Informed consent constitutes a fundamental ethical principle in medical practice. With the in-depth integration of generative artificial intelligence （AI） represented by Chat Generative Pre-trained Transformer （ChatGPT） with medicine， it has brought revolutionary development to traditional informed consent while also introducing new ethical challenges. ChatGPT offers features such as improving the readability of informed consent content， enhancing its comprehensiveness and accuracy， and increasing the convenience of obtaining informed consent. However， as the application of ChatGPT in informed consent is still in the exploratory stage， it is imperative to proactively and fully consider the accompanying ethical issues， such as information security， liability determination， transparency， and fairness. This paper conducted an ethical analysis on the challenges faced by generative AI， represented by ChatGPT， in the application of informed consent and proposed countermeasures， such as upholding free and fully informed consent， strengthening the balance of rights and obligations in informed consent， and establishing a transparent and fair supervision mechanism. The aim was to promote the ethically compliant， orderly， and controllable development of generative AI in the field of medical informed consent.

Metabolic associated fatty liver disease （MAFLD） is the main type of chronic liver disease in the world， with an increasingly higher incidence rate and a younger age of onset. At present， the treatment of MAFLD mainly depends on lifestyle intervention and comorbidity management， and there is still a lack of effective drugs for MAFLD itself. As a classic nonsteroidal anti-inflammatory drug of the salicylic acid family， aspirin can intervene in the pathological process of MAFLD by regulating lipid metabolism， relieving insulin resistance， reducing liver inflammation and oxidative stress response， exerting an anti-liver fibrosis effect， and inhibiting hepatocellular carcinoma， and therefore， it has the value of preventing disease onset， delaying disease progression， and reversing disease condition. This article systematically reviews the mechanism of action and safety of aspirin in the treatment of MAFLD， in order to provide more drug treatment options for MAFLD patients.

Objective:To explore the efficacy and safety of intravascular lithotripsy (IVL) for the treatment of calcified lesions in lower limb peripheral artery disease (PAD).Methods:A literature search was conducted on PubMed, Web of Science, Cochrane Library, and Embase, including studies related to IVL for calcified lesions in PAD published from January 2016 to December 2024. Data on patient baseline characteristics, lesion information, IVL procedural parameters, changes in vascular stenosis, and complication occurrence were extracted and included. The Methodological Index for Non-Randomized Studies (MINORS) was used to assess the quality of the included studies. The meta-analysis was performed using STATA 15.1 software. The heterogeneity of different studies was evaluated using Cochran′s Q test. The publication bias was assessed through funnel plots and Egger test.Results:A total of nine studies were included (1 983 patients, 2 387 lesions). The meta-analysis demonstrated that regarding efficacy, after IVL treatment, the average reduction in vascular stenosis was 52.1% (95% CI 45.3%-58.9%). Regarding safety, the incidence of flow-limiting dissection was only 0.6% (95% CI 0.1%-1.4%), and the perforation rate was 0.4%-0.5%, with no events of severe amputation or death. In combined treatments, the usage rate of drug-coated balloons reached 51.2%, and the stent implantation rate was 20.4%. Conclusions:IVL can effectively reduce the degree of vascular stenosis in calcified lesions and has a high safety profile. Combined treatment with drug-coated balloons can reduce the dependence on stents.

Objective To explore the feasibility and safety of bilateral uterine artery embolization(UAE)via distal radial artery access.Methods Thirty patients who underwent bilateral UAE were selected.They were divided into distal radial artery group(14 cases)and femoral artery group(16 cases).The clinical signs,puncture times,operation time,compression hemostasis time,discomfort scores,microcatheter non-use rates,and complication rates of the two groups were analyzed,the feasibility and safety of bilateral UAE via distal radial artery access were evaluated.Results The mean number of puncture times in the distal radial artery group was 1.6 times that of the femoral artery group,and the puncture pain score was 1.5 times that of the femoral artery group(P＜0.05).The operation time and puncture point compression hemostasis time in the distal radial artery group were shorter than those in the femoral artery group,and the discomfort score of compression hemostasis in the distal radial artery group was lower than that in the femoral artery group(P＜0.01).The proportions who did not use microcatheters in the two groups accounted for 28.6％and 6.3％,respectively,the difference was not statistically significant(P＞0.05).Four patients with poor access vessels were found in the distal radial artery group(P＜0.05).Conclusion Bilateral UAE via distal radial artery access is safe and feasible.

