Volume 106 · Issue 20 · 2026

Congenital ossicular chain malformation constitutes a pivotal etiological factor in conductive hearing loss. Despite its relatively low clinical incidence, the diagnosis and management of this condition persist as a formidable challenge in contemporary otological practice. In recent years, the expeditious evolution of high-resolution imaging modalities, minimally invasive endoscopic surgical techniques, innovative artificial ossicular prostheses, advanced hearing implant systems, and artificial intelligence (AI)-assisted clinical decision-making frameworks has precipitated a paradigm shift in diagnostic and therapeutic paradigms. This article systematically elaborates on the diagnostic strategies, therapeutic modalities, and future research directions pertaining to congenital ossicular chain malformation, with the overarching goal of advancing the precision and individualization of clinical care for affected populations.

Based on the 2023 consensus, the Chinese Breast Cancer Endocrine Therapy Consensus Group systematically reviewed the key points of endocrine therapy in the neoadjuvant, adjuvant, and metastatic settings, and updated the 2026 edition consensus. We interpreted the key points of the consensus in this article. In precision testing, the consensus emphasized the standard immunohistochemical test for hormone receptor and human epidermal growth factor receptor 2 (HER2) receptor, defined HER2-low and ultra-low expression, clarified the timing and methods of genetic testing. For different treatment stages of breast cancer, the consensus defined the eligible population for neoadjuvant endocrine therapy, expanded adjuvant cyclin-dependent kinases 4/6 (CDK4/6) inhibitor application in moderate and high-risk patients, optimized treatment strategies for first-line endocrine therapy plus CDK4/6 inhibitors in metastatic breast cancer, and recommended preferred regimens for post-CDK4/6 inhibitor patients. In conclusion, clinicians should follow the consensus recommendations, so as to achieve precise and individualized treatment for patients with hormone receptor-positive breast cancer.

The prevalence of type 2 diabetes mellitus has been rising continuously in China. However, glycemic control rates remain suboptimal, posing a significant public health challenge. Although traditional intensive insulin strategies are effective in improving glycemic control, they are often associated with risks such as hypoglycemia and weight gain. Fixed-ratio combinations of basal insulin and glucagon-like peptide-1 receptor agonist (GLP-1RA) offer complementary mechanisms of action, enhancing efficacy and safety while simplifying treatment regimens, making them a key focus of clinical development. Insulin icodec/semaglutide fixed-ratio combination (IcoSema), the first once-weekly dual-component preparation combining a basal insulin and a GLP-1RA, utilizes advanced formulation technology to achieve stable co-formulation of the ultra-long-acting once-weekly basal insulin and the once-weekly GLP-1RA, with the two components acting in a complementary and synergistic manner. The Phase 3 COMBINE clinical trial program demonstrated that, compared with insulin icodec, semaglutide(1.0 mg), or basal-bolus insulin regimens, IcoSema provides superior or equivalent glycemic control, and the risk of clinically significant or severe hypoglycemic events is comparable to that of semaglutide(1.0 mg). Once-weekly administration helps to simplify the treatment regimen and improve treatment adherence. The clinical application of IcoSema is expected to alleviate the dilemma in Chinese type 2 diabetes management of balancing effective glycemic control with safety and simplicity, offering a new therapeutic option for patients requiring insulin intensification that combines efficacy, safety, and convenience.

In response to the challenges of insufficient precision and limited safety associated with traditional techniques in the diagnosis and treatment of complex spinal diseases, intelligent technologies—represented by 3D visualization, additive manufacturing (3D printing), surgical navigation and robotics, artificial intelligence, and telemedicine—are driving spine surgery into a new era of precision and personalized treatment. However, there is currently a lack of standardized protocols or guidelines for the clinical application of these intelligent technologies in spine surgery. To standardize and promote their clinical use, this guideline was developed through an initiative led by the Spinal Trauma Group of the Chinese Association of Orthopaedic Surgeons (CAOS) and the Intelligent Orthopaedics Group of CAOS, in collaboration with Shaanxi Medical Doctor Association Professional Committee on Orthopaedic Minimally Invasive Surgery. Multidisciplinary experts participated, formulating recommendations based on evidence-based medicine and multi-center Delphi expert consensus. This guideline systematically summarizes the application scope of intelligent technologies in spine surgery, covering six aspects: 3D visualization, 3D printing, surgical navigation and robotics, artificial intelligence, telemedicine, and the implementation of intelligent technologies. It finally forms 15 recommendations, clarifies the applicable scenarios, evidence levels, and recommendation strength for each technology, and aims to promote their scientific, standardized, and efficient application, provide practical suggestions for medical institutions at different levels, and ultimately enhance the overall clinical diagnosis and treatment level and clinical decision-making support capacity in spine surgery.

