Purpose: Three-dimensional (3D)–printed models have been increasingly used in medical education, but most studies have focused on satisfaction or outcomes following isolated learning activities. This study aimed to explore students’ perceptions of learning, engagement, usability, and learning strategies after completing a series of neuroanatomy-related coloring activities using a low-cost 3D-printed model. Methods: This cross-sectional study involved Year 1 medical students at Duke-NUS Medical School. Students participated in 3 structured coloring activities using a modular 3D-printed brain model during a neuroanatomy session. An anonymous survey was administered 1 week after the third activity to assess students’ perceived learning value, engagement (behavioral, cognitive, emotional, and agentic), usability, and learning strategies using Likert-scale items and open-ended questions. Results: A total of 48 students completed the survey, and the instrument showed acceptable to high internal consistency. Students reported high perceived learning value, positive engagement across multiple domains during the coloring activity, and high usability of the model. Participation in the learning activities was associated with significantly higher behavioral and agentic engagement, perceived learning value, and greater use of learning strategies than non-participation. Overall, active manipulation and hands-on exploration were perceived as beneficial for learning. Conclusion Low-cost 3D-printed brain models may serve as valuable learning tools to complement existing anatomy teaching approaches when paired with well-designed learning activities. Students reported positive learning experiences and high engagement during the activities. These findings highlight the importance of sound pedagogical design and curriculum integration to maximize learning.

Objective To describe the clinical characteristics and nutritional management status of hospitalized elderly patients with multimorbidity in a tertiary hospital's geriatric center in 2024, and to analyze the correlation between nutritional status and hospitalization outcomes, thereby providing a basis for optimizing nutritional management pathways for this population. Methods A retrospective study was conducted, including 2 937 elderly patients with multimorbidity. Data on general information, clinical indicators, nutritional risk screening and assessment, nutritional therapy, and costs were collected for descriptive analysis. The relationship between nutritional status (based on BMI and serum albumin levels) and hospitalization outcomes was explored. Results The average age of the patients was (77.45±10.70) years, with 57.17% being male. The average number of chronic diseases diagnosed was (11.56±5.08) per patient, and 26.01% were critically ill. The nutritional risk screening rate was 80.40%, with a screening positivity rate of 33.44%. The nutritional assessment rate was 31.63%, and the malnutrition prevalence was 23.08%. The low BMI group had the longest median hospital stay [15 (9.75, 22) days] and the highest hospitalization costs [15 057.2 (8 980.48, 28 160.46) CNY]. Serum albumin levels were negatively correlated with hospital stay duration (rs=-0.276, P< 0.01) and hospitalization costs (rs=-0.276, P<0.01). Conclusion Hospitalized elderly patients with multimorbidity are characterized by multiple comorbidities and high healthcare resource consumption. While the nutritional risk screening rate is relatively high, there remains room for improvement in nutritional assessment and therapy. It is necessary to strengthen standardized management throughout the entire process. Nutritional status is a significant variable affecting hospital stay duration and costs, with poorer nutritional status significantly associated with prolonged hospitalization and higher costs, suggesting that it may be an important factor influencing hospitalization outcomes.

Aim To investigate the protective effect of Vaccarin(Va)on epithelial-mesenchymal transition(EMT)in renal fibrosis model mice through regulating STAT3,and the underlying mechanism.Methods Left ureter ligation was used to establish a mouse model of unilateral ureteral obstruction(UUO);human kid-ney tubular epithelial(HK2)cells were induced to differentiate by transforming growth factor-β(TGF-β)in vitro.HE and Masson staining were used to observe the morphological changes of renal tissue;kits were used to detect the levels of BUN,Cr,IL-1β and IL-7 in mouse serum;CCK-8 was used to detect the effect of Va on the viability of HK2 cells;RT-PCR was used to detect the levels of inflammatory factors in HK2 cells;Western blot was used to detect the expression of STAT3,p-STAT3,E-cadherin,and α-SMA proteins in renal tissue and HK2 cells;to further investigate the regulation of Va on STAT3,JAK/STAT3 pathway acti-vator RO8191 was used to treat TGF-β-induced HK2 cells,and functional loss was detected.Results Va improved the pathological damage in UUO mice,inhibi-ted the levels of BUN,Cr and inflammatory factors;Va inhibited the phosphorylation of STAT3,upregulated E-cadherin,and downregulated α-SMA protein expres-sion;RO8191 counteracted the inhibitory effect of Va on the phosphorylation of STAT3.Conclusions Va inhibits the phosphorylation of STAT3 and the release of inflammatory factors,improves EMT,thus exerting an anti-renal fibrosis effect.

