The construction of a training system for visiting physicians in the department of rare diseases in China is an important measure to improve the overall diagnosis and treatment capacity for rare diseases and address the critical challenge of insufficient knowledge and skills among clinicians in practice. This article systematically describes the visiting physician training system established by the Department of Rare Diseases at Peking Union Medical College Hospital. It summarizes the training objectives and positioning, design logic, and learning modules of the system, aiming to provide a reference for the construction of the specialized talent team for rare diseases in China.

To investigate the clinical efficacy of neoadjuvant imatinib in the treatment of rectal gastrointestinal stromal tumor (GIST).

Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disorder primarily caused by pathogenic variants in the TSC1 or TSC2 genes. It is characterized by multisystem hamartomatous lesions and neuropsychiatric manifestations. Here we report a young male patient with TSC involving multiple organs, caused by a heterozygous frameshift mutation in TSC2 (c.2071delC, p.Arg691Alafs^*7). The patient initially presented with classic facial angiofibromas and hypomelanotic macules, and subsequently developed psychiatric and behavioral disturbances with auditory hallucinations. Neuroimaging revealed an intracranial mass lesion, which was confirmed as a subependymal giant cell astrocytoma on postoperative histopathology following surgery performed at an outside institution. After admission, the patient underwent a comprehensive diagnostic workup, and multidisciplinary treatment evaluation revealed extensive multisystem involve-ment, including the nervous system, skin, kidneys, lungs, heart, eyes, pancreas, liver and bones. Combined with relevant literature, this article discusses the molecular mechanisms, clinical phenotypes, and comprehensive management of TSC, in order to provide a reference for the standardized and individualized management of this disease.

AIM: To observe the preoperative and postoperative clinical efficacy of comprehensive dry eye treatment in cataract patients complicated with diabetes mellitus, with a focus on comparing the differences between the two groups in terms of postoperative dry eye symptoms, tear film function, visual recovery, and complication rates, aiming to provide an effective protocol for the perioperative management and long-term prognosis improvement in this patient population.METHODS:Patients diagnosed with both cataract and diabetes mellitus and presenting with varying degrees of dry eye symptoms, scheduled for cataract surgery at the hospital from May 2023 to December 2024, were enrolled as study subjects. They were divided into two groups using a random number method: the control group received sodium hyaluronate eye drops alone, and the experimental group underwent comprehensive preoperative dry eye treatment(sodium hyaluronate eye drops+warm compress+meibomian gland cleaning and massage+Chinese herbal fumigation+health guidance). Tear film breakup time(BUT), corneal fluorescein staining(FL), Ocular Surface Disease Index(OSDI)score, tear meniscus height(TMH), and non-invasive first tear film breakup time(NIBUT)were compared between the two groups before and after 4 wk of treatment. Meibomian gland loss, tear film lipid layer thickness, and basic ocular symptoms were also assessed.RESULTS:This study included 60 eyes of 60 patients, with a control group of 30 eyes of 30 patients(aged 56.24±10.24 y, 13 males and 17 females)and an experimental group of 30 eyes of 30 patients(aged 58.01±9.79 y, 15 males and 15 females).After 4 wk of preoperative treatment, the BUT in the experimental group increased from 4.09±1.13 s to 10.35±1.46 s, and from 4.15±1.05 s to 8.26±1.36 s in the control group, showing a significant intergroup difference(t=5.737, P<0.001). The FL score in the experimental group decreased from 6.83±0.46 points to 2.86±0.38 points, whereas in the control group it decreased from 6.79±0.39 points to 5.32±0.43 points(t=23.480, P<0.001). After 4 wk of treatment, the NIBUT in the experimental group increased from 5.19±1.12 s to 9.36±1.47 s, compared to an increase from 5.21±1.04 s to 7.18±1.25 s in the control group(t=6.188,P<0.001). The proportion of patients with a thin tear film lipid layer was significantly higher in the experimental group than in the control group(all P<0.01). Ocular clinical symptoms decreased after treatment in both groups, with the experimental group showing lower scores than the control group(all P<0.001).CONCLUSION:Preoperative comprehensive dry eye treatment can multi-dimensionally improve dry eye symptoms and tear film stability in cataract patients with diabetes mellitus, providing an effective strategy for the perioperative management of cataract patients.

