Objective:To investigate the application value of gastric suspension method in supra-pancreatic lymph node dissection of laparoscopic radical gastrectomy of gastric cancer.Method:The retrospective cohort study was conducted. The clinicopathological data of 84 patients who under-went laparoscopic radical gastrectomy of gastric cancer at Zhejiang Cancer Hospital from August 2023 to July 2024 were collected. There were 61 males and 23 females, aged (64±11)years. Of the 84 patients, 42 patients undergoing supra-pancreatic lymph node dissection during laparoscopic radical gastrectomy of gastric cancer with traditional method for surgical field exposure were divided into the control group, and 42 patients undergoing supra-pancreatic lymph node dissection during laparoscopic radical gastrectomy of gastric cancer with gastric suspension method for surgical field exposure were divided into the suspension group. Observation indicators: (1) surgical conditions; (2) postoperative conditions. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test. Results:(1) Surgical condi-tions. The time for supra-pancreatic lymph node dissection of the control group was (78±14)minutes. Number of grasping operations was 116±34, number of bleeding sites caused by grasping operations was 7.8±2.7, and operation time was (3.9±0.8)hours. The above indicators of the suspension group were (59±12)minutes, 68±19, 2.1±1.5, and (3.3±0.7)hours, respectively. There were significant diffe-rences in the above indicators between the two groups ( t=5.42, 8.10, 8.31, 3.14, P<0.05). (2) Post-operative conditions. The tumor diameter was 2.5(2.0,3.5)cm for patients of the control group, versus 3.0(2.4, 4.4)cm for patients of the suspension group, showing a significant difference between the two groups ( Z=-1.98, P<0.05). Conclusion:Compared with the traditional non-suspension method, the gastric suspension method in laparoscopic radical gastrectomy of gastric cancer for supra-pancreatic lymph node dissection is associated with shorter operation time and less trauma.

Objective To look for cognitive assessment paradigms and electrocardiographic(ECG)characteristics sensitive to mental fatigue through an experimental study.Methods Data were collected from 10 healthy students of the University of Shanghai for Science and Technology who participated in the 4-day National Undergraduate Electronics Design Contest,including their Stanford sleepiness scale(SSS)scores,sleep duration,cognitive task performance,and ECG signal data.Ten ECG features,including time-domain,frequency-domain,and information-domain characteristics,were extracted during cognitive tasks.The cognitive task performance and ECG features sensitive to changes in mental fatigue were analyzed.Results Significant differences were observed in SSS scores(x2=23.116,P＜0.001)and sleep duration(x2=19.608,P＜0.001)across the 4 d.For cognitive task performance,word-color congruent accuracy and word-color incongruent accuracy in the Stroop task and Single-visual target stimulus accuracy and Visual target-auditory non-target stimulus accuracy in the audiovisual competition task all showed significant negative correlations with SSS scores(all P＜0.05).Regarding ECG features,Poincaré plot SD2 during the Stroop task was positively correlated with sleep duration(P＜0.05),while Poincaré plot SD2 during the 2-back task was positively correlated with mental fatigue assessment scores and was negatively correlated with sleep duration(both P＜0.05).Conclusion The accuracy of the Stroop task and audiovisual competition task is a cognitive ability indicator sensitive to mental fatigue,while the Poincaré plot SD2 during Stroop and 2-back tasks is an ECG indicator sensitive to mental fatigue.

