Composed of professionals from all walks of life, Rotary International is the largest non-governmental volunteer service organization with the longest tradition in the world. Through providing various social services ...Composed of professionals from all walks of life, Rotary International is the largest non-governmental volunteer service organization with the longest tradition in the world. Through providing various social services and humanitarian assistance, it encourages high ethical standards展开更多
This paper aims to explore the construct validity of long dialogue multiple-choice (MC) listening comprehension tests through examining the retrospective verbal reports of eight Chinese EFL test-takers at tertiary lev...This paper aims to explore the construct validity of long dialogue multiple-choice (MC) listening comprehension tests through examining the retrospective verbal reports of eight Chinese EFL test-takers at tertiary level. It is found that the grammatical knowledge, discourse knowledge, pragmatic knowledge and sociolinguistic knowledge of language competence and all the cognitive and metacognitive strategies proposed in the framework of listening constructs are measured in the tests, which supports the constr...展开更多
This year marks the 10-year anniversary of the strategy on development of China’s western region. With a land area of 6.85 million square km, accounting for 71.4 percent of the country’s total, the western region ha...This year marks the 10-year anniversary of the strategy on development of China’s western region. With a land area of 6.85 million square km, accounting for 71.4 percent of the country’s total, the western region has been an indispensable part in achieving China’s overall prosperity展开更多
BACKGROUND The objective of the current study was to elucidate the clinical mechanism through which phospholipase D2(PLD2)exerted a regulatory effect on neutrophil migra-tion,thereby alleviating the progression of acu...BACKGROUND The objective of the current study was to elucidate the clinical mechanism through which phospholipase D2(PLD2)exerted a regulatory effect on neutrophil migra-tion,thereby alleviating the progression of acute pancreatitis.AIM To elucidate the clinical mechanism through which PLD2 exerted a regulatory effect on neutrophil migration,thereby alleviating the progression of acute pan-creatitis.METHODS The study involved 90 patients diagnosed with acute pancreatitis,admitted to our hospital between March 2020 and November 2022.A retrospective analysis was conducted,categorizing patients based on Ranson score severity into mild(n=25),moderate(n=30),and severe(n=35)groups.Relevant data was collected for each group.Western blot analysis assessed PLD2 protein expression in patient serum.Real-time reverse transcription polymerase chain reaction was used to evaluate the mRNA expression of chemokine receptors associated with neutrophil migration.Serum levels of inflammatory factors in patients were detected using enzyme-linked immunosorbent assay.Transwell migration tests were conducted to compare migration of neutrophils across groups and analyze the influence of PLD2 on neutrophil migration.RESULTS Overall data analysis did not find significant differences between patient groups(P>0.05).The expression of PLD2 protein in the severe group was lower than that in the moderate and mild groups(P<0.05).The expression level of PLD2 in the moderate group was also lower than that in the mild group(P<0.05).The severity of acute pancreatitis is negatively correlated with PLD2 expression(r=-0.75,P=0.002).The mRNA levels of C-X-C chemokine receptor type 1,C-X-C chemokine receptor type 2,C-C chemokine receptor type 2,and C-C chemokine receptor type 5 in the severe group are significantly higher than those in the moderate and mild groups(P<0.05),and the expression levels in the moderate group are also higher than those in the mild group(P<0.05).The levels of C-reactive protein,tumor necrosis factor-α,interleukin-1β,and interleukin-6 in the severe group were higher than those in the moderate and mild groups(P<0.05),and the levels in the moderate group were also higher than those in the mild group(P<0.05).The number of migrating neutrophils in the severe group was higher than that in the moderate and mild groups(P<0.05),and the moderate group was also higher than the mild group(P<0.05).In addition,the number of migrating neutrophils in the mild group combined with PLD2 inhibitor was higher than that in the mild group(P<0.05),and the number of migrating neutrophils in the moderate group combined with PLD2 inhibitor was higher than that in the moderate group(P<0.05).The number of migrating neutrophils in the severe group+PLD2 inhibitor group was significantly higher than that in the severe group(P<0.05),indicating that PLD2 inhibitors significantly stimulated neutrophil migration.CONCLUSION PLD2 exerted a crucial regulatory role in the pathological progression of acute pancreatitis.Its protein expression varied among patients based on the severity of the disease,and a negative correlation existed between PLD2 expression and disease severity.Additionally,PLD2 appeared to impede acute pancreatitis progression by limiting neutrophil migration.展开更多
BACKGROUND Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outco...BACKGROUND Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outcomes.Existing studies have investigated risk factors for POD,but most are limited by single-factor analyses or small sample sizes.This study systematically determines independent risk factors using large-scale data and machine learning techniques and develops a validated nomogram model to support early prediction and management of POD.AIM To investigate POD incidence in elderly patients with HF and the independent risk factors,according to which a nomogram prediction model was developed and validated.METHODS This retrospective study included elderly patients with HF who were surgically treated in Dongying People’sHospital from April 2018 to April 2022. The endpoint event includes POD. They were categorized into themodeling and validation cohorts in a 7:3 ratio by randomization. Both cohorts were further classified into thedelirium and normal (non-delirium) groups according to the presence or absence of the endpoint event. Theincidence of POD was calculated, and logistic multivariate analysis was conducted to determine the independentrisk factors. The calibration curve and the Hosmer-Lemeshow test as well as the net benefit threshold probabilityinterval by the decision curve were utilized to statistically validate the accuracy of the nomogram predictionmodel, developed according to each factor’s influence intensity.RESULTSThis study included 532 elderly patients with HF, with an overall POD incidence of 14.85%. The comparison ofbaseline data with perioperative indicators revealed statistical differences in age (P < 0.001), number of comorbidities(P = 0.042), American Society of Anesthesiologists grading (P = 0.004), preoperative red blood cell(RBC) count (P < 0.001), preoperative albumin (P < 0.001), preoperative hemoglobin (P < 0.001), preoperativeplatelet count (P < 0.001), intraoperative blood loss (P < 0.001), RBC transfusion of ≥ 2 units (P = 0.001), andpostoperative intensive care unit care (P < 0.001) between the delirium and non-delirium groups. The participantswere randomized to a training group (n = 372) and a validation group (n = 160). A score-risk nomogram predictionmodel was developed after screening key POD features using Lasso regression, support vector machine, and therandom forest method. The nomogram showed excellent discriminatory capacity with area under the curve of0.833 [95% confidence interval (CI) interval: 0.774-0.888] in the training group and 0.850 (95%CI: 0.718-0.982) in thevalidation group. Calibration curves demonstrated good agreement between predicted and actual probabilities,and decision curve analysis confirmed clinical net benefits within risk thresholds of 0%-30% and 0%-36%, respectively.The model has strong accuracy and clinical utility for predicting the risk of POD.CONCLUSIONThis study reveals cognitive impairment history, American Society of Anesthesiologists grade of > 2, RBCtransfusion of ≥ 2 units, postoperative intensive care unit care, and preoperative hemoglobin level as independentrisk factors for POD in elderly patients with HF. The developed nomogram model demonstrates excellent accuracyand stability in predicting the risk of POD, which is recommended to be applied in clinical practice to optimizepostoperative management and reduce delirium incidence.展开更多
