Patients with Takayasu arteritis combined with aortic valve disease often have a poor prognosis following surgical valve replacement, frequently encountering complications such as perivalvular leakage, valve detachment, and anastomotic aneurysm. This article presents a high-risk case wherein severe aortic valve insufficiency associated with Takayasu arteritis was successfully managed through transcatheter aortic valve implantation via the transapical approach. The patient had satisfactory valve function with no complications observed during the six-month postoperative follow-up. This case provides a minimally invasive and feasible alternative for the clinical management of such high-risk patients.

Objective:To investigate the pathological characteristics of post-cholecystectomy specimens from patients with benign gallbladder diseases.Methods:This retrospective case series study analyzed clinical and pathological data from 1 712 patients who underwent cholecystectomy for benign gallbladder diseases at the Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between September 2022 and August 2024. The cohort included 757 males and 955 females, with an age ( M(IQR)) of 57(23) years (range: 14 to 91 years). Clinical and pathological features were analyzed. The χ2 test was used to compare clinical characteristics between patients with neoplastic and non-neoplastic polyps. Factors statistically significant in the χ2 test were subsequently included in a binary logistic regression analysis. Results:Postoperative pathological examination revealed gallbladder cancer in 7 patients (0.41%). These 7 cases, including 2 with pT3 stage cancer, were not detected preoperatively by various imaging examinations (ultrasound+magnetic resonance cholangiopancreatography/MRI plain scan in 3 cases, ultrasound+enhanced MRI in 1 case, ultrasound+enhanced CT in 2 cases, enhanced CT+enhanced MRI in 1 case). Gallbladder adenoma was found in 23 cases (1.34%), neoplastic polyps (including cholesterol polyps with dysplasia) in 29 cases (1.69%), and non-neoplastic polyps in 154 cases (9.00%). Statistically significant differences were observed in age and polyp number between patients with neoplastic and non-neoplastic polyps ( χ2=10.436 and 8.030; both P<0.05). Binary logistic regression analysis identified age ≥60 years ( P=0.003) and solitary polyps ( P=0.009) as risk factors for neoplastic polyps. Mucosal dysplasia was present in 164 cases (9.58%), including 9 cases of severe dysplasia, 4 of which exhibited focal carcinomatous transformation. Gallbladder polyps combined with stones were found in 90 cases (5.26%), among which 10 were associated with adenoma and mucosal dysplasia, and 2 showed focal carcinomatous transformation. Conclusions:The incidence of incidental gallbladder carcinoma was 0.41%. Intraoperative bile spillage can severely compromise prognosis. Preoperative imaging demonstrates a low detection rate for neoplastic polyps. Particular vigilance for neoplastic polyps is warranted in patients aged ≥60 years or with solitary polyps. Cholecystectomy should be performed promptly for benign gallbladder diseases meeting surgical indications.

Objective:To investigate the pathological characteristics of post-cholecystectomy specimens from patients with benign gallbladder diseases.Methods:This retrospective case series study analyzed clinical and pathological data from 1 712 patients who underwent cholecystectomy for benign gallbladder diseases at the Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between September 2022 and August 2024. The cohort included 757 males and 955 females, with an age ( M(IQR)) of 57(23) years (range: 14 to 91 years). Clinical and pathological features were analyzed. The χ2 test was used to compare clinical characteristics between patients with neoplastic and non-neoplastic polyps. Factors statistically significant in the χ2 test were subsequently included in a binary logistic regression analysis. Results:Postoperative pathological examination revealed gallbladder cancer in 7 patients (0.41%). These 7 cases, including 2 with pT3 stage cancer, were not detected preoperatively by various imaging examinations (ultrasound+magnetic resonance cholangiopancreatography/MRI plain scan in 3 cases, ultrasound+enhanced MRI in 1 case, ultrasound+enhanced CT in 2 cases, enhanced CT+enhanced MRI in 1 case). Gallbladder adenoma was found in 23 cases (1.34%), neoplastic polyps (including cholesterol polyps with dysplasia) in 29 cases (1.69%), and non-neoplastic polyps in 154 cases (9.00%). Statistically significant differences were observed in age and polyp number between patients with neoplastic and non-neoplastic polyps ( χ2=10.436 and 8.030; both P<0.05). Binary logistic regression analysis identified age ≥60 years ( P=0.003) and solitary polyps ( P=0.009) as risk factors for neoplastic polyps. Mucosal dysplasia was present in 164 cases (9.58%), including 9 cases of severe dysplasia, 4 of which exhibited focal carcinomatous transformation. Gallbladder polyps combined with stones were found in 90 cases (5.26%), among which 10 were associated with adenoma and mucosal dysplasia, and 2 showed focal carcinomatous transformation. Conclusions:The incidence of incidental gallbladder carcinoma was 0.41%. Intraoperative bile spillage can severely compromise prognosis. Preoperative imaging demonstrates a low detection rate for neoplastic polyps. Particular vigilance for neoplastic polyps is warranted in patients aged ≥60 years or with solitary polyps. Cholecystectomy should be performed promptly for benign gallbladder diseases meeting surgical indications.

