1.Mechanism Exploration of Doxorubicin and Sepsis Induced Myocardial Injury: Differences and Convergences
Tao ZHANG ; Zihan NAN ; Lixia LIU ; Jiaqi LIU ; Xiukai CHEN ; Xiaoting WANG ; Suwen SU
Medical Journal of Peking Union Medical College Hospital 2026;17(1):23-32
Doxorubicin (DOX)-induced cardiotoxicity and sepsis-induced myocardial injury (SIMI) represent significant clinical challenges in patients undergoing chemotherapy, sharing a common pathological basis of oxidative stress and mitochondrial dysfunction. Ferroptosis, an iron-dependent form of regulated cell death driven by lipid peroxidation, has recently been shown to play a critical role in DOX-induced cardiotoxicity and lipopolysaccharide (LPS)-induced SIMI. This article systematically reviews the mechanisms underlying myocardial injury caused by DOX and sepsis, identifying ferroptosis as a central common pathway. DOX triggers a burst of reactive oxygen species within mitochondria and inhibits glutathione peroxidase 4 (GPX4) activity through redox cycling of its quinone group and high-affinity accumulation in mitochondrial cardiolipin. LPS, by activating pattern recognition receptors and related inflammatory signaling pathways, provokes a cytokine storm and mitochondrial dysfunction. Both can disrupt the core regulatory axis of cysteine-glutathione (GSH)-GPX4, synergistically promoting ferroptosis in cardiomyocytes. Moreover, epigenetic regulation plays a key role in DOX- and LPS-induced cardiomyocyte ferroptosis and may serve as a promising therapeutic target. A deeper understanding of the ferroptosis mechanism and its epigenetic regulatory network in the synergistic injury induced by DOX and sepsis is of great importance for developing novel strategies to mitigate chemotherapy-related cardiotoxicity and improve outcomes in cancer patients with concurrent infections.
2.Explainable Machine Learning Model for Predicting Prognosis in Patients with Malignant Tumors Complicated by Acute Respiratory Failure: Based on the eICU Collaborative Research Database in the United States
Zihan NAN ; Linan HAN ; Suwei LI ; Ziyi ZHU ; Qinqin ZHU ; Yan DUAN ; Xiaoting WANG ; Lixia LIU
Medical Journal of Peking Union Medical College Hospital 2026;17(1):98-108
To develop and validate a model for predicting intensive care unit (ICU) mortality risk in patients with malignant tumors complicated by acute respiratory failure (ARF) based on an explainable machine learning framework. Clinical data of patients with malignant tumors and ARF were extracted from the eICU Collaborative Research Database in the United States, including demographic characteristics, comorbidities, vital signs, laboratory test indicators, and major interventions within the first 24 hours after ICU admission.The study outcome was ICU death.Enrolled patients were randomly divided into a training set and a validation set at a ratio of 7:3.Predictor variables were selected using least absolute shrinkage and selection operator (LASSO) regression.Five machine learning algorithms-extreme gradient boosting (XGBoost), support vector machine (SVM), Logistic regression, multilayer perceptron (MLP), and C5.0 Decision Tree-were employed to construct predictive models.Model performance was evaluated based on the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and other metrics.The optimal model was further interpreted using the Shapley additive explanations (SHAP) algorithm. A total of 3196 patients with malignant tumors complicated by ARF were included.The training set comprised 2, 261 patients and the validation set 935 patients; 683 patients died during ICU stay, while 2513 survived.LASSO regression ultimately selected 12 variables closely associated with patient ICU outcomes, including sepsis comorbidity, use of vasoactive drugs, and within the first 24 hours after ICU admission: minimum mean arterial pressure, maximum heart rate, maximum respiratory rate, minimum oxygen saturation, minimum serum bicarbonate, minimum blood urea nitrogen, maximum white blood cell count, maximum mean corpuscular volume, maximum serum potassium, and maximum blood glucose.After model evaluation, the XGBoost model demonstrated the best performance.The AUCs for predicting ICU mortality risk in the training and validation sets were 0.940 and 0.763, respectively; accuracy was 88.3% and 81.2%;sensitivity was 98.5% and 95.9%.Its predictive performance also remained optimal in sensitivity analyses.SHAP analysis indicated that the top five variables contributing to the model's predictions were minimum oxygen saturation, minimum serum bicarbonate, minimum mean arterial pressure, use of vasoactive drugs, and maximum white blood cell count. This study successfully developed a mortality risk prediction model for ICU patients with malignant tumors complicated by ARF based on a large-scale dataset and performed explainability analysis.The model aids clinicians in early identification of high-risk patients and implementing individualized interventions.
