Objective:To investigate the value of MULTI-parametric MR imaging with flexible design (MTP) combined with microview diffusion weighted imaging (DWI) in predicting pituitary tumor invasion of cavernous sinus.Methods:This was a cross-sectional study. The clinicopathological and imaging data of 59 patients with suspected pituitary tumor who were admitted to the First Affiliated Hospital of Dalian Medical University from December 2021 to August 2024 were prospectively analyzed. According to Knosp classification, patients with pituitary tumor were divided into non-invasive group (28 cases) and invasive group (31 cases). All patients underwent MTP and microview DWI sequence scanning, and the corresponding parameter values [T 1, R 2*, T 2* and apparent diffusion coefficient (ADC)] were measured on the MTP quantitative map and ADC map at the maximum diameter level of the pituitary tumor. Independent sample t test and Mann-Whitney U test were used to compare the clinical data, quantitative parameter values and proliferation index (Ki-67) between the non-invasive group and the invasive group. Quantitative parameter values with statistically significant differences were jointly included in logistic regression to construct the model. Receiver characteristic curve and area under the curve (AUC) were used to analyze single variables and logistic model in predicting the value invasion of pituitary tumor cavernous sinus invasion. Spearman correlation was used to analyze the correlation between the quantitative values and Ki-67 level. Results:There was no significant difference in age and gender between the non-invasive group and the invasive group ( P>0.05). T 1 and T 2* values in invasion group were higher than those in non-invasion group ( Z=4.42, P<0.001; Z=3.43, P<0.001), R 2* values and ADC values in the invasion group were lower than those in the non-invasion group, and the difference was statistically significant (t=4.07, P<0.001; Z=-3.07, P=0.002). The AUC values of T 1, R 2*, T 2*, ADC, logistic model 1(T 1+R 2*+ADC) and logistic model 2(T 1+T 2*+ADC) for predicting pituitary tumor cavernous sinus invasion were 0.835, 0.767, 0.760, 0.733, 0.926 and 0.925, respectively. Correlation analysis showed that the value of pituitary tumor T 1 was positively correlated with Ki-67 ( r=0.431, P=0.002). Conclusion:Quantitative parameters of MTP sequence and microview DWI sequence can quantitatively evaluate pituitary tumor invasion of cavernous sinus, and the combination of the two sequences can significantly improve the prediction efficiency.

Objective:To explore and verify the value of neoadjuvant rectal (NAR) score in predicting the prognosis of patients with middle and low locally advanced rectal cancer.Methods:A retrospective analysis of 207 patients with middle and low locally advanced rectal adenocarcinoma who received neoadjuvant radiotherapy and chemotherapy in Tianjin Medical University Cancer Institute & Hospital from January 2015 to December 2021 was performed. The neoadjuvant radiotherapy regimen was pelvic external irradiation of 45-50.4 Gy, 1.8 Gy/f, 5 times per week and concurrent oral capecitabine chemotherapy on days 1-14 and 22-36 during radiotherapy. Total mesorectal excision (TME) was then performed. The NAR score was calculated based on the initial clinical stage and postoperative pathological stage, and divided into the low (<8), medium (8-16) and high (>16) layers, respectively. The 3-year disease-free survival (DFS) and overall survival (OS) were calculated using the Kaplan-Meier method, and the differences in DFS and OS among different NAR score layers were compared using the log-rank test. Some patients received consolidation chemotherapy during the interval between concurrent radiotherapy-chemotherapy and surgery, even the total neoadjuvant therapy (TNT) model. Subgroup analysis was further used to verify the predictive value of the NAR score in the strengthened neoadjuvant therapy model.Results:The median follow-up of all patients was 46.0 months (range: 19.5-88.0 months), the 3-year DFS was 79.2%, and the 3-year OS was 87.4%. Univariate analysis found that the NAR score had a significant impact on the 3-year DFS and OS. The 3-year DFS of patients with low, medium, and high NAR scores were 90.3%, 86.1% and 58.7% ( P<0.001), and the 3-year OS were 94.4%, 91.7% and 74.6%, ( P<0.001), respectively. Subgroup analysis showed that the predictive value of the NAR score also applied to the strengthened neoadjuvant therapy model. The 3-year DFS of patients with low, medium, and high NAR scores were 86.9%, 83.8% and 68.3% ( P=0.044), and the 3-year OS were 92.9%, 90.7% and 85.4% ( P=0.029), respectively. Conclusion:The NAR score can effectively predict the prognosis of patients with middle and low locally advanced rectal adenocarcinoma, whether using neoadjuvant therapy or strengthened neoadjuvant therapy followed by TME surgery.

