Table of Content

15 June 2026, Volume 29 Issue 17

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Guidelines·Consensus

Guidelines for Diagnosis and Treatment of Acute Mastitis with Integrated Traditional Chinese and Western Medicine

MENG Zixi, ZHAO Huiduo, LIU Ruidong, WANG Beibei, JIANG Mingqiang, CHENG Xufeng

2026, 29(17):  2273-2281.  DOI: 10.12114/j.issn.1007-9572.2025.0462

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Acute mastitis is a common clinical acute suppurative infection of the breast, which is more common in lactating women 3-4 weeks after delivery. Without timely intervention, it can develop into abscess and even sepsis, which seriously affects the physical and mental health of mothers and children. In recent years, simple Western medicine treatment had a certain effect, but there were problems of drug resistance and high recurrence rate. Integrated traditional Chinese and Western medicine can effectively relieve symptoms, shorten the course of disease and reduce the risk of complications through syndrome differentiation and treatment combined with modern medical means, reflecting significant therapeutic advantages. This guideline was based on evidence-based medicine, the latest diagnosis and treatment standards at home and abroad, combined with expert recommendations and opinions, condensed clinical problems, and systematically sorted out the etiology, pathogenesis, diagnostic criteria, integrated traditional Chinese and Western medicine key points of acute mastitis, so as to provide reference for the clinical diagnosis and treatment of acute mastitis with integrated traditional Chinese and Western medicine.

Thematic Report on China's Medical and Health System Reform: 15 Years of Deepening Efforts (Ⅲ)

Fifteen Years Review and Future Prospects of China's National Essential Public Health Services

YOU Lili, LIU Lu, CHEN Ying, KANG Qixue, WANG Yuxing, WANG Jingbo, ZHANG Bingli

2026, 29(17):  2282-2295.  DOI: 10.12114/j.issn.1007-9572.2025.0532

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Since the launch of the National Essential Public Health Services Program in 2009, China's primary public health system has undergone a structural transformation from a focus on "building foundations and ensuring equitable access" to one centered on "improving quality and promoting population health". From the perspectives of policy evolution and public governance, this study systematically reviewed the fifteen-year development of the program (2009-2024), with a focus on its policy trajectory, institutional development, implementation outcomes, and future directions. The results showed that, over the past fifteen years, China had progressively established an institutional framework characterized by strong government leadership, stable fiscal support, and implementation through primary health care institutions. Notable progress had been made in the formalization of the system, sustained growth in public financing, expansion of service packages, transformation of primary care delivery models, and strengthening of digital governance capacity. These developments had collectively contributed to the establishment of a primary public health service network that covered the entire population across the life course. At the implementation level, key services—including electronic health records, chronic disease management, maternal and child health services, elderly health management, and the national immunization program—had been continuously strengthened. Service coverage and the level of standardized management had improved substantially, contributing to enhanced equity, strengthened primary care capacity, and improved public experience and perceived benefits of health services. Despite these achievements, several challenges remained, including regional disparities, shortages in the primary health workforce, performance evaluation systems that continue to emphasize process indicators, and limited interoperability among health information systems. Looking ahead, it is essential to further strengthen fiscal investment and performance-based incentive mechanisms, refine the design of service packages, promote integration between medical care and public health, and advance digital governance. These efforts will help improve the quality of primary public health services and strengthen health governance capacity, thereby providing institutional support for the Healthy China strategy and the achievement of universal health coverage.

Fifteen Years of Development and Future Directions of China's Family Doctor Contractual Service

HUANG Jiaoling, KANG Li, GE Min, PAN Zhigang, LIANG Hong

2026, 29(17):  2296-2302.  DOI: 10.12114/j.issn.1007-9572.2025.0369

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After nearly fifteen years of evolution, China's family doctor contractual service has progressed from initial pilot trials to a phase of rapid expansion, achieving system creation "from scratch", optimizing institutional structures, and swiftly extending coverage to the target population. It has now entered a stage of high quality development, focusing on thorough and refined implementation. The rollout of this initiative has contributed positively to raising residents' health literacy, effectively managing the incidence and progression of chronic diseases, improving overall public health, and advancing health equity. Nevertheless, practical challenges remain, including workforce shortages, insufficient operational dynamism, constrained service offerings, and less than ideal user experience. To address these issues, this paper puts forward a blueprint described as "one core, two boosters, three mechanisms, and four outcomes". Specifically, it proposes consolidating the central role of contractual services, strengthening the dual pillars of capability and motivation, reinforcing the three mechanisms of training, collaboration, and incentives, and enhancing the four outcome dimensions: health status, cost containment, sense of benefit, and public recognition. This framework offers a decision making reference for advancing the construction of family doctor contractual services in the context of high quality development.

General Practice/Community Health Service

Research on the Driving Mechanism of Patients' Willingness to Continue Primary Diagnosis from the Perspective of Trust

XIAO Lei, MIAO Xingyu, LIU Xingyu, HU Xinyi, ZHANG Song, WU Yingmin

2026, 29(17):  2303-2311.  DOI: 10.12114/j.issn.1007-9572.2025.0325

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Background

Primary medical first consultation plays an important role in the rational utilization of medical services and alleviating the contradiction between supply and demand of medical resources. However, the rate of primary medical first consultation in China is lower than the policy expectations, and it is very important to guide patients to primary care. Therefore, it is of great significance to conduct an in-depth exploration of the driving mechanism of patients' willingness for primary medical first consultation.

Objective

Based on the family doctor contract service scenario, a theoretical model of "expectation confirmation-patient trust-sustained willingness to first visit at the grassroots level" was constructed based on the expectation confirmation theory. Through empirical research, this paper verifies the social psychological mechanism of patients' willingness to continue grassroots first diagnosis, reveals the path of patient trust, and provides theoretical basis and practical enlightenment for improving patients' willingness to continue grassroots first diagnosis.

Methods

Taking a community health service center in Chengdu as the research site, a questionnaire survey was conducted on the patients served by the center in March 2024, including four parts: general information questionnaire, expectation confirmation, patient trust, and medical seeking willingness at the grassroots level. Independent sample t-test and one-way analysis of variance were used to study the differences in patients' trust between groups, and the structural equation model was used to verify the theoretical hypothesis and mediating effect.

