Kaiyu Zhang

Background: Infective endocarditis (IE) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) is rare and associated with limited treatment options because of extensive antimicrobial resistance. Case Presentation: We hereby present a case of prosthetic valve endocarditis (PVE) caused by CRAB, presenting with fever, persistent bloodstream infection, cerebellar hemorrhage, and aortic valve vegetation. The application of a novel combination therapy comprising eravacycline and cefiderocol effectively eliminated the bloodstream infection. Concomitantly, the monitoring of adverse reactions and the subsequent adjustment of medication and dosage ensured the favorable safety. Although bloodstream infection and valve vegetation were controlled, progressive perivalvular leakage indicated the need for timely surgical intervention when clinically feasible. Conclusion: This case indicates that eravacycline combined with cefiderocol may represent a novel and effective treatment option for refractory IE caused by carbapenem-resistant Gram-negative pathogens, including PVE caused by CRAB.

Complications of aneurysmal subarachnoid hemorrhage (aSAH), including vasospasm and delayed cerebral ischemia (DCI) substantially contribute to morbidity and mortality. We investigated the correlation between quantitative measurements on MRA performed immediately post-endovascular embolization and subsequent development of DCI or vasospasm. We included consecutive patients scanned between 9/1/2016 and 1/14/2022 with ruptured intracranial aneurysms (IAs) after endovascular treatment. We recorded clinical data including sex, age, BMI, smoking history, vascular risk factors, baseline CTA/CT features, modified Fisher score, and Glasgow Coma Score. We extracted quantitative MRA features, including total arterial length, total branch number, and average tortuosity, using a custom semi-automated software (VesselVoyager). Correlations between baseline quantitative MRA, other imaging and clinical features with DCI and vasospasm were determined using logistic regression analysis. Receiver operating characteristic (ROC) curves were calculated for clinical-only models and for models augmented with quantitative MRA features. 78 patients with ruptured IAs were included, of whom 48 developed vasospasm and 24 developed DCI. Multivariable logistic regression analysis showed that only average tortuosity was significantly and independently associated with subsequent DCI (OR 0.62, 95% CI 0.39-0.91, p=0.02). For vasospasm, total arterial length (0.87, 0.78-0.95, p=0.005), average tortuosity (0.37, 0.18-0.62, p=0.001), and age (0.92, 0.86-0.98, p=0.02) were independently associated with vasospasm incidence on multivariable regression. Adding quantitative MRA features improved ROC performance for both DCI (AUC 0.63 [95% CI 0.51-0.75])vs 0.75 [0.64-0.87]) and vasospasm (0.67 [0.54-0.79] vs 0.85 [0.77-0.94]). In patients with aSAH, average tortuosity is independently inversely associated with future development of DCI. Total branch number and average tortuosity are independently inversely associated with future vasospasm. With further validation, quantitative MRA features may serve as predictive markers for DCI and vasospasm after aSAH.

Tick-borne encephalitis virus (TBEV) is a neurotropic Orthoflavivirus that causes severe encephalitis and long-term neurological sequelae. Due to the limit

Most prior unsupervised domain adaptation approaches for medical image segmentation are narrowly tailored to either the source-accessible setting, where adaptation is guided by source-target alignment, or the source-free setting, which typically resorts to implicit adaptation mechanisms such as pseudo-labeling and network distillation. This substantial divergence in methodological designs between the two settings reveals an inherent flaw: the lack of an explicit, structured construction of anatomical knowledge that naturally generalizes across domains and settings. To bridge this longstanding divide, we introduce a unified, semantically grounded framework that supports both source-accessible and source-free adaptation. Fundamentally distinct from all prior works, our framework’s adaptability emerges naturally as a direct consequence of the model architecture, without relying on explicit cross-domain alignment strategies. Specifically, our model learns a domain-agnostic probabilistic manifold as a global space of anatomical regularities, mirroring how humans establish visual understanding. Thus, the structural content in each image can be interpreted as a canonical anatomy retrieved from the manifold and a spatial transformation capturing individual-specific geometry. This disentangled, interpretable formulation enables semantically meaningful prediction with intrinsic adaptability. Extensive experiments on challenging cardiac and abdominal datasets show that our framework achieves state-of-the-art results in both settings, with source-free performance closely approaching its source-accessible counterpart, a level of consistency rarely observed in prior works. Beyond quantitative improvement, we demonstrate strong interpretability of the proposed framework via manifold traversal for smooth shape manipulation. The results provide a principled foundation for anatomically informed, interpretable, and unified solutions for domain adaptation in medical imaging. The code and trained models will be released upon acceptance.

