Volume 106 · Issue 15 · 2026

Helicobacter pylori (Hp) infection is associated with a wide range of diseases. Bismuth quadruple therapy is currently the first-line regimen for Hp eradication in China. However, potential adverse effects of the acid suppressants, antibiotics, and bismuth agents included in this regimen may increase the risk of adverse events in the elderly and patients with liver dysfunction, renal dysfunction, hypertension, diabetes and other diseases. Moreover, complex drug interactions between eradication therapies and medications for pre-existing conditions further elevate clinical risks. Currently, major domestic and international guidelines generally lack specific recommendations for Hp eradication in these special populations, posing significant challenges in clinical practice. To address this gap, the paper reviewed relevant guidelines on Hp treatment at home and abroad, and systematically summarized the pathophysiological characteristics and potential drug interactions in special populations, including the elderly and those with liver and renal dysfunction, cardio cerebrovascular and metabolic diseases. Based on the latest evidence, individualized treatment strategies, including drug selection, dose adjustment, use of dual therapy and susceptibility-guided precision therapy, were proposed, aiming to provide practical guidance for clinicians.

With the development of critical care techniques, continuous renal replacement therapy (CRRT) has become one of the most important life support methods. It is a key procedure to select and apply prescribed fluids for CRRT correctly, which is helpful to guarantee the performance and effect of CRRT and avoid some adverse complications. Critical Care Medicine Branch of China International Exchange and Promotion Association for Medical and Health Care and the Chinese Cooperation Group of Critical Care Blood Purification (CCG-CCBP) have developed this guideline to improve the CRRT level of related medical personnel, promote the standardization of CRRT, and improve the prognosis of those patients who receive CRRT. This guideline addresses five aspects: common types and components of CRRT prescription solutions, solute loss and replenishment in CRRT, clinical use of CRRT prescription solutions, adjustments to CRRT prescription solutions in special circumstances, and local citrate anticoagulation. It raises 17 clinical questions and uses the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) grading method to assess the quality of evidence and the strength of recommendations, ultimately resulting in 22 recommendations.

To evaluate the predictability of psoas muscle index (PMI) and paraspinal muscle fat infiltration rate (PSM FI%) for mechanical complications (MC) in patients with degenerative scoliosis (DS).

The clinical data of 89 DS patients who underwent corrective surgery in Nanjing Drum Tower Hospital from January 2019 to December 2022 were retrospectively analyzed. According to the presence of MC after corrective surgery, the patients were divided into MC group (n=25) and non-MC group (n=64). MC included proximal junctional kyphosis/failure (PJK/PJF), distal junctional kyphosis/failure (DJK/DJF), rod breakage and implant-related complications. The cross-sectional area (CSA) of psoas muscle and posterior paraspinal muscle and PSM FI% were measured at L₁-L₅ level on preoperative MRI. The PMI was defined as the ratio of the total psoas CSA to height squared (cm²/m²). The PSM FI% and PMI were compared between MC group and non-MC group. In addition, the sagittal spinopelvic parameters were collected as covariates and incorporated into the analysis. The multivariate logistic regression analysis was performed to identify potential risk factors for MC following corrective surgery in patients with DS. The predictive efficacy of PMI and PSM FI% for MC was evaluated with receiver operating characteristic (ROC) curve, decision curve analysis (DCA), and calibration curve.

Of the 89 patients with DS included in this study, there were 19 males and 70 females with a mean age of (62.2±6.6) years, and 25(28.1%) patients experienced MC. The patients in MC group demonstrated lower PMI at all the L₁-L₅ levels and higher PSM FI% at L₁-L₄ when compared with those in the non-MC group (all P<0.05). The area under ROC curve (AUC) of PMI for predicting MC at L₁-L₅ was 0.629, 0.678, 0.725, 0.645 and 0.651, respectively; while the AUC of PSM FI% was 0.608, 0.666, 0.732, 0.609 and 0.592, respectively. Both PMI and PSM FI% showed maximal predictive accuracy at the L₃ level; and the threshold for predicting MC in DS patients following corrective surgery was L₃ PMI<4.38 cm²/m² and L₃ PSM FI%>25.5%, respectively. The multivariate logistic regression analysis indicated that lower L₃ PMI (OR=0.363, 95%CI: 0.200-0.660, P<0.001) and higher L₃ PSM FI% (OR=1.101, 95%CI: 1.032-1.176, P=0.004) were risk factors for MC in DS patients following corrective surgery. The combination of L₃ PMI and L₃ PSM FI% showed better predictability for MC in DS patients following corrective surgery with an AUC of 0.848 (sensitivity: 80.0%, specificity: 81.3%).

The low PMI and high PSM FI% are risk factors of MC following corrective surgery in patients with DS. The combination of PMI and PSM FI% shows better predictive accuracy in MC in patients with DS after corrective surgery than individual parameter.

