Patients with lung cancer experience a heavy symptom burden during the perioperative period, which seriously affects their recovery and quality of life. Traditional symptom management models rely mainly on scheduled ward rounds during hospitalization and outpatient follow-up after discharge. However, they have limitations such as delayed symptom recognition, lack of post-discharge monitoring, and non-quantitative symptom assessment, which often lead to delayed interventions and low patient satisfaction. In recent years, the symptom management model based on electronic patient-reported outcomes (ePRO) has been increasingly valued in clinical practice. Existing high-level evidence from both domestic and international studies indicates that, through proactive monitoring, real-time alerts, and remote interventions, this model enables dynamic and continuous symptom management and helps improve patient recovery and healthcare experience. As a supplement to routine medical care, the ePRO-based symptom management model aims to enhance the quality of care rather than replace existing medical processes. To promote the standardized application of this model in perioperative lung cancer care, this consensus integrates domestic and international evidence. After multiple rounds of voting by more than 50 experts, it formulates 12 consensus statements covering the three core components, symptom monitoring, alerting, and intervention, to provide scientific and practical recommendations for clinical practice.

In light of the professional characteristics of oral medicine,oral medical students may be challenged with higher medical risks during the clinical internship stage.This article analyzes the potential risk factors in the process of oral medicine internships and proposes corresponding preventive strategies,aiming to ensure medical safety and promote the healthy development of medical students.

Objective To explore the influencing factors of depression risk in elderly patients with hypertension and construct and validate a nomogram prediction model.Methods A total of 869 elderly patients with hypertension were selected from national survey database of the China Health and Retirement Longitudinal Study(CHARLS)in 2018.Multivariate Logistic regression analysis was used to identify the risk factors for depression in elderly patients with hypertension,and a nomogram prediction model was constructed.The accuracy and effectiveness of the model were validated by the Hosmer-Lemeshow(H-L)goodness-of-fit test,the area under the curve(AUC)of the receiver oper-ating characteristic(ROC)curve,and the calibration curve.Results The incidence of depression in elderly patients with hypertension was 47.18％.Factors influencing the risk of depression included rural residence(OR=2.191,P＜0.05),impaired basic activities of daily living(BADL)(OR=2.338,P＜0.05),impaired instrumental activitiesofdaily living(IADL)(OR=1.674,P＜0.05),poor life satisfaction(OR=7.348,P＜0.05),fair self-rated health(OR=0.441,P＜0.05),good self-rated health(OR=0.259,P＜0.05),and sleep duration of 6 to 9 hours(OR=0.510,P＜0.05).The AUC of the ROC curve was 0.795,the slope of the calibration curve was close to 1,and the H-L goodness-of-fit test yielded x2=5.074.The validation set showed an AUC of 0.703.Conclusion The prediction model established in this study has high accuracy and discriminative ability.Healthcare professionals can take effective preventive measures based on individual patient factors.

Recently, photodynamic therapy (PDT) has gained considerable attention as a promising therapeutic approach for the treatment of psoriasis. Unfortunately, the activation of high mobility group box 1 protein (HMGB1) by PDT triggers innate and adaptive immune responses, which exacerbate skin inflammation. Herein, we combined glycyrrhizic acid (GA), a natural anti-inflammatory compound and immunomodulator derived from the herb Glycyrrhiza uralensis Fisch., with PDT actuated by the photosensitizer chlorin e6 (Ce6) by co-loading them in GA-based lipid nanoparticles coated with a catechol-modified quaternary chitosan salt (GC NPs/QCS-C). GC NPs/QCS-C exhibited high drug loading efficacy, uniform size distribution, an ideal topical adhesive property, enhanced skin retention and penetration in psoriasis-like lesions, and high intracellular uptake in epidermal cells compared with the counterparts. Subsequently, the transdermal administration of GC NPs/QCS-C followed by near-infrared laser radiation in an imiquimod-induced psoriasis-like mouse model significantly ameliorated psoriasis symptoms, promoted the apoptosis of hyperproliferative epidermal cells, and alleviated the inflammatory cascade. The significant therapeutic outcomes of GC NPs/QCS-C were attributed to the synergistic effects of GA and PDT on modulating immune cell recruitment and inhibiting dendritic cell maturation. Our results demonstrated that the topical bio-adhesive nanosystem that combines GA and Ce6 offers a synergistic chemo-phototherapeutic strategy for psoriasis treatment.

