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: 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 To understand the current situation of healthcare-associated infection(HAI)in China,pro-vide data support and decision-making basis for formulating scientific and effective strategies for HAI prevention and control.Methods A nationwide cross-sectional survey on HAI was conducted among various types and levels of medical institutions in China according to a unified protocol of bedside surveys and case investigations.Results In 2024,a total of 5 736 medical institutions and 2 751 765 patients were surveyed.Among them,34 889 HAI cases were identified,with a prevalence rate of 1.27％.The number of HAI episodes was 38 032,and case prevalence rate was 1.38％.The prevalence rate of HAI in medical institutions in different regions of China ranged from 0.66％to 2.35％.Among medical institutions of different scales,those with a bed capacity of ≥900 had the high-est incidence of HAI,reaching 1.65％.The most common infection site was the lower respiratory tract(44.66％),followed by the urinary tract(12.94％),surgical site(9.32％),upper respiratory tract(7.02％),and bloodstream infection(5.78％).The top 3 departments with the highest HAI rates were the general intensive care unit(10.02％),department of neurosurgery(5.51％),and department(group)of hematology(5.34％).A total of 23 238 strains of HAI pathogens were detected,with 10 714 strains(46.10％)from lower respiratory tract speci-mens.The top 5 detected strains were Klebsiella pneumoniae(14.76％),Pseudomonas aeruginosa(13.33％),Escherichia coli(12.79％),Acinetobacter baumannii(9.23％),and Staphylococcus aureus(7.88％).231 944 pa-tients underwent class Ⅰ incision surgery were monitored,with 1 647 cases experienced surgical site infection,and the prevalence rate of surgical site infection was 0.71％.The number of patients who should undergo pathogen de-tection(patients receiving therapeutic and therapeutic combined prophylactic antimicrobial agents)was 715 179,while the actual number was 480 492,with a pathogen detection rate of 67.18％.425 225 patients received patho-genic detection before treatment,with a detection rate of 59.46％.Conclusion The overall HAI prevalence in Chi-na is lower,showing disparities among medical institutions of different regions and scales.Therefore,precise imple-mentation of measures is necessary for HAI prevention and control,with a focus on high-risk institutions and high-risk departments,key areas,and critical procedures.All levels of medical institutions should continuously reduce the incidence of HAI by strengthening monitoring,standardizing the use of antimicrobial agents,and reinforcing basic HAI prevention and control measures.

Objective To observe the predictive factors of poor prognosis in patients with acute basilar artery occlusion(BAO)who got first-pass effect(FPE)after mechanical thrombectomy(MT).Methods Eighty-two acute BAO patients who got FPE following MT were retrospectively collected and divided into good prognosis group(modified Rankin scale[mRS]score≤3,n=48)and poor prognosis group(mRS score＞3,n=34)90 days after treatments.The data were compared between groups,and variables which showed P＜0.1 were included in multivariate logistic regression analysis to identify independent predictors of poor prognosis in acute BAO patients who got FPE after MT.Results Higher age of patients,pre-treatment National Institute Health stroke scale(NIHSS)and neutrophil-to-lymphocyte ratio(NLR),also higher proportions of patients with diabetes mellitus,atrial fibrillation(AF)and cardioembolic stroke in trial of org 10 172 in acute stroke treatment(TOAST)classification were found in poor prognosis group than those in good prognosis group(all P＜0.05).Conversely,patients in poor prognosis group had lower pre-treatment Glasgow coma scale(GCS)scores,lower posterior circulation-Alberta stroke program early CT score(pc-ASPECTS)and basilar artery on CT angiography(BATMAN)scores(all P＜0.05).Multivariate logistic regression analysis revealed patients complicated with AF(OR[95%CI]=29.769[1.470,602.943])and elevated pre-treatment NLR(OR[95%CI]=1.212[1.016,1.446])had relatively poor prognosis(both P＜0.05),whereas those with increased pre-treatment GCS score(OR[95%CI]=0.615[0.429,0.882]),elevated pc-ASPECTS(OR[95%CI]=0.263[0.092,0.748])and higher BATMAN score(OR[95%CI]=0.260[0.085,0.796])had relatively better prognosis(all P＜0.05).Conclusion Complicated with AF,low pre-treatment GCS score,high NLR,low pc-ASPECTS and low BATMAN score were all predictive factors for poor prognosis in acute BAO patients who got FPE after MT.

Objective To develop and implement a drug treatment pathway for the initial treatment of diffuse large B-cell lymphoma(DLBCL)and to provide a foundation for refined medication use and cost control management under the Diagnosis Related Groups(DRG)payment system.Methods Clinical pharmacists collaborated to develop a drug treatment pathway for the initial treatment of DLBCL,utilizing evidence-based medicine and evidence-based pharmacy principles.The PDCA(Plan-Do-Check-Act)cycle method was employed for administrative intervention.The hematology department served as a pilot unit to assess the impact on economic indicators,including inpatient costs,drug expenses,and DRG payment balance,as well as treatment efficacy and the incidence of adverse reactions.Results Compared to the control group,the RG13 intervention group exhibited a significant reduction in average total hospitalization costs and drug expenses,along with a decreased DRG payment balance deficits.All differences were statistically significant(P＜0.05).Conclusion The development and implementation of a drug treatment pathway for the initial treatment of DLBCL can effectively reduce treatment costs,prevent DRG overspending,and alleviate the economic burden on patients,while ensuring the safety and effectiveness of the treatment.

