Objective: 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). Methods: 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 t test, whereas categorical variables were compared using Pearson's χ2 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. Results: 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 P>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), P=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 (P=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), P=0.002]. Conclusions: 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 mainly related to higher cumulative incidence of non-cardiovascular death. Further studies are required to establish the long-term safety of DCB angioplasty in this high-risk population.
Objective: To analyze the differences in blink patterns among patients with mild thyroid-associated ophthalmopathy (TAO, with eyelid retraction<2 mm), patients with primary dry eye disease (DED), and non-dry-eye controls, and to explore the association between these patterns and tear film stability. Methods: The data of patients who were admitted to the Department of Ophthalmology at Ningbo Medical Center Lihuili Hospital between July and September 2025 were retrospectively collected. Based on clinical features, patients were classified into three groups: mild TAO group, primary DED group, and non-dry-eye control group. All subjects underwent standardized ocular surface assessments. Dry eye-related parameters were measured, and spontaneous blink frequency and incomplete blink ratio were quantified. Intergroup differences were compared, correlations between blink patterns and dry eye parameters were analyzed, and multiple linear regression was performed to identify factors associated with incomplete blink ratio. Results: A total of 140 patients (140 eyes) were included. The mild TAO group comprised 45 patients (45 eyes; 19 males and 26 females), with a median age of 45 (31, 50) years. The primary DED group comprised 45 patients (45 eyes; 18 males and 27 females), with a median age of 40 (32, 54) years. The non-dry-eye control group comprised 50 subjects (50 eyes; 19 males and 31 females), with a median age of 40 (30, 50) years. No significant differences were observed in age or sex among the three groups (all P>0.05). Between the mild TAO group and the primary DED group, no significant differences were found in Schirmer test results, tear meniscus height, ocular redness score, meibomian margin morphology score, lipid layer saturation, or lipid spread speed (all P>0.05). However, non-invasive tear film breakup time (NIBUT) was significantly shorter in the mild TAO group than in the primary DED group [2.0 (2.0, 2.5) s vs 4.2 (2.4, 6.0) s, P<0.001]. The meibomian gland area ratio was higher in the mild TAO group than that in the primary DED group (P<0.001), but was comparable to that in the non-dry-eye control group (P=0.051). Blink frequency was lower in the mild TAO group than those in both the primary DED group (P=0.026) and the non-dry-eye control group (P<0.001). The incomplete blink ratio in the mild TAO group [50.0% (31.7%, 70.7%)] was significantly higher than that in the primary DED group [16.7% (7.7%, 26.7%)] and the non-dry-eye control group [5.6% (0, 11.1%)] (both P<0.001). In the mild TAO group, the incomplete blink ratio was strongly negatively correlated with NIBUT (rₛ=-0.826, P<0.001) and positively correlated with ocular surface disease index (OSDI) score (rₛ=0.320, P=0.032). Multiple linear regression showed that shortened NIBUT (β=-0.061, 95%CI:-0.093--0.029, P<0.001) and reduced blink frequency (β=-0.042, 95%CI:-0.053--0.030, P<0.001) were independently associated with an increased incomplete blink ratio. Conclusion: In patients with mild TAO who have minimized mechanical exposure (eyelid retraction<2 mm), an abnormal blink pattern characterized by increased incomplete blink ratio and decreased blink frequency is observed, and this pattern is significantly correlated with reduced tear film stability.
The clinical data of 26 patients with littoral cell angioma (LCA) of the spleen admitted to the First Affiliated Hospital of Zhengzhou University from January 2013 to August 2025 were retrospectively analyzed. There were 14 males and 12 females, with a mean age of (39.4±17.7) years. Ten patients presented with abdominal symptoms, and 5 had concurrent malignancies in other organs. CT/MRI findings predominantly showed single or multiple slightly hypodense/hypointense nodules within the spleen, with mild to moderate heterogeneous enhancement in the arterial phase and persistent enhancement in the venous phase. Pathological examination revealed that tumor cells co-expressed vascular endothelial markers (CD31, CD34, ERG, etc.) and histiocytic markers (CD68, etc.), with a biphenotypic expression rate of 17/18. Among 5 cases preoperatively suspected as splenic metastases, 2 were confirmed by needle biopsy and 3 were pathologically verified after simultaneous surgical resection. Twenty-four patients underwent splenectomy. All patients were alive without LCA-related recurrence, with a median follow-up and progression-free survival time both of 71 months (range: 3-144 months). The current study indicates that preoperative contrast-enhanced CT and MRI are helpful in the diagnosis of LCA. Splenectomy is the first choice for LCA treatment, and the prognosis is favorable.
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.
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.
