Lung cancer is a leading cause of cancer-related morbidity and mortality worldwide. Coupled with the substantial workload, the clinical management of lung cancer is challenged by the critical need to efficiently and accurately process increasingly complex medical information. In recent years, large language models (LLMs) technology has undergone explosive development, demonstrating unique advantages in handling complex medical data by leveraging its powerful natural language processing capabilities, and its application value in the field of lung cancer diagnosis and treatment is continuously increasing. The paper systematically analyzes that the exceptional potential of LLMs in lung cancer auxiliary diagnosis, tumor feature extraction, automatic staging, progression/outcome analysis, treatment recommendations, medical documentation generation, and patient education. However, they face critical technical and ethical challenges including inconsistent performance in complex integrated decision-making (e.g., TNM staging, personalized treatment suggestions) and "black box" opacity issues, along with dilemmas such as training data biases, model hallucinations, data privacy concerns, and cross-lingual adaptation challenges ("data colonization"). Future directions should prioritize constructing high-quality multimodal corpora specific to lung cancer, developing interpretable and compliant specialized models, and achieving seamless integration with existing clinical workflows. Through dual drivers of technological innovation and ethical standardization, LLMs should be prudently advanced for holistic lung cancer management processes, ultimately promoting efficient, standardized, and personalized diagnosis and treatment practices.

Objective To investigate the status of job crafting, change fatigue, and organizational silence among clinical nurses, and to examine the mediating role of organizational silence in the relationship between change fatigue and job crafting. Methods A total of 500 clinical nurses from a tertiary grade A hospital in Shaanxi Province were selected as study participants using the convenience sampling method. The level of job crafting, change fatigue, and organizational silence was assessed using the Job Crafting Scale, Change Fatigue Scale, and Organizational Silence Scale, and the mediating effect of organizational silence between change fatigue and job crafting was examined by the Bootstrap method among clinical nurses. Results The mean scores of job crafting, change fatigue, and organizational silence among clinical nurses were (59.0±11.7), (22.9±5.6), and (81.3±8.5), respectively. Multiple linear regression analysis showed that higher education level, longer working years, and more severe change fatigue were associated with higher job crafting scores among clinical nurses (all P<0.05). A higher level of organizational silence was related to lower job crafting scores (P<0.01). Mediation analysis showed that organizational silence was negatively associated with both change fatigue and job crafting among clinical nurses (all P<0.01), while change fatigue was positively associated with job crafting (P<0.01). Organizational silence partially mediated the relationship between change fatigue and job crafting. The direct effect of change fatigue on job crafting was 0.26, and the indirect effect of organizational silence was 0.70, accounting for 72.8% of the total effect. Conclusion Organizational silence mediates the relationship between change fatigue and job crafting. Reducing organizational silence may help enhance the level of job crafting among nurses.

ObjectiveTo investigate the mechanism underlying the weight loss effect of electrothermal acupuncture （ETA） in diet-induced obese （DIO） model mice based on the hypoxia-inducible factor-1α （HIF-1α）/sphingosine-1-phosphate （S1P）sphingosine-1-phosphate receptor 3 （S1PR3） signaling pathway-mediated macrophage polarization. MethodsAn obesity mouse model was established by continuously feeding at a high-fat diet （HFD） for 8 weeks. Twenty successfully modeled obese mice were randomly divided into a model group and an electrothermal acupuncture （ETA） group with 10 mice per group， both of which continued to receive the HFD till week 12. Another 10 mice were assigned to the normal group and fed a standard chow diet continuously for 12 weeks. Starting from week 9 of the experiment， mice in the ETA group received electrothermal acupuncture stimulation at Zhongwan （CV12）， bilateral Tianshu （ST25）， and bilateral Zusanli （ST36） for 30 minutes per session， with the instrument current set at （40±0.5）mA and a constant temperature of （40±0.5）℃. Mice in the normal group and the model group were restrained in the same manner for 30 minutes without acupuncture. All interventions were performed once every other day for a total of 4 weeks. Ten hours after the final intervention， the body weight， waist circumference， and body length of mice in each group were measured， and Lee's index was calculated. Serum biochemical analysis was performed to assess fasting blood