Objective To develop and validate a fusion model that integrates a multi-parametric magnetic resonance imaging deep learning algorithm with clinicopathological factors to improve the accuracy of preoperative prediction for lymph node metastasis (LNM) in rectal cancer. Methods A total of 191 rectal cancer patients who received treatment at Zhongshan Hospital (Xiamen), Fudan University from January 2022 to December 2024 (modeling group, n＝141) and at Zhongshan Hospital, Fudan University from January to June 2021 (external validation group, n＝50) were retrospectively included. Magnetic resonance imaging and clinical data of all patients were collected to compare the diagnostic performance of the previously developed algorithm with that of two radiologists. Logistic regression was further employed to identify independent risk factors for LNM, and an integrated model combining ‘‘algorithm + clinicopathological features’’ was constructed. The clinical value of this model was evaluated using the area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA). Results In the modeling group, the algorithm’s predictive performance for LNM (AUC＝0.763) was higher than those of two physicians (AUC＝0.675, 0.655). Multivariate analysis results indicated that carcinoembryonic antigen ＞5 μg/L and low differentiation were independent risk factors for LNM (P＜0.01). The fusion model improved predictive performance, with an AUC of 0.872 in the modeling group and 0.830 in the external validation group. DCA analysis showed that the fusion model provided higher net benefits across the clinically common threshold range. Conclusions The fusion model based on multi-parametric magnetic resonance image deep learning algorithm and clinical features shows good predictive performance for LNM of rectal cancer, which is superior to simple algorithms and manual interpretation. It is expected to become an auxiliary tool for preoperative risk stratification and treatment strategy selection of rectal cancer.

Objective To evaluate the safety and efficacy of simultaneous resection for initially resectable rectal cancer with synchronous liver metastases. Methods A retrospective analysis was conducted on 305 patients with initially resectable rectal cancer with synchronous liver metastases. These patients were diagnosed at Zhongshan Hospital, Fudan University from January 2016 to June 2020. Among them, 191 underwent simultaneous rectum and liver resection and 114 underwent staged resection. Propensity score matching (PSM) was performed at a 1∶1 ratio. Clinical data were compared and Kaplan-Meier survival curves were plotted. Results After PSM, 85 patients were included in each group. General data showed no significant differences. Except for liver metastasis resection method, no statistical differences were found in primary tumor surgery approach, intraoperative blood loss, intraoperative complications, time to first flatus and defecation, 30-day mortality, and postoperative hospital stay between the simultaneous resection group and the staged resection group. The overall complication rate was higher in the simultaneous resection group (48.2% vs 29.4%, P＝0.04). Specifically, the grade Ⅱ complications were significantly higher (29.4% vs 14.1%, P＝0.016), but there’s no differences in severe complications (grade Ⅲ-Ⅴ). No statistically differences were observed in median progression-free survival (HR＝0.70, 95%CI 0.50-0.97, P＝0.103) and 5-year overall survival (HR＝0.95, 95%CI 0.63-1.44, P＝0.259). Conclusions Simultaneous resection demonstrates comparable safety and efficacy to staged resection for initially resectable rectal cancer with synchronous liver metastases.

Objective To investigate the effect of Huangjiao granule on inflammatory factors and apoptosis-related proteins in rats with cerebral ischemia-reperfusion injury.Methods A total of 40 Sprague-Dawley rats were divided into sham operation group, model group and Huangjiao granule group, with ten rats in each group, and ten rats standby. The cerebral ischemia for two hours and reperfusion model was established by suture method. The sham operation group and the model group were given saline 10 ml/kg intragastrically 30 minutes before operation. The Huangjiao granule group was given Huangjiao granule solution 10 ml/kg (the content of crude drug was 1 g/ml) intragastrically 30 minutes before ischemia-reperfusion. Longa scoring method was used to evaluate the neurological function score 24 hours after reperfusion, while the percentage of cerebral infarction volume was detected by TTC staining, the pathological morphology of brain tissue was observed by HE staining, the cell apoptosis of brain tissue was detected with TUNEL, the levels of interleukin (IL)-1β, IL-6 and tumor necrosis factor α (TNF-α) in serum were detected by ELISA, the expression of cleaved-caspase 3, cleaved-caspase 9, Bax and Bcl-2 proteins of brain tissue was evaluated by Western blotting.Results Compared with the model group, the neurological score decreased, the percentage of cerebral infarction volume and the apoptosis rate of the brain tissue decreased in Huangjiao granule group (P<0.05). The levels of IL-1β, IL-6 and TNF-α in serum and the expression of cleaved-caspase 3, cleaved-caspase 9 and Bax proteins of brain tissues significantly decreased (P<0.05), and the expression of Bcl-2 protein of brain tissues inreased in Huangjiao granule group (P<0.05).Conclusion The protective effect of Huangjiao granule on rats with cerebral ischemia-reperfusion injury may be related to the inhibition of inflammatory response and the reduction of apoptosis.

AIM: To investigate the influence of the cornus officinalis glycosides (COG) on immunological function of corneal transplantation model of rats, and to clarify the immunosuppressive mechanism of COG through observing the activation of lymphocytes in blood. METHODS: Wister rats were used as recipients and SD rats were used as corneal graft donors, then the corneal allografts transplantation model on the closed colony rats were set up. Splenocytes proliferation and mixed lymphocyte reaction of Wister rats activated by ConA were observed. The phenotype change of CD4, CD8, CD25 in blood in different time postoperatively were observed by the di-sign flow cytometry, and the rate of CD4/CD8 was calculated. RESULTS: 1. The COG suppressed the proliferation of T lymphocytes and one-way mixed lymphocyte reaction on the corneal allografting. 2. The phenotype change of lymphocytes in boold was as follows: there was no significant difference between the different time of the CD4, CD8 expression and the CD4/CD8 rate in blood of the control group. The CD4 positive cells expressed CD25 postoperatively increased obviously. The CD4/CD8 rate of medicine group had the tendency to decrease. The CD4 positive cells expressed CD25 postoperation in the medicine group were less than that in the control group obviously. CONCLUSION: The suppression of the T lymphocyte proliferation, mixed lymphocyte reaction, CD molecule expressed by the activated T lymphocytes and the IL-2 receptor expression may be the main immunosuppressive mechanisms of Cornus officinalis glycosides on the cell-mediated immunity.