Volume 106 · Issue 24 · 2026

The 2026 Surviving Sepsis Campaign guidelines represent a systematic update built upon the 2021 version. The core changes are reflected not only in the adjustment of clinical recommendations but also, more significantly, in the restructuring of the methodological framework. This article provides an in-depth analysis of the new guidelines across four key dimensions: methodological innovations, evolution of clinical diagnostic and treatment strategies, extension of whole-course management, and the establishment of an independent recommendation system for resource-limited settings. The 2026 guidelines achieve four major paradigm shifts: transitioning from simple evidence updates to methodological restructuring, from uniform recommendations to risk-stratified precision medicine, from acute-phase treatment to whole-course management, and from a high-resource medical center perspective to a global health equity perspective. However, systematically identifying evidence gaps, integrating effective strategies into clinical practice, and placing greater emphasis on patients′ long-term functional recovery and life quality remain future research priorities.

Transcranial temporal interference stimulation (tTIS) generates a low-frequency envelope through the interference of two high-frequency electric fields, enabling non-invasive and precise neuromodulation of deep brain regions. This article systematically reviews the technical principles, neuromodulatory mechanisms, and preliminary applications of tTIS in the treatment of mental disorders. It analyzes the impact of key parameters on therapeutic efficacy, including target selection, frequency difference, current intensity, stimulation protocol, and individualized computational modeling. The review also summarizes current research evidence for tTIS in major depressive disorder, bipolar disorder, schizophrenia, and substance use disorders. Finally, this article discusses future directions, including mechanistic exploration, validation through randomized controlled trials, multi-target intelligent stimulation, and combination therapies, aiming to provide a reference for the clinical translation of tTIS.

Irreparable massive rotator cuff tears represent a highly challenging clinical problem in shoulder sports medicine, and their surgery strategy remains a major focus and persistent challenge in the field. In recent years, with the deepening of basic research and the accumulation of clinical experience, notable progress has been made in fundamental theories, surgical techniques, and graft selection for reconstructive treatment. This article systematically reviews the latest advances in the reconstruction of irreparable massive rotator cuff tears, covering emerging theories, innovative surgical procedures, and the application of grafts. It also offers insights into the future directions of clinical diagnosis and treatment and scientific research, aiming to provide valuable references for further development in this area.

Psoriasis arthropathica, also known as psoriatic arthritis (PsA), is a highly heterogeneous systemic inflammatory disease. In addition to involving the skin with characteristic psoriatic lesions such as erythematous scaly plaques, it may also affect the joints, leading to joint pain, swelling, stiffness, and functional impairment, thereby substantially reducing patients′ quality of life. To develop clinical practice guidelines that align with international standards for guideline development while reflecting Chinese clinical practice, the China Dermatologist Association, in collaboration with the Chinese Dermatovenerology Society of Integrative Medicine, initiated a guideline project focusing on 14 key clinical questions in the diagnosis and management of PsA in China. Evidence-based recommendations were formulated accordingly. This guideline systematically reviews recent domestic and international advances in the diagnosis and treatment of PsA, and covers diagnosis, disease activity assessment, therapeutic strategies, comorbidity management, and pharmacotherapy in special populations. The guideline aims to improve the overall standard of PsA diagnosis and management in China and ultimately enhance patient outcomes.

Modified electroconvulsive therapy (MECT) is one of the key physical treatments for mental disorders. Despite the rapidly growing demand for outpatient MECT among patients with mental disorders, a unified set of standardized operational guidelines has not yet been established in China. This expert consensus was initiated and developed by the Chinese Psychiatrist Association in collaboration with the Professional Committee of Physical Therapy, Mental Health Association of Guangdong Province. Under the guidance of the steering committee, based on evidence-based medical evidence and multidisciplinary expert opinions from psychiatry, anesthesiology and other related fields, this consensus systematically introduces the operational standards of outpatient MECT, covering core components including patient inclusion criteria, facility and equipment requirements, team composition, personnel qualifications and job responsibilities, treatment procedures, quality control and safety management, professional training and continuing medical education. Finally, 11 recommendations were formulated. This expert consensus aims to provide standardized and practical operational guidance for clinicians, ensure patient treatment safety, and promote the standardized application and sustainable development of outpatient MECT.

