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 evaluate the effect of low-dose ¹⁸F-fluorodeoxyglucose (FDG) injection on image quality in pediatric patients, calculate the whole-body effective dose and absorbed doses to critical organs, and provide a reference for clinical protection in pediatric low-dose positron emission tomography/computed tomography (PET/CT) examination. Methods A total of 67 pediatric patients aged 4-14 years who underwent ¹⁸F-FDG whole-body PET/CT imaging in the Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University between January 2024 and December 2025 were enrolled in a retrospective study. According to the injected ¹⁸F-FDG dose, patients were divided into a full-dose group (37 cases, 2.96-3.7 MBq/kg, PET acquisition duration of 10 min) and a low-dose group (30 cases, 1.85-2.4 MBq/kg, PET acquisition duration of 15 min). All scans were performed using a uEXPLORER PET/CT scanner. The standardized uptake value, standard deviation, and signal-to-noise ratio were measured for the liver and mediastinal blood pool. Image quality was compared between the two groups. The PET effective dose was calculated based on body mass index, and the total effective dose was obtained by combining PET effective dose with CT effective dose. The doses to critical organs were calculated according to ICRP Publication 128. Statistical analysis was performed using SPSS 26.0 and Prism 9.0 software. Differences were compared between groups. Results There were no significant differences in age, sex, weight, height, or body mass index between the two groups (P>0.05), while the injected dose showed a significant difference (P<0.001). In terms of image quality, there were no significant differences in standardized uptake value, standard deviation, and signal-to-noise ratio between the two groups. In terms of radiation dose, compared with the full-dose group, the low-dose group showed a 35.13% reduction in PET effective dose and a 15.22% reduction in total effective dose (P<0.05), whereas the CT effective dose was reduced by 2.4% and the difference was not significant (P=0.0892). The doses to critical organs (gonads, breasts, thyroid, red bone marrow, lungs) in the low-dose group were significantly lower than those in the full-dose group (P<0.01). Conclusion Under the premise of meeting clinical diagnostic requirements, low-dose ¹⁸F-FDG whole-body PET/CT imaging in pediatric patients can reduce the overall radiation exposure by 15%, and decrease the doses to critical organs, including the gonads, by more than 20%.

Objective To evaluate the effect of low-dose ¹⁸F-fluorodeoxyglucose (FDG) injection on image quality in pediatric patients, calculate the whole-body effective dose and absorbed doses to critical organs, and provide a reference for clinical protection in pediatric low-dose positron emission tomography/computed tomography (PET/CT) examination. Methods A total of 67 pediatric patients aged 4-14 years who underwent ¹⁸F-FDG whole-body PET/CT imaging in the Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University between January 2024 and December 2025 were enrolled in a retrospective study. According to the injected ¹⁸F-FDG dose, patients were divided into a full-dose group (37 cases, 2.96-3.7 MBq/kg, PET acquisition duration of 10 min) and a low-dose group (30 cases, 1.85-2.4 MBq/kg, PET acquisition duration of 15 min). All scans were performed using a uEXPLORER PET/CT scanner. The standardized uptake value, standard deviation, and signal-to-noise ratio were measured for the liver and mediastinal blood pool. Image quality was compared between the two groups. The PET effective dose was calculated based on body mass index, and the total effective dose was obtained by combining PET effective dose with CT effective dose. The doses to critical organs were calculated according to ICRP Publication 128. Statistical analysis was performed using SPSS 26.0 and Prism 9.0 software. Differences were compared between groups. Results There were no significant differences in age, sex, weight, height, or body mass index between the two groups (P>0.05), while the injected dose showed a significant difference (P<0.001). In terms of image quality, there were no significant differences in standardized uptake value, standard deviation, and signal-to-noise ratio between the two groups. In terms of radiation dose, compared with the full-dose group, the low-dose group showed a 35.13% reduction in PET effective dose and a 15.22% reduction in total effective dose (P<0.05), whereas the CT effective dose was reduced by 2.4% and the difference was not significant (P=0.0892). The doses to critical organs (gonads, breasts, thyroid, red bone marrow, lungs) in the low-dose group were significantly lower than those in the full-dose group (P<0.01). Conclusion Under the premise of meeting clinical diagnostic requirements, low-dose ¹⁸F-FDG whole-body PET/CT imaging in pediatric patients can reduce the overall radiation exposure by 15%, and decrease the doses to critical organs, including the gonads, by more than 20%.

