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.

From the perspective of biopolitics， brain organoids represent an emerging technological field for life governance， embodying the governmentality logic of biopower and posing challenges to traditional ethical systems and bodily categories. Under the effect of the Foucauldian medical gaze and disciplinary mechanisms， brain organoid technology may objectify life processes and give rise to new forms of subjectivation， with risk governance standing as one of the core logics behind the ethical regulation of brain organoids. This paper further compared existing regulatory paths in China， the United States， and Europe to reveal the underlying disparities in political cultures and power distribution structures. On this basis， it is proposed to introduce institutional proposals into ethical regulation， such as the formulation of ethical regulation， the implementation of ethical review， and the setting of identifiable risks， to balance the governance tension between innovative exploration and disciplinary mechanisms.

Objective:To analyze transcranial sonography（TCS）imaging characteristics of rats with 6-hydroxydopamine hydrochloride（6-OHDA）and explore the correlations between the imaging characteristics with motor deficits and pathological changes.Methods:Twenty-nine male SD rats were divided into 3 groups：8 in the no-treatment control（NC）group，10 in the Sham group and 11 in the 6-OHDA group. The model for Sham/Parkinson's disease（PD）was established by stereotacticly injecting saline/6-OHDA containing ascorbic acid to bilateral substantia nigra pars compacta（SNpc）. After three weeks，the models were stable. At the fourth week and seventh week，the behavioral testing was accomplished. The TCS examination was performed weekly at the same time for four weeks. At the eighth week，the rats were sacrificed for pathology.Results:①Behavioral testing：6-OHDA group showed asymmetric motor deficits and the difference was significant compared with the NC group and Sham group（both P<0.001）. ②TCS examination：compared with the NC and Sham group，there were asymmetric substantia nigra hyperechogenicity（SNH）in 6-OHDA group（both P<0.05）；meanwhile the area of SNH in the left was significantly larger in the right side（ P<0.05）.No significant change in SNH area was found during the continuous observation period of weeks 4-7. For 6-OHDA group，the area of SNH was negatively correlated with the number of forelimb wall-touches（ r=-0.825， P＜0.001）. ③Pathological examination：compared with NC group and sham group，the substantia nigra（SN）of 6-OHDA group showed a series of pathological events，including dopaminergic（DA）neurons asymmetrically decreasing，asymmetric ironion deposition and the number of active microglia increasing（all P＜0.05）. Correlation analysis showed that the area of SNH was negatively correlated with the number of DA neurons survivors（ r=-0.689， P=0.013），while the activation of microglial and the deposition of iron were positively correlated with the area of SNH（ r=0.915，0.735；all P＜0.001）. Conclusions:Asymmetric SNH of 6-OHDA PD rats is a representation of asymmetric motor deficits，and the mechanism is related to a catalogue of asymmetric pathological changes in SN，which comprise DA neurons decreasing，asymmetric iron ions deposition，microglial activating.

Objective The causal relationship between endometriosis(EMs)and 15 trace elements including copper,calcium,carotene,folic acid,iron,magnesium,potassium,selenium,vitamin A,vitamin B12,vitamin B6,vitamin C,vitamin D,vitamin E and zinc was analyzed by double sample Mendelian randomization(MR).Methods Multiple trace elements were used as exposure factors,and the incidence risk of EMs was used as the outcome factor for two-sample MR analysis.The data were sourced from the publicly available integrative epidemiology unit open Genome-Wide Association Studies database and Finnish Genome Research Project database.Five Mendelian randomization analysis methods were employed to investigate the causal relationship between EMs and trace elements.Additionally,sensitivity analysis was carried out to evaluate the influence of heterogeneity and horizontal pleiotropy on the results of the MR analysis.Results The impact of trace elements on various types of EMs varies.The results of the inverse variance weighted(IVW)method indicated that trace element calcium(OR=1.465,95％CI:1.094-1.962)and vitamin B6(OR=1.580,95％CI:1.146-2.178)might be risk factors for ovarian EMs.Vitamin B6(OR=0.203,95％CI:0.044-0.939)may be a protective factor for tubal EMs.The above research results were not affected by heterogeneity and horizontal pleiotropy(P＞0.05).This study did not find a causal relationship between other trace elements and EMs.Conclusion The trace elements calcium and vitamin B6 predicted by genetics may play a regulatory role in the development of EMs.

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 examine the changing prevalence and antimicrobial resistance profiles of Burkholderia cepacia in 52 hospitals across China from 2015 to 2021.Methods A total of 9 261 strains of B.cepacia were collected from 52 hospitals between January 1,2015 and December 31,2021.Antimicrobial susceptibility of the strains was tested using Kirby-Bauer method or automated antimicrobial susceptibility testing systems according to a unified protocol.The results were interpreted according to the breakpoints released in the Clinical & Laboratory Standards Institute(CLSI)guidelines(2023 edition).Results A total of 9 261 strains of B.cepacia were isolated from all age groups,especially elderly patients.The proportion was 11.1％(1 032 strains)in children,significantly lower than the proportion in adults.About half(46.5％,4 310/9 261)of the strains were isolated from patients at least 60 years old and 42.3％(3 919/9 261)of the strains were isolated from young adults.Most isolates(71.1％)were isolated from sputum and respiratory secretions,followed by urine(10.7％)and blood samples(8.1％).B.cepacia isolates were highly susceptible to the five antimicrobial agents recommended in the CLSI M100 document(33rd edition,2023).B.cepacia isolates showed relatively higher resistance rates to meropenem and levofloxacin.However,the resistance rates to ceftazidime,trimethoprim-sulfamethoxazole,and minocycline remained below 8.1％.The percentage of B.cepacia strains resistant to levofloxacin was the highest compared to other antibiotics in any of the three age groups(from 12.4％in the patients＜18 years old to 20.6％in the patients aged 60 years or older).Conclusions B.cepacia is one of the clinically important non-fermenting gram-negative bacteria.Accurate and timely reporting of antimicrobial susceptibility test results and ongoing antimicrobial resistance surveillance are helpful for rational prescription of antimicrobial agents and proper prevention and control of nosocomial infections.

