With the rapid advancement of medical technology and the increasing complexity of clinical environments, competence in clinical ethical decision-making has become an indispensable core competency for exemplary physicians. However, traditional medical ethics education has long been confronted with the persistent challenges of theory-practice dissociation and the disconnect between pedagogical settings and clinical realities. Thus, how to construct a "Clinical Ethics" curriculum that aligns with the objectives of training high-caliber medical professionals has emerged as a critical and challenging issue in current medical education reform. To effectively address this challenge, the Office of Education at Peking University Third Hospital, since 2021, has assembled a multidisciplinary "Clinical Ethics" teaching and management team comprising faculty from Peking University School of Humanities and key clinical specialists from the hospital. In 2022, the "Clinical Ethics" elective course was formally launched for fourth-year students in the eight-year MD program who had completed coursework in "Medical Ethics" and organ-system-based curricula, with the aim of exploring and operationalizing a pre-clinical ethics education model tailored for senior medical students. The course employs a modular instructional design encompassing "theoretical review-case-based deliberation-clinical workshop", which effectively facilitates the deep integration of medical humanities with clinical practice.Following four years of iterative refinement through the "plan-act-observe-reflect" cycle, the course has demonstrated positive outcomes in enhancing students' ethical awareness and decision-making capabilities, and has preliminarily established a sustainable collaborative mechanism among the multidisciplinary faculty team. This article systematically delineates the course development background, pedagogical model and methodological innovations, and the multidisciplinary collaborative framework, alongside reflections and summaries based on implementation outcomes, with the intent of providing references for the future development of "Clinical Ethics" curricula.

An effective method for simultaneously detecting four semivolatile earthy-musty odors in freshwater fish by gas chromatography-mass spectrometry(GC-MS)was developed.The concurrent extraction of geosmin(GSM),2-methylisoborneol(MIB),2-isopropyl-3-methoxypyrazine(IPMP),and 2-isobutyl-3-methoxypyrazine(IBMP)in fish tissue was conducted with n-hexane.The optimized QuEChERS material was implemented,and it was found that C18,primary secondary amine(PSA)and MgSO4 could adsorb the target analytes in n-hexane.So only the graphitized carbon black(GCB)could be used to purify the extraction.The adsorption rates of different materials for the four kinds of odors materials were explored in n-hexane and ethyl acetate.The experimental results revealed that the adsorption rates of silica for the four targets were 99.5%-100%in n-hexane and 0.7%-5.0%in ethyl acetate respectively.Then the silica solid phase extraction(SPE)method was utilized to eluent the compounds using 1.0 mL n-hexane/ethyl acetate in different proportions.The results of the comparative analysis demonstrated that n-hexane/ethyl acetate(4∶1,V/V)was the optimized eluent.Based on the obtained results,n-hexane extraction and GCB purification combined with silica SPE were used to isolate GSM,MIB,IPMP and IBMP from fish and the method was validated.It was found that the method showed good linearity in the range of 0.5-200 ng/mL,and with detection limits of 0.6 μg/kg for GSM and MIB,0.2 μg/kg for IPMP and IBMP.The limits of quantitation(LOQ)were 1.0 μg/kg for GSM and MIB,0.6 μg/kg for IPMP and IBMP.Good recoveries(77.5%-112.0%)and relative standard deviations(1.56%-9.42%)were also obtained.The use of silica SPE greatly mitigated the issue that the off-flavor compounds were easily lost in the gas blowing concentration process.There was no cross contamination in this method because the sample pretreatments were conducted separately,which was different with the most commonly used HS-SPME method for detecting semi-volatile substances.The sensitivity of this method was high enough to produce good quantitative results below the odor thresholds of the examined off-flavor compounds.

