Objective:To analyze the value of abdominal CT angiography (CTA) and three-dimensional reconstruction fusion technology for larger (2 - 5 cm) gastric submucosal tumors (SMT) in the preoperative evaluation of super minimally invasive surgery(SMIS).Methods:A retrospective study was conducted, collecting data from 20 patients with gastric SMTs measuring 2 - 5 cm in diameter who were hospitalized in the the First Medical Center of the Chinese PLA General Hospital from March 2023 to December 2024. All patients underwent abdominal CTA prior to SMIS, and three-dimensional reconstructions of the tumors were performed. Clinical data were collected to analyze the visualization of the tumors and surrounding blood vessels in the fused three-dimensional images and the corresponding surgical plans.Results:In 19 cases, the abdominal CTA and three-dimensional imaging clearly and intuitively displayed the anatomical structures surrounding the tumors and provided panoramic images of small blood vessels around the tumors, enabling the selection of appropriate surgical plans. One case required conversion to laparoscopic surgery due to the intraoperative discovery of a small artery.Conclusions:The abdominal CTA examination and gastric SMT three dimensional reconstruction before SMIS can better display the anatomical location of the tumor and its relationship with surrounding small blood vessels, which is beneficial for gastroenterologists to formulate surgical plans and facilitate the smooth progress of SMIS under endoscopy.

Objective To evaluate the clinical evidence and overall value of Shuangdan Mingmu Capsule in treating diabetic retinopathy(DR),highlight its advantages and characteristics,clarify the exact clinical positioning for DR,and propose a reference that can aid the National Medical Management Department in its decision-making.Methods This study combined qualitative and quantitative evaluation methods.Multiple method ologies were used to analyze the"6+1"dimensions.Each dimension was measured using the Multi-criteria Decision Analysis Model and calculated using CSC software V2.0.Results SRS monitored since the launch of Shuangdan Mingmu Capsule were general adverse reactions and those reported in the literature;phase Ⅱ,Ⅲ,and Ⅳ clinical studies primarily focused on the gastrointestinal system,no serious adverse reactions were reported,and the safety was rated as A.When Shuangdan Mingmu Capsule was combined with calcium hydroxybenzenesulfonate or laser photocoagulation in the treatment of DR in a meta-analysis,it further enhanced ophthalmologic parameters such as macular thickness,hemorrhagic spot area,leakage area,best-corrected visual acuity,and the degree of visual field defect.It also increased serum vascular endothelial growth factor and platelet-derived growth factor levels,the scores from the low vision quality of life scale and ultrasound indexes,and the validity was rated as grade A.A pharmacoeconomic evaluation study of Shuangdan Mingmu Capsule combined with calcium hydroxybenzenesulfonate compared to calcium hydroxybenzenesulfonate alone for DR treatment indicated that assuming the per capita disposable income in 2023 was applied as the willingness-to-pay threshold for patients,with an ICER of 3,730.98—which is approximately 2.85％of the per capita disposable income in 2023—the treatment regimen of Shuangdan Mingmu Capsule combined with calcium hydroxybenzenesulfonate was more economical than the calcium hydroxybenzenesulfonate treatment plan alone.The economy was rated as grade B.Therefore,Shuangdan Mingmu Capsule can meet clinical needs,and the formula includes medicines to tonify the liver and kidney,activate blood,and clear the channels,which is a combination of both symptomatic and fundamental treatments.Shuangdan Mingmu Capsule can also tonify the kidney,nourish the liver,stimulate blood circulation,and improve eyesight,and it is rated as grade A for innovativeness.Therefore,the drug is widely used,has no special technical and administrative requirements,is convenient to carry,and does not need to be administered at special times.The comprehensive questionnaire survey indicated that the appropriateness of the drug is good(grade B),that the production capacity is sufficient,and that the accessibility has been rated as grade B.This drug originates from ancient prescriptions of Er Zhi Pill and Liuwei Dihuang Pill,which have a long-standing reputation in traditional medicine.The combination of disease and evidence embodies the Chinese medicine characteristics of holistic concept and identification of evidence-based treatment,and the special features of Chinese medicine are rated as grade A.Conclusion The clinical value of Shuangdan Mingmu Capsule was evaluated as Class A by synthesizing the"6+1"dimensions and calculated using CSC V2.0 software.The clinical value of Shuangdan Mingmu Capsule is Class A.However,clinical needs must be focused upon and transformed into relevant clinical medication policies,providing a strong reference for the efficacy research of clinical trials.

