[Objective] To explore the strategy of blood management in patients with massive transfusion in the frigid plateau region. [Methods] The treatment process of a patient with liver rupture in the frigid plateau region was analyzed, and the blood management strategy of the frigid plateau region was discussed in combination with the difficulties of blood transfusion and literature review. [Results] The preoperative complete blood count (CBC) test results of the patient were as follows: RBC 3.14×10¹²/L, Hb 10⁶ g/L, HCT 30.40%, PLT 115.00×10⁹/L; coagulation function: PT 18.9 s, FiB 1.31 g/L, DD > 6 μg/mL, FDP 25.86 μg/mL; ultrasound examination and imaging manifestations suggested liver contusion and laceration / intraparenchymal hematoma, splenic contusion and laceration, and massive blood accumulation in the abdominal cavity; it was estimated that the patient's blood loss was ≥ 2 000 mL, and massive blood transfusion was required during the operation; red blood cell components were timely transfused during the operation, and the blood component transfusion was guided according to the patient's CBC and coagulation function test results, providing strong support and guarantee for the successful treatment of the patient. The patient recovered well after the operation, and the CBC test results were as follows: RBC 4.32×10¹²/L, Hb 144 g/L, HCT 39.50%, PLT 329.00×10⁹/L; coagulation function: APTT 29.3 s, PT 12.1 s, FiB 2.728 g/L, DD>6 μg/mL, FDP 25.86 μg/mL. The patient was discharged after 20 days, and regular follow-up reexamination showed no abnormal results. [Conclusion] Individualized blood management strategy should comprehensively consider the patient’s clinical symptoms, the degree of hemoglobin decline, dynamic coagulation test results and existing treatment conditions. Efficient and reasonable patient blood management strategies can effectively improve the clinical outcomes of massive transfusion patients in the frigid plateau region.

The widespread application of medical artificial intelligence （AI） has brought technological breakthroughs to traditional diagnosis and treatment and has also altered the traditional doctor-patient interaction mode and formed a new doctor-patient relationship of “doctor-medical AI-patient” which faces a series of challenges. The intervention of AI may form a new “paternalistic style，” affecting the shared decision-making model. When its recommendations lack explanation， it may lead to clinical decision-making paralysis and affect the doctor-patient trust relationships. There may be confusion between the roles and responsibilities of AI and doctors in the process of medical practice， affecting the establishment of an emotionally responsible doctor-patient relationship. Through an in-depth analysis of the impact and causes of medical AI on the doctor-patient relationships， this paper proposed that a collaborative mechanism should be established between AI and professional doctors to complement each other， clarifying the auxiliary status of AI， reinforcing the dominant role of doctors， enhancing the regulatory mechanism， and dynamically improved the doctor-patient relationships to promote the healthy and orderly development of smart healthcare.

