Medicine is the subject of studying human and its inherent humanistic attribute endows medicine with the temperature it deserves. However, with the continuous improvement of medical testing technology and treatment technology, medical workers pay more attention to diseases and ignore humanistic care, which has become an important factor in the aggravation of patients’ burden and the tension relationship between doctors and patients. There are many virtues in Chinese traditional culture. Sun Simiao’s medical ethics thought of "great doctor with professionalism and sincerity" embodies the core value of the humanistic spirit of Chinese traditional medicine. In his medical ethics thought, the moral and ethics of "great doctor with professionalism and sincerity", the medical practice attitude of "being cautious and diligent", the values of "benevolence for the world" and the professional conduct of "honesty and truth" still have strong practical significance at present. It is the good material to cultivate the humanistic spirit of medical students. This is of great value to integrate Sun Simiao’s medical ethics thought into cultivate medical students with both "professionalism" and "sincerity", practice the original intention of medical and health undertakings, and carry forward cultural self-confidence.

Objective To retrospectively analyze the periprocedural and postprocedural antithrombotic therapy regimens for patients undergoing percutaneous left atrial appendage closure(PLAAC)at Nanjing Drum Tower Hospital(hereinafter referred to as"the hospital")and their association with prognosis,and to provide a basis for antithrombotic therapy in clinical practice for such patients.Methods We systematically collected medical records of non-valvular atrial fibrillation patients underwent PLAAC treatment from January 2018 to January 2022 at our hospital.We recorded basic patient information,preoperative left atrial appendage(LAA)thrombus screening,and antithrombotic regimens,and analyzed the incidence of bleeding and thrombotic events during the periprocedural period and up to 12 months postprocedure.Results A total of 96 patients underwent PLAAC,with 86 included in the final analysis.Eight patients had LAA thrombus detected by transesophageal echocardiography before the procedure,and all thrombi resolved after one month of extended antithrombotic therapy.There was one bleeding event in the continuous anticoagulation group during the periprocedural period,while no bleeding events occurred in the interrupted anticoagulation group.Within one year postprocedure,11 patients(18.0%)in the continuous anticoagulation group and 4 patients(16.0%)in the interrupted anticoagulation group experienced bleeding events.All patients adhered to anticoagulant therapy as prescribed for the first three months postprocedure;between three to six months postprocedure,33.7%of patients received dual antiplatelet therapy(DAPT),and 29.1%discontinued therapy;between six to twelve months,47.7%of patients received single antiplatelet therapy(SAPT)and 48.8%discontinued therapy.During the one-year follow-up,there was one case each of device-related thrombus,ischemic stroke,and cerebral hemorrhage,indicating a low overall incidence of adverse events.Conclusion In the real-world setting,the individualized antithrombotic regimens provided by physicians at the hospital,both periprocedurally and postprocedurally,were reasonable and consistent with guidelines.However,poor medication adherence was a significant issue among patients.It is recommended that clinical pharmacists actively engage in pharmacotherapy monitoring and enhance medication education to improve medication adherence.

Objective To investigate the clinical characteristics of the hepatolenticular degeneration in children,and to clarify the significance of gene diagnosis in children with hepatolenticular degeneration.Methods A total of 75 patients with hepatolenticular degeneration were enrolled in the Department of Pediatrics,Peking Union Medical College Hospital from 2011 to 2018.All of them carried out a generation of gene sequencing for ATPase Cu2+trans-porting beta polypeptide(ATP7B)gene and multiplex ligation-dependent probe amplification(MLPA)analysis.Results Among the 75 pediatric patients,55 patients were asymptomatic and had elevated aminotransferases as the incidental findings.All the pediatric patients had decreased ceruloplasmin.Seventy-two of pediatric patients had 24-hour urinary copper＞40 μg/d.There were 16 cases that had Kayser-Fleischer(K-F)rings.Sixteen six out of 75(21.33%)cases were diagnosed clinically and 15 cases were＞7 years old.All the remaining patients needed genetic diagnosis.Sixty-six patients had two mutations and 9 patients had only one mutation,1 had no mutation.Forty eight different mutations were found to be localized in ATP7B gene.These mutations included 32 missense mutations,6 splice mutations,5 deletion mutations,2 repeated mutations,2 insert mutations and 1 nonsense muta-tions.The most frequently three mutations were c.2333G＞T,p.R778L,c.2621C＞T,p.A874V,c.2975C＞T,p.P992L,whose allele frequencies were 30.49%,14.89%,9.92%.Conclusions The research showed that in young aged patients,the nervous system symptoms are not obvious and the positive rate of laboratory tests are lower than adults so is a challenge to clinical diagnosis.So Genetic testing is of great significance for the early diagnosis and early treatment of disease in pediatric patients.

