Objective To evaluate the performance of lightweight Chinese large language models (LLMs) in answering specialized lung cancer questions, and to explore the impact of retrieval-augmented generation (RAG) on model performance. Methods Eleven lightweight Chinese LLMs with parameter sizes ranging from 7B to 32B were included. A lung cancer-specific evaluation dataset consisting of 200 questions [100 A1-type (basic knowledge) and 100 A2-type (clinical case) questions], constructed based on clinical guidelines and thoracic surgery textbooks, was used for assessment. Model performance was evaluated under two conditions (with and without RAG). Accuracy was used to assess model performance, and response latency was recorded to reflect inference efficiency. An accuracy–latency scatter plot was constructed for descriptive analysis of overall model performance. Results All models successfully completed the evaluation. With the introduction of RAG, the overall average accuracy improved from 61.68% to 76.36%. Smaller models demonstrated the most significant improvement (e.g., the accuracy of DeepSeek-7B increased from 32.50% to 60.00%, P<0.001). The average response latency increased from 12.58 s to 13.80 s. The Qwen3 series showed the best overall performance, and Qwen3-32B achieved the highest accuracy under both conditions (76.50% and 84.00%, respectively). After RAG integration, performance differences among model families were markedly reduced. Based on the accuracy-latency trade-off, Qwen3-32B achieved the best balance between accuracy and response latency under the baseline condition, whereas Qwen3-14B demonstrated superior overall performance in terms of accuracy, latency, and computational cost after RAG integration. Conclusion The integration of RAG technology improves the ability of lightweight Chinese LLMs to answer specialized lung cancer questions. Under the dual practical constraints of limited computational resources and medical data security requirements, the "lightweight model+RAG" technical framework may represent a promising deployment solution.

Objective To investigate the clinical features of thyroid dysfunction in lung cancer patients treated with programmed cell death receptor-1(PD-1)or programmed cell death receptor-ligand 1(PD-L1)and their value for predicting therapeutic efficacy.Methods Lung cancer patients treated with PD-1/PD-L1 inhibitors at West China Hospital,Sichuan University between March 2018 and September 2022 were retrospectively enrolled.Data concerning the medical records,therapeutic efficacy,and thyroid function indicators of the patients were retrieved from the hospital electronic medical record information system.The data were then analyzed to identify risk factors and predictive factors for immune-related adverse events(irAEs)of the thyroid.The predictive value of thyroid irAEs for treatment efficacy and prognosis was assessed.Objective response rate(ORR)was defined as the indicator for therapeutic efficacy and progression-free survival(PFS)was defined as the prognostic indicator.Results A total of 368 lung cancer patients were enrolled.Among them,31.5％(116/368)developed thyroid irAEs.According to the results of logistic regression analysis,baseline thyroid stimulating hormone(TSH)concentration and baseline positive results for thyroglobulin antibody(TGAb)and thyroid peroxidase antibody(TPOAb)were risk factors for thyroid dysfunction caused by PD-1/PD-L1 inhibitors.Among the three measures,baseline TPOAb concentration demonstrated good predictive value for thyroid irAEs,with an area under the receiver-operating characteristic(ROC)curve(AUC)of 0.745.Patients with thyroid irAEs had a longer median PFS(16.0 months vs.9.7 months,P＜0.001)and a higher ORR(55.2％vs.34.9％,P＜0.001)compared to those without thyroid irAEs.Patients with thyroid irAEs had a better ORR than those without thyroid irAEs did.It was more likely for patients with thyroid irAEs to achieve an objective response compared to those without thyroid irAEs(odds ratio[OR]=2.29;95％CI,1.46-3.60).Conclusion In lung cancer patients treated with the PD-1/PD-L1 inhibitors,the TPOAb antibody demonstrates good predictive value for thyroid irAEs.Patients who develop thyroid irAEs have better treatment outcomes and prognosis.

To explore the application effectiveness of generative artificial intelligence(GAI) in the standardized training assessment of critical care medicine residents.

