Volume 106 · Issue 07 · 2026

Carbapenem resistant Pseudomonas aeruginosa (CRPA) is an important pathogen of hospital acquired infections, especially in patients with chronic lung disease, long-term hospitalization, or those who have received broad-spectrum antibiotic treatment. CRPA often manifests as multidrug resistance, which can lead to difficult treatment and poor prognosis. In order to standardize the clinical management of CRPA infection in China and improve the standardization and accuracy of diagnosis and treatment, the Branch of Bacterial Infection and Drug Resistance Prevention of the Chinese Medical Association and the Infectious Diseases Specialty Committee of the Chinese Medical Education Association organized multidisciplinary experts to formulate norms and grading of recommendations, assessment, development, and evaluation methods in accordance with international guidelines. This guidance systematically focuses on and answers 10 key clinical questions, covering the core aspects of diagnosis and treatment, mainly including: the clinical application value of carbapenemases phenotype or genotype detection, the necessity and methods of combined drug susceptibility testing, adjustment of the treatment plan based on monitoring the minimum inhibitory concentration during the treatment process, the role of drug concentration monitoring in optimizing dosing regimens, comparison of the efficacy of polymyxin monotherapy and combination therapy, the treatment indications and strategies for chronic pulmonary CRPA infection, the clinical application of inhaled antibiotics and azithromycin, the role of intravenous combined nebulization inhalation therapy in acute pulmonary infections, recommendations for the treatment of central nervous system infections with intravenous combined intrathecal/intraventricular administration, and combined treatment strategies for severe CRPA infections. This guideline aims to provide practical guidance for clinical physicians based on current evidence, emphasizing individualized comprehensive treatment based on precise detection and individual patient conditions, in order to improve the clinical outcomes of CRPA infected patients and promote the rational use of antibiotics.

Enteral nutrition (EN) is one of the important approaches in clinical nutritional support therapy. EN intolerance (ENI) occurs frequently during the implementation of EN. Currently, there is a lack of unified diagnostic criteria and monitoring methods for ENI identification and prevention both domestically and internationally, and intervention strategies remain inconsistent, which significantly impede the standardized application of EN. To further standardize the clinical identification, monitoring and intervention of ENI, the China International Exchange and Promotive Association for Medical and Health Care Clinical Nutrition Health Branch, the Chinese Society of Parenteral and Enteral Nutrition, the Chinese Nutrition Society Branch of Clinical Nutrition organized nearly 100 Chinese experts in related fields to make current consensus. The consensus is based on the best evidence and focus on the following topics: assessment and monitoring of ENI, prevention and treatment of ENI, etc. Finally, 22 recommendations were proposed to offer guidance on identification, prevention and treatment of ENI, as well as to promote the standardized implementation of EN.

To compare the safety and efficacy differences between self-expanding stents (SES) and balloon-expandable stents (BES) in single-stage carotid artery stenting (CAS) for tandem carotid lesions (TCL) involving both extracranial and intracranial carotid segments.

Clinical data from 48 patients who underwent single-stage CAS for TCL at the First Affiliated Hospital of Xi′an Jiaotong University between January 2016 and September 2019 were retrospectively analyzed. Based on the stent type deployed in the intracranial segment, patients were divided into SES (n=23) and BES (n=25) groups. Follow-up was initiated at 1 month postoperatively and conducted monthly via outpatient visits or telephone. Baseline characteristics, perioperative adverse event rates, long-term stroke-free survival, and primary stent patency rates between the two groups were compared. Survival curves were constructed using the Kaplan-Meier method.

The age of the 48 patients was (65±11) years, including 30 males and 18 females. The technical success rate was 100% (48/48). No significant difference was found in perioperative complication rates between SES and BES groups [8.7% (2/23) vs 4.0% (1/25)]. Cerebral hyperperfusion syndrome occurred in 1 case in each group (4.3% and 4.0%). One ischemic stroke (4.3%) occurred in the SES group. There were no death or major adverse cardiovascular event during the perioperative period in either group. The follow-up time [M(Q₁, Q₃)] was 38 (14,45) months for the SES group and 36 (15,45) months for the BES group. During follow-up, the SES group experienced 1 (4.3%) major adverse cardiovascular event, 2 (8.7%) stroke events, and 2 (8.7%) cases of in-stent restenosis, while the BES group had 1 (4.0%) major adverse cardiovascular event and 1 (4.0%) case of in-stent restenosis. No statistically significant differences were observed in stroke-free survival (78.3% vs 92.0%) or primary patency rates (91.3% vs 96.0%) between the two groups (both P>0.05).

With strict patient selection and standardized perioperative management, single-stage CAS for TCL demonstrated excellent technical success and acceptable safety.

To assess the mid-to long-term outcomes in patients treated with drug-eluting stent specifically designed for vertebral artery origin stenosis.

