Volume 105 · Issue 40 · 2025

Temporal bone cholesteatoma is a common invasive lesion affecting the temporal bone, leading to a series of extracranial and intracranial complications, with facial nerve paralysis being one. The treatment of temporal bone cholesteatoma typically requires surgical resection to prevent its complications. The article discusses the preservation of the facial nerve during temporal bone cholesteatoma surgery, the management of intraoperative facial nerve injury, and the treatment of cholesteatoma-associated facial paralysis.

Based on the latest clinical research evidence and domestic practical experience, the Breast Cancer Committee of the Chinese Society of Clinical Oncology has systematically sorted out the core points regarding human epidermal receptor 2 (HER2) testing standardization, neoadjuvant therapy, adjuvant therapy, treatment of relapsed and metastatic breast cancer, and diagnosis and treatment of populations with HER2 low expression/ultra-low expression. The Chinese experts′ consensus on the diagnosis and treatment of HER2-targeted breast cancer 2025 edition was updated. Combining with key clinical issues, this article further interprets the key points of the Expert Consensus and proposes that precise HER2 testing should focus on spatiotemporal heterogeneity, and clarify the definitions and testing standards for low expression and ultra-low expression; it also summarizes clinical key points according to different stages, and puts forward that for neoadjuvant therapy, the trastuzumab combined with pertuzumab regimen is preferred, and specific regimens should be selected according to patient characteristics, and adjuvant strategies should be formulated based on pathological complete response status; in adjuvant therapy, dual-targeted therapy is the standard regimen for high-risk patients, while low-risk and special populations require individualized selection; the treatment of relapsed and metastatic breast cancer should be formulated according to the degree of trastuzumab sensitivity, trastuzumab treatment failure, and characteristics of special populations; populations with HER2 low expression/ultra-low expression can benefit from new antibody-drug conjugates, and standardized testing and treatment selection are required. In conclusion, the diagnosis and treatment of HER2-related breast cancer should be based on precise testing, combined with patients′ clinical characteristics and follow the consensus recommendations, so as to achieve individualized treatment and improve prognosis.

As global ageing continues to increase, the problem of geriatric skin disorders is becoming more and more serious. Geriatric dermatoses are different from other age groups in terms of epidemiology characteristics, etiology, pathogenesis, clinical manifestations, diagnosis, treatment, and management, exhibiting unique complexity and distinctiveness. These conditions involve age-related systemic functional decline, multimorbidity, and elevated medication safety risks, placing higher demands on clinical diagnosis and comprehensive management. This article focuses on the impaired skin barrier function in the elderly, inflammatory skin diseases, infectious skin disorders, and skin problems associated with disability, discussing key aspects of their diagnosis, treatment, and management, with the aim of providing reference for clinical practice. There is a substantial body of knowledge that requires updating, necessitating increased attention to the diagnosis and management of geriatric skin diseases. Geriatric dermatology will face numerous new challenges and development opportunities.

Temporal bone cholesteatoma is an aggressive lesion of the temporal bone that frequently involves the middle ear, facial nerve, and inner ear, and may even lead to severe complications such as facial paralysis and hearing loss. This consensus, jointly developed by the Ear Surgery Group of the Otorhinolaryngology Head and Neck Surgery Branch of the Chinese Medical Association and a multidisciplinary panel of experts, systematically outlines the diagnostic criteria for temporal bone cholesteatoma, the mechanisms underlying facial nerve and hearing impairment, and the surgical approaches for different types of the disease. It aims to standardize intraoperative strategies for the protection and functional reconstruction of the facial nerve and hearing, with the ultimate goal of improving surgical outcomes.

Gastrointestinal cancers are common malignant tumors posing a serious threat to human health. Irinotecan liposome, a recently approved chemotherapeutic agent primarily indicated for pancreatic cancer within the gastrointestinal malignancies, has seen the publication of numerous high-quality clinical studies with high levels of evidence over the past two years. Scholars continue to explore new clinical applications for this agent. To standardize the clinical application of irinotecan liposomes in gastrointestinal cancers, this expert consensus was developed through multiple rounds of drafting and review led by several specialized committees of the Chinese Anti-Cancer Association, with reference to relevant domestic and international guidelines and the latest evidence-based medical data. This consensus aims to promote rational clinical drug use, prolong patient survival, and provide guidance for the clinical management of gastrointestinal cancers by standardizing chemotherapy regimens, optimizing treatment strategies, and managing adverse events. It details the clinical application strategies, supporting evidence, and adverse event management of irinotecan liposomes in pancreatic, biliary tract, colorectal, and gastric cancers. Furthermore, the consensus addresses key contentious issues—including, but not limited to, dosage, administration, combination therapies, and adverse event management—through expert voting within the oncology field. These deliberations formed the basis for the consensus recommendations provided herein for the reference of clinical practitioners.

