Objective To observe MRI manifestations of malignant triton tumor(MTT)combined with literature review.Methods Four patients with MTT confirmed by operation and pathology were retrospectively collected,and MRI findings were observed and analyzed combined with literature review.Results Single MTT was found in all 4 cases,located in the right thigh,right side of sacral region,neck and right shoulder,respectively,with the maximum diameter of 8.05-19.91 cm,and the average of 11.62 cm.The tumors shaped irregularly with unclear boundaries,presented as isointensity on T1WI and hyperintensity on T2WI.Intratumoral necrosis smaller than 50%of tumor volume was observed in all 4 cases,showing hypointensity on T1WI and hyperintensity on T2WI.Nodular-like structures were noticed both inside and at the edges of tumors,and"satellite"changes could be observed in some marginal nodules.All 4 lesions showed intratumoral separation presented as isointensity or hyperintensity on T1WI and hypointensity on T2WI were detected in all 4 cases,and intratumoral fascicular structures were found in 3 cases.On enhanced MRI,moderate enhancement and obvious enhancement were noticed each in 2 cases,while no enhancement was observed in the necrotic areas.All 4 MTT lesions grew in diffuse infiltration to the around tissue.Extensive peritumoral edema was found in 3 cases,while local peritumoral edema was observed in 1 case,and bone invasion was detected in 2 cases.No lymph node metastasis was observed in 4 cases.Conclusion MRI manifestations of MTT had certain characteristics.

Objective To analyze the reasons for the failure of subject screening in clinical trials of antineoplastic drugs and the impact of natriuretic criteria on the entry of subjects into clinical trials,to explore the strategies to improve the suc-cessful enrolment of screened subjects,and to provide reference bases for research institutes and sponsors in the formulation of na-triuretic criteria.Methods This study selected data from 40 drug clinical trials conducted at the Drug Clinical Trial Research Center of the Cancer Hospital of the Chinese Academy of Medical Sciences from January 1,2016,to June 30,2022.It statistically described the collected data on the frequency and percentage composition of screening failures among participants and the inclu-sion and exclusion criteria in the protocols.Results A total of 425 subjects were screened out of 40 clinical trial programmers covering 8 tumor types,with the majority being＜65 years of age(333,78.4％),of which the most important reasons included vol-untary withdrawal(71,16.7％),tumor metastasis(52,12.2％),failure to recover from treatment of pre-existing disease(38,8.9％),failure of bone marrow function(19,4.5％),and non-compliant liver function(15,3.5％).Among the nadir indicators,the age of the subjects(100％),ECOG score(97.5％),bone marrow function(ANC:95.0％,PLT:97.5％,HB:97.5％),liver function(T-BiL:95.0％,ALT:87.5％,AST:95.0％),renal function(CR:80.0％),and viral screening(HIV:80.0％,HBV:70.0％,HCV:62.5％)were relatively stringent.Conclusion The main reasons for subject screening failure in clinical trials in oncology in our hospital are voluntary withdrawal,brain metastasis,and failure of their biochemical test standards,which are close-ly related to the setting of clinical trial nadir criteria.Therefore,an in-depth understanding of subjects'characteristics,accurate set-ting of appropriate nadir criteria,continuous improvement of trial design,and strengthening of communication with subjects to pro-vide more relevant information will help to improve the screening success rate of clinical trials.

