Lung transplantation is currently the only effective treatment for end-stage lung disease. However, the field of lung transplantation still faces numerous challenges, including donor shortage, primary graft dysfunction, rejection, infection and others. In 2025, scholars worldwide have made remarkable progress in clinical research on lung transplantation. This article systematically reviews the cutting-edge developments in clinical research on lung transplantation in 2025, focusing on the application of novel evaluation tools in donor lung screening, optimization of lung perfusion techniques, exploration of extracorporeal membrane oxygenation and robot-assisted minimally invasive surgery, as well as mechanistic research and intervention strategies for primary graft dysfunction, acute kidney injury and chronic lung allograft dysfunction. Meanwhile, hot topics such as the management of special populations, prevention and control of postoperative infections, and improvement of quality of life are summarized. This review aims to conclude the important annual research findings and provide references for the clinical practice and research development of lung transplantation in China.

ObjectiveTo establish three standardized rehabilitation unit models covering acute, critical and comprehensive recovery stages for traumatic brain injury (TBI) that fit the whole-course characteristics, clarify their multidisciplinary collaborative framework, standardized procedures, and information management system, and verify the clinical effectiveness of this staged rehabilitation unit on long-term functional prognosis and in-hospital complications of TBI patients. MethodsThis study was conducted at two stages: model construction and efficacy verification. At the first stage, TBI rehabilitation units for acute, critical and recovery stages were established in the Department of Neurosurgery, Intensive Care Unit and Department of Rehabilitation Medicine, respectively, with unified multidisciplinary team configuration, standardized assessment and treatment protocols, collaborative workflows, and a dedicated information management system. At the second stage, 324 TBI patients admitted to the newly built rehabilitation units from July, 2023 to July, 2025 were enrolled as the observation group, and 167 TBI patients receiving traditional management from January, 2018 to December, 2022 were retrospectively selected as the control group. The primary outcomes were 1-year post-injury Glasgow Outcome Scale (GOS) and Disability Rating Scale (DRS) scores. Secondary outcomes included the incidence of in-hospital complications and the mean indwelling time of tracheal intubation, gastric tube and urinary catheter. ResultsThe 1-year GOS score was significantly higher (t = -7.836, P < 0.001), and the DRS score was significantly lower (t = -6.742, P < 0.001) in the observation group than in the control group. The overall incidence of complications was significantly lower in the observation group than in the control group (χ² = 18.762, P < 0.001). The incidences of pulmonary infection, urinary tract infection, pressure ulcer, lower extremity venous thrombosis and joint contracture deformity were all significantly reduced (χ² > 4.328, P < 0.05). The indwelling time of tracheal intubation, gastric tube and urinary catheter was significantly shorter in the observation group than in the control group (t > 10.276, P < 0.001). ConclusionThe acute-critical-comprehensive three-stage standardized TBI rehabilitation unit could significantly improve the long-term functional outcomes of TBI patients, reduce the incidence of complications, and shorten the indwelling time of invasive tubes through multidisciplinary collaboration, whole-course standardized management and information-based quality control. This model conforms to the pathological and functional laws of TBI, realizes seamless whole-course connection from acute treatment to recovery rehabilitation, and has good clinical feasibility and promotion value. It can provide evidence-based evidence and practical reference for the homogenized and standardized development of TBI rehabilitation in China.