Transarterial interventions (TAI) for hepatocellular carcinoma (HCC) include transarterial chemoembolization (TACE), transarterial embolization (TAE), hepatic arterial infusion chemotherapy (HAIC), and selective internal radiation therapy (SIRT). TACE remains the first-line treatment for unresectable HCC. Chinese College of Interventionalists (CCI) previously issued and updated the Chinese Clinical Practice Guidelines of TACE for HCC in 2018, 2021, and 2023, which have played a pivotal role in standardizing TACE procedures in China. In recent years, the application of HAIC and SIRT has become increasingly widespread and standardized in China. With the continuous advancement of TAI techniques, the evolution of therapeutic concepts, and the emergence of high-level evidence, CCI has comprehensively revised and expanded its previous guidelines. The updated Chinese clinical practice guidelines for transarterial interventions of hepatocellular carcinoma (2026 edition) now formally incorporates TACE, HAIC, and SIRT as standard treatment modalities. With the aims to further standardize the use of TAI in the management of HCC, this guideline is developed based on the most current evidence-based medical research, integrates China-specific clinical practices, and incorporates the latest advancements in TAI for HCC. It elaborates on clinical diagnostic criteria and staging, patient indications and contraindications, operational procedures and requirements, perioperative management, common complications management, follow-up and efficacy evaluation, combination therapy, quality control, as well as hot topics and prospects.

Congenital ossicular chain malformation (COCM) is a congenital developmental disorder that impairs hearing function. It most commonly presents unilaterally, either as an isolated anomaly or in association with a variety of systemic syndromes; in severe cases, it may coexist with malformations of the auricle and external auditory canal. Owing to its insidious onset and the presence of an intact tympanic membrane, affected children are frequently misdiagnosed with secretory otitis media. Bilateral COCM, if left untreated in a timely manner, can hinder speech and cognitive development, while specific anatomical variants may elevate the risk of cholesteatoma formation. Diagnosis is predicated on the presence of persistent conductive hearing loss from early childhood, with preoperative high-resolution temporal bone CT scanning serving as a pivotal tool for anatomical evaluation. The management of COCM is primarily guided by patient and family preferences, with therapeutic options encompassing hearing aid fitting and surgical intervention. To standardize the diagnosis and treatment of COCM, optimize the selection of surgical strategies, and enhance clinical outcomes, domestic otology experts have jointly developed the "Expert consensus on a novel classification system, surgical management strategies, and prognostic evaluation for congenital ossicular chain malformations based on stapes footplate mobility and suprastructural integrity (2026 edition)". This consensus is grounded in the latest research evidence and accumulated clinical experience, systematically summarizing the epidemiology, pathogenesis, clinical manifestations, auxiliary examinations, treatment principles, and complications of non-syndromic COCM. Building upon existing classification systems, the consensus introduces a novel clinical classification framework centered on stapes footplate mobility and the integrity of suprastapes structures, which directly informs surgical decision-making. This new classification prioritizes guiding surgical strategy formulation and predicting postoperative outcomes, thereby providing a robust reference for the standardized diagnosis and clinical management of COCM.

To investigate the high-resolution CT (HRCT) imaging characteristics and endoscopic surgical outcomes in patients with congenital ossicular chain malformation and concomitant external auditory canal stenosis.

The clinical data from congenital ossicular chain malformation patients with concomitant external auditory canal stenosis who were admitted to the Eye and ENT Hospital of Fudan University between July 2017 and March 2025 were retrospectively analyzed. The clinical presentations, HRCT findings, endoscopic examinations, and postoperative follow-up results were summarized.

