Through literature review and analysis of clinical practice cases,this paper proposes that narrative dialogue refers to the conscious expression and communication between physicians and patients,with a clear narrative orientation within specific clinical contexts.Its core lies in externalizing patients’ implicit,unspoken suffering and establishing empathic connections.Narrative dialogue comprises four constituent elements—context,subject,orientation,and connection—and manifests distinct objectives and characteristics at three levels:value,narrative essence,and practice.This article synthesizes the general core principles and practical steps of narrative dialogue and argues that narrative dialogue constitutes a recognizable,analyzable,and teachable core component in the clinical practice of narrative medicine.It bridges narrative medicine theory with clinical practice and provides a new breakthrough point for the systematic construction of narrative medicine education and clinical paths.

Current medical education faces an imbalance between technical rationality and humanistic spirit,with medical students’ empathy declining as their training progresses.Narrative medicine offers a new path for reform.This paper systematically elaborates on the talent cultivation pathway of “five-dimension education integration and innovation” constructed by Sun Yat-sen University since 2017 under the guiding principle of five-dimension education (moral,intellectual,physical,aesthetic,and labor education) based on narrative medicine.This study innovatively proposes a teaching framework of “one body and two wings” and extends GUO Liping’s “little red flower” model to construct a “five-dimension education-little red flower” interdisciplinary collaborative teaching model,which takes the narrative medicine course cluster as the “body” and clinical practice and humanistic experience as the two “wings,” achieving deep integration of the five dimensions of education.At the practical level,a three-stage progressive closed loop of “sprouting-deepening-transformation” has been established,with a four-step teaching method of “demonstration analysis-collaborative writing-independent writing-reflection internalization” formed at the transformation stage,along with a “1∶1 interdisciplinary collaboration” general education course for all first-year students.Teaching evaluations show that the curriculum effectively enhances medical students’ empathy and communication initiative,with non-medical students benefiting particularly significantly.This practical model validates and extends the application boundaries of localized narrative medicine theory,realizing a conceptual leap from cultivating “technical executors” to nurturing future caregivers” and providing a practical model and operational experience for reference in the reform of medical humanities education in the context of emerging medical education in China.

It has been 15 years since the introduction of narrative medicine into China.The growing of medical humanistic demand,the gradual improvement of industry recognition,and the continuous support of relevant national policies have provided good opportunities for the development of narrative medicine.The current development of narrative medicine faces both opportunities and challenges.The continuous accumulation of favorable conditions provides strong support for the standardized promotion of narrative medicine,while there are still obvious shortcomings,mainly manifested in the weak foundation of the discipline and the unclear path of practice and research.Although the exploration of localization has begun to bear fruit,the overall development still needs to be deepened.China has an improving environment and outstanding potential for the development of narrative medicine.At the same time,it faces many problems such as discipline construction,practical research,and localization deepening,presenting a pattern characterized by coexistence of opportunities and challenges.

Assessment is a critical link in the transition of narrative medicine education from concept to institutionalized curriculum,yet its methods have long faced challenges such as insufficient standardization,poor cross-institutional comparability,and a lack of long-term outcome tracking,while few studies have traced how this situation arose.Focusing on assessment in the educational measurement sense—the measurement of learners’ outcomes,as distinct from the evaluation of programs as a whole—and adopting an abductive approach that infers epistemological foundations from actual assessment practices,this article divides the evolution of assessment methods in narrative medicine education since 2001 into three stages according to their epistemological foundations and methodological features.The first stage (2001—2008),grounded in phenomenology and constructivism,was dominated by qualitative text analysis such as reflective writing,emphasizing lived experience and reflection but lacking standardized,generalizable instruments.The second stage (2009-2016),responding to the evidence-based medicine paradigm and seeking disciplinary legitimacy,widely borrowed generic instruments such as the Jefferson Scale of Physician Empathy and the Maslach Burnout Inventory and made initial attempts at mixed methods,thereby exposing an epistemological conflict between positivism and interpretivism.The third stage (2017-present) has shifted toward developing specialized instruments for assessing narrative competence,reflecting a pragmatist integration of quantitative and qualitative approaches,though its maturation remains constrained by weak measurement standardization and the absence of long-term behavioral and clinical outcome assessment.This study suggests that the evolution of assessment methods in narrative medicine education is essentially an ongoing dialogue between humanistic and positivist epistemological traditions,through which the field continually clarifies its assessment aims and defines its disciplinary identity.

