Objective:To evaluate the application effectiveness of Kolb's experiential learning theory in teaching the course of Fundamentals of Surgery.Methods:A total of 90 undergraduate clinical medicine students enrolled in 2019 and 2020 at Harbin Medical University were selected as the research subjects. The students enrolled in 2019 were assigned to the control group and those in 2020 to the research group, with 45 students in each group. The control group received traditional teaching, while the research group received a reconstructed teaching mode for the course of Fundamentals of Surgery guided by Kolb's experiential learning theory. The teaching content was designed through a four-stage cycle (specific experience, reflective observation, abstract conceptualization, and active experimentation). The teaching effectiveness was verified using multiple evaluation indicators. The teaching effectiveness was evaluated through teaching evaluation and satisfaction evaluation. The t-test and chi-square test were performed using SPSS 24.0. Results:The research group scored higher than the control group in cognitive transformation [depth of incorrect attribution: (4.53±0.35) vs. (2.90±0.68)], clinical decision-making [reasonable index of surgical choice: (4.05±0.45) vs. (3.25±0.58)], and emotional attitude [metacognitive level: (4.57±0.34) vs. (2.75±0.72)] (all P<0.001). The teaching satisfaction survey showed that the depth of reflective guidance [(4.62±0.38) vs. (3.15±0.67)] and personalized support [(4.53±0.41) vs. (2.97±0.73)] were scored significantly higher in the research group than in the control group (both P<0.001). The two groups demonstrated no significant differences in basic operation efficiency [(4.25±0.38) vs. (4.20±0.42)] and technical equipment evaluation [(4.60±0.39) vs. (4.55±0.42)] (both P>0.05). Conclusions:Applying Kolb's experiential learning theory to teaching the course of Fundamentals of Surgery not only effectively cultivates the critical thinking and clinical decision-making abilities of students, but also significantly enhances their knowledge transfer ability and self-learning awareness through structured reflection tools and personalized training programs. This approach provides an innovative teaching paradigm for the cultivation of surgical clinical talents.

Objective To evaluate the efficacy and safety of transforaminal lumbar interbody fusion(TLIF)and oblique lateral interbody fusion(OLIF)combined with posterior pedicle screw fixation in treating degenerative lumbar spondylolisthesis.Methods This retrospective analysis included 65 patients with degenerative lumbar spondylolisthesis treated at the Second Affiliated Hospital of Xi'an Medical University's Department of Spine Surgery from January 2021 to February 2023.Patients were divided into two groups based on the surgical method:30 patients underwent OLIF combined with posterior pedicle screw fixation,and 35 patients underwent TLIF combined with posterior pedicle screw fixation.Perioperative outcomes(surgical time,intraoperative blood loss,etc.)were assessed,along with pre-and post-operative evaluations using the Visual Analog Scale(VAS)for back pain,the Oswestry Disability Index(ODI),the Japanese Orthopaedic Association(JOA)score,the modified Macnab criteria,and radiological parameters(intervertebral disc height,foraminal height,lumbar lordosis angle,fusion segment lordosis angle,and vertebral slip rate).Results Both groups of patients completed a 6-month follow-up.The intraoperative blood loss in the OLIF group was(57.79±11.54)ml,and the postoperative hospital stay was(5.85±0.94)days,while in the TLIF group,the values were(150.57±29.68)ml and(6.76±1.13)days,respectively.The differences between the two groups were statistically significant(P＜0.05).The VAS score,ODI index,and JOA score on the 3rd postoperative day in the OLIF group were(1.50±0.61)points,(17.06±2.92)％,and(12.06±2.90)points,respectively,while in the TLIF group,they were(2.05±0.72)points,(26.41±3.38)％,and(10.24±2.68)points.The differences between the two groups were statistically significant(P＜0.05).The intervertebral space height and foramen height on the 3rd postoperative day in the OLIF group were(14.43±1.50)mm and(23.87±1.41)mm,respectively,while in the TLIF group,they were(13.66±1.12)mm and(23.14±1.39)mm.The differences between the two groups were statistically significant(P＜0.05).At 3 months postoperatively,the intervertebral space height and foramen height in the OLIF group were(13.42±1.41)mm and(23.34±1.33)mm,while in the TLIF group,they were(12.63±1.33)mm and(22.42±1.40)mm.The differences between the two groups were statistically significant(P＜0.05).However,there were no statistically significant differences between the two groups in VAS score,ODI index,JOA score,modified Macnab criteria score,intervertebral space height,or foramen height at 6 months postoperatively(all P＞0.05).From the 3rd postoperative day to 6 months,there were no statistically significant differences between the two groups in lumbar lordosis angle,segmental lordosis angle,or vertebral slippage rate(all P＞0.05).Conclusion OLIF combined with posterior pedicle screw fixation may provide better short-term perioperative outcomes,particularly in terms of intraoperative blood loss and postoperative pain control,compared to TLIF.However,there were no significant differences in short-term outcomes between the two methods.

