Volume 105 · Issue 11 · 2025

Myelosuppression is a common hematological side effect of oncological treatment, mainly including neutropenia, thrombocytopenia and anemia. Due to the delay in its clinical manifestation, a well-established out-of-hospital management system can help clinicians better prevent and manage the myelosuppression associated with oncology treatment and ensure the effectiveness and safety of antitumor therapy. This consensus focuses on a detailed compilation and summary of the definition and grading of myelosuppression associated with oncological treatment, the principles of out-of-hospital management, the management process and management methods, develops a risk stratification assessment table for oncology treatment-related myelosuppression, and puts forward 8 recommendations based on the risk stratification, which is aimed at providing medical workers with a reference plan for the out-of-hospital management of myelosuppression associated with oncological treatment.

Spinal cord stimulation (SCS) has been used for decades in clinical treatment of chronic pain such as painful diabetic neuropathy, and its efficacy and safety have been widely confirmed. The selection of appropriate patients, professional SCS implantation technology, precise postoperative programming, and regular follow-up are the basis for curative effect, which puts higher requirements on the theoretical knowledge and practical skills of clinicians. To address this need, the Physicians Branch of the Department of Pain of the Chinese Medical Doctor Association and the Professional Committee of Neuroregulation of the Chinese Medical Doctor Association organized expert clinicians in relevant fields to develop this consensus on patient selection, preoperative planning, intraoperative techniques, postoperative care, and prevention and treatment of common adverse reactions, aiming to enhance the quality of SCS therapy for patients with painful diabetic neuropathy.

To analyse the efficacy and safety of endoscopic direct-vision appendicitis therapy (EDAT) in patients with acute appendicitis.

The clinical data of patients diagnosed with acute appendicitis and underwent surgical treatment from May 2023 to July 2024 at Zhongda Hospital of Southeast University were analysed retrospectively. The patients were divided into EDAT group (41 cases) and laparoscopic appendectomy (LA) group (630 cases) according to the surgical methods. After 1∶2 propensity score matching (PSM) based on general baseline information, Alvarado score and underlying diseases, the perioperative period and prognosis indicators were compared between the 2 groups. The deadline for follow-up was October 30, 2024.

A total of 123 patients were included after PSM, 41 patients in EDAT group, including 21 males and 20 females, aged [M (Q₁, Q₃)] 55 (37, 61) years; and 82 patients in LA group, including 41 males and 41 females, aged 50 (35, 60) years. A total of 366(221, 492) days were followed up. The operative time [ (38.7±22.3) vs (54.8±16.2) min], postoperative intestinal function recovery time [(2.5±1.3) vs (21.8±5.0) h], duration of antibiotic use [2 (2, 2) vs 3 (3, 4) d] and hospitalisation days [2 (1, 2) vs 3(2, 4) d] in EDAT group were shorter than those in LA group; postoperative visual analogue scale (VAS) score at 6 hours [(3.2±1.3) vs (5.5±1.2) scores] was lower than that in LA group; the proportion of patients with intraoperative bleeding >20 ml [0 vs 61% (50/82)] and proportion of painkiller use [7.3% (3/41) vs 69.5% (57/82)] were lower than those of LA group (all P<0.001). The rate of postoperative recurrence in EDAT group was higher than that in LA group [4.9% (2/41) vs 0, P=0.035].

EDAT is effective and safe in treating patients with acute appendicitis, but patients are at risk of recurrence.

To investigate the correlation between the completion rate of sepsis 1-hour bundle therapy and the prognosis of patients with sepsis or septic shock, as well as to survey the awareness and implementation status of sepsis bundle therapy among medical staff in intensive care unit (ICU).

The medical records of patients with sepsis or septic shock admitted to the Department of Critical Care Medicine of Zhongda Hospital, Southeast University from January 2020 to January 2024 were analyzed retrospectively. The patients were divided into two groups based on whether the bundle therapy was completed. The correlation between the completion of sepsis bundle therapy and the 28-day mortality rate of patients was analyzed. From August 3 to 20, 2023, a survey on the awareness and implementation status of sepsis bundle therapy among ICU medical staff in China was conducted using the WJX (Questionnaire Star) form.

A total of 712 patients with sepsis or septic shock were included in the analysis, comprising 470 males and 242 females, with a mean age of (66.92±16.36) years. Among them, 575 (80.8%) were in the bundle therapy completion group, and 137 (19.2%) were in the non-completion group. There were no statistically significant differences in age, gender, and disease severity between the two groups (P>0.05). However, the 28-day mortality rate was lower in the completion group compared to that in the non-completion group (28.7% vs 39.4%, P=0.015). Completion of bundle therapy was associated with a lower mortality risk in patients with sepsis or septic shock (OR=0.358, 95%CI: 0.216-0.595). The survey part included 1 339 ICU medical staff from 680 hospitals across 32 provinces, autonomous regions, and municipalities in China, with a valid response rate of 99.0% (1 325/1 339). Among them, 92.5% (1 226/1 325) of the ICU medical staff claimed to have mastered the diagnostic criteria and treatment measures of sepsis bundle therapy, but in reality, only 25.2% (334/1, 325) of the ICU medical staff could fully grasp the relevant knowledge. The surveyed ICU medical staff focused their suggestions for improving the completion rate of sepsis bundle therapy on knowledge training (86.6%, 1 148/1 325), quality supervision and feedback (79.8%, 1 057/1 325), and improvement of information-based data capture (72.2%, 957/1 325).