Results

A total of 318 questionnaires were collected for the survey, of which 288 (90.6%) were valid. The average expection confirmation score for patients was (3.99±0.74) points, with 208 cases (72.2%) exhibiting high expected confirmation. The average patient trust score was (4.13±0.61) points, with the three dimensions of technical trust, service trust, and emotional trust averaging (4.18±0.65), (3.60±1.02), and (4.35±0.64) points respectively. Patients who were adults, aged 60 years or older, had hypertension/diabetes, had signed up with a family doctor, and had high expectations demonstrated higher trust in primary care (P<0.05). Patients who did not have a designated doctor showed lower trust in primary care (P<0.05). Patient trust had a complete mediating effect between expectation confirmation and the willingness to seek initial treatment at primary care facilities (P<0.05).

Conclusion

Patient trust has a significant full mediating effect between expectation confirmation and willingness to continue primary care. It is the starting point to cultivate patients' trust by providing patients with super-expected experience through targeted demand satisfaction, so as to improve patients' expectation confirmation. Taking public health services as an opportunity to establish emotional trust, relying on the improvement of diagnosis and treatment ability and the optimization of referral services to establish technical trust and service trust may be the key path to enhance the first diagnosis of patients' willingness at the grassroots level.

The Design of Family Doctor Contract Service Packages for Primary and Secondary School Students in Beijing

CUI Mingming, ZHENG Xiaoguo, YIN Tao, LI Wen, YIN Delu

2026, 29(17):  2312-2318.  DOI: 10.12114/j.issn.1007-9572.2025.0191

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Background

The health of primary and secondary school students in China faces many challenges. Against the policy background of the state strengthening physical health management and promoting family doctor contract services, it is imperative to extend family doctor contract services to functional communities such as schools.

Objective

Research on the design of family doctor contract service package suitable for the characteristics of Beijing from the perspective of grass-roots medical and health institutions and schools, and provide for promoting the work of family doctor contract service in functional communities such as schools.

Methods

Using convenient sampling method, 62 participants, including heads of family doctor teams from community healthcare services and school doctors from primary and secondary schools in seven districts of Beijing were selected for a questionnaire survey in August 2024. The survey included the basic information of the respondents, assessing the necessity of basic health service package and four types of personalized service packages (vision, nutrition, oral, and psychological), covering service necessity, implementation feasibility, and recommendation rates. The numbers of items in the basic health service package and the vision, nutrition, oral, and mental health service packages were 10, 9, 8, 9, and 7, respectively. Item evaluations for each type of health service package were calculated using the number of records, where number of records =number of service items × total number of evaluations. Recommendation rate=number of positive responses / total number of records.

Results

The overall recommended proportions of the basic health service package and four types of personalized health service packages were 83.5% (518/620), 74.2% (414/558), 72.2% (358/496), 66.6% (372/558), and 70.0% (304/434), respectively. Among them, the recommended proportions of services such as establishing and updating health records and vaccination services, visual health education and intervention services, nutritional counseling and guidance services, establishing student oral records service items, and establishing student mental health records services were relatively high, at 93.5% (58/62), 93.5% (58/62), 91.9% (57/62), 83.8% (52/62), 83.8% (52/62), and 77.4% (48/62), respectively. The recommended proportions of services such as carrying out self-filling screening scales for psychological problem screening, discovering common eye diseases such as conjunctivitis, nutritional therapy services, root canal therapy services, appropriate technologies such as psychological relief were relatively low, at 75.8% (47/62), 56.5% (35/62), 53.2% (33/62), 53.2% (33/62), and 59.7% (37/62), respectively. Apart from the necessity and feasibility of the basic health service package, the evaluations of the family doctor contract services for primary and secondary school students showed statistically significant differences between primary healthcare institutions and school medical professionals (P<0.05).

Conclusion

Basic health services, as well as personalized health record management, health education and intervention, and nutrition consultation and guidance services are key contents of the family doctor contract service package for primary and secondary school students in Beijing. The diagnosis and treatment service items are also necessary, but the items should selected and included in the contract service package according to the actual diagnosis and treatment capacity of the grass-roots medical and health institutions.

The Association between the Specialists Outreach and the Job Perception and Diabetes Management Competence of Primary Care Providers

SUN Xibin, LI Jiawei, GE Aoqi, YUAN Beibei

2026, 29(17):  2319-2325.  DOI: 10.12114/j.issn.1007-9572.2025.0429

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Background

There exist structural issues in China's healthcare system, where secondary and tertiary medical institutions are more likely to attract medical professionals with advanced academic degrees and high professional qualifications. Guiding the outreach of superior medical resources through a combination of administrative requirements and moderate incentives is an important measure to improve the quality of primary care services in the short term, with personnel outreach as the core priority of this initiative.

Objective

The outreach of specialists from county-level hospitals is one of the key measures to strengthen primary-level medical services. This study analyzed the potential classes of specialist outreach activities in a certain city and explored the impact of different classes on the job perception and competence of primary care providers, aiming to provide references for improving the practice of personnel downward mobility.

Methods

The study was conducted in a city of Shandong Province in October 2022, using multistage cluster sampling. First, 6 counties/county-level cities were selected; next, 6 townships/towns/subdistricts were randomly sampled from each of them, totaling 36 sites. Questionnaires were distributed to all on-duty medical staff (general practitioners, nurses, public health workers, etc.) on the day of investigation at sampled township health centers/community health service centers, plus 15 village doctors (active in family doctor teams) from each institution. Data were collected via a general information questionnaire, an evaluation of medical personnel outreach practices scale (assessing opportunities for case discussions, outpatient consultations, joint home visits, and training with higher-hospital specialists), a job satisfaction scale, and a diabetes management competence scale. Latent class analysis (LCA) identified patterns of outreach participation, and multiple linear regression examined how these latent classes affected primary staff's job satisfaction and diabetes management competence. A multi-stage cluster sampling method was used to select primary care providers in a certain city. Data were collected using a general information questionnaire, an evaluation questionnaire on personnel outreach practices, a job satisfaction scale, and a diabetes management capability scale. Latent class analysis was conducted on the participation of primary care providers in outreach activities, and multiple linear regression was used to analyze the impact of potential classes of outreach on the job satisfaction and diabetes management competence of primary medical personnel.

Results

A total of 2 233 primary medical personnel were surveyed. Their participation in specialist downward mobility activities could be clustered into 3 potential classes: the comprehensive support group (31.66%, n=707), the in-hospital support group (16.93%, n=378), and the overall support deficiency group (51.41%, n=1 148). Results of multiple linear regression analysis showed that compared with the overall support deficiency group, both the comprehensive support group (B=4.798, P<0.001) and the in-hospital support group (B=3.241, P=0.002) positively predicted job satisfaction scores. Additionally, both the comprehensive support group (B=3.922, P<0.001) and the in-hospital support group (B=1.659, P<0.001) positively predicted diabetes management capability scores.

