Volume 105 · Issue 21 · 2025

Since its inception in the early 20th century at Peking Union Medical College Hospital, neurosurgery in China has gone through a century-long process from its initial establishment, development to modernization, forming a complete system, covering vascular diseases, tumors, epilepsy, and other diseases. This article reviews the key pioneers and historical milestones in Chinese neurosurgery, highlights the founding and advancement of the Society of Neurosurgery of Chinese Medical Association, and shows major achievements in standardization, training, and international cooperation, etc. At present, with the application of technologies such as artificial intelligence and brain-computer interfaces, network-based neurosurgery has emerged and developed rapidly, marking the transition to Neurosurgery 4.0. In the future, Chinese neurosurgery is poised to further promote interdisciplinary integration and clinical translation in support of the high-quality development of brain science.

In 2015, the Spinal Trauma Working Group of the Chinese Association of Orthopaedic Surgeons (CAOS) developed the Evidence-Based Clinical Guidelines of Acute Atlantoaxial Fractures in Adults based on literature published prior to 2014. Over the past decade, extensive research of acute atlantoaxial fractures in adults has been conducted globally, with the number of published studies in Chinese and English exceeding the cumulative total of all previous literature. To address evolving clinical needs and align with evidence-based principles, CAOS initiated a comprehensive revision of the guidelines. Following the methodology framework of the 2015 edition, the expert panel systematically retrieved, screened, and synthesized literature published between January 1, 2015, and December 31, 2023, integrating evidence from the original guideline. The expert panel carefully analyzed the medical evidence provided by the literature and rigorously graded it according to evidence-based medicine standards. The 2025 guidelines retain prior recommendations while introducing updates and integrating new evidence, ultimately proposing 6 clinical questions paired with 6 evidence-based recommendations. Each recommendation is accompanied by detailed interpretations and supporting rationale to enhance clinical understanding and application.

Gastroparesis is a gastric motility disorder characterized by delayed gastric emptying in the absence of mechanical obstruction. Gastroparesis significantly impacts patients′ psychological well-being and quality of life, potentially leading to psychological disorders such as anxiety and depression, and also imposes a heavy economic burden on patients and society. This expert consensus covers relevant views on its etiology (diabetes, surgery, drug-induced, idiopathic, scleroderma, etc.), symptomatology, diagnosis (scintigraphic imaging, ultrasound contrast meal assessment, and radiopaque marker gastric motility testing), and treatment (pharmacological therapy, nutritional support, traditional Chinese medicine, and interventions targeting the pylorus, such as endoscopic surgery and surgical procedures). Therefore, this expert consensus advocates the establishment of a multidisciplinary team diagnosis and treatment model, which will further standardize and optimize the diagnosis and treatment process of Gastroparesis in China.

To evaluate the immediate component precision and surgical safety in robot-assisted reverse shoulder arthroplasty (RSA).

A retrospective cohort study was conducted on 32 patients with proximal humeral fractures treated at the Intelligent Orthopedic Research Ward of Beijing Jishuitan Hospital, Capital Medical University between May 2023 and October 2024. The patients were divided into two groups according to surgical options: the robotic group and the conventional group. The robotic group underwent preoperative planning and glenoid baseplate positioning using the TiRobot^®, while the conventional group used standard manufacturer-provided instrumentation. Postoperative computed tomography (CT) scans were analyzed via the Picture Archiving and Communication System (PACS) to measure angular deviations (anteversion and inferior tilt) of the glenoid baseplate relative to preoperative plans. Operative time, intraoperative blood loss, and complications were compared between two groups.

