Norms and consensus

• Chinese expert consensus on diagnosis, prevention and control of sea motion sickness

  Expert Writing Group of Chinese expert consensus on diagnosis, prevention, control of sea motion sickness, Nautical Translational Medicine Specialty Group, Chinese Society of Nautical Medicine, Chinese Medical Association, Nautical Phenomics Specialty Group, Chinese Society of Nautical Medicine, Chinese Medical Association, Nautical Special Diseases Specialty Group, Chinese Society of Nautical Medicine, Chinese Medical Association, Nautical Traditional Chinese Medicine Specialty Group, Chinese Society of Nautical Medicine, Chinese Medical Association

  2026,47(8):977-999 ,DOI: 10.16781/j.CN31-2187/R.20260488

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  aritime personnel. Currently, there is a lack of standardized diagnostic criteria and guidelines for the prevention and control of SMS both domestically and internationally. To improve the standardization of diagnosis and scientific prevention and control of SMS, the Expert Writing Group organized multidisciplinary experts to formulate the Chinese expert consensus on diagnosis, prevention and control of sea motion sickness, initiated by the Chinese Society of Nautical Medicine of Chinese Medical Association. Based on domestic and international evidence-based medical evidence and clinical practice experience, the Expert Writing Group conducted 4 rounds of systematic argumentation and 2 rounds of correspondence review on the concept, epidemiology, etiology and predisposing factors, pathogenesis, clinical manifestations, laboratory and other auxiliary examinations, diagnosis, susceptibility prediction, and prevention and control measures of SMS. Ultimately, the consensus is reached and covers 12 statements, aiming to standardize clinical diagnosis and improve comprehensive prevention and control of SMS.

Monographic report: Heat acclimatization training and evaluation

• Physiological mechanisms and training methods of heat acclimatization: research progress

  LI Binxu△, WANG Junqin△, XIAO Shuifeng, PAN Leilei, QI Ruirui, XU Zichao, CAI Yiling*

  2026,47(8):1000-1007 ,DOI: 10.16781/j.CN31-2187/R.20260061

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  Heat acclimatization is a physiological adaptive response in the human body exposed to high temperature environments over a long-term. It involves the regulation of the central nervous system, cardiovascular system, and other systems. Research on heat acclimatization mechanisms covers multiple aspects, including systemic, cellular, and molecular levels. The activity and electrophysiological changes of warm sensitive neurons are closely related to the formation of heat acclimatization. Heat acclimatization exhibits environmental and temporal effects and is closely related to training modalities. Different training methods are suitable for different populations, and evaluation of heat acclimatization requires integration of physiological, biochemical, and metabolic markers. This article reviews the research progress on physiological changes and mechanisms, biomarkers, and training methods of heat acclimatization, and prospects future trends in theoretical research and training practice of heat acclimatization.

• Regularity of heat acclimatization training load and screening of evaluation indicators based on visualized continuous monitoring technology in adult males

  WANG Junqin, SONG Jie, LI Binxu, XIAO Shuifeng, PAN Leilei, QI Ruirui, CAI Yiling

