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.

The Expert Consensus on Clinical Application of Qinbaohong Zhike Oral Liquid in Treatment of Acute Bronchitis and Acute Attack of Chronic Bronchitis （GS/CACM 337-2023） was released by the China Association of Chinese Medicine on December 13^th， 2023. This expert consensus was developed by experts in methodology， pharmacy， and Chinese medicine in strict accordance with the development requirements of the China Association of Chinese Medicine （CACM） and based on the latest medical evidence and the clinical medication experience of well-known experts in the fields of respiratory medicine （pulmonary diseases） and pediatrics. This expert consensus defines the application of Qinbaohong Zhike oral liquid in the treatment of cough and excessive sputum caused by phlegm-heat obstructing lung， acute bronchitis， and acute attack of chronic bronchitis from the aspects of applicable populations， efficacy evaluation， usage， dosage， drug combination， and safety. It is expected to guide the rational drug use in medical and health institutions， give full play to the unique value of Qinbaohong Zhike oral liquid， and vigorously promote the inheritance and innovation of Chinese patent medicines.

Objective:To conduct a multi-center cross-sectional study of elderly patients with cognitive impairment based on real-world data; To analyze the clinical characteristics and core medication law of the disease population.Methods:The medical records of elderly patients diagnosed with cognitive impairment from January 1, 2016 to December 31, 2024 were retrieved from Chinese Evidence-based TCM Database. Excel 2010 software was used to collect general information, TCM syndrome elements and syndrome types, use frequency of Chinese materia medica, property, taste, meridian tropism, efficacy classification and other information, using PivotTable to establish Chinese materia medica matrix. IBM SPSS Modeler 18.0 software was used to display the frequency of co-occurrence among high-frequency Chinese materia medica, and the association rules were analyzed based on the Apriori algorithm. R language 4.4.1 was used for clustering analysis on Chinese materia medica and the cluster pedigree and correlation heat map were drawn.Results:A total of 1 194 elderly patients with cognitive impairment were enrolled, with a mean age of (79.51±7.65) years, and the highest frequency of comorbidities was hypertension (891 cases, 74.62%); AD was the most frequent diagnosis of cognitive impairment (367 times, 30.74%). The proportion of mild cognitive impairment in the low value group of Systemic Immune Inflammation Index (SII) was relatively high, and the high value group of SII was mainly vascular dementia and AD. Wind-phlegm blocking syndrome (106 times, 13.73%) topped the list; phlegm was the most frequent element of pathogenicity (353 times, 45.73%), and meridians and collaterals (194 times, 25.13%). Totally 328 prescriptions were included, involving 308 kinds of Chinese materia medica. The total recorded frequency of Chinese materia medica was 5 665, with tonifying herbs constituting the most frequently used category, accounting for 1 633 times; the medicinal property of drugs for treating elderly patients with cognitive disorders was mostly warm (103 times, 33.44%), the taste was mostly bitter (141 times, 45.78%), and attributed to the liver meridian (145 times, 47.08%); among the two and three association rules, the drug pairs with the highest confidence were Gastrodiae Rhizoma→Uncariae Ramulus cum Uncis (97.22%) and Hyperici Perforati Herba→Acanthopanacis Senticosi Radix et Rhizoma seu Caulis+Alpiniae Oxyphyllae Fructus (97.06%); five medicinal combinations were obtained by high frequency drug clustering analysis.Conclusions:Elderly patients with cognitive impairment are mainly diagnosed with AD. There may be a potential correlation between SII level and the progression of cognitive impairment. The drugs are used to tonify the kidney and replenish essence, detoxify and unblock collaterals, replenish qi and activate blood circulation, and awaken the brain and open the orifices. Shengmai Decoction, Renshen Yangrong Decoction and other TCM classic prescriptions can be used in clinic.

