Taking chronic atrophic gastritis （CAG） as an example， the frontier technologies in data science have been introduced into the inheritance， innovation and development of traditional Chinese medicine （TCM）， providing reference for conducting real-world clinical research on specialized diseases of TCM. This paper put forward the construction of CAG data science system by elaborating the connotation of data science and its application value in TCM， and discussed the path to build CAG data science system， namely through "data acquisition-knowledge expression-knowledge reasoning" to establish CAG database， knowledge base and develop diagnosis platform differentiating diseases and syndromes. Besides， this paper analyzed the prospects of CAG data science in improving data governance ability and knowledge discovery efficiency， deepening the level of knowledge sharing， promoting interdisciplinary integration， and strengthening the integration process of industry， academia and research.

Objective To analyze three-dimensional imaging characteristics and advantages for severe portal vein stenosis after liver transplantation, and to evaluate clinical efficacy of portal vein stent implantation. Methods Clinical data of 10 patients who received portal vein stent implantation for severe portal vein stenosis after liver transplantation were retrospectively analyzed. Imaging characteristics of severe portal vein stenosis, and advantages of three-dimensional reconstruction imaging and interventional treatment efficacy for severe portal vein stenosis were analyzed. Results Among 10 patients, 3 cases were diagnosed with centripetal stenosis, tortuosity angulation-induced stenosis in 2 cases, compression-induced stenosis in 2 cases, long-segment stenosis and/or vascular occlusion in 3 cases. Three-dimensional reconstruction images possessed advantages in accurate identification of stenosis, identification of stenosis types and measurement of stenosis length. All patients were successfully implanted with portal vein stents. After stent implantation, the diameter of the minimum diameter of portal vein was increased [(6.2±0.9) mm vs. (2.6±1.7) mm, P<0.05], the flow velocity at anastomotic site was decreased [(57±19) cm/s vs. (128±27) cm/s, P<0.05], and the flow velocity at the portal vein adjacent to the liver was increased [(41±6) cm/s vs. (18±6) cm/s, P<0.05]. One patient suffered from intrahepatic hematoma caused by interventional puncture, which was mitigated after conservative observation and treatment. The remaining patients did not experience relevant complications. Conclusions Three-dimensional visualization technique may visually display the location, characteristics and severity of stenosis, which is beneficial for clinicians to make treatment decisions and assist interventional procedures. Timely implantation of portal vein stent may effectively reverse pathological process and improve portal vein blood flow.

Objective:To analyze and discuss the clinical significance of preoperative planning and guidance based on three-dimensional reconstruction of perigastric vessels in precision surgery for gastric cancer.Methods:A prospective study was conducted to analyze the data of 50 patients with gastric cancer who received surgical treatment in Jiangyin People′s Hospital from December 2020 to December 2022, including 35 males and 15 females, aged from 38 to 79 years old, with an average age of 66.3 years old. All patients were divided into control group ( n=25) and experimental group ( n=25) according to random number table method. Both groups underwent enhanced multi-slice spiral CT scan of the chest, abdomen and pelvis before surgery. The experimental group underwent 3D reconstruction based on CT data for preoperative planning and guidance, while the control group did not undergo 3D reconstruction. Patients in both groups received radical surgery for gastric cancer. Operation time, intraoperative blood loss, total postoperative drainage volume, postoperative hospital stay, number of lymph node dissection and postoperative complications were compared between the two groups. The statistical software SPSS27.0 was used to obtain the relevant data analysis results. Results:The intraoperative blood loss, total drainage volume and postoperative hospital stay of the experimental group were lower than those of the control group( P<0.05). The operative time, number of lymph node dissection and postoperative complications of the experimental group were not significantly different from those of the control group( P>0.05). Conclusions:Preoperative three-dimensional reconstruction of gastric perivascular with CT data can provide better preoperative evaluation, surgical planning and intraoperative guidance, reduce intraoperative accidental vascular injury, blood loss, total postoperative drainage and postoperative hospital stay. It has positive clinical application value to complete accurate radical resection of gastric cancer.

