Volume 106 · Issue 32 · 2026

Neuropathic pain (NP) refers to pain caused by a lesion or disease affecting the somatosensory nervous system. It typically follows a chronic course, characterized by persistent or recurrent pain that can lead to substantial suffering and functional impairment. Because conventional treatments often provide inadequate relief, neuromodulation has emerged as an important therapeutic approach. Focusing on the developmental trajectory of neuromodulation techniques, this article systematically reviews their historical evolution in the treatment of neuropathic pain, the current core technological systems, and the selection of treatment regimens. It further discusses future directions, with an emphasis on precision, intelligence, and standardization, aiming to provide a reference for clinical decision-making in pain medicine, the application of relevant technologies, and scientific research orientation.

Acute kidney injury (AKI) is a common and severe complication in critically ill patients, associated with high morbidity and mortality. Renal replacement therapy (RRT) is a vital life-support modality for critically ill patients with AKI. However, there remains a lack of unified clinical standards for core issues including the timing of RRT initiation, treatment modality, anticoagulation strategy, and weaning from RRT.In response, the Chinese Society of Critical Care Medicine organized a multidisciplinary expert panel to develop the"Clinical practice guideline for renal replacement therapy in critically ill patients with acute kidney injury (2026 edition)"in accordance with the Grading of Recommendations Assessment, Development and Evaluation(GRADE) approach for grading evidence quality. This guideline was developed through systematic literature retrieval, meta-analysis, and evidence-based medical evidence synthesis, followed by multiple rounds of manuscript review and revision via online and offline meetings of the working group, and final approval by the Standing Committee of the Society. A total of 34 recommendations were finalized, covering key clinical topics including timing of RRT initiation, establishment and maintenance of vascular access, selection of treatment modalities, application of specialized membrane filters, anticoagulation regimens, replacement fluid formulations, prescribed treatment dose, and RRT weaning strategies. This guideline aims to provide scientific, standardized, and clinically actionable guidance for critical care practitioners in China, promoting standardized RRT management in adult critically ill patients with AKI.

To investigate the efficacy and safety of neoadjuvant radiotherapy in patients with resectable hepatocellular carcinoma (HCC).

A retrospective analysis was conducted on the clinical data of 34 patients with HCC who received neoadjuvant radiotherapy from February 2016 to August 2022 at the Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing, China. Radiographic and pathological tumor response were evaluated. Follow-up period ended on September 30, 2025. The Kaplan-Meier method was used to calculate disease-free survival (DFS) and overall survival (OS), and the log-rank test was applied to compare DFS and OS between groups. Radiotherapy-and surgery-related adverse events were also evaluated.

Among the 34 patients [median age, 55 years (range:20-77 years); 31 male (91.2%) individuals], five patients (14.7%) had distal tumor thrombus. Thirty patients (88.2%) had tumor located within 1 cm of major blood vessels or their branches. Twenty-four patients (70.6%) had lesions with a maximum diameter>5 cm, two patients (5.9%) had serum alpha-fetoprotein levels>1 000 ng/ml. All patients completed the planned conventional fractionated radiotherapy (RT). According to Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1), 14 patients (41.2%) had partial response (PR); according to modified RECIST, 9 patients (26.5%) had complete response and 17 patients (50%) had PR. No patient had progressive disease before surgery. The median (range) interval between surgery and last RT was 9.9 (4.6-44.3) weeks. Severe treatment response was found in 16 patients (47.1%), while pathologic complete response in 4 patients (11.8%) and major pathological response in 15 patients (44.1%). With a median (range) follow-up of 83.7 (6.2-110.3) months, the median OS was not reached, and OS rates were 97.0% at 1 year, 84.8% at 3 years, and 84.8% at 5 years. The median DFS was 42.7 months, and DFS rates were 76.9% at 1 year, 63.0% at 3 years, and 37.8% at 5 years. Radiotherapy-related grade 3 adverse events were observed in 3 patients (7.7%). The remaining adverse events were all grade 1-2. Eleven patients (32.4%) developed operative complications, including grade Ⅰ complications in 2 patients (5.9%), grade Ⅱ in 4 patients (11.8%) and grade Ⅲa in 5 patients (14.7%). No grade Ⅲb or higher operative complications were observed.

