Objective:To investigate the clinical value of preoperative gadolinium ethoxy-benzyldiethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) in predicting microvascular invasion (MVI) and intratumoral tertiary lymphoid structures (TLSs) in hepatocellular carcinoma (HCC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 304 HCC patients who were admitted to The First Affiliated Hospital of Army Medical University and 10 HCC patients who were admitted to The Second Affiliated Hospital of Chongqing Medical University from June 2021 to June 2023 were collected. There were 272 males and 42 females, aged (56±11)years. Using a random number table method, patients were divided into a training set including 220 cases and a validation set including 94 cases in a 7:3 ratio. Among the 314 patients, 106 cases had MVI and TLSs-positive HCC (MT-HCC), and 208 cases had non-MT-HCC. All patients underwent preoperative Gd-EOB-DTPA-enhanced MRI and radical resection. Observation indicators: (1) clinicopathological characteristics of MT-HCC and non-MT-HCC patients; (2) imaging characteristics of MT-HCC and non-MT-HCC patients; (3) imaging features associated with MT-HCC diagnosis; (4) nomogram predictive model construction and evaluation for MT-HCC. Comparison of measurement data with normal distribution between groups was analyzed using the t test. Comparison of measurement data with skewed distribution between groups was analyzed using the nonpara-meter rank sum test. Univariate analysis was conducted using the corresponding statistical methods based on data type. Multivariate analysis was conducted using the logistic regression model. A nomo-gram predictive model was constructed based on results of multivariate analysis, and receiver operating characteristic (ROC) curves were plotted to evaluate the model's performance with the area under curve (AUC). Calibration curve and decision curve analyses were used to assess the calibration and clinical validity of nomogram predictive model. Results:(1) Clinicopathological characteristics of MT-HCC and non-MT-HCC patients. In the training set, there were significant differences between MT-HCC and non-MT-HCC patients in terms of age, white blood cell count, and alpha fetoprotein level ( t=2.488, Z=-2.515, χ2=4.014, P<0.05). (2) Imaging characteristics of MT-HCC and non-MT-HCC patients. In the training set, there were significant differences in tumor morphology, intratumoral hemorrhage, peritumoral abnormal enhancement in arterial phase, capsule presence, intratumoral necrosis or ischemia >20%, intratumoral necrosis or ischemia >50%, peritumoral hypointensity in the hepatobiliary phase, intravascular tumor thrombus, arterial phase rim-like hyperenhancement, and mosaic architecture between MT-HCC and non-MT-HCC patients ( χ2=8.811, 5.586, 13.962, 31.616, 10.154, 4.835, 5.111, 14.425, 7.112, 5.526, P<0.05). (3) Imaging features associated with MT-HCC diagnosis. Results of multivariate analysis identified the absence of intratumoral hemorrhage, incom-plete capsule, and mosaic architecture as independent risk factors for diagnosing MT-HCC ( hazard ratio=3.846, 7.827, 2.345, P<0.05). (4) Nomogram predictive model construction and evaluation for MT-HCC. A nomogram predictive model for MT-HCC was constructed based on the independent risk factors (absence of intratumoral hemorrhage, incomplete capsule, and mosaic architecture) iden-tified in the multivariate analysis. The ROC curve analysis showed that AUC of nomogram predictive model was 0.778 (95% confidence interval as 0.714-0.843), with sensitivity and specificity of 0.857 and 0.573 in the training set. In the validation set, the area under the curve, sensitivity, and specifi-city were 0.825 (95% confidence interval as 0.745-0.926), 0.655, and 0.877, respectively. The calibra-tion curves for both the training set and the validation set closely aligned with the standard curve, indicating high calibration accuracy. The decision curve analysis demonstrated net clinical benefits at thresholds of 0.130-0.690 in the training set and 0.060-0.750 in the validation set. Conclusions:The absence of intratumoral hemorrhage, incomplete capsule, and mosaic architecture are independent risk factors for diagnosing MT-HCC. A nomogram model based on imaging features can predict MT-HCC in HCC patients.

