Artificial intelligence (AI) is transforming the diagnosis and treatment of chronic liver diseases in an unprecedented way, from the laboratory to clinical practice. AI has achieved significant progress across multiple domains, including radiomics, digital pathology and multimodal clinical decision support systems. This article provides a comprehensive review of current AI applications in the holistic management of chronic liver diseases, encompassing machine learning and deep learning, generative AI and large language models, digital twin systems, radiomics and digital pathology, digital health technologies and multimodal data integration. Machine learning aids in early encephalopathy detection and cirrhosis nutrition; generative AI, digital twins, imaging biomarkers and digital pathology show potential, with digital pathology as a new trial endpoint. Currently, however, AI still faces considerable challenges in the field of chronic liver disease. Even after achieving technological breakthroughs, translating these advances into routine clinical practice requires overcoming multiple obstacles, including limited generalizability, the difficulty of balancing clinical practicality with model complexity, insufficient explainability, data heterogeneity, ethical and fairness concerns, and unclear regulatory approval pathways. Therefore, the key to the success of future clinical translation lies in conducting multi-center prospective validation, developing interpretable AI frameworks, designing deployment strategies that meet clinical needs, and actively designing algorithms centered on patients to ensure their fairness. Only when development is carried out responsibly, and deployment is reasonable, can AI truly transform the comprehensive management model for chronic liver diseases and provide clinical doctors with powerful, reliable decision-making support tools.
Inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, is a chronic, relapsing immune-mediated disorder of the gastrointestinal tract. Its pathogenesis involves complex interactions among genetic susceptibility, the intestinal microbiota, environmental factors and dysregulated mucosal immunity. The development and refinement of disease models have been central to mechanistic understanding and therapeutic innovation in IBD. This review provides a comprehensive overview of the major disease models currently employed in IBD research, including chemically induced rodent models (dextran sodium sulfate, trinitrobenzene sulfonic acid and oxazolone), genetic and immune-transfer models (IL-10 knockout, T-cell transfer colitis, MDR1a knockout, SAMP1/YitFc ileitis and Nod2/Nox2 knockout model mice), microbiota-associated models (germ-free, gnotobiotic and human microbiota-associated mice), humanized mouse models, and human-derived in vitro and ex vivo platforms (intestinal organoids, colonoids, explant cultures and organ-on-a-chip). We discuss the mechanistic basis, histopathological features, advantages and limitations of each model in the context of Crohn's disease or ulcerative colitis biology. We further highlight recent advances including patient-derived organoid biobanks, organoid-immune cell co-culture systems, CRISPR-engineered IBD knock-in models, the integration of single-cell and spatial transcriptomics and AI-assisted model prediction. Critical gaps remain, particularly in modeling intestinal fibrosis and accounting for sex as a biological variable. No single model fully recapitulates the multifaceted pathogenesis of human IBD; strategic selection and complementary use of multiple models across biological scales remain essential for translational progress. This review aims to guide researchers in selecting appropriate models and interpreting findings within their biological and translational context.
Bartonella quintana endocarditis, which is traditionally associated with homelessness and lice exposure, poses a significant diagnostic challenge due to its fastidious nature and nonspecific presentation. Here, we report a case of blood culture–negative endocarditis caused by B. quintana in a 75-year-old man with no classic risk factors. The patient presented with recurrent heart failure, progressive anemia, thrombocytopenia and renal impairment. Blood and valve cultures demonstrated no growth after prolonged incubation. Diagnosis was ultimately achieved through a multimodal approach: serology suggested Bartonella infection and metagenomic next-generation sequencing of excised aortic valve tissue provided identification of B. quintana . The patient was successfully treated with doxycycline and rifampicin, leading to full clinical recovery. This case illustrates the evolving epidemiology of bartonellosis beyond classic risk factors and underscores the critical role of metagenomic next-generation sequencing as a decisive diagnostic tool in blood culture–negative endocarditis, enabling accurate identification of fastidious pathogens and facilitating targeted therapy.
