Volume 106 · Issue 12 · 2026

The incidence of refractory inner ear disease (RIED) has exhibited an upward trend in recent years, emerging as a significant clinical issue characterized by long-term patient functional impairment and an exacerbated societal burden. However, considerable controversies persist regarding the therapeutic and intervention strategies for RIED. To address these challenges, the "Expert consensus on clinical diagnosis and treatment of refractory inner ear disease (2026 edition)" was jointly developed by the Otology Subdivision of the Chinese Geriatrics Society, the Audiology Group of the Otorhinolaryngology-Head and Neck Surgery Branch of the Chinese Medical Association, the National Clinical Research Center for Otorhinolaryngologic Diseases, the National Key Laboratory of Hearing and Balance, and the China Consortium for RIED. Grounded in the latest evidence-based medicine and clinical practice experience, this consensus adopts a modular format to accentuate key recommendations. It provides comprehensive clinical management guidance encompassing the epidemiology, pathogenesis, diagnosis, intervention strategies, and long-term management of RIED, thereby establishing standardized protocols for clinical practice. This article presents an in-depth interpretation of the developmental background, core principles, and key recommendations of the consensus. It aims to offer precise, systematic, and practical clinical references for healthcare professionals involved in RIED management, ultimately promoting the standardization of RIED diagnosis and treatment in China.

"Clinical practice guidelines for the treatment and prophylaxis of influenza in China (2025 edition)" (hereinafter referred to as "the guideline") were jointly released by the Chinese Thoracic Society and Chinese Society of Infectious Diseases of the Chinese Medical Association. As an influenza guideline developed using evidence-based methodology in China, its key strength lies in providing systematic and actionable recommendations grounded in evidence. This article aims to provide a clinical interpretation of the guidelines, highlighting five major advancements compared with previous consensus documents: methodological innovation, stratified treatment strategies, integration of new evidence on domestically developed innovative drugs, clarification of the therapeutic window and explicit preventive strategies. This interpretation is intended to assist clinicians in thoroughly understanding the core principles and clinical considerations of the guideline, thereby promoting effective implementation.

Pulmonary embolism (PE) is a common and potentially fatal venous thromboembolic disease. Traditional management paradigms, often characterized by insufficient multidisciplinary collaboration, frequently lead to inadequate risk assessment and treatment delays. The pulmonary embolism response team (PERT), a patient-centered and multidisciplinary rapid-response model, has emerged to enhance therapeutic efficiency and promote standardized management. This review systematically elucidates the structural framework, operational mechanisms, and clinical implementation of PERT. Current evidence indicates that PERT effectively optimizes treatment selections for intermediate-high and high risk PE patients through a standardized "rapid activation, risk stratification, and collective decision-making" workflow. This approach has shown positive impacts on reducing in-hospital mortality, minimizing bleeding complications, and shortening the length of hospital stay. With increasing awareness of PE prevention and management, the PERT model is gradually being promoted nationwide in China, with ongoing exploration into leveraging internet-based medical technologies to enhance the treatment capabilities of primary healthcare institutions. Although the establishment of the PERT system remains subject to multifaceted challenges, with the deep integration of emerging technologies such as artificial intelligence and big data, it holds the potential to become the standard paradigm for optimizing PE resource allocation and elevating the overall standard of care.

