Volume 106 · Issue 38 · 2026

Postoperative pain and postoperative delirium (POD) may share some pathophysiological mechanisms in frail older patients. Persistent nociceptive input, accumulation of analgesic drugs, hemodynamic fluctuations, and respiratory depression may increase the risk of acute brain dysfunction. Potential mechanisms include blood-brain barrier disruption and neuroinflammation, disturbances in cerebral perfusion and oxygen metabolism, and disruption of sleep and arousal networks. A systematic review suggests a dose-response relationship between postoperative pain intensity and POD, although the certainty of the evidence is low and causality remains unproven. This article proposes a "dual-exposure, three-pathway, closed-loop management" framework for perioperative analgesia and the prevention and management of postoperative delirium in frail older patients. Preoperative assessment should include frailty, cognitive status, and pain-related risk. Intraoperatively, precision multimodal analgesia should be tailored to incisional, visceral, and inflammatory pain, with the regimen adjusted using data from nociception, electroencephalographic, cerebral oxygenation, and hemodynamic monitoring. Postoperatively, pain should be assessed repeatedly over time, together with concurrent screening for POD and identification of reversible precipitating factors. The goal of analgesia in frail older patients should not be defined simply as "zero pain" or complete avoidance of opioids. Instead, adequate analgesia should be provided while minimizing treatment-related adverse effects that may impair brain function.

Perioperative stroke refers to embolic, thrombotic, or hemorrhagic cerebrovascular disease occurring during surgery or within 30 days postoperatively, which can lead to disability or death in patients. This review systematically describes the pathogenesis, risk factor identification, and prevention and treatment strategies for perioperative stroke. The pathogenesis of perioperative ischemic stroke involves multiple pathological processes including thromboembolism, hemodynamic disturbances, inflammatory responses, and blood-brain barrier disruption. Risk factors include patient-related factors, surgical factors, and anesthesia management factors. Prevention strategies emphasize preoperative precise identification of high-risk patients using risk assessment tools and predictive models, optimizing control of underlying diseases; intraoperative maintenance of hemodynamic stability, implementation of cerebral oxygen saturation monitoring, and timely detection of cerebral ischemia; postoperative establishment of neurological function monitoring systems, adoption of standardized stroke screening tools to achieve early identification and timely intervention. Establishing multidisciplinary collaboration mechanisms, implementing effective perioperative management, and exploring novel neuroprotective targets and intervention strategies are key to reducing perioperative stroke incidence and improving patient outcomes.

The sole measurement of fasting blood lipids fails to capture the complete profile of an individual′s lipid metabolism. Postprandial lipid levels are strongly correlated with multiple diseases, including diabetes and atherosclerotic cardiovascular disease. The oral high-fat tolerance test (OFTT) is a clinical method used to evaluate postprandial lipid metabolism by analyzing changes in postprandial blood lipid levels after subjects consume a fixed high-fat meal. It facilitates early clinical screening of individuals with normal fasting lipids but who already have reduced fat tolerance and postprandial dyslipidemia, which is of great significance for early intervention and the early prevention and management of diabetes, cardiovascular and cerebrovascular diseases, and other conditions. Currently, there is no unified international or domestic standard for the OFTT procedure and result interpretation, which limits its application and promotion.This manuscript drawing on relevant domestic and international literature and practical experience from experts in the field, proposes several recommendations for the procedure and clinical application of the OFTT, aims to promote the standardization and unification of the OFTT, providing guidance and reference for the early screening and timely intervention of dyslipidemia.

Membranous nephropathy (MN) is one of the most common primary glomerular diseases in China. In recent years, substantial progress has been made in the diagnosis, treatment, and management of MN both domestically and internationally, and a growing body of new evidence has emerged. Therefore, it is imperative to standardize current diagnostic and therapeutic approaches and to provide clinicians with actionable, evidence-based guidance. The National Clinical Research Center for Kidney Diseases has organized a guideline working group to develop the "Guideline for the diagnosis, treatment and management of membranous nephropathy (2026 edition)". This guideline adopts the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to evaluate the quality of evidence and strength of recommendations, with the final recommendations presented as formal "Recommendations" and "Practice Suggestions". The guideline focuses specifically on the diagnosis, risk stratification, treatment strategies, and comprehensive management of MN, with the aim of providing clinicians with a practical reference tosupport scientific, well-standardized therapeutic decision-making and disease management.