Objective:To explore the effect of ginsenoside Rg1 on spermatogenic dysfunction in mice caused by diabetes and its mechanism of action.Methods:Eighteen male C57BL mice were randomly divided into control group, the model group and the ginsenoside Rg1 group by completely random method, with 6 mice in each group. Type 2 diabetes models were established in the model group and the ginsenoside Rg1 group by a high-fat diet combined with intraperitoneal injection of streptozotocin, while control group was injected with the same amount of normal saline. After successful modeling, control group was given a regular diet for 8 weeks, while the model group and ginsenoside Rg1 group were given a high-fat diet for 8 weeks. The ginsenoside Rg1 group was also treated with ginsenoside Rg1 medication. Reproductive hormone levels were detected by enzyme-linked immunosorbent assay test kits, and Western blotting was used to detect the expressions of apoptosis-related proteins (Bcl2 protein, Caspase-3 protein, Bax protein), autophagy-related proteins (P62, LC3Ⅰ, LC3Ⅱ, Beclin1), β-Catenin protein, mTOR protein, LAMP1 protein and transcription factor EB. The body weight, blood glucose levels, testicular index of mice in each group were compared, as well as the testicular injury status.Results:The body weight [(18.77±1.14) g], testosterone level [(141.07±8.47) ng/L], follicle-stimulating hormone level [(9.19±0.74) U/L], and luteinizing hormone level [(1 497.91±99.57) pg/L] of mice in the model group were significantly lower than those in the control [(31.57±2.35) g, P<0.001; (171.50±11.76) ng/L, P<0.001; (12.46±1.54) U/L, P<0.001; (1 807.29±92.76) pg/L, P<0.001]; fasting blood glucose level [(20.82±1.11) mmol/L], glycosylated hemoglobin (12.67%±1.03%), the testis index (0.65%±0.03%) were significantly higher than those in the control [(6.40±1.34) mmol/L, P<0.001; 5.17%±1.17%, P<0.001; 0.48%±0.04%, P<0.001]. Compared with the model group, the body weight [(22.62±0.92) g, P=0.023], testosterone level [(172.63±9.20) ng/L, P<0.001], follicle-stimulating hormone level [(12.37±1.15) U/L, P<0.001], and luteinizing hormone level [(1 847.80±108.80) pg/L, P<0.001] of mice in the ginsenoside Rg1 group increased significantly, fasting blood glucose level [(18.63±1.14) mmol/L, P=0.017], glycosylated hemoglobin (8.50%±1.05%, P<0.001) and testicular index (0.54%±0.02%, P<0.001) decreased significantly. Compared with the control, the expressions of P62 ( P=0.039), LC3Ⅱ/LC3Ⅰ( P<0.001), Beclin1 ( P=0.002) and mTOR ( P=0.036) in the testicular tissue of mice in the model group all increased, the expression of β-Catenin ( P<0.001), LAMP1 ( P=0.005), transcription factor EB ( P<0.001) all decreased. Compared with the model group, the expressions of autophagy-related proteins P62 ( P=0.048), LC3Ⅱ/LC3Ⅰ( P<0.001) , Beclin1 ( P=0.023) and mTOR ( P=0.005) in the ginsenoside Rg1 group all decreased, while the expression of β-Catenin ( P=0.001), LAMP1 ( P=0.011) and transcription factor EB ( P=0.022) all increased. Transmission electron microscopy detected a decrease in the number of autophagosomes in the testicles of mice in the model group, and it improved after drug intervention. The HE staining showed that the testes of mice in the model group exhibited phenotypes such as the shedding and disorganization of spermatogenic cells, while ginsenoside Rg1 was able to improve these phenotypes. Conclusion:Ginsenoside Rg1 can improve testicular injury caused by diabetes in mice by regulating autophagy.