Objective:To evaluate the effects of wearing defocus incorporated multiple segments (DIMS) spectacle lenses on binocular visual function and visual quality in myopic children.Methods:A randomized double-blind controlled study was conducted.A total of 176 children (352 eyes) with myopia aged 6 to 15 years were enrolled in the West China Hospital of Sichuan University from January 2021 to March 2022.They were randomly divided into DIMS group of 85 cases (170 eyes) and single-vision group of 91 cases (182 eyes) wearing DIMS and single-vision lenses, respectively, using the random number table method.A total of 151 cases (302 eyes) who completed follow-up visits were included in the analysis, including 72 cases (144 eyes) in the DIMS group and 79 cases (158 eyes) in the single-vision group.Before and after 6 and 12 months of lens wear, accommodation amplitude, binocular accommodative sensitivity, distance/near horizontal eye position, and accommodative convergence/accommodation (AC/A) of subjects were measured.Changes in visual function over the year were compared between the two groups.In addition, subjective contrast sensitivity (CS) was assessed at each follow-up visit to evaluate the effect of the lenses on visual quality.The study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of West China Hospital of Sichuan University (No.2020-06).Parents or legal guardians signed written informed consent before the child's participation.Results:There were significant differences in monocular accommodation amplitude and binocular accommodation sensitivity at different time points between before and after lens wear in both groups (Wald χ2time=84.435, 48.201; both P<0.001).In both groups, monocular accommodation amplitude was decreased and the biocular accommodation sensitivity was increased at 6 and 12 months after wearing glasses compared with baseline (all P<0.001).After 12 months of lens wear, the monocular accommodation amplitude decreased by 2.68 D (95% CI: 1.60-3.75 D) in DIMS group and 2.82 D (95% CI: 1.81-3.84 D) in single-vision group.There were statistically significant differences in distance and near horizontal eye position between the two groups at different time points before and after wearing glasses (Wald χtime2=10.398, 23.947; both P<0.01).In the DIMS group, after 12 months of wearing lenses, the distance horizontal eye position drifted outward by 0.68 △(95% CI: 0.06-1.25 △) compared to baseline, with a significant difference ( P<0.05).There was 1.67 △ (95% CI: 0.15-3.20 △) outward drift at near horizontal eye position in the DIMS group and 1.73 △ (95% CI: 0.49-2.96 △) outward drift in the single-vision group compared with baseline, with significant differences (both P<0.05).There were statistically significant differences in gradient AC/A values and calculated AC/A values between the two groups at different time points before and after wearing glasses (Wald χtime2=22.001, 13.411; both P<0.01).After 12 months of wearing glasses, the gradient AC/A values significantly decreased in both groups compared to respective baseline, and the calculated AC/A values in the single-vision group showed a significant decrease compared to baseline (all P<0.05).There were no significant difference in the monocular accommodation amplitude, binocular accommodation sensitivity, distance and near horizontal eye position, gradient AC/A values and calculated AC/A values between the two groups (Wald χgroup2=2.385, 2.266, 2.070, 0.571, 0.578, 0.053; all P>0.05).There was no significant difference in the CS at 3, 6, 12, and 18 cpd spatial frequencies between the two groups at different time points before and after wearing lenses (Wald χ2group=1.104, 2.263, 1.861, 3.671; all P>0.05.Wald χ2time=2.260, 5.382, 2.573, 1.637; all P>0.05). Conclusions:Visual function performance after wearing DIMS lenses is consistent with that after wearing single-vision lenses.Wearing DIMS lenses has no obvious negative effect on the long-term visual quality in children.

