The brain-gut interaction theory is a multidimensional integrative concept based on the brain-gut axis， involving neural， endocrine， and immune regulatory networks as well as the gut microbiota. Zang-fu organs （脏腑） theory in traditional Chinese medicine （TCM） shows a high degree of consistency with the brain-gut interaction theory， and the core functions such as the spleen and stomach governing the ascending of the clear and descending of the turbid， the liver governing the free flow of qi， and the heart governing mental and emotional activities are closely associated with the multi-level regulatory mechanisms of the brain-gut axis. TCM therapy can modulate brain-gut interactions through multiple pathways in the treatment of spleen and stomach diseases， including the regulation of gastrointestinal hormone secretion， neurotransmitter levels， the hypothalamic-pituitary-adrenal （HPA） axis， immune homeostasis and inflammatory responses， as well as the gut microecology. However， current basic research on the brain-gut interaction theory in TCM for spleen and stomach diseases still faces several challenges， such as difficulties in integrating TCM spleen-stomach theory with modern pathophysiology， lack of innovation in research concepts， and limitations in research methodologies. It is therefore proposed that multidisciplinary collaboration， multi-omics technologies， and targeted research approaches should be adopted to provide more comprehensive methods for basic research on TCM spleen and stomach diseases， thereby promoting the in-depth development of brain-gut interaction theory.

Objective: To evaluate the diagnostic potential of fluid suppression (FS) techniques combined with amide proton transferweighted imaging (APTw) for assessment of isocitrate dehydrogenase (IDH) mutation status, glioma subtypes, and tumor proliferation. Materials and Methods: This retrospective study included 117 patients with adult-type diffuse gliomas. Conventional APTw, FSAPTw, and spillover-corrected FS-APTw (SCFS-APTw) metrics were calculated from 3T MRI data in tumor parenchyma, necrotic or cystic regions, and contralateral normal-appearing white matter. APTw signals were compared across the three techniques within each region, between IDH-mutant and IDH-wildtype gliomas, and among astrocytoma, oligodendroglioma, and glioblastoma subtypes. Diagnostic performance for distinguishing IDH mutation status and glioma subtypes was assessed using receiver operating characteristic (ROC) analysis. Correlations between APTw metrics and Ki-67 expression were also analyzed. Results: Both FS-APTw and SCFS-APTw significantly reduced signal intensity in tumor parenchyma and necrotic or cystic regions, with SCFS-APTw demonstrating a stronger suppression effect. IDH-wildtype gliomas showed significantly higher APTw metrics than IDH-mutant gliomas (all P < 0.001). Glioblastomas exhibited significantly higher metrics than oligodendrogliomas (all corrected P ≤ 0.015) and astrocytomas (all corrected P < 0.001). SCFS-APTw achieved the highest area under the ROC curve (AUC) of 0.846 for identification of IDH mutation status. For differentiation between astrocytomas and glioblastomas, the 90th percentile of APTw yielded the highest AUC (0.860), followed by SCFS-APTw (0.849). For discrimination between oligodendrogliomas and glioblastomas, the highest AUC (0.832) was obtained using the 90th percentile of SCFS-APTw. None of these metrics successfully differentiated oligodendrogliomas from astrocytomas. SCFS-APTw demonstrated the strongest correlation with Ki-67 expression (r = 0.451). Conclusion FS techniques effectively reduce elevated APTw signals originating from fluid compartments. Their combination with APTw imaging enables evaluation of IDH mutation status, glioma subtypes, and tumor proliferative activity in adulttype diffuse gliomas.

Objective To identify potential immunosenescence markers in benign prostatic hyperplasia(BPH)and to explore BPH-related senescent phenotypes. Methods Three transcriptome datasets and one single-cell RNA-sequencing(scRNA-seq)dataset for BPH and normal prostate tissues were obtained from the Gene Expression Omnibus(GEO)database. The GSE7307 and GSE119195 were combined to analyze differentially expressed genes(DEGs). Enrichment analysis and immune infiltration analysis were used to explore aging-related changes in the immune microenvironment. Weighted gene coexpression network analysis(WGCNA)was applied to identify immune-related genes in GSE132714. ScRNA-seq data were employed to investigate the transcriptomic landscape, luminal cell heterogeneity, and aging-related alterations in BPH through cell-cell communication and pseudotime analysis. Finally, the results were validated with in vitro experiments. Results A total of 1202 DEGs and 627 immune-related genes were identified in BPH and normal prostate tissues. Enrichment analysis indicated that the vascular endothelial growth factor(VEGF)signaling pathway exhibited a downregulated aging phenotype in BPH. In scRNA-seq analysis, 9 cell types were identified. The VEGF signaling pathway in BPH exhibited an aging-related expression pattern, characterized by decreased vascular endothelial growth factor A(VEGFA)in luminal cells. Conclusion Our study identified VEGFA as a marker of immunosenescence in BPH, with changes of the VEGF pathway. Meanwhile, low expression of VEGFA, coupled with high expression of placental growth factor(PlGF)and vascular endothelial growth factor receptor(VEGFR), represented a senescent phenotype of the prostate.