Conclusion

There are 3 potential categories of primary medical personnel's participation in specialist downward mobility activities. The richness of practical support activities varies, and more abundant support activities are positively correlated with job satisfaction and diabetes management competence. It is suggested to focus on specific and diversified support content in the downward mobility of specialists to truly improve the professional fulfillment and diabetes management competence of primary care providers.

Article

Study on Fixed and Mobile Exoskeleton Robots in Improving Lower Limb Function and Quality of Life in Stroke Patients: a Randomized Controlled Trial

WU Ruining, ZHOU Ming, ZHANG Gongzi, LI Jun, XIE Suhang, LIU Yangxiaoxue, ZHANG Jiali, LIU Maomao, HUANG Liping

2026, 29(17):  2326-2333.  DOI: 10.12114/j.issn.1007-9572.2025.0474

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Background

Stroke has an extremely high mortality and disability rate, making it a critical public health issue. Patients with stroke are often accompanied by lower limb motor dysfunction, which severely impairs their quality of life. In the past, one-on-one manual rehabilitation training was commonly administered to such patients, which consumes a large amount of human resources and makes it difficult to guarantee the training quality. In recent years, the advent of exoskeleton robots is expected to address this pain point. Exoskeleton robots can be classified into two major categories, fixed and mobile based on their structural forms and operational postures. However, it remains unclear whether these two distinctly designed robots are effective in improving lower limb motor function and quality of life in stroke patients, and whether there are differences in their therapeutic effects.

Objective

To investigate the effects and therapeutic benefits of stationary versus mobile exoskeleton robots in enhancing lower limb function and quality of life among stroke patients.

Methods

Forty stroke inpatients admitted to the Department of Rehabilitation Medicine at the First Medical Center of Chinese PLA General Hospital between 2021 and 2024 were enrolled as study participants. Using a random number table method, they were randomly assigned to either the fixed robot group (n=20) or the mobile robot group (n=20). In addition to conventional rehabilitation training, the fixed robot group underwent Lokomat robotic-assisted gait training for 20 minutes per session, five times weekly, over two consecutive weeks. The mobile robot group received Aikang robotic-assisted training under the same regimen: 20 minutes per day, five times per week, for two consecutive weeks, alongside standard rehabilitation. Outcome measures were collected before and after the intervention period and included the Fugl-Meyer Assessment of Lower Extremity (FMA-LE), peak torque (PT) of hip and knee flexion and extension, absolute error angle (AE) angular error of the affected knee joint, Functional Ambulation Category (FAC) scale, gait analysis parameters, and the Modified Barthel Index (MBI).

Results

All 40 patients completed the entire trial protocol with no dropouts reported during the study. Intergroup comparisons: prior to training, there were no statistically significant differences between the two groups in FMA-LE scores, AE angle of the affected knee joint, MBI scores, PT of hip and knee flexion/extension, and FAC grades (P>0.05). After training, no statistically significant differences were found between the two groups in FMA-LE scores, MBI scores, PT of hip and knee flexion/extension, and FAC grades (P>0.05), whereas the AE angle of the affected knee joint in the fixed robot group was significantly lower than that in the mobile robot group (P<0.05). Intragroup comparisons: after training, both groups exhibited a significant increase in the lower extremity FMA-LE scores and MBI scores, with a significant improvement in the AE angle of the affected knee joint and the PT of hip and knee flexion/extension compared with the baseline (P<0.05). The FAC grades of both groups were significantly better than those at baseline (P<0.05). Gait analysis was conducted in only 7 patients in the fixed robot group and 8 patients in the mobile robot group. For gait parameters, intergroup comparisons showed no statistically significant differences in walking speed, step length and gait cycle between the two groups both before and after training (P>0.05). Intragroup comparisons indicated that walking speed was significantly increased after training in both groups (P<0.05); the fixed robot group had a significant increase in step length (P<0.05) and a significant reduction in gait cycle (P<0.05) compared with the baseline.

Conclusion

Both fixed exoskeleton robots and mobile exoskeleton robots can effectively improve the lower limb function and quality of life of stroke patients, and fixed exoskeleton robots have more advantages in improving patients' knee joint proprioception.

Study on Glycemic Control Status and Influencing Factors among Community Diabetic Patients

LI Menglin, DING Fang, QIAN Yu, PU Dong, DU Qianqian, GUAN Tianhang, HE Yilin

2026, 29(17):  2334-2339.  DOI: 10.12114/j.issn.1007-9572.2024.0597

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Background

Currently, the health management of diabetic patients in the community is still facing many challenges, and it is difficult to effectively improve the glycemic control rate, so exploring the factors affecting glycemic control to delay or reverse the development of complications in diabetic patients is important.

Objective

Exploring the characteristics of specific categories of glycemic control in community diabetic patients, the influencing factors, and the association with common complications to provide a scientific basis for the management of community diabetic patients.

Methods

A questionnaire survey conducted from March 2023 to April 2024 was used to collect demographic characteristics, health education, diseases, and health management of 417 community diabetes patients in three county-level regions of Qintong Town in Jiangyan District, Taizhou City, Jishi Town in Jingjiang City, and Chenbao Town in Xinghua City. The patients' glycemic control was categorized by potential category analysis, and the prevalence of diabetic complications and their influencing factors under different glycemic control categories were investigated by multiple Logistic regression analysis.

Results

Based on the latent class analysis results, the 417 diabetic patients were categorized into three groups: Class 1: the older-age/low-health-literacy group (n=181, 43.40%); Class 2: the middle-age/moderate-health-literacy group (n=158, 37.89%); and Class 3: the younger-age/high-health-literacy group (n=78, 18.71%). Significant differences were observed among the three groups in the prevalence of hypertension, stroke, and neuropathic complications (P<0.05). Specifically, the older-age/low-health-literacy group and the middle-age/moderate-health-literacy group exhibited higher rates of comorbid hypertension, stroke, and neuropathy compared to the younger-age/high-health-literacy group (all P<0.01). Multiple Logistic regression analysis revealed that, compared to the younger-age/high-health-literacy group, having a junior high school education or above (OR=0.256, 95%CI=0.129-0.510, P<0.001; OR=0.355, 95%CI=0.181-0.696, P=0.003) and implementing more than three blood glucose control measures (OR=0.272, 95%CI=0.148-0.499, P<0.001; OR=0.542, 95%CI=0.298-0.986, P=0.045) were protective factors for blood glucose control in the older-age/low-health-literacy group and the middle-age/moderate-health-literacy group, respectively. Conversely, being unmarried/divorced/widowed (OR=3.303, 95%CI=1.208-9.035, P=0.020) was identified as a risk factor for blood glucose control in the middle-age/moderate-health-literacy group.

