Genetically modified pigs for welfare assurance is crucial for conducting xenotransplantation. However, traditional experimental animal ethics principles cannot address the social benefits issues brought about by xenotransplantation, and there is a lack of ethical justification for the assurance of experimental animal welfare. Degrazia and Bechtel proposed six principles for the welfare of experimental animals: the principle of no alternative methods, the principle of expected net benefits, the principle of adequate defense of harm, the principle of no harm without necessity, the principle of basic needs and the principle of harm limit. This paper conducts an ethical-level argumentation on the six principles for the welfare of genetically modified pigs in xenotransplantation, and points out that these six principles are of great significance in closely integrating the social benefits of xenotransplantation with the welfare of genetically modified pigs, emphasizing the moral status of genetically modified pigs, and providing standards for the ethical review of the welfare of genetically modified pigs.

Objective To analyze survival outcomes and influencing factors among patients with colorectal cancer in Yunnan Province. Methods Clinical data were retrospectively collected from 4 892 patients with colorectal cancer. Survival data were obtained through follow-up. Overall survival (OS) was calculated by using the Kaplan-Meier method. Univariate analysis was performed by applying the log-rank test. Meanwhile, multivariate analysis employed the Cox proportional hazards regression model. Results The 1-, 3-, 5-, and 10-year OS rates for the entire cohort were 91.90%, 74.40%, 64.40%, and 28.70%, respectively. Univariate analysis revealed that age, ethnicity, region, differentiation grade, TNM stage, clinical stage, metastatic status, histological type, and treatment modality (chemotherapy, radiotherapy, and surgery) were associated with patient prognosis (all P<0.05). Multivariate analysis identified age (HR=1.250), region (HR=1.262), differentiation grade (HR=0.761), clinical stage (HR=3.128), and treatment modality (chemotherapy, HR=0.644; radiotherapy, HR=1.605; surgery, HR=0.384) as independent factors affecting survival prognosis in patients with colorectal cancer (all P<0.001). Conclusion Age, region, clinical stage, and treatment modality are independent factors influencing survival among patients with colorectal cancer in Yunnan Province. In clinical practice, these factors should be integrated to develop individualized prevention and treatment strategies, thereby improving patient outcomes.

ObjectiveTo summarize the incidence and clinical features of drug hypersensitivity reactions in children treated with sustained-releasing gonadotropin-releasing hormone agonists （GnRHa）， aiming to provide guidance for the safe clinical application of GnRHa in children. MethodsThe medical data of children diagnosed with central precocious puberty （CPP） or early and fast puberty （EFP） were retrospectively analyzed， who received GnRHa treatment at the Children's Growth Center of the First Affiliated Hospital of Sun Yat-sen University between January 1990 and July 2023. The occurrence of GnRHa-related drug hypersensitivity reactions were summarized， including the incidence and clinical features of systemic reactions and sterile abscesses. ResultsAmong the 1 684 children treated with GnRHa for CPP/EFP， the female-to-male ratio was 3.8∶1. A total of nine children （0.53%） developed 44 occurrences of drug hypersensitivity reactions. Four children （0.24%） presented with sterile abscesses （21 occurrences）， and five children （0.30%） experienced systemic hypersensitivity reactions （14 occurrences）. Four children were hypersensitive to triptorelin acetate， three were hypersensitive to leuprorelin acetate， and two were hypersensitive to both triptorelin acetate and leuprorelin acetate. The predominant hypersensitivity reactions to leuprorelin acetate were sterile abscesses， observed in four cases （4/277， 1.44%）， whereas the main reactions to triptorelin acetate were systemic hypersensitivity reactions， affecting five cases （5/1 501， 0.33%）. Case one presented with a severe and complex condition， exhibiting hypersensitivity to multiple GnRHa preparations （sustained-releasing triptorelin， sustained-releasing leuprorelin， and short-acting triptorelin）， and presenting with diverse manifestations， including induration， sterile abscesses， systemic hypersensitivity reactions， and even loss of suppression of the hypothalamic-pituitary-gonadal axis， leading to treatment failure. ConclusionsThe proportion of children experiencing drug hypersensitivity reactions to sustained-releasing GnRHa is relatively low at 0.53%， with diverse manifestations. The reactions primarily manifest as sterile abscesses and systemic hypersensitivity reactions， and in severe cases， may lead to treatment failure due to loss of suppression of the hypothalamic-pituitary-gonadal axis.