Objective:To investigate intraoperative pathological findings and the interventional effects of "deep cervical lymphaticovenous anastomosis+" (dcLVA+) on deep cervical lymphatic drainage as well as the blood flow of carotid artery and jugular vein in elderly patients with cognitive impairment, and to put forward the thoughts based on the findings from the surgery.Methods:Between May 2024 and December 2024, retrospective analysis of Microsurgery Hospital, Fengcheng Hospital, Xi'an Medical College performed dcLVA+ between the deep cervical lymphatics or lymph nodes and jugular veins in 50 elderly patients with cognitive impairment (19 males and 31 females, aged 55-88 years with 69.94 years in average). Nine patients were found with Clinical Dementia Rating (CDR) score at 1 (mild), 7 with CDR score at 2 (moderate) and 34 with CDR score at 3 (severe). Intraoperative observations based on literature reviews had identified anatomical relationships between the lymphatic sacs containing cervical lymphatic chain and the carotid sheath. The lymph node count, size, distribution, thickness of fat tissue and conditions of lymphatic vessels were documented. Ultrasound was used to compare the blood flow of carotid artery and jugular vein as well as the cross-sectional areas at the planes of hyoid and cricoid cartilage before and after the closure of incisions under anaesthesia in 39 patients. Correlation analyses for Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCa), Activities of Daily Living (ADL) and Agitation behavior score before and 1 week after surgery were performed using Spearman's correlation and Wilcoxon paired tests. P<0.05 was considered statistically significant. Postoperative follow-ups were conducted via the visit of outpatient clinic and WeChat and telephone interviews. Results:In surgery, the cervical lymphatic chain was found running within an almost enclosed sac surrounding the carotid sheath. There were enlarged lymph nodes, increased fat deposition, lymphatic dilation or fibrosis in the sac. The preoperative blood flow in the carotid artery at the planes of hyoid and cricoid cartilage in the 39 patients was recorded at 150.52 ml/min±40.33 ml/min and 358.29 ml/min±129.30 ml/min, while that in the jugular vein was at 172.50 ml/min±63.94 ml/min and 317.00 ml/min±105.21 ml/min, respectively, both were far lower than the normal blood flow. There were statistically significant differences in the blood flow of carotid artery and jugular vein before and after surgery ( P<0.01). It was found that the preoperative blood flow of the internal carotid artery at the plane of hyoid was positively correlated with the preoperative scores of MMSE ( P<0.01), MoCa ( P<0.05) and ADL ( P<0.01). The blood flow of the common carotid artery at the plane of cricoid cartilage was found significantly and positively correlated with the preoperative scores of MMSE ( P<0.05). It was also noted that the blood flow of the internal carotid artery at the plane of hyoid was significantly and positively correlated with the postoperative ADL ( P<0.01) but negatively correlated with the Agitation behavior score ( P<0.05). The blood flow of the common carotid artery at the plane of cricoid cartilage was significantly and positively correlated with the postoperative scores of MMSE and MoCa ( P<0.05). The blood flow of the internal jugular vein at the plane of hyoid was negatively correlated with the Agitation behavior score ( P<0.01). The cross-sectional area of carotid artery at the plane of left hyoid was significantly and positively correlated with the MMSE score ( P<0.05). Statistically significant differences were observed in MMSE, MoCa, ADL and Agitation behavior score before and after surgery ( P<0.01). Conclusion:dcLVA+ shows a certain therapeutic benefit to the elderly patients with cognitive impairment. The intraoperatively observed pathological changes in cervical lymphatic sacs affect deep cervical lymphatic drainage and the blood flow of carotid artery and jugular vein. Further studies are necessary to find out whether the findings from this study would be the specific pathological changes and the morbidity mechanisms among the elderly patients with cognitive impairment.