Objective:To evaluate the clinical outcomes of right vertical infra-axillary thoracotomy technique (RVIAT) versus traditional median sternotomy (MS) for ventricular septal defect (VSD) repair in infants weighing ≤5 kg.The study further investigates the safety and feasibility of these two surgical approaches.Methods:Retrospective case-series study.Three hundred and fourteen children weighing no more than 5 kg who received VSD repair in Fuwai Central China Cardiovascular Hospital from January 2020 to June 2024 were analysized.Of these children, 252 cases who underwent RVIAT were included in the RVIAT group, and 62 cases who received traditional MS were classified as the MS group.Clinical data such as day age, body mass, the VSD type and diameter were compared between the 2 groups.The operation time, extracorporeal circulation time, block and postoperative mechanical ventilation time, intensive care unit (ICU) treatment time, 24-hour postoperative chest drainage volume and intraoperative bleeding, postoperative secondary intubation, and cardiac arrhythmia of the 2 groups of patients were recorded.Children with unstable blood pressure and active bleeding after taking vasoactive and hemostatic drugs underwent a secondary surgery.The peak airway pressure, oxygenation index, and lung dynamic compliance of the 2 groups of children were recorded before chest opening, immediately after surgery, and 24 hours after surgery. t test, χ2 test and rank sum test were used to compare the clinical data, perioperative results, complications and lung function data of the two groups. Results:(1) No significant differences were observed between the two groups in gender, age, body mass, VSD type and diameter, preoperative pneumonia, and mechanical ventilation rate (all P>0.05).(2) One-stage VSD repair was successfully completed in all cases.In the MS group, 1 infant required a secondary surgery for pericardial tamponade due to excessive bleeding.In the RVIAT group, 1 case necessitated a secondary surgery for third-degree atrioventricular block.Two cases in the MS group and 3 cases in the RVIAT group suffered postoperative arrhythmia, all of who supplemented electrolytes, received a secondary surgery to remove patches and adjust suture positions, and took antiarrhythmic drugs to restore sinus rhythm.(3) The operation time [(137.4±9.1) minutes], hospital stay [(8.2±2.1) days], postoperative mechanical ventilation time [8.0 (6.0, 13.0) hours], postoperative ICU stay [2.9 (2.0, 3.6) days], 24-hour postoperative chest drainage volume [(11.3±1.2) mL], intraoperative bleeding [(11.6±1.2) mL], and hospital costs [(70±7) thousand yuan], the postoperative incidence of incision infection [0.4%(1/252)] and the postoperative incidence of sternal malformation (0) in the RVIAT group were significantly lower than those in the MS group [(151.9±20.2) minutes, (13.1±1.7) days, 12.0 (9.0, 15.0) hours, 2.9 (2.5, 3.7) days, (14.3±1.6) mL, (15.8±2.0) mL, (78±4) thousand yuan, 4.8%(3/62), and 4.8%(3/62), respectively] (all P<0.05).There was no significant difference in extracorporeal circulation time, aortic occlusion time, postoperative arrhythmia rate, residual shunt, and atelectasis between the two groups (all P>0.05).(4) The peak airway pressure, oxygenation index and lung dynamic compliance before chest opening, immediately after surgery, and 24 hours after surgery did not differ significantly between the two groups (all P>0.05). Conclusions:In infants with low body mass (≤5 kg), RVIAT for VSD repair offers good exposure through a small incision, capable of reducing operation time, intraoperative bleeding, postoperative hospital stay, and hospital costs, and facilitating faster recovery.With high safety and effects, RVIAT can be considered as a viable alternative to MS.

