Zhonghua yi xue za zhi最新文献

{"title":"[Comparison of diagnostic performance between artificial intelligence-assisted automated breast ultrasound and handheld ultrasound in breast cancer screening].","authors":"D S Yi, W Y Sun, H P Song, X L Zhao, S Y Hu, X Gu, Y Gao, F H Zhao","doi":"10.3760/cma.j.cn112137-20250508-01132","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20250508-01132","url":null,"abstract":"<p><p><b>Objective:</b> To compare the diagnostic performance of artificial intelligence-assisted automated breast ultrasound (AI-ABUS) with traditional handheld ultrasound (HHUS) in breast cancer screening. <b>Methods:</b> A total of 36 171 women undergoing breast cancer ultrasound screening in Futian District, Shenzhen, between July 1, 2023 and June 30, 2024 were prospectively recruited and assigned to either the AI-ABUS or HHUS group based on the screening modality used. In the AI-ABUS group, image acquisition was performed on-site by technicians, and two ultrasound physicians conducted remote diagnoses with AI assistance, supported by a follow-up management system. In the HHUS group, one ultrasound physician conducted both image acquisition and diagnosis on-site, and follow-up was led by clinical physicians. Based on the reported malignancy rates of different BI-RADS categories, the number of undiagnosed breast cancer cases in individuals without pathology was estimated, and adjusted detection rates were calculated. Primary outcomes included screening positive rate, biopsy rate, cancer detection rate, loss-to-follow-up rate, specificity, and sensitivity. <b>Results:</b> The median age [interquartile range, <i>M</i> (<i>Q</i><sub>1</sub>, <i>Q</i><sub>3</sub>)] of the 36 171 women was 43.8 (36.6, 50.8) years. A total of 14 766 women (40.82%) were screened with AI-ABUS and 21 405 (59.18%) with HHUS. Baseline characteristics showed no significant differences between the groups (all <i>P</i>>0.05). The AI-ABUS group had a lower screening positive rate [0.59% (87/14 766) vs 1.94% (416/21 405)], but higher biopsy rate [47.13% (41/87) vs 16.10% (67/416)], higher cancer detection rate [1.69‰ (25/14 766) vs 0.47‰ (10/21 428)], and lower loss-to-follow-up rate (6.90% vs 71.39%) compared to the HHUS group (all <i>P</i><0.05). There was no statistically significant difference in the distribution of breast cancer pathological stages among those who underwent biopsy between the two groups (<i>P</i>>0.05). The specificity of AI-ABUS was higher than that of HHUS [89.77% (13, 231/14 739) vs 74.12% (15, 858/21 394), <i>P</i><0.05], while sensitivity did not differ significantly [92.59% (25/27) vs 90.91% (10/11), <i>P</i>>0.05]. After estimating undiagnosed cancer cases among participants without pathology, the adjusted detection rate was 2.30‰ (34/14 766) in the AI-ABUS group and ranged from 1.17‰ to 2.75‰ [(25-59)/21 428] in the HHUS group. In the minimum estimation scenario, the detection rate in the AI-ABUS group was significantly higher (<i>P</i><0.05); in the maximum estimation scenario, the difference was not statistically significant (<i>P</i>>0.05). <b>Conclusions:</b> The AI-ABUS model, combined with an intelligent follow-up management system, enables a higher breast cancer detection rate with a lower screening positive rate, improved specificity, and reduced loss to follow-up. This suggests AI-ABUS is a promising alternative model for breast cancer s","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 32","pages":"2761-2767"},"PeriodicalIF":0.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971911","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":"[Prognostic factors and construction of a predictive model for patients with refractory low-frequency sudden sensorineural hearing loss].","authors":"Q X Cui, Y Gao, X H Zhao, X N Wu, X Zhou, D Y Wang, Q J Wang","doi":"10.3760/cma.j.cn112137-20250417-00953","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20250417-00953","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the prognostic factors for patients with refractory low-frequency sudden sensorineural hearing loss, and develop a predictive model. <b>Methods:</b> Patients with refractory low-frequency sudden sensorineural hearing loss who were admitted to the PLA General Hospital from January 2009 to December 2023 and did not respond to standard outpatient treatment were retrospectively enrolled. Based on treatment outcomes, patients were divided into a recovery group and a non-recovery group. Clinical data were compared between the two groups. Multivariate logistic regression analysis was used to identify prognostic factors, and a nomogram