Purpose To evaluate the value of arterial-phase CT-based radiomics and habitat imaging models in predicting programmed death ligand 1(PD-L1)expression levels in non-small cell lung cancer(NSCLC).Materials and Methods Clinical and imaging data from 258 pathologically confirmed NSCLC patients at Yijishan Hospital of Wannan Medical College from April 2022 to May 2024 were retrospectively analyzed.Patients were randomly divided into training(n=207)and validation(n=51)sets at a 4∶1 ratio.Whole-lesion radiomic features were extracted from arterial-phase CT images.Subregional habitats were generated using local feature clustering,and their radiomic features were fused to derive habitat analysis features.Dimensionality reduction identified features for constructing whole-lesion radiomic and habitat analysis models.Logistic regression algorithms were used to build models and develop nomograms.Model performance was evaluated using the area under the receiver operating characteristic curve(AUC),and clinical utility was assessed via decision curve analysis.Results Two independent clinical risk factors(tumor location and necrosis presence),14 whole-lesion radiomic features and 16 habitat analysis features were selected.The clinical model achieved AUCs of 0.685(training)and 0.682(validation).The habitat analysis model(AUC:0.776 training,0.761 validation)outperformed the whole-lesion radiomic model(AUC:0.701 training,0.647 validation).The combined model integrating clinical,whole-lesion and habitat analysis features demonstrated superior performance(AUC:0.838 training,0.826 validation)and the highest clinical net benefit on decision curve analysis.Conclusion Habitat imaging features derived from arterial-phase CT effectively predict PD-L1 expression in NSCLC.Combining clinical characteristics with whole-lesion and habitat analysis features further enhances predictive performance.

Background and Aims:Laparoscopic cholecystectomy(LC)is a common surgical method for the treatment of gallbladder diseases.However,some patients experience symptoms such as dyspepsia after surgery,which can affect their quality of life.Compound azinomide enteric-coated tablets,a novel drug,may improve dyspeptic symptoms after LC.This study was conducted to explore the clinical efficacy of compound azinomide enteric-coated tablets in treating post-LC dyspepsia symptoms through a multicenter clinical trial.Methods:A multicenter,superior efficacy,open-label,parallel-controlled design was used.Patients with postoperative dyspepsia were enrolled in 7 centers between January 2023 and May 2024.Patients were randomly assigned to either the observation or control groups using a random number table.The observation group received compound azinomide enteric-coated tablets,while the control group was treated with a combination of oryzae pancreatin tablets and ursodeoxycholic acid tablets.Both groups were treated for 4 weeks.The primary endpoints included gastrointestinal symptom scores and quality of life scores assessed before and at 14 and 28 d after treatment.Additionally,the incidence of adverse reactions and cost-effectiveness ratio(CER)were compared between the groups.Results:A total of 303 patients were included,with 150 in the observation group and 153 in the control group.Baseline characteristics were balanced between the groups before treatment(all P>0.05).After treatment,the observation group showed significantly higher effective rates at 14 d and 28 d than the control group(44.7%vs.29.4%;98.0%vs.73.9%,both P<0.05).The observation group also had significantly lower symptom scores and quality of life scores at both 14 and 28 d,with a significantly higher improvement rate in symptom scores compared to the control group(all P<0.05).Further analysis of the improvement rate and treatment efficacy for individual symptoms revealed that,except for the 14-d improvement in abdominal pain/discomfort,the observation group showed better improvement in all other symptoms at 14 d and in all symptoms at 28 d compared to the control group(all P<0.05).No adverse reactions were observed in either group.The CER for the observation group was 283.78 yuan/efficacy rate at 14 d and 128.57 yuan/efficacy rate at 28 d,while the control group's CER was 729.93 yuan/efficacy rate at 14 d and 290.22 yuan/efficacy rate at 28 d.Conclusion:Compound azinomide enteric-coated tablets demonstrated good clinical efficacy in treating dyspepsia symptoms after LC with excellent safety and high cost-effectiveness.Despite some limitations,the results provide a new treatment option for dyspepsia after LC.Larger-scale randomized controlled trials are needed to validate this study's conclusions further.

