Background Accurate T-staging is critical for esophageal cancer therapy,but CT-based assessment has significant limitations.Large vision models(LVMs)hold promise,yet their zero-shot clinical diagnostic capability without fine-tuning remains unvalidated.Methods A retrospective analysis was conducted on the chest CT images from 98 esophageal cancer patients and 50 normal controls.Using radiologist-consensus as the gold standard,the zero-shot T-staging performance of 3 LVMs(GPT-5,Gemini,and MedGemma)was evaluated with prompts of varying complexity.Results GPT-5 exhibited the highest accuracy and stability.Significant biases were observed among models:Gemini tended to over-stage,while MedGemma showed a tendency to under-stage.All models faced challenges in identifying early-stage tumors,but structured prompts improved diagnostic performance for mid-to-late stage lesions.Conclusion LVMs have potential for zero-shot T-staging,but their performance highly depends on model choice and prompt design.The generic model GPT-5 show superior zero-shot generalization.However,current model performance is not yet clinically viable,especially for early diagnosis.Future work should focus on fine-tuning with high-quality clinical data and developing standardized prompt frameworks.

Background Accurate T-staging is critical for esophageal cancer therapy,but CT-based assessment has significant limitations.Large vision models(LVMs)hold promise,yet their zero-shot clinical diagnostic capability without fine-tuning remains unvalidated.Methods A retrospective analysis was conducted on the chest CT images from 98 esophageal cancer patients and 50 normal controls.Using radiologist-consensus as the gold standard,the zero-shot T-staging performance of 3 LVMs(GPT-5,Gemini,and MedGemma)was evaluated with prompts of varying complexity.Results GPT-5 exhibited the highest accuracy and stability.Significant biases were observed among models:Gemini tended to over-stage,while MedGemma showed a tendency to under-stage.All models faced challenges in identifying early-stage tumors,but structured prompts improved diagnostic performance for mid-to-late stage lesions.Conclusion LVMs have potential for zero-shot T-staging,but their performance highly depends on model choice and prompt design.The generic model GPT-5 show superior zero-shot generalization.However,current model performance is not yet clinically viable,especially for early diagnosis.Future work should focus on fine-tuning with high-quality clinical data and developing standardized prompt frameworks.

Objective To compare H_p(3) calibration with a homemade (A) thermoluminescent dosimeter (TLD) and an imported (B) TLD in a standard X-ray RQR radiation field, to explore the different responses of A and B, and to provide foundation for the calibration of H_p(3). Methods A column mode was selected. H_p(3) calibration was performed using A and B in a standard X-ray RQR radiation field in the Secondary Standard Dosimetry Laboratory, National Institute for Radiological Protection, China Center for Disease Control and Prevention. Angle response, energy response, and linear response were calibrated with RQR4 (60 kV), RQR7 (90 kV), and RQR9 (120 kV), respectively. Results In terms of angle response, the calibration results of A were relatively high, while the calibration results of B were relatively low. In terms of energy response, the calibration results showed a similar pattern to angle response. In terms of linear response, the calibration results of both A and B were satisfactory. Conclusion Both A and B can be used for normal calibration of H_p(3) in a standard X-ray RQR radiation field. However, in actual monitoring, attention should be paid to the energy and angle response values of TLDs.

Objective:To evaluate the safety and efficacy at 1-year follow-up of the use of drug-coated balloon (DCB) for the treatment of femoropopliteal in-stent restenosis (ISR).Methods:This study enrolled 252 patients undergoing Orchid DCB angioplasty for peripheral arterial disease in the femoral-popliteal segment. The clinical data were retrospectively analyzed.Results:Forty-nine patients were eligible, including 29 (59.2%) chronic total occlusions belonging to TransAtlantic Inter-Society Consensus-Ⅱ(TASC Ⅱ) D, 7 (14.3%) thrombosis, and 14 (28.6%) moderate to severe calcifications. The mean lesion length was (215.9±97.1) mm. 69.4% were of occlusive lesions (Tosaka Ⅲ category). Only 1 provisional stent was implanted. 98% patients had severe claudication or even worse. Of these cases, 34 (73.9%) showed improvements in Rutherford category, while 11 (23.9%) did not change and 1 (2.2%) case deteriorated. The average value of ABI was 0.478±0.264 before surgery and 0.907±0.207 at the end of follow-up. The improvement in Rutherford category ( P<0.01) and ABI ( P<0.005) were both significant. The primary patency (PP) was 80.4%, and the freedom from clinically driven TLR was 84.8% at 1 year. During the follow-up period, there was no all-cause death and major limb amputation. Conclusion:This multicenter study demonstrated the effectiveness of DCB as a treatment for complicated and extensive ISR lesions within 12 months.

Currently, thoracic endovascular aortic repair (TEVAR) is the first-line treatment for patients with complicated Stanford type B aortic dissections. However, TEVAR does not occlude the distal entry tear of dissections, and blood flow persists in the false lumen. Dissections might progress in some patients. Studies showed that distal entry tear increased the possibility of late aortic events during follow-up. Thus, treatment of distal entry tear is necessary in some high-risk patients after TEVAR. In this article, the current treatment strategies of distal entry tear are summarized, which include PETTICOAT, STABILISE, covered stent, fenestrated and branched stent-grafts, false lumen embolization, vascular occluder, and Knickerbocker. However, the number of the cases of most approaches is so limited that the indications and effectiveness need to be further studied. Selecting the right treatment for the right patient is of great importance.

