To cultivate composite medical professionals capable of adapting to the development of intelligent healthcare,this consensus is grounded in the competency-based medical education,integrating the competency model and Miller’s pyramid of clinical competence. A two-round Delphi method involving a multidisciplinary expert panel was conducted,combined with a systematic literature review,to develop a 21-indicator artificial intelligence(AI) literacy competency list for medical students across three domains:knowledge (8 indicators),skills (8 indicators),and attitudes (5 indicators). Furthermore,the consensus proposes a practical assessment system:standardized testing for the knowledge domain,situational judgment tests for the attitudes domain,and objective structured clinical examinations incorporating AI-related scenarios for the skills domain. In addition,a longitudinal assessment strategy spanning the phases of admission,preclinical training,and clinical training is recommended. The competency list and assessment framework established in this consensus demonstrate strong scientific rigor,authority,and practical applicability,and can serve as an important reference for medical schools seeking to advance the deep integration of AI and medical education and to cultivate composite medical talents suited to the era of intelligent healthcare.

Gallbladder-duodenal fistula,a severe complication of cholecystitis caused by gallstones,is clinically rare.Its clinical presentation lacks specificity,and conventional preoperative imaging often fails to establish a definitive diagnosis.This report describes a case where a gallbladder-duodenal fistula was diagnosed using oral microbubble ultrasound contrast agent for gastric-duodenal contrast-enhanced ultrasound,providing a novel approach for diagnosing this condition.

In response to the challenges posed by the profound integration of generative artificial intelligence(AI)into medical education,this consensus proposes a logically coherent,medically distinctive,forward-looking,and operable AI proficiency framework for medical educators(competency items of medical educators’ AI proficiency,CAIP-ME).Through systematic literature review,preliminary framework construction,multiple rounds of expert pre-study,and a structured Delphi method involving extensive consultations with 60 interdisciplinary experts,the core competency items and assessment standards for AI proficiency among medical educators were demonstrated and calibrated.The framework encompasses five core dimensions and 25 specific competency items.The five dimensions are value recognition and ethical foundation,technical understanding and tool application,teaching integration and innovative practice,learning assessment and precise empowerment,and professional development and ecosystem co-construction.Competency items are categorized into 11 foundational competency items essential for all educators and 14 developmental competency items for those pursuing excellence.Each competency item is described in terms of its conceptual definition and key behavioral manifestations,accompanied by observable assessment indicators.This consensus aims to provide a scientific basis for the professional development of medical educators and the faculty building in medical institutions,while establishing a key reference standard for educator competency development in the context of digital transformation in medical education.

The research and innovative applications of generative medical artificial intelligence(GMAI)are rapidly advancing in the healthcare field.Significant breakthroughs of GMAI have been achieved in areas such as generating diagnostic suggestions,optimizing treatment plans,and assisting doctor-patient communication,profoundly reshaping the paradigm of clinical diagnosis and treatment.However,the open-ended nature of GMAI’s generation raises novel ethical challenges,including algorithmic bias,ambiguous accountability,data privacy breaches,and insufficient cultural adaptability.Current ethical governance lags behind technological implementation,necessitating the establishment of a standardized governance framework.Our research team assembled a multidisciplinary panel of experts spanning medical ethics,clinical medicine,medical artificial intelligence,hospital management,public health,and law.According to the governance logic of “prevention-control-remediation” and integrating international norms with domestic policies,this consensus was developed through two rounds of expert consultation to unify opinions and perspectives.It aims to provide a reference for the specific practice of clinical ethical review in the research and clinical application of GMAI and to establish an authoritative guidance framework for the clinical ethical governance of GMAI,tailored to China’s cultural context and national requirements.

Adriamycin is an anthracycline chemotherapy drug used in cancer treatment,and its cardiotoxicity primarily manifests as structural and functional damage to myocardial cells,which can lead to severe cardiovascular diseases such as heart failure.This article reviews recent advances in adriamycin-induced myocardial injury,focusing on its pathological mechanisms,potential therapeutic drugs,and commonly used animal models,to provide a research basis and intervention strategies for developing effective treatments.

Head and neck squamous cell carcinoma(HNSCC) associated with a poor prognosis and diminished quality of life for patients is the most prevalent pathological type among head and neck tumors. Currently,the standard treatment modalities comprise systemic therapies(including chemotherapy,targeted therapy,and immunotherapy) and local therapies(surgery and radiotherapy).Immunotherapy,characterized by high specificity and low toxicity,is progressively expanding from advanced palliative care to the stage of locally advanced curative treatment and has demonstrated promising efficacy.This review summarizes the latest advances in immunotherapy for HNSCC,aiming to provide reference for optimizing clinical management strategies and facilitating the clinical research.

