Objective To observe the value of synthetic MRI(SyMRI)MAGnetic resonance image Compilation(MAGiC)sequence parameters for differentiating cervical squamous cell carcinoma and cervical adenocarcinoma.Methods Sixty-six patients with pathologically confirmed cervical cancer were retrospectively enrolled and divided into cervical squamous cell carcinoma group(n=56)and cervical adenocarcinoma group(n=10).Quantitative MAGiC parameters were collected and compared between groups,and those being significantly different were combined to construct a logistic regression model.The performance of each parameter alone and their combination for differentiating cervical squamous cell carcinoma and cervical adenocarcinoma was evaluated with receiver operating characteristic(ROC)curve and the area under the curve(AUC).Results In cervical adenocarcinoma group,lesions's T1 and T2 were higher,while R1 and R2 were lower than those in cervical squamous cell carcinoma group(all P＜0.05).No statistically significant difference of proton density was found between groups(P＞0.05).The AUC of T1,T2,R1,R2 alone and their combination for differentiating cervical squamous cell carcinoma and cervical adenocarcinoma was 0.959,0.945,0.961,0.942 and 0.996,respectively,and no significant difference was found between each two ones(Z=0.267 to 1.396,all P＞0.05).Conclusion SyMRI had high value for differentiating cervical squamous cell carcinoma and cervical adenocarcinoma.

Objective This study aimed to adapt the data-driven Palliative Care Outcomes Collaboration(PCOC)model to the local context and evaluate its feasibility and preliminary effectiveness in a palliative care unit in China,with the goal of informing its broader integration into national palliative care practice.Methods Based on international experience,a localized implementation protocol for the PCOC model was developed through expert con-sultations and a pilot study.The protocol incorporated key elements including organizational and managerial sup-port,team training and capacity building,information system integration,supervision and feedback mechanisms,pro-cess optimization,and data-driven decision-making.From June to December 2023,the protocol was piloted in the palliative care unit of a tertiary cancer hospital in Changsha,China.Implementation outcomes were assessed by comparing patients' urgent care response rates,symptom stability rates,and symptom improvement rates between the first 1～3 months and 4～6 months after implementation.Results During the study period,a total of 355 inpatients were enrolled,with the PCOC assessment achieving full coverage(100％)and a completion rate of 97.78％.There was no statistically significant difference in the urgent needs response rate between the first 1～3 months and the 4～6 months after the implementation of the PCOC model(P=0.533).However,compared to the first 1～3 months af-ter implementation,patients in the 4～6 months period showed significantly higher symptom stability rates for pain,psychological/spiritual issues,and family/caregiver problems,as well as a higher improvement rate for pain(P＜0.05).Conclusion The localized PCOC implementation protocol facilitates standardized assessment and symptom manage-ment,and its application can enhance the quality of palliative care.

