Hepatocellular carcinoma(HCC),which is essentially primary liver cancer,is closely related to CD8+T cell immune infiltration and immune suppression.We constructed a CD8+T cells related risk score model to pre-dict the prognosis of HCC patients and provided therapeutic guidance based on the risk score.Using integrated bulk RNA sequencing(RNA-seq)and single-cell RNA sequencing(scRNA-seq)datasets,we identified stable CD8+T cell signatures.Based on these signatures,a 3-gene risk score model,comprised of KLRB1,RGS2,and TN-FRSF1B was constructed.The risk score model was well validated through an independent external validation co-hort.We divided patients into high-risk and low-risk groups according to the risk score and compared the differ-ences in immune microenvironment between these two groups.Compared with low-risk patients,high-risk patients have higher M2-type macrophage content(P＜0.0001)and lower CD8+T cells infiltration(P＜0.0001).High-risk patients predict worse response to immunotherapy treatment than low-risk patients(P＜0.01).Drug sensitivity a-nalysis shows that PI3K-β inhibitor AZD6482 and TGFβRII inhibitor SB505124 may be suitable therapies for high-risk patients,while the IGF-1R inhibitor BMS-754807 or the novel pyrimidine-based anti-tumor metabolic drug Gemcitabine could be potential therapeutic choices for low-risk patients.Moreover,expression of these 3-gene mod-el was verified by immunohistochemistry.In summary,the establishment and validation of a CD8+T cell-derived risk model can more accurately predict the prognosis of HCC patients and guide the construction of personalized treatment plans.

Objective To evaluate the efficacy of the manual cyclotorsion compensation method based on the obser-vation screen in the correction of with-the-rule astigmatism during small incision lenticule extraction(SMILE).Methods This prospective study enrolled 40 patients who underwent SMILE and another 40 patients who underwent Q-value-guided femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)at the Ophthalmology Center of the Second Affiliated Hospital of Nanchang University from April to September 2024.Through the random number method,one eye of each pa-tient who underwent SMILE was assigned to the manual cyclotorsion compensation group(the cyclotorsion group,40 eyes),while the contralateral eye was assigned to the non-cyclotorsion group(the non-cyclotorsion group,40 eyes).Meanwhile,one eye of each patient who underwent FS-LASIK was randomly selected for the FS-LASIK group(40 eyes).The age,uncorrected distance visual acuity(UDVA),spherical power,cylindrical power,spherical equivalent(SE),and corrected distance visual acuity(CDVA)were recorded before surgery and 3 months after surgery,respectively.Astigma-tism was subjected to Alpins vector analysis,and the indicators for assessing astigmatism included target-induced astigma-tism(TIA),surgically-induced astigmatism(SIA),difference vector(DV),correction index(CI),success index(IOS),angle of error(AE),and absolute value of angle of error(|AE|).Results Before surgery,there was no significant difference in age,spherical power,cylindrical power,SE,and CDVA among the cyclotorsion group,the non-cyclotorsion group,and the FS-LASIK group(all P＞0.05).At 3 months after surgery,the cyclotorsion group showed better UDVA and lower cylindrical power than the non-cyclotorsion group,with statistically significant differences(both P＜0.05);howev-er,there was no significant difference in CDVA,spherical power,and SE between the two groups(all P＞0.05).Besides,there was no significant difference in UDVA,CDVA,or refractive parameters between the cyclotorsion and FS-LASIK groups(all P＞0.05).The Alpins vector analysis of astigmatism 3 months after surgery revealed better SIA,CI,IOS,and|AE|in the cyclotorsion group compared with the non-cyclotorsion group,with statistically significant differences(all P＜0.05);however,there was no significant difference in TIA,DV,and AE between the two groups(all P＞0.05).No signifi-cant differences were found between the cyclotorsion and FS-LASIK groups in any astigmatism vector parameter(all P＞0.05).The linear regression analysis results indicated a high linear correlation between TIA and SIA in all groups.Conclu-sion The manual cyclotorsion compensation method based on the observation screen in the correction of with-the-rule astigmatism during SMILE is comparable to Q-value-guided FS-LASIK and superior to the conventional central tear film marking method in SMILE.

