Volume 106 · Issue 25 · 2026

Electroconvulsive therapy (ECT) is an effective treatment for depression,but it is associated with severe side effects such as memory impairment. The number of ECT sessions is a key determinant of clinical efficacy and adverse effects, such as memory impairment. The frequency of ECT is the main factor affecting clinical efficacy and side effects, yet its clinical application has long relied on an empirical range of 6-12 sessions, with significant controversy and practice heterogeneity, leading to insufficient or excessive treatment. This article systematically analyzes the current status of ECT session, deeply explores the session-effect relationship with efficacy and side effects, and clarifies the key influencing factors of the number of ECT sessions from the perspectives of patients, diseases, and technology. Based on these insights, an integrated standardization path with standardized construction, individualized decision-making, precision technology, and innovative joint models as the core is proposed to promote the transformation of the number of ECT sessions to an evidence-based medicine model, which has important clinical value for optimizing the quality of depression treatment and reducing cognitive risks.

The incidence of perioperative malnutrition in surgical patients is relatively high. Surgical trauma can further aggravate the malnutrition status, which is one of the key factors that increases postoperative complications and affects postoperative recovery. Developed by multidisciplinary domestic experts and scholars organized by the Chinese Society of Parenteral and Enteral Nutrition, "practice guidelines for the whole-course perioperative nutritional management in adults(2026 Edition)"complies with relevant domestic and international codes and adheres to the principles of scientization, standardization, transparency and institutionalization. This guideline is compiled on the basis of the nutritional and metabolic characteristics of surgical patients across preoperative, postoperative and post-discharge stages, as well as the core methodologies and standard procedures for formulating clinical diagnosis and treatment guidelines. It summarizes 18 clinical questions and 39 recommendations. The guideline intends to provide a reference for domestic surgeons to conduct perioperative medical nutritional therapy and benefit all surgical patients in need of nutritional intervention. It will be dynamically revised according to updated domestic and international evidence and research progress, so as to continuously promote the standardized application of perioperative medical nutritional therapy.

Alzheimer′s disease (AD) is a major health threat to the elderly. With the clinical application of disease-modifying therapeutic drugs, early and accurate diagnosis of AD has become increasingly essential. Given the ease of collection, blood biomarker detection has emerged as a crucial method for early screening, clinical diagnosis, and disease monitoring of AD. In recent years, substantial progress has been achieved in the research of AD blood biomarkers, and some indicators have been introduced into clinical practice. However, the detection of AD blood biomarkers, such as β-amyloid protein and phosphorylated tau protein, are highly susceptible to pre-analysis factors, which reduces the reliability of their clinical application and restricts the comparability among different blood biomarker studies. Currently, in China, there is a growing trend in the scientific research, testing product development, and clinical application of AD blood biomarkers. Therefore, it is necessary to standardize the AD blood biomarker detection in China. Based on this background, Cognitive Impairment Working Group of the National Medical Quality Control Center for Neurological Diseases established the "Standard operating procedure for pre-analytical blood biomarker processing in Alzheimer′s disease (2026 edition)". This standard is developed in line with international recommendations, incorporating the practical experience of blood biomarker research in China and taking into consideration both clinical and research needs. It formulates a standardized operating procedure for the pre-treatment of blood samples, providing a quality control reference for the research and clinical application of AD blood biomarkers in China.

To explore the clinical and objective sleep characteristics of the severity of sleepiness in children and adolescents with narcolepsy type 1 (NT1), and to analyze the influence of nocturnal sleep parameters on excessive daytime sleepiness (EDS).

This was a cross-sectional study. One hundred and fourteen children and adolescents (age <18 years) diagnosed with NT1 at the Department of Neurology, Tangdu Hospital, the Fourth Military Medical University from January 2015 to January 2025 were retrospetively included. The patients were divided into mild [mean sleep latency (MSL)>2.80 min], moderate (0.97 min<MSL≤2.80 min), and severe (MSL≤0.97 min) EDS groups according to quartiles of the (MSL on multiple sleep latency test (MSLT). Demographic data, clinical features, nocturnal polysomnography (nPSG) parameters, and MSLT parameters were compared among the three groups. Pearson correlation and Spearman rank correlation were used to analyze the correlation of MSL with mean rapid eye movement sleep latency (MRL) and with the Epworth sleepiness scale (ESS) score, respectively. Generalized linear models were used to analyze factors influencing MSL and MRL.

