Narrative medicine focuses on empathy， relevance， and emotion， precisely aligning with the elements of “clown doctor” such as compassion， interaction， and pain relief. From the perspective of narrative medicine， the practice of “clown doctors” not only focuses on the emotional changes of patients but also enhances their sense of belonging by recreating their experiences. The key element for the success of “clown doctors” lies in establishing a multi-dimensional trust relationship among medical workers， patients， colleagues， and society， while ensuring their practice adheres to medical ethics norms. “Clown doctors” should concentrate on dimensions such as concept dissemination， clinical application， social recognition， and ethical practice of narrative medicine. They should also constantly optimize narrative techniques， deepen the understanding of patients’ stories， and intervene in the medical process in a more delicate and comprehensive way， thereby fostering in-depth communication and understanding between doctors and patients.

Objective To investigate the value of split-bolus dual-phase contrast-enhanced computed tomography (CT) in preoperative staging of clear cell renal cell carcinoma (ccRCC), and to analyze its effect on radiation dose. Methods From June 2021 to July 2024, 118 patients with suspected renal space occupying lesions admitted to Changsha Fourth Hospital were initially selected. Using a random number table, these patients were assigned to a single-bolus group (single-bolus three-phase enhancement program) and a split-bolus group (split-bolus dual-phase enhancement program), with 59 patients in each group. According to the postoperative pathological results, 100 patients with ccRCC were selected as the study subjects, including 48 patients in the single-bolus group and 52 patients in the split-bolus group. The CT values of ccRCC tissues in various phases were compared between the two groups. The accuracy of preoperative ccRCC staging was analyzed using postoperative pathological staging as the gold standard, and the effective dose (ED) was compared between the two groups. Results There was no significant difference in ccRCC staging between the two groups (P > 0.05). The CT value in the parenchyma-excretion phase of the split-bolus group was (88.24 ± 18.34) HU, which was lower than that of the single-bolus group in the parenchyma phase [(102.43 ± 20.66) HU, P < 0.05]. The accuracy of preoperative staging of ccRCC was 86.54% in the split-bolus group, which was not significantly different from 87.50% in the single-bolus group (P > 0.05). The mean ED was (14.54 ± 1.42) mSv in the split-bolus group, which was lower than (20.43 ± 1.18) mSv in the single-bolus group (P < 0.05). Compared with the single-bolus group, the ED of the split-bolus group decreased by 28.83%. Conclusion Split-bolus dual-phase contrast-enhanced CT provides similar accuracy compared to single-bolus CT in evaluating the preoperative staging of ccRCC, and can reduce the radiation dose.

Antibody-drug conjugates (ADCs) are antitumor drugs composed of monoclonal antibodies and cytotoxic payload covalently coupled by a linker. Currently, 15 ADCs have been clinically approved worldwide. More than 100 clinical trials at different phases are underway to investigate the newly developed ADCs. ADCs represent one of the fastest growing classes of targeted antitumor drugs in oncology drug development. It takes advantage of the specific targeting of tumor-specific antigen by antibodies to deliver cytotoxic chemotherapeutic drugs precisely to tumor cells, thereby producing promising antitumor efficacy and favorable adverse effect profiles. However, emergence of drug resistance has severely hindered the clinical efficacy of ADCs. In this review, we introduce the structure and mechanism of ADCs, describe the development of ADCs, summarized the latest research about the mechanisms of ADC resistance, discussed the strategies to overcome ADCs resistance, and predicted biomarkers for treatment response to ADC, aiming to contribute to the development of ADCs in the future.

Although a single nucleotide polymorphism for N-acetyltransferase 10 (NAT10) has been identified in patients with early-onset stroke, the role of NAT10 in ischemic injury and the related underlying mechanisms remains elusive. Here, we provide evidence that NAT10, the only known RNA N4-acetylcytidine (ac4C) modification "writer", is increased in the damaged cortex of patients with acute ischemic stroke and the peri-infarct cortex of mice subjected to photothrombotic (PT) stroke. Pharmacological inhibition of NAT10 with remodelin on Days 3-7 post-stroke or astrocytic depletion of NAT10 via targeted virus attenuates ischemia-induced infarction and improves functional recovery in PT mice. Mechanistically, NAT10 enhances ac4C acetylation of the inflammatory cytokine tissue inhibitor of metalloproteinase 1 (Timp1) mRNA transcript, which increases TIMP1 expression and results in the accumulation of microtubule-associated protein 1 light chain 3 (LC3) and progression of astrocyte autophagy. These findings demonstrate that NAT10 regulates astrocyte autophagy by targeting Timp1 ac4C after stroke. This study highlights the critical role of ac4C in the regulation of astrocyte autophagy and proposes a promising strategy to improve post-stroke outcomes via NAT10 inhibition.

