Volume 106 · Issue 03 · 2026

Ischemic stroke caused by carotid stenosis has become a significant societal burden. The treatment of carotid artery stenosis serves as an effective strategy for stroke prevention, for which carotid endarterectomy (CEA) is considered the gold standard. However, in clinical practice, certain limitations were observed in traditional carotid endarterectomy (CEA) regarding the reduction of perioperative complication risks and the assurance of mid-to long-term efficacy. Therefore, exploration of modifications to the CEA technique held substantial practical significance. Our center proposed the quality of life-modified eversion carotid endarterectomy (QCEA). The key technical modifications included: making an oblique arteriotomy at approximately a 60° angle relative to the bifurcation plane, shaping the arterial anastomosis through longitudinal trimming and remodeling it into a trumpet-shaped orifice, and employing a minimally invasive cosmetic transverse incision along the natural skin lines.

As the aging process accelerates in China, disability has become a critical public health issue affecting the health and quality of life of the elderly. The incidence of disability significantly increases with age, adding the caregiving burden on families and society. Disability results from the interaction between impairments in body functions and structures and environmental factors, rather than a single cause. This consensus focuses on eight core functional dimensions: mobility, cognition, emotion, vision, hearing, speech and swallowing, excretion, daily activities, and social participation, along with corresponding assessment measures. It systematically reviews clinical evidence and the latest developments of relevant assessment schemes, both domestically and internationally. By integrating expert opinions from multiple disciplines using the Delphi method, the consensus presents eight assessment schemes and recommendations covering the above dimensions and suitable for elderly population in the community, aiming to provide evidence-based guidance for the early screening of disability risks among the elderly in the community.

Femoroacetabular impingement syndrome (FAIS) is a prevalent hip disorder, and arthroscopic surgery has emerged as the preferred treatment modality, which has been rapidly adopted in clinical practice across China. Rehabilitation plays a pivotal role in ensuring functional recovery, normal daily activities, and return to sports for orthopedic surgery patients. However, standardized protocols and evidence-based guidelines for perioperative rehabilitation following FAIS arthroscopic surgery remain lacking in China. This expert group organized specialists to develop a rehabilitation consensus for patients with femoroacetabular impingement syndrome (FAIS) requiring arthroscopic surgery, based on systematic literature review, evidence quality assessment, and clinical rehabilitation practice, using the modified Delphi method. The consensus addresses three key aspects: basic principles and common methods, critical issues in rehabilitation intervention, and considerations for special populations. Specifically, it covers fundamental rehabilitation principles, common assessment methods, preoperative rehabilitation, psychological rehabilitation, and postoperative rehabilitation (including phased rehabilitation and progression criteria, pain management, muscle function training, joint range of motion training, weight-bearing training, the clinical value of platelet-rich plasma injections, and return-to-sport criteria). Additionally, it includes rehabilitation considerations for patients of different age groups and those undergoing various surgical approaches, totaling 13 recommendations. This consensus aims to provide evidence-based guidance for clinicians and rehabilitation therapists, facilitating personalized and comprehensive rehabilitation management for FAIS patients undergoing arthroscopic surgery.

To evaluate the clinical efficacy and safety of carotid endarterectomy (CEA) in the treatment of completely collapsed carotid artery near-occlusion (CANO).

A retrospective analysis was performed on the clinical data of patients with completely collapsed CANO who underwent CEA in the Department of Neurosurgery, Affiliated Hospital of Qingdao University, from January 2020 to December 2024. The changes in the diameter of the collapsed distal internal carotid artery and cerebral blood perfusion on the near-occlusion side before and after surgery were compared, so as to comprehensively assess the clinical efficacy of CEA for completely collapsed CANO. The postoperative follow-up was conducted via outpatient visits or hospitalization at 1, 3, and 6 months after discharge, followed by regular visits every 12 months thereafter. The follow-up content included the occurrence of perioperative complications and long-term clinical outcomes.

