Objective To explore the predictive value of the modified frailty index-11 (mFI-11) for postoperative complications in elderly lung cancer patients undergoing robot-assisted lobectomy. Methods Clinical data were retrospectively collected from lung cancer patients aged ≥65 years who underwent robot-assisted lobectomy at the Department of Thoracic Surgery, Gansu Provincial Hospital, from January 2022 to June 2025. Based on the optimal grouping threshold of 0.27 in previous studies for the mFI-11 score, patients were divided into a frail and a non-frail group. Postoperative complications of the two groups were analyzed, and multivariable logistic regression was used to assess the relationship between mFI-11 and postoperative complications. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficiency of mFI-11 for postoperative complications. Results A total of 161 patients were included, with 77 males and 84 females, and an average age of (68.48±2.90) years. Among them, 103 (64.0%) patients were in the non-frail group and 58 (36.0%) in the frail group. Differences between the two groups in terms of independent functional status, hypertension requiring drug control, history of type 2 diabetes, history of chronic obstructive pulmonary disease, American Society of Anesthesiologists classification, and tumor staging were all statistically significant (P<0.05). The length of postoperative hospital stay in the frail group was longer than that in the non-frail group [5.50 (5.00, 8.25) d vs. 5.00 (4.00, 5.00) d, P<0.001]. The incidence rates of general respiratory diseases (25.9% vs. 8.7%), hypoproteinemia (15.5% vs. 4.9%), arrhythmia (12.1% vs. 1.9%), bronchopleural fistula (5.2% vs. 0.0%), transfer to ICU for severe complications (10.3% vs. 1.0%), and readmission within 30 days after discharge (12.1% vs. 1.9%) were all higher in the frail group compared to the non-frail group (P<0.05). Multivariable logistic regression analysis found that mFI-11 had a good predictive efficiency for postoperative complications: general respiratory diseases [area under the curve (AUC)=0.759], hypoproteinemia (AUC=0.723), arrhythmia (AUC=0.795), transfer to ICU for severe complications (AUC=0.713), and readmission within 30 days after discharge (AUC=0.702). Conclusion mFI-11 can effectively predict postoperative complications in elderly lung cancer patients undergoing robot-assisted lobectomy and can serve as an objective indicator for identifying high-risk elderly lung cancer patients.

In recent years,the market share of food and medicine homology substances has continued to grow,and various types of contamination issues have become the focus of attention both inside and outside the industry.The contamination not only affects the original medicinal quality,but also leads to the accumulation of toxic substances in the human body,causing acute and chronic severe hazards such as vomiting,poisoning and cancer.Therefore,the development of biosensors that can conveniently,accurately and sensitively detect various pollutants in food and medicine homology substances has become a research hotspot.Aptasensors based on metal-organic frameworks(MOFs)with advantages such as strong specificity,rapid response and simple operation,have been widely used in detection of various pollutants.This review focused on the research progress of aptasensors based on MOFs for detection of food and medicine homology contamination in the past few years,and provided a detailed comparison and analysis for detection of chemical pollutants(such as pesticide residues,heavy metal residues,mycotoxins,etc.)and microbial contamination in food and medicine homology substances.Besides,the development trend and possible challenges of MOFs aptasensors in detection of food and medicine homology substances in the future were discussed,which was anticipated to provide a reference for the development of new MOFs aptasensors.

Objective:To propose policy recommendations for the compensation mechanism of high-quality development of municipal public hospitals.Methods:Taking the municipal public hospitals in Shanghai as the research object,the aspects of financial subsidies,the structure of medical service income,investment in scientific research and education,and other social compensations were examined to conduct a systematic simulation of the operation of the average municipal public hospital in Shanghai under different policy intervention scenarios.Results:If the current conditions remain unchanged,the average municipal public hospital in Shanghai will face a deficit starting in 2032,the proportion of income from examinations and laboratory tests will surpass that of medical service income in 2026 and 2031,respectively.If the hospitals follow a plan of Combination Plan 3,4,and 5,the average municipal public hospital in Shanghai will be able to break even from 2023 to 2033,and the structure of medical service income will be significantly optimized.Conclusion:To establish a new compensation mechanism for high-quality hospital development that enhances medical services,it is recommended to optimize the structure of government financial compensation,explore rational pricing strategies based on categories,increase investment in scientific research and education while paying attention to the transformation of scientific and technological achievements,expand compensation channels for public hospitals,and improve relevant laws and regulations.

