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25 June 2026, Volume 25 Issue 03 Previous Issue   

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Expert forum

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Current status and research advances in laboratory diagnosis of non-tuberculous mycobacteria HUANG Hui, ZHANG Tingting, SUN Hongli 2026, 25 (03):  249-259.  DOI: 10.16150/j.1671-2870.2026.03.001 Abstract ( 0 )   HTML ( 3 )   PDF (727KB) ( 13 )   Non-tuberculous mycobacteria (NTM) are a group of opportunistic pathogens widely present in the environment. The global incidence of NTM infections and associated drug resistance rates are increasing. Although unified global surveillance data are lacking, studies based on national surveillance or large-scale databases from multiple countries have consistently reported a significant increasing trend in the incidence of NTM infections. In Japan, the incidence of pulmonary disease caused by NTM infections increased from 15.8 to 19.2 cases per 100 000 population between 2013 and 2017, representing an increase of 17.7%. In Denmark, a national registry study covering 1991 to 2022 shows that the incidence of NTM-related pulmonary diseases has continuously increased over the 30-year period, with an average annual growth rate of 2.3%. The clinical manifestations of non-tuberculous mycobacterial pulmonary disease are non-specific and highly similar to those of pulmonary tuberculosis, but the treatment strategies are markedly different. Moreover, treatment schemes vary greatly among different NTM species. Therefore, rapid and accurate laboratory identification and species differentiation are essential. Conventional diagnostic methods such as smear microscopy and culture have technical limitations including low sensitivity and long turnaround time, making it difficult to meet the requirements of early and precise clinical diagnosis and treatment. Molecular diagnostic techniques, represented by real-time fluorescent PCR, have greatly shorte-ned detection duration and enabled rapid screening and differentiation of NTM. Genomic technologies, represented by next-generation sequencing and nanopore sequencing, can achieve integrated and precise identification of bacterial species to the subspecies level and detect drug resistance genes directly from clinical specimens, thereby guiding early clinical medication. Artificial intelligence technology demonstrates strong potential in integrating imaging features, clinical data, and even genomic information, and can assist in auxiliary diagnosis, optimize treatment schemes, and predict prognosis. The development of these novel NTM laboratory diagnostic techniques is driving the transformation of NTM diagnosis and treatment from an empirical model to an efficient, precise, and individualized model. Figures and Tables | References | Related Articles | Metrics

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Current status and future prospects of drug treatment strategies for functional cure of chronic hepatitis B LI Qiang, CHEN Liang 2026, 25 (03):  260-267.  DOI: 10.16150/j.1671-2870.2026.03.002 Abstract ( 0 )   HTML ( 2 )   PDF (476KB) ( 12 )   Chronic hepatitis B (CHB) remains a major global health challenge. Functional cure represents the ideal therapeutic endpoint for CHB. The pathogenesis of CHB is complex, including hepatitis B virus (HBV) DNA integration, persistent covalently closed circular DNA, and impaired specific immune response against HBV, which poses significant challenges to achieving functional cure in CHB. Current therapeutic drugs have limited efficacy in achieving functional cure. After 10 years of nucleos(t)ide analogs (NAs) monotherapy, less than 5% of patients achieve functional cure, while less than 15% of patients achieve functional cure after 48 weeks of pegylated interferon (Peg-IFN) monotherapy. For the favorable population that achieves HBV e antigen (HBeAg) negativity with NAs treatment and has baseline HBV surface antigen (HBsAg) <1 500 IU/mL, the functional cure rate with sequential Peg-IFN therapy is over 20%, with a functional cure rate of over 30% for patients with baseline HBsAg between 500 and 1 500 IU/mL and over 60% for those with baseline HBsAg <100 IU/mL. For non-cirrhotic patients who meet the recommended drug discontinuation criteria in the guidelines, NAs cessation may accelerate HBsAg clearance and facilitate functional cure. However, close monitoring of hepatitis flares and hepatocellular carcinoma is required. To overcome the low functional cure rate of current drugs for CHB, researchers are exploring novel drugs, including direct-acting antivirals targeting different stages of HBV life cycle, and immunomodulatory drugs aimed at restoring immune function against HBV. Based on current research results, no new drug has achieved a functional cure rate of CHB above 30% through monotherapy. Therefore, combination therapy strategies based on new drugs are currently a research focus. References | Related Articles | Metrics

