Zhonghua yi xue za zhi最新文献

Neutropenia is one of the most common hematologic toxicities during the treatment of hematologic malignancies. It can lead to delays in subsequent treatments, dose reduction of chemotherapeutic agents, or even treatment discontinuation. Furthermore, neutropenia increases the risk of febrile neutropenia and severe infections, which adversely affect patient prognosis. Pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) is effective in preventing and treating neutropenia, and is widely used in the treatment of hematologic malignancies and hematopoietic stem cell transplantation (HSCT). To further promote the standardized application of PEG-rhG-CSF in hematological malignancies, the Hematology Oncology Committee of China Anti-Cancer Association organized domestic experts in the related fields, based on current evidence-based medical data and clinical practice, to focus on the clinical application of PEG-rhG-CSF in hematologic malignancies, hematopoietic stem cell mobilization and hematopoietic function reconstitution after HSCT. Eight recommendation opinions were finally proposed to guide the standardized use of drugs in clinical practice.

The rapid advancement of artificial intelligence (AI) technologies, particularly deep learning algorithms and hardware devices, has profoundly transformed diagnostic and therapeutic paradigms in sports medicine. This article reviews the applications and recent progress of AI across multiple domains in the field, including the use of deep learning and machine learning models for injury risk prediction and early screening; the application of computer vision techniques in imaging diagnosis; the integration of intelligent algorithms into surgical planning and intraoperative assistance; the dynamic monitoring of rehabilitation processes; and the deployment of large language models to support patient education and consultation. The deep integration of sports medicine and AI requires interdisciplinary collaboration across clinical medicine, sports science, materials science, and computer science. This article highlights the current applications, discusses existing challenges and potential risks, and provides an outlook on future development trends.

With the rapid aging of the population, disability and dementia have become major public health challenges affecting the health and quality of life of the elderly in the community. The multidisciplinary collaborative intervention model for the risk of disability and dementia in the elderly, covering key areas such as clinical medicine, public health and social support systems, has become a current research focus. This expert consensus concentrates on eight core functional dimensions-mobility, cognition, emotion, vision, hearing, excretion, swallowing, and comorbidity management-and the corresponding modifiable risk factors. It systematically reviews the clinical evidence and latest advances in relevant interventions in China and abroad. By integrating opinions from multidisciplinary experts through the Delphi method, the consensus ultimately formulates 15 intervention strategies and recommendations across these eight dimensions for the elderly in the community, with the aim of establishing effective approaches to delay the progression of disability and dementia, providing evidence-based support for primary health-care services, and promoting healthy ageing in China.

With a focus on strengthening innovative drug development and promoting the clinical application of emerging medical technologies, we have summarized innovation-driven pharmaceutical development and clinical advancement, highlighting the key challenges, current hotspots, and potential breakthroughs, while outlining priority directions for fostering deeper integration between pharmaceutical development and medical practice. This paper provides a systematic analysis of the progress, challenges, and future directions of China's innovative drug development. Currently, through biomedical technology innovation, comprehensive policy support, accelerated regulatory reviews and approval processes, and reforms in the payment system, China has risen to a leading global position in terms of the number of innovative drugs developed and license-out deals. However, challenges remain, including weak capacity for original innovation, insufficient alignment with clinical needs, and limited international engagement. To address these, the country has recently launched the national major science and technology special project on drug development in the new phase. This initiative aims to shift the focus toward capacity building, drug discovery and original innovation, while optimizing the project organization and management to foster a collaborative innovation ecosystem. The goal is to establish an independent, controllable, and world-leading drug innovation system by 2035, thereby providing strong support for the "Healthy China" initiative.

