hyperplasia,and the models were tested in test set to screen out the best one with the highest classification accuracy.The efficacy of the best CNN model for assisting distinguishment of cervical lymph node lymphoma and atypical reactive hyperplasia was observed.Results Among 5 CNN models,the accuracy of ResNet18 model in test set was the highest(78.21％),and ResNet18 model was regarded as the best CNN model,its sensitivity,specificity and accuracy for assisting distinguishment of cervical lymph node lymphoma and atypical reactive hyperplasia were all higher than those of independent diagnosis made by ultrasound physicians(all P＜0.01).Conclusion The constructed ResNet18 model could be used to effectively assist differentiating cervical lymph node lymphoma and atypical reactive hyperplasia.

Purpose: Neuroendocrine prostate cancer (NEPC) represents a particularly aggressive subtype of prostate cancer with a challenging prognosis. The purpose of this investigation is to craft and confirm the reliability of nomograms that can accurately forecast the 1-, 3-, and 5-year overall survival (OS) and cancer-specific survival (CSS) rates for individuals afflicted with NEPC. Materials and Methods: Data pertaining to patients diagnosed with NEPC within the timeframe of 2010 to 2020 was meticulously gathered and examined from the Surveillance, Epidemiology, and End Results Program (SEER). To predict OS and CSS, we devised and authenticated two distinct nomograms, utilizing predictive variables pinpointed through both univariate and multivariate Cox regression analyses. Results: The study encompassed 393 of NEPC patients, who were systematically divided into training and validation cohorts at a 2:1 ratio. Key prognostic factors were isolated, verified, and integrated into the respective nomograms for OS and CSS. The performance metrics, denoted by C-indices, stood at 0.730, 0.735 for the training set, and 0.784, 0.756 for the validation set. The precision and clinical relevance of the nomograms were further corroborated by the analysis of receiver operating characteristic curves, calibration plots, and decision curve analyses. Conclusions The constructed nomograms have demonstrated impressive efficacy in forecasting the 1-, 3-, and 5-year OS and rates for patients with NEPC. Implementing these predictive tools in clinical settings is anticipated to considerably enhance the care and treatment planning for individuals diagnosed with this aggressive form of prostate cancer, thus providing tailored and more precise prognostic assessments.

Purpose: Neuroendocrine prostate cancer (NEPC) represents a particularly aggressive subtype of prostate cancer with a challenging prognosis. The purpose of this investigation is to craft and confirm the reliability of nomograms that can accurately forecast the 1-, 3-, and 5-year overall survival (OS) and cancer-specific survival (CSS) rates for individuals afflicted with NEPC. Materials and Methods: Data pertaining to patients diagnosed with NEPC within the timeframe of 2010 to 2020 was meticulously gathered and examined from the Surveillance, Epidemiology, and End Results Program (SEER). To predict OS and CSS, we devised and authenticated two distinct nomograms, utilizing predictive variables pinpointed through both univariate and multivariate Cox regression analyses. Results: The study encompassed 393 of NEPC patients, who were systematically divided into training and validation cohorts at a 2:1 ratio. Key prognostic factors were isolated, verified, and integrated into the respective nomograms for OS and CSS. The performance metrics, denoted by C-indices, stood at 0.730, 0.735 for the training set, and 0.784, 0.756 for the validation set. The precision and clinical relevance of the nomograms were further corroborated by the analysis of receiver operating characteristic curves, calibration plots, and decision curve analyses. Conclusions The constructed nomograms have demonstrated impressive efficacy in forecasting the 1-, 3-, and 5-year OS and rates for patients with NEPC. Implementing these predictive tools in clinical settings is anticipated to considerably enhance the care and treatment planning for individuals diagnosed with this aggressive form of prostate cancer, thus providing tailored and more precise prognostic assessments.