Peptide receptor radionuclide therapy (PRRT) with radiolabeled SSTR2 agonists is a treatment option that is highly effective in controlling metastatic and progressive neuroendocrine tumors (NETs). Previous studies have shown that an SSTR2 agonist combined with albumin binding moiety Evans blue (denoted as ¹⁷⁷Lu-EB-TATE) is characterized by a higher tumor uptake and residence time in preclinical models and in patients with metastatic NETs. This study aimed to enhance the in vivo stability, pharmacokinetics, and pharmacodynamics of ¹⁷⁷Lu-EB-TATE by replacing the maleimide-thiol group with a polyethylene glycol chain, resulting in a novel EB conjugated SSTR2-targeting radiopharmaceutical, ¹⁷⁷Lu-LNC1010, for PRRT. In preclinical studies, ¹⁷⁷Lu-LNC1010 exhibited good stability and SSTR2-binding affinity in AR42J tumor cells and enhanced uptake and prolonged retention in AR42J tumor xenografts. Thereafter, we presented the first-in-human dose escalation study of ¹⁷⁷Lu-LNC1010 in patients with advanced/metastatic NETs. ¹⁷⁷Lu-LNC1010 was well-tolerated by all patients, with minor adverse effects, and exhibited significant uptake and prolonged retention in tumor lesions, with higher tumor radiation doses than those of ¹⁷⁷Lu-EB-TATE. Preliminary PRRT efficacy results showed an 83% disease control rate and a 42% overall response rate after two ¹⁷⁷Lu-LNC1010 treatment cycles. These encouraging findings warrant further investigations through multicenter, prospective, and randomized controlled trials.

Objective:To investigate the current status of fear of falling in postoperative cardiac surgery patients, and to analyze its influencing factors and interrelationships.Methods:A convenience sample of 246 postoperative cardiac surgery patients hospitalized in the Department of Cardiac Surgery, the First Affiliated Hospital of Xiamen University, from December 2023 to December 2024 was surveyed. The Body Image Scale, the Personal Mastery Scale, the Fear of Falling Questionnaire-Revised, and a self-designed demographic and clinical questionnaire were used for data collection. Pearson correlation analysis was conducted to examine the relationships among body image, personal mastery, and fear of falling. PROCESS Model 4 was applied to test the mediating role of personal mastery between body image and fear of falling, with bootstrapping for verification.Results:A total of 246 questionnaires were distributed, and 236 valid responses were obtained (valid response rate: 95.93%) . The body image score was (14.02±6.36) , personal mastery score was (20.44±4.16) , and fear of falling score was (38.28±10.83) . Body image was positively correlated with fear of falling ( r=0.324, P<0.01) , while personal mastery was negatively correlated with fear of falling ( r=-0.552, P<0.01) . After controlling for variables with statistically significant differences in univariate analysis (including sex, age, education level, body mass index, history of syncope, pain level, and self-rated preoperative exercise capacity) , PROCESS analysis showed that body image had a direct positive effect on fear of falling ( β=0.288, P<0.05) , and also indirectly affected fear of falling through personal mastery, with the indirect effect accounting for 49.5% of the total effect (0.237/0.525) . Conclusions:Postoperative cardiac surgery patients require improvement in body image, personal mastery, and fear of falling. Understanding how body image influences fear of falling through personal mastery not only enriches theoretical frameworks but also provides guidance for psychological interventions in clinical practice, thereby meeting patients' psychological support needs during rehabilitation.

Clinical teaching managers are the designers, implementers, and supervisors of clinical medical education. Their competence level directly affects the quality of hospital teaching management and clinical medical education. The competence evaluation systems for medical education managers in countries such as the United States and the United Kingdom are well-established, which provides a reference for the competence evaluation of clinical teaching managers in China. This research systematically reviews the construction process and current situation of the competence evaluation systems for medical education managers in the world, and summarizes the basis, methods, and dimensions of competence evaluation. According to the actual situation of clinical teaching management, suggestions were put forward, including developing systematic scientific evaluation tools, carrying out competence-oriented training and assessment, focusing on student-centered education, and creating a career path of sustainable development.

Objective:To investigate the current status of fear of falling in postoperative cardiac surgery patients, and to analyze its influencing factors and interrelationships.Methods:A convenience sample of 246 postoperative cardiac surgery patients hospitalized in the Department of Cardiac Surgery, the First Affiliated Hospital of Xiamen University, from December 2023 to December 2024 was surveyed. The Body Image Scale, the Personal Mastery Scale, the Fear of Falling Questionnaire-Revised, and a self-designed demographic and clinical questionnaire were used for data collection. Pearson correlation analysis was conducted to examine the relationships among body image, personal mastery, and fear of falling. PROCESS Model 4 was applied to test the mediating role of personal mastery between body image and fear of falling, with bootstrapping for verification.Results:A total of 246 questionnaires were distributed, and 236 valid responses were obtained (valid response rate: 95.93%) . The body image score was (14.02±6.36) , personal mastery score was (20.44±4.16) , and fear of falling score was (38.28±10.83) . Body image was positively correlated with fear of falling ( r=0.324, P<0.01) , while personal mastery was negatively correlated with fear of falling ( r=-0.552, P<0.01) . After controlling for variables with statistically significant differences in univariate analysis (including sex, age, education level, body mass index, history of syncope, pain level, and self-rated preoperative exercise capacity) , PROCESS analysis showed that body image had a direct positive effect on fear of falling ( β=0.288, P<0.05) , and also indirectly affected fear of falling through personal mastery, with the indirect effect accounting for 49.5% of the total effect (0.237/0.525) . Conclusions:Postoperative cardiac surgery patients require improvement in body image, personal mastery, and fear of falling. Understanding how body image influences fear of falling through personal mastery not only enriches theoretical frameworks but also provides guidance for psychological interventions in clinical practice, thereby meeting patients' psychological support needs during rehabilitation.

