BACKGROUND: Neoadjuvant chemoradiotherapy followed by radical surgery has been a common practice for patients with locally advanced rectal cancer, but the response rate varies among patients. This study aimed to develop a ResNet-Vision Transformer based magnetic resonance imaging (MRI)-endoscopy fusion model to precisely predict treatment response and provide personalized treatment. METHODS: In this multicenter study, 366 eligible patients who had undergone neoadjuvant chemoradiotherapy followed by radical surgery at eight Chinese tertiary hospitals between January 2017 and June 2024 were recruited, with 2928 pretreatment colonic endoscopic images and 366 pelvic MRI images. An MRI-endoscopy fusion model was constructed based on the ResNet backbone and Transformer network using pretreatment MRI and endoscopic images. Treatment response was defined as good response or non-good response based on the tumor regression grade. The Delong test and the Hanley-McNeil test were utilized to compare prediction performance among different models and different subgroups, respectively. The predictive performance of the MRI-endoscopy fusion model was comprehensively validated in the test sets and was further compared to that of the single-modal MRI model and single-modal endoscopy model. RESULTS: The MRI-endoscopy fusion model demonstrated favorable prediction performance. In the internal validation set, the area under the curve (AUC) and accuracy were 0.852 (95% confidence interval [CI]: 0.744-0.940) and 0.737 (95% CI: 0.712-0.844), respectively. Moreover, the AUC and accuracy reached 0.769 (95% CI: 0.678-0.861) and 0.729 (95% CI: 0.628-0.821), respectively, in the external test set. In addition, the MRI-endoscopy fusion model outperformed the single-modal MRI model (AUC: 0.692 [95% CI: 0.609-0.783], accuracy: 0.659 [95% CI: 0.565-0.775]) and the single-modal endoscopy model (AUC: 0.720 [95% CI: 0.617-0.823], accuracy: 0.713 [95% CI: 0.612-0.809]) in the external test set. CONCLUSION The MRI-endoscopy fusion model based on ResNet-Vision Transformer achieved favorable performance in predicting treatment response to neoadjuvant chemoradiotherapy and holds tremendous potential for enabling personalized treatment regimens for locally advanced rectal cancer patients.
Humans ; Rectal Neoplasms/diagnostic imaging* ; Magnetic Resonance Imaging/methods* ; Male ; Female ; Middle Aged ; Neoadjuvant Therapy/methods* ; Aged ; Adult ; Chemoradiotherapy/methods* ; Endoscopy/methods* ; Treatment Outcome

Objective:This study identifies independent predictive indicators to distinguish autoimmune gastritis from Helicobacter pylori ( H. pylori)-induced atrophic gastritis and validates their diagnostic performance to compare laboratory indicators of autoimmune gastritis and H. pylori-induced atrophic gastritis. Methods:A retrospective comparison of laboratory examination indicators was conducted for chronic atrophic gastritis patients with involvement of the gastric fundus and corpus, who were followed up at the Department of Gastroenterology, Xijing Hospital, from January 2014 to September 2024. Receiver operating characteristic (ROC) curves were utilized to determine the optimal cutoff points and corresponding diagnostic thresholds. In addition, multivariate logistic regression analysis was conducted to identify independent predictive indicators for autoimmune gastritis, with further assessment in a validation cohort.Results:A total of 139 patients with autoimmune gastritis and 209 patients with H. pylori-induced atrophic gastritis were included. Pepsinogen (PG) Ⅰ levels and the PG Ⅰ/PG Ⅱ ratio in patients with autoimmune gastritis were significantly lower than in those with H. pylori-induced atrophic gastritis [11.0 (4.8, 22.5) vs. 41.8 (32.2, 59.9) μg/L, U=722.00, P<0.001; 1.24 (0.75, 3.54) vs. 5.76 (4.31, 7.12), U=817.00, P<0.001], while gastrin levels were significantly higher [375 (84, 738) vs. 49 (35, 81) ng/L, U=378.00, P<0.001]. PG Ⅰ was identified as an independent predictive variable, with an area under the ROC curve of 0.847 (95% CI 0.791-0.904), sensitivity of 77.6%, specificity of 91.8%, positive predictive value of 80.5%, and negative predictive value of 90.5%. Conclusions:Significant differences in laboratory indicators were observed between autoimmune gastritis and H. pylori-induced atrophic gastritis in chronic atrophic gastritis involving gastric fundus and corpus. Besides, PG Ⅰ demonstrated good diagnostic performance in identifying autoimmune gastritis and can effectively differentiate between different types of atrophic gastritis.