OBJECTIVE To evaluate the cost-effectiveness of iruplinalkib for ALK-positive non-small cell lung cancer(NSCLC)patients who had not previously received ALK-tyrosine kinase inhibitors(TKIs)from the perspective of the Chinese healthcare system.METHODS Based on the INSPIRE clinical trial,a three-health state partitioned survival model was developed to simulate the progression of disease,with model cycle of 3 weeks and a life-year time range of 15 years;the discount rate was 5％.For the treatment of ALK-positive advanced NSCLC,total cost,quality-adjusted life year(QALY),and incremental cost-effectiveness ratio(ICER)were compared between iruplinalkib and crizotinib;using 1-3 times China's per capita gross domestic product(GDP)(89 358-268 074 yuan)in 2023 as the willingness-to-pay(WTP)threshold,the cost-effectiveness of two regimens were compared.The sensitivity analysis and scenario analysis(altering the distribution of survival curves,utility values)were conducted to assess model robustness.RESULTS Compared with the crizotinib regimen,the ICER for the iruplinalkib regimen was 194 412.74 yuan/QALY,which was below the WTP threshold of three times China's per capita GDP in 2023(268 074 yuan).The results under the scenario of altering the survival curve distribution were consistent with the base case analysis.However,after increasing the utility value of the disease progression state,the ICER exceeded the WTP threshold,and iruplinalkib no longer had a cost-effective advantage.The results of the one-way sensitivity analysis indicated that the cost of iruplinalkib and the utility values of disease progression states had a significant impact on the ICER.The probabilistic sensitivity analysis confirmed the robustness of the base case analysis results.CONCLUSIONS From the perspective of China's healthcare system,compared with crizotinib regimen,the therapy with iruplinalkib is cost-effective for ALK-positive NSCLC patients who have not previously received ALK-TKIs.

Objective To analyse correlation between automatic quantification of emphysema and lung function based on artificial intelligence(AI)model algorithm by chest computed tomography(CT)in patients with chronic obstructive pulmonary disease(COPD).Methods The clinical and imaging data of hospitalized COPD patients who received chest CT plain scan in Taizhou Hospital of Zhejiang Province,Enze Hospital of Taizhou Enze Medical Center(Group)from December 2020 to May 2021 were retrospectively collected,patients were classified into five levels of ventilator-function decline.By using the AI model,the extent of emphysema lesions in COPD patients were calculated,low-attenuation areas below-950HU were identified and their low attenuation area percentage(LAA％)were calculated.Combined with the output results of AI model and whether each variable met the characteristics of normal distribution,Pearson correlation coefficient between percentage of measured forced expiratory volume at the end of 1 second to estimated value(FEV1％)and LAA％of each lung lobe,and the Spearman correlation coefficient between FEV1 as a percentage of forced vital capacity(FEV1/FVC)and LAA％of each lung lobe in patients with different COPD grades were calculated respectively.Results There was a negative correlation between total lung LAA％and FEV1/FVC in moderate COPD(r=-0.632,P=0.001).Total lung LAA％in very severe COPD was negatively correlated with both FEV1/FVC and FEV1％(r=-0.562,P=0.045 and r=-0.701,P=0.004).The results of lung segment analysis showed that LAA％of the left upper lung lobe was more strongly correlated with pulmonary function indicators in extremely severe COPD(r=-0.650,P=0.016 andr=-0.731,P=0.002).The correlation between left inferior lobe LAA％and FEV1/FVC was stronger correlation in patients with moderate COPD(r=-0.712,P=0.000).In smoking patients,LAA％was moderate correlated with FEV1(r=-0.534,P=0.006),and LAA％was moderate correlated with FEV1/FVC(r=-0.564,P=0.003).Conclusion AI-based emphysema quantification results have a good correlation with FEV1/FVC and FEV1％,which can provide strong support for the diagnosis and classification of COPD based on CT plain scan images.