Chronic graft-versus-host disease (cGVHD) is the most common late complication after allogeneic hematopoietic stem cell transplantation, with an incidence rate of 30% to 70%. It significantly affects the long-term survival of patients. The clinical manifestations of this disease are highly heterogeneous and can involve multiple organs such as the skin, mouth, eyes, lungs and liver. Its core mechanism involves chronic inflammation, disruption of immune tolerance and dysregulation of T and B cells, ultimately leading to tissue fibrosis. In recent years, with the deepening of research on the pathogenesis, the treatment of cGVHD has evolved from traditional glucocorticoids to targeted drugs targeting key signaling pathways such as JAK, ROCK2 and BTK, biological agents that deplete pathogenic immune cells, and cell therapies for reestablishing immune tolerance, forming a diversified and precise treatment landscape. This article reviews the progress in the epidemiology, pathogenesis, diagnostic assessment and treatment strategies of cGVHD. Current evidence suggests that combined and sequential treatment targeting fibrosis and immune tolerance is a key direction for breaking through the current treatment bottleneck of cGVHD.

Chronic graft-versus-host disease (cGVHD) is a major challenge affecting the long-term survival of patients after allogeneic hematopoietic stem cell transplantation, especially for those who are resistant to glucocorticoid. In recent years, cell therapy, as an "active drug", has brought breakthroughs in the treatment of cGVHD by actively regulating immunity rather than using traditional broad-spectrum immunosuppression. Mesenchymal stem cells have shown potential in reducing the incidence of cGVHD and treating refractory patients, but their efficacy is affected by the cell source and heterogeneity; regulatory T cell (Treg) has performed outstandingly in restoring immune tolerance and are gradually evolving towards antigen-specific and chimeric antigen receptor (CAR)-Treg in a precise direction; in addition, CAR-T cell therapies targeting pathogenic B cell, plasma cell, or fibroblast, as well as novel strategies such as regulatory B cell and myeloid-derived suppressor cell, have further expanded the treatment options. Despite challenges such as product standardization, efficacy prediction and cost, in the future, through the integration of combination therapy, universal products and genetic engineering technologies, cell therapy is expected to drive cGVHD towards an individualized and precise treatment era.

Objective Jejunal interposition is an important option for restoring gastrointestinal continuity in patients with complex esophageal cancer in whom the stomach is unavailable for reconstruction due to previous gastrectomy, tumor involvement, failed gastric conduit, or other constraints. Although the jejunum offers a caliber similar to the esophagus, a rich blood supply, and preserved peristaltic function, anatomical variations in mesenteric length and vascular arcades render long-segment and high-level reconstruction susceptible to excessive tension, mesenteric torsion, venous congestion, and inadequate distal perfusion. This consensus aims to provide standardized recommendations for the application of jejunal interposition in this specific patient population. Methods This consensus was developed in accordance with the WHO Handbook for Guideline Development and Chinese national guideline development standards, with reference to the Appraisal of Guidelines for Research & Evaluation Ⅱ(AGREE Ⅱ), Reporting Items for Practice Guidelines in Healthcare (RIGHT), and Scientific, Transparent and Applicable Rankings (STAR) checklists. The project was registered on the international practice guidelines registry platform (PREPARE-2026CN1384). The working group systematically searched Chinese and English evidence addressing 12 clinical questions. Evidence was graded using the Oxford Centre for Evidence-Based Medicine (OCEBM) 2009 system, with structured appraisal of risk of bias, inconsistency, indirectness, and imprecision. Recommendations were formulated through two rounds of Delphi surveys and a face-to-face consensus meeting, with an agreement threshold of ≥75%. Results The consensus generated 12 recommendations covering indications, selection between jejunum and colon, preoperative assessment, surgical approach and reconstruction route, pedicled jejunal interposition (PJI), supercharged pedicled jejunal interposition (SPJ), indocyanine green (ICG) perfusion assessment, perioperative nutrition, management of anastomotic leakage, long-term follow-up, and special treatment scenarios. Given that the available direct evidence is predominantly derived from single-center retrospective cohorts and case series, recommendations extrapolated from general esophagectomy or other gastrointestinal surgical evidence are deliberately phrased with caution. Conclusion Jejunal interposition is a safe and effective approach for digestive tract reconstruction in patients with complex esophageal cancer in whom the stomach is unavailable. This consensus emphasizes that clinical decision-making should be individualized based on the patient's prior treatment history, reconstruction height, vascular anatomy, technical availability, and institutional experience in the Chinese context.