Lung cancer, the leading cause of cancer deaths worldwide and in China, has a 19.7% five-year survival rate due to terminal-stage diagnosis^([1-3]).Although low-dose computed tomography(CT) screening can reduce mortal...Lung cancer, the leading cause of cancer deaths worldwide and in China, has a 19.7% five-year survival rate due to terminal-stage diagnosis^([1-3]).Although low-dose computed tomography(CT) screening can reduce mortality, high false positive rates can create economic and psychological burdens.展开更多
BACKGROUND Pancreatic cancer remains one of the most lethal malignancies worldwide,with a poor prognosis often attributed to late diagnosis.Understanding the correlation between pathological type and imaging features ...BACKGROUND Pancreatic cancer remains one of the most lethal malignancies worldwide,with a poor prognosis often attributed to late diagnosis.Understanding the correlation between pathological type and imaging features is crucial for early detection and appropriate treatment planning.AIM To retrospectively analyze the relationship between different pathological types of pancreatic cancer and their corresponding imaging features.METHODS We retrospectively analyzed the data of 500 patients diagnosed with pancreatic cancer between January 2010 and December 2020 at our institution.Pathological types were determined by histopathological examination of the surgical spe-cimens or biopsy samples.The imaging features were assessed using computed tomography,magnetic resonance imaging,and endoscopic ultrasound.Statistical analyses were performed to identify significant associations between pathological types and specific imaging characteristics.RESULTS There were 320(64%)cases of pancreatic ductal adenocarcinoma,75(15%)of intraductal papillary mucinous neoplasms,50(10%)of neuroendocrine tumors,and 55(11%)of other rare types.Distinct imaging features were identified in each pathological type.Pancreatic ductal adenocarcinoma typically presents as a hypodense mass with poorly defined borders on computed tomography,whereas intraductal papillary mucinous neoplasms present as characteristic cystic lesions with mural nodules.Neuroendocrine tumors often appear as hypervascular lesions in contrast-enhanced imaging.Statistical analysis revealed significant correlations between specific imaging features and pathological types(P<0.001).CONCLUSION This study demonstrated a strong association between the pathological types of pancreatic cancer and imaging features.These findings can enhance the accuracy of noninvasive diagnosis and guide personalized treatment approaches.展开更多
BACKGROUND Chronic hepatitis B often progresses silently toward hepatocellular carcinoma(HCC),a leading cause of mortality worldwide.Early detection of HCC is crucial,yet challenging.AIM To investigate the role of dyn...BACKGROUND Chronic hepatitis B often progresses silently toward hepatocellular carcinoma(HCC),a leading cause of mortality worldwide.Early detection of HCC is crucial,yet challenging.AIM To investigate the role of dynamic changes in alkaline phosphatase to prealbumin ratio(APR)in hepatitis B progression to HCC.METHODS Data from 4843 patients with hepatitis B(January 2015 to January 2024)were analyzed.HCC incidence rates in males and females were compared using the log-rank test.Data were evaluated using Kaplan–Meier analysis.The Linear Mixed-Effects Model was applied to track the fluctuation of APR levels over time.Furthermore,Joint Modeling of Longitudinal and Survival data was employed to investigate the temporal relationship between APR and HCC risk.RESULTS The incidence of HCC was higher in males.To ensure the model’s normality assumption,this study applied a logarithmic transformation to APR,yielding ratio.Ratio levels were higher in females(t=5.26,P<0.01).A 1-unit increase in ratio correlated with a 2.005-fold higher risk of HCC in males(95%CI:1.653-2.431)and a 2.273-fold higher risk in females(95%CI:1.620-3.190).CONCLUSION Males are more prone to HCC,while females have higher APR levels.Despite no baseline APR link,rising APR indicates a higher HCC risk.展开更多
This paper purports to expound a special(technical)notion of paths.A neglected fundamental fact(especially under indeterminism)is that the path-dependent direction of any diachronic outcome is backward,i.e.,later step...This paper purports to expound a special(technical)notion of paths.A neglected fundamental fact(especially under indeterminism)is that the path-dependent direction of any diachronic outcome is backward,i.e.,later steps depend on earlier ones successively,despite the ineradicable chance in their respective formation.In this paper,a token-oriented retrospective approach is proposed to overcome the limitation of the type-oriented approach in explaining path-related phenomena.My argument for the validity and utility of this approach is largely based on the elements of(PD),a definitional schema for diachronic sequences subject to a recursive counterfactual formula.I explore certain aspects of path individuation that have so far not been discussed,despite(PD)’s formal congeniality with Lewis’s‘causal chain’.Two basic patterns of path generation are examined:the first is for distinguishing actual vs possible branching paths,while the second introduces a metaphysical theme regarding the retrospective grounding of the causal status of an upstream event by its downstream(joint)effect.A central example of the paper,viz.,the Gobang game,is used to illustrate how the token-oriented approach works for path individuation.展开更多
OBJECTIVE The emergence of evolving variants of Coronavirus disease 2019(COVID-19)has fostered the need for change of newer and adaptive treatments for these infections.During the COVID-19 pandemic and persists,tradit...OBJECTIVE The emergence of evolving variants of Coronavirus disease 2019(COVID-19)has fostered the need for change of newer and adaptive treatments for these infections.During the COVID-19 pandemic and persists,traditional Chinese medicine(TCM)herbs exhibit significant bioactivity and therapeutic effect.This study is aimed to evaluate the efficacy of four TCM preparations on 28-day mortality risk of patients and changes of the laboratory indicators.METHODS The retrospective cohort study included patients with COVID-19 who were admitted to the Jiangsu Province Hospital of Chinese Medicine from December 15,2022 to January 15,2023,and those died within 48 hours of admission or cannot be tracked for outcomes were excluded.The primary outcome was survival status in 28 days(death or survival)starting from the day of admission.The second outcomes were laboratory indicators,including absolute lymphocyte count,lactate dehydrogenase,creatinine,and blood urea nitrogen.Binary logistic regressions were used to estimate the effect of TCM preparations on the primary and secondary outcomes in main analysis.Meanwhile,heterogeneity and robustness of results from main analysis were assessed by subgroup analyses and multiple sensitivity analyses.RESULTS 1816 eligible patients were included in analysis dataset,including 573 patients received standard care(control group)and 1243 patients received TCM preparations(hospital preparation group).The 28-day mortality rate of hospital preparation group was lower than that of control group(4.75%vs.14.83%),and the difference was statistically significant(χ^(2)=54.666,P<0.001).The risk of 28-day mortality was 0.535 times lower in the hospital preparation group as compared with the control group(OR=0.46,95%CI:0.305-0.708,P<0.001)showed by multivariable binary logistic regressions.Subgroup analyses showed that taking TCM preparations reduced the 28-day mortality risk.Sensitivity analyses demonstrated that the results of the main analysis for primary outcomes were robust.For secondary outcomes,the risk of abnormal absolute lymphocyte counts at discharge in the hospital preparation group decreased by 0.284 times(OR=0.703,95%CI:0.515-0.961,P=0.027).CONCLUSION Compared with standard of care,taking four hospital preparations including Kanggan Heji,Feining Heji,Qishen Gubiao Keli,and Qianghuo Qushi Qingwen Heji decreased risk of 28-day mortality among hospitalized COVID-19 patients.TCM therapy achieves adequate therapeutic effects in COVID-19.展开更多
