Duodenum-preserving pancreatic head resection， also known as Beger surgery， has a high incidence rate of bile duct injury after surgery， while the treatment modality for bile duct injury depends on the severity of the injury， and endoscopic therapy is often challenging in case of severe bile duct injury. Recently a patient with biliary fistula after Beger surgery was admitted to Affiliated Hangzhou First People’s Hospital， Westlake University， and successful diagnosis and treatment were achieved through oral choledochoscopy-assisted percutaneous-endoscopic rendezvous technique.

N-acetyl-p-aminophenol （APAP） is an antipyretic analgesic commonly used in clinical practice， and APAP overdose can cause severe liver injury and even death. In recent years， the incidence rate of APAP-induced liver injury （AILI） tends to increase， and it has become the second most common cause of liver transplantation worldwide. Autophagy is a highly conserved catabolic process that removes unwanted cytosolic proteins and organelles through lysosomal degradation to achieve the metabolic needs of cells themselves and the renewal of organelles. A large number of studies have shown that autophagy plays a key role in the pathophysiology of AILI， involving the mechanisms such as APAP protein conjugates， oxidative stress， JNK activation， mitochondrial dysfunction， inflammatory response and apoptosis. This article elaborates on the biological mechanism of autophagy in AILI， in order to provide a theoretical basis for the treatment of AILI and the development of autophagy regulators.

Micro/nanoplastics (MNPs), recognized as emerging environmental pollutants, are widely distributed in natural environments. Due to their small particle size and significant migratory capacity, MNPs can infiltrate diverse environmental matrices, then invade and accumulate in the organism via the skin, respiration, and digestion. Recently, concerns have grown over the detrimental effects and potential toxicity of MNPs on reproductive health. This review summarized published epidemiological and toxicological studies related to MNPs exposure and their effects on reproductive health. Firstly, this review critically examined the current landscape of epidemiological evidence and found that MNPs (e.g., polystyrene, polypropylene, polyvinyl chloride, polyethylene, etc.) are present in various biological specimens from both males and females, and their presence may be associated with an increased risk of reproductive disorders. Secondly, extensive toxicological studies revealed that MNPs exposure induces reproductive health damage through mechanisms such as disrupting the microstructure of reproductive organs and altering molecular-level expressions. Oxidative stress, inflammatory responses, and apoptosis are identified as potential links between MNPs exposure and reproductive damage. Finally, this review addressed the prevalent shortcomings in existing studies and proposed future directions to tackle the challenges posed by MNPs-induced reproductive harm. These insights aim to inform strategies for safeguarding public reproductive health and ecological security, providing a scientific foundation for mitigating risks associated with MNPs pollution.

OBJECTIVES: To develop a risk prediction model for the transformation of chronic atrophic gastritis to high-grade intraepithelial neoplasia (HGIN) based on traditional Chinese medicine (TCM) syndrome patterns. METHODS: Clinical data of 201 chronic atrophic gastritis patients who visited the Second People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine and Dong'erhuan Branch between January 2022 and March 2023 were retrospectively analyzed, including 32 patients with HGIN (HGIN group) and 169 patients with moderate and severe chronic atrophic gastritis (non-HGIN group). The information of demographic characteristics, dietary habits, lifestyle factors, social and psychosocial factors, family history of tumors, medical history and comorbidities, long-term medication, endoscopic findings, histopathological examination results, as well as TCM syndrome types were collected. Potential HGIN risk factors were screened using LASSO regression, and the significant risk factors for establishing an HGIN risk prediction model were identified using logistic regression analysis. The final model was visually presented using a nomogram, and its diagnostic performance was evaluated through receiver operating characteristic curve analysis. RESULTS: Spleen-stomach Qi deficiency was the most common TCM syndrome in both HGIN and non-HGIN groups. LASSO-logistic regression model analysis showed that heavy alcohol consumption (X1), syndrome of static blood in stomach collaterals (X2), low-grade intraepithelial neoplasia (X3), high-salt diet (X4), and age (X5) were independent risk factors related to the occurrence of HGIN, and the predictive model was ln［P/(1－P)］=2.159X1+2.230X2+1.664X3+2.070X4+0.122X5- 11.096. The model demonstrated good discriminative ability, calibration, and goodness-of-fit, with area under the curve values of 0.940 and 0.891 in the training and validation sets, respectively. CONCLUSIONS The TCM syndrome of static blood in stomach collaterals shows correlation with the transformation from chronic atrophic gastritis to HGIN. The HGIN prediction model based on TCM syndrome patterns developed in the study demonstrates potential value in clinical application.
Humans ; Gastritis, Atrophic/diagnosis* ; Medicine, Chinese Traditional ; Retrospective Studies ; Female ; Male ; Middle Aged ; Stomach Neoplasms/diagnosis* ; Adult ; Risk Factors ; Carcinoma in Situ/diagnosis* ; Aged ; Nomograms ; Chronic Disease ; Logistic Models

