The application of immunosuppressants has significantly reduced the incidence rate of rejection reaction after liver transplantation， but the clinical efficacy of immunosuppressants is greatly affected by individual differences between patients. This article systematically reviews the recent research advances in the interaction between immunosuppressants and gut microbiota， with a focus on the regulatory role and mechanism of intestinal microflora communities on the efficacy of immunosuppressants. Studies have shown that intestinal microbiome is one of the key factors influencing the efficacy of immunosuppressive therapy after liver transplantation. This review aims to provide a theoretical basis for in-depth research in this field and provide new insights for developing individualized immunosuppressive treatment regimens based on the regulation of intestinal microflora.

Objective To investigate the status of feeding intolerance in patients with enteral nutrition after lung transplantation and analyze its influencing factors,to provide a reference for formulating a reasonable enteral nutrition plan and improving patients'nutritional status.Methods Convenient sampling method was used to retrospectively collect the clinical data of 115 patients who received enteral nutrition support after lung transplantation and were hospitalized in the ICU of a tertiary hospital in Guangdong Province from August 2022 to November 2023.According to the occurrence of feeding intolerance during ICU hospitalization,the patients were divided into a feeding tolerance group and a feeding intolerance group.Univariate and logistic regression analysis were used to analyze the influencing factors of feeding intolerance patients with enteral nutrition after lung transplantation.Results Within 7 days of initiating enteral nutrition,a total of 63 patients developed feeding intolerance,with an incidence of 54.78％.Among them,the incidence of feeding intolerance was relatively high within 1 to 3 days after initiating enteral feeding.The clinical manifestations of feeding intolerance were diarrhea,bloating,gastric retention,vomiting/regurgitation,among which the diarrhea was the highest incidence(87.30％).Logi-stic regression analysis showed that intraoperative net balance volume(OR=0.999),intraoperative blood transfusion(OR=1.001)volume and diabetes history(OR=0.170)were independent influencing factors for feeding intolerance in patients with enteral nutrition after lung transplantation(P＜0.05).Conclusion There was a high incidence of feed-ing intolerance in patients with enteral nutrition after lung transplantation.Patients undergoing lung transplantation who have a high net intraoperative fluid balance,receive a low volume of intraoperative blood transfusions,and have a history of diabetes are at a lower risk of developing feeding intolerance when receiving postoperative enteral nutrition.When starting enteral nutrition,medical staff should dynamically evaluate the risk factors of feeding intolerance,screen high-risk patients as early as possible,and formulate reasonable enteral nutrition programs to improve the nutritional status of patients and promote their rehabilitation.

Objective To investigate the association between single nucleotide polymorphisms(SNP)rs57095329 and rs6864584 of miR-146a gene and cervical intraepithelial neoplasia(CIN).Methods A total of 96 patients diagnosed with CIN were randomly collected as the CIN group,and 225 healthy individuals examined during the same period were selected as the control group using SPSS software.Genotyping of the above SNP loci was performed using the TaqMan probe method,and their correlation with CIN was analyzed.Results The allele and genotype distribution of rs57095329 showed a statistically significant differences compared to the control group,with the frequency of the allele A in the CIN group significantly lower than that in the control group(P<0.001;OR=0.48,95%CI:0.32～0.70).In the dominant model,individuals carrying the G allele(A/G-G/G)had a significantly increased risk of CIN(P<0.001;OR=2.67,95%CI:1.64～4.37).In contrast,no correlation was found between the rs6864584 and the risk of CIN.Conclusion The A allele of the miR-146a gene at the rs57095329 locus may be a protective factor for CIN.

