Zhonghua Yi Xue Za Zhi[JOURNAL]
Sun
200 papers
[Identification of multidimensional symptom subgroups in parents who lost their only child and its neurostructural and neurofunctional characteristics].
Liu Y, Luo YF, Cao ZH … +7 more , Li YF, Ge JY, Lan QY, Qi RF, Wu LA, Zhang L, Lu GM
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41820056 · Publisher ↗
To identify potential clinical subgroups among parents who lost their only child and compare inter-subgroup differences in brain structure and function. Parents who lost their only child and participated in a psychologi...
To identify potential clinical subgroups among parents who lost their only child and compare inter-subgroup differences in brain structure and function. Parents who lost their only child and participated in a psychological assistance program organized by the local civil affairs department in Southern Jiangsu, China, between April 2021 and June 2022 were retrospectively recruited. They were randomly divided into a discovery set and a validation set in a 1∶1 ratio using a random number table. Assessments included the Clinician Administered Post-Traumatic Stress Disorder Scale (CAPS), the 24-item Hamilton Depression Rating Scale (HAMD-24), and the Hamilton Anxiety Rating Scale (HAMA). Seven symptom dimension factors were extracted: re-experiencing, avoidance, hyperarousal, depressive mood, somatic/anxiety, psychic anxiety, and somatic anxiety. Hierarchical clustering was applied in the discovery set to identify clinical subgroups. The stability of this classification was verified in the validation set. Cranial MRI scans were conducted to compare differences in fractional anisotropy (FA) from diffusion tensor imaging, as well as degree centrality (DC) and regional homogeneity (ReHo) from functional MRI among the different subgroups. Pearson correlation analysis was used to assess the correlations between neuroimaging metrics and scale scores. A total of 154 parents who lost their only child were enrolled, with an average age of (57.6±5.2) years, including 68 males (44.2%), and a mean trauma duration of (15.1±5.1) months. The discovery set and the validation set each comprised 77 participants. Hierarchical clustering and cross-validation consistently identified two stable subgroups. Subgroup A was characterized by core features of traumatic re-experiencing, cognitive avoidance, and depressive mood, while subgroup B was dominated by somatization symptoms and anxiety. Neuroimaging results showed that compared with subgroup B, subgroup A exhibited significantly higher FA values in multiple white matter tracts closely associated with emotion regulation and cognitive processing (<0.05, corrected with threshold-free cluster enhancement). Compared with subgroup A, subgroup B demonstrated higher DC in the left precentral gyrus (=-3.02, Gaussian random field-corrected =0.003) and lower ReHo in the left middle frontal gyrus (=3.90, Gaussian random field-corrected =0.001). Correlation analyses indicated that FA values in white matter tracts were positively correlated with total CAPS score, total HAMD-24 score, and specific CAPS factors (avoidance, re-experiencing) (=0.30-0.36, false discovery rate-corrected <0.05). DC values in the left precentral gyrus were positively correlated with total HAMA score and the somatic anxiety factor (=0.32-0.37, false discovery rate-corrected <0.05). Parents who lost their only child can be categorized into two clinical subgroups: one dominated by emotional disturbances and the other by somatic anxiety. The observed differences in brain structure and function provide neurobiological evidence for this subgroup classification and may suggest potential targets for precise neuromodulation interventions.
[Efficacy and safety of combined immunotherapy and targeted therapy as adjuvant treatment for hepatocellular carcinoma with microvascular invasion after surgery].
Jiang HX, Hu YQ, Gao S … +4 more , Cao YB, Tang HW, Yang ZY, Lu SC
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41820055 · Publisher ↗
To compare and analyze the efficacy and safety of immune checkpoint inhibitors (ICIs) combined with tyrosine kinase inhibitors (TKIs) as adjuvant therapy after surgery for hepatocellular carcinoma (HCC) with microvascula...
To compare and analyze the efficacy and safety of immune checkpoint inhibitors (ICIs) combined with tyrosine kinase inhibitors (TKIs) as adjuvant therapy after surgery for hepatocellular carcinoma (HCC) with microvascular invasion (MVI). Patients with HCC accompanied with MVI who underwent R0 liver resection at the First Medical Center of the PLA General Hospital between January 2016 and December 2024 were retrospectively enrolled. The clinicopathological data, surgical details, and follow-up data were recorded. Adverse events after medication were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Recurrence-free survival (RFS) and overall survival (OS) curves were plotted using the Kaplan-Meier method and compared with the Log-rank test. The Cox proportional hazards regression model was used to analyze factors influencing recurrence. The study included 39 patients in the adjuvant therapy group and 41 patients in the follow-up observation group. There were no significant differences in baseline characteristics between the two groups (all >0.05). The follow-up time [(, )] was 21.8 (10.9, 50.7) months. The RFS rates at 6, 12, 24, and 36 months in the adjuvant therapy group were 92.3%, 76.0%, 71.2%, and 51.8%, respectively, all higher than those in the follow-up observation group (75.1%, 56.3%, 44.3%, and 16.9%). The median RFS in the adjuvant therapy group was 46.7 months (95%:15.19-78.22), significantly better than the 19.33 months (95%: 3.22-35.44) in the follow-up observation group (=0.004). The median OS was not reached in either group(=0.480). Multivariate Cox analysis showed that postoperative adjuvant therapy (=0.46, 95%: 0.24-0.89, =0.020) and liver cirrhosis (=2.22, 95%: 1.00-4.92, =0.050) were influencing factors for RFS. In terms of safety, 43.59% (17/39) of patients in the adjuvant therapy group experienced grade 1-4 adverse events, and 15.38% (6/39) experienced grade 3 or higher adverse events, primarily manifested as abnormal liver and kidney function, rash, etc. No treatment-related deaths occurred, and the safety profile was manageable. For patients with HCC accompanied by MVI, postoperative adjuvant therapy with immunotherapy combined with targeted therapy significantly prolongs recurrence-free survival, reduces the risk of recurrence, and demonstrates a manageable safety profile.
