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25 October 2026, Volume 25 Issue 05 Previous Issue   

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Special report

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The China Alzheimer Report 2026 ZHI Nan, XU Gang, REN Rujing, LIN Shaohui, HUANG Zishuo, HU Yisong, GENG Jieli, SONG Yaying, CAO Wenwei, WANG Jintao, XIAO Jinwen, LI Haixia, XIE Xinyi, LI Jianping, JI Chenhui, ZHANG Bei, ZHOU Ying, ZHOU Yan, LI Yansheng, XU Qun, YANG Junjie, WANG Yiran, GAO Mengyi, LIU Langyan, PAN Xu, ZHU Yikang, HUANG Yucheng, CHEN Shengdi, CHEN Xiaochun, WANG Ying, LI Chunbo, WANG Gang 2026, 25 (05):  523-564.  DOI: 10.16150/j.1671-2870.2026.05.001 Abstract ( 0 )   HTML ( 7 )   PDF (4926KB) ( 29 )   With the continuing deepening of population aging in China, neurodegenerative diseases represented by Alzheimer's disease (AD) have become a major public health challenge that seriously affects the health and quality of life of older adults. In 2023, the number of people living with AD and other dementias in China reached 20.299 million, accoun-ting for approximately 33.75% of the global total; there were 3.477 million new cases and 0.586 million deaths, and the di-sease burden ranked first in the world. To further delineate the epidemiological trends, the current status of diagnosis and treatment, and the allocation of public health resources for AD in China, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, together with experts from Shanghai Jiao Tong University School of Public Health, Fudan University School of Public Health, Shanghai Mental Health Center and other authoritative institutions, compiled The China Alzheimer Report 2026 on the basis of the 2022, 2023, 2024 and 2025 reports. This report updates the epidemiological data to 2023, systematically reviews the latest therapeutic advances, including disease-modifying therapies, neuromodulation, deep cervical lymphatic-venous anastomosis, traditional Chinese medicine and cognitive training interventions, and comprehensively updates the latest policy documents such as the National Action Plan for Responding to Dementia in Old Age (2024-2030) as well as the current status of public health resource allocation. This report aims to provide a scientific basis for the prevention, diagnosis and treatment of AD, to provide data support for the government in formulating health policies, and to promote joint efforts of all sectors of society to advance the cause of elderly health in China, so as to conti-nuously empower the realization of "healthy aging". Figures and Tables | References | Related Articles | Metrics

Expert forum · Comprehensive data

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Epidemiology of structural heart disease and new technologies for diagnosis and treatment WANG Han, YE Yuanzheng, FAN Ping 2026, 25 (05):  565-573.  DOI: 10.16150/j.1671-2870.2026.05.002 Abstract ( 0 )   HTML ( 3 )   PDF (2090KB) ( 3 )   Structural heart disease (SHD) refers to any disease involving the structure of the heart and adjacent great vessels, excluding electrical cardiac disorders and coronary artery disease. It is characterized by the potential for treatment through correction or alteration of the structure of the heart and great vessels. Major types of SHD include ventricular cardiomyopathies, valvular heart diseases, and congenital heart diseases. Globally, the incidence of SHD is showing an increasing trend, and is gradually becoming a major global public health concern. In recent years, with the development of artificial intelligence (AI), AI has been widely applied in imaging examinations (including echocardiography, X-ray, cardiac CT, and MRI), electrocardiographic examinations, patient management, and risk assessment. AI models can identify features of SHD on echocardiographic, X-ray, cardiac CT, and MRI images, thereby playing an important role in large-scale SHD screening. Meanwhile, AI can be used to construct patient-specific cardiac anatomical models for accurate preoperative assessment, surgical planning, and prediction of postoperative mortality risk. Clinicians can also use AI to predict individual responses to medications, identify drug interactions, predict adverse reactions, and optimize treatment strategies. Although the application of AI in SHD diagnosis and treatment still faces challenges, including poor accessibility of high-cost technologies, complexity in multimodal data integration, and difficulties in adapting to new diagnostic standards, advances in AI technology for clinical practice, multimodal imaging technologies, and preventive strategy formulation are expected to enable precise prevention and treatment of SHD and reduce the disease burden. Figures and Tables | References | Related Articles | Metrics

