Volume 106 · Issue 30 · 2026

Standardized cancer pain management is an essential component of comprehensive cancer care. Pain is one of the most common and distressing symptoms in palliative care for patients with advanced cancer. Persistent pain severely impairs daily function and quality of life. The implementation of standardized cancer pain management, including standardized assessment, analgesic treatment, adverse effect management, follow-up, and end-of-life care, has significantly improved pain control and quality of life, with the goal of achieving optimal pain relief and preserving dignity throughout the disease course. However, several challenges remain, including inadequate attention, non-standardized assessment, uneven access to analgesics, and limited application of minimally invasive interventions. This review summarizes the current status, role, and key strategies of standardized cancer pain management, aiming to provide evidence for establishing standardized pain management systems and improving comprehensive cancer care.

Currently, anesthesia-based sleep therapy is experiencing a role expansion from short-term intervention for perioperative sleep disturbances to long-term treatment of chronic refractory insomnia. Integrating evidence-based data and clinical practice, this article systematically reviews the clinical application of anesthetic agents and techniques in perioperative sleep management and the treatment of chronic refractory insomnia. Rational perioperative use of anesthetic agents such as dexmedetomidine, esketamine, and propofol, together with anesthetic techniques like stellate ganglion block, can ameliorate perioperative sleep disturbances. In the domain of chronic insomnia, anesthesia-induced sleep balance therapy, patient-controlled sleep, and multimodal sleep promotion encompassing innovative anesthesia-based sleep therapy provide novel therapeutic avenues for refractory insomnia. However, current anesthesia-based sleep therapy is confronted with challenges, including low-quality evidence, high dependence on in-hospital medical resources, and underdeveloped professional standards and regulatory frameworks. Future efforts should focus on improving the evidence system, promoting clinical standardization, and advancing systematic framework construction, thereby facilitating the high-quality development of the innovative anesthesia-based sleep therapy within the field of sleep medicine.

Cancer pain not only affects the physiological functions of patients with malignancies but also significantly impairs their mental health and quality of life. Single-discipline treatment approaches are often insufficient to address the complex and diverse needs of pain management. The multi-disciplinary team (MDT) model integrates expertise from pain medicine, oncology, psychology, rehabilitation, and other relevant fields to provide comprehensive care through pain assessment, individualized treatment, and continuous follow-up. This review summarizes the current status of MDT-based cancer pain management and focuses on its clinical application and future development.

Cancer pain in pancreatic ductal adenocarcinoma (PDAC) is characterized by complex mechanisms, severe, and often difficult-to-control. Pain not only represents a major source of suffering for PDAC patients but can also promote tumor progression through intricate neuro-immune crosstalk networks. The traditional three-step analgesic ladder is often insufficient for managing PDAC pain. In recent years, the earlier application of minimally invasive interventional techniques, the adoption of multi-disciplinary team, and the integration of smart healthcare tools are driving PDAC pain management toward more precise approaches. Exploration of the tumor-neuro-immune interaction network offers novel insights for driving personalized analgesia. This article systematically reviews the latest advances in analgesic approaches for PDAC, with an emphasis on optimizing existing therapies, defining the role of minimally invasive interventions, and outlining future research directions for precision analgesia.

Congenital external and middle ear malformations (CEMEMs) represent a key etiology of conductive hearing loss, arising from dysplastic development of the first and second pharyngeal arches during embryogenesis. These malformations may occur in isolation or as a localized manifestation of a syndrome. This review synthesizes recent evidence-based medical findings to elaborate on advances in understanding the pathogenic mechanisms, clinical characteristics, and auditory intervention strategies for CEMEMs, thereby offering a reference framework for clinical diagnosis and management.