To analyze reflux, esophageal motility, and psychological characteristics of patients with gastroesophageal reflux disease (GERD)-related chest pain and the association with chest pain symptom.

The patients with GERD who underwent 24-hour impedance-pH monitoring and high-resolution esophageal manometry at Peking University Third Hospital from July 2016 to April 2024 were retrospectively included. The psychometric scale, reflux monitoring and esophageal manometry were collected. According to the presence of chest pain, the patients were divided into chest pain group (with chest pain symptom) and non-chest pain group. The reflux, esophageal motility and psychological characteristics were compared between the two groups. Correlation analysis was used to identify the related characteristics of chest pain, and multivariate logistic regression model was used to analyze the risk factors for chest pain symptom.

A total of 272 patients with GERD were included, comprising 175 males and 97 females, with a median age[M (Q₁, Q₃)] of 49 (38, 58) years. There were 153 cases in the chest pain group and 119 cases in the non-chest pain group. The chest pain group exhibited a lower prevalence of hiatal hernia [17.6% (27/153) vs 37.8% (45/119)] and lower esophageal acid exposure time (AET) [2.0% (0.6%, 4.7%) vs 4.3% (1.1%, 8.2%)], compared to the non-chest pain group (all P<0.001). The chest pain group demonstrated significantly higher scores on the Symptom Checklist-90 (SCL-90) [133 (112, 173) vs 108 (99, 134) scores, P<0.001], Self-rating Anxiety Scale (SAS) [44 (38, 49) vs 39 (31, 45) scores, P<0.001], and Self-rating Depression Scale (SDS) [48 (38, 57) vs 43 (34, 54) scores, P=0.014], compared to the non-chest pain group. The occurrence of chest pain showed positive correlations with SAS (r=0.274), SDS (r=0.134), and SCL-90 (r=0.369)scores, whereas negative correlations were observed with hiatal hernia (r=-0.227) and AET (r=-0.215) (all P<0.05). Multivariate logistic regression analysis identified elevated SCL-90 score (OR=1.02, 95%CI: 1.01-1.03) and SAS score (OR=1.05, 95%CI: 1.01-1.10) as the risk factors for GERD-related chest pain.

Compared with GERD patients without chest pain, those with chest pain had a lower incidence of esophageal hiatal hernia, lower AET, and increased mental and psychological abnormalities. Elevated SCL-90 and SAS scores were identified as the risk factors for GERD-related chest pain.

To investigate the association of Toll-like receptor 5 (TLR5) gene polymorphisms with the clinical efficacy of ustekinumab (UST) in the treatment of Crohn′s disease (CD) patients.

The patients with active CD who received UST treatment were retrospectively recruited from the Department of Gastroenterology, the Second Affiliated Hospital of Wenzhou Medical University between January 2022 and April 2025. The loci rs5744168 and rs5744174 in TLR5 gene were genotyped by multiplex polymerase chain reaction-ligase detection reaction technique. The clinical response of CD patients was evaluated by Harvey-Bradshaw index (HBI) at week 8 of follow-up. The patients were divided into the response group (a decline of HBI≥ 3 points compared with week 0) and the non-response group. The mucosal healing was assessed by the Simplified Endoscopic Score for Crohn′s disease (SES-CD) at week 32 of UST treatment. The patients were divided into the mucosal healing group (SES-CD≤2 points or absence of mucosal ulcerations) and the mucosal non-healing group. The distribution differences of TLR5 gene polymorphism were compared between the response group and the non-response group, as well as between the mucosal healing group and the mucosal non-healing group. The genotypes or alleles with distribution differences were included into unconditional logistic regression models to investigate the association between the gene polymorphisms of TLR5 and the clinical efficacy of UST treatment in CD patients.

A total of 198 CD patients were included (133 males, 65 females), with age of (32±12) years. There were 117 cases in the response group and 81 cases in the non-response group at week 8 of UST treatment. The homozygous variant genotype (GG) [1.7% (2/117) vs 11.1% (9/81), corrected P=0.024] and variant allele (G) [15.8% (37/234) vs 27.8% (45/162), corrected P=0.008] of locus rs5744174 in the response group were less frequent than those in the non-response group. The homozygous variant genotype (GG) (OR=0.17, 95%CI: 0.04-0.83, P=0.029) and variant allele (G) (OR=0.51, 95%CI: 0.31-0.85, P=0.010) of locus rs5744174 were shown to be associated with the clinical response at week 8. There were 79 cases in the mucosal healing group and 119 cases in the mucosal non-healing group at week 32 of UST treatment. The frequency of variant genotype (GA+AA) [15.2% (12/79) vs 1.7% (2/119), corrected P<0.001] and the frequency of variant allele (A) [9.5% (15/158) vs 0.8% (2/238), corrected P<0.001] of locus rs5744168 in mucosal healing group were higher than those in the mucosal non-healing group. The variant genotype (GA+AA) (OR=8.94, 95%CI: 1.88-42.50, P=0.006) and variant allele (A) (OR=9.54, 95%CI: 2.09-43.66, P=0.004) of locus rs5744168 were found to be related with the mucosal healing at week 32.