A total of 54 patients (58 ears) aged [M (Q₁, Q₃)] 18.5 (12.0, 26.3) years were included, with 29 males and 25 females. The diagnostic concordance rates of HRCT for detecting incus, malleus, and stapes defects were 96.6% (56/58), 94.8% (55/58), and 53.4% (31/58), respectively. HRCT identified severe bony segment stenosis in 7 cases (12.1%) and mild bony segment stenosis in 35 cases (60.3%), whereas otoendoscopy revealed partially visualized stenosis in 16 cases (27.6%). Of the 58 affected ears, 44 underwent concurrent artificial ossicular implantation and external auditory canal reconstruction. Postoperative audiometric assessments at 3 to 12 months demonstrated statistically significant reductions in mean air conduction thresholds [(37.1±18.3) decibel hearing level (dB HL) vs (61.7±12.7) dB HL, P<0.001], mean bone conduction thresholds [(18.5±12.3) dB HL vs (26.3±9.5) dB HL, P=0.001], and air-bone gaps [(18.8±7.8) dB HL vs (35.3±9.6) dB HL, P<0.001] compared with preoperative measurements.

The integrated application of HRCT and otoendoscopy enables effective evaluation of the anatomical characteristics of ossicular chain malformation and external auditory canal stenosis. Concurrent ossicular chain reconstruction and external auditory canal reconstruction results in significant improvements in auditory outcomes.

To explore the clinical efficacy of stapes prosthesis surgery for the treatment of congenital fixation of stapes or oval window atresia in pediatric patients.

The clinical data of children with congenital fixation of stapes or oval window atresia who underwent stapes prosthesis surgery in Xi′an Children′s Hospital from January 2017 to July 2025 were retrospectively analyzed. All the children underwent high-resolution computed tomography (HRCT) of the temporal bone and pure-tone audiometry before and after the surgery. According to the type of auditory chain deformity, the children were divided into the stapes fixation group and the oval window atresia group. The surgical methods included incudovestibular fenestration (IVF) and malleovestibulopexy (MVP), with four types of opening methods, namely stapes footplate drilling, stapes resection, vestibular windowing, and vestibular semicircular canal interposition, respectively. The preoperative and postoperative air-conducted pure tone average (PTA), bone-conducted PTA, and air-bone conduction difference (ABG) were observed and compared.

A total of 19 children (25 ears) aged (8.9±3.1) years were included, with 13 males and 6 females. There were 13 ears on the right side and 12 ears on the left side. Preoperative HRCT yielded a positive diagnostic rate of 56.0% (14/25), while the incidence of facial nerve malformation was 40.0% (10/25). Surgical intervention was performed in 24 of the 25 affected ears. Among these, 13 ears were diagnosed with stapes fixation, of which four underwent IVF and nine underwent MVP. The remaining 11 ears presented with oval window atresia, with four undergoing IVF and seven undergoing MVP. Six months postoperatively, both the stapes fixation group and oval window atresia group demonstrated statistically significant improvements in air-conduction PTA and ABG compared with preoperative values. In the stapes fixation group, air-conduction PTA decreased from (62.2±8.7) dB HL to (32.8±10.8) dB HL (P=0.002), and ABG improved from (49.3±10.5) dB HL to (22.5±5.8) dB HL (P<0.001). In the oval window atresia group, air-conduction PTA decreased from (66.2±8.4) dB HL to (42.0±11.6) dB HL (P<0.001), and ABG improved from (54.0±5.0) dB HL to (31.1±11.7) dB HL (P<0.001). No statistically significant differences were observed in bone-conduction PTA before and after surgery in either group (both P>0.05). Intergroup comparisons revealed that the stapes fixation group exhibited significantly greater improvements in postoperative air-conduction PTA [(32.8±10.8) dB HL vs (42.0±11.6) dB HL] and ABG [(22.5±5.8) dB HL vs (31.1±11.7) dB HL] compared with the oval window atresia group (both P<0.05). Subgroup analyses based on surgical technique showed that patients who underwent MVP in both the stapes fixation and oval window atresia groups achieved statistically significant reductions in ABG compared with preoperative levels (both P<0.05). In contrast, IVF did not yield statistically significant improvements in ABG in either group (both P>0.05). No statistically significant difference was detected in postoperative ABG between patients who underwent IVF versus MVP, nor among the four different types of window opening techniques (all P>0.05).All patients received outpatient follow-up at six months postoperatively. Nineteen ears were followed up for≥1 year, with a mean duration of (25.1±12.4) months, while five ears were lost to follow-up (loss to follow-up rate: 20.8%). No serious complications, including sensorineural hearing loss or facial paralysis, were reported in any patient.

