ObjectiveTo observe the clinical efficacy of Anshen Buxin Gao in patients with coronary artery disease （CAD） complicated with somatization disorder after percutaneous coronary intervention （PCI）， as well as its effect on heart rate variability （HRV）. MethodsA total of 96 patients with somatization disorder after PCI were selected and randomized into control and treatment groups （48 cases）. On the basis of standardized Western medical treatment for CAD， the control group received Dailixin， while the treatment group received Dailixin combined with Anshen Buxin Gao. The somatic symptom scale （SSS）， generalized anxiety disorder 7-item scale （GAD-7）， patient health questionnaire-9 （PHQ-9）， and self-rating scale of sleep （SRSS） scores in both groups were recorded before and after treatment. The traditional Chinese medicine symptom efficacy， HRV， and incidence of adverse drug reactions were observed. ResultsA total of 90 patients completed the trial， encompassing 45 patients in the control group and 45 patients in the treatment group. Baseline characteristics between the two groups showed no statistically significant differences， indicating comparability. After treatment， both groups exhibited reductions in SSS， GAD-7， and PHQ-9 scores （P<0.05）， and the treatment group outperformed the control group in alleviating somatic symptoms and anxiety-depression symptoms （P<0.05）. The control group did not achieve a significant reduction in SRSS score， whereas the treatment group effectively lowered the SRSS score （P<0.05）. Regarding traditional Chinese medicine symptom efficacy， the total response rate in the treatment group was 91.1% （41/45）， which was higher than that （71.1%， 32/45） in the control group （Z=-2.663， P<0.05）. Both groups improved HRV in patients with somatization disorder， and the treatment group showed greater improvement （P<0.05）. There were no serious clinical adverse events during the study period. The incidence of adverse reactions in the treatment group was 6.7% （3/45）， which was lower than that （14/45， 31.10%） in the control group （χ²=7.252， P<0.05）. ConclusionThe addition of Anshen Buxin Gao to Dailixin therapy significantly alleviates the clinical symptoms and improves the sleep quality， treatment efficacy， and HRV in patients with CAD complicated with somatization disorder after PCI， while reducing the adverse effects associated with Dailixin alone. This approach demonstrates considerable clinical value and warrants further promotion.

Objective To develop a combined model integrating radiomics and 3D deep learning features for improving the predictive efficacy of overall survival in non-small cell lung cancer(NSCLC)patients undergoing radiotherapy,thereby providing a foundation for optimizing individualized radiotherapy strategies.Methods A retrospective analysis was conducted on 522 NSCLC patients from 3 centers.Radiomics features were extracted from the tumor region of interest on radiotherapy planning CT scans,and a 3D-SE-ResNet was constructed to extract deep learning features.Following feature extraction,features were selected via univariate Cox analysis and Lasso-Cox regression,and a combined model was established by fusing the two feature types through principal component analysis.The discriminative ability of the model was evaluated using the concordance index(C-index)and the area under the receiver operating characteristic curve(AUC),while the risk stratification efficacy was verified by Kaplan-Meier survival analysis.Results The predictive performance of deep learning features was significantly superior to that of radiomics features(C-index:0.73 vs 0.65).The combined model achieved the highest predictive performance in the training set,internal test set,and external test set(C-index:0.74,0.69,0.72 respectively),with higher AUC values for predicting 1-year,2-year,and 3-year OS than either single model.Kaplan-Meier analysis showed significant differences in survival between the high-and low-risk groups(Log-rank test,P<0.001),and calibration curves indicated good consistency between predicted and actual survival outcomes.Conclusion The combined model integrating radiomics and 3D deep learning features can accurately predict survival outcomes in NSCLC patients undergoing radiotherapy.The multi-center validation results support its potential application in prognosis stratification for individualized radiotherapy.

