Biomaterials provide a reliable and safe treatment for the repair of ear defects,especially microtia.With the continuous promotion of interdisciplinary research,the types and properties of materials used in auricle reconstruction have been greatly expanded and improved.In this paper,the latest research progress of polymer materials and tissue engineering scaffolds in the field of auricle reconstruction was reviewed,and the physical and chemical properties and clinical application effects of these scaffolds in vitro and in vivo were discussed.However,despite significant progress in ear stent research,there are still some challenges and limitations in the application of current polymer materials,such as the hydrophobicity of high-density polyethylene and the uncontrolled differen-tiation of stem cells in tissue engineering.Therefore,this paper discusses the research and clinical application of new modified materials,especially emphasizing the importance of surface modification technology and innovative synthesis strategies,so that the properties of modified materials are infinitely close to the characteristics of human ear cartilage.In addition,this paper also summarizes the control methods of stem cell differentiation in ear carti-lage tissue engineering.The application performance and biocompatibility of different ear scaffolds were reviewed in order to provide guidance for auricle reconstruction.

The integration of artificial intelligence(AI)into medical practice has significantly impacted the field of cerebrovascular disease.AI algorithms are increasingly being employed to enhance the diagnosis and management of cerebrovascular conditions.However,the clinical application and accuracy of these AI tools require further rigorous evaluation.This review probes into the current applications of AI in diagnosis and decision-making in cerebrovascular disease,and explores the potential and challenges associated with their implementation.

Acute myeloid leukemia (AML) is an aggressive malignant tumor with high heterogeneity. It is characterized by rapid proliferation, dysapoptosis and impaired differentiation of leukemic blast cells. It can develop at any age. The complexity of the etiology, the diversity of mechanisms, and the variability of cytogenetics and genomics hid behind the development and evolution of AML, among which some specific cytogenetic and genomic abnormalities cause the high recurrence rate and drug resistance rate of clinical AML patients. At present, the clinical application of mutated genes has become a hot field in clinical medicine. This paper reviews the role of common mutated genes and molecular targeted therapy in order to provide help for clinical treatment.

Objective To investigate prognostic value of serum levels of cathepsin B(CTSB)and NADPH oxidase 4(NOX4)in patients with sepsis associated acute kidney injury(S-AKI).Methods A total of 306 pa-tients with sepsis treated to the hospital from June 2023 to June 2024 were selected,including 192 patients with S-AKI(S-AKI group)and 114 patients without S-AKI(non-S-AKI group).According to the prognosis of S-AKI patients,they were divided into poor prognosis group(n=127)and non-poor prognosis group(n=65).The differences of CTSB and NOX4 in different groups were compared.Pearson analysis was conducted to analyze the correlation between CTSB,NOX4 and clinical indicators.The influencing factors of poor prognosis in S-AKI patients was analyzed according to multivariate Logistic regression.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of CTSB and NOX4 on the poor prognosis of S-AKI pa-tients.Results Th e serum levels of CTSB,NOX4 and serum creatinine(SCr)in S-AKI group were signifi-cantly higher than those in non-S-AKI group(P＜0.05),while the mean arterial pressure and oxygenation in-dex were lower than those in non-S-AKI group(P＜0.05).Serum levels of CTSB and NOX4 in patients with sepsis were positively correlated with SCr(P＜0.05).Compared to non-poor prognosis group,the age,SCr,CTSB and NOX4 of patients in the poor prognosis group were higher,while the mean arterial pressure and ox-ygenation index were lower(P＜0.05).The increased mean arterial pressure and oxygenation index were pro-tective factors for poor prognosis in S-AKI patients(P＜0.05),and the increased age,SCr,CTSB and NOX4 levels were risk factors for poor prognosis in S-AKI patients(P＜0.05).ROC curve showed that the area un-der the curve(AUC)of CTSB combined with NOX4 was significantly higher than AUC of single detection of CTSB and NOX4(Z=4.066,P＜0.001,Z=3.801,P＜0.001).Conclusion The serum levels of CTSB and NOX4 in S-AKI patients are elevated,and can indirectly reflect kidney function.CTSB combined with NOX4 can significantly improve the prediction efficiency of poor prognosis in S-AKI patients,which has potential ap-plication value for clinical treatment and nursing.