Objective To investigate the clinical and imaging features of alveolar soft part sarcoma(ASPS).Methods A retro-spective analysis was conducted on the clinical and imaging data of 41 patients with pathologically confirmed ASPS.Results The primary clinical manifestation of 41 patients with ASPS was progressive tumour enlargement.The tumors were located in the but-tocks(14 cases),thighs(11 cases),lower legs(5 cases),forearms(3 cases),upper arms(2 cases),psoas major muscles(2 cases),and one case each in the paracervical region,shoulder,axilla,and plantar regions.Pulmonary metastasis were observed in 30 patients,and 7 patients had metastases to other sites,including 2 cases of intracranial metastasis,1 case of lymph node metastasis,and 4 cases of bone and soft tissue metastasis.Five patients experienced postoperative local recurrence or metastasis.MR was performed in 34 patients,and CT was performed in 32 patients.The tumors were oval or irregular in shape.On CT,the tumors appeared as soft tissue density shadow,with calcification in 8 cases and 68％(17/25)showed marked enhancement with peripheral vascular plexus.On MR,the tumors exhibited isointense T1 and long T2 signals,67％(23/34)showed flow-void vessels within the tumor and 94％(32/34)showed tortuous vascular plexus at the tumor margins.Conclusion ASPS predominantly occurs in the muscles of buttocks and thigh and is prone to lung metastasis.Enhanced CT and MR can reveal vessels within and at the margins of the tumor,which is diagnosti-cally significant for ASPS.

Objective To explore the imaging data and pathological factors affecting the postoperative recurrence of solitary fibrous tumor(SFT)of the central nervous system.Methods A retrospective analysis was conducted on the data of 40 patients with SFT confirmed by pathology.All patients were divided into recurrence group(n=12)and non-recurrence group(n=28)based on the follow-up results.Univariate analysis and Cox proportional hazards model were used to screen the risk factors of recurrence,and the Kaplan-Meier method was used to compare the recurrence-free survival(RFS)among different groups.Results Univariate analysis showed that the Ki-67 index in the recurrence group was significantly higher than that in the non-recurrence group(median 38.5%vs 10.0%,P<0.001),and the proportion of WHO grade 3 was higher than that in the non-recurrence group(66.67%vs 7.14%,P<0.001).MRI features were significantly associated with recurrence,including the maximum diameter of the tumor[(6.63±1.10)cm vs(4.16±1.64)cm,P<0.001],peritumoral edema(91.67%vs 28.57%,P<0.001),and midline structure shift(83.33%vs 17.86%,P<0.001).Multivariate analysis suggested that the risk of recurrence increased by 122%for each 1 cm increase in the maximum diameter of the tumor[hazard ratio(HR)=2.22,95%confidence interval(CI)1.33-3.72],and by 27%for each 1%increase in the Ki-67 index(HR=1.27,95%CI 1.02-1.61),respectively.Conclusion MRI features such as maximum diameter of the tumor,significant peritumoral edema,and midline structure shift should be alert to high recurrence risk,and with pathological grading and Ki-67 index,it can provide significant basis for prognosis evaluation.

Objective:To evaluate the effectiveness of the Total Nutritional Therapy (TNT) course initiated by the Chinese Society for Parenteral and Enteral Nutrition (CSPEN) over the 20 years since its implementation in China.Methods:Participants who attended the CSPEN-organized TNT course between 2005 and 2024 were randomly selected as survey subjects. A four-level questionnaire (reaction, learning, behavior, and results) was developed via expert consensus, based on the Kirkpatrick model. An electronic link to the survey, created via Wenjuanxing, was distributed to invite participants to complete the questionnaire.Results:A total of 1,548 healthcare professionals from various specialties who had received TNT course participated in the online survey. Over 93% of participants reported improvements in theoretical knowledge and 94% in enhanced clinical diagnosis and treatment capabilities. Additionally, 65.4% of participants reported a "significant" or "noticeable" increase in the frequency of nutritional screening and assessments, with the frequency of nutritional support therapy utilization increased by 91.2%. Furthermore, 52.6% of respondents perceived a "significant" or "noticeable" career advancement, particularly in professional title promotion and international academic exchanges. The TNT course also positively impacted discipline development and management: 63.6% of the trainees' hospitals established clinical nutrition departments, 58.98% opened nutrition outpatient clinics, and 56.9% formed nutrition support teams. The adoption rate of standardized procedures, such as nutritional screening, exceeded 92.5% in relevant departments.Conclusions:Over the past 20 years, the CSPEN-led TNT course has successfully established a virtuous cycle of "knowledge dissemination–practice transformation–system innovation" in China. It has played a positive role in enhancing the professional competencies of healthcare workers and promoting the development of clinical nutrition as a discipline.