Clinical teaching managers are the designers, implementers, and supervisors of clinical medical education. Their competence level directly affects the quality of hospital teaching management and clinical medical education. The competence evaluation systems for medical education managers in countries such as the United States and the United Kingdom are well-established, which provides a reference for the competence evaluation of clinical teaching managers in China. This research systematically reviews the construction process and current situation of the competence evaluation systems for medical education managers in the world, and summarizes the basis, methods, and dimensions of competence evaluation. According to the actual situation of clinical teaching management, suggestions were put forward, including developing systematic scientific evaluation tools, carrying out competence-oriented training and assessment, focusing on student-centered education, and creating a career path of sustainable development.

Objective:To analyze the advantages of human epididymis protein 4 (HE4) compared with traditional tumor markers in the diagnosis and treatment of lung cancer.Methods:From February 2021 to June 2022, 230 lung cancer patients (138 males, 92 females; age (61.1±12.3) years), 96 benign lung disease patients (62 males, 34 females; age (60.2±14.8) years; including 43 cases of lung benign placeholder and 53 cases of pulmonary infection), and 60 healthy volunteers (40 males, 20 females; age (62.8±11.4) years) from the Second Affiliated Hospital of Soochow University were prospectively collected. Serum HE4, carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cytokeratin 19 fragment (CYFRA21-1), pro-gastrin-releasing peptide (ProGRP) and carbohydrate antigen (CA)125 were detected by electrochemical analysis. The expression of HE4 in tumor tissues of 55 patients with lung cancer was detected by immunohistochemical method. χ2 test, Mann-Whitney U test, Kruskal-Wallis rank sum test and Bonferroni correction method were used to analyze data. The diagnostic efficiencies of HE4 and other tumor markers were evaluated by ROC curve analysis and the difference of AUCs was analyzed by Delong test. Results:The positive expression rate of HE4 in adenocarcinoma tissue was significantly higher than that in non-adenocarcinoma tissue (93.1%(27/29) vs 23.1% (6/26); χ2=28.01, P<0.001). The level of serum HE4 in the lung cancer group (70.70(51.93, 109.05) pmol/L) was significantly higher than that in the pulmonary benign placeholder group (59.80(48.20, 73.50) pmol/L) and the healthy control group (55.25(44.60, 74.25) pmol/L), and that in the pulmonary infection group (97.90(76.62, 155.00) pmol/L) was higher than that in the lung cancer group ( H=46.19, all P<0.008 (Bonferroni correction method)). The levels of serum HE4 were significantly different in age, sex, smoking, disease stage and pathological types in early stage ( z values: from -5.07 to 9.83, all P<0.05). The ROC curve analysis indicated that the optimal cut-off value of serum HE4 for diagnosing lung cancer was 79.22 pmol/L, with the sensitivity and specificity of 41.30%(95/230) and 83.33%(50/60). Compared with other traditional tumor markers, serum HE4 and CA125 showed the higher diagnostic value (AUC CA125 (0.695)>AUC HE4(0.656)>AUC CEA(0.614)>AUC CYFRA21-1(0.599)>AUC ProGRP (0.501)>AUC NSE (0.470)). The combination of HE4 with other traditional tumor markers significantly improved the diagnostic efficacy (AUC=0.750; z=2.75, P=0.006). Conclusions:HE4 is highly expressed in lung adenocarcinoma by immunohistochemistry. Serum HE4 exhibits a great application value in the differential diagnosis between benign and malignant pulmonary nodules, and plays an important role in assessment of patients′ conditions.

The psychoactive properties of cannabinoids are well known,and there are controversies over whether cannabinoids can be used for therapeutic purposes worldwide.Δ9-tetrahydrocannabinol(THC)is the main psychoactive substance in cannabis.The neurological mechanisms of THC were only recently discovered,and its neurological mechanism of action is still not fully understood.The blood-brain barrier(BBB)is a very important structure protecting the brain and is the first line of defense preventing foreign substances from entering the brain.THC's lipophilic nature and its interaction with the endocannabinoid system make it more likely to act on the BBB.In this paper,we review the neurotoxic effects of THC,focusing on its effect and mechanism of action on the BBB,and provide a theoretical basis for studies elucidating the neural mechanism of THC.