glucose （FBG）， total cholesterol （TC）， triglycerides （TG）， high-density lipoprotein cholesterol （HDL-C）， low-density lipoprotein cholesterol （LDL-C）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， blood urea nitrogen （BUN）， and creatinine （Cr）. Serum leptin （LEP） and adiponectin （ADPN） levels， as well as sphingosine-1-phosphate （S1P） levels in epididymal white adipose tissue （eWAT）， were detected by ELISA. Histomorphological changes in eWAT were monitored via HE staining. Flow cytometry was used to analyze macrophage subtype-related indexes in eWAT， including the total proportion of macrophages， the proportion of M1 macrophages， the proportion of M2 macrophages， and the M1/M2 ratio. Antibody array technology was used to determine the levels of differentially expressed inflammatory factors in eWAT between the model and blank groups， as well as between the ETA and model groups. Western blot and qPCR were used to detect the protein and mRNA expression levels of HIF-1α and S1PR3 in the eWAT， respectively. ResultsCompared to the normal group， the model group showed significantly increased body weight， Lee's index， waist circumference， and FBG， TC， TG， HDL-C， LDL-C， AST， and ALT levels， upgraded LEP and S1P levels， decreased ADPN level and ADPN/LEP ratio， elevated proportion of M1 macrophages and the M1/M2 ratio， reduced proportion of M2 macrophages， and upregulated protein and mRNA expression levels of HIF-1α and S1PR3 （P＜0.05 or P＜0.01）. With the exception of HDL-C， all the abovementioned indicators in the ETA group were significantly improved compared to the model group （P＜0.05 or P＜0.01）. Analysis of differentially expressed inflammatory cytokines revealed that， compared to the normal group， the levels of interleukin-1β （IL-1β）， interferon-γ （IFN-γ）， interleukin-6 （IL-6）， and interleukin-12p70 （IL-12p70） in the eWAT of the model group were elevated； conversely， the levels of interleukin-17 （IL-17）， interleukin-5 （IL-5）， IL-6， and interleukin-23 （IL-23） in the eWAT of the ETA group decreased compared to the model group （P＜0.05 or P＜0.01）. ConclusionETA exerts a weight-reducing effect in obese model mice， and the mechanism may involve inhibition of the HIF-1α/S1P/S1PR3 signaling pathway activation， which shifts macrophage polarization from the M1 to M2 phenotype， thereby alleviating chronic inflammation.

Objective: To investigate the effect of neurite outgrowth inhibitor extracellular peptide residues 1-40 (NEP1-40) combined with poly (lactic-co-glycolic acid) (PLGA) and gelatin electrospun fiber membrane on facial nerve repair in rats. Methods: According to the principle of random grouping, 108 male SD rats were divided into four groups (n = 27 in each group, approved by the ethics committee), namely, the sham group, control group, PLGA group, and NEP1-40 + PLGA group. A facial nerve fracture model was established for all of the groups except for the sham group. The control group received no further treatment, the PLGA group and the NEP1-40+PLGA group were supported by PLGA membrane, and the NEP1-40+PLGA group received one immediate local injection of NEP1-40 (5 μg/μL) at a dose of 10 μL. Facial nerve function analysis, electrophysiological examination, transmission electron microscope observation, HE staining, and immunohistochemical staining of myelin marker S100β and axonal marker β3-tubulin were used to evaluate the recovery of injured facial nerves of rats at 2, 4 and 8 weeks. Results : At 8 weeks, the facial nerve function score of the NEP1-40+PLGA group was better than that of the control group and PLGA group (P < 0.001), and facial nerve function was significantly restored. Electrophysiological examination of nerve action potentials at the injured facial nerve showed that the amplitude in the NEP1-40+PLGA group was higher than that of the control group and PLGA group (P < 0.001), but there was no significant difference in latency and conduction velocity results between the groups (P > 0.05). At 2, 4, and 8 weeks, transmission electron microscopy showed that the number of myelinated nerve fibers and myelin sheath thickness in the cross-section of the injured facial nerve in the NEP1-40+PLGA group were greater than those in the other groups (P < 0.05). At 8 weeks, HE staining showed that the facial nerves in the control group had partially recovered, but the overall cell distribution was uneven and the boundary with surrounding tissues was slightly blurred. In contrast, the NEP1-40+PLGA group had a relatively uniform cell distribution and a clearer boundary with surrounding tissues. At 2, 4, and 8 weeks, the immunohistochemical results showed that in the cross-section of the injuried facial nerve, NEP1-40 increased the expression of neural markers S100 β and β3-tubulin, especially β3-tubulin, which was close to normal levels (P > 0.05) Conclusion NEP1-40 is beneficial for the generation of new myelin sheaths and axons at the site of injury, and it can promote the repair and regeneration of injured facial nerves to a certain extent, thus accelerating the recovery of injured nerve function.

