Volume 106 · Issue 26 · 2026

Stress is a series of non-specific, adaptive physiological and psychological response processes generated by the body when challenged, burdened, or threatened by internal or external environments (e.g., social pressure), with the aim of maintaining homeostasis. Currently, stress-related disorders have become a major public health issue affecting national health. Daily persistent micro-stressors are widely prevalent, and in some individuals, the cumulative effects may lead to decompensation of the regulatory system, manifesting as a subclinical state. However, current diagnostic systems mainly rely on adjustment disorder and posttraumatic stress disorder (PTSD) as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, text revision (DSM-5-TR) and the International Classification of Diseases, Eleventh Edition (ICD-11), both of which have significant limitations: adjustment disorder is a diagnosis of exclusion, while PTSD only covers major traumatic events. Neither DSM-5-TR nor ICD-11 adequately identifies subclinical populations who, under the cumulative effect of daily persistent micro-stressors, have developed mild symptoms and functional decline but do not meet the diagnostic criteria. To address this gap, this paper systematically proposes the concept of "allostatic load stress state" (ALSS), defined as "a transitional clinical state arising from decompensation of the individual′s regulatory system under the cumulative effect of daily persistent micro-stressors, characterized by persistent stress-related symptoms with mild functional decline, but falling below the threshold of existing diagnostic criteria". ALSS integrates the previously indistinguishable core features of "allostatic load" (physiological wear and tear) and "allostatic overload" (clinical distress), filling the gap between normal stress and clinical disorders, and for the first time provides a structured identification criterion for this subclinical population. On this basis, this paper constructs a three-stage continuous spectrum theoretical framework-"normal stress (healthy population)-allostatic load stress (subclinical population)-persistent excessive stress (clinical disorder population)"-clarifying the clinical features, prevention and intervention principles for each stage; establishes a three-dimensional integrated assessment system centered on "stressor-symptom-function" to enable early identification of ALSS; and proposes a non-pharmacological, stratified, stepwise early intervention strategy aimed at providing actionable pathways for subclinical populations and promoting a forward shift in the prevention and management of stress-related disorders.

In recent years, with the publication of multiple prospective randomized controlled trials, abundant evidence-based data have accumulated for axillary management in early breast cancer, and the concept of axillary de-escalation therapy has been widely recognized. Clinical strategies have evolved from the traditional invasive axillary lymph node dissection to minimally invasive sentinel lymph node biopsy, and further to precise individualized treatment with axillary surgery omission (non-invasive management). Such approaches maintain therapeutic efficacy, reduce postoperative complications and improve patients′ quality of life. This paper systematically reviews landmark clinical trials in this field and thoroughly interprets their core findings. Integrating the latest evidence-based data and clinical practical experience, it discusses the core controversies, key clinical implementation considerations and future prospects of axillary de-escalation therapy, so as to provide references for clinical decision-making.

Neoadjuvant therapy (NAT) has strengthened systemic control in breast cancer and promoted precision de-escalation of axillary management. For clinically node-negative patients, evidence supports sentinel lymph node biopsy (SLNB) after NAT; among human epidermal growth factor receptor 2(HER2)-positive and triple-negative breast cancer patients achieving breast pathological complete response, the risk of residual axillary metastasis is extremely low, suggesting the potential omission of axillary surgery. For clinically node-positive patients converting to node-negative (cN1➝ycN0) after NAT, targeted axillary dissection can reduce the false-negative rate of SLNB to 2%-4% with good local control, supporting SLNB as a substitute for axillary lymph node dissection. In patients with low-volume residual nodal disease, axillary radiotherapy is increasingly considered as an alternative to surgery, though long-term evidence is still required. With studies such as NSABP B-51 demonstrating reduced regional irradiation in selected patients, dual de-escalation of surgery and radiotherapy has become a research focus. Future advances in imaging, artificial intelligence, and circulating tumor DNA (ctDNA) may enable individualized axillary decision-making.

