Objective To analyze the effect of releasing the lower pulmonary ligament on right residual lung expansion after right upper lobe resection under different body mass index (BMI) levels. Methods The clinical data of patients who underwent thoracoscopic right upper lobe resection in the First Affiliated Hospital with Nanjing Medical University from 2021 to 2022 were retrospectively analyzed. Patients were divided into a group A (17 kg/m2＜BMI≤23 kg/m2), a group B (23 kg/m2＜BMI≤29 kg/m2) and a group C (BMI＞29 kg/m2) according to BMI. The presence of residual cavity was judged by chest X-ray at 7-10 days after operation, the degree of compensation change of the right main bronchus angle was measured, and the changes in lung volume were determined by CT three-dimensional reconstruction. Results A total of 157 patients who underwent thoracoscopic right upper lobe resection were included, including 71 males and 86 females, with an average age of (59.7±11.2) years. There were 50 patients in the group A, 75 patients in the group B, and 32 patients in the group C. In the group A, compared with those without releasing the lower pulmonary ligament, patients with releasing had a lower incidence of postoperative residual cavity (P=0.016), greater changes in bronchus angle (P<0.001), and smaller changes in lung volume (P<0.001). In the group B and C, there was no significant effect of releasing the lower pulmonary ligament on postoperative residual cavity, bronchus angle, and lung volume changes (P>0.05). Conclusion For patients with thin and long body shape and low BMI, releasing the lower pulmonary ligament is helpful to promote the expansion of the residual lung after right upper lobe resection and reduce the occurrence of postoperative residual cavity in patients.

ObjectiveTo investigate the effect of different visual inputs and task conditions on balance function and lower limb biomechanical characteristics in children with spastic hemiplegia. MethodsFrom March to July, 2025, 30 children aged six to nine years old with spastic hemiplegia (hemiplegia group) and 30 healthy children (control group) were selected. A 2×2×2 mixed experimental design was employed, involving groups (hemiplegia vs. healthy), tasks (single-task vs. dual-task), and vision (eyes open vs. eyes closed). One week before test, they were evaluated with Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Wee Function Independent Measurement (WeeFIM) and Wechsler Intelligence Scale for Children, Fourth Edition (WISC-Ⅳ). A 3D gait analysis system and a plantar pressure testing system were used to collect spatio-temporal parameters of walking speed, stride length, cadence and step width, kinematic parameters of hip/knee/ankle joint angles, kinetic parameters of forefoot loading ratio, center of pressure (CoP) displacement, while dual-task cost (DTC) was caculated. ResultsSpatio-temporal parameters showed that under dual-task and eyes-closed conditions, walking speed and stride length decreased while step width increased in the hemiplegia group. Significant interaction effects among group, task, and vision were observed for speed, stride length, and step width (F > 4.886, P < 0.05). Kinematic parameters indicated that during dual-tasks, the hemiplegia group exhibited increased hip flexion and decreased ankle dorsiflexion; under eyes-closed conditions, knee flexion increased. The interaction of the three factors significantly affected all joint angles (F > 4.876, P < 0.05). Kinetic parameters showed that under dual-task and eyes-closed conditions, the forefoot loading ratio and anteroposterior CoP displacement decreased, while mediolateral CoP displacement increased. The interaction of the three factors significantly affected CoP displacement (F > 4.355, P < 0.05). All the DTC was significantly higher in the hemiplegia group than in the control group, except DTC of the cadence (|t| > 14.393, P < 0.001). Correlation analysis revealed that the score of FMA-LE was strongly negatively correlated with DTC (|r| > 0.731, P < 0.01). The Functional Independence Measure for Children and Working Memory Index showed moderate negative correlations with the DTC of walking speed and cadence (|r| > 0.462, P < 0.05). ConclusionThe gait and balance of children with spastic hemiplegia are concurrently influenced by dual-tasking and visual input. The superposition of visual deprivation and dual-tasks significantly exacerbates gait abnormalities. Furthermore, is strongly correlated with motor function and working memory.

