This paper reviewed the development history of doctor-patient shared decision-making （SDM） at home and abroad， emphasizing the importance of cross-cultural analysis in constructing a Chinese doctor-patient SDM model. It also delved into the relationship between Western “individualistic” sociocultural values and doctor-patient SDM， as well as the influence of China’s “collectivist” sociocultural values on doctor-patient SDM， revealing significant disparities in doctor-patient SDM models under distinct sociocultural contexts. Although the doctor-patient SDM theory in China originated from the West， this theory requires profound “collision” and adaptation with local Chinese culture to form a localized theory suited to China’s national conditions. Through cross-cultural adaptation and integrating China’s familism tradition and medical ethics concepts， the future construction of the doctor-patient SDM model in China should emphasize family members’ involvement and seek cultural balance to facilitate its widespread application in clinical practice.

Objective: To explore the impact of different blood donation scenarios on population characteristics and blood donation behaviors, and to provide a basis for precise blood donation recruitment. Methods: Eligible voluntary blood donors with complete records from four scenarios in Xi'an: medical institutions, cultural tourism SITES, commercial superstores, and blood centers. After a preliminary analysis of overall donor characteristics across the four scenarios, three core subgroups were defined based on scenarios and donor population differences: the medical subgroup (aged 30-39 years), the blood center subgroup (aged 30-39 years), and the cultural tourism and commercial superstore subgroup (aged 18-29 years). Baseline characteristics, blood donation behaviors, and blood test results were compared among the subgroups. Results: The blood donors in all four scenarios were mainly male, but the proportion of female donors in the medical scenario was the highest (26.4%, 8 878/33 634). In terms of age distribution, the cultural tourism and commercial superstore scenarios were dominated by donors aged 18-29, while the blood center and medical scenarios were dominated by those aged 30-39, with the highest proportion of donors over 40 in the medical scenario. The occupational and educational composition of blood donors in the blood center scenario spanned a wide range, exhibiting a clear bipolar distribution. Significant differences were observed in baseline characteristics, blood donation behaviors, and blood test results among the three core subgroups (P<0.001). The medical subgroup was mainly composed of enterprise/industrial workers and married individuals, with high proportions of first-time blood donors, and the highest unqualified rate of infectious indicators (2.0%, 274/13 509). The cultural tourism and commercial superstore subgroup was mainly unmarried and students, featured high proportions of large-volume donations and evening donations, and had a relatively high unqualified rate for ALT (0.4%, 130/31 443). The blood center subgroup had a complex population structure, a high proportion of repeat blood donors (45.3%, 6449/14 225), and moderate results in all test indicators. Conclusion: There is an inherent correlation between the attributes of blood donation scenarios, population characteristics, and blood donation behaviors. The differences among the three core subgroups provide a clear basis for precise scenario operation. By constructing transformation channels between different scenarios and optimizing scenario-specific strategies, the structure of blood donors can be improved, thereby supporting the sustainable development of voluntary blood donation.

ObjectiveTo observe the clinical efficacy of Anshen Buxin Gao in patients with coronary artery disease （CAD） complicated with somatization disorder after percutaneous coronary intervention （PCI）， as well as its effect on heart rate variability （HRV）. MethodsA total of 96 patients with somatization disorder after PCI were selected and randomized into control and treatment groups （48 cases）. On the basis of standardized Western medical treatment for CAD， the control group received Dailixin， while the treatment group received Dailixin combined with Anshen Buxin Gao. The somatic symptom scale （SSS）， generalized anxiety disorder 7-item scale （GAD-7）， patient health questionnaire-9 （PHQ-9）， and self-rating scale of sleep （SRSS） scores in both groups were recorded before and after treatment. The traditional Chinese medicine symptom efficacy， HRV， and incidence of adverse drug reactions were observed. ResultsA total of 90 patients completed the trial， encompassing 45 patients in the control group and 45 patients in the treatment group. Baseline characteristics between the two groups showed no statistically significant differences， indicating comparability. After treatment， both groups exhibited reductions in SSS， GAD-7， and PHQ-9 scores （P<0.05）， and the treatment group outperformed the control group in alleviating somatic symptoms and anxiety-depression symptoms （P<0.05）. The control group did not achieve a significant reduction in SRSS score， whereas the treatment group effectively lowered the SRSS score （P<0.05）. Regarding traditional Chinese medicine symptom efficacy， the total response rate in the treatment group was 91.1% （41/45）， which was higher than that （71.1%， 32/45） in the control group （Z=-2.663， P<0.05）. Both groups improved HRV in patients with somatization disorder， and the treatment group showed greater improvement （P<0.05）. There were no serious clinical adverse events during the study period. The incidence of adverse reactions in the treatment group was 6.7% （3/45）， which was lower than that （14/45， 31.10%） in the control group （χ²=7.252， P<0.05）. ConclusionThe addition of Anshen Buxin Gao to Dailixin therapy significantly alleviates the clinical symptoms and improves the sleep quality， treatment efficacy， and HRV in patients with CAD complicated with somatization disorder after PCI， while reducing the adverse effects associated with Dailixin alone. This approach demonstrates considerable clinical value and warrants further promotion.