A total of 30 patients were enrolled with the age of (68±7) years old, including 26 males and 4 females. All patients presented neurological symptoms prior to admission, consisting of 7 cases (23.3%) of transient ischemic attack and 23 cases (76.7%) of cerebral infarction. All patients underwent eversion CEA. The diameter of the collapsed distal internal carotid artery on the near-occlusion side was (3.99±0.80) mm postoperatively, which was larger than the preoperative value of (2.34±0.55) mm. The cerebral blood flow on the near-occlusion side was (63±22) ml·100 g^-1·min^-1 postoperatively, higher than the preoperative level of (34±15) ml·100 g^-1·min^-1 (both P<0.05). Perioperative complications occurred in 5 patients (16.67%), while no severe complications such as intracranial hemorrhage, surgical site hematoma, incision infection, or death were observed in any patient during the entire perioperative period. A postoperative death occurred in 1 patient (3.3%) at 4 months.

For patients with completely collapsed CANO, CEA could not only partially restore the diameter of the collapsed distal internal carotid artery but also effectively improve cerebral perfusion, making it a safe and effective therapeutic method.

To investigate the correlation between periodontitis staging and plaque stability in patients with carotid artery stenosis (CAS).

Clinical data of patients with CAS combined with periodontitis who underwent carotid endarterectomy in the Department of Vascular Surgery, Nanjing Drum Tower Hospital, from January 2020 to December 2024 were retrospectively collected. All patients underwent preoperative carotid computed tomography angiography (CTA), cone-beam computed tomography (CBCT) of the jaw, and laboratory tests of biochemical indices. Periodontitis staging was assessed according to CBCT findings. Based on pathological examination of carotid plaque specimens, patients were divided into a stable plaque group (n=233) and a vulnerable plaque group (n=175). Multivariable logistic regression analysis was used to examine the association between periodontitis staging and plaque stability. Furthermore, receiver operating characteristic (ROC) curves were drawn to evaluate the efficacy of periodontitis staging and related indicators in predicting plaque stability.

A total of 408 patients were enrolled with the age of (67±8) years, including 286 men and 122 women. The stable plaque group aged (67±9) years consisted of 156 men and 77 women, while the vulnerable plaque group aged (69±9) years included 130 men and 45 women. Multivariate analysis revealed that elevated interleukin-6 (IL-6) levels (OR=1.18,95%CI:1.08-1.30), higher C-reactive protein (CRP) levels (OR=1.10,95%CI: 1.03-1.18) and moderate to severe periodontitis stage (moderate periodontitis: OR=1.58, 95%CI: 1.12-2.23; severe periodontitis: OR=2.26, 95%CI: 1.72-3.45), were risk factors for carotid plaque vulnerability. ROC curve analysis demonstrated that when periodontitis severity was moderate or higher, the area under the curve (AUC) of periodontitis stage for predicting plaque stability was 0.75 (95%CI:0.71-0.79,P<0.001), with a sensitivity of 76% and a specificity of 64%.

Periodontitis staging is closely associated with plaque stability in patients with CAS. Patients with moderate to severe periodontitis are more likely to have vulnerable carotid plaques.

To investigate the perioperative outcomes of transcarotid artery revascularization (TCAR) in patients with carotid artery stenosis and analyze the related factors of intraprocedural plaque debris capture.

Clinical data from 56 patients who underwent TCAR for carotid artery stenosis at Zhongshan Hospital, Fudan University was retrospectively collected between September 2024 and August 2025. Follow-up were conducted for the patients on the day of surgery, 3 days, 1 week, 2 weeks, and 1 month after surgery through outpatient or inpatient settings. The analysis focused on technical success rates and perioperative complication incidence. Firth's penalized maximum likelihood estimation for multivariable logistic regression analyses were used to screen the risk factors related to plaque debris capture in the reverse-flow device during TCAR procedures.

Among the 56 patients aged (70±7) years, 50 were male and 6 were female. The surgical technique achieved a 100% (56/56) success rate with a perioperative complication rate of 1.8% (1/56). All patients [M(Q₁, Q₃)] had the procedure duration of 95 (80, 141) minutes and the positive arterial blood flow occlusion time of 8 (7, 10) minutes. A total of 40 patients registered the situation of plaque debris capture. Reverse-flow device capture of plaque debris was confirmed in 50% (20/40) of patients following TCAR procedures. Multivariate logistic regression analysis demonstrated that symptomatic patients (OR=15.89, 95%CI: 1.96-257.81) and residual lumen diameter at the narrowest-point (OR=0.20, 95%CI: 0.04-0.63) were the related risk factors for plaque debris capture during TCAR procedures.

In patients with carotid artery stenosis, TCAR achieved a high technical success rate with few perioperative complications. Symptomatic patients and residual lumen diameter at the narrowest-point were the related factors for plaque debris capture.

To compare the clinical features of different treatment strategies between patients with type Ⅰ and type Ⅱ spontaneous extracranial carotid artery dissection (sECD). To investigate the efficacy of different treatment methods.

A retrospective analysis was conducted on 181 sECD patients admitted to the First Affiliated Hospital of Zhengzhou University between June 2018 and February 2025, of whom 23 had bilateral involvement, resulting in a total of 204 dissected vessels. Based on the Borgess classification, 204 dissected vessels were categorized into 2 groups: type Ⅰ (intact intima, 71 vessels) and type Ⅱ (with an intimal tear, 133 vessels). Patients were followed up at 3, 6, and 12 months, and every 12 months thereafter via outpatient visits or readmission. Demographic data, clinical manifestations, imaging features, treatment regimens, and follow-up data were collected to analyze and compare the incidence of cerebral ischemic events, cerebral hemorrhage, and mortality during hospitalization and follow-up between the 2 groups. To observe the efficacy between surgical and conservative treatments as well.

A total of 181 patients aged (50±11) years were included, comprising 139 males and 42 females. Compared with type Ⅱ sECD, type Ⅰ were younger [48 (40, 56) vs 51 (44, 57) years, P=0.043] and had higher National Institute of Health Stroke Scale scores at admission and discharge [2 (0, 5) vs 0 (0, 3) points, P=0.029; and 0 (0, 2) vs 0 (0, 1) points, P=0.026, respectively]. The incidence of ischemic stroke was significantly higher in type Ⅰ sECD [60.6% (43/71) vs 43.6% (58/133), P=0.021]. Type Ⅰ sECD also exhibited a higher proportion of true lumen stenosis >70% [78.9% (56/71) vs 36.8%(49/133), P<0.001]. A total of 67 patients (71 vessels) underwent surgical treatment with a 100.0% (71/71) success rate and no perioperative complications. Among 114 patients (133 vessels) receiving conservative treatment, the cerebral ischemia recurrence rate was 3.7% (2/53) for type Ⅰ and 6.3% (5/80) for type Ⅱ, with no statistically significant difference (P>0.05). However, the complete and partial healing rates were higher in type I sECD than in type Ⅱ [88.7% (47/53) vs 30.0% (24/80), P<0.001].

Type Ⅰ sECD is more common in younger patients and is associated with a higher risk of severe ischemic stroke, yet it exhibits better healing rates with antithrombotic therapy. Surgical treatment intervention is safe and effective for both types.

To analyze the risk factors of deep vein thrombosis (DVT) after core decompression in patients with osteonecrosis of the femoral head (ONFH) and construct a predictive model.

A retrospective analysis was conducted on the clinical data of 244 patients with ONFH who underwent core decompression and were hospitalized in Guizhou Hospital of Jishuitan, Beijing from January 2020 to May 2025. There were 143 males and 101 females, with an age of (62.2±4.2) years. According to whether DVT occurred within 3 months after the operation, the patients were divided into the non-DVT group (n=167) and the DVT group (n=77), and the differences in various clinical indicators between the two groups were analyzed. After screening for variables through least absolute shrinkage and selection operator (LASSO) regression, a multivariate logistic regression model was conducted to analyze the risk factors of DVT after core decompression in patients with ONFH, and a nomogram of the DVT prediction model was drawn. The predictive ability, accuracy and clinical applicability of the model were evaluated respectively by the area under the receiver operating characteristic curve (AUC), calibration curve and decision analysis curve.

The age, ONFH volume, proportion of diabetes, postoperative bed rest time, fibrinogen (FIB), D-dimer, complement C3, complement C4, matrix metalloproteinase-1 (MMP-1), matrix metalloproteinase-2 (MMP-2), and Caprini score of patients in the DVT group were greater than those in the non-DVT group (all P<0.05). LASSO regression screened out 10 variables for analysis, namely age, ONFH volume, postoperative bed rest time, FIB, D-dimer, complement C3, complement C4, MMP-1, MMP-2, and Caprini score. The analysis of the multi-factor logistic regression model showed that large ONFH volume (OR=1.90, 95%CI:1.34-2.68), postoperative bed rest time≥3 d (OR=11.22, 95%CI:1.46-16.04), elevated FIB (OR=2.83, 95%CI:1.29-6.21), elevated D-dimer (OR=2.17, 95%CI:1.11-4.25), elevated complement C3 (OR=5.28, 95%CI:4.22-8.08), elevated MMP-1 (OR=18.78, 95%CI:15.90-27.37) and a higher Caprini score (OR=4.44, 95%CI:1.74-11.35) were risk factors for DVT in patients with ONFH after core decompression. Based on the above parameters, a prediction model for DVT after core decompression in patients with ONFH was drawn. The predictive model predicted that the AUC of DVT after core decompression in patients with ONFH was 0.82 (95%CI: 0.77-0.88).The sensitivity was 78.3%, and specificity was 81.2%. The calibration curve has a high degree of fit with the standard model curve (P=0.521) and has good clinical applicability.

Large ONFH volume, postoperative bed rest time≥3 d, elevated FIB, elevated D-dimer, elevated complement C3, elevated MMP-1, and high Caprini score are risk factors for DVT after core decompression in patients with ONFH. The nomogram prediction model constructed based on the above parameters has good clinical applicability.

To investigate the clinicopathological characteristics of neuroendocrine(NE) cell dysplasia in gastric oxyntic gland mucosa. The clinical data of the patients with gastric mucosal NE cell dysplasia who underwent endoscopic submucosal dissection or endoscopic mucosal resection treatment at Xiangcheng County People′s Hospital and the 989th Hospital of the Joint Logistics Support Force from January 2011 to October 2024 were retrospectively included. The clinical and endoscopic manifestations of the patients were analyzed, and their pathological morphological characteristics were observed in combination with immunohistochemical staining. A total of 15 patients were included, aged 54 years (32-69 years), including 6 males and 9 females. There were a total of 25 lesions (4 and 3 patients with 2 and 3 lesions, respectively) lincluding 21 lesions in the gastric body (84.0%) and 4 lesions in the gastric fundus (16.0%). Paris classification: 24 cases (96.0%) were classified as 0-Ⅱa type, 1 case (4.0%) as 0-Ⅱc type, with a median lesion diameter of 11.0 mm (2.0-36.0 mm). Narrowband imaging under endoscopy showed glandular duct disorder and abnormal blood vessels, and the mucosal features were consistent with autoimmune gastritis changes. Histological examination showed intrinsic glandular atrophy accompanied by intestinal metaplasia, and NE cells in mucosal hyperplasia presented as solid micro nodules (≤150 μm), arranged in a beam or glandular pattern. Enlarged micro nodules (>150 μm), fusion, sprout, and micro infiltration foci or single-cell infiltration can be seen, as well as nodules with newly formed stroma. It can be seen that the nodules are located within the mucosal muscle or above the lamina propria. Immunohistochemistry showed positive synaptic and chromaffin in NE cells, with nodules smaller than 0.5 mm in diameter and no submucosal infiltration. Sixteen (64.0%) cases of dysplasia lesions were accompanied by G1 grade neuroendocrine tumors, with continuous cell shape and unclear boundaries between the two. Gastric NE cell dysplasia is a precursor lesion of neuroendocrine tumors, and the key to diagnosis lies in identifying interstitial infiltration.

To explore the feasibility and timeliness of using unmanned aerial vehicle (UAV) to deliver automated external defibrillator (AED) for the emergency rescue of out-of-hospital cardiac arrest (OHCA), a simulation experiment was conducted in the urban area of Jiaxing from November 2023 to November 2024. With the emergency rescue center as the center, 43 simulated OHCA events were randomly set within a radius of 6.5 kilometers. The distance and time indicators among emergency medical services (EMS), UAV-delivered AED, and public AED retrieval were compared. The results showed that the UAV flight distance [2.29 (1.21, 3.58) vs 3.10 (2.10, 5.30) km], flight time [266.0 (193.0, 344.0) vs (555.3±11.6) seconds], and response time [353.0 (272.0, 426.0) vs (597.2±210.0) seconds] were all shorter than those of EMS (all P<0.05). However, the UAV′s activation time [(76.4±8.7) vs 40.0 (35.0, 51.0) seconds] was longer than that of EMS (P<0.05). The distance for retrieving public AEDs was shorter than the UAV flight distance [0.76 (0.40, 1.12) vs 2.29 (1.21, 3.58) km], but the retrieval time was longer [550.1 (286.6, 803.5) vs 353.0(272.0, 426.0) seconds] (both P<0.05). This study indicates that UAVs have a significant advantage in emergency rescue timeliness, and the integrated use of EMS, UAV, and AED is a feasible new model for OHCA emergency rescue.

Growth hormone (GH) is closely associated with liver cirrhosis. The effects of GH-insulin-like growth factor-1 (IGF-1) axis on the development and treatment of liver cirrhosis were systematically reviewed. Studies have shown that GH deficiency can lead to GH-related cirrhosis (GHRC), and physiological dose GH treatment can prevent, slow down, or even reverse GHRC; Non-GHRC (alcoholic, viral, hemochromatosis cirrhosis and partial cryptogenic cirrhosis, etc.) may have GH resistance, which is manifested by increased GH and decreased IGF-1. At this time, superphysiological dose (2~3 times physiological dose) GH treatment can increase IGF-1 to normal level and also play a role in relieving liver cirrhosis. If the increase of IGF-1 level is not obvious after superphysiological dose of GH treatment, indicating complete failure of hepatocyte function, liver transplantation should be performed in time; Partial GH and IGF-1 deficiencies often exist in metabolism-related fatty liver disease cirrhosis. GH supplementation may be one of the treatment methods for this kind of liver disease.

Chronic atrophic gastritis (CAG) is a gastric precancerous disease caused by gastric mucosal damage and glandular reduction. The prevalence rate in China exceeds 20%, but effective treatment methods and drugs are still lacking. Oxidative stress plays a key role in the development of CAG to gastric cancer. Regulation of oxidative stress pathway can help interfere with the pathological process of CAG and reduce the risk of gastric cancer. This paper focuses on the research progress of oxidative stress in CAG, systematically reviews its mechanism of action and related biomarkers in disease development, and focuses on sorting out key regulatory pathways; At the same time, the role of Helicobacter pylori, ferroptosis and intestinal flora in CAG oxidative stress damage was further discussed, and the intervention strategies targeting oxidative stress were summarized, aiming at providing theoretical basis and research direction for the prevention and treatment of CAG.

Immunity is the comprehensive ability of the body to maintain homeostasis, resist pathogens and regulate inflammation. Immunity decoding refers to the use of multi-omics and other technologies, starting from multi-dimensions, systematically measuring, in-depth analyzing and scientifically evaluating the state and function of human immune system. In-depth decoding the underlying operating logic of immunity and realizing precise immune remodeling are the core paths for modern medicine to deal with the challenges of complex diseases. This "Medical Frontier Thirty Academic Conference" focuses on the frontier direction of immunity decoding, and conducts in-depth discussions around six core topics: biophysics and immunity, aiming at clarifying the operation logic of the immune system at the level of molecular structure and dynamics, revealing the interaction mechanism of mechanical signal perception, energy conversion and immune response, and developing targeted intervention strategies; Neuro-immune regulation is committed to clarifying the mechanism by which the nervous system accurately regulates immune response through cross-organ dialogue such as "brain-spleen axis", "brain-intestine axis" and "brain-liver axis", and providing a theoretical basis for neural intervention therapy; Research on the interaction between immunity and metabolism focuses on the role of metabolic reprogramming of immune cells in tumors, inflammation and aging, and explores new ways of metabolic intervention to enhance immune efficacy; Transplant immune remodeling focuses on the dynamic monitoring and reconstruction of immune homeostasis after organ transplantation, and promotes the optimization of xenograft immune compatibility and individualized immune tolerance induction; Digital decoding of immunity aims to build an individualized "three-dimensional map of immunity" and a "digital twin" of immune cells and immune systems through multi-omics and artificial intelligence drive, so as to realize real-time assessment, prediction and intervention of immune health status; New tumor immune technologies focus on solving the problems of immune escape and drug resistance, and explore new strategies for immune microenvironment remodeling, multi-target combination therapy and personalized precision immunotherapy. This conference brings together interdisciplinary wisdom, condenses key scientific issues, and looks forward to future development trends. It aims to provide systematic support for in-depth understanding of immune laws, development of innovative immunotherapies, and optimization of disease prevention and control systems.