Zhonghua Yi Xue Za Zhi[JOURNAL]
Sun
200 papers
[Clinical analysis of ultrasound-guided percutaneous sclerotherapy combined with radiofrequency ablation in the treatment of intrahepatic biliary cystadenoma].
Wu J, Zhang YA, Dong G … +1 more , Sun JM
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42373473 · Publisher ↗
Intrahepatic bile duct cystadenoma(IBC) is rare in clinic, and some patients can not tolerate or refuse surgical treatment.The clinical data of patients with IBC who underwent ultrasound-guided percutaneous sclerotherapy...
Intrahepatic bile duct cystadenoma(IBC) is rare in clinic, and some patients can not tolerate or refuse surgical treatment.The clinical data of patients with IBC who underwent ultrasound-guided percutaneous sclerotherapy combined with radiofrequency ablation (RFA) in the First Affiliated Hospital of Zhengzhou University from January 2020 to November 2024 were retrospectively analyzed. A total of 11 patients were included, including 1 male and 10 females, aged from 35 to 73 years. All the 11 patients successfully completed the operation, and the postoperative complication rate was 36.4%, all of which were Clavien-Dindo grade Ⅰ. The median follow-up time was 36 months (range, 12-66 months), and the last follow-up date was December 1, 2025. One patient had recurrence one month after operation and was treated with ultrasound-guided sclerotherapy combined with RFA again. Up to the last follow-up, the patient had no recurrence or malignant transformation. There was no recurrence or malignant transformation in the remaining 10 patients.There were statistically significant differences in the volume of lesions between before operation and 1, 3, 6, 12 months after operation (all 0.05), and there were statistically significant differences in the reduction rate of lesion volume between 1 month after operation and 3, 6, 12 months after operation (all 0.05).This pilot study shows that ultrasound-guided sclerotherapy combined with RFA is safe and effective in the treatment of IBC.
[Metabolic profiles in umbilical cord blood associated with neonatal brain injury in selective fetal growth restriction].
Su ZY, Huang NN, Li YX … +6 more , Yuan PB, Yu Y, Sun XY, Liu JY, Zhao YY, Yang J
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42373472 · Publisher ↗
This study aimed to analyze metabolic characteristics of the umbilical cord blood associated with brain injury in neonates with selective fetal growth restriction (sFGR). A prospective cohort of 30 sFGR twin pairs delive...
This study aimed to analyze metabolic characteristics of the umbilical cord blood associated with brain injury in neonates with selective fetal growth restriction (sFGR). A prospective cohort of 30 sFGR twin pairs delivered at Peking University Third Hospital between September 2017 and December 2019 was enrolled. Maternal-fetal clinical data and information on neonatal complications, including brain injury, were collected for both the growth-restricted (sFGR-S) and larger (sFGR-L) fetuses. The mean maternal age at delivery was (30.7±3.9) years, and the mean gestational age at delivery was (32.7±2.2) weeks. Among the 30 sFGR cases, there were 12 cases of type Ⅰ, 11 type Ⅱ, and 7 type Ⅲ. The cohort comprised 30 male and 30 female neonates (50% each). Brain injury occurred in 12 (40%) of the sFGR-S group, including 7 cases of intracranial hemorrhage (IVH), 3 cases of periventricular leukomalacia (PVL), and 2 case with both. In the sFGR-L group, brain injury occurred in 9 (30%) neonates, including 6 cases of IVH, 2 cases of PVL, and 1 case with both. Receiver operating characteristic (ROC) curve analysis for the sFGR-S group yielded an area under the curve (AUC) of 0.853 (95%: 0.698-1.000) for tyrosine alone, and an AUC of 0.944 (95%: 0.859-1.000) for the combination of tyrosine and myristic acid. For the sFGR-L group, the AUC was 0.880 (95%: 0.708-1.000) for S-adenosyl methionine (SAM) alone, and 0.917 (95%: 0.749-1.000) for the combination of SAM and trans-vaccenic acid. In conclusion, neonates in the sFGR-S and sFGR-L groups exhibit distinct metabolic profiles, and differential metabolites with their related pathways hold potential predictive value for neonatal brain injury.
[Relationship between the consistency of auxiliary provocation tests with the supine roll test and treatment outcomes for horizontal semicircular canal benign paroxysmal positional vertigo].
Yun YN, Yun ZX, Xu XY … +4 more , Yang P, Li L, Chang HM, Xing JL
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42373471 · Publisher ↗
To explore the consistency of lateralization of the head-shaking test (HST), lying-down test (LDT), and rapid axial roll test (RART) with the supine roll test (SRT), and to investigate their relationship with repositioni...
To explore the consistency of lateralization of the head-shaking test (HST), lying-down test (LDT), and rapid axial roll test (RART) with the supine roll test (SRT), and to investigate their relationship with repositioning efficacy in patients with horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV). Patients diagnosed with primary HC-BPPV using SRT and Dix-Hallpike test at the First Affiliated Hospital of Xi'an Jiaotong University between December 1, 2021 and June 30, 2024 were prospectively enrolled. Based on the order of their visits, all patients were semi-randomly assigned to subgroups to undergo the HST, LDT, or RART as auxiliary provocative tests. The nystagmus elicitation rates of the three tests and their consistency with SRT-based lateralization were compared, and the relationship between lateralization consistency and repositioning efficacy was analyzed. A total of 585 patients with HC-BPPV were included in the study: 199 cases in the HST group, 190 cases in the LDT group, and 196 cases in the RART group. There were no statistically significant differences in sex, age, body mass index, disease duration, and lesion side among the three groups (all >0.05). The nystagmus elicitation rate of RART (99.0%, 194/196) was higher than that of HST (31.7%, 63/199) and LDT (56.8%, 108/190), with statistically significant differences (both <0.017). The consistency rate of lateralization between RART and SRT (86.7%, 170/196) was higher than that of HST (17.6%, 35/199) and LDT (44.2%, 84/190), and there were statistically significant differences (both <0.017). The impact of lateralization distribution between auxiliary provocation tests and SRT on repositioning efficacy in HC-BPPV was analyzed. The results showed that the cure rate of the consistent lateralization group (92.4%, 267/289) was higher than that of the inconsistent lateralization group (55.3%, 30/76) and the nystagmus non-elicitation group (63.2%, 139/220), with statistically significant differences (both <0.017). In addition, the cure rate of the RART and SRT lateralization consistent group (98.2%, 167/170) was higher than that of the LDT group (88.1%, 74/84) and the HST group (74.3%, 26/35), with statistically significant differences (both <0.017). RART can serve as an effective auxiliary provocation test for the SRT, enhancing the accuracy of determining the affected side in HC-BPPV through a "dual verification" approach and providing valuable reference for clinical assessment.