Cancer pain is one of the most common symptoms in patients with malignancies and significantly impairs quality of life. Inadequate pain control may reduce treatment adherence and adversely affect overall prognosis. Cancer pain clinics are specialized outpatient services dedicated to standardized assessment, diagnosis, treatment, and longitudinal management of cancer pain. To standardize the establishment and operational management of cancer pain clinics in China, the Chinese Association for the Study of Pain convened experts in relevant fields. Grounded in evidence-based principles and informed by national and international guidelines and policy documents, this consensus was developed using the RAND/UCLA Appropriateness Method and a modified Delphi process to generate recommendations. This consensus provides standardized recommendations on the functional positioning of cancer pain clinics, tiered construction models, personnel qualifications and training, medication and facility requirements, standardized clinical pathways, multidisciplinary collaboration, and quality management. It aims to provide scientific and practical guidance for healthcare institutions to establish standardized cancer pain outpatient clinics, promote the standardization, homogenization, and sustainable development of outpatient cancer pain management.

Herpes zoster (HZ) is a skin disease caused by the reactivation of latent varicella-zoster virus (VZV) in the body, clinically characterized by a unilateral vesicular rash distributed along the affected dermatomes. It commonly occurs in older adults and immunocompromised individuals. With the acceleration of global population aging, the incidence of HZ has significantly increased, showing a trend toward younger age groups and a high risk of complications, such as postherpetic neuralgia (PHN), which imposes a heavy health and economic burden on patients and society. In recent years, China has made remarkable progress in the development and application of HZ vaccines, particularly with the approval and use of the recombinant zoster vaccine (RZV) and the zoster vaccine live (ZVL), which are of great significance for the prevention of HZ and its complications. To further standardize HZ vaccination strategies, the Varicella and Herpes Zoster Prevention and Control Branch of the China Association for Vaccines organized national experts in virology, immunology, infectious diseases, geriatrics, and preventive medicine to formulate this consensus based on evidence-based medical evidence and clinical practice experience. This consensus systematically elaborates on the disease burden of HZ, vaccine efficacy and safety, vaccination strategies, recommendations for special populations, and other aspects, aiming to provide scientific and standardized guidance for clinicians and public health workers, and to promote widespread vaccination against HZ in adults and the prevention and control of the disease.

To analyze the clinical characteristics of patients with high-frequency sudden sensorineural hearing loss and the factors affecting therapeutic efficacy.

The clinical data of patients with high-frequency sudden sensorineural hearing loss who were treated in the Department of Otology, Chinese PLA General Hospital, from January 2009 to April 2025 were retrospectively reviewed. Demographic characteristics, precipitating factors, accompanying symptoms, comorbidities, and audiological features were collected and analyzed. Multivariate logistic regression analysis was further performed to identify factors affecting treatment efficacy.

A total of 90 patients aged (41.1±14.1) years were included, with 57 males and 33 females. Definite precipitating factors were identified in 38.9% (35/90) of patients, and excessive fatigue was the most common factor (14.4%, 13/90). Hypertension was the most frequent comorbidity (20.0%, 18/90). Tinnitus was the most common accompanying symptom (94.4%, 85/90), followed by aural fullness (66.7%, 60/90) and vertigo (20.0%, 18/90). Compared with patients with involvement at 4 and 8 kHz, those with involvement at 2, 4, and 8 kHz were older, had lower phonetically balanced maximum scores, and showed lower otoacoustic emission response rates, with statistically significant differences (all P<0.05). The overall treatment effectiveness rate was only 20.0% (18/90). Multivariate logistic regression analysis demonstrated that delayed presentation after onset (OR=1.07, 95%CI: 1.02-1.12, P=0.005), aural fullness (OR=3.68, 95%CI: 1.05-12.86, P=0.042), and female sex (OR=7.73, 95%CI: 1.70-35.14, P=0.008) were associated with poor prognosis.

Patients with high-frequency sudden sensorineural hearing loss frequently present with high-pitched tinnitus and aural fullness. Compared with patients without 2 kHz involvement, those with 2 kHz impairment are older and have poorer speech recognition ability. Overall treatment outcomes are unsatisfactory, and delayed presentation after onset, ear fullness, and female sex are associated with poor prognosis.

To investigate the clinical efficacy of Bankart repair combined with Remplissage procedure in the treatment of anterior shoulder instability with glenoid bone defect≤20%.

