Objective: To characterize perioperative dynamic changes in immune-cell phenotypes and inflammatory cytokines in patients undergoing CPB (cardiopulmonary bypass) cardiac surgery, and to explore their associations with postoperative outcomes. Methods: In this prospective cohort study, 120 adult patients who underwent elective cardiac surgery under CPB at West China Hospital from May 2022 to March 2023 were enrolled. Perioperative immune-cell phenotypes and concentrations of 40 inflammation-related cytokines were measured. The primary outcomes were the sequential organ failure assessment (SOFA) score at 24 h after surgery and ΔSOFA (the peak SOFA score within 48 h after surgery minus the preoperative SOFA score). Secondary outcomes included major adverse cardiovascular events (MACE), acute kidney injury (AKI), respiratory failure, severe liver injury, and infection. Results: The mean age of enrolled patients was 57±10 years. Of these, 52% (62/120) were male and 90% (108/120) underwent valve surgery. During the rewarming to the end of CPB, neutrophil counts rapidly increased (7.39×10 /L vs preoperative 3.07×10 /L, P<0.001), with significant upregulation of CD11b (7.30×10 /L vs preoperative 3.05×10 /L, P<0.001) and CD54 (7.15×10 /L vs preoperative 2.99×10 /L, P<0.001). Lymphocyte counts increased at the end of CPB (1.75×10 /L vs preoperative 1.12×10 /L, P<0.001) but decreased significantly at 24 h after surgery (0.59×10 /L vs preoperative 1.12×10 /L, P<0.001). Plasma analysis showed that multiple pro-inflammatory cytokines increased during CPB and remained elevated up to 24 h after surgery; five chemokines and the anti-inflammatory cytokine IL-10 peaked at the end of CPB. The SOFA score increased from 1 (1, 2) preoperatively to 7 (5, 10) at 24 h after surgery, with a ΔSOFA of 6 (4, 8). Within 30 days after surgery, 48 patients (40.0%) developed AKI, 17 (14.2%) developed infection, 4 (3.3%) developed severe liver injury, 3 (2.5%) developed respiratory failure, and 3 (2.5%) experienced MACE. During the 2-year follow-up, 8 patients (6.7%) experienced MACE and 5 (4.2%) died. Conclusion: Multi-organ dysfunction is common after cardiac surgery under CPB (median ΔSOFA, 6), accompanied by perioperative activation of multiple immune-cell subsets and upregulation of pro-inflammatory, anti-inflammatory, and chemotactic mediators. This study provides data-driven evidence and research clues for further investigation of the associations between CPB-related immune perturbations and postoperative organ dysfunction and clinical outcomes.

With the continuous deepening of the concept of precision diagnosis and treatment for lung cancer, how to achieve higher efficiency and accuracy in the screening, diagnosis, and treatment pathways in clinical practice has become an important issue that urgently needs to be overcome. The current clinical difficulty lies in the fact that despite continuous advancements in imaging and molecular diagnostic technologies, there are still limitations in manual efficiency and subjective experience when it comes to massive data analysis and multi-scale feature extraction. Artificial intelligence (AI), especially algorithm systems based on deep learning, is an innovative technology capable of deeply empowering medical big data. This method utilizes algorithms such as convolutional neural networks, combined with radiomics, pathomics, and multi-modal data fusion analysis, demonstrating immense potential in early precise detection and benign-malignant differentiation of pulmonary nodules, digital pathological subtype recognition and non-invasive prediction of driver genes, precise 3D surgical planning and automatic delineation of radiotherapy target volumes, as well as dynamic risk warning during follow-up. This innovative technology provides a brand-new solution for realizing intelligent and individualized lung cancer diagnosis and treatment models. This consensus, based on the latest evidence from evidence-based medicine and combined with the development trends in the AI field and real-world clinical needs, was ultimately formed by gathering the consensus opinions of multidisciplinary experts in radiology, pathology, thoracic surgery, and other fields. The main content covers the application specifications of AI in the three core scenarios of lung cancer screening, diagnosis, and treatment, the technical standards for data collection and algorithm validation, as well as the ethical and regulatory challenges faced at the current stage. It aims to clarify the applicable boundaries of AI as a clinical auxiliary decision support tool, providing scientific guidance and standardized exploration directions for peers currently engaged in or planning to carry out AI-assisted clinical diagnosis, treatment, and translation of lung cancer.