  2026,47(8):1008-1016 ,DOI: 10.16781/j.CN31-2187/R.20260067

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  Objective To investigate the variation patterns of rectal temperature and heart rate during outdoor heat acclimatization training, and to identify sensitive physiological indicators for monitoring the training load. Methods A total of 110 healthy adult male volunteers were recruited and assigned to high endurance (HE) group (n=60) or qualified endurance (QE) group (n=50) based on their 3-km running performance. The 2 groups received 7 and 12 d of outdoor heat acclimatization training, respectively, which mainly consisted of 5-km loaded fast walking. Rectal temperature and heart rate were monitored in real time throughout the training, and the variation patterns were analyzed. Results Training intensity was adjusted daily according to the wet-bulb globe temperature outdoors. In the HE group, mean rectal temperature and maximum heart rate reached heat acclimatization on days 6 and 5, respectively; in the QE group, both indicators reached heat acclimatization on day 8. During the first 5-km loaded fast walking session, both heart rate and rectal temperature showed a continuous upward trend, with heart rate changing earlier and more rapidly than rectal temperature. During the 10-min rest interval between the 2 sessions, heart rate rapidly decreased, while rectal temperature paradoxically continued to rise. During the second 5-km loaded fast walking session, heart rate continued to rise, whereas rectal temperature initially decreased, then increased and remained consistently elevated. Using rectal temperature ≥38.00 ℃ as the criterion for training compliance, more than 88% of the subjects achieved the desired heat acclimatization training effect, and acquiring heat acclimatization required a daily compliant training duration ＞24 min. Conclusion The continuous variation of rectal temperature accurately reflects the physiological responses of the human body during heat acclimatization training. It is recommended as a monitoring indicator for outdoor heat acclimatization training load. In contrast, heart rate primarily reflects exercise intensity and is not recommended as a monitoring indicator for heat acclimatization training load.

• Efficacy of plasma heat shock protein 70 combined with cortisol in assessing active heat acclimatization

  QI Ruirui△, LI Binxu△, XU Zichao, WANG Junqin, XIAO Shuifeng, PAN Leilei, XIAO Shihan, CAI Yiling*

  2026,47(8):1017-1027 ,DOI: 10.16781/j.CN31-2187/R.20260068

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  Objective To investigate the effects of active heat acclimatization training on plasma heat shock protein 70 (HSP70), cortisol, tetraiodothyronine (T4), and creatinine levels, and to identify effective evaluation factors for active heat acclimatization and establish an evaluation model. Methods A total of 170 healthy adult male volunteers were recruited and assigned to high or qualified endurance groups based on their 3-km running performance, and were further subdivided into heat acclimatization training group or control group, namely high endurance training (HET) group (n=60), high endurance control (HEC) group (n=30), qualified endurance training (QET) group (n=50), and qualified endurance control (QEC) group (n=30). The HET and QET groups underwent 7 and 12 d of outdoor active heat acclimatization training, respectively, primarily consisting of 5-km loaded fast walking. Plasma levels of HSP70, cortisol, T4, and creatinine were detected using enzyme-linked immunosorbent assay before and after training on the 1st day (baseline test) and the last day (heat acclimatization efficacy evaluation test). Multivariate logistic regression analysis was used to identify evaluation factors for active heat acclimatization, and a combined evaluation model was established. Receiver operating characteristic (ROC) curve was used to evaluate the evaluation performance of individual factors and their combination. Results After both the baseline test and the efficacy evaluation test, plasma levels of HSP70, cortisol, and creatinine in all subjects were significantly elevated compared with those before the baseline test (all P＜0.05). In the heat acclimatization training group, HSP70 and cortisol levels were significantly lower after the efficacy evaluation test than those after the baseline test (both P＜0.01), whereas creatinine level showed no significant change (P＞0.05). Although T4 level was significantly lower after the efficacy evaluation test than that after the baseline test (P＜0.01), there was no significant difference between the pre- and post-test of efficacy evaluation (P＞0.05). Both the HET and QET groups exhibited changes consistent with the overall training group. Multivariate logistic regression analysis indicated that plasma HSP70 and cortisol levels after the efficacy evaluation test could serve as evaluation factors for heat acclimatization, with area under curve (AUC) values of 0.836 and 0.791, sensitivities of 0.767 for both, and specificities of 0.809 and 0.718, respectively. The combination of both factors yielded an AUC of 0.887 in evaluating active heat acclimatization, with sensitivity and specificity of 0.882 and 0.750, respectively. The combined prediction model was logitP=7.466-0.303×HSP70-0.024×cortisol. Conclusion A single session of heat exposure training induces elevations in plasma HSP70 and cortisol. Active heat acclimatization reduces the magnitude of these elevations without altering resting levels, and these changes are not affected by differences in endurance capacity. Plasma HSP70 and cortisol can serve as evaluation factors for active heat acclimatization, and their combination may offer better predictive performance.

