Zhonghua yi xue za zhi最新文献

{"title":"[Expert consensus on evaluating large language models for aided diabetes diagnosis and treatment (2026 edition)].","authors":"","doi":"10.3760/cma.j.cn112137-20260313-00702","DOIUrl":"10.3760/cma.j.cn112137-20260313-00702","url":null,"abstract":"<p><p>Large language models are being introduced into diabetes care at an accelerating pace, but their knowledge accuracy, safety boundaries, explainability, and real-world usability remains uncertain. A diabetes-specific evaluation framework is urgently needed. To address this gap, the National Clinical Research Center for Endocrine and Metabolic Diseases (Changsha) and Chinese Society of Endocrinology and Metabolism, Chinese Medical Doctor Association convened experts in diabetology, artificial intelligence, clinical research, biostatistics, medical informatics, public health, and ethics. Based on a systematic literature review and two Delphi rounds, we developed the consensus for primary use in Chinese clinical settings. This consensus is primarily intended for clinical application in China, emphasizes that physicians retain ultimate responsibility for diagnosis and treatment, and proposes a three-tier evaluation framework covering dimensions, methods, and indicators across five domains: accuracy and reliability, safety, clinical utility and value, user experience and interactivity, ethics and compliance. It provides a practical basis for the development, validation, adoption, and continuous monitoring of large language models for diabetes care.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 33","pages":"3478-3491"},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907411","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":"[T-cell engagers: a transformative force or a redundant option in B-cell depletion therapy for rheumatic diseases?]","authors":"Q B Li, X Guan, C L Mei, Jason Xu","doi":"10.3760/cma.j.cn112137-20260330-00853","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20260330-00853","url":null,"abstract":"<p><p>The treatment of rheumatic diseases (RMD) is still challenged by long-term treatment dependence and refractory relapses. Therapeutic goals are therefore shifting from suppression of inflammation toward deep B-cell depletion and immune resetting. Conventional B-cell-depleting monoclonal antibodies have insufficient capacity for tissue B-cell depletion. Autologous chimeric antigen receptor T-cell (CAR-T) therapy has shown the potential for deep immune reconstitution, but its clinical use is constrained by individualized manufacturing, lymphodepleting conditioning, cost, and safety-management requirements. T-cell engagers (TCE) simultaneously bind cluster of differentiation (CD) 3 on T cells and target antigens on B cells or plasma cells. They redirect endogenous T cells to eliminate pathogenic target cells. TCE can offer the advantages of standardized manufacturing, no requirement for ex vivo cell preparation, and flexible adjustment of dose and treatment duration. Focusing on the latest advances in TCE therapy for rheumatic diseases, this review systematically summarizes studies targeting CD19, CD20, and B-cell maturation antigen (BCMA). Available evidence indicates that TCE can rapidly deplete B cells or plasma cells in systemic lupus erythematosus, systemic sclerosis, idiopathic inflammatory myopathies, and rheumatoid arthritis, and may reduce disease activity and promote remission. The main adverse events include cytokine release syndrome, infections, and hypogammaglobulinemia, most of which appear manageable. Accordingly, the clinical value of TCE in rheumatic diseases is becoming increasingly apparent. However, several key issues remain to be resolved, including the depth of tissue B-cell depletion, the quality of immune reconstitution, endogenous T-cell fitness, mechanisms of inadequate response, and long-term safety. TCE therapy is neither a costly duplication of existing B-cell-depleting therapies nor a definitive solution for immune resetting. Rather, it represents a more accessible and clinically manageable therapeutic approach that may offer a practical route toward immune resetting in RMD.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 33","pages":"3423-3430"},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907478","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":"[Clinical practice guideline for the application of intravenous to oral switch in adult inpatients (2026 edition)].","authors":"","doi":"10.3760/cma.j.cn112137-20260427-01141","DOIUrl":"10.3760/cma.j.cn112137-20260427-01141","url":null,"abstract":"<p><p>Intravenous to oral switch (IVOS) is the core strategy to optimize the route of administration and reduce unnecessary intravenous infusion. Although the drug administration switching mode has been gradually implemented in China, there is still a lack of unified and implementable standardized guidance in key links such as patient evaluation and switching opportunity. Therefore, the National Pharmaceutical Affairs Management Medical Quality Control Center and the Clinical Pharmacy Branch of the Chinese Medical Association organized experts and scholars in related fields in China to compile this guidelines based on the latest evidence-based medicine evidence at home and abroad. This guidelines focus on the core contents of IVOS screening for adult inpatients, switching timing, evaluation criteria, operational procedures, etc. Finally 18 questions and 24 recommendations were formed, forming the clinical application guidelines for IVOS medication in adult inpatients, aiming at providing scientific and practical decision-making basis for clinical rational intravenous drug use, improving medical quality, ensuring the safety of patients' medication, and optimizing the allocation of medical resources.