Objective:To develop a deep learning model based on super-resolution endorectal ultrasound（ERUS）images for the preoperative prediction of perineural invasion（PNI）in patients with rectal cancer，thereby providing a reference for risk stratification and individualized treatment planning.Methods:A retrospective analysis was conducted on 382 patients with rectal cancer who underwent total mesorectal excision at Fujian Medical University Union Hospital between June 2019 and February 2024. Patients were randomly divided into a training set（ n=305）and a test set（ n=77）at a ratio of 8∶2，and further grouped into PNI-negative group and PNI-positive group subgroups based on pathological results. Super-resolution ultrasound images were generated from original ERUS images using a generative adversarial network（GAN）. Deep convolutional neural networks were developed based on features from intratumoral and peritumoral regions to identify the optimal region of interest（ROI）. The dSR5_ResNet18 and dSR5_ResNet50 models were constructed using the super-resolution images with a 5-pixel peritumoral extension. Representative clinical features were selected for subgroup analysis based on sample size and intergroup statistical differences between PNI-positive and PNI-negative patients. Forest plots were used to evaluate model applicability and robustness across subgroups. Results:The dSR5_ResNet18 model，built using super-resolution images of the tumor combined with a 5-pixel peritumoral region，achieved the best predictive performance，with an AUC of 0.867（95% CI=0.782 - 0.952）in the test set. Decision curve analysis demonstrated that the dSR5_ResNet18 model provided the greatest net clinical benefit. Forest plot analysis indicated strong generalizability of the models across subgroups such as pathological N stage，maximum lesion length，and lymph node enlargement，though relatively weaker performance was observed in the carcinoembryonic antigen（CEA）subgroup. Among all models，dSR5_ResNet18 exhibited the most consistent performance across subgroups，with the narrowest confidence intervals and highest robustness. Conclusions:The deep learning model incorporating ERUS-based super-resolution reconstruction demonstrated excellent performance in the preoperative prediction of PNI in rectal cancer. It offers significant advantages in image quality and generalizability，and may serve as a valuable tool to assist clinicians in formulating personalized treatment strategies.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Objective:To develop a deep learning model based on super-resolution endorectal ultrasound（ERUS）images for the preoperative prediction of perineural invasion（PNI）in patients with rectal cancer，thereby providing a reference for risk stratification and individualized treatment planning.Methods:A retrospective analysis was conducted on 382 patients with rectal cancer who underwent total mesorectal excision at Fujian Medical University Union Hospital between June 2019 and February 2024. Patients were randomly divided into a training set（ n=305）and a test set（ n=77）at a ratio of 8∶2，and further grouped into PNI-negative group and PNI-positive group subgroups based on pathological results. Super-resolution ultrasound images were generated from original ERUS images using a generative adversarial network（GAN）. Deep convolutional neural networks were developed based on features from intratumoral and peritumoral regions to identify the optimal region of interest（ROI）. The dSR5_ResNet18 and dSR5_ResNet50 models were constructed using the super-resolution images with a 5-pixel peritumoral extension. Representative clinical features were selected for subgroup analysis based on sample size and intergroup statistical differences between PNI-positive and PNI-negative patients. Forest plots were used to evaluate model applicability and robustness across subgroups. Results:The dSR5_ResNet18 model，built using super-resolution images of the tumor combined with a 5-pixel peritumoral region，achieved the best predictive performance，with an AUC of 0.867（95% CI=0.782 - 0.952）in the test set. Decision curve analysis demonstrated that the dSR5_ResNet18 model provided the greatest net clinical benefit. Forest plot analysis indicated strong generalizability of the models across subgroups such as pathological N stage，maximum lesion length，and lymph node enlargement，though relatively weaker performance was observed in the carcinoembryonic antigen（CEA）subgroup. Among all models，dSR5_ResNet18 exhibited the most consistent performance across subgroups，with the narrowest confidence intervals and highest robustness. Conclusions:The deep learning model incorporating ERUS-based super-resolution reconstruction demonstrated excellent performance in the preoperative prediction of PNI in rectal cancer. It offers significant advantages in image quality and generalizability，and may serve as a valuable tool to assist clinicians in formulating personalized treatment strategies.

