In the challenging and specific military environment， medical activities are not only confined to traditional medical care but must also adapt to the special requirements of military operations. Meanwhile， when military operations employ medical interventions for treatment and research， they introduce complexities and ethical considerations inherent in the medical domain. Against this backdrop， the ethical conflicts and moral dilemmas confronted by the special identity of military doctors have become an inevitable and urgent issue requiring resolution. The identities of doctors and soldiers， typically distinct， overlap and intersect in the role of the military doctors on the battlefield， inevitably giving rise to intricate ethical predicaments that frequently place them in arduous moral choices. The special considerations in behavioral decision-making， contradictions in value judgments， and the reconciliation of moral injury among military doctors in battlefield scenarios should be comprehensively considered based on factors such as professional codes of conduct， values and emotions， international law， and humanitarian principles. Military doctors should regard respecting life as the supreme principle， while also taking into account the protection needs of special groups， and adhering to the core concept of fairness and reasonableness， all of which should serve as the fundamental guidance for their behavioral standards.

BACKGROUND: The American Heart Association (AHA) introduced the concept of cardiovascular-kidney-metabolic (CKM) health and stage, reflecting the interaction among metabolism, chronic kidney disease (CKD), and the cardiovascular system. However, the association between CKM stage and the long-term risk of cardiovascular disease (CVD) has not been validated. This study aimed to evaluate the long-term CVD risk associated with CKM health metrics and CKM stage using data from a population-based cohort study. METHODS: In total, 5293 CVD-free participants were followed up to around 13 years in the Chinese Multi-provincial Cohort Study (CMCS). Considering the pathophysiologic progression of CKM health metrics abnormalities (comprising obesity, central adiposity, prediabetes, diabetes, hypertriglyceridemia, CKD, and metabolic syndrome), participants were divided into CKM stages 0, 1, and 2. The time-dependent Cox regression models were used to estimate the cardiovascular risk associated with CKM health metrics and stage. Additionally, broader CVD outcomes were examined, with a specific assessment of the impact of stage 3 in 2581 participants from the CMCS-Beijing subcohort. RESULTS: Among participants, 91.2% (4825/5293) had at least one abnormal CKM health metric, 8.8% (468/5293), 13.3% (704/5293), and 77.9% (4121/5293) were in CKM stages 0, 1, and 2, respectively; and 710 incident CVD cases occurred during a median follow-up time of 13.3 years (interquartile range: 12.1 to 13.6 years). Participants with each poor CKM health metric exhibited significantly higher CVD risk. Compared with stage 0, the hazard ratio (HR) (95% confidence interval [CI]) for CVD incidence was 1.31 (0.84-2.04) in stage 1 and 2.27 (1.57-3.28) in stage 2. Significant interactive impacts existed between CKM stage and age or sex, with higher CVD risk related to increased CKM stages in participants aged <60 years or females. CONCLUSION These findings highlight the contribution of CKM health metrics and CKM stage to the long-term risk of CVD, suggesting the importance of multi-component recognition and management of poor CKM health in CVD prevention.
Humans ; Female ; Male ; Cardiovascular Diseases/etiology* ; Middle Aged ; Adult ; Cohort Studies ; Renal Insufficiency, Chronic/metabolism* ; Aged ; Risk Factors ; Metabolic Syndrome/metabolism* ; China ; East Asian People

This study aimed to elucidate the mechanism of action of metformin (MET) in inhibiting the malignant progression of hepatocellular carcinoma (HCC) by regulating the degradation of aldo-keto reductase family 1 member C3 (AKR1C3). The correlation between the sensitivity of different hepatocellular carcinoma cell lines to MET and their basal expression levels of AKR1C3 was firstly evaluated. MET was found to significantly reduce the level and accelerate the degradation rate of AKR1C3 protein by Western blot. The interaction between MET and AKR1C3 protein was confirmed by cellular thermal shift assay (CETSA). Proteasome inhibitor MG132 and the lysosomal inhibitor chloroquine (CQ) were used to screen the degradation pathway, and confirm, in combination with the HBSS starvation-induced autophagy model, that MET mediated the degradation of AKR1C3 through the autophagy lysosome pathway. Ubiquitylation assay showed that MET specifically enhanced the K63-linked polyubiquitylation modification of AKR1C3. Sequestosome 1 (SQSTM1/p62) knockdown, immunoprecipitation, and immunofluorescence co-localization analyses confirmed that the autophagy receptor p62 plays a key role in mediating MET-induced degradation of AKR1C3. The adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK) inhibitor compound C was used to demonstrate that the regulatory effect of MET on AKR1C3 is independent of the classical AMPK signaling pathway. The experimental results showed that metformin promoted the ubiquitination modification of AKR1C3 by targeting AKR1C3, enhanced the binding of AKR1C3 to autophagy receptor p62, then degraded the AKR1C3 protein through selective autophagy-like pathway, and ultimately inhibited the malignant phenotypes of hepatocellular carcinoma cells, which is a regulatory mechanism free of the classical AMPK activation pathway of metformin.