Ethical Statements and Participant’s Consents were not included in the published version of the following articles that appeared in previous issues of Allergy Medicine.The appropriate Ethical Statements and Particip...Ethical Statements and Participant’s Consents were not included in the published version of the following articles that appeared in previous issues of Allergy Medicine.The appropriate Ethical Statements and Participant’s Consents provided by the Authors,are included below:“Exploring drug-induced toxic epidermal necrolysis:A case series and comprehensive review”[Allergy Medicine,Volume 3,March 2025,100011]https://doi.org/10.1016/j.allmed.2024.100011 Ethical Statement:This research involves retrospective case analyses using de-identified patient data.There were no prospective interventions,and informed consent has been obtained.展开更多
BACKGROUND Post-hepatectomy portal vein thrombosis(PH-PVT)is a life-threatening complication;however,the available literature on this topic is limited.AIM To examine the incidence,risk factors,and outcomes associated ...BACKGROUND Post-hepatectomy portal vein thrombosis(PH-PVT)is a life-threatening complication;however,the available literature on this topic is limited.AIM To examine the incidence,risk factors,and outcomes associated with PH-PVT.METHODS Medical records of patients who underwent hepatic resection for various diseases between February 2014 and December 2023 at Beijing Tsinghua Changgung Hospital affiliated with Tsinghua University(Beijing,China)were retrospectively reviewed.The patients were divided into a PH-PVT group and a non-PH-PVT group.Univariate and multivariate logistic regression analyses were performed to identify the risk factors for PH-PVT.RESULTS A total of 1064 patients were included in the study cohort,and the incidence and mortality rates of PH-PVT were 3.9%and 35.7%,respectively.The median time from hepatectomy to the diagnosis of PH-PVT was 6 days.Multivariate analysis revealed that hepatectomy combined with pancreaticoduodenectomy(HPD)[odds ratio(OR)=7.627(1.390-41.842),P=0.019],portal vein reconstruction[OR=6.119(2.636-14.203),P<0.001]and a postoperative portal vein angle<100°[OR=2.457(1.131-5.348),P=0.023]were independent risk factors for PH-PVT.Age≥60 years[OR=8.688(1.774-42.539),P=0.008]and portal vein reconstruction[OR=6.182(1.246-30.687),P=0.026]were independent risk factors for mortality in PH-PVT patients.CONCLUSION Portal vein reconstruction,a postoperative portal vein angle<100°and HPD were independent risk factors for PHPVT.Age≥60 years and portal vein reconstruction were independent risk factors for mortality in PH-PVT patients.展开更多
BACKGROUND: The increasing morbidity of liver cancer has led to a growing demand for transplantation. Split liver transplantation(SLT) is a promising way to ameliorate organ shortages. However, the safety and efficacy...BACKGROUND: The increasing morbidity of liver cancer has led to a growing demand for transplantation. Split liver transplantation(SLT) is a promising way to ameliorate organ shortages. However, the safety and efficacy of SLT are still controversial. The aim of this study was to assess the clinical outcome of SLT in liver cancer patients at our center. METHODS: A total of 74 patients who received liver transplantation at a tertiary hospital from March 2019 to July 2023 were retrospectively studied, of whom 37 recipients underwent SLT and 37 recipients underwent whole-graft liver transplantation(WGLT). Clinical data were analyzed and compared between patients who underwent SLT and WGLT.RESULTS: SLT and WGLT were successfully performed, with no intraoperative transplantrelated mortality. Postoperatively, no significant differences in total bilirubin(TB, P=0.266), alanine transaminase(ALT, P=0.403) and aspartate transaminase(AST, P=0.160) levels within 30 d were detected between the two groups. The transplant-related mortality rates were 8.1% in the SLT group and 5.4% in the WGLT group within 30 d of surgery(P=1.000), and 10.8% and 8.1%, respectively, at 90 d after surgery(P=1.000). There were no significant differences in overall survival(OS) and progress-free survival(PFS) between the SLT and WGLT groups(P=0.910, P=0.190). CONCLUSION: Our results show that SLT does not imply additional risks in treating liver cancer compared with WGLT.展开更多
Objective:The varying environmental exposure to iodine has long been a topic of interest,particularly given the noticeable increase in the incidence of papillary thyroid carcinoma(PTC)compared to other histopathologic...Objective:The varying environmental exposure to iodine has long been a topic of interest,particularly given the noticeable increase in the incidence of papillary thyroid carcinoma(PTC)compared to other histopathological subtypes globally.This rise in thyroid cancer incidence has been attributed to several factors,including improved detection of early tumors,a higher prevalence of modifiable individual risk factors,and differing exposure to environmental risk factors such as iodine levels.This study aims to explore the epigenetic mechanisms that promote thyroid cancer progression under excess iodine exposure.Materials and methods:This study outlines the following strategy:(i)risk factors were identified through statistical analysis of questionnaire responses in a retrospective iatrogenic study;(ii)following the identification of risk factors,RNA sequencing was performed using tissues from iodine-adequate(IA)and iodine-excess(IE)regions;(iii)candidate hub genes were selected via bioinformatics analysis;(iv)molecular biological techniques were employed to verify the functionality of the key gene.Results:Through careful selection,we focused on SPSB4,a ubiquitin ligase previously unreported in relation to both iodine and thyroid cancer.By optimizing the dosage of PTC cell line activities,we determined how varying iodine levels can either enhance or impair the vitality of thyroid cancer cells.As anticipated,migration and invasion assays revealed significant changes when SPSB4 function was disrupted at the critical dose of KIO3.Conclusion:In terms of epigenetic alterations,SPSB4 emerges as a promising candidate for further investigation,particularly in understanding thyroid cancer progression and potential carcinogenesis.Moreover,E3 ubiquitin ligases,including SPSB4,play a role in orchestrating adipose thermogenesis to maintain body temperature during cold stimuli.This study could also shed light on the influence of iodine on thermogenesis mediated by SPSB4 under cold conditions,while suggesting future exploration of SPSB4's effects on thyroid cancer in colder regions.展开更多
BACKGROUND Gastric cancer is a malignancy with high morbidity and mortality rates.Surgical intervention,particularly gastrectomy,is essential for curative treatment but carries a substantial risk of complications.Iden...BACKGROUND Gastric cancer is a malignancy with high morbidity and mortality rates.Surgical intervention,particularly gastrectomy,is essential for curative treatment but carries a substantial risk of complications.Identifying key risk factors and understanding complication profiles are crucial for improving outcomes and guiding perioperative management.AIM To analyze the incidence of postoperative complications in patients with gastric cancer and identify potential risk factors.METHODS We conducted a retrospective analysis of 500 patients who underwent gastrectomy between January 2018 and December 2022.Postoperative complications were classified using the Clavien-Dindo system.RESULTS The overall complication rate was 28.4%(142/500),with 15.2%(76/500)experiencing major complications(Clavien-Dindo grade≥III).Pulmonary complications were the most frequent(10.8%),followed by surgical site infections(8.6%),and anastomotic leakage(4.2%).Age 70 years or more,body mass index of 25 kg/m²or more,advanced tumor stage,total gastrectomy,and operative time 240 min or more emerged as independent risk factors.CONCLUSION Focused preoperative risk assessment,targeted interventions,and reduced operative time for older or obese patients requiring total gastrectomy or presenting with advanced disease are important to improve surgical outcomes.展开更多