Objective To develop a multimodal nomogram for predicting the risk of postoperative metastasis and recurrence in patients with stage Ⅱ colorectal cancer(CRC)who do not receive adjuvant therapy.Methods A total of 424 patients with stage Ⅱ CRC who underwent radical resection without adjuvant therapy at our institution between January 2016 and December 2021 were retrospectively enrolled.Clinicopathological characteristics[including T stage,carcinoembryonic antigen(CEA)levels,and tumor differentiation],inflammatory markers(preoperative neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio),radiomic features(MRI texture entropy),and molecular biomarkers(KRAS mutation status)were collected.Radiologically confirmed metastasis or recurrence was defined as the primary endpoint.Univariate and multivariate logistic regression analyses were performed to identify independent prognostic factors and construct a predictive nomogram.The model's discriminatory performance was assessed using receiver operating characteristic(ROC)curve analysis.Internal validation was conducted via bootstrapping,and model calibration was evaluated using the Hosmer-Lemeshow goodness-of-fit test.Decision curve analysis was applied to assess the clinical utility of the nomogram,and risk stratification was subsequently performed.Results Among the patients,104(24.53%)developed metastasis or recurrence within three years after surgery.Multivariate analysis revealed the following independent risk factors(all P<0.05):CEA>5 μg/L,moderate to poor differentiation,presence of lymphovascular invasion,perineural invasion,elevated neutrophil-to-lymphocyte ratio(NLR),increased radiomic entropy,and KRAS mutation.The nomogram demonstrated strong predictive accuracy(AUC=0.870,95%CI:0.850～0.930),and the calibration curve indicated excellent agreement between predicted and observed outcomes.Following risk stratification,the recurrence rate was only 6.1%in the low-risk group,compared to 74.2%in the high-risk group(P<0.05).Conclusions This study develops a clinical-inflammatory-radiomic integrated prediction model specifically for stage Ⅱ colorectal cancer patients who do not receive adjuvant therapy.The model effectively identifies the risk of postoperative metastasis and recurrence,enabling the establishment of a risk stratification system to guide subsequent treatment decisions.

Objective:To observe the application value of Yifei Fumai Tang in the treatment of difficulty offline and intensive care unit-acquired weakness(ICU-AW).Methods:Used random number table method,60 patients with difficulty offline and ICU-AW who were admitted to our hospital from June 2022 to June 2024 were divided into control group(received conventional Western medicine comprehensive treatment,n=30)and study group(received Yifei Fumai Tang treatment in addition to the control group,n=30).Medical Research Council(MRC),Barthel Index(BI)scores,clinical indicators(total mechanical ventilation time,weaning success rate,secondary intubation rate,ICU stay,and mobilization time),diaphragm thickness,diaphragm mobility,and incidence of adverse reactions between two groups were compared.Results:Compared with the control group at 7 d after treatment and 14 d after treatment,the MRC and BI scores in the study group were higher(P＜0.05).Compared with the control group,the study group had lower rate of secondary intubation rate,shorter total mechanical ventilation time,ICU stay time,and mobilization time,higher weaning success rate,and greater diaphragm thickness,diaphragm mobility(P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion:Yifei Fumai Tang combined with Western Medicine in the treatment of Difficulty Offline and ICU-AW,can effectively improve the prognosis of patients,shorten total mechanical ventilation time,ICU stay,mobilization time,increase weaning success rate,and improve respiratory function.