OBJECTIVE To investigate the ameliorating effect and mechanism of the effective substance groups from Artemisia ordosica（Abbreviated as HSH） on rheumatoid arthritis （RA） based on cluster of differentiation 4/lymphocyte cell-specific protein- tyrosine kinase/zeta-chain-associated protein kinase of 70 kDa/interleukin-17（CD4/LCK/ZAP70/IL-17） signaling pathway. METHODS The rats were divided into normal group， model group， HSH low-dose， medium-dose and high-dose groups （2.7， 10.8， 21.6 mg/kg） and positive control group （Tripterygium glycosides tablet， 6.3 mg/kg）， with 10 rats in each group. Except for normal group， RA rat model was induced by complete Freund’s adjuvant in other groups. After modeling， each group was given relevant medicine or normal saline intragastrically， once a day， for 28 consecutive days. The changes in ankle joint swelling and arthritis index in rats were determined； the pathological changes of ankle joint tissue were observed； the levels of inflammatory factors [IL-1β， IL-21， IL-17A， IL-2， interferon-γ （IFN-γ） and IL-6] in serum and joint fluid of rats were determined； the levels of Th1， Th17 and Treg cells in the whole blood and spleen of rats were detected； protein and mRNA expressions of LCK， proto-oncogene tyrosine-protein kinase Fyn （Fyn）， ZAP70， CD45， RAR-related orphan receptor γt （RORγt）， and forkhead box protein 3 （Foxp3） in ankle synovial tissue were determined. RESULTS Compared with normal group， the changes in ankle joint swelling， arthritis index， the levels of IL-1β， IL-21， IL-17A， IL-2， IFN-γ and IL-6 in serum and joint fluid， the levels of Th1， Th17 cells and Th17/Treg value in whole blood and spleen， and the protein and mRNA expression levels of LCK， Fyn， ZAP70， CD45， and RORγt in ankle joint synovium were all significantly increased/elevated （P＜0.05）. The level of Treg cells in the spleen， as well as the protein and mRNA expression levels of Foxp3 in the ankle joint synovium were significantly decreased （P＜0.05）. Compared with model group， most of the above-mentioned indicators were significantly reversed in the positive control group and all dose groups of HSH （P＜0.05）. The degree of pathological changes in ankle joint tissues was markedly improved， and inflammation was alleviated. CONCLUSIONS HSH can regulate the cascade reactions in the CD4/LCK/ZAP70/IL-17 pathway within the T-cell receptor signaling pathway， thereby modulating the Th17/Treg balance. This leads to the suppression of inflammatory responses and the alleviation of synovial tissue damage in rats with RA.

Antimicrobial resistance (AMR) has emerged as a major global public health challenge, with traditional prevention and control methods exhibiting significant limitations in detection efficiency, data processing, and clinical decision-making. Leveraging its robust capabilities in data analysis and pattern recognition, artificial intelligence (AI) technology has been widely applied across multiple critical aspects of AMR containment. Current evidence demonstrates that AI technologies can significantly enhance the efficiency of resistancediagnosis, optimize personalized treatment strategies, and improve real-time monitoring of resistant pathogen transmission. Despite persistent challenges such as data heterogeneity, model interpretability, and ethical compliance in practical applications, AI holds immense promise in supporting precision infection management and addressing the growing crisis of antimicrobial resistance.This article systematically reviews the clinical applications of AI in AMR prevention and control, including resistance detection and prediction based on mass spectrometry and genomic data, the use of clinical decision support systems in anti-infective therapy, as well as the role of AI in epidemiological surveillance, pathogen tracking, early warning systems, and novel antimicrobial drug discovery aiming to provide reference for clinical practice.

With the increasing number of people with immune deficiency in recent years, fungal infections become an important factor threatening human health.Likewise, the number of children who are immunosuppressed due to hematological diseases, malignancies, use of immunosuppressants and spectrum antibacterial drugs has increased, leading to a high mortality of fungal infections.Moreover, infections of the non-candida albicans and aspergillu are prevalent, serving as important causes for the death of critically ill children. Therefore, this review aims to introduce and summarize the epidemiological characteristics, diagnosis and treatment of pediatric invasive fungal infections, thus yielding the concern of pediatric invasive fungal infections, reducing the occurrence of pediatric fungal infections and improving the prognosis.

This paper examines the integration of Confucian ethics into modern nursing practice and its implications,offering a review of the book Contemporary Medicine and Confucian Thought by Professor Fan Ruiping.The book addresses six key topics:medical decision-making,healthcare systems,medical technology,organ transplantation,mental health,and elderly care.It highlights the conflicts between individual autonomy emphasized in Western ethics and the family-centered approach of Confucianism,especially in clinical decision-making.Through case studies and ethical discussions,the book suggests integrating Confucian ethics with modern medical systems to balance personal and familial interests in patient care.From the perspective of nursing,this review emphasizes the relevance of Confucian principles such as family-centered care,the integration of moral emotions like benevolence and respect,and the importance of developing culturally appropriate ethical models for clinical decision-making.It calls for a paradigm shift in nursing education and practice toward a family-centered approach,promoting harmony between individual and collective needs.Additionally,it discusses the challenges and opportunities for integrating Confucian ethics into cross-cultural nursing in a globalized healthcare environment.The review concludes that Confucian ethics can provide valuable insights into the development of more humanistic and ethically sound nursing practices,particularly in the context of a rapidly evolving medical landscape.

