Shared Decision-Making （SDM） is a crucial concept in modern medicine， emphasizing the joint participation of doctors and patients in the medical decision-making process. However， the authoritative position of doctors and the passive role of patients in traditional medical models often overlook the personal wishes and needs of patients， leading to tense doctor-patient relationships and medical disputes. By listening to and understanding their stories， narrative medicine helps doctors gain a more comprehensive understanding of patients’ situations and balances medical advice with patient needs in the decision-making process. Through systematic literature analysis and theoretical exploration， this paper investigated the application effects and mechanisms of narrative medicine in different medical contexts， as well as analyzed its specific role in the process of SDM. The aim is to explore the value of narrative medicine in bridging differences in SDM， revealing its role in promoting doctor-patient communication， enhancing decision-making participation， and improving medical outcomes. Researches had found that narrative medicine enhanced doctors’ “narrative ability”， promoted emotional communication and trust between doctors and patients， reduced conflicts and misunderstandings in decision-making， and improved patients’ sense of participation and trust， thus playing an important role in SDM. Therefore， by enhancing doctor-patient communication and understanding， promoting SDM and treatment selection between doctors and patients， personalized care and treatment optimization， advocating for doctor-patient co-construction， improving consultation efficiency， restoring the patient’s subject position， and other methods， it can bridge doctor-patient differences， promote communication and enhance decision-making participation， and improve medical outcomes and patient satisfaction.

Objective To investigate the diagnostic value of biparametric magnetic resonance imaging(bpMRI)radiomics combined with prostate-specific antigen density(PSAD)in predicting low-grade and high-grade prostate carcinoma(PCa).Methods The clinical and imaging data of patients with PCa confirmed by pathology in Taizhou Central Hospital from June 2018 to October 2022 were retrospectively analyzed.According to Gleason grade group(GGG),GGG≤2 was defined as low-grade PCa,and GGG＞2 was defined as high-grade PCa.PCa patients with different grades were randomly divided into training group and test group according to a ratio of 7∶3.Radiomics features were extracted based on T2 weighted imaging(T2WI)and apparent diffusion coefficient(ADC)sequences.Feature selection and dimensionality reduction were carried out using maximum relevance minimum redundancy,least absolute shrinkage and selection operator,and 5-fold cross validation was performed to retain the best radiomics features.Receiver operating characteristic(ROC)curve and Delong's test were used to evaluate the performance of each model.Decision curve analysis(DCA)was used to evaluate the clinical utility of the model.Results Among all the models,T2WI-ADC-PSAD combined model had the best diagnostic efficiency,the area under the curve(AUC)in training group and test group were 0.882,0.772,respectively.Delong's test showed that in training group,there was no significant difference in AUC between T2WI-ADC-PSAD model and T2WI model(P＞0.05),but there were significant differences between T2WI-ADC-PSAD model and other models(P＜0.05).In test group there were no significant differences in AUC between T2WI-ADC-PSAD model and other models(P＞0.05).The DCA showed that the T2WI-ADC-PSAD model provided a higher net benefit for clinical decision-making when the threshold probability was less than 97％.Conclusion BpMRI radiomics combined with PSAD can improve the diagnostic efficiency of low-grade and high-grade PCa,and guide the treatment decision of patients.