Objective: To investigate the status of condom use and its influencing factors among men who have sex with men (MSM), so as to provide a basis for improving condom utilization rates and AIDS prevention and control in this population. Methods: From May to October 2024, a snowball sampling method was employed to recruit MSM in Songjiang District, Shanghai Municipality. Self-administered questionnaires were used to collect data on demographic characteristics, AIDS-related knowledge, sexual behaviors, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), and condom use in the past six months. Multivariable logistic regression model was used to analyze the influencing factors for consistent condom use. Results: A total of 921 MSM were surveyed, with a median age of 29.00 (interquartile range, 9.00) years. Among them, 697 (75.68%) were aware of AIDS-related knowledge, 826 (89.69%) expressed willingness to use PrEP, and 835 (90.66%) were willing to use PEP. Additionally, 787 (85.45%) MSM reported their age at first homosexual intercourse as ≥18 years, while 519 (56.35%) reported consistent condom use in the past six months. Multivariable logistic regression analysis revealed that MSM who were aware of AIDS-related knowledge (OR=0.582, 95% CI: 0.423-0.801), willing to use PrEP (OR =0.611, 95% CI: 0.385-0.969), and whose age at first homosexual intercourse was <18 years (OR=0.480, 95% CI: 0.330-0.700) were less likely to consistent use condoms. Conclusion The proportion of consistent condom use among the MSM remains relatively low, which is primarily associated with AIDS-related knowledge, willingness to use PrEP, and the age at first homosexual intercourse.

OBJECTIVE: To explore the genetic etiology of 46 Chinese pedigrees affected with Hereditary multiple exostoses (HME) and provide genetic counseling and reproductive intervention. METHODS: Whole-exome sequencing and Sanger sequencing were carried out on 87 patients from the 46 pedigrees to analyze the variants of EXT1 and EXT2 genes. Pathogenicity of the variants was assessed based on the guidelines from the American College of Medical Genetics and Genomics and Association for Molecular Pathology (ACMG/AMP). Prenatal diagnosis and preimplantation genetic testing (PGT) were provided for couples with identified pathogenic mutations. This study was approved by the Medical Ethics Committee of the hospital (Ethics No.: LL-SC-SG-2014-010). RESULTS: In total 17 and 22 pathogenic variants were respectively identified in the EXT1 and EXT2 genes, among which 5 EXT1 and 12 EXT2 variants were unreported previously. Three patients with no family history were found to harbor de novo variants of the EXT1 gene. Twenty nine couples had opted for PGT or underwent prenatal diagnosis following natural conception, and 17 healthy babies were born. CONCLUSION This study has clarified the genetic etiology of 45 HME pedigrees and identified 17 novel variants, which has enriched the mutational spectrum of the EXT1 and EXT2 genes. Reproductive intervention through PGT and prenatal diagnosis have prevented the recurrence of HME in these families.
Humans ; Female ; Male ; Pedigree ; Exostoses, Multiple Hereditary/diagnosis* ; N-Acetylglucosaminyltransferases/genetics* ; Adult ; Exostosin 1 ; Asian People/genetics* ; Genetic Testing ; Exostosin 2 ; Mutation ; China ; Prenatal Diagnosis ; Pregnancy ; Genetic Counseling ; Preimplantation Diagnosis ; Exome Sequencing ; East Asian People

