Adrenocortical carcinoma (ACC) is a highly aggressive endocrine malignancy originating from the adrenal cortex, among which the undifferentiated subtype is rare and associated with a high risk of clinical misdiagnosis. Here we report a case of ACC with concurrent RET gene fusion and undifferentiated pathological features. The patient presented without classic clinical manifestations of ACC and tested negative for canonical adrenocortical immunohistochemical markers. The definitive diagnosis was established based on biopsy and surgical histopathology, endocrine function assessment, systemic imaging, molecular pathological testing using next-generation sequencing, and multidisciplinary team consultation. This study highlights the value of an integrated diagnostic strategy for the identification and differential diagnosis of rare ACC subtypes and suggests that RET may serve as a potential therapeutic target. In addition, through a review of the relevant literature, this study summarizes the molecular-pathological characteristics of ACC carrying genetic variants, aiming to improve clinicians' understanding of the diagnosis and management of rare ACC subtypes.
Objective To explore the heterogeneity of hope levels and associated factors among young and middle-aged patients with diabetic retinopathy (DR), to provide a reference for stratified and precision nursing interventions.Methods Using a convenience sampling method, young and middle-aged patients with DR who visited Zhongnan Hospital of Wuhan University, Zengdu Hospital of Suizhou City, and Dawu County People's Hospital from January 2025 to June 2025 was selected as the research subjects. Data were collected using a general information questionnaire, the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the Medical Coping Modes Questionnaire (MCMQ), the Social Support Rating Scale (SSRS), and the Herth Hope Index (HHI). The overall hope level was described according to the standard HHI criteria, and latent profile analysis(LPA) was conducted using the 12 HHI items as indicator variables. Multivariate Logistic regression was performed to examine factors associated with latent class membership.Results A total of 393 young and middle-aged patients with DR were included. Three latent profiles of hope levels were identified among young and middle-aged patients with DR: the nostalgic-defensive type (32.3%), the lonely-fearful type (35.9%), and the actively maintaining type (31.8%). Multivariate Logistic regression analysis showed that sex, age, monthly per capita family income, visual impairment, glycated hemoglobin, coping style, social support, and fear of disease progression were associated with latent class membership of hope levels (P < 0.05).Conclusion Hope levels among young and middle-aged patients with DR showed significant heterogeneity. LPA may help identify subgroups with distinct psychological characteristics that may be overlooked by traditional total-score-based stratification. The findings provide a reference for clinical nurses to identify different psychological subgroups of young and middle-age patients with DR and implement stratified and precision nursing interventions.
Objective To investigate the effectiveness of artificial intelligence (AI)-assisted diagnostic tools in clerkship teaching of medical imaging for undergraduate students.Methods Undergraduate clinical medical students who interned in the Department of Radiology of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from March to April 2025 were enrolled and randomly assigned to an AI group and a control group. The AI group received teaching supported by a picture archiving and communication system (PACS) and its integrated AI-assisted diagnostic system. In contrast, the control group received conventional lecture-based teaching with PowerPoint slides plus routine film-reading guidance. Teaching effectiveness was evaluated using the end-of-clerkship assessment, a theoretical knowledge test in medical imaging, and a teaching feedback questionnaire.Results Ninety-nine students were included (49 in the AI group and 50 in the control group). The AI group achieved higher scores on the written examination and higher total scores on the medical imaging theory test than the control group (P < 0.05). The teaching feedback questionnaire indicated that the AI group scored higher in satisfaction with teaching methods, teaching content, and classroom activities, and performed significantly better than the control group in knowledge acquisition, learning interest, clinical thinking, and self-directed learning ability (P < 0.05).Conclusion Integrating AI-assisted diagnostic tools into clerkship teaching of medical imaging for undergraduate students can improve learning outcomes and learning experience, promote a shift from passive observation to active operation and self-directed learning, and has potential value for wider implementation.
In randomized controlled trials (RCTs) and Meta-analysis, effect modification (EM) is often used to explore the differences in intervention effects across populations. However, a large number of EM claims actually stem from random error, multiple testing or selective reporting, and lack reliable verification, which may mislead clinical decision-making and thus urgently necessitates dedicated credibility assessment tools for identification. The Instrument for assessing the Credibility of Effect Modification Analyses (ICEMAN) has developed differentiated assessment frameworks for individual RCTs and Meta-analysis respectively, covering multiple core dimensions, and ultimately comprehensively rates the credibility into four grades: very low, low, moderate and high. This paper aims to interpret the conceptual framework, scope of application and key operational points of ICEMAN, and to provide a reference for domestic researchers in applying this tool.
Objective To gain an in-depth understanding of the stress experience and coping strategies of patients during their home recovery period after radical prostatectomy (RP), and to provide a reference basis for improving their home adaptation ability and optimizing home recovery intervention strategies.Methods A descriptive qualitative study was conducted. Using purposive sampling, patients who had RP in Department of Urology of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School from November 2024 to January 2025 were selected for semi-structured interviews, and directed content analysis was conducted based on the contents of the interviews.Results A total of 16 patients were interviewed, from which 3 themes and 7 sub-themes were identified: the multiple stressors of home-based recovery (physical dysfunction, self-identity crisis, and gaps in ongoing care), distorted cognitive appraisal (misreading of one's own condition and available resources), and diverging coping strategies (either active, goal-oriented efforts or avoidance and passive endurance).Conclusion Stress experience and coping strategies of patients during home-based recovery after RP exhibit multidimensional and complex characteristics. Clinical nursing should move beyond a single model of physical rehabilitation guidance and place equal importance on patients' psychological status; emotional counseling, multi-source support channels, and refined home-based rehabilitation guidance can improve stress coping capacity and postoperative quality of life.
