OBJECTIVE: To develop a digital intelligent multimodal shift handover system for the intensive care unit (ICU) and evaluate its application effect in ICU shift handovers. METHODS: A research and development team was established, consisting of 1 department director, 1 head nurse, 3 information technology engineers, 3 nurses, and 2 doctors. Team members were assigned responsibilities including overall coordination and planning, platform design and maintenance, pre-application training, collection and organization of clinical feedback, and research investigation respectively. A digital intelligent multimodal shift handover system was developed for ICU based on the Shannon-Weaver linear transmission model. This innovative system integrated automated data collection, intelligent dynamic monitoring, multidimensional condition analysis and visual reporting functions. A cloud platform was used to gather data from multi-parameter vital signs monitors, infusion pumps, ventilators and other devices. Artificial intelligence algorithms were employed to standardize and analyze the data, providing personalized recommendations for healthcare professionals. A self-controlled before-after method was adopted. Before the application of the ICU digital intelligent multimodal shift handover system (from December 2023 to March 2024), the traditional verbal bedside handover was used; from June 2024 to March 2025, the ICU digital intelligent multimodal shift handover system was applied for shift handovers. Questionnaires before the application of the shift handover system were collected in April 2024, and those after the application were collected in April 2025. The shift handover time, handover quality (scored by the nursing handover evaluation scale), satisfaction with doctor-nurse communication (scored by the ICU doctor-nurse scale) before and after the application of the handover system were compared, and nurses' satisfaction with the shift handover system (scored by the clinical nursing information system effectiveness evaluation scale) was investigated. RESULTS: After the application of the ICU digital intelligent multimodal shift handover system, the shift handover time was significantly shorter than that before the application [minutes: 20 (15, 25) vs. 30 (22, 40)], the handover quality was significantly higher than that before the application [score: 84.0 (78.0, 88.5) vs. 71.0 (55.0, 79.0)], and the satisfaction with doctor-nurse communication was also significantly higher than that before the application (score: 84.58±6.79 vs. 74.50±11.30). All differences were statistically significant (all P < 0.05). In addition, the nurses' system effectiveness evaluation scale score was 102.30±10.56, which indicated that nurses had a very high level of satisfaction with the ICU digital intelligent multimodal shift handover system. CONCLUSIONS The application of the ICU digital intelligent multimodal shift handover system can shorten the shift handover time, improve the handover quality, and enhance the satisfaction with doctor-nurse communication. Nurses have a high level of satisfaction with this system.
Intensive Care Units ; Humans ; Patient Handoff ; Artificial Intelligence ; Algorithms

Perilla frutescens (L.) Britt. is a characteristic oil crop rich in polyunsaturated fatty acids, particularly α-linolenic acid, which has important development and utilization value. The Dof transcription factor is one of the plant-specific transcription factor families, which is widely involved in important biological processes such as plant growth, development, and metabolic regulation. In order to explore the key Dof transcription factors involved in the oil biosynthesis and systematically analyze their regulatory mechanisms of P. frutescens seeds, a total of 56 PfDof gene family members were identified from the genome and transcriptome data of P. frutescens and classified into four subfamilies according to sequence characteristics. All PfDofs contained highly conserved C₂-C₂ zinc finger domains, with gene duplication being the primary mechanism driving their evolution and expansion. Genes within the same subgroup exhibited similar gene structures and conserved motifs. The 56 PfDofs were predicted as unstable hydrophilic proteins, with α-helixes and random coils as their predominant structural components. The RNA-seq results revealed that 11 PfDofs exhibited differential expression during different developmental stages of P. frutescens seeds. RT-qPCR was performed to further validate the expression patterns of these 11 members across various tissue samples (root, stem, leaf, and flower) of P. frutescens and at different developmental stages of its seeds. The results showed that PfDof29 exhibited the highest expression level in seeds, which was consistent with the transcriptome data. Subcellular localization studies demonstrated that PfDof29 was localized to the nucleus and had a transcriptional activation activity. Overexpression of PfDof29 in Nicotiana tabacum resulted in a significant increase in total oil content of tobacco leaves, accompanied by reductions in starch and soluble sugar content, while the protein content remained unchanged. Additionally, the metabolic balance between saturated and unsaturated fatty acids in the transgenic tobacco leaves was altered, with a significant increase in α-linolenic acid content. The expression levels of the fatty acid desaturase genes NtFAD2, NtFAD3, and NtFAD8 were significantly upregulated. A yeast one-hybrid assay revealed that PfDof29 could directly bind to the promoter region of PfFAD8, thereby regulating its expression. This study provides an initial understanding of the regulatory mechanisms of PfDof transcription factors in the synthesis and accumulation of oil in P. frutescens. These findings offer new insights into the enhancement of oil content and quality of P. frutescens seeds.
Transcription Factors/physiology* ; Perilla frutescens/metabolism* ; Plant Proteins/metabolism* ; Gene Expression Regulation, Plant ; alpha-Linolenic Acid/biosynthesis* ; Lipids/biosynthesis* ; Seeds/genetics*