Objective:To evaluate the clinical outcomes of right vertical infra-axillary thoracotomy technique (RVIAT) versus traditional median sternotomy (MS) for ventricular septal defect (VSD) repair in infants weighing ≤5 kg.The study further investigates the safety and feasibility of these two surgical approaches.Methods:Retrospective case-series study.Three hundred and fourteen children weighing no more than 5 kg who received VSD repair in Fuwai Central China Cardiovascular Hospital from January 2020 to June 2024 were analysized.Of these children, 252 cases who underwent RVIAT were included in the RVIAT group, and 62 cases who received traditional MS were classified as the MS group.Clinical data such as day age, body mass, the VSD type and diameter were compared between the 2 groups.The operation time, extracorporeal circulation time, block and postoperative mechanical ventilation time, intensive care unit (ICU) treatment time, 24-hour postoperative chest drainage volume and intraoperative bleeding, postoperative secondary intubation, and cardiac arrhythmia of the 2 groups of patients were recorded.Children with unstable blood pressure and active bleeding after taking vasoactive and hemostatic drugs underwent a secondary surgery.The peak airway pressure, oxygenation index, and lung dynamic compliance of the 2 groups of children were recorded before chest opening, immediately after surgery, and 24 hours after surgery. t test, χ2 test and rank sum test were used to compare the clinical data, perioperative results, complications and lung function data of the two groups. Results:(1) No significant differences were observed between the two groups in gender, age, body mass, VSD type and diameter, preoperative pneumonia, and mechanical ventilation rate (all P>0.05).(2) One-stage VSD repair was successfully completed in all cases.In the MS group, 1 infant required a secondary surgery for pericardial tamponade due to excessive bleeding.In the RVIAT group, 1 case necessitated a secondary surgery for third-degree atrioventricular block.Two cases in the MS group and 3 cases in the RVIAT group suffered postoperative arrhythmia, all of who supplemented electrolytes, received a secondary surgery to remove patches and adjust suture positions, and took antiarrhythmic drugs to restore sinus rhythm.(3) The operation time [(137.4±9.1) minutes], hospital stay [(8.2±2.1) days], postoperative mechanical ventilation time [8.0 (6.0, 13.0) hours], postoperative ICU stay [2.9 (2.0, 3.6) days], 24-hour postoperative chest drainage volume [(11.3±1.2) mL], intraoperative bleeding [(11.6±1.2) mL], and hospital costs [(70±7) thousand yuan], the postoperative incidence of incision infection [0.4%(1/252)] and the postoperative incidence of sternal malformation (0) in the RVIAT group were significantly lower than those in the MS group [(151.9±20.2) minutes, (13.1±1.7) days, 12.0 (9.0, 15.0) hours, 2.9 (2.5, 3.7) days, (14.3±1.6) mL, (15.8±2.0) mL, (78±4) thousand yuan, 4.8%(3/62), and 4.8%(3/62), respectively] (all P<0.05).There was no significant difference in extracorporeal circulation time, aortic occlusion time, postoperative arrhythmia rate, residual shunt, and atelectasis between the two groups (all P>0.05).(4) The peak airway pressure, oxygenation index and lung dynamic compliance before chest opening, immediately after surgery, and 24 hours after surgery did not differ significantly between the two groups (all P>0.05). Conclusions:In infants with low body mass (≤5 kg), RVIAT for VSD repair offers good exposure through a small incision, capable of reducing operation time, intraoperative bleeding, postoperative hospital stay, and hospital costs, and facilitating faster recovery.With high safety and effects, RVIAT can be considered as a viable alternative to MS.

OBJECTIVE: To investigate and analyze the risk factors of massive hemorrhage in patients with renal cell carcinoma and venous tumor thrombus undergoing radical nephrectomy and removal of venous tumor thrombus. METHODS: From January 2014 to June 2020, 241 patients with renal cancer and tumor thrombus in a single center of urology at Peking University Third Hospital were retrospectively analyzed. All patients underwent radical nephrectomy and removal of venous tumor thrombus. The relevant preoperative indicators, intraoperative conditions, and postoperative data were statistically analyzed by using statistical software of SPSS 18.0. The main end point of the study was intraoperative bleeding volume greater than 2 000 mL. Logistic regression analysis was used to determine the relevant influencing factors. First, single factor Logistic regression was used for preliminary screening of influencing factors, and variables with single factor Logistic regression