The widespread application of medical artificial intelligence （AI） has brought technological breakthroughs to traditional diagnosis and treatment and has also altered the traditional doctor-patient interaction mode and formed a new doctor-patient relationship of “doctor-medical AI-patient” which faces a series of challenges. The intervention of AI may form a new “paternalistic style，” affecting the shared decision-making model. When its recommendations lack explanation， it may lead to clinical decision-making paralysis and affect the doctor-patient trust relationships. There may be confusion between the roles and responsibilities of AI and doctors in the process of medical practice， affecting the establishment of an emotionally responsible doctor-patient relationship. Through an in-depth analysis of the impact and causes of medical AI on the doctor-patient relationships， this paper proposed that a collaborative mechanism should be established between AI and professional doctors to complement each other， clarifying the auxiliary status of AI， reinforcing the dominant role of doctors， enhancing the regulatory mechanism， and dynamically improved the doctor-patient relationships to promote the healthy and orderly development of smart healthcare.

[Objective] To explore the strategy of blood management in patients with massive transfusion in the frigid plateau region. [Methods] The treatment process of a patient with liver rupture in the frigid plateau region was analyzed, and the blood management strategy of the frigid plateau region was discussed in combination with the difficulties of blood transfusion and literature review. [Results] The preoperative complete blood count (CBC) test results of the patient were as follows: RBC 3.14×10¹²/L, Hb 10⁶ g/L, HCT 30.40%, PLT 115.00×10⁹/L; coagulation function: PT 18.9 s, FiB 1.31 g/L, DD > 6 μg/mL, FDP 25.86 μg/mL; ultrasound examination and imaging manifestations suggested liver contusion and laceration / intraparenchymal hematoma, splenic contusion and laceration, and massive blood accumulation in the abdominal cavity; it was estimated that the patient's blood loss was ≥ 2 000 mL, and massive blood transfusion was required during the operation; red blood cell components were timely transfused during the operation, and the blood component transfusion was guided according to the patient's CBC and coagulation function test results, providing strong support and guarantee for the successful treatment of the patient. The patient recovered well after the operation, and the CBC test results were as follows: RBC 4.32×10¹²/L, Hb 144 g/L, HCT 39.50%, PLT 329.00×10⁹/L; coagulation function: APTT 29.3 s, PT 12.1 s, FiB 2.728 g/L, DD>6 μg/mL, FDP 25.86 μg/mL. The patient was discharged after 20 days, and regular follow-up reexamination showed no abnormal results. [Conclusion] Individualized blood management strategy should comprehensively consider the patient’s clinical symptoms, the degree of hemoglobin decline, dynamic coagulation test results and existing treatment conditions. Efficient and reasonable patient blood management strategies can effectively improve the clinical outcomes of massive transfusion patients in the frigid plateau region.

OBJECTIVE To investigate the ameliorating effect and mechanism of the effective substance groups from Artemisia ordosica（Abbreviated as HSH） on rheumatoid arthritis （RA） based on cluster of differentiation 4/lymphocyte cell-specific protein- tyrosine kinase/zeta-chain-associated protein kinase of 70 kDa/interleukin-17（CD4/LCK/ZAP70/IL-17） signaling pathway. METHODS The rats were divided into normal group， model group， HSH low-dose， medium-dose and high-dose groups （2.7， 10.8， 21.6 mg/kg） and positive control group （Tripterygium glycosides tablet， 6.3 mg/kg）， with 10 rats in each group. Except for normal group， RA rat model was induced by complete Freund’s adjuvant in other groups. After modeling， each group was given relevant medicine or normal saline intragastrically， once a day， for 28 consecutive days. The changes in ankle joint swelling and arthritis index in rats were determined； the pathological changes of ankle joint tissue were observed； the levels of inflammatory factors [IL-1β， IL-21， IL-17A， IL-2， interferon-γ （IFN-γ） and IL-6] in serum and joint fluid of rats were determined； the levels of Th1， Th17 and Treg cells in the whole blood and spleen of rats were detected； protein and mRNA expressions of LCK， proto-oncogene tyrosine-protein kinase Fyn （Fyn）， ZAP70， CD45， RAR-related orphan receptor γt （RORγt）， and forkhead box protein 3 （Foxp3） in ankle synovial tissue were determined. RESULTS Compared with normal group， the changes in ankle joint swelling， arthritis index， the levels of IL-1β， IL-21， IL-17A， IL-2， IFN-γ and IL-6 in serum and joint fluid， the levels of Th1， Th17 cells and Th17/Treg value in whole blood and spleen， and the protein and mRNA expression levels of LCK， Fyn， ZAP70， CD45， and RORγt in ankle joint synovium were all significantly increased/elevated （P＜0.05）. The level of Treg cells in the spleen， as well as the protein and mRNA expression levels of Foxp3 in the ankle joint synovium were significantly decreased （P＜0.05）. Compared with model group， most of the above-mentioned indicators were significantly reversed in the positive control group and all dose groups of HSH （P＜0.05）. The degree of pathological changes in ankle joint tissues was markedly improved， and inflammation was alleviated. CONCLUSIONS HSH can regulate the cascade reactions in the CD4/LCK/ZAP70/IL-17 pathway within the T-cell receptor signaling pathway， thereby modulating the Th17/Treg balance. This leads to the suppression of inflammatory responses and the alleviation of synovial tissue damage in rats with RA.

