Objective To investigate the effectiveness of a higher-order thinking-oriented BOPPPS-based blended teach-ing model in otolaryngology-head and neck surgery education,focusing on its impact on the academic performance and teaching satisfaction of undergraduate clinical medicine students.Methods A total of 199 undergraduate clinical medicine students from Guangzhou Medical University were enrolled,divided into a control group(2021-2022 academic year,n=118)and an experi-mental group(2022-2023 academic year,n=81).The control group received conventional blended teaching via Chaoxing plat-form combined with case discussions,while the experimental group implemented the BOPPPS-integrated blended teaching model.Results Students in the experimental group achieved significantly higher average scores than the control group(Δ=11.71 points),with the excellent rate increasing from 0% to 11.1% and the failure rate decreasing to 1.2% .Additionally,the experi-mental group reported high satisfaction with the BOPPPS-integrated blended teaching model,with an overall satisfaction rate of 80.25%.Furthermore,54.32% of students expressed a preference for blended teaching approaches.Students widely acknowl-edged that this model facilitated flexible knowledge application.Conclusion The BOPPPS-integrated blended teaching model ef-fectively enhances the academic performance and teaching satisfaction of undergraduate clinical medicine students,providing a valuable reference for medical education reform oriented toward fostering higher-order thinking and clinical competency.

BACKGROUND:In recent years,it has been found that physical interventions play a significant role in influencing proliferation,differentiation,and migration of bone marrow mesenchymal stem cells.However,the current physical intervention still exists such as basic research data to be strengthened,unified parameter standards need to be further improved and other shortcomings.OBJECTIVE:To review the effects of physical interventions on the differentiation of bone marrow mesenchymal stem cells.METHODS:PubMed and CNKI databases were searched for relevant articles using"bone marrow mesenchymal stem cells(BMSC),bone marrow stromal cells,osteogenesis differentiation,chondrocytes differentiation,electrical stimulation,mechanical stimulation,hypoxia,electromagnetic fields,low intensity pulsed ultrasound"as English and Chinese search terms.A total of 58 articles were selected for review.RESULTS AND CONCLUSION:(1)Physical interventions have been applied to regulate the proliferation and differentiation of bone marrow mesenchymal stem cells by altering specific microenvironments,but the parameters have not yet been unified.The future investigation should further optimize and explore the best parameters and conditions of action of the relevant physical factors on the role of bone marrow mesenchymal stem cell proliferation and differentiation.(2)It is difficult to carry out the application of certain special physical environmental conditions through low-cost conventional means,pending subsequent research and development to further reduce the difficulty of constructing special physical conditions.(3)The use of physical factors to rationally intervene in differentiation and proliferation of bone marrow mesenchymal stem cells has not yet been widely applied in the clinic,and further research is needed to promote clinical translation in the future.

Objective To investigate the effectiveness of a higher-order thinking-oriented BOPPPS-based blended teach-ing model in otolaryngology-head and neck surgery education,focusing on its impact on the academic performance and teaching satisfaction of undergraduate clinical medicine students.Methods A total of 199 undergraduate clinical medicine students from Guangzhou Medical University were enrolled,divided into a control group(2021-2022 academic year,n=118)and an experi-mental group(2022-2023 academic year,n=81).The control group received conventional blended teaching via Chaoxing plat-form combined with case discussions,while the experimental group implemented the BOPPPS-integrated blended teaching model.Results Students in the experimental group achieved significantly higher average scores than the control group(Δ=11.71 points),with the excellent rate increasing from 0% to 11.1% and the failure rate decreasing to 1.2% .Additionally,the experi-mental group reported high satisfaction with the BOPPPS-integrated blended teaching model,with an overall satisfaction rate of 80.25%.Furthermore,54.32% of students expressed a preference for blended teaching approaches.Students widely acknowl-edged that this model facilitated flexible knowledge application.Conclusion The BOPPPS-integrated blended teaching model ef-fectively enhances the academic performance and teaching satisfaction of undergraduate clinical medicine students,providing a valuable reference for medical education reform oriented toward fostering higher-order thinking and clinical competency.

