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.

With the accelerating aging of the population, the proportion of elderly patients with lung cancer continues to rise, presenting multiple challenges to perioperative management. This paper systematically reviews the clinical characteristics of elderly lung cancer patients. Based on the comprehensive geriatric assessment, it proposes incorporating seven major geriatric syndromes—frailty, delirium, sarcopenia, cognitive impairment, malnutrition, dysphagia, and mood disorders—into the core evaluation system. By integrating multimorbidity management with complication prevention and control, an integrated "geriatric syndrome-multimorbidity-complication" perioperative management model is constructed. Furthermore, this paper outlines stratified intervention strategies for geriatric syndromes, a "five-step" workflow for comorbidity management, and a comprehensive intervention pathway for complications across the preoperative, intraoperative, and postoperative phases. Multidisciplinary team (MDT) collaboration serves as the core mechanism to achieve individualized comprehensive treatment. This paper aims to provide a novel perioperative comprehensive treatment model for elderly lung cancer patients, which is centered on geriatrics, supported by multidisciplinary collaboration, and guided by precision medicine.

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.

Parkinson’s disease (PD) is a neurodegenerative disorder characterized by the progressive loss of dopamine (DA) neurons in the substantia nigra pars compacta (SNpc), primarily manifesting as motor dysfunctions such as resting tremor, muscle rigidity, and bradykinesia. According to the classical model of basal ganglia motor control, approximately half of the medium spiny neurons (MSNs) in the striatum are D1-MSNs, which constitute the direct pathway. These neurons express D₁-dopamine receptor (D₁R) and substance P, and they mainly participate in the selection, initiation, and execution of movements. The other half are D2-MSNs, which constitute the indirect pathway. These neurons express D₂-dopamine receptor (D₂R) and adenosine 2A receptors and are involved in inhibiting unnecessary movements or terminating ongoing movements, thereby adjusting movement sequences to perform more precise motor behaviors. The direct pathway in the striatum modulates the activity of motor cortex neurons by exciting D1-MSNs through neurotransmitters such as glutamate (Glu), allowing the motor cortex to send signals more freely to the motor system, thus facilitating the generation and execution of specific motor behaviors. Studies using D1-Cre and D2-Cre mice with neurons labeled for D₁R and D₂R have shown that both types of neurons are involved in the execution of movements, with D1-MSNs participating in movement initiation and D2-MSNs in inhibiting actions unrelated to the target movement. These findings suggest that the structural and functional plasticity of D1-MSNs and D2-MSNs in the basal ganglia circuitry enables motor learning and behavioral regulation. Additionally, when SNpc DA neurons begin to degenerate, D1-MSNs are initially affected but do not immediately cause motor impairments. In contrast, when D2-MSNs undergo pathological changes, they are first activated by upstream projecting neurons, leading to the inhibition of most motor behaviors and resulting in motor dysfunction. Therefore, it is hypothesized that motor impairments such as bradykinesia and initiation difficulties are more closely related to the functional activity of D2-MSNs. The extracellular signal-regulated kinase (Erk)/mitogen-activated protein kinase (MAPK) signaling pathway has been identified as a critical modulator in the pathophysiology of PD. Recent findings indicate that Erk/MAPK signaling pathway can mediate DA and Glu signaling in the central nervous system, maintaining normal functional activity of striatal MSNs and influencing the transmission of motor control signals. Within this complex regulatory network, the Erk/MAPK signaling pathway plays a key role in transmitting motor information to downstream neurons, regulating normal movements, avoiding unnecessary movements, and finely tuning motor behaviors. Our laboratory’s previous research found that 4 weeks of aerobic exercise intervention improved motor dysfunction in PD mice by inhibiting the Erk1/2 signaling upstream of striatal MSNs, primarily involving the Erk1/2 signaling in D2-MSNs rather than D1-MSNs. This review summarizes the neurobiological mechanisms of Erk/MAPK signaling pathway in D2-MSNs for the prevention and treatment of motor dysfunction in PD. By exploring the role of this signaling pathway in regulating motor abnormalities and preventing motor dysfunction in the central nervous system of PD, this review provides new theoretical perspectives for related mechanistic research and therapeutic strategies.

