Objective:To evaluate the effect of acupuncture on postoperative delirium (POD) in diabetic patients undergoing surgery under general anesthesia.Methods:In this randomized controlled trial, 92 diabetic patients of either sex, aged 30-80 yr, with a body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective surgery under general anesthesia, were divided into 2 groups ( n=46 each) using a table of random numbers: control group (group C) and acupuncture group (group A). Group A received acupuncture at the Baihui (GV20), Shenting (GV24) and Sishencong (EX-HN1) acupoints before anesthesia. The needles were retained for 30 min, with manual stimulation applied every 10 min for 10 s each time. After 4 stimulations, routine anesthesia was carried out. Group C received routine anesthesia only. Regional cerebral oxygen saturation was recorded on admission to the operating room (T 0), after anesthesia induction (T 1), at the start of surgery (T 2), at the end of surgery (T 3), and immediately after tracheal extubation (T 4). The POD developed within 3 days after surgery was assessed. The occurrence of needle-related adverse effects such as fainting, subcutaneous bleeding, and local paresthesia was recorded. Results:Compared with group C, the incidence of POD was significantly reduced, and the regional cerebral oxygen saturation was increased at T 1, 4 in group A ( P<0.05). Conclusions:Acupuncture can decrease the development of POD in diabetic patients undergoing surgery under general anesthesia, which is related to an increase in regional cerebral oxygen saturation.

Acute pancreatitis(AP)is a common digestive disorder associated with moderate to high nutritional risks,necessitating timely nutritional support.Over the past five decades,medical nutrition therapy for AP has undergone a paradigm shift,transitioning from traditional fasting based on the"pancreatic rest theory"to the current emphasis on early enteral feeding to"awaken the gut."Currently,nutritional treatment has become a cornerstone of comprehensive AP management.The European Society for Clinical Nutrition and Metabolism(ESPEN),founded in 1980,is a leading professional organization dedicated to advancing research,clinical practice,and education in clinical nutrition and metabolism.To date,ESPEN has published five evidence-based guidelines on nutritional management in pancreatic diseases.This article reviews the evolution of AP nutritional therapy as outlined in these ESPEN guidelines,highlighting key recommendations and their clinical implications.

Lung cancer poses a serious threat to global public health security.Chemotherapy,as the main strategy for cancer treatment,faces challenges such as high toxicity and drug resistance.Anticancer peptides have the potential of being developed into new anticancer drugs due to their advantages of broad-spectrum anticancer activity,rapid action,and difficulty in generating drug resistance,but they also face shortcomings such as weak activity and strong toxic side effects.The weakly acidic microenvironment of tumors(pH 6.5-6.8)provides a good idea for the design of anticancer peptides of high-efficiency and low-toxicity.Previously,we designed the acid-sensitive antibacterial peptide pHly-1 using the wolf spider(Lycosa singoriensis)toxin Lycosin-Ⅰ as a template.In this study,we found that pHly-1 also had acid-sensitive anticancer activity.Further alanine scanning analysis of pHly-1 was carried out,and we ob-tained a mutant pHTP-2 with better acid sensitivity,whose IC50(half maximal inhibitory concentration)against A549 cells was 15.68 μmol/L at pH 6.6 and was greater than 100 μmol/L at pH 7.4.At pH 6.6,pHTP-2 could act on various lung cancer cell lines and induce the death of A549 cells by rapid ly-sis;at pH 7.4,500 μmol/L pHTP-2 had weak toxicity to red blood cells(the hemolysis rate was ap-proximately 38％)and primary myocardial cells(the inhibition rate was 49.7％,with P＜0.05).Analy-sis of its charge,particle size,morphology,and secondary structure showed that at pH 6.6,the histidine in the sequence of pHTP-2 was protonated,increasing the positive charge(P＜0.01),decreasing the hy-drated particle size(P＜0.05)and forming an α-helical structure to induce membrane lysis of A549 cells.At pH 7.4,it was deprotonated,the positive charge decreases,a β-sheet structure was formed and self-aggregation occurred,limiting its effect on the A549 cell membrane and showing weak activity.In summary,pHTP-2 could respond to the weakly acidic microenvironment of tumors to exert selective cyto-toxic activity,effectively overcoming the shortcomings of anticancer peptides such as low efficiency and high toxicity.Our findings suggest that it is a high-quality lead molecule for anticancer drugs.