Neoadjuvant radiotherapy combined with surgery demonstrates promising local efficacy for patients with resectable HCC, achieving a 5-year OS of exceeding 80% with good tolerance of surgery.

To observe the efficacy of maintenance therapy with or without Pembrolizumab in patients with advanced gastric cancer after first-line chemotherapy.

A total of 182 patients with advanced gastric cancer who received first-line induction therapy in our hospital from August 2021 to August 2023 were retrospectively included. According to the maintenance treatment strategy, the patients were divided into two groups. Patients received single-agent maintenance therapy with Pembrolizumab were in the single-agent group, and patients received combined maintenance therapy with Pembrolizumab and chemotherapy were in the combination group. The follow-up period was until October 2025. The levels of tumor-related markers, immune function indexes, tumor response, progression-free survival, overall survival, and adverse reactions within 1 year of maintenance treatment between the two groups were compared. Kaplan-Meier method was used to estimate median progress free survival (PFS) and overall survival (OS), and the log-rank test was used to compare survival differences between groups. Multivariate Cox proportional hazards regression model was used to analyze the impact of different maintenance treatment strategies on survival.

There were 98 cases in the monotherapy group, with an age of (64.81±7.55) years, and 84 cases in the combination therapy group, with an age of (64.55±8.47) years. The results of repeated measures analysis showed that during maintenance treatment, the levels of tumor markers such as carcinoembryonic antigen, cancer antigen(CA)125, CA199 in both the combination and monotherapy groups exhibited a decreasing trend, with a more pronounced decrease in the combination group (all P<0.05). Both the intergroup differences and the change trend differences in immunogloblin (Ig)A, IgG, and CD4+levels were statistically significant (all P<0.05); the monotherapy group remained relatively stable for these indicators, while the combination group showed a decreasing trend. The change trend differences in CD3+and CD8+levels between the two groups were statistically significant (all P<0.05), but the intergroup differences were not statistically significant (all P>0.05). Neither the intergroup difference nor the change trend difference in IgM level was statistically significant (all P>0.05). The RR of the combination group and the single drug group were 14.29% and 7.14%, and the DCR were 36.90% and 24.49%, respectively, with no significant difference (P>0.05). The median PFS in the combination group and the single drug group were 9.24 (95%CI: 8.19-10.29) and 8.92 (95%CI: 7.95-9.89) months, respectively, and the median OS in the combination group and the single drug group were 14.58 (95%CI: 12.65-16.51) and 16.04 (95%CI: 14.19-17.89) months, respectively, with no statistically significant difference (P>0.05). After adjusting for confounding factors by multivariate Cox regression analysis, treatment grouping was not an influencing factor for PFS or OS (all P>0.05). The incidence or severity of gastrointestinal reactions, leukopenia, hand foot syndrome, liver and kidney dysfunction, and thyroid dysfunction in the combination group were higher than those in the single drug group (all P<0.05).

In patients with advanced gastric cancer after first-line chemotherapy for disease control, there is no statistically significant difference in the efficacy of maintenance therapy with or without Pembrolizumab combined with chemotherapy, and it can reduce the cumulative toxicity caused by continuous chemotherapy.

To investigate the correlations between pain intensity and insomnia, depression, and anxiety in patients with zoster-associated pain (ZAP), and to examine the mediating role of insomnia in the associations between pain and depression as well as pain and anxiety.

Patients with ZAP who presented to the Department of Pain Medicine, the First Affiliated Hospital of Zhejiang University School of Medicine, from February 2024 to February 2025 were enrolled and divided into acute and chronic phases according to whether the ZAP duration was<30 days. General clinical data were collected. Pain intensity, insomnia, depression, and anxiety were assessed using the Numerical Rating Scale (NRS), Insomnia Severity Index (ISI), 9-item Patient Health Questionnaire (PHQ-9), and 7-item Generalized Anxiety Disorder scale (GAD-7), respectively. Logistic regression was performed to analyze the associations of pain with insomnia, depression and anxiety, and mediation analysis was employed to explore the mediating effect of insomnia on the relationships between pain and depression as well as pain and anxiety.