Objective This study aimed to adapt the data-driven Palliative Care Outcomes Collaboration(PCOC)model to the local context and evaluate its feasibility and preliminary effectiveness in a palliative care unit in China,with the goal of informing its broader integration into national palliative care practice.Methods Based on international experience,a localized implementation protocol for the PCOC model was developed through expert con-sultations and a pilot study.The protocol incorporated key elements including organizational and managerial sup-port,team training and capacity building,information system integration,supervision and feedback mechanisms,pro-cess optimization,and data-driven decision-making.From June to December 2023,the protocol was piloted in the palliative care unit of a tertiary cancer hospital in Changsha,China.Implementation outcomes were assessed by comparing patients' urgent care response rates,symptom stability rates,and symptom improvement rates between the first 1～3 months and 4～6 months after implementation.Results During the study period,a total of 355 inpatients were enrolled,with the PCOC assessment achieving full coverage(100％)and a completion rate of 97.78％.There was no statistically significant difference in the urgent needs response rate between the first 1～3 months and the 4～6 months after the implementation of the PCOC model(P=0.533).However,compared to the first 1～3 months af-ter implementation,patients in the 4～6 months period showed significantly higher symptom stability rates for pain,psychological/spiritual issues,and family/caregiver problems,as well as a higher improvement rate for pain(P＜0.05).Conclusion The localized PCOC implementation protocol facilitates standardized assessment and symptom manage-ment,and its application can enhance the quality of palliative care.

The occurrence of malignant tumors is related to immune evasion caused by the upregulation of immune checkpoint inhibitory receptors. T cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domain (TIGIT) is a novel immune checkpoint receptor with remarkable prospects in the treatment of hematologic malignancies. In addition to acting on T cells, TIGIT can also participate in the development of hematologic malignant diseases by regulating antigen-presenting cells, but the specific mechanism of action is still unclear. This review summarizes the latest research progress in the molecular structure, inhibitory function, immunomodulatory effect of TIGIT and the mechanism by which TIGIT modulates antigen-presenting cells to participate in the pathogenesis of malignant hematological diseases, so as to provide a theoretical basis for an in-depth understanding of the immune regulatory role of TIGIT in hematologic malignant diseases.

Objective:To investigate the correlation between vitamin D levels and thyroid hormone sensitivity in euthyroid individuals.Methods:This cross-sectional study included 5 894 euthyroid individuals who underwent health examinations at the Department of Health Management, Peking Union Medical College Hospital, from December 2023 to February 2024. Thyroid feedback quantile-based index (TFQI), TSH index (TSHI), thyrotroph thyroxine resistance index (TT4RI), and the ratio of free triiodothyronine (FT3)/free thyroxine (FT4) were calculated to assess thyroid hormone sensitivity. Participants were categorized into vitamin D deficiency and non-deficiency groups based on serum 25(OH)D levels. The differences in thyroid hormone sensitivity indices and other clinical characteristics between the two groups were compared. Multivariate logistic regression models were used to analyze the association between vitamin D levels and thyroid hormone sensitivity, and stratified analysis was conducted to explore the association in different genders.Results:Among the study participants, 4 731 (80.3%) had vitamin D deficiency. Compared with the non-deficient group, the deficient group had a lower TFQI (-0.03(-0.31, 0.23) and -0.01(-0.28, 0.27)) ( Z=-2.130, P=0.033) and a higher FT3/FT4 ratio ((0.36±0.04) and (0.35±0.04)) ( t=-4.592, P<0.001). After adjusting for confounding factors including gender and age, the risk of impaired central and peripheral thyroid hormone sensitivity significantly increased in the non-deficient group (TFQI ( OR=1.16, 95% CI: 1.01-1.34); FT3/FT4 ( OR=1.23, 95% CI: 1.05-1.45)) (all, P<0.05). Conclusion:In euthyroid individuals, people with higher vitamin D levels have a higher risk of impaired thyroid hormone sensitivity.