[Early-and mid-trimester glycolipid metabolism indicators for predicting adverse pregnancy outcomes in normoglycemic women].
Zhang H, Shi CH, Sun XN … +2 more , Zhang J, Li H
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42373470 · Publisher ↗
To explore the predictive value of early-and mid-trimester glycolipid metabolic indicators for adverse pregnancy outcomes in pregnant women with normal glucose levels. A total of 12 457 pregnant women admitted to Yantai...
To explore the predictive value of early-and mid-trimester glycolipid metabolic indicators for adverse pregnancy outcomes in pregnant women with normal glucose levels. A total of 12 457 pregnant women admitted to Yantai Yantaishan Hospital from January 2020 to December 2024 were retrospectively included. According to the occurrence of adverse pregnancy outcomes, they were divided into an adverse pregnancy outcome group (=852) and a normal pregnancy outcome group (=11 605). General data, pregnancy-related information, lipid profile, and fasting plasma glucose (FPG) in early pregnancy (gestational age≤14 weeks; T1), and oral glucose tolerance test (OGTT) results in the second trimester (24-28 weeks; T2) were compared between the two groups. The participants were randomly assigned to a training set (=8 712) and a validation set (=3 745) in a 7∶3 ratio. Multivariable logistic regression was applied in the training set to identify independent risk factors for adverse pregnancy outcomes, and a nomogram prediction model was constructed. The area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve were used to evaluate the discrimination, calibration, and clinical applicability of the model, respectively. The overall age was (30.9±3.8) years, BMI was (22.77±2.12) kg/m², T1 FPG was (4.43±0.29) mmol/L, T2 FPG was (4.51±0.27) mmol/L, the second-trimester 1 h glucose was (8.54±0.43) mmol/L, and the second-trimester 2 h glucose was (7.10±0.54) mmol/L. Multivariable logistic regression analysis showed that age (=1.126, 95%: 1.080-1.175), history of adverse pregnancy outcomes (=2.080, 95% 1.023-4.232), ΔMAP (the change in mean arterial pressure from the first to the second trimester) (=1.162, 95% 1.124-1.202), the TG/HDL-C ratio (=18.849, 95%: 11.512-30.862), T1 FPG (=3.191, 95% 2.120-4.803), ΔFPG (T2 FPG-T1 FPG) (=1.154, 95%: 1.036-1.285), ΔT2(1 h-FPG) (T2 1 h glucose-FPG) (=3.427, 95%: 2.674-4.391), and ΔT2(2 h-FPG) (T2 2 h glucose-FPG) (=4.155, 95%: 3.306-5.221) were risk factors for adverse pregnancy outcomes (all <0.05). The AUC of the nomogram was 0.902 (95%: 0.884-0.919) in the training set and 0.895 (95%: 0.877-0.913) in the validation set. The calibration curve showed good agreement between predicted and observed probabilities (Hosmer-Lemeshow test: training set, =0.708; validation set, =0.102), and decision curve analysis indicated a net clinical benefit over a threshold probability range of 0.05 to 0.95. Age, history of adverse pregnancy outcomes, ΔMAP, the TG/HDL-C ratio, and dglycemic dynamic indicators during early and mid-trimester are independent predictors of adverse pregnancy outcomes in pregnant women with normal perinatal glucose levels. The nomogram constructed based on these factors demonstrates good discrimination, calibration, and clinical utility, and can serve as a quantitative tool for early risk identification in this population.
[Value of a deep learning-based visual model for predicting postoperative upper limb functional recovery after severe acute cervical spinal cord injury].
Deng MY, Li WB, Wang QY … +6 more , Li C, Xiong W, Cai BW, Xu LN, Yin GY, Fan J
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42373469 · Publisher ↗
To assess the value of a deep learning-based visual model for predicting postoperative upper limb functional recovery after severe acute cervical spinal cord injury. A retrospective study was conducted involving 162 pat...
To assess the value of a deep learning-based visual model for predicting postoperative upper limb functional recovery after severe acute cervical spinal cord injury. A retrospective study was conducted involving 162 patients with severe acute cervical spinal cord injury treated at the First Affiliated Hospital of Nanjing Medical University between 2020 and 2025. The Upper Extremity Motor Score (UEMS) was used to assess prognosis before treatment and at 6 months post-treatment. Patients with an improvement of ≥10 points were assigned to the good outcome group, and those with an improvement of <10 points to the poor outcome group. Variables showing statistical significance in univariate analysis were taken as initial inputs, and the least absolute shrinkage and selection operator (LASSO) was applied to identify variables associated with prognosis. The patients were divided into a training set (=97), a validation set (=32), and a test set (=33) at a ratio of 6∶2∶2. A predictive model was constructed based on a multilayer perceptron (MLP) and validated on the independent test set. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. Among the 162 patients, 129 were male and 33 were female, with a mean age of (55.5±9.8) years. Based on univariate analysis and LASSO regression, the four variables, i.e., the BASIC score, SCC>50%, preoperative UEMS, and light touch score, were identified. An MLP prediction model was constructed using these four variables. The distributions of risk factors among the training, validation, and test sets were balanced (all >0.05). During model training, the training loss approached 0, while the validation loss gradually decreased and stabilized. In the training set, the AUC (95%) was 0.987 (0.969-0.999), with a sensitivity of 93.33% and a specificity of 89.55%. In the validation set, the AUC (95%) was 0.955 (0.868-1.000), with a sensitivity of 90.00% and a specificity of 95.45%. In the test set, the AUC (95%) was 0.930 (0.830-0.991), with a sensitivity of 80.00% and a specificity of 95.65%. Neural network weight analysis showed that preoperative UEMS was the strongest positive predictor, followed by the light touch score, SCC, and BASIC score; among them, the BASIC score and SCC were negative predictors, while preoperative UEMS and the light touch score were positive predictors. The calibration curve demonstrated good calibration ability of the model. The deep learning prediction model based on MLP demonstrates good predictive performance for predicting upper limb functional outcomes in patients with SACSCI,with preoperative UEMS being the most important predictor.