Exercise during pregnancy and postpartum is of significant importance for maternal and infant health. To further standardize the clinical practice of exercise for pregnant and postpartum women in China, the Chinese Society of Perinatal Medicine China Medical Association and China Institute of Sport Science, General Administration of Sport of China have jointly developed this expert consensus. The consensus is based on the latest international exercise guidelines, evidence from clinical research, and the specific national context of China. It was developed using the Delphi method through three rounds of expert consultations, combined with multidisciplinary discussions, resulting in the "Expert Consensus on Exercise for Pregnant and Postpartum Women (2025 edition)." This consensus covers key areas such as the appropriate population for exercise during pregnancy, exercise contraindications, exercise structure, and postpartum exercise, offering 10 key recommendations. Its aim is to provide scientific and actionable guidance for exercise interventions for pregnant and postpartum women in China and to promote the application of the integration of sports and medicine in perinatal health management.

To investigate the efficacy of malleostapedotomy (MS) in treating congenital ossicular malformations and analyze the influencing factors of postoperative hearing outcomes using ultra-high-resolution computed tomography (U-HRCT).

Patients with ossicular malformation who underwent MS surgery in the Center of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University from January 2015 to August 2024 were retrospectively included. Based on U-HRCT, the thickness of the stapes footplate or the oval window atresia plate and the angle and depth of Piston inserted into the vestibule were measured, and their correlations with postoperative efficacy were analyzed.

A total of 25 patients (26 ears) aged 15 (9, 27) years were included, with 15 males and 10 females. The average pure tone postoperative air-bone gap (ABG) of the 26 ears was lower than preoperative ABG [(22.7±10.1) decibels hearing level (dB HL) vs (44.8±12.0) dB HL, P<0.001]. Among them, eight ears underwent U-HRCT after the surgery. The measurement results showed that there was no correlation between postoperative ABG and the depth of Piston insertion (r=-0.061, P=0.885). Postoperative ABG was not correlated with the angle of Piston insertion (r=0.239, P=0.569). There was no correlation between postoperative ABG and the thickness of the stapes footplate or the atresia plate (r=0.099, P=0.852). The preoperative and postoperative bone conduction threshold (BC) was positively correlated with the thickness of the stapes footplate or the atresia plate (r=0.903, P=0.014; r=0.907, P=0.013). The preoperative and postoperative air conduction threshold (AC) was not correlated with the thickness of the stapes footplate or the atresia plate (r=0.167, P=0.752; r=0.732, P=0.098).

MS surgery has a safe and reliable curative effect on patients with congenital ossicular malformations. As long as the insertion depth and angle of Piston are within a certain reasonable range, their impact on postoperative hearing is not significant. There is a correlation between the thickness of the stapes footplate or the oval window atresia plateand the bone conduction threshold.

To explore the accuracy and comprehensiveness of responses from four large language models [ChatGPT-3.5 (Model A), ChatGPT-4.0 (Model B), ChatGPT-4o (Model D) developed by OpenAI in the United States, and a domestically developed Obstetric artificial intelligence assistant robot (Model C)] to inquiries from patients with placenta accreta spectrum disorders and their families.

A prospective study was conducted from June 2024 to March 2025, involving 25 pairs of patients and their families and 8 obstetric experts at the Third Affiliated Hospital of Guangzhou Medical University. Sixteen questions commonly asked by patients and their families regarding placenta accreta spectrum disorders were collected, covering six disease-related areas such as disease mechanism, risk factors, clinical symptoms, diagnosis, pregnancy management, and prognosis. A physician then input all the questions into the four different large language models to obtain their responses. The responses were randomized and independently evaluated by four maternal-fetal medicine physicians using a three-point Likert scale and a six-point Likert scale to assess the accuracy of the responses. The majority consensus method was used to determine the final rating for each model′s response. For responses rated as "good" and scored 5 or above on the six-point Likert scale, a three-point Likert scale was further used to assess the comprehensiveness of the content. The accuracy and comprehensiveness of the 4 large language models was compared.

