With advancements in surgical techniques and increasing complexity of patients' underlying conditions, the management of perioperative bleeding and coagulation disorders has intensified. Clinical practice faces issues such as non-standardized monitoring, inconsistent management protocols for specific patient populations, and unclear thresholds for blood transfusion and hemostatic agent administration. Based on evidence-based principles and integrating the latest evidence since 2020, the task force developed this consensus, titled "Expert Opinion on Perioperative Management of Bleeding and Coagulation in Anesthesiology (2026 Edition)". Focusing on the entire perioperative process, it covered coagulation assessment and monitoring, indications for blood product transfusion, rational use of hemostatic agents, and individualized strategies for special populations, including patients on antithrombotic therapy and those undergoing cardiac, neurosurgical, orthopedic or obstetric surgery. It emphasized preoperative risk screening, intraoperative dynamic monitoring, and post-operative balance between hemostasis and thrombosis prevention. Clinical decision-making should integrate the patient's baseline condition, surgical type, and real-time monitoring results. This opinion aims to provide standardized, multi-disciplinary guidance, optimize management protocols, reduce transfusion-related risks and thrombotic complications, and ultimately enhance perioperative patient safety and improve outcomes.

Medical education is moving beyond a model dominated by classroom teaching and opportunistic bedside exposure toward one characterized by contextualization, interactivity, continuity, and competency-based learning, driven by the rapid development of extended reality, artificial intelligence, digital humans, virtual patients, digital twins, and the Internet of Medical Things. Metaverse medicine should not be understood as a single device or software platform; rather, it represents an integrated educational and clinical ecosystem built on immersive interaction, virtual-real fusion, real-time connectivity, and data-driven learning. Respiratory education is particularly well suited to this transformation because it involves complex knowledge structures, dynamic monitoring, procedure-intensive training, and strong reliance on teamwork and workflow coordination. Current evidence suggests that XR/VR/AR, virtual patients, simulation-based education, and large language model-assisted teaching can improve knowledge acquisition, procedural performance, learner engagement, and clinical reasoning, although stronger evidence is still needed regarding long-term transfer, real-world clinical outcomes, and cost-effectiveness. In respiratory education, digital human teachers, virtual cases, virtual wards, bronchoscopy and EBUS simulation, immersive training for respiratory failure recognition, and mechanical ventilation education appear to be the most practice-relevant and immediately actionable scenarios. In parallel, concepts proposed by Professor Chunxue Bai’s team—including metaverse medicine, medical GPT, and BAIMGPT—provide an important localized theoretical foundation and implementation pathway for the intelligent upgrading of respiratory education in China. This review summarizes the theoretical basis, major application scenarios, educational value, practical challenges, and implementation strategies of metaverse medicine in respiratory education, with the aim of informing future educational reform and talent development in respiratory medicine.

Key Words: metaverse medicine; respiratory education; digital human teacher; virtual case; virtual ward; immersive clinical training; BAIMGPT

Objective: This study utilizes finite element modeling to investigate the coupled electric-thermal field distributions for three novel electrode designs, assessing their ability to induce electric breakdown in saline for plasma generation. Furthermore, the ablation effects of various electrode shapes were validated through ex vivo tissue ablation experiments, ensuring both the safety and feasibility of the electrodes. Methods: Three electrode structures were designed: the ring-needle electrode, the needle electrode, and the cylinder electrode. A COMSOL Multiphysics finite element model simulated their behavior in saline. This modeling approach enabled a detailed analysis of the spatial variations in both the electric and temperature fields. Furthermore, the electrodes were tested at four voltages (180 V, 220 V, 260 V, and 300 V) and a frequency of 100 kHz on porcine liver tissue to evaluate ablation performance. Results: Simulations showed temperatures of 25-70 °C at 0.3 mm above the three electrodes, with electric field strength exceeding 1 *10^6 V/m, which are sufficient to trigger electric breakdown and plasma formation. Ex vivo experiments confirmed ablation efficacy, with the ring-needle electrode exhibited the best performance at a voltage of 300 V, achieving a 2.3 mm ablation depth and 0.72 mm² thermal damage area. Conclusion: Finite element simulation and ex vivo experiments demonstrate the feasibility of the proposed electrodes, highlighting their potential as an innovative solution for plasma-based ablation technologies.

