Objective To study the five-year survival status and influencing factors of elderly patients with lung cancer complicated with chronic obstructive pulmonary disease (COPD). Methods A cohort study was conducted to follow up 450 patients with lung cancer and chronic obstructive pulmonary disease who were hospitalized in our hospital from January 2018 to December 2023. The endpoint of the follow-up was the end of a five-year period or death. The Life Tables method was used to calculate survival rates and plot survival curves. The Cox proportional hazards model was used to analyze the influencing factors of five-year survival. Results The results indicated that the overall five-year survival rate of patients was 4.89%, and it decreased year by year. Cox regression analysis showed that age, gender, family functioning, and psychological status significantly influenced patient survival rate (all P<0.05). Stratified analysis found that the smoking status, family functioning, and psychological status of male patients all had an impact on survival rate (all P<0.05), while the psychological status of female patients had a more significant impact on survival (P=0.008). Conclusion This study provides a scientific basis for comprehensive intervention of elderly lung cancer patients with COPD. It is recommended that clinical attention should be paid to psychological and family factors to improve patient prognosis.

Objective: To address systemic challenges in the blood system, such as supply-demand imbalance, inefficient allocation, and inappropriate clinical use, while bridging gaps in current theories regarding the integration of social mobilization, institutional practice, and policy coordination. It sought to construct a system dynamics model spanning from macro to micro levels to analyze the blood management system holistically. Methods: Key variables were identified by a systematic literature search in both Chinese and English databases. An improved Delphi method was then employed to conduct expert consultations across different fields, leading to the selection and determination of core variable sets for each sub-model. Furthermore, by defining their logical relationships, a system dynamics model was constructed to systematically analyze the operation mechanism of the blood management system. Results: Four core sub-models were developed: 1) A macro "Dynamic Balance" model quantifying regional supply-demand equilibrium and inventory control; 2) a mobilization "Three-Layer Funnel" model analyzing how socio-cultural factors, service channels, and policy incentives influence donation behavior; 3) an institutional "Dual-Cycle Regulation" model revealing hospital blood usage is driven by both disease burden (demand cycle) and management practices (regulation cycle); and 4) an individual "Three-Layer Filter" model standardizing clinical transfusion decisions based on necessity, risk-benefit, and context. These were integrated into a "Multi-Layer Linkage and Feedback" model, elucidating bidirectional interactions among five levels: policy environment, regional supply, blood station mobilization, hospital application, and clinical decision-making. Conclusion: This study constructed a system dynamics model for blood management. By defining key variables and their logical relationships, it systematically analyzes the system′s operational mechanism. The integrated framework connects multiple levels—regional supply, voluntary donation, hospital blood use, and clinical decision-making—revealing their intrinsic linkages. Future efforts should employ systems thinking to synergistically enhance supply-side mobilization, demand-side management, systemic regulation, and decision standardization to build a safe, efficient, and sustainable blood security system.

Lung transplantation is a definitive treatment for end-stage lung disease and can significantly improve patient prognosis. However, postoperative complications such as infection, rejection, ischemia-reperfusion injury and chronic lung allograft dysfunction intertwine to form a complex pathological network, posing persistent challenges to long-term patient survival. In 2025, research teams worldwide have made systematic progress in the field of basic lung transplantation research. By integrating cutting-edge technologies including single-cell multi-omics, spatial transcriptomics and novel animal models, significant breakthroughs have been achieved in the evolutionary dynamics of drug-resistant infections, molecular mechanisms of immune regulation, programmed cell death, optimization of donor lung protection strategies and early warning of chronic lung allograft dysfunction. This article systematically reviews the representative advances in basic lung transplantation research worldwide in 2025, and deeply analyzes the implications of mechanistic breakthroughs for optimizing diagnosis and treatment strategies, aiming to anchor the direction for innovative breakthroughs and clinical translation in basic lung transplantation research.

Enhancing medical humanistic care has become an important management issue for the high-quality development of the healthcare sector. The actions and processes of medical humanistic care represent the result of mutual selection and negotiation between the contextual system and the subject. Therefore， it is necessary to explain the deep mechanisms of the mismatch between the concept and actions through both the macro and micro levels. The structural contradictions， such as the disconnection between medical humanities education theory and practice， the alienation of medical evaluation mechanisms， and the imbalance in resource allocation， as well as the subjective obstacles， such as technical rationality and parametrization of diseases， insufficient understanding of humanistic care by medical professionals， and their cognitive deviations in realizing self-identity， jointly influence the specific practice of medical humanistic care actions. Modern medicine emphasizes patient-centeredness. Thus， it is essential to collaboratively realize medical humanistic care that unifies knowledge and actions through the coupled development of education training and clinical practice， the dual orientation of evaluation systems and institutional incentives， the dynamic balance of resource allocation and demand response， and the symbiotic evolution of individual professional identity and value rationality.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.