Objective:To explore the efficacy and safety of intravascular lithotripsy (IVL) for the treatment of calcified lesions in lower limb peripheral artery disease (PAD).Methods:A literature search was conducted on PubMed, Web of Science, Cochrane Library, and Embase, including studies related to IVL for calcified lesions in PAD published from January 2016 to December 2024. Data on patient baseline characteristics, lesion information, IVL procedural parameters, changes in vascular stenosis, and complication occurrence were extracted and included. The Methodological Index for Non-Randomized Studies (MINORS) was used to assess the quality of the included studies. The meta-analysis was performed using STATA 15.1 software. The heterogeneity of different studies was evaluated using Cochran′s Q test. The publication bias was assessed through funnel plots and Egger test.Results:A total of nine studies were included (1 983 patients, 2 387 lesions). The meta-analysis demonstrated that regarding efficacy, after IVL treatment, the average reduction in vascular stenosis was 52.1% (95% CI 45.3%-58.9%). Regarding safety, the incidence of flow-limiting dissection was only 0.6% (95% CI 0.1%-1.4%), and the perforation rate was 0.4%-0.5%, with no events of severe amputation or death. In combined treatments, the usage rate of drug-coated balloons reached 51.2%, and the stent implantation rate was 20.4%. Conclusions:IVL can effectively reduce the degree of vascular stenosis in calcified lesions and has a high safety profile. Combined treatment with drug-coated balloons can reduce the dependence on stents.

Objective To explore the feasibility and safety of bilateral uterine artery embolization(UAE)via distal radial artery access.Methods Thirty patients who underwent bilateral UAE were selected.They were divided into distal radial artery group(14 cases)and femoral artery group(16 cases).The clinical signs,puncture times,operation time,compression hemostasis time,discomfort scores,microcatheter non-use rates,and complication rates of the two groups were analyzed,the feasibility and safety of bilateral UAE via distal radial artery access were evaluated.Results The mean number of puncture times in the distal radial artery group was 1.6 times that of the femoral artery group,and the puncture pain score was 1.5 times that of the femoral artery group(P＜0.05).The operation time and puncture point compression hemostasis time in the distal radial artery group were shorter than those in the femoral artery group,and the discomfort score of compression hemostasis in the distal radial artery group was lower than that in the femoral artery group(P＜0.01).The proportions who did not use microcatheters in the two groups accounted for 28.6％and 6.3％,respectively,the difference was not statistically significant(P＞0.05).Four patients with poor access vessels were found in the distal radial artery group(P＜0.05).Conclusion Bilateral UAE via distal radial artery access is safe and feasible.

Objective To evaluate the application of evidence-based perioperative patient-controlled analgesia(PCA)management in patients with liver cancer receiving transcatheter arterial chemoembolization(TACE)treatment.Methods By using the application model of clinical evidence-based practice,the review indicators were formulated based on the best evidence.The baseline assessment was conducted,the barrier factors were analyzed,the best clinical decision was made,the implementation steps of PCA management,including training,monitoring,education,etc.were refined,and two rounds of clinical review were carried out.The knowledge-belief-practice level and the implementation of review indicators in 50 medical and nursing staff engaged in PCA management,as well as the changes in pain scores,the incidence of adverse reactions due to PCA management,and the patient's satisfaction in 159 patients after the application of evidence were compared with their corresponding values determined before the application of evidence.Results After implementing the evidence-based practice plan and applying the evidence,at multiple time points the pain scores and the incidences of adverse reactions were decreased significantly(P＜0.05),the patient's satisfaction increased remarkably(P＜0.01),the execution rate of medical and nursing staff for the review indicators were strikingly increased(P＜0.01),and the knowledge-belief-practice level concerning PCA management was prominently improved(P＜0.01).Conclusion The implementation of perioperative PCA management in patients with liver cancer receiving TACE treatment can help to reduce the perioperative pain level,improve the patient discomfort,increase the patient's satisfaction degree,and improve the ability of medical staff in performing PCA management and evidence-based practices.

Objective To explore the effect of home-based pharmaceutical care for patients with stable chronic obstruc-tive pulmonary diseases(COPD)based on a digital remote management applet.Methods A total of 237 patients with stable COPD from a hospital pharmaceutical outpatient service from March 2022 to March 2023 were divided into a control group,a home visit group,and a remote management group according to the random number table method.Patients in the home visit and re-mote management groups received home-based pharmaceutical interventions such as health science popularization,medication con-sultation,medication guidance,effect evaluation of pharmacotherapy,prescription simplification,and reorganization.Such interven-tions were not provided in the control group.Regular follow-up was performed for 12 months.Results After a pharmaceutical intervention,the operating scores of the inhalation device and medication compliance scores of the home visit and remote manage-ment groups were significantly better than the control group(P＜0.05).The improvement in medication compliance was greater in the remote management group than in the home visit group(54.3％ vs.44.6％).In the three groups between enrollment and 12 months follow-up,CAT scores decreased by 0.78,6.16,and 7.30 points in the control group,home visit group,and remote manage-ment group,respectively.The mean scores of SGRQ symptom decreased by 1.19,4.24,and 6.10 points,the mean activity scores decreased by 1.65,3.56,4.80 points,the impact mean score decreased by 1.08,4.19,5.16 points,and the mean score of the total score decreased by 1.29,4.00,4.80 points in the control group,home visit group,and remote management group,respectively.The remote management group showed dia better decline in CAT score and SGRQ score than the home visit group,and there were sig-nificant differences between the two groups compared with the control group after intervention(P＜0.05).Conclusions Digital remote management of home-based pharmaceutical care mode can effectively improve medication compliance,operation accuracy of inhalation devices,clinical symptoms,and the patient quality of life.This is an effective and efficient pharmaceutical care mode for the long-term home medication management of stable COPD patients.