Patients with symptomatic vertebral artery stenosis who underwent implantation of the specific drug-eluting stents at 7 centers from January to December 2021 were enrolled. Postoperative follow-up assessments were conducted at 1, 2, 3, and 4 years, with the maximum duration of follow-up being 4 years. Endpoint events, including transient ischemic attack, stroke, and all-cause mortality, were systematically monitored primarily through telephone follow-ups, supplemented by clinical visits when necessary. The cumulative occurrence of events is evaluated by drawing Kaplan-Meier survival curves.

A cohort of 117 patients (with a total of 122 target vascular lesions, 123 stents were implanted) was enrolled in the study. The age of the participants (87 men and 30 women) [M (Q₁, Q₃)] was 65 (61, 70). The follow-up duration was (49.3±2.5) months. During the study, 20 patients (17.1%) were lost to follow-up. Ten (8.5%) endpoint events were documented, including 6 (5.1%) all-caused death, all of which were determined to be unrelated to the stent, and 4 (3.4%) cerebral ischemic events. The cerebrovascular adverse events consisted of 2 (1.7%) cerebral infarctions and 2 (1.7%) instances of in-stent restenosis or occlusion. The recurrence rate of stent-related symptoms was 2 (1.7%). Kaplan-Meier analysis revealed cumulative clinical endpoint event rates of 1.7% at 1 year, 6.0% at 2 years and 8.5% at 3 years. The cumulative stent-related clinical endpoint event rates were 0.9% at 1 year and 1.7% at 3 years.

The recurrence rate of mid- and long-term clinical endpoint events after Maurora stent implantation was observed to be relatively low. Furthermore, there appears to be a decreasing trend in the incidence of cerebrovascular adverse events, including stent-related stroke, transient ischemic attack, and restenosis.

To analyze the influencing factors of high-risk colorectal adenomas and establish and validate a predictive model.

The clinical data of 321 patients with colorectal adenomas who underwent colonoscopy and biopsy at Beijing Shijitan Hospital from January 2017 to January 2019 were retrospectively analyzed, including 201 males and 120 females, with the age (61.5±10.6) years. According to the colonoscopy pathology results, the patients were divided into the high-risk colorectal adenoma group and the non-high-risk colorectal adenoma group, and the differences in clinical indicators between the two groups were analyzed. The patients were randomly divided into a training set (n=225) and a validation set (n=96) at a ratio of 7∶3 using random sampling function. Multivariate logistic regression was used to screen the influencing factors of high-risk colorectal adenomas, and a nomogram of the predictive model was drawn. The predictive ability, accuracy and clinical applicability of the model were evaluated by the area under the receiver operating characteristic curve (AUC), calibration curve and decision curve analysis.

Among the 225 cases in the training set, there were 107 cases in the non-high-risk adenoma group and 118 cases in the high-risk adenoma group. In the training set, the proportion of patients with a history of coronary heart disease, the proportion of severe hepatic steatosis, body mass index, triglyceride levels, low-density lipoprotein cholesterol levels, and high-density lipoprotein cholesterol levels were higher in the high-risk colorectal adenoma group compared to the non-high-risk adenoma group. Conversely, hemoglobin levels and total bilirubin levels were lower in the high-risk group (all P<0.05). The results of the multivariate logistic regression model analysis revealed that a history of coronary heart disease (OR=9.172, 95%CI: 2.444-43.143), severe hepatic steatosis (OR=12.803, 95%CI: 4.423-36.987), and a high level of body mass index (OR=2.132, 95%CI: 1.659-2.874) were risk factors for high-risk rectal adenomas. Conversely, a high level of high-density lipoprotein cholesterol (OR=0.055, 95%CI: 0.005-0.518) and a high level of total bilirubin (OR=0.907, 95%CI: 0.833-0.982) were identified as protective factors against high-risk rectal adenomas. Construct a predictive model for high-risk colorectal adenomas based on the aforementioned influencing factors. The AUC of training set was 0.925 (95%CI: 0.893-0.958), with a sensitivity of 88% and a specificity of 82%, while the AUC of validation set was 0.886 (95%CI: 0.823-0.949), with a sensitivity of 72% and a specificity of 88%. The calibration curves of the training set and validation set show that the predictive model has good calibration (training set: P=0.130; validation set: P=0.910). The decision curves for both the training set and validation set demonstrate that the predictive model offers a clinical net benefit when the risk threshold exceeds 5%.

A history of coronary heart disease, severe hepatic steatosis, a high level of body mass index, a high level of high-density lipoprotein cholesterol, and a high level of total bilirubin are influencing factors for high-risk colorectal adenomas. Incorporating these factors into a nomogram model allows for a more intuitive assessment of the risk of high-risk colorectal adenomas.