Among the patients with active CD receiving UST treatment, the variation of locus rs5744174 in TLR5 gene may be associated with a reduced clinical response rate at week 8. However, the variation of locus rs5744168 may be linked to an increased mucosal healing rate at week 32.

To compare the clinical outcomes of modified full-endoscopic foraminotomy versus conventional foraminotomy in the treatment of lumbar foraminal stenosis.

A retrospective analysis was conducted on the clinical data of patients who underwent uniportal full-endoscopic foraminotomy for foraminal stenosis at Beijing Friendship Hospital between January 2022 and December 2023. The patients were divided into two groups based on whether sublaminar resection of the superior vertebral lamina was performed: the modified group (superior articular process resection combined with ventral sublaminar decompression of the superior vertebral lamina) and the conventional group (superior articular process resection alone). The clinical data were collected for both groups, included age, gender, body mass index (BMI), stenotic segment, and stenosis grade. The visual analog scale (VAS) for low back pain and leg pain were recorded preoperatively and at 1 week, 6 months, 1 year postoperatively. Clinical outcomes at 1 year after the operation were evaluated using the modified MacNab criteria. Perioperative complications and the rate of reoperation within one year were recorded. The foraminal area before and after surgery was compared between the two groups using sagittal CT reconstruction.

A total of 72 patients were included in this study, with 38 in the traditional group and 34 in the modified group. There was no statistically significant differences between the two groups in terms of age, gender, BMI, stenotic level, or grade of stenosis (all P>0.05). No significant differences were observed in the VAS scores for low back pain between the two groups preoperatively or at 1 week, 6 months, 1 year postoperatively (all P>0.05). There was no significant difference in preoperative leg pain VAS scores between the two groups (P>0.05). The modified group demonstrated significantly lower postoperative VAS scores for lower limb pain compared to the traditional group at all follow-up time points: at 1 week [(1.91±0.57) vs (2.10±0.61) points, P=0.004], at 6 months [(1.35±0.95) vs (2.05±0.61) points, P<0.001], and at 1 year [(0.85±0.70) vs (1.55±0.98) points, P=0.029]. According to the modified MacNab criteria, the excellent-to-good rate was 91.2% (31/34) in the modified group and it was 86.8% (33/38) in the traditional group (P=0.559). The incidence of perioperative complications was comparable between the modified group (2.9%, 1/34) and the traditional group (5.3%, 2/38) (P=0.623). The foraminal area was significantly enlarged in both groups postoperatively. The modified group exhibited a significantly larger postoperative foraminal area [(181.4±9.6) mm²] compared to the traditional group [(165.5±10.1) mm²) (P<0.001).

Full-endoscopic modified transforaminal decompression provides more extensive decompression and better improvement in leg pain symptoms compared to traditional transforaminal endoscopic decompression in patients with lumbar foraminal stenosis.

To explore the risk factors and construct a prediction model for heart failure with preserved ejection fraction (HFpEF) after percutaneous coronary intervention (PCI) in patients with type 2 diabetes mellitus (T2DM) and coronary heart disease(CHD).

A retrospective analysis was conducted on the clinical data of 210 patients with T2DM complicated with CHD who underwent PCI at Tianjin Medical University Chu Hsien-I Memorial Hospital from January 2021 to June 2024. Among them, 136 were males and 74 were females, with the age of (66.4±9.1) years. Patients were divided into a training set and a validation set at a ratio of 7∶3 using the random number generator built into R software. Based on the occurrence of HFpEF within 12 months after PCI, patients in the training set were further categorized into the HFpEF group and the non-HFpEF group. Differences between the two groups were compared. The least absolute shrinkage and selection operator (LASSO) regression analysis and multivariate logistic regression models were used to screen variables, and a nomogram of the prediction model was plotted. The area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA) were adopted to evaluate the predictive ability, calibration degree, and clinical applicability of the model.

