Volume 106 · Issue 19 · 2026

Infections caused by carbapenem-resistant Enterobacterales (CRE) pose significant challenges in clinical practice. In practical work, laboratory detection of CRE, as well as the diagnosis, treatment, and prevention of related clinical diseases, still face numerous difficulties due to a lack of consensus and standardization. To better guide clinical practice related to CRE in China, Clinical Microbiology Society of China International Exchange and Promotive Association for Medical and Health Care and Chinese Thoracic society, Chinese Medical Association invited experts in clinical microbiology, respiratory medicine, infectious diseases, critical care medicine, clinical pharmacy, epidemiology, and other relevant clinical fields to jointly discuss and formulate this consensus, and finally formed 15 recommendations. The consensus systematically summarizes information related to CRE, including terminology, mechanisms of formation, resistance mechanisms, transmission mechanisms, epidemiology, laboratory testing, clinical diagnosis, treatment, infection prevention and control, with the aim of standardizing laboratory and clinical aspects of CRE-related work.

To explore the relationships of plasminogen activator inhibitor 1 (PAI-1) gene polymorphisms with the efficacy of ustekinumab (UST) in the treatment of patients with Crohn disease (CD).

The patients with active CD who received UST treatment at the Department of Gastroenterology, the Second Affiliated Hospital of Wenzhou Medical University between January 2021 and January 2025 were retrospectively enrolled. Genotypes of PAI-1 gene at loci rs2227631, rs7242 and rs6092 were examined. The clinical response was evaluated based on the Crohn disease activity index (CDAI) at week 8 of follow-up. All the patients were divided into response group (a decline of CDAI≥100 points compared with week 0 or total CDAI<150 points) and non-response group. According to the CDAI and the simplified endoscopic score for Crohn disease (SES-CD), the deep remission was assessed in the patients who had undergone re-examination of colonoscopy at week 32 of follow-up. These patients were divided into deep remission group (CDAI<150 points, plus SES-CD≤2 points or absence of ulcerations) and non-deep remission group. Those patients who achieved clinical response at week 8 and underwent re-examination of colonoscopy at week 32 were further stratified into deep remission subgroup (CDAI<150 points, plus SES-CD≤2 points or absence of ulcerations) and non-deep remission subgroup. The distribution differences of PAI-1 gene polymorphisms were compared between response group and non-response group, deep remission group and non-deep remission group, as well as deep remission subgroup and non-deep remission subgroup. The genotypes or alleles with distribution differences were included into unconditional logistic regression models to explore the relationships of PAI-1 gene polymorphisms with the efficacy of UST treatment in CD patients.

A total of 191 CD patients were enrolled, 128 males and 63 females, aged (33±12) years. At week 8 of UST treatment, there were 118 patients in response group and 73 patients in non-response group. The homozygous variant genotype (GG) of locus rs2227631 was less frequent in response group than that in non-response group [36.4% (43/118) vs 54.8% (40/73), P=0.039]. The homozygous variant genotype (GG) (OR=0.48, 95%CI: 0.26-0.87) of locus rs2227631 was a factor associated with the clinical response at week 8. At week 32, 176 patients received re-examination of colonoscopy, with 52 patients in deep remission group and 124 patients in non-deep remission group. No significant distribution differences of PAI-1 gene polymorphisms existed between both groups (all P>0.05). Among the 118 patients who achieved clinical response at week 8, 110 patients completed re-examination of colonoscopy, with 39 patients in deep remission subgroup and 71 patients in non-deep remission subgroup. Compared with non-deep remission subgroup, the homozygous variant genotype (GG) [33.3% (13/39) vs 12.7% (9/71), P=0.030] and variant allele (G) [59.0% (46/78) vs 38.7% (55/142), P=0.012] of locus rs7242 were more frequent in deep remission subgroup. The homozygous variant genotype (GG) (OR=2.45, 95%CI: 1.12-5.37) and variant allele (G) (OR=1.88, 95%CI: 1.17-3.03) of locus rs7242 were factors related with the deep remission at week 32 in those patients who achieved clinical response at week 8.

