Objective To explore the application value of the PDCA(Plan-Do-Check-Act)cycle in hospital document supervision management,with the aim of improving document processing efficiency and optimizing administrative workflows.Methods A tertiary hospital in South China was selected as the study subject.In response to a low document completion rate in 2023(74.99％),a fishbone diagram analysis was conducted to identify key efficiency bottlenecks.A classified and hierarchical supervision model based on the PDCA cycle was established.Departments were grouped into high-volume(＞400 cases/year),medium-volume(100-400 cases/year),and low-volume(＜100 cases/year).Targeted interventions were implemented in low-efficiency departments using a"liaison officer+negative list+responsible person tracking"mechanism.Results After im-plementation,the completion rate in low-efficiency departments improved from 26.93％-87.86％ to 58.25％-100％(P=0.028).The hospital's overall average document completion rate reached 93.30％ in 2024,an 18.31％ increase compared to baseline.Conclusion The stratified document supervision model based on the PDCA cycle can significantly enhance administra-tive efficiency and provides practical reference for refined management in public hospitals.

Objective:To analyze the value of abdominal CT angiography (CTA) and three-dimensional reconstruction fusion technology for larger (2 - 5 cm) gastric submucosal tumors (SMT) in the preoperative evaluation of super minimally invasive surgery(SMIS).Methods:A retrospective study was conducted, collecting data from 20 patients with gastric SMTs measuring 2 - 5 cm in diameter who were hospitalized in the the First Medical Center of the Chinese PLA General Hospital from March 2023 to December 2024. All patients underwent abdominal CTA prior to SMIS, and three-dimensional reconstructions of the tumors were performed. Clinical data were collected to analyze the visualization of the tumors and surrounding blood vessels in the fused three-dimensional images and the corresponding surgical plans.Results:In 19 cases, the abdominal CTA and three-dimensional imaging clearly and intuitively displayed the anatomical structures surrounding the tumors and provided panoramic images of small blood vessels around the tumors, enabling the selection of appropriate surgical plans. One case required conversion to laparoscopic surgery due to the intraoperative discovery of a small artery.Conclusions:The abdominal CTA examination and gastric SMT three dimensional reconstruction before SMIS can better display the anatomical location of the tumor and its relationship with surrounding small blood vessels, which is beneficial for gastroenterologists to formulate surgical plans and facilitate the smooth progress of SMIS under endoscopy.

Objective:To investigate the completion rate of tumor evaluation at initial assessment and after neoadjuvant therapy for mid and low rectal cancer patients in the national multicenter real-world database.Methods:The prospective real-world study was conducted. The clinicopathological data of 1 074 patients who underwent surgical treatment for mid and low rectal cancer in 47 national medical institutions, including Peking Union Medical College Hospital et al, from May 12,2023 to May 11,2024 were collected. Observation indicators: (1) clinical characteristics of patients with mid and low rectal cancer; (2) initial colonoscopy and pathologic evaluation of tumors in patients with mid and low rectal cancer; (3) initial imaging evaluation of patients with mid and low rectal cancer; (4) imaging evaluation after neoadjuvant therapy for patients with mid and low rectal cancer. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3). Count data were described as absoluter numbers and/or percentages. Results:(1) Clinical characteristics of patients with mid and low rectal cancer. Of the 1 074 patients, there were 713 males and 361 females, aged 63(56,70)years. The body mass index of 1 074 patients was 24(21,26)kg/m 2.For American Society of Anesthesiologists classification, there were 147 cases of stage Ⅰ, 641 cases of stage Ⅱ, 157 cases of stage Ⅲ, 2 cases of stage Ⅳ, and there were 127 cases missing data. (2) Initial colonoscopy and pathologic evaluation of tumors in patients with mid and low rectal cancer. Of the 1 074 patients, there were 787 cases (73.28%) undergoing complete colonoscopy, and there were only 197 cases (18.34%) undergoing immunohistochemical evaluation of all four mismatch repair proteins. (3) Initial imaging evaluation of patients with mid and low rectal cancer. Of the 1 074 patients, there were 842(78.40%) patients completing magnetic resonance imaging (MRI) or ultrasound evaluation, and there were 914(85.10%) patients completing chest, abdomen, and pelvis enhanced computed tomography (CT) evaluation. In the 149 patients completing rectal ultrasound evaluation, there were 122 cases (81.88%) comple-ting T staging evaluation, and there were 81 cases (54.36%) completing N staging evaluation. In the 808 patients completing rectal MRI evaluation, there were 708 cases (87.62%) completing T staging evaluation, and there were 590 cases (73.02%) completing N staging evaluation. (4) Imaging evalua-tion after neoadjuvant therapy for patients with mid and low rectal cancer. Of the 388 patients with neoadjuvant therapy, there were 332 patients (85.57%) completing MRI or ultrasound evaluation, and there were 327 patients (84.28%) completing chest, abdomen, and pelvis enhanced CT evalua-tion. In the 70 patients completing rectal ultrasound evaluation, there were 65 cases (92.86%) com-pleting T staging evaluation, and there were 49 cases (70.00%) completing N staging evaluation. In the 327 patients completing rectal MRI evaluation, there were 246 cases (75.23%) completing T staging, and there were 228 cases (69.72%) completing N staging evaluation. Conclusion:The com-pletion rate of tumor imaging evaluation at initial assessment and after neoadjuvant therapy for mid and low rectal cancer patients on a national scale is relatively good.

