Objective To investigate the distribution characteristics of pathogens causing infections within 90 days after liver transplantation and the influencing factors of infection. Methods Clinical data of 176 recipients who underwent liver transplantation at the Liver Transplant Center of Beijing Friendship Hospital Affiliated to Capital Medical University from September 2021 to August 2024 were retrospectively analyzed. Patients were divided into the infection group (n=124) and the non-infection group (n=52) based on whether they developed infection within 90 days after transplantation. The distribution characteristics of pathogens in infected patients were analyzed. Univariate and multivariate logistic regression analyses were used to explore the influencing factors of infection. Results Among the 176 liver transplant recipients, 124 cases developed 243 episodes of 518 bacterial, fungal, viral or mycoplasma infections within 90 days after transplantation, with an overall infection rate of 70.5% (124/176). The composition of pathogens was mainly Gram-negative bacteria (38.6%, 200/518), followed by Gram-positive bacteria (32.2%, 167/518) and viruses (15.4%, 80/518), and fungi accounted for 13.1% (68/518). Among Gram-negative bacteria, the main pathogen was Klebsiella pneumoniae (6.8%, 35/518), and among Gram-positive bacteria, the main pathogen was Enterococcus faecalis (8.5%, 44/518). Viruses included Epstein-Barr virus (3.7%, 19/518) and cytomegalovirus (3.7%, 19/518), and fungi were mainly Candida albicans (6.8%, 35/518). The most common infection site among the 243 episodes was pulmonary infection (42.0%, 102/243), followed by abdominal infection (22.6%, 55/243) and bloodstream infection (18.1%, 44/243). The infections mainly occurred within 2 weeks after transplantation (60.9%, 148/243). Multivariate logistic regression analysis indicated that preoperative infection within 2 weeks, a high preoperative model for end-stage liver disease (MELD) score, and preoperative sarcopenia were independent risk factors for infection within 90 days after liver transplantation (all odds ratio>1, P<0.05). After multivariate correction, the levels of CD4⁺T cells and CD8⁺T cells within 90 days after surgery were independently associated with the occurrence of infection. Low levels of CD4⁺T cells and CD8⁺T cells might be related to an increased risk of infection. Conclusions The infection rate after liver transplantation is high, and the pathogens are mainly Gram-negative bacteria. The lungs are the most common infection site. Preoperative MELD score, preoperative sarcopenia and preoperative infection within 2 weeks are independent risk factors for infection within 90 days after liver transplantation. Regular monitoring of immune indicators CD4⁺T cells and CD8⁺T cells levels after transplantation is helpful to reduce the occurrence of post-transplantation infection.

To thoroughly implement the strategic deployment outlined in the Opinions of the Central Committee of the Communist Party of China and the State Council on Promoting the Inheritance and Innovative Development of Traditional Chinese Medicine regarding research on dominant diseases of traditional Chinese medicine and to uphold the development philosophy of equal emphasis on traditional Chinese medicine and western medicine，the China Association of Chinese Medicine has fully played a leading academic role by systematically organizing and conducting a series of academic youth salons on clinical dominant diseases of traditional Chinese medicine. On September 13，2024，the 36^th Youth Salon on Clinical Dominant Diseases was successfully held in Nanjing，focusing on the advantages of traditional Chinese medicine and the integrative traditional Chinese medicine and western medicine in the diagnosis and treatment of erectile dysfunction （ED）. The conference brought together leading experts from traditional Chinese medicine，western medicine，and interdisciplinary fields，facilitating in-depth multidisciplinary discussions that led to key consensus on optimizing traditional Chinese medicine treatment protocols for ED，researching and developing new drugs of traditional Chinese medicine，and advancing interdisciplinary development in traditional Chinese medicine. This salon systematically sorted out the clinical strengths and distinctive features of traditional Chinese medicine in the diagnosis and treatment of ED. Based on current research foundations and clinical needs，it identified key directions for future scientific layout and scientific research tackling： （1） Standardization of syndrome differentiation system of traditional Chinese medicine for ED. （2） Optimization and standardization of intervention methods of integrated traditional Chinese medicine and western medicine. （3） High-quality clinical research guided by evidence-based medicine. （4） In-depth analysis of the pharmacological mechanisms of traditional Chinese medicine in the treatment of ED. （5） Clinical translation and application promotion of new drugs of traditional Chinese medicine. （6） Interdisciplinary integration and innovation in traditional Chinese medicine. For each research direction，key focus areas，expected objectives，and clinical value were further refined，along with the establishment of a scientifically sound priority funding level evaluation system. Therefore，building on the series of salons on the ED-focused dominant diseases of traditional Chinese medicine，this paper provides standardized guidance for clinical practice of traditional Chinese medicine in ED management，effectively contributing to the high-quality development of traditional Chinese medicine. It serves as a valuable reference for national scientific and technological strategic layout， research and development decision-making in new drugs of traditional Chinese medicine，research topic planning，and clinical guideline formulation.