Objective:To explore the effect of ginsenoside Rg1 on spermatogenic dysfunction in mice caused by diabetes and its mechanism of action.Methods:Eighteen male C57BL mice were randomly divided into control group, the model group and the ginsenoside Rg1 group by completely random method, with 6 mice in each group. Type 2 diabetes models were established in the model group and the ginsenoside Rg1 group by a high-fat diet combined with intraperitoneal injection of streptozotocin, while control group was injected with the same amount of normal saline. After successful modeling, control group was given a regular diet for 8 weeks, while the model group and ginsenoside Rg1 group were given a high-fat diet for 8 weeks. The ginsenoside Rg1 group was also treated with ginsenoside Rg1 medication. Reproductive hormone levels were detected by enzyme-linked immunosorbent assay test kits, and Western blotting was used to detect the expressions of apoptosis-related proteins (Bcl2 protein, Caspase-3 protein, Bax protein), autophagy-related proteins (P62, LC3Ⅰ, LC3Ⅱ, Beclin1), β-Catenin protein, mTOR protein, LAMP1 protein and transcription factor EB. The body weight, blood glucose levels, testicular index of mice in each group were compared, as well as the testicular injury status.Results:The body weight [(18.77±1.14) g], testosterone level [(141.07±8.47) ng/L], follicle-stimulating hormone level [(9.19±0.74) U/L], and luteinizing hormone level [(1 497.91±99.57) pg/L] of mice in the model group were significantly lower than those in the control [(31.57±2.35) g, P<0.001; (171.50±11.76) ng/L, P<0.001; (12.46±1.54) U/L, P<0.001; (1 807.29±92.76) pg/L, P<0.001]; fasting blood glucose level [(20.82±1.11) mmol/L], glycosylated hemoglobin (12.67%±1.03%), the testis index (0.65%±0.03%) were significantly higher than those in the control [(6.40±1.34) mmol/L, P<0.001; 5.17%±1.17%, P<0.001; 0.48%±0.04%, P<0.001]. Compared with the model group, the body weight [(22.62±0.92) g, P=0.023], testosterone level [(172.63±9.20) ng/L, P<0.001], follicle-stimulating hormone level [(12.37±1.15) U/L, P<0.001], and luteinizing hormone level [(1 847.80±108.80) pg/L, P<0.001] of mice in the ginsenoside Rg1 group increased significantly, fasting blood glucose level [(18.63±1.14) mmol/L, P=0.017], glycosylated hemoglobin (8.50%±1.05%, P<0.001) and testicular index (0.54%±0.02%, P<0.001) decreased significantly. Compared with the control, the expressions of P62 ( P=0.039), LC3Ⅱ/LC3Ⅰ( P<0.001), Beclin1 ( P=0.002) and mTOR ( P=0.036) in the testicular tissue of mice in the model group all increased, the expression of β-Catenin ( P<0.001), LAMP1 ( P=0.005), transcription factor EB ( P<0.001) all decreased. Compared with the model group, the expressions of autophagy-related proteins P62 ( P=0.048), LC3Ⅱ/LC3Ⅰ( P<0.001) , Beclin1 ( P=0.023) and mTOR ( P=0.005) in the ginsenoside Rg1 group all decreased, while the expression of β-Catenin ( P=0.001), LAMP1 ( P=0.011) and transcription factor EB ( P=0.022) all increased. Transmission electron microscopy detected a decrease in the number of autophagosomes in the testicles of mice in the model group, and it improved after drug intervention. The HE staining showed that the testes of mice in the model group exhibited phenotypes such as the shedding and disorganization of spermatogenic cells, while ginsenoside Rg1 was able to improve these phenotypes. Conclusion:Ginsenoside Rg1 can improve testicular injury caused by diabetes in mice by regulating autophagy.