Objective:To establish 30-day of age transcutaneous bilirubin (TcB) reference curves for healthy neonates, and to investigate regional variations in bilirubin dynamics.Methods:A multicenter retrospective cohort study was conducted. A total of 220 950 healthy neonates born at a gestational age of 35-<42 weeks, with a birth weight ≥2 000 g, who did not receive phototherapy within 60 h after birth were recruited. All of them underwent remote TcB monitoring using the Bilibaby remote jaundice monitoring system between August 1 st, 2020 and December 31 st, 2024 in 426 hospitals. TcB data were collected within the period from birth to 30-day of age. The P40, P75, and P95 of TcB values were calculated, and dynamic TcB curves for 30-day of age were constructed. Patterns of bilirubin change, rates of change, and transition outcomes were described. Regional comparisons between South and North were conducted using linear mixed-effects models for TcB trajectories and Pearson′s chi-square test for outcome differences. Results:A total of 220 950 neonates were included, of whom 101 711 (46.03%) were female. Gestational age at birth was (38.75±1.12) weeks, and birth weight was (3 272±417) g. TcB levels increased rapidly within 3-day of age, peaked at 4-6-day of age, with peak values at P40, P75, and P95 of 200.6, 239.7 and 275.4 μmol/L (11.8, 14.1 and 16.2 mg/dl), respectively. TcB levels gradually declined thereafter and stabilized after 13-day of age, with values at P40, P75, and P95 fluctuating between 147.9-159.8, 190.4-200.6, and 231.2-239.7 μmol/L (8.7-9.4, 11.2-11.8, 13.6-14.1 mg/dl), respectively. Notably, among neonates categorized as low-or low-intermediate-risk within 3-day of age, 6 700 (12.76%) progressed to intermediate-high or high risk between 4 and 30 days of age. Before 13-day of age, TcB levels in the southern regions were consistently higher than those in the northern regions ( P=0.039); from 14 to 30 days of age, the overall TcB levels had no statistically difference, but the temporal changes in TcB still showed regional differences (degrees of freedom=3, all interaction P<0.05). Among neonates classified as low-or low-intermediate risk within 3-day of age, 25 326 were from southern regions, of whom 4 254 (16.80%) progressed to intermediate-high or high risk between 4 and 30 days of age. In northern regions, 27 193 neonates were classified as low-or low-intermediate risk within 3-day of age, among whom 2 446 (8.99%) progressed to intermediate-high or high risk. The risk progression between the 2 regions had statistically difference ( χ2=716.49, P<0.001). Conclusions:A TcB percentile curve for neonates within 30-day of age was established, revealing that both the overall TcB level and its temporal trend were higher in southern than in northern newborns. These findings provide baseline data to support continuous management of neonatal jaundice.

Objective:To propose policy recommendations for the compensation mechanism of high-quality development of municipal public hospitals.Methods:Taking the municipal public hospitals in Shanghai as the research object,the aspects of financial subsidies,the structure of medical service income,investment in scientific research and education,and other social compensations were examined to conduct a systematic simulation of the operation of the average municipal public hospital in Shanghai under different policy intervention scenarios.Results:If the current conditions remain unchanged,the average municipal public hospital in Shanghai will face a deficit starting in 2032,the proportion of income from examinations and laboratory tests will surpass that of medical service income in 2026 and 2031,respectively.If the hospitals follow a plan of Combination Plan 3,4,and 5,the average municipal public hospital in Shanghai will be able to break even from 2023 to 2033,and the structure of medical service income will be significantly optimized.Conclusion:To establish a new compensation mechanism for high-quality hospital development that enhances medical services,it is recommended to optimize the structure of government financial compensation,explore rational pricing strategies based on categories,increase investment in scientific research and education while paying attention to the transformation of scientific and technological achievements,expand compensation channels for public hospitals,and improve relevant laws and regulations.

