Journal of Shandong University (Health Sciences)

Shandong Provincial expert consensus on perioperative quality control for VATS/RATS in non-small cell lung cancer(2026 Edition)

Thoracic Surgery Branch, Shandong Medical Association

Journal of Shandong University (Health Sciences). 2026, 64(9): 1-7. doi:10.6040/j.issn.1671-7554.0.2026.0971

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Lung cancer ranks first in both incidence and mortality among all malignancies worldwide and in China. Surgical resection remains the most effective treatment for early-stage non-small cell lung cancer(NSCLC). In alignment with the "Healthy China 2030" initiative, a series of policies and guidelines have been introduced to enhance quality control in cancer diagnosis and treatment, with lung cancer identified as one of the priority cancer types for such oversight. In response, the Thoracoscopy Committee of the Shandong Provincial Endoscopic Surgery Quality Control Center developed the Shandong Provincial Expert Consensus on Perioperative Quality Control for Video-Assisted Thoracoscopic Surgery(VATS)/Robot-Assisted Thoracoscopic Surgery(RATS)in Non-Small Cell Lung Cancer(2025 Edition). During its implementation, medical institutions across Shandong Province accumulated substantial clinical experience and provided constructive feedback regarding several quality control aspects that could be further optimized. Based on this feedback and a comprehensive review of the 2025 experience, the Thoracic Surgery Branch of the Shandong Medical Association has updated and refined the consensus, resulting in the present 2026 Edition. This updated version is intended to promote continuous improvement and guide perioperative management of NSCLC toward greater precision and efficiency across thoracic surgery practice in Shandong Province.

Construction and application of an endogenous LSR-targeted dual-reporter cell line integrating EGFP and Gluc

LIU Hao, JIAO Peng, CHEN Liuyan, GONG Yongfeng, ZHAO Shengtian, AN Yanan

Journal of Shandong University (Health Sciences). 2026, 64(9): 8-16. doi:10.6040/j.issn.1671-7554.0.2025.1536

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Objective To construct a dual-reporter system capable of detecting lipolysis-stimulated lipoprotein receptor(LSR)expression at both transcriptional and translational levels, thereby achieving accurate monitoring of LSR expression and function. Methods Using a CRISPR/Cas9-mediated gene knock-in strategy, the coding sequences of enhanced green fluorescent protein(EGFP)and Gaussia luciferase(Gluc)were site-specifically integrated upstream of the stop codon in the last exon of the LSR gene in HEK293 cells. Real-time visualization of LSR expression was achieved via EGFP fluorescence, and quantitative analysis was accomplished by measuring the activity of secreted Gluc. The reliability of the system was validated by endogenous LSR knockdown combined with Western blotting, immunofluorescence staining, and quantitative real-time PCR. Results The established LSR-EGFP-Gluc knock-in cell line accurately mimicked the expression and function of endogenous LSR. EGFP fluorescence dynamically reflected LSR expression, while Gluc activity detection provided a highly sensitive and specific quantitative readout. Functional validation confirmed that LSR expression in this cell line responded to endogenous LSR knockdown and protein synthesis inhibition as expected. Screening of transcriptional regulators identified sterol regulatory element-binding protein 2(SREBP2)and peroxisome proliferator-activated receptor γ(PPARγ)as transcriptional regulators of LSR expression. Conclusion The LSR dual-reporter system constructed in this study enables complementary monitoring of dynamic changes in LSR, offering high sensitivity, accuracy, and versatility.

Diagnostic value of millimeter-wave radar monitoring for paediatric obstructive sleep apnoea syndrome

SHI Xiaoli, GUO Ruixiang, ZHAO Yan, BIAN Tianshuai, WANG Xiaohua, MU Hong

Journal of Shandong University (Health Sciences). 2026, 64(9): 17-25. doi:10.6040/j.issn.1671-7554.0.2025.1237