was constructed. The predictive performance of the model was evaluated using the receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test, and decision curve analysis to assess its discrimination, calibration, and clinical utility. <b>Results:</b> A total of 211 patients (89 males and 122 females) aged (45.8±12.0) years were included. There were 68 and 143 patients in the recovery group and non-recovery group, respectively. Compared to the non-recovery group, the recovery group exhibited younger age, shorter onset-to-treatment time, lower 1 000 Hz hearing thresholds, milder hearing loss, and higher proportions of headache and hypotension/low intracranial pressure (all <i>P</i><0.05). Multivariate logistic regression analysis identified that hypertension (<i>OR</i>=3.380, 95%<i>CI</i>: 1.166-9.794, <i>P</i>=0.025), delayed treatment (8-21 days: <i>OR</i>=3.306, 95%<i>CI</i>: 1.469-7.440, <i>P</i>=0.004;>21 days: <i>OR</i>=11.722, 95%<i>CI</i>: 4.805-28.599, <i>P</i><0.001), and impaired 1 000 Hz hearing (<i>OR</i>=3.001, 95%<i>CI</i>: 1.476-6.099, <i>P</i>=0.002) were risk factors for poor prognosis. The presence of headache (<i>OR</i>=0.335, 95%<i>CI</i>: 0.123-0.912, <i>P</i>=0.032) and hypotension/low intracranial pressure (<i>OR</i>=0.214, 95%<i>CI</i>: 0.060-0.767, <i>P</i>=0.018) were protective factors. The area under the ROC curve (AUC) was 0.822 (95%<i>CI</i>: 0.762-0.881). The calibration curve demonstrated good agreement with the ideal line, and the Hosmer-Lemeshow test showed good model fit (χ²=3.917, <i>P</i>=0.789). The decision curve shows that the predictive model has a positive net benefit across almost all threshold probability ranges. <b>Conclusions:</b> Hypertension, delayed medical consultation, and 1 000 Hz hearing impairment are independent risk factors for poor prognosis in patients with low-frequency sudden sensorineural hearing loss, whereas headache and hypotension/low intracranial pressure are protective factors. The predictive model developed based on these factors provides a reliable tool for prognostic assessment in clinical practice.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 32","pages":"2754-2760"},"PeriodicalIF":0.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971925","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 hepatocellular carcinoma treated with external beam radiation therapy (2025 edition)].","authors":"","doi":"10.3760/cma.j.cn112137-20250609-01413","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20250609-01413","url":null,"abstract":"<p><p>Hepatocellular carcinoma (HCC) is one of the most prevalent malignant tumors in China. As one of the important and effective treatment options, external beam radiation therapy (RT) has been briefly recommended in the \"Primary Hepatocellular Carcinoma Diagnosis and Treatment Guidelines (2024 Edition)\". In order to further standardize and guide the clinical implementation of RT for HCC, the Expert consensus on hepatocellular carcinoma treated with external beam radiation therapy (2025 edition) was developed by the Chinese Association of Liver Cancer of Chinese Medical Doctor Association through multiple rounds of discussion. This expert consensus covers the five key elements of RT: purpose and benefits of RT, target area and dose, RT techniques, combination with other treatments, and post-RT follow-up, comprising a total of 10 recommendations. It aims to familiarize clinicians with and standardize the use of RT for HCC, thereby improving the effectiveness of RT and reducing side effects.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 32","pages":"2718-2730"},"PeriodicalIF":0.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971874","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 characteristics and prognosis of invasive aspergillosis after lung transplantation and the diagnostic value of bronchial washing fluid galactomannan testing].","authors":"L Zhao, L J Guo, Y Zhang, B Xing, C Y Liang, W H Chen","doi":"10.3760/cma.j.cn112137-20250105-00040","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20250105-00040","url":null,"abstract":"<p><p><b>Objective:</b> To analyze the clinical characteristics and prognosis of invasive aspergillosis (IA) after lung transplantation, and to evaluate the diagnostic value of galactomannan (GM) testing in bronchial washing fluid (BWF) for post-transplant IA. <b>Methods:</b> This retrospective study enrolled 43 recipients diagnosed with IA among 157 patients who underwent lung transplantation at China-Japan Friendship Hospital between April 2017 and December 2018. Demographic characteristics, laboratory