In response to the challenge posed by the significant shape and scale variations of tumors and organs in three-dimensional medical images,which often results in low segmentation accuracy,an end-to-end three-dimensional fully convolutional segmentation model is introduced.A dilated cubic integration module is designed to achieve multi-scale integration at different resolution stages,thereby enhancing the recognition capability on complex boundaries.Subsequently,a cross-stage context fusion module is incorporated to merge shallow and deep features,thereby facilitating convergence and more precise localization of the target objects.Finally,features from the encoder are concatenated by the decoder to realize segmentation.The average Dice similarity coefficients reach 85.37%on the brain tumor segmentation dataset and 83.99%on the abdominal organ segmentation dataset.Experimental results indicate that the proposed model exhibits high accuracy in three-dimensional tumor and organ segmentation.

Outpatient service is a direct reflection of a hospital′s medical level and service efficiency.In February 2024, a tertiary hospital sorted out the existing problems in outpatient services, and constructed a digital intelligent service mode for outpatient services based on the theory of ubiquitous learning, including theoretical foundation layer, data foundation layer, patient profile layer, knowledge fusion layer, and application layer. Based on this mode, the hospital integrated existing outpatient data and knowledge resources using technologies such as artificial intelligence, big data, and knowledge organization, and created multiple application services such as " precision plus", full process self-service guidance, " one code pass" for elderly patients, and one-stop inspection and examination appointments, forming a digital intelligent service ecosystem for outpatient services and providing patients with accurate, efficient, and convenient outpatient services. As of November 2024, the relevant application services had provided accurate online booking services for 90 000 patients, accurate appointment services for 21 000 patients, and completed the " One Code Pass" service for 107 000 elderly patients, achieving good results and providing references for other hospitals to optimize outpatient services.

Outpatient service is a direct reflection of a hospital′s medical level and service efficiency.In February 2024, a tertiary hospital sorted out the existing problems in outpatient services, and constructed a digital intelligent service mode for outpatient services based on the theory of ubiquitous learning, including theoretical foundation layer, data foundation layer, patient profile layer, knowledge fusion layer, and application layer. Based on this mode, the hospital integrated existing outpatient data and knowledge resources using technologies such as artificial intelligence, big data, and knowledge organization, and created multiple application services such as " precision plus", full process self-service guidance, " one code pass" for elderly patients, and one-stop inspection and examination appointments, forming a digital intelligent service ecosystem for outpatient services and providing patients with accurate, efficient, and convenient outpatient services. As of November 2024, the relevant application services had provided accurate online booking services for 90 000 patients, accurate appointment services for 21 000 patients, and completed the " One Code Pass" service for 107 000 elderly patients, achieving good results and providing references for other hospitals to optimize outpatient services.

Objective:To explore the acceptance of advanced breast cancer patients to the advance care planning, and analyze its potential influencing factors.Methods:From October 2019 to January 2021, convenience sampling was used to select 75 advanced breast cancer patients in the Oncology Department of the Second Affiliated Hospital of Xi'an Jiaotong University as the research object. The patients were investigated with the General Information Questionnaire, Patient's Advance Care Planning Acceptance Questionnaire (ACPQ), Eysenck Personality Questionnaire-Revised Short Scale for Chinese (EPQ-RSC) and the Social Support Rating Scale (SSRS). Univariate analysis, Pearson correlation analysis and multiple linear regression analysis were used for data analysis.Results:A total of 75 questionnaires were distributed and 72 valid questionnaires were returned. The total ACPQ score of advanced breast cancer patients was (70.60±4.46). The results of univariate analysis showed that there were statistically significant differences in the ACPQ scores of patients with different education levels, residence, marital status, bereavement experience, hospitalization experience, and knowledge of the time of disease diagnosis ( P<0.05). Multiple linear regression analysis showed that the social support was an influencing factor of patients' acceptance of the advance care planning, and the difference was statistically significant ( P<0.01) . Conclusions:The acceptance of advanced breast cancer patients to the advance care planning is mainly related to the patient's social support. Medical and nursing staff should strengthen the understanding and utilization of patients' social support, and promote patients' participation in advance care planning.

