Objective:To analyze the current status and factors influencing clinician participation in remote patient management in China.Methods:In December 2023, a structured electronic questionnaire was administered to 7 980 clinicians, including 930 cardiologists. The survey assessed clinicians′ participation in online doctor-patient interactions; differences in hospital support across city tiers, hospital grades, professional titles, and departments; and factors influencing the willingness of clinicians to invest time in remote patient management.Results:Among the 7 980 surveyed clinicians, online consultations had the highest participation rate (72.2%). Among cardiologists, participation rates for online consultations, health education, and post-consultation management were 73.3%, 66.9%, and 38.5%, respectively, which were relatively higher than those of other specialties. Hospital-based support for physicians in remote patient management showed significant variations across specialties and regions. Among cardiologists, 68.4% received "encouraging" policies, with the majority falling under "encouragement without incentive policies" (42.6%). In tier 3 cities, the proportion of physicians receiving "encouragement without incentive policies" was the highest (47.9%), while the proportion in the "cautious, requiring reporting" category was the lowest (3.9%). During remote patient management, the proportions of clinicians receiving support from professional teams were highest among those in tier 3 cities (29.6%) and cardiologists (30.5%). A significant interaction effect was observed between hospital policy and specialty (cardiologists vs. all clinicians) regarding physicians′ willingness to invest time in remote patient management ( F=5.95, P<0.001). Among cardiologists, those working in institutions with "encouraging, with incentives" policies reported a significantly longer median weekly investment time (10.0 h) compared to those under "neutral, unrestricted" policies (7.0 h, P<0.001). Cardiologists with team support reported a significant increase in the time they were willing to invest (10 h/week) than those without team support (7.0 h/week, P<0.001), although no significant interaction effect was found when compared with all clinicians ( P=0.186). Cardiologists with a high online income (>5 000 Yuan/month) reported a significantly longer weekly investment time in remote management (25.0 h) compared to those with lower income (<200 yuan/month; 8.0 h, P<0.001). However, whether the income met their personal expectations had no significant effect on their time commitment ( P=0.638). Conclusions:Clinicians from tertiary hospitals and tier 3 cities demonstrated a higher level of engagement in remote patient management. Strengthening hospital policy support, enhancing team-based collaborations, and increasing online income levels may help promote the broader adoption of telemedicine.

Background and aims:Liver fibrosis is a prevalent pathological stage of various chronic liver diseases and has the potential to progress to liver cirrhosis and hepatocellular carcinoma.However,experimental models for in vivo research are limited.Unexpectedly,increased liver inflammation and fibrosis were previously observed in mice treated with aluminum adjuvant(commercial Imject Alum,a mixture of Al(OH)3 and Mg(OH)2).Our study aimed to reveal the pathogenesis and pathological features of Imject Alum-induced liver injury and evaluate its potential as an experimental model of fibrotic liver disease.Methods and materials:C57BL/6J mice were randomly divided into the following four groups:(ⅰ)control group,which received phosphate-buffered saline injections on days 1,12,26,40,and 54;(ⅱ)Imject Alum(Al(OH)3 160 mg/kg)D26 group,which was administered with Imject Alum(Al(OH)3 160 mg/kg)on days 1,12,and 26;(ⅲ)Imject Alum(Al(OH)3 80 mg/kg)D54;and(ⅳ)Imject Alum(Al(OH)3 160 mg/kg)D54 groups,which were treated with 80 mg/kg and 160 mg/kg of Imject Alum(Al(OH)3),respectively,on days 1,12,26,40,and 54.All reagents were delivered by intraperitoneal injection.Serum biochemical pa-rameters,liver pathology,and expression of genes related to inflammation and fibrogenesis were eval-uated.Transcriptome sequencing was performed.The genetic characteristics of the Imject Alum-induced liver lesions in the existing fibrosis model and patients with cirrhosis were determined.Results:Administration of Imject Alum(Al(OH)3 160 mg/kg)at certain points for 54 days led to extensive hepatic inflammation and fibrosis,accompanied by disturbed bile acid metabolism in mice.Moreover,Imject Alum aggravated liver inflammation and injury by activating the pyroptosis-related inflamma-some pathway.Transcriptome analysis revealed that Imject Alum-induced liver lesions had differentially expressed genes that were significantly enriched in pathways related to inflammation,fibrogenesis,and multiple metabolic processes.Moreover,Imject Alum-induced liver lesions exhibited gene signatures similar to those of existing fibrosis models and patients with cirrhosis.Conclusions:Aluminum adjuvant(Imject Alum;Al(OH)3 160 mg/kg)administration at certain points for 54 days resulted in notable liver injury,inflammation,and fibrosis.This model had similar gene expression characteristics with existing fibrosis models and liver samples from patients with cirrhosis.Overall,aluminum adjuvant(Imject Alum)-induced mouse model may be a novel approach for estab-lishing a liver fibrosis animal model.

