Volume 105 · Issue 46 · 2025

Amid frequent global population mobility, rapid socioeconomic development, accelerated climate change and population aging process, the coexistence of multiple infectious disease threats and the complex interplay of various health determinants have made the co-circulation of multiple infectious diseases a new challenge for public health. Multi-disease prevention targets infectious diseases that share commonalities in clinical manifestations, modes of transmission, risk factors, as well as prevention and control strategies and measures. It integrates the planning, surveillance, testing, prevention, control, and management of such diseases to enhance the quality and efficiency of public health responses. The feasibility of multi-disease prevention lies in its scientific approach to identifying common patterns in the epidemiological characteristics, transmission mechanisms, and control logic of various infectious diseases, thereby enabling highly coordinated and efficient prevention and control efforts. Multi-disease prevention is an urgent practical response to the co-circulation of multiple diseases, a vital means of optimizing resource allocation and improving control efficiency, and an inevitable pathway toward modernizing the public health system. It is recommended to improve the institutional mechanisms for multi-disease prevention. Guided by the principle of"integrated planning, integrated surveillance, integrated testing, integrated prevention and control, and integrated assessment", scientific approaches should be adopted to advance multi-disease prevention efforts.

Since the publication of the "Chinese guidelines for the diagnosis and treatment of insomnia disorder" in 2017, the diagnostic and treatment system for insomnia has achieved significant advances in precision medicine, digital therapeutics, and multidisciplinary integration. The Chinese Sleep Research Society organized domestic experts from relevant fields to develop the"Guidelines for the diagnosis and treatment of insomnia disorder (2025 edition)", which features significant updates in both diagnostic classification and treatment strategies. The guidelines adopt the International Classification of Sleep Disorders-Third Edition, Text Revision diagnostic classification, systematically introduce insomnia subtype classification, and expand coverage of digital cognitive behavioral therapy for insomnia, novel medications, and individualized management strategies for special populations including children/adolescents, women, and elderly patients. This article aims to elucidate the core updates and clinical implications of the guidelines by examining the revisions to the diagnostic system and advancements in treatment strategies, thereby providing a reference for promoting standardized and precision-based diagnosis and treatment of insomnia in China.

Bone trabeculae are key components of bone microstructure, and their complex three-dimensional interconnected microarchitecture is closely related to bone mechanical properties. Traditional imaging studies have been mostly limited to two-dimensional morphological analysis of bone trabeculae, with insufficient attention paid to their interconnected topology, making it difficult to comprehensively reflect bone quality characteristics. The development of ultra-high resolution CT (U-HRCT) technology has brought revolutionary breakthroughs to three-dimensional imaging of bone microstructure. Its spatial resolution can reach up to 50 μm, enabling clear visualization of the three-dimensional structure of bone trabeculae and providing a technical foundation for in vivo assessment of the interconnected trabecular network. Placing emphasis on imaging assessment of bone quality based on three-dimensional interconnected bone microstructure is of great significance for innovating the diagnosis and treatment paradigm of osteoporosis and improving the accuracy of fracture risk prediction. On the basis of systematically reviewing research progress on the three-dimensional interconnected microarchitecture of bone trabeculae, this article focuses on commenting on the technical advantages of U-HRCT in bone microstructure imaging, analyzes the equipment and technical feasibility of evaluation based on the three-dimensional interconnected trabecular network, proposes developing new pathways for bone quality imaging assessment, constructs novel imaging parameters that reflect interconnected topological features, and establishes new bone quality assessment models by integrating multi-level information. It also points out current challenges, including lack of standardization, lengthy imaging durations, and complex data processing, and emphasizes that clinical translation still requires multidisciplinary integration and collaborative advancement across endocrinology, orthopedics, radiomics, biomechanics, and AI.

