The pathogenesis of metabolic associated fatty liver disease （MAFLD） is closely associated with gut microbiota dysbiosis. Dysbiosis can lead to translocation of bacterial derivatives （such as lipopolysaccharide）， which drives hepatic inflammatory response and metabolic imbalance by activating Toll-like receptors （TLR） and their downstream signaling pathways. This article systematically reviews the mechanism of action of the gut microbiota-TLR axis in MAFLD， and elaborates on the function of the key receptors such as TLR2 and TLR4 and the lesser-studied members （TLR5， TLR7， and TLR9）. This article also summarizes the downstream signaling events after TLR activation， including the canonical NF-κB and MAPK pathways， as well as the role of the JAK-STAT and PI3K-Akt pathways in the pathological mechanism of MAFLD. Finally， this article reviews the potential intervention strategies for MAFLD by targeting gut microbiota and regulating the gut microbiota-TLR signaling axis， in order to provide new ideas for clinical prevention and treatment.

Post-stroke depression(PSD),a common stroke complication characterized by depressed mood and diminished interest,severely affects patients'recovery and quality of life.Microglial abnormal activation and polarization play key roles in PSD pathogenesis,closely associated with neuroinflammation and imbalance in neu-rotransmitter metabolism.In contrast,traditional Chinese medicine(TCM)demonstrates unique multi-target and multi-level mechanisms:regulating microglial function,ameliorating post-stroke neuroinflammatory environments,and promoting neuroplasticity,thereby potentially alleviating PSD symptoms.This review summarizes TCM's effects on microglial activation/polarization states and its therapeutic advances in PSD,providing novel perspectives and strategies for clinical management.

Objectives:To investigate the clinical effect of inferior parietal osteotomy in the treatment of pa-tients with degenerative thoracolumbar kyphosis with apex located at T12.Methods:The clinical and imaging data of 29 patients with thoracolumbar kyphosis treated with posterior correction and fusion as well as single segment pedicle subtraction osteotomy(PSO)at the inferior parietal level in our hospital from January 2017 to December 2021 were retrospectively analyzed.The patients were all female aged 60.6±5.5 years old,and were followed up for 28.1±3.8 months.Radiographic parameters including global kyphosis(GK),thoracic kyphosis(TK),thoracolumbar junctional kyphosis(TJK),lumbar lordosis(LL),sagittal vertical axis(SVA),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),T1-pelvic angle(T1PA)were measured in the standing radiographs before and after operation and at the final follow-up.Quality of life of the patients were evaluated by the Scoliosis Research Society-22 questionnaire(SRS-22),the lumbar stiffness disability index(LSDI),the Oswestry disability index(ODI)and the visual analog scale(VAS).Intraoperative neurophysiological monitoring events(IONM),post-operative neurologic damage,and complications were recorded.Results:The sagittal GK was corrected from 63.3°±11.3° preoperatively to 27.3°±8.3° postoperatively(P＜0.001),and the correction rate was(56.4±12.4)％.At the final follow-up,the GK was 29.5°±8.4°,and the rate of correction loss was(10.1±14.6)％.TJK was corrected from 52.9°±10.2° preoperatively to 17.0°±3.3° postoperatively(P＜0.001),and the correction rate was(67.0±7.8)％.The TJK at the final follow-up was 16.9°±3.0°,showing no significant difference from that after operation(P=0.609).SVA was improved from preoperatively 44.3±34.1mm to postoperatively 20.4±23.6mm(P＜0.001),and it was 25.5±24.9mm at the final follow-up,which showed no significant difference compared with that after operation(P=0.086).After surgical treatment,the postoperative quality of life of the patients was sig-nificantly improved compared with that before surgery.The scores of SRS-22(pain,image,psychological,activ-ity function),ODI,VAS and LSDI at final follow-up were significantly different from those before surgery(P＜0.001).IONM events occurred in 2 patients(6.9％),and none of the patients showed neurologic impairment re-lated complications after surgery.Four patients had proximal junction kyphosis(PJK)during follow-up period.Infection,screw loosening,screw fracture and rod fracture were not identified in the cohort.Conclusions:For patients with degenerative thoracolumbar kyphosis(apical vertebra at T12),PSO performed at one lower level of the apex vertebra not only can achieve satisfactory clinical results,but also improve the safety of the opera-tion and reduce the risk of postoperative complications.

