This study aims to compare multi-disciplinary team-based learning (MDTBL), problem-based learning (PBL) and lecture-based learning (LBL) on the learning outcomes and experiences of medical students. A randomized controlled study was designed to recruit 30 medical students with a minimum of one year of clinical experience and 45 with less than one year of clinical experience to take a course on clinical diagnosis and evaluation of pulmonary nodules from September 15, 2022, to December 31, 2023. The participants were randomly assigned to the MDTBL group, PBL group, and LBL group to complete a full-course curriculum. Before, during, and after the learning phases, all participants underwent identical theoretical assessments and received a score on their learning progress. In the MDTBL and PBL groups, group discussions were permitted. After the completion of the learning phase, self-evaluation and course satisfaction were assessed through a questionnaire. The authors collected basic information on participants to ensure comparability between groups. All groups showed significant improvement in their competence in the clinical diagnosis and evaluation of pulmonary nodules, with the MDTBL group demonstrating notably higher gains in theoretical knowledge and case analysis skills (P < 0.05). The learning participation scale indicated that student engagement in the MDTBL group was higher than in the other two groups (P < 0.05). Additionally, the MDTBL group perceived the course as more engaging and enjoyable. This study demonstrates that the MDTBL teaching model, as an innovative approach, excels in enhancing knowledge acquisition, collaborative skills, and clinical practice application skills in medical students. It positions itself as a valuable teaching model for future medical education, providing educators with a new toolkit for training specialists. This study was retrospectively registered in 2023 as No.JG2023-0203.

CD26 (DPP4) is shown in literature to be implicated in multiple tumors and antitumor immunity, yet its pan-cancer and context-dependent roles remain imprecisely defined. This study comprehensively characterizes the clinical relevance of CD26 and its association with invasion-related features and immunotherapy-relevant immune infiltration and response-associated biomarkers, and to validate key findings in breast cancer cells. The integrated pan-cancer analysis of CD26 was performed using public databases, assessing its expression patterns, associations with cancer staging and prognostic value. Co-expression and protein-interaction data were used for GO/KEGG enrichment to infer potential biological pathways. Correlations between CD26 and immune cell infiltration, cancer-associated fibroblasts (CAFs), immune checkpoints, tumor mutational burden (TMB), microsatellite instability (MSI), and neoantigen load were systematically evaluated. R software and online bioinformatics tools were employed. Additionally, qPCR, western blot and other in-vitro experiments compared CD26 expression in MCF-7 breast cancer cells and MCF-10A normal breast epithelial cells, and examined the effects of pharmacologic CD26 inhibition (alogliptin) on proliferation, invasion, and MMP9 expression in vitro. CD26 exhibited broad but low tissue specificity and was significantly upregulated in multiple malignancies compared with normal tissues, particularly in highly aggressive tumors (P < 0.01). Higher CD26 expression was associated with advanced pathological stage and adverse prognosis in several tumor types (p < 0.01), including breast cancer, while exhibiting a favorable prognostic association in a subset of tumors, indicating context-dependent relationships. Functional enrichment suggested involvement of CD26-related networks in chemokine signaling and EMT-related processes. CD26 expression correlated with estimated immune infiltration in 34 of 38 tumor types, including CD4+ and CD8+ T cells and CAFs, and was associated with multiple immune checkpoints, as well as TMB, MSI and neoantigens in selected cancers. In vitro, CD26 was elevated in MCF-7 versus MCF-10A cells (p < 0.05), and alogliptin treatment reduced MCF-7 cell proliferation and invasion (p < 0.05), accompanied by decreased MMP9 expression (p < 0.05). This study presents an integrative pan-cancer framework linking CD26 expression to immune infiltration, together with in vitro observations in breast cancer cells, offering a comprehensive pan-cancer and experimental characterization of CD26. CD26 might be a novel prognostic biomarker candidate and therapeutic target to counteract tumor development in highly aggressive cancer.