OBJECTIVE Identify the incentive and constraint factors of artificial intelligence （AI） application in the pharmaceutical field， and promote the application of AI in the field of pharmacy. METHODS Based on the technology acceptance model （TAM）， technology-organization-environment （TOE） framework， and diffusion of innovation theory （DOI）， a TAM-TOE-DOI integrated framework was constructed through a four-stage research process of “theoretical review → dimension mapping → mechanism integration → proposition development”. Combining the analytical pathways of the above three theories in AI application in pharmacy with the integration mechanisms and core propositions of the TAM-TOE-DOI， literature review and deductive reasoning were employed to systematically identify the incentive and constraint factors of AI application in pharmacy from three levels：micro （TAM）， meso （TOE）， and macro （DOI）， and to propose optimization strategies. RESULTS & CONCLUSIONS At the micro level， the efficiency transformation and quality improvement brought by AI technology were the main incentive factors for perceived usefulness， while technological complexity and algorithmic opacity were the main constraint factors for perceived ease of use. At the meso level， the completeness of technological infrastructure， the strength of top management support and innovation climate， as well as external institutional pressure and competitive driving forces were the core incentive factors， whereas scarcity of organizational resources and talent shortage were the main constraint factors. At the macro level， relative advantage and observability were typical incentive factors， while technological complexity was a typical constraint factor. China’s health administration， medical insurance authorities， and other relevant departments should coordinate efforts at the macro， meso， and micro levels to advance AI application in pharmacy： optimizing human-computer interaction and implementing tiered training programs at the micro level； reinforcing organizational support systems and capacity building at the meso level； dismantling data barriers and building social trust at the macro level. Differentiated implementation pathways should be developed for medical institutions at different tiers.

With the continuous deepening of the concept of precision diagnosis and treatment for lung cancer, how to achieve higher efficiency and accuracy in the screening, diagnosis, and treatment pathways in clinical practice has become an important issue that urgently needs to be overcome. The current clinical difficulty lies in the fact that despite continuous advancements in imaging and molecular diagnostic technologies, there are still limitations in manual efficiency and subjective experience when it comes to massive data analysis and multi-scale feature extraction. Artificial intelligence (AI), especially algorithm systems based on deep learning, is an innovative technology capable of deeply empowering medical big data. This method utilizes algorithms such as convolutional neural networks, combined with radiomics, pathomics, and multi-modal data fusion analysis, demonstrating immense potential in early precise detection and benign-malignant differentiation of pulmonary nodules, digital pathological subtype recognition and non-invasive prediction of driver genes, precise 3D surgical planning and automatic delineation of radiotherapy target volumes, as well as dynamic risk warning during follow-up. This innovative technology provides a brand-new solution for realizing intelligent and individualized lung cancer diagnosis and treatment models. This consensus, based on the latest evidence from evidence-based medicine and combined with the development trends in the AI field and real-world clinical needs, was ultimately formed by gathering the consensus opinions of multidisciplinary experts in radiology, pathology, thoracic surgery, and other fields. The main content covers the application specifications of AI in the three core scenarios of lung cancer screening, diagnosis, and treatment, the technical standards for data collection and algorithm validation, as well as the ethical and regulatory challenges faced at the current stage. It aims to clarify the applicable boundaries of AI as a clinical auxiliary decision support tool, providing scientific guidance and standardized exploration directions for peers currently engaged in or planning to carry out AI-assisted clinical diagnosis, treatment, and translation of lung cancer.