Conclusion

Glycemic control of diabetic patients in the Taizhou community has obvious categorical characteristics. The distribution of hypertension, stroke, and neurological complications is different among different potential categories, and the influencing factors are education level, marital status, glycemic control measures, etc. Categorical interventions should be carried out according to the characteristics of the different categories of the population.

Heterogeneity and Influencing Factors of Cognitive Function Impairment in Patients with Major Depressive Disorder

NIE Jiahui, LI Guojuan, HAO Zhuoqun, DU Qiaorong, LIU Penghong, LIU Zhifen, LIU Sha, ZHANG Aixia, WANG Yanfang

2026, 29(17):  2340-2346.  DOI: 10.12114/j.issn.1007-9572.2024.0697

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Background

Patients with major depressive disorder (MDD) have certain cognitive function impairment, but there are still research gaps in the heterogeneity of cognitive function impairment and the influencing factors of different types.

Objective

To explore the potential cognitive function impairment subtypes in MDD patients and analyze the influencing factors of subtypes.

Methods

The subjects were MDD patients (n=209) in the outpatient and inpatient Department of Psychiatry in the First Hospital of Shanxi Medical University from July 2020 to December 2023, and healthy controls (n=51) recruited in the same period. The demographic data questionnaires, Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Hamilton Depression Scale (HAMD-17), and Pittsburgh Sleep Quality Index (PSQI) were used to investigate. Latent profile analysis was conducted on cognitive function classification of MDD patients based on RBANS scores in various dimensions, and unordered multinomial Logistic regression analysis was used to explore the influencing factors of potential cognitive function classifications.

Results

The latent profile analysis results showed that the cognitive function of MDD patients could be divided into three potential subtypes: good cognitive function type (64.6%, 136/209), poor cognitive function-high perceptual type (27.7%, 57/209), and poor cognitive function-low perceptual and attention type (7.7%, 16/209). There were significant differences (P<0.05) in the total RBANS score and various dimension scores, HAMD-17 total score, PSQI total score, age, and education years between MDD patients with different cognitive function subtypes and healthy control groups. The results of the unordered multinomial Logistic regression analysis showed that taking good cognitive function type as the reference, MDD patients with fewer years of education had a higher risk of being classified into poor cognitive function-low perceptual and attention type and poor cognitive function-high perceptual type (P<0.05). In addition, MDD patients with higher HAMD-17 total scores and higher PSQI total scores were more likely to be classified into poor cognitive function-low perceptual and attention type (P<0.05).

Conclusion

The cognitive function impairment of MDD patients has significant heterogeneity, and the risk factors of further cognitive impairment are high degree of depression, poor sleep quality and low years of education.

The Current Status of Awareness and Influencing Factors Analysis of Metabolic-associated Fatty Liver Disease among the General Population in Multiple Regions of Yunnan

HUANG Minshan, CHEN Hang, LI Liya, YANG Taiming, CHEN Lifang, LI Shenchao, REN Li, WANG Hui, LI Mingke, WANG Xianmei, WANG Da, WAN Ying, HE Yule, ZHOU Qingqing, LI Yu, LI Mengwei, LU Lihong, LUO Yifan, MA Lanqing

2026, 29(17):  2347-2353.  DOI: 10.12114/j.issn.1007-9572.2025.0095

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Background

With the ongoing changes in lifestyle, the prevalence of metabolic-associated fatty liver disease has been increasing year by year. However, public awareness of this condition remains insufficient. Enhancing public knowledge is essential for early prevention and intervention, highlighting the urgent need for related population-based investigations.

Objective

To investigate the current awareness of metabolic-associated fatty liver disease among the general population in multiple regions of Yunnan Province and analyze the factors affecting this awareness, providing a basis for improving public understanding of fatty liver disease.

Methods

This study collected questionnaires on knowledge related to metabolic-associated fatty liver disease from the general population in 11 regions of northeastern, southeastern, northwestern, and southwestern Yunnan Province (including Baoshan City, Dehong Dai and Jingpo Autonomous Prefecture, Honghe Hani and Yi Autonomous Prefecture, Lijiang City, Lincang City, Puer City, Wenshan Zhuang and Miao Autonomous Prefecture, Xishuangbanna Dai Autonomous Prefecture, Kunming City, Yingjiang County of Dehong Dai and Jingpo Autonomous Prefecture, and Huize County of Qujing City) through free medical consultations from June 2022 to October 2023. The questionnaire covered general information (such as residence, gender, age, ethnicity, place of residence, occupation, education level, and income) and fatty liver disease awareness (including epidemiology, causes, risk factors, diagnosis, harm, treatment, and prevention). Data were analyzed using SPSS 25.0, and logistic regression was applied to identify factors related to awareness.

Results

A total of 975 questionnaires were collected. After eliminating 12 invalid questionnaires, 963 valid questionnaires were retrieved, with an effective recovery rate of 98.77%. The overall average awareness accuracy rate was 60.36%. 78.61% (757/963) of respondents correctly recognized the symptoms of fatty liver disease. 80.48% (775/963) believed that both obese and non-obese individuals could develop fatty liver disease. 35.62% (343/963) were aware of the risk groups for fatty liver disease. 25.34% (244/963) had never been screened for fatty liver disease, with 60.25% (147/244) of these individuals having an annual income of less than 50 000 yuan. The correct rates for knowledge about fatty liver disease's causes and risk factors, diagnostic methods, dietary restrictions, preventive measures, and treatment methods were 35.62% (343/963), 1.25% (12/963), 79.13% (762/963), 57.42% (553/963), and 58.36% (562/963), respectively. 39.15% (377/963) believed that careful use of medications, health supplements, and alcohol limitation could reduce liver burden. About 90% could correctly identify the timing for medication (886/963) and medical consultation for fatty liver disease (861/963). 76.53% (737/963) had a clear understanding of the adverse prognosis of fatty liver disease. Multivariate Logistic regression analysis showed that educational attainment of primary school (OR=2.905, 95%CI=1.701-4.961), junior high school (OR=3.791, 95%CI=2.318-6.200), and senior high school (OR=2.993, 95%CI=1.868-4.795) were risk factors for low awareness of metabolism-related fatty liver disease (P<0.05); household annual income ranging from 50 000 yuan to less than 100 000 yuan (OR=0.547, 95%CI=0.375-0.796) and 100 000 yuan to less than 200 000 yuan (OR=0.629, 95%CI=0.399-0.993) were protective factors for low awareness of metabolism-related fatty liver disease (P<0.05).