Significant differences in accuracy were observed among the four large language models (P=0.005). 25% (4/16) of Model A responses were rated as "good", which was lower than the 75% (12/16) for both Model B and Model D (both P<0.05). The comprehensiveness score for Model A was 1.8 (1.5, 2.0), for Model B was 2.0 (1.8, 2.0), for Model C was 2.3 (2.0, 2.3), and for Model D was 2.6 (2.3, 2.7). There were statistically significant differences in comprehensiveness scores among the four large language models (P<0.001). Pairwise comparisons showed that Model D was significantly more comprehensive than Model A (P=0.004) and Model B (P<0.001).

Significant variations exist in both the accuracy and comprehensiveness of responses from the four large language models to questions in six areas related to placenta accreta spectrum disorders. Model D performs better in both aspects. Model C has a better performance in comprehensiveness, but its accuracy needs further improvement.

To compare the neuromuscular blocking effects and postoperative recovery profiles of continuous infusion of two doses of mivacurium during laryngeal microsurgery.

From October to December 2022, 62 patients scheduled for elective laryngeal microsurgery under general anesthesia with endotracheal intubation were enrolled prospectively at Beijing Tongren Hospital, Capital Medical University. Patients were randomly assigned using a random number table to the low-dose mivacurium group (Group L,mivacurium 0.3 mg·kg^-1·h^-1) or the high-dose mivacurium group (Group H,mivacurium 0.5 mg·kg^-1·h^-1) based on different infusion doses of mivacurum. The following parameters were compared between the two groups: extubation time, surgical condition rating, recovery index, Cooper′s intubation score, Cormack-Lehane (C-L) laryngoscopy grade, incidence of postoperative residual neuromuscular blockade, and incidence of allergy-related adverse events.

There were 17 males and 14 females in Group L, with a mean age of (48.0±13.7) years. Group H included 19 males and 12 females, aged (47.7±9.8) years. No significant differences in age or gender were observed between the two groups (all P>0.05). The extubation time in Group L was significantly shorter than that in Group H [(15.2±4.8) min vs (18.5±6.8) min, P<0.05]. The surgical condition grade (excellent/good) in group L and group H were 28/3 and 29/2, with no significant difference (P>0.05). No statistically significant differences were observed in recovery index, Cooper′s intubation score, Cormack-Lehane laryngoscopy grade, incidence of postoperative residual neuromuscular blockade, or adverse events between Group L and Group H (all P>0.05).

In laryngeal microsurgery, compared with continuous infusion of mivacurium at 0.5 mg·kg⁻¹·h⁻¹, a continuous infusion of 0.3 mg·kg⁻¹·h⁻¹ resulted in a shorter extubation time, maintained deep intraoperative neuromuscular blockade, provided satisfactory surgical conditions, and improved postoperative recovery.

To investigate the effect of ultrasound-guided continuous quadratus lumborum block(CQLB) on the quality of early postoperative recovery in elderly patients undergoing total hip arthroplasty.

A total of 80 elderly patients who underwent elective total hip arthroplasty under general anesthesia in the 901st Hospital of the Joint Logistics Support Force of the People′s Liberation Army from July 2023 to December 2024 were prospectively included. The participants were divided into two groups by the random number table method: the patient-controlled intravenous analgesia (PCIA) group (Group V, n=40) and the ultrasound-guided CQLB group (Group Q, n=40). The scores of the Quality of Recovery-15 (QoR-15) on postoperative days 1 and 2, intraoperative anesthetic drug dosage, intraoperative fluid intake and output, visual analog scale (VAS) scores for pain at rest and during movement at 6, 12, 24, and 48 hours after surgery, maximum flexion and abduction degrees of the hip joint at 12, 24, and 48 hours after surgery, the number of disrupted sleep episodes during the night after surgery, the time to the first out-of-bed activity and the first gas exhaust, the incidence of adverse reactions and rescue analgesia, as well as patient satisfaction were compared between the two groups.