• Comparative study on changes in physiological indicators before and after heat acclimatization training in personnel with different endurance capacities

  XIAO Shuifeng, SUN Qicheng, WANG Junqin, LI Binxu, PAN leilei, QI Ruirui, XU Zichao, XIAO Shihan, CAI Yiling

  2026,47(8):1028-1036 ,DOI: 10.16781/j.CN31-2187/R.20260081

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  Objective To evaluate and compare the changes in physiological indicators before and after heat acclimatization training in personnel with different endurance capacities. Methods A total of 170 healthy adult male volunteers were recruited and assigned to high or qualified endurance groups based on their 3-km running endurance test performance, and were further randomly assigned to 4 groups: high endurance training (HET) group (n=60), qualified endurance training (QET) group (n=50), high endurance control (HEC) group (n=30), or qualified endurance control (QEC) group (n=30). The HET and QET groups underwent 7 and 12 d of outdoor heat acclimatization training, respectively. All subjects underwent a baseline test 1 d prior to training and a heat acclimatization efficacy evaluation test on the 2nd day after completion of training. During the tests, core temperature, heart rate, body weight, water intake, blood oxygen saturation, and blood pressure were monitored, and sweat samples were collected to detect electrolyte concentrations. Results Compared with the baseline test, both the HET and QET groups showed decreases in core temperature and reductions in sweat Na⁺ and Cl^- concentrations during the efficacy evaluation test; the QET group exhibited decreases in mean heart rate and maximum heart rate, whereas the HET group had opposite trends; and the HET group showed increases in body weight loss and water intake, while the QET group showed no significant change in body weight and a decrease in water intake. During the efficacy evaluation test, compared with their respective control groups, both the HET and QET groups showed decreases in core temperature and sweat Na⁺ and Cl^- concentrations; the QET group also showed reductions in mean heart rate, maximum heart rate, and body weight loss, whereas the HET group showed no significant changes. The heat acclimatization training had no significant effects on blood oxygen saturation, blood pressure, or the concentrations of K⁺, Ca²⁺, and Mg²⁺ in sweat. Conclusion Personnels with high endurance can achieve heat acclimatization following 7 d of training and those with qualified endurance following 12 d. Regardless of whether endurance capacity is rated as high or qualified, the core temperature and the concentrations of Na⁺ and Cl^- in sweat decrease after heat acclimatization.

Original article

• Preoperative multimodal prediction model for axillary lymph node metastasis in breast cancer based on clinical, conventional ultrasound, and ultrasomics features: a two-center study

  YU Liping, LIN Mingzhi, CHEN Jiahai, WANG Zhenbao, ZHENG Tao, XU Min, LAI Jiangqiong