Objective To investigate the clinical characteristics of patients with clinical and subclinical Cushing's syndrome caused by primary bilateral macronodular adrenal hyperplasia(PBMAH).Methods A retrospective analysis was performed on the clinical data of 198 patients with Cushing's syndrome caused by PBMAH diagnosed in the First Medical Center of Chinese PLA General Hospital from January 2004 to October 2024.According to clinical manifestations,the patients were classified into clinical type Cushing's syndrome(n=61)and subclinical type Cushing's syndrome(n=137),and the clinical characteristics of the two types were compared.Results The mean age at diagnosis of patients with PBMAH-induced Cushing's syndrome was(53.5±10.4)years,including 118 males and 80 females,with a male-to-female ratio of 1.475:1.Compared with the subclinical type,the clinical type had a higher proportion of females,higher levels of serum cortisol,24-hour urine free cortisol(24 h UFC),and inhibited serum cortisol after low-dose dexamethasone suppression.Additionally,the clinical type had lower plasma ACTH,larger adrenal nodules and a higher risk of surgery(P<0.05)compared with those in subclinical type.The incidences of hypertension,dyslipidemia,obesity,diabetes mellitus,hypokalemia,vitamin D deficiency,osteoporosis,coronary heart disease,and cerebrovascular disease in patients with Cushing's syndrome caused by PBMAH were 87.9%,50.5%,37.1%,36.9%,27.8%,25.9%,18.7%,18.7%and 12.1%,respectively.Among them,compared with subclinical type patients,clinical type patients had higher incidence of hypokalaemia,vitamin D deficiency and osteoporosis(P<0.05),while there were no statistically significant differences in the incidences of other comorbidities between the two types(P>0.05).The results of postoperative follow-up for PBMAH patients showed that the short-term biochemical remission rate of unilateral total adrenalectomy was 41.5%(22/53)and the long-term biochemical remission rate was 32.0%(8/25).The short-term biochemical remission rate of unilateral partial(or nodular)adrenalectomy was 52.9%(9/17),and the long-term biochemical remission rate was 14.3%(1/7).All patients who underwent unilateral total adrenalectomy plus contralateral partial resection developed adrenal insufficiency(3/3),and 1 patient(1/3)relapsed 3.4 years after surgery.Conclusion Clinical and subclinical types of Cushing's syndrome caused by PBMAH have their distinct clinical characteristics.Surgery is an effective treatment for PBMAH,but a certain proportion of patients fail to achieve biochemical remission after non-bilateral total adrenalectomy.

This article reports a first case of combined infection with severe fever with thrombocytopenia syndrome(SFTS)and scrub typhus in Dalian City.The patient was admitted to the hospital due to recurrent fever for 7 days and loss of consciousness for 1 day.Pathogen metagenomic sequencing(mNGS),SFTSV quantitative PCR,and enzyme-linked immunosorbent assay(ELISA)IgM tests were performed,showing positive results for Orientia tsutsugamushi and SFTSV nucleic acids.Based on clinical manifestations and epidemiological history,the patient was diagnosed with combined infections.

Objective To analyze the characteristics of spirometry and type 2 inflammation indicators of patients with CVA,ACO and CA to determine their clinical utility in identifying and distinguishing among CVA,ACO and CA patients.Methods Clinical data from 483 patients diagnosed with bronchial asthma,CVA,and bronchial asthma combined with chronic obstructive pulmonary disease in the outpatient department of the First Affiliated Hospital of Soochow University from July 2023 to June 2024 were collected and divided into CA,CVA and ACO groups according to diagnosis.Comparison of spirometry,fractional exhaled nitric oxide(FeNO),blood eosinophil(EOS),serum total immunoglobulin E(tIgE)and other tests between CA and CVA,CA and ACO groups.Perform logistic regression analysis on significant test results,then construct receiver operating characteristic(ROC)curves to compare the area under the curve and corresponding cut-off values.Result There was a statistically significant difference in tIgE between the CVA and CA groups(P=0.018),whereas no significant differences were observed in FeNO and EOS.Additionally,no notable differences were found between the ACO and CA groups in tIgE,FeNO,or EOS.Finally,FEV1％pred(OR=1.086,P=0.019),FEV1/FVC(OR=1.153,P=0.023),and MEF50％pred(OR=0.922,P=0.045)were used to construct the discriminative model between CA and CVA.ROC curves were plotted,with FEV1％pred showing an AUC of 0.680(P<0.001),a Youden index of 0.358,and a corresponding cutoff value of 89.200.FEV1/FVC had an AUC of 0.684(P<0.001),a Youden index of 0.334,and a cutoff value of 76.075.MEF50％pred had an AUC of 0.668(P<0.001),a Youden index of 0.309,and a cutoff value of 59.800.The combined sensitivity of these three measures was 0.909,specificity was 0.514,positive predictive value was 0.600,negative predictive value was 0.873,and the AUC was 0.773(P<0.001),with a Youden index of 0.423.FEV1(OR=0.002,P=0.045),FEV1％pred(OR=1.490,P=0.006),and FEV1/FVC(OR=0.749,P=0.005)were used to construct the discriminative model between CA and ACO.ROC curves were plotted,with FEV1 showing an AUC of 0.819(P<0.001),a Youden index of 0.532,and a corresponding cutoff value of 2.060.FEV1％pred had an AUC of 0.788(P<0.001),a Youden index of 0.501,and a cutoff value of 75.000.FEV1/FVC had an AUC of 0.891(P<0.001),a Youden index of 0.678,and a cutoff value of 68.620.The combined sensitivity of these three measures was 1.000,specificity was 0.904,positive predictive value was 0.771,negative predictive value was 1.000,and the AUC was 0.973(P<0.001),with a Youden index of 0.904.Conclusions Differences exist in the spirometry among CVA,ACO and CA.The spirometry results incor-porated into the discriminative models provide good discriminative value for distinguishing between CA and CVA patients with similar clinical symptoms,as well as for identifying ACO in the CA population.