[Effect of sodium bicarbonate Ringer's solution on postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass grafting].
Yuan B, Zhai WQ, Zhang Z … +4 more , Wang T, Ren M, Guo ZG, Han JG
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41820054 · Publisher ↗
To explore the effect of sodium bicarbonate Ringer's solution on postoperative acute kidney injury (AKI) in elderly patients undergoing off-pump coronary artery bypass grafting (OPCABG). The medical records of patients...
To explore the effect of sodium bicarbonate Ringer's solution on postoperative acute kidney injury (AKI) in elderly patients undergoing off-pump coronary artery bypass grafting (OPCABG). The medical records of patients undergoing elective OPCABG at Tianjin Chest Hospital, Tianjin University, between September 2021 and October 2023 were retrospectively reviewed. The inclusion criteria were as follows: age ≥65 years, body mass index (BMI) of 18 to 30 kg/m, and American Society of Anesthesiologists (ASA) physical status class Ⅲ-Ⅳ. Patients were allocated to either the sodium bicarbonate Ringer's solution group or the compound electrolyte solution group (control group) based on the type of intraoperative crystalloid administered. Potential confounders were adjusted using propensity score matching (PSM) and multivariable logistic regression models. The primary outcome was the incidence of AKI within 7 days postoperatively. A total of 868 patients aged (69±5) years were included in the final analysis, with 591 males and 277 females. Postoperative AKI occurred in 105 patients (12.1%). After PSM, there were no statistically significant differences in baseline characteristics and intraoperative variables between the two groups (all >0.05). Multivariable logistic regression analyses demonstrated that, intraoperative use of sodium bicarbonate Ringer's solution was a protective factor against postoperative AKI following OPCABG (=0.52, 95%: 0.28-0.97, =0.040). Compared with compound electrolyte solution, use of sodium bicarbonate Ringer's solution during surgery is associated with a lower risk of AKI after OPCABG.
[Association between long-term cumulative levels of non-high-density lipoprotein cholesterol and the risk of cardiovascular disease: a prospective cohort study].
Ma WJ, Liu FC, Shen C … +10 more , Hu LB, Li JY, Liu HR, Huang KY, Li JX, Cao J, Chen SF, Huang JF, Lu XF, Gu DF
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41820053 · Publisher ↗
To investigate the relationship between long-term cumulative burden of non-high-density lipoprotein cholesterol (Non-HDL-C) and the incidence of cardiovascular disease(CVD). The study subjects were derived from three pr...
To investigate the relationship between long-term cumulative burden of non-high-density lipoprotein cholesterol (Non-HDL-C) and the incidence of cardiovascular disease(CVD). The study subjects were derived from three prospective sub-cohorts of the China-PAR project. Baseline surveys were carried out in 1998, 2000-2001, and 2007-2008, with follow-up until 2021. A total of 113, 448 participants were included at baseline. Non-HDL-C was calculated as total cholesterol (TC) minus high-density lipoprotein cholesterol (HDL-C). Long-term cumulative exposure to Non-HDL-C was estimated using the time-weighted 10-year cumulative exposure value. According to the cumulative Non-HDL-C exposure levels, participants were categorized into four groups:<34 mmol/L×years, 34~<41 mmol/L×years, 41~<49 mmol/L×years, and≥49 mmol/L×years. Multivariable Cox proportional hazards regression models were used to assess the association between cumulative Non-HDL-C exposure and the risk of incident cardiovascular disease. Restricted cubic spline curves were applied to visualize the exposure-response relationship. A total of 63, 211 participants were finally included, with an average age of (58.2±11.7) years, including 24, 493 men (38.8%). The results of the multivariable Cox proportional hazards regression analysis showed that for each standard deviation increase in Non-HDL-C cumulative exposure level (7.5 mmol/L×year), the risk of CVD, coronary heart disease, and stroke incidence increased by 8% (=1.08, 95%: 1.05-1.11), 15% (=1.15, 95%: 1.06-1.22), and 7% (=1.07, 95%: 1.04-1.11), respectively. Compared with the group with Non-HDL-C cumulative exposure<34 mmol/L×year, the HRs for CVD, coronary heart disease, and stroke incidence in the group with cumulative exposure≥49 mmol/L×year were 1.33 (95%: 1.13-1.57), 2.06 (95%: 1.53-2.76), and 1.23 (95%: 1.01-1.50), respectively. Subgroup analyses showed that the association between cumulative Non-HDL-C levels and the risk of CVD incidence was more pronounced in individuals under 60 years of age ( for interaction<0.05). In participants younger than 60 years of age, each standard deviation increase in Non-HDL-C cumulative exposure (7.5 mmol/L×year) was associated with a 14% increase in the risk of CVD incidence (=1.14, 95%: 1.08-1.21), higher than the increase of 5% observed in participants aged 60 years or older (=1.05, 95%: 1.01-1.08). High cumulative Non-HDL-C exposure is associated with an increased risk of CVD incidence.
[Neoadjuvant radiotherapy for hepatocellular carcinoma: the path to synergy with surgery].
Chen B
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41820052 · Publisher ↗
Neoadjuvant radiotherapy is an important strategy for patients with resectable hepatocellular carcinoma (HCC) with high-risk recurrence profiles. In China, HCC is primarily caused by hepatitis virus infection, making it...