  2026,47(8):1037-1051 ,DOI: 10.16781/j.CN31-2187/R.20250860

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  Objective To construct a multimodal fusion model integrating clinical features, conventional ultrasound parameters and ultrasomics features for preoperative prediction of axillary lymph node metastasis (ALNM) in breast cancer, and to evaluate its cross-center generalizability and clinical application value. Methods A total of 321 breast cancer patients were retrospectively enrolled from Jan. 1, 2020 to Jan. 1, 2025, including 230 patients from No. 910 Hospital of Joint Logistics Support Force (randomly assigned to training set or internal validation set at a 7∶3 ratio, yielding 161 and 69 cases, respectively) and 91 patients from Quanzhou First Hospital (serving as external validation set). Recursive feature elimination method was adopted to screen clinical and conventional ultrasound parameters, and least absolute shrinkage and selection operator regression was used to select ultrasomics features. Based on the optimal algorithm glmnet, a clinical model (incorporating only clinical and conventional ultrasound parameters), an ultrasomics model (incorporating only ultrasomics features), and a fusion model (incorporating clinical and conventional ultrasound parameters together with ultrasomics features) were established. The predictive performance and generalizability of each model for ALNM were evaluated in the training set, internal validation set, and external validation set using receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test, Brier score, decision curve analysis (DCA), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). In a subgroup of 142 patients who underwent both sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND), the diagnostic efficacy was compared between the fusion model and SLNB. In the external validation set, based on the optimal cut-off value determined by the Youden index of ROC curve and the clinical benefit-to-risk ratio calculated by DCA, the patients were assigned to low-, intermediate-, or high-risk groups to evaluate the ability of the fusion model to guide clinical decision-making. Subgroup analyses stratified by molecular subtype (Luminal, human epidermal growth factor receptor 2-positive, and triple-negative) or clinical T stage were further performed to assess performance of the fusion model. Results Among the 321 patients, 139 (43.3%) had positive ALNM. Four key clinical and conventional ultrasound parameters and 18 ultrasomics features were screened. In the internal and external validation sets, the area under curve (AUC) values of the fusion model were 0.829 (95% confidence interval ［95%CI］ 0.779-0.878) and 0.854 (95%CI 0.810-0.898), respectively, which were superior to those of the clinical and ultrasomics models. The fusion model showed excellent calibration, with Hosmer-Lemeshow test P values of 0.921 and 0.365, and Brier scores of 0.010 and 0.020 in the internal and external validation sets, respectively. DCA demonstrated that the fusion model yielded the highest net benefit across most threshold probability ranges. With the fusion model as the reference, the clinical model and ultrasomics model had negative NRI and IDI values. In the comparison subgroup, the sensitivity of the fusion model for predicting ALNM was 0.862, showing no significant difference compared with SLNB (sensitivity=0.914, McNemar test P=0.286). In the subgroup analyses by molecular subtype or clinical T stage, the fusion model effectively identified patients at high risk for ALNM. Conclusion The multimodal fusion model based on clinical, conventional ultrasound, and ultrasomics features can accurately predict ALNM in breast cancer, with favorable stability, calibration, and cross-center generalizability. This model is expected to provide a reliable non-invasive quantitative basis for preoperative axillary lymph node management strategies, including decision-making regarding SLNB or ALND.

• Development of a nomogram model for predicting pelvic lymph node metastasis in prostate cancer patients based on clinical, MRI, and puncture biopsy parameters

  YU Ziqin△, WU Hanchang△, LIU Fang*

  2026,47(8):1052-1058 ,DOI: 10.16781/j.CN31-2187/R.20250596

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  Objective To develop a nomogram model for predicting pelvic lymph node metastasis in prostate cancer patients based on clinical, magnetic resonance imaging (MRI), and biopsy pathological features, and to evaluate its diagnostic performance. Methods Patients who were diagnosed with prostate cancer and underwent radical prostatectomy plus extended pelvic lymph node dissection at our hospital from Jan. 2013 to Jun. 2024 were retrospectively enrolled. The clinical, MRI, and biopsy data were collected. The least absolute shrinkage and selection operator (LASSO) regression and binary multivariate logistic regression were used to identify independent predictors for pelvic lymph node metastasis, which were then incorporated to construct a nomogram model. The performance of the nomogram model was evaluated using receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis. Results A total of 538 patients with prostate cancer were included. Age, maximum diameter of tumor, clinical T stage, prostate-specific antigen density, biopsy International Society of Urological Pathology grade, and European Society of Urogenital Radiology score were identified by LASSO regression and binary multivariate logistic regression as independent predictors for pelvic lymph node metastasis in patients with prostate cancer; these variables were incorporated into the nomogram model. The area under the ROC curve of the nomogram for predicting pelvic lymph node metastasis in prostate cancer patients was 0.88 (95% confidence interval ［95%CI］ 0.84-0.92). The mean C-index of the model was 0.877 (95%CI 0.862-0.884), indicating good stability. The model provided greater net benefit than either the “treat-all” or “treat-none” strategies across threshold probability ranges of 0.01-0.75 and 0.81-0.99. Conclusion The nomogram model constructed using routine clinical, MRI, and biopsy pathological features can predict the risk of pelvic lymph node metastasis in patients with prostate cancer. This model may provide a scientific basis for determining lymph node dissection strategies and postoperative adjuvant treatment decisions.

