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 explore the principle of antibacterial drug therapy and the strategy of program optimization in elderly patients with Helicobacter pylori（Hp）. Methods The common therapeutic regimen of Hp was summarized, and the better therapeutic regimen of elderly Hp patients was screened ultimately. Results Amoxicillin and cefuroxime were relatively safe compared with other recommended antibacterial drugs. Using other commonly antibiotics for Hp should pay attention to the disease of patients and current drug. Conclusion Elderly patients usually suffered from a variety of diseases and required multiple drugs. The application of therapeutic regimen for elderly patients with Hp should be supposed to fully weigh the risks and benefits.

Poloxamer， as a non-ionic surfactant， exhibits a unique triblock [polyethylene oxide-poly （propylene oxide）-polyethylene oxide] structure， which endows it with broad application potential in various fields， including solid dispersion technology， nanotechnology， gel technology， biologics， gene engineering and 3D printing. As a carrier， it enhances the solubility and bioavailability of poorly soluble drugs. In the field of nanotechnology， it serves as a stabilizer etc.， enriching preparation methods. In gel technology， its self-assembly behavior and thermosensitive properties facilitate controlled drug release. In biologics， it improves targeting efficiency and reduces side effects. In gene engineering， it enhances delivery efficiency and expression levels. In 3D printing， it provides novel strategies for precise drug release control and the production of high-quality biological products. As a versatile material， poloxamer holds promising prospects in the pharmaceutical field.

Objective:To investigate the efficacy of posterior cranial fossa in- situ floating bone flap osteotomy in the treatment of syndromic craniosynostosis(SCS). Methods:The clinical data of SCS children who underwent posterior cranial fossa in- situ floating bone flap osteotomy at the Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine from April 2020 to August 2022 were retrospectively analyzed. The surgical procedures were as follows. The occipital bone was cut into several mosaic bone flaps of varying sizes, without peeling it off the dura, which were left as a small free floating bone flap. The anteroposterior cranial diameter, cranial height, intracranial volume, and degree of improvement in tonsillar herniation and hydrocephalus of the children (hydrocephalus quantification was performed using the ratio of the ventricular diameter to the biparietal diameter)were measured preoperatively, 7 days postoperatively, 3 months postoperatively, and at the last follow-up (at least 12 months after the operation) to evaluate the surgical outcomes. The measurement data of normal distribution were expressed as Mean±SD. The paired t-test was used for comparison within the repeated measurement data groups at the two time points. One-way repeated measures analysis of variance (ANOVA) was performed on the repeated measurement data at multiple time points, and pairwise comparisons in post hoc tests were corrected using the Bonferroni method. Results:A total of 17 pediatric patients with SCS were included, comprising 10 males and 7 females, with ages ranging from 4 to 18 months (mean age: 9.5 months). Among them, 12 patients were complicated with Chiari malformation and hydrocephalus (1 severe case, 8 moderate cases, and 3 mild cases). Postoperative follow-up lasted 12 to 35 months, with an average of 17 months. After surgery, the posterior cranial appearance of the children was enlarged, with increased convexity of the occiput and a full contour. At the last follow-up, the middle cranial height [(107.80±10.72) mm vs. (102.82±10.09) mm, P<0.05], the posterior cranial height [(124.91±10.40) mm vs. (107.58±13.46) mm, P<0.01] and anteroposterior diameter [(153.30±11.26) mm vs. (123.64±17.44) mm, P<0.01] as well as the intracranial volume [(1 317.92±225.77) cm 3 vs. (1 014.93±231.81) cm 3,P<0.01] were increased compared with the preoperative period, and the average improvement rate of intracranial volume was 37.0% (18.1%-79.2%). Among the 12 cases of tonsillar herniation, 7 cases had improvement. Moreover, all the 12 cases of hydrocephalus witnessed a mitigation in severity, from (46.33±9.34)% preoperatively to (35.24±9.88)% postoperatively, with a statistically significant difference ( P<0.01). Conclusion:Posterior cranial fossa in- situ floating bone flap osteotomy can effectively improve the appearance of patients with SCS, increase the intracranial volume, relieve the degree of hydrocephalus, and reduce the intracranial pressure.

Objective To explore the effects of family functioning,peer victimization and school connectedness on nonsuicidal self-injury in adolescents,as well as the mediating effect of psychache in these relationships.Methods A total of 525 junior high school students in Foshan City were surveyed using the brief Family Function Scale,Peer Victimization Scale,School Connectedness Scale,Psychache Scale,and Nonsuicidal Self-injury Scale.Descriptive statistics and correlation analyses were performed using SPSS 23.0,and mediation analysis was conducted using Mplus 7.4.Results ① Family functioning could directly predict adolescent non-suicidal self-injury(β=-0.20,P＜0.01),but did not exert an indirect effect through psychache(P=0.123).② Peer victimization could not directly predict adolescent non-suicidal self-injury(β=0.10,P=0.133),but had an indirect effect through psychache,with an indirect effect value of 0.142(P＜0.001).③ School connectedness could not directly predict adolescent non-suicidal self-injury(β=0.13,P=0.053),but had an indirect effect through psychache,with an indirect effect value of-0.128(P＜0.001).Conclusion Psychache fully mediates the relationship between peer victimization,school connectedness,and non-suicidal self-injury in adolescents,but it does not mediate the relationship between family functioning and adolescent non-suicidal self-injury.