BackgroundSchizophrenia， as a common chronic mental disorder， although second-generation antipsychotic drugs have shown significant efficacy in alleviating positive symptoms， the widespread cognitive dysfunction among patients remains a challenge in clinical treatment. Traditional Chinese medicine has unique advantages in the treatment of mental disorders. However， the current clinical research on the combination of Wendan Decoction and antipsychotic drugs for schizophrenia varies in quality， and there is a lack of systematic reviews evaluating its effects on cognitive improvement and safety. ObjectiveTo systematically evaluate the effects of modified Wendan Decoction combined with antipsychotic drugs on schizophrenia symptoms and cognitive improvement， providing evidence-based support for the clinical application of Wendan Decoction. MethodsLiterature searches were conducted in China National Knowledge Infrastructure （CNKI）， Wanfang Data， VIP Information， China Biomedical Literature Service System， China Clinical Trial Registry， PubMed， Web of Science， the Cochrane Library， and Embase to collect randomized controlled trials （RCTs） of modified Wendan Decoction combined with antipsychotic drugs for the treatment of schizophrenia. The search period was from the establishment of the databases to March 19， 2026. The quality of the included literature was evaluated using the Cochrane 6.3. Meta-analysis was performed using RevMan 5.3 software. ResultsA total of 11 studies were included， involving 1 130 patients with schizophrenia. Among them， 566 cases were in the study group （receiving modified Wendan Decoction combined with antipsychotic drugs）， and 564 cases were in the control group （receiving antipsychotic drugs only）. Meta-analysis showed that the effective rate of improvement in psychotic symptoms in the study group was higher than that in the control group （RR=1.21，95% CI： 1.15–1.27， P<0.01）. In terms of psychotic symptoms， the Positive and Negative Symptom Scale （PANSS） positive symptom score （MD=-3.69， 95% CI： -5.87–-1.51， P<0.01） and PANSS total score （MD=-9.20， 95% CI： -11.80–-6.59， P<0.01） of the study group were lower than those of the control group. In cognitive function assessments， the Mini-Mental State Examination （MMSE） score （MD=2.51， 95% CI： 1.33–3.68， P<0.01） and the Loewenstein Occupational Therapy Cognitive Assessment （LOTCA） score （MD=11.85， 95% CI： 2.55–21.15， P=0.010） of the study group were higher than those of the control group， and the Wisconsin Card Sorting Test （WCST） score was lower than that of the control group （MD=-9.34， 95% CI： -12.57–-6.11， P<0.01）. The levels of brain-derived neurotrophic factor （BDNF） （SMD=1.34， 95% CI： 0.63–2.05， P<0.01） and nerve growth factor （NGF） （MD=6.94， 95% CI： 4.00–9.89， P<0.01） of the study group were higher than those of the control group. In terms of safety， there was no