Volume 105 · Issue 24 · 2025

Scientific and technological evaluation serves as a pivotal mechanism for fostering innovation. Objective and scientific evaluation markedly enhances technological innovation capacity and vitality. Presently, research-oriented hospitals in China bear the mission of facing four key orientations: the global scientific and technological frontiers, the development of the economy, the major needs of the country, the health and safety of people. These institutions also bear the responsibility for high-quality development. Establishment of a technological evaluation system aligned with contemporary needs is essential. Such a system can scientifically lead an advanced medical innovation, accelerate transformation of research outcomes, and contribute substantially to the "Healthy China" strategy. Collaborative research group on deepening reform of science and technology evaluation in Chinese hospitals and clinical research management group of scientific research management branch of medical scientific research management of Chinese Medical Association, in collaboration with institutions and expert teams, dedicated to research and management of hospital technological evaluation systems, alignment with national demands occurs. Reference to the global research advancements and integrations of hospital practices inform the formulation of this expert consensus. This consensus systematically delineates the framework for constructing and applying a technological evaluation system in Chinese hospitals. Through a scientific and standardized evaluation mechanism, enhancement of hospital innovation capacity and optimization of medical service quality will be promoted. The consensus encompasses evaluation objectives, principles, system constructions, application strategies, and supportive measures. A highly operational indicator system and implementation pathway are provided. Guidance is offered for hospital administrators, policymakers, and researchers.

In recent years, rapid pathogen nucleic acid testing has emerged in clinical settings with development towards to point-of-care testing (POCT), featuring with ease of operation, short detection time, and minimal laboratory space requirements. This is conducive to enhancing the accessibility and timeliness of nucleic acid testing, of great value to identify the pathogen quickly and accurately in clinical settings, and meanwhile, novel issues occurred for the construction and management for clinical gene amplification test laboratory. Therefore, aiming at enhancing standardized application of rapid pathogen nucleic acid testing in clinical laboratory and ensure testing quality, the China Association of Medical Equipment of Genetic Testing, the National Clinical Research Center for Laboratory Medicine, and the Beijing Medical Laboratory Quality Control and Improvement Center jointly developed the expert consensus and formulated 8 recommendations focusing on laboratory environment, reagents and consumable materials, instrument equipment, personnel requirements, specimen collection, transportation and storage, development of standard operating procedures, performance verification, internal quality control, external quality assessment, and result analysis and reporting.

To explore the association between the atherogenic index of plasma (AIP) and cognitive impairment (CI) in patients on maintenance hemodialysis (MHD).

A multicenter cross-sectional study was conducted between June and August 2022, involving adult MHD patients from 18 hemodialysis centers in Guizhou Province. Cognitive function was assessed by Mini Mental State Examination (MMSE) scale. General data and laboratory parameters of patients were collected, and the AIP was calculated. Participants were divided into four groups (Q1-Q4) based on the quartiles of the AIP. Multivariate logistic regression analysis was used to analyze the association between AIP and CI, and subgroup analysis was performed.

A total of 1 031 MHD patients aged (56.0±15.0) years were enrolled in the study, with 621 males (60.2%) and 410 females (39.8%), of whom 491 patients (47.6%) had CI. After adjusting for confounders, the risk of CI in Q4 group (AIP≥0.30) was 2.17 times that of the Q1 group (AIP<-0.13) (OR=2.17, 95%CI: 1.47-3.22, P<0.001). Subgroup analysis revealed that elevated AIP levels (Q4) correlated with a higher risk of CI in males, younger and middle-aged populations, as well as in subgroups with diabetes or hypertension (all P<0.05). Notably, in patients aged 18 to <45 years, the risk of CI in Q4 group was 3.73 times that of the Q1 group (OR=3.73, 95%CI: 1.18-11.80, P=0.025). Among patients with diabetes, the risk of CI was 2.30 times that of the Q1 group (OR=2.30, 95%CI: 1.29-4.09, P=0.004).

