Objective:To examine the prevalence of malnutrition and evaluate the impact of nutritional support on clinical outcomes in elderly patients diagnosed with gastric and colorectal cancer.Methods:A retrospective cohort study was conducted, analyzing elderly patients with gastrointestinal tumors who underwent surgical treatment in the general surgery department from January 2019 to June 2020.The Global Leadership Initiative on Malnutrition(GLIM)criteria were utilized to diagnose malnutrition, and the effects of malnutrition and nutritional support on clinical prognosis were investigated.Results:A total of 426 elderly hospitalized patients with gastric and colorectal tumors who underwent surgical treatment were included in this study.This cohort comprised 199 cases of gastric cancer and 227 cases of colorectal cancer, with ages ranging from 65 to 91 years(mean age: 72.05±5.99).According to the GLIM criteria, 43.7%(186/426)of the patients were diagnosed with malnutrition, of which 25.6%(109/426)were moderately malnourished and 18.1%(77/426)were severely malnourished.Among the gastric cancer patients, 73.4%(146/199)were identified as having nutritional risk, with 48.7%(97/199)being malnourished and 22.6%(45/199)experiencing severe malnutrition.In the colorectal cancer group, 63.9%(145/227)were at nutritional risk, 39.2%(89/227)were malnourished, and 14.1%(32/227)had severe malnutrition.Additionally, 60.3%(257/426)of the patients received nutritional support therapy: 25.4%(108/426)received parenteral nutrition(PN), 11.3%(48/426)received enteral nutrition(EN), 23.7%(101/426)received a combination of EN and PN, while 39.7%(169/426)did not receive any nutritional support.Regardless of the presence or degree of malnutrition, patients who received nutritional support had significantly shorter total hospital stays compared to those who did not receive nutritional support, and this difference was statistically significant( t=5.58, 3.69, 2.21, 3.03, all P<0.05). Conclusions:Providing nutritional support to malnourished patients can reduce the length of hospital stay and improve clinical outcomes.

Purpose To analyze CT and MRI manifestations of rare primary malignant liver tumors in adults to improve the diagnostic accuracy.Materials and Methods This retrospective study analyzed imaging,clinical and pathological data from 28 patients with pathologically confirmed rare primary malignant liver tumors at the Affiliated Hospital of Zunyi Medical University(April 2011 to July 2024).Clinical presentations,laboratory findings,and CT/MRI characteristics of different tumor types were evaluated.Results The cohort included eight cases of hepatic sarcomatoid carcinoma,eight of primary hepatic lymphoma,six of primary hepatic gastrointestinal stromal tumor,three of intrahepatic biliary cystadenocarcinoma,and three of hepatic adenosquamous carcinoma.Distinct imaging features were observed:all eight sarcomatoid carcinomas presented as solitary,large cystic-solid masses;three showed progressive or persistent enhancement of solid components/septae,with four demonstrating portal vein tumor thrombus.Seven cases of primary hepatic lymphomas appeared as homogeneous,round/oval lesions,with one case restricted diffusion on diffusion weighted imaging,and seven cases exhibited mild homogeneous enhancement;two exhibited the vessel penetration sign;all six primary hepatic gastrointestinal stromal tumors manifested as cystic-solid masses with extensive central necrosis;two showed peripheral pseudocapsules while four had tortuous feeding vessels,with mild-to-moderate persistent enhancement of solid components;all three intrahepatic biliary cystadenocarcinomas occurred in the left lobe,presenting as multilocular cystic lesions with papillary mural nodules showing variable enhancement of walls,septations and nodules;two adenosquamous carcinomas demonstrated irregular morphology with distal biliary dilation and predominant delayed enhancement.Conclusion Imaging diagnosis of rare primary malignant liver tumors remains challenging.While some lesions demonstrate characteristic features,pathological confirmation remains essential for definitive diagnosis.