Objective:To explore the impact of different nutritional statuses on the prognosis of elderly patients with idiopathic pulmonary fibrosis(IPF), and to provide a basis for early intervention of the nutritional status of elderly IPF patients.Methods:A retrospective analysis was conducted on 237 elderly patients clinically diagnosed with IPF who were admitted to the First Hospital of Shanxi Medical University from January 2018 to May 2024.The GLIM criteria were applied to diagnose malnutrition and classify its severity.The patients were divided into two groups: those without nutritional risk(Group A)and those with nutritional risk(Group B). Group B was further subdivided into three subgroups: patients with only nutritional risk(Subgroup B1), those with moderate malnutrition(Subgroup B2), and those with severe malnutrition(Subgroup B3). The study observed the clinical characteristics of elderly IPF patients and the impact of nutritional factors on hospital admission frequency, activities of daily living(ADL), and all-cause mortality.Results:A total of 237 patients was included, with 129 patients(54.43%)in Group A and 108 patients(45.57%)in Group B. Among them, there were 34 patients(14.35%)in Subgroup B1, 57 patients(24.05%)in Subgroup B2, and 17 patients(7.17%)in Subgroup B3.The number of hospitalizations was significantly higher in both Group B and Subgroup B3 compared to Group A(both P < 0.05). However, no significant differences were found in the number of hospitalizations between Subgroup B1 or Subgroup B2 and Group A. There was no significant difference in the reduction of ADL between Group B(including all its subgroups)and Group A. The risk of mortality significantly increased with the increase in the severity of malnutrition(all P<0.05). After adjusting for factors such as gender, age, polypharmacy, home oxygen therapy, self-care ability, days of hospital stay, number of hospitalizations, pulmonary function, and inflammatory factors, nutritional risk and the degree of malnutrition remained independent risk factors for all-cause mortality in elderly IPF patients. Conclusions:A significant proportion of elderly IPF patients were found to have nutritional risk or malnutrition.The number of hospitalizations was significantly correlated with the nutritional status of these patients.After adjusting for multiple relevant factors, nutritional risk and the severity of malnutrition remained independent risk factors for mortality in elderly IPF patients.Therefore, greater emphasis should be placed on nutritional assessment and early nutritional intervention in the management of elderly IPF patients, so as to prevent and reduce the occurrence of nutrition-related adverse events.

Cardiac arrest is a major health event that poses a major threat to human life and health.Post-cardiac arrest brain injury is the main adverse prognostic factor and cause of death in patients who experience cardiac arrest.Currently,the therapeutic methods and effects are limited.In recent years,with the in-depth research on microbiota-gut-brain communication,it has been found that intestinal microbiota and their metabolites may play a role in the regulation of neuroinflammation in post-cardiac arrest brain injury.Short-chain fatty acids are the key substances in microbiota-gut-brain communication,and the mechanism involves immune,endocrine and neuroregulatory pathways.Supplementation of short-chain fatty acid-producing bacteria or short-chain fatty acids can improve intestinal flora disorder and reduce neuroinflammation after cardiopulmonary resuscitation.As a key mediator in microbial-gut-brain communication,short-chain fatty acids have great potential for the treatment of brain injury after cardiac arrest.This review explores the role and regulatory mechanism of microbiota-gut-brain communication in the neuroinflammation of brain injury after cardiopulmonary resuscitation through immune,endocrine and neuro-regulatory pathways,providing a new idea for the treatment of post-cardiac arrest brain injury.