ObjectiveTo investigate the therapeutic mechanism of Xuefu Zhuyutang （XFZYT） for metabolic-associated fatty liver disease （MAFLD） through integrated network pharmacology and animal experiments. MethodsNetwork pharmacology was utilized to predict the core components， key therapeutic targets， and signaling pathways of XFZYT in the treatment of MAFLD. For animal experiments， a rat model of MAFLD was established by feeding a high-cholesterol diet for 4 weeks. Intervention was then administered with low-dose （2 g·kg^-1） and high-dose （4 g·kg^-1） XFZYT for 2 weeks. Biochemical assays were performed to measure the serum levels of aspartate aminotransferase （AST）， alanine aminotransferase （ALT）， total cholesterol （TC）， triglycerides （TG）， high-density lipoprotein （HDL）， and low-density lipoprotein （LDL）. In addition， the activities of superoxide dismutase （SOD） and catalase （CAT） and levels of malondialdehyde （MDA） and glutathione （GSH） in the serum were measured. The same way was adopted to measure the levels of TC and TG in the liver tissue. Enzyme-linked immunosorbent assay （ELISA） was employed to quantify the serum levels of interleukin （IL）-6， IL-1β， and tumor necrosis factor-alpha （TNF-α）. Histopathological evaluations included hematoxylin and eosin （HE） staining for liver tissue morphology， Oil Red O staining for lipid deposition， and dihydroethidium （DHE） probe staining for reactive oxygen species （ROS） levels. Western blot analysis was conducted to assess the protein levels of AMP-activated protein kinase （AMPK）， phosphorylated （p）-AMPK， nuclear factor erythroid 2-related factor 2 （Nrf2）， heme oxygenase-1 （HO-1）， nuclear factor-kappa B （NF-κB）， and p-NF-κB in the liver tissue. Untargeted metabolomics analysis of the serum was performed by liquid chromatography-tandem mass spectrometry （LC-MS/MS）. ResultsNetwork pharmacology analysis predicted 155 potential targets of XFZYT for MAFLD treatment， with core targets including signal transducer and activator of transcription 3 （STAT3）， protein kinase B1 （Akt1）， TNF， and IL-6. Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment primarily implicated the AMPK signaling pathway. Animal experiments demonstrated that compared with the normal group， the model group exhibited dyslipidemia， hepatic function impairment， pronounced hepatic lipid deposition， and inflammatory manifestations， with elevated serum levels of AST， ALT， TC， TG， LDL， and MDA （P<0.05）， reduced HDL and GSH levels plus decreased SOD and CAT activities （P<0.05）， downregulated protein levels of Nrf2， HO-1， and p-AMPK （P<0.05）， and upregulated protein level of p-NF-κB （P<0.05） in the liver tissue. Compared with the model group， XFZYT intervention groups showed significant amelioration of dyslipidemia and hepatic function impairment， markedly reduced hepatic lipid deposition and inflammatory cell infiltration， decreased serum levels of AST， ALT， TC， TG， LDL， and MDA （P<0.05）， increased HDL and GSH levels plus enhanced SOD and CAT activities （P<0.05）， upregulated protein levels of Nrf2， HO-1， and p-AMPK （P<0.05）， and downregulated protein level of p-NF-κB （P<0.05）. Serum metabolomics revealed 511 differentially expressed metabolites （231 upregulated and 280 downregulated） between normal and model groups， while XFZYT groups versus model group showed 94 differential metabolites （51 upregulated and 43 downregulated）. Among them， 11 metabolites displayed the most significant alterations， with enriched pathways including glycerolipid metabolism， cholesterol metabolism， and insulin resistance， multiple of which demonstrated AMPK association. ConclusionXFZYT alleviates MAFLD by regulating the AMPK signaling pathway and associated metabolic networks.

Prostate cancer is one of the most common malignant tumors of male genitourinary system. Prostate cancer has the following characteristics： insidious onset， early asymptomatic or not obvious symptoms， complex etiology and pathogenesis， long incubation period and so on. Therefore， the realization of its early diagnosis and treatment is of great significance to the prognosis of patients. Prostate-specific membrane antigen （PSMA） is a type 2 transmembrane glycoprotein that is highly expressed on the membrane of almost all primary and metastatic prostate cancer cells， and is an ideal target for prostate cancer imaging and treatment. In recent years， with the approval of urea-containing small molecule PET （positron emission computed tomography） radiopharmaceutical based on PSMA （⁶⁸Ga-PSMA-11， ¹⁸F-PSMA-1007）， PET-CT （positron emission computed tomography/computed tomography） has shown new potential for early diagnosis and accurate staging of prostate cancer patients. This review mainly summarizes the research progress of urea-containing PSMA PET imaging agents and finds that they have defects such as uptake in non-target tissues like the kidneys， lacrimal glands， and salivary glands. Thus， further optimizing their structure to reduce the uptake in non-target tissues， providing provide convenience for the labeling of therapeutic radiopharmaceuticals， thereby achieving the goal of integrated diagnosis and treatment， is an important development direction in this field.