Neoadjuvant radiotherapy is an important strategy for patients with resectable hepatocellular carcinoma (HCC) with high-risk recurrence profiles. In China, HCC is primarily caused by hepatitis virus infection, making it sensitive to radiotherapy. Based on this characteristic, this paper systematically elaborates on the objectives of preoperative neoadjuvant radiotherapy, the applicable patient populations, the technical prerequisites for its combination with surgery, its clinical application advantages, future directions, and proposes a "surgery-oriented" radiotherapy concept. Traditional stereotactic body radiotherapy (SBRT), when used as preoperative therapy for large hepatocellular carcinoma, can easily lead to perhepatic adhesions which increases surgical difficulty and risks. To address this challenge, our team has proposed a patented method for generating a resection-mimicking dose distribution with high-dose radiotherapy for large HCC. This approach optimizes dose distribution and precisely protects the future liver remnant, significantly reducing postoperative recurrence without substantially increasing surgical difficulty. Neoadjuvant radiotherapy offers unique advantages, including high local control rates, durable response, reduced risk of microvascular invasion, low progression rates, and favorable safety profiles, while also providing a time window of liver function recovery for surgery. This paper also explores the strategy selection for combining neoadjuvant radiotherapy with systemic therapy, the timing of surgery, and points out that promoting this technology requires collaborative innovation between hepatobiliary surgeons and radiation oncologists to optimize radiotherapy design and its integration with surgery. Practical experience indicates that neoadjuvant radiotherapy has the potential to improve the prognosis of patients with high-risk resectable HCC, though more high-level clinical evidence is needed to support its use in the future.
[Recent advances in hepatic arterial infusion chemotherapy for conversion therapy of hepatocellular carcinoma].
Chen MS, Xiao R
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41820051 · Publisher ↗
Hepatocellular carcinoma(HCC) is one of the common malignant tumors in China. Most patients are diagnosed at an intermediate or advanced stage, thereby losing the opportunity for curative treatment. This article systemat...
Hepatocellular carcinoma(HCC) is one of the common malignant tumors in China. Most patients are diagnosed at an intermediate or advanced stage, thereby losing the opportunity for curative treatment. This article systematically reviewed the clinical significance, combination strategies, and comparisons with other approaches of hepatic arterial infusion chemotherapy (HAIC) in the conversion therapy of HCC. It highlighted the significant efficacy of HAIC, particularly for patients with massive tumor or those accompanied by vascular tumor thrombus, and emphasized that combination therapies could further enhance the conversion success rate. This review summarized recent advances in HAIC, provided valuable references for clinical practice, and held important implications for improving the prognosis of patients with advanced HCC.
[Sequential surgery following conversion therapy based on the combination of immune checkpoint inhibitors and antiangiogenic targeted drugs alters the treatment landscape and outcomes for advanced hepatocellular carcinoma].
Tang HW, Jiang HX, Cao YB … +1 more , Lu SC
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41820050 · Publisher ↗
Hepatocellular carcinoma (HCC) often presents insidiously, and the majority of patients are diagnosed at an advanced stage, missing the opportunity for curative surgery. In recent years, breakthrough advances in systemic...
Hepatocellular carcinoma (HCC) often presents insidiously, and the majority of patients are diagnosed at an advanced stage, missing the opportunity for curative surgery. In recent years, breakthrough advances in systemic therapy, particularly represented by the combination of immune checkpoint inhibitors (ICI) and antiangiogenic targeted drugs (AATD), have driven a paradigm shift in the treatment modality for advanced HCC. This article elaborates on the definition and theoretical basis of conversion therapy, analyses the strategy for selecting conversion treatment regimens centered on immune-targeted combination therapy, defines the timing and value of sequential surgical therapy following conversion, and demonstrates the significant survival benefits brought by this strategy through multiple clinical study evidences. Evidence indicates that conversion therapy based on immune-targeted combinations followed by sequential surgery has emerged as a novel treatment mode for advanced HCC. Guided by multidisciplinary collaboration and personalized decision-making, it can tangibly improve long-term survival outcomes for patients.
[Clinical and imaging characteristics of carotid artery dissection-induced stroke in young adults associated with elongated styloid process].
Xu BN, Shi D, Zhu LH … +2 more , Cao YJ, Shi JJ
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41796009 · Publisher ↗
A retrospective analysis was conducted on 36 young stroke patients with carotid artery dissection(CAD) enrolled from the Second Affiliated Hospital of Soochow University from January 2015 to December 2023. According to s...
A retrospective analysis was conducted on 36 young stroke patients with carotid artery dissection(CAD) enrolled from the Second Affiliated Hospital of Soochow University from January 2015 to December 2023. According to styloid length (>3 cm) and abnormal angulation, the patients were divided into the Elongated Styloid Process (ESP)-induced CAD group (ESP group, 11 cases) and the non-ESP-induced CAD group (NESP group, 25 cases). The demographic characteristics, clinical manifestations, laboratory index, imaging features, and 1-year follow-up outcomes were compared. 31 male and 5 female patients aged [(,)] 41(36, 44) years were enrolled in the study. 30.6% (11/36) of CAD-related young stroke patients have ESP. The ESP group showed higher rates of head/neck pain (6/11 vs 1/25, =0.006), and higher levels of creatinine [73.0(59.0,77.0) μmol/L vs 59.0(53.0,66.0) μmol/L, =0.010] and homocysteine [(18.6±18.2) μmol/L vs (2.4±0.7) μmol/L, =0.020], but lower levels of admission glucose [5.3(4.7,7.6) mmol/L vs 13.6(9.3,17.3) mmol/L, <0.001] and fibrinogen [2.8(2.5, 3.5) g/L vs 6.4(5.2,6.8) g/L, <0.001] than those in the NESP group. In terms of imaging data, the ESP group was mainly characterized by dissecting aneurysm (4/11) and "string-of-pearls" signs (4/11), without double-lumen sign. During the 1-year follow-up, 5 cases in the ESP group achieved favorable dissection repair (5/11), and 1 case developed recurrent cerebral infarction (1/11). ESP screening should be emphasized in young stroke patients with CAD, especially those with hyperhomocysteinemia and head/neck pain symptoms. The treatment should involve a personalized approach combining antithrombotic therapy, endovascular intervention, and styloidectomy to reduce the risk of stroke recurrence.