Kleine-Levin syndrome is an extremely rare sleep disorder.In addition to recurrent daytime sleepiness,symptoms such as overeating,hypersexuality,cognitive impairment,and mental and behavioral abnormalities usually occur.Hypothalamic dysfunction may be the underlying pathogenesis.Cases with headache are rare.We reported a case of Kleine-Levin syndrome with headache symptoms during narcolepsy,and his headache was characterized by both migraine and cluster headache.It is hypothesized that Kleine-Levin syndrome may have a potential common pathogenesis with functional headaches such as migraine or cluster headache,which may be related to hypothalamic dysfunction.

Objective To explore the risk factors for secondary uterine arteriovenous fistula (UAVF) after induced abortion. Methods A retrospective case-control study was conducted.Fifty-two patients with secondary UAVF after induced abortion in Peking Union Medical College Hospital between January 2013 and January 2025 were enrolled in the patient group.According to a 1∶3 ratio,patients who underwent the same method of abortion to terminate pregnancy within the same two weeks but did not develop UAVF post-surgery were selected and included in the control group (n=156).The basic information was compared between the two groups. Multivariate logistic regression analysis was performed to identify the risk factors for UAVF after induced abortion. Results Multivariate logistic regression analysis showed that residual pregnancy tissue in the uterus was an independent risk factor for the occurrence of UAVF (OR=16.02,P=0.037).The patients with residual pregnancy tissue after induced abortion had a 16 fold higher incidence of secondary UAVF than the control group. Conclusions Residual pregnancy tissue in the uterus is an independent risk factor for secondary UAVF after induced abortion.Avoiding residual pregnancy tissue may reduce the occurrence of UAVF.

Objective To evaluate the effect of pressure-controlled ventilation-volume guaranteed(PCV-VG)on the perioperative pulmonary oxygenation function of the patients undergoing off-pump coronary artery bypass grafting(OPCABG).Methods Forty patients aged 40-65 years,of both sexes,with the American Society of Anesthesiologists physical status Ⅲ or Ⅳ,preoperative cardiac function(NYHA)class Ⅱ or Ⅲ,scheduled for elective OPCABG were assigned via the random number table method into two groups(n=20):a volume-controlled ventilation(VCV)group(Group V)and a PCV-VG group(Group P).Other respiratory parameters of the anesthesia machine were set consistently in both groups.At the time of sawing the sternum(T₀),when left internal mammary artery harvesting with the operating table tilted 10° to the left(T₁),when left anterior descending coronary artery bypass grafting with the operating table tilted 10° to the right(T₂),when right coronary artery bypass grafting with the operating table in a 30° head-down and tilted 10° to the right(T₃),when circumflex coronary artery bypass grafting with the operating table in a 20° head-down and tilted 15° to the right(T₄),and at the end of the surgery(T₅),the peak airway pressure(Ppeak),mean airway pressure(Pmean),plateau airway pressure(Pplat),and pulmonary dynamic compliance(Cdyn)were recorded.The alveolar-arterial partial pressure difference of oxygen(PA-aDO₂),oxygenation index(OI),and respiratory index(RI)were recorded at the aforementioned time points as well as on postoperative day 1(T₆),day 3(T₇),and day 7(T₈).The dosages of intraoperative drugs(sufentanil,remifentanil,and rocuronium bromide),postoperative endotracheal tube indwelling time,the stay time in the cardiac surgery intensive care unit,and the occurrence of pulmonary complications within 7 days after the surgery were also recorded.Results Compared with Group V,Group P showed significant downward trends in Ppeak,Pmean,and Pplat during T₃-T₅,as well as in PA-aDO₂ and RI during T₃-T₈(all P<0.05).Meanwhile,Group P exhibited significant upward trends in Cdyn during T₃-T₅ and in OI during T₃-T₈(all P <0.05).Compared with those in Group V,the postoperative endotracheal tube indwelling time and the stay time in the cardiac surgery intensive care unit were shortened in Group P(all P<0.05).There was no statistically significant difference in dosages of intraoperative drugs(sufentanil,remifentanil,and rocuronium bromide)or incidence of pulmonary complications within 7 days after the surgery between the two groups of patients(all P>0.05).Conclusion Compared with VCV,PCV-VG can improve the perioperative pulmonary oxygenation function of the patients undergoing OPCABG.