Objective:To evaluate the application effectiveness of Kolb's experiential learning theory in teaching the course of Fundamentals of Surgery.Methods:A total of 90 undergraduate clinical medicine students enrolled in 2019 and 2020 at Harbin Medical University were selected as the research subjects. The students enrolled in 2019 were assigned to the control group and those in 2020 to the research group, with 45 students in each group. The control group received traditional teaching, while the research group received a reconstructed teaching mode for the course of Fundamentals of Surgery guided by Kolb's experiential learning theory. The teaching content was designed through a four-stage cycle (specific experience, reflective observation, abstract conceptualization, and active experimentation). The teaching effectiveness was verified using multiple evaluation indicators. The teaching effectiveness was evaluated through teaching evaluation and satisfaction evaluation. The t-test and chi-square test were performed using SPSS 24.0. Results:The research group scored higher than the control group in cognitive transformation [depth of incorrect attribution: (4.53±0.35) vs. (2.90±0.68)], clinical decision-making [reasonable index of surgical choice: (4.05±0.45) vs. (3.25±0.58)], and emotional attitude [metacognitive level: (4.57±0.34) vs. (2.75±0.72)] (all P<0.001). The teaching satisfaction survey showed that the depth of reflective guidance [(4.62±0.38) vs. (3.15±0.67)] and personalized support [(4.53±0.41) vs. (2.97±0.73)] were scored significantly higher in the research group than in the control group (both P<0.001). The two groups demonstrated no significant differences in basic operation efficiency [(4.25±0.38) vs. (4.20±0.42)] and technical equipment evaluation [(4.60±0.39) vs. (4.55±0.42)] (both P>0.05). Conclusions:Applying Kolb's experiential learning theory to teaching the course of Fundamentals of Surgery not only effectively cultivates the critical thinking and clinical decision-making abilities of students, but also significantly enhances their knowledge transfer ability and self-learning awareness through structured reflection tools and personalized training programs. This approach provides an innovative teaching paradigm for the cultivation of surgical clinical talents.

Objective To evaluate the efficacy and safety of transforaminal lumbar interbody fusion(TLIF)and oblique lateral interbody fusion(OLIF)combined with posterior pedicle screw fixation in treating degenerative lumbar spondylolisthesis.Methods This retrospective analysis included 65 patients with degenerative lumbar spondylolisthesis treated at the Second Affiliated Hospital of Xi'an Medical University's Department of Spine Surgery from January 2021 to February 2023.Patients were divided into two groups based on the surgical method:30 patients underwent OLIF combined with posterior pedicle screw fixation,and 35 patients underwent TLIF combined with posterior pedicle screw fixation.Perioperative outcomes(surgical time,intraoperative blood loss,etc.)were assessed,along with pre-and post-operative evaluations using the Visual Analog Scale(VAS)for back pain,the Oswestry Disability Index(ODI),the Japanese Orthopaedic Association(JOA)score,the modified Macnab criteria,and radiological parameters(intervertebral disc height,foraminal height,lumbar lordosis angle,fusion segment lordosis angle,and vertebral slip rate).Results Both groups of patients completed a 6-month follow-up.The intraoperative blood loss in the OLIF group was(57.79±11.54)ml,and the postoperative hospital stay was(5.85±0.94)days,while in the TLIF group,the values were(150.57±29.68)ml and(6.76±1.13)days,respectively.The differences between the two groups were statistically significant(P＜0.05).The VAS score,ODI index,and JOA score on the 3rd postoperative day in the OLIF group were(1.50±0.61)points,(17.06±2.92)％,and(12.06±2.90)points,respectively,while in the TLIF group,they were(2.05±0.72)points,(26.41±3.38)％,and(10.24±2.68)points.The differences between the two groups were statistically significant(P＜0.05).The intervertebral space height and foramen height on the 3rd postoperative day in the OLIF group were(14.43±1.50)mm and(23.87±1.41)mm,respectively,while in the TLIF group,they were(13.66±1.12)mm and(23.14±1.39)mm.The differences between the two groups were statistically significant(P＜0.05).At 3 months postoperatively,the intervertebral space height and foramen height in the OLIF group were(13.42±1.41)mm and(23.34±1.33)mm,while in the TLIF group,they were(12.63±1.33)mm and(22.42±1.40)mm.The differences between the two groups were statistically significant(P＜0.05).However,there were no statistically significant differences between the two groups in VAS score,ODI index,JOA score,modified Macnab criteria score,intervertebral space height,or foramen height at 6 months postoperatively(all P＞0.05).From the 3rd postoperative day to 6 months,there were no statistically significant differences between the two groups in lumbar lordosis angle,segmental lordosis angle,or vertebral slippage rate(all P＞0.05).Conclusion OLIF combined with posterior pedicle screw fixation may provide better short-term perioperative outcomes,particularly in terms of intraoperative blood loss and postoperative pain control,compared to TLIF.However,there were no significant differences in short-term outcomes between the two methods.

