Lung cancer remains the leading cause of cancer-related mortality worldwide, with non-small cell lung cancer (NSCLC) accounting for approximately 80–85

Coronary no-reflow (NR) after percutaneous coronary intervention (PCI) predicts adverse prognosis in patients with acute coronary syndrome (ACS). This study aimed to establish a machine learning-based risk prediction model for periprocedural NR in ACS patients undergoing PCI. We conducted a single-center, prospective, observational cohort study enrolling consecutive ACS patients undergoing PCI between January 2023 and March 2024. Patients were allocated to a training set (n = 692) and a test set (n = 297) based on admission order. Key predictive features were screened using Lasso regression and the Boruta algorithm, and the overlapping variables were utilized to construct 5 models: Logistic regression, support vector machine, random forest, extreme gradient boosting, and light gradient boosting machine (LightGBM). Model performance was validated in the test set. Among 989 included patients, 145 (14.7%) developed NR. The final predictors included cardiac troponin, aspartate aminotransferase, pre-PCI Thrombolysis in Myocardial Infarction flow grade, number of stents implanted, intraoperative hypotension, and ACS subtypes. The logistic regression model showed the optimal discriminative capacity, with an area under the receiver operating characteristic curve of 0.8799 (95% confidence interval: 0.8151 to 0.9447), as well as favorable accuracy (0.8822), F1-score (0.6316), G-mean (0.7983), and precision-recall curve-area under the curve (PR-AUC) (0.6249). Restricted cubic spline analysis confirmed a nonlinear relationship between aspartate aminotransferase levels and NR risk (p-nonlinear <0.001). In conclusion, we established a concise machine learning-based model for post-PCI NR risk stratification; the nomogram and online calculator support efficient periprocedural risk assessment in ACS patients.

To address the need for precise drug delivery in the clinical treatment of pulmonary arterial hypertension (PAH), this study ingeniously leverages the high stability, high drug-loading capacity, and pH-responsive release characteristics of ZIF-8 material to innovatively design a lung artery-targeted nanoparticle (GA-SZ). This nanoparticle uses ZIF-8 as the core to load the drug stattic, with a surface coating of glucuronic acid to achieve targeted delivery. Both in vitro and in vivo experimental results demonstrate that GA-SZ can significantly inhibit the abnormal proliferation of pulmonary artery smooth muscle cells (PASMCs) and effectively block pulmonary artery remodeling, thereby reversing PAH. Additionally, the study confirmed that the designed GA-SZ can markedly suppress right ventricular (RV) remodeling. This strategy opens a new avenue for targeted therapy of PAH and provides fresh insights.

Clinical clerkship learning effectiveness is influenced by patient age, but there has been limited research in this area. This study explores the relationship between patient age and clerkship learning, investigating its impact on learning outcomes. We randomized 30 clerkship students into three groups and categorized them into three groups: young (18-40 years old), middle-aged (41-65 years old), and older (66 years and above). Students conducted consultations and physical examinations with patients from their respective age groups. The assessment included teacher feedback, post-class interview-based questionnaire surveys, and test scores. The study revealed the highest level of student satisfaction was among middle-aged patients, followed by young patients, and the lowest level of satisfaction was among older patients. Classroom interest and consultation participation were similar between young and middle-aged individuals but greater than they were among older individuals. Physical examination ratios were higher in middle-aged and older individuals than in young individuals. Theoretical test scores were consistent across age groups, but practical test scores were higher among middle-aged and older individuals. These results suggested that clinical educators should consider the age of patients and the use of middle-aged patients as learning cases to increase communication and clerkship effectiveness.

Efferocytosis of macrophages infiltrated in psoriatic lesions is mostly impaired, thus promoting the progression of psoriasis. Herein, we reveal that there exists a feedback loop between activated platelets and efferocytosis-impaired macrophages in psoriatic. Or rather, efferocytosis-impaired macrophages stimulate platelet activation, which in turn down-regulates the expression of the phagocytic receptor Mer on macrophages and polarizes macrophages to the M1-phenotype of weaker efferocytosis ability. Therefore, we construct a combined nanoplatform for more precise targeting to efferocytosis-impaired macrophages and activated platelets. The macrophage-targeting part of the nanoplatform efficiently orientates to efferocytosis-impaired macrophages through macrophage membrane encapsulation and targeting peptide modification. This increases the expression of Mer, simultaneously enhances the acidification and maturation of efferosomes, ultimately restores efferocytosis of macrophages, and promotes the phagocytosis and clearance of apoptotic cells. On the other hand, the activated platelet-targeting nanoparticles inhibit the activation of platelets, thus blocking the feedback loop and eventually preventing the down-regulation of Mer expression on macrophages. Furthermore, the combined nanoplatform suppresses the infiltration of macrophages and platelets in psoriatic lesions, reduces the release of pro-inflammatory factors such as IL-17A, and consequently improves the therapeutic effect of psoriasis and prevention of its recurrence in vivo. Collectively, this two-pronged strategy with multifunctionality in repairing efferocytosis, inhibiting platelet activation, and blocking the feedback loop may provide options available for the treatment of psoriasis.

