2026年 · 第139卷第12期

Volume management is one of the most common clinical interventions performed for critically ill patients. Both insufficient and excessive fluid volume are associated with increased mortality. Fluid therapy should be tailored to each patient’s condition and hemodynamic status. Before and during fluid administration/removal, it is necessary to dynamically estimate volume status (S), volume responsiveness (R), and volume tolerance (T).^[1]In this editorial, an SRT strategy for volume management in critically ill patients has been recommended, and five echocardiography-based steps have been summarized to help better perform this strategy.

Generalized pustular psoriasis (GPP) is a rare but severe, potentially life-threatening condition characterized by widespread rashes and sterile pustule eruptions on nonacral skin. Flares often include systemic symptoms, such as high fever and malaise, which may lead to sepsis and multiorgan failure, with mortality rates between 4% and 24%. Reported prevalence rates differ widely, ranging from 1.76 to 198 cases per million people.^[1]A variety of proinflammatory cytokines, particularly interleukin (IL)-36, are central to GPP pathogenesis. Its rapid onset and recurrent flares present significant management challenges. However, recent years have seen substantial progress in understanding GPP pathogenesis, development of targeted biological therapies, and clinical guideline updates, offering new hope for patients.

To the Editor: Depression affects at least 300 million people globally to varying degrees and is projected to be the number one disorder in terms of disability and disease burden by 2030.^[1]Among university students, depressive symptoms are mostly manifested as a sub-healthy state characterized by low mood, despair, nervousness, and even suicidal intentions. At present, the detection rate of depressive symptoms among college students is much higher than that of other groups, with a year-by-year upward trend. Working memory is the cognitive function of temporary storage and processing of current information. Importantly, there is a high degree of overlap between the brain regions affected by depression and those related to executive functions of working memory.^[2]As one of the core cognitive functions, improvements in working memory are closely related to the ability of depressed people to regain normal social functioning.^[3]Compared to their healthy counterparts, depressed populations have greater difficulty removing irrelevant information from working memory and may experience amnesia.

To the Editor: Metabolic dysfunction-associated steatotic liver disease (MASLD) is becoming a leading cause of chronic liver disease globally, with its prevalence continuing to rise.^[1]Substantial evidence indicates that MASLD can progress to severe hepatic conditions and increase the risk of extrahepatic complications. Consequently, understanding the underlying mechanisms of MASLD is crucial. Extended exposure to a western dietary pattern alters the gut microbiota (GM) composition, which constitutes an initial trigger for MASLD development. The liver–GM communication operates through the structural foundation of the biliary tract, portal vein, and systemic circulation. The GM and associated metabolites compromise the intestinal barrier, migrate to the portal system, and trigger hepatic steatosis and inflammation. Conversely, the liver influences microbial populations through bile acid (BA) circulation and bioactive molecules. Thus, the bidirectional regulation of the gut–liver axis serves as a critical factor in both the onset and progression of MASLD.

To the Editor: Locally advanced renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus (IVCT) (RCC-IVCT) poses a significant challenge in renal cancer surgery. Traditionally, the Mayo classification system has offered invaluable guidance for the surgical treatment of IVCT in the open and robot-assisted surgical era by designing surgical strategies based on the height of the IVCT.^[1]However, additional factors can influence the surgical strategy for IVCT, including thrombus morphology, bland thrombus, and IVC invasion.^[2,3]In the present study, we aimed to develop a decision-making scheme for IVCT morphological grouping and report surgical strategies for IVCT with various special morphologies.

To the Editor: Cytomegalovirus (CMV) infection remains a leading cause of morbidity and mortality in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients, particularly in high-risk populations with human leukocyte antigen (HLA) mismatch, haploidentical donors, or intensive conditioning regimens.^[1]Letermovir, a selective inhibitor of the CMV terminase complex, has demonstrated efficacy in reducing CMV reactivation in phase 3 trials.^[2]However, the optimal time for initiating letermovir prophylaxis post-transplantation remains unclear, with clinical practices varying widely between institutions. Here, we report a multicenter retrospective study evaluating the impact of letermovir initiation timing on clinically significant CMV infection (csCMVi) in high-risk patients with allo-HSCT.