[Mechanism of vitamin K2 in modulating matrix Gla protein to inhibit tumor growth in inflammation-associated colorectal cancer model mice].
Zhang HM, Wu MX, Wang HY … +2 more , Yang H, Qian JM
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41796008 · Publisher ↗
To explore the mechanism of vitamin K2 (VitK2) regulating matrix Gla protein (MGP) in inhibiting tumor growth in inflammation-associated colorectal cancer (CAC) model mice. Twenty-six C57BL/6 male mice, 6-8 weeks old an...
To explore the mechanism of vitamin K2 (VitK2) regulating matrix Gla protein (MGP) in inhibiting tumor growth in inflammation-associated colorectal cancer (CAC) model mice. Twenty-six C57BL/6 male mice, 6-8 weeks old and weighing 20-25 g, were divided into 4 groups according to the random number table method (each group received different treatments): normal group (treated with olive oil gavage and physiological saline intraperitoneal injection) (=5), model group [treated with olive oil gavage, azoxymethane (AOM) intraperitoneal injection, and dextran sulfate sodium (DSS) solution drinking treatment)] (=5), 30 mg group (treated with 30 mg·kg·d of vitamin K2 gavage, AOM intraperitoneal injection, and DSS solution drinking treatment) (=8), and 60 mg group (treated with 60 mg·kg·d of vitamin K2 gavage, AOM intraperitoneal injection, and DSS solution drinking treatment) (=8). The mice were sacrificed at the end of the 12th week, and the number and length diameter of colon tumors in each group were compared. The expression level of nuclear proliferation antigen (Ki-67) in colon tissues was assessed by immunohistochemistry (IHC), while the levels of MGP protein and Smad1/5 pathway-associated proteins were determined by Western blotting (WB). Additionally, the expression of MGP mRNA was quantified using real-time quantitative PCR (RT-qPCR). According to different treatment methods, colon cancer epithelial cell line SW480 cells were divided into control group [treated with dimethyl sulfoxide (DMSO)], 100 μmol/L group (treated with 100 μ mol/L VitK2), 200 μmol/L group (treated with 200 μ mol/L VitK2), 400 μmol/L group (treated with 400 μ mol/L VitK2), empty vector group (SW480 cells were transfected with empty plasmid) and MGP overexpressing group (SW480 cells were transfected with MGP overexpressing plasmid). After 48 hours of treatment, the expression of MGP protein, changes in the Smad1/5 pathway, and cell proliferation at different time points (24, 48, 72, and 96 hours) after treatment were detected. All mice in the model group, 30 mg group, and 60 mg group developed colorectal tumors, with a tumorigenesis rate of 100% (17/17). There was no significant difference in the number of colon tumors between the 30 mg and 60 mg groups and the model group (both >0.05), but the long diameter of tumors in the 30 mg or 60 mg groups was smaller than those in the model group (both <0.05). There was no significant difference in tumor number or long diameter between the 30 mg and 60 mg groups (both >0.05). The Ki-67 protein expression levels in the 30 mg and 60 mg groups were both lower than those in the model group (both 0.05). Meanwhile, the MGP protein expression levels and pSmad1/5 protein expression levels in the 30 mg and 60 mg groups were both higher than those in the model group (all 0.05). There was no statistically significant difference in MGP mRNA levels between the 30 mg and 60 mg groups and the model group (both 0.05). Furthermore, there was no statistically significant difference in the expression levels of Ki-67 protein, MGP protein, pSmad1/5 protein, or MGP mRNA between the 30 mg and 60 mg groups (all 0.05). In the cell experiments, the MGP and pSmad1/5 protein expression levels in the 100 μmol/L group showed no statistically significant difference compared to the control group (both >0.05). The MGP and pSmad1/5 expression levels in the 200 μmol/L and 400 μmol/L groups were both higher than those in the control group (both <0.001). After 72 and 96 hours, the cell proliferation capacity in the 200 μmol/L and 400 μmol/L groups was both lower than that in the control group (both <0.001). The pSmad1/5 protein expression level in the MGP overexpression group was higher than that in the empty vector group (<0.001). After 24, 48, 72, and 96 hours, the cell proliferation capacity in the MGP overexpression group was lower than that in the empty vector group (all 0.001). VitK2 can inhibit the growth of CAC model mice by promoting MGP expression and activating Smad1/5 pathway.
[Analysis of clinical characteristics and factors associated with mortality in hematological patients infected with ].
Cao QY, Wu XR, Liu CY … +12 more , Qi WW, Li LJ, Song J, Wang HQ, Wu YH, Wang GJ, Guan J, Qu W, Xing LM, Liu H, Fu R, Shao ZH
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41796007 · Publisher ↗
To investigate the clinical characteristics and factors associated with mortality in hematological patients infected with (SMA). The clinical data of hematological patients with SMA infection who were admitted to the D...
