ObjectiveTo introduce visual teaching into the course design of medical humanistic care based on the concept of implementation science， evaluate the teaching implementation effect and feedback， and provide references for optimizing course teaching outcomes and improving students’ humanistic care competence. MethodsA visual teaching program for medical humanistic care was designed， with key steps including clarifying teaching objectives， content， methods， and curriculum assessment. This program was implemented in the medical humanistic care course teaching involving 50 elective students. Multi-dimensional evaluation of teaching effectiveness was conducted through course grades， visual teaching evaluation， and humanistic workshop assessment， combined with inductive content analysis of students’ learning experiences in the workshops. ResultsThe 50 students achieved above-average course grades （89.60±3.41） and demonstrated high satisfaction with the overall course and visual teaching. All the 6 groups obtained relatively high scores in the medical humanistic care workshops. Four themes were extracted， namely， enhancing humanistic care competencies， deepening familial and interpersonal relationships， realizing emotional expression and self-growth， and strengthening integration of humanistic care concepts with practice. ConclusionThe teaching of medical humanistic care course has achieved favorable effects， which contributes to deepening students’ understanding of humanistic care and enhancing their humanistic care competence. Students demonstrate high levels of recognition and satisfaction with the course.

Objective To investigate the registration rate and trend of pulmonary tuberculosis complicated with diabetes mellitus (PTB-DM) in Wuhan from 2020 to 2024, and to provide scientific evidence for formulating PTB-DM prevention and control policies. Methods PTB-DM case data in Wuhan (2020-2024) were collected through the Infectious Disease Registration and Management Information System. Joinpoint regression model was employed to analyze the trend of registration rates of PTB-DM among the general population and across different regions, genders, and age groups. ARIMA model was used to predict the short-term prevalence of PTB-DM. Results Among 26275 pulmonary tuberculosis cases registered in Wuhan (2020-2024), 2669 cases (10.16%) were PTB-DM. The average annual registration rate of PTB-DM was 3.96/100,000, increasing from 2.74/100,000 in 2020 to 5.40/100,000 in 2024 (APC=19.07%, 95% CI:12.99%-26.92%, P<0.001). The PTB-DM registration rates showed an upward trend across different regions, genders, and age groups in Wuhan, with higher registration rates observed in near urban area, males, and individuals aged 60~64 and 65 years and above (χ²=99.566, P<0.001; χ²=781.891, P<0.001; χ²=2211.930, P<0.001). ARIMA model predicted that the prevalence of PTB-DM in Wuhan would remain stable and fluctuating in the short time. Conclusion PTB-DM registration rate in Wuhan increases from 2020 to 2024. Near urban area, males, and elderly populations are high risk groups. Future efforts should focus on strengthening the prevention and control of PTB-DM among these populations.

ObjectiveTo investigate the effect of high-definition transcranial direct current stimulation (HD-tDCS) combined with upper limb robot on upper limb dysfunction in patients with ischemic stroke. MethodsFrom January, 2023 to March, 2024, 56 inpatients with upper limb dysfunction after ischemic stroke were selected from Zhejiang Rehabilitation Medical Center, and divided into control group (n = 28) and experimental group (n = 28) randomly. All the patients received comprehensive treatment and upper limb robot training, while the control group received sham HD-tDCS and the experimental group received HD-tDCS, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Wolf Motor Function Test (WMFT) and modified Barthel Index (MBI) before and after treatment. The cortical amplitude, cortical latency and central motor conduction time (CMCT) of transcranial magnetic stimulation motor-evoked potential (MEP) were recorded, and a correlation analysis was conducted. ResultsThe scores of FMA-UE, WMFT and MBI, and MEP cortical amplitude, cortical latency and CMCT improved in both groups after treatment (t > 3.177, P < 0.01), and they were better in the experimental group than in the control group (t > 3.610, P < 0.01). The scores of FMA-UE and WMFT negatively correlated with MEP cortical latency and CMCT, and positively correlated with MEP cortical amplitude (|r| > 0.448, P < 0.001). ConclusionHD-tDCS is effective on upper limb motor function and activities of daily living for patients with ischemic stroke, and can improve corticospinal motor conduction.

