With the rapid development of network technology， live surgery has become the new way of surgery teaching. However， the issue of patient privacy protection caused by live surgery has received widespread attention. Based on the evolutionary game theory， this paper constructed an evolutionary game model from the three-party perspectives of doctors， patients， and government and analyzed the game behaviors of the three parties in the process of live surgery. Matlab software was utilized to conduct dynamic simulation and numerical simulation analysis. It was found that the factors affecting the choice of doctors’ strategies included protection costs， the cost of privacy leakage， the benefits of protection， high-traffic benefits， and other aspects； the factors affecting the choice of patient strategies encompassed surgical costs， the risk of privacy leakage， additional benefits， and other aspects； the factors affecting the choice of government strategies embodied regulatory costs and the improvement of credibility. To realize a win-win situation among doctors， patients， and the government， the three parties need to work together to ensure that patient privacy is not violated and find a balance between expanding the influence of medical education and protecting patient privacy.

ObjectiveTo understand the current situation of medical damage liability disputes involving breach of the duty to inform in China， analyze the factors influencing the types of medical staff’s breach of the duty to inform， and explore the notification problems of medical staff in clinical practice. On these foundations， suggestions were proposed to improve the performance of the duty to inform and reduce medical disputes. MethodsUsing public cases from the China Judgements Online as the data source， the relationship between risk points and types of breach of duty to inform was analyzed using the Chi-square test. Logistic regression analysis was performed to explore the influencing factors of the types of breach of the duty to inform， and qualitative research summarized the specific contents of breach of the duty to inform. ResultsThere were differences in the effects of factors， including whether the patient was hospitalized， whether surgery was performed， whether Intensive Care Unit （ICU） treatment was required， the level of the medical institution， and whether a consultation occurred， on the types of breach of the duty to inform （P<0.05）. Whether surgery was performed was an influencing factor for the types of breach of the duty to inform. Qualitative research showed that the contents of breach of duty to inform primarily involve risk， treatment plan， and deficiencies in disease notification. ConclusionStrengthening the performance of the medical staff’s duty to inform should mainly focus on the medical side， coordinating with multiple parties and taking measures to improve the performance of the duty to inform， to reduce unnecessary medical disputes.

Humans ; Adolescent ; Acne Vulgaris/therapy* ; Skin Care ; Surveys and Questionnaires ; Cognition ; China ; Skin

Children and adults differ significantly in physiology,biochemistry and immune function,which leads to sig-nificant differences in blood transfusion strategies between children and adults.To guide the clinical transfusion practice of pediatric patients and improve the prognosis of children,the National Health Commission organized the formulation and re-lease of the health industry standard Guideline for Pediatric Transfusion(WS/T 795-2022).This paper will briefly introduce some concepts that help understand of the Standard and the preparation process of the Standard,and explain and interpret the preparation of the"scope","general provisions"and"factors to consider"of the Standard,hoping to contribute to the understanding and implementation of the Standard.

Objective:To examine the correlation between serum 25-hydroxyvitaminD [25(OH)D] levels and all-cause mortality risk among adult women in the United States.Methods:Data for this retrospective cohort study were obtained from the National Health and Nutrition Examination Survey 2011—2016. A total of 6 452 women with complete data were enrolled and the end point event was all-cause mortality. The subjects were categorized into four groups based on serum 25(OH)D levels: severe deficiency group [25(OH)D<25.0 nmol/L, n=285], deficiency group [25(OH)D 25.0-49.9 nmol/L, n=1 695], insufficient group [25(OH)D 50.0-74.9 nmol/L, n=2 119], and sufficient group [25(OH)D≥75.0 nmol/L, n=2 353]. The serum 25 (OH) D level was included in cox proportional hazards model as a continuous variables and a categorical variables, respectively, to estimate the risk of all-cause mortality. Cox regression model based on restricted cubic splines was used to observe the curve relationship between the continuous change of serum 25(OH)D and the risk of all-cause mortality. A two-piecewise linear regression model was used to analyze the saturation threshold effect and examine the correlation between serum 25(OH)D levels and all-cause mortality risk among adult women in the United States. Results:A total of 6 452 women were enrolled. The mean level of serum 25(OH)D was (68.2±31.6) nmol/L, and only 36.5% (2 353/6 452) of the women had sufficient vitamin D. During the follow-up time of (5.8±1.8) years, 375 women died, and the all-cause mortality rate of 5.8%. After multivariate adjustment, for every 10 nmol/L increase in serum 25(OH)D level, the risk of all-cause mortality was reduced by 5% ( HR=0.95, 95% CI: 0.91-0.98) ( P<0.05). Compared with serum 25(OH)D severe deficiency group, the risk of all-cause mortality in 25(OH)D sufficient group was 54% lower ( HR=0.46, 95% CI: 0.29-0.75) ( P<0.05, Ptrend<0.001). The association between serum 25(OH)D levels and all-cause mortality risk exhibited an L-shaped curve ( P=0.007) and the inflection point was 128.5 nmol/L; when the serum level of 25(OH)D was less than 128.5 nmol/L, for every 10 nmol/L increase in 25(OH)D, the risk of all-cause mortality was reduced by 8% ( HR=0.92, 95% CI: 0.88-0.96) ( P<0.001). Conclusion:High serum 25(OH)D concentrations are non-linearly associated with low risk of all-cause mortality. These findings suggest that maintaining adequate vitamin D status may lower mortality risk in American women individuals.

