To retrospectively summarize the clinical teaching application of our team's self-developed artificial intelligence (AI) full-chain clinical diagnostic reasoning training teaching agent, observe the differences in teaching outcomes among medical students under different teaching models, and preliminarily analyze the application trends and potential value of the Plan-Do-Check-Act (PDCA) management mechanism in AI-assisted clinical teaching, so as to provide reference practical data and experiential insights for the optimization and improvement of "AI + clinical medical teaching".

This study was a retrospective observational study that enrolled clinical medicine students who had completed the Fundamentals of Diagnostics course at Shanghai Jiao Tong University School of Medicine from September 2024 to September 2025 as the study subjects. Based on the established teaching reform implementation plan, the participants were divided into three groups: traditional teaching group (Group A), blended AI teaching group (Group B), and PDCA cycle-optimized blended AI teaching group (Group C). The three groups maintained essential consistency in teaching syllabi, core content, and total class hours (32 credit hours). Group A received conventional lecture-based classroom instruction and ward-based small-group mentoring. Group B received traditional teaching plus AI-assisted instruction using the AI full-chain clinical diagnostic reasoning training system, but without implementing PDCA management. Group C received traditional teaching plus AI-assisted instruction with PDCA management, i.e., a full-cycle teaching quality management closed-loop system based on conventional teaching and AI training. Baseline assessment data before the course, final theoretical examination scores in Basic Diagnostics, and objective structured clinical examination (OSCE) clinical skills assessment data after course completion were collected across the three groups to compare the differences in teaching effectiveness among different teaching models.

A total of 180 clinical medicine students were enrolled, with 60 students in each of Groups A, B, and C. No statistically significant differences were observed among the three groups in baseline data, including age, gender, previous grade point average, pre-internship diagnostic theory test scores, and doctor-patient communication assessment scores (all P > 0.05), indicating comparability of baseline data between groups. Post-course assessments showed that the final theoretical examination scores in Basic Diagnostics for Groups A, B, and C were (83.1±5.9), (83.4±6.0), and (82.6±5.4), respectively, with no statistically significant difference between groups (P=0.739). In terms of OSCE clinical skills assessment, Groups B and C scored higher than Group A in both the "history taking" module [(16.0±0.7) and (17.2±0.9) vs. (14.4±0.8), respectively] and the "case analysis" module[(14.9±0.7) and (16.0±0.7) vs. (13.0±0.8), respectively]. Furthermore, Group C outperformed Group B in both modules. All between-group differences were statistically significant (all P < 0.017).

Compared with the traditional teaching model, the teaching protocol incorporating our self-developed AI full-chain teaching tool, combined with the PDCA closed-loop management composite teaching model, may help improve medical students' practical abilities in clinical diagnostic reasoning, without exerting negative interference on their mastery of theoretical knowledge. The teaching format integrating AI empowerment with PDCA closed-loop optimization may have potential effects in enhancing the stability and homogenization level of clinical teaching outcomes. It may serve as an optional improvement strategy for clinical diagnostic reasoning teaching. However, its long-term effectiveness and broader applicability still require further validation.

BACKGROUNDIn order to minimize the injury reaction during the surgery and reduce the morbidity rate, hence reducing the mortality rate of esophagectomy, minimally invasive esophagectomy (MIE) was introduced. The aim of this study was to compare the postoperative outcomes in patients with esophageal squamous cell carcinoma undergoing minimally invasive or open esophagectomy (OE).

METHODSThe medical records of 176 consecutive patients, who underwent minimally invasive esophagectomy (MIE) between January 2009 and August 2013 in Cancer Institute & Hospital, Chinese Academy of Medical Sciences, were retrospectively reviewed. In the same period, 142 patients who underwent OE, either Ivor Lewis or McKeown approach, were selected randomly as controls. The clinical variables of paired groups were compared, including age, sex, Charlson score, tumor location, duration of surgery, number of harvested lymph nodes, morbidity rate, the rate of leak, pulmonary morbidity rate, mortality rate, and hospital length of stay (LOS).

RESULTSThe number of harvested lymph nodes was not significantly different between MIE group and OE group (median 20 vs. 16, P = 0.740). However, patients who underwent MIE had longer operation time than the OE group (375 vs. 300 minutes, P < 0.001). Overall morbidity, pulmonary morbidity, the rate of leak, in-hospital death, and hospital LOS were not significantly different between MIE and OE groups. Morbidities including anastomotic leak and pulmonary morbidity, inhospital death, hospital LOS, and hospital expenses were not significantly different between MIE and OE groups as well.

CONCLUSIONSMIE and OE appear equivalent with regard to early oncological outcomes. There is a trend that hospital LOS and hospital expenses are reduced in the MIE group than the OE group.

Aged ; Carcinoma, Squamous Cell ; surgery ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Female ; Humans ; Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Thoracoscopy ; Treatment Outcome

When we try to establish the gene recombinant yeast cell to screen the androgenic endocrine disruptors, the key procedure is the androgen receptor (AR) expression in the yeast cell. For this purpose, we obtained the GPD (glyceraldehyde-3-phosphote dehydrogenase) promoter from the yeast genosome of W303-1A using PCR system and inserting it into Swa I and BamH I sites of pYestrp2. The new constructed vector was named pGPD. The V5 epitope tag DNA with a 5'-BamH I and a 3'-EcoR I sticky end was cloned into the corresponding site of the pGPD vector to yield the vector of pGPDV5. The 2 723 bp full length AR ORF amplified by PCR from pcDNA3.1/AR was fused to V5 epitope tag DNA in pGPDV5 to give the AR yeast expression vector of pGPDV5/AR. This fused vector was transformed into the yeast cell (W303-1A). Western blot was used to detect the V5 fused protein of AR, in the protocol of which the primary monoclonal antibody (IgG(2a)) of mouse anti-V5 and the polyclonal secondary antibody of goat anti-mouse (IgG) linked to horseradish peroxidase (HRP) were used to detect the specific protein in the given sample of the transformed yeast extract. The result showed that the fused protein of AR was expressed successfully in the yeast cell.
Base Sequence ; Endocrine Disruptors ; analysis ; Epitopes ; biosynthesis ; genetics ; Genetic Vectors ; genetics ; Glyceraldehyde-3-Phosphate Dehydrogenases ; genetics ; Humans ; Molecular Sequence Data ; Promoter Regions, Genetic ; Receptors, Androgen ; biosynthesis ; genetics ; Recombinant Fusion Proteins ; genetics ; Yeasts ; genetics ; metabolism