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.

Objective:To analyze the structural changes and influencing factors of Total Health Expenditure(THE)in Inner Mongolia from 2008 to 2023,and provide references for formulating and adjusting relevant health policies in the region.Methods:Structural change degree analysis was used to examine the financing structure of THE,while principal component regression was employed to identify the influencing factors of THE.Results:From 2008 to 2023,THE in Inner Mongolia showed continuous growth,with a significant increase in per capita health expenditure,though there is still room for improvement compared with other regions.Government health expenditure and social health expenditure generally showed positive changes,while individual health expenditure showed negative changes.Per capita disposable income,urbanization rate,and per capita regional GDP were positively correlated with THE,while natural population growth rate and hospital bed utilization rate were negatively correlated with THE.Conclusion:THE in Inner Mongolia continued to grow from 2008 to 2023,but problems such as insufficient government investment and the need to optimize the financing structure existed.Given that economic factors dominate THE growth,it is recommended to achieve reasonable control of THE by improving the efficiency of health resources.

Objective:To explore the effectiveness of rapid cycle deliberate practice (RCDP) in training newly hired nurses′comprehensive emergency competence and to provide references for enhancing their capabilities.Methods:A quasi-experimental study was conducted using purposeful sampling. From September to December 2022, newly hired nurses at Liaocheng Second People′s Hospital were selected as research subjects and randomly assigned to a controlor an observation group using random number table. The control group received traditional group drill training, while the observation group underwent RCDP training. The study compared pre- and post-training scores of emergency theory and skill assessments, scores on the Chinese version of the Perceived Cognitive Ability Scale in Emergency Situations (PCAS), and training satisfaction levels between the two groups.Results:Each group comprised 30 nurses. The control group consisted of 3 males and 27 females, with a mean age of (22.70 ± 1.09) years; the observation group included 2 males and 28 females, with a mean age of (22.93 ± 0.87) years. Post-training comprehensive emergency competence assessment scores was (89.19 ± 1.47) in the control group and (93.00 ± 1.41) in the observation group, with a statistically significant difference ( t = - 4.60, P<0.01). The scores and total scores of PCAS in the observation group were (34.23 ± 1.91), (12.70 ± 1.62), (10.03 ± 1.52) and (56.97 ± 3.09), respectively, which were higher than the (31.70 ± 2.42), (11.90 ± 1.16), (9.10 ± 1.42), and (52.47 ± 3.65) in the control group, the difference between the two groups were statistically significant ( t value were - 5.16 - - 2.20, all P<0.05). The total score of training satisfaction of nurses in the observation group was (41.93 ± 2.53) points, and the difference was statistically significant compared with the (33.80 ± 2.58) pointsin the control group ( t = - 12.33, P<0.01). Conclusions:The application of the RCDP method in training newly recruited nurses′comprehensive emergency competence effectively enhances their learning enthusiasm and initiative, thereby improving training outcomes.

Atrial fibrillation(AF)is one of the most common clinical arrhythmias and a significant risk factor for thromboembolism.The left atrial appendage(LAA)is the primary site of thrombus formation in AF patients.Recent studies have explored the mechanisms of LAA thrombosis from multiple dimensions,including anatomical structure(LAA morphology and architecture),functional indicators(hemodynamic alterations),pathophysiological mechanisms(endothelial injury,inflammatory activation),systemic diseases(renal dysfunction)and genetic factors(gene polymorphisms),providing critical evidence for precise clinical anticoagulation.This article systematically reviews the latest research advances in the mechanisms of LAA thrombosis in AF patients,aiming to offer theoretical support for the accurate assessment of thromboembolic risk and the formulation of individualized anticoagulation strategies.Additionally,it lays the foundation for exploring the intrinsic relationship and mechanisms between LAA hemodynamics and heart failure as well as thromboembolic events.