There were 28 (24.56%), 58 (50.88%) and 28 (24.56%) cases in mild, moderate, and severe EDS groups, respectively. Intergroup comparisons showed statistical differences in age of consultation (P=0.012) and the prevalence of comorbid anxiety (P=0.020) and depression (P=0.035). nPSG results revealed that sleep latency (SL) progressively shortened with increasing EDS severity, with significant differences among all three groups (all P<0.05); The proportion of N1 sleep was higher in the moderate EDS group than that in the mild group (P<0.05); The lowest nocturnal oxygen saturation was lower in the moderate and severe EDS groups than that in the mild group (all P<0.05). MSLT results indicated that MRL progressively shortened with increasing EDS severity, with significant differences among all three groups (all P<0.05); The number of sleep-onset rapid eye movement (REM) periods and the average duration of REM sleep were higher in the moderate and severe EDS groups than those in the mild group (all P<0.05); The severe EDS group showed more frequent Awake-REM transitions compared with the mild group (P<0.05). Generalized linear modeling identified shorter nocturnal SL, longer N1 sleep duration, higher arousal index, and higher periodic limb movements index as factors associated with shorter MSL (β=0.08, P<0.001; β=-0.01, P=0.022; β=-0.08, P=0.003; β=-0.27, P=0.024); Shorter nocturnal SL and shorter nocturnal REM sleep latency were factors of shorter MRL (β=1.26, P<0.001; β=0.01, P=0.019). Spearman′s rank correlation coefficient showed that no significant correlation was found between Epworth sleepiness scale scores and objective MSL (ρ=-0.099, P=0.299).

The severity of objective EDS in children and adolescents with NT1 is associated with nocturnal sleep disturbances. Therefore, in clinical practice, clinical evaluation should encompass both daytime symptoms and nocturnal sleep quality to improve overall prognosis.

To evaluate the consistency of measurement results and diagnostic agreement of core cerebrospinal fluid (CSF) biomarkers for Alzheimer disease (AD) in a Chinese population, which were measured across a domestically developed electrochemiluminescence platform (Lifotronic eCL8000), a Japanese chemiluminescence immunoassay platform (LUMIPULSE), and an American electrochemiluminescence platform (Meso Scale Discovery, MSD).

CSF samples were retrospectively collected from 253 subjects recruited at Peking Union Medical College Hospital, Xuanwu Hospital Capital Medical University, and Beijing Tiantan Hospital between July 2013 and September 2019. The cohort was comprised of 132 males and 121 females, with the age of (62.4±13.3) years. All CSF samples were collected via standardized protocols and cryopreserved at -80 ℃. Inter-assay repeatability (coefficient of variation, CV) of the Lifotronic platform on different days was validated. Spearman′s rank correlation analysis was used to evaluate the degree of correlation between the results of the Pumen platform and those of the LUMIPULSE and MSD platforms, with the correlation coefficient expressed as ρ. Subsequently, 4 core CSF biomarkers [β-amyloid 40 (Aβ40), β-amyloid 42 (Aβ42), phosphorylated tau (p-tau), and total tau (t-tau)] were quantitatively measured across the three platforms. The consistency of test results between platforms was evaluated using the Passing-Bablok regression model and Bland-Altman analysis. The 95% limits of agreement (LoA) were calculated by Bland-Altman analysis, with good agreement indicated when <5% of points fell outside the limits. Proportional and constant errors between the measurement systems were quantified by the Passing-Bablok regression model, utilizing a robust non-parametric method. ¹⁸F-florbetapir positron emission tomography/positron emission tomography/computed tomography (PET/CT) imaging has been performed on 40 of the 253 subjects. With the PET/CT diagnostic results utilized as the gold standard, the diagnostic agreement between the CSF results from the 3 platforms and the PET/CT findings was compared by calculating Cohen′s Kappa coefficient. Furthermore, AD diagnostic reference cut-off values for each platform were determined by employing receiver operating characteristic (ROC) curves.

