Objective:To develop an artificial intelligence (AI)-based automatic scoring model for magnetic resonance imaging-detected extramural vascular invasion (AI-mrEMVI) and evaluate its performance and prognostic value in patients with rectal cancer.Methods:In this multicenter retrospective cohort study, a total of 2 501 rectal cancer patients from seven centers between November 2012 and December 2020 were included and divided into completely independent training ( n=1 830) and validation ( n=671) cohorts. A nnUNet-based AI-mrEMVI scoring model was constructed. Manual mrEMVI scores assigned by two radiologists served as the reference standard for accessing the accuracy of the AI-mrEMVI scoring. Kaplan-Meier survival analysis and Cox regression were used to evaluate the prognostic stratification ability of the AI-mrEMVI scores. The concordance index (C-index) was calculated to evaluate prognostic performance. Results:In the validation cohort, the manual mrEMVI scores were 0-2 in 425 patients (63.3%), 3 in 89 (13.4%), and 4 in 157 (23.4%). The AI-mrEMVI model identified 0-2 in 375 patients (55.9%), 3 in 95 (14.2%), and 4 in 201 (30.0%), with an overall accuracy of 81.1% (544/671, 95% CI 77.9%-84.0%). The 3-year disease-free survival (DFS) rates for patients with AI-mrEMVI scores of 0-2, 3, and 4 were 85.2%, 70.0%, and 58.2%, respectively, and the 5-year overall survival (OS) rates were 87.2%, 81.6%, and 62.6%, respectively (DFS: χ2=48.74, P<0.001; OS: χ2=30.04, P<0.001). Multivariable Cox regression showed that for DFS, AI-mrEMVI scores of 3 and 4 were associated with hazard ratios ( HR) of 1.75 (95% CI 1.11-2.77, P=0.016) and 2.65 (95% CI 1.86-3.78, P<0.001), respectively. For OS, an AI-mrEMVI score of 4 was associated with an HR of 2.56 (95% CI 1.62-4.03, P<0.001). The C-index values of the AI-mrEMVI scoring model for predicting DFS and OS were 0.647 (95% CI 0.608-0.686) and 0.650 (95% CI 0.598-0.702), respectively. Conclusion:The proposed AI-mrEMVI automatic scoring model demonstrated high diagnostic accuracy and performed favorably in predicting DFS and OS prognostic risk in patients with rectal cancer.

Objective:To summarize the clinical characteristics of congenital chylothorax (CC) in neonates, and to analyze the effects of conservative treatment and the prognosis.Methods:A case control study was conducted.Clinical data of neonates with CC treated in the Department of Neonatal Surgical Intensive Care Unit, Guangzhou Women and Children′s Medical Center Guangzhou Medical University, from January 2015 to April 2023 were collected.The patients were divided into a survival group and a death group according to the outcome.SPSS 26.0 software was used for statistical analysis, and binary Logistic regression was used for the analysis of risk factors for death.Results:A total of 55 patients were included in this study, including 35 males and 20 females.The gestational age at birth and birth weight were 37.1 (34.7, 38.7) weeks and 3 250 (2 640, 3 540) g, respectively.Among the patients included, 30 cases had bilateral pleural effusion, 25 cases had unilateral pleural effusion, and 22 cases had hydrops fetalis; 50 cases were prenatally diagnosed with pleural effusion, with the mean gestational age at diagnosis being 31.0(26.0, 34.6) weeks.Additionally, 21 cases had polyhydramnios, and 18 cases had mediastinal displacement.Ten cases received intrauterine treatment and 17 cases were treated with octreotide.The maximum daily amount of pleural effusion was 31.7(12.0, 62.5) mL/kg, and pleural effusion resolved within 14 (6, 22) days.The length of hospital stay was 23 (12, 36) days.Forty-four cases survived, while 11 cases died.The differences in polyhydramnios, gestational age, bilateral pleural effusion, hydrops fetalis and Apgar score were significant between the survival and death groups (all P<0.05).Binary Logistic regression analysis revealed that bilateral pleural effusion and a low 5-minute Apgar score were independent risk factors for early death in neonates with CC (all P<0.05).A total of 38 children were followed up at the age of 2.30 (1.24, 3.46) years.There was 1 case of recurrence, and none of the patients experienced recurrent respiratory infections. Conclusions:CC is most common in full-term infants and has a predominantly bilateral effusion, its long-term prognosis with conservative treatment is promising.However, neonates with CC who present with bilateral pleural effusion or low 5-minute Apgar scores have an increased risk of early mortality.