Objective To investigate the clinical effect of Qizhi Mixture combined with telmisartan tab-lets in the treatment of qi deficiency and blood stasis type IgA nephropathy.Methods A total of 98 patients with qi deficiency and blood stasis type IgA nephropathy admitted and treated in this hospital from January 2020 to December 2023 were selected and divided into the experimental group and control group according to the envelope method.The control group adopted telmisartan tablets,and the experimental group adopted Qizhi Mixture combined with telmisartan tablets.The clinical efficacies were compared between the two groups,as well as the renal function,liver function,vessel endothelial cell function and oxidative stress response indica-tors in the two groups.The occurrence of adverse reactions in the two groups were observed.Results The to-tal treatment effective rate in the experimental group was significantly higher than that in the control group(95.92％vs.79.59％).After treatment,the levels of SCr,BUN and NGAL in the experimental group were lower than those in the control group,and the differences were statistically significant(P＜0.05).The ALB level after treatment in the experimental group was higher than that in the control group,the ALT and TBIL levels were lower than that in the control group,and the difference was statistically significant(P＜0.05).The levels of VEGF and ET-1 after treatment in the experimental group were lower than those in the control group,and the differences were statistically significant(P＜0.05).The levels of GSH-Px and SOD after treat-ment in the experimental group were higher than those in the control group,the level of MDA was lower than that in the control group,and the differences were statistically significant(P＜0.05).The incidence rate of ad-verse reactions in the experimental group was lower than that in the control group,and the difference was sta-tistically significant(6.12％vs.22.45％,P＜0.05).Conclusion Qizhi Mixture combined with telmisartan tablets in the treatment of qi deficiency and blood stasis type IgA nephropathy could improve the liver and re-nal function and endothelial cell function of the patients,reduce the oxidative stress responses and decrease the adverse reactions.

This article introduces the concept of death literacy and reviews the content,evaluation methods,target populations,reliability and validity of assessment tools for death literacy in China and abroad.It summarises the advantages and disadvantages of the tools as well as current status in application of the tools.The aim of this study is to provide a reference for researchers to select an appropriate assessment tool or to develop the assessment tools that are more suitable for the death literacy in China.