Objective To investigate the value of nutritional status control(CONUT)score,platelet to albumin ratio(PAR)and mean platelet volume to lymphocyte ratio(MPVLR)before treatment on immunotherapy efficacy and immune-related adverse reactions(irAEs)in advanced gastric cancer patients.Methods A total of 113 patients with advanced gastric cancer admitted to the hospital from January 2020 to June 2023 were selected as the gas-tric cancer group,and 113 healthy volunteers were selected as the control group.According to the efficacy of immunotherapy,the patients with advanced gastric cancer were divided into effective group(70 cases)and in-effective group(43 cases),and divided into irAEs group(51 cases)and non-irAEs group(62 cases)according to whether irAEs occurred.The factors influencing the occurrence of irAEs in advanced gastric cancer were analyzed,and the value of CONUT score,PAR and MPVLR before treatment in predicting the efficacy of im-munotherapy and irAEs in advanced gastric cancer was analyzed.Results The CONUT score,PAR and MPV-LR in gastric cancer group before treatment were higher than those in control group(P＜0.05).The CONUT score,PAR and MPVLR before treatment in the ineffective group were higher than those in the effective group(P＜0.05).The area under the curve(AUC)of CONUT score,PAR and MPVLR alone in predicting the ineffective immunotherapy in advanced gastric cancer patients before treatment were 0.779,0.739 and 0.766,respectively,the AUC predicted by combined detection was 0.889,which was higher than that predic-ted by alone(P＜0.05).The CONUT score,PAR and MPVLR before treatment in irAEs group were higher than those in non-irAEs group(P＜0.05).The age of irAEs group was lower than that of non-irAEs group(P＜0.05),and the proportion of Ki-67 index,CD4+T lymphocytes and Treg cells was lower than that of non-irAEs group(P＜0.05).The increase of CONUT score,PAR and MPVLR before treatment were risk factors for irAEs in advanced gastric cancer patients(P＜0.05),and the increase of Treg cell proportion was a protective factor(P＜0.05).The AUC of CONUT score,PAR and MPVLR alone in predicting the occurrence of irAEs in advanced gastric cancer patients before treatment was 0.816,0.798 and 0.783,respectively,the AUC predic-ted by combined detection was 0.887,which was higher than that predicted alone(P＜0.05).Conclusion The CO-NUT score,PAR and MPVLR before treatment are significantly increased in advanced gastric cancer patients,and are associated with ineffective immunotherapy and the occurrence of irAEs.The combined detection of the three indicators can effectively predict the immunotherapy efficacy and irAEs in advanced gastric cancer pa-tients.

Background and Aims:Laparoscopic cholecystectomy(LC)is a common surgical method for the treatment of gallbladder diseases.However,some patients experience symptoms such as dyspepsia after surgery,which can affect their quality of life.Compound azinomide enteric-coated tablets,a novel drug,may improve dyspeptic symptoms after LC.This study was conducted to explore the clinical efficacy of compound azinomide enteric-coated tablets in treating post-LC dyspepsia symptoms through a multicenter clinical trial.Methods:A multicenter,superior efficacy,open-label,parallel-controlled design was used.Patients with postoperative dyspepsia were enrolled in 7 centers between January 2023 and May 2024.Patients were randomly assigned to either the observation or control groups using a random number table.The observation group received compound azinomide enteric-coated tablets,while the control group was treated with a combination of oryzae pancreatin tablets and ursodeoxycholic acid tablets.Both groups were treated for 4 weeks.The primary endpoints included gastrointestinal symptom scores and quality of life scores assessed before and at 14 and 28 d after treatment.Additionally,the incidence of adverse reactions and cost-effectiveness ratio(CER)were compared between the groups.Results:A total of 303 patients were included,with 150 in the observation group and 153 in the control group.Baseline characteristics were balanced between the groups before treatment(all P>0.05).After treatment,the observation group showed significantly higher effective rates at 14 d and 28 d than the control group(44.7%vs.29.4%;98.0%vs.73.9%,both P<0.05).The observation group also had significantly lower symptom scores and quality of life scores at both 14 and 28 d,with a significantly higher improvement rate in symptom scores compared to the control group(all P<0.05).Further analysis of the improvement rate and treatment efficacy for individual symptoms revealed that,except for the 14-d improvement in abdominal pain/discomfort,the observation group showed better improvement in all other symptoms at 14 d and in all symptoms at 28 d compared to the control group(all P<0.05).No adverse reactions were observed in either group.The CER for the observation group was 283.78 yuan/efficacy rate at 14 d and 128.57 yuan/efficacy rate at 28 d,while the control group's CER was 729.93 yuan/efficacy rate at 14 d and 290.22 yuan/efficacy rate at 28 d.Conclusion:Compound azinomide enteric-coated tablets demonstrated good clinical efficacy in treating dyspepsia symptoms after LC with excellent safety and high cost-effectiveness.Despite some limitations,the results provide a new treatment option for dyspepsia after LC.Larger-scale randomized controlled trials are needed to validate this study's conclusions further.

