Autoimmune hepatitis (AIH) is a chronic, immune-mediated liver injury of unknown etiology. The onset of this disease involves the activation and recruitment of diverse immune and non-immune cells, which in turn trigger hepatic damage. Immune checkpoint molecules (ICM) are expressed on the surface of multiple cell types. By regulating cellular functional states, they help limit the intensity and duration of immune responses, thereby preventing excessive inflammation and tissue damage, and maintaining immune homeostasis. In AIH, however, this natural "braking" mechanism is impaired, leading to aberrant activation of both immune and non-immune cells and the breakdown of immune homeostasis. Consequently, ICM are likely to play a critical role in the pathogenesis of AIH. A deeper understanding of the function of ICM in AIH not onlyadvances our insight into the disease mechanism, but also suggests that targeting these molecules may represent a promising therapeutic strategy for the treatment of AIH.

Based on spleen deficiency-phlegm dampness as the core pathogenesis of obesity， and integrating recent advances in modern medicine regarding the key role of immune inflammation in obesity， this paper proposes a multidimensional pathogenic network of "obesity-spleen deficiency-phlegm dampness-immune imbalance". Various traditional Chinese medicine （TCM） herbs that strengthen the spleen， regulate qi， and resolve phlegm and dampness can treat obesity by improving spleen-stomach transport and transformation， promoting water-damp metabolism， and regulating immune homeostasis. This highlights immune inflammation as an important entry point to elucidate the TCM concepts of "spleen deficiency-phlegm dampness" and the therapeutic principle of "strengthening the spleen and eliminating dampness to treat obesity". By systematically analyzing the intrinsic connection between "spleen deficiency generating dampness， internal accumulation of phlegm dampness" and immune dysregulation in obesity， this paper aims to provide theoretical support for TCM treatment of obesity based on dampness.

Objective To explore the clinical characteristics of patients with diffuse large B-cell lymphoma (DLBCL) accompanied with KMT2D gene mutation and the impact of its co-mutated genes on prognosis. Methods Clinical data of 155 newly diagnosed DLBCL patients were obtained. The second-generation sequencing method was used to detect 475 hotspot genes, including KMT2D mutation. Patients were divided into the KMT2D mutation group and KMT2D wild-type group based on the presence or absence of KMT2D gene mutation. Clinical characteristics, differences in co-mutated genes, and survival differences between the two groups were compared. Results The frequency of KMT2D mutation was 31%, which is predominantly observed in elderly patients (P=0.07) and less in the double-expressor phenotype (P=0.07). Compared with the KMT2D wild-type group, KMT2D gene mutation was associated with higher co-mutation rates of CDKN2A (OR=2.82, P=0.01) and BCL2 (OR=3.84, P=0.016), while being mutually exclusive with MYC gene mutation (OR=0.11, P=0.013). In univariate survival analysis, no statistically significant difference in overall survival (OS) was found between the KMT2D mutation group and the wild-type group (P=0.54). Further analysis of the prognostic significance of KMT2D with other gene mutations indicated that patients with KMT2D^mutBTG2^mut had poorer OS than those with KMT2D^wt BTG2^mut (P=0.07) and KMT2D^wt BTG2^wt (P=0.05). On the contrary, patients with KMT2D^mut CD79B^mut had better OS than those with KMT2D^mut CD79B^wt (P=0.09), with no prognostic impact observed for other co-mutated genes. Multivariate Cox regression analysis revealed that Ann Arbor stages Ⅲ and Ⅳ (HR=2.751, 95%CI: 1.169-6.472, P=0.02), elevated LDH levels (HR=2.461, 95%CI: 1.396-4.337, P=0.002), Ki-67 index>80% (HR=1.875, 95%CI: 1.066-3.299, P=0.029), and KMT2D^mutBTG2^mut(HR=4.566, 95%CI: 1.348-15.471, P=0.015) were independent risk factors for OS in patients with DLBCL (P<0.05). Conclusion DLBCL patients with KMT2D mutation often have multiple gene mutations, among which patients with a co-mutated BTG2 gene have poor prognosis.