Vascular homeostasis is a cornerstone for the normal operation of body tissues and organs,and it is closely related to the pathophysiological processes of cardiovascular and other systemic diseases.The maintenance of vas-cular homeostasis relies on a normal vascular microenvironment,and disturbances in this microenvironment are key factors in the development and progression of diseases.In recent years,significant progress has been made in the study of endo-thelial damage and hemodynamics in the pathogenesis of cervical spondylosis of vertebral artery type(CSA).However,these aspects represent only part of the vertebral artery microenvironment disorder and do not fully explain the pathogenesis of CSA.Therefore,this paper reviews endothelial dysfunction,abnormal vasomotor function of vascular smooth muscle,damage perception effects of the vascular adventitia,and matrix microenvironment disorders.The aim is to systematically elucidate the role of vascular microenvironment disorder in the pathological process of CSA,providing new perspectives for research into the disease's pathogenesis and therapeutic targets.

Objective To analyse correlation between automatic quantification of emphysema and lung function based on artificial intelligence(AI)model algorithm by chest computed tomography(CT)in patients with chronic obstructive pulmonary disease(COPD).Methods The clinical and imaging data of hospitalized COPD patients who received chest CT plain scan in Taizhou Hospital of Zhejiang Province,Enze Hospital of Taizhou Enze Medical Center(Group)from December 2020 to May 2021 were retrospectively collected,patients were classified into five levels of ventilator-function decline.By using the AI model,the extent of emphysema lesions in COPD patients were calculated,low-attenuation areas below-950HU were identified and their low attenuation area percentage(LAA％)were calculated.Combined with the output results of AI model and whether each variable met the characteristics of normal distribution,Pearson correlation coefficient between percentage of measured forced expiratory volume at the end of 1 second to estimated value(FEV1％)and LAA％of each lung lobe,and the Spearman correlation coefficient between FEV1 as a percentage of forced vital capacity(FEV1/FVC)and LAA％of each lung lobe in patients with different COPD grades were calculated respectively.Results There was a negative correlation between total lung LAA％and FEV1/FVC in moderate COPD(r=-0.632,P=0.001).Total lung LAA％in very severe COPD was negatively correlated with both FEV1/FVC and FEV1％(r=-0.562,P=0.045 and r=-0.701,P=0.004).The results of lung segment analysis showed that LAA％of the left upper lung lobe was more strongly correlated with pulmonary function indicators in extremely severe COPD(r=-0.650,P=0.016 andr=-0.731,P=0.002).The correlation between left inferior lobe LAA％and FEV1/FVC was stronger correlation in patients with moderate COPD(r=-0.712,P=0.000).In smoking patients,LAA％was moderate correlated with FEV1(r=-0.534,P=0.006),and LAA％was moderate correlated with FEV1/FVC(r=-0.564,P=0.003).Conclusion AI-based emphysema quantification results have a good correlation with FEV1/FVC and FEV1％,which can provide strong support for the diagnosis and classification of COPD based on CT plain scan images.

The control and utilization of microorganisms in space-based animal culture constitute a pivotal challenge underpinning research domains such as space life sciences and extraterrestrial life-support system.This paper systematically examines the origins,transmission routes,and latent risks of microbial contamination in space-based animal culture facilities.A comprehensive analysis is conducted on the advancements in on-orbit implementation of microbial containment strategies,including physical filtration systems,antimicrobial surface coatings,and environmental parameter optimization.Additionally,the study evaluates the prospective applications of probiotic consortia and functionally engineered microorganisms in enhancing animal welfare,stabilizing biosphere conditions,and enabling closed-loop waste recycling.Notably,this work highlights the paradigm shift from reactive microbial suppression to proactive microbiome engineering in space-based animal husbandry,thereby establishing a theoretical framework for sustainable development of space-based animal culture.

