Objective To investigate the correlation between the level of platelet autophagy related factors and the neurological impairment and prognosis of the patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods From July 2020 to March 2023,90 aSAH patients admitted to the intensive care unit of neurosurgery department of our hospital were analyzed retrospectively.Based on mRS score 3 months after discharge,patients with aSAH(n=46,mRS 0-2)were divided into the good prognosis group,while those with mRS 3-5(n=44)as the poor prognosis group.Platelets of all the participants were collected,and the levels of autophagy-associated protein 7(ATG7),benzalkonium chloride 1(BECN1),microtubule-associated protein 1 light chain 3(LC3)and sequestosome 1(p62)were determined by enzyme-linked immunosorbent assay(ELISA).Results Compared with the good prognosis group,the mechanical ventilation time,ICU stay,cases of early brain injury,vasospasm and delayed cerebral ischemia in the poor prognosis group increased significantly(P<0.05).Compared with the good prognosis group,the ΔPLT in the poor prognosis group decreased significantly(P<0.05),and ΔLC3-Ⅱ and ΔATG7 increased significantly(P<0.05).Spearman correlation analysis showed that ΔPLT was positively correlated with ΔATG7,ΔLC3-Ⅱ and ΔBECN1(r=0.239,0.389 and 0.487,all P<0.05).Platelet ΔLC3-Ⅱ in patients with vasospasm and delayed cerebral ischemia was higher than that in patients without vasospasm and delayed cerebral ischemia(P<0.05).ICU stay(OR=1.187,95%CI=1.045～1.349,P=0.008),ΔPLT(OR=0.972,95%CI=0.947～0.998,P=0.034)and ΔLC3-Ⅱ(OR=2.840,95%CI=1.049～7.694,P=0.040)were independent influencing factors for the poor prognosis of aSAH patients.The combination of ICU stay,ΔPLT and ΔLC3-Ⅱ had the greatest ability to predict the poor prognosis of aSAH patients,with AUC of 0.921,sensitivity of 86.4%and specificity of 84.8%.Conclusion The decrease of platelet count and LC3-Ⅱ improvement in early treatment of aSAH patients can be regarded as the independent influencing factors of adverse outcomes.

Background and Aims:The incidence of intrahepatic cholangiocarcinoma(ICC)has been increasing in recent years.Due to its insidious onset and low rate of early diagnosis,radical resection remains the only potential curative treatment.Lymph node metastasis is a major adverse prognostic factor in ICC,but the scope and therapeutic value of lymphadenectomy remain controversial.Previous studies suggest that patients with central ICC may derive greater survival benefit from lymphadenectomy than those with peripheral ICC.Preoperative assessment of lymph node status mainly relies on imaging,but its accuracy is limited.This study aimed to investigate the prognostic impact of lymphadenectomy in ICC patients at different anatomical sites to inform surgical decision-making.Methods:A retrospective analysis was conducted on 220 ICC patients who underwent radical resection at the 904th Hospital of the Joint Logistic Support Force of the PLA from May 2016 to May 2021.The cohort included 126 males and 94 females,with a mean age of(56.76±13.15)years.Patients were categorized into peripheral ICC(n=144)and central ICC(n=76)groups.Clinical characteristics,albumin-bilirubin(ALBI)grade,preoperative risk of lymph node metastasis,number of lymph nodes dissected,lymph node metastasis status,and postoperative survival outcomes were compared.Subgroup analyses were conducted to assess the prognostic value of the number of lymph nodes dissected under different risk stratifications.Results:Significant differences were observed between peripheral and central ICC in ALBI grade(x2=9.952,P=0.002),preoperative lymph node metastasis risk(x2=6.166,P=0.014),number of lymph nodes dissected(x2=4.167,P=0.042),and lymph node metastasis rate(x2=7.331,P=0.007).The 3-year overall survival(OS)rate was higher in peripheral ICC(31.94％)than in central ICC(15.79％)(x2=13.890,P＜0.001).Among central ICC patients,those with ≥6 lymph nodes dissected had better 3-year OS than those with＜6(16.89％vs.13.04％,x2=3.894,P=0.048).In the high-risk subgroup of central ICC,≥6 lymph nodes dissected was also associated with improved 3-year OS compared with＜6(15.62％vs.11.11％,x2=3.962,P=0.047).In contrast,the number of lymph node dissections had no significant prognostic impact in peripheral ICC or in patients classified as low risk.Conclusion:Patients with peripheral ICC had a better prognosis than those with central ICC.Adequate lymphadenectomy(≥6 nodes)improved survival and enhanced staging accuracy in central ICC patients at high risk of lymph node metastasis,highlighting the importance of preoperative risk assessment for optimizing surgical strategies.