Objective To investigate the prevalence of parasitic infections in market-sold aquatic products in Shanghai Municipality, and to understand the knowledge and practice towards food-borne parasitic diseases among residents, so as to provide insights into the surveillance and control of food-borne parasitic diseases. Methods Freshwater products, seawater products and pickled products were randomly obtained from agricultural trade markets, supermarkets, retail stores and restaurants in Huangpu, Putuo, Minhang and Qingpu districts of Shanghai Municipality from 2020 to 2023. Parasite metacercariae and larvae were detected in these aquatic products using pressing method, digestion method and the dissection method, and the detection of parasitic infection was compared in different types of aquatic products. In addition, the knowledge and practice towards food-borne parasitic diseases were investigated among residents aged 10-80 years old who randomly selected from agricultural trade markets, supermarkets, community streets and other population concentration areas in these four districts by questionnaire in 2023, and the awareness of food-borne parasitic diseases knowledge and percentage of healthy behaviors formation were analyzed. Results A total of 2 109 aquatic products sampled from Huangpu, Putuo, Minhang and Qingpu districts of Shanghai Municipality from 2020 to 2023 were detected, and there were 317 products detected with parasitic infections, with an overall detection rate of 15.03%. There were 8 products detected with parasitic infections in 1 221 freshwater products, with a detection rate of 0.66%, and Clonorchis sinensis was the predominant parasite, which was detected in Pseudorasbora parva, Rhodeus amarus and Carassius auratus. There were 82 products detected with parasitic infections in 501 seawater products, with a detection rate of 16.37%, and Anisakis was the predominant parasite, which was detected in Trichiurus lepturus, Larimichthys polyactis, Pneumatophorus japonicus, Collchthys lucidus, Mugil cephalus, Larimichthys crocea, Scomberomorus niphonius, Stromateoides argenteus and Cololabis saira. There were 227 products detected with parasitic infections in 387 pickled products, with a detection rate of 58.66%, and the prevalence rates of Echinostoma metacercariae were 76.27% (225/295) in Bullacta exarata and 11.11% (2/18) in crab pastes, respectively (χ² = 159.511, P < 0.05). No Paragonimus infection was found in freshwater shrimps, crabs and pickled products, and no Diphyllobothrium latum larvae infection was detected in freshwater and seawater fish. Questionnaire surveys showed that the awareness of food-borne parasitic diseases knowledge was 79.00% (222/281), and the percentages of washing hands before and after meals, not drinking filtered water or tap water directly, not eating raw or semi-raw food, being willing to change special dietary preferences or bad living habits for health, and being willing to learn more about food-borne parasitic diseases knowledge were 99.64% (280/281), 72.24% (203/281), 56.23% (158/281), 96.80% (272/281) and 97.51% (274/281) among residents living in Huangpu, Putuo, Minhang and Qingpu districts, respectively. Conclusions There are food-borne parasite contaminations in market-sold aquatic products in Shanghai Municipality. Although residents are aware of food-borne parasitic diseases knowledge, sustainable surveillance of food-borne parasitic diseases and improved health education are required to minimize the risk of human parasitic infections.

