Objective To develop and validate a machine learning model based on preoperative clinical characteristics, laboratory indices, and radiological features for the non-invasive prediction of spread through air spaces (STAS) in patients with early-stage lung adenocarcinoma. Methods Preoperative data from patients with early-stage lung adenocarcinoma who underwent surgical resection at Northern Jiangsu People's Hospital between January 2020 and August 2025 were retrospectively collected. The data included clinical characteristics, laboratory indices, and radiological features. Patients were divided into a STAS-positive and a STAS-negative group based on postoperative pathological findings. The dataset was randomly split into a training set and a testing set at a 7 : 3 ratio. Feature variables were selected using the maximum relevance and minimum redundancy (mRMR) algorithm and the least absolute shrinkage and selection operator (LASSO) regression. Five machine learning models were constructed: logistic regression (LR), random forest (RF), support vector machine (SVM), light gradient boosting machine (LightGBM), and extreme gradient boosting (XGBoost). Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA). The shapley additive explanations (SHAP) method was employed to interpret the optimal prediction model. Results A total of 377 patients were included, comprising 177 (46.9%) males and 200 (53.1%) females, with a mean age of (63.31±9.73) years. There were 261 patients in the training set and 116 patients in the testing set. In the training set, statistically significant differences were observed between the STAS-positive group (n=130) and STAS-negative group (n=131) across multiple features, including age, sex, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), clinical T stage, and maximum solid component diameter (P<0.05). A final set of 10 feature variables was selected by combining mRMR and LASSO regression, and five machine learning models (LR, RF, SVM, LightGBM, XGBoost) were developed. The XGBoost model demonstrated optimal performance in both the training and testing sets, achieving AUCs of 0.947 [95%CI (0.920, 0.975)] and 0.943 [95%CI (0.894, 0.993)], respectively. DCA indicated that the XGBoost model provided a high net clinical benefit across a wide range of threshold probabilities. SHAP analysis revealed that the vessel convergence sign, clinical T stage, age, consolidation-to-tumor ratio (CTR), and MLR were the features with the highest contributions to STAS prediction. Conclusion The XGBoost model effectively predicts preoperative STAS status in early-stage lung adenocarcinoma, exhibiting excellent discriminative performance and good clinical interpretability. Key predictors such as the vessel convergence sign, clinical T stage, age and CTR provide a crucial reference for preoperative risk assessment and the individualized selection of surgical strategies, ultimately benefiting patients.

Objective To explore the role of DNAJC5B in immunotherapy for esophageal squamous cell carcinoma (ESCC). Methods Using the ESCC dataset from The Cancer Genome Atlas (TCGA) database, genes correlated with DNAJC5B expression were identified through Pearson correlation analysis. Subsequently, Gene Ontology (GO) functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were performed. Additionally, single-cell RNA sequencing (scRNA-seq) data were utilized to analyze the expression of DNAJC5B in different T-cell subsets. The prognostic value of DNAJC5B was evaluated using Kaplan-Meier survival curves, receiver operating characteristic curves, and Cox proportional hazards models. Results DNAJC5B was highly expressed in patients with advanced-stage ESCC, particularly in males. GO and KEGG analyses revealed a significant correlation between DNAJC5B expression and immune-related processes, such as the adaptive immune response and cell surface receptor signaling pathways. Single-cell analysis results indicated that DNAJC5B expression was positively correlated with immune function, with DNAJC5B predominantly accumulating in CD8+ T cells. Kaplan-Meier survival curves showed that the median survival time for patients with high DNAJC5B expression was 681 days, significantly shorter than the 1 361 days for patients with low expression (P<0.05). Furthermore, univariate and multivariate independent prognostic analyses demonstrated that DNAJC5B was an independent risk factor, with hazard ratios (HRs) of 3.577 and 4.114, respectively (both P<0.05). Conclusion DNAJC5B may play a crucial immunomodulatory role in ESCC, particularly in regulating CD8+ T-cell function and tumor immune escape. These findings support the potential of DNAJC5B as a biomarker for the treatment and prognostic assessment of ESCC.