The five-year survival rate of gastric cancer in China is close to that in European and American countries but far lower than that in the Republic of Korea and Japan,which have established national gastric cancer screening systems.It is of great significance to build a high-quality gastric cancer screening system adaptive to China’s national conditions.Due to the large number of people at risk of gastric cancer and uneven distribution of medical resources,it is still difficult for China to carry out a nationwide gastroscopy screening plan for gastric cancer.Gastric ultrasound,with painlessness,no radiation,and easy acceptance and popularization,could be used as one of the alternative methods for initial screening of gastric cancer.Based on two gastric ultrasound-related consensuses published in 2020,this consensus elaborates on the necessity,feasibility,and existing problems of conducting preliminary gastric cancer ultrasound screening in China by analyzing the gastric cancer screening strategies and the difficulties faced by nationwide gastric cancer screening.Furthermore,this consensus introduces the indications and contraindications of gastric ultrasound examination,requirements for the operator and the contrast agent,ultrasound standard section,essentials of scanning operations,and stomach ultrasound report and data system (Su-RADS) and proposes the relevant consensus opinions accordingly.After multiple rounds of discussions and voting by experts from multiple societies,a total of 17 consensus opinions have been formed on gastric ultrasound as a preliminary screening technique for gastric cancer,with the aim of standardizing the popularization of gastric ultrasound.In addition,the consensus calls for conducting nationwide multicenter prospective studies to improve the level of evidence and provide data support for the construction of a preliminary gastric cancer ultrasound screening system that is in line with China’s national conditions.

Sigmoid colon schwannoma is a rare benign gastrointestinal tumor that is challenging to be diagnosed preoperatively.This paper reported a case of sigmoid colon schwannoma that was preoperatively misdiagnosed as a gastrointestinal stromal tumor on ultrasonography.Intraoperative frozen section analysis identified it as a spindle cell tumor,with definitive diagnosis confirmed as gastrointestinal schwannoma via immunohistochemistry.This paper summarizes the similarities and differentiating features of intestinal stromal tumors and schwannomas on ultrasonographic imaging.By analyzing and discussing previous literature,we aim to enhance the diagnostic and differential diagnostic capabilities of ultrasonographers in preoperative evaluation of intestinal schwannomas,thereby providing reliable evidence for clinicians in the diagnosis and management of this condition.

Objective To examine the progress in incorporating hospice care as a key component to improve the quality of life for the elderly within Beijing’s city-wide elderly health support system.Methods Relevant policy documents and literature,as well as the progress in system construction and service model development of hospice care in Beijing,were reviewed to comprehensively evaluate the effects and challenges of policy implementation.Results Guided by national policies,Beijing has advanced hospice care through innovative service models that integrate hospital,community,and home-based care,supported by “Internet+” technologies to enhance service accessibility and efficiency.Multiple healthcare institutions have established hospice care departments and adopted multidisciplinary team approaches to improve service quality.In addition,progress has also been made in workforce training,digital infrastructure,and supportive socio-economic policies.Conclusions While Beijing has achieved initial success in developing a hospice care system,challenges remain,including uneven resource distribution and a shortage of qualified professionals.Further efforts are needed to optimize resource allocation,strengthen professional training,enhance public awareness,and improve digital support.These efforts are expected to promote the building of a comprehensive and sustainable hospice care system that ensures dignity and compassion for the elderly at the end of life.This study has for the first time constructed a gradient allocation model of palliative care resources,providing a reference for developing countries.

Objective To investigate the effects of folate deficiency on changes in histone H3 lysine 4 (H3K4) mono-methylation (me1)-marked enhancers and the molecular mechanism underpinning the folate deficiency-induced neural tube defects (NTD). Methods Mouse embryonic stem cells (mESCs) were cultured in the folate-free DMEM medium (folate-deficient group) and the DMEM medium containing 4 mg/L folate (normal control group),respectively.Chromatin immunoprecipitation sequencing (ChIP-seq) was performed for H3K4me1. The mouse model of folate-induced NTD was established,and transcriptome sequencing (RNA-seq) was performed for the brain tissue of fetal mice to reveal the differential expression profiles.The results were validated through real-time quantitative polymerase chain reaction (RT-qPCR).The activity of the differential peak regions of H3K4me1 was verified through the luciferase reporter assay. Results The folate content in the mESCs cultured in the folate-free medium reduced compared with that in the normal control group (P=0.008).The H3K4me1-maked enhancers in the mESCs cultured in the folate-free medium induced significant changes in intronic regions,and these changes were concentrated in metabolic and energy metabolism processes (q=9.56×10^-48,P=1.28×10^-47).The differentially expressed genes harboring H3K4me1-marked enhancers in mESCs were mainly enriched in the Wnt signaling pathway (q=0.004,P=0.004 7).ChIP-qPCR results confirmed that H3K4me1 binding decreased in the differential peak regions of the Ldlrap1 gene (P=0.008),Camta1 gene (P=0.002),and Apc2 gene (P=0.012).The H3K4 demethylase inhibitor T-448 effectively reversed the H3K4me1 binding in the differential peak regions of the aforementioned genes (P=0.01).The results of RNA-seq for the brain tissue of NTD fetal mice showed significant enrichment of the differentially expressed genes in the Wnt signaling pathway (P=1.52×10^-5).The enrichment of differential peak regions of H3K4me1-marked enhancers in Apc2,Ldlrap1,and Camta1 genes in the brain tissue also showed significant changes.The differential peak region in Apc2 exhibited transcription factor activity (P=0.020). Conclusion Folate deficiency may affect changes in H3K4me1-marked enhancers to participate in the regulation of neural tube closure genes,thereby inducing the occurrence of NTD.