The completion rate of sepsis bundle therapy is correlated with the 28-day mortality rate of patients with sepsis or septic shock. The mastery of sepsis bundle therapy by ICU medical staff is not satisfactory.

To evaluate the efficacy and safety of stereotactic electroencephalography (SEEG)-guided 3D radiofrequency thermocoagulation (RF-TC) in the treatment of drug-resistant mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE-HS).

This study was a randomized controlled trial. The patients with drug-resistant mTLE-HS recruited from Xuanwu Hospital, Capital Medical University between August 2019 and October 2022 were prospectively enrolled. The patients were randomly assigned to receive either anterior temporal lobectomy (ATL) or RF-TC treatment using a variable block randomization method. All patients were assessed both preoperatively and 1 year postoperatively. The postoperative outcomes in terms of epileptic seizure results, visual field defects, and surgery-related complications were compared between the two groups.

A total of 38 patients were included, 19 males and 19 females, with an average age of (28.3±6.9) years. There were 20 cases in the ATL group and 18 cases in the RF-TC group. There was no statistically significant difference in age [(28.5±5.7) vs (28.2±8.1), P=0.848] or gender distribution (7/20 vs 12/18, P=0.103) between the both groups. At the 1-year follow-up post-surgery, there was no statistically significant difference in the proportion of patients achieving Engel Class Ⅰfor epileptic seizure results between the ATL group and the RF-TC group (17/20 vs 13/18, P=0.438). The proportion of patients in the ATL group who developed visual field defects was higher than that in the RF-TC group (15/20 vs 3/18, P<0.010). No severe adverse events were observed in both groups.

The epilepsy control efficacy of SEEG-guided 3D RF-TC is comparable to that of traditional surgery, while offering superior outcomes in visual field preservation.

Three hundred and twelve acute large vessel occlusion stroke patients who underwent mechanical thrombectomy at Changshu Hospital of Traditional Chinese Medicine, Suzhou Ninth People′s Hospital, and the Second Affiliated Hospital of Soochow University from July 2016 to December 2023 were retrospectively collected. The patients were divided into effective recanalization group(mRS<3) and ineffective recanalization (mRS≥3) group based on 90-day modified Rankin scale(mRS) scores. Serum magnesium levels were categorized into tertiles: T1(Mg²⁺≤0.75 mmol/L), T2(0.75 mmol/L<Mg²⁺≤0.84 mmol/L) and T3(Mg²⁺>0.84 mmol/L), and the relationship between serum magnesium levels and ineffective recanalization was evaluated. Multivariable logistic regression model was used to analyze the related factors of ineffective recanalization. Low serum magnesium levels (Mg²⁺≤0.75 mmol/L) (OR=1.94, 95%CI: 1.03-3.64), previous stroke history (OR=2.22, 95%CI: 1.04-4.75), pre-procedural hyperglycemia (OR=1.16, 95%CI: 1.05-1.29), and lower Alberta stroke early CT scores(ASPECTS) (OR=0.38, 95%CI: 0.20-0.72) were related risk factors for ineffective recanalization after mechanical thrombectomy. The proportion of patients with mRS scores of≥3 was highest in the T1 group [65.1% (71/109)] and lowest in the T3 group [51.0% (49/96)]. Serum magnesium level is closely related to functional prognosis of patients.

To investigate the efficacy and safety of transvenous lead removal (TLR) in the treatment of patients with cardiac lead perforation. The case data of 82 patients who underwent TLR for lead perforation at Peking University People's Hospital from January 2014 to June 2024 were retrospectively analyzed. The patients' age was (68.0±12.6) years, with 38 males and 44 females. Clinical symptoms of patients with lead perforation, characteristics of the perforated leads, operation success rate, complication incidence, tools used in TLR, and follow-up situation were analyzed. Clinical symptoms related to lead perforation were present in 80.5% (66/82) of patients, with chest pain being the most common [57.3%(47/82)]. Among the perforated leads, 6.1%(5/82) penetrated outside the pericardium, 58.5%(48/82) were delayed perforations, 65.9%(54/82) were active fixation leads, 78.0%(64/82) of the perforation sites were at the right ventricular apex, and 76.8%(63/82) had abnormal programmed lead parameters. The diagnosis of all lead perforations was confirmed by imaging examinations. Eight high-risk patients received percutaneous dry pericardiocentesis before surgery. Eighty-two patients underwent TRL surgery successfully, and no major complications occurred. Among the perforated leads, 57.3% (47/82) of the perforated leads were successfully removed manually. New leads were implanted in 91.5% (75/82) of patients during the same operation. Follow-up was conducted until August 2024, with a total follow-up duration of (5.1 ± 2.7) years. During the follow-up period, a total of 7 patients reached the end events, including 5 deaths and 2 patients who underwent TLR again. In experienced centers, TLR is a safe and effective treatment approach for cardiac implantable electronic devices lead perforation. Prophylactic dry pericardiocentesis can be used as an unconventional option.

