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.

ObjectiveTo analyze the research hotspots and development trends in the field of spinal cord stimulation (SCS) for spinal cord injury (SCI). MethodsLiterature about SCS for SCI was retrieve from the Web of Science (WOS) Core Collection database, with a time range from January, 1999 to July, 2025. VOSviewer 1.6.20 and CiteSpace 6.4.R2 were used to analyze the annual publication volume, countries, authors, institutions, journals and keywords. ResultsA total of 636 literatures were included. From 1999 to 2025, the overall publication trend in this field showed an upward trajectory, with recent years fluctuating but tending to stabilize. The country with the most publications was the United States (429 papers), followed by Russia (98 papers) and China (70 papers). The institution with the highest number of publications was the University of California, Los Angeles (76 papers), the author with the most publications was V. Reggie Edgerton (70 papers), and the journal with the most publications was Journal of Clinical Medicine (31 papers). The most frequently cited study focused on exploring the combination of epidural spinal cord stimulation with task-specific training to restore motor function in patients with complete SCI. Keyword analysis showed that the research hotspots in this field were mainly focused on neuroregulation mechanisms, recovery of motor and autonomic nervous dysfunction, artificial intelligence, closed-loop stimulation and brain-computer interface technology innovations. In recent years, the research focus gradually shifted from basic mechanisms to personalized and precise multifunctional rehabilitation strategies. ConclusionThe field of SCS for SCI has undergone phases of basic mechanism exploration and clinical application expansion. Current research hotspots and future trends focus primarily on the development of new stimulation paradigms and combined innovative technologies.

Objective: The CT/MRI Liver Imaging Reporting and Data System (LI-RADS) demonstrates high specificity with relatively limited sensitivity for diagnosing hepatocellular carcinoma (HCC) in high-risk patients. This study aimed to explore the possibility of improving sensitivity by combining CT/MRI LI-RADS v2018 with second-line contrast-enhanced ultrasound (CEUS) LI-RADS v2017 using sulfur hexafluoride (SHF) or perfluorobutane (PFB). Materials and Methods: This retrospective analysis of prospectively collected multicenter data included high-risk patients with treatment-naive hepatic observations. The reference standard was pathological confirmation or a composite reference standard (only for benign lesions). Each participant underwent concurrent CT/MRI, SHF-enhanced US, and PFB-enhanced US examinations. The diagnostic performances for HCC of CT/MRI LI-RADS alone and three combination strategies (combining CT/ MRI LI-RADS with either LI-RADS SHF, LI-RADS PFB, or a modified algorithm incorporating the Kupffer-phase findings for PFB [modified PFB]) were evaluated. For the three combination strategies, apart from the CT/MRI LR-5 criteria, HCC was diagnosed if CT/MRI LR-3 or LR-4 observations met the LR-5 criteria using LI-RADS SHF, LI-RADS PFB, or modified PFB. Results: In total, 281 participants (237 males; mean age, 55 ± 11 years) with 306 observations (227 HCCs, 40 non-HCC malignancies, and 39 benign lesions) were included. Using LI-RADS SHF, LI-RADS PFB, and modified PFB, 20, 23, and 31 CT/MRI LR-3/4 observations, respectively, were reclassified as LR-5, and all were pathologically confirmed as HCCs. Compared to CT/MRI LI-RADS alone (74%, 95% confidence interval [CI]: 68%–79%), the three combination strategies combining CT/MRI LI-RADS with either LI-RADS SHF, LI-RADS PFB, or modified PFB increased sensitivity (83% [95% CI: 77%–87%], 84% [95% CI: 79%–89%], 88% [95% CI: 83%–92%], respectively; all P < 0.001), while maintaining the specificity at 92% (95% CI: 84%–97%). Conclusion The combination of CT/MRI LI-RADS with second-line CEUS using SHF or PFB improved the sensitivity of HCC diagnosis without compromising specificity.

