Volume 105 · Issue 13 · 2025

With the acceleration of population aging, the number of elderly individuals suffering from dementia continues to rise sharply, becoming a significant social issue that affects public health and urgently requires a comprehensive management model throughout the disease course to address it. However, China still faces numerous challenges in the diagnosis and treatment of senile dementia, including insufficient public awareness, limited screening capabilities at the grassroots level, a shortage of specialist physicians, a lack of continuity in management systems, and inadequate rehabilitation and care services. Drawing on the Cognitive Disorder Specialty Capacity Building Project and the establishment of a cognitive disorder diagnosis and treatment center system across various levels of medical and health institutions,the authors conduct a strategic analysis on three key aspects of dementia in the elderly: early screening and intervention, standardized diagnosis and treatment, and rehabilitation and care. It proposes specific measures such as integrating existing resources, conducting screening and early intervention according to local conditions, optimizing referral channels, improving multidisciplinary collaborative diagnosis and treatment models, and promoting the connection between home and community care services. Through these measures, the paper explores a management model and path for the entire course of dementia in the elderly that is suitable for national conditions, providing a reference for the prevention and control of dementia in the elderly in China.

Malnutrition is a crucial factor affecting the prognosis of various diseases, especially among elderly, surgical and critically ill patients. With the implementation of diagnosis related groups (DRGs) and diagnosis-intervention packet (DIP) in China, accurate diagnosis and treatment of malnutrition is essential for enhancing clinical decision-making and patient prognosis. These guidelines were developed by multidisciplinary experts through a systematic review of evidence-based medical literature. They adopt the new international standard for malnutrition diagnosis from the Global Leadership Initiative on Malnutrition (GLIM) proposed by the Global Nutrition Organization and categorize evidence levels, providing recommendations tailored to the Chinese population′s data and characteristics. The guidelines cover the entire process of malnutrition diagnosis in adult patients, including definition, epidemiology, nutrition risk screening, multi-level nutrition assessment, and diagnostic procedures. They also propose individualized diagnostic strategies for specific patient groups, such as obese or critically ill patients, and establish a standardized process for malnutrition diagnosis. At last, the guidelines form 27 questions, 38 recommendations, in order to improve the practical capacity of malnutrition diagnosis in China.

Non-radiographic axial spondyloarthritis (nr-axSpA) is a new term of disease entity, which was introduced in 2009. Nearly ten targeted drugs have been approved for the indication of nr-axSpA abroad, and one drug has also been approved in China. However, in both China and other countries, many doctors, including rheumatologists, are not familiar with the accurate meaning of nr-axSpA. Overdiagnosis or misdiagnosis of nr-axSpA occurs occasionally in both clinical practice and clinical research. Therefore, Chinese Rheumatology Association and Committee for Rheumatologists and Immunologists of Chinese Primary Health Care Foundation convened a task force with the goal of providing an evidence-based guideline for the accurate diagnosis and appropriate treatment of nr-axSpA. The guideline focused on the detailed definitions of axSpA and nr-axSpA, key clues and pitfalls in imaging diagnosis, differential diagnosis, assessing disease activity, long-term outcome, risk factors of radiographic progression, therapeutic principles, non-pharmacological therapy, choices of therapeutic drugs and tapering of drugs, which covered 37 detailed clinical questions.

To compare the accuracy of spinal magnetic resonance myelography (MRM) and CT myelography (CTM) in the detection of spontaneous intracranial hypotension (SIH).

The clinica data of SIH patients at the Neurology Department of Zhongshan Hospital Affiliated to Fudan University between June 2021 and August 2023 were prospectively collected . MRM was performed first, CTM, followed by CTM. CTM results were used as the gold standard to verify the consistency of MRM and CTM examination, and the diagnostic results of epidural cerebrospinal fluid accumulation were observed. The abnormal accumulation of cerebrospinal fluid (CSF) was further recorded in 4 parts, namely, the posterior part of the cervical vertebra, the nerve root walking area, the side of the vertebra and the side of the ribs. Kappa consistency test was used to compare and analyze the evaluation results of the two examination methods.