Acute respiratory tract infection (ARTI) is a common and prevalent disease in children. Defining its etiology is essential for precise and standardized prevention and treatment. There exists a disparity in the understanding of pathogen detection and clinical management of childhood ARTI among pediatricians at all levels, particularly regarding the lack of a unified definition and diagnostic and therapeutic pathway for ARTI of unknown etiology in children. To improve the rationality of etiological detection for ARTI, optimize treatment strategies and management processes, the Subspecialty Group of Respiratory Diseases, the Society of Pediatrics, Chinese Medical Association developed this expert consensus. It addresses initial etiological assessment, diagnostic workflow, selection of diagnostic methods, clinical guidance based on next-generation sequencing results, severity evaluation, empirical treatment and management, as well as early identification and management of emerging and re-emerging infectious respiratory diseases. Based on relevant domestic and international literature and clinical experience, this consensus provides recommendations on the etiological diagnosis and management of childhood ARTI, aiming to uniformly improve the overall level of medical services as well as improve the outcome and prognosis of ARTI in children.

The emulated target trial (TTE) is a real-world data-based research approach that seeks to emulate randomized controlled trials within observational datasets to enable relatively high-quality causal inference. In recent years, with the accumulation of medical big data and real-world cohort data, an increasing number of clinical studies have adopted TTE designs following the principles of randomized controlled trials. However, the methodological rigor and quality of such studies remain uneven. In this context, a multidisciplinary group composed of the Rehabilitation Big Data Working Committee of Chinese Association of Rehabilitation Medicine and experts and scholars from institutions across China—with expertise in clinical medicine, epidemiology and biostatistics, research methodology, evidence-based medicine, and data science—conducted extensive literature reviews and multiple rounds of expert consultation and discussion. This process culminated in the development of the Expert Consensus on the Standardized Application of Emulated Target Trials in Clinical Research (2025 edition). This consensus explicitly proposes 17 recommendations, systematically defining the concept, applicable scenarios, and core components of TTE, and comprehensively addressing key methodological aspects of TTE studies, including selection of data sources, new-user design, determination of time zero, and choice of post-hoc randomization methods. It fills an important gap in China's methodological standards for TTE applications, offering scientific guidance for the rigorous implementation of TTE designs and making a meaningful contribution to the advancement of clinical research.

Comparison of the epidemiological profile, clinical characteristics, and disease-related factors in vitiligo patients between 2001-2011 and 2022-2024.

Clinical data from the inital visits of patients diagnosed with vitiligo at the Dermatology Department of Xijing Hospital were retrospectively collected during the periods of 2001-2011 and 2022-2024. The distribution of demographic and clinical characteristics, including age at the first visit, onset age, and disease duration, were compared between the 2001-2011 group and the 2022-2024 group.

The 2001-2011 group included 8 053 patients (4 284 males and 3 769 females), while the 2022-2024 group included 1 041 patients (581 males and 460 females). No significant difference was found in the gender distribution between the two groups (P=0.119). Compared to the 2001-2011 group, the 2022-2024 group was significantly older at the first visit [median 29 (IQR 16-39) years vs 21 (11-31) years] and at onset [22 (11-33) years vs 17 (9-26) years], with a higher proportion of patients with disease onset at ≥50 years of age [7.5% (78/1 041) vs 3.8% (305/8 053)]. The proportion of mild cases was significantly increased in 2022-2024 group [73.8% (768/1 041) vs 66.3% (5 341/8 053)], while the proportion of extremely severe cases was lower [0.4% (4/1 041) vs 1.9% (157/8 053)] (all P<0.05). Additionally, the 2022-2024 group showed a higher proportion of cases with onset in winter [14.2% (148/1 041) vs 4.4% (353/8 053)] and a lower proportion with onset in summer [15.3% (159/1 041) vs 18.6% (1 495/8 053)] (all P<0.05).

Compared with the 2001-2011 period, patients in the 2022-2024 period exhibit important shifts in disease characteristics, including an older age at onset and a higher propensity for onset in winter.

To evaluate the efficacy and safety of the Janus kinase (JAK) inhibitors ritlecitinib and baricitinib in the treatment of alopecia totalis and alopecia universalis.

The clinical data of alopecia totalis and alopecia universalis patients with a Severity of Alopecia Tool (SALT) score≥95 who received baricitinib or ritlecitinib therapy in the Department of Dermatology, Xiangya Hospital, Central South University from December 2022 to April 2025 were retrospectively analyzed. Assessment was performed at baseline and at weeks 12, 24, and 36 post-treatment using the SALT, Eyebrow Assessment (EBA), and Eyelash Assessment (ELA). Safety was evaluated based on adverse events observed during the treatment period. The primary efficacy endpoint was the proportion of patients achieving a SALT score of≤20 after treatment. The secondary efficacy endpoints included the eyebrow response rate and the eyelash response rate.