Objective: To understand the subjective and objective comfort evaluations of students from different age groups on desks and chairs, so as to provide reference for standardized allocation and use of desks and chairs. Methods: From January to April 2024, a total of 2 446 students were selected from 26 schools in 13 districts (counties/cities) in Shanghai, Tianjin, and Wuxi from Jiangsu Province by using cluster random method, including students in kindergartens, primary schools, junior high schools,senior high schools, colleges and universities. Standardized procedures were used to measure the height and weight of participants, and the matching desks and chairs models were selected according to the height. The subjective comfort of students on matching desks and chairs was investigated, and their objective comfort was evaluated by using a self designed questionnaire. The χ 2 test was used to analyze the differences of subjective perception and objective evaluation in comfort between different types of desks and chairs. Results: About 84.1% of the students subjectively thought that large desks and small chairs were very comfortable or relatively comfortable, followed by large desks and chairs (75.7%), and the proportion of small desks and chairs was the lowest among the three types (46.2%), and the difference was statistically significant ( χ 2=722.46, P <0.01). The reporting rates of primary school, junior high school and senior high school students who subjectively considered large desks and chairs to be very comfortable/relatively comfortable were higher than that of other types of desks and chairs, and the differences were statistically significant ( χ 2=297.49, 252.82, 343.67, P <0.01). However, there was no significant difference in the subjective comfort evaluation of different types of desks and chairs among kindergarten children ( χ 2=3.21, P >0.05), and 66.3% of the students in colleges and universities felt very comfortable/relatively comfortable when they used the matching standard desks and chairs. The objective evaluation results of the comfort for the three types of desks and chairs were consistent with the subjective evaluation, but the proportions of the objective evaluation as very comfortable/relatively comfortable were higher than that of the subjective evaluation ( χ 2=20.76- 813.47, P <0.01). Conclusions Large desks and chairs, as well as large desks with small chairs are perceived comfortable, while small desks and chairs are perceived less comfortable. It is recommended to match the large desks and chairs or large desks and small chairs that are suitable for them according to the "standard", to promote physical and mental health of students.

Objective: To investigate the differences in the comfort of desks and chairs furniture among students with different body types according to the standard, so as to provide a reference for guiding students with overweight and obesity to choose the correct study furniture and revising the standards. Methods: From January to April 2024, 2 443 students from 26 schools in 13 districts (counties/cities) in Shanghai, Tianjin, and Jiangsu Province were selected by the cluster random sampling method to conduct physical examination. The subjective and objective evaluations of the comfort of height matched desks and chairs were investigated. The students were divided into non overweight, overweight, and obesity groups according to relevant criteria, and stratified analysis was performed. The χ 2 test was used to analyze differences in the comfort evaluations of desks and chairs among students with different body types. Results: Among the 2 443 students surveyed, 16.7% and 12.6% were respectively classified as overweight and obese. All students assigned the highest comfort ratings to large desks and small chairs (84.1%), and consistency was observed between students subjective and objective evaluations. The reporting rate of samll desks and chairs of obesity students subjective evaluation was lower (36.8%) than that of overweight and non overweight/obesity students (52.1%, 48.0%) ( χ 2=14.63, P <0.01). The overweight and obese group of primary school students had a worse evaluation of the comfort of large desks and chairs and small desks and chairs than those of the non overweight and obese groups( χ 2=15.78, 7.63, P <0.05). Among high school students, the overweight and obese group had worse evaluation of the comfort of large desks and chairs, as well as large desks and small chairs, than those of the non-overweight and obese groups( χ 2=9.62, 11.77, P <0.05). The objective evaluations revealed low compliance ratings on the posture of the thighs and calves for naturally forming an angle greater than 90° (55.6%), and headroom height under the table (50.3%) with small desks and chairs ( χ 2=94.05, 166.47, P <0.05). Conclusions Compared with non overweight/obese students, students with overweight and obese students report poor comfort evaluations of height matched desks and chairs. Revision of the standard should consider the body types of students, and evaluations of the comfort of desks and chairs furniture by students with overweight and obesity should be improved.