A total of 675 ZAP patients were included, of whom 336 (49.8%) were male, with a median age [M (Q₁, Q₃)] of 67.0 (59.0, 73.0) years. The NRS score for the past 24 hours at admission was (4.3±1.9) points. The prevalence of insomnia was 70.7% (477/675), depression 47.0% (317/675), and anxiety 31.7% (214/675). There were 223 patients in the acute phase and 452 in the chronic phase; no statistically significant differences were found between the two groups in NRS, ISI, PHQ-9, or GAD-7 scores (all P>0.05). Logistic regression analysis demonstrated that, in the overall ZAP cohort, higher NRS scores were significantly associated with higher risks of insomnia, depression, and anxiety, and these associations remained statistically significant after adjusting for important confounders including sex, age, educational level, medical history, and ZAP duration(all P<0.05). Mediation analysis revealed that insomnia partially mediated the relationships between pain and depression [mediation effect β=0.026 (95%CI: 0.018-0.035), proportion mediated=30.6%] and between pain and anxiety [mediation effect β=0.019 (95%CI: 0.014-0.026), proportion mediated=27.6%].

Pain intensity is correlated with the levels of insomnia, depression, and anxiety in ZAP patients, and insomnia exerts a partial mediating effect on the association pathways between pain and depression as well as between pain and anxiety.

To analyze the differences in blink patterns among patients with mild thyroid-associated ophthalmopathy (TAO, with eyelid retraction<2 mm), patients with primary dry eye disease (DED), and non-dry-eye controls, and to explore the association between these patterns and tear film stability.

The data of patients who were admitted to the Department of Ophthalmology at Ningbo Medical Center Lihuili Hospital between July and September 2025 were retrospectively collected. Based on clinical features, patients were classified into three groups: mild TAO group, primary DED group, and non-dry-eye control group. All subjects underwent standardized ocular surface assessments. Dry eye-related parameters were measured, and spontaneous blink frequency and incomplete blink ratio were quantified. Intergroup differences were compared, correlations between blink patterns and dry eye parameters were analyzed, and multiple linear regression was performed to identify factors associated with incomplete blink ratio.

A total of 140 patients (140 eyes) were included. The mild TAO group comprised 45 patients (45 eyes; 19 males and 26 females), with a median age of 45 (31, 50) years. The primary DED group comprised 45 patients (45 eyes; 18 males and 27 females), with a median age of 40 (32, 54) years. The non-dry-eye control group comprised 50 subjects (50 eyes; 19 males and 31 females), with a median age of 40 (30, 50) years. No significant differences were observed in age or sex among the three groups (all P>0.05). Between the mild TAO group and the primary DED group, no significant differences were found in Schirmer test results, tear meniscus height, ocular redness score, meibomian margin morphology score, lipid layer saturation, or lipid spread speed (all P>0.05). However, non-invasive tear film breakup time (NIBUT) was significantly shorter in the mild TAO group than in the primary DED group [2.0 (2.0, 2.5) s vs 4.2 (2.4, 6.0) s, P<0.001]. The meibomian gland area ratio was higher in the mild TAO group than that in the primary DED group (P<0.001), but was comparable to that in the non-dry-eye control group (P=0.051). Blink frequency was lower in the mild TAO group than those in both the primary DED group (P=0.026) and the non-dry-eye control group (P<0.001). The incomplete blink ratio in the mild TAO group [50.0% (31.7%, 70.7%)] was significantly higher than that in the primary DED group [16.7% (7.7%, 26.7%)] and the non-dry-eye control group [5.6% (0, 11.1%)] (both P<0.001). In the mild TAO group, the incomplete blink ratio was strongly negatively correlated with NIBUT (rₛ=-0.826, P<0.001) and positively correlated with ocular surface disease index (OSDI) score (rₛ=0.320, P=0.032). Multiple linear regression showed that shortened NIBUT (β=-0.061, 95%CI:-0.093--0.029, P<0.001) and reduced blink frequency (β=-0.042, 95%CI:-0.053--0.030, P<0.001) were independently associated with an increased incomplete blink ratio.