Objective:To investigate the current awareness of large language models (LLM) among Chinese clinical physicians and analyze the application needs of cardiovascular specialists.Methods:This is a cross-sectional study utilized convenience sampling. In December 2023, a self-designed questionnaire was distributed to 7 980 clinical physicians, including 930 cardiologists. The survey collected demographic information, including work city (categorized as first-tier, new first-tier, second-tier, third-tier, and fourth-tier and below), hospital level, professional title, and department. And the awareness of LLM, and their application demands in clinical decision-making support, information filtering, and scientific research work were also collected. Differences in awareness and application requirements across geographic regions, hospital tiers, professional ranks, and medical departments were analyzed. Besides, specific demands of cardiovascular specialists were further examined.Results:Among the 7 980 clinical physicians, the awareness rate of LLM was 76.3% (6 088/7 980), and the utilization rate was 11.8% (942/7 980). For the 930 cardiologists, the awareness rate was 78.5% (730/930) and the utilization rate was 11.4% (106/930). Significant differences in awareness and utilization rates were observed across city tiers, hospital grades, and departments (all P<0.05). No significant difference was found among professional titles ( P=0.053). Among the 6 088 physicians aware of LLM, demand rates for clinical information filtering, clinical decision support, and research assistance were 87.3% (5 312/6 088), 78.4% (4 774/6 088), and 75.8% (4 616/6 088), respectively. For the 730 cardiologists aware of LLM, these rates were 91.0% (664/730), 79.2% (578/730), and 75.9% (554/730), respectively. Significant differences in demands for clinical information filtering and research assistance were observed across city tiers, hospital grades, professional titles, and departments (all P<0.05), while no significant difference was noted for decision support demands across hospital grades ( P=0.085). In clinical information screening and acquisition, cardiologists from different city tiers exhibited statistically significant differences in the demand for literature interpretation. Similarly, variations in the demand for conference summaries, expert biographies, healthcare policies, and social news were noted among cardiologists with different professional titles, while disparities in patient education and science popularization needs were identified across city tiers and hospital grades (all P<0.05). In clinical decision-making support, cardiologists from diverse city tiers and professional titles demonstrated distinct differences in guideline and consensus inquiries, and those from various city tiers showed varied demands for pharmaceutical and medical device-related content (all P<0.05). For research support, cardiologists across city tiers and professional titles exhibited statistically significant differences in trial protocol design requirements, while those from varying city tiers differed in literature search/analysis and research application procedures. Additionally, physicians from different hospital grades displayed divergent needs for data collection (all P<0.05). Conclusions:The adoption of LLM is significantly influenced by regional disparities, institutional resources, and professional backgrounds. Implementing targeted interventions, such as enhancing technical training, optimizing LLM functionalities, and improving accessibility across diverse healthcare settings, could encourage widespread integration of LLM into clinical practice. Such measures could ultimately enhance the quality and efficiency of medical services in China and foster innovations in healthcare delivery.

Objective:To investigate the influencing factors of adult dental fluorosis in drinking water-borne endemic fluorosis areas of Inner Mongolia Autonomous Region.Methods:A case-control study was conducted in January 2024 to select adult fluorosis patients (case group) and healthy individuals (control group) from the drinking water-borne endemic fluorosis areas in Helinger County, Hohhot City, Inner Mongolia Autonomous Region as the survey subjects. Urine samples were collected to determine urinary fluoride concentration. A questionnaire survey was conducted. SPSS 25.0 software was used for χ 2 test and multivariate logistic regression analysis. Restricted cubic spline (RCS) was used to analyze the association between urinary fluoride concentration and the risk of dental fluorosis in adults. Results:A total of 161 individuals were included in the survey, including 100 in the case group and 61 in the control group. The results of univariate analysis showed that there were statistically significant differences in the distribution of gender, smoking, and urinary fluoride concentration between the case group and the control group (χ 2 = 7.54, 5.02, 9.69, P < 0.05). The results of multivariate logistic regression analysis indicated that gender ( OR = 0.36, 95% CI: 0.18 - 0.73, P = 0.005) and urinary fluoride concentration ( OR = 3.08, 95% CI: 1.46 - 6.67, P = 0.003) were the influencing factors of adult fluorosis. RCS analysis showed a significant linear dose-response relationship between the risk of dental fluorosis and urinary fluoride concentration ( Poverall trend = 0.001, Pnonlinear = 0.071). When the urinary fluoride concentration was greater than 1.57 mg/L, the risk of dental fluorosis increased with the increase of urinary fluoride concentration. Conclusion:Gender and urinary fluoride concentration are the risk factors of dental fluorosis in adults in drinking water-borne endemic fluorosis areas of Inner Mongolia Autonomous Region.

