Volume 105 · Issue 29 · 2025

On the occasion of the 110th anniversary of the Chinese Medical Association, this article reflects on the author′s over six decades of experience in medical education, including leadership roles as president and dean at multiple medical schools, sharing insights into advancing medical science and improving medical education. This article details the author′s journey and achievements in publishing medical journals and book series, introducing foreign scientific literature, reforming medical education and residency training systems, and facilitating the translation of research into clinical practice. Furthermore, this article calls upon healthcare professionals to embrace artificial intelligence (AI) in medical education, research, and patient care, advocating for its integration to propel China′s medical progress and contribute to the nation′s Healthy China initiative and rejuvenation.

Autoimmune diseases are conditions in which the immune system mistakenly recognizes and attacks its own tissues, triggering a series of inflammatory responses and tissue damage. Pathogenic IgG plays a pivotal role in the pathogenesis and progression of these diseases. Traditional therapeutic agents often yield limited efficacy and are frequently associated with significant adverse effects. The advent of novel biologics, particularly neonatal Fc receptor (FcRn) inhibitors, represents a breakthrough in the treatment of autoimmune diseases. FcRn inhibitors specifically block the interaction between FcRn and IgG, thereby accelerating the degradation of pathogenic IgG and alleviating damage to target organs. Multiple high-quality clinical studies have demonstrated that FcRn inhibitors exhibit remarkable efficacy and favorable safety in various IgG-mediated autoimmune diseases. However, several challenges remain, including variability in individual therapeutic responses, and the need for optimization of dosing regimens. Future research should prioritize the following areas: structural optimization of FcRn inhibitors, expansion of the therapeutic indications, exploration of combination therapy strategies, and the development of personalized dosing regimens. With the improvement in drug structure, accumulation of clinical evidence, and refinement of treatment approaches, FcRn inhibitors hold considerable promise as a major therapeutic option in the field of autoimmune disease treatment, offering more profound clinical benefits for patients.

Intracranial atherosclerotic stenosis (ICAS) is an important cause of ischemic stroke and transient ischemic attack (TIA), which can also lead to cognitive impairment and dementia. Overall, the prevalence of ICAS is significantly higher in Asian than in Western countries/regions. In recent years, new evidence has emerged regarding the epidemiology, diagnosis, assessment, prognosis and treatment of ICAS, hence there have been guidelines or consensus statements published on the topic in other countries/regions. To better guide the screening, diagnosis and treatment of ICAS in China, the Chinese Research Hospital Association, the Neurointerventional Professional Committee of Chinese Medical Doctor Association, and the Branch of Cerebrovascular Function & Disease convened an expert panel to develop the'Guidelines for Diagnosis and Treatment of Intracranial Atherosclerotic Stenosis (2025 edition). The guidelines are developed based on published research evidence and in reference to relevant domestic and international guidelines or expert consensus, aiming to further clarify the definition, epidemiology and prognosis of ICAS and profiles of high-risk ICAS patients, and provide 30 recommendations on screening, diagnosis, assessment and treatment strategies based on current evidence. We also aim to enhance awareness and understanding of ICAS among clinical and research professionals, promote standardized patient management, and ultimately reduce the prevalence of ICAS and the subsequent risks of stroke, cognitive impairment and other clinical events, thereby improving patient outcomes.

Hyperuricemia (HUA) is highly prevalent in China with an increasing prevalence and a growing trend towards the youth. Long-term HUA can lead to gout, kidney stones and renal impairment, and is also associated with the development and progression of other organ damage, including cardiovascular diseases, metabolic disorders, and neurological conditions, etc. To identify high-risk individuals for HUA-related complications and establish standardized management strategies, including determining which HUA patients may be recommended for urate-lowering therapy (ULT) and outlining detailed treatment regimens (such as optimal timing, drug selection and treatment targets, etc.), the Chinese Rheumatology Association and the Committee for Rheumatologists and Immunologists of Chinese Primary Health Care Foundation organized domestic experts to develop the Expert Consensus on Urate-lowering Therapy for High-Risk Hyperuricemia (2025 edition). This consensus systematically summarizes the latest evidence, defines high-risk hyperuricemia (HrHUA) as well as 11 ULT relevant clinical issues, and provides detailed recommendations to treatment practices, ultimately improving patient outcomes.