Interpretation

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Interpretation of 2025 Expert Consensus on Clinical Testing Pathway For Infectious Fever ZHU Zhaoqin, WU Wenjuan 2026, 25 (03):  268-277.  DOI: 10.16150/j.1671-2870.2026.03.003 Abstract ( 0 )   HTML ( 2 )   PDF (589KB) ( 13 )   To establish a scientific, standardized, and operable clinical laboratory pathway for infectious fever, and to address current problems such as blind selection of testing items, inappropriate testing timing, and inadequate multidisciplinary collaboration in clinical testing for infectious fever, the Clinical Microbiology Committee of the Shanghai Society for Microbiology and the Laboratory Medicine Branch and Molecular Diagnosis Branch of the Shanghai Medical Association jointly organized an expert panel. The panel integrated the current status of clinical diagnosis and treatment of infectious fever across different medical institutions, combined evidence-based medical evidence with the characteristics of clinical practice in China, and referred to existing consensuses and guidelines (such as the 2017 Expert Consensus on the Diagnosis and Treatment of Fever of Unknown Origin), as well as relevant domestic and international regulations and standards, to formulate the Expert Consensus on the Clinical Testing Pathway for Infectious Fever. The revision of this consensus unified the standards for the clinical testing pathway for infectious fever, standardized diagnosis and treatment behaviors, optimized allocation of medical resources, improved the quality of diagnosis and treatment, and addressed practical problems such as coexistence of overuse and underuse of testing items, poor multidisciplinary collaboration, and disconnection of testing services among medical institutions at different levels. This article interprets the revision background, implementation difficulties, and clinical significance of the consensus. It focuses on newly added contents such as the differential diagnosis and clinical feature definition of infectious fever, precise testing strategies for high-risk populations, hierarchical testing strategies, and application of novel laboratory diagnostic technologies. Additionally, it highlights core topics including hierarchical testing strategies, optimal selection of special pathogen detection technologies, individualized diagnosis and treatment for high-risk populations, and multidisciplinary collaboration mechanisms. Meanwhile, this article discusses current challenges in the implementation of the consensus, including unbalanced allocation of medical resources, inadequate multidisciplinary collaboration, and limitations in the application of new technologies. It also provides an outlook on the continuous improvement of the consensus with advances in testing technologies and promotion of progress in the diagnosis and treatment of infectious diseases, aiming to provide practical guidance for clinicians and laboratory personnel in medical institutions at all levels, further improve the diagnostic efficiency and accuracy of infectious fever, and promote standardized development of clinical diagnosis and treatment. Figures and Tables | References | Related Articles | Metrics

Academic trend at home and abroad

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Advances in novel tumor markers for cancer diagnosis and treatment in an era of integration of multi-omics technologies and artificial intelligence LU Renquan, HU Ling 2026, 25 (03):  278-286.  DOI: 10.16150/j.1671-2870.2026.03.004 Abstract ( 0 )   HTML ( 2 )   PDF (649KB) ( 12 )   The integration of multi-omics technologies and artificial intelligence is jointly promoting the application of more precise and dynamic novel tumor markers in cancer diagnosis and treatment. In terms of genomics, high-throughput sequencing technologies have promoted in-depth research into tumor driver genes, epigenetic reprogramming, and circulating cell-free DNA fragmentomics, providing actionable biomarkers for early cancer screening, molecular subtyping, and targeted therapy. Examples include the use of mismatch repair (MMR) deficiency to predict the efficacy of programmed death-1 (PD-1) inhibitors, and the combination of methylation markers with protein markers for the early detection of hepatocellular carcinoma. Transcriptomics, by analyzing mRNA and non-coding RNA combined with single-cell sequencing technologies, reveals tumor heterogeneity and identifies biomarkers for efficacy evaluation. Proteomics utilizes mass spectrometry to analyze protein expression levels and post-translational modifications (phosphorylation, glycosylation, acetylation), overco-ming the sensitivity bottleneck in early detection and providing new approaches for tumor subtyping and the discovery of therapeutic targets. Metabolomics systematically quantifies metabolic reprogramming processes, including glucose metabolism, amino acid metabolism, lipid metabolism, and nucleotide metabolism, providing a basis for tumor diagnosis and intervention strategies. Microbiomics confirms that the intratumoral microbiota can serve as functional biomarkers to aid in tumor diagnosis and prognosis assessment. Despite challenges such as biological interference, technical standardization, and the risk of false positives, artificial intelligence technologies, particularly machine learning algorithms, provide powerful computational capabilities for multi-omics data mining and pathological image assessment. This is driving the development of tumor markers towards high sensitivity and high specificity, and facilitating a comprehensive breakthrough in precision oncology. Figures and Tables | References | Related Articles | Metrics