In patients with mild TAO who have minimized mechanical exposure (eyelid retraction<2 mm), an abnormal blink pattern characterized by increased incomplete blink ratio and decreased blink frequency is observed, and this pattern is significantly correlated with reduced tear film stability.

To investigate the clinical efficacy and safety of ultrasound-guided thoracic paravertebral block (TPVB) combined with pectoral nerve block (Pecs) in the treatment of acute herpetic neuralgia (AHN) involving the upper thoracic segments in middle-aged and elderly patients, a prospective study was conducted. A total of 70 middle-aged and elderly patients with upper thoracic AHN who visited the Department of Pain Medicine at Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, from June to December 2023, were enrolled and randomly divided into a control group and an experimental group using a random number table, with 35 patients in each group. The control group received TPVB once weekly for a total of 3 sessions, while the experimental group received TPVB combined with Pecs block using the same regimen. Outcome measures included the Visual Analogue Scale (VAS) for pain, Pittsburgh Sleep Quality Index (PSQI), 7-item Generalized Anxiety Disorder Scale (GAD-7), 9-item Patient Health Questionnaire (PHQ-9), treatment satisfaction score, incidence of postherpetic neuralgia (PHN), rescue analgesia, and adverse events. Assessments were conducted at 1, 4, 8, and 12 weeks post-treatment, and between-group differences were compared. Ultimately, 33 patients in the experimental group and 31 in the control group completed the follow-up and were included in the final analysis. The results showed that both groups demonstrated significant improvements in VAS scores, PSQI, GAD-7, PHQ-9, and satisfaction scores compared with baseline (all P<0.05). Compared with the control group, the experimental group exhibited significantly lower VAS scores and higher satisfaction scores at 1, 4, and 8 weeks post-treatment (P<0.05), as well as significantly lower PSQI, GAD-7, and PHQ-9 scores at 4 and 8 weeks (P<0.05). There were no statistically significant differences between the two groups in the incidence of PHN, rescue analgesia, or adverse events (all P>0.05). This study demonstrates that compared with TPVB alone, the combination of TPVB and Pecs block provides better pain relief, improves sleep quality, and alleviates anxiety and depression in middle-aged and elderly patients with upper thoracic AHN, with a favorable safety profile.

The clinical data of 26 patients with littoral cell angioma (LCA) of the spleen admitted to the First Affiliated Hospital of Zhengzhou University from January 2013 to August 2025 were retrospectively analyzed. There were 14 males and 12 females, with a mean age of (39.4±17.7) years. Ten patients presented with abdominal symptoms, and 5 had concurrent malignancies in other organs. CT/MRI findings predominantly showed single or multiple slightly hypodense/hypointense nodules within the spleen, with mild to moderate heterogeneous enhancement in the arterial phase and persistent enhancement in the venous phase. Pathological examination revealed that tumor cells co-expressed vascular endothelial markers (CD31, CD34, ERG, etc.) and histiocytic markers (CD68, etc.), with a biphenotypic expression rate of 17/18. Among 5 cases preoperatively suspected as splenic metastases, 2 were confirmed by needle biopsy and 3 were pathologically verified after simultaneous surgical resection. Twenty-four patients underwent splenectomy. All patients were alive without LCA-related recurrence, with a median follow-up and progression-free survival time both of 71 months (range: 3-144 months). The current study indicates that preoperative contrast-enhanced CT and MRI are helpful in the diagnosis of LCA. Splenectomy is the first choice for LCA treatment, and the prognosis is favorable.