With the continuous optimization of systemic treatment regimens and the advancement of imaging assessment technologies, the overall survival rate of early-stage breast cancer has been steadily improving, providing an evidence-based basis for exploring de-escalation of local surgical treatment. This article systematically reviews five pathways for de-escalation of local surgical treatment in breast cancer and their key clinical evidence: selective exemption from breast surgery after neoadjuvant therapy by verifying pathologic complete response through imaging combined with vacuum-assisted biopsy (NRG-BR005, MICRA, MD Anderson Exceptional Responders trials, etc.); active surveillance replacing immediate surgery for low-risk ductal carcinoma in situ (COMET, LORIS, LORD, etc.); percutaneous ablation replacing partial breast-conserving surgery (ICE3, PO-RAFAELO, etc.); exemption from sentinel lymph node biopsy for patients with clinically negative lymph nodes and negative axillary ultrasound (INSEMA, SOUND, etc.); and reducing the false-negative rate (FNR) by using sentinel combined with targeted axillary dissection to avoid axillary lymph node dissection in initially node-positive patients who convert to clinically node-negative after neoadjuvant therapy (ACOSOG Z1071, SENTINA, SN FNAC, etc.). The clinical translation of the above strategies requires precise risk stratification, standardized pathological assessment, closed-loop long-term follow-up, and fully informed decision-making. Its core lies in establishing a comprehensive management plan based on rigorous screening and evidence-driven approaches, grounded in verifiable complete remission or low risk.

This article systematically reviews the latest advances in systemic therapy for early breast cancer (EBC) across different molecular subtypes—hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+HER2-), HER2-positive, and triple-negative breast cancer (TNBC). It elaborates on the evolution of treatment strategies in endocrine therapy, targeted therapy, and immunotherapy. The combination of CDK4/6 inhibitors with adjuvant endocrine therapy has redefined the high-risk population in HR+HER2-breast cancer. PARP inhibitors have become an important therapeutic option for patients with germline pathogenic or likely pathogenic BRCA mutations in HER2-negative disease. Novel oral selective estrogen receptor degraders are expected to emerge as a new adjuvant treatment choice for this subtype. For HER2 positive patients, treatment is now in an era where de-escalation and escalation strategies are pursued in parallel. Antibody drug conjugates (ADC) have profoundly reshaped the treatment landscape for patients who do not achieve pathological complete response (pCR) after neoadjuvant therapy, and their role in neoadjuvant and adjuvant settings is being further explored. In TNBC, refined subtyping and the investigation of subtype-specific combination strategies have significantly improved outcomes in a subset of patients. The use of PD-1/PD-L1 inhibitors combined with chemotherapy in the neoadjuvant setting has entered the exploratory phase of de-escalation. PARP inhibitors and TROP-2 ADC have also achieved breakthrough progress in both neoadjuvant and adjuvant settings. Precision diagnostic tools, including genetic testing and liquid biopsy, are increasingly being integrated into treatment decision-making across all subtypes of breast cancer. Molecular subtype-guided precision medicine now enables individualized systemic therapy for EBC via novel agents and biomarker-driven strategies, optimizing clinical decisions and improving outcomes.

Differentiated thyroid cancer (DTC), the most common subtype of thyroid cancer, exhibits marked regional variations in epidemiology worldwide, with management strategies evolving in response to evidence-based advances in diagnosticsand therapeutic protocols.This article synthesizes global and China-specific epidemiological patterns in DTC, evaluates temporal trends in disease-specific survival across populations, and reviews the evolution of evidence-based guidelines. Building on emerging clinical evidence, it analyzes the rationale for therapeutic de-escalation and critically assesses its implications for clinical practice and patient outcomes.Drawing on adverse outcomes observed in international de-escalation protocols, this study advocates the principle of early detection, early diagnosis, and early treatment (the "three earlies"), establishes a surgery-led multidisciplinary team (MDT) for full-cycle management, and gradually advances to precision diagnosis and treatment, aiming to consolidate and enhance China′s DTC care outcomes.

In recent years, the incidence of breast cancer in young women is increasing across the world, especially in China. Younger patients face a high risk of recurrence and metastasis, along with unique needs related to fertility, psychological well-being, and return to work. Therefore, clinical management must not only aim to ensure survival outcomes but also address their long-term quality of life. More than one hundred Chinese experts from breast surgical oncology, medical oncology, radiation oncology, gynecology, reproductive medicine, genetics and nursing have gathered together to address these challenges. Based on the latest evidence from China and abroad, they have updated the "Expert consensus on the diagnosis and treatment of young breast cancer in China" from "2022 edition" to "2026 edition". This new consensus delves into the diagnosis and treatment of young breast cancer patients, offering suggestions for many clinical questions lacking standard answers. The consensus aims to standardize the diagnosis and treatment procedures, optimize treatment strategies, guide future clinical research, and ultimately improve patients′ prognosis and quality of life.