In Group V, there were 22 males and 18 females with an average age of (69.0±5.7) years; in Group Q, there were 21 males and 19 females with an average age of (67.5±5.1) years. There was no statistically significant difference in age and gender between the two groups (all P>0.05). The QoR-15 scores of Group Q on postoperative day 1 and 2 were higher than those of Group V [respectively (131.4±9.7) vs (122.6±9.6) scores and (137.2±9.1) vs (128.9±8.4) scores, all P<0.05]. Compared to Group V, Group Q had lower VAS scores at rest and during exercise at all postoperative time points, greater maximum flexion and abduction degrees of the hip joint, lower frequency of postoperative nighttime sleep disruption, lower incidence of postoperative nausea and vomiting and rescue analgesia, shorter time to the first out-of-bed activity and the first gas exhaust, and higher satisfaction score of patients (all P<0.05). There were no statistically significant differences in postoperative dizziness, drowsiness, respiratory depression, and discharge time between the two groups (all P>0.05). No complications associated with nerve block were occurred in Group Q.

Ultrasound-guided CQLB can improve the early postoperative recovery quality of elderly patients undergoing total hip arthroplasty and accelerate their rehabilitation.

To systematically evaluate the efficacy and safety of the levonorgestrel-releasing intrauterine system (LNG-IUS) in patients with endometrial hyperplasia (EH).

PubMed, Embase, the Cochrane Library, CNKI, Wanfang, CBM, and VIP were searched from inception to January 2023 for clinical trials or cohort studies involving Chinese EH patients treated with LNG-IUS alone or in combination. After screening the eligible studies, data on study population characteristics, efficacy, and safety indicators were extracted and analyzed.

A total of 141 studies involving 12 919 Chinese patients diagnosed with EH were included, of which 92 were randomized controlled trial (RCT) and 49 were cohort studies. The systematic review showed that after 3-12 months of LNG-IUS monotherapy, the complete response (CR) rates among Chinese patients with atypical endometrial hyperplasia (AEH) and non-atypical endometrial hyperplasia (NAEH) were 36.0%-92.3% and 23.9%-100.0%, respectively. After 12 months of treatment, the CR rate reached 84.2%-93.3%. Compared with oral progestin (OP) therapy, the CR rate after 3-12 months of LNG-IUS monotherapy was 43.6%-100.0%, while that for OP was 26.7%-97.5%. The CR rate among EH patients receiving LNG-IUS combined with gonadotropin-releasing hormone agonist (GnRHa) for 3-6 months was 31.3%-100.0%, and that for those receiving LNG-IUS combined with OP was 33.3%-93.8%. In regimens combining LNG-IUS with other drugs, LNG-IUS did not increase the incidence of adverse events (≤7.1%).

LNG-IUS is a feasible and effective treatment option for Chinese patients with EH, offering high tolerability and low safety risks.

The article aimed to explore the differences in clinical features of facial paralysis secondary to petrous bone cholesteatoma and middle ear cholesteatoma. The clinical data of 156 patients (156 ears) aged (37.9±16.3) years with petrous apex cholesteatoma or middle ear cholesteatoma at the Eye & ENT Hospital of Fudan University from December 2014 to December 2024 were retrospectively collected, with 97 males and 59 females. There were 101 and 55 cases diagnosed with petrous apex cholesteatoma and middle ear cholesteatoma, respectively. The proportion of cases with facial paralysis as the initial symptom in petrous apex cholesteatoma [42.6% (43/101)] was statistically significantly higher than that of middle ear cholesteatoma [18.2% (10/55)] (P=0.002). The proportion of facial paralysis duration to the total disease course was significantly higher in petrous apex cholesteatoma [M (Q₁, Q₃)] [20.0% (0, 100%)] compared with middle ear cholesteatoma [0.4% (0, 23.3%)] (P=0.003). The main injury sites of facial nerve canal observed in patients of petrous apex cholesteatoma during surgery were the labyrinthine segment (58 ears, 57.4%), the geniculate ganglion (61 ears, 60.4%) and the tympanic segment (65 ears, 64.4%), while the tympanic segment (43 ears, 78.2%) was the most observed injury site in middle ear cholesteatoma, with a statistically significant difference between the two groups (P<0.001). The common lesion type of facial nerve seen in the surgery was compression (50 ears, 49.5%) inpetrous apex cholesteatoma and bareness (21 ears, 38.2%) in middle ear cholesteatoma, with a statistically significant difference between the two groups (P<0.001). The current study suggests that compared with middle ear cholesteatoma, petrous apex cholesteatoma, due to its deep location and insidious symptoms, often induces more severe damage to the facial nerve by the time of diagnosis.

