Objective:To investigate the value of habitat radiomic features based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI in establishing a predictive model for cytokeratin 19 (CK19) expression in hepatocellular carcinoma (HCC) and to evaluate its role in prognostic risk stratification.Methods:This multicenter case-control study retrospectively enrolled 489 patients with pathologically confirmed HCC who underwent Gd-EOB-DTPA-enhanced MRI between June 2016 and June 2024. Among them, 346 patients from the First Affiliated Hospital of Soochow University were divided into a training cohort ( n=245) and an internal test cohort ( n=101) via stratified sampling at a 7∶3 ratio. And 143 patients from Nantong Third Hospital Affiliated to Nantong University served as an external validation cohort. The training cohort included 53 CK19-positive and 192 CK19-negative patients. The internal test cohort included 21 CK19-positive and 80 CK19-negative patients. The external validation cohort included 30 CK19-positive and 113 CK19-negative patients. Univariate logistic regression analysis was performed to identify potential factors associated with CK19 expression, and a clinical-radiologic model was constructed. The k-means clustering algorithm was applied to segment target HCC lesions into 3 subregions. Radiomic features were extracted and selected from these habitat subregions. Habitat radiomics models were constructed for the arterial phase (AP), portal venous phase, hepatobiliary phase (HBP), and combined phases (CP). Multivariate logistic regression analysis identified independent clinical and radiologic predictors of CK19 expression, and the optimal habitat model score was integrated to build a clinical-radiologic-habitat combined model. The area under the receiver operating characteristic curve (AUC) was used to evaluate model predictive performance. Recurrence-free survival (RFS) was analyzed using the Kaplan-Meier method and the differences in survival curves were compared with the log-rank test. Results:Univariate logistic regression analysis revealed that alpha-fetoprotein (AFP) ( OR=2.629, 95% CI 1.412-4.896, P=0.002), AP enhancement ( OR=3.636, 95% CI 1.642-8.052, P=0.001), AP peritumoral enhancement ( OR=2.219, 95% CI 1.084-4.542, P=0.029), and HBP peritumoral hypointensity ( OR=2.010, 95% CI 1.004-4.021, P=0.049) were potential factors associated with CK19 expression, which were incorporated into the clinical-radiologic model. In the internal and external validation cohorts, the AUC of the clinical-radiologic model was 0.690 (95% CI 0.590-0.778) and 0.650 (95% CI 0.565-0.727), respectively. The habitat radiomics model based on CP images demonstrated the highest performance. It achieved AUC of 0.729 (95% CI 0.622-0.836) and 0.725 (95% CI 0.607-0.842) in the internal and external validation cohorts, respectively. Multivariate analysis identified AFP ( OR=2.494, 95% CI 1.163-5.348, P=0.019), AP enhancement ( OR=5.230, 95% CI 1.868-14.643, P=0.002) and habitat radiomics model score ( OR=4.105, 95% CI 2.643-6.368, P<0.001) as independent predictors of CK19 positivity. Based on these factors, a combined clinical-radiologic-habitat combined model was established. The clinical-radiologic-habitat combined model achieved AUCs of 0.767 (95% CI 0.671-0.846) and 0.730 (95% CI 0.649-0.801) in the internal and external validation cohorts, respectively. Significant differences in RFS were observed between the CK19-positive group (25.1 month) and CK19-negative group (51.0 month) as predicted by the clinical-radiologic-habitat model ( χ2=4.17, P=0.041). Conclusion:The clinical-radiologic-habitat combined model based on Gd-EOB-DTPA-enhanced MRI habitat radiomics demonstrates good predictive performance for CK19 expression in HCC and offers valuable prognostic stratification for clinical practice.