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Objective To evaluate the application value of a sleep respiratory non-contact portable monitoring device(Qinglei PMD)based on millimeter-wave radar technology in the diagnosis of paediatric obstructive sleep apnoea(OSA). Methods A total of 101 children aged 4-15 years suspected of OSA from July 2023 to July 2024 were enrolled in the study. All participants underwent aseries of evaluations,including simultaneous overnight polysomnography(PSG, regardedas the gold standard)and Qinglei PMD monitoring. The differences and correlations of indicators including the obstructive apnoea-hypopnea index(OAHI)and the lowest pulse oxygen saturation(LSpO₂)between the two devices were analyzed. Subgroup consistency analysis was performed on the basis of age, gender, and comorbidities. The diagnostic efficacy of Qinglei PMD was assessed using the receiver operating characteristic curve(ROC). The optimal diagnostic cut-off value was determined via the Youden index, and the sensitivity and specificity of Qinglei PMD for diagnosing paediatric OSA were calculated accordingly. Results No significant statistical difference was observed in OAHI between Qinglei PMD and PSG(P>0.05), with a strong positive correlation(r_s=0.89, P<0.01)and an intraclass correlation coefficient(ICC)of 0.85(P<0.01). The Bland-Altman agreement analysis demonstrated that 95.05% of the data points fell within the limits of agreement, and consistency in all subgroups reached good or excellent levels. Statistical disparities were identified in AHI, LSpO₂, and mean oxygen saturation between Qinglei PMD and PSG(all P<0.01). However, these disparities did not attain clinically significant thresholds. ROC analysis revealed that the area under the curve(AUC)of Qinglei PMD for diagnosing paediatric OSA was 0.91. Utilizing the optimal cut-off value-of OAHI≥2.15 events/hour, the sensitivity was determined to be 76.90%, while the specificity was found to be 100.00%. Conclusion Qinglei PMD demonstrates a high degree of consistency with PSG in the diagnosis of paediatric OSA, with reliable measurement of the core indicator OAHI. The device exhibits both high specificity(100%)and non-contact monitoring advantages, which have the potential to enhance patient compliance and are well-suited for initial screening in primary healthcare settings. Consequently, it possesses significant clinical promotion value.

Causal effects of plasma and urinary metabolites on Alzheimers disease: a metabolome-wide Mendelian randomization study

PENG Qiang, ZHANG Xueqin, WEN Jun, WANG Kai, ZHANG Xiaojuan, LIU Shiping

Journal of Shandong University (Health Sciences). 2026, 64(9): 26-35. doi:10.6040/j.issn.1671-7554.0.2025.1202

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Objective To identify metabolic biomarkers causally associated with Alzheimers disease(AD)using Mendelian randomization(MR)and metabolomics, explore related risk factors, and elucidate the mediating role of metabolites. Methods Two-sample MR was used to evaluate the causal associations of 690 plasma metabolites and 211 urinary metabolites with AD. Functional enrichment analysis of potential metabolic markers was performed using Met Origin, and druggability assessment was conducted via Drug Bank. MR analyses were further performed to identify modifiable risk factors for AD and their causal relationships with candidate metabolites, followed by two-step MR to assess mediating effects of metabolites. Results Thirteen plasma metabolites and seven urinary metabolites showed significant causal associations with AD(P<0.05). Functional enrichment analysis identified five significantly enriched metabolic pathways(P<0.05). Druggability assessment indicated two metabolites as potential therapeutic targets. Additionally, five modifiable risk factors for AD were identified(P<0.05), and mediation analysis confirmed the mediating roles of two metabolites in risk factor-induced AD. Conclusion Thirteen plasma metabolites and seven urinary metabolites were causally associated with AD. Among them, S-adenosylhomocysteine and lactose emerged as potential therapeutic targets, while epiandrosterone sulfate and 1-palmitoyl-2-oleoyl-GPI mediated the effects of depressive symptoms and Parkinsons disease on AD, respectively.

