Gastric cancer with peritoneal metastasis (GCPM) is a common and lethal manifestation of advanced gastric cancer, with a median survival of only 5-11 months. This consensus was developed by 30 experts from Asia (China, Japan, Korea, and Singapore) using the Delphi method and the GRADE evidence grading system. A total of 29 statements were formulated, covering the diagnosis and assessment of GCPM, indications for laparoscopic exploration and NIPS (normothermic intraperitoneal and systemic treatment), treatment regimens, prevention and management of complications, criteria for conversion surgery, and postoperative intraperitoneal therapy. The consensus aims to standardize clinical practice and improve the prognosis of patients with GCPM.

Objective Viral encephalitis is an infectious disease severely affecting human health.It is caused by a wide variety of viral pathogens,including herpes viruses,flaviviruses,enteroviruses,and other viruses.The laboratory diagnosis of viral encephalitis is a worldwide challenge.Recently,high-throughput sequencing technology has provided new tools for diagnosing central nervous system infections.Thus,In this study,we established a multipathogen detection platform for viral encephalitis based on amplicon sequencing. Methods We designed nine pairs of specific polymerase chain reaction(PCR)primers for the 12 viruses by reviewing the relevant literature.The detection ability of the primers was verified by software simulation and the detection of known positive samples.Amplicon sequencing was used to validate the samples,and consistency was compared with Sanger sequencing. Results The results showed that the target sequences of various pathogens were obtained at a coverage depth level greater than 20×,and the sequence lengths were consistent with the sizes of the predicted amplicons.The sequences were verified using the National Center for Biotechnology Information BLAST,and all results were consistent with the results of Sanger sequencing. Conclusion Amplicon-based high-throughput sequencing technology is feasible as a supplementary method for the pathogenic detection of viral encephalitis.It is also a useful tool for the high-volume screening of clinical samples.

Recent advancements in the field of medical artificial intelligence (AI) have led to the widespread adoption of foundational and large language models. This review paper explores their applications within medical AI, introducing a novel classification framework that categorizes them as disease-specific, general-domain, and multi-modal models. The paper also addresses key challenges such as data acquisition and augmentation, including issues related to data volume, annotation, multi-modal fusion, and privacy concerns. Additionally, it discusses the evaluation, validation, limitations, and regulation of medical AI models, emphasizing their transformative potential in healthcare. The importance of continuous improvement, data security, standardized evaluations, and collaborative approaches is highlighted to ensure the responsible and effective integration of AI into clinical applications.

Humans ; Otolaryngology ; Head/surgery* ; Neck/surgery*

AIM:To explore the effect of genetic factors on the pathogenesis of keratoconus and its genetic model.METHODS: Genetic epidemiological methods were used to investigate the prevalence of keratoconus in 280 first-degree relatives of 100 patients with keratoconus who attended Henan Eye Hospital between July 2020 and April 2023. The heritability was estimated by Falconer regression method. The general genetic model was calculated using Penrose method, and the genetic model was confirmed by Falconer formula, Edwards approximation formula and the projection formula of San-Duo Jiang's threshold model theory.RESULTS: The results showed that there were 16(5.714%)first-degree relatives of keratoconus probands suffering from keratoconus, and the heritability of keratoconus was(86.100±7.400)%. The S/q score calculated by the Penrose method was 35.348, which was near to 1/(q)1/2, suggesting that the genetic model of keratoconus might be polygenic inheritance. The expected prevalence in first-degree relatives of keratoconus patients by Falconer formula, Edwards approximation formula and the projection formula of San-Duo Jiang's threshold model theory were 5.900%, 7.714% and 5.700%, respectively, which showed no significant differences from the actual prevalence(5.714%), suggesting that keratoconus was a polygenetic disease.CONCLUSION:Genetic factors might play an important role in the pathogenesis of keratoconus, and keratoconus is a polygenetic disease.

