Objective:To explore the characteristics of gut microbiota changes in individuals with Sarcopenic Obesity(SO)based on 16S rRNA sequencing.Methods:This cross-sectional study was conducted in Chongming District, Shanghai from April to November 2021.Fecal samples were collected from 20 elderly SO patients (case group)and 40 elderly non-SO individuals(control group)for 16S rRNA sequencing in order to analyze the diversity, structural composition, and species differences of gut microbiota, and then to predict the differential metabolic functions of the gut microbiota.Results:A total of 60 subjects were included.The case group consisted of 20 individuals(15 males and 5 females)with an average age of 73.15 ± 4.09 years; the control group included 40 individuals(20 males and 20 females)with an average age of 71.20 ± 4.12 years.The α-diversity analysis revealed that the richness indices ACE and Chao 1 of the case group were significantly lower than those of the control group( P<0.05), while the diversity indices Shannon and Simpson showed a trend of being lower in the case group, but the differences were not statistically significant( P>0.05). Principal coordinate analysis based on the Unweighted-unifrac distance metric demonstrated a statistically significant difference in β-diversity between the two groups( P=0.003). The structure and composition of the gut microbiota in the case group were altered, with a significant reduction in the relative abundance of the Blautia genus in the case group( P<0.05). LEfSe analysis identified 5 and 16 enriched microbial species in the case and control groups, respectively (Linear Discriminant Analysis score >2, P<0.05). Additionally, PICRUSt2 functional prediction revealed significant differences( P<0.05)in metabolic pathways between the two groups, including quorum sensing, fat digestion and absorption, and folate biosynthesis. Conclusions:The gut microbiota in elderly SO patients is disordered, mainly manifested as a decrease in diversity and characteristic changes in structural composition, as well as a reduction in the abundance of the beneficial bacterium Blautia.The Progression of SO is closely associated with gut microbiota metabolic disturbances, and targeting the gut microbiota is expected to become a novel therapeutic approach for SO.

Strengthening the cultivation of innovation ability is the new requirement put forward by the state for higher educa-tion.High-quality curriculum design is the primary means of achieving high-quality talent cultivation.By constructing the"disease case library"and"problem graph"of immune system and related diseases,and adopting the teaching method of"combining large and small cases and integrating online and offline",this study not only consolidates students'basic knowledge,but also builds a bridge for students from theory to practice,from knowledge accumulation to creation and application.It further exercises students'ability to dis-cover,analyze and solve problems,and enhances students'innovation awareness and ability.

Strengthening the cultivation of innovation ability is the new requirement put forward by the state for higher educa-tion.High-quality curriculum design is the primary means of achieving high-quality talent cultivation.By constructing the"disease case library"and"problem graph"of immune system and related diseases,and adopting the teaching method of"combining large and small cases and integrating online and offline",this study not only consolidates students'basic knowledge,but also builds a bridge for students from theory to practice,from knowledge accumulation to creation and application.It further exercises students'ability to dis-cover,analyze and solve problems,and enhances students'innovation awareness and ability.