Objective To evaluate the effect of low-dose ¹⁸F-fluorodeoxyglucose (FDG) injection on image quality in pediatric patients, calculate the whole-body effective dose and absorbed doses to critical organs, and provide a reference for clinical protection in pediatric low-dose positron emission tomography/computed tomography (PET/CT) examination. Methods A total of 67 pediatric patients aged 4-14 years who underwent ¹⁸F-FDG whole-body PET/CT imaging in the Department of Nuclear Medicine, The First Affiliated Hospital of Shandong First Medical University between January 2024 and December 2025 were enrolled in a retrospective study. According to the injected ¹⁸F-FDG dose, patients were divided into a full-dose group (37 cases, 2.96-3.7 MBq/kg, PET acquisition duration of 10 min) and a low-dose group (30 cases, 1.85-2.4 MBq/kg, PET acquisition duration of 15 min). All scans were performed using a uEXPLORER PET/CT scanner. The standardized uptake value, standard deviation, and signal-to-noise ratio were measured for the liver and mediastinal blood pool. Image quality was compared between the two groups. The PET effective dose was calculated based on body mass index, and the total effective dose was obtained by combining PET effective dose with CT effective dose. The doses to critical organs were calculated according to ICRP Publication 128. Statistical analysis was performed using SPSS 26.0 and Prism 9.0 software. Differences were compared between groups. Results There were no significant differences in age, sex, weight, height, or body mass index between the two groups (P>0.05), while the injected dose showed a significant difference (P<0.001). In terms of image quality, there were no significant differences in standardized uptake value, standard deviation, and signal-to-noise ratio between the two groups. In terms of radiation dose, compared with the full-dose group, the low-dose group showed a 35.13% reduction in PET effective dose and a 15.22% reduction in total effective dose (P<0.05), whereas the CT effective dose was reduced by 2.4% and the difference was not significant (P=0.0892). The doses to critical organs (gonads, breasts, thyroid, red bone marrow, lungs) in the low-dose group were significantly lower than those in the full-dose group (P<0.01). Conclusion Under the premise of meeting clinical diagnostic requirements, low-dose ¹⁸F-FDG whole-body PET/CT imaging in pediatric patients can reduce the overall radiation exposure by 15%, and decrease the doses to critical organs, including the gonads, by more than 20%.

Total-body PET/CT, with its long axial field of view and high sensitivity detector, has shown potential for reducing the dose of radiopharmaceuticals. However, pediatric patients are significantly more sensitive to radiation and have a higher long-term cancer risk than adults, posing fundamental challenges for dose management in PET/CT examinations for these patients. In this article, the technical characteristics of total-body PET/CT and its radiation exposure status in children were systematically analyzed. The radiation exposure could be controlled by the following optimization strategies: adjusting the CT exposure parameters, optimizing the scanning mode, adding reconstruction algorithm, and reducing the injected dose of radioactive tracer. By addressing both external and internal radiation during the PET/CT scanning process, the overall radiation dose received by pediatric patients can be reduced within a certain range. In addition, this article also discusses the technical differences between “total-body” and “whole-body” concepts, and emphasizes that the future optimization of radiation dose in pediatric PET/CT should be realized by integration of personalized scanning protocols. Through reasonable management of scanning protocols and processes, low-dose and high-quality PET/CT imaging can be achieved in clinical environments, thus maximizing protection of pediatric patient health while minimizing the risks associated with ionizing radiation exposure.

Objective To explore the risk factors for medium-and long-term mortality in patients with severe community-acquired pneumonia(SCAP)based on the Medical Information Mart for Intensive Care Ⅳ(MIMIC-Ⅳ),construct a prognostic model and evaluate its predictive efficacy.Methods In this retrospective cohort study,1943 SCAP patients from the U.S.MIMIC-Ⅳdatabase(2008-2019)were randomly divided into training(n=1363)and validation(n=580)sets(7:3 ratio).Primary and secondary endpoints were 1-year and 30-/90-day all-cause mortality,respectively.Prognostic factors were selected using LASSO regression and multivariable Cox proportional hazards modeling,and a visual nomogram model was built.Model performance was assessed via C-index,receiver operator characteristic(ROC)curves,and calibration curves,and compared with the CURB-65 score.Risk stratification was validated using Kaplan-Meier analysis.Results The 30-day,90-day,and 1-year all-cause mortality rates for SCAP patients were 25.9％,34.5％,and 42.6％,respectively.Seven independent risk factors were identified:age(HR=1.037),heart rate(HR=1.007),red blood cell distribution width(RDW,HR=1.092),Acute Physiology Score Ⅲ(APS-Ⅲ,HR=1.013),cerebrovascular disease(HR=1.453),liver disease(HR=1.272),and malignancy(HR=2.007).Based on these factors,Cox regression model was constructed and nomogram was drawn,C-indices of training set and validation set were 0.710 and 0.688,respectively.For 1-year mortality prediction,the model achieved superior area under the ROC curve(AUC)values(training set:0.768;validation set:0.738)compared with CURB-65 score(training set:0.648;validation set:0.616).Kaplan-Meier survival analysis revealed significantly worse survival in high-risk group than low-risk group(P<0.0001).Conclusions Age,heart rate,RDW,APS-Ⅲ,cerebrovascular disease,liver disease,and malignant tumor were medium-and long-term mortality risk factors in SCAP patients.The prognostic model constructed based on these factors has high predictive power and provides an important clinical diagnosis and treatment reference.

