Zhonghua yi xue za zhi最新文献

{"title":"[Efficacy and safety of endoscopic submucosal dissection versus surgery for early gastric cancer in patients aged 75 years and above: a systematic review and meta-analysis].","authors":"H K Chang, X Ji, Q Zhang, P Li","doi":"10.3760/cma.j.cn112137-20260326-00815","DOIUrl":"10.3760/cma.j.cn112137-20260326-00815","url":null,"abstract":"<p><p><b>Objective:</b> To systematically evaluate the clinical efficacy and safety of endoscopic submucosal dissection (ESD) versus surgical resection for early gastric cancer (EGC) in patients aged 75 years and above. <b>Methods:</b> A systematic search was conducted in PubMed, Embase, Cochrane Library, and CNKI from the inception of the database to April 2026, to include relevant literature on ESD and surgery for aged 75 years and above patients with EGC. The experimental group consisted of patients aged≥75 years treated with ESD (ESD group), while the control group included those treated with surgery (surgery group). According to inclusion and exclusion criteria, two researchers independently performed literature screening, data extraction using the Newcastle-Ottawa Scale, and conducted meta-analysis using RevMan 5.4 and Stata 18.0 software to assess heterogeneity using <i>I</i>². Outcome measures included the 5-year survival rate, recurrence rate, recurrence-related mortality rate, and tumor incidence rates across different mucosal layers in both groups of patients. Funnel plots and leave-one-out analysis were adopted for publication bias analysis and sensitivity analysis. <b>Results:</b> A total of 6 studies involving 2 045 patients were included, with 988 in the ESD group and 1 057 in the control group. The 5-year survival rate (82.9% vs 77.4%, <i>OR</i>=1.29, 95%<i>CI</i>: 1.01-1.65, <i>P</i>=0.040, <i>I</i>²=0) and gastric cancer recurrence rate (8.5% vs 4.3%, <i>OR</i>=2.39, 95%<i>CI</i>: 1.37-4.14, <i>P</i>=0.002, <i>I</i>²=24%) were higher in the ESD group than those in the surgical group, whereas the recurrence-related mortality rate was lower in the ESD group (1.9% vs 4.9%, <i>OR</i>=0.47, 95%<i>CI</i>: 0.25-0.86, <i>P</i>=0.020, <i>I</i>²=34%). Subgroup analysis by tumor incidence rates across different mucosal layers showed that the proportion of mucosal tumors was higher in the ESD group than that in the surgical group (78.8% vs 38.3%, <i>OR</i>=3.40, 95%<i>CI</i>: 1.15-10.07, <i>P</i>=0.030, <i>I</i>²=95%), whereas the proportion of submucosal tumors was lower in the ESD group than in the surgical group (20.7% vs 61.4%, <i>OR</i>=0.29, 95%<i>CI</i>: 0.10-0.87, <i>P</i>=0.030, <i>I</i>²=95%). Funnel plot analysis showed that the studies were generally symmetrically distributed on both sides of the pooled effect size (log <i>OR</i>), forming an inverted funnel shape; sensitivity analysis demonstrated that the point estimates of individual studies fluctuated slightly around the original pooled effect size (log <i>OR</i>=1.05). <b>Conclusion:</b> For EGC patients aged 75 years and above, ESD demonstrates superior clinical efficacy and safety compared to surgical treatment.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 35","pages":"3790-3797"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Analysis of related factors for the occurrence of cardiovascular-renal-metabolic syndrome stage 4 in patients with primary aldosteronism].","authors":"M X Yang, B Li, J X Wang, Y Zhou, G Q Yang, W J Gu, Y M Mu","doi":"10.3760/cma.j.cn112137-20260408-00949","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20260408-00949","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To explore the related factors of patients with primary aldosteronism (PA) developing into stage 4 of cardiovascular-renal-metabolic syndrome (CKM). &lt;b&gt;Methods:&lt;/b&gt; A total of 397 patients diagnosed with PA from January 2016 to December 2024 were retrospectively enrolled. According to the CKM staging criteria, the patients were divided into the early stage group (stages 0-2), stage 3 group and stage 4 group. To analyze the differences in each indicator among the three groups. Multivariate logistic regression models were applied to analyze the correlation between each indicator and the occurrence of CKM stage 4 via stepwise adjustment for confounding factors. Subgroup