Hepatocellular carcinoma （HCC） is a common malignant tumor with a high mortality rate， an insidious onset， and complex pathological mechanisms. In the tumor microenvironment， tumor-promoting immune cells protect tumor cells from immune attacks， while dysfunction of anti-tumor immune cells causes the inhibition of immune response， thereby leading to the continuous deterioration of cancer. In recent years， traditional Chinese medicine has shown good efficacy in the treatment of HCC， and it can inhibit the proliferation and metastasis of cancer cells by regulating immune cells. By analyzing related articles in China and globally， this article summarizes how immune cells affect the progression of HCC through the immunosuppressive pathway and how traditional Chinese medicine exerts an anti-HCC effect by regulating immune cells， in order to provide theoretical basis and reference for optimizing the treatment of HCC.

The aim of this study is to identify the cause of death of a South China tiger cub at the Meihuashan breeding institute of Fujian Province.Pathogenic bacteria were isolated and cultured from liver,spleen,lung and other tissue samples of the dead South China tiger aseptically.The iso-lated bacteria were identified through morphological observation,biochemical characterization,sequence analysis of housekeeping gene gyrB,virulence gene detection,animal pathogenicity test and drug sensitivity test.A pathogenic Aeromonas hydrophila strain,designated FJ/Tiger-201809 was successfully isolated from the trachea of dead South China tiger.The nucleotide sequence ho-mology between the isolate and 11 strains of Aeromonas gyrB ranged from 91.2％to 99.1％,with the highest homology of 99.1％observed with Aeromonas hydrophila(AF208251.1).Genetic evo-lution analysis showed that the isolated strain FJ/Tiger-201809 was in the same evolutionary branch as other reference strains of Aeromonas hydrophila and was closely related.The pathoge-nicity test in mice showed artificial infection of mice with the strain resulted in varying degrees of lesions in several organs of the mice,and the median lethal dose(LD50)was 1 × 107.8 CFU/mL.Virulence gene test results showed that the isolate FJ/Tiger-201809 carried two virulence genes,aer and act.The results of drug sensitivity test showed that FJ/Tiger-201809 was highly sensitive to enrofloxacin and ampicillin among 18 commonly used antibiotics,relatively sensitive to penicil-lin G and doxycycline,and resistant to the other 14 antibiotics.In conclusion,this study isolated and identified a strain of Aeromonas hydrophila from a dead South China tiger with multiple drug resistance and strong pathogenicity,which provided an important reference for the prevention and control of bacterial diseases in South China tiger.

Objective:To analyze the incidence and mortality of malignancies in cancer registration areas of Shaanxi Province in 2019.Methods:A cross-sectional study was conducted. According to the data quality control requirements of the "Guidelines for Tumor Registration Work in China", cancer incidence and mortality data in 2019 reported by qualified cancer registration areas in Shaanxi Province were comprehensively evaluated. Data from 48 qualified cancer registration areas whose quality met the standards were selected for combined analysis. The incidence and mortality rate, age-specific incidence and mortality rate, standardized incidence and mortality rate, cumulative incidence and mortality rate of malignancies and the top 10 cancer incidence rankings were calculated.Results:Among the 48 cancer registration areas of Shaanxi Province in 2019, 20 were in urban areas and 28 were in rural areas, covering a total population of 20 118 219, which accounted for 49.63% (20 118 219/40 536 407) of the total population. In 2019, the incidence of cancer in Shaanxi Province in 2019 was 209.56 per 100 000 population, age-standardized incidence rates of Chinese standard population and world standard population were 137.58 per 100 000 population and 136.26 per 100 000 population, respectively; the cumulative incidence rate of population aged 0-74 years was 15.62%. The mortality rate of cancer was 145.54 per 100 000 population, the age-standardized mortality rates of Chinese standard population and world standard population were 92.80 per 100 000 population and 92.87 per 100 000 population, respectively; the cumulative mortality rate of population aged 0-74 years was 10.44%. The incidence and mortality of malignant tumors were at a low level in groups with the age before 40-year-old, increased rapidly in groups with the age after 40-year-old, and reached a peak level in 85-year-old group. In 2019, the top 5 of the incidence of malignancies in Shaanxi Province were lung cancer, stomach cancer, breast cancer, liver cancer and esophageal cancer; and the top 5 of deaths were lung cancer, stomach cancer, liver cancer, esophageal cancer and colorectal cancer. The top 10 of malignant cancer cases accounted for 78.87% (33 252/42 160) of all malignant cancer cases; the top 10 of malignant deaths accounted for 84.30% (24 684/29 281) of all cancer deaths.Conclusions:The situation of prevention and treatment of malignancies in Shaanxi Province is still serious, and it is necessary to focus on the prevention and treatment of cancer in population aged 40 and above, especially the prevention and treatment of key cancers such as lung cancer, stomach cancer, breast cancer, liver cancer, esophageal cancer and colorectal cancer.