AIM To investigate the effects of rice wine type and wine processing method on chemical constituents and anti-coagulation effect of Angelicae sinensis Radix.METHODS Wine-washed products and wine-stir-fried products were prepared by different types and ages of rice wine,respectively,after which HPLC was adopted in the content determination of tryptophan,chlorogenic acid,vanillic acid,phthalic acid,ferulic acid,senkyunolide I,senkyunolide H,coniferyl ferulate and ligustilide,and PT,APTT,TT were detected in rabbit plasma.RESULTS Phenolic acids and volatile constituents demonstrated lower contents in the wine-stir-fried products than those in the raw product(P＜0.05),while those in the wine-washed products displayed no obvious changes(except for senkyunolide I)(P＞0.05).The contents of volatile constituents in the wine-washed products were higher than those in the wine-stir-fried products(P＜0.05).After being processed with dry rice wine,various constituents exhibited increased contents as compared with those after being processed with sweet rice wine(P＜0.05).Compared with the raw product,prolonged PT,APTT and TT were observable in the processed products prepared by 3-year semi-dry rice wine(P＜0.05).CONCLUSION The optimal rice wine type is determined to be 3-year semi-dry.Wine-washed Angelicae sinensis Radix shows high contents of ferulic acid and volatile constituents,whose activating blood and resolving stasis effect may be stronger.

Objective:To explore the application value of radiomics, deep learning, and their combined models in predicting the efficacy of radioiodine adjuvant therapy in patients with papillary thyroid cancer (PTC).Methods:A retrospective analysis was conducted on the clinical and imaging data of 131 PTC patients (38 males, 93 females; age 41(33, 48) years) who received first 131I treatment at the Affiliated Hospital of Guilin Medical University from January 2018 to March 2023. Patients were randomly divided into a training set ( n=105) and a test set ( n=26) at the ratio of 8∶2. Multivariate logistic regression analysis was used to screen clinical features to determine independent predictors affecting the efficacy of 131I therapy. Radiomics and deep learning features were extracted from the enhanced CT scans and were combined by using the extremely randomized trees (ExtraTrees) algorithm to construct radiomics, deep learning, and combined models. The predictive abilities of the models were evaluated by AUC, and the Delong test was applied to compare the difference between AUCs. Results:Higher pre-ablation stimulated thyroglobulin (ps-Tg) levels (odds ratio( OR)=1.060, 95% CI: 1.025-1.095, P=0.004) and bilateral lesions ( OR=5.085, 95% CI: 1.452-17.814, P=0.033) were independent predictors of the efficacy of 131I therapy in intermediate to high-risk PTC patients. In the training set, the radiomics model (AUC=0.853) and combined model (AUC=0.880) significantly outperformed the deep learning model (AUC=0.711; Z values: 2.48, 3.09, P values: 0.013, 0.002), while there was no statistically significant difference between the radiomics and combined models ( Z=0.51, P=0.610). In the test set, AUCs of the radiomics, deep learning, and combined models were 0.746, 0.624, and 0.876, respectively, and the AUC of the combined model was higher than that of the radiomics model or deep learning model ( Z values: 2.05, 1.99, P values: 0.040, 0.047). Conclusion:The combined model demonstrates superior performance over the standalone radiomics model and deep learning model in predicting the efficacy of 131I treatment in PTC patients.

Good endometrial receptivity is an essential factor for embryo implantation,and gene expression in endometrial tissue during the window of implantation(WOI)is closely related to receptivity.Transcriptome sequencing technology enables the identification of gene expression profiles of endometrium during different menstrual phases,as well as microRNAs and long-chain non-coding RNA sequences involved in regulating gene expression.Combining this technology with bioinformatics analysis provides a better understanding of specific gene expression during the receptive period and offers technical support for studying its regulatory mechanism.Moreover,gene expression profiles of the endometrium during different menstrual phases hold significant clinical application value for accurately assessing endometrium receptivity in infertility patients and those with repeated implantation failure,thereby guiding individualized embryo transfer strategies.This review summarizes the progress of transcriptome sequencing in evaluating human endometrial receptivity and discusses future research directions.This review aims to understand the complex molecular mechanisms of endometrial receptivity formation and regulation from the transcriptional level,in order to improve the implantation rate of embryos in assisted reproductive technology and reduce the abortion rate.

