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.

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Objective:To assess the safety,effectiveness and economy of some brands and models of domestic and imported anesthesia machine in clinical application,so as to provide reference for improving the competitiveness of anesthesia machine of domestic brands.Methods:A total of 195 patients who underwent general anesthesia in surgery through used respectively domestic Mindray WATO-EX-55Pro anesthesia machine,and imported GE CS620 and GE Aelite NXT anesthesia machines at Inner Mongolia People's Hospital from January 2021 to January 2023 were selected.According to the different brands of the used anesthesia machine by the patients,they were divided into domestic Mindray WATO-EX-55Pro anesthesia machine group(Domestic group),imported GE Aelite NXT anesthesia machine group(Import group of NXT)and imported GE CS620 anesthesia machine group(Import group of 620),with 65 cases in each group.Based on the clinical application data of anesthesia machines in real-world,the actual application effects of anesthesia machines of different brands were assessed in terms of 3 aspects included effectiveness,safety and economy.Results:In the indicators about effectiveness,there was statistically significant difference in postoperative blood oxygen saturation among the Domestic group[100%(99%,100%)],Import group of NXT[99%(98%,100%)]and Import group of 620[99%(99%,100%)](Z=14.723,P<0.05).There was statistically significant difference in the different value of blood oxygen saturation between before and after surgery among three groups(Z=-1.681,P<0.05),and there was significant difference in the postoperative partial pressure of carbon dioxide(PCO2)among three groups(Z=5.574,P<0.05).There was no statistically significant difference in the other indicators of effectiveness among three groups(P>0.05).In the indicators about safety,there was no statistically significant difference in the incidence of adverse events among the three groups(P>0.05).In the indicators about economy,the total costs of anesthesia for patients were respectively 1190.00 CNY(870.00,1582.50),2650.00 CNY(2357.50,2928.75)and 2462.00 CNY(1657.50,2847.50)in the Domestic group,Import group of NXT and Import group of 620,and the difference of that among three groups was statistically significant(Z=88.825,P<0.05).Conclusion:There are not significant differences in the analyzed effectiveness and safety among the domestic anesthesia machine and the imported anesthesia machines,and domestic anesthesia machine is more economical than imported anesthesia machines,which can reduce the cost of anesthesia in surgery,and alleviate the financial burden of patients in medical expenses.

OBJECTIVES: To explore the relationship between the Observer's Assessment of Alertness/Sedation (OAAS) score and the bispectral index (BIS) during propofol titration for general anesthesia induction and analyze the impact of BIS monitoring delay on anesthetic depth assessment. METHODS: This study was conducted among 90 patients (ASA class I-II) undergoing elective surgery under general anesthesia. For anesthesia induction, the patients received propofol titration at the rate of 0.5 mg·kg^-1·min^-1 till OAAS scores of 4, 3, 2, and 1 were reached. After achieving an OAAS score of 1, remifentanil (2 μg·kg⁻¹) and rocuronium (0.6 mg·kg⁻¹) were administered, and tracheal intubation was performed 2 min later. BIS values, mean arterial pressure (MAP), heart rate (HR), and propofol dosage at each OAAS score were recorded, and the correlation between OAAS scores and BIS values was analyzed. The diagnostic performance of BIS values for determining when the OAAS score reaches 1 was analyzed using ROC curve. RESULTS: All the patients successfully completed tracheal intubation. BIS values of the patients at each of the OAAS scores differed significantly (P<0.01), and the mean BIS value decreased by 4.08, 8.32, 5.43 and 5.24 as the OAAS score decreased from 5 to 4, from 4 to 3, from 3 to 2, and from 2 to 1, respectively. There was a significant correlation between the OAAS score and BIS values (ρ=0.775, P<0.001). The median BIS value for an OAAS score of 1 was 76, at which point 83.33% of the patients had BIS values exceeding 60. ROC curve analysis showed that for determining an OAAS score of 1, BIS value, at the optimal cutoff value of 84, had a sensitivity of 88.9%, a specificity of 73.3%, and an area under the curve of 0.842 (0.803-0.881). CONCLUSIONS OAAS score during induction of general anesthesia is strongly correlated with BIS value and is a highly sensitive and timely indicator to compensate for the delay in BIS monitoring.
Humans ; Propofol/administration & dosage* ; Male ; Female ; Middle Aged ; Anesthesia, General/methods* ; Adult ; Consciousness Monitors ; Aged ; Young Adult ; Monitoring, Intraoperative/methods* ; Electroencephalography

