With the continuous deepening of the concept of precision diagnosis and treatment for lung cancer, how to achieve higher efficiency and accuracy in the screening, diagnosis, and treatment pathways in clinical practice has become an important issue that urgently needs to be overcome. The current clinical difficulty lies in the fact that despite continuous advancements in imaging and molecular diagnostic technologies, there are still limitations in manual efficiency and subjective experience when it comes to massive data analysis and multi-scale feature extraction. Artificial intelligence (AI), especially algorithm systems based on deep learning, is an innovative technology capable of deeply empowering medical big data. This method utilizes algorithms such as convolutional neural networks, combined with radiomics, pathomics, and multi-modal data fusion analysis, demonstrating immense potential in early precise detection and benign-malignant differentiation of pulmonary nodules, digital pathological subtype recognition and non-invasive prediction of driver genes, precise 3D surgical planning and automatic delineation of radiotherapy target volumes, as well as dynamic risk warning during follow-up. This innovative technology provides a brand-new solution for realizing intelligent and individualized lung cancer diagnosis and treatment models. This consensus, based on the latest evidence from evidence-based medicine and combined with the development trends in the AI field and real-world clinical needs, was ultimately formed by gathering the consensus opinions of multidisciplinary experts in radiology, pathology, thoracic surgery, and other fields. The main content covers the application specifications of AI in the three core scenarios of lung cancer screening, diagnosis, and treatment, the technical standards for data collection and algorithm validation, as well as the ethical and regulatory challenges faced at the current stage. It aims to clarify the applicable boundaries of AI as a clinical auxiliary decision support tool, providing scientific guidance and standardized exploration directions for peers currently engaged in or planning to carry out AI-assisted clinical diagnosis, treatment, and translation of lung cancer.

With the widespread adoption of low-dose CT screening and the extensive application of high-resolution CT, the detection rate of sub-centimeter lung nodules has significantly increased. How to scientifically manage these nodules while avoiding overtreatment and diagnostic delays has become an important clinical issue. Among them, lung nodules with a consolidation tumor ratio less than 0.25, dominated by ground-glass shadows, are particularly worthy of attention. The therapeutic challenge for this group is how to achieve precise and complete resection of nodules during surgery while maximizing the preservation of the patient's lung function. The "watershed topography map" is a new technology based on big data and artificial intelligence algorithms. This method uses Dicom data from conventional dose CT scans, combined with microscopic (22-24 levels) capillary network anatomical watershed features, to generate high-precision simulated natural segmentation planes of lung sub-segments through specific textures and forms. This technology forms fluorescent watershed boundaries on the lung surface, which highly fit the actual lung anatomical structure. By analyzing the adjacent relationship between the nodule and the watershed boundary, real-time, visually accurate positioning of the nodule can be achieved. This innovative technology provides a new solution for the intraoperative positioning and resection of lung nodules. This consensus was led by four major domestic societies, jointly with expert teams in related fields, oriented to clinical practical needs, referring to domestic and foreign guidelines and consensus, and finally formed after multiple rounds of consultation, discussion, and voting. The main content covers the theoretical basis of the "watershed topography map" technology, indications, operation procedures, surgical planning details, and postoperative evaluation standards, aiming to provide scientific guidance and exploration directions for clinical peers who are currently or plan to carry out lung nodule resection using the fluorescent microscope watershed analysis method.

