ObjectiveTo investigate the current situation and influencing factors of moral injury among physicians in China， and to analyze the relationship between moral injury and medical professionalism， providing a reference for preventing and treating moral injury and protecting physicians’ physical and mental well-being. MethodsFrom September to October 2023， the convenience sampling method was used to conduct a questionnaire survey on practicing physicians， interns， or resident physicians in hospitals at all levels in Heilongjiang Province， Guangdong Province， Xinjiang Uygur Autonomous Region， and Beijing. ResultsA total of 421 practicing physicians， interns， or resident physicians were included. The total score of the Moral Injury Symptom Scale for Healthcare Professionals was （42.07 ± 13.67）， of which 31.6% of the respondents had significant clinical distress and functional impairment related to moral injury， with the highest mean score for the dimension “unforgiveness.” Correlation analysis revealed that the total score of medical professionalism， as well as the scores of each dimension， were significantly negatively correlated with the total score of the Moral Injury Symptom Scale. Linear regression analysis showed that job satisfaction， medical professionalism， whether they felt a low level of organizational support in the handling of doctor-patient disputes， whether they had witnessed patients’ suffering or dying， gender， whether they had worked overtime， and whether they had needed professional help in relieving psychological stress were influencing factors of physicians’ moral injury. ConclusionThe physicians’ moral injury in China is at a medium level overall. Physicians’ moral injury is affected by numerous factors， with a significant negative correlation between moral injury and medical professionalism. It is recommended to improve the level of organizational support in medical institutions and medical professionalism， establish specialized psychological and moral aid institutions， and create a caring organizational atmosphere， to prevent and repair physicians’ moral injury and better protect their physical and mental well-being.

OBJECTIVE: To evaluate the effectiveness and safety of minimally invasive treatment for bilateral tibial plateau fractures using the double reverse traction reducer. METHODS: The clinical data of 4 patients with bilateral tibial plateau fractures who met the selection criteria and treated between January 2016 and April 2024 were retrospectively analyzed. The cohort included 3 males and 1 female, aged 30-65 years (mean, 52.5 years). Injury mechanisms comprised traffic accidents (2 cases) and falls (2 cases). According to the Schatzker classification, 2 limbs were type Ⅱ and 6 were type Ⅵ. The time from injury to surgery ranged from 5 to 9 days (mean, 7 days). All patients underwent minimally invasive reduction using the double reverse traction reducer. Surgical duration, intraoperative blood loss, and hospitalization time were recorded. Functional outcomes were assessed at last follow-up using the Hospital for Special Surgery (HSS) knee score and range of motion (ROM), while fracture reduction quality was evaluated using the Rasmussen radiological score. RESULTS: All 4 patients successfully completed the procedure without conversion to open reduction. The total mean operation time was 80.25 minutes (range, 73-86 minutes), with a mean total intraoperative blood loss of 132.5 mL (range, 100-150 mL). The mean hospitalization time was 13.5 days (range, 11-16 days). All incisions healed primarily without neurovascular complications. X-ray film at 1 day after operation confirmed satisfactory reduction and articular surface alignment. Follow-up time ranged from 12 to 26 months (mean, 17.0 months). Fractures achieved clinical union at an average of 13 weeks (range, 12-16 weeks). No complication, such as deep vein thrombosis, joint stiffness, post-traumatic arthritis, or implant failure, was observed. At last follow-up, the mean HSS score was 92.9 (range, 90-97), mean knee ROM was 128.1° (range, 115°-135°), and mean Rasmussen radiological score was 16.4 (range, 15-19), with 2 limbs rated as excellent and 6 as good. CONCLUSION The double reverse traction reducer facilitates minimally invasive treatment of bilateral tibial plateau fractures with advantages including minimal trauma, shorter surgical duration, precise reduction, and fewer complications, effectively promoting fracture healing and functional recovery of the knee joint.
Humans ; Tibial Fractures/diagnostic imaging* ; Middle Aged ; Male ; Minimally Invasive Surgical Procedures/instrumentation* ; Female ; Adult ; Retrospective Studies ; Aged ; Traction/methods* ; Treatment Outcome ; Fracture Fixation, Internal/instrumentation* ; Range of Motion, Articular ; Operative Time ; Tibial Plateau Fractures

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective With the development of manned space missions to the moon and space exploration,extravehicular activities become more frequent and extravehicular mission become more complex,which puts forward higher requirements for the extravehicular spacesuit.In order to ensure the ergonomics of spacesuit,the flexible joints are usually adopted in the limbs of spacesuit.The structural design of large angle of movement and low resistance joints is the basic for ensuring the ergonomics of spacesuit.Methods This study established a method of spacesuit joint structure to analysis the motion characteristic of typical joints.Firstly,the structure and activity characteristics of the spacesuit and lunar space suits were comprehensively analyzed,and the activity characteristics of different typical structure are qualitatively analyzed based on existing empirical method.Then,the dynamics of typical structure was analyzed by finite element model.By studying the change trend of motion of spacesuit joint with motion angle,and the motion characteristic curve was obtained.Finally,the model was studied according to different structural size parameters.The influence of structural parameters on the motion characteristics was analyzed,and the curves was obtained to provide a basis for design of spacesuit motion joint structure.Results Through the above analysis,the motion characteristics of different typical structure are obtained qualitatively.And the influence of different structure parameters on the motion characteristics was analyzed.This establishes the method basis for structure design.Conclusion The study was carried out a method based on finite element model for joint motion analysis,which is suitable for the design of typical joint structure of spacesuit.

