Objective To evaluate the predictive value of enhanced CT combined with serum N-myc downstream regulated gene 4(NDRG4) and transmembrane 4 L six family member 1(TM4 SF1) for lymph node metastasis and prognosis in gastric cancer(GC). Methods From January 2024 to January 2025, 122 GC patients admitted to our hospital were enrolled as the study subjects and were divided into a metastasis group(n = 49) and a non-metastasis group(n = 73) based on lymph node metastasis status. Patients underwent enhanced CT examination to determine lymph node metastasis and to assess the risk of postoperative death. Serum NDRG4 and TM4 SF1 levels were detected by ELISA. GC patients were further divided into a death group(n = 42) and a survival group(n = 80) based on postoperative survival status. ROC curve analysis was used to evaluate the predictive efficacy of enhanced CT and serum NDRG4 and TM4 SF1 for lymph node metastasis and prognosis in GC patients. The Kappa test was used to assess the consistency of enhanced CT, NDRG4, TM4 SF1 alone and their combination in predicting lymph node metastasis and prognosis. The four-grid table method was used to analyze the predictive efficacy of enhanced CT combined with serum NDRG4 and TM4 SF1. Results Serum NDRG4 and TM4 SF1 levels were significantly lower in the metastasis group than in the non-metastasis group(t = 6.851, 8.187, both P<0.05). Serum NDRG4 and TM4 SF1 levels were significantly lower in the death group than in the survival group(t = 6.639, 6.005, both P<0.05). The AUC values of serum NDRG4 for predicting lymph node metastasis and prognosis were 0.867 and 0.756, with sensitivities of77.55% and 73.81%, and specificities of 89.04% and 68.75%, respectively. The AUC values of serum TM4 SF1 were 0.845 and 0.844, with sensitivities of 89.80% and 61.90%, and specificities of 64.38% and 92.50%, respectively. The Kappa values of enhanced CT compared with pathological examination was 0.571, respectively(P<0.05), with specificities of 75.34% and63.75%, and sensitivities of 83.67% and 78.57%, respectively. The Kappa values of enhanced CT combined with serum NDRG4 and TM4 SF1 compared with pathological examination was 0.783, respectively(P<0.05), with diagnostic AUC values of 0.901 and 0.908, specificities of 86.30% and 88.75%, and sensitivities of 93.88% and 92.86%, respectively. The combination of enhanced CT with serum NDRG4 and TM4 SF1 showed improved sensitivity, misdiagnosis rate, and accuracy in predicting lymph node metastasis and prognosis, demonstrating good diagnostic efficacy. Conclusion Serum NDRG4 and TM4 SF1 levels are decreased in GC patients with lymph node metastasis and are associated with increased postoperative mortality. The combination of enhanced CT with serum NDRG4 and TM4 SF1 has high value in predicting lymph node metastasis and prognosis in gastric cancer.

Objective To investigate the impact of preoperative jaundice reduction via PTCD on the surgical prognosis of patients with pancreatic head cancer accompanied by obstructive jaundice, and to analyze whether it acts by regulating the TGF-β/Smad signaling pathway, reversing the epithelial-mesenchymal transition(EMT) process, and alleviating systemic inflammatory status. Methods A total of 150 patients with pancreatic head cancer and obstructive jaundice admitted between October 2023 and June 2025 were selected. According to preoperative total bilirubin levels and whether they received PTCD,they were divided into a jaundice-reduction group(n = 50), a low-bilirubin group(n = 50), and a non-jaundice-reduction group(n = 50). Baseline data, tumor pathological characteristics, surgical outcomes, and postoperative complications were compared among the three groups. Serum levels of inflammatory factors(TNF-α, IL-6) were detected by enzyme-linked immunosorbent assay( ELISA). The expression of EMT-related proteins( E-cadherin, N-cadherin, Vimentin) and TGF-β/Smad pathway proteins(p-Smad2, p-Smad3) in tumor tissues was detected by Western blotting. Pearson correlation analysis was used to analyze the correlation between serum inflammatory factors and EMT-related protein expression. Results The lymph node metastasis rate in the jaundice-reduction group was significantly lower than that in the non-jaundice-reduction group(χ2/P =6.507/0.039), while the proportion of stage I was significantly higher(χ2/P = 7.177/0.028), with no statistically significant difference compared to the low-bilirubin group(P>0.05). On postoperative day 7, the IL-6 level in the jaundice-reduction group was significantly lower than that in the non-jaundice-reduction group and the low-bilirubin group(F/P = 38.674/<0.001);the TNF-α level was significantly lower than that in the non-jaundice-reduction group(F/P = 78.451/<0.001), with no statistically significant difference compared to the low-bilirubin group(P = 0.067). The expression of E-cadherin in the jaundice-reduction group was significantly higher than that in the non-jaundice-reduction group(t/P = 202.402/<0.001), while N-cadherin and Vimentin were significantly lower(t/P = 12.502/<0.001, 63.273/<0.001). The levels of p-Smad2 and p-Smad3 in the jaundice-reduction group were significantly lower than those in the non-jaundice-reduction group(t/P = 87.194/<0.001, 117.004/<0.001). Correlation analysis showed that TNF-α and IL-6 were negatively correlated with E-cadherin(r/P =-0.397/0.008,-0.487/<0.001) and positively correlated with N-cadherin and Vimentin(all P<0.05). The R0 resection rate in the jaundicereduction group was significantly higher than that in the non-jaundice-reduction group(χ2/P = 13.043/<0.001), with a shorter hospital stay than the non-jaundice-reduction group and the low-bilirubin group(F/P = 36.542/<0.001), and a lower total complication rate than the non-jaundice-reduction group(χ2/P = 16.672/<0.001). Conclusion Preoperative jaundice reduction can effectively improve the surgical prognosis of patients with pancreatic head cancer and obstructive jaundice. The mechanism may be related to the alleviation of systemic inflammatory response, inhibition of TGF-β/Smad signaling pathway activation,and consequent reversal of the EMT process.