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 33","pages":"3459-3477"},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907498","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":"[Comparison of clinical outcomes of DCB angioplasty versus DES implantation in patients with recently diagnosed cancer and coronary artery disease undergoing PCI].","authors":"X H Li, Y H Tan, H Li","doi":"10.3760/cma.j.cn112137-20260430-01184","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20260430-01184","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To investigate the difference of clinical outcomes of drug-coated balloon (DCB) angioplasty and drug-eluting stent (DES) implantation in patients with recently diagnosed cancer and concomitant coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). &lt;b&gt;Methods:&lt;/b&gt; A total of 155 patients hospitalized in the Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University from January 2018 to December 2024 were restrspectively enrolled. All patients were definitively diagnosed with CAD via coronary angiography, underwent PCI, and had been diagnosed with cancer within 5 years prior to the current admission. Among them, 61 patients were treated with DCB and 94 with DES implantation. Demographic characteristics, cardiovascular risk factors, previous cardiovascular history, cancer type, as well as the number of diseased blood vessels, target vessels, in stent restenosis, bifurcation and small vessel lesions, use of interventional instruments, immediate postoperative blood flow, and intravascular imaging or functional evaluation of two groups of patients were collected. Continuous variables with normal distribution were compared using the independent-samples &lt;i&gt;t&lt;/i&gt; test, whereas categorical variables were compared using Pearson's &lt;i&gt;χ&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; test or Fisher's exact test, as appropriate. Overall survival was estimated using the Kaplan-Meier method and Log-rank test. Cardiovascular and non-cardiovascular deaths were treated as competing events, and cumulative incidence function and Gray's test were used for competitive analysis. &lt;b&gt;Results:&lt;/b&gt; No significant between-group differences were observed in age, sex, body mass index, current smoking, dyslipidemia, hypertension, previous myocardial infarction, or chronic kidney disease (all &lt;i&gt;P&lt;/i&gt;&gt;0.05). The DCB group had higher proportion of diabetes mellitus, triple-vessel disease, in-stent restenosis, bifurcation lesions, and small-vessel disease, whereas the DES group had higher proportion of previous PCI, previous coronary artery bypass grafting (CABG), and left anterior descending artery interventions. Kaplan-Meier analysis demonstrated that overall survival was significantly lower in the DCB group than that in the DES group [82.0% (50/61) vs 95.7% (90/94), &lt;i&gt;P&lt;/i&gt;=0.005]. Competive risk analysis showed that the cumulative incidences of cardiovascular death were 4.9% (3/61) in the DCB group and 3.2% (3/94) in the DES group, with no statistically significant difference (&lt;i&gt;P&lt;/i&gt;=0.589). However, the cumulative incidence of non-cardiovascular death was significantly higher in the DCB group than that in the DES group [13.1% (8/61) vs 1.1% (1/94), &lt;i&gt;P&lt;/i&gt;=0.002]. &lt;b&gt;Conclusions:&lt;/b&gt; Among patients with recently diagnosed cancer and concomitant CAD undergoing PCI, DCB angioplasty was associated with lower overall survival than DES implantation, without a significant increase in cardiovascular mortality. The survival difference is m","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 33","pages":"3492-3498"},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907421","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":"[Where is the way-out for prediabetes management?]","authors":"G W Li, R T Shao","doi":"10.3760/cma.j.cn112137-20260608-01480","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20260608-01480","url":null,"abstract":"<p><p>The impact of prediabetes on cardiovascular health is a widely recognized fact. However, intervention worldwide at the community level has been challenging. Some experts believe the reason is that the term \"pre-stage\" is too mild, misleading the public and health authorities into underestimating the health risks to this population. To promote proactive intervention across society, there have been increasing recommendations in recent years to classify prediabetes as part of diabetes. Given the hundreds of millions of people with prediabetes, the multiplied medical burden caused by turning all of them into diabetes will be the biggest obstacle to this \"renaming\". How can we resolve the world-wide challenges? The new diabetes diagnostic criteria proposed by the International Diabetes Federation (IDF, one-hour blood glucose above 11.6 mmol/L) may offer us fresh ideas. It is worth considering designating the current World Health Organization (WHO) standard diabetes as diabetes (WHO) and those people with prediabetes who meet the IDF diagnostic criteria as diabetes (IDF). This approach will protect the legal health rights of the high-risk groups previously defined as prediabetes without excessively increasing the burden on the current medical payment system. Besides, great efforts should be made to educate the public to effectively improve the public's understanding of dangerous outcomes of prediabetes, and highly individualized interventions should be carried out based on the heterogeneity of the prediabetes population.