Expert forum · Ultrasonic diagnosis

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Recent advances in echocardiography for diagnosis and management of valvular heart disease PANG Kunjing, JIANG Yutong 2026, 25 (05):  574-582.  DOI: 10.16150/j.1671-2870.2026.05.003 Abstract ( 0 )   HTML ( 3 )   PDF (870KB) ( 2 )   According to estimates from the Global Burden of Disease Study, rheumatic heart disease, non-rheumatic calcific aortic valve disease, and non-rheumatic degenerative mitral valve disease caused approximately 388 900, 149 400, and 39 700 deaths worldwide in 2023, respectively. A nationwide cross-sectional survey of 31 499 residents aged 35 years and older in China found a weighted prevalence of valvular heart disease of 3.8%, corresponding to an estimated 25 million patients, with rheumatic and degenerative lesions accounting for 55.1% and 21.3%, respectively. The number of people with valvular heart disease is substantial and continues to increase with population aging, and the disease may result in cardiac chamber remodeling, cardiac dysfunction, and adverse cardiovascular outcomes. Risk assessment in valvular heart disease has expanded from grading stenosis or regurgitation alone to integrated evaluation of lesion mechanism, myocardial damage, haemodynamic reserve, and longitudinal disease trajectory. Echocardiography has evolved from a diagnostic tool focused on determining the severity of valvular stenosis or regurgitation into an integrated platform spanning screening, identification of aetiology and mechanism, staging of cardiac damage, interventional planning and guidance, treatment assessment, and long-term follow-up. Real-time three-dimensional and four-dimensional transthoracic, transoesophageal, and intracardiac echocardiography can delineate complex valvular anatomy and provide time-resolved regurgitation and cardiac chamber quantification. Strain imaging, myocardial work, and stress echocardiography extend assessment beyond the valve itself to multichamber mechanical responses and dynamic haemodynamic reserve, and artificial intelligence facilitates view recognition, segmentation, quantification, screening, and risk prediction. Multimodality integration of echocardiography with computed tomography, cardiovascular magnetic resonance, fusion navigation, patient-specific computational models, and continuous physiological monitoring is establishing a diagnostic and therapeutic framework transitioning from structural phenotyping to dynamic functional phenotyping. Three-dimensional transesophageal echocardiography plays key roles in preprocedural assessment of indications, core intraprocedural guidance, and postprocedural complication detection during transcatheter atrioventricular valve interventions. In contrast, four-dimensional intracardiac echocardiography, valvular biomechanical modelling, digital twins, and wearable-enabled closed-loop follow-up remain in feasibility validation or early clinical validation stages. Organized around the three clinical tasks of diagnosis, treatment, and follow-up, this review summarizes recent research and development advances in echocardiography and related technologies, together with their evidence maturity and translational boundaries. It aims to delineate the strengths, limitations, and applicable scenarios of ultrasound-related technologies, provide a reference for precise diagnosis and treatment throughout the course of valvular heart disease, and inform clinical translational research on new technologies. Figures and Tables | References | Related Articles | Metrics

