Volume 106 · Issue 22 · 2026

Component-resolved diagnosis (CRD), a cornerstone of precision allergology, enables the identification of specific allergenic molecules and refines the diagnosis, risk stratification, and personalized management of allergic diseases. However, its widespread clinical adoption, especially in primary care and non-specialist settings in China, remains constrained by the complexity of component-based data, limited interpretability among clinicians, and the absence of standardized clinical pathways. To address these challenges, the establishment of a systematic and tiered continuing medical education framework is essential. This article examines the technological foundations, clinical applications, and interpretation challenges of CRD, and proposes a structured educational framework incorporating competency-based tiered training, case-driven and problem-oriented learning, standardized interpretation workflows, multidisciplinary collaboration, and digital support tools. By strengthening the educational infrastructure, this approach can enhance clinicians′ interpretive competence, facilitate the translation of CRD from a diagnostic tool into a clinical decision-making aid, and ultimately advance the precision and standardization of allergy care.

To further promote continuous quality improvement of clinical practice guidelines (CPGs) and expert consensuses (ECs) in China, the Scientific, Transparent, and Applicable Rankings (STAR) Working Group conducted its 2023-2024 biennial appraisal based on its previous work. In this round, 40 specialty committees and over 1 000 experts participated, and large language model technologies were integrated to comprehensively evaluate guidelines and consensuses led by Chinese scholars and published in journals between 2023 and 2024. A total of 305 guidelines and 1 153 consensuses were included for 2023, compared to 424 guidelines and 1 391 consensuses for 2024. The average scores for guidelines and consensuses increased from 41.0 and 28.8 in 2023 to 49.2 and 33.0 in 2024, respectively, indicating a significant upward trend compared with previous years. Among the evaluation domains, "Recommendations" achieved the highest scoring rate, whereas "Protocols" and "Funding and Conflict of Interest Disclosures" recorded the lowest. In terms of publication volume, Oncology, Traditional Chinese Medicine, and Pediatrics were the top three specialties. Overall, medical guidelines and consensus documents in China are at a critical stage of transitioning from"quantity-driven"expansion to"high-quality development."In the future, guideline developers, academic journals, and the STAR Working Group should establish long-term collaborative mechanisms to jointly promote the dynamic and intelligent evolution of the ranking system.

Stillbirth is one of the most common adverse pregnancy outcomes. It not only causes physical and psychological trauma to pregnant and puerperal women but also imposes heavy family and socioeconomic burdens. Standardized clinical management of stillbirth is crucial for improving the quality of the birth population. Such management should be based on a multidisciplinary collaborative diagnosis and treatment model, covering a complete pathway including high-risk factor screening, risk stratification and early warning, whole-pregnancy monitoring, and intervention in subsequent pregnancies. Accordingly, this guideline was jointly developed by the Fetal Medicine Group of the Chinese Society of Perinatal Medicine (Chinese Medical Association), the National Obstetric Quality Control Center, and the National Clinical Research Center for Obstetric and Gynecologic Diseases of China. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system and international reporting standards for practice guidelines. A multidisciplinary expert team was established to systematically review evidence on 32 key clinical questions in China and formulate evidence-based recommendations, so as to provide guidance for the standardized management of stillbirth in China. This guideline aims to provide a knowledge framework and practical guidance for primary healthcare professionals, obstetricians, clinical pharmacists, nurses at all levels of medical institutions, as well as pregnant women and their families.

To investigate the cervical reasonable range of motion (ROM) after anterior cervical discectomy and fusion (ACDF), so that the intradiscal pressure (IDP) in adjacent segments of the fusion segments did not increase compared with normal cervical spine.

