1.Application advances, ethical dilemmas, and future directions of large language models in lung cancer diagnosis and treatment
Zhizhen REN ; Yufan XI ; Xu ZHU ; Yijie LUO ; Geting HUANG ; Junqiao SONG ; Xiuyuan XU ; Nan CHEN ; Qiang PU
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2026;33(03):353-362
Lung cancer is a leading cause of cancer-related morbidity and mortality worldwide. Coupled with the substantial workload, the clinical management of lung cancer is challenged by the critical need to efficiently and accurately process increasingly complex medical information. In recent years, large language models (LLMs) technology has undergone explosive development, demonstrating unique advantages in handling complex medical data by leveraging its powerful natural language processing capabilities, and its application value in the field of lung cancer diagnosis and treatment is continuously increasing. The paper systematically analyzes that the exceptional potential of LLMs in lung cancer auxiliary diagnosis, tumor feature extraction, automatic staging, progression/outcome analysis, treatment recommendations, medical documentation generation, and patient education. However, they face critical technical and ethical challenges including inconsistent performance in complex integrated decision-making (e.g., TNM staging, personalized treatment suggestions) and "black box" opacity issues, along with dilemmas such as training data biases, model hallucinations, data privacy concerns, and cross-lingual adaptation challenges ("data colonization"). Future directions should prioritize constructing high-quality multimodal corpora specific to lung cancer, developing interpretable and compliant specialized models, and achieving seamless integration with existing clinical workflows. Through dual drivers of technological innovation and ethical standardization, LLMs should be prudently advanced for holistic lung cancer management processes, ultimately promoting efficient, standardized, and personalized diagnosis and treatment practices.
2.Similarities and Differences between Myofascial Trigger Points and Sinew Knot:from the Perspective of the Channel Sinew Theory
Zijie CHEN ; Haohan ZHU ; Xingke SONG ; Xue PU ; Junying WANG
Journal of Traditional Chinese Medicine 2026;67(9):1023-1026
Myofascial trigger points, as hyperirritable spots within taut bands of skeletal muscle, can induce local or referred pain, and show a high degree of similarity to acupoints in traditional Chinese medicine (TCM), particularly the so-called sinew knot lesion point. From the perspective of channel sinew theory, and by examining the correlations of myofascial trigger points with acupoints and channel sinew disorders, this study aims to compare the similarities and differences between MTrPs and sinew knot lesion points in terms of pathological mechanisms, needling analgesic mechanisms, and therapeutic approaches. The goal is to deepen the understanding of MTrPs and dry needling, and provide a modern scientific perspective on channel sinew theory and the sinew knot lesion point.
3.Similarities and Differences between Myofascial Trigger Points and Sinew Knot:from the Perspective of the Channel Sinew Theory
Zijie CHEN ; Haohan ZHU ; Xingke SONG ; Xue PU ; Junying WANG
Journal of Traditional Chinese Medicine 2026;67(9):1023-1026
Myofascial trigger points, as hyperirritable spots within taut bands of skeletal muscle, can induce local or referred pain, and show a high degree of similarity to acupoints in traditional Chinese medicine (TCM), particularly the so-called sinew knot lesion point. From the perspective of channel sinew theory, and by examining the correlations of myofascial trigger points with acupoints and channel sinew disorders, this study aims to compare the similarities and differences between MTrPs and sinew knot lesion points in terms of pathological mechanisms, needling analgesic mechanisms, and therapeutic approaches. The goal is to deepen the understanding of MTrPs and dry needling, and provide a modern scientific perspective on channel sinew theory and the sinew knot lesion point.