Currently, thoracic endovascular aortic repair (TEVAR) is the first-line treatment for patients with complicated Stanford type B aortic dissections. However, TEVAR does not occlude the distal entry tear of dissections, and blood flow persists in the false lumen. Dissections might progress in some patients. Studies showed that distal entry tear increased the possibility of late aortic events during follow-up. Thus, treatment of distal entry tear is necessary in some high-risk patients after TEVAR. In this article, the current treatment strategies of distal entry tear are summarized, which include PETTICOAT, STABILISE, covered stent, fenestrated and branched stent-grafts, false lumen embolization, vascular occluder, and Knickerbocker. However, the number of the cases of most approaches is so limited that the indications and effectiveness need to be further studied. Selecting the right treatment for the right patient is of great importance.

Objective To determine the incidence and clinical features of headache after carotid endarterectomy (CEA).Methods A retrospective analysis was made on the data of patients undergoing CEA in the Department of Vascular Surgery,Peking Union Medical College Hospital from Jan 2014 to Jan 2015.There were 119 males and 24 females,including 97 cases of symptomatic carotid stenosis and 110 cases of severe carotid stenosis.Results The incidence of newly emergent headache after surgery was 44％ (63/143).The earliest time of headache was 30 minutes after surgery and the latest was 6 days after surgery.95％ of headache occurred within 48 hours after surgery (60/63).79.4％ (50/63) of the headache lay ipsilaterally with CEA,and bilateral headache accounted for 20.6％ (13/63).Severe headache accounted for 4.8％ (3/63),all were ipsilaterally frontal and temporal headache,complicating central nervous system symptoms.Conclusions After CEA headache is a common clinical symptom.Most were mild to moderate and unilateral,which can be relieved spontaneously.Cerebral hemodynamics need to be further examined to differentiate the different pathological states of severe headache on the operative side after CEA because of the high risk of developing hyperperfusion syndrome or cerebral infarction.History of TIA or stroke is the risk factor of post-CEA headache.

Objective To explore the value of the molecular probe USPIO-PEG-sLeX on nasopharyngeal carcinoma xenograft in nude mice.Methods The USPIO nanoparticles was synthesized by physical deposition method,and which was modified by PEG to synthesize USPIO-PEG-sLeX .The nude mice of nasopharyngeal carcinoma xenograft were divided into experimental and control groups.USPIO-PEG-sLeX and USPIO-PEG were injected into nude mice of experimental and control groups by caudal vein,respectively.MR T2 mapping imaging was scanned before and after the injection,and analyzed the changes of T2 values between experimental and control groups. Results USPIO-PEG-sLeX had a good representation.The non-enhanced T2 values between control and experimental group had no statistical significance (P >0.05).However,T2 values of the mice in two groups before and after injections were statistically significant (P <0.05);and T2 values of experimental group were much lower than that of the control group after the injection,additionally,the difference of enhanced rate between the two groups was statistically significant (P <0.05).Conclusion USPIO-PEG-sLeX magnetic nanoparticles is potential to be a targeted contrast agent to ELAM-1 expression of nasopharyngeal carcinoma,and can be valuable in non-invasive dynamic monitoring the expression of ELAM-1.

Objective To determine the utility of single energy CT value and spectrum energy curve in identifying different cause of diffuse spleen enlargement.Methods 43 patients confirmed by either surgical pathology,aspiration biopsy or clinical comprehensive diagnosis and follow-up were assessed,including lymphoma with spleen infiltration(lymphoma group,n=18) and cirrhotic splenomegaly(liver cirrhosis group,n=25).All patients underwent upper abdomen CT scans in GSI mode and the GSI data were transferred to the Workstation AW 4.6 to acquire single energy CT value(40-140 keV,10 keV's interval) and spectrum energy curve of the spleen on the venous phase.All single energy CT values and the slope of curves were comparatively analyzed through independent-samples t test.The diagnostic efficiency were evaluated by ROC analysis.Results Under 40-140 keV energy range,single energy CT values were significantly lower in the lymphoma group than in the liver cirrhosis group(all P＜0.05).The spectrum energy curve were both types of decreasing.Under 40-90 keV,100-140 keV energy range,the slop of curves in the lymphoma group(2.42 ± 0.70,0.27± 0.08) were also significantly lower than in the liver cirrhosis group (3.11 ± 0.62,0.34± 0.07),respectively(all P ＜0.05).When the slope of curve under 40-90 keV energy range was selected as a diagnostic indicator,the area under the curve(AUC) would reach 0.77.If threshold value of 1.39 was taken,the sensitivity and specificity would be equal to 86 ％ and 64 ％,respectively.Conclusion Single energy CT value and spectrum energy curve are helpful for differentiation of lymphoma with spleen infiltration from cirrhotic splenomegaly.

Objective To investigate the distribution of anxiety and depression disorders in patients of carotid artery stenosis (CAS),and the relationship between symptoms of cerebral infarction and the severity of anxiety and depression.Methods We used Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale(SDS) created by William W.K.Zung to evaluate the anxiety and depression disorders associated with CAS in 93 patients hospitalized at the Department of Vascular Surgery,and 146 hospitalized varicose veins patients as acontrols.Results The scales of CAS are significantly higher than the control group(SAS:32 ± 8 vs 29 ± 7,P ＜ 0.001 ; SDS:42 ± 14 vs 35 ± 11,P ＜ 0.001),within-group analysis of CAS shows that there is no statistical difference between symptomatic group and non-symptomatic group (SAS:32 ±8 vs 32 ± 7,P =0.780; SDS:41 ± 14 vs 42 ± 14,P =0.830),or between infarction group and non-infaction group (SAS:31 ± 8 vs 33 ± 8,P =0.147; SDS:39 ± 14 vs 43 ± 13,P =0.241).Conclusions CAS can cause anxiety and depression disorders,and the disorders are not related to symptoms of cerebral ischemia and cerebral infarction.