Objective To evaluate the efficacy of the manual cyclotorsion compensation method based on the obser-vation screen in the correction of with-the-rule astigmatism during small incision lenticule extraction(SMILE).Methods This prospective study enrolled 40 patients who underwent SMILE and another 40 patients who underwent Q-value-guided femtosecond laser-assisted laser in situ keratomileusis(FS-LASIK)at the Ophthalmology Center of the Second Affiliated Hospital of Nanchang University from April to September 2024.Through the random number method,one eye of each pa-tient who underwent SMILE was assigned to the manual cyclotorsion compensation group(the cyclotorsion group,40 eyes),while the contralateral eye was assigned to the non-cyclotorsion group(the non-cyclotorsion group,40 eyes).Meanwhile,one eye of each patient who underwent FS-LASIK was randomly selected for the FS-LASIK group(40 eyes).The age,uncorrected distance visual acuity(UDVA),spherical power,cylindrical power,spherical equivalent(SE),and corrected distance visual acuity(CDVA)were recorded before surgery and 3 months after surgery,respectively.Astigma-tism was subjected to Alpins vector analysis,and the indicators for assessing astigmatism included target-induced astigma-tism(TIA),surgically-induced astigmatism(SIA),difference vector(DV),correction index(CI),success index(IOS),angle of error(AE),and absolute value of angle of error(|AE|).Results Before surgery,there was no significant difference in age,spherical power,cylindrical power,SE,and CDVA among the cyclotorsion group,the non-cyclotorsion group,and the FS-LASIK group(all P＞0.05).At 3 months after surgery,the cyclotorsion group showed better UDVA and lower cylindrical power than the non-cyclotorsion group,with statistically significant differences(both P＜0.05);howev-er,there was no significant difference in CDVA,spherical power,and SE between the two groups(all P＞0.05).Besides,there was no significant difference in UDVA,CDVA,or refractive parameters between the cyclotorsion and FS-LASIK groups(all P＞0.05).The Alpins vector analysis of astigmatism 3 months after surgery revealed better SIA,CI,IOS,and|AE|in the cyclotorsion group compared with the non-cyclotorsion group,with statistically significant differences(all P＜0.05);however,there was no significant difference in TIA,DV,and AE between the two groups(all P＞0.05).No signifi-cant differences were found between the cyclotorsion and FS-LASIK groups in any astigmatism vector parameter(all P＞0.05).The linear regression analysis results indicated a high linear correlation between TIA and SIA in all groups.Conclu-sion The manual cyclotorsion compensation method based on the observation screen in the correction of with-the-rule astigmatism during SMILE is comparable to Q-value-guided FS-LASIK and superior to the conventional central tear film marking method in SMILE.

OBJECTIVE To explore the clinical characteristics of the nontuberculous Mycobacteria pulmonary dis-ease(NTMPD)patients with previous pulmonary tuberculosis(PPTB)and analyze the clinical difference from the recurrence of pulmonary tuberculosis.METHODS By means of retrospective survey,the patients who were diag-nosed with NTMPD and recurrent pulmonary tuberculosis in Wuhan Pulmonary Hospital from Mar.2021 to Oct.2023 were recruited as the research subjects,a total of 395 patients with NTMPD were enrolled in the study and were divided into the PPTB-NTMPD group with 92 cases and the NPPTB-NTMPD group with 303 cases according to the history of PPTB.The baseline data,clinical symptoms,imaging findings,underlying diseases,pulmonary diseases,and species of nontuberculous Mycobacteria(NTM)were observed and compared.Totally 92 patients with recurrent pulmonary tuberculosis were randomly screened and assigned as the recurrent pulmonary tuberculo-sis group in a 1:1 ratio by matching the PPTB-NTMPD group with the gender and age.The major clinical charac-teristics were compared between the two groups.The 92 patients with PPTB-NTMPD were divided into the 1-10 years group with 40 cases,the 10-30 years group with 37 cases,and the more than 30 years group with 15 cases according to the interval between the initial diagnosis of pulmonary tuberculosis and the diagnosis of NTMPD.The major clinical characteristics were compared among the groups.RESULTS The age was(64.21±10.71)years old in the PPTB-NTMPD group,(60.26±11.83)years old in the NPPTB-NTMPD group(t=3.020,P=0.003).The proportion of patients with body mass index less than 18.5 kg/m2 was 59.78％in the PPTB-NTMPD group,41.25％in the NPPTB-NTMPD group(x2=6.155,P=0.013);the proportion of patients with cough was 77.17％in the PPTB-NTMPD group,65.68％in the NPPTB-NTMPD group(x2=4.313,P=0.038);the inci-dence of cavitary shadow was 50.00％in the PPTB-NTMPD group,35.31％in the NPPTB-NTMPD group(x2=6.414,P=0.011);the incidence of emphysema and pulmonary bullae was 29.35％in the PPTB-NTMPD group,12.87％in the NPPTB-NTMPD group(x2=13.766,P＜0.001);the incidence of chronic obstructive pulmonary disease(COPD)was 22.83％in the PPTB-NTMPD group,14.19％in the NPPTB-NTMPD group(x2=3.875,P=0.049);the incidence of damaged lung was 9.78％in the PPTB-NTMPD group,2.97％in the NPPTB-NT-MPD group(x2=7.530,P=0.014);there were significant differences.Mycobacterium intracellulare and Myco-bacterium abscessus were the predominant species of NTM in both the PPTB-NTMPD group and the NPPTB-NT-MPD group,there was no significant difference in the distribution of NTM species between the two groups of pa-tients.The incidence of patch shadow of the PPTB-NTMPD group was lower than that of the recurrent pulmonary tuberculosis group(P＜0.05),the incidence of bronchiectatic shadow of the PPTB-NTMPD group was higher than that of the recurrent pulmonary tuberculosis group(P＜0.05).There were significant differences in the age,incidence of pleural thickening and incidence of COPD among the patients with different time intervals between ini-tial diagnosis of pulmonary tuberculosis and the diagnosis of NTMPD in the PPTB-NTMPD group(P＜0.05).CONCLUSIONS The previous pulmonary tuberculosis mainly affect the body mass index less than 18.5 kg/m2 and the post-tuberculosis pulmonary diseases such as cough,pulmonary cavity,emphysema,pulmonary bullae,COPD and damaged lung of the NTMPD patients.The NTMPD patients with previous pulmonary tuberculosis are more likely to have bronchiectasia than the patients with recurrent tuberculosis.It is necessary for the clinicians to attach great importance.

