Highly pathogenic fungi are classified as Category Ⅱ pathogenic microorganisms in the Catalogue of Pathogenic Microorganisms Transmissible to Humans. With the increasing use of histopathology, fungal culture, serological assays, mass spectrometry-based identification, and high-throughput sequencing in the diagnosis of difficult-to-identify infections, these pathogens are increasingly detected, isolated, and re-identified from clinical specimens, thereby creating an urgent need for standardized management of diagnosis-related positive cultures, suspected isolates, confirmed strains, and residual infectious materials. The spore-producing nature, prolonged environmental survival, and dimorphic transition confer distinctive biological characteristics that render strain preservation, transport, inactivation, and retirement management particularly challenging. Current regulations provide only general principles for preservation, transport, and inactivation, lacking technical specifications tailored to fungal biology. The Fungal Study Group of the Chinese Medical Association Dermatology Branch, in collaboration with multidisciplinary experts, systematically reviewed domestic and international regulations and literature, conducted preliminary investigations to generate a pool of candidate items, and employed a modified Delphi method to solicit expert opinions. Consensus was defined as simultaneously meeting the following four criteria: (1)≥ 75% of experts scoring 4-5 (agree/strongly agree); (2)<10% of experts scoring 1-2 (strongly disagree/disagree); (3)< 20% of experts scoring 3 (neutral); (4)a median score≥ 4. Evidence levels and recommendation strengths were graded according to the Oxford Centre for Evidence-Based Medicine criteria. Nine recommendations were ultimately formulated, covering seven domains: prerequisites for biological safety level 3 (BSL-3) laboratories, preservation zoning and container management, inbound and outbound inventory verification, intra-hospital and inter-institutional transport, liquid and solid material inactivation, emergency response to leakage, post-exposure medical management, and strain retirement and disposal. This consensus represents China′s first operational technical document specifically addressing preservation, inventory handling, operation, transport and shipping, disposal, risk management, and emergency response of highly pathogenic fungal strains. It aims to translate statutory requirements into fungal-specific, enforceable, verifiable, and traceable technical standards, providing a management framework for qualified laboratories engaged in pathogenic diagnosis, re-identification, and strain management.

Traditional Chinese medicine and Western medicine share the term " spleen, " yet there are fundamental differences in its functions, location, and structure. In traditional Chinese medicine, the " spleen" is a functional concept that encompasses multiple systems, including digestion, metabolism, and immunity. However, in Western medicine, the " spleen" is an anatomical concept referring to the largest solid organ in the immune system. This article systematically explores the similarities and differences between the two from five distinct dimensions: conceptual essence, physiological functions, pathological mechanisms, clinical diagnosis, and clinical intersections. We conclude that the integration and cross-fertilization between the traditional Chinese medicine " spleen" and the Western medicine " spleen" have significant theoretical and clinical value for standardizing the diagnostic and therapeutic approach to integrated Chinese and Western medicine and optimizing clinical treatment plans.

To evaluate the application of a self-prepared diluent in automated fecal analysis and assess the consistency of its detection results with those of the manufacturer′s original diluent.

A total of 4 127 stool specimens were collected from inpatients at the First People′s Hospital of Tianmen between December 2023 and January 2024. Parallel testing was performed using the self-prepared and commercial diluents on the same automated fecal analyzer. Performance validation of the self-prepared diluent, including the blank test, repeatability, carryover rate, fecal occult blood (FOB) test, homogeneity, and stability was conducted according to industry standards. Differences in the detection of stool physical appearance, FOB, red blood cells (RBCs), white blood cells (WBCs), parasites, fungi, and fat globules were compared between the two diluents.

The self-prepared diluent complied with all industry standards for the evaluated performance indicators. The sensitivities for detecting stool physical appearance, FOB, WBCs, RBCs, parasites, fat globules, and fungi were 97.25%, 99.63%, 89.96%, 87.38%, 94.55%, 96.02%, and 92.86%, respectively. The specificity and accuracy both exceeded 95.00% across these parameters. High consistency was observed between the two diluents (> 95.00%), with all Kappa values > 0.850. Additionally, the self-prepared diluent reduced the reagent cost by 85 CNY per liter.