Purpose To investigate the clinical,imaging,and pathological features of Kikuchi-Fujimoto disease(KFD).Methods A retrospective analysis was conducted on 123 pathologically confirmed KFD cases.Clinical and imaging data were collected,and histopathological features were evaluated using HE staining,immunohistochemistry,in situ hybridization for EBER,and molecular analyses(TCR/Ig gene rearrangements by PCR with capillary electro-phoresis).Results Among the 123 patients,the male-to-female ratio was 1∶2,with a median age of 30 years.All patients presented with lymphadenopathy.Among 30 hospitalized patients,63.3％(19/30)had fever,and 23.3％(7/30)had concurrent autoimmune diseases.Of the 12 patients who underwent PET-CT,91.7％(11/12)were sus-pected of malignancy,prompting biopsy recommendations.Among 47 consultation cases,27.7％(13/47)were ini-tially misdiagnosed as lymphoma.Histopathological examination revealed proliferative,necrotic,and xanthomatous phases,which coexisted or occurred independently.The proliferative phase was characterized by atypical lymphocytes and histiocytes,the necrotic phase by abundant eosinophilic fibrin deposits and nuclear debris,and the xanthomatous phase by clusters of foam-like histiocytes.Immunohistochemically analyses revealed that atypical lymphocytes were neg-ative for CD20,CD4,and CD56 but positive for CD3,CD8,TIA1,Granzyme B,and Perforin.Histiocytes expressed CD68,CD163,and MPO,while CD123-positive plasmacytoid dendritic cells were predominantly located around the le-sions and blood vessels.EBER was positive in individual cells in 4 cases.TCR gene rearrangement was positive in 2 cases and suspected positive in 3 cases,while Ig rearrangement was positive and suspected positive in 1 case each.Conclusion KFD exhibits clinical,imaging,and pathological features that can mimic lymphoma,highlighting the im-portance of accurate diagnosis to avoid misdiagnosis and inappropriate treatment.

Gut microorganisms are central to the intestinal microecosystem, regulating digestive functions and related to immune regulation, metabolic disorders, and nervous system development. Recent studies reveal the multifaceted interactions between micronutrients (MNs) and gut microbiota, where MNs provide essential nutrients to the intestinal flora and influence the production and absorption of various MNs through direct or indirect pathways. This article reviews the recent advances in the effects of water-soluble vitamins, fat-soluble vitamins, and micronutrients on the intestinal microecology, aiming to provide new ideas for future research.

Objective To evaluate the caregiving capacity of family caregivers of children with hirschsprung's disease(HD)and to establish an evidence base for developing family-empowered home care interventions.Methods An explanatory sequential mixed-method design was employed.A total of 308 family caregivers of HD patients admitted to the Pediatric Surgery Department of a tertiary children's hospital in Shanghai,were enrolled from July 2019 to July 2024.Quantitative data were collected in 2024 using a demographic questionnaire,the Zarit Caregiver Burden Interview and the Family Caregiver Task Inventory.Semi-structured interviews were conducted in August to December 2024 with 15 caregivers of children with HD with poor caregiving skills.Quantitative data were analyzed using nonparametric tests and multiple linear regression,and qualitative information was refined through Colaizzi's 7-step analysis of themes.Results In the end,281 valid questionnaires were recovered.The total caregiving competence was 12.00(6.00,20.00).Multivariate analysis identified significant predictors of caregiving competence,including children in the postoperative dilation period,frequency of enterocolitis episodes,place of residence monthly household income and burden of caregiving were the factors influencing the ability of family caregivers to take care of their children(P＜0.05).Qualitative analysis revealed 4 themes:persistent multidimensional adaptive challenges,disparity in clinical caregiving skills,systemic support limitations,and role multiplicity strain.Conclusion Family caregivers of children with HD face multidimensional stressors,necessitating a dynamic,family-centered support ecosystem.Strategic interventions should focus on enhancing clinical caregiving literacy while improving access to socioeconomic resources and establishing role-specific support networks.

