Volume 105 · Issue 26 · 2025

The article systematically reviewed the key historical stages of the development of National Medical Journal of China over more than a century. It provides a comprehensive discussion on the significant contributions made by the journal to the advancement of China′s medical and healthcare during different periods, under the leadership of successive chief editors. The article reflects the journal′s development history from its original purpose and core content. By showcasing the academic achievements published in the journal, it highlights the country′s accomplishments in academia, and elucidates the important role the journal has played in guiding the development of Chinese medicine, facilitating academic exchanges, and nurturing medical talent.

Chronic obstructive pulmonary disease (COPD) affects nearly 100 million individuals in China and has become a major public health challenge. Primary healthcare institutions serve as the frontline for implementing comprehensive COPD management strategies. However, current primary care practices face multiple limitations, including inadequate screening capacity, insufficient resource allocation, suboptimal hierarchical diagnosis systems, and low public awareness of the disease. Based on policy guidance, this article explores strategies for early screening high-risk populations, optimization of hierarchical diagnosis practices, development of primary-level respiratory specialty clinics, application of artificial intelligence-assisted diagnosis, and adaptation of international experience. We explore multidimensional pathways to standardize COPD management in primary care settings, providing a reference for the prevention, control, and precision management of COPD in China.

Pulmonary thromboembolism (PTE) is a major clinical manifestation of venous thromboembolism (VTE), characterized pathologically by thrombotic obstruction of the pulmonary arteries or their branches, resulting in hemodynamic disturbances and impaired gas exchange. In severe cases, PTE may lead to right heart failure or even sudden death. In recent years, diagnostic and therapeutic capabilities for PTE in China have significantly improved. However, disparities remain across different regions, healthcare institutions, and clinical departments with respect to early identification, standardized prevention and treatment, and multidisciplinary collaboration. To enhance clinical practice, the Pulmonary Embolism and Pulmonary Vascular Disease Group of the Chinese Thoracic Society, the Pulmonary Vascular Disease Working Group of Chinese Association of Chest Physicians, and the National Cooperative Group for the Prevention and Treatment of Pulmonary Embolism and Pulmonary Vascular Diseases jointly convened a multidisciplinary panel of experts. Based on both domestic and international evidence from evidence-based medicine and using the Delphi method, the Chinese guidelines for the diagnosis, treatment, prevention, and management of pulmonary thromboembolism (2025) have been developed. These guidelines cover the definition, epidemiology, risk factors, diagnostic strategies, risk stratification, comprehensive scenario-based acute phase management strategies, management of special clinical conditions, long-term follow-up and preventive measures. The aim is to establish a standardized PTE management system suited to the national conditions and to promote consistent development of PTE prevention and treatment capabilities across all levels of healthcare institutions.

To investigate the value of CT-based tumor and peritumoral radiomics in predicting the World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading for non-metastatic clear cell renal cell carcinoma (ccRCC).

A total of 503 patients with non-metastatic ccRCC were retrospectively enrolled from 7 tertiary hospitals between February 2017 and December 2023. Patients from 4 hospitals within Shandong Province were divided into a training set and an internal validation set in a 7∶3 ratio, while patients from 3 hospitals outside Shandong Province constituted the external validation set. Regions of interest (ROI) were manually delineated slice-by-slice along the tumor margin on contrast-enhanced CT images. Peritumoral regions were obtained by expanding 10 mm outward from the tumor boundary. Key radiomics features were selected using Least Absolute Shrinkage and Selection Operator (LASSO) regression with five-fold cross-validation to build tumor models and peritumoral models for predicting the WHO/ISUP grading. Univariate logistic regression was used to screen clinical factors associated with the WHO/ISUP grading, which was included to construct a combined predictive model together with tumor and peritumoral features. The predictive performance of the models for WHO/ISUP grading was evaluated using receiver operating characteristic (ROC) curves, and the Youden index and optimal cutoff value were calculated for risk stratification. Calibration curves were used to validate model performance, and decision curve analysis (DCA) was employed to evaluate the clinical value of the models.