analyses were further conducted by gender, age (≤50 years and &gt;50 years) and PA subtypes [idiopathic hyperaldosteronism (IHA) and aldosterone-producing adenoma]. &lt;b&gt;Results:&lt;/b&gt; Among the 397 PA patients, 231 were males and 166 were females, with a confirmed diagnosis age of (51.1±10.9) years. There were 179 patients in the early CKM stage group (including 1 case in stage 0, 7 cases in stage 1, and 171 cases in stage 2), 107 patients in the CKM stage 3 group, and 111 patients in the CKM stage 4 group. There were statistically significant differences among the 3 groups in age, gender, PA subtype, body mass index, diastolic blood pressure, systolic blood pressure, hypertension duration, proportion of dyslipidemia, proportion of diabetes, proportion of atherosclerosis, proportion of chronic kidney disease, proportion of cerebral infarction, and proportion of coronary heart disease (all &lt;i&gt;P&lt;/i&gt;&lt;0.05). In terms of laboratory indicators, there were statistically significant differences among the 3 groups in fasting blood glucose, total cholesterol, low-density lipoprotein cholesterol, γ-glutamyl transferase, blood potassium, serum creatinine, urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), supine aldosterone, and aldosterone 2 hours after the captopril test (all &lt;i&gt;P&lt;/i&gt;&lt;0.05). Multivariate logistic regression showed that after adjusting for a series of influencing factors including gender, age, BMI, metabolic indicators, disease history and medication history, 2 h post-captopril aldosterone remained independently and positively correlated with the occurrence of CKM stage 4 in PA patients (&lt;i&gt;OR&lt;/i&gt;=1.003, 95%&lt;i&gt;CI&lt;/i&gt;: 1.001-1.005). Subgroup analyses revealed that the correlation between 2-hour post-captopril aldosterone and CKM stage 4 was more significant in the male subgroup (&lt;i&gt;OR&lt;/i&gt;=1.005, 95%&lt;i&gt;CI&lt;/i&gt;: 1.002-1.008),the subgroup aged ≤50 years (&lt;i&gt;OR&lt;/i&gt;=1.006, 95%&lt;i&gt;CI&lt;/i&gt;: 1.002-1.010) andthe IHA subgroup (&lt;i&gt;OR&lt;/i&gt;=1.005, 95%&lt;i&gt;CI&lt;/i&gt;: 1.002-1.008). &lt;b&gt;Conclusions:&lt;/b&gt; High aldosterone level is a factor associated with progression of CKM to the clinical event phase (CKM stage 4). Among aldosterone-related indicators, 2 h post-captopril aldosterone has the most stable predictive value, and this correlation presents het","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 35","pages":"3764-3771"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Mechanism of GRK2-mediated AdipoR1 Ser205 phosphorylation in myocardial injury in diabetic mice and the cardioprotective effect of site-directed mutagenesis].","authors":"Z J Yang, S C Hu, D Zhu, Z Y Zhang, Y F Kang, Y M Tian, L Zhang, Q Ye, L M Fang","doi":"10.3760/cma.j.cn112137-20260508-01227","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20260508-01227","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To explore the role and mechanism of G-protein coupled receptor kinase 2 (GRK2)-mediated phosphorylation of adiponectin receptor 1 (AdipoR1) in diabetic cardiomyopathy (DCM), and to verify the therapeutic effect of site-directed mutagenesis targeting serine at position 205 (Ser205) of AdipoR1. &lt;b&gt;Methods:&lt;/b&gt; Twenty 4-week-old C57BL/6J mice were randomly assigned to the normal control (NC) group and the DCM model group using a random-number table, with 10 mice per group. The DCM model was established in the DCM group by high-fat diet (HFD) feeding combined with intraperitoneal injection of streptozotocin (STZ). After 21-week intervention, 6 mice from each group were selected using a random-number table for measurements of serum biochemical parameters, adiponectin (APN) levels and cardiac diastolic function. Following euthanasia, myocardial tissues were harvested for Masson's trichrome staining to evaluate the degree of myocardial fibrosis. Co-immunoprecipitation and Western blot (WB) assays were performed to determine GRK2 expression, phosphorylated serine (p-Ser) levels, and the binding capacity between AdipoR1 and adaptor protein, phosphotyrosine-binding domain and leucine zipper motif 1 (APPL1). The remaining 4 mice per group were used for isolation of primary adult cardiomyocytes, which were