Volume 105 · Issue 34 · 2025

The confluence diseases of pancreaticobiliary ducts are important causes of benign and malignant diseases such as inflammation, stones, and tumors of the biliary and pancreatic systems. Endoscopic retrograde cholangiopancreatography (ERCP) has played an important role in the diagnosis and treatment of the confluence diseases of pancreaticobiliary ducts and the biliary and pancreatic systems diseases. However, excessive damage to the sphincter of Oddi (SO) can break the biliary tightness, leading to complications such as reflux cholangitis, stones, and tumors. Under the guidance of the concept of precision surgery, this article elaborates on the precise classification, diagnosis, treatment, and strategies of the confluence diseases of pancreaticobiliary ducts based on the anatomy and physiological function of the SO. By adopting the precise surgical strategies of cause elimination, damage control, and organ protection, which can not only effectively alleviate the obstruction of the biliary and pancreatic outflow tract, promote the rapid recovery of biliary and pancreatic diseases, reduce the incidence of postoperative complications, but also maximize the protection of the SO function, reduce the occurrence of long-term postoperative complications, and bring maximum benefits to doctors and patients.

To further standardize lung cancer prevention and treatment measures in China, enhance the quality of diagnosis and treatment, improve patient prognosis, and provide evidence-based medical guidance for clinicians at all levels, the Chinese Medical Association convened experts from respiratory medicine, oncology, thoracic surgery, radiotherapy, imaging, and pathology to develop the Chinese Medical Association′s Clinical diagnosis and treatment guidelines for lung cancer (2025 edition). This consensus resulted in several updates from the 2024 version. In the screening section, a new recommendation has been added to specify populations not advised to undergo lung cancer screening. It also emphasizes that individuals at high risk for lung cancer should be fully informed of the potential benefits and risks of low-dose CT (LDCT) screening before undergoing the examination. With the advancement of treatment options, updates have been made to the recommended genetic testing for patients with early-and mid-stage postoperative and advanced non-small cell lung cancer (NSCLC). For patients with advanced EGFR mutations, in addition to a broader range of monotherapy options, the application of combination therapies may offer better disease control for certain patients. Furthermore, more treatment options have been approved for patients undergoing immunotherapy-based neoadjuvant treatment and for those who develop resistance to epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKI). For patients with previously limited treatment options, such as those with KRAS G12C mutations, HER2 mutations, or small cell lung cancer after resistance develops, the approval of novel drugs has brought significantly improved efficacy and prognosis. These recommendations are based on State-approved drug applications, international guidelines, and current clinical practices in China, integrating the latest evidence-based medical research in screening, diagnosis, pathology, genetic testing, immune molecular marker detection, treatment methods, and follow-up care. The goal is to provide comprehensive and reasonable recommendations for clinicians, imaging specialists, laboratory technicians, and other medical staff at all levels.

Insomnia disorder is a common sleep disturbance, primarily characterized by difficulties in sleep initiation, sleep maintenance, or early morning awakening, accompanied by impaired daytime functioning. Since the publication of the Chinese Guidelines for Diagnosis and Treatment of Insomnia in 2017, classifications and diagnostic criteria for insomnia have evolved, and clinical management protocols have been continuously updated, necessitating guideline revisions to better inform clinical practice. Therefore, the Chinese Sleep Research Society organized domestic experts in relevant fields to develop the Guidelines for the diagnosis and treatment of insomnia disorder (2025 edition) following established clinical practice guideline development methodology. It comprehensively addresses and updates the epidemiology, pathophysiological mechanisms, diagnostic criteria, clinical assessment, differential diagnosis, and treatment approaches for insomnia, with specific recommendations for special populations (women, older adults, children/adolescents). The guideline establishes 32 evidence-informed recommendations to standardize the clinical management of insomnia disorder.

To investigate the efficacy and influencing factors of pharmacological mydriasis in type 2 diabetic patients undergoing cataract surgery.

The study used a single-arm clinical trial design. Patients with type 2 diabetes who underdoing cataract surgery in the Second Affiliated Hospital, Zhejiang University School of Medicine from April to July 2024 were selected using convenience sampling method. The pupil diameter and compliance rate were observed at eight time points: 20 min (T₁), 30 min (T₂), 40 min (T₃), 50 min (T₄), 60 min (T₅), 70 min (T₆), 80 min (T₇) and 90 min (T₈) after mydriasis with compound tropicamide before cataract surgery. Multivariate logistic regression was used to analyze the influencing factors of preoperative mydriasis.