Objective:To analyze the value of abdominal CT angiography (CTA) and three-dimensional reconstruction fusion technology for larger (2 - 5 cm) gastric submucosal tumors (SMT) in the preoperative evaluation of super minimally invasive surgery(SMIS).Methods:A retrospective study was conducted, collecting data from 20 patients with gastric SMTs measuring 2 - 5 cm in diameter who were hospitalized in the the First Medical Center of the Chinese PLA General Hospital from March 2023 to December 2024. All patients underwent abdominal CTA prior to SMIS, and three-dimensional reconstructions of the tumors were performed. Clinical data were collected to analyze the visualization of the tumors and surrounding blood vessels in the fused three-dimensional images and the corresponding surgical plans.Results:In 19 cases, the abdominal CTA and three-dimensional imaging clearly and intuitively displayed the anatomical structures surrounding the tumors and provided panoramic images of small blood vessels around the tumors, enabling the selection of appropriate surgical plans. One case required conversion to laparoscopic surgery due to the intraoperative discovery of a small artery.Conclusions:The abdominal CTA examination and gastric SMT three dimensional reconstruction before SMIS can better display the anatomical location of the tumor and its relationship with surrounding small blood vessels, which is beneficial for gastroenterologists to formulate surgical plans and facilitate the smooth progress of SMIS under endoscopy.

Depression and circadian rhythms exhibit bidirectional interactions,suggesting a close association with the biological clock system.The biological clock in the suprachiasmatic nucleus of the hypothalamus is regulated by circadian genes.Recent clinical and basic research has revealed multifaceted associations between depression and circadian genes.For instance,significant phase abnormalities in BMAL1,PER2,and PER3 were detected in brain tissue from depressed patients,while plasma levels of CRY1,ARNTL,and PER1 proteins showed marked reduction,demonstrating good diagnostic value.Mice with CLOCK and BMAL1 knockouts exhibited depression-like behaviors.Single nucleotide polymorphisms(SNPs)in genes such as PER1 and PER3 directly influence depression susceptibility.Methylation levels of BMAL1,PER3,and CLOCK genes correlate closely with depressive symptoms.Antidepressant mechanisms like ketamine exert their effects by downregulating PER2 and other genes.This review summarizes the differential expression patterns of circadian clock genes in depression and associated therapeutic approaches,aiming to provide new theoretical foundations for precision diagnosis and personalized treatment strategies for depression.

