Volume 106 · Issue 36 · 2026

The development of cardiovascular interventional therapies has always been closely linked to synergistic innovation in devices, materials, and methodologies. Taking occlusion technique as an example, traditional metal occluders have a fixed shape and are relatively rigid; their inadequate morphological and mechanical adaptation to the dynamic structure of the heart may affect patients′ long-term prognosis. This article reviews biodegradable occluders and magnetofluid-based in situ adaptive shaping technique, exploring the progress and challenges in the field of interventional occlusion regarding device design, material systems, and tissue repair concepts, and discusses the methodological value of ultrasound-guided intervention in the translation of novel materials and non-metallic devices. In the future, it will be necessary to deepen our understanding of these topics, strengthen multidisciplinary collaboration and the development of clinical translation platforms, and drive cardiovascular interventional occlusion therapy toward greater precision, lower physiological burden, evidence-based practices, and scalable technologies.

Unicompartmental knee arthroplasty (UKA) is a core procedure in the stepped treatment of knee osteoarthritis. It has been increasingly widely used due to its advantages, such as minimal trauma, rapid recovery, and preservation of bone mass, yet it still faces challenges. In terms of patient selection, traditional criteria have been reasonably expanded on the basis of clinical evidence, and individualized comprehensive assessment has become the core principle. In terms of surgical techniques, precision and intelligence are the key breakthrough points. AI-assisted preoperative planning, 3D-printed patient-specific instruments, and robot-assisted surgery have significantly improved the accuracy, but the "gold standard" for prosthesis positioning remains undefined. Kinematic optimization is crucial for enhancing therapeutic efficacy; relevant technologies can reduce complications, but the understanding of postoperative UKA kinematic still needs to be deepened. Regarding prosthesis selection, fixed-bearing and mobile-bearing prostheses each have their merits and drawbacks, while cementless prostheses and new materials show promising potential, requiring multi-dimensional collaborative optimization. There is a lack of exclusive standardized protocols for perioperative management in UKA, while the management system constructed by digital technology has achieved remarkable results. In the future, UKA will develop towards the deep integration of digitalization and intelligence, the collaborative innovation of materials and kinematics, and the internationalization of Chinese treatment protocols, aiming to further improve knee preservation efficacy. Based on existing literature evidence and clinical practice, this article discusses the evolution of case-selection criteria and individualized assessment for UKA, the values and limitations of digital and intelligent technologies in precision surgery, the concept and implementation of kinematic optimization, prosthesis design, fixation modes and material selection, as well as perioperative management. It is intended to provide references for the standardized, precise and function-oriented development of UKA.

The Annual Meeting of the Society of Gynecologic Oncology (SGO) is one of the most influential academic conferences in the international field of gynecologic oncology, playing a pivotal role in driving clinical research progress and standardizing clinical practice. This article systematically reviews the endometrial cancer-related research presented at the 2026 SGO annual Meeting. Integrating current clinical practice, it provides a comprehensive analysis of research hotspots, unmet clinical needs, and future trends in this field, aiming to outline a clear academic framework for clinical and pharmaceutical professionals, facilitating their understanding of the frontiers of research. Overall, molecular classification has become an essential foundation for risk stratification, yet it still faces significant challenges in quality control, result interpretation, and clinical integration. Adjuvant therapy for early-stage patients is shifting toward biomarker-driven individualized strategies, while HER2-targeted antibody-drug conjugate (ADC) are gradually moving into earlier lines of treatment, and intensified adjuvant therapies for high-risk populations continue to be explored. Advanced and recurrent diseases have entered an era of concurrent treatment options, highlighted by immunotherapy and ADC. However, patient selection, sequential therapy, and toxicity management remain to be optimized. Surgical treatment exhibits a trend toward minimally invasive approaches and precise staging centered on sentinel lymph node (SLN) mapping, with its rational integration with neoadjuvant and systemic therapies, emerging as a new research focus. Future efforts should rely on high-quality prospective studies and real-world evidence to further advance the application of molecular classification in treatment decision-making and to refine multidisciplinary collaborative management systems.

