Driven by the internal pressure of the traditional elderly care model and the external impetus of the new technological revolution， the intelligent elderly care model is emerging. However， the rapid technological development has also triggered a series of ethical controversies. Existing ethical rules struggle to interpret， adapt to， or regulate the risks of ethical norms being out of control， alienated ethical behaviors， and unclear ethical responsibility that have emerged in the intelligent elderly care model. Specifically， these risks manifest in three aspects， including infringement of the rights and interests of the elderly， imbalance in social fairness and justice， and difficulties in defining responsibility. The analysis revealed that the generative factors of ethical risks include both internal system factors and external environmental factors. To prevent and control the ethical risks of the intelligent elderly care model， efforts should focus on three levels. At the technical level， it was necessary to promote the development of responsible intelligent elderly care technologies. In terms of regulatory level， it was essential to innovate the rules and methods of responsibility allocation. Regarding cognitive level， it was vital to strengthen users’ awareness and response capacity to ethical risks. These approaches will continuously promote the upward and virtuous development of technology and foster harmonious coexistence between humans and machines.

Objective To construct a lung cancer surgery-oriented disease-specific database covering the entire perioperative care pathway, thereby improving the quality and usability of key surgical data elements. Methods Real-world clinical data were extracted from a single-center thoracic surgery department. A standardized data model was established based on the open electronic health record (openEHR) standard. Large language model (LLM), optical character recognition (OCR), and artificial intelligence (AI)-driven techniques were employed to extract, structure, and perform quality control on unstructured clinical narratives, imaging reports, and radiological data, with a focus on capturing surgically relevant perioperative indicator. Results A multimodal database comprising 19 917 patients was established, including 7 930 males and 11 987 females, with ages ranging from 15 to 97 (61.7±9.7) years. The database includes 582 structured data variables, textual report data corresponding to 69 clinical indicators, 13 000 pulmonary function test PDF reports, and chest CT imaging data from 16 884 patients. This database comprehensively covers major information relevant to surgical diagnosis and treatment of lung cancer, significantly improving the completeness and granularity of surgical detail data. Large language models (LLMs) and optical character recognition (OCR) technologies enhanced the efficiency of converting unstructured data into structured formats, while a multi-level manual verification process ensured data accuracy and traceability. The database supports real-world research including comparisons of surgical procedures, prediction of postoperative complications, prognosis assessment, and multimodal data association analyses.

Although global brain science research has progressed rapidly in recent decades, several fundamental questions in neuroscience remain unresolved. In particular, the physical mechanism underlying neural signal transmission remains controversial, and the carriers responsible for neural information storage and retrieval have not yet been fully clarified. These unresolved issues motivate us to re-examine the processes of neural information generation, transmission, integration, storage, and retrieval from multiple perspectives. A key observation is that neural electromagnetic activities are closely associated with time. Their duration, temporal structure, and dynamic evolution play crucial roles in neural information processing. In this work, we analyze neural electromagnetic activities from the perspective of temporal scales (referred to here as the “time course”). By reviewing and integrating findings from previous studies, we examine the characteristic time requirements and dynamic features of neural processes occurring at different stages of information processing. These stages include neural signal generation, signal transmission along axons, synaptic integration, synaptic plasticity, and memory formation and retrieval. Based on this temporal analysis, we outline a framework describing neural electromagnetic activities across a wide range of time scales, spanning from microseconds to minutes, hours, or even longer periods associated with long-term memory, which suggests that neural information processing involves multiple physical processes operating at different time levels. Rapid electromagnetic events may occur on microsecond scales, whereas electrophysiological phenomena such as action potentials typically last on the order of milliseconds. Longer time scales are associated with synaptic plasticity and memory-related processes. From this perspective, we propose that the physical carrier of neural information may be transient electromagnetic pulses with durations on the microsecond scale. In this framework, action potentials can be interpreted as the macroscopic electrophysiological manifestation of underlying electromagnetic processes triggered by ionic currents across neuronal membranes. Rather than being the fundamental neural signal itself, the action potential may represent a measurable membrane-level response associated with the successful activation of these electromagnetic events. Moreover, we discuss a possible mechanism for long-term memory storage. Considering the apparent temporal contradiction between the millisecond-scale excitation of neurons and the long-term persistence of memories, we believe that long-term memory information may be stored within neural network topologies formed by electrical synapse coupling. Such structures, referred to as electrically coupled memory networks (ECMNs), may enable neurons within the same network to respond rapidly and synchronously to stimuli, thereby facilitating efficient memory retrieval. Overall, this study emphasizes the importance of considering the temporal organization of neural electromagnetic activities when interpreting neural signaling mechanisms. It may provide new insights into the physical nature of neural information carriers and the mechanisms of memory storage and retrieval. Furthermore, highlighting the potential role of electromagnetic interactions in neural activity may contribute to the development of new theoretical frameworks and experimental approaches in neuroscience. Such perspectives may also offer valuable references for future research on neural coding, brain function mechanisms, and neuromodulation technologies.

