Objective To explore the clinical efficacy of plasma exchange (PE) and double-filtration plasmapheresis (DFPP) pretreatment regimens for high-titer ABO-incompatible kidney transplantation (ABOi-KT). Methods A retrospective analysis was conducted on 31 cases of ABOi-KT with a follow-up period ≥1 year admitted to Zhongshan Hospital Affiliated to Fudan University from April 2016 to August 2025. The efficacy differences between the PE combined with rituximab (RTX) + oral triple immunosuppressive regimen and the DFPP combined with RTX + oral triple immunosuppressive regimen were compared and analyzed. The titers of blood group antibodies and serum creatinine levels before and after the operation were monitored. The survival curves and cumulative risk occurrence curves were plotted using the Kaplan-Meier method. The survival rates of recipients and transplanted kidneys and the occurrence of complications were analyzed. Results Both the PE regimen and the DFPP regimen may effectively reduce the preoperative blood group antibody titer of the recipients to ≤1∶16. The one-year survival rate of the recipients and the transplanted kidneys both reached 100% after the operation. The postoperative serum creatinine levels of recipients who received the DFPP regimen were lower and more stable. There was no statistically significant difference in the incidence of complications between the two regimens during the same follow-up period. Conclusions Both the PE and DFPP regimens are effective pretreatment regimens for ABOi-KT. The DFPP regimen has more advantages in reducing treatment operations, lowering drug dosage and maintaining the stability of postoperative renal function. For recipients with a high initial antibody titer (≥ 1∶32), individualized determination of the number and frequency of plasma processing for pretreatment may achieve ideal therapeutic effects.

Building a harmonious doctor-patient relationship reflects the people’s expectations and society’s aspirations. It is an important factor related to the well-being of the population and the implementation of the healthy China strategy. The theory of intersubjectivity focuses on responding to the relationship between subjects. Based on the principles of interactivity， liveliness， and dialogue rationality， it highlights equal interaction， mutual understanding， and effective dialogue between subjects. Applying the intersubjectivity theory to the construction of a harmonious doctor-patient relationship can help to break the behavioral paradigm of the doctor-patient subject-object dichotomy， highlighting the true freedom of the doctor-patient dual subjects. From the perspective of intersubjectivity， a harmonious doctor-patient relationship is generated from intersubjective behavior， facilitated by pre-understanding between subjects， and realized through effective dialogue between subjects. In the real world， the obfuscation of subjective rationality， the division of cognitive structure， and the uneven demands of interest between doctors and patients eliminate the inherent mechanisms of a harmonious doctor-patient relationship. This leads to multiple practical dilemmas， such as a “subject-object” one-dimensional thinking mode， a “professional-life” structural cognitive difference， and “reason-sensibility” dislocation dialogue styles presented between doctors and patients. Promoting the transformation of doctor-patient interactive thinking form， the integration of their communication perspectives， and the enhancement of dialogue skills can help to achieve mutual understanding in cognition， mutual trust and empathy in emotions， and harmonious alignment in actions. Therefore， to address these dilemmas， this paper proposed a path by embedding intersubjectivity theory， strengthening bidirectional doctor-patient interaction， emphasizing doctor-patient illness narratives， bridging doctor-patient cognitive differences， focusing on improving subjective competencies， and enhancing doctor-patient humanistic care.

Objective: To explore the psychological connection between non-suicidal self injury (NSSI) behavior and childhood trauma among vocational college students, thereby informing the optimization of mental health services. Methods: From June to July 2025, 18 students with NSSI behavior and childhood trauma were recruited from two vocational colleges in Heze City for semi structured interviews. Data were analyzed using Colaizzi s seven step analysis method for coding and thematic extraction. Results: Four core themes and ten subthemes were identified. Childhood trauma drove NSSI behavior through four interrelated psychological pathways, containing a cognitive pathway for internalization of traumatic beliefs and self punishment, an emotional pathway for dysregulation of traumatic emotions and compensatory behaviors, a somatic behavioral pathway for somatization and reenactment of traumatic memories, and an interpersonal pathway for impaired trust and isolation based coping. These pathways intertwined and reinforced each other, forming a psychological network underlying NSSI behavior. Conclusions Childhood trauma serves as a core risk factor for NSSI, establishing NSSI behavior through "intertwined cognitive, emotional, somatic and interpersonal" pathways. Effective intervention should adopt an integrated approach incorporating cognitive restructuring, emotional regulation training, trauma recovery, and the social support reconstruction.