Fever is the most common symptom of illness in early childhood and the leading cause of pediatric visits. The management of childhood fever extends beyond antipyretic treatment and should emphasize comprehensive assessment throughout the febrile episode, including symptom monitoring, etiological diagnosis, daily care, dietary adjustments, and nutritional supplements. These aspects represent core issues frequently encountered and addressed by both parents and pediatric healthcare professionals. The home is typically the primary setting for fever management. Although the internet provides abundant information on childhood fever for parents and caregivers, its variable quality often leads to parents′ confusion. Concurrently, healthcare providers at all levels must stay abreast of advances in clinical evidence, continuously update diagnostic, therapeutic, and care concepts, and consistently improve the clinical management of childhood fever. Therefore, a multidisciplinary consensus working group comprising pediatric clinicians, clinical pharmacists, nurses, nutrition experts, and child health specialists was formed. Focusing on key and common issues in the holistic management of childhood fever, the expert group developed consensus recommendations based on existing literature and sound clinical practice principles. This consensus aims to provide primary care professionals, junior pediatric medical staff and pharmacists across healthcare institutions, and parents with a systematic knowledge base and practical guidance for the standardized, holistic management of childhood fever throughout the entire process.

Refractory inner ear disease (RIED) encompasses a group of diseases in which pathologic lesions involve both the cochlea and vestibule, disrupting auditory-vestibular conduction pathways and their central projections. Clinically, RIED typically manifests as varying combinations of hearing loss, tinnitus, and vertigo. Despite adherence to standardized treatment protocols recommended by current clinical guidelines, a subset of inner ear diseases remain resistant to therapy and fail to achieve satisfactory outcomes. Recent epidemiological studies from both domestic and international sources indicate an increasing incidence of RIED, which not only compromises patients′ hearing and balance function but also exerts profound effects on quality of life, mental health and social participation. These challenges impose a growing burden on healthcare systems and highlight the urgent need for more effective, evidence-based management strategies. To address these issues, a multidisciplinary expert panel encompassing otolaryngology, audiology, vestibular medicine, public health, and basic science in China has established the "China Consortium for Refractory Inner Ear Diseases" and formulated the "Expert consensus on the diagnosis and treatment of refractory inner ear disease (RIED)". This consensus comprehensively reviews the current understanding of RIED, including its epidemiology, pathogenesis, diagnostic criteria, differential diagnosis, therapeutic interventions, and long-term management. It further provides structured recommendations designed to promote standardization of clinical practice and improve diagnostic accuracy and treatment efficacy for RIED in China.

To investigate the psychological changes in tinnitus patients at different disease stages and associated factors of comorbid somatic symptoms (SS).

This was a cross-sectional study. Tinnitus patients visited the Otolaryngology, Head and Neck Surgery Outpatient Clinic of Peking University People′s Hospital between January 2023 and June 2024 were enrolled. Baseline demographic and clinical data were collected, and tinnitus severity as well as psychological status were evaluated for all participants. All patients completed the Tinnitus Handicap Inventory (THI), Somatic Symptom Self-Rating Scale (SSSRS), Generalized Anxiety Disorder 7-item scale (GAD-7), and Patient Health Questionnaire 9-item(PHQ-9). Tinnitus characteristics and psychological status were analyzed across patients with different disease courses. Participants were stratified into the SS group (score≥30) and the non-SS group based on SSSRS scores. Multivariate logistic regression analysis was performed to identify factors associated with comorbid SS in tinnitus patients.

A total of 691 tinnitus patients aged (44.8±13.1) years were enrolled, including 367 males and 324 females. Among them, 377 patients (54.6%) had chronic tinnitus (>6 months), 265 (38.4%) had comorbid anxiety, 312 (45.2%) had comorbid depression, and 394 (57.0%) had comorbid SS. Compared with the tinnitus patients with a disease duration of ≤3 months and >6 months, those with a disease duration of >3-6 months showed an increasing trend in THI scores, but the difference was not statistically significant (all P>0.017). Multivariate logistic regression analysis revealed that female sex (OR=1.886, 95%CI: 1.267-2.806, P=0.002), THI functional subscale (THI-F) score (OR=1.053, 95%CI: 1.033-1.073, P<0.001), anxiety (OR=2.454, 95%CI: 1.509-3.991, P<0.001), and depression (OR=7.902, 95%CI: 4.886-12.782, P<0.001) were independent associated factors for comorbid SS in tinnitus patients.

