Objective To construct a model for predicting ki-67 expression in hepatocellular carcinoma using the intratumoral and peritumoral radiomic features of contrast enhanced magnetic resonance imaging(CEMRI)in the arterial phase as well as clinical imaging features.Methods A total of 120 patients pathologically diagnosed with hepatocellular carcinoma(HCC)from January 2016 to December 2024 in No.910 Hospital of the Joint Logis-tics Support Force of the Chinese People's Liberation Army were retrospectively enrolled and randomly divided into a training set(84 cases)and a test set(36 cases)in a ratio of 7∶3.ITK-SNAP software was used to delineate the global region of interest(ROI)of HCC on the arterial phase MR images.The ROIs of all patients were automatically expanded outward by 2 mm,and then the intratumoral ROI areas were eliminated to obtain the peritumoral ROI.With the help of PyRadiomics software,1 198 intratumoral and peritumoral radiomic features were extracted.Spearman correlation analysis,maximum relevance-minimum redundancy(mRMR),and least absolute shrinkage and selection operator(LASSO)regression were used to reduce the data dimension and select the best features.Then,a radiomics model of the logistic regression(LR)machine learning algorithm was constructed.A combined model including clinical imaging features and radiomics features was established.The area under the curve(AUC),accuracy,sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),calibration curve and decision curve analysis(DCA)were used to evaluate the efficacy of the intratumoral and peritumoral radiomics features combined with clinical imaging features model in predicting ki-67 expression in hepatocellular car-cinoma.Results The intratumor model exhibited an efficacy in predicting the expression of ki-67 in hepatocellular carcinoma with AUC values of 0.817 and 0.787 in the training set and test set,respectively.The peritumoral model showed an efficacy with AUC values of 0.805 and 0.633 in the training set and test set,respectively.The intratumoral and peritumoral model demonstrated AUC values of 0.874 and 0.836 in the training set and test set,respectively.The combined model constructed by integrating the intratumoral and peritumoral model with clinical imaging features yielded AUC values of 0.877 and 0.849 in the training set and test set,respectively,indicating clinical imaging features improved the performance of the model.DCA showed that the combined models all had good clinical benefits,with the intratumoral and peritumoral model performing the best.Conclusion The intratumoral and peritumoral radiomics model based on CEMRI arterial phase combined with clinical imaging data can accurately predict the expression of ki-67 in hepatocellular carcinoma.This combined model yields the best clinical benefit.

In the era of big data,artificial intelligence(AI)technology has developed rapidly,with medical field being one of its most deeply penetrated application domains.Leveraging the advantages of big data and AI requires the sharing and integration of medical data,yet balancing privacy protection and data sharing poses significant challenges.This paper analyzes the focus issues of patient privacy and data security in medical AI from a global perspective across 6 dimensions:challenges in data sovereignty and cross-border flow compliance,technical vulnerabilities in de-anonymization and re-identification risks,failure of informed consent mechanisms and dynamic authorization needs,regulatory gaps in algorithmic"black boxes"and data misuse,technological dependency and supply chain security risks,and the dilemma of balancing privacy protection with public health interests.Corresponding solutions and strategies are also proposed.

Objective To construct a model for predicting ki-67 expression in hepatocellular carcinoma using the intratumoral and peritumoral radiomic features of contrast enhanced magnetic resonance imaging(CEMRI)in the arterial phase as well as clinical imaging features.Methods A total of 120 patients pathologically diagnosed with hepatocellular carcinoma(HCC)from January 2016 to December 2024 in No.910 Hospital of the Joint Logis-tics Support Force of the Chinese People's Liberation Army were retrospectively enrolled and randomly divided into a training set(84 cases)and a test set(36 cases)in a ratio of 7∶3.ITK-SNAP software was used to delineate the global region of interest(ROI)of HCC on the arterial phase MR images.The ROIs of all patients were automatically expanded outward by 2 mm,and then the intratumoral ROI areas were eliminated to obtain the peritumoral ROI.With the help of PyRadiomics software,1 198 intratumoral and peritumoral radiomic features were extracted.Spearman correlation analysis,maximum relevance-minimum redundancy(mRMR),and least absolute shrinkage and selection operator(LASSO)regression were used to reduce the data dimension and select the best features.Then,a radiomics model of the logistic regression(LR)machine learning algorithm was constructed.A combined model including clinical imaging features and radiomics features was established.The area under the curve(AUC),accuracy,sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),calibration curve and decision curve analysis(DCA)were used to evaluate the efficacy of the intratumoral and peritumoral radiomics features combined with clinical imaging features model in predicting ki-67 expression in hepatocellular car-cinoma.Results The intratumor model exhibited an efficacy in predicting the expression of ki-67 in hepatocellular carcinoma with AUC values of 0.817 and 0.787 in the training set and test set,respectively.The peritumoral model showed an efficacy with AUC values of 0.805 and 0.633 in the training set and test set,respectively.The intratumoral and peritumoral model demonstrated AUC values of 0.874 and 0.836 in the training set and test set,respectively.The combined model constructed by integrating the intratumoral and peritumoral model with clinical imaging features yielded AUC values of 0.877 and 0.849 in the training set and test set,respectively,indicating clinical imaging features improved the performance of the model.DCA showed that the combined models all had good clinical benefits,with the intratumoral and peritumoral model performing the best.Conclusion The intratumoral and peritumoral radiomics model based on CEMRI arterial phase combined with clinical imaging data can accurately predict the expression of ki-67 in hepatocellular carcinoma.This combined model yields the best clinical benefit.