Objective Exploring the components of complex scenarios of healthcare surges triggered by major epidemics to provide a theorical basis for building resilience in healthcare organizations.Methods A hybrid analysis method is used to summarize macro-meso-micro multi-level and multi-source heterogeneous information,extract the elements of complex scenarios of medical surge and evaluate the rationality.Fault Tree Analysis method is used to clarify the logical relationship between various scenario elements and construct scenario reasoning paths.Results 10 scenario states,11 disaster-bearing,24 emergency management and 23 scenario results are summarized and extracted to form the key elements of complex surge scenarios.Among them,M4 expansion and coordinated scheduling of key positions,B2 conventional drug inventory emergency/insufficient core treatment drugs,B emergency medical material transportation breakage,S3 disease symptom spectrum shift to severe disease,R13 prevention and control awareness laxity,and M5 media information dissemination management are the key driving factors that promote a major turning point in the scenario.The most positive scenario result is the orderly operation of the medical service system,and the most negative scenario result is the paralysis of the medical service system.Conclusion Medical institutions need to improve emergency plans based on the complex evolution scenarios of medical surges and agile governance capabilities targeting key turning points,focus on dynamically expanding and scheduling personnel in key positions,strengthen material rotation and reserve mechanisms,maintain smooth emergency logistics channels,and improve efficient management of media and public opinion,so as to comprehensively improve overall resilience.

Objective:To investigate the possible mechanism of Zaogong Erteng decoction (ZGETD) in the treatment of endometritis.Methods:Femal mice were injected 2.5 mg/mL lipopolysaccharide into uterine horn to induce endometritis model. After modelling, low-dose ZGETD, high-dose ZGETD or amoxicillin was given once a day for 7 d. The appearance of the uterus and pathological changes of uterine tissue were observed 7 d later, and the uterine index was calculated. The expression of tumor necrosis factor (TNF)-α, interleukin (IL)-1β and IL-6 in mouse uterine tissue was detected by enzyme-linked immunosorbent assay. The activity of myeloperoxidase (MPO) in mouse uterine tissue was measured by redox reaction. The active ingredients of ZGETD and the target and signal pathway of treatment of endometritis were analyzed by network pharmacology. Western blotting and qRT-PCR were used to detect the expressions of Toll-like receptor 4 (TLR4), P65, p-P65, interferon regulatory factor 3 (IRF3) and p-IRF3 proteins and chemokines CXCL5 and CXCL8 in the mouse uterus, respectively. Terminal dUTP nick end labeling detected endometrial cell apoptosis and endometrial thickness was measured. After treatment, the female rats were mated with the male rats, and the mating rate, the pregnancy rate and the number of implantation sits in the injected uterine horn on day 8 of gestation were counted. Results:Both ZGETD and amoxicillin have atherapeutic effect on endometritis, but compared with low-dose ZGETD and amoxicillin, high-dose ZGETD can significantly alleviate the edema and congestion of uterine tissue and reduce the uterine index (all P=0.001). After treatment, the uterine cavity epithelium of mice was smooth and complete, the uterine gland structure was normal, and no bleeding area and inflammatory cell aggregation were observed. Compared with amoxicillin, high-dose ZGETD significantly decreased the expression of inflammatory factors (TNF-α, IL-1β and IL-6) and MPO activity (all P<0.001). The expression of chemokines ( CXCL5 and CXCL8) was significantly reduced (all P<0.05). The signaling pathways TLR4, nuclear factor kappa-B (NF-κB) and TNF related to the treatment of endometritis by ZGETD were screened by network pharmacology, and their action targets (TLR4, NF-κB and IRF3) were verified. Quercetin, fisetin and luteolin were found to be the most active ingredients acting on these targets. High-dose ZGETD significantly inhibited the activation of TLR4/NF-κB and TLR4/IRF3 pathways ( P<0.05), decreased endometrial cell apoptosis ( P<0.05), and increased endometrial thickness ( P<0.001), mating rate ( P<0.001), pregnancy rate ( P<0.001) and implantation site number of uterine horn on the injection side of LPS after treatment ( P=0.001). Conclusion:High-dose ZGETD has a significant therapeutic effect on endometritis, which may be closely related to the down-regulation of TLR4 signaling pathway.