Objective To investigate the relationships of serum microRNA-9-3p(miR-9-3p),microRNA-27b-3p(miR-27b-3p),with brain glioma(BG)grading and their impacts on prognosis.Methods A total of 172 BG patients admitted in Suqian Hospital of Jiangsu Provincial People's Hos-pital from May 2020 to May 2023 were enrolled and divided into high-grade group(grade Ⅲ to Ⅳ,n=101)and low-grade group(grade Ⅰ to Ⅱ,n=71)according to the World Health Organization(WHO)classification of central nervous system tumors.Additionally,85 healthy individuals of the same age range during the same period were selected as control group.General information,serum levels of miR-9-3p,and miR-27b-3p were compared among the three groups.The correlations of pre-treatment serum levels of miR-9-3p and miR-27b-3p with BG grading were analyzed.The prognosis of BG patients one year after treatment was recorded,and clinical data were compared between the poor prognosis group and the good prognosis group.Factors influencing poor prognosis in BG patients as well as the value of pretreatment serum miR-9-3p and miR-27b-3p in predicting poor prognosis were analyzed.Conventional factors influencing poor prognosis were used to establish a conventional prediction mod-el,and model combined with pretreatment serum miR-9-3p and miR-27b-3p levels was used as a new prediction model.The value of these two models in predicting poor prognosis in BG patients was compared.Results Before treatment,serum levels of miR-9-3p and miR-27b-3p were lower in the high-grade group than those in the low-grade and control groups,and lower in the low-grade group than those in the control group(P＜0.05).Correlation analysis showed that pretreatment serum levels of miR-9-3p and miR-27b-3p were negatively correlated with BG grading(r=-0.573,P＜0.001;r=-0.498,P＜0.001),and serum miR-9-3p level was positively correlated with miR-27b-3p level in BG patients(r=0.509,P＜0.05).Before treatment,the poor prognosis group had a higher proportion of patients with WHO grade Ⅲ to Ⅳ,low differentiation,Karnofsky Performance Scale(KPS)＜70,and higher serum interleukin-17(IL-17)levels compared to the good prognosis group,while serum levels of miR-9-3p and miR-27b-3p were lower(P＜0.05).Logistic regression analysis showed that pretreatment WHO grading,differentiation,KPS,serum IL-17,miR-9-3p,and miR-27b-3p levels were all influencing factors of poor prognosis in BG patients(P＜0.05).Receiver operating characteristic(ROC)curves showed that the areas under the curve(AUCs)for pretreatment serum miR-9-3p and miR-27b-3p alone in predicting poor prognosis in BG patients were 0.714 and 0.720,respectively,with no statistically significant difference(Z=0.086,P=0.413).The AUC of the conventional prediction model for predicting poor prognosis in BG patients was 0.829,and the AUC of the new prediction model was 0.926(P＜0.05).Conclusion Serum levels of miR-9-3p and miR-27b-3p are negatively correlated with BG grading and are factors influ-encing poor prognosis,demonstrating certain value in predicting poor prognosis.