Purpose To evaluate the value of arterial-phase CT-based radiomics and habitat imaging models in predicting programmed death ligand 1(PD-L1)expression levels in non-small cell lung cancer(NSCLC).Materials and Methods Clinical and imaging data from 258 pathologically confirmed NSCLC patients at Yijishan Hospital of Wannan Medical College from April 2022 to May 2024 were retrospectively analyzed.Patients were randomly divided into training(n=207)and validation(n=51)sets at a 4∶1 ratio.Whole-lesion radiomic features were extracted from arterial-phase CT images.Subregional habitats were generated using local feature clustering,and their radiomic features were fused to derive habitat analysis features.Dimensionality reduction identified features for constructing whole-lesion radiomic and habitat analysis models.Logistic regression algorithms were used to build models and develop nomograms.Model performance was evaluated using the area under the receiver operating characteristic curve(AUC),and clinical utility was assessed via decision curve analysis.Results Two independent clinical risk factors(tumor location and necrosis presence),14 whole-lesion radiomic features and 16 habitat analysis features were selected.The clinical model achieved AUCs of 0.685(training)and 0.682(validation).The habitat analysis model(AUC:0.776 training,0.761 validation)outperformed the whole-lesion radiomic model(AUC:0.701 training,0.647 validation).The combined model integrating clinical,whole-lesion and habitat analysis features demonstrated superior performance(AUC:0.838 training,0.826 validation)and the highest clinical net benefit on decision curve analysis.Conclusion Habitat imaging features derived from arterial-phase CT effectively predict PD-L1 expression in NSCLC.Combining clinical characteristics with whole-lesion and habitat analysis features further enhances predictive performance.

Background and Aims:The success of thyroid surgery largely depends on an accurate understanding and proper handling of cervical anatomical structures. As a key anatomical landmark,the middle cervical fascia plays a critical role in thyroid lobe resection and precise identification of the recurrent laryngeal nerve (RLN) during thyroid surgery. However,existing anatomical literature provides limited descriptions of the middle cervical fascia and surrounding spaces. This study was performed to explore the anatomical characteristics of the middle cervical fascia and its adjacent spaces in detail,providing more accurate anatomical evidence and practical guidance to improve the safety and efficacy of thyroid surgery.Methods:First,systematic anatomical studies were conducted on formalin-fixed cadaveric specimens. During the dissections,the structural features of the middle cervical fascia and its surrounding spaces were meticulously recorded,with special attention to its relationships with the thyroid gland,common carotid artery,and infrahyoid muscles. Second,real-time observations and records were made during thyroid surgery on patients with thyroid cancer. The appearance of the middle cervical fascia and changes in related anatomical structures were documented during surgery. Results:Both cadaveric dissections and intraoperative observations revealed that the middle cervical fascia is closely attached to the thyroid gland medially,while laterally it extends across the surface of the common carotid artery to the infrahyoid muscles. When the fascial plane was incised,important structures such as adipose tissue,lymph nodes,RLN,middle thyroid vein,inferior thyroid artery,and inferior thyroid vein were clearly observed. Additionally,it was found that the RLN is enveloped by a thin layer of fascia and adipose tissue. Intraoperative findings showed that RLN exposure techniques based on the middle cervical fascia significantly facilitated RLN identification and improved surgical efficacy. Conclusion:The middle cervical fascia is a key supportive structure on the thyroid surface and an independent fascial plane critical for tissue dissection and precise RLN exposure during thyroid surgery. A deeper understanding of the anatomy of the middle cervical fascia and its surrounding spaces is essential for ensuring the safety and effectiveness of thyroid surgery.