Original articles

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Fungal resistance surveillance report in East China in 2025 LIN Huiping, WANG Dongjiang, GUO Jian, LI Teng, YANG Simin, WANG Shasha, ZHOU Aiping, HU Liang, TIAN Wenjie, MA Zhexiao, WU Jiaqi, GULIZIBA Yalimaimaiti, ZHANG Yan, CHEN Hui, XIAO Chenlu, GUO Wei, WANG Suzhen, WAN Zhimin, HAN Chunhua, WANG Shenghua, WEN Kaizhen, LI Bin, CHEN Yanlin, XIE Yuping, CHEN Wenjing, MENG Hongwei, LI Zhifu, XU Heping, HE Lei, WEI Muyun, LI Tinghua, YANG Haihui, XI Wei, WU Yongqin, LU Huaiwei, ZHUANG Yihui, LIU Yan, SHEN Dandan, QIN Jie, LI Shengchao, YANG Qing, HUANG Jingjing, TANG Chaogui, XU Jie, REN Jianmin, LIU Shufen, HU Xiuhua, SHANG Anquan, YUAN Yiqun, ZHOU Ling, DENG Weiping, CHEN Sijia, HU Haiqing, LU Xiuhai, HU Yongqi, LI Zhilan, DAI Yun, HU Niya, ZENG Lingbing, QIAN Minjian, HUANG Xiaochun, PAN Fen, JIANG Na, HU Juan, ZHU Zhaoqin, JIN Ying, YANG Leyuan, LIU Huaiyu, LI Niya, WENG Lizhen, XIA Yilan, LI Na, GAO Jing, ZHANG Xiaoxue, LIU Yun, CHEN Xu, DAI Junhua, LIU Jun, QIAN Duoduo, HOU Weiwei, WANG Yueling, SUN Jingfang, HUANG Lili, SHU Wen, LI Li, SHI Jianying, ZHANG Haomin, LIU Chunhong, YANG Weihua, WANG Fang, WU Wenjuan 2026, 25 (03):  287-307.  DOI: 10.16150/j.1671-2870.2026.03.005 Abstract ( 0 )   HTML ( 7 )   PDF (734KB) ( 11 )   Objective This study aims to monitor the antifungal susceptibility of clinically isolated fungi in East China in 2025, thereby providing a reference for clinical diagnosis and treatment. Methods A retrospective analysis was conducted on clinical fungi collected by the East China Invasive Fungal Infection Group (ECIFIG) from January to December 2025. Species identification was performed using morphological characteristics combined with mass spectrometry, and the results were verified by internal transcribed spacer (ITS) sequencing and β-tubulin gene sequencing. Antifungal susceptibility testing for azoles (fluconazole, itraconazole, voriconazole, posaconazole, isavuconazole), echinocandins (micafungin, anidulafungin, caspofungin), amphotericin B, and flucytosine was carried out using the broth microdilution method. Results In 2025, a total of 2 044 yeast isolates were collected in East China, and blood was the primary specimen type, accounting for 37.06% (763/2 044). The yeast species distribution was as follows: Candida albicans 38.51% (793/2 044), Candida tropicalis 18.89% (389/2 044), Candida parapsilosis 16.61% (342/2 044), Candida glabrata 15.20% (313/2 044), and Candida krusei 1.75% (36/2 044). A total of 310 filamentous fungal isolates were collected in East China, predominantly Aspergillus species: Aspergillus fumigatus (62.26%), Aspergillus flavus (26.45%), Aspergillus niger (5.81%), and Aspergillus terreus (3.55%). Filamentous fungi were mainly isolated from respiratory specimens, with sputum specimen accounting for 53.23% and bronchoalveolar lavage fluid (BALF) specimen accounting for 31.29%. Resistance in Candida species was primarily observed for azoles. The fluconazole resistance rate in C. albicans was 3.66%, and the rate of non-wild-type (NWT) isolates for posaconazole was 6.81%. For C. tropicalis, the fluconazole resistance rate was 29.05%, the voriconazole non-susceptible rate was 24.45%, the itraconazole NWT rate was 17.48%, and the posaconazole NWT rate was 61.18%. C. parapsilosis showed a fluconazole resistance rate of 11.7% and an amphotericin B NWT rate of 2.30%. C. glabrata exhibited a fluconazole resistance rate of 5.75%, and the NWT rates for itraconazole, posaconazole, and voriconazole were 1.92%, 12.78%, and 28.12%, respectively. For A. fumigatus, the voriconazole intermediate rate was 3.63%, and the resistance rate was 5.18%. The isavuconazole intermediate rate was 1.04%, the resistance rate was 4.70%, and the NWT rate for itraconazole was 3.11%. All A. flavus isolates were wild-type for caspofungin, amphotericin B, and azoles. Conclusions In 2025, East China Fungal Surveillance Network collects 2 044 yeast isolates, primarily from blood specimens, with C. albicans being the most prevalent. A total of 310 filamentous fungal isolates are collected, mainly from respiratory specimens, with A. fumigatus being the most common. Azole resistance in C. tropicalis is significantly higher than that in other Candida species. The azole resistance rate in A. fumigatus is 5.18%, showing an increase compared to it in previous years. No azole-resistant A. flavus isolates have been detected. Figures and Tables | References | Related Articles | Metrics

