With the accelerating trend of population aging, the number of elderly patients with lung cancer continues to rise, and the disease burden is becoming increasingly heavy. The clinical management of these patients faces severe challenges due to their decreased physiological reserve, complex comorbidities, and significant individual heterogeneity. Consequently, under traditional diagnosis and treatment models, doctors often struggle to identify the individualized risks of elderly patients in a timely and comprehensive manner, which can easily lead to decision biases such as undertreatment or overtreatment. In view of this, this study advocates for the establishment of an umbrella decision-making model specifically tailored for elderly lung cancer patients. Grounded in a multidisciplinary team (MDT) platform, this model deeply integrates oncological indicators with the comprehensive geriatric assessment (CGA) system. By holistically considering multidimensional variables including tumor burden, organ function, frailty index, cognitive status, and social support, the model establishes an operational mechanism characterized by "single entry, precise stratification, and targeted selection". Accordingly, patients can be scientifically triaged into distinct intervention tiers, such as active surveillance, minimally invasive surgery, drug therapy, radiotherapy, and best supportive care, thereby achieving real-time alignment between treatment intensity and patient fitness. This article elaborates on the construction logic and key operational procedures of this novel decision-making framework, aiming to guide clinical practice beyond the limitations of a tumor-centric perspective toward a holistic, dynamic, whole-course management strategy. This transition seeks to ensure optimal quality of life and clinical net benefit for elderly patients alongside survival prolongation.

Objective To evaluate the application of the Huaxi Intelligent Endoscopic Skill Training and Assessment System in minimally invasive surgery (MIS) skills training and provide insights for optimizing MIS training models, we analyzed trainee performance during training and assessment. Methods A retrospective analysis was conducted on the use of this system across 28 medical institutions from January 2022 to January 2025. Results By January 2025, the standardized deployment of 139 simulation units had been completed. A total of 403 trainees from various surgical specialties, including thoracic surgery and general surgery, participated in five customized endoscopic skill training modules: endoscopic recognition, grasping training, positioning and placement, cutting training, and suturing training. Throughout the training period, a total of 78 participants took part in 27 formal assessments. Correlation analysis based on Spearman showed that pre-assessment training pass rates were significantly correlated with final assessment scores, indicating enhancing the quality of each training module and overall training efficacy is a key to improving the effectiveness of MIS training. Conclusion The Huaxi Intelligent Endoscopic Skill Training and Assessment System effectively supports MIS training and evaluation.

Although great progress has been achieved in the techniques and materials of cardiopulmonary bypass (CPB), cardiac surgery under CPB is still one of the surgeries with the highest complication rate. The systemic inflammatory response is an important cause of complications, mainly characterized by activation of innate immune cells and platelets, and up-regulation of inflammatory cytokines. After activation, a variety of molecules on the membrane surface are up-regulated or down-regulated, which can amplify tissue inflammatory damage by releasing cytoplasmic protease and reactive oxygen species, and activate multiple inflammatory signaling pathways in the cell, ultimately leading to organ dysfunction. Therefore, the expression of these cell membrane activation markers is not only a marker of cell activation, but also plays an important role in the process of vital organ injury after surgery. Identification of these specific activation markers is of great significance to elucidate the mechanisms related to organ injury and to find new prevention and treatment methods. This article will review the relationship between these activated biomarkers in the innate immune cells and vital organ injuries under CPB.

Objective To explore the influence of organizational support on the career satisfaction of doctors in public hospitals and the mediating effect of role stress.Methods Using the survey data of 523 public hospital doctors from 9 medical institutions in 4 places in 2022,OLS linear regression model was used to analyze the influence of organizational support on career satisfaction,and Bootstrap test was used to explore the mediating effect of role stress.Results Organizational support had a positive effect on the career satisfaction of doctors in public hospitals,and for every unit increase in organizational support score,career satisfaction score will increase by 0.528 points.And role stress had a negative effect on the career satisfaction of doctors in public hospitals.Conclusion Organizational managers should take measures to promote the positive impact of organizational support on doctors'career satisfaction in public hospitals,reduce doctors'role stress,and continuously improve their career satisfaction.