Tsutsugamushi disease is an acute infectious disease caused by Rickettsia. Occasionally it has been reported in Macau, China. Critical cases are rare. Because the clinical manifestations of tsutsugamushi disease are non-specific and diverse, if not diagnosed and treated in time, the disease may progress to multiple organ dysfunction syndrome (MODS), severe acute respiratory distress syndrome (ARDS), and even death. A patient with tsutsugamushi disease complicated by MODS was admitted to the intensive care unit (ICU) of Kiang Wu Hospital in Macau, China on September 30, 2021. Combined with the history of outdoor activities (exposure to chigger mite larvae), clinical symptoms and signs (characteristic eschar of tsutsugamushi disease was found on the abdominal skin), related laboratory examinations (Weil-Felix test: negative). Diagnosis of tsutsugamushi disease with MODS. After admission, the patient was treated by anti-infection, correction of coagulation dysfunction, tracheal intubation and mechanical ventilation, noradrenalin to maintain blood pressure, continuous renal replacement therapy (CRRT), but the condition didn't improve significantly. We initiated veno-venous ECMO (VV-ECMO), which was initially setted blood flow to 5 L/min (70 mL·kg -1·min -1), rotate speed to 3 500 rpm, fractional concentration of inspired oxygen (FiO 2) to 1.00. Heparin was used as anticoagulant and activated coagulation time (ACT) was kept between 180 and 200 seconds. Meanwhile the speed of fluid removal in CRRT was adjusted. After 9 hours of ECMO support, the oxygenation improved, the blood flow of ECMO was reduced to about 4 L/min (58 mL·kg -1·min -1), rotate speed to 3 000 rpm. The patient's condition improved after 4 days of ECMO treatment and her ECMO flow rate and FiO 2 could be decreased gradually. On hospital day 5, ECMO was removed. Eight days on mechanical ventilation, the patient was successfully weaned and extubated. On day 11 of hospitalization, weaned the CRRT and turned to intermittent hemodialysis. The patient was transferred out of ICU due to her stable condition on the 12th day hospitalization. After that, her spontaneous urine output increased gradually. The functions of various organs returned to normal. After 36 days of hospitalization, she recovered and was discharged.

Objective To study the effect of target controlled infusion of etomidate and propofol during general anesthesia induction period on haemodynamics and stress by cerebral state index (CSI) in elderly hypertensive patients. Methods Forty ASAⅠor Ⅱelderly hypertensive patients undergoing selective laparoscopic cholecystectomy were randomly divided into two groups by random digits table method with 20 cases each: propofol group and etomidate group. CSI, mean arterial pressure (MAP), heart rate, blood glucose, concentration of plasma cortisol in the two groups were observed before induction of anesthesia, at 1 min before intubation, and at 1 min, 3 min and 5 min after intubation. Results The level of CSI, MAP, heart rate, blood glucose, cortisol between two groups at before induction of anesthesia had no significant difference (P>0.05).The levels of CSI in two groups at 1 min before intubation, and at 1 min, 3min after intubation were significantly lower than that at before induction of anesthesia, but compared with that at 1 min before tracheal intubation, CSI was significantly higher in two group at 1 min, and 3 min after intubation, and there was significant difference (P<0.05). The level of MAP in etomidate group was higher than that in propofol group at 1 min before intubation, and at 1 min , 3 min and 5 min after intubation: (85.9 ± 9.2) mmHg (1 mmHg = 0.133 kPa) vs. (70.8 ± 8.1) mmHg, (112.6 ± 9.8) mmHg vs. (90.6 ± 10.8) mmHg, (96.5 ± 8.2) mmHg vs. (86.5 ± 8.6) mmHg, (95.2 ± 8.3) mmHg vs. (80.6 ± 8.7) mmHg, and there was significant difference (P<0.05). The level of heart rate at 1 min before intubation in propofol group was lower than that before induction of anesthesia and that at the same period in etomidate group: (65.1 ± 6.2) bpm vs. (85.8 ± 10.2) bpm, (78.2 ± 6.7) bpm], and there was significant difference (P<0.05), while there was no significant differenc in the level of heart rate in etomidate group at each time point (P>0.05). Compared with before induction of anesthesia, the concentrations of blood glucose and cortisol at 1min before intubation in patients of the two groups decreased significantly, while glucose and cortisol concentrations at 1 min, 3 min and 5 min after intubation in two group significantly increased , and there was significant difference (P<0.05);cortisol concentration in etomidate group at 1 min before intubation and 1 min, 3 min, 5 min after intubation was significantly lower than that at the same period in propofol group:(260.6 ± 39.6) nmol/L vs. (290.2 ± 35.6) nmol/L, (380.3 ± 37.6) nmol/L vs.(410.8 ± 46.6) nmol/L, (361.2 ± 25.2) nmol/L vs. (392.6 ± 31.6) nmol/L, (352.3 ± 25.6) nmol/L vs. (370.3 ± 28.8) nmol/L, and there were significant differences (P < 0.05). Conclusions During induction of general anesthesia with the guidance of cerebral state index, target controlled infusion of etomidate has more stable hemodynamics, and also attenuates the stress response to tracheal intubation in elderly hypertensive patients.