Objective To summarize the changing prevalence of carbapenem resistance in Enterobacterales based on the data of CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021 for improving antimicrobial treatment in clinical practice.Methods Antimicrobial susceptibility testing was performed using a commercial automated susceptibility testing system according to the unified CHINET protocol.The results were interpreted according to the breakpoints of the Clinical & Laboratory Standards Institute(CLSI)M100 31st ed in 2021.Results Over the seven-year period(2015-2021),the overall prevalence of carbapenem-resistant Enterobacterales(CRE)was 9.43％(62 342/661 235).The prevalence of CRE strains in Klebsiella pneumoniae,Citrobacter freundii,and Enterobacter cloacae was 22.38％,9.73％,and 8.47％,respectively.The prevalence of CRE strains in Escherichia coli was 1.99％.A few CRE strains were also identified in Salmonella and Shigella.The CRE strains were mainly isolated from respiratory specimens(44.23±2.80)％,followed by blood(20.88±3.40)％and urine(18.40±3.45)％.Intensive care units(ICUs)were the major source of the CRE strains(27.43±5.20)％.CRE strains were resistant to all the β-lactam antibiotics tested and most non-β-lactam antimicrobial agents.The CRE strains were relatively susceptible to tigecycline and polymyxins with low resistance rates.Conclusions The prevalence of CRE strains was increasing from 2015 to 2021.CRE strains were highly resistant to most of the antibacterial drugs used in clinical practice.Clinicians should prescribe antimicrobial agents rationally.Hospitals should strengthen antibiotic stewardship in key clinical settings such as ICUs,and take effective infection control measures to curb CRE outbreak and epidemic in hospitals.

Objective To characterize the changing species distribution and antibiotic resistance profiles of respiratory isolates in hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program from 2015 to 2021.Methods Commercial automated antimicrobial susceptibility testing systems and disk diffusion method were used to test the susceptibility of respiratory bacterial isolates to antimicrobial agents following the standardized technical protocol established by the CHINET program.Results A total of 589 746 respiratory isolates were collected from 2015 to 2021.Overall,82.6％of the isolates were Gram-negative bacteria and 17.4％were Gram-positive bacteria.The bacterial isolates from outpatients and inpatients accounted for(6.0±0.9)％and(94.0±0.1)％,respectively.The top microorganisms were Klebsiella spp.,Acinetobacter spp.,Pseudomonas aeruginosa,Staphylococcus aureus,Haemophilus spp.,Stenotrophomonas maltophilia,Escherichia coli,and Streptococcus pneumoniae.Each microorganism was isolated from significantly more males than from females(P＜0.05).The overall prevalence of methicillin-resistant S.aureus(MRSA)was 39.9％.The prevalence of penicillin-resistant S.pneumoniae was 1.4％.The prevalence of extended-spectrum β-lactamase(ESBL)-producing E.coli and K.pneumoniae was 67.8％and 41.3％,respectively.The overall prevalence of carbapenem-resistant E.coli,K.pneumoniae,Enterobacter cloacae,Pseudomonas aeruginosa,and Acinetobacter baumannii was 3.7％,20.8％,9.4％,29.8％,and 73.3％,respectively.The prevalence of β-lactamase was 96.1％in Moraxella catarrhalis and 60.0％in Haemophilus influenzae.The H.influenzae isolates from children(＜18 years)showed significantly higher resistance rates to β-lactam antibiotics than the isolates from adults(P＜0.05).Conclusions Gram-negative bacteria are still predominant in respiratory isolates associated with serious antibiotic resistance.Antimicrobial resistance surveillance should be strengthened in clinical practice to support accurate etiological diagnosis and appropriate antimicrobial therapy based on antimicrobial susceptibility testing results.

Objective The causal relationship between endometriosis(EMs)and 15 trace elements including copper,calcium,carotene,folic acid,iron,magnesium,potassium,selenium,vitamin A,vitamin B12,vitamin B6,vitamin C,vitamin D,vitamin E and zinc was analyzed by double sample Mendelian randomization(MR).Methods Multiple trace elements were used as exposure factors,and the incidence risk of EMs was used as the outcome factor for two-sample MR analysis.The data were sourced from the publicly available integrative epidemiology unit open Genome-Wide Association Studies database and Finnish Genome Research Project database.Five Mendelian randomization analysis methods were employed to investigate the causal relationship between EMs and trace elements.Additionally,sensitivity analysis was carried out to evaluate the influence of heterogeneity and horizontal pleiotropy on the results of the MR analysis.Results The impact of trace elements on various types of EMs varies.The results of the inverse variance weighted(IVW)method indicated that trace element calcium(OR=1.465,95％CI:1.094-1.962)and vitamin B6(OR=1.580,95％CI:1.146-2.178)might be risk factors for ovarian EMs.Vitamin B6(OR=0.203,95％CI:0.044-0.939)may be a protective factor for tubal EMs.The above research results were not affected by heterogeneity and horizontal pleiotropy(P＞0.05).This study did not find a causal relationship between other trace elements and EMs.Conclusion The trace elements calcium and vitamin B6 predicted by genetics may play a regulatory role in the development of EMs.