Antimicrobial resistance (AMR) has emerged as a major global public health challenge, with traditional prevention and control methods exhibiting significant limitations in detection efficiency, data processing, and clinical decision-making. Leveraging its robust capabilities in data analysis and pattern recognition, artificial intelligence (AI) technology has been widely applied across multiple critical aspects of AMR containment. Current evidence demonstrates that AI technologies can significantly enhance the efficiency of resistancediagnosis, optimize personalized treatment strategies, and improve real-time monitoring of resistant pathogen transmission. Despite persistent challenges such as data heterogeneity, model interpretability, and ethical compliance in practical applications, AI holds immense promise in supporting precision infection management and addressing the growing crisis of antimicrobial resistance.This article systematically reviews the clinical applications of AI in AMR prevention and control, including resistance detection and prediction based on mass spectrometry and genomic data, the use of clinical decision support systems in anti-infective therapy, as well as the role of AI in epidemiological surveillance, pathogen tracking, early warning systems, and novel antimicrobial drug discovery aiming to provide reference for clinical practice.

BACKGROUND: Endoscopic sphincterotomy (EST) is widely used to treat common bile duct stones (CBDS); however, long-term studies have revealed the increasing incidence of recurrent CBDS after EST. Loss of sphincter of Oddi function after EST was the main cause of recurrent CBDS. Reparation of the sphincter of Oddi is therefore crucial. This study aims to investigate the effectiveness and safety of endoclip papilloplasty (ECPP) for repairing the sphincter of Oddi and elucidate its mechanism. METHODS: Eight healthy Bama minipigs were randomly divided into the EST group and the ECPP group at a 1:1 ratio, and bile samples were collected before endoscopy and 6 months later. All minipigs underwent transabdominal biliary ultrasonography for the diagnosis of cholelithiasis 6 months after endoscopy. The biliary microbiota composition and alpha and beta diversity were analyzed by 16S ribosomal RNA gene sequencing. Differential metabolites were analyzed by bile acid metabolomics to explore the predictive indicators of cholelithiasis. RESULTS: Three minipigs were diagnosed with cholelithiasis in the EST group, while none in the ECPP group showed cholelithiasis. The biliary Firmicutes/Bacteroidota (F/B) ratio was increased after EST and decreased after ECPP. The Chao1 and observed species index significantly decreased 6 months after EST ( P  = 0.017 and 0.018, respectively); however, the biliary α-diversity was similar before and 6 months after ECPP. The β-diversity significantly differed in the EST group before and 6 months after EST, as well as in the ECPP group before and 6 months after ECPP (analysis of similarities [ANOSIM]: R  = 0.917, P  = 0.040; R  = 0.740, P  = 0.035; respectively). Glycolithocholic acid (GLCA) and taurolithocholic acid (TLCA) accumulated in bile 6 months after EST. CONCLUSIONS ECPP has less impact on the biliary microenvironment than EST and prevents duodenobiliary reflux by repairing the sphincter of Oddi. The bile levels of GLCA and TLCA may be used to predict the risk of cholelithiasis.
Animals ; Swine, Miniature ; Swine ; Cholelithiasis/prevention & control* ; Sphincterotomy, Endoscopic/methods* ; Sphincter of Oddi/surgery* ; Female ; Male

Objective To discuss the application value of XperCT combined with needle-guided Glubran-2 glue for small pulmonary nodule localization in thoracoscopic pulmonary nodule resection.Methods The clinical data of 67 patients,who received XperCT combined with needle-guided Glubran-2 glue for small pulmonary nodule localization before thoracoscopic resection of a single small pulmonary nodule at the Jining Municipal First People's Hospital of China between June 2018 and February 2023,were retrospectively analyzed.The size of the pulmonary nodule,the maximum vertical distance from the visceral pleura to the lesion,the technical success rate of localization,the number of puncturing times,the complications,the time spent for operation,and the postoperative pathological diagnosis were recorded.Results The average size of the small pulmonary nodules in the 67 patients was 8.7 mm,and the average vertical distance from the visceral pleura to the lesion was 19.4 mm.Successful preoperative localization of nodule was accomplished in all patients.The average number of puncturing times was 1.1,and no serious complications occurred.The average time spent for operation was 12.7 min.Definite pathological results were obtained in all 67 patients.Conclusion XperCT combined with needle-guided Glubran-2 glue for small pulmonary nodule localization carries advantage of accurate localization with fewer complications.Therefore,this technique is a highly-efficient and quickly-accomplished positioning method,and it is highly valuable in clinical practice.(J Intervent Radiol,2024,33:623-626)

