Background: This research analyses the relations between anxiety symptoms from the network perspective to deepen the understanding of anxiety in front-line medical staff during the COVID-19 pandemic and can also provide a reference for determining potential goals of clinical interventions. Methods: A convenience sampling was adopted, and the Generalized Anxiety Disorder 7-item scale (GAD-7) was administered to front-line medical staff through online platforms. A regularized partial correlation network of anxiety was constructed and then we evaluated its accuracy and stability. The expected influence and predictability were used to describe the relative importance and the controllability, using community detection to explore community structure. The gender-based differences and the directed acyclic graph were implemented. Results: The connections between A1 “Feeling nervous, anxious or on edge” and A2 “Not being able to stop or control worrying”, A6 “Becoming easily annoyed or irritable” and A7 “Feeling afraid as if something awful might happen”, etc., were relatively strong; A2 “Not being able to stop or control worrying” and A3 “Worrying too much about different things” had the highest expected influence, and A2 “Not being able to stop or control worrying” had the highest predictability. The community detection identified two communities. The results of the gender network comparison showed the overall intensity of the anxiety network in women was higher than that in men; DAG indicated that A2 “Not being able to stop or control worrying” had the highest probabilistic priority; the lines from A2 “Not being able to stop or control worrying” to A1 “Feeling nervous, anxious or on edge” and A2 “Not being able to stop or control worrying” to A7 “Feeling afraid as if something awful might happen” represented the most important arrows. Conclusion: There exist broad interconnections among anxiety symptoms of front-line medical staff on the GAD-7. A2 “Not being able to stop or control worrying” might be the core symptom and a potential effective intervention target. It was possible to bring an optimal result for the entire GAD symptom network by interfering with A2 “Not being able to stop or control worrying”. GAD may have two “subsystems”. The modes of interconnection among anxiety may be consistent between genders.

BACKGROUND Esophageal squamous cell carcinoma (ESCC) is a prevalent gastrointestinal malignancy associated with significant morbidity and mortality rates. Tumor metastasis leads to a poor prognosis for patients. Intramural gastric metastasis (IGM), is an uncommon pathway of ESCC metastasis, and is more likely to occur when in situ tumor cells show deep infiltration. In this study, we describe the diagnosis and management of two rare cases of T1-stage ESCC with IGM in clinical practice. CASE SUMMARY Case 1: In this patient, the submucosal tumor-like lesion was initially thought to be a gastrointestinal stromal tumor. T1-stage ESCC was then diagnosed by gastro-endoscopy during subsequent evaluation. The lesion was finally confirmed to be submucosal metastasis of ESCC following pathological analysis. The patient has been receiving treatment for over seven months, with an encouraging outcome. Case 2: In this patient, the initial diagnostic phase showed esophageal and gastric lesions which were classified as two distinct conditions: Early-stage ESCC and a gastrointestinal stromal tumor, respectively. However, postoperative pathology revealed ESCC with IGM. The patient received adjuvant chemotherapy following surgical intervention. Regrettably, the patient was lost to follow-up shortly after surgery. CONCLUSION The occurrence of IGM in T1-stage ESCC is rare. IGM should be taken into consideration when diagnosing submucosal tumor-like lesions to prevent misdiagnosis and missed diagnosis.