Objective: To investigate the effects of Zolpidem combined with Shugan Jieyu capsules on sleep quality and daytime cognitive function in patients with insomnia disorder with depressive symptoms. Methods: Randomized controlled trial. Sixty patients with insomnia disorder with depressive symptoms prospectively recruited from Nanfang Hospital, Southern Medical University from March to October 2023, were randomly divided into an experimental group and a control group, with 30 patients in each group. The experimental group received oral administration of Zolpidem 10 mg/d and Shugan Jieyu capsules 0.72 g/d for 8 weeks, while the control group received oral administration of Zolpidem 10 mg/d and placebo 0.72 g/d for 8 weeks. Repeated-measures analysis of variance was used to assess changes in the insomnia severity index (ISI), Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), patient health questionnaire-9 (PHQ-9), working memory (low-load 1-back task, high-load 2-back task), and polysomnography at baseline, 4 weeks, and 8 weeks between the two groups. Result: A total of 59 patients completed the trial, with 30 in the experimental group [14 males, age (28.5±7.8) years] and 29 in the control group [9 males, age (26.5±5.3) years]. There were no statistically significant differences in age, gender, education level, body mass index, illness duration, apnea-hypopnea index (AHI) and periodic limb movement index (PLMI) between the two groups (all P>0.05). At week 4 and 8 of treatment, the ISI scores of the experimental group [(10.6±5.9) and (8.7±6.7), respectively] and the control group [(11.7±5.1) and (10.6±5.1), respectively] were lower than the baseline values (experimental group: 18.7±4.4) and (control group: 18.9±3.6). In addition, at weeks 4 and 8 of treatment, both groups showed lower PSQI scores, ESS scores, and PHQ-9 scores than baseline and higher N2 sleep stage, sleep efficiency, and accuracy of the high-load cognitive 2-back task than baseline values (all P<0.05). Among them, there was an interaction between the time and the group of high-load cognitive 2-back tasks (the improvement rates of the experimental group at week 4 and 8 were 9.4%±13.2% and 5.7%±13.8% respectively, and the improvement rates in the control group at week 4 and 8 were 20.1%±19.8% and 5.5%±8.7% respectively) (all P<0.05). There were no significant differences between the two groups in terms of ISI score, PSQI score, ESS score, PHQ-9 score, N2 sleep stage, sleep efficiency, and accuracy of 2-back tasks on high-load cognitive tasks at week 4 and 8 of treatment (all P>0.05). Conclusion: Based on comparable improvements achieved in sleep quality and depressive symptoms, the combination of Zolpidem and Shugan Jieyu capsules showed further improvement in the recovery pattern of high-load working memory during the day.

Objective: To explore otologic symptoms and audiological features in patients with spontaneous intracranial hypotension (SIH), and provide reference for clinical diagnosis and treatment. Methods: The clinical data of 348 patients with SIH who were hospitalized and treated at the Chinese PLA General Hospital from January 2001 to June 2025 were retrospectively reviewed. Demographic characteristics, otologic symptoms (hearing loss, tinnitus, ear fullness, dizziness/vertigo), audiological findings, and their associations were analyzed. Results: Among the 348 patients, there were 156 males (44.8%) and 192 females (55.2%). The mean age was (39.5±14.4) years, with the highest proportion in the 30-39-year group (28.7%, 100/348), followed by the 40-49-year group (20.7%, 72/348). All patients presented with headache. Ear symptoms were detected in 104 cases (29.9%). Among them, hearing loss was found in 43 cases (12.4%), with 25 bilateral cases (58.1%) and 18 unilateral cases (41.9%); 51 cases (14.7%) and six cases (1.7%) had tinnitus and ear fullness, respectively; 55 cases (15.8%) had dizziness/vertigo. Of the 34 patients who completed the audiological test, 32 cases (94.1%) had sensorineural hearing loss and two cases (5.9%) had conductive hearing loss. Of 68 ears assessed, mild, moderate, moderately severe, and severe loss occurred in 22, 13, four, and two ears respectively; mild-to-moderate loss accounted for 51.5% (35/68). Descending audiograms were most frequent (36.8%, 25/68), followed by notch (23.5%, 16/68), flat (22.1%, 15/68), and ascending types (17.6%, 12/68). Hearing loss occurred more frequently in the older age group (>18 years old) and in patients with tinnitus or dizziness/vertigo compared with other groups (all P<0.001). Conclusions: Otologic symptoms are common in patients with SIH, with hearing loss, tinnitus, and dizziness/vertigo being predominant. Hearing loss is mainly mild-to-moderate sensorineural type, and the descending audiogram is the most frequent pattern.

Inner ear comorbidity (IEC) refers to a group of diseases caused by lesions in the cochlea, vestibule, and their neural pathways. These diseases are usually accompanied by hearing loss, tinnitus, vertigo and other symptoms simultaneously or dynamically alternating, forming a comorbidity phenomenon with inner ear dysfunction as the core. Inner ear comorbidities increase the complexity and cost of diagnosis and treatment, putting high difficulty and stress on clinicians and health systems. At present, the main symptoms are mostly treated in clinical practice, and the inherent connection between cochlea and vestibule and other systemic diseases is often ignored, making it difficult to accurately classify and target the disease. This article puts forward the definition and category of inner ear comorbid diseases, explains their inherent correlation and multiple drivers in the etiological mechanism, and proposes a precise typing paradigm for multimodal data integration. Moreover, in order to cope with the three challenges of cognitive fragmentation of multiple disease spectra, complexity of disease heterogeneity and fragmentation of medical system, it is urgent to build an interdisciplinary diagnosis and treatment platform, strengthen the research on systematic medicine perspective and full-chain mechanism, and promote the strategic transformation from symptom management to overall health maintenance, aiming to realize the goal of paying attention to inner ear comorbidity, implementing precise prevention and treatment, and effectively reducing disease burden.