Objective:To summarize the clinical phenotypes, genotypes, and treatment outcomes of NPRL2-related epilepsy. Methods:This was a case summary.Clinical data of patients with NRPL2 variants admitted to the Department of Pediatrics, Peking University People′s Hospital between October 1, 2013 and October 31, 2023 were retrospectively analyzed.Previous reports of patients with the same disease were reviewed. Results:Six cases of NPRL2-related epilepsy were collected, and 37 cases were reported in the previous literatures.The age of onset ranged from 3 days to 18 years with the median age of 24 months.There were 15 patients with onset in infancy.Among the 41 patients diagnosed with epilepsy, 73.1% (30/41) had focal seizures, 34.1% (14/41) had frontal lobe epilepsy, and 17.1% (7/41) had epileptic spasms.Among the patients with known cranial imaging, 58.6% (17/29) had cortical malformations. NPRL2 variants involved 11 nonsense mutations, 10 splice site mutations, 7 frameshift mutations, 1 large fragment deletion, and 14 missense mutations; among them, 39 mutations were pathogenic or likely pathogenic, while the rest 4 mutations had unclear pathogenicity.Among the 27 patients with known outcomes, 11 (40.7%) had no seizures after administration of 1 or 2 types of drugs, and 16 (59.2%) had drug-resistant epilepsy.Among the 16 patients, 1 had no seizures after treatment with 3 types of anti seizure medications, and 7 had no seizures after surgery.Most patients had varying degrees of delay in intellectual and motor development. Conclusions:Patients with NPRL2 variants usually present with frequent focal seizures and epileptic spasms, and the age of onset varies greatly.About half of the patients have drug-resistant epilepsy, half of whom have cortical malformations.For those with drug-resistant epilepsy and abnormal cranial imaging, surgery may be considered.

Objective:To summarize the phenotype and genotype of leukoencephalopathy with calcifications and cysts(LCC).Methods:A case summary.Clinical, imaging, and genetic data of 2 patients with early-onset LCC admitted to the Department of Pediatrics, Peking University People′s Hospital between December 2023 and August 2024 were retrospectively summarized.A review of the literature was also conducted.Results:Case 1: a 19-month-old female infant presented with febrile seizures in infancy and mild developmental delay.Trio whole-exome sequencing (trio-WES) identified compound heterozygous pathogenic variants in the SNORD118 gene: n.92C>T (paternally inherited) and n. 72A>G (maternally inherited). Case 2: an 11-year-and-4-month-old girl had non-specific encephalopathy in the neonatal period, developmental delay with regression, and seizures since early childhood.Trio-WES revealed compound heterozygous pathogenic variants in SNORD118: n.3C>T (paternally inherited) and n. 57G>C (maternally inherited). Both cases showed typical imaging findings of leukoencephalopathy, intracranial calcifications, and cysts.Case 2 has been treated with Bevacizumab for 3 months and remains under follow-up.Combining this 2 cases with previously reported genetically confirmed cases, a total of 97 LCC patients with identified SNORD118 variants were analyzed.The median age of onset was 5 years.Seventy-one cases had childhood onset, including 31 cases with onset at ≤1 year.The inaugural symptoms were: seizures in 40 patients (41.2%), motor disorders in 25 patients (25.8%), developmental delay or cognitive impairment in 19 patients (19.6%) and headaches or increased intracranial pressure in 13 patients (13.4%). Neurological dysfunctions progress during the course.All patients had typical leukoencephalopathy, intracranial calcifications and cysts, with varied imaging progress.A total of 61 variants of SNORD118 were reported and most were compound heterozygous variants.Treatment is primarily symptomatic.Three out of the 4 patients treated with Bevacizumab showed improvement. Conclusions:LCC is a rare autosomal recessive inherited cerebral microangiopathy, characterized by progressive neurological dysfunction and radiological triad of diffuse and asymmetric leukoencephalopathy, intracranial calcifications and cysts.Patients with pathogenic SNORD118 variants should definitely be diagnosed.Symptomatic treatment is the mainstay therapy and Bevacizumab may slow down the progression.