Objective: To evaluate the feasibility of dynamic contrast-enhanced MRI (DCE-MRI) in differentiating tumor deposits (TDs) from metastatic lymph nodes (MLNs) in rectal cancer. Materials and Methods: A retrospective analysis was conducted on 70 patients with rectal cancer, including 168 lesions (70 TDs and 98 MLNs confirmed by histopathology), who underwent pretreatment MRI and subsequent surgery between March 2019 and December 2022. The morphological characteristics of TDs and MLNs, along with quantitative parameters derived from DCE-MRI (K trans , kep, and v e) and DWI (ADCmin, ADCmax, and ADCmean), were analyzed and compared between the two groups.Multivariable binary logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess the diagnostic performance of significant individual quantitative parameters and combined parameters in distinguishing TDs from MLNs. Results: All morphological features, including size, shape, border, and signal intensity, as well as all DCE-MRI parameters showed significant differences between TDs and MLNs (all P < 0.05). However, ADC values did not demonstrate significant differences (all P > 0.05). Among the single quantitative parameters, v e had the highest diagnostic accuracy, with an area under the ROC curve (AUC) of 0.772 for distinguishing TDs from MLNs. A multivariable logistic regression model incorporating short axis, border, v e, and ADC mean improved diagnostic performance, achieving an AUC of 0.833 (P = 0.027). Conclusion The combination of morphological features, DCE-MRI parameters, and ADC values can effectively aid in the preoperative differentiation of TDs from MLNs in rectal cancer.

Purpose: Retroperitoneal sarcomas (RPS) are rare tumors that present unique challenges, often due to late presentation, and the proximity of critical organs makes complete surgical resection challenging. This study aimed to assess the feasibility of neoadjuvant short-course radiotherapy (SCRT) targeting margins-at-risk and to assess its potential impact on outcomes. Materials and Methods: This is a single-center, prospective, non-randomized feasibility study. SCRT was administered via image-guided volumetric modulated arc therapy, consisting of 5 fractions of daily radiotherapy followed by immediate surgery. As a starting dose, patients were prescribed 25 Gy in 5 fractions. For the escalation stage, patients were prescribed 30 Gy in 5 fractions. Only the presumed threatened surgical margins were delineated for large tumors. Results: Patients with either primary or recurrent RPS were recruited. Eight patients underwent SCRT but one patient did not have a resection as planned. Seven patients underwent surgical resection, of whom one passed away 3 months postoperative from a cardiac event. After a median follow-up of 20.5 months for the six postoperative survivors, there were no overt long-term toxicities and one patient relapsed out-of-radiotherapy-field. Conclusion SCRT to RPS with a margin boost followed by immediate surgery is worth investigating. A starting dose of 30 Gy in 5 fractions is recommended for further studies. Longer-term follow-up is necessary.

Objective:To explore the effect of CO2 fractional laser combined with glucocorticoid(GC)on T follicular helper cell(Tfh)and B cell subsets in patients with advanced vitiligo(VL).Methods:Patients with advanced VL(128 cases)who were treated in Affiliated Hospital of Hebei University of Engineering from August 2019 to March 2022 were selected as research objects,and divided into group A(64 cases,CO2 fractional laser combined with GC)and group B(64 cases,CO2 fractional laser)according to different treatment methods,clinical efficacy and safety of the two groups were compared.Another healthy subjects(64 cases)were selected as control group.Collected clinical data of the three groups of subjects for comparative analysis.Randomized walking model was used to evaluate the effect of CO2 fractional laser combined with GC on immune function and inflammatory response in patients with advanced VL.Results:Compared with group B,group A had a higher clinical total effective rate(P<0.05)and a lower probability of adverse reactions(P<0.05).After treatment,compared with control group,proportion of Tfh2 and Tfh17 in group A had no significant difference(P>0.05),while proportion of Tfh2 and Tfh17 in group B still had significant difference(P<0.05);compared with group B,proportion of Tfh2 in group A after treatment was higher(P<0.05),while proportion of Tfh17 type was lower(P<0.05).After treat-ment,compared with control group,proportion of memory transformed B cell in group B was still significantly different(P<0.05).After treatment,compared with control group,levels of IgA,IgE and IgM in group B were still significantly different(P<0.05);compared with group B,level of IgM in group A was higher after treatment(P<0.05).After treatment,compared with control group,levels of IL-21 and IL-1β in group B were still significantly different(P<0.05);compared with group B,level of IL-10 in group A after treatment was higher(P<0.05),while levels of IL-21 and IL-1β were lower(P<0.05).Evaluation results of random walking model showed that the improvement of immune function and inflammatory reaction in group A was better than that in group B.Conclusion:CO2 fractional laser combined with GC can improve the immune function and inflammatory reaction of patients with advanced VL better after treatment,and the probability of adverse reactions is lower.

