ObjectiveTo assess the performance of preoperative serum Golgi protein 73 （GP73） in diagnosing liver fibrosis degree in patients with resectable hepatocellular carcinoma （HCC）， to investigate its value in predicting postoperative survival， and to provide a basis for risk stratification and individualized decision-making in this population. MethodsA total of 631 patients with HCC who underwent liver resection at The First Hospital of Jilin University from March 1， 2009 to December 31， 2022 were enrolled. The demographic， pathological， and serological features of the patients were collected， and the serum level of GP73 was measured before surgery. Scheuer score determined by liver biopsy was used as the gold standard for diagnosing liver fibrosis； the Spearman correlation analysis was used to investigate the correlation between GP73 and liver fibrosis； the receiver operating characteristic （ROC） curve and the area under the ROC curve （AUC） were used to assess the value of serum GP73 and compound serological markers in the diagnosis of liver fibrosis， and the Delong test was used for comparison of AUC. With all-cause mortality as the outcome， X-Tile 3.6.1 software was used to determine the optimal cut-off value of GP73； the univariate and multivariate Cox regression analyses were used to identify independent influencing factors for prognosis， and a nomogram model was constructed. Ten-fold cross-validation was used for internal validation； index of concordance （C-index）， integrated discrimination improvement （IDI） index， and net reclassification improvement （NRI） index were calculated； calibration curve and decision curve analysis were used to assess the predictive performance of the model. ResultsThe serum level of GP73 was positively correlated with Scheuer liver fibrosis stage （r_s=0.255， P<0.001）. Serum GP73 had a significantly higher AUC than gamma-glutamyl transferase-to-platelet ratio （0.704 vs 0.634， Z=2.00， P=0.046） and S index （0.704 vs 0.637， Z=1.98， P=0.048） in the diagnosis of significant liver fibrosis， with no significant difference compared with aspartate aminotransferase-to-platelet ratio index （AUC=0.722） and fibrosis-4 index （AUC=0.695） （both P>0.05）. During a median follow-up time of 48.66 months， 239 patients （37.9%） died. GP73 had an optimal cut-off value of 65 ng/mL in predicting postoperative mortality in patients with resectable HCC， and high GP73 expression （≥65 ng/mL） alone achieved a C-index of 0.617 for predicting the prognosis of HCC patients， which was better than the C-index of 0.551 for Barcelona Clinic Liver Cancer （BCLC） stage （P<0.001）. The multivariate Cox regression analysis showed that serum GP73 （hazard ratio ［HR］=2.56， 95% confidence interval ［CI］： 1.86 — 3.52， P<0.001）， sex （HR=1.58， 95%CI： 1.10 — 2.28， P=0.014）， vascular invasion （HR=1.69， 95%CI： 1.30 — 2.21， P<0.001）， total bilirubin （HR=1.49， 95%CI： 1.16 — 1.93， P=0.002）， and maximum tumor diameter （HR=1.07， 95%CI： 1.04 — 1.11， P<0.001） were independent risk factors for all-cause mortality after hepatectomy in patients with HCC. In order to assess whether the addition of GP73 to the other four variables could further improve model performance， the model based on GP73， sex， vascular invasion， total bilirubin， and maximum tumor diameter was defined as the GP73-included model， and the model based on all five variables except GP73 was defined as the GP73-excluded model. The GP73-included model achieved an AUC of 0.704 （95%CI： 0.656 — 0.753） for predicting 5-year survival rate after surgery， and ten-fold cross-validation showed that this model had a mean C-index of 0.716 （95%CI： 0.682 — 0.750）， which was higher than the C-index of the GP73-excluded model （C-index=0.682， 95%CI： 0.645 — 0.719， P=0.008） and BCLC stage （C-index=0.551， 95%CI： 0.523 — 0.580， P<0.001）. Compared with the GP73-excluded model， the GP73-included model yielded an IDI index of 0.039 （95%CI： 0.016 — 0.069， P<0.001） and an NRI index of 0.259 （95%CI： 0.179 — 0.335， P<0.001）， and compared with BCLC stage， the GP73-included model had an IDI index of 0.112 （95%CI： 0.069 — 0.163， P<0.001） and an NRI index of 0.272 （95%CI： 0.169 — 0.380， P<0.001）. Calibration curve and decision curve analyses showed that the GP73-included model had good calibration and net clinical benefit. ConclusionGP73 can be used as a serological biomarker for diagnosing liver fibrosis in patients with resectable HCC， and preoperative GP73 level has a certain value in predicting the survival of these patients after hepatectomy. The integrated prognostic model incorporating GP73 can help to optimize postoperative risk stratification， thereby providing a basis for decision-making in precise treatment of HCC.