Background and Aims:Radical resection is the only potentially curative treatment for intrahepatic cholangiocarcinoma(ICC),yet the high recurrence rate results in poor prognosis.In recent years,"textbook outcome"(TO)has been proposed as a comprehensive quality metric,but its association with prognosis remains unclear.This study aimed to analyze the risk factors influencing the achievement of TO after radical resection of ICC and to explore the relationship between TO and survival.Methods:A retrospective analysis was conducted on the clinical data of 180 ICC patients who underwent radical resection at the 904th Hospital of the Joint Logistic Support Force of the PLA between February 2018 and February 2023.Univariate and multivariate Logistic regression analyses were performed to identify risk factors associated with TO,and survival analysis was carried out using the Kaplan-Meier method and Log-rank test.Results:Of the 180 patients,66 achieved TO.Multivariate Logistic regression analysis indicated that preoperative total bilirubin＞22 μmol/L,preoperative CA19-9＞35 U/mL,maximum tumor diameter＞5 cm,poor tumor differentiation,microvascular invasion(MVI),and lymph node metastasis were independent risk factors for failing to achieve TO(all P＜0.05).Survival analysis demonstrated that patients who achieved TO had a significantly longer median survival compared with those who did not(36 months vs.16 months,P＜0.001).Conclusion:Preoperative total bilirubin＞22 μmol/L,preoperative CA19-9＞35 U/mL,maximum tumor diameter＞5 cm,poor tumor differentiation,MVI,and lymph node metastasis are independent risk factors for not achieving TO after radical resection of ICC.Patients who achieved TO exhibited markedly longer survival,suggesting that TO not only reflects perioperative treatment quality but also serves as an important prognostic indicator.Greater attention to these risk factors and optimization of perioperative management may improve the likelihood of achieving TO and enhance long-term outcomes.

Objective To investigate the expression of microRNA-1205(miR-1205)and tripartite motif containing 44(TRIM44)mRNA in colorectal cancer(CRC)tissues,and their correlation with pathological characteristics and prognosis.Methods A total of 140 CRC patients who underwent surgery in the hospital from January 2016 to June 2021 were enrolled as the CRC group,while 140 patients with colorectal adenomas who underwent pathological biopsies during the same period were included as the control group.Real-time flu-orescence quantitative polymerase chain reaction was used to detect the expression of miR-1205 and TRIM44 in CRC and colorectal adenoma tissues.The correlation between miR-1205 and TRIM44 expression and patho-logical parameters was analyzed.Binding sites between miR-1205 and TRIM44 were predicted using an online database,and Pearson correlation was used to analyze the correlation between miR-1205 and TRIM44 expres-sion.Based on miR-1205 and TRIM44 expression in CRC tissues,CRC patients were divided into high-expres-sion and low-expression groups.Kaplan-Meier method was used to plot survival curves of CRC patients in dif-ferent miR-1205 and TRIM44 expression groups.Cox regression analysis was used to investigate the influen-cing factors of mortality in CRC patients.Results The expression level of miR-1205 in the CRC group was lower,while the expression level of TRIM44 was higher compared to the control group(P＜0.05).There was a binding site at the 11583-11590 position in the 3'-untranslated region of TRIM44 and miR-1205.miR-1205 expression was negatively correlated with TRIM44 expression in CRC tissues(P＜0.05).There were statisti-cally significant differences in the expression levels of miR-1205 and TRIM44 among CRC patients with differ-ent differentiation levels,TNM stages,and lymph node metastasis(P＜0.05).The 3-year overall survival rate of the 140 CRC patients was 82.14％(115/140).The 3-year overall survival rate in the high miR-1205 ex-pression group was higher than in the low miR-1205 expression group,while the 3-year overall survival rate was lower in the high TRIM44 expression group compared to the low TRIM44 expression group(P＜0.05).After adjusting for confounding factors,miR-1205≥0.63 was an independent protective factor for mortality in CRC patients(P＜0.05),while TRIM44≥2.84 was an independent risk factor for mortality in CRC patients(P＜0.05).Conclusion miR-1205 is lowly expressed and TRIM44 is highly expressed in CRC tissues,both of which are associated with adverse pathological features and prognosis,and may become prognostic markers for CRC patients.