Objective:To explore the experience of emotion management and program needs of patients with vasovagal syncope (VVS) from the doctor-nurse-patient perspective.Methods:This study was a phenomenological study in qualitative research. Using purposive sampling method, four medical specialists, four nursing specialists, and 10 patients with VVS from the Syncope Center of Shanghai East Hospital, Tongji University were selected from March to May 2024 for semi-structured interviews. Colaizzi's phenomenological data analysis was used to analyze the data.Results:Theme 1 was the initial perception and experience of emotion management, in which the doctor-nurse perspective included two sub-themes of emotion management met the actual needs of clinical patients and the management program was too specialized and unknown, and the patient perspective included three sub-themes of differences in the ability of individuals to recognize their own emotional state, lack of knowledge related to emotion management, and lack of social support. Theme 2 was the need for emotion management programs, in which the doctor-nurse perspective involved two sub-themes of multidisciplinary cooperation, suitable for clinical operation and follow-up, and the combination of online and offline, and in-hospital and out-of-hospital linkage, and the patient perspective involved two sub-themes of the need for healthcare guidance, easy to operate, and the diversification of forms, personalization, and meeting the needs of different populations.Conclusions:The content of emotion management is relatively unknown to doctors, nurses and patients, and even more so to patients. VVS emotion management work is still in its infancy, and emotion management as a branch of rehabilitation needs to be emphasized for its development, and psychological assessment and intervention work should be incorporated into the routine of syncope rehabilitation.

OBJECTIVE To investigate the levels of procalcitonin(PCT),platelet-to-lymphocyte ratio(PLR),neu-trophil-to-lymphocyte ratio(NLR),white blood cell count(WBC)and serum amyloid A(SAA)in newborns with bloodstream infection,and their diagnostic value for early diagnosis of bloodstream infection in newborns.METHODS A total of 100 neonates with positive blood culture results from Jan.2021 to Jan.2024 at Taizhou Hos-pital of Zhejiang Province were selected.These cases were divided into three groups based on the type of pathogen:74 cases in the gram-negative bacterial group,19 cases in the gram-positive bacterial group,and 7 cases in the fungal group.Additionally,100 neonates with negative blood culture results during the same period were selected as the control group.By comparing the levels of PCT,PLR,NLR,WBC and SAA in the blood of newborns infec-ted with different pathogens,the diagnostic value of various indicators on the receiver operating characteristic(ROC)curve for diagnosis of bloodstream infection in newborns was evaluated.RESULTS Among 100 newborns with positive blood cultures,74 strains of gram-negative bacteria,19 strains of gram-positive bacteria,and 7 strains of fungi were identified.The levels of PCT,PLR,NLR,WBC and SAA in the gram-positive,gram-negative and fungal groups were all higher than those in the control group(P＜0.05).The ROC curve re-sults showed that the diagnostic efficacy of the combination of PCT,PLR,NLR,WBC and SAA for gram-nega-tive and gram-positive bloodstream infections was superior to that of each individual indicator(P＜0.05),with ar-ea under the curve(AUC)of 0.982 and 0.969,respectively.CONCLUSION PCT,PLR,NLR,WBC and SAA can serve as effective biomarkers for the early diagnosis of bloodstream infection in newborns,aiding in the rapid and accurate identification of the type of infection.