To investigate the association between childhood trauma and the number of disorders of gut-brain interaction (DGBI) diagnosed in adults, and to explore the mediating role of personality disorder (PD) traits and anxiety in this relationship.

A retrospective study was conducted on adult patients with DGBI who visited the Department of Gastroenterology Outpatient of Beijing Tsinghua Changgung Hospital from November 2023 to October 2024. The Rome Ⅳ questionnaire was used to measure the number of DGBI diagnoses, which was categorized into G1 group (1-2 types), G2 group (3-4 types) and G3 group (≥5 types). The childhood trauma questionnaire-short form (CTQ-SF) was used to measure childhood trauma, the personality disorder questionnaire-4+(PDQ-4+) was used to assess PD traits, and the Zung self-rated anxiety scale (SAS) were used to measure anxiety levels. Poisson regression analysis was employed to evaluate variable associations between childhood trauma, PD traits, anxiety, and the number of DGBI diagnoses [expressed as incidence rate ratio (IRR) and 95%CI]. The chained mediation model was used to calculate the mediating role of PD traits and anxiety among them (95%CI of IRR did not exceed 1, the mediating effect was statistically significant).

A total of 182 DGBI patients were included, including 85 males and 97 females, with an age[M (Q₁, Q₃)] of 42 (34, 58) years. There were 107, 56, and 19 patients in the G1, G2, and G3 groups, respectively. There were significant differences in age, number of births, PDQ-4+total score, SAS total score and CTQ-SF total score among G1, G2 and G3 groups (all P<0.05). The total CTQ-SF score in G3 group was higher than that in G1 group [39.0 (32.0, 45.0) vs 29.0 (25.0, 34.0) score, P=0.003]. The PDQ-4+total score in G3 group was higher than that in G1 group. The SAS total score in G3 group was higher than that in both G1 and G2 groups, and the SAS total score in G2 group was higher than that in G1 group. After adjusting for age, sex, and number of births, the total CTQ-SF score had a positive predictive effect on the number of DGBI diagnoses (IRR=1.013, 95%CI: 1.006-1.020). In addition, both the total PDQ-4+score (IRR=1.006, 95%CI: 1.002-1.010) and the total SAS score (IRR=1.020, 95%CI: 1.013-1.026) had a positive predictive effect on the number of DGBI diagnoses. The chain mediation effect analysis indicated that childhood trauma indirectly influenced the number of DGBI diagnoses through a chain pathway from PD traits to anxiety, and the indirect effect was statistically significant (IRR=1.004, 95%CI: 1.002-1.007), whereas the direct effect was not statistically significant (IRR=1.007, 95%CI: 0.998-1.015).

The severity of childhood trauma is associated with multiple DGBI diagnoses, and PD traits and anxiety play a chain mediating role between childhood trauma experience and DGBI diagnosis.

To investigate the effects and mechanisms of enriched environment(EE) on cognitive function in Alzheimer′s disease (AD) model mice.

Sixteen male 6-month-old APP/PS1 mice of SPF grade were randomly divided into standard environment group (AD group), and enriched environment group (ADEE group), with 8 mice in each group. Additionally, 16 C57BL/6J mice with matched body weight were selected as the control group and randomly divided into an enriched environment group (NCEE group) and a control group (NC group), with 8 mice in each group. The mice were adapted to the environment for 2 weeks, followed by 12 weeks of intervention. The Morris water maze test was used to assess learning, memory, and exploration abilities; Immunofluorescence staining and Western blot (WB) were performed to detect the levels of Aβ, Tau protein, silent information regulator 1 (SIRT1), and peroxisome proliferator-activated receptor γ coactivator 1α (PGC-1α).

The Morris water maze test showed that the AD group had fewer platform crossings, fewer effective area crossings, shorter effective area dwell time, fewer target quadrant entries, and shorter target quadrant dwell time compared to the NC group (all P<0.05). In contrast, the ADEE group exhibited more effective area crossings, longer effective area dwell time, more target quadrant entries, and longer target quadrant dwell time compared to the AD group (all P<0.05). Immunofluorescence staining results revealed more Aβplaques and Tau protein positive cells in the AD group and ADEE group compared to the NC group and NCEE group (all P<0.01). After EE intervention, the ADEE group exhibited lower Aβ plaques and Tau protein positive cells than the AD group (all P<0.05). Immunofluorescence staining and WB both demonstrated that SIRT1 and PGC-1α expression in AD mice was lower than in NCEE and NC mice (all P<0.05). Following EE intervention, both the ADEE and NCEE groups showed higher SIRT1 and PGC-1α levels compared to the AD group and NC group (all P<0.05).

EE may improve the pathological progression and cognitive impairment of AD by activating the SIRT1/PGC-1α signaling pathway.