The training set included 147 patients, with 38 in the HFpEF group and 109 in the non-HFpEF group. In the training set, patients in the HFpEF group had higher values than those in the non-HFpEF group in terms of age, body mass index (BMI), duration of diabetes, fasting blood glucose, glycosylated hemoglobin (HbA1c), triglyceride levels, triglyceride-glucose (TyG) index, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and the ratio of mitral early diastolic flow velocity(E) to mitral annular early diastolic velocity(e′). Conversely, they exhibited lower values in estimated glomerular filtration rate (eGFR), left ventricular ejection fraction (LVEF), the proportion of complete revascularization, and the proportion of sodium-glucose cotransporter 2 inhibitor usage (all P<0.05). LASSO regression analysis screened out 8 variables, including age, BMI, TyG index, HbA1c, Ln(NT-proBNP), LVEF, E/e′ ratio, and eGFR. Multivariate logistic regression analysis showed that advanced age (OR=1.070, 95%CI: 1.011-1.133), elevated TyG index (OR=8.560, 95%CI: 2.581-28.391), elevated Ln(NT-proBNP) (OR=3.880, 95%CI: 1.959-7.684), and elevated E/e′ ratio (OR=1.480, 95%CI: 1.181-1.854) were risk factors for HFpEF after PCI in patients with T2DM complicated with CHD. A nomogram was constructed using the above parameters. In the training set, the AUC of the prediction model for HFpEF after PCI in patients with T2DM complicated with CHD was 0.886 (95%CI: 0.831-0.941), with a sensitivity of 84.2% and a specificity of 82.6%. In the validation set, the AUC was 0.871 (95%CI: 0.782-0.960), with the sensitivity of 81.3% and the specificity of 80.9%. The Hosmer-Lemeshow goodness-of-fit test indicated good calibration in both the training cohort (χ²=6.832, P=0.554) and the validation set (χ²=5.127, P=0.744). DCA demonstrated that the model achieved a high clinical net benefit when the threshold probability ranged from 10% to 90%.

Advanced age, elevated TyG index, elevated Ln(NT-proBNP), and elevated E/e′ ratio are risk factors for HFpEF in patients with T2DM complicated by CHD after PCI. The nomogram of the prediction model constructed based on these factors can intuitively evaluate the risk of HFpEF in patients with T2DM complicated by CHD after PCI.

To investigate the differences in imaging and clinical efficacy between simple decompression and short-segment internal fixation in the treatment of patients with degenerative scoliosis accompanied by lumbar spinal stenosis with a coronal Cobb angle<20°.

A retrospective analysis was conducted on 80 patients diagnosed with degenerative scoliosis complicated by coronal deformity who were admitted to the Department of Spinal Surgery, Tianjin Union Medical Center, between January 2019 and October 2024. According to the surgical approaches, the patients were divided into two groups: the short-segment fixation group (fixation segments≤3) and the simple decompression group (1-2 segments decompressed). For both groups, the following parameters were recorded respectively: gender, age, disease duration, operation time, intraoperative blood loss, length of hospital stay, surgical expenses, American Society of Anesthesiologists (ASA) score, preoperative and postoperative visual analog scale (VAS) scores for low back pain and leg pain, Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) low back pain score, intraoperative complications, as well as preoperative and postoperative spinopelvic parameters. The spinopelvic parameters included coronal Cobb angle, sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Surgical complications were recorded too, included wound infection, cerebrospinal fluid leakage, pneumonia, cardio-cerebrovascular events, and junctional fusion failure.

A total of 80 patients were enrolled, including 45 males and 35 females, with an age of (65.4±8.1) years. There were no significant differences in age, gender, body mass index (BMI), or ASA scores between the two groups before the operation (all P>0.05). The short-segment fixation group exhibited significantly longer operation time, greater intraoperative blood loss, more intraoperative fluoroscopy times, and higher total hospitalization costs compared with the simple decompression group (all P<0.05). At the 1-year follow-up, the low back pain VAS-B score, leg pain VAS-L score, JOA score, and ODI were significantly improved in both groups compared with preoperative values (all P<0.001). At the 1-year follow-up, the VAS-B score was (2.2±0.7) points in the short-segment group and (2.9±1.1) points in the simple decompression group (P<0.001), whereas no significant intergroup differences were observed in VAS-L, JOA score, or ODI index (all P>0.05). Compared with preoperative values, at 1 year postoperatively, the short-segment group showed decreased SVA and increased SS, LL, and PT (all P<0.001), while the simple decompression group showed decreased SVA and significantly increased PT and SS (all P<0.001). At the 1-year follow-up, the TK value was 21.8°±9.9° and 29.3°±10.8° in the short-segment group and the simple decompression group, respectively, and the PT values was 22.4°±3.8° and 26.8°±5.9°, respectively (both P<0.001), whereas no significant differences was detected in SS, PI, or LL between the two groups (all P>0.05). There was no significant differences in incidence of complication between the two groups (P=0.134).

The clinical efficacy of simple decompression for degenerative scoliosis accompanied by lumbar spinal stenosis with a coronal Cobb angle<20° is similar to that of short-segment internal fixation. And simple decompression, with its shorter operative time and less blood loss, serves as a viable alternative for patients who wish to minimize surgical trauma or who have significant comorbidities.