To investigate the clinical characteristics and factors associated with mortality in hematological patients infected with (SMA). The clinical data of hematological patients with SMA infection who were admitted to the Department of Hematology, Tianjin Medical University General Hospital, from January 2022 to December 2024 were retrospectively collected. Based on the 28-day survival status after the confirmed SMA infection, the patients were divided into the deceased group and the survival group. The clinical characteristics of the two groups were compared, and the factors associated with mortality were analyzed. A total of 130 patients were included, comprising 74 males and 56 females, with a median age [ (, )] of 65 (56, 71) years. There were 54 patients in the deceased group and 76 in the survival group. The proportion of patients with indwelling urinary catheters/gastric tubes/pleural effusion drainage tubes [35.2% (19/54) vs 11.8% (9/76), =0.001] and the proportion of patients with a history of tigecycline use prior to the current SMA infection diagnosis [51.9% (28/54) vs 22.4% (17/76), =0.001] were both higher in the death group than those in the survival group. The time interval from hospital admission to etiological confirmation of SMA was longer in the death group than that in the survival group [26 (10, 47) vs 18 (9, 26) days, =0.015]. In the antimicrobial susceptibility testing, the susceptibility rates of the isolates from the death group to compound sulfamethoxazole [75.9% (41/54) vs 89.5% (68/76), =0.039] and levofloxacin [72.2% (39/54) vs 89.5% (68/76), =0.011] were both lower than those in the survival group. The proportion of patients with concurrent fungal infections [46.3% (25/54) vs 21.1% (16/76), =0.002] and viral infections [25.9% (14/54) vs 9.2% (7/76), =0.011] was higher in the death group compared to the survival group. The proportion of patients who received tigecycline both before and after the diagnosis of SMA infection was higher in the death group than that in the survival group [48.1% (26/54) vs 17.1% (13/76), 0.001]. In the death group, the white blood cell count [0.6 (0.2, 3.1)×10⁹/L vs 3.2 (0.3, 6.9)×10⁹/L], platelet count [24 (12, 50)×10⁹/L vs 42 (20, 87)×10⁹/L], absolute neutrophil count [0.2 (0, 2.4)×10⁹/L vs 1.2 (0.1, 4.9)×10⁹/L], and albumin level [28 (26, 31) g/L vs 30 (27, 33) g/L] were all lower than those in the survival group (all <0.05). The use of indwelling urinary catheter/gastric tube/pleural effusion drainage tube (=4.766, 95%: 1.686-13.467), complicated fungal infection (=2.679, 95%: 1.080-6.648), administration of tigecycline both before and after the diagnosis of SMA infection (=4.366, 95%: 1.732-11.006), and platelet count ≤30×10⁹/L (=2.812, 95%: 1.170-6.755) were identified as factors associated with mortality in hematological patients infected with SMA. The patients with hematological disease infected with SMA exhibit clinical characteristics such as widespread exposure to broad-spectrum antibiotics, frequent polymicrobial infections, as well as pancytopenia. The use of indwelling urinary/gastric/pleural drainage tubes, complicated fungal infection, administration of tigecycline both before and after SMA diagnosis, and a platelet count ≤30×10⁹/L are factors associated with mortality in hematological patients infected with SMA.
[Vertebral bone density distribution in different coronal imbalance classifications of degenerative lumbar scoliosis].
Zhou HC, Shi BL, Sun X … +5 more , Shi B, Qiao J, Ma C, Qiu Y, Zhu ZZ
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41796006 · Publisher ↗
To investigate the distribution patterns of vertebral bone density in degenerative lumbar scoliosis (DLS) patients with different coronal imbalance classifications. A retrospective study was conducted on 154 patients wi...
To investigate the distribution patterns of vertebral bone density in degenerative lumbar scoliosis (DLS) patients with different coronal imbalance classifications. A retrospective study was conducted on 154 patients with DLS who underwent long-segment spinal fusion surgery at Nanjing Drum Tower Hospital between January 2017 and December 2022. The patients were classified according to the Nanjing Drum Tower coronal imbalance classification of DLS: Type A, coronal balance distance (CBD) <3 cm; Type B, CBD ≥3 cm and C plumb line (CPL) located on the concave side; Type C, CBD ≥3 cm and CPL located on the convex side. The major curve Cobb angle and CBD were measured on preoperative standing full-spine radiographs. Preoperative assessments also included L T-scores and femoral neck T-scores obtained from dual-energy X-ray absorptiometry (DXA). Additionally, overall vertebral body bone density and Hounsfield unit (HU) values on the concave and convex sides were measured using preoperative CT scans. The patients with L value <110 were diagnosed with osteoporosis (OP). Comparative analyses included OP prevalence and coronal plane bone mass distribution patterns among the different coronal classifications. A total of 154 patients were included in this study, comprising 21 males and 133 females, with an average age of (62.9±6.6) years. Among them, 99 patients were classified as Type A, 30 as Type B, and 25 as Type C. The prevalence of OP was 48.7% (75/154), with the prevalence in Type C (72.0%, 18/25) patients being higher than that in Types A (44.4%, 44/99) and B (43.3%, 13/30) (both <0.05). The mean HU value of the S vertebra for all patients was 140.8±63.1, it was the lowest in Type C patients (108.2±53.4), which was statistically significantly lower than that in Types A and B patients (150.2±66.0 and 137.1±52.0, respectively, both <0.05). For all the patients, the HU values on the concave side of the main curve were all greater than those on the convex side (all <0.005), with the greatest asymmetry observed at the apex vertebra. The asymmetry ratios of the concave to convex sides of the S vertebra in Type B and Type C patients were higher than those in Type A patients (1.25±0.24, 1.23±0.24, and 1.11±0.22, respectively; <0.01). Patients with DLS exhibit a high prevalence of OP, with Type C patients showing the highest OP prevalence and the lowest bone density at the S vertebral body. Based on these findings, it is recommended that, for type C patients, distal internal fixation be performed using iliac screws or S sacroiliac screws to reduce the risk of internal fixation failure.
[The relationship between preoperative thyroglobulin and recurrence risk as well as treatment response in differentiated thyroid cancer].
He X, Ye ZH, Yang LY … +3 more , Qian K, Guo K, Wang ZY
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41796005 · Publisher ↗
To explore the relationship between preoperative thyroglobulin (Tg) levels and recurrence risk as well as treatment response in patients with differentiated thyroid cancer (DTC). A retrospective analysis was conducted o...
