In the era of globalization， medical staff must possess the perspective and concept of cultural diversity， along with the ability and literacy for cross-cultural management. They should break free from the outdated medical cage of the biomedical model， form the new medical vision of the pluralistic medical model， and promote the sublative development of the medical model theory. It is essential to advocate for the prosperous development of disease culturology， face up to the cultural deficiency in disease interpretation under the biomedical model， clarify the cultural “authenticity” in disease definition， correct the pan-medicalization in disease definition， and achieve comfort in disease diagnosis and treatments. In terms of cultivating the cultural soil that promotes the construction of medical humanistic spirits， it is vital to form an inclusive attitude in intercultural interactions and promote the localization of medical humanistic spirits construction. The effective paths for constructing medical humanistic spirits encompass drawing on the strengths of various parties and preserving cross-cultural management literacy， integrating patients’ cultural patterns and implementing the localized situational diagnosis and treatments， as well as building a doctor-patient cultural community and sharing the growth of subjectivity.

AIM: To analyze the influencing factors of cognitive dysfunction in patients with open angle glaucoma, and construct a risk prediction decision tree model. METHODS:Retrospective study. The clinical data of patients with open angle glaucoma treated in the hospital from February 2022 to November 2024 were collected, and patients were divided into a cognitive dysfunction group and a cognitive function normal group according to the evaluation results of the Montreal Cognitive Assessment Scale(MoCA)at the time of admission, and the clinical data of the two groups were compared. The influencing factors of cognitive dysfunction in patients with open angle glaucoma were analyzed through Logistic regression model, and the decision tree model was analyzed and constructed based on the clinical data of the two groups through the decision tree CHAID algorithm, and the predictive performance of two models was compared using receiver operating characteristic(ROC)curves. RESULTS:The total of 179 patients with open angle glaucoma were included in this study, and were divided into a cognitive dysfunction group of 107 cases(59 males and 48 females, with 66 cases aged ≥60 y)and a cognitive function normal group of 72 cases(34 males and 38 females, with 28 cases aged ≥60 y)according to the MoCA assessment results at the time of patient admission.The incidence of cognitive dysfunction was 59.8%(107/179). The proportion of age ≥60y, education level of junior high school or below, hypertension, sleep disorders, and middle/late stage diseases in the cognitive dysfunction group were higher than those in the cognitive function normal group(all P<0.05). Logistic regression analysis showed that age ≥60 y, education level of junior high school or below, hypertension, sleep disorders, and middle/late stage disease were all risk factors for cognitive dysfunction in patients with open angle glaucoma(all P<0.05). The risk prediction decision tree model constructed using the decision tree CHAID algorithm included 4 layers and 11 nodes, and it outputed 5 risk variables: disease severity, age, sleep disorders, education level, and hypertension. Among them,the disease severity was the first layer risk variable. The ROC curve showed that the area under curve for predicting cognitive dysfunction in patients with open angle glaucoma using the risk prediction decision tree model and logistic regression model was 0.849 and 0.842 respectively, and there was no statistically significant difference in the predictive value between the two models(P>0.05). CONCLUSION: The disease severity, age, sleep disorders, education level, and hypertension are influencing factors for cognitive dysfunction in patients with open angle glaucoma, and the risk prediction decision tree model analyzed and constructed by the decision tree CHAID algorithm has good predictive value for cognitive dysfunction.