The Lifotronic platform demonstrated good repeatability in CSF testing (CV<10%). Spearman′s rank correlation analysis was used to evaluate the correlation between the Lifotronic platform and the LUMIPULSE and MSD platforms, with correlation coefficients denoted by ρ. In comparison with the LUMIPULSE platform, all correlation coefficients (ρ) were>0.85. The correlation coefficient (ρ) between the MSD and Lifotronic platforms was>0.80, with a Kappa value of 0.698 (P<0.05). Bland-Altman analysis and Passing-Bablok regression models showed that for t-tau, the mean bias between Lifotronic and LUMIPULSE was 214.95 (95%LoA:-1 490.59-1 920.50), with 99.60% (252/253) of the data points falling within the 95%LoA. In the detection of t-tau, the regression slope between the Lifotronic and LUMIPULSE platforms was 2.041 (Equation: Y=2.041X-75.184), and the regression slope with the MSD platform was 2.360 (Equation: Y=2.360X-87.503). Based on PET/CT imaging validation, the CSF diagnostic results of the Lifotronic platform were consistent with the PET/CT results (Kappa=0.885, P<0.05), as were those of the MSD platform (Kappa=0.714, P<0.05). The Lifotronic platform established AD diagnostic reference thresholds based on the t-tau/Aβ42 and p-tau-181/Aβ42 ratios (the cut-off value for t-tau/Aβ42 was 0.32, and for p-tau-181/Aβ42 was 0.035). The Kappa value between the Lifotronic and LUMIPULSE platforms was 0.928 (P<0.05), and the Kappa value between the Lifotronic and MSD platforms was 0.698 (P<0.05).

This study systematically validated the reliability of domestically developed Lifotronic electrochemiluminescence platform and its corresponding assay kits in detecting AD CSF biomarkers, as well as their comparability with international platforms, demonstrating comparable capabilities in terms of accuracy, consistency, and cost control.

To explore the expression characteristics of complement C3 in childhood asthma and its mechanism of regulating macrophage migration and polarization in immune inflammatory responses.

(1) Clinical research section:a total of 200 children hospitalized and diagnosed with acute asthma exacerbation at Children′s Hospital of Soochow University from January 2020 to December 2023 were retrospectively enrolled, including 135 males and 65 females with a mean age of (7.0±3.0) years. According to clinical symptoms on admission, patients were divided into mild group (n=89), moderate group (n=71) and severe group (n=40). Meanwhile, 100 healthy children receiving physical examination during the same period were recruited as healthy control group, consisting of 64 males and 36 females with a mean age of (6.6±3.5) years. Clinical characteristics were compared between the asthma group and healthy control group as well as among asthma subgroups of different severities. Multivariate logistic regression model was applied to analyze relevant factors associated with asthma severity. (2) Animal experiment section:Female C3 knockout (C3^-/-) mice aged 6 to 8 weeks and weighing (20±2) g were selected. Female wild-type C57BL/6J mice aged 6 to 8 weeks with a body weight of (20±2) g served as the control group. There were 10 mice in each group. All mice were randomly divided into 4 groups using a random number table method: wild-type control group, wild-type asthma group, C3^-/- control group and C3^-/- asthma group, with 5 mice in each group. Asthma mouse models were established by airway instillation sensitization and challenge with cockroach extract, while phosphate buffered saline (PBS) was administered in control groups. All mice were anesthetized and sacrificed on day 14. Bronchoalveolar lavage fluid (BALF) was collected for classification and counting of inflammatory cells. Enzyme-linked immunosorbent assay was used to detect levels of Th2 cytokines including interleukin-4 (IL-4) and interleukin-5 (IL-5) in BALF, as well as serum total immunoglobulin E (IgE) and immunoglobulin G1 (IgG1). Lung tissues were harvested, and quantitative real-time polymerase chain reaction (qRT-PCR) was performed to assess the distribution and polarization of M1-type (iNOS⁺) and M2-type (Arg-1⁺) macrophages. (3) Cell experiment section: murine macrophage cell line RAW264.7 was cultured in vitro and treated with different concentrations of recombinant C3 protein to observe macrophage migration ability. Cells were divided into PBS group, recombinant C3 protein group, and recombinant C3 protein combined with SB290157 (C3a receptor antagonist) group according to interventions. Cells were stimulated with PBS, IL-4 and lipopolysaccharide (LPS), respectively. The polarization of M1 (iNOS⁺) and M2 (Arg-1⁺) macrophages was detected via qRT-PCR.