Objective:To explore the impact of early and late antibody-mediated rejection (AMR) on treatment options and allograft outcomes after kidney transplantation (KT).Methods:From January 2013 to December 2022, the study retrospectively enrolled 141 KT allograft recipients receiving allograft biopsy and diagnosed as AMR according to the Banff 2019 criteria. Recipients with a diagnosis of AMR within 30 days post-KT were classified into early AMR group (n=19) while the remainders assigned as late AMR group (n=122). The outcome endpoints included recipient survival rate, death-censored graft survival rate, follow-up estimated glomerular filtration rate (eGFR) and immunodominant donor-specific antibody (DSA) intensity. Wilcoxon's test was utilized for assessing the differences in eGFR and DSA intensity while Kaplan-Meier curve and Log-rank test were employed for evaluating graft survival impact. Treatment regimens for AMR were collected and categorized.Results:The median follow-up duration was 2.6(1.2, 5.2) year. No graft failure was noted in early AMR group while 44 recipients in late AMR group experienced graft failure, with 34 cases (77.2%) due to AMR progression. The 5-year death-censored graft survival rate was significantly better in early AMR group than that in late AMR group [100% vs 60.1%(50.5%, 71.6%), P=0.002]. The one-year change in eGFR for early AMR group was significantly superior to that of late AMR group [19.3(-2.6, 38.1) vs -3.3(-14.0, 5.4), P=0.001]. One-year mean fluorescent intensity (MFI) of early AMR group was 1 158(401.5, 3 126.5). It was significantly lower than that when diagnosed with early AMR [3 120.5(2 392.8, 9 340.0)] and one-year MFI of late AMR group [8 094(2 251.5, 13 560.5)] ( P=0.005, P<0.001). Early AMR group primarily received standard treatment (3/19, 15.8%) and regimens centered on rituximab and/or bortezomib (7/19, 43.8%). Late AMR group mainly received standard (16/122, 13.1%) or intensified regimens (9/122, 7.4%) and regimens focused upon rituximab and/or bortezomib (32/122, 26.2%) and MP monotherapy (21/122, 17.2%). Conclusion:The outcome for early AMR is significantly better than that for late AMR. For early AMR, early and robust immunosuppression is recommended. For late AMR, early detection and timely treatment are crucial and individualized strategies should be implemented.

Objective:To investigate the correlation of human epidermal growth receptor 2 (HER2) with clinicopathological characteristics and its postoperative prognostic value in patients with gastric cancer.Methods:The clinicopathological data of 543 patients with gastric cancer who underwent open radical gastrectomy were retrospectively analyzed in the Gastrointestinal Surgery Department of Jiangyin People′s Hospital Affiliated to Southeast University from June 2011 to December 2016, including 404 males and 139 females, aged from 26 to 84 years old. According to the results of HER2 immunohistochemical staining, gastric cancer patients were divided into HER2 0+ group ( n=427), HER2 1+ group ( n=56), HER2 2+ group ( n=29) and HER2 3+ group ( n=31), and the differences in clinicopathological indicators of the four groups were compared. Furthermore, HER2 0+ and 1+ gastric cancer patients were classified as HER2-negative group( n=26), and HER2 3+ as HER2-positive group( n=26). Propensity score matching method was used to balance the basic data variables related to prognosis of the two groups, and Kaplan-Meier method was used for survival analysis. Cox risk regression model was used to analyze the risk factors associated with postoperative survival in patients with HER2-positive gastric cancer. Results:The overexpression rate of HER2 in gastric cancer patients was 5.7% (31/543). The expression level of HER2 was significantly correlated with gender ( χ2=8.30, P=0.040), tumor longitudinal location ( χ2=22.86, P=0.029) and histological differentiation ( χ2=13.27, P=0.004). There was no significant correlation between median survival time and HER2 expression level( χ2=5.44, P=0.142). After propensity score matching, the median survival time of gastric cancer in the HER2-positive group was 23 months. Univariate and multivariate analysis showed that ABO blood group ( HR: 1.619, 95% CI: 1.081-2.423, P=0.019) was an independent risk factor for prognosis of HER2-positive gastric cancer. Conclusion:The expression of HER2 is higher in men, cardia fundus and high and medium differentiated gastric adenocarcinoma, but there is no significant correlation between the expression level of HER2 and the median survival time of gastric cancer. ABO blood group may be an independent risk factor for the survival of HER2-positive gastric cancer.

Objective:To explore the value of monoenergetic imaging on dual-layer spectral detector CT combined with individual injection protocol of contrast medium in brain CT angiography (CTA).Methods:Seventy-six patients who underwent brain CTA on the Philips IQon dual-layer spectral detector CT and individual injection protocol of contrast medium in Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from August to November 2020 were retrospectively analyzed. Objective and subjective evaluation of image quality was performed in conventional energetic images (conventional group) which derived from 120 kVp hybrid iterative reconstruction algorithm and 50 keV virtual monoenergetic images (test group) which derived from spectral reconstruction algorithm. The objective evaluation content included CT values, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of internal carotid artery and middle cerebral artery, CT values and standard deviation (SD) of brain parenchyma. The subjective evaluation was completed by two senior radiologists according to the 5-point scale, and the inter-agreement between two radiologists was evaluated by Kappa test. Paired t test or Wilcoxon rank test was used for analysis between two groups. Results:The SNR and CNR of both internal carotid artery and middle cerebral artery, as well as CT values of internal carotid artery, middle cerebral artery and brain parenchyma, were significantly higher in test group than that in conventional group (all P<0.001). The subjective scores of two radiologists for test group were both 5 (5, 5) points, and the subjective scores for conventional group were both 4 (4, 4) points. The subjective scores of the radiologists were in good agreement, and the Kappa values were 0.74 and 0.84 respectively. The subjective scores of test group were significantly higher than that of conventional group ( Z=-11.15, P<0.001). Conclusion:Monoenergetic imaging on dual-layer spectral detector CT combined with individual injection protocol of contrast medium can improve SNR, CNR and the image quality of brain CTA.