This retrospective analysis characterizes the distribution of bacterial pathogens and the drug-resistance profiles of the predominant isolates during the large-scale Mycoplasma pneumoniae (MP) outbreak of 2023. Strains were collected from Beijing Children's Hospital from January through December 2023. In 2023, 23,169 MP isolates were retrieved from 83,793 specimens. For other bacteria, a total of 5680 strains were isolated from 4759 specimens, with gram-negative bacteria constituting the majority (57.2%). During the MP epidemic in the second half of the year, the numbers of MP-positive cases, Haemophilus influenzae –positive cases and coinfection cases with both pathogens all showed similar upward trends. In 2023, the detection rate of methicillin-resistant Staphylococcus aureus was 24.6%. No penicillin-resistant Streptococcus pneumoniae was detected. Vancomycin resistance was detected in 3 strains (1.9%) of Enterococcus faecium . The rates of extended-spectrum β-lactamases production in Klebsiella pneumoniae and Escherichia coli were 64.0% (210/317) and 65.7% (230/350), respectively. Carbapenem resistance rates were 14.2% (45/317) for K. pneumoniae , 2.6% (9/350) for E. coli and 28.6% (28/98) for Enterobacter cloacae . For Pseudomonas aeruginosa and Acinetobacter baumannii , the carbapenem resistance rates were 12.6% (61/483) and 52.7% (127/241), respectively. Our findings delineate the bacterial distribution and resistance pattern among children at our hospital in 2023. The composition of isolated bacteria shifted during the MP outbreak, underscoring the importance of enhanced bacteriological surveillance during epidemics of predominant respiratory pathogens.
The emergence of hypervirulent carbapenem-resistant Klebsiella pneumoniae (Hv-CRKP) poses a critical global health threat, combining extreme antibiotic resistance with increased virulence. This “superbug” evolves via three primary genetic pathways: (i) hypervirulent K. pneumoniae acquiring carbapenem resistance plasmids, (ii) carbapenem-resistant K. pneumoniae acquiring virulence plasmids, and (iii) classical K. pneumoniae integrating resistance and virulence genes through fusion plasmids. Globally, Hv-CRKP exhibits multiregional dissemination, with particular prevalence in Asia, where China serves as one of the major epicenters dominated by the sequence type (ST) 11 clone, in contrast with the predominance of the ST258 clone in Europe and the Americas. Its virulence is orchestrated by multiple factors, including capsule polysaccharides, siderophore systems, the colibactin genotoxin and the Peg-344 protein. Resistance mechanisms involve carbapenemase expression, outer membrane porin mutations and efflux pump overexpression. The synergistic evolution of virulence and resistance in Hv-CRKP poses significant challenges to clinical antimicrobial therapy, necessitating the development of novel intervention strategies and innovative antimicrobial approaches. This review focuses mainly on the genetic evolution, global epidemiological variations and underlying drivers, virulence determinants and resistance mechanisms of Hv-CRKP. Furthermore, this review explores the evolution and divergence of their biological characteristics, providing critical insights for future research and clinical practice to combat this escalating global public health crisis.
Liver cirrhosis represents a significant global health burden and its progression is closely linked to dysregulation of the gut–liver axis. Accumulating evidence reveals stage-specific alterations in gut microbiota throughout the disease continuum. Microbial diversity decreases starting in the compensated stage, whereas the decompensated stage is characterized by marked enrichment of opportunistic pathogens, a decline in protective metabolites and impaired microbial metabolic and barrier-related functions. These changes are implicated in the pathogenesis of complications such as hepatic encephalopathy and spontaneous bacterial peritonitis. In clinical management, the combination of lactulose and rifaximin serves as the cornerstone for preventing and treating hepatic encephalopathy, while probiotics and fecal microbiota transplantation have emerged as promising therapeutic adjuncts or alternatives. For the prevention and management of spontaneous bacterial peritonitis, specific probiotics may serve as an adjunctive strategy. Despite these advances, the field faces challenges, including methodological heterogeneity and gaps in translational research. Future research must prioritize standardizing methodologies, implementing long-term longitudinal cohorts and integrating multiomics data to develop a precision management framework tailored to disease stages. Such efforts are crucial for redefining cirrhosis as a controllable and potentially reversible chronic condition.
Balamuthia amoebic encephalitis (BAE) is a rare and often fatal central nervous system infection caused by the free-living protozoon Balamuthia mandrillaris. Identifying the prognostic factors that affect the survival of pediatric patients is crucial for optimizing treatment strategies. We report a case of a 9-year-old boy with BAE who ultimately recovered without neurological sequelae. Furthermore, we conducted a comprehensive review of 55 cases of BAE in children to determine the risk factors associated with fatal outcomes. Early diagnosis via brain biopsy, complete resection of the lesion when feasible, and the use of combined therapies including azole drugs, sulfonamide drugs and thioridazine, may significantly improve the outcomes of children with amoebic cerebral encephalitis.