Objective:To establish 30-day of age transcutaneous bilirubin (TcB) reference curves for healthy neonates, and to investigate regional variations in bilirubin dynamics.Methods:A multicenter retrospective cohort study was conducted. A total of 220 950 healthy neonates born at a gestational age of 35-<42 weeks, with a birth weight ≥2 000 g, who did not receive phototherapy within 60 h after birth were recruited. All of them underwent remote TcB monitoring using the Bilibaby remote jaundice monitoring system between August 1 st, 2020 and December 31 st, 2024 in 426 hospitals. TcB data were collected within the period from birth to 30-day of age. The P40, P75, and P95 of TcB values were calculated, and dynamic TcB curves for 30-day of age were constructed. Patterns of bilirubin change, rates of change, and transition outcomes were described. Regional comparisons between South and North were conducted using linear mixed-effects models for TcB trajectories and Pearson′s chi-square test for outcome differences. Results:A total of 220 950 neonates were included, of whom 101 711 (46.03%) were female. Gestational age at birth was (38.75±1.12) weeks, and birth weight was (3 272±417) g. TcB levels increased rapidly within 3-day of age, peaked at 4-6-day of age, with peak values at P40, P75, and P95 of 200.6, 239.7 and 275.4 μmol/L (11.8, 14.1 and 16.2 mg/dl), respectively. TcB levels gradually declined thereafter and stabilized after 13-day of age, with values at P40, P75, and P95 fluctuating between 147.9-159.8, 190.4-200.6, and 231.2-239.7 μmol/L (8.7-9.4, 11.2-11.8, 13.6-14.1 mg/dl), respectively. Notably, among neonates categorized as low-or low-intermediate-risk within 3-day of age, 6 700 (12.76%) progressed to intermediate-high or high risk between 4 and 30 days of age. Before 13-day of age, TcB levels in the southern regions were consistently higher than those in the northern regions ( P=0.039); from 14 to 30 days of age, the overall TcB levels had no statistically difference, but the temporal changes in TcB still showed regional differences (degrees of freedom=3, all interaction P<0.05). Among neonates classified as low-or low-intermediate risk within 3-day of age, 25 326 were from southern regions, of whom 4 254 (16.80%) progressed to intermediate-high or high risk between 4 and 30 days of age. In northern regions, 27 193 neonates were classified as low-or low-intermediate risk within 3-day of age, among whom 2 446 (8.99%) progressed to intermediate-high or high risk. The risk progression between the 2 regions had statistically difference ( χ2=716.49, P<0.001). Conclusions:A TcB percentile curve for neonates within 30-day of age was established, revealing that both the overall TcB level and its temporal trend were higher in southern than in northern newborns. These findings provide baseline data to support continuous management of neonatal jaundice.