Objective:To investigate the value of habitat radiomic features based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI in establishing a predictive model for cytokeratin 19 (CK19) expression in hepatocellular carcinoma (HCC) and to evaluate its role in prognostic risk stratification.Methods:This multicenter case-control study retrospectively enrolled 489 patients with pathologically confirmed HCC who underwent Gd-EOB-DTPA-enhanced MRI between June 2016 and June 2024. Among them, 346 patients from the First Affiliated Hospital of Soochow University were divided into a training cohort ( n=245) and an internal test cohort ( n=101) via stratified sampling at a 7∶3 ratio. And 143 patients from Nantong Third Hospital Affiliated to Nantong University served as an external validation cohort. The training cohort included 53 CK19-positive and 192 CK19-negative patients. The internal test cohort included 21 CK19-positive and 80 CK19-negative patients. The external validation cohort included 30 CK19-positive and 113 CK19-negative patients. Univariate logistic regression analysis was performed to identify potential factors associated with CK19 expression, and a clinical-radiologic model was constructed. The k-means clustering algorithm was applied to segment target HCC lesions into 3 subregions. Radiomic features were extracted and selected from these habitat subregions. Habitat radiomics models were constructed for the arterial phase (AP), portal venous phase, hepatobiliary phase (HBP), and combined phases (CP). Multivariate logistic regression analysis identified independent clinical and radiologic predictors of CK19 expression, and the optimal habitat model score was integrated to build a clinical-radiologic-habitat combined model. The area under the receiver operating characteristic curve (AUC) was used to evaluate model predictive performance. Recurrence-free survival (RFS) was analyzed using the Kaplan-Meier method and the differences in survival curves were compared with the log-rank test. Results:Univariate logistic regression analysis revealed that alpha-fetoprotein (AFP) ( OR=2.629, 95% CI 1.412-4.896, P=0.002), AP enhancement ( OR=3.636, 95% CI 1.642-8.052, P=0.001), AP peritumoral enhancement ( OR=2.219, 95% CI 1.084-4.542, P=0.029), and HBP peritumoral hypointensity ( OR=2.010, 95% CI 1.004-4.021, P=0.049) were potential factors associated with CK19 expression, which were incorporated into the clinical-radiologic model. In the internal and external validation cohorts, the AUC of the clinical-radiologic model was 0.690 (95% CI 0.590-0.778) and 0.650 (95% CI 0.565-0.727), respectively. The habitat radiomics model based on CP images demonstrated the highest performance. It achieved AUC of 0.729 (95% CI 0.622-0.836) and 0.725 (95% CI 0.607-0.842) in the internal and external validation cohorts, respectively. Multivariate analysis identified AFP ( OR=2.494, 95% CI 1.163-5.348, P=0.019), AP enhancement ( OR=5.230, 95% CI 1.868-14.643, P=0.002) and habitat radiomics model score ( OR=4.105, 95% CI 2.643-6.368, P<0.001) as independent predictors of CK19 positivity. Based on these factors, a combined clinical-radiologic-habitat combined model was established. The clinical-radiologic-habitat combined model achieved AUCs of 0.767 (95% CI 0.671-0.846) and 0.730 (95% CI 0.649-0.801) in the internal and external validation cohorts, respectively. Significant differences in RFS were observed between the CK19-positive group (25.1 month) and CK19-negative group (51.0 month) as predicted by the clinical-radiologic-habitat model ( χ2=4.17, P=0.041). Conclusion:The clinical-radiologic-habitat combined model based on Gd-EOB-DTPA-enhanced MRI habitat radiomics demonstrates good predictive performance for CK19 expression in HCC and offers valuable prognostic stratification for clinical practice.

A growing body of evidence points to the important role of exercise in reducing cancer risk,enhancing therapeutic efficacy,and improving prognosis.However,the cellular and molecular mechanisms by which exercise intervenes in cancer have not been fully elucidated.This review summarizes the effects of exercise on the tumor microenvi-ronment,cytokines,hormones,and the immune system in the hope of advancing our understanding of the mechanisms underlying exercise in cancer prevention and treatment.

Objective:To investigate the relationship between artificial radionuclide 137Cs and stable cesium (Cs) in wild edible fungi and seek potential correlations. Methods:A total of 30 samples, including the caps (with gills) and stipes of wild edible fungi, were collected from the northeastern region of China. The measurement and analysis of 137Cs were conducted following recommended procedures in GB/T 16145-2022, and stable Cs was determined using inductively coupled plasma mass spectrometry (ICP-MS). Then, the correlation analysis of data on 137Cs and stable Cs was performed using SPSS 11.5 software, and scatter plots were prepared using the Origin 21.0 software. Results:The fungi caps exhibited a specific activity of 137Cs ranging from 0.52 to 55.9 Bq/kg (dry weight) and a stable Cs content from 0.069 mg/kg to 16.2 mg/kg (dry weight). The stipes showed a specific activity of 137Cs ranging from 0.53 Bq/kg to 101 Bq/kg (dry weight) and a stable Cs content from 0.075 to 11.5 mg/kg (dry weight). These data revealed a significant correlation between the specific activity of 137Cs and the stable cesium content in all samples including caps and stipes, with correlation coefficients r of 0.956, 0.912, and 0.931, respectively, and all significant levels P < 0.01. The ratios of the specific activity of 137Cs to stable Cs content varied from 2.09 Bq/kg to 20.1 Bq/kg (dry weight), with an average of 10.7 Bq/kg (dry weight). Conclusions:Wild edible fungi fail to distinguish between 137Cs and stable cesium when absorbing Cs elements from their growing substrates. Furthermore, there is a strong correlation between the specific activity of 137Cs and stable Cs content. In the case of exogenous 137Cs contamination, the ratio of the specific activity of 137Cs and stable Cs content will significantly change. Therefore, an increase in the ratio can be used as a reference for identifying 137Cs contamination events.