OBJECTIVE: To evaluate the feasibility and tolerability of metoprolol standard dosing pathway (MSDP) in Chinese patients with acute coronary syndrome (ACS). METHODS: In this multicenter, prospective, open label, single-arm and interventional study that was conducted from February 2018 to April 2019 in fifteen Chinese hospitals. A total of 998 hospitalized patients aged ≥ 18 years and diagnosed with ACS were included. The MSDP was applied to all eligible ACS patients based on the standard treatment recommended by international guidelines. The primary endpoint was the percentage of patients achieving the target dose at discharge (V2). The secondary endpoints included the heart rate and blood pressure at V2 and four weeks after discharge (V4), and percentage of patients experiencing bradycardia (heart rate < 50 beats/min), hypotension (blood pressure < 90/60 mmHg) and transient cardiac dysfunction at V2 and V4. RESULTS: Of the 998 patients, 29.46% of patients achieved the target dose (≥ 95 mg/d) at V2. The total population was divided into two groups: target group (patients achieving the target dose at V2) and non-target group (patients not achieving the target dose at V2). There was significant difference in the reduction of heart rate from baseline to discharge in the two groups (-4.97 ± 11.90 beats/min vs. -2.70 ± 9.47 beats/min, P = 0.034). There was no significant difference in the proportion of bradycardia that occurred in the two groups at V2 (0 vs. 0, P = 1.000) and V4 (0.81% vs. 0.33%, P = 0.715). There was no significant difference in the proportion of hypotension between the two groups at V2 (0.004% vs. 0.004%, P = 1.000) and V4 (0 vs. 0.005%, P = 0.560). No transient cardiac dysfunction occurred in two groups during the study. A total of five adverse events (1.70%) and one serious adverse event (0.34%) were related to the pathway in target group. CONCLUSIONS In Chinese ACS patients, the feasibility and tolerability of the MSDP have been proved to be acceptable.

Objective: To investigate the effect of centrosomal protein Cep63 on the apoptosis of papillary thyroid carcinoma (PTC) cell lines TPC-1 and underlying mechanism. Methods: With collected PTC tissues and adjacent tissues, Cep63 expression was detected by RT-qPCR and its relationship with clinicopathological factors was analyzed. The experiment included negative control group (NC), low expression group (Cep63(-)) and overexpression group (Cep63(+)), and wild-type TPC-1 cells were transfected with Cep63 lentivirus. The efficiency of Cep63 was detected by western blot (WB) and qRT-PCR. Cell proliferation ability was detected by plate cloning experiment and MTT assay. Cell apoptotic rate was detected by flow cytometry, and expression levels of apoptosis-related proteins were detected by immunohistochemistry and WB. The t-test was used to compare the differences in the means between the two groups, the one-way analysis of variance was used to compare multiple groups, and the chi-square test was used to analyze the association between gene expression levels and pathological factors. Results: Compared with NC group, cell proliferation ability was significantly decreased in Cep63(-) group (3.18±0.07 vs. 2.14±0.09, t=8.54, P<0.01) and significantly increased in Cep63(+) group (3.18±0.07 vs. 3.58±0.10, t=3.21, P<0.05). Apoptotic rates in NC, Cep63 (-) and Cep63 (+) groups were respectively 3.03%±0.24%, 8.66%±0.44% and 1.17%±0.44%, and the flow cytometry showed that the low expression of Cep63 significantly increased the apoptosis TPC-1 cells (F=157.7, P<0.001). Bcl-2 protein expression levels of NC, Cep63 (-) and Cep63 (+) groups were respectively 1.07±0.03, 0.49±0.01 and 1.99±0.09, and BAX protein expression levels of three groups were respectively 0.64±0.02, 1.06±0.01 and 0.21±0.03. WB showed that the expression level of Bcl-2 decreased (F=183.2, P<0.001), while the expression level of BAX was significantly up-regulated (F=283.7, P<0.001). Conclusion: Cep63 may regulate the apoptotic process of TPC-1 cells through Bcl-2/BAX pathway and Cep63 may be a potential oncogene of PTC.
Apoptosis ; Carcinoma, Papillary/genetics* ; Cell Cycle Proteins ; Cell Line, Tumor ; Cell Movement ; Cell Proliferation ; Gene Expression Regulation, Neoplastic ; Humans ; Thyroid Cancer, Papillary/genetics* ; Thyroid Neoplasms/genetics*