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Epidemiological status and drug resistance survey of protothecosis in China from 2015 to 2025 WANG Lili, GUO Jian 2026, 25 (03):  308-314.  DOI: 10.16150/j.1671-2870.2026.03.006 Abstract ( 0 )   HTML ( 1 )   PDF (861KB) ( 10 )   Objective Prototheca is a unicellular microalga belonging to the family Chlorellaceae that has lost its chlorophyll and the ability to perform photosynthesis, exhibiting biological characteristics intermediate between algae and fungi. Protothecosis is predominantly an exogenous infection, with pathogens commonly invading through damaged skin or mucous membranes via contact with contaminated soil, water, or organic matter. Clinical manifestations primarily include cutaneous and subcutaneous infections and olecranon bursitis. This study investigates the epidemiological characteristics and antimicrobial susceptibility distribution of protothecosis in China from 2015 to 2025, aiming to bridge the gap in domestic epidemiological data and clinical management guidelines of protothecosis, and to provide a scientific basis for its clinical diagnosis, treatment, and prevention strategies. Methods A total of 84 clinical Prototheca isolates collected by the Protothecosis Science Popularization and Monitoring Consortium (PSPMC) between 2015 and 2025 were retrospectively analyzed. In vitro susceptibility testing was performed for all isolates using the broth microdilution method. The tested agents included five azoles, three echinocandins, 5-flucytosine, and amphotericin B. Additionally, CYTB gene sequencing was conducted, followed by phylogenetic analysis. Results Among the isolates obtained from patients with protothecosis in China between 2015 and 2025, Prototheca wickerhamii was the predominant species (79.8%), followed by Prototheca bovis (11.9%). The highest number of isolates was found in East China (45.2%). The infections predominantly affected middle-aged and elderly individuals, with 82.1% of patients aged between 41 and 80 years. Skin tissue was the most common isolation source, accounting for 59.5% of all clinical isolates. Non-cutaneous sources included cerebrospinal fluid, blood, ascitic fluid, and bronchoalveolar lavage fluid. Azole antifungal agents, such as itraconazole, posaconazole, and voriconazole, demonstrated strong antimicrobial activity against Prototheca, with the minimum inhibitory concentration (MIC) required to inhibit 50% of isolates (MIC50) being 1.000 μg/mL. Isavuconazole exhibited superior activity, with MICs ranging from 0.015 to 1.000 μg/mL. Amphotericin B also showed strong antimicrobial activity (MIC50 = 0.500 μg/mL). Conversely, fluconazole, 5-flucytosine, and echinocandins showed no significant antimicrobial activity against Prototheca. The antimicrobial activity of isavuconazole against P. wickerhamii was significantly higher than against P. bovis and Prototheca zopfii. Phylogenetic analysis indicated that P. wickerhamii constituted the major evolutionary clade with a highly complex structure, suggesting significant intraspecific genetic heterogeneity. Conclusions Prototheca wickerhamii is the predominant species among isolates obtained from patients with protothecosis in China. The infected population mainly consists of middle-aged and elderly individuals. While skin is the main site of infection, non-cutaneous sites are widely distributed. Amphotericin B and isavuconazole demonstrate strong in vitro antimicrobial activity against these clinical Prototheca isolates, although susceptibility varies among different species. Figures and Tables | References | Related Articles | Metrics

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Clinical manifestations of scrub typhus in atypical endemic areas and application of metagenomic and targeted next-generation sequencing： an analysis of seven cases LI Qiong, LIU Fuqiang, QIU Luoping, LI Shaofen, YAO Lifei, PENG Wei, FAN Jialiang, XU Xianyun 2026, 25 (03):  315-320.  DOI: 10.16150/j.1671-2870.2026.03.007 Abstract ( 0 )   HTML ( 1 )   PDF (463KB) ( 10 )   Objective This study aims to summarize the clinical characteristics of patients with scrub typhus in atypical epidemic areas, and explore the application value of metagenomic next-generation sequencing (mNGS) and targeted next-generation sequencing (tNGS) in etiological diagnosis. Methods A retrospective analysis was conducted on the clinical data of seven patients with scrub typhus diagnosed by next-generation sequencing (NGS) at Ji'an Central People's Hospital from May 2025 to January 2026. Among them, three patients with respiratory symptoms or lung infection as the main manifestation underwent tNGS testing, while four patients with sepsis or systemic infection as the main manifestation underwent mNGS testing. Data on the patients' clinical manifestations, laboratory tests, NGS results, diagnosis time, and treatment outcomes were collected. Results Among the seven patients, four were male and three were female, with a median age of 69 years. All patients presented with high fever as the initial symptom, and only one patient exhibited typical eschar. All seven patients had elevated C-reactive protein levels, five of whom also had thrombocytopenia, and all seven had abnormal liver function. NGS detected Orientia tsutsugamushi sequences within 24 to 72 hours after sample submission. The duration from patient admission to obtaining etiological results ranged from 2 to 4 days, with a median of 3 days. After treatment with doxycycline or minocycline adjusted based on NGS results, the patients' temperatures returned to normal within 1 to 3 days, with a median fever reduction time of 2 days. All patients were cured and discharged. Conclusions Patients with scrub typhus in atypical epidemic areas often exhibit nonspecific clinical manifestations, making them prone to misdiagnosis and missed diagnoses. For high-risk febrile patients who fail to respond to empirical anti-infective treatment and have unidentified causes, NGS can serve as an important supplementary diagnostic tool. Timely NGS testing can facilitate rapid and precise identification of pathogens, providing crucial evidence for subsequent adjustments to targeted anti-infective regimens. Figures and Tables | References | Related Articles | Metrics

