Volume 106 · Issue 10 · 2026

Hepatocellular carcinoma (HCC) often presents insidiously, and the majority of patients are diagnosed at an advanced stage, missing the opportunity for curative surgery. In recent years, breakthrough advances in systemic therapy, particularly represented by the combination of immune checkpoint inhibitors (ICI) and antiangiogenic targeted drugs (AATD), have driven a paradigm shift in the treatment modality for advanced HCC. This article elaborates on the definition and theoretical basis of conversion therapy, analyses the strategy for selecting conversion treatment regimens centered on immune-targeted combination therapy, defines the timing and value of sequential surgical therapy following conversion, and demonstrates the significant survival benefits brought by this strategy through multiple clinical study evidences. Evidence indicates that conversion therapy based on immune-targeted combinations followed by sequential surgery has emerged as a novel treatment mode for advanced HCC. Guided by multidisciplinary collaboration and personalized decision-making, it can tangibly improve long-term survival outcomes for patients.

Hepatocellular carcinoma(HCC) is one of the common malignant tumors in China. Most patients are diagnosed at an intermediate or advanced stage, thereby losing the opportunity for curative treatment. This article systematically reviewed the clinical significance, combination strategies, and comparisons with other approaches of hepatic arterial infusion chemotherapy (HAIC) in the conversion therapy of HCC. It highlighted the significant efficacy of HAIC, particularly for patients with massive tumor or those accompanied by vascular tumor thrombus, and emphasized that combination therapies could further enhance the conversion success rate. This review summarized recent advances in HAIC, provided valuable references for clinical practice, and held important implications for improving the prognosis of patients with advanced HCC.

Neoadjuvant radiotherapy is an important strategy for patients with resectable hepatocellular carcinoma (HCC) with high-risk recurrence profiles. In China, HCC is primarily caused by hepatitis virus infection, making it sensitive to radiotherapy. Based on this characteristic, this paper systematically elaborates on the objectives of preoperative neoadjuvant radiotherapy, the applicable patient populations, the technical prerequisites for its combination with surgery, its clinical application advantages, future directions, and proposes a "surgery-oriented" radiotherapy concept. Traditional stereotactic body radiotherapy (SBRT), when used as preoperative therapy for large hepatocellular carcinoma, can easily lead to perhepatic adhesions which increases surgical difficulty and risks. To address this challenge, our team has proposed a patented method for generating a resection-mimicking dose distribution with high-dose radiotherapy for large HCC. This approach optimizes dose distribution and precisely protects the future liver remnant, significantly reducing postoperative recurrence without substantially increasing surgical difficulty. Neoadjuvant radiotherapy offers unique advantages, including high local control rates, durable response, reduced risk of microvascular invasion, low progression rates, and favorable safety profiles, while also providing a time window of liver function recovery for surgery. This paper also explores the strategy selection for combining neoadjuvant radiotherapy with systemic therapy, the timing of surgery, and points out that promoting this technology requires collaborative innovation between hepatobiliary surgeons and radiation oncologists to optimize radiotherapy design and its integration with surgery. Practical experience indicates that neoadjuvant radiotherapy has the potential to improve the prognosis of patients with high-risk resectable HCC, though more high-level clinical evidence is needed to support its use in the future.

To investigate the relationship between long-term cumulative burden of non-high-density lipoprotein cholesterol (Non-HDL-C) and the incidence of cardiovascular disease(CVD).

The study subjects were derived from three prospective sub-cohorts of the China-PAR project. Baseline surveys were carried out in 1998, 2000-2001, and 2007-2008, with follow-up until 2021. A total of 113, 448 participants were included at baseline. Non-HDL-C was calculated as total cholesterol (TC) minus high-density lipoprotein cholesterol (HDL-C). Long-term cumulative exposure to Non-HDL-C was estimated using the time-weighted 10-year cumulative exposure value. According to the cumulative Non-HDL-C exposure levels, participants were categorized into four groups:<34 mmol/L×years, 34~<41 mmol/L×years, 41~<49 mmol/L×years, and≥49 mmol/L×years. Multivariable Cox proportional hazards regression models were used to assess the association between cumulative Non-HDL-C exposure and the risk of incident cardiovascular disease. Restricted cubic spline curves were applied to visualize the exposure-response relationship.

