Zhonghua Yi Xue Za Zhi[JOURNAL]
Sun
200 papers
[Early outcomes of Sun's procedure in elderly patients with acute type A aortic dissection].
Huang ZF, Zhang ZD, Qiao G … +1 more , Zou GQ
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41781002 · Publisher ↗
A total of 31 patients [17 males and 14 females, with a median (, ) age of 73 (71, 75) years] over 70 years old with acute type A aortic dissection who underwent Sun's operation in Fuwai Central China Cardiovascular Hosp...
A total of 31 patients [17 males and 14 females, with a median (, ) age of 73 (71, 75) years] over 70 years old with acute type A aortic dissection who underwent Sun's operation in Fuwai Central China Cardiovascular Hospital from October 2023 to June 2025 were included, and 11 patients [two males and nine females, with a median (, ) age of 73 (71, 74) years] who underwent simplified ascending aorta replacement were included as the control group. In the Sun's procedure group, bilateral antegrade cerebral perfusion under mild hypothermia (28.1-32.0 ℃) was used for cerebral protection during circulatory arrest. The operation time was (6.6±1.5) h and (6.8±1.5) h, the tracheal intubation time was 39 (21, 132) h and 34 (16, 71) h, and the intensive care time was 113 (68, 179) h and 111 (43, 178) h in the Sun's procedure group and the control group, respectively, with no significant differences between the two groups (all >0.05). In the Sun's procedure group, one patient died of intraoperative bleeding and another died of a new postoperative cerebral infarction. Therefore, the in-hospital mortality rate was 6.5% (2/31). There were no deaths in the control group. The results suggest that Sun's procedure under mild hypothermia combined with bilateral antegrade cerebral perfusion is an effective surgical treatment for patients over 70 years old with acute type A aortic dissection.
[Mechanism of miR-199a-5p prevents migration and invasion of cholangiocarcinoma by targeting hypoxia-inducible factor 1α].
Tang WP, Liu B, Chen GD
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41781001 · Publisher ↗
To investigate the expression of miR-199a-5p in intrahepatic cholangiocarcinoma (ICC) and its regulatory mechanism in tumor invasion and metastasis. Tumor tissues and adjacent normal tissues from 38 ICC patients (aged 4...
To investigate the expression of miR-199a-5p in intrahepatic cholangiocarcinoma (ICC) and its regulatory mechanism in tumor invasion and metastasis. Tumor tissues and adjacent normal tissues from 38 ICC patients (aged 40-80 years, including 14 males) were collected at the First Affiliated Hospital of Nanhua University from January 2020 to April 2023. Differential genes and target genes were screened using transcriptome sequencing and multi-database bioinformatics analysis. Transcriptome sequencing was performed to detect the expression of miR-199a-5p and hypoxia-inducible factor 1α (HIF-1α). At the same time, clinical and pathological data such as patients' TNM staging and pathological differentiation were collected to analyze the correlation between the expression levels of miR-199a-5p and HIF-1α and clinicopathological features. Transcriptome sequencing was used to detect the RNA expression of miR-199a-5p and HIF-1α in tumor tissues and adjacent non-cancerous tissues of ICC patients. Immunohistochemistry was employed to detect HIF-1α expression in the tissues. Human normal bile duct epithelial cells, HuCC-T1 and RBE cell lines were cultured and used. The targeting relationship between miR-199a-5p and HIF-1α was verified by dual-luciferase reporter assay. The expression levels of miR-199a-5p and HIF-1α at the cellular level were detected using real-time quantitative PCR (qRT-PCR). RBE cells were divided into three groups through transfection using Lipofectamine 3000 reagent: control group, miR-199a-5p mimic group, and miR-199a-5p inhibitor group. The transfection efficiency and HIF-1α mRNA expression levels were assessed by qRT-PCR. Western blot analysis was used to detect the protein expression levels of HIF-1α, glyceraldehyde-3-phosphate dehydrogenase (GAPDH), proliferating cell nuclear antigen (PCNA), matrix metalloproteinase 9 (MMP9), and Cleaved caspase3. Cell migration and invasion abilities were assessed using wound healing and Transwell assays. HIF-1α knockdown cell models were established in RBE cells by transfecting them with HIF-1α-specific small interfering RNA (si-HIF-1α), with a negative control group (si-NC) set up simultaneously. After verifying the knockdown efficiency by qRT-PCR and Western blotting, changes in biological behavior of cholangiocarcinoma cells following HIF-1α suppression were observed by examining the expression of proliferation-related protein PCNA, performing wound healing assays, and conducting Transwell migration and invasion assays. This was aimed at clarifying the central role of HIF-1α in cholangiocarcinoma migration and invasion, further supporting that miR-199a-5p exerts its tumor-suppressive effect by targeting and inhibiting HIF-1α. All experimental data were repeated three times. Transcriptome sequencing and multi-database analysis identified miR-199a-5p and HIF-1α as targets. Dual-luciferase reporter assays confirmed that miR-199a-5p directly targets the 3'-UTR of HIF-1α. Transcriptome sequencing tissue expression analysis showed that compared with adjacent non-cancerous tissue, the expression of miR-199a-5p was decreased in ICC (FPKM: 1.24±0.31 vs 3.87±0.56), while the expression of HIF-1α was significantly increased (FPKM: 18.76±6.23 vs 56.15±8.42) (both <0.05). Immunohistochemistry results showed high expression of HIF-1α in ICC. Analysis of clinical pathological features indicated that ICC patients in the low miR-199a-5p expression group and the high HIF-1α expression group both had later TNM staging and poorer pathological differentiation (both <0.05). Mechanistically, overexpression of miR-199a-5p downregulated PCNA and MMP9 and upregulated Cleaved caspase 3, while inhibition of miR-199a-5p led to the opposite changes (all <0.05). Overexpression of miR-199a-5p inhibited the expression of HIF-1α and suppressed cell migration and invasion, whereas inhibition of miR-199a-5p produced the opposite effects (all <0.05). After knocking off HIF-1α, both the number of migrating and invading cells decreased (both <0.05). miR-199a-5p is downregulated in ICC and suppresses tumor migration and invasion by directly targeting HIF-1α and regulating downstream molecules involved in proliferation, invasion and apoptosis.
