Background Effective postoperative analgesia is critical to recovery after cardiac surgery. Continuous wound infiltration (CWI) with local anesthetics (LAs) has been proposed as an opioid-sparing adjunct, but its efficacy beyond pain control and its safety profile remain incompletely defined. Methods We conducted a PRISMA-compliant systematic review and meta-analysis of randomized controlled trials (RCTs) comparing CWI with control in adult cardiac surgery. PubMed, Embase, and Cochrane CENTRAL were searched from inception to August 30, 2025, and updated on April 2, 2026. Primary outcomes were postoperative Visual Analogue Scale (VAS) pain scores and cumulative morphine consumption. Secondary outcomes included mechanical ventilation duration, length of stay, mortality, complications, patient satisfaction, and adverse events. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results Twelve RCTs involving 2,117 patients were included. CWI significantly reduced VAS during mobilization at 24 h (MD=−0.93, 95% confidence interval [CI]: −1.53–−0.33, P = 0.002) and 48 h (MD=−0.80, 95% CI: −1.17–−0.44, P < 0.001), and decreased 48-hour morphine consumption (MD=−8.10 mg, 95% CI: −13.41–−2.79, P = 0.003). No significant effects were observed on VAS at rest, mechanical ventilation duration, ICU or hospital length of stay, mortality, or major cardiovascular, pulmonary, renal, gastrointestinal complications, or postoperative infections. Patient satisfaction was higher with CWI. Technical complications were uncommon, and no clinically significant LA toxicity was reported. Conclusions In adult cardiac surgery, CWI with LAs modestly improves analgesia during mobilization and reduces opioid requirements without clear improvement in major clinical outcomes or length of stay. CWI appears safe and feasible and may serve as an adjunct in multimodal, opioid-sparing analgesia strategies. Further adequately powered trials are warranted to define its comparative effectiveness within contemporary enhanced recovery after surgery (ERAS) pathways.
Objective This study aimed to develop and validate a predictive nomogram for heart failure in patients with hypertension and persistent atrial fibrillation (HT-PeAF). Methods We retrospectively analyzed clinical data from patients with HT-PeAF hospitalized at Chinese People's Liberation Army General Hospital between 2010 and 2019. Predictive variables were selected based on multivariable logistic regression analysis and clinical relevance, which were then incorporated into a clinical nomogram. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) for discrimination, the Hosmer–Lemeshow test for calibration, and decision curve analysis for clinical utility. Results Of the 395 enrolled patients, 151 experienced heart failure. Nine predictive variables were identified: prior catheter ablation, low-density lipoprotein cholesterol, hemoglobin, uric acid, creatinine, total bilirubin, fasting blood glucose, red blood cell distribution width, and coronary artery disease. The nomogram demonstrated good discriminative ability (AUC = 0.77, 95% CI: 0.72–0.81), good calibration (P = 0.44), and favorable clinical utility. Conclusion This accessible tool facilitates individualized risk stratification for heart failure in HT-PeAF patients, though prospective validation in multicenter Asian cohorts is warranted.
Objective To evaluate the global disease burden and indirect economic costs of neurological, mental, and substance use disorders (NMSDs) from 1990 to 2023. Methods This study analyzed data on incidence, prevalence, and disability-adjusted life years (DALYs) for NMSDs using data from the Global Burden of Disease 2023 database. Joinpoint regression analysis was used to calculate average annual percentage change. Spearman correlation was applied to examine the association between age-standardized rates and socio-demographic index (SDI). The indirect economic burden was estimated using the human capital approach, incorporating age-adjusted productivity weights and gross domestic product (GDP) per capita. Results From 1990 to 2023, the absolute numbers of incident cases, prevalent cases, and DALYs for NMSDs increased substantially, with DALYs for neurological and mental disorders approximately doubling. Age-standardized rates demonstrated divergent trends across disease categories. For mental disorders, the age-standardized incidence, prevalence, and DALY rates increased by 15.00%, 24.00%, and 29.00%, respectively, with the overall burden rising markedly in 2019. In contrast, while the overall burden of substance use disorders declined, a notable exception emerged in high-income North America, where rising rates were observed specifically for opioid and cocaine use disorders. The burden of neurological and mental disorders was higher in females than in males, whereas substance use disorders showed the opposite pattern. The age-standardized DALY rate for motor neuron disease exhibited a significant positive correlation with SDI (ρs = 0.82, P < 0.001). The indirect economic burden and its share of GDP increased in most countries, while the share for substance use disorders in China declined by 46.19%. Conclusion The disease burden and economic costs of NMSDs increased globally from 1990 to 2023, with significant geographic, national, and demographic disparities. These findings highlight an urgent need for targeted resource allocation and integrated interventions.