The red doctor spirit is the advanced culture of the Communist Party of China formed under a specific historical and cultural background. It can be summarized as “political firmness， excellent technology， working hard， and healing the wounded and rescuing the dying.” This content has many hidden similarities and integrations with the goal of cultivating humanistic literacy for medical students in military medical universities. This paper aimed to identify the important connection points between the red doctor spirit and the contents and goals of medical humanities teaching， as well as integrate the red doctor spirit into medical humanities teaching by various dimensions， including systematic reconstruction of textbook content， immersive innovation in teaching form， three-dimensional support in resource construction， and innovative implementation of narrative medicine teaching. It also further explored the extension of the red doctor spirit in military medical humanistic literacy， namely， revolutionary humanism and revolutionary heroism， thereby enhancing the effectiveness of medical humanistic teaching.

Post-stroke cognitive impairment (PSCI) is one of the most common complications of stroke and an important reason for the poor prognosis of patients with motor and language dysfunction after stroke. However, its exact pathogenesis has not been fully clarified. An in-depth understanding of the pathophysiological process of PSCI is crucial for establishing effective prevention and treatment strategies. The cerebral lymphoid system is a key waste clearance pathway discovered in the central nervous system in recent years, and its potential role in neurodegenerative diseases has received extensive attention. More and more studies suggest that the cerebral lymphatic system may be closely related to the occurrence and development of PSCI. This article aims to explore the basic structure and function of the cerebral lymphatic system, as well as its mechanism of action in PSCI. We systematically reviewed the research progress on the potential connection between the cerebral lymphatic system and PSCI. Furthermore, this article also summarizes the potential applications of the cerebral lymphatic system in the treatment of PSCI and presents prospects for future research directions.

Objective To analyze the relationship between hypertension combined with obstructive sleep apnea hypopnea syndrome(OSAHS)and intima-media thickness(IMT)and explore the correlation between the risk of IMT and hypertension with OSAHS patients.Methods Select 50 patients with hypertension and OSAHS patients who were treated in Jiaxing Hospital of Traditional Chinese Medicine during January 2020 to February 2024 as observation group,while 50 patients with simple hypertension were used as control groups to collect two groups of patients'sleep respiratory monitoring disorders(AHI),lowest blood oxygen saturation(L-SaO2)at night,average hemodium oxygen saturation(M-SaO2)at night,dynamic blood pressure 24h,daytime and night's average diastolic blood pressure,IMT,conducting relevant statistical analysis,compares correlation between IMT of two groups and the severity of OSAHS.Results Compared with control group,observation group AHI,IMT,average systolic blood pressure voltage and average diastolic blood pressure increased significantly(P＜0.01),L-SaO2,M-SaO2 decreased significantly(P＜0.01).Observation group AHI and average systolic blood voltage and average diastolic pressure of average systolic blood pressure at 24h,daytime,and night were positively correlated(P＜0.01),L-SaO2,24h and daytime average contraction pressure were negatively correlated(P＜0.05).Observation group AHI and IMT were positive,and L-SaO2,M-SaO2 and IMT were negatively related(P＜0.01).Conclusion Severity of the disease of hypertension combined with OSAHS patients is closely related to patient's blood pressure level and change of IMT.Actively controlling blood pressure and IMT may help improve prognosis of patients,reduce the occurrence of cardiovascular events.The prognostic evaluation has certain clinical value.