Objective To explore the interaction mechanisms among different dimensions of online learning competence in undergraduates,providing scientific evidence for optimizing software design and online education strategies.Methods A cross-sectional study was conducted with 347 undergraduates from Kunming Medical University via an online questionnaire in October 2024.Reliability testing and exploratory factor analysis were performed using SPSS 26.0,while structural equation modeling was constructed with Amos 24.0.Results Driving force directly and positively influenced regulatory force(β=0.778,P<0.001)and reciprocal force(β=0.302,P=0.003),but had no significant direct effect on adaptive force(β=0.131,P=0.182).Regulatory force and reciprocal force both exerted direct positive effects on adaptive force(β=0.262,P=0.022;β=0.410,P<0.001).The indirect effect of driving force on adaptive force accounted for 78.1%of the total effect(P=0.007),with regulatory force showing a significant mediating role(β=0.178,P=0.023),while reciprocal force alone did not(β=0.108,P=0.060).A chain mediating effect(driving force→regulatory force→reciprocal force→adaptive force)was confirmed(β=0.124,P=0.004).Conclusion Driving force serves as the core of online learning competence,and adaptive capacity is enhanced through regulatory and reciprocal forces.To promote knowledge internalization and adaptability,it is required to optimize feedback mechanisms and deepen interactive designs in online learning platforms.

Objective To investigate the safety and efficacy of combined confluence microdissection or balloon dilatation followed by laparoscopic transcystic common bile duct exploration (LTCBDE) in day surgery laparoscopic cholecystectomy. Methods The clinical data of 203 patients with day surgery laparoscopic cholecystectomy combined with LTCBDE from June 2021 to June 2024 in Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed. They were divided into an observation group (59 cases, including 42 cases of confluent microdissection and 17 cases of balloon dilatation) and a conventional group (144 cases) according to the surgical technique used. Baseline characteristics, intraoperative exploration results, operation time, postoperative recovery and complications were compared between the two groups. Results The history of preoperative cholangitis or pancreatitis (P<0.001) was more common in the observation group. And total bilirubin level was significantly higher in the observation group than in the conventional group (P=0.035). The observation group had a longer operative time (P=0.014) and higher hospitalization costs (P=0.001), but there was no difference in intraoperative bleeding and postoperative discharge time. There were no serious postoperative complications in either group. Conclusions Under the premise of strict patient screening, day surgery LTCBDE combined with confluence microdissection or balloon dilatation can effectively solve the problem of difficult choledochoscopic access, with high safety and thoroughness of exploration. Both techniques provide a feasible minimally observation solution for day surgery biliary exploration.

Small cell lung cancer (SCLC) is the thoracic malignant tumor and accounts for about 15% of lung malignancies and transfer often occurs by the time of diagnosis. Extensive stage-small cell lung cancer (ES-SCLC) accounts for about 2/3 of all SCLC. For many years, radiotherapy has occupied an important position in the treatment of SCLC, especially in the treatment of ES-SCLC, because SCLC is more sensitive to radiotherapy. However, in recent years, immune checkpoint inhibitor has shown more excellent antitumor activity in the treatment of ES-SCLC and become the mainstream argument for the treatment of ES-SCLC. However, will radiotherapy be buried by the times among the therapeutic approaches for ES-SCLC? In this article, we will review the clinical progress of radiotherapy, immunotherapy and combination therapy for ES-SCLC.
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Humans ; Small Cell Lung Carcinoma/therapy* ; Lung Neoplasms/therapy* ; Immunotherapy ; Neoplasm Staging ; Radiotherapy/methods* ; Combined Modality Therapy