BACKGROUND:Neural stem cels can repair the damaged brain tissues with potentials of proliferation and differentiation, which become one of the important directions for treating cerebral palsy. OBJECTIVE:To observe the clinical effect and safety of neural stem cel transplantation on the treatment of cerebral palsy in children. METHODS:Neural stem cels were isolated from human embryonic brain and identified by immunofluorescence staining, which were transplanted intravenously into 26 children with cerebral palsy. Children's motor functions were evaluated by gross motor function measure scale and Peabody development motor scale-fine motor scale before treatment, and 3 and 6 months after treatment. Routine blood test and liver-kidney function were detected before and after treatment. Clinical adverse reactions in children with cerebral palsy were monitored. RESULTS AND CONCLUSION:The lost cases were not found during 6 months of folow-up. Specific proteins of neural stem cels were al positive in this study. At 3 and 6 months after transplantation, the A, B, C functional area scores and total score on the gross motor function measure scale were obviously increased (P < 0.05,P < 0.01), but the C and D functional area scores were not remarkably elevated (P > 0.05). At 3 months after transplantation, the fine motor quotient, grasping subtest and visual-motor integration were not remarkably increased (P > 0.05); these scores, however, were elevated after 6 months with statistical significance (P < 0.05, P < 0.01). The results of routine blood test and liver-kidney function in 26 children were in normal range, and there were no serious adverse reactions during the cel transplantation. Therefore, neural stem cel transplantation has high safety and good curative effects to improve the motor function of children with severe cerebral palsy, especialy for gross motors.

Objective To investigate the application effect of the ankle foot orthoses (AFO)in the rehabilitation of patients with hemiplegia and abnormal gait after stroke Methods Sixty consecutive stroked patients with hemiplegia admitted to Meizhou People′s Hospital,Guagdong Province from January in 2013 to June in 2015 were enrolled retrospectively,and they were divided into either an AFO group or a non-AFO group (n = 30 in each group)according to the odd or even admission numbers. The patients in the non-AFO group were treated with conventional rehabilitation training and those in the AFO group were treated with AFO. Before and after treatment,the Berg balance scale (BBS)was used to assess the balance ability of the patients,10 m maximum walking speed (MWS)was used to assess the walking speed of the patients,and the physiological cost index (PCI)was used to assess the walking efficiency of the patients. Results After treatment,there was significant difference in Brunnstrom grade between the AFO group and the non-AFO group (P < 0. 05). The BBS score and MWS of the patients in the AFO group were 39 ± 5 and 0. 97 ± 0. 38 m/ s respectively after treatment,and they were higher than those before treatment (33 ± 4 and 0. 28 ± 0. 07 m/ s)and those of non-AFO group (36 ± 4 and 0. 54 ± 0. 31 m/ s)after treatment. There were significant differences (all P <0. 05). The PCI was 0. 84 ± 0. 30 in the AFO group after treatment was 0. 84 ± 0. 30. It was lower than that before treatment (1. 32 ± 0. 31)and that of non-AFO after treatment (0. 96 ±0. 33). There was significant difference (all P < 0. 05). Conclusion The application of APO in stroked patients with hemiplegia and abnormal gait has better clinical efficacy. It can significantly im-prove the balance state of patients and improve the walking speed and efficiency.