ObjectiveTo investigate the effect of different visual inputs and task conditions on balance function and lower limb biomechanical characteristics in children with spastic hemiplegia. MethodsFrom March to July, 2025, 30 children aged six to nine years old with spastic hemiplegia (hemiplegia group) and 30 healthy children (control group) were selected. A 2×2×2 mixed experimental design was employed, involving groups (hemiplegia vs. healthy), tasks (single-task vs. dual-task), and vision (eyes open vs. eyes closed). One week before test, they were evaluated with Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Wee Function Independent Measurement (WeeFIM) and Wechsler Intelligence Scale for Children, Fourth Edition (WISC-Ⅳ). A 3D gait analysis system and a plantar pressure testing system were used to collect spatio-temporal parameters of walking speed, stride length, cadence and step width, kinematic parameters of hip/knee/ankle joint angles, kinetic parameters of forefoot loading ratio, center of pressure (CoP) displacement, while dual-task cost (DTC) was caculated. ResultsSpatio-temporal parameters showed that under dual-task and eyes-closed conditions, walking speed and stride length decreased while step width increased in the hemiplegia group. Significant interaction effects among group, task, and vision were observed for speed, stride length, and step width (F > 4.886, P < 0.05). Kinematic parameters indicated that during dual-tasks, the hemiplegia group exhibited increased hip flexion and decreased ankle dorsiflexion; under eyes-closed conditions, knee flexion increased. The interaction of the three factors significantly affected all joint angles (F > 4.876, P < 0.05). Kinetic parameters showed that under dual-task and eyes-closed conditions, the forefoot loading ratio and anteroposterior CoP displacement decreased, while mediolateral CoP displacement increased. The interaction of the three factors significantly affected CoP displacement (F > 4.355, P < 0.05). All the DTC was significantly higher in the hemiplegia group than in the control group, except DTC of the cadence (|t| > 14.393, P < 0.001). Correlation analysis revealed that the score of FMA-LE was strongly negatively correlated with DTC (|r| > 0.731, P < 0.01). The Functional Independence Measure for Children and Working Memory Index showed moderate negative correlations with the DTC of walking speed and cadence (|r| > 0.462, P < 0.05). ConclusionThe gait and balance of children with spastic hemiplegia are concurrently influenced by dual-tasking and visual input. The superposition of visual deprivation and dual-tasks significantly exacerbates gait abnormalities. Furthermore, is strongly correlated with motor function and working memory.

ObjectiveTo investigate the effect of different visual inputs and task conditions on balance function and lower limb biomechanical characteristics in children with spastic hemiplegia. MethodsFrom March to July, 2025, 30 children aged six to nine years old with spastic hemiplegia (hemiplegia group) and 30 healthy children (control group) were selected. A 2×2×2 mixed experimental design was employed, involving groups (hemiplegia vs. healthy), tasks (single-task vs. dual-task), and vision (eyes open vs. eyes closed). One week before test, they were evaluated with Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Wee Function Independent Measurement (WeeFIM) and Wechsler Intelligence Scale for Children, Fourth Edition (WISC-Ⅳ). A 3D gait analysis system and a plantar pressure testing system were used to collect spatio-temporal parameters of walking speed, stride length, cadence and step width, kinematic parameters of hip/knee/ankle joint angles, kinetic parameters of forefoot loading ratio, center of pressure (CoP) displacement, while dual-task cost (DTC) was caculated. ResultsSpatio-temporal parameters showed that under dual-task and eyes-closed conditions, walking speed and stride length decreased while step width increased in the hemiplegia group. Significant interaction effects among group, task, and vision were observed for speed, stride length, and step width (F > 4.886, P < 0.05). Kinematic parameters indicated that during dual-tasks, the hemiplegia group exhibited increased hip flexion and decreased ankle dorsiflexion; under eyes-closed conditions, knee flexion increased. The interaction of the three factors significantly affected all joint angles (F > 4.876, P < 0.05). Kinetic parameters showed that under dual-task and eyes-closed conditions, the forefoot loading ratio and anteroposterior CoP displacement decreased, while mediolateral CoP displacement increased. The interaction of the three factors significantly affected CoP displacement (F > 4.355, P < 0.05). All the DTC was significantly higher in the hemiplegia group than in the control group, except DTC of the cadence (|t| > 14.393, P < 0.001). Correlation analysis revealed that the score of FMA-LE was strongly negatively correlated with DTC (|r| > 0.731, P < 0.01). The Functional Independence Measure for Children and Working Memory Index showed moderate negative correlations with the DTC of walking speed and cadence (|r| > 0.462, P < 0.05). ConclusionThe gait and balance of children with spastic hemiplegia are concurrently influenced by dual-tasking and visual input. The superposition of visual deprivation and dual-tasks significantly exacerbates gait abnormalities. Furthermore, is strongly correlated with motor function and working memory.