• Spatiotemporal evolution and etiological inference of epidemiological transition of Crohn’s disease in China from a global perspective: based on GBD 2023 data and a multi-phenotype Mendelian randomization study

  ZENG Wanli, LIU Hongyin, OU Jiangqin, LI Ge, SUN Xingli

  2026,47(8):1059-1069 ,DOI: 10.16781/j.CN31-2187/R.20260266

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  Objective To analyze the spatiotemporal evolution of the global and Chinese burden of Crohn's disease, and to explore the potential causal roles of metabolic remodeling and unhealthy lifestyles accompanying Westernized dietary in the surging incidence of Crohn's disease. Methods Based on data from the Global Burden of Disease Study (GBD) 2023, the epidemiological trends and underlying period effects of Crohn's disease from 1990 to 2023 were dissected by Joinpoint regression and an age-period-cohort model, and the disease burden from 2024 to 2035 was predicted by a Bayesian age-period-cohort (BAPC) model. Meanwhile, multi-phenotype Mendelian randomization (MR) analysis was performed based on the genome-wide association study summary data to evaluate the causal associations of isolated dietary components, alcohol consumption, and secondary body fat distribution traits with Crohn's disease. Results Globally, the incidence of Crohn's disease had plateaued, while the incidence in China was in a rapid ascending phase (average annual percentage change: 2.291%), characterized by a younger age of onset and a marked period-based surge from 2004 to 2013. Primary MR analysis showed that neither isolated dietary components nor overall body mass index (BMI) represented major risk factors for Crohn's disease, whereas elevated trunk fat mass (OR=1.76, P=0.016), higher body fat percentage (OR=2.35, P=0.024), and alcohol consumption (OR=2.45, P=0.040) increased the risk of Crohn's disease. BAPC model projections revealed that the incidence and prevalence of Crohn's disease in China will rebound and grow over the next decade. Conclusion The rapid rise in Crohn's disease burden in China is not only related to improved diagnostic capability, but also more likely to be closely associated with central obesity and gut barrier disruption caused by unhealthy lifestyles. In the future, early prevention and control should be prioritized, particularly body fat management and health education for young adults, to address the upcoming burden of high disease prevalence.

• Burden and temporal trends of 3 major etiology-specific chronic kidney diseases attributable to metabolic and lifestyle-related risk factors in China

  MAI Zhefen, MO Yuxiao, MO Meilan, LIN Derong, LIANG Jingrong, ZHANG Weiqing, HAN Xia