ObjectiveTo understand the infection characteristics of multidrug-resistant organisms (MDROs) in hospitalized patients in a tertiary sentinel hospital in Shanghai, so as to provide an evidence for the development of targeted prevention and control measures. MethodsData of MDROs strains and corresponding medical records of some hospitalized patients in a hospital in Shanghai from 2021 to 2023 were collected, together with an analysis of the basic information, clinical treatment, underlying diseases and sources of sample collection. ResultsA total of 134 strains of MDROs isolated from hospitalized patients in this hospital were collected from 2021 to 2023 , including 63 strains of methicillin-resistant Staphylococcus aureus (MRSA), 57 strains of carbapenem-resistant Acinetobacter baumannii (CRAB), and 14 strains of carbapenem-resistant Klebsiella pneumoniae (CRKP). Of the 134 strains, 30 strains were found in 2021, 47 strains in 2022 and 57 strains in 2023. The male-to-female ratio of patients was 2.05∶1, with the highest percentage (70.90%) in the age group of 60‒<90 years. The primary diagnosis was mainly respiratory disease, with lung and respiratory tract as the cheif infection sites. There was no statistically significant difference in the distribution of strains between different genders and infection sites (P>0.05). However, the differences in the distribution of strains between different ages and primary diagnosis were statistically significant (P<0.05). Patients who were admitted to the intensive care unit (ICU), had urinary tract intubation, were not artery or vein intubated, were not on a ventilator, were not using immunosuppresants or hormones, and were not applying radiotherapy or chemotherapy were in the majority. There was no statistically significant difference in the distribution of strains for whether received radiotherapy or chemotherapy or not (P>0.05), while the differences in the distribution of strains with ICU admission history, urinary tract intubation, artery or vein intubation, ventilator use, and immunosuppresants or hormones use or not were statistically significant (all P<0.05). The type of specimen was mainly sputum, the hospitalized ward was mainly comprehensive ICU, the sampling time was mainly in the first quarter throughout the year, the number of underlying diseases was mainly between 1 to 2 kinds, the application of antibiotics ≥4 kinds, and those who didn’t receive any surgery recently accounted for the most. There were statistically significant differences in the distribution of strains between different specimen types, wards occupied and history of ICU stay (P<0.05), but no statistically significant difference in the distribution of strains between different sampling times, number of underlying diseases and types of antibiotics applied (P>0.05). ConclusionThe situation of prevention and control on MDROs in this hospital is still serious. Focus should be placed on high-risk factors’ and infection monitoring and preventive measures should be strengthened to reduce the incidence rate of MDROs infection.

Objective To understand the pathogenic molecular characteristics of the latest prevalent Group A Streptococcus(GAS)in a suburban area of Beijing.Methods Throat swab specimens from children suspected of GAS infection in the outpatient setting of a sentinel surveillance hospital in a suburban area of Beijing from January 2023 to June 2025 were collected.GAS strains were detected and cultured.Antimicrobial susceptibility testing on 12 antimicrobial agents were performed,and molecular epidemiological characteristics of GAS strains was further ana-lyzed by whole genome sequencing technique.Results Data of 326 children suspected of GAS infection in outpatient setting were collected.A total of 41 GAS strains were detected and cultured,with a detection rate of 12.58％.The proportions of children with anterior cervical lymph node enlargement,tonsil congestion,and jaw congestion in the GAS positive group were all higher than those in the GAS negative group,and differences were all statistically sig-nificant(all P＜0.05).All 41 GAS strains carried both erm(B)and tet(M)resistance genes and exhibited a struc-tural type(cMLS)resistance phenotype.All of the emm12 strains were ST36,and emm1 strains were ST28.A to-tal of 6 emm12 subtypes and 1 emm1 subtype were detected,namely emm12.2,emm12.95,emm12.69,emm12.17,emm12.19,emm12.149,and emm1.12.Among them,emm12.149 was a newly discovered subtype.Nucleobase at the 175 100 locus in gene sequence had undergone an A→ T mutation.A total of 5 bacteriophages and 6 superanti-gens were detected.There were statistically significant differences in multi-nucleotide polymorphisms(MNPs)and insertion numbers in the genomes of emm12.0 and emm12 subtypes(both P＜0.05).The phylogenetic tree presen-ted a highly clonal group of 23 GAS strains in this area,accounting for 57.50％.Conclusion The prevalent GAS strain in this area is emm12.emm12.149 is a new subtype.The resistance genes and phenotypes are erm(B),tet(M),and structural type(cMLS).The genome has plenty genetic polymorphism,and the genome sequences of multiple GAS strains are highly cloned,indicating the possibility of clone transmission.This suggests that the sur-veillance of GAS in sentinel hospitals should continue to be strengthened,so as to provide theoretical basis for the prevention and control of GAS epidemics.

