ObjectiveTo introduce visual teaching into the course design of medical humanistic care based on the concept of implementation science， evaluate the teaching implementation effect and feedback， and provide references for optimizing course teaching outcomes and improving students’ humanistic care competence. MethodsA visual teaching program for medical humanistic care was designed， with key steps including clarifying teaching objectives， content， methods， and curriculum assessment. This program was implemented in the medical humanistic care course teaching involving 50 elective students. Multi-dimensional evaluation of teaching effectiveness was conducted through course grades， visual teaching evaluation， and humanistic workshop assessment， combined with inductive content analysis of students’ learning experiences in the workshops. ResultsThe 50 students achieved above-average course grades （89.60±3.41） and demonstrated high satisfaction with the overall course and visual teaching. All the 6 groups obtained relatively high scores in the medical humanistic care workshops. Four themes were extracted， namely， enhancing humanistic care competencies， deepening familial and interpersonal relationships， realizing emotional expression and self-growth， and strengthening integration of humanistic care concepts with practice. ConclusionThe teaching of medical humanistic care course has achieved favorable effects， which contributes to deepening students’ understanding of humanistic care and enhancing their humanistic care competence. Students demonstrate high levels of recognition and satisfaction with the course.

ObjectiveTo investigate the effect of high-definition transcranial direct current stimulation (HD-tDCS) combined with upper limb robot on upper limb dysfunction in patients with ischemic stroke. MethodsFrom January, 2023 to March, 2024, 56 inpatients with upper limb dysfunction after ischemic stroke were selected from Zhejiang Rehabilitation Medical Center, and divided into control group (n = 28) and experimental group (n = 28) randomly. All the patients received comprehensive treatment and upper limb robot training, while the control group received sham HD-tDCS and the experimental group received HD-tDCS, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Wolf Motor Function Test (WMFT) and modified Barthel Index (MBI) before and after treatment. The cortical amplitude, cortical latency and central motor conduction time (CMCT) of transcranial magnetic stimulation motor-evoked potential (MEP) were recorded, and a correlation analysis was conducted. ResultsThe scores of FMA-UE, WMFT and MBI, and MEP cortical amplitude, cortical latency and CMCT improved in both groups after treatment (t > 3.177, P < 0.01), and they were better in the experimental group than in the control group (t > 3.610, P < 0.01). The scores of FMA-UE and WMFT negatively correlated with MEP cortical latency and CMCT, and positively correlated with MEP cortical amplitude (|r| > 0.448, P < 0.001). ConclusionHD-tDCS is effective on upper limb motor function and activities of daily living for patients with ischemic stroke, and can improve corticospinal motor conduction.

To analyze inpatient mortality cases in a tertiary general hospital in Beijing based on diagnosis-related groups (DRG), with the aim of providing references for healthcare quality management.

