2026年 · 第139卷第10期

Limb transplantation is divided into replantation and allotransplantation. Replantation is the direct or indirect replantation of a severed limb, whereas allotransplantation refers to the transplantation of limbs between individuals of different genotypes of the same species. Static cold storage (SCS) remains the gold standard forin vitrolimb preservation. This hypothermic (0–4°C) storage method using ice packs is simple, cost-effective, and easy to implement. However, it is limited by a short preservation window of 4–6 hours, after which tissue viability and functional integrity decline.^[1,2]SCS also fails to preserve muscle architecture and strength, and induces cold ischemic injury, compromising long-term graft survival.^[3,4]Mechanical perfusion, though capable of relieving vasospasm and maintaining basic metabolism, still can not fully preserve tissue function and requires specialized equipment and protocols.^[4,5]Temporary intravascular shunting (TIVS) and temporary ectopic implantation offer alternative approaches, but both present significant challenges.^[6,7]IVS may cause toxin reflux and worsen the spread of infection in severely damaged patients.^[8]Temporary ectopic implantation helps in limb salvage under special circumstances but poses challenges in the second-stage replantation due to the increased risk of infection.^[7]Xenogeneic cross-circulation can initiate the self-repair mechanism of the limb by connecting it to the host’s circulation, promoting physiological function and tissue recovery, thereby prolonging the preservation time. However, it faces the critical challenge of immunological rejection.^[9]To safely and effectively improve the preservation and repair of severed limbs, the Microsurgery Branch of the Chinese Medical Association and the National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation developed this guideline. (The complete guidelines and information are provided in the Supplementary File, http://links.lww.com/CM9/C613).

To the Editor: Deep brain stimulation (DBS) is an established therapy for managing advanced Parkinson’s disease (PD), commonly targeting the subthalamic nucleus (STN) or globus pallidus internus (GPi). Although traditional omnidirectional electrodes effectively alleviate symptoms, they can inadvertently stimulate adjacent structures, resulting in side effects such as dysarthria and paresthesia, which may hinder optimal clinical outcomes. Directional electrodes, using segmented technology, address this limitation by enabling precise "current steering" for targeted stimulation, thereby reducing side effects.^[1]Although global studies have shown promising results with directional DBS, its clinical application in China, particularly in GPi-targeted therapy, remains limited. This study evaluates the safety and efficacy of a novel Chinese directional DBS system, focusing on its performance in both GPi and STN targets.

To the Editor: Proximal fibular osteotomy (PFO) has emerged as a minimally invasive, knee-preserving procedure for mild-to-moderate medial-compartment knee osteoarthritis (KOA), offering faster recovery and fewer complications than high tibial osteotomy (HTO);^[1]however, its mid- to long-term survival rates and predictors of conversion to subsequent surgery remain unclear. Consequently, we conducted a large cohort study to assess the incidence and timing of conversion from PFO to subsequent surgery and to identify associated perioperative predictors.

To the Editor: Bladder cancer (Bca) is the most common malignancy of the urinary tract worldwide.^[1]Muscle-invasive bladder cancer (MIBC), characterized by tumor invasion into the muscularis propria, has a high propensity to spread to lymph nodes and other organs. For patients with localized MIBC, the standard treatment is radical cystoprostatectomy (RCP) with bilateral pelvic lymphadenectomy and urinary diversion.^[2]Notably, incidental prostate cancer (Pca) is frequently identified during the pathological examination of RCP specimens. In clinical practice, managing patients with concomitant Bca and Pca presents several challenges. Many such patients have normal preoperative prostate-specific antigen (PSA) levels and unremarkable findings on conventional imaging, making early diagnosis of Pca difficult and often rendering the indication for prostate biopsy unclear. Furthermore, the clinical significance and prognostic impact of concurrent bladder and prostate cancers remain uncertain, and there are no established criteria for predicting the risk of incidental Pca based on pathological features. Treatment decisions for these patients are also complex. Currently, prostate-sparing cystectomy techniques have been introduced for select cases to preserve sexual function and fertility. However, organ-preserving procedures carry risks: they may leave occult bladder cancer that has invaded the prostate undetected, or they might fail to remove an incidental Pca.^[3,4,5]This study aimed to comprehensively elucidate the clinicopathological features, survival outcomes, and prognostic factors of patients with concomitant Bca and Pca.