Expert forum · Clinical practice

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Transcatheter pulmonary valve replacement： research advances and technical optimizatio MAI Jinxi, FANG Yanxing, WEI Zhixiong, FANG Jun, PAN Wenzhi 2026, 25 (05):  583-591.  DOI: 10.16150/j.1671-2870.2026.05.004 Abstract ( 0 )   HTML ( 3 )   PDF (2768KB) ( 3 )   Right ventricular outflow tract (RVOT) dysfunction is a common long-term complication after surgical repair in patients with RVOT obstructive congenital heart disease. It is mainly caused by pulmonary regurgitation and/or residual obstruction, which may lead to right ventricular dilation, impaired cardiac function, and an increased risk of morta-lity. Given the substantial trauma and high risk associated with repeat surgical intervention, transcatheter pulmonary valve replacement (TPVR), as a minimally invasive approach, has emerged as a first-line therapeutic option. This review systematically summarizes the recent advances and technical optimization strategies of TPVR from four key aspects: device systems, imaging assessment, procedural strategies, and long-term management, aiming to provide references for clinical practice and future research directions in TPVR. Regarding valve systems, balloon-expandable valves are supported by robust long-term data and are primarily suitable for patients with valved conduits. In contrast, self-expanding valves demonstrate superior anatomical adaptability and sealing performance, making them more appropriate for native or patch-augmented RVOTs with larger diameters and irregular morphologies. In terms of imaging evaluation, preprocedural contrast-enhanced computed tomography (CT) remains the core method, while multiple new technologies have emerged for intraoperative guidance and postoperative assessment. In procedural strategies, prestenting combined with balloon-expandable valve implantation has expanded the applicability of interventional treatment for native RVOT dysfunction, and techniques such as the use of an artificial tricuspid annuloplasty ring to reduce RVOT diameter, transthoracic access, and parallel anchoring provide new options for patients with complex anatomy. With the management paradigm shifting from perioperative care to a lifelong perspective, the prevention, monitoring, and treatment of arrhythmias, infective endocarditis, and valve degeneration have become major clinical concerns. Figures and Tables | References | Related Articles | Metrics

Expert forum · Mechanism research

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Advances in evidence-based research on transcatheter mitral valve edge-to-edge repair for mitral regurgitation HE Tao, ZHANG Zhenni, ZHOU Yi, LU Cong, ZENG Jie 2026, 25 (05):  592-600.  DOI: 10.16150/j.1671-2870.2026.05.005 Abstract ( 0 )   HTML ( 2 )   PDF (1557KB) ( 3 )   Transcatheter mitral valve edge-to-edge repair (TEER) is a major advancement in the interventional treatment of mitral regurgitation (MR). Approximately 0.67% of the global population has moderate-to-severe MR. It is estimated that around 7.5 million patients in China require interventional treatment for MR, of whom approximately 5.5 million have severe MR. Accumulating clinical evidence demonstrates that TEER effectively reduces MR severity and improves clinical symptoms. Clinical studies confirm favorable long-term safety outcomes and low periprocedural complication rates associated with TEER. Further studies show that TEER, when added to guideline-directed medical therapy, significantly reduces heart failure rehospitalization and mortality, whereas the discrepant findings of the MITRA-FR trial highlight the critical importance of appropriate patient selection in determining the clinical benefit of TEER. Real-world registry data further demonstrate that 88.9% of patients undergoing TEER achieve procedural success, with residual MR severity closely associated with long-term prognosis. Based on expanding evidence, TEER is an established therapeutic option for patients with primary MR at high surgical risk and for symptomatic secondary MR despite optimized medical therapy. The 2025 European valvular heart disease guidelines assign a Class I recommendation for TEER in patients with ventricular secondary MR, and a Class IIa recommendation for patients with primary MR. In the future, the development of TEER will focus on iterative device innovation, precise patient selection, and enhanced capacity to manage complex anatomical substrates, propelling the treatment of MR toward individualized and precision-based intervention strategies, thereby further improving long-term clinical outcomes. Figures and Tables | References | Related Articles | Metrics