Objective:To investigate the feasibility and value of nomogram based on base line clinical and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) characteristics for pretreatment predicting the depth of myometrial invasion and tumor grade of endometrioid endometrial carcinoma (EEC).Methods:Preoperative baseline clinical characteristics and DCE-MRI characteristics of 194 EEC patients were prospectively collected at Obstetrics and Gynecology Hospital, Fudan University from October 2020 to January 2022 and used as a training set. Univariate analysis was conducted to compare baseline clinical characteristics and DCE-MRI quantitative parameters [including tumor volume, and mean, median, and standard deviation of volume transfer constant (K trans), rate constant (K ep), extravascular extracellular volume fraction (V e), and initial area under the enhancement curve (iAUC)] between patients with deep myometrial invasion (DMI) and those with superficial myometrial invasion (SMI), as well as between high-grade and low-grade EEC. Multivariate logistics regression analysis was used to identify independent predictors for the construction of nomogram. An independent external testing set comprising 127 EEC patients was retrospectively collected from Zhongshan Hospital, Fudan University and Zhongshan Hospital, Fudan University (Xiamen Branch). The area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA) were used for evaluating the model′s predictive performance and clinical net benefit, respectively. Results:(1) The depth of myometrial invasion: univariate analysis showed that in the training set, the EEC patients with DMI differed significantly from those with SMI in clinical characteristics including higher proportion of postmenopausal state and overweight [body mass index (BMI)≥25 kg/m2], and abnormal levels of serum cancer antigen (CA) 125, CA 199, and human epididymis protein 4 (HE4), and in DCE-MRI quantitative parameters including tumor volume, and median, mean, and standard deviation of K trans, median of V e, as well as median, mean, and standard deviation of iAUC (all P<0.05). Multivariate analysis showed that the patient′s menstrual status, BMI, CA 199, tumor volume, and mean of iAUC were independent predictors of the depth of myometrial invasion, and constructed the nomogram (recorded as Nomogram_1), achieving an AUC of 0.861 (95% CI: 0.803-0.919) in the training set. In the independent external testing set, the AUC was 0.876 (95% CI: 0.815-0.938), with corresponding sensitivity of 82.0%, specificity of 80.7%, accuracy of 81.1%, positive predictive value (PPV) of 65.3%, and negative predictive value (NPV) of 91.0% for predicting DMI. (2) The EEC grade: univariate analysis showed that in the training set, high-grade EEC patients differed significantly from low-grade EEC in clinical characteristics including patient′s age, the proportion of postmenopausal state and overweight, and abnormal levels of serum CA 125, and in DCE-MRI quantitative parameters including tumor volume, median, mean, and standard deviation of K trans, median and mean of V e, as well as median, mean, and standard deviation of iAUC (all P<0.05). Multivariate analysis showed that the patient′s menstrual status, BMI, tumor volume, and median of V e emerged as independent predictors of EEC grade, and constructed the nomogram (recorded as Nomogram_2), achieving an AUC of 0.845 (95% CI: 0.786-0.893) in the training set. While in the external testing set, the AUC was 0.819 (95% CI: 0.744-0.894), with corresponding sensitivity of 72.4%, specificity of 72.4%, accuracy of 72.4%, PPV of 43.8%, and NPV of 89.9% for predicting high-grade EEC. (3) The DCA curves demonstrated that both Nomogram_1 and Nomogram_2 yielded obvious positive clinical net benefits across a wide range of threshold probabilities. Conclusion:The nomogram based on pretreatment clinical and DCE-MRI characteristics has the potential to noninvasive predict the depth of myometrial invasion and grade of EEC, providing valuable reference information for clinical management decision-making.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective:To investigate the feasibility and value of nomogram based on base line clinical and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) characteristics for pretreatment predicting the depth of myometrial invasion and tumor grade of endometrioid endometrial carcinoma (EEC).Methods:Preoperative baseline clinical characteristics and DCE-MRI characteristics of 194 EEC patients were prospectively collected at Obstetrics and Gynecology Hospital, Fudan University from October 2020 to January 2022 and used as a training set. Univariate analysis was conducted to compare baseline clinical characteristics and DCE-MRI quantitative parameters [including tumor volume, and mean, median, and standard deviation of volume transfer constant (K trans), rate constant (K ep), extravascular extracellular volume fraction (V e), and initial area under the enhancement curve (iAUC)] between patients with deep myometrial invasion (DMI) and those with superficial myometrial invasion (SMI), as well as between high-grade and low-grade EEC. Multivariate logistics regression analysis was used to identify independent predictors for the construction of nomogram. An independent external testing set comprising 127 EEC patients was retrospectively collected from Zhongshan Hospital, Fudan University and Zhongshan Hospital, Fudan University (Xiamen Branch). The area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA) were used for evaluating the model′s predictive performance and clinical net benefit, respectively. Results:(1) The depth of myometrial invasion: univariate analysis showed that in the training set, the EEC patients with DMI differed significantly from those with SMI in clinical characteristics including higher proportion of postmenopausal state and overweight [body mass index (BMI)≥25 kg/m2], and abnormal levels of serum cancer antigen (CA) 125, CA 199, and human epididymis protein 4 (HE4), and in DCE-MRI quantitative parameters including tumor volume, and median, mean, and standard deviation of K trans, median of V e, as well as median, mean, and standard deviation of iAUC (all P<0.05). Multivariate analysis showed that the patient′s menstrual status, BMI, CA 199, tumor volume, and mean of iAUC were independent predictors of the depth of myometrial invasion, and constructed the nomogram (recorded as Nomogram_1), achieving an AUC of 0.861 (95% CI: 0.803-0.919) in the training set. In the independent external testing set, the AUC was 0.876 (95% CI: 0.815-0.938), with corresponding sensitivity of 82.0%, specificity of 80.7%, accuracy of 81.1%, positive predictive value (PPV) of 65.3%, and negative predictive value (NPV) of 91.0% for predicting DMI. (2) The EEC grade: univariate analysis showed that in the training set, high-grade EEC patients differed significantly from low-grade EEC in clinical characteristics including patient′s age, the proportion of postmenopausal state and overweight, and abnormal levels of serum CA 125, and in DCE-MRI quantitative parameters including tumor volume, median, mean, and standard deviation of K trans, median and mean of V e, as well as median, mean, and standard deviation of iAUC (all P<0.05). Multivariate analysis showed that the patient′s menstrual status, BMI, tumor volume, and median of V e emerged as independent predictors of EEC grade, and constructed the nomogram (recorded as Nomogram_2), achieving an AUC of 0.845 (95% CI: 0.786-0.893) in the training set. While in the external testing set, the AUC was 0.819 (95% CI: 0.744-0.894), with corresponding sensitivity of 72.4%, specificity of 72.4%, accuracy of 72.4%, PPV of 43.8%, and NPV of 89.9% for predicting high-grade EEC. (3) The DCA curves demonstrated that both Nomogram_1 and Nomogram_2 yielded obvious positive clinical net benefits across a wide range of threshold probabilities. Conclusion:The nomogram based on pretreatment clinical and DCE-MRI characteristics has the potential to noninvasive predict the depth of myometrial invasion and grade of EEC, providing valuable reference information for clinical management decision-making.