A total of 404 patients aged (58±11) years were included, with 185 males and 219 females. The pupil diameters at T₁-T₈ were (5.05±1.02) mm, (5.41±1.31) mm, (6.10±1.29) mm, (6.67±1.52) mm, (7.30±1.56) mm, (7.31±1.53) mm, (7.33±1.58) mm, (7.34±1.57) mm, respectively. The compliance rate of preoperative mydriasis was 23.3% (94/404), 30.7% (124/404), 50.7% (205/404), 62.1% (251/404), 77.2% (312/404), 78.7% (318/404), 79.0% (319/404) and 79.5% (321/404), respectively. One-way repeated measures analysis of variance showed that there was a statistically significant difference in pupil diameter among T₁-T₈ (F=705.195, P<0.001). Bonferroni multiple comparison results showed that there were statistically significant differences in pupil diameter among T₁-T₅ (all P<0.001 8). With the prolongation of time, pupil diameter gradually increased. There were no significant differences in pupil diameter at T₅-T₈ (all P>0.001 8). Multivariate logistic regression analysis showed that high level of glycosylated hemoglobin (HbA1c) (OR=1.47, 95%CI: 1.20-1.80, P<0.001), low body mass index (BMI) (OR=0.77, 95%CI: 0.69-0.86, P<0.001), and long duration of diabetes (OR=1.08, 95%CI: 1.04-1.12, P<0.001) were related factors for non-compliance of preoperative mydriasis.

The compliance rate of pupil diameter within 60 min after pharmacological mydriasis before cataract surgery in patients with type 2 diabetes increased significantly with time, and the expansion effect tended to be stable after 60 min. The duration of diabetes, HbA1c levels, and BMI were factors affecting mydriasis achievement in patients with type 2 diabetes.

To analyze the application effect of dural puncture epidural anesthesia (DPE) in elderly patients undergoing hip fracture surgery.

Elderly patients scheduled for elective unilateral hip fracture surgery at the Sir Run Run Hospital Affiliated to Nanjing Medical University from May to December 2024 were prospectively enrolled. They were randomly divided into the DPE group and the epidural anesthesia (EA) group (61 cases each) using a random number table. The two groups were compared in terms of the incidence of intraoperative incomplete block, time to achieve the T₁₀ sensory blockade level, the lowest mean arterial pressure (MAP) within 15 minutes after anesthesia, vasoactive drug usage rate, time for Bromage score to recovery to 0, visual analogue scale (VAS) of pain score at 6 and 12 h postoperatively, surgeon satisfaction, and incidence of anesthesia-related adverse events.

The DPE group had a median age of 69 (67, 72) years, with 36 males and 25 females, while the EA group had a median age of 69 (67, 72) years, with 38 males and 23 females. There were no significant differences between the two groups in age, gender, body mass index, American Society of Anesthesiologists classification, or types of comorbidities (all P>0.05). The DPE group had a lower incidence of incomplete blockade [11.5% (7/61) vs 27.9% (17/61)], a shorter time to achieve the T₁₀ sensory blockade level [(443±38) s vs (559±47) s], and higher surgeon satisfaction [10(9, 11) scores vs 9(9, 10) scores] compared to the EA group (all P<0.05). There were no significant differences between the two groups in the lowest MAP within 15 minutes after anesthesia, vasoactive drug usage rate, time for Bromage score to return to 0, postoperative VAS of pain scores at 6 and 12 h, or incidence of anesthesia-related adverse events (all P>0.05).

Compared to traditional EA, DPE offers superior block quality and faster onset of anesthesia in elderly patients undergoing hip fracture surgery without compromising hemodynamic stability or prolonging motor block.

To dynamically monitor the changes in measles antibody levels in children with tumors pre-and post-chemotherapy, and to evaluate the necessity of revaccination with measles-containing vaccines post-chemotherapy

A prospective cohort study was conducted. Children with tumors under 15 years old who were hospitalized in the Children′s Hospital, Zhejiang University School of Medicine from January 2022 to December 2023 were included as the case group; healthy children of the same age from the community during the same period were included as the control group. Blood samples were collected from the case group before chemotherapy and at 1 month and 6 months after chemotherapy, as well as from the control group. Measles IgG antibody geometric mean concentration (GMC)>200 mU/ml was defined as positive, and ≥800 mU/ml as protective. The differences in GMC of measles IgG antibody, the positive rate and the protective rate were compared between the case group before chemotherapy and at 1 month after chemotherapy, and between the case group at 1 month after chemotherapy and the control group.