Objective:To investigate the clinical experience and efficacy of unrelated umbilical cord blood hematopoietic stem cell transplantation (HSCT) for the treatment of congenital amegakaryocytic thrombocytopenia (CAMT).Methods:A case summary was conducted.The clinical data of 2 children with CAMT who were finally cured by unrelated umbilical cord blood HSCT in the Department of Pediatric Medicine, the First Affiliated Hospital of Zhengzhou University from March 2020 to August 2023 were retrospectively analyzed.Related studies were retrieved from databases CNKI, Wanfang and PubMed using search terms including " congenital amegakaryocytic thrombocytopenia" and " hematopoietic stem cell transplantation" from the inception to July 2024.The clinical characteristics, diagnosis and treatment processes, and prognosis of CAMT patients treated by HSCT were then summarized.Results:Both cases exhibited scattered skin haemorrhages throughout the body and carried 2 compound heterozygous mutations with pathogenicity in the MPL gene.Both patients were finally diagnosed with CAMT.Case 1 was a girl aged 3 at the time of transplantation, and case 2 was also a girl, who aged 5 at the time of transplantation.Both of them received unrelated umbilical cord blood HSCT and hematopoietic reconstruction was achieved.The time of neutrophil and platelet implantation was 21 and 40 days after transplantation in case 1, and 20 and 31 days in case 2, respectively.The chimerism rate of neutrophil implantation in both children was complete chimerism of donor cells.Implantation syndrome was detected in case 1 following transplantation.Case 2 suffered implantation syndrome, hypertensive encephalopathy, and cytomegalovirus infection following transplantation.Both children showed no graft-versus-host disease (GVHD).Both children had hematopoietic and immune reconstruction after transplantation and their primary diseases were cured.Cases 1 and 2 were followed up for more than 14 and 17 months, respectively.Both of them achieved disease-free survival during the follow up.Literature review of 26 cases with CAMT treated by HSCT, including the above-mentioned 2 cases was conducted, with an overall disease-free survival rate of 92.3%(24/26).Of 12 cases with CAMT typing, 10 were type Ⅰ and 2 were type Ⅱ.Of the 26 cases treated by HSCT, 17 had bone marrow HSCT, with an overall survival rate of 88.2%(15/17), and 2 had peripheral blood HSCT.Seven cases had umbilical cord blood HSCT (6 cases receiving unrelated umbilical cord blood HSCT and 1 case receiving related umbilical cord blood HSCT), with an overall survival rate of 100%.Unlike bone marrow and peripheral blood HSCT, unrelated umbilical cord blood HSCT did not result in 3-4 grade GVHD. Conclusions:Unrelated umbilical cord blood HSCT can achieve good therapeutic effects in CAMT patients when there is no suitable donor.Myeloablative pretreatment is conducive to CAMT patients.

Autism spectrum disorder(ASD),characterized by unknown etiology and high heterogeneity,ne-cessitates precise diagnostic and intervention strategies.Neuroimaging techniques have shown great promise in un-covering the neural mechanisms of ASD,providing a foundation for aided diagnosis and transcranial magnetic stim-ulation(TMS)interventions.This review highlights that integrating multimodal neuroimaging and developing indi-vidualized indices with developmental specificity can significantly improve the accuracy of ASD diagnosis and clas-sification.Furthermore,TMS interventions guided by functional connectivity derived from functional magnetic reso-nance imaging(fMRI)offer a personalized approach to ASD treatment.

BACKGROUND:Synovitis is involved in all stages of osteoarthritis and is a key factor contributing to the development of osteoarthritis.Studies have shown that circular RNA(circRNA)plays an important role in the proliferation,apoptosis and extracellular matrix degradation of synovial cells and chondrocytes.OBJECTIVE:To observe the effects of circRNA SEC24A on the interleukin-1β-induced proliferation,apoptosis,and expression of inflammatory factors in human synovial fibroblasts.METHODS:Human synovial fibroblasts were divided into four groups,including control group,interleukin-1β group,empty vector group,and sh-circSEC24A group.Except for the control group,the other three groups were induced with 10 ng/mL interleukin-1β for 24 hours to establish inflammatory cell models;the empty vector group and sh-circSEC24A group were infected with empty vector virus and lentiviral vector knocking down circSEC24A.CCK-8 assay was used to detect cell proliferation.Flow cytometry was used to detect cell apoptosis.ELISA was used to detect the levels of matrix metalloproteinase-9,matrix metalloproteinase-13,interleukin-6,and tumor necrosis factor-α in cell supernatant.Western blot assay was used to detect the relative expression levels of Bax,Bcl-2,matrix metalloproteinase-9,matrix metalloproteinase-13,casepase3,cleaved-casepase3,casepase8,and cleaved-casepase8 proteins in cells.RESULTS AND CONCLUSION:(1)qRT-PCR results showed that compared with the normal group,the expression of circSEC24A in human synovial fibroblasts induced by interleukin 1β was significantly up-regulated.(2)The absorbance value of cells in the sh-circSEC24A group detected by CCK-8 assay was significantly higher than that of interleukin 1β group and empty vector group(P＜0.05).The apoptosis rate of sh-circSEC24A group detected by flow cytometry was significantly lower than that of interleukin 1β group and empty vector group(P＜0.05).(3)The levels of tumor necrosis factor α and interleukin 6 in the supernatant of human synovial fibroblasts in the sh-circSEC24A group detected by ELISA were significantly lower than those in the interleukin 1β group and the empty vector group(P＜0.01,P＜0.001).(4)Western blot assay results showed that compared with the interleukin 1β group and the empty vector group,the expression of the pro-apoptotic factor Bax protein in the sh-circSEC24A group significantly decreased,and the expression of the anti-apoptotic factor Bcl-2 protein increased significantly(P＜0.05);apoptosis and related activating factors cleaved-casepase3 and cleaved-casepase8 protein expressions were both reduced(P＜0.05).(5)ELISA and western blot assay results showed that compared with the interleukin 1β group and the empty vector group,the sh-circSEC24A group had lower levels of matrix metalloproteinase 9 and matrix metalloproteinase 13 protein(P＜0.05).These findings indicated that the expression of circSEC24A was abnormally increased in human synovial fibroblasts induced by interleukin 1β.Knocking down circSEC24A expression could promote the proliferation of human synovial fibroblasts and inhibit apoptosis,inflammatory factor release,and extracellular matrix degradation,suggesting that circSEC24A may be an important intervention target for early osteoarthritis.

