Volume 106 · Issue 27 · 2026

Adrenal diseases encompass functional disorders (including primary aldosteronism, pheochromocytoma and paraganglioma, and Cushing′s syndrome) and non-functional adrenal incidentalomas, requiring endocrine functional evaluation for diagnosis and often surgical intervention for treatment. Under the traditional departmental model, patients frequently experience repeated hospitalizations, fragmented clinical information, and unclear responsibility boundaries. This study describes the institutional design and preliminary operational experience of an integrated ward dedicated to adrenal disorders at Fuzhou University Affiliated Provincial Hospital. The model is centered on a dynamic leadership mechanism that assigns primary clinical responsibility to endocrinology or urology according to the stage of care. This framework is supported by 3 complementary measures: a 48 h embedded ward-round system, tiered multidisciplinary team (MDT) admission criteria, and a written handover protocol, thereby incorporating multidisciplinary collaboration into a structured institutional workflow. During a 2-month pilot period, 36 patients were admitted. Core procedural pathways were successfully implemented, and MDT participation increased compared with the traditional departmental model. No major perioperative adverse events were observed among patients undergoing high-complexity surgical procedures, and no obvious increase in patient cost burden was observed. These preliminary observations suggest that the institutional framework may be feasible for coordinating multidisciplinary care of adrenal diseases. However, given the limited sample size and short observation period, further validation through larger prospective and multicenter studies is required.

Pheochromocytoma and paraganglioma (PPGL) are rare neuroendocrine tumors characterized by remarkable clinical heterogeneity and genetic complexity. Conventional diagnostic and therapeutic strategies have largely relied on catecholamine assessment, anatomical imaging, and surgical resection; however, these approaches exhibit substantial limitations in metastatic risk stratification and personalized management for metastatic PPGL. Advances in genomics have enabled the establishment of the molecular cluster classification for PPGL, including pseudohypoxic, kinase-signaling, and Wnt-altered clusters, and corresponding strategies for precise nuclear medicine imaging and tumor surveillance. Recently, the refined application of nuclear medicine molecular imaging, the publication of international consensus guidelines on the management of patients with SDHB and SDHD mutations, and the approval of the hypoxia-inducible factor-2α (HIF-2α) inhibitor belzutifan, collectively have marked the entry of PPGL management into the era of precision medicine. Nonetheless, molecular cluster-guided targeted therapies for metastatic PPGL have not yet been incorporated into clinical guidelines, due to poorly characterized molecular mechanisms, a lack of patient-derived preclinical models, and the absence of cluster-specific, head-to-head clinical trials. Looking forward, the precision medicine in PPGL will move toward refined molecular subtyping, individualized treatment, integrated theranostic approaches, and multicenter collaboration.

The management of traumatic brain injury (TBI) in maritime settings faces multiple challenges, including significant disparities in medical platform capabilities compared to land-based systems, spatial constraints and persistent vessel motion, limitations in power supply, oxygen, and consumables, unstable conditions for monitoring and imaging, evacuation influenced by sea-state windows, and difficulties in inter-platform handovers. These factors lead to a significantly increased risk of preventable secondary brain injury. To standardize the early treatment and transportation management of patients with TBI in maritime environments, and to enhance the continuity and operability of the maritime treatment chain, Guidelines for the management of traumatic brain injury in the maritime environment (2026 edition) was developed by experts convened under the leadership of the Neurosurgery Specialist Alliance of the Joint Logistics Support Force, in collaboration with the Neurotrauma Society of the China International Exchange and Promotive Association for Medical and Health Care, Neurotrauma Group of the Chinese Congress of Neurological Surgeons, and Craniocerebral Trauma Panel of the Neurosurgery Society of the Beijing Medical Association. With the core principles of "reducing secondary brain injury and ensuring continuity of care", this guideline synthesizes relevant domestic and international guidelines along with practical experience from resource-limited or delayed evacuation scenarios. Utilizing a grading system for evidence quality (A, B, C, D) and recommendation strength (strong recommendation, weak recommendation, conditional strong recommendation), it provides 25 recommendations focusing on: on-scene management and triage upgrade; tiered decision-making under conditions of limited imaging and monitoring; platform capability classification and evacuation pathways; minimum en-route monitoring configurations; and specific risk management for the maritime environment. This guideline aims to provide an executable, verifiable, transferable, and trainable standardized management framework for maritime TBI patients, offering a reference for clinical decision-making on various maritime medical platforms and evacuation nodes.