The data of 5 patients with tardive dyskinesia (TD) who underwent deep brain stimulation (DBS) of the bilateral internal globus pallidus (GPi) at the Affiliated Brain Hospital of Nanjing Medical University between December 2023 and June 2025. There were 3 males and 2 females, with a mean age of (39.8±3.9) years. At the 1-month follow-up, the severity of involuntary movements was assessed using the Abnormal Involuntary Movement Scale (AIMS), and adverse reactions in patients were also evaluated. At the 6-month follow-up, the 36-Item Short Form Health Survey (SF-36) was additionally administered to assess the quality of life of the patients, and compared with the preoperative baseline level to assess the efficacy of DBS.. The preoperative AIMS score was 21.2±1.7, which decreased to 7.0±1.3 at 1 month postoperatively (improvement rate: 64.6%±9.4%) and further to 4.0±0.3 at 6 months postoperatively (improvement rate: 80.8%±1.7%) (all P<0.05). Additionally, the total preoperative SF-36 score was 29.8±2.1, and it improved to 54.3±1.5 at the 6-month follow-up (P<0.05).No serious long-term stimulation-related adverse events were observed during the study. In the small-sample study, GPi-DBS demonstrated potential therapeutic value for TD, which can significantly improve patients′ involuntary movements and quality of life. However, due to the limited sample size, it is necessary to expand the cohort and extend the follow-up period for further investigation.

This paper reports the diagnosis and treatment of a child with PRG4 gene mutation-related flexion dactyloarthropathy-coxa varus-pericarditis syndrome (CACP syndrome). The 11-year-old male was seen in the First Affiliated Hospital of Zhengzhou University on November 1, 2024 due to "restricted mobility of both knees for more than 8 years". The genetic test showed two heterozygous mutations in PRG4 gene: c.3170C>G (exon7) and c.2968_2969del (exon7). Combined with the child's medical history and signs, it is considered that the child has CACP syndrome caused by PRG4 gene mutation. "Arthroscopic synovectomy of right hip and knee" was performed under general anesthesia on 15-Nov-2024. Intraoperative observations: large amount of fibrous necrotic substance and synovial tissue hyperplasia in right knee joint; A large amount of fibrous necrotic substance in the joint cavity of the right hip joint can be seen; Pannus-like objects were visible on the surface of the femoral head. During the postoperative follow-up period (150 days after operation), the MRI of the right knee and right hip joint showed that the fluid accumulation in the right knee and hip joint was reduced compared with the contralateral and the fluid accumulation volume was not significantly increased, and the symptoms of pain and mobility limitation in the right knee joint were significantly relieved.

The patient, a 53-year-old male, was seen in Shenzhen Second People's Hospital on September 21, 2025 due to "discovery of duodenal bulb bulge mass for 4 days". After admission, ultrasound gastroscopy was completed, which indicated that the tumor originated from the muscle propria of the duodenal bulb, showed hypoechoic changes, mixed growth inside and outside the cavity, and the size was about 9.1 mm ×7.9 mm. The mass was successfully removed by elastic band-assisted snare resection (ESR-EB) combined with floss traction pre-suture technique, and the operation took 15 min. The patient had no fever or abdominal pain after operation, and gradually resumed diet after fasting for 2 days, and was successfully discharged from hospital on the 4th day after operation. The postoperative pathological diagnosis was gastrointestinal stromal tumor (GIST), very low risk group, with negative resection margin. The patient was followed up for 1 month (30-Oct-2025), and there were no abnormal symptoms and signs.

In recent years, the problem of global population aging has become increasingly severe, and the research on aging and its related diseases has attracted much attention. Aging biomarkers are biological characteristics that reflect the aging process of cells or organisms, and are more helpful for the identification and assessment of aging than chronological age. As a chronic metabolic disease closely related to aging, the role of aging biomarkers in the occurrence, development, diagnosis and treatment of diabetes mellitus has been paid more and more attention. This paper reviews the interaction between diabetes and aging, the general situation of aging biomarkers and their role in the development of diabetes and related complications, in order to provide new ideas for the prediction, early warning, early screening, diagnosis and treatment of diabetes and its complications.

Circulating tumor cells (CTCs) are key drivers of tumor metastasis, and culturing CTCs in vitro provides a unique perspective on the biological behavior of tumors. However, the in vitro culture efficiency of CTC is limited by the scarcity of cell numbers, high cell heterogeneity, and phenotypic drift caused by environmental differences in vitro and in vivo, which greatly limits its clinical translational potential. This paper systematically reviews the current situation of CTC in vitro culture, analyzes the main bottlenecks of this technology in improving culture efficiency, optimizing culture conditions and ensuring the phenotypic stability of long-term in vitro cultured CTC, and then expounds the application potential of CTC culture in real-time monitoring of tumor evolution, elucidating the mechanism of drug resistance and carrying out individualized drug sensitivity testing. Future research focuses on improving culture efficiency and biological fidelity, while establishing standardized culture processes to promote their application in clinical research.