[Prefrontal near-infrared spectroscopy characteristics in patients with schizophrenia during verbal fluency tasks and their association with clinical efficacy].
Wang XJ, Jiao ZQ, Cheng L … +7 more , Lu YL, Shao ML, Han Y, Yang YF, Mu JL, Zhang YJ, Li WW
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41781000 · Publisher ↗
To investigate the prefrontal cortex activation characteristics in patients with schizophrenia (SZ) during a verbal fluency task (VFT) using functional near-infrared spectroscopy (fNIRS), and to explore their relationshi...
To investigate the prefrontal cortex activation characteristics in patients with schizophrenia (SZ) during a verbal fluency task (VFT) using functional near-infrared spectroscopy (fNIRS), and to explore their relationship with treatment efficacy. In this prospective study, SZ patients hospitalized at the Second Affiliated Hospital of Xinxiang Medical University between March 2022 and October 2024, and healthy controls (HCs) from the same hospital during the same period were enrolled. At baseline, prefrontal cortical activation was assessed by measuring changes in oxygenated hemoglobin (oxy-Hb) concentration using fNIRS during the VFT. Symptom severity in SZ patients was evaluated with the Positive and Negative Syndrome Scale (PANSS). After 4 weeks of treatment, PANSS assessment and fNIRS measurements were repeated. Patients were then classified into responders and non-responders based on whether the PANSS score reduction rate was≥25%. Differences in brain activation were compared between: (1) SZ patients and HCs at baseline; (2) SZ patients before and after treatment; and (3) responders versus non-responders. Eighty SZ patients [40 males, 40 females, mean age (32.4±8.8) years] and 80 HCs [39 males, 41 females, mean age (31.0±10.2) years] were included, with no significant differences in age or gender between groups (all >0.05). During the VFT, the SZ group showed significantly fewer activated channels than the HC group (9 vs 31 channels). In the SZ group, total PANSS score and subscale scores were significantly correlated with oxy-Hb concentrations in channels covering the Broca's area, frontopolar region, and dorsolateral prefrontal cortex (all <0.05). After 4 weeks of treatment, the SZ group exhibited a significant reduction in PANSS scores [(94.2±12.1) score vs (73.1±14.6) score]and an increased number of activated channels (9 vs 12 channels), with channels ch21 and ch48 showing significantly greater activation post-treatment [(0.26±0.73) vs (0.06±0.84) and (0.44±0.90) vs (0.19±0.62), respectively] (all <0.05). The responders had more activated channels than non-responders (15 vs 1 channel), with 7 channels showing statistically significant between-group differences in activation values (all <0.05). SZ patients exhibited significantly impaired prefrontal cortex activation as measured by fNIRS. Following 4-week treatment, the extent of prefrontal activation increased, particularly in responders.
[Clinical features and fistula acoustic characteristics in maintenance hemodialysis patients with versus without diabetes mellitus].
Liu YS, Lin WJ, Zhu YJ … +10 more , Li HX, Han Z, Jin S, Pan ZC, Mou HB, Zhou G, Bao P, Bi GY, Guo HL, Wang R
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41780999 · Publisher ↗
To compare the clinical features and acoustic characteristics of native arteriovenous fistulas (AVF) between maintenance hemodialysis (MHD) patients with and without diabetes mellitus. In this cross-sectional study, MHD...
To compare the clinical features and acoustic characteristics of native arteriovenous fistulas (AVF) between maintenance hemodialysis (MHD) patients with and without diabetes mellitus. In this cross-sectional study, MHD patients using AVF from the Blood Purification Center of Northern Jiangsu People's Hospital Affiliated to Yangzhou University between March and August 2024 were enrolled. AVF morphology and hemodynamics were assessed via ultrasonography, while concomitant audio recordings were obtained for acoustic analysis. Participants were stratified by diabetes status, and differences in clinical, ultrasonographic, and acoustic features were analyzed. A total of 192 patients (119 males and 73 females) aged (58.6±12.7) years were enrolled. Those with diabetes had greater height, weight, and body surface area but shorter dialysis duration and lower albumin, prealbumin, and hemoglobin levels (all <0.05). Ultrasonography revealed smaller vascular diameters at the anastomosis, within 3 cm proximally, at the puncture site, and in the radial artery 2 cm from the brachial artery bifurcation in the diabetic group (all <0.05). Resistive indices (at the anastomosis and within 3 cm proximally) and puncture depth were higher in diabetic patients (all <0.05). The multiple linear regression analysis indicated that diabetes mellitus (β=0.102, 95%: 0.051-0.153, <0.001) was associated with an increased anastomosis resistive index. The diabetic group demonstrated a significantly higher zero-crossing rate [0.011 (0.009, 0.012) vs 0.008 (0.007, 0.011), <0.001], but lower acoustic wave amplitude [-13.2 (-20.6, -10.6) dB vs -11.5 (-14.3, -10.3) dB, =0.049], mean mel-frequency cepstral coefficients (MFCC) [7.6 (0.4, 10.2) vs 10.4 (7.2, 12.2), <0.001], and mean extended Geneva minimalistic acoustic parameter set (eGEmaps) values [112 (109, 114) vs 113 (112, 115), =0.011] compared to the non-diabetic group. MHD patients with diabetes exhibit distinct AVF profiles characterized by smaller vascular diameters, greater puncture depth and resistance indices, higher acoustic zero-crossing rates, and lower mean MFCC and eGEMAPS values compared to non-diabetic patients.
[Guidelines for pulmonary rehabilitation of chronic respiratory diseases in China (2026 edition)].
Pulmonary Rehabilitation Group (Preparatory) of Chinese Thoracic Society, Chinese Pulmonary Rehabilitation Society of Chinese Association of Rehabilitation Medicine, Chinese Association of Chest Physician
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41780998 · Publisher ↗
Chronic respiratory diseases are important contributors to the rising burden of non-communicable diseases globally. Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed...
