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There is limited research on the impact of chemotherapy on the prognosis of different age group patients with small cell lung cancer (SCLC). The aim of this study was to explore the impact of chemotherapy on survival prognosis of elderly patients with SCLC.Based on the Surveillance, Epidemiology and End Results (SEER) database, 57,460 SCLC patients between 2004 and 2015 were identified and divided into a ≤ 80 years group (KM analysis showed that both OS and LCSS were improved in chemotherapy group compared to those in non-chemotherapy group (log rankElderly patients with SCLC should be encouraged to receive chemotherapy provided their general conditions permit.

Since December 2019, medical practitioners discovered a novel coronavirus causing an acute respiratory-tract infection in some hospitals in Wuhan, Hubei Province. COVID-19 has spread globally, making it an epidemic worldwide at present. Understanding the mental-health responses of college students to COVID-19 can help a school staff to better guide students seeking education.The study aimed to explore the differences between nonmedical and medical college students during the COVID-19 epidemic in their cognitive interest about the disease, preventive behaviors, psychological effects, and job-search intentions, hoping to provide more targeted measures for virus-coping education for college students.The research team conducted a cross-sectional study, using an anonymous online questionnaire.The study took place at Shanghai, China.Participants were 1648 college students studying different specialties in various provinces of China, 485 nonmedical students and 1163 medical students.The survey's questions covered the respondents': (1) general demographic characteristics, (2) cognitive interest and knowledge about COVID-19 and its infectiousness as well as efforts at active learning about infectious diseases and viruses, (3) awareness of precautionary behaviors against COVID-19, (4) effects on mental health, and (5) effects on job-search intentions. The research team used descriptive statistics and Chi-square tests to analyze the survey data.Among nonmedical students: (1) 297 participants (61.2%) were interested in learning about COVID-19, (2) 321 participants (66.2%) took the initiative to learn about the virus, (3) 301 participants (62.1%) took the initiative to learn about infectious disease, and (4) 151 participants (31.1%) watched medical-themed movies or TV series about COVID-19. Among medical students, the corresponding proportions were 772 participants (66.4%), 855 participants (73.5%), 791 participants (68.1%), and 791 participants (68.1%), respectively. Among nonmedical students, 223 participants (46.0%) had N95 masks available, 429 participants (88.5%) had disinfectant supplies available, 271 participants (55.9%) wore goggles in public places, 75 participants (15.5%) chose public transportation, and 77 participants (15.9%) were exposed to public places in the week prior to the survey. Among medical students, the corresponding proportions were 470 participants (40.4%), 935 participants (80.4%), 575 participants (49.4%), 243 participants (20.9%), and 297 participants (25.5%), respectively. Furthermore, COVID-19 had a stronger effect on medical students' psychology and job-search ambitions.The news about COVID-19 piqued the interest of medical students. Nonmedical students had stronger protective behavior than medical students. The COVID-19 outbreak had a significant influence on medical students' lives, studies, and moods. In addition, COVID-19 had a greater impact on the job-search intentions of medical students.

In the process of combating the coronavirus disease 2019 (COVID-19) epidemic, medical personnel were at the forefront of the fight. As the future medical workforce, medical students often experienced firsthand how their seniors and teachers had to commit to working hard in combating the epidemic. Many were directly involved in the front line of the fight and that experience could easily have affected their intention to seek employment in a medically related career.The study intended to evaluate the impact of the COVID-19 pandemic on Chinese medical students' employment intentions and the factors associated with them to put forward relevant suggestions to provide a basis for medical education in the future.The research team conducted a cross-sectional study, using an anonymous online questionnaire.The study took place in many provinces and cities in China and was conducted in an online questionnaire.Participants were 1114 college students studying clinical medicine, college students studying nursing, and students interning during standardized resident training, medical interns.The participants completed a self-administered questionnaire, which investigated their psychological statuses related to anxiety and depression as well as COVID-19's impact on their intentions related to job searches, regarding their willingness to engage in clinical or basic research in epidemic-related specialties and epidemic-related work.Compared to college students studying clinical medicine, the employment intentions of nursing students and medical interns were more vulnerable to the epidemic. Females and nursing students were more reluctant to choose clinical work, and the choice was associated with depression. Nursing college students and medical interns were significantly less willing to engage in infection medicine, respiratory medicine, and intensive care medicine (all P.001). Medical students with a bachelor's degree and postgraduate degrees were significantly less willing to engage in infection medicine and respiratory medicine (all P.001), but medical students from regions with stable epidemics were more willing to engage in intensive care medicine. Medical students with a bachelor's degree were significantly less likely to be involved in epidemiology-related work than undergraduate students, and students from severe epidemic regions were significantly less willing to work in isolation wards or to go to Wuhan as volunteers.Participants' psychological statuses related to anxiety and depression, genders, degrees, current educational statuses, and regions affected employment intentions during the epidemic.