Objective:To investigate the protective effects of resveratrol (RSV) on human sperm cryopreservation and explore its underlying protective mechanisms.Methods:A total of 165 normal fresh semen samples were collected from the Reproductive Medicine Center, Department of Obstetrics and Gynecology and Human Sperm Bank of the First Affiliated Hospital of Anhui Medical University between December 2022 and December 2024. Among them, 65 samples were used to obtain semen parameters before and after conventional freezing. Each sample of the other 104 samples was mixed at a 2∶1 volume ratio with cryoprotectant containing 0, 10 -?, 10 -?, or 10 -? mol/L RSV, followed by cryopreservation in liquid nitrogen for 24 h. Post-thaw assessments included routine sperm parameters, sperm DNA fragmentation index (DFI) evaluated by sperm chromatin dispersion assay, reactive oxygen species (ROS) levels measured via flow cytometry, RSV and nuclear factor erythroid 2-related factor 2 (NRF2) interactions examined by molecular docking and cellular thermal shift assay (CETSA), NRF2 protein contents analyzed by immunofluorescence and Western blotting, mRNA levels of NRF2 and downstream antioxidant proteins Heme Oxygenase-1 (HO-1) and NAD(P)H: quinone oxidoreductase 1 (NQO1) quantified by qRT-PCR and effects of NRF2 inhibitor ML385 on sperm parameters. Results:Compared with fresh samples, conventional cryopreservation significantly reduced sperm motility (all P<0.001). The addition of 10 -? mol/L RSV significantly improved the percentage of forward motile sperm after freezing (26.98%±8.98% vs. 19.61%±8.03%, P<0.001) while reducing DFI (9.84%±3.81% vs. 15.06%±4.22%, P<0.001) and ROS levels ( P<0.001) compared with the post-freezing group without the addition of RSV. Both molecular docking analysis and CETSA confirmed that RSV interacted with NRF2. Notably, sperm cryopreserved with 10 -? mol/L RSV exhibited significantly higher contents of NRF2 and its downstream effectors HO-1 and NQO1 compared with the post-freezing group without the addition of RSV (all P<0.001). This protective effect was markedly attenuated by co-treatment with the NRF2 inhibitor ML385, as evidenced by a significant decline in sperm motility ( P<0.001). Conclusion:RSV exerts cryoprotective effects likely through NRF2-mediated antioxidant pathways, reducing oxidative stress and enhancing post-thaw sperm quality.