Objective: To evaluate the feasibility of dynamic contrast-enhanced MRI (DCE-MRI) in differentiating tumor deposits (TDs) from metastatic lymph nodes (MLNs) in rectal cancer. Materials and Methods: A retrospective analysis was conducted on 70 patients with rectal cancer, including 168 lesions (70 TDs and 98 MLNs confirmed by histopathology), who underwent pretreatment MRI and subsequent surgery between March 2019 and December 2022. The morphological characteristics of TDs and MLNs, along with quantitative parameters derived from DCE-MRI (K trans , kep, and v e) and DWI (ADCmin, ADCmax, and ADCmean), were analyzed and compared between the two groups.Multivariable binary logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic performance of significant individual quantitative parameters and combined parameters in distinguishing TDs from MLNs. Results: All morphological features, including size, shape, border, and signal intensity, as well as all DCE-MRI parameters showed significant differences between TDs and MLNs (all P < 0.05). However, ADC values did not demonstrate significant differences (all P > 0.05). Among the single quantitative parameters, v e had the highest diagnostic accuracy, with an area under the ROC curve (AUC) of 0.772 for distinguishing TDs from MLNs. A multivariable logistic regression model incorporating short axis, border, v e, and ADC mean improved diagnostic performance, achieving an AUC of 0.833 (P = 0.027). Conclusion The combination of morphological features, DCE-MRI parameters, and ADC values can effectively aid in the preoperative differentiation of TDs from MLNs in rectal cancer.

Objective This study aims to investigate the epidemiological characteristics of mental disorders in a rural town of Huazhou City,Guangdong Province,and explore their association with the rural revitalization strategy,so as to provide evidence for policy formulation.Methods A combination of questionnaire surveys and in-depth interviews was used to collect in-formation on the demographic characteristics,disease status,economic conditions,and policy awareness of registered mental dis-order patients in the town.Semi-structured interviews were also conducted with local doctors and village committee members.Da-ta were analyzed using descriptive statistics and logistic regression models to assess the impact of awareness of rural revitalization policies on patients'income.Results The average age of the study subjects was 47.71 years,with an average disease duration of 18.38 years.A total of 86.36％of patients had a family history of mental disorders.After onset,42.11％of patients had an annual income≥￥ 10 000,which was an increase compared to pre-illness levels,but 60.75％had completely lost their ability to work.Awareness of rural revitalization policies was low(only 18.29％were fully aware),but policy awareness was significant-ly associated with increased patient income(OR=18.03,P＜0.001).Additionally,medical expenditures were significantly higher among female patients than male patients(P＜0.001).Conclusion In a town in Huazhou City,Guangdong Province,60.75％of mental disorder patients have completely lost their ability to work,while 42.11％have an annual income exceeding ￥ 10,000.Income is positively correlated with policy awareness(OR=18.03).It is recommended to strengthen policy promo-tion,optimize the allocation of medical resources,and develop specialized assistance programs to promote the coordinated devel-opment of mental health and rural revitalization.

Objective:To explore the effect of electric acupuncture combined with Tianding acupoint on the efficacy,syndrome score,and quality of life of post-stroke intractable hiccup(IH).Methods:A total of 102 post-stroke IH patients admitted to our hospital from October 2022 to October 2023 were retrospectively included,and were divided into control group and observation group,with 51 cases in each group.The matched group patients were given conventional acupuncture treatment,while the observation group patients were given conventional electric acupuncture combined with Tianding acupoint treatment.The clinical efficacy,effectiveness,hiccup symptom scores before and Post-treatment,and quality of life score between two groups of patients.Results:The proportion of patients in the observation group who took immediate effect(27.45％vs.5.88％)and the proportion of patients who took effect within 24 hours of the first treatment(60.78％vs.17.65％)were higher than matched group.The average onset time[(32.14±9.72)h vs.(70.34±23.51)h]was significantly shorter than matched group(P＜0.05).The treatment recovery rate of observation group was higher than matched group(80.39％vs.50.98％,P＜0.05),and the total effective rate of treatment was not different from matched group(96.08％vs.86.27％,P＞0.05).Post-treatment,both groups of patients showed a significant decrease in hiccup symptom scores,and there were significant differences at different time points(P＜0.05).The hiccup symptom scores of the observation group patients at 1 d,3 d,and 5 d post-treatment were lower than matched group(P＜0.05).Post-treatment,the overall scores of appetite,mental state,sleep,and quality of life in both groups increased,and the scores in the observation group were higher than matched group(P＜0.05).Conclusion:The combination of electric acupuncture and Tianding acupoint has a significant therapeutic effect on post-stroke IH,which can quickly take effect,improve patients'clinical symptoms,and enhance their quality of life.