Objective:To evaluate the therapeutic effect of intense pulsed light on rosacea.Methods:From December 2022 to April 2023, the Dermatology Department of the Affiliated Hospital of Shaanxi University of Chinese Medicine searched PubMed, Embase, Cochrane Library, CNKI, Wanfang, VIP, CBM and other Chinese and English databases to collect clinical randomized controlled studies on intense pulsed light treatment of rosacea for ameta-analysis.Results:A total of 559 patients were included in 6 randomized controlled trials. The efficacy of the combination of strong pulsed light and medication in the treatment of rosacea was significantly better than that of medication alone ( Z=6.15, P<0.001). After subgroup analysis, the combination of strong pulsed light and tetracycline drugs was more effective in treating rosacea than using tetracycline drugs alone ( Z=3.17, P<0.05). The efficacy of the combination of strong pulsed light and minocycline in the treatment of rosacea was better than that of minocycline alone ( Z=2.37, P<0.05), and clinical evaluation showed the improvements of erythema, papules, and pustules. The differences in scores for itching and capillary dilation were statistically significant ( P<0.05). Conclusions:The efficacy of intense pulsed light therapy for rosacea is definite, and its combination with topical or oral medication is superior to that of medication alone. However, the stability of the effect needs to be confirmed by more high-quality randomized controlled trials.

Ulcerative colitis （UC） is a chronic inflammatory bowel disease with complex etiology. The pathogenesis of this disease， due to a combination of factors， is complex and has not yet been elucidated. Among them， intestinal mucosal barrier damage is the basic pathological change of UC. As a non-destructive response of cells， autophagy regulates intestinal mucosal immunity， inflammation， oxidative stress， and bacterial homeostasis through degradation and reabsorption to actively repair damaged intestinal mucosal barrier， exerting a key role in the occurrence and development of UC. The disease is mainly treated clinically with aminosalicylic acid preparations， glucocorticoids， and immunosuppressants. Western medicine treatment of the disease has a fast onset of effect， and the short-term efficacy is definite， but the long-term application is easy to be accompanied by more adverse reactions. Moreover， some drugs are expensive， bringing great physical and mental pain and economic burden to patients. Therefore， it is urgent to explore new therapies with stable efficacy and mild adverse effects. In recent years， a large number of studies have shown that Chinese medicine can regulate autophagy of the intestinal mucosa with multiple targets and effects and repair the intestinal mucosal barrier function， thereby inhibiting the development of UC. Many experiments have shown that the active ingredient or monomers and compound formulas of Chinese medicine can improve the immunity of the intestinal mucosa， inflammation， oxidative stress， and flora by regulating the level of autophagy to maintain the normal function of the intestinal mucosal barrier to effectively intervene in UC， providing a new measure for the prevention and treatment of UC. However， there is a lack of systematic review of Chinese medicine in regulating the level of autophagy in the intestinal mucosa for the prevention and treatment of UC. Therefore， based on the current research on UC， autophagy process， and Chinese medicine treatment， this article reviewed the relationship of autophagy and its key target proteins with UC to clarify the key role of autophagy in UC production and systematically summarized Chinese medicines targeting the regulation of autophagy to treat UC in recent years to provide new ideas for the treatment and drug development of UC.

Objective To investigate the role of hydrogen therapy in reducing radiation-induced lung injury and the specific mechanism. Methods Forty C57BL/6 mice were randomly divided into four groups: normal control group, model group, hydrogen therapy group I, and hydrogen therapy group II. A mouse model of radiation-induced lung injury was established. The pathological changes in the lung tissue of the mice were examined with HE staining. Immunofluorescence staining was used to detect the expression of surface markers of M1 and M2 macrophages to observe macrophage polarization. The expression of interleukin (IL)-6, tumor necrosis factor-α (TNF-α), and IL-10 in the lung tissue was measured by immunohistochemistry. The expression of nuclear factor-kappa B (NF-κB) p65 and phosphorylated NF-κB (P-NF-κB) p65 was measured by Western blot. Results HE staining showed that compared with the control group, the model group exhibited alveolar septal swelling and thickening, vascular dilatation and congestion, and inflammatory cell infiltration in the lung tissue; the hydrogen groups had significantly reduced pathological damage and inflammatory response than the model group, with more improvements in hydrogen group II than in hydrogen group I. Immunohistochemical results showed that compared with those in the control group, the levels of the inflammatory cytokines IL-6 and TNF-α were significantly increased in the model group; the hydrogen groups showed significantly decreased IL-6 and TNF-α levels and a significantly increased level of the anti-inflammatory factor IL-10 than the model group, which were more marked in hydrogen group II than in hydrogen group I. Immunofluorescence results showed that compared with the control group, the expression of the surface marker of M1 macrophages in the model group was significantly upregulated; the hydrogen groups showed significantly downregulated M1 marker and significantly upregulated M2 marker, and hydrogen group II showed significantly increased M2 marker compared with hydrogen group I. Western blot results showed that compared with that in the control group, the ratio of P-NF-κB p65/NF-κB p65 in the model group was significantly increased; the P-NF-κB p65/NF-κB p65 ratio was significantly reduced in the hydrogen groups than in the model group, and was significantly lower in hydrogen group II than in hydrogen group I. Conclusion Hydrogen inhalation therapy may reduce the inflammatory response of radiation-induced lung injury by inhibiting the NF-κB signaling pathway to promote the polarization of the macrophage M1 subtype to the M2 subtype.