A total of 30 patients were enrolled, comprising 12 males and 18 females, with a median age of 16.5 years (IQR 13.0, 27.0). Among them, 90.0% (27/30) had alopecia totalis, 86.7% (26/30) had eyebrow involvement, and 60.0% (18/30) had eyelash involvement. Twenty-two patients were treated with ritlecitinib, while 8 received baricitinib. The median SALT scores at baseline, week 12, and week 24 were 100.0 (IQR 98.0, 100.0) score, 76.5 (IQR 53.0, 100.0) score, and 28.0 (IQR 4.3, 91.3) score, respectively. Efficacy analysis revealed that at week 12, the SALT response rates were 3/22 for ritlecitinib and 2/8 for baricitinib. At week 24, the response rates were 12/22 for ritlecitinib and 2/8 for baricitinib. Additionally, at week 12, the overall eyebrow and eyelash response rates were 7/19 and 7/12, respectively. At week 24, these rates were 13/19 for eyebrows and 9/12 for eyelashes. A total of 15 adverse events were reported, all of which were mild to moderate, with folliculitis (9/15) being the most common.

Baricitinib and ritlecitinib are both effective and well-tolerated in treating alopecia totalis and universalis, demonstrating a manageable safety profile.

To investigate the regulatory role of methyltransferase-like protein 3 (Mettl3) within CD4⁺T cells in a mouse model of atopic dermatitis (AD) induced by calcipotriol (MC903).

The C57BL/6 mouse model with CD4⁺T cell-specific Mettl3 knockout (Mettl3^-/-) was constructed (cKO group, n=4), with Mettl3^flox/flox mice lacking CD4-Cre recombinase serving as the control group (WT group, n=4). An AD-like dermatitis model was induced by topical application of MC903 to the ventral side of the right ear. The characteristics of AD-like dermatitis were assessed based on erythema and scaling at the lesion site, epidermal and dermal thickness, and the scoring of AD (SCORAD). The mRNA expression levels of key cytokines [interleukin (IL)-4, IL-10, etc.] and filaggrin (FLG) in the skin lesions, as well as the proportions of CD4⁺T cell subsets in the draining lymph nodes, were measured.

In the MC903-induced AD-like skin inflammation model, compared with the WT group, the cKO group exhibited less severe AD-like skin lesions, reduced skin thickening, decreased epidermal thickness [(45.4±16.3) μm vs (59.6±2.9) μm], less edema, and lower SCORAD scores. The mRNA expression level of IL-4 in the skin lesions was lower [(0.7±0.1) vs (1.0±0.1)], while the mRNA expression levels of FLG and IL-10 were higher [(2.7±1.3) vs (1.0±0.1) and (1.4±0.3) vs (1.0±0.1), respectively] (all P<0.05). The proportion of regulatory T cells in the draining lymph nodes was significantly higher in the cKO group [(5.7%±1.3%) vs (2.4%± 0.3%), P<0.05]. The proportion of T helper 2 cells (Th2) was lower, with no significant difference [(0.7%±0.2%) vs (0.8%±0.7%), P>0.05].

CD4⁺T cell-specific deletion of Mettl3 modulates IL-4, IL-10, and FLG expression, alters the Th2/Treg cell ratio, and thereby attenuates MC903-induced AD-like dermatitis in mice.

To explore the value of model based on the stress hyperglycemia ratio (SHR) in predicting acute myocardial infarction (AMI) complicated by cardiogenic shock (CS).

This was a retrospective cross-sectional study. Patients diagnosed with AMI from the MIMIC-Ⅳ 3.0 database in the United States between 2008 and 2022 were included and randomly divided into a training set (1 861 cases) and an internal validation set (799 cases) at a 7∶3 ratio. Additionally, eligible AMI patients from Qingdao Municipal Hospital between January 1, 2021, and February 1, 2025, were included as an external test set (316 cases). Key factors were screened using the Least Absolute Shrinkage and Selection Operator (LASSO) regression. Univariate and multivariate logistic regression models were used to identify factors influencing the occurrence of CS in AMI patients, and a nomogram prediction model based on SHR was established. The predictive performance of the model was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), calibration curve, and decision analysis (DCA) curve.