Medical equipment, as an important indicator of smart hospital evaluation, plays a vital role in hospital operations. To ensure the safe and efficient operation of medical equipment, a reasonable performance evaluation system is indispensable. This study introduces a platform based on Internet of Things (IoT) technology that connects medical devices and collects data, achieving standardized and structured data processing, and supporting online operational supervision. Through the Delphi method, a performance evaluation system for large medical equipment is constructed, including 4 primary indicators and 22 secondary indicators. DICOM data acquisition devices are used to achieve functions such as efficiency analysis, benefit analysis, usage evaluation, and decision-making support for medical equipment. The study is still in its early stages, and in the future, it is expected to integrate more types of equipment, achieve rational resource allocation, and significantly impact decision-making for the development of public hospitals.
Internet of Things ; Delphi Technique

With the increasing proportion of human papilloma virus(HPV)infection in the pathogenic factors of oro-pharyngeal cancer,a series of changes have occurred in the surgical treatment.While the treatment mode has been im-proved,there are still many problems,including the inconsistency between diagnosis and treatment modes,the lack of popularization of reconstruction technology,the imperfect post-treatment rehabilitation system,and the lack of effective preventive measures.Especially in terms of treatment mode for early oropharyngeal cancer,there is no unified conclu-sion whether it is surgery alone or radiotherapy alone,and whether robotic minimally invasive surgery has better func-tional protection than radiotherapy.For advanced oropharyngeal cancer,there is greater controversy over the treatment mode.It is still unclear whether to adopt a non-surgical treatment mode of synchronous chemoradiotherapy or induction chemotherapy combined with synchronous chemoradiotherapy,or a treatment mode of surgery combined with postopera-tive chemoradiotherapy.In order to standardize the surgical treatment of oropharyngeal cancer in China and clarify the indications for surgical treatment of oropharyngeal cancer,this expert consensus,based on the characteristics and treat-ment status of oropharyngeal cancer in China and combined with the international latest theories and practices,forms consensus opinions in multiple aspects of preoperative evaluation,surgical indication determination,primary tumor re-section,neck lymph node dissection,postoperative defect repair,postoperative complication management prognosis and follow-up of oropharyngeal cancer patients.The key points include:① Before the treatment of oropharyngeal cancer,the expression of P16 protein should be detected to clarify HPV status;② Perform enhanced magnetic resonance imaging of the maxillofacial region before surgery to evaluate the invasion of oropharyngeal cancer and guide precise surgical resec-tion of oropharyngeal cancer.Evaluating mouth opening and airway status is crucial for surgical approach decisions and postoperative risk prediction;③ For oropharyngeal cancer patients who have to undergo major surgery and cannot eat for one to two months,it is recommended to undergo percutaneous endoscopic gastrostomy before surgery to effectively improve their nutritional intake during treatment;④ Early-stage oropharyngeal cancer patients may opt for either sur-gery alone or radiation therapy alone.For intermediate and advanced stages,HPV-related oropharyngeal cancer general-ly prioritizes radiation therapy,with concurrent chemotherapy considered based on tumor staging.Surgical treatment is recommended as the first choice for HPV unrelated oropharyngeal squamous cell carcinoma(including primary and re-current)and recurrent HPV related oropharyngeal squamous cell carcinoma after radiotherapy and chemotherapy;⑤ For primary exogenous T1-2 oropharyngeal cancer,direct surgery through the oral approach or da Vinci robotic sur-gery is preferred.For T3-4 patients with advanced oropharyngeal cancer,it is recommended to use temporary mandibu-lectomy approach and lateral pharyngotomy approach for surgery as appropriate;⑥ For cT1-2N0 oropharyngeal cancer patients with tumor invasion depth＞3 mm and cT3-4N0 HPV unrelated oropharyngeal cancer patients,selective neck dissection of levels ⅠB to Ⅳ is recommended.For cN+HPV unrelated oropharyngeal cancer patients,therapeutic neck dissection in regions Ⅰ-Ⅴ is advised;⑦ If PET-CT scan at 12 or more weeks after completion of radiation shows intense FDG uptake in any node,or imaging suggests continuous enlargement of lymph nodes,the patient should undergo neck dissection;⑧ For patients with suspected extracapsular invasion preoperatively,lymph node dissection should include removal of surrounding muscle and adipose connective tissue;⑨ The reconstruction of oropharyngeal cancer defects should follow the principle of reconstruction steps,with priority given to adjacent flaps,followed by distal pedicled flaps,and finally free flaps.The anterolateral thigh flap with abundant tissue can be used as the preferred flap for large-scale postoperative defects.