Type 1 diabetes mellitus (T1DM) is a chronic disease characterized by progressive autoimmune-mediated destruction of pancreatic beta cells. With the establishment of the three-stage classification system for T1DM and the advancement of early screening, disease-modifying therapies (DMT), represented by immunotherapy, are driving a shift in clinical management from "insulin replacement" to "etiological intervention". This guidance statement was jointly developed by adult and pediatric endocrinology experts and is intended for clinical endocrinologists engaged in the diagnosis and management of T1DM. The guidance systematically reviews the immune pathogenesis of T1DM, disease staging, and the mechanisms of action and development progress of five categories of immunotherapeutic agents. It further elaborates on the eligible patient populations, pre-treatment assessment, dosing regimens, adverse event management, and follow-up strategies for teplizumab in patients with stage 2 T1DM. This insight aims to provide clinicians with standardized references for the application of DMT and immunotherapy in clinical practice, promote precision medicine, and improve patient outcomes.

Perioperative glycemic abnormalities, including hyperglycemia, hypoglycemia, and glycemic variability, are important determinants of postoperative outcomes. Conventional glucose monitoring has inherent temporal limitations and fails to capture dynamic glycemic fluctuations in a timely manner. Continuous glucose monitoring (CGM) enables real-time, continuous assessment of glucose levels and trends, thereby facilitating more precise glycemic management. To standardize its clinical application, the Chinese Society of Anesthesiology, in collaboration with the National Alliance of Geriatric Anesthesia, convened a multidisciplinary expert panel to develop the "Expert consensus on the clinical application of CGM in adult patients during the perioperative period (2026 edition)". Key clinical issues, including monitoring strategies across different perioperative phases, data interpretation, and management of special populations, were systematically reviewed and deliberated by the expert panel, resulting in 20 recommendations. This consensus applies primarily to adults with diabetes scheduled to undergo surgery and adults at high risk of perioperative glycemic variability. It covers risk assessment for perioperative dysglycemia, interpretation of CGM data, preoperative initiation and assessment, and intraoperative monitoring and confirmatory testing. It also addresses postoperative handover and continued management, together with the use of CGM in special populations and specific surgical settings. This consensus aims to guide the standardized perioperative use of CGM, optimize glycemic management and improve patient safety.

To investigate the association between continuation, discontinuation, or dose reduction of proton pump inhibitor (PPI) and clinical outcomes in patients with hospital-acquired acute kidney injury (AKI).

This retrospective cohort study included patients hospitalized in Jiangsu Province Hospital between January 2021 and June 2025. According to the PPI management strategy within 48 hours after diagnosis of hospital-acquired AKI, patients were divided into a continued-use group, a dose-reduction group, and a discontinuation group. The primary outcome was 30-day AKI progression, and the secondary outcomes were 30-day kidney replacement therapy (KRT) requirement and non-recovery of renal function before discharge. Propensity score matching was used to control for confounding bias. Matching variables included demographic characteristics, laboratory indicators, AKI stage, comorbidities, indications for PPI use, concomitant medications, and life-support treatments. After matching, outcomes were evaluated using conditional logistic regression models. The primary analysis compared outcomes between the continued-use and discontinuation groups, while exploratory analyses compared outcomes between the dose-reduction group and the other two groups.

A total of 2 203 patients with hospital-acquired AKI were included, with a median (Q₁, Q₃) age of 67.0 years (56.0, 74.0), and 1 526 patients (69.3%) were male. There were 1 273 patients in the continued-use group, 525 in the dose-reduction group, and 405 in the discontinuation group, respectively. After propensity score matching, 391 patients in each of the continued-use and discontinuation groups were included in the primary analysis. The primary analysis showed that, compared with discontinuation, continued PPI use was associated with increased risks of 30-day AKI progression (OR=1.45, 95%CI: 1.03-2.03, P=0.032) and 30-day KRT requirement (OR=2.61, 95%CI: 1.76-3.87, P<0.001), while there was no statistically significant difference in non-recovery of renal function before discharge (OR=0.90, 95%CI: 0.66-1.23, P=0.514). Exploratory analyses of the dose-reduction strategy showed that, compared with continued use, dose reduction was associated with lower risks of 30-day AKI progression (OR=0.59, 95%CI: 0.44-0.80, P<0.001) and KRT requirement (OR=0.69, 95%CI: 0.50-0.93, P=0.016). Compared with the discontinuation group, the dose-reduction group showed no statistically significant difference in 30-day AKI progression (OR=0.67, 95%CI: 0.43-1.04, P=0.075), but was associated with a higher risk of 30-day KRT requirement (OR=1.67, 95%CI: 1.05-2.67, P=0.030) and a lower risk of non-recovery of renal function before discharge (OR=0.62, 95%CI: 0.39-0.97, P=0.036).

