With the rapid advancement of medical technology and the increasing complexity of clinical environments, competence in clinical ethical decision-making has become an indispensable core competency for exemplary physicians. However, traditional medical ethics education has long been confronted with the persistent challenges of theory-practice dissociation and the disconnect between pedagogical settings and clinical realities. Thus, how to construct a "Clinical Ethics" curriculum that aligns with the objectives of training high-caliber medical professionals has emerged as a critical and challenging issue in current medical education reform. To effectively address this challenge, the Office of Education at Peking University Third Hospital, since 2021, has assembled a multidisciplinary "Clinical Ethics" teaching and management team comprising faculty from Peking University School of Humanities and key clinical specialists from the hospital. In 2022, the "Clinical Ethics" elective course was formally launched for fourth-year students in the eight-year MD program who had completed coursework in "Medical Ethics" and organ-system-based curricula, with the aim of exploring and operationalizing a pre-clinical ethics education model tailored for senior medical students. The course employs a modular instructional design encompassing "theoretical review-case-based deliberation-clinical workshop", which effectively facilitates the deep integration of medical humanities with clinical practice.Following four years of iterative refinement through the "plan-act-observe-reflect" cycle, the course has demonstrated positive outcomes in enhancing students' ethical awareness and decision-making capabilities, and has preliminarily established a sustainable collaborative mechanism among the multidisciplinary faculty team. This article systematically delineates the course development background, pedagogical model and methodological innovations, and the multidisciplinary collaborative framework, alongside reflections and summaries based on implementation outcomes, with the intent of providing references for the future development of "Clinical Ethics" curricula.

Objective: To analyze the bidirectional association between sleep status and depressive symptoms among primary school students, so as to provide scientific evidence for developing targeted intervention and health education on children s mental health. Methods: In December 2021, 1 787 students in grades 2 and 3 selected from three primary schools in a district of Tianjin by a convenient sampling method were investigated in a baseline questionnaire survey, which was followed by a one year follow up in December 2022. The survey content included sociodemographic characteristics, lifestyle, etc., and the Children s Sleep Habits Questionnaire and the Center for Epidemiologic Studies Depression Scale for Children were used to assess students sleep quality, sleep duration, social jetlag and depressive symptoms. Linear regression model was applied to examine the association between sleep status and depressive symptoms score in primary school students, and cross lagged panel model was adopted to analyze the bidirectional association between sleep status and depressive symptoms. Results: At baseline, the sleep quality score among primary school students was 43.00(39.00, 47.00), the daily sleep duration was 9.42(9.12, 9.76) h, the social jetlag was 0.58( 0.29 , 0.92) h, and the depressive symptoms score was 5.00(2.00, 9.00). At the oneyear followup, the score of sleep quality among primary school students was 42.00(38.00, 47.00), the daily sleep duration was 9.43(9.12, 9.78)h, the social jetlag was 0.50 (0.25, 0.78)h, and the score of depressive symptoms was 4.00(2.00, 9.00). After adjusting for confounding factors such as gender, parental education level, and monthly family income, linear regression analyses showed that the baseline sleep quality score was positively associated with follow up depressive symptoms scores ( β =0.25) among primary school students, while baseline sleep duration ( β =-0.06) and baseline social jetlag ( β =-0.08) were both negatively associated with follow up depressive symptoms score (all P <0.05). Cross lagged regression models indicated that baseline sleep quality score positively predicted depressive symptoms score at the 1 year follow up ( β =0.10), and baseline depressive symptoms score positively predicted follow up sleep quality score ( β = 0.08 )(both P <0.05). Conclusions There is a bidirectional association between sleep quality and depressive symptoms among primary school students. Improving sleep quality may help alleviate children s depressive symptoms.

Objective To identify the key influencing factors and role mechanisms of large-scale medical equip-ment allocation decision-making in public hospitals,and to provide a reference basis for optimizing resource alloca-tion strategies.Methods Through searching the literature related to large-scale medical equipment decision-making in public hospitals and combing the policies,the system of decision-making influencing factors was initially screened.The Delphi method and decision-making trial and evaluation laboratory method were used to obtain the key influencing factors of equipment allocation decision-making and to determine the interaction effects among the factors.Results A total of seven cause factors and nine effect factors were screened.Among them,cost-benefit analysis,equipment technical performance,and evaluation of similar equipment were the top three key drivers;leadership emphasis,equipment market price,and equipment supporting facilities were the top three key con-straints.Conclusion Priority be given to strengthening the management of driving factors,mainly by conducting a full-cycle assessment of cost-effectiveness,paying attention to the clinical value output of equipment technical performance,and monitoring regionally similar equipment.A dynamic response mechanism for constraints should be established,mainly to strengthen leadership decision-making,implement a centralized procurement price nego-tiation model and improve the pre-assessment system for ancillary facilities.

