This article explores the practical application of multidisciplinary integration in developing the professional competence of postgraduate students’ in respiratory clinical medicine. It identifies the challenges inherent in the current training systems and proposes solutions through the adoption of multidisciplinary integration. By analyzing specific implementation strategies and the obstacles encountered, the study highlights the role of multidisciplinary integration in improving the comprehensive quality and professional competence of postgraduate students. Furthermore, it discusses effective countermeasures to address issues arising during implementation of multidisciplinary integration, emphasizing the positive impact of this approach on fostering enhanced professional readiness in respiratory clinical medicine.

In the past few years, there has been a notable rise in the incidence and prevalence of idiopathic pulmonary fibrosis (IPF) on a global scale. A considerable body of research has highlighted the ‘obesity paradox,’ suggesting that a higher body mass index (BMI) can confer a protective effect against numerous chronic diseases. However, the relationship between BMI and the risk of mortality in IPF patients remains underexplored in the existing literature. We aim to shed light on this relationship and potentially offer novel insights into prevention strategies for IPF. We conducted a systematic search of the PubMed, Embase, and Web of Science databases to collect all published studies examining the correlation between Body Mass Index (BMI) and the mortality risk in patients with IPF, up until February 14, 2023. For the synthesis of the findings, we employed random-effects models. The statistical significance of the association between BMI and the mortality risk in IPF patients was evaluated using the hazard ratio (HR), with the 95

Pulmonary fibrosis is a group of chronic, progressive, and irreversible interstitial lung diseases, which are common to most end-stage lung diseases and are one of the most difficult diseases of the respiratory system. In recent years, due to the frequent occurrence of air pollution and smog, the incidence of pulmonary fibrosis in China has increased year by year, the morbidity and mortality rates of pulmonary fibrosis have gradually increased and the age of the disease tends to be younger. However, the pathogenesis of pulmonary fibrosis is not yet fully understood and is needed to further explore new drug targets. Studies have shown that non-coding RNAs play an important role in regulating the process of pulmonary fibrosis, non-coding RNAs and their specifically expressed can promote or inhibit the process. Here, we review the role of some in the regulation of pulmonary fibrosis signaling pathways and provide new ideas for the clinical diagnosis and treatment of pulmonary fibrosis.

The precise self-assembly of DNA molecules can be used to create nanoprecision supramolecular materials. However, the lack of methods to characterize such supramolecular materials limits their development. Surface-enhanced Raman spectroscopy (SERS) is widely used to detect the secondary structure of simple DNA molecules, but its application in the revealing of complex DNA supramolecular information remains challenging. Herein, we proposed a modified SERS-based platform able to provide structural information on DNA supramolecular materials. The silver nanoparticle-enhanced substrate uses acetonitrile as an internal standard and modifier, and calcium ions are used as an aggregating agent to induce the formation of stable "hotspots " of silver nanoparticles, where the base planes in DNA supramolecules are perpendicular to the surface of the substrate, obtaining enhanced Raman signals of base ring in both single-stranded DNA and DNA supramolecules for the first time. The structure of DNA supramolecules was efficiently characterized using this technique, showing the great application potential of this technique in the structural analysis of nucleic acids and their ligands.

结节病是一种累及全身多系统的肉芽肿性疾病,原因未明,最易侵犯肺组织,其中累及胸膜者称为胸膜肺结节病(pleuropulmonary sarcoidosis,PPS).PPS患者胸膜结节可与肺结节同时出现,也可继发于肺结节之后,临床上多表现为胸闷、气促等胸腔积液的表现,易误诊为结核性胸腔积液、恶性胸腔积液.本文通过报道一例经内科胸腔镜确诊的PPS ,提高广大医生对PPS的认识.

Inflammatory myofibroblastic tumor (IMT) is a rare intermediate tumor that exhibits both benign and malignant behaviors. Whether IMT is an inflammatory or a neoplastic disease remains controversial, and there is currently no standard treatment for this disease. The treatment strategies include surgical tumor removal and drug therapy; however, several patients experience tumor recurrence post-treatment. Herein, we report the endoscopic manifestations and treatment process in a case of IMT. We performed photodynamic therapy (PDT) after endoscopic tumor resection, and no recurrence was found in the patient's re-examination a year later. This indicates that PDT can improve IMT prognosis and reduce its local recurrence, signifying the therapy's potential application value for IMT.