  2026,47(8):1070-1082 ,DOI: 10.16781/j.CN31-2187/R.20260248

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  Objective To analyze the disease burden, risk structure, population distribution, and future trends of 3 major etiology-specific chronic kidney diseases (CKDs) attributable to metabolic and lifestyle-related risk factors in China from 1990 to 2023 based on data from the Global Burden of Disease Study 2023 (GBD 2023). Methods The disability-adjusted life year (DALY) and age-standardized DALY rate (ASDR) data of chronic kidney disease due to type 2 diabetes mellitus (T2DM-CKD), chronic kidney disease due to hypertension (HTN-CKD), and chronic kidney disease due to glomerulonephritis (GN-CKD) attributable to 8 metabolic and lifestyle-related risk factors in China were obtained from the GBD 2023 database. The burden changes in China and traditional BRICS countries (Brazil, Russia, India, China, and South Africa) in 1990 and 2023 were analyzed. Gender- and age-stratified analyses were performed, and the future trends from 2024 to 2035 were projected using an autoregressive integrated moving average (ARIMA) model. The estimated annual percentage change (EAPC) and its 95% confidence interval (95%CI) were calculated using a log-linear regression model fitted to annual ASDRs from 1990 to 2023. Meanwhile, the internal composition ratios of the 8 risk factors were calculated to characterize the evolution of the risk structure. Results From 1990 to 2023, the overall DALYs of the 3 types of CKDs attributable to 8 risk factors in China were increased, whereas the changes in ASDRs diverged. For GN-CKD, high fasting plasma glucose remained the leading attributable risk factor, with an EAPC of the ASDR of -3.98% (95%CI -4.44% to -3.53%), and its internal composition ratio decreased from 65.9% in 1990 to 39.5% in 2023; the composition ratio attributable to high systolic blood pressure increased from 12.1% to 27.3%. For HTN-CKD, high systolic blood pressure remained the predominant attributable risk factor, with an EAPC of the ASDR of -0.60% (95%CI -0.85% to -0.34%); the EAPC of the ASDR attributable to high body mass index (BMI) was 0.69% (95%CI 0.42% to 0.96%). T2DM-CKD showed the greatest increase in absolute burden, with high fasting plasma glucose and high BMI consistently ranking as the top 2 risk factors; the EAPC of the ASDR attributable to high fasting plasma glucose was -1.33% (95%CI -1.45% to -1.20%). The attributable burden of all risk factors for the 3 etiology-specific CKDs was predominantly concentrated among individuals aged 50 years and older. Among traditional BRICS countries, GN-CKD showed the highest heterogeneity in risk structure, while HTN-CKD showed the highest consistency. ARIMA projections suggested that the attributable burden of GN-CKD would generally decline from 2024 to 2035, while the burdens of HTN-CKD and T2DM-CKD would continue to rise. Conclusion From 1990 to 2023, the absolute burden attributable to metabolic and lifestyle-related risk factors for the 3 major etiology-specific CKDs in China has continued to expand, but the risk structures and temporal trends differ substantially. The rise in absolute burden and decline in ASDR suggest that population aging and population growth are important contextual factors driving CKD burden expansion. Etiology- and age-specific integrated management strategies targeting glycemia and body weight control, blood pressure control and salt reduction, and specialist follow-up may be the keys for reducing the future burden of CKDs.

Review

• Ferroptosis and cuproptosis in fibrotic diseases: research progress

  WANG Yue, WANG Pengyuan, HU Lianghao

  2026,47(8):1083-1089 ,DOI: 10.16781/j.CN31-2187/R.20250419

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  Metal ion-dependent regulated cell death pathways, centered on ferroptosis and cuproptosis, play key roles in fibrotic diseases. Disruptions in the cellular uptake, storage, and efflux of iron and copper ions lead to redox imbalance, which subsequently activates the canonical and non-canonical transforming growth factor-β/Smad pathways, drives epithelial-mesenchymal transition (EMT) and fibroblast-myofibroblast transition (FMT), and promotes the release of damage-associated molecular patterns to amplify the inflammation-fibrosis loop, thereby promoting organ fibrosis. The mitochondrial tricarboxylic acid cycle serves as a common convergence point of ferroptosis and cuproptosis. Targeted intervention strategies derived from related pathways, including metal ion chelators, traditional Chinese medicine derivatives, small-molecule targeted drugs, and nanomaterials, show favorable anti-fibrotic potential by restoring metal ion homeostasis, blocking EMT/FMT and inhibiting oxidative stress.

• Regulation of ferroptosis by mitochondria-associated endoplasmic reticulum membranes in nonalcoholic fatty liver disease: research progress

  YAN Zhishu, LIN Shengwei, BIAN Jinjun*

  2026,47(8):1090-1095 ,DOI: 10.16781/j.CN31-2187/R.20250418

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  Nonalcoholic fatty liver disease (NAFLD), also known as metabolic dysfunction-associated steatotic liver disease (MASLD), has a complex pathogenesis with increasing incidence and prevalence; however, the treatment options remain limited. The mitochondria-associated endoplasmic reticulum membrane (MAM) coordinates calcium signaling, lipid synthesis, and endoplasmic reticulum stress responses via dynamic contact interfaces, and its functional aberration is closely related to MASLD. Emerging evidence indicates that MASLD progression is strongly associated with ferroptosis driven by iron-dependent lipid peroxidation, and MAM plays a regulatory role in the ferroptosis process by modulating key pathways involving lipid peroxidation and iron metabolism. This review elucidates the intricate structural composition and ferroptosis regulatory mechanism of MAM and discusses the challenges and future prospects of MAM-targeted therapies for MASLD, aiming to provide novel perspectives for the treatment of MASLD.

