Artificial intelligence （AI） is widely applied in the medical field， including medical imaging， drug research and development， assisted diagnosis， health management， and disease prediction. With the deepening of social aging and the increasingly urgent need to improve the well-being of terminally ill patients， the interdisciplinary integration of AI and hospice care has become imperative. Hospice care aims to improve the quality of life for terminally ill patients and provides them with comprehensive physical， psychological， and spiritual care. AI boasts prominent application advantages in hospice care. Nevertheless， the ethical risks and challenges related to AI in this field also require urgent attention. The paper aimed to explore the application value of AI in hospice care as well as the ethical challenges it faced， with a particular focus on analyzing its practical roles in symptom monitoring， pain management， and psychological counseling. On this basis， this paper further paid attention to ethical challenges such as data privacy protection， safeguarding of life dignity， dilemmas in human-computer interaction， and the digital divide. Corresponding countermeasures were also put forward to provide theoretical support for promoting the digital development of hospice care.

Objective To construct a comprehensive cost management index system for public hospitals.Methods Literature review,policy analysis,and the Delphi expert consultation method were used to establish the index system.Data from a tertiary grade A public hospital in Beijing from 2019 to 2024 were analyzed.Results The response rate for both rounds of expert consultation was 100％,indicating high expert engagement.The average authority level of the experts was 0.905.x2 tests of Kendall's W coefficient for the importance,operability,and sensitivity of the indicators yielded P＜0.001.A comprehensive cost management system comprising 5 dimensions and 13 indicators was established.Conclusion The constructed comprehensive cost management index system for public hospitals is scientifically sound and highly reliable.It enables effective cost control,risk warning,and continuous improvement,laying a solid foundation for the comprehensive advancement of cost management efforts.

Objective To compare the complications,etiology,and clinical manifestations between pediatric patients with heart valve disease undergoing surgical treatment.Methods A retrospective analysis was conducted on the clinical data of 169 pediatric patients aged 0-14 years diagnosed with heart valve abnormalities at Wuhan Union Hospital from January 2019 to October 2022.Patients were divided into two groups based on whether they received surgical intervention for valve abnormali-ties:the surgical treatment group and the medical treatment group.Results There were significant differences in age,type and grade of heart failure,club-finger,pneumonia and cough,cardiac morphology,arrhythmia,ventricular septal width and left ven-tricular ejection fraction(all P＜0.05).Univariate and multivariate binary logistic regression analyses revealed that left ventricu-lar ejection fraction(OR=1.206,95％CI:1.072-1.357,P＜0.05)was an independent risk factor for the surgical treatment group.Conclusion The clinical manifestations of heart valve abnormalities in children are often atypical.Clinicians should ac-tively evaluate the etiology based on clinical symptoms and echocardiographic findings,and develop individualized treatment strategies,either surgical or medical,to prevent the progression of severe heart disease.

Objective To establish and evaluate a mouse model of chronic obstructive pulmonary disease(COPD)induced by cigarette smoke(CS).Methods Forty BALB/c mice were divided randomly into a control group and a CS group.Mice in the CS group were subjected to passive smoking for 20 weeks and a COPD model was established.Morphological changes in the organs and lung,heart,liver,and kidney fibrosis were observed by hematoxylin-eosin(HE)and Masson staining.Lung,cardiac,and brain cognitive function were evaluated by pulmonary function testing,small-animal ultrasound,and Morris water maze trials.Tumor necrosis factor-α(TNF-α),interleukin(IL)-6 and IL-1β levels in lung and brain tissues were detected by ELISA.Liver and renal functions were measured by biochemical method.Results The alveolar septum was narrowed or broken in mice in the CS group,and the adjacent alveolar cavity was enlarged and fused,consistent with the pathological changes of COPD.Neuronal degeneration and necrosis were observed in the hippocampus,but there were no significant morphological changes in other organs.Masson staining showed no obvious fibrosis in the lung,heart,liver,or kidney in CS-group mice.The result of pulmonary function tests showed that the forced expiratory volume in 0.1 second/forced vital capacity(FEV 0.1/FVC)and dynamic compliance were significantly decreased in the CS group compared with the control group,while airway resistance was obviously increased.Cognitive impairment in mice in the CS group was confirmed in the Morris water maze trial.TNF-α,IL-6,and IL-1β levels in lung and brain tissues were higher in the CS group compared with the control group.There were no significant differences in cardiac,liver,and renal functions between the groups.Conclusions A mouse model of COPD can be established by CS exposure for 20 weeks.Lung histomorphology,lung function,brain cognitive function,and levels of inflammatory factors can be used as indicators to evaluate the success of the model.