(1) Clinical sample results: the level of complement C3 in the asthma group was significantly higher than that in the healthy control group [(1.20±0.20) vs (0.98±0.18) g/L, P<0.001]. Children with moderate and severe asthma had elevated complement C3 levels compared with those with mild asthma [(1.27±0.19) vs (1.13±0.20) g/L, (1.22±0.16) vs (1.13±0.20) g/L, both P<0.05]. Multivariate logistic regression analysis indicated that complement C3 was positively correlated with moderate-severe asthma (OR=12.373, 95%CI: 1.756-87.153). (2) Animal experimental results: the total number of inflammatory cells, counts of neutrophils, eosinophils, macrophages and lymphocytes, as well as levels of IL-4 and IL-5 in BALF were lower in the C3^-/- asthma group than those in the wild-type asthma group. Serum total IgE and IgG1 levels were also decreased (all P<0.05). qRT-PCR results revealed that the relative mRNA expression of iNOS and Arg-1, together with the M2/M1 ratio in lung tissues were lower in the C3^-/- asthma group (all P<0.05). (3) Cell experimental results: compared with the PBS group, recombinant C3 protein significantly enhanced macrophage migration ability, and the absorbance (A) increased with the elevation of recombinant C3 protein concentration (all P<0.05). After LPS stimulation, macrophage differentiation toward M1 phenotype was markedly higher in the recombinant C3 protein+SB290157 group than in the PBS group and recombinant C3 protein group (all P<0.001). Following treatment with PBS, IL-4 or LPS, M2 polarization level was higher in the recombinant C3 protein group relative to the PBS group, while the recombinant C3 protein+SB290157 group presented lower M2 polarization than the other two groups (all P<0.01).

Complement C3 is markedly elevated in children with asthma and positively correlated with moderate and severe asthma. Complement C3 may enhance macrophage migration and promote M2 polarization, thereby participating in and aggravating immune inflammatory responses in asthma.

To observe alterations in the intratumoral distribution of CD8⁺T cells in humanized glioblastoma (GBM) bearing mice models during the treatment with dendritic cell (DC) vaccine and/or programmed death monoclonal antibody-1 monoclonal antibody (PD-1mAb), using ⁶⁸Ga-NODAGA-SNA006 with positron emission tomography-computed tomography (PET-CT) imaging.

A humanized glioblastoma xenograft model was established using humanized T cell-reconstituted mice (hu-TCRM). Mice were randomly divided into four groups (n=15 per group) according to the random number table: control (placebo), PD-1mAb, DC, and DC+PD-1mAb groups. Small-animal fluorescence imaging was performed daily to monitor treatment response. After 20 days of treatment, intracranial tumor volumes was calculated using magnetic resonance imaging (MRI). The CD8-targeted probe ⁶⁸Ga-NODAGA-SNA006 was used with PET-CT for in vivo visualization to acess intratumoral CD8⁺T lymphocyte distribution. Subsequently, the ex vivo analyses were conducted: immunohistochemistry was used to observe CD8⁺T lymphocyte infiltration in tumor tissue and lymph nodes, and flow cytometry was employed to quantify the numbers of infiltrating CD8⁺T lymphocytes in each group of mice. The comparisons among multiple groups were conducted using one-way analysis of variance, and pairwise comparisons between groups were performed using the Tukey HSD test.