Key molecular features of acute mountain sickness revealed by metabolomics

DING Wenjing, YANG Yifan, HU Xinyu, CHEN Xiaolan, XUE Xinying, PAN Lei

Journal of Shandong University (Health Sciences). 2026, 64(9): 36-42. doi:10.6040/j.issn.1671-7554.0.2026.0666

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Objective To compare physiological parameters and urinary metabolomic profiles between individuals with acute mountain sickness(AMS)and those without AMS after high-altitude exposure, and to screen AMS-related candidate urinary metabolites and metabolic pathways. Methods In 2024, seventy male participants recruited in Xizang after high-altitude exposure, aged 18-45(20.93±1.55)years, were included, comprising 41 without AMS and 29 with AMS(AMS group). Demographic characteristics and post-exposure physiological parameters, including peripheral oxygen saturation(SpO₂), heart rate, blood pressure, mean arterial pressure, and rate pressure product, were compared between groups. Untargeted urinary metabolomics was performed to characterize metabolic differences. Orthogonal partial least squares discriminant analysis(OPLS-DA), differential metabolite screening, Kyoto encyclopedia of genes and genomes(KEGG)pathway enrichment, and ensemble feature selection(EFS)were further conducted. Results Compared with the non-AMS group, the AMS group had lower SpO₂ and higher systolic blood pressure and rate pressure product(all P<0.05). A total of 5,587 urinary metabolites were detected. OPLS-DA showed a tendency toward separation between the two groups. Using variable importance in projection(VIP)>1 combined with P<0.05, 544 differential metabolites were identified, including 267 upregulated and 277 downregulated metabolites. KEGG analysis showed that these metabolites were mainly enriched in glycine, serine and threonine metabolism, tryptophan metabolism, the pentose phosphate pathway, arginine and proline metabolism, carbon metabolism and branched-chain amino acid-related pathways. EFS highlighted S-(2-carboxypropyl)glutathione, ribose, N-acetyltryptophan, 2-hydroxyglutaric acid, glutamate and 4-hydroxyproline as candidate metabolites with high discriminatory contributions. Conclusion Individuals with AMS exhibit more pronounced oxygen desaturation and increased cardiovascular load after high-altitude exposure, accompanied by altered urinary metabolic profiles. The differential metabolites were mainly involved in amino acid metabolism, carbohydrate metabolism, redox balance regulation, and lipid-related metabolism, suggesting that urinary metabolomics may provide useful clues for AMS-related mechanistic studies and candidate biomarker screening.

Application of whole exome sequencing technology in the clinical diagnosis and treatment of genetic diseases in children

WU Mingli, JIANG Mingdi, LI Jing, SONG Chao, LIU Jing, LI Zhen, ZHOU Yilin, ZHANG Hong, LIU Qinghua

Journal of Shandong University (Health Sciences). 2026, 64(9): 43-49. doi:10.6040/j.issn.1671-7554.0.2025.0958

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Objective To explore the value of whole exome sequencing(WES)in the clinical diagnosis and treatment of children with genetic diseases. Methods The clinical data of 265 children with suspected genetic diseases who visited the The Second Affiliated Hospital of Shandong First Medical University from March 2019 to August 2023 were retrospectively analyzed. All patients underwent WES sequencing analysis. Candidate variants were screened based on the clinical phenotypes of the children, and Sanger sequencing was used for verification. Pathogenicity assessment and genetic diagnosis were completed according to the guidelines of the American College of Medical Genetics and Genomics(ACMG). The overall detection rate of WES was determined based on phenotype categories, inheritance patterns, mitochondrial genome variations, and copy number variations, and the impact of WES on clinical diagnosis and treatment strategies was analyzed. Results Among the 265 children, 98 positive cases were detected, with a total detection rate of 37.0%(98/265). A total of 102 pathogenic or likely pathogenic single nucleotide variations, 20 copy number variations, 1 mitochondrial variation, and 31 de novo mutation sites were detected. In the context of clinical phenotypes, neurological diseases accounted for the highest proportion, reaching 55.5%(147/265). Based on the sequencing results, 61 children(62.3%)received individualized precision medical treatment. Conclusion WES technology is of great significance in revealing the genetic characteristics of children, facilitating early diagnosis, and providing personalized precision treatment plans.