This article reports the diagnosis and treatment of a patient with acute progressive glomerulonephritis (RPGN) complicated with peritoneal effusion. The patient, a 74-year-old male, presented with "6 months of edema in both lower extremities and 2 months of gross hematuria". One month before admission, his blood creatinine rapidly increased to dialysis dependence, accompanied by a decrease in platelets and a large amount of abdominal effusion. There was no fever during the course of the disease. Auxiliary tests showed positive anti-neutrophil cytoplasmic antibodies and anti-phospholipid antibodies, and complement decreased; Antinuclear antibodies and anti-glomerular basement membrane antibodies were negative, and no broken red blood cells were found in blood smears. Both blood culture and high-throughput sequencing (NGS) of peripheral blood pathogens were negative. After admission, high-dose methylprednisolone was applied to RPGN. The patient's renal function and platelet count did not improve, and multiple organ dysfunction occurred. Cardiac echocardiography revealed aortic and mitral valve neoplasms and total heart failure. Considering the high possibility of RPGN secondary to infectious endocarditis, coronary artery bypass grafting + aortic and mitral valve replacement was performed after empirical anti-infection and strengthened systemic support. Valve NGS and culture suggested vestibular streptococcus. Clear diagnosis of RPGN secondary to vestibular streptococcus-associated infective endocarditis. The general condition improved after surgery, and the kidneys remained dialysis-dependent. This case suggests that the clinical manifestations of RPGN secondary to infective endocarditis may be atypical. For RPGN with complement decrease, adequate infection screening and early adjustment of treatment direction are necessary.

This article reports a case of chylophlegm caused by thoracic duct obstruction. The patient, a 58-year-old female, was admitted to the Second Hospital of Lanzhou University on October 8, 2024, due to "intermittent cough, expectoration, and shortness of breath for 7 months". The patient had received anti-infective treatment for "lung infection" multiple times, and the symptoms recurred. After admission, treatment for lung infection and allergic bronchopulmonary aspergillosis was ineffective. After inquiring about the cause related to high-fat diet, the patient was referred to Beijing Century Altar Hospital. Magnetic resonance lymphangiography confirmed the diagnosis of chylophlegm caused by thoracic duct obstruction. Outlet compression band release combined with adventitial dissection was performed. The symptoms were relieved, but the condition relapsed after the operation due to high-fat diet. The patient was given a low-fat diet and his condition stabilized after regular follow-up. This case suggests that in patients with recurrent pulmonary exudation and ineffective anti-infection, we should be vigilant against chylophlegm and improve the lymphatic system-related examinations in a timely manner to reduce misdiagnosis and treatment.

今年的端午节，临近“中国脊髓灰质炎疫苗之父”顾方舟先生百岁诞辰的纪念日。在这个祭奠先贤的传统节日中，居家潜心拜读了刘静和汤国星编著、中国协和医科大学出版社刚刚付梓的新书《糖丸济苍生：顾方舟传》。这本共计12章、近30万字的传记，以翔实的史料和图文并茂的展现方式记述了顾方舟年逾鲐背的精彩人生。编者从顾方舟缘于江南的书香童年开篇，循着他的人生足迹逐步铺展：从逆境求学到受国家委派赴苏联深造，从临危受命研制疫苗到矢志躬耕预防科研，从主政顶级医学院校到惠及亿万儿童。笔者以为，从疫苗研发的千难万险到身先士卒的默默坚守，从改革开放中的探索求真到立德树人的奖掖后学，每一个章节都镌刻着先生的执着，每一段故事都饱含着人文情怀。2025年12月，经联合国教科文组织第四十三届大会审议，顾方舟先生100周年诞辰纪念活动正式被纳入联合国教科文组织2026—2027年可参与的周年纪念活动清单。这不仅是国际社会对一位中国科学家毕生奉献的最高礼赞，更是对中国科技工作者家国担当与科学精神的世界认可。2026年6月16日，当全世界共同纪念这位“糖丸爷爷”百岁诞辰时，纪念的不只是一项里程碑式的科研成就，更是一种将个人命运与国家需要、将科学理性与人性温度完美融合的崇高精神。他的精彩人生，正如吉训明院校长在序中所言：是与脊髓灰质炎殊死搏斗的一生，是为亿万中国儿童守护健康童年的一生。本书不仅是对这位人民科学家一生的忠实记录和深情回望，还是对顾方舟工匠精神的传承和家国情怀的弘扬，更是对老一辈科研工作者奋斗历程的致敬与铭记。顾方舟教授是享誉世界的“中国脊髓灰质炎疫苗之父”，是我国公共卫生与病毒疫苗领域的开拓者，1990年1月至1995年3月曾担任《中华医学杂志》总编辑。顾方舟教授毕生投身脊髓灰质炎防控事业，研制口服糖丸疫苗，终结本土脊髓灰质炎流行，护佑数代儿童免于残疾，他的成就获得了国际广泛认可。任职本刊总编辑期间，他秉持严谨求真的治学理念，大力扶持传染病、疫苗医学原创研究，在本刊发表了多篇脊髓灰质炎临床与基础研究成果，留下珍贵的学术文献。2026年，值顾方舟教授百年诞辰之际，谨以此文致敬先生一生坚守、无私奉献的医者风骨，回溯先生科研求索之路，激励后辈科研工作者承先辈之志，扎根临床与基础研究，守护全民公共卫生健康。

