With the rapid development of artificial intelligence, computational pathology has been seamlessly integrated into the entire clinical workflow, which encompasses diagnosis, treatment, prognosis, and biomarker discovery. This integration has significantly enhanced clinical accuracy and efficiency while reducing the workload for clinicians. Traditionally, research in this field has depended on the collection and labeling of large datasets for specific tasks, followed by the development of task-specific computational pathology models. However, this approach is labor intensive and does not scale efficiently for open-set identification or rare diseases. Given the diversity of clinical tasks, training individual models from scratch to address the whole spectrum of clinical tasks in the pathology workflow is impractical, which highlights the urgent need to transition from task-specific models to foundation models (FMs). In recent years, pathological FMs have proliferated. These FMs can be classified into three categories, namely, pathology image FMs, pathology image-text FMs, and pathology image-gene FMs, each of which results in distinct functionalities and application scenarios. This review provides an overview of the latest research advancements in pathological FMs, with a particular emphasis on their applications in oncology. The key challenges and opportunities presented by pathological FMs in precision oncology are also explored.
Humans ; Precision Medicine/methods* ; Medical Oncology/methods* ; Artificial Intelligence ; Neoplasms/pathology* ; Computational Biology/methods*

The processing mechanism of the human brain for speech information is a significant source of inspiration for the study of speech enhancement technology. Attention and lateral inhibition are key mechanisms in auditory information processing that can selectively enhance specific information. Building on this, the study introduces a dual-branch U-Net that integrates lateral inhibition and feedback-driven attention mechanisms. Noisy speech signals input into the first branch of the U-Net led to the selective feedback of time-frequency units with high confidence. The generated activation layer gradients, in conjunction with the lateral inhibition mechanism, were utilized to calculate attention maps. These maps were then concatenated to the second branch of the U-Net, directing the network's focus and achieving selective enhancement of auditory speech signals. The evaluation of the speech enhancement effect was conducted by utilising five metrics, including perceptual evaluation of speech quality. This method was compared horizontally with five other methods: Wiener, SEGAN, PHASEN, Demucs and GRN. The experimental results demonstrated that the proposed method improved speech signal enhancement capabilities in various noise scenarios by 18% to 21% compared to the baseline network across multiple performance metrics. This improvement was particularly notable in low signal-to-noise ratio conditions, where the proposed method exhibited a significant performance advantage over other methods. The speech enhancement technique based on lateral inhibition and feedback-driven attention mechanisms holds significant potential in auditory speech enhancement, making it suitable for clinical practices related to artificial cochleae and hearing aids.
Humans ; Attention/physiology* ; Speech Perception/physiology* ; Neural Networks, Computer ; Speech ; Noise ; Feedback

【Objective】 To explore the model of "One Core, Multiple Elements" emergency blood donation volunteer team (referred to as the Model) . 【Methods】 The Nanjing City Voluntary Blood Donation Joint Meeting serves as the core, with diverse entities including party committees, government departments, district governments, social organizations, enterprises, blood donors, etc. Following the principles of "emergency response in emergencies, wartime readiness, combining regular and wartime efforts," and adhering to the framework of the Model, the emergency blood donation volunteer team system in Nanjing was constructed. 【Results】 1) After the construction of the Model (2018—2022), the total number of emergency blood donation volunteers in Nanjing City increased by 191% compared to the pre-construction period (2013—2017), with an average annual blood donation of 20 929, showing significant differences (P<0.05). 2) After the construction of the Model, the number of emergency blood donation during the winter and summer increased by 206% and 185%, respectively, compared to the pre-construction period, demonstrating significant differences (P< 0.05) .3) Prior to the construction of the Model, Nanjing lacked a relatively stable emergency volunteer team. After the construction, Nanjing established a total of 5 relatively stable volunteer teams, with the district-level government and township personnel accounting for the highest proportion (52.96%), followed by medical personnel (23.95%), enterprise team (11.10%), State-owned Assets Supervision and Administration Commission team (7%), and Nanjing municipal government team (4.98%). 4) Following the Model, during the COVID-19 pandemic, Nanjing successfully initiated two Level Ⅱ blood emergency responses, with emergency blood donations reaching 23 041. 【Conclusion】 The Model can effectively ensure the blood supply in Nanjing region during emergencies.