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 33","pages":"3405-3408"},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907461","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":"[Development and validation of an integrated intratumoral-peritumoral habitat radiomics model on multiparametric MRI for predicting biochemical recurrence in patients after radical prostatectomy].","authors":"Y T Ji, J Bao, L P Shen, X M Wang, J Ding, Y Song, J Zhang, H F Cai, L Cao","doi":"10.3760/cma.j.cn112137-20251110-02923","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20251110-02923","url":null,"abstract":"<p><p><b>Objective:</b> To develop and validate an MRI-based habitat radiomics model (EPM) integrating intra-and peritumoral features, and to build a combined clinical habitat model (CHPM) for predicting short-term biochemical recurrence (BCR) after radical prostatectomy (RP). <b>Methods:</b> A total of 429 patients who underwent RP were retrospectively enrolled from 2 institutions (Center 1: the First Affiliated Hospital of Soochow University, January 2015 to December 2018, <i>n</i>=335; Center 2: Zhangjiagang Hospital Affiliated with Soochow University, January 2015 to December 2023, <i>n</i>=94). Center 1 was split in a 7∶3 ratio into training (<i>n</i>=234) and internal test (<i>n</i>=101) sets by stratified random sampling based on BCR status; Center 2 served as the external test set (<i>n</i>=94). Follow-up data were retrospectively collected from inpatient and outpatient medical records, with follow-up censored at BCR or the last visit, and only patients with≥1 year of postoperative follow-up were included. Using multi-parametric magnetic resonance imaging (mpMRI), GMM clustering divided intra-and peritumoral (3 mm) regions into K habitat subregions for feature extraction. intratumor habitat (ITH), peritumoral habitat (PTH), and the combined EPM model were built. CHPM integrated ITH/PTH risk scores with independent clinical predictors selected by Cox regression. Model risk stratification was assessed by Kaplan-Meier curves. CHPM performance was evaluated using C-index, calibration curves, decision curve analysis (DCA), integrated discrimination improvement (IDI), and net reclassification improvement (NRI), and compared with CAPRA-S and EPM, with between-model C-index differences compared using Bootstrap resampling (1 000 resamples). <b>Results:</b> All 3 models stratified high-and low-risk patients in both test sets (all <i>P</i><0.05). CHPM showed a higher C-index than CAPRA-S (0.782 vs 0.672, <i>P</i>=0.036; 0.780 vs 0.689, <i>P</i>=0.042). C-index differences between EPM and CAPRA-S, and between EPM and CHPM, were not significant (all <i>P</i>>0.05). EPM and CHPM both outperformed CAPRA-S in calibration, net benefit, IDI, and NRI. <b>Conclusions:</b> EPM and CHPM had comparable C-index values for predicting short-term BCR after RP, and both outperformed CAPRA-S in calibration, net benefit, IDI, and NRI. CHPM showed the best overall performance, suggesting its potential as a noninvasive preoperative risk assessment tool.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 33","pages":"3499-3511"},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907488","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":"[Genomic characteristics of multi-drug resistant of non-O1/non-O139 <i>Vibrio cholerae</i> ST1565 from sepsis cases].","authors":"F Q Ai, W Q Wang, J H Guan, Y R Tian, J Y Du, Y M Ma, C Tai, Y N Wang, X B Xu","doi":"10.3760/cma.j.cn112137-20251229-03459","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20251229-03459","url":null,"abstract":"<p><p>To analyze the genomic characteristics of multi-drug resistant of non-O1/non-O139 <i>Vibrio cholerae</i> ST1565 from sepsis cases. An 88 years old male patient admitted to Huashan Hospital in Shanghai on July 2, 2025, who was retrospectively analyzed. The clinical diagnosis was severe bacterial enteritis and secondary NOVC sepsis. Blood culture confirmed the presence of non-O1/non-O139 group <i>Vibrio cholerae</i>. The strain was a multidrug-resistant isolated of ST1565 as determined by whole-genome sequencing. The ResFinder database predicted 11 resistance genes for 6 classes of antibiotics: qnrVC5, sul2, floR, tet(59), aph(6)-Id, aph(3'')-Ib, dfrA15, dfrA31, almE, almF, and almG. Except for the quinolone qnrVC5, which was not expressed, the other resistance genes were consistent matched the phenotypic results. Additionally, 8 insertion sequences were identified: ISVch1, ISVvu4, ISVch6, ISVvu8, ISVpa3, ISVpa4, ISVsa3, and ISShfr9. Important virulence factors included 3 secreted protein toxin genes: <i>Vibrio cholerae</i> hemolysin, repeat toxin, and <i>Vibrio parahaemolyticus</i> thermostable direct hemolysin. The patient was cured after sequential treatment with meropenem, levofloxacin, and doxycycline. NOVC/ST1565 is a newly identified sequence type in China, which exhibits multidrug-resistant and hypervirulent phenotypes.