Objective: To develop a facial image generation method based on a facial color-preserving generative adversarial network (FCP-GAN) that effectively decouples identity features from diagnostic facial complexion characteristics in traditional Chinese medicine (TCM) inspection, thereby addressing the critical challenge of privacy preservation in medical image analysis. Methods: A facial image dataset was constructed from participants at Nanjing University of Chinese Medicine between April 23 and June 10, 2023, using a TCM full-body inspection data acquisition equipment under controlled illumination. The proposed FCP-GAN model was designed to achieve the dual objectives of removing identity features and preserving colors through three key components: (i) a multi-space combination module that comprehensively extracts color attributes from red, green, blue (RGB), hue, saturation, value (HSV), and Lab spaces; (ii) a generator incorporating efficient channel attention (ECA) mechanism to enhance the representation of diagnostically critical color channels; and (iii) a dual-loss function that combines adversarial loss for de-identification with a dedicated color preservation loss. The model was trained and evaluated using a stratified 5-fold cross-validation strategy and evaluated against four baseline generative models: conditional GAN (CGAN), deep convolutional GAN (DCGAN), dual discriminator CGAN (DDCGAN), and medical GAN (MedGAN). Performance was assessed in terms of image quality [peak signal-to-noise ratio (PSNR) and structural similarity (SSIM)], distribution similarity [Fréchet inception distance (FID)], privacy protection (face recognition accuracy), and diagnostic consistency [mean squared error (MSE) and Pearson correlation coefficient (PCC)]. Results: The final analysis included facial images from 216 participants. Compared with baseline models, FCP-GAN achieved superior performance, with PSNR = 31.02 dB and SSIM = 0.908, representing an improvement of 1.21 dB and 0.034 in SSIM over the strongest baseline (MedGAN). The FID value (23.45) was also the lowest among all models, indicating superior distributional similarity to real images. The multi-space feature fusion and the ECA mechanism contributed significantly to these performance gains, as evidenced by ablation studies. The stratified 5-fold cross-validation confirmed the model’s robustness, with results reported as mean ± standard deviation (SD) across all folds. The model effectively protected privacy by reducing face recognition accuracy from 95.2% (original images) to 60.1% (generated images). Critically, it maintained high diagnostic fidelity, as evidenced by a low MSE (< 0.051) and a high PCC (> 0.98) for key TCM facial features between original and generated images. Conclusion The FCP-GAN model provides an effective technical solution for ensuring privacy in TCM diagnostic imaging, successfully having removed identity features while preserving clinically vital facial color features. This study offers significant value for developing intelligent and secure TCM telemedicine systems.

Objective:To analyze the differential expressions of proteins in aqueous humor in patients with exfoliation syndrome (XFS).Methods:A total of 20 patients were enrolled in the Department of Ophthalmology, People's Hospital of Hotan District from June 2020 to January 2021, including 10 patients with age-related cataract and 10 XFS patients combined with cataract, which were classified as cataract group and XFS group, respectively.A total of 50 to 100 μl aqueous humor was obtained in the middle of the anterior chamber through the intraoperative phacoemulsification channel.The proteins extracted from aqueous humor were analyzed by label-free quantitative proteomics technology.The cataract group was set as the control group, and the differentially expressed proteins (DEPs) in XFS group were screened according to P<0.05 and fold change >1.5.Gene ontology (GO) function analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway analysis were used to explore the function and regulatory signaling pathways of DEPs in the XFS group.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Tianjin Medical University Eye Hospital (No.2020KY[L]-21).Written informed consent was obtained from each subject. Results:In comparison with the cataract group, 25 DEPs were identified in the XFS group, primarily involved in cell adhesion, receptor, hydrolase, and molecular transport.Specifically, there were 14 down-regulated proteins including complement factor H-related protein 1 (CFHR1), endoplasmic reticulum chaperone BiP (HSPA5), biglycan (BGN), FRAS1-related extracellular matrix protein 2 (FREM2), hemoglobin subunit delta (HBD), hemoglobin subunit gamma-1 (HBG1), lysosomal thioesterase PPT2 (PPT2) etc., and 11 up-regulated proteins including latent-transforming growth factor beta-binding protein 2 (LTBP2), very low-density lipoprotein receptor (VLDLR), laminin subunit alpha-2 (LAMA2), coagulation factor Ⅸ (F9).Among them, FREM2 was the most significantly differentially expressed protein in XFS group with consistent expression levels across individual samples.GO analysis revealed that these DEPs mainly localized to the extracellular matrix of collagen, bound globin-hemoglobin complex, plasma lipoprotein particles and lysosomes.Molecular functions and biological processes showed that HBD and HBG1 were involved in cellular detoxification, PPT2 in hydrolase activity, and BGN and LTBP2 in glycosaminoglycan binding.KEGG signaling pathway analysis indicated that CFHR1 and F9 were associated with complement and coagulation cascade pathways, and FREM2 and LAMA2 were linked to the extracellular matrix interaction pathway.Conclusions:Disease progression of XFS may be associated with changes in extracellular matrix proteins, disruption of the blood-aqueous humor barrier, and potential inflammatory responses.The significant down-regulation of FREM2 protein may be a potential biomarker for XFS.