Generative artificial intelligence (GAI) represents a prominent research focus in medicine, with medical education being a key application area. GAI demonstrates potential to enhance residency training efficacy through personalized instruction, automated assessment item generation, question bank updating, and intelligent scoring systems. However, current limitations exist regarding output accuracy and content consistency. To address these constraints, strategic measures are required: continuous GAI model refinement, development of standardized usage guidelines, enhanced data quality control, and implementation of human verification protocols for generated content. Concurrently, residents should proactively acquire GAI utilization skills to strengthen the practical application of theoretical knowledge. With these advancements, GAI is anticipated to evolve into a valuable asset for improving the efficiency and quality of residency training programs.

Objective: To investigate the trend in incidence and change in age at onset of lung cancer in in Wujiang District, Suzhou City, Jiangsu Province from 2012 to 2021, so as to provide a basis for strengthening targeted prevention and control of lung cancer. Methods: Data of lung cancer incidence from 2012 to 2021 were collected through the Wujiang District Tumor Follow-up Registration Information System. The crude incidence, truncated incidence for 35 to 64 years, and cumulative incidence for 0 to 74 years were calculated. Chinese population-standardized incidence, Chinese population-standardized average age at onset, and Chinese population-standardized incidence proportion were calculated using the age structure of the standard population from the Fifth National Population Census in 2000. The trend in incidence of lung cancer from 2012 to 2021 was evaluated using average annual percent change (AAPC). The trend in the Chinese population-standardized average age at onset of lung cancer from 2012 to 2021 was evaluated using a linear regression model. Results: From 2012 to 2021, the crude incidence, the Chinese population-standardized incidence and truncated incidence for 35 to 64 years of lung cancer in Wujiang District were 84.57/100 000, 37.28/100 000 and 52.10/100 000, respectively, all showing upward trends (AAPC=2.489%, 2.034% and 4.654%, all P<0.05). The cumulative incidence for 0 to 74 years was 4.48%, showing no significant trend (P>0.05). The Chinese population-standardized incidence was higher in males than in females (48.16/105 vs. 26.81/105). The Chinese population-standardized incidence of lung cancer in females showed an upward trend (AAPC=8.174%, P<0.05), while the trend in males was not statistically significant (P>0.05). The crude incidence of lung cancer showed upward trends in the total population and females aged 0-<45 years (AAPC=18.287% and 25.343%, both P<0.05) and those aged 45-<55 age group (AAPC=8.003% and 17.629%, both P<0.05). The Chinese population-standardized average age at onset of lung cancer in total population and females decreased from 67.58 and 65.48 years in 2012 to 60.15 and 54.88 years in 2021, with an average annual reduction of 0.611 and 0.964 years, respectively (both P<0.05). The Chinese population-standardized incidence proportion showed upward trends for the total population and females under 65 years (AAPC=3.879% and 4.639%, both P<0.05). No statistically significant trends were observed in the Chinese population-standardized average age at onset or incidence proportion in males (both P>0.05). Conclusions From 2012 to 2021, the incidence of lung cancer in Wujiang District showed an increasing trend and a trend toward younger onset age. Young and middle-aged females had emerged as a key target population for lung cancer prevention and control.

BACKGROUND: Doxorubicin hydrochloride (DOX) is extensively used in the treatment of various tumors. However, its clinical application is limited due to dose-dependent cardiotoxicity. Currently, few effective strategies exist to mitigate or eliminate DOX-induced cardiomyopathy (DIC). Although ferroptosis is implicated in DIC and its inhibition partially alleviates the condition, the direct targets of DOX in the progression of cardiotoxicity remain unclear. This study aimed to discover the direct targets of DOX in ferroptosis-mediated DIC. METHODS: A DOX pulldown assay was performed to identify proteins specifically binding to DOX in murine hearts, followed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) to identify candidate proteins. A cardiac injury mouse model was established by DOX treatment. Based on this, multiple ferroptosis biomarkers were detected by flow cytometry, quantitative real-time polymerase chain reaction, western blotting, immunochemistry, etc. Besides, specific activator and inhibitor of signaling pathways were applied to illuminate molecular mechanisms. RESULTS: Glutathione S-transferase P1 (GSTP1) was identified as a DOX target. GSTP1 activity was inhibited in DOX-treated cardiomyocytes, while its overexpression significantly alleviated DIC. Moreover, GSTP1 overexpression inhibited acyl-CoA synthetase long-chain family member 4 (ACSL4)-dependent ferroptosis. Mechanistically, GSTP1 overexpression suppressed c-Jun N-terminal kinase (JNK) phosphorylation, thereby reducing reactive oxygen species (ROS) production and inhibiting ferroptosis in DIC. CONCLUSIONS This study identifies the DOX/GSTP1/JNK axis as a critical pathway mediating ACSL4-dependent ferroptosis in DIC. GSTP1 is highlighted as a potential key mediator of ferroptosis and a promising therapeutic target for DIC.