Stapes prosthesis surgery for the management of congenital stapes fixation and oval window atresia in pediatric patients demonstrates a favorable safety profile and sustained therapeutic efficacy. Surgical outcomes for congenital stapes fixation are superior to those for oval window atresia. Neither the choice between IVF and MVP nor variations in window-opening techniques has a statistically significant effect on postoperative hearing outcomes.

To investigate the clinical classification and surgical outcomes of congenital middle ear malformations accompanied by facial nerve anomalies.

A retrospective cohort study was conducted to analyze clinical data of patients with congenital middle ear malformations and concomitant facial nerve anomalies who received treatment in the Department of Otolaryngology, Zhujiang Hospital, Southern Medical University, between January 2021 and December 2024. Facial nerve anomalies were categorized into four distinct types: partial obstruction of the oval window, complete obstruction of the oval window, aberrant course over the promontory, and branching anomalies. Ossicular chain malformations were classified in accordance with the Teunissen classification system. Individualized hearing reconstruction strategies were implemented based on the specific anatomical characteristics of the anomalies. All patients were followed up for 3 to 24 months. Postoperative therapeutic efficacy was evaluated by comparing preoperative and postoperative mean air conduction thresholds and air-bone gaps (ABG), while monitoring surgical complications.

Thirteen patients (17 ears) aged [M (Q₁, Q₃)] 15.0 (11.5, 21.0) years were included, with eight males and five females. Facial nerve anomalies were categorized as follows: partial obstruction of the oval window in six ears (three cases of Type Ⅰ, three cases of Type Ⅲ), complete obstruction of the oval window in three ears (one case of Type Ⅰ, two cases of Type Ⅲ), aberrant course over the promontory in six ears (all Type Ⅳ), and branching anomalies in two ears (both Type Ⅳ). Hearing reconstruction modalities employed included: incus-stapedial piston placement following vestibular fenestration in nine ears, malleus-stapedial piston placement following vestibular fenestration in two ears, partial ossicular replacement prosthesis (PORP) implantation in three ears, total ossicular replacement prosthesis (TORP) implantation in one ear, stapes mobilization in one ear, and laser-assisted ossicular chain release in one ear.Statistical analysis revealed that postoperative mean air conduction thresholds [(33.8±15.2) dB HL vs (60.1±13.8) dB HL, P<0.001] and mean ABG [(14.6±6.9) dB vs (37.2±9.2) dB, P<0.001] were significantly reduced compared with preoperative values. Postoperative ABG≤20 dB was achieved in 15 ears (88.2%). Postoperative complications were limited to transient vertigo in five cases and taste disturbance in two cases. No cases of facial paralysis, sensorineural hearing loss, tympanic membrane perforation, or tinnitus were observed. The median follow-up duration was 6.0 (5.5, 20.0) months.

Individualized hearing reconstruction strategies based on the classification of facial nerve and ossicular chain anomalies can effectively protect the facial nerve and achieve significant hearing improvement, demonstrating favorable clinical outcomes.

To compare the clinical efficacy of endoscopic ear surgery (EES) and microscopic ear surgery (MES) in the treatment of congenital ossicular malformation.

PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), and Wanfang databases were systematically searched from inception to June 20, 2025, to identify comparative studies of EES versus MES in patients with congenital ossicular malformation. The evaluated outcomes included postoperative air-bone gap (ABG), ABG improvement, the proportion of patients achieving a postoperative ABG≤20 decibels hearing level (dB HL), operative time, and surgical complications.

