This article systematically reviews and compares the major international English consensus statements/guidelines on the diagnosis and treatment of Wilson disease published since 2022， with a focus on the recommendations from multidisciplinary expert consensus statements/guidelines. These consensus statements/guidelines mainly include the multidisciplinary treatment guidelines issued by the American Association for the Study of Liver Diseases in 2022， the clinical practice guidelines released by the European Union （European Association for the Study of the Liver/European Reference Network） in 2025， and the practice guidelines published by the British Association for Studies of the Liver in 2022， and comparative analysis and summarization were performed with reference to the 2025 edition of Chinese Multidisciplinary Expert Consensus on Orphan/Anticopper Drugs and Other Non-drug Management of Hepatolenticular Degeneration （CMEC-HLD）. Overall， the core content remained basically consistent between the guidelines of the European Union， the US， and the UK and CMEC-HLD， while many details varied due to the differences in experiences and research advances across these countries. Globally， there is still a lack of truly meaningful medical guideline for Wilson disease driven by evidence-based medicine， which requires further research and international cooperation among peers in the future.

Objective To explore the application value of three mainstream large language models in the diagnosis, differential diagnosis, and treatment decision support of the primary diseases related to pediatric liver transplantation. Methods Seventy-nine cases of pediatric liver transplantation-related diseases diagnosed through pathological or clinical follow-up data were collected from Renji Hospital, Shanghai Jiao Tong University School of Medicine or published high-quality case reports. These cases covered 25 types of primary diseases such as cholestatic liver disease, metabolic diseases, and tumors. Standardized prompts were used to input the case information into the DeepSeek-R1, ChatGPT-4o and Grok-3 models, and the accuracy of their preliminary diagnosis and differential diagnosis based on basic clinical data was evaluated. The final diagnosis accuracy and the response time after supplementary examination were also assessed, as well as the completeness and rationality of their analysis of disease treatment principles. Results In the initial diagnosis and differential diagnosis stage, the comprehensive accuracy of DeepSeek-R1 was the highest [72.1%, 95% confidence interval (CI) 61.4% - 80.8%], and there was a statistically significant difference in the comprehensive accuracy of the three models for initial diagnosis (P = 0.008). After adding further examination information, the final diagnosis accuracy of the three models increased, with DeepSeek-R1 at 88.6% (95% CI 79.7% - 93.9%), ChatGPT-4o at 87.3% (95% CI 78.2% - 93.0%), and Grok-3 at 78.5% (95% CI 68.2% - 86.1%). There was no statistically significant difference among the three models (P = 0.05). The scores given by experts for the treatment principles showed good consistency (Kappa = 0.769). In addition, the response time of ChatGPT-4o is shorter than that of the other two models [(24 ± 7) s]. Conclusions Large language models demonstrate good efficacy in the diagnosis and treatment decision-making process of various pediatric liver diseases, have a good application prospect for auxiliary diagnosis and decision support, and are expected to help improve the accuracy and efficiency of clinical diagnosis and treatment of pediatric liver transplantation-related primary diseases.

Traumatic paraplegia, resulting from spinal cord injury, leads to severe motor dysfunction, with limited efficacy and high risks associated with conventional treatments. Brain-computer interface (BCI) has emerged as a promising technology that decodes neural signals to control external devices or stimulate paralyzed muscles, providing a novel approach for functional restoration in paraplegic patients. This article reviews the clinical applications of BCI in treating both high- and low-level traumatic paraplegia. Challenges related to signal decoding, device stability, biocompatibility, clinical safety, and ethical considerations are also discussed. In the future, the integration of artificial intelligence may further enhance BCI as a “neural bridge” for restoring motor and interactive functions in patients with traumatic paraplegia.

Large language models (LLM) are increasingly applied in the medical field, yet their clinical implementation faces numerous ethical and regulatory challenges. This paper reviews seven major ethical challenges: patient safety and accuracy, bias and fairness, privacy and data protection, transparency and explainability, accountability and legal liability, patient autonomy and informed consent, and the doctor-patient relationship and trust. At the regulatory level, international research indicates that United States currently lacks specific regulations for medical LLM use, while is exploring the regulation of high-risk LLM. The EU’s AI Act classifies medical AI as high-risk and imposes stringent compliance requirements. China has issued generative AI management measures and advocates industry standards, though its legal framework remains incomplete. Solutions include embedding ethical principles during model development, strengthening human-machine collaboration and manual oversight in clinical settings, establishing clear legal standards for accountability, safeguarding data privacy and security, implementing continuous monitoring and improvement, and deepening international cooperation and multidisciplinary governance.