Objective:To observe the application value of Yifei Fumai Tang in the treatment of difficulty offline and intensive care unit-acquired weakness(ICU-AW).Methods:Used random number table method,60 patients with difficulty offline and ICU-AW who were admitted to our hospital from June 2022 to June 2024 were divided into control group(received conventional Western medicine comprehensive treatment,n=30)and study group(received Yifei Fumai Tang treatment in addition to the control group,n=30).Medical Research Council(MRC),Barthel Index(BI)scores,clinical indicators(total mechanical ventilation time,weaning success rate,secondary intubation rate,ICU stay,and mobilization time),diaphragm thickness,diaphragm mobility,and incidence of adverse reactions between two groups were compared.Results:Compared with the control group at 7 d after treatment and 14 d after treatment,the MRC and BI scores in the study group were higher(P＜0.05).Compared with the control group,the study group had lower rate of secondary intubation rate,shorter total mechanical ventilation time,ICU stay time,and mobilization time,higher weaning success rate,and greater diaphragm thickness,diaphragm mobility(P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion:Yifei Fumai Tang combined with Western Medicine in the treatment of Difficulty Offline and ICU-AW,can effectively improve the prognosis of patients,shorten total mechanical ventilation time,ICU stay,mobilization time,increase weaning success rate,and improve respiratory function.

Aim To investigate the protective effect of Vaccarin(Va)on epithelial-mesenchymal transition(EMT)in renal fibrosis model mice through regulating STAT3,and the underlying mechanism.Methods Left ureter ligation was used to establish a mouse model of unilateral ureteral obstruction(UUO);human kid-ney tubular epithelial(HK2)cells were induced to differentiate by transforming growth factor-β(TGF-β)in vitro.HE and Masson staining were used to observe the morphological changes of renal tissue;kits were used to detect the levels of BUN,Cr,IL-1β and IL-7 in mouse serum;CCK-8 was used to detect the effect of Va on the viability of HK2 cells;RT-PCR was used to detect the levels of inflammatory factors in HK2 cells;Western blot was used to detect the expression of STAT3,p-STAT3,E-cadherin,and α-SMA proteins in renal tissue and HK2 cells;to further investigate the regulation of Va on STAT3,JAK/STAT3 pathway acti-vator RO8191 was used to treat TGF-β-induced HK2 cells,and functional loss was detected.Results Va improved the pathological damage in UUO mice,inhibi-ted the levels of BUN,Cr and inflammatory factors;Va inhibited the phosphorylation of STAT3,upregulated E-cadherin,and downregulated α-SMA protein expres-sion;RO8191 counteracted the inhibitory effect of Va on the phosphorylation of STAT3.Conclusions Va inhibits the phosphorylation of STAT3 and the release of inflammatory factors,improves EMT,thus exerting an anti-renal fibrosis effect.

Background and Aims:As a core data source in the development of medical informatization,the front page of inpatient medical records plays a crucial role in determining the usability of research data and the scientific quality of clinical decision-making.Given the relatively standardized diagnostic and treatment protocols for thyroid malignancies,this disease serves as a representative model for evaluating the data quality of medical record front sheets.This study aimed to systematically assess the accuracy of diagnostic and surgical procedure coding for thyroid malignancies on the medical record front page,identify existing problems,and explore strategies for improvement and the potential for future application in clinical research.Methods:A total of 3 361 patients who underwent initial surgical treatment and were pathologically confirmed with thyroid cancer at the Department of Thyroid Surgery,the First Affiliated Hospital of Kunming Medical University from January 2018 to December 2020 were retrospectively included.Postoperative pathology reports and surgical records were used as reference standards to evaluate the accuracy of primary and secondary diagnosis codes,as well as primary and secondary surgical procedure codes on the medical record front page.Results:The accuracy rate of primary diagnosis coding reached 98.8%.However,among 1 368 patients with cervical lymph node metastasis,only 31.2%had correctly recorded secondary diagnosis codes and metastatic sites,with an omission rate as high as 67.8%.The overall accuracy rate for primary surgical procedure coding was 90.4%,with thyroid lobectomy(TL)and total thyroidectomy(TT)coding accuracies of 85.5%and 96.0%,respectively.Among the coding errors,70.0%involved TL procedures being incorrectly coded as TT.Secondary surgical procedure codes—mainly for lymph node dissection—were highly inconsistent,with up to 14 different coding types,reflecting a lack of standardization and unified input criteria.Notably,the error rate for primary surgical coding in 2020 increased significantly compared with the previous two years,suggesting subjectivity and variability in manual data entry.Conclusion:This study highlights major accuracy deficiencies in surgical procedure coding for thyroid malignancies on the medical record front page,which may compromise the scientific validity of real-world data.Going forward,leveraging artificial intelligence technologies to support structured documentation and automated coding,alongside establishing a proactive quality control system through multidisciplinary collaboration,may significantly improve data accuracy.These efforts are essential for strengthening data foundations for precision treatment,performance evaluation,insurance payment,and clinical research on thyroid cancer.