treated with exogenous APN or phosphate-buffered saline (PBS). Phosphorylation status of the downstream adenosine monophosphate-activated protein kinase (AMPK)/protein kinase B (Akt) signaling pathway was subsequently detected. Twenty-eight 3-day-old AdipoR1-knockout neonatal mice were included in further experiments. Four of these AdipoR1-knockout neonatal mice were randomly selected by a random-number table to isolate primary cardiomyocytes. Plasmid co-transfection was conducted to assess AdipoR1-APPL1 interaction and downstream AMPK/Akt phosphorylation upon GRK2 overexpression. Four experimental subgroups were set: Adenovirus-empty(Ad-empty)+3×Flag-AdipoR1&lt;sup&gt;WT&lt;/sup&gt;, Ad-empty+3×Flag-AdipoR1&lt;sup&gt;S205A&lt;/sup&gt;, adenovirus-mediated GRK2(Ad-GRK2)+3×Flag-AdipoR1&lt;sup&gt;WT&lt;/sup&gt;, and Ad-GRK2+3×Flag-AdipoR1&lt;sup&gt;S205A&lt;/sup&gt;. This experiment aimed to identify whether Ser205 phosphorylation serves as the key molecular event whereby GRK2 blocks APN signaling. From the remaining 24 AdipoR1-knockout neonatal mice, 12 were randomly allocated into two groups (6 mice per group) using a random-number table. On postnatal day 3, mice received an injection of either adeno-associated virus serotype 9 (AAV9)-AdipoR1&lt;sup&gt;WT&lt;/sup&gt; or AAV9-AdipoR1&lt;sup&gt;S205A&lt;/sup&gt;. Ten weeks later, primary adult cardiomyocytes were isolated and divided into 4 subgroups: AAV9-AdipoR1&lt;sup&gt;WT&lt;/sup&gt;+Ad-empty, AAV9-AdipoR1&lt;sup&gt;WT&lt;/sup&gt;+Ad-GRK2, AAV9-AdipoR1&lt;sup&gt;S205A&lt;/sup&gt;+Ad-empty, and AAV9-AdipoR1&lt;sup&gt;S205A&lt;/sup&gt;+Ad-GRK2. GRK2 was overexpressed in vitro, and immunofluorescence co-localization was applied to quantify the co-localization of AdipoR1 and APPL1. The leftover 12 Ad","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 35","pages":"3772-3781"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Analysis of influencing factors and construction of a predictive model for cardiovascular autonomic neuropathy in type 2 diabetes mellitus].","authors":"Y L Jiang, H M Wu, G Zhu, W Wang, L Wu, Y Z Wu, D L Zhu, W M Wang, H Zhu","doi":"10.3760/cma.j.cn112137-20260410-00979","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20260410-00979","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To investigate the influencing factors for cardiovascular autonomic neuropathy (CAN) in patients with type 2 diabetes mellitus (T2DM) and to develop a predictive model. &lt;b&gt;Methods:&lt;/b&gt; A retrospective analysis was performed on clinical data of 831 patients with T2DM hospitalized in the Suqian Hospital Affiliated to Xuzhou Medical University from September 2024 to December 2025. Patients were divided into a training set (&lt;i&gt;n&lt;/i&gt;=581) and a validation set (&lt;i&gt;n&lt;/i&gt;=250) at a 7∶3 ratio using a random number table method. According to the presence of CAN, patients in the training set were further classified into the non-CAN group (&lt;i&gt;n&lt;/i&gt;=307) and the CAN group (&lt;i&gt;n&lt;/i&gt;=274). Compare the differences in various indicators between the two groups. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression models were used to analyze influencing factors for CAN in patients with T2DM, and a nomogram prediction model was constructed. The area under the receiver operating characteristic curve (AUC), calibration curve and decision curve analysis were adopted to evaluate the predictive performance, accuracy and clinical applicability of the model. &lt;b&gt;Results:&lt;/b&gt; In the training set, patients in the CAN group presented higher age, diabetes duration, glycated hemoglobin (HbA&lt;sub&gt;1c&lt;/sub&gt;), neutrophil count, platelet count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio, systemic immune-inflammation index (SII), and systemic inflammatory response index compared with the non-CAN group. By contrast, height, body weight, total bilirubin, direct bilirubin, alanine aminotransferase, aspartate aminotransferase, fasting C-peptide and fasting insulin were lower in the CAN group (all &lt;i&gt;P&lt;/i&gt;&lt;0.05). The proportions of diabetic nephropathy, diabetic retinopathy (DR), diabetic peripheral neuropathy, history of hypertension, history of cardiovascular disease, history of stroke, anti-platelet