Despite significant advances in the field of critical care medicine over the past three decades, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) remains the primary temporary mechanical circulatory support modality for patients with acute severe circulatory failure. With the accumulation of clinical experience and the increasing maturity of operational techniques in V-A ECMO, its technical management—particularly hemodynamic management—has become a key factor influencing patient outcomes. To further improve patient survival, the Chinese Critical Care Ultrasound Study Group, in collaboration with the Hemodynamic Therapy of Critical Care Collaborative Group and the Critical Care Medicine Branch of the China International Exchange and Promotive Association for Medical and Health Care, organized experts in critical care medicine to develop the Consensus on Hemodynamic Management in Adult Veno-Arterial Extracorporeal Membrane Oxygenation (2026 Edition). Based on years of clinical experience and the latest evidence-based medical evidence, this consensus formulates 15 systematic recommendations covering the entire process of V-A ECMO, including initiation, management during support, and weaning, aiming to promote standardized application of hemodynamic management in V-A ECMO.

Most patients with differentiated thyroid cancer have a good prognosis after radioiodine-131 therapy,but a small number of patients are insensitive to radioiodine-131 therapy and even continue to develop disease.At present,some targeted drugs can improve progression-free survival in patients with radioactive iodine-refractory differentiated thyroid cancer(RAIR-DTC),such as sorafenib and levatinib,have been approved for the treatment of RAIR-DTC.However,due to the presence of primary and acquired drug resistance,drug efficacy in these patients is unsatisfactory.This review introduces the acquired drug resistance mechanism of sorafenib in the regulation of mitogen-activated protein kinase(MAPK)and phosphatidylinositol-3-kinase(PI3K)pathways and proposes related treatment strategies,in order to provide a reference for similar drug resistance mechanism of sorafenib and effective treatment of RAIR-DTC.

Objective: To learn the influencing factors for self-violent thoughts and behaviors among the ninth-grade students in Jiangbei District of Ningbo, so as to provide the basis for carrying out psychological intervention. Methods: The ninth-grade students in a junior high school each of the six streets ( towns ) in Jiangbei District were recruited by multi-stage cluster sampling method from October to November 2018. A self-designed questionnaire was used to investigate the general information, life style, psychological condition, self-violent thoughts and behaviors in the latest year. Multivariate logistic regression model was used to analyze the influencing factors for self-violent thoughts and behaviors. Results: A total of 1 300 questionnaires were issued and 1 238 valid ones were recovered, with an effective rate of 95.23%. The prevalence rates of self-violent thoughts and behaviors among the ninth-grade students were 16.88% and 8.48%. TheResults of the multivariate logistic regression analysis showed that abnormal marital status of parents ( OR=2.074, 95%CI: 1.139-3.775 ) , no moderate physical activity ( OR=1.764, 95%CI: 1.101-2.826 ) , sleeping less than 8 hours ( OR=1.858, 95%CI: 1.273-2.712 ) , alcohol consumption ( OR=2.108, 95%CI: 1.448-3.070 ) , sense of despair ( OR=6.397, 95%CI: 4.195-9.757 ) , sense of anxiety ( OR=4.094, 95%CI: 2.725-6.151 ) , sense of loneliness ( OR=1.879, 95%CI: 1.241-2.854 ) , and cyber-bullying ( OR=5.155, 95%CI: 2.780-9.556 ) were risk factors for self-violent thoughts; not living with parents ( OR=2.057, 95%CI: 1.021-4.145 ) , alcohol consumption ( OR=1.756, 95%CI: 1.074-2.872 ) , sense of despair ( OR=7.197, 95%CI: 4.365-11.864 ) , sense of anxiety ( OR=5.832, 95%CI: 3.276-10.382 ) , fighting ( OR=2.272, 95%CI: 1.219-4.232 ) and physical bullying ( OR=3.462, 95%CI: 1.135-10.558 ) were risk factors for self-violent behaviors. Conclusion Drinking, family relationship, bullying, and mental health problems such as sense of despair and anxiety were associated with the self-violent thoughts and behaviors of ninth-grade students.