To further standardize the clinical application of gene methylation detection technology in endometrial cancer screening in China, enhance the capacity for early detection, early diagnosis and early treatment of endometrial cancer, promote precise prevention, control and standardized management of endometrial cancer nationwide, and provide evidence-based consensus recommendations for clinicians and relevant professional technical personnel, this expert consensus has been formulated through multiple rounds of consensus meetings by the Gynecologic Oncology Branch of Chinese Medical Association, the Obstetrics and Gynecology Professional Committee of Chinese Research Hospital Association, and the Obstetrics and Gynecology Health Medicine Branch of China International Exchange and Promotion Association for Medical and Health Care, together with multidisciplinary experts specializing in gynecologic oncology, obstetrics and gynecology, pathology, cancer epidemiology and other fields. With the continuous rise in the incidence rate of endometrial cancer and its younger-onset trend in China, the prevention and control situation has become increasingly severe. Endometrial cancer has definite high-risk factors, making the precise identification of high-risk populations and the rational application of novel screening technologies particularly crucial. At present, gene methylation detection technology has been approved by the National Medical Products Administration (NMPA) for endometrial cancer screening, yet unified specifications and guidelines are still lacking in clinical practice. Centering on gene methylation detection technology, this consensus systematically elaborates its application procedures, risk assessment and management strategies in endometrial cancer screening targeting symptomatic populations, populations with elevated or high risk, and puts forward corresponding screening and management recommendations for the above three groups respectively. This consensus aims to standardize the clinical application of gene methylation detection in endometrial cancer screening, and offer reference and evidence-based support for clinicians in decision-making on endometrial cancer screening and management.

Thyroid eye disease (TED) is the most common orbital disease in adults, with substantial impacts on patients′ appearance, visual function, and quality of life. Magnetic resonance imaging (MRI) demonstrates distinct advantages in depicting characteristic changes in orbital soft tissue structures and serves as one of the primary imaging tools for evaluating disease extent and characterizing pathological features, playing an important role in differential diagnosis, disease classification, and activity assessment of TED. However, current orbital MRI examination protocols for TED lack unified standardization in operational procedures, scanning parameters, sequence selection, and image interpretation. To address this issue, the Oculoplastic and Orbital Disease Group of Chinese Ophthalmological Society of Chinese Medical Association and the Head and Neck Group of Chinese Society of Radiology Chinese Medical Association have jointly developed this expert consensus. Focusing on the core issues in orbital MRI examination and diagnosis of TED, this consensus proposes standardized examination protocols, presents recommended sequences, and establishes principles of image analysis. Furthermore, it summarizes typical imaging features and key differential diagnostic points, ultimately formulating seven recommendations aimed at providing clear and reliable imaging technical guidance for clinicians and researchers.

To evaluate the effects of oxycodone naloxone prolonged-release tablets on bowel function, analgesic control, quality of life, and safety in patients with severe cancer pain and opioid-induced constipation (OIC).

This study is an interim analysis of a prospective, multicenter, single-arm trial. Patients with severe cancer pain and OIC from nine medical institutions in China between April 2025 and January 2026 were enrolled and treated with oxycodone naloxone prolonged-release tablets for 4 weeks. The primary endpoint was bowel function improvement assessed by the Bowel Function Index (BFI). Secondary endpoints included analgesic effect (Brief Pain Inventory-Short Form, BPI-SF), defecation status (Complete Spontaneous Bowel Movement, CSBM), quality of life (Patient Assessment of Constipation Quality of Life, PAC-QOL), and safety (adverse events). One-way repeated measures analysis of variance was used to compare the above measures between different post-treatment time points and baseline. The Lan-DeMets α-spending function (with O′Brien-Fleming adjustment) was applied to adjust the α level for the interim analysis, yielding an interim analysis boundary value of 0.000 6 (two-sided) and a final analysis boundary value of 0.049 8.