Objective To develop a prediction model for assessing the risk of worsening heart failure (HF) in patients with chronic obstructive pulmonary disease (COPD) in order to provide logical prediction assessment and timely systematic intervention for high-risk individuals. Methods A retrospective study was conducted on 481 COPD patients who were hospitalized for the first time due to congestive HF in our hospital from January 2016 to May 2022. Lasso regression was utilized to reduce the dimensionality of the variables, followed by fitting the Cox proportional hazards model. The accuracy and clinical utility of the model were evaluated using C-index, calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA). Based on the cutoff value determined by the nomogram model, these patients were divided into high-risk and low-risk groups, and Kaplan-Meier analysis and Log-rank test were used to analyze the difference in the probability of composite endpoints between the 2 groups. Results During the observation period, 279 patients (58.0%) experienced the outcome events, with 16 (3.3%) of them dead. The model retained 4 predictive variables: diuretic use, diagnosis of pulmonary infection, moderate or severe anemia, and left ventricular ejection fraction (LVEF). The AUC value of the established model for predicting at 0.5, 1 and 2 years were 0.699, 0.742, and 0.662, respectively, indicating good predictive accuracy. The calibration curve and DCA demonstrated the model had sound accuracy and clinical applicability. There was a significant difference in survival probability between the high-risk and low-risk groups (P < 0.001). Conclusion Our developed prediction model has good predictive performance for the probability of HF exacerbation in COPD patients. When it is used within a clinically acceptable range of risk thresholds, beneficial outcomes could be obtained.

Background Postoperative lung cancer patients belong to the high-risk group for venous thromboembolism (VTE). The standardized preventive measures for perioperative VTE in lung cancer are not perfect, especially for the prevention and treatment of catheter-related thrombosis (CRT) caused by carried central venous catheters (CVCs) in lung cancer surgery. Patients and methods This study included 460 patients with lung cancer undergoing video-assisted thoracic surgery (VATS) in our center from July 2020 to June 2021. Patients were randomized into two groups, and intraoperatively-placed CVCs would be carried to discharge. During hospitalization, the control group was treated with low-molecular-weight heparin (LMWH), and the experimental group with LMWH + intermittent pneumatic compression (IPC). Vascular ultrasound was performed at three time points which included before surgery, before discharge, and one month after discharge. The incidence of VTE between the two groups was studied by the Log-binomial regression model. Results CRT occurred in 71.7% of the experimental group and 79.7% of the control group. The multivariate regression showed that the risk of developing CRT in the experimental group was lower than in the control group (Adjusted RR = 0.889 [95%CI0.799–0.989], p = 0.031), with no heterogeneity in subgroups (P for Interaction > 0.05). Moreover, the fibrinogen of patients in the experimental group was lower than control group at follow-up ( P = 0.019). Conclusion IPC reduced the incidence of CRT during hospitalization in lung cancer patients after surgery. Trial registration No. ChiCTR2000034511.

ObjectiveTo explore the uncomfortable symptoms and solutions related to personal protective equipment（PPE）of epidemic prevention personnel in makeshift COVID-19 hospital.MethodsA cross-sectional study was conducted on 158 people who participated in the fight against COVID-19 in Shanghai from April to June 2022. According to the PPE wearing frequencies and durations, the differences between the groups with PPE-related symptoms were observed, and the problems related to wearing PPE were displayed according to the survey results.ResultsThere were 151 valid questionnaires, and the effective response rate was 95.6%. Those who wore PPE for more than 3 d per week and for more than 3 h/d had a higher proportion of PPE-related symptoms, and some of the differences were statistically significant（P<0.05）. For pressure ulcers and medical goggles-related symptoms, the proportion of patients with any uncomfortable symptoms was higher in the group with PPE wearing<3 d/week and<3 h/d（P<0.01）. According to the results of questionnaire, 33% of the personnel believed that the related discomfort caused by wearing PPE could not be dealt in time, and 15% of the personnel thought that the education related to epidemic prevention was insufficient.ConclusionReducing the frequency and length of time of PPE wearing, providing sufficient personnel and materials and strengthening health protection are the keys to ensuring safe of epidemic prevention workers.