Objective To investigate the accuracy and application value of the Tada formula in evalua-ting the meningioma volume based on 3D reconstruction technology.Methods The thin-slice magnetic reso-nance images of 297 patients with meningioma treated in the neurosurgery department of 940 Hospital of PLA Joint logistics Support Force from January 2014 to May 2022 were retrospectively analyzed.The meningioma volume was evaluated by the Tada formula method and three-dimensional reconstruction method respectively.The accuracy of the evaluation of meningeal tumor volume by the Tada formula was analyzed by grouping sta-tistics.Results In the whole sample and the concentrated sample,the obtained meningioma total volumes had no statistical difference between the two methods(P＞0.05),the Spearman correlation coefficients were 0.995 and 0.993 respectively,and the intragroup correlation coefficients(ICC)were 0.992 and 0.989,respec-tively.In the Bland-Altman plot,most of the data points were within the limit of uniformity.Compared with different groups,the Tada formula had a slightly lower accuracy in the volume assessment of meningiomas with higher degree of irregularity,and a better accuracy in the volume assessment of supratentorial meningio-mas than subtentorial meningiomas.Conclusion The Tada formula could accurately evaluate the volume of meningioma,and it could be used as a preliminary method to evaluate meningioma volume in clinic

Objective To investigate the expression of FBXO43in various cancers and its relationship with immune cell infiltration and prognosis using bioinformatics.Methods Gene expression data for 33 cancers were obtained from The Cancer Genome Atlas(TCGA)and Genotype-Tissue Expression(GTEx)databases to analyze FBXO43expression.Clinical and survival data were sourced from the TCGA database.Gene Expression Profiling Interactive Analysis(GEPIA)was used to assess the correlation between FBXO43expression and the clinical stage.Kaplan-Meier survival analysis was used to evaluate the relationship between FBXO43expression and prognosis.R lan-guage was used to analyze the associations between FBXO43expression and clinical stages,immune cell infiltration,immune checkpoint genes,tumor mutation burden(TMB),microsatellite instability(MSI),and mismatch repair(MMR)genes.The potential biological mech-anisms of FBXO43were explored using gene set enrichment analysis(GSEA).Moreover,qRT-PCR was performed to measure FBXO43 expression in normal gastric mucosal cells(GES-1),gastric cancer cells(HGC-27,MGC-803,and MKN-45),normal liver cells(LO-2),and liver cancer cells(SMMC-7721,HEPG2,HuH7,and MHCC97-H).Results Combined TCGA and GTEx database statistics revealed higher FBXO43expression in 26 types of cancer tissues,including adrenocortical carcinoma(ACC),bladder urothelial carcinoma,breast invasive carcinoma,cervical squamous cell carcinoma and endocervical adenocarcinoma,cholangiocarcinoma,colon adenocarcinoma,and diffuse large B-cell lymphoma,than in normal tissues(P<0.05).However,FBXO43expression was lower in three types of cancer tissues:kidney chromophobe(KICH),testicular germ cell tumor(TGCT),and thyroid carcinoma(P<0.05).GEPIA data analysis showed that FBXO43expression positively correlated with the clinical stages of ACC,KICH,kidney renal clear cell carcinoma(KIRC),and kidney renal papillary cell carcinoma(KIRP)and negatively correlated with the clinical stages of ovarian serous cystadenocarcinoma(OV)and TGCT(P<0.05).Kaplan-Meier survival analysis indicated that abnormal FBXO43expression was associated with the prognosis of various cancers(P<0.05).Specifically,high FBXO43expression was a risk factor for ACC,KICH,KIRC,KIRP,low-grade glioma,liver hepato-cellular carcinoma,mesothelioma,and sarcoma,but protective in thymoma(THYM).The XCELL algorithm found that FBXO43expres-sion was negatively correlated with immune scores in nine types of cancer tissues,including glioblastoma multiforme,KIRP,acute myeloid leukemia,lung squamous cell carcinoma,and OV,and closely related to immune cell infiltration levels in 24 types of cancer tissues,espe-cially showing a significant negative correlation with most immune cells in SARC(P<0.01).Correlation analysis revealed a significant association between FBXO43and TMB,MSI,and MMR in all cancers.GSEA analysis indicated that FBXO43is involved in the cell cycle and immune-related functions in various tumors.qRT-PCR results showed that FBXO43expression was upregulated in liver cancer cells and downregulated in gastric cancer cells(all P<0.05).Conclusion Abnormal FBXO43expression is closely associated with the occur-rence and progression of multiple cancers.Thus,FBXO43may serve as a novel marker of immune cell infiltration and prognosis,thereby offering new directions for targeted cancer therapy.