Breath analysis can be used to diagnose diseases non-invasively. Accurate measurement of volatolomics is critical for breath analysis to be a gold standard. Tedlar bags (TB) are often used to collect breath samples, but they emit contaminants that affect accuracy. This issue was overlooked in previous studies. We found contamination issues with TB ( Inc. , siloxanes and aromatic impurities) that affect the identification of volatile organic compounds (VOCs) due to impurities. Then, home-designed equipment (HD) made with poly-tetrafluoride (PTFE) and quartz glass for breath collection was developed and employed in clinical trials. 15 healthy individuals and 32 non-small cell lung cancer (NSCLC) patients at IA stage participated in this study. 610 VOCs can be collected through TB, which is less than HD (1109 VOCs), demonstrating that the inner wall of the TB easily adsorbs VOCs, leading to decreased detection concentrations. Otherwise, utilizing orthogonal partial least squares discriminant analysis (OPLS-DA), we identified chemical markers with significant discriminatory power (VIP > 1.5, P < 0.05). The HD method identified 12 target VOCs, surpassing the 3 target VOCs discerned by the TB method. A model combined with a machine learning algorithm for distinguishing early-stage lung cancer patients was established based on biomarkers, which were selected based on OPLS-DA. The results showed strong predictive capabilities for the HD-based model. It indicated that 12 biomarkers derived from the HD model were more effective in distinguishing NSCLC patients, with an AUC value of 0.92, compared to the AUC value of 0.5 from 3 markers obtained from the TB model. The sensitivity and specificity in the confusion matrix reached 100 % and 80 % for the HD test, but TB test reached only 40 % and 60 %. This work demonstrated that optimizing and standardizing VOCs collection methodology from breath of lung cancer patients is essential to identify actual volatiles, which could promote disease volatolomics worldwide. (c) 2025 Published by Elsevier B.V. on behalf of Chinese Chemical Society and Institute of Materia Medica, Chinese Academy of Medical Sciences.

Due to constant stimulation by stomach acid and local bleeding, gastric tissue wounds tend to heal slowly and complications such as anastomotic leakage have a high incidence. Suturing is often used to treat gastric wounds in clinic, but it still faces risks such as bleeding, slow healing, and leakage. Recently, hydrogel have been widely used to treat various types of wounds. Although hydrogels have shown promising efficacy in wound healing, it is still a challenge in dealing with wounds in gastric tissue for the poor adaptability of traditional materials in acidic environments. Hence, a series of pH responsive and good tissue adhesive hydrogels (MA-HA/AA) based on methacryloyl hyaluronic acid (MA-HA) and acryloyl-6-aminocaproic acid (AA) via in situ photo-crosslinking were designed, and anti-inflammatory and pro-healing traditional Chinese medicines ginsenoside Rg1 was incorporated into the hydrogel to treat gastric tissue wound. These acid-responsive hydrogels could form effective acid-resistant barriers and could lead to hemostasis rapidly through its strong adhesion. Besides, the hydrogels contracted under an acidic environment, which could tighten the gastric tissue wounds and sustained release the loaded ginsenoside Rg1. In addition, the hydrogels showed excellent biocompatibility and in vivo degradability. In summary, the acid-responsive contractile hyaluronic acid hydrogel loaded with ginsenoside Rg1 had good properties for hemostasis and acid-resistance to facilitate the promotion of gastric wounds healing.

The emergence and proliferation of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia poses a significant global public health threat. Herein, the significant remission effect against acute MRSA pneumonia was realized through the insect cuticle protein (OfCPH-2) nanoassemblies without nonspecific immune response. The lung repair results could be attributed to the transforming of M1-type to M2-type macrophage polarization and the repression of Th17 cell differentiation in mice spleens through the intervention of OfCPH-2 nanoassemblies. These findings offer a valuable insight into the application of insect protein-based materials as effective antidrug resistant strain agents as well as a powerful strategy for acute MRSA pneumonia.