Chronic respiratory diseases are important contributors to the rising burden of non-communicable diseases globally. Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies, which can improve exercise capacity, reduce dyspnea, enhance health-related quality of life, stands as one of the most cost-effective treatment strategies. To better guide clinical practice in pulmonary rehabilitation of chronic respiratory diseases, Pulmonary Rehabilitation Committee of Chinese Association of Rehabilitation Medicine, Pulmonary Rehabilitation Group (preparatory) of Chinese Thoracic Society, Chinese Association of Chest Physician, jointly organized experts from multiple fields to systematically evaluated relevant guidelines and evidence from evidence-based medical research on pulmonary rehabilitation of chronic respiratory diseases published in China and abroad in the recent years. Based on the "Guidelines for respiratory rehabilitation management of chronic respiratory diseases in China (2021)", they formulated the "Guidelines for pulmonary rehabilitation of chronic respiratory diseases in China (2026 edition)" using the Delphi method. These guidelines cover the pulmonary rehabilitation defination and eligible individuals, optimal timing for initiation of pulmonary rehabilitation, pulmonary rehabilitation techniques, multimorbidity assessment and rehabilitation goals in elderly patients with CRD, education of patients and caregivers, inhalation technique, nutritional management, psychological assessment and intervention, use of assistant equipment, novel models of pulmonary rehabilitation and telerehabilitation, management of adverse events in pulmonary rehabilitation. Altogether 19 recommendations were formulated during this revision.
[Thoughts on the molecular characteristics of endometrial cancer in clinical diagnosis and treatment].
Chen XJ
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41780997 · Publisher ↗
Molecular subtyping and detection of other molecular characteristics of endometrial cancer have been widely carried out and applied in clinical diagnosis and treatment. However, there are still many issues, including inc...
Molecular subtyping and detection of other molecular characteristics of endometrial cancer have been widely carried out and applied in clinical diagnosis and treatment. However, there are still many issues, including inconsistent molecular testing methods and the lack of high-quality evidence to guide standardized clinical diagnosis and treatment based on molecular characteristics. For molecular subtyping detection, it is recommended to conduct a comprehensive molecular subtyping assessment by combining immunohistochemistry (IHC) and next-generation sequencing (NGS). Clinically, the molecular subtyping of endometrial cancer, traditional pathological classification, and surgical pathological staging should be considered holistically, and individualized treatment plans should be formulated based on the latest available clinical evidence. POLE-mutant (POLEmut) endometrial cancer generally has a favorable prognosis, and immune checkpoint inhibitors (ICIs) may be an effective adjuvant treatment option for advanced POLEmut endometrial cancer. For stage Ⅲ and above mismatch repair-deficient (MMRd) endometrial cancer, postoperative paclitaxel plus carboplatin chemotherapy combined with ICIs and maintenance therapy are recommended. No specific molecular profile (NSMP) endometrial cancer should undergo risk stratification based on estrogen receptor (ER) expression level and pathological type, and high-risk NSMP should be treated with reference to p53-abnormal (p53abn) endometrial cancer. Precision diagnosis and treatment of endometrial cancer based on molecular characteristics are still in the stage of in-depth exploration and verification. Many issues remain to be resolved, such as whether MMRd endometrial cancer caused by MLH-1 methylation or mutations in MMR-encoding genes has consistent responses to ICIs, and how to predict treatment efficacy. The reduced cost and rapid popularization of high-throughput technologies, as well as the continuous expansion and improvement of evidence from prospective cohorts, will provide high-quality evidence for further refinement of molecular characteristics and risk stratification of endometrial cancer, and guide the implementation of precision treatment for this disease.
[Current advances and challenges of immunotherapy in gestational trophoblastic neoplasia].
Jiang F, Xiang Y
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41780996 · Publisher ↗
Gestational trophoblastic neoplasia (GTN) represents a rare group of malignant tumors arising from trophoblastic tissue. These tumors are highly curable owing to their remarkable sensitivity to chemotherapy, yet treatmen...
Gestational trophoblastic neoplasia (GTN) represents a rare group of malignant tumors arising from trophoblastic tissue. These tumors are highly curable owing to their remarkable sensitivity to chemotherapy, yet treatment remains challenging in patients with high-risk disease, multi-drug resistance, or rare subtypes. Recent advances in immune checkpoint inhibitor (ICI) have expanded therapeutic possibilities for GTN. Some patients with recurrence or drug resistance have achieved long-term remission after treatment with programmed death receptor 1 (PD-1) and its programmed cell death ligand-1 (PD-L1) inhibitors.. Basic studies have revealed unique immunological features of GTN--including strong antigenicity, abundant immune cell infiltration, and high checkpoint expression--providing a biological rationale for immunotherapy. However, several key questions remain, including optimal treatment timing, long-term safety, fertility outcomes, and predictive biomarkers. Based on existing research findings, this review article discusses the current application status and controversies of GTN, proposes key directions for future development, and aims to provide references for clinical practice and follow-up research.
[The trade-off and selection of efficacy endpoints: controversies and challenges between progression-free survival and overall survival in clinical trials of gynecological tumors].
Wang DF, Pei J, Zhang GN
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41780995 · Publisher ↗
Progression-free survival (PFS) is widely used as an alternative endpoint for overall survival (OS) due to its ability to shorten clinical trial cycles and reduce interference with subsequent treatments. However, PFS bas...