Objective This study employs bibliometrics and visualization analysis techniques to systematically review and analyze the current status and evolutionary trends of research on Dysosma versipellis,both domestically and internationally.The discussion encompasses the current state of research on Dysosma versipellis as well as the latest hot topics in the field.Methods The literatures related to Dysosma versipellis and meeting the inclusion criteria were searched through China Knowledge Network(CNKI)and Web of science(WOS)databases,and the core author groups,cooperative relationships among research institutions and key words were analyzed by CiteSpace software.Results Eventually,1793 Chinese documents and 771 English documents were included.The author with the highest number of Chinese articles is Zeng Kang;The authors with the highest number of articles in English are Arora Rajesh;The number of articles published in China generally increases first and then decreases;The Shanghai Institute of Pharmaceutical Industry is the institution that studies Dysosma versipellis the most,and the exchanges and cooperation among institutions in the research field need to be further deepened.The keyword analysis shows that the research content of Dysosma versipellis mainly focuses on anti-tumor application,extraction and synthesis of derivatives.Conclusion At present,the extraction and synthesis of lignans and their related derivatives from Dysosma versipellis and their clinical application in the treatment of condyloma acuminatum and anti-tumor are the research hotspots of Dysosma versipellis.The toxicological mechanisms of damage caused by Dysosma versipellis and its active components,as well as potential therapeutic approaches,are expected to become a focal point of future research.

