On October 9， 2024， the General Office of the National Health Commission， the General Office of the Ministry of Education， the General Department of the National Administration of Traditional Chinese Medicine， and the General Department of the National Bureau of Disease Control and Prevention jointly issued the Action Plan for Enhancing Medical Humanistic Care （2024-2027）， stating that medical humanistic spirit is a concrete manifestation of humanistic spirit in the medical field. Aiming at caring for and respecting patients， this spirit reflects the attitude of medicine towards life. The cultivation of medical humanistic care competencies should serve as a core element of modern medical education， running through the entire process of the medical students’ training system and the full stage of medical workers’ career development. The humanities team of Harbin Medical University pioneered the “consistent system” concept of medical humanities education， inherited the “four-stage” with clinical practice as the primary approach， and closely focused on “three combinations， two considerations， and one assessment.” Through deeply integrating medicine with the humanities， as well as theory with practice， they have embarked on a distinctive implementation path of medical humanities， laying a solid foundation for the cultivation of high-quality medical talents with both skills and expertise in practice.

ObjectiveTo develop a self-assessment tool for medical professionalism （MP）， by comprehensively combing domestic and international definitions of the concept of MP and the core elements of MP， and based on several rounds of expert consultation and China’s medical realities. MethodsAn assessment scale of MP was developed using 1，626 valid physician survey data from 128 medical institutions of all levels in one province. ResultsThe scale of MP consisted of five factors， including patient-centered， integrity and sense of responsibility， altruism， fair and equitable distribution of limited resources， and pursuit of excellence. After testing， the scale has good reliability and validity. ConclusionThe self-evaluation tool of MP provides an effective means for fostering， assessing， and evaluating MP in practice， and has a certain degree of generalizability.

Objective: To investigate the effects of "liver-smoothing and spirit-regulating" acupuncture on the intestinal flora, lipopolysaccharide (LPS) and the hippocampal toll-like receptor 4 (TLR4)/ transcription factor (NF)-κB signaling pathway in depressive disorder mouse model, and to explore its underlying mechanisms. Methods: Eighteen male SPF-grade C57BL/6J mice were randomly assigned to the control, model, and acupuncture groups using a random number method, with six mice in each group. The depression disorder model was induced in mice from both the acupuncture and model groups using CUMS. The mice in the acupuncture group were treated with acupuncture at the acupoints of "Baihui" (DU20), "Yintang" (DU29), "Hegu" (LI4), and "Taichong" (LR3) on the 15th day of modeling, with a duration of 20 min per session, once per day, for 2 consecutive weeks. Behavioral differences were assessed using the sucrose preference test, open field test, and forced swim test. Hematoxylin-eosin staining was used to observe pathological changes in the hippocampus and colon. The levels of the inflammatory factors interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, and LPS in the hippocampus and colon were measured using Enzyme-linked Immunosorbent Assay. Western blotting was used to detect the expression of TLR4 and NF-κB protein in the hippocampus. Changes in gut microbiota structure and abundance were analyzed by 16 S rDNA sequencing. Results: Compared to the control group, the model group showed reduced sucrose preference rate, time in the center area, and total distance, with an increase in immobility time (P<0.01). Inflammatory pathological changes were observed in the hippocampal CA1 region and colon. The contents of IL-1β, IL-6, TNF-α, and LPS in the hippocampus and colon increased (P<0.01). The protein expression levels of hippocampal TLR4 and NF-κB were increased (P<0.01). The Chao1 index was increased (P<0.01). The relative abundances of Pseudomonadales, Acinetobacter, Moraxellaceae, Solibacillus, Escherichia_shigella, Enterobacteriaceae, Enterobacterales, Dubosiella, and Erysipelottichales were decreased, while the relative abundances of Alloprevotella and gram_negative_bacteriurh_cTPY_13 were increased (P<0.05). The pathways of lipopolysaccharide biosynthesis and pathogenic Escherichia coli infection were upregulated, and the pathway of terpenoid backbone biosynthesis was downregulated (P<0.01). Compared to the model group, the acupuncture group showed increased sucrose preference, time in the center area, and total distance, with a decrease in immobility time (P<0.01). The inflammatory pathological changes in the hippocampal CA1 region and colon were alleviated. The contents of IL-1β, IL-6, TNF-α, and LPS in the hippocampus and colon were reduced(P<0.01). The protein expression levels of hippocampal TLR4 and NF-κB were reduced (P<0.01). The Chao1 index was decreased (P<0.05), and the relative abundances of Dubosiella and Erysipelotrichaceae were increased, while the relative abundance of Rikenellaceae, Alloprevotella, and gram_negative_bacteriuch_cTPY_13 were decreased(P<0.05). The pathways of lipopolysaccharide biosynthesis and pathogenic Escherichia coli infection were significantly downregulated, and the pathway of terpenoid backbone biosynthesis was upregulated (P<0.01). Conclusion " Liver-smoothing and spirit-regulating" acupuncture can improve depressive symptoms in depressive disorder mice, potentially through regulating the LPS and TLR4/NF-κB signaling pathway mediated by intestinal flora, reducing the inflammatory response of the hippocampus, and improving the pathological injury of the hippocampus.