This study aimed to comprehensively investigate influencing factors of pregnancy outcomes after frozen-thawed embryo transfer (FET) in infertile women with intramural fibroids≥4 cm in diameter.

This was a retrospective case-control study. We retrospectively enrolled 1 551 FET-cycle patients underwent in-vitro fertilisation-embryo transfer (IVF-ET) with at one least intramural fibroid≥4 cm in diameter documented by preoperative transvaginal ultrasonography in the Reproductive Medicine Center of Peking University Third Hospital between January 2020 and December 2024. According to the fertility outcome of FET, patients were divided into the live birth group (n=372) and the non-live birth group (n=1 179). Medical history, baseline clinical characteristics, transvaginal ultrasonographic parameters and IVF laboratory data were compared between the two groups. Multivariate logistic regression was used to identify factors correlated with live birth, and a subgroup analysis was conducted among patients with enlarged uterine volume.

The mean age of the overall patients was (36.6±3.8) years. The live-birth rate per FET cycle was 24.0% (372/1 551), and the full-term birth rate was 86.6% (322/372). Univariate analysis revealed significant differences between two groups in maternal age, serum anti-Müllerian hormone (AMH) level, bilateral antral follicle count (AFC), number of fibroids, uterine length, uterine width, total uterine volume, endometrial thickness on the day of progesterone initiation, and paternal age (all P<0.05). Multivariable logistic regression identified the following independent predictors of failing to achieve a live birth: maternal age>37 years (OR=0.605, 95%CI: 0.470-0.781, P<0.001); uterine volume≥120 cm³ (OR=0.632, 95%CI: 0.470-0.850, P=0.002); and endometrial thickness≤10.6 mm on the day of progesterone initiation (OR=0.630, 95%CI: 0.496-0.799, P<0.001). Subgroup analysis of patients with uterine volume>120 cm³ showed no significant difference in live-birth rates among the four endometrial preparation protocols (down-regulated hormone-replacement, natural cycle, conventional hormone-replacement, and ovulation-induction cycle) after adjustment for potential confounders (P>0.05).

In infertile women undergoing FET with concomitant intramural fibroid≥4 cm, the likelihood of live birth is significantly associated with advancing maternal age, enlarged uterine volume, and reduced endometrial thickness on the day of progesterone initiation. For patients presenting with a uterine volume>120 cm³, the adoption of a down-regulated hormone-replacement protocol fails to confer a demonstrable improvement in live-birth rates.

To develop and validate a prediction model for the postoperative recurrence of ovarian endometriotic cysts based on preoperative imaging and clinical serum biomarkers.

A retrospective study was conducted on 300 patients who underwent laparoscopic cystectomy at Shanxi Children′s Hospital (Shanxi Maternal and Child Health Hospital) between June 2021 and June 2024. Patients were randomly assigned in a 7∶3 ratio to a training set (n=210) and an internal validation set (n=90) using a computer-generated random number method. Variables were selected using least absolute shrinkage and selection operator (LASSO) regression; multivariable logistic regression, random forest, and extreme gradient boosting (XGBoost) models were constructed; the predictive ability, accuracy, and clinical applicability of the model were evaluated using the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA).