4.The influence of cardiac rehabilitation therapy on the postoperative quality of life, cardiac function and prognosis of patients undergoing transcatheter aortic valve replacement
Wen PU ; Zhengfeng ZHU ; Ling WANG ; Lijuan YU
Journal of Chinese Physician 2025;27(5):688-692
Objective:To explore the influence of cardiac rehabilitation therapy on the postoperative quality of life, cardiac function and prognosis of patients undergoing transcatheter aortic value replacement (TAVR).Methods:A total of 182 patients with aortic valve stenosis who underwent TAVR in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2021 to May 2023 were selected as the research subjects. The patients were divided into the observation group and the control group by the random number table method, with 91 cases in each group. The control group was given conventional drug treatment after the operation, while the observation group was given conventional drug treatment + cardiac rehabilitation treatment after the operation. The baseline clinical data, quality of life before and after intervention (Minnesota Quality of Life Scale score), cardiac function [6-minute walking distance (6MWT), B-type brain natriuretic peptide (BNP)] of the two groups of patients were compared. The left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), and the incidence of adverse events one year after TAVR were evaluated using the Cox regression model to assess the effect of cardiac rehabilitation therapy on the occurrence of adverse events one year after TAVR. Kaplan-Meier survival analysis was used to compare the cumulative rate of no adverse events one year after TAVR in the two groups of patients.Results:After the intervention in both groups, the Minnesota Quality of Life Scale score, 6MWT, BNP, and LVEF were significantly improved compared with those before the intervention (all P<0.05), and the Minnesota Quality of Life Scale score, 6MWT, BNP, and LVEF in the observation group after the intervention were better than those in the control group (all P<0.05). The incidences of stroke and heart failure in the observation group one year after TAVR were significantly lower than those in the control group (all P<0.05). Cox regression analysis showed that cardiac rehabilitation significantly reduced the risk of adverse events one year after TAVR in patients ( HR: 0.72; 95% CI: 0.46-0.97; P=0.035). Kaplan-Meier survival analysis showed that the cumulative rate of no adverse events at 3, 6, and 12 months after TAVR in the observation group was significantly higher than that in the control group (94.3%, 89.5%, 76.8% vs 83.4%, 74.6%, 57.8%, all P<0.05). Conclusions:Cardiac rehabilitation therapy can significantly improve the postoperative quality of life and cardiac function of patients with TAVR, bringing obvious survival benefits to such patients.
5.Evaluation of the effectiveness of simulation-based teaching using standardized patient cases in obstetrics and gynecology internship training
Pu WEI ; Tingting WANG ; Libo ZHU ; Wei ZHANG
Chinese Journal of Medical Education Research 2025;24(9):1177-1180
Objective:To explore and evaluate the effectiveness of integrating standardized patient cases with simulation-based teaching in internship teaching in the department of obstetrics and gynecology.Methods:This study enrolled 60 interns from the Department of Obstetrics and Gynecology at Hangzhou First People's Hospital between January 2022 and December 2023. Participants were randomly assigned using a random number table into a control group (simulator training) and an experimental group (simulated standardized patient consultation integrated with simulation training). Simulation-based teaching was performed for seven skill modules. After training, participants underwent both skill assessments and questionnaire surveys. Skill assessment scores, professional competencies, and self-evaluation outcomes were compared between the two groups.Results:In skill assessments for delivery [(90.50±5.51) vs. (84.90±5.30)], I° perineal laceration repair [(91.98±6.87) vs. (84.18±10.24)], abortion[(90.43±6.79) vs. (84.10±5.36)], and diagnostic curettage [(92.57±8.19) vs. (85.80±8.61)], the experimental group scored significantly higher than the control group ( P<0.05). The experimental group showed higher scores in demonstrating empathy [53.33% (16/30) vs. 23.33% (7/30), P<0.05] and prioritizing doctor-patient communication [96.67% (29/30) vs. 46.67% (14/30), P<0.01]. Additionally, the experimental group reported higher scores in course satisfaction [(9.48±0.50) vs. (9.02±0.45)], performance self-assessment [(9.17±0.35) vs. (8.65±0.27)], engagement during simulation-based training [(9.62±0.43) vs. (8.43±1.21)], and learning gains [(9.53±0.87) vs. (8.88±1.02)]. Conclusions:Compared to simulation-based teaching alone, the integration of standardized patient cases can improve learning outcomes for complex and comprehensive skill modules and contribute to the development of professional competencies.