Although carbon monoxide (CO)-based treatments have demonstrated the high cancer efficacy by promoting mitochondrial damage and core-region penetrating ability, the efficiency was often compromised by protective autophagy (mitophagy). Herein, cannabidiol (CBD) is integrated into biomimetic carbon monoxide nanocomplexes (HMPOC@M) to address this issue by inducing excessive autophagy. The biomimetic membrane not only prevents premature drugs leakage, but also prolongs blood circulation for tumor enrichment. After entering the acidic tumor microenvironment, carbon monoxide (CO) donors are stimulated by hydrogen oxide (H₂O₂) to disintegrate into CO and Mn²⁺. The comprehensive effect of CO/Mn²⁺ and CBD can induce ROS-mediated cell apoptosis. In addition, HMPOC@M-mediated excessive autophagy can promote cancer cell death by increasing autophagic flux via class III PI3K/BECN1 complex activation and blocking autolysosome degradation via LAMP1 downregulation. Furthermore, in vivo experiments showed that HMPOC@M+ laser strongly inhibited tumor growth and attenuated liver and lung metastases by downregulating VEGF and MMP9 proteins. This strategy may highlight the pro-death role of excessive autophagy in TNBC treatment, providing a novel yet versatile avenue to enhance the efficacy of CO treatments. Importantly, this work also indicated the applicability of CBD for triple-negative breast cancer (TNBC) therapy through excessive autophagy.

Postoperative delirium(POD),a common surgical complication,refers to the acute and fluctuating disturbance in attention and awareness after surgery,which seriously affects the recovery and is one of the predictors of poor prognosis of patients.At present,preoperative anxiety is common in periopera-tive patients.As the independent risk factors for POD,preoperative anxiety plays an important role in the occurrence and development of POD.Taking active and reasonable intervention measures for patients with preoperative anxiety may effectively reduce the occurrence of POD.This paper reviews the effects of preoper-ative anxiety on POD,focusing on its mechanism and prevention methods,in order to explore the relation-ship between preoperative anxiety and POD,which might provide new ideas for the clinic.

Objective:To investigate the clinical effect of three different tissue flaps in repairing patients with orbital region tissue loss after enlarged resection of malignant tumors in the orbital region, as well as the indication.Methods:Retrospective analysis of data of patients with malignant tumors in the orbital region treated in the Department of Oral and Maxillofacial Trauma and Orthognathic Surgery, the First Affiliated Hospital of Xinjiang Medical University (Affiliated Stomatological Hospital) between January 2017 and December 2021. All patients underwent extensive resection of periorbital malignant tumors and enucleation of orbital contents, depending on defects in periorbital soft/hard tissues and orbital contents, temporalis myofascial flap combined with full thickness skin grafts (TMF-FTSG group), modified pectoralis major myocutaneous flap (PMMF group), and free anterolateral thigh flap (ALTF group) were used to repair the tissue defect. The wound healing and complications of the donor and recipient areas were followed up after operation, and degree of mouth opening in the TMF-FTSG group was compared at 3 months after operation and before operation. The University of Washington quality of life scale (UW-QOL) score was compared among the three groups before and 1 year after operation (a total of 12 items, each item was assigned from 0 to 100 points, the higher the score, the better the recovery). Statistical software SPSS 26.0 was used to analyze the data. The measurement data were expressed as Mean±SD, and the paired t-test was used to compare the preoperative and postoperative data within the group, the difference was statistically significant at a P value less than 0.05. Results:A total of 22 patients were enrolled. There were 8 patients in TMF-FTSG group, 4 males and 4 females, aged (68.3±9.7) years. There were 6 patients in PMMF group, 5 males and 1 female, aged (65.8±7.8) years. There were 3 males and 5 females in ALTF group, aged (63.8±5.4) years. There were 12 cases of squamous cell carcinoma, 8 cases of basal cell carcinoma and 2 cases of adenoid cystic carcinoma. The size of soft tissue defect after tumor resection in TMF-FTSG group, PMMF group and ALTF group was 4 cm×4 cm-7 cm×8 cm, 4 cm×5 cm-9 cm×9 cm and 5 cm×6 cm-14 cm×9 cm, respectively. And the size of flaps ranged from 5 cm×4 cm to 8 cm×9 cm, from 5 cm×7 cm to 10 cm×10 cm, and from 10 cm×6 cm to 20 cm×9 cm, respectively. All donor sites and 20 recipient sites recovered in stage Ⅰ, 2 recipient sites recovered in stage Ⅱ. The patients were monitored for a mean of (27.2 ±13.0) months. During the period of follow-up, one patient, reconstructed with PMMF, died 13 months after surgery due to local tumor recurrence, while the others did not experience metastasis or recurrence. In TMF-FTSG group, the mouth opening was (3.60±0.36) cm 3 months after operation and (3.84±0.15) cm before operation, with no significant difference ( P>0.05). The UW-QOL scores of appearance, mood and anxiety in the three groups 1 year after operation were higher than those before operation ( P<0.05), and the one year after operation’s scores of activity and shoulder were lower than those before operation ( P<0.05). The UW-QOL scores of pain and recreation in TMF-FTSG group one year after operation were higher than those before operation ( P<0.05), the other two groups were also higher than those before operation, but the difference was not statistically significant ( P>0.05). There was no significant difference in the UW-QOL scores of swallowing, chewing, speech, taste, and saliva in the three groups at one year after operation and before operation ( P>0.05). Conclusion:In the repair of tissue defects after operation of malignant tumors in the orbital region, three distinct types of tissue flaps can be utilized to repair tissue defects. TMF-FTSG has certain advantages for patients with minor bone defects, whereas ALTF and PMMF are more appropriate for patients with extensive tissue loss. PMMF is an effective method of repair for patients with a history of radiotherapy and poor vascular health in the recipient area.

