OBJECTIVE: To investigate the current status of clinical genetics specialization development and the diagnostic and therapeutic capabilities for hereditary diseases across medical institutions in Shanghai, and to assess the necessity and feasibility of establishing training bases for clinical genetics specialists. METHODS: By employing a cross-sectional survey design, the Clinical Genetics Committee of Shanghai Medical Association has conducted questionnaire surveys from March to April 2025 across 54 healthcare institutions in Shanghai (including 33 tertiary hospitals and 21 secondary hospitals). The survey involved administrative departments and medical personnel from 15 clinical specialties. The survey has covered current genetic disease diagnosis and treatment practices, relevant and specialised disease types, genetic department establishment, testing capabilities, personnel teams, and training requirements. RESULTS: The results revealed that 78.0% of clinical departments surveyed had treated patients with hereditary disorders. Shanghai possesses diagnostic and therapeutic expertise for over 95% of hereditary diseases listed in its rare disease catalogue, reflecting both the practical clinical demand for such conditions and the city's overall diagnostic and therapeutic strengths in this field. Nevertheless, significant disparities exist in the development of genetics departments across different tiers of healthcare institutions. Resources for genetic testing capabilities (including molecular, cellular, and biochemical testing) are also unevenly distributed across different tiers of hospitals. The survey further revealed that only 26.0% of departments believe that their current physician structure fully meets the diagnostic and treatment demands. Over 90% of departments consider standard training for clinical genetic specialists necessary, with 74.0% expressing willingness to participate in establishing training bases. Based on above findings and thorough deliberation, the Clinical Genetics Committee of the Shanghai Medical Association proposes advancing specialist training and discipline development through establishing a standard training system. The committee has drafted a three-year training protocol featuring a "joint training"-centered model, recommending a pilot-first, dynamically optimized strategy for steadily advancing training base development. CONCLUSION Shanghai faces substantial demand for genetic disease diagnosis and treatment, yet exhibits shortcomings in clinical genetics specialization development, resource allocation, and talent pipeline cultivation. To establish a standard training system holds significant practical importance and is underpinned by a broad demand.
Humans ; China ; Surveys and Questionnaires ; Genetic Diseases, Inborn/genetics* ; Cross-Sectional Studies ; Genetics, Medical/education* ; Genetic Testing

In recent years, the application of artificial intelligence technology in rectal cancer radiotherapy has become increasingly significant. By constructing models from patient clinical information, accurate prediction of dose distribution, treatment effect, and toxic side effects of rectal cancer can be achieved. This allows optimizing the radiotherapy plan, ensuring the dose is focused on the tumor target area while reducing the radiation damage to the bladder, rectum, and other surrounding tissues. Thus, it can achieve precision and personalization in radiotherapy. In this review, the construction method of artificial intelligence predictive models was described, and the value of different predictive factors to the model was systematically analyzed, including patient clinical data, radiomics, and dosimetry. Moreover, the application and limitations of artificial intelligence predictive models in radiotherapy were summarized. This information can serve as a reference for the clinical application of artificial intelligence predictive models in rectal cancer radiotherapy.

Abstract Frailty is a clinical state characterized by increased vulnerability due to the decline of multiple organ functions. It is clinically manifested as slow movement, reduced activity, low energy level and involuntary weight loss. Frailty heightens the risk of disability, long-term hospitalization and mortality in the elderly when they face stressful events. Early assessment of frailty and personalized interventions can prevent and delay its progression, thereby reducing the occurrence of adverse events. This article reviews the literature on frailty published both domestically and internationally from January 2015 to January 2024. It provides an overview of the tools for assessing frailty in the elderly, such as the Clinical Frailty Scale, Frailty Index, Fried Frailty Phenotype, FRAIL Scale, and biological markers, and the management of frailty, including exercise, nutritional interventions, oral health management, and medication management, so as to provide the evidence for early assessment and intervention of frailty.

Objective To evaluate the impact of integrated medical and nursing care teaching ward rounds on the theo-retical knowledge learning and clinical operational skill training of primary-level medical staff.Methods A total of 90 clinical healthcare workers(39 physicians and 51 nurses)from our hospital between May and December2024 were randomly assigned to either a control group or an intervention group.The control group participated in traditional three-tier nursing teaching ward rounds,while the intervention group underwent integrated medical and nursing care teaching ward rounds.The two groups were compared in terms of improvements in theoretical knowledge,ward round operational skills,and core clinical competencies.Re-sults Both groups demonstrated improvements in theoretical knowledge and ward round operational skills after the intervention,with the intervention group showing significantly greater gains(P＜0.05).Additionally,scores related to physical fitness,emo-tional well-being,and cognitive function improved in both groups,with significantly higher improvements in the intervention group(P＜0.05).The Clinical Nursing Skills(CINS)scores—including judgment,early warning,anticipatory thinking,and overall clinical competence—also improved significantly in the intervention group compared to the control group(P＜0.05).Conclu-sion Integrated medical and nursing care teaching ward rounds significantly enhance theoretical knowledge,operational profi-ciency,and core clinical competencies among primary healthcare providers.This model fosters higher professional engagement and helps cultivate qualified primary-level medical personnel who are better equipped to meet real-world clinical demands.

