Gene enhancement is one of the research hotspots at home and abroad in recent years. Gene enhancement is expected to treat human genetic diseases and improve human abilities and traits, but it also raises a series of ethical problems. From the perspective of ethics, those who support gene enhancement, starting from the open and unfinished state of human nature, advocate that gene enhancement is an effective alternative to promote human nature for kindness and social equity, and believe that gene enhancement does not necessarily lead to inequality, on the contrary, it contributes to moral improvement. Opponents, starting from the integrity of human nature, hold that gene enhancement challenges human dignity, causes a crisis of human identity, has a serious impact on social fairness and justice, and is also a violation of the natural order. By sorting out and analyzing the ethical viewpoints that support and oppose gene enhancement, this paper found that the social fairness and justice issues caused by gene enhancement can be reasonably solved through exercising the roles of the government and the market, while the human nature problems caused by gene enhancement are more complex, and the setting of natural standards lacks a basis. At the same time, gene enhancement also makes people further reflect on the relationship between human and technology.

Objective:To compare the effects of staged percutaneous coronary intervention(PCI)after emergency PCI and emergency culprit-only PCI on clinical outcomes of elderly patients with ST-segment elevation myocardial infarction(STEMI)and multivessel disease.Methods:A retrospective analysis was performed on 389 elderly patients with STEMI and multivessel lesions, aged ≥70 years and within 12 h of onset, admitted to the Clinical College of Thoracic Medicine, Tianjin Medical University, between January 2014 and September 2019.According to different revascularization strategies, enrolled patients were divided into the culprit-only PCI group(79.18%, 308)and the staged PCI group(20.82%, 81). Kaplan-Meier analysis and the Cox proportional hazards regression model were used to compare the incidences of major adverse cardiac and cerebrovascular events(MACCE), all-cause death, cardiac death, recurrent myocardial infarction, stroke and ischemia-driven revascularization between the two groups and to evaluate the effects of different revascularization strategies on MACCE and all-cause death.Then subgroup analysis was performed.Results:During a 56-month follow-up, 131 patients developed MACCE and 96 patients died.Compared with the culprit-only PCI group, the staged PCI group had a lower risk of MACCE( HR: 0.404, 95% CI: 0.227-0.716, P=0.002), all-cause death( HR: 0.354, 95% CI: 0.171-0.730, P=0.005), cardiac death( HR: 0.363, 95% CI: 0.157-0.838, P=0.018), and recurrent myocardial infarction( HR: 0.229, 95% CI: 0.055-0.953, P=0.043). There was no significant difference in the incidence of stroke or ischemia-driven revascularization between the two groups( P>0.05). The reduced risk with staged PCI for MACCE and for all-cause mortality persisted in all subgroups.Multivariate Cox proportional hazards regression revealed that, after adjusting for confounding factors, staged PCI was an independent protective factor for MACCE( HR: 0.44, 95% CI: 0.239-0.815, P=0.009)and for all-cause death( HR: 0.390, 95% CI: 0.90, P=0.020). Conclusion:Compared with culprit-only PCI, staged PCI can significantly improve the long-term prognosis of elderly patients ≥70 years with STEMI and multivessel disease within 12 h of onset.

Objective:To investigate the effect of sarcopenia on physical performance and nutritional status in elderly patients with gastrointestinal tumors.Methods:a total of 120 eligible in-patients were enrolled from gastrointestinal surgery department of a Grade A tertiary hospital in Ningbo city from September 2021 to January 2022. General clinical data were collected, nutritional risk was screened using Nutritional Risk Screening 2002 (NRS 2002), physical performance was assessed by Short Physical Performance Battery (SPPB), skeletal muscle index at the third lumbar vertebra level (L3 SMI) was calculated using abdominal CT scan, and grip strength/muscle strength, gait speed by 6 Meter Timed Walk Test and calf circumference were measured. Subjects were divided into sarcopenia and non-sarcopenia group according to the diagnostic criteria of the Asian Working Group for Sarcopenia (AWGS). Impacting factors of sarcopenia and the correlation between muscle mass and physical performance in elderly patients with gastrointestinal tumors were analyzed.Results:The overall prevalence rate of sarcopenia in elderly patients with gastrointestinal tumors was 28.3% (34/120) and it was 28.9% (22/76) and 27.3% (12/44) in males and females respectively. There were statistically significant differences in age, tumor stage, nutritional risk, body mass index, calf circumference, L3 SMI, grip strength/muscle strength, gait speed and SPPB score between patients with and without sarcopenia (P<0.05). Muscle strength/grip strength, L3 SMI and gait speed were closely correlated with the occurrence of sarcopenia in elderly patients with gastrointestinal tumors (P<0.05). The L3 SMI was positively correlated with physical performance as assessed with SPPB in both groups.Conclusions:Sarcopenia is a common complication in elderly patients with gastrointestinal tumors with multiple influencing factors. Timely nutritional intervention and exercise intervention should be incorporated into the treatment of elderly gastrointestinal tumor patients with sarcopenia in order to improve nutrition status.