Objective:To explore the method of CT quantitative evaluation of silicosis fibrosis in artificial stone and analyze its correlation with the stage of chest X-ray and lung function impairment.Methods:The clinical data of 142 patients with artificial stone silicosis who were treated at Shanghai Pulmonary Hospital from January 2018 to December 2022 were collected. These patients were diagnosed based on GBZ 70-2015 Diagnosis of Occupational Pneumoconiosis and underwent chest X-rays, chest CT scans, and lung function tests within a two-month period. The chest CT scoring method is based on the CT characteristics of silicosis, including ground-glass shadows, small nodule shadows, point-line shadows/cord-line shadows, emphysema/pulmonary bullae and patch shadows/mass shadows, with a scoring range of 0 to 25 points. Lung function indicators included FVC, FEV 1 and DLco. For inter-group comparisons of normally distributed quantitative data, one-way ANOVA was employed with LSD post-hoc test for multiple comparisons. Chi-square test was used for multi-group ratio comparisons. Kruskal-Wallis H test was applied to non-normally distributed quantitative data, followed by LSD post-hoc test. Spearman's rank correlation was used to analyze the relationship between pulmonary function indicators and CT fibrosis scores, Trend test was conducted using the Pearson test. Results:As the silicosis stage progressed, both the CT fibrosis score ( R=0.87, Ptrend<0.001) and the degree of lung function impairment (FVC: R=-0.41, Ptrend<0.001; FEV 1: R=-0.52, Ptrend<0.001) ; DLco: R=-0.38, Ptrend<0.001) showed an increasing trend. The CT fibrosis Score demonstrated a strong positive correlation with silicosis stage ( rs=0.85, Ptrend<0.001) and a moderate negative correlation with FVC, FEV 1, and DLco ( rs=-0.48, -0.56, and -0.45, respectively, with all P<0.05) . Over an average follow-up period of 14 months, it was observed that changes in the CT score had a strong to moderate negative correlation with variations in FVC and FEV 1 ( rs=-0.63 and -0.52, P<0.05) . Additionally, there was a moderate negative correlation between ground glass opacity and DLco ( rs=-0.52, P<0.001) . Conclusion:The CT fibrosis score not only reflects pathological changes associated with artificial stone-related silicosis but also provides a more precise representation of lung function injury.