Background and Aims:Biliary tract cancers(BTCs)are highly aggressive malignancies with dismal prognosis,for which radical resection remains the only potentially curative treatment.Laparoscopic surgery has demonstrated superiority over open surgery in perioperative safety and recovery,yet it is technically limited in complex operations.Robot-assisted laparoscopy,with its high-definition three-dimensional vision and enhanced instrument dexterity,may overcome these limitations.However,comparative evidence balancing baseline differences between laparoscopic and robot-assisted laparoscopic radical resections for BTCs is still lacking.This study aimed to evaluate and compare their short-term safety using propensity score matching(PSM).Methods:A total of 151 patients with biliary tract cancers who underwent radical resection were retrospectively enrolled from the Chinese Biliary Tract Tumor Collaborative Group database,including 128 in the laparoscopic group and 23 in the robotic-assisted laparoscopic group.To balance baseline differences,an initial 1∶1 PSM was performed,yielding 19 laparoscopic and 19 robotic cases.Subsequently,using the robotic group as the reference,a 1∶2 PSM was conducted,resulting in 36 laparoscopic and 18 robotic cases.Primary outcomes(conversion to open surgery,ICU admission,and postoperative complications)and secondary outcomes(operative time,intraoperative blood loss,transfusion,postoperative hospital stay,reoperation,readmission,and hospitalization costs)were compared between the two groups.Multivariate regression analyses were performed to explore factors associated with conversion to open surgery and postoperative hospital stay.Results:After matching,baseline characteristics were well balanced between groups.For primary outcomes,the conversion rate to open surgery was significantly higher in the laparoscopic group than in the robotic group(41.7％vs.0,P=0.001),while ICU admission,overall postoperative complications,and Clavien-Dindo graded complications showed no significant differences(all P＞0.05).For secondary outcomes,the postoperative hospital stay was significantly more extended in the laparoscopic group compared with the robotic group(18.5 d vs.8.0 d,P=0.005),whereas operative time,intraoperative blood loss,transfusion,reoperation,readmission,and hospitalization costs were comparable(all P＞0.05).Logistic regression for conversion did not identify statistically significant predictors,but moderately differentiated tumors,elevated preoperative CA19-9,and higher harvested lymph node counts showed trends toward increased risk.Multivariate linear regression revealed that robotic-assisted surgery was an independent factor for reduced postoperative hospital stay(P=0.024),while preoperative total bilirubin(P=0.020),longer operative time(P=0.000),postoperative complications(P=0.006),and reoperation(P=0.005)were found to be associated with a prolonged hospital stay.Conclusion:Robot-assisted laparoscopic radical resection for BTCs is not inferior to conventional laparoscopy in short-term safety and may further reduce conversion rates and hospital stay.Its technical advantages may be particularly valuable in anatomically complex or challenging cases.Nonetheless,cost-effectiveness and resource allocation should be considered for wider adoption.

Objective:This study identifies independent predictive indicators to distinguish autoimmune gastritis from Helicobacter pylori ( H. pylori)-induced atrophic gastritis and validates their diagnostic performance to compare laboratory indicators of autoimmune gastritis and H. pylori-induced atrophic gastritis. Methods:A retrospective comparison of laboratory examination indicators was conducted for chronic atrophic gastritis patients with involvement of the gastric fundus and corpus, who were followed up at the Department of Gastroenterology, Xijing Hospital, from January 2014 to September 2024. Receiver operating characteristic (ROC) curves were utilized to determine the optimal cutoff points and corresponding diagnostic thresholds. In addition, multivariate logistic regression analysis was conducted to identify independent predictive indicators for autoimmune gastritis, with further assessment in a validation cohort.Results:A total of 139 patients with autoimmune gastritis and 209 patients with H. pylori-induced atrophic gastritis were included. Pepsinogen (PG) Ⅰ levels and the PG Ⅰ/PG Ⅱ ratio in patients with autoimmune gastritis were significantly lower than in those with H. pylori-induced atrophic gastritis [11.0 (4.8, 22.5) vs. 41.8 (32.2, 59.9) μg/L, U=722.00, P<0.001; 1.24 (0.75, 3.54) vs. 5.76 (4.31, 7.12), U=817.00, P<0.001], while gastrin levels were significantly higher [375 (84, 738) vs. 49 (35, 81) ng/L, U=378.00, P<0.001]. PG Ⅰ was identified as an independent predictive variable, with an area under the ROC curve of 0.847 (95% CI 0.791-0.904), sensitivity of 77.6%, specificity of 91.8%, positive predictive value of 80.5%, and negative predictive value of 90.5%. Conclusions:Significant differences in laboratory indicators were observed between autoimmune gastritis and H. pylori-induced atrophic gastritis in chronic atrophic gastritis involving gastric fundus and corpus. Besides, PG Ⅰ demonstrated good diagnostic performance in identifying autoimmune gastritis and can effectively differentiate between different types of atrophic gastritis.