Objective: To explore the association role of anxiety and depressive symptoms with Internet gaming disorder (IGD) and emotional-behavioral problems among junior high school students, so as to provide references for preventing the occurrence and progression of emotional-behavioral problems in middle school students. Methods: From September to October 2024, a random cluster sampling method was adopted to select 38 069 students from 28 junior high schools in 14 counties (cities and districts) and functional areas of Jining City, Shandong Province. Surveys were conducted by Nine item Internet Gaming Disorder Scale-Short Form, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Strengths and Difficulties Questionnaire. The correlation of emotional and behavioral issues, online game addiction, anxiety and depressive symptoms among junior high school students was analyzed by Speaman correlation analysis. Mediation analysis was used to explore the role of anxiety and depressive symptoms between IGD and emotional-behavioral problems among junior high school students. Results: The detection rates of emotional-behavioral problems, anxiety symptoms, depressive symptoms, and IGD among junior high school students were 19.24 %, 9.48%, 16.69%, and 19.68%, respectively. The scores of emotional-behavioral problems, anxiety symptoms, depressive symptoms and IGD were 10.00 (6.00, 15.00), 3.00 (0.00, 7.00), and 4.00 (1.00, 8.00), 13.00 (10.00, 19.00), respectively. There were positive correlations between each pair of emotional-behavioral problem, IGD, anxiety symptoms, and depressive symptoms scores ( r =0.51-0.81, all P <0.01). Anxiety and depressive symptoms played mediating roles between IGD and emotional-behavioral problems among junior high school students, with mediating effect values of 0.16 (95% CI =0.15-0.17) and 0.12 (95% CI =0.11-0.14), respectively (both P <0.01). Conclusions Anxiety and depressive symptoms mediate the relationship between IGD and emotional-behavioral problems among junior high school students. It is necessary to identify early signs of IGD among junior high school students, strengthen intervention for anxiety and depressive symptoms, to prevent the occurrence and development of emotional and behavioral issues.

ObjectiveTo investigate the effect of repetitive peripheral magnetic stimulation (rPMS) combined with upper limb intelligent robotic training on muscle tension, motor function and cortical excitability in children with unilateral spastic cerebral palsy (USCP). MethodsFrom March, 2023 to December, 2024, 90 children with USCP admitted to Children's Hospital of Soochow University were selected and randomly divided into control group (n = 30), rPMS group (n = 30) and combined group (n = 30). The control group received conventional occupational therapy. The rPMS group received rPMS intervention followed by conventional occupational therapy. The combined group received rPMS followed by upper limb intelligent robot training, for four weeks. Before and after treatment, muscle tension of biceps brachii was assessed using the modified Ashworth Scale (MAS); upper limb motor function was evaluated using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and upper limb intelligent parameters; and cortical excitability was measured using transcranial magnetic stimulation (TMS), including resting motor threshold (RMT) and motor-evoked potential (MEP) amplitude of the affected hemisphere. ResultsAfter treatment, MAS grades improved in all groups (|Z| > 3.523, P < 0.001), and the improvement in the combined group was superior to that in the control group (P < 0.05). Significant intra-group (F > 65.21, P < 0.001), inter-group (F > 17.94, P < 0.001) and interaction effects (F > 5.36, P < 0.01) were observed in FMA-UE scores, upper limb intelligent parameters and TMS parameters. Post Hoc analysis showed that the combined group demonstrated significantly greater improvements in FMA-UE scores, upper limb intelligent parameters, and TMS parameters compared with both the control and rPMS groups (all P < 0.01). Except for FMA-UE scores, the rPMS group showed significantly greater improvements than the control group in upper limb intelligent parameters (mechanical feedback, trajectory, and range of motion) and TMS parameters (RMT and MEP amplitude) (P < 0.05). ConclusionrPMS combined with upper limb intelligent robotic training can reduce upper limb muscle tension, improve motor function, and enhance cortical excitability in children with USCP.

