Zhonghua yi xue za zhi最新文献

Since the publication of the "Chinese guidelines for the diagnosis and treatment of insomnia disorder" in 2017, the diagnostic and treatment system for insomnia has achieved significant advances in precision medicine, digital therapeutics, and multidisciplinary integration. The Chinese Sleep Research Society organized domestic experts from relevant fields to develop the"Guidelines for the diagnosis and treatment of insomnia disorder (2025 edition)", which features significant updates in both diagnostic classification and treatment strategies. The guidelines adopt the International Classification of Sleep Disorders-Third Edition, Text Revision diagnostic classification, systematically introduce insomnia subtype classification, and expand coverage of digital cognitive behavioral therapy for insomnia, novel medications, and individualized management strategies for special populations including children/adolescents, women, and elderly patients. This article aims to elucidate the core updates and clinical implications of the guidelines by examining the revisions to the diagnostic system and advancements in treatment strategies, thereby providing a reference for promoting standardized and precision-based diagnosis and treatment of insomnia in China.

Objective: To investigate the regulatory role of methyltransferase-like protein 3 (Mettl3) within CD4⁺T cells in a mouse model of atopic dermatitis (AD) induced by calcipotriol (MC903). Methods: The C57BL/6 mouse model with CD4⁺T cell-specific Mettl3 knockout (Mettl3^-/-) was constructed (cKO group, n=4), with Mettl3^flox/flox mice lacking CD4-Cre recombinase serving as the control group (WT group, n=4). An AD-like dermatitis model was induced by topical application of MC903 to the ventral side of the right ear. The characteristics of AD-like dermatitis were assessed based on erythema and scaling at the lesion site, epidermal and dermal thickness, and the scoring of AD (SCORAD). The mRNA expression levels of key cytokines [interleukin (IL)-4, IL-10, etc.] and filaggrin (FLG) in the skin lesions, as well as the proportions of CD4⁺T cell subsets in the draining lymph nodes, were measured. Results: In the MC903-induced AD-like skin inflammation model, compared with the WT group, the cKO group exhibited less severe AD-like skin lesions, reduced skin thickening, decreased epidermal thickness [(45.4±16.3) μm vs (59.6±2.9) μm], less edema, and lower SCORAD scores. The mRNA expression level of IL-4 in the skin lesions was lower [(0.7±0.1) vs (1.0±0.1)], while the mRNA expression levels of FLG and IL-10 were higher [(2.7±1.3) vs (1.0±0.1) and (1.4±0.3) vs (1.0±0.1), respectively] (all P<0.05). The proportion of regulatory T cells in the draining lymph nodes was significantly higher in the cKO group [(5.7%±1.3%) vs (2.4%± 0.3%), P<0.05]. The proportion of T helper 2 cells (Th2) was lower, with no significant difference [(0.7%±0.2%) vs (0.8%±0.7%), P>0.05]. Conclusion: CD4⁺T cell-specific deletion of Mettl3 modulates IL-4, IL-10, and FLG expression, alters the Th2/Treg cell ratio, and thereby attenuates MC903-induced AD-like dermatitis in mice.

Bone trabeculae are key components of bone microstructure, and their complex three-dimensional interconnected microarchitecture is closely related to bone mechanical properties. Traditional imaging studies have been mostly limited to two-dimensional morphological analysis of bone trabeculae, with insufficient attention paid to their interconnected topology, making it difficult to comprehensively reflect bone quality characteristics. The development of ultra-high resolution CT (U-HRCT) technology has brought revolutionary breakthroughs to three-dimensional imaging of bone microstructure. Its spatial resolution can reach up to 50 μm, enabling clear visualization of the three-dimensional structure of bone trabeculae and providing a technical foundation for in vivo assessment of the interconnected trabecular network. Placing emphasis on imaging assessment of bone quality based on three-dimensional interconnected bone microstructure is of great significance for innovating the diagnosis and treatment paradigm of osteoporosis and improving the accuracy of fracture risk prediction. On the basis of systematically reviewing research progress on the three-dimensional interconnected microarchitecture of bone trabeculae, this article focuses on commenting on the technical advantages of U-HRCT in bone microstructure imaging, analyzes the equipment and technical feasibility of evaluation based on the three-dimensional interconnected trabecular network, proposes developing new pathways for bone quality imaging assessment, constructs novel imaging parameters that reflect interconnected topological features, and establishes new bone quality assessment models by integrating multi-level information. It also points out current challenges, including lack of standardization, lengthy imaging durations, and complex data processing, and emphasizes that clinical translation still requires multidisciplinary integration and collaborative advancement across endocrinology, orthopedics, radiomics, biomechanics, and AI.