Objective:To evaluate the effects of wearing defocus incorporated multiple segments (DIMS) spectacle lenses on binocular visual function and visual quality in myopic children.Methods:A randomized double-blind controlled study was conducted.A total of 176 children (352 eyes) with myopia aged 6 to 15 years were enrolled in the West China Hospital of Sichuan University from January 2021 to March 2022.They were randomly divided into DIMS group of 85 cases (170 eyes) and single-vision group of 91 cases (182 eyes) wearing DIMS and single-vision lenses, respectively, using the random number table method.A total of 151 cases (302 eyes) who completed follow-up visits were included in the analysis, including 72 cases (144 eyes) in the DIMS group and 79 cases (158 eyes) in the single-vision group.Before and after 6 and 12 months of lens wear, accommodation amplitude, binocular accommodative sensitivity, distance/near horizontal eye position, and accommodative convergence/accommodation (AC/A) of subjects were measured.Changes in visual function over the year were compared between the two groups.In addition, subjective contrast sensitivity (CS) was assessed at each follow-up visit to evaluate the effect of the lenses on visual quality.The study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of West China Hospital of Sichuan University (No.2020-06).Parents or legal guardians signed written informed consent before the child's participation.Results:There were significant differences in monocular accommodation amplitude and binocular accommodation sensitivity at different time points between before and after lens wear in both groups (Wald χ2time=84.435, 48.201; both P<0.001).In both groups, monocular accommodation amplitude was decreased and the biocular accommodation sensitivity was increased at 6 and 12 months after wearing glasses compared with baseline (all P<0.001).After 12 months of lens wear, the monocular accommodation amplitude decreased by 2.68 D (95% CI: 1.60-3.75 D) in DIMS group and 2.82 D (95% CI: 1.81-3.84 D) in single-vision group.There were statistically significant differences in distance and near horizontal eye position between the two groups at different time points before and after wearing glasses (Wald χtime2=10.398, 23.947; both P<0.01).In the DIMS group, after 12 months of wearing lenses, the distance horizontal eye position drifted outward by 0.68 △(95% CI: 0.06-1.25 △) compared to baseline, with a significant difference ( P<0.05).There was 1.67 △ (95% CI: 0.15-3.20 △) outward drift at near horizontal eye position in the DIMS group and 1.73 △ (95% CI: 0.49-2.96 △) outward drift in the single-vision group compared with baseline, with significant differences (both P<0.05).There were statistically significant differences in gradient AC/A values and calculated AC/A values between the two groups at different time points before and after wearing glasses (Wald χtime2=22.001, 13.411; both P<0.01).After 12 months of wearing glasses, the gradient AC/A values significantly decreased in both groups compared to respective baseline, and the calculated AC/A values in the single-vision group showed a significant decrease compared to baseline (all P<0.05).There were no significant difference in the monocular accommodation amplitude, binocular accommodation sensitivity, distance and near horizontal eye position, gradient AC/A values and calculated AC/A values between the two groups (Wald χgroup2=2.385, 2.266, 2.070, 0.571, 0.578, 0.053; all P>0.05).There was no significant difference in the CS at 3, 6, 12, and 18 cpd spatial frequencies between the two groups at different time points before and after wearing lenses (Wald χ2group=1.104, 2.263, 1.861, 3.671; all P>0.05.Wald χ2time=2.260, 5.382, 2.573, 1.637; all P>0.05). Conclusions:Visual function performance after wearing DIMS lenses is consistent with that after wearing single-vision lenses.Wearing DIMS lenses has no obvious negative effect on the long-term visual quality in children.

Objective:To explore the relationship between general demographic characteristics,inflammatory indicators,nutritional indicators,pathological data and lymph node metastasis in endometrial cancer(EC)pa-tients,and to construct and validate a model for preoperative prediction of lymph node status in endometrial canc-er patients.Methods:The preoperative clinical data of 473 patients with EC who underwent surgical treatment in the Zhu Jiang Hospital of Southern Medical University from January 2010 to April 2024 were retrospectively ana-lyzed.The independent risk factors of lymph node metastasis of endometrial cancer were screened by univariate and multivariate Logistic regression analyses,and the nomogram prediction model was constructed by R soft-ware.The performance of the model was evaluated by the receiver operating characteristic(ROC)curve,calibra-tion curve and clinical decision curve.Results:Menopausal status,high grade biopsy pathology,CA125 ≥24.47U/ml,systemic immune inflammatory index(SII)≥710.91,and prognostic nutritional index(PNI)＜52.90 were in-dependent risk factors for lymph node metastasis in endometrial cancer(OR＞1,P＜0.05).The nomogram model constructed based on these five factors had an AUC of 0.853 in the training set and 0.871 in the test set.The cali-bration curve fitted well,and the clinical decision curve shows a positive benefit.Conclusions:The endometrial cancer lymph node metastasis prediction model constructed based on menopausal status,biopsy pathology,CA125,SII,and PNI has good accuracy and fit,with certain clinical application value.