As an extension of the central nervous system, the retina is the only tissue in the body that allows direct in vivo observation of both neural and vascular structures, offering a unique non-invasive window for the assessment of cerebral neurovascular diseases. Recent studies have shown that multimodal imaging techniques—such as fundus photography, optical coherence tomography(OCT), and OCT angiography(OCTA)—enable quantitative analysis of retinal indicators including vascular caliber, fractal dimension, retinal nerve fiber layer thickness, and microvascular density. These metrics can, to some extent, reflect the severity and progression risk of cerebrovascular and neurodegenerative diseases such as stroke, Alzheimer's disease, and Parkinson's disease. Consequently, retinal imaging holds promise as a powerful tool for early screening, risk stratification, and treatment monitoring. This article systematically reviews the application of retinal imaging technologies in the diagnosis and management of cerebral neurovascular disorders, with a particular focus on the important role of artificial intelligence(AI)-driven image analysis in enhancing screening efficiency, improving risk assessment accuracy, and promoting multidisciplinary collaborative care, thereby providing insights for clinical translation.

BACKGROUND:The capability of repairing articular cartilage damage is very limited,and tissue engineering technology provides new therapeutic options for repairing damaged cartilage,in which the interaction and induction between chondrocytes,bone marrow mesenchymal stem cells,and synovial mesenchymal stem cells is the basis of autologous healing of cartilage damage. OBJECTIVE:To construct the chondrocyte-bone marrow mesenchymal stem cell-synovial mesenchymal stem cell co-culture system to simulate the in vitro microenvironment of chondrocytes,and to explore the optimal cell inoculation ratio,meanwhile to observe the effects of icariin-containing serum on the proliferation of chondrocytes and the chondrogenic differentiation of stem cells in the system. METHODS:Rat knee chondrocytes,bone marrow mesenchymal stem cells and synovial mesenchymal stem cells were extracted,cultured and identified,and a chondrocyte-bone marrow mesenchymal stem cell-synovial mesenchymal stem cell non-contact co-culture system was constructed according to different cell inoculation ratios.After 72 hours of co-culturing,the chondrocyte proliferative activity and phenotypic ability were observed,and the co-culture system with the best overall effect was selected.New Zealand white rabbits were gavaged with icariin solution(0.25 mg/mL)to prepare icariin-containing serum,and cultured in conventional complete medium(high sugar DMEM culture medium containing 10%fetal bovine serum and 1%double antibody by volume)as the control group,while the experimental group was intervened by adding 10%icariin-containing serum by volume on the basis of above.The proliferative activity of chondrocytes and the expression of collagen type II were tested for the two groups after 24 and 48 hours.The differentiation of bone marrow mesenchymal stem cells and synovial mesenchymal stem cells into chondrocytes in the co-culture system was tested by immunofluorescence staining after 14 days. RESULTS AND CONCLUSION:(1)The three kinds of cells grew normally adherently to the wall in different ratios of co-culture,where chondrocytes showed the best proliferative activity and phenotypic ability in the co-culture system when chondrocytes:bone marrow mesenchymal stem cells:synovial mesenchymal stem cells=2:1:1.(2)Compared with the control group,the proliferative activity and type II collagen expression of chondrocytes in the experimental group were significantly increased after 24 hours(P<0.01),and the two groups still had difference after 48 hours(P<0.05).The two groups showed obvious chondrogenic differentiation of bone marrow mesenchymal stem cells and synovial mesenchymal stem cells after 14 days(P<0.01),and some of the cells appeared round or oval,and the cytoplasmic type II collagen immunofluorescence staining was positive.The fluorescence intensity of the experimental group was significantly higher than that of the control group(P<0.01).(3)The results showed that the chondrocyte-bone marrow mesenchymal stem cell-synovial mesenchymal stem cell co-culture system could be successfully established by the non-contact co-culture method,and the best chondrocyte proliferative activity and phenotypic ability could be obtained when the cell ratio was 2:1:1.Icariin-containing serum had the promoting effect on chondrocyte proliferation,and chondrogenic differentiation of bone marrow mesenchymal stem cells and synovial mesenchymal stem cells in the system.