To summarise the clinical experience of Professor CHAO Enxiang in treating idiopathic pulmonary hemosiderosis （IPH） by staging from heat， phlegm， stasis and deficiency. It is believed that IPH has blood-heat and phlegm-stasis， and deficiency of qi and yin as the core pathomechanisms， in which the pathomechanism of acute pulmonary haemorrhage is based on intense blood heat， and modified Shihui Powder （十灰散） is used to clear heat and regulate ying qi （nutrient qi）， and reduce fire to settle the collaterals. The pathomechanism of pulmonary haemorrhage in the static stage is based on phlegm-heat obstructing the lungs， and modified Qingfei Dingke Decoction （清肺定咳汤） is used to clear the lungs and dissolve phlegm， harmonize the collaterals to stop haemorrhage. The pathomechanism of acute exacerbation at chronic stage is based on deficiency of qi and yin， and also blood-heat and phlegm-stasis， modified Shengmai Powder （生脉散）， Shihui Powder plus Qingfei Dingke Decoction should be used to benefit qi and nourish yin， clear heat， resolve phlegm and eliminate blood stasis. In the chronic prolongation period， the pathogenesis of the disease is based on the deficiency of qi and yin， modified Shengmai Powder may be used to benefit qi and nourish yin， moisten the lungs and rest blood.

Objective:To explore potential risk factors for central lymph node metastasis (CLNM) in papillary thyroid microcarcinoma (PTMC).Methods:The clinicopathological data of 304 PTMC patients admitted to Baotou Cancer Hospital from Oct 2021 to Mar 2023 were retrospectively analyzed. The risk factors of CLNM were analyzed using unifactorial and multifactorial regression.Results:The rate of central regional lymph node metastasis in 304 patients with PTMC was 46.7% (142/304). Univariate analysis showed that male, age <45 years, maximum cancerous lesion diameter ≥5 mm, total cancerous lesion diameter ≥9.5 mm, anterior-posterior lesion diameter ≥5 mm, anterior-posterior lesion diameter ratio of cancerous lesions ≥0.48, breaching of thyroid capsule, number of lymph nodes on the side of cancerous lesions ≥5, and antithyroid peroxidase antibody ≤34 IU/ml were associated with CLNM (all P<0.05); Logistic multivariate regression analysis showed that. male, age <45 years, total diameter of cancer foci ≥9.5 mm ( OR=2.052, 95% CI: 1.176-3.581, P=0.011), anteroposterior diameter ratio of cancer foci ≥0.48 ( OR=2.076, 95% CI: 1.161-3.711, P=0.014), number of lymph nodes on the side of cancer foci ≥5, and anti-thyroid peroxidase antibody ≤34 IU/ml were independent risk factors for CLNM. Conclusion:Male, age ,total diameter of cancer foci, anterior-posterior diameter ratio of cancer foci, number of lymph nodes on the side of cancer foci, and anti-thyroid peroxidase antibody level are all independent risk factors for CLNM in patients with PTMC.