Progression-free survival (PFS) is widely used as an alternative endpoint for overall survival (OS) due to its ability to shorten clinical trial cycles and reduce interference with subsequent treatments. However, PFS based on tumor measurements is susceptible to evaluation bias, insufficient statistical power, and confounding effects of subsequent treatments, leading to doubts about its clinical value, especially in the field of ovarian cancer where controversy is significant. Although the benefits of PFS may not necessarily translate into extended OS or improved quality of life, it is not advisable to completely negate the clinical value of the drug simply because the secondary endpoint OS did not show significant benefits. This article explains the disconnect between PFS and OS in gynecological tumors, proposes the necessityofoptimizing endpoint selection to reduce statistical bias, and emphasizes the importance of precision medicine as the guide to promote clinical trial design innovation. The aim is to provide a strategic framework for balancing accelerated approval and clinical benefit verification, guiding future research to focus more on the dual improvement of endpoint selection scientificity and patient survival improvement.
[Clinical efficacy analysis of globus pallidus internus deep brain stimulation for the treatment of tardive dyskinesia in 5 cases].
Lu GH, Feng LY, Liu JX … +5 more , Qiu C, Zhao L, Dong WW, Yan J, Zhang WB
Zhonghua Yi Xue Za Zhi · 2026 Feb · PMID 41688174 · Publisher ↗
The data of 5 patients with tardive dyskinesia (TD) who underwent deep brain stimulation (DBS) of the bilateral internal globus pallidus (GPi) at the Affiliated Brain Hospital of Nanjing Medical University between Decemb...
The data of 5 patients with tardive dyskinesia (TD) who underwent deep brain stimulation (DBS) of the bilateral internal globus pallidus (GPi) at the Affiliated Brain Hospital of Nanjing Medical University between December 2023 and June 2025. There were 3 males and 2 females, with a mean age of (39.8±3.9) years. At the 1-month follow-up, the severity of involuntary movements was assessed using the Abnormal Involuntary Movement Scale (AIMS), and adverse reactions in patients were also evaluated. At the 6-month follow-up, the 36-Item Short Form Health Survey (SF-36) was additionally administered to assess the quality of life of the patients, and compared with the preoperative baseline level to assess the efficacy of DBS.. The preoperative AIMS score was 21.2±1.7, which decreased to 7.0±1.3 at 1 month postoperatively (improvement rate: 64.6%±9.4%) and further to 4.0±0.3 at 6 months postoperatively (improvement rate: 80.8%±1.7%) (all 0.05). Additionally, the total preoperative SF-36 score was 29.8±2.1, and it improved to 54.3±1.5 at the 6-month follow-up (0.05).No serious long-term stimulation-related adverse events were observed during the study. In the small-sample study, GPi-DBS demonstrated potential therapeutic value for TD, which can significantly improve patients' involuntary movements and quality of life. However, due to the limited sample size, it is necessary to expand the cohort and extend the follow-up period for further investigation.
[Impact and mechanisms of enriched environment on cognitive function in Alzheimer's disease model mice].
Li D, Zhang YJ, Liu T … +3 more , Fang JS, Tan YQ, Meng XL
Zhonghua Yi Xue Za Zhi · 2026 Feb · PMID 41688173 · Publisher ↗
To investigate the effects and mechanisms of enriched environment(EE) on cognitive function in Alzheimer's disease (AD) model mice. Sixteen male 6-month-old APP/PS1 mice of SPF grade were randomly divided into standard...
To investigate the effects and mechanisms of enriched environment(EE) on cognitive function in Alzheimer's disease (AD) model mice. Sixteen male 6-month-old APP/PS1 mice of SPF grade were randomly divided into standard environment group (AD group), and enriched environment group (ADEE group), with 8 mice in each group. Additionally, 16 C57BL/6J mice with matched body weight were selected as the control group and randomly divided into an enriched environment group (NCEE group) and a control group (NC group), with 8 mice in each group. The mice were adapted to the environment for 2 weeks, followed by 12 weeks of intervention. The Morris water maze test was used to assess learning, memory, and exploration abilities; Immunofluorescence staining and Western blot (WB) were performed to detect the levels of Aβ, Tau protein, silent information regulator 1 (SIRT1), and peroxisome proliferator-activated receptor γ coactivator 1α (PGC-1α). The Morris water maze test showed that the AD group had fewer platform crossings, fewer effective area crossings, shorter effective area dwell time, fewer target quadrant entries, and shorter target quadrant dwell time compared to the NC group (all <0.05). In contrast, the ADEE group exhibited more effective area crossings, longer effective area dwell time, more target quadrant entries, and longer target quadrant dwell time compared to the AD group (all <0.05). Immunofluorescence staining results revealed more Aβplaques and Tau protein positive cells in the AD group and ADEE group compared to the NC group and NCEE group (all <0.01). After EE intervention, the ADEE group exhibited lower Aβ plaques and Tau protein positive cells than the AD group (all <0.05). Immunofluorescence staining and WB both demonstrated that SIRT1 and PGC-1α expression in AD mice was lower than in NCEE and NC mice (all <0.05). Following EE intervention, both the ADEE and NCEE groups showed higher SIRT1 and PGC-1α levels compared to the AD group and NC group (all <0.05). EE may improve the pathological progression and cognitive impairment of AD by activating the SIRT1/PGC-1α signaling pathway.
[Association between childhood trauma and the number of disorders of gut-brain interaction diagnosed in adults, as well as the mediating role of personality disorder traits and anxiety].
Ren YT, Xiao X, Zhang K … +4 more , Chen XW, Yu GP, Fu W, Wang RF
Zhonghua Yi Xue Za Zhi · 2026 Feb · PMID 41688172 · Publisher ↗
To investigate the association between childhood trauma and the number of disorders of gut-brain interaction (DGBI) diagnosed in adults, and to explore the mediating role of personality disorder (PD) traits and anxiety i...