To address the challenges of fragmented data, inconsistent standards, and delayed feedback in the full-cycle competency development process at teaching hospitals, this paper proposes the LEADS data governance system for Precision Medical Education (LEADS-PME), drawing on the practical experience of building the integrated medical education management platform at Zhongshan Hospital, Fudan University. The LEADS-PME framework comprises five interconnected core components: Longitudinal foundation, Evidence-chain generation, Analytics and profiling, Decision-support and prediction, and Simulation and digital-twin governance. Currently, Zhongshan Hospital has established a full-cycle educational data infrastructure and achieved multi-system data integration and competency-based profiling and evaluation, while the prediction and simulation modules are still in the prototype exploration phase. A mixed-methods evaluation will be subsequently conducted from the perspectives of data quality, management effectiveness, and predictive intervention. As a locally adapted framework, LEADS-PME can transform operational data derived from clinical practice, teaching, assessment, and management processes into traceable, interpretable, and reusable evidence of competency development. It is expected to facilitate the transformation of medical education management from a outcome-oriented approach to process monitoring, evidence-driven decision-making, and precision governance, thereby providing both a theoretical framework and practical reference for precision medical education in Chinese teaching hospitals.

Objective To observe the expression of serum carcinoembryonic antigen(CEA)and interleu-kin-35(IL-35)in patients with differentiated thyroid cancer(DTC),and to analyze the correlation between them and lung metastasis.Methods A total of 150 patients with DTC treated in the hospital from January 2018 to December 2021 were selected as the case group,and another 150 healthy individuals who underwent the physical examination in the hospital in December 2021 were selected as the control group.The case group was divided into lung metastasis group and non lung metastasis group according to the occurrence of lung me-tastasis.The clinical data,serum CEA,IL-35 levels and other laboratory indexes in each group were counted,the correlation between the expression of serum CEA and IL-35 and lung metastasis of DTC patients was ana-lyzed,and the evaluation value of receiver operating characteristic(ROC)curve and area under curve(AUC)on lung metastasis of DTC patients was evaluated.Results The serum CEA level in the case group was higher than that in the control group,and the serum IL-35 level was lower than that in the control group,and the differences were statistically significant(P＜0.05).Among 150 patients with DTC,25 cases had lung metas-tasis,accounting for 16.67％.The levels of serum thyroid stimulating hormone,thyroglobulin and CEA in pa-tients with DTC in lung metastasis group were higher than those in non lung metastasis group,and the level of serum IL-35 was lower than that in non lung metastasis group,and the differences were statistically significant(P＜0.05).The correlation analysis showed that there was a positive correlation between the expression of serum CEA in DTC patients and lung metastasis(r=0.580,P＜0.001),and there was a negative correlation between serum IL-35 and lung metastasis(r=-0.283,P＜0.001).ROC curve analysis was drawn and showed that the area under the curve(AUC)of serum CEA and IL-35 alone and in combination for predicting lung metastasis in patients with DTC were 0.906,0.711 and 0.936 respectively,the sensitivity corresponding to the cut off value was 0.760,0.840 and 0.840 respectively,and the specificity was 0.984,0.544 and 0.968 respectively.Conclusion There is a certain correlation between the expression of serum CEA and lung metas-tasis in DTC patients.Although serum IL-35 is related to lung metastasis,the correlation is extremely weak.The combination of serum CEA and IL-35 has the potential to be used for the evaluation of clinical DTC lung metastasis.

Objective:To observe the clinical efficacy and safety of Jianpi Bushen Jiedu Prescription combined with 5-fluorouracil (5-FU)-based chemotherapy and targeted therapy for the treatment of advanced colorectal cancer patients with liver and kidney yin deficiency combined with spleen deficiency pattern.Methods:A randomized controlled trial was conducted. A total of 72 hospitalized patients with advanced colorectal cancer treated at the Department of Oncology, Nanjing Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from October 2022 to January 2024 were enrolled as study subjects. Using a random number table method, they were allocated into two groups, with 36 patients in each group. The control group received the mFOLFOX6/FOLFIRI combined with bevacizumab regimen, while the treatment group was administered additional oral Jianpi Bushen Jiedu Prescription on the basis of the control group. Two weeks was a cycle in both groups, with a total of 6 cycles of treatment. Serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199), and carbohydrate antigen 724 (CA724) were detected using electrochemiluminescence; the Karnofsky Performance Status (KPS) scale was utilized to evaluate patients' functional status; vital signs were continuously monitored, and adverse reactions were recorded. The short-term efficacy and TCM syndrome efficacy of patients were evaluated.Results:The treatment group demonstrated higher objective response rate (ORR) [31.25% (10/32) vs. 21.88% (7/32), χ2=0.72] and disease control rate (DCR) [84.38% (27/32) vs. 71.88% (23/32), χ2=1.46] compared to the control group, without statistical significance ( P>0.05). Post-treatment levels of CEA [4.09 (3.31,8.57) μg/L vs. 10.07 (4.55,22.35) μg/L, Z=-2.10] and CA72-4 [4.54 (2.04,10.99) mU/L vs. 9.48 (4.34,18.95) mU/L, Z=-2.52] in the treatment group were significantly lower than those in the control group ( P<0.05). The total effective rate of TCM syndrome was significantly higher in the treatment group [78.13% (25/32)] compared with the control group [50.00% (16/32)], with statistical significance ( χ2=5.50, P=0.019). Post-treatment KPS scores in the treatment group [80.0 (80.0, 80.0) vs. 70.0 (62.5, 80.0), Z=-2.76] were significantly higher compared with the control group ( P<0.01). During the treatment period, the treatment group showed statistical significance compared with the control group in the incidence of hemoglobin decrease ( χ2=4.66), leukopenia decrease ( χ2=4.27), and peripheral neuropathy ( χ2=3.93), with statistical significance ( P<0.05). Conclusion:The addition of Jianpi Bushen Jiedu Prescription to 5-FU-based chemotherapy combined with targeted therapy demonstrates significant clinical benefits in advanced colorectal cancer patients, including reducing tumor marker levels, alleviating clinical symptoms, improving quality of life, and mitigating treatment-related toxicities, with a good safety.