The pharmaceutical industry is a strategic sector bearing on national economy,development,and security.It represents one of the fields featuring highly active scientific innovation,fierce international competition,and high policy attention.Amidst profound adjustments in the global pharmaceutical landscape and the deep advancement of a new round of scientific and technological revolution and industrial transformation,the 15th Five-Year Plan period marks a critical stage for China’s pharmaceutical industry to achieve high-quality development.This article systematically analyzes the characteristics and strategic positioning of the pharmaceutical industry,reviews the development landscape and trends of the global pharmaceutical industry,and objectively summarizes China’s current status of this industry in terms of industrial scale,innovation capability,industrial clustering,and internationalization.The study suggests that during the 15th Five-Year Plan period,China’s pharmaceutical industry faces five major new situations—new strategic positioning,new market demands,emerging technologies,fresh growth drivers,and a reshaped industrial landscape,with opportunities outweighing challenges.To achieve high-quality development during the 15th Five-Year Plan period,the industry should adhere to five principles:prioritizing scale-driven expansion to enlarge industrial footprint,boosting technological foundation to anchor innovation-led development,advancing business model innovation to foster new application scenarios,adhering to people-centered development to ramp up high-quality product supply,and optimizing the industrial ecosystem to refine supporting guarantee systems.

Gastric contrast-enhanced ultrasound is a non-invasive imaging method that uses oral gastrointestinal ultrasound contrast agents to fill the stomach cavity and display the structure and lesions of the stomach wall.In recent years,the development of contrast agents and the technological innovations of ultrasound equipment have boosted the unique advantages of this examination technique in the diagnosis of gastrointestinal diseases.Gastric contrast-enhanced ultrasound is becoming an important complementary examination means to gastroscopy and X-ray barium meal examination.In this paper,we summarize the clinical applications of gastric contrast-enhanced ultrasound at home and abroad in recent years and systematically analyze its clinical application value and limitations in six aspects:screening and staging of gastric cancer,differentiation and diagnosis of gastric tumors,diagnosis and follow-up of gastritis and gastric ulcers,assessment of gastric contents and gastric volume,evaluation of gastric emptying and gastric motility,and other special applications.

Objective To investigate the internalized weight bias and weight control beliefs regarding the current status,influencing factors,and impacts on eating behaviors of women losing weight. Methods A convenient sampling method was used to select the females who underwent physical examination in the Peking Union Medical College Hospital from August to December 2023.The general information questionnaire,Weight Bias Internalization Scale,Weight Control Belief Questionnaire,and Chinese version of Three-Factor Eating Questionnaire were utilized for investigation.Latent class analysis was conducted to explore the potential categories based on the characteristics of internalized weight bias and weight control beliefs.Univariate analysis and multiple-factor linear regression analysis were performed to explore influencing factors of potential categories and their effects on eating behaviors. Results A total of 518 subjects were included in this study.The internalized weight bias and weight control beliefs could be classified into three potential categories: low weight bias tolerance type(53.7%),medium weight bias persistence type(29.5%),and high weight bias overcritical type(16.8%).Logistic regression analysis showed that body mass index,unmarriage,and divorce were the influencing factors of the high weight bias overcritical type.The scores of non-control eating and emotional eating in medium weight bias persistence type and high weight bias overcritical type were higher than those in low weight bias tolerance type(all P<0.001). Conclusions The attitudes of Chinese women towards body weight can be categorized into low weight bias tolerance type,medium weight bias persistence type,and high weight bias overcritical type.The high weight bias overcritical type is characterized by high weight bias and high personal responsibility attribution,and it is closely associated with negative eating behaviors.A high body mass index,unmarriage,and divorce are high-risk factors for developing the high weight bias overcritical type.