The variation of locus rs2227631 may be associated with a reduced clinical response rate at week 8 in CD patients treated with UST. The variation of locus rs7242 may be related to an increased deep remission rate at week 32 in CD patients who achieved clinical response at week 8. However, the variation of locus rs6092 may not affect the efficacy of UST treatment in CD patients.

To compare the efficacy between endoscopic submucosal dissection (ESD) combined with low-dose radiotherapy and direct surgical resection in patients with T1a-MM/T1b-SM stage esophageal squamous cell carcinoma.

A retrospective analysis was performed on the clinical data of 169 patients diagnosed with T1a-MM/T1b-SM stage esophageal squamous cell carcinoma at Zhongda Hospital Affiliated to Southeast University from January 1, 2016 to September 30, 2024. There were 124 males and 45 females, with the age of (65.9±7.9) years. According to different treatment regimens, the patients were divided into the ESD combined with low-dose radiotherapy group (n=58) and the direct surgical resection group (n=111). Propensity score matching (PSM) was used for 1∶2 matching with respect to lesion length, pathological grade and invasion depth. Follow-up was terminated at the time of patient death or September 30, 2024. The recurrence rate, mortality rate, complication rate and quality-of-life-related indicators were compared between the two groups after PSM.

After PSM, a total of 40 patients were included, among whom 18 were in the ESD combined with low-dose radiotherapy group and 22 in the direct surgical resection group. After PSM, there were no statistically significant differences between the two groups in age, lesion length, lesion location, pathological grade, invasion depth, and resection margin status, (all P>0.05). The follow-up time was 36.00 (25.75, 41.50) months in the ESD combined with low-dose radiotherapy group and 37.00 (34.25, 48.25) months in the direct surgical resection group, respectively. One death occurred in the ESD combined with low-dose radiotherapy group (due to myocardial infarction), while no deaths occurred in the direct surgical resection group, with no statistically significant difference between the two groups (P=0.450). Three recurrences were observed in the ESD combined with low-dose radiotherapy group, whereas no recurrences occurred in the direct surgical resection group, with no statistically significant difference between the two groups (P=0.083). The common complication was esophageal stenosis (2 cases in the ESD combined with low-dose radiotherapy group and 1 case in the direct surgical resection group). Complications in the ESD combined with low-dose radiotherapy group were mainly radiotherapy-related, including myelosuppression (4 cases), radiation esophagitis (3 cases), and radiation pneumonitis (2 cases).Complications in the direct surgical resection group mainly included pulmonary infection (4 cases) and anastomotic leakage (1 case). There was no statistically significant difference in the overall complication rate between the two groups (P=0.072). The postoperative pain score was lower in the ESD combined with low-dose radiotherapy group than in the direct surgical resection group [(1.17±1.04) vs (2.09±0.81) points, P=0.004]. However, there were no statistically significant differences in nutritional status or physical performance score between the two groups (all P>0.05). The ESD combined with low-dose radiotherapy group was superior to the direct surgical resection group in all 6 core quality-of-life dimensions: physical function, role physical, bodily pain, general health, vitality, and social functioning(all P<0.05). There were no statistically significant differences in role emotional or mental health between the two groups (all P>0.05).

For patients with T1a-MM/T1b-SM stage esophageal squamous cell carcinoma who have some choose and high-risk factors, ESD combined with low-dose radiotherapy exhibits short-term tumor-control efficacy comparable to that of direct surgical resection. Meanwhile, it demonstrates greater advantages in preserving esophageal function, degree of complications, alleviating postoperative pain and quality of life.

To analyze the influencing factors and establish a predictive model for permanent congenital hypothyroidism (PCH) in neonates with congenital hypothyroidism (CH).