Objective:To investigate the current status of bedside teaching at pediatric bases and existing problems in pediatric bedside teaching, and to discuss how to improve bedside teaching in pediatrics.Methods:A questionnaire on pediatric bedside teaching was administered to 475 instructors who had participated in the backbone teacher training course of pediatric standardized residency training bases in 2022. The instructors were divided into two groups according to their medical professional titles: attending physician group and associate chief physician/chief physician group. The general information, bedside teaching rate, bedside teaching difficulties, and abilities that need to be strengthened were compared between the two groups of instructors. SPSS 21.0 was used to perform the chi-square test.Results:A total of 475 instructors responded to the questionnaire. Among them, 96.84% (460/475) were from tertiary class-A hospitals; 54.11% (257/475) had more than 10 years of clinical teaching practice; and 97.26% (462/475) conducted bedside teaching, but the proportion of bedside teaching time in routine clinical teaching was low, with only 30.11% (143/475) reaching >50.00%. The main difficulties in bedside teaching in pediatrics included noisy environments at pediatric wards or clinics (75.58%, 359/475), the lack of teaching time (71.16%, 338/475), intense clinical pressure (64.63%, 307/475), poor cooperation with children (54.95%, 261/475), the presence of parents at pediatric wards or clinics (44.84%, 213/475), varying levels of qualifications of residents (41.68%, 198/475), and high pressure of scientific research (30.11%, 143/475). There were 41.20% (96/233) of the attending physicians and 28.57% (68/238) of the associate chief physicians/chief physicians spending less than 30.00% of their teaching time at the bedside, respectively, which were significantly different ( P<0.05). Conclusions:The low proportion of time spent on bedside teaching among pediatric instructors is driven by various factors such as noisy pediatric environments and the great clinical pressure of pediatric teachers.

Objective:To analyze the self-evaluation and training needs of standardized parents from pediatric nurses after participating in the standardized residency training of pediatrics, and to explore the feasibility of pediatric nurses as standardized parents and the methods of training and management.Methods:A self-made questionnaire was used to investigate the self-evaluation, the influencing factors, the needs of training content and training form of standardized parents of pediatric nurses. Data analysis was made by SPSS 24.0 statistical software.Results:A total of 37 questionnaires were collected from the standardized parents of nurses. Among them, 36 nurses (97.30%) thought they were very competent for the work of standardized parent; 36 ones (97.30%) thought the most satisfied with their own was responsibility and fairness; 26 ones (70.27%) thought the least satisfied with their own was performance ability; 23 ones (62.16%) thought that the assessment of non-professional diseases would affect their performance in the assessment process; 34 people (91.89%) had the highest demand for training in the contents and skills of consultation; 16 ones (43.24%) thought that "teaching" and "giving cases to doctors and standardized parents for assessment simulation exercise" were the better training methods. Nurses used their own time to participate in training and assessment, and were willing to participate in the certification assessment of standardized parents.Conclusions:In the training of standardized parents of pediatric nurses, it is need to strengthen the training of various abilities, further improve the training contents and forms, reasonably arrange the training and assessment time, and increase policy support to make the standardized parent management of nurses more standardized.

