Zhonghua yi xue za zhi最新文献

{"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}

{"title":"[Preclinical intervention in rheumatoid arthritis: balancing preventive benefits and clinical risks].","authors":"Y C Lyu, G Yin, Q B Xie, C J He","doi":"10.3760/cma.j.cn112137-20260331-00869","DOIUrl":"10.3760/cma.j.cn112137-20260331-00869","url":null,"abstract":"<p><p>Intervention in the preclinical of rheumatoid arthritis (Pre-RA) represents a core strategy for disease prevention and control. To date, there are no unified clinical standards regarding the timing and regimens of Pre-RA intervention. Non-pharmacological interventions are theoretically feasible yet lack support from high-quality randomized controlled trials. Pharmacological interventions are backed by more robust evidence-based data, though they carry both clinical benefits and potential risks. Risk stratification tools enable effective identification of patients at high risk of disease progression, though standardized clinical workflows for such tools have not yet been established. This article systematically reviews the available evidence and limitations of non-pharmacological and pharmacological interventions for pre-RA. On this basis, it comments on the clinical application of risk stratification tools and balances the benefits and risks of implementing early intervention strategies in pre-RA. Based on current evidence, a uniform strategy of aggressive intervention or watchful waiting is not recommended for the clinical management of pre-RA. Individualized precision interventions should be delivered according to risk stratification results combined with patient characteristics.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 33","pages":"3444-3450"},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907493","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":"[CAR-T cell therapy for systemic lupus erythematosus: immune reset or an expensive attempt?]","authors":"R H Li, Q Fu","doi":"10.3760/cma.j.cn112137-20260407-00944","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20260407-00944","url":null,"abstract":"<p><p>In the treatment of rheumatic and autoimmune diseases in China, patients often experience relapses after discontinuing traditional immunosuppressants, and those with refractory disease continue to face the challenge of progressive organ damage. In recent years, chimeric antigen receptor (CAR-T) cell therapy has achieved breakthroughs in autoimmune diseases such as systemic lupus erythematosus (SLE). Anti-cluster of differentiation 19 (CD19) CAR-T therapy can deeply eliminate B cells, enabling some patients to maintain long-term remission without the use of immunosuppressants. This has led to the concept of \"immune reset\", that is, the reconstruction of the immune system starting from hematopoietic progenitor cells and the restoration of self-tolerance. Taking SLE as an example, this article analyzes the success rates and limiting factors of different CAR-T strategies in achieving immune reset, using case data from 17 clinical studies. The results show that the dual-target strategy, targeting B-cell maturation antigen (BCMA) and CD19, has clear advantages in terms of the depth and durability of immune reset, enabling some patients with refractory SLE to achieve long-term drug-free remission. However, immune reset is not universally successful, and its achievement is constrained by multiple factors, including target coverage, pre-existing organ damage, and disease-driving mechanisms. In summary, CAR-T therapy offers an effective new option with the potential for immune reset in patients with refractory SLE, but clinical application requires individualized decision-making based on the patient's specific circumstances. As evidence accumulates and technology is optimized, this strategy may become a viable option for more patients with autoimmune diseases.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 33","pages":"3438-3443"},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907229","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 efficacy and safety of a modified transurethral diode laser four-troughs vaporesection in treating benign prostatic hyperplasia].","authors":"Y X Tao, X P Li, G B Li, W H Luo, H H Yao, J W Deng, J Wei, Z G Chen, J J Zhu, X Q Wen","doi":"10.3760/cma.j.cn112137-20260312-00689","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20260312-00689","url":null,"abstract":"<p><p>To investigate the efficacy and safety of a modified transurethral diode laser four-troughs vaporesection in treating benign prostatic hyperplasia (BPH). The clinical data of BPH patients who underwent prostatic surgery between January 2023 and June 2025 at Guangdong Provincial People's Hospital, Southern Medical University were retrospectively included. The patients were divided into two groups according to the surgical methods: the four-troughs group (patients who underwent modified four-troughs