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.

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.

Objective To investigate the relationship between preoperative serum levels of long noncoding RNA(lncRNA)X inactive specific transcript(XIST)and microRNA(miR)-140-3p in acute myocardial infarction(AMI)patients undergoing percutaneous coronary intervention(PCI)and blood glucose,blood lipids,myocardial injury indexes,degree of coronary artery disease and the occurrence of major adverse cardiovascular events(MACE)within 3 years after surgery.Methods A total of 164 patients with AMI(AMI group)and 148 healthy subjects(healthy group)were selected from Hankuang General Hospital of North China Medical and Health Group from November 2018 to February 2021.Clinical data were collected at admission,and blood glucose,blood lipids,myocardial injury indicators,serum lncRNA XIST and miR-140-3p levels in AMI group before PCI and healthy group during physical examination were detected.According to the degree of coronary artery disease,AMI patients were divided into mild coronary artery disease group(n=33),moderate coronary artery disease group(n=76),and severe coronary artery disease group(n=55).Follow up for 3 years after surgery,AMI patients were divided into MACE group(n=36)and non-MACE group(n=128).Clinical data,preoperative PCI blood glucose,blood lipids,myocardial injury indicators,synergy between percutaneous coronary intervention with TAXUS and cardiac surgery(SYNTAX)score,and serum lncRNA XIST and miR-140-3p expression levels of health group and AMI group,AMI patients with different prognoses within 3 years after PCI were compared.The serum lncRNA XIST and miR-140-3p expression levels of AMI patients with different degrees of coronary artery disease before PCI were compared.The correlation between preoperative PCI serum lncRNA XIST and miR-140-3p with blood glucose,blood lipids,myocardial injury indicators,SYNTAX score in AMI patients,the influencing factors of MACE occurrence,and predicting the value of preoperative PCI serum lncRNA XIST and miR-140-3p in predicting MACE occurrence within 3 years after PCI in AMI patients were analyzed.Results Compared with healthy group,the preoperative PCI fasting plasma glucose(FPG),total cholesterol(TC),triglycerides(TG),low density lipoprotein-cholesterol(LDL-C),hypersensitive C-reactive protein(hs-CRP),creatine kinase isoenzyme(CK-MB),homocysteine(Hcy),cardiac troponin I(cTnI),brain natriuretic peptide(BNP),lncRNA XIST expression levels of AMI group were significantly increased(t=2.426～80.642),and high density lipoprotein-cholesterol(HDL-C),left ventricular ejection fraction(LVEF)and miR-140-3pexpression levels were significantly reduced(t=6.166～66.119),the differences were statistically significant(all P<0.05).Before PCI,the expression levels of serum lncRNA XIST were increased successively,and the expression levels of miR-140-3p were decreased successively in mild,moderate,and severe coronary artery lesions group,the differences were statistically significant(F=174.600,231.138,all P<0.05).The serum lncRNA XIST of AMI patients before PCI was positively correlated with FPG,TC,TG,LDL-C,hs-CRP,CK-MB,Hcy,cTnI,BNP and SYNTAX scores(r=0.235～0.681,all P＜0.05),and negatively correlated with miR-140-3p,HDL-C and LVEF(r=-0.571,-0.262,-0.513,all P＜0.05).miR-140-3p was negatively correlated with FPG,TC,TG,LDL-C,hs-CRP,CK-MB,Hcy,cTnI,BNP and SYNTAX scores(r=-0.672～-0.209,all P＜0.05),and positively correlated with HDL-C and LVEF(r=0.245,0.524,all P＜0.05).Compared with non-MACE group,the hs-CRP,CK-MB,Hcy,cTnI,BNP,SYNTAX scores and lncRNA XIST expression levels before PCI in MACE group were significantly increased(t=3.032～26.330),while the LVEF and miR-140-3p expression levels were significantly reduced(t=2.821,13.318),the differences were statistically significant(all P<0.05).LVEF and miR-140-3p were independent protective factors for MACE in AMI patients within 3 years after PCI(Wald χ2=6.098,7.851,all P＜0.05),while CK-MB,Hcy,cTnI,BNP,SYNTAX score and lncRNA XIST were independent risk factors for MACE in AMI patients within 3 years after PCI(Wald χ2=4.263～7.853,all P＜0.05).Compared with the area under curve(AUC)of serum lncRNA XIST and miR-140-3p before PCI separately predicting MACE occurrence within 3 years after PCI in AMI patients,the combined prediction of MACE occurrence within 3 years after PCI in AMI patients was higher,and the differences were statistically significant(Z=2.059,2.017,all P<0.05).Conclusion The expression of lncRNA XIST in the serum of AMI patients is increased while the expression of miR-140-3p is decreased.Both are associated with blood glucose,blood lipids myocardial injury indicators,degree of coronary artery disease,and the occurrence of MACE within three years after PCI.They have high value in predicting the occurrence of MACE within three years after PCI surgery.