OBJECTIVE To investigate the levels of procalcitonin(PCT),platelet-to-lymphocyte ratio(PLR),neu-trophil-to-lymphocyte ratio(NLR),white blood cell count(WBC)and serum amyloid A(SAA)in newborns with bloodstream infection,and their diagnostic value for early diagnosis of bloodstream infection in newborns.METHODS A total of 100 neonates with positive blood culture results from Jan.2021 to Jan.2024 at Taizhou Hos-pital of Zhejiang Province were selected.These cases were divided into three groups based on the type of pathogen:74 cases in the gram-negative bacterial group,19 cases in the gram-positive bacterial group,and 7 cases in the fungal group.Additionally,100 neonates with negative blood culture results during the same period were selected as the control group.By comparing the levels of PCT,PLR,NLR,WBC and SAA in the blood of newborns infec-ted with different pathogens,the diagnostic value of various indicators on the receiver operating characteristic(ROC)curve for diagnosis of bloodstream infection in newborns was evaluated.RESULTS Among 100 newborns with positive blood cultures,74 strains of gram-negative bacteria,19 strains of gram-positive bacteria,and 7 strains of fungi were identified.The levels of PCT,PLR,NLR,WBC and SAA in the gram-positive,gram-negative and fungal groups were all higher than those in the control group(P＜0.05).The ROC curve re-sults showed that the diagnostic efficacy of the combination of PCT,PLR,NLR,WBC and SAA for gram-nega-tive and gram-positive bloodstream infections was superior to that of each individual indicator(P＜0.05),with ar-ea under the curve(AUC)of 0.982 and 0.969,respectively.CONCLUSION PCT,PLR,NLR,WBC and SAA can serve as effective biomarkers for the early diagnosis of bloodstream infection in newborns,aiding in the rapid and accurate identification of the type of infection.

Objective:To develop an artificial intelligence (AI)-based automatic scoring model for magnetic resonance imaging-detected extramural vascular invasion (AI-mrEMVI) and evaluate its performance and prognostic value in patients with rectal cancer.Methods:In this multicenter retrospective cohort study, a total of 2 501 rectal cancer patients from seven centers between November 2012 and December 2020 were included and divided into completely independent training ( n=1 830) and validation ( n=671) cohorts. A nnUNet-based AI-mrEMVI scoring model was constructed. Manual mrEMVI scores assigned by two radiologists served as the reference standard for accessing the accuracy of the AI-mrEMVI scoring. Kaplan-Meier survival analysis and Cox regression were used to evaluate the prognostic stratification ability of the AI-mrEMVI scores. The concordance index (C-index) was calculated to evaluate prognostic performance. Results:In the validation cohort, the manual mrEMVI scores were 0-2 in 425 patients (63.3%), 3 in 89 (13.4%), and 4 in 157 (23.4%). The AI-mrEMVI model identified 0-2 in 375 patients (55.9%), 3 in 95 (14.2%), and 4 in 201 (30.0%), with an overall accuracy of 81.1% (544/671, 95% CI 77.9%-84.0%). The 3-year disease-free survival (DFS) rates for patients with AI-mrEMVI scores of 0-2, 3, and 4 were 85.2%, 70.0%, and 58.2%, respectively, and the 5-year overall survival (OS) rates were 87.2%, 81.6%, and 62.6%, respectively (DFS: χ2=48.74, P<0.001; OS: χ2=30.04, P<0.001). Multivariable Cox regression showed that for DFS, AI-mrEMVI scores of 3 and 4 were associated with hazard ratios ( HR) of 1.75 (95% CI 1.11-2.77, P=0.016) and 2.65 (95% CI 1.86-3.78, P<0.001), respectively. For OS, an AI-mrEMVI score of 4 was associated with an HR of 2.56 (95% CI 1.62-4.03, P<0.001). The C-index values of the AI-mrEMVI scoring model for predicting DFS and OS were 0.647 (95% CI 0.608-0.686) and 0.650 (95% CI 0.598-0.702), respectively. Conclusion:The proposed AI-mrEMVI automatic scoring model demonstrated high diagnostic accuracy and performed favorably in predicting DFS and OS prognostic risk in patients with rectal cancer.

