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.

ObjectiveTo explore the effect of Shenge Bushen Capsules （SBC） on sexual development in normal 3-week-old mice. MethodsThe experiment consisted of two parts. In the first part， mice were divided into four groups： The control group and the low， medium， and high-dose SBC groups （234.7， 469.4， 938.7 mg·kg^-1， respectively）. In the second part， mice were divided into four groups： Control group， Pseudostellariae Radix polysaccharide （PRP） group， total flavonoids group， and SBC group， all receiving a dose of 469.4 mg·kg^-1. After 7 days of administration， the vaginal opening of female mice and the descent of testes and scrotum in male mice， as well as the ovarian and testicular organ indices， were observed. After 4 weeks of administration， female and male mice were housed together for 2 days， and the pregnancy rate of females was monitored. After delivery， the pregnant female mice continued receiving the treatment for 4 weeks， and the sexual development of their offspring， including vaginal opening， testicular descent， and organ indices of ovaries and testes， was observed. Serum sex hormones were measured by enzyme-linked immunosorbent assay （ELISA）， and the expression of gonadotropin-releasing hormone （GnRH） and growth hormone （GH） proteins in the hypothalamus was assessed by Western blot. ResultsCompared with the control group， there was no significant effect on the vaginal opening of female mice or the descent of testes in male mice after 7 days of SBC administration. After 4 weeks of administration， the pregnancy rate in the low-dose group was significantly reduced （P<0.05）， but no significant effects were observed in the other groups. The three doses of SBC did not significantly affect the ovarian or testicular organ indices， and there was no significant upregulation in the expression of GnRH or GH in the hypothalamus. The primary component of SBC， Pseudostellariae Radix polysaccharide， significantly reduced the vaginal opening in female mice after 7 days of administration （P<0.05）. After 4 weeks， the serum estradiol levels of non-pregnant female mice were decreased （P<0.05）， but there was no significant effect on the expression of GnRH or GH proteins in the hypothalamus of either male or female mice. Additionally， there were no significant effects on precocious puberty indicators， such as vaginal opening and testicular descent， in the offspring mice. ConclusionSBC does not significantly promote precocious puberty in young mice， and it does not have any noticeable effects on the pregnancy rate of adult mice or the sexual development of their offspring.

Objective:To investigate the relationship between plasma levels of protein C(PC), protein S (PS), antithrombin Ⅲ (AT-Ⅲ), and D-dimer (D-D) in patients with preeclampsia and fetal growth restriction (FGR).Methods:A retrospective analysis was conducted to identify 40 patients with preeclampsia complicated by FGR who underwent examination and delivery at the Department of Obstetrics, Puyang Maternal and Child Health Hospital, between January 2021 and January 2023. These patients constituted the study group. An additional 40 patients with preeclampsia that did not develop FGR were selected as the control group. A case-control study design was used to compare general information and levels of PC, PS, AT-Ⅲ, and D-D between the two groups. The areas under the receiver operating characteristic curve for PC, PS, AT-Ⅲ, and D-D were calculated to assess their diagnostic value for FGR.Results:In the study group, the plasma levels of PC [(91.94 ± 10.34)%], PS [(68.79 ± 12.27)%], and AT-Ⅲ [(80.66 ± 9.13)%] were significantly lower than those in the control group [(107.73 ± 13.68)%, (79.62 ± 13.05)%, (92.31 ± 10.54)%, t = 5.82, 3.82, 5.28, all P < 0.05]. Additionally, the level of in the study group [(0.94 ± 0.26) ng/L] was higher than that in the control group [(0.52 ± 0.28) ng/L, t = 6.95, P < 0.05]. Logistic multivariate analysis showed that reduced level of PC ( OR = 1.142), reduced level of PS ( OR = 1.073), reduced level of AT-Ⅲ ( OR = 1.138), and elevated D-D levels ( OR = 1.946) were all risk factors for FGR in patients with preeclampsia (all P < 0.05). The receiver operating characteristic curve analysis for diagnosing FGR in preeclampsia patients indicated area under the curve values of 0.840 for PC, 0.719 for PS, 0.772 for AT-Ⅲ, and 0.819 for D-D. Conclusions:In patients with preeclampsia complicated by FGR, the plasma levels of PC, PS, and AT-Ⅲ are all decreased, while D-D levels are elevated, indicating a hypercoagulable state. Therefore, measuring the plasma levels of PC, PS, AT-Ⅲ, and D-D can assist in diagnosing preeclampsia complicated by FGR.