Academic trend at home and abroad

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Global and Chinese burden of cardiovascular disease and its risk factors from 1990 to 2023 LIU Tong, DING Zijie 2026, 25 (05):  601-609.  DOI: 10.16150/j.1671-2870.2026.05.006 Abstract ( 0 )   HTML ( 2 )   PDF (1043KB) ( 3 )   Cardiovascular disease (CVD) remains the leading cause of global disease burden. The Global Burden of Disease (GBD) Study 2023 systematically assessed the CVD burden and the impact of its risk factors across 204 countries and territories worldwide between 1990 and 2023, integrating diverse data sources including mortality, incidence, and risk factor exposure. CVDs mainly included atherosclerotic CVD (ischemic heart disease, ischemic stroke, peripheral artery disease, and cerebrovascular disease), structural heart disease (cardiomyopathy, and calcific and degenerative valvular disease), atrial myopathy with atrial fibrillation or flutter (atrial fibrillation/atrial flutter), and infection-related heart disease (rheumatic heart disease, endocarditis, and myocarditis in some cases). In 2023, the number of people affected by CVD worldwide reached 626 million, resulting in 437 million disability-adjusted life years (DALYs) and 19.2 million deaths. Notably, 79.6% of these DALYs were attributable to modifiable risk factors, including metabolic, behavioral, and environmental/occupational factors. From 1990 to 2023, the number of CVD patients in China increased from 4.377 5 million to 11.1402 million, with a standardized incidence rate of 512.09 per 100 000 individuals. In 2023, there were 4.522 million CVD deaths, with a standardized mortality rate of 209.05 /100 000 individuals. The spectrum of cardiovascular diseases in China is consistent with that globally, with ischemic heart disease (IHD) and stroke being the most common. According to the China Cardiovascular Disease Surveillance System, the age-standardized incidence rates of ischemic heart disease and stroke in 2023 were 513.28/100 000 and 137.16/100 000 individuals, respectively. China faces a particularly heavy CVD burden, driven by population aging, urbanization, uneven urban-rural development, and various risk factors. Given the severe CVD epidemic situation, there is an urgent need to strengthen CVD prevention and control strategies. Implementing targeted interventions for modifiable risk factors is crucial for effectively addressing the escalating public health challenges and reducing the disease burden. Figures and Tables | References | Related Articles | Metrics

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Annual report on diagnosis and treatment of adrenal diseases （2024-2025） WANG Yajing, ZANG Li 2026, 25 (05):  610-618.  DOI: 10.16150/j.1671-2870.2026.05.007 Abstract ( 0 )   HTML ( 2 )   PDF (930KB) ( 3 )   From 2024 to 2025, significant progress has been made in the exploration of molecular mechanisms, functional assessment techniques, imaging localization, and targeted drug development for adrenal diseases. The cardiovascular and venous thromboembolism risks in patients with Cushing's syndrome (CS) have been further clarified. In terms of treatment, novel targeted drugs (such as osilodrostat) and selective glucocorticoid receptor antagonists, among other precision therapies, provide patients with new options. Research on molecular classification and biomarkers for adrenocortical carcinoma (ACC) continues to deepen, with novel markers such as lamin B1 and centromere protein H showing prognostic value, and the chemokine receptor CXCR4 emerging as a potential theranostic target. Breakthroughs have been achieved in noninvasive subtyping techniques and urinary steroid metabolomics for primary aldosteronism (PA), and the 2025 international guidelines have updated their diagnostic pathways and treatment monitoring indicators. The molecular classification system for phaeochromocytomas (PCC) and paragangliomas (PGL) has been further refined. The systemic therapeutic value of sunitinib has been confirmed through randomized controlled trials, and targeted therapeutic strategies based on metabolic dependencies provide new directions for refractory cases. However, current diagnostic and therapeutic models still face challenges such as difficulties in integrating multi-omics data, high clinical heterogeneity of diseases, and insufficient standar-dization of diagnostic and treatment processes. In the future, it is necessary to promote the development of adrenal disease diagnosis and treatment toward a higher level of precision and individualized care by deeply integrating multi-omics data, strengthe-ning multidisciplinary collaboration, and developing and integrating artificial intelligence-assisted diagnostic systems. Figures and Tables | References | Related Articles | Metrics