Objective:The objective of this longitudinal study is to longitudinally monitor the lexical development and language proficiency of Mandarin-speaking children with cochlear implants (CI) over a three-year post-implantation period while also investigating whether early receptive and expressive vocabulary skills can serve as predictors for later language abilities in CI recipients.Methods:In this study, 42 children with CIs were selected as participants, including 19 males and 23 females, and with a mean age at CI activation of 16.6±4.9 months. Receptive and expressive vocabulary skills were assessed using the Infant Checklist of the Early Vocabulary Inventory for Mandarin Chinese (EVI) at one-year post-activation (T1). Additionally, expressive vocabulary sizes were evaluated using the EVI-Toddler Checklist, while syntactic ability was measured by the Grammatical Complexity test of the Mandarin-Chinese Communicative Developmental Inventory for Infants and Toddlers at two years post-activation (T2). The comprehensive language development level of preschool children, including language comprehension, expression, and grammar ability, was examined during the third year post-activation (T3) using the Revised Scale for Assessment of Language Disorders in Preschool Children. Data analysis was conducted using SPSS 22.0.Results:One year after CI activation, children exhibited a mean receptive vocabulary size of 155.7±52.8 and an expressive vocabulary size of 85.1±63.9. T2′s expressive vocabulary size was 455.7±167.7, while the Grammatical Complexity score was 36.5±13.0. The original language development score was determined to be 53.6±14.2 at T3. Correlation analysis revealed significant positive associations between T1′s receptive and expressive vocabulary with tests conducted at T2 and subsequent language development measured at T3 ( P<0.01). Furthermore, there was a significant correlation between expressive vocabulary at T1 and both tests conducted at T2 ( P<0.01), but no significant correlation with subsequent language development measured at T3. Regression analysis showed that T1 receptive vocabulary significantly predicted T2 expressive vocabulary and Grammatical Complexity scores and T3 language development scores. Moreover, the syntactic ability assessed during T2 independently predicted subsequent language proficiency measured at T3. Conclusions:Early receptive vocabulary and grammar ability two years post CI activation significantly predict later language proficiency in children with cochlear implants. Thus, during rehabilitation, emphasis should be placed on enhancing vocabulary and grammar comprehension.

Objective:To investigate the role of keloid fibroblast-derived exosomes (KF-Exos) in inducing the phenotypic transformation of normal fibroblasts (NFs) into myofibroblasts and to assess their significance in keloid formation.Methods:Normal skin tissues and keloid tissues were collected from female patients aged 20-49 years who underwent surgery at the Department of Plastic Surgery, the Second Hospital of Harbin Medical University from October 2022 to March 2023. Normal fibroblasts and keloid fibroblasts (KFs) were extracted, and the supernatant of KFs was collected to isolate their exosomes. The exosomes were characterized using nanoparticle size analysis (NTA) and transmission electron microscopy (TEM). The samples were divided into the control, KEFS, and KF-Exos groups, then cell proliferation and migration abilities of groups were assessed by scratch assay and Edu assay. The samples were divided into the control, KEFS, KF-Exos, and KFs groups, real-time fluorescence quantitative PCR was used to measure the gene expression levels of Col1a1, Col1a2, Col3a1, α-SMA, TGF-β1, TGF-β2, and TGF-β3. The samples were divided into the control, and KF-Exos groups, Western blot analysis was conducted to evaluate the protein expression levels of Col-1, α-SMA, TGF-β1, Smad2/3, and Smad4. Statistical analysis and plotting were conducted using GraphPad Prism 9.0 software and Image J. Comparisons among multiple groups were analyzed using one-way ANOVA, then comparison of subgroups with the control group was performed using the Dunnett- t test. Independent samples t-test was used to compare the control group with the KF-Exos group in Western blot. P<0.05 was considered statistically significant. Results:The extracted KF-Exos was identified by TEM as a bilayer lipid membrane vesicles. NTA revealed that the average diameter of KF-Exos was 105.4 nm. Scratch and Edu assays demonstrated statistically significant differences in proliferation and migration abilities among the control, KEFS, and KF-Exos groups (all P<0.05). Compared to the control group, the KF-Exos group exhibited statistically significant differences in both proliferation and migration abilities (both P<0.05), while the KEFS group did not show statistically significant differences in these abilities (both P>0.05). Quantitative PCR results showed that, among the control, KEFS, KF-Exos, and KFs groups, there were significant differences in the mRNA expression levels of Col1a1, Col1a2, Col3a1, α-SMA, TGF-β1, TGF-β2, and TGF-β3 (all P<0.05). Compared with the control group, the Col3a1 mRNA level in the KEFS group was significantly different ( P<0.05), whereas the differences in Col1a1, Col1a2, and α-SMA levels were not statistically significant (all P>0.05). The expression levels of Col1a1, Col1a2, Col3a1, α-SMA, TGF-β1, TGF-β2, and TGF-β3 mRNA of the KFs group, and the expression levels of Col1a1, Col1a2, Col3a1, α-SMA, TGF-β1, and TGF-β3 mRNA of the KFs-Exos group had significant differences compared with the control group (all P<0.05), while the difference of TGF-β2 between the KF-Exos group and the control group was not statistically significant ( P>0.05). Western blotting results showed that the protein expression levels of TGF-β1, Smad2/3 and Smad4 were significantly up-regulated in the KF-Exos group compared to the control group (all P<0.05). Conclusion:KF-Exos successfully induced the differentiation of NFs into myofibroblasts and enhanced the expression of extracellular matrix-related factors. This phenomenon may be mediated by the upregulation of the TGF-β1-Smad2/3 and Smad4 signaling pathways.