Objective To develop a combined model integrating radiomics and 3D deep learning features for improving the predictive efficacy of overall survival in non-small cell lung cancer(NSCLC)patients undergoing radiotherapy,thereby providing a foundation for optimizing individualized radiotherapy strategies.Methods A retrospective analysis was conducted on 522 NSCLC patients from 3 centers.Radiomics features were extracted from the tumor region of interest on radiotherapy planning CT scans,and a 3D-SE-ResNet was constructed to extract deep learning features.Following feature extraction,features were selected via univariate Cox analysis and Lasso-Cox regression,and a combined model was established by fusing the two feature types through principal component analysis.The discriminative ability of the model was evaluated using the concordance index(C-index)and the area under the receiver operating characteristic curve(AUC),while the risk stratification efficacy was verified by Kaplan-Meier survival analysis.Results The predictive performance of deep learning features was significantly superior to that of radiomics features(C-index:0.73 vs 0.65).The combined model achieved the highest predictive performance in the training set,internal test set,and external test set(C-index:0.74,0.69,0.72 respectively),with higher AUC values for predicting 1-year,2-year,and 3-year OS than either single model.Kaplan-Meier analysis showed significant differences in survival between the high-and low-risk groups(Log-rank test,P<0.001),and calibration curves indicated good consistency between predicted and actual survival outcomes.Conclusion The combined model integrating radiomics and 3D deep learning features can accurately predict survival outcomes in NSCLC patients undergoing radiotherapy.The multi-center validation results support its potential application in prognosis stratification for individualized radiotherapy.

Objective:To construct a nomogram model for predicting the risk factors of gastrointestinal bleeding following laparoscopic pancreaticoduodenectomy (LPD) based on relevant risk factors and evaluate its predictive value.Methods:A retrospective analysis was conducted on 466 patients with periampullary space occupying lesion who underwent LPD at the Department of Hepatobiliary Surgery, the Second Hospital of Hebei Medical University, from January 2021 to December 2024. Among them, there were 284 males and 182 females, aged (59.9±10.7) years. Patients were randomly divided into a training cohort ( n=326) and a validation cohort ( n=140) using a random number table (7: 3 ratio). Based on whether patients suffered gastrointestinal bleeding, the training cohort was further stratified into a gastrointestinal bleeding group ( n=23) and control group ( n=303). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for gastrointestinal bleeding. A nomogram was constructed based on multivariate results, and its predictive performance was evaluated by receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results:Compared to the control group, the gastrointestinal bleeding group exhibited significantly higher age, higher rates of postoperative pancreatic fistula (POPF) and intra-abdominal infection, along with lower body mass index, and lower levels of fibrinogen and albumin (all P<0.05). Multivariate analysis identified age ( OR=1.065, 95% CI: 1.002-1.132), fibrinogen ( OR=0.486, 95% CI: 0.243-0.969), albumin ( OR=0.840, 95% CI: 0.741-0.953), POPF ( OR=4.299, 95% CI: 1.348-13.716), and postoperative intra-abdominal infection ( OR=6.352, 95% CI: 1.476-27.341) as independent predictors of gastrointestinal bleeding (all P<0.05). The nomogram demonstrated robust discrimination, with an AUC of 0.861 (95% CI: 0.784-0.939), sensitivity of 82.6%, and specificity of 82.2% in the training cohort. In the validation cohort, the AUC was 0.824 (95% CI: 0.675-0.973), with sensitivity and specificity of 80.0% and 83.8%, respectively. Calibration curves indicated excellent agreement between predicted and observed outcomes. DCA revealed superior net clinical benefit of the nomogram over " treat-all" or " treat-none" strategies within threshold probabilities of 0-0.9 (training) and 0-0.75 (validation). Conclusion:The nomogram based on age, fibrinogen, albumin, POPF, and intra-abdominal infection provides accurate prediction of gastrointestinal bleeding after LPD and demonstrates high clinical utility for risk stratification and decision-making in periampullary space occupying lesion patients.

Objective:To construct a nomogram model for predicting the risk factors of gastrointestinal bleeding following laparoscopic pancreaticoduodenectomy (LPD) based on relevant risk factors and evaluate its predictive value.Methods:A retrospective analysis was conducted on 466 patients with periampullary space occupying lesion who underwent LPD at the Department of Hepatobiliary Surgery, the Second Hospital of Hebei Medical University, from January 2021 to December 2024. Among them, there were 284 males and 182 females, aged (59.9±10.7) years. Patients were randomly divided into a training cohort ( n=326) and a validation cohort ( n=140) using a random number table (7: 3 ratio). Based on whether patients suffered gastrointestinal bleeding, the training cohort was further stratified into a gastrointestinal bleeding group ( n=23) and control group ( n=303). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for gastrointestinal bleeding. A nomogram was constructed based on multivariate results, and its predictive performance was evaluated by receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results:Compared to the control group, the gastrointestinal bleeding group exhibited significantly higher age, higher rates of postoperative pancreatic fistula (POPF) and intra-abdominal infection, along with lower body mass index, and lower levels of fibrinogen and albumin (all P<0.05). Multivariate analysis identified age ( OR=1.065, 95% CI: 1.002-1.132), fibrinogen ( OR=0.486, 95% CI: 0.243-0.969), albumin ( OR=0.840, 95% CI: 0.741-0.953), POPF ( OR=4.299, 95% CI: 1.348-13.716), and postoperative intra-abdominal infection ( OR=6.352, 95% CI: 1.476-27.341) as independent predictors of gastrointestinal bleeding (all P<0.05). The nomogram demonstrated robust discrimination, with an AUC of 0.861 (95% CI: 0.784-0.939), sensitivity of 82.6%, and specificity of 82.2% in the training cohort. In the validation cohort, the AUC was 0.824 (95% CI: 0.675-0.973), with sensitivity and specificity of 80.0% and 83.8%, respectively. Calibration curves indicated excellent agreement between predicted and observed outcomes. DCA revealed superior net clinical benefit of the nomogram over " treat-all" or " treat-none" strategies within threshold probabilities of 0-0.9 (training) and 0-0.75 (validation). Conclusion:The nomogram based on age, fibrinogen, albumin, POPF, and intra-abdominal infection provides accurate prediction of gastrointestinal bleeding after LPD and demonstrates high clinical utility for risk stratification and decision-making in periampullary space occupying lesion patients.