Objective:To predict mechanical complications (MC) following spinal deformity surgery for adult spine deformity (ASD) using machine learning models, identify key risk factors, and develop a visualizable tool for individualized risk assessment.Methods:Clinical and radiological data from 525 patients with ASD who underwent surgery in our hospital between January 2017 and December 2021 were collected. Patients were randomly assigned to a training set (70%) and a test set (30%) for model development. The cohort included 88 males and 437 females, with a mean age of 42.2±18.1 years. Variables included demographic data, comorbidities, local and systemic radiological parameters, paraspinal muscle fat infiltration (FI), and vertebral bone quality (VBQ) scores. Multiple machine learning algorithms: Random Forest (RF), Gaussian Naive Bayes (GNB), Light GBM, Support Vector Machine (SVM), XGBoost (XGB), and Logistic Regression (LR) were trained and evaluated. Model performance was compared using the receiver operating characteristic curve (ROC) and precision-recall curve (PRC). SHAP (Shapley Additive Explanations) was used to rank risk factors, while LIME (Local Interpretable Model-Agnostic Explanations) was applied to visualize MC risk in individual cases.Results:Of the 525 patients, 135 (25.7%) developed postoperative MC. Among these, 80 (59.3%) experienced proximal junction kyphosis or failure (PJK/PJF), 7 (5.2%) had distal junction kyphosis or failure (DJK/DJF), 28 (20.7%) sustained rod fractures, and 29 (21.5%) showed significant loss of correction. In the validation cohort, the RF model achieved the highest area under the curve (AUC=0.80), followed by GNB (0.77), XGB (0.76), LR (0.74), LightGBM (0.73), and SVM (0.66). The RF model also demonstrated the best PRC value (0.58), highest sensitivity (0.65), and lowest Brier score (0.20). GNB, Light GBM, and LR models achieved the highest accuracy (0.78 each), while LightGBM exhibited the highest specificity (0.93). SHAP analysis identified higher preoperative VBQ scores, larger T 1 pelvic angle (TPA), and higher paraspinal muscle FI as the main risk factors for MC. Based on the RF model, a LIME-based tool was successfully constructed for individualized MC risk estimation. Conclusion:The RF model demonstrated the best overall predictive performance for MC. A machine learning-based prediction model has the potential to provide valuable guidance for surgical decision-making in ASD patients.

Objective To explore the life satisfaction and related factors of general and assistant general standardized training physicians(hereinafter referred to as training physicians),and analyze the effecting path of resilience between stress perception and life satisfaction.Methods From July to October 2024,a self-designed general demographic survey,Satisfaction With Life Scale(SWLS),Connor-Davidson Resilience Scale(CD-RISC),and Chinese Perceived Stress Scale(CPSS)were used to survey 251 training physicians from two hospitals in Xi'an to understand their life satisfaction,stress perception,and resilience in the past month.Model 4 in the Process V3.3 plugin of SPSS 25.0 software and Bootstrap method were used to analyze the effecting path of resilience between stress perception and life satisfaction among the training physicians.Results A total of 251 questionnaires were distributed,and 236 valid questionnaires were collected,with an effective response rate of 94.02％.The stress perception of 236 training physicians(24.12±7.02)was negatively correlated with life satisfaction(23.24±7.45)(r=-0.556,P＜0.01),but negatively correlated with resilience(54.88±11.37)(r=-0 658,P＜0.01).Resilience partially mediated the relationship between stress perception and life satisfaction,with a mediation effect value of-0.320 6,accounting for 54.39％ of the total effect.Conclusion Stress perception has an independent negative impact on the life satisfaction of training physicians,and indirectly affects life satisfaction through resilience.Improving life satisfaction can be achieved by reducing stress perception or enhancing resilience.

Pregnancy with chronic kidney disease (CKD), particularly in stages 4-5, carries high risks of adverse outcomes including maternal renal failure, preeclampsia/eclampsia, fetal growth restriction, and preterm birth. This report described a 26-year-old woman with congenital solitary kidney, polycystic ovaries, and uterine septum due to PAX2 gene variant, complicated by CKD stage 4. Through multidisciplinary team precision management and individualized treatment strategies, including timely initiation of dialysis, the patient successfully maintained pregnancy until 34 +1 weeks and delivered a female infant via cesarean section. This case summarizes key management experiences for end-stage renal disease in pregnancy, highlighting early risk assessment, precise nutritional management, hemodialysis protocol optimization, and the crucial role of multidisciplinary collaboration, providing valuable references for managing CKD-complicated pregnancies.

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