The emulated target trial (TTE) is a real-world data-based research approach that seeks to emulate randomized controlled trials within observational datasets to enable relatively high-quality causal inference. In recent years, with the accumulation of medical big data and real-world cohort data, an increasing number of clinical studies have adopted TTE designs following the principles of randomized controlled trials. However, the methodological rigor and quality of such studies remain uneven. In this context, a multidisciplinary group composed of the Rehabilitation Big Data Working Committee of Chinese Association of Rehabilitation Medicine and experts and scholars from institutions across China-with expertise in clinical medicine, epidemiology and biostatistics, research methodology, evidence-based medicine, and data science-conducted extensive literature reviews and multiple rounds of expert consultation and discussion. This process culminated in the development of the Expert Consensus on the Standardized Application of Emulated Target Trials in Clinical Research (2025 edition). This consensus explicitly proposes 17 recommendations, systematically defining the concept, applicable scenarios, and core components of TTE, and comprehensively addressing key methodological aspects of TTE studies, including selection of data sources, new-user design, determination of time zero, and choice of post-hoc randomization methods. It fills an important gap in China's methodological standards for TTE applications, offering scientific guidance for the rigorous implementation of TTE designs and making a meaningful contribution to the advancement of clinical research.

Robot-assisted deep brain stimulation (DBS) surgical systems in neurosurgery have demonstrated significant advantages in enhancing operative precision, reducing complications, and improving clinical outcomes. With advancements in robot-assisted surgical systems and evolving surgical techniques, coupled with their wider adoption in DBS procedures, there is a growing need to further refine and standardize surgical workflows and technical details. This consensus specifically focuses on robot-assisted DBS surgery. Through proposing recommendation questions, summarizing and evaluating evidence, formulating recommendations, and incorporating expert discussions and clinical practice, eight recommendations were developed covering aspects such as indications, preoperative preparation, surgical planning, registration, anesthesia, key operative steps, and postoperative assessment. The aim is to enhance surgical precision and safety, improve patient outcomes, comprehensively present the latest research progress in robot-assisted DBS surgery, and integrate the collective expertise and opinions of experts in the field, thereby providing guidance for the clinical practice of DBS surgery.

Objective: To analyze the related factors for intestinal contents refluxing into the biliary tract following endoscopic retrograde biliary drainage (ERBD). Methods: A total of 620 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) to remove biliary stents and perform biliary tract cleaning at the Shanghai East Hospital Gallstone Disease Center from March 2019 to October 2024 were included in this study. Patients were divided into a case group and a control group based on the presence or absence of chyme-fibrin reflux into the biliary tract. Clinical data were collected for all patients, and univariate and multivariate logistic regression analyses were performed to identify related factors for intestinal contents reflux into the biliary tract. Results: A total of 620 patients were included: 397 in the control group, aged 61.0 (51.0, 71.0) years, with 198 males; and 223 in the case group, aged 62.0 (51.0, 70.0) years, with 89 males. The control group had a longer duration of biliary stent placement [3.0 (2.1, 3.5) vs 2.6 (1.8, 3.2) months], a higher proportion of male patients [49.9% (198/397) vs 39.9% (89/223)], history of ERCP procedures [16.4% (65/397) vs 10.3% (23/223)], and hypertension [36.0% (143/397) vs 26.5% (59/223)] compared with the case group (all P>0.05). The proportion of pancreaticobiliary maljunction (PBM)in the case group was higher than that in the control group [10.8% (24/223) vs 4.8% (19/397), P=0.005]. The incidence of endoscopic sphincterotomy (EST) [82.5% (184/223) vs 75.3% (299/397)] and endoscopic papillary balloon dilatation (EPBD) [94.5% (207/223) vs 87.1% (343/397)] was higher in the case group than in the control group (both P<0.05); the total number of biliary stents placed was higher in the control group (10.1% vs 4.9%) than in the case group (P=0.023). Multivariate logistic regression analysis identified PBM (OR=2.00, 95%CI: 1.05-3.81),female gender (OR=1.45, 95%CI: 1.02-2.07), duration of biliary stent placement (OR=0.87, 95%CI: 0.80-0.96) and hypertension (OR=0.61, 95%CI: 0.42-0.89) as related factors for post-ERBD intestinal contents reflux into the biliary tract. Conclusion: Female gender and PBM are related factors for post-ERBD intestinal contents reflux into the biliary tract.