Among patients with AKI who have been using PPI before AKI diagnosis, continued PPI use after AKI is associated with higher short-term risks of AKI progression and KRT requirement. PPI dose reduction may reduce the risk of some adverse renal events.

To investigate the prognostic factors of high-frequency predominant sudden sensorineural hearing loss with concomitant middle- and low-frequency involvement, and develop a prognostic prediction model.

The clinical data of patients with high-frequency predominant sudden sensorineural hearing loss with concomitant middle-and low-frequency involvement at the Chinese PLA General Hospital between January 2009 and April 2025 were retrospectively analyzed. Patients were divided into effective and ineffective groups based on their prognosis. A prognostic prediction model was established using multivariable logistic regression analysis, and a nomogram was constructed. The performance of the model was evaluated by receiver operating characteristic (ROC) curve, Hosmer-Lemeshow goodness-of-fit test, and decision curve analysis (DCA).

A total of 170 patients aged 48 (38, 56) years were included, comprising 96 males (56.5%) and 74 females (43.5%). The overall treatment effective rate was 27.6% (47/170). Multivariable logistic regression analysis showed that prolonged time from onset to presentation (OR=1.17, 95%CI: 1.10-1.26, P<0.001), increased age (OR=1.09, 95%CI: 1.05-1.13, P<0.001), and decreased high-density lipoprotein cholesterol (HDL-C) (OR=4.00, 95%CI: 1.21-13.20, P=0.023) were independent risk factors for poor prognosis in patients with high-frequency predominant sudden sensorineural hearing loss with concomitant middle- and low-frequency involvement. The area under the ROC curve (AUC) of the prediction model was 0.88 (95%CI: 0.82-0.93). The calibration curve demonstrated good fit, with the Hosmer-Lemeshow goodness-of-fit test yielding χ²=7.157 and P=0.520. DCA showed that the model yielded a positive net benefit when the risk threshold probability ranged from 0.04 to 0.99.

Time from onset to presentation, age, and HDL-C are prognostic factors in patients with high-frequency predominant sudden sensorineural hearing loss with concomitant middle- and low-frequency involvement. The nomogram developed based on these variables demonstrates good predictive ability for treatment prognosis in these patients.

To compare the predictive accuracy of the risk stratification strategies from the 2025 Chinese Respiratory Guideline and the 2019 European Society of Cardiology (ESC) Guideline for the prognosis of patients with acute pulmonary embolism (APE).

A retrospective cohort study was conducted, including 713 patients with first-onset APE presented to West China Hospital of Sichuan University between September 1, 2016, and December 30, 2019. Clinical data were collected. Patients were risk-stratified (low-risk, intermediate-low-risk, intermediate-high-risk, high-risk) according to the Chinese Respiratory Guideline and the ESC Guideline. Mortality rates in each stratum were calculated. Using the low-risk group as reference, odds ratios (OR) and 95% confidence intervals (CI) for the association between other strata and in-hospital mortality were computed. Receiver operating characteristic (ROC) curves were plotted to calculate the area under the curve (AUC), and predictive performance indicators such as sensitivity and specificity were compared. The Kaplan-Meier method was used to draw survival curves during hospitalization and for 12 months after discharge.