Objective To develop and validate a preoperative clinical-radiomics model for predicting overall survival(OS)and disease-free survival(DFS)in patients with extrahepatic cholangiocarcinoma(eCCA)undergoing radical resec...Objective To develop and validate a preoperative clinical-radiomics model for predicting overall survival(OS)and disease-free survival(DFS)in patients with extrahepatic cholangiocarcinoma(eCCA)undergoing radical resection.Methods In this retrospective study,consecutive patients with pathologically-confirmed eCCA who underwent radical resection at our institution from 2015 to 2022 were included.The patients were divided into a training cohort and a validation cohort according to the chronological order of their CT examinations.Least absolute shrinkage and selection operator(LASSO)-Cox regression was employed to select predictive radiomic features and clinical variables.The selected features and variables were incorporated into a Cox regression model.Model performance for 1-year OS and DFS prediction was assessed using calibration curves,area under receiver operating characteristic curve(AUC),and concordance index(C-index).Results This study included 123 patients(mean age 64.0±8.4 years,85 males/38 females),with 86 in the training cohort and 37 in the validation cohort.The OS-predicting model included four clinical variables and four radiomic features.It achieved a training cohort AUC of 0.858(C-index=0.800)and a validation cohort AUC of 0.649(C-index=0.605).The DFS-predicting model included four clinical variables and four other radiomic features.It achieved a training cohort AUC of 0.830(C-index=0.760)and a validation cohort AUC of 0.717(C-index=0.616).Conclusion The preoperative clinical-radiomics models show promise as a tool for predicting 1-year OS and DFS in eCCA patients after radical surgery.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography is a challenging procedure involving bile duct cannulation.Despite the development of several cannulation devices,none have effectively facilitated the procedu...BACKGROUND Endoscopic retrograde cholangiopancreatography is a challenging procedure involving bile duct cannulation.Despite the development of several cannulation devices,none have effectively facilitated the procedure.AIM To evaluate the efficacy of a recently developed catheter for bile duct cannulation.METHODS We retrospectively examined 342 patients who underwent initial cholangiopan-creatography.We compared the success rate of bile duct cannulation and the incidence of complications between the groups using existing and novel catheters.RESULTS The overall success rates of bile duct cannulation were 98.3%and 99.1%in the existing and novel catheter groups,respectively(P=0.47).The bile duct cannulation rate using the standard technique was 73.0%and 82.1%in the existing and novel catheter groups,respectively(P=0.042).Furthermore,when catheterization was performed by expert physicians,the bile duct cannulation rate was significantly higher in the novel catheter group(81.3%)than in the existing catheter group(65.2%)(P=0.017).The incidence of difficult cannulation was also significantly lower in the novel catheter group(17.4%)than in the existing catheter group(33.0%)(P=0.019).CONCLUSION The novel catheter improved the bile duct cannulation rate using the standard technique and reduced the frequency of difficult cannulation cases,valuable tool in endoscopic retrograde cholangiopancreatography procedures performed by experts.展开更多
BACKGROUND The survival rate of pancreatic cancer is low,and there is a lack of effective treatment.AIM To explore the epidemiological characteristics of patients with pancreatic cancer in China and compare multiple c...BACKGROUND The survival rate of pancreatic cancer is low,and there is a lack of effective treatment.AIM To explore the epidemiological characteristics of patients with pancreatic cancer in China and compare multiple chemotherapy regimens at different stages.METHODS This was a retrospective study conducted from 2005 to 2014,involving six cancer hospitals and eight general hospitals across seven geographical regions of China(East,South,North,Central,Southwest,Northwest,and Northeast).Stratified sampling was used based on the population distribution of each region.Efficacy assessments were conducted by Cox proportional hazards regression models.When assessing the effectiveness of various chemotherapy regimens,traditional drugs such as gemcitabine used as monotherapy served as the reference.RESULTS A total of 3256 patients were included.The median follow-up time was 407 days,and the median overall survival was 183 days.At diagnosis,56%of patients were already in stage IV.Chemotherapy was administered to 39.73%of patients.In the adjuvant therapy phase,gemcitabine+fluorouracil was superior to gemcitabine monotherapy[hazard ratio(HR)=0.35,95%confidence interval(CI):0.14-0.89].In fluorouracil-based regimens,other combination regimens did not show effectiveness relative to monotherapy.For first-line treatment in patients with advanced disease,tegafur alone(HR=0.20,95%CI:0.06-0.66),gemcitabine plus cisplatin(HR=0.16,95%CI:0.04-0.70),and tegafur,gemcitabine plus platinum-based agents(HR=0.32,95%CI:0.11-0.91)were associated with a lower risk of death compared to gemcitabine alone.In second-line treatment,there were no significant differences in efficacy among various drugs,but FOLFIRINOX(irinotecan+oxaliplatin+leucovorin+5-fluorouracil)had an outstanding point estimate(HR=0.10,95%CI:0.01-1.27).CONCLUSION In China,pancreatic cancer is often diagnosed at advanced stages,emphasizing the need for early diagnosis and treatment.Combined therapies in adjuvant and first-line settings may reduce the risk of death compared with monotherapy,and FOLFIRINOX might offer more significant benefits in second-line treatment.展开更多
Ethical approval is the first essential step for medical master’s students to officially initiate research.This article discusses the ethical issues encountered in various types of research projects conducted by prof...Ethical approval is the first essential step for medical master’s students to officially initiate research.This article discusses the ethical issues encountered in various types of research projects conducted by professional master’s students,the preparation of ethical application materials,conflicts between the timing of ethical applications and the clinical training rotation schedules,and the continuity of ethical applications among students within the same cohort and across different cohorts.展开更多
Objective To compare the effect of patient positioning on bronchoscopy-guided bronchoalveolar lavage(BAL)recovery rate and to inform position selection in clinical practice.Methods A retrospective study was conducted ...Objective To compare the effect of patient positioning on bronchoscopy-guided bronchoalveolar lavage(BAL)recovery rate and to inform position selection in clinical practice.Methods A retrospective study was conducted using routine BAL records from 2019 to 2024 at a single center.Four position groups were analyzed(n=110 each):supine,lateral nondependent(target lung up),lateral dependent(target lung down),and prone.The primary outcome was recovery rate(%).Distributional assumptions were evaluated with the Shapiro-Wilk test and Levene's test.Group differences were assessed by one-way analysis of variance(ANOVA);pairwise post-hoc comparisons used Welch's t test with mean differences and 95%confidence intervals(CI).A linear regression model adjusted for lobar site was used to estimate lobe-adjusted marginal means by position.Results Mean(x±SD)recovery rates were:supine 52.08±7.70%,lateral nondependent 62.66±8.27%,lateral dependent 45.98±8.50%,prone 55.12±7.59%.Between-group differences were significant(ANOVA F=82.14,P<0.001).Lobe-adjusted marginal means were directionally consistent with unadjusted results.Conclusions Patient position is significantly associated with BAL recovery.When clinically feasible and safe,placing the target lung in the nondependent position yields higher recovery rates.展开更多
文摘Composed of professionals from all walks of life, Rotary International is the largest non-governmental volunteer service organization with the longest tradition in the world. Through providing various social services and humanitarian assistance, it encourages high ethical standards
基金a small part of the research project"A Chronological Study of the CET Washback"(07BYY030)supported by the National Philosophy and Social Science Foundation of China . The teamleader is Gu Xiangdong.