The self-prepared diluent demonstrates satisfactory homogeneity, stability, and analytical performance, with detection results highly consistent with those of the commercial diluent. Given its ease of use and significant cost-effectiveness, it holds promise for clinical application and translation.

To investigate the clinical value of shear wave elastography (SWE) in evaluating the therapeutic effect of Shujin Lijie tuina therapy on chronic nonspecific neck pain (CNNP).

This was a prospective randomized controlled study. A total of 60 patients with CNNP were recruited from the Department of Rehabilitation Medicine, Affiliated Hospital of Jining Medical University between February 2024 and December 2025. The patients were randomly divided into a tuina group (n=30) and a control group (n=30) by the random number table method. Both groups received magneto-thermo-vibration therapy combined with topical diclofenac diethylamine emulsion. On this basis, the tuina group additionally received Shujin Lijie tuina therapy. Visual analogue scale (VAS) and neck disability index (NDI) were assessed before and after treatment. SWE was applied to measure the mean Young modulus (Y) values of bilateral upper trapezius, semispinalis capitis, splenius capitis and splenius cervicis muscles. Independent samples t-tests and paired samples t-tests were used for between-group and within-group comparisons, respectively. Pearson correlation analysis was performed to evaluate the correlations between the reduction magnitude of mean muscle Y values and the reduction magnitudes of VAS and NDI before and after treatment.

Before treatment, no significant differences were observed between the tuina and control groups in the mean Y values of all evaluated muscles, VAS, and NDI (all P > 0.05). After treatment, the VAS scores, NDI, and the mean Y values of the upper trapezius, semispinalis capitis, splenius capitis, and splenius cervicis muscles were (1.83±0.79), (6.80±1.47), (12.50±3.70) kPa, (12.18±4.71) kPa, (9.84±3.39) kPa, (12.40±4 13) kPa in the tuina group, and (2.77±0.68), (10.20±2.37), (17.59±4.28) kPa, (15.31±4.90) kPa, (15.00±3.58) kPa, (15.00±3.79) kPa in the control group, respectively. All these parameters decreased significantly compared with their baseline values in both groups (all P<0.01). Furthermore, significant differences were observed between the two groups after treatment regarding the mean Y values of the four aforementioned muscles, as well as the VAS scores and NDI (all P<0.01). Pearson correlation analysis revealed that the reduction amplitude of VAS was weakly positively correlated with those of mean Y values of upper trapezius and splenius cervicis (r=0.356, 0.268, all P<0.05), and moderately positively correlated with those of semispinalis capitis and splenius capitis (r=0.542, 0.480, all P<0.01). The decrease in NDI was moderately positively correlated with the reduced mean Y values of upper trapezius, semispinalis capitis, splenius capitis and splenius cervicis (r=0.465, 0.685, 0.578, 0.540, all P<0.01).

In conclusion, the Shujin Lijie tuina therapy can effectively reduce muscle stiffness in cervical muscles and alleviate pain in patients with CNNP. Furthermore, SWE serves as a reliable objective tool for evaluating the therapeutic efficacy of this intervention.

To investigate the prevalence of fatigue and the effects of special service convalescence, and to analyze factors associated with fatigue in helicopter pilots.

A single center observational study was employed, selecting helicopter pilots undergoing convalescence at a rehabilitation and recuperation institution from April 2024 to August 2024. A general information questionnaire and the Chinese version of the Multidimensional Fatigue Inventory 20 (MFI-20) questionnaire were selected to assess the fatigue scores of 437 helicopter pilots. Basic flight and demographic data were collected, and routine blood tests, biochemical tests, as well as relevant imaging examinations were further conducted. Comparisons of demographic and clinical characteristics between fatigued and non-fatigued groups were performed using independent samples t-tests and chi-square tests. Furthermore, data from improved and non-improved subgroups within the fatigue cohort were compared. Multiple logistic regression analysis was used to analyze the factors influencing fatigue improvement among helicopter pilots.