agent use and insulin use were higher in the CAN group than in the non-CAN group (all &lt;i&gt;P&lt;/i&gt;&lt;0.05). Seven variables were screened out via LASSO regression analysis, including DR, age, diabetes duration, HbA1c, NLR, PLR and SII. Multivariate logistic regression analysis revealed that DR (&lt;i&gt;OR&lt;/i&gt;=2.29, 95%&lt;i&gt;CI&lt;/i&gt;: 1.48-3.56), longer diabetes duration (&lt;i&gt;OR&lt;/i&gt;=1.04, 95%&lt;i&gt;CI&lt;/i&gt;: 1.01-1.08), advancing age (&lt;i&gt;OR&lt;/i&gt;=1.06, 95%&lt;i&gt;CI&lt;/i&gt;: 1.04-1.09), elevated HbA&lt;sub&gt;1c&lt;/sub&gt; (&lt;i&gt;OR&lt;/i&gt;=1.23, 95%&lt;i&gt;CI&lt;/i&gt;: 1.13-1.36), increased NLR (&lt;i&gt;OR&lt;/i&gt;=2.23, 95%&lt;i&gt;CI&lt;/i&gt;: 1.36-3.69) and elevated PLR (&lt;i&gt;OR&lt;/i&gt;=1.01, 95%&lt;i&gt;CI&lt;/i&gt;: 1.00-1.02) were influencing factors for CAN in patients with T2DM. The nomogram prediction model constructed with the above 6 variables yielded AUC values of 0.839 (95%&lt;i&gt;CI&lt;/i&gt;: 0.807-0.871) and 0.787 (95%&lt;i&gt;CI&lt;/i&gt;: 0.732-0.843) for predicting CAN among T2DM patients in the training set and validation set, respectively. The corresponding sen","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 35","pages":"3754-3763"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Guidelines for the diagnosis and treatment of hemophagocytic lymphohistiocytosis (2026 edition)].","authors":"","doi":"10.3760/cma.j.cn112137-20260429-01164","DOIUrl":"10.3760/cma.j.cn112137-20260429-01164","url":null,"abstract":"<p><p>Hemophagocytic lymphohistiocytosis (HLH) is a severe inflammatory response syndrome caused by inherited or acquired dysregulation of immune function. In recent years, with the continuous advancement of basic and clinical research on HLH, novel diagnostic and therapeutic concepts as well as new therapeutic agents have emerged, and international clinical practice guidelines have been updated successively. To promote standardized management of the disease, academic organizations including the Lymphocyte Group of Hematology Branch of the Chinese Medical Association, Professional Committee of Oncological Hematology of the China Anti-Cancer Association, Hematology Group of the Pediatrics Branch of the Chinese Medical Association, Infectious Diseases Branch of the Chinese Medical Association, and National Clinical Research Center for Rheumatic and Autoimmune Diseases jointly initiated the guideline revision. A panel of 80 domestic experts from hematology, pediatrics, infectious diseases, and rheumatology and immunology disciplines was assembled to revise the 2022 edition of Chinese Guidelines for the Diagnosis and Treatment of HLH, on the basis of the latest domestic and international research advances and current evidence-based medical data. The guidelines provides 16 recommendations covering 11 aspects including HLH classification, diagnostic criteria, laboratory testing, therapeutic strategies and efficacy evaluation, aiming to improve the diagnosis and treatment of HLH in China and optimize patients' clinical outcomes.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 35","pages":"3674-3686"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Oncology Society of Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2026 edition)].","authors":"","doi":"10.3760/cma.j.cn112137-20260511-01255","DOIUrl":"10.3760/cma.j.cn112137-20260511-01255","url":null,"abstract":"<p><p>To further standardize the prevention and management of lung cancer in China, improve the level of diagnosis and treatment, enhance patient prognosis, and provide evidence-based professional recommendations for clinical practitioners at all levels, the Oncology Society of Chinese Medical Association organized experts from respiratory medicine, medical oncology, thoracic surgery, radiation oncology, radiology, and pathology to develop the \"Oncology Society of Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2026 edition)\" through a consensus conference. Compared with the 2025 edition, the 2026 edition incorporates updates and refinements in several aspects. In the lung cancer screening section, quality control requirements for low-dose computed tomography screening have been further detailed, and the introduction and scope of application of opportunistic