[Eosinophils and futile recanalization after thrombectomy in acute large vessel occlusion stroke: the mediating effect of malignant brain edema].
Guo CW, Guo ZL
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42373468 · Publisher ↗
To explore the mediating role of malignant brain edema (MBE) in the relationship between eosinophils and futile recanalization after mechanical thrombectomy in patients with acute large vessel occlusion (LVO) stroke. A...
To explore the mediating role of malignant brain edema (MBE) in the relationship between eosinophils and futile recanalization after mechanical thrombectomy in patients with acute large vessel occlusion (LVO) stroke. A retrospective analysis was performed on 399 patients with acute LVO who underwent mechanical thrombectomy in Department of Neurology, the Second Affiliated Hospital of Soochow University from May 2017 to January 2023, all achieving successful recanalization [modified Thrombolysis in Cerebral Infarction (mTICI)≥2b]. Patients were categorized into the ineffective recanalization group and the non-ineffective recanalization group according to the presence or absence of ineffective recanalization, and into the MBE group and the non-MBE group according to the presence or absence of MBE. Futile recanalization was defined as angiographically confirmed recanalization of the occluded vessel after thrombectomy instantly, but with a 90-day modified Rankin Scale (mRS) score of 3-6. Clinical data was collected, including demographic characteristics (age, sex), underlying diseases (hypertension, diabetes, etc.), baseline National Institutes of Health Stroke Scale (NIHSS) score, Alberta Stroke Program Early CT Score (ASPECTS), peripheral blood eosinophil count, and 90-day mRS score. Eosinophils were entered into the model as a -score standardized continuous variable and as a dichotomous variable using a median cutoff of 0.01×109/L(Based on this, it was divided into high eosinophil group and low eosinophil group). Multivariate logistic regression was used to analyze the association between eosinophils and MBE or futile recanalization respectively, and the association between MBE and futile recanalization. Mediation analysis was performed to verify the mediating effect of MBE. Among the 399 patients, there were 229 males and 170 females under the age of (65.5±13.6) years. There were 161 cases (40.35%) in the low eosinophil group and 238 cases (59.65%) in the high eosinophil group. MBE occurred in 84 patients (21.05%), and futile recanalization occurred in 242 patients (60.65%). Multivariate logistic regression analysis showed that lower eosinophil levels were independently associated with an increased risk of MBE [continuous variable: after -score standardization, =0.185 (95%: 0.058-0.589, =0.004); dichotomous variable: =0.136 (95%: 0.062-0.295, <0.001)] and futile recanalization [continuous variable: after score standardization, =0.621 (95%: 0.469-0.821, <0.001); dichotomous variable: =0.206 (95%: 0.109-0.387, <0.001)]; Following thrombectomy, MBE was identified as a risk factor for futile recanalization (=5.286, 95%: 2.054-13.606, <0.001). Mediation analysis revealed that MBE partially mediated the relationship between eosinophils and futile recanalization (indirect effect =-0.229, 95%:-0.688 to -0.057, <0.001), accounting for 12.44% of the total effect. Reduced eosinophils are associated with an increased risk of MBE, and MBE plays a partial mediating role in the association between eosinophils and post-thrombectomy futile recanalization.
[A machine learning diagnostic model for hereditary hearing loss based on and enes: construction and interpretability analysis].
Gu XN, Chen CX, Huang SS … +4 more , Cao ZF, Yang JY, Li XG, Yuan YY
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42373467 · Publisher ↗
To construct a machine learning diagnostic model for hereditary hearing loss based on and genes and perform interpretability analysis using SHapley Additive explanations (SHAP). The data of genetic variants and hearin...
To construct a machine learning diagnostic model for hereditary hearing loss based on and genes and perform interpretability analysis using SHapley Additive explanations (SHAP). The data of genetic variants and hearing status were collected from 1 539 individuals at the Deafness Molecular Diagnosis Center of the Chinese PLA General Hospital from June 2015 to August 2024. Participants were categorized by expert diagnosis as hereditary hearing loss patients or non-hereditary hearing loss individuals, and were randomly assigned to a training set (=1 077) and a test set (=462) in a 7∶3 ratio using a computer-generated random sequence. Using non-zero coefficient variants of and genes screened by least absolute shrinkage and selection operator (LASSO) regression, six machine learning models including logistic regression, decision tree, random forest, gradient boosting (GB), eXtreme Gradient Boosting and k-nearest neighbors were constructed. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) with the DeLong test, and accuracy, precision, sensitivity, F1 score and specificity were calculated. The best model was compared against intermediate-level physicians to assess its clinical value, and SHAP was applied for interpretation. A total of 748 hereditary hearing loss patients (391 males and 357 females) aged 29 (13, 36) years and 791 non-hereditary hearing loss individuals (405 males and 386 females) aged 27 (12, 36) years were included. LASSO regression yielded 121 non-zero coefficient variants: 34 in the gene and 87 in the gene. The GB model produced an AUC of 0.975 (95%: 0.967-0.983), outperforming each of the other five models (all <0.05). Moreover, the GB model also showed higher precision [98.5% (95%: 97.8%-99.2%) vs 92.6% (95%: 90.4%-94.4%)] and specificity [98.7% (95%: 98.1%-99.3%) vs 93.2% (95%: 91.2%-94.8%)] than intermediate-level physicians (both <0.001). SHAP identified the top 10 impactful variants in the GB model: nine pathogenic variants (: p.Leu79CysfsTer3, p.His100ArgfsTer14, p.Val37Ile, p.Gly59AlafsTer18; : c.919-2A>G, p.His723Arg, p.Asn392Tyr, p.Thr410Met, p.Val659Leu) and one benign variant (: p.Val27Ile). The model tends to diagnose individuals carrying pathogenic homozygous or compound heterozygous variants as hereditary hearing loss patients. The machine learning models incorporating the and genes are of referential value for the auxiliary diagnosis of hereditary hearing loss, with the GB model demonstrating the best diagnostic performance.