自21世纪以来,肺移植技术发展迅速,成为治疗各种终末期肺疾病患者的新策略.2020 年全球肺移植手术量已有2500例[1],我国接受肺移植手术的患者呈逐年增长趋势.截止2020年,我国双肺移植患者围术期生存率为80.5％,1年生存率为62.7％,仍低于其余器官移植水平[2].影响肺移植围术期生存率的原因包括感染、手术并发症、免疫排斥反应等,其中移植物的急性损伤直接影响患者术后短期生存率.移植器官的缺血/再灌注损伤(ischemia-reperfusion injury,IRI)是围术期移植物损伤的主要原因之一.导致和影响IRI的因素众多.近年来铁死亡作为一种新的细胞死亡方式,参与及影响了多种生物学行为,铁死亡被认为在越来越多的器官IRI过程中发挥作用[3-4].本综述旨在描述铁死亡在肺移植IRI中的研究进展,为提高肺移植术后患者短期生存率提供新思路.

Developing self-assembled biomedical materials based on insect proteins is highly desirable due to their advantages of green, rich, and sustainable characters as well as excellent biocompatibility, which has been rarely explored. Herein, salt-induced controllable self-assembly, antibacterial performance, and infectious wound healing performance of an insect cuticle protein (OfCPH-2) originating from the Ostrinia furnacalis larva head capsule are investigated. Interestingly, the addition of salts could trigger the formation of beaded nanofibrils with uniform diameter, whose length highly depends on the salt concentration. Surprisingly, the OfCPH-2 nanofibrils not only could form functional films with broad-spectrum antibacterial abilities but also could promote infectious wound healing. More importantly, a possible wound healing mechanism was proposed, and it is the strong abilities of OfCPH-2 nanofibrils in promoting vascular formation and antibacterial activity that facilitate the process of infectious wound healing. Our exciting findings put forward instructive thoughts for developing innovative bioinspired materials based on insect proteins for wound healing and related biomedical fields.

Background: In recent years, pulmonary fibrosis (PF) has increased in incidence and prevalence. Qingzaojiufei decoction (QD) is a herbal formula that is used for the treatment of PF.Objective: In this research, network pharmacology and molecular docking methods were used to explore the major chemical components and potential mechanisms of QD in the treatment of PF.Methods: The principal components and corresponding protein targets of QD were used to screen on Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP), Traditional Chinese Medicine Integrated Database (TCMID) and high-throughput experiment-and reference-guided database (HERB), Cytoscape 3.7.2 was used to construct the drug-component-target network. PF targets were collected by GeneCards and Online Mendelian Inheritance in Man (OMIM) databases. The protein-protein interaction (PPI) network was constructed by importing compound-disease intersection targets into the Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database and visualized by Cytoscape3.7.2. We further performed Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis on the intersecting targets. In the last, we validated the core targets and active compounds by molecular docking.Results: The key compounds of quercetin, (-)-epigallocatechin-3-gallate, and kaempferol of QD were obtained. The key targets of AKT1, TNF, and IL6 of QD were obtained. The molecular docking results show that quercetin, (-)-epigallocatechin-3-gallate and kaempferol work well with AKT1, TNF and IL6.Conclusion: This research shows the multiple active components and molecular mechanism of QD in the treatment of PF and offers resources and suggestions for future studies.

目的 探讨帕博利珠单抗联合新辅助化疗治疗可切除非小细胞肺癌的近期疗效及安全性.方法 回顾性分析2019年12月—2021年6月于西安交通大学第一附属医院胸外科行帕博利珠单抗联合新辅助化疗的11例男性非小细胞肺癌患者的临床资料,年龄52.0～79.0(62.0±6.9)岁.对比新辅助治疗前后的影像学资料及病理学改变,记录新辅助治疗过程中的不良反应,以客观缓解率、主要病理缓解率及病理完全缓解率为主要观察终点.结果 经帕博利珠单抗联合铂类或紫杉醇进行新辅助治疗后,全组患者均成功进行了胸腔镜肺癌根治术.客观缓解率为72.7％,主要病理缓解率为81.8％,其中,45.5％的患者达到了病理完全缓解.主要的不良反应为低白蛋白血症、食欲下降及恶心.术后30 d内死亡率为0,未观察到肿瘤转移.结论 帕博利珠单抗联合新辅助化疗治疗可切除非小细胞肺癌安全可行,可有效改善患者预后.