This paper reviews Professor Gu Fangzhou’s contributions to polio control and elimination in China. Following the 1955 polio outbreak, he advocated for the live oral polio vaccine (OPV) route tailored to national conditions. To validate vaccine safety, he initiated human trials by testing the vaccine on himself and his infant son. He led the construction of the domestic OPV production base and pioneered the sugar-coated pill formulation to overcome cold chain constraints, ultimately facilitating the nationwide elimination of indigenous wild polioviruses by 1994. Furthermore, he established China’s OPV production and quality control standards and trained numerous public health professionals.
Traumatic brain injury can trigger long-term neurodegenerative diseases beyond its devastating acute effects. This narrative review summarizes current understanding of the neurodegenerative mechanisms underlying post-traumatic dementia. Core mechanisms involve multiple pathophysiological processes: long-term dysfunction of the blood-brain barrier, which impairs the clearance of toxic proteins; diffuse axonal injury, leading topersistent disruption of axonal transport, dysregulation of calcium homeostasis, and Wallerian-like degeneration; and the abnormal deposition of key pathological proteins such as amyloid-β, hyperphosphorylation and propagation of tau protein, and dysfunctional TAR DNA-binding protein-43, all of which disrupt protein homeostasis. In addition, chronic neuroinflammation mediated by microglia and astrocytes acts as a critical link, continuously exacerbating synaptic damage and neurodegeneration through the release of pro-inflammatory factors. Genetic factors, such as the APOE4 allele, can significantly amplify these pathological processes. Collectively, this evidence indicates that traumatic brain injury is not an isolated acute event but rather initiates and accelerates a long-term, multifactorial neurodegenerative cascade, ultimately resulting in cognitive dysfunction. These insights provide important targets for the development of targeted intervention strategies.
Commemorating the centenary of Professor Gu Fangzhou’s birth, this memorial article documents his landmark contributions to eliminating poliomyelitis in China. It details his strategic prioritization of the live attenuated oral polio vaccine (OPV) and his team’s breakthroughs in overcoming logistical hurdles through the sugar-coated pill formulation and mass immunization campaigns. Furthermore, the review highlights his development of diagnostic reagents and a national surveillance network, which culminated in China’s polio-free certification in 2000. Ultimately, the paper honors Professor Gu’s legacy as a trailblazing scientist, demonstrating how his low-cost, high-efficiency research model provided a replicable template for global polio eradication and laid the institutional foundation for China’s modern public health system.
Objective To evaluate whether adjunctive virtual reality(VR)spine simulation in neuraxial ultrasound training improves performance competency among anesthesia residents compared with traditional didactic teaching alone. Methods In this single-center,randomized controlled trial,anesthesia residents from the Department of Anesthesiology,Peking Union Medical College Hospital were recruited and randomized(1:1,computer-generated)to receive either a traditional 30-minute didactic lecture of spine ultrasonography(control group)or an identical teaching session followed by 30-minute VR spine simulation(VR group).After the training,participants were required to perform a preprocedural spine ultrasound scan.The primary outcome was a composite learning score evaluating the theoretical knowledge,practical skills,self-assessed satisfaction,and willingness to apply the technique in future practice.The secondary outcomes included scanning time,score of anatomic structure recognition,and accuracy of depth measurement to the posterior complex. Results A total of 46 participants(23 per group)were enrolled.Compared to the control group,the VR group achieved significantly higher composite learning scores(0.80±0.05 vs 0.74±0.09,P=0.01).The score of anatomic structure recognition(0.85±0.15 vs 0.72±0.20,P=0.01)and the accuracy of depth measurement to the posterior complex(73.9%vs 43.5%,P=0.03)were also significantly superior in the VR group. Conclusion Among anesthesia residents,adjunctive VR simulator training improves the technical and cognitive performance in neuraxial ultrasound compared with traditional didactic teaching alone.