Objective To analyze the influencing factors of hepatic encephalopathy(HE)after transjugular intrahepatic portosystemic shunt(TIPS)and construct a nomogram prediction model based on these factors.Methods A total of 290 patients with cirrhotic portal hypertensive variceal gastrointestinal bleeding in the Yuncheng Central Hospital Affiliated to Shanxi Medical University from January 2019 to December 2023 were selected and randomly divided into training set of 145 cases and validation set of 145 cases.All patients underwent TIPS treatment,and the incidence of HE within 3 months after TIPS was recorded.In the training set,patients were divided into HE group(n=42)and non-HE group(n=103)based on the occurrence of HE.Clinical materials were compared between the two groups,and Lasso-Logistic regression analysis was applied to explore the influencing factors of HE after TIPS.A nomogram prediction model was constructed based on the influencing factors and validated in both the training set and the validation set for its clinical value in predicting HE after TIPS.Results The overall incidence of HE was 29.31％,with incidence rates of 28.97％and 29.66％respectively in the training set and the validation set.In the training set,the HE group had significantly higher age,C grading of preoperative Child-Pugh ratio,diabetes mellitus ratio,total bilirubin(TBIL),prothrombin time(PT),serum sodium,serum creatinine,interleukin-6(IL-6),interleukin-18(IL-18),blood ammonia,monocyte chemotactic protein-1(MCP-1),postoperative portal venous pressure,and intestinal flora disturbance ratio when compared to the non-HE group,while the preoperative glial fibrillary acidic protein(GFAP)level was significantly lower in the HE group(P＜0.05).Lasso-Logistic regression analysis showed that preoperative C grading of Child-Pugh grading,diabetes mellitus,TBIL,PT,IL-6,IL-18,blood ammonia,GFAP,MCP-1 level,and postoperative intestinal flora disturbance were influencing factors for HE after TIPS(P＜0.05).A nomogram prediction model was constructed based on ten influencing factors selected by Lasso-Logistic regression analysis.The area under the curve(AUC)of this model for predicting HE after TIPS was 0.933(95％CI,0.889 to 0.976)in the training set and 0.944(95％CI,0.893 to 0.995)in the valida-tion set,with good consistency between the model's prediction and actual observation.Conclusion The nomogram prediction model for HE after TIPS,constructed based on the influencing factors selected by Lasso-Logistic regression analysis,has high predictive efficacy and accuracy.

Objective:To explore the correlation between conventional ultrasound and contrast-enhanced ultrasound features and invasive histological features of T 1a clear cell renal cell carcinoma (ccRCC). Methods:A retrospective case series study was conducted. Sixty-seven T 1a ccRCC patients who were admitted to Shanxi Province Cancer Hospital from May 2018 to August 2023 were selected. According to the World Health Organization (WHO)/International Society of Urology and Pathology (ISUP) renal tumor grading system, the patients were divided into the low-grade group (WHO/ISUP grades 1-2, 53 cases) and the high-grade group (WHO/ISUP grades 3-4, 14 cases). The conventional ultrasound and contrast-enhanced ultrasound characteristics of two groups of patients were compared. Multivariate logistic regression model was used to analyze the independent factors of conventional ultrasound and contrast-enhanced ultrasound related to T 1a ccRCC with WHO/ISUP high grade. Results:There were no statistically significant differences in clinical characteristics between the two groups of patients (all P > 0.05). In conventional ultrasound examination, the proportion of patients with tumor exophytic rate <50% in the high-grade group was higher than that in the low-grade group [64.3% (9/14) vs. 34.0% (18/53)], and the difference was statistically significant ( χ2 = 4.23, P = 0.040); there were no statistically significant differences in the distribution of patients with different tumor maximum diameter, laterality, polarity, depth, echo, boundary, and shape between the two groups (all P > 0.05). In contrast-enhanced ultrasound examination, the proportion of patients lack of pseudocapsule sign in the high-grade group was higher than that in the low-grade group [57.1% (8/14) vs. 24.5% (13/53)], and the difference was statistically significant ( χ2 = 4.06, P = 0.044); there were no statistically significant differences in the distribution of patients with different perfusion mode, enhancement degree, enhancement uniformity, and regression mode between the two groups (all P > 0.05). Multivariate logistic regression analysis showed that the conventional ultrasound tumor exophytic rate < 50% (compared to exophytic rate ≥ 50%, OR = 3.732, 95% CI: 1.019-13.664, P = 0.047) and the absence of pseudocapsule sign (compared to the presence of pseudocapsule sign, OR = 4.357, 95% CI: 1.201-15.804, P = 0.025) on contrast-enhanced ultrasound were independent risk factors for high-grade T 1a ccRCC. Conclusions:T 1a ccRCC with the exophytic rate <50% and absence of pseudocapsule sign may have invasive histological features.

