OBJECTIVE: To investigate the current status of clinical genetics specialization development and the diagnostic and therapeutic capabilities for hereditary diseases across medical institutions in Shanghai, and to assess the necessity and feasibility of establishing training bases for clinical genetics specialists. METHODS: By employing a cross-sectional survey design, the Clinical Genetics Committee of Shanghai Medical Association has conducted questionnaire surveys from March to April 2025 across 54 healthcare institutions in Shanghai (including 33 tertiary hospitals and 21 secondary hospitals). The survey involved administrative departments and medical personnel from 15 clinical specialties. The survey has covered current genetic disease diagnosis and treatment practices, relevant and specialised disease types, genetic department establishment, testing capabilities, personnel teams, and training requirements. RESULTS: The results revealed that 78.0% of clinical departments surveyed had treated patients with hereditary disorders. Shanghai possesses diagnostic and therapeutic expertise for over 95% of hereditary diseases listed in its rare disease catalogue, reflecting both the practical clinical demand for such conditions and the city's overall diagnostic and therapeutic strengths in this field. Nevertheless, significant disparities exist in the development of genetics departments across different tiers of healthcare institutions. Resources for genetic testing capabilities (including molecular, cellular, and biochemical testing) are also unevenly distributed across different tiers of hospitals. The survey further revealed that only 26.0% of departments believe that their current physician structure fully meets the diagnostic and treatment demands. Over 90% of departments consider standard training for clinical genetic specialists necessary, with 74.0% expressing willingness to participate in establishing training bases. Based on above findings and thorough deliberation, the Clinical Genetics Committee of the Shanghai Medical Association proposes advancing specialist training and discipline development through establishing a standard training system. The committee has drafted a three-year training protocol featuring a "joint training"-centered model, recommending a pilot-first, dynamically optimized strategy for steadily advancing training base development. CONCLUSION Shanghai faces substantial demand for genetic disease diagnosis and treatment, yet exhibits shortcomings in clinical genetics specialization development, resource allocation, and talent pipeline cultivation. To establish a standard training system holds significant practical importance and is underpinned by a broad demand.
Humans ; China ; Surveys and Questionnaires ; Genetic Diseases, Inborn/genetics* ; Cross-Sectional Studies ; Genetics, Medical/education* ; Genetic Testing

ObjectiveTo investigate the contamination status of ochratoxin A (OTA) in commercially available food products in Shanghai, and to assess OTA exposure levels and the associated non-carcinogenic and carcinogenic risks among pregnant women by integrating dietary consumption data of this population. MethodsThe levels of OTA contamination in 1 520 food samples collected in Shanghai from 2022 to 2023 were determined using liquid chromatography-tandem mass spectrometry. An exposure assessment model was developed based on the dietary consumption levels of pregnant women from the 2016‒2017 Shanghai Pregnant Women Dietary Monitoring Survey to calculate the estimated daily intake (EDI) of OTA, the margin of exposure for non-carcinogenic toxicity (MOE₁), and the margin of exposure for carcinogenic toxicity (MOE₂). An MOE₁ greater than 200 and an MOE₂ greater than 10 000 indicate that the non-carcinogenic toxicity and carcinogenic toxicity resulting from exposure are negligible, respectively. For samples with OTA contamination levels below the limit of detection (LOD), which accounted for more than 80% of the samples, the OTA levels were assigned values of 0 and LOD, respectively, for subsequent calculations. ResultsThe detection rates of OTA in cereals, nuts, dried fruits, and alcohol samples collected in 2022 were 2.03%, 0, 0, and 0, respectively. The OTA detection rates in cereals, nuts, dried fruits, beans, and alcohol samples collected in 2023 were 2.50%, 0.39%, 2.47%, 1.67%, and 13.33%, respectively. For pregnant women in Shanghai in 2022, simulation results indicated that when assigning a value of 0 and the LOD, theP₅₀ values of EDI for dietary OTA exposure were 0.05 and 0.72 ng·(kg·d)^-1, respectively, and the P₉₅ values of EDI for dietary OTA exposure were 0.25 and 2.40 ng·(kg·d)^-1, respectively. For pregnant women in Shanghai in 2023, the P₅₀ values of EDI for dietary OTA exposure were 0.04 and 1.00 ng·(kg·d)^-1, respectively, and the P₉₅ values of EDI for dietary OTA exposure were 0.23 and 2.67 ng·(kg·d)^-1, respectively, both substantially below the tolerable daily intake (TDI) for OTA [17 ng·(kg·d)^-1]. The EDI for dietary OTA exposure in 100.0% of Shanghai pregnant women was lower than the TDI, indicating an overall low level of dietary OTA exposure among this population. For 100.0% of pregnant women, the MOE₁ for dietary OTA exposure exceeded 200. When assigned a value of 0, the MOE₂ for 100.0% of pregnant women in both 2022 and 2023 exceeded10 000. When assigned the LOD value, 72.3% and 81.8% of pregnant women in 2022 and 2023, respectively, had an MOE₂ exceeding 10 000. ConclusionFrom 2022 to 2023, samples of cereals, nuts, dried fruits, beans, and alcohol sold in Shanghai exhibited varying degrees of OTA contamination. The overall EDI of OTA exposure among pregnant women in Shanghai remained at a low level. The non-carcinogenic and carcinogenic risks associated with OTA exposure were generally low and at controllable levels.