In recent years,the incidence and mortality of heatstroke have been increasing annually alongside global warming,with a marked rise in cases exhibiting atypical symptoms.To address the increasingly complex challenges in heatstroke prevention and treatment,Heatstroke Prevention and Treatment Research Center of Chinese PLA,Expert Group of Heatstroke Prevention and Treatment of Chinese PLA,and Chinese PLA Professional Committee of Critical Care Medicine have jointly developed this guideline(2025 edition).Utilizing the Grading of Recommendations Assessment,Development and Evaluation(GRADE)system,Appraisal of Guidelines for Research and Evaluation(AGREE)criteria,and Reporting Items for Practice Guidelines in Healthcare(RIGHT)standards,and based on the 2015 draft"Expert Consensus on the Standardized Diagnosis and Treatment of Heatstroke"and the 2019"Chinese Expert Consensus on the Diagnosis and Treatment of Heatstroke",this guideline has been crafted.This guideline provides 25 evidence-based recommendations to guide the prevention,treatment and research of heatstroke,which thoroughly covers 8 critical domains:clinical classification,pathophysiological mechanisms,clinical manifestations,diagnostic criteria,differential diagnosis,treatment protocols,rehabilitation and return to work,and prevention.

OBJECTIVE To investigate the mechanism of action of Quzhuo Tongbi Granules(QZTB)in reducing uric acid and anti-inflammation in mice with hyperuricemia(HUA).METHODS The components of QZTB were identified by ultra-performance liquid chromatography-mass spectrometry(UPLC-MS).Sixty-four C57BL/6 mice were randomly divided into control group,model group,benzbromarone group,QZTB low-dose group,QZTB medium-dose group,QZTB high-dose group,MCC950 group,and MCC950+QZTB medium-dose group,with 8 mice in each group.Adenine(100 mg·kg-1)and potassium oxonate(500 mg·kg-1)were used to establish the HUA mouse model.Except for the control group,all other groups underwent 2 weeks of modeling followed by 4 weeks of treatment.After 2 weeks of modeling,blood was collected from the orbital venous plexus to measure serum uric acid(SUA)levels as the criterion for successful model induction.Mice were sacrificed after 4 weeks of continuous treatment for sample collection.An automatic biochemical analyzer was used to measure serum levels of SUA,urea nitrogen(BUN),and creatinine(Cr).Enzyme-linked immunosorbent assay(ELISA)was employed to detect serum levels of interleukin-1β(IL-1β),interleukin-6(IL-6),interleukin-18(IL-18),and tumor necrosis factor-α(TNF-α).The qPCR was used to assess mRNA expression of urate transporter 1(URAT1),ATP-binding cassette transporter G2(ABCG2),glucose transporter 9(GLUT9),and PDZ domain-contai-ning protein kinase 1(PDZK1)in kidney tissue.Western blot was performed to measure protein expression of urate transporters(URAT1,ABCG2,GLUT9,PDZK1),nuclear transcription factor κB(NF-κB)total protein,phosphorylated NF-κB(p-NF-κB),Nod-like receptor protein 3(NLRP3),Cleaved Caspase-1 and Pro-Caspase-1 proteins in kidney tissue.Immunohistochemistry was used to determine the expression levels of urate transporters(URAT1,ABCG2,PDZK1,GLUT9)in kidney tissue.RESULTS A to-tal of 9 representative active ingredients were identified in QZTB.Two weeks after modeling,SUA in the model group was significantly increased compared with that in the control group(P<0.000 1).Four weeks after administration,serum SUA,BUN and Cr in the model group were significantly increased(P<0.000 1),IL-1β,IL-6,IL-18 and TNF-α levels were increased(P<0.01,P<0.001),the