Objective To assess the utility of real-time shear wave elastography(SWE)in diagnosing vascular erectile dysfunction(ED)and to predict the optimal timing for color Doppler flow imaging(CDFI)examination.Methods Patients diagnosed with ED who received intracavernosal injection(ICI)of vasoactive drugs were recruited and categorized based on CDFI findings into three groups:arterial ED(n=17),venous ED(n=33),and non-vascular ED(n=29).SWE technology was utilized to measure the average Young's modulus(E value)of the corpus cavernosum in these patients,both in the flaccid state prior to ICI and at four time points following ICI-induced erection.Subsequently,the differences in E values among the three groups were analyzed.Results There was no significant difference in the E value of the corpus cavernosum in the flaccid state among the arterial,venous,and non-vascular ED groups before ICI(P>0.05).However,the E value in the flaccid state for each group was significantly higher than the mean E values observed at the four time points after ICI-induced erection(P<0.01).Additionally,the mean E values at these four time points post-ICI were also statistically significant(P<0.01).ROC curve analysis revealed that the AUC for diagnosing arterial,venous,and non-vascular ED using the E value after ICI were 0.814,0.770,and 0.711,respectively,with corresponding cutoff values of 9.98,8.16 and 7.06 kPa.The combined use of CDFI and SWE cutoff values following ICI-induced erection significantly shortened the detection time for both arterial and venous ED groups(P<0.01).Conclusions SWE can accurately measure the E value of the corpus cavernosum following erection induced by the vasoactive drug ICI,thereby facilitating the differentia-tion of various types of ED.Additionally,when combined with CDFI,this technique can reduce the time required for examination.

Objective:To investigate the role of platelet-derived zyxin in promoting tumor migration by platelets.Methods:The gene expression profile of platelets was analyzed from cancer patients by using the GEO database.Isolated platelets from wild-type(WT)and Zyx-/-mice were co-cultured with B16F10 cells labeled with green fluorescence to investigate the influence of zyxin deficiency on tumor cell migration,invasion,and wound healing.Optical microscopy was employed to evaluate the impact of zyxin deficiency on epithelial-mesenchymal transition(EMT)in B16F10 cells induced by platelets.Employing specific markers to label platelets,fluorescence confocal microscopy was utilized to investigate the impact of platelet-derived zyxin on the binding between tumor cells and platelets.And an aggregometer was employed to observe the influence of zyxin deficiency on tumor cell-induced platelet aggregation.Results:Compared to platelets from healthy volunteers,zyxin was upregulated in platelets from cancer patients.Zyx-/-mouse platelets exhibited a significant reduction in tumor cell invasion and migration,impaired wound healing,and delayed tumor cell EMT compared to WT mouse platelets.Additionally,zyxin deficiency attenuated the interaction between platelets and tumor cells,and diminished the capacity for tumor cell-induced platelet aggregation.Conclusion:Platelet-derived zyxin deficiency diminishes platelet-tumor cell interactions and weakens the ability of tumor cell-induced platelet aggregation,ultimately suppressing tumor cell migration.

Objective:To investigate the correlation between lung ultrasound score(LUS)and oxygenation index(OI),and between it and the ratio of arterial oxygen partial pressure(PaO2)to fraction of inspired oxygen(PaO2/FiO2)in patients with acute respiratory distress syndrome(ARDS)in intensive care unit(ICU).Methods:The documents of 168 ARDS patients who admitted to ICU of People's Hospital of Ningxia Hui Autonomous Region from June 2023 to June 2024 were retrospectively selected.According to the patients'prognosis,they were divided into survival group(114 cases)and death group(54 cases).The clinical documents,laboratory indexes including PaO2/FiO2 and LUS results of patients in the surviving group and the death group were collected and compared,and the effects of LUS and PaO2/FiO2 on the prognosis of ARDS patients were analyzed by logistic regression.The predictive value of LUS and PaO2/FiO2 on the prognosis of ARDS patients was analyzed by the receiver operating characteristics(ROC)curve.Finally,the correlation between LUS and PaO2/FiO2 of patients was analyzed by using Pearson analysis.Results:There were significant differences in age,Acute Physiology and Chronic Health Evaluation II(APACHE II)score,mean arterial pressure(MAP),ratio of E peak to A peak of mitral valve velocity,positive end expiratory pressure(PEEP),tidal volume(VT),PaO2/FiO2,and LUS between the death group and the survival group,and the differences were statistically significant(t=8.456,2.073,6.780,3.361,3.204,2.925,7.801,12.210,P<0.05),respectively,in which the PaO2/FiO2 level[(180.67±25.61)mmHg]of the death group was significantly lower than that[(217.87±34.70)mmHg]of the survival group,and the LUS score[(21.00±3.97)point]was higher than that[(13.63±3.50)point]of the survival group.The PaO2/FiO2 was a protective factor for the prognosis of ARDS patients(OR=0.943,P<0.05),while LUS was a risk factor(OR=2.729,P<0.05).The area under curve(AUC)values of PaO2/FiO2 and LUS were respectively 0.802 and 0.919 in predicting the prognosis of ARDS patients.LUS and PaO2/FiO2 levels showed a negative correlation(R=-0.707,P<0.001).Conclusion:Both LUS and PaO2/FiO2 have better predictive effect for the prognosis of ARDS patients,and LUS can be used in the early prediction for the oxygenation status and the assessment about prognosis of ARDS patients,and the subsequent guideline for formulating therapeutic measures in clinical practice.