To explore the relationship between preoperative thyroglobulin (Tg) levels and recurrence risk as well as treatment response in patients with differentiated thyroid cancer (DTC). A retrospective analysis was conducted on the clinical data of 604 patients with DTC who underwent total thyroidectomy at Shanghai Renji Hospital from January 1, 2020, to December 31, 2024. The postoperative recurrence status of patients was recorded, with follow-up ending on June 30, 2025. Determine the cut-off value of preoperative Tg for predicting patient prognosis using the maximum selected rank statistic method. Multivariate Cox proportional hazards regression model was used to analyze the risk factors for postoperative recurrence in DTC patients. Survival curves were plotted using the Kaplan-Meier method, and the log-rank test was used to evaluate the differences in postoperative disease-free survival rates and treatment response among DTC patients with different preoperative Tg levels. Among the 604 patients, 417 were female and 187 were male, with the age of 45.0(36.0, 57.0) years. The preoperative Tg was 20.2 (10.4, 44.3) μg/L, and the follow-up period was 1.40 (0.85, 2.84) years. Multivariate Cox proportional hazards regression model analysis revealed that preoperative Tg levels≥36.2 μg/L (=14.180, 95%:1.745-115.200) was a risk factor for postoperative recurrence in DTC. Patients with the preoperative Tg level of<36.2 μg/L had a higher 3-year disease-free survival rate compared to those with the preoperative Tg level of≥36.2 μg/L (99.8% vs 92.3%, <0.001). The proportion of patients with the favorable treatment response was lower among those with the preoperative Tg level of≥36.2 μg/L compared to those with the preoperative Tg level of<36.2 μg/L, whereas the proportions of patients with biochemical incomplete, structural incomplete, and indeterminate responses were higher among those with the preoperative Tg level of≥36.2 μg/L (all <0.05). Preoperative Tg levels are significantly associated with the recurrence risk and treatment response in DTC patients. The Tg level of≥36.2 μg/mL indicates a high recurrence risk and poor treatment response.
[Influencing factors for differentiated thyroid cancer with distant metastasis and construction of a risk prediction model].
Jia YS, Yang XY
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41796004 · Publisher ↗
To analyze the risk factors for differentiated thyroid cancer(DTC) with distant metastases and establish a suitable prognostic risk prediction model. A retrospective analysis was performed on the clinical data of 2 337...
To analyze the risk factors for differentiated thyroid cancer(DTC) with distant metastases and establish a suitable prognostic risk prediction model. A retrospective analysis was performed on the clinical data of 2 337 patients diagnosed with distant metastasis of DTC from January 2000 to December 2021, as recorded in the Surveillance, Epidemiology, and End Results (SEER) database. Using the sample function in R, patients were randomly divided into a training set (=1 635) and an internal validation set (=702) at a ratio of 7∶3. Additionally, 227 patients with DTC and distant metastasis from Tianjin Medical University Cancer Institute and Hospital between January 2010 and December 2021 were included as an external validation set. Univariate and multivariate Cox proportional hazards regression model analysis, least absolute shrinkage and selection operator (LASSO) regression analysis were employed to screen for prognostic factors affecting the outcomes of patients with DTC and distant metastasis, and a prognostic prediction model nomogram was constructed. The predictive ability, accuracy, and clinical applicability of the model were evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). A total of 2 337 patients with distant metastasis of DTC were retrieved from the SEER database, including 988 males and 1 349 females, with the age of (58.4±18.6) years. Among them, 1 254 patients died with a median overall survival (OS) time of [ (, )] 42.0 (13.0, 95.0) months. At Tianjin Medical University Cancer Institute and Hospital, a total of 227 patients with DTC accompanied by distant metastasis were included, comprising 62 males and 165 females, with the age of (56.7±16.8) years. Among these patients, 114 died with a median OS time of 43.0 (15.0, 101.0) months. The follow-up ended upon the patient's death or March 31, 2025. After analysis using a univariate Cox proportional hazards regression model and screening via LASSO regression, 4 variables were included from the training set, including age, maximum tumor diameter, invasion of vital tissues, and surgical treatment. Multivariate Cox proportional hazards regression model analysis showed that age≥55 years (=3.37, 95%: 3.08-4.53), maximum tumor diameter>4 cm (=1.83, 95%: 1.12-2.99), and invasion of vital tissues (=2.15, 95%: 1.81-2.56) were risk factors affecting the OS of patients with DTC accompanied by distant metastasis, while surgical treatment (=0.44, 95%: 0.36-0.53) was a protective factor. A prognostic prediction model for patients with DTC accompanied by distant metastasis was constructed using these influencing factors. The AUC for predicting 3, 5, and 10 year OS were 0.780 (95%: 0.754-0.805), 0.769 (95%: 0.743-0.795), and 0.836 (95%: 0.809-0.864)(in the training set); 0.804 (95%: 0.768-0.841), 0.815 (95%: 0.779-0.850), and 0.877 (95%: 0.844-0.911)(in the internal validation set); and 0.753 (95%: 0.682-0.824), 0.717 (95%: 0.642-0.792), and 0.810 (95%: 0.725-0.894)(in the external validation set). The calibration curves demonstrated good fit between the predicted and observed values (all >0.05), and DCA indicated that the model had high clinical application value. Age≥55 years, maximum tumor diameter>4 cm, and vital tissue invasion are independent risk factors for poor survival in patients with metastatic DTC, whereas surgical treatment improves prognosis. The proposed nomogram provides reliable prognostic assessment and may support individualized risk stratification and clinical decision-making.