目的 了解“健康中国”战略背景下肿瘤学专业型硕士研究生人文素养的现状与培养需求,探索符合肿瘤专科特色的人文素养培养路径。方法 采用便利抽样法,于2024年12月选取中南大学湘雅医院、湘雅二医院、湘雅三医院、湖南省肿瘤医院、中山大学肿瘤防治中心的放射肿瘤学专业型硕士研究生52人进行问卷调查。问卷涵盖人文素养认知、肿瘤防治政策知晓度、医德观念、沟通技能需求4个维度。结果 52名学生中,49人(94.2%)认为需要接受系统的医学人文教育,仅4人(7.6%)认为所在学校非常重视该教育,7人(13.4%)认为人文资源完全满足需求。学生对“健康中国”癌症防治目标知晓率仅为38.5%。医德观念总体积极,但82.7%的学生认为最需提升沟通交流能力,78.8%认为需加强法律法规知识。结论 肿瘤学专业型硕士研究生人文素养培养存在“认知高、供给低、实践弱”的矛盾,亟待从课程体系、临床实践、评价机制三方面进行系统化改革,构建与肿瘤专科深度融合、贯穿培养全程的人文教育新模式。

This article details the diagnosis and treatment of an elderly male patient with VEXAS syndrome who came with fatigue and fever.The patient thereafter developed several clinical manifestations，including macrocytic anemia，tracheal and bronchial wall thickening，polyarthritis，rashes，and elevated levels of inflammatory markers.The final clue for subsequent genetic testing came from the bone marrow smear，which showed vacuolar degeneration in the cytoplasm of immature granulocytes.The UBA1 gene testing showed the mutation c.121A>C （p.Met41Val），which confirmed the diagnosis of VEXAS syndrome.Following glucocorticoid therapy，the patient’s clinical conditions were significantly ameliorated.However，the patient’s recurrence of fever and anemia months after discontinuing glucocorticoid medication was consistent with the repeated relapses described in VEXAS syndrome.The whole diagnostic process for the patient suggests that in clinical settings，thorough integration of clinical clues is crucial for making an appropriate diagnosis.To accomplish precision therapy，clinicians must retain an open mind and actively participate in multidisciplinary collaboration.

Splenic Epstein-Barr virus-positive inflammatory follicular dendritic cell sarcoma （EBV+IFDCS） is a rare low-grade malignant tumor typically associated with Epstein-Barr virus infection.Most patients are asymptomatic，and the splenic mass is often discovered incidentally during routine physical examinations.A minority of patients may present with symptoms such as abdominal distension or pain.Due to the lack of specific clinical manifestations，early diagnosis of EBV+IFDCS is challenging.Pathological examination is the gold standard for the diagnosis of splenic EBV+IFDCS.This article reports a case of splenic EBV+IFDCS and discusses its clinicopathological features with a review of the related literature.

Lumbar puncture is an important clinical technique.In patients with spinal deformities or those who undergo lumbar surgery，using surface anatomical landmarks for localization is often challenging，and real-time ultrasound guidance can be employed to complete the procedure.This article reports two representative difficult cases of lumbar puncture and provides a detailed review and summary of the application and clinical experience of ultrasound-guided lumbar puncture in these types of patients.

Complex regional pain syndrome is a refractory disease characterized by complex pathogenesis，severe chronic pain，and autonomic nervous system dysfunction.This article reports a 26-year-old female patient who presented with severe，electric shock-like pain and hyperalgesia in the first toes of both feet following an ankle sprain.In addition，her symptoms included localized redness，swelling，burning sensation，and hyperhidrosis.She was clinically diagnosed with complex regional pain syndrome.After oral pharmacotherapy for neuropathic pain proved ineffective，she was treated with ultrasound-guided pulsed radiofrequency of the medial plantar nerve combined with platelet-rich plasma injection.Postoperative follow-up showed progressive symptom alleviation.One month after the procedure，the pain score decreased to 0，and autonomic symptoms such as local redness，swelling，and abnormal sweating were completely resolved.No recurrence was observed during the six-month postoperative follow-up period.

