Volume 105 · Issue 23 · 2025

Being enlightened by the idea of "accurate medicine", we analyzed" aplastic anemia sydrome"and found that the "refractory cases" that did not respond to T-cell immunotherapy included a group of bone marrow failure with abnormal humoral immune damage or suppression of bone marrow hematopoiesis, which was named "immune related pancytopenia (IRP)". Those cases were characterized by having such manifestations as follows: pancytopenia with normal or higher percentages of reticulocyte or/and neutrophil in peripheral blood cell count; lower or normal proliferation of bone marrow cells with lower percentage of lymphocyte, and erythrocyte-island and no-dysplasia are easily seen; positive autoantibodies on bone marrow cells, higher percentages of B1 cell or plasma cell, elevated serum level of type Ⅱ lymphokines, more activations of B cells and plasma-dendritic cells (P-DC), and much successful response to immune suppression therapy targeting on humoral immunity. Identifying such diseases is conductive to increase the diagnosis accuracy of bone marrow failure and improve the therapeutic response, which provides a basis for in-depth study of its etiology and provides a reference for the study of other related diseases.

Systemic lupus erythematosus (SLE) is a complex systemic autoimmune disease, with challenges in both its diagnosis and treatment. In recent years, advances in basic and clinical research related to SLE have led to the emergence of new diagnostic and therapeutic approaches, as well as the continuous updating of international clinical guidelines. Against this backdrop, the existing guidelines are no longer fully aligned with current clinical practice in China. Initiated by the National Clinical Research Center for Dermatologic and Immunologic Diseases and the Chinese SLE Treatment and Research Group (CSTAR), and in collaboration with the Chinese Rheumatology Association and other relevant academic societies, an expert panel has comprehensively evaluated the latest research evidence and integrated domestic clinical experience. In accordance with the GRADE framework, the "2020 Chinese guidelines for the diagnosis and treatment of systemic lupus erythematosus" has undergone systematic revision. This updated guideline provides detailed evidence-based recommendations addressing 12 critical clinical concerns prioritized by frontline rheumatologists in China. The revision aims to optimize the scientific rigor of SLE clinical management and enhance patient-centered healthcare services.

Candida auris is an emerging multidrug-resistant fungal pathogen, its infections have been reported in over 50 countries and regions to date. It has gradually become a global public health concern. Characterized by challenges in identification, high drug resistance, treatment difficulties, and rapid transmission, Candida auri is prone to causing hospital infection outbreaks. Given the varying recommendations in domestic and international guidelines for preventing and controlling Candida auris healthcare-associated infection, the National Medical Institution Infection Surveillance System of China, the Healthcare-associated Infection Control Branch of Chinese Preventive Medicine Association, and the National Training Center of Hospital Infection in China jointly organized a panel of national experts. Through reviewing global literature, evidence-based medical research, and experiences in curbing outbreaks and adopting the Oxford Centre for Evidence-Based Medicine′s levels of evidence classification criteria and grading of recommendation strength, and after discussion and voting by the expert panel, 14 recommendation statements consensus on the prevention and control of Candida auris healthcare-associated infection were ultimately formulated. Key contents include an overview of Candida auris outbreaks, microbiological characteristics, laboratory identification, epidemiology, healthcare facility infection prevention and control strategies and specific measures, outbreak investigation and control protocols, and clinical management. The consensus aims to recommend practical and effective prevention and control measures, standardizing and enhancing the capacity to combat Candida auris healthcare-associated infection.

To compare the mid-term clinical efficacy of supraspinatus tendon reconstruction (STR) and superior capsule reconstruction (SCR) for irreparable posterosuperior massive rotator cuff tears (RCTs).

A retrospective analysis was conducted on 27 patients with irreparable posterosuperior massive RCTs treated at the First Affiliated Hospital of Army Medical University between October 2019 and November 2022. The patients were stratified into two groups according to operation procedures: 11 cases underwent STR(STR group), 1 male and 10 females with an average of (65.0±8.3) years; 16 cases underwent SCR (SCR group), 3 males and 13 females with a mean age of (59.6±8.0) years. Preoperative and 24-month postoperative outcomes were assessed and compared using the visual analogue scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, and University of California Los Angeles (UCLA) score between the two groups. Imaging parameters included acromiohumeral distance (AHD), Sugaya grades, and Goutallier grading. Active shoulder range of motion (ROM) was also recorded.

Baseline characteristics were comparable between the two groups (all P>0.05). At 24 months postoperatively, both groups showed improved active ROM, but there was no significant difference in ROM improvement between the two groups [flexion: STR 100.0°(90.0°, 110.0°) vs SCR 85.0° (51.3°, 97.5°); abduction: STR 99.1°±30.2° vs SCR 79.4°±28.8°; internal rotation vertebral level 5.0 (4.0, 6.0) vs 4.5 (1.0, 6.0), and external rotation 30.0° (20.0°, 50.0°) vs 30.0° (20.0°, 39.8°)](all P>0.05). However, the STR group demonstrated significantly greater improvements in VAS [(6.0 (5.0, 6.0) vs 4.0 (3.3, 5.0)], ASES (57.9±8.2 vs 48.0±12.4), and Constant-Murley score [69.0(57.0, 73.0) vs 56.5 (45.5, 61.3)] when compared to those in SCR (P<0.05). In addition, both the STR and SCR group demonstrated significant improvement in AHD compared to preoperative measurements, with no statistically significant intergroup difference in the extent of improvement (all P>0.05). Similarly, postoperative Sugaya classification showed no significant differences between the two groups (P>0.05). However, the STR group exhibited significantly better improvement in Goutallier grading compared to preoperative status (P=0.021).

