Artificial intelligence （AI） is gradually being applied in the field of decision-making support for the daily care of the older adults with disabilities. However， due to their limited cognitive functions， information asymmetry with medical staff and technical parties， and a certain degree of emotional deprivation， the older adults with disabilities are in a structurally vulnerable position. Against this background， several ethical dilemmas arise when AI technology intervenes in care decision-making. First， the informed consent process is difficult to genuinely implement. Second， algorithms based on average models tend to ignore individual differences， leading to “de-personalization” of services. Third， over-reliance on technology may further weaken humanistic care， thereby undermining the individual dignity of the older adults with disabilities. Fourth， in the care decision-making involving the joint participation of the older adults with disabilities， caregivers， medical teams， and AI systems， the boundaries of responsibility among all parties remain unclear， making it difficult to assign accountability when adverse outcomes occur. Drawing on the theories of vulnerability ethics， interactive ethics， and care ethics， this paper proposes a “vulnerability-interaction-care” path and put forward three-tiered countermeasures. The first was baseline safeguards， preventing the exploitation of the vulnerability of the older adults with disabilities and their caregivers， and requiring further safeguards for their dignity. The second was process protection， enhancing transparency and accountability within the human-machine collaboration framework， as well as establishing a multi-party consultation mechanism. The third was capacity empowerment， improving the subjectivity of the older adults with disabilities through age-appropriate interaction， structured expression of intentions， and caregiver participation.

Objective To evaluate the value of modified percutaneous endoscopic gastrostomy(PEG)for patients with amyotrophic lateral sclerosis(ALS)and dysphagia.Methods From January 2018 to December 2023,47 patients with ALS were treated with modified PEG in our hospital.The surgery was performed under local anesthesia.The patients were placed in a semi-seated position,and the surgeon performed surgery with an ultra-fine endoscope through oral entrance to the stomach.Results The modified PEG were successfully completed in all the 47 cases.The operation time was5-20 min[mean,(10.3±1.7)min].The postoperative hospitalization lasted for2-8 d(mean,2.8 d).Postoperative complications occurred in6 cases(12.8%),including aspiration pneumonia in4 cases(8.5%)and incision infection in2 cases(4.3%).The body mass index was17.06±0.89 before PEG and 18.15±0.81 at 3 months after PEG,with significant difference(t=-10.373,P=0.000).Conclusion For ALS patients with dysphagia,modified PEG is feasible,which significantly improves nutritional status of patients.

Objective:To improve the health literacy of homebound elderly with disabilities by systematically using narrative medicine tools.Methods:A combination of qualitative interviews and questionnaire surveys was employed to gain an in-depth understanding of the health literacy and health management status of homebound elderly with disabilities,and to analyze the shortcomings of existing interventions in meeting the elderly's personalized needs,emotional support,and long-term adherence.Results:This paper integrated formal and informal care resources in the community to construct a new application model of narrative medicine,namely the S-P-C-H(story-person-care-health)model.The S-P-C-H model combined the daily life of the elderly with disabilities with narrative medicine tools through story collection,personality analysis,personalized care design,dynamic feedback,and other methods,forming a dynamic health literacy intervention mechanism.Conclusion:The introduction of this model provides a new idea for the health management of the elderly with disabilities and has certain development potential in enhancing the health literacy of the elderly and improving care effectiveness.

Objective:To observe the efficacy of transcutaneous electrical acupoint stimulation (TEAS) when it is combined with warm moxibustion scraping therapy (WMST) in the treatment of myofascial pain syndrome (MPS) in the lumbodorsal region.Methods:A total of 112 patients with lumbodorsal MPS were randomly divided into a control group and a combination group, each of 56. All of the patients received TEAS, but those in the combined group additionally received warm moxibustion scraping therapy. The treatment consisted of 3 consecutive courses, with each course lasting 2 weeks and a 1-day rest interval between courses. Before the treatment and after completing 3 courses (post-treatment), the therapeutic effects were evaluated using traditional Chinese medicine (TCM) syndrome scores, visual analogue scale (VAS) ratings for pain, a pain rating index (PRI), present pain intensity (PPI), the Oswestry Disability Index (ODI), and the Pittsburgh Sleep Quality Index (PSQI).Results:After the treatment, significant decreases were observed in the average TCM syndrome, VAS pain, PRI, PPI, ODI and PSQI scores of both groups, but the combination group′s averages were all significantly lower than those of the control group. Efficacy among the combination group (92.9%) was significantly higher than among the controls (62.5%).Conclusions:Supplementing TEAS with warm moxibustion scraping can more effectively relieve lumbodorsal pain and dysfunction among patients with lumbodorsal MPS, and improve their sleep quality.