In the training set, patients had a median age of 69 (61, 77) years, with 1 293 males, and 16.7% (310/1 861) had concurrent CS. In the internal validation set, patients had a median age of 69 (61, 77) years, with 550 males, and 18.3% (146/799) had concurrent CS. In the external test set, patients had a median age of 72 (64, 80) years, with 199 males, and 11.1% (35/316) had concurrent CS. Multivariate logistic regression analysis indicated that systolic blood pressure (SBP), SHR, white blood cell (WBC) count, hematocrit (HCT), aspartate aminotransferase (AST), anion gap (AG), activated partial thromboplastin time (APTT), heart failure (HF), and acute kidney injury (AKI) were all influencing factors for the occurrence of CS in AMI patients (all P<0.05). A nomogram model based on these nine variables demonstrated an AUC of 0.82 (95%CI: 0.80-0.84), a sensitivity of 0.68 and a specificity of 0.82 in the training set for predicting CS in AMI patients; an AUC of 0.79 (95%CI: 0.75-0.83), a sensitivity of 0.64 and a specificity of 0.77 in the internal validation set; and an AUC of 0.84 (95%CI: 0.77-0.92), a sensitivity of 0.77 and a specificity of 0.80 in the external test set. Calibration curves indicated good consistency across all datasets, and DCA curve demonstrated that the nomogram model had excellent clinical applicability.

SHR is an influencing factor for CS in AMI patients. The nomogram model developed using SBP, SHR, WBC, HCT, AST, AG, APTT, HF and AKI provides a more intuitive method for identifying the risk of CS in AMI patients.

To examine the differences in left heart structure and function between elderly patients with primary aldosteronism (PA) and those with primary hypertension (EH), and identify factors influencing left heart structure and function in elderly PA patients.

A total of 264 elderly PA patients and 266 EH patients diagnosed at Tongren Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2017 to July 2023 were retrospectively included. Propensity score matching (PSM) was performed at a 1: 1 ratio based on age, gender ratio, and blood pressure. The clinical indicators and cardiac differences were compared between the two groups. Multiple linear regression model was utilized to pinpoint risk factors associated with alterations in cardiac structure and function.

Each group included 147 patients. PA group had 61 males and 86 females, and aged [M (Q₁, Q₃)] 66 (63, 69) years; EH group had 63 males and 84 females, and aged 67 (63, 70) years. Patients with PA exhibit increased left ventricular mass index (LVMI), left atrial diameter (LAD), and interventricular septum thickness (IVST) (all P<0.05). There were no statistically significant differences in the left ventricular ejection fraction (LVEF) and the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity (E/e′) between the two groups (both P>0.05). Multiple linear regression analysis revealed that plasma aldosterone concentration (β=0.162, 95%CI: 0.138 to 0.186, P=0.030), systolic blood pressure (β=0.163, 95%CI: 0.053 to 0.273, P=0.026), and plasma renin concentration (β=0.243, 95%CI: 0.039 to 0.447, P=0.002) were linked to LVMI; body mass index (β=0.260, 95%CI: 0.125 to 0.395, P=0.001), systolic blood pressure (β=0.207, 95%CI: 0.187 to 0.227, P=0.004), plasma renin concentration (β=0.155, 95%CI: 0.090 to 0.220, P=0.031), and age (β=0.212, 95%CI: 0.130 to 0.294, P=0.003) were associated with LAD; and body mass index (β=0.165, 95%CI: 0.122 to 0.208, P=0.010), HDL cholesterol (β=-0.192, 95%CI:-0.294 to -0.090, P=0.004), and plasma aldosterone concentration (β=0.151, 95%CI: 0.149 to 0.153, P=0.016) were related to IVST in PA group patients. Patients with aldosterone adenoma had a higher left ventricular mass index than those with adrenal hyperplasia [94 (81, 103) g/m² vs 81 (70, 98) g/m², P=0.039].