Objective:To explore the current dilemmas in the survival and development of elderly-friendly medical institutions from the dual perspectives of medical staff and elderly patients,to optimize the construction of elderly-friendly medical institutions,to create a friendly,safe,and comfortable medical environment,provide comprehensive,continuous,and caring medical services for the elderly.Methods:Based on the questionnaire survey method,the existing dilemmas and development paths of elderly-friendly medical institutions from multiple dimensions were explored,including culture,management,service,and environment.Results:Quantitative research showed that elderly patients satisfaction with the friendly culture of the medical,but 28(21.1%)still thought that the medical staff did not communicate with them adequately,and 73(54.9%)thought that the institutions lacked health education and guidance for them.In the evaluation of the medical environment,the dissatisfaction of elderly patients was manifested as inadequate transportation facilities(33 visits),lack of barrier-free facilities(29 visits),and unclear medical guidance(25 visits).The results of the chi-square test showed that there was a statistically significant difference in waiting time for medical services among elderly patients based on gender(P<0.05),and women were more patient.There were statistically significant differences in the level of service convenience and satisfaction with geriatric syndrome assessment among elderly patients of different age groups(P<0.05).Qualitative research found that there were problems in the management of elderly-friendly medical institutions,such as cumbersome referral processes,low enthusiasm of medical staff,insufficient elderly professionals,and a lack of performance evaluation and training systems.Conclusion:To solve the existing difficulties of elderly-friendly medical institutions,it should start with paths of strengthening the training of medical staff,improving the hospital management system,upgrading the level of service specialization,and improving the aging-appropriate environment,to enhance the sense of accessibility of medical care for elderly patients and improve their quality of life.

Objective:To investigate the CLEC3B protein of differentially expressed proteins(DEPs)in serum of normal persons and patients with sepsis,and explore the possibility that target C-type lectin domain family 3 member B(CLEC3B)protein was used as molecular markers of sepsis.Methods:Peripheral bloods of 10 healthy persons and 18 patients with sepsis were collected,and the data of peripheral serum proteins were collected by data independent acquisition(DIA)method.The data were uploaded to iDEP online platform to analyze the DEPs in peripheral blood of patients with sepsis.Bioinformatics analysis of these DEPs was conducted to screen out the key proteins of sepsis.Enzyme linked immunosorbent assay(ELISA)was used to verify and plot the receiver operating characteristic(ROC)curves of key proteins.Results:A total of 138 differentially expressed proteins(DEPs)were screened out by using proteomics analysis,of which 34 kinds of proteins were significantly down-regulated and 104 kinds of proteins were significantly up-regulated.DEPs mostly concentrated in cellular processes,biological regulation,biological process regulation,participating binding,catalytic activation,molecular function regulation,immune system,signal transduction and so on.A protein-protein interaction network was constructed by DEPs,which screened out the key protein CLEC3B.ELISA results showed that the CLEC3B protein concentration[(297.73±22.00)ng/mL]of patients in the sepsis group was significantly lower than that[(452.42±191.72)ng/mL]in the healthy group,and the difference was statistically significant(t=13.13,P=0.000).The area under curve(AUC)value of ROC curve,sensitivity and specificity of CLEC38 protein were respectively 0.998,97.73%and 100.0%.Conclusion:CLEC3B is significantly decreased in sepsis group,which sensitivity and specificity are high.It can be used as a potentially biological diagnostic biomarker of sepsis.

