In the face of the new scientific and technological revolution and the transformation of medical paradigms, the field of rare disease medicine, as a cross-disciplinary emerging discipline integrating basic research, clinical practice, drug development, and policy support, is experiencing unprecedented development opportunities. This paper systematically sorts out the disciplinary connotation, construction paths and practical challenges of the Department of Rare Diseases, and puts forward countermeasures and suggestions for promoting the high-quality development of this emerging discipline in China.

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.

Rare diseases are characterized by very low incidence and prevalence rates,complex genetic mechanisms,and diverse clinical phenotypes,posing significant diagnostic and therapeutic challenges in clinical research.In principle,the design of clinical research protocols for rare diseases does not differ significantly from general clinical research.However,the difficulties mainly stem from the unique characteristics of rare diseases,which amplify the challenges and limitations inherent in general clinical research.These challenges typically involve five aspects:data collection,data management,technical methods,ethical regulations,and patient engagement.However,with the rapid development of digital technologies such as information technology,artificial intelligence(AI),and blockchain,particularly in the innovative applications of data collection,storage,analysis,sharing,and management,new opportunities have emerged for the implementation and optimization of rare disease clinical research.Strategies for conducting rare disease clinical research using digital technologies are often applied to rare disease clinical research and patient management based on digitalized registration platforms,the development of AI-driven diagnostic aids to improve the accuracy of rare disease diagnosis,the use of digital technologies for decentralized rare disease clinical research,and the promotion of data fusion from multiple sources and modalities.However,during the application process,new challenges have gradually been identified.Despite of many challenges that still exist in terms of data privacy,algorithmic fairness,and ethical norms,with the continuous maturation of technology and the improvement of ethical frameworks,digitally-intelligent-driven clinical research on rare diseases remains promising.

Objective To investigate the effect and safety of Sintilimab combined with Endostar injection in the treatment of programmed cell death ligand-1(PD-L1)positive lung squamous cell carcinoma(LSCC)in elderly patients.Methods A total of 94 elderly patients with PD-L1 positive LSCC diagnosed and treated from November 2019 to November 2021 were selected as the research subjects,and they were divided into the observation group(n=47)and the control group(n=47)by random number table method.The observation group was treated with Sintilimab combined with Endostar injection,and the control group was treated with Sintilimab.Twenty-one days constituted one treatment cycle,and they were treated for 3 consecutive cycles.The clinical efficacy and improvement rate of Karnofsky performance status(KPS)score in the two groups were statistically analyzed,as well as the tumor markers[carcinoembryonic antigen(CEA),cancer antigen 125(CA125),cytokeratin 19 fragment(CYFRA21-1)],angiogenesis factors[endostatin,insulin-like growth factor-1(IGF-1),vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF),and platelet-derived growth factor(PDGF)],apoptosis factor[B-cell lymphoma-2 gene(Bcl-2),Bcl-2-associated X protein(Bax),Livin protein,programmed cell death 5(PDCD5)]before and after treatment.The toxic and side effects during treatment,progression-free survival(PFS)and median survival time at 2-year follow-up were compared between the two groups.Results After treatment,the objective remission rate and disease control rate of the observation group were higher than those of the control group(P<0.01);after treatment,the improvement rate of KPS score in the observation group was higher than that in the control group(P<0.01).After treatment,the levels of serum CEA,CA125,and CYFRA21-1 in both groups decreased,and which were lower in the observation group than in the control group(P<0.05,P<0.01).After treatment,the levels of endostatin increased in both groups,while IGF-1,VEGF,bFGF,and PDGF decreased;the levels of endostatin in the observation group were higher than those in the control group,while the levels of IGF-1,VEGF,bFGF,and PDGF were lower than those in the control group(P<0.05,P<0.01).After treatment,the levels of Bcl-2 and Livin decreased in both groups,while Bax and PDCD5 increased;the levels of Bcl-2 and Livin in the observation group were lower than those in the control group,while the levels of Bax and PDCD5 were higher than those in the control group(P<0.05,P<0.01).There was no significant difference in toxic and side effects between the two groups during treatment(P>0.05).The 2-year survival rate and median survival time of the observation group were higher or longer than those of the control group(P<0.05).Conclusion The treatment of PD-L1 positive LSCC in elderly patients with Sintilimab combined with Endostar injection can improve the therapeutic effect and the survival status of patients,inhibit tumor angiogenesis,induce tumor apoptosis,prolong the survival time of patients,and has good safety.