Post-stroke depression(PSD),a common stroke complication characterized by depressed mood and diminished interest,severely affects patients'recovery and quality of life.Microglial abnormal activation and polarization play key roles in PSD pathogenesis,closely associated with neuroinflammation and imbalance in neu-rotransmitter metabolism.In contrast,traditional Chinese medicine(TCM)demonstrates unique multi-target and multi-level mechanisms:regulating microglial function,ameliorating post-stroke neuroinflammatory environments,and promoting neuroplasticity,thereby potentially alleviating PSD symptoms.This review summarizes TCM's effects on microglial activation/polarization states and its therapeutic advances in PSD,providing novel perspectives and strategies for clinical management.

Objectives:To investigate the clinical effect of inferior parietal osteotomy in the treatment of pa-tients with degenerative thoracolumbar kyphosis with apex located at T12.Methods:The clinical and imaging data of 29 patients with thoracolumbar kyphosis treated with posterior correction and fusion as well as single segment pedicle subtraction osteotomy(PSO)at the inferior parietal level in our hospital from January 2017 to December 2021 were retrospectively analyzed.The patients were all female aged 60.6±5.5 years old,and were followed up for 28.1±3.8 months.Radiographic parameters including global kyphosis(GK),thoracic kyphosis(TK),thoracolumbar junctional kyphosis(TJK),lumbar lordosis(LL),sagittal vertical axis(SVA),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),T1-pelvic angle(T1PA)were measured in the standing radiographs before and after operation and at the final follow-up.Quality of life of the patients were evaluated by the Scoliosis Research Society-22 questionnaire(SRS-22),the lumbar stiffness disability index(LSDI),the Oswestry disability index(ODI)and the visual analog scale(VAS).Intraoperative neurophysiological monitoring events(IONM),post-operative neurologic damage,and complications were recorded.Results:The sagittal GK was corrected from 63.3°±11.3° preoperatively to 27.3°±8.3° postoperatively(P＜0.001),and the correction rate was(56.4±12.4)％.At the final follow-up,the GK was 29.5°±8.4°,and the rate of correction loss was(10.1±14.6)％.TJK was corrected from 52.9°±10.2° preoperatively to 17.0°±3.3° postoperatively(P＜0.001),and the correction rate was(67.0±7.8)％.The TJK at the final follow-up was 16.9°±3.0°,showing no significant difference from that after operation(P=0.609).SVA was improved from preoperatively 44.3±34.1mm to postoperatively 20.4±23.6mm(P＜0.001),and it was 25.5±24.9mm at the final follow-up,which showed no significant difference compared with that after operation(P=0.086).After surgical treatment,the postoperative quality of life of the patients was sig-nificantly improved compared with that before surgery.The scores of SRS-22(pain,image,psychological,activ-ity function),ODI,VAS and LSDI at final follow-up were significantly different from those before surgery(P＜0.001).IONM events occurred in 2 patients(6.9％),and none of the patients showed neurologic impairment re-lated complications after surgery.Four patients had proximal junction kyphosis(PJK)during follow-up period.Infection,screw loosening,screw fracture and rod fracture were not identified in the cohort.Conclusions:For patients with degenerative thoracolumbar kyphosis(apical vertebra at T12),PSO performed at one lower level of the apex vertebra not only can achieve satisfactory clinical results,but also improve the safety of the opera-tion and reduce the risk of postoperative complications.

