Clinical death refers to the permanent cessation of life functions. This article reviews the definition of clinical death and the various scenarios in which it occurs, classifies the process of clinical death, and discusses the criteria for determining uncontrollable cardiac death, controllable cardiac death and the criteria and workflow for determining brain death. It elaborates on the relationship between brain death and death, and proposes the areas to note when standardizing the medical documentation of death cases. Based on this, it introduces the content of the management system and workflow construction for death determination in medical institutions, including management structure, personnel qualifications, document norms, quality control system and training mechanism. Paying attention to the construction of the management system and workflow for death determination in medical institutions is of great significance for ensuring medical quality and safety, promoting the healthy development of organ donation, and maintaining the seriousness of legal and ethical practices.

Objective To analyze the influenza-like illness (ILI) data in Ordos City from 2017 to 2023 and conduct nucleic acid detection of the virus to understand the local influenza epidemic situation, and to provide a reliable basis for influenza prevention and control in the city. Methods Real-time quantitative polymerase chain reaction (qPCR) was used to identify virus subtypes in ILI throat swab samples. Comparisons of positive rates were conducted using the chi-square test, with a significance level of α=0.05. Results From 2017 to 2023, a total of 3,283,434 outpatient and emergency visits were recorded at the Ordos City Central Hospital, including 74,159 ILI cases, with an ILI proportion of 2.26%. The majority of ILI cases (74.43%) occurred in children aged 0~14 years old. The overall positive rate of influenza virus nucleic acid detection was 10.87%, with the highest proportion being subtype A (seasonal H3) at 43.03%. The highest detection rate was observed in the 5~14 years age group, with statistically significant differences in positive rates across age groups (χ²=155.638, P<0.001). Influenza peaks occurred mainly from November to March of the following year. From January to April, three types of influenza were prevalent alternately or mixed, while from October to December, subtype A (seasonal H3) predominated. Positive rates varied significantly across months (χ²=250.923, P<0.001). The temporal trends of ILI proportions and PCR-positive rates were consistent. Conclusion Influenza in Ordos City exhibits distinct seasonal and age distribution characteristics, with alternating or mixed circulation of three virus types. Continued efforts are needed to strengthen influenza surveillance, especially the prevention and control of influenza in infants and adolescents.

As a pivotal strategy to alleviate the shortage of organ donors, xenotransplantation has achieved remarkable advances in both pre-clinical and clinical studies in recent years, driven by continuous optimization of gene modification techniques and immunosuppressive regimens. Nevertheless, clinical translation still confronts formidable challenges, including rejection and heightened infection risks, which severely compromise long-term graft survival. Consequently, the role of immunosuppressive regimens in xenotransplantation has become increasingly prominent. This article summarizes the mechanisms underlying xenogeneic immune rejection, the latest developments in immunosuppressive regimens, cutting-edge strategies for inducing immune tolerance and the major hurdles facing clinical xenotransplantation. It delves into potential optimization strategies and directions for future clinical research, aiming to offer theoretical insights and practical guidance for the safe and effective application of clinical xenotransplantation.

OBJECTIVE To conduct a clinical comprehensive evaluation of five marketed thrombopoietin receptor agonists （TPO-RA） approved in China， providing quantitative evidence for drug selection and therapeutic decision-making in medical institutions. METHODS Relevant data on Romiplostim for injection， Eltrombopag olamine tablets， Herombopag olamine tablets， Avatrombopag maleate tablets， and Lusutrombopag tablets were collected. Based on the Chinese Rapid Guide for Drug Evaluation and Selection in Medical Institutions （Second Edition）， 12 formulations of these five TPO-RA were scored quantitatively and comparatively across five dimensions： pharmacological characteristics， efficacy， safety， cost-effectiveness， and other attributes. RESULTS The comprehensive scores of the 12 formulations ranged from 62.56 to 75.50 points， with most scoring ≥70 points. Using the highest-scoring formulation for each generic name as a representative， the overall rankings of the five TPO-RA were as follows： Lusutrombopag tablets （75.50 points）， Eltrombopag olamine tablets （75.10 points）， Avatrombopag maleate tablets （70.40 points）， Romiplostim for injection （63.93 points）， and Herombopag olamine tablets （63.52 points）. Lusutrombopag tablets scored relatively high in pharmacological characteristics， safety， and cost-effectiveness， while Eltrombopag olamine tablets performed well in efficacy and cost-effectiveness. The other formulations showed varying scores across evaluation dimensions. CONCLUSIONS The five TPO-RA demonstrate favorable overall clinical value， with Lusutrombopag tablets and Eltrombopag olamine tablets ranking higher in comprehensive scores， these two drugs should be prioritized in drug selection and formula optimization by medical institutions.