Background:Following the short-term outbreak of coronavirus disease 2019(COVID-19)in December 2022 in China,clinical data on kidney transplant recipients(KTRs)with COVID-19 are lacking.Methods:We conducted a single-center retrospective study to describe the clinical features,complications,and mortality rates of hospitalized KTRs infected with COVID-19 between Dec.16,2022 and Jan.31,2023.The patients were followed up until Mar.31,2023.Results:A total of 324 KTRs with COVID-19 were included.The median age was 49 years.The median time between the onset of symptoms and admission was 13 d.Molnupiravir,azvudine,and nirmatrelvir/ritonavir were administered to 67(20.7%),11(3.4%),and 148(45.7%)patients,respectively.Twenty-nine(9.0%)patients were treated with more than one antiviral agent.Forty-eight(14.8%)patients were treated with tocilizumab and 53(16.4%)patients received baricitinib therapy.The acute kidney injury(AKI)occurred in 81(25.0%)patients and 39(12.0%)patients were admitted to intensive care units.Fungal infections were observed in 55(17.0%)patients.Fifty(15.4%)patients lost their graft.The 28-d mortality rate of patients was 9.0%and 42(13.0%)patients died by the end of follow-up.Multivariate Cox regression analysis identified that cerebrovascular disease,AKI incidence,interleukin(IL)-6 level of>6.8 pg/mL,daily dose of corticosteroids of>50 mg,and fungal infection were all associated with an increased risk of death for hospitalized patients.Conclusions:Our findings demonstrate that hospitalized KTRs with COVID-19 are at high risk of mortality.The administration of immunomodulators or the late application of antiviral drugs does not improve patient survival,while higher doses of corticosteroids may increase the death risk.

Objective To understand the recognition and coping strategies of ICU nurses on post-ICU syndrome in family members of patients during hospitalisation so as to provide a reference for handling post-ICU syndrome of the family members of patients.Methods A phenomenological approach within qualitative research was adopted.Semi-structured in-depth interviews were conducted with 15 ICU nurses from 3 wards of the Second Affiliated Hospital of South China University.Colaizzi 7-step method was applied to analyse and refine the interview data themes.Results Three main themes and nine sub-themes were identified and they were insufficient cognition of post-ICU syndrome of the family members(limited understanding of post-ICU syndrome in family members,difficulty in recognising or ignoring symptoms,uncertainty about the impact of post-ICU syndrome),active coping with post-ICU syndrome of the family members(coping mainly through listening and explaining,coping mainly through verbal and physical actions,diligent patient care)and various factors hindering nurses'coping with post-ICU syndrome of the family members(compassion fatigue,high ICU work intensity,limited contact time with family members).Conclusion ICU nurses have insufficient understanding of post-ICU syndrome with the family members of patients during hospitalisation.It requires to enhance a comprehensive understanding in ICU nurses about post-ICU syndrome of the family members of patients and to optimise coping strategies to alleviate negative emotions of the family members.Additionally,efforts should be made to overcome factors that hinder nurses'coping with post-ICU syndrome of the family members of patients and to promote a harmonious relationship between medical staff and patients.