Background: s/Aims: Non-invasive models stratifying clinically significant portal hypertension (CSPH) are limited. Herein, we developed a new non-invasive model for predicting CSPH in patients with compensated cirrhosis and investigated whether carvedilol can prevent hepatic decompensation in patients with high-risk CSPH stratified using the new model. Methods: Non-invasive risk factors of CSPH were identified via systematic review and meta-analysis of studies involving patients with hepatic venous pressure gradient (HVPG). A new non-invasive model was validated for various performance aspects in three cohorts, i.e., a multicenter HVPG cohort, a follow-up cohort, and a carvediloltreating cohort. Results: In the meta-analysis with six studies (n=819), liver stiffness measurement and platelet count were identified as independent risk factors for CSPH and were used to develop the new “CSPH risk” model. In the HVPG cohort (n=151), the new model accurately predicted CSPH with cutoff values of 0 and –0.68 for ruling in and out CSPH, respectively. In the follow-up cohort (n=1,102), the cumulative incidences of decompensation events significantly differed using the cutoff values of <–0.68 (low-risk), –0.68 to 0 (medium-risk), and >0 (high-risk). In the carvediloltreated cohort, patients with high-risk CSPH treated with carvedilol (n=81) had lower rates of decompensation events than non-selective beta-blockers untreated patients with high-risk CSPH (n=613 before propensity score matching [PSM], n=162 after PSM). Conclusions Treatment with carvedilol significantly reduces the risk of hepatic decompensation in patients with high-risk CSPH stratified by the new model.

Objective To explore the relationship between hemorheology and Carotid Atherosclerosis.Methods The clinical data of 153 patients who underwent both hemorheological testing and carotid artery ultrasound were divided into a CAS group(n=96)and a non-CAS group(n=57)based on ultrasound findings.Clinical data and laboratory indicators were compared between two groups.Multivariate logistic regression analysis was used to explore the influencing factors of CAS.The ROC curves graph were drawn to observe the role of hemorheological indicators in predicting CAS and select the optimal cutoff value based on the maximum Youden index.Results The CAS group demonstrated higher levels in age,BMI,RBC aggregation index,low&high shear reduced viscosity of whole blood,plasma viscosity and fibrinogen compared to the non-CAS group(P<0.05).The multivariate logistic regression analysis showed that plasma viscosity(OR=38.270,95%CI:1.206～1214.508),age(OR=1.119,95%CI:1.065～1.176)were risk factors for the occurrence of CAS(P<0.05).The ROC curves showed that the area under the curve(AUC)of plasma viscosity and age were 0.623、0.728.Conclusion CAS patients have high levels of plasma viscosity and advanged age compared to the patient without CAS.Elevated plasma viscosity and age is a risk factor for CAS,with plasma viscosity≥1.46 mPa·s,over the age of 56.5 as a significant value for predicting CAS.

Objective To conduct comprehensive clinical evaluation of injectable anti-inflammatory and hepatoprotective drugs with different mechanisms of action,and to provide a basis for drug selection and rational drug use in medical institutions.Methods Twenty-two experts in clinical and pharmacological fields were organized to construct a quantitative rating scale for the comprehensive clinical evaluation of drugs by applying the literature research method,expert interview method,and Delphi method,through seminars and interviews,and by referring to the real-world clinical data and evidence-based medical evidence such as the Guidelines for the Management of Comprehensive Clinical Evaluation of Drugs,so as to conduct a comprehensive evaluation of eight injectable anti-inflammatory and hepatoprotective drugs in terms of six dimensions:effectiveness,safety,economy,appropriateness,accessibility and maturity.Results A comprehensive clinical evaluation index system of injectable anti-inflammatory and hepatoprotective drugs for the treatment of drug-induced liver injury was constructed,including 6 first-level indexes,14 second-level indexes,and 27 third-level indexes,with a total of 100 points.The scoring results showed that among the evaluated varieties,the scores were,in descending order,magnesium isoglycyrrhizinate injection,compound glycyrrhizin injection,polyene phosphatidylcholine injection,reduced glutathione for injection,thiopronin injection,compound ammonium glycyrrhizinate injection,acetylcysteine injection and diammonium glycyrrhizinate injection.Conclusion The constructed quantitative rating scale for comprehensive clinical evaluation of drugs is operable,and the evaluation process can provide academic guidance for exploring the standardized path of comprehensive clinical evaluation of drugs,which needs to be applied in combination with the actual drug varieties of the medical institutions as well as the specific conditions of the patients to make individualized therapeutic choices.