Objective:To investigate the effect of early acupuncture treatment on limb function in patients with acute cerebral infarction (ACI).Methods:A total of 114 patients with first-episode ACI in our hospital from March 2018 to March 2019 were selected and randomly divided into three groups, 38 cases in each group. The control group was treated with conventional western medicine therapy, while the experimental group A and group B were given acupuncture treatment on the basis of the control group. The group A started treatment at 3rd days and the group B started at 10th day after admission. All three groups were treated for 2 weeks. The National Institute of Health Stroke Scale (NIHSS) was used to evaluate the degree of neurological deficit. The Fugl Meyer assessment of motor function (FAM) was used to evaluate the motor function. The Barthel Index (BI) was used to evaluate the activities of daily living, and the rehabilitation status was evaluated according to muscle strength grading. The levels of nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) were detected by ELISA to evaluate the clinical efficacy.Results:The total effective rate was 94.7% (36/38) in group A, 84.2% (30/38) in group B and 73.7% (22/38) in control group. The difference was statistically significant ( χ2=14.748, P<0.01). After treatment, NIHSS scores of three groups were significantly decreased ( F=97.619, P<0.01), and the scores of FAM, BI and muscle strength in group A were significantly lower than those in the group B ( t=12.580, P<0.01); FAM, BI scores and muscle strength of three groups were significantly increased ( F=134.525, 35.100, 164.160, all Ps<0.001), and those of group A were significantly higher than those in group B ( t=8.634, 7.260, 20.305, all Ps<0.001). After treatment, serum NGF (148.80 ± 22.17 pg/ml, 132.14 ± 20.40 pg/ml vs. 125.82 ± 18.31 pg/ml, F=12.926), BDNF (5.01 ± 1.14 ng/ml, 4.10 ± 1.09 ng/ml vs. 3.92 ± 0.95 ng/ml, F=11.481) in the group A and group B were significantly higher than those in the control group ( P<0.01), and serum NGF, BDNF in group A were significantly lower than those in the group B ( t=5.046, 5.277, all Ps<0.01). Conclusions:Early acupuncture treatment can increase the levels of serum NGF and BDNF, promote the recovery of nerve factors and limb function, and the curative effect of acupuncture treatment starting at 3rd days after admission is better than 10th day.

Objective:To investigate the application value of third-generation dual-source CT(3-G DSCT) low-dose scan mode combined with iterative reconstruction technology in the screening of COVID-19 and to evaluate the radiation dose.Methods:One hundred and twenty patients suspected of COVID-19 from December 2019 to February 2020 were retrospectively analysed and randomly divided into two groups (test group and conventional group, 60 patients in each). The parameters for test group included 3-G DSCT, Turbo Flash scan mode, CARE kV, with reference 90 kV, pitch 2.0, and ADMIRE algorithm, while those parameters for conventional group included the 128-slice CT, conventional spiral scan mode, 120 kV, pitch 1.2, and FBP algorithm. The CT values of aorta, spinal posterior muscle, and subcutaneous fat, the aortic noise, signal-to-noise ratio (SNR), and contrast noise ratio (CNR) were compared to evaluate the image quality between two groups. Two experienced doctors scored the image quality using a double-blind method, and compared the CT dose index volume (CTDI vol), dose-length product (DLP), and effective dose ( E) of the two groups. Results:The CT value of the aorta and spinal posterior muscle and the aortic SNR in the test group were (45.38±4.77), (53.41±8.44) HU, and 2.82±0.59, and significantly higher than those in the conventional group [(39.68±6.26), (42.66±6.32) HU, 2.58±0.61, t=5.608, 7.897, 2.162, P<0.05]. The aortic noise, CNR and subjective scores between the two groups had no significant difference( P>0.05). The CTDI vol, DLP, and E in the test group were (3.09±1.02) mGy, (107.57±32.81) mGy·cm, (1.51±0.46) mSv, significantly lower than those in the conventional group [(7.00±1.80) mGy, (261.65±73.93) mGy·cm, (3.66±1.03) mSv; t=-14.680, -14.756, -14.756, P<0.05]. Conclusions:In the screening of COVID-19, using low-dose scanning mode of 3-G DSCT combined with iterative reconstruction technology would provide diagnostic quality images and meanwhile effectively reduce the radiation dose and improve the SNR of the image.