To investigate the association between childhood trauma and the number of disorders of gut-brain interaction (DGBI) diagnosed in adults, and to explore the mediating role of personality disorder (PD) traits and anxiety in this relationship. A retrospective study was conducted on adult patients with DGBI who visited the Department of Gastroenterology Outpatient of Beijing Tsinghua Changgung Hospital from November 2023 to October 2024. The Rome Ⅳ questionnaire was used to measure the number of DGBI diagnoses, which was categorized into G1 group (1-2 types), G2 group (3-4 types) and G3 group (≥5 types). The childhood trauma questionnaire-short form (CTQ-SF) was used to measure childhood trauma, the personality disorder questionnaire-4+(PDQ-4+) was used to assess PD traits, and the Zung self-rated anxiety scale (SAS) were used to measure anxiety levels. Poisson regression analysis was employed to evaluate variable associations between childhood trauma, PD traits, anxiety, and the number of DGBI diagnoses [expressed as incidence rate ratio () and 95%]. The chained mediation model was used to calculate the mediating role of PD traits and anxiety among them (95% of did not exceed 1, the mediating effect was statistically significant). A total of 182 DGBI patients were included, including 85 males and 97 females, with an age[ (, )] of 42 (34, 58) years. There were 107, 56, and 19 patients in the G1, G2, and G3 groups, respectively. There were significant differences in age, number of births, PDQ-4+total score, SAS total score and CTQ-SF total score among G1, G2 and G3 groups (all <0.05). The total CTQ-SF score in G3 group was higher than that in G1 group [39.0 (32.0, 45.0) vs 29.0 (25.0, 34.0) score, =0.003]. The PDQ-4+total score in G3 group was higher than that in G1 group. The SAS total score in G3 group was higher than that in both G1 and G2 groups, and the SAS total score in G2 group was higher than that in G1 group. After adjusting for age, sex, and number of births, the total CTQ-SF score had a positive predictive effect on the number of DGBI diagnoses (=1.013, 95%: 1.006-1.020). In addition, both the total PDQ-4+score (=1.006, 95%: 1.002-1.010) and the total SAS score (=1.020, 95%: 1.013-1.026) had a positive predictive effect on the number of DGBI diagnoses. The chain mediation effect analysis indicated that childhood trauma indirectly influenced the number of DGBI diagnoses through a chain pathway from PD traits to anxiety, and the indirect effect was statistically significant (=1.004, 95%: 1.002-1.007), whereas the direct effect was not statistically significant (=1.007, 95%: 0.998-1.015). The severity of childhood trauma is associated with multiple DGBI diagnoses, and PD traits and anxiety play a chain mediating role between childhood trauma experience and DGBI diagnosis.
[Analysis of influencing factors and construction of a prediction model for high-risk colorectal adenomas].
Zhang MD, Chen J, Guo HL … +2 more , Kuang Z, Wang YD
Zhonghua Yi Xue Za Zhi · 2026 Feb · PMID 41688171 · Publisher ↗
To analyze the influencing factors of high-risk colorectal adenomas and establish and validate a predictive model. The clinical data of 321 patients with colorectal adenomas who underwent colonoscopy and biopsy at Beiji...
To analyze the influencing factors of high-risk colorectal adenomas and establish and validate a predictive model. The clinical data of 321 patients with colorectal adenomas who underwent colonoscopy and biopsy at Beijing Shijitan Hospital from January 2017 to January 2019 were retrospectively analyzed, including 201 males and 120 females, with the age (61.5±10.6) years. According to the colonoscopy pathology results, the patients were divided into the high-risk colorectal adenoma group and the non-high-risk colorectal adenoma group, and the differences in clinical indicators between the two groups were analyzed. The patients were randomly divided into a training set (=225) and a validation set (=96) at a ratio of 7∶3 using random sampling function. Multivariate logistic regression was used to screen the influencing factors of high-risk colorectal adenomas, and a nomogram of the predictive model was drawn. The predictive ability, accuracy and clinical applicability of the model were evaluated by the area under the receiver operating characteristic curve (AUC), calibration curve and decision curve analysis. Among the 225 cases in the training set, there were 107 cases in the non-high-risk adenoma group and 118 cases in the high-risk adenoma group. In the training set, the proportion of patients with a history of coronary heart disease, the proportion of severe hepatic steatosis, body mass index, triglyceride levels, low-density lipoprotein cholesterol levels, and high-density lipoprotein cholesterol levels were higher in the high-risk colorectal adenoma group compared to the non-high-risk adenoma group. Conversely, hemoglobin levels and total bilirubin levels were lower in the high-risk group (all <0.05). The results of the multivariate logistic regression model analysis revealed that a history of coronary heart disease (=9.172, 95%: 2.444-43.143), severe hepatic steatosis (=12.803, 95%: 4.423-36.987), and a high level of body mass index (=2.132, 95%: 1.659-2.874) were risk factors for high-risk rectal adenomas. Conversely, a high level of high-density lipoprotein cholesterol (=0.055, 95%: 0.005-0.518) and a high level of total bilirubin (=0.907, 95%: 0.833-0.982) were identified as protective factors against high-risk rectal adenomas. Construct a predictive model for high-risk colorectal adenomas based on the aforementioned influencing factors. The AUC of training set was 0.925 (95%: 0.893-0.958), with a sensitivity of 88% and a specificity of 82%, while the AUC of validation set was 0.886 (95%: 0.823-0.949), with a sensitivity of 72% and a specificity of 88%. The calibration curves of the training set and validation set show that the predictive model has good calibration (training set: =0.130; validation set: =0.910). The decision curves for both the training set and validation set demonstrate that the predictive model offers a clinical net benefit when the risk threshold exceeds 5%. A history of coronary heart disease, severe hepatic steatosis, a high level of body mass index, a high level of high-density lipoprotein cholesterol, and a high level of total bilirubin are influencing factors for high-risk colorectal adenomas. Incorporating these factors into a nomogram model allows for a more intuitive assessment of the risk of high-risk colorectal adenomas.
[Mid-to long-term efficacy of drug-eluting stents for vertebral artery ostial stenosis].
Xu GY, Zhang TY, Qin D … +5 more , Li W, Li K, Lu G, Li L, Tang F
Zhonghua Yi Xue Za Zhi · 2026 Feb · PMID 41688170 · Publisher ↗
To assess the mid-to long-term outcomes in patients treated with drug-eluting stent specifically designed for vertebral artery origin stenosis. Patients with symptomatic vertebral artery stenosis who underwent implantat...