Obesity is recognized as a major risk factor for endometrial cancer，and its tumor-promoting mechanisms have drawn increasing attention in recent years.Current evidence highlights that obesity drives the initiation and progression of endometrial cancer through three core pathways—elevated estrogen levels，insulin resistance，and chronic inflammation—which form a malignant positive feedback loop.Furthermore，visceral and subcutaneous obesity differentially regulate adipokine secretion and metabolic microenvironments to impact the molecular subtypes，pathological features，and treatment responses of endometrial cancer.This review summarizes recent advances in the molecular mechanisms linking obesity and endometrial cancer，with a focus on adipokines，inflammatory signaling，estrogen metabolism，insulin resistance，and epigenetic regulation.The roles of the adipose-immune-metabolic axis in the initiation and progression of endometrial cancer are expounded.Future research should integrate multi-omics and tumor microenvironment analyses to develop precision therapeutic strategies based on obesity subtypes and epigenetic biomarkers，offering novel insights for clinical management of obesity-related endometrial cancer.

Phytoestrogens are a class of natural compounds existing in plants，with their chemical structures similar to that of the endogenous estrogen 17β-estradiol in mammals.They can exert estrogenic or anti-estrogenic biological effects by binding to estrogen receptors，and have a wide range of effects on diseases caused by estrogen disorders in the body.Recent studies have discovered that phytoestrogens have significant effects in the prevention and treatment of breast cancer.This article reviews the research progress in the prevention and treatment of breast cancer with phytoestrogens from the active components of Chinese medicinal plants，Chinese medicinal plants，and traditional Chinese medicine compound formulas，as well as the related mechanisms. Specifically，the phytoestrogens exert anti-estrogenic effects by binding to estrogen receptors，regulate cell proliferation and apoptosis signaling pathways （such as the Wnt/β-catenin signaling pathway，phosphatidylinositol 3-kinase-protein kinase B signaling pathway，and P53 signaling pathway），inhibit tumor angiogenesis，and modulate metabolism and immune function.The review aims to provide a theoretical basis for clinical research on the prevention and treatment of breast cancer with traditional Chinese medicine.

Cardiovascular diseases are one of the major factors affecting the life and health of people all over the world.Recent studies have found that the cyclic guanosine monophosphate-adenosine monophosphate synthase-stimulator of interferon genes （cGAS-STING） signaling pathway is significantly activated in a variety of cardiovascular diseases including hypertension，coronary heart disease，and cardiac hypertrophy.This signaling pathway plays a key role in the pathogenesis of cardiovascular diseases and is closely related to the occurrence and progression of cardiovascular diseases.Moreover，studies have shown that the ameliorative effect of exercise on cardiovascular diseases is related to the regulation of the cGAS-STING signaling pathway.This article mainly reviews the research progress regarding the cGAS-STING signaling pathway，the relationship between this pathway and cardiovascular diseases，and exercise regulation of cardiovascular diseases through the cGAS-STING signaling pathway.This review aims to expose the pathogeneses of cardiovascular diseases and offer novel therapeutic strategies for clinical treatment and intervention.

Thyroid cancer （TC） is one of the most common endocrine malignancies with high incidence and heterogeneity.Its diagnosis mainly relies on ultrasound-guided fine-needle aspiration biopsy，while it still fails to give a definitive diagnosis in 15%-30% of lesions，leading to a large number of unnecessary repeat biopsies and surgical procedures.Metabolomics，as a newly developed discipline，plays a role in the early diagnosis，treatment，and prognosis of TC by detecting differential metabolites in a variety of biological samples，such as tissue and blood，and researching the differential expression of metabolic pathways in TC.This review summarizes the research progress of metabolomics in the last 5 years，aiming to provide a theoretical basis for the screening of diagnostic biomarkers and exploring potential therapeutic targets for TC.

Endometriosis （EMs） is a common and refractory disease in clinical practice.It has the pathological characteristics of adhesion and invasion，while the pathogenesis remains unclear.In recent years，studies have found that autophagy and ferroptosis are two important regulatory mechanisms of cell life activities，closely related to cell survival and death，and they play a key role in EMs.Moreover，the two have crosstalk cooperation at the molecular level.Whether this interplay contributes to the pathogenesis occurrence and progression of EMs warrants further investigation.Therefore，conducting targeted experiments in vitro and in vivo to clarify the mechanisms of autophagy，ferroptosis，and their interaction in the occurrence and progression of EMs can not only delve into the invasion and migration processes of ectopic lesions in the pelvis and abdomen but also provide new ideas and targets for the treatment of EMs.This article reviews the mechanisms of autophagy and ferroptosis in EMs and the key targets of autophagy-dependent ferroptosis，aiming to provide new strategies and a theoretical basis for revealing the etiology and pathogenesis and developing new prevention and treatment options of EMs.