This study focuses on eleven representative medical figures-including John Heng Liu and Robert K. S. Lim-to provide a historical account of their wartime service during the Chinese People's War of Resistance against Japanese Aggression. It reveals that the faculty and students of the Peking Union Medical College (PUMC) made distinguished contributions in three critical areas: battlefield medical relief, westward evacuation of the medical colleges and nursing school, and epidemic prevention research. Liu laid the groundwork for China's wartime medical system, while Lim organized and commanded the Medical Relief Corps of the Red Cross Society of China. Qizhen Shen established the Medical Division of the New Fourth Army, and James K. Shen oversaw the westward evacuation of the Central Hospital before serving on the Burma front. Shoukai Zhou drafted key health regulations. Together, these figures formed a wartime medical relief network spanning both the frontal battlefields and the resistance bases in enemy-occupied territories. In medical education, Xiaoqian Zhang led the westward evacuation of Hsiang-Ya Medical College, Zongen Li founded the National Guiyang Medical College, and Yuchan Nieh directed the evacuation of the PUMC School of Nursing-efforts that preserved the torch of medical education amid the flames of war. In scientific research, Feifan Tang overcame Western technological blockades to develop vaccines and penicillin; Wengui Chen exposed Japanese germ-warfare atrocities in his Changde PlagueReport; and Dushan Rong supported battlefield medicine through radiological services. Through their scientific expertise and patriotic commitment, these medical figures embodied the collective awakening of PUMC faculty at a moment of existential national crisis. Their service provided indispensable medical support that contributed significantly to China's ultimate victory.
Endometrial carcinoma arising in adenomyosis (EC-AIA) is a rare entity that originates deep within the myometrium and often spares the endometrial lining. We report a 53-year-old woman who presented with a vascularized uterine mass invading the bladder (International Federation of Gynecology and Obstetrics [FIGO] stage ⅢB2). Despite imaging findings suggesting malignancy, endometrial curettage yielded only atrophic cells, and hysterectomy confirmed a histologically normal endometrial cavity. Final pathology revealed endometrioid adenocarcinoma confined to adenomyotic lesions with lymph node involvement. This case underscores a critical diagnostic pitfall: negative endometrial sampling does not exclude EC-AIA. Moreover, applying current FIGO staging systems, designed for endometrial-origin tumors, to EC-AIA presents significant limitations, risking either underestimation of deep invasion or artificial upstaging.