OBJECTIVE: To explore clinical efficacy of autologous platelet-rich plasma(PRP) in treating Rockwood type Ⅲ acromioclavicular dislocation. METHODS: From January 2019 to July 2021, 32 patients with Rockwood type Ⅲ acromioclavicular dislocation were treated with minimally invasive adjustable titanium plate internal fixation, and were divided into PRP group and control group according to whether PRP treatment was performed, with 16 patients in each group. In PRP group, there were 10 males and 6 females, aged from 28 to 47 years old with an average of (36.75±7.14) years old;the time from injury to surgery ranged from 1 to 31 h with an average of (26.13±3.98) h;5 patients on the left side and 11 patients on the right side;PRP was injected once during operation and the 4th and 8th weeks after operation respectively. In control group, there were 8 males and 8 females, aged from 30 to 52 years old with an average of (38.50±5.48) years old; the time from injury to surgery ranged from 1 to 29 h with an average of (25.48±3.11) h;7 patients on the left side and 9 patients on the right side; minimally invasive surgical treatment was performed. Visual analogue scale(VAS) was used to evaluate pain and Constant-Murley score for shoulder joint function was used to evaluate the recovery of shoulder joint movement function before operation and 1, 3, 6, and 12 months after operation respectively. RESULTS: All patients were followed up for 12 to 28 months with an average of (18.3±5.2) months. All incisions patients healed well without adverse events such as infection. Postoperative VAS of PRP group at 1, 3, and 6 months were (5.5±1.2), (3.7±1.6), and (2.4±1.2), respectively, while were lower than those of control group (6.6±1.4), (4.9±1.1), and (3.7±1.3), respectively;and had statistical differences between two groups (P<0.05). There was no statistically significant difference in VAS between two groups before operation and 12 months after operation (P>0.05). Postoperative Constant-Murley scores of PRP group at 1, 3, and 6 months were (64.09±11.61), (73.19±12.89), and (82.61±14.81) points, respectively, which were higher than those of control group were (52.32±17.42), (61.65±14.43), and (72.52±11.04) respectively;and the differences were statistically significant (P<0.05). There was no statistically significant difference in Constant-Murley scores at 12 months after operation between two groups (P>0.05). In PRP group, there was no statistically significant difference at 6 months and 12 months after operation (P>0.05), while there were statistically significant differences at the other time points (1 month after operation compared with before operation, 3 months after operation compared with 6 months after operation, and 3 months after operation compared with 1 month after operation) (P<0.05). In control group, there was no statistically significant difference when comparing 1 month and 3 months after operation (P>0.05), while at the other time points (1 month after operation with before operation, 3 months after operation with 6 months after operation, and 6 months after operation with 12 months after operation), the differences were all statistically significant (P<0.05). CONCLUSION Adjustable titanium plate fixation combined with postoperative injection of PRP for the treatment of Rockwood type III acromioclavicular joint dislocation has effect of promoting the recovery of shoulder joint function and reducing pain.
Humans ; Male ; Female ; Adult ; Middle Aged ; Platelet-Rich Plasma ; Acromioclavicular Joint/surgery* ; Bone Plates ; Titanium ; Joint Dislocations/therapy* ; Fracture Fixation, Internal/methods*

Objective:To investigate the predictive value of serum CC chemokine ligand 20(CCL20)and leucine-rich G protein-coupled receptor 4(LGR4)for recurrence and metastasis in patients with colon cancer after laparoscopic surgery.Methods:A total of 214 patients with colon cancer who underwent laparoscopic surgery for colon cancer from April 2019 to April 2022 were selected as the cancer group,and 214 patients with benign lesions of colon admitted dur-ing the same period were selected as the benign lesion group.According to the results of 2-year follow-up,the patients with colon cancer were divided into recurrent group(66 cases)and non-recurrent group(148 cases).The levels of serum CCL20 and LGR4 were detected by ELISA.ROC curve was used to analyze the predictive value of serum CCL20 and LGR4 for recurrence and metastasis of colon cancer patients after laparoscopic surgery.Multivariate Cox regression analysis of the factors affecting postoperative recurrence and metastasis.Results:The levels of serum CCL20 and LGR4 in the cancer group were significantly lower after operation,but still significantly higher than those in the benign le-sion group(P＜0.05).Serum levels of CCL20 and LGR4 in relapsed group were significantly increased compared with those in non-recurrent group(P＜0.05).There were significant differences in TNM stage,differentiation degree and infil-tration depth between relapse group and non-recurrence group(P＜0.05).Compared with the single prediction,the com-bined detection of serum CCL20(Z=2.733,P=0.006)and LGR4(Z=3.705,P＜0.00)levels significantly increased the AUC in predicting the recurrence and metastasis of colon cancer after laparoscopic surgery.Multivariate Cox regression analy-sis showed that TNM stage,differentiation degree,CCL20 and LGR4 levels were the factors affecting the recurrence and metastasis of colon cancer patients after laparoscopic surgery(P＜0.05).Conclusion:The serum levels of CCL20 and LGR4 increased in patients with colon cancer,and the changes of the levels were closely related to the recurrence and metastasis of colon cancer after laparoscopic surgery.

Nursery services are a vital component of childcare for infants and toddlers.The quality and management of nursery services significantly impact the holistic development of infants and toddlers in terms of their physical,psychological,and social skills and capabilities.The first 1000 days in the life of an infant or toddler are a critical period that shapes their health status for their whole life,which highlights the need to prioritize health in childcare for infants and toddlers and to approach daily childcare services from a medical perspective.Based on the approach of integrating medical care and education,we innovatively explored and constructed a multidisciplinary patrol supervision model for childcare services,focusing on the PDCA cycle(Plan-Do-Check-Act cycle).We aim at establishing a multidisciplinary team of medical and nursing experts who provide evaluation and guidance for the institutional management,health management for infants and toddlers,disease prevention,and risk identification and screening of childcare services for infants and toddlers.This approach addresses the issue of the simplistic nature of the traditional patrol supervision involving only childcare physicians,improves service quality with high efficiency,meets the expectations of both childcare service providers and the families of infants and toddlers-the users of childcare services,enhances the effective implementation of childcare for infants and toddlers based on the integration of medical care and education,and improves the quality of a health-centered approach to childcare for infants and toddlers.