Objective The effect of lunar dust adhesion performance by fiber surface characteristics were investigated for the lunar dust adhesion mitigation of spacesuits.Methods In this research,an adhesion test method under ultraviolet ray radiation in vacuum was developed to measure the adhesion quantity of simulated lunar dust on fiber materials.Based on the microscopic image of the fiber sample after test,the influence of conductive and surface energy characteristics of the fiber materials on the lunar dust adhesion performance was studied.Results The simulated lunar dust were activated under ultraviolet ray radiation,which induced an increase of the adhesion quantity of simulated lunar dust on fiber materials;Lower surface energy or higher conductive characteristics of the fiber was both beneficial to reduce the adhesion quantity of simulated lunar dust.Conclusion The static electric forces were likely to be the major forces between the fiber and the lunar dust under ultraviolet ray radiation in vacuum.In addition to reducing surface energy,improving conductive characteristics of the fiber was more beneficial to reduce the adhesion quantity of simulated lunar dust.

Clinically,the incidence of portal vein thrombosis(PVT)in patients with cirrhosis can be up to 10％-23％.When PVT is not treated promptly,it may develop to cavernous transformation of the portal vein(CTPV).CTPV can aggravate portal hypertension,accelerate the progression of esophagogastric varices bleeding,refractory ascites,refractory peritonitis,biliary tract diseases,and hepatic insufficiency.At present,noninvasive imaging techniques such as portal vein reconstruction,enhanced CT and ultrasound are mostly used to make the diagnosis and evaluation of CTPV.It is rather difficult to perform portosystemic shunt surgery in patients with CTPV complicated by portal hypertension,which was once regarded as a contraindication for interventional portosystemic shunt procedures.With the improvement of related technologies and surgical instruments,the transjugular intrahepatic portosystemic shunt(TIPS)has become an important treatment for CTPV.This paper aims to make a comprehensive review about the relevant researches concerning the portosystemic shunt surgery in patients with CTPV so as to clarify the importance of TIPS in the treatment of CTPV.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Moral distress in clinical practice is an important factor contributing to the moral injury of medical staff.The core idea of caring ethics emphasizes that caring and being cared for are fundamental human needs,which holds important guiding significance for preventing and treating moral injury of medical staff.By sorting out the basic ideas of caring ethics theory,this paper explained and analyzed the moral injury of medical staff,identifying the main causes of moral injury including individual medical staff exhibiting vulnerability and a low level of self-care;disharmonious doctor-patient relationship and asymmetry in the caring relationship between doctors and patients;and low level of organizational support and the lack of a caring ethical atmosphere.Therefore,with caring as the goal,the moral distress can be alleviated by improving the care literacy and moral resilience of medical staff,building a harmonious caring relationship between doctors and patients,creating a caring environment,forming a caring organizational ethical atmosphere,and other pathways.These are also beneficial attempts to prevent and treat the moral injury of medical staff and to build a doctor-patient destiny community.

Objective:Papers related to moral injury on platforms such as CNKI,Wanfang,and VIP were retrieved and analyzed to understand the current status of moral injury research in China,provide a reference for future related content research,as well as lay the foundation for subsequent in-depth research on moral injury.Methods:Quantitative and qualitative analyses were conducted on literature related to moral injury from 2012 to 2023.Using the NVivo12 analysis tool,based on the content analysis method,the current status of research on moral injury in China was reviewed from the three dimensions of moral trauma,including research topics,research objects,and research perspectives.Results:The research themes of moral injury in China were mainly summarized in five aspects:concept,mechanism,measurement and assessment,symptoms and manifestations,as well as prevention and treatment.The research subjects were mainly high-risk occupational groups such as war-related personnel,medical staff,and teachers.The research was mainly conducted from the perspectives of ethics,medicine,cultural studies,and psychology.Conclusion:In the future,research on moral injury in China needs to deepen its theoretical system and promote empirical research.Expand research horizons,as well as enrich the research in the field of interdisciplinary and cross-disciplinary.Raise the level of attention,and pay attention to the physical and mental well-being of special employment groups.

The purpose of medicine is to preserve and develop the treatment in the process of saving lives and helping injuries. Medical professionalism is a comprehensive expression of physician’s clinical abilities, relationships and values between different subjects. In practice, white robed doctors utilize high standards of professionalism to practice the medical purpose and goals of "always centering on the interests of the patient" in specific diagnosis and treatment behaviors. At the same time, fulfilling the promises and expectations of medicine to the public. For these reasons, selfless dedication, self-sacrifice, and one-way pure altruism are all internalized into the basic requirements of medical professionalism: doctors should not only have the skill to revive the dead, but also have the benevolence of evangelists; they not only need to achieve maximum efficiency in technology, but also achieve the highest truth, goodness, and beauty in virtue. When these qualities are exaggerated or unattainable due to uncontrollable reasons, there will be a rift between the entrenched value systems and practical needs. In recent years, the global epidemic has had a huge impact on the medical system and medical staff, and the moral beliefs, role expectations, and value systems of doctors have also been impacted unprecedentedly, resulting in moral injury. The international research on moral injury in medical field has also received attention. China is currently in the adjustment period of epidemic related policies, with medical personnel bearing the brunt. Therefore, referring to relevant international research on moral injury to re-examine the relationship between the medical professionalism, which emphasizes one-way pure altruism, dedication and weakening or even neglecting personal well-being, and current medical practices. And constructing a moral injury early warning-repair system that focuses on doctors, patients, medical teams, medical institutions, medical environments, health systems, and other stakeholders, and ensuring its healthy operation. Not only in extreme periods, but also in ordinary daily diagnosis and treatment, it can support doctors to actively, safely, and healthily fulfill their mission of saving lives and helping injuries.