Objective:To summarize the clinical characteristics of congenital chylothorax (CC) in neonates, and to analyze the effects of conservative treatment and the prognosis.Methods:A case control study was conducted.Clinical data of neonates with CC treated in the Department of Neonatal Surgical Intensive Care Unit, Guangzhou Women and Children′s Medical Center Guangzhou Medical University, from January 2015 to April 2023 were collected.The patients were divided into a survival group and a death group according to the outcome.SPSS 26.0 software was used for statistical analysis, and binary Logistic regression was used for the analysis of risk factors for death.Results:A total of 55 patients were included in this study, including 35 males and 20 females.The gestational age at birth and birth weight were 37.1 (34.7, 38.7) weeks and 3 250 (2 640, 3 540) g, respectively.Among the patients included, 30 cases had bilateral pleural effusion, 25 cases had unilateral pleural effusion, and 22 cases had hydrops fetalis; 50 cases were prenatally diagnosed with pleural effusion, with the mean gestational age at diagnosis being 31.0(26.0, 34.6) weeks.Additionally, 21 cases had polyhydramnios, and 18 cases had mediastinal displacement.Ten cases received intrauterine treatment and 17 cases were treated with octreotide.The maximum daily amount of pleural effusion was 31.7(12.0, 62.5) mL/kg, and pleural effusion resolved within 14 (6, 22) days.The length of hospital stay was 23 (12, 36) days.Forty-four cases survived, while 11 cases died.The differences in polyhydramnios, gestational age, bilateral pleural effusion, hydrops fetalis and Apgar score were significant between the survival and death groups (all P<0.05).Binary Logistic regression analysis revealed that bilateral pleural effusion and a low 5-minute Apgar score were independent risk factors for early death in neonates with CC (all P<0.05).A total of 38 children were followed up at the age of 2.30 (1.24, 3.46) years.There was 1 case of recurrence, and none of the patients experienced recurrent respiratory infections. Conclusions:CC is most common in full-term infants and has a predominantly bilateral effusion, its long-term prognosis with conservative treatment is promising.However, neonates with CC who present with bilateral pleural effusion or low 5-minute Apgar scores have an increased risk of early mortality.

Objective:To explore the experience of emotion management and program needs of patients with vasovagal syncope (VVS) from the doctor-nurse-patient perspective.Methods:This study was a phenomenological study in qualitative research. Using purposive sampling method, four medical specialists, four nursing specialists, and 10 patients with VVS from the Syncope Center of Shanghai East Hospital, Tongji University were selected from March to May 2024 for semi-structured interviews. Colaizzi's phenomenological data analysis was used to analyze the data.Results:Theme 1 was the initial perception and experience of emotion management, in which the doctor-nurse perspective included two sub-themes of emotion management met the actual needs of clinical patients and the management program was too specialized and unknown, and the patient perspective included three sub-themes of differences in the ability of individuals to recognize their own emotional state, lack of knowledge related to emotion management, and lack of social support. Theme 2 was the need for emotion management programs, in which the doctor-nurse perspective involved two sub-themes of multidisciplinary cooperation, suitable for clinical operation and follow-up, and the combination of online and offline, and in-hospital and out-of-hospital linkage, and the patient perspective involved two sub-themes of the need for healthcare guidance, easy to operate, and the diversification of forms, personalization, and meeting the needs of different populations.Conclusions:The content of emotion management is relatively unknown to doctors, nurses and patients, and even more so to patients. VVS emotion management work is still in its infancy, and emotion management as a branch of rehabilitation needs to be emphasized for its development, and psychological assessment and intervention work should be incorporated into the routine of syncope rehabilitation.