expression of ABCG2 and PDZK1 proteins in renal tissue was decreased(P<0.01,P<0.001,P<0.000 1),and the ex-pression of URAT1,GLUT9,NLRP3,p-NF-κB p65/NF-κB p65 and Cleaved Caspase-1/Pro-Caspase-1 proteins was significantly increased(P<0.01,P<0.001,P<0.000 1).Compared with the model group,SUA,BUN and Cr in the benzbromarone group and the low-,medium-and high-dose QZTB intervention groups were reduced to varying degrees(P<0.001,P<0.000 1).QZTB could ef-fectively reduce the levels of serum inflammatory factors IL-1β,IL-6,IL-18 and TNF-α(P<0.05,P<0.01),increase the expres-sion of ABCG2 and PDZK1 proteins in renal tissue(P<0.05,P<0.01,P<0.000 1),and downregulate the expression of URAT1,GLUT9,NLRP3,p-NF-κB p65/NF-κB p65 and Cleaved Caspase-1/Pro-Caspase-1 proteins(P<0.05,P<0.01,P<0.001,P<0.000 1).Compared with the model group,the MCC950 group downregulated the protein expressions of NLRP3,p-NF-κB p65/NF-κB p65,and Cleaved Caspase-1/Pro-Caspase-1(P<0.01).Compared with the MCC950 group or the QZTB group,the MCC950+QZTB group downregulated the protein expressions of NLRP3,p-NF-κB p65/NF-κB p65,and Cleaved Caspase-1/Pro-Caspase-1(P<0.05,P<0.01,P<0.000 1).CONCLUSION QZTB can promote uric acid excretion by inhibiting the NF-κB/NLRP3 signaling pathway,thereby improving the symptoms of HUA.

Objective:To investigate the association between single nucleotide polymorphism (SNP) of the protein phosphatase 1 regulatory subunit 1B( PPP1R1B) gene and schizophrenia in the Han population of northern Henan province. Methods:Utilizing Psychiatric Genomics Consortium 3 (PGC3) data, the SNPs of PPP1R1B gene which were significantly associated with schizophrenia were screened.Subsequently, totally 1 721 schizophrenia patients and 6 726 healthy controls from the Han population in northern Henan province were recruited for further analysis. The SNP rs907094, located within the PPP1R1B gene was validated, and the clinical symptoms of 386 schizophrenia patients were evaluated using the positive and negative syndrome scale (PANSS). Additionally, expression quantitative trait loci (eQTL) association analysis was conducted to explore the relationship between the rs907094 polymorphism and PPP1R1B gene expression.The PLINK v1.9, Genetic Power Calculater, SPSS 20.0 softwares were used for data analysis. Results:Significant differences in genotype AA, AG, GG(schizophrenia group: AA, 489(28.4%); AG, 848(49.3%); GG, 384(22.3%); control group: AA, 1 450(21.6%); AG, 3 386(50.3%); GG, 1 890(28.1%), χ2=45.418, P<0.05) and allele frequency(schizophrenia group: A, 1 826(53.1%); G, 1 616(46.9%); control group: A, 6 286(46.7%); G, 7 166(53.3%), χ2=43.877, P<0.05) were observed for SNP rs907094 between the schizophrenia group and control group. Individuals carrying allele A were identified to have a higher risk of developing schizophrenia compared to those carrying allele G ( OR=1.288, 95% CI=1.195-1.388). Furthermore, the genotype PPP1R1B gene was found to be associated with the clinical features of schizophrenia. A statistically significant difference was observed in the excitement/hostility factor between AA and GG patients with rs907094 (13.62±5.65, 15.54±4.66)( P<0.05). Additionally, significant differences were noted in the cognitive factor scores between AA and GA genotypes (17.76±5.58, 19.43±5.73)( P<0.05). Conclusions:In the Han population from northern Henan province, the rs907094 polymorphism of the PPP1R1B gene is associated with schizophrenia.And the specific locus may be implicated in arousal/hostility symptoms and cognitive dysfunction.