A total of 586 children with tumor and 586 healthy children were included, with ages [M (Q₁, Q₃)] being 5.7 (3.8, 9.8) and 5.8 (3.4, 9.8) years, respectively. The proportions of boys were 52.90% (310 cases) and 53.07% (311 cases), respectively. Compared with pre-chemotherapy, at 1 month post-chemotherapy, the case group showed decreased GMC [(829.7±39.1) vs (1 000.6±44.0) mU/ml], positive rate [82.08% (481 cases) vs 86.01% (504 cases)] and protection rate [32.70% (192 cases) vs 41.47% (243 cases)] (all P<0.05). At 1 month post-chemotherapy, the GMC level, positive rate, and protection rate in the case group were all lower than those in the control group [control group (1 080.6±42.6) mU/ml, 89.59% (525 cases) and 45.22% (265 cases), respectively; all P<0.05]. A total of 87 children with tumors completed the 6-month post-chemotherapy follow-up. The positive antibody rate was 35.63% (31 cases), and the protective rate of measles IgG antibody was 5.75% (5 cases).

The levels of measles IgG antibody in children with tumors after chemotherapy decrease compared with those before chemotherapy and are lower than those in the healthy population. When the children′s condition is stable and their immune function recovers after chemotherapy, it is necessary to administer revaccination with a vaccine containing measles components again.

To investigate the mechanism by which PIWI interacting RNA piR-hsa-26925 regulates the invasion and metastasis of lung adenocarcinoma through Methyltransferase-like 3 (METTL3)-mediated m6A methylation modification.

The expression levels of piR-hsa-26925 were detected in lung adenocarcinoma cell lines (H1650, H1299, H1975, and A549) and normal lung epithelial cells (BEAS-2B) using real-time fluorescent quantitative PCR (qRT-PCR). Lung adenocarcinoma cells were transfected using transient RNA transfection technology, divided into a piR-hsa-26925 knockdown group in the A549 lung adenocarcinoma cell line and a negative control (NC-1) group; the lung adenocarcinoma H1299 cell line piR-hsa-26925 overexpression group and negative control (NC-2) group. qRT-PCR was used to detect the relative expression levels of piR-hsa-26925 to validate transfection success. Cell migration and invasion capabilities were assessed using cell scratch and Transwell assays; Western blot analysis was performed to detect the expression levels of E-cadherin, vimentin, and METTL3 proteins in different groups of cells; m6A spot blot analysis was conducted to assess differences in m6A methylation levels following piR-hsa-26925 overexpression and knockdown; the interaction between piR-hsa-26925 and METTL3 was detected using RNA pull-down experiments and RNA immunoprecipitation (RIP) experiments; fluorescence in situ hybridization (FISH) experiments was used to investigate the cellular localization of piR-hsa-26925 and METTL3 in A549 cells. RNA sequencing and MeRIP sequencing analyses to were combined identify downstream targets; m6A-RIP-qRT-PCR was used to validate the effects of piR-hsa-26925 knockdown on m6A methylation levels of downstream targets, and the regulatory roles of piR-hsa-26925 and METTL3 on the downstream molecule erythropoietin-producing hepatocellular kinase receptor B2 (EPHB2). We then applied transient RNA transfection technology to A549 cell lines, dividing them into METTL3 knockdown, METTL3 overexpression, and negative control (METTL3-NC) groups, and used Western blotting to detect EPHB2 expression levels. In the piR-hsa-26925 knockdown group, the METTL3 activity inhibitor STM2457 was added to observe whether it could reverse the downregulation of lung adenocarcinoma cell migration and invasion caused by piR-hsa-26925 knockdown. In the piR-hsa-26925 overexpression group, EPHB2 was further overexpressed to determine whether it could reverse the upregulation of lung adenocarcinoma cell migration and invasion caused by piR-hsa-26925 overexpression. All experimental data were repeated three times.