Nonunion of osteoporotic vertebral fractures (OVF), predominantly affecting the elderly, can lead to intractable pain, vertebral collapse, progressive kyphotic deformity, and neurological impairment, significantly compromising patients′ quality of life. There exists considerable debate on diagnosis and management of OVF, encompassing key issues such as clinical diagnosis and staging criteria for nonunion, surgical indications and procedure selection, and postoperative rehabilitation planning. Currently, there lacks standardized clinical guideline and expert consensus on the diagnosis and management of OVF nonunion in China. To address this gap, Minimally Invasive Surgery Group of Chinese Orthopedic Association, Osteoporosis Committee of Chinese Association of Orthopedic Surgeons, Prevention and Rehabilitation Committee for Osteoporosis of Chinese Association of Rehabilitation Medicine and Minimally Invasive Orthopedic Surgery Branch of China Association for Geriatric Care jointly organized domestic experts in spinal surgery, endocrinology, and rehabilitation to formulate the Clinical guideline for the diagnosis and treatment for nonunion of osteoporotic vertebral fractures ( version 2025), based on existing literature and clinical experience and adhering to principles of scientific rigor and practicality. The guideline provided 13 evidence-based recommendations encompassing diagnosis and treatment of OVF nonunion, aiming to standardize its clinical management.

Objective:To assess the safety,effectiveness and economy of some brands and models of domestic and imported anesthesia machine in clinical application,so as to provide reference for improving the competitiveness of anesthesia machine of domestic brands.Methods:A total of 195 patients who underwent general anesthesia in surgery through used respectively domestic Mindray WATO-EX-55Pro anesthesia machine,and imported GE CS620 and GE Aelite NXT anesthesia machines at Inner Mongolia People's Hospital from January 2021 to January 2023 were selected.According to the different brands of the used anesthesia machine by the patients,they were divided into domestic Mindray WATO-EX-55Pro anesthesia machine group(Domestic group),imported GE Aelite NXT anesthesia machine group(Import group of NXT)and imported GE CS620 anesthesia machine group(Import group of 620),with 65 cases in each group.Based on the clinical application data of anesthesia machines in real-world,the actual application effects of anesthesia machines of different brands were assessed in terms of 3 aspects included effectiveness,safety and economy.Results:In the indicators about effectiveness,there was statistically significant difference in postoperative blood oxygen saturation among the Domestic group[100%(99%,100%)],Import group of NXT[99%(98%,100%)]and Import group of 620[99%(99%,100%)](Z=14.723,P<0.05).There was statistically significant difference in the different value of blood oxygen saturation between before and after surgery among three groups(Z=-1.681,P<0.05),and there was significant difference in the postoperative partial pressure of carbon dioxide(PCO2)among three groups(Z=5.574,P<0.05).There was no statistically significant difference in the other indicators of effectiveness among three groups(P>0.05).In the indicators about safety,there was no statistically significant difference in the incidence of adverse events among the three groups(P>0.05).In the indicators about economy,the total costs of anesthesia for patients were respectively 1190.00 CNY(870.00,1582.50),2650.00 CNY(2357.50,2928.75)and 2462.00 CNY(1657.50,2847.50)in the Domestic group,Import group of NXT and Import group of 620,and the difference of that among three groups was statistically significant(Z=88.825,P<0.05).Conclusion:There are not significant differences in the analyzed effectiveness and safety among the domestic anesthesia machine and the imported anesthesia machines,and domestic anesthesia machine is more economical than imported anesthesia machines,which can reduce the cost of anesthesia in surgery,and alleviate the financial burden of patients in medical expenses.