Conclusion

The general public has insufficient knowledge about the causes, risk factors, treatment, and prevention of fatty liver disease, and there are significant misconceptions about the diagnosis of liver fat degeneration. Low-income groups severely neglect early screening for the disease, and low education level is independent risk factor for low fatty liver disease awareness, high household income is protective factor for low fatty liver disease awareness.

The Causal Relationship between Sleep Patterns and Serum Uric Acid: a Bidirectional Mendelian Randomization Study

ZHANG Xinwen, WEI Guangcheng, ZHANG Xieyu, SHI Jinjie, LI Xiaoxu, MA Rui, YA Yulong, PENG Jiucheng, CAO Wei

2026, 29(17):  2354-2360.  DOI: 10.12114/j.issn.1007-9572.2025.0353

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Background

Hyperuricemia (HUA) is a global health concern, with its prevalence on the rise in China. Sleep, as an important lifestyle factor, shows an inconsistent relationship with serum uric acid (SUA) levels in previous observational studies, and the causal relationship between them remains unclear. Therefore, it is necessary to employ more reliable methods to clarify their intrinsic association.

Objective

To investigate the bidirectional causal relationships between sleep duration, daytime napping frequency, and SUA levels using a bidirectional Mendelian randomization (MR) approach.

Methods

This study was based on publicly available summary data from large-scale genome-wide association studies (GWAS). Data on sleep duration (n=127 573), daytime napping frequency (n=452 633), and SUA levels (n=288 649) were derived from European populations. A bidirectional two-sample MR design was employed, screening eligible single nucleotide polymorphisms (SNPs) as instrumental variables. The inverse variance weighted (IVW) method, MR-Egger regression, weighted median method, and MR-PRESSO method were used to assess causal effects. Sensitivity analyses, including heterogeneity tests and leave-one-out analysis, were conducted to verify the robustness of the results.

Results

The MR analysis results showed that the genetic prediction of sleep duration was a negative causal relationship with the SUA level (OR=0.81, 95%CI=0.67-0.98, P=0.03), while the frequency of daytime naps predicted by genetics has a positive causal relationship with the level of SUA (OR=1.20, 95%CI=1.05-1.37, P=0.009). Reverse MR analysis found no causal effect of SUA levels on either sleep duration or daytime napping frequency (P>0.05). Sensitivity analyses detected no significant horizontal pleiotropy, indicating robust findings.

Conclusion

This study provides genetic evidence that shorter sleep duration and higher daytime napping frequency are independent risk factors for elevated SUA levels. Improving sleep habits may serve as an effective non-pharmacological intervention strategy for the prevention and management of HUA.

Evaluation of E-test and Whole Genome Sequencing for Detecting Antimicrobial Resistance in Foodborne Staphylococcus Aureus

CHANG Hanxiao, ZHANG Huifang, ZHANG Han, XIAO Di

2026, 29(17):  2361-2367.  DOI: 10.12114/j.issn.1007-9572.2025.0500

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Background

The rising prevalence of antibiotic resistance in foodborne Staphylococcus aureus underscores the critical importance of accurate and rapid antimicrobial susceptibility testing in guiding effective clinical therapy.

Objective

A comparative evaluation of the diagnostic accuracy of E-test and whole-genome sequencing (WGS) was performed for the detection of clinically significant antimicrobial resistance in foodborne Staphylococcus aureus.

Methods

Seventy-two foodborne Staphylococcus aureus were collected from the foodborne disease surveillance programs conducted by the Beijing Chaoyang District Center for Disease Prevention and Control and Xinjiang Uygur Autonomous Region Center for Disease Prevention and Control between March and November 2025, then tested in parallel against eight key antimicrobial agents (oxacillin, vancomycin, daptomycin, linezolid, rifampicin, ciprofloxacin, levofloxacin, and moxifloxacin) using both the E-test and WGS. The broth microdilution method (BMD), performed according to CLSI guideline M07, served as the reference standard for evaluating the diagnostic performance of both methods.

Results

When evaluated against the BMD reference method, high sensitivity (80.0%-100.0%), specificity (94.4%-100.0%), and inter-method agreement (Kappa=0.86-1.00) were observed for the E-test in detecting resistance to oxacillin, linezolid, rifampicin, levofloxacin, and moxifloxacin. Specificity was absolute (100.0%) for both daptomycin and vancomycin. A notable exception was ciprofloxacin, for which the E-test exhibited low sensitivity (57.1%) alongside 100.0% specificity and substantial agreement (Kappa=0.70). Genotypic analysis by WGS accurately identified major resistance determinants (mecA, 23S rRNA G2576T, rpoB H481N), which correlated highly with the phenotypic resistance profile. The predictive performance of WGS was excellent for ciprofloxacin (sensitivity: 100.0%; specificity: 96.9%; Kappa=0.85). However, for levofloxacin and moxifloxacin, predicted phenotypic resistance, while perfectly sensitive (100.0%), showed only moderate specificity (88.4%) and fair agreement (Kappa=0.38) with the BMD reference.

Conclusion

Notwithstanding its reliable performance against the BMD standard for key antibiotics, the E-test is compromised by specific shortcomings, namely: a tendency to overestimate the minimal inhibitory concentration (MIC) of daptomycin, potential failure to detect intermediate resistance to vancomycin, and inadequate sensitivity for identifying low-level ciprofloxacin resistance mediated by the parC S80F mutation. While the performance of WGS is highly concordant for predicting resistance to oxacillin, linezolid, rifampicin, daptomycin and vancomycin via accurate genotyping, it is imperative to integrate and interpret mutations from multiple loci to achieve reliable phenotypic prediction for fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin).

Study on the Diagnostic Performance of Ultrasound Habitat Imaging for the Differentiation between Benign and Malignant Phyllodes Tumors of the Breast

XIE Danling, LIU Boya, LI Xiaoguang, WANG Hanwei, MA Qiang, FANG Jingqin, WANG Shunan

2026, 29(17):  2368-2375.  DOI: 10.12114/j.issn.1007-9572.2025.0346

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Background

Benign and malignant phyllodes tumors of the breast (PTB) exhibit significant differences in surgical strategies, recurrence risks, and metastasis risks. Preoperative differentiation between the two subtypes is crucial for treatment decision-making. Conventional ultrasound has inherent limitations in diagnosis, while the diagnostic performance of ultrasound habitat imaging for distinguishing benign from malignant PTB remains not systematically validated.