A three-dimensional finite element model of intact cervical spine (C₀-C₇) was established based on CT data from a healthy adult female cervical spine, and its effectiveness was verified. ACDF surgery was simulated at the C₅-C₆ level, with implantation of interbody cage and screw-plate system to construct the ACDF model. A 1.0 Nm moment and 73.6 N follower load was applied to the intact model to determine the normal cervical ROMs. A displacement load was applied to the ACDF model under the same follower load to achieve a total C₀-C₇ ROM equivalent to that of the intact model. The fitting function was employed to calculate the total C₀-C₇ ROM of the ACDF model without increasing IDP in adjacent segments, which was defined as the reasonable ROM.

Compared with the intact model, the ACDF model (C_5-6 fusion) demonstrated significantly increased ROM at the adjacent segments C_4-5 and C_6-7 in all motion directions, with an increase of 13.07%-17.77% and 7.78%-18.15%, respectively. The IDP of C_4-5 and C_6-7 increased with increasing total C_0-7 ROM. The IDP of C_4-5 was higher than that of C_6-7 in almost all motion directions, except for extension. Finally, the postoperative reasonable ROMs of ACDF model were 42.4°, 53.6°, 28.6° and 43.0° in flexion, extension, lateral flexion, and axial rotation, which decreased by 6.6%, 3.8%, 3.5% and 5.6% compared with the intact model, respectively.

The postoperative reasonable ROM in flexion, extension, lateral bending, and axial rotation is 42.4°, 53.6°, 28.6°, and 43.0°, respectively. Moderately reducing cervical ROM may offset the increase in adjacent segment IDP, thereby providing a novel strategy for preventing adjacent segment disc degeneration after ACDF.

To evaluate the impact of bone metastasis on the prognosis of lung adenocarcinoma patients receiving first-line third-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and to explore the potential mechanisms by which bone metastasis contributes to EGFR-TKI resistance.

A retrospective analysis was conducted on the clinical data of 370 EGFR-mutant advanced lung adenocarcinoma patients who received first-line treatment with third-generation EGFR-TKI at the First Affiliated Hospital of Nanjing Medical University from January 2019 to June 2024, with follow-up until June 2024. Progression-free survival (PFS) and overall survival (OS) were compared between patients with and without baseline bone metastasis. Survival curves were generated using the Kaplan-Meier method, and differences between groups were assessed by the log-rank test. Univariate and multivariate Cox proportional hazards regression models were applied to identify factors associated with PFS following third-generation EGFR-TKI treatment. Single-cell RNA sequencing (scRNA-seq) was performed on two primary pulmonary tumors and two bone metastatic lesions to characterize transcriptomic differences in cancer cells and immune cells within the tumor microenvironment. Gene Ontology (GO) enrichment analysis was applied to identify bone metastasis-specific signaling pathways. Based on immune regulatory genes upregulated in cancer cells from bone metastatic lesions, an immune-regulatory score was constructed using a LASSO-Cox regression model in a training cohort of EGFR-mutant lung adenocarcinoma patients from The Cancer Genome Atlas (TCGA). Patients in both the training cohort and an independent Asian EGFR-mutant lung adenocarcinoma validation cohort were stratified into high-and low-score groups according to the median immune regulatory score, and OS was compared between groups.

