Definitive chemoradiotherapy (dCRT) has become a cornerstone in the treatment of locally advanced esophageal cancer; however, local control remains suboptimal, and persistent lesions or locoregional recurrences after treatment are not uncommon. For patients without distant metastases but with local failure, whether surgical intervention can still offer curative potential remains a major clinical dilemma. Salvage esophagectomy (SE) offers potential long-term survival for selected patients, but this procedure is performed in the context of severe fibrosis, impaired local blood supply, and obscured anatomical planes following chemoradiotherapy, resulting in significantly higher perioperative risk compared to primary esophagectomy. Consequently, controversies exist regarding patient selection, preoperative restaging, choice of surgical approach, extent of lymphadenectomy, gastrointestinal reconstruction, and perioperative management. In recent years, with the refinement of restaging modalities such as PET/CT, the accumulation of experience in high-volume centers, and emerging evidence from clinical studies, the clinical role of SE has gradually shifted from a "high-risk salvage measure" to a "selective curative strategy aimed at achieving long-term survival in carefully selected patients". Nevertheless, standardized guidelines for patient selection, technical approaches, and perioperative management are still lacking. Based on current evidence and clinical experience, experts organized by the Integrated Esophageal Cancer Committee of Chinese Anti-Cancer Association systematically reviewed key issues regarding SE, including its definition, indications, preoperative evaluation, choice of surgical approach, lymphadenectomy, gastrointestinal reconstruction, and perioperative management, and formulated a Chinese expert consensus. This consensus aims to provide guidance for standardized assessment, appropriate referral, individualized surgical decision-making, and optimized perioperative management of patients with locoregional failure after dCRT. Ultimately, this will increase the likelihood of R0 resection, reduce the risk of severe complications, and promote the safer, more judicious, and standardized implementation of SE in high-risk scenarios.

The concept of competency-based standardized residency training is gaining global popularity. However, the process of assessing, continuously evaluating, and conducting final competency evaluations remains challenging. The Milestones 2.0 system, developed by the Accreditation Council for Graduate Medical Education, provides a framework for evaluating competencies in radiation oncology residents. The core objective of this system is to assess sub-competencies within core competencies, categorizing them from novice to expert across 5 levels. Evaluation occurs every 6 months, with the expectation that all residents reach level 4 in all sub-competencies by the end of their training. This approach aims to enhance the standardization of residency evaluations across the United States. This article aims to analyze the Milestones 2.0 competency framework and explore its potential applicability and reference value for standardized radiation oncology residency training in China.

A complete plant body consists of elements on different scales, including microscopic molecules, mesoscopic multicellular structures, and macroscopic tissues and organs, which are interconnected to form complex biological networks. The growth and development of plants involve the regulation of elements on different scales and their biological networks, which requires the coordinated operation of multiple molecules, cells, tissues, and organs. It is difficult to reveal the essence of multi-level life activities by a single method or technology. In recent years, the development of various novel imaging technologies has provided new approaches for revealing the complex life activities in plants. Using multi-modal imaging technologies to study the cross-scale network connections of plants from the microscopic, mesoscopic, and macroscopic levels is crucial for understanding the complex internal connections behind biological functions. This paper first summarizes multi-modal cross-scale imaging technologies, three-dimensional reconstruction, and image processing methods, outlines the basic framework of cross-scale network connection properties, and then summarizes the applications of multi-modal imaging technologies in elucidating plant multi-scale networks. Finally, this review systematically integrates the combined analysis of cross-scale 3D spatial structural data and single-cell omics, laying a theoretical foundation for the innovation of novel plant imaging technologies. Furthermore, it provides a new research paradigm for in-depth exploration of the interaction mechanisms among cross-scale elements and the principles of biological network connectivity in plant life activities.
Plants/metabolism* ; Imaging, Three-Dimensional/methods* ; Image Processing, Computer-Assisted/methods* ; Multimodal Imaging/methods* ; Plant Physiological Phenomena

The cultivation of top innovative nursing talents with Chinese characteristics in the new era lends critical support to the accomplishment of the strategic goal of the Healthy China Initiative.Herein,we reviewed the historical development of nursing science in China,clarified the conceptual framework of nursing science with Chinese characteristics in the new era,and identified the essential qualities and competencies required for top innovative nursing talents.Furthermore,we analyzed the mission and challenges in cultivating these nursing talents,and put forward new approaches,including formulating new ethics and political education theories specific to nursing science with Chinese characteristics,establishing a cross-disciplinary educational model of Nursing+X,and creating a new nursing talent cultivation ecosystem adapted to the era of human-machine symbiosis.This study provides theoretical insights into the cultivation of top innovative nursing talents who align their development well with national strategic needs,embody patriotism,and possess a strong sense of contemporary responsibility.

