ObjectiveTo explore the clinical value of metagenomic next-generation sequencing（mNGS） in patients with sepsis admitted to the Emergency Intensive Care Unit（EICU），evaluate its role in guiding precision antimicrobial therapy， and to identify key factors influencing mNGS positivity and patient prognosis. MethodsThis retrospective study analyzed clinical data from 524 patients with sepsis admitted to the EICU of Sun Yat-sen Memorial Hospital， Sun Yat-sen University， from November 2020 to October 2024. The positive detection rate， pathogen spectrum， and concordance between mNGS and conventional culture were compared. Factors including infection site， underlying diseases， and immune status associated with mNGS positivity were evaluated. The impact of adjusting antimicrobial therapy based on mNGS results on patient prognosis was also analyzed. ResultsThe positive detection rate of mNGS was significantly higher than that of conventional culture （85.11% vs. 47.14%， P ＜ 0.001）. mNGS enabled rapid identification of rare pathogens and mixed infections， with higher positivity observed in immunosuppressed patients and those with hematological disorders （P ＜ 0.05）. Adjustment of antimicrobial therapy based on mNGS results showed no significant difference in short-term clinical response； however， 28-day mortality differed significantly among groups （adjusted group 39.1%， non-adjusted group 76.3%， supportive group 31.4%； χ²= 22.44， P ＜ 0.001）. Multivariate logistic regression analysis identified age and mechanical ventilation as independent factors associated with pathogen positivity. Age， coronary heart disease， SOFA score， bilirubin level， and the use of mechanical ventilation and vasoactive drugs were independent risk factors for 28-day mortality， whereas platelet count and renal function showed protective associations. Patients whose antimicrobial therapy was adjusted based on mNGS results demonstrated a trend toward clinical improvement， shorter antibiotic duration， faster fever resolution， and lower 28-day case fatality rate. ConclusionmNGS demonstrates high sensitivity and broad pathogen coverage for etiological diagnosis in EICU sepsis patients and provides critical support for precision antimicrobial therapy. Patient age， underlying diseases， disease severity， and organ function are key determinants of pathogen detection and short-term prognosis， offering valuable guidance for risk stratification and optimization of therapeutic strategies.

Ischemia reperfusion injury(IRI)is often accompanied by serious clinical manifestations,including myocardial hibernation,acute heart failure,brain dysfunction,kidney dysfunction,gastrointestinal dysfunction,liver transplant rejection,systemic inflammatory response syndrome,multiple organ dysfunction syndrome,and so on,which pose important treatment challenges for doctors in clinical practice.Single cell sequencing technology is high-throughput sequencing of the genome,transcriptome,or epigenome at the single-cell level,in order to reveal cellular heterogeneity,and to understand the developmental trajectory,type,state,and various interactions of cells.Since its first discovery,single-cell sequencing technology has been widely applied in various fields,especially in early diagnosis and personalized treatment of tumors.This article mainly reviews the application and progress of single-cell sequencing in various organ dysfunctions caused by IRI,so as to further understand the mechanisms and signaling pathways of IRI,and to provide new ideas for targeted therapy of organ IRI.

[Objective]To clarify the application value of nutritional scoring in patients with sepsis and explore the impact of the modified Nutritional Risk in Critically Ill(mNUTRIC)score on the in-hospital fatality of sepsis patients in the emergency intensive care unit(EICU).[Methods]A retrospective analysis was conducted on the clinical data and laboratory examination results of 436 sepsis patients treated in the EICU of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2021 to May 2024.The patients were divided into survival group(298 cases)and death group(138 cases)according to whether they died or not during hospital treatment,and then compared the two groups'data.Logistic multi-factor regression analysis was used to analyze the risk factors for in-hospital death and the ROC curve to evaluate the predictive value of each risk factor for the prognosis of sepsis patients.[Results]The death group exhibited higher Acute Physiology and Chronic Health EvaluationⅡ(APACHE Ⅱ)score,Nutritional Risk Screening 2002(NRS 2002)score,mNUTRIC score,Sequential Organ Failure Assessment(SOFA)score,Padua Prediction Score for Venous Thromboembolism,the proportions of chronic kidney failure and pneumonia patients,C-reactive protein(CRP)level,lactate concentration and neutrophil count,but lower prognostic nutritional index,cholinesterase level,cholinesterase-albumin ratio and lymphocyte count than the survival group,with statistical significance(all P<0.05).Logistic regression analysis revealed that the mNUTRIC score[OR=1.254,95%CI(1.109,1.417)],CRP[OR=1.004,95%CI(1,1.007)],and pneumonia[OR=1.82,95%CI(1.017,3.257)]were independent risk factors for in-hospital death in sepsis patients.ROC curve analysis showed that the area under the curve(AUC)of the mNUTRIC score for predicting in-hospital death in sepsis patients was 0.683[95%CI(0.623,0.742)],with a sensitivity of 83%and a specificity of 49.3%.The AUC for CRP and pneumonia were 0.602[95%CI(0.533,0.671)],and 0.582[95%CI(0.516,0.647)].[Conclusion]The mNUTRIC score is an independent predictive indicator for in-hospital death in sepsis patients in the EICU.