findings, BWF microbiology and GM results, antifungal prophylaxis/therapeutic regimens, and postoperative airway complications were systematically collected. Patients were followed until March 31, 2024. Based on IA diagnosis timing, 43 recipients were stratified into early-onset IA (≤90 days post-transplant) and late-onset IA (>90 days post-transplant) groups. Survival curves were constructed using the Kaplan-Meier method, with between-group differences assessed by log-rank test. The diagnostic performance of BWF GM testing for post-transplant IA was evaluated using receiver operating characteristic (ROC) curve analysis, with optimal cutoff values determined. <b>Results:</b> The incidence of post-transplant IA was 27.4% (43/157). Among IA cases, the age [<i>M</i> (<i>Q</i>₁, <i>Q</i>₃)] was 63.0 (54.0, 67.0) years, with 83.7% (36/43) being male. The median (<i>Q</i>₁, <i>Q</i>₃) time to IA diagnosis was 21.0 (9.0, 58.0) days post-transplant, with 60.5% (26/43) occurring within 1 month and 81.4% (35/43) within 3 months. According to diagnostic certainty: 13.9% (6/43) were proven cases, 60.5% (26/43) clinically diagnosed, and 25.6% (11/43) probable cases. Disease distribution showed: 67.4% (29/43) tracheobronchial aspergillosis (TBA) alone, 23.3% (10/43) invasive pulmonary aspergillosis (IPA) alone, and 9.3% (4/43) concurrent TBA-IPA. Thirty-seven Aspergillus isolates were identified, with <i>Aspergillus flavus</i> (16/37, 43.2%) being the predominant species. The median survival time of 43 IA cases was 693.7 (95%<i>CI</i>: 444.6-942.8) days. The 5-year all-cause mortality rates were comparable between early-onset (77.1%, 27/35) and late-onset IA groups (75.0%, 6/8, <i>P</i>=0.999). However, early-onset IA demonstrated significantly shorter median survival versus late-onset IA groups [544.5 (95%<i>CI</i>: 305.4-783.6) days vs 1 340.3 (95%<i>CI</i>: 533.6-2 147.0) days, <i>P</i>=0.012]. BWF GM levels in IA recipients were significantly higher than in non-IA recipients [6.78 (4.50, 9.16) vs 1.77 (0.99, 3.31), <i>P<</i>0.001]. ROC analysis identified an optimal BWF GM cutoff of 4.5 for post-transplant IA diagnosis (AUC=0.845, 95%<i>CI</i>: 0.769-0.921), with 76.7% sensitivity and 88.0% specificity. <b>Conclusions:</b> IA peaks within 3 months post-transplant, predominantly as TBA, with poorer outcomes in early-onset cases. BWF GM testing demonstrates good diagnostic performance for post-transplant IA.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 32","pages":"2745-2753"},"PeriodicalIF":0.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971890","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 the long-term effects of the conservation surgery for obstructive cervical atresia between using porcine small intestinal submucosal grafts and using autologous lateral femoral split-thickness skin grafts].","authors":"Y Ding, J X Ding, X Y Zhang, Y Zhang, J J Qiu, K Q Hua","doi":"10.3760/cma.j.cn112137-20250521-01250","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20250521-01250","url":null,"abstract":"<p><p><b>Objective:</b> To compare the long-term outcomes of cervicovaginal reconstruction between using small intestinal submucosa (SIS) grafts and using autologous lateral femoral split-thickness skin substitutes (STS) grafts. <b>Methods:</b> This was a prospective cohort study, involving 81 patients with obstructive cervical dysplasia who underwent cervicovaginal reconstruction using either SIS or STS grafts from January 2012 to August 2024. Data were collected, including demographic characteristics, operative duration, hospitalization costs, postoperative menstrual recovery, pregnancy outcomes, reoperation rates, vaginal length, and other relevant clinical parameters. Cosmetic satisfaction was assessed via questionnaire at 6th month post-surgery. Sexual function was evaluated using the Female Sexual Function Index (FSFI) questionnaire after resumption of sexual activity. Differences between the two groups were analyzed. <b>Results:</b> The mean age of overall patients at diagnosis was (16±5) years, with no significant difference between the SIS group [(16±6) years] and the STS group [(16±4) years]. The average operative time was (170.9±76.2) minutes, significantly shorter in the SIS group compared to the STS group [(158.0±67.9) vs (252.6±78.4) min; <i>P</i><0.001)]. Total hospitalization costs were significantly higher in the SIS group than in the STS group [(4.2±1.4) vs (2.0±0.6) ten thousand yuan; <i>P</i><0.001]. At a median follow-up of 67 months, all patients resumed menstruation postoperatively. Twelve patients (14.8%) experienced vaginal or cervical