Acute pancreatitis(AP)is a frequently encountered acute abdominal syndrome in clinical settings,and the integrated model of traditional Chinese and Western medicine(TCM-WM)has demonstrated notable advantages in the diagnosis and treatment of AP.To systematize and standardize clinical practices related to develop clinical pathway for integrated TCM-WM diagnosis and treatment of AP,which enhances the efficiency and quality of patient care.This pathway focuses on AP,a common acute and life-threatening disease within the digestive system,and outlines that the central pathological mechanism involves pancreatic injury and localized inflammation resulting from the abnormal activation of pancreatic enzymes.It has the characteristics of rapid onset,multiple causes,and complex manifestations.Severe cases can be life-threatening.At present,conventional treatments encompass a diverse range of modalities.Moreover,traditional Chinese medicine(TCM)holds distinct advantages in alleviating relevant symptoms,and TCM-WM is gaining increasing prevalence.To enhance the standardization and consistency of diagnostic and therapeutic practices,this clinical pathway clearly delineates the target patient population,which includes individuals diagnosed with abdominal pain disorder according to TCM and with AP in accordance with WM criteria,as well as the corresponding inclusion standards.The diagnostic framework integrates both TCM and WM guidelines,and further incorporates disease staging,severity grading,and syndrome differentiation to support a comprehensive and integrated diagnostic strategy.The treatment integrates approaches from both TCM and WM.Within the WM framework,interventions consist of basic supportive care,infection control,nutritional support,and the management of complications.In the context of TCM,the protocol includes syndrome differentiation and corresponding therapeutic strategies(Distinct syndrome patterns are identified and managed during the acute and convalescent phases),such as acupuncture and retention enema.This clinical pathway addresses multiple key components,including preventive strategies,post-treatment follow-up,criteria for evaluating therapeutic efficacy,admission and discharge,admission examination protocols,discharge criteria,and the rationale for deviations or withdrawal from the pathway.It is designed to provide a systematic and standardized reference framework for relevant clinical practices.

Objective:To investigate the efficacy and safety of fospropofol disodium(FP)in the induction and maintenance of general anesthesia in the adult patients graded Ⅰ or Ⅱ by the American Society of Anesthesiologists(ASA)undergoing elective surgery,and to provide the theoretical basis for application of EP in the induction and maintenance of general anesthesia.Methods:Adult patients of ASA grade Ⅰ or Ⅱ undergoing elective surgery were selected with a total of 100 patients recruited sequentially according to the time of visit,and they were randomly divided into FP group(50 cases)and propofol group(50 cases).All patients were prepared preoperatively,and received a slow injection of midazolam(2 to 3 mg)and sufentanil(0.3 μg·kg-1),followed by induction of anaesthesia 1 to 2 min later.The patients in FP group were given FP(10.0-12.5 mg·kg-1)intravenously,and the patients in propofol group were given propofol(1.5-2.0 mg·kg-1)intravenously.After the Modified Obserational Assessment Alertness/Sedation(MOAA/S)score dropped to 1,muscle relaxant was administrated and the induction was completed.During the maintenance of anaesthesia,the patients in FP group received a continuous intravenous infusion of FP at a rate of 12.5-15.0 mg·kg-1·h-1,and the patients in propofol group received a continuous infusion of propofol at a starting rate of 6 mg·kg-1·h-1.The patients in two groups additionally received remifentanil(0.1-0.4 μg·kg-1·min-1)for co-analgesia,and the rate of administration was adjusted according to the patient's status.Systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),heart rate(HR)and bispectral index(BIS)values of the patients in two groups were recorded at different time points:before induction(T1),immediately after tracheal intubation(T2),5 min after induction(T3),10 min after induction(T4),20 min after induction(T5),30 min after induction(T6),40 min after induction(T7)and at the end of the procedure(T8).The time to onset of sedation/anaesthesia(MOAA/S≤1),the time to eye opening,and the time to awakening(MOAA/S=5)of the patients in two groups were recorded.The lowest intraoperative SBP and BIS values and the time required of the patients in two groups were observed.The incidence of adverse reactions related to agitation,choking,nausea,vomiting and cardiovascular system or respiratory system were compared between two groups.Results:There were no statistically differences in the general informations and the duration of surgery of patients between two groups(P＞0.05).The induction time of the patients in FP group(2.39 min)was significantly longer than that in propofol group(0.70 min)(P＜0.05).In the recovery period of general anesthesia,the eye opening time and recovery time of the patients in FP group were significantly longer than those in propofol group(P＜0.05).There were no significant differences in MAP of the patients between two groups at different time points(P＞0.05).The HR at T4,T5,T6,and T7 time points of the patients in FP group were lower than those in propofol group(P＜0.05).The lowest value of BIS of the patients in FP group was significantly smaller than that in propofol group,and the time taken to reach the lowest value of BIS in FP group was significantly longer than that in propofol group(P＜0.05).The time taken to reach the lowest value of SBP of the patients in FP group was longer than that in propofol group(P＜0.05).However,the lowest value of SBP of the patients and the incidence of adverse reations of the patients in two groups showed no statistical differences(P＞0.05).Conclusion:Compared with propofol,FP injection is safe and effective in the induction and maintenance of general anesthesia in adult patients with ASA class Ⅰ or Ⅱ undergoing elective surgery,with a low incidence of adverse reactions,which is a new anesthesia option.