Objective:To explore the characteristics of gut microbiota changes in individuals with Sarcopenic Obesity(SO)based on 16S rRNA sequencing.Methods:This cross-sectional study was conducted in Chongming District, Shanghai from April to November 2021.Fecal samples were collected from 20 elderly SO patients (case group)and 40 elderly non-SO individuals(control group)for 16S rRNA sequencing in order to analyze the diversity, structural composition, and species differences of gut microbiota, and then to predict the differential metabolic functions of the gut microbiota.Results:A total of 60 subjects were included.The case group consisted of 20 individuals(15 males and 5 females)with an average age of 73.15 ± 4.09 years; the control group included 40 individuals(20 males and 20 females)with an average age of 71.20 ± 4.12 years.The α-diversity analysis revealed that the richness indices ACE and Chao 1 of the case group were significantly lower than those of the control group( P<0.05), while the diversity indices Shannon and Simpson showed a trend of being lower in the case group, but the differences were not statistically significant( P>0.05). Principal coordinate analysis based on the Unweighted-unifrac distance metric demonstrated a statistically significant difference in β-diversity between the two groups( P=0.003). The structure and composition of the gut microbiota in the case group were altered, with a significant reduction in the relative abundance of the Blautia genus in the case group( P<0.05). LEfSe analysis identified 5 and 16 enriched microbial species in the case and control groups, respectively (Linear Discriminant Analysis score >2, P<0.05). Additionally, PICRUSt2 functional prediction revealed significant differences( P<0.05)in metabolic pathways between the two groups, including quorum sensing, fat digestion and absorption, and folate biosynthesis. Conclusions:The gut microbiota in elderly SO patients is disordered, mainly manifested as a decrease in diversity and characteristic changes in structural composition, as well as a reduction in the abundance of the beneficial bacterium Blautia.The Progression of SO is closely associated with gut microbiota metabolic disturbances, and targeting the gut microbiota is expected to become a novel therapeutic approach for SO.

With rapid development of information technology,blended teaching model has gradually become mainstream teaching model in most colleges and universities.How to evaluate students'learning effect and analyze factors that affect students'per-formance is a key research direction of this teaching model.Taking blended teaching of Medical Immunology course in Xinxiang Medical University as an example,this paper introduces implementation process and evaluation system of blended teaching,analyzes main factors affecting students'performance and learning effect,and focuses on discussing influence of formative evaluation and"flipped classroom"on students'academic performance.

Objective To construction of discharge readiness assessment index for patients with percutaneous transhepatic biliary drainage.Methods Based on the framework of the Meleis's transitions theory,the relevant literature was consulted,the semi-structured interview and group discussion were implemented,and the framework of the assessment index system for discharge readiness of patients with percutaneous transhepatic biliary drainage was initially constructed.Then,two rounds of Delphi expert consultations were conducted.The weight of each indicator was set by Analytic Hierarchy Process.Results The effective recovery of 2 rounds of expert consultations were both 100％.The authority coefficients were 0.964 and 0.972,The Kendall harmony coefficients were 0.240 and 0.228(P＜0.001).The final discharge readiness assessment index system for patients with percutaneous transhepatic biliary drainage was established,including 4 first-level indicators and 35 second-level indicators.Conclusion The discharge readiness assessment index system for patients with percutaneous transhepatic biliary drainage was scientific and reliable,which can provide references for the evaluation of discharge readiness for patients with percutaneous transhepatic biliary drainage.

Objective:To explore the safety of simnotrelvir/ritonavir in the treatment of coronavirus disease 2019 (COVID-19).Methods:The medical records of adult patients with COVID-19 who were hospitalized in Lequn Branch, Hospital of the First Hospital of Jilin University from June 9 to September 30, 2023 and treated with simnotrelvir/ritonavir were collected. According to whether adverse drug reactions (ADR) related to simnotrelvir/ritonavir occurred, the patients were divided into ADR group and non-ADR group. The clinical data, occurrence time of ADR, clinical manifestations, severity, treatment and outcome of patients were analyzed retrospectively.Results:A total of 189 patients were enrolled in this study, including 92 males (48.7%) and 97 females (51.3%), with a median age of 69 (60.5, 74.0) years. The usage and dosage of simnotrelvir/ritonavir were in accordance with the instructions (0.75 g of simnotrelvir and 0.1 g of ritonavir orally, once every 12 hours for 5 days). ADR related to simnotrelvir/ritonavir occurred in 18 of 189 patients (9.5%). There were no significant differences (all P>0.05) in gender, age, smoking status, COVID-19 classification and the proportion of patients with basic diseases such as hypertension, diabetes, cardiovascular disease, cerebrovascular disease, lung disease, and tumor after surgery between the ADR group (18 patients) and non-ADR group (171 patients). The difference in the propation of patients with liver injury and kidney injury between the 2 groups were statistically significant (both P<0.05). A total of 23 cases of ADR occurred in the ADR group. The occurrence time of ADR was 1 to 8 days after taking simnotrelvir/ritonavir. The clinical manifestations of ADR included digestive system symptoms, elevated transaminases, elevated serum creatinine, elevated serum uric acid, decreased platelet count, decreased white blood cell and neutrophil counts, dizziness, headache, etc. Five patients had 2 kinds of symptoms at the same time. The severity of ADR was grade 1 in 12 patients and grade 2 in 6 patients, and no ≥ grade 3 severe ADR occurred. Except one patient who stopped taking medication due to thrombocytopenia, all other patients completed 5-day treatment. The ADR disappeared after discontinuation of simnotrelvir/ritonavir and 1 to 5 days of symptomatic treatments. Conclusions:Simnotrelvir/ritonavir has a good safety in the treatment for COVID-19. The main ADRs are diarrhea and elevated transaminases, with the severity of grade 1-2 and the ADRs disappear after drug withdrawal. The patients with liver and kidney injury should be more alert to the occurrence of ADR when applying simnotrelvir/ritonavir.

