Volume 105 · Issue 10 · 2025

This paper discussed the major updates of the 2024 revision of the Declaration of Helsinki-Ethical Principles for Medical Research involving Human Participants from the investigator perspective. Ethical requirements regarding the "risks, burdens and benefits", "vulnerability of individuals, groups and communities", "scientific requirements and research protocols", "Research ethics committees", "free and informed consent" were interpreted, and discussed with identified concerns and challenges. It is emphasized that researchers must assure compliance with ethical requirements and norms throughout the whole process of research, including the topic selection, research participants selection, research implementation process, data analysis, and results reporting. At the same time, researchers must cultivate their ethical literacy, develop partnerships with various stakeholders, and finally assure the responsible conduct of medical research involving human participants.

Hereditary hearing loss, with its well-defined molecular etiology, is a typical disease suitable for applying the concept of individualized precision medicine to clinical practice. Given its genetic heterogeneity and phenotypic diversity, there are particularities for the surgical treatment of hereditary hearing loss. Based on the results of the molecular epidemiological survey of large samples of deafness, various surgical methods and postoperative follow-up data, this expert consensus formulates a detailed guidance plan for the surgical treatment, efficacy evaluation and postoperative rehabilitation of hereditary hearing loss.

To explore the efficacy of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) technology in rigid esophagoscopy for foreign body removal under general anesthesia.

Patients who underwent rigid esophagoscopy for foreign body removal under general anesthesia from September to December 2022 at Beijing Tongren Hospital were prospectively included. After entering the operating room, all patients received high-flow oxygen for 5 minutes, with an inhaled temperature of 37 ℃, an oxygen concentration of 100%, and an oxygen flow rate of 30 L/min. After anesthesia induction, the oxygen flow rate was adjusted to 60-80 L/min until the patients awoke. The primary outcome was the success rate of THRIVE defined as percutaneous oxygen saturation (SpO₂)≥95% throughout anesthesia, while the safety outcome was the incidence of complications associated with THRIVE. The operation time, apnea time, anesthesia duration, heart rate, mean arterial pressure, and SpO₂ were recorded at the following time points,such as entering the operating room (T0), after 5 minutes of high-flow oxygenation (T1), post-anesthesia induction (T2), during esophagoscope insertion (T3), at the end of the procedure upon esophagoscope withdraw (T4), upon awakening (T5), and upon exiting the operating room (T6).

Fifty patients (17 males and 33 females) were enrolled, with an age of (54.0±20.5). The success rate of THRIVE technology was 86%(43/50). A total of 7 patients required airway intervention, among which 6 patients underwent mask compression ventilation and 1 patient underwent endotracheal intubation intraoperatively. Three cases occurred before the end of esophagoscopy and required interruption of esophagoscopy for airway intervention. No complications related to THRIVE technology were observed. The heart rate of all patients was (86±12) beats/min at T6, which was significantly higher than that of (79±15) beats/min at T2 (P<0.001). The mean arterial pressure (MAP) was (90.4±13.3) mmHg (1 mmHg=0.133 kPa) at T2, which were significantly lower than that of (105.5±14.2) mmHg at T0 and (102.0±13.7) mmHg at T1. The mean arterial pressures at T4 and T5 were (84.8±15.0) and (82.9±14.5) mmHg, respectively, which were significantly lower than the (90.4±13.3) mmHg at T2 (all P<0.001). No cardiovascular or respiratory adverse events occurred during the procedure or the postoperative recovery monitoring period.

THRIVE technology can be safely and effectively applied in rigid esophagoscopy for foreign body removal under general anesthesia, providing effective oxygenation, and maintaining stable circulation.

To investigate the association between the microcystic, elongated, and fragmented (MELF) growth pattern and the prognosis of no specific molecular profile endometrial endometrioid carcinoma (NSMP-EEC).