Objective:To investigate the clinical value of preoperative gadolinium ethoxy-benzyldiethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) in predicting microvascular invasion (MVI) and intratumoral tertiary lymphoid structures (TLSs) in hepatocellular carcinoma (HCC).Methods:The retrospective cohort study was conducted. The clinicopathological data of 304 HCC patients who were admitted to The First Affiliated Hospital of Army Medical University and 10 HCC patients who were admitted to The Second Affiliated Hospital of Chongqing Medical University from June 2021 to June 2023 were collected. There were 272 males and 42 females, aged (56±11)years. Using a random number table method, patients were divided into a training set including 220 cases and a validation set including 94 cases in a 7:3 ratio. Among the 314 patients, 106 cases had MVI and TLSs-positive HCC (MT-HCC), and 208 cases had non-MT-HCC. All patients underwent preoperative Gd-EOB-DTPA-enhanced MRI and radical resection. Observation indicators: (1) clinicopathological characteristics of MT-HCC and non-MT-HCC patients; (2) imaging characteristics of MT-HCC and non-MT-HCC patients; (3) imaging features associated with MT-HCC diagnosis; (4) nomogram predictive model construction and evaluation for MT-HCC. Comparison of measurement data with normal distribution between groups was analyzed using the t test. Comparison of measurement data with skewed distribution between groups was analyzed using the nonpara-meter rank sum test. Univariate analysis was conducted using the corresponding statistical methods based on data type. Multivariate analysis was conducted using the logistic regression model. A nomo-gram predictive model was constructed based on results of multivariate analysis, and receiver operating characteristic (ROC) curves were plotted to evaluate the model's performance with the area under curve (AUC). Calibration curve and decision curve analyses were used to assess the calibration and clinical validity of nomogram predictive model. Results:(1) Clinicopathological characteristics of MT-HCC and non-MT-HCC patients. In the training set, there were significant differences between MT-HCC and non-MT-HCC patients in terms of age, white blood cell count, and alpha fetoprotein level ( t=2.488, Z=-2.515, χ2=4.014, P<0.05). (2) Imaging characteristics of MT-HCC and non-MT-HCC patients. In the training set, there were significant differences in tumor morphology, intratumoral hemorrhage, peritumoral abnormal enhancement in arterial phase, capsule presence, intratumoral necrosis or ischemia >20%, intratumoral necrosis or ischemia >50%, peritumoral hypointensity in the hepatobiliary phase, intravascular tumor thrombus, arterial phase rim-like hyperenhancement, and mosaic architecture between MT-HCC and non-MT-HCC patients ( χ2=8.811, 5.586, 13.962, 31.616, 10.154, 4.835, 5.111, 14.425, 7.112, 5.526, P<0.05). (3) Imaging features associated with MT-HCC diagnosis. Results of multivariate analysis identified the absence of intratumoral hemorrhage, incom-plete capsule, and mosaic architecture as independent risk factors for diagnosing MT-HCC ( hazard ratio=3.846, 7.827, 2.345, P<0.05). (4) Nomogram predictive model construction and evaluation for MT-HCC. A nomogram predictive model for MT-HCC was constructed based on the independent risk factors (absence of intratumoral hemorrhage, incomplete capsule, and mosaic architecture) iden-tified in the multivariate analysis. The ROC curve analysis showed that AUC of nomogram predictive model was 0.778 (95% confidence interval as 0.714-0.843), with sensitivity and specificity of 0.857 and 0.573 in the training set. In the validation set, the area under the curve, sensitivity, and specifi-city were 0.825 (95% confidence interval as 0.745-0.926), 0.655, and 0.877, respectively. The calibra-tion curves for both the training set and the validation set closely aligned with the standard curve, indicating high calibration accuracy. The decision curve analysis demonstrated net clinical benefits at thresholds of 0.130-0.690 in the training set and 0.060-0.750 in the validation set. Conclusions:The absence of intratumoral hemorrhage, incomplete capsule, and mosaic architecture are independent risk factors for diagnosing MT-HCC. A nomogram model based on imaging features can predict MT-HCC in HCC patients.