Objective:To investigate the efficacy and safety of dual antiplatelet therapy (DAPT) in patients with minor ischemic stroke (MIS) and tiny unruptured intracranial aneurysm (UIA).Methods:Patients with MIS and tiny UIA admitted to the Department of Neurology, Weifang People's Hospital from October 1, 2022 to February 29, 2024 were included retrospectively. MIS was defined as baseline National Institutes of Health Stroke Scale (NIHSS) score ≤3. Tiny UIA was defined as UIA with a diameter of ≤3 mm. According to the antiplatelet therapy regimen, the patients were divided into an aspirin alone group and an aspirin+clopidogrel DAPT group. The main outcome measure was the clinical outcome at 90 days after onset. The modified Rankin Scale (mRS) score 0-1 was defined as a good outcome and >1 was defined as a poor outcome. Secondary outcome measures included aneurysm rupture, cerebral hemorrhage, and recurrence of cerebral ischemic events. Multivariate logistic regression analysis was used to identify the independent influencing factors for poor outcome. Results:A total of 183 patients with MIS and tiny UIA were included, including 108 males (59.0%), median aged 68 years (interquartile range, 61-73 years). All the UIAs were solitary. The mRS score of all patients before onset was 0; 152 patients (83.1%) had good outcome at 90 days after onset, 31 (16.9%) had poor outcome, and no UIA occurred rupture bleeding. Of the 94 patients (51.4%) who received aspirin monotherapy, 14 patients (14.9%) experienced recurrent cerebral ischemic events during follow-up, and 73 (77.7%) had good outcome. Of the 89 patients (48.6%) who received DAPT, 5 (5.6%) experienced recurrent ischemic events during follow-up, and 79 (88.8%) had good outcome. The recurrence rate of cerebral ischemic events in the aspirin group was significantly higher than that in the DAPT group ( χ2=4.227, P=0.040), while the good outcome rate was significantly lower than that in the DAPT group ( χ2=4.006, P=0.045). Multivariate logistic regression analysis showed that baseline NIHSS score was an independent risk factor for poor outcome (odds ratio 4.597, 95% confidence interval 1.864-11.339; P=0.001), while DAPT was an independent protective factor for good outcome (odds ratio 0.265, 95% confidence interval 0.079-0.892; P=0.032). Conclusion:Compared with aspirin monotherapy, the short-term combination of aspirin and clopidogrel in patients with MIS and tiny UIA may improve the outcome, reduces the recurrence of cerebral ischemic events, and has good safety.

SGLT2 inhibitors currently have clear benefits in the treatment of heart failure whether combined with diabetes or not. Ventricular remodeling after myocardial infarction leads to the occurrence and development of heart failure, and eventually leads to death. There are relatively few studies on SGLT2 inhibitors in patients with myocardial infarction. The purpose of this article is to review the research progress of SGLT2 inhibitors application before and after myocardial infarction.