Objective:To investigate the impact of day 3 embryo quality on pregnancy outcomes in frozen-thawed single blastocyst transfer cycles and analyze its value in embryo selection.Methods:A retrospective cohort study was conducted on clinical data from patients undergoing frozen-thawed single blastocyst transfer at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University from January 2020 to December 2023. A total of 4 691 cycles of high-quality day 3 embryo (H-D3) group and 2 598 cycles of low-quality day 3 embryo (L-D3) group in the same period were included. Multivariate logistic regression was used to analyze the effects of day 3 embryo quality on clinical pregnancy rate (CPR) and live birth rate (LBR). All the cycles were stratified according to developmental day and quality of blastocyst: 3 920 cycles of high-quality day 5 blastocysts (H-D5), 1 271 cycles of low-quality day 5 blastocysts (L-D5), 834 cycles of H-D6 group and 1 264 cycles of L-D6, the influence of day 3 embryo quality was subsequently analyzed under different conditions.Results:1) Significant differences were observed between H-D3 and L-D3 groups in female age [(31.79±4.42) years vs. (32.28±4.43) years, P<0.001], basal follicle-stimulating hormone levels [6.24 (5.32,7.35) U/L vs. 6.48 (5.42,7.62) U/L, P<0.001], proportion of primary infertility [35.86% (1 682/4 691) vs. 31.99% (831/2 598), P<0.001], proportion of ≥2 prior failed embryo transfer cycles [3.77% (177/4 691) vs. 5.93% (154/2 598), P<0.001], proportion of gonadotropin-releasing hormone agonist/antagonist controlled ovarian hyperstimulation protocol in fresh cycles [93.33% (4 378/4 691) vs. 89.80%(2 333/2 598), P<0.001], embryo cryopreservation duration [3.10 (2.23,7.27) months vs. 3.60 (2.30,15.40) months, P<0.001], proportion of day 5 blastocyst transfers [74.82% (3 510/4 691) vs. 64.70% (1 681/2 598), P<0.001] and proportion of high-quality blastocyst transfers [72.59% (3 405/4 691) vs. 51.92% (1 349/2 598), P<0.001]. No significant differences were found in body mass index, infertility duration, endometrial preparation program or endometrial thickness on transfer day (all P>0.05). 2) Multivariable logistic regression analysis demonstrated that the L-D3 group had significantly lower CPR ( OR=0.837, 95% CI: 0.754-0.929, P<0.001) and LBR ( OR=0.880, 95% CI: 0.794-0.974, P=0.014) compared with the H-D3 group. 3) In H-D5 and L-D5 cycles, L-D3 did not significantly affect CPR ( aOR=0.941, 95% CI: 0.805-1.101, P=0.449; aOR=0.910, 95% CI: 0.724-1.142, P=0.415) or LBR ( aOR=1.034, 95% CI: 0.893-1.196, P=0.657; aOR=0.917, 95% CI: 0.729-1.153, P=0.457). However, in D6-H and D6-L cycles, L-D3 significantly reduced CPR ( aOR=0.732, 95% CI: 0.542-0.987, P=0.041; aOR=0.648, 95% CI: 0.515-0.815, P<0.001) and LBR ( aOR=0.645, 95% CI: 0.479-0.869, P=0.004; aOR=0.670, 95% CI: 0.526-0.854, P=0.001). Conclusion:Day 3 embryo quality significantly impacts both CPR and LBR in frozen-thawed day 6 single blastocyst transfer cycles. This suggests that day 3 embryo quality retains clinical relevance as a selection criterion when prioritizing day 6 blastocysts for transfer.

Objective:To retrieve, evaluate and summarize the best evidence on the use of bedside ultrasound by ICU nurses to assess the lungs of adult critically ill patients, and to provide a reference for clinical practice and the construction of related processes and protocols.Methods:Based on the "6S" pyramid model, a computer-based search was conducted on relevant computer decision support system, guideline networks, professional associations, and domestic and international databases, the search time limit was from the establishment of the database to June 5, 2024. The panel members who had been trained in the evidence-based course evaluated the included literature with corresponding tools, extracted evidence according to the theme.Results:Twenty-five papers were finally included, including 6 guidelines, 8 expert consensus, 2 expert opinion, 3 clinical decision-making, 3 systematic evaluation, and 3 randomized controlled trials. A total of 35 pieces of evidence were formed from 4 aspects, including personnel training, operation specifications, clinical application (including dyspnea screening, intervention implementation, efficacy evaluation, diaphragm function evaluation) and precautions.Conclusions:The best evidence for lung assessment and intervention in adult critically ill patients based on bedside ultrasound can provide a reference for the adjustment and decision-making of nursing measures for adult critically ill patients. In the subsequent process of evidence transformation, attention should be paid to combining clinical practice and the joint cooperation of medical staff.

Although significant progress has been made in the modernization of Chinese medicine,the current challenges,inclu-ding inconsistent diagnostic and treatment standards,complex molecular mechanisms,and insufficient safety evidence,have signifi-cantly restricted its modernization process.Microfluidic technology provides a new solution for Chinese medicine research with its ability to precisely control fluids and construct bionic microenvironments.Organoid and organ-on-a-chip technologies use microfluidic tech-nology as carriers to provide technical support for the visualization of Chinese medicine theory,discovery of pharmacological sub-stances,analysis of action mechanisms,and toxicity evaluation through multi-organ interconnection models.These technological break-throughs provide an innovative platform for analyzing Chinese medicine theory,driving Chinese medicine research from empirical analy-sis to systematic and dynamic simulations,providing crucial technical support for Chinese medicine internationalization and precision medicine transformation.