Idiopathic normal pressure hydrocephalus (iNPH) is a common and treatable syndrome related to cerebrospinal fluid circulation disorders in the elderly, with clinical problems including missed diagnosis, misdiagnosis and significant variations in therapeutic efficacy. Therefore, multidisciplinary experts in the Chinese Association for Geriatric Health Care′s Hydrocephalus Specialty Branch, the Chinese Medical Association′s Neurosurgery Branch, the Chinese Neurosurgery Critical Care Management Collaborative Group, and the Beijing Medical Association′s Neurosurgery Branch were organized to formulate the Expert consensus for the diagnosis and treatment of idiopathic normal pressure hydrocephalus (2026 edition). Based on the Chinese expert consensus on the diagnosis and treatment of idiopathic normal pressure hydrocephalu (2016 edition), this consensus systematically reviews relevant literature from January 2016 to June 2025. Combining the findings of comprehensive qualitative analysis and clinical practice, it develops clinical practice recommendations covering epidemiology, pathophysiological mechanisms, diagnosis, assessment, treatment and follow-up. This consensus clarifies the core clinical features, characteristic imaging features, and key auxiliary diagnostic indicators. Comprehensive diagnosis of iNPH requires integration with the results of the cerebrospinal fluid tap test, and differential diagnosis should be made from various neurodegenerative diseases and secondary hydrocephalus. The cerebrospinal fluid tap test is recommended as the core preoperative evaluation tool, with standardized multi-dimensional assessment methods for cognition, urinary function and gaitto match the test. Surgical shunting is confirmed as the current effective treatment, with detailed recommendations on the selection of surgical approaches, shunt system selection and the management of comorbidities, 39 recommendations were finally established. This consensus provides a standardized reference for the clinical diagnosis, assessment and treatment of iNPH. It also highlights future research directions, including early diagnostic biomarkers, minimally invasive surgical techniques and intelligent shunt systems.

The incidence of mucormycosis has been increasing among patients with hematologic malignancies and those undergoing hematopoietic stem cell transplantation (HM/HSCT). Owing to the lack of specific clinical manifestations and sensitive diagnostic modalities, delays in treatment are common, often resulting in rapid disease progression and high mortality. In China, standardized guidelines for the diagnosis, management, and prevention of mucormycosis in this high-risk population remain insufficient. On this basis, the consensus was led by the Mycology Committee of the Chinese Medical Education Association, which convened 23 experts in hematology and infectious diseases from 17 institutions across China. The consensus was developed jointly based on evidence-based medicine and expert experience. During the drafting process, reference was made to the guidelines of the European Organization for Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium (EORTC/MSGRC), the European Confederation of Medical Mycology/Mycoses Study Group Education and Research Consortium (ECMM/MSGERC), the European Conference on Infections in Leukemia (ECIL), as well as the Chinese Expert Consensus on the Clinical Diagnosis and Treatment of Mucormycosis (2022). These were integrated and adapted in accordance with the epidemiological characteristics and clinical needs of mucormycosis in China. This consensus adopts the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system for rating the quality of evidence. Focusing on key aspects of diagnosis, treatment, and prevention of mucormycosis in HM/HSCT patient, a total of 12 core clinical questions were systematically identified. Following multiple rounds of discussion and iterative revision, 19 recommendations were ultimately developed, aiming to provide practical guidance for standardized clinical management of mucormycosis in patients with HM/HSCT in China.

To evaluate the impact of dietary sodium intake on therapeutic efficacy and short-term renal injury in patients after treatment for primary aldosteronism(PA).