Humanistic literacy education for medical students is an important aspect related to medical education and development.Humanistic literacy education for medical students is not only knowledge educationbut also integrates value education and behavioral education.Hospitals as a three-dimensional space that combines knowledge values and practiceplay an irreplaceable role in cultivating medical students' humanistic literacy helping to expand the cognitive space of humanistic educationenhance the recognition space of humanistic educationand expand the practical space of humanistic education.Therefore hospitals should fully utilize their specific function of cultivating humanistic literacy and build a positive humanistic spatial field.By taking measures such as establishing a field and constructing a humanistic entity space conducting field interaction and creating a humanistic value space empowering the field and creating a humanistic practice space.it can achieve good results in the cultivation of medical students' humanistic literacy.

Objective To explore the intervention effect of acceptance and commitment therapy(ACT)on adolescent depression patients with non-suicidal self-injury.Methods A total of 60 adolescent depression patients with non-suicidal self-injury treated in Guilin Mental Health Center from June 2022 to June 2023 were selected as study objects,and they were divided into observation group and control group according to random number table method,with 30 cases in each group.Patients in control group received routine nursing,and patients in observation group received ACT intervention at the same time of routine nursing.Both groups received intervention for 6 weeks.The scores of self-rating depression scale(SDS),self-rating anxiety scale(SAS),nurses's global assessment of suicide risk(NGASR),acceptance and action questionnaire-Ⅱ(AAQ-Ⅱ)and cognitive fusion questionnaire(CFQ)before and after treatment were compared between two groups.Results After the intervention,the scores of SDS,SAS,NGASR,AAQ-Ⅱ and CFQ in observation group were significantly lower than before the intervention(P＜0.05).The NGASR score of observation group was significantly lower than that of control group(P＜0.05).There were no significant differences in SDS,SAS,AAQ-Ⅱ and CFQ scores between two groups(P＞0.05).Conclusion ACT can effectively improve the non-suicidal self-injury behavior of patients,help patients improve psychological flexibility,and is conducive to depression treatment.

Objective:The purpose of this study was to investigate the diagnostic value and clinical significance of cochlear microphonics (CM) combined with otoacoustic emission (OAE) in patients with auditory neuropathy (AN).Methods:The study included patients who were diagnosed with bilateral AN and had CM originating from both sides. The CM amplitude, latency, duration and intensity-amplitude (I/O) function curve were recorded by CM test. According to whether the distortion product otoacoustic emissions (DPOAE) passed through, the patients were divided into three groups: bilateral OAE passed group (OAE PP Group), bilateral OAE failed group (OAE RR Group), and unilateral OAE passed through one side failed group (OAE PR Group). OAE was elicited by four or more frequencies of 750-8 000 Hz. The characteristics of CM and its related influencing factors were analyzed, and data were processed and analyzed by SPSS 26.0 software. Results:(1) A total of 256 patients (512 ears) with AN were enrolled, including 161 patients (322 ears) in OAE PP group, 32 patients (64 ears) in OAE PR group and 63 patients (126 ears) in OAE RR group. OAE failed in 30.9% of patients with AN. (2) When the stimulation intensity was 100 dB nHL, the CM amplitude of OAE passing ear (OAE P+CM P group) in AN patients aged 3 years was 0.43±0.17μV, which was significantly higher than that of OAE not passing ear (OAE R+CM P group) (0.29±0.15) μV ( t=4.876， P<0.001). The CM duration of the OAE P+CM P group was (5.18±1.04) ms, which was longer than that of the OAE R+CM P group at 4.60±1.12 ms ( P=0.005). The I/O function curve of OAE P+CM P group showed a nonlinear trend, while, that of OAE R+CM P group showed a linear trend. (3) In the OAE P+CM P group of AN patients, the amplitude of CM was negatively correlated with the onset age, test age, disease course, PTA, and ASSR threshold ( P<0.001), with correlation coefficients of r=-0.475, r=-0.519, r=-0.367, r=-0.374, and r=-0.494, respectively. In the OAE R+CM P group of AN patients, the amplitude of CM was negatively correlated with the onset age, test age, and ASSR threshold ( P<0.05), with correlation coefficients of r=-0.271, r=-0.240, and r=-0.287, respectively. Conclusions:Excluding patients with high-frequency steeply sloping hearing loss, when ABR is absent or abnormal and OAE is absent, CM detection can reduce the rate of missed diagnosis of AN. The analysis of CM amplitude and I/O function curve is helpful to determine the lesion site of AN patients, which is convenient for early diagnosis and effective intervention.