Hepatic echinococcosis is uncommon in Northeast China and often presents atypically, leading to misdiagnosis. We report a patient initially misdiagnosed with liver abscess whose prolonged and complicated course highlights the pitfalls in recognising this parasitic disease. A 48-year-old woman from Northeast China was referred after an 18-month odyssey of intermittent right-upper-quadrant pain repeatedly labelled "liver abscess". Multiple percutaneous drains, prolonged antibiotics and eventual sinus formation failed to control the lesion. Contrast CT at our centre raised the suspicion of metastases, whereas subsequent PET-CT favoured chronic infection but could not rule out abscess. However, percutaneous liver biopsy coupled with metagenomic sequencing identified Echinococcus multilocularis, and histopathology further confirmed necrotic granulomatous cysts consistent with a diagnosis of hepatic alveolar echinococcosis. She underwent radical hepatic resection in May 2024 followed by continuous albendazole. Post-operative imaging demonstrated complete removal, with no intra- or extra-hepatic relapse at 3-month follow-up, illustrating the importance of considering parasitic disease in indolent hepatic lesions.This case underscores the importance of including echinococcosis in the differential diagnosis of cystic hepatic lesions even in non-endemic areas of Northeast China. Early serological testing and characteristic imaging review can prevent unnecessary invasive procedures and guide definitive treatment.

BACKGROUND AND PURPOSE: Cerebral amyloid angiopathy (CAA) is a leading cause of intracranial hemorrhage and cognitive decline in the elderly. This study seeks to investigate the quantitative MRA features as new markers of CAA. MATERIALS AND METHODS: In this cross-sectional study, consecutive patients with CAA, along with controls, who underwent 3DTime-of-flight-MRA were included. Demographic and clinical data, including sex, age, diabetes, smoking, hypertension, and atrial fibrillation, were collected. Radiologic features, including the microhemorrhage classification, siderosis, and Fazekas scale, were also collected. Using in-house developed semi-automated software (VesselVoyager), quantitative MRA features, including total arterial length, number of branches, and tortuosity, were extracted. Univariable and multivariable logistic regression analyses were then performed to compare the CAA and non-CAA cohorts. RESULTS: Seventy-four patients were included: 43 with CAA and 31 controls. Quantitative MRA analysis showed that patients with CAA had significantly reduced total arterial length (1900±1240 mm vs. 2880±1540 mm, p=0.006). Univariable logistic regression identified total arterial length (p=0.009), age (p=0.012), and total branch number (p=0.107) as relevant predictors of CAA. In multivariable analysis, total arterial length (OR = 0.95; 95% CI: 0.92–0.99; p=0.014) and age (1.06; 1.01–1.12; p=0.023) remained independently associated with CAA diagnosis. CONCLUSIONS: Quantitative MRA total arterial length is inversely independently and significantly associated with CAA diagnosis. This could potentially serve as an imaging marker of CAA diagnosis and potentially further elucidate vascular segment involvement in CAA patients. ABBREVIATIONS: CAA = Cerebral amyloid angiopathy; TOF-MRA = Time-of-flight MRA; LDL = Low-density lipoprotein; BMI = Body mass index.

Introduction: Hemophagocytic lymphohistiocytosis (HLH), a rare and deadly disease, is typically classified as either primary (familial) or secondary (acquired), depending on the etiology and underlying cause. Secondary HLH often develops in the presence of infectious, malignant, rheumatologic, or metabolic conditions, with infections, especially Epstein–Barr virus (EBV) infection, being among the leading causes. Brucella infection-induced HLH is relatively rare, with only eight cases reported in the past decade, all of which had a favorable prognosis following timely diagnosis and treatment.Case description: A 53-year-old man with brucellosis who developed secondary HLH and multiple organ dysfunction presented to our hospital with a 2-month history of fever and abnormal liver enzymes. Initial blood culture following admission confirmed Brucella spp. in the aerobic bottle after ⁓87.85 h of incubation. However, after the initial discharge, the patient did not adhere to the prescribed antibiotic therapy and subsequently developed symptoms of fever and abdominal discomfort, and was readmitted to our hospital. Laboratory examination also revealed pancytopenia. An additional blood culture further revealed the growth of Brucella spp. in the aerobic bottle after ⁓113.67 h of incubation. Other findings included decreased fibrinogen, increased ferritin, increased soluble IL-2 receptor α chain (sCD25), decreased Natural Killer (NK) cell activity, presence of hemophagocytic cells in the bone marrow smear, splenomegaly, and abnormal liver and kidney functions. The HScore score was 230 points. A thorough assessment was made, which led to the exclusion of other possible diseases, culminating in the identification of Brucella infection as the most probable cause of HLH. Consequently, the patient was given anti-infection (doxycycline, levofloxacin, etimicin, and rifampin), glucocorticoids (GCs), human immunoglobulin (HIG), and other symptomatic supportive treatments, which ultimately improved his condition.Conclusion: Despite the generally poor prognosis of HLH patients, those with Brucella-induced HLH may have a favorable outcome with prompt intervention. Conversely, a delayed treatment could increase the risk of HLH onset and progression, leading to death in severe cases.