Objective

To evaluate the diagnostic efficacy of ultrasound habitat imaging in differentiating benign from malignant PTB.

Methods

A retrospective analysis was performed on clinical and ultrasound data of 102 patients with pathologically confirmed PTB who underwent surgery at Daping Hospital, Army Medical University, from September 2014 to June 2024. Patients were divided into the benign group (n=54) and the borderline/malignant group (n=48, including 30 borderline cases and 18 malignant cases) based on pathological findings. Ultrasound images were recorded, and the tumor region of interest (ROI) was manually segmented using ITK-SNAP software. The ROI was divided into 3 habitat subregions via K-means clustering, and habitat features were extracted using PyRadiomics. Optimal features were selected using random forest (RF) algorithm, and a habitat score (Hab-score) was calculated to construct the habitat model. The conventional ultrasound model was established by incorporating conventional ultrasound variables with statistically significant differences in univariate analysis. A combined model was constructed by integrating conventional ultrasound features and Hab-score. Receiver operating characteristic (ROC) curves and Delong test were used to compare the diagnostic efficacy of the three models, and decision curve analysis (DCA) was employed to evaluate their clinical applicability.

Results

Statistically significant differences were observed between the two groups regarding maximum tumor diameter, internal echo, boundary clarity, and cystic changes (all P<0.05). The conventional ultrasound model was built by including these 4 variables; 7 habitat features (including 3 first-order features and 4 texture features) were retained after RF selection for Hab-score calculation and habitat model construction; the combined model was established by adding Hab-score to the 4 conventional ultrasound variables. The areas under the ROC curve (AUC) of the conventional ultrasound model, habitat model, and combined model were 0.718, 0.725, and 0.799, respectively. Delong test results indicated that the AUC of the combined model was significantly higher than those of the other two models (both P<0.05). DCA curve analysis demonstrated that the combined model yielded the highest clinical net benefit for PTB differentiation within the threshold range of 0.4-0.9.

Conclusion

Ultrasound habitat imaging is effective for differentiating benign from malignant PTB. When combined with conventional ultrasound, it further improves diagnostic efficacy and reduces the risks of missed diagnosis and misdiagnosis associated with a single technical approach, thus holding substantial potential for clinical application.

The Impact of Sleep Apnea Induced Immune Dysfunction on the Reproductive System of Female Rats

WANG Zheng, ZHANG Dong, GAO Zhihua

2026, 29(17):  2376-2381.  DOI: 10.12114/j.issn.1007-9572.2025.0136

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Background

Sleep apnea is a high incidence sleep disorder disease in clinic. With the change of lifestyle, the incidence rate continues to rise, which can cause cardiovascular, metabolic and other multiple system damage. In recent years, it has been found that female sleep apnea patients often experience reproductive dysfunction such as menstrual disorders and infertility. However, the immune regulatory mechanism of sleep apnea induced damage to the female reproductive system, especially the abnormal immune response mediated by dendritic cells (DCs), still lacks in-depth analysis.

Objective

To study the effects of sleep apnea induced immune dysfunction on the reproductive system of female rats.

Methods

The research period was from January 2023 to December 2024. Thirty 4-6 month female SD rats (SPF grade) with regular estrous cycles were randomly divided into a blank control group, a short-term group, and a long-term group, with 10 rats in each group. The blank control group was fed normally for 6 weeks, the short-term group was fed for 3 weeks on the basis of preparing a sleep apnea model, and the long-term group was fed for 6 weeks on the basis of preparing a sleep apnea model. The estrous cycle of each group of rats, the expression levels of estrogen receptor alpha (ERα) and estrogen receptor beta (ERβ) subtypes in ovarian tissue, and the number of follicles in ovarian tissue were analyzed. The migration ability of DCs, the ability of DCs to stimulate homologous T lymphocyte proliferation response (MLR), and the changes in Toll-like receptor 4 (TLR4) and RelB expression levels in DCs were observed. The fertility of each group and the growth and development of offspring mice were analyzed.

Results

Compared with the blank control group, the long-term groups showed an increased rate of dysregulation in the estrous cycle (P<0.017). Compared with the blank control group, the expression levels of ERα and ERβ in ovarian tissues were reduced in the short-term and long-term groups (P<0.05). Compared with the short-term group, the long-term group showed a decrease in the expression levels of ER α and ERβ in ovarian tissue (P<0.05). Compared with the blank control group, the number of primordial follicles, primary follicles, and antral follicles decreased in the short-term and long-term groups, while the number of blocked follicles increased (P<0.05). Compared with the short-term group, the long-term group showed a decrease in the number of primordial follicles, primary follicles, and antral follicles, and an increase in the number of blocked follicles (P<0.05). Compared with the blank control group, the migration rate of DCs decreased and the MLR increased in the short-term and long-term groups (P<0.05). Compared with the short-term group, the long-term group showed a decrease in the migration rate of DCs and an increase in MLR (P<0.05). Compared with the blank control group, the expression levels of TLR4 and RelB in DCs in both the short-term and long-term groups increased (P<0.05). Compared with the short-term group, the long-term group showed an increase in the expression levels of TLR4 and RelB in DCs (P<0.05). Compared with the blank control group, the pregnancy rate and live birth rate of long-term groups decreased (P<0.05). Three groups of live born offspring mice showed an increase in daily weight after 21 days of birth, but compared with the blank control group, the short-term and long-term groups showed growth retardation, especially the long-term group.

Conclusion

Sleep apnea can cause ovarian dysfunction and reduced fertility in female rats, suggesting that it may activate TLR4/RelB by altering the migration ability of DCs, leading to immune damage and reproductive system disorders.

Research on the Predictive Ability of Isokinetic Strength Testing for Knee Joint Extension of 1-repetition Maximum

ZHAI Naisheng, HUANG Lihua, ZHANG Ye

2026, 29(17):  2382-2386.  DOI: 10.12114/j.issn.1007-9572.2024.0570

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Background

Muscle strength training is an important part of rehabilitation. Scientific and reasonable strength training exercise prescription usually needs to be set based on the percentage of 1-repetition maximum (1RM). However, accurate 1RM is difficult to obtain in practice, so patients often lack appropriate resistance training prescription, which reduces the efficiency of muscle strength training and delays the recovery of overall function.