Original articles

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Analysis of clinical and echocardiographic characteristics of 37 cases of quadricuspid aortic valve WANG Chenchen, SU Xiuxiu, ZHANG Benyan, YANG Wenbo, FANG Yuehua 2026, 25 (05):  619-627.  DOI: 10.16150/j.1671-2870.2026.05.008 Abstract ( 0 )   HTML ( 2 )   PDF (4116KB) ( 3 )   Objective This study analyzes the specific clinical manifestations of quadricuspid aortic valve (QAV), a rare congenital cardiac malformation, in patients undergoing aortic valve replacement (AVR), focusing on complications and ascending aortic dilatation. Methods The operative records of 3 133 consecutive patients who underwent AVR from January 2012 to June 2024 were retrospectively reviewed. Intraoperative identification of four aortic valve leaflets was used as the gold standard, and 37 cases of QAV were confirmed. The specific clinical manifestations and imaging presentations of these cases were analyzed. The chi-square tests were used to analyze the relationships of hypertension and sex with ascending aortic dilatation and aneurysm. The Student's t-tests were employed to examine the associations of age, height, weight, and body mass index (BMI) with ascending aortic dilatation and aneurysm, and the chi-square tests were also conducted to investigate the relationships of aortic dilatation and aneurysm with QAV subtypes. Results The incidence rate of QAV among patients undergoing AVR was 1.2%, with a slightly higher proportion of male patients (56.8%). The mean age of the patients in this cohort was 52.3 years, and 30 patients (81%) were older than 40 years. Valvular regurgitation was the dominant manifestation. Various concomitant conditions were observed, including severe coronary artery disease (CAD) in three cases and ventricular septal defects (VSD) in two cases. In addition, coronary artery origin anomaly, subvalvular fibrous membrane, constrictive pericarditis (CP), severe mitral regurgitation, and hypertrophic obstructive cardiomyopathy (HOCM) were each observed in one case. Serious complications occurred in 4 of the 37 QAV patients, including two cases of subacute bacterial endocarditis (SBE) and two cases of aortic dissection. Among the other complications, ascending aortic dilatation was common (19 patients, 51.4%), of whom 6 patients had ascending aortic aneurysms. In contrast, aortic root dilatation was uncommon, with only 3 patients having an aortic root diameter of ≥40 mm. Hypertension was also common (20, 54.1%) but showed no association with ascending aorta dilatation. Sex, age, height, weight, and body mass index also showed no statistically significant association with ascending aorta dilatation. Based on these statistical findings, ascending aortic dilatation was therefore inferred to be associated with congenital abnormalities in the number of aortic valve leaflets. There was no significant difference in aortic dilatation between QAV subtypes. However, type B QAV was associated with ascending aortic aneurysm, and the two cases of aortic dissection both occurred in patients with type B QAV. All patients were discharged uneventfully, and the mid-term prognosis was good. Conclusions QAV accounts for 1.2% of patients undergoing AVR. QAV is likely to become dysfunctional in patients older than 40 years, and patients with QAV may also have other types of congenital cardiac malformations. Vigilance is therefore warranted for potentially fatal complications, including SBE and aortic dissection. Ascending aortic dilatation is common in QAV patients, and patients with type B QAV are more likely to develop ascending aortic aneurysm. Targeted imaging examination is recom-mended for these patients. Therefore, regular follow-up should be performed and earlier surgery may be considered in QAV patients at higher risk. Figures and Tables | References | Related Articles | Metrics

