With the rapid advancement of hemodynamic indices and monitoring technologies, their classification methods and application processes have become increasingly complex. Currently, no unified standard hasbeen established, making it difficult to fully meet the clinical requirements for hemodynamic management. To assist in hemodynamic monitoring assessment and therapeutic decision-making in critically ill patients, the Critical Hemodynamic Therapy Collaborative Group, in conjunction with the Critical Ultrasound Study Group, has jointly developed the Standard for the Application of Hemodynamic Monitoring Techniques in Critical Care. The first part of this standard systematically categorizes hemodynamic indicators into flow indicators, pressure and its derivative indicators, and tissue perfusion indicators, while elaborating on the clinical application of each. The second part establishes a standardized clinical implementation pathway for hemodynamic monitoring. It proposes a tiered monitoring strategy-comprising basic, advanced, indication-specific, and special scenario monitoring-tailored to different clinical settings. It emphasizes the central role of critical care ultrasound across all levels of monitoring and establishes hemodynamic assessment standards for organs such as the brain, kidneys, and gastrointestinal tract. This standard aims to provide a unified framework for clinical practice, teaching, training, and research in critical care medicine, thereby promoting standardized development within the discipline.

ObjectiveTranscranial focused ultrasound (tFUS) has emerged as a promising noninvasive neuromodulation technique capable of modulating neural activity with high spatial specificity. However, whether tFUS stimulation of the primary somatosensory cortex (S1) can reliably evoke conscious tactile perception without external peripheral sensory input remains unclear. Therefore, this study examined the feasibility of inducing hand-related tactile perception through targeted S1 stimulation and further investigated how sonication duration (SD), a key temporal parameter, influences the consistency of this perceptual response. The findings may provide empirical evidence for optimizing tFUS parameters in human somatosensory modulation. MethodsForty-eight healthy adults participated in the study and were assigned to two experiments. Experiment 1 included 24 participants and was designed to preliminarily examine whether S1-targeted tFUS could evoke hand-related tactile sensations. This experiment comprised two sub-experiments, Experiment 1a and Experiment 1b, with 12 participants in each. Specifically, Experiment 1a used a randomized active stimulation protocol targeting the bilateral S1 to assess the initial feasibility of inducing contralateral tactile perception, whereas Experiment 1b employed an alternating hemispheric design incorporating both active and sham stimulation to verify the specificity of the tFUS-induced sensations. Experiment 2 enrolled another 24 participants and used a real-sham dual-probe design to control for spatial tactile cues that might arise from probe-scalp contact. Five SD levels, including 200, 400, 600, 800, and 1 000 ms, were systematically tested to evaluate how stimulation duration influenced the behavioral response. The primary behavioral outcome was the perceptual consistency rate, quantified according to the accuracy of contralateral tactile localization. ResultsIn Experiment 1, 91.7% of participants reported reliable hand-related tactile sensations during active tFUS stimulation, including numbness, tingling, or similar sensory experiences. Contralateral localization accuracy under active stimulation was significantly higher than the0.50 chance level (P<0.05). In contrast, localization performance under sham stimulation did not differ from chance, suggesting that the observed tactile responses were mainly induced by active S1-targeted tFUS stimulation rather than nonspecific stimulation cues. In Experiment 2, perceptual consistency rates significantly exceeded the chance level under the 400 and 1 000 ms SD conditions(P<0.05), whereas no significant effect was observed at 200, 600, or 800 ms. Pairwise comparisons further showed that the 400 and 1 000 ms conditions produced significantly higher perceptual consistency rates than the 200 ms condition (P<0.05). ConclusiontFUS stimulation of S1 can elicit distinct hand-related tactile sensations without peripheral sensory input, demonstrating the feasibility of using targeted cortical ultrasound stimulation to induce conscious somatosensory perception. The reliability of this perceptual effect was modulated by sonication duration, indicating that temporal stimulation parameters play an important role in shaping both the occurrence and consistency of behavioral responses. Among the tested conditions, 400 ms appeared to provide a favorable temporal window for generating stable tactile perception, whereas excessively short stimulation may be insufficient to produce consistent responses. These findings highlight the sensitivity of somatosensory networks to ultrasonic modulation and provide useful parameter guidance for the application of tFUS in noninvasive sensory enhancement and cortical functional mapping.