Objective:To investigate the clinical effect of three different tissue flaps in repairing patients with orbital region tissue loss after enlarged resection of malignant tumors in the orbital region, as well as the indication.Methods:Retrospective analysis of data of patients with malignant tumors in the orbital region treated in the Department of Oral and Maxillofacial Trauma and Orthognathic Surgery, the First Affiliated Hospital of Xinjiang Medical University (Affiliated Stomatological Hospital) between January 2017 and December 2021. All patients underwent extensive resection of periorbital malignant tumors and enucleation of orbital contents, depending on defects in periorbital soft/hard tissues and orbital contents, temporalis myofascial flap combined with full thickness skin grafts (TMF-FTSG group), modified pectoralis major myocutaneous flap (PMMF group), and free anterolateral thigh flap (ALTF group) were used to repair the tissue defect. The wound healing and complications of the donor and recipient areas were followed up after operation, and degree of mouth opening in the TMF-FTSG group was compared at 3 months after operation and before operation. The University of Washington quality of life scale (UW-QOL) score was compared among the three groups before and 1 year after operation (a total of 12 items, each item was assigned from 0 to 100 points, the higher the score, the better the recovery). Statistical software SPSS 26.0 was used to analyze the data. The measurement data were expressed as Mean±SD, and the paired t-test was used to compare the preoperative and postoperative data within the group, the difference was statistically significant at a P value less than 0.05. Results:A total of 22 patients were enrolled. There were 8 patients in TMF-FTSG group, 4 males and 4 females, aged (68.3±9.7) years. There were 6 patients in PMMF group, 5 males and 1 female, aged (65.8±7.8) years. There were 3 males and 5 females in ALTF group, aged (63.8±5.4) years. There were 12 cases of squamous cell carcinoma, 8 cases of basal cell carcinoma and 2 cases of adenoid cystic carcinoma. The size of soft tissue defect after tumor resection in TMF-FTSG group, PMMF group and ALTF group was 4 cm×4 cm-7 cm×8 cm, 4 cm×5 cm-9 cm×9 cm and 5 cm×6 cm-14 cm×9 cm, respectively. And the size of flaps ranged from 5 cm×4 cm to 8 cm×9 cm, from 5 cm×7 cm to 10 cm×10 cm, and from 10 cm×6 cm to 20 cm×9 cm, respectively. All donor sites and 20 recipient sites recovered in stage Ⅰ, 2 recipient sites recovered in stage Ⅱ. The patients were monitored for a mean of (27.2 ±13.0) months. During the period of follow-up, one patient, reconstructed with PMMF, died 13 months after surgery due to local tumor recurrence, while the others did not experience metastasis or recurrence. In TMF-FTSG group, the mouth opening was (3.60±0.36) cm 3 months after operation and (3.84±0.15) cm before operation, with no significant difference ( P>0.05). The UW-QOL scores of appearance, mood and anxiety in the three groups 1 year after operation were higher than those before operation ( P<0.05), and the one year after operation’s scores of activity and shoulder were lower than those before operation ( P<0.05). The UW-QOL scores of pain and recreation in TMF-FTSG group one year after operation were higher than those before operation ( P<0.05), the other two groups were also higher than those before operation, but the difference was not statistically significant ( P>0.05). There was no significant difference in the UW-QOL scores of swallowing, chewing, speech, taste, and saliva in the three groups at one year after operation and before operation ( P>0.05). Conclusion:In the repair of tissue defects after operation of malignant tumors in the orbital region, three distinct types of tissue flaps can be utilized to repair tissue defects. TMF-FTSG has certain advantages for patients with minor bone defects, whereas ALTF and PMMF are more appropriate for patients with extensive tissue loss. PMMF is an effective method of repair for patients with a history of radiotherapy and poor vascular health in the recipient area.