Objective:To analyze the gene chip related to dermatomyositis based on bioinformatics,to explore the immune in-filtration mechanism of key genes in dermatomyositis by CIBERSORT deconvolution algorithm,and to predict the therapeutic targets of dermatomyositis by network pharmacology.Methods:The gene microarray of dermatomyositis was searched in GEO database,and the differentially coexpressed genes were screened and analyzed.The differentially coexpressed genes were analyzed by GO analysis,KEGG analysis,protein interaction network construction(PPI)by R software package.Verify the expression levels of key genes,and the correlation of immune cell infiltration was analyzed by CIBERSORT deconvolution method.Through the medical ontology informa-tion retrieval platform Coremine medical database,the traditional Chinese medicine treatment targets of dermatomyositis were screened and summarized.Results:A total of 196 differentially expressed genes were screened.GO enrichment analysis showed that these differentially expressed genes were mainly concentrated in defense response to virus,blood particles,double-stranded RNA binding,polypeptide antigen binding,and so on.KEGG enrichment analysis showed that it was enriched in RIG-Ⅰ-like receptor sig-nal pathway,Toll-like receptor signal pathway and other signal pathways related to the pathogenesis of dermatomyositis.Finally,four key genes of dermatomyositis,STAT1,ISG15,IRF7 and IRF9 were obtained.Through CIBERSORT algorithm,M1 macrophages,M2 macrophages and CD8+T cells were the three kinds of cells with the highest average proportion and the most obvious immune infil-tration,and there was a significant positive correlation between activated natural killer cells and activated dendritic cells,while there was a significant negative correlation between resting mast cells and activated mast cells.The therapeutic targets of traditional Chinese medicine such as fish brain stone were predicted based on Coremine medical database;through channel analysis,it could be found that these traditional Chinese medicines are mainly attributed to liver meridian,lung meridian,spleen meridian;efficacy analysis is mainly focused on clearing heat,detoxification,promoting blood circulation and removing blood stasis,relieving cough and resolving phlegm and so on.Conclusion:Four key genes and some key signal pathways of dermatomyositis,STAT1,ISG15,IRF7 and IRF9 were obtained by bioinformatics method,the immune infiltration mechanism was analyzed by CIBERSORT algorithm,and the thera-peutic potential targets of traditional Chinese medicine were screened out to provide direction for the pathogenesis and treatment of der-matomyositis.

Objectives:To explore the predictive value of residual Murray's law-based quantitative flow ratio(μQFR)on long-term vessel-oriented composite endpoints(VoCE).Methods:This retrospective study included 3 510 patients from the FAVOR Ⅲ China trial.Offline residual μQFR analysis was performed on all vessels(diameter≥2.5 mm)with 50%-90%stenotic lesions.Patients were stratified into high-,intermediate-,and low-risk groups based on residual μQFR tertiles.The primary endpoint was 3-year VoCE,defined as a composite of cardiac death related to the target vessel,target vessel-related spontaneous myocardial infarction,and ischemia-driven target vessel revascularization.Results:Offline analysis was performed on 5 256 vessels from 3 510 patients.The mean residual μQFR was 0.92±0.75.The high-risk group(residual μQFR≤0.91)with 1 554 patients(1 958 vessels);the intermediate-risk group(residual μQFR 0.92-0.96)with 1 211 patients(1 906 vessels);and the low-risk group(residual μQFR>0.96)with 745 patients(1 392 vessels).Over 3-year follow-up,VoCE occurred in 227 vessels(4.3%).The 3-year VoCE incidence was significantly higher in the high-risk group compared to the intermediate-and low-risk groups(6.2%vs.4.1%vs.2.5%,log-rank P<0.001),primarily driven by ischemia-driven target vessel revascularization(5.0%vs.3.0%vs.1.6%,log-rank P<0.001).Hypertension(OR=0.83,95%CI:0.72-0.96),hypercholesterolemia(OR=0.84,95%CI:0.73-0.97),bifurcation lesions(OR=0.72,95%CI:0.63-0.83),moderate/severe calcification(OR=0.70,95%CI:0.57-0.84),and tandem lesions(OR=0.59,95%CI:0.47-0.75)were independent predictors of lower residual μQFR values.Conclusions:Lower residual μQFR is significantly associated with increased VoCE risk during the 3-year follow up period.