Objective To investigate the predictive value of combined radiomic features derived from chest CT scans with clinical characteristics for epidermal growth factor receptor(EGFR)gene mutations in non-small cell lung cancer(NSCLC).Methods A multi-center case-control study was conducted on the clinical data and CT images of 1 070 NSCLC patients from the radiology departments of the 3 medical institutions between January 2013 and October 2023.The 719 NSCLC patients from the First Affiliated Hospital of Army Medical University were randomly divided into a training set and an internal validation set in a ratio of 7∶3;The 173 patients in the Eastern Theatre General Hospital and the 178 patients in Army Medical Centre of PLA were assigned into the external validation set 1 and 2,respectively.Least absolute shrinkage and selection operator(LASSO)regression was employed to identify the optimal radiomic features,which were subsequently used to construct a radiomics model.Univariate and multivariate logistic regression analyses were applied to identify clinical features associated with EGFR mutation,thereby developing a clinical model.The radiomic and clinical features were subsequently combined to develop a comprehensive model.All the 3 classification models were built using random forest(RF)machine learning.The area under curve(AUC),accuracy,sensitivity and specificity were utilized to evaluate the predictive performance of the models.Calibration curve was plotted to assess the goodness of fit of the comprehensive model,while decision curve analysis was performed to assess the clinical utility of the model.Results The AUC value of the radiomics model was 0.762 4(95%CI:0.692 4～0.825 1),0.745 4(95%CI:0.671 1～0.814 3),and 0.724 7(95%CI:0.639 7～0.801 6),respectively,in the internal validation set,external validation set 1,and external validation set 2;The AUC value of the clinical prediction model was 0.691 7(95%CI:0.627 9～0.757 6),0.652 5(95%CI:0.576 7～0.729 1),and 0.779 2(95%CI:0.712 5～0.847 3),respectively in the above sets in turn;The comprehensive model constructed based on clinical features and radiomic features showed the best predictive efficacy,with an AUC value of 0.818 0(95%CI:0.757 7～0.874 3),0.782 4(95%CI:0.703 1～0.848 2),and 0.796 6(95%CI:0.718 1～0.868 6),respectively in the above sets.Calibration curve analysis indicated that the comprehensive model had a good fit,while decision curve analysis revealed that the model provided a favorable net benefit.Conclusion Our comprehensive model constructed based on chest CT radiomic features and clinical characteristics shows superior predictive performance for EGFR gene mutations in NSCLC across multiple center datasets,which may be helpful for clinical decision-making for treatment strategies.

Objective:To explore the influence of different scanning positions based on chest phantom of computed tomography(CT)scan on chest on image quality and radiation dose.Methods:A thermoluminescent dosimeter(TLD)was placed at the breast area of simulating anthropoid chest phantom.GE Revolution evo CT was used to conduct scan on the conventional supine position(supine group)and prone position(prone group)for chest phantom.Different noise indexes(NI=10-23)were adjusted to control ration doses,and other parameters were fixed,and each group collected 12 sequence images.The average value(AV),standard deviation(SD)of the CT scan at region of interest(ROI)under different scanning positions were recorded to calculate the signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the image.The radiation dose at the breast area was measured by TLD,and the volume CT dose index(CTDIvol)and dose-length product(DLP)were recorded.Results:Under different scanning positions,the radiation dose of breast organs in the prone group was lower than that in the supine group,there was a statistically significant difference between the two groups(t=6.57,P<0.05),while there were not statistically significant differences in CTDIvol and DLP between the two groups(P>0.05).There were not statistically significant differences in the CT values,SD,SNR,CNR of lung tissue,and the CT values of breast tissue between the two groups of images(P>0.05).The SD,SNR and CNR of breast tissue in the prone group were lower than those in the supine group,and the differences were statistically significant(t=-13.33,-10.59,6.70,P<0.05).There were no statistically significant differences in the subjective scores of the clarity of the edge of the tissue within lung,the layers of soft tissue of the breast,noise,and artifacts in the bone tissue between the two groups of images(P>0.05).Conclusion:When low-dose CT physical examination on chest is conducted in clinical practice,the scanning of prone position during undergoing CT scan on chest can obtain image quality that can meet the requirements in diagnosing lung,and reduce the radiation dose on the breast,and conform to the technical principle of optimal radiation protection.