OBJECTIVES:Scoliosis is a prevalent spinal deformity that severely impacts the physical and psychological well-being of adolescents and often requires surgical correction. This study aimed to investigate the risk factors for postoperative pulmonary complications (PPCs) following posterior spinal fusion in adolescent scoliosis, with a specific focus on evaluating the predictive value of preoperative forced vital capacity (FVC) and etiological classification. METHODS:This retrospective cohort study enrolled adolescents who underwent posterior spinal fusion for scoliosis correction at Peking Union Medical College Hospital between January 2018 and December 2022. The baseline demographic, clinical, and perioperative variables were collected. The primary endpoint was the occurrence of PPCs prior to hospital discharge. Univariate and multivariable binary logistic regression analyses were conducted to identify independent risk factors. RESULTS:A total of 1,234 patients were included, of whom 29 (2.35%) developed PPCs and 1,205 did not. Univariate analysis revealed that 12 variables, including non-idiopathic scoliosis, a larger main thoracic curve, a decreased FVC% predicted, and increased perioperative blood transfusions, were significantly associated with PPCs (P < 0.05). Multivariable logistic regression model showed that non-idiopathic scoliosis emerged as the sole independent risk factor for PPCs [adjusted odds ratio (OR) = 5.478, 95% confidence interval: 2.017-19.148, P = 0.002]. Preoperative FVC% predicted (adjusted OR = 0.993, P = 0.497) and main thoracic curve (adjusted OR = 1.002, P = 0.736) did not demonstrate independent predictive value. CONCLUSIONS:Non-idiopathic scoliosis, rather than preoperative pulmonary function or curve severity, is an independent risk factor for PPCs following posterior spinal fusion in adolescents. During perioperative respiratory risk assessment, particular emphasis should be placed on the etiological classification of these patients.
High-energy machinery entrapment can result in catastrophic perineal injuries involving complete urethral disruption, extensive soft tissue avulsion, and associated orthopedic trauma. We report a 24-year-old man who suffered a crushing roller injury, resulting in total perineal avulsion with bilateral testicular exposure, complete bulbar urethral transection, right pubo and ischial ramus avulsion, and an open ipsilateral tibiofibular fracture. Given the patient's hemodynamic stability following resuscitation and the intraoperative finding of cleanly transected urethral ends without rectal or bladder neck injuries, a single-stage surgical approach was pursued. Primary urethral anastomosis and in situ subcutaneous testicular burial were performed, with primary closure of the perineal wound. At 6 months postoperatively, debridement was repeated for non-healing wound secondary to infection, followed by regular dressing changes. Complete healing was achieved at 1 year postoperatively. At the 3-year follow-up, the patient could ambulate independently without assistance, void with a normal stream, and reported preserved erectile function. These favourable outcomes support the value of aggressive early single-stage reconstruction in carefully selected, hemodynamically stable patients sustaining devastating perineal avulsion injuries.
Life sciences have entered the era of big data, uncovering the complexity of human biological systems and advancing precision medicine and scientific wellness. In alignment with the Findable, Accessible, Interoperable, and Reusable (FAIR) principles, integrating population-level biological data resources from the academic and industrial sectors can substantially increase the efficiency of data utilization and foster innovative breakthroughs. Here, we introduce a novel framework for Good Data Governance Practice (GDGP) coupled with a grading initiative for the life sciences, focusing on traceability and openness. The GDGP framework systematically defines governance constraints, influencing factors, and functional capabilities to streamline data governance and management efficiency. This achievement lays the groundwork for compliant cross-institutional and cross-border data sharing and collaborative processing, poised to pave the way for standardized, ethical, and scalable data-driven research in precision medicine and beyond.
Acute ischemic stroke ranks as the second leading cause of mortality among noncommunicable diseases globally. Although recent advancements in intravenous thrombolysis and endovascular thrombectomy have markedly increased recanalization rates in patients with large vessel occlusion, improvements in clinical outcomes have not been consistently observed. Accumulating evidence demonstrates that successful recanalization does not necessarily translate into effective tissue reperfusion. Accordingly, the concept of neuroprotection has evolved from a traditional focus on mitigating cellular necrosis toward a strategy aimed at delaying the progression of ischemic penumbra and preserving salvageable brain tissue. This review summarizes the dynamic processes underlying reperfusion injury, microcirculatory dysfunction, neurovascular unit disruption, and associated neuroprotective mechanisms. Particular emphasis is placed on reversible changes within penumbra, reperfusion-induced injury amplification, and emerging imaging-guided approaches and molecular biomarkers for precision interventions. These insights provide a framework for developing spatiotemporally coordinated, individualized neuroprotective strategies.