6.Construction of a nursing follow-up checklist for patients undergoing autologous hematopoietic stem cell transplantation
Ting WANG ; Jiating WANG ; Aiyun JIN ; Xiaming ZHU ; Yun FANG ; Jing WANG ; Fei TIAN ; Yiqin PU ; Ying WAN ; Jin HE ; Xia YAN
Chinese Journal of Nursing 2025;60(8):914-920
Objective To construct a nursing follow-up checklist for patients undergoing autologous hematopoietic stem cell transplantation,providing a basis for postoperative follow-up care.Methods Using evidence-based methods,the literature from major guide websites and databases using Chinese and English search terms was retrieved,and their quality was evaluated.The relevant items were extracted,and a first draft was formed.15 experts were selected in relevant fields from 14 tertiary hospitals in 13 provinces,cities,and autonomous regions across the country for Delphi inquiry.The nursing follow-up checklist was revised again based on expert opinions and clinical practice.The nursing follow-up checklist was initially applied and then revised again to form the final draft.Results 15 experts include 12 undergraduate and 3 master's degree holders.The positivity coefficients of the 2 rounds of inquiry were 100%;the authority coefficients of the experts were 0.815;the Kendall coefficients were 0.119 and 0.144,respectively;the differences were statistically significant(P<0.001).The final nursing follow-up checklist was formed,which includes 6 primary indicators,including physiological status,psychological status,social and family support,living conditions,disease knowledge,and laboratory tests.19 patients(95%)found the follow-up content to be comprehensive.The follow-up nurses's satisfaction rate exceeded 85%.There were 27 secondary indicators and 61 tertiary indicators,with coefficients of variation of all indicators less than 0.25.Conclusion The nursing follow-up checklist is scientific,reliable,and practical,which can provide a basis for clinical nursing staff to follow up and comprehensively manage patients after autologous hematopoietic stem cell transplantation.
7.Effect of professional training-based peer support on patients with gestational diabetes mellitus
Guifeng HU ; Zhijia ZHANG ; Congshan PU ; Chunjian SHAN ; Zhu ZHU ; Hui ZHOU ; Yanqiu GAO ; Xiaonan KONG
Chinese Journal of Nursing 2025;60(4):425-432
Objective To explore the applications and effects of professional training-based peer support on self-management of women with gestational diabetes mellitus.Methods A total of 96 patients diagnosed with gestational diabetes mellitus in a tertiary A-level women's hospital in Nanjing from March to June 2023 were conveniently selected as the research subjects,among which 48 patients with gestational diabetes mellitus diagnosed from May to June 2023 were divided into an experimental group,and 48 patients with gestational diabetes mellitus diagnosed from March to April 2023 were included into a control group.The experimental group received professional training-based peer support based on routine nursing,and the control group received routine nursing.The status of self-management,health literacy,quality of life and blood glucose in 2 groups were compared and analyzed.Results 45 patients in the experimental group and 48 patients in the control group completed the study.After intervention,the Self-Management Scale score of the experimental group was(115.11±9.48),which was higher than(78.46±6.27)of the control group;the score of Health Literacy Scale was(145.38±5.22),higher than(92.19±5.75)of the control group;the Quality of Life Scale score was(79.47±4.11),higher than(60.85±2.80)of the control group;the fasting blood glucose concentration and two-hour postprandial glucose concentration in the experimental group were lower than those in the control group,and the difference between 2 groups was statistically significant(P<0.001).Conclusion Nursing intervention of the professional training-based peer support can effectively improve the levels of self-management,health literacy and quality of life,as well as reduce concentration of blood glucose.