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Risk factors for occurrence and poor prognosis of neonatal candidemia QIN Huihong, YU Fangyuan, JIANG Jie, ZHANG Tiandong, PAN Fen 2026, 25 (03):  321-326.  DOI: 10.16150/j.1671-2870.2026.03.008 Abstract ( 0 )   HTML ( 0 )   PDF (453KB) ( 11 )   Objective This study aims to analyze the risk factors for the occurrence of neonatal candidemia and those associated with poor prognosis, thereby providing evidence for clinical diagnosis and treatment. Methods This retrospective study enrolled consecutive 57 cases of neonatal candidemia diagnosed by blood culture in the neonatal ward of Shanghai Children's Hospital between January 2017 and December 2024. All included neonates aged ≤28 days at the time of infection. The clinical features, laboratory findings, and treatment outcomes were analyzed. According to outcomes, the neonates were divided into death group (5 cases) and improved group (52 cases), and the risk factors for poor prognosis were analyzed. Results Among the 57 neonates with candidemia, 30 were male and 27 were female. The median postnatal age at the onset of candidemia was 14 days (interquartile range, 10, 20). Forty-eight cases (84.21%) were preterm infants (<37 weeks), 46 cases (80.7%) were low birth weight infants (<2 500 g), 54 cases (94.7%) had a history of invasive examination and treatment procedures before the onset of candidiasis, and 55 cases (96.5%) had a history of antimicrobial agent use prior to candidiasis. Etiological analysis showed that the predominant Candida species infecting the neonates was Candida parapsilosis (46 cases, 80.7%), follower by Candida albicans (6 cases, 10.53%), Candida glabrata (3 cases, 5.26%), and Candida guilliermondii (2 cases, 3.51%). Drug susceptibility test results indicated there was no antifungal drug-resistant strains. The time from the onset of clinical symptoms to confirmed diagnosis and initiation of antifungal therapy was (2.3±1.2) days, and the duration of antifungal treatment was 29 days (interquartile range, 23, 37). Univariate analysis showed that septic shock, tracheal intubation/mechanical ventilation, decreased platelet (PLT) count, and elevated procalcitonin (PCT) were risk factors for poor prognosis of neonatal candidemia (P<0.05). Conclusions The risk factors for neonatal candidemia include prematurity, low birth weight, a history of invasive examination and treatment procedures, and a history of antimicrobial drug use. The predominant pathogenic Candida species is Candida parapsilosis. Septic shock and endotracheal intubation/mechanical ventilation are risk factors for poor prognosis of neonatal candidemia. PLT and PCT can serve as important reference indicators for evaluating the prognosis of neonatal candidemia. Figures and Tables | References | Related Articles | Metrics

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Incidence and mortality analysis of lung cancer in Shanghai from 2002 to 2019 DOU Jianming, WU Chunxiao, CHEN Lei, PANG Yi, SHI Yan, GU Kai 2026, 25 (03):  327-336.  DOI: 10.16150/j.1671-2870.2026.03.009 Abstract ( 0 )   HTML ( 1 )   PDF (835KB) ( 12 )   Objective This study aims to analyze the incidence and mortality of lung cancer in Shanghai from 2002 to 2019 and their variation trends. Methods Data on lung cancer incidence and mortality in Shanghai from 2002 to 2019 were obtained from the population-based cancer registry management system and all-cause mortality registration system established by the Shanghai Municipal Center for Disease Control and Prevention. Stratified analyses were conducted by factors including year of diagnosis or death, sex, and age group, and indicators such as number of cases, constituent ratio, crude rate, age-specific rate, and age-standardized rate (ASR) were calculated. ASRs were calculated using Segi's 1960 world standard population. Joinpoint software was used to analyze annual percentage variation trends in ASRs, age-specific rates, and the constituent ratios of selected diagnostic characteristics of new cases across different groups. Results Annual new lung cancer cases in Shanghai increased from 8 005 in 2002 to 21 835 in 2019, and the age-standardized incidence rate increased from 33.73/10⁵ to 63.82/10⁵. Annual deaths increased from 6 871 to 9 573, while the age-standardized mortality rate decreased from 27.90/10⁵ to 21.75/10⁵. In 2019, the age-standardized incidence rate of lung cancer in Shanghai was 63.82/10⁵, including 66.37/10⁵ in males and 62.09/10⁵ in females, and the sex difference was statistically significant (P<0.001). The age-standardized mortality rate was 21.75/10⁵, with 33.50/10⁵ in males and 10.95/10⁵ in females, and the sex difference was statistically significant (P<0.001). Age-specific numbers and rates of lung cancer incidence and mortality generally increased with age. Sex-stratified trend analysis showed that from 2002 to 2019, the age-standardized incidence rate of lung cancer in males in Shanghai increased at an average annual rate of 1.39% (P=0.006), while the age-standardized mortality rate decreased at an average annual rate of 0.98% (P<0.001). In females, the age-standardized incidence rate showed no significant change from 2002 to 2011 (P=0.717), but increased at an average annual rate of 15.57% from 2011 to 2019 (P<0.001). The age-standardized mortality rate showed no statistically significant change from 2002 to 2012 (P=0.779), but decreased at an average annual rate of 2.95% from 2012 to 2019 (P=0.011). Among newly diagnosed lung cancer cases in Shanghai from 2002 to 2019, the proportion confirmed by pathology increased from 44.28% to 61.88%, while the proportion confirmed by imaging examination decreased from 41.50% to 7.99%. The proportion of adenocarcinoma increased from 19.66% to 41.20%, while that of squamous-cell carcinoma decreased from 14.13% to 6.29%. The proportion of stage Ⅰ patients increased from 3.76% to 22.60%, whereas the combined proportion of stage Ⅱ to stage Ⅳ patients decreased. However, the proportions of cases with unspecified anatomic site, unspecified histological type, and unknown stage at diagnosis remained high, and in 2019, the proportions were 75.65%, 45.89%, and 54.05%, respectively. Conclusions In 2019, compared with the global level, the age-standardized incidence rate of lung cancer in Shanghai, China, was relatively high, and mortality showed distinct epidemiological characteristics across sex and age groups. The incidence rate of lung cancer in females showed an overall upward trend from 2002 to 2019. In 2019, the age-standardized incidence rate of lung cancer in females increased with age. These findings suggest that there is still substantial room for improvement in lung cancer screening, diagnosis, and survival. This study provides a basis for further research and prevention and control strategies for lung cancer. Figures and Tables | References | Related Articles | Metrics