Objective:To explore the impact of sleep duration, physical exercise, and their interactions on the risk of dyslipidemia in older adults aged ≥80 (the oldest old) in China.Methods:The study subjects were the oldest old from four rounds of Healthy Aging and Biomarkers Cohort Study (2008-2009, 2011-2012, 2014 and 2017-2018). The information about their demographic characteristics, lifestyles, physical examination results and others were collected, and fasting venous blood samples were collected from them for blood lipid testing. Competing risk model was used to analyze the causal associations of sleep duration and physical exercise with the risk for dyslipidemia. Restricted cubic spline (RCS) function was used to explore the dose-response relationship between sleep duration and the risk for dyslipidemia. Additive and multiplicative interaction model were used to explore the interaction of sleep duration and physical exercise on the risk for dyslipidemia.Results:The average age of 1 809 subjects was (93.1±7.7) years, 65.1% of them were women. The average sleep duration of the subjects was (8.0±2.5) hours/day, 28.1% of them had sleep duration for less than 7 hours/day, and 27.2% had sleep for duration more than 9 hours/day at baseline survey. During the 9-year cumulative follow-up of 6 150.6 person years (follow-up of average 3.4 years for one person), there were 304 new cases of dyslipidemia, with an incidence density of 4 942.6/100 000 person years. The results of competitive risk model analysis showed that compared with those who slept for 7-9 hours/day, the risk for dyslipidemia in oldest old with sleep duration >9 hours/day increased by 22% ( HR=1.22, 95% CI: 1.07-1.39). Compared with the oldest old having no physical exercise, the risk for dyslipidemia in the oldest old having physical exercise decreased by 33% ( HR=0.67, 95% CI: 0.57-0.78). The RCS function showed a linear positive dose-response relationship between sleep duration and the risk for hyperlipidemia. The interaction analysis showed that physical exercise and sleep duration had an antagonistic effect on the risk for hyperlipidemia. Conclusion:Physical exercise could reduce the adverse effects of prolonged sleep on blood lipids in the oldest old.

Intrahepatic cholangiocarcinoma (ICC) is a malignant tumor derived from the biliary epithelial cells of the liver. Radical surgical resection remains the only potentially curative treatment but still with a dismal prognosis. In light of research progress in tumor immunotherapy, the combination of chemotherapy and immunotherapy has recently emerged as a first-line regimen for a significantly improved survival in patients with ICC. Genomics-based targeted therapy can benefit ICC patients with specific gene mutations. Additionally, systemic combined with local treatment can also benefit a group of patients with ICC. The management of ICC remains challenging and we hereby reviewed the treatment strategies of ICC to provide valuable references for clinical diagnosis, treatment, and basic research of ICC.

To evaluate the effects of abdominal belts in colonoscopy for patients with low body mass index (BMI) (BMI<18.5 kg/m2) or a history of abdominal surgery, a prospective, randomized, single-blind study was conducted on colonoscopy outpatients. Patients with low BMI or a history of abdominal surgery who underwent colonoscopy at the Second Affiliated Hospital of Soochow University from January 2018 to January 2022 were enrolled. The patients were divided into the abdominal belts group and non-abdominal belts group according to whether they used abdominal belts. Differences between the two groups were compared in terms of cecal intubation time, length of colonoscope intubation into the cecum, patient repositioning, abdominal pressure, and degree of abdominal distension. A total of 296 patients (98 low BMI patients and 198 patients with a history of abdominal surgery) were enrolled, 148 in each group. The results showed that cecal intubation time (4.35±1.85 min VS 7.99±3.86 min, t=35.624, P<0.001) and length of colonoscope intubation into the cecum (72.03±10.35 cm VS 86.42±17.71 cm, t=38.442, P<0.001) were lower in the abdominal belts group, compared with those of the non-abdominal belts group. The percentage of patients requiring repositioning [18.9% (28/148) VS 71.6% (106/148), χ2=82.959, P<0.001] and abdominal pressure [6.1% (9/148) VS 52.7% (78/148), χ2=77.504, P<0.001] in the abdominal belts group were significantly lower than those in the non-abdominal belts group. There were significant differences in the degree of abdominal distension during and after colonoscopy ( P<0.001). In conclusion, the use of abdominal belts significantly improves the efficiency and effects of colonoscope intubation in difficult colonoscopy patients with low BMI and a history of abdominal surgery.

Objective:To explore the feasibility and safety of retrograde single incision laparoscopic cholecystectomy (SILC) with combined suspension of ligamentum teres hepatis.Methods:A retrospective cohort study was conducted to collect clinical data of 570 cases of laparoscopic cholecystectomy (LC) admitted to the Department of Pancreatic and Bariatric Surgery of Nanjing Drum Tower Hospital from December 2021 to December 2023. Based on the operation methods, 282 cases were classified into retrograde SILC group, 288 cases were classified into three incision LC group. Observation indicators including surgical related index, and incidence of postoperative complications. The continuity data were presented as medium, and compared using Mann-Whitney U test. The comparison of count data between groups was conducted using the chi-square test or Fisher exact probability test. Results:All cases were successfully performed cholecystectomy. The duration of surgery and the proportion of changes in surgical methods in the SILC group were 45(35, 55) minutes and 12.1%, respectively, while in the three port group they were 50(40, 65) minutes and 1.4%, respectively. The difference between the two groups was statistically significant ( P<0.05). The intraoperative bleeding volume, postoperative hospitalization time, and total hospitalization cost of the SILC group were 20(16, 28) mL, 1(1, 1) day, and 13.4(12.9, 14.1) thousand yuan, respectively. The three port group was 18(16, 23) mL, 1(1, 1) day, and 13.4(12.4, 14.6) thousand yuan, respectively. There was no statistically significant difference between the two groups( P>0.05). In terms of postoperative complications, the overall incidence of SILC and three port group were 4.6% and 3.5% respectively, which did not reach significant statistically difference( P>0.05). Meanwhile, there was no statistically significant difference( P>0.05) in the incidence of biliary tract injury, postoperative bile leakage, postoperative bleeding, incision liquefaction infection, and incision hernia between the two groups. Conclusion:The retrograde single incision laproscopic retrograde cholecystectomy combined with ligamentum teres hepatis suspension can achieve satisfactory therapeutic effects without increasing the surgical duration.