OBJECTIVE To systematically analyze the functional system and construction requirements for infection prevention and control('infection control system'in short)in medical institutions so as to facilitate the effective,standardized and practical construction of the infection control system.METHODS The questionnaires were de-signed based on the relevant criteria and literatures that were released in China with the combination of expect con-sultant and were distributed to experts or professionals involving multiple fields such as hospital infection manage-ment,clinical medical treatment and information technology.The questionnaires were recycled,summarized and analyzed.RESULTS The list of functions of the infection control system(consultative draft)was formulated after review of literatures and expert consultation,including fundamental functions such as data management,case sur-veillance and intervention feedback as well as the advanced functions like target surveillance,occupational protec-tion and interconnection.The surveyed subjects agreed unanimously after the questionnaire survey that all of the function modules and elements enlisted were important,the average score of importance was more than 4 points,the score of coefficient of variable(CV)for importance of the function modules was less than 0.25,indicating that there was high consistency in the opinions among the surveyed subjects.The element of tracing and epidemiologi-cal survey function was adopted and added according to the feedback suggestions from some of the subjects;two function elements including data query and clinical interaction were revised,and the list of function requirements for the infection control systems was finally defined.CONCLUSION The requirements for functions of the infection control system that are determined in the study can provide important bases and data support for the research and standardized development of future infection control system.

Objective To design a search and rescue simulation training system to enhance medical command,search and rescue capabilities of the PLA air force.Method A search and rescue simulation training sysgtem was designed based on the war gaming theory and developed with C/S architecture,C++language and MongoDB database for data storage,which was composed of four subsystems for scenario setting,action coordination and commanding operation simulation.The scenario setting subsystem included 3 modules of map editing setting,scenario editing and organization preparation;the action coordination subsystem had 5 modules of deduction process control,deduction coordination intervention,deduction status monitoring,perspective control and addition of deduction conditions;the commanding operation subsystem involved in 3 modules of command and control,real-time information query and operation command;the operation simulation subsy-stem consisted of 3 modules of agent search,rescue and treatment simulation,operation ruling and operation intelligence management.Results The system developed facilitated search,rescue and commanding training-related teaching and search and rescue program rehearsal verification,and thus comprehensively enhanced the trainee's capabilities in search,rescue,commanding and decision making.Conclusion The system developed integrates effectively medical commanding with operational commanding during search and rescue,providing a novel means for air force search and rescue operations and medical service simulation training.[Chinese Medical Equipment Journal,2025,46(4):15-20]

Objective To design a search and rescue simulation training system to enhance medical command,search and rescue capabilities of the PLA air force.Method A search and rescue simulation training sysgtem was designed based on the war gaming theory and developed with C/S architecture,C++language and MongoDB database for data storage,which was composed of four subsystems for scenario setting,action coordination and commanding operation simulation.The scenario setting subsystem included 3 modules of map editing setting,scenario editing and organization preparation;the action coordination subsystem had 5 modules of deduction process control,deduction coordination intervention,deduction status monitoring,perspective control and addition of deduction conditions;the commanding operation subsystem involved in 3 modules of command and control,real-time information query and operation command;the operation simulation subsy-stem consisted of 3 modules of agent search,rescue and treatment simulation,operation ruling and operation intelligence management.Results The system developed facilitated search,rescue and commanding training-related teaching and search and rescue program rehearsal verification,and thus comprehensively enhanced the trainee's capabilities in search,rescue,commanding and decision making.Conclusion The system developed integrates effectively medical commanding with operational commanding during search and rescue,providing a novel means for air force search and rescue operations and medical service simulation training.[Chinese Medical Equipment Journal,2025,46(4):15-20]