Planned enrollment was 203 patients; by January 2026, 78 patients were actually enrolled. The modified full analysis set (mFAS) comprised 64 patients, and the safety analysis set (SAS) comprised 77 patients. In the mFAS group, BFI scores decreased significantly after treatment (F=36.39, P<0.001). The change from baseline in BFI score at week 4 was -26.7 (-39.2, -10.0) points (P<0.001). BPI-SF scores at all post-treatment time points were lower than baseline, and CSBM at all time points increased compared with baseline, and the PAC-QOL score at all time points decreased compared with baseline (all P<0.001). In the SAS group, the daily opioid dose was [M(Q₁, Q₃)] 40.0 (20.0, 65.5) mg. The overall incidence of adverse events was 54.5% (42/77), with the most common being nausea (15.6%, 12/77) and vomiting (14.3%, 11/77). The incidence of serious adverse events was 6.5% (5/77).

Oxycodone naloxone prolonged-release tablets improve bowel function and defecation in Chinese patients with severe cancer pain and OIC, do not compromise analgesic effect, enhance constipation-related quality of life, and demonstrate acceptable safety.

To develop a predictive model for discharge survival in patients with cardiac arrest treated with extracorporeal cardiopulmonary resuscitation (ECPR).

The clinical data of patients with cardiac arrest who received ECPR at Beijing Anzhen Hospital, Capital Medical University from January 2017 to December 2024 were retrospectively analyzed. Three models were constructed using predefined mandatory variables and candidate variables. Model 1 only included pre-specified mandatory variables, Model 2 was a simplified clinical model constructed via variable selection using the least absolute shrinkage and selection operator (LASSO) regression, and Model 3 included both pre-specified mandatory variables and candidate variables with significant contribution, screened by LASSO regression. A multivariable logistic regression model was employed to identify predictors of in-hospital survival, and a prognostic nomogram was developed. Model efficacy was assessed by the area under the receiver operating characteristic curve (AUC), calibration plot, decision curve analysis, optimism-corrected bias, and Brier score.

A total of 149 patients were included, with a hospital survival rate of 31.5% (47/149). Multivariable logistic regression analysis revealed that pre-extracorporeal membrane oxygenation (ECMO) lactate was an independent risk factor for in-hospital survival across all three models (all P<0.05). In Model 2, 24-hour lactate clearance was a protective factor for in-hospital survival (OR=2.676, 95%CI: 1.515-6.264, P=0.007), whereas renal replacement therapy was a risk factor (OR=0.277, 95%CI: 0.107-0.664, P=0.006). In Model 3, both 24-hour lactate clearance (OR=2.691, 95%CI:1.426-6.991, P=0.015) and renal replacement therapy (OR=0.308, 95%CI:0.114-0.775, P=0.015) showed statistically significant differences.The AUC of Model 1, Model 2, and Model 3 were 0.716 (95%CI: 0.630-0.802), 0.821 (95%CI: 0.751-0.891), and 0.827 (95%CI: 0.757-0.898), respectively. The DeLong test demonstrated that the discriminative abilities of both Model 2 and Model 3 were superior to that of Model 1 (both P<0.05), whereas no statistically significant difference was observed between Model 2 and Model 3 (P=0.453). The optimism values of the three models were 0.028, 0.020, and 0.047, respectively, and the Brier scores were 0.189, 0.156, and 0.153, respectively, indicating a lower risk of overfitting in Model 2. Calibration curves and decision curve analysis demonstrated favorable consistency and net benefit of Model 2.

Current model which integrates pre-ECMO lactate, 24-hour lactate clearance rate, renal replacement therapy, age, achieves favorable predictive performance and stability, and can be applied to predict hospital discharge survival in cardiac arrest patients undergoing ECPR.

To evaluate the clinical efficacy of integrated optical-electromagnetic navigation-guided (Ng) transforaminal endoscopic lumbar discectomy (TELD) in the treatment of lumbar disc herniation (LDH).

A retrospective analysis was conducted on data from patients who underwent TELD for LDH at Beijing Chaoyang Hospital, Capital Medical University, between January 2024 and May 2025. A total of 78 patients were included. Patients who underwent TELD using Ng were assigned to the Ng-TELD group (n=37), while those who underwent TELD using the conventional X-ray fluoroscopy method were assigned to the control group (n=41). The operative time, cannulation time, decompression time, number of intraoperative fluoroscopies, visual analogue scale (VAS) scores for leg and back pain, Oswestry Disability Index (ODI), European Quality of Life-5 Dimensions visual analogue scale (EQ-VAS) score, Macnab criteria, and incidence of adverse events during follow-up were recorded and compared between the two groups.