Objective: To analyze the epidemiological characteristics of hand, foot and mouth disease (HFMD) among children aged 0-9 years in Guangzhou, so as to provide reference basis for further exploring scientifically effective prevention and control measures. Methods: Reported cases of HFMD in children aged 0-9 years in Guangzhou City from 2013-2025 were selected from China disease prevention and control information system, and the incidence in different years was analyzed descriptively; the trends of the composition ratio and incidence in various age groups were analyzed by using the Joinpoint regression model, spatial autocorrelation analyses were performed at the district level, and the seasonal autoregressive integrated moving average model (SARIMA) was applied to predict annual incidence rate for 2026. Results: From 2013 to 2025, the average annual reported incidence rate of HFMD among children aged 0-9 years in Guangzhou was 2 513.98/100 000, showing a fluctuating trend. Peaks of incidence occurred from May to July and from September to October. The male to female ratio was 1.49∶1. The average annual incidence rate was 4 743.99/100 000 in the 0-1 years age group, 3 298.19/100 000 in the 2-5 years age group, and 544.22/ 100 000 in the 6-9 years age group. Joinpoint regression analysis showed a decreasing trend in the proportion of the 0-1 years age group (APC= -6.02 %, t =-3.77) and an increasing trend in the proportion of the 6-9 years age group (APC=16.39%, t =5.67) (both P < 0.05 ). No significant global spatial clustering was observed at the district level; however, local scattered clusters were identified in certain areas. Using the SARIMA(2,0,0)(2,0,0) 12 model, the predicted annual incidence rate of HFMD among children aged 0-9 years in Guangzhou in 2026 was 2 680.56/100 000. Conclusions From 2013 to 2025, the annual incidence rate of HFMD among children aged 0-9 years in Guangzhou exhibited a fluctuating trend; the highest incidence rate is observed in the 0-1 years age group, while the proportion of cases in the 6-9 years age group increase year by year;and local spatial clusters of abnormal distribution are identified. It is essential to enhance risk monitoring and health education in key populations and areas to mitigate the risk of infection in children.

To summarize the nursing experience of a sepsis patient with secondary systemic multi-site Candida auris infection after pontine hemorrhage.The key points of nursing care are as follows:to implement precise infection prevention and control measures for Candida auris in hospitals;to reasonably select skin care tools and maintain good skin care;to implement individualized extubation strategies;to conduct proper nursing care for antibiotic medication;to dynamically adjust nutritional support methods;to carry out early rehabilitation training after cerebral hemorrhage;to provide comprehensive psychological care.The patient was discharged after 70 days of hospitalization.

Objective:To study the influence of methyltransferases like 3(METTL3)on the radiosensitivity of oral squamous cell carcinoma cells(OSCCs).Methods:The apoptosis level of OSCCs CAL27,SCC9 and SCC15 treated with X-ray radiation doses of 2,4 and 8 Gy respectively was compared by flow cytometry,the expression of methylated gene RNA and protein in the cells were examined by qRT-PCR and Western blot.m6A in the cells was quantified by LC/LC-MS method.qRT-PCR and Western blot were used to investigate the expression of methylated gene RNA and protein in the cells.Flow cytometry was used to examine the cell apoptosis level of CAL27 and SCC15 cells treated with METTL3 overexpression and knockdown respectively.The clone forma-tion of CAL27 and SCC15 cells after knockdown and overexpression of target genes followed by radiation treatment was observed by clonogenic assays.Results:The apoptosis rate of all the cell lines increased with the increase dose of radiation at each dose,CAL27 cells showed the highest and SCC15 showed the lowerst apoptosis rate.The RNA and protein expression levels of METTL3 in CAL27 were significantly lower than those of SCC15.m6A quantification showed that the methylation modification in CAL27 cells was lower than that in SCC15.The expression of METTL3 was increased in CAL27 and SCC15 cells after radiation treatment.Knockdown of METTL3 increaced the apoptosis rate and decreased the clonogenesity,overession of METTL3 the decreaced the ap optosis rate and increased the clonogenecity of the cells.Conclusion:Regulation of METTL3 can affect the radiotherapy sensitivity of OSCCs,METTL3 may become a new target for radiosensitization of OSCCs.