Elderly PA patients exhibit greater left ventricular hypertrophy and left atrial enlargement than age, gender, and blood pressure-matched elderly EH patients, though both groups show similar left ventricular function. In elderly PA patients, aldosterone and renin levels are significantly linked to changes in left ventricular structure. Patients with aldosterone adenoma exhibit more severe left heart hypertrophy than patients with adrenal hyperplasia.

To analyze the molecular epidemiological features of the mcr-1 gene among intestinal Escherichia coli (E. coli) isolates from healthy individuals during 2016 and 2024.

This cross-sectional study included 362 mcr-1-positive E. coli isolates recovered from the intestinal flora of healthy individuals across six provinces (6 475 participants) in 2016, 2019, 2022, and 2024. Strain identification was conducted using MALDI-TOF/MS, and mcr-1 gene was screened by PCR. Antibiotic susceptibility testing was performed to determine the resistance phenotypes of the strains. Whole-genome sequencing was employed to analyze the genetic environment of mcr-1 and the phylogenetic relationships of the host strains. Differences in the epidemiological patterns, resistance phenotypes, and genetic characteristics of mcr-1-positive E. coli isolates were analyzed across sampling years.

Among 362 participants, the mean age was (49±20) years; 194 were male. The carriage rate of the mcr-1 in E. coli showed a significant downgrade trend, decreasing from 13.3% (91/684) in 2016 to 0.4% (5/1 250) in 2024 (P=0.029). Among mcr-1-positive isolates, resistance was highest to cefotaxime (51.9%, 118/362), followed by ciprofloxacin (46.9%, 170/362) and aztreonam (31.2%, 113/362), while high susceptibility was retained to amikacin, cefoperazone/sulbactam, carbapenems, and tigecycline. Compared to 2016, the resistance of mcr-1-positive isolates to aztreonam, cefotaxime and ciprofloxacin all increased in 2019 (all P<0.05). Compared to 2022, the resistance to seven antimicrobial agents showed varying degrees of decline in 2024 (except for ciprofloxacin and meropenem, all P<0.05). Plasmid analysis identified nine plasmid incompatibility types among mcr-1-positive isolates, with IncI2 being most frequent (40.1%, 145/362), followed by IncX4 (15.5%, 56/362), IncHI2 (6.4%, 23/362), IncHI2A (2.8%, 10/362), IncP (2.2%, 8/362), IncF (1.4%, 5/362), and IncY (1.1%, 4/362). The genetic environment analysis of the mcr-1 gene showed that the IncI2 plasmid retained the mcr-1-pap2 structure of transposon Tn6330 during evolution.

The plasmids carrying mcr-1 were more concentrated, with IncI2 plasmids becoming the dominant plasmid.

To explore how the programmed cell death protein 1(PD-1) antibody-internalizing Arg-Gly-Asp peptide conjugate [αPD-1-(iRGD)₂], combined with adoptive T cell therapy (ACT), modulates the cold tumor microenvironment and exerts synergistic anti-tumor effects.

αPD-1-(iRGD)₂ was synthesized with glycosylation engineering. The penetrability and tumor-cytotoxicity enhancement of αPD-1-(iRGD)₂ towards T cells were analyzed through flow cytometry in both conventional and 3D cell culture conditions for HGC27 cells, divided into the control group, the PD-1 monoclonal antibody monotherapy group (αPD-1 group), the PD-1 monoclonal antibody combined with free iRGD peptide group (αPD-1 iRGD group), and the conjugated drug group [αPD-1-(iRGD)₂ group]. The biomarkers of T cell activation (CD25 and CD69) and effector function (GZMB、IFN-γ) were also characterized by flow cytometry. By establishing a classic"cold tumor"model— the BALB/c mouse 4T1 subcutaneous breast tumor model—using the same grouping as above, the antitumor effect of αPD-1-(iRGD)₂ combined with ACT was evaluated, and flow cytometry was performed to analyze changes in the tumor microenvironment, including T cells, macrophages, and other immune components within the tumor, lymph nodes, and spleen. Fluorescence-labeled T cells were tracked in vivo via real-time near-infrared fluorescence imaging system. Flow cytometric analysis was conducted to characterize phenotypic changes in tumor-infiltrating lymphocyte (TIL) and to quantify TIM3 expression as an indicator of T cell exhaustion.