Radiotherapy remains controversial for resected stage IIIA NSCLC patients. Public records of 2632 NSCLC patients were re-staged using AJCC 8th manual and analyzed using X-tile. 5 + mediastinal N2 lymph nodes metastasis, visceral pleural invasion, age > 65, or larger tumor size ( > 3 cm) were found to be associated with a better outcome . Fur ther well-designed trials are warranted.Introduction: No consensus has been achieved on the benefit of radiotherapy for resected stage IIIA NSCLC patients. The division of stage IIIA has changed significantly in 2017. This study aims to explore the effects of radiotherapy on the survival of patients with resectable stage IIIA NSCLC in the new era. Patients and Methods: Patients diagnosed with NSCLC between 2010 and 2018 were identified in the 8th edition TNM classification from the Surveillance, Epidemiology, and End Results database. A nomogram was developed by integrating all independent predictors for lung cancer-specific survival (LCSS). The Propensity Score Matching (PSM) and subgroup analysis were applied to mitigate potential bias. Survival analyses were conducted using the Kaplan Meier curves and Cox proportional hazards regression. Results: A total of 2632 stage IIIA NSCLC patients were enrolled. The C-index of the nomogram for the prediction of LCSS was 0.636 (95% CI, 0.616-0.656). In the group of patients with N2 stage who featured more than 5 positive regional lymph nodes, compared with non-PORT, PORT did prolong postoperative survival time (50 vs. 31 months; P = .005). N2 patients with visceral pleural invasion (VPI), older (age > 65), or had a larger tumor (size > 3 cm) could also benefit from adjuvant radiotherapy. Conclusion: Treatment protocol for stage IIIA NSCLC patients should be individualized. Based on our findings, N2 patients with more than 5 positive regional lymph nodes, VPI, larger tumor size (greater than 3 cm), and older (age above 65) could benefit from adjuvant radiotherapy. Further well-designed randomized trials are warranted.

AbstractBackgroundThe lobar and segmental anatomy are the basis for anatomical pulmonary segmentectomy.MethodsFrom October 2017 to June 2021, 136 patients with small pulmonary nodules scheduled for anatomical pulmonary segmentectomy at our institution underwent three‐dimensional (3D) lung reconstruction. The anatomy of the left upper lobe (LUL) was statistically analyzed and graphically mapped using the reconstructed models, and the role of this reconstruction method in performing pulmonary segmentectomy was explored.ResultsThrough the analysis of the reconstructed models, the upper stem (S1 + 2 + 3) bronchus was classified as having two (94/136 cases) or three branches (42/136 cases). The upper stem artery had two branches in 24/136 patients, three in 60/136 cases, four in 44/136 cases, and five in 8/136 cases. A total of 103/136 upper stem veins had two branches, 26/136 had three branches, and 7/136 had four branches. The lingual stem (S4 + 5) bronchus was two‐branched in 116/136 cases and three‐branched in 20/136 cases, while the lingual artery was single‐branched in 61/136 cases, two‐branched in 70/136 cases, and three‐branched in rare cases (5/136 cases). The lingual stem vein was unbranched in 119/136 cases and two‐branched in 17/136 cases. Additionally, six unusual variants (<5%) were identified: one in the bronchus, with four cases; three in the pulmonary artery, with six cases; and two in the pulmonary vein, with two cases.Conclusions3D reconstruction can yield results similar to specimens for lung segment studies. The reconstruction strategy and the data presented in this article will be valuable references for thoracic surgeons performing anatomic resections.

目的 分析胸壁恶性肿瘤复发影响因素.方法 2010年1月1日～2020年12月30日收治的胸壁恶性肿瘤手术病人32例,均顺利切除胸壁肿瘤,其中限制性根治切除9例,扩大根治切除15例,姑息性切除8例.10例为复发病人,其中二次手术4例,三次手术5例,四次手术1例.结果 术后随访3～60个月,均无肿瘤复发转移.结论 胸壁恶性肿瘤复发主要是由于术前难以明确肿瘤性质和侵及范围导致手术方法不明确、切除范围不足;术中因重建困难未行扩大根治术;术后姑息性切除的病人未行进一步治疗.胸壁肿瘤术前需获取完备的检查资料、制定严密手术方案;术中需达到R0切除;对于姑息性切除的病人术后一定要行进一步治疗,降低复发率.