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Pathologic spectrum and clinical features of kidney disease in patients with malignancy： A cohort analysis of 395 renal biopsy cases CHEN Xiaohong, SHEN Ziyan, JIN Shi, LIU Hong, DING Xiaoqiang 2026, 25 (05):  628-635.  DOI: 10.16150/j.1671-2870.2026.05.009 Abstract ( 0 )   HTML ( 2 )   PDF (1201KB) ( 3 )   Objective This study aims to analyze the clinical features and renal pathologic findings of kidney di-sease in patients with malignancy, clarify the etiological composition of kidney disease in tumor patients, explore the association between renal pathological features and tumors, and evaluate patient prognosis, thereby providing a basis for the clinical understanding and management of malignancy-related kidney disease. Methods Renal biopsy cases performed in the Department of Nephrology at Zhongshan Hospital, Fudan University from January 2010 to June 2025 were collected, and patients who met inclusion criteria and were diagnosed with malignancy (including hematologic or solid malignancy) before undergoing renal biopsy were consecutively enrolled. The association between kidney disease and the malignancy itself or anticancer therapy was determined based on tumor activity status, anticancer therapy exposure, the background of kidney disease onset, and renal pathologic findings. In addition, follow-up was conducted to compare the renal outcomes among patients with different etiological categories of kidney disease. Results A total of 13 386 renal biopsy cases were collected, among which 395 patients with a confirmed malignancy and relatively complete clinical and follow-up data were included. Proteinuria was present in 329 patients (329/395, 83.29%), and 253 (253/395, 64.05%) had acute kidney injury. Etiologic analysis showed that kidney disease was considered related to the malignancy itself in 63 patients (63/395, 15.95%), related to anticancer therapy in 204 patients (204/395, 51.65%), and not definitely associated with either the malignancy or anticancer therapy in 128 patients (128/395, 32.41%). Among the 267 patients with malignancy- or anticancer therapy-related kidney disease, 152 (152/267, 56.93%) had a single pathologic pattern, whereas 115 (115/267, 43.07%) had two or more pathologic patterns, or showed reactivation of pre-existing kidney disease, or newly superimposed injury. In the 36 patients with hematologic malignancy-related kidney disease, monoclonal immunoglobulin-associated kidney disease was the most common lesion (20/36, 55.56%), followed by renal infiltration by tumor cells (9/36, 25.00%). In the 27 patients with solid tumor-related kidney disease, tumor-associated glomerular disease predominated (22/27, 81.48%), with membranous nephropathy as the most common subtype (10/22, 45.45%). Among the 204 patients with anticancer therapy-related kidney disease, immune checkpoint inhibitor-related cases accounted for the highest proportion (86/204, 42.16%), mainly presenting as acute interstitial nephritis (78/86, 90.70%). This was followed by antiangiogenic therapy-related kidney disease (58/204, 28.43%), among which thrombotic microangiopathy predominated (42/58, 72.41%). As of January 31 2026, the median follow-up duration for all patients was 8.93 (interquartile range, 4.90-22.13) months. Analysis of renal outcomes showed that patients with anticancer therapy-related kidney disease had the highest overall remission rate (158/204, 77.45%). The overall remission rate was also higher in patients with malignancy-related kidney disease than in those without a definite association with the malignancy or its therapy, although the difference was not statistically significant (65.08% vs 52.34%, P=0.095). Conclusions Kidney disease in patients with malignancy is highly heterogeneous and may result from direct tumor infiltration, tumor-related mechanisms, or anticancer therapy. In particular, the consti tution ratio of cases of kidney disease associated with immunotherapy and targeted therapies is high (267/395). A substantial proportion of cases, however, show no definite association with either the malignancy itself or its therapy. Figures and Tables | References | Related Articles | Metrics

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Expression of TREM1 in Aβ-related neuropathological changes： detection based on human brain samples from patients with Alzheimer’s disease YE Mengyao, YU Qihan, ZHOU Yi, CUI Zuqi, ZHANG Yizhou, MI Shixiong, YANG Qian, DU Juan 2026, 25 (05):  636-645.  DOI: 10.16150/j.1671-2870.2026.05.010 Abstract ( 0 )   HTML ( 2 )   PDF (22791KB) ( 17 )   Objective Triggering receptor expressed on myeloid cells 1 is a key amplifier of peripheral inflammatory responses, and its role in the pathological mechanisms of Alzheimer's disease (AD) remains to be explored. This study aims to investigate the expression and distribution of TREM1 in AD and control human brain tissues, and to explore its correlation with the severity of AD neuropathological changes. Methods Human brain samples from pathologically confirmed AD patients (n=5) and cognitively normal controls (n=5) matched for age and post-mortem interval collected by the Human Brain Bank of Hebei Medical University from 2019 to 2025 were selected. Immunohistochemical staining was employed to perform morphological observation of the cortex and hippocampus and to analyze TREM1 expression levels. Furthermore, multiplex immunohistochemistry was utilized to analyze the spatial co-localization of TREM1 with β-amyloid (Aβ) plaques and microglia. Results TREM1 was barely expressed in the control group. Compared with the control group, the area ratio of TREM1-immunopositive cells in the cortex of the AD group increased (0.041±0.015, P=0.009), and the number of plaques formed by TREM1 aggregation in the CA4/hilus (7.60±2.70, P=0.0033), CA3 (3.40±1.14, P=0.0026), CA1 (4.00±1.58, P=0.0048), subiculum (4.80±1.30, P=0.0012), and entorhinal cortex (7.80±1.92, P=0.0009) of the hippocampus increased. Morphological analysis revealed that TREM1 specifically accumulated in activated microglia around Aβ plaques and was widely distributed at the perivascular margins of vessels affected by cerebral amyloid angiopathy (CAA). Spearman correlation analysis showed that the cortical TREM1-positive expression area ratio was positively correlated with the AD-related neuropathological change score. Conclusions The upregulation of TREM1 expression is closely related to Aβ-driven pathological damage, suggesting that targeted inhibition of TREM1-mediated pro-inflammatory signaling pathways may be a new strategy for intervening in AD neuroinflammation and delaying disease progression. Figures and Tables | References | Related Articles | Metrics