Objective:To understand the characteristics of scientific research cooperation network, research hotspots, evolution paths and development trends of advance care planning (ACP) , so as to provide reference for follow-up related research.Methods:With the theme of "advance care planning", the retrieval results based on Web of Science core collection database were respectively imported into VOS viewer and CiteSpace for visual analysis, and the retrieval time was from database construction to February 3, 2021.Results:A total of 2 456 articles meet the selection criteria. The annual publications were all less than 50 from 1993 to 2009, which showed a rapid upward trend from 2010 to now. The distribution trend of citation frequency was basically the same as that of publications. Most of the authors and institutions are European and American. Chan Helen Yue-lai of the Chinese University of Hong Kong ranked first in China and 19th in the world in terms of publicationsand Chinese scholars' research in this field is still in its infancy. Research hotspots included ACP alternative decision-making skills training, and the research frontiers and evolutionary paths included ACP, severe mental illness, alternative decision-making, life planning, end-stage renal disease, doctor's orders, ACP model, advanced dementia, chronic heart failure, etc.Conclusions:Since 2010, the number of articles published in this field and the frequency of citations have shown a rapid upward trend. The United States, Belgium, Canada and other countries have developed well in this field and Scholars of China have a wide space for development in this field. The advanced research experience reported in the foreign ACP literature can be used for reference to deepen and speed up the clinical practice research in the field of ACP in China.

Objective To investigate the effect of time interval between diagnosis and surgical treatment on the prognosis of breast cancer.Methods A retrospective study that include a total of 252 female patients who underwent breast cancer diagnosis and treatment in the Second Affiliated Hospital of Xi'an Jiaotong University from April 2012 to August 2014 were included in the present study,the average age was (58.2 ± 10.8) years old,range from 31 to 67 years old.General demographic information and data of tumor were collected.Information on postoperative recurrence,metastasis,death,and disease-free survival status of breast cancer patients were followed up 5 years by outpatient follow-up or telephone follow-up.All participants were divided into four groups (＜2 weeks,2-4 weeks,4-8 weeks,≥8 weeks) by the time interval between diagnosis and surgical treatment,including 26,118,78 and 30 cases,respectively.In addition,according to the diameter of breast cancer tumors,all participants were divided into three groups (＜20 mm,20-40 mm,and ≥40 mm),including 99,124,and 29 cases,respectively.According to the results of pathological examination of the lymph nodes obtained during intraoperative dissection,the all participants were divided into three groups (lymph nodes without metastasis,1 to 3 metastasis,and ≥3 metastasis),including 66,124,and 62 cases,respectively.The Cox proportional regression risk models were used to assess the hazard ratio (HR) and its 95％ confidence interval (CI) of time interval between diagnosis and surgical treatment with the prognosis of breast cancer,with adjustment for age,education levels and body mass index.Further,stratified analysis by tumor characteristics,including pathological type,histological grade,tumor diameter,lymph node metastasis,and receptor expression were also conducted to evaluated the above association.Kaplan-Meier survival curve was used to evaluate the effects of time interval between diagnosis and surgical treatment on the prognosis of breast cancer.Results The Kaplan-Meier survival curves for the five-year follow-up of total survival time between 4 different time intervals groups showed significantly different (P ＜0.001),and patients with a pre-treatment interval of ＜2 weeks had the longest survival time,while those with ≥8 weeks had the lowest survival time.With a one-week interval before treatment,the overall risk of death in breast cancer patients increased by 6％ (HR =1.06,95％ CI:1.01-1.1 l),and the risk of breast cancer death increased by 8％ (HR =1.08,95％ CI:1.02-1.14),the risk of distant metastasis of breast cancer cells increased by 10％ (HR =1.10,95％ CI:1.08-1.13).With the increase in breast cancer tumor diameter (＜20 mm,20-40 mm,≥40 mm),the overall risk of death due to prolonged treatment interval increased gradually,with HR (95％CI) were 1.06 (1.03-1.09),1.08 (1.02-1.12) and 1.11 (1.05-1.17),respectively.With the increase of lymph node metastasis in breast cancer (no metastasis,metastasis at 1-3,≥ 3 metastasis),the total mortality risk caused by prolonged treatment time interval also showed an increasing trend,with HR (95％CI) were 1.04 (1.02-1.08),1.06 (1.04-1.08) and 1.08 (0.99-1.11),respectively.The same results were also shown in the effect of tumor diameter or distant lymph node metastasis on the association between treatment time interval and breast cancer survival and distant metastasis of breast cancer cells.Conclusion With the prolongation of the time interval between the diagnosis of the breast cancer and the surgical treatment of breast cancer patients,the risk of postoperative death is significantly increased,and the association is more pronounced in breast cancer patients with larger tumor volume or higher distant lymph node metastasis.