A retrospective study was conducted on 911 NSMP-EEC patients diagnosed at the Pathology Department of Peking University Third Hospital from January 2015 to September 2023. Complete hysterectomy specimens were obtained from these patients. Utilizing sanger sequencing, next generation sequencing and immunohistochemical techniques, we conducted endometrial carcinoma molecular classification according to WHO 2020 criteria, and identified clinical staging based on the International Federation of Gynecology and Obstetrics (FIGO) 2023 criteria. The primary endpoints were progression-free survival and disease-specific survival. Patients were divided into MELF (+) and MELF (-) groups based on the presence or absence of the MELF growth pattern, and clinicopathological characteristics were compared between the two groups. Kaplan-Meier survival curves were used to analyze the association between the MELF growth pattern and prognosis, and log-rank tests were performed to compare differences between groups.

The age of the 911 patients was (54.4±10.7) years, with a follow-up time [M (Q₁,Q₃)] of 24.0 (11.0, 41.0) months, and of which 147 patients (16.1%) belonged to the MELF (+) group. The MELF (+) group had a higher proportion of postmenopausal patients and G1/G2, deep myometrial invasion, lymphovascular space invasion, and lymph node metastasis, higher FIGO stages, higher ESGO risk groups, and higher tumor recurrence rates compared to the MELF (-) group (all P<0.05). The cumulative 5-year progression-free survival rate for MELF (-) and MELF (+) patients were 92.2% and 85.8%, respectively (P=0.015). In the G1/G2 NSMP-EEC cohort, the cumulative 5-year progression-free survival rate for MELF (-) and MELF (+) patients were 94.2% and 86.6%, respectively (P=0.003). The prognosis of NSMP-EEC patients with 2023 FIGO stage I was better, exhibiting a cumulative 5-year progression-free survival rate of 95.2% and a cumulative 5-year disease-specific survival rate of 99.1%, respectively, and MELF (+) was not associated with a decrease in either the cumulative progression-free survival rate (P=0.213) or the cumulative disease-specific survival rate (P=0.373) of patients.

In NSMP-EEC patients, MELF (+) is associated with various adverse clinicopathological indicators and increased recurrence risk, providing a simple and rapid morphological indicator for risk stratification. The prognosis of NSMP-EEC patients with 2023 FIGO stage Ⅰis better, and the use of MELF alone is insufficient for risk stratification.

To explore the clinical value of histogram parameters of the whole-leison apparent diffusion coefficient (ADC) in the histological grade of bladder urothelial carcinoma before operation.

A retrospective analysis was conducted on patients with pathologically-proven bladder urothelial carcinoma who underwent preoperative bladder MRI at the First Medical Center of Chinese PLA General Hospital between January 1, 2019 and July 30, 2022. The patients were divided into high-grade and low-grade groups based on the histological grading of bladder urothelial carcinoma. The ADC histogram parameters of the two groups were compared. Multivariate logistic regression analyses were used to identify associated factors of high-grade bladder urothelial carcinoma. The diagnostic performance of the histogram parameters for the histological grade of bladder urothelial carcinoma was analyzed using receiver operating characteristic (ROC) curves.

A total of 63 patients were included, aged [M (Q₁, Q₃), 64 (42, 84)] years and comprising 52 males (82.5%). Among them, 30 patients (47.6%) were classified into the low-grade group, and 33 patients (52.4%) into the high-grade group. Differences were observed between the two groups in tumor volume, ADC_mean, ADC_1%, ADC_5%, ADC_10%, ADC_25%, ADC_50%, ADC_75%, ADC_90%, ADC_95%, ADC_99%, variance, kurtosis and skewness (all P<0.05). ADC_mean (OR=1.042, 95%CI: 1.004-1.082), ADC_10% (OR=0.975, 95%CI: 0.950-0.999) and ADC_75% (OR=0.979, 95%CI: 0.962-0.997) were associated with high-grade bladder urothelial carcinoma. The area under the curve (AUC) of ADC_mean, ADC_10% and ADC_75% for differentiating the histological grade of bladder urothelial carcinoma before surgery were 0.772 (95%CI: 0.649-0.868), 0.690 (95%CI: 0.561-0.800) and 0.816 (95%CI: 0.698-0.902), respectively. The combined model of these 3 parameters demonstrated an AUC of 0.853 (95%CI: 0.741-0.929), with a sensitivity of 78.8% and a specificity of 83.3%. The diagnostic performance of the combined model was superior to that of ADC_10% alone (P=0.017), but no statistically significant differences were observed compared to ADC_mean and ADC_75% (both P>0.05).

