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 and analyze the impact of intraocular higher-order aberrations and total ocular higher-order aberrations on visual quality after the implantation of different types of multifocal intraocular lenses(MIOL),in order to provide personalized MIOL selection recommendations for patients.Methods A total of 107 patients(107 eyes)with age-related cataract were selected and divided into the SBL-3,MF15,ZMB00,and Zeiss809 groups based on the type of MIOL implanted.Uncorrected distance visual acuity(UCDVA),best-corrected distance visual acuity(BCDVA),best-corrected near visual acuity(BCNVA),optical parameters and wavefront aberrations were compared 3 months postop-eratively.Results Preoperatively,there were no statistically significant differences in any optical parameters or visual acuity among the four groups(all P＞0.05).At three months postoperatively,there were no significant differences in UCD-VA,BCDVA,BCNVA,corneal aberration,or intraocular spherical aberration among the four groups(all P＞0.05).How-ever,significant differences were observed in the predicted visual acuity at 100％,20％,and 9％contrast(100％VA,20％VA,9％VA),streller ratio(SR),modulation transfer function cutoff frequency(MTF cutoff),intraocular coma,intraocu-lar trefoil,total higher-order aberrations,and the average modulation transfer function height values(MTF AH)of the en-tire eye across various spatial frequencies showed significant differences(all P＜0.05).Pairwise comparisons showed that the ZMB00 and Zeiss809 groups had significantly better 100％VA,20％VA,9％VA,SR,MTF cutoff,and MTF AH,and sig-nificantly lower intraocular coma,intraocular trefoil,and total higher-order aberrations than the SBL-3 group(all P＜0.05).The MF15 group only had significantly lower intraocular trefoil than the SBL-3 group(P＜0.05).Correlation analy-sis results at 3 months postoperatively showed that in the SBL-3 and MF15 groups,UCDVA(logMAR)was positively corre-lated with the objective scattering index and negatively correlated with 100％VA,20％VA,9％VA,SR,and MTF cutoff(all P＜0.05).MTF AH was negatively correlated with intraocular coma and total higher-order aberrations,and positively cor-related with intraocular spherical aberration(all P＜0.05).In the ZMB00 and Zeiss809 groups,MTF AH was negatively cor-related with intraocular coma,intraocular trefoil,and total higher-order aberrations(all P＜0.05),but showed no correla-tion with intraocular spherical aberration(all P＞0.05).Conclusion There are no differences in UCDVA,BCDVA,or BCNVA among patients implanted with the four types of MIOLs,but differences existed in objective visual quality.The ob-jective visual quality of ZMB00 and Zeiss809 is significantly better than that of SBL-3,making them the preferred choices for patients with high-quality visual demands;SBL-3 is suitable for basic demand scenarios;MF15,which is only superior to SBL-3 in terms of intraocular trefoil,can be a compromise option for those sensitive to trefoil aberration.

Objective:To analyze the risk factors associated with future exacerbations in patients with chronic obstructive pulmonary disease (COPD) who have no history of exacerbation in the past year.Methods:COPD patients with no exacerbation history in the past year, registered in the RealDTC study from January 2018 to December 2023, were enrolled. Demographic data, COPD Assessment Test (CAT) scores, modified Medical Research Council (mMRC) dyspnea questionnaire scores, forced expiratory volume in the first second predicted of percentage (FEV 1%pred), forced expiratory volume in one second (FEV 1) to forced vital capacity (FVC), Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, GOLD groups, and inhaled medication regimens were collected. All patients were followed up for one year, and the number of exacerbations was recorded. Patients were divided into an exacerbation group and a non-exacerbation group based on the occurrence of exacerbations during the follow-up period. Logistic regression analysis was used to screen the influencing factors for exacerbations in COPD patients. Results:A total of 2 901 COPD patients were included, among which 633 patients (21.8%) experienced exacerbations during the follow-up period. Compared with the non-exacerbation group, patients in the exacerbation group were older, with higher CAT and mMRC scores, lower body mass index (BMI), FEV 1%pred, and FEV 1/FVC. The proportions of patients with high school education or above and those using long-acting β 2-agonist (LABA) + long-acting muscarinic antagonist (LAMA) medications were also lower (all P<0.05). Logistic regression analysis showed that age ( OR=1.010, 95% CI: 1.000-1.021), CAT score ≥20 ( OR=1.415, 95% CI: 1.074-1.865), education level of junior high school or below ( OR=1.243, 95% CI: 1.003-1.540), LABA + LAMA inhalation ( OR=0.605, 95% CI: 0.432-0.848), and BMI ( OR=0.969, 95% CI: 0.943-0.995) were independent risk factors for future exacerbations in COPD patients with no exacerbation history in the past year (all P<0.05). Conclusions:The risk of future exacerbations remains high in COPD patients with no exacerbation history in the past year. High CAT scores, low education levels, and low BMI are associated with future exacerbations. Clinicians should pay close attention to the management of such patients and implement appropriate interventions.