Objective:To investigate differences in serum lipid profiles between patients with dermatomyositis (DM) and healthy controls.Methods:A retrospective analysis was conducted on the clinical data and serum samples collected from 51 patients with DM who visited the First Affiliated Hospital, Anhui Medical University from September 2020 to January 2022. Serum samples were also collected from 66 healthy controls during the same period. Serum lipid profiles were analyzed using ultra-performance liquid chromatography-mass spectrometry in both groups. Differential lipids were screened using principal component analysis and orthogonal partial least squares-discriminant analysis. The predictive value of these differential lipids for DM was evaluated by receiver operating characteristic (ROC) curve analysis, and their correlations with clinical indicators were also evaluated.Results:A total of 51 patients with DM were enrolled, including 27 males and 24 females, with ages ( M[ Q1, Q3]) of 55.00 (47.00, 66.00) years and body mass index (BMI) values of 22.64 (19.79, 24.75) . The control group included 66 healthy individuals (33 males and 33 females) , with ages of 51.00 (43.75, 56.00) years and BMI values of 23.60 (21.18, 25.19) . No significant differences were observed between the two groups in terms of sex, age, or BMI (all P > 0.05) . A total of 341 lipid metabolites were identified, and 16 lipid metabolites such as ceramides (Cer) , sphingomyelins, phosphatidylcholines (PC) , phosphatidylethanolamines, lysophosphatidylcholines (LPC) , and triglycerides (TG) significantly differed between the DM group and the control group, of which 8 were upregulated and 8 were downregulated in the DM group. ROC curve analysis identified 7 differential lipids with area under the curve (AUC) values of > 0.9, of which 2 were Cer, 3 were TG, 1 was phosphatidylethanolamine, and 1 was LPC. In the DM patients, serum LPC (22∶1) levels were negatively correlated with creatine kinase isoenzyme MB levels ( r = -0.276, P < 0.05) , serum PC (15∶1/16∶0) levels were negatively correlated with aspartate aminotransferase levels ( r = -0.305, P < 0.05) , and serum Cer (d18∶1/18∶0) levels were positively correlated with C-reactive protein levels ( r = 0.283, P < 0.05) . Significant differences in serum lipid levels were observed between some DM subgroups (all P < 0.05) : sphingomyelin (d24∶0) levels significantly differed between anti-Sj?gren syndrome type A/Ro52 antibody-positive and -negative DM patients; LPC (17∶1) levels significantly differed between anti-PM-SCL75 antibody-positive and -negative DM patients; LPC (20∶0) and PC (32∶1p) levels significantly differed between anti-Mi-2 antibody-positive and -negative DM patients; LPC (22∶1) and TG (9∶0/9∶0/9∶0) levels significantly differed between anti-TIF1-γ antibody-positive and -negative DM patients; Cer (d18∶1/18∶0) levels significantly differed between DM patients with and without Heliotrope's sign. Conclusion:Lipid profiles were significantly altered in DM patients compared with healthy controls, and some lipids showed potential diagnostic value for DM.