Background and Aims:The incidence of intrahepatic cholangiocarcinoma(ICC)has been increasing in recent years.Due to its insidious onset and low rate of early diagnosis,radical resection remains the only potential curative treatment.Lymph node metastasis is a major adverse prognostic factor in ICC,but the scope and therapeutic value of lymphadenectomy remain controversial.Previous studies suggest that patients with central ICC may derive greater survival benefit from lymphadenectomy than those with peripheral ICC.Preoperative assessment of lymph node status mainly relies on imaging,but its accuracy is limited.This study aimed to investigate the prognostic impact of lymphadenectomy in ICC patients at different anatomical sites to inform surgical decision-making.Methods:A retrospective analysis was conducted on 220 ICC patients who underwent radical resection at the 904th Hospital of the Joint Logistic Support Force of the PLA from May 2016 to May 2021.The cohort included 126 males and 94 females,with a mean age of(56.76±13.15)years.Patients were categorized into peripheral ICC(n=144)and central ICC(n=76)groups.Clinical characteristics,albumin-bilirubin(ALBI)grade,preoperative risk of lymph node metastasis,number of lymph nodes dissected,lymph node metastasis status,and postoperative survival outcomes were compared.Subgroup analyses were conducted to assess the prognostic value of the number of lymph nodes dissected under different risk stratifications.Results:Significant differences were observed between peripheral and central ICC in ALBI grade(x2=9.952,P=0.002),preoperative lymph node metastasis risk(x2=6.166,P=0.014),number of lymph nodes dissected(x2=4.167,P=0.042),and lymph node metastasis rate(x2=7.331,P=0.007).The 3-year overall survival(OS)rate was higher in peripheral ICC(31.94％)than in central ICC(15.79％)(x2=13.890,P＜0.001).Among central ICC patients,those with ≥6 lymph nodes dissected had better 3-year OS than those with＜6(16.89％vs.13.04％,x2=3.894,P=0.048).In the high-risk subgroup of central ICC,≥6 lymph nodes dissected was also associated with improved 3-year OS compared with＜6(15.62％vs.11.11％,x2=3.962,P=0.047).In contrast,the number of lymph node dissections had no significant prognostic impact in peripheral ICC or in patients classified as low risk.Conclusion:Patients with peripheral ICC had a better prognosis than those with central ICC.Adequate lymphadenectomy(≥6 nodes)improved survival and enhanced staging accuracy in central ICC patients at high risk of lymph node metastasis,highlighting the importance of preoperative risk assessment for optimizing surgical strategies.

Background and Aims:Radical resection is the only potentially curative treatment for intrahepatic cholangiocarcinoma(ICC),yet the high recurrence rate results in poor prognosis.In recent years,"textbook outcome"(TO)has been proposed as a comprehensive quality metric,but its association with prognosis remains unclear.This study aimed to analyze the risk factors influencing the achievement of TO after radical resection of ICC and to explore the relationship between TO and survival.Methods:A retrospective analysis was conducted on the clinical data of 180 ICC patients who underwent radical resection at the 904th Hospital of the Joint Logistic Support Force of the PLA between February 2018 and February 2023.Univariate and multivariate Logistic regression analyses were performed to identify risk factors associated with TO,and survival analysis was carried out using the Kaplan-Meier method and Log-rank test.Results:Of the 180 patients,66 achieved TO.Multivariate Logistic regression analysis indicated that preoperative total bilirubin＞22 μmol/L,preoperative CA19-9＞35 U/mL,maximum tumor diameter＞5 cm,poor tumor differentiation,microvascular invasion(MVI),and lymph node metastasis were independent risk factors for failing to achieve TO(all P＜0.05).Survival analysis demonstrated that patients who achieved TO had a significantly longer median survival compared with those who did not(36 months vs.16 months,P＜0.001).Conclusion:Preoperative total bilirubin＞22 μmol/L,preoperative CA19-9＞35 U/mL,maximum tumor diameter＞5 cm,poor tumor differentiation,MVI,and lymph node metastasis are independent risk factors for not achieving TO after radical resection of ICC.Patients who achieved TO exhibited markedly longer survival,suggesting that TO not only reflects perioperative treatment quality but also serves as an important prognostic indicator.Greater attention to these risk factors and optimization of perioperative management may improve the likelihood of achieving TO and enhance long-term outcomes.

Intelligent medical devices are flourishing with the deep integration of modern information and artificial intelligence technologies into healthcare.Testing is an important means of performance evaluation and quality control for intelligent medical devices.Compared with traditional medical devices,the testing methods and technologies of intelligent medical devices are still immature,and need active research to promote the progress in this area.Intelligent medical devices are classified according to their characteristics as artificial intelligence medical devices in the form of software and medical robots based on a general discussion of their development.The medical-device Internet of Things(IoT)system has also been included due to its close relation to the construction of smart hospitals.For each type of intelligent medical device,testing indexes and testing plans are discussed.It is suggested that specific test rules should be further developed for various specific devices.Besides,the evaluation method of complex intelligent systems should be introduced and real-world data should be used for evaluation.This paper aims to accelerate the development of intelligent medical device testing,laying the foundation for quality control and performance evaluation of intelligent medical devices.