Objective To analyze the effects of target volume optimization on oral mucosal reaction and salivary gland function in oropharyngeal cancer patients receiving intensity-modulated radiotherapy(IMRT).Methods A total of 120 patients with oropharyngeal cancer admitted to Affiliated Hospital of Jiangsu University from April 2020 to August 2022 were selected and randomly grouped into control group(n=60,conventional IMRT)and treatment group(n=60,cervical region Ⅱ and the oral target region were optimized during IMRT).The therapeutic efficacy,parotid gland dose,incidence of acute oral mucosal reaction,dry mouth and oral pain at 3 months after IMRT were compared between two groups.The resting-state apparent diffusion coefficient(ADC)values of parotid and submandibular glands at different time points(before radiotherapy,the 4th week of radiotherapy,the end of radiotherapy and 3 months after radiotherapy)were recorded.Results The difference in the objective reaction rate between two groups was trivial[80.00％(48/60)vs 75.00％(45/60),P>0.05].The mean dose(Dmean)and V34 of the unaffected parotid gland and the Dmean and V30 of the oral cavity in treatment group were lower than those in control group(P<0.05).The incidences of acute oral mucosal reaction,dry mouth and oral pain at 3 months after radiotherapy in treatment group were 41.67％,50.00％,and 58.33％,lower than those in control group(75.00％,78.33％,and 85.00％)(P<0.05).The resting-state ADC values of parotid and submandibular glands at the 4th week of radiotherapy,the end of radiotherapy,and 3 months after radiotherapy in both two groups were higher than those before radiotherapy(P<0.05).At the 4th week of radiotherapy,the end of radiotherapy,and 3 months after radiotherapy,the resting-state ADC values of parotid and submandibular glands in treatment group were lower than those in control group(P<0.05).Conclusion Optimizing target volume during oropharyngeal IMRT can effectively prevent the occurrence of radiation-induced mucositis,alleviate oral mucosal reaction,oral pain and dry mouth,reduce parotid gland dose,and diminish the effects of IMRT on salivary gland function in patients.

Public hospitals play a dominant role in providing medical services.Meanwhile,they are also critical for un-dertaking missions to handle health emergencies.This paper analyzes the necessity,current situation,and existing weaknesses of the health emergency capacity of public hospitals.It also conducts a comparative study of the emergency response mechanisms of foreign medical institutions.This paper aims to explore a well-developed design for health emergency in public hospitals that is suitable for China's medical conditions and to provide a feasible model for promoting high-quality health emergency management.

Objective To explore the feasibility and diagnostic value of ultra-fast scanning scheme based on deep learning-based reconstruction(DLR)for cervical MR examination.Methods Thirty-six subjects were prospectively enrolled and underwent both conventional scheme(scan time:6 min 14 s)and ultra-fast scheme(2 min)cervical spine MR scanning to acquire encompassing sagittal T1WI,sagittal adipose suppression T2WI and axial T2WI.The ultra-fast MRI were reconstructed using DLR method.The subjective and objective evaluations on imaging qualities of different MRIs were compared,along with the inter-observer agreement for diagnosing intervertebral disc degeneration and herniation.Results Compared with conventional MRI,artifacts in ultra-fast DLR images significantly reduced(P＜0.05).The subjective evaluation results of MRI had good agreement(all Kappa≥0.60).Compared with conventional MRI,the sagittal T1WI,T2WI and axial T2WI obtained with ultra-fast DLR showed significantly improved signal-to-noise ratio(SNR)of the spinal cord,cerebrospinal fluid(CSF)and vertebral body,as well as the spinal cord/CSF contrast(all P＜0.001).The Kappa value of 2 physicians for diagnosing intervertebral disc degeneration based on ultra-fast DLR and conventional scheme images was 0.94 and 1.00,respectively,of intervertebral disc herniation was 0.96 and 0.98,respectively.Conclusion Compared with conventional scanning scheme,using ultra-fast DLR scheme in cervical MR examination could shorten scanning time while achieve similar image quality and diagnostic accuracy.