Objective:To investigate risk factors of arrhythmia in elderly patients with early lung cancer after thoracoscopic pulmonary resection to construct a prediction model.Methods:Two hundreds and twenty elderly patients with early lung cancer after thoracoscopic pulmonary resection were retrospectively chosen in the period from January 2017 to January 2023 in Guang'an People's Hospital of Sichuan Province. The occurrence of arrhythmia was calculated, and the clinical data of patients with arrhythmia and those without arrhythmia were compared. Logistic regression was employeed to analyze the independent influencing factors of arrhythmia in elderly patients with early lung cancer after thoracoscopic pneumonectomy. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of regression model on arrhythmia after thoracoscopic pneumonectomy in elderly patients with early lung cancer.Results:Forty-one of 220 (18.64%) elderly patients with early lung cancer treated by thoracoscopic pneumonectomy had arrhythmia. There were statistically significant differences between patients with arrhythmia and patients without arrhythmia in age ( χ2=17.76, P<0.001), combined with essential hypertension ( χ2=21.06, P<0.001), forced expiratory volume in one second as a percentage of predicted value (FEV 1%) ( χ2=17.88, P<0.001), left atrium anterior-and-posterior diameter ( χ2=37.82, P<0.001), operation type ( χ2=27.09, P<0.001) and postoperative constipation ( χ2=18.25, P<0.001). The results of multivariate analysis showed that age>75 years old ( OR=22.17, 95% CI: 3.78-130.11, P=0.001), combined with essential hypertension ( OR=26.55, 95% CI: 3.99-176.95, P=0.001), FEV 1%≤70% ( OR=6.20, 95% CI: 1.37-28.11, P=0.018), left atrium anterior-and-posterior diameter>40 mm ( OR=10.84, 95% CI: 2.24-52.45, P=0.003), thoracoscopic lobectomy ( OR=7.07, 95% CI: 1.62-30.80, P=0.009), and postoperative constipation ( OR=79.97, 95% CI: 11.87-538.83, P<0.001) were all independent risk factors for arrhythmia after thoracoscopic pulmonary resection in elderly patients with early lung cancer. A prediction model was established for statistically significant indicators in multivariate analysis, ln ( P/1- P) =-7.89+3.10×age+3.28×combined with essential hypertension+1.82×FEV 1%+2.38×left atrium anterior-and-posterior diameter+1.96×operation type+4.38×postoperative constipation ( P was the prediction probability of P value in regression model). ROC curve analysis showed that the area under the curve (AUC) of predict arrhythmia after thoracoscopic pulmonary resection in elderly patients with early lung cancer were 0.64, 0.71, 0.68, 0.74, 0.76, 0.87 and 0.98, respectively. The Yoden index was 27.29%, 42.28%, 34.92%, 47.42%, 73.63%, 50.97% and 91.97%, respectively. Conclusion:Age>75 years old, combined with essential hypertension, FEV 1%≤70%, left atrium anterior-and-posterior diameter>40 mm, thoracoscopic lobectomy and postoperative constipation are all independent risk factors for arrhythmia after thoracoscopic pulmonary resection in elderly patients with early lung cancer. Nomogram model based on the above risk factors has high efficacy in predicting arrhythmia occurance after thoracoscopic pulmonary resection.

{L-End}Objective To analyze the current status of post-traumatic stress disorder (PTSD) among firefighters in Chongqing City and explore its influencing factors. {L-End}Methods A total of 1 021 firefighters in Chongqing City were selected as the study subjects using the convenient sampling method. The PTSD Checklist Civilian Version was used to assess their PTSD symptom and characteristics. The Trait Coping Style Questionnaire and the Social Support Rating Scale were used to investigate coping styles and the level of social support. {L-End}Results The positive detection rate of PTSD among the study subjects was 4.6%(47/1 021), with positive detection rates of re-experiencing, avoidance/numbing, and hyperarousal symptoms of 7.0%, 9.2%, and 16.5%, respectively. The positive detection rates of re-experiencing, avoidance/numbing, and hyperarousal symptoms in the PTSD firefighters were higher than those in non-PTSD firefighters (83.0% vs 3.3%, 93.6% vs 5.1%, 100.0% vs 12.1%, respectively; all P<0.01). The results of the multivariate logistic regression analysis showed that being injured in the past six months and adopting a negative coping style were risk factors for PTSD ［odds ratio (OR) and 95% confidence interval (CI) were 2.65 (1.07-6.56) and 1.26 (1.19-1.33), respectively; both P<0.05］, while adopting a positive coping style and having a higher level of social support were protective factors for PTSD ［OR and 95%CI were 0.90 (0.85-0.95) and 0.95 (0.91-0.99), respectively; both P<0.05］. {L-End}Conclusion The incidence of PTSD among the firefighters in Chongqing City is relatively high, with symptoms mainly characterized by hyperarousal. Being injured in the past six months, coping styles, and the level of social support are influencing factors for PTSD.