Objective:To investigate the role of prophylactic cranial irradiation (PCI) in non-small cell lung cancer (NSCLC) by meta-analysis.Methods:Studies published from January 1, 1980 to August 30, 2021 were searched systematically in PubMed, Embase, Cochrane Systematic Review database and China National Knowledge Infrastructure Database. The searching keywords included "non-small cell lung cancer", "randomized controlled trial", "prophylactic cranial irradiation" and "clinical trial". The data extracted from the above studies were analyzed using Review Manager 5.3 and Stata 12.0 software. Outcomes included the development of brain metastases (BM), overall survival (OS), disease-free survival (DFS), toxicity, and quality of life (QoL).Results:Ten trials, including 2005 NSCLC patients, met the inclusion criteria. Patients who underwent PCI had a significantly lower risk of BM than those who did not ( OR=0.29, 95% CI: 0.22-0.40, P<0.001). Compared with non-PCI group, DFS in PCI group was significantly increased ( HR=0.75, 95% CI: 0.63-0.89, P=0.001). However, there was no significant difference in OS ( OR=0.90, 95% CI: 0.69-1.18, P=0.45). In addition, the incidence of fatigue was significantly increased in the PCI group ( OR=2.64, 95% CI: 1.58-4.40, P<0.001). There was no significant difference in cognitive impairment between the PCI and non-PCI groups ( OR=3.60, 95% CI: 0.97-13.32, P=0.06). Conclusions:PCI is the standard treatment for NSCLC. Compared with non-PCI, PCI significantly reduces the incidence of BM and prolongs the DFS of NSCLC patients. The effect of PCI-related toxicity on the QoL and long-term OS needs further study.

OBJECTIVE: To assess the association of genomic instability of epithelial cadherin 1 (CDH1) gene and clinicopathological characteristics of gastric cancer. METHODS: In total 120 paraffin-embedded gastric cancer tissue specimen were prepared, and genomic DNA was extracted. The genomic instability of the CDH1 gene was analyzed by immunohistochemistry and silver staining PCR-single-strand conformation polymorphism. RESULTS: The number of information individuals (heterozygotes) was 98 for the D16S752 locus. The detection rates for microsatellite instability (MSI) and loss of heterozygosity (LOH) at the D16S752 locus and the positive rate of CDH1 protein were 19.39%, 16.33% and 51.02%, respectively. The detection rate of MSI in TNM stages I or II was significantly higher than that in stages III or IV (P<0.05) while the detection rate of LOH was significantly lower than that in stages III or IV (P<0.05). The positive rate of CDH1 protein in TNM stages III or IV was significantly lower than that in stages I or II (P<0.05). The detection rate of MSI of cases with lymph node metastasis was significantly lower than that of without lymph node metastasis (P<0.05) while the detection rate of LOH was significantly higher than that without lymph node metastasis (P<0.05). The positive rate of CDH1 protein in patients with lymph node metastasis was significantly lower than that in patients without lymph node metastasis (P<0.05). The positive rate of CDH1 protein in MSI-positive group was significantly higher than that in MSI-negative group (P<0.05), and the positive rate of CDH1 protein in the LOH-positive group was significantly lower than that the LOH-negative group (P<0.05). CONCLUSION The genomic instability of the CDH1 gene is associated with the progression of gastric cancer. MSI at the D16S752 locus may be used as a molecular marker for early gastric cancer, while LOH at this locus mostly occurs in advanced gastric cancer and can be regarded as an effective indicators for malignancy evaluation and prognosis.
Humans ; Stomach Neoplasms/pathology* ; Lymphatic Metastasis ; Cdh1 Proteins/genetics* ; Microsatellite Instability ; Loss of Heterozygosity ; Genomic Instability ; Microsatellite Repeats ; Antigens, CD/genetics* ; Cadherins/genetics*

Sea-air joint search and rescue（SAR）is an effective way for saving pilots in distress. This paper explores the characteristics and requirements of joint SAR for pilots in distress at sea，and in view of the existing problems of maritime SAR，it puts forward countermeasures to improve the sea-air joint SAR capabilities，including establishing a more efficient sea-air joint SAR mechanism，strengthening training in real combat conditions of sea-air joint SAR，and improving the capacity building of SAR special equipment.

Sea-air joint search and rescue（SAR）is an effective way for saving pilots in distress. This paper explores the characteristics and requirements of joint SAR for pilots in distress at sea，and in view of the existing problems of maritime SAR，it puts forward countermeasures to improve the sea-air joint SAR capabilities，including establishing a more efficient sea-air joint SAR mechanism，strengthening training in real combat conditions of sea-air joint SAR，and improving the capacity building of SAR special equipment.

Nautical medicine, as a comprehensive discipline, studies various medical problems under the conditions of navigation. As human seafaring activities are affected by various surface and underwater environmental factors, this discipline focuses on exploring and studying the physical and mental health problems of all kinds of seafaring personnel at all levels from the perspectives of diving medicine, nautical hygiene, nautical ergonomics, and nautical psychology, to ensure those personnel’s physical and mental health under special environment, improve their working environment, increase their working efficiency, and realize the on-site medical rescue support. In this paper, the current status and development of nautical medicine research at home and abroad were summarized, and the future research directions of nautical medicine were prospected.