Objective·To investigate the genetic etiology of a rare and complex case clinically suspected to be methylmalonic acidemia(MMA),but with negative whole exome sequencing(WES)results,using a multi-omics sequencing approach.Methods·DNA and RNA samples were extracted from the peripheral blood of the proband and both parents.Targeted MMA-related gene Panel sequencing and WES were first performed.Subsequently,RNA sequencing(RNA-seq)and whole genome sequencing(WGS)were conducted to comprehensively analyze the child's genetic variants,their origins and potential inheritance patterns.Results·No pathogenic variants associated with the patient's phenotype were identified through the MMA Panel or standard WES analysis.Extended analysis of WES suggested the possibility of uniparental disomy(UPD)of chromosome 4.WGS revealed a homozygous splice-site variant(c.-66+2T>C)in the non-coding region of the metabolism of cobalamin associated A(MMAA)gene.The variant was located in the 5'untranslated region(5'UTR),specifically at the second base downstream of the splice donor site of exon 1(reference sequence:NM_172250).In genomic coordinates(hg19),the variant was located at base 146540561 on chromosome 4(chr4:146540561).Sanger sequencing confirmed that the mother was heterozygous for this variant,while the father did not carry it.RNA-seq showed no detectable expression of the MMAA gene on chromosome 4 in the patient.This was further confirmed by reverse transcription real time quantitative PCR,indicating nearly absent mRNA expression,suggesting that the non-coding splice-site variant affected transcriptional expression.Conclusion·A homozygous splice-site variant(c.-66+2T>C)in the non-coding region of the MMAA gene—outside the coverage of WES—is likely the pathogenic cause in this case,presumably resulting from maternal UPD of chromosome 4.

Objective To investigate the changes of diameter of the main trunk of the extracranial segment of the facial nerve,local hemodynamics and facial muscle thickness in patients with peripheral facial palsy(PFP)at acute stage by high frequency ultrasound(HFUS).Methods Sixty patients with acute PFP were enrolled as the PFP group,and 30 healthy people were selected as the control group.The following facial param-eters were scanned and recorded using HFUS:diameter of the main trunk of the extracranial segment of the facial nerve(FN-d),facial artery diameter(FA-d),facial artery systolic velocity(FA-Vs),facial artery diastolic velocity(FA-Vd),facial artery resistance index(FA-RI),frontalis muscle thickness(FM-t),depressor anguli oris muscle thickness(DAO-t),and depressor labii inferioris muscle thickness(DLI-t).The feasibility of facial param-eters in the diagnosis of acute-phase peripheral facial palsy(PFP)was evaluated,with intra-group and inter-group variability comparisons performed.Pearson correlation analysis was conducted to evaluate the relationship between acute-phase facial parameters and House-Brackmann(H-B)scale scores in PFP patients.Results(1)The H-B score of the PFP group was significantly lower than that of the control group,and the difference was statistically significant(P＜0.05).(2)The reliability of repeated measurements of facial parameters by different testers is good(ICC＞0.75).(3)The FN-d and FA-RI values on the affected side of PFP group were higher than those on the healthy side and control group,and FA-Vs,FA-Vd,DAO-t and DLI-t values were lower than those on the healthy side and control group,with statistical significance(P＜0.05).(4)The FN-d and FA-RI values of the affected side in the PFP group were negatively correlated with the H-S scale score(r=-0.847,P＜0.05;r=-0.863,P＜0.05);FA Vs,FA Vd,DAO-t,DLI-t are positively correlated with H-S scale scores(r=0.808,P＜0.05;r=0.757,P＜0.05;r=0.836,P＜0.05;r=0.694,P＜0.05).Conclusions HFUS can effectively detect the characteristic changes such as the increase in the diameter of the extrcranial facial nerve trunk,local microcircula-tion disturbance and facial muscle atrophy in patients with PFP in the acute stage,and the increase and decrease of FN-d,FA Vs,FA Vd,FA-RI,DAO-t,and DLI-t can accurately reflect the improvement or progress of PFP,which has important guiding significance for clinical disease monitoring and efficacy evaluation.

Objective To investigate the relationship between lead exposure and the clinical heterogeneity of amyotrophic lateral sclerosis(ALS).Methods Baseline data were collected from 49 ALS patients hospitalized at the PLA General Hospital.Blood metal levels(copper,zinc,calcium,magnesium,iron,lead)were measured by graphite furnace atomic absorption spectrometry.The Revised ALS Functional Rating Scale(ALSFRS-R)was used to assess the severity of motor function impairment.Patients were grouped by site of onset and ALSFRS-R score,then blood metal levels were compared between two groups.General linear regression,ROC curves and Logistic regression models were applied to analyze the correlation between blood lead levels and disease severity to identify risk factors affecting motor function in ALS patients,and analyze its predictive value.Results The differences of blood metal levels between bulbar onset patients and non-bulbar onset patients were no statistical significance(all P＞0.05).Blood lead levels were significantly lower in the high ALSFRS-R score group than in the low ALSFRS-R score group,and the difference was significant(P=0.02).Blood lead levels were negatively correlated with ALSFRS-R scores in ALS patients(Y=-0.1267X+45.86,R2=0.08937,P=0.04).The area under the ROC curve was 0.70,indicating that blood lead had predictive value for ALS severity.The Logistic regression model demonstrated that elevated blood lead level was an independent risk factor for the severity of ALS disease(OR=1.107,95％CI:1.006-1.219,P=0.04).Conclusions Blood lead levels in ALS patients correlated with disease severity and exhibited predictive utility.Elevated blood lead was an independent risk factor for the severity of motor function impairment in ALS.

