To explore the clinical value of a multimodal predictive model based on multiparametric magnetic resonance imaging(MRI) radiomics combined with deep learning(DL) features for the preoperative noninvasive assessment of mismatch repair-deficient(MMRd) status in endometrial cancer(EC).

Objective:To investigate the effect of myo-inositol on the reactivation of ocular dominance plasticity in the visual cortex of adult mice and its mechanisms.Methods:Thirty-two male SPF-grade C57BL/6J mice at postnatal day 60 (P60) were randomly divided into four groups using a random number table: normal control group, monocular form deprivation (MD) group, myo-inositol group (myo-inositol administered to normal mice), and MD+ myo-inositol group (myo-inositol administered to MD mice), with 8 mice in each group.The right eyes of MD group and MD+ myo-inositol group received MD on P60.Mice in each group were housed until P64 when pattern visual evoked potential (P-VEP) recordings were performed in both eyes.The amplitude and peak time of P100 wave were measured, and the contralateral/ipsilateral ratio (C/I) was calculated to evaluate the shift of ocular dominance.Twenty-four mice were randomly divided into MD group and MD+ myo-inositol group using the random number table method, with 12 mice in each group.RNA was extracted from the visual cortex of the two groups of mice, and transcriptomic sequencing and bioinformatics analysis were performed to screen differentially expressed genes.Six mice were randomly divided into MD group and MD+ myo-inositol group using the random number table method, with 3 mice in each group, and the expression changes of differentially expressed genes cell communication network factor 1( CCN1), fatty acid binding protein 7( Fabp7) and galectin-3 binding protein ( Lgals3bp) were verified by real-time fluorescence quantitative PCR.This study adhered to the Regulations on the Administration of Laboratory Animals (2017 Edition), and the research protocol was approved by the Animal Ethics Committee of Tianjin Medical University (No.TMUaMEC2022004). Results:The P-VEP results showed that the right eye P100 amplitudes in the normal control, MD, myo-inositol and MD+ myo-inositol groups were (89.04±19.87), (83.04±9.42), (88.14±21.75) and (61.75±15.42)μV, and the P100 wave peak time were (102.40±5.64), (101.50±8.26), (101.33±8.66) and (111.30±7.17)ms, and C/I were 2.38±0.17, 2.35±0.22, 2.41±0.31, and 1.65±0.24, respectively, with statistically significant overall differences ( F=5.844, 2.221, 16.634; all P<0.05).Compared with the normal control group, MD group and myo-inositol group, the MD+ myo-inositol group had a significant decrease in the P100 wave amplitude in the right eye, a significant prolongation of the P100 wave peak time, and a significant decrease in the C/I, with statistically significant differences (all P<0.05).There was no significant difference in P100 wave amplitude or peak time in the left eyes among the normal control, MD, myo-inositol and MD+ myo-inositol groups ( F=0.249, 1.356; both P>0.05).The transcriptome sequencing results showed that there were significant differences in the expression of 93 genes between the MD+ myo-inositol group and the MD group, among which the differential expression of CCN1, Fabp7 and Lgals3bp genes related to visual plasticity was particularly significant.The real-time fluorescence quantitative PCR results verified that the expression of CCN1 in the MD+ myo-inositol group was significantly decreased, and the expression of Fabp7 and Lgals3bp was significantly increased, with statistically significant differences ( t=17.561, 9.237, 12.710; all P<0.001). Conclusions:Myo-inositol can effectively reactivate ocular dominance plasticity in the visual cortex in adult mice, and may mediate this process by regulating the expression of specific genes CCN1, Fabp7, and Lgals3bp.