AIM:This study investigated the role of solute carrier family 7 member 11(SLC7A11)in sul-fasalazine(SAS)-induced ferroptosis in acute myeloid leukemia(AML)cells,focusing on the inhibitory effect of nuclear factor E2-related factor 2(NRF2)nuclear translocation-mediated activation of SLC7A11 on ferroptosis and its underlying mechanisms.METHODS:SAS-induced proliferation in AML cell lines,Kasumi-1 and THP-1,was assessed using the MTS assay.Cell death inhibitors were employed to determine the mode of cell death.Lipid reactive oxygen species(ROS)levels were measured by flow cytometry;Fe2+,malonodialdehyde(MDA),glutathione(GSH)levels,and glutathione per-oxidase 4(GPX4)activity were assessed using micromethods.Quantitative PCR(qPCR)was performed to evaluate changes in SLC7A11 mRNA during SAS-induced ferroptosis,while Western blot measured SLC7A11 and GPX4 protein levels.Moreover,Western blot assessed NRF2 nuclear translocation post-SAS treatment.The NRF2 inhibitor ML385 was used to validate these effects.SLC7A11 mRNA and protein levels were then measured following combined SAS and ML385 treatment via qPCR and Western blot.Cell viability and ferroptosis-related indices were evaluated under the same treatment conditions.Furthermore,a shRNA vector targeting SLC7A11 was constructed to assess changes in cell viability and ferroptosis markers after SLC7A11 knockdown with SAS.GPX4 protein levels were examined following SLC7A11 knockdown.RESULTS:SAS significantly inhibited the proliferation of Kasumi-1 and THP-1 cells at 200 μmol/L and 300 μmol/L,respectively(P<0.05).Only ferroptosis inhibitors(Fer-1 and DFO)significantly reversed SAS-induced cy-totoxicity(P<0.01).SAS increased lipid ROS,Fe2+,and MDA levels(P<0.01),while reducing GSH and GPX4 activity(P<0.01).The mRNA and protein expressions of SLC7A11 increased during SAS-induced ferroptosis(P<0.01),where-as GPX4 protein decreased significantly(P<0.01).SAS significantly increased the nuclear-to-cytoplasmic NRF2 ratio(P<0.01),which decreased upon co-treatment with ML385(P<0.05).Following SAS and ML385 co-treatment,both SLC7A11 mRNA and protein levels were downregulated(P<0.01).This combination treatment further reduced AML cell viability(P<0.01),an effect reversed by Fer-1 and DFO(P<0.01).Compared with SAS alone,the combination of SAS and ML385 significantly increased lipid ROS,Fe2+,and MDA while reducing GSH levels and GPX4 activity(P<0.01).SLC7A11 knockdown was successfully achieved.Compared with the NC shRNA group,SLC7A11 knockdown cells showed significantly decreased viability after SAS treatment,which was reversed by Fer-1 and DFO(P<0.01).Lipid ROS,Fe2+,and MDA content were significantly increased(P<0.01),and GSH and GPX4 were substantially decreased(P<0.05).Moreover,GPX4 protein expression was considerably reduced after SLC7A11 knockdown(P<0.01).CONCLUSION:SAS induces ferroptosis in AML cells.It promotes the nuclear translocation of NRF2 protein,which activates SLC7A11 ex-pression.Inhibition of NRF2 or downregulation of SLC7A11 sensitizes AML cells to SAS-induced ferroptosis.

Objective To explore the value of artificial intelligence(AI)based multi-parameter coronary CT angiography(CCTA)features combined with clinical indicators for predicting coronary plaque progression.Methods Totally 143 coronary atherosclerosis(AS)patients were retrospectively enrolled and divided into progression group(arithmetic average annual growth rate of plaque load＞1％,n=73)and non-progression group(arithmetic average annual growth rate of plaque load＜1％,n=70).The baseline clinical data,CT-derived fractional flow reserve(CT-FFR),perivascular fat attenuation index(FAI),and quantitative plaque features were collected and compared between groups.For variables being statistically different between groups,those had collinearity with others were excluded,and then multivariable logistic regression was used to screen independent predictors of plaque progression from the retained variables,and a combined model was constructed.Receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was calculated to evaluate the predictive efficacy of this model.Results Progression group had higher proportions of hypertension and diabetes,higher apolipoprotein A1(ApoA1)and high-sensitivity C-reactive protein(hs-CRP)levels but lower high-density lipoprotein cholesterol(HDL-C)levels than non-progression group(all P＜0.05).Progression group showed smaller minimum lumen area and lower CT-FFR,but greater degree of lumen stenosis,total plaque volume,plaque load,non-calcified plaque volume,lipid-rich plaque volume,fibrolipid plaque volume and FAI values than non-progression group(all P＜0.05).Plaque types were different between groups(P＜0.05).Diabetes,low HDL-C,small minimum lumen area and large lipid-rich plaque volume were all independent predictors of plaque progression in patients with coronary AS(all P＜0.05),and the AUC of the combined model for predicting plaque progression was 0.859.Conclusion Multi-parameter CCTA features based on AI combined with clinical indicators could be used to effectively predict progression of coronary AS plaque.