Chronic Obstructive Pulmonary Disease (COPD) is a highly heterogeneous airway disease, and often coexists with other pulmonary and extra-pulmonary diseases. The traditional single-disciplinary approach cannot meet the medical needs of patients with COPD. A multidisciplinary team (MDT) approach, led by respiratory physicians, has been advocated for the care of patients with COPD, but standardized practice guidelines are still lacking. Therefore, the Chronic Obstructive Pulmonary Disease Assembly of the Chinese Thoracic Society convened experts from relevant fields to reach a consensus based on evidence-based medicine and clinical experience, and formulated 11 recommendations regarding the implementation process, target population, indications, and management of MDT care for COPD. This consensus aims to propose a standardized framework for the implementation and management of MDT, thereby improving the quality of multidisciplinary care for COPD in China.

To construct a machine learning diagnostic model for hereditary hearing loss based on GJB2 and SLC26A4 genes and perform interpretability analysis using SHapley Additive explanations (SHAP).

The data of genetic variants and hearing status were collected from 1 539 individuals at the Deafness Molecular Diagnosis Center of the Chinese PLA General Hospital from June 2015 to August 2024. Participants were categorized by expert diagnosis as hereditary hearing loss patients or non-hereditary hearing loss individuals, and were randomly assigned to a training set (n=1 077) and a test set (n=462) in a 7∶3 ratio using a computer-generated random sequence. Using non-zero coefficient variants of GJB2 and SLC26A4 genes screened by least absolute shrinkage and selection operator (LASSO) regression, six machine learning models including logistic regression, decision tree, random forest, gradient boosting (GB), eXtreme Gradient Boosting and k-nearest neighbors were constructed. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) with the DeLong test, and accuracy, precision, sensitivity, F1 score and specificity were calculated. The best model was compared against intermediate-level physicians to assess its clinical value, and SHAP was applied for interpretation.

A total of 748 hereditary hearing loss patients (391 males and 357 females) aged 29 (13, 36) years and 791 non-hereditary hearing loss individuals (405 males and 386 females) aged 27 (12, 36) years were included. LASSO regression yielded 121 non-zero coefficient variants: 34 in the GJB2 gene and 87 in the SLC26A4 gene. The GB model produced an AUC of 0.975 (95%CI: 0.967-0.983), outperforming each of the other five models (all P<0.05). Moreover, the GB model also showed higher precision [98.5% (95%CI: 97.8%-99.2%) vs 92.6% (95%CI: 90.4%-94.4%)] and specificity [98.7% (95%CI: 98.1%-99.3%) vs 93.2% (95%CI: 91.2%-94.8%)] than intermediate-level physicians (both P<0.001). SHAP identified the top 10 impactful variants in the GB model: nine pathogenic variants (GJB2: p.Leu79CysfsTer3, p.His100ArgfsTer14, p.Val37Ile, p.Gly59AlafsTer18; SLC26A4: c.919-2A>G, p.His723Arg, p.Asn392Tyr, p.Thr410Met, p.Val659Leu) and one benign variant (GJB2: p.Val27Ile). The model tends to diagnose individuals carrying pathogenic homozygous or compound heterozygous variants as hereditary hearing loss patients.

The machine learning models incorporating the GJB2 and SLC26A4 genes are of referential value for the auxiliary diagnosis of hereditary hearing loss, with the GB model demonstrating the best diagnostic performance.

To explore the mediating role of malignant brain edema (MBE) in the relationship between eosinophils and futile recanalization after mechanical thrombectomy in patients with acute large vessel occlusion (LVO) stroke.