Increased AIP is associated with an increased risk of CI in MHD patients, particularly in younger patients and those with diabetes.

To analyze the differences in pulmonary function and inflammatory indicators between patients with chronic obstructive pulmonary disease (COPD) and those with persistent airflow limitation (PAL) asthma, and to explore the influencing factors of acute exacerbation in patients with COPD and PAL asthma.

A total of 192 patients with stable COPD and PAL asthma who visited the Department of Respiratory and Critical Care Medicine of the Shanghai General Hospital of Shanghai Jiao Tong University School of Medicine from January 2021 to December 2022 were prospectively included. Among them, 143 were male and 49 were female; the age ranged from 40 to 87 years [(63.4±12.1) years]; 92 were in the COPD group and 100 were in the PAL asthma group. The differences in lung function and inflammatory markers between the COPD group and the PAL asthma group were compared. The disease exacerbation of COPD and PAL asthma patients was evaluated every 3 months. After 12 months of follow-up, 138 patients completed the acute exacerbation assessment, including 105 males and 33 females; the age was (64.9±10.2) years; 66 were in the COPD group and 72 were in the PAL asthma group. Multivariate logistic regression models were used to analyze the influencing factors of acute exacerbation in COPD and PAL asthma.

The percentage of predicted forced expiratory flow at 75% of forced vital capacity (FEF₇₅%Pred), the percentage of predicted mid-expiratory flow between 25% and 75% of forced vital capacity (FEF_25-75%Pred), and the neutrophil-to-lymphocyte ratio (NLR) in the PAL asthma group were all lower than those in the COPD group (all P<0.05); the eosinophil count, lymphocyte count, fractional exhaled nitric oxide (FeNO), and the proportion of patients with type 2 inflammation were all higher in the PAL asthma group than in the COPD group (all P<0.05). The improvement rates of forced expiratory volume in one second (ΔFEV₁%), forced vital capacity (ΔFVC%), forced expiratory flow at 50% of forced vital capacity (ΔFEF₅₀%), forced expiratory flow at 75% of forced vital capacity (ΔFEF₇₅%), and mid-expiratory flow between 25% and 75% of forced vital capacity (ΔFEF_25-75%) in the COPD group were all lower than those in the PAL asthma group (all P<0.05). There were 22 cases (33.3%) of acute exacerbation in the COPD group. There were 25 cases (34.7%) of acute attack in the PAL asthma group. A lower baseline FEV₁%Pred (OR=0.934, 95%CI: 0.892-0.979) and a higher NLR (OR=1.185, 95%CI: 1.003-1.400) were risk factors for acute exacerbation in COPD patients within one year; a lower baseline FEV₁%Pred (OR=0.896, 95%CI: 0.823-0.976), higher ΔFEF₇₅% (OR=1.038, 95%CI: 1.011-1.066), and type 2 inflammation (OR=7.534, 95%CI: 1.254-45.246) were risk factors for acute attacks in PAL asthma patients within one year.

Patients with PAL asthma have more prominent type 2 inflammation features and stronger reversibility of small airways. Lower FEV₁%Pred and higher NLR are risk factors for acute exacerbation in COPD patients, while lower FEV₁%Pred, higher ΔFEF₇₅%Pred and type 2 inflammation are risk factors for acute attacks in PAL asthma patients.

To investigate the predictive value of liver-to-spleen volume ratio (LSR) for short-term prognosis in patients with hepatitis B virus -related acute-on-chronic liver failure (HBV-ACLF).

