Objective To study the five-year survival status and influencing factors of elderly patients with lung cancer complicated with chronic obstructive pulmonary disease (COPD). Methods A cohort study was conducted to follow up 450 patients with lung cancer and chronic obstructive pulmonary disease who were hospitalized in our hospital from January 2018 to December 2023. The endpoint of the follow-up was the end of a five-year period or death. The Life Tables method was used to calculate survival rates and plot survival curves. The Cox proportional hazards model was used to analyze the influencing factors of five-year survival. Results The results indicated that the overall five-year survival rate of patients was 4.89%, and it decreased year by year. Cox regression analysis showed that age, gender, family functioning, and psychological status significantly influenced patient survival rate (all P<0.05). Stratified analysis found that the smoking status, family functioning, and psychological status of male patients all had an impact on survival rate (all P<0.05), while the psychological status of female patients had a more significant impact on survival (P=0.008). Conclusion This study provides a scientific basis for comprehensive intervention of elderly lung cancer patients with COPD. It is recommended that clinical attention should be paid to psychological and family factors to improve patient prognosis.

Objective To analyze the effect of releasing the lower pulmonary ligament on right residual lung expansion after right upper lobe resection under different body mass index (BMI) levels. Methods The clinical data of patients who underwent thoracoscopic right upper lobe resection in the First Affiliated Hospital with Nanjing Medical University from 2021 to 2022 were retrospectively analyzed. Patients were divided into a group A (17 kg/m2＜BMI≤23 kg/m2), a group B (23 kg/m2＜BMI≤29 kg/m2) and a group C (BMI＞29 kg/m2) according to BMI. The presence of residual cavity was judged by chest X-ray at 7-10 days after operation, the degree of compensation change of the right main bronchus angle was measured, and the changes in lung volume were determined by CT three-dimensional reconstruction. Results A total of 157 patients who underwent thoracoscopic right upper lobe resection were included, including 71 males and 86 females, with an average age of (59.7±11.2) years. There were 50 patients in the group A, 75 patients in the group B, and 32 patients in the group C. In the group A, compared with those without releasing the lower pulmonary ligament, patients with releasing had a lower incidence of postoperative residual cavity (P=0.016), greater changes in bronchus angle (P<0.001), and smaller changes in lung volume (P<0.001). In the group B and C, there was no significant effect of releasing the lower pulmonary ligament on postoperative residual cavity, bronchus angle, and lung volume changes (P>0.05). Conclusion For patients with thin and long body shape and low BMI, releasing the lower pulmonary ligament is helpful to promote the expansion of the residual lung after right upper lobe resection and reduce the occurrence of postoperative residual cavity in patients.

A 51-year-old male presented with nasal obstruction, followed by progressive hearing loss and blurred vision. Imaging identified space-occupying lesions in the paranasal sinuses, orbits, and paraspinal regions, while laboratory tests confirmed positive anti-proteinase 3 anti-neutrophil cytoplasmic antibody(PR3- ANCA) immunoglobulin G (IgG)and markedly elevated serum IgG4. Despite treatment with corticosteroids, immunosuppressants, and radiotherapy, the patient exhibited steroid dependency with relentless disease progression. Following multidisciplinary consultation, a diagnosis of inflammatory myofibroblastic tumor (IMT) coexisting with ANCA- associated vasculitis (AAV) was favored, though IgG4-related disease remained a critical differential. Ultimately, profound immunosuppression precipitated a severe herpesvirus infection, leading to disseminated intravascular coagulation and multiple organ dysfunction syndrome. This case underscores the rarity and diagnostic complexity of concurrent IMT and AAV, highlights the therapeutic dilemma of balancing primary disease control against fatal opportunistic infections, and emphasizes the critical role of multidisciplinary collaboration in the diagnosis and treatment of complex diseases.

Objective To investigate the capacity of municipal and county-level Centers for Disease Control (CDC) in Shandong Province for γ radionuclides in food as well as gross α and gross β in drinking water, and to provide evidence for strengthening radiological laboratories. Method Data regarding radioactive detection capacity were collected from 16 prefecture-level cities and 136 county-level CDCs. Chi-square test and Fisher's exact tests were used to compare capacity differences across regions and between cities with and without nuclear power plants. Correlation analysis was used to evaluate the spatial equity of gross α and gross β detection capacity for drinking water. Result The detection capacity of gross α and gross β in drinking water varied significantly among counties (χ²=81.026, P<0.001），no significant difference was found between coastal and inland cities (χ²=2.021，P>0.155); Cities with nuclear power plants showed better detection capacity (χ²=20.253，P<0.01). The detection capacity for γ radionuclides in food was primarily concentrated in the prefecture-level cities that host nuclear power plants. Conclusion The overall detection capacity for radioactivity in drinking water was acceptable but spatially uneven. The capacity for monitoring radioactive contamination in food was generally weak. It is necessary to strengthen capacity building at the grassroots level.

Objective To develop measurement instruments of dynamic capabilities for public hospitals,providing a reference for the evaluation and enhancement of their dynamic capabilities.Methods The initial construction of the measurement instruments of dynamic capabilities for public hospitals was based on literature review and focused group discussions.Two rounds of expert consultation were conducted using the Delphi method,and the reliability and validity of the questionnaire was initially examined through pre-survey.Results The effective response rates for both rounds of consultation were above 85％,with high positive coefficient,the authority coefficients greater than 0.8,and variation coefficients less than 0.25,indicating a high level of consensus among experts.Furthermore,the reliability and validity are acceptable.After integrating expert feedback,the measurement instruments of dynamic capabilities for public hospitals were finalized,encompassing four dimensions:sensing,learning,integration capability,and innovation capabilities.Conclusion The measurement instruments of dynamic capabilities for public hospitals,developed based on the Delphi method,can be applied in the practice of evaluating and enhancing the dynamic capabilities of public hospitals.

