High-quality clinical research represents the scientific foundation for generating credible medical evidence， guiding evidence-based practice， and optimizing public health strategies. The responsible conduct of research by clinical researchers serves as the core guarantee of research quality. Any act of research misconduct will not only result in the waste of research resources and damage the reputation of relevant individuals and institutions， but also undermine the validity of research evidence， mislead evidence-based medical practice， raise risks for public health decision-making， and ultimately impede the progress of medical innovation. Based on the framework of reinforcement theory， this paper elaborated on the internal correlation between reinforcement theory and the shaping of responsible conduct of research among clinical researchers， and demonstrated the necessity of shaping responsible conduct of research in the new context. It also summarized practical challenges encountered in such shaping， such as utilitarian-oriented research evaluation， complex conflicts of interest， inadequate review and supervision， constrained research resources， and insufficient education on responsible conduct of research. It further proposed countermeasures that were conducive to shaping the responsible research conduct of clinical researchers. These encompassed reconstructing the orientation of performance evaluation， dynamically managing risks arising from conflicts of interest， implementing precise constraints via ethical supervision， arranging tiered resource support， and internalizing cultural recognition of responsible research conduct.

The construction of a new cultural system for high-quality development in public hospitals serves as a crucial pillar for achieving their high-quality advancement.During this developmental processe stablishing a cultural framework that aligns with the new development model holds particular significance.Through content analysis methodology,it identifies 18 core elements of the new cultural system for high-quality development in public hospitals.Furthermore it synthesizes seven implementation pathways across three dimensions-organizational patientand employee perspectives:digital leadership organizational reform capability talent innovation capability resource integration capability normative constraint force value co-creation capability and employee support capability.These findings provide both theoretical and practical references for cultivating new cultural constructs that facilitate high-quality development in public hospitals.

Extensive studies have identified potential adverse effects on semen quality of obesity, based on body mass index, but the association between body fat distribution, a more relevant indicator for obesity, and semen quality remains less clear. We conducted a longitudinal study of 4304 sperm donors from the Guangdong Provincial Human Sperm Bank (Guangzhou, China) during 2017-2021. A body composition analyzer was used to measure total and local body fat percentage for each participant. Generalized estimating equations were employed to assess the association between body fat percentage and sperm count, motility, and morphology. We estimated that each 10% increase in total body fat percentage (estimated change [95% confidence interval, 95% CI]) was significantly associated with a 0.18 × 10 6 (0.09 × 10 6 -0.27 × 10 6 ) ml and 12.21 × 10 6 (4.52 × 10 6 -19.91 × 10 6 ) reduction in semen volume and total sperm count, respectively. Categorical analyses and exposure-response curves showed that the association of body fat distribution with semen volume and total sperm count was stronger at higher body fat percentages. In addition, the association still held among normal weight and overweight participants. We observed similar associations for upper limb, trunk, and lower limb body fact distributions. In conclusion, we found that a higher body fat distribution was significantly associated with lower semen quality (especially semen volume) even in men with a normal weight. These findings provide useful clues in exploring body fat as a risk factor for semen quality decline and add to evidence for improving semen quality for those who are expected to conceive.
Humans ; Male ; Adult ; Semen Analysis ; China ; Body Fat Distribution ; Longitudinal Studies ; Sperm Count ; Sperm Motility ; Body Mass Index ; Tissue Donors ; Obesity/complications* ; Spermatozoa ; Young Adult ; Middle Aged ; East Asian People