statistically significant difference in the incidence of adverse reactions between the two groups （RR=0.60， 95% CI： 0.31–1.18， P=0.14）. ConclusionThe modified Wendan Decoction combined with antipsychotic drugs may be more effective than antipsychotic drugs alone in improving positive symptoms and cognitive function in patients with schizophrenia， and it also exerts a favorable neurotrophic regulatory effect. ［Funded by Postgraduate Education Reform and Quality Improvement Project of Henan Province （number， YJS2023AL060）； Key Scientific Research Projects of Higher Education Institutions in Henan Province （number， 24B320018， 25B310004）］

ObjectiveTo analyze the epidemiological and etiological characteristics of a cluster of human metapneumovirus (HMPV) infection in a kindergarten in Gongshu District of Hangzhou City in May 2024, and to provide reference for the prevention and control of similar outbreaks. MethodsAn on-site investigation was conducted using an epidemiological case investigation form. Throat swab specimens collected from cases were screened for 13 respiratory pathogens using real-time fluorescent polymerase chain reaction (PCR). For HMPV nucleic acid positive specimens, the F gene of HMPV was used as the target gene for amplification and sequencing. The sequencing results were then compared with sequences in GenBank database to determine the virus subtypes and perform phylogenetic analyses. ResultsThe outbreak occurred in a kindergarter junior class with a total of 28 preschoolers and 3 teachers and childcare workers. A total of 11 cases (10 preschoolers and 1 teacher) were identified, including 8 male cases and 3 female cases. Clinical manifestations included fever in all 11 cases (100.00%), cough in 8 cases (72.72%), catarrhal symptoms in 4 cases (36.36%), and headache in 3 cases (27.27%). All symptoms were mild, and no severe cases were observed. A total of 11 throat swab samples were collected. Real-time fluorescent PCR test results showed that 3 samples were positive for HMPV nucleic acid, 2 samples were positive for both HMPV and Streptococcus pneumoniae, and 1 sample was positive for both HMPV and rhinovirus. The sequences of the 6 HMPV nucleic acid positive specimens were amplified and analyzed using specific primers, and all were determined to be HMPV subtype A2b. The F gene fragment sequence showed the highest similarity to PV081665.1/Brazil/2024 (99.65%), and also exhibited high similarity to PP683455.1/Indonesia/2021 (99.48%), PV016275.1/Beijing/2024 (99.31%), and PV052230.1/USA/2024 (99.13%). ConclusionThis cluster of acute respiratory tract infection was caused by HMPV subtype A2b, with co-infection of rhinovirus and Streptococcus pneumoniae. The F gene fragment sequences of the HMPV in this outbreak were highly homologous to those of the A2b strains isolated from Brazil, Beijing, Indonesia, and the the United States.

