Objective: Patients with severe symptomatic aortic stenosis are assessed for coronary artery disease (CAD) prior to transcatheter aortic valve implantation (TAVI) with treatment implications. Invasive coronary angiography (ICA) is the recommended modality but is associated with peri-procedural complications. Integrating machine learning (ML)-based computed tomography-derived fractional flow reserve (CT-FFR) into existing TAVI-planning CT protocol may aid exclusion of significant CAD and thus avoiding ICA in selected patients. Materials and Methods: A single-center, retrospective study was conducted, 41 TAVI candidates with both TAVI-planning CT and ICA performed were analyzed. CT datasets were evaluated by a ML-based CT-FFR software. Beta-blocker and nitroglycerin were not administered in these patients. The primary outcome was to identify significant CAD. The diagnostic performance of CT-FFR was compared against ICA. Results: On per-patient level, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were 89%, 94%, 80%, 97% and 93%, respectively. On per-vessel level, the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 75%, 94%, 67%, 96% and 92%, respectively. The area under the receiver operative characteristics curve per individual coronary vessels yielded overall 0.90 (95% confidence interval 85%–95%). ICA may be avoided in up to 80% of patients if CT-FFR results were negative. Conclusion ML-based CT-FFR can provide accurate screening capabilities for significant CAD thus avoiding ICA. Its integration to existing TAVI-planning CT is feasible with the potential of improving the safety and efficiency of pre-TAVI CAD assessment.

Left hemicolectomy is predominantly utilized for the management of carcinomas located at the splenic flexure, descending colon, and sigmoid colon. The incidence of carcinomas at the splenic flexure and descending colon is comparatively low. With advancements in therapeutic modalities, there has been a progressive improvement in the prognosis of left colon cancer. Presently, the oncological outcomes following radical resection for non-metastatic left colon carcinoma are marginally superior to those observed in right colon carcinoma. The vascular supply to the splenic flexure is subject to variability, encompassing arteries originating from both the superior mesenteric artery and the inferior mesenteric artery systems. Its distinctive anatomical location and intricate lymphatic drainage have sparked debates regarding the appropriate extent of surgical resection. Recent research has demonstrated that adherence to the "10 cm" principle for left hemicolectomy is justified, and a minimal resection of the splenic flexure is adequate. The scope of lymph node dissection can be ascertained based on the positive rate of each lymph node station, with station 253 not necessitating dissection. However, when the accessory middle colic artery is present, it should be regarded as the primary vascular supply for D3 dissection. Furthermore, advancements in the study of fascial anatomy related to the left colon have yielded new perspectives in the surgical management of carcinoma at the splenic flexure left colon carcinoma. The extra-omental sac dissection, which is grounded in the principles of fascial anatomy, facilitates the safe and efficient mobilization of the splenic flexure colon.

BACKGROUND: The effect of air pollution on annual change rates in grip strength and body composition in the elderly is unknown. OBJECTIVES: This study evaluated the effects of long-term exposure to ambient air pollution on change rates of grip strength and body composition in the elderly. METHODS: In the period 2016-2020, grip strength and body composition were assessed and measured 1-2 times per year in 395 elderly participants living in the Taipei basin. Exposure to ambient fine particulate matters (PM_2.5), nitric dioxide (NO₂), and ozone (O₃) from 2015 to 2019 was estimated using a hybrid Kriging/Land-use regression model. In addition, long-term exposure to carbon monoxide (CO) was estimated using an ordinary Kriging approach. Associations between air pollution exposures and annual changes in health outcomes were analyzed using linear mixed-effects models. RESULTS: An inter-quartile range (4.1 µg/m³) increase in long-term exposure to PM_2.5 was associated with a faster decline rate in grip strength (-0.16 kg per year) and skeletal muscle mass (-0.14 kg per year), but an increase in body fat mass (0.21 kg per year). The effect of PM_2.5 remained robust after adjustment for NO₂, O₃ and CO exposure. In subgroup analysis, the PM_2.5-related decline rate in grip strength was greater in participants with older age (>70 years) or higher protein intake, whereas in skeletal muscle mass, the decline rate was more pronounced in participants having a lower frequency of moderate or strenuous exercise. The PM_2.5-related increase rate in body fat mass was higher in participants having a lower frequency of strenuous exercise or soybean intake. CONCLUSIONS Among the elderly, long-term exposure to ambient PM_2.5 is associated with a faster decline in grip strength and skeletal muscle mass, and an increase in body fat mass. Susceptibility to PM_2.5 may be influenced by age, physical activity, and dietary protein intake; however, these modifying effects vary across different health outcomes, and further research is needed to clarify their mechanisms and consistency.
Humans ; Hand Strength ; Aged ; Male ; Female ; Environmental Exposure/adverse effects* ; Follow-Up Studies ; Taiwan ; Air Pollution/adverse effects* ; Particulate Matter/adverse effects* ; Muscle, Skeletal/drug effects* ; Air Pollutants/adverse effects* ; Ozone/adverse effects* ; Aged, 80 and over ; Adipose Tissue/drug effects* ; Body Composition/drug effects* ; Nitrogen Dioxide/adverse effects*