Objective:To investigate the clinicopathological characteristics and differential diagnosis of DICER1-mutant primary intracranial sarcoma.Methods:Five cases of DICER1-mutant primary intracranial sarcoma at Sanbo Brain Hospital, Capital Medical University, Beijing, China during May 2013 to November 2024 were collected. The clinical and imaging data were retrieved. Histological evaluation, immunohistochemical staining and next generation sequencing were performed. Additionally, a literature review was conducted.Results:All five DICER1-mutant primary intracranial sarcomas were located in the supratentorial region, with one case involving the basal ganglia. There were two males and three females. The median age at diagnosis was 25 (14.0, 30.5) years. Morphologically, they were characterized by high-grade spindle cell sarcoma, with brisk mitotic activity and cytoplasmic eosinophilic globules. Myxoid degeneration, necrosis, and invasion into surrounding brain tissue were observed in some cases. The tumor cells showed diffuse staining of vimentin and variable expression of myogenic marker (desmin), with or without focal MyoD1 and/or Myogenin expression. Four tumors exhibited diffuse, strong expression of TLE1 and p53, while only three tumors showed loss of ATRX (nuclear) expression. Two cases showed mosaic loss of H3K27me3 expression in neoplastic cells. The Ki-67 proliferation index was high (40%-80%). Various neuronal markers, such as synaptophysin, NF, SOX2 and MAP2, were expressed in all tumor samples. Genetically, all tumors samples harbored biallelic abnormalities of DICER1. One was a hotspot missense mutation in the RNase Ⅲb domain within exon 25 on one allele (p.E1813 or p.D1810), while the other allele had mutations including a germline mutation in one case, a somatic mutation in two cases, and a copy number deletion in two cases. In addition, these sarcomas showed alterations in TP53 (4/5), ATRX (3/5), and the genes of the mitogen-activated protein kinase pathway (3/5). Finally, all five cases were diagnosed as DICER1-mutant primary intracranial sarcoma. All patients underwent craniotomy that led to complete tumor resection. Three patients received adjuvant radiotherapy and chemotherapy, with progression-free survival time of 28, 48, and 50 months, respectively. Patient 2 succumbed to the tumor after 3 months post-surgery due to rapid progression and tumor dissemination. Patient 5 was lost to follow-up 3 months after the surgery.Conclusions:DICER1-mutant primary intracranial sarcoma is a newly defined tumor entity in the fifth edition of the World Health Organization Classification of Central Nervous System Tumors, and commonly occurs in children and young adults. High-grade malignant spindle cells are their typical morphological feature. Eosinophilic cytoplasmic globules and myogenic differentiation can help establish the diagnosis. This study suggests that DICER1-mutant primary intracranial sarcomas exhibit immunophenotypic neuronal differentiation. Rendering the diagnosis of DICER1-mutant primary intracranial sarcoma largely relies on detecting DICER1 pathogenic alterations or DNA methylation profiling.

Objective:To translate the Triage Risk Screening Tool (TRST) into Chinese and to test its reliability and validity among older patients in the emergency department.Methods:The Brislin translation model was used to translate and back-translate the English version of the TRST. After cultural adaptation and pre-testing, and subsequently, the final Chinese version of the TRST (TRST-C) was formed. Using the convenience sampling method, a questionnaire survey was conducted on 174 elderly patients who visited the emergency department of Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University to verify the reliability and validity of the scale.Results:The item-level content validity index and the scale-level average content validity index were 0.89-1.00 and 0.978, respectively. Exploratory factor analysis extracted 2 common factors, and the cumulative variance explanation rate was 63.095%. Using 2 points as the threshold for high risk of adverse outcomes. The sensitivity of TRST-C for 30-day death, emergency department readmission, rehospitalization and composite adverse outcomes were 94.4%, 81.8%, 84.6% and 84.9% respectively, and the negative predictive values were 98.3%, 86.4%, 86.4% and 76.3%, respectively. The Cronbach α coefficient and the Guttman split-half reliability of the TRST-C were 0.639 and 0.669, respectively. The Kappa coefficient was 0.911. Conclusions:The TRST-C has good reliability and validity, which can screen elderly patients of emergency department at risk of adverse outcomes.

The paper reports a 32-year-old female acute myeloid leukemia patient who developed graft-versus-host disease after paternal hematopoietic stem cell transplantation, which subsequently led to renal thrombotic microangiopathy. She subsequently required a kidney transplant from the same donor 5 years later due to renal failure. Considering that both the bone marrow and kidney were from the same donor and the recovery of renal function was favorable, immunosuppressive therapy was discontinued after a short course of anti-rejection treatment, with maintained stable kidney function. This case suggests that under the condition of high chimerism, allogeneic hematopoietic stem cell transplantation and kidney transplantation from the same donor can achieve immune tolerance, potentially improving solid organ transplantation success rate. The findings provide a novel therapeutic approach for solid organ transplantation following allogeneic hematopoietic stem cell transplantation.