The level of piR-hsa-26925 expression was significantly higher in human lung adenocarcinoma cell lines than in normal lung epithelial cells (all P<0.05). Compared with the piR-hsa-26925-NC-1 group, the piR-hsa-26925 knockdown group showed decreased E-cadherin expression, increased vimentin expression, and increased lung adenocarcinoma cell wound healing area, migration, and invasion (all P<0.05). Compared with the piR-hsa-26925-NC-2 group, the piR-hsa-26925 knockdown group showed increased expression of E-cadherin, decreased expression of vimentin, and reduced wound healing area, cell migration, and invasiveness of lung adenocarcinoma cells (all P<0.05). FISH results showed that piR-hsa-26925 colocalized with METTL3 protein in the cytoplasm of A549 cells. m6A spot hybridization experiment results showed that piR-hsa-26925 was negatively correlated with m6A methylation levels. RNA pull-down and RIP experiments confirmed an interaction between piR-hsa-26925 and METTL3, but Western blot analysis showed that METTL3 expression levels were lower in both the piR-hsa-26925 knockdown and overexpression groups compared to the control group (all P<0.05). Downstream molecules EPHB2 were identified through bioinformatics analysis; Western blot analysis results showed that EPHB2 expression levels were higher in the piR-hsa-26925 knockdown group than in the piR-hsa-26925-NC-1 group, and lower in the piR-hsa-26925 overexpression group than in the piR-hsa-26925-NC-2 group (all P<0.05). In the A549 cell line, the EPHB2 expression level in the METTL3 knockdown group was lower than that in the METTL3-NC group, while the EPHB2 expression level in the METTL3 overexpression group was higher than that in the METTL3-NC group (all P<0.05). m6A-RIP-qRT-PCR results showed that the m6A modification level of EPHB2 in the piR-hsa-26925 knockdown group was higher than that in the piR-hsa-26925-NC-1 group. After treatment with the METTL3 activity inhibitor STM2457, the m6A modification levels of EPHB2 decreased (all P<0.05). Transwell results showed that the numbers of migrating and invading cells increased after treatment with STM2457 in piR-hsa-26925 knockdown group and the numbers of migrating and invading cells decreased after overexpression of EPHB2 in piR-hsa-26925 overexpression group (all P<0.05).

piR-hsa-26925 is significantly upregulated in lung adenocarcinoma tissues and cells and functions as an oncogene to enhance the migration and invasion abilities of lung adenocarcinoma cells, potentially playing a critical role in their invasion and metastasis. piR-hsa-26925 binds to METTL3 and modulates the m6A methylation level of the downstream molecule EPHB2 by regulating METTL3 activity, thereby inhibiting EPHB2 expression and promoting the malignant progression of lung adenocarcinoma.

A retrospective analysis was conducted on a clinically isolated Klebsiella pneumoniae strain KP1050 that produces both New Delhi Metallo-β-lactamase (NDM)-1 and Imipenem-hydrolyzing β-lactamase (IMP)-4 carbapenemases. The minimum inhibitory concentrations of various antimicrobial agents were determined using the microbroth dilution method. Whole-genome sequencing was performed to identify the resistance genes and resistance plasmids carried by the strain. Conjugation assays and gene knockout techniques were employed to clarify the mechanisms of horizontal transfer of resistance plasmids. Klebsiella pneumoniae KP1050 was resistant to multiple antimicrobial agents, including carbapenems, and only susceptible to amikacin, tigecycline, and polymyxin. The strain belonged to ST1245, carrying the bla_NDM-1 and bla_IMP-4 carbapenemase resistance genes on the 59 730 bp IncN-type and 289 270 bp IncHI5-type plasmids, respectively. Both IncN and IncHI5-type plasmids harbored complete gene clusters encoding the type Ⅳ secretion system and could be conjugated to recipient bacteria; however, the conjugation efficiency of the IncN-type NDM-1 plasmid (1×10⁻³) was higher than that of the IncHI5-type IMP-4 plasmid (5×10⁻⁶). Knockout of key genes in the plasmid type Ⅳ secretion system revealed that the IncHI5-type IMP-4 plasmid was not an independently conjugative plasmid but could undergo horizontal transmission through conjugation with the assistance of the IncN-type NDM-1 plasmid. Interactions between plasmids can promote the spread of carbapenemase resistance genes.

Splenic metastatic tumors are rare in clinical practice, and traditional treatment methods are limited. A retrospective analysis was conducted on the clinical data of patients with splenic metastatic tumors who underwent ultrasound-guided percutaneous radiofrequency ablation at the First Affiliated Hospital of Zhengzhou University from January 2020 to January 2024. A total of 5 patients were included, including 3 males and 2 females, with an age of (3-74) years. All 5 patients successfully completed ultrasound-guided percutaneous radiofrequency ablation. The ablation time was 4.0 (2.5, 13.5) min. No serious complications occurred during or after the operation. The spleen lesions of all 5 patients achieved complete ablation. The follow-up period ranged from 11 to 50 months, with a median follow-up time of 23 months. The last follow-up was on May 30, 2025.One patient died of advanced tumor 23 months after the operation, one patient died of liver failure 19 months after the operation, one patient died of respiratory failure 11 months after the operation, while two patients were still alive at the last follow-up. No recurrence or new occurrence of splenic tumors was observed in all 5 patients at the end of the follow-up.Ultrasound-guided percutaneous radiofrequency ablation for splenic metastatic tumors has good safety and efficacy.