With increasing aging， cognitive impairment in elderly coronary heart disease is a "disease group" with high morbidity and mortality in the senior population， which seriously affects the health and quality of life of the elderly. This paper takes the "cardio-cerebral circuit" as the basis of co-morbidity， and under the guidance of the cardio-cerebral homoeopathy， based on the temporal sequential characteristics of the evolution of the disease mechanism of cognitive impairment in elderly coronary heart disease， we construct a “disease-syndrome-phase” prevention and treatment strategy based on the time-sequential characteristics of the pathogenesis of the disease mechanism of "deficiency-blood stasis-toxicity"， from the perspective of pathogenicity of the disease mechanism in time-phase and the spatial multidimensionality of cardio-cerebral homoeopathy. The prevention and treatment strategy of the "disease-syndrome-phase" is constructed from the perspective of the temporal phase of the disease mechanism and the multidimensionality of the space of cardio-cerebral homoeopathy. In the earlier stage， "kidney deficiency and brain emptiness are the foundation"， in the attack stage， "turbid stasis and brain injury are the key"， and in the progression stage， "toxicity and brain damage are the changes". It is emphasized that replenishing the deficiency and benefiting the kidneys to restore the smooth flow of collaterals， eliminating blood stasis and removing turbidity to promote the enrichment of blood， and detoxifying and clearing the heart to tranquilize the spirit and benefit the brain， the spatiotemporal thinking of cognitive impairment of coronary heart disease in the elderly is initially constructed with the spatial dimension to identify the location of the disease， and the temporal dimension to determine the stage of the disease， which will provide a theoretical basis for the spatiotemporal diagnostic and treatments for the heart and brain co-morbidities of TCM.

Ulcerative colitis （UC） is a chronic， non-specific inflammatory bowel disease. The pathogenesis of this disease is complex and is attributed to multiple factors. Intestinal mucosal barrier damage is the basic pathological change of UC， and intestinal flora disorder is one of the important characteristics of UC. Intestinal flora plays a key role in the pathological process of UC by regulating intestinal mucosal immunity and inflammatory response to repair the damaged intestinal mucosal barrier. At present， western medicine has the advantages of rapid action onset and significant short-term efficacy， but the curative effect of long-term use is not good， accompanied by many adverse reactions， causing great physical and mental pain to patients. Therefore， it is urgent to explore new treatment methods with definite long-term efficacy and mild adverse reactions. A large number of studies have shown that Chinese medicine can regulate intestinal flora through multiple targets in an all-around way， restore the homeostasis of the flora， and repair the damaged intestinal mucosal barrier， thereby inhibiting the progression of UC. Numerous studies have shown that the active components， monomers， and compounds of Chinese medicine can effectively antagonize UC by regulating the intestinal flora to improve the intestinal mucosal immunity， reduce the inflammatory response of the intestinal mucosa， and restore the normal physiological function of the intestinal mucosal barrier， providing a new strategy for UC prevention and treatment. Although there are some studies of the regulation of intestinal flora by Chinese medicine to prevent and treat UC， those studies have the shortcomings of systematic and comprehensive inadequacy. Therefore， based on the research status of UC， intestinal flora， and Chinese medicine treatment， this study reviewed the relationship between intestinal flora and UC and clarified the key role of intestinal flora in the occurrence and development of UC. At the same time， this paper comprehensively summarized the Chinese medicine that targeted the regulation of intestinal flora for the treatment of UC in the past five years to provide new strategies and ideas for UC treatment.