INTRODUCTION: Despite reports suggesting an association between COVID-19 mRNA vaccination and pericarditis and myocarditis, detailed nationwide population-based data are sparsely available. We describe the incidence of pericarditis and myocarditis by age categories and sex after COVID-19 mRNA vaccination from a nationwide mass vaccination programme in Singapore. METHODS: The incidence of adjudicated cases of pericarditis and myocarditis following COVID-19 mRNA vaccination that were reported to the vaccine safety committee between January to July 2021 was compared with the background incidence of myocarditis in Singapore. RESULTS: As of end July 2021, a total of 34 cases were reported (9 pericarditis only, 14 myocarditis only, and 11 concomitant pericarditis and myocarditis) with 7,183,889 doses of COVID-19 mRNA vaccine administered. Of the 9 cases of pericarditis only, all were male except one. The highest incidence of pericarditis was in males aged 12-19 years with an incidence of 1.11 cases per 100,000 doses. Of the 25 cases of myocarditis, 80% (20 cases) were male and the median age was 23 years (range 12-55 years) with 16 cases after the second dose. A higher-than-expected number of cases were seen in males aged 12-19 and 20-29 years, with incidence rates of 3.72 and 0.98 case per 100,000 doses, respectively. CONCLUSION Data from the national registry in Singapore indicate an increased incidence of pericarditis and myocarditis in younger men after COVID-19 mRNA vaccination.
Adolescent ; Adult ; COVID-19/prevention & control* ; COVID-19 Vaccines/adverse effects* ; Child ; Female ; Humans ; Male ; Middle Aged ; Myocarditis/etiology* ; Pericarditis/etiology* ; RNA, Messenger ; SARS-CoV-2 ; Vaccination/adverse effects* ; Vaccines, Synthetic ; Young Adult ; mRNA Vaccines

Medicine is the subject of studying human and its inherent humanistic attribute endows medicine with the temperature it deserves. However, with the continuous improvement of medical testing technology and treatment technology, medical workers pay more attention to diseases and ignore humanistic care, which has become an important factor in the aggravation of patients’ burden and the tension relationship between doctors and patients. There are many virtues in Chinese traditional culture. Sun Simiao’s medical ethics thought of "great doctor with professionalism and sincerity" embodies the core value of the humanistic spirit of Chinese traditional medicine. In his medical ethics thought, the moral and ethics of "great doctor with professionalism and sincerity", the medical practice attitude of "being cautious and diligent", the values of "benevolence for the world" and the professional conduct of "honesty and truth" still have strong practical significance at present. It is the good material to cultivate the humanistic spirit of medical students. This is of great value to integrate Sun Simiao’s medical ethics thought into cultivate medical students with both "professionalism" and "sincerity", practice the original intention of medical and health undertakings, and carry forward cultural self-confidence.