Multidrug-resistant (MDR) bacterial infections have emerged as a serious challenge of global public health crisis. The overuse and misuse of conventional antibiotics have dramatically accelerated the emergence, evolution and worldwide spread of drug-resistant bacterial strains, necessitating urgent exploration of novel antibacterial strategies. Bacteriophages serve as natural bacterial predators offering distinct advantages including high host specificity, autonomous self-replication capabilities and cost-effective large-scale production. However, wild-type phages present significant clinical limitations due to their narrow host ranges, susceptibility to rapid immune clearance and poor penetration of bacterial biofilms, which severely restrict their therapeutic applications. The convergence of synthetic biology, nanotechnology and advanced gene editing technologies has accelerated the development of engineered bacteriophage platforms, providing programmable, scalable and clinically translatable pathways to overcome these inherent biological constraints. Here, we systematically delineate four fundamental strategies for engineered bacteriophage development. Chemical modification utilizes reactive functional groups such as amino, carboxyl and thiol moieties on capsid proteins through esterification, amidation or click chemistry reactions to achieve precise drug conjugation and surface functionalization. In vivo editing encompasses ultraviolet or chemical mutagenesis for random mutation induction, homologous recombination for targeted genetic alterations, recombineering methodologies including electroporation-mediated bacteriophage recombination engineering, and CRISPR-Cas systems for precise genome editing to enable exact genetic reconstruction and host range reprogramming. In vitro synthesis leverages genome engineering platforms where intact phage genomes are transferred into yeast or host bacteria to facilitate highly efficient homologous recombination, enabling large DNA fragment assembly and cross-gene host range expansion without bacterial toxicity constraints. Directed evolution combines artificial selection through mutation library screening with rational design approaches involving chimeric receptor binding protein construction or site-specific mutagenesis, effectively balancing the discovery of unknown adaptive pathways with targeted host specificity modification. Moreover, we comprehensively discuss therapeutic applications across diverse clinical scenarios. Engineered bacteriophage effectively disrupt bacterial biofilms through sophisticated functionalized delivery platforms including nanozyme-conjugated phages, phage-liposome nanoconjugates and bio-responsive hydrogels, demonstrating significantly enhanced bactericidal efficiency compared to unmodified free phages. These bioengineered vectors attenuate bacterial virulence and resensitize pathogens to antibiotics by delivering CRISPR-Cas systems or base editors to disrupt critical virulence factors such as pili, capsule synthesis machineries and quorum sensing systems, or by inactivating antibiotic resistance determinants including beta-lactamase genes. As an intelligent nanomedicine delivery platform, engineered bacteriophage enable precise pathogen elimination an through photocatalytic reactive oxygen species generation, immunomodulatory interventions, or controlled release of antibacterial drugs. Furthermore, oral administration of engineered bacteriophage facilitates microbiota modulation, which selectively eliminate intestinal pathogens while preserve beneficial commensal microbiota, thereby restoring microbial community balance and preventing complications associated with dysbiosis. Finally, we critically analyze persistent challenges including host strain matching complexity, evolution of bacterial resistance mechanisms, pharmacokinetic optimization requirements, optimal administration route selection, large-scale production quality control standards and clinical dosing determination protocols. Through multidisciplinary integration of synthetic biology, infectious disease medicine and immunology, future translational medicine studies of bacteriophage should establish comprehensive technical platforms encompassing rapid phage screening, intelligent rational design, rigorous in vivo evaluation and standardized clinical validation processes, ultimately advancing engineered bacteriophage from laboratory innovations to clinically approved therapeutics for effectively combating MDR bacterial infections.

Objective To explore the characteristics and correlation between perivascular spaces (PVS) and diffusion tensor image analysis along perivascular spaces (DTI-ALPS) index in patients with amnestic mild cognitive impairment (aMCI). Methods A retrospective study was conducted on a total of 118 participants, including cognitive normal (CN) healthy controls and aMCI patients, recruited from the Department of Neurology, Zhongshan Hospital, Fudan University from September 2020 to September 2022. All participants underwent structural magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI). An automatic segmentation algorithm was used to quantify PVS metrics in the brain, and DTI-ALPS index was calculated based on DTI. Differences in DTI-ALPS index and PVS metrics between the CN and aMCI groups were compared. Multivariate logistic regression was used to identify independent factors influencing aMCI. Correlation analysis was performed to assess relationships among DTI-ALPS index, PVS metrics, and cognitive scores. Results A total of 80 CN healthy controls and 38 aMCI patients were included. The DTI-ALPS index was significantly lower in the aMCI group compared with the CN group (1.28±0.18 vs 1.37±0.21, P＝0.018), while differences in PVS metrics between groups were not statistically significant. Multivariate logistic regression analysis indicated that DTI-ALPS index was an independent factor affecting aMCI (OR＝0.097, 95%CI 0.011–0.833, P＝0.033). Correlation analysis revealed a positive relationship between DTI-ALPS index and MMSE score (r＝0.210, P＝0.023) as well as PVS length in the centrum semiovale (r＝0.216, P＝0.019). Conclusions The DTI-ALPS index may serve as an imaging biomarker for identifying early cognitive impairment, and patients with aMCI exhibit abnormal DTI-ALPS indices, suggesting that brain glymphatic system dysfunction may occur prior to morphological changes.