With the widespread adoption of low-dose CT screening and the extensive application of high-resolution CT, the detection rate of sub-centimeter lung nodules has significantly increased. How to scientifically manage these nodules while avoiding overtreatment and diagnostic delays has become an important clinical issue. Among them, lung nodules with a consolidation tumor ratio less than 0.25, dominated by ground-glass shadows, are particularly worthy of attention. The therapeutic challenge for this group is how to achieve precise and complete resection of nodules during surgery while maximizing the preservation of the patient's lung function. The "watershed topography map" is a new technology based on big data and artificial intelligence algorithms. This method uses Dicom data from conventional dose CT scans, combined with microscopic (22-24 levels) capillary network anatomical watershed features, to generate high-precision simulated natural segmentation planes of lung sub-segments through specific textures and forms. This technology forms fluorescent watershed boundaries on the lung surface, which highly fit the actual lung anatomical structure. By analyzing the adjacent relationship between the nodule and the watershed boundary, real-time, visually accurate positioning of the nodule can be achieved. This innovative technology provides a new solution for the intraoperative positioning and resection of lung nodules. This consensus was led by four major domestic societies, jointly with expert teams in related fields, oriented to clinical practical needs, referring to domestic and foreign guidelines and consensus, and finally formed after multiple rounds of consultation, discussion, and voting. The main content covers the theoretical basis of the "watershed topography map" technology, indications, operation procedures, surgical planning details, and postoperative evaluation standards, aiming to provide scientific guidance and exploration directions for clinical peers who are currently or plan to carry out lung nodule resection using the fluorescent microscope watershed analysis method.

The sternalis muscle is a rare supernumerary muscle representing a normal anatomical variant in the anterior thoracic musculature. Due to wide variation in its morphology and relative unfamiliarity among radiologists, it has been implicated in the misdiagnosis of breast masses on mammography. A 23-year-old male with no significant medical history was referred to our institution for further management of painless bilateral breast enlargement since adolescence. Physical examination revealed breasts of slightly prominent size but there was no palpable breast lump. Mammography work-up found symmetrical, well-defined soft tissue masses projected over the posteromedial aspect of both breasts. Imaging findings were consistent with bilateral sternalis muscles, unusually hypertrophic in size due to intense upper body weight training by the patient. This case highlights the importance of recognizing the usual and unusual presentations of the sternalis muscles on mammography to avoid any unnecessary work-up.

Objective To explore the correlation between the location of adult peptic ulcers and Helicobacter pylori(Hp)infection and antibody typing,as well as its clinical significance.Methods A retrospective analysis was conducted on the serum Hp antibody typing results of adult patients 850 cases with peptic ulcers at Xuzhou Central Hospital from 2017 to 2024.According to the location of ulcers:duodenal ulcer group(DU group,n=429),gastric ulcer group(GU group,n=291)and ulcerative colitis group(UC group,n=130)were divided into three groups,and the relationship between ulcer location and Hp immunophenotyping was analyzed.The test results of 232 adult health examinees were used as the control group.Results The overall Hp infection rate in peptic ulcers patients was 79.76%(678/850),mainly with high virulence type I,with an rate of 62.71%(533/850),and type II was 17.06%(145/850).The Hp infection rates in the DU group,GU group,UC group and control groups were 86.48%(371/429),79.04%(230/291),59.23%(77/130)and 56.47%(131/232)respectively.The infection rates of type I were 72.96%,57.73%,40.00%and 47.41%,respectively.The infection rates of type II were 13.52%,21.31%,19.23%and 9.05%,respectively.The total infection rate,type I infection rate and type II infection rate of Hp were compared among the DU group,GU group,UC group and control group,and the differences were all statistically significant(χ2=91.838,67.169,17.647,all P<0.05).Compared with the UC group,the overall infection rate and type I infection rate of Hp in the DU group were the highest,followed by the GU group,and the differences were statistically significant(χ2=11.324～47.800,all P<0.05).However,the overall infection rate and the infection rate of type I were compared between the UC group and the control group,and the differences were not statistically significant(χ2=0.261,1.852,all P>0.05).The infection rate of type Ⅱ in GU group and UC group was significantly higher than that in controls groups,and the differences were statistically significant(χ2=14.518,7.782,all P<0.05).In addition,the positive rate of dual antibodies against CagA+VacA in the four groups was significantly higher than that of single antibody against CagA,VacA,and the differences were statistically significant(χ2=7.538～407.569,all P<0.05).Conclusion Adult patients with peptic ulcers are mainly infected with Hp type I strains,and the infection rate of type I strains is the highest in the DU group,followed by GU,while the infection rate of type I strains in UC is the lowest.UC is closely related to type II strain infection,and the infection rate is similar to that of GU patients.