Objective:To study and compare the impact of lymph node metastasis and dissection on the prognosis of intrahepatic cholangiocarcinoma (ICC) patients at different anatomical locations, as well as the effect on prognosis.Methods:A retrospective analysis was conducted on the clinical data of 150 ICC patients who underwent radical surgical resection at the 904th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from September 2017 to September 2020. Among them, 86 were males and 64 were females, with the age of (56.2±12.9) years. Differences in albumin-bilirubin (ALBI) grade, preoperative lymph node metastasis risk, number of lymph nodes dissected, lymph node metastasis, and postoperative survival between peripheral and central ICC patients were compared to analyze the impact of lymph node dissection on the prognosis of ICC patients at different locations.Results:There were statistically significant differences in ALBI grade, preoperative lymph node metastasis risk, the number of lymph nodes dissected, and lymph node metastasis between 98 cases of peripheral ICC and 52 cases of central ICC (all P<0.05). The 3-year overall survival rates for peripheral and central ICC patients were 30.6% and 15.4%, respectively, with a statistically significant difference ( χ2=8.46, P=0.004). Among central ICC patients, the 3-year overall survival rates for those with ≥6 lymph nodes dissected and <6 lymph nodes dissected were 16.7% and 12.5%, respectively, with a statistically significant difference ( χ2=3.96, P=0.046). In the high-risk central ICC patients with preoperative lymph node metastasis, the 3-year overall survival rate of ≥6 lymph nodes dissection ( n=22) and <6 lymph nodes dissection ( n=12) were 13.6% and 8.3%, respectively, with statistical significance ( χ2=5.55, P=0.019). Conclusions:The prognosis of peripheral ICC patients is better than that of central ICC patients. For central ICC patients with a high preoperative lymph node metastasis risk, adequate lymph node dissection can lead to a better prognosis.

Objective:To investigate the survival benefit of radiotherapy on the basis of systemic treatment for stage ⅣB esophageal squamous cell carcinoma (ESCC).Methods:Based on inclusion and exclusion criteria, we collected the treatment information of 298 patients with newly diagnosed stage ⅣB ESCC admitted to Affiliated Cancer Hospital of Zhengzhou University from January 2016 to February 2021. All patients were divided into two groups based on treatment: early radiotherapy intervention group (CRT group, n=197) and salvage radiotherapy intervention or no intervention group (CT group, n=101). Propensity score matching (PSM) was used to balance baseline characteristics between two groups. Kaplan-Meier method was used to calculate the survival rate and log-rank was used to test the difference. Cox model was used to analyze the multivariate prognosis. Results:In the CRT and CT groups, the objective response rate (ORR) and disease control rate (DCR) were 52.8% vs. 31.5%( P=0.006) and 98.9% vs. 85.4%( P=0.001) respectively, and the 1-, 2- and 3-year survival rates were 74.2% vs. 52.8%、31.5% vs. 10.1% and 15.7% vs. 2.2%, respectively. Median progression-free survival (PFS) was 8.5 months (95% CI: 6.7-10.3 months) vs. 4.4 months (95% CI: 3.5-5.3 months)( P<0.001). Median overall survival (OS) were 17.1 months (95% CI: 14.9-19.3 months) vs. 12.7 months (95% CI: 8.0-17.4 months)( P<0.001). The difference of adverse reactions was mainly in hematology. Conclusions:For newly diagnosed stage ⅣB patients with ESCC, radiotherapy should be combined with systemic therapy as early as possible. It yields longer PFS and OS, and effectively improves dysphagia. Adverse reactions are tolerated. Further validation is recommended in larger prospective studies.

Objective:To evaluate the time-zero biopsy of donor kidney with acute kidney injury(AKI)in organ donation donors and examine the clinical effect after transplantation.Methods:From May 2019 to May 2020, clinical data were retrospectively reviewed for 104 donors assessed by time-zero biopsy at First Affiliated Hospital, Zhengzhou University.According to the definition of AKI and Banff2016 criteria, the kidneys of 104 donors were grouped and evaluated for transplantation.And the post-transplantation effects of donor kidneys with different degrees of pathological changes were analyzed.Results:AKI occurred in 32/104 donors.Compared with non-AKI donors, statistically significant differences existed in degrees of renal interstitial fibrosis and acute renal tubular injury ( P<0.05). However, there were no significant differences in other pathological manifestations ( P>0.05). In AKI group, kidneys of 2 donors with Banff score>3 were abandoned; in non-AKI group, among 12 donors with Banff score>3, 1 donor kidney was abandoned due to a high degree of chronic diseases.No significant inter-group difference existed in creatinine value or estimated glomerular filtration rate(eGFR)( P>0.05). AKI group had a higher incidence of postoperative delayed graft function(DGF)and longer duration.There was no statistical significance in other complications ( P>0.05). Conclusions:AKI donor kidneys with pathological manifestations below moderate renal tubular injury and Banff score<3 are feasible for transplantation.Although renal function recovery is slow after transplantation, safe outcomes may be obtained.