Most tinnitus patients suffer from chronic tinnitus and are prone to comorbid psychological problems. Compared with the group with a disease duration of ≤3 months and >6 months, patients with a tinnitus duration of >3-6 months show an increasing trend in THI scores. Female gender, THI-F score, anxiety, and depression are associated factors for comorbid SS in tinnitus patients.

To investigate gender differences in comorbidity profiles among patients with sudden sensorineural hearing loss (SSNHL).

The study was a cross-sectional analysis based on patients with SSNHL enrolled from the Chinese Refractory Inner Ear Disease Cohort, which covered 29 provinces (autonomous regions/municipalities) in China. Patients were consecutively included between July 2024 and November 2025. Demographic characteristics, lifestyle factors, systemic comorbidities, and inner ear comorbidities were collected using a standardized questionnaire. Baseline characteristics and comorbidity distributions were compared between males and females. Multivariable logistic regression models were applied to evaluate the associations between gender and inner ear comorbidities.

A total of 2 844 patients aged 48.7 (37.0, 60.3) years were included, with 1 217 males and 1 627 females. Male patients had significantly higher proportions of smoking, alcohol consumption, and noise exposure, whereas a history of motion sickness was more common in females (P<0.001). Regarding systemic comorbidities, female patients showed higher prevalences of migraine, thyroid dysfunction, cervical spondylosis, and autoimmune diseases, while male patients had higher prevalences of hypertension, coronary heart disease, diabetes mellitus, hyperlipidemia, and cerebrovascular disease (all P<0.05). Multivariable logistic regression analysis demonstrated that, compared with females, males had increased risks of hypertension (OR=2.28, 95%CI: 1.62-3.22), coronary heart disease (OR=3.10, 95%CI: 1.53-6.29), cerebrovascular disease (OR=2.26, 95%CI: 1.15-4.41), and sinusitis (OR=1.59, 95%CI: 1.13-2.22), but lower risks of migraine (OR=0.18, 95%CI: 0.10-0.32), thyroid disease (OR=0.20, 95%CI: 0.09-0.41), cervical spondylosis (OR=0.43, 95%CI: 0.30-0.60), and autoimmune disease (OR=0.34, 95%CI: 0.11-0.90). Regarding inner ear comorbidities, aural fullness (77.7%, 2 189/2 816) and tinnitus (87.1%, 2 454/2 816) were highly prevalent, with no significant differences between males and females (all P>0.05). Age-stratified analysis showed that among patients older than 45 years, males had a significantly lower risk of tinnitus compared with females (OR=0.58, 95%CI: 0.36-0.95).

Gender differences exist in the comorbidity spectrum of patients with SSNHL. Male patients are more likely to be accompanied by hypertension, coronary heart disease, cerebrovascular disease, and sinusitis, whereas female patients are more prone to migraine, thyroid disease, cervical spondylosis, and autoimmune diseases. Among patients older than 45 years, males have a lower risk of tinnitus than females.

To investigate the efficacy of acupuncture as an adjunctive therapy for primary subjective tinnitus and analyze influencing factors of prognosis.

Patients diagnosed with primary subjective tinnitus at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology between March 2024 and October 2025 were enrolled. Participants were divided into an acupuncture group and a control group based on whether they received acupuncture intervention. Changes in Tinnitus Handicap Inventory (THI) scores after treatment and the proportion of patients achieving the minimal clinically important difference (MCID) in THI were compared between the two groups. Key factors influencing tinnitus prognosis and acupuncture efficacy were analyzed using linear and logistic regression.