Objective To systematically summarize the real experiences of the patients with totally implanted venous access ports(TIVAP)over the survival period of port-carrying,and provide references for formulation of the targeted health management programs.Methods A systematic search was conducted on databases of PubMed,Web of Science,Cochrane Library,CINAHL,Embase,PsycNET,China National Knowledge Infrastructure(CNKI),SinoMed,Wanfang Data base,and Vip for a qualitative study on the life experiences,needs,and feelings of patients with implanted infusion ports.The search period spanned from the inception of the databases to 3rd August,2024.Results A total of 14 studies were included,in 12 categories extracted from 38 research findings.Four synthesised results were further summarised,they were:impact on individual physical and mental health,impact on home life,challenges and needs in self-management and self-coping strategies of patients.Conclusion The implantation of TIVAP can produce both positive and negative experiences to the treatment as well as the life of patients.Healthcare professionals should be aware of the differences in emotion,cognition,need and personal coping strategy among the patients,hence to take effective measures to optimise the port-carrying experience of the patients,enhance the self-management enthusiasm and improve the quality of life of patients.

Objective To study the hemodynamic characteristics of autologous arteriovenous fistula(AVF)and provide a theoretical basis for reducing its stenosis rate.Methods Bidirectional fluid-structure interaction(FSI)simulations were conducted on a modified AVF model.Flow field and wall shear stress(WSS)distributions in the internal fistula at different periods and angles in a cardiac cycle were analyzed for retrograde flow(confluence)and anterograde flow(shunt)modes in models with varying anastomosis angles.Results Under confluence modes,the WSS＜1 Pa area in the 60° anastomosis angle model was the smallest(7.027 mm2),while the 45°,60°,and 90° models showed no significant differences in eddy current size and intensity.Under shunt modes,the 45° anastomosis angle model had the smallest WSS＜1 Pa area(9.079 mm2),but the 60° model exhibited the lowest eddy current intensity and distribution area.In addition,the difference in the WSS＜1 Pa area between the 60° and 45° models was only 2.661 mm2.Conclusions Under both confluence and shunt flow modes,establishing an AVF with 60° anastomosis angle is conducive to reducing the risk of vascular stenosis in arteriovenous fistula.