Objective To analyze the characteristics of spirometry and type 2 inflammation indicators of patients with CVA,ACO and CA to determine their clinical utility in identifying and distinguishing among CVA,ACO and CA patients.Methods Clinical data from 483 patients diagnosed with bronchial asthma,CVA,and bronchial asthma combined with chronic obstructive pulmonary disease in the outpatient department of the First Affiliated Hospital of Soochow University from July 2023 to June 2024 were collected and divided into CA,CVA and ACO groups according to diagnosis.Comparison of spirometry,fractional exhaled nitric oxide(FeNO),blood eosinophil(EOS),serum total immunoglobulin E(tIgE)and other tests between CA and CVA,CA and ACO groups.Perform logistic regression analysis on significant test results,then construct receiver operating characteristic(ROC)curves to compare the area under the curve and corresponding cut-off values.Result There was a statistically significant difference in tIgE between the CVA and CA groups(P=0.018),whereas no significant differences were observed in FeNO and EOS.Additionally,no notable differences were found between the ACO and CA groups in tIgE,FeNO,or EOS.Finally,FEV1％pred(OR=1.086,P=0.019),FEV1/FVC(OR=1.153,P=0.023),and MEF50％pred(OR=0.922,P=0.045)were used to construct the discriminative model between CA and CVA.ROC curves were plotted,with FEV1％pred showing an AUC of 0.680(P<0.001),a Youden index of 0.358,and a corresponding cutoff value of 89.200.FEV1/FVC had an AUC of 0.684(P<0.001),a Youden index of 0.334,and a cutoff value of 76.075.MEF50％pred had an AUC of 0.668(P<0.001),a Youden index of 0.309,and a cutoff value of 59.800.The combined sensitivity of these three measures was 0.909,specificity was 0.514,positive predictive value was 0.600,negative predictive value was 0.873,and the AUC was 0.773(P<0.001),with a Youden index of 0.423.FEV1(OR=0.002,P=0.045),FEV1％pred(OR=1.490,P=0.006),and FEV1/FVC(OR=0.749,P=0.005)were used to construct the discriminative model between CA and ACO.ROC curves were plotted,with FEV1 showing an AUC of 0.819(P<0.001),a Youden index of 0.532,and a corresponding cutoff value of 2.060.FEV1％pred had an AUC of 0.788(P<0.001),a Youden index of 0.501,and a cutoff value of 75.000.FEV1/FVC had an AUC of 0.891(P<0.001),a Youden index of 0.678,and a cutoff value of 68.620.The combined sensitivity of these three measures was 1.000,specificity was 0.904,positive predictive value was 0.771,negative predictive value was 1.000,and the AUC was 0.973(P<0.001),with a Youden index of 0.904.Conclusions Differences exist in the spirometry among CVA,ACO and CA.The spirometry results incor-porated into the discriminative models provide good discriminative value for distinguishing between CA and CVA patients with similar clinical symptoms,as well as for identifying ACO in the CA population.

