Cushing's disease is a severe endocrine disorder caused by excess secretion of adrenocorticotropic hormone from pituitary. Due to its subtle early clinical manifestations , the diagnosis of Cushing's disease is often delayed, and differentiating it from ectopic adrenocorticotropic hormone syndrome is a challenge. Combined functional tests can improve the diagnostic accuracy of Cushing's disease. The primary treatment for Cushing's disease is surgical removal of pituitary adenoma. However, about 1/3 of patients do not respond or experience recurrence after surgery, necessitating second-line treatments including medication. The development of novel drugs has enhanced the role of pharmacotherapy in the management of Cushing's disease. The review discusses the classic and emerging diagnostic methods and treatment strategies of Cushing's disease to deepen clinicians' understanding of its current treatment status and prospects.

In recent years, the incidence and mortality of heatstroke have been increasing annually alongside global warming, with a marked rise in cases exhibiting atypical symptoms. To address the increasingly complex challenges in heatstroke prevention and treatment, Heatstroke Prevention and Treatment Research Center of Chinese PLA, Expert Group of Heatstroke Prevention and Treatment of Chinese PLA, and Chinese PLA Professional Committee of Critical Care Medicine have jointly developed this guideline (2025 edition). Utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, Appraisal of Guidelines for Research and Evaluation (AGREE) criteria, and Reporting Items for Practice Guidelines in Healthcare (RIGHT) standards, and based on the 2015 draft "Expert Consensus on the Standardized Diagnosis and Treatment of Heatstroke" and the 2019 "Chinese Expert Consensus on the Diagnosis and Treatment of Heatstroke", this guideline has been crafted. This guideline provides 25 evidence-based recommendations to guide the prevention, treatment and research of heatstroke, which thoroughly covers 8 critical domains: clinical classification, pathophysiological mechanisms, clinical manifestations, diagnostic criteria, differential diagnosis, treatment protocols, rehabilitation and return to work, and prevention.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a highly malignant hematological tumor derived from plasmacytoid dendritic cells (pDC) precursor cells, which has both lymphoma and leukemia characteristics, and is clinically rare. The disease easily involves the bone marrow, with low long-term survival rate and poor prognosis. Skin lesions can be seen in most BPDCN patients as the fi rst symptom, and their skin manifestations lack speci fi city, so is easy to be misdiagnosed and missed in clinic. High dose induction chemotherapy combined with hematopoietic stem cell transplantation (HSCT) are the main treatment methods for BPDCN,and new targeted therapies and immunotherapeutic drugs have also been put into clinical use. The de fi nition, epidemiology, pathogenesis,diagnosis and differential diagnosis, the latest research progress of treatment and prognosis of BPDCN have been summarized and discussed in present article, aiming to provide new ideas and references for the clinical diagnosis and treatment of BPDCN.

Objective To compare the disease burden and evolving trends of major malignant tumors in China and globally from 1990 to 2021, and conduct predictive analysis, so as to provide a reference for formulating prevention and treatment policies for malignant tumor in China. Methods Based on the Global Burden of Disease Database 2021 (GBD 2021), descriptive research methods were used to analyze the incidence and mortality of major malignant tumors in China and globally, as well as the changes in their rankings. The Joinpoint log-linear model was applied to analyze trends in age-standardized incidence rates (ASIR) and age-standardized mortality rates (ASMR) of malignant tumors in China and globally from 1990-2021. A Bayesian age-period-cohort (BAPC) model was constructed using R 4.4.0 to predict the incidence trends of malignant tumor in China and globally from 2022 to 2035. Results In 2021, there were 17.2294 million new cases of malignant tumors (excluding non-melanoma skin cancer) and 9.7763 million deaths globally, with an ASIR of 201.06/100,000 and ASMR of 115.11/100,000. In China, 4.5375 million new cases and 2.7964 million deaths were reported, with ASIR and ASMR of 221.30/100,000 and 136.36/100,000, respectively. Lung cancer ranked first in both incidence and mortality of malignant tumors in China and globally. Female breast cancer had the second-highest ASIR in China. The number of incident cases and deaths from digestive system malignancies included in this study accounted for 42.0% of the total incident cases and 46.8% of the total deaths from all cancers in China, respectively. From 1990 to 2021, the average annual percentage change (AAPC) for overall ASIR of malignant tumors in China was 0.30, while ASMR declined (AAPC: -0.97). Globally, ASIR decreased slightly (AAPC: -0.10), and ASMR declined (AAPC: -0.78). The BAPC model predicted that by 2035, China's ASIR of malignant tumors may rise to 252.44/100,000, whereas the global ASIR is expected to decrease to 183.05/100,000. Conclusions China has achieved some success in cancer prevention and treatment, but still faces a heavy disease burden, with ASIR and ASMR exceeding global averages and ASIR persistently increasing. Cancer prevention and control work such as health education should be strengthened. Precise prevention and control measures should be taken for key cancer types, and preventive interventions should be focused on the elderly population.