Objective:To evaluate the efficacy and safety of anlotinib neoadjuvant therapy for newly diagnosed locally advanced thyroid cancer (LATC).Methods:Twenty-four newly diagnosed LATC patients (10 males and 14 females, age (47.1±3.3) years) admitted to Affiliated Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine were prospectively included from January 2023 to April 2024. Patients were given anlotinib neoadjuvant therapy (12mg/d, 2 weeks of medication, 1 week of discontinuation), and the efficacy of the treatment was evaluated by CT and multi-disciplinary treatment at the end of each treatment cycle. Patients assessed as suitable for surgery would be scheduled for surgery, while those who were not suitable for surgery would continue to receive neoadjuvant therapy and periodic evaluations. The primary endpoints were objective response rate (ORR) and disease control rate (DCR), and the R0/1 resection rate and adverse events (AE) after neoadjuvant therapy were observed. Paired- t test was used to analyze the differences between groups, and the Clopper-Person accurate method was used to calculate the bilateral 95% CI of ORR and other indicators. Results:Twenty-four patients received 2(2, 3) cycles of neoadjuvant therapy with anlotinib, of which 23 underwent surgery after anlotinib therapy. After neoadjuvant therapy, the mean maximum diameter of target lesions decreased by 23.5%(95% CI: 2.8%-44.3%) compared with baseline ( t=9.22, P<0.001). The ORR and DCR were 37.5%(95% CI: 18.8%-59.4%) and 100%(95% CI: 85.8%-100%), respectively. About 91.7%(95% CI: 73.0%-99.0%) of patients eventually underwent R0/1 resection. Hand and foot skin reactions, hypertension, oral mucositis, and leukopenia were common AE; grade 4 and 5 AE were not observed. Conclusion:Anlotinib can be safely used as neoadjuvant therapy for newly diagnosed LATC patients with good antitumor effects, providing better surgical opportunities for R0/1 resection.

Objective:To explore the current implementation status and challenges of family doctor contract services (FDCS) from the perspective of contracted residents.Methods:This qualitative study used purposive sampling to select contracted residents from 11 primary healthcare institutions across five cities in China. Semi-structured interviews were conducted from March to December 2024, covering topics such as awareness of contracting, service experience, health needs, service continuity, and policy recommendations. Thematic framework analysis was applied to organize, code, and summarize the data.Results:A total of 25 contracted residents were interviewed (6 men, 19 women; 11 from central urban areas, 14 from suburban or rural towns; 8 with chronic diseases). Three main themes and ten sub-themes emerged: Theme Ⅰ: Pathways to improved service accessibility (optimized chronic disease management, more efficient referrals, and improved health education). Theme Ⅱ: Structural misalignment between supply and demand (limited specialty services despite patient needs, insufficient coverage and public awareness of home-based medical care, imbalanced human resources, and service disruption due to clinician turnover). Theme Ⅲ: Challenges in service awareness and communication mechanisms (information asymmetry and public misperception regarding FDCS, perverse incentives in administrative performance evaluation, and communication barriers in building patient-doctor trust).Conclusions:While FDCS has shown progress in chronic disease management, referral coordination, and health education, structural supply-demand gaps and communication challenges continue to hinder service quality. Improvements in resource allocation and service models are needed to support high-quality development.

This study explores the integration of party building and business development in public hospitals.Taking the"Receiving Complaints and Handling Them Immediately"mechanism of a hospital as a case study,it analyzes the intrinsic con-nection and mutual influence between party building and business integration.The study found that closely integrating party build-ing with hospital business not only helps improve overall operational efficiency and service quality but also promotes the sustained and healthy development of the hospital.This article proposes specific measures and suggestions to promote the integration of party building and business in public hospitals,including strengthening party building leadership,improving institutional guarantees,and innovating integration methods.These suggestions aim to provide useful references for public hospitals to achieve deep inte-gration of party building and business.

In laparoscopic and robot-assisted ultra-low sphincter-saving surgeries for rectal cancer, preserving sexual function, preventing anastomotic leakage, anastomotic stricture, and low anterior resection syndrome (LARS) is critical to ensuring a good postoperative quality of life. The primary strategy for preventing postoperative sexual dysfunction is the meticulous preservation of the autonomic nerves, particularly the neurovascular bundles in the prostate area, guided by precise anatomical dissection. Partial preservation of the Denonvilliers fascia during total mesorectal excision (TME) not only helps protect the anterior mesorectum but also safeguards the neurovascular bundles. To prevent anastomotic leakage, it is essential to achieve clear oncologic margins, ensure a robust blood supply to both the proximal and distal margins, maintain a tension-free anastomosis, and avoid thermal or radiation injury whenever possible. In elderly patients with metabolic diseases, persistent descending mesocolon, or those undergoing neoadjuvant chemoradiotherapy, selective preservation of the left colic artery may be considered. Additionally, reinforcing the anastomosis with sutures at the 'dog-ear' site, closing the pelvic peritoneum, and placing a transanal tube for drainage are beneficial strategies. Early identification of anastomotic leakage and timely intervention to ensure drainage can prevent delayed leakage, strictures, and the structural sequelae of anastomotic failure. To minimize fecal dysfunction, selective exemption from radiotherapy may be beneficial for mid-to-high rectal cancer, while for low rectal cancer, reconstruction of J-pouch reservoirs, end-to-side anastomosis, and transverse coloplasty can help reduce the incidence of severe low anterior resection syndrome. Additionally, for low rectal cancer following neoadjuvant therapy, a selective rectum-preserving strategy that avoids major surgery can effectively prevent these complications.

