Objective: To improve the efficiency and standardization of preoperative anemia diagnosis and treatment by establishing a systematic intelligent management platform for preoperative anemia. Methods: A multidisciplinary collaborative model was adopted to develop a preoperative anemia management system that integrates intelligent early warning, standardized treatment pathways, and quality control. The system utilizes natural language processing technology to automatically capture laboratory data and establish evidence-based medical decision support functions. A pre-post study design was employed to compare changes in preoperative anemia screening rates, preoperative anemia intervention rates, reasonable use of iron supplements, and perioperative red blood cell transfusion rates before and after system implementation. Results: After system implementation, the standardization of anemia diagnosis and treatment significantly improved: 1) Screening effectiveness: The anemia screening rate increased to 50.00% (an increase of 27.24%); 2) Intervention effectiveness: The anemia treatment rate rose to 56.30% (an increase of 14.02%); 3) Treatment standardization: The reasonable use rate of iron supplements increased to 55.33% (an increase of 21.02%); the red blood cell transfusion rate decreased to 18.29% (a decrease of 4.07%), and the amount of red blood cell transfusions was reduced by 291 units. Conclusion: This system achieves full-process management of preoperative anemia through information technology, significantly enhancing the standardization of diagnosis and treatment as well as intervention effectiveness, providing an effective solution for perioperative anemia management.

Esophageal cancer is a common malignant tumor of the digestive tract. At present， the pathogenesis of esophageal cancer has not been fully clarified. Although surgery， radiotherapy， chemotherapy， targeted therapy， and immunotherapy have achieved good clinical results in the treatment of esophageal cancer， there are still many complications and severe adverse reactions. As an important part of traditional Chinese medicine （TCM）， in recent years， many basic experiments and clinical studies have proved that Chinese medicine has a good effect in treating esophageal cancer. At the same time， the multi-component and multi-target characteristics of Chinese medicine and unclear pathogenesis of esophageal cancer determine that there are some problems such as unclear mechanisms of Chinese medicine in preventing and treating esophageal cancer. It is necessary to start with modern medicine and reveal the mechanism of Chinese medicine in preventing and treating diseases from the aspects of molecular biology and network pharmacology. It is believed in TCM that the occurrence of esophageal cancer is mostly attributed to stagnation of liver Qi， phlegm stasis and Qi stagnation， fluid consumption and heat accumulation， the decline of healthy Qi， and the cementation of cancer toxicity. According to the literature review， Chinese medicinal compounds mainly include tonic formulae （such as Liu Junzitang）， drying and moistening formulas （such as Qigesan）， and heat-clearing formulas （such as Fufang Kushen injection）. Chinese medicinal monomers mainly include drugs potent in attacking poison and killing insects， clearing heat， activating blood and resolving stasis， and regulating Qi， which is consistent with the etiology and pathogenesis of esophageal cancer in TCM. It is also found that Chinese medicine can promote cell apoptosis and autophagy， block cell cycle， and reverse cell resistance by regulating phosphatidylinositol 3-kinase/protein kinase B （PI3K/Akt）， neurogenic locus notch homolog protein （Notch）， Wnt/β-catenin， mitogen-activated protein kinase （MAPK）， nuclear factor-κB （NF-κB）， Janus kinase 2/signal transducer and activator of transcription 3 （JAK2/STAT3）， and other related signaling pathways， but there is no systematic summary. This study systematically summarized the relevant signaling pathways of Chinese medicine in regulating esophageal cancer， which is helpful to clarify the relevant mechanisms of Chinese medicine in the process of esophageal cancer occurrence， development， invasion， and metastasis， so as to provide new targets and new perspectives for the treatment of esophageal cancer and promote the modernization of TCM.