Among the 370 lung adenocarcinoma patients receiving first-line third-generation EGFR-TKI treatment, 161 patients had baseline bone metastasis (mean age 60±11 years; 70 males), while 209 patients had no baseline bone metastasis (mean age 61±9 years; 80 males). No significant differences in baseline clinicopathological characteristics were observed between patients with and without bone metastasis (all P>0.05). The median PFS in the bone metastasis group was 27.5 months (95%CI: 22.0-33.1), which was significantly shorter than that in the non-bone metastasis group [59.0 months (95%CI: 32.8-85.1), P<0.001]. The median OS was 46.2 months (95%CI: 40.4-51.9) in the bone metastasis group, whereas the median OS had not yet been reached in the non-bone metastasis group, with a statistically significant difference (P=0.013). Multivariate Cox regression analysis identified bone metastasis as an independent risk factor for PFS (HR=1.74, 95%CI:1.27-2.37, P<0.001). Cancer cells in bone metastatic lesions exhibited upregulation of C-X-C motif chemokine ligand 17 (CXCL17), complement decay-accelerating factor (CD55), interferon regulatory factor 1 (IRF1), E3 ubiquitin-protein ligase pellino homolog 1 (PELI1), solute carrier family 7 member 5 (SLC7A5) and prostaglandin-endoperoxide synthase 2 (PTGS2), which were predominantly enriched in pathways related to immune cell differentiation, chemotaxis, and inflammatory responses. At the immune cell level, lymphoid cells in bone metastatic lesions showed activation of stress response and apoptotic pathways, whereas myeloid cells demonstrated significant activation of cytokine/chemokine signaling and inflammation-related pathways. An immune-regulatory score based on CXCL17, CD55, IRF1, PELI1, SLC7A5, and PTGS2 was constructed. In the TCGA training cohort, the median OS of 41 patients with a high immune-regulatory score was 23.1 months (95%CI: 17.5-28.7), which was significantly shorter than that of patients with a low score [58.5 months (95%CI: 43.0-73.9), P<0.001]. In the independent Asian cohort of 93 EGFR-mutant lung adenocarcinoma patients, the median OS of 46 patients with a high immune-regulatory score was 85.3 months (95%CI: 80.0-not reached), while the median OS in the low-score group was not reached, with a statistically significant difference (P=0.014).

Bone metastasis is an adverse prognostic factor for progression-free survival in lung adenocarcinoma patients treated with third-generation EGFR-TKIs. Bone metastasis lesions exhibit a distinct immunosuppressive tumor microenvironment in EGFR-mutant advanced lung adenocarcinoma, in which upregulation of immune regulatory genes in cancer cells and dysfunction of immune cells may constitute a potential mechanism underlying resistance to third-generation EGFR-TKIs.

To investigate the effects of oliceridine versus sufentanil for anesthesia induction and postoperative patient-controlled intravenous analgesia (PCIA) on postoperative nausea and vomiting (PONV) in patients undergoing gynecological laparoscopic surgery.

This prospective study enrolled 70 patients scheduled for elective gynecological laparoscopic surgery under general anesthesia with planned postoperative PCIA at Beijing Tongren Hospital, Capital Medical University, from September to December 2025. Patients were randomly assigned using a random number table to either the oliceridine group (Group O, n=35) or the sufentanil group (Group S, n=35). Group O received oliceridine for anesthesia induction and PCIA, while Group S received sufentanil; both groups received ondansetron and flurbiprofen axetil in combination. The primary outcome was the incidence of PONV within 48 hours postoperatively. Secondary outcomes included the incidence of nausea and vomiting during 0-<24 h and 24-48 h postoperatively, severity of nausea within 24 hours postoperatively [assessed by the visual analog scale (VAS), with a score≥4 defined as moderate-to-severe], the impact of PONV (assessed by the Myles simplified scale, with a score≥5 defined as clinically important PONV), postoperative pain numerical rating scale (NRS) scores, recovery parameters, and adverse events.

A total of 34 patients in Group O and 33 patients in Group S completed the study. The mean age was (39.3±9.2) years in Group O and (40.9±10.4) years in Group S, with no significant differences in baseline characteristics between the two groups (all P>0.05). The incidence of PONV within 48 hours postoperatively was significantly lower in Group O than in Group S [35.3% (12/34) vs 66.7% (22/33), χ²=6.59, P=0.010]. Within the first 24 hours postoperatively, Group O had a lower incidence of nausea [29.4% (10/34) vs 66.7% (22/33), χ²=9.32, P=0.002] and a lower incidence of moderate-to-severe nausea [20.6% (7/34) vs 51.5% (17/33), χ²=6.97, P=0.008] compared to Group S. The incidence of clinically important PONV was lower in Group O than in Group S, but the difference was not statistically significant [2.9% (1/34) vs 18.2% (6/33), P=0.054]. There were no significant differences between the two groups in resting or movement NRS scores at any postoperative time point (all P>0.05), and no patient required rescue analgesia. No significant differences were observed between the two groups in awakening time, time to first flatus, or overall incidence of adverse events (all P>0.05).