BACKGROUND:Gold nanoparticles are of great significance in the development of multifunctional transdermal drug delivery systems.Smaller gold nanoparticles can penetrate the dermis through the intercellular pathway,but are limited to their easy agglomeration and colloidal morphology,which makes it difficult to exert effects on low delivery efficiency. OBJECTIVE:To develop an ultrasound-optimized hydrogel delivery system by combining phase change nanodroplets with bio-adhesive hydrogel for percutaneous delivery of gold nanoparticles. METHODS:The ultrasound-responsive nanodroplets loaded with gold nanoparticles were prepared by the emulsion solvent evaporation method and loaded into the polydopamine-modified methylacryloyl gelatin hydrogel to prepare a composite hydrogel scaffold.The structure and chemical composition of the ultrasound-responsive nanogold carrier were characterized.The microstructure,porosity,permeability,rheology,in vitro hemostasis,and antibacterial properties of the composite hydrogel were characterized.The cell compatibility of the hydrogel scaffold was evaluated by live/dead staining,and the optimization effects of low-intensity pulsed ultrasound on the permeability,porosity,and mechanical properties of hydrogel were evaluated. RESULTS AND CONCLUSION:(1)Transmission electron microscopy and ultraviolet-visible spectroscopy proved the successful construction of nanogold carriers.The particle size and potential results demonstrated that the synthesized nanoscaled ultrasonic responsive carrier had good stability.(2)Live/dead cell staining proved that the prepared composite hydrogel scaffold had certain biocompatibility.(3)Scanning electron microscopy exhibited that the prepared composite hydrogel scaffold had a porous network structure,and numerous pores of about 2 μm appeared inside the macropores after the addition of nanodroplets and ultrasonic irradiation.The permeability experiment displayed that low-intensity pulsed ultrasound could optimize the porosity and permeability of hydrogel materials.The hemostatic performance of the composite hydrogel scaffold was better than that of the hemostatic sponge and polydopamine@methylacrylylated gelatin hydrogel scaffold.Under the irradiation of low-intensity pulsed ultrasound,the composite hydrogel scaffolds had good antioxidant effects and antibacterial properties.(4)Thermal imaging results manifested that gold nanoparticles were encapsulated in ultrasound-responsive nanobubbles,and more uniform dispersion could be obtained under ultrasonic excitation.(5)The results of the mechanical property test demonstrated that the storage modulus of the hydrogel increased before and after loading gold nanoparticles-nanodroplets,which showed stronger mechanical properties.The elongation at break was 122%,and the ductility was better than that without gold nanoparticles-nanodroplets(P<0.05).(6)These findings indicate that the composite hydrogel scaffold has good biocompatibility,antibacterial property,oxidation resistance,and hemostatic effect.

Objective:To explore the clinical characteristics and molecular basis for children and adolescents with monogenic diabetes.Methods:A retrospective analysis was carried out for the clinical manifestations and laboratory data of 116 children and adolescents diagnosed with diabetes at Ningbo Women and Children′s Hospital from January 2020 to March 2023. Whole exome sequencing and mitochondrial gene sequencing were carried out on 21 children with suspected monogenic diabetes.Results:A total of 10 cases of monogenic diabetes were diagnosed, all of which were Maturity-onset Diabetes Of the Young (MODY). Six cases of MODY2 were due to GCK gene mutations, 1 case of MODY3 was due to HNF1A gene mutation, 2 cases of MODY12 were due to ABCC8 gene mutations, and 1 case of MODY13 was due to KCNJ11 gene mutation. Nine of the 10 patients with MODY had no typical symptoms of diabetes. A family history of diabetes was significantly more common in the MODY group compared with the T1DM and T2DM groups ( P<0.05). The BMI of the MODY group was higher than that of the T1DM group ( P<0.05). The initial blood glucose level was lower than that of the T1DM group ( P<0.05), and there was no significant difference compared with the T2DM group. The fasting C-peptide level of the MODY group was higher than that of the T1DM group ( P<0.05), and there was no significant difference compared with the T2DM group. Glycosylated hemoglobin of the MODY group was lower than both the T1DM and T2DM groups ( P<0.05). Conclusion:In this study, MODY has accounted for the majority of monogenic diabetes among children and adolescents, and the common mutations were those of the GCK gene in association with MODY2. Blood glucose and glycosylated hemoglobin of children with MODY were slightly increased, whilst the islet cell function had remained, and the clinical manifestations and laboratory tests had overlapped with those of type 2 diabetes. WES and mitochondrial gene sequencing can clarify the etiology of monogenic diabetes and facilitate precise treatment.