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This study aimed to semi-quantitatively evaluate the elastographic imaging color distribution of mediastinal and hilar lymph nodes (LNs), and explored its utility in helping define malignant and benign LNs for lung cancer patients. We prospectively collected patients who underwent preoperative mediastinal staging of suspected lung cancer by EBUS-TBNA. We analyzed the elastography color distribution of each LN and calculated the blue color proportion (BCP). The LN elastographic patterns were compared with the final EBUS-TBNA pathological results. A receiver operating characteristic (ROC) curve was constructed to evaluate the diagnostic value of BCP. We sampled and analyzed 79 LNs from 60 patients. The average BCP in malignant LNs was remarkably higher than that in benign LNs (57.1% versus 30.8%, P < 0.001). The area under the ROC curve (AUC) for the BCP was 0.86 (95% CI: 0.78–0.94). The best cutoff BCP for differentiating between benign and malignant LNs was determined as 36.7%. All the 16 LNs (20.3%) with a BCP lower than 27.9% were diagnosed as benign tissues. Our study suggests that elastography is a feasible technique that may safely help to predict LN metastasis during EBUS-TBNA. We found a clear BCP cutoff value to help define positive and negative LNs.

A proactive personality provides students with strong competitiveness in academic learning. However, previous research primarily focused on the effects of the big five facets, and less attention was paid to proactive personality which shows more incremental validity in learning. The current study aimed to investigate the relationship between proactive personality and academic engagement. The sample consisted of 519 students (245 females, 274 males; Mage = 10.20, SD = 0.891). The study used Mplus 7.0 software to establish structural equation models (SEM). The results showed a significant positive relationship between proactive personality and academic engagement. Teacher-student relationships and academic self-efficacy were found to fully mediate separately between proactive personality and academic engagement. Moreover, the serial mediator model indicated that proactive personality was sequentially related to academic engagement through teacher-student relationships and academic self-efficacy. The implications for learning and teaching are discussed.

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Aims: To determine the clinicopathological features of pulmonary sclerosing pneumocytoma (PSP) with spindle cells and in cases with positive detection of PSP cells in the lymph nodes. Methods and results: This article report the clinical, histological and immunohistochemical features of PSP with dense spindle stromal cells in five patients (including one case with lymph node metastasis) and PSP accompanied by positive nodes in two patients out of 239 cases diagnosed at our institution between 2007 and 2019. The literature on PSP was also reviewed in detail. Six patients were female, and one (with a positive node) was male; their average age was 53 years. Thoracic imaging revealed solid tumours with clear borders and a uniform texture in six patients, but one patient had a lobulated tumour with uneven densities. All tumours were unifocal, and they had an average size of 31 mm. Tumours from five cases were mainly composed of solid regions of diffuse spindle cells rather than polygonal cells. Immunohistochemical staining demonstrated that thyroid transcription factor-1, vimentin, epithelial membrane antigen (weak) and oestrogen receptor (partial) were expressed in spindle cells. The average follow-up time was 31 months. Two of the 234 PSP cases for which adequate data were available had positive nodes (metastasis rate: 0.8%), and one of the five patients with PSP with spindle cells showed lymph node metastasis (metastasis rate: 20%). In addition, stromal cells were found to be predominant at metastatic sites. Conclusions: Spindle cells are present among the stromal cells of PSP, and not all of them are round cells. PSP patients with spindle cells or male patients may be more prone to metastasis than others.