A total of 134 patients (61 males and 73 females) aged (42.9±11.8) years with primary subjective tinnitus were included. Among them, 74 were assigned to the control group and 60 to the acupuncture group. There were 68 cases of acute tinnitus and 66 of chronic tinnitus. After treatment, the reduction in THI score was greater in the acupuncture group than that in the control group [8.0 (0, 22.0) vs 3.0 (-8.0, 10.0), P=0.003], and a higher proportion of patients in the acupuncture group achieved the THI MCID [40.0% (24/60) vs 21.6% (16/74), P=0.034]. After adjusting for age, sex, body mass index (BMI), extraversion and conscientiousness dimension scores, and baseline tinnitus visual analogue scale (VAS) score in multivariate linear regression analysis, acupuncture intervention remained significantly associated with changes in THI total score after treatment (β=9.58, 95%CI: 1.86-17.31, P=0.015). Multivariate logistic regression analysis of the acupuncture group showed that conscientiousness dimension score (OR=1.15, 95%CI: 1.01-1.33), openness dimension score (OR=1.17, 95%CI: 1.02-1.37), and baseline tinnitus VAS score (OR=1.39, 95%CI: 1.05-1.91) were associated with achieving clinically meaningful improvement in THI.

Acupuncture as an adjunct to conventional treatment can improve tinnitus severity. The therapeutic effect of combined treatment is associated with baseline tinnitus severity and personality dimension scores.

To explore the correlation between cardiac right-to-left shunt (RLS) and clinical characteristics and treatment outcomes in patients with sudden sensorineural hearing loss (SSNHL).

Patients with SSNHL admitted to the Third Affiliated Hospital of Sun Yat-sen University from December 2023 to January 2025 were retrospectively included. They were divided into the RLS-positive group and RLS-negative group according to their RLS status. Clinical characteristics, audiogram types and therapeutic efficacy were compared between the two groups. Meanwhile, differences in the degree of initial hearing loss among patients with different RLS grades in the RLS-positive group were analyzed, and a logistic regression model was used to explore the correlation between RLS and therapeutic efficacy of hearing loss.

A total of 149 patients (75 males and 74 females) aged (45.0±18.0) years were enrolled, with 81 cases in the RLS-positive group and 68 cases in the RLS-negative group. Compared with the RLS-negative group, the RLS-positive group had lower mean age [(41.0±17.5) years vs (50.8±16.5) years, P<0.001], hypertension prevalence [14.8% (12/81) vs 39.7% (27/68)] and fasting blood glucose level [(5.49±1.54) mmol/L vs (6.27±2.78) mmol/L] (all P<0.05), but with a higher initial hearing threshold [(83.5±25.2) dB HL vs (74.4±30.0) dB HL, P=0.038]. There was no statistically significant difference in the distribution of audiogram types between the two groups (P=0.554). The hearing threshold improvement amplitude after treatment in the RLS-positive group was larger than that in the RLS-negative group [27.0 (3.5, 50.5) dB HL vs 13.0 (0, 34.3) dB HL, P=0.013], and the therapeutic effective rate of the RLS-positive group was higher than that of the RLS-negative group [67.9% (55/81) vs 51.5% (35/68), P=0.041]. No statistically significant difference was found in the distribution of hearing loss degree among patients with different RLS grades in the RLS-positive group (P=0.194). Multivariate logistic regression analysis showed that after adjusting for age, mean initial pure tone audiometric threshold, fasting blood glucose level and hypertension status, RLS was not significantly correlated with the therapeutic efficacy of SSNHL (with "ineffective" as the reference: OR=1.458, 95%CI: 0.705-3.015, P=0.309).

Compared with the RLS-negative group, the RLS-positive group has a higher mean initial pure tone audiometric threshold, as well as lower age, hypertension prevalence and fasting blood glucose level. RLS shows no significant correlation with therapeutic efficacy. RLS screening should be emphasized in young patients with SSNHL.

To evaluate the predictive value of machine learning combined with radiomics for treatment response to lenvatinib combined with transarterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma (uHCC).