Short article

• Clinical investigation of parathyroid hormone target values in secondary hyperparathyroidism after surgical treatment

  WANG Qiang, ZHOU Shiyi, SHEN Yixuan, LIN Sen, LI Wei, ZHA Siluo, SHAN Chengxiang, ZHU Daqiao, ZHANG Wei

  2026,47(8):1096-1102 ,DOI: 10.16781/j.CN31-2187/R.20250683

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  Objective To analyze the changes of serum parathyroid hormone (PTH) in patients with secondary hyperparathyroidism (SHPT) after parathyroidectomy (PTX) and patients' subjective evaluation of surgical efficacy and adverse effects. Methods A retrospective analysis was conducted on the clinical data of 57 SHPT patients who underwent PTX at Department of Thyroid, Breast and Hernia Surgery of The Second Affiliated Hospital of Naval Medical University from Jan. 2011 to Mar. 2021, with a follow-up ＞1 year. Serum PTH level was recorded preoperatively and during follow-up. Patient satisfaction data regarding surgical efficacy were collected and the distribution intervals of postoperative PTH level were compared among patients with different satisfaction. Additionally, patient satisfaction was analyzed in relation to the PTH target values recommended by different current guidelines. Results Among the 57 patients, 4 underwent reoperation due to recurrence. In the remaining 53 patients, no significant difference was observed in PTH levels between postoperative day 1 and the last follow-up visit (P=0.119); however, PTH levels at both time points were significantly decreased compared with the preoperative level (both P＜0.05). During the follow-up, 23 of the 53 patients had a decrease in PTH level and 30 had an increase, with a significant difference in postoperative PTH change between them (P＜0.05). There was no linear regression relationship between the PTH level on the first postoperative day and the postoperative PTH change in the patients with PTH elevation (P=0.478). Based on satisfaction levels with the surgical efficacy, the patients were categorized into very satisfied group (n=24), moderately satisfied group (n=27), and dissatisfied group (n=2). The postoperative PTH levels in the very satisfied group were concentrated at lower levels, while those in the moderately satisfied group showed more dispersed distribution, with the median values being 23.21 and 24.71 pg/mL on the first postoperative day, and 36.54 and 68.30 pg/mL at the final follow-up, respectively. The PTH levels in the dissatisfied group were distributed at two extremes. When postoperative PTH was evaluated using the Kidney Disease: Improving Global Outcomes guideline (target value: 130-650 pg/mL) or the Japanese Society for Dialysis Therapy guideline (target value: 60-240 pg/mL), the proportion of patients within the PTH target range was relatively low among the patients with high satisfaction, whereas the proportion below the target value was relatively high. When postoperative PTH was evaluated using the normal PTH reference value (15-65 pg/mL), the proportion of patients achieving the target PTH level was significantly increased among patients with high satisfaction. Conclusion PTH levels in SHPT patients significantly decrease after surgical treatment and subsequently exhibit dynamic trend. Maintaining the postoperative PTH target value within a range lower than that recommended by current mainstream guidelines may lead to better clinical experiences for patients.

• Current status and influencing factors of tube feeding medication administration in clinical practice: a study based on retrospective analysis and healthcare professional behavior survey