Purpose::This study evaluated the methods and clinical effects of multidisciplinary collaborative treatment for occlusal reconstruction in patients with old jaw fractures and dentition defects.Methods::Patients with old jaw fractures and dentition defects who underwent occlusal reconstruction at the Third Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2022 were enrolled. Clinical treatment was classified into 3 phases. In phase I, techniques such as orthognathic surgery, microsurgery, and distraction osteogenesis were employed to reconstruct the correct 3-dimensional (3D) jaw position relationship. In phase II, bone augmentation and soft tissue management techniques were utilized to address insufficient alveolar bone mass and poor gingival soft tissue conditions. In phase III, implant-supported overdentures or fixed dentures were used for occlusal reconstruction. A summary of treatment methods, clinical efficacy evaluation, comparative analysis of imageological examinations, and satisfaction questionnaire survey were utilized to evaluate the therapeutic efficacy in patients with traumatic old jaw fractures and dentition defects. All data are summarized using the arithmetic mean ± standard deviation and compared using independent sample t-tests. Results::In 15 patients with old jaw fractures and dentition defects (an average age of 32 years, ranging from 18 to 53 years), there were 7 cases of malocclusion of single maxillary fracture, 6 of malocclusion of single mandible fracture, and 2 of malocclusion of both maxillary and mandible fractures. There were 5 patients with single maxillary dentition defects, 2 with single mandibular dentition defects, and 8 with both maxillary and mandibular dentition defects. To reconstruct the correct 3D jaw positional relationship, 5 patients underwent Le Fort I osteotomy of the maxilla, 3 underwent bilateral sagittal split ramus osteotomy of the mandible, 4 underwent open reduction and internal fixation for old jaw fractures, 3 underwent temporomandibular joint surgery, and 4 underwent distraction osteogenesis. All patients underwent jawbone augmentation, of whom 4 patients underwent a free composite vascularized bone flap (26.66%) and the remaining patients underwent local alveolar bone augmentation. Free gingival graft and connective tissue graft were the main methods for soft tissue augmentation (73.33%). The 15 patients received 81 implants, of whom 11 patients received implant-supported fixed dentures and 4 received implant-supported removable dentures. The survival rate of all implants was 93.82%. The final imageological examination of 15 patients confirmed that the malocclusion was corrected, and the clinical treatment ultimately achieved occlusal function reconstruction. The patient satisfaction questionnaire survey showed that they were satisfied with the efficacy, phonetics, aesthetics, and comfort after treatment.Conclusion::Occlusal reconstruction of old jaw fractures and dentition defects requires a phased sequential comprehensive treatment, consisting of 3D spatial jaw correction, alveolar bone augmentation and soft tissue augmentation, and implant-supported occlusal reconstruction, achieving satisfactory clinical therapeutic efficacy.

Background and objective Small cell lung cancer(SCLC)is known as recalcitrant cancer with high malignancy and heterogeneity.Immunotherapy has changed the treatment pattern of extensive-disease SCLC(ED-SCLC),but the beneficiary population is limited.Therefore,exploring new therapeutic strategies is an urgent clinical problem to be solved for SCLC.SCLC is characterized by highly active glycolytic metabolism and pyruvate kinase Ml(PKM1)is one of the isozymes of PK,an important rate-limiting enzyme in glycolysis pathway.Previous studies have shown that PKM1 is related to autophagy and drug sensitivity,however,how PKM1 regulates drug sensitivity in SCLC and its mechanism remain unclear.The aim of this study was to investigate the biological functions of PKM1 in SCLC,including its effects on proliferation,migra-tion,autophagy,drug sensitivity,and expression of neuroendocrine(NE)-related markers in SCLC.Methods Western blot was used to detect the expression level of PKM1 in SCLC cells.PKM1 gene-overexpressed SCLC cell lines were constructed by stable lentivirus transfection.Proliferation of cells and drug sensitivity were detected by MTT,and migration ability of cells was determined by Transwell.The level of autophagy was detected by flow cytometry.Western blot was used to determine the expression levels of NE-related proteins.Results PKM1 was differentially expressed among various SCLC cell lines,and was lower in H1092 cells(P＜0.01).Compared with the control group,there was no significant difference in proliferation level of PKM1 overexpressing H1092 cell,but the migration ability was significantly increased(P＜0.001),the drug sensitivity was re-duced,and the level of autophagy was inhibited(P＜0.001).Additionally,overexpression of PKM1 could upregulate the expres-sion of non-neuroendocrine(non-NE)-related proteins(P＜0.01)and decrease the expression of NE-related proteins(P＜0.01).Conclusion PKM1 was differentially expressed in SCLC cell lines,and high expression of PKM1 did not affect the prolifera-tion,but affected the migration of SCLC cells.PKM1 might affect drug sensitivity by inhibiting autophagy and regulating the expression of NE markers.These results provide a theoretical basis for exploring the role of PKM1 in SCLC.