High myopia combined with primary open angle glaucoma is an increasingly concerned and complex disease in ophthalmology, and its pathogenesis is closely associated with multiple alterations in structural parameters of the lamina cribrosa. As the main supportive structure of the optic nerve, the lamina cribrosa plays an important role in pathophysiology of glaucoma through parameters including curvature, depth, defects, and thickness. Meanwhile, fundus alterations induced by high myopia may obscure typical glaucomatous features. Current research on the relationship between lamina cribrosa parameters and high myopia combined with primary open angle glaucoma still have certain limitations, particularly in terms of mechanism exploration and clinical application. Through systematically reviewing the relevant literature, this article aims to summarize the latest research advances on lamina cribrosa parameters in high myopia combined with primary open angle glaucoma, with a focus on discussing the potential and current limitations of these parameters as biomarkers for early diagnosis and prognosis assessment.

OBJECTIVE: To analyze a patient with infertility due to complex chromosome rearrangement by optical genome mapping (OGM). METHODS: A female patient who was diagnosed with "primary infertility" at Shenzhen Longhua District Maternal and Child Health Care Hospital in April 2024 was selected as the study subject. Clinical data of the patient was collected. Chromosome G banding karyotyping analysis was carried out for the patient and her parents, in addition with OGM and copy number variation sequencing (CNV-seq). This study was approved by the Medical Ethics Committee of the Hospital (Ethics No.: 2023052504). RESULTS: The patient, a 33-year-old female, had infertility for the past 5 years. OGM revealed formation of two derivative chromosomes through rearrangement of chromosomes 5 and 18. A loss of heterozygosity on chromosome 5 was also detected by OGM and CNV-seq techniques. Both of her parents had a normal karyotype. CONCLUSION The OGM technique can refine the position of chromosomal breakpoints and determine the direction and position of insertional fragment. Combined with karyotype analysis, the OGM can accurately determine the chromosomal karyotype of the patient and facilitate genetic counseling.
Humans ; Female ; Adult ; Karyotyping ; DNA Copy Number Variations/genetics* ; Chromosome Mapping/methods* ; Chromosome Aberrations ; Infertility, Female/diagnosis*