Objective

To explore the predictive ability of isokinetic muscle strength test for 1RM of knee extension and establish the 1RM prediction equation based on isokinetic muscle strength test results.

Methods

From March to June 2024, 61 healthy volunteers were recruited as the test group through the network platform and propaganda posters. Isokinetic muscle strength test and 1RM test of knee extension were carried out at an angular velocity of 60°/s, then peak torque (PT), peak force (PF) and 1RM were collected. Pearson correlation analysis was performed between PT, PF and 1RM, and univariate linear regression equations were established. Bland-Altman plot was constructed to evaluate the consistency between predicted value and the measured value of 1RM prediction equation.

Results

Among the 61 subjects, 23 were male, with an average age of (25.6±6.0) years; there were 38 females with an average age of (24.5±5.3) years. The results of correlation analysis showed that the PT and PF value of male and female were positively correlated with 1RM (P<0.05). The 1RM prediction equation based on PF value was y=0.070x+1.836 for male, R²=0.514; y=0.087x+0.858 for female, R²=0.781; based on the 1RM prediction equation of PT value, y=0.177x+0.250 for male, R²=0.386; y=0.312x+0.464 for female, R²=0.766. The test results showed that the 95% LOA of 1RM prediction equation based on PT value was -8.37 to 14.81 kg for male and -4.47 to 9.33 kg for female. The 95% LOA of 1RM prediction equation based on PF value was -5.29 to 10.82 kg for male and -4.12 to 8.87 kg for female. The 1RM prediction equation based on PF value had better consistency.

Conclusion

The results showed that the PT value and PF value obtained on the isokinetic dynamometer can be used to predict the 1RM value of knee extension, and the predictive ability of PF value for 1RM is better than PT value.

Article·Study of Evidence-based Medicine

Diagnosis and Management of Recurrent Urinary Tract Infections in Women: a Comparison and Interpretation Based on Existing Guidelines and Evidence

WANG Yibo, HE Kaiyu, LIANG Guofen, YANG Zhenhua, ZHAO Tingxian, LIAO Biyi, ZHANG La, LIU Shiwei, GONG Xuezhong, LIU Xusheng, GU Yueyu, QIN Xindong, SU Guobin

2026, 29(17):  2387-2399.  DOI: 10.12114/j.issn.1007-9572.2025.0104

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Background

Recurrent urinary tract infections (rUTI) are a common condition among female patients. It affects patients' quality of life, incurs the medical burden, and is associated with global antibiotic resistance. Currently, European and American countries have established clinical guidelines of rUTI to address the clinical issues. However, there is still a lack of consensus in the management of rUTI in China.

Objective

To summarize the existing evidence and guideline recommendations for the diagnosis, treatment, prevention of rUTI that can be used in China.

Methods

We conducted a systematic search in Chinese and English databases such as CNKI, VIP, Wanfang Data, PubMed, and Web of Science, as well as the associated official websites of urology, nephrology, and obstetrics and gynecology societies. We included guidelines related to female rUTI and the main randomized controlled trials and observational studies mentioned in these guidelines from November 2014 to November 2024.

Results

A total of 274 articles were included in the review, encompassing 98 systematic reviews and meta-analyses, 129 randomized controlled trials, 15 observational studies, and 32 expert opinions/guidelines. In symptom management, guidelines generally recommend routine urine culture during acute exacerbations. For acute-phase antibiotic therapy, most guidelines recommended fosfomycin and nitrofurantoin, etc. Prevention strategies such as estrogen replacement, continuous low-dose antibiotic prophylaxis, immunoactive prophylaxis, and methenamine hippurate were with relatively strong evidence.

Conclusion

Most current guidelines mainly focused on the female population with uncomplicated cystitis. Clinical guidelines from different countries demonstrate consistency in antibiotic protocols for acute infection management, yet exhibit divergence in their recommendations for infection prevention strategies. Future guidelines should consider a broader scope, especially for rUTI populations with complicative factors such as diabetes and kidney diseases, to optimize the assessment and management of rUTI.

Effects of Exercise Dosage on Elderly Patients with Sarcopenia: a Meta-analysis

LI Simin, ZHANG Tingting, WANG Kunbo, YANG Jianzhou, PING Weiwei

2026, 29(17):  2400-2409.  DOI: 10.12114/j.issn.1007-9572.2024.0544

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Background

With global population ageing, sarcopenic obesity has become a common and serious condition in older adults. Exercise guidelines issued by the American College of Sports Medicine (ACSM) are authoritative in exercise science. For older adults with sarcopenic obesity, these guidelines provide multidimensional recommendations on exercise dose, including intensity, frequency, and duration for aerobic and resistance training.

Objective

To compare the effects of exercise doses with high adherence to ACSM recommendations versus those with low or uncertain adherence on body composition [body fat percentage, BMI, body weight, appendicular skeletal muscle mass (ASM) ] and physical function (grip strength and walking speed) in older adults with sarcopenic obesity.

Methods

Relevant studies on exercise interventions for older adults with sarcopenic obesity were systematically searched in PubMed, Embase, Web of Science, Cochrane Library, Ovid, and China National Knowledge Infrastructure (CNKI). The search period was from database inception to 2023-12-26 for the first four databases, and from database inception to 2024-01-14 for Ovid and CNKI. Two investigators independently screened the literature, extracted data, and assessed the risk of bias in the included studies. Study quality was evaluated using the risk-of-bias tool for randomized controlled trials, and Meta-analysis was performed using RevMan 5.4. Based on whether the intervention group's exercise dose adhered to ACSM recommendations, studies were classified as high adherence or low/uncertain adherence. The effects of these two exercise-dose categories on body fat percentage, BMI, body weight, ASM, grip strength, and walking speed were analyzed. Higgins I² was used to assess heterogeneity among studies, and sensitivity analysis was performed by omitting one study at a time.

