Zhonghua yi xue za zhi最新文献

Objective: To evaluate the effect of targeted therapy for primary aldosteronism (PA) on the clinical outcome of coexisting obstructive sleep apnea (OSA). Methods: A prospective study was conducted on patients diagnosed with both PA and OSA in the Sun Yat-sen Memorial Hospital between June 2023 and January 2025. All patients received PA targeted treatment. Full-night portable sleep monitoring was performed before and 3-12 months after treatment. Participants were divided into the OSA improvement group or the non-improvement group based on the change in the apnea-hypopnea index (AHI). Differences in clinical characteristics before and after PA treatment, as well as between the two patient groups, were compared. Multivariate logistic regression model was employed to identify risk factors influencing the lack of OSA improvement. Results: A total of 46 patients were enrolled, including 35 males and 11 females, with a mean age of (51.0±12.0) years. Among them, 34 patients were classified into the OSA improvement group, while 12 patients into the non-improvement group the non-improvement group. Of these, 21 patients underwent unilateral adrenalectomy, and 25 received mineralocorticoid receptor antagonist therapy. Patients were followed up for a duration of [M (Q₁,Q₃)] 6.0 (3.0,8.0) months. After treatment, patients with PA complicated by OSA exhibited a reduction in antihypertensive medication use, the increases in serum potassium, renin activity, and serum creatinine levels, along with the decreases in plasma aldosterone and the aldosterone-to-renin ratio (all P<0.05). Specifically, the AHI declined from 23.8 (9.0,40.2) events/h to 13.1 (8.1,21.8) events/h (P=0.003). In the non-improvement group, baseline body mass index [(30.1±6.4) vs (25.8±5.0) kg/m²] and the clinical non-remission rate of PA [6/12 vs 5.9% (2/34)] were both higher than those in the improvement group (both P<0.05). Multivariate logistic regression model analysis revealed that a higher baseline body mass index (OR=1.18, 95%CI: 1.01-1.39) and clinical non-remission of PA (OR=11.69, 95%CI: 2.13-64.08) were risk factors for lack of improvement in OSA. Conclusions: In patients with PA complicated by OSA, PA-targeted therapy effectively reduces OSA severity. Higher baseline body mass index and clinical non-remission of PA are identified as risk factors for unimproved OSA.

Objective: To investigate the characteristics of theta rhythm functional connectivity and their clinical implications in patients with Meniere's disease. Methods: A cross-sectional study was conducted. Patients diagnosed with Meniere's disease along with matched healthy controlsat the Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital between August 2020 and January 2024 were enrolled. Phase-locking value (PLV) was used to calculate theta-band functional connectivity between brain regions in source space. Intergroup differences of the functional connectivity were compared, and its correlations with clinical characteristics were analyzed. Results: The study included 32 Meniere's disease patients (9 males and 23 female) with a mean age of (54.8±11.9) years, along with 29 healthy controls (7 males and 22 females) with a mean age of (56.7±14.5) years. Compared with the healthy controls, Meniere's disease patients exhibited enhanced theta functional connectivity within a network centered on the paracentral lobule and cingulate gyrus (all P<0.05). This enhanced connectivity between the medial/paracingulate gyri and the paracentral lobule positively correlated with the severity of subjective symptoms (r=0.355, P=0.046) and scores on the anxiety-autonomic symptom subscale (r=0.402, P=0.023). However, no statistically significant correlation was found with hearing levels or dynamic posturography scores (all P>0.05). Conclusions: Patients with Meniere's disease demonstrate enhanced theta rhythm functional connectivity involving the paracentral lobule and cingulate gyrus. This neural signature is dissociated from hearing loss and overall balance performance but is linked to subjective anxiety and autonomic symptoms.

von Hippel-Lindau (VHL) syndrome is an autosomal dominant hereditary disorder caused by germline heterozygous pathogenic variants of the VHL gene or promoter hypermethylation. It is characterized by multiple tumors and cystic lesions, primarily affecting the central nervous system, retina, kidneys, pancreas, adrenal glands, and other organs. In recent years, significant progress has been made in both basic and clinical research on VHL syndrome, particularly in genotype-phenotype correlations and targeted therapies, such as the clinical application of hypoxia-inducible factor-2α inhibitors. To further standardize the diagnosis and management of VHL syndrome in China, the Chinese Society of Rare Diseases of the Chinese Medical Association, the Beijing Society of Rare Diseases, and the Chinese Alliance for Genetic and Rare Diseases of the Urinary System of the Chinese Urological Association have updated the epidemiological, genetic, and clinical characteristics, diagnostic criteria, treatment strategies, and long-term management protocols based on the latest evidence-based medical findings and the "Chinese expert consensus for the diagnosis and treatment of von Hippel-Lindau syndrome" in the 2018 edition, and forms 12 recommended suggestions, aiming to provide scientific guidance for clinical practice.