Objective: To retrospectively analyze the clinical data of 474 newborns with hyperbilirubinemia, and to investigate the clinical characteristics of hyperbilirubinemia caused by ABO hemolytic disease of the fetus and newborn (ABO-HDFN) and factors influencing the phototherapy duration. Methods: A total of 474 neonates with hyperbilirubinemia treated in the First Hospital of Lanzhou University from January 2019 to January 2023 were enrolled. Blood type identification and the standard serological tests (direct antiglobulin test, serum free antibody test, and antibody elution test) were performed for all neonates. Baseline clinical data were collected and analyzed. According to the results of the hemolysis tests, neonates were divided into hemolytic jaundice group and non-hemolytic jaundice group. Clinical indicators, including hemoglobin levels, length of hospital stay, and phototherapy duration, were compared between the two groups. A multiple linear regression model was used to explore clinical factors influencing the duration of phototherapy. Results: Among the 474 neonates with hyperbilirubinemia, 354 were diagnosed with ABO-HDFN (hemolytic group), while 120 were without ABO-HDFN (non-hemolytic group). The incidence of ABO-HDFN in neonates with blood type A (55.93%, 198/354) was significantly higher than those with blood type B (44.07%, 156/354) (P<0.05). Furthermore, neonates born to multiparous women had a significantly higher ABO-HDFN incidence (81.56%, 146/179) than first-born neonates (70.51%, 208/295) (P<0.05). Neonates in the hemolytic group had significantly lower hemoglobin levels (170.67±21.86 g/L vs 178.99±22.05 g/L, P<0.001), lower red blood cell counts (4.66±0.63×10 /L vs 4.89±0.59×10 /L, P<0.05), and lower hematocrit (50.05±6.56% vs 52.61±6.75%, P<0.05) compared to the non-hemolytic group. Additionally, the hemolytic group had significantly longer hospital stays (6 [5, 9] days vs 6 [4, 8] days), longer phototherapy duration (62 [38, 84.25] h vs 53 [34.25, 64.77] h), and higher frequency of jaundice episodes (9 [7, 13] times vs 8 [6, 12] times] compared to the non-hemolytic group (all P<0.05). Regression analysis indicated that a positive indirect Coombs test and multiparity were independent risk factors associated with prolonged phototherapy duration (P<0.05). Conclusion: ABO incompatibility is the leading cause of hemolytic disease in neonates, particularly in cases where the mother has blood type O and the neonate has blood type A. In such cases, close monitoring of bilirubin levels is strongly recommended. Multiparous pregnancies increase the risk of alloimmune hemolysis. Therefore, neonates born to multiparous women may require more frequent bilirubin monitoring and appropriate prenatal interventions when necessary. Additionally, changes in indicators such as hemoglobin level and red blood cell count should be closely monitored as early warning indicators for hemolytic anemia and bilirubin elevation.

The rules of acupoint selection and treatment were identified and discovered from the collected ancient acupuncture-moxibustion prescriptions recorded the earliest for epigastric pain. The database of ancient acupuncture-moxibustion prescriptions for epigastric pain was set up using Excel2016 software. After the disease term, etiology, pathogenesis, symptoms and acupoints were normalized, the underlying multi-dimensional correlation among the elements of acupuncture-moxibustion was explored, using the frequency statistics and the association rule of Apriori algorithm. In the ancient time, in treatment with acupuncture-moxibustion therapy for epigastric pain, the acupoints of the high use frequency were sequenced as Zhongwan (CV12), Shangwan (CV13), Zusanli (ST36), Neiguan (PC6), Gongsun (SP4), Pishu (BL20) and Weishu (BL21). The common combinations of acupoints included the pairs of back-shu points, the combination of back-shu points and front-mu points, the combination of front-mu points and yuan-source points and the combination of back-shu points and the lower he-sea points. The highly involved acupoints were those from the conception vessel, pericardium meridian, spleen meridian, stomach meridian and bladder meridian; and they were commonly distributed on the abdomen, the yin parts of the foot and the arm, the yang part of the leg and on the back. Regarding the etiologies such as parasites, food retention, masses, qi stagnation and stomach cold, Zhongwan (CV12) and Shangwan (CV13) were coordinated; and Sanyinjiao (SP6) and Daling (PC7) were highly associated with masses. Besides cold injury, parasites and masses, for the epigastric pain caused by other factors of etiology (qi stagnation, stomach cold and food retention), moxibustion therapy was greatly applicable. For epigastric pain combined with qi reversion in the lower abdominal region, Qichong (ST30), Sanyinjiao (SP6), Tianshu (ST25) and Zusanli (ST36) must be selected. Dadu (SP2) and Taibai (SP3) must be used if the distention in the chest and abdomen accompanied; and Zhongzhu (TE3) be used if back pain involved. Zusanli (ST36) was commonly selected for hiccups. For the other accompanied symptoms, Zhongwan (CV12) was used, which is consistent with the acupoint selection of main symptoms. On the trunk, moxibustion was generally used at Weishu (BL21), Pishu (BL20), Geshu (BL17), Zhongwan (CV12), Juque (CV14) and Qihai (CV6), except Shangwan (CV13). Among the acupoints below the elbows and knees, moxibustion was commonly applicable at Zusanli (ST36), and acupuncture was often used at Gongsun (SP4) and Daling (PC7).
Acupuncture Points ; Humans ; Moxibustion/history* ; History, Ancient ; Acupuncture Therapy/history* ; Data Mining ; Abdominal Pain/history*