Menkes disease is a rare X-linked recessive multisystem copper metabolism disorder first reported in 1962.Recent studies have shown that its incidence and mortality rates may be underestimated due to miscarriages and early deaths.The clinical manifestations of Menkes disease are closely related to copper metabolism disorder，mainly characterized by neurodegeneration and vascular and connective tissue abnormalities.These symptoms stem from copper transport disorders and abnormal activity of copper-dependent enzymes caused by copper metabolism disorder.By integrating clinical symptoms and mechanism analysis，this paper reveals the core role of copper metabolism disorder in the multisystem damage of Menkes disease，providing a theoretical basis for early diagnosis and intervention.

目的 将行动研究运用于死亡教育课程教学方案的不断完善和优化，以提升医学专业研究生死亡教育课程的实效性。方法 采用行动研究法，于2023年9月至2024年12月，以《死亡应对与死亡教育》课程的选课学生为教学对象，通过“计划—行动—观察—反思”的循环过程，对教学的各要素和环节进行不断优化和完善。结果 经过2轮行动研究，完善了针对不同医学专业背景研究生的死亡教育课程教学方案，有效实现了课程的教学目标，学生对课程具有良好的满意度。结论 行动研究法确保了研究生层次的医学生死亡教育中多学科视野的生死学教学、研究导向的项目式学习以及多渠道的互动教学的有效实现，本研究构建的课程教学方案具有较强的适用性和可推广性。

The implementation of dignified death in China faces multiple practical obstacles.Economic conditions，resource allocation，cultural values and other social factors profoundly shape different groups’ understanding and implementation of dignified death.Against this background，the factors directly constraining its practice are concentrated in several areas：the value tension between traditional filial piety ethics and the concept of self-determination in life，theoretical disagreements and the dilemma of balancing interests at the end of life，the inherent role conflict of physicians and the blurred boundaries of their legal liability，the challenge of verifying patients’ decision-making capacity and the authenticity of their wishes，and dificiencies in the supply of hospice care resources and service systems.Analysis indicates that the practice of dignified death in China remains inadequate，and its transition from conceptual recognition to practical application is systematically constrained by the above multiple factors.The key to advancing this process lies in achieving a positive interaction between values and institutions.Thus，a thorough understanding of the difficulties encountered in the local exploration of dignified death，along with corresponding adjustment in societal attitudes and institutional coordination，constitutes the prerequisite and foundation for moving it toward practice.

Objective To preliminarily investigate the litholytic effects of extracts from Lysimachiae Herba，Selaginellae Herba （Selaginella pulvinata），and Phragmitis Rhizoma on mixed-type urinary calculi （calcium oxalate/carbonate apatite） through in vitro experiments. Methods A total of 264 surgically extracted renal calculus specimens were collected.Compositional analysis was performed through infrared spectroscopy.Extracts of the three herbal medicines were prepared，and their litholytic effects on mixed-type calculi （calcium oxalate/carbonate apatite） were evaluated via in vitro litholysis assays，with normal saline as the negative control. Results Among the 264 calculus specimens，mixed-type calculi exhibited the highest prevalence （52.27%，138/264），of which the calcium oxalate/carbonate apatite subtype accounted for 63.77% （88/138） of mixed calculi.All the three extracts significantly dissolved the mixed-type calculi （all P<0.001），with the efficacy ranking as follows：Lysimachiae Herba>Selaginellae Herba>Phragmitis Rhizoma，with statistically significant intergroup differences （P<0.001）. Conclusions Mixed-type calculi predominate in urolithiasis patients，with calcium oxalate/carbonate apatite being the most common subtype.Extracts of Lysimachiae Herba and Selaginellae Herba demonstrate superior in vitro litholytic effects on this mixed-type calculus subtype，suggesting their potential as therapeutic agents for clinical management of urolithiasis.

