Objective To evaluate the effectiveness of thermal tomography in breast cancer (BC) screening. Methods We conducted a general population-based BC screening in three regions of Hubei Province (Xiantao, Hongan, and Yangxin Districts). Participants underwent a questionnaire-based interview for baseline data collection. They then received a physical examination, thermal tomography, and ultrasound from doctors and technicians. We compared the efficacies, including sensitivity, specificity, and false-positive rates, of ultrasound and thermal tomography in BC screening. Results A total of 59 712 eligible women were included in this screening program. The BI-RADS 1, 2, 3, 4, and 5 accordance rates between the two screening methods were 0.9549, 0.8047, 0.9037, 0.3352, and 0, respectively. The overall accordance rate was 0.933 1. The kappa consistency results showed that the Cicchetti-Allison and Fleiss-Cohen kappa values were 0.7970 and 0.8583, respectively. Although the two methods had equal sensitivities, specificity was higher in thermal tomography than in ultrasound. The false-positive rate was lower in thermal tomography than in ultrasound. The area under the receiver operating characteristic (ROC) curve of thermal tomography was significantly larger than that of ultrasound. Conclusion The general consistency between thermal tomography and ultrasound in BC screening was high. Thermal tomography outperformed ultrasound in terms of specificity and diagnostic efficiency. Therefore, thermal tomography has a high application value for general population-based BC screening.

[摘 要] 目的：探索外周免疫功能状态与肺癌转移的关联，筛选可用于肺癌转移“正虚”评估的外周血免疫标志物。方法：回顾性分析2023年3月至2025年4月期间上海中医药大学附属市中医医院收治的肺癌患者治疗前的外周血免疫标志物，根据是否存在远处转移，将患者分为无转移组与转移组，比较两组间免疫细胞和细胞因子的表达差异。将单因素分析P < 0.05的外周血免疫指标纳入多因素二元Logistic回归模型，以识别肺癌转移的独立预测因素。结果：共纳入193例肺癌患者（无转移组101例，转移组92例），两组在性别、年龄、吸烟史、饮酒史、病理类型间的差异均无统计学意义（均P > 0.05）。单因素分析显示，无转移组与转移组间有多项免疫指标存在显著差异（均P < 0.05），包括：淋巴细胞计数，CD3+、CD4+、CD8+ T、CD19+ B细胞及CD3-CD16+56+ NK细胞绝对计数，Treg细胞、CD8+CD28+ Treg细胞、G-MDSC和CD3-CD16+CD56+dim NK细胞百分率，以及细胞因子IL-1β、IL-6和IL-10水平。将差异性指标行二元Logistic回归分析，提示外周血中Treg细胞和CD8+CD28+ Treg细胞百分率是肺癌发生远处转移的独立预测因素[OR = 1.193, 95% CI（1.047, 1.36）, P < 0.01; OR = 0.978, 95% CI（0.957, 0.999）, P < 0.05]。结论：外周血免疫功能紊乱是肺癌转移“正虚”的生物学基础，本研究以量化指标证实外周免疫功能状态与肺癌转移的相关性，为“正虚伏毒”和“肿瘤转移态”理论提供了实证。

Background::Dual-energy computed tomography (DECT) is purported to accurately distinguish uric acid stones from non-uric acid stones. However, whether DECT can accurately discriminate ammonium urate stones from uric acid stones remains unknown. Therefore, we aimed to explore whether they can be accurately identified by DECT and to develop a radiomics model to assist in distinguishing them.Methods::This research included two steps. For the first purpose to evaluate the accuracy of DECT in the diagnosis of uric acid stones, 178 urolithiasis patients who underwent preoperative DECT between September 2016 and December 2019 were enrolled. For model construction, 93, 40, and 109 eligible urolithiasis patients treated between February 2013 and October 2022 were assigned to the training, internal validation, and external validation sets, respectively. Radiomics features were extracted from non-contrast CT images, and the least absolute shrinkage and selection operator (LASSO) algorithm was used to develop a radiomics signature. Then, a radiomics model incorporating the radiomics signature and clinical predictors was constructed. The performance of the model (discrimination, calibration, and clinical usefulness) was evaluated.Results::When patients with ammonium urate stones were included in the analysis, the accuracy of DECT in the diagnosis of uric acid stones was significantly decreased. Sixty-two percent of ammonium urate stones were mistakenly diagnosed as uric acid stones by DECT. A radiomics model incorporating the radiomics signature, urine pH value, and urine white blood cell count was constructed. The model achieved good calibration and discrimination {area under the receiver operating characteristic curve (AUC; 95% confidence interval [CI]), 0.944 (0.899–0.989)}, which was internally and externally validated with AUCs of 0.895 (95% CI, 0.796–0.995) and 0.870 (95% CI, 0.769–0.972), respectively. Decision curve analysis revealed the clinical usefulness of the model.Conclusions::DECT cannot accurately differentiate ammonium urate stones from uric acid stones. Our proposed radiomics model can serve as a complementary diagnostic tool for distinguishing them in vivo.