Objective To discuss the safety and effectiveness of robot-assisted thyroidectomy using Da Vinci system.Methods Endoscopic thyroidectomy assisted by Da Vinci system was performed in 20 patients,including 5 cases of thyroidadenoma,4 cases of nodular goiter,and 11 cases of thyroid carcinoma.The max diameter of thyroid lump is 5.33 cm.Among 9 cases of benign thyroid neoplasm,5 cases underwent unilateral subtotal lobectomy,and 4 cases underwent unilateral near total thyroidectomy.Among 11 cases of thyroid carcinoma,7 cases underwent bilateral near total thyroidectomy,and 4 cases underwent bilateral total thyroidectomy,at the same time,all the 11 cases underwent central region lymph node dissection.Results The robot-assisted endoscopic thymidectomy was successfully carried out in 20 cases.The mean operation time was 206.4 (105～372)min.The mean operative blood loss was 27.3 ml.The draining tube was moved 3 to 6 days after surgery.The mean postoperative hospital stay was 4.9 days.The mean hospital expense was 60 172 yuan RMB.No complication occurred.20 patients were satisfied with the cosmetic effect and compararive curative effect.Conclusions The robot-assisted endoscopic thymidectomy is an efective method for thyroid diseases.The methed can get more clear vision,higher safety,and good cosmetic efect.

OBJECTIVETo investigate the clinical significance of phosphorylated caspase-8 by Src in patients with operable non-small cell lung cancer.

METHODSSrc and caspase-8 expressions were tested using immunohistochemistry in non-small cell lung cancer tissues and control lung tissues. The expression of phosphorylated caspase-8 at 380 tyrosine by Src was detected using Western blotting. The disease-free survival (DFS) of patients positive and negative for phosphorylated caspase-8 was analyzed with Kaplan-Meire survival curve.

RESULTSNo significant difference was found in the positivity rate of caspase-8 or Src between the cancer tissues and control lung tissues (76.3% vs 83.3%, P>0.05; 70.1% vs 66.4%, P>0.05). All the patients with Casp8- and Src-positive cancers were positive for phosphoryalted caspase-8, whose expression rate was significantly higher in the cancer tissues than in the paired control lung tissues (52.4% vs 7.1%, P<0.05). The 2-year DFS was significantly higher in patients negative for phosphorylated caspase-8 than in the positive patients (32.0% vs 60.3%, P<0.05).

CONCLUSIONPhosphorylated caspase-8 may serve as a predictor for a poorer DFS in patients with operable non-small cell lung cancer.

Blotting, Western ; Carcinoma, Non-Small-Cell Lung ; metabolism ; Caspase 8 ; metabolism ; Disease-Free Survival ; Humans ; Immunohistochemistry ; Lung Neoplasms ; metabolism ; Phosphorylation

Objective To investigate the clinical significance of phosphorylated caspase-8 by Src in patients with operable non-small cell lung cancer. Methods Src and caspase-8 expressions were tested using immunohistochemistry in non-small cell lung cancer tissues and control lung tissues. The expression of phosphorylated caspase-8 at 380 tyrosine by Src was detected using Western blotting. The disease-free survival (DFS) of patients positive and negative for phosphorylated caspase-8 was analyzed with Kaplan-Meire survival curve. Results No significant difference was found in the positivity rate of caspase-8 or Src between the cancer tissues and control lung tissues (76.3% vs 83.3%, P>0.05; 70.1% vs 66.4%, P>0.05). All the patients with Casp8-and Src-positive cancers were positive for phosphoryalted caspase-8, whose expression rate was significantly higher in the cancer tissues than in the paired control lung tissues (52.4%vs 7.1%, P<0.05). The 2-year DFS was significantly higher in patients negative for phosphorylated caspase- 8 than in the positive patients (32.0% vs 60.3% , P<0.05). Conclusion Phosphorylated caspase-8 may serve as a predictor for a poorer DFS in patients with operable non-small cell lung cancer.

Objective To investigate the clinical significance of phosphorylated caspase-8 by Src in patients with operable non-small cell lung cancer. Methods Src and caspase-8 expressions were tested using immunohistochemistry in non-small cell lung cancer tissues and control lung tissues. The expression of phosphorylated caspase-8 at 380 tyrosine by Src was detected using Western blotting. The disease-free survival (DFS) of patients positive and negative for phosphorylated caspase-8 was analyzed with Kaplan-Meire survival curve. Results No significant difference was found in the positivity rate of caspase-8 or Src between the cancer tissues and control lung tissues (76.3% vs 83.3%, P>0.05; 70.1% vs 66.4%, P>0.05). All the patients with Casp8-and Src-positive cancers were positive for phosphoryalted caspase-8, whose expression rate was significantly higher in the cancer tissues than in the paired control lung tissues (52.4%vs 7.1%, P<0.05). The 2-year DFS was significantly higher in patients negative for phosphorylated caspase- 8 than in the positive patients (32.0% vs 60.3% , P<0.05). Conclusion Phosphorylated caspase-8 may serve as a predictor for a poorer DFS in patients with operable non-small cell lung cancer.