This article reports the diagnosis and treatment of a hemodialysis patient with isolated activated partial thromboplastin time (APTT) significantly prolonged. The patient, a 48-year-old male, was admitted to hospital due to "increased serum creatinine for more than 1 year". There was no family history of kidney disease and hemorrhagic disease, and there was no spontaneous bleeding during the course of the disease. APTT was significantly prolonged after admission. Perfect relevant examinations suggested coagulation factor XII deficiency. Relevant secondary factors were excluded, and genetic factors were highly considered. Returned to local regular hemodialysis, hemodialysis was smooth during follow-up, and there were no bleeding events.

Molecular residual lesions (MRDs) are also called minimal residual lesions. In recent years, with the development of liquid biopsy technology, the clinical value of MRD detection in solid tumors has become increasingly prominent. Many clinical studies at home and abroad have confirmed that MRD status is related to the risk of recurrence and treatment effect, and can be used for prognostic assessment and individualized treatment decision-making guidance of patients with solid tumors. In this paper, the key biomarkers, detection methods and technical routes of MRD detection were reviewed, and the clinical application and research progress of MRD in different types of solid tumors were discussed. By integrating existing evidence and cutting-edge technology, this paper aims to provide a reference for the clinical practice and research of MRD, and promote its standardized application in the whole course management of solid tumors.

The management of blood glucose fluctuations in peritoneal dialysis patients remains a current clinical challenge. Traditional monitoring methods, such as fingertip blood glucose measurement, glycosylated hemoglobin and glycosylated albumin, have certain limitations. Continuous glucose monitoring provides real-time data on blood glucose changes, providing a new tool for the management of blood glucose fluctuations in peritoneal dialysis patients. This article reviews the research progress of continuous blood glucose monitoring in peritoneal dialysis patients from the aspects of clinical advantages, clinical application in peritoneal dialysis patients, management optimization, limitations and prospects, and discusses its clinical application value and future research direction.

A 52-year-old female was admitted to the Department of Vascular Surgery, Second Xiangya Hospital, Central South University on August 5, 2021 due to "physical examination found left renal aneurysm for 3 weeks". Deny symptoms such as low back pain and hematuria. He had a history of hypertension for 5 years. He underwent laparoscopic total hysterectomy for "cervical cancer" 7 years ago. He denied his history of trauma and special medication. Admission physical examination: blood pressure 140/80 mmHg (1 mmHg =0.133 kPa), body temperature 36.0 ℃, pulse 80 beats/min, clear mind, soft abdomen, no tenderness and rebound pain, no palpable mass in the kidney area, no percussion pain. Laboratory tests at admission: creatinine 54.7 μ mol/L, urea 4.58 mmol/L, rheumatology immunology and vasculitis tests were negative. Total aortic CT angiography (CTA) showed that there was a true aneurysm with a diameter of about 3 cm at 1 cm near the renal hilum of the left renal artery (Figure 1, indicated by arrows). According to the medical history, physical examination and imaging examination, a true renal artery aneurysm was diagnosed. Digital subtraction angiography (DSA) of the left renal artery was performed under local anesthesia. Intraoperatively, it was confirmed that there was a true aneurysm of the left renal artery of 30 mm ×24 mm near the renal hilum, and three branch arteries were communicated with the aneurysm (Figure 2, shown by arrows). Trans-brachial vascular approach, 1 Gore was first inserted^®Viabahn^®A covered stent (6.0 mm ×2.5 cm) spans the base of the aneurysm and extends to the distal branch; Subsequently, several free coils (8 mm ×6, 5 mm ×3) were used to embolize the aneurysm cavity. Postoperative angiography showed complete isolation of the aneurysm and good preservation of renal perfusion (Figure 3, shown by arrows). Renal function was normal after postoperative review, and aspirin antiplatelet treatment was given for 3 months after discharge. Follow-up on 6 Nov 2023 showed that the patient was generally in good condition, the stent was patent (Figure 4, indicated by arrows), and the renal function remained normal. In severe cases, renal aneurysm can cause hypertension, low back pain, hematuria and even rupture. Indications for surgery included diameter ≥2.0 cm, pregnant and/or pregnant women, co-clinical symptoms, high-risk morphology, or rupture. In this case, endovascular repair with covered stent combined with coil embolization has the advantages of less trauma, quick recovery and short hospital stay, which is a safe and effective choice for the treatment of renal aneurysm.