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.

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 investigate the distribution and antimicrobial resistance profiles of common pathogens isolated from cerebrospinal fluid(CSF)in CHINET program from 2015 to 2021.Methods The bacterial strains isolated from CSF were identified in accordance with clinical microbiology practice standards.Antimicrobial susceptibility test was conducted using Kirby-Bauer method and automated systems per the unified CHINET protocol.Results A total of 14 014 bacterial strains were isolated from CSF samples from 2015 to 2021,including the strains isolated from inpatients(95.3％)and from outpatient and emergency care patients(4.7％).Overall,19.6％of the isolates were from children and 80.4％were from adults.Gram-positive and Gram-negative bacteria accounted for 68.0％and 32.0％,respectively.Coagulase negative Staphylococcus accounted for 73.0％of the total Gram-positive bacterial isolates.The prevalence of MRSA was 38.2％in children and 45.6％in adults.The prevalence of MRCNS was 67.6％in adults and 69.5％in children.A small number of vancomycin-resistant Enterococcus faecium(2.2％)and linezolid-resistant Enterococcus faecalis(3.1％)were isolated from adult patients.The resistance rates of Escherichia coli and Klebsiella pneumoniae to ceftriaxone were 52.2％and 76.4％in children,70.5％and 63.5％in adults.The prevalence of carbapenem-resistant E.coli and K.pneumoniae(CRKP)was 1.3％and 47.7％in children,6.4％and 47.9％in adults.The prevalence of carbapenem-resistant Acinetobacter baumannii(CRAB)and Pseudomonas aeruginosa(CRPA)was 74.0％and 37.1％in children,81.7％and 39.9％in adults.Conclusions The data derived from antimicrobial resistance surveillance are crucial for clinicians to make evidence-based decisions regarding antibiotic therapy.Attention should be paid to the Gram-negative bacteria,especially CRKP and CRAB in central nervous system(CNS)infections.Ongoing antimicrobial resistance surveillance is helpful for optimizing antibiotic use in CNS infections.

Objective To investigate the antimicrobial resistance of clinical isolates from elderly patients(≥65 years)in major medical institutions across China.Methods Bacterial strains were isolated from elderly patients in 52 hospitals participating in the CHINET Antimicrobial Resistance Surveillance Program during the period from 2015 to 2021.Antimicrobial susceptibility test was carried out by disk diffusion method and automated systems according to the same CHINET protocol.The data were interpreted in accordance with the breakpoints recommended by the Clinical and Laboratory Standards Institute(CLSI)in 2021.Results A total of 514 715 nonduplicate clinical isolates were collected from elderly patients in 52 hospitals from January 1,2015 to December 31,2021.The number of isolates accounted for 34.3％of the total number of clinical isolates from all patients.Overall,21.8％of the 514 715 strains were gram-positive bacteria,and 78.2％were gram-negative bacteria.Majority(90.9％)of the strains were isolated from inpatients.About 42.9％of the strains were isolated from respiratory specimens,and 22.9％were isolated from urine.More than half(60.7％)of the strains were isolated from male patients,and 39.3％isolated from females.About 51.1％of the strains were isolated from patients aged 65-＜75 years.The prevalence of methicillin-resistant strains(MRSA)was 38.8％in 32 190 strains of Staphylococcus aureus.No vancomycin-or linezolid-resistant strains were found.The resistance rate of E.faecalis to most antibiotics was significantly lower than that of Enterococcus faecium,but a few vancomycin-resistant strains(0.2％,1.5％)and linezolid-resistant strains(3.4％,0.3％)were found in E.faecalis and E.faecium.The prevalence of penicillin-susceptible S.pneumoniae(PSSP),penicillin-intermediate S.pneumoniae(PISP),and penicillin-resistant S.pneumoniae(PRSP)was 94.3％,4.0％,and 1.7％in nonmeningitis S.pneumoniae isolates.The resistance rates of Klebsiella spp.(Klebsiella pneumoniae 93.2％)to imipenem and meropenem were 20.9％and 22.3％,respectively.Other Enterobacterales species were highly sensitive to carbapenem antibiotics.Only 1.7％-7.8％of other Enterobacterales strains were resistant to carbapenems.The resistance rates of Acinetobacter spp.(Acinetobacter baumannii 90.6％)to imipenem and meropenem were 68.4％and 70.6％respectively,while 28.5％and 24.3％of P.aeruginosa strains were resistant to imipenem and meropenem,respectively.Conclusions The number of clinical isolates from elderly patients is increasing year by year,especially in the 65-＜75 age group.Respiratory tract isolates were more prevalent in male elderly patients,and urinary tract isolates were more prevalent in female elderly patients.Klebsiella isolates were increasingly resistant to multiple antimicrobial agents,especially carbapenems.Antimicrobial resistance surveillance is helpful for accurate empirical antimicrobial therapy in elderly patients.