Objective To establish and evaluate a mouse model of chronic obstructive pulmonary disease(COPD)induced by cigarette smoke(CS).Methods Forty BALB/c mice were divided randomly into a control group and a CS group.Mice in the CS group were subjected to passive smoking for 20 weeks and a COPD model was established.Morphological changes in the organs and lung,heart,liver,and kidney fibrosis were observed by hematoxylin-eosin(HE)and Masson staining.Lung,cardiac,and brain cognitive function were evaluated by pulmonary function testing,small-animal ultrasound,and Morris water maze trials.Tumor necrosis factor-α(TNF-α),interleukin(IL)-6 and IL-1β levels in lung and brain tissues were detected by ELISA.Liver and renal functions were measured by biochemical method.Results The alveolar septum was narrowed or broken in mice in the CS group,and the adjacent alveolar cavity was enlarged and fused,consistent with the pathological changes of COPD.Neuronal degeneration and necrosis were observed in the hippocampus,but there were no significant morphological changes in other organs.Masson staining showed no obvious fibrosis in the lung,heart,liver,or kidney in CS-group mice.The result of pulmonary function tests showed that the forced expiratory volume in 0.1 second/forced vital capacity(FEV 0.1/FVC)and dynamic compliance were significantly decreased in the CS group compared with the control group,while airway resistance was obviously increased.Cognitive impairment in mice in the CS group was confirmed in the Morris water maze trial.TNF-α,IL-6,and IL-1β levels in lung and brain tissues were higher in the CS group compared with the control group.There were no significant differences in cardiac,liver,and renal functions between the groups.Conclusions A mouse model of COPD can be established by CS exposure for 20 weeks.Lung histomorphology,lung function,brain cognitive function,and levels of inflammatory factors can be used as indicators to evaluate the success of the model.

Objective To compare the complications,etiology,and clinical manifestations between pediatric patients with heart valve disease undergoing surgical treatment.Methods A retrospective analysis was conducted on the clinical data of 169 pediatric patients aged 0-14 years diagnosed with heart valve abnormalities at Wuhan Union Hospital from January 2019 to October 2022.Patients were divided into two groups based on whether they received surgical intervention for valve abnormali-ties:the surgical treatment group and the medical treatment group.Results There were significant differences in age,type and grade of heart failure,club-finger,pneumonia and cough,cardiac morphology,arrhythmia,ventricular septal width and left ven-tricular ejection fraction(all P＜0.05).Univariate and multivariate binary logistic regression analyses revealed that left ventricu-lar ejection fraction(OR=1.206,95％CI:1.072-1.357,P＜0.05)was an independent risk factor for the surgical treatment group.Conclusion The clinical manifestations of heart valve abnormalities in children are often atypical.Clinicians should ac-tively evaluate the etiology based on clinical symptoms and echocardiographic findings,and develop individualized treatment strategies,either surgical or medical,to prevent the progression of severe heart disease.

Objective To construct a comprehensive cost management index system for public hospitals.Methods Literature review,policy analysis,and the Delphi expert consultation method were used to establish the index system.Data from a tertiary grade A public hospital in Beijing from 2019 to 2024 were analyzed.Results The response rate for both rounds of expert consultation was 100％,indicating high expert engagement.The average authority level of the experts was 0.905.x2 tests of Kendall's W coefficient for the importance,operability,and sensitivity of the indicators yielded P＜0.001.A comprehensive cost management system comprising 5 dimensions and 13 indicators was established.Conclusion The constructed comprehensive cost management index system for public hospitals is scientifically sound and highly reliable.It enables effective cost control,risk warning,and continuous improvement,laying a solid foundation for the comprehensive advancement of cost management efforts.

Objective:To introduce evidence-based concepts into clinical nursing, and carry out perioperative nutritional risk screening for patients with primary liver cancer treated with Cyberknife, so as to enhance the overall nutritional management awareness and the level of nutritional nursing intervention of the nursing staff, and at the same time provide a basis and support for pushing nursing staff to multidisciplinary cooperation and broadening their professional horizons.Methods:From August 2019 to July 2020, in accordance with the practice model of the Australian Joanna Briggs Institute Evidence-based Health Care Center, we searched the evidence on nutritional risk screening of patients with primary liver cancer treated with Cyberknife in the European Society for Parenteral and Enteral Nutrition website and the Chinese Parenteral and Enteral Nutrition Society website, PubMed, China National Knowledge Infrastructure (CNKI) and Wanfang Data. The evidence was evaluated by the team and applied to nurses and patients in the Liver Oncology Department of the Fifth Medical Center of the People's Liberation Army General Hospital. A total of 21 nurses were selected to conduct a survey with the Nutrition Knowledge Questionnaire of Primary Liver Cancer Patients undergoing Cyberknife Treatment designed by the research team before and after the application of evidence. A total of 41 patients treated with Cyberknife for primary liver cancer admitted from August to December 2019 (without the use of this evidence) were selected as the control group, and 39 patients treated with Cyberknife for primary liver cancer admitted from January to April 2020 (after the application of the evidence) were selected as the observation group. The nutrition-related indicators of the two groups of patients were collected and compared when the patients were admitted to the hospital and when they were discharged after the Cyberknife treatment was completed.Results:After the application of the evidence, 21 nurses' awareness rates of perioperative nutritional risk-related knowledge of patients treated with primary liver cancer Cyberknife, nutritional risk screening implementation rates, patients' nutritional screening knowledge awareness rates and nutritional screening implementation rates were higher than those before the application of the evidence, the differences were statistically significant ( P<0.05) . Conclusions:The evidence-based nursing practice based on the practice model of the Australian Joanna Briggs Institute Evidence-based Health Care Center is used to screen the nutritional risk of perioperative patients with primary liver cancer treated with Cyberknife treatment, which enriches the nurses' knowledge about nutrition risk screening, enhances the initiative of nurses in clinical work, and is also conducive to strengthening multidisciplinary cooperation, and improving the quality of perioperative nutritional nursing management for patients with primary liver cancer treated with Cyberknife.