Both STR and SCR can improve shoulder ROM in patients with irreparable posterosuperior massive rotator cuff tears. However, STR demonstrates superior efficacy in alleviating pain and reducing fat infiltration, yielding better mid-term clinical outcomes.

To explore bone mass changes in patients with SAPHO syndrome, utilizing bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) and vertebral bone quality (VBQ) scores measured by MRI.

Thirty-six patients with SAPHO syndrome at Peking Union Medical College Hospital from February 2014 to February 2024 were retrospectively collected with 36 age- and gender-matched healthy controls. DXA assessed BMD, corresponding T-score and Z-score of the lumbar spine (LS), femoral neck (FN), total hip (TH), and trabecular bone score (TBS). LS MRI T₁-weighted imaging (T₁WI) measured the VBQ scores. Correlations between BMD, TBS, and VBQ scores were analyzed using Pearson correlation. The predictive efficacy of VBQ scores for low bone mass and impaired bone microarchitecture in patients with SAPHO syndrome was assessed using receiver operating characteristic (ROC) curves, with the area under the curve (AUC), optimal diagnostic cut-off values, sensitivity, and specificity documented.

The mean age of patients with SAPHO syndrome was (44.8±9.5) years, with 8 (22.2%) males. There were 36 subjects in the control group with a mean age of (44.8±9.5) years and 8(22.2%) males. Compared to the controls, the case group had lower FN BMD, TH BMD, corresponding T-score and Z-score, TBS, and higher VBQ scores (all P<0.05). Compared to the controls, female patients in the case group had lower LS BMD, FN BMD, TH BMD, corresponding T-score and Z-score, TBS, and higher VBQ scores (all P<0.05), whereas only male patients in the case group had higher VBQ scores (P=0.028). Ten cases (27.8%) in the case group had low bone mass and 19 cases (52.8%) had impaired bone microarchitecture, higher than the 3 cases (8.3%) and 9 cases (25.0%) in controls respectively (both P<0.05). VBQ scores in the case group were negatively correlated with FN BMD, FN T-score, TH BMD, TH T-score, and TBS (r=-0.375, -0.391, -0.368, -0.361, and -0.389, respectively, all P<0.05). The AUCs of VBQ scores for predicting ROC curves of low bone mass and impaired bone microarchitecture in patients with SAPHO syndrome were 0.796 (95%CI: 0.649-0.944) and 0.694 (95%CI: 0.521-0.866), with a sensitivity of 100.0% and 47.4%, and a specificity of 53.9% and 88.2%, respectively.

Patients with SAPHO syndrome present with low bone mass and impaired bone microarchitecture. VBQ score has a high sensitivity for predicting low bone mass and a high specificity for predicting impaired bone microarchitectural in patients with SAPHO syndrome.

An exploration of the efficacy and mechanism analysis of antibiotic-loaded bone cement in patients with diabetic foot ulcers (DFU) in patients with type 2 diabetes mellitus.

A retrospective analysis was conducted on the clinical data of 78 patients with type 2 DFU who were treated at Henan Provincial People′s Hospital between June 2020 and October 2022, including 54 males and 24 females, with a mean age of (63.0±7.9) years. According to the treatment modality, patients were divided into the bone cement group (n=49) and the gel group (n=29). Clinical data were collected. All patients underwent bacterial culture and antibiotic susceptibility testing prior to enrollment, and antibiotics were selected based on susceptibility results. In the bone cement group, antibiotics were mixed with bone cement at a standard ratio for local application, while in the gel group, a 2% antibiotic gel was used topically. Both groups received standardized wound care based on basic treatment. The primary outcomes included wound healing status after 4 weeks, wound healing time, amputation rate, and bacterial clearance rate. Secondary outcomes included microvessel density (MVD) and the relative expression levels of growth factors [vascular endothelial growth factor (VEGF), transforming growth factor-β1 (TGF-β1), fibroblast growth factor-2 (FGF-2), and epidermal growth factor (EGF)] in wound tissues.