ObjectiveTo explore the feasibility， evaluation methods and metabolic differences of high-fat diet（HFD） combined with myocardial ischemia-reperfusion injury（MIRI） to establish a rat model of myocardial ischemia-reperfusion with phlegm and blood stasis blocking collaterals syndrome（PBSBCS）. MethodsThirty-two SD rats were randomly divided into the sham operation， HFD， MIRI， and MIRI+HFD groups. Rats in the sham operation and MIRI groups were fed a standard diet（regular chow）， while the HFD and MIRI+HFD groups received a HFD for 10 weeks. Rats in the MIRI and MIRI+HFD groups underwent myocardial ischemia-reperfusion surgery， while the sham operation group underwent only thread placement without ligation. Cardiac function was assessed via small-animal echocardiography， including left ventricular ejection fraction（EF）， left ventricular fractional shortening（FS）， cardiac output（CO）， and stroke volume（SV）. Serum levels of creatine kinase（CK）， CK-MB， triglyceride（TG）， total cholesterol（TC）， high-density lipoprotein cholesterol（HDL-C）， low-density lipoprotein cholesterol（LDL-C）， lactate dehydrogenase（LDH）， endothelin-1（ET-1）， endothelial nitric oxide synthase（eNOS）， tumor necrosis factor-α（TNF-α）， interleukin-18（IL-18）， oxidized LDL（ox-LDL）， and cardiac troponin T（cTnT） were measured by biochemical assays and enzyme-linked immunosorbent assay（ELISA）. Myocardial histopathology was evaluated via hematoxylin-eosin（HE） staining， while myocardial infarction and no-reflow area were assessed using 2，3，5-triphenyltetrazolium chloride（TTC）， Evans blue， and thioflavin staining. Changes in syndrome characteristics［body weight， tongue surface red-green-blue ［RGB］ values， and pulse amplitude］ of PBSBCS were recorded. Serum differential metabolites were analyzed by ultra-high performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS）. ResultsCompared with the sham operation group， the HFD and MIRI+HFD groups showed significant increases in body weight（P<0.01）， RGB values and pulse amplitude decreased in the HFD， MIRI and MIRI+HFD groups， TC， TG， LDL-C and ox-LDL levels increased in the HFD and MIRI+HFD groups， while HDL-C decreased. Blood perfusion peak time and myocardial no-reflow area increased， serum eNOS level decreased， and CK-MB， LDH， and cTnT activities increased in the HFD， MIRI and MIRI+HFD groups（P<0.05， P<0.01）. Whole blood viscosity was increased in the HFD group at medium shear rate， and in the MIRI and MIRI+HFD groups at low， medium and high shear rates（P<0.05， P<0.01）. Platelet aggregation rate increased in the MIRI and MIRI+HFD groups， accompanied by elevated ET-1， TNF-α， and IL-18 levels， reduced cardiac function indices， expanded myocardial no-reflow and infarction areas， and increased serum CK， CK-MB， LDH， and cTnT activities（P<0.05， P<0.01）. Compared with the MIRI group， the HFD and MIRI+HFD groups showed significant increase in body weight， TC， TG， LDL-C and ox-LDL levels， and significant decrease in HDL-C content（P<0.01）. The MIRI+HFD group showed decrease in RGB values and pulse amplitude， and an increase in whole blood viscosity， platelet aggregation， blood perfusion peak time， myocardial no-reflow and infarction areas， elevated ET-1， TNF-α and IL-18 levels， decreased eNOS content， EF and SV， increased serum CK， CK-MB and cTnT activities， and worsened myocardial pathology（P<0.05）. Compared with the HFD group， the MIRI+HFD group showed similar aggravated trends（P<0.05， P<0.01）. Metabolomics results showed that 34 potential biomarkers involving 13 common metabolic pathways were identified in the MIRI+HFD group compared with the sham operation group. ConclusionThe MIRI group resembles blood stasis syndrome in hemodynamics and myocardial injury， and the HFD group mirrors phlegm-turbidity syndrome in lipid profiles and tongue characteristics. While the MIRI+HFD group aligns with PBSBCS in comprehensive indices， effectively simulating clinical features of coronary heart disease（CHD）， which can be used for the evaluation of the pathological mechanism and pharmacodynamics of CHD with PBSBCS.