Objective To investigate the effects of mirabegron combined with electroacupuncture on urodynamic parameters in rats with overactive bladder(OAB)by regulating the insulin receptor substrate(IRS)/phosphatidylinositol 3-kinase(PI3 K)/protein kinase B(AKT)/endothelial nitric oxide synthase(eNOS)signaling pathway.Methods Sixty female SD rats were selected as the study subjects and randomly divided into control group,model group,mirabegron group,electroacupunc-ture group,and mirabegron+electroacupuncture group using a random number table method,with 12 rats in each group.Except for the control group,the other groups were used to establish OAB rat models by the bladder outlet obstruction method.The mirabegron group received intragastric administra-tion of 8 mg/kg mirabegron suspension.The electroacupuncture group received electroacupuncture stimu-lation for 5 min each time.The mirabegron+electroacupuncture group received intragastric administration of mirabegron suspension while undergoing electroacupuncture stimulation.The control group,the model group,and the electroacupuncture group received an equal volume of normal saline intragastrically once a day for 7 consecutive days.Urodynamic parameters(basal micturition pressure,peak mictu-rition pressure,micturition interval,and residual urine volume)were measured in each group.After measuring bladder blood flow using a laser speckle imaging instrument,the wet weight of the rat bladder tissue was weighed,and the bladder index was calculated.Enzyme-linked immunosorbent assay(ELISA)was used to detect the contents of urinary nerve growth factor(NGF),and interleu-kin-1[3(IL-1β),malondialdehyde(MDA),and superoxide dismutase(SOD)in bladder tissue.Western blot was used to detect the expression levels of phosphorylated(p)-IRS1,p-PI3K,p-AKT and p-eNOS in bladder tissue.Results Compared with the model group,the basal micturition pressure,peak micturition pressure,and bladder index were all decreased,the residual urine vol-ume was reduced,the micturition interval was prolonged,the bladder blood flow was increased,the SOD content in bladder tissue was increased,the NGF content in urine and the IL-1 β and MDA contents in bladder tissue were decreased,and the expression levels of p-IRS1,p-PI3K,p-AKT and p-eNOS were increased in the mirabegron group,the electroacupuncture group,and the mirabegron+electroacupuncture group,with statistically significant differences(P＜0.05 or P＜0.01).The results of the above indicators in the mirabegron+electroacupuncture group were all better than those in the mirabegron group and the electroacupuncture group,with statistically significant differ-ences(P＜0.05 or P＜0.01).Conclusion Mirabegron combined with electroacupuncture can improve urodynamic parameters in OAB rats than used alone,and its mechanism may be related to the activation of the IRS/PI3K/AKT/eNOS signaling pathway.

Objective To analyze the qualitative efficacy of MRI multi-sequence scanning combined with fPSA/tPSA in benign and malignant prostate lesions.Methods A retrospective analysis was conducted on the clinical data of 118 patients with suspected prostate cancer who visited Hebei Provincial First Veterans Hospital from January 2021 to November 2023.All the patients underwent DWI and DCE-MRI examinations.They were divided into the benign group(n=39)and the malignant group(n=39)based on the pathological results of partial prostatectomy or ultrasound-guided prostate biopsy.The DWI parameters,DCE-MRI parameters,PI-RADS scores,and fPSA/tPSA of the two groups were compared to analyze the factors influencing benign and malignant prostate lesions.ROC curves were drawn to analyze the diagnostic value of each index for benign and malignant prostate lesions.Results Among 118 suspected prostate cancer patients,118 lesions were detected through biopsy at our hospital or initial diagnosis at Hebei Provincial First Veterans Hospital followed by surgical and biopsy pathological examinations at external medical institutions.Of these lesions,79(66.95%)were malignant and 39(33.05%)were benign;the Rmax and SImax of the malignant group were higher than those of the benign group,and the Tmax and ADC values were lower than those of the benign group(P<0.05);the PI-RADS scores were higher than the benign group,and fPSA/tPSA was lower than the benign group(P<0.05);Multivariate logistic regression analysis revealed that Rmax[OR:1.374(95%CI:1.211～1.560)],SImax[OR:6.849(95%CI:2.573～18.230)],and PI-RADS score[OR:4.689(95%CI:2.646～8.309)]were the risk factors for malignant prostate lesions(P<0.05),while Tmax[OR:0.906(95%CI:0.873～0.941)],ADC value[OR:0.930(95%CI:0.905～0.955)],and fPSA/tPSA[OR:0.859(95%CI:0.812～0.908)]were protective factors(P<0.05);the ROC curve revealed that the AUC(95%CI)of Rmax,SImax,Tmax,ADC value,fPSA/tPSA,and PI-RADS score for the diagnosis of benign and malignant prostate lesions were 0.827(0.747～0.906),0.752(0.660～0.844),0.851(0.773～0.930),0.845(0.765～0.925),0.813(0.722～0.905),0.844(0.768～0.920),and 0.940(0.883～0.997).Conclusion DCE-MRI and DWI combined with PI-RADS score and fPSA/tPSA can improve the qualitative diagnostic accuracy of malignant prostate lesions,and provide reference for clinical identification of benign and malignant lesions.