The median age [M(Q₁,Q₃)] of the 503 patients was 59.0 (52.0, 66.0) years, with 335 males and 168 females. Univariate logistic regression analysis showed there was a statistically significance in age between low and high WHO/ISUP grades (P=0.043). The AUC of the tumor model and peritumoral model in the internal validation set were 0.744 (95%CI: 0.700-0.788) and 0.742 (95%CI: 0.709-0.774), respectively. In the external validation set, the AUC of the tumor model and peritumoral model were 0.685 (95%CI: 0.651-0.720) and 0.655 (95%CI: 0.628-0.683), respectively. The combined model demonstrated the best predictive performance in both internal and external validation sets, with AUC of 0.760 (95%CI: 0.721-0.800) and 0.706 (95%CI: 0.675-0.737), respectively. Using the Youden index calculated from the ROC curve from the combined model, the optimal cutoff value was 0.504 for risk stratification, where 190 cases were classified as low-grade and 313 as high-grade, achieving a concordance rate of 0.718 (361/503) with the WHO/ISUP grading. Calibration curve tests indicated good fit for the combined model (internal validation set: P=0.932; external validation set: P=0.404). DCA showed that the combined model provided favorable clinical net benefit within the threshold probability range of 0.2-0.8.

The combined model incorporating age, CT-based tumor features, and peritumoral features demonstrates good performance in predicting the WHO/ISUP grading for patients with non-metastatic ccRCC.

To analyze the clinical characteristics and treatment strategies of nasopharyngeal carcinoma (NPC) with concurrent thyroid cancer (TC).

A case series study was carried out. The clinical data of NPC patients with concurrent TC diagnosed by pathology and with complete follow-up data who were initially treated in Sun Yat-sen University Cancer Center from January 2017 to December 2023 were retrospectively reviewed. Patients were divided into NPC-first treatment group and TC-first treatment group based on the treatment sequence. Clinical characteristics, treatment strategies and prognosis of patients were compared between the two groups.

A total of 53 cases (28 males and 25 females) aged [M (Q₁, Q₃)] 42 (34, 48) years were included. Sixteen (31.2%) patients underwent TC treatments first, while 37 patients (69.8%) underwent NPC treatments first. There were 64.2% (34/53) patients diagnosed based on NPC-specific ENT symptoms. The Epstein-Barr virus (EBV) DNA-negative rate [62.5% (10/16) vs 24.3% (9/37), P=0.008], the rate of double-lobe thyroid lesions based on positron emission tomography/computed tomography (PET/CT) scans (3/6 vs 1/26, P=0.015), the rate of cervical lymph node metastasis of TC based on ultrasound scans [31.2% (5/16) vs 5.4% (2/37), P=0.021] and the rate of stageⅠ-Ⅲ NPC [87.5% (14/16) vs 54.1% (20/37), P=0.020] were higher in patients who underwent TC treatment first compared with those who underwent NPC treatment first. The interval between NPC and TC treatments was longer in NPC-first treatment group than that of TC-first treatment group [166 (125, 281) days vs 74 (29, 90) days, P<0.001]. In patients who underwent TC treatment first, fewer level Ⅵ cervical lymph nodes were included in the clinical target volume (CTV) compared with those who underwent NPC treatment first [10.0% (2/20) vs 40.0% (16/40), P=0.017]. After 38.7 (18.3, 52.3) months of follow-up, there was no statistically significant difference in expected 3-year progression free survival rates and overall survival rates between the two groups (87.3% vs 83.6% and 100% vs 87.5%, respectively, both P>0.05).

The majority of NPC patients with concurrent TC were initially diagnosed due to NPC-related symptoms, consequently leading to a higher proportion receiving NPC treatment as their primary therapy. For NPC patients with concurrent TC, receiving TC treatment first facilitates the guidance of CTV.

Analysis of antimicrobial resistance and clinical outcomes in patients infected with different KL types of Acinetobacter baumannii.

This is a cross-sectional study. From 2011 to 2021, 675 non-repetitive A. baumannii strains were isolated from patients with bloodstream infection (BSI, 234 cases), hospital acquired pneumonia (HAP, 423 cases), intra-abdominal infection (IAI, 17 cases) and urinary tract infection (UTI, 1 case) in 10 hospitals across 8 provinces of China. KL types and resistance genes were identified using bioinformatics methods. The minimum inhibitory concentrations of different antibiotics against 675 A.baumannii strains were determined by agar or microbroth dilution method. Ten strains were randomly selected from each KL type using simple random sampling for whole blood survival experiments. Differences in hospitalization duration and clinical outcomes were analyzed among patients infected with different KL types.

