Primary biliary cholangitis （PBC） is an autoimmune liver disease characterized by intrahepatic cholestasis， while fatigue is a common symptom of PBC that significantly affects the quality of life of patients. The pathogenesis of fatigue is complex and may be associated with the factors such as cholestasis-induced inflammation， gut microbiota dysbiosis， brain structural and functional abnormalities， and mitochondrial dysfunction. At present， first-line therapies and liver transplantation have a limited effect in alleviating fatigue， and there is still a lack of standardized comprehensive assessment system. Emerging drugs and non-pharmaceutical interventions， including lifestyle modifications， have shown potential application prospects. This article systematically reviews the research advances in the clinical manifestations， pathogenesis， clinical assessment， and intervention of fatigue in PBC patients， in order to provide a reference for optimizing treatment strategies and promoting the research and development of new therapies.

Lung transplantation is a definitive treatment for end-stage lung disease and can significantly improve patient prognosis. However, postoperative complications such as infection, rejection, ischemia-reperfusion injury and chronic lung allograft dysfunction intertwine to form a complex pathological network, posing persistent challenges to long-term patient survival. In 2025, research teams worldwide have made systematic progress in the field of basic lung transplantation research. By integrating cutting-edge technologies including single-cell multi-omics, spatial transcriptomics and novel animal models, significant breakthroughs have been achieved in the evolutionary dynamics of drug-resistant infections, molecular mechanisms of immune regulation, programmed cell death, optimization of donor lung protection strategies and early warning of chronic lung allograft dysfunction. This article systematically reviews the representative advances in basic lung transplantation research worldwide in 2025, and deeply analyzes the implications of mechanistic breakthroughs for optimizing diagnosis and treatment strategies, aiming to anchor the direction for innovative breakthroughs and clinical translation in basic lung transplantation research.

OBJECTIVE To conduct a literature review of one case of follicular lymphoma complicated with iliac bone Cryptococcus neoformans infection so as to raise the understanding of such pathogen in the field of HIV-negative Hodgkin's/non-Hodgkin's lymphoma.METHODS The clinical data were collected from one case of follicular lymphoma patient complicated with C.neoformans infection who was treated in Xinrui Hospital of Xin-wu District,Wuxi City on Feb.24,2023 and retrospectively analyzed.All of relevant literatures regarding to the subject were retrieved in Pubmed,CNKI,Wanfang and VIP databases,and the clinical data of the patients with HIV-negative Hodgkin's/non-Hodgkin's lymphoma with C.neoformans infection were screened out and summa-rized.RESULTS The case was a 28-year-old male and had the underlying disease of follicular lymphoma.The C.neoformans was detected by iliac bone histopathology and metagenome next generation sequencing(mNGS).The condition of the patient improved after the treatment with amphotericin B cholesterol sulphate com-pound and fluconazole.A total of 28 patients,with this case included,were involved in the literature review,23 of whom were male,and 5 were female,and the age ranged between 16 and 79 years old.With respect to major in-fection sites,there were 15(53.57％)cases of cerebral infection,9(32.14％)cases of blood infections,7(25.00％)cases of pulmonary infection,4(14.285％)cases of skin infections,2(7.14％)cases of muscle tis-sue infections,2(7.14％)cases of pleural effusion infections,2(7.14％)cases of bone infections and 1(3.57％)case of bone marrow infection.Totally 11 patients had disseminated Cryptococcus infection,accounting for 39.28％.CONCLUSIONS The C.neoformans infection is seldom detected in the patients with HIV-negative Hodgkin's/non-Hodgkin's lymphoma.The brain is the major infection site with the high probability of dissemina-ted infection.It is necessary for the hospital to deepen the understanding of the pathogen in the field of HIV-negative Hodgkin's/non-Hodgkin's lymphoma.

OBJECTIVE To conduct a literature review of one case of follicular lymphoma complicated with iliac bone Cryptococcus neoformans infection so as to raise the understanding of such pathogen in the field of HIV-negative Hodgkin's/non-Hodgkin's lymphoma.METHODS The clinical data were collected from one case of follicular lymphoma patient complicated with C.neoformans infection who was treated in Xinrui Hospital of Xin-wu District,Wuxi City on Feb.24,2023 and retrospectively analyzed.All of relevant literatures regarding to the subject were retrieved in Pubmed,CNKI,Wanfang and VIP databases,and the clinical data of the patients with HIV-negative Hodgkin's/non-Hodgkin's lymphoma with C.neoformans infection were screened out and summa-rized.RESULTS The case was a 28-year-old male and had the underlying disease of follicular lymphoma.The C.neoformans was detected by iliac bone histopathology and metagenome next generation sequencing(mNGS).The condition of the patient improved after the treatment with amphotericin B cholesterol sulphate com-pound and fluconazole.A total of 28 patients,with this case included,were involved in the literature review,23 of whom were male,and 5 were female,and the age ranged between 16 and 79 years old.With respect to major in-fection sites,there were 15(53.57％)cases of cerebral infection,9(32.14％)cases of blood infections,7(25.00％)cases of pulmonary infection,4(14.285％)cases of skin infections,2(7.14％)cases of muscle tis-sue infections,2(7.14％)cases of pleural effusion infections,2(7.14％)cases of bone infections and 1(3.57％)case of bone marrow infection.Totally 11 patients had disseminated Cryptococcus infection,accounting for 39.28％.CONCLUSIONS The C.neoformans infection is seldom detected in the patients with HIV-negative Hodgkin's/non-Hodgkin's lymphoma.The brain is the major infection site with the high probability of dissemina-ted infection.It is necessary for the hospital to deepen the understanding of the pathogen in the field of HIV-negative Hodgkin's/non-Hodgkin's lymphoma.