ObjectiveTo observe the clinical efficacy of tonifying kidney and replenishing essence on asthenozoospermia patients with the syndrome of kidney essence deficiency and the effects of this method on the adenosine 5′-monophosphate-activated protein kinase （AMPK）/mammalian target of rapamycin complex 1 （mTORC1） signaling pathway. MethodsSeventy-two eligible asthenozoospermia patients with the syndrome of kidney essence deficiency treated in the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from February 2023 to January 2024 were selected and randomly assigned into an observation group and a control group， with 36 patients in each group. The observation group received oral administration of Guilu Tianjing capsules， while the control group received oral administration of L-carnitine oral solution. The treatment course lasted for 4 weeks in both groups. The observed indicators included sperm progressive motility rate （PR）， total sperm motility （PR+NP）， percentage of normal mitochondrial membrane potential （MMP）， and traditional Chinese medicine （TCM） symptom scores before and after treatment in both groups. A three-month follow-up was instituted to record the conception status of the patients’ spouses. Additionally， eight patients were randomly selected from the eligible patients in the observation group， and four healthy males with normal semen routine examination results were included as the control group for the determination of protein expression. Western blotting was conducted to assess the expression of AMPK， phosphorylated （p）-AMPK， regulatory-associated protein of mTOR （RAPTOR） and p-RAPTOR， and PTEN-induced putative kinase 1 （PINK1） in sperms from the observation group before and after treatment， as well as in the sperms of the control group. ResultsThe pregnancy rate of spouses in the observation group was 9.09% （3/33）， which was higher than that （3.33%， 1/30） in the control group. The total response rate was 84.8% （28/33） in the observation group and 66.7% （20/30） in the control group， with no statistically significant difference. After treatment， both groups were improved considering PR， PR+NP， MMP， and TCM symptom scores （P<0.01）. Moreover， the observation group exhibited more pronounced decreases in TCM symptom scores than the control group （P<0.05）， while the changes in PR， PR+NP， and MMP showed no statistical significance between groups. Compared with the control group， the asthenozoospermia group exhibited upregulations in phosphorylation levels of AMPK and RAPTOR and protein level of PINK （P<0.01）. The administration of Guilu Tianjing Capsules led to downregulations in the phosphorylation levels of AMPK and RAPTOR and protein level of PINK1 （P<0.01）. However， the protein levels of AMPK and RAPTOR demonstrated no significant difference between before and after treatment. During the study period， neither group of patients exhibited any notable adverse reactions. ConclusionGuilu Tianjing capsules can enhance the sperm motility and percentage of normal mitochondrial membrane potential in asthenozoospermia patients with the syndrome of kidney essence deficiency by downregulating the AMPK/mTORC1 signaling pathway， lowering the protein level of PINK1， and inhibiting excessive activation of mitophagy.

ObjectiveTo observe the clinical efficacy of tonifying kidney and replenishing essence on asthenozoospermia patients with the syndrome of kidney essence deficiency and the effects of this method on the adenosine 5′-monophosphate-activated protein kinase （AMPK）/mammalian target of rapamycin complex 1 （mTORC1） signaling pathway. MethodsSeventy-two eligible asthenozoospermia patients with the syndrome of kidney essence deficiency treated in the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from February 2023 to January 2024 were selected and randomly assigned into an observation group and a control group， with 36 patients in each group. The observation group received oral administration of Guilu Tianjing capsules， while the control group received oral administration of L-carnitine oral solution. The treatment course lasted for 4 weeks in both groups. The observed indicators included sperm progressive motility rate （PR）， total sperm motility （PR+NP）， percentage of normal mitochondrial membrane potential （MMP）， and traditional Chinese medicine （TCM） symptom scores before and after treatment in both groups. A three-month follow-up was instituted to record the conception status of the patients’ spouses. Additionally， eight patients were randomly selected from the eligible patients in the observation group， and four healthy males with normal semen routine examination results were included as the control group for the determination of protein expression. Western blotting was conducted to assess the expression of AMPK， phosphorylated （p）-AMPK， regulatory-associated protein of mTOR （RAPTOR） and p-RAPTOR， and PTEN-induced putative kinase 1 （PINK1） in sperms from the observation group before and after treatment， as well as in the sperms of the control group. ResultsThe pregnancy rate of spouses in the observation group was 9.09% （3/33）， which was higher than that （3.33%， 1/30） in the control group. The total response rate was 84.8% （28/33） in the observation group and 66.7% （20/30） in the control group， with no statistically significant difference. After treatment， both groups were improved considering PR， PR+NP， MMP， and TCM symptom scores （P<0.01）. Moreover， the observation group exhibited more pronounced decreases in TCM symptom scores than the control group （P<0.05）， while the changes in PR， PR+NP， and MMP showed no statistical significance between groups. Compared with the control group， the asthenozoospermia group exhibited upregulations in phosphorylation levels of AMPK and RAPTOR and protein level of PINK （P<0.01）. The administration of Guilu Tianjing Capsules led to downregulations in the phosphorylation levels of AMPK and RAPTOR and protein level of PINK1 （P<0.01）. However， the protein levels of AMPK and RAPTOR demonstrated no significant difference between before and after treatment. During the study period， neither group of patients exhibited any notable adverse reactions. ConclusionGuilu Tianjing capsules can enhance the sperm motility and percentage of normal mitochondrial membrane potential in asthenozoospermia patients with the syndrome of kidney essence deficiency by downregulating the AMPK/mTORC1 signaling pathway， lowering the protein level of PINK1， and inhibiting excessive activation of mitophagy.

