Adrenocortical carcinoma（ACC）is a rare and highly aggressive malignant tumor. Currently，mitotane is the first-line treatment. However，reports on neoadjuvant therapy for ACC using mitotane combined with immune checkpoint inhibitors remain scarce. This article reports a case of ACC. The patient was asymptomatic，and a right adrenal mass was detected during examination. Diagnostic imaging and endocrine evaluation confirmed the diagnosis of ACC. Due to the large tumor size，radical resection was initially considered unfeasible. After 7 months of mitotane therapy and two courses of tislelizumab，significant tumor shrinkage was achieved，allowing for successful open resection of the large right adrenal tumor combined with right nephrectomy. Postoperative histopathological examination confirmed the diagnosis of ACC. During the 3-month postoperative follow-up，no evidence of recurrence or metastasis was observed.

Objective:To develop and validate a deep learning-based multimodal model integrating clinical and radiomic features for predicting acute kidney injury（AKI）risk after partial nephrectomy.Methods:A retrospective analysis was conducted on 416 patients who underwent partial nephrectomy at Zhongshan Hospital，Fudan University from January 2023 to January 2025. The cohort included 100 AKI patients［defined by a ≥ 25% reduction in postoperative evaluated glomerular filtration rate（eGFR）within 48 hours sustained for >24 hours］and 316 non-AKI patients（1∶3 ratio，randomly matched with 16 additional cases for redundancy）. Clinical and radiomic features were extracted from preoperative contrast-enhanced CT scans using PyRadiomics. Demographics included 259 males and 158 females，with a median age of 57（49，65）years，body mass index of（24.1 ± 3.3）kg/m2，preoperative eGFR of（88.5 ± 18.3）ml/（min·1.73 m2），postoperative eGFR（48-hour）of（76.0 ± 21.9）ml/（min·1.73 m2），Zhongshan Score（ZSscore）of 7.34 ± 2.01，and R.E.N.A.L. score of 7.50 ± 1.71. All tumors were T 1a stage. Patients were divided into training（n = 312）and test（n = 104）sets（3∶1 ratio）. A clinical model was constructed via multivariate logistic regression，while radiomic and combined（clinical + radiomic）models utilized an artificial neural network（ANN）with 1 input layer，5 hidden layers，1 output layer，and 10 5 training epochs. Model performance was evaluated by using receiver operating characteristic（ROC）curves and area under the curve（AUC），and was compared to the Martini model. Feature contributions were interpreted via SHapley Additive exPlanations（SHAP）. Results:In the test set，the results of multivariate logistic regression showed that patient’s weight，preoperative eGFR，R.E.N.A.L. score，surgical approach，and operation time were risk factors for AKI（ P < 0.05）. The AUC of the clinical feature prediction model constructed based on the above factors was 0.852（95% CI 0.775?0.929）. In the test set，the AUC of the Martini model was 0.725（95% CI 0.565?0.791）. The radiomic model，trained on 1 315 imaging features，achieved an AUC of 0.898（95% CI 0.804?0.993）with 94.2%（98/104）accuracy. The combined clinical and radiomic model，integrating 1 315 radiomic features and clinical features，demonstrated superior performance with an AUC of 0.946（95% CI 0.887?1.000）and 96.2%（100/104）accuracy，outperforming both the clinical model（ P = 0.03）and the Martini model（ P < 0.01）. SHAP analysis identified the top five predictors in the combined model：ZSscore（SHAP value：0.78），long-run low gray-level emphasis（SHAP value：0.61），run-length non-uniformity（SHAP value：0.58），size-zone non-uniformity（SHAP value：0.46），and gray-level co-occurrence matrix joint energy（SHAP value：0.36）. Conclusions:The deep learning-based multimodal model integrating clinical and radiomic features accurately predicts AKI risk after partial nephrectomy，offering a novel strategy for preoperative risk stratification and personalized intervention.