Objective:To analyze the relationship between Twist2 and the prognosis and vascular infiltration of ovarian cancer patients,and to explore the role and mechanism of Twist2 in vascular infiltration of ovarian cancer.Methods:KM plotter was used to explore the correaltion between Twist2 mRNA expression and overall survival(OS),progression free survival(PFS)and post progression survival(PPS)in ovarian cancer.To analyze the cor-relation between Twist2 and vascular infiltration in ovarian cancer using the cancer genomics database cBioPor-tal.In vitro experiment:Transwell method was employed to determine the role of Twist2 in the invasion and migra-tion abilities of ovarian cancer cell CAOV3[blank group,negative control group(siNC group),siTwist2 group].Uti-lizing Realtime-PCR and Western blot to clarify the changes in Twist2 and VEGFC expression in CAOV3 cells af-ter downregulating Twist2 expression at the RNA and protein levels,respectively.Results:①Online data analysis of KM plotter showed that the ovarian cancer patients with high expression of Twist2 were associated with poor prognosis,with OS(HR 1.24,95％Cl 1.01-1.52),PFS(HR 1.39,95％CI 1.14-1.70)and PPS(HR 1.37,95％CI 1.08-1.74)all showing statistical significance(P＜0.05).CBioportal analysis showed that Twist2 mRNA expression was positively correlated with vascular infiltration(r=0.93,P=0.001)and lymphatic infiltration(r=0.89,P=0.009)in ovarian cancer.②Compared with the blank group and siNC group,in vitro experiment Tran-swell assay showed that the invasion and migration ability of ovarian cancer cells in siTwist2 group was significant-ly reduced(P＜0.05).In mRNA and protein level,Realtime-PCR and Western blot showed that compared with the blank group and siNC group,the expression of Twist2,as well as VEGFC,were significantly reduced in the siTwist2 group(P＜0.05).Conclusions:The expression of Twist2 in ovarian cancer is closely related to tumor prognosis and vascular infiltration.After downregulating Twist2,the number of cells that migrate and invade is sig-nificantly reduced,and the expression of VEGFC is reduced.Twist2 can induce migration and invasion of ovarian cancer cells through VEGFC,which may be one of the indicators for prognosis evaluate and targeted therapy of ovarian cancer in future.

Objective:To analyze the electrocardiographic characteristics of patients with chronic pulmonary artery stenosis (PAS), and to explore their relationship with disease severity indicators.Methods:The study was a retrospective case-series analysis. Patients with chronic PAS admitted to Gansu Provincial Hospital from January 2018 to July 2021 were enrolled. The clinical data and the results of electrocardiography, transthoracic echocardiography, right cardiac catheterization, N-terminal B-type natriuretic peptide (NT-proBNP) measurement and 6-min walking distance test of patients were analyzed. The linear regression model or logistic regression model was used to analyze the relationship between electrocardiographic characteristics and the disease severity in patients with chronic PAS.Results:Sixty-three patients aged (62.1±9.7) years including 43 females (68.3%) were enrolled in the study. Among them, 62 patients (98.4%) had (R 1+S Ⅲ)-(S Ⅰ+R Ⅲ)<1.5 mV, and no patients had V 5lead R: S ratio to V 1 lead R: S<0.04 and V 6 lead R: S ratio<0.4. There were 55 patients (87.3%), with flat or inverted T-waves in V 1, and 10 patients (15.9%) with flat or inverted T-waves in all precordial leads (V 1-V 6). There were 18 patients (28.6%) with flat or inverted T-waves in inferior leads (Ⅱ, Ⅲ, aVF). Multiple liner regression analysis showed that Max R V1, 2+Max S I, aVL-S V1 combined with the number of flat or inverted T-waves in limb leads was independently correlated with atrial area ( R2=0.290, P=0.002); R V1+S V5 was independently correlated with right ventricular area ( R2=0.257, P=0.001); R peak V 1 combined with the number of flat or inverted T waves in precordial leads was independently correlated with tricuspid annular plane systolic excursion ( R2=0.407, P<0.001); (R 1+S Ⅲ)-(S Ⅰ+R Ⅲ) combined with the number of flat or inverted T waves in precordial leads was independently correlated with NT-proBNP ( R2=0.504, P<0.001); Max R V1, 2+Max S I, aVL-S V1 were independently correlated with right atrial pressure ( R2=0.803, P=0.036); (R 1+S Ⅲ)-(S Ⅰ+R Ⅲ) were independently correlated with mean pulmonary artery pressure ( R2=0.302, P<0.001); R aVRcombined with the number of flat or inverted T-waves in precordial leads was independently correlated with cardiac index ( R2=0.173, P=0.003); (R 1+S Ⅲ)-(S Ⅰ+R Ⅲ) was independently correlated with pulmonary vascular resistance ( R2=0.173, P=0.002); R peak V 1 combined with the number of flat or inverted T-waves in precordial leads was independently correlated with mixed vein oxygen saturation ( R2=0.302, P<0.001). Conclusion:The vast majority of patients with chronic PAS have (R 1+S Ⅲ)-(S Ⅰ+R Ⅲ)<1.5 mV and flat or inverted T-wave in V 1 lead, and some characteristic electrocardiographic manifestations are correlated with indicators of disease severity.