Objective To investigate the application effect of the anterolateral thigh perforator flap(ALTPF)with end-to-side anastomosis of non-primary source vessels in repairing soft tissue defects in the hands and feet.Methods Ninety-six patients with soft tissue defects in the hands and feet of the Third People's Hospital of Xinjiang Uygur Autonomous Region from March 2021 to June 2023 were randomly divided into two groups using a random number table method,with 48 cases in each group.The control group was treated with a conventional subcutaneous artery perforator flap,while the observation group was treated with an end-to-side anastomosis of non-primary source vessels using an ALTF.The repair indicators of tissue defects,the recovery of sensory function,the recovery of hand and foot function,and the incidence of complications were compared between the two groups at 1 month and 3 months after surgery.Results The wound healing time in the observation group and the control group was(19.35±3.89)days and(23.72±4.76)days,respectively,with a statistically significant difference(P＜0.05).There was no significant difference in the preparation time,survival rate,and stage Ⅰ healing rate of the two groups of skin flaps(P＞0.05).At 1 month and 3 months after surgery,the proportions of patients with pain sensation in the observation group and control group were 70.83％and 50.00％,respectively,and 100.00％and 79.17％,respectively.The proportions of patients with cold and hot sensation were 66.67％and 45.83％,respectively,and 97.92％and 72.92％,respectively.The distance of two-point discrimination was(30.69±6.10)mum and(34.40±7.36)mm,respectively,and(15.23±3.72)mm and(22.36±5.28)mm,respectively,with a statistically significant difference(P＜0.05).There was no significant difference in the excellent and good rate of hand and foot function between the two groups 3 months after surgery(P＞0.05).The incidence of complications in the observation group was 4.17％,which was lower than that in the control group(22.91％),and the difference was statistically significant(P＜0.05).Conclusion ALTPF repair of soft tissue defects in the hands and feet with end-to-side anastomosis of non-primary source vessels can improve wound healing rates,improve sensory function,and reduce the incidence of complications.

In recent years, with the rapid development of artificial intelligence technology, the application of deep learning in the field of pathology has been continuously expanding. Particularly, the rise of multimodal data fusion methods has opened up new technical paths for the precise diagnosis, prognosis assessment, and individualized treatment of tumors. By integrating multi-level and multi-source data such as clinical information, pathological omics, molecular omics, and imaging omics, deep learning models can identify potential associated features and key biological mechanisms that are difficult to reveal by a single modality, thereby significantly improving the accuracy of disease classification and the scientific nature of risk stratification. This article systematically reviews the research progress of multimodal data fusion methods based on deep learning in the field of pathology in recent years, focuses on sorting out different types of fusion strategies, evaluates their advantages and challenges in practical clinical applications, and looks forward to future development trends.