Objective To evaluate the feasibility of early postoperative bathing within the framework of Enhanced recovery after surgery(ERAS)perioperative management.Methods A total of 156 patients who underwent laparoscopic appendectomy or cholecystectomy in the Department of General Surgery between December 2024 and May 2025 were included in the study.Based on the postoperative bathing protocol selected 24 hours after surgery,patients were randomly assigned to one of three groups:the early bathing-exposed group,the early bathing-covered group,or the control group.In the early bathing-exposed group,patients were permitted to bathe with the surgical incision uncovered 24 hours postoperatively.In the early bathing-covered group,sterile,waterproof dressings were applied to the incision site during bathing to maintain aseptic conditions.The control group followed conventional postoperative care guidelines,which restricted bathing until at least three days after suture removal.The outcomes,including the incidence of surgical site infection,postoperative complications,length of hospital stay,and follow-up data,were systematically recorded and analyzed across all three groups.Results Finally,54 patients were included in the early bathing-exposed group,52 in the early bathing-covered group,and 50 in the control group.No statistically significant differences were observed among the three groups in terms of baseline clinical characteristics,including gender,age,primary disease,comorbidities,body mass index(BMI),surgical procedure,operative duration,or incision classification(all P>0.05).Similarly,postoperative comparisons of time to first bathing,incisional infection rates,complication incidence,and length of hospital stay showed no significant intergroup differences(all P>0.05).However,with respect to patient satisfaction during hospitalization,both early bathing groups reported significantly higher satisfaction scores compared to the control group,and these differences were statistically significant(all P<0.05).Conclusions Compared with the conventional principle of postoperative water restriction,early bathing does not increase the incidence of surgical site infection and contributes to improved patient satisfaction during hospitalization.This approach broadens the scope of early postoperative interventions within the ERAS protocol and warrants further clinical implementation.

Objective To evaluate the feasibility of early postoperative bathing within the framework of Enhanced recovery after surgery(ERAS)perioperative management.Methods A total of 156 patients who underwent laparoscopic appendectomy or cholecystectomy in the Department of General Surgery between December 2024 and May 2025 were included in the study.Based on the postoperative bathing protocol selected 24 hours after surgery,patients were randomly assigned to one of three groups:the early bathing-exposed group,the early bathing-covered group,or the control group.In the early bathing-exposed group,patients were permitted to bathe with the surgical incision uncovered 24 hours postoperatively.In the early bathing-covered group,sterile,waterproof dressings were applied to the incision site during bathing to maintain aseptic conditions.The control group followed conventional postoperative care guidelines,which restricted bathing until at least three days after suture removal.The outcomes,including the incidence of surgical site infection,postoperative complications,length of hospital stay,and follow-up data,were systematically recorded and analyzed across all three groups.Results Finally,54 patients were included in the early bathing-exposed group,52 in the early bathing-covered group,and 50 in the control group.No statistically significant differences were observed among the three groups in terms of baseline clinical characteristics,including gender,age,primary disease,comorbidities,body mass index(BMI),surgical procedure,operative duration,or incision classification(all P>0.05).Similarly,postoperative comparisons of time to first bathing,incisional infection rates,complication incidence,and length of hospital stay showed no significant intergroup differences(all P>0.05).However,with respect to patient satisfaction during hospitalization,both early bathing groups reported significantly higher satisfaction scores compared to the control group,and these differences were statistically significant(all P<0.05).Conclusions Compared with the conventional principle of postoperative water restriction,early bathing does not increase the incidence of surgical site infection and contributes to improved patient satisfaction during hospitalization.This approach broadens the scope of early postoperative interventions within the ERAS protocol and warrants further clinical implementation.

Adrenocortical carcinoma（ACC）is a rare and highly aggressive malignant tumor. Currently，mitotane is the first-line treatment. However，reports on neoadjuvant therapy for ACC using mitotane combined with immune checkpoint inhibitors remain scarce. This article reports a case of ACC. The patient was asymptomatic，and a right adrenal mass was detected during examination. Diagnostic imaging and endocrine evaluation confirmed the diagnosis of ACC. Due to the large tumor size，radical resection was initially considered unfeasible. After 7 months of mitotane therapy and two courses of tislelizumab，significant tumor shrinkage was achieved，allowing for successful open resection of the large right adrenal tumor combined with right nephrectomy. Postoperative histopathological examination confirmed the diagnosis of ACC. During the 3-month postoperative follow-up，no evidence of recurrence or metastasis was observed.