Abstract Background Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) is caused by a variety of direct or indirect factors, such as infection including Corona Virus Disease 2019 (COVID19), trauma, inhalation of harmful gases, and shock. Progression of COVID19 severity can lead to ALI/ARDS. Owing to its unclear pathogenesis, there is currently no effective treatment established for this disease. As per a past report, human umbilical cord mesenchymal stem cells (hUC-MSCs) can decrease the extent of the injury of ALI in the mice. Hypoxic preconditioning umbilical cord MSCs (HP-hUC-MSCs) demonstrated significantly enhanced proliferation and differentiation capabilities. Furthermore, the expression of several growth factors was significantly upregulated, which remarkably increased the repair of damaged lung tissues. Methods The hUC-MSCs were cultured by cell adhesion. The properties of hUC-MSCs were identified by morphology, flow cytometry, osteogenesis, and adipogenic differentiation. We employed a transwell chamber to establish a co-culture system of hUC-MSCs and BEAS-2B. Accordingly, we evaluated the hUC-MSCs ability to treat ALI/ARDS in a lipopolysaccharide (LPS)-induced mouse model. The measurements of lung histopathological changes and neutrophil infiltration, wet/dry(W/D), pro-inflammatory, and anti-inflammatory cytokines in the bronchoalveolar lavage fluid (BALF) were performed. Results The cultured hUC-MSCs demonstrated excellent osteogenic and adipogenic differentiation abilities. When compared with normal hUC-MSCs, HP-hUC- MSCs can further reduce the inflammatory response of BEAS-2B and ALI model mice induced by LPS and enhance their anti-apoptotic ability. The level of soluble triggering receptor expressed on myeloid cells (sTREM-1) in patients with severe pneumonia increased, indicating a positive correlation with the disease severity. Conclusions Our positive preclinical results suggest that HP-hUC-MSCs can exert a stronger therapeutic effect on ALI by reducing the expression of TREM-1 and that the mechanism behind this phenomenon may be related to the TLR4/MyD88 and the phosphorylation of PI3K/Akt.

摘 要 目的：探讨小细胞肺癌(SCLC)治疗后合并肺部影像学异常改变的临床表现、诊断及治疗。方法：对1例就诊于吉林大学第二医院肺部出现复杂影像学异常改变SCLC患者的临床资料进行分析。结果：经过以化疗为主的综合治疗后，患者出现发热、进行性呼吸困难，胸部影像学提示双肺各叶见散在斑片样、条索状高密度影。前期抗感染治疗效果不佳，肺部影像学异常改变进展，后考虑肺部影像学异常改变原因为肺部感染合并间质性肺炎(放射性肺炎、免疫相关性肺炎)，调整治疗方案后患者体温下降，肺部影像学异常改变吸收，病情好转出院。结论：SCLC综合治疗后出现肺部影像学异常改变极为常见，应尽早明确病因，制定合理的治疗方案，以免延误病情。

气管内脂肪瘤（Endobronchial lipomas）是一种罕见的气道内良性肿瘤，因内含成熟的脂肪组织在胸部CT表现为均匀一致的低密度影。本文通过报道了 1例在胸部CT上表现为典型低密度影的气管内脂肪瘤，介绍了该病的发病机制、影像特征、内镜表现及治疗方法，分析并总结了以气道内低密度影为表现的疾病的鉴别诊断思路，为临床医生早期诊断该病提供参考。

Objective:To evaluate the diagnostic value of sputum miRNA-21 in lung cancer and provide evidence for the clinical diagnosis and treatment of this malignancy.Methods:The PubMed, Cochrane Library, Embase, CNKI, SinoMed, VIP, and Wanfangdata databases were searched for relevant articles, which were then selected according to the inclusion and exclusion criteria. Stata and MetaDiSc were used for Meta-analysis.Results:Four articles including five studies of diagnostic value of sputum miRNA-21 in lung cancer were used for this Meta-analysis. The results showed that the pooled sensitivity was 0.72 (95%CI: 0.66-0.78), the pooled specificity was 0.77 (95%CI: 0.71-0.82), the pooled diagnostic odds ratio was 8.71 (95%CI: 5.46-13.89), and the area under the summary receiver operating characteristic curve was 0.8263.Conclusion:MiRNA-21 in sputum is of high value in the diagnosis of lung cancer. Limited by the number and quality of the included studies, there still needs more clinical trials to verify our findings.