A total of 63, 211 participants were finally included, with an average age of (58.2±11.7) years, including 24, 493 men (38.8%). The results of the multivariable Cox proportional hazards regression analysis showed that for each standard deviation increase in Non-HDL-C cumulative exposure level (7.5 mmol/L×year), the risk of CVD, coronary heart disease, and stroke incidence increased by 8% (HR=1.08, 95%CI: 1.05-1.11), 15% (HR=1.15, 95%CI: 1.06-1.22), and 7% (HR=1.07, 95%CI: 1.04-1.11), respectively. Compared with the group with Non-HDL-C cumulative exposure<34 mmol/L×year, the HRs for CVD, coronary heart disease, and stroke incidence in the group with cumulative exposure≥49 mmol/L×year were 1.33 (95%CI: 1.13-1.57), 2.06 (95%CI: 1.53-2.76), and 1.23 (95%CI: 1.01-1.50), respectively. Subgroup analyses showed that the association between cumulative Non-HDL-C levels and the risk of CVD incidence was more pronounced in individuals under 60 years of age (P for interaction<0.05). In participants younger than 60 years of age, each standard deviation increase in Non-HDL-C cumulative exposure (7.5 mmol/L×year) was associated with a 14% increase in the risk of CVD incidence (HR=1.14, 95%CI: 1.08-1.21), higher than the increase of 5% observed in participants aged 60 years or older (HR=1.05, 95%CI: 1.01-1.08).

High cumulative Non-HDL-C exposure is associated with an increased risk of CVD incidence.

To explore the effect of sodium bicarbonate Ringer′s solution on postoperative acute kidney injury (AKI) in elderly patients undergoing off-pump coronary artery bypass grafting (OPCABG).

The medical records of patients undergoing elective OPCABG at Tianjin Chest Hospital, Tianjin University, between September 2021 and October 2023 were retrospectively reviewed. The inclusion criteria were as follows: age ≥65 years, body mass index (BMI) of 18 to 30 kg/m², and American Society of Anesthesiologists (ASA) physical status class Ⅲ-Ⅳ. Patients were allocated to either the sodium bicarbonate Ringer′s solution group or the compound electrolyte solution group (control group) based on the type of intraoperative crystalloid administered. Potential confounders were adjusted using propensity score matching (PSM) and multivariable logistic regression models. The primary outcome was the incidence of AKI within 7 days postoperatively.

A total of 868 patients aged (69±5) years were included in the final analysis, with 591 males and 277 females. Postoperative AKI occurred in 105 patients (12.1%). After PSM, there were no statistically significant differences in baseline characteristics and intraoperative variables between the two groups (all P>0.05). Multivariable logistic regression analyses demonstrated that, intraoperative use of sodium bicarbonate Ringer′s solution was a protective factor against postoperative AKI following OPCABG (OR=0.52, 95%CI: 0.28-0.97, P=0.040).

Compared with compound electrolyte solution, use of sodium bicarbonate Ringer′s solution during surgery is associated with a lower risk of AKI after OPCABG.

To compare and analyze the efficacy and safety of immune checkpoint inhibitors (ICIs) combined with tyrosine kinase inhibitors (TKIs) as adjuvant therapy after surgery for hepatocellular carcinoma (HCC) with microvascular invasion (MVI).

Patients with HCC accompanied with MVI who underwent R0 liver resection at the First Medical Center of the PLA General Hospital between January 2016 and December 2024 were retrospectively enrolled. The clinicopathological data, surgical details, and follow-up data were recorded. Adverse events after medication were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Recurrence-free survival (RFS) and overall survival (OS) curves were plotted using the Kaplan-Meier method and compared with the Log-rank test. The Cox proportional hazards regression model was used to analyze factors influencing recurrence.