vaporesection of the prostate using a 1 470 nm diode laser), and the enucleation group (patients who underwent 1 470 nm diode laser enucleation of the prostate). The patients were followed up to 6 months after surgery. Independent sample <i>t</i> test, Mann-Whitney <i>U</i> test and analysis of covariance were used to compare perioperative related indicators between the two groups, including prostate volume, International Prostate Symptom Score (IPSS), quality of life score (QoL), maximum urinary flow rate (Q_max), post-void residual urine volume (PVR), duration of surgery, hemoglobin drop level, length of hospital stay, bladder irrigation time and postoperative complications. A total of 103 male patients, aged of (70±6) years, were included. Fifty-five patients were included in the four-troughs group and 48 patients in the enucleation group. The follow-up duration [<i>M</i> (<i>Q</i>₁, <i>Q</i>₃)] was 3 (2, 5) months. The operative time [(109±36) vs (124±35) min, <i>P</i>=0.024] and hospital stay [(9.4±3.6) vs (11.5±3.4) days, <i>P</i>=0.010], hemoglobin drop level [(6.6±7.8) vs (11.7±8.3) g/L, <i>P</i>=0.002] of the four-troughs group were lower than those of the enucleation group. There were no statistically significant differences in prostate volume, Q_max, PVR, preoperative or postoperative IPSS and QoL between the two groups. (all <i>P</i>>0.05). A total of 5 patients developed mild postoperative complications (2 in the four-troughs group and 3 in the enucleation group), and all improved after symptomatic treatment. The modified transurethral 1 470 nm diode laser four-troughs vaporesection is easy to operate, which is associated with less reduction in hemoglobin level and a shorter operative time. Its short-term therapeutic efficacy and safety are comparable to those of enucleation.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 33","pages":"3517-3521"},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907399","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":"[Glucagon-like peptide-1 receptor agonists: from metabolic regulation to rheumatic disease therapy].","authors":"W H Xie, T Chen, Z L Zhang","doi":"10.3760/cma.j.cn112137-20260312-00692","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20260312-00692","url":null,"abstract":"<p><p>Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RA), originally developed for type 2 diabetes mellitus and obesity, have attracted considerable attention in rheumatology due to their pleiotropic effects. Accumulating evidence indicates that GLP-1RA not only indirectly reduce inflammation through weight loss and metabolic improvement, but also directly act on GLP-1 receptors expressed on immune cells and musculoskeletal cells, exerting anti-inflammatory and tissue-protective effects independent of weight reduction. In recent years, several large real-world studies and randomized controlled trials have shown that GLP-1RA may improve disease activity and reduce cardiovascular events and mortality in osteoarthritis, rheumatoid arthritis (RA), psoriasis/psoriatic arthritis, and systemic lupus erythematosus (SLE). However, the available evidence has notable limitations: most studies are retrospective, with limited sample sizes; different GLP-1RA are often analyzed as a single class; the weight-loss effect is difficult to dissociate from direct anti-inflammatory action; and randomized controlled trials in non-obese, non-diabetic rheumatic patients are lacking. This review systematically summarizes the molecular mechanisms and clinical evidence of GLP-1RA in rheumatic diseases (including RA, psoriasis/psoriatic arthritis, osteoarthritis, and SLE), and based on this, the authors' perspective is put forward: currently, GLP-1RA should only be recommended for rheumatic patients with overweight/obesity or type 2 diabetes who also have high cardiovascular risk. Future research should prioritize head-to-head comparisons of different GLP-1RA, mechanistic studies independent of weight loss, and exploration of combination strategies. It is believed that GLP-1RA hold promise to usher in a new era of \"metabolic-immune\" synergistic intervention in rheumatology, but their benefits and risks must be carefully evaluated.