Objective:To report the 5-year survival outcomes and recurrence patterns of robotic total gastrectomy (RTG) for locally advanced proximal gastric cancer in order to provide more valuable long-term follow-up results for clinical practice.Methods:This was a prospective, single-arm, open-label clinical trial (FUGES-014; Clinical-Trials.gov, NCT03524287). Patients with locally advanced proximal gastric cancer who underwent RTG at Fujian Medical University Union Hospital from March 5, 2018, to February 10, 2020, were included in the analysis. To evaluate the long-term efficacy of RTG in the most objective manner possible, we performed a propensity score-matched (1∶2) comparative analysis with historical control patients who had undergone laparoscopic total gastrectomy (LTG) from the FUGES-002 study (ClinicalTrials.gov, NCT02333721) in which the 5-year disease-free survival (DFS), 5-year overall survival (OS), and recurrence patterns were compared between the two groups.Results:Prior to matching, there were 48 cases in the RTG group and 263 cases in the LTG group; patients in the LTG group had more advanced cT and pT stages ( P=0.044 and 0.006, respectively) compared to the RTG group. After matching, there were 48 cases in the RTG group and 96 cases in the LTG group; however, no statistically significant differences were observed in the baseline clinical characteristics between the two groups (all P>0.05). Both groups had a median follow-up of 72 months. The 5-year DFS rates were 75.0% (95%CI: 63.7%- 88.3%) in the RTG group and 61.4% (95%CI: 52.5%-72.0%) in the LTG group ( P=0.116). Similarly, the 5-year OS rates were 79.2% (95%CI: 68.5%-91.5%) and 64.6% (95%CI: 55.7%-74.9%) in the RTG and LTG groups, respectively ( P=0.100). Within 5 years after surgery, tumor recurrence occurred in 10 patients (20.8%) in the RTG group and 33 patients (34.4%) in the LTG group ( P=0.124), and peritoneal recurrence was the predominant pattern in both groups (8.3%[4/48] vs. 10.4%[10/96]; risk difference: -0.02, P=0.554). Gastric cancer-related death was the predominant cause of death in both groups (16.7% [8/48] vs. 31.2% [30/96]; risk difference: -0.15, P=0.064). Among patients stratified by different pathological stages, no statistically significant differences were found in DFS, OS, or recurrence rates between the RTG and LTG groups (all P>0.05). Conclusions:We find the long-term oncological outcomes of RTG for locally advanced proximal gastric cancer to be noninferior to those of LTG. RTG should therefore be considered as a valid option for standardized minimally invasive surgery for locally advanced proximal gastric cancer.

Objective To explore the correlation between nap frequency and sleep duration and the risk of carotid atherosclerosis(CAS)in the middle-aged and elderly people in Guangzhou.Methods A retrospective study was conducted to select 1170middle-aged and elderly patients over 50 years who were enrolled in"Guangzhou Biobank Cohort-Cardiovascular Disease Subcohort"from Sep-tember 2006 to March 2008.The general data of the subjects were collected,and the intima-media thickness of common carotid artery,CCA-IMT was measured by color Doppler ultrasound.Logistic regression analysis was used to evaluate the correlation between nap fre-quency and sleep duration and the risk of CAS.Results After adjusting for potential confounding factors such as gender,age,body mass index(BMI),waist-to-hip ratio(WHR),physical activity level,smoking,alcohol consumption,and diabetes,the study found that compared with those who never nappers,Daily nappers had a higher risk of CAS[adjusted Exp(β)=2.095,95％CI:1.823-2.407,P＜0.001].In addition,this study observed a"U-shaped"association between sleep duration and CAS prevalence.Further studies found that compared with those who slept for 6h per day,those who slept for ≤5h,8h and≥10h had a significantly increased risk of CAS(adjusted OR=1.420,95％CI:1.117-1.805,P＜0.001;OR=1.356,95％CI:1.142-1.610,P＜0.001;OR=1.537,95％CI:1.156-2.044,P＜0.01).Conclusion Daily napping and short or long sleep duration may increase the risk of CAS.It is recommen-ded to reduce the nap frequency and maintain the appropriate sleep duration in order to reduce the incidence of CAS.