A retrospective analysis was conducted on patients with recurrent anterior shoulder dislocation combined with Hill-Sachs lesions admitted to Huashan Hospital, Fudan University from January 2020 to June 2024. All patients were confirmed with a glenoid bone defect≤20% by three-dimensional computed tomography (CT) reconstruction of the shoulder joint. The Constant-Murley score, American Shoulder and Elbow Surgeons (ASES) score, Rowe score, University of California Los Angeles (UCLA) score, and shoulder range of motion were evaluated before surgery and at the last follow-up. The postoperative function and return to sports were observed between patients with 13.5%≤glenoid bone defect≤20% and those with glenoid bone defect<13.5%.

A total of 40 patients were included, with an age of (26±6) years, including 35 males and 5 females. The follow-up time was (25.8±12.4) months. The postoperative UCLA score [(33.4±1.1) vs (22.1±3.4)], ASES score [(93.0±4.8) vs (73.3±9.6)], Constant-Murley score [(93.5±4.9) vs (79.3±7.0)], and Rowe score [(96.0±4.1) vs (39.2±9.4)] were all improved compared with those before surgery (all P<0.001). There were no statistically significant differences in postoperative angles of forward flexion, abduction, external rotation at the side, and the spinous process level of internal rotation at the side compared with those before surgery (all P>0.05). No complications such as infection or joint adhesion occurred in any of the patients postoperatively, and there was no recurrence of dislocation. At the last follow-up, all patients returned to sports, of which 31 cases (31/40, 77.5%) returned to the preoperative sports level. There was no statistically significant difference in postoperative function between patients with 13.5%≤glenoid bone defect≤20.0% and those with glenoid bone defect<13.5%, but the proportion of returning to the preoperative sports level (13/21 vs 18/19) showed a statistically significant difference (P<0.05).

Arthroscopic Bankart repair combined with Remplissage procedure for patients with recurrent anterior shoulder dislocation combined with Hill-Sachs lesions and a glenoid bone defect≤20% can restore joint stability, improve shoulder function, and does not affect the joint range of motion.

To establish an in vitro fibrotic endometrial organoid model and investigate the early intervention effects of placenta-derived mesenchymal stem cell extracellular vesicles (Pd-MSC-EV) on fibrotic injury in endometrial organoids.

Cell clusters were isolated from the endometrial tissues of healthy female mice and used to establish a three-dimensional endometrial organoid culture system. The structure and cellular composition of the organoids were characterized by histological staining and immunofluorescence staining. To construct an in vitro fibrosis model, the organoids were treated with different concentrations of transforming growth factor-β1 (TGF-β1), and model establishment was evaluated based on organoid morphological changes and the mRNA expression of fibrosis-related genes, including collagen type Ⅰ alpha 1 chain (COL1A1), α-smooth muscle actin (α-SMA), and fibronectin (FN). Pd-MSC-EVs were isolated and characterized by transmission electron microscopy, nanoparticle tracking analysis, and western blotting. The effects of Pd-MSC-EVs on TGF-β1-induced fibrotic changes in endometrial organoids were then assessed by morphological observation, real-time quantitative PCR (RT-qPCR) analysis of COL1A1, α-SMA, and FN mRNA expression, and immunofluorescence detection of COL1A1 and α-SMA protein expression. All experiments were repeated three times.

Mouse endometrial organoids with lumen-like structures were successfully established and expressed the epithelial markers E-cadherin and CK8 as well as the stromal marker Vimentin. Compared with the control group, TGF-β1 treatment disrupted organoid architecture and increased the mRNA expression levels of fibrosis-related genes, including COL1A1, α-SMA and FN, in a dose-dependent manner (all P<0.001). The isolated Pd-MSC-EV showed typical cup-shaped or disk-like vesicular morphology, with an average particle size of (163.8±50.0) nm, and expressed the exosomal markers CD63, CD81 and TSG101. Compared with the TGF-β1 group, co-treatment with Pd-MSC-EV alleviated organoid structural damage and reduced the mRNA expression levels of COL1A1, α-SMA and FN (all P<0.001). Immunofluorescence showed that COL1A1 protein expression was lower in the Pd-MSC-EV group than in the TGF-β1 group (P<0.005), while α-SMA protein expression showed a decreasing trend.