Climate change has led to an increasing frequency and intensity of extreme climate events such as heat and drought extremes with considerable global public health burden. This systematic review collected 87 domestic and international studies from 2000 to 2023, considering the impacts of heat extremes, drought extremes, and compound hot-dry events on infectious diseases attributable to various transmission pathways such as waterborne, foodborne, insect-borne, airborne, and contact-transmitted diseases. Our results showed that high temperature was associated with increased transmission risks of waterborne and foodborne diseases including infectious diarrheal diseases (cholera, dysentery, typhoid, and paratyphoid) and infectious gastroenteritis; vector-borne diseases including dengue fever, Zika virus (ZIKV) disease, chikungunya fever, malaria, West Nile fever, and Rift Valley fever; airborne diseases including influenza-like diseases, influenza A, measles, and mumps; and contact-transmitted diseases including HIV/AIDS, schistosomiasis, and leptospirosis. Additionally, drought conditions also amplified the transmission risks of waterborne and foodborne diseases including cholera, Escherichia coli infection, rotavirus infection, and hepatitis E; vector-borne diseases such as scrub typhus, schistosomiasis, hemorrhagic fever with renal syndrome, and West Nile fever; airborne diseases including meningococcal meningitis, pertussis, measles, and upper respiratory infections; and contact-transmitted diseases such as HIV/AIDS. Along with global warming, the frequency of compound high temperature and drought events shows a considerably increasing trend, causing more adverse health effects than heat or drought alone. However, there is limited research quantifying their effects on infectious diseases. These associations may be mediated through temperature and precipitation on infectious disease pathogens, transmission vectors, population susceptibility, public health services, and behaviors. In the context of climate change, the increasing occurrence of compound events of high temperatures and droughts raises health concerns, and further studies are needed to enhance our understanding of the impacts of climate change on infectious diseases and improve human adaption to climate change.

Jinlingzi San is a formula frequently used in treating pain syndrome， first recorded in the Collection of Writings on the Mechanism of Disease， Suitability of Qi， and the Safeguarding of Life as Discussed in the 'Basic Questions' written by LIU Wansu in the Jin Dynasty. Jinlingzi San is composed of 2 Chinese medicinals Toosendan Fructus and Corydalis Rhizoma with a concise composition and exact clinical efficacy， having been included in the Catalogue of Ancient Classical Formulas （Second Batch： Han Chinese Medicine）. The formula name， historic evolution， medicine origins， composition， dosage， decocting methods， and ancient and modern clinical application were sorted out and analyzed with the bibliometric method. A total of 209 pieces of information were collected from ancient books and literature. After screening， 49 pieces of effective data involving 45 ancient books were included. Results showed that the name of Jinlingzi San was first recorded in Secret Formulas of the Yang Family written by Yang Tan in the Southern Song Dynasty and developed into 3 other versions of the decoction. The Jinlingzi San included in the Collection of Writings on the Mechanism of Disease， Suitability of Qi， and the Safeguarding of Life as Discussed in the 'Basic Questions' written by LIU Wansu invariably plays a dominant role. As for the 3 other versions， although they have the same name of Jinlingzi San， their composition and indications are different from those of the original formula， which were therefore viewed as prescriptions based on Jinlingzi San and also included in the research. The medicine origins and processing of Jinlingzi San are suggested： Toosendan Fructus is the dry mature fruit of Melia toosendan of Meliaceae， and the crude is used after cleansing without putamen. Corydalis Rhizoma is the dry tuber of Corydalis yanhusuo of Papaveraceae， which is used after impurity removal， cleaning， and drying. Depending on the conversion from the measurement system in the Jin Dynasty to modern measurement， it is suggested that Toosendan Fructus and Corydalis Rhizoma （41.3 g each） are ground into fine powder， and one dose includes 12.39 g of the powder， which should be taken with an appropriate amount of wine. If wine is not suitable for the patient， the decoction can also be taken with warm water. Jinlingzi San has the effects of soothing the liver， discharging heat， and activating blood to stop pain. As recorded in ancient books， Jinlingzi San is specialized in treating heart pain caused by reversal heat， chest and abdominal pain， hypochondriac pain， jaundice， hernia， and other diseases. Modern studies have shown that modified Jinlingzi San can be used in treating diseases involving the digestive system， the integumentary system， the gynecological system， the reproductive system， and other systems and has wide clinical application in treating epigastric pain， herpes zoster， dysmenorrhea， and other diseases. This study has made clear the key information of Jinlingzi San by textual research of ancient books and literature in the hope of providing a theoretical reference for the clinical application， set prescriptions， and new drug development.

Traumatic brain injury(TBI)is caused by the direct or indirect effects of external factors that result in structural or functional loss of brain tissue.Astrocytes are homeostatic cells in the central nervous system that proliferate and activate rapidly in the early stages of TBI.They then participate in a series of pathological processes,such as neuroinflammation,blood-brain barrier disruption,glial scarring,and excitotoxicity after injury,and thus play a crucial role in secondary neurological injury following TBI.This paper reviews the role of astrocytes in the repair of TBI damage,with the aim of providing new strategies for the prevention and treatment of TBI.