Although previous publications suggest the 2009 pandemic influenza A(H1N1)virus was reassorted from swine viruses of North America and Eurasia, the immediate ancestry still remains elusive due to the big evolutionary distance between the 2009 H1N1 virus and the previously isolated strains. Since the unveiling of the2009 H1N1 influenza, great deal of interest has been drawn to influenza, consequently a large number of influenza virus sequences have been deposited into the public sequence databases. Blast analysis demonstrated that the recently submitted 2007 South Dakota avian influenza virus strains and other North American avian strains contained genetic segments very closely related to the 2009 H1N1 virus, which suggests these avian influenza viruses are very close relatives of the 2009 H1N1 virus. Phylogenetic analyses also indicate that the2009 H1N1 viruses are associated with both avian and swine influenza viruses circulating in North America. Since the migrating wild birds are preferable to pigs as the carrier to spread the influenza viruses across vast distances, it is very likely that birds played an important role in the inter-continental evolution of the 2009 H1N1virus. It is essential to understand the evolutionary route of the emerging influenza virus in order to find a way to prevent further emerging cases. This study suggests the close relationship between 2009 pandemic virus and the North America avian viruses and underscores enhanced surveillance of influenza in birds for understanding the evolution of the 2009 pandemic influenza.

We isolated a novel Enterobacteria phage IME08 from hospital sewage, then confirmed it was a double-stranded DNA phage by digesting its genetic material with DNase I, RNase A and several restriction endonucleases respectively. BLAST results of random fragments generated by a random PCR cloning method revealed that it belonged to T4-like virus. We subsequently determined the host recognizing genes (g37 and g38) sequence with a PCR-based "genome jumping" protocol based on highly conserved region at 5' terminus of g37 from four other T4-like Bacteriophages (T4, JS98, T2 and K3). These molecular biological methods enabled us to readily characterize the bacteriophage and efficiently determine the sequence of the genes of interest based on very limited conserved sequence information.
Bacteriophage T4 ; genetics ; isolation & purification ; Cloning, Molecular ; DNA, Viral ; genetics ; Escherichia coli ; genetics ; virology ; Genome, Viral ; genetics ; Host Specificity ; genetics ; Polymerase Chain Reaction ; methods

Secretory IgA (SIgA) antibodies in external secretions play an important role in mucosal immune response. Polymeric SIgA was advantageous over monomeric IgA (mIgA) and IgG in several aspects. To express secretory IgA antibody against H5N1 virus, we constructed the secretory component and immunoglobulin J expressing plasmids and co-transfected the plasmids into the Chinese hamster ovary cells (CHO) stably expressing immunoglobulin A. Then we used Zeocin to select the positive clone cells, monoclonal cells stably secreting SIgA was screened through fold dilution method at last. The SIgA antibody secreted from the CHO cells was confirmed by Western blotting, which demonstrated that we had got the complete SIgA molecular. The successful expression of this polymeric anti-H5N1 SIgA in CHO cells will contribute to the production of recombinant SIgA as a preventive agent for infectious disease control.
Animals ; Antibodies, Viral ; biosynthesis ; genetics ; CHO Cells ; Cloning, Molecular ; Cricetinae ; Cricetulus ; Genetic Vectors ; Immunoglobulin A ; immunology ; Immunoglobulin A, Secretory ; biosynthesis ; genetics ; immunology ; Influenza A Virus, H5N1 Subtype ; immunology ; Recombinant Fusion Proteins ; biosynthesis ; genetics ; immunology

Objective To determine the feasibility, safety and techniques of transumbilical single-port laparoscopic liver cyst fenestration. Methods From November 2009 to June 2010, four cases of transumbilical single-port laparoscopic liver cyst fenestration were completed through three adjacent 5 mm trocars around the umbilicus. Normal 5 mm laparoscopic instruments and a 5 mm 30° laparoscope were utilized, and the procedures were similar to conventional multi-port laparoscopic liver cyst fenestration. Results All operations were completed successfully, with no conversion to laparotomy or the multi-port laparoscopic procedure. The mean operation time was 38 minutes (25-70 minutes). All patients were discharged at postoperative days 1-3, and no complications or cyst recurrence occurred during hospitalization and follow-up. Conclusions Transumbilical single-port laparoscopic liver cyst fenestration is safe and feasible. It has the advantages of less pain, cosmetic incision and quick recovery, but is technique-demanding.