BACKGROUND:Virtual reality technology is a popular human-computer intelligent interaction technology in recent years,and has been widely used in leisure and entertainment,vocational training,medical rehabilitation and other fields. OBJECTIVE:To explore the potential of virtual reality technology combined with different therapies in functional recovery of patients with peripheral nerveinjury,summarize its mechanism of action,evaluate its application effects and prospects,and discuss its advantages and disadvantages,so as to provide new ideas and methods for rehabilitation practice after peripheral nerve injury.METHODS:The relevant literature of CNKI and PubMed database from inception to May 2024 was retrieved by computer. Chinese and English search terms were "peripheral nerves injury,virtual reality,endoplasmic reticulum stress,muscle atrophy,cerebral cortex,mirror therapy,tendon vibration,treadmill training." Finally,68 articles were included for analysis.RESULTS AND CONCLUSION:(1) Virtual reality technology,as a new auxiliary means,simulates the real environment to provide immersive multi-sensory experiences for patients,greatly enriching the dimensions of rehabilitation training and significantly accelerating the recovery process of patients with peripheral nerve injury. Its mechanism of action is to promote cortical plasticity through multi-sensory stimulation,invading the dormant areas adjacent to the cortex,and these areas responding to other inputs or generating new muscle activation,thereby promoting functional recovery. (2) Virtual reality technology has been widely combined with traditional therapies,showcasing its unique advantages. When combined with mirror therapy,the advantage of virtual reality is breaking the limitation of body position and advancing the time point of rehabilitation intervention. When combined with tendon vibration,virtual reality technology enhances the dual stimulation of visual and tactile perception to enhance the illusion of movement,significantly improving the perception and motor ability of patients,but also raises the issue of increased perception of limb weight. In running machine training,virtual reality technology further leverages its advantages by simulating real-life environments through multi-sensory stimulation to enhance balance and walking function,but problems such as motion sickness still exist. (3) Therefore,in actual applications,due to the fact that virtual reality combined with mirror therapy and tendon vibration will enhance the illusion of movement for patients,it is more suitable for early stages of rehabilitation. Meanwhile,the combination of virtual reality and treadmill training is suitable for the later stage of rehabilitation,helping patients to better return to their daily lives. (4) Although virtual reality technology has shown great potential in peripheral nerve injury rehabilitation,there are still some problems and challenges,such as motion sickness,the design and application of virtual reality rehabilitation games,and ethical considerations. Future research should focus on solving these problems to further promote the development of virtual reality technology in the field of rehabilitation.

Acute intermittent porphyria(AIP)is a rare autosomal dominant disorder caused by reduced activity of hydroxymethylbilane synthase(HMBS),or porphobilinogen deaminase(PBGD),the third enzyme in the heme biosynthesis pathway,with very low penetrance.AIP mainly affects women and is triggered by vari-ous factors,leading to acute neurovisceral symptoms such as abdominal pain,nausea and vomiting,intestinal obstruction,constipation,and in severe cases,epilepsy,weakness of the limbs,and psychiatric disturbances.Recurrent attacks may result in chronic injuries.Due to nonspecific symptoms and limited clinical awareness,AIP is often misdiagnosed,contributing to high morbidity and mortality.To standardize diagnosis and treatment practices,the Chinese Society of Rare Diseases,in collaboration with the Study Group of Endocrinology Rare Diseases,the Chinese Society of Endocrinology,and the Chinese Pharmacists Association Rare Diseases Medi-cation Working Committee,developed the Expert Consensus on the Diagnosis and Treatment of Acute Intermittent Porphyria in China(2024).This consensus was based on a review of 116 relevant studies,with a professional panel of 27 experts using the Delphi method to reach agreement on 23 key recommendations,aiming to guide standardized clinical practice in the diagnosis,treatment,evaluation,and prevention of AIP.

Acute intermittent porphyria(AIP)is a rare autosomal dominant disorder caused by reduced activity of hydroxymethylbilane synthase(HMBS),or porphobilinogen deaminase(PBGD),the third enzyme in the heme biosynthesis pathway,with very low penetrance.AIP mainly affects women and is triggered by vari-ous factors,leading to acute neurovisceral symptoms such as abdominal pain,nausea and vomiting,intestinal obstruction,constipation,and in severe cases,epilepsy,weakness of the limbs,and psychiatric disturbances.Recurrent attacks may result in chronic injuries.Due to nonspecific symptoms and limited clinical awareness,AIP is often misdiagnosed,contributing to high morbidity and mortality.To standardize diagnosis and treatment practices,the Chinese Society of Rare Diseases,in collaboration with the Study Group of Endocrinology Rare Diseases,the Chinese Society of Endocrinology,and the Chinese Pharmacists Association Rare Diseases Medi-cation Working Committee,developed the Expert Consensus on the Diagnosis and Treatment of Acute Intermittent Porphyria in China(2024).This consensus was based on a review of 116 relevant studies,with a professional panel of 27 experts using the Delphi method to reach agreement on 23 key recommendations,aiming to guide standardized clinical practice in the diagnosis,treatment,evaluation,and prevention of AIP.