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Prospective study on value of 31P magnetic resonance spectroscopic imaging in evaluating efficacy of hepatic arterial infusion chemotherapy for advanced-stage hepatocellular carcinoma LI Jingzhe, LIN Huimin, WU Xinyu, DENG Rong, LIU Peng, YANG Yuchen, YAN Fuhua 2026, 25 (03):  337-345.  DOI: 10.16150/j.1671-2870.2026.03.010 Abstract ( 0 )   HTML ( 1 )   PDF (979KB) ( 6 )   Objective This study aims to investigate the value of 31P magnetic resonance spectroscopy imaging (31P MRSI) in evaluating the therapeutic efficacy of the first cycle of hepatic arterial infusion chemotherapy (HAIC) for patients with hepatocellular carcinoma (HCC). Methods A total of 13 male patients (mean age: 54±14 years) with Barcelona Clinic Liver Cancer-C stage HCC intended to receive HAIC at Ruijin Hospital were prospectively and consecutively enrolled from November 2023 to August 2024. Each patient underwent 31P MRSI before the first cycle [mean (1±1) d] and after the first HAIC cycle [mean (24±6) d]. After the 6th HAIC [median 151 d since the first HAIC (interquartile range, 123-179 d)] or after conversion surgery [median 94 d since the first HAIC (interquartile range, 66-106 d)], patients were divided into response group (n=6) and nonresponse group (n=7) according to modified response evaluation criteria in solid tumor (mRECIST) or pathological assessment criteria. The phosphomonoester (PME)/phosphodiester (PDE) and phosphoethanolamine (PE)/PDE ratios in patients with HCC, as well as their changes and change amplitude (ΔPME/PDE and ΔPE/PDE), were analyzed. Differences in these indicators before and after the first cycle of HAIC were compared between the response and nonresponse groups. The area under the receiver operating characteristic (ROC) curve was used to evaluate the value of these indicators derived from 31P MRSI in predicting HAIC efficacy. Results In the response group, the PME/PDE and PE/PDE ratios showed no change before and after HAIC, whereas it significantly increased in the nonresponse group. Before the first cycle of HAIC, the ratios of PME/PDE (0.97 vs. 1.91, P=0.027) and PE/PDE (0.55 vs. 1.23, P=0.014) in the nonresponse group were lower than those in the response group. In the nonresponse group, the mean ratios of PME/PDE (3.04 vs. 0.97, P=0.006) and PE/PDE (2.03 vs. 0.55, P=0.014) increased significantly after HAIC compared with those before treatment. After the first cycle of HAIC, ΔPME/PDE and ΔPE/PDE (1.69 vs. 0.40, P=0.029; 1.80 vs. 0.47, P=0.032) were significantly greater in the nonresponse group than in the response group. The area under the curve (AUC) values for predicting nonresponders were 0.83, 0.91, 0.86, and 0.83, for the PME/PDE ratio <0.91, and PE/PDE ratio <0.74 before the HAIC, ΔPME/PDE≥0.4 and ΔPE/PDE≥2.2, respectively. Conclusions In patients who do not respond to HAIC, the PME/PDE and PE/PDE ratios increase after the first cycle of HAIC. Baseline PME/PDE and PE/PDE ratios or after the first cycle of HAIC may be useful for predicting the efficacy of HAIC. Figures and Tables | References | Related Articles | Metrics