Objective To analyze the trends in the burden of early-onset cancer attributed to overweight and obesity in China from 1990 to 2021 and to predicted its changes over the next 15 years，thus providing a reference for cancer prevention and control in China. Methods The data were sourced from the 2021 Global Burden of Disease database.The disease burden was described based on mortality rates，disability-adjusted life year （DALY） rates，and their age-standardized rates.R 4.4.1 software was used to analyze the differences and changes in disease burden across different gender and age groups.The Joinpoint regression model was adopted to quantify the temporal trends of the burden of early-onset cancer attributed to overweight and obesity in the Chinese population from 1990 to 2021，and the average annual percentage of change （AAPC） was calculated for age-standardized mortality rates and age-standardized DALY rates.An autoregressive integrated moving average model was established to predict changes in disease burden over the next 15 years. Results Between 1990 and 2021，the burden of early-onset cancers attributed to overweight and obesity in China showed an upward trend.The AAPC values of age-standardized mortality rates for men and women were 2.94% （95%CI=2.90-2.97） and 1.98% （95%CI=1.93-2.02），respectively，while those of age-standardized DALY rates were 2.88% （95%CI=2.83-2.91） and 1.82% （95%CI=1.77-1.86），respectively （all P<0.001）.The age group of 30-34 years old in 2021 compared with 1990 saw the most significant increases （88.24% and 91.02%，respectively） in cancer mortality and DALY rates due to overweight and obesity.It was predicted that in the next 15 years，the age-standardized DALY rates for cancers （except female uterine cancer） attributed to overweight and obesity would keep rising.The top five cancers contributing to the disease burden in men would be colorectal cancer，liver cancer，leukemia，kidney cancer，and gallbladder and biliary tract cancer.For women，the top five cancers contributing to the disease burden in 2028 and earlier would be colon and rectum cancer，breast cancer，liver cancer，uterine cancer，and leukemia.From 2029 to 2036，ovarian cancer would surpass leukemia，rising to the fifth position. Conclusions From 1990 to 2021 and in the next 15 years，the burden of early-onset cancer attributed to overweight and obesity in China shows an overall upward trend.The main cancers causing the burden on men are colon and rectum cancer，liver cancer，leukemia，kidney cancer，and gallbladder and biliary tract cancer.The main cancers imposing the burden on women are colon and rectum cancer，breast cancer，liver cancer，uterine cancer，leukemia，and ovarian cancer.It is recommended that comprehensive prevention and control strategies should be improved for overweight and obesity and targeted interventions should be implemented for high-risk cancers and specific populations to reduce the burden of related cancer diseases.

Objective To characterize the anatomical features of the lesser occipital nerve，thereby providing an applied anatomical basis for cervical neuralgia and local surgical procedures. Methods This study included both left and right sides of 40 adult formalin-fixed adult human specimens，totaling 80 sides.Routine incision was adopted in the dissection of lateral cervical region and the sternocleidomastoid region. Results The dissection rate of the lesser occipital nerve was 100%.Specifically，67.5%，25.0%，and 7.5% originated from the anterior branch of the third cervical nerve，the ansa cervicalis of the second cervical nerve，and the ansa cervicalis of the third cervical nerve，respectively.Below the accessory nerve，the lesser occipital nerve wraps around the accessory nerve in front of it to the vicinity of the posterior edge of the sternocleidomastoid or its shallow surface.It controls the skin on the upper part of the sternocleidomastoid，the upper part of the posterior cervical triangle，and the middle surface behind the auricle.The lesser occipital nerve specimens were classified into a single branch type （17.5%） and a multi-branch type （82.5%） after coiling around the accessory nerve in the posterior cervical triangle，among which the multi-branch type was dominated by the three-branch type. Conclusions The lesser occipital nerve is mainly a shrub-type nerve without a main trunk，and its distribution range spans the skin on the upper part of the sternocleidomastoid，the posterior cervical triangle，and the middle surface behind the auricle，and its position is superficial.The lesser occipital nerve block point should be at the midpoint of the posterior margin of the sternocleidomastoid and should not be too deep.

Objective To investigate the association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio （NHHR） and the risk of sarcopenia in older Chinese men. Methods This study was based on the baseline data from the China Health and Retirement Longitudinal Study，including 1 849 men aged≥60 years.Missing data were handled through multiple imputation.Participants were categorized into quartiles of NHHR （Q1-Q4）.Multivariable Logistic regression models were constructed with stepwise adjustment for demographic factors，lifestyle，chronic diseases，and body mass index （BMI） to estimate odds ratios （OR） and 95%CI.Restricted cubic spline analysis was performed to examine potential non-linear associations.Subgroup and sensitivity analyses （with possible sarcopenia as an alternative outcome） were performed. Results NHHR was significantly and inversely associated with sarcopenia.In models without BMI adjustment，the highest NHHR quartile （Q4） showed a lower risk of sarcopenia than the lowest quartile （Q1） （OR=0.199，95%CI=0.112-0.338，P<0.001）.However，the association was attenuated after adjustment for BMI （OR=0.403，95%CI=0.220-0.709，P=0.002；the OR for each 1-standard-deviation increase in NHHR was approximately 0.680）.Restricted cubic spline analysis indicated a linear association （P_overall<0.001，P_non-linear=0.793）.In sensitivity analyses，NHHR remained significantly and inversely associated with possible sarcopenia.The fully adjusted model showed that the risk of possible sarcopenia was lower in the Q4 group than in the Q1 group （OR=0.613，95%CI=0.404-0.924，P=0.020），and each 1-standard-deviation increase in NHHR was associated with a reduced risk of possible sarcopenia （OR=0.849，95%CI=0.728-0.987，P=0.035）.Subgroup analyses showed that the inverse association between NHHR and sarcopenia risk was directionally consistent across strata of age，smoking，drinking，and hypertension，while the association in the diabetes subgroup did not reach statistical significance，possibly owing to the limited sample size （OR=0.46，95%CI=0.16-1.37，P=0.164）. Conclusions NHHR is inversely associated with sarcopenia risk among older Chinese men，while this association is substantially attenuated after adjustment for BMI，suggesting it may be largely confounded by body size or obesity-related factors.These findings should be interpreted with caution，and future longitudinal studies incorporating direct muscle mass measurements，such as dual-energy X-ray absorptiometry and bioelectrical impedance analysis，are warranted to clarify the independent role of NHHR in sarcopenia.