Background and purpose:In recent years,chimeric antigen receptor T(CAR-T)cell therapy has achieved breakthrough progress in cancer treatment.γδ T cells,with their non-major histocompatibility complex(MHC)-restricted antigen recognition,broad antitumor activity,and low risk of graft-versus-host disease(GVHD),have garnered significant interest in CAR-γδ T cell therapy.However,critical challenges including suboptimal in vitro expansion and low viral transduction efficiency severely hinder the research and clinical application of CAR-γδ T cells.This study aimed to establish an efficient platform for preparing CAR-γδ T cells by optimizing the in vitro expansion conditions of γδ T cells and refining lentiviral transduction strategies.Methods:We first optimized the expansion protocol for γδ T cells by screening various cytokine combinations and the concentrations of individual cytokines within combination,and evaluating cell purity,viability,fold expansion,and expressions of cytotoxicity and exhaustion markers to identify the optimal culture conditions.Subsequently,the transduction conditions for CAR-γδ T cells were improved by determining the optimal activation duration of γδ T cells prior to gene transfer,as well as the optimal multiplicity of infection(MOI)for lentiviral transduction.Finally,CAR-γδ T cells were successfully generated using the optimized protocol,and their cytotoxic activity against target cells was validated via calcein-release assay and flow cytometry,with a preliminary assessment of the potential risk of GVHD induction.Results:Experimental data demonstrated that,compared with the interleukin(IL)-2-only culture,the IL-2+IL-7+IL-15 combination significantly enhanced the expansion capacity of γδ T cells(876.50±238.35-fold vs 1 627.50±472.15-fold),cell purity(73.67%±1.53%vs 90.69%±2.00%),and cell viability(63.01%±7.05%vs 89.00%±3.61%).It also increased the expression of the cytotoxicity marker CD16(4.20%±1.73%vs 14.66%±0.58%)and reduced the expression of the exhaustion marker programmed death-1(PD-1)(35.67%±6.26%vs 21.10%±6.49%).A cytokine concentration gradient orthogonal assay further identified 10 ng/mL IL-7 and 10 ng/mL IL-15 as the optimal concentrations within the IL-2+IL-7+IL-15 combination.Gene transduction performed 96-120 h after activation using a multiplicity of infection(MOI)of 5-10 resulted in the highest transduction efficiency for CAR-γδ T cells(96 h:12.87%±4.35%;120 h:11.37%±2.35%).CAR-γδ T cells generated using the optimized system exhibited specific cytotoxic effects against tumor cells expressing the target antigen,and no evidence of GVHD induction was observed.Conclusion:CAR-γδ T cells produced using the IL-2+IL-7(10 ng/mL)+IL-15(10 ng/mL)regimen combined with a 96-120 h activation period prior to transduction using a multiplicity of infection(MOI)of 5-10 significantly outperformed conventional methods in terms of expansion efficiency,cell purity,and transduction efficiency.The synergistic antitumor effects mediated by both natural immune receptors and CAR-specific recognition,along with the initial absence of GVHD risk,provide critical technical support for the clinical translation of CAR-γδ T cell therapy,establishing a solid theoretical and practical foundation.

Background and purpose:In recent years,chimeric antigen receptor T(CAR-T)cell therapy has achieved breakthrough progress in cancer treatment.γδ T cells,with their non-major histocompatibility complex(MHC)-restricted antigen recognition,broad antitumor activity,and low risk of graft-versus-host disease(GVHD),have garnered significant interest in CAR-γδ T cell therapy.However,critical challenges including suboptimal in vitro expansion and low viral transduction efficiency severely hinder the research and clinical application of CAR-γδ T cells.This study aimed to establish an efficient platform for preparing CAR-γδ T cells by optimizing the in vitro expansion conditions of γδ T cells and refining lentiviral transduction strategies.Methods:We first optimized the expansion protocol for γδ T cells by screening various cytokine combinations and the concentrations of individual cytokines within combination,and evaluating cell purity,viability,fold expansion,and expressions of cytotoxicity and exhaustion markers to identify the optimal culture conditions.Subsequently,the transduction conditions for CAR-γδ T cells were improved by determining the optimal activation duration of γδ T cells prior to gene transfer,as well as the optimal multiplicity of infection(MOI)for lentiviral transduction.Finally,CAR-γδ T cells were successfully generated using the optimized protocol,and their cytotoxic activity against target cells was validated via calcein-release assay and flow cytometry,with a preliminary assessment of the potential risk of GVHD induction.Results:Experimental data demonstrated that,compared with the interleukin(IL)-2-only culture,the IL-2+IL-7+IL-15 combination significantly enhanced the expansion capacity of γδ T cells(876.50±238.35-fold vs 1 627.50±472.15-fold),cell purity(73.67%±1.53%vs 90.69%±2.00%),and cell viability(63.01%±7.05%vs 89.00%±3.61%).It also increased the expression of the cytotoxicity marker CD16(4.20%±1.73%vs 14.66%±0.58%)and reduced the expression of the exhaustion marker programmed death-1(PD-1)(35.67%±6.26%vs 21.10%±6.49%).A cytokine concentration gradient orthogonal assay further identified 10 ng/mL IL-7 and 10 ng/mL IL-15 as the optimal concentrations within the IL-2+IL-7+IL-15 combination.Gene transduction performed 96-120 h after activation using a multiplicity of infection(MOI)of 5-10 resulted in the highest transduction efficiency for CAR-γδ T cells(96 h:12.87%±4.35%;120 h:11.37%±2.35%).CAR-γδ T cells generated using the optimized system exhibited specific cytotoxic effects against tumor cells expressing the target antigen,and no evidence of GVHD induction was observed.Conclusion:CAR-γδ T cells produced using the IL-2+IL-7(10 ng/mL)+IL-15(10 ng/mL)regimen combined with a 96-120 h activation period prior to transduction using a multiplicity of infection(MOI)of 5-10 significantly outperformed conventional methods in terms of expansion efficiency,cell purity,and transduction efficiency.The synergistic antitumor effects mediated by both natural immune receptors and CAR-specific recognition,along with the initial absence of GVHD risk,provide critical technical support for the clinical translation of CAR-γδ T cell therapy,establishing a solid theoretical and practical foundation.