8.The influence of cardiac rehabilitation therapy on the postoperative quality of life, cardiac function and prognosis of patients undergoing transcatheter aortic valve replacement
Wen PU ; Zhengfeng ZHU ; Ling WANG ; Lijuan YU
Journal of Chinese Physician 2025;27(5):688-692
Objective:To explore the influence of cardiac rehabilitation therapy on the postoperative quality of life, cardiac function and prognosis of patients undergoing transcatheter aortic value replacement (TAVR).Methods:A total of 182 patients with aortic valve stenosis who underwent TAVR in the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2021 to May 2023 were selected as the research subjects. The patients were divided into the observation group and the control group by the random number table method, with 91 cases in each group. The control group was given conventional drug treatment after the operation, while the observation group was given conventional drug treatment + cardiac rehabilitation treatment after the operation. The baseline clinical data, quality of life before and after intervention (Minnesota Quality of Life Scale score), cardiac function [6-minute walking distance (6MWT), B-type brain natriuretic peptide (BNP)] of the two groups of patients were compared. The left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), and the incidence of adverse events one year after TAVR were evaluated using the Cox regression model to assess the effect of cardiac rehabilitation therapy on the occurrence of adverse events one year after TAVR. Kaplan-Meier survival analysis was used to compare the cumulative rate of no adverse events one year after TAVR in the two groups of patients.Results:After the intervention in both groups, the Minnesota Quality of Life Scale score, 6MWT, BNP, and LVEF were significantly improved compared with those before the intervention (all P<0.05), and the Minnesota Quality of Life Scale score, 6MWT, BNP, and LVEF in the observation group after the intervention were better than those in the control group (all P<0.05). The incidences of stroke and heart failure in the observation group one year after TAVR were significantly lower than those in the control group (all P<0.05). Cox regression analysis showed that cardiac rehabilitation significantly reduced the risk of adverse events one year after TAVR in patients ( HR: 0.72; 95% CI: 0.46-0.97; P=0.035). Kaplan-Meier survival analysis showed that the cumulative rate of no adverse events at 3, 6, and 12 months after TAVR in the observation group was significantly higher than that in the control group (94.3%, 89.5%, 76.8% vs 83.4%, 74.6%, 57.8%, all P<0.05). Conclusions:Cardiac rehabilitation therapy can significantly improve the postoperative quality of life and cardiac function of patients with TAVR, bringing obvious survival benefits to such patients.
9.Change characteristics of standing-sitting spinopelvic sagittal parameters in patients with diffuse idio-pathic skeletal hyperostosis
Sinian WANG ; Xiaojiang PU ; Yewei JI ; Qingshuang ZHOU ; Bin WANG ; Zezhang ZHU ; Yong QIU ; Xu SUN
Chinese Journal of Spine and Spinal Cord 2025;35(4):376-383
Objectives:To investigate the impact of bone hyperplasia in the thoracolumbar spine caused by diffuse idiopathic skeletal hyperostosis(DISH)on the changes of spinopelvic sagittal parameters between stand-ing and sitting positions.Methods:A total of 61 DISH patients[DISH group,42 males and 19 females,50-76(65.1±6.3)years]who underwent surgical treatment for lumbar spinal stenosis in our hospital between Jan-uary 2019 and December 2023 were retrospectively analyzed.100 age-and sex-matched non-DISH patients undergone the same surgical procedure during the same period were included as control[N-DISH group,63 males and 37 females,54-77(67.5±7.2)years].According to the distribution of osteophytes,the patients in the DISH group with ectopic ossification limited to the thoracic spine were categorized into the T-DISH group,while those with involvement of both thoracic and lumbar spines were divided in the L-DISH group.Preoper-atively,full-spine anteroposterior and lateral X-rays were taken in both standing and sitting positions.All patients were measured for spinopelvic sagittal parameters in standing and sitting positions,including sagittal vertical axis(SVA),pelvic tilt(PT),sacral slope(SS),pelvic incidence(PI),thoracic kyphosis(TK),lumbar lordosis(LL),and proximal femoral angle(PFA).The differences in standing and sitting positions and changes between DISH and N-DISH groups,T-DISH and L-DISH groups were compared.Results:In the standing position,the SVA(P=0.008)and TK(P=0.028)in the DISH group were significantly higher than those in the N-DISH group,while no significant differences were observed in PI,PT,SS,LL,and PFA(P>0.05).In the sitting position,the TK(P=0.003)and LL(P=0.007)in the DISH group were significantly higher than those in the N-DISH group,whereas no significant differences were noted inSVA,PT,PI,SS,and PFA(P>0.05).When transitioning from standing to sitting,the changes in SVA(P=0.021),PT(P=0.008),SS(P=0.001),TK(P=0.002),and LL(P<0.001)in DISH group of patients were significantly smaller than those in N-DISH group of patients.Among DISH patients,the L-DISH group had significantly lower PI(P=0.016),SS(P=0.011),and LL(P=0.006)in the standing position compared to the T-DISH group,while no significant differences were observed in SVA,PT,TK,and PFA(P>0.05).In the sitting position,the PI(P=0.008)and SS(P=0.007)of the L-DISH group were significantly lower than those of the T-DISH group,while no significant differences were observed in SVA,PT,TK,LL,and PFA(P>0.05).The changes in LL when transitioning from standing to sitting were significantly lower in the L-DISH group compared to the T-DISH group(P=0.033),while the changes of other sagittal parameters showed no significant difference(P>0.05).Conclusions:Bone hyperplasia in DISH patients significantly limits spinal mobility,and the restriction is more pronounced in patients with osteophytes extending to the lumbar spine compared to those with isolated thoracic involvement.