Pd-MSC-EV attenuate TGF-β1-induced fibrotic changes in endometrial organoids in vitro and reduce organoid structural injury, providing experimental evidence for mechanistic studies and potential intervention strategies for endometrial fibrosis-related diseases such as intrauterine adhesions.

To describe the epidemiological characteristics of functional dependency, cognitive impairment, and depressive symptoms (the "3Ds": Dependency, Dementia, and Depression) among older adults in China, and to evaluate the association of "3Ds" co-occurrence and index with the risk of all-cause mortality.

Based on the 2018 and 2021 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), adults aged≥65 years were included. To characterize prevalence, the baseline sample was classified into five groups: no "3Ds"(intact physical function, cognition, and mental health), dependency only (functional dependency alone), cognitive impairment only, depressive symptoms only, and co-occurrence of all three. To evaluate the association with mortality, participants were grouped by cumulative "3Ds index" score as 0 (no deficit, reference), 1, 2, or 3 (presence of any one, any two, or all three deficits, respectively). Cox proportional hazards models assessed the effects of the "3Ds" and cardiometabolic multimorbidity (CMM) on all-cause mortality; a Random Survival Forest (RSF) model validated variable importance (VIMP); and causal mediation analysis examined the mediating role of self-rated health.

Among 13 682 participants at baseline in 2018 [mean age (84.74±11.39) years], the prevalence of functional dependency, cognitive impairment, and depressive symptoms was 22.96% (3 142/13 682), 16.04% (2 194/13 682), and 41.70% (5 705/13 682), respectively, and the co-occurrence rate of all three was 4.03% (552/13 682). In the mortality analysis of 11 909 participants [(median follow-up 28 (1-40) months, 2 872 deaths], multivariable Cox regression showed that, compared with participants scoring 0 on the "3Ds index", the risk of all-cause mortality rose significantly across scores of 1 to 3: HR=1.31 (95%CI: 1.19-1.44) for a score of 1, HR=1.86 (95%CI: 1.66-2.09) for 2, and HR=2.16 (95%CI: 1.83-2.55) for 3, indicating a significant linear dose-response relationship (P for trend<0.001); by contrast, CMM was not significantly associated with all-cause mortality (HR=1.02, 95%CI: 0.91-1.13). The RSF model identified the "3Ds index" as a leading predictor of all-cause mortality (VIMP=0.104), second only to age. Self-rated health significantly and partially mediated the "3Ds"-mortality association, accounting for 9.77%-12.37% of the total effect.

Co-occurrence of the "3Ds" is prevalent among Chinese older adults, particularly the oldest-old, and shows significant demographic heterogeneity. The "3Ds index"—reflecting impairment in physical function, cognition, and mental health—shows a significant dose-response association with all-cause mortality that is partially mediated by self-rated health, and may serve as a simple composite indicator for early identification of mortality risk in the oldest-old.

This study explored the influence of progesterone (P) levels on the day of ovulation on pregnancy outcomes in patients with normal ovarian response undergoing natural-cycle frozen-thawed embryo transfer. A total of 384 natural-cycle frozen-thawed embryo transfer cycles of patients with normal ovarian response treated at the Reproductive Medicine Center of Beijing Obstetrics and Gynecology Hospital, Capital Medical University, from August 2022 to December 2024 were retrospectively enrolled in the study. Subjects were divided into Group A (P≤1 μg/L), Group B (1 μg/L<P≤3 μg/L), and Group C (P>3 μg/L) based on serum progesterone concentrations on the ovulation day. Baseline clinical data and pregnancy outcomes were compared across the three groups, and the effects of ovulation-day progesterone levels and other clinical indicators on pregnancy outcomes were statistically analyzed. Group A consisted of 94 patients with a mean age of (31.2±5.4) years; group B included 173 patients with a mean age of (30.4±5.9) years; group C comprised 117 patients with a mean age of (30.8±5.2) years. The results showed that Group B had a clinical pregnancy rate of 55.5%(96/173)and an embryo implantation rate of 46.1%(118/256), which were significantly higher than those of Group A [39.4%(37/94)and 31.5%(45/143)] and Group C [46.2%(54/117)and 37.1%(63/170)], with statistically significant intergroup differences (P<0.05). Multivariate logistic regression after adjustment for confounding variables verified that ovulation-day progesterone level was an independent risk factor for clinical pregnancy (OR=1.27, 95%CI: 1.10-1.45, P=0.001), while BMI acted as a protective factor for clinical pregnancy (OR=0.93, 95%CI: 0.87-1.00, P=0.037). In conclusion, progesterone level on the day of ovulation serves as a crucial indicator affecting clinical pregnancy outcomes of natural-cycle frozen-thawed embryo transfer, and routine monitoring of this parameter in clinical practice is conducive to optimizing transplantation protocols and improving the overall clinical pregnancy rate.