Objective: To investigate the clinical efficacy of short-term spinal cord stimulation (stSCS) in the treatment of segmental zoster paresis (SZP). Methods: A retrospective analysis was performed to collect the clinical data of patients with SZP at the Department of Pain Medicine, Nanjing Hospital Affiliated to Nanjing Medical University from January 2023 to December 2024. The patients were divided into two groups based on whether they received stSCS therapy: the stSCS group (stSCS combined with medication) and the control group (medication only). Evaluations were performed before treatment (T₀) and at the following time points after treatment: day 14 (T₁), 1 month (T₂), 3 months (T₃), and 6 months (T₄). The following parameters were compared between the two groups at different time points: peak torque (PT) of elbow extensors and flexors at an angular velocity of 60°/s, motor nerve conduction velocity (MNCV) of the ulnar and median nerves, as well as scores on the Numerical Rating Scale (NRS) of pain, Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS). Results: The stSCS group consisted of 20 patients (8 males, 12 females) with a median [Q₁, Q₃] age of 73.5 (70.3, 77.3) years and disease duration of 0.9 (0.3, 1.6) months. The control group included 20 patients (6 males, 14 females) with a median age of 69.5 (64.5, 79.0) years and disease duration of 0.7 (0.4, 1.2) months. There were no statistically significant differences in age or gender between the two groups (all P>0.05). At the T₃ and T₄ follow-ups after treatment, the stSCS group demonstrated significantly higher elbow extensor PT [(24.7±1.8) Nm vs (21.9±2.3) Nm], flexor peak PT [(18.6±2.0) Nm vs (20.6±1.9) Nm], ulnar nerve MNCV [(49.0±1.8) m/s vs (52.4±2.3) m/s], and median nerve MNCV [47.3 (46.7, 48.1) m/s vs 51.1 (49.4, 52.1) m/s] compared to the control group, while NRS of pain, SAS, and SDS scores were significantly lower than those in the control group, with significant differences (all P<0.05). No serious stSCS-related adverse reactions occurred, and there were no patient deaths. Conclusion: The stSCS facilitates the recovery of motor function, significantly alleviates pain, and effectively mitigates anxiety and depression symptoms in patients with SZP.

Objective: To compare the efficacy and safety of left hepatectomy with sequential embolization of the tumor-invaded right hepatic artery (RHA) followed by resection without reconstruction versus left hepatectomy with RHA resection and reconstruction for the treatment of hilar cholangiocarcinoma (HCCA). Methods: A retrospective cohort of 10 HCCA patients undergoing the SERRHA protocol between January 2023 and January 2025 at the Sun Yat-sen Memorial Hospital, Department of Biliary and Pancreatic Surgery, was included (SERRHA group). A control group of 24 HCCA patients undergoing left hepatectomy with RHA resection and reconstruction between January 2014 and January 2025 was established (RRRHA group). Follow-up was conducted until April 30, 2025. The incidence of 90-day Clavien-Dindo≥Grade Ⅲ complications, R0 resection rates, and postoperative survival were compared. Results: The SERRHA group included 10 cases, aged (57.6 ± 16.3) years, with 3 males. The RRRHA group included 24 cases, aged (57.3 ± 11.1) years, with 15 males. In the SERRHA group, 2 patients (2/10) developed left liver abscesses post-embolization. There were no 90-day or in-hospital deaths. Median follow-up was 9.3 months (95%CI: 3.6-15.0). In the RRRHA group, there was 1 peri-operative death due to anastomotic haemorrhage. Median follow-up was 44.5 months (95%CI: 25.8-63.2). Median overall survival (OS) was 29.0 months (95%CI: 9.3-48.7), with 1-, 3-, and 5-year OS rates of 90.8%, 45.6%, and 20.3%, respectively. There were no statistically significant differences (P>0.05) between the SERRHA and RRRHA groups in 90-day Clavien-Dindo≥Grade Ⅲ complications [5/10 vs 20.8% (5/24)], R0 resection rate [4/10 vs 70.8% (17/24)], or 1-year OS (83.3% vs 90.8%). Conclusion: For HCCA with RHA invasion where resection and reconstruction are difficult, left hepatectomy following RHA embolization demonstrates a certain degree of safety, and its short-term efficacy is similar to that of cases with RHA resection and reconstruction.