This retrospective study enrolled 117 uHCC patients treated with lenvatinib-TACE at the First Affiliated Hospital of Wenzhou Medical University from January 2020 to December 2023. Patients were randomly divided into a training set (n=81) and an internal validation set (n=36) at a 7∶3 ratio. An additional 24 uHCC patients treated with lenvatinib-TACE between January and December 2024 were included as an external validation set. The follow-up period concluded in September 2025. Patients were stratified into a non-response group (PD+SD) and a response group (PR) based on therapeutic outcomes. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method, with differences between groups compared via the log-rank test. Additionally, abdominal contrast-enhanced CT features were extracted from uHCC patients, and the top 25 most representative features were selected using the maximum relevance minimum redundancy (mRMR) algorithm. Six machine learning algorithms—multilayer perceptron (MLP), decision tree (DT), random forest (RF), logistic regression (LR), extreme gradient boosting (XGBoost), and support vector machine (SVM)—were employed to develop predictive models based on enhanced CT radiomic features after feature selection and dimensionality reduction. Model performance was evaluated using receiver operating characteristic (ROC) curves and area under the curve (AUC), and the differences in AUC were compared using Delong test. Calibration curves and decision curve analysis (DCA) were used to validate model accuracy and clinical utility, respectively.

The response group consisted of 57 patients [mean age: (60.5±9.8) years; 50 males], while the non-response group comprised 84 patients [mean age: (58.9±13.8) years; 74 males]. The overall median follow-up time was 31.7(25.3,44.8) months. Notably, both OS and PFS were significantly superior in the response group compared to the non-response group (both P<0.05). The MLP model yielded an AUC of 0.856 (95%CI: 0.805-0.906) in the training set, 0.790 (95%CI: 0.641-0.927) in the internal validation set, and 0.836 (95%CI: 0.585-1.000) in the external validation set. In terms of model comparison, the MLP significantly outperformed the DT, RF, and XGBoost models in the training set, and surpassed the DT model in the internal validation set (all P<0.05); however, no statistically significant differences were observed against other models in the external validation set. Notably, the MLP was the only model to demonstrate consistent calibration across all three datasets, and DCA confirmed its superior clinical net benefit.

This study developed six machine learning prediction models based on imaging data, among which the MLP model demonstrated optimal performance in predicting treatment response to the combination therapy of lenvatinib and TACE, enabling effective efficacy prediction and clinical decision-making guidance for uHCC patients.

To translate and culturally adapt the Prodromal Questionnaire-Brief Child Version (PQ-BC) into Chinese and to evaluate its reliability and validity among primary and secondary school students.

Following the Brislin translation model, the PQ-BC was translated, back-translated, and culturally adapted to develop the Chinese version. Using stratified cluster random sampling, students from ten primary and secondary schools across three regions in Jiangsu Province were selected between August and October 2024 to complete the Chinese PQ-BC, the Depression-Anxiety-Stress Scale-21 (DASS-21), and the Strengths and Difficulties Questionnaire (SDQ). Item analysis was performed for the PQ-BC. Structural validity was examined using exploratory and confirmatory factor analyses, and criterion validity was assessed using the DASS-21 and SDQ. Reliability was evaluated by internal consistency and split-half reliability.

All item scores and distress scores of the PQ-BC were significantly positively correlated with their respective total scores (item score: r=0.345-0.668; distress score: r=0.337-0.668, all P<0.001). Exploratory factor analysis supported a one-factor structure for both item and distress scores, explaining 70.2% and 69.5% of the variance, respectively. Both total scores and total distress scores were positively correlated with all factors of DASS-21 and SDQ (except prosocial behavior) (r=0.214-0.587, all P<0.001). Cronbach′s α was 0.930 for symptom scores and 0.938 for distress scores, and split-half reliability coefficients were 0.932 and 0.942, respectively.

The Chinese version of the PQ-BC demonstrates a stable one-factor structure with excellent reliability and validity in primary and secondary school students, supporting its use for early identification and stratified screening of psychotic-like experiences.