Objective To explore the value of thyroid lymphatic contrast-enhanced ultrasound （LCEUS） in the differential diagnosis of benign and malignant thyroid nodules. Methods Patients who were suspected of having thyroid cancer by ultrasound and were planned to undergo puncture biopsy or surgery from November 2020 to June 2024 were prospectively enrolled.All the patients underwent conventional ultrasound and LCEUS before surgery.The enhancement characteristics within the nodules，around the nodules，and in the adjacent thyroid capsule were observed and recorded.With the pathological results as the gold standard，the above characteristics were compared between the benign and malignant groups. Results A total of 144 （37 benign and 107 malignant） nodules in 144 patients were finally included.The inter-observer consistency of each LCEUS index was excellent （Kappa value：0.84-0.93）.Compared with benign nodules，malignant nodules were more likely to show non-enhancement （88.79% vs. 18.92%，P<0.001），an enlarged lesion area after contrast injection （60.75% vs. 18.92%，P<0.001），and irregular ring-shaped enhancement （49.53% vs. 10.81%，P<0.001）.The sensitivity，specificity，and accuracy of LCEUS in diagnosing malignant nodules were 97.20%，75.68%，and 91.67% respectively.The area under the receiver operating characteristic curve was 0.864，higher than that （0.761） of conventional ultrasound （P<0.001）. Conclusions By revealing the lymphatic perfusion characteristics inside and around the nodules，LCEUS shows excellent efficacy in the differential diagnosis of benign and malignant thyroid nodules.LCEUS exhibits significantly better specificity and overall diagnostic ability than conventional ultrasound，demonstrating important clinical application value.

Objective To understand the current situation and influencing factors of knowledge，attitudes，and practice of childhood sexuality education among parents in Xichang city，thus providing a basis for improving the current situation of childhood sexuality education and promoting related work of family sexuality education. Methods Through cluster random sampling，8 kindergartens were selected in Xichang city，Sichuan province.A self-designed questionnaire on parents’ knowledge，attitudes，and practice of childhood sexuality education was used to conduct an anonymous survey on parents of young children who were selected from the kindergartens.The data were analyzed by chi-square test and multivariate Logistic regression model. Results The rates of knowledge awareness，positive attitude，and good practice among the 1 496 parents were 3.9%，32.0%，and 36.6%，respectively，and the overall good rate of knowledge，attitudes，and practice was 22.9%.The results of multivariate Logistic regression analysis showed that parents who were of Han ethnicity （OR=1.73，95%CI=1.17-2.56，P=0.006），whose children were female （OR=2.16，95%CI=1.51-3.11，P=0.019），who believed that sexuality education should be the responsibility of parents （OR=2.42，95%CI=1.57-3.73，P<0.001），who had communicated with family and friends about childhood sexuality education （OR=2.95，95%CI=2.22-3.92，P<0.001），and who had conducted sexuality education for their children themselves （OR=1.81，95%CI=1.37-2.40，P<0.001） had higher overall good rates of knowledge，attitudes，and behavior in childhood sexuality education. Conclusions Parents generally have low rates of knowledge awareness，positive attitudes，and good practice and a low overall good rate of knowledge，attitudes，and practice regarding childhood sexuality education.Relevant departments should attach importance to childhood sexuality education，with a particular focus on parents of ethnic minorities and those who have not carried out childhood sexuality education.They should intensify publicity and training efforts to enhance parents’ level of sexuality education，change their attitudes towards sexuality education，and promote the development of family sexuality education.