Objective To investigate the effect of visual soft lens assisted nasotracheal intubation in the treatment of dental caries in children under general anesthesia.Methods Eighty children aged 3-5 years undergoing dental caries treatment under general anesthesia in Stomatological Hospital Affiliated to Nanchang University from April 2020 to April 2023 were selected.According to the random number table method,they were divided into visual laryngoscope group and visual soft lens group,with 40 cases in each group.Children in visual laryngoscope group were used visual laryngoscope endotracheal intubation,children in visual soft lens group were used visual soft lens endotracheal intubation.The incidence of intubation complications such as cuff rupture,oral soft tissue injury and hoarseness were compared between two groups.The glottis exposure time,endotracheal intubation,endotracheal intubation success rate for the first time,heart rate(HR)and mean arterial pressure(MAP)were measured 30min before induction,immediately after induction,immediately after tracheal intubation and 3min after tracheal intubation.Results HR,MAP,tracheal intubation time,the incidence of cuff rupture and oral soft tissue injury immediately after tracheal intubation in visual soft lens group were lower than those in visual laryngoscope group(P＜0.05).Conclusion The use of visual soft lens for nasotracheal intubation in children with dental caries under general anesthesia has stable hemodynamics,short intubation time,and low incidence of intubation complications,which can be effectively applied in clinical practice.

Objective This study established a model of invasive Aspergillus niger lung disease in immunosuppressed rats to provide theoretical support for the pharmacodynamic evaluation of anti-invasive pulmonary aspergillosis drugs and mechanism studies.Methods Sixty SD rats were randomly divided into a normal control group;cyclophosphamide control group,and cyclophosphamide+fungal infection low,medium,and high dose groups,with 12 animals in each group.General clinical observations were performed daily,and the serum levels of immunoglobulin(Ig)G and IgM and galactomannan(GM)were detected by ELISA on the 3rd and 7th days of modeling.Simultaneously,the ratio of CD4+and CD8+cells,content of white blood cells(WBCs)and neutrophils(Neu)in peripheral blood,the Aspergillus niger load in alveolar lavage,and morphological changes to rat lung tissue were observed.Results Rats in the cyclophosphamide control and cyclophosphamide+fungal infection groups showed reduced voluntary activity and erect hair after modeling,and rats in the cyclophosphamide+fungal infection group also had shortness of breath and audible wet rhonchi in the lungs.Compared with the normal control group,rats in the cyclophosphamide control group showed significant reductions in the levels of CD4+,WBC,Neu,IgG,and IgM in the blood,and their proportion of CD8+cells was significantly higher(P＜0.05,P＜0.01).Compared with the cyclophosphamide control group,rats in the cyclophosphamide+fungal infection medium-and high-dose groups had significantly reduced blood levels of IgG,IgM,and CD4+cells(P＜0.05,P＜0.01);while the cyclophosphamide+fungal infection low-,medium-,and high-dose groups had significantly reduced blood levels of WBC and Neu(P＜0.05,P＜0.01).Additionally,rats in the cyclophosphamide+fungal infection medium-and high-dose groups had significantly increased blood CD8+cells(P＜0.05,P＜0.01),Blood GM levels and the alveolar lavage Aspergillus niger load were significantly increased in rats in the cyclophosphamide+fungal infection low-,medium-,and high-dose groups compared with the cyclophosphamide control group(P＜0.05,P＜0.01).The lung tissues of the cyclophosphamide+fungal infection low-,medium-,and high-dose groups showed mycelial distribution and destruction of alveolar epithelium,increase of bronchial epithelial cup cells in the alveoli,and infiltration of inflammatory cells,and the degree of lesions was positively correlated with the modeling dose.Conclusions In this study,we used Aspergillus niger combined with cyclophosphamide immunosuppressant to construct a model of invasive Aspergillus niger lung disease.The duration of the disease was positively correlated with the concentration of bacterial fluid and modeling time,confirming that cellular immunity plays an important role in the pathogenesis of the disease.At the same time,Ig can also affect the development of invasive pulmonary aspergillosis,and it is speculated that the pathogenesis may be related to the level of Ig produced by humoral immunity.