Zhonghua yi xue za zhi最新文献

Oxycodone is an agonist of μ-and κ-opioid receptors which has been commonly used for the management of moderate to severe pain attributing to its distinct pharmacological properties. Due to the lack of unified medication guidance, significant variations exist in the clinical application of oxycodone injection among different medical institutions and healthcare providers, aggravating the standardization and homogenization of pain management. To solve this problem, the Pain Group of the Chinese Society of Anesthesiology has organized a multidisciplinary panel of experts to develop this consensus focusing on 15 key clinical questions. Based on systematic literature review and evidence evaluation, the consensus establishes 15 recommendations covering general anesthesia induction, preventive medication, postoperative analgesia, post-thoracic/abdominal surgery analgesia, epidural anesthesia, procedural sedation and analgesia, special patient use etc. This consensus aims to standardize clinical application and optimize pain management outcomes by providing evidence-based guidance on oxycodone injection.

In recent years, the number of research papers on building disease prognosis prediction models (referred to as modeling) has rapidly increased, but clinical applications are rare, and a vast array of studies and papers failed to improve clinical practice. The reasons for this are worthy of attention. The author proposes that modeling research is a systematic engineering, and the current "one-step" technical approach is the main reason for the above phenomenon. Modeling research can be divided into four stages: topic selection, preliminary preparation, modeling, promotion and application, and re-evaluation. Each stage has a series of clinical and scientific questions that need to be answered, and should be gradually promoted. The paper clarifies from a methodological perspective that modeling research should be guided by clinical problems and needs, and form a series of studies based on clear clinical application scenarios and subsequent solutions. The paper analyzes the objectives and tasks of each research, available research plans, key points and difficulties to be noted, and milestone achievements of each stage. Meanwhile, it is suggested to strive to incorporate modeling research into the framework of scientific community behavior, and empower evidence-based medicine with research results and their promotion and application. Finally, the author points out that modeling research and its subsequent clinical applications face legal, ethical, and management (including potential conflict of interest risks) issues and challenges that need to be addressed through further research.

Conventional radiomics approaches are constrained by suboptimal diagnostic performance, limited capacity to characterize molecular heterogeneity within the tumor microenvironment, and insufficient capture of critical biological information regarding host immune responses. In response, AI-augmented multi-omics analytics have emerged as a core component throughout the management of lung cancer and pulmonary nodules, decoding intricate tumor biological landscapes to deliver novel dimensions for precision diagnosis and treatment, thereby establishing a foundational component of their comprehensive disease management. This cross-dimensional data synthesis not only transcends the informational limitations inherent in unimodal methodologies but also enables integrative profiling spanning anatomical architecture to molecular mechanisms, thereby substantially propelling the advancement of precision diagnosis and treatment of lung cancer and pulmonary nodules. Nevertheless, persistent challenges including inadequate data standardization and limited model interpretability remain to be addressed. The translational pathway is further impeded by delayed clinical validation and technical complexities in multi-omics data integration. Future research endeavors should prioritize the implementation of prospective trials and the development of novel AI technologies to overcome these obstacles, ultimately enabling early detection and personalized therapeutic interventions for lung cancer and pulmonary nodules.

As the aging process accelerates in China, disability has become a critical issue affecting the health and quality of life of the elderly. The incidence of disability significantly increases with age, adding to the caregiving burden on families and society. Disability results from the interaction between impairments in body functions and structures and environmental factors, rather than a single cause. This consensus focuses on the functional dimensions of eight core areas: mobility, cognition, emotion, vision, hearing, speech and swallowing, elimination, daily activities, and social participation, along with corresponding assessment measures. It systematically reviews clinical evidence and the latest developments of relevant assessment protocols both domestically and internationally. By integrating expert opinions from multiple disciplines using the Delphi method, the consensus presents eight assessment protocols and recommendations suitable for elderly populations in the community, aiming to provide evidence-based guidance for the early screening of disability in community-dwelling older adults.