Background Previous research has highlighted the ability of Homeobox A10 (HOXA10) to the promote proliferation, migration, and epithelial-mesenchymal transformation of various cancers, including lung adenocarcinoma (LAD), which is characterized by an aggressive disease course that exhibits rapid proliferation and migration, with studies suggesting histone deacetylase 1 (HDAC1) to be a downstream mediator of HOXA10. The current study aimed to investigate the mechanism by which HOXA10-mediated HDAC1 influences the development of LAD. Methods The expression patterns of HOXA10, HDAC1, DNA methyltransferase 1 (DNMT1), and Kruppel-like factor 4 (KLF4) were determined. Additionally, the effect of HOXA10, HDAC1, or DNMT1 on invasive phenotypes of LAD was analyzed using depletion experiments. The interactions among HOXA10, HDAC1, DNMT1, and KLF4 were evaluated via chromatin immunoprecipitation, dual luciferase assay or co-immunoprecipitation. Furthermore, the tumorigenic ability of the LAD cells following HOXA10 silencing and/or HDAC1 overexpression in vivo was also investigated. Results In the LAD tissues and cells, HOXA10, HDAC1, and DNMT1 all exhibited high levels of expression, while KLF4 was poorly expressed. HOXA10 silencing inhibited the expression of HDAC1, reduced LAD cell proliferation, migration, and invasion, and promoted the apoptosis. HDAC1 promoted DNMT1 expression through deacetylation, and DNMT1 inhibited the KLF4 expression through DNA methyltransferase. The in vitro findings were further attested through the use of in vivo assays. Conclusion Taken together, the key observations of the current study highlight the role of HOXA10 and HDAC1 in promoting the proliferation and migration of LAD cells. HOXA10-induced upregulation of HDAC1 interacts with DNMT1-KLF4 axis, while the inhibition of HOXA10 or HDAC1 represents a promising anti-tumor therapy target for LAD.

Objectives: A novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is causing the worldwide coronavirus disease 2019 (COVID-19) outbreak with high mortality. A unique finding among COVID-19 patients was a decline of eosinophil levels (eosinopenia). However, results from previous studies on the relationship between eosinopenia and disease severity were inconsistent. The objective of this study is to determine the relationship between eosinopenia and COVID-19 mortality as well as the clinical conditions that could potentially lead to mortality. Methods: One hundred ninety patients diagnosed as moderate, severe, or critical COVID-19 at hospital admission were enrolled. Data collected from patients’ medical records on the second day after hospital admission included medical histories, clinical symptoms, chest images of computed tomography (CT), laboratory examinations, and outcomes. Results: Eosinophil levels were significantly lower in patients with critical disease, when compared to those with moderate and severe diseases. After controlled for confounding factors, ie, age, gender, hypertension, coronary heart disease, diabetes, and chronic lung disease, a progressive decline of eosinophil levels was independently associated with mortality. Moreover, eosinophil levels significantly and positively correlated with platelet and D-dimer levels but significantly and inversely correlated with serum levels of urea, creatinine, aspartate aminotransferase, lactate dehydrogenase, and creatine kinase. Conclusions: Eosinopenia, if progressively worsening, indicates that COVID-19 patients may progress to critical disease and have a significantly higher chance of mortality. Additionally, eosinopenia correlates with biomarkers of coagulation disorder and those of tissue damage in kidney, liver, and other tissues.

Objectives: To assess the effects of corticosteroid therapy for patients with severe coronavirus disease 2019 (COVID-19). Methods: We comprehensively searched articles published in the Cochrane Library, PubMed, Embase, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases from January 1, 2019, to March 20, 2021. Results: A total of 6771 patients from eight prospective studies were included in our meta-analysis. The results showed that corticosteroid therapy was associated with lower mortality in severe COVID-19 (OR = 0.70, 95% CI = 0.54-0.92, P = 0.009; I-2 = 54.5%). Since the proportion of the RECOVERY (Randomized Evaluation of COVID19 Therapy) trial included in the meta-analysis was as high as 71.88%, we removed it and recalculated the pooled OR. The results of the remaining seven studies still suggested such a survival benefit (OR = 0.65, 95% CI = 0.44-0.96, P = 0.030; I-2 = 59.8%). Furthermore, subgroup analysis suggested that the pooled OR of three studies using corticosteroids in the early stages of treatment was much lower (OR = 0.37, 95% CI = 0.25-0.57, P < 0.001; I-2 = 47.8%). However, after excluding the RECOVERY trial, the pooled OR of the remaining four studies with unspecific administration timing of corticosteroid therapy no longer supported this result (OR = 0.90, 95% CI = 0.69-1.17, P = 0.415; I-2 = 0.0%). Conclusions: In this meta-analysis, evidence based on seven randomized controlled trials and one prospective cohort study indicates that corticosteroid therapy was associated with a reduction in the mortality of severe COVID-19, especially when administered at an earlier time.