ObjectiveTo explore the law of women reproductive aging based on theory of "seven-year period" in traditional Chinese medicine（TCM） through analyzing the characteristics of basic sex hormone levels and anti-müllerian hormone levels in women of different ages. MethodsThe data of female who visited Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2018 to December 2022 and accepted basic hormone and anti-müllerian hormone determination were collected retrospectively. According to the age of subjects， they were divided into the "1-2 seven" group （under 21 years old）， "3 seven" group （21-27 years old）， "4 seven" group （28-34 years old）， "5 seven" group （35-41 years old）， "6 seven" group （42-48 years old） and "7 seven" and older group （49 years old and above）. The age， average menstrual cycle in the past 3 months， basic hormone levels including follicle stimulating hormone （FSH）， luteinizing hormone （LH）， estradiol （E₂）， testosterone （T） and FSH/LH value， and anti-müllerian hormone （AMH） levels were collected and compared. ResultsA total of 1221 cases were included. The differences in FSH， LH， FSH/LH values， E₂， T， AMH levels and average menstrual cycle among the groups were statistically significant （P＜0.05 or P＜0.01）. AMH peaked in the "3 seven" group. Compared to those in the "3 seven" group， the FSH/LH value in the "4 seven" group increased， while the LH， AMH and T levels decreased， and the menstrual cycle was shortened （P＜0.01）. The FSH/LH， LH， AMH， T and menstrual cycle in the "5 seven" group were consistent with the changing trend of those in the "4 seven" group， while the FSH and E₂ levels in the "5 seven" group were significantly higher （P＜0.05 or P＜0.01）. Compared to those in the "5 seven" group， the FSH， LH and E₂ levels of the "6 seven" group increased， and the AMH and T levels continued to decrease （P＜0.05 or P＜0.01）. Compared to those in the "6 seven" group， the FSH and LH levels of the "7 seven" and older group continued to increase， and the AMH and E₂ levels decreased （P＜0.01）. ConclusionThe law of women reproductive aging in the "seven-year period" theory is basically consistent with the characteristics of basic sex hormone levels and anti-müllerian hormone levels in women of different ages. The reproductive capacity reaches its peak in the "three-seven-year period" and gradually moves towards reproductive aging in the "four-seven-year period".

Objective:To analyze independent influencing factors of surgical textbook outcome (TO) in patients with gallbladder carcinoma, and to establish a nomogram for predicting TO and evaluated the predictive ability.Methods:Patients with gallbladder carcinoma who underwent surgery in Department of Hepatobiliary and Pancreatic Surgery at Dongfang Hospital Affiliated to Shanghai Tongji University and Department of Biliary Tract Surgery Ⅰ, Third Affiliated Hospital of Naval Medical University (Shanghai Eastern Hepatobiliary Surgery Hospital) from January 2013 to December 2018 were included and the clinical features were retrospectively analyzed. A total of 232 patients were included, including 114 males and 118 females, aged (61.0±9.8) years. According to whether TO reached or not, they were divided into TO group ( n=86) and non-TO group ( n=146). Univariate and multivariate logistic regression were used to analyze the independent influencing factors of TO. The predictive nomogram model of TO was constructed. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive ability of the model, and the consistency of the predictive model was evaluated by the consistency curve graph and the Hosmer-Lemeshow test. Results:The 1-year and 3-years cumulative survival rates of patients with gallbladder carcinoma in the TO group (86.0% and 62.8%) were better than those in the non-TO group (46.6% and 27.3%), and the difference was statistically significant (χ 2=60.74, P<0.001). In multivariate analysis, higher T stage ( OR=0.16, 95% CI: 0.03-0.79, P<0.001) and cervical gallbladder cancer ( OR=0.14, 95% CI: 0.02-0.94, P=0.004) had the greatest negative association with a TO, and the higher the degree of tumor differentiation ( OR=7.08, 95% CI: 1.34-37.56, P=0.001), the easier it is to achieve TO. The ROC curve showed that the area under the curve of the predictive model was 0.84 (95% CI: 0.79-0.90), suggesting that the model had good predictive performance. A nomogram to assess the probability of TO was developed and had good accuracy in both the consistency curve and Hosmer-Lemeshow test (χ 2=5.77, P=0.673). Conclusion:Tumor T stage, tumor differentiation degree and tumor location are independent influencing factors for achieving TO in patients with gallbladder carcinoma after surgery. The nomogram model constructed according to the above conclusions could accurately predict the probability of reaching TO.

Remote pharmaceutical care refers to the process that pharmacists provide pharmaceutical care to patients remotely through information technology. Remote pharmaceutical care in China starts late and develops slowly. Therefore ，this paper discusses the pharmaceutical care modes that pharmacists at home and abroad can provide under the remote mode by collecting literature. The results show that foreign remote pharmaceutical care starts early and is relatively mature. The service mainly included remote follow-up and intervention ，24-hour online prescription and order review ，24-hour online drug reorganization ，and guidance on rational drug use in remote areas or community hospitals. The service population covers patients with cardiovascular disease ， diabetes，asthma，AIDS and so on. Some hospitals have established an integrated pharmaceutical care system of “Internet+Medical Consortium”in China ，with which pharmacists can provide patients with pharmaceutical care such as remote follow-up and intervention，drug consultation and so on. With the promotion of telemedicine ，domestic pharmacists can gradually expand the scope of services ，expand pharmaceutical services such as remote consultation and remote popular science push ，and realize the sharing of high-quality pharmaceutical care for the whole people.