Acute decompensated heart failure (ADHF) is the leading cause of death in patients with heart failure, and the prognosis is worse when combined with cardiogenic shock. Short-term mechanical circulatory assistance (tMCS) is a key support method, and its clinical application and technology are constantly innovating. This article reviews the application progress of tMCS in the treatment of ADHF, focusing on the technical characteristics, clinical indications and latest evidence-based evidence of commonly used devices. It also emphasizes that individualized diagnosis and treatment should be carried out by multidisciplinary teams, the timing of treatment should be accurately grasped, the device should be rationally selected, combination therapy and complication management should be strengthened, and the withdrawal process should be standardized, in order to provide a reference for clinical practice.

The patient, a 48-year-old female, was admitted to the Department of Respiratory and Critical Care Medicine of the Eighth Medical Center of the People's Liberation Army on October 31, 2025, due to "cough and difficulty breathing for more than a month". More than a month before admission, there was no obvious cause for cough, coughing up white foamy sputum, accompanied by dyspnea after activity and in the left lateral decubitus position, without fear of chills, fever, chest pain and hemoptysis. There was no special past medical history. The patient's mother died of pancreatic cancer. Physical examination revealed low breathing sounds in the left lung, and dry rales could be heard. On September 27, 2025, the chest CT results of other hospitals showed low-density shadow of the left bronchus and sputum plug? Left pleural effusion with partial atelectasis in the left lung? Enhanced CT scan of the chest showed space occupation in the left lung and multiple metastases in both lungs. On November 3, 2025, the PET-CT results of our hospital showed a huge soft tissue shadow in the lower lobe of the left lung and a bronchial section in the lower lobe of the left lung. Unevenly increased FDG metabolism was considered, indicating a malignant tumor in the left lung, with a high probability of lung cancer, accompanied by obstructive atelectasis in the lower lobe of the left lung. Multiple soft tissue nodules of varying sizes were observed in both lungs, accompanied by a mild increase in FDG metabolism, indicating multiple lung metastases (Figures 1 and 2 show that the middle of the cross line occupies the left bronchial tumor). On November 1, 2025, a fiberoptic bronchoscopy was performed, revealing a bronchial mass in the lower lobe of the left lung (Figure 3). Pathological results showed a mucoadenocarcinoma (neoplasm in the lower lobe of the left lung), papillary type, with local mucus lake formation (Figure 4, hematoxylin-eosin staining × 100). Immunohistochemistry results showed CK7 (partial+), Cytokeratin (+), Ki-67 (+,<10%), Napsin A (+), TTF-1 (+), P40 (-). Genetic testing promptsEGFRandAct1Mutation. The final diagnosis was stage IV mucinous adenocarcinoma of the left lung (T₄N₀M_1a）。 He has been treated with vometinib and his condition is currently stable. Lung mucinous adenocarcinoma accounts for 3% to 10% of lung adenocarcinomas, mostly located in the periphery of the lung, and typically presents as diffuse "pneumonia"-like infiltration or multifocal lesions. However, no case primarily originating in the main bronchus has been reported so far. This case suggests that there may be multiple clinical subtypes of lung mucoadenocarcinoma, and its pathological mechanism deserves further exploration.