文摘This paper aims to explore the construct validity of long dialogue multiple-choice (MC) listening comprehension tests through examining the retrospective verbal reports of eight Chinese EFL test-takers at tertiary level. It is found that the grammatical knowledge, discourse knowledge, pragmatic knowledge and sociolinguistic knowledge of language competence and all the cognitive and metacognitive strategies proposed in the framework of listening constructs are measured in the tests, which supports the constr...
文摘This year marks the 10-year anniversary of the strategy on development of China’s western region. With a land area of 6.85 million square km, accounting for 71.4 percent of the country’s total, the western region has been an indispensable part in achieving China’s overall prosperity
文摘BACKGROUND The objective of the current study was to elucidate the clinical mechanism through which phospholipase D2(PLD2)exerted a regulatory effect on neutrophil migra-tion,thereby alleviating the progression of acute pancreatitis.AIM To elucidate the clinical mechanism through which PLD2 exerted a regulatory effect on neutrophil migration,thereby alleviating the progression of acute pan-creatitis.METHODS The study involved 90 patients diagnosed with acute pancreatitis,admitted to our hospital between March 2020 and November 2022.A retrospective analysis was conducted,categorizing patients based on Ranson score severity into mild(n=25),moderate(n=30),and severe(n=35)groups.Relevant data was collected for each group.Western blot analysis assessed PLD2 protein expression in patient serum.Real-time reverse transcription polymerase chain reaction was used to evaluate the mRNA expression of chemokine receptors associated with neutrophil migration.Serum levels of inflammatory factors in patients were detected using enzyme-linked immunosorbent assay.Transwell migration tests were conducted to compare migration of neutrophils across groups and analyze the influence of PLD2 on neutrophil migration.RESULTS Overall data analysis did not find significant differences between patient groups(P>0.05).The expression of PLD2 protein in the severe group was lower than that in the moderate and mild groups(P<0.05).The expression level of PLD2 in the moderate group was also lower than that in the mild group(P<0.05).The severity of acute pancreatitis is negatively correlated with PLD2 expression(r=-0.75,P=0.002).The mRNA levels of C-X-C chemokine receptor type 1,C-X-C chemokine receptor type 2,C-C chemokine receptor type 2,and C-C chemokine receptor type 5 in the severe group are significantly higher than those in the moderate and mild groups(P<0.05),and the expression levels in the moderate group are also higher than those in the mild group(P<0.05).The levels of C-reactive protein,tumor necrosis factor-α,interleukin-1β,and interleukin-6 in the severe group were higher than those in the moderate and mild groups(P<0.05),and the levels in the moderate group were also higher than those in the mild group(P<0.05).The number of migrating neutrophils in the severe group was higher than that in the moderate and mild groups(P<0.05),and the moderate group was also higher than the mild group(P<0.05).In addition,the number of migrating neutrophils in the mild group combined with PLD2 inhibitor was higher than that in the mild group(P<0.05),and the number of migrating neutrophils in the moderate group combined with PLD2 inhibitor was higher than that in the moderate group(P<0.05).The number of migrating neutrophils in the severe group+PLD2 inhibitor group was significantly higher than that in the severe group(P<0.05),indicating that PLD2 inhibitors significantly stimulated neutrophil migration.CONCLUSION PLD2 exerted a crucial regulatory role in the pathological progression of acute pancreatitis.Its protein expression varied among patients based on the severity of the disease,and a negative correlation existed between PLD2 expression and disease severity.Additionally,PLD2 appeared to impede acute pancreatitis progression by limiting neutrophil migration.
基金Supported by Wang Zhengguo Foundation for Traumatic Medicine“Sequential Medical Research Special Foundation”,No 2024-XGM05.
文摘BACKGROUND Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outcomes.Existing studies have investigated risk factors for POD,but most are limited by single-factor analyses or small sample sizes.This study systematically determines independent risk factors using large-scale data and machine learning techniques and develops a validated nomogram model to support early prediction and management of POD.AIM To investigate POD incidence in elderly patients with HF and the independent risk factors,according to which a nomogram prediction model was developed and validated.METHODS This retrospective study included elderly patients with HF who were surgically treated in Dongying People’sHospital from April 2018 to April 2022. The endpoint event includes POD. They were categorized into themodeling and validation cohorts in a 7:3 ratio by randomization. Both cohorts were further classified into thedelirium and normal (non-delirium) groups according to the presence or absence of the endpoint event. Theincidence of POD was calculated, and logistic multivariate analysis was conducted to determine the independentrisk factors. The calibration curve and the Hosmer-Lemeshow test as well as the net benefit threshold probabilityinterval by the decision curve were utilized to statistically validate the accuracy of the nomogram predictionmodel, developed according to each factor’s influence intensity.RESULTSThis study included 532 elderly patients with HF, with an overall POD incidence of 14.85%. The comparison ofbaseline data with perioperative indicators revealed statistical differences in age (P < 0.001), number of comorbidities(P = 0.042), American Society of Anesthesiologists grading (P = 0.004), preoperative red blood cell(RBC) count (P < 0.001), preoperative albumin (P < 0.001), preoperative hemoglobin (P < 0.001), preoperativeplatelet count (P < 0.001), intraoperative blood loss (P < 0.001), RBC transfusion of ≥ 2 units (P = 0.001), andpostoperative intensive care unit care (P < 0.001) between the delirium and non-delirium groups. The participantswere randomized to a training group (n = 372) and a validation group (n = 160). A score-risk nomogram predictionmodel was developed after screening key POD features using Lasso regression, support vector machine, and therandom forest method. The nomogram showed excellent discriminatory capacity with area under the curve of0.833 [95% confidence interval (CI) interval: 0.774-0.888] in the training group and 0.850 (95%CI: 0.718-0.982) in thevalidation group. Calibration curves demonstrated good agreement between predicted and actual probabilities,and decision curve analysis confirmed clinical net benefits within risk thresholds of 0%-30% and 0%-36%, respectively.The model has strong accuracy and clinical utility for predicting the risk of POD.CONCLUSIONThis study reveals cognitive impairment history, American Society of Anesthesiologists grade of > 2, RBCtransfusion of ≥ 2 units, postoperative intensive care unit care, and preoperative hemoglobin level as independentrisk factors for POD in elderly patients with HF. The developed nomogram model demonstrates excellent accuracyand stability in predicting the risk of POD, which is recommended to be applied in clinical practice to optimizepostoperative management and reduce delirium incidence.