For patients at high risk of PONV undergoing gynecological laparoscopic surgery, oliceridine provides analgesic efficacy equivalent to sufentanil while significantly reducing the incidence and severity of postoperative nausea and vomiting, with a favorable safety profile.

To explore the brain functional and cognitive characteristics of schizophrenia (SZ) patients with predominant positive or negative symptoms using resting-state functional magnetic resonance imaging (rs-fMRI).

SZ patients who visited the Second Affiliated Hospital of Henan Medical University from March 2021 to June 2024 were prospectively included and evaluated with the Positive and Negative Syndrome Scale (PANSS). They were then divided into the positive symptom-dominant SZ group (SZ-Ⅰ group) and the negative symptom-dominant SZ group (SZ-Ⅱ group) based on the results. Healthy individuals were recruited from the surrounding communities as the control group. The cognitive function of SZ patients was assessed using the MATRICS Consensus Cognitive Battery (MCCB). Whole-brain rs-fMRI data was collected from all subjects, and low-frequency amplitude (ALFF), fractional ALFF (fALFF), and regional homogeneity (ReHo) were calculated. Brain regions with significant differences among the three groups were identified through inter-group comparisons and used as regions of interest (ROI) to calculate the whole-brain functional connectivity (FC) and perform inter-group comparisons. Partial correlation analysis was conducted to explore the correlations between rs-fMRI and MCCB subscale scores among the three groups.

The SZ-Ⅰ group included 18 males and 20 females, with an average age of (28.2±7.8) years; the SZ-Ⅱ group included 19 males and 18 females, with an average age of (30.9±6.4) years; and the control group included 16 males and 20 females, with an average age of (32.6±9.3) years. There were no significant differences in gender and age among the three groups (all P>0.05). The fALFF value of the right caudate nucleus showed significant differences among the three groups, with the SZ-Ⅰ group having a higher fALFF value than the SZ-Ⅱ group, and both SZ groups having higher fALFF values than the control group (all P<0.05, FDR corrected). The FC values from the right caudate nucleus to the right angular gyrus and the right caudate nucleus to the right inferior parietal lobule were higher in the SZ-Ⅱ group than in the SZ-Ⅰ group (all P<0.05, GRF corrected). In the SZ-Ⅰ group, the fALFF value of the right caudate nucleus was potentially negatively correlated with the maze test score (r=-0.388, P_FDR=0.340), and in the SZ-Ⅱ group, the fALFF value of the right caudate nucleus was potentially negatively correlated with the spatial span test (r=-0.479, P_FDR=0.100).

There are differences in the brain functional activities and connections related to the right caudate nucleus in SZ patients with predominant positive or negative symptoms. The abnormal brain functional activities are associated with the specific cognitive impairments in SZ patients with different symptom characteristics, suggesting that the right caudate nucleus can be a potential functional imaging biomarker for differentiating SZ patients with different symptom characteristics.

The data of 10 congenital middle ear cholesteatoma (CMEC) patients with concurrent congenital ossicular anomalies (COAs), who were admitted to the Second Hospital of Jilin University between January 1, 2018, and July 31, 2025 were retrospectively reviewed. The cohort comprised 8 males and 2 females, with ages ranging from 4 to 36 years. The predominant clinical manifestations included aural fullness, tinnitus, and progressive hearing loss. Preoperative evaluations included high-resolution CT (HRCT) of the temporal bone, MRI of the ear (with non-contrast, diffusion-weighted, and contrast-enhanced sequences), and comprehensive audiological assessments. Combined with intraoperative findings, the results demonstrated that in these 10 CMEC patients, the ossicular abnormalities were congenital malformations (e.g., hypoplasia or aplasia) rather than ossicular destruction resulting from direct erosion by the CMEC itself. These findings suggest that CMEC with COAs may be a comorbid condition arising from an independent congenital developmental anomaly, rather than from erosion induced by the CMEC itself.

