2026年 · 第139卷第18期

Neonatal arterial ischemic stroke (NAIS) refers to pathological brain tissue damage caused by focal cerebral arterial infarction within the first 28 days after birth.^[1]NAIS accounts for approximately 80% of perinatal strokes.^[2]The reported incidence of NAIS is 18.51/100,000 live births^[3]and 32/100,000 in preterm infants.^[4]The early symptoms of NAIS are atypical, making it prone to misdiagnosis or missed diagnosis.^[5]NAIS is a significant cause of childhood hemiplegia, cerebral palsy, and cognitive dysfunction. In 2017, China issued the Experts’ consensus on the diagnosis and treatment of neonatal arterial ischemic stroke (in Chinese), which provided preliminary clinical diagnoses and treatment suggestions.^[6]However, limited by insufficient evidence at the time of the consensus, many disagreements remain regarding the risk factors, diagnosis, treatment, and prognosis of this disease. These guidelines, formulated based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology and currently available evidence, provides a comprehensive clinical diagnosis and treatment plan for NAIS.

To the Editor: Generalized pustular psoriasis (GPP) is a chronic, systemic, neutrophilic inflammatory disease that is distinct from plaque psoriasis.^[1]Flares are a hallmark of GPP and although the severity, frequency, and length of flares varies widely between patients, significant flares are often accompanied by systemic symptoms. Life-threatening complications of GPP include sepsis and renal, hepatic, respiratory, and heart failure. Reported GPP mortality rates range from 2% to 16%.^[1]

To the Editor: Intestinal lymphoma (IL) is a rare gastrointestinal malignancy that accounts for only 1-5% of all intestinal cancers.^[1]Its diagnosis depends on gastrointestinal endoscopic biopsy or postoperative pathological examination. However, acquiring qualified and sufficient specimens is difficult because IL originates from the submucosal and lamina propria lymphoid tissue. The endoscopic features of IL vary widely depending on the pathological subtypes, resulting in a low endoscopic diagnostic rate.

To the Editor: Colorectal cancer (CRC) ranks third in cancer incidence and second in cancer mortality worldwide.^[1]With the implementation of CRC screening, the occurrence of CRC in those aged 50 years or older has remained stable or decreased in high-income countries. By contrast, CRC diagnosed under the age of 50 years, deemed early-onset CRC, has been increasing worldwide. Early-onset CRC is projected to become the leading cause of cancer-related death among individuals aged 20 to 49 years by 2030.

To the Editor:Progressive decline of pancreatic β-cell insulin secretion, with or without insulin resistance, is a central feature of type 2 diabetes pathophysiology. Accurate assessment of β-cell function is therefore essential for appropriate diagnosis and treatment selection. Several methods exist, including the homeostasis model assessment (HOMA),^[1]which uses fasting glucose and insulin and is widely used in epidemiological studies, but lacks accuracy. Load tests remain the gold standard for precise assessment of islet function, including oral glucose tolerance tests (OGTT),^[2]intravenous glucose tolerance tests (IVGTT),^[3]mixed-meal tolerance tests (MMTT),^[4]and hyperglycemic clamps. These methods require repeated venous sampling for insulin or C-peptide measurements, thereby increasing patient discomfort and restricting their frequent use. Clinically, non-invasive methods for β-cell function assessment are needed.

To the editor: Psoriasis affects more than 125 million people worldwide, with plaque psoriasis being the most common type.^[1]Traditional therapeutic modalities for moderate-to-severe disease are often ineffective and associated with potential safety issues.^[2,3]In recent decades, biologic agents such as interleukin (IL)-17A/IL-23 inhibitors have significantly improved treatment outcomes.^[3]Secukinumab is a first-line biologic agent commonly used in clinical practice in China.^[4]However, clinicians often face challenges when using it for long-term treatment. These challenges include unclear optimal duration, significant interpatient variability in efficacy, and a high relapse rate.^[5]This study used nationwide, multicenter, real-world data to identify relapse risk factors, construct and validate a practical relapse prediction model, and establish a risk stratification system to provide a reference for personalized treatment.

To the Editor: Fever is one of the oldest recognized signs of infection, yet its management in septic patients remains controversial, with inconclusive findings.^[1,2]Given the diverse effects of fever in sepsis, it is crucial to identify patients who can benefit from its antimicrobial and immunomodulatory properties while tolerating the increased metabolic demands of elevated body temperature (BT). Schulmanet al^[3]provided indirect support for this concept, demonstrating that aggressive fever treatment in younger critically ill patients (mean age 47 years) was associated with higher mortality compared to a permissive approach. Age may be a key explanatory factor, as younger patients typically have fewer chronic cardiorespiratory impairments and greater physiological reserve, potentially enabling a more effective adaptive response to fever.

To the Editor: Alzheimer’s disease (AD) is a progressive neurodegenerative disorder involving complex interactions among genetics and structural and functional changes in the brain.^[1]While theAPOEε4 allele is the strongest genetic risk factor for sporadic AD, its influence on cognition varies across the AD spectrum.^[2,3,4]In this study, we investigated whether hippocampal volume and spontaneous local brain activity, measured by four-dimensional consistency of local neural activities (FOCA), moderate or mediate the relationship between theAPOEgenotype and cognitive performance.

To the Editor: Metabolic-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is a prevalent chronic liver disorder characterized by hepatic steatosis and inflammatory progression.^[1]It currently affects approximately 25% of adults worldwide. Although resmetirom has been approved for noncirrhotic non-alcoholic steatohepatitis accompanied by moderate to advanced liver fibrosis (stages F2-F3), effective therapeutic agents for MASLD remain limited.^[2]