Whole-lesion ADC histogram parameters, including ADC_mean, ADC_10%, ADC_75% and the combined model of these 3 parameters could be utilized for the histological grade of bladder urothelial carcinoma before operation, with high sensitivity and specificity.

To investigate the influence of medical environment familiarity on preoperative anxiety, anesthesia induction compliance, and emergence agitation (EA) in children undergoing adenotonsillectomy in a day surgery setting.

A retrospective analysis was conducted on children undergoing elective adenotonsillectomy in a day surgery setting under general anesthesia at the Second Affiliated Hospital of Wenzhou Medical University between January 2018 and December 2019, October 2020 and November 2022, and March and December 2023. The children were divided into three groups according to their familiarity with the medical environment: the control group (Group C), which included children from January 2018 to December 2019; the familiar group (Group F), which comprised children from October 2020 to November 2022; and the fairly familiar group (Group FF), which encompassed children from March to December 2023. The modified Yale preoperative anxiety scale (m-YPAS) score, parental separation anxiety scale (PSAS) score, open vein compatibility score, and induction compliance checklist (ICC) score were compared among the three groups. Multivariate logistic regression analysis was performed to identify factors associated with preoperative anxiety and the occurrence of EA.

A total of 754 children aged (4.8±1.3)years were included, with 485 boys and 269 girls. There were 289, 206, and 259 children in group C, F, and FF, respectively. The incidence of EA was lower in the group F [33.0% (68/206)] and group FF [17.0% (44/259)] compared to the group C [65.4% (189/289)] (all P<0.001). Multivariate logistic regression analysis showed that compared to the control group, familiar and fairly familiar with the medical environment were protective factors associated with lower m-YPAS score (OR=0.227, 95%CI: 0.155-0.333; OR=0.292, 95%CI: 0.205-0.416), lower PSAS score (OR=0.239, 95%CI: 0.158-0.364; OR=0.137, 95%CI: 0.087-0.213), lower ICC score (OR=0.118, 95%CI: 0.071-0.194; OR=0.224, 95%CI: 0.166-0.359), and a lower risk of EA (OR=0.511, 95%CI: 0.298-0.877; OR=0.161, 95%CI: 0.084-0.307). Additionally, these factors were associated with higher open vein compatibility score (OR=3.858, 95%CI: 2.624-5.672; OR=6.807, 95%CI: 4.569-10.141) (all P<0.05).

Familiarity with the medical environment significantly influenced the psychological and behavioral outcomes of children undergoing surgery. Greater familiarity was associated with reduced preoperative parental separation anxiety, improved cooperation during anesthesia induction, and a lower incidence of EA.

To investigate the effect of transcutaneous auricular vagus nerve stimulation (taVNS) on fear memory and its regulatory role in splenic inflammatory responses in fear-conditioned mice.

Twenty-four 12-week-old healthy, male C57BL/6J mice were randomized into two groups using a random number table: taVNS (n=12) and control (n=12). Both groups underwent conditioned fear modeling using a fear conditioning chamber. The taVNS group received daily taVNS stimulation (dense-disperse wave, 2 Hz/15 Hz, intensity 2 mA, 30 min) for 6 consecutive days, while the control group received sham taVNS (intensity 0 mA, with other parameters identical to the taVNS group). Following two stimulations, the freezing time percentage of contextual fear memory was assessed, along with total distance and time spent in the center zone of the open-field test. After the 4th and 6th stimulations, the freezing time percentage of auditory-cued fear memory was evaluated. Following all behavioral tests, mice were euthanized to measure the spleen index, and levels of interleukin (IL)-1β and IL-10 were measured in both the serum and spleen tissues.