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Caffeine-mediated alleviation of imbalance of calcium homeostasis and apoptosis in cardiomyocytes caused by RyR2 knockdown YE Yuanzheng, FU Xiaoxiao, MEN Li, MA Qiancheng, ZHANG Andi, FAN Ping 2026, 25 (03):  346-353.  DOI: 10.16150/j.1671-2870.2026.03.011 Abstract ( 0 )   HTML ( 1 )   PDF (921KB) ( 6 )   Objective This study aims to investigate the effects of low-concentration caffeine on calcium homeostasis and apoptosis in rat cardiomyocytes with ryanodine receptor 2 (RyR2) knockdown. Methods Neonatal Sprague-Dawley (SD) rats of specific pathogen-free (SPF) grade were used, and neonatal rat ventricular myocytes (NRVMs) were isolated and extracted. Synthetic small interfering RNA (siRNA) targeting RyR2 and the negative control (NC) were transfected into NRVMs, and the cells were divided into four groups: NC group (transfected with siRNA NC), siRyR2 group (transfected with RyR2 siRNA), NC+caffeine group (0.2 mmol/L caffeine added after siRNA NC transfection), and siRyR2+caffeine group (0.2 mmol/L caffeine added after RyR2 siRNA transfection). The mRNA and protein expression levels of RyR2 were detected by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot. Cell apoptosis and calcium ions were detected by flow cytometry, and free calcium ion concentration was detected by confocal calcium ion imaging. Data from the NC, siRyR2, NC+caffeine, and siRyR2+caffeine groups were analyzed by one-way analysis of variance. Results Compared with the NC group, the mRNA and protein expression levels of RyR2 in the siRyR2 group were significantly decreased (mRNA: 0.41±0.04 vs 1.00±0.09, P=0.000 3; protein: 0.34±0.04 vs 0.72±0.02, P=0.000 1), calcium ion concentration was significantly decreased (flow cytometry: 0.80±0.02 vs 1.00±0.02, P<0.000 1; confocal: 61.08%±0.75% vs 100.00%±2.33%, P<0.000 1), and the apoptosis rate was significantly increased (9.21%±0.07% vs 4.19%±0.07%, P<0.000 1). In the NC+caffeine group, the mRNA and protein expression levels of RyR2 were significantly increased (mRNA: 1.27±0.15 vs 1.00±0.09, P=0.033 6; protein: 0.92±0.10 vs 0.72±0.02, P=0.006 5), calcium ion concentration was significantly increased (flow cytometry: 01.33±0.04 vs 1.00±0.02, P<0.000 1; confocal: 116.21%±1.51% vs 100.00%±2.33%, P=0.000 6), and the apoptosis rate was significantly decreased (2.97%±0.13% vs 4.19%±0.07%, P<0.000 1). Compared with the siRyR2 group, the mRNA and protein expression levels of RyR2 in the siRyR2+caffeine group were significantly increased (mRNA: 0.67±0.08 vs 0.41±0.04, P=0.044 7; protein: 0.54±0.01 vs 0.34±0.04, P=0.009 1), calcium ion concentration was significantly increased (flow cytometry: 0.87±0.02 vs 0.80±0.02, P=0.026 3; confocal: 79.14%±5.02% vs 61.08%±0.75%, P=0.000 3), and the apoptosis rate was significantly decreased (7.59%±0.10% vs 9.21%±0.07%, P<0.000 1). Compared with the NC+caffeine group, the mRNA and protein expression levels of RyR2 in the siRyR2+caffeine group were significantly decreased (mRNA: 0.67±0.08 vs 1.27±0.15, P=0.000 2; protein: 0.54±0.01 vs 0.92±0.10, P<0.000 1), calcium ion concentration was significantly decreased (flow cytometry: 0.87±0.02 vs 1.33±0.04, P<0.000 1; confocal: 79.14%±5.02% vs 116.21%±1.51%, P<0.000 1), and the apoptosis rate was significantly increased (7.59%±0.10% vs 2.97%±0.13%, P<0.000 1). Conclusions Low-concentration caffeine can promote calcium ion release, restore calcium homeostasis, and reduce apoptosis by upregulating RyR2 in cardiomyocytes. This interaction mechanism between caffeine and RyR2 can provide a reference for the development of therapeutic drugs for heart diseases such as arrhythmias caused by decreased RyR2 expression. Figures and Tables | References | Related Articles | Metrics

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Correlation between serum soluble CD206 and disease activity in patients with anti-neutrophil cytoplasmic antibody-associated glomerulonephritis WEI Zhaonan, AN Xiaoning, NI Liyan, SHEN Pingyan, SHI Hao, ZHANG Wen, CHEN Yongxi 2026, 25 (03):  354-360.  DOI: 10.16150/j.1671-2870.2026.03.012 Abstract ( 0 )   HTML ( 1 )   PDF (677KB) ( 8 )   Objective This study aims to investigate the expression characteristics of serum soluble CD206 (sCD206) in patients with anti-neutrophil cytoplasmic antibodies (ANCA)-associated glomerulonephritis (AGN) and its value in assessing disease activity. Methods A total of 54 AGN patients hospitalized in the Department of Nephrology of Ruijin Hospital from January 2020 to December 2022 were consecutively enrolled, and 38 active-phase serum specimens and 29 remission-phase specimens for each were collected. Among them, 13 patients provided both active-phase and remission-phase serum specimens. Additionally, 14 age- and sex-matched healthy volunteers were recruited as controls. Serum sCD206 levels of all subjects were measured using double-antibody sandwich enzyme-linked immunosorbent assay (ELISA). Comparisons were made among healthy controls, active-phase AGN patients, and remission-phase AGN patients. Paired analysis was performed on active-phase and remission-phase specimens from the 13 patients who achieved clinical remission during the study period. Correlations between serum sCD206 levels and AGN-related clinical indicators [serum creatinine, estimated glomerular filtration rate (eGFR), 24-hour urinary protein, Birmingham Vasculitis Activity Score (BVAS), erythrocyte sedimentation rate, etc.] were analyzed. The efficacy of serum sCD206 levels on assessing disease remission in AGN was evaluated using receiver operating characteristic (ROC) curve. Results Serum sCD206 levels in active-phase AGN patients [(2.359±0.827) AU] were significantly higher than those in remission-phase patients [(0.989±0.230) AU] and healthy controls [(1.074±0.528) AU] (all P<0.000 1). The serum sCD206 levels of the same patients during the remission phase were significantly lower than those during the active phase (ΔsCD206=1.439±0.873 AU, P<0.01). There was no significant difference in serum sCD206 levels between remission-phase AGN patients and healthy controls (P>0.05). Correlation analysis showed that serum sCD206 levels in active-phase AGN patients were positively correlated with BVAS (r=0.577, P<0.001). ROC curve analysis showed that the area under the curve (AUC) of serum sCD206 levels for assessing clinical remission in AGN patients was 0.876. The optimal cutoff value was 1.547 AU, with a sensitivity of 86.21% and a specificity of 78.95%. Conclusions Serum sCD206 levels decrease significantly as disease activity declines, and can serve as a potential biomarker for evaluating clinical remission in AGN patients. Figures and Tables | References | Related Articles | Metrics