αPD-1-(iRGD)₂ significantly enhanced the ability of T cells to penetrate HGC27 tumor spheroids, with the fluorescence intensity at the spheroid center increasing compared with the αPD-1 group at 30 min (P=0.008). The cytotoxicity of T cells in the conventional and 3D cell culture conditions for HGC27 cells was higher than that of the control group (all P<0.05). The competitive inhibition assays of T cell activation mediated by αPD-1-(iRGD)₂ revealed that the proportions of GZMB⁺, IFN-γ⁺, and CD25⁺CD69⁺ T cells were all significantly elevated in the αPD-1-(iRGD)₂ group compared with the control (all P<0.05). In the 4T1 subcutaneous breast tumor mouse model, combined treatment with αPD-1-(iRGD)₂ and ACT reduced tumor volume to the control group (P<0.001), while the number of intratumoral CD8⁺ T cells increased compared with the αPD-1 group (P=0.001). The proportions of GZMB⁺ and IFN-γ⁺ CD8⁺ T cells rose to 61.98%±1.80% and 58.70%±2.15%, respectively (both P<0.05). In vivo near-infrared imaging further confirmed that the fluorescence intensity in tumor regions was higher in the αPD-1-(iRGD)₂ group than in the αPD-1 group (all P<0.05). Phenotypic analysis showed that, compared with αPD-1 treatment, αPD-1-(iRGD)₂ significantly reduced the proportion of TIM3⁺ exhausted T cells (all P<0.05) and increased the frequency of CD44⁺CD62L⁺ memory-phenotype T cells (all P<0.05).

αPD-1-(iRGD)₂ enhances the immune response of cold tumors to ACT by promoting intratumoral-infiltration of transferred T cells, alleviating the immunosuppressive microenvironment, and preserving the effector memory phenotype of T cells.

This study evaluated the application of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) for apneic oxygenation during anesthesia in pediatric surgery for juvenile-onset recurrent respiratory papillomatosis (JORRP). A retrospective analysis included 55 pediatric patients (27 males, 28 females) aged under 12 years who underwent JORRP surgery with THRIVE at Beijing Tongren Hospital between January 2023 and December 2024. Data on patient demographics, surgical details, lowest intraoperative SpO₂, heart rate and mean arterial pressure (MAP) at various time points (before and after anesthesia induction, at the start of surgery, at 5, 10, 20, and 30 minutes after surgery began, at the end of surgery, and upon leaving the operating room), number of extubations, and apnea duration were collected. The median age was 7 (IQR 6-10) years, with preoperative laryngeal obstruction grades ranging from Ⅰ to Ⅲ, including 35 patients (63.6%) with grade II or above. Median apnea time was 9 (IQR 8-12) minutes, and 50 patients (90.9%) required only one intraoperative extubation. The lowest SpO₂ was≥90% in 52 patients (94.6%), including 44 (80.0%) maintaining SpO₂ at 95%-100%. Intraoperative hypoxemia (SpO₂<92%) occurred in 5 patients (9.1%), with no serious THRIVE-related cardiopulmonary complications. Heart rate and MAP showed statistically significant variations across time points (all P<0.001). THRIVE effectively maintained oxygenation and circulation during apnea in pediatric patients with grade Ⅰ to Ⅲ laryngeal obstruction due to JORRP, reducing the need for repeated intubation and proving to be a safe and effective ventilatory support method.

Case 1: A 55-year-old female who visited the Second Xiangya Hospital of Central South University on April 13, 2022 due to chest tightness and dyspnea for more than 10 days. She was diagnosed with stage IVa lung adenocarcinoma with epidermal growth factor receptor (EGFR) L858R mutation and interstitial-epithelial cell transformation factor (MET) gene amplification (amp). She was orally administered osimertinib + savoltinib. After 24 days of treatment, her chest CT was re-examined. The clinical evaluation was partial remission (PR). As of January 2025, the progression-free survival (PFS) reached 32 months. Case 2: A 67-year-old male visited the Second Xiangya Hospital of Central South University on January 30, 2023 due to the discovery of a lung mass for 20 days. He was diagnosed with stage IIIB lung adenocarcinoma with three driver variants of EGFR p.L861Q, PIK3CA p.R88Q and METamp. Oral osimertinib + savoltinib, chest CT was reviewed after 45 days of treatment, and the clinical evaluation was PR. As of March 2025, PFS reached 25 months.