Objective To explore the application value of targeted next-generation sequencing(tNGS)in the detection of influenza A virus.Methods A retrospective analysis was conducted on the clinical data of 116 patients suspected of having influenza A at our hospital from October 2024 to February 2025.All patients underwent sputum tNGS and throat swab influenza nucleic acid tests due to fever and pulmonary infection,and the diagnostic efficacy of the two methods was compared.Results Among 116 patients,93 were diagnosed with influenza A.Among these 93 influenza A patients,the detection rate of tNGS was higher than that of in-fluenza nucleic acid testing(P<0.05).The results of tNGS and influenza nucleic acid testing for influenza A showed significant consistency with the confirmed diagnosis(P<0.05).There was a statistically significant difference in tNGS sequence counts between the influenza nucleic acid-positive and negative groups(P<0.05).Twenty-three patients excluded from influenza A diagnosis served as the control group.Comparisons of white blood cell(WBC)counts among the influenza nucleic acid-positive group,negative group,and control group showed statistically significant differences(P<0.05),whereas comparisons of C-reactive protein(CRP)and serum amyloid A(SAA)showed no statistically significant differences(P>0.05).Conclusion tNGS demonstrates significant advantages in detecting influenza A virus.Combined with peripheral blood infection-related in-dicators for comprehensive diagnosis,it may provide a more effective approach for early diagnosis and treatment of influenza virus infectious diseases.

Objective:To analyze the incidence and mortality of malignancies in cancer registration areas of Shaanxi Province in 2019.Methods:A cross-sectional study was conducted. According to the data quality control requirements of the "Guidelines for Tumor Registration Work in China", cancer incidence and mortality data in 2019 reported by qualified cancer registration areas in Shaanxi Province were comprehensively evaluated. Data from 48 qualified cancer registration areas whose quality met the standards were selected for combined analysis. The incidence and mortality rate, age-specific incidence and mortality rate, standardized incidence and mortality rate, cumulative incidence and mortality rate of malignancies and the top 10 cancer incidence rankings were calculated.Results:Among the 48 cancer registration areas of Shaanxi Province in 2019, 20 were in urban areas and 28 were in rural areas, covering a total population of 20 118 219, which accounted for 49.63% (20 118 219/40 536 407) of the total population. In 2019, the incidence of cancer in Shaanxi Province in 2019 was 209.56 per 100 000 population, age-standardized incidence rates of Chinese standard population and world standard population were 137.58 per 100 000 population and 136.26 per 100 000 population, respectively; the cumulative incidence rate of population aged 0-74 years was 15.62%. The mortality rate of cancer was 145.54 per 100 000 population, the age-standardized mortality rates of Chinese standard population and world standard population were 92.80 per 100 000 population and 92.87 per 100 000 population, respectively; the cumulative mortality rate of population aged 0-74 years was 10.44%. The incidence and mortality of malignant tumors were at a low level in groups with the age before 40-year-old, increased rapidly in groups with the age after 40-year-old, and reached a peak level in 85-year-old group. In 2019, the top 5 of the incidence of malignancies in Shaanxi Province were lung cancer, stomach cancer, breast cancer, liver cancer and esophageal cancer; and the top 5 of deaths were lung cancer, stomach cancer, liver cancer, esophageal cancer and colorectal cancer. The top 10 of malignant cancer cases accounted for 78.87% (33 252/42 160) of all malignant cancer cases; the top 10 of malignant deaths accounted for 84.30% (24 684/29 281) of all cancer deaths.Conclusions:The situation of prevention and treatment of malignancies in Shaanxi Province is still serious, and it is necessary to focus on the prevention and treatment of cancer in population aged 40 and above, especially the prevention and treatment of key cancers such as lung cancer, stomach cancer, breast cancer, liver cancer, esophageal cancer and colorectal cancer.