A total of 682 neonates diagnosed with CH between January and December 2021 at the Third Affiliated Hospital of Zhengzhou University were retrospectively enrolled, including 370 males and 312 females, with the diagnostic age of (17.6±4.3) d. According to the type of CH, the patients were divided into the PCH group (n=212) and the transient CH (TCH) group (n=470). Differences in various indicators between the two groups were analyzed. Multivariate logistic regression analysis was used to identify the influencing factors of PCH, and a nomogram of the predictive model was constructed. The predictive efficacy, accuracy, and clinical applicability of the model were evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis, respectively.

The proportion of maternal thyroid disease history, levels of thyroid-stimulating hormone (TSH) at initial diagnosis, the rate of thyroid ectopia or agenesis, the proportion of pathogenic/likely pathogenic (P/LP) genetic variants, the proportion of biallelic DUOX2/DUOXA2 variants, and the proportion of TPO/TG gene variants were all higher in the PCH group than in the TCH group. In contrast, free thyroxine (FT4) at initial diagnosis, levothyroxine (L-T4) dosage at 1 year of age, and the proportion of normal or enlarged thyroid size were lower in the PCH group than in the TCH group(all P<0.05). Multivariate logistic regression analysis showed that increased birth weight (OR=0.96, 95%CI: 0.92-0.99), greater gestational age (OR=0.90, 95%CI: 0.79-0.98), and higher FT4 at initial diagnosis (OR=0.79, 95%CI: 0.73-0.86) were protective factors for PCH. Conversely, maternal history of thyroid disease (OR=2.14, 95%CI: 1.52-3.81), elevated TSH at initial diagnosis (OR=1.12, 95%CI: 1.08-1.17), higher L-T4 dosage at 1 year of age (OR=1.94, 95%CI: 1.45-2.06), abnormal thyroid imaging (OR=6.83, 95%CI: 3.92-11.91), and P/LP genetic variants (OR=2.87, 95%CI: 1.63-5.06) were risk factors for PCH. Five variables (initial TSH, initial FT4, L-T4 dosage at 1 year of age, thyroid imaging characteristics, and P/LP gene variants) were selected to construct a nomogram prediction model for PCH risk. The AUC of the model for predicting PCH in CH neonates was 0.88(95%CI: 0.85-0.91), with a sensitivity of 84.0% and a specificity of 80.0%. The calibration curve indicated good calibration of the model, and decision curve analysis showed that the model achieved satisfactory net clinical benefit within the threshold probability range of 0.1-0.7.

Higher TSH level at initial diagnosis, lower FT4 level at initial diagnosis, higher L-T4 dosage at 1 year of age, abnormal thyroid imaging, and pathogenic/likely pathogenic (P/LP) genetic variants are factors associated with the prediction of PCH. The nomogram established in this study shows favorable predictive performance and clinical applicability.

To evaluate the efficacy and safety of eliglustat tartrate in adult patients with Gaucher disease type 1 (GD1). Adult patients with GD1 confirmed at the First Medical Center of Chinese People′s Liberation Army General Hospital were prospectively enrolled from October 2023 to June 2024. They received eliglustat tartrate capsules treatment (oral, 84 mg, twice daily) for 52 weeks. The changes in glucosylsphingosine (Lyso-GL1), hemoglobin and platelet count, liver and spleen volumes, multiples of normal (MN) of liver and spleen volumes were observed before and after treatment, and adverse reactions during treatment were recorded. A total of 5 adult patients with GD1 type were included, and all were identified as extensive metabolizers (EMs) via CYP2D6 genotyping. Following 52 weeks of treatment, Lyso-GL1 levels decreased apparently from baseline. Hemoglobin levels and platelet count also increased. Both liver and spleen volumes decreased, with corresponding reductions in MN. One patient reported mild nausea and anorexia, which resolved spontaneously within 2 d without other adverse events. Eliglustat tartrate demonstrates favorable efficacy and safety in these 5 adult GD1patients with EMs.