There were no significant differences between the two groups regarding gender, age, duration of diabetes, glycated hemoglobin levels, ankle-brachial index, toe brachial index, diabetic complications, comorbidities, history of lower limb vascular interventions, Wagner grade, wound duration, infection markers, or bacterial culture positivity rates (all P>0.05). After 4 weeks of treatment, the total effective wound healing rate was higher in the bone cement group than in the gel group [85.7% (42/49) vs 65.5% (19/29), P=0.033], the wound healing time was shorter [(65.5±5.1) vs (80.0±4.3) d, P<0.001], and the major amputation rate was significantly lower [8.2% (4/49) vs 20.7% (6/29), P=0.033], while there was no significant difference in minor amputation rates [42.9% (21/49) vs 37.9% (11/29), P=0.669]. There was no statistically significant difference in bacterial clearance rates between the two groups(P=0.141). The MVD value in the wound tissue of the bone cement group was higher than that in the gel group [(30.73±3.77) vs (20.43±3.74) vessels per high-power field, P<0.001].The relative expression levels of VEGF, TGF-β1, FGF-2, and EGF in wound tissues were significantly higher in the bone cement group compared to the gel group (all P<0.001).

Antibiotic-loaded bone cement is an effective treatment method for infected DFU. Its mechanism of action may be related to promoting angiogenesis and upregulating growth factor expression.

To summarize the imaging findings of Kaposiform hemangioendothelioma (KHE). A retrospective review was conducted on clinical data from pediatric patients diagnosed with KHE through surgery or biopsy at the Children′s Hospital of Nanjing Medical University between January 2014 and January 2023. Based on the depth of lesion involvement, KHE was categorized into superficial, deep, and mixed types. Based on the affected tissues and organs, KHE was categorized into bone KHE, soft tissue KHE, and deep organ (pancreas, intestinal wall mesentery) KHE. A total of 25 children were included, including 15 male and 10 female patients, with a median age of 5 months (ranging from 21 hours to 9 years and 7 months). Seventeen cases occurred within 1 year old, 5 cases between 1 and 5 years, and 3 cases beyond 5 years. Among the cases, there were 11 cases of deep type, 11 cases of mixed type, and 3 cases of superficial type. Soft tissue KHE was observed in 17 cases, deep organ KHE in 2 cases, and bone KHE in 6 cases. Non-contrast CT of soft tissue and deep organs KHE presented as nodular, large or diffuse slightly low density with borderless diffuse, non-contrast MRI showed equal or slightly lower T1, higher T2 signal, with significant enhancement after enhancement. The X-ray and CT of bone KHE presented as worm erosion or osteolytic bone destruction accompanied by peripheral bone hyperplasia and sclerosis, MRI plain scan showed equal or slightly lower T1, mixed or slightly higher T2 signal, with lower T2 signal inside and around the lesion, and with no enhancement after enhancement. Soft tissue and deep organs KHE presents as infiltrative growth, with enhancement after CT or MRI enhancement. In contrast, bone KHE is localized, and characterized by concurrent bone destruction and sclerosis, with no enhancement after CT or MRI enhancement.

A 44-year-old male was admitted to the hospital for "dry mouth, polydipsia and polyuria for more than 5 months". In October 2020, the patient developed dry mouth, polydipsia, and polyuria without obvious triggers, and liked cold drinks, accompanied by decreased sexual desire and decreased sexual function. Auxiliary examination in other hospitals showed that blood sodium level increased, urine osmotic pressure and urine specific gravity decreased, many anterior pituitary hormone levels decreased, and prolactin level increased. Pituitary MRI showed full pituitary gland, thickened pituitary stem, and disappearance of hypersignal in posterior pituitary lobe. Considered as "central diabetes insipidus", desmopressin acetate tablets were given to treat, and the symptoms were relieved. PET/CT examination showed that anterior mediastinal soft tissue density occupied space, and surgical treatment was performed. Postoperative pathology showed B-cell lymphoma in the extranodal marginal area of mucosal associated lymphoid tissue. After admission, the relevant examinations were completed, and pituitary biopsy was performed. The lesion was consistent with lymphocytic hypophysitis, and glucocorticoid treatment was given. One month later, the pituitary gland and pituitary stem occupied a smaller space than before. After regular follow-up, the patient's symptoms of polydipsia and polyuria were significantly improved, his spirit, appetite, physical strength and sexual function were improved, and his eyebrows and body hair were thicker than before.

Alzheimer's disease (AD), a major health challenge facing an ageing society globally, has seen significant progress in 2024 in several key areas. Based on the cutting-edge results published in top international journals in 2024, this article systematically sorts out the research progress in five core directions in the AD field: including disease risk factors, pathophysiological mechanisms, novel biomarkers, accurate early diagnosis technology and disease modification treatment, aiming to clarify the disease mechanism, optimize clinical diagnosis and treatment pathways, and provide reference for future research and clinical practice.

Mycoplasma pneumoniae is a common pathogen of community-acquired pneumonia in children. Macrolide antibacterial drugs are the first-line drugs in clinical treatment of mycoplasma pneumoniae pneumonia in children. Since 2000, the detection rate of macrolide-resistant Mycoplasma pneumoniae (MRMP) has continued to rise and has become a global concern. After 2020, the number of Mycoplasma pneumoniae infection cases in many places in China has increased sharply, and the proportion of MRMP has increased significantly, bringing challenges to clinical treatment. The resistance mechanisms of M. pneumoniae are complex and diverse, and are still not fully elucidated. Therefore, this article reviews the resistance mechanism of MRMP, the relationship between resistance genes and clinical characteristics, and the choice of antimicrobial drugs.