Objective The aim of this study was to investigate whether downregulation of FK506 binding protein 4(FKBP4)could inhibit the malignant progression of non-small cell lung cancer(NSCLC)by blocking the PI3K/Akt/mTOR signaling pathway.Methods NSCLC A549,H1975,H358 and PC-9 cell lines,as well as human bronchial epithelial cells(HBE)were routinely cul-tured.The expression of FKBP4 in these cells was detected by qRT-PCR,and NSCLC cell lines with the most significant different ex-pression of FKBP4 compared with HBE cells was screened.FKBP4 siRNA and NC siRNA were transfected into A549 cells,which were divided into the si-FKBP4 group and NC group.CCK-8 assay was used to detect the proliferative ability of si-FKBP4 group and NC group,flow cytometry was used to detect the apoptosis rate,scratch healing assay was used to detect the migration ability,Transwell assay was used to detect the invasion ability,and Western blot was used to detect the total and phosphorylation protein expression of PI3K and its downstream effectors Akt and mTOR.Results The expression of FKBP4 in A549 cells,H1975 cells,H358 cells and PC-9 cells were significantly higher than those in HBE cells(P<0.05),and its expression in A549 cells was the highest(P<0.001).Downregulation of FKBP4 could inhibit the proliferation,invasion and migration of A549 cells and promote the apoptosis of A549 cells(P<0.001).In addition,downregulation of FKBP4 also could inhibit the phosphorylation of PI3K,Akt and mTOR,resulting in bloc-king the PI3K/Akt/mTOR signaling pathway.Conclusion Downregulation of FKBP4 can inhibit the proliferation,invasion and mi-gration of NSCLC cells by blocking the PI3K/Akt/mTOR signaling pathway,and promote the apoptosis of NSCLC cells.

Objective To investigate the utility of combining breast mass growth orientation quantification with the S-Detect technique for predicting axillary lymph node(ALN)metastasis in breast cancer.Methods Data was collected from 163 breast cancer patients admitted to our hospital between March 2023 and October 2024,who were categorized into metastatic(n=62)and non-metastatic(n=101)groups based on ALN pathology results.All patients underwent routine preoperative ultrasound and S-Detect examination.Univariate and multivariate regression analyses were performed to assess the correlation between each observational index and ALN metastasis.Significant indexes were identified through screening,leading to the establishment of a logistic regression prediction model.The predictive value of the model was evaluated using receiver operating characteristic(ROC)curve analysis.Results The univariate analysis revealed statistically significant differences(P<0.05)in the maximum diameter of the mass,border characteristics,margin features,calcification patterns,orientation angle,and blood flow between the two groups.Multifactorial analysis demonstrated that calcification,border characteristics,orientation angle,margin features,and maximum diameter independently influenced the prediction of axillary lymph node(ALN)status in breast cancer patients(P<0.05).Consequently,a logistic regression prediction model was constructed as follows:Y=-7.995+2.299×maximal diameter+1.171×border+2.137×margin+1.397×calcication+0.034×orientation angle.The area under curve(AUC)for this combined prediction model was 0.869 which significantly outperformed each independent influencing factor alone(P<0.05),indicating good agreement between this joint prediction model and pathological results(Kappa=0.701,P<0.05).Conclusions Quantification of the orientation angle of a breast mass aids in predicting axillary lymph node(ALN)metastasis and enhances the interpretation and application of non-parallel orientations.The combination of quantifying growth orientation based on breast mass with artificial intelligence S-Detect technique demonstrates promising predictive value for ALN metastasis in breast cancer,providing a reference basis for personalized treatment.