Review articles

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Research progress on antibacterial strategies against methicillin-resistant Staphylococcus aureus LI Mengna, LU Lihua, HONG Yelan, WU Yong 2026, 25 (03):  361-369.  DOI: 10.16150/j.1671-2870.2026.03.013 Abstract ( 0 )   HTML ( 0 )   PDF (927KB) ( 9 )   The in-hospital mortality rate of methicillin-resistant Staphylococcus aureus (MRSA) can reach 20%-30%, which has attracted global attention. However, the clinical treatment options for MRSA infections are still very limited. The drug resistance mechanisms of MRSA can be divided into intrinsic and acquired types. Intrinsic drug resistance is mainly achieved through the secretion of β-lactamase and the activation of efflux pumps. MRSA can acquire drug resistance through gene mutations or plasmid transformation involving drug-resistant genes. Additionally, the formation of biofilms and the emergence of small colony variants are also important mechanisms for acquired drug resistance. In clinical practice, traditional antibiotics are still the main approach for treating MRSA bacteremia. As MRSA tolerance to traditional antibiotics gradually increases, research on new therapeutic methods has also made great progress. Among these, quorum-sensing system (QS) inhibitors, antimicrobial peptides, small-molecule compounds, antimicrobial photodynamic therapy, phage therapy, and combination therapy have shown great potential in the treatment of MRSA infections. These novel approaches not only provide more effective, low-toxicity, and sustainable solutions for clinical practice but also offer new ideas for the exploration of new antibiotics with mechanisms of action different from those of traditional antibiotics. Figures and Tables | References | Related Articles | Metrics

Case reports

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A case report of pseudohypoparathyroidism type 1b caused by noval mutation of STX16 LI Siwen, DU Hongyu, CHEN Huaqin 2026, 25 (03):  370-376.  DOI: 10.16150/j.1671-2870.2026.03.014 Abstract ( 0 )   HTML ( 1 )   PDF (4158KB) ( 7 )   Pseudohypoparathyroidism (PHP) is a group of clinical syndromes caused by peripheral target tissue resistance to parathyroid hormone (PTH). Its main clinical features are hypocalcemia, hyperphosphatemia, and resulting tetany, convulsions, or epileptoid seizures. Patients with PHP 1b often present no specific signs and have diverse clinical manifestations, and if biochemical tests and PTH measurements are not performed in time, the diagnosis is likely to be delayed. This paper reports a 11-year-old boy with episodic convulsion as the main manifestation. The boy had low serum calcium and ionized calcium, significantly increased PTH, elevated serum phosphorus, and low urinary calcium and phosphorus. Genetic testing revealed heterozygous deletion of exons 5-7 of STX16 gene and loss of maternal methylation at GNAS-A/B. Parental testing for copy number changes and methylation status of STX16/GNAS-AS1/GNAS genes/regions showed no abnormalities. The patient was definitively diagnosed as a male pediatric case of autosomal dominant PHP 1b (AD-PHP 1b) caused by a new mutation of STX16. After oral treatment with calcitriol and calcium supplements, the patient's serum calcium gradually returned to normal, and no further convulsive seizures occurred. The patient is currently under follow-up. At present, no cases of male AD-PHP 1b caused by a new mutation of STX16 have been reported in China. Figures and Tables | References | Related Articles | Metrics

Medical education

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Application of a scenario-based and virtual simulation-integrated model in rotation assessment of cardiology residents LIU Zhuhui, WANG Lingjie, ZHANG Ning, WU Liqun, REN Hong, XU Jing 2026, 25 (03):  377-382.  DOI: 10.16150/j.1671-2870.2026.03.015 Abstract ( 0 )   HTML ( 1 )   PDF (798KB) ( 8 )   Figures and Tables | References | Related Articles | Metrics

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Exploring innovative pathways for undergraduate education in medical imaging technology based on entrustable professional activities ZHAO Shutian, CHEN Wei, LIU Xiangfan, YAN Fuhua, LI Ruokun 2026, 25 (03):  383-388.  DOI: 10.16150/j.1671-2870.2026.03.016 Abstract ( 0 )   HTML ( 0 )   PDF (481KB) ( 10 )   Figures and Tables | References | Related Articles | Metrics