This retrospective study enrolled 168 HBV-ACLF patients diagnosed at Nantong Third People′s Hospital between September 2019 and August 2023. Participants were stratified into survival (n=106) and non-survival (n=62) groups based on 90-day outcomes. Baseline clinical parameters and laboratory findings were recorded; and abdominal CT measurements were collected to calculate LSR. Comparative analysis of clinical characteristics was performed between groups. Cox proportional hazards regression analyses identified clinical predictors. Restricted cubic spline (RCS) modeling explored the dose-response relationship between baseline LSR and mortality risk. Receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA) were employed to compare the prognostic performance of LSR with established scoring systems: Chinese Group on the Study of Severe Hepatitis B-acute-on-chronic liver failure Ⅱ score (COSSH-ACLF Ⅱ), model for end-stage liver disease (MELD), MELD combined with serum sodium (MELD-Na). Using the Delong test to compare differences in the areas under different curves (AUC).

A total of 168 patients were included, with an average age of (55.0±14.1) years, of which 110 were male. Among them, the survival group consisted of 106 cases, with an average age of (53.7±13.8) years and 70 males; the death group included 62 cases, with an average age of (57.4±14.4) years and 40 males.The survival group had higher results compared to the death group in LSR [M(Q₁, Q₃)] [3.1 (2.3, 4.5) vs 1.2 (1.0, 1.5)], liver volume [1 164.3 (1 002.1, 1 383.4) vs 713.9 (653.6, 884.2) cm³], and platelet count [109.0 (62.0, 147.8)×10⁹/L vs 78.0 (53.3, 133.3)×10⁹/L] (all P<0.05). The survival group demonstrated lower values in the proportion of hepatic encephalopathy, international standardized ratio, lactate, total bilirubin, COSSH-ACLF Ⅱ score, MELD and MELD-Na scores (all P<0.05). The results of the Cox proportional hazards regression modeling analysis demonstrated that hepatic encephalopathy (HR=2.01, 95%CI:1.11-3.63) and LSR (HR=0.17, 95%CI:0.10-0.30) as influencing factors of the death of patients with HBV-ACLF. RCS revealed a nonlinear association between baseline LSR and mortality risk (P_all<0.001, P_nonlinear=0.019). ROC analysis demonstrated the AUC of LSR [0.883 (95%CI:0.82-0.94)] was superior to COSSH-ACLF Ⅱ scores[0.77 (95%CI: 0.69-0.84)], MELD [0.68 (95%CI: 0.60-0.76)], and MELD-Na scores [0.64 (95%CI: 0.55-0.72)] (all P<0.05). Calibration curves and DCA confirmed LSR′s clinical utility in predicting the short-term prognosis in HBV-ACLF patients.

LSR shows significant predictive value for short-term prognosis in HBV-ACLF patients.

To investigate the efficacy and prognostic factors of split liver transplantation (SLT) using pediatric donor livers.

A retrospective analysis was conducted on the clinical data of pediatric donors and recipients who underwent SLT at the Third Affiliated Hospital of Sun Yat-sen University between January 2017 and July 2023. Donors were divided into younger children group (age≤7 years) and older children group (age>7 years) according to age. The clinical data of adult and pediatric recipients, and pediatric recipients receiving liver grafts from younger and older pediatric donors were compared and analyzed. The survival curves were drawn using the Kaplan-Meier method, and the prognosis of adult and pediatric recipients, and pediatric recipients receiving liver grafts from younger and older pediatric donors was compared using the log-rank test. Multivariate Cox proportional hazards regression model was used to analyze the risk factors affecting prognosis in recipients.