Objective:To investigate the correlation of color Doppler flow imaging (CDFI) and shear wave elastography (SWE) with pathological classification and prognosis of breast cancer patients.Methods:A total of 87 patients (103 lesions) with breast cancer admitted to Shanxi Maternal and Child Health Care Hospital and the Second Hospital of Shanxi Medical University From May. 2021 to Mar. 2024 were retrospectively included. All patients underwent CDFI and SWE examinations before surgery. The pathological characteristics and molecular typing of each lesion were recorded, and the correlation of CDFI and SWE examination parameters with molecular typing of breast cancer was evaluated. Patients were followed up for 1 year, and the predictive value of CDFI and SWE parameters in lymph node metastasis was analyzed by receiver operating characteristic curve (ROC) .Results:There were no statistically significant differences in the pulse index (PI) , resistance index (RI) , maximum lesion elastic modulus (E max) , and the ratio between the elastic value at the hardest lesion and the elastic value of adipose tissue (E ratio) among patients with different pathological types ( F=0.64, 0.13, 0.81, 2.84, P>0.05) . There were no statistically significant differences in PI and RI values among patients with different tumor sizes ( F=2.99, 1.81, P>0.05) , and statistically significant differences in E max and E ratio among patients with different tumor sizes ( F=6.42, 34.31, P<0.05) . The differences among different molecular types PI, RI, E max, and E ratio were statistically significant ( F=406.59, 245.23, 206.30, 204.36, P<0.05) , and Luminal B type PI, RI, E max, and E ratio were the highest, followed by HER2-positive, triple-negative, and Luminal A type, with statistically significant differences ( P<0.05) . PI, RI, E max and E ratio in patients with positive lymph node metastasis were higher than those in patients with negative lymph node metastasis ( t=4.99, 3.04, 2.70, 3.13, all P<0.05) . ROC results showed that the area under the curve (AUC) of PI, RI, E max and E ratio for predicting lymph node metastasis of breast cancer were 0.654, 0.704, 0.664 and 0.696, respectively. The sensitivity to predict lymph node metastasis of breast cancer was 74.19%, 54.84%, 51.61%, 64.52, and the specificity was 54.17%, 79.17%, 79.17%, 70.83% (all P<0.05) . Conclusions:The correlation of CDFI and SWE examination parameters are correlated with the molecular classification of breast cancer, and the prediction of lymph node metastasis of breast cancer is good.

Objective:To assess the effectiveness of combining color Doppler ultrasound (CDU) with shear wave elastography (SWE) in forecasting the likelihood of breast cancer (BC) recurrence.Methods:From Jan. 2022 to Jan. 2024, we gathered data on 92 BC patients admitted to Shanxi Maternal and Child Health Hospital and Shanxi Cancer Hospital, focusing on their lesion characteristics. Each patient underwent CDU and SWE examinations pre-surgery and was monitored for a year. Based on BC recurrence, patients were categorized into recurrence and non-recurrence groups. We compared CDU imaging and hemodynamic features of BC between these groups and evaluated SWE elastic modulus values. To assess the agreement between CDU, SWE, and their combined use in predicting BC recurrence and pathological diagnosis, we employed the Kappa test. Additionally, we plotted ROC curves to analyze the predictive power of CDU, SWE, and their combination in assessing BC recurrence risk. Results:Among the 92 BC patients studied, 38 experienced recurrence, while 54 did not. CDU examination revealed that the non-recurrence group exhibited significantly larger tumor maximum diameter, higher peak systolic velocity (PSV), a higher proportion of aspect ratio ≥ 1, irregular margins, calcification, and increased vascular abundance, compared to the recurrence group ( t/ χ2=17.188, 18.491, 6.099, 15.374, 14.526, 19.318, P<0.05). Additionally, the vascular resistance index (RI) was lower in the non-recurrence group ( t=-26.429, P<0.05). SWE results indicated that the recurrence group had higher average (E mean), maximum (E max), and minimum (E min) elastic moduli compared to the non-recurrence group ( t=14.39, 12.34, 8.29, P<0.05). CDU and SWE predictions showed substantial agreement with pathological results, with Kappa values of 0.66 and 0.69, respectively ( P<0.05). The combination of CDU and SWE predictions demonstrated excellent concordance with pathological outcomes ( Kappa=0.91, P<0.05). In terms of predicting BC recurrence risk, CDU and SWE had accuracies of 83.70% and 84.21%, respectively. The ROC curve analysis showed AUC values of 0.830 for CDU, 0.847 for SWE, and 0.955 for their combination. Sensitivity was 0.870 for CDU, 0.852 for SWE, and 0.963 for the combination. Specificity was 0.789 for CDU, 0.842 for SWE, and 0.947 for the combination. Positive predictive values were 78.95% for CDU, 84.21% for SWE, and 94.74% for the combination, while negative predictive values were 87.04% for CDU, 85.19% for SWE, and 96.30% for the combination. The AUC for CDU in predicting post-operative BC recurrence risk was not significantly different from SWE ( χ2=0.04, P>0.05), but the combined prediction AUC was significantly higher than individual predictions ( χ2=8.00, 7.04, P<0.05) . Conclusion:The predictive value of CDU and SWE combined examination for the recurrence risk of BC is better than that of single examination, and it is suggested that the combined examination method should be popularized in clinic.