Objective To evaluate the consistency of multi-slice spiral CT (MSCT), Digital Radiography (DR) and fat-suppression MRI in detecting occult knee joint injury. Method Clinical data from 150 patients with suspected occult knee injuries who presented to the Department of imaging at the General Hospital of Ordnance Industry between August 2022 and August 2023 were retrospectively reviewed. All patients underwent MSCT, DR, and fat-suppression MRI for diagnostic evaluation. Arthroscopic or surgical findings served as the gold standard. We analyzed and compared the detection rates of specific types of occult knee injuries (ligament, meniscus, occult fracture, etc.) across the three modalities, as well as their ability to assess the degree of collapse and horizontal displacement in patients with knee fractures, and their overall diagnostic performance. Result According to the gold standard, among the 150 patients with suspected occult knee injury, 103 tested positive and 47 negative. Statistically significant differences were observed among MSCT, DR, and fat-suppression MRI in detecting occult fractures(P<0.05). The detection rates ranked in descending order asfollows: fat-suppression MRI>MSCT>DR. However, no significant difference were found in the detection rates of joint effusion and patellar cartilage injuries among the three techniques (P>0.05). Statistically differences were also note among the three techniques in detecting the degree of collapse and horizontal displacement in patients with knee fractures (P<0.05). Specifically fat-suppression MRI identified a higher proportion of grade 1 and 2 lesions than both MSCT and DR. Statistically significant differences were observed among the three techniques in diagnostic sensitivity and accuracy for occult knee injuries (P<0.05). Fat-suppression MRI demonstrated superior sensitivity (99.03%) and accuracy (96.67%) compared with MSCT (75.73%, 79.33%) and DR (61.17%, 68.00%). However, no significant difference was found in diagnostic specificity among the three techniques (P>0.05). Conclusion Compared with MSCT and DR, fat-suppression MRI offers higher diagnostic sensitivity and accuracy for occult knee injuries, particularly in identifying ligament injuries, meniscus injuries, and occult fractures.

Objective To explore the epidemiological characteristics of gouty arthritis in Northwest China from 2023 to 2025, and to formulate preventive intervention measures. Methods By retrospectively analyzing the case data of medical institutions in Northwest China from January 2023 to June 2025 (a total of 8 139 cases), the incidence trend and population distribution characteristics of gouty arthritis in this area were analyzed. Multivariate logistic regression analysis was performed to identify risk factors. Results From 2023 to 2025, the prevalence rate of gouty arthritis in adult residents in Northwest China was 3.74% (304/8 139). Among the sites affected by gouty arthritis, the metatarsophalangeal joint accounted for the highest proportion (P<0.05). From the perspective of age distribution, the prevalence rate was the highest in 40-59 years old group (5.90%), followed by 66-80 years old group (4.21%) and >80 years old group (2.75%). The incidence rate in 40-65 years old group was higher than that in the other age groups (P<0.05). High blood uric acid and creatinine, alcohol drinking, obesity, high purine diet, concurrent chronic kidney disease and metabolic syndrome were risk factors affecting gouty arthritis in Northwest China (P<0.05). Conclusion High blood uric acid level, high creatinine level, alcohol drinking, obesity, high purine diet, concurrent chronic kidney disease and metabolic syndrome are risk factors influencing gouty arthritis in Northwest China. Based on the above factors, this study proposes comprehensive prevention strategies from the individual, community and public health levels to provide a scientific basis for reducing the incidence rate of gouty arthritis.