Objective:To investigate the safety and efficacy of the artery-first approach pancreaticoduo-denectomy (PD) combined with portal vein/superior mesenteric vein (PV/SMV) resection and reconstruction for pancreatic head malignancies.Methods:A retrospective analysis was conducted on 322 patients who underwent PD with PV/SMV resection and reconstruction at the Hepatobiliary Pancreatic Surgery Department of the First Hospital Affiliated to Naval Medical University between January 2016 and December 2022. Patients were divided into the artery-first approach PD group (AFA-PD group, n=165) and standard PD group (SPD group, n=157) based on surgical approach. Baseline characteristics, surgical outcomes, postoperative outcomes, pathological results and survival data were compared between two groups. Results:Compared to the SPD group, the AFA-PD group exhibited significantly reduced intraoperative blood loss (500 ml vs 600 ml), lower rates of obvious intraoperative blood loss (≥1 000 ml: 25.45% vs 40.13%), and decreased transfusion requirements (26.67% vs 52.87%). Postoperatively, the AFA-PD group demonstrated lower incidence of grade B/C pancreatic fistula (10.30% vs 19.75%) and higher textbook outcome achievement (78.79% vs 66.24%). Pathologically, the AFA-PD group achieved superior lymph node yield (20 nodes vs 18 nodes) and higher R 0 resection rates (79.39% vs 64.33%), particularly at the posterior pancreatic margin (96.97% vs 91.72%, P=0.040), SMA margin (92.07% vs 82.17%), and SMV margin (88.48% vs 78.98%). Multivariate logistic regression identified arterial invasion >180°, venous invasion >180°, lymph node metastasis, and the artery-first approach as independent predictors of R 0 resection. The AFA-PD group showed prolonged median survival (19.17 month vs 15.73 month). All aforementioned differences were statistically significant (all P value <0.05). Conclusions:The artery-first approach PD combined with PV/SMV resection and reconstruction is safe and effective for pancreatic head malignancies, significantly improving R 0 resection rates and patients' survival outcomes.

Objective:To evaluate the therapeutic value of radiotherapy in combined immunotherapy and chemotherapy as first-line treatment for patients with oligometastatic non-small cell lung cancer (NSCLC).Methods:A retrospective analysis was conducted on data from 195 NSCLC patients who lacked epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) mutations and were treated at the Anyang Tumor Hospital and the Fourth Hospital of Hebei Medical University from January 2019 to December 2021. These patients consisted of 166 male and 29 female cases, aged from 28 to 85 years, with an average age of (61.4 ± 9.3) years. These patients were divided into two groups, with each group receiving the radiotherapy and combined immunotherapy and chemotherapy (the radiotherapy and combination group, n = 60) and combined immunotherapy and chemotherapy only (the combination group, n = 135). Then, propensity score matching (PSM) was performed to analyze the differences in prognosis between both groups before and after PSM, as well as the short-term efficacy and adverse reactions after PSM. Results:For the 195 NSCLC patients, the median follow-up time was 31.8 months, with median overall survival (OS) and median progression-free survival (PFS) recorded at 23.8 months and 9.2 months, respectively. The radiotherapy and combination group exhibited enhanced 1-, 2-, and 3-year survival rates of 78.5%, 55.9%, and 45.1%, respectively, significantly higher than the combination group (48.3%, 35.6%, and 26.6%, respectively, χ2 = 14.65, P < 0.001). Similarly, the radiotherapy and combination group displayed 1-, 2-, and 3-year PFS rates of 51.9%, 29.5%, and 22.7%, respectively, exceeding those of the combination group (30.0%, 24.5%, and 16.9%, respectively, χ2=6.09, P=0.014). After PSM, the radiotherapy and combination group manifested an objective response rate (ORR) of 60.0% (33/55) and a disease control rate (DCR) of 89.1% (49/55), which were 16.4% (9/55) and 56.4% (31/55), respectively for the combination group. These results suggested that the radiotherapy and combination group demonstrated significantly higher ORR and DCR ( χ2 = 22.18, 14.85, P<0.001). After PSM, the radiotherapy and combination group yielded 1-, 2-, and 3-year survival rates of 70.9%, 52.3%, and 41.9%, respectively, significantly than the combination group (43.6%, 29.8%, and 27.1%, respectively, χ2=8.95, P=0.003). The radiotherapy and combination group exhibited 1-, 2-, and 3-year PFS rates of 47.3%, 27.3%, and 18.7%, respectively, significantly higher than the combination group (23.6%, 17.6%, and 15.4%, respectively, χ2 = 6.71, P = 0.010). Multivariate Cox regression analysis revealed that independent factors affecting OS included clinical stage, treatment regimen, number of immunotherapy cycles, and treatment efficacy ( HR = 1.88, 2.11, 0.23, 1.79, P < 0.05). Similarly, independent factors affecting PFS consisted of treatment regimen, number of immunotherapy cycles, and treatment efficacy ( HR = 1.62, 0.37, 3.42, P <0.05). There were no statistical differences in the incidence of grade ≥ 2 bone marrow suppression (18.2% vs. 12.7%) and grade ≥ 2 pneumonia (21.8% vs. 14.5%) between both groups ( P>0.05). Conclusions:Introducing radiotherapy into combined immunotherapy and chemotherapy as first-line treatment for oligometastatic NSCLC can optimize both local and systemic disease control and significantly improve patient prognosis without increasing treatment-related adverse reactions.