Gut microbial communities are likely remodeled in tandem with accumulated physiological decline during aging, yet there is limited understanding of gut microbiome variation in advanced age. Here, we performed a metagenomics-based enterotype analysis in a geographically homogeneous cohort of 367 enrolled Chinese individuals between the ages of 60 and 94 years, with the goal of characterizing the gut microbiome of elderly individuals and identifying factors linked to enterotype variations. In addition to two adult-like enterotypes dominated by Bacteroides (ET-Bacteroides) and Prevotella (ET-Prevotella), we identified a novel enterotype dominated by Escherichia (ET-Escherichia), whose prevalence increased in advanced age. Our data demonstrated that age explained more of the variance in the gut microbiome than previously identified factors such as type 2 diabetes mellitus (T2DM) or diet. We characterized the distinct taxonomic and functional profiles of ET-Escherichia, and found the strongest cohesion and highest robustness of the microbial co-occurrence network in this enterotype, as well as the lowest species diversity. In addition, we carried out a series of correlation analyses and co-abundance network analyses, which showed that several factors were likely linked to the overabundance of Escherichia members, including advanced age, vegetable intake, and fruit intake. Overall, our data revealed an enterotype variation characterized by Escherichia enrichment in the elderly population. Considering the different age distribution of each enterotype, these findings provide new insights into the changes that occur in the gut microbiome with age and highlight the importance of microbiome-based stratification of elderly individuals.
Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Bacteroides ; China ; Diabetes Mellitus, Type 2/microbiology* ; Escherichia coli/classification* ; Gastrointestinal Microbiome/genetics* ; Metagenomics ; East Asian People

Objective:To investigate the relationship between plasma levels of protein C(PC), protein S (PS), antithrombin Ⅲ (AT-Ⅲ), and D-dimer (D-D) in patients with preeclampsia and fetal growth restriction (FGR).Methods:A retrospective analysis was conducted to identify 40 patients with preeclampsia complicated by FGR who underwent examination and delivery at the Department of Obstetrics, Puyang Maternal and Child Health Hospital, between January 2021 and January 2023. These patients constituted the study group. An additional 40 patients with preeclampsia that did not develop FGR were selected as the control group. A case-control study design was used to compare general information and levels of PC, PS, AT-Ⅲ, and D-D between the two groups. The areas under the receiver operating characteristic curve for PC, PS, AT-Ⅲ, and D-D were calculated to assess their diagnostic value for FGR.Results:In the study group, the plasma levels of PC [(91.94 ± 10.34)%], PS [(68.79 ± 12.27)%], and AT-Ⅲ [(80.66 ± 9.13)%] were significantly lower than those in the control group [(107.73 ± 13.68)%, (79.62 ± 13.05)%, (92.31 ± 10.54)%, t = 5.82, 3.82, 5.28, all P < 0.05]. Additionally, the level of in the study group [(0.94 ± 0.26) ng/L] was higher than that in the control group [(0.52 ± 0.28) ng/L, t = 6.95, P < 0.05]. Logistic multivariate analysis showed that reduced level of PC ( OR = 1.142), reduced level of PS ( OR = 1.073), reduced level of AT-Ⅲ ( OR = 1.138), and elevated D-D levels ( OR = 1.946) were all risk factors for FGR in patients with preeclampsia (all P < 0.05). The receiver operating characteristic curve analysis for diagnosing FGR in preeclampsia patients indicated area under the curve values of 0.840 for PC, 0.719 for PS, 0.772 for AT-Ⅲ, and 0.819 for D-D. Conclusions:In patients with preeclampsia complicated by FGR, the plasma levels of PC, PS, and AT-Ⅲ are all decreased, while D-D levels are elevated, indicating a hypercoagulable state. Therefore, measuring the plasma levels of PC, PS, AT-Ⅲ, and D-D can assist in diagnosing preeclampsia complicated by FGR.