The 300 patients had a mean age of (34.2±5.8) years. The median follow-up duration was 28 months (interquartile range: 24-38 months; range: 12-48 months), and recurrence occurred in 75 patients (25.0%) during the follow-up period. LASSO regression identified 10 predictive variables. Subsequent multivariate logistic regression analysis revealed that age<35 years (OR=3.24, 95%CI: 1.74-6.03), revised American Fertility Society (r-AFS) stage Ⅲ-Ⅳ (OR=3.42, 95%CI: 1.81-6.47), maximum cyst diameter≥6 cm (OR=2.89, 95%CI: 1.61-5.19), bilateral involvement (OR=2.56, 95%CI: 1.41-4.65), apparent diffusion coefficient<1.2×10^-3 mm²/s (OR=2.31, 95%CI: 1.31-4.08), CA-125>70 U/ml (OR=2.78, 95%CI: 1.56-4.96), and absence of postoperative pharmacological treatment (OR=4.15, 95%CI: 2.18-7.89) were risk factors for postoperative recurrence, while the duration of pharmacological treatment was a protective factor (OR=0.88, 95%CI: 0.79-0.97) (all P<0.05). The AUC for the three models in the internal validation set were 0.839 (95%CI: 0.759-0.919), 0.876 (95%CI: 0.805-0.947), and 0.894 (95%CI:0.829-0.959), respectively; the XGBoost model outperformed the multivariate logistic regression model (P=0.008), whereas the difference compared with the Random Forest model was not statistically significant (P=0.162). All three models demonstrated good calibration (Hosmer-Lemeshow test χ² values: 6.83, 5.92, and 5.14; P-values: 0.555, 0.656, and 0.743, respectively). Within the threshold probability range of 10% to 60%, the extreme gradient boosting model yielded the highest net benefit.

The extreme gradient boosting model exhibits good predictive performance for the postoperative recurrence of ovarian endometriotic cysts and can serve as a reference for risk stratification and personalized follow-up.

To assess discrepancies in androgen measurements, investigate potential interfering factors, and propose an optimized diagnostic pathway for women with falsely elevated androgen levels.

Thirty female cases with falsely elevated androgen levels at Peking University First Hospital between October 2021 and September 2025 were included to compare chemiluminescence immunoassay (CLIA) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) in measuring testosterone (T), androstenedione (A4), and dehydroepiandrosterone sulfate (DHEAS). We assessed methodological agreement using Passing-Bablok regression and Bland-Altman analysis. Heterophilic antibody (HA) blocking and liquid-liquid extraction were performed to identify potential interfering factors.

The mean patient age was (31.2±6.3) years. Cutaneous hyperandrogenic signs were absent in 63.3% (19/30) of patients, ovarian imaging abnormalities were absent in 60.0% (18/30), and adrenal imaging performed in 43.3% (13/30) of cases revealed no abnormalities. Total testosterone levels measured by the Beckman, Siemens, and Roche CLIA platforms were 1.12, 0.32, and 0.46 ng/ml, respectively, each significantly exceeding the LC-MS/MS value of 0.27 ng/ml (all P<0.05). Moreover, A4 and DHEAS levels determined by the Siemens platform were 2.21 ng/ml and 2 660 μg/L, respectively, also significantly higher than the corresponding LC-MS/MS results of 1.07 ng/ml and 2 164 μg/L (both P<0.05). The rate of false elevation in T varied significantly across different CLIA platforms. The false elevation rate for A4 was 16.7%(5/30), while no false elevation was observed for DHEAS. CLIA assays showed systematic positive biases for all three androgens tested, with median relative biases ranging from 26.0% to 352.0%, 69.0%, and 19.0%, respectively. The proportion of patients exceeding the allowable total error (TEa,±15%) was 76.2% to 100.0%, 93.3%, and 56.6% for the three analytes, respectively. Passing-Bablok regression indicated a significant constant positive bias for T and A4, as measured by CLIA, with proportional bias also observed for A4. In contrast, no significant systematic or proportional bias was found for DHEAS. Bland-Altman analysis confirmed that the limits of agreement for all three androgens by CLIA exceeded the TEa range. Interference verification suggests that factors such as HA may be associated with false elevation of T. In cases of falsely elevated T levels, the low-dose dexamethasone suppression test effectively suppressed DHEAS, but the suppression rate of T lacked diagnostic value for differentiation.

CLIA generally overestimates serum T and A4 levels in women than LC-MS/MS.