Objective:To elucidate the correlation between phase angle and malnutrition and to determine the cut-off value for phase angle to predict malnutrition in pancreatic cancer patients.Methods:This prospective cross-sectional study enrolled patients with pancreatic cancer hospitalized in the Department of Hepato-pancreato biliary Surgery at Beijing Hospital between December 2021 and March 2024. Baseline data, diet survey results, and body composition of these patients were recorded. Phase angle was measured with the InBody 720(Biospace, Korea). The Global Leadership Initiative on Malnutrition (GLIM) criteria were used to diagnose malnutrition.Results:A total of 110 cases (75 males and 35 females) aged 29-87(63.00±12.37) years were included. The prevalence of malnutrition was 63.6% (70/111) among the patients. Patients were divided into malnutrition ( n=77) and non-malnutrition ( n=33) groups as per the GLIM criteria. Phase angle was significantly lower in the malnutrition group than in the non-malnutrition group ( t=-3.808, P<0.001). Positive correlations were found between phase angle and body mass index, appendicular skeletal muscle mass index, fat-free mass index , fat-free mass, total energy intake, total protein, albumin, and prealbumin (all P<0.05).After adjusting for sex and age, low phase Angle remained an independent risk factor for malnutrition ( OR=3.809, 95% CI: 1.150-12.612, P=0.029). The cut-off values of phase angle for predicting malnutrition were 4.43 for males (with a sensitivity of 0.955, specificity of 0.585, area under the curve of 0.636; 95% CI: 0.508-0.763, P=0.037) and 4.54 for females (with a sensitivity of 1.000, specificity of 0.708, area under the curve of 0.799; 95% CI: 0.653-0.946, P<0.001). Conclusion:Phase angle may serve as a valid and simple indicator of malnutrition in pancreatic cancer patients.

Objective:To elucidate the correlation between phase angle and malnutrition and to determine the cut-off value for phase angle to predict malnutrition in pancreatic cancer patients.Methods:This prospective cross-sectional study enrolled patients with pancreatic cancer hospitalized in the Department of Hepato-pancreato biliary Surgery at Beijing Hospital between December 2021 and March 2024. Baseline data, diet survey results, and body composition of these patients were recorded. Phase angle was measured with the InBody 720(Biospace, Korea). The Global Leadership Initiative on Malnutrition (GLIM) criteria were used to diagnose malnutrition.Results:A total of 110 cases (75 males and 35 females) aged 29-87(63.00±12.37) years were included. The prevalence of malnutrition was 63.6% (70/111) among the patients. Patients were divided into malnutrition ( n=77) and non-malnutrition ( n=33) groups as per the GLIM criteria. Phase angle was significantly lower in the malnutrition group than in the non-malnutrition group ( t=-3.808, P<0.001). Positive correlations were found between phase angle and body mass index, appendicular skeletal muscle mass index, fat-free mass index , fat-free mass, total energy intake, total protein, albumin, and prealbumin (all P<0.05).After adjusting for sex and age, low phase Angle remained an independent risk factor for malnutrition ( OR=3.809, 95% CI: 1.150-12.612, P=0.029). The cut-off values of phase angle for predicting malnutrition were 4.43 for males (with a sensitivity of 0.955, specificity of 0.585, area under the curve of 0.636; 95% CI: 0.508-0.763, P=0.037) and 4.54 for females (with a sensitivity of 1.000, specificity of 0.708, area under the curve of 0.799; 95% CI: 0.653-0.946, P<0.001). Conclusion:Phase angle may serve as a valid and simple indicator of malnutrition in pancreatic cancer patients.