The study included 39 patients in the adjuvant therapy group and 41 patients in the follow-up observation group. There were no significant differences in baseline characteristics between the two groups (all P>0.05). The follow-up time [M(Q₁, Q₃)] was 21.8 (10.9, 50.7) months. The RFS rates at 6, 12, 24, and 36 months in the adjuvant therapy group were 92.3%, 76.0%, 71.2%, and 51.8%, respectively, all higher than those in the follow-up observation group (75.1%, 56.3%, 44.3%, and 16.9%). The median RFS in the adjuvant therapy group was 46.7 months (95%CI:15.19-78.22), significantly better than the 19.33 months (95%CI: 3.22-35.44) in the follow-up observation group (P=0.004). The median OS was not reached in either group(P=0.480). Multivariate Cox analysis showed that postoperative adjuvant therapy (HR=0.46, 95%CI: 0.24-0.89, P=0.020) and liver cirrhosis (HR=2.22, 95%CI: 1.00-4.92, P=0.050) were influencing factors for RFS. In terms of safety, 43.59% (17/39) of patients in the adjuvant therapy group experienced grade 1-4 adverse events, and 15.38% (6/39) experienced grade 3 or higher adverse events, primarily manifested as abnormal liver and kidney function, rash, etc. No treatment-related deaths occurred, and the safety profile was manageable.

For patients with HCC accompanied by MVI, postoperative adjuvant therapy with immunotherapy combined with targeted therapy significantly prolongs recurrence-free survival, reduces the risk of recurrence, and demonstrates a manageable safety profile.

To identify potential clinical subgroups among parents who lost their only child and compare inter-subgroup differences in brain structure and function.

Parents who lost their only child and participated in a psychological assistance program organized by the local civil affairs department in Southern Jiangsu, China, between April 2021 and June 2022 were retrospectively recruited. They were randomly divided into a discovery set and a validation set in a 1∶1 ratio using a random number table. Assessments included the Clinician Administered Post-Traumatic Stress Disorder Scale (CAPS), the 24-item Hamilton Depression Rating Scale (HAMD-24), and the Hamilton Anxiety Rating Scale (HAMA). Seven symptom dimension factors were extracted: re-experiencing, avoidance, hyperarousal, depressive mood, somatic/anxiety, psychic anxiety, and somatic anxiety. Hierarchical clustering was applied in the discovery set to identify clinical subgroups. The stability of this classification was verified in the validation set. Cranial MRI scans were conducted to compare differences in fractional anisotropy (FA) from diffusion tensor imaging, as well as degree centrality (DC) and regional homogeneity (ReHo) from functional MRI among the different subgroups. Pearson correlation analysis was used to assess the correlations between neuroimaging metrics and scale scores.

A total of 154 parents who lost their only child were enrolled, with an average age of (57.6±5.2) years, including 68 males (44.2%), and a mean trauma duration of (15.1±5.1) months. The discovery set and the validation set each comprised 77 participants. Hierarchical clustering and cross-validation consistently identified two stable subgroups. Subgroup A was characterized by core features of traumatic re-experiencing, cognitive avoidance, and depressive mood, while subgroup B was dominated by somatization symptoms and anxiety. Neuroimaging results showed that compared with subgroup B, subgroup A exhibited significantly higher FA values in multiple white matter tracts closely associated with emotion regulation and cognitive processing (P<0.05, corrected with threshold-free cluster enhancement). Compared with subgroup A, subgroup B demonstrated higher DC in the left precentral gyrus (t=-3.02, Gaussian random field-corrected P=0.003) and lower ReHo in the left middle frontal gyrus (t=3.90, Gaussian random field-corrected P=0.001). Correlation analyses indicated that FA values in white matter tracts were positively correlated with total CAPS score, total HAMD-24 score, and specific CAPS factors (avoidance, re-experiencing) (r=0.30-0.36, false discovery rate-corrected P<0.05). DC values in the left precentral gyrus were positively correlated with total HAMA score and the somatic anxiety factor (r=0.32-0.37, false discovery rate-corrected P<0.05).

Parents who lost their only child can be categorized into two clinical subgroups: one dominated by emotional disturbances and the other by somatic anxiety. The observed differences in brain structure and function provide neurobiological evidence for this subgroup classification and may suggest potential targets for precise neuromodulation interventions.

To evaluate the vaccine effectiveness (VE) of the Lanzhou lamb rotavirus vaccine (LLR) against rotavirus gastroenteritis (RVGE) in children using a propensity score-matched (PSM) test-negative case-control design.