Objective:To analyze the evaluation of the application effect and deficiency of nurses acting as standardized parents in the graduation examination of standardized residency training of pediatrics and further improve and promote the level of standardized parents.Methods:A questionnaire survey was used to collect the scores of nurse standardized parents by students and examiners who took part in the graduation examination of standardized residency training of pediatrics in 2021. And the self-evaluation scores of standardized parents were collected. Counting data were represented by the number of cases and composition ratio. A Chi-square test was used to compare the rates.Results:A total of 125 questionnaires from students and 37 questionnaires from nurse standardized parents were collected, and the overall satisfaction (very satisfied + satisfied) of standardized parents reached 121 (96.80%). In the three dimensions of simulation ability, compliance with question-and-answer rules, and simulated attitude, students believed that the consistency between standardized parents and actual parents in simulated altitude was lower than that in the simulation ability and compliance with question-and-answer rules ( P=0.007, P=0.001). The overall satisfaction of standardized parents (very satisfied + satisfied) reached 87.38% (388/444). There were 26 (70.27%) nurse standardized parents who had the lowest satisfaction with their own performance ability, followed by 28 (75.68%) cases of imitation ability and 30 (81.08%) cases of adaptability. Conclusions:It is feasible to adopt nurse standardized parents in the assessment of standardized residency training of pediatrics, and both students and examiners have higher satisfaction. The next step is to improve the training of nurses standardized parents in the attitude of simulation and, at the same time, enhance the training of imitation ability and adaptability, so as to further expand the construction of standardized parents.

Objective:To explore the real experience of parturients with pernicious placenta previa and placenta increta undergoing cesarean section from diagnosis to childbirth, so as to provide theoretical basis for clinical treatment and nursing decision-making.Methods:This study was a qualitative study. From November 2022 to January 2023, purposive sampling was used to select 13 parturients with pernicious placenta previa and placenta increta in the Department of Obstetrics of the First Affiliated Hospital of Zhengzhou University for semi-structured in-depth interviews. After collecting and organizing interview data, the Colaizzi 7-step analysis method was used to analyze the data, in order to understand the real experiences of parturients with pernicious placenta previa and placenta increta undergoing cesarean section.Results:The real experience of parturients with pernicious placenta previa and placenta increta undergoing cesarean section was extracted into three themes and 12 sub-themes. The first theme was the difficulties in seeking medical advice, with a complex and tortuous inner experience (the sub-themes include the unknown and fear in the early stages of diagnosis, the difficult struggle to make medical decisions, the arduous journey to protect the fetus, the physical and mental pain during the perioperative period, the joy of being born in a desperate situation, and concerns about the newborn and the new family pattern). The second theme was the personal positive coping experience during pregnancy and childbirth (the sub-themes include actively seeking disease information and professional support, quickly changing roles and completing role adaptation, evoking past experiences and reflecting resilient multipara traits). The third theme was to effectively utilize family social support (the sub-themes include trust and compliance with medical institutions to meet disease diagnosis and treatment needs, receiving professional guidance from medical and nursing staff to eliminate negative psychology and meet knowledge needs, benefiting from spouse and family support to meet life and emotional needs) .Conclusions:Parturients with pernicious placenta previa and placenta increta undergoing cesarean section can actively cope with the disease during pregnancy and childbirth, but still have negative emotions. Medical and nursing staff should promptly anticipate potential risks, provide correct information, professional guidance, and assistance to pregnant and postpartum women and their families, and eliminate their negative psychology among them.