ObjectiveTo explore the feasibility， evaluation methods and metabolic differences of high-fat diet（HFD） combined with myocardial ischemia-reperfusion injury（MIRI） to establish a rat model of myocardial ischemia-reperfusion with phlegm and blood stasis blocking collaterals syndrome（PBSBCS）. MethodsThirty-two SD rats were randomly divided into the sham operation， HFD， MIRI， and MIRI+HFD groups. Rats in the sham operation and MIRI groups were fed a standard diet（regular chow）， while the HFD and MIRI+HFD groups received a HFD for 10 weeks. Rats in the MIRI and MIRI+HFD groups underwent myocardial ischemia-reperfusion surgery， while the sham operation group underwent only thread placement without ligation. Cardiac function was assessed via small-animal echocardiography， including left ventricular ejection fraction（EF）， left ventricular fractional shortening（FS）， cardiac output（CO）， and stroke volume（SV）. Serum levels of creatine kinase（CK）， CK-MB， triglyceride（TG）， total cholesterol（TC）， high-density lipoprotein cholesterol（HDL-C）， low-density lipoprotein cholesterol（LDL-C）， lactate dehydrogenase（LDH）， endothelin-1（ET-1）， endothelial nitric oxide synthase（eNOS）， tumor necrosis factor-α（TNF-α）， interleukin-18（IL-18）， oxidized LDL（ox-LDL）， and cardiac troponin T（cTnT） were measured by biochemical assays and enzyme-linked immunosorbent assay（ELISA）. Myocardial histopathology was evaluated via hematoxylin-eosin（HE） staining， while myocardial infarction and no-reflow area were assessed using 2，3，5-triphenyltetrazolium chloride（TTC）， Evans blue， and thioflavin staining. Changes in syndrome characteristics［body weight， tongue surface red-green-blue ［RGB］ values， and pulse amplitude］ of PBSBCS were recorded. Serum differential metabolites were analyzed by ultra-high performance liquid chromatography-quadrupole-time-of-flight mass spectrometry（UPLC-Q-TOF-MS）. ResultsCompared with the sham operation group， the HFD and MIRI+HFD groups showed significant increases in body weight（P<0.01）， RGB values and pulse amplitude decreased in the HFD， MIRI and MIRI+HFD groups， TC， TG， LDL-C and ox-LDL levels increased in the HFD and MIRI+HFD groups， while HDL-C decreased. Blood perfusion peak time and myocardial no-reflow area increased， serum eNOS level decreased， and CK-MB， LDH， and cTnT activities increased in the HFD， MIRI and MIRI+HFD groups（P<0.05， P<0.01）. Whole blood viscosity was increased in the HFD group at medium shear rate， and in the MIRI and MIRI+HFD groups at low， medium and high shear rates（P<0.05， P<0.01）. Platelet aggregation rate increased in the MIRI and MIRI+HFD groups， accompanied by elevated ET-1， TNF-α， and IL-18 levels， reduced cardiac function indices， expanded myocardial no-reflow and infarction areas， and increased serum CK， CK-MB， LDH， and cTnT activities（P<0.05， P<0.01）. Compared with the MIRI group， the HFD and MIRI+HFD groups showed significant increase in body weight， TC， TG， LDL-C and ox-LDL levels， and significant decrease in HDL-C content（P<0.01）. The MIRI+HFD group showed decrease in RGB values and pulse amplitude， and an increase in whole blood viscosity， platelet aggregation， blood perfusion peak time， myocardial no-reflow and infarction areas， elevated ET-1， TNF-α and IL-18 levels， decreased eNOS content， EF and SV， increased serum CK， CK-MB and cTnT activities， and worsened myocardial pathology（P<0.05）. Compared with the HFD group， the MIRI+HFD group showed similar aggravated trends（P<0.05， P<0.01）. Metabolomics results showed that 34 potential biomarkers involving 13 common metabolic pathways were identified in the MIRI+HFD group compared with the sham operation group. ConclusionThe MIRI group resembles blood stasis syndrome in hemodynamics and myocardial injury， and the HFD group mirrors phlegm-turbidity syndrome in lipid profiles and tongue characteristics. While the MIRI+HFD group aligns with PBSBCS in comprehensive indices， effectively simulating clinical features of coronary heart disease（CHD）， which can be used for the evaluation of the pathological mechanism and pharmacodynamics of CHD with PBSBCS.