The concept of competency-based standardized residency training is gaining global popularity. However, the process of assessing, continuously evaluating, and conducting final competency evaluations remains challenging. The Milestones 2.0 system, developed by the Accreditation Council for Graduate Medical Education, provides a framework for evaluating competencies in radiation oncology residents. The core objective of this system is to assess sub-competencies within core competencies, categorizing them from novice to expert across 5 levels. Evaluation occurs every 6 months, with the expectation that all residents reach level 4 in all sub-competencies by the end of their training. This approach aims to enhance the standardization of residency evaluations across the United States. This article aims to analyze the Milestones 2.0 competency framework and explore its potential applicability and reference value for standardized radiation oncology residency training in China.

Objective:To explore the types of pre-diagnosis symptom clusters in patients with acute coronary syndrome (ACS) and identify bridge symptoms between symptom clusters.Methods:From May to October 2023, convenience sampling was used to select 243 ACS patients who visited Shanxi Provincial People's Hospital as participants. The General Information Questionnaire and Chinese version of the McSweeney Acute and Prodromal Myocardial Infarction Symptoms Survey were used for the survey. Exploratory factors were used to analyze symptom clusters, while network analysis was used to identify bridge symptoms between symptom clusters. A total of 243 questionnaires were distributed, and 230 valid questionnaires were collected, with a valid response rate of 94.7% (230/243) .Results:Before diagnosis, ACS patients had four symptom clusters, namely typical chest symptom cluster, typical shoulder and back symptom cluster, fatigue related symptom cluster, and cardiopulmonary symptom cluster. In symptom network analysis, fatigue and anxiety were bridge symptoms between symptom clusters, with fatigue having the highest expected impact coefficient ( rbei=0.387 3), followed by close centrality ( rbc=0.024 2). The bridge mediation ( rbb=35.000) and close centrality ( rbc=0.024 8) of anxiety were the highest. Conclusions:Fatigue and anxiety are bridge symptoms in ACS patients, connecting different symptom clusters. Identifying bridge symptoms is beneficial for improving the efficiency and accuracy of symptom management. Research needs to consider patient heterogeneity and conduct subgroup studies on symptom clusters to further explore the practical significance of core and bridge symptoms in clinical practice.

Airway management in complex tracheobronchial surgery(TBS)remains a challenge in thoracic sur-gery.The use of extracorporeal membrane pulmonary oxygenation(ECMO)in thoracic surgery is rather rare,except for lung transplantation.To report the safety and efficacy of ECMO in complex TBS,a total of 5 patients with tracheobronchial and bronchial reconstructive surgery supported by ECMO in the Department of Thoracic Surgery of Tangdu Hospital,Air Force Medical University from May 2019 to June 2024 were collected.Among them,4 cases of tracheal tumor(including long-segment trachea resection and reconstruction,or carinal resection and reconstruction)and 1 case of acute airway obstruction caused by tracheal rupture were included,all of which were performed in veno-venous ECMO(V-V ECMO)mode.Systemic heparinization was used in 2 patients,and anticoagulation was not performed in 3 patients,which were maintained only by ECMO heparin-coated lines.4 patients recovered well after surgery,and 1 patient died 1 month after surgery due to immune-related pneumonia.For complex TBS,or in emergency situations(tracheal stenosis with risk of asphyxiation),ECMO can pro-vide adequate support and safeguard.