Objective:A retrospective study was conducted to investigate the safety of Percutaneous Endoscopic Gastrostomy(PEG)in elderly patients with Amyotrophic Lateral Sclerosis(ALS)and to identify the factors influencing major complications.The aim is to establish a more robust foundation for optimizing both the procedure and its timing, thereby enhancing the evidence base for refining the surgical approach.Methods:We retrospectively collected clinical data from elderly ALS patients(≥60 years old)who underwent PEG at Peking University Third Hospital between January 2006 and January 2024.This dataset includes information on general health conditions, the progression of ALS, comorbidities, surgical details, and related complications.Additionally, we analyzed the postoperative complications experienced by the included patients, focusing specifically on the risk factors associated with aspiration pneumonia.Results:A total of 140 patients were included in the study, with a mean age of 68.2±5.9 years.Among these, 69 were male(49.3%)with a mean age of 68.4±6.5 years, and 71 were female(50.7%)with a mean age of 67.7±6.0 years.Successful outcomes were observed in 139 cases(99.3%).One case was not completed due to respiratory arrest caused by intraoperative aspiration.Postoperative complications occurred in 36 cases(25.7%), which included 9 cases of wound infection(6.4%), 1 case of abdominal infection(0.7%), 21 cases of aspiration pneumonia(15.0%), 1 case of local fistula leakage(0.7%), 2 cases of transient fever(1.4%), and 2 cases of death during hospitalization(1.4%).Both univariate and multivariate analyses indicated that an onset duration of ≤1 year( P=0.020)and a half-sitting position( P=0.022)significantly influenced the occurrence of aspiration pneumonia, acting as protective factors( β<0, OR<1). Conclusions:PEG is a safe method for providing enteral nutrition to elderly patients with ALS.While most complications associated with the procedure are mild and can be managed, Aspiration pneumonia remains a common and serious complication.However, early surgical intervention and the use of a semi-seated position during the procedure can help reduce the incidence of aspiration pneumonia.

Antimicrobial resistance (AMR) has emerged as a major global public health challenge, with traditional prevention and control methods exhibiting significant limitations in detection efficiency, data processing, and clinical decision-making. Leveraging its robust capabilities in data analysis and pattern recognition, artificial intelligence (AI) technology has been widely applied across multiple critical aspects of AMR containment. Current evidence demonstrates that AI technologies can significantly enhance the efficiency of resistancediagnosis, optimize personalized treatment strategies, and improve real-time monitoring of resistant pathogen transmission. Despite persistent challenges such as data heterogeneity, model interpretability, and ethical compliance in practical applications, AI holds immense promise in supporting precision infection management and addressing the growing crisis of antimicrobial resistance.This article systematically reviews the clinical applications of AI in AMR prevention and control, including resistance detection and prediction based on mass spectrometry and genomic data, the use of clinical decision support systems in anti-infective therapy, as well as the role of AI in epidemiological surveillance, pathogen tracking, early warning systems, and novel antimicrobial drug discovery aiming to provide reference for clinical practice.

Objective To analyze the epidemiological characteristics of acute respiratory infections(ARIs)during the autumn-winter season in Beijing,providing evidence for the prevention,control,diagnosis,and treatment of ARIs.Methods A convenience sampling method was employed,enrolling patients who visited Peking Union Medical College Hospital(PUMCH)between September 2023 and February 2024 due to ARIs.Na-sopharyngeal swabs were collected,and real-time fluorescence quantitative PCR was used to detect six common respiratory pathogens[influenza A virus(FluA),influenza B virus(FluB),human rhinovirus(HRV),Myco-plasma pneumoniae(MP),respiratory syncytial virus(RSV),and adenovirus(ADV)],as well as SARS-CoV-2 infection.The distribution patterns of pathogen infections were analyzed.Results A total of 5556 eligible patients were included.The overall positivity rate for the six common respiratory pathogens was 63.7％,with sin-gle-pathogen positivity at 54.0％,dual-pathogen positivity at 8.9％,and triple or more pathogen positivity at 0.7％.The predominant pathogens detected were FluA(16.1％)and RSV(15.7％),followed by ADV(11.1％),MP(11.1％),HRV(10.0％),and FluB(10.0％).No significant difference in overall pathogen positivity was observed between genders.However,significant differences were found between autumn and winter(x2=34.617,P＜0.001)and among pediatric,young/middle-aged,and elderly patients(x2=422.38,P＜0.001).Specifically,MP(x2=8.647,P=0.003),FluA(x2=131.932,P＜0.001),and HRV(x2=174.199,P＜0.001)exhibited significantly higher positivity rates in autumn than in winter,whereas FluB was more prevalent in winter(x2=287.894,P＜0.001).In pediatric patients,MP,RSV,HRV,and ADV positivity rates were significantly higher than in young/middle-aged and elderly patients(all P＜0.001),whereas FluB was more common in young/middle-aged patients(both P＜0.001).The positivity rates of the six common respiratory pathogens significantly declined during the SARS-CoV-2 epidemic period,exhibiting an asynchronous seasonal pattern.Conclusions The prevalence of respiratory pathogens in Beijing is associated with age and season.Tar-geted preventive measures should be implemented in different seasons and for key populations.