Objective:To investigate the predictive value of peritoneal protein clearance (Pcl) for cardiovascular events and cardiovascular mortality in peritoneal dialysis (PD) patients.Methods:Eligible PD patients were prospectively enrolled from January 2014 to April 2015 in the PD Center of Renji Hospital, School of Medicine, Shanghai Jiao Tong University. All patients were followed up until death, withdrawing from PD, transferring to other centers, or the end of study period (October 1, 2018). The patients were divided into high Pcl group and low Pcl group by the median Pcl, and the differences of related indicators between the two groups were compared. A multiple linear regression model was used to analyze the influencing factors of Pcl. The Kaplan-Meier method and Log-rank test were used to compare the cumulative survival rates of patients between the two groups. A multivariate Cox regression model was used to estimate the risk of cardiovascular events and cardiovascular mortality in relation to Pcl in PD patients.Results:A total of 271 patients were enrolled, with 135 males (49.8%), age of (56.92±0.84) years old and a median PD duration of 38.77(19.00, 63.10) months. There were 70 patients (25.8%) comorbiding with diabetes and 81 patients (29.9%) with cardiovascular diseases (CVD). The median Pcl of this cohort was 67.93(52.31, 88.36) ml/d. Compared with the low Pcl group (Pcl<67.93 ml/d), the high Pcl group (Pcl≥67.93 ml/d) had older age, and greater proportion of CVD, body mass index (BMI), pulse pressure, brain natriuretic peptide, mass transfer area coefficient of creatinine (MTACcr), and lower serum albumin (all P<0.05). There was no significant difference in gender, dialysis duration, proportion of diabetes, proportion of angiotensin converting enzyme inhibitor and angiotensin receptor blocker, proportion of continuous ambulatory PD, high sensitivity C reactive protein, fluid removal including 24 h urine volume and 24 h ultrafiltration, and residual renal function between the two groups (all P>0.05). Multiple linear regression analysis showed that serum albumin ( β=-0.388, P<0.001), BMI ( β=0.189, P<0.001), and MTACcr ( β=0.247, P<0.001) were independently related to lg(Pcl). During the study period, 55 patients experienced one or more cardiovascular events and 39 patients had cardiovascular mortality. According to Kaplan-Meier analysis, cardiovascular mortality in the high Pcl group was higher than that of low Pcl group (Log-rank χ2=6.902, P=0.009). Multivariate Cox regression analysis showed that, high lg(Pcl) was an independent influencing factor of cardiovascular events in PD patients ( HR=7.654, 95% CI 1.676-34.945, P=0.009). Conclusions:Serum albumin, BMI and MTACcr are independently associated with Pcl, and Pcl is an independent predictor of cardiovascular events in PD patients.

Objective: To analyze the risk factors of frequent gout flare, and to evaluate its susceptibility to identify patients with≥2 acute attacks per year. Methods: A total of 579 of cases gout patients with no history of taking urate lowering treatment (ULT) in recent 12 months were enrolled. The patients were divided into frequent group (gout episodes≥twice per year) and non-frequent group(gout attacksResults: There were significant differences in involvement of upper limb joints, tophi, combining hypertension and renal stone between two groups. The two groups had no statistical differences in family history, gender, history of smoking and drinking, ratios of regular exercise, and combining diabetes, hepatic insufficiency, hypertriglyceridemia, hypercholesterolemia, and overweight/obesity. There was significant differences in the number of joints involved, the history of disease duration, the level of SUA and TG[(4.66±2.54) vs (2.77±1.64), (6.68±5.11) vs (5.14±3.89) years, (525.82±132.11) vs (489.33±139.81) μmol/L, (2.51±1.94) vs (2.05±1.22) mmol/L, P<0.05 or P<0.01]; There were no statistical differences in age of onset, SBP, DBP, age of initial diagnosis, fasting blood glucose, TC, creatinine, glomerular filtration rate, AST, ALT, body mass index, waist circumference, and waist-to-hip ratio. Logistic regression analysis indicated that a large number of joints involved and higher serum uric acid level were risk factors of frequent gout attacks. The ROC curve showed that the number of joints involved had qualified performance in identifying patients with frequent gout attacks. When the number of joints involved was >2, and the sensitivity, specificity, positive predictive value and negative predictive value were 77.8%, 43.3%, 85.6%, and 56.6%, respectively, and the difference was significant. Conclusion Higher SUA and a larger number of joints involved associate independently with frequent gout attacks. The number of joints involved at initial diagnosis>2, which can predict the frequent flare, and start ULT as earlier as possible. Patients with joints involved at initial diagnosis>2 are at greater risk of frequent gout flare.