Humans ; Urinary Bladder Neoplasms/pathology* ; Carcinoma, Transitional Cell/pathology* ; Genetic Markers ; Biomarkers, Tumor/genetics* ; Urothelium/pathology*

Objective:To prospectively observe the changes of tumor-related symptoms in patients with nasopharyngeal carcinoma following the administration of nimotuzumab one week before radiotherapy.Methods:Non-metastatic nasopharyngeal carcinoma patients with positive epidermal growth factor receptor (EGFR) expression and symptoms caused by the primary lesion or metastatic cervical lymph nodes admitted to Cancer Hospital of Chinese Academy of Medical Sciences were prospectively recruited. Investigators recorded tumor-related symptoms in recruited patients one day before the first administration of nimotuzumab (D0) and conducted follow-up visits from day 2 to day 7 after the first administration (D2-D7) to document symptom changes. All recruited patients were asked to assess tumor-related symptoms on D0 and D7 by visual analogue scale (VAS) scores. VAS scores were analyzed by paired t-test. Results:From June 2020 to April 2023, a total of 21 patients met the inclusion criteria. The median age was 49 years (range: 27-69 years), with a male-to-female ratio of 1.3:1. Among the patients, 17 patients (81%) received concurrent nimotuzumab for 8 cycles, 7 cycles for 3 cases (14%), and 6 cycles for 1 case (5%), respectively. All patients completed symptom assessments as required. The overall response rate of symptoms after the first administration of nimotuzumab was 62%, with response rates of 4/6、5/8、4/10、4/10、4/11、3/11 for tinnitus, headache, aural fullness, secondary pain caused by neck mass, nasal bleeding, and nasal obstruction, respectively. The VAS scores for overall symptoms were significantly decreased after the administration of nimotuzumab one week before radiotherapy ( P<0.001), with the most significant decrease in VAS scores for tinnitus, aural fullness, and headache. Conclusion:The administration of nimotuzumab one week before radiotherapy significantly alleviates tumor-related symptoms in patients with nasopharyngeal carcinoma, particularly in alleviating tinnitus, aural fullness, and headache.