A retrospective study was conducted on PA patients admitted between May 2017 and November 2024. Sodium intake was assessed via 24 h urinary sodium excretion before treatment. Patients were categorized into normal sodium (<6 g/d) and moderate-to-high sodium (≥6 g/d) groups. The baseline clinical characteristics of the two groups were compared. Spearman correlation analysis was used to analyze the correlations between sodium intake and baseline clinical indicators. The efficacy and renal function indicators were compared after 6 months of mineralocorticoid receptor antagonist (MRA) therapy or adrenalectomy. Restricted cubic spline model were used to analyze the nonlinear correlations between sodium intake and post-treatment urinary albumin-to-creatinine ratio (UACR).

A total of 239 patients were enrolled, including 122 males and 117 females with the age of (49.0±11.3) years. Among them, 72 patients were categorized into the normal sodium intake group and 167 into the moderate-to-high sodium intake group. Levels of UACR, urinary albumin excretion rate (UAER), 24 h urinary protein and 24 h urinary potassium were significantly higher in the moderate-to-high sodium intake group relative to the normal sodium intake group (all P<0.05). Spearman correlation analysis demonstrated that daily sodium intake was positively correlated with systolic blood pressure (SBP) (r=0.180), 24 h urinary potassium (r=0.375), UACR (r=0.224) and UAER (r=0.150) in patients with primary aldosteronism (all P<0.05). Following MRA pharmacotherapy, patients in the moderate-to-high sodium intake group exhibited higher SBP [130.0(120.0, 140.0) vs 120.0(119.0, 130.0) mmHg(1 mmHg=0.133 kPa), P=0.026] and a lower proportion of normotensive cases [65.6%(40/61) vs 90.9%(30/33), P=0.010] compared with the normal sodium intake group. After surgical intervention, the moderate-to-high sodium intake group achieved a greater reduction in SBP [-17.3(-26.5, -9.5) vs -7.0(-24.7, 1.7) mmHg, P=0.023], alongside a more prominent decline in UACR [-11.15(-35.75, 4.75) vs 0.10(-7.28, 7.33) mg/g, P=0.008] than the normal sodium intake group. Restricted cubic spline analysis revealed a "J-shaped" nonlinear association between baseline sodium intake and postoperative UACR. When sodium intake was ≥6.65 g/d, postoperative UACR increased progressively along with rising sodium intake.

Moderate-to-high sodium intake is detrimental to blood pressure control and renal protection in patients with PA, while surgical treatment can partially alleviate the negative effects of moderate-to-high sodium intake on their blood pressure and kidneys. Sodium intake restriction should be an important component of comprehensive management for PA.

To investigate the diagnostic efficacy of the captopril challenge test (CCT) for primary aldosteronism (PA).

Hypertensive patients suspected of having PA who visited the First Affiliated Hospital of Sun Yat-sen University from July to December 2021 were prospectively collected. The patients were divided into an essential hypertension (EH) group and a PA group based on etiology. All patients completed the CCT, and their plasma aldosterone concentration (PAC) was detected using both chemiluminescence immunoassay (CLIA) and liquid chromatography-tandem mass spectrometry (LC-MS/MS). The area under the receiver operating characteristic curve (AUC) was used to evaluate the diagnostic efficacy of each parameter, with the maximum Youden index selected as the cut-off value. The DeLong test was applied to compare the differences in AUC among various diagnostic parameters.

A total of 88 patients were included, consisting of 45 in the EH group and 43 in the PA group. Patients in the PA group were older than those in the EH group [(52.1±10.5) vs (47.6±13.5) years]. The PA group had lower serum potassium [3.5 (3.1, 4.0) vs 3.9 (3.7, 4.1) mmol/L] and direct renin concentration (DRC) [3.0 (2.0, 6.0) vs 14.0 (9.0, 22.0) ng/L], but higher serum sodium [143.0 (140.0, 145.0) vs 141.0 (139.0, 142.0) mmol/L], PAC [34.9 (26.6, 69.1) vs 23.9 (17.2, 29.8) ng/dl] and plasma aldosterone-to-renin ratio (ARR) [9.8 (5.0, 44.4) vs 1.6 (1.0, 2.7) (ng·dl^-1)/(ng·L^-1)] (all P<0.05). Among all parameters for diagnosing PA, the top 3 indicators with the largest AUC values were ARR at 1 h post-CCT (PAC measured by CLIA) [0.953(95%CI:0.886-0.987)], ARR at 2 h post-CCT (PAC measured by CLIA) [0.970(95%CI:0.909-0.994)], and ARR at 2 h post-CCT (PAC measured by LC-MS/MS) [0.952(95%CI: 0.884-0.986)]. Pairwise comparisons of the AUCs among these 3 indicators showed no statistically significant differences (all P>0.05), and their optimal cut-off values were 2.6, 2.5, and 1.6 (ng·dl^-1)/(ng·L^-1), respectively.