The co-development of the technology pointing to the "external nature" and the technology pointing to the "physical nature" promotes the co-evolution of the man and the machine. The emerging body enhancement technique is derived from the "defective existence" of the man, and it changes the "body nature" from the inside of the man. The emerging body enhancement techniques are rapidly spread out driven by the multiple forces. The emerging body enhancement techniques has led to the weakening of the natural body identity and the strengthening of the symbolic body identity, the class solidification and the rise of "cyberpunk", the mixing of the natural person and the technical person. To consciously guide the development and application of emerging human enhancement surgery used human care theory. The physical care is an important reference to judge the good and the evil of the emerging body enhancement technique. The management about the body ethics is the optimal choice about the management of the emerging body enhancement technique. The physical care is the important content of the education of the emerging body enhancement technique.

Artificial intelligence (AI) has shown a tendency to replace human brain intelligence, and its rise has led to significant social changes. AI has pioneered the historical process of human-machine co-evolution. In the embedding of AI into medicine, it can be seen that there are a wide range of medical application scenarios. Intelligent medicine based on AI technology is of great significance, achieving spatial transmutation under spatial connection and value release under data mining. Intelligent medicine occupies a "high-level position" in value evaluation. Intelligent medicine has become a risk complex due to its tendency towards de-subjectivity of doctors, questioning the effectiveness of the intelligent algorithms, increasing difficulty in protecting information security and individual privacy, and indifference to medical humanistic care. To prevent the risks of intelligent medicine, it is necessary to reasonably define the relationship between AI and doctors, effectively prevent the risks of intelligent algorithms, increase the protection efforts of patient data security and personal privacy, thickly cultivate humanistic care in AI, and promote the improvement of the scientific and technological ethical governance system through ethical review.

Objective:To identify the risk factors for functional delayed gastric emptying(FDGE)after retroperitoneal tumor resection.Meth-ods:Sixty-seven patients with postoperative FDGE after retroperitoneal tumor resection from September 2017 to December 2022 admited in Peking University International Hospital were included in the observation group,and 836 normal patients who underwent ret-roperitoneal tumor resection during the same period were included in the control group.Medical histories and clinical treatment data were obtained for each group and compared to identify the risk factors for FDGE after retroperitoneal tumor resection.Results:The overall incid-ence of postoperative FDGE was 7.42%.Factors that were significantly elevated(P<0.05)in the observation group relative to the control group included adverse mental factors(37.31%),preoperative digestive tract obstruction(41.79%),postoperative abdominal cavity complic-ations(79.10%),diabetes(29.86%),average age of(61.85±6.11)years,and blood loss(1 011.94±507.30)mL.Pre-and post-surgery albumin levels[(38.22±3.75)g/L and(30.22±3.36)g/L,respectively]were significantly reduced(P<0.05)in the observation group compared to the control group.Risk factor analyses revealed that advanced age,diabetes,preoperative digestive tract obstruction,intraoperative blood loss,perioperative albumin level,postoperative abdominal cavity complications,and adverse mental factors were correlated with postoperative FDGE.Conclusions:Diverse factors could impact the risk of FDGE after retroperitoneal tumor resection.Patients should be accurately evalu-ated;reasonable and detailed prevention and treatment plans should be developed.