This paper summarized Professor YE Jianzhou's experience in treating atopic dermatitis （AD） in children with the method of regulating the heart and treating the spirit. According to the clinical manifestations of itching-sleep psychological disorders in children with AD， and the physiological characteristics of "heart qi is prone to hyperactivity" and "liver qi is prone to hyperactivity" in children， it is believed that heart and spirit disharmony is an important pathogenesis of AD in children.From the concept of holism in traditional Chinese medicine， the principle of regulating the heart and treating the spirit has been proposed for treatment of AD in children， which is based on the theory of "the five zang （脏） organs store the spirit". In the acute stage， it is recommended to clear the heart， drain fire and calm the spirit with self-made Qingxin Ningshen Decoction （清心宁神汤） in modifications. In the chronic stage， the method of nourishing the heart， unblocking the meridians and calming the spirit is recommended， by using self-made Yangxin Anshen Decoction （养心安神汤） with modifications. The method to tranquilize the heart， subdue yang and contain the spirit should be implemented throughout the entire treatment， and yang-subduing and spirit-containing medicinals such as Duanlonggu （Os Draconis Praeparatum）， Duanmuli （Concha Ostreae Praeparatum） and Zhenzhumu （Concha Margaritiferae Usta） are usually used to treat the body and the spirit simultaneously. All these are offered to provide new ideas for the individualized treatment of children with AD.

Objective:To compare the clinical effects of endoscopic thyroidectomy with different approaches on patients with thyroid cancer.Methods:A prospective study was conducted on 96 patients with thyroid cancer who underwent complete endoscopic thyroidectomy (CET) by the same experienced surgical team in the Head and Neck Surgery Department of Shanxi Cancer Hospital from Jan. 2020 to Jan. 2023. The patients were randomly divided into a trans-subclavian approach group of 48 cases and a transoral vestibular access group of 48 cases using a random number table method. The trans-subclavian approach group underwent CET via the subclavian approach, while the transoral vestibular access group underwent CET via the oral vestibular approach. The surgical and postoperative rehabilitation conditions, complications, and cosmetic satisfaction scores were compared between the two groups. The immune indicators (T lymphocyte subsets (CD3 +, CD4 +), CD4 +/CD8 +), serum soluble interleukin 2 receptor (SIL-2R), tissue kallikrein 11 (KLK11), midkine (MK) levels were measured before surgery. At 1 d, 3 d, and 7 d postoperatively, neck function was assessed using the visual analog scale (VAS), neck injury index, and dysphagia index. Results:The operation time of the transoral vestibular access group and the Trans-subclavian approach group were (117.58±10.87) min and (101.84±11.35) min, respectively ( P<0.001), and the hospitalization time was (4.31±0.86) d and (5.12±0.91) d, respectively ( P<0.001). The drainage volume was (65.13±12.49) mL and (78.65±15.32) mL, respectively ( P<0.001). At 1, 3, and 7 days after surgery, the CD3 + levels in the transoral vestibular access group and the trans-subclavian approach group were (41.53±3.86) % and (38.29±3.51) %, respectively ( P<0.001), (46.21±4.35) % and (42.81±4.06) %, respectively ( P=0.001), and (48.23±4.47) % and (45.10±4.23) %, respectively ( P<0.001). The CD4 + levels were (33.27±3.90) % and (30.18±3.45) %, respectively ( P<0.001), (36.28±4.15) % and (33.46±3.87) %, respectively ( P=0.001), and (38.69±4.22) % and (35.17±4.10) %, respectively ( P<0.001). The CD4 +/CD8 + levels were (1.31±0.22) and (1.16±0.21), respectively ( P=0.001), (1.40±0.23) and (1.20±0.22), respectively ( P<0.001), and (1.58±0.24) and (1.45±0.25), respectively ( P=0.011). There was no significant difference in the levels of serum SIL-2R, KLK11, MK, VAS scores, cervical injury index, or swallowing dysfunction index between the transoral vestibular access group and the trans-subclavian approach group on postoperative day 1, 3, and 7 ( P>0.05). The incidence of complications in the transoral vestibular access group and the trans-subclavian approach group was 8.33% (4/48) and 22.92% (11/48), respectively ( P=0.049), and the cosmetic satisfaction rate was 95.83% (46/48) and 81.25% (39/48), respectively ( P=0.025) . Conclusions:Both the transoral vestibular approach and the subclavian approach for CET treatment of thyroid cancer can cause damage to cervical function. The former can reduce immune function damage, help with early postoperative recovery, and improve safety and patient satisfaction with cosmetic appearance, but it can prolong the operation time.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.