[Expert consensus on the implementation and management of multidisciplinary team care for chronic obstructive pulmonary disease(2026 edition)].
Consensus Expert Group for the Implementation and Management of Multidisciplinary Team Care for Chronic Obstructive Pulmonary Disease, Chronic Obstructive Pulmonary Disease Assembly, Chinese Thoracic Society
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42373466 · Publisher ↗
Chronic Obstructive Pulmonary Disease (COPD) is a highly heterogeneous airway disease, and often coexists with other pulmonary and extra-pulmonary diseases. The traditional single-disciplinary approach cannot meet the me...
Chronic Obstructive Pulmonary Disease (COPD) is a highly heterogeneous airway disease, and often coexists with other pulmonary and extra-pulmonary diseases. The traditional single-disciplinary approach cannot meet the medical needs of patients with COPD. A multidisciplinary team (MDT) approach, led by respiratory physicians, has been advocated for the care of patients with COPD, but standardized practice guidelines are still lacking. Therefore, the Chronic Obstructive Pulmonary Disease Assembly of the Chinese Thoracic Society convened experts from relevant fields to reach a consensus based on evidence-based medicine and clinical experience, and formulated 11 recommendations regarding the implementation process, target population, indications, and management of MDT care for COPD. This consensus aims to propose a standardized framework for the implementation and management of MDT, thereby improving the quality of multidisciplinary care for COPD in China.
[Expert consensus on the clinical practice of modified electroconvulsive therapy for outpatients with mental disorders (2026 edition)].
Chinese Psychiatrist Association, Professional Committee of Physical Therapy, Mental Health Association of Guangdong Province
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42373465 · Publisher ↗
Modified electroconvulsive therapy (MECT) is one of the key physical treatments for mental disorders. Despite the rapidly growing demand for outpatient MECT among patients with mental disorders, a unified set of standard...
Modified electroconvulsive therapy (MECT) is one of the key physical treatments for mental disorders. Despite the rapidly growing demand for outpatient MECT among patients with mental disorders, a unified set of standardized operational guidelines has not yet been established in China. This expert consensus was initiated and developed by the Chinese Psychiatrist Association in collaboration with the Professional Committee of Physical Therapy, Mental Health Association of Guangdong Province. Under the guidance of the steering committee, based on evidence-based medical evidence and multidisciplinary expert opinions from psychiatry, anesthesiology and other related fields, this consensus systematically introduces the operational standards of outpatient MECT, covering core components including patient inclusion criteria, facility and equipment requirements, team composition, personnel qualifications and job responsibilities, treatment procedures, quality control and safety management, professional training and continuing medical education. Finally, 11 recommendations were formulated. This expert consensus aims to provide standardized and practical operational guidance for clinicians, ensure patient treatment safety, and promote the standardized application and sustainable development of outpatient MECT.
[Guideline for the diagnosis and treatment of psoriasis arthropathica (psoriatic arthritis) in China (2026 edition)].
China Dermatologist Association, Chinese Dermatovenerology Society of Integrative Medicine
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42373464 · Publisher ↗
Psoriasis arthropathica, also known as psoriatic arthritis (PsA), is a highly heterogeneous systemic inflammatory disease. In addition to involving the skin with characteristic psoriatic lesions such as erythematous scal...
Psoriasis arthropathica, also known as psoriatic arthritis (PsA), is a highly heterogeneous systemic inflammatory disease. In addition to involving the skin with characteristic psoriatic lesions such as erythematous scaly plaques, it may also affect the joints, leading to joint pain, swelling, stiffness, and functional impairment, thereby substantially reducing patients' quality of life. To develop clinical practice guidelines that align with international standards for guideline development while reflecting Chinese clinical practice, the China Dermatologist Association, in collaboration with the Chinese Dermatovenerology Society of Integrative Medicine, initiated a guideline project focusing on 14 key clinical questions in the diagnosis and management of PsA in China. Evidence-based recommendations were formulated accordingly. This guideline systematically reviews recent domestic and international advances in the diagnosis and treatment of PsA, and covers diagnosis, disease activity assessment, therapeutic strategies, comorbidity management, and pharmacotherapy in special populations. The guideline aims to improve the overall standard of PsA diagnosis and management in China and ultimately enhance patient outcomes.
[Irreparable massive rotator cuff tears: current treatment status and prospects in reconstruction].
Tian XP, Zhou BH
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42373463 · Publisher ↗
Irreparable massive rotator cuff tears represent a highly challenging clinical problem in shoulder sports medicine, and their surgery strategy remains a major focus and persistent challenge in the field. In recent years,...
Irreparable massive rotator cuff tears represent a highly challenging clinical problem in shoulder sports medicine, and their surgery strategy remains a major focus and persistent challenge in the field. In recent years, with the deepening of basic research and the accumulation of clinical experience, notable progress has been made in fundamental theories, surgical techniques, and graft selection for reconstructive treatment. This article systematically reviews the latest advances in the reconstruction of irreparable massive rotator cuff tears, covering emerging theories, innovative surgical procedures, and the application of grafts. It also offers insights into the future directions of clinical diagnosis and treatment and scientific research, aiming to provide valuable references for further development in this area.
[Application and prospects of transcranial temporal interference stimulation in the treatment of mental disorders].
Fan XY, Wang HH, Guan XY … +3 more , Zhang JJ, Fang YR, Zhang CC
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42373462 · Publisher ↗
Transcranial temporal interference stimulation (tTIS) generates a low-frequency envelope through the interference of two high-frequency electric fields, enabling non-invasive and precise neuromodulation of deep brain reg...