Objective:To explore the clinical and pathological features and survival outcomes of patients with early-onset intrahepatic cholangiocarcinoma (EOICC).Methods:This is a multicenter, retrospective cohort study. Data of 1 160 intrahepatic cholangiocarcinoma patients undergoing radical resection in 14 tertiary Grade A hospitals in China from January 2010 to November 2021 were retrospectively collected. The cohort included 632 males and 528 females, aged( M (IQR)) 61 (14) years (range: 22 to 93 years). ICC aged ≤50 years at the time of diagnosis was defined as EOICC and >50 years as late-onset intrahepatic cholangiocarcinoma (LOICC). Of these, there were 247 cases in the EOICC group and 913 cases in the LOICC. The clinical and pathological characteristics of both groups were analyzed and compared using the independent sample t-test, Mann-Whitney U test or Kaplan-Meier method. Univariate and multivariate Cox regression models for patient outcomes were constructed and forest graphed. Results:Compared with the patients in the LOICC group, patients in the EOICC group had lower carcinoembryonic antigen levels (2.5(4.0) μg/L vs. 3.1(5.2)μg/L, U=124 899, P=0.009) and CA19-9 level (63.4(524.7)U/ml vs. 77.9(611.3)U/ml, U=120 320, P=0.013), higher levels of ALT (29(35)U/L vs. 24(26)U/L, U=101 214, P=0.013), a lower score of the Eastern US Cooperative Oncology Group (0 score patients: 54.7% vs. 44.1%, χ2=12.472, P=0.014), higher TNM stage ( χ2=11.807, P=0.038), and proportion of lymph node dissection (62.3% vs. 54.1%, χ2=5.355, P=0.021). Patients in the two groups in sex, first diagnosis symptoms, intrahepatic bile duct stone history, nail protein, albumin, total bilirubin, transaminase, liver function Child-Pugh grade, T stage, stage, N stage, preoperative laparoscopic exploration proportion, tumor diameter, vascular invasion proportion, differentiation, margin, intraoperative bleeding, postoperative complications, postoperative hospital days were no statistical significance (all P>0.05). Patients in the EOICC group had better outcomes than the LOICC group (median survival time: 29.7 months vs. 25.0 months, 3-year overall survival: 45.1% vs. 37.8%, P=0.027). Conclusion:EOICC patients are better than LOICC patients in carcinoembryonic antigen, CA19-9, ALT, physical strength status and TNM stage, and the long-term prognosis is also better than LOICC patients.

This study was aimed at establishing a method of ultra-fast quantitative PCR for Brucella detection.We used an exogenous recombinant plasmid as the internal reference and targeted the T4SS secretion system,an important Brucella viru-lence factor,to design specific primers and probes.The sensitivity,specificity,and repeatability of this method were evaluated,and a standard curve was constructed.The coincidence rate of detection findings with this method versus quantitative PCR was determined.This method markedly decreased the detection time to only 10 minutes.The standard curve demonstrated a good linear relationship(Y=-3.410 7x+38.357,R2=0.998 5)with a low minimum detection limit of 10 copies/μL.The method exhibited good specificity and did not specifically amplify several common clinical bacteria other than Brucella.The de-tection of three concentrations of positive plasmids yielded coefficients of variation(CVs)of 0.20％to 0.91％,thus demonstra-ting the method's excellent repeatability.Furthermore,140 clinical samples were analyzed concurrently with the fluorescence PCR method,which yielded a 100％compliance rate and consistent results.Our findings indicated that the Brucella ultra-fast quantitative PCR was ultrafast;had high sensitivity,high specificity,and good specificity;and can be used for the clinical de-tection of Brucella and emergency investigation of epidemics.Therefore,this method is valuable for the early diagnosis of Bru-cella.