restenosis or atresia within 30 months after surgery, and 28 patients (34.6%) required secondary surgery. Specifically, 12 cases (14.8%) underwent repeat vaginal or cervical recanalization, 22 cases (27.2%) experienced intrauterine catheter loss, and 2 cases (2.5%) had failed in conservation due to hysterectomy. The mean postoperative vaginal length was (7.3±1.2) cm, with the SIS group showing significantly shorter vaginal length compared to the STS group [(7.2±1.2) vs (7.9±0.6) cm; <i>P</i><0.05]. Patients in the SIS group reported higher body image scores and cosmetic satisfaction scores than those in the STS group [(15.9±1.4) vs (14.2±1.5) points, <i>P</i><0.001; (18.6±2.1) vs (16.8±2.0) points, <i>P</i>=0.009]. Twenty-one patients (25.9%) resumed sexual activity postoperatively, with no statistically significant difference in FSFI scores between the two groups (<i>P</i>>0.05). Eleven patients (13.6%) expressed an intention to conceive, and one patient in the SIS group successfully became pregnant and delivered via assisted reproductive technology. <b>Conclusions:</b> Conservation reconstruction surgery for patients with obstructive cervical dysplasia is safe and effective, allowing patients to resume menstruation, achieve satisfactory sexual life, and achieve pregnancy and childbirth. The method of SIS grafts results in shorter operation times and better aesthetics but at a higher cost.","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 32","pages":"2768-2775"},"PeriodicalIF":0.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971884","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":"[Related factors of in-hospital <i>Acinetobacter baumannii</i> infection after lung transplantation and its impact on postoperative mortality risk].","authors":"T Qian, X S Li, L Man, M Xiong, L Fan, H Yang, J Y Chen, B Wu","doi":"10.3760/cma.j.cn112137-20250214-00335","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20250214-00335","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To investigate the factors associated with in-hospital &lt;i&gt;Acinetobacter baumannii&lt;/i&gt; infection after lung transplantation and its impact on postoperative mortality risk. &lt;b&gt;Methods:&lt;/b&gt; A retrospective analysis was conducted on 549 patients who underwent lung transplantation at the Lung Transplant Center of Wuxi People's Hospital Affiliated to Nanjing Medical University between January 2018 and December 2021, with follow-up until 3 years post-transplantation or death. Clinical characteristics and survival data were collected. Patients were divided into an infection group and a non-infection group based on the occurrence of in-hospital &lt;i&gt;Acinetobacter baumannii&lt;/i&gt; infection. Differences in clinical features between the two groups were compared. Multivariate logistic regression was used to identify factors influencing in-hospital &lt;i&gt;Acinetobacter baumannii&lt;/i&gt; infection post-lung transplantation. Kaplan-Meier survival curves were plotted, and log-rank tests were performed to compare cumulative survival rates at 30 days, 1, 2, and 3 years postoperatively. A multivariate Cox proportional hazards regression model was employed to analyze the impact of &lt;i&gt;Acinetobacter baumannii&lt;/i&gt; infection on postoperative mortality risk. &lt;b&gt;Results:&lt;/b&gt; The infection group comprised 315 patients [mean age (55.4±11.8) years; 256 males], while the non-infection group included 234 patients [mean age (54.4±12.9) years; 193 males]. The incidence of in-hospital &lt;i&gt;Acinetobacter baumannii&lt;/i&gt; infection post-lung transplantation was 57.4% (315/549). Follow-up duration ranged from 1.0 to 36.0 months, with a median of 9.0 months; 257 deaths occurred. The infection group exhibited significantly lower cumulative survival rates at 30 days, 1, 2, and 3 years postoperatively compared to the non-infection group (all &lt;i&gt;P&lt;/i&gt;&lt;0.05). Preoperative hospitalization status was a risk factor for in-hospital &lt;i&gt;Acinetobacter baumannii&lt;/i&gt; infection, with both general ward admission (&lt;i&gt;OR&lt;/i&gt;=6.90, 95%&lt;i&gt;CI&lt;/i&gt;:1.45-32.86) and intensive care unit (ICU) admission (&lt;i&gt;OR&lt;/i&gt;=2.42, 95%&lt;i&gt;CI&lt;/i&gt;:1.13-5.21) associated with higher infection risks than non-hospitalized patients (all &lt;i&gt;P&lt;/i&gt;&lt;0.05). No prior anticoagulant use (&lt;i&gt;OR&lt;/i&gt;=4.67, 95%&lt;i&gt;CI&lt;/i&gt;:1.10-19.74) and donor lung &lt;i&gt;Acinetobacter baumannii&lt;/i&gt; culture positivity (&lt;i&gt;OR&lt;/i&gt;=17.69, 95%&lt;i&gt;CI&lt;/i&gt;:5.37-58.33) were identified as risk factors for