Rare diseases are characterized by very low incidence and prevalence rates,complex genetic mechanisms,and diverse clinical phenotypes,posing significant diagnostic and therapeutic challenges in clinical research.In principle,the design of clinical research protocols for rare diseases does not differ significantly from general clinical research.However,the difficulties mainly stem from the unique characteristics of rare diseases,which amplify the challenges and limitations inherent in general clinical research.These challenges typically involve five aspects:data collection,data management,technical methods,ethical regulations,and patient engagement.However,with the rapid development of digital technologies such as information technology,artificial intelligence(AI),and blockchain,particularly in the innovative applications of data collection,storage,analysis,sharing,and management,new opportunities have emerged for the implementation and optimization of rare disease clinical research.Strategies for conducting rare disease clinical research using digital technologies are often applied to rare disease clinical research and patient management based on digitalized registration platforms,the development of AI-driven diagnostic aids to improve the accuracy of rare disease diagnosis,the use of digital technologies for decentralized rare disease clinical research,and the promotion of data fusion from multiple sources and modalities.However,during the application process,new challenges have gradually been identified.Despite of many challenges that still exist in terms of data privacy,algorithmic fairness,and ethical norms,with the continuous maturation of technology and the improvement of ethical frameworks,digitally-intelligent-driven clinical research on rare diseases remains promising.

Objective To investigate the effect and safety of Sintilimab combined with Endostar injection in the treatment of programmed cell death ligand-1(PD-L1)positive lung squamous cell carcinoma(LSCC)in elderly patients.Methods A total of 94 elderly patients with PD-L1 positive LSCC diagnosed and treated from November 2019 to November 2021 were selected as the research subjects,and they were divided into the observation group(n=47)and the control group(n=47)by random number table method.The observation group was treated with Sintilimab combined with Endostar injection,and the control group was treated with Sintilimab.Twenty-one days constituted one treatment cycle,and they were treated for 3 consecutive cycles.The clinical efficacy and improvement rate of Karnofsky performance status(KPS)score in the two groups were statistically analyzed,as well as the tumor markers[carcinoembryonic antigen(CEA),cancer antigen 125(CA125),cytokeratin 19 fragment(CYFRA21-1)],angiogenesis factors[endostatin,insulin-like growth factor-1(IGF-1),vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF),and platelet-derived growth factor(PDGF)],apoptosis factor[B-cell lymphoma-2 gene(Bcl-2),Bcl-2-associated X protein(Bax),Livin protein,programmed cell death 5(PDCD5)]before and after treatment.The toxic and side effects during treatment,progression-free survival(PFS)and median survival time at 2-year follow-up were compared between the two groups.Results After treatment,the objective remission rate and disease control rate of the observation group were higher than those of the control group(P<0.01);after treatment,the improvement rate of KPS score in the observation group was higher than that in the control group(P<0.01).After treatment,the levels of serum CEA,CA125,and CYFRA21-1 in both groups decreased,and which were lower in the observation group than in the control group(P<0.05,P<0.01).After treatment,the levels of endostatin increased in both groups,while IGF-1,VEGF,bFGF,and PDGF decreased;the levels of endostatin in the observation group were higher than those in the control group,while the levels of IGF-1,VEGF,bFGF,and PDGF were lower than those in the control group(P<0.05,P<0.01).After treatment,the levels of Bcl-2 and Livin decreased in both groups,while Bax and PDCD5 increased;the levels of Bcl-2 and Livin in the observation group were lower than those in the control group,while the levels of Bax and PDCD5 were higher than those in the control group(P<0.05,P<0.01).There was no significant difference in toxic and side effects between the two groups during treatment(P>0.05).The 2-year survival rate and median survival time of the observation group were higher or longer than those of the control group(P<0.05).Conclusion The treatment of PD-L1 positive LSCC in elderly patients with Sintilimab combined with Endostar injection can improve the therapeutic effect and the survival status of patients,inhibit tumor angiogenesis,induce tumor apoptosis,prolong the survival time of patients,and has good safety.

The major obstacle to optimizing the design of rare disease coverage is the fragmented decision-making process among medical services, pharmaceuticals, and medical insurance departments. There is an urgent need to realize data sharing and digital empowerment, as well as to adopt top-level design and systematic decision-making. It is also crucial to establish mechanisms, facilitated by digital intelligence, for sharing power and responsibilities, and assessing rewards and punishments. Furthermore, there is an urgent need to incorporate the theories of collaborative governance, digital governance, and the full life cycle into the entire process, which includes patient classification, diagnosis and treatment, medical assistance, medication protection, and health insurance fund management for rare diseases. This integration aims to provide theoretical reference for the effective linkage of medical services, pharmaceuticals, and medical insurance, and to improve the efficiency and equity of resource allocation in the public sector.