Regular exercise is confirmed as a lifestyle treatment option for all obstructive sleep apnea (OSA) patients. It has beneficial effects other than weight loss, although the mechanisms remain unclear. Autonomic function imbalance plays an important role in OSA, so that it is meaningful to observe the effect of exercise on autonomic function. Seventy mild to moderate OSA patients were divided into two groups. The exercise group received a 12-week exercise program prescribed according to their first cardiopulmonary exercise tests, while the control group kept previous lifestyle. All patients underwent blood tests, cardiopulmonary exercise tests, and polysomnography studies at enrollment and at the 12-week’s follow-up. At the end of 12 weeks, three patients of the exercise group did not complete the program due to lack of adherence. The current study showed 12-week aerobic exercises could improve body mass index (27.6 ± 4.7 kg/m2 vs. 24.5 ± 4.2 kg/m2, P

Background Although traditional diagnostic techniques of infection are mature and price favorable at present, most of them are time-consuming and with a low positivity. Metagenomic next⁃generation sequencing (mNGS) was studied widely because of identification and typing of all pathogens not rely on culture and retrieving all DNA without bias. Based on this background, we aim to detect the difference between mNGS and traditional culture method, and to explore the relationship between mNGS results and the severity, prognosis of infectious patients. Methods 109 adult patients were enrolled in our study in Shanghai Tenth People’s Hospital from October 2018 to December 2019. The diagnostic results, negative predictive values, positive predictive values, false positive rate, false negative rate, pathogen and sample types were analyzed by using both traditional culture and mNGS methods. Then, the samples and clinical information of 93 patients in the infected group (ID) were collected. According to whether mNGS detected pathogens, the patients in ID group were divided into the positive group of 67 cases and the negative group of 26 cases. Peripheral blood leukocytes, C-reactive protein (CRP), procalcitonin (PCT) and neutrophil counts were measured, and the concentrations of IL-2, IL-4, IL-6, TNF-α, IL-17A, IL-10 and INF-γ in the serum were determined by ELISA. The correlation between the positive detection of pathogens by mNGS and the severity of illness, hospitalization days, and mortality were analyzed. Results 109 samples were assigned into infected group (ID, 92/109, 84.4%), non-infected group (NID, 16/109, 14.7%), and unknown group (1/109, 0.9%). Blood was the most abundant type of samples with 37 cases, followed by bronchoalveolar lavage fluid in 36 cases, tissue, sputum, pleural effusion, cerebrospinal fluid (CSF), pus, bone marrow and nasal swab. In the ID group, the majority of patients were diagnosed with lower respiratory system infections (73/109, 67%), followed by bloodstream infections, pleural effusion and central nervous system infections. The sensitivity of mNGS was significantly higher than that of culture method (67.4% vs 23.6%; P P = 0.002), blood (P < 0.001) and sputum (P = 0.037), while the specificity of mNGS was not significantly different from culture method (68.8% vs 81.3%; P = 0.41). The number of hospitals stays and 28-day-motality in the positive mNGS group were significantly higher than those in the negative group, and the difference was statistically significant (P Conclusions The study found that mNGS had a higher sensitivity than the traditional method, especially in blood, bronchoalveolar lavage fluid and sputum samples. And positive mNGS group had a higher hospital stay, 28-day-mortality, which means the positive of pathogen nucleic acid sequences detection may be a potential high-risk factor for poor prognosis of adult patients and has significant clinical value. MNGS should be used more in early pathogen diagnosis in the future.

Approximately 20% of patients with resectable non-small cell lung cancer (NSCLC) are treated nonsurgically. To compare the clinical outcomes between nonsurgical patients receiving radiofrequency ablation (RFA) alone and those receiving no treatment (NT), we assessed RFA effectiveness in terms of survival using the surveillance, epidemiology, and end-results (SEER) database.Using the SEER registry process, we identified 5268 patients who were ineligible for the surgical treatment between 2004 and 2015. Overall survival (OS) and cancer-specific survival (CSS) were compared between the groups using propensity score matching (PSM), inverse probability of treatment weight (IPTW), and overlap weight analysis. In addition, an exploratory analysis was conducted to determine RFA treatment effectiveness based on clinically relevant patient subsets.Of the 5268 patients, 189 (3.6%) received RFA. The OS and CSS in these patients were significantly better than those in the NT group (P0.0001). RFA was associated with a 16-month median OS improvement. Both OS and CSS improved in the nonsurgical patients (hazard ratio [HR], 0.695, 95% confidence interval [CI], 0.585-0.826, P0.0001; HR, 0.636; 95% CI, 0.505-0.800, P0.0001). The 1-, 3-, and 5-year OS in the unmatched RFA and NT groups were 84.2%, 49.0%, and 29.4% vs. 62.8%, 31.1%, and 17.1%, respectively (P0.001). PSM, IPTW, and overlap weight analysis showed comparable results. The odds of receiving RFA decreased with larger tumor size (1, ≤2 cm, odds ratio [OR], 0.623, 95% CI, 0.402-0.966;2, ≤3 cm, OR, 0.300, 95% CI, 0.186-0.483) compared to tumor size s1 cm (P0.05).RFA improves unresected stage IA NSCLC patient survival. Our results are limited by the retrospective nature of the study; however, we believe that our findings are noteworthy for recommending local ablative therapy.