Both guideline risk stratification strategies showed a significant increase in in-hospital mortality with rising risk strata [Chinese respiratory guideline low-risk vs intermediate-low-risk vs intermediate-high-risk vs high-risk: 1.15%(3/260) vs 11.84%(29/245) vs 12.24%(24/196) vs 33.33%(4/12); ESC guideline: 0.69%(1/144) vs 8.20%(36/439) vs 16.10%(19/118) vs 33.33%(4/12), all P<0.001]. The Cochran-Armitage trend test further confirmed a significant ascending linear trend in mortality across the increasing risk categories (P_trend<0.001 for both guidelines). Compared to the low-risk group, the ESC guideline showed a more pronounced incremental gradient in OR for mortality risk across strata (intermediate-low-risk OR=12.77, 95%CI: 1.74-94.03, intermediate-high-risk OR=27.44, 95%CI: 3.62-208.37, high-risk OR=71.50, 95%CI: 7.14-716.08), and the difference in mortality between the intermediate-low-risk and intermediate-high-risk groups was statistically significant (P=0.011). In contrast, the mortality rates and OR values for the intermediate-low-risk and intermediate-high-risk groups in the Chinese Respiratory Guideline were close, with no statistically significant difference between groups. The AUC for predicting in-hospital death were similar between the two guidelines [Chinese respiratory guideline: 0.689 (95%CI: 0.630-0.747); ESC Guideline: 0.673 (95%CI: 0.607-0.740)], with no statistically significant difference (P>0.05). Long-term follow-up (12 months) showed that the ESC guideline low-risk group had the lowest mortality rate [2.10% (3/143)], and the survival curves of the different risk groups showed good separation (log-rank P=0.001). In contrast, there were no significant differences in long-term mortality among the risk groups of the Chinese respiratory guideline (P=0.682).

Both the Chinese respiratory guideline and the ESC guideline demonstrate good overall predictive value for in-hospital mortality risk in APE patients. The ESC Guideline shows superior ability to discriminate risk among intermediate-risk patients and better predictive capability for long-term prognosis.

To investigate the association between ultrasound response assessment during neoadjuvant therapy and pathological outcomes in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer.

This retrospective study included 609 patients with HER2-positive breast cancer who received neoadjuvant therapy at the Breast Center of Peking University Cancer Hospital between June 1, 2018, and December 31, 2024. Ultrasound response was assessed at cycles 2, 4, 6, and 8 according to the World Health Organization (WHO) response criteria and Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and categorized as clinical complete response (cCR), clinical partial response (cPR), clinical stable disease (cSD), or clinical progressive disease (cPD). Patients with cCR or cPR were classified into the response group, whereas those with cSD or cPD were classified into the poor-response group. Pathological complete response (pCR) and Miller-Payne (MP) grade were determined from surgical pathology. The χ² test was used to analyze the associations of ultrasound response with pCR and MP grade. Receiver operating characteristic (ROC) curves and areas under the curves (AUC) were used to assess the performance of ultrasound response in predicting pCR.

The overall pCR rate was 67.5% (411/609), with rates of 68.7% (338/492) among patients receiving sequential anti-HER2 neoadjuvant therapy and 62.4% (73/117) among those receiving upfront anti-HER2 neoadjuvant therapy. Except for the WHO assessment at cycle 2, pCR rates differed significantly between the response and poor-response groups at all assessment time points according to both criteria (all P<0.05). The proportions of patients with MP grades 4-5 also differed significantly between the two groups at all assessment time points (all P<0.05). When ultrasound response according to each criterion was combined with clinicopathological factors, all AUC were<0.8, indicating poor predictive performance for pCR. In the upfront anti-HER2 therapy group, pCR rates differed significantly between the response and poor-response groups at cycles 2-6 (all P<0.05); in the sequential anti-HER2 therapy group, significant differences were observed at cycles 4-8 (all P<0.05). The pCR rate did not differ significantly between patients with SD accompanied by tumor enlargement and those with SD accompanied by tumor shrinkage (all P>0.05).

During neoadjuvant therapy for HER2-positive breast cancer, a treatment response identified by ultrasound at cycle 2 in patients receiving upfront anti-HER2 therapy or at cycle 4 in those receiving sequential anti-HER2 therapy may be associated with pCR; however, ultrasound assessment has limited predictive value for pCR.

To investigate the role and potential mechanism of Growth Differentiation Factor 15 (GDF15) in curcumin-induced ferroptosis of triple-negative breast cancer (TNBC) cells.

