Objective To investigate the risk factors of severe hemolysis during extracorporeal membrane oxygenation (ECMO). Methods The clinical data of adult patients undergoing ECMO after cardiac surgery admitted to Fuwai Hospital from December 2010 to October 2015 were retrospectively analyzed. Demographic characteristics, renal function, primary disease, operation data, ECMO related data and outcomes were recorded. Patients were divided into normal free hemoglobin (FHB) group (FHB ≤ 500 mg/L) and severe hemolysis group (FHB > 500 mg/L) according to the FHB level during ECMO support. The parameters before and after ECMO support were compared between the two groups. Logistic regression was used to identify the independent risk factors of severe hemolysis. Results A total of 81 patients including 19 patients with severe hemolysis was enrolled, and 62 in normal FHB group. There was no difference in cardiopulmonary bypass (CPB) time, clamping time, lactate level before ECMO, cardiopulmonary resuscitation, intra-aortic balloon pump use and central catheter insertion between two groups. The maximums of serum creatinine (SCr) and FHB levels were higher in severe hemolysis group as compared with those in normal FHB group [maximal SCr (μmol/L): 281.02±164.11 vs. 196.67±87.31, maximal FHB (mg/L): 600 (600, 700) vs. 200 (100, 300)], the incidence of clots in circuit or oxygenator, infection, and hemofiltration in severe hemolysis group was increased [26.3% (5/19) vs. 4.8% (3/62), 31.6% (6/19) vs. 12.9% (8/62), 36.8% (7/19) vs. 14.5% (9/62), all P < 0.1]. As well as outcomes including the rate of site of surgery or intubation bleeding and acute renal failure [ARF, 57.9 % (11/19) vs. 30.6% (19/62), 94.7% (18/19) vs. 41.9% (26/62)], and the survival rate was lowered [10.5% (2/19) vs. 51.6% (32/62), all P < 0.05]. As result of univariate analysis, clots in circuit or oxygenator, infection and hemofiltration were associated with severe hemolysis. It was showed by logistic regression analysis that the clots in circuit or oxygenator was a risk factor of severe hemolysis during ECMO [odds ratio (OR) = 6.262, 95% confidence interval (95%CI) = 1.244-31.515, P = 0.026]. Conclusions The clots in circuit or oxygenator were independent risk factors of severe hemolysis during ECMO. Severe hemolysis can induce the increase of the rate of bleeding in the operation site or intubation and the rate of ARF, and decrease of the survival rate.

The outbreak of major public emergencies is an important practical issue that affects social development and human survival and security. In the face of major public emergencies, college students in the new era must have a strong sense of responsibility and mission. This paper took the formation value of college students’ responsibility ethics as a logical clue, deeply analyzed the subject-object function relationship of college students’ responsibility ethics in major public emergencies, and combined the philosophy of subjectivity to reveal the contradictory connotations of college students’ subjects, that is, the contradictory relationship between spontaneity and consciousness, selfishness and dedication, passivity and initiative, and relyed on the connotation logic of responsibility ethics to promote the sense of responsibility and mission of college students in major public emergencies, so that they can develop to a higher level, thus realizing the ultimate goal of generating the value of responsibility ethics.

The outbreak of major public emergencies is an important practical issue that affects social development and human survival and security. In the face of major public emergencies, college students in the new era must have a strong sense of responsibility and mission. This paper took the formation value of college students’ responsibility ethics as a logical clue, deeply analyzed the subject-object function relationship of college students’ responsibility ethics in major public emergencies, and combined the philosophy of subjectivity to reveal the contradictory connotations of college students’ subjects, that is, the contradictory relationship between spontaneity and consciousness, selfishness and dedication, passivity and initiative, and relyed on the connotation logic of responsibility ethics to promote the sense of responsibility and mission of college students in major public emergencies, so that they can develop to a higher level, thus realizing the ultimate goal of generating the value of responsibility ethics.

Virtue ethics and normative ethics are corresponding ethical concepts, and their collision and integration promote the development of ethical system. On the issue of doctor-patient relationship, from virtue to norm is the objective requirement of social transformation and development, and is also the inevitable choice to resolve doctor-patient conflicts and reshape doctor-patient relationships. In the new era, the construction of doctor-patient relationship faces ethical dilemma such as one-sided emphasis on doctors’ virtue cultivation, unclear ethical responsibilities between doctors and patients, and lack of trust and tolerance between doctors and patients. Therefore, it is necessary to strengthen the institutionalization of doctor ethics, clarify the ethical responsibilities of both doctors and patients, optimize the social ethical ecological environment, so as to realize the ethical reconstruction of doctor-patient relationship from virtue to norm.

In the era of deep technologization with the flourishing development of newquality productive forces， China’s medical science and technology innovation has transitioned from “following” to “leading”， and the ethical governance environment of medical science and technology has undergone profound changes. However， the traditional ethical governance system of medical science and technology faces several issues， such as outdated ethical governance concepts， inadequate ethical norms， excessive hidden ethical risks， and numerous loopholes in governance systems， which fail to effectively respond to the diverse and complex ethical risk challenges. To this end， it is essential to promote the transformation of ethical governance thinking in medical science and technology based on the reality of newquality productivity forces and deep technologization， as well as to shift unilateral， extensive， and single governance into comprehensive， precise， and early-warning governance. Additionally， it is necessary to cultivate an ethical governance concept that prioritizes ethics and prevention， establish a diverse and collaborative ethical governance model， set up a prevention mechanism focused on major ethical risks， as well as enhance the systems of ethical communication， review， and feedback in medical science and technology.