A retrospective analysis was performed on 399 patients with acute LVO who underwent mechanical thrombectomy in Department of Neurology, the Second Affiliated Hospital of Soochow University from May 2017 to January 2023, all achieving successful recanalization [modified Thrombolysis in Cerebral Infarction (mTICI)≥2b]. Patients were categorized into the ineffective recanalization group and the non-ineffective recanalization group according to the presence or absence of ineffective recanalization, and into the MBE group and the non-MBE group according to the presence or absence of MBE. Futile recanalization was defined as angiographically confirmed recanalization of the occluded vessel after thrombectomy instantly, but with a 90-day modified Rankin Scale (mRS) score of 3-6. Clinical data was collected, including demographic characteristics (age, sex), underlying diseases (hypertension, diabetes, etc.), baseline National Institutes of Health Stroke Scale (NIHSS) score, Alberta Stroke Program Early CT Score (ASPECTS), peripheral blood eosinophil count, and 90-day mRS score. Eosinophils were entered into the model as a Z-score standardized continuous variable and as a dichotomous variable using a median cutoff of 0.01×109/L(Based on this, it was divided into high eosinophil group and low eosinophil group). Multivariate logistic regression was used to analyze the association between eosinophils and MBE or futile recanalization respectively, and the association between MBE and futile recanalization. Mediation analysis was performed to verify the mediating effect of MBE.

Among the 399 patients, there were 229 males and 170 females under the age of (65.5±13.6) years. There were 161 cases (40.35%) in the low eosinophil group and 238 cases (59.65%) in the high eosinophil group. MBE occurred in 84 patients (21.05%), and futile recanalization occurred in 242 patients (60.65%). Multivariate logistic regression analysis showed that lower eosinophil levels were independently associated with an increased risk of MBE [continuous variable: after Z-score standardization, OR=0.185 (95%CI: 0.058-0.589, P=0.004); dichotomous variable: OR=0.136 (95%CI: 0.062-0.295, P<0.001)] and futile recanalization [continuous variable: after Z-score standardization, OR=0.621 (95%CI: 0.469-0.821, P<0.001); dichotomous variable: OR=0.206 (95%CI: 0.109-0.387, P<0.001)]; Following thrombectomy, MBE was identified as a risk factor for futile recanalization (OR=5.286, 95%CI: 2.054-13.606, P<0.001). Mediation analysis revealed that MBE partially mediated the relationship between eosinophils and futile recanalization (indirect effect β=-0.229, 95%CI:-0.688 to -0.057, P<0.001), accounting for 12.44% of the total effect.

Reduced eosinophils are associated with an increased risk of MBE, and MBE plays a partial mediating role in the association between eosinophils and post-thrombectomy futile recanalization.

To assess the value of a deep learning-based visual model for predicting postoperative upper limb functional recovery after severe acute cervical spinal cord injury.

A retrospective study was conducted involving 162 patients with severe acute cervical spinal cord injury treated at the First Affiliated Hospital of Nanjing Medical University between 2020 and 2025. The Upper Extremity Motor Score (UEMS) was used to assess prognosis before treatment and at 6 months post-treatment. Patients with an improvement of ≥10 points were assigned to the good outcome group, and those with an improvement of <10 points to the poor outcome group. Variables showing statistical significance in univariate analysis were taken as initial inputs, and the least absolute shrinkage and selection operator (LASSO) was applied to identify variables associated with prognosis. The patients were divided into a training set (n=97), a validation set (n=32), and a test set (n=33) at a ratio of 6∶2∶2. A predictive model was constructed based on a multilayer perceptron (MLP) and validated on the independent test set. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity.