Objective To establish a rabbit cardiac arrest(CA)model and observe the effect of a TLR4 antagonist on brain injury after cardiopulmonary resuscitation.Methods Seventy-two adult rabbits weighing 2.8-3.3 kg were divided into three groups:sham operation group(Sham group),CA group,and TLR4 an-tagonist group,with 24 rabbits in each group.The Sham group underwent only arterial/venous puncture and tracheal intubation without ventricular fibrillation,CA,or cardiopulmonary resuscitation.The CA group re-ceived equivalent volume of 0.9％sodium chloride solution at the same time points,while the TLR4 antago-nist group received TAK-242 solution(3 mg·kg-1·d-1)immediately,24 h and 48 h after ROSC.The Sham group received 0.9％sodium chloride solution(equivalent volume to the TLR4 antagonist group)immediately after the surgical procedure,and at 24 h and 48 h.Neurological deficit scores(NDS)and plasma neuron-specif-ic enolase(NSE)levels were assessed before CA and at 12 h,24 h,and 72 h after ROSC.Tumor necrosis fac-tor-α(TNF-α)and interleukin(IL)-1β levels in hippocampal tissue were measured using ELISA.TLR4 and nuclear factor-κB(NF-κB)p65 mRNA expression levels were determined by RT-qPCR.Results At 12 h,24 h,and 72 h after ROSC,the neurological deficit scores(NDS)in both the CA group and TLR4 antagonist group were significantly lower than those in the Sham group and their respective pre-CA baselines(all P＜0.05).However,the TLR4 antagonist group showed significantly higher NDS than the CA group at all post-ROSC time points(P＜0.05).Serum neuron-specific enolase(NSE)levels in the CA group and TLR4 antag-onist group were significantly elevated compared to the Sham group and their pre-CA baselines at 12 h,24 h,and 72 h after ROSC(P＜0.05).Notably,the TLR4 antagonist group exhibited significantly lower serum NSE levels than the CA group at all time points(P＜0.05).At 72 h post-ROSC,TNF-α and IL-1β expression levels in both the CA group and TLR4 antagonist group were significantly higher than those in the Sham group(P＜0.05),while the TLR4 antagonist group demonstrated significantly lower TNF-α and IL-1β ex-pression than the CA group(P＜0.05).Additionally,TLR4 and NF-κB p65 mRNA levels in brain tissue were markedly increased in the CA group and TLR4 antagonist group compared to the Sham group at 72 h post-ROSC(P＜0.05).In contrast,the TLR4 antagonist group showed significantly reduced TLR4 and NF-κB p65 mRNA levels compared to the CA group(P＜0.05).Conclusion TLR4 antagonists reduce inflammatory cy-tokine levels in brain tissue and ameliorate brain injury in rabbits after cardiopulmonary resuscitation.

AIM To investigate effects of petroleum ether fraction from Derris eriocarpa How on glucose and lipid metabolism in a mouse model of metabolic syndrome(MS).METHODS KM mice were fed a high-fat diet and administered streptozotocin intraperitoneally to establish MS models.The MS mice were then randomly assigned to the model group,the metformin hydrochloride group,the lovastatin group,the ursolic acid group,and the high-,medium-and low-dose D.eriocarpa petroleum ether fraction groups,with 10 mice in each group.Ten additional mice maitained on a normal diet served as the normal control group.After 4 weeks of intragastric administration,glucose and lipid metabolism indicators were measured.Hepatic pathological changes were assessed using HE staining and oil red O staining.Liver tissue mRNA expressions of ATF3,PEPCK,FXR,CYP7A1,HNF4ɑ,CYP8B1 and SRB1 were quantified by RT-qPCR.Hepatic protein expressions of ATF3,HNF4ɑ,PEPCK,FXR and CYP7A1 was analyzed by Western blot in MS mice.RESULTS Compared to the model group,the high-dose D.eriocarpa petroleum ether fraction group exhibited significant glucose tolerance improvement(reduced OGTT-AUC,P＜0.01);favorable serum lipid modulation in terms of increased HDL-C levels(P＜0.01)and decreased TG,TC,LDL-C(P＜0.01);reduced renal biomarkers(BUN,SCR)and hepatotoxic indicators of TBA,AST and ALT activities(P＜0.01);alleviated hepatic lipid accumulation and histopathological damage;downregulated mRNA and protein expressions of ATF3,HNF4ɑ and PEPCK,as well as CYP8B1 mRNA expression(P＜0.01);and upregulated mRNA and protein expressions of FXR and CYP7A1,along with SRB1 mRNA expression(P＜0.01).CONCLUSION D.eriocarpa petroleum ether fraction ameliorates glucose and lipid metabolism dysregulation in MS mice by modulating the ATF3/HNF4ɑ/CYP7A1 signaling pathway,consequently eliciting hypoglycemic,hypolipidemic,hepatoprotective and nephroprotective effects.