目的 探讨分析以微课和情景模拟相结合的教学模式在实验诊断学实习教学中的具体应用及教学效果.方法 根据教学大纲编写实习微课及具有临床代表性、应用性的典型病例.于2019年4月—2021年4月以吉林大学白求恩医学院2016级实习学生60名(传统教学方式),及2017级实习学生60名(微课与情景模拟结合教学模式)为研究对象,对两组学生进行调查问卷及分析.结果 学生认为微课与情景模拟相结合的教学方法更利于临床诊断思维的建立,有利于课本知识与实际工作相联系,有利于提高学习兴趣.结论 在实验诊断学实习课教学中利用微课和情景模拟教学法相结合的方式优于传统的教学方法,适用于教学推广.

Background: We aimed to describe the clinical features of novel coronavirus disease 2019 (COVID-19) patients with or without diabetes, focusing on the effect of abnormal HbA1c levels on inflammatory reactions and disease severity.Methods: A total of 190 patients with COVID-19 were included in this cross-sectional study. Clinical and laboratory characteristics were collected and compared among moderate, severe, and critical cases, as well as among diabetes, prediabetes and nondiabetes cases. Receiver operating characteristic (ROC) curves were constructed to determine the diagnostic ability of HbA1c for disease severity. Logistic regression was used to explore the relationship between HbA1c levels and worse prognosis of COVID-19.Results: HbA1c levels at admission were significantly different in patients with moderate, severe, and critical diseases (P<0.001). The area under the curve (AUC) of HbA1c levels to distinguish between moderate and severe-critical diseases was 0.938 (95% CI 0.906–0.970). After adjustment for confounders, the results showed that the increasing odds of in-hospital deaths were associated with HbA1c levels >6.0% (42 mmol/mol) (aOR 2.971 [95% CI 1.002, 8.804], P=0.049), and the increasing odds of severe or critical COVID-19 were associated with HbA1c levels ≥5.7% (39 mmol/mol) (aOR 29.588 [95% CI 8.285, 105.457], P<0.001). In addition, HbA1c levels strongly correlated with inflammatory markers and cytokines.Conclusions: Abnormal glucose metabolism can cause a hyperinflammatory state of COVID-19, which manifests as severe disease.

The development of molecular spectroscopy has facilitated the application of surface-enhanced Raman spectroscopy (SERS) for the detection of biomolecules, such as proteins and antibiotics. However, the sensitive and reproducible detection of SERS signals for unlabeled target antibiotic molecules remains a challenge. Here, we used bromide ions and calcium ions to improve the surface state of silver (Ag) nanoparticles, eliminate the interference of citrate ion signals, and perform an indiscriminate analysis of the different types of antibiotics. Calcium ions also act as aggregating agents to induce the "hot spots" formed by Ag nanoparticles, which can accommodate the entry of antibiotic molecules to realize high-sensitivity detection of antibiotic molecules. Using this method, we obtained the SERS spectra of antibiotic molecules with good reproducibility and a high signal-tonoise ratio. Also, using dichloromethane as the internal standard, we proposed, for the first time, the use of changes in peak intensity to distinguish between different antibiotic molecules and characterize changes in the structure and properties of these antibiotic molecules. Additionally, we detected the Raman signal of antibiotic molecules at low concentrations in human serum successfully. This method will find wide applications in the fields of medical therapy and biological macromolecular analysis.