10.Change characteristics of standing-sitting spinopelvic sagittal parameters in patients with diffuse idio-pathic skeletal hyperostosis
Sinian WANG ; Xiaojiang PU ; Yewei JI ; Qingshuang ZHOU ; Bin WANG ; Zezhang ZHU ; Yong QIU ; Xu SUN
Chinese Journal of Spine and Spinal Cord 2025;35(4):376-383
Objectives:To investigate the impact of bone hyperplasia in the thoracolumbar spine caused by diffuse idiopathic skeletal hyperostosis(DISH)on the changes of spinopelvic sagittal parameters between stand-ing and sitting positions.Methods:A total of 61 DISH patients[DISH group,42 males and 19 females,50-76(65.1±6.3)years]who underwent surgical treatment for lumbar spinal stenosis in our hospital between Jan-uary 2019 and December 2023 were retrospectively analyzed.100 age-and sex-matched non-DISH patients undergone the same surgical procedure during the same period were included as control[N-DISH group,63 males and 37 females,54-77(67.5±7.2)years].According to the distribution of osteophytes,the patients in the DISH group with ectopic ossification limited to the thoracic spine were categorized into the T-DISH group,while those with involvement of both thoracic and lumbar spines were divided in the L-DISH group.Preoper-atively,full-spine anteroposterior and lateral X-rays were taken in both standing and sitting positions.All patients were measured for spinopelvic sagittal parameters in standing and sitting positions,including sagittal vertical axis(SVA),pelvic tilt(PT),sacral slope(SS),pelvic incidence(PI),thoracic kyphosis(TK),lumbar lordosis(LL),and proximal femoral angle(PFA).The differences in standing and sitting positions and changes between DISH and N-DISH groups,T-DISH and L-DISH groups were compared.Results:In the standing position,the SVA(P=0.008)and TK(P=0.028)in the DISH group were significantly higher than those in the N-DISH group,while no significant differences were observed in PI,PT,SS,LL,and PFA(P>0.05).In the sitting position,the TK(P=0.003)and LL(P=0.007)in the DISH group were significantly higher than those in the N-DISH group,whereas no significant differences were noted inSVA,PT,PI,SS,and PFA(P>0.05).When transitioning from standing to sitting,the changes in SVA(P=0.021),PT(P=0.008),SS(P=0.001),TK(P=0.002),and LL(P<0.001)in DISH group of patients were significantly smaller than those in N-DISH group of patients.Among DISH patients,the L-DISH group had significantly lower PI(P=0.016),SS(P=0.011),and LL(P=0.006)in the standing position compared to the T-DISH group,while no significant differences were observed in SVA,PT,TK,and PFA(P>0.05).In the sitting position,the PI(P=0.008)and SS(P=0.007)of the L-DISH group were significantly lower than those of the T-DISH group,while no significant differences were observed in SVA,PT,TK,LL,and PFA(P>0.05).The changes in LL when transitioning from standing to sitting were significantly lower in the L-DISH group compared to the T-DISH group(P=0.033),while the changes of other sagittal parameters showed no significant difference(P>0.05).Conclusions:Bone hyperplasia in DISH patients significantly limits spinal mobility,and the restriction is more pronounced in patients with osteophytes extending to the lumbar spine compared to those with isolated thoracic involvement.

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