(1) Cell experiments: Human TNBC cell line MDA-MB-231 was used. After successful cell transfection and modeling, the cells were divided into MDA-MB-231 GDF15 knockdown group (siGDF15 group) and negative control group (siNC group). After treatment with curcumin, they were further divided into siNC curcumin group and siGDF15 curcumin group. Cell viability, ferrous iron, reactive oxygen species, glutathione levels, and the expression of SLC7A11, GPX4, FTH1, and FTL were detected. (2) Animal experiments: a nude mouse xenograft model was established, and mice were randomly assigned using a random number table into NC group (nude mice inoculated with MDA-MB-231 cells transfected with negative sequence, followed by control reagent), KO-GDF15 group (nude mice inoculated with GDF15 knockdown MDA-MB-231 cells, followed by control reagent), curcumin group (nude mice inoculated with MDA-MB-231 cells transfected with negative sequence, followed by curcumin), and KO-GDF15 curcumin group (nude mice inoculated with GDF15 knockdown MDA-MB-231 cells, followed by curcumin), with 10 mice in each group. The in vivo tumor suppression effect and expression of Ki-67, SLC7A11, GPX4, and 4-HNE in tissues were assessed.

CCK-8 assay results showed that different concentrations of curcumin significantly reduced the viability of MDA-MB-231 cells; after co-treatment with curcumin and iron inhibitors for 24 hours, the decrease in cell viability was partially restored. Levels of Fe²⁺ and reactive oxygen species significantly increased in the curcumin group, while glutathione levels significantly decreased. GDF15 knockdown significantly enhanced the cytotoxicity of curcumin, further promoting Fe²⁺ and reactive oxygen species accumulation and glutathione depletion. mRNA and protein expression levels of GPX4, SLC7A11, FTL, and FTH1 in the GDF15 knockdown group were lower than those in the control group. Tumor volume and weight in the curcumin group were lower than those in the NC group (P<0.001); tumor volume and weight in the GDF15 knockout curcumin group were lower than those in the curcumin group (both P<0.001). Immunohistochemical staining showed that in nude mouse tumor tissues, expression of Ki-67, SLC7A11, and GPX4 decreased, while 4-HNE increased in the curcumin group.

GDF15 knockdown enhances the sensitivity of TNBC cells to curcumin-induced ferroptosis by downregulating the SLC7A11/GPX4 axis and iron storage proteins, exerting a synergistic anti-tumor effect.

This study retrospectively analyzed the feasibility and influencing factors of intraoperative neurophysiological monitoring (IONM) during posterior corrective surgery in patients with achondroplasia (ACH) and kyphoscoliosis. A total of 22 ACH patients (10 males, 12 females) with kyphoscoliosis who underwent one-stage posterior spinal fusion at a single center from February 2010 to June 2023 were enrolled, with a mean age of (11.7±4.0) years. IONM parameters included latency and amplitude of somatosensory evoked potentials (SEP) from bilateral lower limbs, as well as latency and maximum amplitude of transcranial electric motor evoked potentials (MEP); side-to-side differences and the incidence of asymmetric SEP were calculated. Results showed that kyphosis was the most common deformity type (14 cases, 63.7%), and the apex vertebra was most frequently located at the thoracolumbar junction (15 cases, 68.2%); the mean preoperative maximum coronal Cobb angle was (71.9±26.3)°, and the mean maximum sagittal Cobb angle was (84.3±27.0)°. Baseline acquisition rates were 81.8% (18/22) for SEP and 72.7% (16/22) for MEP; intraoperative alerts occurred in 4 cases for SEP and 2 cases for MEP, with postoperative new neurological deficits in 2 cases. Sensitivity and specificity were 100.0% and 87.5% for SEP, and 100.0% and 92.8% for MEP, respectively. The mean side-to-side differences were (1.7±1.6) ms for SEP-P37 latency, (2.5±2.3) ms for SEP-N45 latency, (0.7±0.7) μV for SEP amplitude, (2.2±2.4) ms for MEP latency, and (174.7±150.3) μV for MEP amplitude; the incidence of abnormal SEP was 55.5% (10/18). It is concluded that IONM provides reliable monitoring value in deformity correction surgery for ACH patients with kyphoscoliosis; however, these patients commonly exhibit side-to-side asymmetry of IONM parameters and carry a higher risk of intraoperative positive events, which is closely associated with their inherent spinal stenosis, potential chronic spinal cord compression, and abnormal preoperative spinal cord morphology.