To evaluate the clinical effect of the"six-step" robot-assisted subxiphoid extended thymectomy for myasthenia gravis. Clinical data of 45 patients with myasthenia gravis were retrospectively collected from the First Affiliated Hospital of Fujian Medical University between November 2022 and June 2025, including 22 males and 23 females, with the age of (48.0±12.0) years. Robot-assisted subxiphoid extended thymectomy was performed using a "six-step" approach. Perioperative data were collected, including operative time, intraoperative blood loss, postoperative thoracic drainage time and volume, length of postoperative hospital stay, postoperative complications, pathologic findings, and follow-up outcomes. All 45 procedures were completed without conversion or incision extension. The operation time was (158±26) min, the intraoperative blood loss was 15(8, 20) ml, the thoracic drainage time was 3(2, 3) d, and the postoperative thoracic drainage volume were 180.0(17.5, 400.0) ml on postoperative day 1, 40.0(10.0, 65.0) ml on postoperative day 2, and 15.0(7.5, 35.0) ml on postoperative day 3. The length of postoperative hospital stay was 4(3, 5) d. Postoperative complications occurred in 4 patients, including 1 case of hoarseness, 1 case of myasthenic crisis, and 2 cases of pulmonary infection, all of whom improved or recovered after symptomatic treatment. Pathology showed thymic hyperplasia in 9 cases and thymoma in 36 cases,among which ectopic thymus tissue was identified in 19 cases. Follow-up was conducted up to October 31, 2025, with a follow-up duration of 24.0(14.0, 29.0) months. No recurrence of complications, tumor recurrence or metastasis, or death was observed during follow-up."six-step" robot-assisted subxiphoid extended thymectomy is safe and feasible with favorable short-term outcomes and offers a standardized, generalizable approach for myasthenia gravis surgery.

This paper reports a case of primary type Ⅱ cryoglobulinemic vasculitis with arthralgia, heart failure and multi-system damage as the first manifestation. A 62-year-old female was admitted to hospital due to progressive aggravation of shortness of breath and inability to lie down. Moderate anemia, renal damage, and multiple peripheral neuropathy were found on examination. No obvious stenosis was found on coronary angiography. Cardiac damage caused by rheumatic immune diseases was considered. After asking the medical history, more than 10 years ago, he was diagnosed with RA due to polyarthralgia, morning stiffness, rheumatoid factor and anti-cyclic citrulline peptide antibody positivity, but the long-term standardized treatment effect was not good, and the multiple erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were normal, and there was no joint deformity and destruction. Further examination of autoantibody negative, complement C3 and C4 decreased, renal biopsy showed membrane proliferative glomerulonephritis with immunoglobulin M (IgM), immunoglobulin G (IgG) and complement C3 deposition, serum immunofixation electrophoresis showed IgM-κ type M protein, cryoglobulin positive. Primary cryoglobulinemic vasculitis (type II, severe) was diagnosed, and the condition was rapidly relieved and controlled for a long time after treatment with high-dose glucocorticoids combined with rituximab. This case suggests that patients with RA should be alert to cryoglobulinemia, re-check autoantibodies and complement in time, and avoid misdiagnosis and mistreatment when the inflammatory index is normal, the efficacy of standardized treatment is poor or even there is multi-system damage.

This paper reports a case of an elderly male patient with proteinuria, edema and renal insufficiency as the first manifestation. The pathology of renal biopsy was glomerular microvascular disease. Combined with monoclonal immunoglobulinemia, extensive peripheral nerve damage, endocrine changes, skin changes and organ enlargement, the patient was finally diagnosed as POEMS syndrome. After the patient was transferred from the nephrology department to the hematology department to be treated with pomalidomide combined with dexamethasone (Pd regimen), the treatment response was good: vascular endothelial growth factor (VEGF) decreased, monoclonal immunoglobulin turned negative, numbness of limbs was relieved, and renal function completely recovered. This case suggests that patients with unexplained renal damage with multi-system involvement should be alert to the possibility of POEMS syndrome.