Purpose To analyze CT and MRI manifestations of rare primary malignant liver tumors in adults to improve the diagnostic accuracy.Materials and Methods This retrospective study analyzed imaging,clinical and pathological data from 28 patients with pathologically confirmed rare primary malignant liver tumors at the Affiliated Hospital of Zunyi Medical University(April 2011 to July 2024).Clinical presentations,laboratory findings,and CT/MRI characteristics of different tumor types were evaluated.Results The cohort included eight cases of hepatic sarcomatoid carcinoma,eight of primary hepatic lymphoma,six of primary hepatic gastrointestinal stromal tumor,three of intrahepatic biliary cystadenocarcinoma,and three of hepatic adenosquamous carcinoma.Distinct imaging features were observed:all eight sarcomatoid carcinomas presented as solitary,large cystic-solid masses;three showed progressive or persistent enhancement of solid components/septae,with four demonstrating portal vein tumor thrombus.Seven cases of primary hepatic lymphomas appeared as homogeneous,round/oval lesions,with one case restricted diffusion on diffusion weighted imaging,and seven cases exhibited mild homogeneous enhancement;two exhibited the vessel penetration sign;all six primary hepatic gastrointestinal stromal tumors manifested as cystic-solid masses with extensive central necrosis;two showed peripheral pseudocapsules while four had tortuous feeding vessels,with mild-to-moderate persistent enhancement of solid components;all three intrahepatic biliary cystadenocarcinomas occurred in the left lobe,presenting as multilocular cystic lesions with papillary mural nodules showing variable enhancement of walls,septations and nodules;two adenosquamous carcinomas demonstrated irregular morphology with distal biliary dilation and predominant delayed enhancement.Conclusion Imaging diagnosis of rare primary malignant liver tumors remains challenging.While some lesions demonstrate characteristic features,pathological confirmation remains essential for definitive diagnosis.

Objective:To examine the prevalence of malnutrition and evaluate the impact of nutritional support on clinical outcomes in elderly patients diagnosed with gastric and colorectal cancer.Methods:A retrospective cohort study was conducted, analyzing elderly patients with gastrointestinal tumors who underwent surgical treatment in the general surgery department from January 2019 to June 2020.The Global Leadership Initiative on Malnutrition(GLIM)criteria were utilized to diagnose malnutrition, and the effects of malnutrition and nutritional support on clinical prognosis were investigated.Results:A total of 426 elderly hospitalized patients with gastric and colorectal tumors who underwent surgical treatment were included in this study.This cohort comprised 199 cases of gastric cancer and 227 cases of colorectal cancer, with ages ranging from 65 to 91 years(mean age: 72.05±5.99).According to the GLIM criteria, 43.7%(186/426)of the patients were diagnosed with malnutrition, of which 25.6%(109/426)were moderately malnourished and 18.1%(77/426)were severely malnourished.Among the gastric cancer patients, 73.4%(146/199)were identified as having nutritional risk, with 48.7%(97/199)being malnourished and 22.6%(45/199)experiencing severe malnutrition.In the colorectal cancer group, 63.9%(145/227)were at nutritional risk, 39.2%(89/227)were malnourished, and 14.1%(32/227)had severe malnutrition.Additionally, 60.3%(257/426)of the patients received nutritional support therapy: 25.4%(108/426)received parenteral nutrition(PN), 11.3%(48/426)received enteral nutrition(EN), 23.7%(101/426)received a combination of EN and PN, while 39.7%(169/426)did not receive any nutritional support.Regardless of the presence or degree of malnutrition, patients who received nutritional support had significantly shorter total hospital stays compared to those who did not receive nutritional support, and this difference was statistically significant( t=5.58, 3.69, 2.21, 3.03, all P<0.05). Conclusions:Providing nutritional support to malnourished patients can reduce the length of hospital stay and improve clinical outcomes.

Objective:To analyze the medical service utilization preference of middle-aged and elderly residents (aged 45 and above) in Chongqing,and provide references for the local government to further promote the hierarchical diagnosis and improve the equity and efficiency of medical service utilization. Methods:Using a discrete choice experiment method,the preferences of 576 Chongqing residents,middle-aged and elderly,under conditions of mild and severe illness were measured for 6 attributes:medical service level,doctor's level,medical service mode,registration difficulty,drug supply and medical expenses. Results:Among patients with mild conditions,the attribute level most valued is"ability to register on the same day or the next day"(β=0.298,P<0.001) . They also prefer services from lower-level medical institutions and general practitioners (β=-0.200),as well as medical services with less cost (β=-0.003) . For patients with severe conditions,the attribute level they value the most is the medical service level (authoritative hospitals)(β=0.401,P<0.001),and they prefer services with ample drug supply (β=0.223),specialists (β=0.210),specialized departments (β=0.153),and higher costs (β=0.002) . The willingness to pay for patient shows an overall lower tendency for mild conditions and a higher one for severe conditions. Conclusion:Primary healthcare institutions have played a positive role in diverting patients,yet the tiered diagnosis and treatment system still requires ongoing improvement. Patients with mild conditions prefer convenient medical services,whereas those with severe conditions favor high-quality medical services. Under the burden of serious illness,medical expenses is a secondary factor influencing patients' choice of medical care. It is recommended to enhance the capacity and accessibility of high-quality medical resources,improving infrastructure and equipment at the primary level,expanding the availability of medications at these facilities,increasing the efficiency of specialist utilization,and strengthening the coordination among healthcare delivery,medical insurance,and pharmaceutical services—the"three-medicine linkage",address the difficulties and high costs of medical treatment experienced by the public,and achieve the goal of enabling residents to access affordable,high-quality health services locally.