Under the current situation of "low prevalence and low infection" of schistosomiasis in China, and to provide a basis for achieving the goal of eliminating schistosomiasis by 2030 proposed by the Healthy China Action (2019 - 2030) as scheduled, the Hunan Provincial Corps Hospital of the Chinese People's Armed Police Force established a schistosomiasis monitoring and early warning index system based on the previous studies on schistosomiasis early warning index system and the recent literature analysis, combined with the current potential risk factors affecting the transmission and prevalence of schistosomiasis, and organized two rounds of expert consultation and carried out project promotion meetings. The experts reached a consensus on the comprehensiveness and practicability of the index system, aiming to lay a solid foundation for construction of China's schistosomiasis prevention and control early warning system.

OBJECTIVE To explore the impact of trauma orthopedic implant management on the operating room in-fection control rate and the medical device vendor follow-up rate.METHODS Trauma orthopedic implant manage-ment was implemented at Shaoxing People's Hospital from Mar.2023 to Mar.2024,involving 2 047 trauma or-thopedic surgeries(study group).For comparison,a control group consisting of 2 067 trauma orthopedic surger-ies from Mar.2022 to Feb.2023 under routine management was selected.The impact of trauma orthopedic im-plant management on operating room efficiency,infection control rate and medical device vendor follow-up rate in both groups were analyzed.RESULTS The study group showed satisfaction rates of 78.65％and 91.35％for cir-culating cooperation familiarity and handwashing cooperation familiarity,respectively,both higher than those in the control group(P＜0.001).The study group also demonstrated higher rates of standardized use of orthopedic trauma implants(96.43％),accurate item-code correspondence(98.19％)and timely availability(98.19％)than those in the control group,with a lower medical device vendor follow-up rate of 3.57％(P＜0.001).The study group's monthly overtime hours,costs,time costs,average cost per re-disinfection and re-cleaning service and monthly re-disinfection re-cleaning frequency were 13.85 hours,235.86 yuan/day,25 233.51 yuan,0.35 yuan/time and 183.81 times/month,respectively,all lower than those in the control group(P＜0.001).The study group had higher rates of consumable access compliance(99.22％),accurate charging(98.58％)and timely delivery(97.90％)than the control group(P＜0.001).The study group also achieved a 100.00％implant regulatory recovery rate,higher than the control group(P＜0.001).Furthermore,the surgical site infection rate in the study group was 1.91％,lower than that in the control group(P＜0.001).CONCLUSIONS This study establishes a trauma orthopedic implant management system integrating supply chain management,an identification system and IoT technology.This model effectively addresses core issues such as the difficulty in regulating multiple vendors,blind spots in virtual warehousing and disorder in item-code tracing under the traditional vendor self-management model.It significantly improves operating room efficiency,reduces the surgical site infection rate,and achieves a notable decrease in the medical device vendor follow-up rate.

OBJECTIVE To investigate the application of metagenomic next-generation sequencing(mNGS)of bron-choalveolar lavage fluid(BALF)in the detection of pathogens of pulmonary infection.METHODS The clinical data of 98 patients with pulmonary infections admitted to NO.2 People's Hospital of Fuyang City from Jan.2023 to Jan.2024 were retrospectively analyzed,mNGS and traditional pathogenicity test were performed in BALF,and comprehensive clinical judgment(using a combination of alveolar lavage fluid,sputum,blood,etc.to assess)was used as the gold standard to evaluate the differences between mNGS and traditional pathogenicity tests in the path-ogenic diagnosis of pulmonary infections,compare the pathogen detection rates in pulmonary infections complicat-ed with underlying diseases,severe and non-severe illness and different infection types,and to analyze the impact on clinical adjustment of anti-infection regimens.RESULTS The positive detection rate of mNGS for pulmonary in-fection pathogens was 88.78％,higher than that of traditional pathogenology(P＜0.001).The time required for mNGS was(16.57±2.64)h,shorter than that of traditional pathogenology(P＜0.05).The positive detection rates of mNGS in patients with and without underlying diseases were 93.02％and 85.45％,respectively,higher than those of traditional pathogenology(P＜0.05).The positive detection rates of mNGS in severe and non-severe patients were 91.43％and 87.30％,respectively,higher than those of traditional pathogenology(P＜0.05).A total of 122 strains of pathogens were detected in 87 patients with positive mNGS tests,and EB virus was not de-tected.A total of 75 strains of pathogens were detected in 54 patients with positive traditional pathogenetic tests,and Neisseria,Rhizopus,parvovirus,and Chlamydia psittaci were not detected.The detection rate of bacteria by mNGS was 58.20％,higher than that by traditional pathogenetic tests(P=0.034).The detection rates of mNGS test for monotypic infection and mixed infection were 85.51％and 93.10％,respectively,higher than those by traditional pathogenetic test(P＜0.05).In pulmonary infections,mNGS guided adjustment of anti-infective treat-ment in 53.06％of patients,60.47％of those in the group with underlying pulmonary disease,and 47.27％of those without underlying disease(P=0.194).Among severe cases,68.57％had their anti-infective treatment plan adjusted,compared to 44.44％of non-severe patients(P=0.022).CONCLUSION The mNGS of BALF idenfies some rare pathogens,improves the detection rate of pathogens in pulmonary infections,and may guide the clinical adjustment of anti-infective strategies.