To investigate the relationship between preoperative ultrasound-guided intra-articular local anesthetics injection at different time points and postoperative infection risk and inflammatory response after hip arthroscopy in femoroacetabular impingement(FAI).

This retrospective observational study enrolled FAI patients who underwent hip arthroscopy surgery at the General Hospital of the People′s Liberation Army from May 2017 to October 2023. According to the time interval between intra-articular injection and the surgery, the patients were divided into four groups: injection time≤30 days prior to surgery, injection time between 30-90 days prior to surgery, injection time>90 days prior to surgery, and non-injection group. The temperature and peripheral blood inflammation indicators of patients within one week before surgery and during hospitalization after surgery were collected. The international hip joint score (iHOT-12), visual analogue scale (VAS) of pain and the modified Harris Hip Score (mHHS) before and within 12 months after surgery were collected. The postoperative infection rates, clinical scores, temperature and inflammatory markers between groups were compared.

A total of 425 patients were included, with 264 males and 161 females, aged (37.2±12.9) years. There were 152 cases in the≤30 d group, aged (36.9±12.5) years; 58 cases in the 30-90 d group, aged (41.4±13.2) years; 28 cases in the>90 d group, aged (37.3±12.0) years; and 187 cases in the non-injection group, aged (36.2±13.0) years. No acute and chronic infections were found in the enrolled patients, and 8 cases of suspected acute infections were found: 5 cases (2.7%) in the non-injection group, 2 cases (3.5%) in the 30-90 d group, 1 case (3.6%) in the>90 d group, and 0 case in the≤30 d group, and the difference in the proportion of patients with suspected acute infections among the various groups was not statistically significant (P=0.061). There were 17 patients with maximum body temperature≥38.0 ℃ on postoperative day 1, 9 (4.8%) in the non-injection group, 2 (7.1%) in the > 90 d group, 1 (1.7%) in the 30-90 d group, and 5 (3.3%) in the≤30 d group. There were 143 patients with mildly elevated body temperature (37.0-38.0 ℃), 74 (39.6%) in the non-injection group, 10 (35.7%) in the>90 d group, 17 (29.3%) in the 30-90 d group, and 42 (27.6%) in the≤30 d group, and the difference in the proportion of the number of people with different degrees of fever among the groups was not statistically significant (P=0.180). The peripheral blood leukocyte level was 10.6 (8.5, 12.2)×10⁹/L in the≤30 d group, 9.7 (7.8, 10.5)×10⁹/L in the 30-90 d group, 8.9 (8.0, 10.7)×10⁹/L in the>90 d group, 10.0 (7.9, 11.3)×10⁹/L in the non-injection group, and peripheral blood leukocytes in the≤30 d group were significantly higher than those in the other three groups (all P<0.05). The differences in neutrophil ratio, neutrophil-to-lymphocyte ratio, C-reactive protein, erythrocyte sedimentation rate were not statistically significant among the groups after the surgery (all P>0.05). The iHOT-12, VAS of pain and mHHS scores of patients in all groups improved at 12 months after surgery when compared with the values before the operation (all P<0.001).

Preoperative ultrasound-guided intra-articular hip anesthetic injection performed with standardized sterile technique does not increase postoperative infection risk or inflammatory response in FAI patients.

To analyze the relationship between primary tumor lymph node indicators and prognosis and clinical efficacy in colorectal cancer patients with lung metastases.