Objective:To analyze the clinical efficacy of pasteurization-inactivated tumor bone replantation combined with intramedullary vascularized fibula for reconstructing bone defects after surgery for malignant bone tumors in children and adolescents.Methods:A retrospective analysis was performed on the data of 54 patients who underwent pasteurization-inactivated tumor bone replantation combined with intramedullary vascularized fibula reconstruction for bone defects after surgery for malignant bone tumors at the Bone and Soft Tissue Tumor Treatment Center of Peking University People's Hospital from September 2015 to September 2023. There were 39 males and 15 females, with an age of 12.4±5.6 years (range, 4 to 23 years). The tumor types included 33 cases of osteosarcoma, 19 cases of Ewing sarcoma, and 2 cases of soft tissue sarcoma. All cases were at Enneking stage IIB. The tumor locations were 30 cases in the femur, 19 cases in the tibia, 4 cases in the ilium, and 1 case in the humerus. The survival rate, bone healing time, tumor recurrence, and metastasis were observed. The limb function was evaluated using the Musculoskeletal Tumor Society (MSTS)-93 score.Results:All patients successfully completed the surgery and were followed up, with a follow-up time of 44.6±27.1 months (range, 12 to 96 months). The operation time was 527±132 min (range, 150 to 730 min), and the blood loss was 730±591 ml (range, 300 to 2,800 ml). The length of inactivated tumor bone was 16.5±4.5 cm (range, 9.1 to 24.0 cm), the defect length accounted for 43.4%±12.2% of the total length of the affected bone (range, 23.8% to 75.5%), the proximal osteotomy of the long bones in the extremities was 14.1±8.3 cm from the articular surface (range, 1.9 to 31.1 cm), the distal osteotomy was 9.4±6.2 cm from the articular surface (range, 1.7 to 22.9 cm), and the length of the harvested vascularized fibula was 18.0±4.0 cm (range, 11.0 to 26.4 cm). At the last follow-up, 51 patients were alive, including 47 with no evidence of tumor and 4 with tumor; 3 patients died of tumor progression. Local recurrence occurred in 5 patients, including 4 with soft tissue recurrence in the surgical area (3 underwent surgical resection and 1 received radiotherapy) and 1 with recurrence at the site of inactivated bone. Distant metastasis occurred in 11 patients, including 5 with lung metastasis only, 2 with bone metastasis only, and 4 with combined lung and bone metastasis. Among the 5 patients with lung metastasis only, lung metastases were resected, with 3 surviving with tumor, 2 surviving without tumor; the 2 patients with bone metastasis only underwent surgical resection of bone metastases, both surviving without tumor. Among the 4 patients with combined lung and bone metastasis, 3 died of tumor progression and 1 survived with tumor. The Kaplan-Meier curve showed a 5-year survival rate of 90.8%±6.2% and a 5-year recurrence-free and metastasis-free survival rate of 68.7%±7.9%. The osteotomy healing time at the diaphysis was 8.4±2.3 months (range, 4 to 13 months), the osteotomy healing time at the metaphysis was 5.9±1.7 months (range, 3 to 10 months), and the healing time between inactivated tumor bone and fibula was 6.4±2.0 months (range, 4 to 11 months). No nonunion occurred. The MSTS-93 score at the last follow-up was 94.4%±4.8% (range, 80% to 100%).Conclusion:Pasteurization-inactivated tumor bone replantation combined with intramedullary vascularized fibula reconstruction for bone defects after surgery for malignant bone tumors in children and adolescents has satisfactory clinical efficacy, high bone healing rate, and low rates of local recurrence and distant metastasis.

Hot melt extrusion(HME)technology employs thermodynamic and kinetic principles to mix pharmaceutical polymers with crystalline drugs at high temperatures and extrude them,embedding drug molecules within the polymer matrix to form solid dispersions.Due to its solvent-free nature,capability for one-step processing,and support for continuous operation,HME has garnered significant attention in the pharmaceutical industry in recent years.This article introduced the basic principles and development history of HME technology and its marketed drugs.It reviewed the research progress of HME technology in improving drug solubility,masking taste,controlled release,targeted release,oral dispersible films,implant formulations,semi-solid formulations,and 3D printed formulations.Additionally,the article summarized the advantages and limitations of HME technology and provided an outlook on its future development.

Objective To understand the mortality and potential life loss due to coronary heart disease (CHD) and stroke in Wujiang District, Suzhou from 2011 to 2022, and to provide strategies and basis for the prevention and treatment of CHD and stroke. Methods We collected the data of death cases due to CHD and stroke from the death monitoring system in Suzhou from 2011 to 2022. The mortality of CHD and stroke, potential years of life lost (potential years of life lost , PYLL), average years of life lost (average years of life lost , AYLL) and potential years of life lost rate (potential years of life lost rate , PYLLR) were calculated to analyze the development trend of death and disease burden of CHD and stroke. Results From 2011 to 2022, the crude mortality of CHD was 31.91/10 million, and that of stroke was 118.93/10 million. CHD and stroke mortality rates both showed an upward trend（P＜0.05, a statistically significant trend）. From 2011 to 2022, the mortality rate of CHD and stroke in Wujiang District increased rapidly with the increase of age. From 2011 to 2022, the disease burden caused by CHD totaled 11005 person-years, with PYLLR of 1.26% and AYLL of 12.34 years per person. The PYLL caused by stroke was 13 587.5 people-years, the PYLLR was 1.55%, and the AYLL was 8.93 years per person. PYLL, PYLLR and AYLL all decreased in women（P<0.05）, with no significant change in men（P>0.05）. Conclusion From 2011 to 2022, the mortality rate of CHD and stroke in Wujiang District appeared a tendency towards a rise, effective intervention and prevention measures should be taken among elderly and male residents.