Cancer stands as a significant global public health challenge,and cancer screening serves as a pivotal strategy for reducing its mortality.Presently,only a limited number of cancer types have appropriate screening methods available.Traditional single-cancer screen-ing approaches are fraught with limitations,including invasiveness,low accuracy,and poor patient compliance.Multi-cancer early detection(MCED)leveraging liquid biopsy technology enables non-invasive and efficient early detection of multiple cancers by analyzing biomarkers such as cell-free DNA,cell-free RNA,proteins,and metabolites in blood and other bodily fluids.This innovative approach substantially broadens the spectrum of detectable cancers and enhances population coverage,showcasing immense potential for improving existing can-cer screening strategies.This expert consensus comprehensively reviews the progress of liquid biopsy-based MCED,biomarker selection and detection technologies,the criteria for cancer type selection,research design and clinical utility evaluation,as well as implementation path-ways.The overarching goal of this consensus is to offer scientific guidance for further research and the widespread adoption of MCED,thereby facilitating the continuous optimization of cancer screening strategies.

Objective:Middle ear cholesteatoma is a common otolaryngological disease, and traditional diagnostic methods have certain limitations. This study aims to construct a computer-aided diagnosis model for middle ear cholesteatoma based on integrated convolutional neural networks (CNNs) to improve diagnostic accuracy and efficiency.Methods:Firstly, Data were collected from patients who visited the Department of Otorhinolaryngology Head and Neck Surgery at the First People′s Hospital of Yinchuan between January 2020 and December 2021. 8 000 temporal bone CT images were collected, including 5 000 images diagnosed pathologically as middle ear cholesteatoma and 3 000 normal images. A five-fold cross-validation method was used to divide the dataset into training and testing sets. Next, a transfer learning approach was used to initialize model parameters, and the AlexNet, GoogleNet, and ResNet networks were pre-trained to extract deep features from the images. Then, the Softmax classification algorithm was applied to classify the features, resulting in three independent classifiers. These classifiers were combined using an ensemble learning method with a weighted voting approach to obtain the final diagnostic results. Finally, the model was evaluated by comparing the ensemble classifier with individual classifiers to assess its accuracy, precision, sensitivity, specificity, and diagnostic time, and a comparison with low-mid-and high-experience physician groups was conducted to comprehensively evaluate the model′s diagnostic performance.Results:The experimental results showed that the model achieved an accuracy of 88.8%(178/200), precision of 92.9%,(112/120) sensitivity of 89.8%(108/120), and specificity of 88.1%(70/80). The average diagnostic time for individual patient temporal bone CT images was reduced to 2-3 seconds. Compared to the diagnostic results from low-mid-and high-experience physician groups, the model demonstrated significant advantages and effectively assisted clinicians in making rapid and accurate middle ear cholesteatoma diagnoses.Conclusion:The proposed middle ear cholesteatoma diagnostic model based on integrated convolutional neural networks exhibits high recognition accuracy and rapid diagnostic speed, significantly improving clinical diagnostic efficiency, especially in early screening and auxiliary diagnosis, making it of considerable value in clinical practice.

Objective:To explore the relationship between general demographic characteristics,inflammatory indicators,nutritional indicators,pathological data and lymph node metastasis in endometrial cancer(EC)pa-tients,and to construct and validate a model for preoperative prediction of lymph node status in endometrial canc-er patients.Methods:The preoperative clinical data of 473 patients with EC who underwent surgical treatment in the Zhu Jiang Hospital of Southern Medical University from January 2010 to April 2024 were retrospectively ana-lyzed.The independent risk factors of lymph node metastasis of endometrial cancer were screened by univariate and multivariate Logistic regression analyses,and the nomogram prediction model was constructed by R soft-ware.The performance of the model was evaluated by the receiver operating characteristic(ROC)curve,calibra-tion curve and clinical decision curve.Results:Menopausal status,high grade biopsy pathology,CA125 ≥24.47U/ml,systemic immune inflammatory index(SII)≥710.91,and prognostic nutritional index(PNI)＜52.90 were in-dependent risk factors for lymph node metastasis in endometrial cancer(OR＞1,P＜0.05).The nomogram model constructed based on these five factors had an AUC of 0.853 in the training set and 0.871 in the test set.The cali-bration curve fitted well,and the clinical decision curve shows a positive benefit.Conclusions:The endometrial cancer lymph node metastasis prediction model constructed based on menopausal status,biopsy pathology,CA125,SII,and PNI has good accuracy and fit,with certain clinical application value.