A self-attention generative adversarial network(SAGAN)is proposed to improve the accuracy of histological subtype prediction for lung cancer cases.After collecting and preprocessing the lung cancer image dataset and data augmentation,SAGAN model is trained,where the generator uses self-attention mechanism to strengthen feature extraction,while the discriminator optimizes the generation process.Experimental results show that SAGAN model achieves accuracies of 0.852 and 0.845 on the training and test sets,respectively,with recall rates of 0.833 and 0.829,outperforming the other models.Additionally,the narrow confidence intervals indicate the high stability of SAGAN model in classification.SAGAN is helpful for lung cancer image analysis,providing stronger support for clinical decision-making.

A self-attention generative adversarial network(SAGAN)is proposed to improve the accuracy of histological subtype prediction for lung cancer cases.After collecting and preprocessing the lung cancer image dataset and data augmentation,SAGAN model is trained,where the generator uses self-attention mechanism to strengthen feature extraction,while the discriminator optimizes the generation process.Experimental results show that SAGAN model achieves accuracies of 0.852 and 0.845 on the training and test sets,respectively,with recall rates of 0.833 and 0.829,outperforming the other models.Additionally,the narrow confidence intervals indicate the high stability of SAGAN model in classification.SAGAN is helpful for lung cancer image analysis,providing stronger support for clinical decision-making.

Objective:To investigate the effects of glycopyrrolate on intestinal spasm and hemodynamics in painless colonoscopy.Methods:A total of 100 patients who were scheduled to undergo painless colonoscopy were selected as the study subjects and randomly divided into two groups by a computerized number method. Ten patients in both groups dropped out because of disruption of the study protocol, and 45 patients from each group were included in the final analysis. Before anesthesia induction, patients in group glycopyrrolate (group G) were injected with 0.2 mg glycopyrrolate, while those in congtrol group (group C) were injected with an equal amount of saline. The heart rate, systolic blood pressure, and diastolic blood pressure were recorded at T 0 (baseline period), T 1 (after anesthesia induction), T 2 (colonoscopy over sigmoid colon), T 3 (colonoscopy over the liver region), T 4 (after the end of examination), and T 5 (at the awakening phase), and the degree of intestinal spasm was assessed intraoperatively using the Likert′s four-point scale. The numerical rating scale (NRS) was used to assess preoperative and postoperative pain. The incidence of adverse events was recorded. Results:The general data at baseline were not statistically different between the two groups ( P>0.05). During the procedure, patients in group G had lower intraoperative intestinal spasm scores than those in group C ( P=0.028). Intraoperative hypotension and bradycardia occurrence were lower in group G than in group C ( P<0.05), and intraoperative norepinephrine use was also lower than in the group C ( P=0.034). Postoperative visual analog scale pain scores were lower in group G ( P=0.047), but patients who used glycopyrrolate had a higher proportion of dry mouth ( P=0.035). Conclusion:During painless colonoscopy, preoperative administration of glycopyrrolate significantly improved intraoperative hemodynamic fluctuations, reduced the incidence of hypotension and bradycardia, and relieved postoperative pain. However, glycopyrrolate use resulted in the risk of dry mouth.

[Objective]To discuss Professor LIN Shangzhu's experience in treating chronic atrophic gastritis (CAG).[Methods]Through clinical follow-up learning,analyzing related medical cases and summarizing Professor LIN Shangzhu's clinical experience in treating CAG from the aspects of etiology and pathogenesis,treatment characteristics,and therapeutic methods and prescriptions,with a medical case for substantiating it.[Results]Professor LIN Shangzhu thought that the pathogenesis of CAG was related to deficient root and excessive superficial.It was based on spleen and stomach of asthenia of healthy energy,and Qi stagnation,phlegm dampness stagnation,blood stasis and residual heat toxin are the temporary solutions.He proposed that "Qi deficiency and collateral stasis syndrome" was a common clinical syndrome of CAG.The treatment should be based on invigorating the spleen and replenishing Qi,supplemented by products for promoting blood circulation and removing blood stasis,taking into account the methods of warming Yang,nourishing Yin,regulating Qi and dispelling dampness.In the medical record,the patient was of deficiency of spleen Qi and functional activities of Qi would be obstructed.Combining with symptoms,tongue,pulse and applying syndrome differentiation and treatment,the case was treated with modified Liujunzi Decoction to invigorate the spleen and replenish Qi,promote blood circulation and remove blood stasis,eliminate phlegm and descend inverse,dissipate dampness and promote appetite,clear residual heat toxin in order to tackle both symptoms and root causes for the exact clinical effect.[Conclusion]Professor LIN Shangzhu treats CAG from deficiency,stagnation,phlegm and blood stasis,it has certain reference significance in the prevention and treatment of the disease with traditional Chinese medicine.