Objective:To investigate and analyze the current status of dietary behavior compliance among patients following bariatric metabolic surgery, as well as its associated influencing factors.Methods:A convenience sampling approach was employed to select 149 discharged patients who underwent bariatric metabolic surgery at the Gastric Surgery Department of a tertiary hospital in Fuzhou between August 2021 and February 2024. A WeChat communication group was established for survey participants, and a questionnaire survey was conducted via the mobile app "Wenjuanxing." Patients′ data were collected using the General Information Questionnaire and the Dietary Behavior Compliance Scale for Patients After Bariatric Metabolic Surgery. Multiple stepwise linear regression analysis was used to evaluate the influencing factors of dietary behavior compliance in postoperative patients.Results:A total of 165 questionnaires were distributed, with 149 valid responses retrieved. Among the 149 post-bariatric surgery patients, 37 were males and 112 were females, with an average age of (31.10 ± 7.26) years. The overall level of dietary behavior compliance was (56.91 ± 9.70). Significant differences in dietary behavior compliance were observed among patients of different genders, educational levels, drinking habits, and postoperative durations ( t = 2.17, 1.93, F = 4.27, 3.50, all P<0.05). Specifically, postoperative duration emerged as the primary factor influencing dietary behavior compliance following bariatric metabolic surgery ( t = -2.22, P<0.05). Conclusions:Female patients, those with a college degree or higher, and individuals within 0 to 6 months post-surgery demonstrated better dietary behavior compliance. Medical staff should comprehensively consider patient individual differences, develop, and implement personalized health education plans to enhance patient dietary behavior compliance.

Objective:To investigate the application of time series models in forecasting pre-hospital emergency ambulance trips in Handan City and develop the LPro ensemble model for improved prediction accuracy to support emergency resource allocation.Methods:Pre-hospital emergency data from Handan Emergency Medical Command Center (2019-2023) were retrospectively analyzed. From 324 799 original records, 289 949 valid records were included after cleaning. The training set (2019-2022: 215 918 records) included 35 527 records in 2019, 52 015 in 2020, 61 836 in 2021, and 66 540 in 2022. The validation set (2023) contained 74 031 records. ARIMA, linear trend seasonal, exponential smoothing, and Prophet models were fitted to the training set. The LPro ensemble model was constructed using MAPE-based weighting (linear trend seasonal model: 0.38, Prophet: 0.62). Performance metrics included MAPE, RMSE, MAE, and R 2. Results:Data showed annual growth (compound annual growth rate 23.27%) and seasonal patterns (October peaks, February troughs). Ambulance dispatches increased annually with monthly cyclical patterns. For 2023 validation predictions: ARIMA (MAPE 8.76%, RMSE 619, MAE 491, R 2 0.4563), linear trend seasonal (MAPE 9.83%, RMSE 671, MAE 545, R 2 0.3608), Prophet (MAPE 8.43%, RMSE 562, MAE 503, R 2 0.5513), exponential smoothing (MAPE 8.08%, RMSE 643, MAE 410, R 2 0.4124). LPro model showed superior performance (MAPE 7.05%, RMSE 491, MAE 393, R 2 0.6570), with 16.37% lower MAPE, 12.63% lower RMSE, 21.87% lower MAE, and 19.17% higher R 2 versus Prophet. Conclusion:The LPro ensemble model substantially enhances prediction accuracy and reliability, offering scientific support for emergency resource optimization and dispatch scheduling in Handan City.