OBJECTIVE To predict the possible impact of pembrolizumab（PEM） as a first-line drug after being included in the national medical insurance system in the treatment of advanced or metastatic non-small cell lung cancer based on real-world data from the perspective of the national medical insurance payer， to provide a basis for the decision-making of the medical insurance department. METHODS A budget impact analysis model was constructed to compare the impact of pembrolizumab not included in medical insurance and included in medical insurance on medical insurance fund expenditure in the next five years（ 2024- 2028） with 2023 as the baseline year. The target population was the patients with EGFR gene mutation-negative and anaplastic lymphoma kinase （ALK）-negative locally advanced or metastatic non-small cell lung cancer； estimated cost mainly included the cost of drugs， the cost of adverse reaction treatment， the cost of examination， the cost of admission and monitoring， etc； equipment ratio of PEM in 183 hospitals of Guangdong province from 2020 to 2022 was used as the market share. Univariate sensitivity analysis was used to test the robustness of the basic analysis results. RESULTS When PEM was not included in the medical insurance， the medical insurance reimbursement amount of the target population from 2024 to 2028 was 4 933 623.5 thousand yuan-5 151 198.3 thousand yuan， respectively. If PEM was included in the medical insurance， the above data were 11 871 972.2 thousand yuan-14 540 571.0 thousand yuan， respectively； the increase in medical insurance reimbursement under the two scenarios was 6 720 773.9 thousand yuan-9 606 947.5 thousand yuan， respectively. The proportion of medical insurance reimbursement to the medical insurance expenditure of the year after PEM was included in medical insurance was 0.298 0%， 0.262 1%， 0.228 8%， 0.208 2%， and 0.185 7%， respectively. The increase in medical insurance reimbursement accounted for 1.084 0%， 0.995 7%， 0.888 6%， 0.886 3%， and 0.861 6% of the increase in the expenditure of the medical insurance fund in the current year， all of which showed a decreasing trend year by year. CONCLUSIONS If PEM is included in medical insurance， due to its high unit price， the medical expenditure will increase accordingly， which will have a great impact on the medical insurance fund expenditure. However， when the drug is used in patients with EGFR mutation-negative and ALK-negative locally advanced or metastatic non-small cell lung cancer， the proportion of the medical insurance reimbursement amount in the current year’s medical insurance fund expenditure and the proportion of the increase in medical insurance reimbursement in the current year’s increase in medical insurance fund expenditure are decreasing year by year.

Objective:To investigate the clinical characteristics of small airway dysfunction（SAD）in children with asthma and the diagnostic value of fractional exhaled nitric oxide(FeNO) and alveolar nitric oxide (CaNO) as non-invasive indicators of airway inflammation for SAD.Methods:The informations of children with asthma who were admitted to Department of Pediatrics at the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from March 2023 to February 2024 were collected.The children were divided into SAD group and non-SAD group.The clinical characteristics,eosinophil count,total IgE value,pulmonary function parameters,FeNO value and CaNO value between two groups were compared.The diagnostic value of CaNO and FeNO for SAD in children with asthma was evaluated by the area under the receiver operating characteristic (ROC) curve.Results:A total of 124 children with asthma were included,with 60 patients in the SAD group and 64 patients in the non SAD group.Compared to children in non-SAD group,children in SAD group had higher age at enrollment,history of exposure to tobacco environment,exercise-induced asthma attack,history of repeated respiratory infections,dust mite allergy,children's asthma control test (C-ACT) score <20,poor compliance,allergic rhinitis symptoms in the past year and atopic dermatitis symptoms in the past year(all P<0.05).However,there were no statistically significant differences in family history of asthma and history of milk allergy between two groups ( P>0.05).The ratio of measured and predicted forced expiratory volume in the first second (FEV1% pred),FEV1/FVC measured and predicted (FEV1/FVC%),measured and predicted peak expiratory flow rate (PEF% pred),measured and predicted instantaneous flow rate at 50% forced expiratory capacity (FEF50% pred),measured and predicted instantaneous flow rate at 75% forced expiratory capacity (FEF75% pred),and measured and predicted maximum mid expiratory flow rate (MMEF% pred) were all lower in the SAD group than those in the non-SAD group,while the inflammatory indicators such as total IgE,eosinophil count,FeNO value and CaNO value were higher in the SAD group(all P<0.001).When CaNO and FeNO were used alone or in combination for the diagnosis of SAD,the areas under the ROC curve (95% CI) were 0.92 (0.87-0.97),0.81 (0.73-0.88),and 0.92 (0.87-0.97),with sensitivities of 88.3%,76.7%,and 75.7%,and specificities of 82.8%,71.9%,and 96.9%,respectively.CaNO was negatively correlated with lung function parameters FEV1% pred,FVC% pred,FEF75% pred,MMEF% pred,FEF50% pred,and FEF75% pred ( P<0.001).CaNO was positively correlated with FeNO ( P<0.001). Conclusion:Patients with SAD have higher levels of inflammatory markers.The non-invasive indicators of airway inflammation has diagnostic and evaluation value for SAD,and the diagnostic efficacy of CaNO is higher than that of FeNO.