Objective:To explore the safety of simnotrelvir/ritonavir in the treatment of coronavirus disease 2019 (COVID-19).Methods:The medical records of adult patients with COVID-19 who were hospitalized in Lequn Branch, Hospital of the First Hospital of Jilin University from June 9 to September 30, 2023 and treated with simnotrelvir/ritonavir were collected. According to whether adverse drug reactions (ADR) related to simnotrelvir/ritonavir occurred, the patients were divided into ADR group and non-ADR group. The clinical data, occurrence time of ADR, clinical manifestations, severity, treatment and outcome of patients were analyzed retrospectively.Results:A total of 189 patients were enrolled in this study, including 92 males (48.7%) and 97 females (51.3%), with a median age of 69 (60.5, 74.0) years. The usage and dosage of simnotrelvir/ritonavir were in accordance with the instructions (0.75 g of simnotrelvir and 0.1 g of ritonavir orally, once every 12 hours for 5 days). ADR related to simnotrelvir/ritonavir occurred in 18 of 189 patients (9.5%). There were no significant differences (all P>0.05) in gender, age, smoking status, COVID-19 classification and the proportion of patients with basic diseases such as hypertension, diabetes, cardiovascular disease, cerebrovascular disease, lung disease, and tumor after surgery between the ADR group (18 patients) and non-ADR group (171 patients). The difference in the propation of patients with liver injury and kidney injury between the 2 groups were statistically significant (both P<0.05). A total of 23 cases of ADR occurred in the ADR group. The occurrence time of ADR was 1 to 8 days after taking simnotrelvir/ritonavir. The clinical manifestations of ADR included digestive system symptoms, elevated transaminases, elevated serum creatinine, elevated serum uric acid, decreased platelet count, decreased white blood cell and neutrophil counts, dizziness, headache, etc. Five patients had 2 kinds of symptoms at the same time. The severity of ADR was grade 1 in 12 patients and grade 2 in 6 patients, and no ≥ grade 3 severe ADR occurred. Except one patient who stopped taking medication due to thrombocytopenia, all other patients completed 5-day treatment. The ADR disappeared after discontinuation of simnotrelvir/ritonavir and 1 to 5 days of symptomatic treatments. Conclusions:Simnotrelvir/ritonavir has a good safety in the treatment for COVID-19. The main ADRs are diarrhea and elevated transaminases, with the severity of grade 1-2 and the ADRs disappear after drug withdrawal. The patients with liver and kidney injury should be more alert to the occurrence of ADR when applying simnotrelvir/ritonavir.

CRISPR-Associated Protein 9 ; Gene Editing ; CRISPR-Cas Systems/genetics*