Objective:To conduct a study on pricing by service unit to address the problems of hospice and palliative care pricing and fee system in China.Methods:Combining theoretical research and empirical evidence,this study organized the pricing mechanism of initiative hospice and palliative care services and established a graded and categorized pricing strategy.Empirical research was conducted based on real-world data from 36 pilot institutions in typical areas.Results:This study developed a comprehensive pricing framework for value-based classification price standard of initiative hospice and palliative care services from the perspective of incentive regulation.We proposed a pricing plan based on service units,with inpatient bed fee ranging from 459 to 606 yuan or 459 to 1 102 yuan,and home visit fee ranging from 89 to 264 yuan.Conclusions and suggestions:This study proposes a pricing scheme based on the technique and service value with a gradient fluctuation by service unit,and forms a set of price standards with high economic and technical feasibility,which can provide scientific evidences for solving the pricing problem of hospice care.In addition,there is still a need to establish a multi-level incentive compensation mechanism to motivate all levels and types of organisations and healthcare provider,and to promote the high-quality and sustainable development of hospice and palliative care.

Objective To investigate the effects of Bushen Shengjing Tiaohe Qixue Prescription on rats with diminished ovarian reserve(DOR)based on Wnt/β-catenin signaling pathway.Methods Totally 60 8-week-old SD female rats were randomly divided into control group,model group,estradiol valerate group and TCM low-,medium-and high-dosage groups,with 10 rats in each group.Except for the control group,the rats in the other groups were given a single intraperitoneal injection of cyclophosphamide 75 mg/kg to replicate the DOR rat model.From the next day of modeling,the corresponding drugs was administered for medication groups by gavage for 3 weeks.The general conditions of the rats were observed,ELISA was used to detect the contents of serum follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),anti-mullerian hormone(AMH)and inhibin B(INHB),HE staining was used to observe the morphologic changes in ovarian tissue,Western blot was used to detect GSK3β,β-catenin,CyclinD1 and c-MYC protein expressions in ovarian tissues,immunohistochemical staining was used to observe β-catenin expression in ovarian tissue,RT-qPCR was used to detect Wnt1,Wnt2,Wnt4,GSK3β,β-catenin,CyclinD1 and c-MYC mRNA expression in ovarian tissue,transmission electron microscopy was used to observe ultrapathologic structure of ovarian granulosa cells.Results Compared with the control group,the rats in the model group had reduced intake of food and water,slow or even reduced body mass gain,and disturbed estrous cycle,the serum contents of FSH and LH increased(P<0.01),the contents of E2,AMH and INHB decreased(P<0.01);the number of follicles of all levels in ovarian tissue was reduced,and there was increased number of atretic follicles with disturbed arrangement of the granulosa cells;the expression of GSK3β protein in ovarian tissue increased(P<0.01),the expression of β-catenin,CyclinD1 and c-MYC protein decreased(P<0.05,P<0.01),and β-catenin positive expression decreased(P<0.01),the expression of Wnt1,Wnt2,Wnt4,β-catenin,CyclinD1 and c-MYC mRNA in ovarian tissue decreased(P<0.01),GSK3β mRNA expression was increased(P<0,01);organelles such as mitochondria and nuclei of ovarian granulosa cells were highly swollen and partially lysed.Compared with the model group,the rats in the administered group all had different degrees of body mass increase,partial restoration of the motility cycle,serum FSH and LH contents decreased,and serum E2,AMH and INHB contents increased(P<0.01,P<0.05);the number of follicles at all levels in ovarian tissue increased to varying degrees,and the atretic follicles were reduced;the expression of GSK3β protein in ovarian tissue decreased,β-catenin,CyclinD1 and c-MYC protein expressions increased,β-catenin positive expression increased,the expression of Wnt1,Wnt2,Wnt4,β-catenin,CyclinD1 and c-MYC mRNA in ovarian tissue increased,and GSK3β mRNA expression decreased,with statistical significance in estradiol valerate group and TCM high-dosage group(P<0.05,P<0.01);mitochondria,endoplasmic reticulum and other organelles of ovarian granulosa cells were mildly to moderately swollen.Conclusion Bushen Shengjing Tiaohe Qixue Prescription can improve ovarian function and regulate serum sex hormone levels in DOR model rats,and its mechanism might be related to the activation of Wnt/β-catenin signaling pathway.