screening and artificial intelligence technologies in lung cancer screening have been added. In the pathology section, on the basis of the latest clinical research findings and newly approved indications by the National Medical Products Administration (NMPA), the recommendations for molecular pathological testing have been supplemented, with several new gene testing-related recommendations added. In the treatment section, perioperative neoadjuvant and adjuvant treatment regimens for non-small cell lung cancer have been updated according to newly approved drugs and indications; additional options for consolidation immunotherapy after concurrent or sequential chemoradiotherapy for unresectable stage Ⅲ non-small cell lung cancer have been incorporated; and first-line and subsequent-line treatment strategies for patients with advanced epidermal growth factor receptor (EGFR)-mutations have been further refined. In addition, treatment recommendations for patients with non-small cell lung cancer harboring molecular subtypes such as anaplastic lymphoma kinase (ALK) fusion, KRAS G12C mutation, human epidermal growth factor receptor 2 (HER-2) mutations, and MET amplification have also been updated based on the approval of novel agents. This guideline adheres to NMPA-approved indications as the core principle, is grounded in drugs practically available in China and integrates recommendations from international guidelines as well as the current status of clinical practice in China. It synthesizes the latest evidence-based medical advances in recent years covering lung cancer screening, diagnosis, pathology, genetic testing, immunologic and molecular biomarker testing, treatment modalities, and follow-up, with the aim of providing reasonable and practical recommendations for clinicians at all levels, as well as professionals in radiology, laboratory medicine, and related disciplines.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 35","pages":"3687-3723"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Evaluation value of NRS2002 and MNA-SF on nutritional status and prognosis in adult patients with amyotrophic lateral sclerosis].","authors":"Y W Liu, D S Fan, L Chen","doi":"10.3760/cma.j.cn112137-20251225-03422","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20251225-03422","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To evaluate the value of the Nutritional Risk Screening 2002 (NRS2002) and the Mini-Nutritional Assessment Short-Form (MNA-SF) in assessing nutritional status, disease progression, and prognosis in adult patients with amyotrophic lateral sclerosis (ALS). &lt;b&gt;Methods:&lt;/b&gt; Baseline data of 148 ALS patients who visited Peking University Third Hospital from January to December 2024 were prospectively collected. Patients were divided into malnutrition group and normal group based on the presence of nutritional risk. Assessments were conducted every 3 months over a 1-year follow-up period, during which ALSFRS-R scores, body mass index (BMI), and nutritional scale scores were recorded. The rates of ALSFRS-R score decline (δFS) and BMI change (δBMI) were calculated as (baseline ALSFRS-R score-follow-up ALSFRS-R score)/follow-up months and (baseline BMI-follow-up BMI)/follow-up months, respectively. The primary endpoint events were death or tracheostomy. Clinical data were compared between patients with different nutritional statuses. Spearman and Pearson correlation analyses were used to explore the correlations between scale scores and various indicators. Cohen's &lt;i&gt;Kappa&lt;/i&gt; coefficient was used to evaluate the inter-rater consistency between the two scales. Linear mixed-effects models were applied to assess the relationships between nutritional risk and changes in δFS and δBMI. &lt;b&gt;Results:&lt;/b&gt; A total of 148 ALS patients were collected in this study, including 96 males and 52 females, with the age [&lt;i&gt;M&lt;/i&gt;(&lt;i&gt;Q&lt;/i&gt;&lt;sub&gt;1&lt;/sub&gt;, &lt;i&gt;Q&lt;/i&gt;&lt;sub&gt;3&lt;/sub&gt;)] of 56.0 (49.0, 61.0) years. A total of 4 enrolled patients were excluded from the NRS2002 assessment owing to missing BMI data, which resulted from the inability to measure height and weight in these bedridden individuals. Based on the NRS2002 and MNA-SF, patients