There is a lack of high-quality studies that systematically analyze the burden of communicable diseases (CDs) among women of childbearing age (WCBA), incorporate the impact of COVID-19 and provide forecasts to 2030. In this study, we accessed data from the Global Burden of Disease Study 2021 for WCBA with level 4 causes from 1990 through 2021, analyzed the temporal change patterns and projected the incidences to 2030. The results revealed that in 2021 there were 1.3 million deaths (39.8% of all-causes), 21.2 million years lived with disability and 88.9 million disability-adjusted life-years (DALYs) for CDs among WCBA, representing increases of 60.0%, 36.5% and 50.4% from 2019, respectively. COVID-19, mother-to-child transmission diseases of Triple Elimination Initiative and tuberculosis were the top three causes, collectively accounting for 73.7% and 64.4% of total CD deaths and DALYs, respectively, in 2021. The DALYs were predominantly in low and low-middle sociodemographic index settings, especially in Sub-Saharan Africa and South Asia. The global incidence of CDs excluding COVID-19 among WCBA is projected to increase to 5.42 billion (CI: 5.40–5.45 billion) by 2030, with the crude rate decreasing to 258,215.3 per 100,000. In conclusion, the COVID-19 pandemic reversed previously declining trends in the CD burden among WCBA. In the postpandemic era, CD prevention and control strategies targeting WCBA must be promptly realigned according to disease-specific characteristics to achieve Sustainable Development Goal 3.3 and the WHO’s strategic priorities for women’s health.
Soil-transmitted helminth (STH) infections continue to pose a significant health threat in Southeast Asia (SEA), where a third of global STH infections are estimated to occur. Preventive chemotherapy (PC) through mass treatments has been recommended by the WHO to combat STH infections and their dire consequences in susceptible populations. This review aims to update PC efforts for STH infection control in SEA. We systematically searched MEDLINE via PubMed, ScienceDirect, Scopus, EBSCO Host and ProQuest using specific terms for papers published from 2011 through 2025. From the 4294 initial search hits, 27 studies were included in this research. All SEA countries, except Brunei Darussalam and Singapore, were represented. Benzimidazole (BZ) drugs, namely, albendazole (400 mg) and mebendazole (500 mg), were the most commonly used drug interventions in PC efforts. BZ treatment effectively reduced the prevalence and intensity of STH infections, reinforcing its role in control programs. However, recent research has shown that BZ treatments fail to reduce infection prevalence and have diminished efficacy. Combination therapies, such as ivermectin (200 µg/kg) + albendazole (400 mg), enhanced treatment outcomes across STH species. Combination therapy integrated with health education and water, sanitation and hygiene improvement can accelerate control and elimination. Our review provides valuable insights for strengthening STH control programs in SEA, advocating for a multifaceted approach informed by the current evidence.
Entamoeba dispar, a commensal intestinal protozoan indistinguishable from pathogenic Entamoeba histolytica, has traditionally been considered nonpathogenic. Here, we report a rare case of an E. dispar–associated liver abscess in a 38-year-old man with a newly diagnosed HIV infection, initially misdiagnosed as a syphilitic gumma due to concurrent syphilis seropositivity. Despite initial treatment for syphilis, no significant resolution of the abscess was observed. Metagenomic next-generation sequencing of the drainage fluid identified E. dispar, and subsequent treatment with metronidazole resulted in significant radiological improvement. This case highlights the potential pathogenic role of E. dispar in immunocompromised individuals and underscores the importance of metagenomic next-generation sequencing in distinguishing parasitic infections from syphilitic lesions. This case of an E. dispar–associated liver abscess in China illustrates the diagnostic challenges that can arise with such presentations.
Human brucellosis remains endemic in the Chinese mainland, but its spatiotemporal dynamics remain unclear. This study employed descriptive epidemiology, joinpoint regression and spatial autocorrelation to map clustering patterns from 2010 through 2023. Joinpoint analysis identified an overall nonsignificant upward trend from 2010 to 2023 (average annual percent change = 5.965%, P = 0.200), with significant increases specifically during 2010-2015 (annual percent change = 10.55%, P = 0.041) and 2018-2023 (annual percent change = 14.48%, P = 0.008). Human brucellosis displays distinct seasonal variation, with peak incidence occurring in May across most regions and in June in the northwestern regions. The proportion of elderly patients (61-80 years) increased from 9.75% in 2010 to 21.85% in 2023, while the proportion of younger adults (19-40 years) declined substantially from 37.17% to 20.52%. The 41-60 age group consistently constituted the majority of cases (52.92% overall). Furthermore, a median diagnostic delay of 14 days reflects critical gaps in early diagnosis of the disease. Spatial analysis revealed significant spatial autocorrelation: high-high clusters were located primarily in northern regions and expanded from 156 to 359 counties, while low-low clusters in southern provinces decreased from 1752 to 1307 counties, indicating pronounced southward diffusion of the epidemic. The brucellosis epidemic in the Chinese mainland represents a dynamic progression, marked by simultaneous increasing incidence, aging patient population, southward expansion and systemic diagnostic delays. An integrated strategy, featuring tailored surveillance, preemptive action in northern hotspots and accelerated diagnosis, is urgently needed.