Objective:To determine the clinical application value of transcranial sonography (TCS) in the diagnosis of attention deficit hyperactivity disorder (ADHD) in children.Methods:A total of 50 children aged 6-12 years diagnosed with ADHD (ADHD group) and 45 age-matched healthy children (control group) who presented to Suzhou Municipal Hospital and Children′s Hospital of Soochow University from August 2021 to August 2022 were prospectively enrolled for TCS examination. ADHD was diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-Ⅴ) criteria established by the American Psychiatric Association.Based on clinical symptom characteristics, ADHD was further classified into 3 subtypes, including 14 cases of predominantly inattentive, 3 cases of predominantly hyperactive/impulsive, and 33 cases of combined presentation. The substantia nigra(SN) hyperechoic area and the ratio of SN hyperechoic area to midbrain area (S/M) were measured and compared between the two groups. The examination of the correlation was performed between SN hyperechoic area, S/M ratio, and DSM-Ⅴ scores within the ADHD group.Results:Semi-quantitative analysis: the proportion of the SN grade Ⅲ or more in ADHD group was significantly higher than that in control group [96.00%(48/50) vs 13.3%(6/45), P<0.05]. Quantitative analysis: the area of SN hyperechogenicity and the ratio of S/M were significantly larger in ADHD group than in control group [0.32(0.22, 0.38)cm 2 vs 0.00(0.00, 0.00)cm 2, 7.08(5.11, 8.75)% vs 0.00(0.00, 0.00)%, all P<0.05]. Correlation analysis: The SN hyperechoic area and S/M ratio showed no significant correlations with DSM-Ⅴ scores in the ADHD group ( r=0.144, 0.142, all P>0.05). Conclusions:TCS can detect the SN echo enhancement of ADHD children, and the proportion of SN echo enhancement, SN hyperechoic area and S/M ratio are significantly higher than those of normal children, but the SN hyperecho area and S/M ratio are not significantly correlated with DSM-Ⅴ scores.

Objective:To explore the impact of sleep duration, physical exercise, and their interactions on the risk of dyslipidemia in older adults aged ≥80 (the oldest old) in China.Methods:The study subjects were the oldest old from four rounds of Healthy Aging and Biomarkers Cohort Study (2008-2009, 2011-2012, 2014 and 2017-2018). The information about their demographic characteristics, lifestyles, physical examination results and others were collected, and fasting venous blood samples were collected from them for blood lipid testing. Competing risk model was used to analyze the causal associations of sleep duration and physical exercise with the risk for dyslipidemia. Restricted cubic spline (RCS) function was used to explore the dose-response relationship between sleep duration and the risk for dyslipidemia. Additive and multiplicative interaction model were used to explore the interaction of sleep duration and physical exercise on the risk for dyslipidemia.Results:The average age of 1 809 subjects was (93.1±7.7) years, 65.1% of them were women. The average sleep duration of the subjects was (8.0±2.5) hours/day, 28.1% of them had sleep duration for less than 7 hours/day, and 27.2% had sleep for duration more than 9 hours/day at baseline survey. During the 9-year cumulative follow-up of 6 150.6 person years (follow-up of average 3.4 years for one person), there were 304 new cases of dyslipidemia, with an incidence density of 4 942.6/100 000 person years. The results of competitive risk model analysis showed that compared with those who slept for 7-9 hours/day, the risk for dyslipidemia in oldest old with sleep duration >9 hours/day increased by 22% ( HR=1.22, 95% CI: 1.07-1.39). Compared with the oldest old having no physical exercise, the risk for dyslipidemia in the oldest old having physical exercise decreased by 33% ( HR=0.67, 95% CI: 0.57-0.78). The RCS function showed a linear positive dose-response relationship between sleep duration and the risk for hyperlipidemia. The interaction analysis showed that physical exercise and sleep duration had an antagonistic effect on the risk for hyperlipidemia. Conclusion:Physical exercise could reduce the adverse effects of prolonged sleep on blood lipids in the oldest old.