Lung cancer constitutes the most prevalent and lethal malignant tumor in China. Approximately 85% of lung cancer diagnoses correspond to the non-small cell histological subtype [non-small cell lung cancer (NSCLC)]. Despite surgery being the mainstay for early-stage disease, postoperative recurrence remains high and adjuvant chemotherapy offers limited benefit. In recent years, targeted therapy has demonstrated substantial advantages in driver mutation-positive NSCLC. To this end, the Lung Cancer Medical Education Committee of the Chinese Medical Education Association developed guidelines based on a systematic review of evidence through November 2025, using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach and a modified Delphi method. Focusing on epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK), and addressing ROS proto-oncogene 1 (ROS1), B-Raf proto-oncogene serine/threonine kinase (BRAF) V600E mutation, and mesenchymal-epithelial transition factor (MET) exon 14 (METex14) skipping, the guideline covers molecular testing, neoadjuvant/adjuvant therapy, perioperative strategies, minimal residual disease monitoring, and postoperative surveillance. It defines testing requirements, specifies stage-directed and subtype-specific treatments, and standardizes minimal residual disease monitoring. These recommendations emphasize precision and feasibility to improve survival and quality of life.

ObjectiveThis study aimed to evaluate the effects of cycloastragenol （CAG） on mitochondrial dysfunction during cardiac remodeling and to elucidate its regulatory role in myocardial energy metabolic homeostasis and the associated transcriptional regulatory axis. MethodsA rat model of heart failure （HF） was established by ligation of the left anterior descending coronary artery. Rats were randomly divided into a control group， a model group， a captopril group （3.25 mg·kg^-1）， a low-dose CAG group （10 mg·kg^-1， CAG-L）， and a high-dose CAG group （20 mg·kg^-1， CAG-H）. After 28 days of treatment， left ventricular ejection fraction （LVEF）， left ventricular fractional shortening （LVFS）， left ventricular end-diastolic diameter （LVIDd）， and left ventricular end-systolic diameter （LVIDs） were assessed by echocardiography. Serum levels of N-terminal pro-brain natriuretic peptide （NT-proBNP）， creatine kinase-MB （CK-MB）， cardiac troponinⅠ （cTnI）， interleukin-1β （IL-1β）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， and cyclic adenosine monophosphate （cAMP） were measured by enzyme-linked immunosorbent assay （ELISA）. Hematoxylin-eosin （HE） and Masson's trichrome staining were used to evaluate myocardial histopathology and fibrosis. Wheat germ agglutinin （WGA）， reactive oxygen species （ROS）， and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling （TUNEL） staining were performed to assess cardiomyocyte hypertrophy， oxidative stress， and apoptosis. Adenosine triphosphate （ATP） content and the activities of mitochondrial respiratory chain complexes Ⅰ-Ⅳ were determined by colorimetric assays. The mRNA expression of α-smooth muscle actin （α-SMA）， Col Ⅰ， and Col Ⅲ was detected by Real-time quantitative polymerase chain reaction （Real-time PCR）， while the protein levels of β₂-adrenergic receptor （ADRB2）， protein kinase A （PKA）， phosphorylated cAMP response element-binding protein/total cAMP response element-binding protein （p-CREB/CREB）， peroxisome proliferator-activated receptor γ coactivator-1α （PGC-1α）， nuclear respiratory factor 1 （NRF1）， and mitochondrial transcription factor A （TFAM） were analyzed by Western blot. ResultsCompared with the control group， the model group exhibited significantly decreased LVEF， LVFS， and ATP levels （P<0.05）， and markedly increased LVIDd， LVIDs， NT-proBNP， CK-MB， cTnI， IL-1β， IL-6， TNF-α， ROS