Objective:To explore and evaluate the effectiveness of the new "D 3-teaching" mode in surgical training for ophthalmology standardized residency training. Methods:A total of 40 residents at the Eye Center of The Second Affiliated Hospital of Zhejiang University School of Medicine who participated in the standardized residency training program in Zhejiang Province from September 2020 to June 2024 were selected as the "D 3-teaching" group. This group received an innovative surgical training mode integrating digital resources, three-dimensional teaching, and dry lab simulation. Moreover, another 42 residents who had completed the standardized training program in the 2018 and 2019 were selected as the traditional teaching group. This group received traditional teaching methods involving theoretical lectures, text- and image-based teaching, and video demonstrations. The effectiveness of both teaching modes was assessed by comparing the pass rates of examinations, ICO-OSCAR skill mastery rates, learning periods, and satisfaction survey. Results:After training, there was no significant difference in the pass rates between the two groups. However, the skill mastery rate in the "D 3-teaching" group was significantly higher than that of the traditional teaching group (28/40, 70.00% vs. 15/42, 35.71%, χ2=9.66, P=0.002). Additionally, the learning period in the "D 3-teaching" group was significantly shorter than that of the traditional teaching group [(13.14±5.91) months vs. (21.33±7.73) months, t=3.88, P<0.001]. Furthermore, the scores for satisfaction with all teaching parameters in the "D 3-teaching" group were significantly higher than those in the traditional teaching group. Conclusions:The "D 3-teaching" mode is an innovative surgical teaching method in ophthalmology standardized residency training that significantly improves trainees' skill acquisition, enhances training outcomes, shortens the learning period, and has received high recognition from trainees. This mode is worthy of wider application and promotion.

Objective To investigate the effects of Yishen Zhuyu Tongluo Decoction on chondrocyte pyroptosis and ferroptosis in rats with knee osteoarthritis(KOA).Methods Forty SD were divided randomly into a sham operation group(n=10)and a modeling group(n=30).A KOA model was established in the modeling group by anterior cruciate ligament transection of the right hind limb knee joint.The drawer test was used to confirm the successful establishment of the model.Post-surgery,the rats were subjected to 30 min of forced activity daily to induce KOA.Lameness and hopping movements were observed after 4 weeks,and hematoxylin and eosin staining confirmed cartilage surface damage,deformation,and inflammatory cell infiltration,indicating successful modeling.The model rats were then assigned randomly to a model group(n=8),celecoxib group(n=8),and Yishen Zhuyu Tongluo Decoction group(n=8).The sham operation and model groups received 10 mL/kg of saline by gavage,the celecoxib group received 12 mg/kg of celecoxib solution,and the Yishen Zhuyu Tongluo Decoction group received 5.4 g/kg of the herbal decoction,once daily for 8 weeks.After the interventions,the rats were anesthetized,blood was collected from the abdominal aorta and serum was separated,and the knee joints were isolated.Three samples were fixed in paraformaldehyde,while the remaining cartilage tissue was reserved.Pathological changes in joint cartilage were observed by hematoxylin and eosin and Safranin O-Fast Green staining.Bone microstructure was analyzed using micro-computed tomography.Serum interleukin(IL)-1β and IL-18 protein levels were detected by enzyme-linked immunosorbent assay.Relative mRNA expression levels of NLRP3,ASC,Caspase-1,GSDMD,IL-1β,IL-18,ACSL-4,FTH-1,GPX-4,and cyclooxygenase(COX)-2 were detected by reverse transcription quantitative real-time PCR,and protein expression of NLRP3,Caspase-1,and COX-2 were detected by immunohistochemistry.Results Compared with the sham operation group,model rats showed surface damage and deformation of cartilage tissue,disordered cell arrangement in all layers,significant loss of Safranin O-Fast Green staining,and sparse and irregular trabecular bone distribution.Serum levels of the inflammatory factors IL-1β and IL-18 were elevated(P＜0.01).mRNA expression levels of NLRP3,ASC,Caspase-1,GSDMD,IL-1β,IL-18,ACSL-4,and COX-2 were also significantly increased(all P＜0.01),while FTH-1 and GPX-4 mRNA expression levels were decreased(P＜0.01).Compared with the model group,rats in the celecoxib and Yishen Zhuyu Tongluo Decoction groups showed smoother and more intact cartilage surfaces,significantly increased cell counts,less loss of Safranin O-Fast Green staining,denser trabecular bone,and thicker cortical bone,with improved bone microstructure.Serum IL-1β and IL-18 levels were reduced(P＜0.01),NLRP3(P＜0.01,P＜0.05),ASC,Capase-1,GSDMD,IL-1β,IL-18,ACSL-4,and COX-2 mRNA levels were decreased(all P＜0.01),and relative expression levels of FTH-1 and GPX-4 mRNA were significantly increased(P＜0.01).Conclusions Yishen Zhuyu Tongluo Decoction can treat KOA by inhibiting chondroptosis and ferroptosis in chondrocytes,reducing serum IL-1β and IL-18 levels,and improving bone microstructure.