Objective:This study aimed to propose an innovative modular surgical technique and explore its safety and application value in laparoscopic total gastrectomy combined with spleen-preserving hilar lymphadenectomy for advanced proximal gastric cancer invading the greater curvature.Methods:A retrospective collection was conducted on 34 patients with proximal gastric cancer invading the greater curvature who underwent laparoscopic total gastrectomy combined with spleen-preserving hilar lymphadenectomy in the same center from October 2020 to December 2022. The technical key points, precautions and crucial steps of the modular surgical technique were summarized, and the Clinical indicators were analyzed.Results:All 34 patients successfully completed the operation under laparoscopy without conversion to open surgery. The average operation duration was 151.9±4.1 minutes, and the duration of splenic hilar lymphadenectomy was 12.9±1.5 minutes. The median intraoperative blood loss was 50(20, 50) ml, and the blood loss during splenic hilar lymphadenectomy was 5 (2, 5) ml. The median number of harvested lymph nodes was 32.0 (23.5,39.5), and the number of submitted No.10 lymph nodes was 3 (2, 4). The metastasis rate of No.10 lymph nodes was 20.6% (7/34). No patient had intraoperative complications. During the postoperative hospital stay, one patient had incision infection (Clavien-Dindo I), and one patient had pulmonary infection (Clavien-Dindo II). The time for the first postoperative feeding was 3 (2, 5) days, the time for the first postoperative flatus was 2 (2,3) days, the time for the first postoperative defecation was 3 (3, 4) days, the total postoperative drainage volume was 1047.5 (607.5,1397.5) mL, the time for postoperative drainage tube removal was 7 (6, 9) days, and the length of postoperative hospital stay was 7.0 (6.0, 9.5) days.Conclusions:The application of the innovative modular surgical technique in laparoscopic total gastrectomy combined with spleen-preserving hilar lymphadenectomy can simplify surgical process and enable safe, precise and comprehensive dissection of splenic hilar lymph nodes.

Objective To evaluate the impact of integrated medical and nursing care teaching ward rounds on the theo-retical knowledge learning and clinical operational skill training of primary-level medical staff.Methods A total of 90 clinical healthcare workers(39 physicians and 51 nurses)from our hospital between May and December2024 were randomly assigned to either a control group or an intervention group.The control group participated in traditional three-tier nursing teaching ward rounds,while the intervention group underwent integrated medical and nursing care teaching ward rounds.The two groups were compared in terms of improvements in theoretical knowledge,ward round operational skills,and core clinical competencies.Re-sults Both groups demonstrated improvements in theoretical knowledge and ward round operational skills after the intervention,with the intervention group showing significantly greater gains(P＜0.05).Additionally,scores related to physical fitness,emo-tional well-being,and cognitive function improved in both groups,with significantly higher improvements in the intervention group(P＜0.05).The Clinical Nursing Skills(CINS)scores—including judgment,early warning,anticipatory thinking,and overall clinical competence—also improved significantly in the intervention group compared to the control group(P＜0.05).Conclu-sion Integrated medical and nursing care teaching ward rounds significantly enhance theoretical knowledge,operational profi-ciency,and core clinical competencies among primary healthcare providers.This model fosters higher professional engagement and helps cultivate qualified primary-level medical personnel who are better equipped to meet real-world clinical demands.