Objective To observe the feasibility and accuracy of simplified prenatal ultrasonic evaluation on fetal bilateral lateral fissures.Methods A total of 513 pregnant women with gestational ages ranging from 20-34 weeks were prospectively enrolled.Transabdominal ultrasound screening of fetal bilateral lateral ventricular fissures on the transforaminal plane were performed,the ultrasonic display rate and characteristics like morphology of bilateral lateral fissures were recorded,and a simple grading system(3 levels)was applied for evaluating the fissures.Fetuses with abnormalities were further examined with MR,amniotic fluid/cord blood tests or whole-exome sequencing of umbilical cord tissue after birth.The pregnancy outcomes were documented.Results Normal fetal bilateral lateral fissures were observed using simplified prenatal ultrasonic evaluation in 500 fetuses whom were then successfully delivered,and normal cortical development was found in these 500 newborns,while abnormalities were detected in 13 fetuses.The display rate of transabdominal ultrasound on transforaminal plane for fetal bilateral lateral ventricular fissures was 92.20％(473/513).From 20 to 34 weeks,the morphology of bilateral lateral fissures could be simply graded into 3 levels:Level 1 presented as a shallow arc shape from 20-22 weeks,Level 2 presented as a blunt or right-angled broad platform from 22-26 weeks,and Level 3 presented as an acute-angled broad platform from 25-34 weeks.In 500 fetuses with normal development,the morphology of the near-field lateral fissures consistently developed in parallel with the far-field lateral fissures as gestational age increased.Among 13 fetuses with abnormal findings,abnormalities of bilateral lateral fissures were found in 8 fetuses,while unilateral abnormality was noticed in 5 fetuses.MR examination of all 13 fetuses and amniotic fluid whole-genome sequencing of 9 fetuses indicated abnormal cortical development.Conclusion Simplified prenatal ultrasound based on transforaminal column cross-section could conveniently and accurately classify morphology of fetal bilateral lateral sulcus.

Objective To study the hearing intervention effects of the Shokz condyle-stimulated headband bone-conduction hearing aid on patients with conductive,mixed,and sensorineural hearing loss and to explore its clinical application prospects.Methods A total of 55 patients with hearing loss(age 18～82)participated in the study.Among them,9 had conductive hearing loss,15 had sensorineural hearing loss,and 31 had mixed hearing loss.Their bilat-eral bone conduction pure tone thresholds at 0.5,1,2,and 4 kHz were all ≤60 dB HL.The patients were fitted with the condyle-stimulated headband bone-conduction hearing aid.Hearing thresholds in sound field,single-syllable speech recogni-tion scores in quiet,and sentence recognition thresholds in quiet were assessed before fitting and on the day of 14±2 after fitting to compare differences in results.The effectiveness of the hearing aids on the day of 14±2 after fitting was also eval-uated using the IOI-HA questionnaire.Results After wearing the bone-conduction hearing aid,the average hearing thresh-old and sentence recognition threshold of the patients decreased significantly compared with before fitting(the average hear-ing threshold:56.5±8.2 dB HL before fitting,39.3±4.9 dB HL on the day of 14±2 after fitting;sentence recognition threshold:48.6±9.7 dB HL before fitting,34.3±5.6 dB HL on the day of 14±2 after fitting),and the difference was statistically significant(P＜0.001).The single-syllable speech recognition score before fitting was 29.8％±11.4％,and on the day of 14±2 after fitting,it was 72.4％±14.4％,the difference was statistically significant(P＜0.001).The av-erage total score of the IOI-HA questionnaire was 29.0±3.8 points.Conclusion Condyle-stimulated headband bone-con-duction hearing aids can significantly improve the hearing and speech recognition ability of patients with conductive,mixed and sensorineural hearing loss whose bone conduction pure tone thresholds at 0.5～4 kHz were ≤60 dB HL.It may poten-tially improve the quality of life for patients with hearing loss and holds substantial clinical application value.