Review articles

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Research progress on stroke risk and anticoagulant therapy in patients with subclinical atrial fibrillation ZHAO Yiming, XIE Yucai 2026, 25 (05):  646-651.  DOI: 10.16150/j.1671-2870.2026.05.011 Abstract ( 0 )   HTML ( 2 )   PDF (840KB) ( 3 )   Atrial fibrillation (AF) is a common clinical arrhythmia, while subclinical atrial fibrillation (SCAF) typically refers to AF detected through long-term continuous monitoring with cardiac implantable electronic device (CIED) such as defibrillators or pacemakers. In patients with stroke of unknown cause, extended monitoring can reveal SCAF at a detection rate as high as 30%. Even in elderly populations from general communities (≥70 years old), the three-year cumulative incidence of SCAF detected by implantable monitors is considerable, reaching 33.8%. Its risk factors are similar to those of clinical AF, including advanced age, hypertension, heart failure, and diabetes. With the widespread adoption of monitoring technologies, the detection rate of SCAF has significantly increased, highlighting its high prevalence and substantial potential disease burden at the population level, making it an increasingly critical public health issue in the field of cardiovascular diseases. Numerous observational studies have conclusively demonstrated that the presence of SCAF is significantly associated with an increased risk of stroke and systemic embolic events. Whether oral anticoagulant therapy should be initiated for SCAF remains the most contentious debate in this field. Early observational studies generally supported anticoagulation to reduce stroke risk, but randomized controlled trials have been more cautious, not recommending routine oral anticoagulant therapy for all SCAF patients. Treatment decisions must be based on precise risk stratification, comprehensively evaluating SCAF burden and CHA₂DS₂-VASc scores. Novel oral anticoagulants, due to their superior safety profile, have become the preferred choice for SCAF anticoagulation. Future research will require large-scale clinical trials to determine optimal treatment strategies across different burden thresholds. A deeper understanding of SCAF and individualized management are key to reducing the burden of cardioembolic stroke in the future. References | Related Articles | Metrics