Introduction: To investigate the effects and influencing factors of the COVID-19 epidemic on the employment intention of resident physicians in China. Methodology: 409 questionnaires were statistically analyzed after removing the missing values. We used the Chi-Square test for single-factor analysis and logistic regression analysis for multivariate analysis. The questions include the residents' employment intention and their willingness to engage in epidemic-related subspecialties and participate in epidemic-related work. Results: Residents of severe and high-risk epidemic regions had much lower employment intentions than those of stable epidemic regions (OR = 1.917, 95% CI: 1.024, 3.591, p = 0.042). The higher the Center for Epidemiologic Studies Depression Scale (CES-D) score, the more susceptible was the resident's employement intention (OR = 1.085, 95% CI: 1.044, 1.128, p < 0.001). Residents from severe and high-risk epidemic regions were more willing to participate in clinical work (OR = 4.263, 95% CI: 1.892, 9.604, p < 0.001), and the higher the CES-D score, the lower was the proportion of residents willing to choose clinical work (OR = 0.941, 95% CI: 0.893, 0.992, p = 0.023). Residents from severe epidemics and high-risk provinces were less willing to participate in respiratory medicine (χ2 = 5.070, p = 0.027) and critical care medicine (χ2 = 7.046, p = 0.011). Compared to residents with bachelor’s degrees, residents with master’s and doctoral degrees were less willing to participate in isolation wards (OR = 1.831, 95% CI: 1.122, 2.990, p = 0.016). Residents in epidemic-related current rotation departments were less willing to go to Wuhan as volunteers (OR = 2.197, 95% CI: 1.110, 4.347, p = 0.024). Conclusions: The COVID-19 outbreak had a negative impact on the job intentions of Chinese residents in general.

Background Currently, the integrated curriculum of urology is still on the road of complete integration. Co-teaching, an existing concept in education, however, may be used to promote the integration of urology. Therefore, the present study was designed to explore the effect of co-teaching method compare with the traditional teaching method.Methods Co-teaching and traditional teaching in the topics hematuria and acute kidney injure (AKI) were prepared and validated. 98 undergraduate medical students of Tongji University were randomly assigned to groups A and B. Group A was taught hematuria by Co-teaching (CT) and AKI by traditional teaching (TT) and Group B was taught hematuria by TT and AKI by CT. A knowledge assessment tool of 20 multiple choice items was administered to assess the pre, post and retention knowledge scores. Change between knowledge scores was analyzed using inferential statistics. One students’ questionnaire and one tutors’ questionnaire were designed and used to investigate the perception on teaching-learning experience.Results Both traditional teaching and co-teaching were significantly effective in increasing the knowledge scores with no significant difference in learning outcomes between these two methods. However, co-teaching showed better knowledge retention compared to conventional teaching. At the same time, the feedback from students’ questionnaire showed co-teaching method better than traditional teaching; otherwise, the feedback from tutors’ questionnaire showed it needs more time and cooperation for the co-teaching. ConclusionsCo-teaching can promote the curriculum to be deeply integrated, achieve comparatively better retention of knowledge and improve the teaching effect as revealed by the findings.

BACKGROUND As a serious public health event, the coronavirus disease 2019(COVID-19) pandemic is raging around the world. Whether it has an effect on medical students' employment intention is unknown. OBJECTIVE To explore the impact of COVID-19 on the employment intention of Chinese medical students and its associated factors. METHODS An electronic questionnaire was designed to conduct an anonymous online convenient sampling survey for medical students in China. 1163 medical students from thirty-one different provinces of different academic degrees, current educational status, and regions were surveyed. The questionnaire investigated the overall impression of the impact of the COVID-19 epidemic on medical students’ employment intentions, the willingness to engage in clinical or basic research after graduation, the willingness to engage in epidemic-related specialties after graduation, and the willingness to participate in epidemic-related work. RESULTS The medical students' employment intention was correlated with academic degree (ρ=0.09, P=.003), current educational status (ρ=0.10, P=.001), and geographical region (ρ=-0.07, P=.03). For choosing clinical work or scientific research, statistical significance was observed in gender (21=7.0, P=.008), degree (22=8.6, P=.01), and current educational status (22=65.0, P CONCLUSIONS The COVID-19 pandemic has a significant influence on the employment intention of Chinese medical students from different degrees, educational status and regions. More professional ethics education, preferential policies, and encouragement should be supplied to medical students.