Causal effects of aspirin on phenome-wide diseases: a drug target Mendelian randomization study

ZHANG Xiumei, CHEN Changhai, YUAN Zhongshang, WANG Shukang

Journal of Shandong University (Health Sciences). 2026, 64(9): 50-59. doi:10.6040/j.issn.1671-7554.0.2025.1060

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Objective To systematically investigate the causal effects of genetically proxied aspirin exposure on a broad range of phenotypes using drug-target Mendelian randomization(MR)and polygenic score analysis. Methods Exposure data were obtained from the eQTLGen consortium(31,684 healthy European individuals). Cis-expression quantitative trait loci(cis-eQTL)significantly associated with aspirin target genes were selected as instrumental variables(IVs). Outcome data were derived from the FinnGen study R12 release(500,348 Finnish participants, 2,502 disease endpoints), with 1,265 diseases(case count ≥1,000)included for analysis. The inverse variance weighted(IVW)method was used as the primary MR analysis, complemented by weighted median, MR-Egger regression, simple mode, and weighted mode methods for verification. Heterogeneity and pleiotropy were assessed using Cochrans Q test, MR-Egger intercept test, and leave-one-out analysis. A polygenic score was constructed based on nine aspirin-related genes and tested for associations with disease outcomes in the UK Biobank cohort(402,700 participants). Results A total of 27 SNPs were selected as instrumental variables. After multiple testing correction, the IVW analysis showed that genetically proxied aspirin exposure was significantly causally associated with 34 diseases, among which 13 associations were supported by at least three complementary MR methods(replication evidence). Specifically, reduced risks were observed for fetal growth restriction(OR=0.471, 95%CI: 0.348-0.636, P<0.001), other embolism and thrombosis(OR=0.665, 95%CI: 0.495-0.894, P=0.007), unspecified rheumatic disease(OR=0.651, 95% CI: 0.489-0.867, P=0.003), benign neoplasm of the small intestine(OR=0.449, 95%CI: 0.251-0.802, P=0.003), and senile cataract(OR=0.840, 95%CI: 0.760-0.929, P=0.001).In contrast, increased risks were observed for chronic ulcerative ileocolitis(OR=2.427, 95%CI: 1.363-4.320, P=0.003)and Crohns disease of the large intestine(OR=1.843, 95%CI: 1.156-2.938, P=0.003). Polygenic risk score analysis further indicated a negative association between aspirin use and the risk of senile cataract(OR=0.985, 95% CI: 0.974-0.996, P=0.007). Conclusion Aspirin exhibits pleiotropic effects across multiple disease systems, with protective effects against thromboembolism, fetal growth restriction, rheumatic diseases, and benign small intestinal tumors, but potential risks for inflammatory bowel diseases. This study provides genetic evidence to inform clinical application and drug repurposing of aspirin.

Short-term effects of air pollutants on influenza in Jinan, 2019-2023

WANG Weiru, SUN Zhan, MENG Zhonghua, WU Hong, ZHANG Xin, CHANG Caiyun, ZHENG Min

Journal of Shandong University (Health Sciences). 2026, 64(9): 60-67. doi:10.6040/j.issn.1671-7554.0.2025.1313

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Objective To evaluate the short-term effects of meteorological factors and air pollutants on influenza cases in Jinan City from 2019 to 2023, and to provide evidence for improving influenza early warning and prevention strategies. Methods Daily average mass concentrations of air pollutants(PM_2.5, PM₁₀, SO₂, NO₂, O₃, and CO), daily average temperature, relative humidity, and average wind speed in Jinan from January 2019 to December 2023, as well as influenza case data reported by medical institutions during the same period, were collected. The distributed lag non-linear model(DLNM)was used to analyze the exposure-response relationship and lag effects of environmental pollutants on influenza incidence. Results A total of 46,247 influenza cases was reported in Jinan from 2019 to 2023, with an average of 25 cases per day. The daily average mass concentration changes of PM_2.5, PM₁₀, and SO₂ had statistically significant effects on the risk of influenza incidence. A 10 μg/m³ increase in PM_2.5, PM₁₀, and SO₂ was associated with 1.208%, 2.135%, and 0.383% increases in cumulative influenza cases, respectively. SO₂, CO, NO₂, and O₃ had the strongest effects on the same day, with ER(95%CI)of 0.103(0.063-0.144), 0.007(0.001-0.014), 0.018(0.004-0.033), and 0.014(0.008-0.020), respectively. The effects of PM_2.5 and PM₁₀ were strongest at lag 10 d, with ER(95%CI)of 0.098(0.017-0.186)and 0.213(0.089-0.352), respectively. Conclusion Meteorological factors and air pollutant concentrations have short-term effects on influenza cases in Jinan. A risk warning mechanism for meteorology and air pollution should be established.