OBJECTIVE To review the current research progress on pharmacoeconomics evaluation related to spinal muscular atrophy （SMA）， in order to provide valuable insights for clinical treatment， screening and medical insurance payment decision- making. METHODS A computerized search was conducted across multiple databases including PubMed， Web of Science， Embase， Scopus， Cochrane Library， EBSCOhost， CNKI， VIP， CBM and Wanfang database as well as other important health technology assessment （HTA） websites， such as National Institute for Health and Care Research，International Society of Technology Assessment in Health Care， Agency for Healthcare Research and Quality， etc. The pharmacoeconomics evaluation studies related to SMA were collected from the inception to December 31st， 2023. The literature/reports were rigorously screened based on predefined inclusion and exclusion criteria by two researchers， and the essential information from the included literature/ reports was extracted using Excel 2019. The quality of the included literature/reports was evaluated by Consolidated Health Economic Evaluation Reporting Standards 2022. RESULTS Finally， 9 articles and 15 HTA reports were included， with overall good quality of literature， but poor quality of HTA reports. There were a total of 24 studies on the pharmacoeconomics evaluation of SMA， including treatment options such as nusinersen sodium， sovaprevir， risperidone， and best supportive therapy.The review results showed that nusinersen sodium was not cost-effective in the treatment of SMA； there was no consensus on the economic viability of treatment options such as risperidone and sovaprevir； newborn/prenatal screening combined withmedication therapy was cost-effective. CONCLUSIONS newborn/prenatal screening combined with SMA medication therapy demonstrates economic advantages. It is suggested to further investigate the cost-effectiveness of new SMA drugs and SMA screening in China， taking localization parameters and medical insurance prices into account， and gradually incorporate SMA screening into the scope of neonatal genetic disease detection， in order to alleviate the financial burden of patients’ families and healthcare systems.

Objective To compare the therapeutic effects of flexible ureteroscope(FURS),super-mini percutaneous nephrolithotomy(SMP),and microstomy percutaneous nephrolithotomy(MPCNL)in the treatment of 2-3 cm lower calyceal calculi.Methods Clinical data of 209 patients with 2-3 cm lower calyceal calculi in our hospital from January 2017 to September 2022 were retrospectively analyzed.Among them,65 patients were treated with Olympus electronic FURS(FURS group),62 patients were treated with SMP for stone removal(SMP group),and 82 patients were treated with MPCNL(MPCNL group).The one-session stone-free rate(SFR),operation time,hemoglobin decrease at postoperation immediately,rate of postoperative delayed bleeding,postoperative hospital stay,postoperative fever,and hospitalization cost were compared between the three groups.Results There were significant differences in operation time,postoperative hospital stay,hospitalization costs and one-session SFR among the three groups(P<0.05).The one-session SFR in the MPCNL group(89.0%,73/82)was significantly higher than that in the FURS group(72.3%,47/65;P =0.009).The operation time in the MPCNL group was(38.8±7.6)min,significantly shorter than that in the FURS group[(52.3±7.2)min,P =0.000]and the SMP group[(47.5±7.8)min,P =0.001].The hemoglobin decrease at postoperation immediately in the FURS group was(1.5±0.5)g/L,significantly lower than that in the SMP group[(5.0±1.6)g/L,P = 0.000]and MPCNL group[(6.3±1.8)g/L,P =0.000].The postoperative hospital stay in the FURS group was(2.2±0.5)d,significantly shorter than that in the SMP group[(3.5±0.8)d,P =0.000]and the MPCNL group[(5.3±1.4)d,P =0.000].The hospitalization cost of the FURS group was(22 543.4±1600.4)yuan,significantly lower than that of the SMP group[(26 837.7±2003.9)yuan,P =0.000]and the MPCNL group[(26 784.4±2086.9)yuan,P =0.000],but there was no significant difference between the SMP group and the MPCNL group(P =0.869).There was no significant difference in the incidence of postoperative fever among the three groups(χ2 = 0.462,P = 0.784).Conclusions FURS,SMP,and MPCNL are all effective methods for the treatment of 2-3 cm lower calyceal calculi.FURS has the least intraoperative bleeding,the shortest hospital stay,the lowest hospitalization cost,the lowest one-session stone-free rate,and the longest operation time.MPCNL has the shortest operation time,the highest one-session SFR,the most intraoperative bleeding,and the longest hospital stay.