Objective To understand and evaluate the overall status of nucleic acid detection efficacy for influenza A virus in the na-tionwide clinical laboratories of China,and discover and identify the potential issues to further improve the detection quality.Methods During 2024,the National Center for Clinical Laboratories distributed five samples to nationwide 1 367 participating laboratories.The detection efficacy of each participating laboratory was evaluated by calculating the overall percent agreement(OPA)of the test results using different detection reagents.Results The results of OPA,positive percent agreement(PPA)and negative percent agreement(NPA)of the five samples were 99.87％(6 826/6 835),99.89％(5 462/5 468),and 99.78％(1 364/1 367),respectively.No statistical difference of PPAs was observed between the H3N2 samples with different concentrations,between H1N1(2009)and H3N2 samples with equivalent concentration(1.0×104 copies/mL),and between seasonal H1N1 and H3N2 samples with equivalent concen-tration(1.0×105 copies/mL)(P＞0.05).Conclusion The results indicated the clinical laboratories in China exhibited robust efficacy in the molecular detection for two prevalent influenza A virus subtypes,i.e.,H1N1(2009)and H3N2.However,false-negative and false-positive results were encountered in a few laboratories.

Objective:To investigate the role of keloid fibroblast-derived exosomes (KF-Exos) in inducing the phenotypic transformation of normal fibroblasts (NFs) into myofibroblasts and to assess their significance in keloid formation.Methods:Normal skin tissues and keloid tissues were collected from female patients aged 20-49 years who underwent surgery at the Department of Plastic Surgery, the Second Hospital of Harbin Medical University from October 2022 to March 2023. Normal fibroblasts and keloid fibroblasts (KFs) were extracted, and the supernatant of KFs was collected to isolate their exosomes. The exosomes were characterized using nanoparticle size analysis (NTA) and transmission electron microscopy (TEM). The samples were divided into the control, KEFS, and KF-Exos groups, then cell proliferation and migration abilities of groups were assessed by scratch assay and Edu assay. The samples were divided into the control, KEFS, KF-Exos, and KFs groups, real-time fluorescence quantitative PCR was used to measure the gene expression levels of Col1a1, Col1a2, Col3a1, α-SMA, TGF-β1, TGF-β2, and TGF-β3. The samples were divided into the control, and KF-Exos groups, Western blot analysis was conducted to evaluate the protein expression levels of Col-1, α-SMA, TGF-β1, Smad2/3, and Smad4. Statistical analysis and plotting were conducted using GraphPad Prism 9.0 software and Image J. Comparisons among multiple groups were analyzed using one-way ANOVA, then comparison of subgroups with the control group was performed using the Dunnett- t test. Independent samples t-test was used to compare the control group with the KF-Exos group in Western blot. P<0.05 was considered statistically significant. Results:The extracted KF-Exos was identified by TEM as a bilayer lipid membrane vesicles. NTA revealed that the average diameter of KF-Exos was 105.4 nm. Scratch and Edu assays demonstrated statistically significant differences in proliferation and migration abilities among the control, KEFS, and KF-Exos groups (all P<0.05). Compared to the control group, the KF-Exos group exhibited statistically significant differences in both proliferation and migration abilities (both P<0.05), while the KEFS group did not show statistically significant differences in these abilities (both P>0.05). Quantitative PCR results showed that, among the control, KEFS, KF-Exos, and KFs groups, there were significant differences in the mRNA expression levels of