Objective To explore the short-term and long-term effects of caregiving quality on the psychological and behavioral development among children aged 0-3 years. Methods A prospective study design was adopted，and 220 vulnerable children aged 0-3 years and their primary caregivers were recruited from child care facilities and community healthcare service centers in two districts of Shanghai by stratified cluster sampling.Baseline and one-year follow-up surveys were conducted.Chi-square tests and multivariate Logistic regression analyses were conducted to examine the effects of responsive caregiving and parenting behaviors on the psychological and behavioral development of children. Results Children whose caregivers with poorer respect for children’s autonomy （OR=0.869，95%CI=0.583-0.920，P=0.031） and poorer caregiving support （OR=0.779，95%CI=0.464-0.912，P=0.020） at baseline had a higher risk of developmental delay in the problem-solving domain.In addition，reduced social stimulation in caregiving was linked to a higher risk of developmental delay in the communication domain （OR=0.885，95%CI=0.852-0.963，P=0.032）.Insufficient caregiving support received by parents increased the risk of fine-motor developmental delay in children （OR=0.794，95%CI=0.653-0.952，P=0.043）.Children who already exhibited developmental delay in communication，fine motor，problem-solving，or personal-social domain at baseline were more likely to experience delay in the same domain at the one-year follow-up （communication：OR=5.988，95%CI=2.344-14.502，P<0.001；fine motor：OR=5.618，95%CI=1.690-22.241，P<0.01；problem-solving：OR=15.152，95%CI=1.854-44.841，P=0.004；personal-social：OR=2.525，95%CI=1.041-6.340，P=0.041）.In contrast，children with normal development at baseline demonstrated substantially lower risks of subsequent developmental delay. Conclusions Early caregiving quality has an immediate effect on children’s psychological and behavioral development，and it continues to influence later development through affecting developmental outcomes.

Objective To investigate the effect of polyphyllin I on MCF-7 spheroids enriched with cancer stem cells and to preliminarily observe its effect on the hybrid epithelial-mesenchymal transition （EMT） state and its regulatory role on cell stemness. Methods MCF-7 spheroids were cultured under serum-free，non-adherent conditions.Cell viability，invasion，and key protein expression were assessed through the cell counting kit-8 assay，Transwell assay，and Western blot，respectively.The CD44⁺/CD24^-/low cell population was analyzed by flow cytometry. Results The MCF-7 spheroids exhibited high proliferative and invasive capacities，co-expressing the epithelial marker E-cadherin and the mesenchymal marker vimentin，which is indicative of a hybrid EMT state and high stemness.Polyphyllin I treatment significantly suppressed the viability and invasion of MCF-7 spheroids.From a mechanism perspective，polyphyllin I downregulated the E-cadherin/vimentin ratio，significantly reduced the levels of stemness-associated proteins CD44 antigen，aldehyde dehydrogenase 1 family member A1，as well as the ratio of phosphorylated signal transducer and activator of transcription 3 to total signal transducer and activator of transcription 3.Simultaneously，polyphyllin I decreased the proportion of CD44⁺/CD24^-/low cells.No significant changes were observed in key proteins of the intrinsic apoptosis pathway. Conclusions Polyphyllin I reshapes the hybrid EMT state in MCF-7 spheroids，which is accompanied by the disruption of their high stemness equilibrium.This compound may reduce cellular stemness through the EMT remodeling process，thereby exerting antitumor effects，and this mechanism is independent of the intrinsic apoptosis pathway.