Objective:To analyze the application efficacy of employing high-density porous polyethylene （Su-por） in combination with temporoparietal fascial flaps via a minimally invasive scalp incision in auricular reconstruction. Methods:This study carried out a retrospective analysis of 50 patients （50 ears in total） who underwentprimary auricular reconstruction with a Su-por scaffold in our hospital from June 2022 to January 2024. All patients underwent primary auricular reconstruction using a minimally invasive scalp incision with high-density porous polyethylene （Su-por） and temporoparietal fascial flaps. The postoperative treatment effects and complications were statistically analyzed. Results:The reconstructed ears of all patients survived. After 6 months of follow-up, the scar hyperplasia of the scalp minimally invasive incision was not obvious in any patient, and no significant hair loss was observed. The reconstructed auricle of 48 patients had a realistic shape and strong three-dimensional sense. With the extension of follow-up time, the three-dimensional structure of the auricle became clearer, and patient satisfaction increased. Among the remaining two patients, one case of flap necrosis survived after skin grafting and dressing changes. One patient had scar hyperplasia at the incision of the reconstructed ear due to a scar-prone constitution, and the shape of the auricle was not ideal, but the scar hyperplasia at the scalp incision was not obvious. Conclusion:One-stage ear reconstruction with high-density porous polyethylene （Su-por） combined with superficial temporal fascia flap through a minimally invasive scalp incision can better show the fine structure of the reconstructed ear. The minimally invasive scalp incision can effectively reduce the occurrence of scar hyperplasia and postoperative alopecia at the scalp incision.
Humans ; Plastic Surgery Procedures/methods* ; Retrospective Studies ; Surgical Flaps ; Tissue Scaffolds ; Polyethylene ; Ear Auricle/surgery* ; Male ; Scalp/surgery* ; Female ; Skin Transplantation ; Fascia/transplantation* ; Porosity ; Adult ; Middle Aged

Cemental tear is a rare and indetectable condition unless obvious clinical signs present with the involvement of surrounding periodontal and periapical tissues. Due to its clinical manifestations similar to common dental issues, such as vertical root fracture, primary endodontic diseases, and periodontal diseases, as well as the low awareness of cemental tear for clinicians, misdiagnosis often occurs. The critical principle for cemental tear treatment is to remove torn fragments, and overlooking fragments leads to futile therapy, which could deteriorate the conditions of the affected teeth. Therefore, accurate diagnosis and subsequent appropriate interventions are vital for managing cemental tear. Novel diagnostic tools, including cone-beam computed tomography (CBCT), microscopes, and enamel matrix derivatives, have improved early detection and management, enhancing tooth retention. The implementation of standardized diagnostic criteria and treatment protocols, combined with improved clinical awareness among dental professionals, serves to mitigate risks of diagnostic errors and suboptimal therapeutic interventions. This expert consensus reviewed the epidemiology, pathogenesis, potential predisposing factors, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of cemental tear, aiming to provide a clinical guideline and facilitate clinicians to have a better understanding of cemental tear.
Humans ; Dental Cementum/injuries* ; Consensus ; Diagnosis, Differential ; Cone-Beam Computed Tomography ; Tooth Fractures/therapy*

Objective:To explore the association between sublingual microcirculatory perfusion vessel proportion (PPV), high mobility group protein B1 (HMGB1), and sepsis-induced coagulopathy (SIC), and to identify early predictive markers for clinical intervention.Methods:A total of 66 septic patients admitted to the Respiratory Intensive Care Unit (RICU) between November 2021 and May 2024 were enrolled. Based on SIC diagnosis within 24 hours of admission, patients were categorized into SIC ( n=36) and non-SIC ( n=30) groups. Clinical parameters, including prothrombin time (PT), activated partial thromboplastin time (APTT), sublingual PPV, and serum HMGB1 levels (measured at 0 h and 6 h), were analyzed. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify independent predictors. Results:Compared with the non-SIC group, the SIC group demonstrated significantly prolonged PT ( P<0.05) and APTT ( P<0.05), elevated 0 h lactate levels, and increased 6 h HMGB1. Spearman analysis revealed a positive correlation between 6 h PPV and platelet count ( P<0.05), while an inverse correlation was observed with 6 h PT ( P<0.05). Multivariate regression identified APTT, 6 h PPV, and 6 h HMGB1 as independent predictors of SIC. ROC analysis yielded AUC values of 0.732 for APTT, 0.802 for 6 h PPV, and 0.765 for 6 h HMGB1. The combination of 6 h PPV and HMGB1 further improved predictive accuracy (AUC=0.873). Conclusions:Prolonged APTT, decreased 6 h PPV, and elevated 6h HMGB1 are key indicators of SIC. Integrated assessment of these markers enhances early risk stratification in septic patients, facilitating timely clinical intervention.