A total of 32 patients were included, with 15 in the robotic group [6 males, 9 females, mean age: (63.1±3.1) years] and 17 in the conventional group [9 males, 8 females, mean age: (64.9±3.6) years]. No significant differences were observed between the two groups in demographics, Neer classification, or time from injury to surgery (all P>0.05). All surgeries were successfully completed without intraoperative complications. The robotic group demonstrated significantly lower angular deviations in glenoid baseplate positioning compared to the conventional group:0.77°±0.30° (anteversion) vs 3.35°±1.03° (P<0.001) and 0.81°±0.21° (inferior tilt) vs 5.14°±2.30° (P<0.001). There was no significant differences between the robotic group and the conventional group in surgical duration [(167.0±45.3) min vs (158.0±40.3) min] or intraoperative blood loss [200 (150, 200) ml vs 200 (200, 250) ml] (both P>0.05). Additionally, no surgical adverse events or related complications were observed in either group.

Robot-assisted RSA achieves significantly higher immediate precision in glenoid baseplate positioning compared to conventional surgery, without increasing operative time, blood loss, or complication risks.

To investigate the lower motor neuron (LMN) involvement patterns in the lower medulla oblongata and cervical spinal cord in amyotrophic lateral sclerosis (ALS) patients.

The needle electromyography (EMG) data of 200 patients with non-thoracic onset sporadic ALS, hospitalized in the Neurology Department of the First Medical Center of the Chinese PLA General Hospital from September 2022 to December 2023, were retropectively analyzed. All participants met the EI Escorial-Revised diagnostic criteria. According to the onset site, the patients were divided into the lower medulla oblongata onset group(34 cases), the spinal cord onset group(166 cases) [including the lower cervical spinal cord onset group (92 cases) and the lumbosacral spinal cord onset group (74 cases)]. Electromyography (EMG) abnormalities in the muscles innervated by the lower medulla oblongata and cervical cord were counted, and the characteristics of LMN involvement were analyzed. The binomial distribution test was used to determine whether the progression of LMN involvement to the second central nervous system segment was random.

Among 200 ALS patients, there were 111 males (55.5%) and 89 females (44.5%), with an age onset of 28-86 (56±11) years. 20 (10.0%) cases with normal sternocleidomastoid (SCM)-EMG or trapezius (TRA)-EMG results, and 7 (3.5%) cases with normal SCM-EMG and TRA-EMG results were observed in patients with LMN involvement in both the lower medulla oblongata and lower cervical spinal cord. The abnormal rates of EMG at the onset of lower cervical spinal cord were tongue muscle (GEN)-EMG (88.2%, 30/34), TRA-EMG (70.6%, 24/34) and SCM-EMG (67.6%, 23/34), respectively. The abnormal rates of EMG at the onset of lower cervical spinal cord were TRA-EMG (72.8%, 67/92), SCM-EMG (38.0%, 35/92) and GEN-EMG (32.6%, 30/92), respectively. The binomial distribution test showed that the progression of LMN involvement to the second segment of the central nervous system was not random (all P<0.05). In low bulbar onset patients, the abnormal rate of LMN involvement was higher in the lower cervical spinal cord segment [100.0% (34/34)], and lower in the lumbosacral spinal cord segment[91.2% (31/34)]. In the lower cervical spinal cord onset group, the abnormal rate of LMN involvement was lower in the the low medulla obliterum[32.6% (30/92)] and high in the lumbosacral spinal cord [96.7% (89/92)].In the lumbosacral spinal cord onset group, the abnormal rate of LMN involvement was low in the low medulla oblata [27.0% (20/74)] and high in the lower cervical spinal cord [94.6% (70/74)].

The progression of LMN involvement in the lower medulla oblongata and cervical spinal cord is primarily continuous, while a discontinuous progression pattern was also observed. The lower medulla oblongata of ALS patients with spinal onset is relatively less involved in disease progression.

To evaluate the efficacy and safety of sulodexide in preventing venous thromboembolism (VTE) in high-risk populations and reducing recurrence in established VTE patients.