A retrospective analysis was conducted on the clinical data of patients with giant refractory gastric bezoars treated at Zhongda Hospital of Southeast University between January 2019 and May 2025. All patients underwent modified endoscopic holmium laser-yellow zebra guidewire loop combined lithotripsy. Follow-up gastroscopy was performed 4 weeks postoperatively to analyze the efficacy of this combined technique in treating giant refractory gastric bezoars. A total of 38 patients were included, including 14 males and 24 females, aged (66±12) years (44-88 years). Thirty-five patients successfully achieved bezoar removal after a single treatment session, with a single-session success rate of 92.1% (35/38). Postoperative complications, such as nausea, vomiting, gastric mucosal injury, or pain, occurred in 4 patients (10.5%). At the 4-week follow-up gastroscopy, the complete ulcer healing rate was 87% (20/23). The modified endoscopic holmium laser-yellow zebra guidewire loop combined lithotripsy is a safe and effective treatment for giant refractory gastric bezoars.

Replantation of amputated limbs is the most effective treatment for severe limb injuries, and allogeneic limb transplantation is also one of the potentially most effective methods to address limb amputation injuries in the future. The preservation and repair of severed limbs outside the body is a key factor in improving the success rate of limb replantation and transplantation. Currently, the techniques for preserving and repairing severed limbs outside the body include static refrigeration preservation technology, immersion in cryoprotective solution technology, deep cryogenic freezing technology, mechanical perfusion technology, temporary vascular shunt technology, autologous ectopic grafting technology, and experimental-stage xenogeneic cross-circulation technology. By optimizing key parameters such as temperature, pressure, and preservation solution, these techniques can extend the preservation time of the limbs and increase the success rate of replantation. Traditional techniques have a short preservation time and cannot meet clinical needs. Emerging technologies are in the ascendant and are subject to different opinions. National Clinical Research Center for Orthopedics Sports Medicine & Rehabilitation, the Microsurgery Branch of Chinese Medical Association and the Microsurgery Branch of Beijing Orthopedic Association, based on current evidence-based medical evidence, have formulated the "Clinical practice guidelines for the in vitro preservation and repair of severed limbs (2025 edition)". This guideline systematically evaluates a series of literature and related evidence-based medical research evidence published domestically and internationally in the field of organ preservation in recent years, and adds evidence-based medical research data based on the Chinese population, with the aim of further standardizing the relevant techniques for ex vivo preservation of amputated limbs in China, for industry reference.

Approximately 15%-25% paragangliomas and pheochromocytomas (PPGL) can metastasize. Untreated metastatic PPGL (MPP) patients have a 5-year survival rate below 50%, while standardized diagnosis and treatment can significantly improve prognosis. Currently, there has been no established national guidelines for MPP management in China. To address this gap, the Adrenal Group of Chinese Society of Endocrinology convened a multidisciplinary panel of experts from endocrinology, oncology, surgery, nuclear medicine, radiation oncology, pathology, laboratory medicine, and interventional therapy. Based on evidence-based medicine, the latest global research, and clinical data from China, the panel has developed a consensus statement. This consensus encompasses various aspects of MPP, including its epidemiology, pathogenesis, risk factors and prediction for dissemination, clinical manifestations, diagnosis, treatment, and prognosis. A total of 16 recommendation statements have been formulated, with the aim of assisting clinicians in developing standardized strategies for the diagnosis and treatment of MPP.

In response to the urgent needs and existing challenges of stroke prevention and treatment in high-altitude areas, the Expert Committee of the Million Disability Reduction Project of the National Health Commission took the lead and jointly developed "Expert consensus on the construction of stroke centers at high altitude (2025 edition)" with multidisciplinary experts, on the bsais of the guidelines and standards for the construction of secondary and tertiary stroke centers in high-altitude areas. The consensus clarifies the purpose, the coverage, the initiating and supporting units, the expert group and the process of formulation. It elaborates the construction goals of stroke centers in high-altitude areas and the functional roles of secondary and tertiary stroke centers. It also specifies the organizational management structures for these centers, the construction standards for secondary and tertiary stroke centers, and the quality management systems for stroke prevention and treatment, etc. By providing a framework for the allocation of medical resources and quality oversight in plateau regions, this consensus aims to standardize the stroke diagnosis and treatment processes, enhance the efficiency and quality of stroke care, improve patient prognosis, and elevate the overall level of stroke medical service system construction in China. It is recommended to promote and apply it in relevant medical institutions in high-altitude areas.