Objective:To investigate the feasibility and value of nomogram based on base line clinical and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) characteristics for pretreatment predicting the depth of myometrial invasion and tumor grade of endometrioid endometrial carcinoma (EEC).Methods:Preoperative baseline clinical characteristics and DCE-MRI characteristics of 194 EEC patients were prospectively collected at Obstetrics and Gynecology Hospital, Fudan University from October 2020 to January 2022 and used as a training set. Univariate analysis was conducted to compare baseline clinical characteristics and DCE-MRI quantitative parameters [including tumor volume, and mean, median, and standard deviation of volume transfer constant (K trans), rate constant (K ep), extravascular extracellular volume fraction (V e), and initial area under the enhancement curve (iAUC)] between patients with deep myometrial invasion (DMI) and those with superficial myometrial invasion (SMI), as well as between high-grade and low-grade EEC. Multivariate logistics regression analysis was used to identify independent predictors for the construction of nomogram. An independent external testing set comprising 127 EEC patients was retrospectively collected from Zhongshan Hospital, Fudan University and Zhongshan Hospital, Fudan University (Xiamen Branch). The area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA) were used for evaluating the model′s predictive performance and clinical net benefit, respectively. Results:(1) The depth of myometrial invasion: univariate analysis showed that in the training set, the EEC patients with DMI differed significantly from those with SMI in clinical characteristics including higher proportion of postmenopausal state and overweight [body mass index (BMI)≥25 kg/m2], and abnormal levels of serum cancer antigen (CA) 125, CA 199, and human epididymis protein 4 (HE4), and in DCE-MRI quantitative parameters including tumor volume, and median, mean, and standard deviation of K trans, median of V e, as well as median, mean, and standard deviation of iAUC (all P<0.05). Multivariate analysis showed that the patient′s menstrual status, BMI, CA 199, tumor volume, and mean of iAUC were independent predictors of the depth of myometrial invasion, and constructed the nomogram (recorded as Nomogram_1), achieving an AUC of 0.861 (95% CI: 0.803-0.919) in the training set. In the independent external testing set, the AUC was 0.876 (95% CI: 0.815-0.938), with corresponding sensitivity of 82.0%, specificity of 80.7%, accuracy of 81.1%, positive predictive value (PPV) of 65.3%, and negative predictive value (NPV) of 91.0% for predicting DMI. (2) The EEC grade: univariate analysis showed that in the training set, high-grade EEC patients differed significantly from low-grade EEC in clinical characteristics including patient′s age, the proportion of postmenopausal state and overweight, and abnormal levels of serum CA 125, and in DCE-MRI quantitative parameters including tumor volume, median, mean, and standard deviation of K trans, median and mean of V e, as well as median, mean, and standard deviation of iAUC (all P<0.05). Multivariate analysis showed that the patient′s menstrual status, BMI, tumor volume, and median of V e emerged as independent predictors of EEC grade, and constructed the nomogram (recorded as Nomogram_2), achieving an AUC of 0.845 (95% CI: 0.786-0.893) in the training set. While in the external testing set, the AUC was 0.819 (95% CI: 0.744-0.894), with corresponding sensitivity of 72.4%, specificity of 72.4%, accuracy of 72.4%, PPV of 43.8%, and NPV of 89.9% for predicting high-grade EEC. (3) The DCA curves demonstrated that both Nomogram_1 and Nomogram_2 yielded obvious positive clinical net benefits across a wide range of threshold probabilities. Conclusion:The nomogram based on pretreatment clinical and DCE-MRI characteristics has the potential to noninvasive predict the depth of myometrial invasion and grade of EEC, providing valuable reference information for clinical management decision-making.

Objective To investigate the application effect of the anterolateral thigh perforator flap(ALTPF)with end-to-side anastomosis of non-primary source vessels in repairing soft tissue defects in the hands and feet.Methods Ninety-six patients with soft tissue defects in the hands and feet of the Third People's Hospital of Xinjiang Uygur Autonomous Region from March 2021 to June 2023 were randomly divided into two groups using a random number table method,with 48 cases in each group.The control group was treated with a conventional subcutaneous artery perforator flap,while the observation group was treated with an end-to-side anastomosis of non-primary source vessels using an ALTF.The repair indicators of tissue defects,the recovery of sensory function,the recovery of hand and foot function,and the incidence of complications were compared between the two groups at 1 month and 3 months after surgery.Results The wound healing time in the observation group and the control group was(19.35±3.89)days and(23.72±4.76)days,respectively,with a statistically significant difference(P＜0.05).There was no significant difference in the preparation time,survival rate,and stage Ⅰ healing rate of the two groups of skin flaps(P＞0.05).At 1 month and 3 months after surgery,the proportions of patients with pain sensation in the observation group and control group were 70.83％and 50.00％,respectively,and 100.00％and 79.17％,respectively.The proportions of patients with cold and hot sensation were 66.67％and 45.83％,respectively,and 97.92％and 72.92％,respectively.The distance of two-point discrimination was(30.69±6.10)mum and(34.40±7.36)mm,respectively,and(15.23±3.72)mm and(22.36±5.28)mm,respectively,with a statistically significant difference(P＜0.05).There was no significant difference in the excellent and good rate of hand and foot function between the two groups 3 months after surgery(P＞0.05).The incidence of complications in the observation group was 4.17％,which was lower than that in the control group(22.91％),and the difference was statistically significant(P＜0.05).Conclusion ALTPF repair of soft tissue defects in the hands and feet with end-to-side anastomosis of non-primary source vessels can improve wound healing rates,improve sensory function,and reduce the incidence of complications.