Transcranial temporal interference stimulation (tTIS) generates a low-frequency envelope through the interference of two high-frequency electric fields, enabling non-invasive and precise neuromodulation of deep brain regions. This article systematically reviews the technical principles, neuromodulatory mechanisms, and preliminary applications of tTIS in the treatment of mental disorders. It analyzes the impact of key parameters on therapeutic efficacy, including target selection, frequency difference, current intensity, stimulation protocol, and individualized computational modeling. The review also summarizes current research evidence for tTIS in major depressive disorder, bipolar disorder, schizophrenia, and substance use disorders. Finally, this article discusses future directions, including mechanistic exploration, validation through randomized controlled trials, multi-target intelligent stimulation, and combination therapies, aiming to provide a reference for the clinical translation of tTIS.
[The 2026 Surviving Sepsis Campaign guidelines: from evidence updates to practice implementation].
Xue M, Xie JF, Qiu HB … +1 more , Liu L
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42373461 · Publisher ↗
The 2026 Surviving Sepsis Campaign guidelines represent a systematic update built upon the 2021 version. The core changes are reflected not only in the adjustment of clinical recommendations but also, more significantly,...
The 2026 Surviving Sepsis Campaign guidelines represent a systematic update built upon the 2021 version. The core changes are reflected not only in the adjustment of clinical recommendations but also, more significantly, in the restructuring of the methodological framework. This article provides an in-depth analysis of the new guidelines across four key dimensions: methodological innovations, evolution of clinical diagnostic and treatment strategies, extension of whole-course management, and the establishment of an independent recommendation system for resource-limited settings. The 2026 guidelines achieve four major paradigm shifts: transitioning from simple evidence updates to methodological restructuring, from uniform recommendations to risk-stratified precision medicine, from acute-phase treatment to whole-course management, and from a high-resource medical center perspective to a global health equity perspective. However, systematically identifying evidence gaps, integrating effective strategies into clinical practice, and placing greater emphasis on patients' long-term functional recovery and life quality remain future research priorities.
[Evaluation of the efficacy of different large language models in solving clinical problems of early gastric cancer].
Feng JX, Guo YB, Wang BL … +4 more , Hong KC, Li JB, Li R, Lei CD
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42303589 · Publisher ↗
To evaluate the effectiveness of different large language models (LLM) in addressing clinical questions related to early gastric cancer (EGC). Select four types of LLM, including ChatGPT-4o, DeepSeek-V3.2, Gemini-2.5, a...
To evaluate the effectiveness of different large language models (LLM) in addressing clinical questions related to early gastric cancer (EGC). Select four types of LLM, including ChatGPT-4o, DeepSeek-V3.2, Gemini-2.5, and Grok-3, and develop 25 EGC professional knowledge questions based on international authoritative guidelines. Ten clinical physicians evaluated the accuracy, relevance, completeness scores of the four LLM' responses. Meanwhile, based on patient interviews, 15 EGC life and health questions were extracted, and 10 EGC patients were asked to rate their understanding of the answers to the 4 LLM; The readability of LLM solution was further evaluated by clinicians. One-way analysis of variance or Friedman test was used for comparison between the groups, and paired test corrected by Bonferroni method or Wilcoxon signed rank test corrected by Bonferroni method was used for comparison between two groups. These analyses were used to compare the accuracy, relevance, completeness, comprehension scores and readability assessment of different LLM solutions in addressing clinical questions related to EGC, thereby enabling a dual assessment of both expertise and accessibility. The accuracy scores of DeepSeek-V3.2 [（， ），78.0 (76.5, 82.0) points], Gemini-2.5 [80.0 (77.0, 82.5) points], and Grok-3 [82.0 (74.0, 83.0) points] evaluated by clinical physicians were lower than those of ChatGPT-4o [86.0 (83.5, 89.0) points] (all <0.05); The relevance scores of DeepSeek-V3.2 [82.0 (77.5, 87.0) points] and Grok-3 [86.0 (82.0, 88.0) points] were both lower than those of ChatGPT-4o [88.0 (87.5, 90.5) points] (both <0.05); The completeness scores of DeepSeek-V3.2 [75.0 (69.5, 80.0) points] and Gemini-2.5 [84.0 (81.0, 88.5) points] were both lower than those of Grok-3 [90.0 (85.5, 91.5) points] (both <0.05). Patients' score for the comprehensibility of DeepSeek-V3.2's responses [79.0 (77.0, 90.0) points] was lower than that for ChatGPT-4o [88.0 (86.0, 90.0) points] (<0.05). In terms of readability assessment, the simple measure of gobbledygook (SMOG) score for DeepSeek-V3.2's responses (14.1±1.6) was lower than that of ChatGPT-4o (16.4±2.3), Gemini-2.5 (15.8±2.0) and Grok-3 (15.8±1.1) (all <0.05). Different LLM have their own advantages and disadvantages in answering clinical questions about EGC. ChatGPT-4o has a better comprehensive evaluation, while DeepSeek-V3.2 has better readability in answering questions.
[Efficacy and safety of fourth-generation CAR-T cells targeting CD19 and BCMA with anti-IL-6 antibody secretion in refractory systemic lupus erythematosus].
Xu XX, Wang Q, Zhao XJ … +4 more , Xiang N, Hu BL, Wang XB, Chen Z
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42297600 · Publisher ↗
Clinical data of 3 patients with refractory systemic lupus erythematosus (rSLE) who received chimeric antigen receptor T-cell (CAR-T) therapy at the Department of Rheumatology and Immunology, the First Affiliated Hospita...