Objective:By analyzing peripheral blood indicators, we constructed and validated a novel lung cancer prediction model using machine learning algorithms for riskassessment of lung cancer.Methods:A retrospective case-control design was conducted on the clinical data of 194 newly diagnosed lung cancer patients [mean age: (66.80±9.09) years, 126 males and 68 females] admitted to Qilu Second Hospital of Shandong University between January 9, 2020, and December 31, 2024, serving as the case group. During the same period, 290 healthy individuals undergoing physical examinations [mean age: (61.18±14.31) years, 155 males and 135 females J were enrolled as the control group. A total of 46 peripheral blood indicators-including routine blood tests, coagulation parameters, liver function markers, and tumor-related indices-along with two basic characteristics (age and sex) were included in the analysis. Eleven machinelearning algorithms including logistic regression, randomforest, support vector classifier, extreme gradient boosting, gradient boosting decision tree, decision tree, multilayer perceptron, linear discriminant analysis, adaptive boosting, Gaussian naive Bayes and light gradient-boosting machine-were trained for early diagnosis of lung-cancer.Model performance was evaluated by the area under the ROC, accuracy, positive predictive value, negative predictive value, F1-score and 95% confidence interval (95% CI). The best performing algorithm was selected, and feature importance was ranked with Shapley Additive Planation(SHAP) values. Results:The support-vector classifier achieved the best performance for predicting lung-cancer risk (AUC=0.974; 95 % CI 0.951-0.989) and was retained for final model establishment. After 20 rounds of stratified 10-fold cross-validation the mean AUC was 0.950; learning-curve, decision-curve and calibration analyses confirmed its superior generalizability, clinical utility and calibration.SHAPley additive explanations and decision-tree feature importance consistently identified neuron-specific enolase, carcinoembryonic antigen, and squamous-cell carcinoma antigen as the three most critical predictors of lung-cancer risk. Conclusion:An SVM-based lung cancer prediction model was successfully established to determine the risk of developing lung cancer.

Objective To identify potential biomarkers for proliferative diabetic retinopathy(PDR)using proteomics and transcriptomics data.Methods In this study,the proteomics dataset(PXD046630)and two transcriptomics datasets(GSE60436 and GSE102485)were derived from the aqueous humor samples and fibrovascular membranes of PDR patients,respectively.Differentially expressed genes(DEGs)were identified via R software,specifically the limma and edgeR pack-ages.The shared DEGs between PXD046630 and GSE60436 were analyzed via protein-protein interaction(PPI),Gene On-tology(GO)enrichment,and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses.The key DEGs were validated in GSE102485 via receiver operating characteristic(ROC)curve analysis.A quantitative polymerase chain reaction(qPCR)assay was used to confirm the mRNA of these candidate biomarkers in human retinal microvascular endothelial cells(HRMECs)cultured in high glucose and low oxygen conditions.Results A total of 59 shared DEGs and 26 hub genes were identified from the PXD046630 and GSE60436 datasets.KEGG analysis revealed that six pathways,inclu-ding extracellular matrix-receptor interaction,proteoglycans in cancer,and complement and coagulation cascades,were enriched in 12 key DEGs.Fibronectin 1(FN1),tissue inhibitor of metalloproteinase 3(TIMP3),complement factor H(CFH),decorin(DCN),and lipoprotein receptor-related protein-2(LRP2)were identified as potential biomarkers on the basis of their AUC values being greater than 0.900(CI≥95％).The mRNA expression levels of FN1,CFH,and LRP2 were significantly increased in HRMECs cultured in high glucose and low oxygen conditions.Conclusion FN1,CFH,and LRP2 are potential biomarkers for PDR,and further studies are needed to explore their roles and therapeutic potential in PDR.