Objective To explore the clinical efficacy of different mucosal incision methods in endoscopic submucosal dissection(ESD)for the treatment of gastric submucosal tumors.Methods A retrospective analysis was conducted on the clinical data of 30 patients with gastric submucosal tumors treated with ESD from July 2022 to March 2024.They were divided into a circular group(n=15)and a longitudinal group(n=15)based on different mucosal incision methods.Then compare the pathological data,clinical efficacy,surgical outcomes,and complications between the two groups.Results There were no statistically significant differences between the two groups in length of hospital stay,hospitalization costs,lesion diameter,lesion location and lesion nature(P＞0.05).The surgical time of the longitudinal group was significantly shorter than that of the circular group,and the difference was statistically significant(P＜0.05);There was no statistical significant in the incidence of intraoperative complications in the longitudinal group and the circular group(P＞0.05);The complete resection rate of the longitudinal group was lower than that of the circular group,but the difference was not statistically significant(P＞0.05).Conclusion ESD treatment for gastric submucosal tumors is safe and effective,and the longitudinal incision can shorten the surgical time compared to the circular incision.Both methods have the characteristics of low incidence of complications and high complete resection rate,and are worthy of clinical application.

Objective To explore the clinical efficacy of different mucosal incision methods in endoscopic submucosal dissection(ESD)for the treatment of gastric submucosal tumors.Methods A retrospective analysis was conducted on the clinical data of 30 patients with gastric submucosal tumors treated with ESD from July 2022 to March 2024.They were divided into a circular group(n=15)and a longitudinal group(n=15)based on different mucosal incision methods.Then compare the pathological data,clinical efficacy,surgical outcomes,and complications between the two groups.Results There were no statistically significant differences between the two groups in length of hospital stay,hospitalization costs,lesion diameter,lesion location and lesion nature(P＞0.05).The surgical time of the longitudinal group was significantly shorter than that of the circular group,and the difference was statistically significant(P＜0.05);There was no statistical significant in the incidence of intraoperative complications in the longitudinal group and the circular group(P＞0.05);The complete resection rate of the longitudinal group was lower than that of the circular group,but the difference was not statistically significant(P＞0.05).Conclusion ESD treatment for gastric submucosal tumors is safe and effective,and the longitudinal incision can shorten the surgical time compared to the circular incision.Both methods have the characteristics of low incidence of complications and high complete resection rate,and are worthy of clinical application.