The consequences induced by the use of general anesthetics and better options of the drugs in children and infants have been topics of controversy due to the concerns about their potential impact on cognitive function. To address these concerns and ensure the safety of pediatric general anesthesia, this paper reviews existing basic and clinical studies that have investigated the mechanisms of general anesthetics on pediatric cognitive function. In this paper, the basic research on neurotoxicity of general anesthetics and the clinical research on the effects of general anesthesia drugs on cognitive function in children in recent years were analyzed and summarized. Although some of the clinical studies have suggested that general anesthesia in children or infants may cause neurocognitive damage and a series of behavioral complications, the results of the retrospective studies need to be viewed with caution as they may lack effective control for relevant factors that could have impacts in the perioperative period. It remains uncertain whether general anesthetics affect the cognitive function of pediatric patients. Further research is needed to establish clear evidence-based recommendations for clinical prevention and treatment measures to minimize the potential risks associated with the use of general anesthetics.

With the advancement of metaverse technology and the successful commercialization of head-mounted displays, the application prospects of the metaverse in medical education are increasingly prominent. This article systematically reviews the latest advancements in the application of the metaverse in otolaryngology and head and neck surgery, and proposes ideas for specialty construction. VR surgical simulators, 3D printing combined with VR technology, can significantly improve trainee assessment scores and operational confidence, optimizing hand-eye coordination and spatial perception abilities. AR microscope systems enable contactless interaction through gesture recognition, enhancing surgical efficiency. AR navigation platforms demonstrate real-time 3D visualization advantages in craniofacial surgery, and VR and 360° video training effectively improve the anterior nares packing skills of junior doctors. VR-assisted teaching for peritonsillar abscess drainage significantly enhances medical students' structured clinical examination scores, operational confidence, and engagement. Integrating 3D virtual models and image overlay technology in transoral robotic surgery provides practical value for image-guided surgery. VR technology can effectively alleviate pain and anxiety in patients undergoing otolaryngological surgery, improve satisfaction, and serve as a non-pharmacological intervention to reduce opioid use. VR combined with wearable devices can reduce postoperative opioid consumption, and VR vestibular rehabilitation training can enhance treatment compliance and quality of life for patients with otolith disorders. VR has become an innovative component of ENT digital teaching, demonstrating equivalent or even superior effects compared to traditional methods in anatomy, physiology, and pathology teaching. Based on these advancements, this article proposes the idea of relying on the "Fudan Zhongshan Huisheng Zhiyu" metaverse platform to build a specialized teaching system for otolaryngology: constructing high-fidelity 3D digital twin models and a structured case resource library, forming a tiered training path covering institutional education, post-graduation education, and continuing medical education, promoting the dissemination and sharing of high-quality teaching resources, and driving the innovative development of otolaryngology medical education in China.

Key Words: full-cycle medical education; training and management; Fudan Zhongshan Huisheng Zhiyu; metaverse platform; virtual reality

Radiofrequency ablation (RFA) represents a convenient, minimally invasive, and cost-effective approach for the treatment of small liver cancers measuring less than 3 cm in diameter. Nonetheless, the existing RFA techniques encounter challenges in precisely controlling the extent of ablation and the risk of overheating, which can lead to damage on the surrounding tissues. The ability to control the ablation area also plays a crucial role in the success of RFA procedures. To address these issues, we introduce a novel method that utilizes tumor boundary temperature monitoring to achieve precise control over the RFA process. Through the utilization of COMSOL Multiphysics simulation software, the proposed method was verified by comprehensive simulation and modeling and its efficacy in achieving regional control was testified. Subsequently, ex vivo experiments were conducted employing a custom-designed cooling RFA instrument. The experimental results demonstrated that the RFA controlled by boundary temperature yielded an ablation area with a diameter approaching 30 mm. In comparison to the standard spherical solidification zone (characterized by both the ellipticity and regularity indices of 1), the cooling RFA discoloration zone, under boundary temperature control, exhibited a maximum deviation of 7% in the ellipticity index and 17% in the regularity index. The average ellipticity index was determined to be 0.96, while the average regularity index was 0.86. Collectively, these findings underscore the capability of the proposed temperature-controlled cooling RFA method to attain precise control over the ablation area, contributing to comprehensive ablation of tumor tissue within the target region.