Among the 162 patients, 129 were male and 33 were female, with a mean age of (55.5±9.8) years. Based on univariate analysis and LASSO regression, the four variables, i.e., the BASIC score, SCC>50%, preoperative UEMS, and light touch score, were identified. An MLP prediction model was constructed using these four variables. The distributions of risk factors among the training, validation, and test sets were balanced (all P>0.05). During model training, the training loss approached 0, while the validation loss gradually decreased and stabilized. In the training set, the AUC (95%CI) was 0.987 (0.969-0.999), with a sensitivity of 93.33% and a specificity of 89.55%. In the validation set, the AUC (95%CI) was 0.955 (0.868-1.000), with a sensitivity of 90.00% and a specificity of 95.45%. In the test set, the AUC (95%CI) was 0.930 (0.830-0.991), with a sensitivity of 80.00% and a specificity of 95.65%. Neural network weight analysis showed that preoperative UEMS was the strongest positive predictor, followed by the light touch score, SCC, and BASIC score; among them, the BASIC score and SCC were negative predictors, while preoperative UEMS and the light touch score were positive predictors. The calibration curve demonstrated good calibration ability of the model.

The deep learning prediction model based on MLP demonstrates good predictive performance for predicting upper limb functional outcomes in patients with SACSCI,with preoperative UEMS being the most important predictor.

To explore the predictive value of early-and mid-trimester glycolipid metabolic indicators for adverse pregnancy outcomes in pregnant women with normal glucose levels.

A total of 12 457 pregnant women admitted to Yantai Yantaishan Hospital from January 2020 to December 2024 were retrospectively included. According to the occurrence of adverse pregnancy outcomes, they were divided into an adverse pregnancy outcome group (n=852) and a normal pregnancy outcome group (n=11 605). General data, pregnancy-related information, lipid profile, and fasting plasma glucose (FPG) in early pregnancy (gestational age≤14 weeks; T1), and oral glucose tolerance test (OGTT) results in the second trimester (24-28 weeks; T2) were compared between the two groups. The participants were randomly assigned to a training set (n=8 712) and a validation set (n=3 745) in a 7∶3 ratio. Multivariable logistic regression was applied in the training set to identify independent risk factors for adverse pregnancy outcomes, and a nomogram prediction model was constructed. The area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve were used to evaluate the discrimination, calibration, and clinical applicability of the model, respectively.

The overall age was (30.9±3.8) years, BMI was (22.77±2.12) kg/m², T1 FPG was (4.43±0.29) mmol/L, T2 FPG was (4.51±0.27) mmol/L, the second-trimester 1 h glucose was (8.54±0.43) mmol/L, and the second-trimester 2 h glucose was (7.10±0.54) mmol/L. Multivariable logistic regression analysis showed that age (OR=1.126, 95%CI: 1.080-1.175), history of adverse pregnancy outcomes (OR=2.080, 95%CI 1.023-4.232), ΔMAP (the change in mean arterial pressure from the first to the second trimester) (OR=1.162, 95%CI 1.124-1.202), the TG/HDL-C ratio (OR=18.849, 95%CI: 11.512-30.862), T1 FPG (OR=3.191, 95%CI 2.120-4.803), ΔFPG (T2 FPG-T1 FPG) (OR=1.154, 95%CI: 1.036-1.285), ΔT2(1 h-FPG) (T2 1 h glucose-FPG) (OR=3.427, 95%CI: 2.674-4.391), and ΔT2(2 h-FPG) (T2 2 h glucose-FPG) (OR=4.155, 95%CI: 3.306-5.221) were risk factors for adverse pregnancy outcomes (all P<0.05). The AUC of the nomogram was 0.902 (95%CI: 0.884-0.919) in the training set and 0.895 (95%CI: 0.877-0.913) in the validation set. The calibration curve showed good agreement between predicted and observed probabilities (Hosmer-Lemeshow test: training set, P=0.708; validation set, P=0.102), and decision curve analysis indicated a net clinical benefit over a threshold probability range of 0.05 to 0.95.

