Objective:To investigate the value of CT imaging radiomics in predicting the therapeutic effect of extracorporeal shock wave lithotripsy (ESWL) for pancreatic duct stones.Methods:The clinical data of 167 patients with pancreatic duct stones treated with ESWL in the Department of Gastroenterology, the First People's Hospital of Hangzhou, Westlake University from July 2016 to January 2023 were retrospectively analyzed. Patients were divided into complete lithotripsy group (stone diameter ≤3 mm, n=94) and incomplete lithotripsy group (stone diameter>3 mm, n=73), according to the size of the largest residual stone after the first ESWL treatment. ITK SNAP software was used to delineate the images of pancreatic duct stones, and the artificial intelligence tool kit developed by United Shadow Company was used to extract the image radiomics characteristics. The pancreatic duct stone data set was randomly assigned into the training set ( n=118) and the test set ( n=29) in the ratio of 8∶2, and the absolute maximum normalization treatment was used, followed by peacekeeping selection through the minimum absolute contraction and selection operator (Lasso) to calculate the CT image radiomics score, and the logistic regression classifier was used to construct the ESWL treatment effect prediction model of pancreatic duct stones. Receiver operating characteristic curves (ROC) were plotted, and the area under the curve (AUC) and sensitivity, specificity, and accuracy were calculated to assess the performance of the prediction model. Decision curve analysis was used to evaluate the clinical value of CT radiomics score in the diagnosis of ESWL for pancreatic duct stones. Results:A total of 2 287 imaging radiomics characteristics were extracted, and 11 optimal imaging radiomics characteristics were finally screened by Lasso regression dimensionality reduction to establish a prediction model for ESWL treatment effect of pancreatic duct stones. The AUC values of the training set and the test set were 0.89 and 0.87, respectively, and the sensitivity, specificity, and accuracy were 82% and 79%, 82% and 82%, 82% and 80%, respectively. The AUC value in the independent validation set was 0.90, and the sensitivity, specificity, and accuracy were 78%, 90%, and 85%, respectively. The results of decision curve analysis showed that when the probability of ESWL efficacy in the diagnosis of pancreatic duct stones with CT image radiomics score was >0.05, the use of CT image radiomics score in the diagnosis of ESWL efficacy in pancreatic duct stones was more beneficial to patients in clinical practice than not.Conclusions:The treatment effect of ESWL for pancreatic duct stones can be predicted by CT imaging radiomics model.

Background::Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.Methods::A total of 3053 healthy Han Chinese adults (1922 women) aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, β stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson’s correlation, multiple linear regression, and analyses of covariance.Results::All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The β stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 μm/year in women and 5.8 μm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex. Conclusions::The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.

Background::Long non-coding RNAs (lncRNAs) plays an important role in the progression of gastric cancer (GC). Their involvement ranges from genetic regulation to cancer progression. However, the mechanistic roles of RP11-789C1.1 in GC are not fully understood.Methods::We identified the expression of lncRNA RP11-789C1.1 in GC tissues and cell lines by real-time fluorescent quantitative polymerase chain reaction. A series of functional experiments revealed the effect of RP11-789C1.1 on the proliferation of GC cells. In vivo experiments verified the effect of RP11-789C1.1 on the biological behavior of a GC cell line. RNA pull-down unveiled RP11-789C1.1 interacting proteins. Western blot analysis indicated the downstream pathway changes of RP11-789C1.1, and an oxaliplatin dosing experiment disclosed the influence of RP11-789C1.1 on the drug sensitivity of oxaliplatin. Results::Our results demonstrated that RP11-789C1.1 inhibited the proliferation of GC cells and promoted the apoptosis of GC cells. Mechanistically, RP11-789C1.1 inhibited checkpoint kinase 1 (CHK1) phosphorylation by binding ataxiatelangiectasia mutated and Rad3 related (ATR), a serine/threonine-specific protein kinase, promoted GC apoptosis, and mediated oxaliplatin sensitivity.Conclusion::In general, we discovered a tumor suppressor molecule RP11-789C1.1 and confirmed its mechanism of action, providing a theoretical basis for targeted GC therapy.