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

Objective:To report the results of bacterial resistant investigation collaborative system（BRICS）on the distribution and antimicrobial resistance profile of clinical Gram-negative bacteria isolates from bloodstream infections in China in 2023，and provide reference for clinical tretment of bloodstream infections and prevention and control of bacterial resistance.Methods:The clinical isolates of Gram-negative bacteria from blood cultures in member hospitals of BRICS were collected during January 2023 to December 2023. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical and Laboratory Standards Institute（CLSI）. WHONET 5.6 and SPSS 25.0 were used to analyze the data.Results:During the study period，11 492 strains of Gram-negative bacteria were collected from 60 hospitals，of which 10 098（87.9%）were Enterobacterales and 1 394（12.1%）were non-fermentative bacteria. The top 5 bacterial species were Escherichia coli（50.0%）， Klebsiella pneumoniae（26.1%）， Pseudomonas aeruginosa（5.1%）， Acinetobacter baumannii complex（5.0%）and Enterobacter cloacae complex（4.1%）. The ESBL-producing rates in Escherichia coli， Klebsiella pneumoniae and Proteus mirablilis were 46.8%（2 685/5 741），18.3%（549/2 999）and 44.0%（77/175），respectively. The prevalence of carbapenem-resistant Escherichia coli（CREC）and carbapenem-resistant Klebsiella pneumoniae（CRKP）were 1.3%（76/5 741）and 15.0%（450/2 999）；32.9%（25/76）and 78.0%（351/450）of CREC and CRKP were sensitive to ceftazidime/avibactam combination，respectively. 94.7%（72/76）and 90.2%（406/450）of CREC and CRKP were sensitive to aztreonam/avibactam combination. Furthermore，57.9%（44/76）and 79.1%（356/450）were sensitive to imipenem/relebactam combination. The prevalence of carbapenem-resistant Acinetobacter baumannii（CRAB）complex was 64.6%（370/573），while more than 80.0% of CRAB complex was sensitive to tigecycline，eravacycline and polymyxin B. The prevalence of carbapenem-resistant Pseudomonas aeruginosa（CRPA）was 17.0%（99/581）. There were differences in the composition ratio of Gram-negative bacteria in bloodstream infections and the prevalence of important Gram-negative bacteria resistance among different regions in China，with statistically significant differences in the prevalence of CREC，CRKP，CRPA and CRAB complex（ χ2=10.6，28.6，10.8 and 19.3， P<0.05）. The prevalence of ESBL-producing Escherichia coli， CREC，CRAB complex and CRKP were higher in provincial hospitals than those in municipal hospitals（ χ2=12.5，9.8，12.7 and 57.8，all P<0.01）. Conclusions:Gram-negative bacteria are the main pathogens causing bloodstream infections in China，and Escherichia coli is ranked in the top，while the trend of Klebsiella pneumoniae increases continuously with time. CRKP infection shows a slow upward trend，CREC infecton maintains a low prevalence level，and CRAB complex infection continues to exhibit a high prevalence rate. The composition and resistance patterns of pathogens causing bloodstream infections vary to some extent across different regions and levels of hospitals in China.

Objective:To explore the epidemiological characteristics, imaging findings, pulmonary function changes, dust exposure situations, and treatment outcomes of accelerated silicosis through an analysis of existing literature.Methods:In December 2024, relevant literature from January 1, 1965 to December 15, 2024 was retrieved through the China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database, EMbase, and PubMed databases. Keywords included "rapidly progressive silicosis" "accelerated silicosis" "subacute silicosis""artificial stone" and related terms. By incorporating, analyzing, and retrieving data from literatures, a comprehensive review of the epidemiology, clinical features, treatment options, and prognosis of fast forward silicosis was conducted.Results:A total of 72 literatures were included, including 23 cohort studies, 28 case reports, 3 case-control studies, and 18 cross-sectional studies. The average age of all 1794 patients was 33.67 years, with an average dust exposure duration of 5.58 years. The primary occupations associated with accelerated silicosis were stone processing, mining, and artificial quartz stone manufacturing. Imaging findings predominantly included small nodules, ground-glass opacities, and massive fibrosis. Antifibrotic treatment at the early stage of the disease could clearly delay disease progression. However, dust concentrations in workplaces were significantly above safety limits, with inadequate protective measures.Conclusion:Accelerated silicosis is characterized by its rapid onset, swift progression, and unfavorable prognosis. However, it has not garnered adequate attention in the present context. Reliable standard and guidelines are urgently needed to guide clinical diagnosis and treatment.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.