AIM:To investigate the preventive and therapeutic effects of sesamin(SES)on fatty liver disease in rats with hypertension combined with dyslipidemia,and to explore the potential mecha-nisms based on mRNA-seq.METHODS:Spontane-ously hypertensive rats(SHRs)were fed a high-fat,high-cholesterol diet to establish a rat model of hy-pertension combined with dyslipidemia,and then treated with SES for 16 weeks continuously.The ex-periment was divided into four groups:WKY,SHR,Model,and Model+SES(160 mg·kg-1·d-1).Blood pressure was measured using the tail-cuff method.Body weight was monitored,and body mass index was calculated.Liver morphology was detected by ultrasound,and liver thickness was measured.Liver wet weight was weighed,and liver index was calcu-lated.Liver volume was detected by the water dis-placement method.Serum triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),alanine aminotransferase(ALT),aspartate amino-transferase(AST),and total bile acids(TBA)were de-tected by ELISA.Liver sequencing analysis was per-formed using mRNA-seq.Liver histomorphological changes were observed by HE staining.The degree of hepatic steatosis was observed by Oil Red O stain-ing,and the degree of hepatic fibrosis was observed by MASSON staining.The mRNA expression of Al-dh1a7,Nnmt,Irs2,Pltp,and Scd was detected by q-PCR.The protein expression of Scd,Nnmt,AMPK,p-AMPK,PPARα,and PPARγ was detected by Western blotting.RESULTS:After 16 weeks of continuous SES administration to rats with hypertension combined with dyslipidemia,blood pressure was significantly reduced(P＜0.01),and body weight was decreased.Serum TG,TC,and LDL-C levels were decreased,while HDL-C levels were increased.Serum ALT and AST levels were decreased.Liver weight,organ in-dex,liver thickness,and liver volume were de-creased.The degree of hepatic steatosis and hepat-ic fibrosis was improved.A total of 545 differentially expressed mRNAs were identified in the livers of rats in each group,of which 278 were upregulated and 267 were downregulated.Among the 27 com-monly differentially expressed mRNAs,five mRNAs related to lipid metabolism were screened,namely Aldh1a7,Nnmt,Irs2,Pltp,and Scd.KEGG enrich-ment analysis showed that the enriched pathways were AMPK and PPAR.Further validation revealed that in the SES-treated group,the mRNA expression of Scd in the liver was decreased,while the mRNA expression of Nnmt was increased.The protein ex-pression of Scd was decreased,while the protein ex-pression of Nnmt,AMPK,p-AMPK,PPARα,and PPARγ was increased.CONCLUSION:SES has preven-tive and therapeutic effects on fatty liver disease in rats with hypertension combined with dyslipidemia,and its mechanism of action may be related to the reduction of Scd expression levels in the liver and the increase in the expression of Nnmt,AMPK,p-AMPK,PPARα,and PPARγ.