The ARR at 1 h post-CCT may serve as a simpler, more convenient, and accurate diagnostic indicator for PA.

To compare the predictive efficacy of the midnight 1 mg dexamethasone suppression test combined with the adrenocorticotropic hormone(ACTH) stimulation test versus three prediction models for idiopathic hyperaldosteronism (IHA).

Clinical data of patients diagnosed with aldosterone-producing adenoma (APA) and IHA at the First Medical Center of Chinese PLA General Hospital from January 2020 to August 2025 were retrospectively analyzed. Patients were definitively diagnosed by adrenal vein sampling (AVS), adrenal surgical pathology, and postoperative follow-up, and were divided into APA group and IHA group. The midnight 1 mg dexamethasone suppression test combined with the ACTH stimulation test, the Xiao model, the Kobayashi 2018 model, and the Umakoshi model were respectively used to predict IHA. The McNemar test was used to compare the sensitivity and specificity of the midnight 1 mg dexamethasone suppression test combined with the ACTH stimulation test with those of the three prediction models for IHA.

A total of 175 patients were enrolled, aged 54.0 (45.0, 59.5) years, including 85 males and 90 females. Among them, 82 were in the APA group and 93 in the IHA group. Using the criterion of 90 min plasma aldosterone concentration (PAC)<39.05 ng/dl after the midnight 1 mg dexamethasone suppression test combined with ACTH stimulation test to predict IHA, the sensitivity and specificity were 90.3% and 93.9%, respectively. Using the recommended predictive probability≥0.9 of the Xiao model as the criterion to predict IHA, the sensitivity and specificity for diagnosing IHA were 47.3% and 95.1%, respectively. Using the recommended score≥ 8 points of the Kobayashi 2018 model as the criterion to predict IHA, the sensitivity and specificity for diagnosing IHA were 16.1% and 98.8%, respectively. The Umakoshi model showed a sensitivity of 17.2% and a specificity of 97.6% for diagnosing IHA. The sensitivity of the midnight 1 mg dexamethasone suppression test combined with the ACTH stimulation test in diagnosing IHA was significantly higher than that of the Xiao model, the Kobayashi 2018 model, and the Umakoshi model (all P<0.001), while there were no statistically significant differences in specificity between the combined test and the three models (all P>0.05).

The midnight 1 mg dexamethasone suppression test combined with the ACTH stimulation test shows higher sensitivity for predicting IHA than the Xiao model, Kobayashi 2018 model, and Umakoshi model, and its specificity is comparable to these three prediction models.

To analyze the clinical and genetic characteristics of pheochromocytoma and paraganglioma (PPGL), as well as genotype-phenotype correlations in children and adolescents.

A retrospective analysis was performed on clinical data and germline genetic testing results of 93 pediatric and adolescent patients (age≤18 years) diagnosed with PPGL at Peking Union Medical College Hospital between January 2010 and February 2025. According to germline variant results, enrolled patients were divided into four subgroups(6 cases with variants of uncertain pathogenic significance or benign variants and 3 cases with incomplete genetic testing were excluded. A total of 84 cases were included for analysis): SDHB-mutant group(carring pathogenic or likely pathogenic SDHB variants,n=41), VHL group (carring pathogenic or likely pathogenic VHL variants, n=9), other-gene variant group (carrying pathogenic or likely pathogenic variants in alternative genes,n=8), and wild-type group (no definite pathogenic variants detected, n=26). Clinical manifestations, germline mutation spectrum, long-term prognosis, and genotype-related phenotypic discrepancies were statistically compared across groups.