Digestive tract tumors are currently one of the most common types of cancer,including esophageal cancer,gastric cancer,hepatocellular carcinoma,pancreatic cancer,and colorectal cancer.Their prognoses are poor and the treatments require further improvement.Caveolin-1(CAV1)has a dual regulatory effect on digestive tract tumors as a tumor suppressor and cancer promoter.CAV 1 plays a major role in cell proliferation,invasion,metastasis,angiogenesis,and drug tolerance of digestive tract tumors.The regulation of CAV1 protein and its related signaling pathways may be a strategy for the treatment of digestive tract tumors.This review analyzes the relationship between CAV 1 and digestive tract tumors in terms of structure,function,expression regulation,regulation of epithelial-mesenchymal transition,and drug resistance in digestive tract tumors to provide new ideas for the diagnosis and treatment of digestive tract tumors.

Objective:To explore the changing trajectory of psychological distress in young and middle-aged patients during peridialysis period.Methods:Totally 122 patients in the peridialysis period were investigated with the Self-Designed General Data Questionnaire,Distress Screening Scale(DSS),Connor-Davidson Resilience Scale(CD-RISC),Social Support Revalued Scale(SSRS)and Self-Perceived Burden Scale(SPBS)at the time of diag-nosis,initial dialysis,and dialysis for 1 month,2 months and 3 months,respectively.The growth mix model was used to identify trajectory categories.Results:The time main effect of scores of DSS,CD-RISC and SPBS in peridi-alysis patients was statistically significant(Ps＜0.05),the scores of DSS and SPBS were the highest at the initial dialysis and the lowest at 3 months of dialysis.The CD-RISC scores were the lowest at the first dialysis and the highest at 3 months of dialysis.The trajectory of psychological distress was divided into 3 types,namely continuous high level(26.20％),high level decline(40.72％),and medium-low level decline(33.08％).Conclusion:The psychological distress of young and middle-aged peridialysis patients shows different trajectories from diagnosis to regular dialysis.Clinical staff should pay more attention to the psychological status of the first-time dialysis pa-tients.

BACKGROUND/OBJECTIVES: The specific impact of different fruit and vegetable consumption categories on frailty is not completely understood. This study examined the relationships between the daily consumption of fruit and vegetables and frailty in a large general population. SUBJECTS/METHODS: This study used the data from the US National Health and Nutrition Examination Survey (2005–2020). Two intermittent 24-h dietary recalls were used to evaluate fruit and vegetable consumption. Frailty was assessed using the frailty index. Logistic regression, stratified analyses, and restricted cubic spline models were used to examine these associations. RESULTS: A higher daily intake of citrus, melons, and berries (odds ratio [OR], 0.77; 95% confidence interval [CI], 0.65–0.92), other fruit (OR, 0.74; 95% CI, 0.62–0.88), intact fruit (OR, 0.71; 95% CI, 0.60–0.84), dark-green vegetables (OR, 0.71; 95% CI, 0.60–0.83), and total vegetables (OR, 0.80; 95% CI, 0.66–0.96), along with a lower fruit juice intake (OR, 0.81; 95% CI, 0.69–0.96), were associated with a reduced risk of frailty in adults aged 18 yrs and older.Further analysis showed that the daily consumption of citrus melons and berries, other fruit, intact fruit, fruit juice, and tomatoes and tomato products were inversely associated with frailty in adults under 60 yrs and females. Dark green vegetables were inversely correlated with frailty in individuals aged 40–60 yrs and over 60 yrs, regardless of sex. CONCLUSION The daily consumption of most types of fruit, dark green vegetables, and tomatoes and tomato products may reduce the risk of frailty in American adults, particularly for individuals under 60 yrs of age and females.