Objective To develop a multimodal nomogram for predicting the risk of postoperative metastasis and recurrence in patients with stage Ⅱ colorectal cancer(CRC)who do not receive adjuvant therapy.Methods A total of 424 patients with stage Ⅱ CRC who underwent radical resection without adjuvant therapy at our institution between January 2016 and December 2021 were retrospectively enrolled.Clinicopathological characteristics[including T stage,carcinoembryonic antigen(CEA)levels,and tumor differentiation],inflammatory markers(preoperative neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio),radiomic features(MRI texture entropy),and molecular biomarkers(KRAS mutation status)were collected.Radiologically confirmed metastasis or recurrence was defined as the primary endpoint.Univariate and multivariate logistic regression analyses were performed to identify independent prognostic factors and construct a predictive nomogram.The model's discriminatory performance was assessed using receiver operating characteristic(ROC)curve analysis.Internal validation was conducted via bootstrapping,and model calibration was evaluated using the Hosmer-Lemeshow goodness-of-fit test.Decision curve analysis was applied to assess the clinical utility of the nomogram,and risk stratification was subsequently performed.Results Among the patients,104(24.53%)developed metastasis or recurrence within three years after surgery.Multivariate analysis revealed the following independent risk factors(all P<0.05):CEA>5 μg/L,moderate to poor differentiation,presence of lymphovascular invasion,perineural invasion,elevated neutrophil-to-lymphocyte ratio(NLR),increased radiomic entropy,and KRAS mutation.The nomogram demonstrated strong predictive accuracy(AUC=0.870,95%CI:0.850～0.930),and the calibration curve indicated excellent agreement between predicted and observed outcomes.Following risk stratification,the recurrence rate was only 6.1%in the low-risk group,compared to 74.2%in the high-risk group(P<0.05).Conclusions This study develops a clinical-inflammatory-radiomic integrated prediction model specifically for stage Ⅱ colorectal cancer patients who do not receive adjuvant therapy.The model effectively identifies the risk of postoperative metastasis and recurrence,enabling the establishment of a risk stratification system to guide subsequent treatment decisions.

Acute pancreatitis(AP)is a common digestive disorder associated with moderate to high nutritional risks,necessitating timely nutritional support.Over the past five decades,medical nutrition therapy for AP has undergone a paradigm shift,transitioning from traditional fasting based on the"pancreatic rest theory"to the current emphasis on early enteral feeding to"awaken the gut."Currently,nutritional treatment has become a cornerstone of comprehensive AP management.The European Society for Clinical Nutrition and Metabolism(ESPEN),founded in 1980,is a leading professional organization dedicated to advancing research,clinical practice,and education in clinical nutrition and metabolism.To date,ESPEN has published five evidence-based guidelines on nutritional management in pancreatic diseases.This article reviews the evolution of AP nutritional therapy as outlined in these ESPEN guidelines,highlighting key recommendations and their clinical implications.