[A comparative analysis of hemithyroidectomy and total thyroidectomy in sporadic medullary thyroid carcinoma].
Zhao JZ, Hu LF, Li DP … +3 more , Chi JD, Ruan XH, Zheng XQ
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41796003 · Publisher ↗
To compare the therapeutic effects of hemithyroidectomy (HT) versus total thyroidectomy (TT) on sporadic medullary thyroid carcinoma (sMTC). Clinical data of sMTC patients firstly treated in Tianjin Medical University C...
To compare the therapeutic effects of hemithyroidectomy (HT) versus total thyroidectomy (TT) on sporadic medullary thyroid carcinoma (sMTC). Clinical data of sMTC patients firstly treated in Tianjin Medical University Cancer Institute and Hospital from January 2011 to December 2019 were reviewed retrospectively. The patients were categorized into the HT group and the TT group based on the extents of primary tumor resection. The differences in clinical characteristics between the two groups were compared. A 1∶1 matching of variables including tumor stage and mulifocality was performed using propensity score matching (PSM) to balance the baseline differences between the two groups. Subsequently, the differences in biochemical cure rate, biochemical recurrence rate, and structural recurrence rate between the two groups were compared. Survival curves were plotted using the Kaplan-Meier method, and the log-rank test was utilized to compare the differences in progression-free survival and overall survival between the two groups. A total of 199 patients with sMTC were included in the study, comprising 80 males and 119 females, with the age [(,)] of 51.0 (42.0,59.0) years. Before PSM, 117 patients were in HT group and 82 patients were in TT group. There were statistically significant differences in preoperative calcitonin, N stage, TNM stage, and the number of lesions between the two groups (all <0.05). After PSM, 63 patients were in HT group and 63 patients were in TT group. There was no statistically significant difference in all clinicopathological characteristics between the two groups (all >0.05). Before PSM, the biochemical cure rate in the HT group was higher than that in the TT group [76.4% (81/106) vs 60.5% (46/76), =0.021]. There were no statistically significant differences in the biochemical recurrence rate and structural recurrence rate between the HT group and the TT group [4.7% (5/106) vs 7.9% (6/76), 8.5% (10/117) vs 15.9% (13/82), both >0.05]. The progression-free survival of the HT group was longer than that of the TT group [(137.26±3.53) vs (114.12±5.98) months, =0.025]. There was no statistically significant difference in overall survival between the HT group and the TT group [(142.12±2.91) vs (126.92±5.15) months, =0.140]. After PSM, there were no statistically significant differences between the HT group and the TT group in terms of biochemical cure rate [66.7% (40/60) vs 77.2% (44/57)], biochemical recurrence rate [5.0% (3/60) vs 7.0% (4/57)], structural recurrence rate [12.7% (8/63) vs 17.5% (11/63)], progression-free survival [(130.69±5.07) vs (112.19±6.91) months], and overall survival [(136.05±4.04) vs (124.71±6.83) months] (all >0.05). The therapeutic effects of HT and TT on sMTC are comparable. With careful preoperative evaluation, selective performance of HT is safe and feasible.
[Guideline for primary prevention of osteoporotic fractures (2026 edition)].
Professional Committee for Osteoporosis Prevention and Rehabilitation of Chinese Association of Rehabilitation Medicine, Osteoarthrosis Committee of Chinese Aging Well Association
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41796002 · Publisher ↗
Osteoporotic fractures represent the most severe complication of osteoporosis, characterized by high incidence, high rates of missed diagnosis, high disability rates, and high mortality. These fractures impose substantia...
Osteoporotic fractures represent the most severe complication of osteoporosis, characterized by high incidence, high rates of missed diagnosis, high disability rates, and high mortality. These fractures impose substantial economic and caregiving burdens on both society and families. Strengthening screening in high-risk populations and implementing early interventions to prevent or reduce the occurrence of osteoporotic fractures are therefore of paramount significance. Therefore, the Professional Committee for Osteoporosis Prevention and Rehabilitation of Chinese Association of Rehabilitation Medicine, in collaboration with the Osteoarthrosis Committee of Chinese Aging Well Association, has initiated the development of the guideline for primary prevention of osteoporotic fractures. Key clinical issues of greatest concern to healthcare professionals were identified, including: identification of populations at high risk for osteoporotic fracture and fracture risk assessment; education and guidance for at-risk populations; fall prevention measures; assessment, diagnosis, and treatment of osteoporosis. This process culminated in the formulation of 11 evidence-based recommendations. The guideline aims to optimize primary prevention strategies for osteoporotic fractures, enhance healthcare professionals' management of health in high-risk populations, strengthen self-protection awareness among these individuals, reduce fracture incidence, and ultimately improve the quality of life for those at risk.
[Discovery of multi-omics-based biomarkers for immune-related adverse events: precision management with 3D-SPACE].
Ye RZ, Gong WY, Wang XT … +2 more , Li CQ, Chen XK
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41796001 · Publisher ↗
This article provides a systematic review of the advances in the precise diagnosis and management of immune-related adverse events (irAEs) induced by immune checkpoint inhibitors. IrAEs involve multiple organ systems, ex...
This article provides a systematic review of the advances in the precise diagnosis and management of immune-related adverse events (irAEs) induced by immune checkpoint inhibitors. IrAEs involve multiple organ systems, exhibit strong clinical heterogeneity, and lack specific biomarkers, all of which significantly compromise treatment safety and patient outcomes. This paper proposes a "3T" strategy centered on "Target, Timing, Tailoring" and constructs an integrated "3D-SPACE" management framework encompassing diagnosis, dynamic risk assessment, directed therapy, surveillance, prevention, adaptive regimen adjustment, collaborative multidisciplinary care, and engaged shared decision-making. Key emphases include the application of multi-omics technologies for early identification and subtyping, artificial intelligence-driven dynamic risk prediction and personalized intervention, as well as novel strategies such as microbial modulation. By establishing a multi-omics-informed, longitudinal management architecture, the framework aims to enable early differentiation between irAEs and severe infections, risk stratification, and precision intervention. Ultimately, it forms a closed-loop management model of "monitoring-warning-prevention-treatment-optimization", offering a systematic solution and practical framework to enhance the safety of immunotherapy.