This paper reports a case of elderly Norwegian scabies presenting with intractable severe pruritus. The patient, an 88-year-old male, living alone, visited the Department of Dermatology of the First Affiliated Hospital of Chengdu Medical College on February 13, 2023 due to "intractable severe pruritus throughout the body for 3 months", and has been misdiagnosed as eczema dermatitis many times. Dermatological examination: red papules and nodules on the trunk, buttocks, groin and both thighs, partially fused into plaques; Thick yellow scab was seen in the umbilicus, penis and scrotum. Dermatoscopy revealed scabies tunnel and terminal brown delta wing-like structure (aircraft trail sign), scabies were detected under microscope, and the diagnosis of Norwegian scabies was confirmed. After 2 courses of standard treatment with 10% sulfur ointment, most of the skin lesions resolved and pruritus disappeared.

This paper reports the diagnosis and treatment of a patient with infectious endocarditis caused by Coagulobacter retardant and renal injury. A 42-year-old male was admitted to hospital due to "abnormal urine test with increased serum creatinine for more than 1 month"; Previous history of mitral valve prolapse. Blood culture showed positive for Coagulobacter tardive, renal puncture biopsy showed intracapillary proliferative glomerulonephritis with immune complex deposition, and antibacterial treatment was given. During outpatient follow-up, urine test and renal function improved.

This article reports a case of duodenal metastasis after breast cancer surgery. A 59-year-old female was admitted to hospital in April 2025 due to abdominal pain and jaundice. After admission, MRI and ultrasound gastroscopy of the upper abdomen were completed to consider the possibility of duodenal neoplastic lesions involving the pancreas. The laboratory tests of tumor markers carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) were elevated, and CA-153 was normal. The previous patient underwent right breast cancer surgery in April 2024. Because duodenal metastasis of breast cancer is rare, considering the possibility of primary duodenal tumor, the patient has severe biliary obstruction, and is indicated for surgery. Pancreaticoduodenectomy is performed, but the postoperative pathological examination results show that it is invasive lobular carcinoma of the breast metastasis. Follow-up until October 2025, the patient's condition was stable.

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease driven by multiple factors. Under the synergistic action of genetic, epigenetic and environmental factors, the body's immune tolerance is destroyed, resulting in abnormal activation of immune cells and continuous production of autoantibodies. These antibodies bind to antigens to form immune complexes, which are deposited in multiple organs, eventually causing chronic inflammation and multi-tissue damage. In recent years, research has made breakthroughs in key mechanisms such as type I interferon signaling pathway, metabolic reprogramming, and immune cell interaction. A variety of targeted drugs and cell therapies have entered clinical trials or been approved for application, significantly broadening the treatment options of SLE. The purpose of this article is to summarize the core immunopathogenesis of SLE, and focus on the key therapeutic progress of B cells, T cells, dendritic cells and interferon signaling pathway, in order to provide theoretical basis and clinical reference for promoting the precise and individualized treatment of SLE.

Psoriasis and atopic dermatitis (AD) are common inflammatory diseases in dermatology. Traditional views suggest that there are significant differences in clinical manifestations, immune mechanisms and treatment strategies between them. In recent years, studies have found that there are patients with both disease characteristics. Because of their diverse clinical manifestations, insufficient response to conventional treatment, and the pathological mechanism has not been fully elucidated, it brings challenges to clinical diagnosis and treatment. This review systematically combs the clinical classification of patients with both psoriasis and AD characteristics, including eczema-like psoriasis or psoriasis-like eczema, eczema-like/psoriasis-like dermatitis after biological treatment, and the overlapping phenotype of psoriasis and eczema, as well as its immune mechanism and treatment research progress, aiming to provide theoretical reference for its clinical classification and effective treatment management.