Objective:To investigate the influencing factors of adult dental fluorosis in drinking water-borne endemic fluorosis areas of Inner Mongolia Autonomous Region.Methods:A case-control study was conducted in January 2024 to select adult fluorosis patients (case group) and healthy individuals (control group) from the drinking water-borne endemic fluorosis areas in Helinger County, Hohhot City, Inner Mongolia Autonomous Region as the survey subjects. Urine samples were collected to determine urinary fluoride concentration. A questionnaire survey was conducted. SPSS 25.0 software was used for χ 2 test and multivariate logistic regression analysis. Restricted cubic spline (RCS) was used to analyze the association between urinary fluoride concentration and the risk of dental fluorosis in adults. Results:A total of 161 individuals were included in the survey, including 100 in the case group and 61 in the control group. The results of univariate analysis showed that there were statistically significant differences in the distribution of gender, smoking, and urinary fluoride concentration between the case group and the control group (χ 2 = 7.54, 5.02, 9.69, P < 0.05). The results of multivariate logistic regression analysis indicated that gender ( OR = 0.36, 95% CI: 0.18 - 0.73, P = 0.005) and urinary fluoride concentration ( OR = 3.08, 95% CI: 1.46 - 6.67, P = 0.003) were the influencing factors of adult fluorosis. RCS analysis showed a significant linear dose-response relationship between the risk of dental fluorosis and urinary fluoride concentration ( Poverall trend = 0.001, Pnonlinear = 0.071). When the urinary fluoride concentration was greater than 1.57 mg/L, the risk of dental fluorosis increased with the increase of urinary fluoride concentration. Conclusion:Gender and urinary fluoride concentration are the risk factors of dental fluorosis in adults in drinking water-borne endemic fluorosis areas of Inner Mongolia Autonomous Region.

Objective:To summarize the clinical phenotypes, genotypes, and treatment outcomes of NPRL2-related epilepsy. Methods:This was a case summary.Clinical data of patients with NRPL2 variants admitted to the Department of Pediatrics, Peking University People′s Hospital between October 1, 2013 and October 31, 2023 were retrospectively analyzed.Previous reports of patients with the same disease were reviewed. Results:Six cases of NPRL2-related epilepsy were collected, and 37 cases were reported in the previous literatures.The age of onset ranged from 3 days to 18 years with the median age of 24 months.There were 15 patients with onset in infancy.Among the 41 patients diagnosed with epilepsy, 73.1% (30/41) had focal seizures, 34.1% (14/41) had frontal lobe epilepsy, and 17.1% (7/41) had epileptic spasms.Among the patients with known cranial imaging, 58.6% (17/29) had cortical malformations. NPRL2 variants involved 11 nonsense mutations, 10 splice site mutations, 7 frameshift mutations, 1 large fragment deletion, and 14 missense mutations; among them, 39 mutations were pathogenic or likely pathogenic, while the rest 4 mutations had unclear pathogenicity.Among the 27 patients with known outcomes, 11 (40.7%) had no seizures after administration of 1 or 2 types of drugs, and 16 (59.2%) had drug-resistant epilepsy.Among the 16 patients, 1 had no seizures after treatment with 3 types of anti seizure medications, and 7 had no seizures after surgery.Most patients had varying degrees of delay in intellectual and motor development. Conclusions:Patients with NPRL2 variants usually present with frequent focal seizures and epileptic spasms, and the age of onset varies greatly.About half of the patients have drug-resistant epilepsy, half of whom have cortical malformations.For those with drug-resistant epilepsy and abnormal cranial imaging, surgery may be considered.