Objective:To investigate the relationship between adiponectin (ADPN), the ratio of high-sensitivity C-reactive protein (hs-CRP) to albumin (ALB), and the progression of acute cerebral infarction (ACI).Methods:This case-control study involved 147 patients with ACI who were treated at Xingyuan Hospital of Yulin between January 2023 and March 2024. The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate disease progression. Based on the progression of the disease, the patients were divided into two groups: the progressive group ( n = 38) and the non-progressive group ( n = 109). ADPN level and the hs-CRP/ALB ratio were compared between the two groups. Additionally, multivariate logistic regression analysis was conducted to identify risk factors for disease progression in ACI patients. The predictive value of ADPN and the hs-CRP/ALB ratio for ACI was assessed using receiver operating characteristic curve analysis. Results:In the progressive group, hs-CRP level and hs-CRP/ALB ratio were (14.38 ± 3.27) mg/L and (0.43 ± 0.13), respectively, both of which were significantly higher than those in the non-progressive group [(8.92 ± 2.73) mg/L, (0.20 ± 0.07), t = 9.22, 10.37, both P < 0.001]. In contrast, the levels of ADPN and albumin in the progressive group were (2.71 ± 0.59) mg/L and (33.54 ± 8.66) g/L, respectively, both of which were significantly lower than those in the non-progressive group [(5.36 ± 1.42) mg/L, (45.05 ± 10.42) g/L, t = -15.99, -6.68, both P < 0.001]. The progressive group had higher admission NIHSS scores, a higher proportion of patients with diabetes, higher white blood cell counts, higher hemoglobin A1c (HbA1c) and fibrinogen levels compared with the non-progressive group ( t = 8.43, 2.88, 5.79, 2.77, χ2 = 4.40, all P < 0.05). Multivariate logistic regression analysis results indicated that higher admission NIHSS scores, HbA1c levels, and hs-CRP/ALB ratios were independent risk factors for disease progression in ACI patients ( OR = 2.438, 1.600, 2.971, all P < 0.05), while higher levels of ADPN were identified as a protective factor against disease progression ( OR = 0.321, P < 0.05). The receiver operating characteristic curve analysis showed that the area under the curve for predicting disease progression after admission for ACI patients using serum ADPN and hs-CRP/ALB ratio alone were 0.730 (95% CI: 0.658-0.800) and 0.758 (95% CI: 0.685-0.826), respectively. The area under the curve for the combined prediction of serum ADPN and the hs-CRP/ALB ratio was 0.895 (95% CI: 0.845-0.940), demonstrating higher predictive efficacy ( Z = 1.80, 2.13, both P < 0.05). Conclusions:ADPN level and hs-CRP/ALB ratio are closely related to the progression of ACI and demonstrate good predictive efficacy for disease progression.