外科手术是治疗早期食管癌的经典传统方法,也是医学界公认有效的首选方法.随着内镜技术的发展,在早期食管癌的治疗中,保留食管的食管癌综合治疗(以内镜下微创治疗为主要手段)相比于外科手术已经取得了几乎相同甚至在某些方面更优的效果,诸多临床指南也已经推荐将前者作为早期食管癌的首选治疗方法,外科手术治疗食管癌的空间被进一步压缩.本文就胸外科视角下保留食管的食管癌综合治疗模式进行探讨,旨在寻求胸外科在食管癌治疗中的新位置.

Thyroglobulin measurement in fine-needle aspiration (FNA-Tg) is an additional diagnostic tool of lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC). However, its performance as a preoperative indicator of lateral neck LNM in PTC is unclear. We evaluated the use of FNA cytology and FNA-Tg to detect neck LNM presurgery using a simple methodology, and established a cut-off value for diagnosing LNM in PTC. We performed a retrospective cohort study based on hospital records, including 299 FNA-Tg measurements from 228 patients with PTC. The cut-off value for FNA-Tg was obtained through a receiver operating characteristic (ROC) curve analysis. The relationships between various parameters and FNA-Tg were analyzed using Spearman’s correlation. Of 299 lymph nodes (LNs) from 228 patients following surgery, 151 were malignant and 148 were benign. The median FNA-Tg levels were 414.40 ng/mL and 6.36 ng/mL in the metastatic and benign LNs, respectively. An FNA-Tg cut-off value of 28.3 ng/mL had the best diagnostic performance (93.38% sensitivity, 70.27% specificity, area under the ROC curve [AUC] 0.868) in the whole cohort. The diagnostic value performed better in the lateral neck group (level II–V, n = 163) than in the central neck group (level VI, n = 136); in the lateral neck group, the sensitivity and specificity of the FNA-Tg cut-off (16.8 ng/mL) were 96.25% and 96.36%, respectively. FNA-Tg is a useful technique for the diagnosis of LNM before surgery, especially in lateral neck dissection. ChiCTR1900028547.

The intermediate-risk category of papillary thyroid cancer (PTC) comprises heterogeneous patients within a wide range of stages and varied care management. Understanding the risk features of recurrence observed after the initial therapy should be emphasized. We aimed to evaluate the prognostic significance of radioactive iodine-avid lymph nodes observed during the initial treatment of patients with PTC that were considered to be at intermediate risk. Data on patients with intermediate-risk PTC treated from 2012 to 2018 were retrospectively reviewed. Post-therapeutic SPECT/CT (Rx SPECT/CT) was evaluated in the enrolled patients. The clinical, pathologic, and incidence of radioiodine-avid (RAI-avid) lymph node metastasis (mLN) on Rx SPECT/CT were reviewed, and risk factors related to recurrent disease were analyzed. After a median follow-up of 37.26 (30.90, 46.33) months, structural persistent/recurrent disease was detected in 9.81% (36/367) of patients with intermediate-risk tumors. The incidence of recurrence was higher in patients who demonstrated RAI-avid mLN after the initial therapy than in those who did not (p < 0.001). In a multivariate Cox proportional hazard regression analysis, RAI-avid mLN appeared to be a robust risk factor for recurrent disease after the initial therapy (HR: 8.967, 95% CI: 3.433–23.421, p = 0.000). RAI-avid mLN is a significant risk factor for recurrent intermediate-risk PTC after the initial treatment.