RNA synthetic biology, as a frontier interdisciplinary field, is driving the leap from fundamental research to precision medicine in life sciences through the engineered design of RNA components and the construction of genetic circuits. This paper aims to systematically outline the design principles, key technological breakthroughs, and biomedical applications of synthetic RNA genetic circuits. Building upon this foundation, it provides an in-depth analysis of current research bottlenecks and proposes future development directions. Commencing with a foundational role in the central dogma of RNA, this paper establishes a systematic classification framework for synthetic biology RNA components. At the cis-acting element level, it elaborates on how components such as riboswitches, RNA thermometers, and Toehold switches achieve precise gene expression regulation by responding to specific ligands, temperatures, or trigger RNAs through conformational changes. Concerning trans-acting elements, it delves into the molecular mechanisms of miRNA-mediated gene silencing, the high stability and “sponge-like adsorption” function conferred by the closed-loop structure of circRNA, the targeting role of siRNA within the RNAi pathway, and the targeting specificity of sgRNA within the CRISPR system. The paper emphasizes that rational design, sequence optimization, and chemical modifications can significantly enhance the performance and orthogonality of these natural elements. Secondly, the paper focuses on the design and optimization strategies for synthetic RNA regulatory modules. Taking miRNA-responsive circRNA switches as an example, it elucidates the principles of customized miRNA responsiveness. The engineering applications of circRNA are explored, introducing strategies for constructing functional RNA nanostructures via siRNA self-assembly. Building upon this, the paper emphasizes synthetic genetic circuits: from logical operations to resource allocation, enabling advanced cellular logic and functional regulation. For instance, by combining transcriptional cascade switches or utilizing the CRISPR-Cas13a system, an AND logic gate responsive to multiple miRNAs (such as miRNA-155 and miRNA-21) was constructed, significantly enhancing the specificity of disease diagnosis. Addressing the challenges of resource competition and expression noise faced by synthetic circuits within cells, this paper introduces computational models such as MIRELLA, with particular emphasis on the design of endogenous miRNA-based iFFLs. These advanced circuits, illustrated in this paper, have been successfully applied to real-time monitoring of cellular differentiation states and regulation of stem cell-directed differentiation. For cellular state detection and dynamic regulation, miRNA switches can be integrated with fluorescent systems to track differentiation statuses in real time via fluorescent signal changes. Synthetic genetic circuits, meanwhile, utilize endogenous miRNA logic integration alongside miSFITs technology to achieve state-specific protein regulation in human pluripotent stem cells, laying the groundwork for customized cellular control. This approach ingeniously harnesses intrinsic cellular regulatory mechanisms to buffer gene expression burdens, thereby enhancing circuit robustness. These advanced circuits, illustrated schematically herein, have been successfully applied to real-time monitoring of cellular differentiation states and regulation of stem cell-directed differentiation. At the therapeutic translation level, the paper systematically reviews application strategies for RNA technologies across multiple fields, including cancer, metabolic diseases, neurodegenerative diseases, cardiovascular diseases, regenerative medicine engineering, immunotherapy, and vaccine applications. For instance, in cancer treatment, specific killing of tumor cells is achieved by embedding targets for miRNAs specific to healthy cells within the genomes of oncolytic viruses (such as Zika virus). Within metabolic and degenerative diseases, LNP-delivered mRNA therapeutics and antisense oligonucleotide (ASO) technologies have demonstrated significant clinical progress. Finally, this paper highlights ongoing challenges in the field, including limited programmability of RNA elements, low in vivo delivery efficiency, and inadequate off-target risk assessment systems. It advocates for future integration of epigenomics and computational modelling to optimize element functionality, establishing an integrated “element-circuit-delivery” platform. Furthermore, leveraging single-cell sequencing and organoid technologies to develop a multidimensional safety assessment system is proposed to advance the deep integration and translation of RNA synthetic biology in personalized medicine. Consequently, RNA engineering has transcended single-dimensional regulation, evolving towards multi-layered, dynamic, and intelligent synthetic biological systems. Its deep integration with clinical needs will reshape disease diagnosis and treatment paradigms.