Clinical data of 3 patients with refractory systemic lupus erythematosus (rSLE) who received chimeric antigen receptor T-cell (CAR-T) therapy at the Department of Rheumatology and Immunology, the First Affiliated Hospital of University of Science and Technology of China, from June to September 2024 was prospectively enrolled. After lymphodepleting preconditioning with cyclophosphamide combined with fludarabine, 2 patients received a low dose (0.5×10⁶/kg) and 1 patient received a medium dose (1.0×10⁶/kg) of a 4th-generation CAR-T cells (SCAR02) targeting cluster of differentiation 19 (CD19) and B-cell maturation antigen (BCMA) and secreting interleukin-6 (IL-6) antibodies. Follow-up was conducted at day 14 and months 1, 2, 3, 6, 9, and 12 post-infusion to systematically evaluate safety (including treatment-related adverse events, cytokines, and immunoglobulin levels) and efficacy (including cellular kinetics, clinical efficacy, and serological markers). All 3 patients were females, aged 37, 25, and 41 years, respectively. During the follow-up period, no cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), or other serious adverse events occurred. CAR-T cells expanded well in all patients; peripheral blood CD19⁺ B cells were completely depleted on days 9-13 and gradually recovered over 3-5 months. By month 12, the SLE Disease Activity Index 2000 (SLEDAI-2K) scores of patients 1 to 3 decreased from 8, 8, and 9 at baseline to 0, 4, and 0, respectively; anti-double-stranded DNA antibodies all turned negative, and complement levels returned to normal. Two patients achieved drug-free complete remission based on the Definitions of Remission in SLE (DORIS) criteria, and 1 patient achieved an SLE Responder Index-4 (SRI-4) response. This study demonstrates that SCAR02 exhibits a good safety profile and preliminary efficacy in rSLE patients, and its function of secreting IL-6 antibodies may help alleviate CRS.
[Relationship between small vessel disease load and cerebral blood flow and white matter integrity in patients with subcortical ischemic vascular dementia].
Liu XJ, Tian Z, Liu X … +2 more , Xing MY, Zhang N
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42297599 · Publisher ↗
To evaluate markers of cerebral small vessel disease (SVD), cerebral blood flow (CBF), and white matter integrity in patients with subcortical ischemic vascular dementia (SIVD) using multimodal magnetic resonance imaging...
To evaluate markers of cerebral small vessel disease (SVD), cerebral blood flow (CBF), and white matter integrity in patients with subcortical ischemic vascular dementia (SIVD) using multimodal magnetic resonance imaging (MRI), and to analyze the impact of total SVD load on cerebral perfusion and white matter injury. Fifty SIVD patients who visited the Cognitive Disorders Clinic of Tianjin Medical University General Hospital between October 2017 and October 2022 were enrolled and underwent 3.0 T multimodal MRI examination. A total SVD load score was calculated based on the severity of white matter hyperintensities (WMH), lacunes, enlarged perivascular space (EPVS), and cerebral microbleeds (CMB). The patients were divided into a low total SVD load group (0-4 points, =32) and a high total SVD load group (5-6 points, =18). CBF and white matter integrity were assessed using arterial spin labeling (ASL) and diffusion tensor imaging (DTI), respectively. Independent-sample -test and χ test were used for intergroup comparison. Binary logistic regression model was adopted to analyze the correlation of various imaging markers with CBF and DTI parameters in all subjects. Compared with the low total SVD load group, the high total SVD load group exhibited reduced CBF in the right cerebellar posterior lobe and tonsil [(45.7±14.9) vs (59.6±12.5) ml·(100 g)·min, =3.52, <0.01], left superior frontal gyrus [(22.2±6.3) vs (26.8±6.0) ml·(100 g)·min, =2.55, =0.01], left middle frontal gyrus [(50.6±15.8) vs (60.5±14.8) ml·(100 g)·min, =2.22, =0.03], and right middle frontal gyrus [(58.7±16.1) vs (67.7±12.7) ml·(100 g)·min, =2.18, =0.04]. Decreased fractional anisotropy values (all <0.05) and increased mean diffusivity values (all <0.05) were observed in multiple white matter regions, including the corpus callosum, right cerebral peduncle, bilateral internal capsules, bilateral anterior corona radiata, bilateral posterior corona radiata, bilateral posterior thalamic radiation, bilateral cingulate gyri, and bilateral frontoparietal superior fasciculi. Meanshile, reduced CBF and impaired white matter integrity in these brain regions were correlated with scores of individual SVD markers and the total SVD load score (all <0.05). The total SVD load is closely associated with decreased cerebral perfusion and impaired white matter integrity in SIVD patients, which is an important pathological mechanism underlying brain dysfunction.
[The value of different endotoxin levels in early prognostic evaluation of patients with sepsis].
Wu BY, Zheng YK, Zhu YY … +2 more , Shi YJ, He ZJ
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42297598 · Publisher ↗
To explore the value of different plasma endotoxin levels in evaluating early prognosis of patients with sepsis. A total of 150 sepsis patients confirmed by plasma endotoxin from August 2024 to July 2025 in Department o...
To explore the value of different plasma endotoxin levels in evaluating early prognosis of patients with sepsis. A total of 150 sepsis patients confirmed by plasma endotoxin from August 2024 to July 2025 in Department of Critical Care Medicine, Sun Yat-sen Memorial Hospital were prospectively enrolled. Clinical data was collected, including general information such as gender, age and underlying medical history, vital signs at enrollment, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, Sequential Organ Failure Assessment (SOFA) score, laboratory and imaging results, infection-related indicators, and major treatment measures. Peripheral blood samples were collected after enrollment to detect endotoxin concentration. All patients were followed up for 28 days (follow-up assessments were conducted every 14 days following enrollment). The primary outcome was death within 28 days. Secondary outcomes were as follows: length of ICU stay, total hospital stay, and duration of mechanical ventilation. The relationship between different endotoxin levels and early prognosis in sepsis patients was analyzed. The X-tile software was used to determine the optimal cut-off value of endotoxin.Based on this cutoff value, patients were divided into a high-endotoxin group and a low-endotoxin group. Kaplan-Meier curves were plotted to calculate the 28-day cumulative survival rate and mortality rate. Univariate and multivariate Cox proportional hazards regression models were adopted to explore independent risk factors of early survival of sepsis patients. Among all enrolled patients, there were 101 males and 49 females, with the age of [ (, )] 60.0 (53.0, 72.8) years old. The cut-off value of endotoxin, calculated using X-tile software, was 0.23 EU/ml. Based on this value, the subjects were divided into the high-endotoxin group (=26) and the low-endotoxin group (=124). The 28-day mortality rate of the high-endotoxin group was significantly higher than that of the low-endotoxin group (42.3% vs 19.4%, =0.004). There were no statistically significant between-group differences in the secondary outcome indicators, including ICU stay duration, total hospital stay, and duration of mechanical ventilation. The Kaplan-Meier curve showed that the 28-day cumulative survival rate of the high-endotoxin group was lower than that of the low-endotoxin group (57.7% vs 80.6%, =0.004). The results of multivariate Cox regression analysis indicated that endotoxin (=2.307, 95%: 1.074-4.958), SOFA score (=1.172, 95%: 1.063-1.294), and total bilirubin (=1.004, 95%: 1.001-1.008) were influencing factors for early prognosis in sepsis patients. Plasma endotoxin has the potential to serve as a promising biomarker for early prognostic assessment of sepsis.