Background and Aims:Colorectal cancer liver metastasis(CRCLM)is a major cause of poor prognosis in patients with colorectal cancer.Accurate and noninvasive preoperative diagnosis is essential for treatment planning.Conventional clinical biomarkers have limited specificity.This study aimed to develop an efficient predictive model for CRCLM by integrating multimodal MRI imaging omics features with machine learning algorithms,and to evaluate its clinical value.Methods:A total of 150 patients with colorectal cancer who underwent preoperative MRI and were pathologically confirmed at Nanyang First People's Hospital between May 2022 and May 2024 were retrospectively analyzed.Patients were randomly divided into a training set(n=120)and a validation set(n=30),including 57 cases with CRCLM and 93 cases without.Univariate and multivariate analyses were performed to identify independent risk factors for CRCLM and to construct a clinical diagnostic model.Radiomics features were extracted from multimodal MRI,and the least absolute shrinkage and selection operator(LASSO)method was used for feature selection.Logistic regression(LR),support vector machine(SVM),and random forest(RF)models were built and compared for diagnostic performance.A combined clinical-imaging omics model was further established,and its performance and clinical utility were assessed using receiver operating characteristic curves and decision curve analysis(DCA).Results:Carcinoembryonic antigen(OR=1.323,95%CI=1.079-1.567),carbohydrate antigen 19-9(OR=2.512,95%CI=1.225-3.799),and neutrophil-to-lymphocyte ratio(OR=1.881,95%CI=1.354-2.409)were identified as independent risk factors for CRCLM(all P<0.05).The clinical model constructed with these three factors achieved an AUC of 0.793.Among radiomics models,the RF model demonstrated the highest AUC in both training and validation sets(0.770 and 0.763),outperforming LR and SVM.The combined RF-based model yielded AUC of 0.913 and 0.947 in the training and validation sets,respectively,significantly exceeding the performance of the clinical or imaging omics models alone.DCA confirmed the superior net clinical benefit of the combined model.Conclusion:The RF model showed the best diagnostic performance among imaging omics models.When integrated with clinical features,the combined RF model significantly improved the noninvasive diagnostic efficacy of CRCLM and demonstrated high potential for clinical application.