To investigate the effect and underlying mechanism by which taurocholic acid (TCA) promotes colorectal cancer liver metastasis (CRLM) through regulation of neutrophil extracellular trap (NET) formation.

A total of 20 CRLM patients and 20 non-metastatic colorectal cancer (non-mCRC) patients admitted to Qilu Hospital of Shandong University from 2021 to 2022 were retrospectively included. The age of the CRLM patients was (57±12) years, including 11 males and 9 females; the age of the non-mCRC patients was (60±9) years, including 15 males and 5 females. Non-targeted metabolomics was employed to identify differential serum metabolites associated with liver metastasis, and the distinguish efficacy of TCA was evaluated by receiver operating characteristic (ROC) curve analysis. Neutrophils from healthy donors were isolated by density gradient centrifugation. The differentiated HL-60 (dHL-60) model was established by inducing the acute promyelocytic leukemia cell line HL-60 to differentiate into neutrophil-like cells with all-trans retinoic acid (ATRA). The expression characteristics of carcinoembryonic antigen-related cell adhesion molecule 8 (CD66b) and integrin subunit alpha M (CD11b) were detected by flow cytometry. The cell morphology and the proportion of live cells were assessed respectively by wright-giemsa staining and trypan blue staining. In neutrophils and dHL-60 models, cells were divided into a negative control group, a phorbol 12-myristate 13-acetate (PMA, 0.5 μmol/L) positive control group and different concentrations of TCA treatment groups (0.01, 0.1, 1, 10 and 100 μmol/L). The formation of the NET reticular structure after stimulation was observed by Sytox Green staining, and the content of double-stranded deoxyribonucleic acid (ds-DNA) released after stimulation was quantitatively evaluated by PicoGreen. Western blotting was used to detect the expression levels of p44/42 mitogen-activated protein kinase (p44/42 MAPK) and its phosphorylated form (p-p44/42 MAPK), mammalian target of rapamycin (mTOR) and its phosphorylated form (p-mTOR), and peptidylarginine deiminase 4 (PAD4) in dHL-60 following stimulation. NET induced by TCA were divided into a control group, a low-dose NET group (0.1 μg/ml) and a high-dose NET group (0.3 μg/ml) according to dose, and co-cultured respectively with colorectal cancer (CRC) cell lines DLD1 and HCT116. Transwell assay was used to analyze the effect of TCA-induced NET on the migration behavior of CRC cells. The expression levels of epithelial cadherin (E-cadherin), neural cadherin (N-cadherin), and vascular endothelial growth factor A (VEGFA) were detected by Western blotting in CRC cells after co-culture. Comparisons of measurement data between groups were performed using the independent samples t-test, Mann-Whitney U test, and one-way ANOVA. Comparisons of enumeration data between groups were performed using the χ² test or Fisher′s exact test.

The relative abundance of 64 metabolites, including TCA [M (Q₁, Q₃)] [4.445 (1.669, 9.579) vs 0.956 (0.649, 1.372), P<0.01], in the serum metabolic profile of CRLM patients was higher than that of non-mCRC patients (all P<0.05), while the relative abundance of 27 metabolites was lower than that of non-mCRC patients (all P<0.05). In the ROC analysis distinguishing the 2 sample groups, TCA achieved an area under the curve (AUC) of 0.873 (95%CI: 0.741-0.984). In cell identification, both peripheral blood neutrophils and dHL-60 models displayed typical neutrophil morphology: nuclear lobulation and cytoplasm rich in fine neutral granules; the positive rates of CD66b/CD11b were>90%, and the cell viability was>90%. In vitro stimulation of peripheral blood neutrophils for 1 h or 3 h, when the TCA stimulation concentration was greater than 0.01 μmol/L, the formation of NET was more than that of the negative control group (all P<0.05). After intervention of dHL-60 for 4 h and 6 h, when the TCA stimulation concentration was greater than 0.1 μmol/L, the NET reticular structure was more than that of the negative control (all P<0.05). When the TCA stimulation concentration was greater than 10 μmol/L, the ds-DNA release was higher than that of the negative control group (P<0.001). The expression levels of p44/42 MAPK, p-p44/42 MAPK, mTOR, p-mTOR, and PAD4 in the TCA treatment group were higher than those in the negative control group (P<0.001). In co-culture experiments of NET and CRC cells, after high-dose NET treatment of DLD1 cells, the expression of E-cadherin was lower than that of the control group (P<0.001). After high and low-dose NET treatment of HCT116 cells, the expression of E-cadherin was lower than that of the control group (both P<0.001). In both CRC cell lines, after high and low-doses of NET intervention, the expression of N-cadherin and VEGFA was higher than that of the control group (all P<0.001), and their migration and invasion abilities were higher than those of the control group (all P<0.001).