With the rapid development of biomedical research in China,biobanks have been widely established as crucial infrastructure supporting precision medicine and big data research.However,at the practical level,informed consent—central to safeguarding the rights and interests of research participants—often shows a disconnection between ethical principles and technological realities.This study first examines the Chinese translation of the term “biobank”, arguing that “biological sample data bank” better reflects both the data-centric nature and governance complexity of such entities.It then systematically reviews the ethical debates surrounding various models of informed consent,including blanket consent,broad consent,dynamic consent,and meta-consent.Building on this analysis,this paper identifies key ethical elements that an effective informed consent form should include.Special attention is paid to the legitimacy and practical challenges of components such as research purpose,data collection,data use,storage duration,risk disclosure,and return of results.This study aims to provide an ethical foundation and practical guidance for improving the informed consent framework in China’s biobank governance,thereby promoting a shift from mere regulatory compliance to robust ethical engagement and fostering a virtuous cycle between public trust and sustainable research development.

Ischemic stroke(IS)remains a predominant contributor to mortality and disability,with current clinical interventions demonstrating suboptimal therapeutic efficacy.Recent studies have shown that circular RNA(circRNA)participates in pathological processes through the competing endogenous RNA(ceRNA)regulatory network,involving key processes such as apoptosis,inflammatory response,angiogenesis,autophagy,oxidative stress,and neuronal regeneration.This study reviews the molecular mechanism and application progress of circRNA regulating IS through the ceRNA network,aiming to provide theoretical support for the in-depth development of circRNA in the diagnosis and treatment strategies of IS and offer guidance for future related research and clinical practice.

Objective To investigate the value of repeat renal biopsy in the treatment and prognosis of nephrotic syndrome(NS)and acute kidney injury(AKI)following immunosuppressive therapy in patients with lupus nephritis(LN). Methods A retrospective analysis was conducted for the clinicopathological data and follow-up records of LN patients undergoing repeat renal biopsy at Peking Union Medical College Hospital from January 1,2009 to December 31,2021. Results A total of 76 patients(55 females,72.4%)were included in this study,with the mean age at the first biopsy being(29.0±10.4)years,the median inter-biopsy interval of 4.0(2.0,7.0) years,and the median total follow-up duration of 7.5(5.0,13.8)years.Pathological transformation occurred in 46(60.5%)patients,and 2 patients had comorbid diabetic nephropathy.At repeat renal biopsy,50(65.8%) patients presented NS.These patients demonstrated lower estimated glomerular filtration rate(eGFR)(P<0.001),higher chronicity index(CI)(P=0.029),and higher complement C3(P<0.001)and C4(P<0.001)levels than those with NS at the first renal biopsy(n=50).Among the 28(36.8%) patients with AKI at repeat renal biopsy,8(28.6%)experienced acute exacerbation of chronic renal insufficiency.These patients exhibited higher serum creatinine level(P=0.002),C4 level(P=0.033),CI(P=0.042),and prevalence of thrombotic microangiopathy(P=0.046)than the patients showing AKI at the first renal biopsy(n=16),while the activity index(AI)showed no significant difference(P=0.051).Over 50% of NS and AKI patients underwent treatment modifications post-repeat renal biopsy,with clinical remission rates comparable to those after the first renal biopsy(both P>0.05).Elevated CI(≥5,P=0.001)and serum creatinine(≥140 μmol/L,P<0.001)at repeat renal biopsy were identified as independent risk factors for poor prognosis.The patients with AKI at repeat renal biopsy had higher incidence of endpoint events than the non-AKI patients(P=0.015).Neither AKI at the first renal biopsy nor NS at both biopsies had significant associations with prognosis. Conclusions Repeat renal biopsy reveals not only sustained high disease activity but also accelerates chronic progression in LN patients,which underscore its critical role in guiding the therapy for severe LN post-immunosuppression.AKI,CI≥5,and serum creatinine ≥140 μmol/L at repeat renal biopsy are strongly associated with poor prognosis.

Atherosclerosis (AS) is characterized by lipid deposition and the formation of arterial intimal plaques,which can lead to serious cardiovascular events such as acute coronary syndrome,myocardial infarction,or stroke.It is one of the leading causes of mortality among Chinese residents.Recent studies have demonstrated that porphyromonas gingivalis lipopolysaccharide activates the inflammatory pathway through binding to Toll-like receptors,thereby stimulating the expression of inflammatory mediators.This process induces functional impairments in macrophages and endothelial cells,promotes foam cell formation,and consequently accelerates the progression of AS.This article reviews the latest research progress in the roles and mechanisms of porphyromonas gingivalis lipopolysaccharide in AS and explores its potential value as a clinical therapeutic target,aiming to provide new insights for the prevention and treatment of AS.