Due to the problems of language barriers and cultural differences existing in the current clinical practice teaching activities of overseas students, this study proposes to divide the oversea students and Chinese students into bilingual mixed groups in the ward rounds teaching. Through the selection of typical cases and the application of flipped classroom, the Chinese and English versions of learning materials related to disease are provided to the interns for learning in advance, and the oversea students and Chinese students are requested to complete the history and auxiliary examination data collection in Chinese and English in cooperation, and then the teacher leads the group to carry out ward rounds teaching, including bedside English history report, physical examination, case analysis, discussion and summary, so as to improve the participation enthusiasm of overseas students and also improve the teaching effects.

Objective To investigate the optimal gamma passing rate of intensity-modulated radiotherapy (IMRT) dosimetric verification in the treatment of esophageal cancer using a three-dimensional dose verification system EDoseTM.Methods Twenty five esophageal cancer patients treated by 7-field IMRT were retrospectively reviewed.Measured dose distribution were reconstructed on CT image and evaluated by gamma analysis and DVH metrics using the EDoseTM system.Plans with DVH metrics dose difference ＜ 5％ or with gamma passing ＞ 90％ under 3％/3 mm criteria were accepted.The optimal gamma passing rate for criteria of 5％/3 mm,3％/3 mm,2％/2 mm were investigated by drawing the receiver operating characteristic (ROC) curves and calculating the Youden Index.The sensitivity and specificity of the these optimal thresholds in the plan verification were also analyzed.Results The optimal thresholds for global gamma indices with 5％/3 mm,3％/3 mm,2％/2 mm were 98.66％,94.84％,78.56％,respectively.In the 90％ common threshold,The sensitivity and specificity for common 90％ threshold and optimal threshold under 3％/3 mm criteria were 0.17 vs.0.85 and t 0.84 vs.0.27,respectively.The sensitivity and specificity were 0.89,0.65 and 0.23,0.47 for optimal thresholds under 5％/3 mm and 2％/2 mm criteria,respectively.Conclusions The sensitivity of optimal threshold gamma passing rate improved significantly compared with the common threshold (90％) at 3％/3 mm criteria.,The sensitivity and the specificity were more balanced at the 2％/2 mm criteria compared with those at 3％/3 mm criteria.

Objective To explore the influencing factors on spiritual health of postoperative patients with gastric neuroendocrine neoplasm (gNEN). Methods A total of 108 patients with gNEN who undertook operation in the First Affiliated Hospital of Zhengzhou University from July 2013 to July 2016 were recruited by purposive sampling method. All the research subjects were investigated with a general information questionnaire, the Chinese Version of Functional Assessment of Chronic Illness Therapy-Spiritual-12 (FACIT-Sp-12), Herth Hope Index (HHI) and Social Dysfunction Screening Scale (SDSS). Results Multivariate linear regression analysis showed that age, educational level, religious belief, SDSS and HHI were the influencing factors of spiritual health in patients with gNEN (P＜0.01). Conclusions Age, educational level, religious belief, social function and hope level were the influencing factors of spiritual health in patients with gNEN. Nursing staff need to construct a scientific and effective spiritual health care model according to the characteristics of patients.