Association between relative fat mass index and all-cause mortality and cardiovascular mortality among individuals with diabetes and prediabetes

LI Aijing, WEI Maoying, WU Chan, GUO Jingyi, SUN Anning, GU Xin, GONG Yanbing

Journal of Shandong University (Health Sciences). 2026, 64(9): 68-77. doi:10.6040/j.issn.1671-7554.0.2025.0820

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Objective To investigate the association between the relative fat mass(RFM)index and all-cause mortality as well as cardiovascular mortality in patients with diabetes or prediabetes. Methods A total of 11,852 patients with diabetes or prediabetes from the American National Health and Nutrition Examination Survey(NHANES)database(1999-2018)were included. The study participants were divided into four groups according to the quartiles of the RFM index: Q1(9.63-29.75), Q2(29.75-35.54), Q3(35.54-44.05), and Q4(44.05-58.41). Multivariable Cox proportional hazards regression models were applied to evaluate the associations of RFM index, treated both as a continuous variable and as a categorical variable, with all-cause mortality and cardiovascular mortality. Restricted cubic spline and threshold effect analyses were applied to explore potential nonlinear relationships. Additionally, subgroup and sensitivity analyses were conducted. Results During a mean follow-up of 103.94 months, a total of 2,039 all-cause deaths(17.20%)and 661 cardiovascular deaths(5.58%)occurred among the 11,852 participants with diabetes or prediabetes. In the fully adjusted model, when RFM index was analyzed as a continuous variable, each unit increase in RFM index was associated with a 1.6% increase in all-cause mortality risk(HR=1.016, 95%CI: 1.002-1.030, P=0.029)and a 3.6% increase in cardiovascular mortality risk(HR=1.036, 95%CI: 1.007-1.066, P=0.005). When the RFM index was analyzed as a categorical variable, compared to the Q1 group, the Q3 and Q4 groups showed a 58.8%(HR=1.588, 95%CI: 1.286-1.961, P<0.001)and 61.3%(HR=1.613, 95%CI: 1.229-2.116, P=0.001)increase in all-cause mortality risk, respectively, and a 79.8%(HR=1.798, 95%CI: 1.238-2.610, P=0.002)and 124.8%(HR=2.248, 95%CI: 1.355-3.729, P=0.002)increase in cardiovascular mortality risk, respectively. Restricted cubic spline analysis revealed a nonlinear U-shaped curve between RFM index and all-cause mortality, while cardiovascular mortality showed a linear increasing trend with higher RFM index. Subgroup analysis indicated that education level significantly modified the associations of RFM index with both all-cause and cardiovascular mortality. Sensitivity analyses yielded results consistent with the main findings. Conclusion In patients with diabetes or prediabetes, a higher RFM index is associated with increased risks of both cardiovascular mortality and all-cause mortality.

Association of early-life exposure factors with irritable bowel syndrome: a population-based cohort study

WANG Xiaohan, ZHONG Yang, CHEN Hao, CHONG Wei, QIU Chengmiao, BAI Hao, LYU Ming, LI Leping

Journal of Shandong University (Health Sciences). 2026, 64(9): 78-87. doi:10.6040/j.issn.1671-7554.0.2026.0289