A retrospective analysis was conducted on microtia patients with concomitant ossicular malformation who underwent hearing intervention at Sun Yat-sen Memorial Hospital, Sun Yat-sen University from August 2019 to November 2024. A total of 22 patients aged (10.4±7.3) years were included. Among them, 11 patients underwent hearing reconstruction surgery, six were fitted with non-implantable bone conduction hearing aids, and five received bone-anchored hearing aid Attract (BAHA Attract). No significant intergroup differences were observed in pre-intervention air-conduction thresholds, bone-conduction thresholds, or air-bone gaps (all P>0.05). In the hearing reconstruction group, postoperative air-conduction pure-tone averages (PTA) and air-bone gap were significantly decreased compared with preoperative values [(51.8±5.1) dB HL vs (74.4±5.0) dB HL, P=0.003; (29.0±2.0) dB HL vs (51.3±3.9) dB HL, P=0.001]. In the non-implantable bone conduction hearing aid group and the BAHA Attract group, the pre-intervention PTA were (58.5±2.4) dB HL and (76.8±4.6) dB HL, respectively, while the postoperative sound-field pure-tone averages were (27.5±1.9) dB HL and (28.5±3.1) dB HL, respectively. There was no significant difference in postoperative sound-field thresholds between the two groups (P=0.790). No statistically significant difference was found in total costs among the three groups (P=0.118). However, out-of-pocket costs differed significantly (P=0.007), being higher in the bone conduction hearing aid group than in the hearing reconstruction group and the BAHA Attract group (both P<0.05). Collectively, these findings demonstrate that all three intervention modalities yield favorable audiological outcomes, with comparable total treatment costs but distinct out-of-pocket financial burdens.

The malignancy of pancreatic cancer is extremely high, and more than 80% of patients are advanced at the time of initial diagnosis, with extremely poor prognosis, and patients often face multiple physical and psychological pain during the course of the disease. As a key means to improve patients' quality of life, integrated hospice care has evolved from the traditional end-stage "hospice care" to a supportive treatment system that runs through the whole course of the disease and complements anti-tumor treatment. This article systematically reviews the latest progress of integrated hospice care in the treatment of pancreatic cancer, focusing on the application value and stratification strategy of early integrated hospice care, core symptom management tasks based on disease stage, multi-disciplinary collaboration and multi-scenario service model innovation, as well as social support and tool research and development results, and deeply analyzes the challenges faced by current clinical practice in cognition, resources, education and system levels, so as to provide reference for future clinical practice optimization and research direction formulation.

As one of the malignant tumors with the highest incidence among women in the world, breast cancer has become a major public health problem that threatens women's physical and mental health, and brings a heavy burden to the global medical system and patients' families. Autophagy, as a highly conserved metabolic process in cells, plays a key "double-edged sword" role in the occurrence and development of breast cancer-it can inhibit tumorigenesis by eliminating abnormal proteins and inhibiting abnormal cell proliferation; It can also help breast cancer cells to maintain survival and evade treatment under the conditions of nutritional deficiency, radiotherapy and chemotherapy stress, and become an important promoter of tumor progression and treatment resistance. In-depth analysis of its regulatory mechanism is of great significance to the precise treatment of breast cancer.

In the article "Expert Consensus on the Clinical Application of Inhaled Nitric Oxide in the Perioperative Period of Adult Surgical Procedures (2026 Edition)", Volume 106, Issue 6, February 10, 2026, Chinese Journal of Medicine, "Du Juan (Adult Surgical Intensive Care Unit, Fuwai Hospital, Chinese Academy of Medical Sciences)" in the list of experts on page 530 shall be hereby corrected as "Du Juan (Adult Surgical Intensive Care Unit, Fuwai Hospital, Chinese Academy of Medical Sciences)".