ObjectiveIn the context of the digital transformation of education, this study aims to construct a triadic interactive teaching model for surgical animal surgery in clinical medicine using modern information technology. It explores the effectiveness of different teaching methods in improving students' practical skills, aseptic awareness, and teamwork abilities, providing a reference for the reform of clinical practice education. MethodsA quasi-experimental research design was adopted. A total of 80 students from the eight-year clinical medicine program at Nanjing University were selected, including the Class of 2020 (control group, n=40) and the Class of 2021 (experimental group, n=40). The control group received traditional teaching methods, while the experimental group implemented the "Teacher-Student-AI" triadic interactive teaching model. This model utilized a smart teaching platform for personalized pre-class preparation , as well as data-driven post-class review and feedback throughout the entire teaching process. The "assessment indicators and scoring criteria for the surgical animal surgery course" were used to evaluate teaching effectiveness, with independent samples t-tests used for statistical analysis. ResultsPre-course assessments revealed no statistically significant differences in baseline theoretical knowledge or practical skills between the two groups (P>0.05). Upon completion of the course, the experimental group achieved higher scores than the control group across three key dimensions: practical skills (47.98±1.34 vs 46.92±2.51, P=0.022), aseptic awareness (17.84±1.16 vs 16.94±2.29, P=0.029), and teamwork (16.82±1.44 vs 15.95±1.22, P=0.004). However, no statistically significant difference was observed in the scores for humane care awareness between the two groups (8.24±0.70 vs 8.16±0.53, P=0.589). ConclusionThe AI-based triadic interactive teaching model can, to some extent, address the limitations of traditional surgical animal surgery education. It plays a positive role in enhancing medical students' surgical skills, aseptic awareness, and collaborative abilities. This model facilitates the transition from traditional to personalized teaching and offers a practical framework for the digital reform of clinical practice education.

Acute pelvic inflammatory disease (PID) is an infection of the female upper genital tract, including the endometrium, fallopian tubes, ovaries, and adjacent pelvic structures. PID can lead to serious reproductive complications, such as tubal infertility, ectopic pregnancy, and chronic pelvic pain. Prompt initiation of empiric antibiotic therapy, with subsequent adjustment based on disease severity and clinical context, is essential. Recommended regimens consist of broad-spectrum antibiotics that target likely pathogens. This review summarizes the principles of antibiotic therapy and current guidelines for the management of acute PID.Current concepts: Empiric broad-spectrum antibiotics remain the cornerstone of PID management. Recommended regimens should provide coverage against Neisseria gonorrhoeae, Chlamydia trachomatis, anaerobic bacteria, and other facultative organisms, including Mycoplasma genitalium, which has emerged as a potential causative pathogen in some regions. Treatment should be initiated immediately upon clinical suspicion without awaiting microbiological confirmation, as delays significantly increase the risk of long-term sequelae.Discussion and conclusion: Key recommendations for PID include the following: (1) Use outpatient combination antibiotic therapy for mild to moderate disease. (2) Hospitalize and initiate parenteral therapy in cases of severe disease, pregnancy, suspected tubo-ovarian abscess, inability to tolerate oral therapy, or lack of clinical improvement within 72 hours. (3) Use cephalosporin-based regimens combined with doxycycline and metronidazole as first-line therapy, consistent with current Centers for Disease Control and Prevention guidelines. (4) Initiate treatment early, monitor closely, and adjust therapy as needed to optimize outcomes and minimize complications. (5) Notify and treat sexual partners to prevent reinfection and disease transmission.

Metaverse-based mental health interventions have recently emerged as an extension of telepsychiatry, digital therapeutics (DTx), and virtual reality (VR)–based treatments for children and adolescents. The coronavirus disease 2019 pandemic accelerated the adoption of remote psychological assessment and intervention, raising critical questions regarding their clinical validity, developmental appropriateness, and long-term applicability in youth populations. Accumulating evidence has demonstrated that remote assessments and internet-based interventions can achieve clinical outcomes comparable to face-to-face approaches in selected domains, particularly anxiety, depression, and social communication difficulties. In parallel, immersive technologies such as VR and metaverse-based platforms have been applied to exposure-based interventions, social skills training, and emotion regulation in controlled and repeatable environments. This narrative review examined 48 empirical and review studies on telepsychiatry, internet-based cognitive behavioral therapy, DTx, VR, and metaverse-based interventions for children and adolescents. Neurobiological mechanisms relevant to fear extinction, executive function, emotion regulation, and social cognition were critically reviewed. In addition, real-world implementation experiences from a hospital-based Wee Center in Korea were integrated to evaluate feasibility within school-linked mental health services. The findings suggested that metaverse-based counseling should not be conceptualized as a stand-alone replacement for face-to-face treatment, but rather as a complementary, hybrid platform linking remote screening, structured digital intervention, and in-person clinical care. While current evidence supported feasibility and conditional clinical utility, further longitudinal, controlled, and cost-effectiveness studies were required to establish its role in pediatric mental health.