Objective Focusing on the problems of unbalanced nursing education resources and insufficient training,it discusses the path of nursing echelon training and nursing education resources optimization in secondary hospitals.Methods Based on nursing questionnaire,interview data and platform logs from 4 secondary hospitals in Hainan Province,Latent Dirichlet Allocation topic modeling,sentiment analysis and Social Network Analysis were used.Identify the core problems of educational resources and training system and propose optimization schemes.Results Topic modeling revealed that insufficient educational resources and information silos were major obstacles to shared platform development.Similarity analysis result showed high consistency in feedback regarding disconnected training content and single training models.Sentiment analysis result indicated that 50％of negative feedback focused on inadequate evaluation and incentive mechanisms.Social Network Analysis validated the significant role of multi-node collaboration in optimizing resource flows.Conclusion Building shared platforms,implementing differentiated training systems,and developing localized nursing faculty are critical pathways to achieving homogenized nursing education,providing valuable references for optimizing regional nursing education.

Objective To explore the mechanism of Quhan Zhufeng Mixture on proliferation and apoptosis of rheumatoid arthritis fibroblast-like synoviocyte(RA-FLS)based on NDRG2/JAK2/STAT3 signaling pathway.Methods RA-FLS cells were cultured in vitro,and were divided into ① blank serum group,methotrexate group,Quhan Zhufeng Mixture low-,medium-and high-dosage groups;② blank serum group,AG490 group,Quhan Zhufeng Mixture low-,medium-and high-dosage groups.Different concentrations of drug-containing serum were used to intervene cells.Cell proliferation was detected by CCK-8 method,apoptosis was detected by flow cytometry,and mRNA expressions of Bax,Bcl-2,Caspace-3,Caspace-9,N-myc downstream regulatory gene 2(NDRG2),Janus kinase 2(JAK2)and signal transduction and transcription activator 3(STAT3)were detected by RT-qPCR,Western blot was used to detect the protein expressions of Bax,Bcl-2,Caspace-3,Caspace-9,NDRG2,JAK2,STAT3,p-JAK2 and p-STAT3 in cells.Results Compared with the blank serum group,cell survival rate in methotrexate group,Quhan Zhufeng Mixture all dosage groups significantly decreased(P<0.01),the apoptosis rate significantly increased(P<0.01),the mRNA and protein expressions of Bax and Caspase-9 significantly increased(P<0.05,P<0.01),while the mRNA and protein expression of Bcl-2 significantly decreased(P<0.01),and Caspase-3 mRNA and protein expression in methotrexate group and Quhan Zhufeng Mixture medium-and high-dosage groups significantly increased(P<0.01).Compared with the blank serum group,the mRNA and protein expression of NDRG2 significantly increased in Quhan Zhufeng Mixture all dosage groups(P<0.05,P<0.01),the mRNA and protein expressions of JAK2 and STAT3 were significantly reduced in AG490 group and Quhan Zhufeng Mixture medium-and high-dosage groups(P<0.05,P<0.01),and the expressions of p-JAK2 and p-STAT3 proteins were significantly reduced(P<0.01).Conclusion Quhan Zhufeng Mixture can regulate the proliferation and apoptosis of RA-FLS by regulating the activity of NDRG2/JAK2/STAT3 signaling pathway,playing a role in treating rheumatoid arthritis.

Bow hunter's syndrome,also referred to as rotational vertebral artery occlusion syndrome,is a rare etiological factor of posterior circulation infarction.This article reported a case of a young male patient who experienced recurrent posterior circulation infarctions caused by bilateral bow hunter's syndrome.Carotid ultrasonography confirmed a marked reduction in blood flow velocity in both vertebral arteries during neck rotation.High-resolution MR angiography and CT angiography of the head and neck revealed dissection involving the V3 segment of the left vertebral artery.The findings suggested that bow hunter's syndrome may be associated with thrombus formation secondary to repetitive mechanical compression of the vertebral artery intima,which could potentially lead to arterial embolism and subsequent cerebral infarction.This paper presents the patient's diagnostic and therapeutic course and includes a review of relevant literature aimed to enhance clinical awareness and understanding of this uncommon condition.