postoperative in-hospital &lt;i&gt;Acinetobacter baumannii&lt;/i&gt; infection. Multivariate Cox analysis revealed that in-hospital &lt;i&gt;Acinetobacter baumannii&lt;/i&gt; infection increased mortality risk at 1 year (&lt;i&gt;HR&lt;/i&gt;=1.55, 95%&lt;i&gt;CI&lt;/i&gt;:1.11-2.19), 2 years (&lt;i&gt;HR&lt;/i&gt;=1.63, 95%&lt;i&gt;CI&lt;/i&gt;:1.20-2.23), and 3 years (&lt;i&gt;HR&lt;/i&gt;=1.53, 95%&lt;i&gt;CI&lt;/i&gt;:1.15-2.04) postoperatively (all &lt;i&gt;P&lt;/i&gt;&lt;0.05), but its impact on 30-day mortality (&lt;i&gt;HR&lt;/i&gt;=1.53, 95%&lt;i&gt;CI&lt;/i&gt;:0.92-2.54) was not statistically significant. &lt;b&gt;Conclusions:&lt;/b&gt; Preoperative general ward admission, ICU admission, no prior ant","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 32","pages":"2738-2744"},"PeriodicalIF":0.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971935","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 characteristics and outcomes of invasive mucormycosis after allogeneic hematopoietic stem cell transplantation].","authors":"C Li, R Ma, Q Wang, Y He, X Y Luo, D P Zhu, X D Mo, Y Wang, L P Xu, X H Zhang, K Y Liu, X J Huang, Y Q Sun","doi":"10.3760/cma.j.cn112137-20250226-00456","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20250226-00456","url":null,"abstract":"<p><p><b>Objective:</b> To explore the clinical characteristics and prognostic factors of patients with invasive mucormycosis (IM) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). <b>Methods:</b> The clinical data of IM patients after allo-HSCT in Peking University People's Hospital from January 1, 2010 to December 31, 2021 were retrospectively collected and followed up until October 1, 2022. The survival curve was plotted by the Kaplan-Meier method. The multivariate Cox regression model was used to analyze the risk factors affecting the death of patients. <b>Results:</b> Among the 50 patients with IM, 39 were male (78.0%) and 11 were female (22.0%), with a median age [<i>M</i>(<i>Q</i>₁,<i>Q</i>₃)] of 35.5 (22.0, 46.8) years. Twenty-one cases (42.0%) were confirmed in diagnosis and 29 cases (58.0%) were clinically diagnosed. Pathogens included <i>Rhizopus</i> spp (<i>n</i>=26, 52.0%), <i>Mucor</i> spp (<i>n</i>=15, 30.0%), <i>Rhizomucor</i> spp (<i>n</i>=5, 10.0%) and <i>Lichtheimia ramosa</i> spp (<i>n</i>=4, 8.0%). Clinical types included pulmonary mucormycosis (<i>n</i>=35, 70.0%), rhinocerebral mucormycosis (<i>n</i>=6, 12.0%), disseminated mucormycosis (<i>n</i>=5, 10.0%), gastrointestinal mucormycosis (<i>n</i>=2, 4.0%) and cutaneous mucormycosis (<i>n</i>=2, 4.0%). The time [<i>M</i>(<i>Q</i>₁, <i>Q</i>₃)] of IM infection after allo-HSCT was 119 (56, 241) days. Forty-five patients (90%) received antifungal treatment and the effective rate was 53.3% (24/45) after 6 weeks of treatment. Among the 50 IM patients, 41 cases (82.0%) died, among which 21 cases (42.0%) died of IM. The median follow-up time was 2 169 days (95%<i>CI:</i> 1 264-3 073 days), and the 1-year survival rate was 25.8% and the median survival time was 51 days (95%<i>CI</i>: 0-124 days). Comorbidities before allo-HSCT (<i>HR</i>=2.103, 95%<i>CI</i>:1.056-4.191, <i>P</i>=0.034), non-engraftment of platelets (<i>HR</i>=2.213, 95%<i>CI</i>:1.149-4.264, <i>P</i>=0.018), and platelets<30×10⁹/L at infection (<i>HR</i>=2.129, 95%<i>CI</i>: 1. 093-4.150, <i>P</i>=0.026) were the influencing factors of patient death. <b>Conclusions:</b> <i>Rhizopus</i> spp is the predominant pathogen of IM after allo-HSCT, primarily affecting the lungs. The prognosis of IM patients after allo-HSCT is poor. Comorbidities before allo-HSCT, non-engraftment of platelets and platelets<30×10⁹/L at infection may affect the survival time of the patients.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 32","pages":"2731-2737"},"PeriodicalIF":0.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971937","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":"[The updated key points of the 2025 international clinical practice guidelines for primary aldosteronism].","authors":"A L Tong, Z W Li","doi":"10.3760/cma.j.cn112137-20250721-01804","DOIUrl":"10.3760/cma.j.cn112137-20250721-01804","url":null,"abstract":"<p><p>On July 15, 2025, the updated 2025 Clinical Practice Guideline for the Management of Primary Aldosteronism (PA) was released on the American Society of Endocrinology Annual Meeting. This guideline was spearheaded by the Endocrine Society and co-endorsed by 6 international academic organizations. Compared with the 2016 version, the new guideline has made significant updates in screening, diagnosis, classification and treatment. The