Total pelvic exenteration (TPE) is widely regarded as the most effective intervention for the management of primary locally advanced rectal cancer and locally recurrent rectal cancer. However, TPE presents several challenges, including the potential for failing to achieve R0 resection, high incidence of complication, decreased postoperative quality of life, and the possible overtreatment in patients without carcinomatous adhesions or with only inflammatory adhesions, as well as in those who achieve pathological complete response after neoadjuvant therapy. In the context of precision medicine, further investigation is necessary to enhance the accuracy of preoperative diagnoses of extrarectal cancer invasion and to explore the comprehensive application of genetic molecular typing methods alongside innovative neoadjuvant treatment strategies. Such research should aim to enhance the R0 resection rate of TPE, minimize surgical complications and mortality, improve postoperative quality of life, and achieve an optimal balance between radical resection and the preservation of organ function.

Fusarium head blight (FHB), caused by Fusarium graminearum, not only leads to severe yield losses but also poses a threat to food safety due to the mycotoxins produced by the pathogen. Since this disease is preventable but not curable, the current control mainly relies on chemical fungicides, the long-term use of which may lead to pathogen resistance and environmental pollution. To develop green control methods, we screened 13 biocontrol strains from the rhizosphere soil of wheat, among which strain No. 12 (identified as Pythium aphanidermatum) showed significant antifungal effects. In the plate confrontation test, this strain reduced the colony diameter of the pathogen by 69.2% (1.47 mm vs. 4.78 mm in the control group), with an inhibition rate of 77% (P < 0.01). Microscopic observation revealed obvious deformations in the pathogen hyphae, suggesting a lysing effect. The coleoptile experiment further confirmed that the pre-treatment with this strain reduced the incidence rate to 0. These findings provide new candidate strains for the biocontrol of FHB and offer a scientific basis for reducing the use of chemical fungicides and promoting sustainable agricultural development.
Triticum/growth & development* ; Fusarium/growth & development* ; Plant Diseases/prevention & control* ; Soil Microbiology ; Pest Control, Biological/methods* ; Pythium/physiology* ; Biological Control Agents ; Rhizosphere ; Fungicides, Industrial

BACKGROUND:The pathogenesis of steroid-induced osteonecrosis of the femoral head is not yet fully understood.A deep comprehension of the pathology and molecular mechanisms of steroid-induced osteonecrosis of the femoral head,as well as the search for diagnostic markers with high specificity and sensitivity,are crucial for the prevention and treatment of this condition.OBJECTIVE:To identify immune diagnostic markers for steroid-induced osteonecrosis of the femoral head and predict potential drug targets through drug enrichment analysis and molecular docking techniques.METHODS:The study utilized gene expression profile data(GSE123568 and GSE74089)from the GEO databases(a public gene expression database built by the U.S.National Center for Biotechnology Information).R software was used for data normalization and differential gene screening,followed by weighted gene co-expression network analysis(WGCNA)to identify disease-related genes.Immune-related genes were obtained from the GeneCards database and intersected with the differential genes and WGCNA gene sets to select immune-related genes for steroid-induced osteonecrosis of the femoral head.Mendelian randomization was used to validate the potential causal relationship between these immune-related genes and steroid-induced osteonecrosis of the femoral head.Gene Set Enrichment Analysis was conducted to analyze the immune-related pathways involved,and protein-protein interaction networks were used to assess functional associations.Finally,drug enrichment analysis and molecular docking were performed to predict potential drugs targeting these immune-related genes.RESULTS AND CONCLUSION:Three key immune-related genes-RNASEL,SECTM1,and HSPA6-were identified.These genes were highly expressed in steroid-induced osteonecrosis of the femoral head and exhibited good diagnostic potential,which were involved in multiple immune-related signaling pathways.Mendelian randomization analysis confirmed their potential causal relationship with steroid-induced osteonecrosis of the femoral head.Drug enrichment analysis and molecular docking identified nine potential drugs,including β-ecdysterone,showing the possibility of intervening in the pathological process of steroid-induced osteonecrosis of the femoral head by regulating the HSPA6 protein.These findings provide new biomarkers and drug targets for the early diagnosis and personalized treatment of steroid-induced osteonecrosis of the femoral head.They also highlight the potential application of bioinformatics in Chinese biomedical research,facilitating the integration and translational use of international data in local disease studies.