Objective:To investigate the relationship between adiponectin (ADPN), the ratio of high-sensitivity C-reactive protein (hs-CRP) to albumin (ALB), and the progression of acute cerebral infarction (ACI).Methods:This case-control study involved 147 patients with ACI who were treated at Xingyuan Hospital of Yulin between January 2023 and March 2024. The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate disease progression. Based on the progression of the disease, the patients were divided into two groups: the progressive group ( n = 38) and the non-progressive group ( n = 109). ADPN level and the hs-CRP/ALB ratio were compared between the two groups. Additionally, multivariate logistic regression analysis was conducted to identify risk factors for disease progression in ACI patients. The predictive value of ADPN and the hs-CRP/ALB ratio for ACI was assessed using receiver operating characteristic curve analysis. Results:In the progressive group, hs-CRP level and hs-CRP/ALB ratio were (14.38 ± 3.27) mg/L and (0.43 ± 0.13), respectively, both of which were significantly higher than those in the non-progressive group [(8.92 ± 2.73) mg/L, (0.20 ± 0.07), t = 9.22, 10.37, both P < 0.001]. In contrast, the levels of ADPN and albumin in the progressive group were (2.71 ± 0.59) mg/L and (33.54 ± 8.66) g/L, respectively, both of which were significantly lower than those in the non-progressive group [(5.36 ± 1.42) mg/L, (45.05 ± 10.42) g/L, t = -15.99, -6.68, both P < 0.001]. The progressive group had higher admission NIHSS scores, a higher proportion of patients with diabetes, higher white blood cell counts, higher hemoglobin A1c (HbA1c) and fibrinogen levels compared with the non-progressive group ( t = 8.43, 2.88, 5.79, 2.77, χ2 = 4.40, all P < 0.05). Multivariate logistic regression analysis results indicated that higher admission NIHSS scores, HbA1c levels, and hs-CRP/ALB ratios were independent risk factors for disease progression in ACI patients ( OR = 2.438, 1.600, 2.971, all P < 0.05), while higher levels of ADPN were identified as a protective factor against disease progression ( OR = 0.321, P < 0.05). The receiver operating characteristic curve analysis showed that the area under the curve for predicting disease progression after admission for ACI patients using serum ADPN and hs-CRP/ALB ratio alone were 0.730 (95% CI: 0.658-0.800) and 0.758 (95% CI: 0.685-0.826), respectively. The area under the curve for the combined prediction of serum ADPN and the hs-CRP/ALB ratio was 0.895 (95% CI: 0.845-0.940), demonstrating higher predictive efficacy ( Z = 1.80, 2.13, both P < 0.05). Conclusions:ADPN level and hs-CRP/ALB ratio are closely related to the progression of ACI and demonstrate good predictive efficacy for disease progression.

Objective To construct an evaluation index system of core competence of assisted reproductive technology specialist nurses,and to conduct preliminary validation,so as to provide reference standards for the training and evaluation of assisted reproductive technology specialist nurses.Methods Based on the core competence of specialist nurses of the International Council of Nurses and the Hamric Advanced Practice Nurse competence framework as the theoretical framework,through literature research and research group discussion,the core competence index of specialist nurses in assisted reproductive technology was preliminarily established.A total of 23 experts were consulted with 2 rounds of Delphi method to complete index and determine weight coefficients in April 2024.In August 2024,50 assisted reproductive technology specialist nurses from 18 provinces and cities across the country were selected to conduct a satisfaction survey on the evaluation index system,in order to preliminarily verify the application effect of indicators.Results The questionnaire recovery rates for 2 rounds of expert consultations were both 100％,and the expert authority coefficients were both 0.943.The coefficient of variation was 0～0.287 and 0～0.236,and the Kendall harmony coefficient was 0.241～0.337 and 0.250～0.431,respectively.The final evaluation index of core competence of assisted reproductive technology specialist nurses included 6 first-level indicators,20 second-level indicators and 57 third-level indicators.Assisted reproductive technology specialist nurses were satisfied with the evaluation index system of core competence,with a score of(18.26±2.52).Conclusion The evaluation index system of core competence of assisted reproductive technology specialist nurses is practical,with comprehensive content and outstanding professional characteristics.

Structural and functional explorations on bio-soft matter such as micelles,vesicles,nanoparticles,ag-gregates or polymers derived from traditional Chinese medicine(TCM)has emerged as a new topic in the field of TCM.The discovery of such cross-scaled bio-soft matter may provide a unique perspective for unraveling the new effective material basis of TCM as well as developing innovative medicine and biomaterials.Despite the rapid rise of TCM-derived bio-soft matter,their hierarchical structure and as-sembly mechanism must be unambiguously probed for a further in-depth understanding of their pharmacological activity.In this review,the current emerged TCM-derived bio-soft matter assembled from either small molecules or macromolecules is introduced,and particularly the unambiguous elucidation of their hierarchical structure and assembly mechanism with combined electron microscopic and spectroscopic techniques is depicted.The pros and cons of each technique are also discussed.The future challenges and perspective of TCM-derived bio-soft matter are outlined,particularly the requirement for their precise in situ structural determination is highlighted.