new guideline recommends expanding the screening scope, conducting aldosterone-renin ratio screening for all patients with hypertension, without the need for strict drug elimination; it simplifies the diagnostic process, reducing the four diagnostic tests to three aldosterone suppression tests; it adopts a probability stratification strategy, allowing high-probability patients to skip the aldosterone suppression test and directly proceed to the classification assessment; at the same time, it optimizes the classification method, further clarifying the exemption conditions for adrenal venous sampling. In terms of treatment, unilateral lesions are recommended for surgery, while for bilateral or those with surgical contraindications, lifelong use of mineralocorticoid receptor antagonists is suggested, and the recovery of renin levels is used as a monitoring indicator of the efficacy. The new guideline focuses on \"population-wide screening-precise classification-individualized intervention\", aiming to reduce the risk of PA-related complications through early identification and targeted intervention. This article provides an interpretation of the core recommendations outlined in the 2025 guideline, presents a point-by-point comparison highlighting differences from the 2016 edition, and aims to deliver rapid and accurate, evidence-based information.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 ","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883908","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":"[Epilepsy comorbid with psychiatric disorders:current status and future prospects].","authors":"J M Li","doi":"10.3760/cma.j.cn112137-20250515-01180","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20250515-01180","url":null,"abstract":"<p><p>The high prevalence of comorbid psychiatric disorders in epilepsy significantly impaires clinical outcomes prognosis and represents an critical phenotypic manifestation of epilepsy. In recent years, with advancements in neuroimaging, molecular genetics, and precision medicine, research on epilepsy with psychiatric comorbidities has gradually shifted from clinical phenomenology to mechanistic exploration. To date, studies on the underlying mechanisms of these comorbidities remain in their early stages. Future research directions should focus on conducting large-scale, high-quality neuroimaging, genetic, and pathological studies, as well as integrating multimodal data for comprehensive analysis. Strengthening multidisciplinary collaboration, implementing early screening, and standardizing treatment for epilepsy with psychiatric comorbidities constitute the cornerstone in improving patient outcomes.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 31","pages":"2621-2624"},"PeriodicalIF":0.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971851","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":"[Diagnosis and treatment of epilepsy: from seizure control to targeted intervention].","authors":"X Wang","doi":"10.3760/cma.j.cn112137-20250514-01179","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20250514-01179","url":null,"abstract":"<p><p>Epilepsy management is experiencing a fundamental paradigm shift, moving beyond seizure control toward precision medicine. Despite continuous innovation in antiseizure medications, approximately one-third of patients still develop drug-resistant epilepsy, highlighting the limitations of traditional symptomatic treatment. In recent years, interdisciplinary convergence has catalyzed a series of breakthrough technologies: cerebral organoid technology demonstrates exceptional capability in modeling pathological features of genetic epilepsy, providing revolutionary tools for personalized drug screening and disease-modifying therapy; multimodal brain network imaging has revealed neural network characteristics of epilepsy, driving the transition of treatment models toward precise neural network-based interventions; the synergistic application of AI-driven drug target prediction, novel nano-drug delivery systems, and gene editing technologies offers innovative strategies for intervening in disease progression. Looking ahead, establishing standardized biomarker systems, conducting real-world studies, and optimizing clinical guidelines will further advance epilepsy treatment from seizure control to disease modification, bringing new therapeutic hope to patients.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 31","pages":"2611-2615"},"PeriodicalIF":0.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971877","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}