Objective To investigate the distribution and antimicrobial resistance profiles of the common pathogens isolated from urine from 2015 to 2021 in the CHINET Antimicrobial Resistance Surveillance Program.Methods The bacterial strains were isolated from urine and identified routinely in 51 hospitals across China in the CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021.Antimicrobial susceptibility was determined by Kirby-Bauer method,automatic microbiological analysis system and E-test according to the unified protocol.Results A total of 261 893 nonduplicate strains were isolated from urine specimen from 2015 to 2021,of which gram-positive bacteria accounted for 23.8％(62 219/261 893),and gram-negative bacteria 76.2％(199 674/261 893).The most common species were E.coli(46.7％),E.faecium(10.4％),K.pneumoniae(9.8％),E.faecalis(8.7％),P.mirabilis(3.5％),P.aeruginosa(3.4％),SS.agalactiae(2.6％),and E.cloacae(2.1％).The strains were more frequently isolated from inpatients versus outpatients and emergency patients,from females versus males,and from adults versus children.The prevalence of ESBLs-producing strains in E.coli,K.pneumoniae and P.mirabilis was 53.2％,52.8％and 37.0％,respectively.The prevalence of carbapenem-resistant strains in E.coli,K.pneumoniae,P.aeruginosa and A.baumannii was 1.7％,18.5％,16.4％,and 40.3％,respectively.Lower than 10％of the E.faecalis isolates were resistant to ampicillin,nitrofurantoin,linezolid,vancomycin,teicoplanin and fosfomycin.More than 90％of the E.faecium isolates were ressitant to ampicillin,levofloxacin and erythromycin.The percentage of strains resistant to vancomycin,linezolid or teicoplanin was＜2％.The E.coli,K.pneumoniae,P.aeruginosa and A.baumannii strains isolated from ICU inpatients showed significantly higher resistance rates than the corresponding strains isolated from outpatients and non-ICU inpatients.Conclusions E.coli,Enterococcus and K.pneumoniae are the most common pathogens in urinary tract infection.The bacterial species and antimicrobial resistance of urinary isolates vary with different populations.More attention should be paid to antimicrobial resistance surveillance and reduce the irrational use of antimicrobial agents.

Objective To understand the distribution and changing resistance profiles of clinical isolates of Enterococcus in hospitals across China from 2015 to 2021.Methods Antimicrobial susceptibility testing was conducted for the clinical isolates of Enterococcus according to the unified protocol of CHINET program by automated systems,Kirby-Bauer method,or E-test strip.The results were interpreted according to the Clinical & Laboratory Standards Institute(CLSI)breakpoints in 2021.WHONET 5.6 software was used for statistical analysis.Results A total of 124 565 strains of Enterococcus were isolated during the 7-year period,mainly including Enterococcus faecalis(50.7％)and Enterococcus faecalis(41.5％).The strains were mainly isolated from urinary tract specimens(46.9％±2.6％),and primarily from the patients in the department of internal medicine,surgery and ICU.E.faecium and E.faecalis strains showed low level resistance rate to vancomycin,teicoplanin and linezolid(≤3.6％).The prevalence of vancomycin-resistant E.faecalis and E.faecium was 0.1％and 1.3％,respectively.The prevalence of linezolid-resistant E.faecalis increased from 0.7％in 2015 to 3.4％in 2021,while the prevalence of linezolid-resistant E.faecium was 0.3％.Conclusions The clinical isolates of Enterococcus were still highly susceptible to vancomycin,teicoplanin,and linezolid,evidenced by a low resistance rate.However,the prevalence of linezolid-resistant E.faecalis was increasing during the 7-year period.It is necessary to strengthen antimicrobial resistance surveillance to effectively identify the emergence of antibiotic-resistant bacteria and curb the spread of resistant pathogens.