Among the 93 patients, 54 were male and 39 were female; the mean onset age was (13.7±3.7) years, with the follow-up duration of 2.5 (1.0, 7.0) years. Follow-up was terminated in February 2026. Tumor classification included 56 paragangliomas, 34 pheochromocytomas, and 3 composite tumors with both lesions. Eighty-four patients received surgical resection. Ki-67 index≥5% was confirmed in 54% (27/50) of available pathological specimens. Postoperative tumor recurrence occurred in 21 cases, distant metastasis developed in 36 cases, and 12 patients presented with concurrent recurrence and metastasis. Germline pathogenic or likely pathogenic variants were identified in 64 patients (68.8%, 64/93), among which definite pathogenic/likely pathogenic mutations accounted for 58 cases (62.4%, 58/93): 41 with SDHB variants, 9 with VHL variants, and 8 with rare alternative-gene variants (2 cases each for SDHD and RET, 1 case apiece for SDHA, SDHC, MAX, and FH). In the SDHB-mutant group, paraganglioma accounted for 85.4% (35/41), all tumors were solitary (100.0%, 41/41), and metastatic rate reached 53.7% (22/41). In the VHL-mutant group, pheochromocytoma constituted 66.7% (6/9), multifocal lesions were seen in 77.8% (7/9), and metastatic rate was only 11.1% (1/9).

PPGL in children and adolescents presents a strong hereditary predisposition; SDHB and VHL germline variants lead to distinctly divergent clinical phenotypes. SDHB mutations are characterized by solitary paragangliomas with high metastatic risk, whereas VHL mutations are associated with multiple pheochromocytomas featuring low metastatic risk.

To explore the prognostic impact of hypomethylating agents (HMA) versus hydroxyurea plus best supportive care (HU/BSC) in patients with intermediate-and high-risk chronic myelomonocytic leukemia (CMML), and to analyze the patterns of clonal evolution and dynamic changes of inflammatory cytokines in patients with disease progression before and after HMA treatment.

A total of 63 patients diagnosed with intermediate-and high-risk CMML admitted to the Department of Hematology, the Second Hospital of Tianjin Medical University between October 20 2017 and May 8 2025 were retrospectively enrolled. All patients were followed up every 3 months via outpatient and inpatient visits after discharge, with the last follow-up conducted on February 28, 2026. According to treatment regimens, the patients were divided into HMA group (n=31) and HU/BSC group (n=32). Treatment response, disease progression and survival outcomes were compared between the 2 groups. The Kaplan-Meier method was used to plot the survival curves of overall survival (OS) and progression-free survival (PFS). Bone marrow DNA was collected from patients with disease progression before and after treatment with HMA (n=20) and HU/BSC (n=13). Next-generation sequencing was used to detect 325 mutated genes related to hematological malignancies, and the clonal evolution of gene mutations in patients receiving the 2 treatment regimens before and after disease progression was investigated. Bone marrow supernatant specimens were collected from patients with disease progression treated with HMAs (n=8) and HU/BSC (n=8), and enzyme-linked immunosorbent assay (ELISA) was used to measure the expression levels of 21 inflammatory cytokines including IL-6 and IFN-γ. The differences in inflammatory cytokine expression before and after disease progression were compared.

The median follow-up duration for all patients [M(Q₁,Q₃)] was 21 (10, 40) months. The median OS was 22.0 months (95%CI: 11.8-32.2) in the HMA group and 36.0 months (95%CI: 23.6-48.4) in the HU/BSC group, with no statistically significant difference between groups (P=0.208). The median PFS was 18.0 months (95%CI: 10.8-25.2) and 26.0 months (95%CI: 19.9-21.1) respectively, and the difference was also not statistically significant (P=0.108). Among patients with disease progression after HMA treatment, newly acquired mutations were predominantly enriched in RAS pathway genes, accounting for 25% (5/20). Clonal expansion of SF3B1, TP53 and RUNX1 was observed, and the mutational burden of each gene accounted for 10% (2/20). Compared with baseline levels, the concentrations of TNF-α [113.6 (104.1, 147.1) pg/ml vs 25.7 (20.2, 41.3) pg/ml, P<0.001] and IL-8 [77.5 (54.6, 115.8) pg/ml vs 7.0 (2.6, 9.2) pg/ml, P=0.003] were significantly increased after disease progression, while the level of IFN-γ [341.5 (221.2, 460.7) pg/ml vs 732.7 (389.0, 852.4) pg/ml, P=0.013] was markedly decreased.