基金supported by the National Natural Science Foundation of China(grant numbers 82204127 and 72204172)。
文摘Lung cancer, the leading cause of cancer deaths worldwide and in China, has a 19.7% five-year survival rate due to terminal-stage diagnosis^([1-3]).Although low-dose computed tomography(CT) screening can reduce mortality, high false positive rates can create economic and psychological burdens.
文摘BACKGROUND Pancreatic cancer remains one of the most lethal malignancies worldwide,with a poor prognosis often attributed to late diagnosis.Understanding the correlation between pathological type and imaging features is crucial for early detection and appropriate treatment planning.AIM To retrospectively analyze the relationship between different pathological types of pancreatic cancer and their corresponding imaging features.METHODS We retrospectively analyzed the data of 500 patients diagnosed with pancreatic cancer between January 2010 and December 2020 at our institution.Pathological types were determined by histopathological examination of the surgical spe-cimens or biopsy samples.The imaging features were assessed using computed tomography,magnetic resonance imaging,and endoscopic ultrasound.Statistical analyses were performed to identify significant associations between pathological types and specific imaging characteristics.RESULTS There were 320(64%)cases of pancreatic ductal adenocarcinoma,75(15%)of intraductal papillary mucinous neoplasms,50(10%)of neuroendocrine tumors,and 55(11%)of other rare types.Distinct imaging features were identified in each pathological type.Pancreatic ductal adenocarcinoma typically presents as a hypodense mass with poorly defined borders on computed tomography,whereas intraductal papillary mucinous neoplasms present as characteristic cystic lesions with mural nodules.Neuroendocrine tumors often appear as hypervascular lesions in contrast-enhanced imaging.Statistical analysis revealed significant correlations between specific imaging features and pathological types(P<0.001).CONCLUSION This study demonstrated a strong association between the pathological types of pancreatic cancer and imaging features.These findings can enhance the accuracy of noninvasive diagnosis and guide personalized treatment approaches.
文摘BACKGROUND Chronic hepatitis B often progresses silently toward hepatocellular carcinoma(HCC),a leading cause of mortality worldwide.Early detection of HCC is crucial,yet challenging.AIM To investigate the role of dynamic changes in alkaline phosphatase to prealbumin ratio(APR)in hepatitis B progression to HCC.METHODS Data from 4843 patients with hepatitis B(January 2015 to January 2024)were analyzed.HCC incidence rates in males and females were compared using the log-rank test.Data were evaluated using Kaplan–Meier analysis.The Linear Mixed-Effects Model was applied to track the fluctuation of APR levels over time.Furthermore,Joint Modeling of Longitudinal and Survival data was employed to investigate the temporal relationship between APR and HCC risk.RESULTS The incidence of HCC was higher in males.To ensure the model’s normality assumption,this study applied a logarithmic transformation to APR,yielding ratio.Ratio levels were higher in females(t=5.26,P<0.01).A 1-unit increase in ratio correlated with a 2.005-fold higher risk of HCC in males(95%CI:1.653-2.431)and a 2.273-fold higher risk in females(95%CI:1.620-3.190).CONCLUSION Males are more prone to HCC,while females have higher APR levels.Despite no baseline APR link,rising APR indicates a higher HCC risk.
文摘This paper purports to expound a special(technical)notion of paths.A neglected fundamental fact(especially under indeterminism)is that the path-dependent direction of any diachronic outcome is backward,i.e.,later steps depend on earlier ones successively,despite the ineradicable chance in their respective formation.In this paper,a token-oriented retrospective approach is proposed to overcome the limitation of the type-oriented approach in explaining path-related phenomena.My argument for the validity and utility of this approach is largely based on the elements of(PD),a definitional schema for diachronic sequences subject to a recursive counterfactual formula.I explore certain aspects of path individuation that have so far not been discussed,despite(PD)’s formal congeniality with Lewis’s‘causal chain’.Two basic patterns of path generation are examined:the first is for distinguishing actual vs possible branching paths,while the second introduces a metaphysical theme regarding the retrospective grounding of the causal status of an upstream event by its downstream(joint)effect.A central example of the paper,viz.,the Gobang game,is used to illustrate how the token-oriented approach works for path individuation.
文摘OBJECTIVE The emergence of evolving variants of Coronavirus disease 2019(COVID-19)has fostered the need for change of newer and adaptive treatments for these infections.During the COVID-19 pandemic and persists,traditional Chinese medicine(TCM)herbs exhibit significant bioactivity and therapeutic effect.This study is aimed to evaluate the efficacy of four TCM preparations on 28-day mortality risk of patients and changes of the laboratory indicators.METHODS The retrospective cohort study included patients with COVID-19 who were admitted to the Jiangsu Province Hospital of Chinese Medicine from December 15,2022 to January 15,2023,and those died within 48 hours of admission or cannot be tracked for outcomes were excluded.The primary outcome was survival status in 28 days(death or survival)starting from the day of admission.The second outcomes were laboratory indicators,including absolute lymphocyte count,lactate dehydrogenase,creatinine,and blood urea nitrogen.Binary logistic regressions were used to estimate the effect of TCM preparations on the primary and secondary outcomes in main analysis.Meanwhile,heterogeneity and robustness of results from main analysis were assessed by subgroup analyses and multiple sensitivity analyses.RESULTS 1816 eligible patients were included in analysis dataset,including 573 patients received standard care(control group)and 1243 patients received TCM preparations(hospital preparation group).The 28-day mortality rate of hospital preparation group was lower than that of control group(4.75%vs.14.83%),and the difference was statistically significant(χ^(2)=54.666,P<0.001).The risk of 28-day mortality was 0.535 times lower in the hospital preparation group as compared with the control group(OR=0.46,95%CI:0.305-0.708,P<0.001)showed by multivariable binary logistic regressions.Subgroup analyses showed that taking TCM preparations reduced the 28-day mortality risk.Sensitivity analyses demonstrated that the results of the main analysis for primary outcomes were robust.For secondary outcomes,the risk of abnormal absolute lymphocyte counts at discharge in the hospital preparation group decreased by 0.284 times(OR=0.703,95%CI:0.515-0.961,P=0.027).CONCLUSION Compared with standard of care,taking four hospital preparations including Kanggan Heji,Feining Heji,Qishen Gubiao Keli,and Qianghuo Qushi Qingwen Heji decreased risk of 28-day mortality among hospitalized COVID-19 patients.TCM therapy achieves adequate therapeutic effects in COVID-19.