were classified into the malnutrition group (NRS2002 malnutrition group, &lt;i&gt;n&lt;/i&gt;=45; MNA-SF malnutrition group, &lt;i&gt;n&lt;/i&gt;=59) and the normal group (NRS2002 normal group, &lt;i&gt;n&lt;/i&gt;=99; MNA-SF normal group, &lt;i&gt;n&lt;/i&gt;=89). The &lt;i&gt;Kappa&lt;/i&gt; values for the consistency between NRS2002 and MNA-SF at baseline, 3, 6, 9, and 12 months were 0.726, 0.713, 0.698, 0.648, and 0.769, respectively (all &lt;i&gt;P&lt;/i&gt;&lt;0.001). NRS2002 was negatively correlated with BMI (&lt;i&gt;r&lt;/i&gt;=-0.413, &lt;i&gt;P&lt;/i&gt;&lt;0.001), body weight (&lt;i&gt;r&lt;/i&gt;=-0.442, &lt;i&gt;P&lt;/i&gt;&lt;0.001), prealbumin (&lt;i&gt;r&lt;/i&gt;=-0.253, &lt;i&gt;P&lt;/i&gt;&lt;0.001), creatinine (&lt;i&gt;r&lt;/i&gt;=-0.139, &lt;i&gt;P&lt;/i&gt;=0.049), and triglycerides (&lt;i&gt;r&lt;/i&gt;=-0.228, &lt;i&gt;P&lt;/i&gt;=0.003); MNA-SF was positively correlated with BMI (&lt;i&gt;r&lt;/i&gt;=0.573, &lt;i&gt;P&lt;/i&gt;&lt;0.001), body weight (&lt;i&gt;r&lt;/i&gt;=0.514, &lt;i&gt;P&lt;/i&gt;&lt;0.001), prealbumin (&lt;i&gt;r&lt;/i&gt;=0.277, &lt;i&gt;P&lt;/i&gt;&lt;0.001), creatinine (&lt;i&gt;r&lt;/i&gt;=0.233, &lt;i&gt;P&lt;/i&gt;=0.002), and triglycerides (&lt;i&gt;r&lt;/i&gt;=0.289, &lt;i&gt;P&lt;/i&gt;&lt;0.001). After adjusting for confounders using linear mixed-effects models, a higher NRS2002 score was identified as a risk factor for increases in δFS (β = 0.127, 95%&lt;i&gt;CI&lt;/i&gt;: 0.065-0.189, &lt;i&gt;P&lt;/i&gt;&lt;0.001) and","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 35","pages":"3746-3753"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Predicting the risk of proximal junctional kyphosis after modified grade Ⅳ osteotomy for thoracolumbar old fractures with kyphotic deformity using machine learning].","authors":"F Cai, Y Feng, L J Wang, K Xi, J C Tang, X D Lu, Y Gu, L Chen","doi":"10.3760/cma.j.cn112137-20260708-01714","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20260708-01714","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To predict the risk of proximal junctional kyphosis (PJK) following modified grade Ⅳ osteotomy for thoracolumbar old fractures with kyphosis based on machine learning (ML). &lt;b&gt;Methods:&lt;/b&gt; A retrospective analysis was conducted, including patients with thoracolumbar old fractures and kyphotic deformity who underwent modified grade Ⅳ osteotomy at department of orthopedics, the first affiliated hospital of Soochow University between January 2011 and June 2023. All patients had a minimum follow-up of two years. Patients were divided into the PJK group and the non-PJK group based on the occurrence of PJK, and the clinical indicators were compared between the two groups. After performing multicollinearity diagnosis using Least Absolute Shrinkage and Selection Operator (LASSO) regression, multivariate logistic regression was conducted to identify risk factors for PJK. Five machine learning models including optimized XGBoost, GradientBoosting, Random Forest, linear discriminant analysis (LDA) and model driven architecture (MDA) were constructed and trained, with their predictive performances evaluated subsequently. The Shapley Additive Explanations (SHAP) method was employed for model interpretation and feature importance ranking. &lt;b&gt;Results:&lt;/b&gt; The study included 128 patients (47 men, 81 women), with a mean age of (68.8±7.2) years.The local kyphosis angle improved from 32.65°±8.17° preoperatively to 2.83°±1.99° at 2 weeks postoperatively in the non-PJK group, and from 32.97°± 8.51° preoperatively to 3.01°±1.72° at 2 weeks postoperatively in the PJK group (both &lt;i&gt;P&lt;/i&gt;&lt;0.01). Significant differences were found between the non-PJK and PJK groups in body mass index (BMI), bone mineral density (BMD), upper instrumented vertebra-cemented screw (UIV-CS), relative sagittal alignment (RSA), relative functional cross-sectional area of the paraspinal muscles (rFCSA), and functional muscle-fat index (FMFI) (all &lt;i&gt;P&lt;/i&gt;&lt;0.05). LASSO regression identified moderate multicollinearity between rFCSA (VIF=5.0) and FMFI (VIF=4.96); therefore, the variant FMFI was excluded. Multivariate logistic regression was then performed including BMI, UIV-CS, BMD, RSA, and rFCSA. The results indicated that