Objective To determine the predictive power of negative fluid balance in the risk of death in septic shock patients after fluid resuscitation therapy.Methods The medical records of patients with septic shock admitted to the Intensive Care Department of Tianjin Medical University Cancer Hospital from March 2022 to December 2024 were retrospectively collected,and the final outcome was defined as death within 28 days during hospitalization.The study objects were randomly divided into the training set and the validation set,and then the model was built by Logistic regression method,and the nomogram and receiver operating characteristic curve(ROC curve)were drawn.Hosmer-Lemeshow test was used to evaluate the calibration degree of the prediction model,and the calibration curve was drawn to evaluate the differentiation degree of the prediction model.Decision curve analysis(DCA)was used to test the efficiency of the prediction model.Results A total of 286 patients with septic shock were included in the study,including 200 in the training set and 86 in the verification set,which were comparable.Multivariate Logistic regression analysis showed that negative fluid balance,APACHE II score and SOFA score were independent risk factors for poor survival and prognosis of ICU septic shock patients(all P<0.05).Based on the results of multivariate Logistic regression analysis,a nomogram was constructed to predict the survival and prognosis of patients with septic shock in ICU.In the training set and validation set,the area under the curve(AUC)of the ROC curve prediction model was 0.83(95%CI:0.73～0.93)and 0.83(95%CI:0.66～1.00),respectively.Hosmer-Lemeshow calibration curve has a good fit(training set P=0.169;The verification set P=1.000)is not significant.DCA showed that when the threshold probability of patients was 0.05～0.70,it was more beneficial to use the nomogram prediction model to predict the risk of death in septic shock patients.Conclusion Negative fluid balance after fluid resuscitation is associated with survival and prognosis of patients with septic shock.The predictive model of mortality risk of patients with septic shock was established by combining APACHEⅡ score and SOFA score,which has good predictive ability and clinical practicability.

The application of genetic testing technologies in assisted reproduction, such as preimplantation genetic testing (PGT) and carrier screening for monogenic diseases, has provided infertile couples with more reproductive options and played a crucial role in the prevention of genetic disorders, significantly improving reproductive health. However, the widespread use of these technologies has also raised various ethical challenges, including the uncertainty of mosaic embryo transfer and its implications for reproductive rights, the cost-effectiveness debate surrounding PGT for structural rearrangement for chromosomal inversion carriers, the predictive accuracy and ethical boundaries of polygenic embryo screening, and the ethical concerns related to extensive carrier screening, such as information overload, restricted informed choice, disputes over screening scope, and disparities in healthcare access. The reproductive medicine ethics committee plays a central role in addressing these challenges by overseeing ethical reviews of technological applications, ensuring patients' informed consent, balancing technological innovation with ethical responsibility, and promoting social equity. This article explores the ethical challenges brought by the application of technologies such as PGT and carrier screening in assisted reproduction, and proposes corresponding suggestions based on ethical principles framework, in order to promote the standardized application of genetic testing technology in reproductive medicine.

