The widespread implementation of low-dose computed tomography screening has led to a substantial rise in the detection of pulmonary nodules,with multiple pulmonary nodules(MPNs)now representing a common clinical presentation.Conventional diagnostic and therapeutic paradigms,characterized by sequential,multi-site processes,are often limited by inefficiency,safety concerns,and suboptimal patient outcomes.In contemporary thoracic surgery,a transformative"one-stop"precision management strategy has emerged within hybrid operating theaters.This integrated approach synergizes intraoperative imaging,advanced navigation,and surgical intervention to address these limitations.Cone-beam CT plays a pivotal role in this model by leveraging its maneuverability,low radiation,and high spatial resolution to greatly facilitate the development of precise diagnosis and treatment for MPNs.

Non-small cell lung cancer(NSCLC)is the leading cause of cancer-related mortality worldwide,with approximately 30％of patients initially presenting at stage Ⅱ-Ⅲ and thus potentially eligible for surgical resection.However,surgery alone is insufficient to control postoperative recurrence and distant metastasis effectively.Therefore,neoadjuvant treatment has gradually become a critical approach to improving patient prognosis.Conventional neoadjuvant chemotherapy has historically shown limited pathological complete response(pCR)rates,while neoadjuvant targeted therapy,despite enhancing objective response rates(ORR),still results in relatively low pCR.Recently,neoadjuvant immunotherapy combined with chemotherapy has demonstrated groundbreaking progress.Several large-scale international and domestic clinical trials have reported that this combination strategy significantly increases pCR rates to between 17％and 41％and notably prolongs event-free survival.However,neoadjuvant immunotherapy also introduces new surgical challenges,including increased intraoperative difficulty due to tissue fibrosis,expanded surgical resections resulting from inadequate preoperative prediction,and emerging concerns surrounding the perioperative management of immune-related adverse events(irAEs).Recent advancements in artificial intelligence(AI)-assisted imaging models,multi-omics integration,and dynamic ctDNA monitoring offer novel perspectives and tools for accurately predicting pathological responses preoperatively.Furthermore,intensive studies on mechanisms underlying immunotherapy resistance,such as exosomal PD-L1 regulatory pathways and oxidative stress pathways,alongside emerging strategies involving bispecific antibodies and metabolic interventions,provide theoretical foundations for further optimizing therapeutic approaches.Looking forward,the development of precise preoperative efficacy prediction systems,deep integration of AI technology,and the expansion of multi-modal combination strategies will represent primary directions in the evolution of neoadjuvant immunotherapy for NSCLC.

The widespread implementation of low-dose computed tomography screening has led to a substantial rise in the detection of pulmonary nodules,with multiple pulmonary nodules(MPNs)now representing a common clinical presentation.Conventional diagnostic and therapeutic paradigms,characterized by sequential,multi-site processes,are often limited by inefficiency,safety concerns,and suboptimal patient outcomes.In contemporary thoracic surgery,a transformative"one-stop"precision management strategy has emerged within hybrid operating theaters.This integrated approach synergizes intraoperative imaging,advanced navigation,and surgical intervention to address these limitations.Cone-beam CT plays a pivotal role in this model by leveraging its maneuverability,low radiation,and high spatial resolution to greatly facilitate the development of precise diagnosis and treatment for MPNs.

Non-small cell lung cancer(NSCLC)is the leading cause of cancer-related mortality worldwide,with approximately 30％of patients initially presenting at stage Ⅱ-Ⅲ and thus potentially eligible for surgical resection.However,surgery alone is insufficient to control postoperative recurrence and distant metastasis effectively.Therefore,neoadjuvant treatment has gradually become a critical approach to improving patient prognosis.Conventional neoadjuvant chemotherapy has historically shown limited pathological complete response(pCR)rates,while neoadjuvant targeted therapy,despite enhancing objective response rates(ORR),still results in relatively low pCR.Recently,neoadjuvant immunotherapy combined with chemotherapy has demonstrated groundbreaking progress.Several large-scale international and domestic clinical trials have reported that this combination strategy significantly increases pCR rates to between 17％and 41％and notably prolongs event-free survival.However,neoadjuvant immunotherapy also introduces new surgical challenges,including increased intraoperative difficulty due to tissue fibrosis,expanded surgical resections resulting from inadequate preoperative prediction,and emerging concerns surrounding the perioperative management of immune-related adverse events(irAEs).Recent advancements in artificial intelligence(AI)-assisted imaging models,multi-omics integration,and dynamic ctDNA monitoring offer novel perspectives and tools for accurately predicting pathological responses preoperatively.Furthermore,intensive studies on mechanisms underlying immunotherapy resistance,such as exosomal PD-L1 regulatory pathways and oxidative stress pathways,alongside emerging strategies involving bispecific antibodies and metabolic interventions,provide theoretical foundations for further optimizing therapeutic approaches.Looking forward,the development of precise preoperative efficacy prediction systems,deep integration of AI technology,and the expansion of multi-modal combination strategies will represent primary directions in the evolution of neoadjuvant immunotherapy for NSCLC.