Of the 437 questionnaires retrieved, 379 were valid. A total of 379 helicopter pilots were enrolled, including 150(39.58%) in the fatigue group and 229(60.42%) in the non-fatigue group. Compared with the non-fatigue group, the fatigue group exhibited significantly higher age [32.0(27.5, 38.0)years, 30.0(26.0, 34.0)years, Z=-3.429, P< 0.01], a greater proportion of personnel with flight hours ≥1 000 h [56.67%(85/150), 39.30%(90/229), χ²=10.997, P< 0.01], and a higher prevalence of transport helicopter pilots [59.33%(89/150), 48.47%(111/229), χ²=4.290, P< 0.05]. Significant difference was also observed in the regional distribution across units (χ²=19.717, P< 0.01). Flight personnel with more than one COVID-19 infection or persistent post-COVID-19 symptoms beyond three months exhibited a higher prevalence of fatigue (χ²=6.524, 16.897, all P< 0.05). Following standardized convalescent care, the discharge fatigue score (35.27±12.07) was significantly lower than the admission score (37.60±11.45, t=4.919, P<0.01). Among the fatigued cohort, the proportion of smokers was significantly higher in the non-improved subgroup [75.93%(41/54)] than in the improved subgroup [32.29%(31/96)]. Smoking emerged as a significant independent factor associated with fatigue improvement (OR=0.151, 95%CI: 0.071-0.322, P< 0.01).

Standardized recuperation effectively alleviates fatigue among helicopter pilots. Higher age, extended flight hours, piloting transport helicopters, duty station location, repeated COVID-19 infections, and persistent symptoms 3 months post-COVID-19 represent major risk factors for fatigue. Smoking may significantly impede fatigue recovery.

To investigate the clinical and diagnostic characteristics of autoimmune encephalitis (AE) double-positive for anti-γ-aminobutyric acid type B receptor (GABA_BR) and anti-metabotropic glutamate receptor 2 (mGluR2) antibodies.

A retrospective analysis was performed on the clinical data of a patient who was initially admitted to the Department of Neurology at the First Affiliated Hospital of Harbin Medical University in January 2025 and was readmitted in March 2025 due to symptom exacerbation, where a diagnosis of AE double-positive for anti-GABA_BR and anti-mGluR2 antibodies was confirmed via serological and CSF testing. Relevant literature was also reviewed to explore the clinical features of this condition.

A 54-year-old female patient presented with epileptic seizures as the initial symptom, and subsequently developed psychiatric and behavioral abnormalities, visual hallucinations, cognitive decline, and sleep disorders during the disease course, consistent with limbic encephalitis syndrome. Brain MRI showed bilateral hippocampal long T₂ signals. Anti-GABA_BR antibodies were positive in both serum and CSF, with titers of 1∶1 000 and 1∶10, respectively. Anti-mGluR2 antibodies were positive in CSF at a titer of 1∶1 but negative in serum. Systemic oncological screening revealed no definitive malignant lesions; however, serum tumor markers showed mild elevations in neuron-specific enolase (17.18 μg/L) and carbohydrate antigen 72-4 (28.79 U/mL). Symptoms improved significantly after treatment with glucocorticoids combined with plasma exchange and mycophenolate mofetil.

AE with double positivity for anti-GABA_BR and anti-mGluR2 antibodies is extremely rare. Early comprehensive antibody testing and immunotherapy may help improve short-term prognosis, and long-term follow-up is warranted to exclude a potential paraneoplastic etiology. The clinical significance of anti-mGluR2 antibodies needs further investigation.

To investigate the clinical diagnostic characteristics and molecular genetic mechanisms of Gitelman syndrome(GS) combined with reversible glucose metabolism disorder.

A retrospective analysis was conducted on the clinical data of a GS patient with reversible glucose metabolism disorder who was admitted to the Endocrinology and Metabolism Department of the Ninth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine on July 20, 2020, and the relevant literature was reviewed.