The transcription factor BTB and CNC homology 1 (Bach1) impairs angiogenesis after ischemic injury by suppressing Wnt/β-catenin signaling; however, the specific domains responsible for the antiangiogenic effects of Bach1 remain unclear. This study determined the role of the BTB domain of Bach1 in ischemic angiogenesis. Bach1 is highly expressed in circulating endothelial cells from acute myocardial infarction patients, and is the early induction gene after ischemic inuced injury. Mice were treated with adenoviruses coding for GFP (AdGFP), Bach1 (AdBach1), or a Bach1 mutant lacking the BTB domain (AdBach1-ΔBTB) after surgically induced hind-limb ischemia. Measures of blood-flow recovery, capillary density, and the expression of vascular endothelial growth factor (VEGF) were significantly lower in the AdBach1 group, but not in AdBach1-ΔBTB animals. Furthermore, transfection with AdBach1, but not AdBach1-ΔBTB, in human umbilical-vein endothelial cells (HUVECs) was associated with significant declines in 1) capillary density and hemoglobin content in the Matrigel-plug assay, 2) proliferation, migration, tube formation, and VEGF transcriptional activity and mRNA expression in HUVECs. Bach1 binds directly with TCF4, and this interaction is mediated by residues 81-89 of the Bach1 BTB domain and the N-terminal CTNNB1 domain of TCF4. Bach1, but not Bach1-ΔBTB, also copreciptated with histone deacetylase 1 (HDAC1), while the full-length HDAC1 proteins, but not HDAC1 mutants lacking the protein-interaction domain, co-precipitated with Bach1. Collectively, these results demonstrate that the anti-angiogenic activity of Bach1 is crucially dependent on molecular interactions that are mediated by the protein's BTB domain, and this domain could be a drug target for angiogenic therapy. Funding Statement: This work was supported by the Great Program (91639103 to D. Meng), and General Programs (81670450 and 81873469 to D. Meng, 81570081 and 81770083 to S. Li, 81800234 to L. Jiang, 81572713 to X. Zhi, 81873536 to X. Wang) of the National Natural Science Foundation of China, the National Key Research and Development Program of China (2018YFC1313600 to S. Li). Declaration of Interests: The authors state: "None." Ethics Approval Statement: HUVECs were isolated (12) from the fresh umbilical cord of normal parturients with informed consent. The procedure was approved by the Ethics Committee of Experimental Research at Fudan University Shanghai Medical College. All experimental protocols were approved by the Ethics Committee of Experimental Research at Fudan University Shanghai Medical College and performed in accordance with the National Institutes of Health Guide for the Care and Use of Laboratory Animals (NIH publication No 85-23).

Acute intensive insulin therapy causes a transient worsening of diabetic retinopathy in type 1 diabetes patients and is related to VEGF expression. Reactive oxygen species (ROS) have been shown to be involved in HIF-1α and VEGF expression induced by insulin, but the role of specific ROS sources has not been fully elucidated. In this study we examined the role of NADPH oxidase subunit 4 (Nox4) in insulin-stimulated HIF-1α and VEGF expression, and angiogenic responses in human microvascular endothelial cells (HMVECs). Here we demonstrate that knockdown of Nox4 by siRNA reduced insulin-stimulated ROS generation, the tyrosine phosphorylation of IR-β and IRS-1, but did not change the serine phosphorylation of IRS-1. Nox4 gene silencing had a much greater inhibitory effect on insulin-induced AKT activation than ERK1/2 activation, whereas it had little effect on the expression of the phosphatases such as MKP-1 and SHIP. Inhibition of Nox4 expression inhibited the transcriptional activity of VEGF through HIF-1. Overexpression of wild-type Nox4 was sufficient to increase VEGF transcriptional activity, and further enhanced insulin-stimulated the activation of VEGF. Downregulation of Nox4 expression decreased insulin-stimulated mRNA and protein expression of HIF-1α, but did not change the rate of HIF-1α degradation. Inhibition of Nox4 impaired insulin-stimulated VEGF expression, cell migration, cell proliferation, and tube formation in HMVECs. Our data indicate that Nox4-derived ROS are essential for HIF-1α-dependent VEGF expression, and angiogenesis in vitro induced by insulin. Nox4 may be an attractive therapeutic target for diabetic retinopathy caused by intensive insulin treatment.