OBJECTIVE To summarize the implementation experiences of the China Hospital Association’s Clinical Pharmacist Instructor Training Program Reform， and to evaluate the effectiveness of the reform， thus continuously enhancing the quality and standards of clinical pharmacist instructor training. METHODS The study drew on project evaluation methodologies to summarize the main characteristics of the comprehensive system and new model for clinical pharmacist instructor training established through the reform by literature review. The “learning assessment” and “reaction assessment” were conducted by using Kirkpatrick’s four-level model of evaluation in order to evaluate the effectiveness of the clinical pharmacist instructor training reform through statistically processing and analyzing the performance data and teaching evaluation data of the instructor participants. Based on problem and trend analysis， the future development directions were anticipated for the reform of clinical pharmacist instructor training. RESULTS & CONCLUSIONS The latest round of clinical pharmacist instructor training reform initiated by the Chinese Hospital Association had initially established a four-pronged training system encompassing “recruitment， training， assessment， and management”. It had also forged a training 。 model “oriented towards enhancing clinical teaching competency， with practical learning and skill-based assessment conducted on clinical teaching sites as its core”. Following a period of over three years of gradual reform， the new training system and model became increasingly mature. In both 2023 and 2024， the participants achieved relatively high average total scores in their initial completion assessments [with scores of （84.05± 5.83） and （85.82±4.35） points， respectively]. They also reported a strong sense of gain from the training reform [with self- perceived gain scores of （4.80±0.44） and （4.85±0.39） points， respectively]. The operation and implementation effects of the reform were generally satisfactory. In the future， clinical pharmacist instructor training reforms should continue to address the issues remaining from the current phase， while aligning with global trends in pharmacy education and industry development. Additionally， sustained exploration and practice will be carried out around the core objective of “enhancing clinical teaching competence”.

Objective:To investigate the structural changes in the spinal cord in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) and their relationship with clinical disability.Methods:This study was cross-sectional. A retrospective analysis of clinical and imaging data from 124 patients with MS (MS group), 101 patients with aquaporin-4 antibody-positive NMOSD (NMOSD group), and 110 healthy controls (HC group) from seven medical centers were conducted from January 2018 to October 2021. All subjects underwent 3D T 1WI, and the upper cervical spinal cord cross-sectional area (MUCCA) was segmented and measured. All patients completed the expanded disability status scale (EDSS) assessments at baseline and during follow-up, as well as the baseline 25-foot walk test (T25FW) and the nine-hole peg test (NHPT). Patients were classified into EDSS progression and non-progression groups based on follow-up EDSS scores. Comparisons of MUCCA among the three groups were conducted using analysis of covariance, controlling for age and sex as covariates. Pairwise comparisons between groups were performed using the HSD test. Univariate linear regression and logistic models were employed to identify candidate predictors of baseline clinical disability status or EDSS progression in the MS and NMOSD groups. L1 regularized multivariable linear regression analysis was used to determine independent predictors of baseline clinical disability status or EDSS progression. Independent predictors were then combined to establish a logistic regression model, and the model′s performance in predicting EDSS progression was evaluated using receiver operating characteristic analysis and the area under the curve (AUC). Results:A total of 144 patients completed follow-up EDSS assessments, with a follow-up duration of 3.30 (1.10, 6.42) years, including 82 patients in the MS group and 62 patients in the NMOSD group. Controlling for sex and age as covariates, the overall difference in MUCCA among the MS, NMOSD, and HC groups was statistically significant ( P=0.001). The MUCCA in the MS group was lower than that in the HC group, with a significant difference ( t=-2.54, P=0.007); the MUCCA in the NMOSD group was also lower than that in the HC group, with a significant difference ( t=-2.80, P=0.002). However, the difference in MUCCA between the MS and NMOSD groups was not statistically significant ( t=-0.40, P=0.882). In the MS group, MUCCA was an independent predictor of baseline EDSS score (β=-0.03), baseline T25FW score (β=-0.09), and baseline NHPT score (β=-0.30). In the NMOSD group, MUCCA (β=-0.08), age (β=0.06), and baseline EDSS score (β=-0.43) were independent predictors of EDSS progression, and the logistic regression model incorporating these three factors predicted EDSS progression with an AUC of 0.82. Conclusions:Significant spinal cord atrophy occurs in patients with both MS and NMOSD. Atrophy of the upper cervical spinal cord can predict the degree of disability in MS patients and the progression of clinical disability in NMOSD patients.

The peripheral pulmonary lesions are located far from the central airway and close to the pleura, so it is a challenge for clinical diagnosis of their nature through biopsy. Therefore, the Ion robot-assisted bronchoscopy system which has started its commercialization in China is proposed to diagnose and treat peripheral pulmonary lesions. The Ion system can be used for navigation, registration, biopsy and treatment. In this paper, the structural principle of the Ion system is expounded, and its technical advantages such as shape perception, slender catheter and flexible operation are summarized. It represents the latest development direction of the diagnosis and treatment of peripheral pulmonary lesions. Then, the clinical application and development status of the Ion system are analyzed and discussed in detail. Finally, the development trend of the robot-assisted bronchoscopy system is prospected, which provides new ideas for realizing the "integrated and one-stop" diagnosis and treatment services for peripheral pulmonary lesions based on this system.
Bronchoscopy/instrumentation* ; Humans ; Robotics ; Robotic Surgical Procedures