Objective:To evaluate the safety and complications of external cephalic version(ECV)for term breech presentation and to explore factors influencing the occurrence of ECV-related complications.Methods:Pregnant women with term breech presentation who underwent ECV(ECV group,n=751)and those who under-went direct cesarean section(CS)without ECV(CS group,n=706)at Guangzhou Women and Children's Medi-cal Center of Guangzhou Medical University,from January 1,2018,to July 31,2024,were enrolled.Differences in maternal clinical characteristics and neonatal outcomes were compared between the two groups.The ECV group was further divided into a successful ECV subgroup(n=537)and a failed ECV subgroup(n=214)to compare complication rates.Based on the presence or absence of complications,the ECV group was divided into a compli-cation subgroup(n=86)and a no-complication subgroup(n=665).Univariate analysis was performed on the clinical data of these subgroups.Statistically significant factors identified in the univariate analysis were subse-quently included in a multivariate Logistic regression analysis to identify high-risk factors for ECV complications.Results:①Among the 751 women undergoing ECV,the success rate was 71.50％(537/751).The vaginal deliv-ery rate following successful ECV was 57.26％(430/751).The overall complication rate was 11.45％(86/751),with a perinatal mortality rate of 0.13％(1/751).②There were no significant differences with regard to severe neonatal asphyxia and neonatal intensive care admission rate between ECV group and CS group(P＞0.05).③The total complication rate,incidence of cesarean delivery(CS)within 24 h,and incidence of uterine contrac-tions were significantly higher in the failed ECV group compared to the successful ECV group(P＜0.05).Howev-er,there was no statistically significant difference in the incidence of severe complications(fetal demise,placental abruption,emergency CS)between the two groups(P＞0.05).④Univariate and multivariate Logistic regression analyses revealed that three factors were associated with a reduced risk of ECV complications(P＜0.05):a high-er amniotic fluid index(AFI),non-engagement of the presenting part,and a palpable fetal head.Conversely,the use of anesthesia and the use of nifedipine as the tocolytic were associated with an increased risk of ECV compli-cations(P＜0.05).Conclusions:ECV does not increase the adverse outcomes of full-term neonates with breech presentation.But failed ECV can increase complications.Higher amniotic fluid index,not engaged of fetal presen-tation,touchable of fetal head and appropriate tocolytic agent application can reduce the complications while anes-thesia during ECV procedure can increase the complications of ECV.

Objective:To analyze the disease burden and changing trend of pancreatic cancer in our country from 1990 to 2021, and predict the incidence and mortality trends of pancreatic cancer from 2022 to 2036.Methods:Utilizing the data from the Global Burden of Disease 2021 Study, the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and disability-adjusted life rate (DALY) of pancreatic cancer in our country from 1990 to 2021 were evaluated. DALY is calculated by adding the number of years of life lost due to pancreatic cancer to the years of life lost due to disability. The Joinpoint model was used to calculate the average annual percentage change (AAPC), the age-period-cohort model was applied to control the influence of age, period and birth cohort, and the Bayesian age-period-cohort model was used to predict the incidence and mortality trends of pancreatic cancer in our country from 2022 to 2036.Results:Compared with 1990, the data of ASIR, ASMR and age-standardized disability-adjusted life years (DALY) rates of pancreatic cancer in our country in 2021 all increased, and the increase in men was more significant than that in women. The peaks of morbidity and mortality in 1990 and 2021 were both occurred in the elderly. The incidence rate, mortality rate and changes of men in all age groups were higher than those of women. The changes in the age-standardized DALY rate were mainly reflected in the male population. The first peaks of the age-standardized DALY rate in 1990 and 2021 both occurred at the age of 70-74, and the second peak of the age-standardized DALY rate in 2021 shifted to the age of 85-89. The peak rate of age-standardized DALY in females is earlier than that in males. The AAPC of ASIR and ASMR for all genders of pancreatic cancer in our country from 1990 to 2021 was 0.72 (95% CI: 0.50-0.94, P<0.001) and 0.56 (95% CI: 0.31-0.82, P<0.001), respectively, and the difference was statistically significant. In our country men with pancreatic cancer, ASIR (AAPC=0.89, 95% CI: 0.68-1.10, P<0.001) and ASMR (AAPC=0.71, 95% CI: 0.49-0.93, P<0.001) were compared with ASIR (AAPC=0.48, 95% CI: ) in women. 0.22-0.73, P<0.001) and ASMR (AAPC=0.33, 95% CI: 0.08-0.58, P=0.010) increased rapidly, and the difference was statistically significant. The ASDR of all genders showed an upward trend (AAPC=0.36, 95% CI: 0.18-0.54, P<0.001), and the difference was statistically significant. The incidence rate and mortality rate of all genders are on the rise. When the age of the population is over 60 years old, the incidence and mortality of specific diseases show an upward trend with the delay of the birth cohort. It is expected that from 2022 to 2036, the ASIR and ASMR of both men and women will increase annuallyand eventually double. Conclusion:From 1990 to 2021, the burden of pancreatic cancer in our country has generally shown an increasing trend, and it is expected that the disease burden will further increase in the future.