To evaluate the clinical and functional outcomes of unicompartmental knee arthroplasty (UKA) in patients with medial compartment knee osteoarthritis across different body mass index (BMI) categories.

The clinical data of 1 483 patients who underwent medial UKA at the First Hospital of Hebei Medical University between May 2021 and December 2023 were retrospectively analyzed. According to BMI, the patients were divided into 4 groups: BMI<25 kg/m², 25 kg/m²≤BMI<30 kg/m², 30 kg/m²≤BMI<35 kg/m², and BMI≥35 kg/m². Preoperative and postoperative knee function and clinical outcomes were recorded. The primary outcome was the incidence of reoperation. Secondary outcomes included the Knee Society score (KSS), Oxford Knee score (OKS), visual analogue scale (VAS) for pain, and forgotten joint score (FJS). Changes in knee function scores from preoperatively to postoperatively were analyzed within each BMI group, and postoperative function scores, the magnitude of score improvement, and the occurrence of reoperation were compared across BMI groups.

The patients had a mean age of (63.0±6.5) years, with a male-to-female ratio of 1∶3.72, and a mean follow-up duration of (33.9±5.3) months. The BMI<25, 25-<30, 30-<35, and≥35 kg/m² groups comprised 317, 790, 325, and 51 patients, respectively. Patients in the BMI≥35 kg/m² group were younger than those in the BMI<25 kg/m² group [(58.9±6.3) years vs (64.3±6.9) years, P<0.001]. The postoperative KSS clinical score, KSS functional score, OKS, and VAS improved significantly compared with the corresponding preoperative values in all BMI groups (all P<0.001). There were no statistically significant differences among the 4 groups in postoperative KSS clinical score, KSS functional score, OKS, VAS score, or FJS, or in the magnitude of improvement in functional scores (all P>0.05). No patient in any group underwent reoperation during follow-up.

Medial UKA significantly improves the clinical and functional outcomes of patients across different BMI categories. Patients with a BMI≥35 kg/m² achieve short-to mid-term clinical and functional outcomes comparable to those of patients with lower BMI.

To investigate the role and mechanism of the cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) pathway in mediating blood-brain barrier (BBB) injury within the prefrontal cortex of 15-month-old mice with postoperative cognitive dysfunction (POCD).

Fifteen-month-old male C57BL/6J mice were enrolled and randomly assigned to experimental groups using a random-number table. Experiment 1: twenty-four mice were randomly divided into four groups (n=6): control group (no intervention), sham group, POCD group, and POCD+RU.521 group. On postoperative day 3, cognitive function and spontaneous activity were evaluated by the Morris water maze test and open field test. Prefrontal cortex tissues were subsequently collected for transcriptome sequencing. Experiment 2: twenty-four mice were randomly allocated to eight groups (n=3): sham group, sham+RU.521 group, sham+diABZI group, sham+diABZI+RU.521 group, POCD group, POCD+RU.521 group, POCD+diABZI group, and POCD+diABZI+RU.521 group. On postoperative day 3, prefrontal cortex tissues were harvested for detection of pathway-related protein expression by Western blotting, and assessment of BBB permeability by Evans blue leakage assay. Experiment 3: transcriptome sequencing was performed using prefrontal cortex tissues obtained from experiment 1. Experiment 4: eighteen mice were randomly allocated to three groups (n=6): sham group, POCD group, and POCD+RU.521 group. On postoperative day 3, prefrontal cortex tissues were collected to verify the mRNA expression of target genes by quantitative real-time polymerase chain reaction (RT-qPCR). The POCD model was established by isoflurane anesthesia combined with laparotomy. The cGAS-STING pathway was inhibited or activated by intraperitoneal injection of the cGAS inhibitor RU.521 (5 mg/kg), the STING agonist diABZI (2.5 mg/kg), or diABZI combined with RU.521 at 2 h before surgery, respectively.