analysis P < 0.05 were included in multivariate Logistic regression. In all statistical analyses, P < 0.05 is considered statistically significant. RESULTS: Among the 241 patients included, there were 60 cases of massive hemorrhage, 48 males and 12 females, with a median age of 62 years. The number of non-massive hemorrhage was 181. There were 136 males and 45 females, with a median age of 59 years. Univariate analysis showed that the clinical symptoms (both systemic and local symptoms, OR 2.794, 95%CI 1.087-7.181, P=0.033), surgical approach (open surgery, OR 9.365, 95%CI 4.447-19.72, P < 0.001), Mayo grade (Mayo 3-4, OR 5.257, 95%CI 2.806-10.886, P < 0.001), American Society of Anesthesiologists (ASA) score (ASA level 3, OR 2.842, 95%CI 1.338-6.036, P=0.007), preoperative hemoglobin (OR 0.978, 95%CI 0.965-0.991, P=0.001), preoperative platelet count (OR 0.996, 95%CI 0.992-1.000, P=0.037), maximum tumor thrombus width (OR 1.061, 95%CI 1.033-1.091, P < 0.001), Complicated with bland thrombus (OR 4.493, 95%CI 2.264-8.915, P < 0.001), adrenalectomy (OR 3.101, 95%CI 1.614-5.958, P=0.001), segmental resection of the inferior vena cava (OR 2.857, 95%CI 1.395-5.852, P=0.004). There was a statistically significant difference in these aspects(P < 0.05). Multivariate Logistic regression analysis showed that there was a statistically significant difference in surgical approach (open surgery, OR 6.730, 95%CI 2.947-15.368;P < 0.001), Mayo grade (Mayo 3-4, OR 2.294, 95%CI 1.064-4.948, P=0.034), Complicated with bland thrombus (OR 3.236, 95%CI 1.492-7.020, P=0.003). CONCLUSION Combining the results of univariate and multivariate Logistic regression analysis, the surgical approach, Mayo grade, and tumor thrombus combined with conventional thrombus were associated risk factors for massive hemorrhage during surgery for renal cell carcinoma with tumor thrombus. Patients who undergo open surgery, high Mayo grade, and tumor thrombus combined with conventional thrombus are at a relatively higher risk of massive hemorrhage.
Male ; Female ; Humans ; Middle Aged ; Carcinoma, Renal Cell/pathology* ; Retrospective Studies ; Thrombosis/etiology* ; Kidney Neoplasms/pathology* ; Vena Cava, Inferior/surgery* ; Nephrectomy/methods* ; Thrombectomy/methods* ; Risk Factors ; Hemorrhage

Objective:To analyze the short and mid-term efficacy of aortic valvuloplasty with autopericardium on children with aortic valve diseases.Methods:A total of 26 children with aortic valve diseases (stenosis or regurgitation) who underwent aortic valvuloplasty with autopericardium in Fuwai Central China Cardiovascular Hospital from September 2017 to June 2021 were retrospectively analyzed.The short-term and mid-term follow-up data were collected.The maximum aortic valve pressure gradient, subaortic regurgitation area, left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) were compared before and after operation.Paired t test was used to analyze the short-term and mid-term efficacy of aortic valvuloplasty with autopericardium on children with aortic valve diseases. Results:All 26 cases were successfully operated, and there were no deaths and serious complications during the follow-up period of (22.96±6.45) months.There was a significant difference between the preoperative and postoperative maximum aortic valve pressure gradient at 1 month ( t=7.85, P<0.05), 6 months ( t=6.43, P<0.05), 1 year ( t=6.16, P<0.05) and 2 years postoperatively ( t=4.22, P<0.05) in children with aortic stenosis or that combined with mild-to-moderate closure.The follow-up data of 9 children with simple aortic stenosis showed that there was a significant difference between the preoperative (8.87±3.57) cm 2 and postoperative aortic regurgitation area at 1 month ( t=6.85, P<0.05), 6 months ( t=5.13, P<0.05), 1 year ( t=6.62, P<0.05) and 2 years postoperatively ( t=5.41, P<0.05). The LVEDV of 26 children was significantly lower at 6 months[(63.54±27.61) mL], 1 year [(53.61±20.20) mL] and 2 years postoperatively [(64.39±17.78) mL] compared with that of preoperative level[(89.42±45.89) mL]( t=3.89, 4.67, 3.58, all P<0.05). The left ventricular pressure and volume decreased, the enlarged heart was narrowed down, and the geometry of the heart was restored.The LVEF of 26 patients also from (61.65±9.67)% before surgery increased to (67.88±4.69)% 6 months after surgery( t=3.68, P<0.05), and increased to (68.62±4.46)% 1 year after surgery( t=4.01, P<0.05), and increased to (67.55±3.09)% 2 years after operation( t=3.01, P<0.05), and the heart function was improved. Conclusions:Aortic valvuloplasty with autopericardium presents an effective short and mid-term efficacy on children with aortic valve diseases, which prevents or delays the aortic valve replacement.