Objective: This study examined the trends in emergency medicine research in Korea over the past three decades and to how the field has evolved over time. Methods: We analyzed 2,720 articles published in the Journal of the Korean Society of Emergency Medicine from 1990 to 2023 using text-mining techniques. Results: Over the past 34 years, major research topics in Korean emergency medicine have included cardiopulmonary resuscitation, emergency medical service, emergency department, mortality, prognosis, poisoning, cardiac arrest, triage, ultrasonography, and education. The main research topics have evolved over the decades. In the 1990s, studies focused on cardiopulmonary resuscitation, injury severity score, Glasgow Coma Scale, mortality, and trauma. In the 2000s, the focus shifted to cardiopulmonary resuscitation, cardiac arrest, emergency medical service, emergency department, and poisoning. In the 2010s, research focused on cardiopulmonary resuscitation, emergency medical service, prognosis, mortality, and cardiac arrest. Since 2020, studies have predominantly addressed emergency departments, mortality, coronavirus disease 2019, emergency medical services, and prognosis. Conclusion These findings provide a reference for identifying future research direction for emergency medicine researchers in Korea and may contribute to diversifying, balancing, and promoting emergency medicine research nationwide.

Objective: This study evaluated the clinical outcomes of patients with acute ischemic stroke (AIS) based on different reperfusion strategies-intravenous thrombolysis (IVT) alone, mechanical thrombectomy (MT) alone, combined IVT+MT, or non-reperfusion therapy (non-RT)-managed under a standardized “Brain Salvage through Emergent Stroke Therapy (BEST) Protocol” in a single emergency center. Methods: This study conducted a single-center, retrospective cohort study of 261 AIS patients diagnosed under the BEST Protocol between March 2022 and February 2023. The patients were classified into four groups: IVT alone (n=38), MT alone (n=34), IVT+MT (n=30), and non-RT (n=159). The primary outcome was a favorable functional outcome (modified Rankin Scale≤2) at 90 days. Multivariable logistic regression was performed to determine the independent association of treatment strategies, adjusting for age, initial National Institutes of Health Stroke Scale score, and atrial fibrillation (AF). Results: The baseline characteristics showed significant differences in initial NIHSS, large vessel occlusion (LVO), and AF (P<0.001). After excluding LVO from the final model for parsimony, multivariable analysis revealed that, compared to the non-RT group, the MT alone group (adjusted odds ratio [aOR], 3.58; 95% confidence interval [CI], 1.23-10.42; P=0.019) and the IVT+MT group (aOR, 5.75; 95% CI, 1.75-18.92; P=0.004) were strongly associated with a favorable 90-day outcome after adjusting for covariates. Conclusion In a standardized system like the BEST Protocol, MT-based strategies (MT alone or IVT+MT) were independently associated with a significantly higher likelihood of favorable 90-day functional outcomes compared to non-RT.

Verrucous carcinoma of the larynx is a rare, well-differentiated variant of squamous cell carcinoma that is locally invasive but rarely metastasizes. However, diagnosis can be difficult because superficial biopsies often fail to demonstrate the characteristic pushing border of verrucous carcinoma. Consequently, multiple biopsies may fail to establish a definitive diagnosis. Surgical excision remains the primary treatment. We present a case of a 54-year-old man who required several years to achieve a definitive diagnosis of verrucous carcinoma and whose lesion recurred repeatedly despite multiple excisions. This case emphasizes the importance of obtaining adequately deep and wide biopsy specimens for the accurate diagnosis of verrucous carcinoma. It also illustrates the therapeutic dilemma in the management of glottic verrucous carcinoma, as aggressive excision may compromise vocal function, whereas conservative excision increases the risk of recurrence.

Background and Objectives: Patients with voice disorders often face difficulties in managing their vocal health in daily life, highlighting the need for voice management and hygiene education without temporal or spatial limitations. This study aimed to evaluate the usability of a smartphone-based voice hygiene application developed for patients with voice disorders.Materials and Method Thirty patients diagnosed with voice disorders who underwent voice therapy participated in the study. After using the voice hygiene application for 4 weeks, participants completed a usability questionnaire composed of ten items across five key categories: aesthetics, functionality, engagement, usability, and reliability (two items per category). Results: The overall usability score of the voice hygiene application was 3.94 out of 5. The highest ratings were observed in aesthetic design and convenience. Engagement was positively influenced by the app’s reminder feature, and satisfaction regarding information reliability and system functionality was also generally high. Conclusion The voice hygiene application was found to be a useful tool for supporting self-management and maintaining vocal hygiene among patients with voice disorders through unrestricted accessibility. This study suggests that such applications can promote consistent voice hygiene practices and contribute to the improvement of vocal health.