To assess the mid-to long-term outcomes in patients treated with drug-eluting stent specifically designed for vertebral artery origin stenosis. Patients with symptomatic vertebral artery stenosis who underwent implantation of the specific drug-eluting stents at 7 centers from January to December 2021 were enrolled. Postoperative follow-up assessments were conducted at 1, 2, 3, and 4 years, with the maximum duration of follow-up being 4 years. Endpoint events, including transient ischemic attack, stroke, and all-cause mortality, were systematically monitored primarily through telephone follow-ups, supplemented by clinical visits when necessary. The cumulative occurrence of events is evaluated by drawing Kaplan-Meier survival curves. A cohort of 117 patients (with a total of 122 target vascular lesions, 123 stents were implanted) was enrolled in the study. The age of the participants (87 men and 30 women) [ (, )] was 65 (61, 70). The follow-up duration was (49.3±2.5) months. During the study, 20 patients (17.1%) were lost to follow-up. Ten (8.5%) endpoint events were documented, including 6 (5.1%) all-caused death, all of which were determined to be unrelated to the stent, and 4 (3.4%) cerebral ischemic events. The cerebrovascular adverse events consisted of 2 (1.7%) cerebral infarctions and 2 (1.7%) instances of in-stent restenosis or occlusion. The recurrence rate of stent-related symptoms was 2 (1.7%). Kaplan-Meier analysis revealed cumulative clinical endpoint event rates of 1.7% at 1 year, 6.0% at 2 years and 8.5% at 3 years. The cumulative stent-related clinical endpoint event rates were 0.9% at 1 year and 1.7% at 3 years. The recurrence rate of mid- and long-term clinical endpoint events after Maurora stent implantation was observed to be relatively low. Furthermore, there appears to be a decreasing trend in the incidence of cerebrovascular adverse events, including stent-related stroke, transient ischemic attack, and restenosis.
[Safety and efficacy of different stent types in single-stage carotid artery stenting for extracranial and intracranial tandem carotid lesions].
Jia YF, Ye YP, Wang JC … +4 more , Dong J, Yue YY, Liu JX, Feng J
Zhonghua Yi Xue Za Zhi · 2026 Feb · PMID 41688169 · Publisher ↗
To compare the safety and efficacy differences between self-expanding stents (SES) and balloon-expandable stents (BES) in single-stage carotid artery stenting (CAS) for tandem carotid lesions (TCL) involving both extracr...
To compare the safety and efficacy differences between self-expanding stents (SES) and balloon-expandable stents (BES) in single-stage carotid artery stenting (CAS) for tandem carotid lesions (TCL) involving both extracranial and intracranial carotid segments. Clinical data from 48 patients who underwent single-stage CAS for TCL at the First Affiliated Hospital of Xi'an Jiaotong University between January 2016 and September 2019 were retrospectively analyzed. Based on the stent type deployed in the intracranial segment, patients were divided into SES (=23) and BES (=25) groups. Follow-up was initiated at 1 month postoperatively and conducted monthly via outpatient visits or telephone. Baseline characteristics, perioperative adverse event rates, long-term stroke-free survival, and primary stent patency rates between the two groups were compared. Survival curves were constructed using the Kaplan-Meier method. The age of the 48 patients was (65±11) years, including 30 males and 18 females. The technical success rate was 100% (48/48). No significant difference was found in perioperative complication rates between SES and BES groups [8.7% (2/23) vs 4.0% (1/25)]. Cerebral hyperperfusion syndrome occurred in 1 case in each group (4.3% and 4.0%). One ischemic stroke (4.3%) occurred in the SES group. There were no death or major adverse cardiovascular event during the perioperative period in either group. The follow-up time [(, )] was 38 (14,45) months for the SES group and 36 (15,45) months for the BES group. During follow-up, the SES group experienced 1 (4.3%) major adverse cardiovascular event, 2 (8.7%) stroke events, and 2 (8.7%) cases of in-stent restenosis, while the BES group had 1 (4.0%) major adverse cardiovascular event and 1 (4.0%) case of in-stent restenosis. No statistically significant differences were observed in stroke-free survival (78.3% vs 92.0%) or primary patency rates (91.3% vs 96.0%) between the two groups (both >0.05). With strict patient selection and standardized perioperative management, single-stage CAS for TCL demonstrated excellent technical success and acceptable safety.
[Expert consensus on identification and prevention in adult enteral nutrition intolerance (2026 edition)].
China International Exchange and Promotive Association for Medical and Health Care Clinical Nutrition Health Branch, Chinese Society of Parenteral and Enteral Nutrition, Chinese Nutrition Society Branch of Clinical Nutrition
Zhonghua Yi Xue Za Zhi · 2026 Feb · PMID 41688168 · Publisher ↗
Enteral nutrition (EN) is one of the important approaches in clinical nutritional support therapy. EN intolerance (ENI) occurs frequently during the implementation of EN. Currently, there is a lack of unified diagnostic...
Enteral nutrition (EN) is one of the important approaches in clinical nutritional support therapy. EN intolerance (ENI) occurs frequently during the implementation of EN. Currently, there is a lack of unified diagnostic criteria and monitoring methods for ENI identification and prevention both domestically and internationally, and intervention strategies remain inconsistent, which significantly impede the standardized application of EN. To further standardize the clinical identification, monitoring and intervention of ENI, the China International Exchange and Promotive Association for Medical and Health Care Clinical Nutrition Health Branch, the Chinese Society of Parenteral and Enteral Nutrition, the Chinese Nutrition Society Branch of Clinical Nutrition organized nearly 100 Chinese experts in related fields to make current consensus. The consensus is based on the best evidence and focus on the following topics: assessment and monitoring of ENI, prevention and treatment of ENI, etc. Finally, 22 recommendations were proposed to offer guidance on identification, prevention and treatment of ENI, as well as to promote the standardized implementation of EN.
[Guidelines for the diagnosis and treatment of carbapenem-resistant infection(2026 edition)].