Objective To investigate the risk factors for concomitant acute ischemic stroke(AIS)in elderly patients with cervical artery dissection(CAD)based on high-resolution vessel wall mag-netic resonance imaging(VW-MRI)features,and to construct a nomogram prediction model.Methods A retrospective analysis was performed on 125 CAD patients admitted to our hospital from April 2021 to April 2024.According to complication of AIS or not,they were divided into a concomitant group(52 cases)and a non-concomitant group(73 cases).The general data and VW-MRI features were collected and analyzed in the two groups.Multivariate logistic regression analy-sis was used to identify the risk factors for AIS in CAD patients.Then a nomogram prediction model was constructed,and ROC curve was plotted to analyze its predictive efficacy.Results Sig-nificantly larger proportions of smoking history,hypertension and hyperlipidemia,and higher LDL-C level were observed in the concomitant group than the non-concomitant group(50.00％vs 30.14％,P=0.024;42.31％vs 12.33％,P=0.000;36.54％vs 10.96％,P=0.001;1.15±0.36 mmol/L vs 1.03±0.31 mmol/L,P=0.048).The incidences of multiple lesions,double lumen sign,high signal intensity of intramural hematoma,intralumenal thrombus,and severe vascular stenosis/occlusion were obviously higher(38.46％vs 16.44％,P=0.005;44.23％vs 13.70％,P=0.000;48.08％vs 16.44％,P=0.000;50.00％vs 12.33％,P=0.000;28.85％vs 5.48％,P=0.000),while that of moderate vascular stenosis was notably lower in the concomitant group than the non-concomitant group(44.23％vs 63.01％,P=0.037).Smoking history,hypertension,hy-perlipidemia,number of lesions,double lumen sign,signal intensity of intermural hematoma,in-traluminal thrombus,and severity of stenosis were risk factors for AIS occurrence in CAD pa-tients(P＜0.05,P＜0.01).For our risk prediction model based on the above risk factors,calibra-tion curve analysis showed a consistency index(C-index)of 0.856,Hosmer-Lemeshow goodness-of-fit test indicated X2=5.947,P=0.625,and an AUC value was 0.924(95％CI:0.833-0.961,P＜0.05),with a sensitivity and a specificity of 88.86％and 75.36％,respectively.Conclusion Smoking history,hypertension,hyperlipidemia,number of lesions,double lumen sign,signal in-tensity of intermural hematoma,intraluminal thrombus,and severity of stenosis are risk factors for AIS occurrence in CAD patients.Our nomogram model based on these factors has a good pre-dictive performance for the complication of AIS in these patients.

Objective:To investigate the completion rate of tumor evaluation at initial assessment and after neoadjuvant therapy for mid and low rectal cancer patients in the national multicenter real-world database.Methods:The prospective real-world study was conducted. The clinicopathological data of 1 074 patients who underwent surgical treatment for mid and low rectal cancer in 47 national medical institutions, including Peking Union Medical College Hospital et al, from May 12,2023 to May 11,2024 were collected. Observation indicators: (1) clinical characteristics of patients with mid and low rectal cancer; (2) initial colonoscopy and pathologic evaluation of tumors in patients with mid and low rectal cancer; (3) initial imaging evaluation of patients with mid and low rectal cancer; (4) imaging evaluation after neoadjuvant therapy for patients with mid and low rectal cancer. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3). Count data were described as absoluter numbers and/or percentages. Results:(1) Clinical characteristics of patients with mid and low rectal cancer. Of the 1 074 patients, there were 713 males and 361 females, aged 63(56,70)years. The body mass index of 1 074 patients was 24(21,26)kg/m 2.For American Society of Anesthesiologists classification, there were 147 cases of stage Ⅰ, 641 cases of stage Ⅱ, 157 cases of stage Ⅲ, 2 cases of stage Ⅳ, and there were 127 cases missing data. (2) Initial colonoscopy and pathologic evaluation of tumors in patients with mid and low rectal cancer. Of the 1 074 patients, there were 787 cases (73.28%) undergoing complete colonoscopy, and there were only 197 cases (18.34%) undergoing immunohistochemical evaluation of all four mismatch repair proteins. (3) Initial imaging evaluation of patients with mid and low rectal cancer. Of the 1 074 patients, there were 842(78.40%) patients completing magnetic resonance imaging (MRI) or ultrasound evaluation, and there were 914(85.10%) patients completing chest, abdomen, and pelvis enhanced computed tomography (CT) evaluation. In the 149 patients completing rectal ultrasound evaluation, there were 122 cases (81.88%) comple-ting T staging evaluation, and there were 81 cases (54.36%) completing N staging evaluation. In the 808 patients completing rectal MRI evaluation, there were 708 cases (87.62%) completing T staging evaluation, and there were 590 cases (73.02%) completing N staging evaluation. (4) Imaging evalua-tion after neoadjuvant therapy for patients with mid and low rectal cancer. Of the 388 patients with neoadjuvant therapy, there were 332 patients (85.57%) completing MRI or ultrasound evaluation, and there were 327 patients (84.28%) completing chest, abdomen, and pelvis enhanced CT evalua-tion. In the 70 patients completing rectal ultrasound evaluation, there were 65 cases (92.86%) com-pleting T staging evaluation, and there were 49 cases (70.00%) completing N staging evaluation. In the 327 patients completing rectal MRI evaluation, there were 246 cases (75.23%) completing T staging, and there were 228 cases (69.72%) completing N staging evaluation. Conclusion:The com-pletion rate of tumor imaging evaluation at initial assessment and after neoadjuvant therapy for mid and low rectal cancer patients on a national scale is relatively good.