Results

A total of 15 studies involving 810 participants were included, of which 7 studies had high adherence to ACSM recommendations and 8 had low or uncertain adherence. Eleven studies reported body fat percentage as an outcome. Compared with the control group, the high-adherence intervention group showed a greater reduction in body fat percentage (MD=-3.54, 95%CI= -5.65 to -1.44, P<0.05), whereas the low/uncertain-adherence intervention group showed no statistically significant difference versus the control group (MD=-0.94, 95%CI=-2.54 to 0.67, P>0.05). Five studies reported BMI as an outcome. Compared with the control group, the high-adherence intervention group showed a greater reduction in BMI (MD=-1.98, 95%CI=-3.02 to -0.93, P<0.05). The low/uncertain-adherence intervention group also showed a reduction in BMI, but the difference was not statistically significant (MD=-1.72, 95%CI=-3.42 to -0.03, P=0.05). Five studies reported body weight as an outcome. Compared with the control group, the high-adherence intervention group showed a greater reduction in body weight (MD=-4.85, 95%CI=-7.84 to -1.86, P<0.05), while the low/uncertain-adherence intervention group showed no statistically significant difference versus the control group (MD=-1.56, 95%CI=-5.94 to 2.81, P>0.05). Four studies reported ASM as an outcome. For both high-adherence and low/uncertain-adherence exercise doses, no statistically significant differences were observed in ASM compared with the control group (MD=-0.18, 95%CI=-1.03 to 0.67; MD=-0.05, 95%CI=-0.85 to 0.76, P>0.05). Eight studies reported grip strength as an outcome. Compared with the control group, the high-adherence intervention group showed a greater increase in grip strength (MD=2.86, 95%CI=0.76 to 4.97, P<0.05), whereas the low/uncertain-adherence intervention group showed no statistically significant difference versus the control group (MD=3.04, 95%CI=-0.26 to 6.34, P>0.05). Seven studies reported walking speed as an outcome. The high-adherence intervention group improved walking speed more than the control group (MD=0.32, 95%CI=0.23 to 0.41, P<0.05), while the low/uncertain-adherence intervention group showed no statistically significant difference versus the control group (MD=0.05, 95%CI=-0.01 to 0.11, P>0.05).

Conclusion

High-adherence exercise interventions had significant effects on improving body fat percentage, BMI, body weight, grip strength, and walking speed in patients with sarcopenic obesity. However, exercise intervention had no effect on ASM. Further studies are needed to verify these findings.

Functional Dyspepsia Guideline Quality Assessment: Based on AGREE Ⅱ and RIGHT Tools

TONG Min, WANG Ying, XU Yanshen, ZENG Yongjian, WEN Hua, LIU Xue, SUN Xiangjuan, ZHANG Fenghua

2026, 29(17):  2410-2417.  DOI: 10.12114/j.issn.1007-9572.2024.0128

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Background

Functional dyspepsia (FD) is a common clinical disease with numerous guidelines and consensus, but the quality is uneven.

Objective

To explore current status of clinical guidelines and consensus of FD, evaluate and analyze their quality, and provide a reference for future clinical decision-making and guideline revision.

Methods

CNKI, Wanfang Data, VIP, PubMed, Web of Science, Ovid, and Embase were searched from the time of construction to March 30, 2024. Supplemental searches were conducted in databases and publishing platforms, including Guidelines International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate guidelines network, National guideline clearinghouse, Medlive and Chinese Medical Association. The AGREEⅡand RIGHT checklists were used to evaluate the methodological and reporting quality of included studies by well-trained investigators with consistent understanding of the entries independently.

Results

A total of 17 guidelines and consensus were included. The results of AGREEⅡquality evaluation showed that average scores for each of the 6 areas were scope and purpose (71.49±2.38)%, stakeholder involvement (42.48±5.03)%, rigour of development (36.00±5.88)%, clarity of presentation (60.29±5.05)%, applicability (20.47%±2.69%)%, and editorial independence 50.00% (0, 57.29%). 9 literatures were recommended as grade B, 8 literatures as grade C, and no A-rated literature. The results of RIGHT evaluation showed that average reporting rates for each of the seven areas were basic information (70.83±3.03)%, background (68.02±2.98)%, evidence 15.00% (10.00%, 55.00%), recommendation (36.76±3.21)%, review and quality assurance 0 (0, 6.25%), funding and declaration and management of interests (25.37±5.18) %, and other information 16.67% (0, 37.50%).

Conclusion

The overall methodological and reporting quality of clinical guidelines and expert consensus need to be improved, and it is recommended that guidelines should be written in strict accordance with the requirements of AGREE Ⅱand RIGHT checklist.

Review & Perspectives

Research Progress on Potential Biomarkers of Neuromyelitis Optica Spectrum Disorder

LUAN Xiaoqing, SUN Jingjing, LI Xiaoling, WANG Manxia

2026, 29(17):  2418-2424.  DOI: 10.12114/j.issn.1007-9572.2024.0659

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Neuromyelitis optica spectrum disorder (NMOSD) is a demyelinating disease of central nervous system characterized by high recurrence rate and high disability rate. Biomarkers play an important role in the diagnosis, differential diagnosis, treatment and prognosis assessment of NMOSD, which can better help clinicians to diagnose NMOSD, distinguish it from multiple sclerosis (MS) and other demyelinating diseases of the central nervous system, and help doctors to evaluate the treatment effect and prognosis of the disease. Finding more potential biomarkers and tapping the application potential of the discovered biomarkers can not only further elucidate the pathogenesis of NMOSD, but also discover new therapeutic targets. This will help doctors develop better treatment plans, more accurately assess the risk and severity of disease recurrence, and reduce the recurrence and disability rate of NMOSD. This article reviewed the research progress of newly discovered NMOSD biomarkers with potential value in recent years, including lncRNA, complement components, markers of neuronal and astrocyte damage, granulocyte activation markers, AQP-4 antibody titers, and cytokines.

Research Progress of Neutrophil Extracellular Traps in Gastric Cancer

MA Xiaoyu, MA Xiaomei, WU Guozhi, ZHENG Ya, GUO Qinghong

2026, 29(17):  2425-2432.  DOI: 10.12114/j.issn.1007-9572.2024.0289

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In recent years, neutrophil extracellular traps (NETs) have garnered increasing attention in cancer research, particularly regarding their mechanisms and clinical significance in gastric cancer. This paper systematically and comprehensively explores the research progress of NETs in gastric cancer, including the formation mechanisms of NETs, their role in the gastric cancer microenvironment, and their impact on the occurrence, development, and metastasis of gastric cancer. By reviewing relevant literature, the paper summarizes the crucial roles of NETs in gastric cancer immune evasion, inflammatory response, and interactions with other tumor cells. The paper indicates that NETs not only promote the proliferation and metastasis of tumor cells during the occurrence and progression of gastric cancer but are also closely associated with poor prognosis in gastric cancer patients. Additionally, NETs affect the treatment outcomes of gastric cancer by inducing an immunosuppressive environment and enhancing cancer cell drug resistance. This paper provides a reference for the diagnosis and treatment of gastric cancer and offers insights for further research on NETs in gastric cancer.