A total of seven retrospective cohort studies involving 304 patients (320 ears, age range: 3-62 years) were included. Of these, 148 ears underwent EES and 172 ears underwent MES. Qualitative analysis indicated that EES had a lower complication rate. Serious complications reported in the MES group, including chorda tympani nerve injury and sensorineural hearing loss, were not observed in the EES group. Quantitative analysis demonstrated that EES was associated with significantly shorter operative time (MD=-10.38 min, 95%CI:-14.05 to -6.72 min, P<0.001) and greater postoperative ABG improvement (MD=4.22 dB HL, 95%CI: 0.05 to 8.39 dB HL, P=0.048) compared with MES. No statistically significant differences were found between the two groups in preoperative ABG (MD=-0.96 dB HL, 95%CI:-3.09 to 1.17 dB HL, P=0.379), postoperative ABG (MD=-1.95 dB HL, 95%CI:-3.98 to 0.08 dB HL, P=0.059), or the proportion achieving postoperative ABG≤20 dB HL [EES, 80.0% (64/80) vs MES, 75.0% (75/100), RR=1.04, 95%CI: 0.89 to 1.22, P=0.617].

For patients with congenital ossicular malformation, EES is associated with shorter operative time and greater postoperative ABG improvement than MES. EES may serve as a reasonable alternative to conventional MES.

To investigate the effects of fasting on anxiety-and depression-like behaviors in mice, and to elucidate the underlying neural mechanisms.

Eight-week-old male C57BL/6J mice (n=44) and Fos-2A-iCreER transgenic mice (n=48) were randomly assigned using a random number table.The male C57BL/6J mice were divided into six groups (n=36): anxiety-like models were established by 2-hour acute restraint stress (ARS), depression-like models were induced by intraperitoneal injection of lipopolysaccharide, and control groups were also set up. Within each model, mice were further divided into a fasting group (24-hour food deprivation) and an ad libitum feeding group. Fasting efficacy was assessed by monitoring changes in body weight and food intake. Anxiety-like behaviors were evaluated using the open field test and elevated plus maze test, while depression-like behaviors were assessed using the tail suspension test and forced swimming test. Whole-brain neuronal activation in response to fasting was detected in both fasted and non-fasted C57BL/6J mice (n=8) was detected through c-Fos immunofluorescence staining. Subsequently, the Fos-2A-iCreER transgenic mice were selected. The targeted recombination into active promoters (TRAP) technique was employed to specifically label fasting-activated neurons, and chemogenetic techniques were employed to activate or inhibit fasting-related neuronal ensembles (n=24 per experiment). Anxiety-like and depression-like models were re-established separately, and mice in each model were divided into a fasting group (24-hour food deprivation) and an ad libitum feeding group, in order to investigate the effects of activating or inhibiting neurons related to fasting on anxiety-and depression-like behaviors.

The open field test and the elevated plus maze test provided evidence that anxiety-like models had been successfully established. In addition, the tail suspension test and the forced swimming test provided evidence that depression models had been successfully established. In comparison with the ad libitum feeding group, the mice fasted for 24 h showed lower body weight and higher food intake (all P<0.05). Fasted mice demonstrated increased distance travelled, prolonged duration, and elevated entries in the central area of the open field, as well as greater distance traveled, higher percentage of duration, and more entries in the open arms of the elevated plus maze. Additionally, fasted mice showed shorter immobility times in both the tail suspension test and the forced swimming test. All differences were statistically significant (all P<0.05). c-Fos staining revealed enhanced neuronal activation in the paraventricular thalamus (PVT) region after fasting (all P<0.05). Chemogenetic activation of fasting-related neuronal ensembles in the PVT mimicked the anti-anxiety and anti-depression effects observed following fasting: anxious mice showed greater distance traveled, longer duration, and more entries in the central area of the open field, as well as greater distance traveled, higher percentage of duration, and more entries in the open arms of the elevated plus maze; depressed mice showed shorter immobility times in both the tail suspension test and the forced swim test (all P<0.05).Conversely, chemogenetic inhibition of these neuronal ensembles reversed these effects (all P<0.05).

Fasting activates PVT-related neuronal ensembles to elicit anti-anxiety and antidepression effects in mice.

Congenital ossicular chain malformation is a rare disease caused by morphological aberration or absence of ossicular bone due to embryonic development disorder, which is mostly in men and unilateral. This paper reviews the epidemiological characteristics, embryonic development theory, classification and surgical treatment strategies of congenital ossicular chain malformations, focusing on comparing the advantages and disadvantages of endoscopic otoscopic surgery (EES) and microscopic otoscopic surgery (MES). EES has advantages in visual field clarity, trauma size, postoperative recovery time, etc., and is especially suitable for Teunissen Class III deformity; MES is more suitable for complex cases and situations requiring two-hand operation. Studies have shown that the two procedures are comparable in hearing improvement, but EES may have shorter surgery time and higher patient comfort. With the progress of endoscopic technology in the future, EES is expected to become the preferred method for more ossicular chain deformity surgery.