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective:To examine the regulatory effects of a potential antifibrotic tetrapeptide called N-acetyl-seryl-aspartyl-lysyl-proline (Ac-SDKP) on the expression of epidermal growth factor (EGFR) and signal transducer and activator of transcription 3 (STAT3) in lung tissues with fibrosis induced by silicosis in rats. This study aims to explore the potential therapeutic benefits of Ac-SDKP in the prevention and treatment of fibrotic lung diseases associated with silicosis.Methods:In January 2024, disease targets and Ac-SDKP active ingredients were predicted through GeneCards (https://www.genecards.org) and OMIM (https://www.omim.org) databases. Using R 4.2.1 software, we identified overlapping targets between pulmonary fibrosis and AC-SDKP. Cytoscape 3.10.2 was employed to visualize interactions between active chemical components and these targets, followed by GO enrichment analysis and KEGG pathway analysis using R 4.2.1. Forty healthy adult Wistar rats were selected to establish silicosis models through single-dose gavage with 50 mg/ml silica suspension (1. 0 ml per rat). The rats were randomly divided into four groups: model control group (4 weeks), silicosis model group (4 weeks), Ac-SDKP preventive treatment group (acquired via intraperitoneal injection of a micro-release pump containing Ac-SDKP [800 μg/ (kg·d) ] during modeling, maintained for 4 weeks), and Ac-SDKP anti-fibrosis treatment group (acquired via intraperitoneal injection of the same pump after 2 weeks of modeling, continued maintenance for 2 weeks). Each group contained 10 rats. The pathological changes in rat lung tissues were observed. Western blot technology was used to detect the protein expression levels of α-smooth muscle actin (α-SMA), epidermal growth factor receptor (EGFR), signal transduction and activation transcription factor 3 (STAT 3), caspase 3, and caspase 8 in lung tissues. Immunohistochemical techniques were employed to assess the expressions of EGFR, STAT3, caspase 3, and caspase 8. Overall differences between groups were compared using one-way ANOVA.Results:Compared with the control group in the silicosis model, rats in the 4-week group exhibited significant fibrotic nodules. The lung tissues of these rats showed statistically significant increases in α-SMA, EGFR, STAT 3, Caspase 3, and Caspase 8 protein expression ( P<0.05). In contrast, the Ac-SDKP prevention and anti-fibrosis treatment group demonstrated markedly reduced expression levels of these proteins compared to the 4-week silicosis model group, with statistically significant differences ( P<0.05). Immunohistochemical staining revealed that brownish-yellow expression of EGFR, STAT3, Caspase3, and Caspase8 was significantly enhanced in silicotic nodules within the silicosis model group. Conversely, this brownish-yellow expression was notably decreased in the Ac-SDKP prevention and anti-fibrosis treatment group compared to the 4-week silicosis model group. Conclusion:Ac-SDKP may exert antifibrotic effects on the lungs of rats with silicosis by regulating the EGFR/STAT3 pathway.

Objective:To explore the pathogenesis,clinical features,treatment strategies,and prognosis of pediatric lymphoepithelioma-like carcinoma(LELC).Methods:A retrospective analysis was conducted on the clinical data of patients with LELC aged<18 years,treated at Sun Yat-sen University Cancer Center from March 2008 to June 2023.Results:A total of 19 children and adolescents were included in the analys-is,comprising 10 males(52.6%)and 9 females(47.4%),with a median age of 12.9(4.3-17.0)years.Fourteen patients(73.7%)lived in Guangdong province,with the remainder scattered across other regions.Primary LELC sites were the mediastinum(11 cases,57.9%),parot-id glands(4 cases,21%),neck(1 case,5.3%),lungs(1 case,5.3%),salivary glands(1 case,5.3%),and submandibular glands(1 case,5.3%).Among these,15 patients(78.9%)had at least one distant metastasis at initial diagnosis,with common metastasis sites being cervical lymph nodes.Multivariate Cox regression analysis identified tumor volume≥801 cm3 as an independent adverse prognostic factor of poor overall survival(OS)(P<0.01).The 2-year OS and progression-free survival(PFS)rates were 84.2%and 57.9%,respectively.The 2-year OS for pa-tients who underwent surgery,chemotherapy,and radiotherapy was 100%,compared with 25%for those who received only partial treat-ment(P=0.007).The 2-year PFS rate was significantly higher in patients receiving first-line combination therapy with programmed death-1(PD-1)antibodies(100%)compared with those not treated with PD-1 antibodies(38.5%)(P=0.020).For patients with tumor volume≥801 cm3,the 2-year OS was 40.0%,whereas for those with a tumor volume<801 cm3,the 2-year OS was 100%(P<0.001).The 2-year OS for pa-tients who underwent radiotherapy was 100%,while it was 0 for those who did not receive radiotherapy(P<0.001).Conclusions:Pediatric LELC exhibits a relatively favorable prognosis with multidisciplinary treatment,including surgery,chemotherapy,and radiotherapy.The com-bined use of PD-1 antibodies at the time of initial diagnosis could offer potential benefits and warrants further exploration.