Objective To evaluate the indications and clinic outcomes of vaginal high uterosacral ligament suspension (HUS) for treatment of recurrent advanced pelvic organ prolapse (POP). Methods This retrospective study analyzed 42 women with recurrent advanced POP who were referred to Fourth Medical Center of PLA General Hospital and underwent transvaginal HUS between November 2005 and January 2018. Primary surgeries included 30 vaginal colporrhaphy, 5 Manchester operation, 5 transvaginal mesh repair,2 sacrospinous ligament fixation.The median time for recurrence from primary pelvic floor repair surgery was 9 months, including 14 cases (33%, 14/42)≤3 months (median time was 2 months) and 25 cases (67%, 28/42) longer than 3 months (median time was 18 months).The rate of recurrent prolapse in stageⅢorⅣ was 79% (33 cases), 45% (19 cases) and 17%(7 cases) in anterior, apical and posterior compartment respectively. Results Transvaginal high bilateral uterosacral ligaments were identified and used for successful vaginal vault suspension after vaginal hysterectomy and residual cervical resection in all 42 consecutive patients. The cases of transvaginal mesh used in anterior wall and posterior wall were 25 (60%, 25/42) and 3 (7%, 3/42) respectively. There was no major intra-and postoperative complications,such as ureter and other pelvic organ injury. The median time of follow-up was 5.3 years after transvaginal HUS. The points of pelvic organ prolapse quantification system reduced significantly and point C improved from+0.3 cm to-8.2 cm after reoperation (P<0.01). The objective cure rate were 100% (42/42) both in apex and posterior compartment,while 93% (39/42) in anterior compartment. None had reoperation or pessary usage for recurrence of prolapse. Conclusion Transvaginal HUS with vaginal wall repair could be as a safety, cost-effective, minimal traumatic and durable procedure for recurrent POP in the most of cases.

Objective To explore the clinical management and outcomes of polypropylene mesh and sling exposure after reconstructive pelvic surgery(RPS). Methods A total of 110 cases of mesh and sling exposure after RPS were analyzed, who admitted between Jan. 2002 and Oct. 2017 in First Affiliated Hospital of PLA General Hospital, in which 3 cases were referred from other hospitals. Mesh and sling exposures were identified in the outpatient clinic and categorized and managed according to International Continence Society and International Urogynecology Association(ICS-IUGA)classification about category, time and site(CTS)of mesh complication. Outpatient management included observation, topical estrogen use and mesh removal. Management in hospital included surgical removal of exposed mesh and repair of the resulting defects under the anesthesia. Seventy-four cases were managed in the outpatient setting, and 36 cases required inpatient management. Follow-up was consecutively performed from 1 month to 10 years. Objective outcome included the surgeon′s assessment of the healing state of the vaginal mucosa. Subjective outcome was evaluated with patient global impression of improvement questionnaire(PGI-I). Results One hundred and ten patients with mesh exposure were classified according to the different RPS underwent. There were 95 cases from transvaginal mesh surgery, 5 cases from anti-stress urinary incontinence sling surgery, and 10 cases from sacrocolpopxy. The outpatient group healed at an average of(3.0 ± 1.8)months. Of the 36 patients who required inpatient management, 21 cases healed completely at an average of 7 days after one surgery. The remaining 8 cases required either two or three times surgeries or conservative management. In the outpatient group, the PGI-I scale very much better was found in 65 cases(87.8％)and much better in 9 cases(12.2％). In the inpatient surgery group, the scale was very much better in 30 cases (83.3％), and much better in 6 cases(16.7％). Conclusions Among patients with mesh exposure after mesh-augmented RPS, 2/3 of patients with a CTS classification 1-3 could be managed in the office,and remaining 1/3 with CTS classification 4-6 need operation under anesthesia in hospital. If the mesh and sling exposure could be scientifically classified, according to the size, site and accompany symptoms, as well as pain, most of the mesh complications after explosure could be resolved. Using the pelvic floor repair and polypropylene mesh sling, the majority of the patients could get a better outcome, without affecting the effect of the original operation.