Standardized datasets are foundational to healthcare informatization by enhancing data quality and unleashing the value of data elements. Using bibliometrics and content analysis, this study examines China's healthcare dataset standards from 2011 to 2025. It analyzes their evolution across types, applications, institutions, and themes, highlighting key achievements including substantial growth in quantity, optimized typology, expansion into innovative application scenarios such as health decision support, and broadened institutional involvement. The study also identifies critical challenges, including imbalanced development, insufficient quality control, and a lack of essential metadata-such as authoritative data element mappings and privacy annotations-which hampers the delivery of intelligent services. To address these challenges, the study proposes a multi-faceted strategy focused on optimizing the standard system's architecture, enhancing quality and implementation, and advancing both data governance-through authoritative tracing and privacy protection-and intelligent service provision. These strategies aim to promote the application of dataset standards, thereby fostering and securing the development of new productive forces in healthcare.
OBJECTIVES:To examine the temporal trends in the prevalence, incidence, and disability-adjusted life years (DALYs) of autism spectrum disorder (ASD) in China from 1990 to 2021 and to project the future burden to 2036. METHODS:Data were sourced from the Global Burden of Disease (GBD) 2021 provided by the Institute for Health Metrics and Evaluation (IHME). Join-point regression was applied to estimate the annual percentage change (APC) of prevalence, incidence, and DALYs. Age-period-cohort analysis was used to assess the effects of age, period, and cohort. Decomposition analysis quantified the contributions of population growth, demographic aging, and epidemiological changes. An AutoRegressive Integrated Moving Average (ARIMA) model was employed for projections to 2036. RESULTS:Between 1990 and 2021, the average annual percentage change (AAPC) was 0.22% (95% uncertainty interval [UI]: 0.20%-0.24%) for prevalence, -0.07% (95% UI: -0.14%-0.28%) for incidence, and 0.23% (95% UI: 0.21%-0.25%) for DALYs. ASD prevalence and DALYs peaked in children aged 0-5 years and declined after age 60. Rising prevalence and DALYs were mainly attributable to population growth (89.7% and 95.2%) and epidemiological changes (32.6% and 36.2%), while aging offset growth (-22.4% and -16.0%). Projections indicated stable age-standardized incidence for both sexes but divergent prevalence trends, with rates increasing among males and decreasing among females. CONCLUSIONS:The ASD burden in China is rising, largely driven by demographic and epidemiological dynamics, with young children and males being the most affected groups. Prioritizing early detection and gender-sensitive interventions are recommended.
OBJECTIVES:To determine the prevalence, distribution, and associated clinical factors of chronic neuropathic cancer pain (CNCP) among outpatients with chronic cancer pain (CCP) and to inform improved recognition and management. METHODS:In this cross-sectional study, consecutive outpatients with CCP diagnosed according to the International Association for the Study of Pain (IASP) criteria were recruited from the pain clinic at Peking Union Medical College Hospital between June and October 2025. CNCP was diagnosed based on the Neuropathic Pain Special Interest Group (NeuPSIG) criteria. Patients were classified into the CNCP group if they met at least one of the four NeuPSIG criteria, regardless of coexisting visceral or bone pain. Demographic, oncologic, and pain-related data were collected through standardized interviews. Between-group differences in baseline characteristics were assessed using absolute standardized differences and Chi-square or t-tests. Logistic regression analyses were conducted to identify clinical factors associated with CNCP. RESULTS:Of 138 eligible patients with CCP, 85 (61.6%) were classified into the CNCP group and 53 (38.4%) into the non-CNCP group. Multivariable logistic regression analysis revealed that bone metastasis (adjusted OR = 2.316, 95% CI: 1.074-5.178, P = 0.032), radiotherapy (adjusted OR = 2.489, 95% CI: 1.119-5.803, P = 0.025), and voiding dysfunction (adjusted OR = 5.470, 95% CI: 2.150-16.396, P < 0.001) were independently associated with CNCP. Pancreatic cancer was inversely associated with CNCP (OR = 0.371, P = 0.031). Only 5 (3.6%) patients in the CNCP group received neuropathic pain-specific interventions, indicating a predominant reliance on single-modality pain management. CONCLUSIONS:CNCP was present in nearly two-thirds of outpatients with CCP. The identified associations with bone metastasis, radiotherapy, and voiding dysfunction may aid in the early recognition of neuropathic pain components and support the adoption of mechanism-based multimodal pain management strategies.