Objective To explore the incidence rate,risk factors and outcome of hyperbilirubinemia in adult cardiac patients supported by extracorporeal membrane oxygenation(ECMO).Methods Clinical data of 89 adult cardiac patients with ECMO in Fuwai Hospital were retrospectively analyzed.All patients were divided into normal group,high bilirubin group and severe high bilirubin group.In a multiple linear regression analysis,logarithmic transformation was performed for non-normally distributed variables.Results The incidence rate of hyperbilirubinemia was 73％,including 30 cases in high bilirubin group and 35 cases in severe high bilirubin group.A multiple linear regression analysis showed that lg(peak TBIL+1)was significantly associated with lg(peak AST+1)(P=0.001),lg(peak free hemoglobin +1)(P=0.003)and TBIL before ECMO(P=0.009).There was also a linear correlation between peak TBIL and TBIL before ECMO support(P=0.011),peak AST(P=0.004)and peak free hemoglobin during ECMO(P<0.001).The patients in severe high bilirubin group had lower platelets during ECMO,and the survival rate was the lowest.Conclusion Hyperbilirubinemia remains common in patients with ECMO,and is associated with low platelet and a high rate of in-hospital mortality.Hemolysis and liver dysfunction during ECMO support and high bilirubin level before ECMO are risk factors of hyperbilirubinemia.

Objective To explore the incidence rate,risk factors and outcome of hyperbilirubinemia in adult cardiac patients supported by extracorporeal membrane oxygenation(ECMO).Methods Clinical data of 89 adult cardiac patients with ECMO in Fuwai Hospital were retrospectively analyzed.All patients were divided into normal group,high bilirubin group and severe high bilirubin group.In a multiple linear regression analysis,logarithmic transformation was performed for non-normally distributed variables.Results The incidence rate of hyperbilirubinemia was 73％,including 30 cases in high bilirubin group and 35 cases in severe high bilirubin group.A multiple linear regression analysis showed that lg(peak TBIL+1)was significantly associated with lg(peak AST+1)(P=0.001),lg(peak free hemoglobin +1)(P=0.003)and TBIL before ECMO(P=0.009).There was also a linear correlation between peak TBIL and TBIL before ECMO support(P=0.011),peak AST(P=0.004)and peak free hemoglobin during ECMO(P<0.001).The patients in severe high bilirubin group had lower platelets during ECMO,and the survival rate was the lowest.Conclusion Hyperbilirubinemia remains common in patients with ECMO,and is associated with low platelet and a high rate of in-hospital mortality.Hemolysis and liver dysfunction during ECMO support and high bilirubin level before ECMO are risk factors of hyperbilirubinemia.

【Objective】 To investigate the intrinsic relationship of social support and psychological capital with college students’ volunteer motivation in the post-epidemic era so as to provide theoretical basis for formulating policies and measures to increase college students’ participation in volunteer activities. 【Methods】 In March 2022, 1 120 college students from 15 universities in Henan Province were selected by convenient sampling method. Their general information, social support, psychological capital, and volunteer motivation were investigated, and univariate analysis, correlation analysis and intermediary effect analysis were performed. 【Results】 The differences of scores in six dimensions of volunteer motivation (i.e., values, understanding, enhancement, career, social interaction, and self-protection) were statistically significant (F=124.90, P<0.001). There were significant differences in social support level of college students of different genders (t=-2.40, P<0.05), and the difference in volunteer motivation level among different grades of college students was statistically significant (F=6.72, P<0.001). Social support, psychological capital, and volunteer motivation were positively correlated with one another (r=0.41, r=0.35, r=0.50, P<0.001). Part of the intermediary effect of psychological capital between social support and volunteer motivation was significant (intermediary effect value=0.49, 95% CI: 0.39-0.59). 【Conclusion】 Colleges and universities can take corresponding measures to improve college students’ volunteer motivation level by improving social support and psychological capital level.

Breast cancer has become the most commonly diagnosed cancer type in the world. A combination of chemotherapy and photothermal therapy (PTT) has emerged as a promising strategy for breast cancer therapy. However, the intricacy of precise delivery and the ability to initiate drug release in specific tumor sites remains a challenging puzzle. Therefore, to ensure that the therapeutic agents are synchronously delivered to the tumor site for their synergistic effect, a multifunctional nanoparticle system (PCRHNs) is developed, which is grafted onto the prussian blue nanoparticles (PB NPs) by reduction-responsive camptothecin (CPT) prodrug copolymer, and then modified with tumor-targeting peptide cyclo(Asp-d-Phe-Lys-Arg-Gly) (cRGD) and hyaluronic acid (HA). PCRHNs exhibited nano-sized structure with good monodispersity, high load efficiency of CPT, triggered CPT release in response to reduction environment, and excellent photothermal conversion under laser irradiation. Furthermore, PCRHNs can act as a photoacoustic imaging contrast agent-guided PTT. In vivo studies indicate that PCRHNs exhibited excellent biocompatibility, prolonged blood circulation, enhanced tumor accumulation, allow tumor-specific chemo-photothermal therapy to achieve synergistic antitumor effects with reduced systemic toxicity. Moreover, hyperthermia-induced upregulation of heat shock protein 70 in the tumor cells could be inhibited by CPT. Collectively, PCRHNs may be a promising therapeutic way for breast cancer therapy.