Objective To investigate the feasibility of automatic spectral imaging protocol selection (ASIS) and adaptive statiatical iterative reconstruction (ASiR) technique to reduce radiation dose and dose of contrast agent.Methods Sixtyfour patients underwent routine abdominal examination were randomly divided into two groups.The test group used ASIS technique,with 30％ ASiR and 50％ ASiR reconstruction algorithm.The control group used 120 kVp tube voltage,FBP reconstruction method.The noise of liver,pancreas,sacrospinal muscle,CNR of liver and pancreas,subjective image score in arterial phase and portal venous phase were compared between the image of 70 keV+30％ ASIR and control group.CNR of abdominal aorta and its branchs,CNR of portal vein,and subjective image score were statistically analyzed between im age 55 keV+50％ ASiR and control group in the arterial phase and portal venous phase.Results Compared with control group,CT dose index volume for arterial phase and portal venous phase in test group decreased by 23.68％,23.57％ and dose length product decreased by 25.61％,18.45 ％,total contrast injection decreased 16.86 ％,the noise of liver,pancreas and sacrospinal muscle in 70 keV+30％ ASiR were lower than those of control group in abdominal arterial and portal phase (all P＜0.05).CNR of abdominal aorta,superior mesenteric artery,celiac axis and score in 55 keV+50％ ASiR were higher than those of control group in abdominal arterial phase (all P＜0.05),CNR of portal vein and score in portal phase had no statistically difference (all P＞ 0.05).Conclusion Combining of ASIS and ASiR including 70 keV + 30％ ASiR and 55 keV+50％ ASiR,images are superior to that of the conventional 120 kVp+FBP scan mode for abdominal CT image and vessel image quality,which can reduce the radiation dose and the dose of contrast agent.

[Abstrca t] Objective BRCA 1 ( breast cancer susceptibility gene 1) and RAP80 ( receptor-associated protein 80) play key roles in predicting chemosensitivity of platinum and taxanes .A randomized trial was carried out to compare non-selected cisplatin-based chemotherapy with therapy customized according to BRCA1 and RAP80 expression.Methods Advanced stage NSCLC patients whose tumor specimen was sufficient for molecular analysis were randomized (1∶3) to the control or experimental arm.Patients in the control arm received docetaxel/cisplatin; in the experimental arm , patients with low RAP 80 expression received gemcitabine/cisplatin ( Arm 1 ) , those with intermediate/high RAP 80 expression and low/intermediate BRCA 1expression received docetaxel/cisplatin ( Arm 2 ) , and those with intermediate/high RAP80 expression and high BRCA1 expression received docetaxel alone (Arm 3).The primary end point was progression-free survival (PFS).Results 226 patients were screened and 124 were randomized in this trial.ORR in the four subgroups was 22.6%, 48.4%, 30.3%and 19.2%, respectively (P=0.08);PFS was 4.74, 5.59, 3.78 and 2.73 months, respectively (P=0.55); and OS was 10.82, 14.44, 10.86 and 10.86 months, respectively (P=0.84).The common adverse effects included neutropenia , nausea, anemia and fatigue.Conclusions No statistically significant difference of ORR , PFS or OS is observed in the experimental arms compared with the control arm .Patients with low RAP 80 mRNA levels have a trend of better survival and higher response rate to gemcitabine /cisplatin chemotherapy .

[Abstrca t] Objective BRCA 1 ( breast cancer susceptibility gene 1) and RAP80 ( receptor-associated protein 80) play key roles in predicting chemosensitivity of platinum and taxanes .A randomized trial was carried out to compare non-selected cisplatin-based chemotherapy with therapy customized according to BRCA1 and RAP80 expression.Methods Advanced stage NSCLC patients whose tumor specimen was sufficient for molecular analysis were randomized (1∶3) to the control or experimental arm.Patients in the control arm received docetaxel/cisplatin; in the experimental arm , patients with low RAP 80 expression received gemcitabine/cisplatin ( Arm 1 ) , those with intermediate/high RAP 80 expression and low/intermediate BRCA 1expression received docetaxel/cisplatin ( Arm 2 ) , and those with intermediate/high RAP80 expression and high BRCA1 expression received docetaxel alone (Arm 3).The primary end point was progression-free survival (PFS).Results 226 patients were screened and 124 were randomized in this trial.ORR in the four subgroups was 22.6%, 48.4%, 30.3%and 19.2%, respectively (P=0.08);PFS was 4.74, 5.59, 3.78 and 2.73 months, respectively (P=0.55); and OS was 10.82, 14.44, 10.86 and 10.86 months, respectively (P=0.84).The common adverse effects included neutropenia , nausea, anemia and fatigue.Conclusions No statistically significant difference of ORR , PFS or OS is observed in the experimental arms compared with the control arm .Patients with low RAP 80 mRNA levels have a trend of better survival and higher response rate to gemcitabine /cisplatin chemotherapy .