文摘Ethical Statements and Participant’s Consents were not included in the published version of the following articles that appeared in previous issues of Allergy Medicine.The appropriate Ethical Statements and Participant’s Consents provided by the Authors,are included below:“Exploring drug-induced toxic epidermal necrolysis:A case series and comprehensive review”[Allergy Medicine,Volume 3,March 2025,100011]https://doi.org/10.1016/j.allmed.2024.100011 Ethical Statement:This research involves retrospective case analyses using de-identified patient data.There were no prospective interventions,and informed consent has been obtained.
文摘BACKGROUND Post-hepatectomy portal vein thrombosis(PH-PVT)is a life-threatening complication;however,the available literature on this topic is limited.AIM To examine the incidence,risk factors,and outcomes associated with PH-PVT.METHODS Medical records of patients who underwent hepatic resection for various diseases between February 2014 and December 2023 at Beijing Tsinghua Changgung Hospital affiliated with Tsinghua University(Beijing,China)were retrospectively reviewed.The patients were divided into a PH-PVT group and a non-PH-PVT group.Univariate and multivariate logistic regression analyses were performed to identify the risk factors for PH-PVT.RESULTS A total of 1064 patients were included in the study cohort,and the incidence and mortality rates of PH-PVT were 3.9%and 35.7%,respectively.The median time from hepatectomy to the diagnosis of PH-PVT was 6 days.Multivariate analysis revealed that hepatectomy combined with pancreaticoduodenectomy(HPD)[odds ratio(OR)=7.627(1.390-41.842),P=0.019],portal vein reconstruction[OR=6.119(2.636-14.203),P<0.001]and a postoperative portal vein angle<100°[OR=2.457(1.131-5.348),P=0.023]were independent risk factors for PH-PVT.Age≥60 years[OR=8.688(1.774-42.539),P=0.008]and portal vein reconstruction[OR=6.182(1.246-30.687),P=0.026]were independent risk factors for mortality in PH-PVT patients.CONCLUSION Portal vein reconstruction,a postoperative portal vein angle<100°and HPD were independent risk factors for PHPVT.Age≥60 years and portal vein reconstruction were independent risk factors for mortality in PH-PVT patients.
基金Key Project of Traditional Chinese Medicine Science and Technology Plan of Zhejiang Province (GZY-ZJ-KJ-24077)National Natural Science Foundation of China (No. U23A202181, 8207101520, 82272860)+2 种基金Central Guidance on Local Science and Technology Development Fund of Zhejiang Province (2023ZY1017)Fundamental Research Funds for the Central Universities (No. 226-2023-00038)Special Financial Support for Zhejiang Traditional Chinese Medicine Innovation Teams。
文摘BACKGROUND: The increasing morbidity of liver cancer has led to a growing demand for transplantation. Split liver transplantation(SLT) is a promising way to ameliorate organ shortages. However, the safety and efficacy of SLT are still controversial. The aim of this study was to assess the clinical outcome of SLT in liver cancer patients at our center. METHODS: A total of 74 patients who received liver transplantation at a tertiary hospital from March 2019 to July 2023 were retrospectively studied, of whom 37 recipients underwent SLT and 37 recipients underwent whole-graft liver transplantation(WGLT). Clinical data were analyzed and compared between patients who underwent SLT and WGLT.RESULTS: SLT and WGLT were successfully performed, with no intraoperative transplantrelated mortality. Postoperatively, no significant differences in total bilirubin(TB, P=0.266), alanine transaminase(ALT, P=0.403) and aspartate transaminase(AST, P=0.160) levels within 30 d were detected between the two groups. The transplant-related mortality rates were 8.1% in the SLT group and 5.4% in the WGLT group within 30 d of surgery(P=1.000), and 10.8% and 8.1%, respectively, at 90 d after surgery(P=1.000). There were no significant differences in overall survival(OS) and progress-free survival(PFS) between the SLT and WGLT groups(P=0.910, P=0.190). CONCLUSION: Our results show that SLT does not imply additional risks in treating liver cancer compared with WGLT.
基金supported by National Natural Science Foundation of China(8183000355)。
文摘Objective:The varying environmental exposure to iodine has long been a topic of interest,particularly given the noticeable increase in the incidence of papillary thyroid carcinoma(PTC)compared to other histopathological subtypes globally.This rise in thyroid cancer incidence has been attributed to several factors,including improved detection of early tumors,a higher prevalence of modifiable individual risk factors,and differing exposure to environmental risk factors such as iodine levels.This study aims to explore the epigenetic mechanisms that promote thyroid cancer progression under excess iodine exposure.Materials and methods:This study outlines the following strategy:(i)risk factors were identified through statistical analysis of questionnaire responses in a retrospective iatrogenic study;(ii)following the identification of risk factors,RNA sequencing was performed using tissues from iodine-adequate(IA)and iodine-excess(IE)regions;(iii)candidate hub genes were selected via bioinformatics analysis;(iv)molecular biological techniques were employed to verify the functionality of the key gene.Results:Through careful selection,we focused on SPSB4,a ubiquitin ligase previously unreported in relation to both iodine and thyroid cancer.By optimizing the dosage of PTC cell line activities,we determined how varying iodine levels can either enhance or impair the vitality of thyroid cancer cells.As anticipated,migration and invasion assays revealed significant changes when SPSB4 function was disrupted at the critical dose of KIO3.Conclusion:In terms of epigenetic alterations,SPSB4 emerges as a promising candidate for further investigation,particularly in understanding thyroid cancer progression and potential carcinogenesis.Moreover,E3 ubiquitin ligases,including SPSB4,play a role in orchestrating adipose thermogenesis to maintain body temperature during cold stimuli.This study could also shed light on the influence of iodine on thermogenesis mediated by SPSB4 under cold conditions,while suggesting future exploration of SPSB4's effects on thyroid cancer in colder regions.
基金Supported by the Chongqing Natural Science Foundation,No.cstc2020jcyj-msxmX0288the Chongqing Medical University Program for Youth Innovation in Future Medicine,No.W0190.