[Objective]To discuss Professor LIN Shangzhu's experience in treating chronic atrophic gastritis (CAG).[Methods]Through clinical follow-up learning,analyzing related medical cases and summarizing Professor LIN Shangzhu's clinical experience in treating CAG from the aspects of etiology and pathogenesis,treatment characteristics,and therapeutic methods and prescriptions,with a medical case for substantiating it.[Results]Professor LIN Shangzhu thought that the pathogenesis of CAG was related to deficient root and excessive superficial.It was based on spleen and stomach of asthenia of healthy energy,and Qi stagnation,phlegm dampness stagnation,blood stasis and residual heat toxin are the temporary solutions.He proposed that "Qi deficiency and collateral stasis syndrome" was a common clinical syndrome of CAG.The treatment should be based on invigorating the spleen and replenishing Qi,supplemented by products for promoting blood circulation and removing blood stasis,taking into account the methods of warming Yang,nourishing Yin,regulating Qi and dispelling dampness.In the medical record,the patient was of deficiency of spleen Qi and functional activities of Qi would be obstructed.Combining with symptoms,tongue,pulse and applying syndrome differentiation and treatment,the case was treated with modified Liujunzi Decoction to invigorate the spleen and replenish Qi,promote blood circulation and remove blood stasis,eliminate phlegm and descend inverse,dissipate dampness and promote appetite,clear residual heat toxin in order to tackle both symptoms and root causes for the exact clinical effect.[Conclusion]Professor LIN Shangzhu treats CAG from deficiency,stagnation,phlegm and blood stasis,it has certain reference significance in the prevention and treatment of the disease with traditional Chinese medicine.

Purpose: We aimed to evaluate whether the addition of pemetrexed is effective in improving progression-free survival (PFS) in epidermal growth factor receptor (EGFR)–mutated patients with or without concomitant alterations. Materials and Methods: This multicenter clinical trial was conducted in China from June 15, 2018, to May 31, 2019. A total of 92 non–small cell lung cancer (NSCLC) patients harboring EGFR-sensitive mutations were included and divided into concomitant and non-concomitant groups. Patients in each group were randomly treated with EGFR–tyrosine kinase inhibitor (TKI) monotherapy or EGFR-TKI combined with pemetrexed in a ratio of 1:1. PFS was recorded as the primary endpoint. Results: The overall median PFS of this cohort was 10.1 months. There were no significant differences in PFS between patients with and without concomitant and between patients received TKI monotherapy and TKI combined with pemetrexed (p=0.210 and p=0.085, respectively). Stratification analysis indicated that patients received TKI monotherapy had a significantly longer PFS in non-concomitant group than that in concomitant group (p=0.002). In concomitant group, patients received TKI combined with pemetrexed had a significantly longer PFS than patients received TKI monotherapy (p=0.013). Molecular dynamic analysis showed rapidly emerging EGFR T790M in patients received TKI monotherapy. EGFR mutation abundance decreased in patients received TKI combined chemotherapy, which supports better efficacy for a TKI combined chemotherapy as compared to TKI monotherapy. A good correlation between therapeutic efficacy and a change in circulating tumor DNA (ctDNA) status was found in 66% of patients, supporting the guiding role of ctDNA minimal residual disease (MRD) in NSCLC treatment. Conclusion EGFR-TKI monotherapy is applicable to EGFR-sensitive patients without concomitant alterations, while a TKI combined chemotherapy is applicable to EGFR-sensitive patients with concomitant alterations. CtDNA MRD may be a potential biomarker for predicting therapeutic efficacy.