Objective:To investigate the feasibility and value of nomogram based on base line clinical and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) characteristics for pretreatment predicting the depth of myometrial invasion and tumor grade of endometrioid endometrial carcinoma (EEC).Methods:Preoperative baseline clinical characteristics and DCE-MRI characteristics of 194 EEC patients were prospectively collected at Obstetrics and Gynecology Hospital, Fudan University from October 2020 to January 2022 and used as a training set. Univariate analysis was conducted to compare baseline clinical characteristics and DCE-MRI quantitative parameters [including tumor volume, and mean, median, and standard deviation of volume transfer constant (K trans), rate constant (K ep), extravascular extracellular volume fraction (V e), and initial area under the enhancement curve (iAUC)] between patients with deep myometrial invasion (DMI) and those with superficial myometrial invasion (SMI), as well as between high-grade and low-grade EEC. Multivariate logistics regression analysis was used to identify independent predictors for the construction of nomogram. An independent external testing set comprising 127 EEC patients was retrospectively collected from Zhongshan Hospital, Fudan University and Zhongshan Hospital, Fudan University (Xiamen Branch). The area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA) were used for evaluating the model′s predictive performance and clinical net benefit, respectively. Results:(1) The depth of myometrial invasion: univariate analysis showed that in the training set, the EEC patients with DMI differed significantly from those with SMI in clinical characteristics including higher proportion of postmenopausal state and overweight [body mass index (BMI)≥25 kg/m2], and abnormal levels of serum cancer antigen (CA) 125, CA 199, and human epididymis protein 4 (HE4), and in DCE-MRI quantitative parameters including tumor volume, and median, mean, and standard deviation of K trans, median of V e, as well as median, mean, and standard deviation of iAUC (all P<0.05). Multivariate analysis showed that the patient′s menstrual status, BMI, CA 199, tumor volume, and mean of iAUC were independent predictors of the depth of myometrial invasion, and constructed the nomogram (recorded as Nomogram_1), achieving an AUC of 0.861 (95% CI: 0.803-0.919) in the training set. In the independent external testing set, the AUC was 0.876 (95% CI: 0.815-0.938), with corresponding sensitivity of 82.0%, specificity of 80.7%, accuracy of 81.1%, positive predictive value (PPV) of 65.3%, and negative predictive value (NPV) of 91.0% for predicting DMI. (2) The EEC grade: univariate analysis showed that in the training set, high-grade EEC patients differed significantly from low-grade EEC in clinical characteristics including patient′s age, the proportion of postmenopausal state and overweight, and abnormal levels of serum CA 125, and in DCE-MRI quantitative parameters including tumor volume, median, mean, and standard deviation of K trans, median and mean of V e, as well as median, mean, and standard deviation of iAUC (all P<0.05). Multivariate analysis showed that the patient′s menstrual status, BMI, tumor volume, and median of V e emerged as independent predictors of EEC grade, and constructed the nomogram (recorded as Nomogram_2), achieving an AUC of 0.845 (95% CI: 0.786-0.893) in the training set. While in the external testing set, the AUC was 0.819 (95% CI: 0.744-0.894), with corresponding sensitivity of 72.4%, specificity of 72.4%, accuracy of 72.4%, PPV of 43.8%, and NPV of 89.9% for predicting high-grade EEC. (3) The DCA curves demonstrated that both Nomogram_1 and Nomogram_2 yielded obvious positive clinical net benefits across a wide range of threshold probabilities. Conclusion:The nomogram based on pretreatment clinical and DCE-MRI characteristics has the potential to noninvasive predict the depth of myometrial invasion and grade of EEC, providing valuable reference information for clinical management decision-making.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Histological staining is the basis of pathological analysis,but the traditional staining method relies on chemical reagents,which not only consumes a lot of resources,but also causes harm to the environment and human health.In recent years,with the rapid development of deep learning technology,virtual staining technology,as a new method,is expected to effectively replace and supplement the traditional histological staining methods.It uses neural networks to analyze unstained tissue images,generate digital images that are highly similar to chemical staining effects,and even realize the mutual conversion between different staining modes,reducing the laboratory's dependence on chemical reagents and providing sustainable research programs.In this paper,the basic principles of virtual staining and its potential applications in histopathology are introduced in detail,and the current challenges and future research directions are discussed.