Congenital ossicular chain deformity is the most common middle ear deformity, and accurate evaluation of its lesion features before surgery is the key to hearing reconstruction. At present, high-resolution CT is an important method to evaluate ossicular chain deformities, but its evaluation of subtle lesions and ossicular chain mobility still has limitations. Ultra-high resolution CT and CT-related three-dimensional imaging technology can further improve the detection ability of subtle lesions of the ossicular chain, and clearly demonstrate the spatial position relationship between the deformed ossiculae and the surrounding structures of the middle ear. At the same time, broadband acoustic impedance correlation derived techniques can indirectly assess the degree of ossicular chain fixation or interruption before surgery. Laser vibrometer or force feedback detection can quantitatively analyze the movement of ossicular chain during operation, which provides theoretical basis for the choice of surgical mode. In addition, some congenital ossicular chain malformations have a genetic background, and further molecular diagnosis can help to clarify the cause and guide clinical diagnosis and treatment. This article focuses on the diagnosis and research progress of congenital ossicular chain malformation, and reviews the aspects of imaging, audiology, molecular diagnosis and new intraoperative evaluation techniques.

low-grade serous ovarian carcinoma (LGSOC) is a rare pathological type of ovarian cancer, with young onset age, mild biological behavior, slow progression and good prognosis. Most LGSOCs are advanced at the time of diagnosis, their pathogenesis is still unclear, their sensitivity to chemotherapy is poor, and there is a lack of effective treatment for advanced and recurrent patients. LGSOC has unique molecular characteristics, its common MAPK pathway molecular changes, and corresponding targeted therapies such as mitogen-activated protein kinase kinase (MEK) inhibitors have certain curative effects, and have been clinically recommended for use in the treatment of patients with recurrent LGSOC. At the same time, estrogen and progesterone receptors are usually highly expressed, and hormone therapy occupies an important position in the first-line and recurrent treatment. Other targeted therapeutic preparations such as bevacizumab have limited clinical application experience and need to be further studied. This article reviews the clinicopathological characteristics, molecular characteristics and targeted therapy progress of LGSOC, aiming to provide reference for individualized and standardized diagnosis and treatment of LGSOC.

Public health is the cornerstone of addressing multiple health challenges and safeguarding the health of the whole population. At present, it is urgent to build a more accurate, systematic and active risk prevention and control system through deep cross-integration and technical method innovation. This "Medical Frontier Thirty Academic Conference" focuses on six frontier hot issues in the fields of public health and preventive medicine: new pollutants and health research focuses on broad-spectrum identification, mixed exposure assessment and risk management and control; Climate change (air pollution) and health research focuses on revealing the synergistic health effects of pollution and climate, and develops individualized risk assessment, intelligent early warning decision-making system and integrated intervention path of medical and prevention integration for key areas and key populations; The study of toxicity effects and mechanisms relies on the systematic toxicology paradigm empowered by multi-omics, organoid models and artificial intelligence to promote the transformation from toxicity pathway analysis to health effect prediction, and from single endpoint evaluation to multi-scale and multi-organ comprehensive evaluation; In the field of occupational (special environment) hazards and health, we pay attention to the hidden hazards of emerging industries and special environments, and build a full-chain protection system relying on the intersection of medical and industrial technologies, intelligent monitoring and individualized protection technologies; Food nutrition and safety research is committed to achieving precision nutrition and full-chain risk control, and solving the problems of accurate assessment of dietary exposure and evidence-based transformation and application; Children and maternal and child health research integrates genetics, environmental exposure and artificial intelligence to promote precise prevention and control of key diseases and early warning of risks. Experts at the meeting suggested that cross-integration and collaborative research among the six major fields should be strengthened, and through interdisciplinary and cross-field organized scientific research, efforts should be made to build a modern public health science and technology system covering all factors, all scenarios, all chains and all people, so as to provide scientific support for comprehensively improving the health level of the whole people and accelerating the realization of high-quality development.