Objective To preliminary explore the imaging manifestations of digital breast tomosynthesis (DBT) and contrast-enhanced mammography (CEM) in triple-negative breast cancer (TNBC) patients with different levels of human epidermal growth factor receptor 2 (HER2) expression. Methods A retrospective analysis was conducted on TNBC patients who underwent preoperative DBT or CEM examinations at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to December 2019 and Shanghai Second People’s Hospital from January 2022 to May 2025. Clinical data, pathological and immunohistochemical results, and imaging data were collected. Results A total of 69 TNBC patients pathologically confirmed as invasive ductal carcinoma were included, among which 34 underwent DBT and 35 underwent CEM. Among these patients, 34 (49.28%) had HER2-low expression and 35 (50.72%) had HER2-zero expression. DBT results showed that the proportion of spiculation signs in HER2-low group (n＝14) was significantly higher than that in HER2-zero group (n＝20; P＝0.009, P_adj＝0.045). However, there were no significant differences in breast density type, mass shape, or calcification between the two groups. CEM results showed that on low-energy images, the proportion of spiculation signs in the HER2-low group (n＝20) was higher than that in the HER2-zero group (n＝15; P＝0.011, P_adj＝0.077). Results of CEM showed that on reconstructed images, differences in background parenchymal enhancement and mass enhancement patterns between the two groups were not statistically significant; in both groups, heterogeneous enhancement was the most common, followed by homogeneous enhancement, with ring enhancement being the least common. Conclusions TNBC with low HER2 expression and TNBC with zero HER2 expression may have potential differences in the presentation of spiculation signs on DBT. However, the correlation between CEM manifestations and TNBC with different HER2 expression levels requires further research.

OBJECTIVE To establish a Chinese drug-related problem （DRP） classification system applicable to pharmacist-led pharmaceutical care in China， providing pharmacists with an effective and practical tool for pharmaceutical care. METHODS A multi-stage process was employed to construct the DRP classification system， including literature review and analysis， comparison of existing classification systems， refinement of classification items and framework development， two rounds of standard case validation， expert discussion， and system revision. The Fleiss′ kappa test was used to calculate the consistency coefficient κ， assessing the reliability of pharmacists participating in evaluating the classification system. An electronic questionnaire comprising six items was employed to evaluate the system’s applicability. RESULTS The constructed Chinese DRP classification system comprised six sections [problem（including potential problems）， DRP evaluation， cause （including possible causes of potential problems）， intervention， acceptance of intervention and DRP status]， with 24 primary codes and 96 secondary codes. In the first round of case validation， κ values exceeded 0.4 for all sections except “intervention” and “DRP status”. In the second round， κ values exceeded 0.4 for all sections. In the applicability evaluation of the classification system， positive ratings （“strongly agree” or “agree”） exceeded 85% for all items. Specifically， positive ratings for“the classification system can provide appropriate category selection”，“ the classification system is comprehensive”，“ the classification system is convenient to use” and “the classification system is highly satisfactory” exceeded 92%. CONCLUSIONS The Chinese DRP classification system developed demonstrates both high reliability and applicability， providing an effective and practical classification tool for pharmacists in China to conduct pharmaceutical care.

The promulgation of the Technical Specifications for Clinical Use of Blood (2025 Edition) signifies that China's clinical blood transfusion management has transitioned from mere technical operations to a new stage centered on patient blood management (PBM). Through an in-depth comparison of the new and old specifications, this paper analyzes the core transformations regarding conceptual reconstruction, legal alignment, technological upgrades, and closed-loop management. The new specifications establish PBM principles, reinforce legal safeguards for informed consent and emergency treatment, and construct a comprehensive, refined quality control system by specifying compatibility testing standards and introducing a post-transfusion evaluation system. Medical institutions should seize this opportunity to update management protocols and information systems, deepen multidisciplinary collaboration, and drive the profound transformation of clinical blood use from focusing solely on safety assurance to placing equal emphasis on science and value.