To the Editor: Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening disease characterized by immune overstimulation and hyperinflammatory response.^[1]Although the prognosis is poor, with a high mortality rate of up to 58% in critically ill patients,^[2]the treatment for HLH is potentially curative. Active HLH treatment involves immunosuppressive induction therapy, followed by hematopoietic stem-cell transplant (HSCT).^[3]This treatment has potentially high value, because progressive HLH can lead to the failure of multiple organs if left untreated, but at a very high cost. Although HSCT has been included in the medical insurance reimbursement list in China, coverage for HLH remains limited, and patients often face substantial out-of-pocket expenses, particularly for self-paid medications. Consequentially, patients with HLH will experience a very significant burden of the expenditure for medical care as well as the disease itself. A certain proportion of patients might also give up HSCT treatment due to unaffordability. Furthermore, the medical management of HLH, especially for the HSCT treatment, needs multiple hospital admissions, which unquestionably would impact patients’ lives in meaningful and costly ways.

To the Editor: Cataracts, the leading cause of global visual impairment, affect nearly 80% of people aged 60–89 years and over 90% of those over 90 years old in China, with prevalence estimated to reach 200 million by 2025.^[1]Traditional diagnosis relies on slit-lamp examinations,^[2]but inter-observer variability and limited access in low-resource settings highlight the need for improved diagnostic approaches. Artificial intelligence (AI) and deep learning, particularly convoluted neural network (CNN)-based models such as ResNet and VGG, have demonstrated strong potential for cataract grading using anterior segment images, which allow direct visualization of the lens compared with fundus photography.^[3]Key limitations include variability in disease progression, demographic biases, and dependence on pupil dilation. We propose a novel dual-input deep learning model using slit-lamp and diffuse light images to enhance diagnostic accuracy, incorporate bilateral asymmetry, and support early detection across diverse clinical settings, improving patient outcomes and care accessibility.

To the Editor: Hyperammonemia, a severe metabolic anomaly, often precipitates life-threatening neurological disruptions. Recent studies confirm a definitive association between sustained hyperammonemia and adverse outcomes in acute hepatic failure (AHF) patients. Therefore, the importance of ammonia-lowering therapies in the management of AHF cannot be ignored. Various treatments are recommended to control blood ammonia levels in AHF, including hemofiltration, supplementation with arginine and citrulline, lactulose, and antibiotics. However, these approaches primarily address the symptoms rather than the underlying cause of the condition. Mesenchymal stromal cells (MSCs) have emerged as a promising alternative for treating AHF. Although previous findings underscore MSCs’ capability to lower blood ammonia levels, their exact molecular pathways of action remain to be elucidated.

To the Editor: Owing to the difficulty of self-repair, large segmental bone defects caused by fractures, infections, and bone tumors generally result in nonunion.^[1]Artificial bone, which has a structure and functions similar to autogenous bone, is urgently required in clinical settings. For repairing a large segmental bone defect, growth factors and cultured cells have been incorporated as composite scaffolds to mimic the structure and osteoinductive components of autogenous bone. However, the difficulty in producing hierarchical structures, early burst release of growth factors, high costs, tumorigenic potential of synthetic growth factors, and indeterminate differentiation of mesenchymal stem cells (MSCs) have hindered the development of novel bone materials. We previously designed true bone ceramic (TBC) by sintering cancellous bovine bone.^[2]Additionally, we previously designed a short peptide, P28 (S[PO4]DDDDDDDKIPKASSVPTELSAISTLYL, molecular weight: 3091.20), which is derived from the knuckle epitope of bone morphogenetic protein-2 (BMP2).^[3]In this study, TBC scaffolds were enhanced with carboxylated graphene oxide (CGO) to control the delivery of P28 and growth factors [Supplementary Figure 1, http://links.lww.com/CM9/C495].