The aim of this study is to identify the cause of death of a South China tiger cub at the Meihuashan breeding institute of Fujian Province.Pathogenic bacteria were isolated and cultured from liver,spleen,lung and other tissue samples of the dead South China tiger aseptically.The iso-lated bacteria were identified through morphological observation,biochemical characterization,sequence analysis of housekeeping gene gyrB,virulence gene detection,animal pathogenicity test and drug sensitivity test.A pathogenic Aeromonas hydrophila strain,designated FJ/Tiger-201809 was successfully isolated from the trachea of dead South China tiger.The nucleotide sequence ho-mology between the isolate and 11 strains of Aeromonas gyrB ranged from 91.2％to 99.1％,with the highest homology of 99.1％observed with Aeromonas hydrophila(AF208251.1).Genetic evo-lution analysis showed that the isolated strain FJ/Tiger-201809 was in the same evolutionary branch as other reference strains of Aeromonas hydrophila and was closely related.The pathoge-nicity test in mice showed artificial infection of mice with the strain resulted in varying degrees of lesions in several organs of the mice,and the median lethal dose(LD50)was 1 × 107.8 CFU/mL.Virulence gene test results showed that the isolate FJ/Tiger-201809 carried two virulence genes,aer and act.The results of drug sensitivity test showed that FJ/Tiger-201809 was highly sensitive to enrofloxacin and ampicillin among 18 commonly used antibiotics,relatively sensitive to penicil-lin G and doxycycline,and resistant to the other 14 antibiotics.In conclusion,this study isolated and identified a strain of Aeromonas hydrophila from a dead South China tiger with multiple drug resistance and strong pathogenicity,which provided an important reference for the prevention and control of bacterial diseases in South China tiger.

Objective To evaluate the efficiency of fluorescent PCR melting curve method in early diag-nosis of fluoroquinolones (FQs) resistance in the patients with tuberculosis,and to analyze the situation and characteristics of FQs resistance,so as to provide a basis for the standardized diagnosis and treatment of rifam-picin resistance/multidrug resistant tuberculosis (RR/MDR-TB) and pre-extensively drug resistant tuberculo-sis (pre-XDR-TB).Methods A total of 1094 smear positive samples from the outpatients and inpatients of Guiyang Municipal Public Health Treatment Center from January 2021 to August 2022 were collected and conducted the Roche solid culture method and bacterial species identification.Finally,589 cases of tuberculosis conducted the phenotypic drug sensitivity test and fluorescent PCR melting curve method for detecting rifam-picin (RFP),isoniazid(INH),ethambutol(EMB) and FQs resistance.The phenotypic drug sensitivity test served as the standard to evaluated the diagnostic efficiency of the fluorescent PCR melting curve method;the relationship between the patients' FQs resistance and clinical characteristics was analyzed according to the phenotypic drug sensitivity results.Results The sensitivity,specificity,coincidence rate and Kappa value of fluorescence PCR melting curve method for detecting FQs drug resistance were 91.30％,97.69％,96.94％ and 0.86 respectively;the area under the curve (AUC) was 0.945,which was higher than 0.924,0.923 and 0.850 of RFP,INH and EMB.The drug resistance rate of FQs in the patients with RR/MDR-TB was 22.80％,the Kappa value of fluorescence PCR melting curve method for detecting the patients' FQs drug re-sistance was 0.83,the consistency was good,AUC was 0.936.There was no statistically significant difference in sensitivity,specificity and coincidence rate of FQs resistance in TB patients with different bacterial loads by fluorescence PCR fusion curve (P>0.05).The treatment type,history of anti-tuberculosis,pulmonary cavity and MDR-TB were related with FQs resistance (P<0.05).Conclusion The fluorescent PCR melting curve method has good diagnostic efficiency for FQs resistance in the patients with tuberculosis.

Hepatitis C is one of the main causes of liver cancer.With the application of direct-acting antiviral agents,more than 95%of patients can achieve the eradication of hepatitis C virus and obtain sustained virologic response(SVR).Effective antiviral therapy can change the natural course of hepatitis C and reduce the risk of liver cancer;however,some patients are still affected by age,sex,liver fibrosis,diabetes,hepatic steatosis,alcohol consumption,and genetic factors and become the high-risk population of liver cancer.Therefore,it is needed to further clarify and improve the identification and prediction of high-risk populations of liver cancer after SVR of hepatitis C.This article reviews the risk factors and predictive models for liver cancer after SVR in patients with hepatitis C,in order to provide a basis for identifying the high-risk population of liver cancer after SVR of hepatitis C in clinical practice.