Background and Aims:Colorectal cancer liver metastasis(CRCLM)is a major cause of poor prognosis in patients with colorectal cancer.Accurate and noninvasive preoperative diagnosis is essential for treatment planning.Conventional clinical biomarkers have limited specificity.This study aimed to develop an efficient predictive model for CRCLM by integrating multimodal MRI imaging omics features with machine learning algorithms,and to evaluate its clinical value.Methods:A total of 150 patients with colorectal cancer who underwent preoperative MRI and were pathologically confirmed at Nanyang First People's Hospital between May 2022 and May 2024 were retrospectively analyzed.Patients were randomly divided into a training set(n=120)and a validation set(n=30),including 57 cases with CRCLM and 93 cases without.Univariate and multivariate analyses were performed to identify independent risk factors for CRCLM and to construct a clinical diagnostic model.Radiomics features were extracted from multimodal MRI,and the least absolute shrinkage and selection operator(LASSO)method was used for feature selection.Logistic regression(LR),support vector machine(SVM),and random forest(RF)models were built and compared for diagnostic performance.A combined clinical-imaging omics model was further established,and its performance and clinical utility were assessed using receiver operating characteristic curves and decision curve analysis(DCA).Results:Carcinoembryonic antigen(OR=1.323,95%CI=1.079-1.567),carbohydrate antigen 19-9(OR=2.512,95%CI=1.225-3.799),and neutrophil-to-lymphocyte ratio(OR=1.881,95%CI=1.354-2.409)were identified as independent risk factors for CRCLM(all P<0.05).The clinical model constructed with these three factors achieved an AUC of 0.793.Among radiomics models,the RF model demonstrated the highest AUC in both training and validation sets(0.770 and 0.763),outperforming LR and SVM.The combined RF-based model yielded AUC of 0.913 and 0.947 in the training and validation sets,respectively,significantly exceeding the performance of the clinical or imaging omics models alone.DCA confirmed the superior net clinical benefit of the combined model.Conclusion:The RF model showed the best diagnostic performance among imaging omics models.When integrated with clinical features,the combined RF model significantly improved the noninvasive diagnostic efficacy of CRCLM and demonstrated high potential for clinical application.

Objective To investigate the risk factors for concomitant acute ischemic stroke(AIS)in elderly patients with cervical artery dissection(CAD)based on high-resolution vessel wall mag-netic resonance imaging(VW-MRI)features,and to construct a nomogram prediction model.Methods A retrospective analysis was performed on 125 CAD patients admitted to our hospital from April 2021 to April 2024.According to complication of AIS or not,they were divided into a concomitant group(52 cases)and a non-concomitant group(73 cases).The general data and VW-MRI features were collected and analyzed in the two groups.Multivariate logistic regression analy-sis was used to identify the risk factors for AIS in CAD patients.Then a nomogram prediction model was constructed,and ROC curve was plotted to analyze its predictive efficacy.Results Sig-nificantly larger proportions of smoking history,hypertension and hyperlipidemia,and higher LDL-C level were observed in the concomitant group than the non-concomitant group(50.00％vs 30.14％,P=0.024;42.31％vs 12.33％,P=0.000;36.54％vs 10.96％,P=0.001;1.15±0.36 mmol/L vs 1.03±0.31 mmol/L,P=0.048).The incidences of multiple lesions,double lumen sign,high signal intensity of intramural hematoma,intralumenal thrombus,and severe vascular stenosis/occlusion were obviously higher(38.46％vs 16.44％,P=0.005;44.23％vs 13.70％,P=0.000;48.08％vs 16.44％,P=0.000;50.00％vs 12.33％,P=0.000;28.85％vs 5.48％,P=0.000),while that of moderate vascular stenosis was notably lower in the concomitant group than the non-concomitant group(44.23％vs 63.01％,P=0.037).Smoking history,hypertension,hy-perlipidemia,number of lesions,double lumen sign,signal intensity of intermural hematoma,in-traluminal thrombus,and severity of stenosis were risk factors for AIS occurrence in CAD pa-tients(P＜0.05,P＜0.01).For our risk prediction model based on the above risk factors,calibra-tion curve analysis showed a consistency index(C-index)of 0.856,Hosmer-Lemeshow goodness-of-fit test indicated X2=5.947,P=0.625,and an AUC value was 0.924(95％CI:0.833-0.961,P＜0.05),with a sensitivity and a specificity of 88.86％and 75.36％,respectively.Conclusion Smoking history,hypertension,hyperlipidemia,number of lesions,double lumen sign,signal in-tensity of intermural hematoma,intraluminal thrombus,and severity of stenosis are risk factors for AIS occurrence in CAD patients.Our nomogram model based on these factors has a good pre-dictive performance for the complication of AIS in these patients.