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Objective To explore the association of early-life exposure factors as well as their weighted risk scores, and the risk of developing irritable bowel syndrome(IBS). Methods The present study included a total of 468,709 participants from the UK Biobank, with information on early-life exposures-such as breastfeeding, maternal smoking around birth, multiple birth, adoption during childhood, and birthweight-collected via baseline questionnaire. Following multiple imputation of missing covariates, associations among the variables were assessed using logistic regression models with IBS as the outcome. The initial analysis examined the relationship between each individual early-life exposure and the risk of IBS. Subsequently, breastfeeding, maternal smoking around birth, multiple birth, and birthweight were included in a multivariable logistic regression model. An early-life exposure risk score was then constructed based on the models β coefficients, and its association with IBS risk was evaluated. Results A comprehensive adjustment for covariates revealed that early-life factors, encompassing non-breastfeeding(OR=1.12, 95%CI: 1.08-1.15), maternal smoking around birth(OR=1.11, 95%CI: 1.08-1.14), and low birth weight(OR=1.16, 95%CI: 1.03-1.32)were associated with increased risk of IBS. Furthermore, compared with participants with lower early-life exposure risk score(the lowest quartile, Q1), those with higher scores(the third and fourth quartiles, Q3-Q4)had an 11% and 19% higher risk of IBS, respectively(Q3: OR=1.11, 95%CI: 1.06-1.17; Q4: OR=1.19, 95%CI: 1.14-1.25). Conclusion A higher burden of adverse early-life exposures(indicated by a higher weighted risk score)is associated with a higher subsequent risk of IBS. From an epidemiological standpoint, these findings imply that public health and health promotion strategies targeting early life may have a beneficial effect on reducing the long-term burden of IBS. It is recommended that future research efforts concentrate on establishing the causal relationship between these early-life exposures and IBS.

Disease burden trends and risk factors of depressive disorders among children and adolescents in China: an explainable machine learning analysis based on SHAP

JIANG Xiuyu, ZHENG Fengjia, LIU Xuan, LI Suyun, LYU Cuixia, LIU Zhaolu, ZHENG Shoujuan, ZHOU Han, YU Lianlong

Journal of Shandong University (Health Sciences). 2026, 64(9): 88-99. doi:10.6040/j.issn.1671-7554.0.2025.1017

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Objective To analyze the long-term trends and age- and sex-specific differences in the burden of depressive disorders among children and adolescents aged <20 years in China from 1990 to 2021, and to explore the contributions of relevant exposure features to model predictions. Methods Data were obtained from the Global Burden of Disease Study 2021. The estimated annual percentage change(EAPC)and Joinpoint regression were used to analyze long-term trends in incidence, prevalence, and disability-adjusted life years(DALYs). A Bayesian age-period-cohort(BAPC)model was used to project changes in incidence from 2021 to 2049. Light gradient boosting machine(LightGBM), combined with Shapley additive explanations(SHAP)and negative binomial regression, was used to explore relevant summary exposure value(SEV)features and the strengths of their associations. Results From 1990 to 2021, the incidence, prevalence, and DALYs of depressive disorders among children and adolescents in China decreased overall, whereas the corresponding global indicators increased. In China, the disease burden increased with age and was higher among females than among males. The burden of depressive disorders increased among children aged ≤9 years but decreased among those aged 15-19 years. SHAP analysis showed that childhood underweight made the greatest contribution to model predictions, while iron deficiency, sexual violence against children, and occupational exposure to particulate matter, gases, and fumes also showed relatively high contributions. Negative binomial regression showed that sexual violence against children had the strongest association(RR=2.212, 95%CI: 2.099-2.331). Conclusion The burden of depressive disorders among children and adolescents in China has decreased overall, but younger children and females remain priority populations. These findings support strengthening early screening and implementing comprehensive interventions targeting violence prevention, nutritional improvement, and living environments.

Mechanisms and research progress on the association between dietary antioxidant capacity and metabolic dysfunction-associated fatty liver disease

YOU Xinyu, WANG Wenhua, WANG Sen, LIU Shaozhuang, HUANG Xin, LIU Teng, WANG Baozhen

Journal of Shandong University (Health Sciences). 2026, 64(9): 100-110. doi:10.6040/j.issn.1671-7554.0.2026.0084