文摘BACKGROUND Gastric cancer is a malignancy with high morbidity and mortality rates.Surgical intervention,particularly gastrectomy,is essential for curative treatment but carries a substantial risk of complications.Identifying key risk factors and understanding complication profiles are crucial for improving outcomes and guiding perioperative management.AIM To analyze the incidence of postoperative complications in patients with gastric cancer and identify potential risk factors.METHODS We conducted a retrospective analysis of 500 patients who underwent gastrectomy between January 2018 and December 2022.Postoperative complications were classified using the Clavien-Dindo system.RESULTS The overall complication rate was 28.4%(142/500),with 15.2%(76/500)experiencing major complications(Clavien-Dindo grade≥III).Pulmonary complications were the most frequent(10.8%),followed by surgical site infections(8.6%),and anastomotic leakage(4.2%).Age 70 years or more,body mass index of 25 kg/m²or more,advanced tumor stage,total gastrectomy,and operative time 240 min or more emerged as independent risk factors.CONCLUSION Focused preoperative risk assessment,targeted interventions,and reduced operative time for older or obese patients requiring total gastrectomy or presenting with advanced disease are important to improve surgical outcomes.
文摘Objective To develop and validate a preoperative clinical-radiomics model for predicting overall survival(OS)and disease-free survival(DFS)in patients with extrahepatic cholangiocarcinoma(eCCA)undergoing radical resection.Methods In this retrospective study,consecutive patients with pathologically-confirmed eCCA who underwent radical resection at our institution from 2015 to 2022 were included.The patients were divided into a training cohort and a validation cohort according to the chronological order of their CT examinations.Least absolute shrinkage and selection operator(LASSO)-Cox regression was employed to select predictive radiomic features and clinical variables.The selected features and variables were incorporated into a Cox regression model.Model performance for 1-year OS and DFS prediction was assessed using calibration curves,area under receiver operating characteristic curve(AUC),and concordance index(C-index).Results This study included 123 patients(mean age 64.0±8.4 years,85 males/38 females),with 86 in the training cohort and 37 in the validation cohort.The OS-predicting model included four clinical variables and four radiomic features.It achieved a training cohort AUC of 0.858(C-index=0.800)and a validation cohort AUC of 0.649(C-index=0.605).The DFS-predicting model included four clinical variables and four other radiomic features.It achieved a training cohort AUC of 0.830(C-index=0.760)and a validation cohort AUC of 0.717(C-index=0.616).Conclusion The preoperative clinical-radiomics models show promise as a tool for predicting 1-year OS and DFS in eCCA patients after radical surgery.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography is a challenging procedure involving bile duct cannulation.Despite the development of several cannulation devices,none have effectively facilitated the procedure.AIM To evaluate the efficacy of a recently developed catheter for bile duct cannulation.METHODS We retrospectively examined 342 patients who underwent initial cholangiopan-creatography.We compared the success rate of bile duct cannulation and the incidence of complications between the groups using existing and novel catheters.RESULTS The overall success rates of bile duct cannulation were 98.3%and 99.1%in the existing and novel catheter groups,respectively(P=0.47).The bile duct cannulation rate using the standard technique was 73.0%and 82.1%in the existing and novel catheter groups,respectively(P=0.042).Furthermore,when catheterization was performed by expert physicians,the bile duct cannulation rate was significantly higher in the novel catheter group(81.3%)than in the existing catheter group(65.2%)(P=0.017).The incidence of difficult cannulation was also significantly lower in the novel catheter group(17.4%)than in the existing catheter group(33.0%)(P=0.019).CONCLUSION The novel catheter improved the bile duct cannulation rate using the standard technique and reduced the frequency of difficult cannulation cases,valuable tool in endoscopic retrograde cholangiopancreatography procedures performed by experts.
文摘BACKGROUND The survival rate of pancreatic cancer is low,and there is a lack of effective treatment.AIM To explore the epidemiological characteristics of patients with pancreatic cancer in China and compare multiple chemotherapy regimens at different stages.METHODS This was a retrospective study conducted from 2005 to 2014,involving six cancer hospitals and eight general hospitals across seven geographical regions of China(East,South,North,Central,Southwest,Northwest,and Northeast).Stratified sampling was used based on the population distribution of each region.Efficacy assessments were conducted by Cox proportional hazards regression models.When assessing the effectiveness of various chemotherapy regimens,traditional drugs such as gemcitabine used as monotherapy served as the reference.RESULTS A total of 3256 patients were included.The median follow-up time was 407 days,and the median overall survival was 183 days.At diagnosis,56%of patients were already in stage IV.Chemotherapy was administered to 39.73%of patients.In the adjuvant therapy phase,gemcitabine+fluorouracil was superior to gemcitabine monotherapy[hazard ratio(HR)=0.35,95%confidence interval(CI):0.14-0.89].In fluorouracil-based regimens,other combination regimens did not show effectiveness relative to monotherapy.For first-line treatment in patients with advanced disease,tegafur alone(HR=0.20,95%CI:0.06-0.66),gemcitabine plus cisplatin(HR=0.16,95%CI:0.04-0.70),and tegafur,gemcitabine plus platinum-based agents(HR=0.32,95%CI:0.11-0.91)were associated with a lower risk of death compared to gemcitabine alone.In second-line treatment,there were no significant differences in efficacy among various drugs,but FOLFIRINOX(irinotecan+oxaliplatin+leucovorin+5-fluorouracil)had an outstanding point estimate(HR=0.10,95%CI:0.01-1.27).CONCLUSION In China,pancreatic cancer is often diagnosed at advanced stages,emphasizing the need for early diagnosis and treatment.Combined therapies in adjuvant and first-line settings may reduce the risk of death compared with monotherapy,and FOLFIRINOX might offer more significant benefits in second-line treatment.
文摘Ethical approval is the first essential step for medical master’s students to officially initiate research.This article discusses the ethical issues encountered in various types of research projects conducted by professional master’s students,the preparation of ethical application materials,conflicts between the timing of ethical applications and the clinical training rotation schedules,and the continuity of ethical applications among students within the same cohort and across different cohorts.
文摘Objective To compare the effect of patient positioning on bronchoscopy-guided bronchoalveolar lavage(BAL)recovery rate and to inform position selection in clinical practice.Methods A retrospective study was conducted using routine BAL records from 2019 to 2024 at a single center.Four position groups were analyzed(n=110 each):supine,lateral nondependent(target lung up),lateral dependent(target lung down),and prone.The primary outcome was recovery rate(%).Distributional assumptions were evaluated with the Shapiro-Wilk test and Levene's test.Group differences were assessed by one-way analysis of variance(ANOVA);pairwise post-hoc comparisons used Welch's t test with mean differences and 95%confidence intervals(CI).A linear regression model adjusted for lobar site was used to estimate lobe-adjusted marginal means by position.Results Mean(x±SD)recovery rates were:supine 52.08±7.70%,lateral nondependent 62.66±8.27%,lateral dependent 45.98±8.50%,prone 55.12±7.59%.Between-group differences were significant(ANOVA F=82.14,P<0.001).Lobe-adjusted marginal means were directionally consistent with unadjusted results.Conclusions Patient position is significantly associated with BAL recovery.When clinically feasible and safe,placing the target lung in the nondependent position yields higher recovery rates.