A 31-year-old man was admitted with severe hyperglycemia (random blood glucose >33 mmol/L, HbA1c 12.6%), profound hypokalemia (2.40 mmol/L), and hypomagnesemia (0.41 mmol/L). The levels of supine plasma aldosterone (251.61 ng/L), upright plasma renin activity [5.83 ng/(mL·h)], and urinary aldosterone (22.31 μg/d) were mildly elevated, whereas the aldosterone to renin ratio (ARR) was normal. His blood pressure and 24-hour urinary calcium(0.92 mmol) were within normal limits, and no metabolic alkalosis was observed, with no evidence of adrenal, thyroid, or catecholamine abnormalities. Whole-exome sequencing combined with Sanger sequencing validation identified a compound heterozygous variation in the SLC12A3 gene (IVS7EX8B and D486N). Following potassium and magnesium repletion combined with antidiabetic therapy, his clinical symptoms, blood glucose, and electrolyte levels improved significantly. Notably, all glucose-lowering agents were successfully withdrawn two months post-discharge, and normal glycemic control was steadily maintained (fasting glucose ≤6.0 mmol/L; postprandial glucose, 5.0-6.0 mmol/L). At the 1-year follow-up, HbA1c was 5.3%, and serum potassium ranged from 2.5 to 3.5 mmol/L.

Genetic testing is of great value for early diagnosis and phenotypic evaluation. Patients with GS are prone to impaired glucose metabolism. Timely potassium and magnesium repletion can improve glycemic control and even allow discontinuation of glucose-lowering medications.

To investigate the prenatal ultrasound diagnostic features of frontonasal dysplasia (FND).

A retrospective analysis was conducted on the prenatal two-dimensional (2D) and three-dimensional (3D) ultrasound findings of a fetus initially diagnosed with " cleft nose" at the Department of Ultrasound Medicine, Affiliated Hospital of Jining Medical University on June 7, 2025. Combined with post-delivery examination findings and literature review, the sonographic characteristics of the fetal nose and face were analyzed to establish a refined diagnosis.

A 30-year-old pregnant woman at 25^{+ 2} weeks of gestation was referred to the hospital due to two previous ultrasound examinations elsewhere suggesting fetal nasal abnormalities. The ultrasound revealed ocular hypertelorism. The coronal view of the nose and lips showed an intact upper lip, absence of the nasal tip, and " bifid" nostrils. 3D ultrasound demonstrated a broad nose, a " V-shaped" nasal tip, and a longitudinal depression on the mid-portion of the nasal dorsum. An initial diagnosis of possible nasal cleft was made, and genetic testing was recommended, but the patient declined. The patient opted for termination of pregnancy locally. Post-delivery external examination confirmed the prenatal findings, with no additional malformations observed. Based on a literature review and embryological analysis, the combination of hypertelorism and nasal cleft was recognized as falling within the FND spectrum, leading to an additional diagnosis of mild FND.

The presence of hypertelorism accompanied by a nasal cleft on prenatal ultrasound should raise high suspicion for FND. A comprehensive systematic ultrasound evaluation and genetic counseling are warranted in such cases.

To explore the clinical features and diagnostic strategies of delayed-onset Fabry disease (FD) involving multiple systems.

A retrospective analysis was conducted on the clinical data and treatment process of a patient with delayed-onset FD admitted to the Department of Neurology, the Affiliated Hospital of Jining Medical University on August 27, 2024. The lessons from the diagnostic delay and key diagnostic features were summarized.

A 60-year-old male presented with a 14-hour history of hypoesthesia in the left hand and weakness in the left lower limb. The patient had a history of lacunar cerebral infarction (14 years), tinnitus and proteinuria (14 years), and left ventricular hypertrophy (12 years). On admission, cranial MRI revealed an acute cerebral infarction in the right parieto-occipital lobe. Cardiac MRI revealed non-uniform left ventricular wall thickening (maximal wall thickness of 19 mm), diffuse reduction of native T₁ values in the remaining myocardial segments, and marked late gadolinium enhancement (LGE) with localized elevated T₁ and T₂ values in the left ventricular lateral wall. Genetic testing identified a hemizygous missense variation in the GLA gene: c. 671A>G (p.Asn224Ser). Furthermore, enzymatic activity of α-galactosidase A [0.97 μmol/(L·h)] was decreased, and the biomarker Lyso-Gb3 (48.41 μg/L) was markedly elevated; urinary microalbumin was level 1 170.0 mg/L, and slit-lamp examination revealed bilateral cornea verticillata, confirming the diagnosis of FD. Notably, the patient experienced a diagnostic delay of 14 years from the onset of initial symptoms to definitive diagnosis. The primary reason for this missed diagnosis was the failure to trace and integrate the multisystem manifestations into a unified etiology.