A literature search was conducted in databases including China National Knowledge Infrastructure, Wanfang Data, VIP Chinese Periodical Database, China Biology Medicine disc, PubMed, Embase, the Cochrane Library, and Web of Science to retrieve relevant literature on sulodexide in the treatment of VTE, with the retrieval time frame set from the establishment of the databases to April 2024. According to the inclusion and exclusion criteria, two researchers independently screened the literature and extracted the data. The Cochrane risk of bias tool or the Newcastle-Ottawa Scale was used to evaluate the quality of the included studies. Meta-analysis was performed using Revman5.4.1 software, with the RR value as the effect measure. The trial group comprised high-risk individuals or VTE patients treated with sulodexide, while the control group consisted of patients treated with other traditional anticoagulants or placebos. The outcome measures included the incidence and recurrence rate of VTE, the incidence of post-thrombotic syndrome (PTS), and the risk of bleeding, among others.

A total of 11 articles involving 11 studies and 3 364 patients were included according to the inclusion and exclusion criteria. For high-risk populations of VTE, prophylactic use of sulodexide was more effective than the control group in reducing the incidence of VTE in high-risk individuals [2.2% (3/138) vs 10.9% (15/138), RR=0.25, 95%CI: 0.09-0.72, P=0.010]. For VTE patients, sulodexide was more effective than control group in reducing the recurrence rate of VTE [5.6% (56/996) vs 9.7% (198/2 043), RR=0.59, 95%CI: 0.44-0.80, P<0.001]. There was no statistically significant difference in the incidence of PTS between patients treated with sulodexide and those treated with other traditional anticoagulants [14.0% (36/257) vs 16.6% (149/897), RR=0.86, 95%CI: 0.61-1.20, P=0.370]. Moreover, the incidence of bleeding events was lower in patients treated with sulodexide compared to those treated with other traditional anticoagulants [0.8% (2/251) vs 6.1% (40/656), RR=0.11, 95%CI: 0.03-0.37, P<0.001].

Sulodexide exhibits favorable efficacy and safety for VTE prevention in high-risk populations and recurrence reduction in VTE patients.

To analyze the genomic characteristics of Campylobacter fetus subsp. testudinum (Cft) sequence type (ST) 80 from bacteremia patient. The clinical data of a male patient admitted to Shanghai Xinhua Hospital on October 16, 2023 were retrospectively analyzed. The clinical diagnoses were type B aortic dissection, thoracic and abdominal aortic infection, and bacteremia. The isolated was resistant to nalidixic acid, ciprofloxacin and tetracycline. The whole genome sequencing revealed a novel sequence type ST80 and resistance genes are predicted: Aminoglycosides aph(3′)-Ⅱa, tetracyclines tet(O), glycopeptides (blmt) and a single amino acid mutation gyrA (T86I) in the Quinolone resistance determining region. Nine heterologous genes were predicted in the 19 genes, and 41 of the 79 genes were flagella genes. The virulence genes included ciaB and cell lethal expansion toxins (typhoid toxin) cdtA, cdtB, cdtC. Type Ⅳ secretion system and S-layer surface protein colonization gene (sapA) coexist. The patient was treated with piperacillin/tazobactam sodium combined with doxycycline and azithromycin for 20 d and discharged after thoracoabdominal aortic replacement and branch artery reconstruction. Soft-shelled turtles may be a potential new host of Cft infection or a vector of foodborne invasive cases due to their biological characteristics of fusion recombinant.

The patients diagnosed with cholestatic liver disease at Beijing Children′s Hospital, Capital Medical University from April 2022 to April 2024 were retrospectively collected and divided into non-biological artificial liver (NBAL) group and standard medical therapy (SMT) group according to treatment methods. The decline of liver function indexes 3, 7 and 14 days after treatment was compared until Auaust 2024. The NBAL group was divided into plasma exchange (PE) group, plasma adsorption group and combined treatment group according to the treatment mode. The decline of liver function indicators before and after different treatment modes was compared. A total of 16 patients were included. There were 8 patients in the SMT group, including 5 males and 3 females, aged (7.5±3.3) years. There were 8 patients in the NBAL group, including 2 males and 6 females, aged (6.9±4.6) years. The patients were followed up for 28 months. On the 3rd day of treatment, the decrease of total bilirubin (TBIL) [(118.8±95.3) vs (18.2±45.7) μmol/L] and direct bilirubin (DBIL) [(96.2±81.5) vs (18.2±45.7) μmol/L] in NBAL group was higher than that in SMT group; On the 7th and 14th day of treatment, the decrease of TBIL and DBIL in NBAL group was higher than that in SMT group (all P<0.05). The 8 children in the NBAL group received artificial liver treatment for 23 times, including 8 in the PE group, 9 in the plasma adsorption group, and 6 in the combined treatment group. The decrease of alanine aminotransferase (ALT) in PE group was higher than that in plasma adsorption group and combined treatment group [(175.5±79.4) vs (107.9±70.5) and (60.3±87.2) U/L, respectively, both P<0.05]. The therapeutic effect of NBAL on cholestatic liver disease in children is better than that of medical treatment. The effect of plasma adsorption and combined therapy is equivalent to that of PE in reducing liver function indexes.