3.Guidelines for endoscopic and robotic breast surgery in China (2026 edition): Part one
Zhenggui DU ; Qing LÜ ; ; Pengwei LÜ ; ; Dajiang SONG ; Zihan WANG ; Benlong YANG ; Shicheng SU
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2026;33(02):167-203
Recent research from the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO) indicates that breast cancer is the most prevalent malignant tumor among women, posing a significant threat to women's health. Surgery remains the primary therapeutic modality for breast cancer. Recently, endoscopic and robotic breast surgical techniques have gained acceptance among both surgeons and patients. However, considerable variation exists in surgical approaches and outcomes. To standardize these techniques, facilitate their broader clinical adoption, and ultimately improve patient care, the Endoscopic-robotic Breast Surgery Clinical Trials Consortium (ErBSCTC) of China has developed this guideline. This document encompasses the technologies and instrumentation utilized in endoscopic and robotic breast surgery, surgical techniques, perioperative management, complication handling, long-term follow-up, and oncologic outcomes, aiming to provide evidence-based guidance for healthcare professionals involved in the prevention, diagnosis, and treatment of breast diseases.
4.Protocol for China endoscopic and robotic breast surgery guidelines (2026 edition)
Zhenggui DU ; Qing LÜ ; ; Pengwei LÜ ; ; Dajiang SONG ; Zihan WANG ; Benlong YANG ; Shicheng SU
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2026;33(03):333-338
Breast cancer is the most common malignant tumor among women in China, with surgery being one of the primary treatment modalities. Endoscopic/robotic breast surgery (ErBS) is gaining widespread acceptance among patients and surgeons alike due to its advantages of minimal invasiveness, superior cosmetic outcomes, and accelerated recovery. However, substantial heterogeneity currently exists across China regarding patient selection, standardized operative techniques, perioperative management, and complication handling, underscoring the urgent need for evidence-based consensus guidelines. To promote standardization and ensure consistent quality of ErBS, the Chinese Endoscopic-Robotic Breast Surgery Clinical Trials Consortium (CErBSCTC) has systematically reviewed the latest high-quality evidence and formulated the "Protocol for China Endoscopic and Robotic Breast Surgery Guidelines (2026 edition)", which outlines a comprehensive methodology for guideline development.
5.Guidelines for endoscopic and robotic breast surgery in China (2026 edition): Part two
Zhenggui DU ; Qing LÜ ; ; Pengwei LÜ ; ; Dajiang SONG ; Zihan WANG ; Benlong YANG ; Shicheng SU
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2026;33(04):487-521
This guideline, presented in three parts, details the core aspects of endoscopic/robotic breast surgery, including its techniques, equipment, surgical procedures, perioperative management, complication treatment, long-term follow-up, and outcomes. Part one offered a comprehensive overview of indications for endoscopic and robotic breast surgery, intraoperative techniques, surgical instrument choices, and common endoscopic and robotic breast reconstruction procedures. This part will cover other endoscopic breast procedures beyond immediate breast reconstruction and include perioperative management strategies, to provide healthcare professionals involved in endoscopic and robotic breast surgery with systematic operational guidelines and clinical decision-making references.
6.Peyton's Four-Step Teaching Method for Intestinal Ultrasound Training: Efficacy and Practical Implications
Zihan NIU ; Xiaoyan ZHANG ; Zhaojue WANG ; Qingli ZHU ; Mengsu XIAO ; Li MA ; Yudi HE ; Wenbo LI
Medical Journal of Peking Union Medical College Hospital 2026;17(2):591-596
To evaluate the application value of the Peyton four-step teaching method in the standardized training of intestinal ultrasound and compare it with traditional teaching methods, so as to provide an optimized approach for clinical ultrasound training. Participants from the Department of Ultrasound at Peking Union Medical College Hospital between September 2024 and March 2025 were randomly assigned to either the traditional group or Peyton group. The traditional group followed the conventional "lecture- demonstration-practice" model, while the Peyton group implemented the standardized "demonstration-deconstruction-comprehension-execution" four-step approach. All training focused on standard intestinal ultrasound scanning techniques. After the training, the operational skills were independently evaluated by the instructors. To verify the reproducibility of the teaching method, the participants in traditional teaching group received additional Peyton method training after the initial assessment and underwent a second evaluation. A total of 18 participants were included in this study, with 9 in the traditional teaching group and 9 in the Peyton teaching group. Participants in the Peyton group demonstrated significantly higher scores than those in the traditional group at every anatomical site assessed (all The Peyton four-step method is significantly more effective than traditional teaching in improving residents' intestinal ultrasound skills, demonstrating its suitability as the preferred approach for standardized training programs.