Objective:To measure pancreatic fat deposition by magnetic resonance chemical shift imaging (CSI), and analyze the correlation between pancreatic fat deposition and pancreatic fistula after pancreaticoduodenectomy (PD).Methods:A retrospective analysis was conducted on the data of 55 patients who underwent PD in the Affiliated Hospital of Xuzhou Medical University from September 2021 to April 2024. Among them, 34 were male (61.8%) and 21 were female (38.2%), with the age of (63.5±12.0) years. The 55 patients included 17 cases (30.9%) of pancreatic ductal adenocarcinoma, 1 case (1.8%) of pancreatic serous cystadenoma, 2 cases (3.6%) of pancreatic mucinous cystadenoma, 1 case (1.8%) of pancreatic solid pseudopapillary tumor, 11 cases (20.0%) of ampullary carcinoma, 10 cases (18.2%) of common bile duct carcinoma, and 13 cases of other pathological types (such as high-grade intraepithelial neoplasia of the ampullary gland, duodenal adenocarcinoma, etc.) (23.6%). Before the operation, pancreatic fat deposition was measured by CSI and the fat fraction was calculated. With a fat fraction of 6.2% as the cut-off value, 55 patients were divided into the normal pancreas group (fat fraction ≤ 6.2%, n=29) and the fat pancreas group (fat fraction > 6.2%, n=26). The total hospitalization cost, postoperative hospital stay, biochemical leakage, grade B pancreatic fistula of the two groups were compared, and the correlation between pancreatic fat fraction and pancreatic fistula was analyzed. Result:The total hospitalization cost in the normal pancreas group was (91 527.3±19 118.4) yuan, and the postoperative hospital stay was 9.0 (8.0, 13.0) days, both of which were lower than those in the fatty pancreas group (107 772.4 ± 27 055.6) yuan and 11.0 (8.0, 22.0) days, and the differences were statistically significant ( t=-2.59, P=0.012; Z=-2.08, P=0.038). In the normal pancreas group, 8 cases (27.6%) of biochemical leakage and 1 case (3.4%) of grade B pancreatic fistula occurred after the operation. In the fat pancreas group, 10 cases (38.5%) of biochemical leakage and 8 cases (30.8%) of grade B pancreatic fistula occurred after the operation. There was no statistically significant difference in the incidence of biochemical leakage between the two groups ( χ2=0.74, P=0.391). The incidence of grade B pancreatic fistula after surgery in the adipose pancreas group was significantly higher than that in the normal pancreas group, and the difference was statistically significant ( χ2=5.61, P=0.018). The relationship between pancreatic body fat fraction and the occurrence of pancreatic fistula is correlated (the correlation coefficient was 0.334, 95% CI: 0.127-0.515, P=0.013) The relationship between the overall fat fraction of the pancreas and the occurrence of pancreatic fistula is correlated (the correlation coefficient was 0.472, 95% CI: 0.235-0.689, P<0.001). Conclusions:The incidence of grade B pancreatic fistula after PD in patients with a low fat fraction of the pancreas measured by CSI was lower than that in patients with a high fat fraction. Fat deposition in the pancreatic body and the pancreas as a whole is associated with the incidence of pancreatic fistula.