Objective:To explore the multiple mediating roles of intrinsic motivation and proactive behavior in the influence mechanism of perceived overqualification on the information literacy of Operating Room nurses engaged in organ transplantation.Methods:On November 2023, 308 Operating Room nurses engaged in organ transplantation from 12 hospitals in China were selected for the survey using convenience sampling method. General information questionnaire, Information Literacy Self-Rating Scale for Clinical Nurses, the 9-item Scale of Perceived Over Qualification, Intrinsic Motivation Scale, and Proactive Behavior Scale were used to investigate and to construct the chain mediating model.Results:A total of 308 questionnaires were collected and 294 questionnaires were valid, with a valid recovery rate of 95.45%. The total scores of information literacy, perceived overqualification, intrinsic motivation and proactive behavior of 294 Operating Room nurses engaged in organ transplantation were (133.95±19.07), (23.71±7.82), (76.47±13.38) and (38.01±6.31) respectively. The indirect effect of perceived overqualification of Operating Room nurses engaged in organ transplantation on information literacy existed, with a total indirect effect value of -0.348. The specific indirect effect of intrinsic motivation was 40.80% of the total indirect effect, the specific indirect effect of proactive behavior was 31.03% of the total indirect effect, and the chain mediating effect of intrinsic motivation and proactive behavior was 28.16% of the total indirect effect.Conclusions:Multiple mediating roles of intrinsic motivation and proactive behavior in the influence mechanisms of perceived overqualification on the information literacy of Operating Room nurses involved in organ transplantation are established. Managers can improve the information literacy of Operating Room nurses engaged in organ transplantation by reducing their perceived overqualification and stimulating intrinsic motivation and proactive behavior.

Objective To construct and validate a nomogram prediction model for poor prognosis in elderly patients with gastrointestinal bleeding.Methods A total of 176 elderly patients with gastrointestinal bleeding were enrolled as the research objects.According to the prognosis during hospitalization,patients were divided into the poor prognosis group(56 cases)and the good prognosis group(120 cases).The clinical data of the two groups of patients were collected.The best variables of poor prognosis were screened by Lasso regression model,and the selected variables were included in the multivariate Logistic regression model to analyze the influencing factors.Nomogram was constructed based on the above influencing factors.Receiver operating characteristic(ROC)curve,clinical calibration curve and decision curve analysis(DCA)were drawn to validate clinical practicability of nomogram prediction model.Results Multivariate Logistic regression analysis showed that urea nitrogen(BUN,OR=2.766,95％CI:1.066-7.175)and high level of shock index(SI,OR=3.853,95％CI:1.028-14.446)were independent risk factors of poor prognosis in elderly patients with gastrointestinal bleeding(P＜0.05),while high levels of albumin(ALB,OR=0.100,95％CI:0.036-0.277)were protective factors(P＜0.05).ROC curve validated that the area under the curve of the prediction model was 0.845(95％CI:0.786-0.904).Calibration curve showed that the model had a relatively high degree of calibration.DCA showed that the model had a clear positive net benefit.Conclusion The nomogram prediction model constructed based on BUN,SI and ALB levels to predict the poor prognosis of elderly patients with gastrointestinal bleeding has a high predictive value.

Objective To evaluate the applicability and guideline concordance of the Chinese Society of Clinical Oncology(CSCO)arti-ficial intelligence(AI)system in clinical decision-making for colorectal cancer(CRC)patients,and to explore its feasibility in real-world clinical applications.Methods A total of 972 CRC patients diagnosed and treated at the Second Affiliated Hospital,Zhejiang University School of Medicine,from January 2010 to December 2021,were included.Patient data were analyzed by the CSCO AI system to gener-ate treatment decisions,and decision concordance was assessed by a blinded independent central review(BICR)panel.The applicability and guideline concordance rates of the CSCO AI system were calculated for different treatment stages,and a logistic regression model was used to analyze factors influencing the system's decision discrepancies with actual treatments.Results The overall applicability rate of the CSCO AI system was 96.2%,and the overall guideline concordance rate was 94.9%.In the adjuvant and palliative treatment stages,the system's applicability rates were 95.8%and 96.7%,respectively,and the guideline concordance rates were 95.0%and 94.9%,respective-ly.Multivariate logistic regression analysis showed that age≥65 years and high-risk stage Ⅱ treatment were significant factors affecting guideline concordance in the adjuvant treatment stage(both P<0.05).Conclusions The CSCO AI system demonstrated high applicability and guideline concordance in the adjuvant and palliative treatment stages for CRC.The system's clinical decision-making potential is sig-nificant,and it can be further optimized for specific clinical scenarios and promoted for use across various medical institutions.