RNA synthetic biology, as a frontier interdisciplinary field, is driving the leap from fundamental research to precision medicine in life sciences through the engineered design of RNA components and the construction of genetic circuits. This paper aims to systematically outline the design principles, key technological breakthroughs, and biomedical applications of synthetic RNA genetic circuits. Building upon this foundation, it provides an in-depth analysis of current research bottlenecks and proposes future development directions. Commencing with a foundational role in the central dogma of RNA, this paper establishes a systematic classification framework for synthetic biology RNA components. At the cis-acting element level, it elaborates on how components such as riboswitches, RNA thermometers, and Toehold switches achieve precise gene expression regulation by responding to specific ligands, temperatures, or trigger RNAs through conformational changes. Concerning trans-acting elements, it delves into the molecular mechanisms of miRNA-mediated gene silencing, the high stability and “sponge-like adsorption” function conferred by the closed-loop structure of circRNA, the targeting role of siRNA within the RNAi pathway, and the targeting specificity of sgRNA within the CRISPR system. The paper emphasizes that rational design, sequence optimization, and chemical modifications can significantly enhance the performance and orthogonality of these natural elements. Secondly, the paper focuses on the design and optimization strategies for synthetic RNA regulatory modules. Taking miRNA-responsive circRNA switches as an example, it elucidates the principles of customized miRNA responsiveness. The engineering applications of circRNA are explored, introducing strategies for constructing functional RNA nanostructures via siRNA self-assembly. Building upon this, the paper emphasizes synthetic genetic circuits: from logical operations to resource allocation, enabling advanced cellular logic and functional regulation. For instance, by combining transcriptional cascade switches or utilizing the CRISPR-Cas13a system, an AND logic gate responsive to multiple miRNAs (such as miRNA-155 and miRNA-21) was constructed, significantly enhancing the specificity of disease diagnosis. Addressing the challenges of resource competition and expression noise faced by synthetic circuits within cells, this paper introduces computational models such as MIRELLA, with particular emphasis on the design of endogenous miRNA-based iFFLs. These advanced circuits, illustrated in this paper, have been successfully applied to real-time monitoring of cellular differentiation states and regulation of stem cell-directed differentiation. For cellular state detection and dynamic regulation, miRNA switches can be integrated with fluorescent systems to track differentiation statuses in real time via fluorescent signal changes. Synthetic genetic circuits, meanwhile, utilize endogenous miRNA logic integration alongside miSFITs technology to achieve state-specific protein regulation in human pluripotent stem cells, laying the groundwork for customized cellular control. This approach ingeniously harnesses intrinsic cellular regulatory mechanisms to buffer gene expression burdens, thereby enhancing circuit robustness. These advanced circuits, illustrated schematically herein, have been successfully applied to real-time monitoring of cellular differentiation states and regulation of stem cell-directed differentiation. At the therapeutic translation level, the paper systematically reviews application strategies for RNA technologies across multiple fields, including cancer, metabolic diseases, neurodegenerative diseases, cardiovascular diseases, regenerative medicine engineering, immunotherapy, and vaccine applications. For instance, in cancer treatment, specific killing of tumor cells is achieved by embedding targets for miRNAs specific to healthy cells within the genomes of oncolytic viruses (such as Zika virus). Within metabolic and degenerative diseases, LNP-delivered mRNA therapeutics and antisense oligonucleotide (ASO) technologies have demonstrated significant clinical progress. Finally, this paper highlights ongoing challenges in the field, including limited programmability of RNA elements, low in vivo delivery efficiency, and inadequate off-target risk assessment systems. It advocates for future integration of epigenomics and computational modelling to optimize element functionality, establishing an integrated “element-circuit-delivery” platform. Furthermore, leveraging single-cell sequencing and organoid technologies to develop a multidimensional safety assessment system is proposed to advance the deep integration and translation of RNA synthetic biology in personalized medicine. Consequently, RNA engineering has transcended single-dimensional regulation, evolving towards multi-layered, dynamic, and intelligent synthetic biological systems. Its deep integration with clinical needs will reshape disease diagnosis and treatment paradigms.