Objective : To investigate the expression differences of helix⁃loop⁃helix hand domain family member D 1/2(EFhd1/2) in Alzheimer′s disease (AD) patients and model mice. Methods : The expression changes of EFhd1/2 in AD patients were compared by using data from Alzheimer′s disease database (AlzData), and the changes in mRNA levels and protein levels of EFhd1/2 in brain tissues of AD patients and healthy control group were detected by qPCR and Western blot. The changes of EFhd1/2 mRNA and protein expression in brain tissues of AD models and wild⁃type mice of 3⁃month⁃old and 6⁃month⁃old were detected. Microglia were isolated from AD models and detected the changes of EFhd1/2 by RNA⁃sequencing. Results : The Analysis of Alzheimer′s Disease Database data showed that the mRNA levels of EFhd1 in AD patients increased, while EFhd2 decreased. AD patients brain tissue samples showed an upward trend in the expression of EFhd1 in different brain regions of AD patients compared with healthy controls, while EFhd2 was not different. In the AD mice model, the mRNA levels of EFhd1 were similar in both 3⁃month⁃old and 6⁃month⁃old AD mice compared with wild⁃type mice, but the protein levels of EFhd1 increased; the mRNA levels of EFhd2 increased in 3⁃month⁃old AD mice, and protein levels remained similar in the brain tissue from AD mice aged 3 months and 6 months. However, EFhd2 increased in microglia from 6⁃month old AD mice. Conclusion EFhd1 increased in both AD model mice and brain tissue of AD patients, suggesting that EFhd1 might play an important role in the development of AD, while EFhd2 increased in microglia in AD model mice, indicating that EFhd2 might be involved in AD related microglia activation and neuroinflammation.

Objective:To establish the biology reference interval (RI) of peripheral blood procalcitonin (PCT) for children between 3 days and 6 years old in China.Methods:Totally 3 353 reference individuals with apparent health or no specific diseases were recruited in 18 hospitals throughout the country during October 2020 to May 2021. Reference individuals were divided into four groups: 3-28 days, 29 days - 1 year, 1-3 years and 4-6 years. Vein blood or capillary blood were collected by percutaneous puncture from every reference individual. The PCT level in serum and the capillary whole blood were assayed by Roche Cobas e601 and Norman NRM411-S7 immunoanalyzer. Outliers were deleted and 95th percentiles of every group were provided as RIs. Man-Whitney U test or Kruskal-Wallis test were used performed to assess the difference among different gender, age or method groups. Results:The difference of PCT distribution between male and female is not statistically significant, but the difference between serum and capillary whole blood is statistically significant. The differences between age groups are significant too. For Roche e601, serum PCT RI of 3-28 days group is <0.23 μg/L, 29 days - 6 years are <0.11 μg/L. For NRM411, Serum PCT RI of 3-28 days group is <0.21 μg/L, 29 days - 1 year: <0.09 μg/L, 1 - 6 years: <0.10 μg/L. For whole blood PCT, RI of 3-28 days group is <0.26 μg/L, 29 days - 6 years is <0.15 μg/L.Conclusions:Serum and capillary whole blood PCT have different RIs, however, capillary whole blood PCT testing is valuable in pediatric application. Children in 3-28 days show higher PCT levels than other age group. To establish the RIs and understand the differences among different groups are essential for the interpretation and clinical application of peripheral blood PCT testing results.

Objective:To examine treatment outcomes of breast phyllodes tumors and the prognosis factors of local recurrence.Methods:This retrospective cohort study included 276 patients who underwent surgical resection at Breast Center, Peking University People′s Hospital from January 2011 to December 2019. Tumor subtype and histopathological features were determined from pathology reports, and the deadline of follow-up was September 30 th, 2020. All 276 patients underwent open surgery, including 17 patients of mastectomy, and 259 patients of lumpectomy. The enrolled patients were all female, with age of (41.5±11.3) years (rang: 11 to 76 years), and tumor diameter of 35(28) mm ( M( Q R)). The Kaplan-Meier method and Log-rank test were used for survival analysis. The multivariate analysis was implemented using the Cox proportional hazard model. Results:According the pathologic test, there were 191 patients of benign phyllodes tumor, 67 patients of borderline tumor and 18 patients of malignant tumor. There were 249 patients with a follow-up of more than 6 months, and 14.1% (35/249) had local recurrence. The time-to-recurrence was (28.6±22.2) months (range: 2 to 96 months), (29.1±18.1) months (range: 2 to 80 months), (32.1±30.1) months (range: 5 to 96 months) and (12.0±6.9) months (range: 8 to 20 months) for benign, borderline and malignant phyllodes tumors. Tumor diameter (≥100 mm vs.<50 mm, HR=3.968, 95%CI: 1.550 to 10.158, P=0.004) and malignant heterologous element (yes vs. no, HR=26.933, 95%CI: 3.105 to 233.600, P=0.003) were prognosis factors of local recurrence. One death from malignant phyllodes occurred after distant metastasis. The 3-year disease-free survival rates of benign, borderline and malignant phyllodes tumor were 88.2%, 81.7% and 81.4% ( P=0.300). Conclusion:Phyllodes tumors have a considerable local recurrence rate, which may be associated with tumor diameter and malignant heterologous element.