In order to effectively prevent and control the occurrence of catheter-associated urinary tract infection and ensure the safety of both patients and medical personnel,the National Health Commission of the People's Re-public of China officially released the recommended health industry standard"Standard for prevention and control of catheter-associated urinary tract infection"(WS/T862-2025)in Aug.2025.This paper provides an interpreta-tion of the standard,covering its drafting background,basis and content,to assist relevant medical personnel in healthcare institutions in enhancing their understanding and recognition of the standard,and to further promote its implementation and enforcement.

Amorphous calcium phosphate（ACP）is a component of urinary stones，primarily forming mixed stones with calcium oxalate，while pure ACP stones are relatively rare. This article reports a case of a patient with an ACP bladder stone who was admitted due to progressive dysuria over 5 years，which had worsened in the past months. Upon admission，tPSA was 29.63 ng/ml. CT and enhanced MRI revealed multiple bladder stones and prostatic hyperplasia. The patient underwent ultrasound-guided prostate biopsy and transurethral cystolithotripsy with pneumatic lithotripsy. Postoperative infrared spectroscopy confirmed the stone composition as ACP，and prostatic adenocarcinoma was diagnosed by prostate biopsy pathology. Endocrine therapy was administered postoperatively，and follow-up imaging at 3 months showed no stone. This article presents the first reported case of an ACP bladder stone coexisting with prostate cancer，providing important clinical insights into the etiology of such stones and the rare local manifestations of prostate cancer.

Amorphous calcium phosphate（ACP）is a component of urinary stones，primarily forming mixed stones with calcium oxalate，while pure ACP stones are relatively rare. This article reports a case of a patient with an ACP bladder stone who was admitted due to progressive dysuria over 5 years，which had worsened in the past months. Upon admission，tPSA was 29.63 ng/ml. CT and enhanced MRI revealed multiple bladder stones and prostatic hyperplasia. The patient underwent ultrasound-guided prostate biopsy and transurethral cystolithotripsy with pneumatic lithotripsy. Postoperative infrared spectroscopy confirmed the stone composition as ACP，and prostatic adenocarcinoma was diagnosed by prostate biopsy pathology. Endocrine therapy was administered postoperatively，and follow-up imaging at 3 months showed no stone. This article presents the first reported case of an ACP bladder stone coexisting with prostate cancer，providing important clinical insights into the etiology of such stones and the rare local manifestations of prostate cancer.

Objective To investigate the effect of gender on prognosis after transcatheter patent foramen ovale(PFO)closure in patients with cerebral infarction or transient ischemic attack.Methods A retrospective cohort study was conducted involving patients with cerebral infarction or transient ischemic attack(TIA)who underwent PFO closure at our hospital between January 2013 and December 2023.The patients were grouped by gender,and related data were collected,including age,comorbidities,Risk of Paradoxical Embolism(RoPE)score,laboratory results,findings of transthoracic/transesophageal echocardiography(TTE/TEE),and post-procedural complications,such as device-related thrombosis(DRT),recurrent stroke,bleeding,and atrial fibrillation(AF).Results A total of 112 patients were enrolled,including 59 males and 53 females,at a mean age of 42.47±12.35 years.The females had significantly higher preoperative RoPE score than the males(6.6±1.4 vs 6.0±1.5,P=0.046),and a statistical difference was observed in the distribution of infarction sites between them(Chi-square=10.25,P=0.006),indicating that the males were prone to posterior circulation infarction.Intraoperative transthoracic echocardiography revealed a greater distance from the PFO to the aortic root in the females(9.3±2.4 mm vs 7.6±2.0 mm,P<0.001).During a median follow-up of 4 years,the male group had 1 case of myocardial infarction,1 cerebral hemorrhage,1 paroxysmal AF,2 gingival bleeding episodes,and 1 skin ecchymosis.In the female group,1 case experienced pulmonary embolism,1 paroxysmal atrial fibrillation,3 gingival bleeding episodes,2 skin ecchymoses,2 recurrent cerebral infarctions,and 2 recurrent TIAs.There was no statistical difference in overall adverse events between gender(P=0.291).Although the females had higher rates of recurrent cerebral infarction and TIA,this difference lacked statistical significance(P=0.222).Multivariate Cox regression analysis indicated that after adjusting for various potential confounding factors,such as RoPE score,age,hypertension,coronary heart disease,and other factors,gender was not an independent predictor of composite endpoint events after surgery.Conclusion Gender does not significantly affect overall prognosis after PFO closure in patients with cerebral infarction or TIA.However,females showed a trend toward higher rates of recurrent cerebral infarction and TIA.