Objective:To develop and validate a deep learning-based multimodal model integrating clinical and radiomic features for predicting acute kidney injury（AKI）risk after partial nephrectomy.Methods:A retrospective analysis was conducted on 416 patients who underwent partial nephrectomy at Zhongshan Hospital，Fudan University from January 2023 to January 2025. The cohort included 100 AKI patients［defined by a ≥ 25% reduction in postoperative evaluated glomerular filtration rate（eGFR）within 48 hours sustained for >24 hours］and 316 non-AKI patients（1∶3 ratio，randomly matched with 16 additional cases for redundancy）. Clinical and radiomic features were extracted from preoperative contrast-enhanced CT scans using PyRadiomics. Demographics included 259 males and 158 females，with a median age of 57（49，65）years，body mass index of（24.1 ± 3.3）kg/m2，preoperative eGFR of（88.5 ± 18.3）ml/（min·1.73 m2），postoperative eGFR（48-hour）of（76.0 ± 21.9）ml/（min·1.73 m2），Zhongshan Score（ZSscore）of 7.34 ± 2.01，and R.E.N.A.L. score of 7.50 ± 1.71. All tumors were T 1a stage. Patients were divided into training（n = 312）and test（n = 104）sets（3∶1 ratio）. A clinical model was constructed via multivariate logistic regression，while radiomic and combined（clinical + radiomic）models utilized an artificial neural network（ANN）with 1 input layer，5 hidden layers，1 output layer，and 10 5 training epochs. Model performance was evaluated by using receiver operating characteristic（ROC）curves and area under the curve（AUC），and was compared to the Martini model. Feature contributions were interpreted via SHapley Additive exPlanations（SHAP）. Results:In the test set，the results of multivariate logistic regression showed that patient’s weight，preoperative eGFR，R.E.N.A.L. score，surgical approach，and operation time were risk factors for AKI（ P < 0.05）. The AUC of the clinical feature prediction model constructed based on the above factors was 0.852（95% CI 0.775?0.929）. In the test set，the AUC of the Martini model was 0.725（95% CI 0.565?0.791）. The radiomic model，trained on 1 315 imaging features，achieved an AUC of 0.898（95% CI 0.804?0.993）with 94.2%（98/104）accuracy. The combined clinical and radiomic model，integrating 1 315 radiomic features and clinical features，demonstrated superior performance with an AUC of 0.946（95% CI 0.887?1.000）and 96.2%（100/104）accuracy，outperforming both the clinical model（ P = 0.03）and the Martini model（ P < 0.01）. SHAP analysis identified the top five predictors in the combined model：ZSscore（SHAP value：0.78），long-run low gray-level emphasis（SHAP value：0.61），run-length non-uniformity（SHAP value：0.58），size-zone non-uniformity（SHAP value：0.46），and gray-level co-occurrence matrix joint energy（SHAP value：0.36）. Conclusions:The deep learning-based multimodal model integrating clinical and radiomic features accurately predicts AKI risk after partial nephrectomy，offering a novel strategy for preoperative risk stratification and personalized intervention.

The CRISPR/Cas9 based prime editing (PE) technique enables all 12 types of base substitutions and precise small DNA deletions or insertions without generating DNA double-strand breaks. Prime editing has been successfully applied in plants and plays important roles in plant precision breeding. Although plant prime editing (PPE) can substantially expand the scope and capabilities of precise genome editing in plants, its editing efficiency still needs to be further improved. Here, we review the development of PPE technique, and introduce structural composition, advantages and limitations of PPE. Strategies to improve the PPE editing efficiency, including the T_m-directed PBS length design, the RT template length, the dual-pegRNA strategy, the PlantPegDesigner website, and the strategies for optimizing the target proteins of PPE, were highlighted. Finally, the prospects of future development and application of PPE were discussed.
CRISPR-Cas Systems/genetics* ; DNA ; Gene Editing ; Genome, Plant/genetics* ; Plant Breeding ; Plants/genetics*

Objective To evaluate the effect of special rectification of clinical antimicrobial use in a hospital. Methods Medical records of patients receiving inguinal hernia repair before (in 2011)and after (in 2012)the per-formance of special rectification were reviewed,and the rationality of perioperative antimicrobial prophylaxis was compared.Results Prophylactic antimicrobial usage rate in patients receiving inguinal hernia repair decreased from 53.90%(76/114)in 2011 to 5.59%(10/179)in 2012,the difference was significant (χ2 =93.68,P <0.05);aver-age expense of antimicrobial use per patient decreased by 86.95% (from ￥ 624.73 in 2011 to ￥ 81 .52 in 2012);Combination use and single use was 93.42% and 80.00% respectively.Surgical site infection did not occur in both groups.Conclusion Through the special rectification activities of the clinical antimicrobial use,perioperative anti-microbial prophylaxis and expense of antimicrobial agents in patients receiving inguinal hernia repair is effectively re-duced.