This study retrospectively analyzed the clinical data of patients with central nervous system infections (CNSI) after neurosurgery in the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, from September 2010 to September 2022. Based on vancomycin administration regimens, the patients were divided into the intermittent intravenous infusion (IIV) group and the continuous intravenous infusion (CIV) group. Hematological indices were evaluated before and after vancomycin therapy to compare short-term efficacy and safety between the two regimens.A total of 90 patients were included, including 50 patients in the IIV group [28 males and 22 females, aged (50.9±12.6) years] and 40 patients in the CIV group [29 males and 11 females, aged (54.5±13.3) years].The CIV group demonstrated significantly lower post-treatment neutrophil-to-lymphocyte ratio (NLR: 7.0±4.4 vs 9.2±4.8), systemic inflammatory response index (SIRI) (6.1±6.0 vs 9.9±8.2), and incidence of augmented renal clearance (ARC) [10.0% (4/40) vs 42.0% (21/50)] compared to the IIV group. Additionally, the CIV group achieved higher trough concentration target attainment rates [85.0% (34/40) vs 56.0% (28/50)] and superior short-term clinical efficacy [72.5% (29/40) vs 52.0% (26/50)]than those in the IIV group (P<0.05). No significant difference in nephrotoxicity was observed between the two groups after the treatment (P>0.05).Compared to IIV, CIV can improve trough concentration target attainment, reduced ARC incidence, and enhance therapeutic efficacy in CNSI patients, suggesting that CIV may be a more optimized administration strategy for CNSI management.

To address the problems of traditional naso-jejunal tube replacement in post-pyloric feeding, such as high blind insertion failure rate, high radiation exposure and high risk of complications, this study proposed a naso-jejunal tube replacement technique with real-time ultrasound guidance and zebra guide wire, and applied it to the clinical practice of a 67-year-old male patient with severe traumatic brain injury. The patient needed long-term post-pyloric enteral nutrition support due to severe traumatic brain injury, but blind tube insertion was difficult (the first tube insertion was assisted by gastroscope), which increased the difficulty of regular replacement of the tube. By using the modified Seldinger technique and zebra guide wire with flexible and hydrophilic coating characteristics, the changes of duodenal horizontal image characteristics were dynamically monitored by visual ultrasound, and the naso-jejunal tube was accurately replaced in situ. The key imaging steps for ultrasound-guided duodenal horizontal part evaluation include: "double-track sign" after the verification of the former tube patency; After the guide wire is placed, the real-time image changes into "five-line sign". The "bright strip sign" when the original tube is withdrawn and the "five-wire sign" after the new tube is placed and the "double-track sign" when the guide wire is removed. Position verified by abdominal X-ray. The whole course took about 10 minutes. The catheter tip was precisely positioned behind the pylorus. There were no complications such as bleeding and perforation, and the enteral nutrition was well tolerated. The technique is able to effectively reduce or replace X-ray verification through ultrasonic dynamic visualization navigation, and zebra guide wire can effectively reduce the risk of tissue damage.