Objective:To evaluate the clinical effect of anterior mediastinal tumor resection under xiphoid process by sternal suspension with retractor and to discuss its application advantages.Methods:A retrospective review of 14 patients with anterior mediastinal tumors in the First Affiliated Hospital of Xi’an Jiaotong University between January 2019 to September 2020 was performed. Preoperative CT confirmed the location and size of the tumor, and single-suspended-assisted video-assisted thoracoscopic surgery resection through the inferior mediastinum of xiphoid process was performed. The basic operation conditions and postoperative recovery were observed and counted.Results:All the 14 patients successfully completed the surgery. There were 6 females (42.86%) and 8 males, aged 17-74 (46.35±9.28) years old. The maximum diameter of the mass was (5.03±2.32) cm. All the 14 patients underwent video-assisted thoracoscopic surgery under the assistance of sternal suspension with a single retractor. The operation duration was (124.32±35.71) min, the operation bleeding volume was (43.27±20.31) mL, the postoperative hospital stay was (5.32±1.34) d, the postoperative indwelling time of thoracic drainage tube was (1.84±0.82) d, and the average daily drainage volume was (230.45±70.35) mL. No patient was transferred to thoracotomy for treatment, and there was no hospital death or postoperative complications. No tumor metastasis was found after follow-up for 3 to 6 months.Conclusion:In the clinical treatment of anterior mediastinal tumors, the video-assisted thoracoscopic surgery assisted by single-pull suspension retractor has the advantages of clear field of view during the operation, small trauma, significant therapeutic effect, and convenient operation. There is no suspension-related complication after operation, and the surgical method is safe and effective.

大数据时代的到来使医学研究生教育迎来巨大的挑战及机遇.本项目组通过近几年的探索,将前期总结的经验应用于15名外科学专业学位的研究生,进行为期一年的观察,收集干预组与对照组的临床研究生论文发表、专利成果等科研相关取得情况.结果显示,干预组相较于对照组,其研究成果丰硕(x2 = 6.694,P=0.035).因此,导师掌握大数据科研方法,研究生提高利用医学数据库及数据处理的能力,对研究生培养质量的提高具有重要意义.

BACKGROUND:Lung cancer has the highest mortality in China. Different treatments are of great significance to the prognosis of patients. By comparing stage Ia non-small cell lung cancer (NSCLC) patients' survival rates for ablation and for sub-lobectomy, we studied the difference in the effects of the two treatments on patient prognosis.METHODS:Using the Surveillance, Epidemiology, and End Results (SEER) database, we screened eligible patients with stage Ia NSCLC from January 2004 to December 2015. Then, 228 patients treated with ablation and 228 patients treated with sub-lobotomy were then selected based on propensity score matching. After stratification, matching, and adjustment the Kaplan-Meier analysis was performed to compare the overall survival rates of patients treated with the two procedures.RESULTS:The Kaplan-Meier survival analysis showed that there is a significant difference between the ablation group and the sub-lobectomy group (P<0.05). In the univarlable analysis, the hazard ratio (HR) of sub-lobotomy group was 0.571 (95%CI: 0.455-0.717) compared with the ablation group. Patients treated with sub-lobectomy had a 0.571 times greater risk of adverse outcomes than those treated with ablation. In the multivariable analysis, the HR for sub-lobectomy group was 0.605 (95%CI: 0.477-0.766) compared with the ablation group. Patients treated with sub-lobectomy had a 0.605 time greater risk of adverse outcomes than those treated with ablation. The results suggested that the overall survival rate of patients with stage Ia NSCLC treated with sub-lobotomy was higher than that of patients treated with ablation.CONCLUSIONS:This study suggests that there is a significant difference in overall survival of stage Ia NSCLC patients treated with ablation and with sub-lobotomy. Patients treated with sub-lobotomy for stage Ia NSCLC had higher overall survival than those treated with ablation.

Esophageal anastomotic fistula is one of the severe complications of esophagectomy. It is reported that the incidence rate of esophageal anastomotic fistula accounts for 2% to 30% among all postoperative complications of esophagectomy, which can lead to severe infection of the neck, mediastinum, or even retrosternal abscess, and even cause death if not being treated in time. Despite the continuous development of suture techniques and materials, anastomotic fistula remains a unsolved problem. However, at present, there are no stable, reliable and specific animal models, and stable and reliable animal models are important means to clarify the pathogenesis, pathophysiological processes and treatment modalities of esophageal anastomotic fistula. Therefore, we are eager to establish a perfect functional animal model to promote the animal experimental study of esophageal anastomotic fistula and the prevention, treatment and rehabilitation of postoperative esophageal anastomotic fistula. In this paper, the present situation of esophageal anastomotic fistula, the preparation method and evaluation method of animal model of esophageal anastomotic fistula are described and summarized.