Objective:To retrieve and analyze the evidence related to perioperative blood glucose management in patients with coronary heart disease (CHD) complicated by diabetes undergoing percutaneous coronary intervention (PCI) , and provide clinical guidance for glucose management.Methods:Systematic searches were conducted on domestic and international guideline websites, evidence-based databases, primary research databases, and related association websites for evidence concerning perioperative blood glucose management for this patient group. The search included clinical decisions, guidelines, expert consensus, evidence summaries, and systematic reviews, covering the time span from database inception to February 2022. Two evidence-trained researchers independently conducted literature quality assessments and evidence extraction, with disputes resolved by a third party.Results:Eighteen articles were included: one clinical decision, nine guidelines, and eight expert consensuses. The findings were summarized into eight aspects: team formation and training, admission assessment and treatment, blood glucose control targets, preoperative glucose management, intraoperative glucose management, postoperative glucose management, perioperative abnormal glucose management, and discharge management, totaling 35 evidence points.Conclusions:This study consolidates evidence related to perioperative blood glucose management for patients with CHD complicated by diabetes undergoing PCI. However, during the evidence translation and application process, conditions of the application site, medical resources, and patient preferences should be fully considered. After assessing the feasibility and applicability of the evidence, a personalized blood glucose management plan should be developed for the patient, aiming to improve blood glucose levels and prognosis.

Objective:To evaluate clinical efficacy and safety of topical compound oleum lithospermi in the treatment of mild to moderate diaper dermatitis.Methods:A multicenter, randomized, positive-drug parallel-controlled clinical trial was conducted in 19 hospitals from July 2019 to August 2020. Children aged 0 - 12 months with mild to moderate diaper dermatitis were enrolled and randomly divided into 2 groups using a random number table: test group topically treated with compound oleum lithospermi, and control group topically treated with zinc oxide cream. The treatment was carried out 6 - 8 times a day for 7 days. Visits were scheduled on days 0 and 7, and total response rate and clinical healing time were evaluated. Changes in the dermatitis family impact (DFI) score were compared between the test group and control group, and adverse events were recorded. Statistical analysis was carried out by using independent-sample t test for normally distributed continuous data, Wilcoxon rank sum test for non-normally distributed continuous data, and chi-square test or Fisher′s exact test for unordered categorical data; survival curves were drawn, and log-rank test was used for comparisons between two groups. Results:A total of 343 children with diaper dermatitis were enrolled in this study. Among them, 31 children violated the protocol, so 312 were included in the per protocol set, including 157 in the test group and 155 in the control group, and all completed the visits on days 0 and 7. The total response rate was significantly higher in the test group (87.26%, 137/157) than in the control group (78.71%, 122/155; χ2 = 4.04, P = 0.044) . The clinical healing time was significantly shorter in the test group (5.33 days) than in the control group (6.13 days; χ2 = 4.67, P = 0.025) . After 7-day treatment, the DFI score significantly decreased in both the 2 groups compared with that before the treatment, but there was no significant difference in the DFI score between the 2 groups (test group: 4.02 ± 6.96, control group: 3.58 ± 5.90, Z = -0.39, P = 0.686) . The incidence of adverse events was 2.92% (5/171) and 5.45% (9/165) in the test group and control group respectively, and there was no significant difference between the 2 groups ( χ2 = 0.03, P = 0.865) . Conclusion:Compound oleum lithospermi can markedly reduce the clinical severity of diaper dermatitis, improve the total response rate, shorten the clinical treatment period, and improve the quality of life of children′s families with a favorable safety profile.