Objective:To study the clinical and immunological features of two case of rare antisynthetase syndrome (ASS), so as to improve the level of diagnosis and treatment.Methods:Two cases with rare antisynthetase syndrome admitted to the First Affiliated Hospital of Zhengzhou University from July 2020 to August 2022 were collected.Results:The two rare ASS were anti-Zo antibody and anti-Ha antibody positive patients, both of which had interstitial lung disease (ILD) as the main clinical manifestation and positive anti-Ro52 antibody. Two rare antisynthetase autoantibodies manifested cytoplasmic ANA indirect immunofluorescence (IIF) staining pattern, but it is different from the cytoplasmic dense speckled pattern of several common ASS antibodies. After treatment with glucocorticoids and immunosuppressants, case 1 died of respiratory failure due to a long course of disease and late diagnosis, the lung lesions of case 2 improved significantly.Conclusion:When encountering the cytoplasmic ANA fluorescent pattern in ILD patients, especially with anti-Ro52 antibody, it is necessary to screen more myositis specific antibodies to rule out the possibility of rare ASS.

Objective:To conduct a nationwide physician survey to better understand clinicians’ disease awareness, treatment patterns, and experience of Waldenstr?m macroglobulinemia (WM) in China.Methods:This cross-sectional study was conducted from February 2022 to July 2022 by recruiting clinicians with WM treatment experience from hematology, hematology-oncology, and oncology departments throughout China. Quantitative surveys were designed based on the qualitative interviews.Results:The study included 415 clinicians from 219 hospitals spread across thirty-three cities and twenty-two provinces. As for diagnosis, the laboratory tests prescribed by physicians for suspected WM patients were relatively consistent (92% -99% recommendation for laboratory, 79% -95% recommendation for pathology, 96% recommendation for gene testing, and 63% -83% recommendation for imaging examination). However, from a physician's perspective, there was 22% misdiagnosis occurred in clinical practice. The rate of misdiagnosis was higher in lower-level hospitals than in tertiary grade A hospitals (29% vs 21%, P<0.001). The main reasons for misdiagnosis were that WM was easily confused with other diseases, and physicians lacked the necessary knowledge to make an accurate diagnosis. In terms of gene testing in clinical practice, 96% of participating physicians believed that WM patients would require gene testing for MYD88 and CXCR4 mutations because the results of gene testing would aid in confirming diagnosis and treatment options. In terms of treatment, 55% of physicians thought that the most important goal was to achieve remission, while 54% and 51% of physicians wanted to improve laboratory and/or examination results and extend overall survival time, respectively. Among patients with treatment indications, physicians estimated that approximately 21% of them refused to receive treatment, mainly owing to a lack of affordable care and disease awareness. When selecting the most appropriate treatment regimens, physicians would consider patient affordability (63% ), comorbidity (61% ), and risk level (54% ). Regimens containing Bruton tyrosine kinase inhibitor (BTKi) were most widely recommended for both treatment-na?ve and relapsed/refractory patients (94% for all patients, 95% for treatment-na?ve patients, and 75% for relapsed/refractory patients), and most physicians recommended Ibrutinib (84% ). For those patients who received treatment, physicians reported that approximately 23% of patients did not comply with the treatment regimen due to a lack of affordability and disease awareness. Furthermore, 66% of physicians believe that in the future, increasing disease awareness and improving diagnosis rates is critical. Conclusions:This study is the first national physician survey of WM conducted in China. It systematically describes the issues that exist in WM diagnosis and treatment in China, such as a high rate of misdiagnosis, limited access to gene testing and new drugs, and poor patient adherence to treatment. Chinese doctors believe that improving doctors’ and patients’ understanding of WM is one of the most urgent issues that must be addressed right now.