CRLM patients exhibit distinct serum metabolic profiles, among which high-abundance TCA can induce NET release and thereby promote CRC cell metastasis. This process is associated with the activation of the p44/42 MAPK/mTOR signaling pathways in neutrophils and the epithelial-mesenchymal transition in CRC cells.

A retrospective analysis was conducted on the data of 9 female patients with bladder urothelial carcinoma who underwent robot-assisted radical cystectomy and transvaginal-assisted total intracavitary orthotopic neobladder surgery in the Department of Urology, the Second Hospital of Tianjin Medical University from January 2022 to August 2025. Perioperative indicators (overall operation time, neobladder construction time, intraoperative blood loss, and recovery time of intestinal function) were observed postoperatively. The National Aeronautics and Space Administration-Task Load Index (NASA-TLX) score of the chief surgeon was evaluated and the learning curve was drawn using the cumulative sum (CUSUM) method. Postoperative complications within 30 days (using the Clavien-Dindo classification) and the recovery of urinary control function at 1, 6, and 12 months after surgery were followed up. The tumor control and other indicators were evaluated every 3 months within 2 years and every 6 months from the third year after surgery. The age of patients was (51.3±11.0) years, body mass index was (19.5±4.2) kg/m², and the American Society of Anesthesiologists score was 1-2 points. The overall operation time was (342.5±58.3) min, the neobladder construction time was (121.7±22.6) min, the intraoperative blood loss was (150±50) ml, the time to first postoperative exhaust was (1.74±0.63) d, and the NASA-TLX score of the chief surgeon was (66.3±5.5) points. The CUSUM learning curve of neobladder construction time and NASA-TLX score was divided into the learning stage (cases 1-5) and the proficient stage (cases 6-9). Four patients had early postoperative complications (within 30 days after surgery), all of which were Clavien-Dindo grade I-II. At 6 months after surgery, 8 patients had complete dryness during the day and night, and 1 patient had chronic urinary retention. The prognosis was good, with no tumor recurrence or metastasis. The cancer-specific survival (CSS) was 100%. In this study, the transvaginal natural orifice-assisted total intracavitary orthotopic neobladder surgery showed a promising clinical application prospect. The preliminary results indicated that this technique was feasible, had a short learning curve, and had good short-term tumor control and urinary control recovery effects.

To explore the efficacy of rituximab in treating patients with EB virus-related hemophagocytic syndrome (EBV-HLH) caused by B lymphocyte infection. A retrospective analysis was conducted on the data of patients diagnosed with EBV-HLH, without hematopoietic stem cell transplantation and receiving rituximab treatment at Beijing Friendship Hospital, Capital Medical University from November 2021 to January 2025. All patients received treatment with a regimen containing rituximab, such as the R-DEP regimen (rituximab+liposomal doxorubicin+etoposide+methylprednisolone), the R+HLH-94 regimen (rituximab+dexamethasone+etoposide+cyclosporine), the R regimen (rituximab), and the R+P-Gemox regimen (rituximab+gemcitabine+oxaliplatin). Follow-up was conducted until August 2025 or until the patients′ death to analyze the related efficacy. A total of 20 patients with EBV-HLH who received rituximab-containing regimens were enrolled. There were 11 males and 9 females, with a median age of 40 (range 5-70) years. There were 12, 5, 2, and 1 cases receiving the R-DEP, R, R+HLH-94, and R+P-Gemox regimens, respectively. The median EBV-DNA load in peripheral blood mononuclear cells before treatment was 7 000 (range 590-240 000) copies/ml. The median follow-up time [M (Q₁, Q₃)] was 15 (6, 24) months, the median survival time was 19 (7, 27) months, and 18 patients survived. The overall disease remission rate after treatment was 95% (19/20), and EBV-DNA was negative in 17 patients. For patients with B lymphocyte infection-related EBV-HLH, early application of a regimen centered on rituximab can effectively eliminate the virus, induce clinical remission, and improve the survival prognosis of patients.