A retrospective analysis was made on clinical data of a child with osteopathia striata with cranial sclerosis (OS-CS) diagnosed in the Department of Neonatology, Children′s Hospital Affiliated to Shandong University in January 2024.The proband was admitted to hospital due to premature delivery at 30 + 2 weeks, shortness of breath and poor response for 13 days after resuscitation.After birth, the child had no spontaneous breathing with floppy limbs.Tracheal intubation was required for positive pressure ventilation.Cranial ultrasound showed right subventricular hemorrhage with bilateral intraventricular hemorrhage and bilateral parieto-occipital subdural hemorrhage; cardiac ultrasound showed patent ductus arteriosus and tricuspid regurgitation; scrotal ultrasound showed bilateral inguinal cryptorchidism with right testicular hydrocele; gastrointestinal ultrasound showed that the lumen of the transverse colon was filled with many fecal matters with strong echoes.Whole exome sequencing(WES) indicated that the proband carried a hemizygous variant of c. 1489C>T(p.Arg497 *) in the AMER1 gene, which was inherited from his mother, as verified by Sanger sequencing.The hemizygous variant of c. 1489C>T(p.Arg497 *) in the AMER1 gene was rated as likely pathogenic (PVS1+ PM2-Supporting) according to the American College of Medical Genetics and Genomics(ACMG) guidelines, which was not included in the Human Gene Mutation Database(HGMD) database.High-throughput sequencing identified the hemizygous variant of c. 1489C>T(p.Arg497 *) in the AMER1 gene as the genetic etiology of the proband.This was the first report of AMER1 gene variant leading to OS-CS in China.The study enriches the variation spectrum and clinical phenotype spectrum of the AMER1 gene, providing a valuable foundation for clinical diagnosis, treatment, and subsequent research of the disease.

Objective:To investigate differences in serum lipid profiles between patients with dermatomyositis (DM) and healthy controls.Methods:A retrospective analysis was conducted on the clinical data and serum samples collected from 51 patients with DM who visited the First Affiliated Hospital, Anhui Medical University from September 2020 to January 2022. Serum samples were also collected from 66 healthy controls during the same period. Serum lipid profiles were analyzed using ultra-performance liquid chromatography-mass spectrometry in both groups. Differential lipids were screened using principal component analysis and orthogonal partial least squares-discriminant analysis. The predictive value of these differential lipids for DM was evaluated by receiver operating characteristic (ROC) curve analysis, and their correlations with clinical indicators were also evaluated.Results:A total of 51 patients with DM were enrolled, including 27 males and 24 females, with ages ( M[ Q1, Q3]) of 55.00 (47.00, 66.00) years and body mass index (BMI) values of 22.64 (19.79, 24.75) . The control group included 66 healthy individuals (33 males and 33 females) , with ages of 51.00 (43.75, 56.00) years and BMI values of 23.60 (21.18, 25.19) . No significant differences were observed between the two groups in terms of sex, age, or BMI (all P > 0.05) . A total of 341 lipid metabolites were identified, and 16 lipid metabolites such as ceramides (Cer) , sphingomyelins, phosphatidylcholines (PC) , phosphatidylethanolamines, lysophosphatidylcholines (LPC) , and triglycerides (TG) significantly differed between the DM group and the control group, of which 8 were upregulated and 8 were downregulated in the DM group. ROC curve analysis identified 7 differential lipids with area under the curve (AUC) values of > 0.9, of which 2 were Cer, 3 were TG, 1 was phosphatidylethanolamine, and 1 was LPC. In the DM patients, serum LPC (22∶1) levels were negatively correlated with creatine kinase isoenzyme MB levels ( r = -0.276, P < 0.05) , serum PC (15∶1/16∶0) levels were negatively correlated with aspartate aminotransferase levels ( r = -0.305, P < 0.05) , and serum Cer (d18∶1/18∶0) levels were positively correlated with C-reactive protein levels ( r = 0.283, P < 0.05) . Significant differences in serum lipid levels were observed between some DM subgroups (all P < 0.05) : sphingomyelin (d24∶0) levels significantly differed between anti-Sj?gren syndrome type A/Ro52 antibody-positive and -negative DM patients; LPC (17∶1) levels significantly differed between anti-PM-SCL75 antibody-positive and -negative DM patients; LPC (20∶0) and PC (32∶1p) levels significantly differed between anti-Mi-2 antibody-positive and -negative DM patients; LPC (22∶1) and TG (9∶0/9∶0/9∶0) levels significantly differed between anti-TIF1-γ antibody-positive and -negative DM patients; Cer (d18∶1/18∶0) levels significantly differed between DM patients with and without Heliotrope's sign. Conclusion:Lipid profiles were significantly altered in DM patients compared with healthy controls, and some lipids showed potential diagnostic value for DM.