There were 30 pediatric donors, including 21 males and 9 females, aged (12.4±3.9) years and weighing (45.4±17.0) kg. There were 6 younger pediatric donors, aged (6.3±0.6) years and weighing [M (Q₁, Q₃)] 20.0(19.0, 21.0) kg. There were 24 older pediatric donors, aged (14.0±2.3) years and weighing 50.0(47.5, 60.0) kg. Grafts were allocated to 60 matched recipients based on graft-to-recipient weight ratio (GRWR), including 16 adult recipients [aged 50.0(44.0, 57.0) years and weighing 61.5(50.0, 65.0) kg] and 44 pediatric recipients [aged 1.0(0.3, 4.0) years and weighing 8.0(7.0, 15.0) kg], with 12 pediatric recipients receiving grafts from younger pediatric donors. The Model for End-Stage Liver Disease score for adult recipients was (24.4±11.7) points, with a GRWR of (1.6%±0.3%). Postopercitive complications occurred in 4 adult recipients, and 3 died. The Pediatric End-Stage Liver Disease score for pediatric recipients were (19.5±7.9) points, with a GRWR of (3.2%±1.0%). Among pediatric recipients, 12 experienced complications, and 6 died. Among the 12 recipients who received liver grafts from younger donors, 1 experienced a complication, and 2 died. There was no significant difference in the survival rate between pediatric and adult recipients at 1 year after surgery (95.5% vs 81.3%, P=0.100) and at 2 years after surgery (84.1% vs 81.3%, P=0.796). There was no significant difference in the survival rate between pediatric recipients receiving liver grafts from younger and older pediatric donors at 1 year after surgery (100.0% vs 93.8%, P=0.253) and at 2 years after surgery (91.7% vs 81.3%, P=0.374). Multivariate Cox proportional hazards regression analysis showed that long cold ischemia time (HR=0.990, 95%CI: 0.979-1.000), greater intraoperative blood loss (HR=1.000, 95%CI: 1.000-1.001), and postoperative infection (HR=15.736, 95%CI: 2.486-99.593) were risk factors for SLT recipient postoperative survival.

SLT using pediatric donor livers is safe and feasible with favorable outcomes, however, grafts from younger donors warrant cautious evaluation. Cold ischemia time, intraoperative blood loss, and postoperative infection are prognostic factors.

This study utilized vector flow mapping (VFM) technology to evaluate the characteristics of wall shear stress (WSS) in each segment of the left ventricle in patients with dilated cardiomyopathy (DCM). A total of 39 DCM patients [DCM group, 17 males and 22 females, aged (56.4±12.3) years] treated at the Second Affiliated Hospital of Air Force Medical University from May 2020 to September 2022 were prospectively enrolled. Additionally, 46 age-and gender-matched healthy volunteers [control group, 20 males and 26 females, aged (55.2±11.8) years] were selected during the same period. VFM was applied to annlyze WSS in the apical four-chamber, three-chamber, and two-chamber views of the left ventricle, and differences in WSS between the two groups were compared. The results showed that WSS at each phase of cardiac cycle gradunlly decreased gradually from basal to apical segments of the left uenrtricle in the control group but not in the DCM group. The DCM group exhibited significantly lower WSS than the control group in the mid-inferolateral wall during rapid filling; the basal posterior septum, basal inferolateral wall, mid-inferolateral wall, basal anterior septum, basal inferior wall, mid-anterior wall, and basal anterior wall during isovolumic contraction; and the basal, mid, and apical inferolateral segments during rapid ejection (all P<0.05). In addition, the global WSS was significantly lower in the DCM group than in the control group only in the mid-systolic phase [0.23(0.16, 0.31) N/m² vs 0.34(0.24, 0.38) N/m², P<0.05]. This study suggests that abnormal WSS distribution in DCM patients may reflect differences in ventricular mechanics, and changes in this parameter could serve as a novel indicator of ventricular dysfunction.

The data of 15 surgical cases who underwent type A and type B tympanic paragangliomas resections using a complete transcanal approach under otoscopic endoscopy in plasma mode from January 2021 to February 2024 at Senior Department of Otolaryngology Head and Neck Surgery, the 6th Medical Center of Chinese PLA General Hospital were retrospectively analyzed. Among the 15 patients, 3 were male and 12 were female, with a mean age of (43±11) years. All the cases achieved complete resection of the tumors under the plasma hemostasis mode. The mean operative time was (51±7) min. No sensorineural deafness was observed postoperatively in any of the patients. The current study indicates that the innovative surgical modality for treating various types of tympanic paragangliomas can achieve complete tumor resection with minimal or no bone grinding in an almost bloodless state, demonstrating high efficacy and safety profile.