This article reports the diagnosis and treatment of a patient with primary cardiac lymphoma with sick sinus syndrome. A 66-year-old woman with repeated dizziness and amaurosis showed sick sinus syndrome on electrocardiogram. The right atrial mass was found 6 weeks after pacemaker implantation, and the postoperative pathology was primary cardiac diffuse large B-cell lymphoma. Primary cardiac lymphoma is rare and atypical in clinical practice, and it is easy to misdiagnose and misdiagnose. This case suggests that patients with sudden and rapidly progressing cardiac conduction system disorders with abnormal cardiac cavity structure should be alert to the possibility of cardiac tumors, so as not to delay the diagnosis.

Refractory sudden deafness (sudden deafness) refers to a clinical phenotype of sudden deafness with poor efficacy after standardized initial treatment. Studies have shown that the diagnosis of refractory sudden deafness tends to be multidimensional and refined, but a unified standard has not yet been formed. Factors such as type of audiogram and timing of treatment may be related to the occurrence of refractory sudden deafness. Rescue therapy mainly included topical glucocorticoid administration and hyperbaric oxygen, but there were still differences in initiation timing, administration mode and dose course. The purpose of this paper is to summarize the diagnostic criteria of refractory sudden deafness, the influencing factors of refractory sudden deafness and the research progress of salvage treatment.

Thoracic electrical impedance tomography (EIT) is a noninvasive dynamic functional imaging technique realized by detecting changes in tissue electrical impedance. In the past 10 years, this technology has been widely used in bedside lung function monitoring in the fields of intensive care, perioperative anesthesia, pediatrics and chronic respiratory diseases. Since the introduction of this technology in 2014, China has gradually established a complete system covering basic research, clinical application and equipment research and development, which has promoted the localization, standardization and multidisciplinary clinical transformation of EIT. This paper systematically combs the unique paths and models of clinical transformation of EIT in China in the past 10 years (2015-2025), and analyzes the clinical application of EIT in different scenarios such as severe disease, anesthesia, and chronic disease. However, we still face challenges such as insufficient technical standardization, limited grassroots promotion, and lack of high-quality evidence-based evidence. In the future, it is necessary to promote multi-center real-world research, the development of artificial intelligence-assisted decision-making system and the integration of multi-modal technologies to promote the standardization and inclusive application of EIT. This paper aims to provide an academic reference based on China's perspective for the standardized application and sustainable development of EIT, and also provide decision-making basis for policymakers.

A 49-year-old male was seen in Guizhou Provincial People's Hospital on February 23, 2020 due to "upper abdominal pain with fever for 4 days, aggravated with dyspnea for 1 day". The patient went to the local hospital 4 days ago because of "abdominal pain with fever without obvious trigger", which was considered as "appendicitis". After anti-infective treatment, there was no significant improvement, and the symptoms worsened and dyspnea occurred. Acutely ill face at admission, body temperature 39.3 ℃, heart rate 119 beats/min, blood pressure 90/50 mmHg (1 mmHg =0.133 kPa), 30 breaths/min, blood oxygen saturation 89%; Grade 2/6 systolic soft murmur was heard from the 2nd to 3rd intercostal margin of the left sternum, and the second heart sound of the pulmonary valve was hyperactive; Total abdominal tenderness, no rebound pain, swelling of left lower limb. Cardiac ultrasound showed atrial septal defect, left and right atrial thrombosis, large strip-shaped embolus riding across the atrial septal defect, and the thrombus dislodged into the right and left ventricles with blood flow (Figure 1, shown by arrows). Total arterial CT angiography showed atrial septal defect and multiple thrombosis in left and right atrium; Multiple embolism of lower abdominal aorta (bifurcation of celiac trunk), celiac trunk, common hepatic artery, splenic artery, left gastric artery, superior mesenteric artery and its branches; Right lobe infarction and splenic infarction; Multiple pulmonary artery embolism (Figures 2-3, indicated by arrows).