7.Systemic Lupus Erythematosus as a Dominant Disease in Traditional Chinese Medicine
Zihan WANG ; Yanyu CHEN ; Yong CUI ; Qingwen TAO ; Mei MO ; Ke XUE ; Xiaoxiao ZHANG ; Yuan XU
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(13):263-269
Systemic lupus erythematosus (SLE), a refractory autoimmune disease, is among the dominant diseases where traditional Chinese medicine (TCM) shows advantages in the field of rheumatology and immunology. The China-Japan Friendship Hospital hosted the "46th Youth Salon on Dominant Diseases (Systemic Lupus Erythematosus)" organized by the China Association of Chinese Medicine, which led to a consensus on "the advantages, challenges, interdisciplinary approaches, and translational achievements of integrated TCM and Western medical approaches in the diagnosis and treatment of SLE." The diagnosis and treatment of SLE currently face several challenges, such as frequent misdiagnosis and missed diagnosis in the early stages, difficulty in achieving treatment targets, multiple side effects from pharmacotherapy, and the lack of management strategies for special populations, all of which hinder the fulfillment of the clinical needs of patients. Integrated TCM and Western medical approaches can improve clinical symptoms such as skin erythema, aversion to cold and cold limbs, fatigue, dry mouth, restlessness, and heat sensation in the palms and soles, thereby improving patients' quality of life. The approaches also help consolidate the efficacy of conventional Western medicine, slow disease progression, reduce relapse rates, address multi-organ involvement, and prevent or treat complications. Additionally, they enhance efficacy and reduce toxicity, prevent the side effects of Western medications, help reduce hormone use, and offer distinct advantages in the individualized intervention of special populations, contributing to the whole-process management of the disease. However, evidence-based medical support for this integrated approach remains limited, and the quality of available evidence is generally low. Common evaluation systems and modern research methodologies should be adopted to clarify the efficacy of TCM in SLE treatment. Efforts should be made to carry out high-quality evidence-based medical research, strengthen the development of fundamental and pharmacological research, and further explain the distinct advantages of TCM in the diagnosis and treatment of SLE. Future efforts should focus on advancing the integration of TCM and modern medicine, incorporating multi-omics technologies, individualized stratification, and other precision medicine concepts, in combination with artificial intelligence. Moreover, interdisciplinary collaboration should be promoted to utilize modern technology in exploring the essence of TCM theories and screening effective formulae, thereby comprehensively improving the diagnosis and treatment of SLE through integrated TCM and Western medical approaches.
8.Systemic Lupus Erythematosus as a Dominant Disease in Traditional Chinese Medicine
Zihan WANG ; Yanyu CHEN ; Yong CUI ; Qingwen TAO ; Mei MO ; Ke XUE ; Xiaoxiao ZHANG ; Yuan XU
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(13):263-269
Systemic lupus erythematosus (SLE), a refractory autoimmune disease, is among the dominant diseases where traditional Chinese medicine (TCM) shows advantages in the field of rheumatology and immunology. The China-Japan Friendship Hospital hosted the "46th Youth Salon on Dominant Diseases (Systemic Lupus Erythematosus)" organized by the China Association of Chinese Medicine, which led to a consensus on "the advantages, challenges, interdisciplinary approaches, and translational achievements of integrated TCM and Western medical approaches in the diagnosis and treatment of SLE." The diagnosis and treatment of SLE currently face several challenges, such as frequent misdiagnosis and missed diagnosis in the early stages, difficulty in achieving treatment targets, multiple side effects from pharmacotherapy, and the lack of management strategies for special populations, all of which hinder the fulfillment of the clinical needs of patients. Integrated TCM and Western medical approaches can improve clinical symptoms such as skin erythema, aversion to cold and cold limbs, fatigue, dry mouth, restlessness, and heat sensation in the palms and soles, thereby improving patients' quality of life. The approaches also help consolidate the efficacy of conventional Western medicine, slow disease progression, reduce relapse rates, address multi-organ involvement, and prevent or treat complications. Additionally, they enhance efficacy and reduce toxicity, prevent the side effects of Western medications, help reduce hormone use, and offer distinct advantages in the individualized intervention of special populations, contributing to the whole-process management of the disease. However, evidence-based medical support for this integrated approach remains limited, and the quality of available evidence is generally low. Common evaluation systems and modern research methodologies should be adopted to clarify the efficacy of TCM in SLE treatment. Efforts should be made to carry out high-quality evidence-based medical research, strengthen the development of fundamental and pharmacological research, and further explain the distinct advantages of TCM in the diagnosis and treatment of SLE. Future efforts should focus on advancing the integration of TCM and modern medicine, incorporating multi-omics technologies, individualized stratification, and other precision medicine concepts, in combination with artificial intelligence. Moreover, interdisciplinary collaboration should be promoted to utilize modern technology in exploring the essence of TCM theories and screening effective formulae, thereby comprehensively improving the diagnosis and treatment of SLE through integrated TCM and Western medical approaches.