Objective:To evaluate the effect of electroacupuncture (EA) on ionotropic purinergic receptor 4 (P2X4R)/nuclear factor-kappa B (NF-κB) signaling pathway during spinal cord injury (SCI) in rats.Methods:Thirty-six clean-grade healthy adult female Sprague-Dawley rats, weighing 210-250 g, were divided into 3 groups ( n=12 each) using a random number table method: sham surgery group (S group), SCI group, and SCI+ EA treatment group (SCI+ EA group). The SCI model was established by the Allen′s method in anesthetized animals. In group S, only the spinous processes and vertebral laminae were resected, but the spinal cord was not injured. On the 7th day after developing the model, EA of Jiaji, Dazhui, and Mingmen lasting 30 min was performed once a day for 7 consecutive days, with a depth of 2 mm, intensity of 12-15 mV, frequency of 2 Hz, in SCI+ EA group. The mechanical paw withdraw threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 1 day before developing the model and 3, 7, 14, 21 and 28 days after developing the model, and the motor function was assessed using the Basso-Beattie-Bresnahan (BBB) score. The recovery of motor function was assessed using footprint analysis at 28 days after developing the model. After the final behavioral testing, the rats were sacrificed, and spinal cord tissues were harvested to observe the pathological changes of the spinal cord tissues using hematoxylin-eosin staining, to detect the expression of P2X4R and phosphorylated NF-κB p65 (p-NF-κB p65) (by immunohistochemical analysis and Western blot) and to determine contents of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and IL-6 (by enzyme-linked immunosorbent assay). Results:Compared with the baseline measured at 1 day before developing the model, the MWT and BBB scores were significantly decreased and the TWL was shortened at each time point after developing the model in SCI group and SCI+ EA group ( P<0.05). Compared with S group, the MWT and BBB scores were significantly decreased and the TWL was shortened at each time point after developing the model, the expression of P2X4R and p-NF-κB p65 in spinal cord tissues was up-regulated, and the contents of TNF-α, IL-1β and IL-6 were increased in SCI group ( P<0.05). Compared with SCI group, the MWT and BBB scores were significantly increased and the TWL was prolonged at 14, 21 and 28 days after developing the model, the expression of P2X4R and p-NF-κB p65 in spinal cord tissues was down-regulated, and the contents of TNF-α, IL-1β and IL-6 were decreased ( P<0.05), and the pathological damage of spinal cord tissues was alleviated and footprints were reduced in SCI+ EA group. Conclusions:The mechanism by which EA alleviates SCI may be related to the inhibition of the activation of the P2X4R/NF-κB signaling pathway and the reduction in the inflammatory response in rats.

Objective:To analyze the structural changes and influencing factors of Total Health Expenditure(THE)in Inner Mongolia from 2008 to 2023,and provide references for formulating and adjusting relevant health policies in the region.Methods:Structural change degree analysis was used to examine the financing structure of THE,while principal component regression was employed to identify the influencing factors of THE.Results:From 2008 to 2023,THE in Inner Mongolia showed continuous growth,with a significant increase in per capita health expenditure,though there is still room for improvement compared with other regions.Government health expenditure and social health expenditure generally showed positive changes,while individual health expenditure showed negative changes.Per capita disposable income,urbanization rate,and per capita regional GDP were positively correlated with THE,while natural population growth rate and hospital bed utilization rate were negatively correlated with THE.Conclusion:THE in Inner Mongolia continued to grow from 2008 to 2023,but problems such as insufficient government investment and the need to optimize the financing structure existed.Given that economic factors dominate THE growth,it is recommended to achieve reasonable control of THE by improving the efficiency of health resources.

Objective To explore the clinical effect of 3D-printed interbody fusion cage applied in anterior cervical decompression and bone graft fusion for the treatment of cervical spondylotic myelopathy.Methods A total of 100 patients with cervical spondylotic myelopathy who underwent anterior cervical fusion surgery in our hospital from June 2020 to June 2023 were selected as the research subjects,they were randomly divided into the 3D group and the control group according to the random number table method,with 50 cases in each group.Patients in the 3D group were implanted with a 3D-printed interbody fusion cage which was made of microporous metal materials,while patients in the control group were implanted with intervertebral fusion cage which was made of polyetheretherketone material.The surgery-related indicators,cervical imaging parameters,cervical spinal cord function,cervical axial function and surgical complications of patients between the two groups were compared.Results There was no statistically significant difference in the operation time,intraoperative blood loss or length of hospital stay of patients between the two groups(P>0.05).The height of the cervical fusion segments and the Cobb angle of the fusion segments of patients in both groups at each time point after the operation were significantly increased compared with those before the operation(P<0.05).The height of the cervical fusion segments and the Cobb angle of the fusion segments of patients 1 month,3 months,and 6 months after the operation in the 3D group were all greater than those in the control group(P>0.05).The subjective symptom score and the total score of the Japanese orthopaedic association(JOA)of patients 6 months after the operation in the 3D group were higher than those in the control group(P<0.05).The cervical axial function of patients 6 months after the operation in the 3D group was better than that in the control group(P<0.05).The incidence of surgical complications in the 3D group was lower than that in the control group(P<0.05).Conclusion The use of 3D-printed interbody fusion cage during the anterior cervical decompression and bone graft fusion for patients with cervical spondylotic myelopathy can significantly improve the clinical symptoms of patients,achieve better cervical axial function,and have fewer complications.