Compared with HU/BSC regimen, HMA failed to significantly improve OS and PFS in patients with intermediate-and high-risk CMML. Disease progression after HMA treatment may be closely associated with newly emerging mutations in the RAS pathway, clonal expansion of pre-existing mutations such as TP53, as well as the upregulation of TNF-α and IL-8 and downregulation of IFN-γ.

To evaluate the effects of a structured language intervention based on predictive coding theory (PCT) on the examination experience and completion status of patients undergoing conventional gastroscopy.

A randomized controlled trial was conducted. The adult patients undergoing conventional gastroscopy at the First Medical Center of the Chinese PLA General Hospital between June and December 2025 were prospectively enrolled. The patients were randomly assigned to the intervention group and the control group using the random number table method. The control group received standard preoperative and intraoperative verbal guidance, whereas the intervention group received a PCT-based structured language intervention. The primary outcome was the discomfort score, assessed by the visual analogue scale (VAS) immediately after gastroscopy, while the secondary outcomes were endoscopic operation time, endoscopic operation termination rate, and the proportion of patients willing to undergo regular gastroscopy again. Independent samples t-test, Mann-Whitney U test or χ² test were used to compare the primary and secondary outcomes between the two groups.

A total of 150 patients were enrolled, including 83 males and 67 females, aged (49±3) years. The intervention group and control group each included 75 patients. Compared to the control group, the intervention group had a significantly lower VAS discomfort score [3 (3, 4) vs 6 (5, 7), P<0.001], shorter endoscopic operation duration [(9.7±0.9) vs (13.0±1.2) min, P<0.001], and a higher proportion of patients willing to repeat gastroscopy [92.0% (69/75) vs 68.0% (51/75), P<0.001]. There was no statistically significant difference in procedure termination rates between the two groups [1.3% (1/75) vs 4.0% (3/75), P=0.311].

The structured language intervention based on PCT can reduce patients′ discomfort, shorten operation duration, and promote willingness for repeated gastroscopy.

To evaluate the effectiveness of different large language models (LLM) in addressing clinical questions related to early gastric cancer (EGC).

Select four types of LLM, including ChatGPT-4o, DeepSeek-V3.2, Gemini-2.5, and Grok-3, and develop 25 EGC professional knowledge questions based on international authoritative guidelines. Ten clinical physicians evaluated the accuracy, relevance, completeness scores of the four LLM′ responses. Meanwhile, based on patient interviews, 15 EGC life and health questions were extracted, and 10 EGC patients were asked to rate their understanding of the answers to the 4 LLM; The readability of LLM solution was further evaluated by clinicians. One-way analysis of variance or Friedman test was used for comparison between the groups, and paired t test corrected by Bonferroni method or Wilcoxon signed rank test corrected by Bonferroni method was used for comparison between two groups. These analyses were used to compare the accuracy, relevance, completeness, comprehension scores and readability assessment of different LLM solutions in addressing clinical questions related to EGC, thereby enabling a dual assessment of both expertise and accessibility.

The accuracy scores of DeepSeek-V3.2 [M（Q₁，Q₃），78.0 (76.5, 82.0) points], Gemini-2.5 [80.0 (77.0, 82.5) points], and Grok-3 [82.0 (74.0, 83.0) points] evaluated by clinical physicians were lower than those of ChatGPT-4o [86.0 (83.5, 89.0) points] (all P<0.05); The relevance scores of DeepSeek-V3.2 [82.0 (77.5, 87.0) points] and Grok-3 [86.0 (82.0, 88.0) points] were both lower than those of ChatGPT-4o [88.0 (87.5, 90.5) points] (both P<0.05); The completeness scores of DeepSeek-V3.2 [75.0 (69.5, 80.0) points] and Gemini-2.5 [84.0 (81.0, 88.5) points] were both lower than those of Grok-3 [90.0 (85.5, 91.5) points] (both P<0.05). Patients′ score for the comprehensibility of DeepSeek-V3.2′s responses [79.0 (77.0, 90.0) points] was lower than that for ChatGPT-4o [88.0 (86.0, 90.0) points] (P<0.05). In terms of readability assessment, the simple measure of gobbledygook (SMOG) score for DeepSeek-V3.2′s responses (14.1±1.6) was lower than that of ChatGPT-4o (16.4±2.3), Gemini-2.5 (15.8±2.0) and Grok-3 (15.8±1.1) (all P<0.05).