This article reports a case of a 42-year-old male patient who was admitted to Peking Union Medical College Hospital on March 21, 2024 due to "fever for more than 2 months, convulsions accompanied by disorder of consciousness for 10 days". The patient had long-term fever, reduced blood lines with disturbance of consciousness, unclear etiology in routine screening, poor empirical antiviral and anti-infective effects, and elevated lactate dehydrogenase and lactate. A single abdominal wall subcutaneous fat biopsy (blind examination) was performed, and the final diagnosis was intravascular large B-cell lymphoma (IVLBCL). The patient's condition worsened and eventually died. The clinical symptoms of IVLBCL are not specific, and because there is no tumor space-occupying lesion, it is difficult to diagnose by routine laboratory examination, especially when the central nervous system is involved, it is difficult to obtain pathology, and it is easy to miss and misdiagnose. This case is helpful to improve the awareness and emphasis of medical workers on IVLBCL.

This article reviews the basic and clinical research progress in the field of cerebral small vessel disease (CSVD) at home and abroad in 2024 and puts forward corresponding thoughts. The genetic level confirmed the high risk of cognitive impairment caused by white matter hypersignal-cortical atrophy, and found potential gene intervention CSVD targets; A new cerebral blood flow regulation mechanism "synaptic-like connection" was discovered at the microscopic level, and the mechanism of hypertension damaging the blood-brain barrier in patients with CSVD was explored. Cognitive impairment markers such as eye movement and gait characteristics were found at the macro level; Different types of CSVD have different manifestations of blood-brain barrier dysfunction, and chronic stress may become a potential therapeutic target for cerebral amyloid angiopathy; Basic research on multisensory gamma stimulation provides new potential therapeutic targets for Alzheimer's disease and chronic CSVD; The results of clinical studies of sildenafil and minocycline have driven the exploration of more future intervention targets; Many consensus have been issued at home and abroad on standardizing the expression and staging of CSVD, which provides more consistent standards for follow-up research.

Atherosclerosis (AS) is a chronic systemic inflammatory disease of the arteries. Vulnerable AS plaques are the most common cause of acute coronary syndrome and sudden cardiac death, so early identification of vulnerable plaques before these adverse cardiovascular events is crucial for the precise prevention and treatment of cardiovascular diseases. Molecular imaging combines molecular information and imaging technology, can accurately monitor the physiological and pathological processes of AS, and has unique advantages in the evaluation of vulnerable plaques, which brings new choices for AS diagnosis. Current molecular imaging strategies for vulnerable plaque targeting in AS and their recent advances are reviewed.

Immune checkpoint inhibitors targeting programmed cell death receptor-1 (PD-1) and programmed cell death ligand-1 (PD-L1) have achieved significant efficacy in a variety of lymphoma treatments, especially in Hodgkin's lymphoma and primary mediastinal large B-cell lymphoma. However, although some patients have good initial response, most patients still develop primary or secondary drug resistance, which becomes a key factor affecting the quality of life of patients. In recent years, the research on the resistance mechanism of PD-1/PD-L1 immunotherapy has gradually become a hot spot. Studies have shown that changes in tumor microenvironment, immunosuppressive cells and metabolites in tumor cells play a key role in the mechanism of drug resistance. In particular, the upregulation of regulatory T cells, tumor-associated macrophages and other immune checkpoints may promote tumor immune escape, thus promoting the occurrence of drug resistance. This article reviews the research progress of PD-1/PD-L1 immunotherapy in the mechanism of drug resistance in lymphoma, aiming to provide reference for optimizing clinical treatment strategy and formulating personalized treatment plan.

In the article "Correlation between extracellular fluid/intracellular fluid ratio and depression in maintenance hemodialysis patients", Chinese Journal of Medicine, Volume 105, Issue 16, 2025, page 1262, author and unit label, "Yan Cha²"Should be" Cha Yan^1，2”。 Corrections are hereby made.