  ZHOU Hao, WANG Zhuo, CAI Yanfang, DENG Min

  2026,47(8):1103-1109 ,DOI: 10.16781/j.CN31-2187/R.20260233

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  Objective To systematically analyze the current status of clinical tube feeding medication administration, the differences in knowledge-attitude-practice (KAP) among medical and nursing staff, and the associated influencing factors. Methods A combined approach of retrospective analysis and preliminary questionnaire survey was adopted. Medical records of inpatients receiving tube feeding medication in The First Affiliated Hospital of Naval Medical University from Jul. to Dec. 2024 were retrieved, and the inappropriate medication orders were statistically analyzed. Based on the KAP theoretical framework, a KAP questionnaire on tube feeding medication for physicians and an operation questionnaire for nursing staff were separately developed. A single-center small-sample exploratory survey was conducted to evaluate the cognitive level, attitudinal orientation and practical behavioral characteristics of staff in different positions regarding tube feeding medication administration. Results A total of 12 934 medication orders were included, involving 297 types of drugs. The top 5 departments with the highest frequency of tube feeding medication administration, namely the emergency department, geriatrics department, gastroenterology department, thoracic surgery department, and respiratory department, accounted cumulatively for 78.86% (10 200/12 934). The irrational medication orders for tube feeding medication were primarily manifested as improper use of special dosage forms (57.52%, 325/565), mainly involving enteric-coated tablets and sustained/controlled-release tablets. In addition, 12.59% (1 629/12 934) of the orders involved injectable preparations administered via feeding tubes, of which hypertonic sodium chloride solution and others posed potential safety risks via this route. The questionnaire survey revealed that the physicians generally exhibited favorable KAP toward tube feeding medication administration, yet 64.71% (11/17) had cognitive gaps concerning the suitability of specific drugs such as aspirin enteric-coated tablets. Non-standard practices were prevalent among the nursing staff; nursing assistants showed significantly lower compliance than registered nurses in tube flushing methods, drug mixing and grinding, and adherence to standard procedures (all P＜0.01). Over 80% of both physicians and nurses reported demands for professional training and pharmaceutical quick-reference tools. Conclusion Clinical tube feeding medication administration is plagued by issues including improper use of special dosage forms and unsuitable administration routes. Physicians have insufficient knowledge on specific drugs, and the operational standardization of registered nurses and nursing assistants requires improvement. Current management and training support fail to fully meet clinical requirements. It is recommended to formulate standardized guidelines, optimize the electronic medical order system, strengthen multidisciplinary collaboration, and implement targeted training, so as to improve the rationality and safety of tube feeding medication administration.

• Relationship between personality resilience and campus-related factors among students in a medical university in Shanghai

  ZHANG Chunyu, WANG Shengjie, XIE Kangping, YUAN Xiaojian

  2026,47(8):1110-1116 ,DOI: 10.16781/j.CN31-2187/R.20260318

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  Objective To explore the influencing factors of personality resilience among students in a medical university in Shanghai. Methods With stratified random cluster sampling, freshmen and juniors majoring in clinical medicine in a medical university in Shanghai were enrolled. A self-designed general information questionnaire was used to collect basic information and campus-related conditions, and the Lu Guohua's version of psychological resilience scale was used to assess personality resilience. Multiple linear regression was used to analyze the effects of basic information and campus-related factors (including perceived training intensity, gender, only-child status, and competition experience) on personality resilience. Results A total of 193 valid samples were obtained. The total score of the personality resilience scale was 78.91±14.68 among the 193 college students. Multiple linear regression analysis showed that female (β= -0.19, P=0.01), perceived training intensity (β=-0.31, P＜0.01), and competition experience (β=-0.17, P=0.02) had negative effects on personality resilience, while only-child status had no significant effect on personality resilience (β=-0.12, P=0.10). The above variables together explained 13% of the variation in the personality resilience. Conclusion Among students of the medical university in Shanghai, personality resilience is affected by gender, perceived training intensity, and competition experience. Perceived training intensity is negatively correlated with personality resilience, suggesting that excessive training loads may paradoxically weaken psychological resilience.

Case report

• Acute isolated posterior wall myocardial infarction: a case report

  LENG Siqi, HUANG Huixiang, HUANG Xinmiao, ZHANG Qin*

  2026,47(8):1117-1119 ,DOI: 10.16781/j.CN31-2187/R.20250535

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• Multi-target treatment for IgA nephropathy with membranoproliferative glomerulonephritis-like features: a case report

  SUN Jing, LI Juan, BIAN Qi, GUO Zhiyong, XU Jing*

  2026,47(8):1120-1124 ,DOI: 10.16781/j.CN31-2187/R.20250378

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  Abstract: