Volume 106 · Issue 09 · 2026

Thyroid cancer is one of the fastest-growing solid malignancies in recent years. While the five-year survival rate of thyroid cancer in China has improved significantly, reoperation remains common due to factors such as inadequate initial diagnosis, insufficient evaluation, inappropriate surgical approaches, and high-risk pathological types. Although reoperation for thyroid cancer generally has a favorable prognosis, its difficulty and risk are significantly increased due to altered anatomy, scar adhesion, and tumor invasion. Precise preoperative evaluation, appropriate surgical access, proper surgical techniques, and effective protective measures can enhance surgical safety. This article reviews the latest research on the indications, surgical strategies, complication prevention, and future directions for reoperation in thyroid cancer, aiming to provide insights for reducing reoperation incidence and improving surgical safety.

Thyroid-stimulating hormone (TSH) suppression therapy plays an important role in the postoperative management of patients with differentiated thyroid cancer (DTC). However, its role in low-risk DTC (LR-DTC) remains controversial. This article reviewed domestic and international guidelines and relevant literature on TSH suppression therapy, finding that current guidelines worldwide generally show a trend toward gradually relaxing TSH suppression targets for LR-DTC patients. The latest guidelines from the American Thyroid Association (ATA), the National Comprehensive Cancer Network Thyroid Carcinoma Guidelines, and the Japanese Guidelines for the Treatment of Thyroid Tumors advocate a more lenient TSH suppression strategy for LR-DTC patients, recommending no suppression for those with excellent response or those who have undergone lobectomy. The most recent European Society for Medical Oncology Clinical Practice Guidelines for thyroid cancer and the Chinese Guidelines for the Diagnosis and Treatment of Thyroid Nodules and Differentiated Thyroid Cancer primarily reference the 2015 ATA guidelines, currently adopting a mild suppression approach by recommending that the TSH levels be maintained at the low end of the normal range. Recent large-scale studies tend to support further relaxation of TSH suppression targets for LR-DTC patients. There has still been no consensus regarding the optimal duration of TSH suppression therapy, as well as its application during active surveillance and after thermal ablation. There is an urgent need for more large-scale, multicenter prospective studies to provide stronger evidence-based support for formulating TSH suppression strategies in LR-DTC patients.

Critically ill patients have a high incidence of organ dysfunction, and how to accurately and effectively assess organ function has long been a focus of attention. The Sequential Organ Failure Assessment (SOFA) score, an important tool for evaluating organ dysfunction, has been widely used in clinical practice for nearly 30 years, but it still has certain limitations. The SOFA-2 score, released in 2025 by a team of 60 experts from 9 countries specializing in critical care medicine, epidemiology, and data science, has achieved a significant upgrade from an assessment tool to a standardized system by optimizing variable definitions, updating thresholds, and clarifying standardized rules, with the potential to improve its clinical applicability. The promotion of SOFA-2 is of great value for strengthening the stratified management of critically ill patients and enhancing the quality of clinical research. This article aims to systematically expound on the main updates of SOFA-2, its core differences from SOFA-1, and recommendations for clinical application, as well as analyze the current challenges and its impact on the practice and research of critical care medicine, in order to provide a reference for the accurate understanding and application of this score.

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host immune response to infection, representing a critical global public health challenge, its high incidence and mortality rates continue to pose severe challenges in critical care medicine. Antibacterial agents are the cornerstone of sepsis management, yet its strategies are not static. Over the past decades, the philosophy of antimicrobial stewardship in sepsis has undergone profound evolution, driven by a deeper understanding of its pathophysiology, the escalating global crisis of antimicrobial resistance, and the continuous accumulation of evidence-based medical data. This article aims to systematically review the evolving landscape of anti-infective therapy for sepsis, focusing on key aspects such as epidemiology and pathogen resistance, timing of antibiotic initiation, empirical selection, dosing and administration methods, de-escalation and short-course strategies, as well as emerging sepsis sub-phenotypes and artificial intelligence-assisted decision-making. This article seeks to summarize past experiences, clarify misconceptions, and outline a future path toward transformation based on precision medicine.

This article provides a systematic review of the advances in the precise diagnosis and management of immune-related adverse events (irAEs) induced by immune checkpoint inhibitors. IrAEs involve multiple organ systems, exhibit strong clinical heterogeneity, and lack specific biomarkers, all of which significantly compromise treatment safety and patient outcomes. This paper proposes a "3T" strategy centered on "Target, Timing, Tailoring" and constructs an integrated "3D-SPACE" management framework encompassing diagnosis, dynamic risk assessment, directed therapy, surveillance, prevention, adaptive regimen adjustment, collaborative multidisciplinary care, and engaged shared decision-making. Key emphases include the application of multi-omics technologies for early identification and subtyping, artificial intelligence-driven dynamic risk prediction and personalized intervention, as well as novel strategies such as microbial modulation. By establishing a multi-omics-informed, longitudinal management architecture, the framework aims to enable early differentiation between irAEs and severe infections, risk stratification, and precision intervention. Ultimately, it forms a closed-loop management model of "monitoring-warning-prevention-treatment-optimization", offering a systematic solution and practical framework to enhance the safety of immunotherapy.

Osteoporotic fractures represent the most severe complication of osteoporosis, characterized by high incidence, high rates of missed diagnosis, high disability rates, and high mortality. These fractures impose substantial economic and caregiving burdens on both society and families. Strengthening screening in high-risk populations and implementing early interventions to prevent or reduce the occurrence of osteoporotic fractures are therefore of paramount significance. Therefore, the Professional Committee for Osteoporosis Prevention and Rehabilitation of Chinese Association of Rehabilitation Medicine, in collaboration with the Osteoarthrosis Committee of Chinese Aging Well Association, has initiated the development of the guideline for primary prevention of osteoporotic fractures. Key clinical issues of greatest concern to healthcare professionals were identified, including: identification of populations at high risk for osteoporotic fracture and fracture risk assessment; education and guidance for at-risk populations; fall prevention measures; assessment, diagnosis, and treatment of osteoporosis. This process culminated in the formulation of 11 evidence-based recommendations. The guideline aims to optimize primary prevention strategies for osteoporotic fractures, enhance healthcare professionals′ management of health in high-risk populations, strengthen self-protection awareness among these individuals, reduce fracture incidence, and ultimately improve the quality of life for those at risk.

To compare the therapeutic effects of hemithyroidectomy (HT) versus total thyroidectomy (TT) on sporadic medullary thyroid carcinoma (sMTC).

Clinical data of sMTC patients firstly treated in Tianjin Medical University Cancer Institute and Hospital from January 2011 to December 2019 were reviewed retrospectively. The patients were categorized into the HT group and the TT group based on the extents of primary tumor resection. The differences in clinical characteristics between the two groups were compared. A 1∶1 matching of variables including tumor stage and mulifocality was performed using propensity score matching (PSM) to balance the baseline differences between the two groups. Subsequently, the differences in biochemical cure rate, biochemical recurrence rate, and structural recurrence rate between the two groups were compared. Survival curves were plotted using the Kaplan-Meier method, and the log-rank test was utilized to compare the differences in progression-free survival and overall survival between the two groups.

A total of 199 patients with sMTC were included in the study, comprising 80 males and 119 females, with the age [M(Q₁,Q₃)] of 51.0 (42.0,59.0) years. Before PSM, 117 patients were in HT group and 82 patients were in TT group. There were statistically significant differences in preoperative calcitonin, N stage, TNM stage, and the number of lesions between the two groups (all P<0.05). After PSM, 63 patients were in HT group and 63 patients were in TT group. There was no statistically significant difference in all clinicopathological characteristics between the two groups (all P>0.05). Before PSM, the biochemical cure rate in the HT group was higher than that in the TT group [76.4% (81/106) vs 60.5% (46/76), P=0.021]. There were no statistically significant differences in the biochemical recurrence rate and structural recurrence rate between the HT group and the TT group [4.7% (5/106) vs 7.9% (6/76), 8.5% (10/117) vs 15.9% (13/82), both P>0.05]. The progression-free survival of the HT group was longer than that of the TT group [(137.26±3.53) vs (114.12±5.98) months, P=0.025]. There was no statistically significant difference in overall survival between the HT group and the TT group [(142.12±2.91) vs (126.92±5.15) months, P=0.140]. After PSM, there were no statistically significant differences between the HT group and the TT group in terms of biochemical cure rate [66.7% (40/60) vs 77.2% (44/57)], biochemical recurrence rate [5.0% (3/60) vs 7.0% (4/57)], structural recurrence rate [12.7% (8/63) vs 17.5% (11/63)], progression-free survival [(130.69±5.07) vs (112.19±6.91) months], and overall survival [(136.05±4.04) vs (124.71±6.83) months] (all P>0.05).

The therapeutic effects of HT and TT on sMTC are comparable. With careful preoperative evaluation, selective performance of HT is safe and feasible.

To analyze the risk factors for differentiated thyroid cancer(DTC) with distant metastases and establish a suitable prognostic risk prediction model.

A retrospective analysis was performed on the clinical data of 2 337 patients diagnosed with distant metastasis of DTC from January 2000 to December 2021, as recorded in the Surveillance, Epidemiology, and End Results (SEER) database. Using the sample function in R, patients were randomly divided into a training set (n=1 635) and an internal validation set (n=702) at a ratio of 7∶3. Additionally, 227 patients with DTC and distant metastasis from Tianjin Medical University Cancer Institute and Hospital between January 2010 and December 2021 were included as an external validation set. Univariate and multivariate Cox proportional hazards regression model analysis, least absolute shrinkage and selection operator (LASSO) regression analysis were employed to screen for prognostic factors affecting the outcomes of patients with DTC and distant metastasis, and a prognostic prediction model nomogram was constructed. The predictive ability, accuracy, and clinical applicability of the model were evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA).

A total of 2 337 patients with distant metastasis of DTC were retrieved from the SEER database, including 988 males and 1 349 females, with the age of (58.4±18.6) years. Among them, 1 254 patients died with a median overall survival (OS) time of [M (Q₁, Q₃)] 42.0 (13.0, 95.0) months. At Tianjin Medical University Cancer Institute and Hospital, a total of 227 patients with DTC accompanied by distant metastasis were included, comprising 62 males and 165 females, with the age of (56.7±16.8) years. Among these patients, 114 died with a median OS time of 43.0 (15.0, 101.0) months. The follow-up ended upon the patient′s death or March 31, 2025. After analysis using a univariate Cox proportional hazards regression model and screening via LASSO regression, 4 variables were included from the training set, including age, maximum tumor diameter, invasion of vital tissues, and surgical treatment. Multivariate Cox proportional hazards regression model analysis showed that age≥55 years (HR=3.37, 95%CI: 3.08-4.53), maximum tumor diameter>4 cm (HR=1.83, 95%CI: 1.12-2.99), and invasion of vital tissues (HR=2.15, 95%CI: 1.81-2.56) were risk factors affecting the OS of patients with DTC accompanied by distant metastasis, while surgical treatment (HR=0.44, 95%CI: 0.36-0.53) was a protective factor. A prognostic prediction model for patients with DTC accompanied by distant metastasis was constructed using these influencing factors. The AUC for predicting 3, 5, and 10 year OS were 0.780 (95%CI: 0.754-0.805), 0.769 (95%CI: 0.743-0.795), and 0.836 (95%CI: 0.809-0.864)(in the training set); 0.804 (95%CI: 0.768-0.841), 0.815 (95%CI: 0.779-0.850), and 0.877 (95%CI: 0.844-0.911)(in the internal validation set); and 0.753 (95%CI: 0.682-0.824), 0.717 (95%CI: 0.642-0.792), and 0.810 (95%CI: 0.725-0.894)(in the external validation set). The calibration curves demonstrated good fit between the predicted and observed values (all P>0.05), and DCA indicated that the model had high clinical application value.

Age≥55 years, maximum tumor diameter>4 cm, and vital tissue invasion are independent risk factors for poor survival in patients with metastatic DTC, whereas surgical treatment improves prognosis. The proposed nomogram provides reliable prognostic assessment and may support individualized risk stratification and clinical decision-making.

To explore the relationship between preoperative thyroglobulin (Tg) levels and recurrence risk as well as treatment response in patients with differentiated thyroid cancer (DTC).

A retrospective analysis was conducted on the clinical data of 604 patients with DTC who underwent total thyroidectomy at Shanghai Renji Hospital from January 1, 2020, to December 31, 2024. The postoperative recurrence status of patients was recorded, with follow-up ending on June 30, 2025. Determine the cut-off value of preoperative Tg for predicting patient prognosis using the maximum selected rank statistic method. Multivariate Cox proportional hazards regression model was used to analyze the risk factors for postoperative recurrence in DTC patients. Survival curves were plotted using the Kaplan-Meier method, and the log-rank test was used to evaluate the differences in postoperative disease-free survival rates and treatment response among DTC patients with different preoperative Tg levels.

Among the 604 patients, 417 were female and 187 were male, with the age of 45.0(36.0, 57.0) years. The preoperative Tg was 20.2 (10.4, 44.3) μg/L, and the follow-up period was 1.40 (0.85, 2.84) years. Multivariate Cox proportional hazards regression model analysis revealed that preoperative Tg levels≥36.2 μg/L (HR=14.180, 95%CI:1.745-115.200) was a risk factor for postoperative recurrence in DTC. Patients with the preoperative Tg level of<36.2 μg/L had a higher 3-year disease-free survival rate compared to those with the preoperative Tg level of≥36.2 μg/L (99.8% vs 92.3%, P<0.001). The proportion of patients with the favorable treatment response was lower among those with the preoperative Tg level of≥36.2 μg/L compared to those with the preoperative Tg level of<36.2 μg/L, whereas the proportions of patients with biochemical incomplete, structural incomplete, and indeterminate responses were higher among those with the preoperative Tg level of≥36.2 μg/L (all P<0.05).

Preoperative Tg levels are significantly associated with the recurrence risk and treatment response in DTC patients. The Tg level of≥36.2 μg/mL indicates a high recurrence risk and poor treatment response.

To investigate the distribution patterns of vertebral bone density in degenerative lumbar scoliosis (DLS) patients with different coronal imbalance classifications.

A retrospective study was conducted on 154 patients with DLS who underwent long-segment spinal fusion surgery at Nanjing Drum Tower Hospital between January 2017 and December 2022. The patients were classified according to the Nanjing Drum Tower coronal imbalance classification of DLS: Type A, coronal balance distance (CBD) <3 cm; Type B, CBD ≥3 cm and C₇ plumb line (C₇PL) located on the concave side; Type C, CBD ≥3 cm and C₇PL located on the convex side. The major curve Cobb angle and CBD were measured on preoperative standing full-spine radiographs. Preoperative assessments also included L_1-4 T-scores and femoral neck T-scores obtained from dual-energy X-ray absorptiometry (DXA). Additionally, overall vertebral body bone density and Hounsfield unit (HU) values on the concave and convex sides were measured using preoperative CT scans. The patients with L_{1 HU} value <110 were diagnosed with osteoporosis (OP). Comparative analyses included OP prevalence and coronal plane bone mass distribution patterns among the different coronal classifications.

A total of 154 patients were included in this study, comprising 21 males and 133 females, with an average age of (62.9±6.6) years. Among them, 99 patients were classified as Type A, 30 as Type B, and 25 as Type C. The prevalence of OP was 48.7% (75/154), with the prevalence in Type C (72.0%, 18/25) patients being higher than that in Types A (44.4%, 44/99) and B (43.3%, 13/30) (both P<0.05). The mean HU value of the S₁ vertebra for all patients was 140.8±63.1, it was the lowest in Type C patients (108.2±53.4), which was statistically significantly lower than that in Types A and B patients (150.2±66.0 and 137.1±52.0, respectively, both P<0.05). For all the patients, the HU values on the concave side of the main curve were all greater than those on the convex side (all P<0.005), with the greatest asymmetry observed at the apex vertebra. The asymmetry ratios of the concave to convex sides of the S₁ vertebra in Type B and Type C patients were higher than those in Type A patients (1.25±0.24, 1.23±0.24, and 1.11±0.22, respectively; P<0.01).

Patients with DLS exhibit a high prevalence of OP, with Type C patients showing the highest OP prevalence and the lowest bone density at the S₁ vertebral body. Based on these findings, it is recommended that, for type C patients, distal internal fixation be performed using iliac screws or S₂ sacroiliac screws to reduce the risk of internal fixation failure.

To investigate the clinical characteristics and factors associated with mortality in hematological patients infected with Stenotrophomonas maltophilia (SMA).

The clinical data of hematological patients with SMA infection who were admitted to the Department of Hematology, Tianjin Medical University General Hospital, from January 2022 to December 2024 were retrospectively collected. Based on the 28-day survival status after the confirmed SMA infection, the patients were divided into the deceased group and the survival group. The clinical characteristics of the two groups were compared, and the factors associated with mortality were analyzed.

A total of 130 patients were included, comprising 74 males and 56 females, with a median age [M (Q₁, Q₃)] of 65 (56, 71) years. There were 54 patients in the deceased group and 76 in the survival group. The proportion of patients with indwelling urinary catheters/gastric tubes/pleural effusion drainage tubes [35.2% (19/54) vs 11.8% (9/76), P=0.001] and the proportion of patients with a history of tigecycline use prior to the current SMA infection diagnosis [51.9% (28/54) vs 22.4% (17/76), P=0.001] were both higher in the death group than those in the survival group. The time interval from hospital admission to etiological confirmation of SMA was longer in the death group than that in the survival group [26 (10, 47) vs 18 (9, 26) days, P=0.015]. In the antimicrobial susceptibility testing, the susceptibility rates of the isolates from the death group to compound sulfamethoxazole [75.9% (41/54) vs 89.5% (68/76), P=0.039] and levofloxacin [72.2% (39/54) vs 89.5% (68/76), P=0.011] were both lower than those in the survival group. The proportion of patients with concurrent fungal infections [46.3% (25/54) vs 21.1% (16/76), P=0.002] and viral infections [25.9% (14/54) vs 9.2% (7/76), P=0.011] was higher in the death group compared to the survival group. The proportion of patients who received tigecycline both before and after the diagnosis of SMA infection was higher in the death group than that in the survival group [48.1% (26/54) vs 17.1% (13/76), P<0.001]. In the death group, the white blood cell count [0.6 (0.2, 3.1)×10⁹/L vs 3.2 (0.3, 6.9)×10⁹/L], platelet count [24 (12, 50)×10⁹/L vs 42 (20, 87)×10⁹/L], absolute neutrophil count [0.2 (0, 2.4)×10⁹/L vs 1.2 (0.1, 4.9)×10⁹/L], and albumin level [28 (26, 31) g/L vs 30 (27, 33) g/L] were all lower than those in the survival group (all P<0.05). The use of indwelling urinary catheter/gastric tube/pleural effusion drainage tube (OR=4.766, 95%CI: 1.686-13.467), complicated fungal infection (OR=2.679, 95%CI: 1.080-6.648), administration of tigecycline both before and after the diagnosis of SMA infection (OR=4.366, 95%CI: 1.732-11.006), and platelet count ≤30×10⁹/L (OR=2.812, 95%CI: 1.170-6.755) were identified as factors associated with mortality in hematological patients infected with SMA.

The patients with hematological disease infected with SMA exhibit clinical characteristics such as widespread exposure to broad-spectrum antibiotics, frequent polymicrobial infections, as well as pancytopenia. The use of indwelling urinary/gastric/pleural drainage tubes, complicated fungal infection, administration of tigecycline both before and after SMA diagnosis, and a platelet count ≤30×10⁹/L are factors associated with mortality in hematological patients infected with SMA.

To explore the mechanism of vitamin K2 (VitK2) regulating matrix Gla protein (MGP) in inhibiting tumor growth in inflammation-associated colorectal cancer (CAC) model mice.

Twenty-six C57BL/6 male mice, 6-8 weeks old and weighing 20-25 g, were divided into 4 groups according to the random number table method (each group received different treatments): normal group (treated with olive oil gavage and physiological saline intraperitoneal injection) (n=5), model group [treated with olive oil gavage, azoxymethane (AOM) intraperitoneal injection, and dextran sulfate sodium (DSS) solution drinking treatment)] (n=5), 30 mg group (treated with 30 mg·kg^-1·d^-1 of vitamin K2 gavage, AOM intraperitoneal injection, and DSS solution drinking treatment) (n=8), and 60 mg group (treated with 60 mg·kg^-1·d^-1 of vitamin K2 gavage, AOM intraperitoneal injection, and DSS solution drinking treatment) (n=8). The mice were sacrificed at the end of the 12th week, and the number and length diameter of colon tumors in each group were compared. The expression level of nuclear proliferation antigen (Ki-67) in colon tissues was assessed by immunohistochemistry (IHC), while the levels of MGP protein and Smad1/5 pathway-associated proteins were determined by Western blotting (WB). Additionally, the expression of MGP mRNA was quantified using real-time quantitative PCR (RT-qPCR). According to different treatment methods, colon cancer epithelial cell line SW480 cells were divided into control group [treated with dimethyl sulfoxide (DMSO)], 100 μmol/L group (treated with 100 μ mol/L VitK2), 200 μmol/L group (treated with 200 μ mol/L VitK2), 400 μmol/L group (treated with 400 μ mol/L VitK2), empty vector group (SW480 cells were transfected with empty plasmid) and MGP overexpressing group (SW480 cells were transfected with MGP overexpressing plasmid). After 48 hours of treatment, the expression of MGP protein, changes in the Smad1/5 pathway, and cell proliferation at different time points (24, 48, 72, and 96 hours) after treatment were detected.

All mice in the model group, 30 mg group, and 60 mg group developed colorectal tumors, with a tumorigenesis rate of 100% (17/17). There was no significant difference in the number of colon tumors between the 30 mg and 60 mg groups and the model group (both P>0.05), but the long diameter of tumors in the 30 mg or 60 mg groups was smaller than those in the model group (both P<0.05). There was no significant difference in tumor number or long diameter between the 30 mg and 60 mg groups (both P>0.05). The Ki-67 protein expression levels in the 30 mg and 60 mg groups were both lower than those in the model group (both P<0.05). Meanwhile, the MGP protein expression levels and pSmad1/5 protein expression levels in the 30 mg and 60 mg groups were both higher than those in the model group (all P<0.05). There was no statistically significant difference in MGP mRNA levels between the 30 mg and 60 mg groups and the model group (both P>0.05). Furthermore, there was no statistically significant difference in the expression levels of Ki-67 protein, MGP protein, pSmad1/5 protein, or MGP mRNA between the 30 mg and 60 mg groups (all P>0.05). In the cell experiments, the MGP and pSmad1/5 protein expression levels in the 100 μmol/L group showed no statistically significant difference compared to the control group (both P>0.05). The MGP and pSmad1/5 expression levels in the 200 μmol/L and 400 μmol/L groups were both higher than those in the control group (both P<0.001). After 72 and 96 hours, the cell proliferation capacity in the 200 μmol/L and 400 μmol/L groups was both lower than that in the control group (both P<0.001). The pSmad1/5 protein expression level in the MGP overexpression group was higher than that in the empty vector group (P<0.001). After 24, 48, 72, and 96 hours, the cell proliferation capacity in the MGP overexpression group was lower than that in the empty vector group (all P<0.001).

VitK2 can inhibit the growth of CAC model mice by promoting MGP expression and activating Smad1/5 pathway.

A retrospective analysis was conducted on 36 young stroke patients with carotid artery dissection(CAD) enrolled from the Second Affiliated Hospital of Soochow University from January 2015 to December 2023. According to styloid length (>3 cm) and abnormal angulation, the patients were divided into the Elongated Styloid Process (ESP)-induced CAD group (ESP group, 11 cases) and the non-ESP-induced CAD group (NESP group, 25 cases). The demographic characteristics, clinical manifestations, laboratory index, imaging features, and 1-year follow-up outcomes were compared. 31 male and 5 female patients aged [M(Q₁,Q₃)] 41(36, 44) years were enrolled in the study. 30.6% (11/36) of CAD-related young stroke patients have ESP. The ESP group showed higher rates of head/neck pain (6/11 vs 1/25, P=0.006), and higher levels of creatinine [73.0(59.0,77.0) μmol/L vs 59.0(53.0,66.0) μmol/L, P=0.010] and homocysteine [(18.6±18.2) μmol/L vs (2.4±0.7) μmol/L, P=0.020], but lower levels of admission glucose [5.3(4.7,7.6) mmol/L vs 13.6(9.3,17.3) mmol/L, P<0.001] and fibrinogen [2.8(2.5, 3.5) g/L vs 6.4(5.2,6.8) g/L, P<0.001] than those in the NESP group. In terms of imaging data, the ESP group was mainly characterized by dissecting aneurysm (4/11) and "string-of-pearls" signs (4/11), without double-lumen sign. During the 1-year follow-up, 5 cases in the ESP group achieved favorable dissection repair (5/11), and 1 case developed recurrent cerebral infarction (1/11). ESP screening should be emphasized in young stroke patients with CAD, especially those with hyperhomocysteinemia and head/neck pain symptoms. The treatment should involve a personalized approach combining antithrombotic therapy, endovascular intervention, and styloidectomy to reduce the risk of stroke recurrence.

A 66-year-old male was seen in the First Affiliated Hospital of Zhejiang University School of Medicine in September 2024 due to "memory loss for 2 years and speech difficulty for 1 year". The core manifestations were difficulty in finding words, poor speech fluency, and unclear speech expression. After cognitive assessment, magnetic resonance imaging and β-amyloid positron emission tomography (A β-PET), it was diagnosed as early-onset atypical Alzheimer's disease (AD) with Logopenic variant primary progressive aphasia (lvPPA) subtype. After 9 months of treatment with lencanezumab, the overall cognitive function of the patient was slightly improved, and the language expression was improved. A β-PET reexamination showed that the pathological deposition of amyloid protein was reduced, and no related adverse reactions were observed during the treatment. It suggests that it may have potential safety and efficacy for this type of atypical AD patients.

The 14-year-old child was seen in Peking Union Medical College Hospital on April 17, 2025 with "anemia for 10 years, intermittent fever for 4 years and repeated abdominal pain for more than 1 year". The children suffered from chronic anemia, intermittent abdominal pain with fever, obvious lagging in growth and development, height 3 standard deviations lower than the mean value of people of the same age and sex, and no menstrual cramps. Laboratory tests suggest increased inflammatory indicators,¹⁸F-fluorodeoxyglucose positron emission computed tomography (¹⁸F-FDG PET/CT) showed a mass with abnormally increased metabolism in the mesenteric root. After multidisciplinary consultation, "retroperitoneal mass resection" was performed, and the pathological diagnosis was single-center, mixed Castleman's disease (CD). The child recovered well after surgery, and the inflammatory index dropped to normal. Follow-up until July 16, 2025, the child had menarche and height increased by 2.2 cm compared with that before surgery.

Knee osteoarthritis (KOA) is a common disease with degenerative lesions of articular cartilage as its core, which seriously affects the quality of life of patients. Infrapatellar fat pad (IPFP) plays a key role in the pathological process of KOA. It is not only a mechanical buffer structure of the knee joint, but also an active endocrine and inflammatory regulatory organ. In KOA, IPFP secretes various inflammatory factors and adipokines, which participate in local inflammatory reaction of joints, metabolic disorders and cell senescence, and accelerate cartilage degeneration and pain. This paper systematically combs the pathogenesis of KOA and the anatomical characteristics of IPFP, focuses on explaining the dual mechanism of IPFP in KOA, and reviews new treatment strategies targeting IPFP, aiming at providing a new perspective for the mechanism research and prevention of KOA.

Cerebral amyloid angiopathy (CAA), characterized by the deposition of β-amyloid (A β) in the brain and the wall of small blood vessels, is an important cause of cerebral lobar hemorrhage and vascular cognitive impairment. Recent studies suggest that immune cells have phased and bidirectional regulation of CAA progression. Microglia can participate in peritubular A β clearance and reduce deposition to some extent, but sustained activation can induce inflammation, aggravate vascular damage and be associated with amyloid-related imaging abnormalities. Reactive astrocytic hyperplasia was observed in the early stage of CAA, and its phenotypic transformation and astrocyte-derived apolipoprotein E affected vascular deposition, vascular remodeling and bleeding risk. Edge-associated macrophages, especially perivascular macrophages, not only promote A β clearance, but also mediate cerebrovascular dysfunction through oxidative stress and aging-related mechanisms. In addition, the regulatory effects of peripheral immune cells on blood-brain barrier integrity and vascular inflammation have gradually received attention. Of course, partial immune intervention shows opposite effects in different pathological stages, and its boundary of action and safety still need to be further studied.

Overactive bladder (OAB) is a common chronic disease. In the adult population, the overall prevalence of OAB exceeds 10%, of which the elderly account for about 30%. However, commonly used nerve electrical stimulation therapies such as sacral nerve electrical stimulation are limited in the elderly because of its high surgical difficulty, the possibility of equipment displacement and high cost. This paper reviews the history and mechanism of tibial nerve stimulator, emphasizes the application status of new implantable tibial nerve stimulator in elderly OAB, foreign Revi^TMAnd eCoin^®Its safety and efficacy for elderly patients have been verified in recent clinical studies, and domestic implantable tibial nerve stimulators, such as Streamliner, have also begun to be developed in China. ™ The new implantable tibial nerve stimulation device provides a safe, minimally invasive and highly compliant effective treatment plan for elderly OAB patients with its adaptability advantages such as low power wireless control, simple implantation operation and higher economic accessibility, and has broad clinical application prospects, but its long-term efficacy still needs further verification. With the continuous advancement of technology iteration and evidence-based research, implantable tibial nerve stimulation devices are expected to become an important part of the treatment of elderly OAB, providing new solutions for improving patients' quality of life and alleviating the social medical burden.