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Metabolic dysfunction-associated fatty liver disease(MAFLD)is a prominent global public health issue, and its onset and progression are closely associated with oxidative stress. Diet is a primary source of exogenous antioxidants; however, previous studies have mostly focused on single nutrients or specific dietary patterns, failing to quantify individual-level overall dietary antioxidant capacity. This has led to inconsistent conclusions regarding the association between dietary antioxidant capacity and MAFLD, along with a lack of integrated evidence to guide clinical practice. This review compares the differences between two core evaluation indicators, dietary total antioxidant capacity(DTAC)and the composite dietary antioxidant index(CDAI), and provides an in-depth analysis of the sources of inconsistent findings from the perspectives of methodological heterogeneity, disease stage specificity, and differences in population metabolic characteristics. Focusing on three aspects, including oxidative stress mechanisms in MAFLD, evaluation indicators of dietary antioxidant capacity, and the evidence linking dietary antioxidant capacity to MAFLD, this review synthesizes current research progress and provides a theoretical basis for dietary intervention and clinical prevention of MAFLD.

Advances in diagnosis and management of hypernatremia after severe burns

YANG Hongkun, LI Tianxin, FAN Chunjie, ZHANG Canyong, HUANG Jun, HUANG Guobao

Journal of Shandong University (Health Sciences). 2026, 64(9): 111-117. doi:10.6040/j.issn.1671-7554.0.2026.0773

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Hypernatremia is a common and severe electrolyte disorder in patients with major burns, with an incidence significantly higher than that in the general intensive care unit population, and it is closely associated with increased mortality, prolonged hospital stay, and impaired wound healing. This article systematically summarized the latest research advances in hypernatremia after major burns, with a focus on its etiology, pathophysiological mechanisms, clinical manifestations, diagnostic strategies, and treatment regimens. Its core pathophysiological alterations involve disruption of the skin barrier, activation of the neuroendocrine axis, and systemic inflammatory response. The main etiologies include free water deficit, excessive sodium load, and secondary infection. Clinically, it predominantly presents with neurological symptoms and is frequently accompanied by multiple organ dysfunction. Diagnosis should be centered on dynamic monitoring of serum sodium, with standardized exclusion of pseudohypernatremia, correction of blood glucose, and etiological differential diagnosis. In terms of treatment, individualized fluid management is emphasized, and the correction rate for acute and chronic hypernatremia must be clearly defined. Meanwhile, early wound management, infection control, and organ support should be prioritized. For refractory hypernatremia, continuous renal replacement therapy with regional citrate anticoagulation is recommended to achieve precise sodium reduction. This article aims to provide clinicians with the latest reference for the diagnosis and treatment of hypernatremia after major burns and points out potential directions for future research.

A novel drug for chronic spontaneous urticaria: Brutons tyrosine kinase inhibitor remibrutinib

HUANG Peiwen, WANG Xudong

Journal of Shandong University (Health Sciences). 2026, 64(9): 118-124. doi:10.6040/j.issn.1671-7554.0.2025.1551

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Chronic spontaneous urticaria(CSU)is a common mast cell-mediated skin disease. However, most patients respond poorly to current antihistamines, and the second-line treatment omalizumab also shows poor response or fails to achieve complete remission. Therefore, safe, effective, and convenient new drugs are still needed. Remibrutinib is an oral, highly selective inhibitor of Bruton's tyrosine kinase(BTK). On September 30, 2025, it was approved by the U.S. Food and Drug Administration for the treatment of adult patients with CSU who remain symptomatic after antihistamine therapy, becoming the first BTK inhibitor globally approved for CSU. The drug was subsequently approved for marketing in China by the National Medical Products Administration on November 25, 2025. By irreversibly inhibiting BTK activity, remibrutinib specifically blocks downstream signal transduction triggered by IgE receptor cross-linking, thereby inhibiting mast cell and basophil degranulation, reducing the release of inflammatory mediators such as histamine, and effectively alleviating wheals and pruritus. Phase III clinical trials have shown that remibrutinib can rapidly and significantly improve patients symptoms and maintain efficacy for up to 52 weeks, with a favorable safety profile. However, its long-term efficacy and safety in different racial populations still require further observation. This article briefly reviews the mechanism of action, pharmacokinetic characteristics, clinical research, and safety of remibrutinib, aiming to provide a reference for the clinical treatment and new drug development of CSU in China.

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