Transcatheter aortic valve replacement(TAVR)is increasingly being applied in low-risk and younger patients.However,this trend necessitates that cardiac surgeons take on the responsibility of comprehensive lifetime management.This article explores three critical aspects of lifetime management,including the selection of the initial valve,the procedural success and the device success rates of TAVR,and the durability of the valve.Younger TAVR recipients require comprehensive lifetime management strategies,including the potential risk of reintervention.Improving TAVR's procedural and device success rates is the cornerstone of lifetime management,necessitating efforts in surgical strategy and operation to reduce complications.Valve durability is a key guarantee;current surgical bioprosthetic valves show good durability,but long-term data on TAVR valves'durability is still needed.Meanwhile,novel valves are being improved in durability,offering new directions for optimizing lifetime management in TAVR patients.

Transcatheter aortic valve replacement(TAVR)is increasingly being applied in low-risk and younger patients.However,this trend necessitates that cardiac surgeons take on the responsibility of comprehensive lifetime management.This article explores three critical aspects of lifetime management,including the selection of the initial valve,the procedural success and the device success rates of TAVR,and the durability of the valve.Younger TAVR recipients require comprehensive lifetime management strategies,including the potential risk of reintervention.Improving TAVR's procedural and device success rates is the cornerstone of lifetime management,necessitating efforts in surgical strategy and operation to reduce complications.Valve durability is a key guarantee;current surgical bioprosthetic valves show good durability,but long-term data on TAVR valves'durability is still needed.Meanwhile,novel valves are being improved in durability,offering new directions for optimizing lifetime management in TAVR patients.

This study was aimed at understanding the relationships among the drug resistance and genome characteristics of group A Streptococcus in Jiangsu Province.A total of 149 group A Streptococcus strains were collected from hospitals between 2016 and 2023.Thirteen antimicrobial minimal inhibitory concentrations were detected with the micro-dilution broth method.The GAS strains were typed with emm genotyping analysis and whole genome sequencing,to determine the carriage rates of drug resistance genes and the evolutionary relationships among strains.The resistance rates of 149 GAS strains to erythromy-cin,tetracycline,and clindamycin exceeded 90％,whereas the strains showed sensitivity to 8 different antibiotics,including penicillin.Notably,the resistance rates to erythromycin,tetracycline,and clindamycin consistently increased over time.All strains were classified into 9 emm types,among which emm12 accounted for the highest proportion(77/149;51.68％).Signifi-cant statistical differences were observed among emm types,in terms of the drug resistance rate,number of resistant species,and prevalence of drug resistance genes.Furthermore,SNP evolutionary tree analysis revealed 3 distinct clusters within the GAS strains:emm12,emm1,and other emm types.emm 12 and emm1 were the dominant GAS strains in Jiangsu Province.Most isolates were resistant to erythromycin,tetracycline,and clindamycin.Differences in phenotypes and genomic characteris-tics were observed among emm types.