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 33","pages":"3431-3437"},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907440","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":"[Efficacy and safety of thoracic paravertebral block combined with thoracic nerve block for acute herpes zoster neuralgia involving upper thoracic dermatomes in middle-aged and elderly patients].","authors":"M Y Qin, D L Zhao, R Wang, L J Lu","doi":"10.3760/cma.j.cn112137-20251217-03345","DOIUrl":"10.3760/cma.j.cn112137-20251217-03345","url":null,"abstract":"<p><p>To investigate the clinical efficacy and safety of ultrasound-guided thoracic paravertebral block (TPVB) combined with pectoral nerve block (Pecs) in the treatment of acute herpetic neuralgia (AHN) involving the upper thoracic segments in middle-aged and elderly patients, a prospective study was conducted. A total of 70 middle-aged and elderly patients with upper thoracic AHN who visited the Department of Pain Medicine at Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, from June to December 2023, were enrolled and randomly divided into a control group and an experimental group using a random number table, with 35 patients in each group. The control group received TPVB once weekly for a total of 3 sessions, while the experimental group received TPVB combined with Pecs block using the same regimen. Outcome measures included the Visual Analogue Scale (VAS) for pain, Pittsburgh Sleep Quality Index (PSQI), 7-item Generalized Anxiety Disorder Scale (GAD-7), 9-item Patient Health Questionnaire (PHQ-9), treatment satisfaction score, incidence of postherpetic neuralgia (PHN), rescue analgesia, and adverse events. Assessments were conducted at 1, 4, 8, and 12 weeks post-treatment, and between-group differences were compared. Ultimately, 33 patients in the experimental group and 31 in the control group completed the follow-up and were included in the final analysis. The results showed that both groups demonstrated significant improvements in VAS scores, PSQI, GAD-7, PHQ-9, and satisfaction scores compared with baseline (all <i>P</i><0.05). Compared with the control group, the experimental group exhibited significantly lower VAS scores and higher satisfaction scores at 1, 4, and 8 weeks post-treatment (<i>P</i><0.05), as well as significantly lower PSQI, GAD-7, and PHQ-9 scores at 4 and 8 weeks (<i>P</i><0.05). There were no statistically significant differences between the two groups in the incidence of PHN, rescue analgesia, or adverse events (all <i>P</i>>0.05). This study demonstrates that compared with TPVB alone, the combination of TPVB and Pecs block provides better pain relief, improves sleep quality, and alleviates anxiety and depression in middle-aged and elderly patients with upper thoracic AHN, with a favorable safety profile.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 32","pages":"3380-3384"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907125","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":"[Efficacy and safety of neoadjuvant radiotherapy in patients with resectable hepatocellular carcinoma].","authors":"Y Zong, Y R Zhai, D Y Cao, F Wu, Y F Zhang, S L Wang, Y P Liu, Y Tang, H Jing, H Fang, N N Lu, S N Qi, W W Zhang, Z B Yang, S Y Chen, J X Wu, X Y Bi, B Chen","doi":"10.3760/cma.j.cn112137-20260104-00028","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20260104-00028","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the efficacy and safety of neoadjuvant radiotherapy in patients with resectable hepatocellular carcinoma (HCC). <b>Methods:</b> A retrospective analysis was conducted on the clinical data of 34 patients with HCC who received neoadjuvant radiotherapy from February 2016 to August 2022 at the Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing, China. Radiographic and pathological tumor response were evaluated. Follow-up period ended on September 30, 2025. The Kaplan-Meier method was used to calculate disease-free survival (DFS) and overall survival (OS), and the log-rank test was applied to compare DFS and OS between groups. Radiotherapy-and surgery-related adverse events were also evaluated. <b>Results:</b> Among the 34 patients [median age, 55 years (range:20-77 years); 31 male (91.2%) individuals], five patients (14.7%) had distal tumor thrombus. Thirty patients (88.2%) had tumor located within 1 cm of major blood vessels or their branches. Twenty-four patients (70.6%) had lesions with a maximum diameter>5 cm, two patients (5.9%) had serum alpha-fetoprotein levels>1 000 ng/ml. All patients completed the planned conventional fractionated radiotherapy (RT). According to Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1), 14 patients (41.2%) had partial response (PR); according to modified RECIST, 9 patients (26.5%) had complete response and 17 patients (50%) had PR. No patient had progressive disease before surgery. The median (range) interval between surgery and last RT was 9.9 (4.6-44.3) weeks. Severe treatment response was found in 16 patients (47.1%), while pathologic complete response in 4 patients (11.8%) and major pathological response in 15 patients (44.1%). With a median (range) follow-up of 83.7 (6.2-110.3) months, the median OS was not reached, and OS rates were 97.0% at 1 year, 84.8% at 3 years, and 84.8% at 5 years. The median DFS was 42.7 months, and DFS rates were 76.9% at 1 year, 63.0% at 3 years, and 37.8% at 5 years. Radiotherapy-related grade 3 adverse events were observed in 3 patients (7.7%). The remaining adverse events were all grade 1-2. Eleven patients (32.4%) developed operative complications, including grade Ⅰ complications in 2 patients (5.9%), grade Ⅱ in 4 patients (11.8%) and grade Ⅲa in 5 patients (14.7%). No grade Ⅲb or higher operative complications were observed. <b>Conclusion:</b> Neoadjuvant radiotherapy combined with surgery demonstrates promising local efficacy for patients with resectable HCC, achieving a 5-year OS of exceeding 80% with good tolerance of surgery.