Objective To evaluate the consistency of multi-slice spiral CT (MSCT), Digital Radiography (DR) and fat-suppression MRI in detecting occult knee joint injury. Method Clinical data from 150 patients with suspected occult knee injuries who presented to the Department of imaging at the General Hospital of Ordnance Industry between August 2022 and August 2023 were retrospectively reviewed. All patients underwent MSCT, DR, and fat-suppression MRI for diagnostic evaluation. Arthroscopic or surgical findings served as the gold standard. We analyzed and compared the detection rates of specific types of occult knee injuries (ligament, meniscus, occult fracture, etc.) across the three modalities, as well as their ability to assess the degree of collapse and horizontal displacement in patients with knee fractures, and their overall diagnostic performance. Result According to the gold standard, among the 150 patients with suspected occult knee injury, 103 tested positive and 47 negative. Statistically significant differences were observed among MSCT, DR, and fat-suppression MRI in detecting occult fractures(P<0.05). The detection rates ranked in descending order asfollows: fat-suppression MRI>MSCT>DR. However, no significant difference were found in the detection rates of joint effusion and patellar cartilage injuries among the three techniques (P>0.05). Statistically differences were also note among the three techniques in detecting the degree of collapse and horizontal displacement in patients with knee fractures (P<0.05). Specifically fat-suppression MRI identified a higher proportion of grade 1 and 2 lesions than both MSCT and DR. Statistically significant differences were observed among the three techniques in diagnostic sensitivity and accuracy for occult knee injuries (P<0.05). Fat-suppression MRI demonstrated superior sensitivity (99.03%) and accuracy (96.67%) compared with MSCT (75.73%, 79.33%) and DR (61.17%, 68.00%). However, no significant difference was found in diagnostic specificity among the three techniques (P>0.05). Conclusion Compared with MSCT and DR, fat-suppression MRI offers higher diagnostic sensitivity and accuracy for occult knee injuries, particularly in identifying ligament injuries, meniscus injuries, and occult fractures.

Objective To evaluate the consistency of multi-slice spiral CT (MSCT), Digital Radiography (DR) and fat-suppression MRI in detecting occult knee joint injury. Method Clinical data from 150 patients with suspected occult knee injuries who presented to the Department of imaging at the General Hospital of Ordnance Industry between August 2022 and August 2023 were retrospectively reviewed. All patients underwent MSCT, DR, and fat-suppression MRI for diagnostic evaluation. Arthroscopic or surgical findings served as the gold standard. We analyzed and compared the detection rates of specific types of occult knee injuries (ligament, meniscus, occult fracture, etc.) across the three modalities, as well as their ability to assess the degree of collapse and horizontal displacement in patients with knee fractures, and their overall diagnostic performance. Result According to the gold standard, among the 150 patients with suspected occult knee injury, 103 tested positive and 47 negative. Statistically significant differences were observed among MSCT, DR, and fat-suppression MRI in detecting occult fractures(P<0.05). The detection rates ranked in descending order asfollows: fat-suppression MRI>MSCT>DR. However, no significant difference were found in the detection rates of joint effusion and patellar cartilage injuries among the three techniques (P>0.05). Statistically differences were also note among the three techniques in detecting the degree of collapse and horizontal displacement in patients with knee fractures (P<0.05). Specifically fat-suppression MRI identified a higher proportion of grade 1 and 2 lesions than both MSCT and DR. Statistically significant differences were observed among the three techniques in diagnostic sensitivity and accuracy for occult knee injuries (P<0.05). Fat-suppression MRI demonstrated superior sensitivity (99.03%) and accuracy (96.67%) compared with MSCT (75.73%, 79.33%) and DR (61.17%, 68.00%). However, no significant difference was found in diagnostic specificity among the three techniques (P>0.05). Conclusion Compared with MSCT and DR, fat-suppression MRI offers higher diagnostic sensitivity and accuracy for occult knee injuries, particularly in identifying ligament injuries, meniscus injuries, and occult fractures.