Objective To screen the influencing factors of hepatitis C cirrhosis patients progressing to hepatocellular carcinoma(HCC)using commonly used laboratory testing indicators,establish a prediction model using these indicators and validate them.Methods A total of 231 patients with hepatitis C cirrhosis and 179 patients with hepatitis C HCC hospitalized at the First Affiliated Hospital of Xi'an Jiaotong University between June 2020 and May 2023 were enrolled as the training set,and 105 patients with hepatitis C cirrhosis and 86 patients with hepatitis C HCC hospitalized between June 2023 and February 2024 were enrolled as the validation set.The routine laboratory test indexes of the study subjects in the two groups within the training set were compared,and logistic regression analysis was applied to screen the independent predictors of hepatocellular carcinoma occurrence.Receiver operating characteristic(ROC)curve was used to construct the curve model and validate the model.Results The age,male ratio,ALT,AST,AFP,WBC,NEU,MO,PLT,MPV,PDW,Fbg,NLR and PLR levels of the HCC group were higher than those of the cirrhosis group in the training set(H=-9.07～-2.19),while the levels of INR and LMR were lower than those of the cirrhosis group(H=-4.49,-2.65),and the differences were significant(all P＜0.05).The differences in TP,eGFR,LY and AST/ALT values between the two groups of patients were not significant(H=-1.46～-0.15,all P＞0.05).Multifactorial Logistic regression analysis showed that age(OR=1.048,95％CI:1.023～1.074),Male(OR=1.467,95％CI:1.413～1.765),AST(OR=1.010,95％CI:1.002～1.019),NEU(OR=1.186,95％CI:1.018～1.382)and Fbg(OR=2.245,95％CI:1.639～3.076)were independent risk factors for hepatocellular carcinoma patients(all P＜0.05),and these five independent risk factors were used to construct the HCC column-line graph prediction model,with the AUC for the training set and the validation set AUC(95％Cl)were 0.813(0.771～0.854)and 0.712(0.639～0.784),respectively,and the Hosmer-Lemeshow test showed a good fit of the model with P=0.650 for the training set and P=0.310 for the validation set.Conclusion The prediction model of HCC based on age,gender,AST,NEU and Fbg can have good predictive efficacy and clinical application value.

AIM: To compare the clinical efficacy, vault, and rotational stability of horizontal, oblique, and vertical implantation of Toric implantable collamer lens(TICL).METHODS: Retrospective cohort study. A total of 92 cases(120 eyes)who underwent TICL implantation from July 2018 to March 2022 and had regular follow-up for at least 1 a postoperatively(1 d, 1 wk, 1, 3, 6 mo, and 1 a)at Wuhan Bright Eye Hospital were collected. The patients were divided into three groups, with 34 cases(45 eyes)in horizontal implantation group, 25 cases(29 eyes)in oblique implantation group(29 cases), and 33 cases(46 eyes)in vertical implantation group. Uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA), diopters, vault, and rotation angle(deviation of the actual axis of TICL from the expected axis).RESULTS: All surgeries were uneventful, and there were no complications such as infection, secondary glaucoma, or cataract opacity. Safety and efficacy of the surgery: the CDVA of the three groups of patients was better than or equal to the preoperative CDVA at 1 a postoperatively, and there was no statistically significant differences in postoperative UDVA and CDVA of the three groups(P>0.05). The safety index at 1a postoperatively was 1.34±0.21, 1.34±0.17, and 1.31±0.18 for the horizontal, oblique, and vertical groups, respectively. The efficacy index was 1.26±0.21, 1.33±0.18, and 1.27±0.16 for the three groups, respectively, both with no statistically significant differences(P>0.05). Vault: there was a significant difference in postoperative vault among the three groups(P=0.003), with the vertical group having the lowest vault, followed by the horizontal group and the oblique group. The vaults at different follow-up time points within each group showed significant differences(P<0.001), and all decreased over time. Residual astigmatism: there was no significant difference in residual astigmatism among the three groups(P=0.130), but there were differences at different follow-up time points within each group(P<0.001). Rotation angle: no significant differences in rotation angle were observed among the three groups(P=0.135), but there were differences at different follow-up time points within each group(P<0.001).CONCLUSION: The implantation of TICL in different orientations has good safety and efficacy, the postoperative rotational stability is good, and the appropriate angle can be selected to implant TICL according to the clinical situation.