Objective To explore the risk factors for healthcare-associated infection(HAI)in lung transplant re-cipients(LTRs),and construct a predictive nomogram model.Methods Clinical data of patients who underwent lung transplant in Wuxi People's Hospital from January 2019 to December 2023 were analyzed retrospectively.The patients were divided into a training set(n=506)and a validation set(n=218).Independent risk factors were screened through LASSO regression,and multivariate logistic regression was included to construct a nomogram pre-diction model.The discrimination,calibration,and clinical applicability of the model were evaluated using receiver operating characteristic(ROC)curves,Hosmer-Lemeshow goodness-of-fit,and decision curves.Results Among the 506 LTRs,201 developed HAIs,with an incidence of 39.72％.The major infection site was lower respiratory tract,and the major pathogen were Gram-negative bacilli(Acinetobacter baumannii).Older age,use of extracorpo-real membrane oxygenation(ECMO),double-lung transplant,surgery duration＞3 hours,long duration of contin-uous fever,frequent abnormal blood routine examination,and long duration of combined use of antimicrobial agents were identified as independent risk factors for HAI after lung transplant.The ROC curve analysis results showed that the areas under the curve(AUCs)of the training set and the validation set were 0.74(95％CI:0.70-0.78)and 0.71(95％CI:0.64-0.78),respectively.The Hosmer-Lemeshow test results showed that there was no sta-tistically significant difference between the predictive and actual probability of HAI(P＞0.05).The clinical decision curve results indicated that the model had clinical benefits at a threshold probability value of 7％-71％.Conclusion The nomogram prediction model constructed in this study can effectively evaluate the risk of postoperative infection in LTRs.The model is stable and has high clinical application value,providing scientific reference for postoperative infection prevention and control.

This study aims to describe the population and regional distribution characteristics of smoking behavior among adult twins in the China Twin Registry (CNTR), as well as the concordance rates for smoking behavior in monozygotic and dizygotic twins, and estimate the heritability. The study population included adult twins in CNTR who had smoking questionnaire data. A random-effects regression model was used to describe the distribution of smoking behavior among different subgroups based on various characteristics. The concordance of smoking behavior between different zygosity groups was calculated, and heritability was estimated. A total of 28 444 twin pairs were included in this study, with an average age of (36.6±12.0) years. Among male twins, 41.2% were current smokers, while only 1.2% of females smoked. Higher smoking rates were observed among male smokers in the 50-59 age group ( z=23.0, P<0.001), northern regions ( z=2.9, P<0.01), rural areas ( z=-5.2, P<0.001), those who were divorced/widowed ( z=3.8, P<0.001), and first-born twins ( z=-4.3, P<0.001), while lower smoking rates were found in those with higher education ( z=-16.1, P<0.001) and unmarried individuals ( z=-16.0, P<0.001). The smoking concordance rate for male monozygotic twins was 69.6%, significantly higher than the 57.3% concordance rate for dizygotic twins ( χ 2=105.0, P<0.05). The heritability of smoking behavior in male twins was estimated at 28.9% (95% CI: 24.3%-33.4%). Stratified analyses showed differences in heritability across regions and age groups: the heritability in northern regions was 32.6% (95% CI: 27.3%-38.0%), higher than the 21.0% (95% CI: 12.4%-29.5%) observed in southern regions; the highest heritability of 35.1% (95% CI: 26.3%-43.9%) was found in the 18-29 age group, with heritability decreasing with age. In conclusion, the smoking rate and influencing factors in the twin population are similar to those in the general population, with unique characteristics, such as higher smoking rates in first-born twins. Genetic factors have a significant impact on smoking behavior.

Objective To analyze the characteristics of postoperative hospital-acquired infections and drug sensitivity in lung transplant recipients over the past 5 years in a single center. Methods A total of 724 lung transplant recipients at Wuxi People's Hospital from January 2019 to December 2023 were selected. Based on the principles of hospital-acquired infection diagnosis, a retrospective analysis was conducted on the hospital infection situation and infection sites of lung transplant recipients, and an analysis of the distribution of hospital-acquired infection pathogens and their antimicrobial susceptibility test status was performed. Results Among the 724 lung transplant recipients, 275 cases of hospital-acquired infection occurred, with an infection rate of 38.0%. The case-time infection rate decreased from 54.2% in 2019 to 22.8% in 2023, showing a downward trend year by year (Z=30.98, P<0.001). The main infection site was the lower respiratory tract, accounting for 73.6%. The pathogens were mainly Gram-negative bacteria, with the top four being Acinetobacter baumannii (37.1%), Pseudomonas aeruginosa (17.3%), Klebsiella pneumoniae (13.7%), and Stenotrophomonas maltophilia (13.4%), with imipenem resistance rates of 89%, 53%, 58% and 100%, respectively. Gram-positive bacteria were mainly Staphylococcus aureus (3.6%), with a methicillin resistance rate of 67%. Conclusions Over the past 5 years, the hospital-acquired infections in lung transplant recipients have shown a downward trend, mainly involving lower respiratory tract infections, with the main pathogens being Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae, all of which have high resistance rates to imipenem.