Restenosis is a severe complication after percutaneous transluminal coronary angioplasty which limits the long-term efficacy of the intervention. In this study, we investigated the efficiency of exosomes derived from AT2R-overexpressing bone mesenchymal stem cells on the prevention of restenosis after carotid artery injury. Our data showed that AT2R-EXO promoted the proliferation and migration of vascular endothelial cells and maintained the ratio of eNOS/iNOS. On the contrary, AT2R-EXO inhibited the proliferation and migration of vascular smooth muscle cells. In vivo study proved that AT2R-Exo were more effectively accumulated in the injured carotid artery than EXO and Vehicle-EXO controls. AT2R-EXO treatment could improve blood flow of the injured carotid artery site more effectively. Further analysis revealed that AT2REXO prevents restenosis after carotid artery injury by attenuating the injury-induced neointimal hyperplasia. Our study provides a novel and more efficient exosome for the treatment of restenosis diseases after intervention.

Although statins are the cornerstone of lipid management, hardly any of the existing studies on statin treatment of dyslipidemia in nephrotic syndrome (NS) addressed patient‐centered outcomes of cardiovascular events.

目的 探讨术后早期快速康复护理对行心脏植入电子装置(CIED)治疗患者自理能力及舒适度的影响.方法 本研究为单中心、回顾性研究.选取2019年3月至2020年3月在该院心血管内科接受CIED治疗的216例患者为研究对象,根据护理方法的不同分为快速康复护理干预组与常规术后护理对照组,各108例.比较两组患者术后第7、28天的手术并发症发生率、手术前后生活自理能力、恢复基本自理能力时间、简化Kolcaba的舒适状况量表(GCQ)评分.结果 术后第7、28天,干预组肩痛、背痛及上肢活动障碍发生率均明显低于对照组(P<0.001),两组其他并发症发生率无明显差异(P>0.05);术后第7天,两组控制大、小便评分均无明显差异(P>0.05),干预组进食、洗澡、修饰、穿衣、如厕、床椅转移、平地行走、上下楼梯评分及总评分均高于对照组,差异有统计学意义(P<0.05).干预组恢复基本自理能力所需时间明显短于对照组(P<0.001);术后干预组Kolcaba GCQ各项评分及总分均高于对照组,差异有统计学意义(P<0.001).结论 CIED术后快速康复护理能加速患者自理能力的恢复,提高患者舒适度,且不会增加手术并发症发生风险.

目的 评估随机森林模型对肾病综合征(NS)患者5年心血管疾病风险的预测价值.方法 选取陆军军医大学第一附属医院就诊的350例NS患者随访5年的诊疗资料,按照约7:3的比例划分为训练集和测试集.模型纳入28个预测变量,通过训练集进行随机森林模型构建,测试集数据进行模型验证,选取最优节点值和决策树数目,观察变量的预测重要性并评价模型预测性能.结果 随机森林模型最佳节点值为6、最佳决策树数目为446.模型中预测因子重要性排序依次为:肾小球滤过率(eGFR)、年龄、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白B(apoB)、清蛋白(ALB)、载脂蛋白A1(apoA1)、纤维蛋白原(Fib)、血尿酸(UA)、低密度脂蛋白胆固醇(LDL-C).模型预测的准确率为0.919、精确率为0.935、召回率为0.829,AUC及95％CI为0.899(0.832～0.966).结论 随机森林分类算法确定的重要预测因子可为预测NS患者5年心血管风险提供有用的信息,模型预测性能良好.

临床手术能力教学是贯穿整个住院医师规范化培训阶段的重点和难点内容,有效解决办法较少,临床手术能力教学的高效实施和保证培训效果关系到住院医师规范化培训质量.该院将多模态的数据、影像、3D重建、手术规划、手术导航等混合现实技术应用于住院医师规范化培训,在临床手术能力教学中提高了学员学习积极性、效率和质量,这种基于医疗大数据与人工智能技术平台的培训方法值得推广.