Brucellosis is a highly contagious zoonotic disease characterized by a non-specific clinical presentation and complex disease progression and outcome. Hemophagocytic lymphohistiocytosis (HLH) is an abnormal immune response syndrome marked by potentially fatal cytokine storms. Brucella-associated HLH is exceedingly rare and associated with a high mortality rate. We report a case involving a 23-year-old male residing in a brucellosis-endemic region, with a documented history of exposure to cattle and sheep. He was admitted to the hospital presenting with fever and arthralgia. Laboratory tests indicated splenomegaly, pancytopenia, elevated serum aminotransferases and ferritin levels, as well as decreased fibrinogen levels. Blood and bone marrow cultures yielded negative results. The Brucella serum agglutination test returned a positive result (titer, 1:200). Bone marrow aspirate results revealed an increased number of hemophagocytes, and PET-CT scans demonstrated splenomegaly, suggesting hemophagocytic changes. Following a comprehensive exclusion of hematological malignancies and neoplastic diseases, the patient was diagnosed with probable Brucella infection complicated by secondary HLH. Standard anti-brucellosis therapy was initiated immediately upon hospital admission. Remarkably, significant clinical improvement was observed within 7 days of targeted antibiotic treatment, without the need for corticosteroid therapy. This case, when analyzed alongside a systematic review of 12 published HLH cases associated with brucellosis, underscores the importance of maintaining a heightened clinical suspicion for this life-threatening complication in endemic regions, which may facilitate earlier diagnosis and optimized antimicrobial management strategies.

To delineate the clinical differences between Pneumocystis jirovecii pneumonia (PJP) and colonization, identify independent risk factors associated with PJP development, and construct a multidimensional diagnostic model to address the ongoing clinical challenge of accurately distinguishing P. jirovecii infection status in practice. This retrospective study analyzed the clinical characteristics, imaging findings, and laboratory parameters of patients who tested positive for P. jirovecii by next-generation sequencing (NGS) at the First Hospital of Jilin University between January 2014 and October 2024. Multivariable logistic regression was performed to determine independent predictors of PJP. Of the 292 patients included in the analysis (210 diagnosed with PJP and 82 classified as colonized), those with PJP had significantly higher rates of immunosuppression (64.4% vs. 9.9%, P < 0.001) and markedly increased P. jirovecii sequence counts from NGS (median: 1,686 vs. 4, P < 0.001).Human immunodeficiency virus coinfection, decreased lymphocyte count, elevated BDG levels, and increased LDH levels were identified as independent risk factors for PJP. A diagnostic model incorporating these four variables demonstrated excellent predictive capability, yielding an area under the receiver operating characteristic curve of 0.892 (P < 0.001; 95% confidence interval: 0.855–0.929). The optimal NGS sequence count threshold for differentiating PJP from colonization was determined to be 37, achieving a sensitivity of 91% and a specificity of 87.8% (area under the receiver operating characteristic curve: 0.964). The developed risk prediction model—comprising lymphocyte count, BDG, and LDH levels—facilitates rapid, pre-NGS clinical risk stratification for PJP, enabling prompt and informed therapeutic decision-making. When NGS results yield a P. jirovecii-specific sequence reads below the cutoff value of 37, a definitive diagnosis of PJP is unlikely. However, such findings should be interpreted in the context of the patient’s clinical presentation and assessed using the diagnostic model to ensure an accurate evaluation of infection status.