This article reports a 58-year-old male patient who went to Peking Union Medical College Hospital on August 4, 2016 due to "dry mouth, dry eyes, and weight loss for more than half a year". The patient started with dry mouth and dry eyes, accompanied by progressive weight loss and multi-system involvement: the digestive system was prominently manifested as diffuse enlargement of the pancreas, rough gastric mucosa and shallow ulcer, and intestinal wall thickening; The respiratory system manifests as progressively aggravated ground glass nodules and patches; The hematological manifestations were multiple lymph nodes enlargement, mainly located in the mediastinum, retroperitoneal, peripancreatic and perigastric, with persistent M protein positivity; Other systems such as parotid gland, submandibular gland, lacrimal gland and other exocrine glands are involved. IgG4-related disease (IgG4-RD) was considered, but adequate hormone therapy was not effective; Finally, through repeated gastric mucosal biopsy and multidisciplinary diagnosis and treatment, it was confirmed to be mucosa-associated lymphoid tissue lymphoma (MALToma). On July 27, 2018, the patient started regular R-CHOP regimen (rituximab, cyclophosphamide, epirubicin, vindesine and prednisone) chemotherapy. The patient's condition improved and stabilized, and his daily life was unlimited. Follow-up until Oct. 5, 2024, the patient occasionally had chest tightness and fatigue after activity, and no other symptoms such as dry mouth and eyes.

The patient, a 73-year-old male, was seen in Gulou Hospital affiliated to Nanjing University School of Medicine on May 28, 2024 due to "lumbar pain and discomfort for more than 20 days". The patient was admitted to the hospital with active intestinal sounds, deep tenderness and percussion pain in the waist. Thoracoabdominal aortic CT angiography (CTA) suggests that infected abdominal aortic aneurysm complicated with duodenal fistula is possible; Blood culture results suggest that Salmonella enteritidis is positive. After 2 weeks of anti-infective treatment, "abdominal aortectomy with artificial vessel replacement + duodenectomy + gastrointestinal anastomosis + enteroduodenostomy + enteroenterostomy + duodenostomy" was performed. Postoperative symptomatic supportive treatment (abdominal aortic aneurysm lumen, retroperitoneum and duodenal stump drainage tube connected with negative pressure drainage, physiological saline irrigation, anti-infective treatment, etc.), pathological diagnosis was infected abdominal aortic pseudoaneurysm. After 201 d follow-up, the patient recovered well.

Pregnancy-related acute kidney injury, as a public health problem, is one of the causes of increasing maternal and fetal morbidity and mortality. Pregnancy-related acute kidney injury can progress to chronic kidney disease and end-stage kidney disease, resulting in increased risk of adverse cardiovascular events and events in intensive care units, as well as prolonged hospital stay. This article expounds the etiology, diagnosis and treatment of pregnancy-related acute kidney injury, in order to improve the understanding of relevant professionals on this disease, improve the diagnosis and treatment level of this disease, and further improve the success rate of maternal and infant treatment.

Pregnancy complicated by hyperglycemia and obesity is associated with adverse pregnancy outcomes and may have long-term effects on offspring. Metformin is a basic therapeutic drug for controlling hyperglycemia, and it has the effects of weight loss and cardiovascular protection. The use of metformin in pregnant patients with hyperglycemia and insulin resistance can improve their insulin resistance, exert a hypoglycemic effect and limit weight gain during pregnancy, thus having a beneficial effect on the cardiovascular system of offspring. In addition, metformin can pass through the placenta and may have a direct effect on the fetus. Early findings suggest that intrauterine exposure to metformin may increase the risk of obesity in childhood in offspring. However, in recent years, with the gradual development of research on the efficacy and safety of metformin during pregnancy, more and more evidence shows that the use of metformin during pregnancy is safe and even has potential benefits to the cardiovascular system of offspring. Therefore, it can be considered as a complementary treatment in pregnancy complicated by hyperglycemia, especially in obesity. This article reviews the current research progress on the effects of intrauterine exposure to metformin on the cardiovascular system of offspring.

Tuberculosis is still a serious public health problem facing the world today, and its infection is closely related to the immunity of susceptible populations. In the process of infection, on the one hand, it involves the recognition, phagocytosis and clearance of Mycobacterium tuberculosis by host immune cells; On the other hand, Mycobacterium tuberculosis fights the clearance of the host immune system through camouflage, escape and the evolution of self-resistance genes, showing a complex network regulatory system. Moderate activation of c-Jun amino terminal kinase (JNK) signaling pathway can regulate immune cells and play a positive regulatory role in anti-tuberculosis immune response. In this paper, the regulatory effects of JNK signaling pathway on immune cells such as macrophages, natural killer (NK) cells and T cells were reviewed, and the molecular mechanisms of upstream and downstream signals involved in the regulatory process of JNK signaling pathway were reviewed, so as to deeply understand the mechanism of JNK signaling pathway in regulating anti-tuberculosis immunity, so as to be a clinical therapeutic target.