N6-methyladenosine modification is regulated by methylase and demethylase,resulting in a dynamic and reversible process.Changes in m6A levels are involved in a wide range of cellular processes,including nuclear RNA output,mRNA metabolism,protein translation,and RNA splicing,and have strong associations with various diseases.The purpose of this paper is to generalize and summarize the role and mechanism of the change of m6A expression level in mRNA in three common diseases,as well as the research trend based on the change of m6A level in mRNA as a drug intervention target.

Objective:To explore the correlation between subclavian artery stenosis disease (SASD) classification and posterior circulation ischemia.Methods:A retrospective study was performed; the clinical data, and Doppler vascular ultrasound and vascular imaging results of 81 SASD patients, admitted to Cerebrovascular Stenosis Diagnosis and Treatment Center, Second Affiliated Hospital of Qiqihar Medical College and Department of Neurology, Rocket Force Specialty Medical Center from May 2018 to August 2023, were collected. SASD was categorized into 2 types (single type and concurrent type) based on the presence or absence of other posterior circulation artery (basilar artery, vertebral artery, or subclavian artery distal segment) stenosis/occlusion, and into 3 groups (non-posterior circulation ischemia group, posterior circulation transient ischemic attack group and posterior circulation cerebral infarction group) based on the presence or absence of posterior circulation ischemia. Blood stealing pathways in different SASD classifications were analyzed, and correlation of SASD classification with posterior circulation ischemia was discussed.Results:Single-type SASD was noted in 44 patients (54.3%), mainly initiating blood stealing through the vertebral artery to the vertebral artery and then to the subclavian artery ( n=26); concurrent-type SASD was noted in 37 patients (45.7%), mainly initiating blood stealing through the occipital artery to the costocervical trunk and then to the subclavian artery ( n=10). Sixty-five patients (80.2%) were into the non-posterior circulation ischemia group, 4 (4.9%) into the posterior circulation transient ischemic attack group and 12 (14.8%) into the posterior circulation cerebral infarction group. Among the 44 patients with single-type SASD, 39 did not have posterior circulation ischemia, and 3 had posterior circulation cerebral infarction. Among the 37 patients with concurrent-type SASD, 26 did not have posterior circulation ischemia, and 9 had posterior circulation cerebral infarction. Conclusion:Initiation of blood stealing in SASD patients is related to SASD classification, and concurrent-type SASD patients trend to have posterior circulation ischemia.

Objective To investigate the effects of remazolam on melatonin secretion,sleep rhythm and postoperative delirium(POD)in elderly patients undergoing spinal surgery.Methods A total of 160 elderly patients,76 males and 84 females,aged 65-80 years,BMI 18.5-24.0 kg/m2,ASA physical status Ⅱ or Ⅲ,from November 2023 to January 2024 undergoing spinal surgery(lumbar interbody fusion,posterior approach)under general anesthesia were selected.The patients were divided into two groups by random number table method:the remazolam group(group R)and the propofol group(group P),80 pa-tients in each group.Group R was given remazolam 0.3 mg/kg for anesthesia induction,and then continued to pump remazolam 0.3-0.8 mg·kg-1·h-1 for anesthesia maintenance.Group P was given propofol 2.0 mg/kg for anesthesia induction,and then continued to pump propofol 4-6 mg·kg-1·h-1 for anesthesia maintenance.The levels of melatonin and cortisol were recorded at 04:00 a.m.on the day of surgery,1 day,2 and 3 days after surgery.Pittsburgh sleep quality index(PSQI)and VAS pain scores at rest were recorded 1 day before surgery,1 day and 2 days after surgery and before discharge.The occurrence of POD and post-operative sleep disorder(POSD)were recorded.The duration of extubation,PACU stay time,total analgesia pump compressions,effective analgesia pump compressions,number of remedial analgesia cases,intraoperative hypotension,postoperative nausea and vomiting,dizziness,respiratory depression and other adverse events were recorded.Results Compared with group P,the extubation time and PACU residence time in group R were significantly shortened(P＜0.05),the level of melatonin was significantly increased while the level of cortisol was significantly decreased at 4:00 a.m.,and the PSQI was significantly decreased 1 day after surgery(P＜0.05),the incidence of POD,POSD,and intraoperative hypotension were signifi-cantly decreased(P＜0.05).There were no significant differences in extubation time,total and effective times of analgesic pump,rate of remedial analgesia,intraoperative hypotension,postoperative nausea,vom-iting,dizziness and respiratory depression between the two groups.Conclusion Remazolam has little effect on the secretion rhythm of melatonin and cortisol and the sleep rhythm after spinal surgery in elderly pa-tients,and the recovery is faster,which can reduce the incidence of POD and alleviate the sleep disorder af-ter spinal surgery.