Objective:To analyze the relationship between Twist2 and the prognosis and vascular infiltration of ovarian cancer patients,and to explore the role and mechanism of Twist2 in vascular infiltration of ovarian cancer.Methods:KM plotter was used to explore the correaltion between Twist2 mRNA expression and overall survival(OS),progression free survival(PFS)and post progression survival(PPS)in ovarian cancer.To analyze the cor-relation between Twist2 and vascular infiltration in ovarian cancer using the cancer genomics database cBioPor-tal.In vitro experiment:Transwell method was employed to determine the role of Twist2 in the invasion and migra-tion abilities of ovarian cancer cell CAOV3[blank group,negative control group(siNC group),siTwist2 group].Uti-lizing Realtime-PCR and Western blot to clarify the changes in Twist2 and VEGFC expression in CAOV3 cells af-ter downregulating Twist2 expression at the RNA and protein levels,respectively.Results:①Online data analysis of KM plotter showed that the ovarian cancer patients with high expression of Twist2 were associated with poor prognosis,with OS(HR 1.24,95％Cl 1.01-1.52),PFS(HR 1.39,95％CI 1.14-1.70)and PPS(HR 1.37,95％CI 1.08-1.74)all showing statistical significance(P＜0.05).CBioportal analysis showed that Twist2 mRNA expression was positively correlated with vascular infiltration(r=0.93,P=0.001)and lymphatic infiltration(r=0.89,P=0.009)in ovarian cancer.②Compared with the blank group and siNC group,in vitro experiment Tran-swell assay showed that the invasion and migration ability of ovarian cancer cells in siTwist2 group was significant-ly reduced(P＜0.05).In mRNA and protein level,Realtime-PCR and Western blot showed that compared with the blank group and siNC group,the expression of Twist2,as well as VEGFC,were significantly reduced in the siTwist2 group(P＜0.05).Conclusions:The expression of Twist2 in ovarian cancer is closely related to tumor prognosis and vascular infiltration.After downregulating Twist2,the number of cells that migrate and invade is sig-nificantly reduced,and the expression of VEGFC is reduced.Twist2 can induce migration and invasion of ovarian cancer cells through VEGFC,which may be one of the indicators for prognosis evaluate and targeted therapy of ovarian cancer in future.

Objective:To analyze the relationship between Twist2 and the prognosis and vascular infiltration of ovarian cancer patients,and to explore the role and mechanism of Twist2 in vascular infiltration of ovarian cancer.Methods:KM plotter was used to explore the correaltion between Twist2 mRNA expression and overall survival(OS),progression free survival(PFS)and post progression survival(PPS)in ovarian cancer.To analyze the cor-relation between Twist2 and vascular infiltration in ovarian cancer using the cancer genomics database cBioPor-tal.In vitro experiment:Transwell method was employed to determine the role of Twist2 in the invasion and migra-tion abilities of ovarian cancer cell CAOV3[blank group,negative control group(siNC group),siTwist2 group].Uti-lizing Realtime-PCR and Western blot to clarify the changes in Twist2 and VEGFC expression in CAOV3 cells af-ter downregulating Twist2 expression at the RNA and protein levels,respectively.Results:①Online data analysis of KM plotter showed that the ovarian cancer patients with high expression of Twist2 were associated with poor prognosis,with OS(HR 1.24,95％Cl 1.01-1.52),PFS(HR 1.39,95％CI 1.14-1.70)and PPS(HR 1.37,95％CI 1.08-1.74)all showing statistical significance(P＜0.05).CBioportal analysis showed that Twist2 mRNA expression was positively correlated with vascular infiltration(r=0.93,P=0.001)and lymphatic infiltration(r=0.89,P=0.009)in ovarian cancer.②Compared with the blank group and siNC group,in vitro experiment Tran-swell assay showed that the invasion and migration ability of ovarian cancer cells in siTwist2 group was significant-ly reduced(P＜0.05).In mRNA and protein level,Realtime-PCR and Western blot showed that compared with the blank group and siNC group,the expression of Twist2,as well as VEGFC,were significantly reduced in the siTwist2 group(P＜0.05).Conclusions:The expression of Twist2 in ovarian cancer is closely related to tumor prognosis and vascular infiltration.After downregulating Twist2,the number of cells that migrate and invade is sig-nificantly reduced,and the expression of VEGFC is reduced.Twist2 can induce migration and invasion of ovarian cancer cells through VEGFC,which may be one of the indicators for prognosis evaluate and targeted therapy of ovarian cancer in future.