The clinical data of 24 petrous bone cholesteatoma (PBC) patients (13 males and 11 females) aged (35±13) years who underwent surgical treatment in the Department of Otolaryngology, Peking Union Medical College Hospital from January 2015 to May 2023 were retrospectively analyzed. The clinical characteristics, surgical strategies and prognosis of PBC were explored. The results showed that the main clinical manifestations of patients were hearing loss (100.0%, 24/24) and facial paralysis (87.5%, 21/24). According to the Sanna classification, the majority of cases were supralabyrinthine type (45.8%, 11/24) and extensive type (41.7%, 10/24). Subtotal petrosectomy was the most commonly used surgical approach (45.8%, 11/24), followed by the infratemporal fossa Type B approach (25.0%, 6/24). Intraoperative facial nerve intervention was performed in 19 cases, with a postoperative facial nerve function improvement rate of 52.6% (10/19). Hearing reconstruction was conducted in four patients. During the follow-up period of 24-124 (44±26) months, only one patient experienced recurrence 43 months after surgery due to incomplete removal of lesions during the operation. The current study suggests that the surgical approach for PBC should be selected based on the lesion condition, and sufficient exposure and complete removal of the cholesteatoma matrix during surgery can prevent lesion recurrence.

The data of three patients (two males and one female) aged 19-30 years who underwent combined microscopic-endoscopic surgery via the cochlear-carotid recesses for petrous bone cholesteatoma (PBC) at the Eye & ENT Hospital of Fudan University from June 2017 to August 2022 were retrospectively analyzed. All patients achieved complete cholesteatoma resection with cochlea preservation. No recurrence was observed during the longest follow-up of six years. However, varying degrees of cochlear ossification were noted. Radiology analysis revealed that the mean minimal cross-sectional areas of the triangle anterior and superior to the cochlea (TASC) and the triangle anterior and inferior to the cochlea (TAIC) were (2.24±0.49) cm² and (0.62±0.04) cm², respectively, indicating sufficient space for both microscopic and endoscopic instrumentation. The current study demonstrates that the cochlear-carotid approach effectively removes cholesteatoma while preserving key structures such as the cochlea and facial nerve, highlighting its clinical value. However, its indications require further clarification.

The clinical data of patients who underwent revision surgery for residual or recurrent petrous bone cholesteatoma at the Chinese PLA General Hospital between January 2009 and January 2023 were retrospectively analyzed. A total of 44 patients aged 16-66 (36±17) years were included, with 33 males and 11 females. The extent of the lesions before revision surgery was classified according to the Sanna classification. Based on preoperative imaging and intraoperative findings, the most common site of residual disease was the middle cranial fossa dura (26 cases, 59.1%). The primary reasons for residual lesions during the initial surgery were an inappropriate surgical approach and insufficient exposure of the affected area (36 cases, 81.8%). During revision surgery, it is essential to thoroughly understand the causes of recurrence and residual disease, select an appropriate surgical approach, and pay particular attention to hidden lesions in areas such as the dural surface, peritubal region, and jugular foramen region. Complete resection should be achieved while preserving critical anatomical structures including the facial nerve and internal carotid artery.

The clinical data of petrous bone cholesteatoma (PBC) patients who underwent surgical treatment at Beijing Friendship Hospital, Capital Medical University, between January 2015 and December 2024 were retrospectively analyzed. A total of 45 patients aged (37.4±15.2) years were included, with 21 males and 24 females. Surgical approaches were selected according to Sanna classification and preoperative facial and auditory function. Facial nerve interventions were required in 34 cases, while hearing reconstruction was performed in six cases. The median (Q₁, Q₃) follow-up duration was 26 (12, 53) months, with seven cases of recurrence. Meanwhile, facial nerve function improved in six cases, hearing improvement was observed in four patients, and air conduction thresholds improved by 15-30 dB HL. The current article suggests that PBC presents with non-specific clinical manifestations. Selection of the surgical approach should be guided by the Sanna classification, aiming to completely remove the lesion while preserve facial and auditory function, and minimize postoperative complications and recurrence risk.