Objective: To explore the clinical effect of different coronary artery flow isolation methods in off-pump coronary artery bypass grafting (OPCABG). Methods: A total of 60 patients who accepted OPCABG in the Department of Cardiovascular Surgery, the First Affiliated Hospital of Zhengzhou University from June 2021 to June 2024 were randomly divided into three groups by computer. The different coronary flow isolation methods were used in three groups. The coronary artery was occluded with tourniquets in the occlusion group (n=20). The coronary artery was shunted with shunt in the shunt group (n=20). The coronary artery was selectively shunted or occluded according to the different blood flow conditions of each target vessel in the combined group (n=20). The anastomosis time and the amount of bleeding were observed and compared. The serum levels of cardiac troponin T (cTnT) and N-terminal pro B-type natriuretic peptide (NT-ProBNP) were detected after eight hours of operation. Results: Among the 60 patients with coronary artery disease, 48 patients were male and 12 patients were female. The anastomotic time of each anastomosis in the shunt group was longer than that in the occlusion group and the combined group [(18.4±2.8) min vs (12.3±2.2) min, (14.3±2.9) min, both P<0.017]. There was no statistically significant difference in anastomotic time between the occlusion group and the combined group (P=0.176). Postoperative serum cTnT in the occlusion group was higher than that in the shunt group and the combined group [(0.28±0.07) μg/L vs (0.16±0.03) μg/L, (0.17±0.04) μg/L, both P<0.017]. There was no statistically significant difference in postoperative serum cTnT between the shunt group and the combined group (P=0.152). Postoperative serum NT-ProBNP in the combined group was lower than that in the occlusion group and the shunt group [(254±27) ng/L vs (481±19) ng/L, (373±42) ng/L, both P<0.017]. Postoperative serum NT-ProBNP in the shunt group was lower than that in the occlusion group [(373±42) ng/L vs (481±19) ng/L, P=0.001]. There were no significantly differences in the amount of bleeding among the three groups (P=0.191). Conclusion: The selected method of occlusion or shunting depending on the flow condition of target coronary artery in OPCABG can decrease anastomosis time and myocardial injury.

To evaluate the efficacy and safety of Holmium laser combined with balloon dilation in treating benign bile duct columnar stenosis, a retrospective analysis was performed on the clinical data of 58 patients diagnosed with benign biliary strictures at Sichuan Provincial People's Hospital from October 2019 to October 2022. Among these patients, 31 patients underwent minimally invasive holmium laser combined with balloon dilation treatment as the study group, with an age of (58.3±5.1) years, including 13 males; 27 patients underwent hepatic segment resection as the control group, with an age of (56.3±4.9) years, including 11 males. The median follow-up time was 17.5 months (range: 12-26 months). The study group showed shorter recovery time of gastrointestinal function [(1.0±0.5) vs (3.2±1.0) d], lower medical costs [(1.2±0.2) vs (2.7±0.6) ten thousand yuan], lower incidence of cholangitis [6.5% (2/31) vs 22.2% (6/27)], lower rates of bile leakage [3.2% (1/31) vs 18.5% (5/27)], shorter hospitalization duration [(5.6±0.5) vs (8.4±1.2) d], shorter operative time [(68.5±20.5) vs (145.2±50.5) min], reduced intraoperative blood loss [(5.0±0.4) vs (80.4±17.1) ml], and lower incision infection rate [3.2% (1/31) vs 14.8% (4/27)], and lower recurrence rate of biliary stricture [6.4% (2/31) vs 33.3% (9/27)] compared to the control group (all P<0.05). The study group achieved a higher biliary stricture relief rate than the control group [96.7% (30/31) vs 85.2% (23/27), P=0.037]. The study results indicate that the combination of holmium laser and balloon dilation is effective in treating benign biliary strictures, reduces the incidence of surgical complications and recurrence of biliary strictures, and is safe and reliable, with potential for clinical application and promotion.