[Analysis of clinical characteristics and disease spectrum trend of children in short stature outpatient clinic of a tertiary hospital in Beijing in different years].
Lyu J, Wang C, Li YC … +1 more , Wu D
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42297597 · Publisher ↗
To analyze the clinical characteristics and disease spectrum trend of children in short stature outpatient clinic of Beijing Children's Hospital, Capital Medical University in different years. A retrospective analysis w...
To analyze the clinical characteristics and disease spectrum trend of children in short stature outpatient clinic of Beijing Children's Hospital, Capital Medical University in different years. A retrospective analysis was performed on the medical records of children attending the short stature outpatient department of Beijing Children's Hospital, Capital Medical University during the summer vacation (July 1 to September 30) in 2021, 2023 and 2025. Analyze the clinical characteristics and their distribution of children patients in 3 years. The Mantel-Haenszel trend χ² test was used to analyze the changing trends of various indicators and disease spectrum across the 3 years. A total of 5 862 children were enrolled, including 3 022 boys and 2 840 girls, with the age of (9.6±3.2) years and the height of (131.7±20.4) cm. The age of children in the three years was (9.0±3.3), (9.6±3.1), and (10.1±2.9) years, respectively. No infants were admitted to the short stature outpatient clinic in any of the 3 years. The proportion of children in the toddler and preschool periods decreased year by year, while that in the school-age and adolescent periods increased gradually (all <0.001). The height of children in the 3 years was (123.4±23.9), (131.6±19.9), and (139.9±21.2) cm, respectively. The proportion of children with low height percentile (<P, P-<P) showed a decreasing trend, whereas the proportions of children with moderate to high height percentile (P-<P to≥P) presented an increasing trend (all <0.05). The proportion of children with constitutional short stature decreased year by year, while the proportions of patients with adolescent short stature, slow or poor height growth, and precocious puberty increased annually (all <0.05). During the summer periods of 2021, 2023 and 2025, among patients visiting the short stature outpatient clinic of Beijing Children's Hospital, Capital Medical University, the proportions of school-age and adolescent children, children with height at≥P percentile, and cases of precocious puberty all increased year by year.
[Analysis of hospital associated infection characteristics in pediatric patients undergoing hematopoietic stem cell transplantation].
Wang YY, Wang XH, Zhang P … +7 more , Peng YG, Tian J, Jing YF, Chen FJ, Yang J, Wang P, Chen NN
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42297596 · Publisher ↗
To analyze the characteristics of hospital associated infection (HAI) in children undergoing hematopoietic stem cell transplantation (HSCT). The clinical data of children who underwent HSCT at Baoding Hospital, Beijing...
To analyze the characteristics of hospital associated infection (HAI) in children undergoing hematopoietic stem cell transplantation (HSCT). The clinical data of children who underwent HSCT at Baoding Hospital, Beijing Children's Hospital Affiliated to Capital Medical University and Beijing Children's Hospital Affiliated to Capital Medical University between July 2021 and August 2024 were retrospectively collected. Based on the occurrence of HAI, the patients were divided into the infected group (children who developed at least one HAI during hospitalization) and the uninfected group (children who did not develop HAI during multiple hospitalizations). The characteristics of HAI in the two groups were analyzed. A total of 651 patients were enrolled, including 138 patients (21.2%) in the infected group [93 males and 45 females; aged 8 (4, 12) years] and 513 patients in the uninfected group [328 males and 185 females; aged 7 (4, 11) years]. The infected group had 181 cases of HAI occurring during 150 hospitalizations among 138 pediatric patients. The incidence rate of HAI was 8.4% (episode incidence rate 10.1%), and the daily incidence rate of HAI was 3.3‰ (4.0‰). The mortality rate in the infected group was higher than that in the uninfected group [6.5% (9/138) vs 0.6% (3/513), <0.001]. The top five HAI were gastrointestinal infections (41.4%), vascular catheter-related bloodstream infections (19.3%), bloodstream infections (non catheter-related, sepsis type, 12.2%), lower respiratory tract infections (8.3%), and upper respiratory tract infections (6.6%). A total of 179 pathogenic microorganisms were detected in 181 cases of HAI in the infected group. The proportion of viruses in gastric intestinal infection accounted for 76.0% (57/75). The proportion of bacteria in catheter-related bloodstream infections was 100.0% (35/35), while in septic-type bloodstream infections it accounted for 90.1% (20/22). Lower respiratory tract infections were caused by bacteria and viruses in equal proportions, each accounting for 29.4% (5/15). The proportion of viruses in upper respiratory tract infections accounts for 91.7% (11/12), and bacteria accounted for 68.2% (15/22) of other infections. The median hospitalization duration for HAI was 21 (11, 38) days, with statistically significant difference in the timing of infection occurrence across various infection sites (=20.09, =0.001). A total of 117 cases (64.6%) of HAI were treated with antimicrobial agents, with a median duration of antimicrobial use of 7 (0, 18) days. There was a statistically significant difference in the duration of antibiotic use among different infection sites (=84.10, <0.001). The children with HAI have a higher mortality rate. Viral gastrointestinal infections are the most common type of HAI, followed by bacterial bloodstream infections; the timing of infection occurrence and the duration of antimicrobial use vary across different infection sites.