Macrophages,key cells in the heart's innate immune system,are highly heterogeneous and plastic,playing dual roles in cardiac physiology and pathology.In recent years,macrophage-derived exosomes have drawnsignificant attention for their regulatory mechanisms and potential therapeutic applications in heart disease,as they serve as crucial mediators of intercellular communication.This paper aims to comprehensively summarize the origin,distribution,and function of cardiac-resident macrophages.It also explores the roles of M1and M2 macrophages in cardiac inflammatory responses and tissue repair,and delves into the regulatory mechanisms and therapeutic application prospects of macrophage exosomes in heart disease.In the acute phase of cardiac injury,M1 macrophages secrete pro-inflammatory cytokines to induce inflammation and clear cellular debris.Nevertheless,their overactivation can result in myocardial cell damage and fibrosis.During the recovery phase,M2 macrophages take the lead,releasing anti-inflammatory cytokines and growth factors to inhibit inflammation and facilitate tissue repair.Macrophage exosomes,which contain proteins,lipids,and nucleic acids,can regulate inflammation,tissue repair,and angiogenesis.In various types of heart disease,including myocardial infarction,ischemia-reperfusion injury,atherosclerosis,myocarditis,and dilated cardiomyopathy,macrophage exosomes exhibit different functions.While M1-derived exosomes often exacerbate cardiac damage through pro-inflammatory actions,M2-derived exosomes protect cardiac tissue via anti-inflammatory and pro-repair effects.These findings offer new insights and targets for developing macrophage-exosome-based heart disease therapies,which is expected to promote the innovative development of diagnosis and treatment for heart diseases,improve patients'prognosis,and alleviate the burden of public health.

The interaction between microbes and the human immune system has long been a focus in biomedical research. Next-generation sequencing has revealed that in addition to gut microbiota， the respiratory tract also harbors microbial communities， forming an interconnected network with the gut microbiota through immune cells and active factors. This review aims to explore how the gut and lung microbiota regulate immune responses， including their roles in local and systemic immune modulation. It also delineates the immunological connections along the gut-lung axis. Further elucidating the influence of microbes on the immune system holds important clinical significance for understanding diseases and exploring novel diagnostic and therapeutic strategies.

Purpose: Precise electrode placement is crucial for the success of sacral neuromodulation (SNM). The aim of this study was to explore a more accurate and convenient method for positioning punctures during the first stage of SNM. Methods: This retrospective study compared preoperative baseline values, intraoperative indicators, postoperative scores, and other clinical data from 130 patients who underwent SNM electrode implantation at our department between 2018 and 2023. The patients were divided into an experimental group and a control group to assess the advantages and feasibility of augmented reality (AR)-guided sacral nerve electrode implantation. Results: The experimental group experienced fewer intraoperative puncture attempts and achieved more accurate AR-guided localization punctures. Additionally, there were more responsive electrode contact points (2.74±0.51 vs. 2.46±0.74) and a lower initial voltage postimplantation (1.09±0.39 V vs. 1.69±0.43 V). The number of intraoperative x-ray fluoroscopies was significantly lower in the experimental group than in the control group (5.94±1.46 vs. 9.22±1.93), leading to a shorter overall operation time (61.32±11.27 minutes vs. 83.49±15.84 minutes). Furthermore, there was no need for additional local anesthetic drugs during the surgery in the experimental group. Comparative observations revealed no significant differences in intraoperative blood loss or the sacral hole location for electrode implantation between the 2 groups. Although the incidence of wound infection and the rate of permanent implantation in stage 2 were similar in both groups, the pain score on the first day postoperation was significantly lower in the experimental group than in the control group (2.62±0.697 vs. 2.83±0.816). Conclusions AR-guided sacral nerve modulation implantation can reduce both the number of punctures and the duration of the operation while ensuring safety and effectiveness. This technique can enhance the contact points of the response electrode, effectively lower the initial response voltage, and stabilize the electrode.