Dental implantology has developed rapidly for over half a century,since pure titanium(99.7％)dental cylindrical threaded implants were exploited and osseointegration was introduced in 1960s by Prof.Br?nemark.The long term retention rates of 10 years or more are over 95％.However,the biological complications jeopardize the long term effects of dental implant treatment seriously.The prevalence of dental implant biological complications varies greatly among different reports resulting from the disparities on the defini-tions of dental implant biological complications.After analyzing and summarizing the major opinions proposed internationally in recent years,the consensus for the definition of dental implant biological complications has been reached.Generally the dental implant biologi-cal implications can be classified into early stage(before restoration)biological complications and late stage(after restoration)biological complications.The early stage biological complications include acute and chronic infections,pain,soft tissue deficiency,and osseointegration failure,etc.The late stage complications include peri-implant diseases(peri-implant mucositis and peri-implantitis),soft tissue deficiency around implant,implant loosening and dropping off,etc.The various risk factors related to different dental implant biological complications,the strategies of the prevention and treatment for the dental implant biological complications have been discussed comprehensively,and the consensus has been reached.It is aimed to advocate the dentist to pay more attention to the early prevention of the biological implant complications,to promote more researches on the implant biological complications,and to help elevate the level of dental implantology in our country.

Objective To analyze risk factors of acute cardio-cerebrovascular accidents in elderly patients with lower extremity fracture,and to construct a risk prediction diagram model.Methods A retrospective analysis was conducted on the clinical data of 510 elderly patients with lower extremity fractures,and the patients were divided into the occurrence group and the non-occurrence group based on the occurrence of acute cardiovascular and cerebrovascular accidents during the postoperative hospitalization.Univariate and multivariate Logistic regression analysis was used to analyze risk factors affecting acute cardiovascular and cerebrovascular accidents in elderly patients with lower extremity fracture,and the risk prediction model was constructed and verified.Results A total of 52 cases of acute cardio-cerebrovascular accidents occurred during hospitalization in 510 patients(10.20%).Age,ASA grade Ⅲ ratio,preoperative concurrent cerebrovascular disease,postoperative pneumonia ratio and postoperative bed time≥5 days ratio were higher in the occurrence group than those in the non-occurrence group(P＜0.05).Multivariate Logistic regression analysis showed that age,ASA grade Ⅲ,preoperative concurrent cardiovascular and cerebrovascular disease,and postoperative pneumonia were risk factors for acute cardio-cerebrovascular accidents in elderly patients with lower limb fracture(P＜0.05).Multivariate Logistic regression analysis was used to screen risk factors as predictive variables to build a risk early warning histogram model for acute cardio-cerebrovascular accidents.The total score ranged from 103 to 168 points,corresponding to a risk range of 0.1 to 0.9 points.Receiver operating characteristic curve(ROC)curve results showed that the area under the curve(AUC)of this model for predicting acute cardiovascular and cerebrovascular accidents was 0.980(95%CI:0.964-1.000),and discrete choice approach(DCA)showed that when the risk threshold was 0.2-0.6,the prediction model of this column graph had a good clinical advantage.Conclusion The risk diagram model constructed based on risk factors has good predictive value for the occurrence of acute cardio-cerebrovascular accidents after lower extremity fracture in elderly patients.