This study reports a 61-year-old female patient with moyamoya disease who was admitted to the emergency department of Zhengzhou People's Hospital in May 2024 due to "sudden disturbance of consciousness for 1 h". CT examination of the head showed right ventricular hemorrhage, and right ventricular drilling and drainage were performed in emergency department. The postoperative drainage fluid was chyloid, and the serum and cerebrospinal fluid triglycerides were significantly increased by examination. After adjusting the diet and giving fenofibrate treatment, the cerebrospinal fluid properties returned to normal, the clinical symptoms improved, and the blood lipids did not increase again after 8 months of follow-up. This case emphasizes that patients with intracranial hemorrhage with chylocerebrospinal fluid should be vigilant against hyperlipidemia, suggesting the importance of blood lipid management in disease prevention and treatment.

Osteoarthritis (OA) is a degenerative disease with joint pain and limited movement as the main clinical manifestations. Its prevalence is high, seriously affects the quality of life of patients, and it is the main cause of disability in middle-aged and elderly people. In 2024, numerous high-quality research results have been published in the field of OA research at home and abroad. This article centers on the 2024 publication in the Chinese Medical Journal,The New England Journal of Medicine, Lancet, JAMA, BMJ, Cell, Nature, Science, Annals of the Rheumatic Diseases, Arthritis & RheumatologyOA-related literature in 10 academic journals, such as risk factors, prediction models, pathogenesis, therapeutic targets and treatment methods, are reviewed, and the cutting-edge progress of OA clinical, basic and translational research is shared. It is pointed out that the current OA research still lacks the key evidence of clinical effective transformation. In the future, it is necessary to strengthen the collaborative innovation of basic and clinical research, promote the rapid transformation of cutting-edge results, point out the direction and provide safe and effective methods for completely solving the health dilemma of OA patients.

Type 1 diabetes (T1DM) has become an important global disease burden. Early prediction, effective prevention and restoration of pancreatic islet β cell function are important goals in current diagnosis and treatment. In 2024, the deep integration of immunotherapy, regenerative medicine and artificial intelligence technology has driven breakthrough progress in the field of T1DM, and the treatment strategy is shifting from "passive glucose control" to "active intervention in the disease process". This article systematically reviews the important achievements of this year's T1DM research from three dimensions: mechanism research, clinical translation and management innovation, and discusses the future research direction. It is expected that follow-up research can further promote the refinement, diversification and individualization of T1DM management, and finally realize the disease Prevention and cure.

As a major global problem and challenge, the prevention and control of viral diseases urgently needs to build a new prevention and control system through theoretical and technological innovation. The composition of human virus (viriome), virus structure and function, pathogenic variation and evolution, virus-host interaction and immune mechanism of virus infection are the core research directions in the field of virology. The research on viromes focuses on revealing the structure and biological functions of viral communities related to humans, breaking through technical bottlenecks to analyze the functions of viromes, constructing perfect high-quality data sets, and improving the research depth and accuracy of viromes; The research on the structure and function of virus focuses on the dynamic process of virus infection, providing a basis for understanding the life cycle of virus and the development of vaccines and drugs; The study of virus evolution reveals how viruses adapt to hosts and escape immunity through gene mutation, recombination and natural selection. The challenge lies in the prediction of virus evolution. It is necessary to combine epidemiological surveillance and artificial intelligence prediction tools to explore the law of gene mutation, immune escape and cross-species transmission; The study of virus-host interaction aims to decode the mechanism of virus invasion, replication and immune escape, and explore the influence of host genetic factors. In the future, multi-dimensional data integration and intelligent algorithms will be used to enhance the research depth, and a new virus-host interaction model will be constructed to panoramically reveal the dynamic interaction characteristics of virus and host; Immunology research provides a scientific basis for vaccines and immunotherapy, especially the design of vaccines and the establishment of herd immunity in virus prevention and control strategies. It is necessary to focus on the development of new broad-spectrum vaccines, the enhancement of immune response and the construction of digital immune system. As the field of virology enters a new era of multidisciplinary intersection and technological innovation, the future development direction needs to pay attention to the breakthrough of basic research, promote the practical application of new theories, new technologies and new models, and provide innovative support for the prevention and control of viral diseases.