After two stimulations, the freezing time percentage of contextual fear memory in the taVNS group was lower than that of the control group (10.7%±8.0% vs 25.8%±14.3%, P=0.004), while the total distance [(363.1±125.8) cm vs (234.1±99.2) cm, P=0.011] and total time [(39.0±14.7) s vs (23.4±11.6) s, P=0.008] in the center zone of the open-field test were higher in the taVNS group. The freezing time percentage of auditory-cued fear memory was lower in the taVNS group compared to the control group after the 4th (36.4%±18.5% vs 58.4%± 21.5%, P=0.013) and 6th (30.3%±20.7% vs 63.2%±26.6%, P=0.003) stimulations. Serum and splenic IL-1β levels were lower in the taVNS group compared to the control group (all P<0.05), while serum and splenic IL-10 levels were higher in the taVNS group (all P<0.05).

This study indicates that taVNS reduces fear memory in fear-conditioned mice, accompanied by improvements in systemic and splenic inflammatory respcnses, suggesting that splenic inflammatory response may be associated with the effect of taVNS in reducing fear memory.

To analyze the maternal and neonatal outcomes of pregnancy after sleeve gastrectomy (SG), the clinical data of 20 pregnant women who had pregnancy after SG and received regular prenatal examinations and delivered in the obstetrics department of Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2018 to April 2024 were retrospectively collected. The weight gain during pregnancy, pregnancy complications, comorbidities and maternal and neonatal outcomes were observed. The age of the 20 pregnant women after SG was (33.9±3.5) years, the interval [M(Q₁,Q₃)] between SG and pregnancy was 28 (20, 57) months, 12 cases (60.0%) were overweight or obese before pregnancy, and the weight gain during pregnancy was (10.1±5.4) kg. There were 8 cases (40.0%) with hyperglycemia during pregnancy, 7 cases (35.0%) with hypertensive disorders of pregnancy, 12 cases (60.0%) with anemia during pregnancy, and 7 cases (35.0%) with dyslipidemia. There were 21 newborns with the birth weight of (3 003.6±559.7) g. Among the newborns, there were 5 small for gestational age infants, and there were no macrosomia or large for gestational age infants. There were 10 cases (50.0%) of cesarean section, 10 cases (50.0%) of vaginal delivery, and 2 cases (10.0%) of postpartum hemorrhage. There were no deaths among the pregnant women or the newborns.Pregnancy after SG belongs to high-risk pregnancy. Pre-pregnancy health care and guidance should be strengthened, and after pregnancy, close attention should be paid to the related indicators of pregnancy metabolic diseases such as blood glucose, blood pressure and blood lipids as well as the weight gain during pregnancy to ensure the safety of mothers and infants.

The current study aimed to evaluate the application value of the domestic otolaryngology-specific flexible-arm robotic system in the resection of throat tumors. A 53-year-old male patient diagnosed with a left-sided throat tumor underwent tumor resection with robotic assistance at ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University in October 2024. Intraoperative parameters including positioning time, operation time, intraoperative blood loss, vital signs, and length of hospital stay were observed. The postoperative pathological report was analyzed through outpatient follow-up, and the results were evaluated in conjunction with laryngoscopic examinations. The surgery was successfully completed in 30 minutes, with the blood loss of less than 1 ml. The patient recovered well and was discharged as scheduled. Pathological findings revealed moderate to severe atypical hyperplasia of the laryngeal mucosa. The study indicates that robotic system has substantial application value and holds significant potential for clinical promotion.