Objective:To analyze the value of 68Ga-fibroblast activation protein inhibitor (FAPI)-04 PET/CT in the detection of myocardial injury in patients treated with anti-tumor therapy. Methods:A retrospective study was conducted on 164 patients who underwent 68Ga-FAPI-04 PET/CT to evaluate the efficacy of anti-tumor therapy in Renji Hospital, School of Medicine, Shanghai Jiao Tong University between August 2021 and March 2024. The patients were divided into 68Ga-FAPI-04-positive group ( n=63, 36 males, 27 females, age (66.7±9.6) years) and 68Ga-FAPI-04-negative group ( n=101, 42 males, 59 females, age (55.2±14.1) years) based on the uptake of left ventricular myocardium (LVM). Moreover, FAPI-04 uptake was analyzed based on different types and locations, and the corresponding SUV max differences were analyzed by Kruskal-Wallis rank sum test. The differences of SUV max between 68Ga-FAPI-04-positive group and 68Ga-FAPI-04-negative group were analyzed by Mann-Whitney U test. The clinical factors such as gender, age, body mass index (BMI), previous history of coronary heart disease, left ventricular ejection fraction (LVEF), smoking history, hypertension, diabetes, cancer types and immune checkpoint inhibitors (ICIs) treatment were collected, and their predictive values for LVM 68Ga-FAPI-04 uptake were investigated by the binary logistic regression analysis. Results:Fifty patients of the 68Ga-FAPI-04-positive group (79.4%, 50/63) showed focal uptake of LVM, 7 patients (11.1%, 7/63) showed multifocal myocardial uptake, and 6 patients (9.5%, 6/63) showed diffuse myocardial uptake. A total of 127 uptake lesions were found, and most of them were located in the septum (37.8%, 48/127). The SUV max of LVM in 68Ga-FAPI-04-positive group and 68Ga-FAPI-04-negative group were 4.00(3.10, 5.40) and 1.31(1.20, 1.40) respectively ( z=-10.82, P<0.001). Differences of the SUV max among focal uptake group, multifocal myocardial uptake group, and diffuse myocardial uptake group were not significantly different (4.00(3.00, 5.10) vs 7.60(3.60, 9.30) vs 3.95(3.05, 5.05); H=3.81, P=0.149). There is no statistically significant difference either in FAPI uptake among different sites of LVM ( H=1.51, P=0.825). Age, previous history of coronary heart disease, BMI, LVEF and ICIs treatment were independent predictive factors for positive 68Ga-FAPI-04 uptake in the LVM (odds ratio ( OR) values: 0.87-10.43, all P<0.05). Conclusion:68Ga-FAPI-04 PET/CT is a potential new imaging method for the visualization of myocardial injury in patients with anti-tumor therapy.

Objective:To explore the effect of identifying pelvic lymph nodes by different injection of indocyanine green (ICG) during fluorescent laparoscopic radical cystectomy.Methods:The data of 54 male bladder cancer patients admitted to the First Hospital of Shanxi Medical University from September 2021 to September 2022 were analyzed. Preoperative cystoscopic biopsy all revealed a pathological diagnosis of urothelial carcinoma. All patients underwent fluorescent laparoscopic radical cystectomy plus pelvic lymph node dissection.They were divided into 3 groups according to the annotated route: 6 in the medial malleolus injection group, 68(61, 73) years; 4 in the perineal injection group, 67(59, 74) years; 44 in the medial malleolus and perineum, 64(45, 78) in the combined injection group. Under general anesthesia, patients were placed in the supine position with 0.3 to 0.5 ml of subcutaneous ICG solution (2.5 mg/ml) injected from 1.0 to 1.5 h before surgery. In the medial malleolus injection group, 0.3 to 0.5 ml (0.75 mg/place) was injected at 2 cm above the medial malleolus and 0.3 to 0.5 ml (0.75 mg/place) at two symmetrical sites above the anus. Intraoperatively, 4K fluorescent laparoscopy was used to observe the color development of the injection site and lymphatic vessels in vitro, and then to observe the development of pelvic lymph nodes in vivo.Results:In 3 groups, inguinal lymph nodes were developed about 30 min after ICG injection, and 1 h later, the longest (4.5±0.3) h. The external iliac and common iliac lymph nodes, the obturatorius lymph nodes in the perineal injection group, and the inguinal, obturatorius, external iliac, internal, anterior sacral, and common iliac lymph nodes in the medial malleolar and perineal injection group. In this study, in 54 cases, the postoperative pathological examination confirmed that the removed fluorescently labeled tissue was lymph node tissue, and the lymph node detection rate was 100%. The postoperative stage was pT 2, 14, 32 pT 3 and 8 pT 4; 4 pNx, 44 pN 0, 5 pN 1and 1 pN 2. In the medial malleolar injection group, 2 patients staged pT 2, 3 stage pT 3, 1 stage pT 4; 1stage pNx stage, 4 stage pN 0 and 1 stage pN 1 stage. In the perineal injection group, 4 patients had postoperative pathological stage pT 3N 0; in the medial malleolar and perineal injection group, 12 pT 2, 25 and 7 pT 3; 3 pNx, 36 pN 0, 4 pN 1 and 1pN 2. Conclusions:ICG injection through the perineum and subcutaneous labeling of pelvic lymph nodes, and the simple malleolus or perineal injection can not completely develop the pelvic lymph nodes. The combined injection could fully develop the pelvic lymph nodes, which may accurately guide the operator to locate, identify and remove pelvic lymph nodes.