OBJECTIVE To investigate the mechanism of action of Quzhuo Tongbi Granules(QZTB)in reducing uric acid and anti-inflammation in mice with hyperuricemia(HUA).METHODS The components of QZTB were identified by ultra-performance liquid chromatography-mass spectrometry(UPLC-MS).Sixty-four C57BL/6 mice were randomly divided into control group,model group,benzbromarone group,QZTB low-dose group,QZTB medium-dose group,QZTB high-dose group,MCC950 group,and MCC950+QZTB medium-dose group,with 8 mice in each group.Adenine(100 mg·kg-1)and potassium oxonate(500 mg·kg-1)were used to establish the HUA mouse model.Except for the control group,all other groups underwent 2 weeks of modeling followed by 4 weeks of treatment.After 2 weeks of modeling,blood was collected from the orbital venous plexus to measure serum uric acid(SUA)levels as the criterion for successful model induction.Mice were sacrificed after 4 weeks of continuous treatment for sample collection.An automatic biochemical analyzer was used to measure serum levels of SUA,urea nitrogen(BUN),and creatinine(Cr).Enzyme-linked immunosorbent assay(ELISA)was employed to detect serum levels of interleukin-1β(IL-1β),interleukin-6(IL-6),interleukin-18(IL-18),and tumor necrosis factor-α(TNF-α).The qPCR was used to assess mRNA expression of urate transporter 1(URAT1),ATP-binding cassette transporter G2(ABCG2),glucose transporter 9(GLUT9),and PDZ domain-contai-ning protein kinase 1(PDZK1)in kidney tissue.Western blot was performed to measure protein expression of urate transporters(URAT1,ABCG2,GLUT9,PDZK1),nuclear transcription factor κB(NF-κB)total protein,phosphorylated NF-κB(p-NF-κB),Nod-like receptor protein 3(NLRP3),Cleaved Caspase-1 and Pro-Caspase-1 proteins in kidney tissue.Immunohistochemistry was used to determine the expression levels of urate transporters(URAT1,ABCG2,PDZK1,GLUT9)in kidney tissue.RESULTS A to-tal of 9 representative active ingredients were identified in QZTB.Two weeks after modeling,SUA in the model group was significantly increased compared with that in the control group(P<0.000 1).Four weeks after administration,serum SUA,BUN and Cr in the model group were significantly increased(P<0.000 1),IL-1β,IL-6,IL-18 and TNF-α levels were increased(P<0.01,P<0.001),the expression of ABCG2 and PDZK1 proteins in renal tissue was decreased(P<0.01,P<0.001,P<0.000 1),and the ex-pression of URAT1,GLUT9,NLRP3,p-NF-κB p65/NF-κB p65 and Cleaved Caspase-1/Pro-Caspase-1 proteins was significantly increased(P<0.01,P<0.001,P<0.000 1).Compared with the model group,SUA,BUN and Cr in the benzbromarone group and the low-,medium-and high-dose QZTB intervention groups were reduced to varying degrees(P<0.001,P<0.000 1).QZTB could ef-fectively reduce the levels of serum inflammatory factors IL-1β,IL-6,IL-18 and TNF-α(P<0.05,P<0.01),increase the expres-sion of ABCG2 and PDZK1 proteins in renal tissue(P<0.05,P<0.01,P<0.000 1),and downregulate the expression of URAT1,GLUT9,NLRP3,p-NF-κB p65/NF-κB p65 and Cleaved Caspase-1/Pro-Caspase-1 proteins(P<0.05,P<0.01,P<0.001,P<0.000 1).Compared with the model group,the MCC950 group downregulated the protein expressions of NLRP3,p-NF-κB p65/NF-κB p65,and Cleaved Caspase-1/Pro-Caspase-1(P<0.01).Compared with the MCC950 group or the QZTB group,the MCC950+QZTB group downregulated the protein expressions of NLRP3,p-NF-κB p65/NF-κB p65,and Cleaved Caspase-1/Pro-Caspase-1(P<0.05,P<0.01,P<0.000 1).CONCLUSION QZTB can promote uric acid excretion by inhibiting the NF-κB/NLRP3 signaling pathway,thereby improving the symptoms of HUA.