AIM:To investigate the mechanism by which resveratrol(Res)up-regulates the hypoxia-inducible factor-1α(HIF-1α)/BCL2-adenovirus E1B 19 kD-interacting protein 3(BNIP3)signaling pathway to induce autophagy,thereby alleviating cerebral ischemia-reperfusion injury(CIRI)in rats.METHODS:Totally 120 SD rats were randomly divided into 6 groups:sham group,CIRI group,Res group,Res+HIF-1α activator CoCl2 group,Res+HIF-1α inhibitor 2-methoxyestradiol(2ME2)group,and Res+autophagy inhibitor 3-methyladenine(3-MA)group.Twelve rats with failed surgical modeling were excluded,leaving 18 rats in each group.The rats in CIRI group,Res group,Res+CoCl2 group,Res+2ME2 group and Res+3-MA group were subjected to middle cerebral artery occlusion(MCAO)modeling using the su-ture method,with 2 h of ischemia followed by 24 h of reperfusion.The rats in sham group underwent MCAO modeling sur-gery without suture insertion.The Zea Longa modified scoring method was used to assess rat neurological behavior,TTC staining was used to measure rat cerebral infarct volume,and immunohistochemistry and immunoblotting were performed to detect the expression levels of HIF-1α,BNIP3,beclin-1 and mammalian target of rapamycin(mTOR)proteins in the rat cerebral cortex.RESULTS:Compared with CIRI group,the rats treated with Res showed significantly improved spon-taneous behavioral function and reduced cerebral infarct volume.The expression of HIF-1α,BNIP3 and beclin-1 proteins increased,while mTOR protein expression decreased in rat brain tissue.Compared with the Res group,rats treated with Res+CoCl2 showed further improvement in spontaneous behavioral function and further reduction in cerebral infarct vol-ume.The expression of HIF-1α,BNIP3 and beclin-1 proteins increased,while mTOR protein expression decreased in rat brain tissue.Rats in the Res+2ME2 and Res+3-MA groups exhibited weakened neurological function and increased cere-bral infarct volume,accompanied by decreased expression of HIF-1α,BNIP3 and beclin-1 proteins,and increased expres-sion of mTOR protein in rat brain tissue.CONCLUSION:Resveratrol may alleviate cerebral ischemia-reperfusion injury by upregulating the HIF-1α/BNIP3 pathway and subsequently activating autophagy.

With the increasing number of people with immune deficiency in recent years, fungal infections become an important factor threatening human health.Likewise, the number of children who are immunosuppressed due to hematological diseases, malignancies, use of immunosuppressants and spectrum antibacterial drugs has increased, leading to a high mortality of fungal infections.Moreover, infections of the non-candida albicans and aspergillu are prevalent, serving as important causes for the death of critically ill children. Therefore, this review aims to introduce and summarize the epidemiological characteristics, diagnosis and treatment of pediatric invasive fungal infections, thus yielding the concern of pediatric invasive fungal infections, reducing the occurrence of pediatric fungal infections and improving the prognosis.

Objective:To investigate the CLEC3B protein of differentially expressed proteins(DEPs)in serum of normal persons and patients with sepsis,and explore the possibility that target C-type lectin domain family 3 member B(CLEC3B)protein was used as molecular markers of sepsis.Methods:Peripheral bloods of 10 healthy persons and 18 patients with sepsis were collected,and the data of peripheral serum proteins were collected by data independent acquisition(DIA)method.The data were uploaded to iDEP online platform to analyze the DEPs in peripheral blood of patients with sepsis.Bioinformatics analysis of these DEPs was conducted to screen out the key proteins of sepsis.Enzyme linked immunosorbent assay(ELISA)was used to verify and plot the receiver operating characteristic(ROC)curves of key proteins.Results:A total of 138 differentially expressed proteins(DEPs)were screened out by using proteomics analysis,of which 34 kinds of proteins were significantly down-regulated and 104 kinds of proteins were significantly up-regulated.DEPs mostly concentrated in cellular processes,biological regulation,biological process regulation,participating binding,catalytic activation,molecular function regulation,immune system,signal transduction and so on.A protein-protein interaction network was constructed by DEPs,which screened out the key protein CLEC3B.ELISA results showed that the CLEC3B protein concentration[(297.73±22.00)ng/mL]of patients in the sepsis group was significantly lower than that[(452.42±191.72)ng/mL]in the healthy group,and the difference was statistically significant(t=13.13,P=0.000).The area under curve(AUC)value of ROC curve,sensitivity and specificity of CLEC38 protein were respectively 0.998,97.73%and 100.0%.Conclusion:CLEC3B is significantly decreased in sepsis group,which sensitivity and specificity are high.It can be used as a potentially biological diagnostic biomarker of sepsis.