AIM: To analyze the changes in binocular visual function before and after small incision lenticule extraction(SMILE)in patients with different degrees of myopia.METHODS:A prospective non-randomized controlled study was conducted. A total of 94 patients(188 eyes)who visited the refractive outpatient department of the ophthalmology department of the General Hospital of the PLA from June 2022 to June 2023 and voluntarily chose SMILE were consecutively included. They were grouped according to the degree of myopia, including 24 cases(48 eyes)in the low myopia group(-3.00 D

This consensus will introduce the characteristics of fillers used in the surgical cavities of domestic nasal surgery patients based on relevant literature and expert opinions. It will also provide recommendations for the selection of cavity fillers for different nasal diseases, with chronic sinusitis as a representative example.
Humans ; Nasal Cavity/surgery* ; Nasal Surgical Procedures ; China ; Consensus ; Sinusitis/surgery* ; Dermal Fillers

Objective:To summarize and investigate the ultrasound manifestations, clinical characteristics, causes, and prognosis of hepatic portal vein gas (HPVG) after liver transplantation in children.Methods:A case series study. Clinical data of 9 pediatric recipients diagnosed with HPVG by ultrasound after liver transplantation between January 2012 and August 2023 were collected, and the ultrasound manifestations, causes, clinical features, and prognosis of HPVG were analyzed.Results:A total of 1,850 pediatric liver transplantations were performed during the same period in Tianjin First Central Hospital, among which 9 cases (0.48%) developed HPVG; 6 cases occurred within 1 month after surgery, and 3 cases occurred more than 1 month after surgery; the duration ranged from 2 to 15 days, with a median of 7 (4.5, 9.0) days. HPVG was first detected by ultrasound in all cases, with common ultrasound manifestations including bubble-like or punctate strong echoes flowing with blood in the portal vein, and patchy strong echoes with unclear borders in the liver parenchyma. Among the 9 patients, 3 had diarrhea with intestinal flora imbalance, 2 had abdominal distension with incomplete intestinal obstruction, 1 had colonic fistula with repeated replacement of Li's tube and concurrent abdominal distension, 1 was experiencing acute T-cell-mediated rejection of the transplanted liver, and the remaining 2 were asymptomatic. Patients with diarrhea and intestinal dysbiosis were treated with Bifidobacterium Lactobacillus triple viable tablets to regulate flora and montmorillonite powder to relieve diarrhea, which gradually subsided. Patients with abdominal distension and incomplete intestinal obstruction were treated with fasting, intravenous nutrition, and enema, and the obstruction gradually resolved, along with disappearance of HPVG.Conclusion:HPVG after liver transplantation has characteristic ultrasound manifestations, and its occurrence may be related to intestinal gas, obstruction, dysbiosis, or mucosal damage. Treatment may be conservative or surgical depending on the underlying cause and severity.

This report presents two cases of penicillium marneffei infection occurring after kidney transplantation. Both recipients presented initially with gastrointestinal symptoms and were diagnosed early by metagenomic next generation sequencing (mNGS). Treatment included amphotericin B combined with voriconazole, adjustment of immunosuppressive therapy, and nutritional support, resulting in favorable outcomes. This study aims to characterize the clinical presentation, diagnostic challenges, and individualized treatment strategies for penicillium marneffei infection in kidney transplant recipients, providing valuable insights for clinical management.