The paper reported a case of a young male patient, with graft-versus-host disease (GVHD) multi-organ involvement lesions after allo-hematopoietic stem cell transplantation. The patient had diverse clinical manifestations, and overlapping acute and chronic disease processes. Acute GVHD were mainly hyperbilirubinemia, with or without elevated transaminase, bloody watery stools; chronic GVHD were highlighted by extensive skin depigmentation, oral mucosal ulcer, sick nails, etc., and chronic signs, such as membranous nephropathy, polyserositis and pulmonary restrictive ventilatory insufficiency. The diagnosis of chronic GVHD mainly relies on medical history combined with clinical manifestations, and it's needed to exclude infections, drugs and tumors. Besides, the rate of missed diagnosis and misdiagnose is high, and it requires multidisciplinary diagnosis and treatment. Combined with the literature review, it indicates that there is a greater risk of GVHD in the male recipient with female donor, and peripheral blood stem cell transplant patients have a higher incidence than bone marrow transplant patients after hematopoietic stem cell transplantation, but the effect of the graft-versus-leukemia exists. Currently, glucocorticoids therapy with or without calcineurin inhibitors are the first-line treatment for GVHD, but the overall prognosis is poor.

Objectives:To investigate the clinical and genetic features of young Chinese patients with myeloproliferative neoplasms (MPN) .Methods:In this cross-sectional study, anonymous questionnaires were distributed to patients with MPN patients nationwide. The respondents were divided into 3 groups based on their age at diagnosis: young (≤40 years) , middle-aged (41-60 years) , and elderly (>60 years) . We compared the clinical and genetic characteristics of three groups of MPN patients.Results:1727 assessable questionnaires were collected. There were 453 (26.2%) young respondents with MPNs, including 274 with essential thrombocythemia (ET) , 80 with polycythemia vera (PV) , and 99 with myelofibrosis. Among the young group, 178 (39.3%) were male, and the median age was 31 (18-40) years. In comparison to middle-aged and elderly respondents, young respondents with MPN were more likely to present with a higher proportion of unmarried status (all P<0.001) , a higher education level (all P<0.001) , less comorbidity (ies) , fewer medications (all P<0.001) , and low-risk stratification (all P<0.001) . Younger respondents experienced headache (ET, P<0.001; PV, P=0.007; MF, P=0.001) at diagnosis, had splenomegaly at diagnosis (PV, P<0.001) , and survey (ET, P=0.052; PV, P=0.063) . Younger respondents had fewer thrombotic events at diagnosis (ET, P<0.001; PV, P=0.011) and during the survey (ET, P<0.001; PV, P=0.003) . JAK2 mutations were found in fewer young people (ET, P<0.001; PV, P<0.001; MF, P=0.013) ; however, CALR mutations were found in more young people (ET, P<0.001; MF, P=0.015) . Furthermore, mutations in non-driver genes (ET, P=0.042; PV, P=0.043; MF, P=0.004) and high-molecular risk mutations (ET, P=0.024; PV, P=0.023; MF, P=0.001) were found in fewer young respondents. Conclusion:Compared with middle-aged and elderly patients, young patients with MPN had unique clinical and genetic characteristics.

Objective:To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test.Methods:This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ2 test. A kappa test was used to compare the consistency between groups. Results:After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea ( Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences ( P < 0.001). Conclusion:The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.

Objective:To evaluate the compliance with Chinese Residency Training Program of radiation oncology and provide reference for the improvement of system reform and base construction.Methods:An survey was conducted among residents who had completed residency training program of radiation oncology by online questionnaires in four dimensions, including the fulfillment of training center in hardware, personnel and procedures, the compliance with syllabuses, mechanism of trainee evaluation, and the passing rate and satisfaction degree of trainees.Results:The results showed that most training centers fulfilled the requirement of equipment, mentoring personnel and procedures. The training syllabuses had been followed and integrated with organization multi-modalities. The trainees with high degree of satisfaction accounted for 65.6%, and the final qualification passing rate reached 75.5%. However, there were less reference textbooks, insufficient training in general medicine, limited clinical practice, and low output in academic publication.Conclusions:The residency training program of radiation oncology has been established in China and achieved notable progress. For the further improvement, quantitative optimization of procedures, increasing opportunity of practice and strengthening scientific research involvement would be beneficial.