Objective . To investigate the clinical significance of the mRNA expression of RRM 1, TUBB 3, and ERCC 1 in non-small-cell lung cancer (NSCLC) tissues for the selection of adjuvant/postoperative chemotherapy regimens. Methods . Patients diagnosed with stage Ib-IIIa NSCLC were enrolled and randomly divided into a control group (undetected group) and an experimental group (detected group) after radical operation. The control group randomly received chemotherapy with gemcitabine plus cisplatin or paclitaxel plus cisplatin. The mRNA expression of RRM 1, TUBB 3, and ERCC 1 was detected in the experimental group before chemotherapy, and based on the detected expression, the chemotherapy regimen of cisplatin plus gemcitabine or cisplatin plus paclitaxel was chosen. The disease-free survival (DFS) of the control group and experimental group was compared. Results . Pathological type, stage, gene expression detection, and treatment method were not significantly correlated with DFS ( P > 0.05). In the subgroups treated with gemcitabine, the median DFS was 17 months in the detected group and 10.5 months in the undetected group (hazard ratio = 0.2147, 95% confidence interval: 0.07909–0.5827, P = 0.0025). Multivariate regression analysis was performed to analyse whether gene expression detection was independently correlated with DFS in the subgroups treated with gemcitabine ( P = 0.025). In the detected group, the prognosis of patients with low expression of RRM 1 was better than that of patients with high expression of RRM 1 after paclitaxel treatment ( P = 0.0039). Conclusions . The selection of chemotherapy regimen based on mRNA expression of the RRM 1, TUBB 3, and ERCC 1 genes may improve selection of candidate patients to receive clinical chemotherapy. However, large-scale prospective clinical studies are needed for in-depth investigation.

Background : The early diagnosis of non-small cell lung cancer is of great significance to the prognosis of patients. However, traditional histopathology and imaging screening have certain limitations. Therefore, new diagnostical methods are urgently needed for the current clinical diagnosis. In this study we evaluated the sensitivity and specificity of CanPatrol TM technology for the detection of circulating tumor cells in patients with non-small cell lung cancer (NSCLC). Methods: CTCs in the peripheral blood of 98 patients with NSCLC and 38 patients with benign pulmonary diseases were collected by the latest typing of CanPatrol TM detection technology. A 3-year follow-up was performed to observe their recurrence and metastasis. Kruskal-Wallis test was used to compare multiple groups of data, Mann-Whitney U test was used to compare data between the two groups, and ROC curve analysis was used to obtain the critical value. The COX risk regression and Kaplan-Meier survival analysis were performed in the 63 NSCLC patients who were effectively followed up. Results: The epithelial, epithelial-mesenchymal, and total CTCs were significantly higher in NSCLC patients than that in patients with benign lung disease (P < 0.001). The mesenchymal CTCs of NSCLC patients was slightly higher than that of benign lung diseases (P = 0.013). The AUC of the ROC curve of the total CTCs was 0.837 (95% CI: 0.76-0.914), and the cut-off value corresponding to the most approximate index was 0.5 CTCs/5 ml, at which point the sensitivity was 81.6% and the specificity was 86.8%. COX regression analysis revealed that the clinical stage was correlated with patient survival (P = 0.006), while gender, age, and smoking were not (P > 0.05). After excluding the confounders of staging, surgery, and chemotherapy, Kaplan-Meier survival analysis showed that patients in stage IIIA with CTCs ≥ 0.5 had significantly lower DFS than those with CTCs < 0.5 (P = 0.022). Conclusions : CTC positive can well predict the recurrence of NSCLC patients. CanPatrol TM technology has good sensitivity and specificity in detecting CTCs in peripheral blood of NSCLC patients and has a certain value for clinical prognosis evaluation.

Objective:To explore the application of problem-based learning (PBL) combined with case-based learning (CBL) teaching mode in the clinical practice teaching of diagnosis and treatment of heart failure.Methods:A total of 116 interns doing the internship in the hospital from September 2017 to March 2019 were selected in this study. They were divided into two groups according to the internship time, the control group ( n=63) and the research group ( n=53). The control group adopted traditional teaching, and PBL combined with CBL teaching mode was performed in the research group. The theoretical examination results and practical diagnostic operation scores of the two groups were compared. T-test and chi-square test were performed by SPSS 17.0. Results:The results showed that the scores of theoretical examination and practical operation of the interns taught by PBL combined with CBL teaching mode were (87.34±5.69) and (89.58±4.92), respectively, which were significantly higher than those of the traditional teaching mode ( P<0.01); and the teaching satisfaction in the control group was also significantly better than that in the control group. Conclusion:PBL combined with CBL teaching mode has a good effect in the practice teaching of heart failure, effectively improve students' interest in learning, and is worthy of further promotion of practices in other cardiovascular diseases.