The data of eight patients with end-stage heart failure who experienced in-hospital sudden cardiac arrest and received cardiopulmonary resuscitation (CPR), followed by extracorporeal membrane oxygenation (ECMO) combined with delayed left ventricular assist device (LVAD) implantation in Fujian Medical University Union Hospital from January 2022 to June 2025 were retrospectively reviewed. Among them, there were seven males and one female, with a median age of 56 (50, 63) years. The etiologies included ischemic cardiomyopathy (five cases), dilated cardiomyopathy (two cases) and low cardiac output syndrome after severe valvular heart disease surgery (one case). All patients were stabilized by ECMO rescue before LVAD implantation, with an ECMO support time of 9.5 (6.5, 12.0) days. All surgeries were performed under general anesthesia with cardiopulmonary bypass. Postoperatively, six cases discharged smoothly, two cases died in hospital, and one case developed cerebral infarction which recovered after interventional thrombectomy. For discharged patients, follow-up was conducted at 1, 3, 6 and 12 months, the mechanical pump functioned normally, and cardiac function was significantly improved. The study suggests that ECMO can stabilize the condition of these high-risk patients, and bridging to LVAD can relieve the pressure on the donor heart and improve prognosis.

A patient with pain of refractory bone metastasis was treated with intrathecal morphine pump. The 14-year-old male was diagnosed as "secondary malignant tumor of right shoulder joint" at the Pain Diagnosis and Treatment Center of Xinjiang Uygur Autonomous Region People's Hospital on June 12, 2025 with "left root bone osteosarcoma 3 years after operation, right shoulder swelling and pain for 6 months and aggravation for 2 months". After admission, oral morphine sulfate sustained-release tablets were gradually titrated to 140 mg every 12 hours, and obvious adverse reactions such as nausea, vomiting and decreased appetite occurred. After that, a semi-implantable intrathecal drug infusion system (IDDS) was performed. The final maintenance dose of intrathecal morphine was 0.72 mg/d, and the oral morphine was gradually stopped, and the pain control was satisfactory. Two months after operation, due to the rapid progression of tumor and aggravation of pain, the morphine dose was gradually increased to 1.8~2.2 mg/d, and good analgesic effect was obtained, and the quality of life of children was significantly improved. Six months after surgery, the child died at home due to advanced cancer. This case suggests that IDDS implantation may be considered for older children with refractory cancer pain with a high degree of cooperation.

Non-small cell lung cancer (NSCLC) is the main type of lung cancer. Immune checkpoint inhibitors have brought a new treatment model for NSCLC, but the efficacy is still limited in some patients. Bispecific antibodies (BsAb) can recognize two different antigens or epitopes simultaneously, and a number of related studies have been carried out in the field of NSCLC, showing good anti-tumor activity. This review expounds the structural classification and mechanism of action of BsAb, focuses on the clinical research progress of immune BsAb and targeted BsAb in NSCLC, analyzes key clinical trial data in first-line, post-line and neoadjuvant therapy of NSCLC, and discusses existing challenges such as predictive biomarkers, treatment-related adverse events, and drug resistance mechanisms. The synergistic mechanism of BsAb with one drug and two targets is expected to provide more accurate and efficient treatment strategies for NSCLC patients with different molecular subtypes and promote the development of individualized anti-tumor therapy.