Objective To investigate the relationship between preoperative serum levels of long noncoding RNA(lncRNA)X inactive specific transcript(XIST)and microRNA(miR)-140-3p in acute myocardial infarction(AMI)patients undergoing percutaneous coronary intervention(PCI)and blood glucose,blood lipids,myocardial injury indexes,degree of coronary artery disease and the occurrence of major adverse cardiovascular events(MACE)within 3 years after surgery.Methods A total of 164 patients with AMI(AMI group)and 148 healthy subjects(healthy group)were selected from Hankuang General Hospital of North China Medical and Health Group from November 2018 to February 2021.Clinical data were collected at admission,and blood glucose,blood lipids,myocardial injury indicators,serum lncRNA XIST and miR-140-3p levels in AMI group before PCI and healthy group during physical examination were detected.According to the degree of coronary artery disease,AMI patients were divided into mild coronary artery disease group(n=33),moderate coronary artery disease group(n=76),and severe coronary artery disease group(n=55).Follow up for 3 years after surgery,AMI patients were divided into MACE group(n=36)and non-MACE group(n=128).Clinical data,preoperative PCI blood glucose,blood lipids,myocardial injury indicators,synergy between percutaneous coronary intervention with TAXUS and cardiac surgery(SYNTAX)score,and serum lncRNA XIST and miR-140-3p expression levels of health group and AMI group,AMI patients with different prognoses within 3 years after PCI were compared.The serum lncRNA XIST and miR-140-3p expression levels of AMI patients with different degrees of coronary artery disease before PCI were compared.The correlation between preoperative PCI serum lncRNA XIST and miR-140-3p with blood glucose,blood lipids,myocardial injury indicators,SYNTAX score in AMI patients,the influencing factors of MACE occurrence,and predicting the value of preoperative PCI serum lncRNA XIST and miR-140-3p in predicting MACE occurrence within 3 years after PCI in AMI patients were analyzed.Results Compared with healthy group,the preoperative PCI fasting plasma glucose(FPG),total cholesterol(TC),triglycerides(TG),low density lipoprotein-cholesterol(LDL-C),hypersensitive C-reactive protein(hs-CRP),creatine kinase isoenzyme(CK-MB),homocysteine(Hcy),cardiac troponin I(cTnI),brain natriuretic peptide(BNP),lncRNA XIST expression levels of AMI group were significantly increased(t=2.426～80.642),and high density lipoprotein-cholesterol(HDL-C),left ventricular ejection fraction(LVEF)and miR-140-3pexpression levels were significantly reduced(t=6.166～66.119),the differences were statistically significant(all P<0.05).Before PCI,the expression levels of serum lncRNA XIST were increased successively,and the expression levels of miR-140-3p were decreased successively in mild,moderate,and severe coronary artery lesions group,the differences were statistically significant(F=174.600,231.138,all P<0.05).The serum lncRNA XIST of AMI patients before PCI was positively correlated with FPG,TC,TG,LDL-C,hs-CRP,CK-MB,Hcy,cTnI,BNP and SYNTAX scores(r=0.235～0.681,all P＜0.05),and negatively correlated with miR-140-3p,HDL-C and LVEF(r=-0.571,-0.262,-0.513,all P＜0.05).miR-140-3p was negatively correlated with FPG,TC,TG,LDL-C,hs-CRP,CK-MB,Hcy,cTnI,BNP and SYNTAX scores(r=-0.672～-0.209,all P＜0.05),and positively correlated with HDL-C and LVEF(r=0.245,0.524,all P＜0.05).Compared with non-MACE group,the hs-CRP,CK-MB,Hcy,cTnI,BNP,SYNTAX scores and lncRNA XIST expression levels before PCI in MACE group were significantly increased(t=3.032～26.330),while the LVEF and miR-140-3p expression levels were significantly reduced(t=2.821,13.318),the differences were statistically significant(all P<0.05).LVEF and miR-140-3p were independent protective factors for MACE in AMI patients within 3 years after PCI(Wald χ2=6.098,7.851,all P＜0.05),while CK-MB,Hcy,cTnI,BNP,SYNTAX score and lncRNA XIST were independent risk factors for MACE in AMI patients within 3 years after PCI(Wald χ2=4.263～7.853,all P＜0.05).Compared with the area under curve(AUC)of serum lncRNA XIST and miR-140-3p before PCI separately predicting MACE occurrence within 3 years after PCI in AMI patients,the combined prediction of MACE occurrence within 3 years after PCI in AMI patients was higher,and the differences were statistically significant(Z=2.059,2.017,all P<0.05).Conclusion The expression of lncRNA XIST in the serum of AMI patients is increased while the expression of miR-140-3p is decreased.Both are associated with blood glucose,blood lipids myocardial injury indicators,degree of coronary artery disease,and the occurrence of MACE within three years after PCI.They have high value in predicting the occurrence of MACE within three years after PCI surgery.

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.