OBJECTIVE: This study reports the first imported case of Lassa fever (LF) in China. Laboratory detection and molecular epidemiological analysis of the Lassa virus (LASV) from this case offer valuable insights for the prevention and control of LF. METHODS: Samples of cerebrospinal fluid (CSF), blood, urine, saliva, and environmental materials were collected from the patient and their close contacts for LASV nucleotide detection. Whole-genome sequencing was performed on positive samples to analyze the genetic characteristics of the virus. RESULTS: LASV was detected in the patient's CSF, blood, and urine, while all samples from close contacts and the environment tested negative. The virus belongs to the lineage IV strain and shares the highest homology with strains from Sierra Leone. The variability in the glycoprotein complex (GPC) among different strains ranged from 3.9% to 15.1%, higher than previously reported for the seven known lineages. Amino acid mutation analysis revealed multiple mutations within the GPC immunogenic epitopes, increasing strain diversity and potentially impacting immune response. CONCLUSION The case was confirmed through nucleotide detection, with no evidence of secondary transmission or viral spread. The LASV strain identified belongs to lineage IV, with broader GPC variability than previously reported. Mutations in the immune-related sites of GPC may affect immune responses, necessitating heightened vigilance regarding the virus.
Humans ; China/epidemiology* ; Genome, Viral ; Lassa Fever/virology* ; Lassa virus/classification* ; Molecular Epidemiology ; Phylogeny

Objective To investigate the application value of 320-slice wide-detector multi-phase left at-rial appendage computed tomography angiography(LAA-CTA)with pulmonary artery(PA)monitoring in the preoperative evaluation of left atrial appendage closure.Methods A retrospective analysis was conducted on the clinical data of 110 patients who underwent LAA-CTA before left atrial appendage closure.Among them,47 patients underwent single-phase enhanced scanning with superior vena cava(SVC)monitoring(con-trol group),and 63 patients underwent multi-phase enhanced scanning with pulmonary artery monitoring(study group).The differences in imaging effects of the left atrial appendage under different monitoring points and phase imaging methods were compared,as well as the accuracy of comparing with the diagnostic results of transesophageal ultrasound(TEE),and the differences in the presentation of thrombus,perithrombus,and hypoperfusion areas in the left atrial appendage.Results The study group could comprehensively display the multi-phase CT value changes of different components(thrombus,peri-thrombotic viscosity,normal blood)within the left atrial appendage cavity,and its evaluation of lesion size and progression was superior to that of the control group.Using TEE as the gold standard,the study group demonstrated better diagnostic ac-curacy for different components and normal regions within the left atrial appendage cavity compared to the control group(P<0.001).Additionally,the study group improved the detection rate of peri-thrombotic vis-cosity,clearly delineated thrombus boundaries,and enhanced diagnostic accuracy(P<0.001).Conclusion Multi-phase LAA-CTA with pulmonary artery monitoring can effectively evaluate the morphological dimensions,thrombus,and peri-thrombotic CT manifestations of the left atrial appendage.It is simple to operate,with an accuracy rate close to the gold standard,providing reliable imaging evidence for preoperative evaluation of left atrial appendage closure.

Facing the opportunities and challenges of pediatric education in the situation of talent emergency, this article aims to present the history of pediatric education development, offer considerations in pediatric talent cultivation from the perspective of the government, society/industry, and school in current social contexts, and provide ideas about seeking a path that can not only address the talent dilemma but also nurture pediatric talents in accordance with educational attributes. Strategies for the development of pediatric education should be guided by values and highlight child development as a priority; macro-regulate the number of enrollments based on the demand for pediatric care; and improve teaching curricula according to the development direction of the discipline. We hope to provide theoretical support for the future development of pediatric education as well as the cultivation of pediatric talents and high-quality development of child health in China.