Objective:To evaluate the effectiveness,safety and economics of absorbable drug-eluting coronary stent systems using rapid health technology assessment tools,and to provide evidence-based basis for rational use for clinicians use and expert evaluation.Methods:A computer search was performed on PubMed,CNKI,Wanfang,VIP and other databases from 1 January 2014 to 1 January 2023 for relevant literature on patients with coronary artery disease who were treated with coronary artery stent interventional surgery.The 210 collected literatures were screened and extracted according to the inclusion and exclusion criteria,and the literature quality evaluation was carried out.The extracted data related to the intravascular thrombosis rate,myocardial infarction rate,cardiac mortality rate,all-cause mortality rate,target lesion revascularization rate and intravascular adverse event incidence of absorbable drug-eluting coronary stents and drug-eluting coronary stents were meta-analyzed by Revman5.4 software.Results:7 studies were ultimately included in the comparative study of absorbable drug-eluting coronary stents and drug-eluting coronary stents.The thrombosis rate,all-cause mortality rate and intravascular adverse event rate of absorbable drug-eluting coronary stents were lower than those of drug-eluting coronary stents,and the difference was statistically significant(Z=2.16,1.89,2.22,P＜0.05).There were no statistically significant difference in the myocardial infarction rate,cardiac mortality rate and target lesion revascularization rate between absorbable drug-eluting coronary stents and drug-eluting coronary stents(P＞0.05).Conclusion:There was no significant difference in safety and efficacy between absorbable drug-eluting coronary stents and drug-eluting coronary stents.In terms of economy,the cost of absorbable drug-eluting coronary stents is significantly higher than that of drug-eluting coronary stents,and patients can choose stents according to their own economic conditions and other actual conditions.

Objective:To summarize the clinical, pathological and molecular characteristics of various types of pediatric glioma, and to explore the differences in the morphology and clinical significance among various types of pediatric glioma.Methods:Based on the fifth edition of the World Health Organization classification of central nervous system tumors, this study classified or reclassified 111 pediatric gliomas that were diagnosed at Guangzhou Medical University Affiliated Women and Children′s Medical Center from January 2020 to June 2023. The clinical manifestations, imaging findings, histopathology, and molecular characteristics of these tumors were analyzed. Relevant literature was also reviewed.Results:The 111 patients with pediatric glioma included 56 males and 55 females, with the age ranging from 10 days to 13 years (average age, 5.5 years). Clinically, manifestations presented from 5 days to 8 years before the diagnosis, including epilepsy in 16 cases, increased intracranial pressure in 48 cases and neurological impairment in 66 cases. MRI examinations revealed tumor locations as supratentorial in 43 cases, infratentorial in 65 cases, and spinal cord in 3 cases. There were 73 cases presented with a solid mass and 38 cases with cystic-solid lesions. The largest tumor diameter ranged from 1.4 to 10.6 cm. Among the 111 pediatric gliomas, there were 6 cases of pediatric diffuse low-grade glioma (pDLGG), 63 cases of circumscribed astrocytoma glioma (CAG), and 42 cases of pediatric diffuse high-grade glioma (pDHGG). Patients with pDLGG and CAG were younger than those with pDHGG. The incidence of pDLGG and CAG was significantly lower in the midline of the infratentorial region compared to that of pDHGG. They were more likely to be completely resected surgically. The pDLGG and CAG group included 4 cases of pleomorphic xanthoastrocytoma, showing histological features of high-grade gliomas. Among the high-grade gliomas, 13 cases were diffuse midline gliomas and also showed histological features of low-grade glioma. Immunohistochemical studies of H3K27M, H3K27ME3, p53, ATRX, BRAF V600E, and Ki-67 showed significant differences between the pDLGG and CAG group versus the pDHGG group ( P<0.01). Molecular testing revealed that common molecular variations in the pDLGG and CAG group were KIAA1549-BRAF fusion and BRAF V600E mutation, while the pDHGG group frequently exhibited mutations in HIST1H3B and H3F3A genes, 1q amplification, and TP53 gene mutations. With integrated molecular testing, 2 pathological diagnoses were revised, and the pathological subtypes of 35.3% (12/34) of the pediatric gliomas that could not be reliably classified by histology were successfully classified. Conclusions:There are significant differences in clinical manifestations, pathological characteristics, molecular variations, and prognosis between the pDLGG, CAG and pDHGG groups. The integrated diagnosis combining histology and molecular features is of great importance for the accurate diagnosis and treatment of pediatric gliomas.