BACKGROUND:In recent years,it has been found that physical interventions play a significant role in influencing proliferation,differentiation,and migration of bone marrow mesenchymal stem cells.However,the current physical intervention still exists such as basic research data to be strengthened,unified parameter standards need to be further improved and other shortcomings.OBJECTIVE:To review the effects of physical interventions on the differentiation of bone marrow mesenchymal stem cells.METHODS:PubMed and CNKI databases were searched for relevant articles using"bone marrow mesenchymal stem cells(BMSC),bone marrow stromal cells,osteogenesis differentiation,chondrocytes differentiation,electrical stimulation,mechanical stimulation,hypoxia,electromagnetic fields,low intensity pulsed ultrasound"as English and Chinese search terms.A total of 58 articles were selected for review.RESULTS AND CONCLUSION:(1)Physical interventions have been applied to regulate the proliferation and differentiation of bone marrow mesenchymal stem cells by altering specific microenvironments,but the parameters have not yet been unified.The future investigation should further optimize and explore the best parameters and conditions of action of the relevant physical factors on the role of bone marrow mesenchymal stem cell proliferation and differentiation.(2)It is difficult to carry out the application of certain special physical environmental conditions through low-cost conventional means,pending subsequent research and development to further reduce the difficulty of constructing special physical conditions.(3)The use of physical factors to rationally intervene in differentiation and proliferation of bone marrow mesenchymal stem cells has not yet been widely applied in the clinic,and further research is needed to promote clinical translation in the future.

Objective:To investigate and analyze the current status of dietary behavior compliance among patients following bariatric metabolic surgery, as well as its associated influencing factors.Methods:A convenience sampling approach was employed to select 149 discharged patients who underwent bariatric metabolic surgery at the Gastric Surgery Department of a tertiary hospital in Fuzhou between August 2021 and February 2024. A WeChat communication group was established for survey participants, and a questionnaire survey was conducted via the mobile app "Wenjuanxing." Patients′ data were collected using the General Information Questionnaire and the Dietary Behavior Compliance Scale for Patients After Bariatric Metabolic Surgery. Multiple stepwise linear regression analysis was used to evaluate the influencing factors of dietary behavior compliance in postoperative patients.Results:A total of 165 questionnaires were distributed, with 149 valid responses retrieved. Among the 149 post-bariatric surgery patients, 37 were males and 112 were females, with an average age of (31.10 ± 7.26) years. The overall level of dietary behavior compliance was (56.91 ± 9.70). Significant differences in dietary behavior compliance were observed among patients of different genders, educational levels, drinking habits, and postoperative durations ( t = 2.17, 1.93, F = 4.27, 3.50, all P<0.05). Specifically, postoperative duration emerged as the primary factor influencing dietary behavior compliance following bariatric metabolic surgery ( t = -2.22, P<0.05). Conclusions:Female patients, those with a college degree or higher, and individuals within 0 to 6 months post-surgery demonstrated better dietary behavior compliance. Medical staff should comprehensively consider patient individual differences, develop, and implement personalized health education plans to enhance patient dietary behavior compliance.

Objective:To investigate the effects of Feiji Formula on the migration and invasion of lung cancer cells,as well as lung metastasis in animal models and explore its possible mechanisms.Methods:TNMplot,TCGA,and DAVID databases were used to analyze the expression of complement-related proteins(CFHR5[complement factor H-related protein 5],MBL2[mannose-binding lectin 2],C9[complement component 9])in lung metastatic tissues and their relationship with immune cell infiltration,as well as related biological processes and signaling pathways.A subcutaneous xenograft mice model was established using 2LL cells.Mice were administered 2 g/mL Feiji Formula decoction(0.2 mL per dose)via oral gavage for 21 days.The effects of Feiji Formula on the incidence of lung metastasis,the number of lung metastatic nodules,and the protein expression of CFHR5/MBL2/C9 in the lung tissues of the model mice were observed.Exosome tracing assay was performed to observe the secretion and uptake of exosomes by CTC-TJH-01 and H1299 cells.Different concentrations of Feiji Formula were applied to treat H1299 and CTC-TJH-01 cells,and its effects on cell viability,invasion,migration,and CFHR5/MBL2/C9 protein expression were detected by CCK-8,scratch healing assay,Transwell assay,and WB method.Results:Network pharmacology analysis showed that CFHR5/MBL2/C9 proteins were highly expressed in lung metastatic tissues(all P<0.05)and were closely related to the complement system involved in immune response regulation.Compared with the control group,the Feiji Formula group demonstrated a significant reduction in the number of lung metastatic nodules(P<0.05).Feiji Formula(0-200 μg/mL)had no significant effect on the viability of H1299 and CTC-TJH-01 cells(both P>0.05).Both CTC-TJH-01 and H1299 cells could secrete and uptake each other's exosomes.Compared with the 0 μg/mL control group,Feiji Formula at concentrations of 50-200 μg/mL significantly inhibited the migration and invasion abilities of H1299 and CTC-TJH-01 cells(P<0.05 or P<0.01),and significantly reduced the protein expression levels of CFHR5 and MBL2(P<0.05 or P<0.01).Notably,the expression level of C9 protein in CTC-TJH-01 cells increased only after treatment with 200 μg/mL Feiji Formula(P<0.05).Conclusion:Feiji Formula can inhibit the migration and invasion of lung cancer cells as well as lung metastasis in model mice by regulating complement-associated proteins CFHR5/MBL2/C9.This effect may be related to exosome-mediated intercellular communication.