Branch of Bacterial Infection and Drug Resistance Prevention of Chinese Medical Association, Infectious Diseases Specialty Committee, China Medicine Education Association
Zhonghua Yi Xue Za Zhi · 2026 Feb · PMID 41688167 · Publisher ↗
Carbapenem resistant (CRPA) is an important pathogen of hospital acquired infections, especially in patients with chronic lung disease, long-term hospitalization, or those who have received broad-spectrum antibiotic tre...
Carbapenem resistant (CRPA) is an important pathogen of hospital acquired infections, especially in patients with chronic lung disease, long-term hospitalization, or those who have received broad-spectrum antibiotic treatment. CRPA often manifests as multidrug resistance, which can lead to difficult treatment and poor prognosis. In order to standardize the clinical management of CRPA infection in China and improve the standardization and accuracy of diagnosis and treatment, the Branch of Bacterial Infection and Drug Resistance Prevention of the Chinese Medical Association and the Infectious Diseases Specialty Committee of the Chinese Medical Education Association organized multidisciplinary experts to formulate norms and grading of recommendations, assessment, development, and evaluation methods in accordance with international guidelines. This guidance systematically focuses on and answers 10 key clinical questions, covering the core aspects of diagnosis and treatment, mainly including: the clinical application value of carbapenemases phenotype or genotype detection, the necessity and methods of combined drug susceptibility testing, adjustment of the treatment plan based on monitoring the minimum inhibitory concentration during the treatment process, the role of drug concentration monitoring in optimizing dosing regimens, comparison of the efficacy of polymyxin monotherapy and combination therapy, the treatment indications and strategies for chronic pulmonary CRPA infection, the clinical application of inhaled antibiotics and azithromycin, the role of intravenous combined nebulization inhalation therapy in acute pulmonary infections, recommendations for the treatment of central nervous system infections with intravenous combined intrathecal/intraventricular administration, and combined treatment strategies for severe CRPA infections. This guideline aims to provide practical guidance for clinical physicians based on current evidence, emphasizing individualized comprehensive treatment based on precise detection and individual patient conditions, in order to improve the clinical outcomes of CRPA infected patients and promote the rational use of antibiotics.
[Guidelines for diagnosis and treatment of hepatocellular carcinoma with portal vein tumor thrombus in China(2026 edition)].
Chinese Association of Liver Cancer and Chinese Medical Doctor Association
Zhonghua Yi Xue Za Zhi · 2026 Feb · PMID 41672891 · Publisher ↗
Hepatocellular carcinoma with portal vein tumor thrombus (PVTT) has a high incidence and an extremely poor prognosis. Current international guidelines still exhibit discrepancies in the diagnosis and management of PVTT,...
Hepatocellular carcinoma with portal vein tumor thrombus (PVTT) has a high incidence and an extremely poor prognosis. Current international guidelines still exhibit discrepancies in the diagnosis and management of PVTT, while Chinese patients require individualized strategies due to differences in etiology and biological behavior. To adapt to the developments and changes in the clinical diagnosis and treatment of hepatocellular carcinoma with PVTT, and to standardize related clinical procedures, the Chinese Association of Liver Cancer and Chinese Medical Doctor Association initiated the revision of the"Chinese Guidelines for Diagnosis and Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus (2026 Edition)"in 2025, which was the new evidence since the publication of the 2021 edition. This guideline was developed through a systematic literature search up to October 2025, evaluated the evidence using the GRADE system, and formulated recommendations via multidisciplinary expert consensus. The guideline recommends Cheng's classification as the Chinese standard for PVTT typing, emphasizes a multidisciplinary team (MDT)-based approach, and advocates for individualized comprehensive treatment strategies based on liver function, tumor resectability, and PVTT type. For patients with resectable type Ⅰ/Ⅱ PVTT, surgical resection is the preferred option; for unresectable cases, a combination of local therapies such as hepatic arterial infusion chemotherapy (HAIC), transarterial chemoembolization (TACE), and radiotherapy with systemic therapies including targeted and immunotherapy is recommended. Furthermore, the guideline clarifies the importance of conversion therapy and supportive care, and outlines future research directions, including optimizing staging systems and deepening mechanistic studies. This guideline aims to provide the latest evidence-based basis for the standardized diagnosis and treatment of hepatocellular carcinoma with PVTT, with the goal of improving patient survival and quality of life.
[Impact of bone metastasis on the prognosis of lung adenocarcinoma patients treated with third-generation EGFR-TKI and the underlying mechanisms].
Zhang C, Shi XL, Jiang YQ … +3 more , Li J, Xu JL, Guo RH
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 41672890 · Publisher ↗
To evaluate the impact of bone metastasis on the prognosis of lung adenocarcinoma patients receiving first-line third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) and to explore the po...