Objective To evaluate the effects of the traditional Chinese herbal formula YA3D3 on cognitive impairment and cerebral β-amyloid （Aβ） deposition in APP/PS1 transgenic mice and to determine whether these effects are mediated by up-regulation of the autophagy-related gene 14 （ATG14）. Methods Network pharmacology was employed to predict YA3D3 targets.Total antioxidant capacity and hydroxyl free radical scavenging activity were measured in vitro.BV2 microglial cells were infected with short hairpin RNA （shRNA） lentivirus targeting ATG14 （designated as sh-ATG14） and then treated with 0.5 mg/mL of either water-extract （YA3D3-HF） or fermented （YA3D3-MHF） preparation for 24 h.The expression levels of ATG14 and downstream ATG16L1 were assessed by qPCR and Western blot.Sixty-four 3-month-old male APP/PS1 mice were randomly allocated to eight groups （n=8）：APP/PS1 model，donepezil，low-，medium-，and high-dose YA3D3-HF，and low-，medium-，and high-dose YA3D3-MHF.All the drugs were administered ad libitum in drinking water for 90 days.Spatial learning and memory were evaluated through the Morris water maze.Cerebral Aβ deposition was quantified by immunofluorescence.Autophagy-related gene expression in the brain tissue was analyzed by qPCR. Results Network pharmacology indicated significant enrichment of YA3D3 targets in autophagy and phosphatidylinositol 3-kinase/protein kinase B signaling pathways.YA3D3-MHF showed stronger antioxidant activity than YA3D3-HF in vitro （P<0.001）.In BV2 cells，both preparations reversed ATG14 knock-down-induced down-regulation in the expression of ATG14 and ATG16L1，with YA3D3-MHF being more potent （P=0.003）.The animal experiment showed that all the YA3D3 groups exhibited shorter escape latency and more platform crossings than the APP/PS1 model group （all P<0.05），along with reduced Aβ fluorescence intensity （all P<0.001）.The efficacy of high-dose YA3D3-MHF was similar to that of donepezil.qPCR confirmed that YA3D3 up-regulated the expression of ATG14 and modulated the expression of downstream autophagy-related genes in the brain tissue （all P<0.05）. Conclusions The traditional Chinese herbal formula YA3D3 may up-regulate the expression of ATG14 to slow down Aβ deposition and ameliorate cognitive impairment in APP/PS1 mice，serving as a potential candidate for Alzheimer’s disease intervention.It should be noted that this study has not directly verified the necessity of ATG14 in vivo，and the causal relationship between the in vivo therapeutic efficacy of YA3D3 and the up-regulation of ATG14 requires further confirmation.In addition，this study only verifies the expression regulation of autophagy-related molecules and does not confirm the enhancement of autophagy flux.

Objective To construct a novel carrier-free nanovaccine to trigger a strong anti-tumor immune effect in the body. Methods The Toll-like receptor 4 agonist monophosphoryl lipid A （MPLA） was covalently conjugated with mucin 1 （MUC1）-targeting amino acid motif （Maa） to form MPLA-Maa monomer molecules.Subsequently，MPLA-Maa was self-assembled with Leu-His modified MUC1 polypeptide （LMP） to construct the nanovaccine system （MAP NVs）. Results MAP NVs exhibited a particle size of （169.85±4.05） nm，a polydispersity index of 0.308±0.021，and the Zeta potential of （-19.10±1.00） mV，and remained stable in vitro for over 10 days.Cell experiments showed that the nanovaccine significantly promoted dendritic cell maturation and activation and promoted tumor necrosis factor-α secretion.In the B16-MUC1 melanoma model，MAP NVs demonstrated remarkable antitumor effects，significantly inhibiting tumor growth and prolonging the survival of tumor-bearing mice.Mechanism analysis further revealed that MAP NVs effectively activated T cell immune response，promoted the proliferation of CD4⁺ and CD8⁺ T cells，and induced the production of CD8⁺ central memory T cells.After antigen restimulation，the secretion levels of tumor necrosis factor-α and interferon-γ were significantly elevated，which indicated long-lasting immune memory. Conclusions A carrier-free spherical peptide nanovaccine based on the co-delivery strategy of MPLA and LMP was successfully constructed.By promoting dendritic cell activation and enhancing T cell immune response，this system exhibits significant antitumor activity and long-lasting immune memory effect.This study provides a new technical approach and an experimental basis for developing nanovaccines against tumors.

Objective To identify the core demands of three key stakeholder groups—oncology patients,family caregivers,and healthcare professionals—regarding family meetings in oncology wards based on the tripartite framework of stakeholder theory (ST),family systems theory (FST),and timing it right framework (TIR) and delineate the role positioning and functional transition of oncology ward head nurses,thus providing empirical evidence for developing a head nurse-led multidisciplinary team (MDT) family meeting model. Methods A descriptive qualitative study was conducted.Semi-structured interviews were performed with 31 participants recruited from Peking Cancer Hospital,and the Colaizzi's seven-step method was adopted to extract and refine themes. Results A total of 12 core needs were summarized,including 4 from patients,5 from family caregivers,and 3 from healthcare professionals.Meanwhile,five functional requirements of head nurses were concluded in terms of role reshaping,full-process closed-loop management,and competency development. Conclusions Family meetings in oncology wards need to balance the diverse needs of all stakeholders.Head nurses have evolved from performers into meeting leaders,and their pivotal role is the key to the regular operation of such meetings.