Objective:To investigate the impact of preoperative anti-tumor necrosis factor (anti-TNF) -α monoclonal antibody therapy on postoperative infectious complications in patients with Crohn′s disease (CD) after intestinal resection with primary anastomosis.Methods:The clinical data of CD patients who underwent intestinal resection with primary anastomosis at Jinling Hospital from January 2017 to December 2021 were retrospectively analyzed. Propensity score matching was used to match patients who did not receive or received anti-TNF treatment within 12 weeks before surgery at a ratio of 1∶2. The relationship between preoperative anti-TNF treatment and postoperative infectious complications was analyzed, and the related risk factors of postoperative infectious complications were analyzed by logistic regression analysis.Results:A total of 501 patients with CD who underwent resection and primary anastomosis were collected. After propensity score matching, 135 patients with CD were included in the analysis, 45 in the treatment group and 90 in the control group. There were no significant differences in the incidence of overall postoperative complications (24.4% vs. 25.6%, P = 0.889) and infectious complications (13.3% vs. 14.4%, P = 0.861) between the two groups. Previous history of intestinal resection due to CD and surgical site of colon were independent risk factors for infectious complications within 30 days after surgery. Conclusion:Previous history of intestinal resection of CD and colon surgery are associated with infectious complications after intestinal resection with primary anastomosis.

Objective:To investigate the impact of preoperative anti-tumor necrosis factor (anti-TNF) -α monoclonal antibody therapy on postoperative infectious complications in patients with Crohn′s disease (CD) after intestinal resection with primary anastomosis.Methods:The clinical data of CD patients who underwent intestinal resection with primary anastomosis at Jinling Hospital from January 2017 to December 2021 were retrospectively analyzed. Propensity score matching was used to match patients who did not receive or received anti-TNF treatment within 12 weeks before surgery at a ratio of 1∶2. The relationship between preoperative anti-TNF treatment and postoperative infectious complications was analyzed, and the related risk factors of postoperative infectious complications were analyzed by logistic regression analysis.Results:A total of 501 patients with CD who underwent resection and primary anastomosis were collected. After propensity score matching, 135 patients with CD were included in the analysis, 45 in the treatment group and 90 in the control group. There were no significant differences in the incidence of overall postoperative complications (24.4% vs. 25.6%, P = 0.889) and infectious complications (13.3% vs. 14.4%, P = 0.861) between the two groups. Previous history of intestinal resection due to CD and surgical site of colon were independent risk factors for infectious complications within 30 days after surgery. Conclusion:Previous history of intestinal resection of CD and colon surgery are associated with infectious complications after intestinal resection with primary anastomosis.

The STAR tool was used to evaluate and analyze the science, transparency, and applicability of Chinese pathology guidelines and consensus published in medical journals in 2022. There were a total of 18 pathology guidelines and consensuses published in 2022, including 1 guideline and 17 consensuses. The results showed that the guideline score was 21.83 points, lower than the overall guideline average (43.4 points). Consensus ratings scored an average of 27.87 points, on par with the overall consensus level (28.3 points). Areas that scored above the overall level were "conflict of interest" and "working groups", while areas that scored below the overall level were "proposals", "funding", "evidence", "consensus approaches" and "accessibility". To sum up, the formulation of pathology guidelines and consensuses in 2022 is not standardized, and the evidence retrieval process, evidence evaluation methods and grading criteria for recommendations on clinical issues are not provided in the formulation process; the process and method for reaching consensus are not provided, the plan is lacking, and registration is not carried out. It is therefore suggested that guidelines/consensus makers in the field of pathology should attach importance to evidence-based medical evidence, strictly follow guideline formulation methods and processes, further improve the scientific, applicable and transparent guidelines/consensuses in the field, and better provide support for clinicians and patients.