A patient with autologous renal cell carcinoma complicated with hemophagocytic syndrome after renal transplantation was reported. The patient, a 40-year-old male, was admitted to the Third Xiangya Hospital of Central South University on June 3, 2023 due to "low fever for more than 1 month and shortness of breath for 2 days". The patient had previously undergone allogeneic kidney transplantation in our hospital on August 28, 2012, and undergone radical left nephrectomy on July 9, 2020 due to autologous left kidney renal cell carcinoma. This time, he was re-admitted 3 years later due to pulmonary infection, showing fever, splenomegaly, decreased red blood cells, hemoglobin and platelets, increased ferritin and soluble interleukin-2 receptors, and decreased natural killer cell activity, and was diagnosed as hemophagocytic syndrome. The patient was in critical condition. After informing his family of his illness, his family asked to be transferred to a local hospital for palliative care, and finally died.

In May 2024, the health industry standard WS/T 230-2024 "Guidelines for the Application of Real-time Fluorase Chain Reaction in Clinical Laboratories" was released. The formulation of this standard fully refers to the relevant national medical laws, regulations and industry standards, relevant domestic and foreign standards/guidelines and literature evidence, the application and management practice of real-time fluorescence polymerase chain reaction in clinical laboratories and expert opinions. This paper explains the requirements of sample collection and processing, methods, pollution prevention and control, quality management, result interpretation and reporting, laboratory biosafety, clinical scope of application, etc. in the application of real-time fluorescence polymerase chain reaction in clinical laboratory, aiming at helping relevant staff and managers to better understand and apply this standard.

Cell burial is a rapid and efficient process of removing apoptotic cells, mainly in macrophages. This process inhibits secondary necrosis and inflammation by removing apoptotic cells, and maintains the body's immune balance. More and more studies have confirmed the link between cell burial and lung disease. In this paper, the mechanism, regulation and immune effect of cell burial were introduced in detail, and the role of cell burial in the pathological process of acute and chronic lung diseases such as acute respiratory distress syndrome, asthma, chronic obstructive pulmonary disease, pulmonary fibrosis and lung tumor were analyzed. The therapeutic drugs and methods targeting cell burial were analyzed, such as the application of corticosteroids, statins and macrolide antibiotics, and local antioxidant therapy, so as to provide new directions for exploring cell burial in the future and provide new ideas for the treatment of lung diseases.

A 60-year-old male was admitted with "weakness of both lower limbs for 3 months, neck stiffness for 20 d, aggravation with pain for 3 d". Three months before admission, the patient developed weakness in both lower limbs after labor, which could be relieved by rest. Later, the symptoms aggravated with numbness, which gradually failed to be completely relieved. 20 days ago, he felt neck stiffness and discomfort, and 3 days ago, it aggravated with local persistent pain. Physical examination: Muscle strength of both lower limbs grade 4, no hypoesthesia, and bilateral pathological signs were negative. Twenty years of previous history of hypertension. MRI: Thickening of medulla oblongata and cervical spinal cord, T₂Long strip abnormal lesions with high signal were seen in WI (Figure 1, arrows), T₂FLAIR showed hyperintensity lamellar abnormal lesions in the medulla oblongata (Figure 2, arrow), which was suspected of myelitis. After hormone therapy, limb weakness was aggravated. Physical examination: muscle strength of both lower limbs was grade 4, accompanied by superficial hypoesthesia, and bilateral pathological signs were positive. Enhanced MRI showed abnormally enhanced vascular shadows on the ventral side of the medulla oblongata and cervical cord (Figure 3, arrow), and high cervical spinal dural arteriovenous fistula (SDAVF) was suspected. Digital subtraction angiography (DSA): a thick drainage vein connected to a branch of the left vertebral artery V3 segment was visible, and the spinal vein was thickened (Figure 4, arrows), and SDAVF was diagnosed. SDAVF is a rare spinal vascular malformation, which is caused by the communication between the arteries supplying the dura and the drainage veins of the spinal cord on the dura, and is clinically characterized by progressive aggravation of limb motor and sensory dysfunction. Hormone therapy aggravates the condition. MRI shows long-segment myelitis-like abnormal changes, similar to long-segment myelitis of neuromyelitis optica spectrum diseases, but with local vascular flow empty shadows or abnormal enhancement of malformed vessels on the spinal cord surface. DSA examination can confirm the diagnosis.