Currently,a wide range of oral antibacterial materials are clinically used,including metal element antibacterial materials(such as silver,zinc,copper,titanium),and non-metal element antibacterial materials(such as fluorine).In recent years,cerium ox-ide nanoparticles have attracted great interest in the field of oral medicine due to their unique antibacterial,anti-inflammatory,antioxi-dant,redox capabilities.At the same time,they also have the characteristics of promoting tissue regeneration,inhibiting biofilm forma-tion and good biocompatibility.To enhance the performance of oral materials,nanoparticles have been integrated into products such as composite resins,adhesives,and denture systems.Additionally,they have shown potential for modifying oral ceramic materials and an-ti-tumor effects.This review focuses on the latest research progress in various fields of oral medicine,including endodontics,periodon-tology,implantology,prosthodontics,and orthodontics,based on the biological characteristics of nano-cerium oxide.Our goal is to re-veal the potential of cerium oxide in the diagnosis and treatment of oral diseases and to provide ideas and references for the expansion of clinical applications in oral medicine.

Gastric cancer is a highly lethal malignant tumor, with early diagnosis being difficult and treatment outcomes influenced by multiple factors. In recent years, comprehensive treatment approach, incorporating surgery, chemotherapy, radiotherapy, targeted therapy, and immuno-therapy, has significantly improved efficacy. The advantages of comprehensive treatment are most important in patients with locally advanced and metastatic gastric cancer. For locally advanced cases, surgery serves as the core treatment, with various therapeutic modalities applied during the peri-operative period to enhance surgical outcomes. For metastatic patients, drug therapy is the primary method, supplemented by local treatments to achieve the best benefit. With the understanding of the molecular mechanisms underlying gastric cancer development, the use of molecular biomarkers for prognostic stratification and guidance for targeted therapy or immuno-therapy has become a crucial aspect of comprehensive treatment. Based on the latest research advancements, the authors discuss comprehensive treatment strategies for gastric cancer at different stages, offering insights into impro-ving efficacy and prognosis.

The profound integration of novel qualitative productive forces throughout the entire process of diagnosing and treating gastrointestinal cancer has catalyzed innovative advance-ments in surgical techniques and postoperative rehabilitation. In the field of minimally invasive resection, technological innovations, from laparoscopic surgery to robot-assisted surgical systems that transcend traditional visual and operational limitations, and further to the integration of artificial intelligence and 5G technologies that overcome spatiotemporal barriers for real-time decision-making and telemedicine, have significantly enhanced the precision and safety of gastrointestinal tumor surgery. Concurrently, the development of innovative medical devices plays a pivotal role in improving perioperative and postoperative rehabilitation efficiency. Functional device design focuses on addressing the holistic needs of patients throughout their clinical journey, systematically resolving efficiency and safety bottlenecks inherent in conventional diagnostic and therapeutic approaches. Technological progress has further enabled non-invasive, convenient remote health management for patients. Novel qualitative productive forces not only redefine surgical paradigms but also deliver efficient, safe, and patient-centered diagnostic and therapeutic experiences through comprehensive innovation across all treatment phases. This evolution marks a critical breakthrough in modern medicine's transition toward intelligence and systematization, heralding a new era of intelligent healthcare delivery.

Currently,a wide range of oral antibacterial materials are clinically used,including metal element antibacterial materials(such as silver,zinc,copper,titanium),and non-metal element antibacterial materials(such as fluorine).In recent years,cerium ox-ide nanoparticles have attracted great interest in the field of oral medicine due to their unique antibacterial,anti-inflammatory,antioxi-dant,redox capabilities.At the same time,they also have the characteristics of promoting tissue regeneration,inhibiting biofilm forma-tion and good biocompatibility.To enhance the performance of oral materials,nanoparticles have been integrated into products such as composite resins,adhesives,and denture systems.Additionally,they have shown potential for modifying oral ceramic materials and an-ti-tumor effects.This review focuses on the latest research progress in various fields of oral medicine,including endodontics,periodon-tology,implantology,prosthodontics,and orthodontics,based on the biological characteristics of nano-cerium oxide.Our goal is to re-veal the potential of cerium oxide in the diagnosis and treatment of oral diseases and to provide ideas and references for the expansion of clinical applications in oral medicine.

Gastric cancer is a highly lethal malignant tumor, with early diagnosis being difficult and treatment outcomes influenced by multiple factors. In recent years, comprehensive treatment approach, incorporating surgery, chemotherapy, radiotherapy, targeted therapy, and immuno-therapy, has significantly improved efficacy. The advantages of comprehensive treatment are most important in patients with locally advanced and metastatic gastric cancer. For locally advanced cases, surgery serves as the core treatment, with various therapeutic modalities applied during the peri-operative period to enhance surgical outcomes. For metastatic patients, drug therapy is the primary method, supplemented by local treatments to achieve the best benefit. With the understanding of the molecular mechanisms underlying gastric cancer development, the use of molecular biomarkers for prognostic stratification and guidance for targeted therapy or immuno-therapy has become a crucial aspect of comprehensive treatment. Based on the latest research advancements, the authors discuss comprehensive treatment strategies for gastric cancer at different stages, offering insights into impro-ving efficacy and prognosis.