Hepatocellular carcinoma(HCC)is the most common type of primary liver cancer and the third leading cause of cancer-related deaths,and it is a serious threat to human health and has become a clinical problem that needs to be solved urgently.Extracellular vesicles(EV)are membrane vesicles containing multiple components and play an important role in the development and progression of HCC.This article summarizes the effect of EVs of different origins on HCC and analyzes the mechanism of action of EV on HCC,so as to provide new perspectives for the diagnosis and treatment of HCC.

Treatment resistance of hepatocellular carcinoma(HCC)is an important factor restricting its treatment outcome.Autophagy is a process involving multiple steps and targets and is closely associated with the proliferation and apoptosis of tumor cells.At the same time,there is significant crosstalk between autophagy and tumor treatment resistance.Therefore,autophagy may be one of the key factors hindering tumor cell death after medical intervention.Transforming growth factor-β(TGF-β),epithelial-mesenchymal transition(EMT),and long non-coding RNA(lncRNA)are important factors leading to drug resistance of HCC.This article discusses the possible mechanism of TGF-β,EMT,and lncRNA mediating complex molecular networks and inducing drug resistance of HCC,in order to provide new ideas for improving the sensitivity of HCC treatment.

After kidney transplantation,the recipients have been under long-term immunosuppression due to the use of immunosuppressive drugs,and they are high-risk population of Pneumocystis jirovecii pneumonia(PJP).The risk of PJP is the highest within 6 months after kidney transplantation and after intensified anti-rejection therapy.Fever,dry cough,progressive dyspnea and hypoxemia are common clinical manifestations of PJP after kidney transplantation.Trimethoprim-sulfamethoxazole(TMP-SMX)can effectively prevent and treat PJP,and significantly reduce the incidence rate and fatality of PJP.To standardize the diagnosis,treatment and prevention of PJP after kidney transplantation,Branch of Organ Transplantation of Chinese Medical Association organized relevant Chinese experts to formulate the"Guidelines for Clinical Diagnosis and Treatment of Pneumocystis Jirovecii Pneumonia After Kidney Transplantation in China"based on clinical concerns,aiming to provide guidance for the prevention and comprehensive clinical treatment of PJP after kidney transplantation.