Objective:To investigate the clinical characteristics of small airway dysfunction（SAD）in children with asthma and the diagnostic value of fractional exhaled nitric oxide(FeNO) and alveolar nitric oxide (CaNO) as non-invasive indicators of airway inflammation for SAD.Methods:The informations of children with asthma who were admitted to Department of Pediatrics at the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from March 2023 to February 2024 were collected.The children were divided into SAD group and non-SAD group.The clinical characteristics,eosinophil count,total IgE value,pulmonary function parameters,FeNO value and CaNO value between two groups were compared.The diagnostic value of CaNO and FeNO for SAD in children with asthma was evaluated by the area under the receiver operating characteristic (ROC) curve.Results:A total of 124 children with asthma were included,with 60 patients in the SAD group and 64 patients in the non SAD group.Compared to children in non-SAD group,children in SAD group had higher age at enrollment,history of exposure to tobacco environment,exercise-induced asthma attack,history of repeated respiratory infections,dust mite allergy,children's asthma control test (C-ACT) score <20,poor compliance,allergic rhinitis symptoms in the past year and atopic dermatitis symptoms in the past year(all P<0.05).However,there were no statistically significant differences in family history of asthma and history of milk allergy between two groups ( P>0.05).The ratio of measured and predicted forced expiratory volume in the first second (FEV1% pred),FEV1/FVC measured and predicted (FEV1/FVC%),measured and predicted peak expiratory flow rate (PEF% pred),measured and predicted instantaneous flow rate at 50% forced expiratory capacity (FEF50% pred),measured and predicted instantaneous flow rate at 75% forced expiratory capacity (FEF75% pred),and measured and predicted maximum mid expiratory flow rate (MMEF% pred) were all lower in the SAD group than those in the non-SAD group,while the inflammatory indicators such as total IgE,eosinophil count,FeNO value and CaNO value were higher in the SAD group(all P<0.001).When CaNO and FeNO were used alone or in combination for the diagnosis of SAD,the areas under the ROC curve (95% CI) were 0.92 (0.87-0.97),0.81 (0.73-0.88),and 0.92 (0.87-0.97),with sensitivities of 88.3%,76.7%,and 75.7%,and specificities of 82.8%,71.9%,and 96.9%,respectively.CaNO was negatively correlated with lung function parameters FEV1% pred,FVC% pred,FEF75% pred,MMEF% pred,FEF50% pred,and FEF75% pred ( P<0.001).CaNO was positively correlated with FeNO ( P<0.001). Conclusion:Patients with SAD have higher levels of inflammatory markers.The non-invasive indicators of airway inflammation has diagnostic and evaluation value for SAD,and the diagnostic efficacy of CaNO is higher than that of FeNO.

OBJECTIVE To study the effects and potential mechanism of anaphylactoid reaction induced by nonapeptide IVQKIKHCF activating mast cells. METHODS Using human mast cell line LAD2 as subject， and substance P as positive control， the activation effects of 25， 50 and 100 μmol/L IVQKIKHCF on mast cells were investigated by determining the release rate of β-aminohexosidase， histamine release， and the contents of inflammatory factors； using MrgprX2-knockdown LAD2 cells and Mas- related G protein-coupled receptor X2 （MRGPRX2） high-expression human embryonic kidney cell line HEK293 （MRGPRX2/ HEK293 cells） as subject， the correlation between the activation effect of IVQKIKHCF and MRGPRX2 was investigated by determining the release rate of β-aminohexosidase， and intracellular calcium ion concentration. RESULTS IVQKIKHCF with 25， 50， 100 μmol/L could significantly increase the release rate of β-aminohexosidase and histamine release in LAD2 cells （P＜0.05）， and promote the release of tumor necrosis factor-α， interleukin-8， macrophage inflammatory protein-1β and monocyte chemotactic protein-1 to varying degrees （P＜0.05）. After knocking down MrgprX2， the effects of 25， 50， 100 μmol/L IVQKIKHCF promoting the release of β-aminohexosidase in LAD2 cells were reversed significantly （P＜0.05）， resulting in an increase of calcium ion concentration in MRGPRX2/HEK293 cells. CONCLUSIONS Nonapeptide IVQKIKHCF can promote mast cells to release granular matter and inflammatory mediators by activating MRGPRX2 thus inducing anaphylactoid reaction.