[Objective]To assess the repeatability(intra-operator variability)and reproducibility(inter-operator variability)of a new partial coherence interferometry(PCI)-based ocular biometer,Myopia Master,and its agreement with IOL Master 500 for measuring axial length(AL)and corneal curvature(K)in children aged 8-12 years.[Methods]The same operator measured school children with the Myopia Master and the IOL Master 500 in random order to assess agreement.Additionally,some of these children received measurements from another operator using the Myopia Master to assess repeatability and reproducibility.AL,flat keratometry(Kf),steep keratometry(Ks),mean keratometry(Km),J0 and J45 were analyzed.The repeatability and reproducibility were assessed by the within-subject standard deviation(Sw),test-retest repeatability(TRT),coefficient of variation(CoV)and intra-class correlation coefficient(ICC).The agree-ment between the Myopia Master and the IOL Master 500 was assessed by Bland-Altman plots and 95%limits of agree-ment(LoA).[Results]Both repeatability and reproducibility of the Myopia Master were high for AL measurements(Sw=0.02 mm,ICC=0.999;Sw=0.04 mm,ICC=0.998),but moderate for K measurements(Sw range,0.04 to 0.12 D,ICC range,0.861 to 0.991;Sw range,0.06 to 0.20 D,ICC range,0.835 to 0.992).There were significant mean differences be-tween the Myopia Master and the IOL Master 500 in measurements of AL(-0.01±0.04)mm,Kf(-0.09±0.15)D,Ks(-0.47±0.40)D,and Km(-0.28±0.23)D,J0(0.18±0.20)D and J45(-0.01±0.12)D.[Conclusions]The Myopia Master provided high repeatability and reproducibility for AL measurements in schoolchildren with myopia,but the Myopia Master and the IOL Master 500 cannot be used interchangeably in measuring AL and K.

Purpose: Precise electrode placement is crucial for the success of sacral neuromodulation (SNM). The aim of this study was to explore a more accurate and convenient method for positioning punctures during the first stage of SNM. Methods: This retrospective study compared preoperative baseline values, intraoperative indicators, postoperative scores, and other clinical data from 130 patients who underwent SNM electrode implantation at our department between 2018 and 2023. The patients were divided into an experimental group and a control group to assess the advantages and feasibility of augmented reality (AR)-guided sacral nerve electrode implantation. Results: The experimental group experienced fewer intraoperative puncture attempts and achieved more accurate AR-guided localization punctures. Additionally, there were more responsive electrode contact points (2.74±0.51 vs. 2.46±0.74) and a lower initial voltage postimplantation (1.09±0.39 V vs. 1.69±0.43 V). The number of intraoperative x-ray fluoroscopies was significantly lower in the experimental group than in the control group (5.94±1.46 vs. 9.22±1.93), leading to a shorter overall operation time (61.32±11.27 minutes vs. 83.49±15.84 minutes). Furthermore, there was no need for additional local anesthetic drugs during the surgery in the experimental group. Comparative observations revealed no significant differences in intraoperative blood loss or the sacral hole location for electrode implantation between the 2 groups. Although the incidence of wound infection and the rate of permanent implantation in stage 2 were similar in both groups, the pain score on the first day postoperation was significantly lower in the experimental group than in the control group (2.62±0.697 vs. 2.83±0.816). Conclusions AR-guided sacral nerve modulation implantation can reduce both the number of punctures and the duration of the operation while ensuring safety and effectiveness. This technique can enhance the contact points of the response electrode, effectively lower the initial response voltage, and stabilize the electrode.