Compared with the sham group, the POCD group exhibited longer escape latency, lower percentage of time in the target quadrant, and fewer platform crossings in the Morris water maze test, as well as shorter total locomotor distance and less residence time in the central area in the open field test. Compared with the sham group, the relative expression levels of cGAS, STING, p-IRF3 and p-TBK1 in the prefrontal cortex were significantily higher, whereas the relative expression levels of tight junction proteins ZO-1 and Claudin5 were significantily lower, and the Evans blue content in brain tissue was significantily higher in the POCD group (all P<0.05). Intraperitoneal administration of diABZI further aggravated the aforementioned pathway activation, downregulation of tight junction proteins and BBB injury in POCD mice, while intraperitoneal administration of RU.521 reversed these pathological changes and ameliorated cognitive impairment; all these differences were statistically significant (all P<0.05). Compared with the sham group, the sham+diABZI group showed higher expression of cGAS-STING pathway-related proteins and more severe BBB injury, which could be reversed by combined administration with RU.521. Transcriptome sequencing combined with RT-qPCR identified Sdc4, Nnt, Gpt2, Rbp7 and Mertk as relevant target genes.

Excessive activation of the cGAS-STING signaling pathway is involved in the pathogenesis of POCD in 15-month-old mice. Inhibition of this pathway can ameliorate postoperative cognitive impairment by alleviating prefrontal cortex blood-brain barrier injury and regulating the expression of relevant target genes.

This study aims to analyze the epidemiological characteristics of colorectal cancer incidence and mortality in Shandong Province from 2012 to 2023, and predict its development trends from 2024 to 2030.

The incidence and mortality data of colorectal cancer in Shandong Province from 2012 to 2023 were obtained from the Shandong Provincial Cancer Registry. The annual, gender-specific, urban-rural crude incidence rate, age-specific incidence rate, crude mortality rate and age-specific mortality rate of colorectal cancer were calculated. The standardized rates were based on the age composition of the 2000 Chinese Standard Population. Joinpoint 4.8.0.1 software was used to calculate the average annual percent change (AAPC). The Bayesian age-period-cohort (BAPC) model was applied to predict the incidence and mortality trends of colorectal cancer from 2024 to 2030.

From 2012 to 2023, the standardized incidence rate of colorectal cancer in Shandong Province increased from 16.21/100 000 to 19.16/100 000 (AAPC=1.38%, P=0.009), while the standardized mortality rate decreased from 7.02/100 000 to 5.84/100 000 with no statistically significant overall change (AAPC=-1.66%, P=0.120). The standardized incidence rate showed an upward trend in males and rural residents (AAPC=1.76%, P=0.003; AAPC=2.23%, P=0.001, respectively), with no significant changes observed in females and urban residents. The standardized mortality rate declined significantly in females and urban residents (AAPC=-2.78%, P=0.037; AAPC=-2.39%, P=0.026, respectively), and remained stable in males and rural residents. Both age-specific incidence and mortality rates rose rapidly after the age of 45 and peaked in the 80-84 age group. The BAPC model prediction results indicated that the standardized incidence rate of colorectal cancer in Shandong Province would level off from 2024 to 2030 (AAPC=0.32%, P=0.005), rising slowly from 18.93/100 000 in 2024 to 19.26/100 000 in 2030. The standardized mortality rate would show a continuous downward trend (AAPC=-0.91%, P<0.001), decreasing from 5.79/100 000 in 2024 to 5.51/100 000 in 2030.

The standardized incidence rate of colorectal cancer in Shandong Province presents an upward trend and is expected to level off before 2030, while the standardized mortality rate shows a downward trend. Males and rural areas are the key populations and regions for prevention and control.

To systematically evaluate the protective effect of influenza vaccine among healthcare workers (HCW).

Relevant literature from January 1, 2000 to November 4, 2025, was retrieved from China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, China National Biomedical Literature Service System, National Library of Medicine database, Dutch Medical Abstracts database, and Cochrane Collaboration Library. Two independent researchers screened the literature, extracted data and assessed the quality of the studies, based on predefined inclusion and exclusion criteria. Studies using cohort design and test-negative design were included. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. A meta-analysis was performed using R software version 4.3.3, with vaccine effectiveness (VE) as the effect measure, to calculate the effectiveness of influenza vaccine among HCW.