This article reports a rare case of pregnancy complicated with pelvic retroperitoneal lymphatic cyst. Female, 35 years old, G1P0, multilocular cysts in the bilateral adnexal region were first discovered in the first trimester of pregnancy, which progressively increased with gestational weeks and persisted after termination of pregnancy due to fetal trisomy 18 at 14 weeks of gestation. Pelvic abdominal CT showed multiple cystic foci in the pelvic cavity, but lymphatic cysts were not excluded. Laparoscopic exploration was performed in August 2025. During the operation, bilateral pelvic retroperitoneal multilocular thin-walled cysts were observed. Because they were closely adjacent to the lumbosacral plexus nerve, only a partial resection of the superficial cyst was performed to avoid permanent nerve damage. Pathologically confirmed lymphangioma/lymphatic malformation. The symptoms of reversible lumbosacral plexus (L5~S2) nerve injury appeared the next day after the operation, which was rapidly relieved after nerve nutrition and rehabilitation physiotherapy. After six months of follow-up, the residual cyst in the deep pelvic cavity was stable, and only mild numbness remained in the right lower leg and plantar. Based on the diagnosis and treatment of this case, this article reviews the pathogenesis, key points of imaging identification, perioperative neuroprotection program, and multidisciplinary management strategies for repeated pregnancy of retroperitoneal lymphatic cysts during pregnancy, providing a reference for the clinical treatment of such rare cases.

This paper reports the diagnosis and treatment of a patient with membranous nephropathy (MN) who developed vitiligo-like depigmentation of the skin of both hands after treatment with rituximab (RTX). The patient, a 58-year-old male, was admitted to the hospital due to "increased serum creatinine for more than 2 years". The blood creatinine was 85 μmol/L, serum albumin was 43.6 g/L, and urine spot albumin was 197.25 mg/g. He was previously diagnosed with stage II MN by renal biopsy. Due to the re-elevation of urine protein, a single low-dose intravenous infusion of RTX (0.5 g) was given to prevent recurrence of the primary disease. About 2 weeks after the infusion, the patient developed symmetrical vitiligo-like depigmentation spots on the dorsal side of both hands. He went to the local hospital and was clinically diagnosed with vitiligo. He was given external glucocorticoids, white spirit tincture and narrow-spectrum medium-wave ultraviolet treatment, but the efficacy was not good, and the skin lesions continued to progressively expand. In October 2024, I visited the dermatology department of our hospital. Considering the characteristics of the skin lesion and the medical history, I was given vitiligo-like pigmentation. After topical application of tacrolimus ointment, the skin lesion gradually stabilized, but no obvious recoloration was observed. Follow-up continued until April 2026, and the loss of pigment on the back of both hands persisted, with no obvious recoloration observed. This case suggests that RTX treatment may be associated with vitiligo-like pigment loss in the skin, and clinical application should be vigilant against such delayed, non-classic adverse events.

Acute angle-closure glaucoma (AACG) is a common blinding eye disease in Asia. It is characterized by extensive closure of the chamber angle and sudden increase in intraocular pressure. Timely diagnosis and treatment can reduce irreversible optic nerve damage and the risk of blindness. In recent years, new progress has been made in the research on the pathogenesis and treatment strategies of AACG. Based on domestic and international guidelines and evidence-based medicine evidence, this article systematically summarizes and analyzes the epidemiological characteristics of AACG, the mechanism of angle closure, and the clinical application progress of comprehensive treatment methods such as drugs, lasers, and surgery. It focuses on reviewing the application value of glaucoma cataract combined surgery and sequential treatment strategies in AACG, in order to provide reference for clinical diagnosis and treatment and scientific research, and help improve the clinical diagnosis and treatment level of AACG.