Restenosis is a serious problem in patients who have undergone percutaneous transluminal angioplasty. Endothelial injury resulting from surgery can lead to endothelial dysfunction and neointimal formation by inducing aberrant proliferation and migration of vascular smooth muscle cells. Exosomes secreted by mesenchymal stem cells have been a hot topic in cardioprotective research. However, to date, exosomes derived from mesenchymal stem cells (MSC-Exo) have rarely been reported in association with restenosis after artery injury. The aim of this study was to investigate whether MSC-Exo inhibit neointimal hyperplasia in a rat model of carotid artery balloon-induced injury and, if so, to explore the underlying mechanisms. Characterization of MSC-Exo immunophenotypes was performed by electron microscopy, nanoparticle tracking analysis and western blot assays. To investigate whether MSC-Exo inhibited neointimal hyperplasia, rats were intravenously injected with normal saline or MSC-Exo after carotid artery balloon-induced injury. Haematoxylin-eosin staining was performed to examine the intimal and media areas. Evans blue dye staining was performed to examine re-endothelialization. Moreover, immunohistochemistry and immunofluorescence were performed to examine the expression of CD31, vWF and α-SMA. To further investigate the involvement of MSC-Exo-induced re-endothelialization, the underlying mechanisms were studied by cell counting kit-8, cell scratch, immunofluorescence and western blot assays. Our data showed that MSC-Exo were ingested by endothelial cells and that systemic injection of MSC-Exo suppressed neointimal hyperplasia after artery injury. The Evans blue staining results showed that MSC-Exo could accelerate re-endothelialization compared to the saline group. The immunofluorescence and immunohistochemistry results showed that MSC-Exo upregulated the expression of CD31 and vWF but downregulated the expression of α-SMA. Furthermore, MSC-Exo mechanistically facilitated proliferation and migration by activating the Erk1/2 signalling pathway. The western blot results showed that MSC-Exo upregulated the expression of PCNA, Cyclin D1, Vimentin, MMP2 and MMP9 compared to that in the control group. Interestingly, an Erk1/2 inhibitor reversed the expression of the above proteins. Our data suggest that MSC-Exo can inhibit neointimal hyperplasia after carotid artery injury by accelerating re-endothelialization, which is accompanied by activation of the Erk1/2 signalling pathway. Importantly, our study provides a novel cell-free approach for the treatment of restenosis diseases after intervention.

急性冠状动脉综合征(ACS)事件早期前蛋白转化酶枯草溶菌素9(PCSK9)水平的动态升高,可促进动脉粥样硬化发展和血栓形成,进而增加未来心血管事件风险.大量研究证据表明PCSK9抑制剂除迅速、强效降低低密度脂蛋白胆固醇作用外,也具有抗炎、稳定斑块、抗血栓等多效性作用.本文就PCSK9在ACS早期进程中的相关作用机制及PCSK9抑制剂的应用前景进行综述.

Objective To compare the clinical efficacy of ticagrelor versus clopidogrel on the vessels without percutaneous coronary intervention(PCI),the cardiac structure and cardiac function in patients with acute coronary syndrome(ACS).Methods The clinical data of 95 patients with ACS who received PCI in southwest hospital from January 2014 to December 2016 were analyzed retrospectively,who were divided into two groups,47 patients in the treatment group with ticagrelor and 48 patients in the treatment group with clopidogrel.The average follow-up results of vessels without PCI,the changes of cardiac structure,cardiac function between two groups were compared.Results The follow-up results at 1 years after PCI showed that the revascularization rate 6.4％ of the vascular without PCI in ticagrelor group was significantly lower than 12.5％ of clopidogrel group(P ＜ 0.000 1);vascular disease progression and recurrence rate of angina in ticagrelor group was significantly lower than those of clopidogrel group;the LEVF and LVEDD of ticagrelor group improved better,and level of BNP was significantly decreased.There was no significant difference in risk of hemorrhage between two groups,but the incidence of dyspnea in ticagrelor group was higher than that of clopidogrel group.Conclusion Ticagrelor is superior to clopidogrel in the protection of vessels without PCI,and be helpful to improve the cardiac structure and cardiac function in patients with acute coronary syndrome(ACS) after PCI.