Objective To investigate the risk factors associated with perioperative hemodynamic disorders(HD)following carotid artery stenting(CAS)for carotid sinus stenosis.Methods The clinical data of 71 patients who underwent CAS for carotid sinus stenosis were retrospectively analyzed.The patients were divided into the HD group(20 cases)and the non-HD group(51 cases)based on the occurrence of HD,and inter-group comparisons along with binary logistic regression analysis were performed.All patients underwent carotid computed tomography angiography(CTA)prior to surgery.Results In the HD group,the duration of dopamine usage ranged from 9 to 71 hours,the mean age was(73.90±5.24)years old(P=0.038),and the average length of hospital stay was(9.60±3.63)days(P＜0.001).Univariate logistic regression analysis revealed that plaque calcification(P=0.035),annular calcification(P＜0.001),plaque length(P=0.012),and the degree of stenosis(P=0.014)were associated with perioperative HD after CAS.Multivariate logistic regression analysis identified annular calcification and plaque length as independent predictors of perioperative HD(P＜0.05).Conclusion Age,plaque calcification,annular calcification,plaque length,and the degree of stenosis are closely associated with the occurrence of perioperative HD after CAS in patients with carotid sinus stenosis.Annular calcification and plaque length are independent risk factors for the occurrence of HD.

The clinical data of 2 pediatric patients with atypical hemolytic uremic syndrome (aHUS) who were admitted to the Department of Nephrology at the Children′s Hospital of Nanjing Medical University on July 2018 to June 2023 were retrospectively analyzed.Both patients had combined CFH and CD46 gene mutations.One patient, a 2-year-old boy, presented jaundice and darkened urine following mumps.The other patient, a 7-month-old girl and the younger sister of the boy, developed fever, cough, vomiting, and thrombocytopenia without any apparent cause.Laboratory tests revealed hemolytic anemia, thrombocytopenia, and acute kidney injury in both patients.The genetic test results revealed mutations in both CFH (c.3572C>T, p.Ser1191Leu) and CD46 genes (c.293C>T, p.Thr98Ile) in both patients.The patients′ mother is a heterozygous carrier of the CFH gene mutation, while their father is a heterozygous carrier of the CD46 gene mutation.Both parents exhibit normal phenotypes and are currently receiving regular infusions of Eculizumab.The pediatric aHUS caused by combined CFH and CD46 gene mutations is reported in this study for the first time in China.The clinical features of these patients are summarized and analyzed.

Objective:To explore the mediating role of self-perceived aging in the relationship between perceived social support and self-efficacy for exercise in aged patients undergoing surgery for lung cancer and provide a basis for formulating relevant clinical intervention strategies.Methods:Totally 220 aged lung cancer patients who underwent surgery and were hospitalized at the Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, from April to June 2024 were recruited by convenience sampling. Patients completed a demographic questionnaire, the Self-Efficacy for Exercise (SEE) , the Ageing Perceptions Questionnaire (B-APQ) , and the Perceived Social Support Scale (PSSS) . The mediation effect of self-perceived aging between perceived social support and self-efficacy for exercise was analyzed using Model 4 in the SPSS Process macro.Results:A total of 220 questionnaires were distributed, and 207 valid questionnaires were returned, with an effective recovery rate of 94.09%. The total score for B-APQ was (46.93±11.35) , the SEE score was (44.12±12.83) , and the PSSS score was (53.18±13.53) . Perceived social support had a direct effect on self-efficacy for exercise (effect value: 0.278; P<0.01) . Self-perceived aging played a partial mediating role between perceived social support and self-efficacy for exercise, with a mediation effect value of 0.138 ( P<0.01) , accounting for 33.17% of the total effect (0.138/0.416) . Conclusions:Perceived social support directly influences self-efficacy for exercise in aged patients undergoing surgery for lung cancer and also exerts an indirect effect through self-perceived aging. It is recommended that healthcare providers guide these patients to establish a positive perception of aging while focusing on enhancing their social support levels to improve their self-efficacy for exercise and promote recovery.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

To analyze the standard establishment approach and compilation rationale for metallic pharmaceutical packaging standard development in the 2025 edition of the Pharmacopeia of the People's Republic of China.This article systematically explained the background and process of establishing the guiding principles for metallic materials and containers used in pharmaceutical packaging in the Chinese Pharmacopoeia through basic information,relevant domestic and international standards,the establishment of key quality attributes of metallic pharmaceutical packaging materials,and the construction of metallic pharmaceutical packaging material standards.The newly established guidelines,the Pharmacopeia of the People's Republic of China 9625,prioritized product critical quality attributes(CQAs)and real-world applicability.This dual emphasis on rigidity and adaptability enhances drug safety,meets the regulatory requirements,and promotes the globalization and scientific advancement of China's pharmaceutical packaging industry.