Objective: To translate the common metrics for donation attitude, subjective norm, perceived behavioral control, and intention for the blood donation context (BD-ASPI) into Chinese, and to test its reliability and validity among college students. Methods: A research team was established. Following Beaton's cross-cultural adaptation guidelines, the BD-ASPI was translated, culturally adapted, and pre-tested to develop the Chinese version. Using convenience sampling, 620 students from four universities in Wuhan were surveyed form August to November 2024 to test the scale's reliability and validity. Results: The Chinese version of the scale consisted of 21 items across four dimensions: attitude towards blood donation, subjective norm, perceived behavioral control, and intention. The item-level content validity index ranged from 0.89 to 1.00, and the average scale-level content validity index was 0.984. Confirmatory factor analysis indicated a good fit for the second-order factor model. The Criterion validity was 0.509 (P<0.001). The overall Cronbach's α coefficient was 0.965, with the coefficients for each dimension ranging from 0.891 to 0.974. The test-retest reliability was 0.894. Conclusion: The Chinese version of the BD-ASPI demonstrates good reliability and validity, and can serve as an effective tool for assessing the behavioral intention of voluntary blood donation among college students in China.

Objective To explore the prevalence of Helicobacter pylori (Hp) infection and its association with dietary and lifestyle habits among the adult physical examination population in Xuzhou area. Methods Retrospectively selected the physical examination population who underwent HP testing at our hospital's physical examination center from May 2021 to December 2023 as the research object. The prevalence of Hp infection in the population was analyzed based on the physical examination results. A questionnaire survey was used to collect information on the eating and living habits of all study subjects. Logistic regression was used to analyze the relationship between eating and living habits and Hp infection. Results A total of 1 354 physical examination people were included in the study, and the Hp infection rate was 37.30% (505/1354). The difference in Hp infection rates among people of different age groups is statistically significant (P<0.05), with the middle-aged population (41-59 years old) having the highest Hp positive infection rate (45.38%).High salt (41.11%), hot diet (40.56%), history of smoking (45.23%) and drinking (43.80%), less consumption of fruits and vegetables (43.73%), irregular exercise (41.29%), irregular diet People who frequently eat out (43.56%) and eat out frequently (42.57%) have a higher Hp infection rate (P<0.05).After adjusting for demographic factors such as gender, age, place of residence and education level, multivariate Logistic regression results showed that high-salt diet (OR=3.975, 95%CI: 2.670-5.917) and hot diet (OR=3.357, 95%CI: 2.291-4.919), smoking (OR=1.458, 95%CI: 1.082-1.964), drinking alcohol (OR=1.654, 95%CI: 1.279-2.138), eating fruits and vegetables (OR=1.759, 95%CI: 1.345-2.301), regular exercise (OR=1.822, 95%CI: 1.371-2.421), regular diet (OR=1.893, 95%CI: 1.391-2.575), eating out (OR=1.690, 95%CI: 1.277-2.237) were associated with the risk of Hp infection (P<0.05). Conclusion The positive infection rate of Hp among the physical examination population in Xuzhou is slightly lower than the average epidemic level in China. Cultivating healthy eating and living habits can effectively reduce the risk of Hp infection.

Objective To explore the effects of CYP2C19, CYP2C9 and CYP3A5 genotypes on the plasma concentration of voriconazole in children. Methods Collected blood samples from 50 hospitalized children with invasive fungal infections who received intravenous voriconazole from January 2020 to December 2020. High performance liquid chromatography was used to detect the blood trough concentration of voriconazole, and the time-of-flight mass spectrometry detection system was used to detect the genotypes of CYP2C19, CYP2C9 and CYP3A5, and the effects of children’s genotyping on the plasma concentration, efficacy and adverse reactions of voriconazole were analyzed. Results The total effective rate of 50 children with IFI was 84% （42/50 cases） after voriconazole treatment. The incidence of adverse reactions was 20% （10/50 cases）. The measured plasma concentration of voriconazole ranged from 0.56~7.62 μg/ml. Combined with the different mutation types of CYP2C19 gene loci, three metabolic activities were produced: fast, medium and slow, and the test results showed that there were 16 cases of fast metabolism, 27 cases of intermediate metabolism and 7 cases of slow metabolism. There was a significant difference in plasma concentrations among the three groups （F=15.359, P<0.001）, and the drug concentrations in the fast metabolic group were significantly lower than those in the intermediate metabolic and slow metabolic groups. The mutations of CYP2C9 and CYP3A5 had no significant effect on the plasma concentrations of the drugs, which were （F=2.213, P=0.086 and F=0.757, P=0.475）. Conclusion Voriconazole had significant efficacy in the treatment of invasive fungal infections in children, and the adverse reactions were mild. CYP2C19 genotype was significantly related to the rate of drug metabolism and was an important factor affecting blood drug concentration, the detection of drug concentration and genotype of voriconazole was helpful to adjust the effective drug dose clinically and would achieve more scientific and individualized treatment.