The application of genetic testing technologies in assisted reproduction, such as preimplantation genetic testing (PGT) and carrier screening for monogenic diseases, has provided infertile couples with more reproductive options and played a crucial role in the prevention of genetic disorders, significantly improving reproductive health. However, the widespread use of these technologies has also raised various ethical challenges, including the uncertainty of mosaic embryo transfer and its implications for reproductive rights, the cost-effectiveness debate surrounding PGT for structural rearrangement for chromosomal inversion carriers, the predictive accuracy and ethical boundaries of polygenic embryo screening, and the ethical concerns related to extensive carrier screening, such as information overload, restricted informed choice, disputes over screening scope, and disparities in healthcare access. The reproductive medicine ethics committee plays a central role in addressing these challenges by overseeing ethical reviews of technological applications, ensuring patients' informed consent, balancing technological innovation with ethical responsibility, and promoting social equity. This article explores the ethical challenges brought by the application of technologies such as PGT and carrier screening in assisted reproduction, and proposes corresponding suggestions based on ethical principles framework, in order to promote the standardized application of genetic testing technology in reproductive medicine.

Objective:To construct a calcium alginate (ALG-Ca 2+) composite hydrogel loaded with chlorella protein (Cp) (ALG-Ca 2+@Cp) and investigate its combined effect with microwave hyperthermia on the proliferation, apoptosis, and immune activation of mouse pancreatic cancer cells. Methods:ALG-Ca 2+@Cp was prepared using a physical cross-linking method and its physiochemical properties was characterized via scanning electron microscopy, rheological analysis, Ca 2+ release experiments, and microwave thermal conversion tests. The BCA protein quantification assay was used to evaluate the adsorption capacity of ALG-Ca 2+@Cp for pancreatic cancer cell antigens. The effects of ALG-Ca 2+@Cp extract combined with microwave intervention on pancreatic cancer cell proliferation, apoptosis protein expression, and cell viability were assessed using CCK-8 assays, ELISA, and Calcein-AM/PI double fluorescence staining. Flow cytometry was performed to determine the maturation-promoting ability of ALG-Ca 2+@Cp on immature mouse bone marrow-derived dendritic cells (BMDCs). Results:ALG-Ca 2+@Cp exhibited a three-dimensional network structure with a storage modulus (G') greater than the loss modulus (G''), demonstrating typical hydrogel properties. The hydrogel loaded with 0.5 mol/ml Ca 2+ reached 48°C after 5 minutes of microwave irradiation at 5.0 W/cm 2, and Ca 2+ release plateaued within 5 minutes. ALG-Ca 2+@Cp effectively adsorbed pancreatic cancer cell antigens. Combined with microwave treatment, it significantly reduced pancreatic cancer cell proliferation ( A450 value 0.39±0.07 vs 2.78±0.15) and increased apoptosis markers calreticulin (CRT) and high mobility group box-1 protein (HMGB1) [(557.09±37.84) pg/ml vs (135.14±11.84) pg/ml, (4.77±0.18) ng/ml vs (1.6±0.16) ng/ml], leading to decreased cell viability; and all the differences were statistically significant (all P value <0.05). ALG-Ca 2+@Cp synergistically promoted the maturation of immature BMDCs in the presence of pancreatic cancer antigens, with a CD 80+ positivity rate of (75.67±6.53)%. Conclusions:ALG-Ca 2+@Cp is successfully constructed. Its combination with microwave hyperthermia can significantly enhance the cytotoxicity and immune activation against mouse pancreatic cancer cells by targeting intracellular antigens and inducing immunogenic cell death.