Objective To investigate the clinical features of chronic hepatitis C(CHC)patients with hepatitis C virus genotype 3(HCV GT3)infection and the risk factors for disease progression.Methods A multicenter retrospective cohort study was conducted among 1 002 CHC patients from 11 clinical centers in Northwest China from December 2017 to November 2023,and according to their genotype,they were divided into GT1,GT2,GT3,and GT6 groups.Clinical features were compared between the patients with different genotypes.The one-way analysis of variance was used for comparison of normally distributed continuous data between groups,and the Scheffe test was used for further comparison between two groups.The Kruskal-Wallis H test was used for comparison of data with skewed distribution between groups;the chi-square test or Fisher test was used for comparison of categorical data between groups.The multivariate logistic regression analysis was used to explore the influencing factors for the progression of CHC to liver cirrhosis.Results In terms of the genotype,there were 427 patients with GT1 infection,242 with GT2 infection,299 with GT3 infection(210 patients with GT3a infection,87 with GT3b infection,and 2 with unclassified genotype),and 34 with GT6 infection.The patients with GT3 infection had a significantly younger age than those with GT1 infection(51.3±0.5 years vs 53.2±0.6 years,P<0.05)or GT2 infection(51.3±0.5 years vs 53.7±0.8 years,P<0.05),and for the patients with liver cirrhosis,the patients with GT3 infection had a significantly younger age than those with GT1 infection(52.1±0.5 years vs 59.4±0.9 years,P<0.001)or GT2 infection(52.1±0.5 years vs 58.1±1.1 years,P<0.001).Among the patients with GT3 infection,male patients accounted for 77.9%and the patients with liver cirrhosis accounted for 46.2%,which were significantly higher than those among the patients with GT1,GT2 or GT6 infection(all P<0.001).At baseline,the patients with GT3 infection had significantly higher levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)than those with GT1 or GT2 infection,significantly higher aspartate aminotransferase-to-platelet ratio index(APRI)and fibrosis-4(FIB4)than those with GT1,GT2 or GT6 infection,a significantly lower platelet count(PLT)than those with GT2 or GT6 infection,a significantly higher level of alpha-fetoprotein than those with GT2 or GT6 infection,and a significantly lower level of albumin(Alb)than those with GT6 infection(all P<0.05).There were no significant differences between the patients with GT3a infection and those with GT3b infection in age,sex,the proportion of patients with liver cirrhosis,comorbidities,HCV RNA quantification,PLT,ALT,AST,alkaline phosphatase,Alb,APRI,and FIB-4(all P>0.05).The multivariate logistic regression analysis showed that PLT≤150×109/L(odds ratio[OR]=10.72,95%confidence interval[CI]:5.76-35.86,P<0.001)and Alb≤35 g/L(OR=3.74,95%CI:1.22-11.45,P=0.021)were risk factors for liver cirrhosis.Conclusion Most CHC patients with GT3 infection are male in Northwest China,and compared with the patients with other genotypes,such patients tend to have a younger age of onset and higher degrees of liver inflammation activity and fibrosis.Low PLT and a low level of Alb are risk factors for progression to liver cirrhosis in CHC patients with GT3 infection.