AIM To compare the in vivo pharmacokinetics of paeoniflorin,paeoniflorin,liquiritin,isoliquiritin,liquiritigenin and glycyrrhizic acid from Shaoyao Gancao Decoction in normal and gastric ulcer rats.METHODS Six rats were randomly assigned into two groups,after which the 75%ethanol-induced gastric ulcer model was established,the gastric tissues were collected.Twelve rats were randomly assigned into two groups and given intragastric administration(9.9 g/kg),after which blood collection was made at different time points,UPLC-MS/MS method was adopted in the determination of plasma concentrations,and main pharmacokinetic parameters were calculated.RESULTS Prolonged Tmax(P＜0.05,P＜0.01)of various active constituents,prolonged T1/2,MRT0-t(P＜0.05,P＜0.01),increased Cmax,AUC(P＜0.05,P＜0.01)and decreased Vd/F,CL/F(P＜0.05,P＜0.01)of paeoniflorin,increased Cmax,AUC(P＜0.05,P＜0.01)and decreased CL/F(P＜0.05)of albiflorin,prolonged MRT(P＜0.05),increased AUC(P＜0.05)and decreased CL/F(P＜0.01)of liquiritin,prolonged MRT(P＜0.05,P＜0.01)and decreased Vd/F(P＜0.05)of isoliquiritin,no obviously changed pharmacokinetic parameters(except for Tmax)of liquiritigenin(P＞0.05),and prolonged T1/2,MRT0-∞(P＜0.05,P＜0.01),increased Cmax,AUC(P＜0.05,P＜0.01)and decreased CL/F(P＜0.01)of glycyrrhizic acid were observable in the model group as compared with those in the normal group.CONCLUSION Gastric ulcer exhibits certain influences on the velocities and degrees of in vivo absorption and metabolism of active constituents from Shaoyao Gancao Decoction.

Objective To investigate the role and mechanism of β-catenin protein in the maintenance of malignant biological characteristics of pancreatic cancer stem cells.Methods Primary pancreatic cancer cells were isolated and cultured,then divided into the negative control(NC)group and the AD β-catenin group,cells in the NC group were transfected with negative empty vectors,and cells in the AD β-catenin group were transfected with β-catenin overexpression lentiviral vectors.Flow cytometry was used to analyze the expression of tumor stem cell surface markers CD24,CD44,and ESA.CD24+CD44+ESA+cells were sorted and expanded in culture,and their sphere-forming ability,colony-forming ability,proliferation ability,invasion ability and migration ability,cell cycle,and apoptosis were assessed.The impact of β-catenin overexpression on the biological characteristics of pancreatic cancer stem cells was analyzed.Results The relative expression levels of β-catenin mRNA and protein in the AD β-catenin group were significantly higher than those in the NC group(P=0.016,P=0.015).Flow cytometry analysis revealed that the percentage of CD24+and CD24+CD44+ESA+cells in the AD β-catenin group was significantly higher than that in the NC group(P<0.05).Compared with the NC group,the colony-forming ability,sphere-forming ability,numbers of invasion and migration of pancreatic cancer stem cells in the AD β-catenin group were significantly increased(P<0.05).The optical density(OD)values at 24 hours,48 hours,and 72 hours were significantly higher in the AD β-catenin group than those in the NC group(P<0.05).Compared with the NC group,the proportion of G0/G1 phase cells in the AD β-catenin group was significantly decreased(P<0.05),and the proportion of S phase cells was increased(P<0.05).The apoptosis rate in the AD β-catenin group was significantly lower than that in the NC group(P<0.05).Conclusion β-catenin can improve the percentage of CD24+CD44+ESA+cells in primary pancreatic cancer cells,promote sphere-forming ability,enhance cell proliferation,invasion,and migration,and inhibit cell apoptosis,thereby maintaining the malignant biological characteristics of pancreatic cancer stem cells.