A 69-year-old female was seen in the Affiliated Hospital of Zunyi Medical University on March 23, 2025 due to "intermittent hematochezia for 1 month and colonic lesions found for 5 days". Colonoscopy in the local hospital revealed giant rectal nodule mixed lateral developing tumor (LST-G-M). After admission, complete total abdominal CT plain scan + enhancement revealed rectal lesions. Fine examination painless colonoscopy considering rectal giant LST-G-M [tubular villous adenoma (TVA) with high-grade intraepithelial neoplasia (HGIN)? ］； Endoscopic submucosal dissection (ESD) was performed, and pathology showed (rectal) TVA, local with HGIN and traditional serrated adenoma (TSA). The final diagnosis was rectal flat TVA combined with TSA. After symptomatic treatment, he was discharged from hospital. Retrospective colonoscopy at 3 months postoperatively (30 June 2025) showed no recurrence. Through the diagnosis and treatment of this case, there is still an opportunity for endoscopic treatment of the giant rectal lesion trans-Heinz flap near the anal canal if the microvascular or glandular duct is found to be regular under magnification and endoscopy without obvious signs of infiltration. At the same time, when crystal violet staining of the lesion is performed to find III-H and IV-H glandular duct openings with jagged edges, fern leaf appearance or pine tower appearance, it is necessary to be alert to the possibility of TSA.

Idiopathic cervical dystonia (ICD) is the most common focal dystonia in adults. At present, the diagnosis relies on subjective assessment of clinical symptoms and lacks objective and specific biomarkers. In recent years, remarkable progress has been made in the field of ICD biomarkers. This paper adopts the definition of generalized biomarkers, systematically combs the research results in the fields of genetics, neuroimaging, neuroelectrophysiology and molecular biology, and divides them into risk, diagnosis and status markers according to their potential application values, and looks forward to the future research direction from the perspective of brain network diseases, in order to provide theoretical basis for early screening, accurate diagnosis and individualized diagnosis and treatment of ICD.

Idiopathic retroperitoneal fibrosis (iRPF) is a space-occupying autoimmune disease of unknown etiology, characterized by chronic retroperitoneal inflammation and fibrous tissue hyperplasia, and often presents great challenges in differential diagnosis from retroperitoneal malignancies. Imaging techniques play an important role in the differential diagnosis of iRPF and retroperitoneal malignancies, especially lymphomas. This paper discusses the value of CT, MRI and positron emission tomography/computed tomography (PET/CT) in the differential diagnosis of retroperitoneal malignant tumors and iRPF. By analyzing the location, morphology, influence on adjacent organs and characteristic imaging parameters of retroperitoneal tumor, the current situation of different imaging methods in clinical practice was reviewed. At the same time, the role of these imaging methods in identifying the early, late and different active states of iRPF was analyzed, which provided a new research direction for the non-invasive differential diagnosis of iRPF and retroperitoneal malignant tumors. It should be noted that imaging is not a substitute for the decisive role of pathological examination, especially when the imaging is atypical or suspected to be malignant. Its identification value still needs to be further explored.

In the article "Analysis of Influencing Factors and Construction of Prediction Model of High-risk Colorectal Adenoma", Issue 7, 2026, this journal deleted page 643 "Fund Project: Beijing Pinggu District Health Commission Science and Technology" Young Crops Program "(QMJH202525); Pinggu District Hospital Young Talents Research Project (Pgyyqn2022-04)"; Delete page 644 "Fund Program:" Young Talents Program "Project of the Health Commission of Pinggu District, Beijing (QMJH202525); Young Talents Research Project of Pinggu District Hospital (Pgyyqn2022-04)"; Page 645 "2022-Young Talent 001-01" is replaced by "sjtkyll-lx-2020 (19)" and is hereby corrected.