Objective To investigate the distribution of A subgroups in the A and AB blood type populations among voluntary blood donors in Zhongshan,study the antigen-antibody characteristics of A subgroups,establish a local A subgroup database,and support the development of precision medicine.Methods ABO subgroup screening was performed using the microplate method.Specimens negative for monoclonal anti-A1 reactivity underwent sequencing of exons 1～7 of the ABO gene to confirm genotypes.Cryopreservation and thawing of glycerolized subgroup red blood cells(RBCs),as well as preservation efficacy of concentrated human-derived antibodies with preservatives,were studied.Results Among 1 212 blood donor specimens,28 subgroup specimens were identified,with a prevalence of 1.54%(15/971)in blood type A and 5.39%(13/241)in blood type AB.Sequencing of 10 specimens revealed 7 ABO genotypes:ABO*A2.01/O.01.02(2 cases),ABO*A1.02/B.01(3 cases),ABO*BA.02/O.01.02,ABO*AW.31.02-05/A2.05,ABO*A2.05/B.01,ABO*A2new/O.01.01,and ABO*A1.02/O.01.01(1 case each).Additionally,one rare allele mutation(c.700C>G)and one novel allele mutation(c.203G>T)(GenBank accession number:PQ152337)were identified.Human anti-A1 antibodies with a titer of 8 were successfully concentrated.Optimal preservation conditions included 0.1%preservative concentration and cryopreserved subgroup RBCs stored at 4℃for 3 days post-thaw.Conclusion The predominant A subgroups in Zhongshan donors are A2 and B(A).A preliminary database for A2 and A2B subgroups is established,along with the discovery of a novel ABO allele mutation.Cryopreservation with glycerol,PEG antibody concentration,and ProClin 300 preservative demonstrate effective applications in preserving ABO blood group antigens and antibodies.

Objective:Bidirectional causal associations of 41 cytokines with atopic dermatitis(AD)were explored based on a Mendelian randomization(MR)approach.Methods:Pooled data from genome wide association study(GWAS)of 41 cytokines and AD were utilized for instrumental variable(IV)screening,and single nucleotide polymorphism(SNP)affecting the results of MR analyses was excluded by the MR-PRESSO outlier test as well as by the MR Steiger filtering method.Two-sample bidirectional MR analyses were performed using inverse variance weighting(IVW),MR-Egger regression,and weighted median methods(WM).MR-Egger intercept term test and Cochran's Q test were performed to test the pleiotropy and heterogeneity of IV,and MR results were visu-alized by scatterplots,funnel plots,and leave-one-out plots.Results:Forward MR analysis showed that MIG(IVW:OR=0.89;95%CI:0.81～0.97;P=0.006)reduced the risk of AD development.In contrast,IL-5(IVW:OR=1.17;95%CI:1.01～1.36;P=0.042)and IL-18(MR Egger:OR=1.17;95%CI:1.03～1.33;P=0.030)increased the risk of AD development.Inverse MR analysis showed a potential causal association between AD and increased MIG(IVW:Beta=0.10;95%CI:0.02～0.17;P=0.014).None of the sensitivity analyses indicated pleiotropy and heterogeneity of the included IV.Conclusion:MIG may be an important marker in the progression of AD with a potential bidirectional causal association with risk of morbidity.IL-5 and IL-18 have a potential positive causal association for AD.

Objective To investigate the distribution of A subgroups in the A and AB blood type populations among voluntary blood donors in Zhongshan,study the antigen-antibody characteristics of A subgroups,establish a local A subgroup database,and support the development of precision medicine.Methods ABO subgroup screening was performed using the microplate method.Specimens negative for monoclonal anti-A1 reactivity underwent sequencing of exons 1～7 of the ABO gene to confirm genotypes.Cryopreservation and thawing of glycerolized subgroup red blood cells(RBCs),as well as preservation efficacy of concentrated human-derived antibodies with preservatives,were studied.Results Among 1 212 blood donor specimens,28 subgroup specimens were identified,with a prevalence of 1.54%(15/971)in blood type A and 5.39%(13/241)in blood type AB.Sequencing of 10 specimens revealed 7 ABO genotypes:ABO*A2.01/O.01.02(2 cases),ABO*A1.02/B.01(3 cases),ABO*BA.02/O.01.02,ABO*AW.31.02-05/A2.05,ABO*A2.05/B.01,ABO*A2new/O.01.01,and ABO*A1.02/O.01.01(1 case each).Additionally,one rare allele mutation(c.700C>G)and one novel allele mutation(c.203G>T)(GenBank accession number:PQ152337)were identified.Human anti-A1 antibodies with a titer of 8 were successfully concentrated.Optimal preservation conditions included 0.1%preservative concentration and cryopreserved subgroup RBCs stored at 4℃for 3 days post-thaw.Conclusion The predominant A subgroups in Zhongshan donors are A2 and B(A).A preliminary database for A2 and A2B subgroups is established,along with the discovery of a novel ABO allele mutation.Cryopreservation with glycerol,PEG antibody concentration,and ProClin 300 preservative demonstrate effective applications in preserving ABO blood group antigens and antibodies.