Background and Aims:Postoperative intra-abdominal infection(PIAI)is a common postoperative complication in abdominal surgery and a challenging issue worldwide,with a treatment failure rate of 68.3％and an in-hospital mortality rate as high as 40.8％.The key to managing this condition is early control of the infection source,debridement and adequate drainage.Delayed control of the infection source is an independent risk factor for predicting treatment failure.Many PIAI lesions are located deep within the abdominal cavity,lacking optimal routes for percutaneous drainage,and the risks and difficulties of reoperation are significant.Thus,controlling the infection source in PIAI is a difficult task.Here,the authors report the management of 4 PIAI patients treated with nephroscopic debridement and catheter irrigation and drainage via the sinus tract,aiming to provide clinical insights and references. Methods:The clinical data of 4 patients undergoing nephroscopic debridement,catheter irrigation and drainage for PIAI from October 2020 to September 2022 in the Department of Hepatobiliary and Pancreatic Surgery of the Second Affiliated Hospital of Guilin Medical University were retrospectively analyzed.Key techniques of nephroscopic management of PIAI were summarized and contextualized with relevant literature. Results:The 4 PIAI cases included a right-sided retroperitoneal abscess after catheter drainage for severe acute pancreatitis,a hepatic abscess at the liver raw surface after right hemihepatectomy,bile leakage and secondary duodenal fistula after laparoscopic choledocholithotomy and T-tube drainage,and a pancreatic abscess at the pancreatic raw surface after distal pancreatectomy with splenectomy.All patients underwent nephroscopic debridement and catheter irrigation and drainage via the sinus tract:guidewires were inserted into the drainage sinus tract,followed by a minimally invasive expansion drainage kit and nephroscopy;pus was irrigated out,and pus moss was clamped out with foreign body forceps under nephroscopy.Then,irrigation drainage tubes were placed under the guidance of the guidewire,and continuous irrigation and drainage were performed.The 4 patients underwent a total of 5 nephroscopic debridement and catheter irrigation and drainage procedures,with one case requiring two operations.The preoperative catheterization time ranged from 14 to 58 d,with an average of 38.4 d.One patient concurrently underwent choledochoscopy for stone extraction and biliary drainage via the T-tube sinus tract.The operative time ranged from 30 to 115 min,with an average of 67.4 min.Aside from one case of minor intraoperative bleeding,which stopped after injecting diluted norepinephrine solution into the sheath and blocking the sheath,there were no surgical complications in the other three cases.The postoperative drainage tube duration ranged from 7 to 30 d,with an average of 20.75 d.After treatment,all PIAI lesions disappeared,and no recurrence was observed during follow-up,which ranged from 16 to 40 months. Conclusion:Nephroscopic debridement and catheter irrigation and drainage via the sinus tract for PIAI is simple,feasible,and safe,allowing for direct visualization to avoid organ damage.It is effective in removing pus and necrotic tissue,replacing drainage tubes,and can be repeatedly performed with high efficiency and remarkable results.This method is particularly suitable for patients with postoperative abdominal drainage tube obstruction combined with encapsulated intra-abdominal fluid collections.

Objective:To evaluate the safety and efficiency of China-made Toumai Robot-assisted laparoscopic radical prosta-tectomy(LRP).Methods:This study included 40 cases of PCa treated from January 2023 to May 2023 by robot-assisted LRP with preservation of the bladder neck and maximal functional urethral length,15 cases with the assistance of Toumai Robot(the TMR group)and the other 25 with the assistance of da Vinci Robot as controls(the DVR group).We recorded the docking time,laparo-scopic surgery time,vesico-urethral anastomosis time,intraoperative blood loss and postoperative urinary continence,and compared them between the two groups.Results:Operations were successfully completed in all the cases.No statistically significant differ-ences were observed between the TMR and DVR groups in the docking time(6 min vs 5 min,P＞0.05)or intraoperative blood loss(200 ml vs 150 ml,P＞0.05).The TMR group,compared with the DVR group,showed a significantly longer median laparoscopic surgery time(146 min vs 130 min,P＜0.05)and median vesico-urethral anastomosis time(19 min vs 16 min,P＜0.05).There were no statistically significant differences between the TMR and DVR groups in the rates of urinary continence recovery immediately af-ter surgery(60.0％[9/15]vs 64.0％[16/25],P＞0.05)or at 1 month(80.0％[12/15])vs(76.0％[19/25],P＞0.05),3 months(93.3％[14/15])vs(92.0％[23/25],P＞0.05)and 6 months postoperatively(100％[15/15])vs(96％[24/25],P＞0.05).Conclusion:China-made Toumai? Robot surgical system is safe and reliable for laparoscopic radical prosta-tectomy,with satisfactory postoperative recovery of urinary continence.