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Advances in imaging-based scoring systems for renal tumors and their applications in ultrasound MENG Fanyu, ZHANG Ao, CHEN Ziwei, SONG Luda, LI Qiuyang 2026, 25 (05):  652-659.  DOI: 10.16150/j.1671-2870.2026.05.012 Abstract ( 0 )   HTML ( 3 )   PDF (924KB) ( 6 )   In 2020, approximately 431 000 new cases of renal cancer were diagnosed worldwide, and annual deaths reached 179 000. In the current imaging assessment of renal tumors, different types of tumors continue to be evaluated using different scoring systems that lack a unified framework. For cystic renal tumors, the Bosniak classification system is the most widely used tool for malignant risk stratification. Based on imaging features such as cyst wall thickness, number and morphology of septa, and degree of solid component enhancement on CT or MRI, this system categorizes cystic lesions into classes Ⅰ-Ⅳ to distinguish different levels of malignant risk. With advances in ultrasound technology, especially contrast-enhanced ultrasound (CEUS), the Bosniak classification system is increasingly applied to ultrasound. Studies indicate that the CEUS-Bosniak class is higher than the CT/MRI-Bosniak class in 40.4% (21/52) of cases and lower in only 1.9% (1/52), demonstrating the high sensitivity of CEUS in detecting microvascular enhancement. For solid renal tumors, the MRI-based clear cell likelihood score (ccLS) is used to assess the likelihood that a renal tumor is a clear cell renal cell carcinoma. Based on the tumor's MRI features, this score provides a 5-point scale to assist in determining the pathological type of the tumor. A higher score indicates a greater likelihood of clear cell renal cell carcinoma, offering important guidance for pathological diagnosis and treatment planning. In terms of anatomical complexity assessment, the R.E.N.A.L. score systematically quantifies the anatomical features of the tumor from five key dimensions: tumor radius, exophytic/endophytic proportion, nearness of the tumor to the collecting system, anterior/posterior location, and location relative to the polar lines. This provides precise guidance for selecting surgical approaches. Although the R.E.N.A.L. score is not yet used in ultrasound examinations, researchers are exploring its extension to ultrasound through preliminary studies. The above grading and scoring systems are primarily developed based on CT and MRI findings, with ultrasound serving as an initial screening or adjunctive tool. However, the Bosniak, ccLS, and R.E.N.A.L. systems address the malignant risk of cystic lesions, pathological type prediction of solid tumors, and tumor anatomical features, respectively. This makes it difficult to conduct comprehensive assessments of different types of renal tumors within a unified framework, thereby affecting the precision of treatment decisions. Therefore, there is an urgent need to develop a unified quantitative assessment system that can simultaneously incorporate the lesion characteristics of renal tumors. Figures and Tables | References | Related Articles | Metrics

Case reports

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Neonatal Ebstein’s anomaly combined with ventricular preexcitation and right bundle branch block： a case report and literature review LI Xiaoyan, WANG Li 2026, 25 (05):  660-664.  DOI: 10.16150/j.1671-2870.2026.05.013 Abstract ( 0 )   HTML ( 3 )   PDF (3333KB) ( 3 )   Ebstein's anomaly (EA) is a rare cardiac disease, and there are few reports of cases in newborns with ventricular preexcitation and right bundle branch block. This article reports a case of a child diagnosed with EA and ventricular preexcitation via a left-sided accessory pathway on the day of birth, who was found to have incomplete right bundle branch block on a follow-up electrocardiogram three months later. After the child's condition stabilized, corrective surgery for a congenital double aortic arch was performed, while surgery for EA was deferred. During regular follow-up over two years after surgery, the child remained clinically stable, although ventricular preexcitation and incomplete right bundle branch block persisted. The China National Knowledge Infrastructure (CNKI), Chinese Medical Journal Network, Wanfang Database, PubMed, and Embase databases were searched for literature published between 1990 and 2025. A total of seven articles reporting eight cases of EA combined with preexcitation and right bundle branch block were retrieved. Among them, three patients with EA and preexcitation developed right bundle branch block after electrophysiological stimulation, all of whom had right-sided accessory pathways. Five patients with EA had both preexcitation and right bundle branch block, including four with right-sided accessory pathways and one with a left-sided accessory pathway. These findings suggest that when EA is accompanied by preexcitation and right bundle branch block, a right-sided accessory pathway is more common. Of the eight patients, two recovered satisfactorily after tricuspid valvuloplasty and radiofrequency ablation. Three underwent radiofrequency ablation alone, two of whom developed right bundle branch block after the procedure. The outcomes of the remaining three patients were unknown. Therefore, when a newborn's electrocardiogram indicates ventricular preexcitation or right bundle branch block, attention should be paid to the possibility of tricuspid valve disease to avoid missed diagnosis. Figures and Tables | References | Related Articles | Metrics

Medical education

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Interest in infectious diseases among medical students WANG Xiaolin, HUANG Haohua, YU Mengna, CAO Qingren, GU Qian, ZHOU Huijuan, XIE Qing 2026, 25 (05):  665-670.  DOI: 10.16150/j.1671-2870.2026.05.014 Abstract ( 0 )   HTML ( 4 )   PDF (878KB) ( 4 )   Figures and Tables | References | Related Articles | Metrics