Objective:To summarize the clinicopathological features, evolving trends in treatment and surgical approaches, and survival outcomes of patients who underwent D2 radical gastrectomy for gastric cancer in Shanxi Provincial Cancer Hospital over the past 11 years with the goal of providing a reference for the clinical practice of gastric cancer in this region.Methods:A retrospective observational study was conducted to analyze the clinicopathological data of patients who underwent D2 radical gastrectomy for pathologically confirmed gastric malignancy at the Department of Gastrointestinal Surgery, Shanxi Provincial Cancer Hospital from January, 2013 to December, 2023. Exclusion criteria consisted of: (1) residual gastric cancer or recurrent gastric cancer after surgery; (2) emergency gastric cancer resection due to bleeding, perforation, obstruction, or other causes; (3) comorbidity with other primary malignant tumors; (4) severe preoperative cardiopulmonary insufficiency or hepatic and renal insufficiency who cannot tolerate radical surgery; and (5) inconsistent main diagnosis information across the medical record system, pathological system, and gastric cancer-specific database. Patients were divided into three groups based on treatment methods: the surgery-only group, the perioperative chemotherapy group, and the adjuvant chemotherapy group. Endpoints included: (1) baseline patient characteristics; (2) trends in tumor location and pathological features; (3) evolution of treatment modalities; and (4) survival outcomes.Results:A total of 15,644 patients were included in the analysis, with 12,591 males and 3,053 females, the male-to-female gender ration was approximately 4∶1; the mean age was (61.2±9.5) years. The tumor sites were mainly concentrated in the esophagogastric junction (EGJ) (57.4%), followed by the antrum (25.9%). The incidence of EGJ cancer initially rose and then declined. However, gastric antrum tumors remained stable, and gastric body tumors showed a slow upward trend after 2020, accounting for 16.7%. In terms of pathological types, poorly differentiated carcinoma was the most prevalent, accounting for 55.9%, followed by moderately differentiated carcinoma (24.2%), mucinous adenocarcinoma (or signet ring cell carcinoma,14.1%), neuroendocrine carcinoma (4.8%), and well-differentiated carcinoma (0.9%). The proportion of poorly differentiated adenocarcinoma showed a significant upward trend overall as well, peaking at 65.6% in 2022 and decreasing to 57.5% in 2023. Mucinous adenocarcinoma (or signet ring cell carcinoma) exhibited fluctuations with a first increase followed by a decrease: it peaked at 17.3% in 2018, dropped sharply to 8.4% in 2022, and rose back to 13.8% in 2023. The proportions of well-differentiated adenocarcinoma, moderately differentiated adenocarcinoma, and neuroendocrine tumors remained stable year by year. In terms of pathological staging, the overall proportions of gastric cancer at Stage 0, Stage I, Stage II, Stage III, and Stage IVa were 0.5%, 17.3%, 25.1%, 54.9%, and 2.3%, respectively. For Stage III, its proportion was 74.6% in 2013, which decreased to 46.4% by 2023. Stages I and II gastric cancer showed an upward trend, with their proportions rising from 10.2% and 12.1% in 2013 to nearly 21.0% and 29.6% in 2023, respectively. Between 2013 and 2023, the proportion of patients who received surgery alone continued to decrease, with this proportion dropping to 34.7% in 2023. In contrast, the number of patients who received adjuvant chemotherapy increased year by year, reaching 54.2% in 2023. Since 2017, the application of perioperative chemotherapy has gradually increased, rising to 11.1% in 2023. Immunotherapy showed an almost synchronous growth trend with perioperative chemotherapy. However, targeted therapy exhibited a downward trend after a period of growth. There were 10,704 cases of open surgery (68.4%), 4,744 cases of laparoscopic surgery (30.3%), and 193 cases of transthoracic surgery (1.2%). Pathological margin positivity was observed in 443 cases (2.8%), and the volume of gastric cancer surgeries gradually increased, peaked in 2021 before subsequently decreasing gradually. However, the volume of laparoscopic surgeries did not decrease; instead, it showed an upward trend. The main resection method for EGJ tumors was total gastrectomy, accounting for 78.5% of the total, followed by proximal gastrectomy, which accounted for 21.5%. After total gastrectomy, esophagojejunal Roux-en-Y anastomosis was the primary anastomotic method, and for proximal gastrectomy, the main anastomotic method was esophagogastric anastomosis, which accounted for 68.0% of the total. For distal gastrectomy, Billroth II anastomosis was the most common anastomotic technique, accounting for 92.7% of these procedures. The overall incidence of postoperative complications was 14.5% (2,264/15,644), among which the incidence of severe complications (grades III-IV) was 4.5% (706/15,644). The entire cohort was followed up with for (47.1±36.8) months, and the 1-year, 3-year, and 5-year overall survival rates were 86.4%, 65.9%, and 58.1%, respectively. For patients with stage 0, I, II, III, and IV gastric adenocarcinoma, the 1-year overall survival rates were 95.7%, 98.0%, 89.4%, 81.0%, and 49.1%, respectively; the 3-year overall survival rates were 92.1%, 94.6%, 81.9%, 51.4%, and 14.7%, respectively; and the 5-year overall survival rates were 89.4%, 91.7%, 75.1%, 41.5%, and 10.0%, respectively. For patients with stage I, II, III, and IV gastric neuroendocrine carcinoma, the 1-year overall survival rates were 96.7%, 91.1%, 73.8%, and 52.6%, respectively; the 3-year overall survival rates were 87.2%, 69.6%, 46.1%, and 32.1%, respectively; and the 5-year overall survival rates were 87.2%, 62.2%, 36.7%, and 32.1%, respectively.Conclusions:Gastric cancer in Shanxi Province is characterized by a male predominance, a high prevalence of tumors at the esophagogastric junction, a large proportion of poorly differentiated adenocarcinoma, and presentation at advanced stages (predominantly Stage III). The detection rate of early gastric cancer has been increasing year by year, the volume of laparoscopic surgeries has been on the rise annually, and the treatment model has shifted from single surgery to comprehensive treatment.