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 32","pages":"3352-3359"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907082","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 the relationship between herpes zoster-associated neuralgia and depressive- anxiety states and the mediating role of insomnia].","authors":"Z Y Peng, Q M Xiang, Z Y Feng","doi":"10.3760/cma.j.cn112137-20260114-00170","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20260114-00170","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the correlations between pain intensity and insomnia, depression, and anxiety in patients with zoster-associated pain (ZAP), and to examine the mediating role of insomnia in the associations between pain and depression as well as pain and anxiety. <b>Methods:</b> Patients with ZAP who presented to the Department of Pain Medicine, the First Affiliated Hospital of Zhejiang University School of Medicine, from February 2024 to February 2025 were enrolled and divided into acute and chronic phases according to whether the ZAP duration was<30 days. General clinical data were collected. Pain intensity, insomnia, depression, and anxiety were assessed using the Numerical Rating Scale (NRS), Insomnia Severity Index (ISI), 9-item Patient Health Questionnaire (PHQ-9), and 7-item Generalized Anxiety Disorder scale (GAD-7), respectively. Logistic regression was performed to analyze the associations of pain with insomnia, depression and anxiety, and mediation analysis was employed to explore the mediating effect of insomnia on the relationships between pain and depression as well as pain and anxiety. <b>Results:</b> A total of 675 ZAP patients were included, of whom 336 (49.8%) were male, with a median age [<i>M</i> (<i>Q₁, Q₃</i>)] of 67.0 (59.0, 73.0) years. The NRS score for the past 24 hours at admission was (4.3±1.9) points. The prevalence of insomnia was 70.7% (477/675), depression 47.0% (317/675), and anxiety 31.7% (214/675). There were 223 patients in the acute phase and 452 in the chronic phase; no statistically significant differences were found between the two groups in NRS, ISI, PHQ-9, or GAD-7 scores (all <i>P</i>>0.05). Logistic regression analysis demonstrated that, in the overall ZAP cohort, higher NRS scores were significantly associated with higher risks of insomnia, depression, and anxiety, and these associations remained statistically significant after adjusting for important confounders including sex, age, educational level, medical history, and ZAP duration(all <i>P</i><0.05). Mediation analysis revealed that insomnia partially mediated the relationships between pain and depression [mediation effect <i>β</i>=0.026 (95%<i>CI</i>: 0.018-0.035), proportion mediated=30.6%] and between pain and anxiety [mediation effect <i>β</i>=0.019 (95%<i>CI</i>: 0.014-0.026), proportion mediated=27.6%]. <b>Conclusion:</b> Pain intensity is correlated with the levels of insomnia, depression, and anxiety in ZAP patients, and insomnia exerts a partial mediating effect on the association pathways between pain and depression as well as between pain and anxiety.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 32","pages":"3368-3373"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906339","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 evolution, current practice, and future directions of neuromodulation for neuropathic pain].","authors":"Y J Luo, Z Y Feng","doi":"10.3760/cma.j.cn112137-20260306-00627","DOIUrl":"10.3760/cma.j.cn112137-20260306-00627","url":null,"abstract":"<p><p>Neuropathic pain (NP) refers to pain caused by a lesion or disease affecting the somatosensory nervous system. It typically follows a chronic course, characterized by persistent or recurrent pain that can lead to substantial suffering and functional impairment. Because conventional treatments often provide inadequate relief, neuromodulation has emerged as an important therapeutic approach. Focusing on the developmental trajectory of neuromodulation techniques, this article systematically reviews their historical evolution in the treatment of neuropathic pain, the current core technological systems, and the selection of treatment regimens. It further discusses future directions, with an emphasis on precision, intelligence, and standardization, aiming to provide a reference for clinical decision-making in pain medicine, the application of relevant technologies, and scientific research orientation.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"106 32","pages":"3319-3326"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907294","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}