Objective To explore the application value of CT combined with ultrasound in the clinical diagnosis of appendiceal tumors. Methods A total of 264 patients with appendiceal lesions admitted to Kaifeng Central Hospital Affiliated to Xinxiang Medical College from January 2022 to January 2025 were retrospectively analyzed, including 132 patients with appendiceal tumors as the study group and 132 patients with appendicitis as the control group. General clinical data of the two groups were collected. CT features(appendix morphology, maximum appendiceal diameter, size of ileocecal lymph nodes, pelvic effusion) and ultrasound features(appendiceal outer diameter and wall thickness, presence of nodules, presence of peripheral mesangial thickening, and changes in appendix shape including " onion skin "-like changes, " sausage "-like changes, and tip "spherical" expansion) were examined and recorded. Binary logistic regression was used to analyze whether CT combined with ultrasound features were influencing factors for the diagnosis of appendiceal tumors. Receiver operating characteristic(ROC) curve analysis was used to evaluate the diagnostic value of CT, ultrasound, and their combination for appendiceal tumors. Results Ultrasound examination showed that appendiceal outer diameter and wall thickness were significantly increased in the study group(t/P = 7.702/<0.001, 7.201/<0.001), and the proportions of intramural nodules, peripheral mesangial thickening, and onion skin-like and spherical shape changes of the appendix were significantly higher in the study group than in the control group(χ2/P = 7.343/0.007, 7.076/0.008, 7.443/0.006, 7.072/0.008). CT examination showed that the proportions of irregular appendix shape and pelvic effusion were significantly higher in the study group than in the control group(χ2/P = 11.528/0.001, 10.481/0.001), and the maximum appendiceal diameter and size of ileocecal lymph nodes were significantly greater in the study group than in the control group(t/P = 7.198/<0.001, 7.142/<0.001). Irregular appendix shape,pelvic effusion, increased maximum appendiceal diameter, and increased size of ileocecal lymph nodes were independent risk factors for appendiceal tumors(OR = 2.033, 2.165, 1.446, 1.529, all P<0.05). ROC curve analysis evaluating the diagnostic efficacy of ultrasound, CT, and their combination for appendiceal tumors showed that the area under the curve(AUC) for ultrasound alone was 0.808(95%CI : 0.757-0.860), and the AUC for CT alone was 0.791(95%CI : 0.735-0.847). The AUC of the combined diagnostic model of ultrasound and CT increased to 0.850(95%CI : 0.802-0.899). The combined diagnosis of appendiceal tumors was significantly better than ultrasound or CT alone(Z/P = 2.436/0.025 and 3.272/0.014, respectively). Conclusion The multimodal diagnostic strategy combining CT and ultrasound integrates the advantages of both techniques, providing a more comprehensive imaging basis and facilitating early and accurate diagnosis of appendiceal tumors.

Objective To evaluate the efficacy and safety of bevacizumab combined with niraparib in maintenance therapy for recurrent ovarian cancer. Methods A total of 112 patients with recurrent ovarian cancer treated at the Department of Gynecologic Oncology, Gansu Wuwei Cancer Hospital, from January 2020 to August 2024 were enrolled. Patients were randomly assigned in a 1:1 ratio to an observation group or a control group using a computer-generated random number table.The foundation chemotherapy regimens were carboplatin + paclitaxel or gemcitabine + docetaxel. The control group received bevacizumab, while the observation group received niraparib in addition to the regimen of the control group. Clinical efficacy,changes in tumor marker levels, quality of life, and incidence of adverse reactions were compared between the two groups. Results Among the 112 enrolled patients, 110 completed follow-up and reached the treatment endpoint, with a follow-up rate of98.2%(110/112). The last follow-up was on February 20, 2025. The objective response rate(ORR) and disease control rate(DCR) in the observation group were 61.8%(34/55) and 90.9%(50/55), respectively, which were significantly higher than those in the control group [41.8%(23/55) and 76.4%(42/55)](χ2= 4.406,P = 0.036;χ2= 4.251,P = 0.039). The median progression-free survival(PFS) in the observation group was 16 months(95%CI : 11.95-21.06), and the median overall survival(OS) was 20 months(95%CI :12.97-25.03); in the control group, the median PFS and OS were 12 months(95%CI : 9.11-14.89) and 16 months(95%CI :13.11-18.89), respectively(Log-rankχ2= 7.406,P = 0.007; Log-rankχ2= 6.576,P = 0.010). Serum levels of carbohydrate antigen 125(CA125) and human epididymis protein 4(HE4) decreased significantly in both groups during treatment, while scores for physical function, role function, emotional function, social function, and overall quality of life increased significantly(all P<0.05). After 3 and 6 cycles of treatment, patients in the observation group had significantly lower serum CA125 and HE4 levels and significantly higher scores for the aforementioned quality-of-life domains compared with the control group(all P<0.05). The overall incidence of adverse reactions in the observation group was 47.3%(26/55),which was not statistically significantly different from that in the control group [40.0%(22/55)](χ2= 0.591,P = 0.442). Conclusion The combination of bevacizumab and niraparib demonstrates superior disease control in patients with recurrent ovarian cancer, more significantly reduces tumor marker levels, and improves patients' quality of life, with a favorable clinical safety profile.