Objective:To analyze the relationship between Twist2 and the prognosis and vascular infiltration of ovarian cancer patients,and to explore the role and mechanism of Twist2 in vascular infiltration of ovarian cancer.Methods:KM plotter was used to explore the correaltion between Twist2 mRNA expression and overall survival(OS),progression free survival(PFS)and post progression survival(PPS)in ovarian cancer.To analyze the cor-relation between Twist2 and vascular infiltration in ovarian cancer using the cancer genomics database cBioPor-tal.In vitro experiment:Transwell method was employed to determine the role of Twist2 in the invasion and migra-tion abilities of ovarian cancer cell CAOV3[blank group,negative control group(siNC group),siTwist2 group].Uti-lizing Realtime-PCR and Western blot to clarify the changes in Twist2 and VEGFC expression in CAOV3 cells af-ter downregulating Twist2 expression at the RNA and protein levels,respectively.Results:①Online data analysis of KM plotter showed that the ovarian cancer patients with high expression of Twist2 were associated with poor prognosis,with OS(HR 1.24,95％Cl 1.01-1.52),PFS(HR 1.39,95％CI 1.14-1.70)and PPS(HR 1.37,95％CI 1.08-1.74)all showing statistical significance(P＜0.05).CBioportal analysis showed that Twist2 mRNA expression was positively correlated with vascular infiltration(r=0.93,P=0.001)and lymphatic infiltration(r=0.89,P=0.009)in ovarian cancer.②Compared with the blank group and siNC group,in vitro experiment Tran-swell assay showed that the invasion and migration ability of ovarian cancer cells in siTwist2 group was significant-ly reduced(P＜0.05).In mRNA and protein level,Realtime-PCR and Western blot showed that compared with the blank group and siNC group,the expression of Twist2,as well as VEGFC,were significantly reduced in the siTwist2 group(P＜0.05).Conclusions:The expression of Twist2 in ovarian cancer is closely related to tumor prognosis and vascular infiltration.After downregulating Twist2,the number of cells that migrate and invade is sig-nificantly reduced,and the expression of VEGFC is reduced.Twist2 can induce migration and invasion of ovarian cancer cells through VEGFC,which may be one of the indicators for prognosis evaluate and targeted therapy of ovarian cancer in future.

Objective:To analyze the relationship between Twist2 and the prognosis and vascular infiltration of ovarian cancer patients,and to explore the role and mechanism of Twist2 in vascular infiltration of ovarian cancer.Methods:KM plotter was used to explore the correaltion between Twist2 mRNA expression and overall survival(OS),progression free survival(PFS)and post progression survival(PPS)in ovarian cancer.To analyze the cor-relation between Twist2 and vascular infiltration in ovarian cancer using the cancer genomics database cBioPor-tal.In vitro experiment:Transwell method was employed to determine the role of Twist2 in the invasion and migra-tion abilities of ovarian cancer cell CAOV3[blank group,negative control group(siNC group),siTwist2 group].Uti-lizing Realtime-PCR and Western blot to clarify the changes in Twist2 and VEGFC expression in CAOV3 cells af-ter downregulating Twist2 expression at the RNA and protein levels,respectively.Results:①Online data analysis of KM plotter showed that the ovarian cancer patients with high expression of Twist2 were associated with poor prognosis,with OS(HR 1.24,95％Cl 1.01-1.52),PFS(HR 1.39,95％CI 1.14-1.70)and PPS(HR 1.37,95％CI 1.08-1.74)all showing statistical significance(P＜0.05).CBioportal analysis showed that Twist2 mRNA expression was positively correlated with vascular infiltration(r=0.93,P=0.001)and lymphatic infiltration(r=0.89,P=0.009)in ovarian cancer.②Compared with the blank group and siNC group,in vitro experiment Tran-swell assay showed that the invasion and migration ability of ovarian cancer cells in siTwist2 group was significant-ly reduced(P＜0.05).In mRNA and protein level,Realtime-PCR and Western blot showed that compared with the blank group and siNC group,the expression of Twist2,as well as VEGFC,were significantly reduced in the siTwist2 group(P＜0.05).Conclusions:The expression of Twist2 in ovarian cancer is closely related to tumor prognosis and vascular infiltration.After downregulating Twist2,the number of cells that migrate and invade is sig-nificantly reduced,and the expression of VEGFC is reduced.Twist2 can induce migration and invasion of ovarian cancer cells through VEGFC,which may be one of the indicators for prognosis evaluate and targeted therapy of ovarian cancer in future.