With the accelerated aging society in China, the incidence of biliary surgical diseases in the elderly has increased significantly. The clinical characteristics of these patients indicate that improving treatment outcomes and realizing healthy aging are worthy of attention. How to effectively improve the treatment effect of geriatric biliary surgical diseases has attracted widespread attention. This paper reviews and comments on the hotspots and difficulties of biliary surgery in older patients from six aspects: (1) higher morbidity associated with an aging society, (2) prevention and control of pre-operative risks, (3) extending the indications of laparoscopic surgery, (4) urgent standardization of minimally invasive surgery, (5) precise technological progress in hepatobiliary surgery, and (6) guarantee of peri-operative safety. It is of great significance to fully understand the focus of controversy, actively make use of its favorable factors, and effectively avoid its unfavorable factors, for further improving the therapeutic effects of geriatric biliary surgical diseases, and thus benefits the vast older patients with biliary surgical diseases. Accordingly, a historical record with the highest age of 93 years for laparoscopic transcystic common bile duct exploration has been created by us recently.
Humans ; Aged ; Aged, 80 and over ; Biliary Tract Surgical Procedures ; Gallstones ; Laparoscopy ; Treatment Outcome ; Aging ; Retrospective Studies

Objective:To investigate the malignant potential of histopathological class B3 and B5a lesions by ultrasound-guided core needle biopsy (CNB).Methods:Retrospective analysis of the histopathological results of 712 breast lesions that successively underwent CNB process and surgical resection in the Shanghai General Hospital from January 2018 to December 2022, of which 47 lesions were reported as class B3 and 70 lesions as class B5a.Results:CNB identified 47 category B3 lesions, comprising 19 cases of atypical ductal hyperplasia, 17 papillary lesions, 8 phyllodes tumors, and 3 complex sclerosing lesions. Of these cases, surgical pathology was in full agreement with CNB pathology in 27 instances, indicating a concordance rate of 57.4% (27/47) and an inconsistency rate of 42.6% (20/47). Out of the 20 inconsistent cases, 70.0% (14/20) were upgraded based on the findings from the surgical pathology.Specifically, 4 cases of atypical ductal hyperplasia and 2 cases of intraductal papilloma were upgraded to invasive breast cancer (B5b) after surgery. Among the 4 cases with puncture pathology indicating atypical ductal hyperplasia and one complex sclerosing lesion, these five lesions were upgraded to ductal carcinoma in situ (B5a) after surgery. Two puncture pathologies were diagnosed as atypical ductal hyperplasia, and these were upgraded to ductal carcinoma in situ with microinvasion (B5b) after surgery. One puncture pathology indicated a borderline phyllodes tumor, and this was upgraded to malignant phyllodes tumor (B5b) after surgery. And 30.0% (6/20) resulted in downgrade after surgery, specifically 4 cases of atypical ductal hyperplasia, which were downgraded to breast adenopathy (B2). Of these, 1 puncture pathology was identified as atypical ductal hyperplasia and one as a borderline phyllodes tumor, which were both downgraded to fibroadenoma (B2). Seventy lesions were diagnosed as B5a lesions by CNB pathology, with 28 of them showing complete concurrence with the surgical pathology, a concordance rate of 40.0% (28/70), and an inconsistency rate of 60.0% (42/70). Of the 42 cases with discrepancies, all 42 were upgraded, yielding an upgrading rate of 100% (42/42). Of these, 21 were upgraded to ductal carcinoma in situ with microinvasion (B5b) and 21 to invasive breast cancer (B5b).Conclusions:Lesions with CNB pathology in categories B3 and B5a have a high rate of postoperative escalation. B3 and B5a lesions should be treated with considerable care, especially atypical ductal hyperplasia, which should be surgically resected, and CNB examination should be performed twice if necessary.