Objective:Standardized sample resources and high-quality clinical big data are important resources for medical research, only through resource sharing can maximize its utilization.Which can be utilized to the max only through resource sharing.Methods:This paper attempts to explore the sharing mechanism of the resource sharing platform and proposes some aspects such as the platform construction background, management regulations, legal ethical system, data sharing principles, benefit distribution, etc.This article attempts to explore the sharing mechanism based on the resource sharing platform of the respiratory disease biobank, proposes the contents that should be included in the sharing mode.Detailed information including the platform construction background, management procedures, legal and ethical system, data sharing principles and benefit distribution should take into consideration in the operating mechanism of the platform.Results:Establishing a resource sharing platform matches the development of clinical research in China.The tailored sharing model which is suitable for the field of respiratory diseases will also guide the rapid development of clinical research.Conclusions:The construction of a respiratory disease biobank sharing platform is conducive to promoting the opening and sharing of biological samples and information resources in the context of big data.

Objective: To compare the changes in liver function in patients with different types of hepatic alveolar echinococcosis after radiofrequency ablation. Methods: The data of 32 patients with hepatic alveolar echinococcosis treated by radiofrequency ablation from December 2016 to December 2018 at the Qinghai Provincial People's Hospital were retrospectively analyzed. There were 12 males and 20 females. The patients were divided into the single lesion group (n=17) and the multiple lesions group (n=15) according to the number of hydatid lesions. The lesions were further divided into the small lesion group (n=12) and the large or medium lesion group (n=20). The operation time, changes in AST and ALT were compared among these groups. Results: The operation time of the single lesion group was 1.5 (1.0, 1.8) hour, and that of the multiple lesions group was 3.0 (1.5, 3.5) hour. The difference was statistically significant (P<0.05). On the 1st and 3rd day after treatment, ALT in the multiple lesions group was significantly higher than that in the single lesion group (P<0.05). Compared with the 1st day after operation, ALT of the two groups decreased on the 5th day after treatment, and the difference was statistically significant (P<0.05). The changes in AST in the two groups were basically the same as that of ALT. The operation time of the small lesion group was 1.0 (1.0, 1.9) hour, and of the large and medium lesion group was 2.5 (1.5, 3.0) hour. The difference was statistically significant (P<0.05). On the 1st, 3rd and 5th day after treatment, ALT in the small lesion group was significantly lower than the large or medium lesion group (P<0.05). Compared with the 1st day after treatment, ALT of the two groups decreased on the 5th day after treatment, and the difference was statistically significant (P<0.05). There was a significant difference in AST between the small lesion group and the large or medium lesion group only on the 1st day after operation (P<0.05). Conclusion Radiofrequency ablation for hepatic alveolar echinococcosis with a single lesion and a small lesion had shorter operation time with less changes in liver function after treatment.

Objective: To investigate the expressions of migration and invasion inhibitory protein (MIIP) and p21-activated kinase 1 (PAK1) in endometrial carcinoma (EC) and their correlation with clinicopathological features. Methods: The protein levels of MIIP and PAK1 in 135 paraffin-embedded EC tissues, 55 atypical hyperplasia of endometrium (AHE) and 88 normal endometrium (NE) tissues were quantified by immunohistochemistry, the clincial significance and the relationship of these two proteins were also analyzed. Results: The positive rates of MIIP expression in NE, AHE and EC tissues were 52.3%(46/88), 41.8% (23/55) and 34.8% (47/135), respectively. The expression of MIIP in EC was significantly lower than that of MIIP in NE (P<0.05). The positive rates of PAK1 expression in NE, AHE and EC tissues were 45.5% (40/88), 50.9% (28/55) and 62.2% (84/135), respectively. The expression of PAK1 in EC tissues was significantly higher than that of PAK1 in NE tissues (P<0.05). The expression of MIIP in EC tissues was significantly associated with myometrial invasion, International Federation of Gynaecology and Obstetrics (FIGO) stage and lymph node metastasis (P<0.05). The expression of PAK1 in EC tissues was significantly related with differentiation, myometrial invasion, FIGO stage and lymph node metastasis (P<0.05). The expressions of MIIP and PAK1 in EC tissues were marginally related with the overall survival of patients (P=0.092, P=0.052). The expression of MIIP in EC was negatively correlated with PAK1 (r=-0.329, P<0.001). Conclusions The down-regulation of MIIP and up-regualtion of PAK1 paticipate in the initiation and development of EC, which are correlated with the poor prognosis of EC. The protein expression of MIIP is inversely related with PAK1 in EC.