Objective: To explore the association between blood lipid levels and prognosis in patients with sudden sensorineural hearing loss (SSNHL) and develop a predictive model. Methods: The clinical data of unilateral SSNHL patients from the Chinese PLA General Hospital between January 2008 and December 2022 were retrospectively analyzed. Patients were divided into treatment-effective and ineffective groups based on their hearing recovery (prognosis) after treatment. Restricted cubic spline (RCS) analysis was used to examine the nonlinear relationship between blood lipid levels and prognosis. The data were randomly split into training and testing sets at a 7∶3 ratio using a computer-based algorithm, and sex-stratified predictive models for prognosis were developed using stepwise logistic regression. The performance of the models was evaluated through receiver operating characteristic (ROC) curves, Hosmer-Lemeshow goodness-of-fit tests, and decision curve analysis (DCA), respectively. Results: A total of 1 329 patients aged (41.4±10.9) years were included, with 682 males and 647 females. RCS analysis showed no nonlinear relationship between lipid metabolism indicators and prognosis in sudden sensorineural hearing loss (all P>0.05). The male predictive model included eight variables: age, low-density lipoprotein cholesterol (LDL-C), smoking, drinking, time of onset, tinnitus, vertigo, and audiogram type. The areas under the ROC curve (AUC) for the training set and validation set were 0.873 (95%CI: 0.839-0.908) and 0.823 (95%CI: 0.760-0.886), respectively. The female predictive model included sevenvariables: age, body mass index (BMI), triglycerides (TG), time of onset, vertigo, hearing level, and audiogram type. The AUC was 0.864 (95%CI: 0.828-0.901) for the training set and 0.833 (95%CI: 0.766-0.900) for the validation set. The model evaluation showed no significant bias in the Hosmer-Lemeshow test for both groups (both P>0.05). The DCA showed a positive net benefit for risk-threshold probabilities of 0-0.93 in both the training and validation sets for male patients. For female patients, the net benefit was positive for thresholds of 0-0.94 in the training set and across nearly the entire range in the validation set. Conclusions: The prognosis of male patients is significantly influenced by smoking, drinking, and LDL-C metabolism disorders, while female patients are affected by BMI and TG levels. The predictive models based on blood lipid levels demonstrated good discrimination, calibration, and clinical applicability.

To explore the clinical and pathological characteristics of reoperation cases after thermal ablation treatment for thyroid carcinoma, the restrospective analysis included 40 patients with thyroid cancer who underwent reoperation after thermal ablation treatment in the Department of Thyroid Surgery of the First Hospital of China Medical University from December 2014 to April 2025, with an average age of (48.3±12.9) years including 9 male patients. A total of 49 cancer foci underwent thermal ablation treatment. Before thermal ablation, fine-needle aspiration was performed in all 40 patients (49 cancer foci), but 31 patients (37 cancer foci) underwent thermal ablation without obtaining cytological pathology. The maximum diameter of the cancer foci before thermal ablation was (1.50±0.99) cm, with 29 cancer foci≥1 cm and 20 cancer foci <1 cm. Nineteen cancer foci were adjacent to the thyroid capsule. Postoperative pathology confirmed that 29 patients (33 cancer foci) still had residual cancer foci. The residual rate of lesions with a maximum diameter≥1 cm was higher than that of lesions with a maximum diameter<1 cm [79.3% (23/29) vs 50.0% (10/20), P=0.032]. The residual rate of cancer foci adjacent to the thyroid capsule was higher than that of those far from the thyroid capsule [89.5% (17/19) vs 53.3% (16/30), P=0.009)]. Three cases had occult multifocal cancer, and 14 patients had metastatic lymph nodes. One patient with follicular carcinoma had multiple bone metastases. The results of this study suggest that non-standard initial thermal ablation treatment may lead to residual cancer foci or metastatic lymph nodes. For patients that are eligible for surgery,thermal ablation should not be blindly promoted or overused as an initial treatment.

Congenital hypothyroidism (CH) is one of the most common inherited metabolic disorders in children, and delayed diagnosis and treatment can adversely affect intellectual development and growth. In April 2025, the Chinese Society of Endocrinology and the Chinese Society of Pediatrics jointly released the "Guidelines for the diagnosis and treatment of congenital hypothyroidism". Based on the latest evidence-based medical data and clinical experience, these guidelines systematically established a comprehensive management framework covering screening, diagnosis, treatment, and follow-up, aiming to standardize CH screening, diagnosis, treatment, and long-term management. This article provides an interpretation of the main content of the guidelines. The guidelines emphasize that early diagnosis and treatment can improve the prognosis of CH and set a newborn screening cut-off value of≥8-10 mU/L as the standard for recall and examination. In terms of treatment, the guidelines stress the principle of "early and adequate" intervention, recommending levothyroxine (LT₄) as the first-line treatment with a starting dose of at least 10 μg/kg. Timely follow-up and avoidance of overtreatment are also highlighted. For transient CH, it is recommended to discontinue LT₄ treatment after the age of 3 and conduct further evaluations of thyroid function and imaging examinations. The guidelines also note that genetic testing to identify the molecular etiology of CH has significant guiding value for the treatment of specific types of CH. The guidelines achieve standardization of the diagnostic and therapeutic process, address the gap in lifelong management of CH in China from the neonatal period to adulthood, and provide healthcare professionals with an accurate, effective, and comprehensive normative document.