Different LLM have their own advantages and disadvantages in answering clinical questions about EGC. ChatGPT-4o has a better comprehensive evaluation, while DeepSeek-V3.2 has better readability in answering questions.

Diabetic foot is a common condition that imposes a substantial burden on patients and society. Although prolonged activity restriction in traditional management may facilitate ulcer healing, it is detrimental to overall health. Therefore, a balance must be achieved between promoting wound healing and preserving mobility. Offloading and immobilization constitute the core principles of diabetic foot management. Offloading reduces wound stress by redistributing plantar pressure, whereas immobilization promotes local healing by limiting joint motion. To effectively balance these two therapeutic principles, the medical team led by German physicians Dirk Hochlenert and Gerald Engels has accumulated extensive clinical experience through years of clinical practice combining FiF!mobil^® felt padding with non-removable offloading orthoses. This article elaborates on the core concepts of pressure offloading and immobilization with targeted clinical examples. The introduced protective devices are structural components designed to redistribute abnormal plantar pressure points without inducing secondary tissue damage, enabling standardized clinical implementation. Given the limited nationwide adoption of this technique in China, our research team co-authored this paper with the aforementioned German specialists to introduce this integrated therapeutic regimen, provide standardized training protocols and practical tools for clinicians, and facilitate continuous improvement in the prevention and management of diabetic foot disease.

This paper reports the diagnosis and treatment of a patient with low-grade intraepithelial neoplasia at the anastomosis after rectal cancer surgery. The patient, a 65-year-old male, was admitted to the Cancer Hospital of the Chinese Academy of Medical Sciences on August 21, 2025, primarily due to "six months after rectal cancer surgery, a follow-up examination revealed a low-grade intraepithelial neoplasia at the anastomosis for one week". The patient's lesion is located in the anastomotic area, and the pathology suggests low-grade intraepithelial neoplasia. If traditional surgical treatment is performed, it is traumatic and risky. Due to severe submucosal fibrosis and unclear anatomical hierarchy caused by scarring at the anastomosis, part of the muscle layer may need to be removed during the operation, which increases the risk of perforation during the operation and requires high endoscopic treatment techniques. After adequate preoperative evaluation, endoscopic submucosal dissection (ESD) combined with endoscopic wound suture was successfully performed. The lesion was completely resected and the wound was safely closed during the operation. Postoperative pathology confirmed that it was a rectal tubular villous adenoma with low-grade intraepithelial neoplasia, which met the criteria for curative resection. The postoperative follow-up recovery was good. Followed up to May 2026, the patient recovered well with no definite tumor recurrence or distant tumor metastasis. This case suggests that early colorectal lesions at the special site of the anastomosis can be treated endoscopically to avoid reoperation.

The patient, a 41-year-old female, presented to the Department of Gastroenterology at the First Affiliated Hospital of Xi'an Medical College on November 7, 2025, due to "upper abdominal pain for 3 days". During the physical examination, upper abdominal tenderness, abdominal CT showed thickening of the gastric antral wall, and gastroscopy showed mucosal bulge in the posterior wall of the gastric antral. After excluding acute abdomen, conservative treatment was given. After the results were not good, endoscopic submucosal dissection (ESD) was performed for fenestration and drainage. After the operation, combined with pathology, the final diagnosis was acute cellulitis gastritis (gastric antral cavity abscess). One month after the operation (December 12, 2025), a reexamination of the gastroscopy showed that the condition was significantly relieved compared with before. This case suggests that for patients with acute upper abdominal pain who are ineffective in conservative treatment, abdominal CT and gastroscopy should be completed as soon as possible to clarify the diagnosis; For patients with localized abscess formation, ESD can be used as an effective minimally invasive treatment to provide a reference for clinical diagnosis and treatment.