Objective To summarize the diagnosis and treatment experience of surgical site infection(SSI)after percutaneous endoscopic lumbar discectomy(PELD).Methods A retrospective analysis was made on 11 cases of postoperative SSI after PELD from January 2016 to December 2022.After PELD surgery,severe lower back or lower limb pain occurred in all the patients,with a Visual Analog Scale(VAS)score of 7-9(average,8.1).The erythrocyte sedimentation rate(ESR)was 17-114 mm/h(average,54.4 mm/h),and the level of C-reactive protein(CRP)was 8-151 mg/L(average,56.5 mg/L).The MRI showed changes of inflammatory signals in the intervertebral space of the surgical area.The SSI was diagnosed at 2-17 d(average,9.5 d)after PELD surgery.All the cases were treated with antibiotics(4 cases with empiric antibiotic therapy and 7 cases with sensitive antibiotic treatment),8 of which underwent combined surgery,including percutaneous endoscopic lesion removal,catheter irrigation and drainage in 4 cases,posterior lesion removal in 2 cases,and posterior lesion removal combined with internal fixation in 2 cases.Results The patients were followed up for 14-75 months(average,36.8 months).According to the modified MacNab criteria,5 cases were excellent,4 cases were good,and 2 cases were fair.Conclusions SSI after PELD is characterized by acute onset,recurrent severe lower back or lower limb pain,elevated inflammatory markers,and characteristic imaging features.Standardized antibiotic treatment combined with surgery can achieve good therapeutic effects.

Objective:To accurately ascertain the whole genome sequencing and the composition of open reading frames (ORFs) of non-replicating Tiantan strain of vaccinia virus (NTV) using next-generation long-read sequencing technology.Methods:NTV, obtained from our laboratory stock, was amplified and purified on chicken embryo fibroblast cells(CEFs), and the full-length genomic nucleic acid of NTV was extracted. The PacBio HiFi sequencing platform was utilized for de novo assembly to obtain the complete genomic sequence of NTV. Using a homology annotation strategy, we identified its ORF composition and compared it with known non-replicating vaccinia virus strains. Results:The total length of NTV′s genome was 171 729 bp, with a GC content of 33%. Its unique inverted terminal repeat (ITR) region comprised hairpin structures, two tandem repeat regions, and three non-repeat regions. NTV contained 166 ORFs, with major differences observed in the ITR and its surrounding regions when compared to MVA-BN and NYVAC. These three strains shared a common set of 138 ORFs. NTV encoded six unique ORFs related to virus evasion of host antiviral response.Conclusions:This study accurately determines the whole genome sequencing and ORFs composition of NTV, and reveals its similarities and differences with other replication-deficient vaccinia virus strains, which pave a way for the development and application of the next generation of monkeypox vaccines and novel viral vectors.

Lymphoma-associated hemophagocytic syndrome is aggressive with rapid progression, particularly in NK/T cell lymphoma. The MINE regimen is a salvage treatment for aggressive non-Hodgkin lymphoma. In our center, the modified MINE regimen was applied to treat three patients with hemophagocytic syndrome secondary to aggressive NK cell leukemia and T-cell lymphoma. The modified MINE regimen showed good efficacy against NK/T cell lymphoma, control of the inflammatory state of secondary hemophagocytic syndrome, and good tolerability.

Solitary cervical submental nodule is a relatively rare case in clinical procedure and prone to miss diagnosis.Differential diagnosis with various head and neck diseases is necessary.This article reported a case of solitary cervical submental metastasis of papillary thyroid carcinoma received in the department of surgery,Civil Aviation Shanghai Hospital,Ruijin Gubei Branch,Shanghai Jiao Tong University School of Medicine.The patient came to the outpatient clinic for treatment due to"consciously larger submental tubercle than before".Ultrasound examination revealed suspicious lesions in both the thyroid and submental regions.Ultrasound-guided final needle aspiration biopsy diagnosed as malignant tumor.Surgical resection was performed and the central group lymph nodes dissected Pathological examination confirmed papillary thyroid carcinoma with solitary submental metastasis.This article reported the clinical diagnosis and treatment of this case,in order to improve the disease recognition for clinicians,and make differential diagnosis with other rare neck diseases,and avoid missing diagnoses.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.