Objective:To investigate the plasma level of interleukin(IL)-37 and assess its regulatory effects on monocyte activity in type 1 diabetes mellitus(T1DM) patients.Methods:This prospective study included 57 T1DM patients and 21 healthy controls who were continuously enrolled from December 2022 to January 2024 at Xinxiang Central Hospital. Plasma and peripheral blood mononuclear cells were isolated. IL-37 and soluble interleukin 1 receptor 8(IL-1R8) levels were measured by enzyme-linked immunosorbent assay(ELISA). Levels of IL-37 receptor subunits in monocytes were analyzed via flow cytometry. Purified monocytes were stimulated with recombinant IL-37 and co-cultured with a human pancreatic β-cell line to assess cytotoxicity, measured by target cell death and cytokine levels. Additionally, monocytes were co-cultured with autologous CD4 + T cells to evaluate antigen presentation by measuring interferon-γ(IFN-γ) and IL-17A secretion. Results:Plasma IL-37 level and IL-37 receptor subunit expression in monocytes were significantly lower in T1DM patients compared to controls(both P<0.001). However, there was no significant difference in soluble IL-1R8 levels between the groups( P=0.457). Monocytes from T1DM patients exhibited increased cytotoxicity, as indicated by higher target cell death and elevated levels of granzyme A, granzyme B, granzyme H, IL-1β, IL-6, and tumor necrosis factor-α( P<0.05). Additionally, monocyte-induced secretion of IFN-γ and IL-17A by CD4 + T cells was elevated in T1DM patients(all P<0.05). Stimulation of T1DM monocytes with recombinant IL-37 reduced target cell death and decreased granzyme B secretion compared to unstimulated monocytes(both P<0.05). However, IL-37 stimulation had no significant effect on other cytokine levels or monocyte-induced IFN-γ and IL-17A secretion( P>0.05). Conclusions:Monocytes exhibit enhanced cytotoxicity and antigen-presenting capacity in T1DM patients. IL-37 reduces monocyte cytotoxicity by inhibiting granzyme B secretion, but does not affect antigen presenting function in T1DM.

Diabetic kidney disease (DKD) is one of most common microvascular complications of diabetes mellitus. A subset of patients with DKD may experience rapid disease progression, ultimately developing end-stage renal disease. The timing of hemodialysis initiation is a critical influencing factor of the survival outcomes in end-stage renal disease patients undergoing dialysis. However, a unified standard for the optimal timing of hemodialysis initiation in DKD patients is currently lacking, and the issue remains controversial in clinical practice. This article reviews research progress on the timing of hemodialysis in patients with DKD, covering aspects such as the current status of hemodialysis treatment, advances in research on hemodialysis timing, relevant guidelines, intentional delayed dialysis strategies, and evaluation criteria for dialysis timing to provide a reference for scientifically developing hemodialysis initiation plans and strategies in clinical practice.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Pain assessment in children is vital in clinical practice. Accurate evaluation of pain intensity in children is the prerequisite for implementing effective analgesic interventions, it is necessary to chose age-specific assessment tools tailored to developmental stages of children. The degrees of patin reported by children themselves are the gold standard for evaluation, and self-assessment should be prioritized when feasible. In addition, behavioral and physiological assessments also show good reliability and validity. This review summarizes current domestic and international researches on pediatric pain assessment tools and their clinical applications, aiming to provide reference for optimizing pain evaluation in pediatric practice.