Infectious diseases caused by bacteria,viruses,and other pathogens are a significant global public health challenge.Accurate and efficient detection methods are crucial for the diagnosis and prevention of infec-tious diseases.Nucleic acid detection technologies based on the clustered regularly interspaced short palin-dromic repeats(CRISPR)and CRISPR-associated protein(Cas)systems have begun to be applied in the de-tection of pathogenic microorganisms due to their high sensitivity,high specificity,and rapid simplicity.In re-cent years,various convenient and efficient nucleic acid detection technologies and platforms for pathogenic microorganisms have been derived from the CRISPR/Cas system,further expanding the field of pathogen nu-cleic acid detection.This article summarizes the research progress of pathogen nucleic acid detection technolo-gies based on the CRISPR/Cas system,discusses the value of these detection technologies in the in vitro diag-nosis of pathogens,and provides references for the further development of CRISPR/Cas nucleic acid detection technologies.

Objective To analyze the main epidemiological characteristics of fungal infection in this hospital in the past 7 years,and to provide reference for clinical treatment and prevention and control strategies of fun-gal infection.Methods The fungal data and clinical data of related patients isolated from clinical samples in Peking Union Medical College Hospital from early January 2018 to the end of May 2024 were selected,and the main epidemiological characteristics of fungal infection in this hospital were identified and described through multi-angle statistical analysis.Results A total of 4 479 patients with filamentous fungal infection were en-rolled.The proportion of male patients[57.5％(2 576/4 479)]was higher than that of female patients[42.5％(1 903/4 143)],mainly distributed in internal medicine,Intensive Care Unit(ICU)and emergency de-partment,among which internal medicine accounted for the highest proportion[50.0％(2 241/4 479)].About 90.0％of the specimens were from the lower respiratory tract,in addition to specimens from skin and soft tis-sue,tissue,ear and blood culture.In terms of seasonal distribution,there are more patients in winter.The fun-gi were mainly composed of Aspergillus,Mucor,Cerdosporium,Fusarium and Penicillium,among which As-pergillus was the most abundant,accounting for 74.6％of the total.Aspergillus fumigatus was the most a-bundant Aspergillus,accounting for 42.5％of the total Aspergillus(1 418/3 340).Among the related infec-tions caused by mold,Aspergillus was the most common in the lower respiratory tract,accounting for 76.8％.Among them,Aspergillus fumigatus accounted for the highest proportion(33.6％).98.6％of the molds infected the ear were Aspergillus,of which Aspergillus niger and Aspergillus terreus were the most common.Skin infections are mainly caused by Sporothrix schenckii,Trichophyton rubrum,Microsporum ca-nis.The results of in vitro drug sensitivity test showed that the four common Aspergillus isolated in this hos-pital were sensitive to voriconazole,and amphotericin B had better antifungal activity against Mucorales in vitro.Conclusion Based on the main epidemiological characteristics of fungal infections in this hospital,it is recommended that special attention be paid to the admission of patients in the respiratory department during the peak infection period in autumn and winter.In the treatment of fungal infections in different regions and on different body parts,attention should be paid to the differences in the distribution of bacterial species.

The widespread application of medical artificial intelligence （AI） has brought technological breakthroughs to traditional diagnosis and treatment and has also altered the traditional doctor-patient interaction mode and formed a new doctor-patient relationship of “doctor-medical AI-patient” which faces a series of challenges. The intervention of AI may form a new “paternalistic style，” affecting the shared decision-making model. When its recommendations lack explanation， it may lead to clinical decision-making paralysis and affect the doctor-patient trust relationships. There may be confusion between the roles and responsibilities of AI and doctors in the process of medical practice， affecting the establishment of an emotionally responsible doctor-patient relationship. Through an in-depth analysis of the impact and causes of medical AI on the doctor-patient relationships， this paper proposed that a collaborative mechanism should be established between AI and professional doctors to complement each other， clarifying the auxiliary status of AI， reinforcing the dominant role of doctors， enhancing the regulatory mechanism， and dynamically improved the doctor-patient relationships to promote the healthy and orderly development of smart healthcare.