Objective To determine the predictive power of negative fluid balance in the risk of death in septic shock patients after fluid resuscitation therapy.Methods The medical records of patients with septic shock admitted to the Intensive Care Department of Tianjin Medical University Cancer Hospital from March 2022 to December 2024 were retrospectively collected,and the final outcome was defined as death within 28 days during hospitalization.The study objects were randomly divided into the training set and the validation set,and then the model was built by Logistic regression method,and the nomogram and receiver operating characteristic curve(ROC curve)were drawn.Hosmer-Lemeshow test was used to evaluate the calibration degree of the prediction model,and the calibration curve was drawn to evaluate the differentiation degree of the prediction model.Decision curve analysis(DCA)was used to test the efficiency of the prediction model.Results A total of 286 patients with septic shock were included in the study,including 200 in the training set and 86 in the verification set,which were comparable.Multivariate Logistic regression analysis showed that negative fluid balance,APACHE II score and SOFA score were independent risk factors for poor survival and prognosis of ICU septic shock patients(all P<0.05).Based on the results of multivariate Logistic regression analysis,a nomogram was constructed to predict the survival and prognosis of patients with septic shock in ICU.In the training set and validation set,the area under the curve(AUC)of the ROC curve prediction model was 0.83(95%CI:0.73～0.93)and 0.83(95%CI:0.66～1.00),respectively.Hosmer-Lemeshow calibration curve has a good fit(training set P=0.169;The verification set P=1.000)is not significant.DCA showed that when the threshold probability of patients was 0.05～0.70,it was more beneficial to use the nomogram prediction model to predict the risk of death in septic shock patients.Conclusion Negative fluid balance after fluid resuscitation is associated with survival and prognosis of patients with septic shock.The predictive model of mortality risk of patients with septic shock was established by combining APACHEⅡ score and SOFA score,which has good predictive ability and clinical practicability.

Objective:To construct a calcium alginate (ALG-Ca 2+) composite hydrogel loaded with chlorella protein (Cp) (ALG-Ca 2+@Cp) and investigate its combined effect with microwave hyperthermia on the proliferation, apoptosis, and immune activation of mouse pancreatic cancer cells. Methods:ALG-Ca 2+@Cp was prepared using a physical cross-linking method and its physiochemical properties was characterized via scanning electron microscopy, rheological analysis, Ca 2+ release experiments, and microwave thermal conversion tests. The BCA protein quantification assay was used to evaluate the adsorption capacity of ALG-Ca 2+@Cp for pancreatic cancer cell antigens. The effects of ALG-Ca 2+@Cp extract combined with microwave intervention on pancreatic cancer cell proliferation, apoptosis protein expression, and cell viability were assessed using CCK-8 assays, ELISA, and Calcein-AM/PI double fluorescence staining. Flow cytometry was performed to determine the maturation-promoting ability of ALG-Ca 2+@Cp on immature mouse bone marrow-derived dendritic cells (BMDCs). Results:ALG-Ca 2+@Cp exhibited a three-dimensional network structure with a storage modulus (G') greater than the loss modulus (G''), demonstrating typical hydrogel properties. The hydrogel loaded with 0.5 mol/ml Ca 2+ reached 48°C after 5 minutes of microwave irradiation at 5.0 W/cm 2, and Ca 2+ release plateaued within 5 minutes. ALG-Ca 2+@Cp effectively adsorbed pancreatic cancer cell antigens. Combined with microwave treatment, it significantly reduced pancreatic cancer cell proliferation ( A450 value 0.39±0.07 vs 2.78±0.15) and increased apoptosis markers calreticulin (CRT) and high mobility group box-1 protein (HMGB1) [(557.09±37.84) pg/ml vs (135.14±11.84) pg/ml, (4.77±0.18) ng/ml vs (1.6±0.16) ng/ml], leading to decreased cell viability; and all the differences were statistically significant (all P value <0.05). ALG-Ca 2+@Cp synergistically promoted the maturation of immature BMDCs in the presence of pancreatic cancer antigens, with a CD 80+ positivity rate of (75.67±6.53)%. Conclusions:ALG-Ca 2+@Cp is successfully constructed. Its combination with microwave hyperthermia can significantly enhance the cytotoxicity and immune activation against mouse pancreatic cancer cells by targeting intracellular antigens and inducing immunogenic cell death.