Objective To explore the correlation between systemic inflammatory response index(SIRI)and the prognosis of elderly heart failure(HF)patients.Methods A retrospective study was conducted on 300 elderly HF patients with complete medical records hospitalized in our de-partment from January to December 2022.During the follow-up period for 1 year in different ways,46 of them were lost,and 254 were finally included.Baseline data,complete blood count at admission,and results of auxiliary examinations,and medicine adherence after discharge were col-lected and recorded.According to the occurrence of major adverse cardiovascular events(MACE),the subjected patients were divided into a MACE group(96 cases)and a non-MACE group(158 cases).The baseline data and relevant examination indicators were compared between the two groups,and the relevant factors for the occurrence were analyzed by using logistic regression.ROC curve analysis was employed to assess the predictive value of SIRI for MACE occurrence.Results The MACE group had significantly advanced age,larger proportion of diabetes mellitus,higher neutrophil and platelet counts,and elevated D-dimer level,but lower standardized medication rate when compared with the non-MACE group(P＜0.05,P＜0.01).The SIRI level was obviously higher in the MACE group than the non-MACE group[1.70(1.13,2.33)vs 1.29(0.85,2.06),P=0.002].Multivariate logistic regression analysis showed that atrial fibrillation,standardized medi-cation,mononuclear cells,and SIRI were independent risk factors for the occurrence of MACE in elderly HF patients(P＜0.05,P＜0.01).ROC curve analysis indicated that the AUC value of SIRI in predicting the occurrence of MACE was 0.614(95％CI:0.544-0.683),with a sensitivity of 0.813 and a specificity of 0.437.Conclusion SIRI is significantly correlated with the occurrence of MACE in elderly HF patients,and has a certain predictive value for their prognosis.

Objective:To analyze the risk factors associated with future exacerbations in patients with chronic obstructive pulmonary disease (COPD) who have no history of exacerbation in the past year.Methods:COPD patients with no exacerbation history in the past year, registered in the RealDTC study from January 2018 to December 2023, were enrolled. Demographic data, COPD Assessment Test (CAT) scores, modified Medical Research Council (mMRC) dyspnea questionnaire scores, forced expiratory volume in the first second predicted of percentage (FEV 1%pred), forced expiratory volume in one second (FEV 1) to forced vital capacity (FVC), Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, GOLD groups, and inhaled medication regimens were collected. All patients were followed up for one year, and the number of exacerbations was recorded. Patients were divided into an exacerbation group and a non-exacerbation group based on the occurrence of exacerbations during the follow-up period. Logistic regression analysis was used to screen the influencing factors for exacerbations in COPD patients. Results:A total of 2 901 COPD patients were included, among which 633 patients (21.8%) experienced exacerbations during the follow-up period. Compared with the non-exacerbation group, patients in the exacerbation group were older, with higher CAT and mMRC scores, lower body mass index (BMI), FEV 1%pred, and FEV 1/FVC. The proportions of patients with high school education or above and those using long-acting β 2-agonist (LABA) + long-acting muscarinic antagonist (LAMA) medications were also lower (all P<0.05). Logistic regression analysis showed that age ( OR=1.010, 95% CI: 1.000-1.021), CAT score ≥20 ( OR=1.415, 95% CI: 1.074-1.865), education level of junior high school or below ( OR=1.243, 95% CI: 1.003-1.540), LABA + LAMA inhalation ( OR=0.605, 95% CI: 0.432-0.848), and BMI ( OR=0.969, 95% CI: 0.943-0.995) were independent risk factors for future exacerbations in COPD patients with no exacerbation history in the past year (all P<0.05). Conclusions:The risk of future exacerbations remains high in COPD patients with no exacerbation history in the past year. High CAT scores, low education levels, and low BMI are associated with future exacerbations. Clinicians should pay close attention to the management of such patients and implement appropriate interventions.

Objective:To conduct a study on pricing by service unit to address the problems of hospice and palliative care pricing and fee system in China.Methods:Combining theoretical research and empirical evidence,this study organized the pricing mechanism of initiative hospice and palliative care services and established a graded and categorized pricing strategy.Empirical research was conducted based on real-world data from 36 pilot institutions in typical areas.Results:This study developed a comprehensive pricing framework for value-based classification price standard of initiative hospice and palliative care services from the perspective of incentive regulation.We proposed a pricing plan based on service units,with inpatient bed fee ranging from 459 to 606 yuan or 459 to 1 102 yuan,and home visit fee ranging from 89 to 264 yuan.Conclusions and suggestions:This study proposes a pricing scheme based on the technique and service value with a gradient fluctuation by service unit,and forms a set of price standards with high economic and technical feasibility,which can provide scientific evidences for solving the pricing problem of hospice care.In addition,there is still a need to establish a multi-level incentive compensation mechanism to motivate all levels and types of organisations and healthcare provider,and to promote the high-quality and sustainable development of hospice and palliative care.