Objective To construct and assess a training program for newly appointed nurse managers.Methods According to the evaluation index system of nurse manager's post competency,a training team was set up,training experts were selected,and a training program for newly appointed nurse managers was constructed,which was based on the learning pyramid theory,and implemented in 20 newly appointed nurse managers.The scores of post competency scale,core competence scale,team assistance ability scale,and emergency management scale,and the result of practical examination were used as evaluation indexes.Results After half-year training,the mean and four dimension scores of post competency,the mean and six dimension scores of core competence,the mean and four dimension scores of team assistance ability,and the mean and four dimensions scores of emergency management in the 20 newly appointed nurses were significantly higher than those before training(all P<0.05).The mean total score of practical assessment was 92.45±1.81.Conclusion The training program for newly appointed nurse mangers on the basis of the learning pyramid theory can effectively improves the post competence,core competence and practical ability.It can provide theoretical reference for cultivating newly appointed nurse mangers.

Objective To investigate the regulatory mechanism of the central nervous system in patients with refractory overactive bladder (rOAB) using diffusion tensor imaging (DTI) and graph theory analysis. Methods A total of 43 rOAB patients (rOAB group) and 46 matched healthy controls (HC group) were recruited during May and Nov.2024. All participants were scanned with DTI, and surveyed with the overactive bladder symptom score (OABSS), and overactive bladder questionnaire (OAB-q). Their age, gender, height, weight, and educational years were collected.DTI plus graph theory analysis was employed to explore the alterations in global and local topological properties of the brain structural network in rOAB patients. Brain regions showing significant group differences in structural metrics [specifically, the right paracentral lobule (PCL.R) ]were further used as seed points for functional connectivity (FC) analysis. Correlations between the nodal clustering coefficient (NCp) of the identified region, FC strength, OABSS, and OAB-q score were investigated. Results The OABSS [8 (6,10) vs.0 (0,1) ]and OAB-q [71 (53,80) vs.20 (19,24) ]were higher in the rOAB group than the HC group (P<0.001). Graph theory analysis revealed no statistically significant differences in global network metrics between the two groups (P>0.05). However, the NCp was significantly higher in the PCL.R of rOAB group compared to HC group (P<0.05, FDR-corrected).FC analysis using the PCL.R as a seed region demonstrated significantly reduced FC value in the left cerebellar crus Ⅱ (Cerebelum_Crus2_L) of the rOAB group (P<0.05, FDR-corrected). Partial correlation analysis showed that the NCp of PCL.R was positively correlated with both OABSS (r=0.255, P=0.018) and OAB-q score (r=0.257, P=0.017). Conversely, the FC of Cerebelum_Crus2_L was significantly negatively correlated with OABSS (r=-0.545, P<0.001) and OAB-q score (r=-0.535, P<0.001). Conclusion Patients with rOAB exhibit distinct brain structural network alterations compared to healthy individuals, primarily manifestation in the NCp value of PCL.R increased, and the FC intensity of Cerebelum_Crus2_L is significantly weakened. These alterations in the topological properties of the structural network may be implicated in the pathogenesis of rOAB.

A 10-year-old girl was admitted with a 38-hour history of widespread subcutaneous petechiae and hematuria and a 6-hour history of jaundice and oliguria. Physical examination revealed widespread subcutaneous petechiae and jaundice of the skin and sclera. Laboratory tests showed anemia, thrombocytopenia, acute kidney injury, and markedly elevated lactate dehydrogenase. Thrombotic microangiopathy was initially diagnosed, with a high suspicion of atypical hemolytic uremic syndrome (aHUS). Eculizumab was initiated within 9 hours of admission (within 48 hours of onset). After the first infusion, hemolysis rapidly ceased, and the platelet count and renal function gradually returned to normal. Whole-exome sequencing identified homozygous deletions of CFHR1 exon 2 and CFHR4 exon 1. aHUS typically has abrupt onset and rapid progression. Clinicians should maintain high suspicion for aHUS when the triad of thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury is present. Ultra-early eculizumab (within 48 hours of onset) rapidly blocks complement-mediated thrombotic microangiopathy, reverses organ injury, and improves long-term prognosis. Additionally, complement-related genetic testing is important for etiological clarification and individualized determination of eculizumab treatment duration.
Humans ; Antibodies, Monoclonal, Humanized/administration & dosage* ; Female ; Atypical Hemolytic Uremic Syndrome/drug therapy* ; Child ; Complement C3b Inactivator Proteins

This consensus will introduce the characteristics of fillers used in the surgical cavities of domestic nasal surgery patients based on relevant literature and expert opinions. It will also provide recommendations for the selection of cavity fillers for different nasal diseases, with chronic sinusitis as a representative example.
Humans ; Nasal Cavity/surgery* ; Nasal Surgical Procedures ; China ; Consensus ; Sinusitis/surgery* ; Dermal Fillers