报道1例支气管结石合并曲霉感染的病例，因支气管结石阻塞管腔后继发曲霉感染，并引起咯血，最终经取石治疗后好转。本文介绍了该病的发病机制、诊断、鉴别诊断及治疗方法，以提高临床医生对该病的认识。

目的 通过分析特发性肺纤维化(IPF)患者的临床资料和血清标志物水平变化,探讨血清标志物在肺纤维化患者早期诊断中的应用价值.方法 选取2015年6月～2017年6月间,吉林大学第二医院呼吸内科明确诊断为IPF的患者20例为IPF组,同期选取健康对照组(HC组)10例,支气管哮喘组(Asthma组)6例,慢性阻塞性肺疾病组(COPD组)6例,对4组患者临床资料进行回顾性统计分析.比较4组血清标志物的表达水平,并对各个血清标志物的敏感性及特异性进行对比分析.结果 与HC组比较,IPF组血清涎液化糖链抗原(KL-6)、肺表面活性物质结合蛋白A(SP-A)、肺表面活性物质结合蛋白D (SP-D)、人表皮生长因子(EGF)、血管内皮生长因子(VEGF)、趋化因子配体13(CXCL-13)水平均明显高于HC组(P＜0.05).IPF组血清KL-6、SP-D、EGF、VEGF、CXCL-13水平均较Asthma组、COPD组高,差异均有统计学意义(P＜0.05).由ROC曲线可知,诊断IPF各生物指标中,敏感性EGF＞ CXCL-13＞KL-6＞ SP-D＞SP-A＞VEGF＞趋化因子配体18 (CCL-18).联合指标的AUC值明显大于单个血清标记物的AUC值,当7个标志物联合时所测的AUC值最大,且联合标志物和各单一标志物之间的AUC值差异有统计学意义(P＜0.05).结论 7项血清标志物对IPF的早期诊断均有一定意义,联合血清标志物较各单一标志物诊断IPF具有高敏感性和高特异性,对IPF患者管理有更高的成本效益.

Idiopathic pulmonary fibrosis (IPF) is an agnogenic, rare, and lethal disease, with high mortality and poor prognosis and a median survival time as short as 3 to 5 years after diagnosis. No effective therapeutic drugs are still not available not only in clinical practice, but also in preclinical phases. To better and deeper understand pulmonary fibrosis will provide more effective strategies for therapy. Mounting evidence suggests that noncoding RNAs (ncRNAs) and their interactions may contribute to lung fibrosis; however, the mechanisms underlying their roles are largely unknown. In this review, we systematically summarized the recent advances regarding the crucial roles of long non-coding RNAs (lncRNAs), microRNAs (miRNAs), and circular RNAs (circRNAs) and crosstalk among them in the development of IPF. The perspective for related genes was well highlighted. In summary, ncRNA and their interactions play a key regulatory part in the progression of IPF and are bound to provide us with new diagnostic and therapeutic targets.

Background and Objective: We performed this systematic review and meta-analysis to assess the efficacy and safety of antigen-specific immunotherapy (Belagenpumatucel-L, MAGE-A3, L-BLP25, and TG4010) in the treatment of patients with non-small-cell lung cancer (NSCLC). Methods: A comprehensive literature search on PubMed, Embase, and Web of Science was conducted. Eligible studies were clinical trials of patients with NSCLC who received the antigen-specific immunotherapy. Pooled hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated for overall survival (OS), progression-free survival (PFS). Pooled risk ratios (RRs) were calculated for overall response rate (ORR) and the incidence of adverse events. Results: In total, six randomized controlled trials (RCTs) with 4,806 patients were included. Pooled results showed that, antigen-specific immunotherapy did not significantly prolong OS (HR=0.92, 95% CI: 0.83, 1.01; P=0.087) and PFS (HR=0.93, 95% CI: 0.85, 1.01; P=0.088), but improved ORR (RR=1.72, 95% CI: 1.11, 2.68; P=0.016). Subgroup analysis based on treatment agents showed that, tecemotide was associated with a significant improvement in OS (HR=0.85, 95% CI: 0.74, 0.99; P=0.03) and PFS (HR=0.70, 95% CI: 0.49, 0.99, P=0.044); TG4010 was associated with an improvement in PFS (HR=0.87, 95% CI: 0.75, 1.00, P=0.058). In addition, NSCLC patients who were treated with antigen-specific immunotherapy exhibited a significantly higher incidence of adverse events than those treated with other treatments (RR=1.11, 95% CI: 1.00, 1.24; P=0.046). Conclusion: Our study demonstrated the clinical survival benefits of tecemotide and TG4010 in the treatment of NSCLC. However, these evidence might be limited by potential biases. Therefore, further well-conducted, large-scale RCTs are needed to verify our findings.