ObjectiveTo investigate the efficacy of transurethral fenestration with holmium laser as the initial management for duplex kidney associated with ureterocele in children. MethodsThe clinical data of 35 children with duplex kidney and ureterocele who underwent surgical treatment in our department from January 2016 to December 2020 were retrospectively analyzed. According to the different initial treatment options， the subjects were divided into two groups： transurethral fenestration by holmium： YAG laser （group A） and single-port laparoscopic heminephrectomy and transperitoneal single-port laparoscopic ureterovesical replantation（group B）. Group A （n=22） received endoscopic holmium laser ureterotomy and group B （n=13） underwent kidney or bladder level reconstruction and ureterocele exclusion surgery. The age， gender， upper urinary tract condition， location of ureterocele， preoperative and postoperative vesicoureteral reflux， postoperative complications requiring additional surgery were recorded and statistically analyzed. ResultsIn group A， 13 cases had cyst crumpled and hydronephrosis subsided， 4 cases had completely disappeared cysts， de novo vesicoureteral reflux occurred in 8 cases， 5 cases underwent reoperation 3~6 months after operation， among which 4 cases underwent ureterovesical replantation because of urinary tract infection by de novo vesicoureteral reflux， 1 case received heminephrectomy and cystoscopic cystectomy because of the cyst collapse. In group B， 9 cases had favorable prognosis， 4 cases underwent reoperation from 6 to 12 months after operation， among which 1 case underwent replantation due to postoperative anastomotic obstruction， 3 cases underwent replantation due to ureteral stump syndrome. The mean operation time between group A and B was （31.77±13.43） min vs. （174.46±37.79） min，t=-13.131，P=0.000； the mean hospital stay was （2.27±1.93） d vs. （11.54±7.33） d，t=-4.465，P=0.001， and the difference was statistically significant. There was no significant difference in the early reoperation rate between the two groups （Fisher P=0.698）. ConclusionEndoscopic fenestration with holmium laser could be used as the initial management for duplex kidney combined with ureterocele in infants and young children.

ObjectiveTo investigate the practicability and efficacy of Inlay preputial graft urethroplasty combined with Buck fascia integral covering technique （Inlay-BFIC） in the treatment of hypospadias. MethodsA total of 85 surgeries of hypospadias with urethral plate width of 3-5mm at the level of the glans navicular fossa from January 2018 to August 2020 were retrospectively analyzed. The patients were divided into two groups according to the time of technique applied. Group A： from November 2018 to December 2020， 38 consecutive patients， including 5 re-operation cases， were operated with Inlay-BFIC urethroplasty. Surgical approach： a thin and full-thickness free preputial graft was embedded in the middle incision of the urethral plate when patients underwent TIP procedure； after the urethroplasty， the pre-reserved Buck fascia combined with glans wings was sutured at the midline as an intermediate layer to cover the neo-urethra. Group B： from January 2018 to December 2018， 47 consecutive primary hypospadias patients underwent conventional TIP procedure. The data of perioperative period and postoperative follow-up were recorded and analyzed statistically. ResultsTotally 85 patients were repaired by one-stage procedure. Group A with Inlay-BFIC vs. group B with conventional TIP： the mean age （39.46±34.66） vs.30.23±26.02） m， t=1.362， P=0.178， the mean length of penis （3.53±1.00） vs. （3.46±0.76） cm， t=0.373， P=0.710， the mean width of glans （1.32±0.36） cm vs. （1.37±0.22） cm， t=-0.779， P=0.438， the mean length of urethroplasty （2.10±0.68） vs.（1.92±0.61） cm， t=1.282， P=0.203. There was no significant difference between the two groups. The preoperative degree of ventral curvature and the mean operative time between group A and group B were （28.29±21.38） vs. （19.68±7.62）°， t=2.364， P=0.023 and （135.29±39.79） vs. （96.60±27.21） min， t=5.107， P=0.000. There was significant difference between the two groups. The postoperative follow-up time was 4 to 36 months. There were 2 cases of urinary fistula in Group A and 6 cases in Group B （χ²=1.387，P=0.239）， 1 cases of urethral stricture in Group A and 3 in Group B （χ²=0.659，P=0.417）. There was no significant difference between the two groups. There was no recurrent ventral curvature and urethral diverticulum in both groups. There were 4 cases of glans or urethral dehiscence in Group A and 17 cases in Group B （χ²=7.428，P=0.006）. There was significant difference between the two groups. Fifteen patients in each group received urinary flow rate test. There was no significant difference between two groups in maximum flow rate （Qmax）， average flow rate （Qavc）， flow time （FT） and voided volume （V）. ConclusionsFor the treatment of hypospadias by Buck fascia integral covering technique combined with Inlay preputial graft urethroplasty， the incidence of urinary fistula， urethral stricture， urethral diverticulum， residual penis curvature and postoperative urinary flow rate are similar to those of conventional TIP procedure， but it can significantly reduce the occurrence of glans or urethral dehiscence.

Adult ; Aged ; Antiviral Agents ; administration & dosage ; Betacoronavirus ; Coronavirus Infections ; drug therapy ; Drug Therapy, Combination ; Humans ; Interferon-alpha ; administration & dosage ; Lopinavir ; administration & dosage ; Middle Aged ; Pandemics ; Pneumonia, Viral ; drug therapy ; Randomized Controlled Trials as Topic ; Ribavirin ; administration & dosage ; Ritonavir ; administration & dosage