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 33","pages":"3512-3516"},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907454","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":"[From PCOS to PMOS: nomenclature revision and paradigm shift in disease perception].","authors":"Y F Shao, Y Yang, K Wang, C Liu","doi":"10.3760/cma.j.cn112137-20260616-01565","DOIUrl":"10.3760/cma.j.cn112137-20260616-01565","url":null,"abstract":"<p><p>In May 2026, <i>Lancet</i> published an online global consensus statement on the unified renaming of polycystic ovary syndrome (PCOS). Developed with participation from 56 international organizations, tens of thousands of patient survey datasets, and multidisciplinary expert deliberations, the consensus officially replaced the nearly 90-year-old term PCOS with polyendocrine metabolic ovarian syndrome (PMOS). This nomenclature revision rectifies misleading terminology and accurately reflects the disease's core nature of concurrent endocrine, metabolic, and ovarian dysfunction. This paper reviews the background, methodological rationale, and core connotations of the global renaming consensus, illustrates the paradigm shifts in disease understanding, standardized screening, stratified therapy, and chronic disease management driven by the name change, and proposes targeted countermeasures and transitional management recommendations for endocrinology and metabolism specialties tailored to clinical practice in China. It aims to deliver actionable practical guidance for frontline clinicians.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 ","pages":"3409-3414"},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798710","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":"[Is osteoarthritis merely a local \"wear and tear\" or a systemic disease? :exploration of the pathogenesis and therapeutic strategies for osteoarthritis].","authors":"N Lin, S Q Huang, C H Ding","doi":"10.3760/cma.j.cn112137-20260414-01011","DOIUrl":"10.3760/cma.j.cn112137-20260414-01011","url":null,"abstract":"<p><p>Osteoarthritis (OA) has traditionally been characterized as a purely biomechanically driven, localized degenerative disease of the articular cartilage. However, the \"local wear-and-tear\" theory cannot fully explain clinical phenomena such as the high incidence of OA in non-weight-bearing joints and the inconsistency between symptoms and imaging findings, which has prompted researchers to propose a new hypothesis that OA represents a systemic disease. Based on advances in the understanding of OA, from localized cartilage degradation to a heterogeneous whole-joint disorder, this review summarizes the roles of mechanical stress-and joint trauma-related phenotypes, as well as systemic driving factors including metabolic syndrome, endocrine disorders, gut dysbiosis, senescence and genetic susceptibility in the initiation and progression of OA. It is further elaborated that the remodeling of the local microenvironment, involving the infrapatellar fat pad, synovium and subchondral bone, acts as a hub mediating the transition from distinct pathogenic phenotypes to irreversible cartilage degradation. In addition, potential phenotype-based disease-modifying therapeutic strategies, including mechanical intervention, metabolic regulation, anti-inflammatory therapy and targeted treatment for local microenvironment, are summarized. This review holds the view that OA is neither simply a local wear-and-tear disorder nor a pure systemic disease; instead, it is a whole-joint disease with different phenotypes driven by local mechanical injury and/or systemic metabolic-inflammatory imbalance. Future efforts should optimize patient screening and therapeutic decision-making based on phenotypic stratification, so as to advance the precise diagnosis and treatment of OA as well as the clinical translation of disease-modifying OA drugs.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 33","pages":"3451-3458"},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907471","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":"[Endgame of glucocorticoid therapy in rheumatic diseases: Slay or Stay?]","authors":"Z Q Zhang, L L Ji, Z L Zhang","doi":"10.3760/cma.j.cn112137-20260409-00965","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20260409-00965","url":null,"abstract":"<p><p>Glucocorticoids have played a central role in treating rheumatic diseases since their introduction in the mid-20th century, owing to their anti-inflammatory and immunosuppressive effects. However, prolonged glucocorticoid exposure is closely associated with adverse outcomes, including organ damage, metabolic disturbances, osteoporosis, and infection, making long-term glucocorticoid management a major clinical challenge. With the emergence of targeted therapies and novel immunotherapies, the rheumatology community has increasingly debated 'Slay or Stay' in glucocorticoid management:'Slay' refers to tapering and discontinuing glucocorticoids whenever feasible after disease control, aiming for glucocorticoid-free remission, while 'Stay' emphasizes maintaining low-dose glucocorticoids in selected patients to sustain remission and reduce relapse risk. This review summarizes recent international guidelines and representative clinical trials and discusses glucocorticoid tapering and withdrawal strategies in major rheumatic diseases, including systemic lupus erythematosus, rheumatoid arthritis, and systemic vasculitis. Overall, glucocorticoid management should not be viewed as an absolute choice between 'Slay' and 'Stay', but should balance disease control and long-term safety through individualized tapering based on relapse risk and glucocorticoid-related toxicity.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 33","pages":"3415-3422"},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907446","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}