Small animal fluorescence imaging showed that on day 12 of treatment, tumor fluorescence intensity in the DC+PD-1mAb group was significantly lower than that in the control group (P<0.001). MRI results indicated that the tumor volumes in the DC+PD-1mAb group was significantly smaller than that in the control group (P<0.001). Both PET-CT and flow cytometry analyses revealed that on day 20 probe accumulation within tumors and the numbers of CD8⁺T lymphocytes in tumor tissue were significantly increased in the DC group and the DC+PD-1 mAb group compared to the control group (Intratumoral probe accumulation: control group vs DC group, P<0.001; control group vs DC+PD-1mAb group, P<0.001. Intratumoral CD8⁺ T lymphocyte count: control group vs. DC group, P<0.01).

Tumor-bearing mice treated with DC vaccine or PD-1 mAb showed significantly increased intratumoral infiltration of CD8⁺T lymphocytes, with the most pronounced infiltration observed in the combination therapy group. The ⁶⁸ Ga-NODAGA-SNA006 probe combined with PET-CT can reliably visualize changes of intratumoral CD8⁺T lymphocytes in brain GBM tumors during immunotherapy.

To systematically evaluate the prevalence of small intestinal bacterial overgrowth (SIBO) in patients with functional gastrointestinal disorders (FGID).

The literature were systematically searched from PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Chinese Periodical Database, with the search period from the database establishment to November 20th, 2025. Studies that diagnosed SIBO via breath tests or jejunal/duodenal aspirate culture and FGID based on Rome criteria were included. The trial group consisted of patients with FGID, while the control group comprised individuals without significant gastrointestinal symptoms. According to the inclusion and exclusion criteria, two investigators independently performed literature screening, data extraction, and quality assessment. The outcome measure was the prevalence of SIBO (including the total sample size and the number of positive cases). Data processing and meta-analyses were performed using R software (version 4.5.2). The effect measures were the SIBO prevalence and odds ratio (OR), and heterogeneity was evaluated using the I² statistic. Subgroup analysis (by FGID subtype, testing method, etc.) and regression analysis (variables include age, region, etc.) were conducted.

A total of 81 studies were included, involving 6 017 cases in the trial group and 1 826 cases in the control group. The prevalence of SIBO in the trial group was 39.0% (95%CI: 33.3%-44.8%, I²=95.0%), higher than 11.5% (95%CI: 8.7%-14.6%, I²=72.2%) in the control group. FGID patients had an increased risk of SIBO (OR=5.27, 95%CI: 3.91-7.10, P<0.001, I²=58.3%). Subgroup analysis by FGID subtypes showed that the overall prevalence of SIBO in irritable bowel syndrome (IBS) was 40.4% (95%CI: 36.2%-44.9%, I²=93.0%), with the highest prevalence in diarrhea-predominant IBS(IBS-D) (41.3%, 95%CI: 36.6%-46.1%, I²=76.6%); The prevalence of SIBO was 37.9% (95%CI: 26.8%-50.4%, I²=79.5%) in functional constipation (FC) and 30.1% (95%CI: 21.8%-39.9%, I²=84.4%) in functional dyspepsia (FD). Subgroup analysis by testing method showed that lactulose breath test yielded higher prevalence (45.7%, 95%CI: 41.3%-50.2%, I²=91.7%) than glucose breath test (28.7%, 95%CI: 23.6%-34.4%, I²=86.1%) (P<0.001). Regression analysis suggested a weak positive correlation between age and SIBO prevalence (β=0.003, 95%CI: -0.001-0.008, P=0.178), and a higher risk of SIBO in Asian populations compared with non-Asian populations (β=0.182, 95%CI: 0.094-0.278, P<0.001).

SIBO prevalence is elevated in patients with FGID, particularly among those with IBS-D;with diagnostic modality and geographic region contributing to variability in estimates.