Objective: To observe the efficacy of maintenance therapy with or without Pembrolizumab in patients with advanced gastric cancer after first-line chemotherapy. Methods: A total of 182 patients with advanced gastric cancer who received first-line induction therapy in our hospital from August 2021 to August 2023 were retrospectively included. According to the maintenance treatment strategy, the patients were divided into two groups. Patients received single-agent maintenance therapy with Pembrolizumab were in the single-agent group, and patients received combined maintenance therapy with Pembrolizumab and chemotherapy were in the combination group. The follow-up period was until October 2025. The levels of tumor-related markers, immune function indexes, tumor response, progression-free survival, overall survival, and adverse reactions within 1 year of maintenance treatment between the two groups were compared. Kaplan-Meier method was used to estimate median progress free survival (PFS) and overall survival (OS), and the log-rank test was used to compare survival differences between groups. Multivariate Cox proportional hazards regression model was used to analyze the impact of different maintenance treatment strategies on survival. Results: There were 98 cases in the monotherapy group, with an age of (64.81±7.55) years, and 84 cases in the combination therapy group, with an age of (64.55±8.47) years. The results of repeated measures analysis showed that during maintenance treatment, the levels of tumor markers such as carcinoembryonic antigen, cancer antigen(CA)125, CA199 in both the combination and monotherapy groups exhibited a decreasing trend, with a more pronounced decrease in the combination group (all P<0.05). Both the intergroup differences and the change trend differences in immunogloblin (Ig)A, IgG, and CD4+levels were statistically significant (all P<0.05); the monotherapy group remained relatively stable for these indicators, while the combination group showed a decreasing trend. The change trend differences in CD3+and CD8+levels between the two groups were statistically significant (all P<0.05), but the intergroup differences were not statistically significant (all P>0.05). Neither the intergroup difference nor the change trend difference in IgM level was statistically significant (all P>0.05). The RR of the combination group and the single drug group were 14.29% and 7.14%, and the DCR were 36.90% and 24.49%, respectively, with no significant difference (P>0.05). The median PFS in the combination group and the single drug group were 9.24 (95%CI: 8.19-10.29) and 8.92 (95%CI: 7.95-9.89) months, respectively, and the median OS in the combination group and the single drug group were 14.58 (95%CI: 12.65-16.51) and 16.04 (95%CI: 14.19-17.89) months, respectively, with no statistically significant difference (P>0.05). After adjusting for confounding factors by multivariate Cox regression analysis, treatment grouping was not an influencing factor for PFS or OS (all P>0.05). The incidence or severity of gastrointestinal reactions, leukopenia, hand foot syndrome, liver and kidney dysfunction, and thyroid dysfunction in the combination group were higher than those in the single drug group (all P<0.05). Conclusions: In patients with advanced gastric cancer after first-line chemotherapy for disease control, there is no statistically significant difference in the efficacy of maintenance therapy with or without Pembrolizumab combined with chemotherapy, and it can reduce the cumulative toxicity caused by continuous chemotherapy.
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.
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.
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.
Objective: 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). Methods: 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, n=335; Center 2: Zhangjiagang Hospital Affiliated with Soochow University, January 2015 to December 2023, n=94). Center 1 was split in a 7∶3 ratio into training (n=234) and internal test (n=101) sets by stratified random sampling based on BCR status; Center 2 served as the external test set (n=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). Results: All 3 models stratified high-and low-risk patients in both test sets (all P<0.05). CHPM showed a higher C-index than CAPRA-S (0.782 vs 0.672, P=0.036; 0.780 vs 0.689, P=0.042). C-index differences between EPM and CAPRA-S, and between EPM and CHPM, were not significant (all P>0.05). EPM and CHPM both outperformed CAPRA-S in calibration, net benefit, IDI, and NRI. Conclusions: 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.
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.
Objective: 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. Methods: 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. Results: A total of 675 ZAP patients were included, of whom 336 (49.8%) were male, with a median age [M (Q1, Q3)] 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 P>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 P<0.05). Mediation analysis revealed that insomnia partially mediated the relationships between pain and depression [mediation effect β=0.026 (95%CI: 0.018-0.035), proportion mediated=30.6%] and between pain and anxiety [mediation effect β=0.019 (95%CI: 0.014-0.026), proportion mediated=27.6%]. Conclusion: 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.
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 P<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 (P<0.05), as well as significantly lower PSQI, GAD-7, and PHQ-9 scores at 4 and 8 weeks (P<0.05). There were no statistically significant differences between the two groups in the incidence of PHN, rescue analgesia, or adverse events (all P>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.
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.
To analyze the genomic characteristics of multi-drug resistant of non-O1/non-O139 Vibrio cholerae 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 Vibrio cholerae. 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: Vibrio cholerae hemolysin, repeat toxin, and Vibrio parahaemolyticus 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.
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.
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.
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.
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 t test, Mann-Whitney U 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 (Qmax), 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 [M (Q1, Q3)] was 3 (2, 5) months. The operative time [(109±36) vs (124±35) min, P=0.024] and hospital stay [(9.4±3.6) vs (11.5±3.4) days, P=0.010], hemoglobin drop level [(6.6±7.8) vs (11.7±8.3) g/L, P=0.002] of the four-troughs group were lower than those of the enucleation group. There were no statistically significant differences in prostate volume, Qmax, PVR, preoperative or postoperative IPSS and QoL between the two groups. (all P>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.
Objective: To investigate the efficacy and safety of neoadjuvant radiotherapy in patients with resectable hepatocellular carcinoma (HCC). Methods: 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. Results: 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. Conclusion: 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.