Based on electronic health records from medical institutions and the National Immunization Program Information System, demographic information, disease diagnoses, rotavirus pathogen test results, and rotavirus vaccination details (vaccine type, number of doses, dates) were collected for acute gastroenteritis cases aged 2 months to 4 years in Chaoyang District (Beijing), Guangdong Province, and Wuhan City (Hubei Province) from 2020 to 2024. Patients were divided into a case group (rotavirus-positive) and a control group (rotavirus-negative) based on etiological test results, and vaccination proportions were calculated for each group. To reduce effects of confounding factors, a PSM test-negative case-control design was employed. The VE of LLR against different clinical outcomes was calculated using a conditional logistic regression model, and the VE of LLR against healthcare visits for rotavirus infection across different age groups was calculated using a multivariate logistic regression model.

A total of 16 460 children with acute gastroenteritis aged 2 months to 4 years were collected, with an age [M (Q₁, Q₃)] of 1.4 (0.7, 2.7) years, and 9 713 (59.01%) were male. The number of children who received 1, 2, and 3 doses of LLR was 2 391 (14.53%), 894 (5.43%), and 180 (1.09%) cases, respectively. There were 1 799 cases (10.93%) in the case group. Among them, the majority were from Hubei Province (953 cases, 52.97%), with a visiting age of 2-4 years (947 cases, 52.64%), males (1 082 cases, 60.14%), in the outpatient department (1 430 cases, 79.49%), with a visiting month of April (574 cases, 18.73%), and with 0 doses of vaccination (1 523 cases, 84.66%). There were statistically significant differences in province, age, case type, month of visit and dose of vaccination between the case and the control groups (P<0.001). After PSM matching, the VE (95%CI) of 1-dose and 2-dose LLR against the RVGE visits were 55.66% (45.83%-63.71%) and 59.37% (45.48%-69.72%), respectively, and for RVGE hospitalizations were 63.87% (38.96%-78.62%) and 82.95% (58.37%-93.01%), respectively. Multivariate logistic regression models analysis showed that among the RVGE visits, the VE of children aged 2 months to 1 year and 1 to 2 years after one dose of LLR was greater than that of children aged 2-4 years [54.96% (16.42%-78.62%) vs 59.29% (45.69%-69.98%) vs 49.53% (37.22%-59.75%), all P<0.001].

LLR has a good protective effect on children aged 2 months to 4 years. Two doses provide better protection against rotavirus infection, especially for hospitalized patients with RVGE and children under 2 years old.

To determine the prevalence, clinical characteristics, and associated factors of chronic kidney disease-associated pruritus (CKD-aP) among patients undergoing maintenance hemodialysis (MHD).

A multicenter, cross-sectional study was conducted from July to October 2024 via the Jiangsu Provincial Dialysis Information Platform. A total of 39 212 MHD patients were enrolled. CKD-aP was diagnosed if pruritus persisted≥6 weeks after exclusion of other dermatoses, and its severity was graded with the modified Duo pruritus scale. Patients were categorized into mild to moderate pruritus group (1-12 points) and severe pruritus group (>12 points) based on the severity of itching. Demographic, laboratory, and dialysis parameters were collected. Multivariable logistic regression was used to identify independent associated factors, and differences in treatment and comorbidities across pruritus severity groups were compared.

Overall, 3 638 patients were diagnosed with CKD-aP, yielding a prevalence of 9.28%; 985 patients (27.08%, 985/3 638) had severe pruritus. Multivariable analysis showed that elevated corrected serum calcium (OR=16.115, 95%CI: 3.215-81.424), hyperphosphatemia (OR=2.568, 95%CI: 1.072-6.100), and lower body mass index (BMI) (OR=0.892, 95%CI: 0.804-0.991) were independently associated with CKD-aP. The severe pruritus subgroup exhibited significantly higher prevalences of sleep disturbance [71.57% (705/985) vs 28.65% (760/2 653)], cardiovascular disease [38.48% (379/985) vs 28.87% (766/2 653)], and cerebrovascular disease [10.66% (105/985) vs 4.07% (108/2 653)] than the mild-to-moderate subgroup (all P<0.001). Topical emollients (27.30%, 993/3 638) and gabapentin (13.80%, 502/3 638) were the most frequently used antipruritic agents, whereas the κ-opioid receptor agonist nalfurafine hydrochloride was used in only 1.35% (49/3 638) of patients.

Although the prevalence of CKD-aP among MHD patients in Jiangsu Province is relatively low, a considerable proportion suffers from severe pruritus. The occurrence of CKD-aP is related to calcium-phosphorus metabolic disorder and low BMI. Compared with mild-to-moderate pruritus, patients with severe pruritus showed a higher prevalence of sleep disturbances, cardiovascular disease, and cerebrovascular disease.