The 675 patients were aged (59±20) years, including 460 males. The predominant KL types included KL2 (22.0%, 149 strains), KL3 (17.5%, 118 strains), KL210 (7.0%, 47 strains) and KL160 (7.0%, 47 strains), while non-predominant KL types accounted for 314 strains (46.5%). The four predominant KL types showed higher overall resistance rates to most antibiotics compared with non-predominant KL types (all P<0.05). KL2 (92.6%, 113 strains) showed higher resistance to sulfamethoxazole-trimethoprim than KL3 (55.9%, 66 strains) (P<0.05). KL2 (87.2%, 130 strains) and KL210 (91.5%, 43 strains) showed higher resistance to minocycline than KL3 (67.8%, 80 strains) and KL160 (66.0%, 31 strains) (all P<0.05). KL2 exhibited stronger whole blood survival capacity [(58.36±20.33)%] than other KL types (all P<0.05). The fatality rate of KL2-infected patients was 30.9% (46 cases), higher than that of patients infected with KL3 (11.9%, 14 cases) and KL210 (6.4%, 3 cases) (all P<0.05). The hospitalization duration [M(Q₁,Q₃)] of KL2-infected patients was 46.00 (26.50, 74.00) days, longer than that of patients infected with KL3 [30.00 (15.25, 40.75) days], KL210 [27.00 (21.00, 44.00) days], KL160 [27.00 (20.00, 34.00) days] and non-predominant KL types [25.00 (12.00, 40.00) days] (all P<0.05).

Different KL types of A.baumannii show variations in antimicrobial resistance and clinical outcomes of infected patients. KL2 demonstrates higher resistance rates and is associated with poorer clinical prognosis.

To investigate the protective effect and its mechanism of intratympanic administration of diselenide cross-linked nano-carriers of astaxanthin (AST@dSe-AFT) on vestibular toxicity induced by gentamicin (GM) in mice.

Forty-two male ICR mice aged 6-8 weeks were randomly divided into seven groups according to a random number table: control group, GM injury group, natural astaxanthin (AST) protection group (GM+AST group), and four AST@dse-AFT protection groups (GM+AST/NP 0.1 group, GM+AST/NP 1 group, GM+AST/NP 10 group, and GM+AST/NP 100 group), which were given 0.1, 1, 10, and 100 mg/ml AST@dSe-AFT, respectively. The control group did not receive any intervention;the GM injury group was established by intraperitoneal injection of 200 mg/kg GM for 7 consecutive days to construct a vestibular injury model; the GM+AST group received an intratympanic injection of 0.1 ml of 1 mg/ml AST dimethyl sulfoxide solution, while the remaining four groups received intratympanic injections of corresponding concentrations of AST@dSe-AFT. Afterwards, a vestibular injury model was constructed. The vestibular function was evaluated through swimming experiments, balance beam experiments, and rotating rod fatigue instrument experiments. The morphology and number of hair cells in the macula of the utricle and saccule were observed by immunofluorescence staining, and the expression levels of apoptosis-related proteins in the vestibular tissues were analyzed.

The behavioral experiments revealed that the balance beam passing time in the GM+AST/NP 10 and GM+AST/NP 100 groups were shorter than that in the GM injury group [(18.8±1.5) and (19.3±1.2) vs (33.9±2.0) s, all P<0.05], and the total distance,dwell time and speed of the rotating rod fatigue test were higher than those in the GM injury group [(2.9±0.4), (3.3±0.6), (1.0±0.1) m; (121.6±9.2), (125.7±11.4), (70.9±5.1) s; (30.7±2.4), (31.7±3.0), (17.2±1.4) m/s, respectively, all P<0.05]. Immunofluorescence staining results showed that the number of hair cells in the utricle macula in the GM+AST/NP 10 and GM+AST/NP 100 groups were higher than that in the GM injury group (all P<0.05). The expression of apoptosis-related proteins Cleaved caspase 3, Cleaved caspase 9, and Cleaved PARP-1 in the GM+AST/NP 10 group was lower than that in the GM injury group (all P<0.05).

Intratympanic injection of AST@dSe-AFT can antagonize GM-induced vestibular damage, and its protective effect on vestibular function may be related to the inhibition of hair cell apoptosis.