Objective:To observe the efficacy and safety of polatuzumab vedotin(pola)combined with chemotherapy in the treatment of relapsed and refractory diffuse large B-cell lymphoma(R/R DLBCL).Methods:A total of 23 patients with R/R DLBCL treated at the First Affiliated Hospital of Zhejiang University and its Liangzhu Branch from April 2023 to March 2024 were retrospectively collected.All patients were treated with pola combined with chemotherapy regimens such as BR,R-GDP,R-CHOP,or other regimens.Results:All 23 patients were evaluable for efficacy,with 10 achieving complete response(CR),7 partial response(PR),3 stable disease(SD),and 3 progressive disease(PD).The most common adverse events included myelosuppression,fever,and pulmonary infection.No severe adverse events resulted in drug withdrawal.Conclusion:Pola combined with chemotherapy demonstrates promising efficacy and a favorable safety profile in the treatment of R/R DLBCL.

Objective:To assess the impact of urban-rural health insurance integration on the non-agricultural employment of rural labor in China.Methods:Using CHFS data(2011-2019)and a DID model,this study analyzed the impact on non-agricultural employment probability and quality(wage income,job stability)and examined the effect of different integration models.Results:The integration of urban and rural health insurance significantly increases the probability and quality of non-agricultural employment among rural labor.This effect operates through three key mechanisms:easing household liquidity constraints,improving health-related human capital,and expanding job search scope.Moreover,the"unified urban-rural tier"model proves more effective than the"one-system-multi-tiers"model in promoting non-agricultural employment and enhancing job quality.Conclusion:The integration positively contributes to improving rural labor allocation efficiency and mobilizing surplus rural labor capacity.Policy recommendations include accelerating the adoption of the"unified urban-rural tier"model and further refining the urban-rural resident health insurance system.

Objective To develop measurement instruments of dynamic capabilities for public hospitals,providing a reference for the evaluation and enhancement of their dynamic capabilities.Methods The initial construction of the measurement instruments of dynamic capabilities for public hospitals was based on literature review and focused group discussions.Two rounds of expert consultation were conducted using the Delphi method,and the reliability and validity of the questionnaire was initially examined through pre-survey.Results The effective response rates for both rounds of consultation were above 85％,with high positive coefficient,the authority coefficients greater than 0.8,and variation coefficients less than 0.25,indicating a high level of consensus among experts.Furthermore,the reliability and validity are acceptable.After integrating expert feedback,the measurement instruments of dynamic capabilities for public hospitals were finalized,encompassing four dimensions:sensing,learning,integration capability,and innovation capabilities.Conclusion The measurement instruments of dynamic capabilities for public hospitals,developed based on the Delphi method,can be applied in the practice of evaluating and enhancing the dynamic capabilities of public hospitals.

Objective:To assess the impact of urban-rural health insurance integration on the non-agricultural employment of rural labor in China.Methods:Using CHFS data(2011-2019)and a DID model,this study analyzed the impact on non-agricultural employment probability and quality(wage income,job stability)and examined the effect of different integration models.Results:The integration of urban and rural health insurance significantly increases the probability and quality of non-agricultural employment among rural labor.This effect operates through three key mechanisms:easing household liquidity constraints,improving health-related human capital,and expanding job search scope.Moreover,the"unified urban-rural tier"model proves more effective than the"one-system-multi-tiers"model in promoting non-agricultural employment and enhancing job quality.Conclusion:The integration positively contributes to improving rural labor allocation efficiency and mobilizing surplus rural labor capacity.Policy recommendations include accelerating the adoption of the"unified urban-rural tier"model and further refining the urban-rural resident health insurance system.

Aim To investigate the role of FRMD4A in autophagy of placental trophoblast cells in preeclampsia(PE).Methods The placental tissues and clinical data of normal pregnancy and PE were obtained,and the histopathological changes were observed by HE staining.An in vitro model of hypoxia-induced HTR-8/SVneo trophoblast cells was established.The expres-sions of LC3B Ⅱ/Ⅰ and p62 in placental tissues and hypoxic cell models were analyzed by Western blot.The expression of FRMD4A was detected by qRT-PCR,Western blot and immunofluorescence,and the correlation between the expression level of FRMD4A and the clinical characteristics of the subjects was ana-lyzed by Pearson correlation analysis.Hypoxia induced trophoblast cells were transfected with si-FRMD4A,and the expression of LC3 B Ⅱ/Ⅰ and p62 was analyzed by Western blot.Results Compared with the normal group,the expression of LC3B Ⅱ/Ⅰ in PE placental tissues and hypoxia-induced trophoblast models was significantly upregulated,while the expression of p62 was significantly downregulated.Meanwhile,the ex-pression of FRMD4A increased significantly.Moreo-ver,its expression was positively correlated with the maternal systolic blood pressure,diastolic blood pres-sure,and platelet count,but negatively correlated with the neonatal weight(P＜0.01).In addition,hypoxia-induced trophoblast cells transfected with si-FRMD4A showed a significant decrease in LC3B Ⅱ/Ⅰ and an increase in p62 expression.Conclusions The expres-sion of FRMD4A is upregulated in PE placenta and hy-poxia-induced trophoblast cell model.Interfering with it can significantly hinder the autophagy process of trophoblast cells,suggesting that it may serve as a po-tential molecular target to participate in the pathologi-cal process of PE.