Age, history of adverse pregnancy outcomes, ΔMAP, the TG/HDL-C ratio, and dglycemic dynamic indicators during early and mid-trimester are independent predictors of adverse pregnancy outcomes in pregnant women with normal perinatal glucose levels. The nomogram constructed based on these factors demonstrates good discrimination, calibration, and clinical utility, and can serve as a quantitative tool for early risk identification in this population.

To explore the consistency of lateralization of the head-shaking test (HST), lying-down test (LDT), and rapid axial roll test (RART) with the supine roll test (SRT), and to investigate their relationship with repositioning efficacy in patients with horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV).

Patients diagnosed with primary HC-BPPV using SRT and Dix-Hallpike test at the First Affiliated Hospital of Xi′an Jiaotong University between December 1, 2021 and June 30, 2024 were prospectively enrolled. Based on the order of their visits, all patients were semi-randomly assigned to subgroups to undergo the HST, LDT, or RART as auxiliary provocative tests. The nystagmus elicitation rates of the three tests and their consistency with SRT-based lateralization were compared, and the relationship between lateralization consistency and repositioning efficacy was analyzed.

A total of 585 patients with HC-BPPV were included in the study: 199 cases in the HST group, 190 cases in the LDT group, and 196 cases in the RART group. There were no statistically significant differences in sex, age, body mass index, disease duration, and lesion side among the three groups (all P>0.05). The nystagmus elicitation rate of RART (99.0%, 194/196) was higher than that of HST (31.7%, 63/199) and LDT (56.8%, 108/190), with statistically significant differences (both P<0.017). The consistency rate of lateralization between RART and SRT (86.7%, 170/196) was higher than that of HST (17.6%, 35/199) and LDT (44.2%, 84/190), and there were statistically significant differences (both P<0.017). The impact of lateralization distribution between auxiliary provocation tests and SRT on repositioning efficacy in HC-BPPV was analyzed. The results showed that the cure rate of the consistent lateralization group (92.4%, 267/289) was higher than that of the inconsistent lateralization group (55.3%, 30/76) and the nystagmus non-elicitation group (63.2%, 139/220), with statistically significant differences (both P<0.017). In addition, the cure rate of the RART and SRT lateralization consistent group (98.2%, 167/170) was higher than that of the LDT group (88.1%, 74/84) and the HST group (74.3%, 26/35), with statistically significant differences (both P<0.017).

RART can serve as an effective auxiliary provocation test for the SRT, enhancing the accuracy of determining the affected side in HC-BPPV through a "dual verification" approach and providing valuable reference for clinical assessment.

This study aimed to analyze metabolic characteristics of the umbilical cord blood associated with brain injury in neonates with selective fetal growth restriction (sFGR). A prospective cohort of 30 sFGR twin pairs delivered at Peking University Third Hospital between September 2017 and December 2019 was enrolled. Maternal-fetal clinical data and information on neonatal complications, including brain injury, were collected for both the growth-restricted (sFGR-S) and larger (sFGR-L) fetuses. The mean maternal age at delivery was (30.7±3.9) years, and the mean gestational age at delivery was (32.7±2.2) weeks. Among the 30 sFGR cases, there were 12 cases of type Ⅰ, 11 type Ⅱ, and 7 type Ⅲ. The cohort comprised 30 male and 30 female neonates (50% each). Brain injury occurred in 12 (40%) of the sFGR-S group, including 7 cases of intracranial hemorrhage (IVH), 3 cases of periventricular leukomalacia (PVL), and 2 case with both. In the sFGR-L group, brain injury occurred in 9 (30%) neonates, including 6 cases of IVH, 2 cases of PVL, and 1 case with both. Receiver operating characteristic (ROC) curve analysis for the sFGR-S group yielded an area under the curve (AUC) of 0.853 (95%CI: 0.698-1.000) for tyrosine alone, and an AUC of 0.944 (95%CI: 0.859-1.000) for the combination of tyrosine and myristic acid. For the sFGR-L group, the AUC was 0.880 (95%CI: 0.708-1.000) for S-adenosyl methionine (SAM) alone, and 0.917 (95%CI: 0.749-1.000) for the combination of SAM and trans-vaccenic acid. In conclusion, neonates in the sFGR-S and sFGR-L groups exhibit distinct metabolic profiles, and differential metabolites with their related pathways hold potential predictive value for neonatal brain injury.