Acute pancreatitis(AP)is a frequently encountered acute abdominal syndrome in clinical settings,and the integrated model of traditional Chinese and Western medicine(TCM-WM)has demonstrated notable advantages in the diagnosis and treatment of AP.To systematize and standardize clinical practices related to develop clinical pathway for integrated TCM-WM diagnosis and treatment of AP,which enhances the efficiency and quality of patient care.This pathway focuses on AP,a common acute and life-threatening disease within the digestive system,and outlines that the central pathological mechanism involves pancreatic injury and localized inflammation resulting from the abnormal activation of pancreatic enzymes.It has the characteristics of rapid onset,multiple causes,and complex manifestations.Severe cases can be life-threatening.At present,conventional treatments encompass a diverse range of modalities.Moreover,traditional Chinese medicine(TCM)holds distinct advantages in alleviating relevant symptoms,and TCM-WM is gaining increasing prevalence.To enhance the standardization and consistency of diagnostic and therapeutic practices,this clinical pathway clearly delineates the target patient population,which includes individuals diagnosed with abdominal pain disorder according to TCM and with AP in accordance with WM criteria,as well as the corresponding inclusion standards.The diagnostic framework integrates both TCM and WM guidelines,and further incorporates disease staging,severity grading,and syndrome differentiation to support a comprehensive and integrated diagnostic strategy.The treatment integrates approaches from both TCM and WM.Within the WM framework,interventions consist of basic supportive care,infection control,nutritional support,and the management of complications.In the context of TCM,the protocol includes syndrome differentiation and corresponding therapeutic strategies(Distinct syndrome patterns are identified and managed during the acute and convalescent phases),such as acupuncture and retention enema.This clinical pathway addresses multiple key components,including preventive strategies,post-treatment follow-up,criteria for evaluating therapeutic efficacy,admission and discharge,admission examination protocols,discharge criteria,and the rationale for deviations or withdrawal from the pathway.It is designed to provide a systematic and standardized reference framework for relevant clinical practices.

Objective To evaluate whether the measurement of tibialis anterior muscle thickness(TA-MT)in sepsis can be used as an alternative method to understand systemic changes in skeletal muscle mass by comparing the trend of ultrasonic measurement of TA-MT with bioelectrical impedance analysis(BIA)in detecting skeletal muscle mass.Methods A single-center prospective study was conducted.The patients with tumor sepsis who were treated in the department of intensive care unit(ICU)of Tianjin Medical University Cancer Hospital from March to December 2022 were selected as the study subjects.The changes of TA-MT within 6 hours after sepsis and 3 days after treatment were measured by ultrasound.The changes of body mass,body mass index(BMI),lean body mass,body fat percentage,body fat,whole body protein,skeletal muscle mass,skeletal muscle index(SMI),arm circumference,right lower limb lean body mass,and body water were measured by BIA.The 28-day prognosis was followed up.The correlation between TA-MT and skeletal muscle indicators measured by BIA was analyzed by Pearson correlation analysis.Results Eventually,40 patients were included.Compared with before treatment,the levels of TA-MT by ultrasound and acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA)and oxygen metabolism index blood lactic acid(Lac)measured after treatment were significantly reduced[TA-MT(cm):2.31±0.35 vs.2.50±0.36,APACHEⅡscore:11.00±3.18 vs.17.50±5.44,SOFA score:3.28±2.18 vs.6.30±3.11,Lac(mmol/L):1.38±0.35 vs.2.40±1.02,all P＜0.05].Meanwhile,the BIA test showed that body mass,body mass index,lean body mass,body fat percentage,body fat,whole body protein,skeletal muscle mass,SMI,arm circumference,right lower limb lean body mass and body water were also significantly decreased after treatment[body mass(kg):63.87±13.96 vs.66.58±14.95,BMI(kg/m2):22.57±4.37 vs.23.52±4.59,lean body mass(kg):46.32±6.89 vs.49.66±7.84,whole body protein(kg):9.36±1.37 vs.9.93±1.55,skeletal muscle mass(kg):26.23±4.17 vs.27.96±4.72,SMI(kg/m2):7.12±1.04 vs.7.78±1.18,arm circumference(cm):29.41±3.66 vs.30.17±3.59,right lower limb lean body mass(kg):7.21±1.26 vs.7.77±1.42,total body water(L):36.38±5.44 vs.39.11±6.19,all P＜0.05],body fat percentage and body fat were significantly elevated[body fat percentage:(21.96±8.30)%vs.(19.98±8.43)%,body fat(kg):14.81±8.64 vs.14.12±8.81,both P＜0.05].Pearson correlation analysis showed that:the right TA-MT was negatively correlated with the electrical impedance of the right lower extremity(r =-0.445 2,P＜0.001),the right side TA-MT was positively correlated with the right lower limb lean body mass,whole body protein,skeletal muscle mass,SMI and lean body mass(r values were 0.571 4,0.629 9,0.628 3,0.575 9,0.634 4,all P＜0.000 1).Conclusion Significant skeletal muscle depletion can be observed in tumor patients with sepsis,and ultrasound measurement of TA-MT is an effective alternative method to assess systemic skeletal muscle mass trends.