FD should be considered in the differential diagnosis for patients with cryptogenic stroke, left ventricular hypertrophy, and proteinuria. Prompt enzymatic assays and genetic analysis are crucial for early confirmation.

To investigate the effects of BOPPPS combined with scenario-based simulation teaching method in cardiac physical examination.

A total of 90 third-year undergraduate students majoring in clinical medicine (class of 2022) from Hunan University of Chinese Medicine from September to December 2025 were selected and randomly divided into an experimental group and a control group by the random number table method, with 45 students in each group. The experimental group adopted the BOPPPS structured design concept, incorporating scenario-based simulation teaching method for instruction in cardiac physical examination, while the control group followed the traditional teaching model. Independent samples t-test and Mann-Whitney U test were used to compare the distributions of clinical skill examination scores and knowledge test scores between the 2 groups. Paired-samples t-tests were used to compare intragroup changes in learning engagement before and after the teaching intervention, while independent samples t-tests were performed for intergroup comparisons of learning engagement and course satisfaction scores. Qualitative analysis was performed on the reflective journals and interviews of students in 2 groups.

One week after course completion, the skills assessment score of the experimental group (86.47±2.15)was significantly higher than that of the control group (71.82±3.06), and the difference was statistically significant (t=26.26, P< 0.01). The excellent rate on the knowledge test among students in the experimental group (84.4%, 38/45) was higher than that in the control group (42.2%, 19/45), and the difference in grade distribution between the two groups was statistically significant (Z=4.19, P< 0.01). Before the teaching intervention, no significant differences were found between the 2 groups in the 4 dimensions of vigor, dedication, absorption, and behavioral self-assessment, or in the total score (all P> 0.05). After the teaching intervention, the experimental group scored significantly higher than the control group on all dimensions and the total score (t=7.332, 7.947, 6.881, 6.434, 24.928, all P<0.01). Regarding learning satisfaction, the experimental group scored significantly higher than the control group on all 8 dimensions: clarity of teaching objectives, logical coherence of teaching structure, authenticity of simulation scenarios, depth of classroom engagement, quality of reflection and feedback, knowledge integration and application, team collaboration experience, and appropriateness of learning workload (t=5.010, 5.087, 5.657, 6.774, 7.011, 5.380, 2.300, 2.263, all P< 0.05). Further qualitative analysis combining students′ reflective journals and interview data revealed a fundamental shift in the learning mode of students in the experimental group: they transitioned from conventional passive " procedural practice" to active " meaningful inquiry". Within structured teaching scenarios, students completed early clinical thinking training and gradually cultivated and established professional identity.

The combination of the BOPPPS model and scenario-based simulation teaching can significantly improve both skill performance and knowledge excellence rates in cardiac physical examination. Furthermore, it effectively facilitates students′ transition from procedural operations to meaningful inquiry-based learning.

With the rapid advancement of digital medical technologies, digital and intelligent surgical techniques including three-dimensional image reconstruction, artificial intelligence, and 3D printing have been progressively integrated into the full clinical workflow of hand and foot surgery, greatly facilitating the transformation from a traditional experience-guided paradigm to a digital precision diagnosis and treatment paradigm. Digital and intelligent surgical technologies span the entire perioperative continuum of hand and foot surgery, encompassing preoperative surgical planning, intraoperative high-precision execution, and postoperative functional rehabilitation. Moreover, they demonstrate substantial advantages in the repair of severe hand and foot trauma, correction of congenital hand and foot deformities, and functional reconstruction of small joints of the hands and feet. By reviewing recent literature regarding the clinical application of digital and intelligent surgical technologies in hand and foot surgery, this paper systematically summarizes the technical framework, clinical value and developmental bottlenecks of such technologies, and outlines prospects for their future development. The findings aim to provide practical references for the standardized and regulated clinical promotion of digital and intelligent surgical technologies in hand and foot surgery.