Objective:To investigate the relationship between artificial radionuclide 137Cs and stable cesium (Cs) in wild edible fungi and seek potential correlations. Methods:A total of 30 samples, including the caps (with gills) and stipes of wild edible fungi, were collected from the northeastern region of China. The measurement and analysis of 137Cs were conducted following recommended procedures in GB/T 16145-2022, and stable Cs was determined using inductively coupled plasma mass spectrometry (ICP-MS). Then, the correlation analysis of data on 137Cs and stable Cs was performed using SPSS 11.5 software, and scatter plots were prepared using the Origin 21.0 software. Results:The fungi caps exhibited a specific activity of 137Cs ranging from 0.52 to 55.9 Bq/kg (dry weight) and a stable Cs content from 0.069 mg/kg to 16.2 mg/kg (dry weight). The stipes showed a specific activity of 137Cs ranging from 0.53 Bq/kg to 101 Bq/kg (dry weight) and a stable Cs content from 0.075 to 11.5 mg/kg (dry weight). These data revealed a significant correlation between the specific activity of 137Cs and the stable cesium content in all samples including caps and stipes, with correlation coefficients r of 0.956, 0.912, and 0.931, respectively, and all significant levels P < 0.01. The ratios of the specific activity of 137Cs to stable Cs content varied from 2.09 Bq/kg to 20.1 Bq/kg (dry weight), with an average of 10.7 Bq/kg (dry weight). Conclusions:Wild edible fungi fail to distinguish between 137Cs and stable cesium when absorbing Cs elements from their growing substrates. Furthermore, there is a strong correlation between the specific activity of 137Cs and stable Cs content. In the case of exogenous 137Cs contamination, the ratio of the specific activity of 137Cs and stable Cs content will significantly change. Therefore, an increase in the ratio can be used as a reference for identifying 137Cs contamination events.

OBJECTIVE: To investigate the effect of intraoperative blood salvage autotransfusion on local recurrence and long-term metastasis of patients after carotid body tumor resection. METHODS: We retrospectively reviewed a consecutive series of 61 patients undergoing elective carotid body tumor resection from August 2009 to December 2020. Among them, 14 received intraoperative blood salvage autotransfusion (autotrasfusion group) and 47 did not (non-autotransfusion). Data of general information, surgical status and postoperative follow-up results were collected. RESULTS: The proportion of Shamblin Ⅲ in the autotransfusion group was 85.7%, which was significantly higher than 31.9% in the non-autotransfusion group (P=0.003). The average operation time of the 14 patients in the autotransfusion group was (264±84) min, intraoperative blood loss was 1 200 (700, 2 700) mL, and autologous blood transfusion was 500 (250, 700) mL. Of these, 8 patients (57%) required concomitant allogeneic blood with 400 (260, 400) mL of allogeneic blood. The average operation time of the 47 patients in the non-autotransfusion group was (153±75) min, and the intraoperative blood loss was 300 (100, 400) mL. Of these, 6 (13%) required allogeneic blood transfusion, and 520 (400, 520) mL of allogeneic blood was used. Compared with the non-autotransfusion group, the average operation time in the autologous blood transfusion group was significantly longer (P < 0.001), and the intraoperative blood transfusion volume was larger (P=0.007). Of the 14 patients undergoing autotransfusion, 8 (57%) needed allogeneic blood at the same time; while in the 47 non-autologous transfusion patients, 6 (13%) needed allogeneic blood transfusion. The proportion of autotransfusion group using allogeneic blood at the same time was even higher (P=0.002). The incidence of nerve injury within 30 days after surgery was 29.5%, and there was no significant difference between the two groups. No early deaths occurred. The average follow-up was (76±37) months. One case of local recurrence occurred in the non-autotransfusion group. There was no distant metastasis. There were no tumor-related deaths. The estimated 5-year and 10-year overall survival rates were 96.4% and 83.8%, respectively. There was no significant difference in overall survival between the two groups (P=0.506). CONCLUSION The use of intraoperative blood salvage autotransfusion increased no risk of local recurrence and distant metastasis in patients with carotid body tumor, which is safe and effective in carotid body tumor resection.