The intratumoral microbiota is emerging as a key modulator of tumor progression and responses to therapies. In this study, we investigated the role of the genus Lachnoclostridium in lung squamous cell carcinoma by analyzing paired microbiome and transcriptome data from 482 patients. We found that a high relative abundance of Lachnoclostridium was significantly associated with an inflamed tumor microenvironment, characterized by elevated immune infiltration, stromal content and expression of immune checkpoint genes, as well as a lower tumor immune dysfunction and exclusion score, suggesting a potentially enhanced response to immunotherapy. Leveraging this association, we developed a machine learning model based on Lachnoclostridium-related gene signatures, which demonstrated robust pan-cancer predictive performance for immune checkpoint inhibitor efficacy. Mechanistically, the Lachnoclostridium-high phenotype was linked to a potent local inflammatory response, marked by chemokine upregulation, which was further correlated with the activation of the epithelial-mesenchymal transition program, implying a role in prometastatic signaling. Furthermore, profiling of the intratumoral microbiota revealed distinct diversity, composition and network interactions across Lachnoclostridium abundance groups. Crucially, the abundance of Lachnoclostridium significantly influenced tumor cell sensitivity to various anticancer drugs, including BI-2536 and lapatinib. Collectively, our findings identify intratumoral Lachnoclostridium as a key modulator associated with the tumor immune microenvironment, inflammatory signaling and therapeutic response in lung squamous cell carcinoma. These associations have potential implications for predicting the outcomes of immune checkpoint inhibitor therapy and understanding the mechanisms of drug resistance.
Streptococcus pneumoniae is a well-established etiological agent of community-acquired bacterial meningitis in adults and frequently leads to diverse neurological complications. Standard treatment involves antibiotics and a 4-day dexamethasone regimen to prevent complications. This report presents a unique case of S. pneumoniae meningitis-associated cerebral vasculitis in a middle-aged male, characterized by a trifecta: probable vasculitis, vasogenic edema and symptom relapse after a steroid taper, which was uncommon in prior case reports. Despite adhering to standard therapy, the patient exhibited a significant neurological decline. Timely detection and appropriate supportive care played pivotal roles in alleviating neurological deficits. This distinctive case highlights the exceptional rarity of S. pneumoniae meningitis-induced cerebral vasculitis, emphasizing the critical importance of early recognition, prompt diagnosis and effective management strategies. Notably, an extended steroid taper appeared beneficial in this case, suggesting the need for further studies to guide treatment duration.
The serofast state of syphilis poses a major clinical challenge, yet its long-term pathophysiological implications remain poorly defined. To characterize the persistent biological alterations associated with this state, we conducted a two-center retrospective cohort study involving 382 serofast syphilis patients and 84 healthy controls, who were stratified by duration of seropositivity to simulate long-term follow-up. Our analysis revealed persistent and dynamic immune dysregulation, characterized by a progressive decline in neutrophils, persistently suppressed NK cells, and a biphasic T lymphocyte and immunoglobulin (IgM and IgA) response-initial posttreatment normalization followed by a significant secondary increase during prolonged seropositivity. In addition to the immune system response, patients developed progressive normocytic anemia, a trend toward hypocoagulability and widespread subclinical metabolic alterations; the latter was evidenced by consistently lower levels of glucose, proteins, uric acid and key electrolytes (K+, Ca & sup2;(+)), as well as lower levels of cardiac (alpha-hydroxybutyrate dehydrogenase and creatine kinase) and hepatic (albumin) metabolic function markers, all in the absence of overt organ damage. These findings demonstrate that the serofast state is not immunologically inert or benign, but is associated with ongoing immune activation and subclinical multisystem alterations. Our results challenge the prevailing clinical perception of this condition and underscore the imperative to reevaluate current management strategies for this patient population, with potential implications for mitigating the risk of long-term complications.