【Objective】 To understand the current situation of blood components distribution in domestic prefecture-level blood stations through analyzing the components distribution data of 24 prefecture-level blood stations in China. 【Methods】 The data of components distribution of 24 blood stations from 2017 to 2020 as well as the data of blood deployment of 24 blood stations from 2019 to 2020 were collected and analyzed. 【Results】 From 2017 to 2020, positive annual growth in red blood cells, plasma and cryoprecipitate was observed in 22, 19 and 15 out of the 24 blood stations, and the annual growth median rate of above three components was 5.24%, 3.80% and 3.25%, respectively. Among the 24 prefecture-level blood stations, 23 carried out the preparation of cryoprecipitate. 【Conclusion】 The distribution of red blood cells, cryoprecipitate and plasma in prefecture-level blood stations is increasing year by year. However, there is a overstock of plasma, and most blood stations need blood employment.

OBJECTIVE: To investigate the expression of calponin-1 (CNN1) in systemic sclerosis (SSc) and its pathogenic role in fibrosis. METHODS: Skin biopsy samples were collected from 19 patients with SSc and 21 healthy subjects. Real-time PCR was used to detect the expression of and mRNAs in the samples, and the protein expression of CNN1 was detected using immunohistochemistry. In cultured primary human dermal fibroblasts, expression was knocked down RNA interference, and the mRNA expression levels of and the fibrosis-related genes , , , , and were detected using real-time PCR; the proliferation of the cells was assessed using a real-time cell proliferation detection system. RESULTS: Compared with that in samples from normal subjects, the expression of mRNA was significantly increased in the skin tissue of patients with SSc ( < 0.05) with a positive correlation with α-SMA (=0.7219, < 0.0001); the protein expression of CNN1 was also significantly increased in the skin tissue of patients with SSc. In cultured primary skin fibroblasts, the expression of CNN1 mRNA was positively correlated with and mRNA expressions (=0.6547, < 0.05; =0.6438, < 0.05). knockdown in the fibroblasts significantly inhibited the cell proliferation, obviously lowered the expressions of fibrosis-related genes, and reduced the protein expression of collagen. CONCLUSIONS The expression of is increased in the skin tissues of patients with SSc, and knockdown can reduce the activity of dermal fibroblasts, suggesting the close correlation of CNN1 with fibrosis in SSc.
Calcium-Binding Proteins ; Cells, Cultured ; Fibroblasts ; Fibrosis ; Humans ; Microfilament Proteins ; Scleroderma, Systemic ; Skin

Objective To understand the knowledge,attitude and behavior on health hazards of haze and secondhand smoke exposure among middle school students in Beijing,and provide us with guidance to carry out effective health education for middle school students.Methods A total of 1 294 students were selected randomly using stratified cluster sampling method;1 085 valid questionnaires were recovered.Among them,739 were junior high school students and 346 were senior high school students.The questionnaire included questions on middle school students' knowledge on haze and secondhand smoke exposure,their attitudes towards the judgement of severity of haze and secondhand smoke exposure and their utilization of protective measures when they are exposed to haze or secondhand smoke.Pearson's chi-squared test was performed to assess differences in knowledge,attitude and behavior between junior middle school students and senior high school students,boys and girls.Results Middle-school students' awareness rate on "the haze and exposure to secondhand smoke may cause respiratory disease" was the highest,which was 93.55％ and 95.76％ respectively.The awareness rate of the fact that haze,secondhand smoke exposure can cause cardiovascular disease was 38.99％ and 55.85％ respectively;while the rate of their awareness on the haze and exposure to secondhand smoke can lead to cancer was the lowest,which was 54.10％ and 69.95％ respectively.The differences was significant in the awareness rate of the fact that respiratory disease,cardio-cerebrovascular disease and cancer can be caused by the haze (x2=732.539,P＜0.05),likewise the differences were significant in the awareness rate of the above three kinds of diseases can be caused by secondhand smoke exposure (x2=460.291,P＜0.05).In the comparison between the severity of haze and smoking hazards,35.94％ of students believe that haze hazards is heavier than tobacco;48.02％ of the students think that the dangers of smoking is greater than haze;16.04％ of the students cannot determine the extent of damage of the haze and smoke.The proportion of students who think smoking was more harmful than haze was higher in junior high school group than in senior high school group.The two groups had a significant difference in the understanding of the severity comparison between haze and smoking (x2=13.014,P＜0.05).The differences between boys and girls in the view of the severity comparison between haze and smoking are also statistically significant,more boys believed smoking was more harmful than haze (x2=9.650,P＜0.05).In the aspect of protection from haze and secondhand smoke exposure,86.36％ of the students would like to protect themselves from haze,while 55.94％ of the students would take measures to prevent the secondhand smoke exposure initiatively,the junior high school students performed better than the senior high school students in this two aspects(x2=17.125,P＜0.05;x2=45.785,P＜0.05).Conclusion While middle school students have a certain understanding of the impact of haze and secondhand smoke exposure on health hazards,their understanding is limited.They have not paid enough attention to the harm of secondhand smoke exposure and their awareness of active refusal to secondhand smoke exposure needs to be improved.Schools should strengthen the health education for students and educate them not only to stay away from haze but also should be far away from secondhand smoke exposure.