Objective:This study aims to explore the application value of the "liftoff" modular method in robot-assisted laparoscopic surgery for complex adrenal tumors.Methods:We retrospectively analyzed the clinical data of 15 patients with complex adrenal tumors treated at the General Hospital of Southern Theater Command from May 2022 to June 2023. The cohort comprised 5 males and 10 females with an average age of (47.6±7.8) years and a body mass index (BMI) of 26.5 (23.8-27.9) kg/m 2. Among the patients, 3 had a BMI ≥28 kg/m 2, 2 had diabetes, 6 had hypertension, and 1 had coronary heart disease. Preoperative endocrine hormone examination revealed abnormal blood catecholamines in 5 cases and abnormal blood cortisol in 2 cases. Ultrasound and CT scans indicated that 9 tumors were located on the left side and 6 on the right, with 4 cases showing tumor compression on adjacent large blood vessels or organs. The average tumor diameter was (7.61±2.79) cm, with 10 cases having a diameter ≥ 6 cm. All patients underwent laparoscopic adrenalectomy assisted by robots through the transperitoneal approach. The surgeries were performed in a lateral position under general anesthesia. The "liftoff" modular method was utilized to separate the treatment of adrenal tumors into lateral, medial, dorsal, cephalic, and adrenal renal plane sides. Tumors were appropriately manipulated during the operations to achieve a "liftoff" shape. Different modular dissociation steps were adopted based on the size and location of the left and right adrenal tumors. The left adrenal gland was dissected in the order of medial and dorsal, adrenal renal plane side, and lateral and cephalic sides, while the right adrenal gland was dissected in the order of lateral and dorsal, adrenal renal plane side, and medial and cephalic sides. Postoperative related indicators and follow-up status of patients were recorded and analyzed. Results:All 15 surgeries were successfully completed without any conversions to open adrenalectomy, with an average operation time of 118 (102-130) minutes and an average intraoperative blood loss of 102 (69-163) ml. The postoperative drainage time was 4 (3-5) days, and the postoperative hospital stay was 6 (4-7) days. The postoperative pathological diagnoses included 5 cases of pheochromocytoma, 3 cases of macronodular adrenal hyperplasia, 6 cases of adrenocortical adenoma, and 1 case of myelolipoma. Follow-up for 6-12 months after surgery showed good recovery and no recurrence.Conclusions:The application of the "liftoff" modular method in robot-assisted laparoscopic surgery for complex adrenal tumors is safe and feasible. It efficiently aids in tumor removal and holds significant clinical application value.

Purpose: Precise electrode placement is crucial for the success of sacral neuromodulation (SNM). The aim of this study was to explore a more accurate and convenient method for positioning punctures during the first stage of SNM. Methods: This retrospective study compared preoperative baseline values, intraoperative indicators, postoperative scores, and other clinical data from 130 patients who underwent SNM electrode implantation at our department between 2018 and 2023. The patients were divided into an experimental group and a control group to assess the advantages and feasibility of augmented reality (AR)-guided sacral nerve electrode implantation. Results: The experimental group experienced fewer intraoperative puncture attempts and achieved more accurate AR-guided localization punctures. Additionally, there were more responsive electrode contact points (2.74±0.51 vs. 2.46±0.74) and a lower initial voltage postimplantation (1.09±0.39 V vs. 1.69±0.43 V). The number of intraoperative x-ray fluoroscopies was significantly lower in the experimental group than in the control group (5.94±1.46 vs. 9.22±1.93), leading to a shorter overall operation time (61.32±11.27 minutes vs. 83.49±15.84 minutes). Furthermore, there was no need for additional local anesthetic drugs during the surgery in the experimental group. Comparative observations revealed no significant differences in intraoperative blood loss or the sacral hole location for electrode implantation between the 2 groups. Although the incidence of wound infection and the rate of permanent implantation in stage 2 were similar in both groups, the pain score on the first day postoperation was significantly lower in the experimental group than in the control group (2.62±0.697 vs. 2.83±0.816). Conclusions AR-guided sacral nerve modulation implantation can reduce both the number of punctures and the duration of the operation while ensuring safety and effectiveness. This technique can enhance the contact points of the response electrode, effectively lower the initial response voltage, and stabilize the electrode.