To investigate the association of sleep duration and fasting plasma glucose with the risk of stroke.

A Prospective cohort study. Two towns in Xin′an County, Henan Province were selected as study sites. Using natural villages as the sampling unit, cluster random sampling was used to recruit 20 194 participants in 2007-2008 for the baseline study, and two follow-up studies were completed in 2013-2014 and 2018-2020, respectively. A total of 13 741 eligible participants were included in the analysis. Multivariate Cox proportional hazards regression model was used to assess the association of sleep duration and fasting plasma glucose with stroke risk and the restricted cubic spline was applied to fit the dose-response relationships.

The age [M (Q₁, Q₃)] of 13 741 participants was 51.0 (41.0, 60.0) years, and 5 308 (38.63%) participants were male. Over a median follow-up of 10.18 years, 1 612 incident stroke events were observed. Compared with participants sleeping 7 to<8 h/d, the risk of stroke increased for those sleeping<6 and≥10 h/d, with HR (95%CI) of 1.44 (1.04-2.00) and 1.37 (1.13-1.66), respectively. A U-shaped relationship between sleep duration and stroke risk was observed (P_nonlinear<0.001). Compared to people with normal fasting glucose, the HR (95%CI) of stroke risk was 1.58 (1.36-1.84) for diabetes patients. A nonlinear association between fasting plasma glucose level and stroke risk was observed (P_nonlinear=0.036). Compared to individuals with sleep duration of 7 to<9 h/d and normal fasting glucose, the HR (95%CI) of stroke risk was 1.60 (1.18-2.16) for those with sleep duration<7 h/d and prediabetes, and 2.07 (1.27-3.39) for those with sleep duration<7 h/d and diabetes; the HR (95%CI) of stroke risk was 1.18 (1.01-1.39) for those with sleep duration≥9 h/d and prediabetes, and 1.84 (1.50-2.26) for those with sleep duration≥9 h/d and diabetes. But no significant interaction between sleep duration and fasting plasma glucose was found on stroke risk (P>0.05).

Inadequate sleep duration, prolonged sleep duration and elevated fasting plasma glucose level were associated with increased risk of stroke, and the stroke risk was further increased when sleep duration<7 or≥9 h/d coexisted with abnormal fasting plasma glucose states.

To explore the relationship between different types of physical activities and health longevity among older adults aged≥75 years in China.

The study participants were from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). There were 11 357 older participants who were≥75 years old and met the criteria of being able to achieve longevity (≥90 years) at the last follow-up in 2018. To assess whether healthy longevity was achieved at the endpoint of follow-up, the participants were categorized into healthy longevity group and control group. Healthy longevity was defined as participants living to≥90 years while maintaining health across five functional domains, including activities of daily living, mental health, cognitive function, as well as visual and hearing functions. Logistic regression models were used to analyze the effect of three types of physical activities including regular exercise, leisure activities and physical labor on healthy longevity.

Of all the participants, 729 (6.4%) were in healthy longevity group, aged (85.4±3.3) years, 417 (57.2%) male, and 10 628 (93.6%) were in control group, aged (83.2±3.7) years, 5 352 (50.4%) male. The proportion of regular exercise [40.5% (295/729) vs 32.7% (3 474/10 628)] and high leisure activity levels [56.9% (415/729) vs 43.6% (4 639/10 628)] were higher in the healthy longevity group than in the control group (all P<0.05). The results showed that regular exercise increased the likelihood of achieving healthy longevity by 35% (OR=1.35, 95%CI: 1.13-1.61), whereas leisure activity could increase it by 94% (OR=1.94, 95%CI: 1.64-2.31). Physical labor was not found to be statistically significant (OR=1.07,95%CI:0.86-1.33, P=0.818). In addition, there was a joint effect among different physical activities. The OR (95%CI) for achieving healthy longevity by participating in both regular exercise and high levels of leisure activity was 2.46 (1.98-3.06), compared to participants with no regular exercise and low levels of leisure activity. The OR (95%CI) for the combined effect of regular exercise and physical labor to achieve healthy longevity for participants was 1.44 (1.06-1.94), compared to participatnts with no regular exercise and no physical labor. The OR (95%CI) for the combined effect of physical labor and high leisure activity levels to enable participants to achieve healthy longevity was 2.09 (1.51-2.91), using non-participation in physical labor and low leisure activity levels as a reference.