For middle-aged and elderly patients with conditions such as spinal fractures and degenerative spinal diseases, spinal internal fixation is a core surgical procedure for reconstructing spinal stability, heavily relying on the biomechanical stability provided by pedicle screw systems. Whereas, these patients are often complicated by osteoporosis that can significantly compromise the stability of the bone-pedicle screw interface, leading to a marked increase in pedicle screw loosening and surgical failure rates. The bone cement-augmented pedicle screw technique, which involves injecting bone cement into the vertebral body or screw trajectory to optimize the mechanical properties of the bone-pedicle screw composite, has been proven to significantly enhance fixation strength and effectively prevent screw-related failures, thereby reducing the incidence of internal fixation failure in high-risk populations undergoing spinal fusion. However, the widespread clinical application of this technique has faced challenges such as inaccurate clinical decision-making (indication and contraindication selection), non-standardized operative practices, and insufficient awareness of complication prevention, resulting in considerable variability in clinical outcomes and even severe complications. To address this, Prof. Luo Fei from First Affiliated Hospital of Army Medical University initiated the project and the Chinese Association Orthopaedic Surgeons organized relevant experts to develop the Evidence-based clinical practice guideline for bone cement-augmented pedicle screw technique ( version 2025), based on current evidence. The guidelines put forward 8 recommendations regarding the clinical value, scope of application, and operational standards of the technique, aiming to provide evidence-based medical support and technical standardization for clinical decision-making.

Objective:To investigate the effect of Lulongzaisheng decoction on ferroptosis in aplastic anemia (AA) model mice and its potential mechanism of action on AA.Methods:Using female BALB/c mice as controls (control group), a mouse model of AA was established by intraperitoneal injection of interferon-γ (IFN-γ) combined with oral gavage of busulfan. The AA group was treated with continuous oral gavage of Lulongzaisheng decoction for 10 days. The effects on the Jak2/Stat3/Acsl4 signaling pathway were assessed. Bone marrow biopsy and histopathological examination were performed to observe the degree of AA in each group of mice. Flow cytometry was used to detect the production of lipid reactive oxygen species (ROS) in the bone marrow cells. Immunohistochemical staining was performed to observe the expression of 4-HNE in the sternum. Western blot analysis was conducted to determine the protein expression levels of Jak2, p-Jak2, Stat3, p-Stat3, and Acsl4. ELISA was used to measure the levels of interleukin-6 (IL-6) in the peripheral blood plasma.Results:Compared with the control group, mice in the AA group exhibited a reduction in hematopoietic tissues within the bone marrow cavity and significant fatty infiltration. In contrast, mice in the AA+Lulongzaisheng decoction group showed partial recovery of the bone marrow and a decrease in fatty infiltration. The lipid ROS proportions in the control, AA, and AA+Lulongzaisheng decoction groups were (47.01±3.07) %, (53.81±1.99) %, and (49.50±3.98) %, respectively ( P<0.05), indicating that the AA + Lulongzaisheng decoction group had a slightly lower accumulation of lipid ROS than the AA group. The expression areas of 4-HNE in the bone marrow cavity for the control, AA, and AA+Lulongzaisheng decoction groups were (6.34±1.07) %, (35.26±3.68) %, and (16.97±1.30) %, respectively ( P<0.05), demonstrating a significant reduction in 4-HNE accumulation in the bone marrow in the AA + Lulongzaisheng decoction group compared with that in the AA group. Compared with the control group, the AA group exhibited upregulated expression of the ferroptosis-related protein Acsl4, along with increased expression of p-Stat3 and p-Jak2. In the AA+ Lulongzaisheng decoction group, the expression of Acsl4 was downregulated, whereas those of p-Stat3 and p-Jak2 were inhibited ( P<0.05). The levels of IL-6 in the peripheral blood plasma were (65.60±6.01), (166.50±3.32), and (119.37±4.29) pg/ml in the control, AA, and AA+Lulongzaisheng decoction groups, respectively ( P<0.05). Compared with the AA group, the AA + Lulongzaisheng decoction group exhibited a significant decrease in IL-6 levels. Conclusion:This study shows that Lulongzaisheng decoction has a significant therapeutic effect on AA model mice by regulating the Jak2/Stat3/Acsl4 pathway. The mechanism of action of this traditional Chinese medicine involves inhibiting the Jak2/Stat3 signaling pathway and regulating the expression of Acsl4, thereby improving hematopoietic function in AA model mice. These findings provide new drug targets and treatment strategies for the treatment of AA.