BACKGROUND: After major liver resection, the volume status of patients is still undetermined. However, few concerns have been raised about postoperative fluid management. We aimed to compare gut function recovery and short-term prognosis of the patients after laparoscopic liver resection (LLR) with or without inferior vena cava (IVC) respiratory variability-directed fluid therapy in the anesthesia intensive care unit (AICU). METHODS: This randomized controlled clinical trial enrolled 70 patients undergoing LLR. The IVC respiratory variability was used to optimize fluid management of the intervention group in AICU, while the standard practice of fluid management was used for the control group. The primary outcome was the time to flatus after surgery. The secondary outcomes included other indicators of gut function recovery after surgery, postoperative length of hospital stay (LOS), liver and kidney function, the severity of oxidative stress, and the incidence of severe complications associated with hepatectomy. RESULTS: Compared with patients receiving standard fluid management, patients in the intervention group had a shorter time to anal exhaust after surgery (1.5 ± 0.6 days vs. 2.0 ± 0.8 days) and lower C-reactive protein activity (21.4 [95% confidence interval (CI): 11.9-36.7] mg/L vs. 44.8 [95%CI: 26.9-63.1] mg/L) 24 h after surgery. There were no significant differences in the time to defecation, serum concentrations of D -lactic acid, malondialdehyde, renal function, and frequency of severe postoperative complications as well as the LOS between the groups. CONCLUSION: Postoperative IVC respiratory variability-directed fluid therapy in AICU was facilitated in bowel movement but elicited a negligible beneficial effect on the short-term prognosis of patients undergoing LLR. TRIAL REGISTRATION ChiCTR-INR-17013093.
Humans ; Hepatectomy ; Vena Cava, Inferior/surgery* ; Liver ; Laparoscopy ; Fluid Therapy

ObjectiveTo investigate whether cytotoxic T lymphocyte （CTL）－derived exosomes can downregulate HBx expression and inhibit hepatic stellate cell （HSC） activation. MethodsThe supernatants of HepG2， HepGA14， and CTL cells were collected to extract exosomes， which were referred to as NC－exo， HBV－exo， and CTL－exo， respectively）. Transmission electron microscopy was used to observe their morphology， and Western Blot was used to measure the expression of the markers of exosomes CD63 and TSG101. NC－exo， HBV－exo， and CTL－exo labeled by BODIPY dye were mixed with HBV－exo at different ratios and were then co－cultured with HSC LX－2 （HSC－LX2）. A fluorescence microscope was used to observe whether exosomes could enter LX－2 cells， and an fluorescence microscope was used to observe cell morphological changes； quantitative real－time PCR （qPCR） was used to measure the expression of the activated biomarkers such as transforming growth factor－β1 （TGF－β1）， ɑ－smooth muscle actin （ɑ－SMA）， and collagen type I （Collagen I） in LX－2 cells. CTL－exo was added to the HepGA14 culture system； then qPCR was used to measure the mRNA expression level of HBV DNA， cccDNA， and HBx in exosomes in HepGA14 cells， and Western Blot was used to measure the protein expression level of HBx in exosomes. The t-test was used for comparison of normally distributed continuous data between two groups； a one-way analysis of variance was used for comparison between multiple groups， and the least significant difference t-test was used for further comparison between two groups. ResultsThe exosomes were all microcysts with a double－layer membrane structure and were circular or elliptical in shape， with the expression of the signature proteins CD63 and TSG101， and the vesicles had a diameter of 50－100 nm. The fluorescence microscope showed that exosomes could enter LX－2 cells， and HSC were enlarged with extended cell processes. The results of qPCR showed that there were significant differences in the expression levels of TGF－β1， ɑ－SMA， and Collagen I genes between the NC－exo， HBV－exo， NC－exo+HBV－exo， and Con groups （F=444.678， 417.144， and 571.508， all P<0.05）. After the intervention of HepGA14 cells with CTL－exo， qPCR results showed that compared with the control group， there were significant reductions in the expression levels of HBV DNA and cccDNA in HepGA14 cells （all P<0.05）， the relative mRNA expression level of HBx in exosomes （P<0.05）， and the protein expression level of HBx （P<0.05）. CTL－exo and HBV－exo were mixed at different ratios （2∶1， 5∶1， 10∶1） and were then used for the intervention of LX－2 cells， and qPCR results showed that the expression levels of TGF－β1， ɑ－SMA， and Collagen I genes in LX－2 cells gradually decreased with the increase in the ratio of CTL－exo between groups （P<0.05）. ConclusionCTL－exo can downregulate the protein expression of HBx in HBV－exo to inhibit HSC activation， suggesting that CTL－exo has an anti－hepatitis B liver fibrosis effect.