Objective To explore the effect of opioid-free anesthesia(OFA)combined with quad-ratus lumborum block(QLB)in laparoscopic radical colorectal cancer resection.Methods Sventy patients were selected for undergoing laparoscopic radical colorectal cancer resection from March to December 2023,49 males and 21 females,aged 18-75 years,BM1 18.5-28.0 kg/m2,ASA physical status Ⅱ or Ⅲ.The patients were divided into two groups using random number table method:the OFA group(group OFA)and the conventional opioid anesthesia group(group OA),35 patients in each group.Group OFA underwent bi-lateral posterior QLB under ultrasound guidance before anesthesia induction(0.25％ropivacaine 30 ml on each side),and anesthesia induction and maintenance were performed using opioid-free anesthesia regimen.And group OA cannot undergo QLB,and anesthesia induction and maintenance were carried out using opioid containing regimen.The patient's HR and MAP were recorded before anesthesia induction(T0),1 minute after endotracheal intubation(T1),before pneumoperitoneum establishment(T2),1 minute after pneumo-peritoneum establishment(T3),1 hour after surgery(T4),the end of surgery(T5),and leaving the oper-ating room(T6).The time from the patient's anesthetic discontinuation to extubation,the length of stay in the PACU,and the Steward and VAS pain scores when the patient leaves the operating room,which were recorded.NRS scores at rest and in the motor state 6,12,24,and 48 hours after surgery,time to first ex-haust,time to first ambulation,and length of postoperative hospital stay,effective PCIA pressing times and use of additional analgesic drugs within 48 hours after the operation,and postoperative adverse reactions(nausea,vomiting,hallucinations)were also recorded.Results Compared with T0,the MAP of the two groups decreased significantly at T1,T2,T4,and T5(P＜0.05),the HR in group OFA increased signifi-cantly at T1 and slowed down at T4 and T5(P＜0.05),and the HR in group OA decreased significantly at T1-T5(P＜0.05).Compared with group OA,the HR in group OFA increased significantly at T1-T3,and the MAP increased significantly at T1(P＜0.05).Compared with group OA,the extubation time and PACU residence time were significantly delayed(P＜0.05),and the Steward score when leaving the oper-ating room was significantly lower in group OFA(P＜0.05).Compared with group OA,NRS score was sig-nificantly deceased 6,12,24,and 48 hours after the surgery(P＜0.05),time to first exhaust,time to first ambulation,and length of postoperative hospital stay were significantly shartened(P＜0.05),and ef-fective PCIA pressing times and additional analgesia times were significantly decreased(P＜0.05),inci-dence of intraoperative hypotensionand postoperative nausea and vomiting(P＜0.05).Conclusion OFA combined with QLB can safely and effectively complete laparoscopic radical colorectal cancer surgery.Pa-tients with such anesthetic methods are hemodynamically more stable during anesthesia induction and intrao-peratively.These patients have better postoperative analgesia and less need for additional analgesics,and less incidence of postoperative nausea and vomiting.This approach is more beneficial for the recovery of the patient's gastrointestinal function.