A retrospective analysis was performed on the clinical data of 204 patients diagnosed with colorectal cancer accompanied by solitary pulmonary metastases at the Cancer Hospital, Chinese Academy of Medical Sciences between January 2010 and December 2020. The cohort comprised 121 male and 83 female, with a mean age of (58.6±9.1) years. Patient survival status was documented, and the follow-up continued until the patient′s death or December 31, 2024. The influencing factors of overall survival (OS) in colorectal cancer patients with pulmonary metastases were analyzed using a multivariate Cox proportional hazards regression model. Survival curves were plotted using the Kaplan-Meier method, and the log-rank test was employed to evaluate the differences in OS among colorectal cancer patients with lung metastases who had primary colorectal tumors with different lymph node statuses. An efficacy analysis was also conducted for patients with pulmonary metastases who solely received medical treatment.

A total of 204 patients were followed up for 48.0(34.1, 80.4) months. One patient was lost to follow-up, and 39.7% (81/204) patients had died. The median OS was 48.0 months (95%CI: 11.5-119.3 months), with a 5-year overall survival rate of 58.5%. Multivariate analysis showed that pathological lymph node stage (pN) (+) (HR=2.14, 95%CI: 1.17-3.92), number of negative lymph node (NLN)<13 (HR=1.97, 95%CI: 1.22-3.18), carcinoembryonic antigen (CEA) during lung metastasis≥10 μg/L (HR=2.25, 95%CI: 1.28-3.98), multiple lung metastases (HR=2.16, 95%CI: 1.08-4.31), and non-surgical resection of lung metastases (HR=2.28, 95%CI: 1.11-4.65) were risk factors affecting OS in patients with colorectal cancer lung metastasis. Kaplan-Meier survival curves showed that patients with colorectal cancer lung metastases had shorter OS when primary tumor pN (+), primary tumor logarithmic odds of positive lymph node (LODDS)≥-1.1, primary tumor lymph node ratio (LNR)≥0.02, primary tumor NLN<13, or primary tumor total number of lymph node (TLN)<16(all P<0.05). Among the 204 patients, 72 with pulmonary metastases did not undergo surgical intervention and solely received medical treatment. Based on their prognosis, they were categorized into the partial response (PR) group (n=32) and the stable disease (SD)+progressive disease (PD) group (n=40). The results indicated that the PR group had significantly lower rates of pN(+), LODDS≥-1.1, LNR≥0.02, NLN<13, and TLN<16 compared to the SD+PD group (all P<0.05).

Patients with colorectal cancer lung metastases who have primary tumors with pN(+), LODDS≥-1.1, LNR≥0.02, NLN<13, or TLN<16, tend to have shorter OS and poorer treatment outcomes. It is recommended to adopt an intensified systemic therapy strategy to improve the efficacy of medical treatment and, if possible, create conditions for surgical intervention.

To explore the influencing factors of the efficacy of vedolizumab (VDZ) in the treatment of ulcerative colitis (UC) patients.

The clinical data of patients with active UC, who underwent VDZ treatment from November 2020 to February 2024 in the Second Affiliated Hospital of Wenzhou Medical University were retrospectively collected. Each patient received intravenous injection of VDZ (300 mg per dose) at weeks 0, 2 and 6, and then received the same dose of intravenous injection of VDZ every 8 weeks. At week 16, the patients were divided into clinical remission group (who achieved clinical remission) and clinical non-remission group. At week 34, the patients were divided into mucosal healing group (who achieved mucosal healing) and mucosal non-healing group, as well as pathological remission group (who achieved pathological remission) and pathological non-remission group. The serum cytokines levels [interleukin (IL)-4, IL-6, IL-10, and tumor necrosis factor (TNF)-α] were detected at week 0, and 16, and the magnitude of cytokine changes (the difference between week 16 and week 0) was caculated. At week 16, the clinical remission of the patients was evaluated. At week 34, the patients underwent re-examination of colonoscopy to assess intestinal inflammation and histopathological activity. Multivariate logistic regression models were used to explore the influencing factors of clinical remission, mucosal healing, and pathological remission.