Objective:To use machine learning to predict the efficacy of accelerated corneal collagen cross-linking (A-CXL) surgery, identify prognostic factors, and construct models to predict postoperative disease progression.Methods:A single-center retrospective study was conducted.A total of 82 keratoconus patients (112 eyes) who underwent A-CXL surgery at the West China Hospital of Sichuan University between March and December 2021 were enrolled.Preoperative and follow-up examinations included anterior segment evaluation by slit-lamp microscopy, corneal topography using Pentacam, and corneal biomechanical indices using Corvis ST.Disease progression was defined as an increase in maximum keratometry (Kmax) of ≥1 D from the preoperative level at the last follow-up.Various machine learning algorithms were employed to analyze corneal topography, biomechanical parameters and corneal densitometry values to identify prognostic factors and construct models for predicting postoperative disease progression.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of West China Hospital, Sichuan University (No.2023496).Written informed consent was obtained from each subject.Results:During follow-up, 15.1% (17/112) of the eyes showed progression after A-CXL.The preoperative astigmatism and stress-strain index (SSI) in the progression group were (-5.41±2.72)D and 1.41±0.78, respectively, which were significantly higher than (-3.30±2.54)D and 0.95±0.98 in the non-progression group ( t=2.80, 2.03; both P<0.05).Cox regression analysis identified preoperative astigmatism (hazard ratio [HR]=1.20), SSI (HR=1.10), and anterior corneal densitometry of 2-6 mm (CDA6) (HR=2.10) as significant risk factors for post-A-CXL progression.Among various machine learning models developed and validated, the area under the curve (AUC) values for logistic regression, multilayer perceptron (MLP) model, and random forest (RF) exceeded 0.700.For F1-score, the AUC values for logistic regression, MLP, and RF were 0.870, 0.880, and 0.880, respectively.The network structure of the visualized MLP was a single-layer, 24-neurons neural network with 80% accuracy in predicting whether progression occurred after A-CXL.The clinical nomogram developed in conjunction with astigmatism, SSI, and CDA6 predicted the cumulative probability of progression at 0.5, 1, and 2 years postoperatively based on the sum of the specified values for each variable, and based on the optimal cutoff value, keratoconus corneas could be classified into high-, intermediate-, and low-risk groups, respectively.The time-dependent subject operating characteristic curves of the nomogram showed AUCs of 0.734, 0.685, and 0.935 at 0.5, 1, and 2 years postoperatively, respectively, all of which performed well in predicting progression. Conclusions:Preoperative astigmatism, SSI, and CDA6 are significant risk factors for post-A-CXL progression in keratoconus.The MLP model can accurately predict postoperative disease progression, and the clinical nomogram combining preoperative astigmatism, SSI, and CDA6 can effectively differentiate between low-, medium-, and high-risk postoperative progression outcomes.

Objective To investigate the feasibility,efficacy and safety of cold snare polypectomy(CSP)and endoscopic mucosal resection(EMR)in treatment of colonic adenoma in proximity to the orifice of appendix.Methods Clinical data of 41 cases of colonic adenoma in the orifice of appendix treated with CSP(CSP group)and 15 cases treated with EMR(EMR group)from January 2018 to January 2023 were collected.The clinicopathological features and outcomes were analyzed.The main outcome was postoperative complications,including bleeding,perforation and postoperative appendicitis,while the secondary outcome was the total resection rate,block resection rate and local recurrence rate.Results The operation time and treatment cost of CSP group were shorter than EMR group,and the differences were statistically significant(P<0.05).The diameter of applicable lesions in CSP group was smaller than that in EMR group,and the proportion of lesions with tubular adenoma was significantly higher than that in EMR group.There were no significant differences in the time of admission,intestinal preparation score,length of stay,lesion morphology and lesion type between the two groups(P>0.05).Perforation and postoperative appendicitis were not observed in both groups,and delayed postoperative hemorrhage occurred in 1 case in the CSP group,but it could heal itself after surgery without endoscopic intervention.The complete resection rate was 100.0%in both groups.The total removal rate of CSP group was 100.0%,which was significantly higher than that of EMR group(86.7%),and the difference was statistically significant(P<0.05).The local recurrence rate was 2.4%(1/41)in CSP group,and no local recurrence was observed in EMR group(0/15),with no statistical significance(P>0.05).Conclusion CSP and EMR are safe and effective in the treatment of colonic adenoma in proximity to the orifice of appendix,and they are trustworthy.Compared with EMR,CSP is more applied to small diameter tubular adenomas,which has the characteristics of economy and time saving,but at the same time there is the risk of recurrence.EMR obviously has a wider application range,but there is a disadvantage in price and time,and individual cases need to be segmented resection.