Objective:To compare the efficacy of subfascial and extrafascial anterior quadratus lumborum block (AQLB).Methods:This study included two trials. TrialⅠ This trail was a retrospective study. The images of patients undergoing abdominal CT examination from January to December 2023 were retrospectively analyzed in the picture archiving and communication system of the Affiliated Hospital of Jiangsu University. One hundred adult patients with no musculoskeletal disorders or history of thoracolumbar surgery were randomly selected, and the anatomical relation between the quadratus lumbar muscle (QLM) and psoas major muscle (PMM) at the L 4 level was observed. Trial Ⅱ This trail was a prospective study. Twenty American Society of Anesthesiologists Physical Status classification Ⅰor Ⅱ male patients, aged 18-65 yr, with a body mass index of 18-25 kg/m 2, who underwent elective unilateral AQLB lower abdominal surgery in Affiliated Hospital of Jiangsu University from January to February 2024, were included and divided into subfascial group and extrafascial group using computer-generated random numbers, with 10 cases per group (5 cases on the left and 5 cases on the right side each). AQLB was performed using 0.375% ropivacaine 30 ml: the injection point for subfascial group was located between the fascia of the QLM and the anterior layer of the thoracolumbar fascia at the L 4 level, while the injection point for extrafascial group was located underneath the fascia of the PMM at the L 4 level. The blocked side of the body was divided into 15 regions using the anatomical landmarks on the body surface. The positive rates of skin sensory block and sensory disappearance of dermatomes in each region were assessed by cold stimulation at 40 min after block. The modified Bromage score was used to evaluate the lower limb motor block at 40 min after block and 1 h after surgery. Results:PartⅠ At the L 4 level, the overlapping of the bilateral QLM and PMM only occurred in 1 patient (1%), the overlapping only appearing on the left side occurred in 1 patient (1%), and the PMM and QLM in the remaining 98 patients (98%) were separated. Part Ⅱ The positive rates in 3, 5, 6 and 8 regions and the sensory disappearance rates of T 7 to T 12 dermatomes were significantly higher in subfascial group than in extrafascial group ( P<0.05). One patient in extrafascial group had a modified Bromage score of 1 on the block side at 40 min after block, and both groups scored 0 at the other time points. Conclusions:QLM and PMM are separated at the L 4 level in most patients. Subfascial AQLB is more effective than extrafascial AQLB in blocking the middle-lower region of the abdominal wall and has no motor block.

BACKGROUND/OBJECTIVES: The specific impact of different fruit and vegetable consumption categories on frailty is not completely understood. This study examined the relationships between the daily consumption of fruit and vegetables and frailty in a large general population. SUBJECTS/METHODS: This study used the data from the US National Health and Nutrition Examination Survey (2005–2020). Two intermittent 24-h dietary recalls were used to evaluate fruit and vegetable consumption. Frailty was assessed using the frailty index. Logistic regression, stratified analyses, and restricted cubic spline models were used to examine these associations. RESULTS: A higher daily intake of citrus, melons, and berries (odds ratio [OR], 0.77; 95% confidence interval [CI], 0.65–0.92), other fruit (OR, 0.74; 95% CI, 0.62–0.88), intact fruit (OR, 0.71; 95% CI, 0.60–0.84), dark-green vegetables (OR, 0.71; 95% CI, 0.60–0.83), and total vegetables (OR, 0.80; 95% CI, 0.66–0.96), along with a lower fruit juice intake (OR, 0.81; 95% CI, 0.69–0.96), were associated with a reduced risk of frailty in adults aged 18 yrs and older.Further analysis showed that the daily consumption of citrus melons and berries, other fruit, intact fruit, fruit juice, and tomatoes and tomato products were inversely associated with frailty in adults under 60 yrs and females. Dark green vegetables were inversely correlated with frailty in individuals aged 40–60 yrs and over 60 yrs, regardless of sex. CONCLUSION The daily consumption of most types of fruit, dark green vegetables, and tomatoes and tomato products may reduce the risk of frailty in American adults, particularly for individuals under 60 yrs of age and females.