A total of 100 patients were included, 54 males and 46 females, aged (43.5±13.7) years. At week 16, there were 68 patients in clinical remission group and 32 patients in clinical non-remission group. In clinical remission group, the reductions of IL-6 [M (Q₁, Q₃), -0.85 (-1.23, -0.46) vs -0.26 (-1.04, 0.19) ng/L, P<0.001] and IL-6+TNF-α [-0.99 (-1.46, -0.52) vs -0.30 (-0.83, 0.47) ng/L,P<0.001] were higher than those in clinical non-remission group. IL-6 reduction≥0.40 ng/L (OR=15.33, 95%CI: 4.42-53.19), disease location limited to the rectum and left sided colon (OR=0.16, 95%CI: 0.05-0.51) and baseline partial Mayo score<5 scores (OR=0.25, 95%CI: 0.07-0.84) were favorable factors of clinical remission at week 16. At week 34, a total of 87 patients underwent re-examination of colonoscopy. There were 43 patients in mucosal healing group and 44 patients in mucosal non-healing group. In mucosal healing group, the reductions of IL-6 and IL-6+TNF-α were higher than those in mucosal non-healing group, and the increase in IL-10 was also higher than that in the mucosal non healing group (all P<0.05). IL-6 reduction≥0.45 ng/L (OR=13.53, 95%CI:2.67-68.45) and baseline Mayo endoscopic score (MES)<2 scores (OR=0.08, 95%CI: 0.01-0.65) were the favorable factors of mucosal healing at week 34. At week 34, there were 23 patients in pathological remission group and 64 patients in pathological non-remission group. The reductions of IL-6 and IL-6+TNF-α, as well as the increase of IL-10 were higher than those in pathological non-remission group (all P<0.05). IL-6 reduction≥0.45 ng/L (OR=18.23, 95%CI: 2.32-143.52) was a favorable factor of pathological remission at week 34.

IL-6 reduction≥0.40 ng/L, disease location limited to the rectum and left sided colon, as well as baseline partial Mayo score<5 scores are favorable factors of clinical remission at week 16. IL-6 reduction≥0.45 ng/L and baseline MES<2 scores are favorable factors of mucosal healing at week 34. IL-6 reduction≥0.45 ng/L is a favorable factor of pathological remission at week 34.

The ultrasonic image data of children who underwent abdominal ultrasound examination in Tianjin Children′s Hospital from January 2018 to December 2024 and were confirmed by surgery and pathology were retrospectively analyzed, and their ultrasonic manifestations were summarized. A total of 6 children, 1 male and 5 female, were included. At the time of first diagnosis, the children were 1-14 years old with a median age of 9 years. Ultrasound showed that the twisted spleen was enlarged, with 5 cases showing abnormal spleen position and 1 case showing in-situ splenic torsion. Taking the echo of the liver as a reference, the internal echo of 4 cases showed diffuse echo enhancement and roughness, and the internal echo of 2 cases was alternating with high and low echo, with extremely low echo liquefaction area; In 6 cases, the structure of splenic pedicle at the hilum of spleen was disordered and thickened, with enhanced echoes, of which 2 cases showed vortex sign by dynamic observation; The echo of tissues around the spleen was enhanced in 6 cases and here was perisplenic effusion in 2 cases. Color Doppler flow imaging indicated that there was no blood flow signal or sparse blood flow signal in spleen parenchyma and splenic hilum. Splenectomy was performed in 6 children, and splenic torsion and infarction were confirmed by postoperative pathology. Ultrasonographic manifestations of splenic torsion in children are multiple abnormal positions of spleen; The internal echo is thickened and enhanced, and some extremely low echo liquefaction areas can be seen; The spleen pedicle is thickened and the echo is enhanced, and some of them show vortex sign; The echo of the tissue around the spleen is enhanced.