Col1a1, Col1a2, Col3a1, α-SMA, TGF-β1, TGF-β2, and TGF-β3 (all P<0.05). Compared with the control group, the Col3a1 mRNA level in the KEFS group was significantly different ( P<0.05), whereas the differences in Col1a1, Col1a2, and α-SMA levels were not statistically significant (all P>0.05). The expression levels of Col1a1, Col1a2, Col3a1, α-SMA, TGF-β1, TGF-β2, and TGF-β3 mRNA of the KFs group, and the expression levels of Col1a1, Col1a2, Col3a1, α-SMA, TGF-β1, and TGF-β3 mRNA of the KFs-Exos group had significant differences compared with the control group (all P<0.05), while the difference of TGF-β2 between the KF-Exos group and the control group was not statistically significant ( P>0.05). Western blotting results showed that the protein expression levels of TGF-β1, Smad2/3 and Smad4 were significantly up-regulated in the KF-Exos group compared to the control group (all P<0.05). Conclusion:KF-Exos successfully induced the differentiation of NFs into myofibroblasts and enhanced the expression of extracellular matrix-related factors. This phenomenon may be mediated by the upregulation of the TGF-β1-Smad2/3 and Smad4 signaling pathways.

Objective:The objective of this longitudinal study is to longitudinally monitor the lexical development and language proficiency of Mandarin-speaking children with cochlear implants (CI) over a three-year post-implantation period while also investigating whether early receptive and expressive vocabulary skills can serve as predictors for later language abilities in CI recipients.Methods:In this study, 42 children with CIs were selected as participants, including 19 males and 23 females, and with a mean age at CI activation of 16.6±4.9 months. Receptive and expressive vocabulary skills were assessed using the Infant Checklist of the Early Vocabulary Inventory for Mandarin Chinese (EVI) at one-year post-activation (T1). Additionally, expressive vocabulary sizes were evaluated using the EVI-Toddler Checklist, while syntactic ability was measured by the Grammatical Complexity test of the Mandarin-Chinese Communicative Developmental Inventory for Infants and Toddlers at two years post-activation (T2). The comprehensive language development level of preschool children, including language comprehension, expression, and grammar ability, was examined during the third year post-activation (T3) using the Revised Scale for Assessment of Language Disorders in Preschool Children. Data analysis was conducted using SPSS 22.0.Results:One year after CI activation, children exhibited a mean receptive vocabulary size of 155.7±52.8 and an expressive vocabulary size of 85.1±63.9. T2′s expressive vocabulary size was 455.7±167.7, while the Grammatical Complexity score was 36.5±13.0. The original language development score was determined to be 53.6±14.2 at T3. Correlation analysis revealed significant positive associations between T1′s receptive and expressive vocabulary with tests conducted at T2 and subsequent language development measured at T3 ( P<0.01). Furthermore, there was a significant correlation between expressive vocabulary at T1 and both tests conducted at T2 ( P<0.01), but no significant correlation with subsequent language development measured at T3. Regression analysis showed that T1 receptive vocabulary significantly predicted T2 expressive vocabulary and Grammatical Complexity scores and T3 language development scores. Moreover, the syntactic ability assessed during T2 independently predicted subsequent language proficiency measured at T3. Conclusions:Early receptive vocabulary and grammar ability two years post CI activation significantly predict later language proficiency in children with cochlear implants. Thus, during rehabilitation, emphasis should be placed on enhancing vocabulary and grammar comprehension.