To the Editor: Lung cancer has been the leading cause of cancer-related deaths worldwide for many years and an estimated 2.2 million new lung cancer cases and 1.8 million lung cancer-related deaths occurred in 2020.^[1]Lung adenocarcinoma (LUAD) is the most common pathological subtype of lung cancer recorded in the clinic, accounting for 50% of all diagnosed cases. Immunotherapy has been employed in the treatment of LUAD to inhibit the progression of disease and prolong survival.^[2]Nevertheless, LUAD continues to exhibit a poor prognosis due to the high mutation rates of genes that enable tumor to evade T cell detection and impair T cell function through multiple mechanisms. Therefore, it is imperative to decipher the mechanism of immune escape in LUAD to enhance our understanding of the pathogenesis of LUAD progression in the context of immune evasion. This article briefly summarizes the mechanisms of immune escape in LUAD.

To the Editor: Atrial fibrillation (AF), the most common sustained arrhythmia, affects approximately 59.7 million people globally, with patient numbers rising.^[1]Despite current treatments, patients with AF face elevated risks of mortality, heart failure (HF), and stroke, due to heterogeneity in presentation, progression, and outcomes. AF is traditionally classified into paroxysmal, persistent, and permanent, but these temporal patterns minimally influence management decisions beyond rhythm restoration. Given the complex and multifactorial pathophysiology of AF, personalized assessment integrating clinical features, biomarkers, and noninvasive tools may improve classification. Current guidelines recommend individualized management based on four domains: stroke risk, symptom severity, AF burden, and substrate severity. Although validated tools exist for stroke risk (CHA2DS2-VASC score), symptom severity (European Heart Rhythm Association [EHRA] score), and AF burden (the International Classification of Diseases [ICD] codes), no standardized criteria are available for substrate severity, highlighting the need for refined approaches.

To the Editor: Transcranial alternating current stimulation (tACS), a noninvasive brain stimulation (NIBS) technique, alters neural activity and behavior in humans by delivering low-intensity sinusoidal alternating current at a specific frequency (Hertz) to targeted brain areas through electrodes placed on the scalp.^[1]tACS regulates endogenous cortical oscillations through entrainment mechanisms to improve brain network communication.^[2]Over the past decade, it has been applied in various fields and has demonstrated promising outcomes in reducing psychiatric and neurological symptoms.^[3]

To the Editor: Telesurgery represents a promising advancement in medical technology, allowing skilled surgeons to perform complex procedures remotely. By leveraging high-speed internet infrastructure such as 5th generation mobile communication technology (5G), telesurgery has the potential to overcome geographical constraints and expand access to expert surgical care. However, its successful implementation depends on several critical factors, including stable, low-latency data transmission, reliable network performance, and the ability to maintain surgical precision over long distances. Patelet al^[1]established a remote surgical connection between Orlando and Shanghai using 5G, Wi-Fi, and fiber-optic technologies, and performed 10 robot-assisted nephrectomies on pig models. Rogerset al^[2]reported on a short-distance study in which three surgeons completed remote robot-assisted prostatectomies, demonstrating that telesurgery can be safely performed using low-latency telecommunications. Additionally, our team has previously conducted a series of remote animal model procedures and short-distance clinical trials.^[3,4]In this study, we evaluated the feasibility of cross-continental telesurgery, specifically examining the use of 5G networks and dedicated internet lines to ensure high-speed, uninterrupted communication between the surgical console and operative site [Figure 1A].

To the Editor: Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable lung condition characterized by the progressive obstruction of the airway following chronic inflammation of airways and/or alveoli. The prevalence of spirometry-defined COPD, which is characterized by post-bronchodilator forced expiratory volume in one second/forced vital capacity (FEV₁/FVC) ratio <0.7 in adults aged ≥ 40 years, is estimated to be 13.7% in the China Pulmonary Health (CPH) study.^[1]Unfortunately, due to the asymptomatic initiation, COPD is underdiagnosed, resulting in missed opportunities to treat the condition. Patients with undiagnosed early-stage COPD are likely to progress to more advanced stages, which are associated with poor health-related quality of life and increased healthcare costs.^[1]