Objective To explore the application effect of health education based on gain and loss message framing on the treatment behavior intention and self-management of patients with high-risk diabetic foot.Methods From July to September 2024,convenience sampling was used to select patients with high-risk diabetic foot who were hospitalized in the endocrinology department of a tertiary general hospital in Guiyang as the study subjects.They were divided into 3 groups according to the admission time,with 30 patients in each group.The experimental group adopted health education based on gain message framing or framing loss message,while in the control group,health education was provided in a conventional manner.Before and after intervention,the differences of intervention effects among the 3 groups were compared by using diabetic foot pre-hospital delay intention questionnaire,diabetic foot care knowledge questionnaire and Chinese version of Nottingham foot care assessment scale(CNAFF).Results Ultimately,29 cases in the gain framing group,29 cases in the loss framing group,and 29 cases in the control group completed the study.After intervention,the score of pre-hospital delay intention questionnaire of diabetic foot in the gain framing group was(21.48±4.32),and it was(24.31±2.49)in the loss framing group,and(17.76±5.03)in the control group.The difference among the 3 groups was statistically significant(F=18.725,P＜0.001);the loss framing group was superior to the gain framing group(P=0.01)and the control group(P＜0.001).After the intervention,the score of the CNAFF in the gain framing group was(55.83±3.06),and it was(59.14±2.90)in the loss framing group,and(48.66±2.58)in the control group.The difference between the 3 groups was statistically significant(F=102.245,P＜0.001).The loss framing group was superior to the gain framing group and the control group(all P＜0.001).Conclusion Health education based on the loss message framing is more conducive to improving patients' intention to delay diabetic foot visits,leading to good foot care behaviors,and may provide an effective means of pre-hospital prevention and control of diabetic foot.

Objective:To establish and evaluated a logistic regression model for predicting the acute biliary pancreatitis (ABP) based on liver-injury related indexes.Methods:Clinical data of 210 patients diagnosed with acute pancreatitis (AP) at the Affiliated Hospital of Jiangnan University from October 2020 to December 2022 were retrospectively analyzed, including 113 males and 97 females, with a median age of 52 years (range, 43 to 58). Among these, 88 were diagnosed with ABP and 122 with acute non-biliary pancreatitis (ANBP). Additionally, a test cohort was created using data from 101 AP patients diagnosed between January and December 2023, including 60 males and 41 females, with a median age of 53 years (range, 43 to 63). Based on the original dataset, univariate and multivariate logistic regression analyses were conducted to identify the factors influencing ABP. A prediction probability formula (Pre) was then established based on the multivariate results. The effectiveness of each indicator in predicting ABP was evaluated using the receiver operating characteristic (ROC) curve. The ROC curve analysis determined the optimal cutoff value of Pre, which was subsequently used to diagnose ABP and ANBP in the test cohort.Results:Multivariate logistic regression analysis showed the factors influencing ABP include direct bilirubin (DBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), cholinesterase (CHE), and fibrinogen (FIB). Based on the multivariate analysis results, the prediction probability formula (Pre) for ABP was established as follows: P=1/{1+ exp[-(4.807+ 0.134×DBIL-1.859×AST/ALT-0.0003×CHE-0.387×FIB)]}. ROC curve analysis revealed that the area under the curve (AUC) for Pre in predicting ABP was 0.858, with an optimal cutoff value of 0.56, at which the sensitivity was 69.3% and the specificity was 91.0%. Using the cutoff value of 0.56 for Pre, ABP was diagnosed when Pre≥0.56 and ANBP was diagnosed when Pre<0.56. This criterion was applied to diagnose patients in the test cohort, where the sensitivity and specificity of Pre for diagnosing ABP were 86.1% and 92.3%, respectively.Conclusion:The logistic regression model based on liver injury-related indicators is a valuable tool for clinically assessing the incidence of ABP.

Objective:To analyze the changes of serum metabolites in patients with acute pancreatitis (AP) by non-targeted metabolomics method.Methods:Serum samples and clinical data of 15 AP patients hospitalized in the Affiliated Hospital of Jiangnan University from August to September 2024 were collected and included in the AP group, including 9 males and 6 females, aged (55.4±15.3) years. The serum and clinical data of 25 patients with colon polyps in the same hospital during the same period of time were collected, including 15 males and 10 females, aged (61.2±11.5) years, and were included in the control group. Serum metabolomic detection was performed using the ultra-high performance liquid chromatography tandem Fourier transform mass spectrometer. The modeling method was orthogonal partial least square discriminant analysis, and principal component analysis was performed on the data matrix to screen the differential metabolites in serum of AP patients. The Kyoto Encyclopedia database of Genes and Genomes was used to annotate differential metabolites, and the pathway of differential metabolite enrichment was analyzed by software.Results:The principal component analysis showed that the contribution ratio of the first principal component was 15.1%, the proportion of the second principal component was 10.8%, and the total proportion of the two was 25.9%. In principal component analysis, two groups of samples can be clearly distinguished and show obvious clustering characteristics. According to the analysis of OPLS-DA model, there were significant differences in serum metabolic profiles between AP group and control group. There were 683 differentially expressed metabolites between the two groups, with 367 differentially expressed metabolites up-regulated compared with the control group and 316 differentially expressed metabolites down-regulated compared with the control group. It is mainly Phosphatidic Acid (Lte4/8: 0) (+ 218%), Omeprazole Sulphone (-38%), and 2-(Propylthio) Nicotinic Acid (2-propyl thionicotinic acid) (-58%), Gein (salicyricetin) (-47%) and so on. Pathway enrichment analysis showed that the differential metabolites in AP patients were mainly concentrated in citric acid cycle, arginine biosynthesis and glycerophospholipid metabolism pathways.Conclusion:Serum metabolites in AP patients change significantly, including citric acid cycle, arginine biosynthesis, glycerophospholipid metabolism.