Objective To evaluate the clinical application of TCM nursing therapies and identify the problems during the therapy implementation, in order to explore the countermeasures to promote its clinical improvement. Methods A descriptive cross-sectional study was conducted,and a self-designed questionnaire was employed to investigate 218 nurses from 148 grade A class three TCM hospitals in China. Results 25 TCM nursing therapies were implemented in these hospitals. Ear acupressure therapy was the most frequently implemented,accounting for 83.5%(182/218);while wax therapy was the least implemented, accounting for 7.8%(17/218). The implementation frequency of these technologies varied significantly, 0~860 times a week. The top three of them were acupoint application therapy, hot compression of Chinese medicine and ear acupoints therapy.TCM nursing therapies were considered to be the most frequently used in insomnia, headache, edema, arthralgia, cold, epigastric pain, hypochondriac pain and fever.Storage of TCM nurses,lacking of TCM knowledge and inapposite therapy implementation were the main problems in the application. Conclusions Scientific and rational allocation of human resources, cultivation of the TCM-specific nursing professional, enhancement of nurses'awareness of Chinese medicine, establishment of a reasonable charging standard, and strengthening the risk management in implementation will promote its clinical development.

This study was aimed to investigate the requirement of our hospital nurses in the effect evaluation of fifteen traditional Chinese medicine (TCM) nursing programs,and to make it as the basis for making feasible evaluation tables of TCM nursing programs.The investigation survey was given among 78 nurses from the internal medicine ward,surgical ward and the department of orthopedics in our hospital.The questionnaire was graded according to the Likert 5 scoring method,including 3 themes and 11 items.The SPSS 17.0 package was used for statistical processing.The results showed that 93％ nurses participated in the training of effect evaluation table of unified TCM nursing program in the hospital or department,but the overall attitude was negative in terms of the operability and objectivity on the effect evaluation of the program.Requirements of guidelines for effectiveness evaluation of TCM nursing program showed that most nurses agreed that the new TCM nursing program needed to increase quantifiable indicators and to increase its objectivity and reproducibility.It was concluded that nurses generally considered that the evaluation system of nursing program of TCM had no quantitative indicators,but with strong subjective.In the clinical practice,it is in urgent need of an objective TCM nursing program with quantitative indicators and strong operability.

This paper was aimed to study the safety of moxibustion with FMEA method.Failure mode and effects analysis (FMEA) were used in every aspect of the operation process of moxibustion.And the local skin temperature was measured in 80 patients treated with moxa box moxibustion.The results showed that the skin temperature reached the highest when the moxibustion was given for 15 min,which was in consistence with the patients' chief complaints and their tolerances.It indicated that moxibustion for 15 min was the best moxibustion amount.Meanwhile,inspection should be made to avoid burning.After the application of FMEA,the RPN of the inspection activities,the temperature and distance of moxibustion were significantly decreased (P ＜ 0.05).It was concluded that the application of FMEA management mode strengthened the risk management of moxibustion treatment,standardized treatment process,provided the basis for the temperature and distance of moxibustion,and ensured the safety and efficacy of treatment.

This study was aimed to evaluate the apocatastasis effect and adverse reaction of external application of mirabilite in the treatment of patients with renal edema.Randomized controlled trials (RCTs) were conducted.Patients in the control group were treated with routine treatment plus prescribed diuretics.In the test group,patients were treated with routine nursing,prescribed diuretics,and the external application of mirabilite.The results showed that there was significant difference in the changes of body weight and circumference of the leg.There was no significant difference in the change of urine volume.In the experimental group,2 patients had adverse reactions of the lower limb pruritus,which may be related to the sensitivity of the bag material.It was concluded that a noninvasive external therapy of TCM,mirabilite had quickly apocatastasis effect in the treatment of renal edema patients.Meanwhile,it does not affect the treatment effect of diuretics.The adverse reaction is less.It is an effective method which should be promoted to use.

This study was aimed to observe the clinical effect and quality of life (QOL) of Si-Zi (SZ) powder for hot compress to improve gastrointestinal functions of hemodialysis patients.A total of 60 hemodialysis patients were randomly divided into the treatment group and the control group.Gastrointestinal Symptom Rating Scale (GSRS) and QOL of both groups before and after the treatment of SZ powder were compared continuously.The results showed that after intervention,the total relieve rate was 96.7％ in treatment group,and 53.3％ in the control group.The effect of SZ powder group was to obviously improve the gastrointestinal symptoms and QOL (P ＜ 0.05).It was concluded that SZ powder for hot compress can improve gastrointestinal functions and increase QOL of hemodialysis patients.