Objective To investigate the effect of esketamine on postoperative depression in frail elderly patients undergoing thoracoscopic radical resection of lung cancer.Methods A total of 88 frail elderly patients undergoing elective thoracoscopic radical resection of lung cancer were assigned randomly(using a randomization table)and in a double-blind way(blinding applies to both researchers and patients)to an esketamine group(Esk group,n=44)and a normal saline group(NS group,n=44).In the Esk group,0.25 mg/kg esketamine was injected intravenously during anesthesia induction,followed by continuous infusion of esketamine at 0.125 mg/kg per hour until 20 min before the end of surgery.In the NS group,equivalent volumes of normal saline were administered using the same method.The primary outcome was the score for the 17-item Hamilton Rating Scale for Depression(HAMD-17)on days 7 and 30 after surgery.The secondary outcomes included sleep quality and cognitive function.Sleep quality was assessed using the numerical rating scale(NRS)on days 1,3,and 7 after surgery and the Pittsburgh Sleep Quality Index(PSQI)on day 30 after surgery.Cognitive function was assessed using the Mini-Mental State Examination(MMSE)on days 1,3,7,and 30 after surgery.The other indicators included the levels of serum brain-derived neurotrophic factor(BDNF),5-hydroxytryptamine(5-HT),S100β protein,and neuron specific enolase(NSE)at 24 hours(T1),48 hours(T2),and 72 hours(T3)after surgery,as well as perioperative data and postoperative safety outcomes.Results Three patients were excluded from the Esk group and the NS group,respectively,and eventually,41 patients in each group were included in the statistical analysis.There were no statistically significant differences between the two groups in terms of age,sex,body mass index,American Society of Anesthesiologists(ASA)classification,comorbidities,educational attainment,and the scores for HAMD-17,PSQI,and MMSE 1 day before surgery(P＞0.05).Concerning the primary outcome,compared with those of the NS group,the HAMD-17 scores of patients in the Esk group were significantly lower at 7 days(median[P25,P75])(7[6,8]vs.7[6,12],P=0.045)and 30 days(6[6,7]vs.7[6,9],P=0.020)after surgery.Concerning the secondary outcomes,compared with those of the NS group,the sleep NRS scores of patients in the Esk group were significantly lower at 1,3,and 7 days after surgery(P＜0.01),and the MMSE scores were significantly higher(P＜0.05).Concerning the other indicators,compared with those of the NS group,the concentrations of serum BDNF and 5-HT in the Esk group were significantly higher(P＜0.05 or 0.01)at T1-T3,while the content of S100β was significantly lower(P＜0.01)at T1-T3;the levels of serum NSE were significantly lower at T1 and T2(P＜0.01);the consumption of propofol,sufentanil,remifentanil,and sevoflurane during surgery in the Esk group was significantly reduced(P＜0.05 or 0.01);the incidence of postoperative nausea/vomiting and hyperalgesia was significantly lower(P＜0.01);the duration of postoperative mechanical ventilation,length-of-stay in postanesthesia care unit(PACU),and postoperative length-of-stay in the hospital were significantly shorter(P＜0.01).Conclusion Esketamine can improve the postoperative depressive state,sleep quality,and cognitive function in frail elderly patients undergoing thoracoscopic radical resection of lung cancer.

To construct a recombinant fowl adenovirus 4(FAdV-4)expressing the Cap protein of goose astrovirus genotype 2(GoAstV-2),the expression cassette of Cap gene was inserted into the natural 1 966 bp deletion region of the FAdV-4 genome in the infectious clone p15A-cm-FAdV4-HNJZ.The resulted recombinant plasmid p15A-cm-FAdV4-HNJZ-Cap/GoAstV-2 was linearized with restriction enzyme and transfected into chicken hepatoma cell line(LMH)to rescue the recombinant FAdV-4 expressing the Cap protein of GoAstV-2,rF Ad V4-Cap/GoAstV-2.After 15 passages in LMH cells,the recombinant rFAdV4-Cap/GoAstV-2 was identified by PCR using primers flanking the insertion site of the Cap gene expression cassette and using viral genome DNA extracted from rFAdV4-Cap/GoAstV-2 infected LMH cells as template.LMH cells were in-fected with 15th passage rFAdV4-Cap/GoAstV-2 and indirect immunofluorescence was performed with a polyclonal antibody against Cap protein as the primary antibody.Western blot was carried out with lysates of rFAdV4-Cap/GoAstV-2 infected LMH cells.The in vitro replication dynamic of the 15th passage of the rFAdV4-Cap/GoAstV-2 was also investigated in LMH cells.The results demonstrated that the Cap gene of GoAstV-2 was presented in the genome of the recombinant vi-rus rF AdV4-Cap/Go Ast V-2,and could be expressed stably.The prepared recombinant virus in this study will lay a foundation for developing inactivated bivalent vaccine candidate against co-in-fection of FAdV-4 and GoAstV-2 in goose.