Clinical data were retrospectively collected from 13 children with type 2 neuronal ceroid lipofuscinosis (CLN2) who underwent genetic testing for definitive diagnosis and were followed up at the Chinese PLA General Hospital from January 2018 to December 2023. The clinical features, disease progression, and prognosis were analyzed. The age at onset was [M(Q₁, Q₃)] 3.7 (3.2, 4.5) years, including 7 males and 6 females. The follow-up was conducted once every 3 months during the first 2 years after diagnosis, and once every 6 months starting from the 3rd year, with the last follow-up until December 2025. All patients presented with epilepsy as the initial manifestation, of whom 8 patients had myoclonic seizures. Psychomotor regression occurred in 10 patients shortly after seizure onset. Tripeptidyl peptidase 1 (TPP1) activity was below the normal reference range in all patients, and all harbored biallelic pathogenic or likely pathogenic variants in the TPP1 gene. Brain magnetic resonance imaging revealed cerebellar atrophy in all cases, and electroencephalography demonstrated generalized abnormalities in all patients. Disease progression exhibited relatively distinct stage-wise features. Within>1-2 years of onset, eleven patients developed ataxia and 10 experienced language regression. Within>2-3 years, ten patients had lost independent ambulation and 9 had lost language function. Within>3-5 years, all patients lost motor and language abilities, and 10 developed severe dysphagia. Five patients died during follow-up. In conclusion, CLN2 typically presents in early childhood with epilepsy as the predominant initial manifestation, followed by progressive neurofunctional decline and cerebellar atrophy. Markedly reduced TPP1 activity together with pathogenic TPP1 variants supports the diagnosis.

This article reports two adult patients, both with fever and lymph node enlargement as the main manifestation, who visited Beijing Friendship Hospital affiliated to Capital Medical University on August 24, 2023 and November 23, 2023, respectively. After admission, the relevant laboratory and imaging examinations were completed to meet the diagnostic criteria of hemophagocytic syndrome [fever, cytopenia, hemophagic phenomenon seen in bone marrow cytology, elevated ferritin, decreased natural killer (NK) cell activity, elevated soluble CD25, and splenomegaly]. Positron emission tomography-computed tomography (PET/CT) showed increased metabolism of multiple lymph nodes in the whole body. The pathological results of lymph node biopsy were consistent with Hodgkin's lymphoma, and it was accompanied by Epstein-Barr virus (EBV) infection. After admission to hospital to control disease progression, chemotherapy was performed for Hodgkin's lymphoma. PET/CT assessment after multiple courses of chemotherapy suggested that the lymphoma was in remission, but there were still repeated hemophagic symptoms and EBV-DNA continued to be expressed at a high load. The patient's EBV-infected lymphocyte type was examined, and it was found that the patient's EBV was mainly infected with T/NK cells, and the bone marrow biopsy of one patient was positive for EBV-encoded small RNA (EBER). Two patients were finally diagnosed as Hodgkin's lymphoma with chronic active Epstein-Barr virus disease (CAEBVD), and one patient was treated with allogeneic hematopoietic stem cell transplantation (allo-HSCT). After transplantation, the patient's condition was stable for 18 months (July 5, 2025). Another patient gave up the transplantation and chose to return to the local hospital for treatment. The condition recurred many times and was lost to follow-up in April 2025. The above cases suggest that the effect of chemotherapy alone is limited in patients with Hodgkin's lymphoma with persistent EBV infection. Early identification of CAEBVD and timely allo-HSCT can help improve the prognosis.

A 45-year-old male was seen in Beijing Friendship Hospital affiliated to Capital Medical University on August 27, 2018 due to "multiple purple-red hydroherpes on the face, limbs and trunk for 4 months". The patient had multiple dark purple-red rash throughout his body. Blood routine showed elevated white blood cells; Skin pathology showed positive CD1a, S-100, Langerin, Ki-67 (80% +), CD33, CD68, CD163; Bone scan showed local bone destruction of cranial plate; Bone marrow examination showed blasts accounted for 56%, and Auer bodies were seen; Cytogenetic and molecular tests confirmed the presence of trisomy 8 and BRAF in skin and bone marrow tissues^G464VKRAS^A146TMutations. The final diagnosis was multisystem Langerhans histiocytosis (LCH) and acute myeloid leukemia (AML). After one course of induction therapy with DA regimen (daunorubicin + cytarabine) combined with sorafenib, the rash decreased, but AML was poorly controlled (bone marrow blasts rose to 70%), and the patient died of AML progression in January 2019. This patient suggests that LCH can occur simultaneously with myeloid tumors and may have a common clonal origin. We should be alert to the possibility of hematological malignancies when encountering this skin lesion in clinic.

Xenogeneic lung transplantation is a potential solution to the shortage of allogeneic lung donors in end-stage lung disease. Because of the complex anatomical structure, high immunogenicity and special physiological environment, lung is faced with particularly prominent biological problems in xenotransplantation. At present, the core challenges in this field mainly involve immune rejection, as well as the closely related coagulation dysfunction, inflammatory activation and zoonosis risk. In response to the above challenges, the construction of multiple gene editing donor pigs (such as the combined knockout of GGTA1/CMAH/β 4GalNT2 antigen gene and transfer into human complement regulatory protein, coagulation factor, etc.) has become the mainstream strategy to overcome hyperacute and acute humoral rejection; At the same time, for macrophages, natural killer cells and T cell-mediated cellular immune rejection, emerging gene modification strategies [such as expression of humanized integrin-related protein (CD47), human leukocyte antigen, etc.] also show great potential in regulating immune response. Future research will focus on more accurate multi-gene modified pigs, bioengineered lungs constructed by decellularized lung scaffolds, and blastocyst complementary technology to cultivate humanized lungs. These breakthroughs are expected to jointly promote xenogeneic lung transplantation from experimental research to clinical transformation.