Objective:This study aimed to propose an innovative modular surgical technique and explore its safety and application value in laparoscopic total gastrectomy combined with spleen-preserving hilar lymphadenectomy for advanced proximal gastric cancer invading the greater curvature.Methods:A retrospective collection was conducted on 34 patients with proximal gastric cancer invading the greater curvature who underwent laparoscopic total gastrectomy combined with spleen-preserving hilar lymphadenectomy in the same center from October 2020 to December 2022. The technical key points, precautions and crucial steps of the modular surgical technique were summarized, and the Clinical indicators were analyzed.Results:All 34 patients successfully completed the operation under laparoscopy without conversion to open surgery. The average operation duration was 151.9±4.1 minutes, and the duration of splenic hilar lymphadenectomy was 12.9±1.5 minutes. The median intraoperative blood loss was 50(20, 50) ml, and the blood loss during splenic hilar lymphadenectomy was 5 (2, 5) ml. The median number of harvested lymph nodes was 32.0 (23.5,39.5), and the number of submitted No.10 lymph nodes was 3 (2, 4). The metastasis rate of No.10 lymph nodes was 20.6% (7/34). No patient had intraoperative complications. During the postoperative hospital stay, one patient had incision infection (Clavien-Dindo I), and one patient had pulmonary infection (Clavien-Dindo II). The time for the first postoperative feeding was 3 (2, 5) days, the time for the first postoperative flatus was 2 (2,3) days, the time for the first postoperative defecation was 3 (3, 4) days, the total postoperative drainage volume was 1047.5 (607.5,1397.5) mL, the time for postoperative drainage tube removal was 7 (6, 9) days, and the length of postoperative hospital stay was 7.0 (6.0, 9.5) days.Conclusions:The application of the innovative modular surgical technique in laparoscopic total gastrectomy combined with spleen-preserving hilar lymphadenectomy can simplify surgical process and enable safe, precise and comprehensive dissection of splenic hilar lymph nodes.

Objective:To establish an epidemiological cut-off value (ECV) for antifungal drugs against Cryptococcus neoformans in East China through a multicenter in vitro drug susceptibility test. Methods:A retrospective collection of 479 clinical isolates of Cryptococcus neoformans was conducted by the East China Invasive Fungal Infection Group (ECIFIG) from January 1, 2017 to December 31, 2022. Mass spectrometry and gene sequencing were used for identification. A unified drug susceptibility testing system was established in the fungal laboratories across three sub centers in Shanghai, Jiangxi, and Jiangsu provinces. Drug susceptibility testings of Cryptococcus neoformans were independently completed in each center after passing consistency evaluation. Epidemiological breakpoints were established against fluconazole, voriconazole, amphotericin B, 5-fluorocytosine, isaconazole, posaconazole and itraconazole following the principles and procedures of the Clinical and Laboratory Standards Institute (CLSI) M57. Results:External consistency evaluation revealed that the minimum inhibitory concentration values ??for all drugs in each center did not differ by more than one dilution gradient. A new ECV type of Cryptococcus neoformans in East China was established, including fluconazole 16 mg/L, voriconazole 0.12 mg/L, amphotericin B 1 mg/L, 5-fluorocytosine 8 mg/L, isavuconazole 0.12 mg/L, posaconazole 0.5 mg/L, and itraconazole 0.5 mg/L. Conclusion:This study preliminarily revealed the drug susceptibility characteristics of clinical Cryptococcus neoformans in East China and established the ECVs for antifungal drugs against Cryptococcus neoformans in the region.

Objective To monitor the antifungal resistance of clinical isolates of Candida spp.in the East China region.Methods MALDI-TOF MS or molecular methods were used to re-identify the strains collected from January 2018 to December 2022.Antifungal susceptibility testing was performed using the broth microdilution method.The susceptibility test results were interpreted according to the breakpoints of 2022 Clinical and Laboratory Standards Institute(CLSI)documents M27 M44s-Ed3 and M57s-Ed4.Results A total of 3 026 strains of Candida were collected,65.33％of which were isolated from sterile body sites,mainly from blood(38.86％)and pleural effusion/ascites(10.21％).The predominant species of Candida were Candida albicans(44.51％),followed by Candida parapsilosis complex(19.46％),Candida tropicalis(13.98％),Candida glabrata(10.34％),and other Candida species(0.79％).Candida albicans showed overall high susceptibility rates to the 10 antifungal drugs tested(the lowest rate being 93.62％).Only 2.97％of the strains showed dose-dependent susceptibility(SDD)to fluconazole.Candida parapsilosis complex had a SDD rate of 2.61％and a resistance rate of 9.42％to fluconazole,and susceptibility rates above 90％to other drugs.Candida glabrata had a SDD rate of 92.01％and a resistance rate of 7.99％to fluconazole,resistance rates of 32.27％and 48.24％to posaconazole and voriconazole non-wild-type strains(NWT),respectively,and susceptibility rates above 90％to other drugs.Candida tropicalis had resistance rates of 29.55％and 26.24％to fluconazole and voriconazole,respectively,resistance rates of 76.60％and 21.99％to posaconazole and echinocandins non-wild-type strains(NWT),and a resistance rate of 2.36％to echinocandins.Conclusions The prevalence and species distribution of Candida spp.in the East China region are consistent with previous domestic and international reports.Candida glabrata exhibits certain degree of resistance to fluconazole,while Candida tropicalis demonstrates higher resistance to triazole drugs.Additionally,echinocandins resistance has emerged in Candida albicans,Candida glabrata,Candida tropicalis,and Candida parapsilosis.