Objective To evaluate the effect of preoperative metabolic syndrome on early function of renal allografts in allogeneic kidney transplant recipients.Methods Clinical data of 117 kidney transplant recipients were retrospectively analyzed.According to the renal allograft function,they were divided into the delayed graft function(DGF)group(n=29)and non-DGF group(n=88).Relevant risk factors of DGF in recipients undergoing allogeneic kidney transplantation were assessed by univariate and multivariate regression analyses.The effect of preoperative metabolic syndrome on early function of renal allografts was analyzed.Results Among 117 kidney transplant recipients,47 cases were complicated with preoperative metabolic syndrome,and 29 cases developed postoperative DGF.In the DGF group,83％of the recipients were complicated with preoperative metabolic syndrome,higher than 74％in the non-DGF group(P＜0.05).Univariate analysis showed that the body mass index(BMI)and terminal serum creatinine(Scr)level of the donors,and BMI,blood glucose level,triglyceride level and the proportion of preoperative metabolic syndrome of the recipients in the DGF group were higher than those in the non-DGF group(all P＜0.05).Multivariate logistic regression analysis revealed that high Scr levels of the donors,high hemoglobin levels of the recipients and preoperative metabolic syndrome of the recipients were the independent risk factors for DGF after kidney transplantation(all P＜0.05).Conclusions Preoperative metabolic syndrome is an independent risk factor for DGF in allogeneic kidney transplant recipients.Corresponding measures should be taken to lower the incidence of DGF and other metabolic complications.

The rapid development of digital intelligence technologies is providing a powerful boost to the high-quality development of the healthcare system.Considering the current state of our healthcare services and guided by General Secretary Xi Jinping's insights on new quality productive forces and the directives from Third Plenary Session of Communist Party of China's 20th Central Committee,the high-quality development of the healthcare service system should focus on digital intelligence technologies such as cloud computing,big data,privacy computing,blockchain,Internet of Things(IoT),mobile computing,and AI.The key measures should include the optimization of production factors,services,and governance.Emphasis should be placed on enhancing the efficient and intensive development of the development model,ensuring the high-quality and continuous integration of the supply model,and transitioning to scientific and modern management methods.Herein,we analyzed the"factor optimization—service optimization—governance optimization"development mechanism driven by digital intelligence and proposed corresponding implementation pathways,intending to provide references for establishing a high-quality and efficient healthcare service system with Chinese characteristics.

Objective:To analyze the medical service utilization preference of middle-aged and elderly residents (aged 45 and above) in Chongqing,and provide references for the local government to further promote the hierarchical diagnosis and improve the equity and efficiency of medical service utilization. Methods:Using a discrete choice experiment method,the preferences of 576 Chongqing residents,middle-aged and elderly,under conditions of mild and severe illness were measured for 6 attributes:medical service level,doctor's level,medical service mode,registration difficulty,drug supply and medical expenses. Results:Among patients with mild conditions,the attribute level most valued is"ability to register on the same day or the next day"(β=0.298,P<0.001) . They also prefer services from lower-level medical institutions and general practitioners (β=-0.200),as well as medical services with less cost (β=-0.003) . For patients with severe conditions,the attribute level they value the most is the medical service level (authoritative hospitals)(β=0.401,P<0.001),and they prefer services with ample drug supply (β=0.223),specialists (β=0.210),specialized departments (β=0.153),and higher costs (β=0.002) . The willingness to pay for patient shows an overall lower tendency for mild conditions and a higher one for severe conditions. Conclusion:Primary healthcare institutions have played a positive role in diverting patients,yet the tiered diagnosis and treatment system still requires ongoing improvement. Patients with mild conditions prefer convenient medical services,whereas those with severe conditions favor high-quality medical services. Under the burden of serious illness,medical expenses is a secondary factor influencing patients' choice of medical care. It is recommended to enhance the capacity and accessibility of high-quality medical resources,improving infrastructure and equipment at the primary level,expanding the availability of medications at these facilities,increasing the efficiency of specialist utilization,and strengthening the coordination among healthcare delivery,medical insurance,and pharmaceutical services—the"three-medicine linkage",address the difficulties and high costs of medical treatment experienced by the public,and achieve the goal of enabling residents to access affordable,high-quality health services locally.