Objective:To explore the clinical effect of a modified single-trunk arterialised venous flap in reconstruction of soft tissue defect in hand and foot.Methods:From January 2019 to June 2022, 25 patients with soft tissue defect in hand and foot were treated in the Department of Hand and Foot Plastic Surgery of Lecong Hospital of Shunde in Foshan. The soft tissue defects were reconstructed with a venous flap, of which a single trunk of vein was ligated and then a blood flux of the flap was re-established via a modified single vein trunk. One patient had soft tissue defect in dorsal foot and toes, 3 patients had defects in dorsal hand, 3 patients had defects in 2 digits and 18 patients had defects in single-digit. The sizes of defects were 2.0 cm×1.0 cm-10.0 cm×4.5 cm. The sizes of flaps were 2.0 cm×1.0 cm-12.0 cm×5.5 cm. Donor sites of the 19 cases were directly sutured and 6 were covered by skin grafts. The postoperative follow-ups were conducted at outpatient clinics and via telephone reviews to observe the survival of flaps. Functional recovery of 23 cases whose soft tissue defects in hand were evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association. The sensory recovery of flaps was evaluated according to the comprehensive flap scale.Results:All 25 single-trunk venous flaps survived successfully. There were small number of blisters on 5 flaps, due to tissue oedema. One patient lost in follow-up. The other 24 patients had 2-18 months of follow-up. The appearance of flaps was soft and thin, with wear-resistant. According to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, the function recovery were excellent in 12 cases, good in 9 cases and poor in 2 cases. Sensations of the flaps were 90-99 point with an average of 97 point according to the comprehensive flap scale, of which 22 flaps were in excellent and 2 in good.Conclusion:The method of ligation of single vein-trunk to make a arterialised venous flap is a simple surgical procedure. There are many selections of donor site with minimum damage. It is an effective method and with satisfactory outcomes.

Paraneoplastic neurological syndrome (PNS) is an autoimmune syndrome involving the nervous system caused by tumors through distant effects. The diagnosis of PNS is difficult, and PNS-associated autoantibodies are crucial for disease diagnosis, classification, and individualized treatment. PNS-associated autoantibodies are classified into high-, intermediate-, and low-risk antibodies based on their predictive risk of tumors. Their laboratory detection is mainly carried out through indirect immunofluorescence, immunohistochemical analysis, immunoblotting, and other methods. The correct application and interpretation of antibody detection results is crucial for the diagnosis and treatment of PNS. This article reviews the current status and future prospects of the clinical application of autoantibodies related to PNS.

Objective:To explore the clinical effect of repairing interphalangeal joint defect of hand with free transfer of part of the 2nd metatarsophalangeal joint tissue flap precisely cut with the aid of digital 3D printing technology.Methods:From December 2016 to December 2020, 7 patients with partial joint defects of proximal interphalangeal joints of fingers were treated in Department of Hand and Foot Surgery, Shunde Hospital Affiliated to Guangzhou Medical University(Foshan Shunde Lecong Hospital). Before surgery, three-dimensional data of hand and foot bones were collected, and the 3D printing model was used to simulate the operation in vitro. During the operation, the first dorsal metatarsal artery-the 2nd dorsal metatarsal artery was used as the pedicle, and the 2nd metatarsophalangeal joint composite tissue flap with a required size was harvested with the assistance of the navigation template to tranfer and repair the small joint defects of hand. All 7 cases entered follow-up at outpatient and telephone. Results:All 7 cases survived. Postoperative follow-up was 3-24(mean 9.5) months, Range of motion of the repaired interphalangeal joint was (56 ± 6)°; According to the Evaluation Standard of Thumb and Finger Reconstruction Function of the Society of Hand Surgery of the Chinese Medical Association, 2 cases were excellent, 4 cases were good, and 1 case was poor.Conclusion:Transfer of the free 2nd metatarsophalangeal joint tissue flap assisted by 3D printing technology in repair of the small joint defect of the hand can accurately harvest the tissue flap, which is clinically reliable.