[The evolution of antimicrobial therapy for sepsis].
Zhu C, Yu YT
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41796000 · Publisher ↗
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host immune response to infection, representing a critical global public health challenge, its high incidence and mortality rates continue to pose s...
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host immune response to infection, representing a critical global public health challenge, its high incidence and mortality rates continue to pose severe challenges in critical care medicine. Antibacterial agents are the cornerstone of sepsis management, yet its strategies are not static. Over the past decades, the philosophy of antimicrobial stewardship in sepsis has undergone profound evolution, driven by a deeper understanding of its pathophysiology, the escalating global crisis of antimicrobial resistance, and the continuous accumulation of evidence-based medical data. This article aims to systematically review the evolving landscape of anti-infective therapy for sepsis, focusing on key aspects such as epidemiology and pathogen resistance, timing of antibiotic initiation, empirical selection, dosing and administration methods, de-escalation and short-course strategies, as well as emerging sepsis sub-phenotypes and artificial intelligence-assisted decision-making. This article seeks to summarize past experiences, clarify misconceptions, and outline a future path toward transformation based on precision medicine.
[Innovations in organ function assessment in critically ill patients: insights from the updated SOFA-2 score].
Liu SQ, Xie JF, Huang YZ
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41795999 · Publisher ↗
Critically ill patients have a high incidence of organ dysfunction, and how to accurately and effectively assess organ function has long been a focus of attention. The Sequential Organ Failure Assessment (SOFA) score, an...
Critically ill patients have a high incidence of organ dysfunction, and how to accurately and effectively assess organ function has long been a focus of attention. The Sequential Organ Failure Assessment (SOFA) score, an important tool for evaluating organ dysfunction, has been widely used in clinical practice for nearly 30 years, but it still has certain limitations. The SOFA-2 score, released in 2025 by a team of 60 experts from 9 countries specializing in critical care medicine, epidemiology, and data science, has achieved a significant upgrade from an assessment tool to a standardized system by optimizing variable definitions, updating thresholds, and clarifying standardized rules, with the potential to improve its clinical applicability. The promotion of SOFA-2 is of great value for strengthening the stratified management of critically ill patients and enhancing the quality of clinical research. This article aims to systematically expound on the main updates of SOFA-2, its core differences from SOFA-1, and recommendations for clinical application, as well as analyze the current challenges and its impact on the practice and research of critical care medicine, in order to provide a reference for the accurate understanding and application of this score.
[Current status and controversies of thyroid stimulating hormone suppression therapy in low-risk differentiated thyroid carcinoma].
Ma ZT, Zhang H
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41795998 · Publisher ↗
Thyroid-stimulating hormone (TSH) suppression therapy plays an important role in the postoperative management of patients with differentiated thyroid cancer (DTC). However, its role in low-risk DTC (LR-DTC) remains contr...
Thyroid-stimulating hormone (TSH) suppression therapy plays an important role in the postoperative management of patients with differentiated thyroid cancer (DTC). However, its role in low-risk DTC (LR-DTC) remains controversial. This article reviewed domestic and international guidelines and relevant literature on TSH suppression therapy, finding that current guidelines worldwide generally show a trend toward gradually relaxing TSH suppression targets for LR-DTC patients. The latest guidelines from the American Thyroid Association (ATA), the National Comprehensive Cancer Network Thyroid Carcinoma Guidelines, and the Japanese Guidelines for the Treatment of Thyroid Tumors advocate a more lenient TSH suppression strategy for LR-DTC patients, recommending no suppression for those with excellent response or those who have undergone lobectomy. The most recent European Society for Medical Oncology Clinical Practice Guidelines for thyroid cancer and the Chinese Guidelines for the Diagnosis and Treatment of Thyroid Nodules and Differentiated Thyroid Cancer primarily reference the 2015 ATA guidelines, currently adopting a mild suppression approach by recommending that the TSH levels be maintained at the low end of the normal range. Recent large-scale studies tend to support further relaxation of TSH suppression targets for LR-DTC patients. There has still been no consensus regarding the optimal duration of TSH suppression therapy, as well as its application during active surveillance and after thermal ablation. There is an urgent need for more large-scale, multicenter prospective studies to provide stronger evidence-based support for formulating TSH suppression strategies in LR-DTC patients.
[Current status and strategies for reoperation in thyroid cancer].
Li P, Xi P, Shen WW … +2 more , Li C, Liu ST
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41795997 · Publisher ↗
Thyroid cancer is one of the fastest-growing solid malignancies in recent years. While the five-year survival rate of thyroid cancer in China has improved significantly, reoperation remains common due to factors such as...
Thyroid cancer is one of the fastest-growing solid malignancies in recent years. While the five-year survival rate of thyroid cancer in China has improved significantly, reoperation remains common due to factors such as inadequate initial diagnosis, insufficient evaluation, inappropriate surgical approaches, and high-risk pathological types. Although reoperation for thyroid cancer generally has a favorable prognosis, its difficulty and risk are significantly increased due to altered anatomy, scar adhesion, and tumor invasion. Precise preoperative evaluation, appropriate surgical access, proper surgical techniques, and effective protective measures can enhance surgical safety. This article reviews the latest research on the indications, surgical strategies, complication prevention, and future directions for reoperation in thyroid cancer, aiming to provide insights for reducing reoperation incidence and improving surgical safety.
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