The first month of the Year of the Horse in 2026 had just passed, and this morning, as usual, I led my team to make rounds in the respiratory ward. A female patient was lying in a hospital bed with a cyanotic complexion. She was wearing a mask and inhaling oxygen, and her blood oxygen saturation was only about 85%. I remember the chief resident physician reported to me that the emergency department had admitted a patient with a pulmonary vascular malformation with severe respiratory failure, and asked if he could be admitted through the "green channel" as soon as possible. I was busy at the time and casually replied, "Take it, this kind of patient needs surgery as soon as possible!" It must be the patient in front of me. To promote the widespread dissemination of the spirit of medical humanities, this journal will launch the "Medical Humanities" column starting in 2026. The author of this article narrates from the perspective of a doctor, recalling the different state of mind between practicing medicine in his youth and now as a senior medical expert, and recounting in detail his experience of treating the same patient twice, twelve years apart. The words truly demonstrate the doctors' dedication to upholding their original aspirations and fulfilling their duties, as well as their benevolence in always caring for patients and devoting themselves wholeheartedly. At the same time, they vividly reveal the patients' long-standing complete trust and gratitude to the medical staff. The article is simple and sincere in its emotions, vividly outlining the sincere feelings of mutual understanding, mutual support, and warm dependence between doctors and patients.

The patient, a 58-year-old female, was admitted to the Department of Cardiology at West China Hospital of Sichuan University on July 22, 2021, due to "difficulty breathing for 6 months after activity". He had previously visited the respiratory medicine department, and a chest CT scan showed increased texture in both lungs. The forced expiratory volume decreased by 10% in the first second. Budesonide formoterol inhalation powder was given once per inhalation, and there was no significant improvement after twice a day. Post-perfect echocardiography showed a left ventricular ejection fraction of 20%. Post-admission laboratory tests showed an increase in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels to 2,031 ng/L (reference value: 0 to 227 ng/L). The dynamic electrocardiogram showed a sinus rhythm with a heart rate of 74 beats/min, accompanied by atrial premature beats and multiple ventricular premature beats. Echocardiography showed a dilated left ventricle (63 mm end-diastolic inner diameter of the left ventricle, reference value: 37.8-52.2 mm), a decrease in left ventricular ejection fraction to 25% (reference value: 54%-74%), accompanied by "jungle-like" trabeculae, and a 5:1 ratio of non-densified to densified myocardium (Figures A, B). Cardiovascular MRI suggested an enlarged heart and a "jungle-like" myocardium (Figures C, D). No typical delayed gadolinium enhancement was found. The patient received medication (torasemide 10 mg once daily; tolvaptan 7.5 mg once every other day; sacubitril valsartan sodium tablets 100 mg twice daily). As of the last follow-up visit (October 10, 2025), the patient had not experienced acute heart failure for more than 4 years after spontaneous disease. The left ventricular ejection fraction fluctuated between 23% and 26% at follow-up, and the NT-proBNP ranged from 1,340 to 2,497 ng/L. Whole exon sequencing detectedBAG5A possibly pathogenic variant (stop codon mutation) in a gene that is associated with dilated cardiomyopathy. Based on the above results, the preliminary diagnosis was dilated cardiomyopathy combined with excessive trabeculosis of the left ventricle, and heart transplantation was recommended. This patient was accompanied byBAG5Cases of "jungle-like" excessive trabecularization occur in patients with genetically mutated dilated cardiomyopathy, and left ventricular remodeling with significant trabecularization helps achieve higher stroke output and limits the increase in wall stress. Nearly half of the ventricular cavity is occupied by abnormally abundant trabeculae, which may contribute to the relative stabilization of NT-proBNP during its follow-up.

In the article "Expert Consensus on Clinical Application of Intravenous Insulin Infusion (2026 Edition)" in the 21st issue of this journal in 2026, page 2103, "Secretary: Tang Xiaohan" has been changed to "Secretary: Tang Xiaohan", which is hereby corrected.