The treatment of abdominal pain-related intestinal-brain interaction abnormalities (AP-DGBI) in children and adolescents needs to be based on the comprehensive biological-psychological-social medical model and adopt multi-dimensional and individualized intervention strategies. In non-drug therapy, soluble dietary fiber and probiotics showed certain symptom improvement effect; Psychotherapy represented by intestinal directed hypnotherapy and cognitive behavioral therapy (CBT) has been highly recommended by international guidelines; Non-invasive neuromodulation techniques such as transcutaneous electrical nerve stimulation (PENFS) have also shown application potential. In terms of drug therapy, antispasmodics and some antihistamines are commonly used choices, and the efficacy and safety of neuromodulators (such as amitriptyline) still need to be further verified by large sample high-quality studies. This article reviews the above treatment modalities to improve the level of clinical practice.

Micropuberty is a transient activation stage of hypothalamus-pituitary-gonad axis after birth, which has important physiological significance for the development of reproductive organs, the establishment of fertility and the development of neurobehavior. Changes in hormone levels during this period provide a critical window for the early identification of congenital hypogonadotropic hypogonadism (CHH) and primary hypogonadism. The study found that for male CHH children with minimal puberty loss due to congenital diseases, the use of gonadotropin treatment in infancy can make them partially "reappear", but their long-term efficacy and treatment plan need further observation and optimization. This article reviews the clinical problems associated with micropuberty and emphasizes the importance of this physiological stage.

The patient, a 36-year-old female, was seen in the Second Hospital of Lanzhou University on September 5, 2025 mainly because she "found multiple subcutaneous masses all over her body for 2 months, cough with fever for 10 days". Two months ago, a subcutaneous mass, about the size of an egg, appeared on the anterior side of the patient's right thigh, and there was no redness, swelling, ulceration and tenderness on the local skin. One month ago, the patient developed multiple subcutaneous masses in the trunk and limbs. The patient experienced cough and fever 10 days before admission, with a maximum body temperature of 38 ℃. During the course of the disease, the patient felt fatigue, no night sweats, and lost 2 kg of weight. Physical examination: Multiple subcutaneous nodules in the neck, trunk and limbs, with asymmetric distribution, hard texture, no tenderness, poor mobility, and adhesion to surrounding tissues. Blood routine: white blood cells 2.64×10⁹/L, hemoglobin 111 g/L, platelets 208×10⁹/L; Procalcitonin 0.113 μ G/L, serum fungal 1,3-β-D-glucan (G-GM) test was negative, and two blood cultures were negative. Chest enhanced CT showed multiple round nodules in both lungs, with ground glass exudation around the nodules, and mild-moderate enhancement after enhancement (Figures 1 and 2, shown by arrows); Bilateral subclavicular and left axillary lymph nodes were enlarged. Positron emission tomography-computed tomography (PET-CT) showed lymph nodes of unequal size in both cervical, axillary, abdominopelvic and inguinal areas, nodules of unequal size in both lungs, nodules of unequal size subcutaneously throughout the body, and increased metabolism, all considering lymphoma involvement (Figure 3, indicated by arrows). Biopsy pathology of two subcutaneous nodules in the right upper limb showed that the tumor was abnormally proliferating neoplastic lymphoid cells, medium to large, diffusely distributed, accompanied by coagulative necrosis, and invading fat (Figure 4, indicated by arrows). The tumor cells expressed T-line markers and cytotoxic markers, CD56 and EBER were positive, and combined with other immunohistochemical staining, it was diagnosed as extranodal natural killer (NK) /T cell lymphoma (ENKTL) occurring in the skin. Immunohistochemical staining: CD3 (+), CD43 (+), CD56 (+), GranzymeB (+), TIA-1 (+), CD2 (+), CD20 (-), CKp (-), CD7 (-), Perforin (+), in situ hybridization EBER (+). Lymph node T cell receptor (TCR) clonality test showed: TCRD (+). Extranodal NK/T cell lymphoma was confirmed by multidisciplinary consultation. After being transferred to the hematology department, the patient was given chemotherapy with cyclophosphamide 0.4 g, vincristine sulfate 2 mg and dexamethasone 15 mg. The patient's body temperature returned to normal and was discharged. Follow-up until 26 Feb 2026, the patient received regular chemotherapy in another hospital (specific regimen unknown), and his condition was stable.