INTRODUCTION: Obstructive sleep apnoea (OSA) is common in Singapore, with moderate to severe OSA affecting around 30% of residents. These consensus statements aim to provide scientifically grounded recommendations for the management of OSA, standar-dise the management of OSA in Singapore and promote multidisciplinary collaboration. METHOD: An expert panel, which was convened in 2024, identified several areas of OSA management that require guidance. The expert panel reviewed the current literature and developed consensus statements, which were later independently voted on using a 3-point Likert scale (agree, neutral or disagree). Consensus (total ratings of agree and neutral) was set a priori at ≥80% agreement. Any statement not reaching consensus was excluded. RESULTS: The final consensus included 49 statements that provide guidance on the screening, diagnosis and management of adults with OSA. Additionally, 23 statements on the screening, diagnosis and management of paediatric OSA achieved consensus. These 72 consensus statements considered not only the latest clinical evidence but also the benefits and harms, resource implications, feasibility, acceptability and equity impact of the recommendations. CONCLUSION The statements presented in this paper aim to guide clinicians based on the most updated evidence and collective expert opinion from sleep specialists in Singapore. These recommendations should augment clinical judgement rather than replace it. Management decisions should be individualised, taking into account the patient's clinical characteristics, as well as patient and caregiver concerns and preferences.
Humans ; Sleep Apnea, Obstructive/diagnosis* ; Singapore ; Consensus ; Adult

Perilla frutescens (L.) Britt. is a characteristic oil crop rich in polyunsaturated fatty acids, particularly α-linolenic acid, which has important development and utilization value. The Dof transcription factor is one of the plant-specific transcription factor families, which is widely involved in important biological processes such as plant growth, development, and metabolic regulation. In order to explore the key Dof transcription factors involved in the oil biosynthesis and systematically analyze their regulatory mechanisms of P. frutescens seeds, a total of 56 PfDof gene family members were identified from the genome and transcriptome data of P. frutescens and classified into four subfamilies according to sequence characteristics. All PfDofs contained highly conserved C₂-C₂ zinc finger domains, with gene duplication being the primary mechanism driving their evolution and expansion. Genes within the same subgroup exhibited similar gene structures and conserved motifs. The 56 PfDofs were predicted as unstable hydrophilic proteins, with α-helixes and random coils as their predominant structural components. The RNA-seq results revealed that 11 PfDofs exhibited differential expression during different developmental stages of P. frutescens seeds. RT-qPCR was performed to further validate the expression patterns of these 11 members across various tissue samples (root, stem, leaf, and flower) of P. frutescens and at different developmental stages of its seeds. The results showed that PfDof29 exhibited the highest expression level in seeds, which was consistent with the transcriptome data. Subcellular localization studies demonstrated that PfDof29 was localized to the nucleus and had a transcriptional activation activity. Overexpression of PfDof29 in Nicotiana tabacum resulted in a significant increase in total oil content of tobacco leaves, accompanied by reductions in starch and soluble sugar content, while the protein content remained unchanged. Additionally, the metabolic balance between saturated and unsaturated fatty acids in the transgenic tobacco leaves was altered, with a significant increase in α-linolenic acid content. The expression levels of the fatty acid desaturase genes NtFAD2, NtFAD3, and NtFAD8 were significantly upregulated. A yeast one-hybrid assay revealed that PfDof29 could directly bind to the promoter region of PfFAD8, thereby regulating its expression. This study provides an initial understanding of the regulatory mechanisms of PfDof transcription factors in the synthesis and accumulation of oil in P. frutescens. These findings offer new insights into the enhancement of oil content and quality of P. frutescens seeds.
Transcription Factors/physiology* ; Perilla frutescens/metabolism* ; Plant Proteins/metabolism* ; Gene Expression Regulation, Plant ; alpha-Linolenic Acid/biosynthesis* ; Lipids/biosynthesis* ; Seeds/genetics*