Objective To study the hemodynamic characteristics of autologous arteriovenous fistula(AVF)and provide a theoretical basis for reducing its stenosis rate.Methods Bidirectional fluid-structure interaction(FSI)simulations were conducted on a modified AVF model.Flow field and wall shear stress(WSS)distributions in the internal fistula at different periods and angles in a cardiac cycle were analyzed for retrograde flow(confluence)and anterograde flow(shunt)modes in models with varying anastomosis angles.Results Under confluence modes,the WSS＜1 Pa area in the 60° anastomosis angle model was the smallest(7.027 mm2),while the 45°,60°,and 90° models showed no significant differences in eddy current size and intensity.Under shunt modes,the 45° anastomosis angle model had the smallest WSS＜1 Pa area(9.079 mm2),but the 60° model exhibited the lowest eddy current intensity and distribution area.In addition,the difference in the WSS＜1 Pa area between the 60° and 45° models was only 2.661 mm2.Conclusions Under both confluence and shunt flow modes,establishing an AVF with 60° anastomosis angle is conducive to reducing the risk of vascular stenosis in arteriovenous fistula.

Objective This study aimed to adapt the data-driven Palliative Care Outcomes Collaboration(PCOC)model to the local context and evaluate its feasibility and preliminary effectiveness in a palliative care unit in China,with the goal of informing its broader integration into national palliative care practice.Methods Based on international experience,a localized implementation protocol for the PCOC model was developed through expert con-sultations and a pilot study.The protocol incorporated key elements including organizational and managerial sup-port,team training and capacity building,information system integration,supervision and feedback mechanisms,pro-cess optimization,and data-driven decision-making.From June to December 2023,the protocol was piloted in the palliative care unit of a tertiary cancer hospital in Changsha,China.Implementation outcomes were assessed by comparing patients' urgent care response rates,symptom stability rates,and symptom improvement rates between the first 1～3 months and 4～6 months after implementation.Results During the study period,a total of 355 inpatients were enrolled,with the PCOC assessment achieving full coverage(100％)and a completion rate of 97.78％.There was no statistically significant difference in the urgent needs response rate between the first 1～3 months and the 4～6 months after the implementation of the PCOC model(P=0.533).However,compared to the first 1～3 months af-ter implementation,patients in the 4～6 months period showed significantly higher symptom stability rates for pain,psychological/spiritual issues,and family/caregiver problems,as well as a higher improvement rate for pain(P＜0.05).Conclusion The localized PCOC implementation protocol facilitates standardized assessment and symptom manage-ment,and its application can enhance the quality of palliative care.

Objective To systematically summarize the real experiences of the patients with totally implanted venous access ports(TIVAP)over the survival period of port-carrying,and provide references for formulation of the targeted health management programs.Methods A systematic search was conducted on databases of PubMed,Web of Science,Cochrane Library,CINAHL,Embase,PsycNET,China National Knowledge Infrastructure(CNKI),SinoMed,Wanfang Data base,and Vip for a qualitative study on the life experiences,needs,and feelings of patients with implanted infusion ports.The search period spanned from the inception of the databases to 3rd August,2024.Results A total of 14 studies were included,in 12 categories extracted from 38 research findings.Four synthesised results were further summarised,they were:impact on individual physical and mental health,impact on home life,challenges and needs in self-management and self-coping strategies of patients.Conclusion The implantation of TIVAP can produce both positive and negative experiences to the treatment as well as the life of patients.Healthcare professionals should be aware of the differences in emotion,cognition,need and personal coping strategy among the patients,hence to take effective measures to optimise the port-carrying experience of the patients,enhance the self-management enthusiasm and improve the quality of life of patients.