Objective To analyze the application effect of blunt dissection for myotomy of incision in single-port thoracoscopic lung wedge resection.Methods Patients who underwent single-port thoracoscopic lung wedge resection in our hospital from January to June 2024 were selected and divided into the observation group(32 cases,received blunt dissection for myotomy of incision during the surgery)and the control group(35 cases,received electrosurgical knife for myotomy of incision during the surgery)according to random number table method.The anesthesia time,operation time,intraoperative blood loss,the earliest time to get out of bed after the operation,the dosage of dezocine,and the resting and cough visual analogue scale(VAS)scores in each postoperative period of patients in the two groups were compared.Results There was no significant difference in terms of anesthesia time,operation time,intraoperative blood loss,or dosage of dezocine of patients between the two groups(P>0.05).The earliest time to get out of bed after operation of patients in the observation group was shorter than that in the control group,with significant difference(P<0.05).No significant difference was observed in resting VAS scores 6 hours or 12 hours after operation of patients in both two groups(P>0.05),but significant differences were found in resting VAS scores 24 hours and 48 hours after operation between the two groups(P<0.05).No significant difference was found in cough VAS scores 6 hours after operation of patients between the two groups(P>0.05),but significant differences were observed in cough VAS scores 12 hours,24 hours,and 48 hours after operation between the two groups(P<0.05).Conclusion Compared with electrosurgical knife for myotomy of incision,blunt dissection for myotomy of incision in single-port thoracoscopic lung wedge resection can reduce postoperative pain,promote postoperative ambulation for patients,which is beneficial to postoperative recovery.

Hepatocellular carcinoma(HCC),which is essentially primary liver cancer,is closely related to CD8+T cell immune infiltration and immune suppression.We constructed a CD8+T cells related risk score model to pre-dict the prognosis of HCC patients and provided therapeutic guidance based on the risk score.Using integrated bulk RNA sequencing(RNA-seq)and single-cell RNA sequencing(scRNA-seq)datasets,we identified stable CD8+T cell signatures.Based on these signatures,a 3-gene risk score model,comprised of KLRB1,RGS2,and TN-FRSF1B was constructed.The risk score model was well validated through an independent external validation co-hort.We divided patients into high-risk and low-risk groups according to the risk score and compared the differ-ences in immune microenvironment between these two groups.Compared with low-risk patients,high-risk patients have higher M2-type macrophage content(P＜0.0001)and lower CD8+T cells infiltration(P＜0.0001).High-risk patients predict worse response to immunotherapy treatment than low-risk patients(P＜0.01).Drug sensitivity a-nalysis shows that PI3K-β inhibitor AZD6482 and TGFβRII inhibitor SB505124 may be suitable therapies for high-risk patients,while the IGF-1R inhibitor BMS-754807 or the novel pyrimidine-based anti-tumor metabolic drug Gemcitabine could be potential therapeutic choices for low-risk patients.Moreover,expression of these 3-gene mod-el was verified by immunohistochemistry.In summary,the establishment and validation of a CD8+T cell-derived risk model can more accurately predict the prognosis of HCC patients and guide the construction of personalized treatment plans.

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.

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.

Objective To analyze the application effect of blunt dissection for myotomy of incision in single-port thoracoscopic lung wedge resection.Methods Patients who underwent single-port thoracoscopic lung wedge resection in our hospital from January to June 2024 were selected and divided into the observation group(32 cases,received blunt dissection for myotomy of incision during the surgery)and the control group(35 cases,received electrosurgical knife for myotomy of incision during the surgery)according to random number table method.The anesthesia time,operation time,intraoperative blood loss,the earliest time to get out of bed after the operation,the dosage of dezocine,and the resting and cough visual analogue scale(VAS)scores in each postoperative period of patients in the two groups were compared.Results There was no significant difference in terms of anesthesia time,operation time,intraoperative blood loss,or dosage of dezocine of patients between the two groups(P>0.05).The earliest time to get out of bed after operation of patients in the observation group was shorter than that in the control group,with significant difference(P<0.05).No significant difference was observed in resting VAS scores 6 hours or 12 hours after operation of patients in both two groups(P>0.05),but significant differences were found in resting VAS scores 24 hours and 48 hours after operation between the two groups(P<0.05).No significant difference was found in cough VAS scores 6 hours after operation of patients between the two groups(P>0.05),but significant differences were observed in cough VAS scores 12 hours,24 hours,and 48 hours after operation between the two groups(P<0.05).Conclusion Compared with electrosurgical knife for myotomy of incision,blunt dissection for myotomy of incision in single-port thoracoscopic lung wedge resection can reduce postoperative pain,promote postoperative ambulation for patients,which is beneficial to postoperative recovery.