smaller rFCSA (&lt;i&gt;OR&lt;/i&gt;=0.990, 95%&lt;i&gt;CI&lt;/i&gt;: 0.981-0.999), lower BMD (&lt;i&gt;OR&lt;/i&gt;=0.680, 95%&lt;i&gt;CI&lt;/i&gt;: 0.471-0.983), and higher BMI (&lt;i&gt;OR&lt;/i&gt;=1.206, 95%&lt;i&gt;CI&lt;/i&gt;: 1.036-1.403) were independent risk factors of PJK. Based on PJK risk variables, five ML models were constructed. In the test set, the optimized XGBoost model achieved the highest area under the receiver operating characteristic curve (AUC) of 0.841 (95%&lt;i&gt;CI&lt;/i&gt;: 0.675-0.972), followed by RandomForest [0.813 (95%&lt;i&gt;CI&lt;/i&gt;: 0.632-0.941)], LDA[0.786 (95%&lt;i&gt;CI&lt;/i&gt;: 0.613-0.956)], GradientBoosting[0.782 (95%&lt;i&gt;CI&lt;/i&gt;: 0.601-0.967)] and MDA[0.724 (95%&lt;i&gt;CI&lt;/i&gt;: 0.514-0.896)]. The XGBoost model demonstrated high specificity (96.4%), positive predictive value (83.3%), and accuracy (82.05%). SHAP visual","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 34","pages":"3590-3597"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Expert consensus on multidisciplinary diagnostic and therapeutic pathways for eosinophil-associated diseases (2026 edition)].","authors":"","doi":"10.3760/cma.j.cn112137-20260529-01415","DOIUrl":"10.3760/cma.j.cn112137-20260529-01415","url":null,"abstract":"<p><p>Eosinophil associated diseases (EAD) are heterogeneous disorders characterized by increased and/or activated eosinophils in blood or tissues, with potential involvement of the respiratory, cutaneous, gastrointestinal, cardiovascular, neurological and hematological systems. Under-recognition and delayed diagnosis are common in clinical practice. To establish a standardized cross-disease, cross-organ and multidisciplinary clinical pathway, the National Collaborative Project of Standardized Diagnosis and Treatment Centers for Eosinophil Associated Diseases convened a multidisciplinary expert panel. Domestic and international guidelines, expert consensuses, systematic reviews and clinical studies were reviewed. Recommendations were developed using grading of recommendations assessment, development and evaluation (GRADE)-informed evidence appraisal and a modified Delphi process. This consensus addresses 14 clinical questions, including disease spectrum recognition, eosinophil assessment, multidisciplinary management, therapy, and longitudinal follow-up. It aims to provide practical guidance for early identification, etiologic screening, and standardized management of adults with suspected or confirmed EAD.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 34","pages":"3548-3563"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Artificial intelligence empowering spinal deformity surgery: from clinical assessment to decision integration].","authors":"Y Hai, J X Huang, Z H Feng","doi":"10.3760/cma.j.cn112137-20260720-01797","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20260720-01797","url":null,"abstract":"<p><p>Spinal deformity, characterized by complex anatomical structures and significant individual heterogeneity, is a highly challenging disease in the field of orthopedics. The traditional \"experience-driven\" clinical decision-making model has limitations, such as strong subjectivity and insufficient standardization. The application of artificial intelligence (AI) technology, especially deep learning in medical image analysis, risk prediction, and surgical planning, has brought revolutionary opportunities to spinal deformity surgery. From the perspectives of clinical experts, this article systematically expounds on the application progress and value of AI in core links, such as imaging parameter measurement, surgical risk prediction, and individualized plan formulation, analyzes the bottlenecks in technology promotion, and looks forward to the development direction of \"human-machine co-intelligence\". The article emphasizes that through the integration with clinical experience, AI promotes the transformation of the discipline from \"standardized treatment\" to \"individualized precision treatment\", and constructs an intelligent diagnosis and treatment system.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 34","pages":"3535-3539"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148971169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}