Objective To propose a classification model based on a pseudo-bag strategy and feature adjustment for whole slide imaging in pathology.Methods A pseudo-bag generator was constructed to divide a parent bag into 3 pseudo-bags for increasing the number of training bags.Then,a pseudo-bag learning method based on Nystr?m-based algorithm for approximating self-attention and a selective feature fusion method were employed to process the pseudo-bags.Specifically,the pseudo-bag learning method based on Nystr?m-based algorithm for approximating self-attention reduced computational complexity through an improved multi-head self-attention mechanism while deeply extracting instance features to obtain pseudo-bag classification predictions,thereby enhancing pseudo-bag classification accuracy;and the selective feature fusion method refined pseudo-bag features by filtering and extracting relevant instances.Finally,the model adjusted bag features by extracting confounding factors to avoid interference from irrelevant information and further improve classification accuracy.Results The proposed model was evaluated on two datasets(CAMELYON-16 and TCGA-NSCLC)and compared with 10 other methods,and the results demonstrated that the proposed model achieved the best performance.The proposed method reached an accuracy of 0.943 on the CAMELYON-16 dataset and 0.906 on the TCGA-NSCLC dataset.Conclusion The proposed model can significantly improve the accuracy of whole-slide pathological image classification by effectively mitigating the overfitting and avoiding interference from irrelevant information.

Objective:To investigate the clinical characteristics of patients with multiple myeloma(MM)complicated by bone lesions and the risk factors associated with bone lesions.Methods:The clinical data of 294 newly diagnosed MM patients in Gansu Provincial Hospital from January 2017 to June 2021 were retrospectively analyzed.The patients were divided into the bone lesion group(154 cases)and the non-bone lesions group(140 cases)based on the presence of absence of bone lesions at diagnosis.The general data and laboratory parameters were compared between the two groups.The risk factors for bone lesions in MM patients were analyzed by logistic regression analysis,and the characteristic(ROC)curves were plotted to assess the predictive value of each risk factor for the occurrence of bone lesions in MM patients.Results:Compared to the non-bone lesion group,the bone lesion group had significantly higher serum calcium levels and significantly greater proportions of patients with Durie-Salmon(DS)stage Ⅲ,and bone pain(all P＜0.05).Logistic regression analysis showed that elevated serum calcium(OR=5.135,95％CI:1.931-13.653,P=0.001),DS stage Ⅲ(OR=1.841,95％CI:1.019-3.328,P=0.043),and bone pain(OR=8.208,95％CI:4.761-14.151,P＜0.001)were independent risk factors for bone lesions in MM patients.ROC curve analysis showed that serum calcium(AUC=0.619,95％CI:0.555-0.683,P＜0.001)and bone pain(AUC=0.743,95％CI:0.692-0.793,P＜0.001)had predictive value for bone lesions in MM patients.Conclusion:MM patients have a high incidence of bone lesions,and active monitoring and management of risk factors may improve treatment outcomes and prognosis.

A VLi-net based cell nucleus segmentation method integrating convolutional neural networks(CNN)and Vision Transformer(ViT)is proposed to address the limitation that the U-Net with CNN as its backbone is only proficient in capturing local features and has a restricted receptive field.Firstly,to mitigate challenges such as high cost of data annotation and insufficient annotated data,text annotations are introduced to enhance the network's understanding of image information.Secondly,to improve the segmentation performance of VLi-net,ViT and CNN are combined to fully extract global and local features,with multi-receptive field convolution features incorporating into the ViT structure for effectively mitigating the issues of limited local information interaction and single feature representation in ViT.Finally,an interactive fusion module(ViFusion)is used to efficiently fuse the multi-level features from the CNN and ViT branches.Experimental results show that VLi-net achieves a Dice coefficient of 80.85%and a mean intersection over union(MIoU)of 66.83%on the MoNuSeg dataset,obtains a Dice coefficient of 80.53%and a MIoU of 67.54%on the DSB-2018 dataset,and has a Dice coefficient of 86.87%and a MIoU of 77.44%on the TNBC dataset.These findings confirm that VLi-net outperforms other methods across multiple experimental metrics.