Objective:To explore the short-term clinical effects of deep cervical lymph node-venous anastomosis in the treatment of Alzheimer’s disease (AD).Methods:A prospective exploratory study was conducted on the treatment of AD patients using the cervical deep lymph node-venous anastomosis technique in Scar and Wound Treatment Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from September to October 2024. The patients underwent high-frequency ultrasound to locate deep cervical lymph nodes and the external jugular vein. Under general anesthesia, bilateral deep cervical lymph node-venous anastomoses were performed. Indocyanine green (ICG) lymphography was conducted via subcutaneous injection behind the ear to visualize lymph nodes in levels Ⅱ and Ⅲ. After making a skin incision along the posterior margin of the sternocleidomastoid muscle, the external jugular vein, internal jugular veins, and associated lymph nodes were exposed. Adjacent veins were selected for anastomosis of lymph node. Using microsurgical techniques, end-to-side or end-to-end anastomosis was completed for lymph nodes in levels Ⅱ and Ⅲ. Preoperative assessments included the mini-mental state examination (MMSE, a higher score indicates better cognitive function), Alzheimer’s disease assessment scale-cognitive subscale (ADAS-Cog, a higher score indicates greater impairment of cognitive function), Alzheimer’s disease cooperative study scale for activities of daily living (ADCS-ADL, a higher score indicates better ability to perform daily activity), and neuropsychiatric inventory (NPI, a higher score indicates more severe behavioral and emotional symptom). Postoperative follow-up included the same scales to observe changes in cognitive function, activities of daily living, and emotional communication.Results:Four patients (1 male, 3 females, aged 58-79 years) with AD were included. All were diagnosed based on cerebrospinal fluid biomarkers. All patients successfully underwent bilateral deep cervical lymph node-venous anastomoses. On average, 4.3 (2-7 per person) anastomoses were performed per patient. Surgical procedures lasted an average of 6.5 h (5.5-8.5 h) with minimal blood loss (less than 50 ml). Patients resumed normal activity within 6 hours postoperatively and were discharged after an average of 4.1 d (3.5-5.0 d). Postoperative complications included one case each of aspiration pneumonia, lower limb venous thrombosis, and transient delirium, all of whom resolved without long-term effects. Clinical symptoms, including memory decline, mood swings, and anxiety, showed varying degrees of improvement. Patients reported enhanced quality of life, emotional stability, and social engagement, confirming the procedure’s safety and potential cognitive benefits. At one month postoperatively, the MMSE scores of the four patients increased by an average of 0.8 points compared to preoperative levels. Additionally, the two patients who completed the ADAS-Cog assessments showed a decrease in their scores (reduced by 1.0 points and 11.3 points, respectively, compared to preoperative scores), indicating a certain degree of improvement in cognitive function during this period. The ADCS-ADL and NPI scores of four patients varied significantly, without showing any clear pattern.Conclusion:Lymphovenous anastomosis of the deep cervical lymph node-venous anastomosis may provide a new surgical intervention approach for AD, but further large-scale studies and long-term follow-up are needed to validate its safety and effectiveness.

Objective:To analyze the relationship between the optimal surgical margin value and clinical prognosis of transoral robotic surgery（TORS） in treating human papillomavirus（HPV） -positive oropharyngeal squamous cell carcinoma. Methods:A single-center, prospective, observational cohort study was conducted, enrolling patients with early and moderated stage（≤T3 stage） oropharyngeal carcinoma undergoing TORS between July 2020 and April 2024. The proposed optimal surgical margin cutoff value for TORS was set as 2 mm. The primary objectives were to evaluate the optimal clear margin for TORS and its association with overall survival（OS） and progression-free survival（PFS）. Logistic regression was used to analyze correlations between surgical margins and clinical variables, while Cox regression models assessed the impact of surgical margins on OS and PFS. Results:A total of 90 patients（60 males, 66.7%） were included, all had squamous cell carcinoma, with a mean age of 58.0±9.0 years（range: 39-84 years） old. The 1, 2 and 3-year OS rates were 92.3%, 89.9% and 85.0%, respectively, while the 1, 2 and 3-year PFS rates were all 90.1%. For surgical margins ≤2 mm, the 1, 2 and 3-year OS rates were 80.8%, 69.3% and 69.3%, respectively, and PFS rates were 77.9% across three time points. For surgical margins>2 mm, the 1, 2 and 3-year OS rates were 96.5%, 96.5% and 90.6%, respectively, with PFS rates of 94.6%. Logistic regression showed no correlation between surgical margins and tumor type, T/N stage, smoking, alcohol use, or gender（P>0.05）. Cox analysis identified surgical margins>2 mm as a significant factor improving PFS（HR=0.14, 95%CI 0.02-0.90, P=0.038）. Conclusion:This systematic analysis suggests setting a 2 mm and longer as clear surgical margin for TORS. Margins>2 mm are associated with superior postoperative PFS rate and prolonged PFS time in HPV-positive oropharyngeal carcinoma patients.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Carcinoma, Squamous Cell/virology* ; Human Papillomavirus Viruses/isolation & purification* ; Margins of Excision ; Oropharyngeal Neoplasms/virology* ; Papillomavirus Infections/virology* ; Prognosis ; Prospective Studies ; Robotic Surgical Procedures/methods*