Objective:To summarize the phenotype and genotype of leukoencephalopathy with calcifications and cysts(LCC).Methods:A case summary.Clinical, imaging, and genetic data of 2 patients with early-onset LCC admitted to the Department of Pediatrics, Peking University People′s Hospital between December 2023 and August 2024 were retrospectively summarized.A review of the literature was also conducted.Results:Case 1: a 19-month-old female infant presented with febrile seizures in infancy and mild developmental delay.Trio whole-exome sequencing (trio-WES) identified compound heterozygous pathogenic variants in the SNORD118 gene: n.92C>T (paternally inherited) and n. 72A>G (maternally inherited). Case 2: an 11-year-and-4-month-old girl had non-specific encephalopathy in the neonatal period, developmental delay with regression, and seizures since early childhood.Trio-WES revealed compound heterozygous pathogenic variants in SNORD118: n.3C>T (paternally inherited) and n. 57G>C (maternally inherited). Both cases showed typical imaging findings of leukoencephalopathy, intracranial calcifications, and cysts.Case 2 has been treated with Bevacizumab for 3 months and remains under follow-up.Combining this 2 cases with previously reported genetically confirmed cases, a total of 97 LCC patients with identified SNORD118 variants were analyzed.The median age of onset was 5 years.Seventy-one cases had childhood onset, including 31 cases with onset at ≤1 year.The inaugural symptoms were: seizures in 40 patients (41.2%), motor disorders in 25 patients (25.8%), developmental delay or cognitive impairment in 19 patients (19.6%) and headaches or increased intracranial pressure in 13 patients (13.4%). Neurological dysfunctions progress during the course.All patients had typical leukoencephalopathy, intracranial calcifications and cysts, with varied imaging progress.A total of 61 variants of SNORD118 were reported and most were compound heterozygous variants.Treatment is primarily symptomatic.Three out of the 4 patients treated with Bevacizumab showed improvement. Conclusions:LCC is a rare autosomal recessive inherited cerebral microangiopathy, characterized by progressive neurological dysfunction and radiological triad of diffuse and asymmetric leukoencephalopathy, intracranial calcifications and cysts.Patients with pathogenic SNORD118 variants should definitely be diagnosed.Symptomatic treatment is the mainstay therapy and Bevacizumab may slow down the progression.

Objective:To analyze the current status and factors influencing clinician participation in remote patient management in China.Methods:In December 2023, a structured electronic questionnaire was administered to 7 980 clinicians, including 930 cardiologists. The survey assessed clinicians′ participation in online doctor-patient interactions; differences in hospital support across city tiers, hospital grades, professional titles, and departments; and factors influencing the willingness of clinicians to invest time in remote patient management.Results:Among the 7 980 surveyed clinicians, online consultations had the highest participation rate (72.2%). Among cardiologists, participation rates for online consultations, health education, and post-consultation management were 73.3%, 66.9%, and 38.5%, respectively, which were relatively higher than those of other specialties. Hospital-based support for physicians in remote patient management showed significant variations across specialties and regions. Among cardiologists, 68.4% received "encouraging" policies, with the majority falling under "encouragement without incentive policies" (42.6%). In tier 3 cities, the proportion of physicians receiving "encouragement without incentive policies" was the highest (47.9%), while the proportion in the "cautious, requiring reporting" category was the lowest (3.9%). During remote patient management, the proportions of clinicians receiving support from professional teams were highest among those in tier 3 cities (29.6%) and cardiologists (30.5%). A significant interaction effect was observed between hospital policy and specialty (cardiologists vs. all clinicians) regarding physicians′ willingness to invest time in remote patient management ( F=5.95, P<0.001). Among cardiologists, those working in institutions with "encouraging, with incentives" policies reported a significantly longer median weekly investment time (10.0 h) compared to those under "neutral, unrestricted" policies (7.0 h, P<0.001). Cardiologists with team support reported a significant increase in the time they were willing to invest (10 h/week) than those without team support (7.0 h/week, P<0.001), although no significant interaction effect was found when compared with all clinicians ( P=0.186). Cardiologists with a high online income (>5 000 Yuan/month) reported a significantly longer weekly investment time in remote management (25.0 h) compared to those with lower income (<200 yuan/month; 8.0 h, P<0.001). However, whether the income met their personal expectations had no significant effect on their time commitment ( P=0.638). Conclusions:Clinicians from tertiary hospitals and tier 3 cities demonstrated a higher level of engagement in remote patient management. Strengthening hospital policy support, enhancing team-based collaborations, and increasing online income levels may help promote the broader adoption of telemedicine.