Objective:To explore medical students'cognition,current status,and demands regarding practical skills training in a medical college under the background of new medical science.Methods:A cross-sectional survey was conducted among medical undergraduates from Year 1 to Year 5 in a medical college.A self-designed scale was used to investigate the cognition,current status,and demands related to new medical education concepts.Pearson correlation analysis was used to analyze the relationship between satisfaction with practical teaching facilities and variables including understanding of new medical education,curriculum design,and proportion of practical teaching.Multiple linear regression was conducted to investigate the factors influencing satisfaction.Results:Among 1 253 participants,70.71%acquired new medical science information through online media,while 52.99%learned about it via school courses.Over 80%endorsed"whole-cycle health management"(preventive care before disease onset 91.94%,disease treatment 81.72%,and post-illness rehabilitation 82.60%).Experimental courses(85.16%),clinical skills training(66.88%),and social practice(66.24%)were primary practical forms,but the participation rates of research practice(40.78%)and innovation/entrepreneurship practice(34.72%)was comparatively lower.The satisfaction with practical teaching was positively correlated with adequacy of faculty guidance(r=0.707)and curriculum rationality(r=0.522)(P＜0.01).The multiple linear regression analysis showed that faculty guidance(β=0.436)and the proportion of practical teaching(β=0.319)were the key predictors of satisfaction.Conclusion:Medical students'cognition of practical skills training,curriculum optimization,and adequacy of faculty guidance significantly influence satisfaction with practical teaching,with faculty guidance and rationality of practical process playing key roles.

Objective To construct a dynamic framework for bidirectional transitions of mild cognitive impairment(MCI),quantifying both rare reversion and high-risk progression trajectories in cognitive dynamics.Methods Patients diagnosed with MCI at baseline from 2005 to 2022 and completed at least two follow-up visits were selected from the Alzheimer's Disease Neuroimaging Initiative(ADNI),and a retrospective cohort was constructed.Demographic information,APOEε4 genotype,and neuropsychological scales data were collected.Longitudinal cognitive assessments were functionally reconstructed using multivariate functional principal component analysis(MFPCA),with functional principal components(FPCs)extracted based on cumulative variance contribution rate(PVE＞90％).Functional multi-state Markov models were developed to estimate inter-state transition intensities,year to year transition probabilities,and covariate effects.Results Among 1,019 MCI patients(4,657 follow-up visits),93(9.1％)reverted to normal cognition,while 359(35.2％)progressed to Alzheimer's disease(AD).Longitudinal trajectory analysis revealed significant heterogeneity:progressive MCI＞stable MCI＞reverted MCI in the first functional principal component(MFPC1)scores.The transition intensity for MCI reversion(0.020)was approximately one-fourth of the AD progression risk(0.086),but the post-reversion cognitive re-impairment intensity was 0.138.Reduced MFPC1(HR=0.993,95％Cl:0.991,0.995)and elevated MFPC2(HR=1.004,95％Cl:1.001,1.007)were closely associated with MCI reversion.Conclusion MCI exhibits marked heterogeneity in longitudinal cognitive trajectories.Although reversion is rare,reversed patients remain at high risk of cognitive re-impairment.

Relevant China's literature on the application of brain-computer interface technology in the field of rehabilita-tion of stroke patients was retrieved in the China Knowledge Network database from its establishment to December 31,2024,and CiteSpace visual analysis software was used to analyze the selected literature in terms of trend of annual publica-tion number,author collaboration network,keyword co-occurrences and emergences and to generate a corresponding knowledge map.It's pointed out brain-computer interface technology showed significant application potential for motor function recovery and neurorehabilitation,which had the research hotspots of the cross technologies covering motor imagina-tion,rehabilitation training and virtual reality and the research frontiers of the fusion application of intelligent algorithms of deep learning and pattern recognition.The challenges and future development directions of the field were investigated,and references were provided for promoting the application of brain-computer interface technology to rehabilitation of sroke patients in China.[Chinese Medical Equipment Journal,2025,46(9):65-69]