With the improvement of people's health awareness and the popularization of low-dose spiral CT (LDCT) screening, more and more pulmonary nodules have been found. Pulmonary nodules gradually become a common and frequently occurring disease. The diagnosis and treatment of pulmonary nodules has also become a clinical problem. The rise of transbronchial pulmonary nodule diagnosis and treatment technology guided by various navigation technologies provides possibility for more minimally invasive diagnosis and treatment of pulmonary nodules. Navigation guided bronchoscopy is in a rapid development stage both at home and abroad. In order to standardize and promote the development of navigation bronchoscopy technology in China, Committee for the Prevention and Treatment of Senile Tumors of the CSCO organized domestic experts with rich experience in this field to jointly agree and write the consensus.

Objective To explore the value of a combined model based on high-kilovoltage CT radiomics and clinical factors for predicting monosodium urate (MSU) crystal deposition in gouty arthritis. Methods The clinical data of 136 patients with MSU crystal deposition adjacent to joints confirmed by dual-energy CT (DECT) and 79 patients with non-MSU calcifications adjacent to joints were retrospectively analyzed. The dataset was randomly divided into a training set (n=150) and a validation set (n=65) at a ratio of 7:3 for the construction of predictive models. Radiomic features were extracted from high-kilovolt (135 kV) images, and 20 radiomic features were selected using minimum redundancy-maximum relevance and least absolute shrinkage and selection operator (LASSO) regression. Logistic regression, light gradient boosting machine (LightGBM), and support vector machine models were built based on the selected features, and the best-performing model was identified. Multivariate logistic regression analysis was used to screen for risk factors associated with MSU crystal deposition adjacent to joints. A nomogram model was then constructed by integrating radiomic features and clinical variables. The diagnostic performance of the models was evaluated by means of the receiver operating characteristics (ROC) area under the curve (AUC). Results Multivariate logistic regression analysis revealed that CT value was an independent risk factor for MSU crystal deposition adjacent to joints (P<0.001). Among the three machine-learning models, the LightGBM model demonstrated the best predictive performance and good dataset robustness. Therefore, the nomogram was constructed using the LightGBM model. The AUCs of the nomogram model for predicting MSU crystal deposition in the training and validation sets were 0.932 and 0.856, respectively, both exceeding 0.85 and significantly higher than those of the clinical model (De-long test, P<0.05). No statistically significant difference was observed between nomogram model and radiomics model (De-long test, P>0.05). Conclusions High-kilovoltage CT radiomics analysis can predict MSU crystal deposition adjacent to joints. The nomogram model and the radiomics model both demonstrate high diagnostic performance, which can provide valuable references for clinical decision-making.

Status epilepticus is one of the critical illnesses involving multiple clinical disciplines. Although treatment is comprehensive, rapid termination of status epilepticus episodes is critical. The purpose of this article is to provide an actionable approach to rapidly terminating status epilepticus episodes by organizing multidisciplinary experts to improve patient outcomes.In the consensus, the experts put forward the purpose of the consensus, the scope of adaptation, the method and clinical practice of rapid termination of status epilepticus, and discuss several issues that need to be paid attention to in the treatment of status epilepticus, hoping to provide clinicians with an alternative when faced with status epilepticus.

Heat stroke is a heat-related illness caused by an imbalance between the body's heat production and heat dissipation, which could lead to multiple organ dysfunction syndrome with a high mortality rate. Rapid and effective reduction of core body temperature is key to successful treatment. This article reviews recent progress in the treatment of heat stroke, including new understandings of organ injury mechanisms, the timing, velocity and goals of cooling treatment, evaluation and selection of traditional cooling techniques (such as cold water immersion), and scientific evaluation of new cooling technologies (such as blood purification technology and intravascular heat exchange cooling technology), aiming to promote understanding and treatment of heat stroke.

Sepsis-induced coagulopathy (SIC), a critical and potentially lethal condition arising from sepsis, results in endothelial damage and significant coagulation dysregulation, making it a major factor contributing to mortality among sepsis patients. Early diagnosis and treatment of SIC are expected to improve the prognosis of sepsis patients. In 2019, the International Society on Thrombosis and Hemostasis (ISTH) issued the first guidelines for the diagnosis and treatment of SIC, but there are no corresponding protocols in China. Therefore, Chinese Society of Thrombosis, Hemostasis and Critical Care, Chinese Medicine Education Association, and Chinese People's Liberation Army Professional Committee of Critical Care Medicine jointly formulated the "Chinese Expert Consensus on the Diagnosis and Treatment of Sepsis-induced Coagulopathy (2024 edition)." This consensus includes 5 parts: pathogenesis, classification, laboratory approaches, diagnosis and treatment, with a total of 14 evidence-based recommendations to guide clinical practice.

The prothrombin complex concentrate (PCC) is a blood product that mainly contains vitamin K-dependent coagulation factors. PCC has been used clinically for more than 70 years, and its safety has been significantly improved. It has been widely used in the treatment of coagulation disorders or severe bleeding in critically ill patients. If used improperly, it may weaken the hemostatic effect or increase the risk of thrombosis. In order to standardize the rational use of PCC, Chinese Society of Thrombosis, Hemostasis and Critical Care, Chinese Medicine Education Association, People's Liberation Army Professional Committee of Critical Care Medicine, Chinese Society of Thrombosis and Hemostasis, Chinese Research Hospital Association have organized the formulation of this expert consensus, including three parts: definition, indications, and monitoring and evaluation of efficacy, with a total of 10 suggestions, aiming to help clinicians reasonably use PCC and improve the treatment in critical illness.