Objective To compare the efficacy and safety of surgical thrombectomy with those of catheter-directed thrombolysis (CDT) in treating acute lower limb ischemia (ALLI) . Methods The clinical data of 107 patients with ALLI, who underwent CDT or surgical thrombectomy at authors' hospital during the period from January 2012 to December 2017, were retrospectively analyzed. The incidence of complications, mortality, re-intervention rate and amputation rate within 30 days after operation were calculated. Cooley standard of efficacy score was used to assess the clinical curative effect of patients with grade Ⅱ of American Society of Vascular Surgeons (SVS) and International Society of Cardiovascular Surgery (ISCVS) classification of acute limb ischemia. Results A total of 107 patients with ALLI were enrolled in this study. Among them, 59 patients received CDT therapy and 48 patients received surgical thrombectomy. The technical success rate of both groups was 100％. Within 30 days after operation, the incidence of complications in CDT group and surgical thrombectomy group was 11.9％ and 14.6％ respectively, the mortality was 5.1％ and 6.3％respectively, and the re-intervention rate was 17.0％ and 22.9％ respectively, all the differences were not statistically significant (P>0.05) . The amputation rate of patients with grade Ⅱ of SVS/ISCVS ischemia classification in CDT group was 8.9％, which was higher than 2.3％ in surgical thrombectomy group, but the difference between the two groups was not statistically significant (P>0.05) . In patients with grade Ⅱ of ischemia assessed by the ca uses and Cooley curative effect standard at the time of discharge, the cure percentage of embolism-caused ALLI patients in surgical thrombectomy group was 82.5％, which was remarkably higher than 62.8％ in CDT group (P <0.05) . The cure percentage of thrombosis-caused ALLI patients in CDT group was 92.3％, which was strikingly higher than 25.0％ in surgical thrombectomy group (P <0.05) . The difference in the improvement of ischemia, which was assessed by the duration of ischemia and Cooley therapeutic criteria at the time of discharge, between the two groups was not statistically significant (P>0.05) . Conclusion In treating ALLI, no significant differences in curative effect, incidence of postoperative complications and mortality exist between surgical thrombectomy and CDT. The formulation of therapeutic regimen should be based on ischemia grade of SVS/ISCVS, etiology and coexisting underlying diseases.

Objective: To explore the survival difference of patients with colon and rectal neuroendocrine neoplasm (NEN) at different stages. Methods: We identified 8 679 patients with colorectal NEN diagnosed between 1988 and 2014 from the Surveillance, Epidemiology, and End Results (SEER) registry, including 5 437 rectal NEN and 3 242 colon NEN ( 1 681 cecum NEN ). Survival curve was drawn by Kaplan-Meier method. Prognostic factors were analyzed by univariate analysis and multivariate Cox regression model. Results: The ratio of male patients with colon and rectal NEN was similar to female (P=0.095). Rectal NEN patients were younger (P<0.001), more highly differentiated (P<0.001), and with earlier stage (P<0.001). Survival analysis showed that the survival of rectal NEN was superior to that of colon NEN, with 10-year tumor-specific survival rates of 86.8% and 44.8% respectively (P<0.001). Multivariate Cox analysis showed that age, gender, marital status, primary tumor site, grade, stage and surgery were independent prognostic factors of colorectal NEN (all P<0.01). The most important factor was stage (HR=3.531), followed by differentiation grade (HR=1.856). Stratified analysis displayed that the survival of rectal NEN in stage Ⅰ, Ⅱ and Ⅳ were better than those of corresponding stage of colon NEN (all P<0.05), but worse in stage Ⅲ (P=0.012). While the survival of rectal NEN were significantly better than those of colon NEN within all stages after excluding 1681 cases of cecal NEN (all P<0.05). Among the patients with well-differentiated NEN, the survival of rectal NEN in stage Ⅰ, Ⅲ and Ⅳ were better than those of corresponding stage of colon NEN (all P<0.05) while there was no significant difference in stage Ⅱ(P=0.169). For poor-differentiated NEN, only the survival of rectal NEN patients in stage Ⅳ (P=0.001) was significant longer than those of colon NEN, while there was no significant difference in stage Ⅰ, Ⅱ and Ⅲ (stage Ⅰ: P=0.760; stage Ⅱ: P=0.181; stage Ⅲ: P=0.313). Conclusions The survival of NEN patients in colon and rectum is different. Cecum NEN should be considered as a separated tumor for prognostic analysis due to its special clinicopathologic characteristics.