Objective:To evaluate the efficacy and safety of da Vinci robot-assisted laparoscopic partial splenectomy (LPS).Methods:A retrospective review was conducted on 12 patients who underwent robot-assisted LPS for benign splenic lesions at the Department of General Surgery, Affiliated Hospital of Xuzhou Medical University, between January 2021 and August 2024. Among the patients, 5 were males and 7 were females, aged 35(21, 58) years. The operation time, intraoperative blood loss, and other related indicators, as well as postoperative complications and follow-up conditions were reviewed.Results:Robot-assisted LPS was successfully performed in all patients, with no conversions to open surgery, achieving a 100% spleen preservation rate (12/12). The operative time was (168.92±44.64) min, and the intraoperative blood loss was 75 (50, 175) ml, with no intraoperative blood transfusions required. The duration of postoperative drainage tube placement was (3.92±1.44) d, and the postoperative hospital stay was (5.33±1.07) d. No complications, such as bleeding, surgical site effusion, or pancreatic fistula occurred in the 12 patients. Minimal pleural effusion was observed in four cases, which required no special treatment. All patients were followed up for at least 6 months. During the follow-up period, there were no occurrences of portal vein thrombosis, overwhelming post-splenectomy infection, recurrent thrombocytosis, or disease recurrence.Conclusion:Robot-assisted LPS is a safe and feasible surgical approach for benign splenic lesions, demonstrating favorable outcomes.

Objective To investigate the composition ratios and trends of different etiologies after liver biopsy for patients with unexplained liver diseases.Methods A retrospective analysis was performed for the etiology of 960 patients with unexplained liver diseases who were hospitalized and underwent liver biopsy in The Third Affiliated Hospital of Sun Yat-Sen University from January 2011 to December 2020,and the etiologies were categorized by year and age group.The chi-square test was used for comparison of categorical data between multiple groups,and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups.Results There was a tendency of increase in the overall composition ratio of unexplained liver diseases over the past decade.The leading diagnosis after liver biopsy was autoimmune liver disease(AILD)in 306 patients(31.9%),followed by nonalcoholic fatty liver disease(NAFLD)in 95 patients(9.9%)and drug-induced liver disease(DILI)in 82 patients(8.5%),and there were still 320 patients with undetermined causes(33.3%).There were significant differences in sex ratio and median age distribution between the patients with different etiologies(sex ratio:χ2=155.36,P<0.001;median age distribution:H=182.48,P<0.001).AILD had been the leading etiology in 2011-2020,and there was a tendency of reduction in the composition ratio of AILD(χ2=24.40,P<0.001).NAFLD accounted for the highest proportion of 17.6%in the adolescent stage,while AILD accounted for the highest proportion of 17.8%,47.3%,and 56.3%,respectively,in the young,middle-aged,and elderly stages.Conclusion There is a tendency of increase in the composition ratio of unexplained liver diseases in patients undergoing liver biopsy,with AILD being the main disease diagnosed after liver biopsy,followed by NAFLD and DILI,but one-third of the patients still have an unclear etiological diagnosis.