Fatty acid metabolism (FAM) plays a critical role in cancer development and progression, especially in hepatocellular carcinoma (HCC), as the liver is an important site of FAM. However, the associations of FAM with the tumor microenvironment and tumor phenotypes in HCC have not been fully elucidated. Here, we retrospectively obtained bulk RNA-seq and single-cell RNA sequencing data, intratumoral microbiome data and immune response data from HCC patients. Patients with activation of the FAM pathway exhibited elevated tumor purity, increased tumor mutational burden and a poor response to immunotherapy. Based on FAM-related genes, we constructed a robust machine learning framework combining least absolute shrinkage and selection operator (Lasso) and partial least squares Cox regression (PlsRcox) to predict survival; its performance was validated using multiple independent datasets. Single-cell sequencing revealed that risk scores were increased in malignant cells and tumor-associated macrophages. Furthermore, associations between FAM and the intratumoral microbiota were detected, and we constructed a biological network linking specific genera, immune cells and FAM-related genes. These findings provide a clinically applicable prognostic tool and highlight FAM and the intratumoral microbiota as promising therapeutic targets to improve HCC treatment, particularly for immunotherapy-resistant patients.
This retrospective analysis characterizes the distribution of bacterial pathogens and the drug-resistance profiles of the predominant isolates during the large-scale Mycoplasma pneumoniae (MP) outbreak of 2023. Strains were collected from Beijing Children's Hospital from January through December 2023. In 2023, 23,169 MP isolates were retrieved from 83,793 specimens. For other bacteria, a total of 5680 strains were isolated from 4759 specimens, with gram-negative bacteria constituting the majority (57.2%). During the MP epidemic in the second half of the year, the numbers of MP-positive cases, Haemophilus influenzae-positive cases and coinfection cases with both pathogens all showed similar upward trends. In 2023, the detection rate of methicillin-resistant Staphylococcus aureus was 24.6%. No penicillin-resistant Streptococcus pneumoniae was detected. Vancomycin resistance was detected in three strains (1.9%) of Enterococcus faecium. The rates of extended-spectrum beta-lactamases production in Klebsiella pneumoniae and Escherichia coli were 64.0% (210/317) and 65.7% (230/350), respectively. Carbapenem resistance rates were 14.2% (45/317) for K. pneumoniae, 2.6% (9/350) for E. coli and 28.6% (28/98) for Enterobacter cloacae. For Pseudomonas aeruginosa and Acinetobacter baumannii, the carbapenem resistance rates were 12.6% (61/483) and 52.7% (127/241), respectively. Our findings delineate the bacterial distribution and resistance patterns among children at our hospital in 2023. The composition of isolated bacteria shifted during the MP outbreak, underscoring the importance of enhanced bacteriological surveillance during epidemics of predominant respiratory pathogens.
China has maintained a low overall HIV/AIDS prevalence over the past 20 years. Nevertheless, the disease has undergone a growing variety of transmission pathways, with a substantial increase in infection rates among young people and the elderly. Through a thorough analysis of nationally disclosed epidemiological data, this study methodically summarizes the evolving trends and changing patterns of HIV epidemics in China, with a particular focus on the epidemiological characteristics of identified high-risk populations. Additionally, it assesses the advancements made in China’s prevention and control efforts and suggests improvement tactics, including expanding the dissemination of sexual education, improving the effectiveness of interventions for vulnerable groups, and increasing the establishment of social support networks according to the country’s unique circumstances.
Mucormycosis is a rare and severe fungal infection that typically affects immunocompromised individuals, although it has increasingly been reported in immunocompetent patients. Postoperative mucormycosis, particularly following emergency abdominal surgery, is an exceedingly rare complication. We present the case of a man in his late 30s who developed fatal postoperative mucormycosis after an emergency laparotomy for trauma. Despite prompt initial antifungal treatment with amphotericin B, the infection rapidly progressed, leading to sepsis and death. This case of postoperative mucormycosis in an immunocompetent patient in Iran is unusual and emphasizes the need for a high index of suspicion for rare infections such as mucormycosis, even in patients without traditional risk factors. Early antifungal therapy, close monitoring, and prompt multidisciplinary management are critical for improving outcomes.
The aim of this study was to assess the age-specific seroprevalence of antibodies against varicella-zoster virus (VZV) in the Varna region of Bulgaria. From January 2017 to December 2024, a total of 5117 individuals were tested for VZV-specific IgG and 4380 for VZV-specific IgM using commercially available ELISA and chemiluminescent immunoassay kits. The overall IgM seroprevalence was 12% (95% CI: 11%–13%), with the highest proportion of IgM-positive samples observed among children aged one to nine years. IgG seropositivity was detected in approximately 81% of individuals (95% CI: 79%–82%), with the seroprevalence reaching 90% by the age of 40 years. These findings suggest a delayed age of seroconversion and later exposure to VZV compared with patterns observed in the pre-vaccination era in Europe and underscores the need for reconsideration of current immunization policies in Bulgaria.