Objective:To describe the distribution characteristics of alcohol consumption in adult twins in the Chinese National Twin Registry (CNTR), and further explore the influence of genetic factors on alcohol consumption in adult twins.Methods:The subjects of the study were twins registered by CNTR in 11 project areas across China from 2010 to 2018. A total of 56 966 twins (28 483 pairs) aged 18 years and above who answered questions about drinking behavior were included, and the random effect model was used to describe the population and regional distribution characteristics of alcohol consumption. Intra-pair analysis was performed to calculate the concordance rate and heritability of their alcohol consumption.Results:The age of all subjects was (36.6±12.0) years, and current drinkers accounted for 16.6% (9 461/56 966) of all subjects. In men, those aged 50-59 years, those in northern China, those living in rural area, those with low education level and those with high BMI, the proportions of current drinkers were higher. After excluding 468 pairs of twins who had stopped alcohol use and 21 764 pairs of twins who had no drink or had small amount drink, an intra-pair analysis was conducted in 4 929 pairs of same-sex twins, and found that the concordance rate of alcohol consumption was 64.0% (2 059/3 215) in monozygotic twins, and 52.6% (902/1 714) in dizygotic twins, the difference was significant ( P<0.001), and the heritability of alcohol consumption was 24.1% (95% CI: 18.9%- 29.3%). The further stratified analysis found that in southern men, the heritability was highest in those aged 40-49 years (36.1%, 95% CI: 21.6%-50.7%), while in northern men, the heritability was highest in those aged 50-59 years (34.2%, 95% CI: 18.1%-50.3%). Conclusions:In adult twins in China, there were population and regional differences in the distribution of alcohol consumption behavior, and alcohol consumption was influenced by genetic factors, and gender, age and region had potential modifying effects.

Objective To explore the risk factors for healthcare-associated infection(HAI)in lung transplant re-cipients(LTRs),and construct a predictive nomogram model.Methods Clinical data of patients who underwent lung transplant in Wuxi People's Hospital from January 2019 to December 2023 were analyzed retrospectively.The patients were divided into a training set(n=506)and a validation set(n=218).Independent risk factors were screened through LASSO regression,and multivariate logistic regression was included to construct a nomogram pre-diction model.The discrimination,calibration,and clinical applicability of the model were evaluated using receiver operating characteristic(ROC)curves,Hosmer-Lemeshow goodness-of-fit,and decision curves.Results Among the 506 LTRs,201 developed HAIs,with an incidence of 39.72％.The major infection site was lower respiratory tract,and the major pathogen were Gram-negative bacilli(Acinetobacter baumannii).Older age,use of extracorpo-real membrane oxygenation(ECMO),double-lung transplant,surgery duration＞3 hours,long duration of contin-uous fever,frequent abnormal blood routine examination,and long duration of combined use of antimicrobial agents were identified as independent risk factors for HAI after lung transplant.The ROC curve analysis results showed that the areas under the curve(AUCs)of the training set and the validation set were 0.74(95％CI:0.70-0.78)and 0.71(95％CI:0.64-0.78),respectively.The Hosmer-Lemeshow test results showed that there was no sta-tistically significant difference between the predictive and actual probability of HAI(P＞0.05).The clinical decision curve results indicated that the model had clinical benefits at a threshold probability value of 7％-71％.Conclusion The nomogram prediction model constructed in this study can effectively evaluate the risk of postoperative infection in LTRs.The model is stable and has high clinical application value,providing scientific reference for postoperative infection prevention and control.