Among the 78 patients, the age was (60.4±16.6) years, with 46 males (59.0%) and 32 females (41.0%). At 3 months postoperatively, significant improvements were observed compared to preoperative values for leg pain VAS [(0.7±0.7) vs (6.2±1.0)], back pain VAS [(0.9±0.6) vs (4.2±1.8)], ODI [(8.4±3.1)% vs (58.5±8.2)%], and EQ-VAS score [(84.0±10.2) vs (53.3±12.0)] (all P<0.05). The Ng-TELD group demonstrated significantly shorter total operative time [(66.3±11.7) vs (81.6±15.6) min], shorter puncture and cannulation time [(5.9±1.2) vs (15.2±4.1) min], shorter endoscopic decompression time [(55.4±11.6) vs (66.3±13.9) min], and fewer intraoperative fluoroscopies [(3.2±1.5) vs (15.7±5.3) times] compared to the control group (all P<0.05). There were no statistically significant differences between the two groups in terms of efficacy evaluation metrics, MacNab criteria outcomes, or the incidence of adverse events (all P>0.05).

Ng-TELD for the treatment of LDH is safe, accurate, and effective.

To analyze the clinical efficacy of high-frequency electromagnetic wave therapy for high-grade vaginal intraepithelial neoplasia (VaIN Ⅱ and Ⅲ) and its advantages over high-frequency electrosurgery. A retrospective study was conducted on 72 patients who underwent colposcopy-guided biopsy in the Department of Gynecology, Guizhou Provincial People′s Hospital from January 2020 to June 2023 and were histologically diagnosed with VaIN Ⅱ and Ⅲ. The patients were divided into a high-frequency electromagnetic wave radiofrequency therapy group (observed group, 42 cases) and a high-frequency electrosurgery group (control group, 30 cases) according to the treatment they received. The age of the control group was 52 (42, 61) years, and that of the observed group was 49 (39, 60) years. Follow-ups were conducted at 1, 3, 6, 12, 18, and 24 months after treatment. The overall cure rate, therapeutic efficacy by lesion grade and location, wound healing time, and intraoperative and postoperative adverse reactions were compared between the two groups. Additionally, the effects of different treatment ranges and power parameters on efficacy in the observed group were analyzed, and changes in HPV clearance rates were compared between the two groups. The results showed that within 24 months, the overall cure rate in the observed group was 71.4% (30 cases), which was higher than that in the control group (46.7%, 14 cases) (P=0.034). The cure rate for vaginal sidewall lesions in the observed group was higher than that in the control group (84.6% vs 63.0%, P=0.042). Wound healing time was shorter in the observed group than in the control group (1.64 vs 2.67 months) (P=0.002). No intraoperative or postoperative bleeding occurred in the observed group, while 5 cases (16.7%) of bleeding occurred in the control group. High-frequency electromagnetic wave radiofrequency therapy has good clinical efficacy for high-grade VaIN. Compared with high-frequency electrosurgery, it offers more significant advantages in improving the cure rate, promoting wound healing, and reducing intraoperative and postoperative bleeding, demonstrating good clinical application value.

Pruritus is a common manifestation of many skin diseases and systemic diseases, which seriously affects the quality of life of patients. Skin is composed of keratinocytes, mast cells, lymphocytes, dendritic cells, fibroblasts, hair follicle stem cells and other resident cells, and these cells are significantly heterogeneous, which play a key role in the generation, maintenance and regulation of pruritus signals. This review summarizes the latest classification of skin resident cells and explores the potential role of these cells in pruritic diseases such as atopic dermatitis, psoriasis, chronic urticaria, prurigo nodosum, bullous pemphigoid, etc. Through the in-depth understanding of the classification of skin resident cells and the mechanism of pruritus, it will provide important reference for the diagnosis and treatment of pruritus diseases.

In the article "Clinical Practice Guidelines for Perioperative Monitoring of Elderly Patients (2026 Edition)", Volume 106, Issue 16, April 28, 2026, Chinese Medical Journal, "EEG" in pages 1563, 1566~1567 should be "electrocardiogram", which is hereby corrected.