A total of 31 patients were included in the study, including 13 males and 18 females, aged (40.7±7.0) years. The positive rate of CSF leakage detected by MRM was 93.5%(29 cases), and that detected by CTM was 87.1% (27 cases). Kappa consistency analysis showed that there was a high consistency between MRM and CTM (Kappa=0.635, P<0.001). MRM had good consistency with CTM in detecting CSF accumulation along the nerve root area and paracostal area (Kappa values were 0.469 and 0.652, respectively). MRM had relatively low consistency with CTM in detecting CSF accumulation behind the C_1-2 vertebrae and in the paravertebral area (Kappa values were 0.241 and 0.271, respectively), but the former had a higher sensitivity (0.833, 95%CI:0.436-0.991), and the latter had a higher specificity (0.963, 95%CI:0.817-0.998).

MRM has a comparable value to CTM in diagnosing epidural CSF accumulation in SIH patients, with good consistency. Besides, it is non-invasive and radiation-free, and may be a suitable alternative method for the initial assessment of SIH patients.

To evaluate retinal microvascular characteristics in patients with Leber hereditary optic neuropathy (LHON) by optical coherence tomography angiography (OCTA).

The LHON patients diagnosed with 11778G>A mutation in the Department of Neurology, Beijing Tongren Hospital, Capital Medical University from August 2022 to August 2024 were retrospectively collected. Family members of the patients and hospital staff were recruited as healthy controls during the same period. LHON patients were divided into group A (asymptomatic stage), group B (subacute stage), group C (dynamic stage) and group D (chronic stage) according to the course of disease. OCTA images were used to compare the macular microvascular characteristics of each group, and the correlation between visual impairment and the blood flow parameters and structural parameters was analyzed.

A total of 21 LHON patients with 42 eyes and 15 healthy controls with 30 eyes were included. There were 5 eyes in group A , 11 eyes in group B , 10 eyes in group C, and 16 eyes in group D. The ages of LHON patients and healthy controls were (24.2±4.0) years and (24.3±3.9) years, respectively. The duration of disease in group B, C and D were (3.1±1.4) months, (9.6±1.2) months and (16.4±3.4) months, respectively. The Logarithm of the minimum Angle of Resolution (LogMAR) of best corrected visual acuity (BCVA) in LHON patients (1.30±0.76) was higher than that in the healthy control group (0) (P<0.001). When macular perfusion density (PD) and blood flow length density (VLD) in LHON patients were compared with those in healthy controls, nasal PD and VLD in group A (P=0.034 and P=0.044), the average value, nasal and inferior PD and VLD, and superior VLD in group B (P<0.05) , and the average values of PD, VLD and macular areas in groups C and D were lower than those in the healthy control group (P<0.001). The thickness and average value of the general ganglion cell complex (GCC) in all regions of the macular in the LHON group were lower than those in the healthy control group (P<0.05). The temporal and inferior peripapillary retinal nerve fiber layer (pRNFL) thickness and average value in group A were thicker than those in the healthy control group (P<0.05). The temporal pRNFL thickness and average value in group B were lower than those in the healthy control group (P<0.001). The average pRNFL thickness and all regional thicknesses in C and D groups were lower than those in healthy controls (P<0.001). The BCVA LogMAR was negatively correlated with all blood flow parameters and structural parameters (r=-0.744--0.969, P<0.001). Among blood flow parameters, the correlation between BCVA LogMAR and VLD (r=-0.881--0.900) was relatively strong.

The macular microvascular impairment in LHON patients gradually increases with the progression of the disease. The visual impairment is correlated with both the blood flow parameters and structural parameters of OCTA, and early macular microvascular changes suggeste poor visual prognosis.

To establish reference intervals for exophthalmometric values in adults based on MRI method, and to analyze the consistency between exophthalmometric values obtained via MRI and Hertel method in patients with thyroid eye disease (TED).

A total of 769 patients who underwent head MRI examination at the First Medical Center of the Chinese PLA General Hospital from April to September 2024 were prospectively included as a reference population, with an age [M (Q₁, Q₃)] of 54.0 (39.0, 64.0) years, including 369 males and 400 females. The orbital MRI axial T₂-weighted image sequence was used to measure the exophthalmometric values and to establish the reference intervals. A total of 152 TED patients aged (44.6±11.2) years old, 75 males and 77 females, from January 2013 to August 2024 in the First Medical Center of the Chinese PLA General Hospital were retrospectively included. The patients were used to evaluate the consistency of MRI and Hertel methods in measuring exophthalmometric values. Bland-Altman diagram was used to analyze the consistency of the two measurement methods, and the 95% limits of agreement(LoA) was calculated. The number of points exceeding the limit was <5%, which was considered to have a good consistency.