[Role of exogenous supplementation of umbilical cord blood immune cells in reconstructing immune function and restoring hematopoietic function in elderly high-risk myeloid neoplasms patients].
Du CX, Zhang HQ, Zhang YH … +8 more , Peng L, Luo SQ, Wang Y, Li YQ, Teng GS, Jiang EL, Chen B, Bai J
Zhonghua Yi Xue Za Zhi · 2026 Jun · PMID 42297595 · Publisher ↗
To investigate the effect of exogenous supplementation of umbilical cord blood (UCB) immune cells on immune function reconstruction and hematopoietic function recovery in elderly high-risk myeloid neoplasms (MN) patients...
To investigate the effect of exogenous supplementation of umbilical cord blood (UCB) immune cells on immune function reconstruction and hematopoietic function recovery in elderly high-risk myeloid neoplasms (MN) patients. The research includes clinical studies and cell experiments. Clinical data of elderly high-risk MN patients aged >60 years admitted to the Department of Hematology at the Second Hospital of Tianjin Medical University from January 2023 to June 2025 were retrospectively included. Based on treatment regimens, the patients were categorized into chemotherapy group ("3+7"regimen), demethylation therapy (HMA) group (decitabine-based therapy), and UCB group (venetoclax combined with azacitidine plus UCB reinfusion). At 28 days post-treatment, differences were compared among the groups regarding disease remission (complete remission rate), hematopoietic function reconstruction (recovery time of white blood cells and platelets), survival outcomes (overall survival rate and event-free survival rate), and cellular immune function reconstruction [levels of various CD4T cells, CD8T cells, natural killer (NK)cells, etc.]. To further confirm the role of UCB in the bone marrow microenvironment of MN patients, primary bone marrow cells were collected from 3 elderly high-risk MN patients in the UCB group (ileal bone marrow aspiration was performed on day 15 post-treatment and before UCB infusion, with 10 ml of bone marrow aspirated each time); additionally, UCB cells were obtained from 3 healthy donors (sourced from the Shandong Umbilical Cord Blood Hematopoietic Stem Cell Bank of China, all HLA 2/10 matched male donors). Based on different seeding methods of patient primary bone marrow cells and healthy donor UCB mononuclear cells in Transwell chambers, the cells were divided into a control group (patient bone marrow mononuclear cells cultured separately), an indirect co-culture group (non-contact co-culture of patient bone marrow mononuclear cells and UCB cells), and a direct co-culture group (contact co-culture of patient bone marrow mononuclear cells and UCB cells). After 48 hours of culture, the cells from the lower chamber and the supernatant were collected from each group. The proportional differences among immune cell subsets (various T-cell, B-cell, and NK cell subsets) were compared among the three groups, and the differences in cytokine levels among the three groups of the supernatants [tumor necrosis factor (TNF)-α, interferon (IFN)-γ, and interleukin (IL)-6] were also compared. A total of 109 patients were enrolled, including 54 males and 55 females, with an age range [ (, )] of 68 (60, 87) years. There were 38, 39, and 32 cases in the chemotherapy group, HMA group, and UCB group, respectively. Analysis of disease response revealed that the complete response rates in the UCB group [43.8% (14/32) vs 28.2% (11/39), <0.001] and the chemotherapy group [44.7% (17/38) vs 28.2% (11/39), <0.001] were higher than those in the HMA group. In terms of hematopoietic function recovery, the median time to achieve target leukocyte counts in the UCB group was shorter than that in the chemotherapy group [22 (14, 28) vs 28 (24, 37) days, <0.05] and the HMA group [22 (14, 28) vs 31 (21, 42) days, <0.05]. Similarly, the median time to achieve target platelet counts in the UCB group was shorter than that in the chemotherapy group [24 (17, 29) vs 28 (23, 33) days, <0.05] and the HMA group [24 (17, 29) vs 29 (22, 37) days, <0.05]. The survival analysis demonstrated that the 3-year overall survival rate in the UCB group was higher than that in the HMA group (39.1% vs 19.7%, <0.05), while no statistically significant difference was observed compared to the chemotherapy group (>0.05). Similarly, the 3-year event-free survival rate in the UCB group was higher than that in the HMA group (35.8% vs 25.5%, <0.05), with no statistically significant difference compared to the chemotherapy group (>0.05). Regarding the reconstruction of cellular immune function, the proportion of CD4central memory T cells in the UCB group at 28 days post-treatment was lower than that in the chemotherapy group [20% (9%, 29%) vs 32%(23%, 39%), <0.05], while no statistically significant difference was observed compared to the HMA group (>0.05). At 28 days post-treatment, the proportions of CD4naive T cells [45% (30%, 58%) vs 22% (10%, 34%)] and CD8naive T cells [41% (31%, 52%) vs 22% (8%, 36%)] in the UCB group were significantly higher than those in the HMA group (both <0.05), while no statistically significant difference was observed compared to the chemotherapy group (both >0.05). At 28 days post-treatment, the UCB group exhibited higher proportions of CD8effector T cells [40% (33%, 50%) vs 18% (8%, 28%)], CD19B cells [20% (13%, 27%) vs 12% (7%, 14%)], and NK cells [20% (15%, 26%) vs 14% (7%, 21%)] compared to the chemotherapy group (all <0.05). However, the UCB group showed lower proportions of regulatory T cells at 28 days post-treatment than both the chemotherapy group [4% (4%, 6%) vs 7% (7%, 8%), <0.05] and the HMA group [4% (4%, 6%) vs 8% (6%, 12%), <0.05]. In terms of cellular experiments, differential analysis of immune cells revealed that the indirect co-culture group exhibited higher levels of CD8naive T cells, CD4naive T cells, NK cells, and CD19B cell subsets compared to the control group; conversely, the levels of regulatory T cells and CD4central memory T cells were lower than those in the control group (all <0.05). Cytokine level analysis demonstrated that the direct co-culture group showed higher levels of TNF-α and IFN-γ, as well as lower levels of IL-6 compared to the control group (<0.001). Immunocytes such as NK cells in UCB may promote immune function reconstruction and hematopoietic recovery in patients, thereby improving their prognosis.
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