To evaluate the impact of bone metastasis on the prognosis of lung adenocarcinoma patients receiving first-line third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) and to explore the potential mechanisms by which bone metastasis contributes to EGFR-TKI resistance. A retrospective analysis was conducted on the clinical data of 370 EGFR-mutant advanced lung adenocarcinoma patients who received first-line treatment with third-generation EGFR-TKI at the First Affiliated Hospital of Nanjing Medical University from January 2019 to June 2024, with follow-up until June 2024. Progression-free survival (PFS) and overall survival (OS) were compared between patients with and without baseline bone metastasis. Survival curves were generated using the Kaplan-Meier method, and differences between groups were assessed by the log-rank test. Univariate and multivariate Cox proportional hazards regression models were applied to identify factors associated with PFS following third-generation EGFR-TKI treatment. Single-cell RNA sequencing (scRNA-seq) was performed on two primary pulmonary tumors and two bone metastatic lesions to characterize transcriptomic differences in cancer cells and immune cells within the tumor microenvironment. Gene ontology (GO) enrichment analysis was applied to identify bone metastasis-specific signaling pathways. Based on immune regulatory genes upregulated in cancer cells from bone metastatic lesions, an immune-regulatory score was constructed using a LASSO-Cox regression model in a training cohort of EGFR-mutant lung adenocarcinoma patients from The Cancer Genome Atlas (TCGA). Patients in both the training cohort and an independent Asian EGFR-mutant lung adenocarcinoma validation cohort were stratified into high-and low-score groups according to the median immune regulatory score, and OS was compared between groups. Among the 370 lung adenocarcinoma patients receiving first-line third-generation EGFR-TKI treatment, 161 patients had baseline bone metastasis [mean age (60±11) years; 70 males], while 209 patients had no baseline bone metastasis [mean age (61±9) years; 80 males]. No significant differences in baseline clinicopathological characteristics were observed between patients with and without bone metastasis (all >0.05). The median PFS in the bone metastasis group was 27.5 months (95%: 22.0-33.1), which was significantly shorter than that in the non-bone metastasis group [59.0 months (95%: 32.8-85.1), <0.001]. The median OS was 46.2 months (95%: 40.4-51.9) in the bone metastasis group, whereas the median OS had not yet been reached in the non-bone metastasis group, with a statistically significant difference (=0.013). Multivariate Cox regression analysis identified bone metastasis as an independent risk factor for PFS (=1.74, 95%:1.27-2.37, <0.001). Cancer cells in bone metastatic lesions exhibited upregulation of C-X-C motif chemokine ligand 17 (CXCL17), complement decay-accelerating factor (CD55), interferon regulatory factor 1 (IRF1), E3 ubiquitin-protein ligase pellino homolog 1 (PELI1), solute carrier family 7 member 5 (SLC7A5) and prostaglandin-endoperoxide synthase 2 (PTGS2), which were predominantly enriched in pathways related to immune cell differentiation, chemotaxis, and inflammatory responses. At the immune cell level, lymphoid cells in bone metastatic lesions showed activation of stress response and apoptotic pathways, whereas myeloid cells demonstrated significant activation of cytokine/chemokine signaling and inflammation-related pathways. An immune-regulatory score based on CXCL17, CD55, IRF1, PELI1, SLC7A5, and PTGS2 was constructed. In the TCGA training cohort, the median OS of 41 patients with a high immune-regulatory score was 23.1 months (95%: 17.5-28.7), which was significantly shorter than that of patients with a low score [58.5 months (95%: 43.0-73.9), <0.001]. In the independent Asian cohort of 93 EGFR-mutant lung adenocarcinoma patients, the median OS of 46 patients with a high immune-regulatory score was 85.3 months (95%: 80.0-not reached), while the median OS in the low-score group was not reached, with a statistically significant difference (=0.014). Bone metastasis is an adverse prognostic factor for progression-free survival in lung adenocarcinoma patients treated with third-generation EGFR-TKI. Bone metastasis lesions exhibit a distinct immunosuppressive tumor microenvironment in EGFR-mutant advanced lung adenocarcinoma, in which upregulation of immune regulatory genes in cancer cells and dysfunction of immune cells may constitute a potential mechanism underlying resistance to third-generation EGFR-TKI.
[Interpretation of "Clinical practice guidelines for the treatment and prophylaxis of influenza in China (2025 edition)"].
Wang YM, Li JY, Chen SY … +1 more , Cao B
Zhonghua Yi Xue Za Zhi · 2026 Mar · PMID 41668281 · Publisher ↗
"Clinical practice guidelines for the treatment and prophylaxis of influenza in China (2025 edition)" (hereinafter referred to as "the guideline") were jointly released by the Chinese Thoracic Society and Chinese Society...
"Clinical practice guidelines for the treatment and prophylaxis of influenza in China (2025 edition)" (hereinafter referred to as "the guideline") were jointly released by the Chinese Thoracic Society and Chinese Society of Infectious Diseases of the Chinese Medical Association. As an influenza guideline developed using evidence-based methodology in China, its key strength lies in providing systematic and actionable recommendations grounded in evidence. This article aims to provide a clinical interpretation of the guidelines, highlighting five major advancements compared with previous consensus documents: methodological innovation, stratified treatment strategies, integration of new evidence on domestically developed innovative drugs, clarification of the therapeutic window and explicit preventive strategies. This interpretation is intended to assist clinicians in thoroughly understanding the core principles and clinical considerations of the guideline, thereby promoting effective implementation.
[Analysis of dermoscopic and histopathological features in misdiagnosed cases of early mycosis fungoides].
Qiu XH, Zou ZJ, Xu YZ … +3 more , Sun LJ, Zeng LY, Lin SQ
Zhonghua Yi Xue Za Zhi · 2026 Feb · PMID 41644459 · Publisher ↗
Retrospectively, patients who were pathologically diagnosed with early-stage mycosis fungoides (MF) in the Department of Dermatology, Zhongshan Hospital Affiliated to Xiamen University, from October 1, 2023 to April 1, 2...
Retrospectively, patients who were pathologically diagnosed with early-stage mycosis fungoides (MF) in the Department of Dermatology, Zhongshan Hospital Affiliated to Xiamen University, from October 1, 2023 to April 1, 2024 and had a history of misdiagnosis were enrolled in this study. Their clinical characteristics, dermoscopic manifestations of skin lesions as well as cutaneous histopathological features were analyzed. A total of 10 patients with early-stage MF were included, among whom 8 were males and 2 were females, with a mean age of (30.1±14.3) years. Dermoscopic examination revealed that all patients presented with a dark yellowish-red background accompanied by patchy orange-yellow areas. The main vascular pattern in most cases (9/10) was "spermatozoa-like vessels", and dotted vessels as well as short linear vessels were observed in all 10 cases. Histopathological examination showed vacuolar interface change accompanied by superficial perivascular inflammation pattern in all cases, together with lymphocytic epidermotropism, intraepidermal atypical lymphocytes and Pautrier microabscesses. After standardized treatment, follow-up dermoscopic examinations were performed one year later, and the aforementioned dermoscopic manifestations disappeared in 9 patients. This study suggests that early-stage MF with different clinical phenotypes has relatively consistent dermoscopic and cutaneous histopathological features.
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