Purpose To investigate the clinical,imaging,and pathological features of Kikuchi-Fujimoto disease(KFD).Methods A retrospective analysis was conducted on 123 pathologically confirmed KFD cases.Clinical and imaging data were collected,and histopathological features were evaluated using HE staining,immunohistochemistry,in situ hybridization for EBER,and molecular analyses(TCR/Ig gene rearrangements by PCR with capillary electro-phoresis).Results Among the 123 patients,the male-to-female ratio was 1∶2,with a median age of 30 years.All patients presented with lymphadenopathy.Among 30 hospitalized patients,63.3％(19/30)had fever,and 23.3％(7/30)had concurrent autoimmune diseases.Of the 12 patients who underwent PET-CT,91.7％(11/12)were sus-pected of malignancy,prompting biopsy recommendations.Among 47 consultation cases,27.7％(13/47)were ini-tially misdiagnosed as lymphoma.Histopathological examination revealed proliferative,necrotic,and xanthomatous phases,which coexisted or occurred independently.The proliferative phase was characterized by atypical lymphocytes and histiocytes,the necrotic phase by abundant eosinophilic fibrin deposits and nuclear debris,and the xanthomatous phase by clusters of foam-like histiocytes.Immunohistochemically analyses revealed that atypical lymphocytes were neg-ative for CD20,CD4,and CD56 but positive for CD3,CD8,TIA1,Granzyme B,and Perforin.Histiocytes expressed CD68,CD163,and MPO,while CD123-positive plasmacytoid dendritic cells were predominantly located around the le-sions and blood vessels.EBER was positive in individual cells in 4 cases.TCR gene rearrangement was positive in 2 cases and suspected positive in 3 cases,while Ig rearrangement was positive and suspected positive in 1 case each.Conclusion KFD exhibits clinical,imaging,and pathological features that can mimic lymphoma,highlighting the im-portance of accurate diagnosis to avoid misdiagnosis and inappropriate treatment.

Purpose To investigate the expression of chromogranin A(CgA)in gastroenteropancreatic neuroendo-crine neoplasms(GEP-NENs)and its relationship with clinicopathological features.Methods The clinicopathological data of GEP-NENs diagnosed in the Department of Pathology,Beijing Chao-yang Hospital,Capital Medical University from May 2011 to December 2024 were retrospectively analyzed.Immunohistochemical staining was applied to evaluate the expression of CgA,and the patients were divided into CgA(+)group and CgA(-)group.Differences in clinico-pathological features between the 2 groups were compared.Results The age of 229 patients ranged from 21 to 89 years,with an average age of 54.4 years.The most common primary site was the rectum(56.8％,130/229),fol-lowed by the stomach(16.6％,38/229),pancreas(14.4％,33/229),small intestine(6.1％,14/229),and colon(6.1％,14/229).There were 206 cases of single lesion and 23 cases of multiple lesions(number of tumors ≥2).There were 153 cases of G1(66.8％),29 cases of G2(12.7％),7 cases of G3(3.1％),and 40 cases of neuroendocrine carcinoma(NEC,17.5％).The positive rates of CgA in G1,G2,G3,and NEC groups were 37.2％,75.8％,71.4％,and 65.0％,respectively,with statistically significant differences(P＜0.001).The positive rates of CgA in T1,T2,T3,and T4 were 37.2％,83.3％,75.9％,and 57.7％,respectively,with statistically significant differences(P＜0.001).There were significant differences in age,vascular invasion,lymph node metasta-sis,and number of tumors between CgA(+)group and CgA(-)group(P＜0.001),but there was no significant difference in sex,tumor location,Syn,and CD56 expression between the two groups(P=0.595,P=0.098,P=0.173,P=0.557).Conclusion Immunohistochemical antibody CgA is a useful marker for GEP-NENs.CgA positiv-ity may be a poor prognostic factor for GEP-NENs patients.