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.

Through an in-depth exploration on dimensions of the value implications， inheritance challenges， and countermeasure paths of the red doctor culture， this paper systematically analyzed its historical origin and connotation， emphasizing its unique position in revolutionary history and significant value in the new era. Examining the challenges confronting the inheritance of the red doctor culture against the backdrop such as the rapid development of modern science and technology， changes in the social environment， weakened public cognition， and restricted dissemination channels， a three-dimensional countermeasure framework of “coordination， integration， and transformation” was proposed for the inheritance of the red doctor culture. This countermeasure included coordinating the layout to construct a systematic inheritance system， deepening integration to realize the innovation of educational inheritance， and transforming and empowering to embed and reconstruct the inheritance paradigm with modern thinking. The aim was to activate the vitality of the red doctor culture and promote its practical application and innovative development in contemporary medical and health undertakings.

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.

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.

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:To investigate the application value of gastric suspension method in supra-pancreatic lymph node dissection of laparoscopic radical gastrectomy of gastric cancer.Method:The retrospective cohort study was conducted. The clinicopathological data of 84 patients who under-went laparoscopic radical gastrectomy of gastric cancer at Zhejiang Cancer Hospital from August 2023 to July 2024 were collected. There were 61 males and 23 females, aged (64±11)years. Of the 84 patients, 42 patients undergoing supra-pancreatic lymph node dissection during laparoscopic radical gastrectomy of gastric cancer with traditional method for surgical field exposure were divided into the control group, and 42 patients undergoing supra-pancreatic lymph node dissection during laparoscopic radical gastrectomy of gastric cancer with gastric suspension method for surgical field exposure were divided into the suspension group. Observation indicators: (1) surgical conditions; (2) postoperative conditions. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test. Results:(1) Surgical condi-tions. The time for supra-pancreatic lymph node dissection of the control group was (78±14)minutes. Number of grasping operations was 116±34, number of bleeding sites caused by grasping operations was 7.8±2.7, and operation time was (3.9±0.8)hours. The above indicators of the suspension group were (59±12)minutes, 68±19, 2.1±1.5, and (3.3±0.7)hours, respectively. There were significant diffe-rences in the above indicators between the two groups ( t=5.42, 8.10, 8.31, 3.14, P<0.05). (2) Post-operative conditions. The tumor diameter was 2.5(2.0,3.5)cm for patients of the control group, versus 3.0(2.4, 4.4)cm for patients of the suspension group, showing a significant difference between the two groups ( Z=-1.98, P<0.05). Conclusion:Compared with the traditional non-suspension method, the gastric suspension method in laparoscopic radical gastrectomy of gastric cancer for supra-pancreatic lymph node dissection is associated with shorter operation time and less trauma.

Objective:To investigate the application value of gastric suspension method in supra-pancreatic lymph node dissection of laparoscopic radical gastrectomy of gastric cancer.Method:The retrospective cohort study was conducted. The clinicopathological data of 84 patients who under-went laparoscopic radical gastrectomy of gastric cancer at Zhejiang Cancer Hospital from August 2023 to July 2024 were collected. There were 61 males and 23 females, aged (64±11)years. Of the 84 patients, 42 patients undergoing supra-pancreatic lymph node dissection during laparoscopic radical gastrectomy of gastric cancer with traditional method for surgical field exposure were divided into the control group, and 42 patients undergoing supra-pancreatic lymph node dissection during laparoscopic radical gastrectomy of gastric cancer with gastric suspension method for surgical field exposure were divided into the suspension group. Observation indicators: (1) surgical conditions; (2) postoperative conditions. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test. Results:(1) Surgical condi-tions. The time for supra-pancreatic lymph node dissection of the control group was (78±14)minutes. Number of grasping operations was 116±34, number of bleeding sites caused by grasping operations was 7.8±2.7, and operation time was (3.9±0.8)hours. The above indicators of the suspension group were (59±12)minutes, 68±19, 2.1±1.5, and (3.3±0.7)hours, respectively. There were significant diffe-rences in the above indicators between the two groups ( t=5.42, 8.10, 8.31, 3.14, P<0.05). (2) Post-operative conditions. The tumor diameter was 2.5(2.0,3.5)cm for patients of the control group, versus 3.0(2.4, 4.4)cm for patients of the suspension group, showing a significant difference between the two groups ( Z=-1.98, P<0.05). Conclusion:Compared with the traditional non-suspension method, the gastric suspension method in laparoscopic radical gastrectomy of gastric cancer for supra-pancreatic lymph node dissection is associated with shorter operation time and less trauma.

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.