levels， TUNEL-positive rate， Col deposition area， and the mRNA expression of α-SMA， Col Ⅰ， and Col Ⅲ （P<0.05）. In addition， the activities of mitochondrial respiratory chain complexes Ⅰ-Ⅳ， the protein expression of ADRB2， PKA， p-CREB， PGC-1α， NRF1， and TFAM， as well as the cAMP content， were significantly reduced （P<0.05）. Compared with the model group， both low- and high-dose CAG significantly increased LVEF and LVFS， and decreased LVIDd， LVIDs， and the levels of NT-proBNP， CK-MB， and cTnI （P<0.05）. CAG treatment alleviated myocardial disarray and Collagen deposition， and downregulated the mRNA expression of α-SMA， Col Ⅰ， and Col Ⅲ. The treatment markedly reduced ROS generation and the TUNEL-positive rate （P<0.05）， thereby attenuating cardiomyocyte hypertrophy and inflammatory responses. Furthermore， CAG treatment increased ATP content and the activities of mitochondrial respiratory chain complexes Ⅰ-Ⅳ， accompanied by upregulation of PGC-1α， NRF1， TFAM， ADRB2， PKA， and p-CREB protein expression as well as cAMP levels （P<0.05）. The CAG-H group showed the most pronounced improvements， which were superior to those of the captopril group and the CAG-L group. ConclusionCycloastragenol delays adverse cardiac remodeling and improves cardiac function by activating the ADRB2-mediated GPCR/cAMP/PKA/CREB signaling pathway， enhancing the PGC-1α/NRF1/TFAM activity， promoting mitochondrial energy metabolism remodeling， and suppressing oxidative stress， inflammation， and myocardial fibrosis.

ObjectiveThis study aimed to evaluate the effects of cycloastragenol （CAG） on mitochondrial dysfunction during cardiac remodeling and to elucidate its regulatory role in myocardial energy metabolic homeostasis and the associated transcriptional regulatory axis. MethodsA rat model of heart failure （HF） was established by ligation of the left anterior descending coronary artery. Rats were randomly divided into a control group， a model group， a captopril group （3.25 mg·kg^-1）， a low-dose CAG group （10 mg·kg^-1， CAG-L）， and a high-dose CAG group （20 mg·kg^-1， CAG-H）. After 28 days of treatment， left ventricular ejection fraction （LVEF）， left ventricular fractional shortening （LVFS）， left ventricular end-diastolic diameter （LVIDd）， and left ventricular end-systolic diameter （LVIDs） were assessed by echocardiography. Serum levels of N-terminal pro-brain natriuretic peptide （NT-proBNP）， creatine kinase-MB （CK-MB）， cardiac troponinⅠ （cTnI）， interleukin-1β （IL-1β）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， and cyclic adenosine monophosphate （cAMP） were measured by enzyme-linked immunosorbent assay （ELISA）. Hematoxylin-eosin （HE） and Masson's trichrome staining were used to evaluate myocardial histopathology and fibrosis. Wheat germ agglutinin （WGA）， reactive oxygen species （ROS）， and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling （TUNEL） staining were performed to assess cardiomyocyte hypertrophy， oxidative stress， and apoptosis. Adenosine triphosphate （ATP） content and the activities of mitochondrial respiratory chain complexes Ⅰ-Ⅳ were determined by colorimetric assays. The mRNA expression of α-smooth muscle actin （α-SMA）， Col Ⅰ， and Col Ⅲ was detected by Real-time quantitative polymerase chain reaction （Real-time PCR）， while the protein levels of β₂-adrenergic receptor （ADRB2）， protein kinase A （PKA）， phosphorylated cAMP response element-binding protein/total cAMP response element-binding protein （p-CREB/CREB）， peroxisome proliferator-activated receptor γ coactivator-1α （PGC-1α）， nuclear respiratory factor 1 （NRF1）， and mitochondrial transcription factor A （TFAM） were analyzed by Western blot. ResultsCompared with the control group， the model group exhibited significantly decreased LVEF， LVFS， and ATP levels （P<0.05）， and markedly increased LVIDd， LVIDs， NT-proBNP， CK-MB， cTnI， IL-1β， IL-6， TNF-α， ROS levels， TUNEL-positive rate， Col deposition area， and the mRNA expression of α-SMA， Col Ⅰ， and Col Ⅲ （P<0.05）. In addition， the activities of mitochondrial respiratory chain complexes Ⅰ-Ⅳ， the protein expression of ADRB2， PKA， p-CREB， PGC-1α， NRF1， and TFAM， as well as the cAMP content， were significantly reduced （P<0.05）. Compared with the model group， both low- and high-dose CAG significantly increased LVEF and LVFS， and decreased LVIDd， LVIDs， and the levels of NT-proBNP， CK-MB， and cTnI （P<0.05）. CAG treatment alleviated myocardial disarray and Collagen deposition， and downregulated the mRNA expression of α-SMA， Col Ⅰ， and Col Ⅲ. The treatment markedly reduced ROS generation and the TUNEL-positive rate （P<0.05）， thereby attenuating cardiomyocyte hypertrophy and inflammatory responses. Furthermore， CAG treatment increased ATP content and the activities of mitochondrial respiratory chain complexes Ⅰ-Ⅳ， accompanied by upregulation of PGC-1α， NRF1， TFAM， ADRB2， PKA， and p-CREB protein expression as well as cAMP levels （P<0.05）. The CAG-H group showed the most pronounced improvements， which were superior to those of the captopril group and the CAG-L group. ConclusionCycloastragenol delays adverse cardiac remodeling and improves cardiac function by activating the ADRB2-mediated GPCR/cAMP/PKA/CREB signaling pathway， enhancing the PGC-1α/NRF1/TFAM activity， promoting mitochondrial energy metabolism remodeling， and suppressing oxidative stress， inflammation， and myocardial fibrosis.

With the rapid advancement of medical technology and the increasing complexity of clinical environments, competence in clinical ethical decision-making has become an indispensable core competency for exemplary physicians. However, traditional medical ethics education has long been confronted with the persistent challenges of theory-practice dissociation and the disconnect between pedagogical settings and clinical realities. Thus, how to construct a "Clinical Ethics" curriculum that aligns with the objectives of training high-caliber medical professionals has emerged as a critical and challenging issue in current medical education reform. To effectively address this challenge, the Office of Education at Peking University Third Hospital, since 2021, has assembled a multidisciplinary "Clinical Ethics" teaching and management team comprising faculty from Peking University School of Humanities and key clinical specialists from the hospital. In 2022, the "Clinical Ethics" elective course was formally launched for fourth-year students in the eight-year MD program who had completed coursework in "Medical Ethics" and organ-system-based curricula, with the aim of exploring and operationalizing a pre-clinical ethics education model tailored for senior medical students. The course employs a modular instructional design encompassing "theoretical review-case-based deliberation-clinical workshop", which effectively facilitates the deep integration of medical humanities with clinical practice.Following four years of iterative refinement through the "plan-act-observe-reflect" cycle, the course has demonstrated positive outcomes in enhancing students' ethical awareness and decision-making capabilities, and has preliminarily established a sustainable collaborative mechanism among the multidisciplinary faculty team. This article systematically delineates the course development background, pedagogical model and methodological innovations, and the multidisciplinary collaborative framework, alongside reflections and summaries based on implementation outcomes, with the intent of providing references for the future development of "Clinical Ethics" curricula.