The German philosopher Walter Benjamin, who died attempting to cross a border to escape persecution, described both the impossibility and the possibilities of translation[ 1]. The impossibility is implicit in the very title of Benjamin's essay, Die Aufgabe des Übersetzers. The German word Aufgabe can mean "task" or "endeavor" but also a "giving up" or "surrender." There is no English word that conveys the ambiguities and nuances of Aufgabe. And as I write this, I am aware that translating my English sentences into Chinese will create new impossibilities. But the impossibility of "true" or "literal" translation also opens new possibilities, for interpretation, adaptation, and (re)creation of new meaning. The same holds for translating palliative care: both the term and the discipline or practice.
Adamantinoma-like Ewing sarcoma (ALES) is a rare variant of Ewing sarcoma that predominantly occurs in the head and neck region, characterized by epithelial differentiation and overlapping morphology with other small round cell tumors. We present three cases of head and neck ALES (two in the parotid gland and one in the nasal cavity) in patients aged 23-42 years. Histologically, the tumors exhibited a spectrum of features, including small round blue cells and basaloid squamous morphologies. Immunohistochemically, the tumor cells variably expressed CKpan, p63, CD99, NKX2.2, FLI1, CD56, and Syn. The Ki-67 proliferation index ranged widely from 15% to 90%. Notably, one case initially misdiagnosed as squamous cell carcinoma harbored a canonical EWSR1::FLI1 fusion. Crucially, we report the first case of ALES had a negative EWSR1 rearrangement but a somatic NF1 mutation, expanding the molecular spectrum of this entity. Our findings underscore the diagnostic challenge of ALES and highlight the necessity of comprehensive molecular profiling, including next-generation sequencing, for accurate diagnosis and the identification of potential therapeutic targets, particularly in genetically atypical cases.
With a growing population of elderly patients undergoing hip arthroplasty, traditional nursing care often faces challenges dus to fragmented services and inadequate continuity. Based on Peplau's interpersonal relationship theory, we explored a comprehensive hospital-home-community management model for an 80-year-old female patient following total hip arthroplasty. This nursing model was structured into four sequential phases (orientation, identification, exploitation, and resolution) and incorporated a structured multidisciplinary team, a stepwise health education system, discharge preparation services, and evidence-based postoperative care. Post-discharge management integrated traditional Chinese medicine-based pain management, intelligent rehabilitation training, and evidence-based constipation management. After six months of intervention, the patient achieved satisfactory wound healing and optimal prosthesis positioning. Significant improvements were observed in pain, constipation, sleep, anxiety, hip function, self-care ability, and self-management competence. This approach established a closed-loop management system encompassing assessment, screening, referral, liaison, home visits, multidisciplinary collaboration, and continuous follow-up. This model bridges hospital-home care gap, enhances care continuity, and improves rehabilitation outcomes, thereby providing a replicable framework for the postoperative management of elderly surgical patients.
Pelvic floor dysfunction (PFD), including conditions such as stress urinary incontinence, pelvic organ prolapse, and fecal incontinence, significantly affects women's quality of life and their physical and mental health. With advancement of digital medicine, the systematic collection of data and the high-quality development of database platforms have increasingly become central pillars of PFD research and management. We systematically review the developmental stages of PFD-related databases. We then conduct a comparative analysis of representative international and domestic platforms, examining key aspects including organizational structures and construction models, data sources and integration strategies, core functionalities, data quality control and standardization, data security and access management, and research applications. Finally, based on the current status of PFD database development both globally and in China, we offer recommendations to strengthen data infrastructure and guide future directions. The findings may serve as a valuable reference for the optimization of PFD databases worldwide.