Non-alcoholic fatty liver disease （NAFLD） is a chronic liver disease closely related to metabolism， which is mainly characterized by abnormal lipid deposition in hepatocytes. In recent years， with the increasing prevalence of obesity and metabolic syndrome， NAFLD has become one of the most common chronic diseases in the world. The pathogenesis of NAFLD is complex and varied， involving the cross-regulation of multiple signaling pathways such as glucose-lipid metabolism， oxidative stress， and inflammation. The TLR4 signaling pathway plays a key role in the development and progression of NAFLD， and abnormal activation of this pathway accelerates the deterioration of NAFLD by promoting the release of pro-inflammatory cytokines， inducing oxidative stress， and exacerbating insulin resistance. Studies have shown that traditional Chinese medicine （TCM） can regulate the TLR4 signaling pathway to alleviate the symptoms and pathological features of NAFLD. The present review summarizes the experimental research progress in the TCM regulation of the TLR4 signaling pathway in treating NAFLD in the past 5 years， covering a wide range of TCM active ingredients （such as polysaccharides， terpenoids， alkaloids， flavonoids） and compound prescriptions. The active ingredients and compound prescriptions of TCM can effectively ameliorate lipid metabolism disorders， reduce insulin resistance， regulate intestinal flora， and inhibit inflammation and oxidative stress by regulating the TLR4 signaling pathway via multiple targets and pathways， thus slowing down the progression of NAFLD. Through in-depth analysis of the pathological mechanisms of NAFLD and exploration of the potential of TLR4 signaling pathway as a therapeutic target， we can provide theoretical support for the application of TCM in the treatment of NAFLD， as well as new perspectives and directions for future clinical research and new drug development， thereby promoting the innovation and development of therapeutic strategies for NAFLD.

Objective:Acute myocardial infarction (AMI) secondary to acute gastrointestinal bleeding (AGIB) is a common severe condition in emergency department. Currently, there is a lack of sufficient data regarding the use of emergency endoscopy in patients suffering from acute gastrointestinal bleeding (AGIB) complicated with acute myocardial infarction (AMI). The objective of this study is to examine the present status, effectiveness, and safety of emergency endoscopy in such patients, and to determine the factors that influence clinicians' decision-making regarding the use of emergency endoscopy.Methods:Clinical data of AGIB patients complicated with AMI who were admitted to the emergency department of the First Affiliated Hospital of Nanjing Medical University from January 2020 to June 2023 were respectively collected. Based on their survival status at discharge, patients were categorized into survival and non-survival groups. Additionally, according to whether emergency endoscopy was performed, patients were further classified into the emergency endoscopy group and the conventional treatment groupStabilized inverse probability of treatment weighting (SIPTW) and logistic regression analysis were used to explore the correlation between emergency endoscopy and prognosis. A paired wilcoxon test was used to analyze whether emergency endoscopy could worsen myocardial injury. A multiple logistic regression model was used to explore the factors influencing clinicians to make emergency endoscopic decisions.Results:A total of 106 patients with AMI secondary to AGIB were included, and 22 patients underwent emergency endoscopy. After weighing, logistic regression analysis showed that emergency endoscopy was a protective factor for patients' survival after discharge ( OR = 0.808, 95% CI: 0.6755-0.967, P = 0.022). In the emergency endoscopy group, there was no significant change in hypersensitive troponin T before and after emergency endoscopy [ 61.1 (35.4, 164.1) ng/L vs 69.8 (60.1, 159.5) ng/L, P = 0.078]. Previous history of coronary heart disease ( OR = 0.098, 95% CI: 0.015-0.381, P = 0.003) was an independent negative factor for emergency endoscopic decision-making. Glasgow Blatchford Score (GBS) on admission ( OR = 1.217, 95% CI: 1.019-1.482, P = 0.038) was an independent positive factor for emergency endoscopic decision-making. Conclusions:Emergency endoscopy is safe and effective in patients with AMI secondary to AGIB. GBS score and previous history of coronary heart disease were the main factors affecting emergency endoscopic decision-making.