Intrahepatic bile duct cystadenoma(IBC) is rare in clinic, and some patients can not tolerate or refuse surgical treatment.The clinical data of patients with IBC who underwent ultrasound-guided percutaneous sclerotherapy combined with radiofrequency ablation (RFA) in the First Affiliated Hospital of Zhengzhou University from January 2020 to November 2024 were retrospectively analyzed. A total of 11 patients were included, including 1 male and 10 females, aged from 35 to 73 years. All the 11 patients successfully completed the operation, and the postoperative complication rate was 36.4%, all of which were Clavien-Dindo grade Ⅰ. The median follow-up time was 36 months (range, 12-66 months), and the last follow-up date was December 1, 2025. One patient had recurrence one month after operation and was treated with ultrasound-guided sclerotherapy combined with RFA again. Up to the last follow-up, the patient had no recurrence or malignant transformation. There was no recurrence or malignant transformation in the remaining 10 patients.There were statistically significant differences in the volume of lesions between before operation and 1, 3, 6, 12 months after operation (all P<0.05), and there were statistically significant differences in the reduction rate of lesion volume between 1 month after operation and 3, 6, 12 months after operation (all P<0.05).This pilot study shows that ultrasound-guided sclerotherapy combined with RFA is safe and effective in the treatment of IBC.

患者女，64岁，因“咳嗽咳痰10 d，咯血半天”于2024年3月11日入住温州市人民医院呼吸内科。既往体健，无吸烟史。2024年3月12日实验室检查结果显示：白细胞计数8.3×10⁹/L，C反应蛋白2.3 mg/L。2024年3月13日胸部增强CT检查结果显示左肺上叶实性结节，大小约26 mm×21 mm，边缘伴毛刺（图A红箭头处），增强扫描后结节边缘强化、中央坏死（图B动脉期图像，红箭头示中心坏死）。结合患者的症状及实验室指标，初步考虑非典型炎症性病变，不除外肿瘤性病变。先后予阿洛西林钠、莫西沙星及美罗培南序贯抗感染治疗，患者症状无改善，复查胸部CT结果显示病灶未吸收；2024年3月15日痰细菌培养结果为阴性，2024年3月19日行支气管镜检查，灌洗液未检出肿瘤细胞。2024年4月3日PET-CT检查结果显示该结节糖代谢增高，病灶的最大标准摄取值为8.3，高度提示恶性可能（图C）。2024年4月10日行CT引导下经皮肺穿刺，病理结果显示镜下可见肺组织肺泡间隔纤维组织增生伴淋巴细胞浸润，肺泡腔内见纤维栓形成。结合患者临床症状及相关检查，最终确诊为隐匿性机化性肺炎（COP）。初始给予口服泼尼松片20 mg，每日2次，后续更换为等效剂量甲泼尼龙片16 mg，每日2次，口服维持治疗，患者临床症状逐步改善；经规范治疗5个月后，2024年9月3日复查胸部CT提示肺内病灶基本吸收（图D）。COP是病因不明的特发性机化性肺炎，核心病理特征为远端气道内机化结缔组织栓填充。该病好发于50~60岁，当表现为孤立性肺结节时，其形态学（如毛刺、坏死）及PET-CT高摄取特征与肺癌高度相似，临床易误诊。对常规抗感染无效疑似肺癌的结节，应将COP纳入鉴别诊断。治疗首选糖皮质激素（疗程6~12个月），期间需严密随访并防治相关并发症。