Objective:To study the effect of insulin intraperitoneal administration combined with dietary intervention on glycemic regulation in in KKAy mice with spontaneous type 2 diabetes.Methods:An animal model of type 2 diabetes was established, and healthy C57BL/6J mice were selected as the normal control group and healthy KKAy mice as the non-disease group. The successfully modeled KKAy mice were randomly divided into the subcutaneous group, the intraperitoneal group, and the untreated group. The non-disease group was given a maintenance diet, and all other groups were fed a high-fat, high-sugar diet. The daily feeding time was from 08:00 to 20:00, with one feeding at a 4-hour interval, for a total of four times. The subcutaneous and intraperitoneal groups were given subcutaneous and intraperitoneal insulin injections before feeding, and recombinant glargine insulin injection (subcutaneous group: 0.125 IU/g; intraperitoneal group: 0.250 IU/g) was injected before the first feeding, and biosynthetic human insulin injection (subcutaneous group: 0.075 IU/g; intraperitoneal group: 0.125 IU/g) was injected after a 0.5 h interval; the rest 3 times before feeding, the biosynthetic human insulin injection (subcutaneous group: 0.075 IU/g; intraperitoneal group: 0.125 IU/g) was injected for 4 weeks. The dietary intake, body mass, fasting blood glucose, and 1 and 2 h postprandial blood glucose of mice in each group were tested regularly, and an oral glucose tolerance test was performed.Results:The total dietary intake of mice in the intraperitoneal group was lower than that in the subcutaneous group. Compared with the initial body mass, the body mass of the mice in the subcutaneous and intraperitoneal groups decreased by 5.05 and 3.59 g at week 4, respectively. The changes of fasting blood glucose in the subcutaneous and intraperitoneal groups ranged from 5.4 to 9.4 and 5.4 to 6.4 mmol/L, respectively, and the changes of 1 h postprandial blood glucose ranged from 4.6 to 12.3 and 5.7 to 8.9 mmol/L, respectively, and the changes of 2 h postprandial blood glucose ranged from 2.5 to 9.8 and 3.8 to 7.1 mmol/L, respectively. For the glucose tolerance index, the intraperitoneal group showed improvement at all time points, and the subcutaneous group showed a decrease at all time points except for 0 and 60 min.Conclusions:In combination with dietary intervention, insulin intraperitoneal injection was more effective in controlling blood glucose in KKAy mice with spontaneous type 2 diabetes compared with subcutaneous insulin injection, and had a significant improvement in glucose tolerance.

Objective:To investigate the effects of pre-pregnancy health examination combined with standardized health care during pregnancy on the pregnancy outcome at advanced maternal age.Methods:A total of 300 pregnant women who visited the Perinatal Clinic of the First Affiliated Hospital, School of Medicine, Shihezi University, China who received treatment between September 2018 and September 2019 were included in this study. They were divided into three groups according to pre-pregnancy health examination and heath care during pregnancy. In the observation group ( n = 78), pregnant women received pre-pregnancy health examination and health care during pregnancy on time and regularly. In the control group 1 ( n = 110): pregnant women did not receive pre-pregnancy health examination or regular health care during pregnancy. In the control group 2 ( n = 112), pregnant women received pre-pregnancy health examination or regular heath care during pregnancy. The pregnancy outcome was compared among three groups. The pre-pregnancy health examination and regular health care during pregnancy in women at advanced maternal age were correlated with gestational hypertension, gestational diabetes mellitus, premature delivery and other pregnancy risks. Results:There were significant differences in premature delivery (20.5%, 9.8%, 2.7%), gestational hypertension (23.1%, 12.5%, 3.6%), gestational diabetes mellitus (19.2%, 8.9%, 2.7%), premature rupture of membrane (17.9%, 10.7%, 3.6%), postpartum hemorrhage (12.8%, 8.0%, 1.8%), gestational anemia (19.2%, 8.0%, 2.7%) and placental abruption (7.7%, 8.0%, 0.9%) among control group 1, control group 2, and observation group ( χ2 = 16.047, 16.376, 14.724, 10.489, 8.781, 15.380, 6.744, all P < 0.05). The rate of cesarean section rate in the control group 1, control group 2, and observation group was statistically significant (70.5%, 44.6% and 27.3%, χ2 = 34.468, P < 0.05). There were significant differences in the incidence rates of macrosomia (15.4%, 8.9%, 2.7%), low birth weight infants (11.5%, 5.4%, 0.0%), stillbirth or late-term abortion (10.3%, 4.7%, 0.9%), neonatal asphyxia (16.7%, 7.1%, 1.8%) among the control group 1, control group 2 and observation group ( χ2 = 9.654, 12.840, 8.979, 14.284, all P < 0.05). Conclusion:The risk of adverse pregnancy outcomes is increased at advanced maternal age. Pre-pregnancy health examination combined with standardized health care during pregnancy can improve the pregnancy outcomes at advanced maternal age.