Background::Heterogeneity of tumor cells and the tumor microenvironment (TME) is significantly associated with clinical outcomes and treatment responses in patients with urothelial carcinoma (UC). Comprehensive profiling of the cellular diversity and interactions between malignant cells and TME may clarify the mechanisms underlying UC progression and guide the development of novel therapies. This study aimed to extend our understanding of intra-tumoral heterogeneity and the immunosuppressive TME in UC and provide basic support for the development of novel UC therapies.Methods::Seven patients with UC were included who underwent curative surgery at our hospital between July 2020 and October 2020. We performed single-cell RNA sequencing (scRNA-seq) analysis in seven tumors with six matched adjacent normal tissues and integrated the results with two public scRNA-seq datasets. The functional properties and intercellular interactions between single cells were characterized, and the results were validated using multiplex immunofluorescence staining, flow cytometry, and bulk transcriptomic datasets. All statistical analyses were performed using the R package with two-sided tests. Wilcoxon-rank test, log-rank test, one-way analysis of variance test, and Pearson correlation analysis were used properly.Results::Unsupervised t-distributed stochastic neighbor embedding clustering analysis identified ten main cellular subclusters in urothelial tissues. Of them, seven urothelial subtypes were noted, and malignant urothelial cells were characterized with enhanced cellular proliferation and reduced immunogenicity. CD8 + T cell subclusters exhibited enhanced cellular cytotoxicity activities along with increased exhaustion signature in UC tissues, and the recruitment of CD4 + T regulatory cells was also increased in tumor tissues. Regarding myeloid cells, coordinated reprogramming of infiltrated neutrophils, M2-type polarized macrophages, and LAMP3 + dendritic cells contribute to immunosuppressive TME in UC tissues. Tumor tissues demonstrated enhanced angiogenesis mediated by KDR + endothelial cells and RGS5 +/ACTA2 + pericytes. Through deconvolution analysis, we identified multiple cellular subtypes may influence the programmed death-ligand 1 (PD-L1) immunotherapy response in patients with UC. Conclusion::Our scRNA-seq analysis clarified intra-tumoral heterogeneity and delineated the pro-tumoral and immunosuppressive microenvironment in UC tissues, which may provide novel therapeutic targets.

The co-development of the technology pointing to the "external nature" and the technology pointing to the "physical nature" promotes the co-evolution of the man and the machine. The emerging body enhancement technique is derived from the "defective existence" of the man, and it changes the "body nature" from the inside of the man. The emerging body enhancement techniques are rapidly spread out driven by the multiple forces. The emerging body enhancement techniques has led to the weakening of the natural body identity and the strengthening of the symbolic body identity, the class solidification and the rise of "cyberpunk", the mixing of the natural person and the technical person. To consciously guide the development and application of emerging human enhancement surgery used human care theory. The physical care is an important reference to judge the good and the evil of the emerging body enhancement technique. The management about the body ethics is the optimal choice about the management of the emerging body enhancement technique. The physical care is the important content of the education of the emerging body enhancement technique.

The emerging body enhancement technique repairs the "defective structure" of the body from the inside of the person, so that the body can get the support of technical strength. The emerging body enhancement technique starts the process of gradual disintegration of natural body, and its technical oppression dispels individual freedom, and forms a deep connection between power and capital in emerging body enhancement technique. In order to promote the synthetic development between the technique progress and the order construction, it is significant to rescue the emerging body enhancement technique from the fighting between the biological conservatism and the super humanism, promote the development of the emerging body enhancement technique from the professional education to the popularity education, regulate the development of the emerging body enhancement technique with the theory framework of the body ethics, and promote the development of the supervision of the emerging body enhancement technique to all directions and the whole process.