This study intends to compare the differences in psychological status of patients with chronic pain in different lower extremity joints. A retrospective cross-sectional study was used to assess patients with chronic hip, knee, and ankle pain hospitalized from June to December 2024 in the Sports Medicine Ward of the Department of Orthopaedic Medicine, General Hospital of the People′s Liberation Army. A total of 75 patients with chronic pain in the joints, 36 males and 39 females, aged (31.6±9.5) years, were included. General information such as age, gender, and body mass index (BMI) were recorded, and the psychological status of patients was assessed by the Zong-type Anxiety Scale (SAS) and Beck Depression Inventory (BDI). A total of 25 patients each with chronic hip, knee, and ankle pain were included, and the differences in baseline data among the three groups were not statistically significant and were comparable. The results showed that the SAS scores in the hip group were higher than those in the ankle group (mean difference=0.101, 95%CI: 0.029-0.174) and the knee group (mean difference=0.164, 95%CI: 0.094-0.235); the BDI scores in the hip group were higher than those in the ankle group (mean difference=2.081, 95%CI: 0.848-3.314) and knee group (mean difference=2.044, 95%CI: 0.866-3.222). This study suggests that psychological disorders in patients with chronic hip pain are more significant compared to other lower extremity arthralgia patients, and psychological intervention support should be strengthened in this group of patients.

A 29-year-old male patient with acute right limb weakness with speech disorder started, and went to Xiangtan First People's Hospital in November 2024. Laboratory tests showed positive serum and cerebrospinal fluid Treponema pallidum antibody (TRUST 1:128/1:4), myelin oligodendrocyte glycoprotein (MOG) antibody (titer 1:32/1:3.2), and human immunodeficiency virus (HIV) positive; MRI of the head showed multiple ischemic lesions in the left frontoparietotemporal lobe, the left radiation corona region and the right frontal lobe. The symptoms improved after treating with treponema pallidum. Young stroke patients should be alert to the possibility of neurosyphilis. When combined with MOG antibody positive, anti-infective treatment should be given priority to avoid excessive immune intervention.

The patient, a 76-year-old female, went to the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine on September 18, 2020 for "repeated palpitations and chest tightness for more than 10 years". After hospitalization for transesophageal echocardiography, sudden chest and abdominal pain occurred after drinking hot water. Chest CT showed pneumothorax and right lung compression of 50%, and urgent closed chest drainage was performed. Subsequently, hydropneumothorax, respiratory failure and septic shock occurred, and gastroscopy found esophageal perforation (about 30 cm from the incisors), which was clamped with titanium clips and drained with a tube. After multi-disciplinary cooperation, anti-infection, nutritional support and endoscopic treatment, his condition improved and he was discharged from hospital.

Anti-Mullerian hormone (AMH) is a biomarker secreted by testicular sertoli cells and belongs to the transforming growth factor beta superfamily, which is involved in male sex differentiation, testicular development, and spermatogenesis. Male infertility affects about 50% of men of childbearing age. In recent years, studies on AMH in different male infertility diseases have been increasing. Abnormal AMH levels are closely related to many male reproductive diseases such as azoospermia, cryptorchidism, congenital hypogonadotropic hypogonadism, Mullerian duct persistence syndrome, etc. This article aims to review the latest research progress of AMH in the diagnosis and treatment of male infertility diseases, and to explore the clinical application potential of AMH as a biomarker, in order to provide a new perspective and direction for the diagnosis and treatment of related diseases in the future.

Hemophagocytic lymphohistiocytosis (HLH), or hemophagocytic syndrome, is a rare, life-threatening immune disorder syndrome characterized by abnormal activation of the immune system that triggers a cytokine storm. Gamma interferon (IFN-γ) has been shown to play a key role in the development of HLH. The critical role of IFN-γ in the pathogenesis of HLH is elaborated herein, including its role in activating macrophages and CD8⁺Mechanisms by which T cells trigger cytokine storms; At the same time, the key value of IFN-γ as a biomarker in the diagnosis, differential diagnosis and disease assessment of HLH was analyzed, especially the level difference in different HLH subtypes and its association with organ involvement. This article also focuses on the evaluation of anti-IFN-γ treatment strategies, especially the clinical efficacy and safety of imalimumab in different subtypes of HLH, and explores its potential as a bridging therapy before hematopoietic stem cell transplantation; In addition, the article also mentioned the possible adverse reactions and preventive measures of imaliumab, aiming to provide reference for the diagnosis and treatment strategies of different subtypes of HLH.