Abstract OBJECTIVE To analyze the differences in adverse drug reactions between newborns using medium/long chain fat emulsions and multiple types of oil fat emulsions, and to explore potential risk factors. METHODS A retrospective cohort study was conducted using data from newborns who used medium/long chain fat emulsions or multiple oil fat emulsions from January 2020 to June 2023. The China Hospital Pharmacovigilance System(CHPS) was used to retrieve adverse reaction information and evaluate it. Four hundred and ninety-nine newborns in the medium/long chain fat emulsion group and 1 940 newborns in the multiple oil fat emulsion group were included. Using logistic regression and stratified analysis to explore the safety differences between groups and the risk factors that affect the occurrence of adverse reactions. RESULTS The total incidence of adverse reactions in the medium/long chain fat emulsion group was 19.24%, with common adverse reactions including fever(5.81%), decreased hemoglobin(3.01%), increased blood pressure(2.40%) and hypoglycemia(2.40%); The total incidence of adverse reactions in the group of multiple oil fat emulsions was 36.44%, with a very common adverse reaction being fever(10.57%); common adverse reactions include decreased hemoglobin(8.97%), decreased blood pressure(3.20%), and increased blood pressure(3.09%); rare adverse reactions include liver dysfunction(0.05%), splenomegaly(0.05%) and cyanosis (0.05%). In univariate analysis, the risk of fever, decreased hemoglobin, and increased blood sugar in the group of multiple oil fat emulsions was higher than that in the medium/long chain fat emulsion group(P<0.05), but this association did not show statistical differences in the overall multivariate analysis. Furthermore, a stratified factor analysis based on gestational age found that the risk of fever and decreased hemoglobin in the group of multiple oil fat emulsions was significantly higher than that in the medium/long chain fat emulsion group in extremely premature infants. The corresponding OR(95%CI) were 6.437(1.327, 31.227) and 5.066(1.089, 23.570), respectively, with no significant differences observed in other gestational age stratification. CONCLUSION The risk of using medium/long chain fat emulsions in newborns is similar to that of using multiple types of oil fat emulsions. However, in extremely premature infants, the risk of fever and decreased hemoglobin in multiple types of oil fat emulsions is higher than that in medium/long chain fat emulsions. It is recommended to regularly monitor indicators such as body temperature, hemoglobin, and blood pressure, and do a good job in drug vigilance.

Objective:To compare the prenatal diagnosis and pregnancy outcome of increased nuchal translucency (NT) with or without nuchal cystic hygroma (CH) in fetuses with first-trimester NT ≥5 mm.Methods:Data from 131 fetuses with NT ≥5 mm who received invasive prenatal diagnosis at Guangzhou Women and Children's Medical Center from July 2017 to December 2020 were retrospectively collected and analyzed. Those with a septum in the cyst were grouped as NT with CH group ( n=57), and those without as increased NT without CH group ( n=74). Genetic test results, incidence of structural malformations, survival rate after birth were compared using Chi-square test or Fisher's exact test and non-parametric test. Results:There was no significant difference in the incidence of fetal genetic abnormalities[67.6%(50/74) vs 61.4%(35/57), χ 2=0.54, P=0.464], ultrasonic structural malformations [21.6%(16/74) vs 33.3%(19/57), χ 2=2.26, P=0.133], or in the survival rate (12/14 vs 3/8, P=0.053) between increased NT without CH group and NT with CH group. Conclusions:For increased NT with or without CH, although the two groups had different spectrum of disease, they had a high incidence of chromosomal abnormalities and structural malformations, and both groups had a certain healthy survival rate after birth.

Objective: To explore the relationship of physical activity and sedentary leisure time with muscle mass, strength, and quality in Chinese adults. Methods: Based on the second resurvey of China Kadoorie Biobank (CKB) in 2013-2014, logistic regression models were used to analyze the correlation of physical activity and sedentary leisure time with low muscle mass, grip strength, and muscle quality. Results: A total of 24 245 participants were included in the analysis. The average daily physical activity level was (18.3±13.8) MET-h/d, and the sedentary leisure time was (4.4±1.9) hours. We took the lowest physical activity quartile as the reference and found that the participants' physical activity was negatively correlated to low muscle mass, strength, and quality. The ORs (95%CIs) of low appendicular skeletal muscle mass index (ASMI), low total skeletal muscle mass index (TSMI), low grip strength and low arm muscle quality (AMQ) were 0.68 (0.60-0.77), 0.66 (0.58-0.75), 0.82 (0.72-0.94) and 0.84 (0.74-0.95), respectively. The subtypes of physical activity, including those related to work, transportation, housework, and leisure, also showed negative correlations with low muscle mass, strength, and quality to varying degrees. Compared with participants with the shortest sedentary leisure time, those who had the longest were more likely to have low TSMI (OR=1.13, 95%CI: 0.99-1.30). Conclusions: Physical activity was negatively correlated with a lower risk of low muscle mass and strength, while longer sedentary leisure time positively correlated with low muscle mass.
Adult ; China ; Exercise ; Humans ; Leisure Activities ; Muscles ; Sedentary Behavior