Objective The aim of this study was to investigate the microbiological characteristics and antimicrobial resistance of Nocardia isolates in Hebei Province during the 9-year period.Methods The medical records of all hospitalized patients from whom Nocardia was isolated from 2015 to 2023 were analyzed retrospectively.The isolates were identified to the species level by amplification and sequencing of 16S rRNA,secA1 and ropB genes of Nocardia.Antimicrobial susceptibility of Nocardia isolates were tested by microbroth dilution method.Results Of the 162 strains of Nocardia,128(79.0％)were isolated from respiratory tract specimens,followed by skin and soft tissue infection(25/162,15.4％).Most of the patients with respiratory tract infection were elderly(＞65 years old).Most of the patients with skin and soft tissue infection were middle-aged and elderly(＞45 years old).Twelve species were identified among the 162 isolates.The most common species were N.cyriacigeorgica(36.4％,59/162),N.farcinica(25.3％,41/162),and N.otitidiscaviarum(9.9％,16/162).The most common Nocardia species isolated from the respiratory tract was N.cyriacigeorgica,followed by N.farcinica.The most common species causing skin and soft tissue infection were N.cyriacigeorgica,N.farcinica and N.brasiliensis.All Nocardia strains were susceptible to linezolid,followed by 98.8％susceptible to amikacin and 98.1％susceptible to trimethoprim-sulfamethoxazole(TMP-SMZ).Conclusions Nocardia is mainly isolated from respiratory tract,skin and soft tissues.N.cyriacigeorgica and N.farcinica are the most prevalent species.TMP-SMZ is the first choice for treatment of nocardiosis.Combination therapy may be appropriate for moderate and severe infections according to the results of antimicrobial susceptibility testing.

Objective To explore the influence of nicorandil and tirofiban on coronary microcircula-tion and myocardial remodeling in patients with acute myocardial infarction(AMI)after percuta-neous coronary intervention(PCI).Methods A total of 118 AMI patients undergoing PCI in our hospital from January 2020 to January 2024 were enrolled,and divided into nicorandil group(n=39,nicorandil on the basis of routine treatment),tirofiban group(n=37,tirofiban on the basis of routine treatment)and combined group(n=42,nicorandil and tirofiban on the basis of routine treatment)according to their treatment regimens.The levels of the coagulation-related factors,coronary microcirculation indicators,microvascular function,myocardial remodeling indicators,oxidative stress indicators and major adverse cardiovascular events were compared among the three groups.Results In 7 d after PCI,prothrombin time(PT)value,activated partial prothrom-bin time(APTT),left ventricular ejection fraction(LVEF)value and serum levels of von Wille-brand factor(vWF),tissue factor(TF)and superoxide dismutase(SOD)were increased,while in-dex of microcirculatory resistance(IMR),left ventricular end-systolic volume(LVESV)value,left ventricular end-diastolic volume(LVEDV)value and serum endothelin(ET)level were de-creased in the three groups when compared with the corresponding levels before surgery(P＜0.05).At the time point,the combined group had higher LVEF value and serum levels of vWF,TF and SOD,while lower IMR,LVESV and LVEDV values and serum ET level when compared to the nicorandil group and tirofiban group(P＜0.05).The incidence of reperfusion arrhythmia(2.38％vs 16.22％and 15.38％,P＜0.05),incidence of angina pectoris within 6 months after surger-y(2.38％vs 18.92％and 15.38％,P＜0.05),and readmission rate of heart failure(2.38％vs 16.22％and 17.95％,P＜0.05)were notably lower in the combined group than the other two groups(P＜0.05).Conclusion For AMI patients after PCI,combination of nicorandil and tirofi-ban can effectively improve the postoperative coronary microcirculation,promote myocardial re-modeling,improve body's oxidative stress status and vascular endothelial function,and reduce the occurrence of cardiovascular adverse events.