Taking part in exercise and a higher level of leisure activities at the same time are most beneficial to healthy longevity for the older adults aged 75 and above.

To investigate the clinical anesthetic and analgesic effects of sub-anesthetic doses of esketamine in elderly patients with gastrointestinal tumors during the perioperative period in plateau areas, a prospective study was conducted to include elderly patients (≥60 years) undergoing laparoscopic radical resection of gastrointestinal tumors under general anesthesia at the Affiliated Hospital of Qinghai University from June 2023 to October 2024. They were randomly divided into an experimental group and a control group. The experimental group received an intravenous infusion of esketamine at 0.2 mg·kg⁻¹·h⁻¹ from 10 min before anesthesia induction until 10 min before the end of surgery, while the control group was administered an equal-volume infusion of normal saline at the same rate during the same period. The perioperative clinical data and differences in anesthesia and pain-related indicators at different time points were compared between the two groups. Finally, 67 patients were included for analysis, including 33 patients in the control group [23 males, aged (68.8±6.2) years] and 34 patients in the experimental group [24 males, aged (67.7±5.1) years]. There were no significant differences in age, gender, American Society of Anesthesiologists classification, and operation duration between the two groups (all P>0.05). The mean arterial pressure in the experimental group was higher than that in the control group at 1 min of pneumoperitoneum and 30 min of extubation [(87.6±8.5) mmHg vs (81.7±8.8) mmHg; (95.6±10.3) mmHg vs (90.1±9.0) mmHg (1 mmHg=0.133 kPa), all P<0.05]. The visual analog scale for pain in the experimental group was lower than that in the control group at 2, 12, and 24 h after surgery (all P<0.05). The amount of propofol, remifentanil, norepinephrine, and fluid infusion in the experimental group were all lower than those in the control group (all P<0.05), and the recovery time of spontaneous breathing [(8.6±2.6) min vs (13.4±4.1) min, P<0.05] and the awakening time [(11.6±3.5) min vs (16.4±5.2) min, P<0.05] were both shorter than those in the control group. This study suggests that in elderly patients with gastrointestinal tumors undergoing general anesthesia in plateau areas, the combination of sub-anesthetic doses of esketamine can improve the efficacy of anesthesia and analgesia without affecting recovery, and reduce the amount of other anesthetic drugs used.

This paper reports the diagnosis and treatment of a patient undergoing maintenance hemodialysis (MHD) with chronic mesenteric ischemia (CMI). A 67-year-old female was admitted to the hospital on October 5, 2024 due to "20 years after kidney transplantation, 5 years of hemodialysis, 1 year of intermittent abdominal pain, aggravated for 3 days". She was initially treated with cholecystitis and residual gastritis, but the curative effect was not good; CMI was diagnosed after further improvement of angiography, and the condition improved after interventional treatment. After follow-up until 2 Apr 2025, the patient did not experience abdominal pain again.

As an important mechanism of cross-organ pathophysiological regulation, the monitoring of abnormal activities of heart-brain interaction has great clinical value for early detection and intervention of cardiovascular diseases. In this paper, the application of PET tracers in heart-brain interaction was systematically combed from various aspects such as glucose metabolism, autonomic nervous system, neuroinflammation and blood perfusion tracers. The authors emphasize that the application of amygdala PET-CT in cardiovascular diseases provides a new way to study heart-brain interaction. In this paper, the research progress of PET in coronary heart disease and stress cardiomyopathy, and the relationship between other factors affecting amygdala activity and cardiovascular diseases are described in detail. The challenges and future development trends of PET molecular imaging research on heart-brain interaction are discussed.

Transcranial direct current stimulation is a non-invasive neuromodulation technique. Its main mechanism is to change the resting membrane potential of neurons to regulate the excitability of cortical neurons. At present, it is mainly used to regulate cognitive function and symptoms of mental and neurological diseases, and it also shows an improving effect in the regulation of auditory and speech ability. This paper focuses on the effect of transcranial direct current stimulation on auditory and speech ability in different populations, and summarizes the new progress of transcranial direct current stimulation in auditory and speech ability regulation from the perspectives of healthy subjects, tinnitus, aphasia and hearing loss patients, so as to provide reference for clinical application.