A total of 24 articles involving 27 studies were included, analyzing the effectiveness of influenza vaccine among 38 855 HCW. Meta-analysis results showed that the VE (95%CI) was 33.26% (14.08%-48.15%) for cohort studies and 36.85% (9.05%-56.15%) for test-negative design studies. No statistically significant difference was observed between the two groups (χ²=0.05, P=0.814); thus data were pooled. The pooled effectiveness of influenza vaccine (95%CI) was 34.11% (18.69%-46.60%). Subgroup analysis revealed that the effectiveness against influenza-like illness (ILI) (95%CI) was 25.97% (1.88%-44.15%), while the effectiveness against laboratory-confirmed influenza cases (95%CI) was 42.68% (21.64%-58.07%). Additionally, sensitivity analysis indicated that the results were stable and not significantly affected by publication bias.

The effectiveness of influenza vaccine among HCW is heterogeneous but generally moderate, particularly more pronounced in laboratory-confirmed cases.

To summarize the ultrasonographic features and causes of misdiagnosis of Müllerian-Wolffian duct combined anomalies and to evaluate their clinical diagnostic value through a literature review. A retrospective analysis was performed on the clinical data and three-dimensional transvaginal sonographic findings of 5 patients with surgically confirmed Müllerian-Wolffian combined anomalies treated at Fuxing Hospital, Capital Medical University, from March 2021 to December 2025. Relevant case reports were retrieved from PubMed, Google Scholar, Wanfang Data, VIP, and CNKI from database inception to December 31, 2025 for literature review. Five cases were included, with a median age of 21 (16, 37) years; 1 patient was married and 4 were unmarried. The main clinical manifestations included dysmenorrhea, prolonged menstruation, abnormal vaginal discharge, postmenstrual spotting, and infertility. Ultrasonography achieved a diagnostic concordance rate of 100.0% for uterine malformation type and unilateral renal agenesis, but showed limited accuracy in identifying cervical diverticula and cervical communicating tracts. Some paracervical cystic lesions were misdiagnosed preoperatively as cervical cysts, and were confirmed intraoperatively to be mesonephric or ureteric remnant-related lesions. All 5 patients underwent combined hysteroscopic and laparoscopic exploration followed by individualized minimally invasive treatment, and all symptoms were relieved after surgery. Additionally, a total of 9 cases were identified from the literature review. Preoperative imaging was generally accurate in identifying uterine malformation types. Magnetic resonance imaging (MRI) and hysterosalpingography (HSG) provided additional value in evaluating cervical canal patency, cervicovaginal communication, and complex mesonephric-related anomalies; however, some complex cases still required confirmation by hysteroscopic and laparoscopic exploration. Müllerian-Wolffian combined anomalies are frequently associated with occult cervical abnormalities and mesonephric-derived lesions. Three-dimensional transvaginal sonography combined with urinary system evaluation may improve initial screening and preoperative diagnosis, and provide a basis for individualized uterus-preserving minimally invasive treatment.

With the acceleration of aging, elderly patients face prominent problems such as perioperative weakness, sarcopenia, multiple diseases, cognitive decline, and malnutrition. Traditional risk assessment tools have limited predictions of outcomes such as functional impairment and quality of life. Comprehensive geriatric assessment (CGA) can more comprehensively identify perioperative risks through multi-dimensional assessment and multidisciplinary collaboration, and provide a basis for individualized intervention, joint decision-making and continuous care. This paper reviews the main application dimensions of CGA in perioperative management and the whole-process management path of preoperative-intraoperative-postoperative, summarizes the existing perioperative optimization management mode based on CGA, and analyzes its implementation challenges, providing a reference for building a localized and scalable perioperative management path for the elderly in my country.