ENT surgery typically shares airway features, and changes in upper airway anatomy or head position often significantly increase the complexity of airway management. This article focuses on the anatomical and pathophysiological basis of airway management during ENT surgical anesthesia, preoperative risk assessment, the latest advances in ventilation and oxygen supply techniques, and postoperative airway management strategies. The characteristics of cardiopulmonary function involvement caused by special anatomy and disease were analyzed, and the importance of differences in airway manifestations between conscious and relaxed states in management was discussed. At the same time, the key elements of difficult airway prediction, the development of tubeless operation, small diameter endotracheal tubes and biphasic thoracic ventilation technologies were summarized. It is emphasized that extubation is a second high-risk airway intervention and requires risk stratification based on the patient's underlying disease, the scope of surgery, and the difficulty of reintubation. Choose the strategy of immediate extubation, delayed extubation or tracheotomy, and improve postoperative airway safety by exchanging airway catheters, laryngeal mask exchange and optimizing sedation and analgesia. Airway management under ENT anesthesia is becoming more standardized, and incorporating artificial intelligence risk prediction tools into clinical decision-making is expected to further improve perioperative safety and refined management.

The patient, a 50-year-old woman, visited the Department of Respiratory and Critical Care Medicine at the Affiliated Hospital of Hebei University on May 5, 2026, due to "cough and expectoration for more than half a month". There was no obvious cause of cough or expectoration, no fever, and no history of chronic diseases such as hypertension or diabetes in the first half of the month before admission. Physical examination: The breathing sounds in both lungs were rough, no dry or wet rales were heard, and the heart rhythm was uniform. The patient's outpatient chest plain CT scan showed multiple solid nodules of varying sizes in both lungs, suggesting a high possibility of metastasis. Upon admission, neuron-specific enolase was 27.60 μg/L (reference value: 0~16.30) and hemoglobin was 104 g/L (reference value: 115~150).¹⁸Fluorine-fluorodeoxyglucose positron emission computed tomography (¹⁸F-FDG PET/CT) showed soft tissue density mass shadows in the right ventricle, with a maximum cross-section of approximately 4.7 cm × 2.8 cm × 2.6 cm, a CT value of 26 HU, high metabolism, and a maximum standard uptake (SUVmax) of 21.8 (Figure 1, indicated by arrow); Multiple solid nodules of varying sizes were seen in both lungs, with high metabolism and SUVmax of 3.9–13.8 (Figure 2, indicated by arrows). The CT value of the right ventricular lesion after enhancement was 35 HU (Figure 3, indicated by arrows). CT-guided percutaneous pulmonary nodule biopsy was performed, and the pathology showed epithelioid hemangioendothelioma (as shown in Figure 4, HE staining, ×100). Immunohistochemistry: cytokeratin (CK) (partial+), Calretinin (-), CD31 (+), ETS-related gene (ERG) (+), S-100 (-), proliferating cell nuclear antigen (Ki-67) (15%+), CD68 (-), CD1a (-), thyroid transcription factor-1 (TTF-1) (-), P40 (-), integrase interacting protein 1 (INI-1) (+), Friend leukemia integration virus 1 (FLI-1) (+), CK7 (partial+). According to the imaging and pathological examination results, the diagnosis was cardiac and pulmonary epithelioid hemangioendothelioma (EHE). After 2 cycles of targeted combined chemotherapy, the lesions in the right ventricle and both lungs shrank slightly, and the efficacy was evaluated as stable disease (SD). EHE is a rare vascular tumor, and there are few reports of EHE involving the heart and lungs at the same time at home and abroad. Cardiac EHE is rare, most patients have no obvious symptoms, and it often occurs in the right atrium. The imaging manifestations are non-specific, the enhancement is mild, and PET/CT shows high metabolism. The confirmed diagnosis requires pathological examination. The typical manifestation of pulmonary EHE is multiple solid nodules of varying sizes in the lungs, mainly distributed in the middle and lower lung fields, with light to high metabolism. The treatment of EHE is mainly surgery, and cases that lose the opportunity for surgery can be treated with radiotherapy, chemotherapy or targeted therapy. The overall prognosis of EHE is poor, easy to recur and metastasize, and the survival time of patients with EHE involving the heart and lungs is significantly shortened. The postoperative survival time of cardiac tumors is 4 to 10 months.