This article reports a diagnostically and therapeutically challenging case of small intestinal marginal zone lymphoma. The patient presented with recurrent abdominal pain as the chief complaint, and imaging revealed multifocal small bowel wall thickening with high uptake, multisegmental luminal stenosis, and proximal dilation. Initial diagnostic workup, including gastroscopy, colonoscopy, and enteroscopy with biopsy, failed to establish a definitive diagnosis. Empirical anti-tuberculosis therapy was ineffective. A repeat enteroscopic biopsy performed over eight months after symptom onset eventually confirmed the diagnosis of mucosa-associated lymphoid tissue (MALT) extranodal marginal zone lymphoma. Despite three different chemotherapy regimens, the patient's intestinal obstruction symptoms persisted, with imaging still showing multifocal bowel wall thickening and hypermetabolic activity. A critical diagnostic dilemma arose regarding whether the PET/CT-positive lesions represented residual lymphoma or fibrotic scarring, whether further chemotherapy adjustments were warranted, and whether surgical resection was necessary. Multidisciplinary discussion concluded that imaging had limited discriminatory value in this scenario and that surgical intervention should be pursued if feasible. The patient successfully underwent partial small bowel resection, with postoperative pathology confirming no residual lymphoma but significant fibrotic changes. The patient has since resumed a normal diet, with body weight nearly restored to pre-illness levels. This case highlights that fibrotic transformation is a common sequela of treated marginal zone lymphoma and that PET/CT may misleadingly suggest residual disease, potentially leading to unnecessary chemotherapy. Timely surgical intervention is crucial in such scenarios.

Objective:To analyze the value of abdominal CT angiography (CTA) and three-dimensional reconstruction fusion technology for larger (2 - 5 cm) gastric submucosal tumors (SMT) in the preoperative evaluation of super minimally invasive surgery(SMIS).Methods:A retrospective study was conducted, collecting data from 20 patients with gastric SMTs measuring 2 - 5 cm in diameter who were hospitalized in the the First Medical Center of the Chinese PLA General Hospital from March 2023 to December 2024. All patients underwent abdominal CTA prior to SMIS, and three-dimensional reconstructions of the tumors were performed. Clinical data were collected to analyze the visualization of the tumors and surrounding blood vessels in the fused three-dimensional images and the corresponding surgical plans.Results:In 19 cases, the abdominal CTA and three-dimensional imaging clearly and intuitively displayed the anatomical structures surrounding the tumors and provided panoramic images of small blood vessels around the tumors, enabling the selection of appropriate surgical plans. One case required conversion to laparoscopic surgery due to the intraoperative discovery of a small artery.Conclusions:The abdominal CTA examination and gastric SMT three dimensional reconstruction before SMIS can better display the anatomical location of the tumor and its relationship with surrounding small blood vessels, which is beneficial for gastroenterologists to formulate surgical plans and facilitate the smooth progress of SMIS under endoscopy.