Objective:To investigate the clinical characteristics, auxiliary examinations, and genetic mutations of a patient with myotonia congenita (MC).Methods:A retrospective analysis was conducted on the clinical data and whole exome sequencing results of a patient who visited the Department of Neurology, the First Affiliated Hospital of Xinjiang Medical University on April 13, 2023, and her family members. Candidate variants were verified by Sanger sequencing.Results:The patient was a 30-year-old female who presented with muscle stiffness and transient weakness during the transition from rest to movement since childhood, which improved after repeated limb movements. With age, involvement of upper limb skeletal muscles, extraocular muscles, and masticatory muscles was noted. Electromyography (EMG) showed abundant myotonic potentials in the muscles of the limbs, and serum creatine kinase levels (586.80 IU/L) were elevated. Genetic testing revealed that the patient carried 2 mutations in the CLCN1 gene: a newly discovered single nucleotide deletion mutation c.1388del (p.Phe463SerfsTer4), and a known missense mutation c.1679T>C (p.Met560Thr). These mutations were present in a compound heterozygous state. The patient′s father carried the c.1388del single heterozygous mutation, while her mother, son, aunt, younger uncle, and grandmother carried the c.1679T>C single heterozygous mutation. Conclusions:MC is primarily characterized by muscle stiffness and transient weakness at the onset of movement, which improves after "warm-up". The proband in this pedigree exhibits typical MC symptoms, with significantly elevated creatine kinase levels and EMG revealing abundant myotonic potentials in the muscles of the limbs indicating myopathic damages. The new mutation c.1388del (p.Phe463SerfsTer4) in the CLCN1 gene further expands the spectrum of pathogenic mutations in the CLCN1 gene.

Objective:To investigate the clinicopathological characteristics and diagnosis of high-grade succinate dehydrogenase-deficient renal cell carcinoma (SDH-RCC).Methods:Three cases of high-grade SDH-RCC diagnosed by immunohistochemical staining and/or molecular testing were collected from Affiliated Hospital of Qingdao University and 971 Hospital of Navy of Chinese People′s Liberation Army from January 2015 to December 2023. The clinicopathological characteristics and immunohistochemical features were summarized using light microscopy. Two cases were tested for gene mutations by next-generation sequencing.Results:Of the 3 cases, 2 were male and 1 was female. The ages were 49, 61, and 53 years, respectively. Gross examination revealed that all tumors were single nodules with diameters of 7.0, 4.5, and 5.2 cm, respectively, grayish white in color with irregular borders. Cases 1 and 2 exhibited solid cut sections, whereas case 3 had cystic and solid cut sections. Microscopically, all cases had high WHO/ISUP nuclear grade (3 or 4) and overt invasion. Case 1 exhibited a solid, sheet-like growth pattern with numerous scattered glandular ducts or acinar structures. Case 2 displayed a diffusely growth pattern reminiscent of sarcoma. Case 3 demonstrated intracystic papillary and nodular infiltrative growth patterns. Large clear cytoplasmic vacuoles could be observed in the focal areas of case 1 and case 3. Prominent peritumoral lymphocytes in stroma were noted in case 1. Case 1 was diagnosed with regional lymph node metastasis, and case 2 was diagnosed with renal vein thrombosis. Immunohistochemical staining revealed that SDHB and SDHA were deficiently expressed in 3 cases, while PAX8, FH, and INI-1 exhibited diffuse expression. CD10 (1/3), CA9 (1/3), and CK20 (1/3) were occasionally expressed. The Ki-67 proliferation index ranged from 10% to 50%. Two cases underwent next-generation sequencing and were both found to harbor pathogenic mutations in SDHA (case 2 had a frameshift mutation, and case 3 had a splice site mutation). All 3 cases were followed up for 11 to 112 months. Case 2 died 11 months post-operation, while case 1 and case 3 survived for 19 and 112 months, respectively, without any recurrence or metastasis.Conclusions:High-grade SDH-RCC is a rare subtype of SDH-RCC. The tumor exhibits various architectural patterns and is often misdiagnosed as other types of renal cell carcinoma. The presence of cytoplasmic vacuoles may be indicative for diagnosis. Compared to typical SDH-RCC, the high-grade subtype generally shows a larger tumor size, higher TNM stage, greater invasive potential, and poorer prognosis. For high-grade SDH-RCC, routine SDHB immunohistochemical staining may be necessary. The occurrence of high-grade SDH-RCC may be associated with mutations in SDHA.