Objective To explore the role of indole-3-propionic acid(IPA)in the pathogenesis of metabolic associated fatty liver disease(MAFLD)induced by high-fat diet(HFD)in order to reveal the role and related mechanism of adipose tissue metabolism in the process.Methods A mouse model of MAFLD was induced by HFD.Male C57BL/6J mice(6～7 weeks old)were randomly divided into control group(CON),HFD group,and HFD+IPA intervention group(HFD+IPA).The CON group was fed with control diet,and the HFD group and HFD+IPA group were fed with 60％of high-fat diet.The experiment period was 12 weeks,and IPA was administered at 20 mg/(kg·d)for 6 weeks starting from the 7th week.The body weight and food intake of each group were monitored weekly.After the intervention,the body composition of mice was detected by animal body composition analyzer.After the mice were euthanized,the morphological and structural changes in the liver and adipose tissues were observed by HE staining,the indicators relevant to lipid metabolism in the serum,l iver and adipose tissues were detected by automatic blood biochemical analyzer and biochemical kits,and the mRNA expression changes of lipid metabolism and inflammation related genes were detected by qRT-PCR.Results Compared with the CON group,the HFD group had significantly increased body weight and body fat percentage,obvious lipid deposition in the liver,obviously elevated serum alanine aminotransferase,aspartate aminotransferase,liver triglyceride and total cholesterol levels(P＜0.05),and raised mRNA levels of liver fatty acid transporter CD36(P＜0.05),while IPA intervention significantly reversed the above changes(P＜0.05).IPA intervention significantly inhibited the HFD-induced enlargement of visceral and brown fat cells,reduced the content of visceral adipose tissue(VAT)and serum level of free fatty acids(P＜0.05),and increased the mRNA expression levels of VAT lipolysis(HSL,CGI58),browning genes(Cidea,ND5,UCP1,Prdm16)(P＜0.05),as well as those of brown adipose tissue(BAT)lipolysis(HSL,ATGL)and fatty acid beta oxidation(Cpt1a,PPARα)genes(P＜0.05).Meanwhile,the mRNA levels of TNF-α,IL-1β,CXCL1 and CCL2 in VAT and BAT were decreased after IPA intervention(P＜0.05).Conclusion IPA can improve the occurrence of MAFLD induced by HFD,and its mechanism may be closely associated with its regulation of BAT and VAT morphology,and the mRNA expression of metabolic function and inflammation related genes.

Objective To investigate the impact of exosomal miRNAs derived from endoplasmic reticulum-stressed(ERS)head and neck squamous cell carcinoma(HNSCC)cells on macrophages.Methods This study was reviewed and approved by the Ethics Committee.The expression levels of ERS-associated proteins,including protein kinase R-like endoplasmic reticulum kinase(PERK)and glucose-regulated protein 78(GRP78),in HNSCC tissues and para-tumor tissues were detected by Western blot(WB)and quantitative real-time PCR(RT-qPCR).HN4 human laryngeal squamous cell carcinoma cells were treated with 500 U/mL interferon-γ(IFN-γ)for 48 h to induce ER stress,and exo-somes secreted by ER-stressed HN4 cells were collected and identified.The types of miRNAs in exosomes were identi-fied through bioinformatics analysis,and the target genes of miRNAs were predicted.Macrophages were transfected with miRNA,co cultured with collected exosomes,and the expression of PTEN in macrophages was knocked down.The downstream signaling pathway regulated by exosomal miRNAs was studied by WB and RT-qPCR.Results Compared with that in para-tumor tissues,the expression level of ER stress-associated proteins in HNSCC tissues was increased(P＜0.05).RNA-seq analysis revealed that miR-26a-5p was highly upregulated in ER-stressed HN4 cell-derived exo-somes(P＜0.05).PTEN is the target gene for miR-26a-5p.miR-26a-5p increased the expression level of PD-L1 in mac-rophages and downregulated the expression of PTEN(P＜0.05).Macrophages co cultured with ERS extracellular vesi-cles showed an increase in miR-26a-5p and PD-L1 expression,a decrease in PTEN expression,and an increase in p-AKT expression(P＜0.05).Knock down the expression of PTEN in macrophages and increase the expression of PD-L1(P＜0.01).Conclusion ERS HNSCC cell-derived exosomal miR-26a-5p promotes the expression of PD-L1 in macro-phages through the PTEN/AKT signaling pathway.