Objective To explore the value of spectral CT imaging in the preoperative evaluation on histodifferentiation of rectal adenocarcinoma.Methods 90 patients with rectal adenocarcinoma underwent dual-phase enhanced spectral CT scan,and were divided into well,moderately and poorly differentiated adenocarcinoma groups according to the pathology.Single-energy images with energy levels from 40 to 140 keV were generated by GSI Viewer software,and the slope K value of the energy curves were calculated.Iodine concentrations were derived from iodine-based material-separation images and normalized to the iodine concentrations in the aorta. ROC curves were derived to evaluate the differentiation diagnosis efficiency of normalized iodine concentration (NIC)and slope K in rectal adenocarcinoma,respectively.Results There were 22,50 and 18 cases in the well,moderately and poorly differentiated group,respectively.The iodine concentration,NIC and slope K value were statistically different both in the arterial and venous phase (P<0.05).According to the ROC curve,the diagnostic value of NIC was close to that of the slope K,with the sensitivity>76% and the specificity>74% in the arterial phase,and the sensitivity>77% and the specificity>70% in the venous phase by choo-sing the appropriate threshold.Conclusion The spectral CT can provide a new method for preoperatively evaluating the histodiffer-entiation of rectal adenocarcinoma.

Objective To investigate the influence of intensive antiplatelet scheme assisted with gamma-immunoglobulin on clinical efficacy, the relieve time of clinical symptoms and the levels of inflammatory factors of children with Kawasaki disease.Methods80 children with Kawasaki disease were chosen in the period form July 2014 to July 2016 in Yiwu hospital of Zhejiang province and randomly divided into two groups including the control group (40 cases) with bigeminy scheme including aspirin and dipyridamole and the observation group (40 cases) with trigeminy scheme including aspirin, dipyridamole and clopidogrel on the basis of gamma-globulin;and the clinical efficacy for short-term, the relieve time of clinical symptoms and signs, the the levels of WBC, PLT, PCT, CRP, IL-6, TNF-α, HMGB1 and MIF before and after treatment, the incidence of coronary artery injury and the incidence of adverse drug reactions of both groups were compared.ResultsThe total clinical effects of observation group were significantly higher than control group(P<0.05).The relieve time of symptoms and signs of observation group were significantly shorter than control group(P<0.05).The levels of WBC and PLT after treatment of observation groups were significantly lower than control group and before treatment(P<0.05).The levels of PCT, CRP, IL-6, TNF-α, HMGB1 and MIF after treatment of observation groups were significantly lower than control group and before treatment(P<0.05).The incidence of coronary artery injury of observation groups were significantly lower than control group(P<0.05).There was no significant difference in the adverse drug effects incidence between 2 groups.ConclusionIntensive antiplatelet scheme assisted with immunoglobulin in the treatment of children with Kawasaki disease can efficiently relieve the respiratory symptoms and signs, control the levels of inflammatory reaction, inhibit the platelet aggregation, prevent the occurrence of coronary artery injury and not cause the serious adverse drug reactions.