This paper reports the diagnosis and treatment of a case of microscopic polyangiitis with the first onset of ear symptoms. A 66-year-old female presented with binaural stuffy sensation with hearing loss without obvious trigger, which was ineffective after anti-infection and catheterization. Examination showed severe mixed hearing loss in both ears, tympanic membrane pathology showed severe chronic inflammation with necrotizing vasculitis, positive anti-myeloperoxidase antibody, and the final diagnosis was polyangiitis under active microscope. After treatment with glucocorticoid combined with rituximab for 10 days, air conduction hearing in both ears improved, bone conduction hearing in left ear and right ear improved after 2 and 6 months respectively, and conscious hearing improved significantly after 1 year.

This paper reports the diagnosis and treatment of delayed bladder perforation in a schizophrenic female patient on peritoneal dialysis. A 37-year-old female was admitted to the Central Affiliated Hospital of Shandong First Medical University on February 14, 2025 due to "increased urine output during continuous peritoneal dialysis, accompanied by frequent urination, urgency, poor drainage, and reduced ultrafiltration for 6 days". 15 years of prior schizophrenic disease (oral olanzapine, quetiapine, alprazolam medication). After admission, abdominal CT examination was performed, and it was found that the intra-abdominal segment of the peritoneal dialysis tube penetrated the bladder from the right upper pole of the bladder floor and entered about 88.79 mm. Then, the peritoneal dialysis tube was removed from the bladder under laparoscopy and sutured to the bladder fistula, and the tip of the intra-abdominal segment of the peritoneal dialysis tube was cut off about 2 cm, and anti-infective treatment was given at the same time. After follow-up until July 2025, the patient did not have increased urine output, frequent urination, urgency and decreased ultrafiltration. Tidal peritoneal dialysis was performed, 1.5% and 2.5% low-calcium peritoneal dialysate were alternately administered, the exchange volume was 8 L/d, the perfusion and drainage time were>1 h, the ultrafiltration was 400~600 ml/d, the daily urine volume was 200~400 ml/d, the body weight was 75 kg, there was no edema on the eyelid surface and both lower limbs, no chest tightness, asthma and other symptoms, and he could fall asleep on his back at night.

Aortic stenosis (AS) is one of the most common heart valve diseases in the elderly population. Early screening and accurate diagnosis and treatment are crucial to improve the prognosis of patients. Echocardiography (Echo) is the "gold standard" for diagnosing valve disease, but the traditional method relies heavily on manual measurement and physician experience, which has subjective bias and efficiency problems. In recent years, AI technology has significantly improved the screening efficiency, diagnostic accuracy and treatment decision support capabilities of AS through automated image analysis, multi-modal data integration and the construction of risk prediction models. This paper systematically analyzes the innovative application of AI in the field of cardiac ultrasound, covering screening, diagnosis, treatment and prognosis prediction, and focuses on its technical path to break through the traditional manual experience dependence and subjective error limitation, providing key technical support for building an intelligent cardiac ultrasound diagnosis system.

Primary angle closure glaucoma (PACG) and cataract are common blinding eye diseases in the elderly. Phacoemulsification, cataract extraction and intraocular lens implantation combined with goniotomy (PEI + GSL) has become the main surgical method for the treatment of PACG. Because of the special anatomical structures such as short axis and shallow anterior chamber, large refractive errors are prone to appear after operation. This paper systematically reviewed the related influencing factors of refractive error after PEI + GSL in PACG patients, and clarified that the new generation of intraocular lens calculation formula has better prediction accuracy in patients with short eye axis. At the same time, the uncertainty of refractive status in patients with abnormal suspensory ligament and microphthalmos after operation was pointed out, so as to provide an accurate basis for clinical selection of intraocular lens power and optimize the postoperative visual quality of such patients.

Chinese Medical Journal, Volume 105, Issue 48, December 30, 2025, "Expert Consensus on the Diagnosis and Treatment of von Hippel-Lindau Syndrome in China (2025 Edition)", the table contents corresponding to the columns "11~14 years old", "15~29 years old", "30~64 years old", "≥65 years old" and "Pregnancy" in Table 3 on page 4449 are wrong. Revised Table 3 is shown below. Corrections are hereby made.