Objective:To evaluate the safety and complications of external cephalic version(ECV)for term breech presentation and to explore factors influencing the occurrence of ECV-related complications.Methods:Pregnant women with term breech presentation who underwent ECV(ECV group,n=751)and those who under-went direct cesarean section(CS)without ECV(CS group,n=706)at Guangzhou Women and Children's Medi-cal Center of Guangzhou Medical University,from January 1,2018,to July 31,2024,were enrolled.Differences in maternal clinical characteristics and neonatal outcomes were compared between the two groups.The ECV group was further divided into a successful ECV subgroup(n=537)and a failed ECV subgroup(n=214)to compare complication rates.Based on the presence or absence of complications,the ECV group was divided into a compli-cation subgroup(n=86)and a no-complication subgroup(n=665).Univariate analysis was performed on the clinical data of these subgroups.Statistically significant factors identified in the univariate analysis were subse-quently included in a multivariate Logistic regression analysis to identify high-risk factors for ECV complications.Results:①Among the 751 women undergoing ECV,the success rate was 71.50％(537/751).The vaginal deliv-ery rate following successful ECV was 57.26％(430/751).The overall complication rate was 11.45％(86/751),with a perinatal mortality rate of 0.13％(1/751).②There were no significant differences with regard to severe neonatal asphyxia and neonatal intensive care admission rate between ECV group and CS group(P＞0.05).③The total complication rate,incidence of cesarean delivery(CS)within 24 h,and incidence of uterine contrac-tions were significantly higher in the failed ECV group compared to the successful ECV group(P＜0.05).Howev-er,there was no statistically significant difference in the incidence of severe complications(fetal demise,placental abruption,emergency CS)between the two groups(P＞0.05).④Univariate and multivariate Logistic regression analyses revealed that three factors were associated with a reduced risk of ECV complications(P＜0.05):a high-er amniotic fluid index(AFI),non-engagement of the presenting part,and a palpable fetal head.Conversely,the use of anesthesia and the use of nifedipine as the tocolytic were associated with an increased risk of ECV compli-cations(P＜0.05).Conclusions:ECV does not increase the adverse outcomes of full-term neonates with breech presentation.But failed ECV can increase complications.Higher amniotic fluid index,not engaged of fetal presen-tation,touchable of fetal head and appropriate tocolytic agent application can reduce the complications while anes-thesia during ECV procedure can increase the complications of ECV.

Objective:To report the nationwide surveillance results of pathogenic profiles and antimicrobial resistance patterns of Gram-positive bloodstream infections in China in 2023.Methods:The clinical isolates of Gram-posttive bacteria from blood cultures were collected in member hospitals of National Bloodstream Infection Bacterial Resistant Investigation Collaborative System（BRICS）during January to December 2023. Antimicrobial susceptibility testing was performed using the dilution method recommended by the Clinical and Laboratory Standards Institute（CLSI）. Statistical analyses were conducted using WHONET 5.6 and SPSS 25.0 software.Results:A total of 4 385 Gram-positive bacterial isolates were obtained from 60 participating center. The top five pathogens were Staphylococcus aureus（ n=1 544，35.2%），coagulase-negative Staphylococci（ n=1 441，32.9%）， Enterococcus faecium（ n=574，13.1%）， Enterococcus faecalis（ n=385，8.8%），and α-hemolytic Streptococci（ n=187，4.3%）. The prevalence of methicillin-resistant Staphylococcus aureus（MRSA）and methicillin-resistant coagulase-negative Staphylococci（MRCNS）was 26.2%（405/1 544）and 69.8%（1 006/1 441），respectively. Notably，all Staphylococci remained susceptible to glycopeptide or daptomycin. Staphylococcus aureus demonstrated excellent susceptibility（>97.0%）to cephalobiol，rifampicin，trimethoprim-sulfamethoxazole，linezolid，minocycline，tigecycline，and eravacycline. No Enterococcus exhibiting resistance to linezolid were detected. Glycopeptide resistance was uncommon but more frequent in Enterococcus faecium（resistance to vancomycin and teicoplanin：both 1.7%）compared to Enterococcus faecalis（both 0.3%）. The detection rates of MRSA and MRCNS exhibited significant regional variations across the country（ χ2=17.674 and 148.650，respectively，both P<0.001）. No vancomycin-resistant Enterococci were detected in central China. Institutional comparison demonstrated higher prevalence of MRSA（ χ2=14.111， P<0.001）and MRCNS（ χ2=4.828， P=0.028）in provincial hospitals than that in municipal hospitals. Socioeconomic analysis identified elevated detection rates of both MRSA（ χ2=18.986， P<0.001）and MRCNS（ χ2=4.477， P=0.034）in less developed regions（per capita GDP