Abnormal uterine bleeding (AUB) is a common gynecological problem in women of childbearing age. Endometrial removal (EA) reduces menstrual flow and even achieves amenorrhea by removing the entire endometrium and part of the superficial muscle layer below it. It has become an effective treatment option for AUB patients when drug treatment is ineffective and they are unwilling or unable to remove the uterus. EA technology is divided into the first generation and the second generation: the first generation includes laser, resection scope and rolling ball removal, which has problems such as high risk of complications and difficult technical operation; The second-generation technology uses energy methods such as physical heating, freezing, and radiofrequency to simplify the operation process and reduce some perioperative risks while maintaining the curative effect. It has now become an important technical form for the clinical application of EA in most regions. This article aims to systematically summarize the development history, clinical application status and related controversies of EA technology. Second-generation EA technology has become an important treatment option for AUB patients who have failed drug treatment and have no fertility needs due to its advantages such as ease of operation, high safety and stable efficacy. The future development of EA will focus on precise patient screening, intelligent energy control, and combination therapy strategies to further improve long-term efficacy and safety.

The clinical application of percutaneous implants has always faced the serious challenge of poor integration of the surrounding skin. This paper systematically analyzes the biological processes and failure mechanisms of skin integration, and focuses on summarizing advanced design strategies to promote integration. Existing studies have shown that host material optimization, surface topography modification, and functional modification can significantly improve early tissue response and initially establish skin integration, but it is difficult to maintain long-term stability in dynamic mechanical environments and continuous tissue remodeling. Recent studies have achieved synergistic regulation of epithelial sealing and dermal integration by introducing a flexible interlayer that combines mechanical buffering and spatial barrier functions, which may become a potential paradigm to overcome long-term failure of percutaneous interfaces. This paper also prospects a multidisciplinary strategy integrating interface mechanics regulation, structural partitioning design, and immune homeostasis regulation, hoping to provide a theoretical basis for the design and clinical application of next-generation percutaneous implants.

The abnormal enrichment of regulatory T cells (Tregs) in the tumor microenvironment (TME) is a key factor in achieving immune escape in hepatocellular carcinoma (HCC). This article reviews the mechanisms of Treg recruitment, metabolic adaptation, and cellular interaction in the HCC microenvironment. Tregs accumulate locally in liver cancer tissues through chemokine recruitment and utilize liver-specific metabolic stress conditions (hypoxia, lactic acid accumulation, bile acids, etc.) for deep metabolic reprogramming. Tregs gain survival advantages and immunosuppressive abilities by enhancing fatty acid oxidation, lactic acid uptake, and responding to intestinal-hepatic axis metabolic signals. Finally, a new therapeutic strategy for hepatocellular carcinoma targeting Treg metabolic characteristics was discussed, providing a theoretical basis for developing a new therapeutic model targeting Treg.

In the article "Clinical Practice Guidelines for Perioperative Fluid Therapy for Adult Patients in China (2025 Edition)" published in the Chinese Medical Journal on January 14, 2025, Vol. 105, No. 2, the lower right corner of page 132, where "HCTf is preoperative/pre-blood loss hematocrit" should read "HCTf is postoperative/pre-blood loss hematocrit", this correction is hereby made.

In hypertensive patients, long-term maintenance of systolic blood pressure within established target ranges is associated with a significantly reduced risk of chronic kidney disease. A recent post-hoc analysis based on the STEP study showed that the "time-in-target range" (TTR) of systolic blood pressure is expected to become an important treatment goal and quality evaluation indicator in the management of hypertension.

Colorectal cancer is one of the most common malignant tumors of the gastrointestinal tract. Because its early symptoms are not obvious, it often leads to delayed diagnosis and seriously affects the prognosis of patients. Improving the ability to identify high-risk groups early is the key to improving the survival rate of colorectal cancer. In recent years, DNA methylation, as a stable epigenetic modification closely related to tumorigenesis, has increasingly become an important research direction in the field of early cancer screening. In particular, the DNA methylation state of leukocytes is affected by the tumor microenvironment and immune response, and has the potential to reflect tumor changes in the body. Against this backdrop, the research team systematically screened peripheral blood leukocyte DNA methylation markers based on population screening cohorts and constructed a colorectal tumor risk prediction model, aiming to provide a scientific basis for individualized screening strategies.