In the reference population, the exophthalmometric values for the left and right eyes were (15.8±2.1) and (15.8±2.1) mm respeclively, with reference intervals of 11.9-20.1 and 12.0-20.1 mm, respectively. Bland-Altman analysis showed that the difference in exophthalmometric values measured by the MRI and Hertel methods for the left eye was 0.66 (95%LoA:-4.67-5.99)mm, with 95.4% (145/152) of the measurements within this range. For the right eye, the difference was 0.28 (95%LoA:-4.79-5.34) mm, with 94.7% (144/152) of the measurements within this range.

In this study, the reference intervals for exophthalmometric values established based on MRI for the left and right eyes of adults were 11.9-20.1 and 12.0-20.1 mm. In TED patients, the exophthalmometric values obtained by MRI and Hertel methods may not be consistent.

To analyze the genomic characteristics of patients with double bacteremia caused by extraintestinal pathogenic Escherichia coli (ExPEC)/sequence type(ST)88 and monophasic Salmonella Typhimurium (MST)/ST34. The clinical data of a female patient admitted to Shanghai Huashan Hospital on July 25, 2024 were retrospectively analyzed, and the clinical diagnosis was pelvic abscess secondary to soft tissue infection, pulmonary infection and double bacteremia. The whole-genome sequencing results of the strains were ExPEC/ST88 and MST/ST34, respectively, with resistance to 15 antibiotics belonging to 8 classes for ExPEC/ST88 and 18 antibiotics belonging to 10 classes for MST/ST34. ResFinder and CARD database predicted that 12 resistance mechanisms or microstructures of the two strains overlapped or crossed to varying degrees. ExPEC/ST88 had 84 virulence genes in 19 species. MST/ST34 had 150 virulence genes in 27 species. The patient′s temperature returned to normal after anti-infection treatment with linezolid and glucose injection, imipenem and cistatin, and meropenem successively. ExPEC/ST88 is the primary pathogen causing bloodstream infection in this patient, marking the first case reported in Asia, and the coexistence with colistin-resistant MST makes this case even more rare. ExPEC/ST88 has the characteristics of high antibiotic resistance, high virulence, and high recombination of zoonotic and foodborne invasive diseases.

The patient, a 63-year-old female, was seen in the Affiliated Cancer Hospital of Nantong University on July 25, 2023 due to "upper abdominal discomfort for more than 1 month and liver occupation for 1 day". The patient had dull pain in the upper abdomen without obvious trigger, without rhythm; There is no tenderness or rebound pain in the whole abdomen. Enhanced MRI showed that the left inner lobe of the liver occupied space, with a size of about 2.8 cm ×2.3 cm. Considering malignant tumor, "partial lobectomy + cholecystectomy" was performed. The postoperative pathology was malignant perivascular epithelioid cell tumor (PEComa) of the liver. Due to small lesions and negative margins, no adjuvant treatment was performed after operation. Follow-up MRI 5 and a half months after surgery showed recurrence with intrahepatic metastasis, and sirolimus for injection (albumin-bound) was further used to participate in clinical trial treatment. Follow-up until August 22, 2024. The tumor was controlled, and continuous follow-up is ongoing.

Alzheimer's disease (AD) is characterized by β-amyloid (A β) deposition and neuroinflammation, and existing treatments have limited effectiveness. Photobiomodulation (PBM) provides a non-invasive strategy for AD treatment by stimulating mitochondrial function, enhancing energy metabolism, and promoting A β clearance through specific wavelengths of light. This paper reviews the neuroprotective mechanism of PBM and its research progress in AD, emphasizing the key role of imaging technology. Animal experiments have confirmed that transcranial PBM can reduce A β plaque, improve cerebral blood flow and neural network functional connectivity; Clinical studies have initially shown its potential to improve cognitive function in patients with mild cognitive impairment and AD. Magnetic resonance imaging (MRI), functional magnetic resonance (fMRI) and other technologies provide a basis for efficacy evaluation and treatment optimization by dynamically monitoring brain structure, metabolism and blood flow changes. However, clinical translation still faces challenges such as unclear mechanism and insufficient standardization of parameters. In the future, it is necessary to combine multi-center research and advanced imaging technology to promote PBM as a new strategy for AD treatment and provide theoretical support for clinical translation.