Objective:To analyze the characteristics of transabdominal bowel ultrasound (TBUS) in immune checkpoint inhibitor-related colitis (IRC) and their correlation with endoscopic manifestations.Methods:A cross-sectional study was conducted. Clinical data from 10 patients with IRC treated at Peking Union Medical College Hospital from January 2022 to January 2024 were collected. The ulcerative colitis endoscopic index of severity (UCEIS) and Limberg classification were used to assess the severity of colonoscopy and TBUS examinations, respectively. Kendall's tau-b method was applied for correlation analysis between UCEIS scores and Limberg classification.Results:All the 10 patients were male with a median age of 65 years (59-74 years). The majority had lung cancer (8 patients) and all were in advanced stages, with 6 patients in stage Ⅲ and 4 in stage Ⅳ. They all received anti-programmed death 1 (PD-1) /anti-programmed death ligand 1 (PD-L1) combined with chemotherapy, among whom 2 patients were combined with anti-angiogenic drug treatment. The median time from the first immunotherapy to the onset of IRC was 1.50 (0.25-12.00) months; the median time from IRC treatment to clinical symptom relief to G1 was 2.45 (0.50-8.00) weeks. Nine patients were in the active phase, mainly G3 (8 patients) ; 1 was in the remission phase after treatment. TBUS showed that among the 9 active IRC patients, the entire colon was mainly involved (7 patients), with combined small intestine involvement (3 patients) ; the main manifestations were thickening of the bowel wall, with the thickest bowel wall being 7.0 (5.0-8.0) mm, mainly located in the sigmoid colon (3 patients) and descending colon (3 patients) ; increased bowel wall blood flow signals (Limberg classification 2-4) occurred in 7 patients; 3 active patients had perienteric fat wrapping, and 2 had blurred bowel wall stratification. The Kendall's tau-b correlation coefficient r between the entire colon UCEIS scores and Limberg classification was 0.891 ( P = 0.003), and the Kendall's tau-b correlation coefficient r between the colon segment UCEIS scores and Limberg classification was 0.690 ( P < 0.001) . Conclusion:During the active phase, the left colon of IRC is more severe in TBUS, which mainly manifests as the thickening bowel wall and increased blood flow signals, and the TBUS has good correlation with colonoscopy evaluation.

Objective To explore the correlation between the location of adult peptic ulcers and Helicobacter pylori(Hp)infection and antibody typing,as well as its clinical significance.Methods A retrospective analysis was conducted on the serum Hp antibody typing results of adult patients 850 cases with peptic ulcers at Xuzhou Central Hospital from 2017 to 2024.According to the location of ulcers:duodenal ulcer group(DU group,n=429),gastric ulcer group(GU group,n=291)and ulcerative colitis group(UC group,n=130)were divided into three groups,and the relationship between ulcer location and Hp immunophenotyping was analyzed.The test results of 232 adult health examinees were used as the control group.Results The overall Hp infection rate in peptic ulcers patients was 79.76%(678/850),mainly with high virulence type I,with an rate of 62.71%(533/850),and type II was 17.06%(145/850).The Hp infection rates in the DU group,GU group,UC group and control groups were 86.48%(371/429),79.04%(230/291),59.23%(77/130)and 56.47%(131/232)respectively.The infection rates of type I were 72.96%,57.73%,40.00%and 47.41%,respectively.The infection rates of type II were 13.52%,21.31%,19.23%and 9.05%,respectively.The total infection rate,type I infection rate and type II infection rate of Hp were compared among the DU group,GU group,UC group and control group,and the differences were all statistically significant(χ2=91.838,67.169,17.647,all P<0.05).Compared with the UC group,the overall infection rate and type I infection rate of Hp in the DU group were the highest,followed by the GU group,and the differences were statistically significant(χ2=11.324～47.800,all P<0.05).However,the overall infection rate and the infection rate of type I were compared between the UC group and the control group,and the differences were not statistically significant(χ2=0.261,1.852,all P>0.05).The infection rate of type Ⅱ in GU group and UC group was significantly higher than that in controls groups,and the differences were statistically significant(χ2=14.518,7.782,all P<0.05).In addition,the positive rate of dual antibodies against CagA+VacA in the four groups was significantly higher than that of single antibody against CagA,VacA,and the differences were statistically significant(χ2=7.538～407.569,all P<0.05).Conclusion Adult patients with peptic ulcers are mainly infected with Hp type I strains,and the infection rate of type I strains is the highest in the DU group,followed by GU,while the infection rate of type I strains in UC is the lowest.UC is closely related to type II strain infection,and the infection rate is similar to that of GU patients.