Objective:The Fuxing Program was established in Zhuhai as an action plan to micro-eliminate hepatitis C in response to the World Health Organization's goal of eliminating hepatitis C by 2030. Therefore, the effectiveness of this program in terms of hepatitis C screening, treatment, follow-up, and other aspects is evaluated here.Methods:The "Fuxing Project" was established in May 2021 under the supervision of the Zhuhai Medical Quality Control Center for Infectious Diseases. A bridge was formed among the governmental entities, hospitals at all levels, and the community to train hepatitis C prevention and control strategies. Hepatitis C screening, publicity, and educational awareness were conducted in-and out-of-hospital. The responsibility for the diagnosis, treatment, and follow-up of a patient with hepatitis C was assigned to the staff. The screening and treatment rates of hepatitis C in hospitals before and after the initiation of the project were compared and analyzed using the χ2 test or Fisher's exact test. The hepatitis C virus (HCV) infection and treatment status were investigated and analyzed among the general population, high-risk populations such as human immunodeficiency virus (HIV) infection, drug addicts, and the population residing in supervised sites within Zhuhai communities, rural areas, schools, or factories. Results:Anti-HCV positivity rate (0.82% vs. 0.43%, P<0.001), HCV RNA detection rate (98.1% vs. 59.5%, P<0.001), HCV RNA detection positivity rate (52.56% vs. 29.76%, P<0.001), HCV RNA positivity rate (0.4% vs. 0.13%, P<0.001), and hepatitis C treatment rate (76.76% vs. 31.97%, P<0.001) were significantly higher among the inpatient population after the Fuxing Program initiation than before. The HCV RNA detection rate (58.52% vs. 6.93%, P<0.001) and HCV RNA detection positivity rate (77.72% vs. 29.41%, P<0.001) in Zhuhai were significantly higher after the Fuxing Program initiation than before. Anti-HCV positivity rate (0.46% vs. 1.28%, P=0.009) and HCV RNA (0.32% vs. 0.99%, P=0.03) were significantly lower in the Zhuhai general population of urban communities than those of the general population in rural areas. The HCV infection rate was more than three times higher in rural populations than in urban populations. Anti-HCV positivity rate, HCV RNA positivity rate, HCV RNA detection positivity rate, and hepatitis C treatment rates were 2.64% (31/1 175), 3.40% (69/2 022) and 94.4% (34/36), 2.64% (31/1 175), 2.72% (55/2 022), 50.00% (18/36), and 100% (31/31), 79.71% (55/69) and 52.94% (18/34), and 100% (31/31), 0 (0/55) and 55.55% (10/18) among the HIV infection, supervised population under supervised sites, and methadone maintenance treatment clinic population, respectively. Anti-HCV positivity rate (4.15% vs. 0.72%, P<0.001) and HCV RNA (3.22% vs. 0.53%, P<0.001) were significantly higher in the high-risk group than those in the general population, while the treatment rate of hepatitis C in the high-risk group (39.42% vs. 82.35%, P<0.01) was significantly lower than that of the general population. Conclusion:The establishment of the hospital grid linkage mechanism and the management model of hepatitis C follow-up by specialists, with the infectious diseases medical quality control center as the supervisory body, have improved the screening rate, the HCV RNA detection rate, and the treatment rate in the hospital, thereby providing a reference for exploring a management model to eliminate the nationwide threat of hepatitis C.

Cervical spinal cord injury without fracture-dislocation (CSCIWFD) is referred to as a special type of cervical spinal cord injury characterized by traumatic spinal cord dysfunction and no significant bony structural abnormalities on imagines. Duo to the high risk of missed diagnosis during the initial consultation, CSCIWFD may lead to progressive neurological deterioration or even complete paralysis, severely impacting patients′ prognosis. Currently, there are no established consensuses over the diagnosis and treatment of CSCIWFD, such as the lack of evidence-based standards for indications of non-surgical treatment and risk of secondary neurological injury, as well as debates over the optimal timing for surgical intervention and indications for different surgical approaches. To address these issues, the Spine Trauma Group of the Orthopedic Branch of the Chinese Medical Doctor Association organized experts in the relevant fields to formulate Diagnosis and treatment guideline for acute cervical spinal cord injury without fracture- dislocation in adults ( version 2025) . Based on evidence-based medicine and the principles of scientific rigor and clinical applicability, the guidelines proposed 11 recommendations covering terminology, diagnosis, evaluation treatment, and rehabilitation, etc., aiming to standardize the management of CSCIWFD.