Objective:To investigate the correlation of programmed death receptor-1(PD-1)and V-domain im-munoglobulin suppressor of T-cell activation(VISTA)expression with the imbalance of helper T lymphocytes(Th)1/Th2,Th17/regulatory T cells(Treg),and Th22 in the microenvironment of endometrial cancer(EC).Methods:From March 1,2020 to June 30,2023,94 patients with EC(EC group),94 patients with atypical hyperplasia of the endometrium(AH),and 94 controls without uterine and endometrial diseases such as EC and AH(control group)were selected for treatment at the Tangshan Maternal and Child Health Hospital.The expression of PD-1 and VIS-TA in various tissues and the levels of Th1/Th2,Th17/Treg,and Th22 in the endometrial microenvironment were compared.Pearson analysis was used to investigate the correlation between the expression of PD-1 and VISTA in tissues and the imbalance of Th1/Th2,Th17/Treg,and Th22 in the EC microenvironment.The positive expression of PD-1 and VISTA in tissues of patients with different pathological characteristics was also compared.Results:①The expression of PD-1 and VISTA was higher in EC group and AH group than that in the control group,and high-er in EC group than AH group,with statistically significant differences(P＜0.05).In both EC group and AH group,Th1/Th2 and Th17/Treg levels in the microenvironment were lower than those in the control group,while Th22 level was higher.EC group showed lower Th1/Th2 and Th17/Treg levels but higher Th22 level than AH group,with statistically significant differences(P＜0.05).②No correlation was found between the expression of PD-1 and VISTA and the Th1/Th2,Th17/Treg,and Th22 in the microenvironment in control group(P＞0.05).In AH group and EC group,the expression of PD-1 and VISTA was negatively correlated with the Th1/Th2 and Th17/Treg lev-els in the microenvironment(r＜0,P＜0.05),but positively correlated with Th22 level in the microenvironment(r＞0,P＜0.05).③In EC patients,the expression of PD-1 was related with clinical stage,invasion depth,and lymph node metastasis(P＜0.05);VISTA expression was related with clinical stage and lymph node metastasis(P＜0.05).Conclusions:The high expression of PD-1 and VISTA in EC is closely associated with the imbalance of Th1/Th2,Th17/Treg,and Th22 in the tumor microenvironment,as well as the tumor ivasiveness.The dual inhibi-tion strategy targeting PD-1 and VISTA immune checkpoints may offer a novel approach for EC treatment.

Arterial thrombosis is a major cause of death in several cardiovascular diseases(CVDs),including coronary heart disease and stroke.Since platelets play a pivotal role in arterial thrombosis,antiplatelet drug is an important part of the clinical therapy of CVD patients.Currently,the long-term antithrombotic effect of the dual antiplatelet thera-py of P2Y12 antagonists combined with aspirin are showed to be effective.And αⅡbβ3 antagonists rep-resented by tirofiban are widely used for antiplate-let therapy in emergency surgery.However,the bleeding risk caused by antiplatelet therapy is a clinical issue that cannot be ignored.In order to provide a reference for further research on anti-platelet drugs,this article reviews the major tar-gets of antiplatelet drugs and the drugs that have been under clinical research in recent years.

Atrial fibrillation(AF)is one of the most common clinical arrhythmias and a significant risk factor for thromboembolism.The left atrial appendage(LAA)is the primary site of thrombus formation in AF patients.Recent studies have explored the mechanisms of LAA thrombosis from multiple dimensions,including anatomical structure(LAA morphology and architecture),functional indicators(hemodynamic alterations),pathophysiological mechanisms(endothelial injury,inflammatory activation),systemic diseases(renal dysfunction)and genetic factors(gene polymorphisms),providing critical evidence for precise clinical anticoagulation.This article systematically reviews the latest research advances in the mechanisms of LAA thrombosis in AF patients,aiming to offer theoretical support for the accurate assessment of thromboembolic risk and the formulation of individualized anticoagulation strategies.Additionally,it lays the foundation for exploring the intrinsic relationship and mechanisms between LAA hemodynamics and heart failure as well as thromboembolic events.