Objective To evaluate the different arteriographic manifestations of acute renal arterial hemorrhage,and the treatment effects of emergency interventional embolization.Methods 87 patients with renal arterial hemorrhage who were failed to conservative treatment underwent the renal arteriography to confirm the position and degree of lesion.According to the arteriographic manifesta-tions,appropriate embolic agents such as spring coil,acrylic acid microspheres and the like were used to embolize the targeted vessel. The arteriographic manifestations and embolization efficacy were retrospectively analyzed.Results Contrast medium leakage was showed by renal angiography in 43 patients,13 of whom had arterio-venous fistula (AVF)and 1 5 of whom had renal pseudoaneu-rysms (RAP).Among this 1 5 patients,there were 5 patients with arteriovenous fistula and one patiernt with artery-calyces fistula. Hemorrhage of tumor vessel was shown in 1 5 patients and renal arteriovenous malformation (RAVM)in 1.47 patients underwent renal artery CT arteriography before emergency interventional embolization.The hematuresis was completely stopped or significantly relieved in 82 of all patients.Only 3 patients with renal trauma and 2 patients with percutaneous nephroscope were still had haematu-ria.All patients were followed up for 2 years.The total effective rate of emergency interventional embolization treatment was 94.25%(82/87),and no serious complications were observed.Conclusion As a safe,effective and micro-invasive treatment,emergency in-terventional embolization therapy can be used to treat the acute renal hemorrhage effectively.It can keep the maximum renal func-tion.Though acute renal hemorrhage angiography may have different manifestations,the choice of embolic agents is the key to stop the symptom.Renal artery CTA before embolotherapy is important for the diagnosis and therapy of acute renal hemorrhage.

ObjectiveTo examine biochemical characteristics of the frontal lobe and hippocampus in unaffected parentsof schizophreniaprohandsusingprotonmagneticresonancespectroscopy(1H-MRS).Method 19 unaffected fathers of schizophrenia probands with matched 19 male healthy control subjects and 24 unaffected mothers of schizophrenia probands with matched 24 female healthy control subjects were included in the study.1 H-MRS was performed in two sides of the hippocampus and frontal lobes regions.The ratios of N-Acetylaspartate ( NAA ),choline (Cho) to creatine (Cr) were measured.One-sample T test and paired-samples t test were used for statistic process.ResultsUnaffected mothers of schizophrenia probands had a higher Cho/Cr ratio ( left ( 1.10 ± 0.13,right ( 1.08 ± 0.12 ) ) in the frontal white matter compared with matched female health control subjects(left( 1.03 ± 0.10),right( 1.02 ± 0.09 )).The NAA/Cr ratio was significantly reduced in the left frontal white matter of female health control subjects compared to right( 1.64 ± 0.12 vs 1.74 ± 0.13 ),but this difference was not observed in unaffected mothers of schizophrenia probands.There were no significant differences in metabolites for frontal lobe and hippocampus regions between unaffected fathers of schizophrenia probands and male healthy control subjects groups( all P＞0.05 ).ConclusionThe results implicate that the metabolic abnormalities and disappeared asymmetry of NAA/Cr might exist in the frontal white matter among unaffected mothers of schizophrenia probands.

OBJECTIVETo explore an exercise method for the prevention and treatment of the patients with shoulder and back fasciitis.

METHODSFrom 2006.8 to 2008.3, 120 patients with shoulder and back fasciitis were randomly divided into control group (n = 60, including 21 females and 39 males, the average age was (47.0 +/- 12.0) years, and the average course of disease was (14.1 +/- 12.0) months) and treatment group (n = 60,including 19 females and 41 males, the average age was (43.7 +/- 9.9) years, and the average course of disease was (16.4 +/- 13.4) months). The patients in the control group received massage therapy and the ones in the treatment group were treated with massage therapy and horizontal bar exercise. After 3 weeks treatment, the curative effects of the patients in two groups were observed. All the patients were followed up for 6 to 26 months, the recurrence were observed.

RESULTSAfter 3 weeks treatment, the scores of pain, sense of heaviness, strip sign, tenderness, shoulder and back function of the patients in two groups had significant differences compared with those before treatment (all P < 0.01). After treatment, the scores of pain, sense of heaviness, strip sign, tenderness, shoulder and back function of the patients in the treatment group were lower than those in the control group (P < 0.05). After 6 to 26 months following-up, the rate of recurrence in the treatment group was lower than that in the control group (P < 0.01).

CONCLUSIONHorizontal bar exercise is a simple, no expense and effective method in the prevention and treatment of shoulder and back fasciitis, which can improve the effect of the treatment and reduce the rate of recurrence.

Adult ; Back Pain ; etiology ; prevention & control ; therapy ; Exercise Therapy ; methods ; Fasciitis ; prevention & control ; therapy ; Female ; Humans ; Male ; Middle Aged ; Shoulder Pain ; etiology ; prevention & control ; therapy ; Treatment Outcome