Objective:To compare the detection rate of genital Chlamydia trachomatis (CT) DNA between urine and urethral/cervical swab samples. Methods:From December 2018 to December 2019, a total of 1 475 outpatients were collected from sexually transmitted disease clinics in 7 medical institutions, such as Department of Venereology, Guangzhou Institute of Dermatology, including 1 118 males and 357 females. One urethral/cervical swab sample and one urine sample were collected successively from each patient. Real-time fluorescence-based PCR was performed to detect CT DNA in urine and urethral/cervical swab samples, and paired chi-square test was used to compare the positive rate of CT DNA between the 2 kinds of samples. Random- or fixed-effect meta-analysis was conducted for the test of heterogeneity and merging of positive rates of CT DNA in the urine and urethral/cervical swabs among 7 medical institutions.Results:The positive rate of CT DNA in the urine samples was significantly higher than that in the swab samples from 4 medical institutions (all P < 0.05) , while there was no significant difference in the positive rate of CT DNA between the 2 kinds of samples from 3 medical institutions (all P > 0.05) . The heterogeneity ( I2) estimates of the CT-DNA positive rate in urine and swab samples among different medical institutions were 78.6% (95% CI: 55.9% - 89.6%) and 73.7% (95% CI: 43.7% - 87.7%) , respectively; meta-analysis showed that the total merged positive rate of CT DNA in the urine samples was 10.8% (95% CI: 7.2% - 15.9%) , which was significantly higher than that in the swab samples (7.8%, 95% CI: 4.9% - 12.1%; χ2 = 39.2, P < 0.05) . Compared with the swab sample-based CT-DNA detection method, the sensitivity, specificity, positive predictive value, negative predictive value and consistency rate of the urine sample-based CT-DNA detection method were 97.0% (128/132) , 96.3% (1 293/1 343) , 71.9% (128/178) , 99.7% (1 293/1 297) , and 96.3% (1 421/1 475) , respectively. The positive rate of CT DNA in the urine samples from 1 118 male patients was 11.0% (95% CI: 7.2% - 16.5%) , which was significantly higher than that in the swab samples (7.6%, 95% CI: 4.9% - 11.8%; χ2 = 34.3, P < 0.05) . There was no significant difference in the positive rate of CT DNA between the urine (11.9%, 95% CI: 7.7% - 17.9%) and cervical swab samples from 357 female patients (10.4%, 95% CI: 7.6% - 14.0%; χ2 = 3.2, P > 0.05) . Conclusions:The positive rate of CT DNA in urine samples is higher than or similar to that in urethral/cervical swab samples. The urine sample-based CT-DNA detection method has characteristics of convenience, non-invasiveness, painlessness and low cost, and is worthy of clinical promotion.

OBJECTIVETo detect mutations of SLC25A13 gene in 20 families affected with citrin deficiency and provide prenatal diagnosis for them.

METHODSThe 20 probands and their parents were subjected to high-frequency mutation screening combined with Sanger sequencing. After confirming the genotype of each pedigree, genetic counseling and prenatal diagnosis were performed for their subsequent pregnancies.

RESULTSBiallelic pathogenic mutations of the SLC25A13 gene were identified in all probands. These included three deletions (c.851del4, c.1092_1095delT, and c.495delA), two splice-site mutations (IVS6+5G to A and IVS11+1G to A), two nonsense mutations (c.775C to T (p.Q259X) and c.72T to A (p.Y24X)), one duplication mutation (c.1638_1660dup), one insertion (IVSl6ins3kb), and one missense mutation (c.1775A to C (p.Q592P)). Among 24 fetuses undergoing prenatal diagnosis, 8 had normal genotypes, 11 were mutation carriers, while 5 harbored biallelic mutations. Those with wild type alleles or heterozygous SLC25A13 mutations were delivered. Two fetuses harboring homozygous c.851del4 mutations were also delivered. Three fetuses harboring biallelic mutations were terminated.

CONCLUSIONAnalysis of SLC25A13 gene mutations in families affected by citrin deficiency can provide evidence for molecular diagnosis and facilitate genetic counseling and prenatal diagnosis for the subsequent pregnancy, which can effectively reduce the risk of birth of further affected children.