9.Clinical Dominant Disease of Traditional Chinese Medicine: Rheumatoid Arthritis
Jinping WANG ; Qingwen TAO ; Mei MO ; Zihan WANG ; Nan ZHANG ; Yuan XU ; Xiaoxiao ZHANG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(17):202-210
Rheumatoid arthritis (RA) is an autoimmune disease characterized primarily by erosive arthritis, with a high prevalence and disability rate. Although significant progress has been made in the treatment of RA in recent years, challenges such as suboptimal efficacy, drug resistance, severe side effects, and high costs of long-term treatment remain, especially for patients in the early stages of RA, as well as those with RA complications, comorbidities, and severe conditions. Hosted by the China-Japan Friendship Hospital and organized by the Youth Committee of the China Association of Chinese Medicine, the 27th session of the Clinical Dominant Disease Series (Rheumatoid Arthritis) Youth Salon invited nearly 20 experts and scholars from traditional Chinese medicine (TCM), western medicine, and interdisciplinary fields to actively discuss the clinical needs of modern medicine and the advantageous stages and aspects of TCM in RA. Experts at the salon agreed that TCM has unique advantages in the treatment of RA, especially during the early stage, periods of low to moderate disease activity, remission phase, and in addressing complications and comorbidities. TCM can achieve both prevention and treatment by regulating the immune system and restoring immune homeostasis. The integrated approach of traditional Chinese and western medicine demonstrates significant advantages in active RA, refractory cases, and stages with severe complications, by rapidly controlling disease progression, alleviating symptoms, enhancing the quality of life, and facilitating recovery. Given the frequent occurrence of multiple comorbidities in RA, TCM shows potential in regulating immunity, alleviating symptoms, and improving physical constitution, which provides new insights into the comprehensive treatment of RA with comorbidities. However, high-quality clinical studies on integrated traditional Chinese and western medicine in RA are still lacking. It is necessary to establish large-scale clinical cohorts and biological databases to provide a scientific basis for the development of precision-targeted therapies and clinical treatment protocols. In the future, individualized treatment strategies integrating traditional Chinese and western medicine are expected to become an important direction for improving the quality of life in RA patients.
10.Clinical Dominant Disease of Traditional Chinese Medicine: Rheumatoid Arthritis
Jinping WANG ; Qingwen TAO ; Mei MO ; Zihan WANG ; Nan ZHANG ; Yuan XU ; Xiaoxiao ZHANG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(17):202-210
Rheumatoid arthritis (RA) is an autoimmune disease characterized primarily by erosive arthritis, with a high prevalence and disability rate. Although significant progress has been made in the treatment of RA in recent years, challenges such as suboptimal efficacy, drug resistance, severe side effects, and high costs of long-term treatment remain, especially for patients in the early stages of RA, as well as those with RA complications, comorbidities, and severe conditions. Hosted by the China-Japan Friendship Hospital and organized by the Youth Committee of the China Association of Chinese Medicine, the 27th session of the Clinical Dominant Disease Series (Rheumatoid Arthritis) Youth Salon invited nearly 20 experts and scholars from traditional Chinese medicine (TCM), western medicine, and interdisciplinary fields to actively discuss the clinical needs of modern medicine and the advantageous stages and aspects of TCM in RA. Experts at the salon agreed that TCM has unique advantages in the treatment of RA, especially during the early stage, periods of low to moderate disease activity, remission phase, and in addressing complications and comorbidities. TCM can achieve both prevention and treatment by regulating the immune system and restoring immune homeostasis. The integrated approach of traditional Chinese and western medicine demonstrates significant advantages in active RA, refractory cases, and stages with severe complications, by rapidly controlling disease progression, alleviating symptoms, enhancing the quality of life, and facilitating recovery. Given the frequent occurrence of multiple comorbidities in RA, TCM shows potential in regulating immunity, alleviating symptoms, and improving physical constitution, which provides new insights into the comprehensive treatment of RA with comorbidities. However, high-quality clinical studies on integrated traditional Chinese and western medicine in RA are still lacking. It is necessary to establish large-scale clinical cohorts and biological databases to provide a scientific basis for the development of precision-targeted therapies and clinical treatment protocols. In the future, individualized treatment strategies integrating traditional Chinese and western medicine are expected to become an important direction for improving the quality of life in RA patients.

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