The application of artificial intelligence (AI) in the whole process of tumor CT and MRI imaging shows great potential, throughout the whole process from image acquisition, image reconstruction, lesion detection and auxiliary diagnosis to automated report generation. However, different links in the application of AI in the whole process of tumor imaging are at different stages of development and face many challenges in the clinical translation process. The Technology Maturity Level (TRL) provides a standardized framework for the development level of AI tools in tumor imaging, and can also be used to assess the feasibility, risks, and clinical translational potential of AI technologies. Based on TRL, this paper reviews the current application status and challenges of AI in tumor CT and MRI imaging, aiming to bridge the gap between the cutting-edge research and clinical practical application of AI tools in tumor CT and MRI imaging.

Depression is a common mental disorder, and comorbid chronic pain has become a difficult point in clinical treatment due to poor curative effect. There are "shared" neurobiological mechanisms between depression and pain. Repetitive transcranial magnetic stimulation (rTMS) as a non-invasive neuromodulation technique can simultaneously improve depression and pain symptoms. This article reviews the comorbid mechanism of depression and chronic pain, systematically summarizes the optimized parameters of rTMS in the treatment of depression and chronic pain, and proposes that left or bilateral dorsolateral prefrontal cortex (DLPFC) is the main effective target, which provides evidence-based evidence for the clinical practice of rTMS in the treatment of comorbid chronic pain in depression.

A 46-year-old male was admitted to the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Zhengzhou University on July 1, 2024 due to "intermittent massive hemoptysis for 4 days". Previous history of hypertension, no medical treatment. Physical examination reduced breathing sounds in the right lower lung. After admission, hemostatic treatment was given with phenolsulfamide 1 g/d and tranexamic acid 0.5 g/d. An electrocardiogram performed on the first day of admission showed atrial fibrillation. On the second day of admission, CT angiography of the pulmonary artery (Figures A and B) showed no signs of embolism. There was a large patch of low-density filling defect on the right side of the left atrium, about 5.6 cm ×6.4 cm in size (Figure C). There was no enhancement of the right upper and lower pulmonary veins, which were connected to the filling defect of the left atrium. The right hilar shadow was enlarged, the right lung had multiple interlobular septal thickening, bilateral pleural effusion, and the right side was marked by multiple slightly larger lymph nodes in the mediastinum, slightly larger heart shadow, and a small amount of pericardial effusion. No tumor cells were found in the pathological findings of pleural effusion. Hemoptysis was relieved after bronchial artery embolization on the third day of admission because hemoptysis was still intermittent after 2 days of hemostatic treatment, and the volume of hemoptysis was about 100 ml each time. In order to exclude atrial tumors, PET-CT examination on the 6th day of admission revealed inflammatory lesions in the right hilar and soft tissue masses in the left and right atrium in the pericardium (CT value 40 Hu). A cardiac ultrasound examination on the 11th day of admission showed that the right pulmonary vein thrombosis extended into the left atrium (Figure D, arrow). On the 13th day of admission, bronchoscopy showed protuberance of the mucosa in the anterior segment of the right upper lobe and the dorsal segment of the right lower lobe. Biopsy pathology showed chronic inflammation of the bronchial mucosa with epithelial squamation, subepithelial congestion and hemorrhage of the mucosa with organization. Combined with the imaging characteristics, considering pulmonary vein sarcoma or pulmonary vein thrombosis, he was transferred to the cardiac surgery department and performed "pulmonary vein foreign body removal + left atrial thrombosis removal" on the 25th day of admission. Postoperative pathology showed pulmonary vein thrombosis with partial organization. Pulmonary venous thrombosis (PVT) was confirmed. PVT is a rare thromboembolic disease. Pulmonary surgery, atrial fibrillation and tumors are common causes, and the clinical manifestations are not specific. Massive hemoptysis caused by PVT is very rare, and its mechanism may be related to the obstruction of local venous return caused by pulmonary venous thrombosis, increased pulmonary capillary pressure and rupture.

As a major global health threat, the morbidity and mortality rate of cancer continue to rise. The rise of nanocarrier technology has brought a new paradigm to cancer treatment-greatly improving efficacy and reducing toxicity through accurate drug delivery, regulation of tumor microenvironment, and synergy of multiple treatment methods.