Humans ; Blood Transfusion, Autologous/methods* ; Operative Blood Salvage/methods* ; Retrospective Studies ; Male ; Female ; Carotid Body Tumor/pathology* ; Middle Aged ; Prognosis ; Neoplasm Recurrence, Local ; Blood Loss, Surgical ; Aged ; Adult ; Operative Time

Objective:To investigate the risk factors associated with preoperative heart failure in elderly patients with intertrochanteric fracture and evaluate their predictive efficacy.Methods:A retrospective cohort study was conducted to analyze the clinical data of 163 elderly patients with intertrochanteric fracture admitted to the Affiliated Drum Tower Hospital of Nanjing University School of Medicine from July 2018 to July 2022, including 57 males and 106 females, aged 63-98 years [83.3(78.0, 87.0)years]. The patients were divided into high-risk heart failure group ( n=66) and non-high-risk group ( n=97) based on whether the serum B-type natriuretic peptide (BNP) level within 24 hours on admission was greater than 100 pg/ml. The following data in the two groups were collected, including gender, age, AO/OTA fracture classification, fracture laterality, associated underlying comorbidities (diabetes, cardiovascular diseases, cerebral infarction), past history of fracture, history of surgeries, time from injury to hospitalization less than 48 hours, first blood pressure on admission, first routine blood test on admission [leukocyte count (WBC), neutrophil count (NEUT), lymphocyte count, platelet (PLT), hemoglobin (Hb)], first blood biochemistry on admission [alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), albumin, glucose, serum calcium, creatinine, glomerular filtration rate (GFR), and first other related tests on admission [D-dimer, prothrombin time (PT), C-reactive protein (CRP)]. Independent risk factors for preoperative heart failure in elderly patients with intertrochanteric fracture were identified through univariate analysis and binary logistic regression analysis. The predictive efficacy of each indicator or two combined indicators for preoperative heart failure in elderly patients with intertrochanteric fractures was assessed by plotting the receiver operating characteristic (ROC) curve and calculating the area under the curve (AUC). Results:Univariate analysis demonstrated that age, associated cardiovascular diseases, history of fracture, time from injury to hospitalization less than 48 hours, Hb, creatinine and GFR were significantly correlated with the preoperative heart failure ( P<0.05), while gender, AO/OTA fracture classification, fracture laterality, diabetes, cerebral infarction, history of surgeries, blood pressure, WBC, NEUT, lymphocyte count, PLT, CRP, ALT, AST, LDH, albumin, glucose, serum calcium, D-dimer, PT, and CRP were not correlated with the preoperative heart failure in elderly patients with intertrochanteric fractures ( P>0.05). Logistic regression analysis revealed that age (95% CI 1.02, 1.15, P<0.05), associated cardiovascular disease (95% CI 1.31, 5.88, P<0.01), Hb (95% CI 0.96, 1.00, P<0.05), and GFR (95% CI 0.97, 1.00, P<0.05) were independent risk factors for heart failure in elderly patients with intertrochanteric fracture. ROC curve analysis demonstrated that age, associated cardiovascular diseases, Hb, and GFR could predict preoperative heart failure in elderly patients with intertrochanteric fractures, with the combination of associated cardiovascular disease and GFR showing a relatively higher predictive ability (AUC=0.76, 95% CI 0.68, 0.84). Conclusions:Age, associated cardiovascular diseases, Hb and GFR are independent risk factors for preoperative heart failure in elderly patients with intertrochanteric fracture. Moreover, the combination of associated cardiovascular diseases and GFR possesses a relatively higher predictive value for preoperative heart failure in elderly patients with intertrochanteric fracture.

With the continuous advancement of internet technology and the improvement of internet literacy among the general population, the concept of online-offline integration in internet hospitals has gradually gained acceptance and has been applied and developed both domestically and internationally. In thoracic surgery, the applicability of this model lies in enhancing efficiency and delivering comprehensive, diversified, and personalized medical services to address complex and severe conditions. However, challenges such as hardware limitations and diagnostic/treatment risks persist during the implementation of internet hospitals. Through future in-depth and localized research, the online-offline integration of internet hospitals is expected to undergo further development and refinement. This progress will facilitate its integration into clinical practice in thoracic surgery, ultimately providing patients with improved medical care services.