Combined with the pathophysiological basis of sepsis, the application progress of blood adsorption technology in this field was analyzed comprehensively. The paper focuses on the theoretical advantages, clinical application effects and existing controversies of blood adsorption technology, and points out the key challenges in treatment, including the choice of treatment opportunity, the formulation of individualized treatment plan for patients, and the standardization of treatment effect evaluation. Through a summary of current research results, this paper systematically evaluates the potential of hemosorption technology in removing pathogens and inflammatory mediators from the blood of patients with sepsis, while analyzing its controversial points in clinical practice, including safety and efficacy. The article also emphasizes the importance of individualized treatment strategies and suggestions for future research directions aimed at optimizing treatment timing and improving patient survival. Through comprehensive analysis, this article aims to provide a comprehensive reference for hemosorption therapy strategies in sepsis with a view to improving the clinical prognosis of sepsis patients.

The patient, a 45-year-old male, denied smoking history. He had a history of bronchial asthma for 3 years, and was treated with intermittent inhalation of budesonide and formoterol powder inhalation (160 μ g: 4.5 μ g), and his cough and wheezing symptoms were controlled smoothly. In March 2023, cough and wheezing worsened, and the local hospital gave anti-infection and other treatments that were not effective, and sputum plugs were coughed up intermittently (Figure 1). In May 2023, he visited the Department of Respiratory Medicine, Ninth Medical Center, PLA General Hospital. Chest CT showed multiple bronchial mucous plugs in both lungs, some of which were high density (Figures 2 and 3, arrows), and the CT value was as high as 220 HU. The percentage of blood eosinophils was 11.3% and the blood eosinophils were 0.75×10⁹/L, serum total immunoglobulin E (IgE) was 229 kU/L, Aspergillus fumigatus-specific IgE was 0.62 kU/L, and Aspergillus fumigatus immunoglobulin G (IgG) antibody was negative. No bacteria and fungi were observed in alveolar lavage fluid culture, and no bacteria and fungi were observed in metagenomic second-generation sequencing (mNGS). The forced expiratory volume (FEV1) at the first second of the pulmonary function test was 1.79 L, FEV1 accounted for 49.0% of the predicted value, FEV1/forced vital capacity (FVC) was 49.8%, the relaxation test was positive, FEV1 increased by 580 ml, the improvement rate was 32.8%, and exhaled nitric oxide (NO) was 183 ppb. Allergic bronchopulmonary aspergillosis (ABPA) was diagnosed. Prednyl acetate was administered 30 mg once/d and tapered, along with inhalation of budegefor inhalation aerosol (160 μ g: 7.2 μ g: 4.8 μ g), 2 inhalations, 2 times/d, without antifungal therapy. After 2 months of treatment, the patient's cough and wheezing improved significantly, and the pulmonary function improved. Chest CT reexamination on July 10 showed that the bronchial mucus plug disappeared, with residual local bronchiectasis (Figure 4, arrow), and blood eosinophils were 0.03×10⁹/L, total serum IgE was 234 kU/L, pulmonary function test FEV1 accounted for 109.1% of the predicted value, FEV1/FVC was 77.6%, and exhaled NO was 51 ppb. Follow-up until March 2024, the patient was inhaled budesonide formoterol powder inhalation alone (160 μ g: 4.5 μ g), 2 inhalations, 2 times/d, and the condition was stable without recurrence. The 2024 International Society of Human and Zoomycology Allergic Bronchopulmonary Aspergillosis Guidelines include high-density mucus plugs as one of the diagnostic criteria for ABPA. High-density mucus plugs are defined as mucus plugs with higher density than paravertebral muscles on high-resolution CT, with CT density values>70 HU as the cut-off value.