OBJECTIVE: To access the efficacy and safety of the double-ProGlide technique for the femoral vein access-site closure in cryoballoon ablation with uninterrupted oral anticoagulants (OAC), and its impact on the electrophysiology laboratory time as well as hospital stay after the procedure in this observational study. METHODS: Patients with atrial fibrillation undergoing cryoballoon ablation with uninterrupted OAC at Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China from May 2019 to May 2021 were enrolled in this study. From October 2020, double-ProGlide technique was consistently used for hemostasis (ProGlide group), and before that conventional manual compression was utilized (manual compression group). The occurrence of vascular and groin complications was accessed during the hospital stay and until the three-month follow-up. RESULTS: A total of 140 participants (69.30% of male, mean age: 59.21 ± 10.29 years) were evaluated, 70 participants being in each group. Immediate hemostasis was achieved in all the patients with ProGlide closure. No major vascular complications were found in the ProGlide group while two major vascular complications were occurred in the manual compression group. The incidence of any groin complication was obviously higher in subjects with manual compression than patients with ProGlide devices (15.71% vs. 2.86%, P = 0.009). In addition, compared with the manual compression group, the ProGlide group was associated with significantly shorter total time in the electrophysiology laboratory [112.0 (93.3-128.8) min vs. 123.5 (107.3-158.3) min, P = 0.006], time from sheath removal until venous site hemostasis [3.8 (3.4-4.2) min vs. 8.0 (7.6-8.5) min, P < 0.001], bed rest time [8.0 (7.6-8.0) h vs. 14.1 (12.0-17.6) h, P < 0.001] and hospital stay after the procedure [13.8 (12.5-17.8) h vs. 38.0 (21.5-41.0) h, P < 0.001]. CONCLUSIONS Utilization of the double-ProGlide technique for hemostasis after cryoballoon ablation with uninterrupted OAC is feasible and safe, which has the clinical benefit in reducing the total electrophysiology laboratory time and the hospital stay length after the procedure.

Clustered Regularly Interspaced Short Palindromic Repeats/genetics* ; CRISPR-Cas Systems/genetics* ; Gene Editing

In 2021, a total of 151 pregnant women were selected from the suburb of Shanghai. A questionnaire survey was conducted to obtain data about maternal age, gestational week, total annual household income, education level and passive smoking among pregnant women and one spot urine was collected. The concentrations of eight neonicotinoid pesticides and four metabolites in urine were measured by ultra-high performance liquid chromatography-tandem quadrupole time-of-flight mass spectrometry. The differences in detection frequencies and concentrations of neonicotinoid pesticides and their metabolites among pregnant women with different characteristics were compared, and the influencing factors of the detection of neonicotinoid pesticides in urine were analyzed. The results showed that at least one neonicotinoid pesticide was detected in 93.4% (141 samples) of urine samples. The detection frequencies of N-desmethyl-acetamiprid, clothianidin, thiamethoxam, and N-desmethyl-clothianidin were high, about 78.1% (118 samples), 75.5% (114 samples), 68.9% (104 samples), and 44.4% (67 samples), respectively. The median concentration of the sum of all neonicotinoid pesticides was 2.66 μg/g. N-desmethyl-acetamiprid had the highest detection concentration with a median concentration of 1.04 μg/g. A lower urinary detection frequency of imidacloprid and its metabolites was seen in pregnant women aged 30-44 years [OR (95%CI): 0.23 (0.07-0.77)]. A higher detection frequency of clothianidin and its metabolites was seen in pregnant women with per capita annual household income≥100 000 yuan [OR (95%CI): 6.15 (1.56-24.28)]. There was widespread exposure to neonicotinoid pesticides and their metabolites in pregnant women from the suburb of Shanghai, which might pose potential health risks to pregnant women, and maternal age and household income were potential influencing factors of the exposure to neonicotinoid pesticides.
Humans ; Female ; Pregnancy ; Pesticides/analysis* ; Pregnant Women ; China ; Neonicotinoids/analysis* ; Insecticides