Objective The purpose of writing the"expert consensus on humanistic care for patients in hospice care"(hereinafter referred to as the"consensus")aims to standardize the practice of humanistic care in the field of hospice care,ensuring that humanistic care is integrated throughout the entire service process for hospice care patients and their families.Methods A systematic search was conducted in domestic and foreign databases for literature related to hospice care and humanistic care,including guidelines,expert consensuses,systematic reviews or Meta-analyses,and evidence summaries.High-quality evidence was evaluated,extracted,and summarized to form the initial draft of the"consensus".From June to October 2024,20 experts from the fields of hospice care,nursing humanities,and evidence-based nursing were invited to participate in 1 round of expert consultation.Among them,13 experts were selected for 2 rounds of expert demonstration meetings.After collating and analyzing the experts' opinions,the initial draft was revised and refined,ultimately resulting in the final version of the"consensus".Results The effective response rate of the consultation questionnaire was 100％,with expert authority coefficient of 0.880,judgment coefficient of 0.935,and familiarity level of 0.825.The Kendall harmony coefficient of the expert consultation was 0.134(P＜0.05).The"consensus"consisted of 13 aspects,including the targets and objectives,principles,institutional guarantees,environmental requirements,etc.Conclusion This"consensus"possesses strong scientific rigor and practicality,which can provide guidance and references for the practice of humanistic care in the field of hospice care,promoting the standardization and humanization of hospice care services.

Objective:To evaluate the diagnostic value of metagenomic next-generation sequencing（mNGS）in bone and joint infections caused by non-tuberculous mycobacteria（NTM）.Methods:Clinical data of 175 patients with suspected NTM bone and joint infections admitted in Beijing Chest Hospital，Capital Medical University from January 2019 to January 2023 were retrospectively analyzed. Mycobacterium growth indicator tube（MGIT）method was used for mycobacterial culture on the bone tissue or abscess samples and mNGS test was performed on bone tissue samples in all patients. Taking clinical diagnosis as the gold standard，the sensitivity，specificity，positive predictive value，negative predictive value，positive likelihood ratio，and negative likelihood ratio of the two methods were compared.Results:Twenty-six patients（14.9%）were clinically diagnosed as NTM bone and joint infections. The mNGS showed higher sensitivity（100.0% vs. 57.7%，），specificity（99.3% vs. 86.6%），positive predictive value（96.3% vs. 42.9%），and negative predictive value（100.0% vs. 92.1%），compared to MGIT culture（all P<0.001）. The positive likelihood ratio（149.00 vs. 4.31）and negative likelihood ratio（0 vs. 0.49）of mNGS were also superior to those of MGIT. Conclusion:Compared to MGIT culture，mNGS has high diagnostic value in NTM bone and joint infections and can serve as an efficient and reliable method for clinical diagnosis.